春温一证,由冬令收藏未固,昔人以冬寒内伏,藏于少阴,入春发于少阳,以春木内应肝胆也。寒邪深伏,已经化热,昔贤以黄芩汤为主方,苦寒直清里热。热伏于阴,苦味坚阴,乃正治也。知温邪忌散,不与暴感门同法。若因外邪先受,引动在里伏热,必先辛凉以解新邪,继进苦寒以清里热。况热乃无形之气,时医多用消滞,攻治有形,胃汁先涸,阴液劫尽者多矣。
风温者,春月受风,其气已温。《经》谓“春气病在头”,治在上焦,肺位最高,邪必先伤。此手太阴气分先病,失治则入手厥阴心包络,血分亦伤。盖足经顺传,如太阳传阳明,人皆知之;肺病失治,逆传心包络,人多不知者。俗医见身热咳喘,不知肺病在上之旨,妄投荆、防、柴、葛,加入枳、朴、杏、苏、菔子、楂、麦、橘皮之属,辄云解肌消食。有见痰喘,便用大黄礞石滚痰丸,大便数行,上热愈结。幼稚谷少胃薄,表里苦辛化燥,胃汁已伤,复用大黄大苦沉降丸药,致脾胃阳和伤极,陡变惊痫,莫救者多矣。
(自注:风温肺病,治在上焦。夫春温忌汗,初病投剂,宜用辛凉,若杂入消导发散,不但与肺病无涉,劫尽胃汁,肺乏津液上供,头目清窍,徒为热气薰蒸,鼻干如煤,目瞑或上窜无泪,或热深肢厥,狂躁溺涩,胸高气促,皆是肺气不宣化之征。斯时若以肺药少加一味清降,使药力不致直趋肠中,而上痹可开,诸窍自爽,无如市医佥云结胸,皆用连、蒌、柴、枳苦寒直降,致闭塞愈甚,告毙者多。
又此证初因发热喘嗽,首用辛凉清肃上焦,如薄荷、连翘、牛蒡、象贝、桑叶、沙参、栀皮、蒌皮、花粉。若色苍,热胜烦渴,用石膏、竹叶辛寒清散,痧疹亦当宗此。若日数渐多,邪不得解,芩、连、凉膈亦可用。至热邪逆传膻中,神昏目瞑,鼻窍无涕(氵夷),诸窍欲闭,其势危急,必用至宝丹或牛黄清心丸。病减后余热,只甘寒清养胃阴足矣。)
春月暴暖忽冷,先受温邪,继为冷束,咳嗽痰喘最多,辛解凉温,只用一剂,大忌绝谷。若甚者宜昼夜竖抱勿倒,三四日。夫轻为咳,重为喘,喘急则鼻掀胸挺。
(自注:春温皆冬季伏邪,详于大方诸书,幼科亦有伏邪,治从大方。然暴感为多,如头痛恶寒发热,喘促鼻塞声重,脉浮无汗,原可表散,春令温舒,辛温宜少用,阳经表药,最忌混乱。至若身热咳喘有痰之证,只宜肺药清解,泻白散加前胡、牛蒡、薄荷之属,消食药只宜一二味;若二便俱通者,消食少用,须辨表里上中下何者为急施治。
又春季温暖,风温极多,温变热最速,若发散风寒消食,劫伤津液,变证尤速。
初起咳嗽喘促,通行用:薄荷、连翘、象贝、牛蒡、花粉、桔梗、沙参、木通、枳壳、橘红。
表解热不清用:黄芩、连翘、桑皮、花粉、地骨皮、川贝、知母、山栀。
备用方:黄芩汤、葱豉汤、凉膈散、清心凉膈散、苇茎汤、泻白散、葶苈大枣汤、白虎汤、至宝丹、牛黄清心丸、竹叶石膏汤、喻氏清燥救肺汤
里热不清,朝上凉,晚暮热,即当清解血分,久则滋清养阴。若热陷神昏,痰升喘促,急用牛黄丸之属。
风温乃肺先受邪,遂逆传心包,治在上焦,不与清胃攻下同法,幼科不知,初投发散消食,不应,改用柴、芩、瓜蒌、枳实、黄连,再下夺,不应,多致危殆,皆因不明手经之病耳。
若寒痰阻闭,亦有喘急胸高,不可与前法,用三白吐之,或妙香丸。)
夏为热病,然夏至已前,时令未为大热,《经》以先夏至病温,后夏至病暑。温邪前已申明,暑热一证,医者易眩。夏暑发自阳明,古人以白虎汤为主方。后贤刘河间创议迥出诸家,谓温热时邪,当分三焦投药,以苦辛寒为主,若拘六经分证,仍是伤寒治法,致误多矣。盖伤寒外受之寒,必先从汗解,辛温散邪是矣。口鼻吸入之寒,即为中寒阴病,治当温里,分三阴见证施治。若夫暑病,专方甚少,皆因前人略于暑,详于寒耳。考古如《金匮》暑暍痉之因,而洁古以动静分中暑中热,各具至理,兹不概述。论幼科病暑热,夹杂别病有诸,而时下不外发散消导,加入香薷一味,或六一散一服。考本草香薷辛温发汗,能泄宿水。夏热气闭无汗,渴饮停水,香薷必佐杏仁,以杏仁苦降泄气,大顺散取义若此。长夏湿令,暑必兼湿,暑伤气分,湿亦伤气,汗则耗气伤阳,胃汁大受劫烁,变病由此甚多,发泄司令,里真自虚。张凤逵云:“暑病首用辛凉,继用甘寒,再用酸泄酸敛,不必用下。”可称要言不烦矣。然幼科因暑热蔓延,变生他病,兹摘其概。
(暑邪必挟湿,状如外感风寒,忌用柴、葛、羌、防,如肌表热无汗,辛凉轻剂无误。香薷辛温气升,热服易吐,佐苦降如杏仁、黄连、黄芩则不吐。宣通上焦,如杏仁、连翘、薄荷、竹叶。
暑热深入,伏热烦渴,白虎汤、六一散。
暑病头胀如蒙,皆热盛上炽,白虎、竹叶,酒湿食滞者,加辛温通里。)
夏令受热,昏迷若惊,此为暑厥,即热气闭塞孔窍所致,其邪入络,与中络同法,牛黄丸、至宝丹芳香利窍可效。神苏以后,用清凉血分,如连翘心、竹叶心、元参、细生地、鲜生地、二冬之属。此证初起,大忌风药。初病暑热伤气,竹叶石膏汤或清肺轻剂。大凡热深厥深,四肢逆冷,但看面垢齿燥,二便不通,或泻不爽为是,大忌误认伤寒也。
(右暑厥。)
幼儿断乳纳食,值夏月脾胃主气,易于肚膨泄泻,足心热,形体日瘦,或烦渴善食,渐成五疳积聚,当审体之强弱,病之新久,有余者疏胃清热,食入粪色白,或不化,健脾佐消导清热;若湿热内郁,虫积腹痛,导滞驱虫,微下之;缓调用肥儿丸之属。
(右热疳。)
夏季秋热,小儿泄泻,或初愈未愈,满口皆生疳蚀,尝有阻塞咽候致危者,此皆在里湿盛生热,热气蒸灼,津液不生,湿热偏伤气分,治在上焦,或佐淡渗,世俗常刮西瓜翠衣治疳,取其轻扬渗利也。
(右口疳。)
夏季湿热郁蒸,脾胃气弱,水谷之气不运,湿著内蕴为热,渐至浮肿腹胀,小水不利,治之非法,水湿久渍,逆行犯肺,必生咳嗽喘促,甚则坐不得卧,俯不得仰,危期速矣。大凡喘必生胀,胀必生喘,方书以先喘后胀治在肺,先胀后喘治在脾,亦定论也。《金匮》有风水、皮水、石水、正水、黄汗,以分表里之治,河间有三焦分消,子和有磨积逐水,皆有奥义,学者不可不潜心体认,难以概述。阅近代世俗论水湿喘胀之证,以《内经》开鬼门取汗为表治,分利小便洁净府为里治;经旨病能篇谓:诸湿肿满,皆属于脾。以健脾燥湿为稳治。治之不效,技穷束手矣。不知凡病皆本乎阴阳,通表利小便,乃宣经气利腑气,是阳病治法;暖水脏温脾胃,补土以驱水,是阴病治法。治肺痹以轻开上,治脾必佐温通。若阴阳表里乖违,脏真日漓,阴阳不运,亦必作胀,治以通阳,乃可奏绩,如局方禹余粮丸,甚至三焦交阻,必用分消,肠胃窒塞,必用下夺。然不得与伤寒实热同例,擅投硝、黄、枳、朴扰动阴血。若太阴脾脏饮湿阻气,温之补之不应,欲用下法,少少甘遂为丸可也。其治实证,选用方法备采。
(喘胀备用方:葶苈大枣汤、泻白散、大顺散、牡蛎泽泻散、五苓散、越婢汤、甘遂半夏汤、控涎丹、五子五皮汤、子和桂苓汤、禹功丸、茯苓防己汤、中满分消汤、小青龙汤、木防己汤。)
吐泻一证,幼儿脾胃受伤,陡变惊搐最多。若是不正秽气触入,或口食生冷,套用正气散、六和汤、五积散之类;正气受伤,肢冷呃忒,呕吐自利,即用钱氏益黄散,有痰用星附六君子汤、理中汤等;倘热气深伏,烦渴引饮,呕逆者连香饮,黄连竹茹橘皮半夏汤;热闭神昏,用至宝丹;寒闭,用来复丹。
稚年夏月食瓜果,水寒之湿,著于脾胃,令人泄泻,其寒湿积聚,未能遽化热气,必用辛温香窜之气,古方中消瓜果之积,以丁香、肉桂,或用麝香,今七香饼治泻,亦祖此意;其平胃散胃苓汤亦可用。
疟之为病,因暑而发者居多,方书虽有痰食寒热瘴疠之互异,幼稚之疟,多因脾胃受病。然气怯神昏,初病惊痫厥逆为多,在夏秋之时,断不可认为惊痫,大方疟证,须分十二经,与咳证相等,若幼科,庸俗但以小柴胡去参,或香薷、葛根之属,不知柴胡劫肝阴,葛根竭胃汁,致变屡矣。幼稚纯阳,暑为热气,证必热多烦渴,邪自肺受者,桂枝白虎汤二进必愈。其冷食不运,有足太阴脾病见证,初用正气,或用辛温如草果、生姜、半夏之属。方书谓草果治太阴独胜之寒,知母治阳明独胜之热。疟久色夺,唇白汗多馁弱,必用四兽饮。阴虚内热,必用鳖甲、首乌、知母,便渐溏者忌用。久疟营伤,寒胜,加桂、姜。拟初中末疟门用药于左。
(初病暑风湿热疟药:
脘痞闷:枳壳、桔梗、杏仁、厚朴、瓜蒌皮、山栀、香豉。
头痛宜辛凉轻剂:连翘、薄荷、赤芍、羚羊角、蔓荆子、滑石。
重则用石膏,口渴用花粉,烦渴用竹叶石膏汤
热甚则用黄芩、黄连、山栀。)
夏季身痛属湿,羌、防辛温宜忌,宜用木防己、蚕砂。暑热邪伤,初在气分,日多不解,渐入血分,反渴不多饮,唇舌绛赤,芩、连、膏、知不应,必用血药,量佐清气热一味足矣。
(轻则用青蒿、丹皮、犀角、竹叶心、元参、鲜生地、细生地、木通、淡竹叶,若热久痞结,泻心汤选用。)
夏月热久入血,最多蓄血一证,谵语昏狂,看法以小便清长,大便必黑为是,桃核承气汤为要药。
(疟多用乌梅,以酸泄木安土之意;用常山、草果,乃劫其太阴之寒,以常山极走,使二邪不相并之谓;用人参、生姜,曰露姜饮,一以固元,一以散邪,取通神明去秽恶之义。总之久疟气馁,凡壮胆气,皆可止疟,未必真有疟鬼。又疟疾既久,深入血分,或结疟母,鳖甲煎丸设用煎方,活血通络可矣。
徐忠可云:幼儿未进谷食者,患疟久不止,用冰糖浓汤,余试果验。)
痢疾一证,古称滞下,盖里有滞浊而后下也。但滞在气,滞在血,冷伤热伤而滞非一,今人以滞为食,但以消食,并令禁忌饮食而已。
(夫疟痢皆起夏秋,都因湿热郁蒸,以致脾胃水谷不通,湿热灼气,血为粘腻,先痛后痢,痢后不爽,若偶食瓜果水寒即病,未必即变为热,先宜辛温疏利之剂。若脓血几十行,(疒(朽-木))痛后重,初用宣通驱热,如芩、连、大黄,必加甘草以缓之,非如伤寒粪坚,须用芒硝咸以软坚,直走破泄至阴,此不过苦能胜湿,寒以逐热,足可却病。古云,行血则便脓愈,导气则后重除。行血凉血,如丹皮、桃仁、延胡、黑楂、归尾、红花之属;导气如木香、槟榔、青皮、枳、朴、橘皮之属,世俗通套,不过如此。盖疟伤于经,犹可延挨,痢关乎脏,误治必危。诊之大法,先明体质强弱,肌色苍嫩,更询起居致病因由;初病体坚质实,前法可遵;久病气馁神衰,虽有腹痛后重,亦宜详审,不可概以攻积清夺施法。
噤口不纳水谷,下痢都因热升浊攻,必用大苦如芩、连、石莲清热,人参辅胃益气,热气一开,即能进食,药宜频频进二三日。
小儿热病最多者,以体属纯阳,六气著人气血,皆化为热也。饮食不化,蕴蒸于里,亦从热化矣。然有解表已复热,攻里热已复热,利小便愈后复热,养阴滋清热亦不除者,张季明谓元气无所归著,阳浮则倏热矣,六神汤主之。)
秋深初凉,稚年发热咳嗽,证似春月风温证,但温乃渐热之称,凉即渐冷之意。春月为病,犹是冬令固密之余,秋令感伤,恰值夏月发泄之后,其体质虚实不同。但温自上受,燥自上伤,理亦相等,均是肺气受病。世人误认暴感风寒,混投三阳发散,津劫燥甚,喘急告危。若果暴凉外束,身热痰嗽,只宜葱豉汤,或苏梗、前胡、杏仁、枳、桔之属,仅一二剂亦可。更有粗工亦知热病,与泻白散加芩、连之属,不知愈苦助燥,必增他变。当以辛凉甘润之方,气燥自平而愈,慎勿用苦燥劫烁胃汁。
(秋燥一证,气分先受,治肺为急,若延绵数十日之久,病必入血分,又非轻浮肺药可治,须审体质证端,古谓治病当活泼泼地,如盘走珠耳。
沈尧峰云:在天为燥,在地为金,燥亦五气之一也。然燥万物者,莫熯乎火。故火未有不燥,而燥未有不从火来,温热二证论火,即所以论燥也,若非论燥,仲景条内两渴字从何处得来,且热病条云口燥渴,明将燥字点出。喻氏云:古人以燥热为暑,故用白虎汤主治。此悟彻之言也,明乎此则温热二证火气兼燥,夫复何疑?)
春温这一病证,是由于冬季收藏功能不固所致。古人认为冬寒之邪内伏,藏于少阴(肾经),到了春季发于少阳(胆经),因为春木之气在内对应肝胆。寒邪深伏体内,已经化热,前代名医以黄芩汤为主方,用苦寒之药直接清泄里热。热邪伏于阴分,苦味能坚阴,这是正治法。要知道温邪忌用发散解表,其治法与暴感风寒不同。如果是因为外邪先受,引动在里的伏热,必须先辛凉解表以解除新感之外邪,接着再用苦寒之药清泄里热。况且热是无形的邪气,当时的医生多用消食导滞的方法,去攻治有形的积滞,导致胃汁先被耗干,阴液被劫夺殆尽的情况很多。
风温,是春季感受风邪,此时气候已变暖。《内经》说“春气病在头”,治疗应针对上焦,肺的位置最高,邪气必先伤害它。这是手太阴肺经的气分先发病,若失治则传入手厥阴心包络,血分也会受伤。足经的顺传,如太阳传阳明,人们都知道;但肺病失治,逆传心包络,人们大多不知道。世俗医生见到身热咳喘,不明白肺病在上焦的道理,妄用荆芥、防风、柴胡、葛根,加入枳实、厚朴、杏仁、苏叶、莱菔子、山楂、麦芽、橘皮等药物,就说是解肌消食。有的见到痰喘,就用大黄、礞石滚痰丸,大便数次后,上部的热邪反而更加郁结。幼儿谷气少、胃壁薄,表里用苦辛药化燥,胃汁已伤,再用大黄等大苦沉降的丸药,导致脾胃阳气受损极重,突然变成惊痫,无法救治的情况很多。
(自注:风温肺病,治疗在上焦。春温忌用汗法,初病投药,宜用辛凉,若杂入消导发散药,不但与肺病无关,还会劫尽胃汁,肺缺乏津液上供,头目清窍,徒然被热气熏蒸,出现鼻干如煤、闭目或眼球上窜无泪、或热深肢厥、狂躁尿涩、胸高气促等症状,这些都是肺气不宣化的征象。这时若在肺药中加一味清降药,使药力不致直趋肠道,而上部痹阻可开,诸窍自然清爽,无奈市井医生都说这是结胸,都用黄连、瓜蒌、柴胡、枳实等苦寒直降之药,导致闭塞更甚,死亡者很多。
另外此证初起因发热喘嗽,首选辛凉清肃上焦的药,如薄荷、连翘、牛蒡子、象贝母、桑叶、沙参、栀子皮、瓜蒌皮、天花粉。若面色苍老,热盛烦渴,用石膏、竹叶辛寒清散,痧疹也应当遵循此法。若天数渐多,邪气不得解,黄芩、黄连、凉膈散也可用。至热邪逆传膻中,神昏闭目,鼻窍无涕,诸窍欲闭,病情危急,必须用至宝丹或牛黄清心丸。病减后的余热,只用甘寒之药清养胃阴即可。)
春季天气突然变暖忽又变冷,先受温邪,继为寒气束缚,咳嗽痰喘最多见,辛凉解表只需一剂,最忌讳绝食断粮。如果病情严重,宜昼夜竖抱不要倒置,持续三四天。轻的为咳,重的为喘,喘急则鼻孔煽动、胸部挺起。
(自注:春温都是冬季伏邪,详细记载于大方书籍中,儿科也有伏邪,治疗参照大方。然而暴感较多,如头痛恶寒发热、喘促鼻塞声重、脉浮无汗,原本可以表散,春季气候温舒,辛温药宜少用,阳经表药,最忌讳混乱。至于身热咳喘有痰之证,只宜用肺药清解,泻白散加前胡、牛蒡子、薄荷等,消食药只宜一二味;若二便俱通者,消食药少用,须辨别表里上中下何者为急再施治。
另外春季温暖,风温极多,温变热最快,若发散风寒消食,劫伤津液,变证尤其迅速。
初起咳嗽喘促,通用方:薄荷、连翘、象贝母、牛蒡子、天花粉、桔梗、沙参、木通、枳壳、橘红。
表解热不清用:黄芩、连翘、桑白皮、天花粉、地骨皮、川贝母、知母、山栀。
备用方:黄芩汤、葱豉汤、凉膈散、清心凉膈散、苇茎汤、泻白散、葶苈大枣汤、白虎汤、至宝丹、牛黄清心丸、竹叶石膏汤、喻氏清燥救肺汤。
里热不清,早晨凉晚上热,即当清解血分,久则滋清养阴。若热陷神昏,痰升喘促,急用牛黄丸之类。
风温乃肺先受邪,遂逆传心包,治疗在上焦,不与清胃攻下同法,儿科医生不懂,初投发散消食药,无效,改用柴胡、黄芩、瓜蒌、枳实、黄连,再下夺,无效,多导致危殆,都是因为不明白手经之病。
若寒痰阻闭,也有喘急胸高,不可与前法,用三白吐之,或妙香丸。)
夏季为热病,然而夏至以前,时令未为大热,《内经》说先夏至病温,后夏至病暑。温邪前文已申明,暑热这一病证,医生容易迷惑。夏暑发自阳明,古人以白虎汤为主方。后贤刘河间创议超出各家,认为温热时邪,应当分三焦投药,以苦辛寒为主,若拘泥于六经分证,仍是伤寒治法,导致误治很多。大概伤寒外受的寒邪,必先从汗解,辛温散邪是对的。口鼻吸入的寒邪,即为中寒阴病,治疗当温里,分三阴见证施治。至于暑病,专用方很少,皆因前人略于暑,详于寒罢了。考古如《金匮要略》中暑暍痉的原因,而洁古以动静分中暑中热,各具至理,这里不再概述。论儿科病暑热,夹杂别病有吗,而时下不外发散消导,加入香薷一味,或六一散一服。考本草香薷辛温发汗,能泄宿水。夏热气闭无汗,渴饮停水,香薷必佐杏仁,以杏仁苦降泄气,大顺散取义若此。长夏湿令,暑必兼湿,暑伤气分,湿亦伤气,汗则耗气伤阳,胃汁大受劫烁,变病由此甚多,发泄司令,里真自虚。张凤逵说:“暑病首用辛凉,继用甘寒,再用酸泄酸敛,不必用下。”可称要言不烦了。然而儿科因暑热蔓延,变生他病,这里摘取其概要。
(暑邪必挟湿,状如外感风寒,忌用柴胡、葛根、羌活、防风,如肌表热无汗,辛凉轻剂无误。香薷辛温气升,热服易吐,佐苦降如杏仁、黄连、黄芩则不吐。宣通上焦,如杏仁、连翘、薄荷、竹叶。
暑热深入,伏热烦渴,白虎汤、六一散。
暑病头胀如蒙,皆热盛上炽,白虎、竹叶,酒湿食滞者,加辛温通里。)
夏令受热,昏迷若惊,此为暑厥,即热气闭塞孔窍所致,其邪入络,与中络同法,牛黄丸、至宝丹芳香利窍可效。神苏以后,用清凉血分药,如连翘心、竹叶心、玄参、细生地、鲜生地、二冬之类。此证初起,大忌风药。初病暑热伤气,竹叶石膏汤或清肺轻剂。大凡热深厥深,四肢逆冷,但看面垢齿燥,二便不通,或泻不爽为是,大忌误认伤寒也。
(右暑厥。)
幼儿断乳纳食,值夏月脾胃主气,易于肚膨泄泻,足心热,形体日瘦,或烦渴善食,渐成五疳积聚,当审体之强弱,病之新久,有余者疏胃清热,食入粪色白,或不化,健脾佐消导清热;若湿热内郁,虫积腹痛,导滞驱虫,微下之;缓调用肥儿丸之类。
(右热疳。)
夏季秋热,小儿泄泻,或初愈未愈,满口皆生疳蚀,尝有阻塞咽候致危者,此皆在里湿盛生热,热气蒸灼,津液不生,湿热偏伤气分,治在上焦,或佐淡渗,世俗常刮西瓜翠衣治疳,取其轻扬渗利也。
(右口疳。)
夏季湿热郁蒸,脾胃气弱,水谷之气不运,湿著内蕴为热,渐至浮肿腹胀,小水不利,治之非法,水湿久渍,逆行犯肺,必生咳嗽喘促,甚则坐不得卧,俯不得仰,危期速矣。大凡喘必生胀,胀必生喘,方书以先喘后胀治在肺,先胀后喘治在脾,亦定论也。《金匮要略》有风水、皮水、石水、正水、黄汗,以分表里之治,河间有三焦分消,子和有磨积逐水,皆有奥义,学者不可不潜心体认,难以概述。阅近代世俗论水湿喘胀之证,以《内经》开鬼门取汗为表治,分利小便洁净府为里治;经旨病能篇谓:诸湿肿满,皆属于脾。以健脾燥湿为稳治。治之不效,技穷束手矣。不知凡病皆本乎阴阳,通表利小便,乃宣经气利腑气,是阳病治法;暖水脏温脾胃,补土以驱水,是阴病治法。治肺痹以轻开上,治脾必佐温通。若阴阳表里乖违,脏真日漓,阴阳不运,亦必作胀,治以通阳,乃可奏绩,如局方禹余粮丸,甚至三焦交阻,必用分消,肠胃窒塞,必用下夺。然不得与伤寒实热同例,擅投硝、黄、枳、朴扰动阴血。若太阴脾脏饮湿阻气,温之补之不应,欲用下法,少少甘遂为丸可也。其治实证,选用方法备采。
(喘胀备用方:葶苈大枣汤、泻白散、大顺散、牡蛎泽泻散、五苓散、越婢汤、甘遂半夏汤、控涎丹、五子五皮汤、子和桂苓汤、禹功丸、茯苓防己汤、中满分消汤、小青龙汤、木防己汤。)
吐泻一证,幼儿脾胃受伤,陡变惊搐最多。若是不正秽气触入,或口食生冷,套用正气散、六和汤、五积散之类;正气受伤,肢冷呃忒,呕吐自利,即用钱氏益黄散,有痰用星附六君子汤、理中汤等;倘热气深伏,烦渴引饮,呕逆者连香饮,黄连竹茹橘皮半夏汤;热闭神昏,用至宝丹;寒闭,用来复丹。
稚年夏月食瓜果,水寒之湿,著于脾胃,令人泄泻,其寒湿积聚,未能遽化热气,必用辛温香窜之气,古方中消瓜果之积,以丁香、肉桂,或用麝香,今七香饼治泻,亦祖此意;其平胃散胃苓汤亦可用。
疟之为病,因暑而发者居多,方书虽有痰食寒热瘴疠之互异,幼稚之疟,多因脾胃受病。然气怯神昏,初病惊痫厥逆为多,在夏秋之时,断不可认为惊痫,大方疟证,须分十二经,与咳证相等,若幼科,庸俗但以小柴胡去参,或香薷、葛根之类,不知柴胡劫肝阴,葛根竭胃汁,致变屡矣。幼稚纯阳,暑为热气,证必热多烦渴,邪自肺受者,桂枝白虎汤二进必愈。其冷食不运,有足太阴脾病见证,初用正气,或用辛温如草果、生姜、半夏之类。方书谓草果治太阴独胜之寒,知母治阳明独胜之热。疟久色夺,唇白汗多馁弱,必用四兽饮。阴虚内热,必用鳖甲、首乌、知母,便渐溏者忌用。久疟营伤,寒胜,加桂、姜。拟初中末疟门用药于左。
(初病暑风湿热疟药:
脘痞闷:枳壳、桔梗、杏仁、厚朴、瓜蒌皮、山栀、香豉。
头痛宜辛凉轻剂:连翘、薄荷、赤芍、羚羊角、蔓荆子、滑石。
重则用石膏,口渴用花粉,烦渴用竹叶石膏汤
热甚则用黄芩、黄连、山栀。)
夏季身痛属湿,羌活、防风辛温宜忌,宜用木防己、蚕砂。暑热邪伤,初在气分,日多不解,渐入血分,反渴不多饮,唇舌绛赤,芩、连、膏、知不应,必用血药,量佐清气热一味足矣。
(轻则用青蒿、丹皮、犀角、竹叶心、玄参、鲜生地、细生地、木通、淡竹叶,若热久痞结,泻心汤选用。)
夏月热久入血,最多蓄血一证,谵语昏狂,看法以小便清长,大便必黑为是,桃核承气汤为要药。
(疟多用乌梅,以酸泄木安土之意;用常山、草果,乃劫其太阴之寒,以常山极走,使二邪不相并之谓;用人参、生姜,曰露姜饮,一以固元,一以散邪,取通神明去秽恶之义。总之久疟气馁,凡壮胆气,皆可止疟,未必真有疟鬼。又疟疾既久,深入血分,或结疟母,鳖甲煎丸设用煎方,活血通络可矣。
徐忠可云:幼儿未进谷食者,患疟久不止,用冰糖浓汤,余试果验。)
痢疾一证,古称滞下,盖里有滞浊而后下也。但滞在气,滞在血,冷伤热伤而滞非一,今人以滞为食,但以消食,并令禁忌饮食而已。
(夫疟痢皆起夏秋,都因湿热郁蒸,以致脾胃水谷不通,湿热灼气,血为粘腻,先痛后痢,痢后不爽,若偶食瓜果水寒即病,未必即变为热,先宜辛温疏利之剂。若脓血几十行,腹痛后重,初用宣通驱热,如芩、连、大黄,必加甘草以缓之,非如伤寒粪坚,须用芒硝咸以软坚,直走破泄至阴,此不过苦能胜湿,寒以逐热,足可却病。古云,行血则便脓愈,导气则后重除。行血凉血,如丹皮、桃仁、延胡索、黑楂、归尾、红花之类;导气如木香、槟榔、青皮、枳、朴、橘皮之类,世俗通套,不过如此。盖疟伤于经,犹可延挨,痢关乎脏,误治必危。诊之大法,先明体质强弱,肌色苍嫩,更询起居致病因由;初病体坚质实,前法可遵;久病气馁神衰,虽有腹痛后重,亦宜详审,不可概以攻积清夺施法。
噤口不纳水谷,下痢都因热升浊攻,必用大苦如芩、连、石莲清热,人参辅胃益气,热气一开,即能进食,药宜频频进二三日。
小儿热病最多者,以体属纯阳,六气著人气血,皆化为热也。饮食不化,蕴蒸于里,亦从热化矣。然有解表已复热,攻里热已复热,利小便愈后复热,养阴滋清热亦不除者,张季明谓元气无所归著,阳浮则倏热矣,六神汤主之。)
秋深初凉,稚年发热咳嗽,证似春月风温证,但温乃渐热之称,凉即渐冷之意。春月为病,犹是冬令固密之余,秋令感伤,恰值夏月发泄之后,其体质虚实不同。但温自上受,燥自上伤,理亦相等,均是肺气受病。世人误认暴感风寒,混投三阳发散,津劫燥甚,喘急告危。若果暴凉外束,身热痰嗽,只宜葱豉汤,或苏梗、前胡、杏仁、枳、桔之类,仅一二剂亦可。更有粗工亦知热病,与泻白散加芩、连之类,不知愈苦助燥,必增他变。当以辛凉甘润之方,气燥自平而愈,慎勿用苦燥劫烁胃汁。
(秋燥一证,气分先受,治肺为急,若延绵数十日之久,病必入血分,又非轻浮肺药可治,须审体质证端,古谓治病当活泼泼地,如盘走珠耳。
沈尧峰云:在天为燥,在地为金,燥亦五气之一也。然燥万物者,莫熯乎火。故火未有不燥,而燥未有不从火来,温热二证论火,即所以论燥也,若非论燥,仲景条内两渴字从何处得来,且热病条云口燥渴,明将燥字点出。喻氏云:古人以燥热为暑,故用白虎汤主治。此悟彻之言也,明乎此则温热二证火气兼燥,夫复何疑?)
Chapter on External Contraction of Hidden Pathogenic Qi in Three Seasons
Spring-warmth (Chunwen) is a syndrome caused by the failure of storage during winter. Ancients believed that cold pathogenic qi from winter hides internally, residing in Shaoyin (the Kidney meridian), and emerges in Spring in Shaoyang (the Gallbladder meridian), as the Wood energy of Spring corresponds internally to the Liver and Gallbladder. The cold pathogen hides deeply and has already transformed into heat. Former sages used Huangqin Tang (Scutellaria Decoction) as the main formula, using bitter-cold herbs to directly clear interior heat. Heat hiding in the Yin aspect, bitter taste can firm the Yin; this is the correct treatment. One must know that warm pathogens are contraindicated for dispersing/sweating methods; its treatment differs from acute external contraction. If new external pathogen is first contracted, triggering latent heat inside, one must first use acrid-cool herbs to resolve the new external pathogen, then proceed with bitter-cold herbs to clear interior heat. Moreover, heat is formless qi; contemporary physicians often use digestion-promoting methods to treat有形 (formful) stagnation, causing stomach fluids to dry up first, leading to many cases where yin fluids are depleted.
Wind-warmth (Fengwen) occurs when wind is contracted in spring, when the climate is already warming. The Classics state "Spring disease affects the head," so treatment should target the Upper Jiao. The Lung position is highest, so pathogenic qi must injure it first. This is a disease of the Qi aspect of the Hand-Taiyin Lung meridian initially; if untreated, it enters the Hand-Jueyin Pericardium meridian, injuring the Blood aspect. The sequential transmission of Foot meridians, such as Taiyang transmitting to Yangming, is well known; however, people mostly do not know that Lung disease, if untreated, transmits inversely to the Pericardium meridian. Vulgar physicians seeing fever, cough, and wheezing do not understand the principle that Lung disease is in the upper part, and recklessly administer Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Chaihu (Bupleurum), Gegen (Pueraria), adding Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Xingren (Apricot Seed), Suye (Perilla Leaf), Fuzi (Radish Seed), Shanzha (Hawthorn), Maoya (Malt), and Chenpi (Tangerine Peel), claiming to release the muscle layer and digest food. Some, seeing phlegm and wheezing, use Dahuang (Rhubarb) and Mengshi (Calamine) Gun Tan Wan (Rolling Phlegm Pill); after several bowel movements, the heat above becomes more constrained. Children have little Gu Qi (grain qi) and thin stomach walls; using bitter-acrid drugs for exterior-interior transformation causes dryness, damaging stomach fluids. Using Dahuang and other bitter-cold sinking pills further damages Spleen-Stomach Yang harmony, suddenly transforming into fright-epilepsy, with many untreatable cases.
(Self-note: Wind-warmth Lung disease is treated in the Upper Jiao. Spring-warmth forbids sweating. Initial prescription should use acrid-cool; mixing in digestion-promoting and dispersing drugs not only fails to address Lung disease but depletes stomach fluids. Lacking fluid supply, the Lung allows head and eye orifices to be steamed by heat, causing nose dryness like coal, closed eyes or upward gaze without tears, deep heat with cold limbs, mania/restlessness, difficult urination, chest distension and rapid breathing—all signs of Lung Qi failing to diffuse. At this time, adding one clearing-descending herb to Lung herbs prevents force rushing to intestines, opening upper obstruction and refreshing orifices. Yet market doctors all call this Jie Xiong (Chest Binding), using Lianqiao (Forsythia), Gualou (Trichosanthes), Chaihu, Zhishi bitter-cold direct descending, worsening blockage, leading to many deaths.
Furthermore, this syndrome begins with fever, cough, and wheezing; first use acrid-cool to clear and purify the Upper Jiao, such as Bohe (Mint), Lianqiao, Niubangzi (Burdock Fruit), Xiangbei (Fritillaria Thunbergii), Sangye (Mulberry Leaf), Shashen (Glehnia), Zhipi (Gardenia Peel), Gualou Pi (Trichosanthes Peel), Huafen (Trichosanthes Root). If complexion is dark, heat is severe with vexation and thirst, use Shigao (Gypsum) and Zhuye (Bamboo Leaf) acrid-cold to clear and disperse; sand-rash should follow this. If days pass and pathogen is not resolved, Huangqin (Scutellaria), Huanglian (Coptis), Liangge San (Cooling Chest Powder) can also be used. When heat pathogen inversely transmits to Danzhong (Chest Center), causing confusion and closed eyes, no nasal discharge, orifices about to close, condition is critical; Zhibao Dan (Precious Treasure Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) must be used. After improvement, residual heat requires only sweet-cold herbs to clear and nourish Stomach Yin.)
In spring, sudden warmth followed by cold contracts warmth pathogen first, then cold binds it, causing much cough and phlegm-wheezing. Acrid-release and cool-warmth require only one dose; fasting is strictly forbidden. If severe, hold upright day and night without tilting for three to four days. Light is cough, heavy is wheezing; urgent wheezing involves flaring nostrils and protruding chest.
(Self-note: Spring-warmth is all winter hidden pathogen, detailed in general medicine books; pediatrics also has hidden pathogen, treating according to general medicine. However, acute contraction is common, e.g., headache, aversion to cold, fever, panting, nasal congestion, heavy voice, floating pulse, no sweat—originally can be released. Spring climate is warm and comfortable, acrid-warm herbs should be used sparingly; Yang meridian exterior drugs are most forbidden to be mixed. As for fever, cough, wheezing with phlegm, only Lung herbs for clearing resolution are suitable, such as Xiebai San (Drain White Powder) plus Qianhu (Peucedanum), Niubangzi, Bohe; digestion-promoting herbs only one or two flavors; if both bowels and urine are open, use digestion promoters sparingly; must distinguish whether exterior, interior, upper, middle, or lower is urgent before treating.
Also, spring is warm, wind-warmth is very common; warmth transforms to heat fastest. If dispersing wind-cold and promoting digestion deplete fluids, transformation syndromes occur even faster.
Initial cough and wheezing, common usage: Bohe, Lianqiao, Xiangbei, Niubangzi, Huafen, Jiegeng (Platycodon), Shashen, Mutong (Akebia), Zhike (Immature Bitter Orange), Juhong (Tangerine Pith).
Exterior resolved, heat not cleared: Huangqin, Lianqiao, Sangpi (Mulberry Root Bark), Huafen, Digupi (Groundcherry Bark), Chuanbei (Fritillaria Cirrhosa), Zhimu (Anemarrhena), Shanzhi (Gardenia).
Backup formulas: Huangqin Tang, Congchi Tang, Liangge San, Qingxin Liangge San, Weijing Tang, Xiebai San, Tingli Dazao Tang, Baihu Tang, Zhibao Dan, Niuhuang Qingxin Wan, Zhuye Shigao Tang, Yu Shi Qingzao Jiufei Tang.
Interior heat not cleared, cool in morning, hot in evening, must clear and resolve Blood aspect; long-term nourish yin with clearing. If heat traps causing confusion, phlegm rising, wheezing, urgently use Niuhuang Wan type.
Wind-warmth is Lung first contracting pathogen, then inversely transmitting to Pericardium; treatment is in Upper Jiao, not same method as clearing Stomach and attacking accumulation. Pediatricians don't know, initially giving dispersing and digestion-promoting drugs, ineffective, then changing to Chaihu, Huangqin, Gualou, Zhishi, Huanglian, again purging downward, ineffective, mostly leading to danger, all due to not understanding Hand meridian diseases.
If cold-phlegm blocks, there is also urgent wheezing and high chest, cannot use previous methods; induce vomiting with Sanbai, or Miaoxiang Wan.)
Summer is for heat diseases, but before Summer Solstice, seasonal climate is not yet very hot. The Classics say "before Summer Solstice disease is Warmth, after Summer Solstice disease is Summerheat." Warmth pathogen was explained earlier; Summerheat-heat syndrome confuses physicians easily. Summerheat originates from Yangming. Ancients used Baihu Tang (White Tiger Decoction) as main formula. Later scholar Liu Hejian proposed differing from others, saying warm-heat seasonal pathogen should be medicated by dividing Three Jiao, mainly using bitter-acrid-cold. If sticking to Six Meridian differentiation, it remains Cold Damage treatment, causing many errors. Generally, cold pathogen externally contracted in Cold Damage must be resolved via sweating; acrid-warm dispersing pathogen is correct. Cold pathogen inhaled through mouth/nose is Middle-Cold Yin disease, treatment should warm interior, treating according to Three Yin manifestations. As for Summerheat disease, specific formulas are few, because predecessors neglected Summerheat and detailed Cold Damage. Ancient texts like *Jingui Yaolue* discuss Summerheat, Sunstroke, and Spasm; Jiuguy distinguished Zhongshu (Heatstroke) and Zhongre (Heat Injury) by movement/stillness, each having profound logic, not summarized here. Discussing pediatric Summerheat, are there mixed other diseases? Current practice is only dispersing and digestion-promoting, adding one dose of Xiangru (Mosla) or Liuyi San (Six-to-One Powder). Pharmacopoeia says Xiangru is acrid-warm, induces sweating, drains old water. Summer heat closes Qi, no sweat, thirsty drinking stagnant water; Xiangru must be assisted by Xingren, as Xingren bitter-descends and drains Qi, Dayushun San takes meaning thus. Late Summer damp command, Summerheat must combine with dampness; Summerheat injures Qi aspect, dampness also injures Qi; sweating consumes Qi and damages Yang, stomach fluids greatly depleted, many transformations arise from this, venting commander, internal truth self-deficient. Zhang Fengkui said: "Summerheat disease first uses acrid-cool, then sweet-cold, then sour-draining and sour-astringing, no need for purgation." This can be called essential words not verbose. However, pediatrics due to Summerheat spreading, transforming into other diseases, here extract its outline.
(Summerheat pathogen must carry dampness, resembling external wind-cold; forbid Chaihu, Gegen, Qianghuo, Fangfeng. If muscle surface hot, no sweat, acrid-cool light agent is error-free. Xiangru acrid-warm, Qi rises, hot drink easy to vomit; assist bitter-descending like Xingren, Huanglian, Huangqin then no vomiting. Unblock Upper Jiao, like Xingren, Lianqiao, Bohe, Zhuye.
Summerheat deep, hidden heat vexation/thirst, Baihu Tang, Liuyi San.
Summerheat disease head distension like covered, all heat severe burning up, Baihu, Zhuye; wine-damp food-stagnation, add acrid-warm unblocking interior.)
Summer season heat injury, coma resembling fright, this is Summerheat Jue (Syncope), caused by heat qi blocking orifices; pathogen enters collaterals, same method as Collateral Stroke, Niuhuang Wan, Zhibao Dan aromatic benefiting orifices can be effective. After spirit returns, use cooling Blood aspect drugs, like Lianqiao Xin (Forsythia Heart), Zhuye Xin (Bamboo Leaf Heart), Xuanshen (Scrophularia), Xi Shengdi (Fine Rehmannia), Xian Shengdi (Fresh Rehmannia), Er Dong (Two Winter Melons) type. This syndrome initial stage, strictly forbid Wind drugs. Initial Summerheat injuring Qi, Zhuye Shigao Tang or light Lung-clearing agent. Generally heat deep, Jue deep, limbs inverted cold, look at greasy face, dry teeth, urine/feces not passing, or loose stool unsatisfactory is correct; strictly forbid misidentifying as Cold Damage.
(Right Summerheat Jue.)
Toddler weaning and eating, value Summer month Spleen-Stomach ruling Qi, prone to abdominal distension and diarrhea, sole heat, body daily thinning, or vexation/thirst good appetite, gradually forming Five Kan Accumulation, must examine body strength, disease new/long, excess ones疏胃清热 (vent Stomach clear heat), food eaten feces white, or undigested, strengthen Spleen assist digestion promote clearing heat; if damp-heat internal depression, parasite accumulation abdominal pain, guide stagnation expel parasites, slight purgation; slow regulation use Fei'er Wan type.
(Right Heat Kan.)
Summer Autumn heat, pediatric diarrhea, or just healed not healed, full mouth all grow Kan erosion, once had blocking throat causing danger, this all in-dampness strong generating heat, heat qi steaming scorching, fluids not born, damp-heat bias injuring Qi aspect, treatment in Upper Jiao, or assist light seepage, secular often scrape Watermelon Green Skin treating Kan, taking its light floating seeping benefit.
(Right Mouth Kan.)
Summer damp-heat郁蒸 (stifling steaming), Spleen-Stomach Qi weak, grain-water Qi not moving, damp adhering internal accumulating as heat, gradually to edema abdominal distension, small water not beneficial, treating illegally, water-damp long soaking, reverse attacking Lung, must generate cough wheezing, even sit cannot lie, bend cannot straight, danger period fast. Generally wheezing must generate distension, distension must generate wheezing, medical books say first wheezing then distension treatment in Lung, first distension then wheezing treatment in Spleen, also fixed conclusion. *Jingui Yaolue* has Fengshui (Wind Edema), Pishui (Skin Water), Shishui (Stone Water), Zhengshui (Regular Water), Huanghan (Yellow Sweat), to divide exterior-interior treatment, Hejian has Three Jiao separate elimination, Zihe has grinding accumulation chasing water, all have profound meaning, scholars cannot not潜心体认 (concentrate mind experience), hard to summarize. Read recent secular discussing water-damp wheezing-distension syndrome, using *Neijing* Kai Guimen (Open Ghost Gate) taking sweat as exterior treatment, separating benefiting small water cleansing Fu as interior treatment; Classic intent Bingneng Pian says: All damp swelling-fullness, all belong to Spleen. Strengthen Spleen dry damp as stable treatment. Treating not effective, skill exhausted hands tied. Not knowing all diseases base on Yin-Yang, unblocking exterior benefiting small water, is宣经气利腑气 (diffuse meridian Qi benefit Fu Qi), is Yang disease treatment method; warming Water Organ warming Spleen-Stomach, supplement Earth driving water, is Yin disease treatment method. Treating Lung Bi lightly opening upper, treating Spleen must assist warm-unblocking. If Yin-Yang exterior-interior deviate, Zang True daily leaking, Yin-Yang not moving, also must make distension, treat with unblocking Yang, then can achieve merit, like Bureau Formula Yuyuliang Wan, even Three Jiao cross-blocking, must use separate elimination, Intestines-Stomach blocked, must use purging-down. But cannot with Cold Damage excess heat same example, arbitrarily administering Xiaoshi (Mirabilite), Huanglian (Coptis), Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark) disturbing Yin-blood. If Taiyin Spleen organ drinking damp obstructing Qi, warming it supplementing it not responding, want to use purging method, slightly Gan Sui (Euphorbia Kansui) as pill possible. Its treating excess syndrome, selected methods prepared collected.
(Wheezing-Distension Backup Formulas: Tingli Dazao Tang, Xiebai San, Dayushun San, Muli Zexie San, Wuling San, Yuespi Tang, Gansui Banxia Tang, Kongxian Dan, Wuzi Wupi Tang, Zihe Guiling Tang, Yugong Wan, Fuling Fangji Tang, Zhongman Fenxiao Tang, Xiao Qinglong Tang, Mufangji Tang.)
Vomit-diarrhea syndrome, toddler Spleen-Stomach injured, suddenly transforming fright-tremor most common. If improper foul air touches in, or mouth eats raw-cold, copy Zhengqi San, Liuhe Tang, Wuji San type; Zhengqi injured, limb cold hiccup, vomit spontaneous diarrhea, immediately use Qian Shi Yihuang San, with phlegm use Xingfu Liujunzi Tang, Lizhong Tang etc.; if heat qi deep hidden, vexation-thirst drawing drink, vomit-reverse use Lianxiang Yin, Huanglian Zhuru Jupi Banxia Tang; heat closing confusion, use Zhibao Dan; cold closing, use Laifu Dan.
Young age Summer month eating melon-fruit, water-cold dampness, adhering to Spleen-Stomach, making person diarrhea, its cold-damp accumulation, unable quickly transform heat qi, must use acrid-warm aromatic penetrating Qi, ancient formula eliminating melon-fruit accumulation, using Dingxiang (Clove), Rougui (Cinnamon Bark), or using Shexiang (Musk), now Seven-Aromatic Cake treating diarrhea, also ancestors this meaning; its Pingwei San Weiling Tang also can use.
Malaria disease, due to Summerheat emerging mostly, medical books although have phlegm-food cold-heat miasma pestilence mutual difference, young child Malaria, mostly due to Spleen-Stomach receiving disease. However Qi timid spirit confused, initial disease fright-epilepsy Jue-ni mostly, in Summer-Autumn time, absolutely cannot consider as fright-epilepsy, general medicine Malaria syndrome, must divide Twelve Meridians, equal to Cough syndrome, if pediatrics, vulgar only with Xiaochaihu removing Ginseng, or Xiangru, Gegen type, not knowing Chaihu robs Liver Yin, Gegen exhausts Stomach Juice, causing transformations repeatedly. Young child pure Yang, Summerheat is heat qi, syndrome must heat more vexation-thirst, pathogen from Lung receiving, Guizhi Baihu Tang two advances must heal. Its cold-food not moving, has Foot-Taiyin Spleen disease manifesting, initial use Zhengqi, or use acrid-warm like Caoguo (Black Cardamom), Shengjiang (Fresh Ginger), Banxia (Pinellia) type. Medical books say Caoguo treats Taiyin alone winning cold, Zhimu treats Yangming alone winning heat. Malaria long color snatched, lips white sweat much weak, must use Sishe Yin (Four Beasts Drink). Yin deficiency internal heat, must use Biejia (Turtle Shell), Shouwu (Polygonum Multiflorum), Zhimu, stool gradually loose forbid use. Long malaria Ying injured, cold winning, add Guizhi (Cinnamon Twig), Shengjiang. Draft beginning-middle-end Malaria door medication on left.
(Initial disease Summerheat wind-damp-heat Malaria medicine:
Epigastric stuffy-suffocating: Zhike, Jiegeng, Xingren, Houpo, Gualou Pi, Shanzhi, Xiangchi (Fermented Soybean).
Headache suitable acrid-cool light agent: Lianqiao, Bohe, Chishao (Red Peony Root), Lingyangjiao (Antelope Horn), Manjingzi (Vitex Fruit), Huashi (Talc).
Heavy then use Shigao, thirsty use Huafen, vexation-thirst use Zhuye Shigao Tang
Heat severe then use Huangqin, Huanglian, Shanzhi.)
Summer season body pain belongs to dampness, Qianghuo (Notopterygium), Fangfeng acrid-warm suitable forbid, suitable use Mufangji (Stephania Tetrandra), Can Sha (Silkworm Frass). Summerheat pathogen injury, initial in Qi aspect, days more not resolving, gradually enter Blood aspect, contrary thirsty not much drink, lips tongue crimson, Qin-Lian-Gao-Zhimu not responding, must use Blood drugs, measure assist clearing Qi heat one flavor sufficient.
(Light then use Qinghao (Artemisia Annua), Danpi (Moutan Bark), Xijiao (Rhinoceros Horn - substitute with Buffalo Horn), Zhuye Xin, Xuanshen, Xian Shengdi, Xi Shengdi, Mutong, Dan Zhuye (Light Bamboo Leaf), if heat long stuck-binding, Xiexin Tang selected.)
Summer month heat long entering Blood, mostly Xueyu (Blood Stasis) one syndrome, delirium confusion madness, looking method with urine clear-long, feces must black is correct, Taohé Chengqi Tang (Peach Kernel Decocting Qi Decoction) is key medicine.
(Malaria mostly use Wumei (Dark Plum), with sour draining Wood calming Earth meaning; use Changshan (Dichroa), Caoguo,乃劫其太阴之寒 (rob its Taiyin cold), with Changshan extremely walking, making two pathogens not combining meaning; use Renshen (Ginseng), Shengjiang, called Lujiang Yin (Dew Ginger Drink), one to solid Yuan, one to scatter pathogen, taking unblocking Spirit removing filth meaning. Anyway long malaria Qi weak,凡是壮胆气 (all strengthening Gallbladder Qi), can stop malaria, not necessarily truly have Malaria Ghost. Also Malaria disease since long, deep entering Blood aspect, or knot Malaria Mother, Biejia Jian Wan (Turtle Shell Frying Pill) set use decoction formula, activating blood unblocking collaterals possible.
Xu Zhongke said: Toddler not entered grain food, suffering Malaria long not stopping, use Rock Sugar thick soup, I test indeed verified.)
Dysentery syndrome, ancient called Zhixia (Stagnant Down), covering inside has stagnation turbidity then down. But stagnation in Qi, stagnation in Blood, cold injury heat injury and stagnation not one, modern people take stagnation as food, only with digesting food, and order taboo diet only.
(For Malaria Dysentery all rise Summer-Autumn, all due to damp-heat stifling steaming, causing Spleen-Stomach grain-water not passing, damp-heat burning Qi, Blood becomes sticky, first pain then dysentery, dysentery after not satisfying, if occasionally eat melon-fruit water-cold then sick, not necessarily immediately transform to heat, first suitable acrid-warm unblocking-benefiting agent. If pus-blood dozens rows, abdominal pain tenesmus, initial use unblocking driving heat, like Qin-Lian-Dahuang, must add Gancao (Licorice) to缓之 (slow it), not like Cold Damage feces hard, must use Mangxiao (Mirabilite) salty to soften hardness, straight walk breaking leaking to Yin, this only bitter can overcome damp, cold to chase heat, sufficient to repel disease. Ancient said, moving blood then pus-stool heals, guiding Qi then tenesmus removes. Moving blood cooling blood, like Danpi, Taoren (Peach Kernel), Yanhu (Corydalis), Hei Zha (Black Hawthorn), Guiwei (Angelica Tail), Honghua (Safflower) type; guiding Qi like Muxiang (Aucklandia), Binglang (Areca Nut), Qingpi (Green Tangerine Peel), Zhishi, Houpo, Jupi type, secular common routine, only so. For Malaria injured in Meridian, still can delay, Dysentery concerns Zang, mistreating must danger. Diagnosis big method, first clarify body strength, skin color dark-tender, further ask living habits causing cause; initial disease body hard substance solid, previous method can follow; long disease Qi weak spirit decay, although have abdominal pain tenesmus, also suitable careful examine, cannot generally with attacking accumulation clearing-purging apply method.
Jinkou (Clamped Mouth) not accepting grain-water, lower dysentery all due to heat rising turbid attacking, must use great bitter like Qin-Lian-Shilian (Lotus Seed) clearing heat, Renshen assisting Stomach boosting Qi, heat qi one open, then able eat food, medicine suitable frequently advance two-three days.
Pediatric heat disease most, because body belongs pure Yang, Six Qi attaching to person Qi-Blood, all transform to heat. Food digestion not transforming, fermenting inside, also from heat transforming. However there releasing exterior already recurring heat, attacking interior heat already recurring heat, benefiting small water healing after recurring heat, nourishing yin moistening clearing heat also not removing, Zhang Jiming said Yuan Qi nowhere settling, Yang floating then sudden heat, Liushen Tang main it.)
Autumn deep initial cool, young child fever cough, syndrome resembles Spring month Wind-Warmth syndrome, but Warmness is gradual heat name, Cool is gradual cold meaning. Spring month disease, still is Winter month solid-sealed remainder, Autumn month feeling-injury, exactly value Summer month venting-after, its body substance empty-solid different. But Warmness from top receiving, Dryness from top injuring, reason also equal, all are Lung Qi receiving disease. World people mistakenly recognize acute feeling wind-cold, mix throw Three Yang dispersing, Jin robbed dryness severe, wheezing urgent warning danger. If truly sudden cold outside binding, body heat phlegm cough, only suitable Congchi Tang, or Sugeng (Perilla Stem), Qianhu, Xingren, Zhiji, Jiejie type, only one-two doses also ok. More rough worker also know heat disease, give Xiebai San add Qin-Lian type, not knowing more bitter assist dryness, must increase other transformation. Should use acrid-cool sweet-moist formula, Qi dryness self-level then heal, carefully do not use bitter-dry roasting Scorching Stomach Juice.
(Autumn Dryness one syndrome, Qi aspect first receiving, treating Lung is urgent, if lingering dozens days long, disease must enter Blood aspect, also not light-floating Lung drug can treat, must examine body substance syndrome end, ancient said treating disease should lively-lively, like plate rolling pearl ear.
Shen Yaofeng said: In Heaven is Dryness, in Earth is Metal, Dryness also Five Qi one. However drying Ten Thousand Things, none hotter than Fire. So Fire not without dryness, and Dryness not without from Fire coming, Warm-Heat two syndrome discussing Fire, is therefore discussing Dryness, if not discussing Dryness, Zhongjing clause inside two Thirst characters from where come, and Heat disease clause say mouth-dry-thirst, clearly point out Dryness character. Yu Shi said: Ancient people take Dryness-Heat as Summerheat, so use Baihu Tang main treating. This enlightened speech also, understand this then Warm-Heat two syndrome Fire Qi combine Dryness, what doubt?)