发热的表现特点与机制

概括：
这一段讲了发热翻译成heat effusion而不是通常的fever的原因，以及六经病中发热的表现特点与机制。

Heat effusion 发热:

The Chinese term 发热 is usually rendered as ”fever.” However, unlike “fever”, it includes subjective sensations of heat as well as a palpable increase in body temperature. For this reason，we consistently render it literally as “heat effusion”. Heat effusion is associated with many conditions and occurs both in externally contracted disease and miscellaneous disease (杂病 za bing disease due to causes other than external pathogens). 

发热一般翻译成fever。与fever不同，发热既包括自觉身热，也包括触摸后能感觉的体温升高。为此，我们坚持将其直译为heat effusion。发热可见于多种疾病，外感、内伤均可发生。

In externally contracted diseases of the three yang channels, heat effusion is a manifestation of the struggle between right qi and pathogenic qi; it does not necessarily indicate the presence of pathogenic heat. In the exterior syndromes of Taiyang disease, it occurs even in syndromes caused by the contraction of cold, which constitute the majority of syndromes discussed in this chapter. 

外感病的三阳病中，发热是正邪交争的主要表现，而且不意味着一定由热邪导致。太阳病篇主体的内容是讨论寒邪导致的太阳表证的发热。

In exterior syndromes, pathogenic qi is in the exterior of the body, impairing the normal function of Wei Qi; hence heat effusion is accompanied by aversion to wind or cold. Heat effusion also occurs in Yangming and Shaoyang disease. Here, however, different pathomechanisms and locations of the struggle between right qi and pathogenic qi are reflected in different accompanying signs. 

表证，邪侵肌表，卫气功能受损，故而发热会伴有恶风寒。发热也可见于阳明病、少阳病。不同的伴随症状反应不同的正邪交争的病机、病位。

In Yangming disease, the disease pathogen transforms into heat and enters the interior, so heat effusion is accompanied by aversion to heat rather than aversion to cold. In

Shaoyang disease, the struggle is taking place between the interior and exterior, so heat effusion alternates with aversion to cold. In diseases of the three yin, right qi is not strong enough to counter pathogenic qi; hence heat effusion is absent, and instead only aversion to cold is present.

阳明病，邪气化热入里，发热不恶寒，反恶热。少阳病，正邪交争于表里之间，发热与恶寒交替出现。三阴病，正气虚衰，无力抗邪，恶寒而不发热。

注释

1)subjective主观的；

2)as well as既…又…；

3)palpable明显的；

4)literally字面意思上；

5)be associated with与…有关；

6)other than除了；

7)three yang channels三阳（太阳、阳明、三阳）经；

8)manifestation表示；

9)struggle奋斗；

10)right qi正气；

11)pathogenic qi邪气；

12)pathogenic heat热邪；

13)constitute构成；

14)the majority of大多数；

15)accompany陪伴；

16)transform into转变成…；

17)rather than…而不…；

18)take place发生；

19)alternate with交替；

20)diseases of the three yin三阴病；

21)instead反而。

讲解：

发热一般是体温升高，可以触摸出、或测量到，是一个客观的症状；也可以是体温正常时患者自觉身热的主观感受。英文中的fever只是体温升高，没有自我感觉热的意思，所以译者将《伤寒论》中的发热，译为heat effusion。

Heat effusion is abnormal bodily heat that can be detected by palpation or that is experienced subjectively. Fever is the temporary increase in the body's temperature in response to a disease or illness. For this reason，we consistently translate it literally as “heat effusion”.

发热与热证不同。《素闻》“今夫热病者皆伤寒之类也”，已经把发热和热邪区分考来。邪气侵袭肌表，正邪交争，均可以引起发热。与里热不同，这种表热会伴有不同程度的恶寒。风寒表证，恶寒重发热轻；风热表证，发热重恶寒轻。

Heat effusion is deferent from pathogenic heat. Heat effusion occurring with aversion to cold or wind at the onset of illness indicates external pathogens invading the fleshy exterior. If the aversion to cold is more pronounced than the heat effusion, the syndrome is one of wind-cold. Pronounced heat effusionIf with only aversion to wind suggests wind-heat.

六经病中，太阳病发热恶寒，阳明病发热不恶寒及日晡潮热，少阳病往来寒热，而三阴病则多恶寒而不发热。

When in the six channel disease, Heat effusion with aversion to cold indicates Taiyang disease, while Heat effusion without aversion to cold indicates Yangming disease, Heat effusion alternating with aversion to cold Shaoyang disease, aversion to cold without Heat effusion the three Yin diseases.