Line 4 of the Wēnbìng tiáobiàn (Systematic Differentiation of Warm Diseases溫病條辨) – Part 1

Line 4 of the Wēnbìng tiáobiàn (Systematic Differentiation of Warm Diseases 溫病條辨) – Part 1 by  吴鞠通 Wú jū tōng

The bold text is the line, the unbolded text is his commentary.

太陰風溫、溫熱、溫疫、冬溫,初起惡風寒者,桂枝湯主之;但熱不惡寒而渴者,辛涼平劑銀翹散主之。溫毒、暑溫、濕溫、溫瘧,不在此例。

Tàiyīn wind warmth, warm heat, warm epidemic, winter warmth, [all] at the onset have aversion to wind, Guìzhī Tāng governs it; but if there is heat and absence of aversion to cold moreover with thirst, pungent cooling Yínqiào Sàn governs it. For warm toxin, summerheat warmth, damp warmth, warm malaria, do not follow this precedent.

按仲景《傷寒論》原文,太陽病(謂如太陽証,即上文頭痛身熱惡風自汗也),但惡熱不惡寒而渴者,名曰溫病,桂枝湯主之。蓋溫病忌汗,最喜解肌,桂枝本為解肌,且桂枝芳香化濁,芍藥收陰斂液,甘草敗毒和中、薑、棗調和營衛,溫病初起,原可用之。

According to the original text in Zhòngjǐng’s Shānghán Lùn”, Tàiyáng disease (this is tàiyáng pattern, headache, body heat, aversion to wind, spontaneous sweating), but there is aversion to heat and no aversion to cold with also with thirst, this is called warm disease (wēn bìng), Guìzhī Tāng governs it. Because in warm disease one should abstain from [causing] sweat, the favourable method is resolving the flesh, guìzhī fundamentally resolves the flesh, moreover it transforms turbidity with aroma[1], sháoyào contracts yīn and constrains yè-fluids, gāncǎo relieves toxins and harmonises the centre, [sheng] jiāng and [da] zǎo regulate and harmonise the yíng and wèi [qi], at the onset of warm disease, one can use it.

此處卻變易前法,惡風寒者主以桂枝,不惡風寒主以辛涼者,非敢擅違古訓也。仲景所云不惡風寒者,非全不惡風寒也,其先亦惡風寒,迨既熱之後,乃不惡風寒耳,古文簡、質,且對太陽中風熱時亦惡風寒言之,故不暇詳耳。

In this situation I alter the past methods, aversion to wind and cold is governed with guìzhī, if there is an absence of aversion to wind and cold it is governed by pungent cooling [herbs], I dare not violate the ancient teachings? Zhòngjǐng states absence of aversion to wind and cold, it is not all absence of wind and cold, it initially is aversion to wind and cold, after a short period of time it becomes hot, as a result there is no longer aversion to wind and cold, classic writing is succinct and unadorned, moreover it states in tàiyáng wind strike there is periodic fevers with aversion to wind and cold, therefore it is not necessary to go into more detail [here].

蓋寒水之病,冬氣也,非辛溫春夏之氣,不足以解之,雖曰溫病,既惡風寒,明是溫自內發,風寒從外搏,成內熱外寒之証,故仍舊用桂枝辛溫解肌法,俾得微汗,而寒熱之邪皆解矣。溫熱之邪,春夏氣也,不惡風寒,則不兼寒風可知,此非辛涼秋金之氣,不足以解之。桂枝辛溫,以之治溫,是以火濟火也,故改從內經“風淫於內、治以辛涼、佐以苦甘”法。

Because the disease of cold water, that is winter qì, that is not the qì of warm pungent spring and summer, if it is insufficient then one must resolve it, although it is called warmth disease, jì aversion to wind cold, clearly this is warmth originating in the interior and effusing [outwards], wind and cold from exterior struggle, then the pattern of internal heat and external cold is formed, therefore as before use the method of pungent warm of guìzhī to resolve the flesh, cause a slight sweat, and the evils of cold and heat will then both be resolved. The evil of warmth heat, it is the qì of spring and summer, there is absence of aversion to wind and cold, thus one knows there is not concurrent cold wind, this is not the qì of pungent cooling autumn metal, it is not enough to resolve the flesh. Guìzhī is pungent and warm, using it to treat warmth, that is akin to using fire to aid fire, therefore modify the method to follow the Nèijīng (Inner Classic) [which states] “wind excess in the interior, treat with pungent and cooling, assist with bitter and sweet [herbs]”.

胸膈悶者,加藿香三錢、鬱金三錢︰護膻中;渴甚者,加花粉;項腫咽痛者,加馬勃、元參,衄者,去芥穗、豆豉,加白茅根三錢、側柏炭三錢、梔子炭三錢;咳者,加杏仁利肺氣;二、三日病猶在肺,熱漸入裡,加細生地、麥冬保津液;再不解或小便短者,加知母、黃芩、梔子之苦寒,與麥、地之甘寒,合化陰氣,而治熱淫所勝。

Modifications [of Yinqiao San]

Oppression in the chest and diaphragm, add 3 qián of huòxiāng, 3 qián of yùjīn; to protect the dànzhōng, with extreme thirst, add huāfěn; swelling of the nape and pain in the throat, add mǎbó, yuán shēn; nose bloods, remove jièsuì, dòuchǐ, add 3 qián of bái máogēn, 3 qián of cèbó tàn, 3 qián of zhīzi tàn; cough, add xìngrén to disinhibit lung qì; if after 2-3 days the diseases is still in the lung, heat will gradually enter the interior, add xì shēngdì, mài dōng to protect jīnyè fluids; if again the [flesh] is not resolved or short voidings of urination, add  bitter cold [herbs] zhīmǔ, huángqín and zhīzǐ, together with sweet cold mài [mendong], [sheng] di, together transform yīn qì, and treat the heat excess that is prevalent.

[Author thanks Stephen Boyanton for his help]

[1] This is a herbal method

Commentary on Xiāoyáo sàn(逍遙散)from Yīfāng jíjiě 《医方集解》 1689 CE.

退熱調經《局方》

Abates heat and regulates menstruation, from the 《Júfang》 1151 CE.

治血虛肝燥,骨蒸勞熱,欬嗽潮熱,往來寒熱,口乾便澀,月經不調(骨蒸潮熱,肝血虛也。肝火乘肺故欬嗽,邪在少陽故往來寒熱,火盛爍金,不能生水,故口渴便秘,肝病故經水不調。)。

This treats blood deficiency and liver dryness, steaming bone taxation heat, cough with tidal fevers, alternating chills and fever, dry mouth with constipation, menstrual irregularities (steaming bone and tidal fevers, this is liver blood deficiency.  If the liver is hot then it will overwhelm the lung, therefore there is cough, the evil is located in shǎoyáng therefore there is alternating chills and fevers, if fire is exuberant then metal will be scorched, [metal] cannot generate water, therefore there is thirst and constipation, the liver is diseased therefore there is menstrual irregularities.).

此足少陽厥陰藥也。肝虛則血病,當歸芍藥養血而斂陰,木盛則土衰,甘草白朮和中而補土(補土生金,亦以平木)。柴胡升陽散熱,合芍藥以平肝,而使木得條達(木喜條達,故以瀉為補,取疏通之義)。茯苓清熱利溼,助甘朮以益土,而令心氣安寧(茯苓能通心腎。)。生薑暖胃祛痰,調中解鬱,薄荷搜肝瀉肺,理血消風,疏逆和中,諸證自已,所以有逍遙之名( 有乾咳嗽者,丹溪曰:極為難治,此係火鬱之證,乃痰鬱其火邪在中,用逍遙散以開之,下用補陰之劑可愈,昂按:此即後條醫貫所言之旨也。)。

These are foot shǎoyáng and juéyīn medicinals. If the liver is deficient then there will be diseases of the blood, dāngguī and sháoyào nourish blood and constrain yīn, if wood is exuberant then earth will be debilitated, gāncǎo and báizhú harmonise the middle and tonify earth (tonify earth to generate metal, this will additionally help balance wood). Cháihú rises yang and disperses heat, combined with sháoyào it balances the liver, and this causes the liver to be orderly reaching (the liver prefers orderly reaching, therefore drain in order to tonify, this is the meaning of dredging (coursing and freeing)). Fúlíng clears heat and disinhibits dampness, assists gān[cǎo] and bái[zhú] in order to supplement earth, and orders the heart qì to be tranquil (fúlíng facilitates the communication of heart and kidney.). Shēng jiāng warms the stomach and dispels phlegm, regulates the middle and resolves depression, bòhé seeks the liver and drains the lung, regulates (rectifies) the blood and disperses wind, courses counterflow and harmonises the middle, all of these signs naturally cease, therefore it is given the name xiāoyáo (if dry cough is present, Dānxī says: this is extremely difficult to treat, this correlates to the pattern of depressed fire, also with phlegm depression and fire evil in the middle, use xiāoyáo sàn in order to open it, after use yīn tonifying formulas for the patient to recover, Wáng’àn says this statement is decreed in the 《Yīguàn》.).