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医宗金鉴卷十二
<<Yi
Zong Jin Jian>>
Chapter 12
辨温病脉证并治篇
Wenbing, pulse, conditions and treatment.
『内经』言,热病皆伤寒之类也,非谓类乎伤寒,乃谓与伤寒同乎一类之病也。盖伤寒因伤时令之寒而得名也,温病、热病,亦随时而易其名耳!经曰:冬伤於寒,则为病热,此即时而病者也。经曰:冬伤於寒,春必病温,此过时而病者也。经曰:凡病寒伤而成温者,先夏至为病温,後夏至为病暑,暑即热之谓也,此随时而病者也。是则秋分以前,皆得以热病名之;秋分以後,皆得以伤寒名之矣。此轩岐、仲景立伤寒、温病、热病之名义也。
<<Nei Jin[1]>> told the
Rebing[2] belongs to the same kind as
Shanghan diease. It does not mean it similar to Shanghan
disease, but mean it is the same kind of disease as the Shanghan.
Shangan is due to the seasonal Xieqi which is Cold in nature
invades into the body. Wenbing, Rebing, also change their name
according the season! <<Nei Jing>> said, if the Cold invades the
body in winter, the person will have fever. This is a disease
that happens right in that season. <<Nei Jing>> also said: if
the Cold invades into the body in Winter, the person will have
Wenbing in spring. This is a disease that happens after the
season during which a Xieqi invades. <<Nei Jing>> said: When a
person is affected by a Cold Xieqi and later develops Wenbing,
if it happens before Xiazhi[3], it is
called Wenbing, if it happens after the Xiazhi, it is called
Shubing. Here the Shu means more hot than the Wen. Apparently
the disease changes its manifestation according to the time of
the year. Furthermore, if the disease comes before the Qiufen[4], it is
called Firebing; if it happens after the Qiufen, it is called
Shanghan. This is the principle that Great Mater Xuanyuan
(emperor) and Zhang Zhongjing establish the meaning of Shanghan,
Wenbing, and Rebing.
经又云:藏於精者,春不病温,此明过时不病之原也。经曰:冬不藏精,春必病温,此明过时必病之故也。於此可知伤寒为病,不在精之藏与不藏,而但有触犯即得为病。非若温病、热病、藏精则不病,不藏精则必病也。但能藏精者,纵偶感於邪,或温或暑,其病自轻;不藏精者,虽微感其邪,或温或暑,其病必重,差为稍异耳!
<< Nei Jing >> again said: if the person
can save, hold, and nourish his Jingye (also called Ying
sometimes) in winter, he will has no Wenbing in spring. It
explains the reason why a disease does not happen after the
season during which the Xieqi invaded. In another words, if the
person waste, deplete, did not save his Jingye in winter, he
will have Wenbing in spring. Therefore, we should know that, for
a Shanghan disease, it happens independent of whether the person
saved his Jingye in winter or not. Once the Cold Xieqi invades,
he will develop the Shanghan disease. Whereas for Wenbing,
Rebing, if the person saved his Jingye in winter, he will have
no such disease in later time of the year. If he saved his
Jingye in winter, even if he is attacked by the Xieqi, his
Wenbing or Rebing will be mild in extent. If he did not save his
Jingye in winter, even if the attack of the Xieqi is mild, his
disease manifestation is severe.
若专以冬不藏精,毫无外感,为少阴本病,热从内生,则悖仲景温病之旨矣。仲景论中,但言太阳初病,发热而渴,不恶寒者为温病。辨其非伤寒,非谓太阳之寒,不由表入,竟从少阴之热内生为病也。经又曰:风温为病,脉阴阳俱浮。是明指温病之发,因感春风辄动内热而始发,所以阴阳脉俱浮也。盖以温病、风温与热病论,互发其义。但热病一论,经已昭然,若复立论,未免赘疣,非仲景详於伤寒,而略於温证也。今将伏气、温病、风温合为一篇,其温热治法,同於六经,读者再细玩『素问·热病论』,及『刺热』、『评热』诸论,与是论互相叁考,自有得焉。
There is an opinion that if the person did
not save Jingye in winter, he has no Taiyang condition, his
condition should belong to Shaoyin stage, in which the Fire
develops from inside of the body. This is wrong and against the
view of Master Zhang Zhongjing about Wenbing. The Master said,
if in the early stage of Taiyang, the person has fever and
thirsty, but no chilly, it belongs to Wenbing. He said this
condition is not Shanghan disease, does not mean it is not Cold
comes not from Taiyang, but from Shaoyin. << Nei Jing >> said:
For Wind Wenbing, the pulse is floating both when pressed
slightly and heavily. It is clearly that the Wenbing comes from
Taiyang stage first, due to the disturbance of inside fever by
spring Xieqi from outside of the body, that makes the pulse is
floating not only when slight press the pulse or heavily press
it. The meaning of Wenbing, Fengwen, or Rebing, are all the
similar. Here the Master introduced more in detail about the
Wenbing, but the diagnosis and treatment of Rebing, Shubing, are
all similar. If the Master introduce all the diseases one by
one, it is certainly too long version and not necessary. It does
not mean that the Master knows the Shanghan more than the
Wenbing and Rebing. Here we combine the Fuqi, Wenbing and
Fengwen in one version. The principle for their treatments are
the same as the six stages as Shanghan. If readers study the
books of <<So Wen
·Rebing >>, << Ci Re>> nad << Ping Re >,
together with the book here << Shanghan Lun>>, they should
understand more.
【注】四时令气,正气也;非时之气,邪气也。正气之中人也浅,感之甚者即病,微者藏在肌肤,不即为病,壮实之人可以自已。邪气之中人也深,感之虽微,亦即为病,甚则直入於藏不能自已,虚者死焉。此篇所谓伏气之病,即四时令气正病,非四时不正之邪,与非常异气之疫邪
Every season has its own normal Qi. The
spring Qi is warm; the summer Qi is hot; the autumn Qi is cold;
and winter Qi is freeze. If the warm Qi comes in spring; the hot
Qi comes in summer; cold Qi comes in fall and freeze Qi comes in
winter, it is normal Qi. If they come in other seasons, they
belong to Xieqi, disease-causing Qi, since such Qi causes
disease. For example, if the weather in spring is cold (the fall
Qi), it is not normal. The cold Qi is then called Xieqi, the
Coldxie. If the warm Qi (the spring Qi) comes in winter, the
warm Qi is also called a Xieqi, since the winter should be very
cold Qi, not the warm Qi. The warm Qi is then also called a
Xieqi. So, the Qi is the same, but it is called a Xieqi because
it comes into the body in an improper time. It does not mean
that the Xieqi is originally and naturally an evil.
The normal seasonal Qi can also invade into
the body to cause disease. For example, a person is invaded by a
spring warm Qi in spring. Mild invasion does not cause severe
problem. Only when it is very strong, it can cause severe body
reaction. The mild normal seasonal Qi can hidden in the body
surface, not cause any clear illness feeling. A strong body can
heal it by itself. In the person is invaded by a Xieqi, the
Xieqi can penetrate deeper into the body. Even a mild invasion
can cause illness reaction. Stronger Xieqi invasion can
penetrate into the deeper organs so that the body cannot heal by
itself, and a weaker person will so die.
01
师曰:伏气之病,以意候之,今月之内,欲有伏气,假令旧有伏气,当须脉之。若脉微弱者,当喉中痛,似伤,非喉痹也。病人云:实咽中痛,虽尔,今复欲下利。
Master: Fuqi[5]means a
person was attacked by a Cold and Wind in winter. If the
invasion is strong, he will have either Cold-invasion or a
Wind-invasion Shanghan disease. If the Xieqi is mild, it hided
in the body surface, but starts to grow, to disturb the body in
later season as in spring, to cause so called Wenbing. Spring is
the developing season. It is the season the Fuqi starts to
develop as the grass to start to grow. If a person has old Fuqi
in the body, and he did not pay attention to hold, to save, to
nourish his Jingye in winter, he will have the burning of the
Fuqi in spring. The person with the Fuqi disease can be told by
his pulse. In spring, if the person just has a Shanghan disease
or Wenbing disease but his pulse is weak, it is Shaoyin pulse,
suggesting a Shaoyin stage; if he has sour throat, it is Shaoyin
condition. However, his throat sour is mild, not severe, not as
painful as a person catches normal Shanghan Xieqi. So, the mild
sour throat and weak pulse suggest his Fire condition now is
Shaoyin inside Fire burning. Though he has sour throat, he may
tend to have diarrhea, so the treatment for such Shaoyin
condition is different from typical Shanghan Xieqi invasion.
02
太阳病,发热而渴,不恶寒者,为温病。发汗已,身灼热者,名风温。风温为病,脉阴阳俱浮,自汗出,身重多眠睡,鼻息必鼾,语言难出。若被下者,小便不利,直视失溲;若被火者,微发黄色,剧则如惊痫,时瘐;若火熏之,一逆尚引日,再逆促命期。
In Taiyang stage, if the person has fever
and thirsty, not chilly, it belongs to Wenbing. After a sweat
therapy, if the body is very hot to be a fever, it is
furthermore called Fengwen. For Fengwen, the pulse is floating
when pressed slight or heavily. The person has sweat, heavy
body, tends to fall into sleep with snooze, hard to have voice.
If he is given a bowel-cleansing therapy, he will have
difficulty in urine, staring forward eyes; if he is given fire
roast or lie on a hot bed, he will have mild yellow color on
skin. For severe cases, the person may have epilepsy,
scaring/phobia, loss of consciousness; if he is given a fire
roast or lie down on hot bed, or covered with hot covering, his
recover will be delayed, if such wrong treatment is repeated
again and again, he may die sooner.
【注】发热不渴,恶寒者,太阳证也。发热而渴,不恶寒者,阳明证也。今太阳病始得之,不俟寒邪变热,转属阳明,而即热渴不恶寒者,知非太阳伤寒,乃太阳温病也。
Note: if a person has fever, chilly, but no
thirsty, his condition belongs to typical Shanghan Taiyang
stage. If he has fever, thirsty, but no chilly, his condition
belongs to Yangming stage. Now he just has the disease and the
clinic condition is as in Yangming stage, suggesting that his
condition is not Shanghan Taiyang, but a Wenbing Taiyang stage.
由於膏梁之人,冬不藏精;辛苦之人,冬伤於寒,内阴已亏,外阳被郁,周身经络,早成温化,所以至春一遇外邪,即从内应:感寒邪者,则无汗,名曰温病,当以河间法用水解散,审其表里以解之。水解散,即天水六一散,防风通圣之合剂也。感风邪者,则有汗,名曰风温,当以水解散减麻黄,加桂枝,倍石膏,令微似汗以和之,若大发其汗,则益助蕴热,必令身热如火灼也。
For person lives in a rich condition, he
may waste his Jingye in winter (due to frequent sex activity);
for person lives in a poor condition, he may also lose his
Yingye in winter because heavy exposure in cold in winter. When
the inside Yingye is in deficiency, not enough, the inside
Yangqi (the Yang) is hard to hold to the Jingye (the Yin), e.g.
there is no enough Yin in the body to attract and to hold the
Yangqi in the body in winter. Winter is the time in which the
Yangqi in the nature is to be hold in the inside of the earth;
and in the body, the body Yangqi is to be hold in the Yinye of
the body in winter. Now, there is no enough Jingye, so the body
Yangqi is floating. Once the spring comes, the Yangqi floating
furthermore to cause a Fire reaction, a condition called Wenbing.
If the person is attacked by a Cold Xieqi in spring, it is
called a Wenbing. For the treatment of Wenbing, use Shuijie San.
This formula is a combination of herb formula Tianshui Liuyi San
and Fangfen Tongshen San. If he is attacked by a Wind Xieqi, and
he has sweat, his condition belongs to Fengwen. For the
treatment, use Shuijie San jian Mahuang, jia Guizhi, double
Shigao, to make him have mild sweat to harmonize. A heavy sweat
will trigger more Fire and cause sever fever in the body.
盖风温为病,乃风邪外盛於表,故阴阳六脉俱浮;热邪内壅於胸,故多眠睡,鼻息鼾也。风邪伤卫,表气不固,故自汗出;壮热伤气,故身重倦,声微语难出也。若被下者,则愈夺阴液,故水泉竭而小便不利也。太阳府气将绝,故目直视也。少阴藏气不固,故遗失溲也。若被火者,则以火益火而阳气
灼,将欲发黄,故微发黄也;剧者热极生风,故如惊
时
也。微黄,病深色渐加黑,故若火熏之也。
Fengwen is the overwhelming of Wind Xieqi
in the body surface, so the pulse is floating when pressed
slightly or heavily; the Fire Xieqi accumulated and stagnated
inside of the body, so the person has trend to lie to fall into
sleep with big and strong snooze. The Wind attacks the body
surface, the surface Weiqi is fragile, so there is sweat; strong
hot damage the body Yangqi, so the body feels heavy and tired,
voice is low and hard to speak out. A bowel-cleansing therapy
depletes body Yinye, so there is no enough water goes down to
the bladder as a urine, so the urine is difficult. Taiyang Qi is
depleting, so the eyes staring forwards. Shaoyin Zangqi is
depleting, so the person has leak in urine or stool. If the
person is put in front of fire, or on hot bed, the fire helps
the inside fire, cause jaundice. When the hot is extreme, it
causes inside wind, the same as the hot weather creates big
storm in nature. The body inside wind shows as spasm,
epilepsy-like spasm of the muscle, arms, leg, and body truck.
With the development of the disease, the yellow color becomes
dark so the skin color looks as fire smoked.
温病、热病不恶寒者,表热也。口渴引饮者,
热也。表热无寒,故不宜汗;
热无实,故不宜下。表里俱热,尤不宜火。曰一逆者,若汗、若下、若火也;再逆者,汗而复下,下而复火也。一逆已令阴竭,尚可延引时日;再逆则阴立亡,故曰促命期也。
With the Wenbing or Rebing, the person has
no chilly, since his body surface is hot. His thirsty and
willingness to drink water suggest hot too. For the body surface
has hot but no cold, so the sweat the is forbidden; the Fire is
without Shi condition in the abdomen, so bowel-cleansing therapy
should not be used either. Fire is in both body surface and
inside, so warm therapy is absolutely not good. If the sweat
therapy, or bowel-cleansing therapy, or warm therapy is used, it
is so called one time wrong treatment; if the person already has
sweat, but is given bowel-cleansing therapy again, then with
warm therapy followed, it is called repeated wrong treatment.
One time of the wrong treatment depleted the Yinye, but the life
can still remain; whereas the repeated wrong treatments are
performed, the Yinye will exhaust quickly, so it said the
repeated wrong treatment shortens the life.
其温病、热病无汗者,宜大青龙汤;时无汗、时有汗者,宜桂枝二越婢一汤;有汗者,宜桂枝合白虎汤。内热者,防风通圣散。表实者,倍麻黄;里实者,倍大黄。量其病之轻重,药之多少而解之,三日之前,未有不愈者。其有外感邪重,内早伤阴,已经汗下而不愈者,则当审其表
,随其传变所见之证,治之可也。此法惟西、北二方四时皆可行之,无不随手取效。若江淮间地偏暖处,冬月初春乃可用之。若春末秋前,即脉证允合,当用麻、桂、青龙等汤者,亦必轻而减之,随证消息,适可即止,慎不可过,过则反致变逆。经所谓同病异治者,此之谓也。
For person with Wenbing, if he has fever
but no sweat, use Da Qinglong Tang; if he has sweat only from
time to time, use Guizhi two Yuebi one Tang; if he has
continuous sweat, use the combination of Guizhi Tang and Baihu
Tang. If he has inside hot, use Fangfen Tongshen San. If the
body surface condition is strong, double the amount of Mahuang;
if the abdomen is hard and pain with difficult in bowel
movement, double the amount of Dahuang. Adjust the amount of
herb ingredients according to the severity of the disease. It
should be solved within three days.
For person has had depletion of Yinye
inside before a heavy attack of Xieqi from outside of the body,
and if he has had a sweat therapy, or a bowel-cleansing therapy
but has no improvement, pay attention to his body surface
condition to use a proper treatment. This is the principle for
person living in the north and west of
China. It usually works well.
For person who lives in the Yangzi
River and Huai
River in China, where the weather is warmer,
such a principle in the treatment can be applied in winter and
in early spring only. Between the later spring and autumn, use
it only if the clinic condition and pulse match the use of
Mahuang, Guizhi and Qinglong Tang but with less amounts. Don’t
let it work over to cause various wrong-conditions. This is what
the << Nei Jing >> said, the same disease also needs to be
treated in a different way.
【集注】程知曰:温病热自内出,故发热而渴不恶寒。风温内外交热,加之自汗,故有身重多眠诸证,有轻重死生之分。医者当以有汗、无汗为辨别之大要,亦即可汗、不可汗为救治之微权。又曰:仲景之青龙、白虎神矣!得此意而推广之,可以应用於不穷。盖温病宜於发散中重加清凉,风温不可於清凉中重加发散也。
Comments for Chen Zhi: For Wenbing, its
Fire comes from inside of the body, so that the
person has fever, thirsty but no chilly. For Fengwen, the
Fire from both outside and inside of the body, together with the
sweat, so the person feels heavy body, tends to fall into sleep,
etc. The severity of the Wenbing and Fengwen is quite different.
Readers need to pay much attention to whether there is sweat or
not, to decide if the sweat therapy should or should not be
used. Comments again: the Qinglong Tang and Baihu Tang of Master
Zhang Zhongjing work fantastic!
[1] <<Nei Jing>> is the name of a book
<<Huang Di Nei Jing>>. It is the fundamental book for
Chinese medicine. Many or almost all principles in
diagnosis, treatment, and health maintenance are
introduced in it. However, it does not tell the exact
ways for the treatment. It is usually believed and there
is evidences
that there is another book, its sister book, that talks
about the exact way for the treatment. But it is still
missing.
[2] Rebing, Wenbing, Shubing, are
names of diseases. Re in Chinese means hot; Wen, warm,
Shu, summer. Bing means a disease.
[3] Xiazhi is a seasonal point used by
Chinese calendar. It happens on June 21 or June 22, in
which the sunshine reaches the most far to the north of
the earth. From this day, the summer comes. It is also
the day, on which the daytime is longest on the north
part of the earth.
[4] Qiufen is a seasonal point in
Chinese calendar. It is about Sept. 22 or 23 each year.
It is a day, on which the daytime and night time is
equal. It is also the starting time for a fall season.
[5] Fu here means lie down in a lower
position, to hide, not to stand up, not to lift.
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