周梦觉曰∶冬月伤于寒,即病者为伤寒。不即病而伏伤于
中,至春随阳气发见者,为温病。其症头痛项强,与伤寒无异。唯初起不恶寒,便发热,脉数为异耳。伤寒由
表入里,不得不先发其表。温病由里达表,不得不先清其里。所以温病有误汗无误下之语。仲景着伤寒一书,自
秋分后至春分前为止;若春分后,则为温病矣。《内经》虽有先夏至日者为温病之文,仲景虽有太阳病先发热
者为温之论。晋唐以来,无人别晰伤寒温病,概以伤寒书治之,得失参半。治此症者,茫无主张。延至于金,
刘河间出,始作温论。有明喻嘉言,复畅其说。温病乃有圭臬,而仲景之书,亦得以昭着于世。当此韶光明媚之
天,三阳出于地上,日丽风和,花香鸟语,一片春温之气,盎盎蓬蓬,故病亦名之曰温。轻则白虎汤、黄芩芍药
汤、葛根升麻汤,重则三承气汤,无不应验。间亦有先恶寒而后发热者,仍以伤寒治之。又曰∶冬不藏精,春
必病温。盖冬主闭藏、漏泄春光,邪之所凑,其气必虚。古人婚姻六礼,定在夭桃之时,良有以也。余则谓热
蕴之至,必致煎熬肾水。遇体之充足者,但以前汤治之。倘体之虚怯者,不问精之藏与不藏,前汤中重加生熟二
地,以培其本。则二说不相岐,而相为用矣。何必如喻嘉言之分疏其说也乎。
涂蔚生曰∶查仲景《伤寒论》中,只有太阳病,发热而渴,不恶寒者,为温病之说。并无自秋分后至春分前
为止,若春分后则为温病之说。不知梦觉是否出自别有经本,抑是根据他人臆说。惟其说颇佳,总算瑕不掩瑜。
人参白虎汤
人参(一钱) 石膏(一钱) 知母(一钱) 粳米(一钱) 炙甘草(一钱)
大承气汤(见前痉病方内)
小承气汤
大黄(一钱) 浓朴(七分) 枳实(七分)
调胃承气汤
大黄(一钱) 芒硝(一钱) 炙甘草(一钱) 大枣(一枚)
黄芩芍药汤
黄芩(一钱) 芍药(一钱) 炙甘草(一钱)
葛根升麻汤
升麻(六分) 葛根(一钱) 芍药(一钱) 炙甘草(一钱)
周梦觉说:冬季感受寒邪,随即发病的称为伤寒。没有立即发病而寒邪潜伏于体内,到了春季随着阳气升发而显现出来的,称为温病。其症状表现为头痛、项部僵硬,与伤寒没有区别。只是初起时不恶寒,而是直接发热,脉象数(快),这是不同的地方。伤寒的病邪由表入里,不得不先发散表邪;温病的病邪由里达表,不得不先清泄里热。所以有“温病误用发汗法无害,但误用攻下法则有害”的说法。张仲景撰写《伤寒论》,时间范围是从秋分后到春分前为止;如果是春分之后,就属于温病了。《内经》中虽然有“夏至日之前发生的为温病”的记载,张仲景也有“太阳病中先发热的属于温病”的论述。但从晋代、唐代以来,没有人将伤寒和温病清晰地区分开来,一概用治疗伤寒的方法去治疗,结果得失参半。治疗这类病症的人,茫然无主见。到了金代,刘河间出现,才开始撰写关于温病的理论著作。明代喻嘉言出来,又进一步阐发了这一学说。温病的治疗才有了准则,而张仲景的著作也因此得以在世上彰显。在这春光明媚的天气里,三阳之气出于地面,阳光明媚,和风习习,花香鸟语,一片春天的温热之气,蓬勃旺盛,所以疾病也称之为“温”。病情轻的,用白虎汤、黄芩芍药汤、葛根升麻汤;病情重的,用三承气汤,没有不应验的。偶尔也有先恶寒而后发热的,仍然按照伤寒的方法治疗。又说:冬天如果不注意藏精,春天必定会患温病。因为冬季主闭藏,如果漏泄了春天的生机,邪气就会乘虚而入,此时正气必然虚弱。古人将婚姻的六礼定在桃花盛开的时节,是有道理的。我认为,热邪蕴结至极,必然会煎熬肾水。遇到体质充足的人,只用上述方剂治疗即可。如果遇到体质虚弱怯懦的人,不论其精气是否封藏,在上述方剂中重用生地黄和熟地黄,以培补根本。这样两种说法就不相冲突,而是相辅相成的了。何必像喻嘉言那样对这两种说法进行分别解释呢?
涂蔚生说:查阅张仲景的《伤寒论》,只有“太阳病,发热而口渴,不恶寒的,是温病”的说法。并没有从秋分后到春分前为止,若春分后则为温病的说法。不知道周梦觉的说法是否出自其他版本的经典,还是根据他人的臆测之说。不过他的说法颇为精妙,总算瑕不掩瑜。
人参白虎汤
人参(一钱) 石膏(一钱) 知母(一钱) 粳米(一钱) 炙甘草(一钱)
Zhou Mengjue stated: When one is injured by cold in winter and falls ill immediately, it is termed Shanghan (Cold Damage). If the illness does not manifest immediately but the pathogenic factor lies dormant within, emerging in spring along with the rising Yang Qi, it is termed Wenbing (Warm Disease). The symptoms include headache and stiffness of the neck, which are no different from those of Shanghan. The difference lies only in that at the onset, there is no aversion to cold, but rather immediate fever, and the pulse is rapid (Shu). Shanghan moves from the exterior to the interior, so it is imperative to first release the exterior. Wenbing moves from the interior to the exterior, so it is imperative to first clear the interior. Hence, there is a saying that "for Wenbing, mistaken use of diaphoresis is harmless, but mistaken use of purgation is harmful." Zhang Zhongjing wrote the *Treatise on Cold Damage* (*Shanghan Lun*), covering the period from after the Autumnal Equinox to before the Vernal Equinox; if it occurs after the Vernal Equinox, it is considered Wenbing. Although the *Neijing* contains text stating that those occurring before the Summer Solstice are Warm Diseases, and although Zhang Zhongjing discussed that "those with fever appearing first in Taiyang disease belong to Warm," since the Jin and Tang dynasties, no one clearly distinguished between Shanghan and Wenbing, treating all with methods for Shanghan, resulting in mixed outcomes. Physicians treating these conditions were often at a loss. It was not until the Jin Dynasty, when Liu Hejian emerged, that he began to compose treatises on Warm Diseases. In the Ming Dynasty, Yu Jiayan further elaborated on this theory. Thus, standards for treating Warm Diseases were established, and Zhang Zhongjing's works were thereby brought to light. During this bright and beautiful springtime, when the Three Yang energies emerge from the earth, with sunny skies, gentle breezes, fragrant flowers, and singing birds, a pervasive atmosphere of spring warmth fills the air; hence the disease is named "Wen" (Warm). For mild cases, Baihu Tang (White Tiger Decoction), Huangqin Shaoyao Tang (Scutellaria and Peony Decoction), or Gegen Shengma Tang (Kudzu and Cimicifuga Decoction) are used; for severe cases, the Three Chengqi Decoctions (San Chengqi Tang) are used, all of which prove effective. Occasionally, there are cases where aversion to cold precedes fever; these are still treated according to Shanghan protocols. It is also said: "If one fails to conserve essence in winter, one will inevitably contract Warm Disease in spring." This is because winter governs storage and conservation; if the spring vitality is leaked, pathogens will gather where the Qi is deficient. Ancient people scheduled the six rites of marriage during the time of blooming peach blossoms, which had its rationale. I hold that extreme accumulation of heat must inevitably boil down Kidney Water. For those with sufficient constitution, the aforementioned decoctions suffice. However, for those with weak and timid constitutions, regardless of whether their essence is conserved or not, heavy doses of Sheng Dihuang (Raw Rehmannia Root) and Shu Dihuang (Prepared Rehmannia Root) should be added to the aforementioned decoctions to nourish the root. In this way, the two theories do not contradict each other but complement each other. Why is it necessary to differentiate them as Yu Jiayan did?
Tu Weisheng stated: Consulting Zhang Zhongjing's *Treatise on Cold Damage* (*Shanghan Lun*), there is only the statement that "Taiyang disease with fever, thirst, and no aversion to cold is Warm Disease." There is no statement regarding the period from after the Autumnal Equinox to before the Vernal Equinox, nor that diseases after the Vernal Equinox are Warm Diseases. It is unknown whether Zhou Mengjue's view comes from another version of the classics or is based on others' speculative theories. Nevertheless, his view is quite excellent, having flaws that do not obscure its merits.
Renshen Baihu Tang (Ginseng White Tiger Decoction)
Renshen (1 qian) Shigao (1 qian) Zhimu (1 qian) Jingmi (1 qian) Zhi Gancao (1 qian)
Da Chengqi Tang (See formula for Spasm Disease above)
Xiao Chengqi Tang (Minor Order the Qi Decoction)
Dahuang (1 qian) Nongpo (0.7 fen) Zhishi (0.7 fen)
Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction)
Dahuang (1 qian) Mangxiao (1 qian) Zhi Gancao (1 qian) Dazao (1 piece)
Huangqin Shaoyao Tang (Scutellaria and Peony Decoction)
Huangqin (1 qian) Shaoyao (1 qian) Zhi Gancao (1 qian)
Gegen Shengma Tang (Kudzu and Cimicifuga Decoction)
Shengma (0.6 fen) Gegen (1 qian) Shaoyao (1 qian) Zhi Gancao (1 qian)