阳脉浮滑阴脉濡弱者更遇于风变为风温(此前热未歇又感于风者也难经曰中风之脉阳浮而滑阴濡而弱风来乘热故变
风温)
若发汗以身灼热者名曰风温风温为病脉阴阳俱浮自汗出身重多眠睡鼻息必鼾语言难出若被下者小便不利直视失溲
若被火者微发黄色剧则如惊痫时螈 若火熏之一逆尚引日再逆促命期(成 伤寒发汗已则身凉若发汗已身灼热者非伤寒
为风温也风伤于上而阳受风气风与温相合则伤卫脉阴阳俱浮自汗出者卫受邪也卫者气也风则伤卫温则伤气身重多眠睡
者卫受风温而气昏也鼻息必鼾语言难出者风温外甚而气拥不利也若被下者则伤脏气太阳膀胱经也内经曰膀胱不利为癃
不约为遗溺癃者小便不利也太阳之脉起目内 内经曰瞳子高者太阳不足戴眼者太阳已绝小便不利直视失溲为下后竭津
液损脏气风温外胜经络欲绝也为难治若被火者则火助风温成热微者热瘀而发黄剧者热甚而生风如惊痫而时螈 也先曾
被火为一逆若更以火熏之是再逆也一逆尚犹延引时日而不愈其再逆者必致危殆故云促命期)
附
活 风温者脉尺寸俱浮头疼身热常自汗出体重其息必喘四肢不收嘿嘿但欲眠治在少阴厥阴不可发汗发即谵语独语
内烦躁不得卧若惊痫目乱无精如此死者医杀之耳风温忌发汗宜葳蕤汤身灼热者知母干葛汤如渴甚者栝蒌根汤脉沉身重
汗出者汉防己汤
萎蕤汤 治风温兼疗冬温及春月中风伤寒发热头眩疼咽喉干舌强胸内疼痞腰背强
葛根 白芷 麻黄(用沸汤泡) 杏仁(去尖皮双仁者) 甘草(炙各半两) 萎蕤(七钱半) 石膏(杵碎) 羌
活(去芦各一两) 川芎(三钱) 青木香(一钱)上 咀每服五钱水一盏半煎半钟日三四服
又方
萎蕤 白薇 麻黄 独活 杏仁 川芎 青木香 甘草(各一两) 石膏(三两)上 咀以水八升煮取三升
去滓分三服取汗若一寒一热加朴硝二钱半大黄三两下之如无木香可用麝香一分短剧方云葳蕤汤治冬温春月中风伤寒则
发头脑疼痛咽喉干舌强肉疼心胸痞满腰背强
知母干葛汤 治风温身体灼热甚者
知母 葳蕤(各三钱) 天南星(生) 麻黄(去根节) 防风 杏仁 羌活(各二钱) 甘草 黄芩 木香 升
麻人参 川芎(各一钱) 石膏(六钱) 葛根(八钱)上 咀每服五钱水一盏半煎至一盏去滓服
防己汤 治风温脉浮身重汗出(一方无人参)
防己(四两) 甘草(炙) 黄 (蜜炙) 人参(各一两) 生姜(二两) 白术(三两)上 咀每服五钱水一
盏半煮取一中盏去滓饮讫仍坐被中汗出如虫行或被卧取汗出(许学士云风温误汗用防己黄 汤救之)
栝蒌根汤 治风温灼热大渴
石膏 人参 干葛(各二钱) 栝蒌根(三钱) 防风 知母(各一钱半) 甘草(一钱)上作一服水二钟煎至一
钟通口服滓再煎
葛根龙胆汤 治风温脉弱身重汗出
石膏(五分) 甘草(七分) 龙胆草 桂枝(各一钱无汗不用) 白芍药 大青(各一钱半) 葛根 升麻(各
二钱) 葳蕤(三钱) 生姜(三片)上煎服法同前
海 治风温活人本方葳蕤汤以有麻黄不敢用宜白术汤主之(方见前太阳病发热条)若头眩汗出筋惕肉 者加牡蛎若
腰背强硬者加羌活若舌干发渴者加人参若身灼热甚者加知母若身体重多汗者加黄 若内伤冷者不加
阳脉浮滑,阴脉濡弱,如果再感受风邪,就会转变为风温病(这是此前热邪未完全消退,又再次感受风邪所致。《难经》说:中风病的脉象是阳脉浮而滑,阴脉濡而弱。风邪乘袭热邪,所以变为风温)。
如果采用发汗法治疗,导致身体灼热的,称为风温。风温这种病,寸关尺三部脉象都浮,自汗出,身体沉重,嗜睡,呼吸时必然有鼾声,言语困难。如果误用泻下法,会导致小便不利,两眼直视,大小便失禁。如果误用火疗,轻微的发黄,严重的如同惊痫发作,时时抽搐。如果用火熏法,这是一种逆治,尚且会拖延病程;如果是第二次逆治,则会加速死亡(成无己注:伤寒发汗后身体应当凉爽,如果发汗后身体依然灼热,就不是伤寒,而是风温。风邪伤于上部,阳经受风气侵袭,风与温邪相合,则损伤卫气。脉象阴阳俱浮,自汗出,是卫气受邪的表现。卫属于气,风邪伤卫,温邪伤气。身体沉重、嗜睡,是卫气受到风温侵袭而昏沉。呼吸有鼾声、言语困难,是风温邪气外盛,导致气机壅滞不通。如果误用泻下法,则损伤脏气,特别是太阳膀胱经的气。《内经》说:膀胱气化不利则为癃闭,约束无力则为遗溺。癃就是小便不利。太阳经脉起于目内眦。《内经》说:瞳子高是太阳经气不足,戴眼(眼球上翻)是太阳经气已绝。小便不利、直视、失禁,是因为下法耗竭津液,损伤脏气,风温邪气外盛,经络欲绝,这属于难治之症。如果误用火疗,火邪助长风温,化为热邪。轻者热郁发黄,重者热极生风,如同惊痫并伴有抽搐。先前已经误用火疗是一次逆治,如果再用火熏,就是第二次逆治。一次逆治尚且拖延时日不能痊愈,两次逆治必定导致危殆,所以说“促命期”即加速死亡)。
附方:
风温病,寸尺脉俱浮,头痛,身体发热,经常自汗出,身体沉重,呼吸必然气喘,四肢无力收持,沉默寡言只想睡觉。治疗应在少阴、厥阴经考虑,不可发汗。如果发汗,会导致谵语、独语、心中烦躁不得卧。如果像惊痫一样,目光散乱无神,如此死者,是医生误治造成的。风温忌用发汗法,宜用葳蕤汤。身体灼热的,用知母干葛汤。如口渴严重的,用栝蒌根汤。脉沉、身体沉重、汗出的,用汉防己汤。
萎蕤汤:治疗风温,兼治冬温及春月中风伤寒,症状为发热、头眩痛、咽喉干燥、舌强、胸中疼痛、痞闷、腰背强直。
药材:葛根、白芷、麻黄(用沸水浸泡)、杏仁(去尖皮及双仁者)、甘草(炙,各半两)、萎蕤(七钱半)、石膏(捣碎)、羌活(去芦,各一两)、川芎(三钱)、青木香(一钱)。
用法:将药材切碎,每次服用五钱,加水一盏半,煎至半钟,每日三四次服用。
又一方:
药材:萎蕤、白薇、麻黄、独活、杏仁、川芎、青木香、甘草(各一两)、石膏(三两)。
用法:将药材切碎,用水八升,煮取三升,去渣,分三次服用,以出汗为度。如果有一阵冷一阵热的症状,加朴硝二钱半、大黄三两,以泻下之法治疗。如果没有木香,可用麝香一分。《短剧方》说葳蕤汤治疗冬温、春月中风伤寒,症状为头脑疼痛、咽喉干燥、舌强、肌肉疼痛、心胸痞满、腰背强直。
知母干葛汤:治疗风温身体灼热严重者。
药材:知母、葳蕤(各三钱)、天南星(生用)、麻黄(去根节)、防风、杏仁、羌活(各二钱)、甘草、黄芩、木香、升麻、人参、川芎(各一钱)、石膏(六钱)、葛根(八钱)。
用法:将药材切碎,每次服用五钱,加水一盏半,煎至一盏,去渣服用。
防己汤:治疗风温脉浮、身体沉重、汗出。(另一方无人参)
药材:防己(四两)、甘草(炙)、黄芪(蜜炙)、人参(各一两)、生姜(二两)、白术(三两)。
用法:将药材切碎,每次服用五钱,加水一盏半,煮取一中盏,去渣饮用。服完后仍坐在被中,出汗感觉如虫行爬动;或者躺卧以取汗。(许学士说:风温误用发汗法,用防己黄芪汤来补救)。
栝蒌根汤:治疗风温灼热、大渴。
药材:石膏、人参、干葛(各二钱)、栝蒌根(三钱)、防风、知母(各一钱半)、甘草(一钱)。
用法:以上为一服量,用水二钟,煎至一钟,通口服下,药渣再煎。
葛根龙胆汤:治疗风温脉弱、身体沉重、汗出。
药材:石膏(五分)、甘草(七分)、龙胆草、桂枝(各一钱,无汗不用)、白芍药、大青(各一钱半)、葛根、升麻(各二钱)、葳蕤(三钱)、生姜(三片)。
用法:煎服方法同前。
海藏(张元素/李东垣学派观点):治疗风温,依据《活人书》本方葳蕤汤,因为有麻黄不敢使用,宜用白术汤为主方(方见前文太阳病发热条)。如果头眩、汗出、筋惕肉瞤的,加牡蛎;如果腰背强硬的,加羌活;如果舌干发渴的,加人参;如果身体灼热严重的,加知母;如果身体沉重多汗的,加黄芪;如果内伤冷食的,不加。
Yang pulse is floating and slippery, yin pulse is soft and weak. If exposed to wind again, it transforms into Wind-Warmth (this occurs when previous heat has not subsided and wind is contracted again. *Nan Jing* states: the pulse of Wind-Strike is yang floating and slippery, yin soft and weak. Wind attacks heat, thus transforming into Wind-Warmth).
If diaphoresis is induced and the body becomes burning hot, it is named Wind-Warmth. In Wind-Warmth disease, the pulses at cun, guan, and chi are all floating; there is spontaneous sweating, heaviness of the body, excessive sleepiness, snoring in respiration, and difficulty in speech. If purgation is mistakenly applied, it leads to difficult urination, fixed gaze, and loss of bowel and bladder control. If fire therapy is mistakenly applied, mild cases result in yellowing of the skin; severe cases resemble convulsive epilepsy with occasional spasms. If moxibustion or fumigation is used, this is a first error that prolongs the illness; a second error accelerates death (Cheng Wuji notes: After diaphoresis for Cold Damage, the body should be cool. If the body remains burning hot after diaphoresis, it is not Cold Damage but Wind-Warmth. Wind damages the upper part, affecting the Yang channels. Wind combining with Warmth damages the Defensive Qi. Pulses being floating indicates Defensive Qi invasion; spontaneous sweating confirms this. Wind damages the Defensive layer, Warmth damages the Qi layer. Heaviness and sleepiness indicate Defensive Qi obscured by Wind-Warmth. Snoring and speech difficulty indicate external excess of Wind-Warmst obstructing Qi flow. Mistaken purgation damages Zang Qi, specifically the Taiyang Bladder channel. *Nei Jing* states: Bladder dysfunction causes retention of urine (Long), and lack of restraint causes enuresis. Long refers to difficult urination. The Taiyang channel originates from the inner canthus. *Nei Jing* states: High pupils indicate Taiyang deficiency; staring upward indicates Taiyang exhaustion. Difficult urination, fixed gaze, and incontinence result from purgation depleting fluids and damaging Zang Qi, while external Wind-Warmth threatens the meridians. This is difficult to treat. Mistaken fire therapy aids Wind-Warmth, generating Heat. Mild heat stagnation causes jaundice; severe heat generates Wind, resembling epilepsy with spasms. A previous fire treatment was one error; adding fumigation is a second error. One error prolongs the illness; two errors lead to critical danger, hence "accelerating death".)
Appendix:
Wind-Warmth presents with floating pulses at both cun and chi, headache, fever, frequent spontaneous sweating, heavy body,必喘 (inevitable panting), flaccidity of the four limbs, silence, and desire to sleep. Treatment should focus on Shaoyin and Jueyin channels; diaphoresis is contraindicated. Inducing sweat leads to delirium, muttering, internal irritability, and inability to lie down. Death resembling epilepsy with scattered gaze is due to medical error. Wind-Warmth contraindicates diaphoresis; Wei Yu Tang is appropriate. For burning heat, Zhi Mu Gan Ge Tang is used. For severe thirst, Gua Lou Gen Tang is used. For sinking pulse, heavy body, and sweating, Han Fang Ji Tang is used.
Wei Yu Tang: Treats Wind-Warmth, also Winter-Warmth, and Spring Wind-Cold with symptoms of fever, vertigo, headache, dry throat, stiff tongue, chest pain, fullness, and stiffness in waist and back.
Ingredients: Gegen (Kudzu Root), Baizhi (Angelicae Dahuricae Radix), Mahuang (Ephedrae Herba - soaked in boiling water), Xingren (Armeniacae Semen Amarum - remove tip, skin, and twin kernels), Gancao (Licorice Root - honey-fried, each 0.5 liang), Weiyu (Polygonati Rhizoma - 7.5 qian), Shigao (Gypsum Fibrosum - crushed), Qianghuo (Notopterygii Rhizoma et Radix - remove rhizome, each 1 liang), Chuanxiong (Ligusticum Chuanxiong Rhizoma - 3 qian), Qingmuxiang (Aucklandiae Radix - 1 qian).
Usage: Coarsely powder. Take 5 qian per dose, add 1.5 sheng of water, decoct to 0.5 zhong. Take 3-4 times daily.
Another Prescription:
Ingredients: Weiyu, Baiwei (Cynanchi Atrati Radix), Mahuang, Duhuo (Angelicae Pubescentis Radix), Xingren, Chuanxiong, Qingmuxiang, Gancao (each 1 liang), Shigao (3 liang).
Usage: Coarsely powder. Decoct in 8 sheng of water to obtain 3 sheng. Strain and divide into three doses. Aim for sweating. If alternating chills and fever occur, add Poxiao (Mirabilite) 2.5 qian and Dahuang (Rhei Radix et Rhizoma) 3 liang to purge. If Muxiang is unavailable, use Shexiang (Moschus) 1 fen. *Duan Ju Fang* states Wei Yu Tang treats Winter-Warmth and Spring Wind-Cold with symptoms of head pain, dry throat, stiff tongue, muscle pain, chest fullness, and back stiffness.
Zhi Mu Gan Ge Tang: Treats severe burning heat in Wind-Warmth.
Ingredients: Zhi Mu (Anemarrhenae Rhizoma), Weiyu (each 3 qian), Tiannanxing (Arisaematis Rhizoma - raw), Mahuang (remove roots and joints), Fangfeng (Saposhnikoviae Radix), Xingren, Qianghuo (each 2 qian), Gancao, Huangqin (Scutellariae Radix), Muxiang (Vladimiriae Radix), Shengma (Cimicifugae Rhizoma), Renshen (Ginseng Radix), Chuanxiong (each 1 qian), Shigao (6 qian), Gegen (8 qian).
Usage: Coarsely powder. Take 5 qian per dose, add 1.5 sheng of water, decoct to 1 sheng. Strain and take.
Fang Ji Tang: Treats Wind-Warmth with floating pulse, heavy body, and sweating. (Another version lacks Renshen).
Ingredients: Fangji (Stephaniae Tetrandrae Radix - 4 liang), Gancao (honey-fried), Huangqi (Astragali Radix - honey-fried), Renshen (each 1 liang), Shengjiang (Fresh Ginger - 2 liang), Baizhu (Atractylodis Macrocephalae Rhizoma - 3 liang).
Usage: Coarsely powder. Take 5 qian per dose, add 1.5 sheng of water, decoct to 1 zhong. Strain and drink. After drinking, sit wrapped in blankets until sweating feels like insects crawling; or lie down to induce sweat. (Xu Yishi states: If Wind-Warmth is mistakenly treated with diaphoresis, Fang Ji Huang Qi Tang saves the patient).
Gua Lou Gen Tang: Treats Wind-Warmth with burning heat and extreme thirst.
Ingredients: Shigao, Renshen, Gan Ge (each 2 qian), Gua Lou Gen (Trichosanthis Radix - 3 qian), Fangfeng, Zhi Mu (each 1.5 qian), Gancao (1 qian).
Usage: One dose. Add 2 zhong of water, decoct to 1 zhong. Drink thoroughly. Decoct the dregs again.
Gegen Longdan Tang: Treats Wind-Warmth with weak pulse, heavy body, and sweating.
Ingredients: Shigao (5 fen), Gancao (7 fen), Longdancao (Gentianae Radix), Guizhi (Cinnamomi Ramulus - each 1 qian, omit if no sweating), Baishao (Paeoniae Radix Alba), Daqing (Indigo Naturalis - each 1.5 qian), Gegen, Shengma (each 2 qian), Weiyu (3 qian), Shengjiang (3 slices).
Usage: Decoct and take as above.
Haizang (Zhang Yuansu/Li Dongyuan school): For treating Wind-Warmth, based on the *Huo Ren Shu*, Wei Yu Tang contains Mahuang which is avoided; therefore, Baizhu Tang is preferred (see formula under Taiyang Fever section earlier). If vertigo, sweating, and muscle twitching occur, add Muli (Ostrea Concha). If waist and back stiffness occur, add Qianghuo. If dry tongue and thirst occur, add Renshen. If severe burning heat occurs, add Zhi Mu. If heavy body and profuse sweating occur, add Huangqi. If internal cold injury from food occurs, do not add [Huangqi].