The Clear Exposition on Cold Damage 傷寒明理論 ShangHanlunMingLiLun
The Clear Exposition on Cold Damage
傷寒明理論
(ShangHanlunMingLiLun)
Written by Cheng WuJi
Translated by Lee Joungeun
tabld of contents.
Bibliogrphy
Although famous doctors of many generations recover
patients, save one’s life from disease, and treat disease by eliminating evil,
but they do not say that ‘I was born with knowledge’, always mention and write
according to the bible of the saint (聖人), they thought that they can treat well because
they can understand deep meaning of the bible by researching hidden meaning of
the bible with outstanding talent and insight. On the other hand, in all of the
acute disease, cold damage (傷寒) is the first, after six or eight days, on in ten
days, either death or recover occurs, owing to this, Zhang Zhongjing (張仲景) in han dynasty [漢] grieved over failing to
save one’s life so that made a shang han lun [傷寒論] which is ancestral root and rules to medical
question.
But, from han dynasty until now, only Wang Shuhe (王淑和) understands the meaning,
the others are unable to understand so that there is few comments and lecture
since Wang Shuhe (王淑和). In famous doctors since song dynasty [宋], there is a work of Zu
Bing Lun (卒病論) of Pang ancahng (龐安常), Huo Ren Shu (活人書) of Zhu gong (朱肱), Wei Zhi (微旨) of Han zhihe (韓祗和), and Zheng Zhi (證治) of Wang shi (王寔), all of them explain
something but cannot explain all of the deep meaning of Zhang Zhongjing (張仲景).
The house of Cheng wuji (成無己) have been doctors and scholars
for generations. He is very smart and has a wide knowledge so that he writes
the meaning of cold damage which has not been mentioned by the foregoer.
on the full moon of the 8th lunar month. 1142 year 錦幈山 嚴器之.
余常思歷代明醫廻骸起死祛邪愈疾非曰生而知之必也祖述前聖之經才高識妙探微賾隱研究義理得其旨趣故無施而不可. 且百病之急無急於傷寒. 或死或愈止於六七日之間十日以上. 故漢張長沙感往昔之淪 喪傷橫夭之莫救撰爲[傷寒論]一十卷三百九十七法一百一十三方爲醫門之規繩治病之宗本.然自漢逮今千有餘年唯王叔和得其旨趣後 人皆不得其門而入是以其間少於注釋闕於講義. 我宋以來名醫間有著述者 如龐安常作[卒病論]朱肱作[活人書]韓祗和作[微旨]王寔作[證治]雖皆互有闡明之義然而未能盡張長沙之深意. 聊攝成公家世儒醫性識明敏記問該博.撰述傷寒義皆前人未經道者.
歲在壬戌八月望日錦幈山嚴器之.
45. Yellowing 發黃
How to explain yellowing in cold damage? Jing [經] says that damp-heat interaction occurs
jaundice [dan, 癉].’ Dan [癉] is yellow and there is only yang without yin. If
yellowing occurs from cold damage, this is severe, when damp and heat is
severe, yellowing occurs. when internal heat is already severe, if it is
treated with fire, yellowing also occurs.
How to explain yellowing in cold damage? Jing [經] says that damp-heat interaction occurs
jaundice [dan, 癉].’ Dan [癉] is yellow and there is only yang without yin. If
yellowing occurs from cold damage, this is severe, when damp and heat is
severe, yellowing occurs. when internal heat is already severe, if it is
treated with fire, yellowing also occurs.
‘If evil wind is exacerbated by fire-heat and
then the two yang fume and scorch each other, there will be generalized
yellowing’, ‘when a yang brightness disease is treated with fire and there is
slight sweating from the forehead and inhibited urination, there will be
yellowing’; these are that there is heat in the interior and it is treated with
fire, therefore yellowing occurs.
‘When in yang brightness disease, sweating is absent, and there is
inhibited urination and anguish in the heart, there will be generalized
yellowing’; the yellowing is originated from yang brightness heat exuberance. ‘In
cold damage, sweating has been promoted and there is generalized yellowing,
including the eyes. Why this is so is because there is unrecovered cold-damp in
the interior. It is assumed that in this situation one cannot precipitate, but
should seek to treat the disease by addressing cold and dampness’; the
yellowing is due to cold-damp. Both damp and heat can cause yellowing, how to differentiate?
The two are different in not only origin but also color. The yellowing of damp
patients is generalized yellowing as like being fumigated, in other words, this
is dark. The yellowing due to exuberant heat is generalized yellowing with the
color of a tangerine, when this is severe, clothes is dyed yellow. Judging from
this, damp and heat yellowing are different.
Generally yellowing patients belong to greater yin, greater yin is related
with the spleen channel. The spleen is earth and yellow is the color of earth.
If the spleen channel is fumed by damp-heat, the color appears outward,
therefore generalized yellowing always occurs. This is mentioned in Shang Han
Lun that ‘when in cold damage, the pulse is floating and moderate and the
extremities are spontaneously warm, this is related to the greater yin. In
greater yin disease, there should be generalized yellowing.’ Even though heat
is exuberant, if sweat issues spontaneously or the urine is uninhibited,
yellowing will not occur, but if there is only sweat issuing from the head -and
without sweat elsewhere- that stops at the neck, and urination is inhibited,
and there is a desire to drink water due to thirst, this means that there is stasis
heat in the interior, therefore there will be generalized yellowing
Even though yellowing patients are related with exuberant heat, the
treatment is different. ‘When in cold damage that has lasted for seven and
eight days, there is generalized yellowing the color of a tangerine, inhibited
urination, and mild abdominal fullness, Capillaris Decoction (yin chen hao
tang) governs’; this is due to discharging and flushing the heat. ‘In cold
damage with generalized yellowing and heat effusion, Gardenia and Phellodendron
Decoction (zhi zi bai pi tang) governs’; this is to resolve and dissipate the
heat. ‘In cold damage with stasis heat in the interior, there will be
generalized yellowing, Ephedra, Forsythia, and Rice Bean Decoction (ma huang
lian qiao chi xiao dou tang) governs’; this is to dissipate the heat. As like
these, discharging with flushing and dissipating are different, but both of
them are to break fire and flush heat. There is another case that ‘there is
generalized yellowing, a pulse that is sunken and bound, hardness in the lesser
abdomen, and inhibited urination, and the person is as if manic’; the yellowing
occurs due to blood amassment in the lower burner, this is treated after
precipitation with di dang tang (Dead-On Decoction).
Yellowing patients indicate that the disease is
already severe, so there is lots of a case which cannot be treated. If pulse
cannot feel around inch and cold qi comes out from the nose, this cannot be
treated. And also if the looks of the patient blackens as if by smoke and there
is forward-staring eyes and shaking of the head, this means heart expiry. If
the perimeter of the mouth is black and one has yellowing and oily sweat, this
means spleen expiry.
45. 發黃
傷寒發黃何以明之? [經]曰濕熱相交民當病癉. 癉者黃也單陽而無陰者也. 傷寒至於發黃爲疾之甚也. 濕也熱也甚者則發黃. 內熱已盛復被火者亦發黃也. 邪風被火熱兩陽相熏灼其身必發黃. 陽明病被火額上微汗出而小便不利者必發黃是由內有熱而被火致發黃者也.陽明病無汗小便不利心中懊憹者必發黃是由陽明熱盛致發黃者也. 傷寒發汗已身自爲黃所以然者寒濕在裏 不解故也. 以爲不可下也 於寒濕中求之是由寒濕致發黃者也. 濕亦令黃也熱亦令黃也 其能辨之乎? 二者非止根本來有異而色澤亦自不同. 濕家之黃也. 身黃如似熏黃雖黃而色暗不明也. 至於熱盛之黃也必身黃如橘子色. 甚者勃勃出染著衣正黃如蘗 是其正黃色也. 由是觀之濕之與熱豈不異矣!大抵黃家屬太陰太陰者脾之經也. 脾者土黃土色也. 脾經爲濕熱蒸之則色見於外必發身黃.[經]曰傷寒脈浮緩手足自溫者是爲系在太陰太陰當發身黃者是矣. 熱雖內盛若已自汗出小便利者則不能發黃必也頭汗出身無汗劑頸而還小便不利渴引水漿此爲瘀熱在裏 身必發黃.黃家爲熱盛而治法亦自有殊. 傷寒八九日身黃如橘子色小便不利少腹滿者茵蔯蒿湯主之此欲泄滌其熱也. 傷寒身黃發熱者梔子蘗皮湯主之此欲解散其熱也. 傷寒瘀熱在裏 身必發黃麻黃連翹赤小豆湯主之此欲解散其熱也. 此數者泄滌解散乃治之不同亦皆折火徹熱之劑也. 一或身黃脈沈 結少腹硬而小便自利其人如狂者又爲蓄血在下焦使之黃也 必須抵當湯下之而愈.黃家既是病之已極是以有不治之者多矣非止寸口近掌無脈鼻氣出冷爲不治之疾. 又若形體如烟熏直視搖頭者是爲心絶. 環口黧黑油汗發黃是爲脾絶. 皆不治之證醫者更詳視之.
46. Mania 發狂
How to explain mania in cold damage? Mania [狂] is to run amuck so that means disquieting. Nan
Jing says that ‘when mania is about to occur, the one gets little sleep, does
not feel hungry, considers oneself wise, well spoken, and a noble person,
thoughtlessly laughs, sings a song, acts, and moves without pause.
The cause of mania is due to yang exuberance.
Nei Jing says that if yin does not overcome yang, the flow of channels gets
rapid, giving rise to mania’, ‘if evil enters yang, mania occurs, and if evil
enters yin, impediment occurs.’ Nan Jing says that double yang causes mania and
double yin causes withdrawal. Mai Jing says that yin attached yang causes mania
and yang attached yin does withdrawal. Bing Yuan says that yang evil
concentrated in yang causes mania and yin evil concentrated in yin causes
withdrawal.; judging from these, it is sure that all kinds of mania are related
with yang exuberance.
On the other hand, it is said that ‘yang brightness contracts disease,
the patient dislikes person and fire, suddenly gets frightened and one’s heart
gets to beat by wood sound, intends to be stay alone with door and window
closed, in severe case, goes up to someplace high and sings a song, runs with
taking off one’s clothes, jumps over a fence, and goes up on the roof, the
place which one try to go up is not where one usually can do’; this is that yang
evil concentrates in yang brightness. In cold damage, if heat toxin in the
stomach concentrates in the stomach, the spirit gets disquieted and mind is not
stable, after all, mania occurs. If cold damage arrives at mania, this
indicates that evil heat is in extreme, without great vomiting or
precipitation, this cannot be treated.
And also there is the other case of mania-like
when heat is in the lower burner. Shang han lun says that ‘if heat enters the
bladder, mania-like signs occur’; if it is said that mania-like signs occur,
this means that this has not yet become mania and there is just fidgetiness
whether lying or up.
On the other hand, it is said that ‘if there is manic
raving and forward-staring eyes, this indicates kidney expiry’, ‘after
promotion of sweating, heat effuses again, and there is manic raving and inability
to eat, this is due to the loss of the mind’; this cannot be treated with.
46. 發狂
傷寒發狂何以明之?
狂者猖狂也謂其不寧也.
[難經]曰狂之始發也少臥不饑而自高賢也自辯智也自貴倨也妄笑好歌樂也妄行走不休也. 狂家所起皆陽盛致然. [內經]曰陰不勝其陽脈留薄疾幷乃狂也. 又曰邪入於陽則狂邪入於陰則痺. [難經]曰重陽者狂重陰者癲. [脈經]曰陰附陽則狂陽附陰則癲. [病源]曰陽邪幷於陽則狂陰邪幷於陰則癲. 即諸經之狂爲陽盛也
明矣!又陽明之病惡人與火聞木音則惕然而驚心欲動獨閉戶牖而處甚則欲上高而歌棄衣而走逾垣上屋其所上之處皆非素能者是謂陽邪幷於陽明也. 傷寒熱毒在胃幷於心臟使神不寧而志不定遂發狂也. 傷寒至於發狂爲邪熱至極也非大吐下則不能已.又有熱在下焦其人如狂者. [經]曰熱入膀胱其人如狂. 謂之如狂則未至於狂但臥起不安爾.其或狂言目反直視又爲腎之絶. 汗出輒復熱狂言不能食又爲失志死
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Wang Ang's Collected and Analyzed Medical Formulas: (Yi Fang Ji Jie)