shang han lun qian zhu :Simplified Commentary on Cold Damage (傷寒論淺注, 陳修園 ) - 讀法 (how to read)

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按：宋元以後醫書 皆謂邪從三陽傳入 俱是熱證 惟有下之一法. 論中四逆、白通、理中等方 俱為直中立法. 何以謂之直中？謂不從三陽傳入 徑入三陰之臟 惟有溫之一法. 凡傳經俱為熱證 寒邪有直中而無傳經 數百年來相沿之說也. 余向亦深信其然 及臨證之久 則以為不然.“直中”二字 《傷寒論》雖無明文 而直中之病則有之. 有初病即見三陰寒證者 宜大溫之；有初病即是三陰熱證者 宜大涼之、大下之. 是寒熱俱有直中 世謂直中皆為寒證者 非也；有謂遞次傳入三陰盡無寒證者 亦非也. 蓋寒熱二氣 盛則從化 余揆其故則有二：一從病體而分 一從誤藥而變 何則？人之形有厚薄 氣有盛衰 臟有寒熱 所受之邪 每從其人之臟氣而為熱化、寒化. 今試譬之於酒 酒取諸水泉 寒物也；酒釀以曲蘖 又熱物也. 陽臟之人過飲之 不覺其寒 第覺其熱. 熱性迅發則吐血、面瘡諸熱證作矣；陰臟之人過飲之 不覺其熱 第覺其寒. 寒性凝滯則停飲、腹脹、泄瀉諸寒邪作矣 知此愈寒熱之化 由病人之體而分也. 何謂誤藥而變？凡汗下失宜 過之則傷正而虛其陽 不及則熱熾而傷其陰. 虛其陽 則從少陰陰化之證多 以太陽、少陰相表裏也；傷其陰 則從陽明陽化之證多 以太陽、陽明遞相傳也. 所謂寒化、熱化 由誤治而變者此也. 至云寒邪不相傳 更為不經之說. 仲景云：下利 腹脹滿、身體疼痛者 先溫其裏 乃攻其表 溫裏宜四逆湯 攻表宜桂枝湯 此三陽陽邪傳入三陰 邪從陰化之寒證也. 如少陰證下利 白通湯主之 此太陰寒邪傳入少陰之寒證也；如下利清穀 表寒外熱 汗出而厥者 通脈四逆湯主之 此少陰寒邪傳入厥陰之寒證也. 誰謂陰不相傳.

Note：since the song and yuan (宋元) dynasty, every medical books mentioned that every evil enters and passes through three yang (greater yang, yang brightness, and lesser yang) and they are all heat pattern, and there is only the treatment method of precipitation. The patterns of si ni tang, bai tong tang, and li zhong tang are cuased be evil which strikes directly without channel passage. What is a ‘direct strik’ (直中)? This occurs when [the evil] does not enter through the three yang and enters directly three yin(greater yin, lesser yin, reverting yin) and there is only the warming method. In general, every channel passage becomes heat pattern and when cold evil enters directly there is absence of channel passage, for a few hundred years, people had sticked on this theory. I also believed the theory firmly but it does not takes too long time for me to recongnize that the theory is not true in practice. In shang han lun there is a diasea which is caused by evil which enters directly. In initial stage, when there is cold pattern of three yin, this should be treated with warming greatly. And in initial stange, if there is heat pattern of three yin, the should be treated with cooling and precipitation. Both cold and heat pattern can occur through ‘direct entry’ (直中). It is wrong that every ‘direct entry’(直中) cuases cold pattern. It is also wrong that in case evil enteres three yin in order, there is no cold pattern. In gereral, when the two of cold and heat are exuberant, it is said that there is transformation through something, I thought about it and there is two reason. The one occurs through the body [in other words, people’s constitution] and the other does through erroneous medicine. Why is this so? In the form of body there is fat[thick] and thin, in qi there is exbueration and debilitation, and in vescera there is cold and heat, therefore contracted evil transforms into heat or cold through [according to] the person’ viscera qi. If metaphorically applied to liquor, liquor is made from water [spring], so this is cold thing, and this is made with yeat, so this is also heat thing. If a person with yang constitution drinks alcohol too much, the person will not feels cold and experience heat. The nature of heat is fast and tends to effuse and dissipate, so this causes every heat patter such as vomiting of blood, sores on the face, etc. if a person with yin constitution drinks alcohol too much, the person does not fee heat but cold. The nature of cold tends to be congealed and stagnated, so there is collecting rheum, abdominal distention, diarrhea, etc, which are cuased by cold evil. One should know that the transformation of cold and heat is divided through the patient’s constitution.1) what is it called that erroneous medicine causes transmutation？ In general, inappropriate excessive sweating or precipitation can damage right [qi] and make yang vacuous, insufficient sweating or precipitation can maks heat exuberant and damage yin. If the yang becomes vacuous, soon, the pattern of transforming into yin often occurs through lesser yin, this is because greater yang and lesser yin is in the relationship of exterior and interior. If the yin is damaged, the pattern of transforming into yang often occurs through yang brightness, this is because greater yang and yang brightness pass with each other in order. In other words, transforming into cold or heat mean that erroneous treatment causes transmutation [change]. Zhang Zhong Jing says that ‘after precipitation if there is distention and fullness in the abdomen and generalzed patin, first warm the interior and then attack the extgerior, when warming the interior, si ni tang is appropriate, and when attacking the exterior, gui zhi tang is appropriate.’; this indicates that yang evil enters three yin from three yang and evil transforms into cold pattern through yin. If there is lesser yin pattern with diarrhea, bai tong tang governs this, this is that cold evil enters lesser yin from greater yin and this is cold pattern. When there is clear-food diarrhea, the exterior is cold and the outside is heat, and sweat issues with reversal, tong mai si ni tang governs, this is that cold evil enters reverting yin from lesser yin and this is cold pattern. Who says that yin does not channel passage.

[COMMENTARY]

1) in other words, strong constitution tends to havb cold damage (ma huang tang) and heat pattern, wherease, weak constitution tends to have wind strike (gui zhi tang) and cold pattern. I recommend, before cheking of signs, fist you should check the patiant’s constitution, then you can get a hint more and guess well prognosis.