春温一症。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。幼医多用消滞。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。失治则入手厥阴心胞络。血分亦伤。盖足经顺传。如太阳传阳明。人皆知之。肺病失治。逆
传心胞络。幼科多不知者。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
杏苏卜子查麦广皮之属。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。
按此症风温肺病。治在上焦。夫风温春温忌汗。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。徒为热气熏蒸。鼻干如煤。目暝。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。诸窍自爽无如城市庸医。佥云结胸。皆用连蒌柴枳。苦寒直降。
致闭塞愈甚。告毙甚多。
按此症。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。痧症亦当宗此。若日数渐多。邪不得解。芩连凉膈亦
可选用。至热邪逆传入膻中。神昏目暝。鼻窍无涕泪。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。
春温这一病症,是由于冬季封藏功能不固所致。古人认为,冬寒之邪内伏,藏于少阴经;到了春季发作时,发于少阳经,这是因为春季的木气在体内对应肝胆的缘故。
寒邪深伏体内,已经转化为热邪。以前的医家以黄芩汤作为主要方剂,用苦寒之药直接清泄里热。热邪伏藏在阴分,苦味药物能够坚固阴液,这是正确的治疗方法。
要知道,温病邪气忌讳使用发散解表的方法,这与暴感(突然感受外邪)的治疗原则不同。如果是先受了外邪,进而引动了体内的伏热,那么必须先使用辛凉的药物来解除新受的外邪,随后再进服苦寒的药物以清泄里热。况且热邪属于无形的“气”,年幼的医生多用消食导滞的方法,去攻治有形的积滞,导致胃中津液先被耗竭,阴液被劫夺殆尽的情况很多。
【备用方】:黄芩汤、葱豉汤(用于新邪引动伏邪的情况)、凉膈散、清心凉膈散。
风温病,是在春季感受了风邪,此时的气候之气已经变暖。《内经》说:“春气之病在头。”治疗应针对上焦。肺的位置最高,邪气必然首先伤害肺脏。这属于手太阴肺经的气分先发病,如果失治,就会传入手厥阴心包络,血分也会受到损伤。足经的传变是顺传的,比如太阳经传给阳明经,人们都知道。但肺病如果失治,会逆传至心包络,这是儿科医生大多不了解的。世俗医生见到身体发热、咳嗽气喘,不知道肺病位于上焦的道理,妄投荆芥、防风、柴胡、葛根等药物,并加入枳实、厚朴、杏仁、苏子、卜子(莱菔子)、山楂、麦芽、广陈皮之类的药物,就声称能解肌消食。有的见到痰喘,就用大黄、礞石制作滚痰丸,使大便多次排泄,结果上部的热邪更加郁结。幼儿谷气少,胃气薄弱,表里之间因使用苦辛药物而化燥,胃汁已经受伤,如果再复用大黄等大苦大寒沉降的丸药,导致脾胃阳气受损极其严重,突然转变为惊痫,无法救治的情况很多。
按语:此症为风温肺病,治疗应针对上焦。风温和春温都忌讳发汗。初病投药,宜用辛凉之法。如果杂入消导和发散药物,不仅与肺病无关,还会劫尽胃汁,导致肺缺乏津液上供,头目清窍只被热气熏蒸,出现鼻干如煤烟色、眼睛闭合或向上窜动无泪,或者热邪深入四肢厥冷、狂躁、小便涩痛、胸部高耸呼吸急促等症状,这些都是肺气不能宣发转化的征象。此时如果使用肺经药物,稍微加一味清降的药,使药力不至于直趋肠道,那么上部的痹阻可以打开,各个孔窍自然清爽。无奈城市中的庸医,都说这是结胸证,都用黄连、瓜蒌、柴胡、枳实等苦寒直降的药物,导致闭塞更加严重,死亡的人很多。
按语:此症起初因为发热、喘嗽,首选辛凉药物,清肃上焦。如薄荷、连翘、牛蒡子、象贝母、桑叶、沙参、栀子皮、瓜蒌皮、天花粉。如果面色苍老、热盛烦渴,用石膏、竹叶进行辛寒清散。痧症也应当遵循这个原则。如果天数渐多,邪气不得解除,黄芩、黄连、凉膈散也可以选择使用。直到热邪逆传入膻中,出现神志昏迷、眼睛闭合、鼻窍无涕泪、各种孔窍将要闭塞,病情危急,必须使用至宝丹,或者牛黄清心丸。病势减轻后的余热,只用甘寒药物清养胃阴就可以了。
Chunwen (Spring Warmth) is a syndrome caused by the failure of storage and consolidation during winter. Ancients believed that cold pathogenic factors from winter lie latent within, hidden in Shaoyin (Lesser Yin). Upon entering spring, it erupts in Shaoyang (Lesser Yang), as the Wood Qi of spring corresponds internally to the Liver and Gallbladder.
When cold pathogenic factors are deeply latent and have already transformed into heat, past sages used Huangqin Tang (Scutellaria Decoction) as the primary formula. Bitter-cold herbs directly clear interior heat. Since heat lies latent in the Yin aspect, bitter flavors firm the Yin; this is the correct treatment method.
It must be known that warm pathogenic factors contraindicate dispersing methods; they do not follow the same principles as sudden exogenous infections (Baogan). If an external pathogen is first contracted, thereby stirring up latent interior heat, one must first use acrid-cool herbs to resolve the new external pathogen, followed by bitter-cold herbs to clear the interior heat. Moreover, heat is formless Qi. Inexperienced physicians often use methods for resolving stagnation to attack有形 (formidable/physical) accumulations, leading to the premature depletion of Stomach fluids and frequent cases where Yin fluids are entirely exhausted.
[Alternative Formulas]: Huangqin Tang (Scutellaria Decoction); Congchi Tang (Green Onion and Fermented Soybean Decoction) [for new pathogens stirring up latent pathogens]; Liangge San (Cool the Diaphragm Powder); Qingxin Liangge San (Clear Heart Cool the Diaphragm Powder).
Fengwen (Wind Warmth) occurs when wind is contracted in spring, when the atmospheric Qi is already warm. The Classics state: "Diseases of Spring Qi affect the head." Treatment should target the Upper Jiao (Upper Burner). The Lung is located at the highest position, so pathogenic factors inevitably injure it first. This is a disease of the Qi aspect of the Hand-Taiyin Lung Meridian initially. If mismanaged, it enters the Hand-Jueyin Pericardium Meridian, injuring the Blood aspect as well. Transmission along the Foot meridians is sequential (Shunchuan), such as Taiyang transmitting to Yangming, which everyone knows. However, if Lung disease is mismanaged, it transmits inversely (Nichuan) to the Pericardium Meridian, a fact largely unknown to pediatricians. Vulgar physicians, seeing fever, cough, and wheezing, fail to understand the principle that Lung disease resides in the upper part. They recklessly prescribe Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Chaihu (Bupleurum), and Gegen (Pueraria), adding Zhishi (Immature Bitter Orange), Houpo (Magnolia Bark), Xingren (Apricot Seed), Suzi (Perilla Fruit), Boluizi (Radish Seed), Shanzha (Hawthorn), Maoya (Malt), and Guangchenpi (Citrus Peel). They claim these resolve the muscle layer and digest food. Seeing phlegm and wheezing, they use Dagong (Rhubarb) and Mengshi (Magnetite) to make Guntan Wan (Rolling Phlegm Pill), causing multiple bowel movements. Consequently, upper heat becomes more constrained. Children have little Gu Qi (Grain Qi) and thin Stomach Qi. The use of acrid-warm and bitter-cold drugs on both exterior and interior leads to drying transformation, injuring Stomach fluids. Reusing Dagong and other bitter-cold, sinking pills further damages Spleen and Stomach Yang harmony, suddenly transforming into Jingxian (Convulsive Epilepsy), with many cases becoming incurable.
Commentary: This case involves Fengwen Lung disease; treatment targets the Upper Jiao. Both Fengwen and Chunwen contraindicate sweating. Initial medication should employ acrid-cool methods. If mixed with digestive and dispersing agents, not only does it fail to address the Lung disease, but it also exhausts Stomach fluids. The Lung lacks Jin-Ye (Body Fluids) to supply upwards. The orifices of the head and eyes are merely steamed by hot Qi, resulting in a nose dry as coal, closed eyes, or upward-gazing eyes without tears. Alternatively, deep heat causes limb coldness (Jue), mania, restlessness, and dysuria. Chest distension and rapid breathing are all signs of Lung Qi failing to diffuse and transform. At this time, using Lung-targeting herbs with just one additional clearing-and-descending agent prevents the medicinal force from rushing directly to the intestines. This opens upper obstruction, allowing all orifices to become clear. Regrettably,庸医 (quack physicians) in cities all diagnose this as Jiexiong (Chest Binding), prescribing Lianqin (Scutellaria), Gualou (Trichosanthes), Chaihu (Bupleurum), and Zhishi (Immature Bitter Orange). These bitter-cold direct-descending agents cause even greater closure, leading to many deaths.
Commentary: Initially, due to fever, wheezing, and coughing, acrid-cool herbs should be used first to clear and purify the Upper Jiao, such as Bohe (Mint), Lianqiao (Forsythia), Niubangzi (Arctium Seed), Xiangbei (Fritillaria Thunbergii), Sangye (Mulberry Leaf), Shashen (Glehnia), Zhipi (Gardenia Peel), Loupi (Trichosanthes Peel), and Huafen (Trichosanthes Root). If the complexion is dark/cyanotic with severe heat, irritability, and thirst, use Shigao (Gypsum) and Zhuye (Bamboo Leaf) for acrid-cold clearing and dispersing. Shazheng (Sha Disease/Rash Illness) should also follow this principle. If days pass and the pathogen is not resolved, Huangqin (Scutellaria), Huanglian (Coptis), and Liangge San (Cool the Diaphragm Powder) can be selected. When heat pathogen inversely transmits to Danzhong (Chest Center/Shanzhong), causing coma, closed eyes, absence of nasal discharge and tears, and impending closure of all orifices, the situation is critical. Zhibao Dan (Precious Treasure Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) must be used. After the illness subsides, residual heat requires only sweet-cold herbs to clear and nourish Stomach Yin.