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!