凡寒病之由于外者,或由风寒以伤形,或由生冷以伤脏;其由于内者,或由劳欲以败阳
,或由禀赋之气弱。若寒自外入者,必由浅及深,多致呕恶胀满,或为疼痛泄泻;寒由内生
者,必由脏及表,所以战栗憎寒,或为厥逆拘挛。总之,热者多实,寒者多虚。故凡治寒证
者,当兼察其虚而仍察其脏,此不易之法也。
一、凡阴毒寒邪直中三阴者,此即伤寒类所谓直中阴经之阴证也。其于仓卒受寒,以致
身冷战栗,或四体拘挛,或心肠疼痛,或口噤失音,昏迷厥逆,或吐泻蜷卧,脉来微细,或
沉紧无神者,皆其证也。切不可妄用风药,再散其气,但速宜温中,则寒邪自散。轻则理中
汤、温胃饮,甚则四逆汤、大温中饮,或附子理阴煎之类主之。其有势在危急,唇青囊缩,
无脉者,宜用华陀救阳脱方急治之。或仍灸气海、关元二、三十壮,但得手足渐温,脉微出
者,乃可生也。一方以胡椒研碎,用滚酒泡服,外用葱盐熨法。一方用黑豆二合炒热,以酒
烹入,滚数沸,去豆取酒,服二碗即愈。
一、寒中太阴,则中脘疼痛,宜理中汤、温胃饮。寒中少阴,则脐腹疼痛,宜归气饮,
或五积散加吴茱萸。寒中厥阴,则少腹疼痛,宜四逆汤、归气饮、暖肝煎。其有寒中三阴而
寒滞不散,因致胀满痛甚者,宜暂用排气饮,或韩氏温中汤,先散其滞,然后调补之。或用
五味沉附汤,或暖肝煎,俱可择用。
一、生冷内伤,以致脏腑多寒,或为疼痛,或为呕吐,或为泄泻等证,治法随见各门。
又或素禀阳脏,每多恃强,好食生冷茶水,而变阳为阴者,治亦同前。
一、禀赋素弱,多有阳衰阴胜者,此先天之阳气不足也。或斫丧太过,以致命门火衰者
,此后天之阳气失守也。其证则未冷先寒,或手足清厥,或身为寒栗,或脾胃不健,或肚腹
不实,或小水频数,或阳道不壮,或每多恐畏,或眼耳少神,是皆阳虚生寒也,治宜温补元
气。其微者,宜五君子煎、理阴煎、六气煎、温胃饮、寿脾煎之类,择而用之。其甚者,宜
大补元煎、右归饮、右归丸、四味回阳饮、六味回阳饮、海藏八味地黄丸之类主之。其有脾
肾虚寒,每多腹痛飧泄。肾泄者,宜九气丹、一气丹,并于泄泻门求法治之。
凡是寒病,如果是由于外感引起的,可能是因为风寒损伤了形体,也可能是因为生冷食物损伤了内脏;如果是由于内伤引起的,可能是因为过度劳累和房事耗败了阳气,也可能是因为先天禀赋的气血虚弱。如果寒气从外部侵入,必定是由浅入深,多导致呕吐、恶心、腹胀、满闷,或者出现疼痛、泄泻;寒气从内部产生的,必定是由内脏波及体表,所以出现战栗、怕冷,或者出现四肢厥冷、拘挛抽搐。总之,热证多属实证,寒证多属虚证。所以凡是治疗寒证,应当同时观察其是否属于虚证,并且仔细辨别病变所在的脏腑,这是不可改变的治疗法则。
一、凡是阴毒寒邪直接中伤三阴经的,这就是伤寒类著作中所说的直中阴经的阴证。如果在突然之间受寒,导致身体颤抖战栗,或者四肢拘挛抽搐,或者心腹疼痛,或者牙关紧闭、失音,昏迷不醒、四肢厥逆,或者呕吐泄泻、蜷缩而卧,脉象微细,或者沉紧而没有神气,这些都是该证的临床表现。切不可胡乱使用祛风药,以免进一步发散正气,应当迅速采用温中散寒的方法,那么寒邪自然消散。病情轻的,用理中汤、温胃饮;病情重的,用四逆汤、大温中饮,或者附子理阴煎之类的方剂主治。如果有形势危急,嘴唇发青、睾丸收缩(囊缩)、没有脉搏的,适宜使用华陀救阳脱方紧急治疗。或者仍然艾灸气海、关元穴二三十壮,只要得到手足逐渐转温,脉搏微微显现的,才可以存活。另一偏方是用胡椒研碎,用滚烫的酒泡服,外用葱白和盐熨烫的方法。又一偏方是用黑豆二合炒热,用酒烹煮,煮沸几滚后,去掉豆渣取酒,服用两碗即可痊愈。
一、寒气侵犯太阴经,则中脘部位疼痛,适宜用理中汤、温胃饮。寒气侵犯少阴经,则脐腹部疼痛,适宜用归气饮,或者五积散加吴茱萸。寒气侵犯厥阴经,则少腹部疼痛,适宜用四逆汤、归气饮、暖肝煎。如果有寒气侵犯三阴经且寒邪凝滞不散,因此导致胀满疼痛严重的,适宜暂时使用排气饮,或者韩氏温中汤,先疏散其寒滞,然后再进行调补。或者使用五味沉附汤,或者暖肝煎,都可以选择使用。
一、因内生生冷食物损伤,导致脏腑多有寒邪,或者出现疼痛,或者出现呕吐,或者出现泄泻等证候,治疗方法参照各相关章节。又或者素来体质偏阳(阳脏),常常倚仗身体强壮,喜好食用生冷茶水和食物,从而由阳证转变为阴证的,治疗方法也同前所述。
一、先天禀赋素来虚弱的人,多有阳气衰微、阴气偏胜的情况,这是先天阳气不足。或者因纵欲过度,导致命门火衰的,这是后天阳气失守。其临床表现是:还没感到冷就先觉得寒冷,或者手脚清冷厥逆,或者身体寒冷战栗,或者脾胃功能不健运,或者肚腹不实(指腹部按之柔软无力或肠鸣),或者小便频数,或者性功能不强壮,或者经常恐惧畏怯,或者眼耳缺乏神采,这些都是阳虚生寒的表现,治疗适宜温补元气。病情轻微的,适宜用五君子煎、理阴煎、六气煎、温胃饮、寿脾煎之类的方剂,选择其中一种使用。病情严重的,适宜用大补元煎、右归饮、右归丸、四味回阳饮、六味回阳饮、海藏八味地黄丸之类的方剂主治。如果有脾肾虚寒,经常发生腹痛和完谷不化的泄泻。肾泄者,适宜用九气丹、一气丹,并在泄泻章节中寻求治疗方法。
In general, cold diseases caused by external factors may result from wind-cold damaging the body surface or from raw and cold foods damaging the internal organs; those caused by internal factors may result from excessive labor and sexual indulgence depleting Yang Qi, or from weak congenital constitution. When cold enters from the exterior, it inevitably progresses from superficial to deep levels, often leading to vomiting, nausea, abdominal distension, fullness, pain, or diarrhea. When cold originates internally, it spreads from the zang-fu organs to the exterior, resulting in shivering, aversion to cold, cold limbs (Jue Ni), or spasms and contractures. In summary, heat syndromes are mostly excess patterns, while cold syndromes are mostly deficiency patterns. Therefore, when treating cold syndromes, one must simultaneously assess for deficiency and carefully identify the affected Zang-Fu organs; this is an unchangeable principle.
1. When Yin-toxic cold pathogens directly strike the Three Yin meridians, this corresponds to the "Yin syndrome of direct strike into Yin meridians" described in Shanghan Lun (Treatise on Cold Damage) literature. Sudden exposure to cold can lead to bodily tremors and shivering, limb spasms, heart and abdominal pain, locked jaw with loss of voice, coma, cold limbs, vomiting and diarrhea with a curled posture, a faint and thin pulse, or a deep and tight pulse lacking spirit. These are all manifestations of this condition. One must absolutely avoid recklessly using wind-dispelling herbs, which would further scatter the healthy Qi. Instead, rapid warming of the Middle Jiao should be employed so that the cold pathogen dissipates spontaneously. For mild cases, Lizhong Tang (Regulate the Middle Decoction) or Wenwei Yin (Warm the Stomach Beverage) are indicated; for severe cases, Sini Tang (Frigid Extremities Decoction), Dawenzhong Yin (Greatly Warm the Middle Beverage), or Fuzi Liyin Jian (Aconite Nourish Yin Decoction) are used as main prescriptions. In critical situations where the lips are cyanotic, the scrotum is retracted, and there is no palpable pulse, Huatuo Jiuyang Tuo Fang (Hua Tuo’s Rescue Yang Collapse Formula) should be used urgently. Alternatively, moxibustion on Qihai (CV6) and Guanyuan (CV4) for 20-30 moxa cones may be applied; survival is possible if the hands and feet gradually warm up and the pulse becomes faintly perceptible. Another folk remedy involves crushing pepper, soaking it in boiling wine, and drinking it, combined with external application of hot compresses made of green onion and salt. Another remedy uses two he of black beans stir-fried until hot, cooked in wine, boiled briefly, then the beans removed, and two bowls of the wine consumed for recovery.
1. When cold invades the Taiyin channel, pain occurs at Zhongwan (CV12); Lizhong Tang or Wenwei Yin is appropriate. When cold invades the Shaoyin channel, pain occurs around the umbilicus and abdomen; Guiqi Yin or Wuji San (Five Accumulations Powder) added with Evodiae Fructus (Wuzhuyu) is appropriate. When cold invades the Jueyin channel, pain occurs in the lower abdomen; Sini Tang, Guiqi Yin, or Nuangan Jian (Warm Liver Decoction) is appropriate. If cold invades the Three Yin channels and cold stagnation fails to dissipate, leading to severe distension and pain, Paxi Yin (Discharge Gas Beverage) or Han Shi Wenzhong Tang (Master Han’s Warm Middle Decoction) should be temporarily used to first disperse the stagnation, followed by regulation and tonification. Alternatively, Wuwei Chenfu Tang or Nuogan Jian may be selected.
1. Internal injury from raw and cold foods leads to coldness in the Zang-Fu organs, manifesting as pain, vomiting, diarrhea, etc. Treatment methods refer to respective chapters. Furthermore, individuals with a constitutive Yang pattern who rely on their robustness and habitually consume raw/cold tea and food may transform their condition from Yang to Yin; the treatment is the same as described above.
1. Those with inherently weak constitutions often suffer from Yang deficiency and Yin excess, which is due to insufficient congenital Yang Qi. Excessive depletion through sexual indulgence may lead to decline of the Fire of the Gate of Life (Mingmen), representing a loss of acquired Yang Qi. Manifestations include feeling cold before actual temperature drops, cold and frigid extremities, bodily cold shivering, poor spleen and stomach function, empty/unfirm abdomen, frequent urination, impotence, frequent fearfulness, and lack of spirit in the eyes and ears. All these indicate cold generated by Yang deficiency, treated by warming and tonifying Yuan Qi (Original Qi). For mild cases, Wujunzi Jian, Liyin Jian, Liuqi Jian, Wenwei Yin, or Shoupi Jian are chosen. For severe cases, Dabu Yuan Jian, Yougui Yin, Yougui Wan, Siwei Huiyang Yin, Liuwei Huiyang Yin, or Haizang Bawei Dihuang Wan are used. Spleen and Kidney deficiency-cold often presents with abdominal pain and undigested stool diarrhea (Sun Xie). For Kidney diarrhea, Jiuqi Dan or Yiqi Dan are indicated, and treatment principles should be sought in the Diarrhea chapter.