或
者
必
。
谵
栝
着
后
争
而
食
呕吐。寒热无时。脉小紧者。大柴胡下之。
痰证伤寒类。伤寒有痰。头项皆和畅。外热憎寒。寸浮。上头疼。右手脉数。身不疼。
左手
疼。
汤。
疼。
缓
人迎主外风寒入之。气口主中饮食伤之。是以有右左手之别。中脘痞闷。呕而热者。二陈汤
加生姜、乌梅。寒多不甚热者。治中汤、五积散。心腹满痛者。大柴胡下之。胸膈实而呕吐
者。食在上脘。瓜蒂散吐之。
夹食伤寒证候。按病源云。下后六七日不大便。烦热腹满而痛。为胃中有干粪。亦夹宿
食故
主胸
皮、
用青
张氏
不可
若吐
虚烦香港脚。伤寒虚烦。身首全无痛。脉自和平。多热壅转筋。恶食。大便难。香港脚酸疼
而弱
汤。
初病
屈弱
苏饮
养正
除
散
筋
降
痛
恶闻食臭。大类伤寒。但猝起腿脚屈弱顽痹。肢节挛急酸疼。或历节及髀胫间顽然赤肿。为
异耳。伤寒传足六经。在太阳则头痛项强。腰背酸重。在阳明则口燥鼻干。恶热谵语。在少
阳则耳聋口苦。胁疼。在太阴则胸腹满痞。肢体浮肿。在少阴则咳喘面黧。咽痛。在厥阴则
瘫缓筋挛。阴器胀痛。六经所传。又有合病并病。香港脚外证与伤寒并同。凡遇发热躁烦。大
便不通。呕哕痰涎。而恶食者起于热。热则下而愈。须审问之。脉浮而弦者起于风。则汗而
愈。濡而弱者起于湿。湿则渗而愈。洪而数者起于热。热则下而愈。迟而涩者起于寒。寒则
温而愈。风寒暑湿证状不同。然风为走注。寒为疼痛。暑为热烦。湿为重着。必有可验之证
。治法总贵乎疏导。但不可过剂。其补汤淋洗则医家之大戒也。虽然香港脚渐入顿深。非药力
相接不可也。治之亦当究其源。或因风寒发动。则为之解风寒。或因饮食酿成。则为之消饮
食。气触而发者。则与之调气。续生于他病者。则以他病方药理之。所患气实而死。未有服
药致虚而殂者。甚至喘嗽上冲心痛。呕吐。腹胁胀满。顽痹不仁。最为恶候。然所谓寒则温
之。热则寒之。在表则散之。在里则下之。太虚者扶养之。是为不刊之法。
伤寒传经之邪。病至厥阴。其脉微带浮缓之状。是则脾气将复。邪无所容。寒热作而得
汗以
之证
伤寒表证当汗而不可下。里证当下而不可汗。在半表半里当和解。不可发汗吐下。在上
则通
入于
下之
天
下
此
大承气
不见。
者。或
反无汗
寒。或畏
三一承气
柴胡、天
退。本气
热势之甚
小便赤
虚不能
青冷。
实痛。
阳热势
虽古人
而未愈
而昏
毒汤
用。
六经传变。太阴、少阴、厥阴，皆属阴证也。少阴者肾也。厥阴者肝也。太阴者脾也。
脾何
心
阴
阴
若
利
人之伤寒则为热病。古人通谓之伤寒病。前三日。巨阳、阳明、少阳受之。热在于表。
汗之
是热
景本
伤寒则。别。语无伦者曰谵语。实则呓语也。外证大便秘。小便赤。声重。曰郑声。虚
则郑
衣。
肠
病
证
脉
子
胯
挛
曰
何逆有四种。或变为湿疟。或变为风温。或为湿毒。或为温疫也。发而汗不止曰漏风。漏风
亦亡阳之别名也。又大下之后损伤阴血。亦谓之亡阳。又太阳病。桂枝证而投麻黄。汗出多
遂
反
寒
汗
俗谓之天行。发湿温汗。日重 。重 者死。温病汗出。辄后复发热。而脉躁疾不为汗衰。
狂言不能食。曰阴阳交。交者死也。评热论云。发热。脉躁。狂言不能食。谓之三死。发热
脉躁盛不得汗者。曰阳极。死。又若已得汗。而脉躁盛者。亦主死也。大都汗后。脉躁盛者
皆死也。病瘥后更发热。曰遗热。病瘥后。劳动再病曰劳复。病瘥后。食肉再病曰食复。脉
浮迟或弱。不能作汗。其身痒者。曰无阳。目乱无神。吐利并作。曰霍乱。鼻出血曰衄。阳
病
之
证
关脉小细沉紧。舌上白苔而滑者。曰脏结。死不治。上唇有疮。虫食其喉。或食其脏。曰惑
。下唇有疮。虫食其肛。或食其阴。曰狐。咳逆曰哕。干呕曰 。脉相克贼曰负。负者死。
谓阳明与少阳合病。其脉但长大者。谓有胃脉为顺。若脉中有弦。即是有木脉也。土被木贼。
故曰负。所以死也。伤寒有所不利者行之。取其渗泄也。利小曰渗泄。大抵小便数则大便难。
小便曰溲。民病 溏。大便寒而鸭溏。水谷不别也。大便坚硬。曰硬。此有热而硬也。
曰寒则溏。热则垢也。肠热而利谓之肠垢。渴欲饮水。水入即吐。名曰水逆。黄病曰疸。内
经疟论中。谓疸为热。活人书。以黄为疸。南方暑湿。近夏瘅热。故病黄也。疸与瘅同。因
热而病黄胆也。心振寒而动曰悸。厥阴证云。厥逆怔忪。此有水也。宜治水。香港脚有小腹不
仁。而怔忪者。少阳呕而发热。胸胁满。小便不利。怔忪者。心中若有所失。曰懊 。当汗
而误下者。为痞为结胸。为懊 。应下而汗者。为亡阳。为谵语。为下厥上竭。强发少阴汗
则动血。或退场门鼻。或出耳目。谓之下厥上竭也。目中不了了。谓不明了也。或谓之睛不和
。言不和平如寻常也。口中不仁。小腹不仁者。即所谓皮肤不仁之义。皮肤不仁者。顽麻而
不知有无也。身振摇而动。曰肉 。脐下有动气曰奔豚。在上者涌之曰吐。在下者泄之曰利
。左关曰人迎。右关曰气口。足趺上动脉曰冲阳内踝骨上陷中动脉。曰太溪。乳直下筋骨间
。近腹处曰期门。脐下一寸曰气海。千金方指迷方。并云一寸五分。此谓从其心量下一寸五
分也。二寸曰丹田。三寸曰关元。血曰营。气曰卫。玄府曰汗孔。素问生气通天论。劳汗当
风。注云。玄府即汗孔也。手足搐搦曰螈 。二阳俱病曰合病。先一阳病。而后一阳又病
曰并病。阴阳俱病曰两感。先曰阴阳双传。四肢病曰末疾。大抵有风则四肢不收。左传
曰。
伤寒诸笃证。摇头直视。形如烟熏。心绝。唇吻反青。四肢多汗。肝绝。反目直视。狂
言遗
无已
曰
鼻
剂
药
阳
通
下利恶寒而蜷。发躁无脉。不治。下利日十余行。其脉反实者逆。少阳、阳明合病。下利脉
长大而弦。曰负。不治。阳病见阴脉者不治。发斑属阳。见阴脉不治。代脉不治。吐血衄血
。脉反浮大而牢。不治。阴易阳易。脉离经。外肾肿。腹中绞痛。手足拳挛。不治。咳逆上
气。脉止者不治。谵语。脉反沉微。四肢厥冷。不治。脉阴阳俱虚。热不止者不治。七八日
以上发大热。难治。舌本烂身热。或汗不止。厥不止。并不治。下利发热。厥逆。躁不得眠
。不治。谵语直视。或喘满。或下利。并不治。谵语属阳。见阴证者逆。伤寒脉乍疏乍数。
不治。发斑先赤后黯。面色黧晦。不治。发斑大便自利。不治。发黄而变黑。不治。舌干黑
不治。张目陷不治。张口出气。干呕。骨体热痛者逆。咳逆不止者不治。心下痞闷。上气喘
粗者逆。霍乱。喘胀烦躁。不治。误下湿家。额汗喘促。或小便不利。大便自利。不治。头
汗。内外关格。小便不利。此为阳脱。不治。腹满咳逆。不得小便。不治。腹大满而不泄。
不治。若脉洪紧而滑。尤可虑。脏结如结胸。舌上白苔。阴筋引脐腹痛。时下利。不治。结
胸证具。更加烦躁。不治。脏厥七八日。肤冷烦躁下利。无时暂安。不治。少阴吐利。厥逆
烦躁。不治。厥而下利。反能食者。曰除中。不治。四肢厥逆。脐下绞痛石硬。睛定者逆。
厥阴唇青舌卷。黑面耳聋囊缩。不治。头连胸痛甚。手足俱寒。不治。阴毒阳毒。过六七日
不治。狐惑咽干声哑。唇疮不治。赤斑。五救其一。黑斑。十救其一。寻衣摸空者逆。
总括论云。伤寒汗下吐之法。最不可轻据脉以验证。问证而对脉。太阳者。阳证之表也。
阳
也
多
表
白
其
弱
居
伤
伤
可以
令营
辨
邪
脏
者次
气，投之
故曰得中
分之剂散
与之和
理。虽未遽安。亦无传变。故曰宁可不及者次也。太过者。粗工不知深浅。轻举妄动者为之。
或问
者不
动经
可轻
进病
与。
在纲
最为得
节。且
人之立
里证。
中有柴
下。无
谓阴
汗也
固
四
病
阳
证
而
。是日数之不可拘也如此。孙思邈云。服承气得利。谨勿补中。以热气得补复盛。此所以言
实热也。王叔和有曰。虚热不可去。热去则寒起。此所以言虚热也。二言之殊途同归。是虚
实之不可不辨也如此。又况寒温热同实而不同名。暑湿风异种而有兼病。异气之相乘。他
邪之并作。表证中之有不可汗。里证中之有不可下。三阴可温攻。有热证者不同。表里俱见
。与半表里者有异。中暑热病疑似难明。伤寒中风脉证互见。阳明本多汗。而有反无汗之别
。少阴本无汗。而有反自汗之证。或阴极发燥。热极发厥。阳证似阴。阴证似阳。差之毫厘
。谬以千里。又有痰证食积。虚烦香港脚等证。似伤寒之病。自非心领意会。达变知机。体认
之精。发用之审。则纵横泛应。几何而不穷哉。孔子曰。可与适道。未可与立。可与立。未
可与权。是说也。亦在夫人权之而已矣。
危氏得效方。伤寒撮要论云。凡发汗法。欲令手足俱周。 然一时许为佳。不欲淋漓
如
为度
四
汤
重
以吐为度。若吐少病不除。明日再服吐药。可至再三。但虚人宜少吐。药力过多者饮水解之
。凡水渍法。以叠布数重。新水渍之。稍捩去水。搭于胸上。须臾蒸热。又渍令冷。如前用
之。仍数易新水。日数十易。热甚者着病患于水中。热势退则已。亦良法也。凡葱熨法。已
用葱一束。以丝缠如饼馅大。去根。惟存白三寸许。先以火 。一面令通热勿至灼人。乃
热处着病患脐下。上用熨斗盛火熨之。令葱饼热气透入腹中。更用三四饼。候病患醒。手足
温有汗乃止。凡蒸法。以新火烧地。良久可以水洒之。取蚕砂、柏叶、桃叶、糠麸皆可用。
相和铺烧地。上面铺草席令病患上卧。温覆之。夏月热只用布单覆之。汗移时立至。俟脚心
有汗。乃用温粉扑上。移上床。最得力者。蚕砂、柏叶、桃叶也。无蚕砂亦得。
或者必定出现谵语。呕吐，寒热发作没有定时。脉象小且紧的，用大柴胡汤攻下。
痰证伤寒类似的情况：伤寒伴有痰饮，头项部感觉舒缓通畅，体表发热而憎恶寒冷，寸口脉浮，头部疼痛，右手脉数，身体不疼痛，左手疼痛。人迎脉（左关）主外感风寒入侵，气口脉（右关）主内伤饮食积滞，因此有左右手脉象的区别。中脘部位痞闷胀满，呕吐且发热的，用二陈汤加生姜、乌梅治疗；寒气重而发热不明显的，用治中汤或五积散治疗；心腹部胀满疼痛的，用大柴胡汤攻下；胸膈实邪导致呕吐的，说明食积在上脘，用瓜蒂散催吐。
夹食伤寒的证候：根据《病源》记载，泻下后六七天不大便，烦热、腹部胀满且疼痛，这是胃中有干燥的粪便，也是夹杂宿食所致。
虚烦和香港脚（脚气病）：伤寒引起的虚烦，全身和头部完全没有疼痛，脉象自然平和，多因热邪壅盛导致转筋，厌恶食物气味，大便困难。香港脚酸疼且肢体软弱无力，初起时腿脚屈曲软弱、麻木不仁，肢节挛急酸疼，或者历节疼痛以及大腿和小腿之间顽固性红肿，这与伤寒不同。伤寒传变至足六经：在太阳经则头痛项强，腰背酸重；在阳明经则口燥鼻干，恶热谵语；在少阳经则耳聋口苦，胁痛；在太阴经则胸腹满闷痞塞，肢体浮肿；在少阴经则咳喘面色黧黑，咽痛；在厥阴经则瘫缓筋挛，阴器胀痛。六经传变中，还有合病和并病的情况。香港脚的外证与伤寒相同。凡是遇到发热烦躁，大便不通，呕吐哕逆痰涎，且厌恶食物的，起于热邪，热邪则通过攻下而愈，必须仔细审问。脉象浮而弦的，起于风邪，则通过发汗而愈；脉象濡而弱的，起于湿邪，湿邪则通过渗利而愈；脉象洪而数的，起于热邪，热邪则通过攻下而愈；脉象迟而涩的，起于寒邪，寒邪则通过温补而愈。风寒暑湿的症状表现不同，但风邪致病特点是游走不定，寒邪致病特点是疼痛，暑邪致病特点是热烦，湿邪致病特点是沉重困着，一定有可以验证的证候。治疗方法总以疏导为贵，但不可用药过量。至于用补益汤药淋洗，是医家的大忌。虽然如此，香港脚病逐渐深入，非药物力量接续不断不能治愈。治疗也应当探究其根源，如果因风寒诱发，就为之解除风寒；如果因饮食酿成，就为之消导饮食；气机触动而发作的，就为之调理气机；继发于其他疾病的，就用治疗其他疾病的方剂药理来治理。患气实证而死的人，没有因为服药导致虚弱而死亡的。甚至出现喘嗽气上冲心痛，呕吐，腹胁胀满，顽痹不知痛痒，是最为凶险的证候。然而所谓寒证用温法，热证用清法，表证用散法，里证用下法，极度虚弱的用扶正法，这是不可更改的根本法则。
伤寒传经之邪，病至厥阴经，脉象微带浮缓之状，这是脾气将要恢复，邪气无处容身，寒热发作而出汗得以退去。
伤寒表证应当发汗而不可攻下，里证应当攻下而不可发汗，在半表半里应当和解，不可发汗、催吐或攻下。
六经传变，太阴、少阴、厥阴，都属于阴证。少阴经对应肾，厥阴经对应肝，太阴经对应脾。
人感受伤寒就会变成热病，古人通称为伤寒病。前三日，巨阳（太阳）、阳明、少阳经受邪，热邪在表，应当发汗。
伤寒与中风有别。言语错乱无伦次的是谵语，属于实证；声音低微重复的是郑声，属于虚证。
有四种逆证：或者变为湿疟，或者变为风温，或者变为湿毒，或者变为温疫。出汗不止的叫漏风，漏风也是亡阳的别名。又大泻之后损伤阴血，也称为亡阳。另外太阳病，本是桂枝汤证却用了麻黄汤，导致汗出过多，俗称为天行（流行性传染病）。发湿温病出汗，病情日渐加重，加重的会死亡。温病出汗后再次发热，且脉象躁疾不因出汗而衰减，狂言不能进食，叫阴阳交，阴阳交者死。《评热论》说：发热，脉象躁动，狂言不能进食，叫做三死。发热脉象躁盛且不出汗的，叫阳极，死。如果已经出汗，但脉象依然躁盛的，也主死。大都出汗后，脉象躁盛的都主死。病愈后再次发热，叫遗热。病愈后，劳动导致复发叫劳复。病愈后，吃肉类导致复发叫食复。脉象浮迟或弱，不能作汗，身体瘙痒的，叫无阳。眼睛昏乱无神，吐利同时发作的，叫霍乱。鼻出血叫衄。
关脉小细沉紧，舌上有白苔且滑润的，叫脏结，死证难治。上唇有疮，虫蚀咽喉，或者侵蚀内脏，叫惑。下唇有疮，虫蚀肛门，或者侵蚀阴部，叫狐。咳嗽气逆叫哕。干呕叫干呕。脉象相克贼叫负，负者死。
谓阳明与少阳合病，脉象只是长大，说明有胃气为顺。如果脉中有弦象，就是有木脉，土被木克制，所以叫负，因此致死。
伤寒中有不利症状的，用行之法，取其渗泄作用。小便量少叫渗泄。大抵小便频数则大便困难。小便叫溲。百姓患病大便稀溏，大便寒而像鸭粪一样稀薄，是水谷不分。大便坚硬，叫硬，这是有热导致的硬。寒则便溏，热则便垢。肠热而下利叫肠垢。口渴想喝水，水入即吐，名叫水逆。黄疸病叫疸。《内经·疟论》中，称疸为热，《活人书》以黄为疸。南方暑湿，近夏炎热，所以患黄疸病。疸与瘅同义，因热而患黄胆病。心脏震颤寒冷而动叫悸。厥阴证说：厥逆怔忪，这是有水饮，宜治水。香港脚有小腹麻木不仁且怔忪的，少阳病呕吐且发热，胸胁满闷，小便不利，怔忪是心中若有失的样子，叫懊憹。应当发汗而误用下法的，成为痞证或结胸，成为懊憹。应当攻下而误用发汗的，成为亡阳，成为谵语，成为下厥上竭。强行发少阴经的汗则会动血，或者从肛门、鼻孔出血，或者从耳朵、眼睛出血，这叫下厥上竭。目中视物不清，叫不了了，或者叫睛不和，意思是眼神不和平如常。口中感觉麻木，小腹麻木不仁，就是所谓的皮肤不仁。皮肤不仁，是顽固麻木而不知有无的感觉。身体振摇而动，叫肉瞤。脐下有动气叫奔豚。在上部的用涌吐法叫吐，在下部的用泄下法叫利。左关脉叫人迎，右关脉叫气口。足背上的动脉叫冲阳，内踝骨上方凹陷中的动脉叫太溪。乳房直下筋骨间，靠近腹部处叫期门。脐下一寸叫气海，《千金方》和《指迷方》都说是一寸五分，这是指从心窝量下一寸五分。二寸叫丹田，三寸叫关元。血叫营，气叫卫。玄府叫汗孔。《素问·生气通天论》说：劳作出汗当风，注解说：玄府即汗孔也。手足抽搐叫螈疭。两阳经同时发病叫合病。先一个阳经发病，而后另一个阳经又发病叫并病。阴阳经同时发病叫两感。先叫阴阳双传。四肢发病叫末疾。大抵有风邪则四肢不能收持。《左传》说……
伤寒各种危重证候：摇头直视，形体如烟熏，心绝。嘴唇吻部反青，四肢多汗，肝绝。反目直视，狂言遗尿，无已，鼻……
下利恶寒而蜷缩，发躁无脉，不治。下利一天十多次，脉象反而实，为逆证。少阳、阳明合病，下利脉象长大而弦，叫负，不治。阳病见阴脉者不治。发斑属阳，见阴脉不治。代脉不治。吐血衄血，脉象反而浮大而牢，不治。阴易、阳易，脉离经，外肾肿，腹中绞痛，手足拳挛，不治。咳逆上气，脉止者不治。谵语，脉象反而沉微，四肢厥冷，不治。脉阴阳俱虚，热不止者不治。七八日以上发大热，难治。舌本烂身热，或者汗不止，厥不止，都不治。下利发热，厥逆，躁不得眠，不治。谵语直视，或者喘满，或者下利，都不治。谵语属阳，见阴证者为逆。伤寒脉象乍疏乍数，不治。发斑先红后暗，面色晦暗，不治。发斑大便自利，不治。发黄而变黑，不治。舌干黑不治。张目陷不治。张口出气，干呕，骨体热痛者为逆。咳逆不止者不治。心下痞闷，上气喘粗者为逆。霍乱，喘胀烦躁，不治。误下湿家，额汗喘促，或者小便不利，大便自利，不治。头汗，内外关格，小便不利，此为阳脱，不治。腹满咳逆，不得小便，不治。腹大满而不泄，不治。如果脉象洪紧而滑，尤其可虑。脏结如结胸，舌上白苔，阴筋引脐腹痛，时下利，不治。结胸证具备，更加烦躁，不治。脏厥七八日，肤冷烦躁下利，无时暂安，不治。少阴吐利，厥逆烦躁，不治。厥而下利，反能食的，叫除中，不治。四肢厥逆，脐下绞痛石硬，睛定者为逆。厥阴唇青舌卷，黑面耳聋囊缩，不治。头连胸痛甚，手足俱寒，不治。阴毒阳毒，过六七日不治。狐惑咽干声哑，唇疮不治。赤斑，五救其一。黑斑，十救其一。寻衣摸空者为逆。
总括论说：伤寒汗、下、吐的方法，最不可以轻易依据脉象来验证，要问证候而对脉象。太阳经，是阳证的表证。……里证。其中有柴胡……下。无……谓阴……汗也。固……四……病……阳……证……而……。是日数之不可拘也如此。孙思邈说：服用承气汤得利后，谨慎不要补中，因为热气得到补益会重新旺盛，这是所说的实热。王叔和有话说：虚热不可去除，热去则寒起，这是所说的虚热。两句话殊途同归，虚实是不可不辨别的，如此。更何况寒温热同实而不同名，暑湿风异种而有兼病，异气相乘，他邪并作，表证中有不可汗的，里证中有不可下的，三阴可温攻，有热证的不同，表里俱见，与半表里有异，中暑热病疑似难明，伤寒中风脉证互见，阳明本多汗，而有反无汗的区别，少阴本无汗，而有反自汗的证候，或者阴极发燥，热极发厥，阳证似阴，阴证似阳，差之毫厘，谬以千里。又有痰证食积，虚烦香港脚等证，似伤寒的病，如果不是心领意会，达变知机，体认之精，发用之审，那么纵横泛应，怎么能不穷尽呢？孔子说：可与适道，未可与立，可与立，未可与权。是说这个意思，也在乎人的权衡罢了。
危氏《得效方》，《伤寒撮要论》说：凡是发汗法，想要让手足都周全，漐然一时许为佳，不欲淋漓……以吐为度。如果吐得少病不除，明天再服吐药，可至再三，但虚人宜少吐，药力过多者饮水解之。凡水渍法，用叠布数重，新水浸渍它，稍微拧去水，搭在胸上，一会儿蒸热，又浸令冷，如前使用它，仍多次换新的水，一天数十次更换。热甚者把病患放在水中，热势退了就停止，也是好方法。凡葱熨法，已经用葱一束，用丝缠绕如饼馅大，去根，只留白三寸许，先用火……一面令通热勿至灼人，乃在热处贴着病患脐下，上用熨斗盛火熨之，令葱饼热气透入腹中，再用三四饼，候病患醒，手足温有汗才停止。凡蒸法，用新火烧地，良久可以洒水，取蚕砂、柏叶、桃叶、糠麸都可以用，混合铺烧地，上面铺草席令病患上卧，温覆之。夏月热只用布单覆之，汗移时立至，等脚心有汗，然后用温粉扑上，移到床上。最得力的是蚕砂、柏叶、桃叶。没有蚕砂也可以。
Or there may be delirium. Vomiting, with chills and fever occurring at irregular intervals. If the pulse is small and tight, treat with Da Chai Hu Tang (Major Bupleurum Decoction) to purge.
Phlegm-pattern Cold Damage resembles this: In Cold Damage with phlegm, the head and neck feel relaxed and smooth, there is external heat with aversion to cold, the cun position is floating, there is headache, the right hand pulse is rapid, the body does not ache, but the left hand side aches. Ren Ying (Left Guan) governs external wind-cold invasion; Qi Kou (Right Guan) governs internal dietary injury. Hence the distinction between left and right hands. If there is fullness and stuffiness in the Zhong Wan region, vomiting with fever, treat with Er Chen Tang (Two-Cured Decoction) added with Sheng Jiang (Fresh Ginger) and Wu Mei (Mume Fruit). If cold is predominant with slight heat, treat with Zhi Zhong Tang (Regulate the Middle Decoction) or Wu Ji San (Five Accumulations Powder). If there is abdominal fullness and pain, treat with Da Chai Hu Tang (Major Bupleurum Decoction) to purge. If there is chest and diaphragm excess leading to vomiting, indicating food retention in the upper jiao, induce vomiting with Gua Di San (Melon Seed Powder).
Symptoms of Cold Damage complicated by food retention: According to *Bing Yuan* (Source of Diseases), after purgation, if there is no bowel movement for six or seven days, accompanied by irritability, heat, abdominal fullness, and pain, this indicates dry feces in the stomach, also caused by retained old food.
Deficient irritability and Hong Jiao (Foot Qi / Beriberi): Deficient irritability from Cold Damage presents with no pain in the body or head, and a naturally peaceful pulse. It often involves heat obstruction leading to muscle cramps, aversion to food odor, and difficulty in defecation. Foot Qi presents with soreness and weakness in the legs. Initially, the legs and feet are weak, stiff, and numb, with joint spasms and soreness, or stubborn red swelling in the joints, thighs, and calves, which differs from Cold Damage. When Cold Damage transmits to the six foot meridians: in Tai Yang, there is headache and stiff neck, with soreness and heaviness in the lower back; in Yang Ming, there is dry mouth and nose, aversion to heat, and delirium; in Shao Yang, there is deafness, bitter taste, and hypochondriac pain; in Tai Yin, there is chest and abdominal fullness and stuffiness, with limb edema; in Shao Yin, there is cough, asthma, dark complexion, and sore throat; in Jue Yin, there is flaccidity and tendon contraction, with distending pain in the genitalia. Among the transmission of the six meridians, there are also He Bing (Combined Disease) and Bing Bing (Concurrent Disease). The external signs of Foot Qi are the same as those of Cold Damage. Whenever there is fever, restlessness, constipation, vomiting, retching, phlegm, and aversion to food, it arises from Heat; Heat is cured by purging, so careful inquiry is necessary. If the pulse is floating and wiry, it arises from Wind, and is cured by sweating. If the pulse is soggy and weak, it arises from Dampness, and is cured by promoting urination. If the pulse is surging and rapid, it arises from Heat, and is cured by purging. If the pulse is slow and choppy, it arises from Cold, and is cured by warming. The symptoms of Wind, Cold, Summer-heat, and Dampness differ: Wind causes wandering pain, Cold causes pain, Summer-heat causes heat and restlessness, and Dampness causes heaviness and sticking. There must be verifiable signs. The treatment principle emphasizes dredging and unblocking, but one must not overdose. Using tonic decoctions for washing is a major taboo for physicians. Nevertheless, as Foot Qi gradually deepens, continuous medicinal effort is required. Treatment must investigate the source: if triggered by wind-cold, resolve wind-cold; if caused by diet, digest food; if triggered by qi stagnation, regulate qi; if secondary to other diseases, treat the primary disease. Patients die from excess qi conditions, rarely from becoming deficient due to medication. Even with severe symptoms like wheezing, cough, qi rushing to the heart causing pain, vomiting, abdominal and hypochondriac distension, and stubborn numbness, these are dire prognoses. However, the principles remain: warm the cold, cool the heat, disperse the exterior, purge the interior, and support the severely deficient. These are immutable laws.
When pathogenic factors from Cold Damage transmit to Jue Yin, the pulse is slightly floating and relaxed, indicating that Spleen Qi is recovering and pathogens have no place to reside. Chills and fever occur, and sweating leads to resolution.
Exterior patterns of Cold Damage should be treated by sweating, not purging; Interior patterns should be purged, not sweated; Half-exterior, half-interior patterns should be harmonized, not sweated, vomited, or purged.
The transmission through the six meridians: Tai Yin, Shao Yin, and Jue Yin all belong to Yin patterns. Shao Yin corresponds to the Kidney; Jue Yin to the Liver; Tai Yin to the Spleen.
When humans contract Cold Damage, it becomes a Heat Disease, generally called Cold Damage by ancients. In the first three days, Ju Yang (Tai Yang), Yang Ming, and Shao Yang are affected. Heat is in the exterior, so sweat it out.
Cold Damage differs from Wind Strike. Disordered speech is Delirium (Zhen Yu), an excess condition; monotonous repetition of words is Zheng Sheng, a deficiency condition.
There are four types of adverse changes: it may transform into Damp Malaria, Wind-Warmth, Damp-Toxin, or Warm Epidemic. Sweating without stopping is called Lou Feng (Leaking Wind), another name for Wang Yang (Loss of Yang). Severe purgation damaging Yin blood is also called Wang Yang. Also, in Tai Yang disease, if Guizhi Tang pattern is mistakenly given Mahuang Tang, excessive sweating occurs, commonly called Tian Xing (Heavenly Travel/Epidemic). In Shi Wen (Damp-Warmth), sweating worsens the condition daily; worsening leads to death. In Wen Bing (Warm Disease), fever recurs after sweating, with a rapid, restless pulse unrelieved by sweat, delirium, and inability to eat, called Yin Yang Jiao (Yin-Yang Intersection); this is fatal. *Ping Re Lun* states: Fever, restless pulse, delirium, and inability to eat constitute "Three Deaths." Fever with rapid pulse and no sweat is Yang Ji (Extreme Yang); fatal. If sweat occurs but the pulse remains rapid, also fatal. Generally, post-sweat rapid pulse indicates death. Fever recurring after recovery is Yi Re (Lingering Heat). Relapse due to exertion after recovery is Lao Fu (Labor Recurrence). Relapse due to eating meat after recovery is Shi Fu (Food Recurrence). Floating, slow, or weak pulse with inability to sweat and itchy skin is Wu Yang (No Yang). Confused eyes and lack of spirit, with simultaneous vomiting and diarrhea, is Huo Luan (Cholera-like disorder). Nosebleed is Xu.
Guan pulse small, fine, deep, and tight, with a white slippery coating on the tongue, is Zang Jie (Organ Knotting); fatal and untreatable. Sores on the upper lip with worms eating the throat or organs is Huo (Confusion). Sores on the lower lip with worms eating the anus or genitals is Hu (Fox). Coughing and reverse flow of qi is Yue (Hiccups). Dry retching is Gan Ou. Pulses overcoming each other are Fu (Negative); Fu indicates death.
In combined disease of Yang Ming and Shao Yang, if the pulse is merely large and long, it indicates Stomach Qi and is favorable. If the pulse contains a wiry quality, it indicates Wood overacting on Earth, hence "Fu," leading to death.
For unfavorable conditions in Cold Damage, use methods to promote permeation and drainage. Scanty urination is permeation-drainage. Generally, frequent urination leads to difficult defecation. Urine is Sou. Loose stools in people indicate Cold-Damp. Cold, duck-dung-like loose stools indicate failure to separate clear and turbid. Hard stool indicates Heat-hardness. Cold causes loose stools; Heat causes foul stools. Intestinal Heat with diarrhea is Chang Gou (Intestinal Filth). Thirst with immediate vomiting upon drinking water is Shui Ni (Water Counterflow). Jaundice is Dan. *Nei Jing* says Dan is Heat; *Huo Ren Shu* equates Yellow with Dan. Southern summer dampness and heat cause Jaundice. Dan and Dan are synonymous, caused by Heat leading to yellow bile disease. Heart palpitations with chills are Ji. Jue Yin pattern mentions Jue Ni Zheng Zhong due to Water; treat Water. Foot Qi with lower abdominal numbness and palpitations; Shao Yang with vomiting, fever, chest/hypochondriac fullness, and dysuria; palpitations feeling like loss are Ao Nao (Regret/Restlessness). Mistaken purgation when sweating was indicated leads to Pi (Glomus) or Jie Xiong (Chest Binding) or Ao Nao. Mistaken sweating when purgation was indicated leads to Wang Yang, Delirium, Xia Jue Shang Jie (Lower Cold, Upper Exhaustion). Forcing sweat in Shao Yin moves blood, causing bleeding from anus, nose, ears, or eyes, called Xia Jue Shang Jie. "Mu zhong liao liao bu" means unclear vision, or Jing Bu He (Eyes not harmonious). Mouth and lower abdomen numbness refers to Skin Bu Ren (Skin insensitivity), meaning stubborn numbness. Body tremors are Rou Dun (Muscle Twitching). Pulsation below the umbilicus is Ben Tun (Running Piglet). Upper pathology uses Vomiting; lower pathology uses Purging. Left Guan is Ren Ying; Right Guan is Qi Kou. Pulse on dorsum of foot is Chong Yang; pulse above medial malleolus is Tai Xi. Below breast, near abdomen is Qi Men. One cun below umbilicus is Qi Hai; *Qian Jin Fang* says 1.5 cun from heart center. Two cun is Dan Tian; three cun is Guan Yuan. Blood is Ying; Qi is Wei. Xuan Fu is Sweat Pore. *Su Wen* notes labor sweat exposed to wind; commentary says Xuan Fu is sweat pore. Hand-foot convulsions are Chong Zhu. Two Yang meridans diseased simultaneously is He Bing. Sequential involvement of Yang meridians is Bing Bing. Simultaneous Yin-Yang involvement is Liang Gan. Limb disease is Mo Ji. Wind causes limbs to collapse.
Critical Cold Damage syndromes: Head shaking and fixed gaze, body like smoke-stained, indicates Heart Extinction. Lips turning blue, excessive sweating on limbs, indicates Liver Extinction. Fixed gaze, delirium, incontinence...
Diarrhea with aversion to cold and curling up, restlessness, and absence of pulse is untreatable. Diarrhea >10 times/day with excess pulse is adverse. Combined Shao Yang/Yang Ming diarrhea with large-long-wiry pulse is Fu (Negative), untreatable. Yang disease with Yin pulse is untreatable. Macules (Yang) with Yin pulse is untreatable. Dai (Intermittent) pulse is untreatable. Hematemesis/epistaxis with floating-large-firm pulse is untreatable. Yi (Transmission) with pulse leaving its channel, testicular swelling, colic, clenched hands/feet is untreatable. Cough/reverse qi with stopped pulse is untreatable. Delirium with deep-micro pulse and cold limbs is untreatable. Yin-Yang deficiency with persistent fever is untreatable. High fever after 7-8 days is difficult to treat. Tongue ulceration with fever, incessant sweat, or persistent cold limbs is untreatable. Diarrhea with fever, cold limbs, restlessness, insomnia is untreatable. Delirium, fixed gaze, asthma/fullness, or diarrhea is untreatable. Delirium (Yang) with Yin signs is adverse. Erratic pulse is untreatable. Macules turning dark, sallow face is untreatable. Macules with spontaneous diarrhea is untreatable. Yellow turning black is untreatable. Dry black tongue is untreatable. Sunken eyes is untreatable. Open mouth breathing, dry retching, bone pain is adverse. Incessant hiccups is untreatable. Epigastric fullness with coarse asthma is adverse. Cholera with asthma/distension/restlessness is untreatable. Mistaken purgation in Damp patient with forehead sweat, asthma, or dysuria/spontaneous diarrhea is untreatable. Forehead sweat with exterior-interior blockage and dysuria indicates Yang Collapse, untreatable. Abdominal fullness with hiccups and inability to urinate is untreatable. Massive abdominal fullness without evacuation is untreatable. Surging-tight-slippery pulse is particularly concerning. Zang Jie like Jie Xiong, white tongue coating, painful abdomen pulled by genitals, intermittent diarrhea is untreatable. Jie Xiong with added restlessness is untreatable. Zang Jue (Cold Jue) for 7-8 days, cold skin, restlessness, diarrhea, temporary relief is untreatable. Shao Yin vomiting/diarrhea, cold limbs, restlessness is untreatable. Cold limbs with diarrhea but ability to eat is Chu Zhong (Eliminated Middle), untreatable. Cold limbs, severe umbilical colic, fixed eyes is adverse. Jue Yin blue lips, curled tongue, black face, deafness, retracted testes is untreatable. Severe head/chest pain with cold limbs is untreatable. Yin/Yang Toxin after 6-7 days is untreatable. Hu Huo with dry throat, hoarseness, lip sores is untreatable. Red macules save 1 in 5; black macules save 1 in 10. Grasping at empty air is adverse.
General Theory: Sweat, purge, and vomit methods in Cold Damage must not rely lightly on pulse verification; question symptoms then check pulse. Tai Yang is the exterior of Yang patterns... Interior patterns... Contains Chai Hu... Purge... No... Yin... Sweat. Thus, days cannot be rigidly bound. Sun Simiao said: After Cheng Qi Tang produces stool, do not tonify, as heat will rebound with tonification; this refers to Excess Heat. Wang Shuhe said: Deficient Heat must not be cleared, or Cold will arise; this refers to Deficient Heat. Both sayings converge; thus, Excess and Deficiency must be distinguished. Cold, Heat, Warmth share reality but differ in name; Summer-heat, Dampness, Wind differ in type but can combine. Pathogens interact, other evils arise. Exterior has non-sweatable cases; Interior has non-purgable cases. Three Yin can be warmed/purged, but Heat patterns differ. Exterior-Interior simultaneous presentation differs from Half-Exterior. Summer-Heat/Warmth are hard to distinguish. Cold Damage/Wind Strike pulses/symptoms intermix. Yang Ming usually sweats, but may not; Shao Yin usually doesn't sweat, but may. Extreme Yin causes dryness; Extreme Heat causes cold limbs. Yang looks like Yin; Yin looks like Yang. A slight error leads to huge mistakes. Phlegm, Food Retention, Deficient Irritability, Foot Qi resemble Cold Damage. Without intuitive understanding and adaptability, how can one handle complexities? Confucius said: "One may discuss the Way, but not yet establish it; one may establish it, but not yet weigh circumstances." This applies here; it depends on human discretion.
Wei's *De Xiao Fang*, *Shang Han Cuo Yao Lun*: Sweating should cover hands and feet evenly for about an hour; profuse sweating is undesirable... Use vomiting as the limit. If little vomited and disease persists, repeat tomorrow. Weak patients should vomit less; if medicine is too strong, drink water to relieve. Water compress method: Fold cloth several times, soak in fresh water, wring slightly, place on chest. When hot, re-soak in cold water. Repeat many times daily. For high fever, immerse patient in water until fever subsides. Green Onion Moxibustion: Bundle green onions, tie like a cake, remove roots, keep 3 cun white part. Heat one side gently, place on patient's lower abdomen, iron over it to penetrate heat. Use 3-4 cakes until patient wakes, limbs warm, and sweat appears. Steaming method: Burn ground, sprinkle water, spread silkworm sand, cypress leaves, peach leaves, bran. Lay straw mat, patient lies on top, cover warmly. In summer, use single cloth. Sweat arrives quickly. When soles sweat, apply warm powder, move to bed. Silkworm sand, cypress, and peach leaves are most effective. Silkworm sand alone is acceptable.