伤寒邪从毛窍而入。自下而上。始于足太阳。温病邪从经络及口鼻而入。自上而下。始于手太阴。寒为阴邪。阴盛
必伤阳。故首郁遏太阳经中之阳气。而为头痛身热项强脊痛等证。以阴盛伤人之阳也。温为阳邪。阳盛必伤阴。故首郁
遏太阴经中之阴。气而为咳嗽自汗口渴头痛身热等证。以阳盛伤人之阴也。知此阴阳两大法门。则伤寒温病之辨自 然
于心目矣。
伤寒初病。身虽发热。一二日内必不烦渴。左手之脉必紧盛倍于右手。温病身一热即口燥咽干而渴。右手之脉洪大
倍于左手。
冬温初起头痛恶风寒身热自汗。与伤寒证太阳中风无异。此处最易相混。但伤寒中风脉浮缓。中寒脉浮紧此则不缓
不紧而动数。且有口渴及午后热甚等证。与伤寒判然不同。至春夏时天气渐暖。则只有温病。绝无伤寒。更不难知矣。
伤寒病六经递传。或汗或下。邪退即愈。温病则传变不常。不能一发便尽。有得汗热退。二三日复热如前者。有得
下里和。二三日复见表热者。有表和复见里证者。总由邪气未尽之故。宜随其见证。细心体认。根据法疗治。方不致误。
不可一见变证。遽尔张皇。胡疑乱猜。以致误人性命也。
（温热冬温温毒温疫同法）
风温初起。头痛身热自汗。不恶寒而渴。或不渴而咳。午后热甚。脉动数。右大于左。或两寸独大者。邪在上焦手
太阴肺经气分也。辛凉平剂银翘散主之。
银翘散
连翘（三钱） 银花（三钱） 苦桔梗（二钱） 薄荷（二钱） 竹叶（一钱） 甘草（一钱五分） 芥穗（一钱）
淡豆豉（一钱五分） 牛蒡子（二钱） 鲜苇根（二钱）
水煎。俟香气大出即取服。勿过煮。病重者。日再服。咳者加杏仁。胸膈闷加藿香郁金。口渴甚者加天花粉。项肿
咽痛加马勃元参衄血去芥穗豆豉加白茅根侧柏炭栀子炭病二三日后。热渐入里。酌加细生地麦冬以保津。如仍不解。或
小便短。再加知母黄芩栀子合麦地以清热。温病初起恶风寒无汗。头痛身热。或渴或咳者。温自内发。风寒外搏也。加
减杏苏散微解之。服后恶寒已退。余证未除者。仍用银翘散。（按风温证。本以辛凉为正治。忌辛温发表。此因风寒外
搏。
内热外寒。故用微温之杏苏等暂解其表。服后恶寒既退。即宜仍用辛凉不可过散伤阴亦万不可因其恶寒无汗。竟用麻桂
羌独升柴等辛温升散之峻剂也。）加减杏苏散（尤拙吾王孟英皆极言温病初起。虽恶风寒。不可用桂枝汤。故易以此方。）
杏仁（二钱） 苏叶（一钱五分） 前胡（一钱五分） 淡豆豉（三钱） 牛蒡子（二钱） 苦桔梗（二钱） 甘
草（一钱）
水煎服。
银翘散（见前）
温病初起。身不甚热。咳而微渴者。热伤肺络也。辛凉轻剂桑菊饮主之。
桑菊饮
杏仁（二钱） 连翘（一钱五分） 薄荷（八分） 桑叶（二钱五分） 菊花（一钱） 苦桔梗（二
钱） 甘草（八分） 苇根（二钱）
水二杯。煎一杯。日二服。二三日不解。气粗似喘。燥在气分者。加石膏知母。舌绛暮热甚。燥邪初入营。加元参
（二钱） 犀角（一钱） 在血分者。去薄荷苇根。加麦冬细生地玉竹丹皮（各二钱）
肺热甚加黄芩 渴者加花粉
太阴温病。脉浮洪舌黄大渴大汗。面赤恶热者。邪热已深。逼烁津液。邪欲出而未遂也。辛凉重剂白虎汤主之。（白
虎乃剽悍之剂。若其人脉浮而细。或脉沉。或不渴。或无汗。均不可用。倘误用之。祸不旋踵。慎之毋忽。）
白虎汤
生石膏（三钱） 知母（二钱） 甘草（一钱） 白粳米（一撮）
水煎温服。脉浮大而芤。汗大出微喘。甚至鼻孔扇者。加人参（一钱）脉若散大者倍用人参。太阴温病。脉数右大
烦渴舌绛者。气血两燔也。加减玉女煎主之。
生石膏（五钱） 知母（二钱） 元参（二钱） 细生地（三钱） 麦冬（三钱）
水煎服。太阴温病。血从上溢者。温邪逼迫血液上走清道也。犀角地黄汤合银翘散主之。（若见中焦证以中焦法治
之）
若吐粉红血水者死不治。血从上溢脉七八至以上面反黑者死不治。可用清络育阴法。以挽救之。
犀角地黄汤
干地黄（五钱） 生白芍（一钱五分） 丹皮（一钱五分） 犀角（一钱五分）
银翘散（见前）
以上二方。合为一剂煎服。若已用过表药者。去豆豉芥穗薄荷。
太阴温病。口渴甚者悉尼浆沃之。吐粘滞白沫者五汁饮沃之。
悉尼浆
大甜梨（一个） 切薄片。新汲水内浸半日。频饮之。
五汁饮
梨汁 荸荠汁 鲜苇根汁 麦冬汁 藕汁（或用蔗浆）
临时斟酌多少。和匀凉服。不喜凉者。重汤炖温服。
温病二三日。舌微黄。寸脉盛。心烦懊 。起卧不安。欲呕不得。无中焦证者。邪在膈中也。以栀子豉汤涌吐之。
如兼胸痞痰多者。膈中结为热痰也。瓜蒂散主之。
栀子豉汤
栀子（二钱捣碎） 香豆豉（三钱）
水三杯。先煎栀子数沸。后入香豉。煎取一杯服。
瓜蒂散
甜瓜蒂（一钱） 赤小豆（二钱研） 山栀子（二钱）
水二杯。煎一杯。先服半杯得吐则止。虚者加人参芦（一钱五分）
太阴温病。两寸脉大。舌绛而干。口不渴者。热在营中也。减味清营汤主之。
减味清营汤
犀角（一钱五分） 生地（二钱五分） 元参（一钱五分） 竹叶心（五分） 麦冬（一钱五分）
丹参（一钱） 银花（一钱五分） 连翘（一钱。连心用） 水煎服。
温病发斑（如云片无颗粒为斑）者。邪郁肌表也。化斑汤主之。发疹（有颗粒为疹）者。邪郁血络也。葛根解肌汤
主之。神昏谵语者。心阳伤而神明乱也。清宫汤主之。安宫牛黄丸紫雪丹局方至宝丹亦主之（牛黄丸最凉紫雪次之。至
宝又次之。临时酌用可耳。）
化斑汤
石膏（三钱） 知母（一钱五分） 生甘草（一钱） 元参（一钱） 犀角（七分） 白粳米（半合）
水煎服。
葛根解肌汤（吴鞠通用加减银翘散治疹。药味过凉。往往不能透发。不如此方稳妥。至升柴等品。升散太过。
实非温疹所宜也。）
葛根（一钱五分） 前胡（一钱五分） 荆芥（一钱五分） 牛蒡子（二钱） 连翘（一钱） 赤芍（二钱） 木
通（七分） 蝉蜕（二钱） 甘草（一钱） 竹叶（一钱） 苦桔梗（一钱） 鲜苇根（三钱） 水煎服。
清宫汤
元参心（三钱） 莲子心（五分） 竹叶卷心（二钱） 连翘心（二钱） 犀角尖（二钱磨冲） 连
心麦冬（三钱）
热痰盛加竹沥梨汁（各五匙） 咯痰不清加栝蒌皮（一钱五分） 热毒盛加金汁人中黄。渐欲神昏加银花（三钱）
荷叶（二钱） 石菖蒲（一钱）
安宫牛黄丸（如僻地无制成丸药或现配。或研末冲服皆可。）
牛黄（一两） 郁金（一两） 犀角（一两） 黄连（一两） 朱砂（一两） 梅片（二钱五分） 麝香（二钱五
分） 珍珠（五钱） 山栀（一两） 雄黄（一两） 黄芩（一两） 金箔衣
上为极细末炼老蜜为丸每丸一钱金箔为衣蜡护。脉虚者人参汤下 脉实者银花薄荷汤下。每服一丸。大人病重体实
者。日再服。甚至日三服。小儿服半丸。不知。再服半丸。
紫雪丹（从本事方去黄金）
滑石（一斤） 石膏（一斤） 寒水石（一斤） 磁石（二斤） 共捣煎去渣入后药。
羚羊角（五两） 木香（五两） 犀角（五两） 沉香（五两） 丁香（一两） 升麻（一斤） 元参（一两） 炙
甘草（半斤）
以上八味。并捣锉。入前药汁中煎。去渣。入后药。
朴硝 硝石 各二斤提净。入前药汁中微火煎。不住手将柳木搅。候汁欲凝。再加入后二味。
辰砂（三两研细） 麝香（一两二钱，研细入前药拌匀）
合成退火气。冷水调服一二钱。
局方至宝丹
犀角（一两镑） 朱砂（一两飞） 琥珀（一两研） 玳 （一两镑） 牛黄（五钱） 麝香（五钱）
以安息重汤炖化和诸药为丸一百丸。蜡护。
温病舌蹇肢厥者。热邪已入心包也。牛黄丸主之。紫雪丹亦主之。
牛黄丸
紫雪丹（见前）
温毒咽痛喉肿。耳前后连颊肿。或外肿而喉不痛。甚则耳聋。俗名大头温。又名虾蟆温者。加减普济消毒饮主之。
外敷水仙膏。（如神昏谵语者。先与紫雪丹牛黄丸之属。再服清宫汤。）
加减普济消毒饮
连翘（三钱） 薄荷（一钱） 马勃（一钱五分） 牛蒡子（二钱） 芥穗（一钱） 僵蚕
（二钱） 元参（三钱） 银花（三钱） 板蓝根（一钱五分） 苦桔梗（三钱） 甘草（一钱五分） 鲜苇根（二钱）
水煎服。三四日后酌加黄芩黄连。
水仙膏
水仙花根（不拘多少） 剥去老赤皮与根须。入石臼捣如膏。敷肿处。中留一孔出热气。干则另敷以
肉上生黍米大小黄疮为度。
温毒敷水仙膏。皮间生小黄疮后。不可再敷水仙膏。宜用三黄二香散。
三黄二香散
黄连（一两） 黄柏（一两） 生大黄（一两） 乳香（五钱） 没药（五钱）
共为极细末。初用细茶汁调敷。干则易之。继用香油调敷。
伤寒的邪气从皮毛孔窍侵入，病势由下向上发展，起始于足太阳膀胱经。温病的邪气从经络及口鼻侵入，病势由上向下发展，起始于手太阴肺经。寒属于阴邪，阴气过盛必然损伤人体的阳气，所以首先郁遏阻滞足太阳经中的阳气，从而出现头痛、身体发热、项部僵硬、脊背疼痛等症状，这是阴盛损伤人体阳气的缘故。温属于阳邪，阳气过盛必然损伤人体的阴液，所以首先郁遏阻滞手太阴经中的阴气，从而出现咳嗽、自汗、口渴、头痛、身体发热等症状，这是阳盛损伤人体阴液的缘故。明白了这两大阴阳辨别的法门，那么伤寒与温病的区别自然就在心中明确了。
伤寒初起时，虽然身体发热，但一两天内必定不会出现心烦和口渴的症状，左手脉象必定比右手紧盛一倍。温病一旦发热，就会立刻出现口燥、咽干且口渴的症状，右手脉象洪大，比左手大一倍。
冬温初起时，出现头痛、恶风寒、身体发热、自汗等症状，与伤寒证中的太阳中风证没有区别，此处最容易混淆。但是，伤寒中风的脉象浮而缓，伤寒中寒的脉象浮而紧，而冬温的脉象不缓不紧而是动数（急促），并且伴有口渴以及午后热势加重等症状，这与伤寒截然不同。到了春夏季节，天气逐渐变暖，此时只有温病，绝无伤寒，就更不难分辨了。
伤寒病按照六经顺序依次传变，或者用发汗法，或者用攻下法，邪气退去即痊愈。温病则传变无常，不能一发汗或一下利就彻底治愈。有的患者得汗后热退，但两三天后又像以前一样发热；有的患者得下利后里气调和，但两三天后又出现表热症状；有的患者表证解除后又出现里证。这都是因为邪气未尽的缘故。应当根据见证，细心体察认识，依法治疗，才不会误治。不可一见变证，就惊慌失措，胡乱猜疑，以致误人性命。
风温初起时，出现头痛、身体发热、自汗，不恶寒而口渴，或者不渴但咳嗽，午后热势加重，脉象动数，右脉大于左脉，或者两手寸脉特别大的，是邪气在上焦手太阴肺经的气分。主治方剂为辛凉平剂银翘散。
银翘散
连翘（三钱） 金银花（三钱） 苦桔梗（二钱） 薄荷（二钱） 竹叶（一钱） 甘草（一钱五分） 荆芥穗（一钱） 淡豆豉（一钱五分） 牛蒡子（二钱） 鲜苇根（二钱）
用水煎煮，等到香气大出时就取药服用，不要过度煎煮。病情重的，一天服两次。咳嗽的加杏仁；胸膈闷的加藿香、郁金；口渴严重的加天花粉；项肿咽痛的加马勃、玄参；鼻出血的去掉荆芥穗、淡豆豉，加白茅根、侧柏炭、栀子炭。病在两三天后，热势逐渐入里，酌情加入细生地、麦冬以保护津液。如果仍然不解，或者小便短少，再加知母、黄芩、栀子配合麦冬、生地以清热。温病初起若恶风寒无汗，头痛身热，或者口渴或者咳嗽的，这是温邪从内发出，风寒从外搏击所致。用加减杏苏散轻微解表。服药后恶寒已退，其余症状未除的，仍用银翘散。（按：风温证，本应以辛凉为正治法，忌用辛温发表。这是因为风寒外搏，内热外寒，所以用微温的杏苏散等暂时解其表。服药后恶寒既退，就应立即改用辛凉，不可过散伤阴，也万不可因其恶寒无汗，竟用麻黄、桂枝、羌活、独活、升麻、柴胡等辛温升散的峻猛药剂。）加减杏苏散（尤在泾、王孟英都极力强调温病初起，虽有恶风寒，不可用桂枝汤，所以用此方替代。）
杏仁（二钱） 紫苏叶（一钱五分） 前胡（一钱五分） 淡豆豉（三钱） 牛蒡子（二钱） 苦桔梗（二钱） 甘草（一钱）
用水煎服。
银翘散（见前文）
温病初起，身体发热不明显，咳嗽且轻微口渴的，是热邪损伤肺络。主治方剂为辛凉轻剂桑菊饮。
桑菊饮
杏仁（二钱） 连翘（一钱五分） 薄荷（八分） 桑叶（二钱五分） 菊花（一钱） 苦桔梗（二钱） 甘草（八分） 苇根（二钱）
水两杯，煎成一杯，一天服两次。两三天后仍不解，呼吸粗重似喘，燥邪在气分的，加石膏、知母。舌质深红，傍晚热势重，燥邪初入营分的，加玄参（二钱）、犀角（一钱）。在血分的，去掉薄荷、苇根，加麦冬、细生地、玉竹、丹皮（各二钱）。肺热甚的加黄芩；口渴的加花粉。
太阴温病，脉象浮洪，舌苔黄，大渴，大汗，面赤，恶热的，是邪热已经深入，逼迫灼烧津液，邪气欲出而未遂。主治方剂为辛凉重剂白虎汤。（白虎汤是剽悍猛烈的药剂，如果病人脉象浮而细，或者脉沉，或者不渴，或者无汗，都不可使用。倘若误用，灾祸立至，务必谨慎，不可疏忽。）
白虎汤
生石膏（三钱） 知母（二钱） 甘草（一钱） 白粳米（一撮）
用水煎煮，温服。脉象浮大而芤，大汗出，微喘，甚至鼻孔扇动的，加人参（一钱）。脉象若散大的，加倍用人参。太阴温病，脉数，右脉大，心烦口渴，舌绛的，是气血两燔。主治方剂为加减玉女煎。
生石膏（五钱） 知母（二钱） 玄参（二钱） 细生地（三钱） 麦冬（三钱）
用水煎服。太阴温病，血液从上溢出的，是温邪逼迫血液上行走清道。主治方剂为犀角地黄汤合银翘散。（如果见到中焦证，按中焦法治之）
如果吐出粉红血水的，死症不治。血液从上溢出，脉象七八至以上，面色反而发黑的，死症不治。可用清络育阴法来挽救。
犀角地黄汤
干地黄（五钱） 生白芍（一钱五分） 丹皮（一钱五分） 犀角（一钱五分）
银翘散（见前文）
以上两个方子，合为一剂煎服。如果已经用过解表药的，去掉淡豆豉、荆芥穗、薄荷。
太阴温病，口渴严重的，用悉尼浆滋润它；呕吐粘滞白沫的，用五汁饮滋润它。
悉尼浆
大甜梨（一个） 切成薄片，在新汲水中浸泡半天，频繁饮用。
五汁饮
梨汁 荸荠汁 鲜苇根汁 麦冬汁 藕汁（或用蔗浆）
临时斟酌多少，混合均匀凉服。不喜欢凉的，隔水炖温服。
温病两三天，舌苔微黄，寸脉盛，心烦懊恼，坐卧不安，想吐却吐不出来，没有中焦证的，是邪气在膈中。用栀子豉汤涌吐。
如果兼有胸痞痰多的，是膈中结聚为热痰。主治方剂为瓜蒂散。
栀子豉汤
栀子（二钱捣碎） 香豆豉（三钱）
水三杯，先煎栀子几沸，后放入香豉，煎取一杯服用。
瓜蒂散
甜瓜蒂（一钱） 赤小豆（二钱研碎） 山栀子（二钱）
水二杯，煎取一杯，先服半杯，得吐则停止。体虚的加人参芦（一钱五分）。
太阴温病，两手寸脉大，舌绛而干，口不渴的，是热在营分中。主治方剂为减味清营汤。
减味清营汤
犀角（一钱五分） 生地（二钱五分） 玄参（一钱五分） 竹叶心（五分） 麦冬（一钱五分） 丹参（一钱） 银花（一钱五分） 连翘（一钱，连心用）
用水煎服。
温病发斑（如云片状无颗粒称为斑）的，是邪气郁滞在肌表。主治方剂为化斑汤。发疹（有颗粒称为疹）的，是邪气郁滞在血络。主治方剂为葛根解肌汤。神昏谵语的，是心阳受伤而神明混乱。主治方剂为清宫汤。安宫牛黄丸、紫雪丹、局方至宝丹也可主治。（牛黄丸最凉，紫雪丹次之，至宝丹又次之，临时酌情选用即可。）
化斑汤
石膏（三钱） 知母（一钱五分） 生甘草（一钱） 玄参（一钱） 犀角（七分） 白粳米（半合）
用水煎服。
葛根解肌汤（吴鞠通用加减银翘散治疹，药味过凉，往往不能透发，不如此方稳妥。至于升麻、柴胡等品，升散太过，实在不适合温疹。）
葛根（一钱五分） 前胡（一钱五分） 荆芥（一钱五分） 牛蒡子（二钱） 连翘（一钱） 赤芍（二钱） 木通（七分） 蝉蜕（二钱） 甘草（一钱） 竹叶（一钱） 苦桔梗（一钱） 鲜苇根（三钱）
用水煎服。
清宫汤
玄参心（三钱） 莲子心（五分） 竹叶卷心（二钱） 连翘心（二钱） 犀角尖（二钱磨冲） 连心麦冬（三钱）
热痰盛的加竹沥、梨汁（各五匙）；咯痰不清的加栝蒌皮（一钱五分）；热毒盛的加金汁、人中黄；渐欲神昏的加银花（三钱）、荷叶（二钱）、石菖蒲（一钱）。
安宫牛黄丸（如果在偏僻地方没有制成丸药，或现配，或研末冲服都可以。）
牛黄（一两） 郁金（一两） 犀角（一两） 黄连（一两） 朱砂（一两） 梅片（冰片）（二钱五分） 麝香（二钱五分） 珍珠（五钱） 山栀（一两） 雄黄（一两） 黄芩（一两） 金箔衣
以上药物研成极细末，用老蜜炼制成丸，每丸一钱，金箔为衣，蜡封护。脉虚的用参汤送下，脉实的用银花薄荷汤送下。每次服一丸。成人病重体实的，一天服两次，甚至一天三次。小儿服半丸，不知情的，再服半丸。
紫雪丹（从《本事方》中去掉黄金）
滑石（一斤） 石膏（一斤） 寒水石（一斤） 磁石（二斤） 共同捣碎煎煮，去渣，加入后面的药。
羚羊角（五两） 木香（五两） 犀角（五两） 沉香（五两） 丁香（一两） 升麻（一斤） 玄参（一两） 炙甘草（半斤）
以上八味，一起捣碎锉细，放入前面的药汁中煎煮，去渣，加入后面的药。
朴硝 硝石 各二斤提净，放入前面的药汁中用微火煎煮，不停地用柳木搅拌，等到药汁快要凝固时，再加入后面两味药。
辰砂（三两研细） 麝香（一两二钱，研细融入前药拌匀）
合成后退去火气，用冷水调服一二钱。
局方至宝丹
犀角（一两镑片） 朱砂（一两飞制） 琥珀（一两研碎） 玳瑁（一两镑片） 牛黄（五钱） 麝香（五钱）
以安息香隔水炖化，调和诸药制成一百丸，蜡封护。
温病出现舌强语蹇、四肢厥冷的，是热邪已经进入心包。主治方剂为牛黄丸。紫雪丹也可主治。
牛黄丸
紫雪丹（见前文）
温毒导致咽喉疼痛、喉部肿胀，耳前后连颊部肿胀，或者外部肿胀而喉咙不痛，甚至耳聋，俗名大头温，又名虾蟆温的，主治方剂为加减普济消毒饮。
外用敷水仙膏。（如果出现神昏谵语的，先给予紫雪丹、牛黄丸之类的药，再服用清宫汤。）
加减普济消毒饮
连翘（三钱） 薄荷（一钱） 马勃（一钱五分） 牛蒡子（二钱） 荆芥穗（一钱） 僵蚕（二钱） 玄参（三钱） 银花（三钱） 板蓝根（一钱五分） 苦桔梗（三钱） 甘草（一钱五分） 鲜苇根（二钱）
用水煎服。三四日后酌情加入黄芩、黄连。
水仙膏
水仙花根（不拘多少） 剥去老赤皮与根须，放入石臼中捣成膏状，敷在肿胀处，中间留一个孔排出热气。干了就重新敷，直到肉上生出黍米大小的黄疮为止。
温毒敷水仙膏，皮肤间生出小黄疮后，不可再敷水仙膏，宜用三黄二香散。
三黄二香散
黄连（一两） 黄柏（一两） 生大黄（一两） 乳香（五钱） 没药（五钱）
共同研成极细末。初用时用细茶汁调敷，干了就更换。继后用香油调敷。
The pathogenic factor of Cold Damage (Shanghan) enters through the hair pores and skin, moving from below upward, starting in the Foot-Taiyang Bladder Channel. The pathogenic factor of Warm Disease (Wenbing) enters through the meridians and the mouth and nose, moving from above downward, starting in the Hand-Taiyin Lung Channel. Cold is a Yin pathogenic factor; excessive Yin inevitably damages Yang. Therefore, it first stagnates and obstructs the Yang Qi within the Taiyang channel, leading to symptoms such as headache, fever, stiffness of the neck, and pain in the spine, due to Yin excess damaging the body's Yang. Warmth is a Yang pathogenic factor; excessive Yang inevitably damages Yin. Therefore, it first stagnates and obstructs the Yin Qi within the Taiyin channel, leading to symptoms such as cough, spontaneous sweating, thirst, headache, and fever, due to Yang excess damaging the body's Yin. Understanding these two major principles of Yin and Yang differentiation allows one to naturally distinguish between Cold Damage and Warm Disease in mind and vision.
In the initial stage of Cold Damage, although there is fever, there will be no irritability or thirst within one or two days. The pulse at the left hand will be tight and vigorous, twice that of the right hand. In Warm Disease, as soon as fever occurs, there is dryness of the mouth, dry throat, and thirst. The pulse at the right hand is surging and large, twice that of the left hand.
At the onset of Winter-Warmth (Dongwen), symptoms include headache, aversion to wind and cold, fever, and spontaneous sweating, which are indistinguishable from the Sun-Taiyang Wind-Strike syndrome in Cold Damage, making confusion easy here. However, the pulse in Cold Damage Wind-Strike is floating and slow, while in Cold Damage Cold-Strike it is floating and tight. In contrast, the pulse in Dongwen is neither slow nor tight but rapid and frequent (dong shu), accompanied by thirst and worsening heat in the afternoon, clearly differentiating it from Cold Damage. When spring and summer arrive and the weather gradually warms, only Warm Diseases occur, and Cold Damage is absolutely absent, making differentiation even easier.
Cold Damage disease transmits sequentially through the Six Channels (Liu Jing). Treatment involves either sweating or purging; once the pathogen recedes, recovery ensues. Warm Disease transmission is irregular and cannot be resolved with a single emission of sweat or purge. Some patients have fever recede after sweating, only to relapse with similar fever after two or three days. Some have interior harmony after purging, only to show exterior heat again after two or three days. Some have exterior resolution followed by interior symptoms. This is all due to incomplete elimination of the pathogen. One must carefully observe and recognize the manifestations and treat according to the method to avoid error. Do not panic or guess wildly upon seeing changed symptoms, lest you cause death.
(The methods for Warm Heat, Winter-Warmth, Warm Toxin, and Warm Epidemic are the same.)
At the onset of Wind-Warmth (Fengwen), symptoms include headache, fever, spontaneous sweating, no aversion to cold but thirst, or no thirst but cough, worsening heat in the afternoon, rapid and frequent pulse, right pulse larger than left, or both Cun positions particularly large. This indicates the pathogen is in the Qi level of the Hand-Taiyin Lung Channel in the Upper Jiao. The primary formula is Yin Qiao San (Honeysuckle and Forsythia Powder), a Neutral Cool Agent.
Yin Qiao San
Forsythiae Fructum (3 qian) Lonicerae Japonicae Flos (3 qian) Platycodonis Radix (2 qian) Menthae Haplocalycis Herba (2 qian) Bambusae Folium (1 qian) Glycyrrhizae Radix et Rhizoma (1.5 qian) Schizonepetae Spica (1 qian) Fermented Soybean (1.5 qian) Armeniacae Semen Amarum (2 qian) Fresh Imperatae Rhizoma (2 qian)
Decoct in water. Take when the aroma is strong; do not overcook. For severe cases, take twice daily. Add Armeniacae Semen Amarum for cough; add Costi Rhizome and Curcuma Aromatica Rhizome for chest oppression; add Trichosanthis Radix for severe thirst; add Ma Bo (Marsdeniae Cauliflora Flower) and Scrophulariae Radix for swollen neck and sore throat; for epistaxis, remove Schizonepetae Spica and Fermented Soybean, add Imperatae Rhizoma, Platycladi Cacumen Carbonized, and Gardeniae Fructus Carbonized. After two or three days, if heat gradually moves inward,酌情 add Rehmanniae Radix Preparata and Ophiopogonis Radix to preserve fluids. If unresolved, or with scanty urine, add Anemarrhenae Rhizoma, Scutellariae Radix, and Gardeniae Fructus combined with Ophiopogonis Radix and Rehmanniae Radix Preparata to clear heat. If Warm Disease initially presents with aversion to wind/cold, no sweat, headache, fever, thirst, or cough, this is Warmth originating internally combated by Cold/Wind externally. Use Modified Xing Su San (Apricot Kernel and Perilla Leaf Decoction) for mild exterior release. After taking, if aversion to cold subsides but other symptoms remain, continue with Yin Qiao San. (Note: For Wind-Warmth, the correct treatment is Neutral Cool agents; Pungent-Warm exterior-releasing agents are contraindicated. Here, because Cold/Wind combats externally and internal heat exists with external cold, mild-warm agents like Xing Su San are used temporarily. Once aversion to cold subsides, switch back to Neutral Cool agents. Do not over-disperse to damage Yin. Never use pungent-warm ascending and dispersing harsh agents like Ephedrae Herba, Cinnamomi Ramulus, Notopterygii Rhizoma, Saussureae Radix, Bupleuri Radix, or Cimicifugae Rhizoma just because of aversion to cold and no sweat.) Modified Xing Su San (You Zhuowu and Wang Mengying emphasized that even with aversion to wind/cold at the onset of Warm Disease, Gui Zhi Tang should not be used; hence this formula is substituted.)
Armeniacae Semen Amarum (2 qian) Perillae Folium (1.5 qian) Peucedani Radix (1.5 qian) Fermented Soybean (3 qian) Armeniacae Semen Amarum (2 qian) Platycodonis Radix (2 qian) Glycyrrhizae Radix et Rhizoma (1 qian)
Decoct in water and take.
Yin Qiao San (see above)
If at the onset of Warm Disease, fever is not significant, with cough and slight thirst, this is heat damaging the Lung collaterals. The primary formula is Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction), a Light Cool Agent.
Sang Ju Yin
Armeniacae Semen Amarum (2 qian) Forsythiae Fructum (1.5 qian) Menthae Haplocalycis Herba (8 fen) Mori Folium (2.5 qian) Chrysanthemi Flos (1 qian) Platycodonis Radix (2 qian) Glycyrrhizae Radix et Rhizoma (8 fen) Imperatae Rhizoma (2 qian)
Decoct two cups of water to one cup. Take twice daily. If unresolved after two or three days, with coarse breathing resembling asthma and dryness in the Qi level, add Gypsum Fibrosum and Anemarrhenae Rhizoma. If the tongue is crimson with evening heat, indicating dryness entering the Ying level, add Scrophulariae Radix (2 qian) and Rhinocerotis Cornu (1 qian). If in the Blood level, remove Menthae Haplocalycis Herba and Imperatae Rhizoma, add Ophiopogonis Radix, Rehmanniae Radix Preparata, Polygonati Odorati Rhizoma, and Moutan Cortex (2 qian each). Add Scutellariae Radix for severe Lung heat; add Trichosanthis Radix for thirst.
For Taiyin Warm Disease, with floating and surging pulse, yellow coating, severe thirst, profuse sweating, red face, and aversion to heat, the pathogenic heat has penetrated deeply, scorching fluids, with the pathogen attempting to exit but failing. The primary formula is Bai Hu Tang (White Tiger Decoction), a Heavy Cool Agent. (Bai Hu Tang is a fierce agent. If the pulse is floating and thin, or deep, or if there is no thirst or no sweat, it must not be used. Misuse brings immediate disaster. Be cautious.)
Gypsum Fibrosum (3 qian) Anemarrhenae Rhizoma (2 qian) Glycyrrhizae Radix et Rhizoma (1 qian) Oryza Sativa (a pinch)
Decoct in water and take warm. If the pulse is floating, large, and hollow, with profuse sweating, slight panting, or even flaring nostrils, add Ginseng Radix (1 qian). If the pulse is scattered and large, double the dose of Ginseng Radix. For Taiyin Warm Disease, with rapid pulse, large right pulse, irritability, severe thirst, and crimson tongue, this is simultaneous burning of Qi and Blood. The primary formula is Modified Yu Nu Jian.
Gypsum Fibrosum (5 qian) Anemarrhenae Rhizoma (2 qian) Scrophulariae Radix (2 qian) Rehmanniae Radix Preparata (3 qian) Ophiopogonis Radix (3 qian)
Decoct in water and take. For Taiyin Warm Disease, with bleeding from above, the Warm pathogen forces blood to ascend through the clear pathways. The primary formula is Xi Jiao Di Huang Tang combined with Yin Qiao San. (If Zhongjiao symptoms appear, treat according to Zhongjiao methods.)
If pinkish bloody fluid is vomited, it is incurable. If bleeding from above occurs with a pulse of 7-8 beats per breath and a blackish face, it is incurable. Qing Luo Yu Yin method may be used to salvage.
Xi Jiao Di Huang Tang
Rehmanniae Radix (5 qian) Paeoniae Radix Alba (1.5 qian) Moutan Cortex (1.5 qian) Rhinocerotis Cornu (1.5 qian)
Yin Qiao San (see above)
Combine these two formulas into one decoction. If exterior-releasing drugs have already been used, remove Fermented Soybean, Schizonepetae Spica, and Menthae Haplocalycis Herba.
For Taiyin Warm Disease with severe thirst, moisten with Xi Ning Jiang (Sydney Syrup); for vomiting sticky white foam, moisten with Wu Zhi Yin (Five Juice Drink).
Xi Ning Jiang
Large sweet pear (one) Slice thinly, soak in fresh well water for half a day, drink frequently.
Wu Zhi Yin
Pear juice, Dioscoreae Hypoglaucae Rhizoma juice, Fresh Imperatae Rhizoma juice, Ophiopogonis Radix juice, Lotus Root juice (or Sugarcane juice)
Adjust quantities, mix evenly, and take cool. If cool intake is disliked, warm by steaming in hot water.
If after two or three days of Warm Disease, the tongue coating is slightly yellow, Cun pulse is vigorous, with irritability, restlessness, desire to vomit but unable to, and no Zhongjiao symptoms, the pathogen is in the diaphragm. Use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce vomiting.
If accompanied by chest fullness and much phlegm, heat-phlegm is knotted in the diaphragm. The primary formula is Gua Di San.
Zhi Zi Chi Tang
Gardeniae Fructus (2 qian, crushed) Fermented Soybean (3 qian)
Three cups of water. Decoct Gardeniae Fructus briefly first, then add Fermented Soybean, decoct to one cup, and take.
Gua Di Dan
Melon Seed (1 qian) Adzuki Bean (2 qian, ground) Gardeniae Fructus (2 qian)
Two cups of water. Decoct to one cup. Take half cup first; stop if vomiting occurs. For deficiency, add Ginseng Radix Stubble (1.5 qian).
For Taiyin Warm Disease, with large pulses at both Cun positions, crimson and dry tongue, and no thirst, the heat is in the Ying level. The primary formula is Jian Wei Qing Ying Tang.
Jian Wei Qing Ying Tang
Rhinocerotis Cornu (1.5 qian) Rehmanniae Radix (2.5 qian) Scrophulariae Radix (1.5 qian) Bamboo Leaf Heart (0.5 qian) Ophiopogonis Radix (1.5 qian) Salviae Miltiorrhizae Radix (1 qian) Lonicerae Japonicae Flos (1.5 qian) Forsythiae Fructum (1 qian, with heart)
Decoct in water and take.
For Warm Disease with macules (cloud-like patches without granules), the pathogen is stagnant in the muscle surface. The primary formula is Hua Ban Tang. For papules (with granules), the pathogen is stagnant in the blood collaterals. The primary formula is Ge Gen Jie Ji Tang. For coma and delirium, Heart Yang is damaged and spirit is chaotic. The primary formula is Qing Gong Tang. An Gong Niu Huang Wan, Zi Xue Dan, and Ju Fang Zhi Bao Dan are also indicated. (Niu Huang Wan is coolest, Zi Xue Dan next, Zhi Bao Dan third; choose according to circumstances.)
Hua Ban Tang
Gypsum Fibrosum (3 qian) Anemarrhenae Rhizoma (1.5 qian) Raw Glycyrrhizae Radix et Rhizoma (1 qian) Scrophulariae Radix (1 qian) Rhinocerotis Cornu (0.7 qian) Oryza Sativa (half he)
Decoct in water and take.
Ge Gen Jie Ji Tang (Wu Jutong used Modified Yin Qiao San for papules, but the herbs were too cooling, often failing to vent them. This formula is safer. Agents like Sheng Ma and Chai Hu are too ascending and dispersing, unsuitable for Warm papules.)
Puerariae Lobatae Radix (1.5 qian) Peucedani Radix (1.5 qian) Schizonepetae Herba (1.5 qian) Armeniacae Semen Amarum (2 qian) Forsythiae Fructum (1 qian) Paeoniae Radix Rubra (2 qian) Akebiae Caulis (0.7 qian) Cicadae Periostracum (2 qian) Glycyrrhizae Radix et Rhizoma (1 qian) Bambusae Folium (1 qian) Platycodonis Radix (1 qian) Fresh Imperatae Rhizoma (3 qian)
Decoct in water and take.
Qing Gong Tang
Scrophulariae Radix Heart (3 qian) Nelumbinis Plumula (0.5 qian) Rolled Bamboo Leaf Heart (2 qian) Forsythiae Fructum Heart (2 qian) Rhinocerotis Cornu Tip (2 qian, ground and mixed) Ophiopogonis Radix with Heart (3 qian)
Add Bamboo Sap and Pear Juice (5 spoons each) for severe heat-phlegm; add Trichosanthis Pericarpium (1.5 qian) for unclear expectoration; add Jin Zhi (Gold Juice) and Ren Zhong Huang for severe heat-toxin; add Lonicerae Japonicae Flos (3 qian), Nelumbinis Folium (2 qian), and Acori Tatarinowii Rhizoma (1 qian) for impending coma.
An Gong Niu Huang Wan (If unavailable in remote areas, prepare fresh or grind into powder and take with liquid.)
Calculus Bovis (1 liang) Curcumae Aromatica Rhizoma (1 liang) Rhinocerotis Cornu (1 liang) Coptidis Rhizoma (1 liang) Cinnabaris (1 liang) Borneolum Syntheticum (2.5 qian) Moschus (2.5 qian) Margarita (5 qian) Gardeniae Fructus (1 liang) Realgar (1 liang) Scutellariae Radix (1 liang) Gold Foil Coating
Grind to extremely fine powder, make pills with old honey, each pill 1 qian, coated with gold foil, sealed with wax. For deficient pulse, take with Ginseng Decoction; for excess pulse, take with Lonicerae Japonicae Flos and Menthae Haplocalycis Herba Decoction. Take one pill per dose. For adults with severe illness and robust constitution, take twice daily, even three times. Children take half a pill; if unresponsive, take another half.
Zi Xue Dan (From Ben Shi Fang, removing Gold)
Talcum (1 jin) Gypsum Fibrosum (1 jin) Halloysitum Rubrum (1 jin) Magnetitum (2 jin) Pound and decoct together, strain, add following herbs.
Antilopis Cornu (5 liang) Aquilariae Lignum Resinatum (5 liang) Rhinocerotis Cornu (5 liang) Aquilariae Lignum Resinatum (Chen Xiang) (5 liang) Caryophylli Flos (1 liang) Cimicifugae Rhizoma (1 jin) Scrophulariae Radix (1 liang) Roasted Glycyrrhizae Radix et Rhizoma (0.5 jin)
Pound and chop the above eight herbs, add to previous decoction, decoct, strain, add following herbs.
Natrii Sulfas Purified (2 jin) Nitrums Purified (2 jin) Add to previous decoction, simmer gently, stir constantly with willow wood until nearly congealed, then add last two ingredients.
Cinnabaris (3 liang, finely ground) Moschus (1.2 qian, finely ground and mixed)
Combine to dissipate fire qi, mix with cold water, take 1-2 qian.
Ju Fang Zhi Bao Dan
Rhinocerotis Cornu (1 liang, sliced) Cinnabaris (1 liang, washed) Succinum (1 liang, ground) Testudinis Carapax et Plastrum (1 liang, sliced) Calculus Bovis (5 qian) Moschus (5 qian)
Melt Benzoin Resin in hot water, mix with herbs, make 100 pills, seal with wax.
For Warm Disease with stiff tongue and cold limbs, the heat pathogen has entered the Pericardium. The primary formula is Niu Huang Wan. Zi Xue Dan is also indicated.
Niu Huang Wan
Zi Xue Dan (see above)
For Warm Toxin causing sore throat and swelling, swelling around ears and cheeks, or external swelling without throat pain, even deafness, commonly known as Da Tou Wen (Big Head Warmth) or Xia Ma Wen (Toad Warmth), the primary formula is Modified Pu Ji Xiao Du Yin.
External application: Shui Xian Gao (Narcissus Paste). (If coma and delirium occur, first give Zi Xue Dan or Niu Huang Wan, then Qing Gong Tang.)
Modified Pu Ji Xiao Du Yin
Forsythiae Fructum (3 qian) Menthae Haplocalycis Herba (1 qian) Ma Bo (1.5 qian) Armeniacae Semen Amarum (2 qian) Schizonepetae Spica (1 qian) Bombyx Batryticatus (2 qian) Scrophulariae Radix (3 qian) Lonicerae Japonicae Flos (3 qian) Isatidis Radix (1.5 qian) Platycodonis Radix (3 qian) Glycyrrhizae Radix et Rhizoma (1.5 qian) Fresh Imperatae Rhizoma (2 qian)
Decoct in water and take. After three or four days, add Scutellariae Radix and Coptidis Rhizoma as appropriate.
Shui Xian Gao
Narcissus bulb (any amount) Peel off old red skin and roots, pound in mortar into paste, apply to swollen area, leaving a hole in center for heat to escape. Reapply when dry until small yellow sores the size of millet grains appear on the skin.
After applying Shui Xian Gao for Warm Toxin, if small yellow sores appear on the skin, stop using Shui Xian Gao. Use San Huang Er Xiang San instead.
San Huang Er Xiang San
Coptidis Rhizoma (1 liang) Phellodendri Chinensis Cortex (1 liang) Rheismi Radix et Rhizoma (1 liang) Boswelliae Resina (5 qian) Myrrha (5 qian)
Grind to extremely fine powder. Initially mix with fine tea juice for application, change when dry. Subsequently mix with sesame oil for application.