经曰∶恶寒战栗，皆属于热。又曰∶禁栗如丧神守，皆属于火。恶寒者，虽当炎月，若遇风霜，重绵在身，自觉凛
凛。战栗、禁栗，动摇之貌。如丧神守，恶寒之甚。《原病式》曰∶病热甚而反觉自冷，此为病热，实非寒也。或曰∶往
往见有得热药而少愈者何也？予曰∶病热之人，其气炎上，郁为痰饮，抑遏清道，阴气不升，病热尤甚。积痰得热，亦
为暂退，热势助邪，其病益深。或曰∶寒热如此，谁敢以寒凉与之，非杀之而何？予曰∶古人遇战栗之证，有以大承气
下燥粪而愈者；恶寒战栗，明是热证，但有虚实之分耳。经曰∶阴虚则发热。夫阳在外，为阴之卫；阴在内，为阳之守。
精神外驰，嗜欲无节，阴气耗散，阳无所附，遂致浮散于肌表之间而恶热也。实非有热，当作阴虚治之，而用补养之法
可也。
或曰∶恶寒非寒，宜用寒药，恶热非热，宜用补药，甚骇耳目，明示我之法可乎？予曰∶进士周本道，年逾三十，
得恶寒病，服附子数日而病甚，求予治。诊其脉弦而似缓，予以江茶入姜汁、香油些少，吐痰一升许，减绵大半，周甚
喜。予曰∶未也，燥热已多，血伤亦深，须淡食以养胃，内观以养神，则水可生而火可降。彼勇于仕进，一切务外，不
守禁忌。予曰∶若多与补血，凉热亦可稍安。内外不静，肾水不生，附毒必发。病安后，官于婺城，巡夜冒寒，非附子
不可疗，而性怕生姜，只得以猪腰子作片，煮附子，与三帖而安。予曰∶可急归。知其附毒易发。彼以为迂。半年后，
果发背而死。
又司丞叔，平生脚自踝以下常觉热，冬不可加绵于上，常自言曰∶我禀质壮，不怕冷。予曰∶此足三阴之虚，宜早
断欲事，以补养阴血，庶乎可免。笑而不答，年方五十，患痿半年而死。
观此二人治法，盖可知矣。或曰∶伤寒病恶寒、恶热者，亦是虚耶？予曰∶若病伤寒者，自外入内，先贤论之详矣。
《黄帝内经》说：恶寒战栗，都归属于热证。又说：寒战发抖如同失守神志，都归属于火邪。所谓恶寒，即使是在炎热的月份，如果遇到风霜侵袭，身穿厚棉衣，仍自觉寒冷刺骨。战栗、寒战，是身体动摇的样子。“如丧神守”，形容恶寒极其严重。刘完素在《原病式》中说：病情极热反而觉得自身发冷，这是病热，实际上并非寒证。有人问：常常见到服用温热药物后病情稍有好转，这是什么原因呢？我说：患热病的人，其气炎上，郁结成为痰饮，阻滞清阳上升的道路，导致阴气不能升发，使得热病更加严重。积存的痰饮遇到热药，也会暂时消退，但热势助长邪气，使病情更加深入。有人问：寒热表现如此复杂，谁敢用寒凉药物治疗呢？这岂不是害死病人吗？我说：古人遇到战栗的证候，有用大承气汤攻下燥屎而痊愈的案例；恶寒战栗，明明是热证，只是有虚实的区别罢了。《内经》说：阴虚则发热。阳气在外，作为阴气的卫护；阴气在内，作为阳气的守持。精神向外驰散，嗜欲没有节制，导致阴气耗散，阳气无所依附，于是浮散于肌表之间而感到恶热。这实际上并不是真的有热，应当当作阴虚来治疗，采用补养的方法即可。
有人问：恶寒并非寒证，适宜用寒药；恶热并非热证，适宜用补药，这非常令人惊骇，能否明示其中的道理？我说：进士周本道，年龄超过三十岁，患上恶寒病，服用附子几天后病情加重，来找我治疗。诊察他的脉象弦而似缓，我用江茶加入姜汁和少许香油，让他吐出约一升痰液，厚棉衣的需求减少了一半以上，周某非常高兴。我说：还没好，燥热已经很多，阴血损伤也很深，必须清淡饮食以养胃气，内省静修以养心神，这样肾水才能滋生而心火得以下降。他热衷于仕途进取，一切追求外在名利，不遵守禁忌。我说：如果多给予补血药物，寒热症状或许可以稍微安定。如果内外不得宁静，肾水无法滋生，附子的毒性必然发作。病愈后，他在婺城做官，巡夜时冒受寒气，非用附子不可治疗，但他本性害怕生姜，只好将猪腰子切成片，煮附子，服用了三帖后病情安定。我说：应该赶快回家。我知道他体内的附子毒性容易发作。他认为我迂腐。半年后，果然因发背疽而死。
还有司丞叔，平生双脚从脚踝以下常觉得发热，冬天不能在脚上加棉袜，常自己说：“我禀赋体质强壮，不怕冷。”我说：这是足三阴经的虚损，应当尽早断绝房事，以补养阴血，或许可以避免祸患。他笑着不回答，年仅五十岁，患痿痹症半年后死亡。
观察这两个人的治疗方法，大概就可以明白了。有人问：伤寒病患者出现的恶寒、恶热，也是虚证吗？我说：如果是患伤寒病，病邪自外入内，先贤们已经论述得很详细了。
The *Classic* states: Aversion to cold and shivering all belong to heat. It also states: Shivering as if losing the control of the spirit all belongs to fire. "Aversion to cold" refers to feeling chilly even in hot months when exposed to wind and frost, wearing heavy cotton clothes, yet still feeling piercingly cold. Shivering and trembling are manifestations of bodily movement. "As if losing the control of the spirit" describes severe aversion to cold. Liu Wansu in *Yuan Bing Shi* (Original Treatise on Disease Mechanisms) states: When a disease is extremely hot but the patient feels cold internally, this is a heat disease, not actually a cold condition. One might ask: Often, patients taking warm-hot medicines show slight improvement; why is this? I say: In patients with heat diseases, their Qi flares upward, stagnating into phlegm-fluids, obstructing the clear pathways, preventing Yin Qi from ascending, thereby exacerbating the heat disease. Accumulated phlegm may temporarily recede upon contact with heat medicine, but the heat trend aids the pathogen, making the disease deeper. One might ask: Given such complexity in cold and heat signs, who dares to use cold-cool medicines? Would that not be killing them? I say: In ancient times, for cases of shivering, there were cures using Da Cheng Qi Tang (Major Order the Qi Decoction) to purge dry feces; aversion to cold and shivering are clearly heat syndromes, differing only in deficiency or excess. The *Classic* states: Yin deficiency leads to fever. Yang resides outside, guarding Yin; Yin resides inside, anchoring Yang. If spirit wanders outward and desires are unregulated, Yin Qi dissipates, leaving Yang without attachment, thus floating and scattering between the muscle and surface, causing aversion to heat. This is not truly heat; it should be treated as Yin deficiency using nourishing methods.
One might ask: Aversion to cold is not cold, so cold medicines are suitable; aversion to heat is not heat, so tonifying medicines are suitable. This is startling. Can you clarify the method? I say: Jinshi Zhou Bendao, over thirty years old, suffered from aversion to cold. After taking Fuzi (Prepared Aconite Root) for several days, his condition worsened, and he sought my treatment. His pulse was wiry yet seemingly moderate. I administered Jiang Cha (Jiang Tea) mixed with Ginger Juice (Shengjiang Zhi) and a little Sesame Oil (Xiangyou), causing him to vomit about one liter of phlegm. His need for heavy cotton clothing decreased by more than half, and he was very pleased. I said: Not yet cured. There is much dry-heat, and blood injury is deep. He must eat bland food to nourish Stomach Qi and practice introspection to nourish Spirit, so that Kidney Water can generate and Heart Fire can descend. He was eager for official advancement, pursuing external matters exclusively, ignoring taboos. I said: If given more blood-nourishing herbs, the cold-heat imbalance might stabilize slightly. Without inner and outer tranquility, Kidney Water will not generate, and the toxicity of Fuzi will inevitably manifest. After recovery, he served as an official in Wucheng. While patrolling at night, he caught cold; only Fuzi could treat it, but he feared Ginger. Thus, he sliced Pork Kidney (Zhuyaozi), boiled it with Fuzi, took three doses, and stabilized. I said: Return home immediately. I knew his Fuzi toxicity would likely flare. He thought me pedantic. Half a year later, he died from a carbuncle on the back.
Another case is Sicheng Shu, whose feet below the ankles always felt hot since birth; he could not wear socks in winter, often saying, "My constitution is strong; I fear no cold." I said: This is deficiency of the Three Yin Meridians of the Foot. He should abstain from sexual activity early on to tonify and nourish Yin Blood, perhaps avoiding disaster. He laughed and did not answer. At fifty, he died after six months suffering from Wei Syndrome (Flaccidity Syndrome).
Observing these two treatments, the principles become clear. One might ask: Are the aversion to cold and heat seen in Shanghan (Cold Damage) diseases also due to deficiency? I say: For Shanghan diseases, where pathogens enter from outside to inside, the sages have discussed this in detail.