伤寒初一日至二日,病在皮肤,名为在表。表者阳也,法宜发汗。今发汗而不解者,此
是阳不受病。阳受病者,其人身体疼痛,发热而恶寒,敕啬拘急,脉洪大者,有此证候,则
为病在表,发汗则愈。若但烦热,不恶寒,身不疼痛,此为表不受病,故虽强发其汗,而不
能解也。
伤寒大法,四日病在胸膈,当吐之愈。有得病二、三日,便心胸烦闷,此为毒瓦斯已入,
有痰实者,便宜取吐。
中风伤寒之状,阳浮而阴弱。阳浮热自发,阴弱汗自出,啬啬恶寒,淅淅恶风,吸
吸发热,鼻鸣干呕,此其候也。
太阳病中风,以火劫发其汗,邪风被火热,血气流溢失常,两阳相熏灼,其身发黄。阳
盛即欲衄;阴虚则小便难。阴阳俱虚竭,身体则枯燥,但头汗出,齐颈而还。腹满微喘,口
干咽烂,或不大便,久则 言,甚者至哕,手足躁扰,寻衣摸床。小便利者,其人可治
。
阳明中风,口苦而咽干,腹满微喘,发热恶寒,脉浮紧,若下之则腹满,小便难。阳明
病,能食为中风;不能食,为中寒。
少阳中风,两耳无闻,目赤,胸中满而烦,不可吐之,吐之则悸而惊。
太阴中风,四肢烦疼,其脉阳微阴涩而长,为欲愈。
少阴中风,其脉阳微阴浮,为欲愈。
厥阴中风,其脉微浮,为欲愈;不浮,为未愈。
伤寒病初起的一到两天,病邪位于皮肤表层,这称为“在表”。体表属阳,治疗法则应当采用发汗法。现在虽然发了汗但病仍未解除,这是因为阳气并未受邪。如果阳气受邪,患者会出现身体疼痛、发热且怕冷、畏缩拘急、脉象洪大等症状,具备这些证候,才说明病在体表,此时发汗即可痊愈。如果只是感到烦热,不怕冷,身体也不疼痛,这说明表证未受邪气侵袭,因此即使强行发汗,也不能使病愈。
伤寒的一般治疗原则是:第四天病邪位于胸膈部位,应当采用催吐法使其痊愈。有些患者在得病两三天后,便出现心胸烦闷的症状,这是因为毒邪热气已经入里,体内有痰饮实邪,此时适宜采用催吐法。
中风兼伤寒的症状表现为:脉象浮取有力而沉取无力(阳浮阴弱)。浮取有力则热自发,沉取无力则汗自出,伴有畏缩怕冷、淅淅怕风、呼吸急促发热、鼻鸣、干呕等症状,这就是其证候表现。
太阳病中风,如果用火疗强行发汗,邪风与火热相合,导致气血运行溢出常度,两阳(风邪与火热)相互熏灼,会导致身体发黄。阳气过盛则想流鼻血;阴液亏虚则小便困难。阴阳俱虚竭时,身体会干枯粗糙,只有头部出汗,至颈部而止。腹部胀满、轻微气喘、口干咽烂,或者大便不通,时间久了可能出现谵语,严重的甚至出现呃逆,手足躁动不安,伸手抓摸床沿。如果小便通利,说明正气尚存,病人可以治愈。
阳明中风,症状为口苦咽干、腹部胀满、轻微气喘、发热怕冷、脉象浮紧。如果误用攻下法,会导致腹部胀满、小便困难。阳明病中,能进食的属于中风;不能进食的属于中寒。
少阳中风,症状为两耳听不见、眼睛发红、胸中胀满且烦躁,不可使用催吐法,因为催吐会导致心悸和惊骇。
On the first to second day of Taiyang Cold Damage (Shanghan), the pathogen is located in the skin and exterior, which is termed "in the exterior" (Zai Biao). The exterior belongs to Yang; the appropriate method is sweating (Fa Han). Now, if sweating fails to resolve the condition, it is because Yang has not been affected by the pathogen. If Yang is affected, the patient experiences body pain, fever with aversion to cold, shivering and stiffness, and a surging-large pulse (Hong Da Mai). With these symptoms, the disease is confirmed to be in the exterior, and sweating will lead to recovery. However, if there is only irritability and heat, without aversion to cold or body pain, this indicates that the exterior is not affected by the pathogen. Therefore, even if forced sweating is applied, the disease cannot be resolved.
The general principle for treating Cold Damage is: on the fourth day, when the pathogen is in the chest and diaphragm, vomiting (Qu Tu) should be induced for recovery. In cases where patients develop chest and heart irritability two or three days after contracting the disease, it indicates that toxic heat has entered internally and phlegm-solidity (Tan Shi) exists; inducing vomiting is then appropriate.
The presentation of Wind-Strike complicated by Cold Damage features a floating pulse that is weak at depth (Yang Fu Yin Ruo). Floating Yang leads to spontaneous heat; weak Yin leads to spontaneous sweating. Symptoms include shivering aversion to cold, chilly aversion to wind, rapid breathing with fever, nasal congestion (Bi Ming), and dry retching. These are its characteristic signs.
In Taiyang Disease with Wind-Strike, if fire therapy is used to force sweating, the evil wind combines with fire heat. Qi and blood flow abnormally due to overflow. The mutual scorching of two Yangs (wind and fire) causes jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to difficult urination. When both Yin and Yang are depleted, the body becomes dry and rough. Sweat appears only on the head, stopping at the neck. Abdominal fullness, slight wheezing, dry mouth, and rotting throat occur. Constipation may ensue; prolonged stagnation leads to delirious speech (Yan Yu); severe cases result in hiccups (Hui), restlessness of hands and feet, and picking at bedsheets. If urination is free, the patient is treatable.
Yangming Wind-Strike presents with bitter taste, dry throat, abdominal fullness, slight wheezing, fever with aversion to cold, and a floating-tight pulse. If purgation is incorrectly applied, abdominal fullness and difficult urination result. In Yangming Disease, ability to eat indicates Wind-Strike; inability to eat indicates Middle Cold (Zhong Han).
Shaoyang Wind-Strike presents with deafness, red eyes, chest fullness with irritability. Vomiting must not be induced, as it causes palpitations and fright.
Taiyin Wind-Strike presents with painful limbs. A pulse that is slightly weak at the Cun position, choppy at the Chi position, yet long, indicates impending recovery.
Shaoyin Wind-Strike features a pulse that is slightly weak at the Cun position and floating at the Chi position, indicating impending recovery.
Jueyin Wind-Strike features a faintly floating pulse, indicating impending recovery; if not floating, recovery has not yet occurred.