伤风头痛,发热恶寒,咳痰带血,而忽加喘促汗
淋,脉虚如数者,其人肾阴素亏,而正不胜邪也。宜
用熟地、茯神、麦冬、桑叶、杏仁、川贝、地骨皮、
鲜玉竹、牛膝、车前、枇杷叶、清铅等味,镇逆化邪
也。
凡情欲不节,则肾水先亏,操劳过度,则阳气疏泄。若
再感风,则正不胜邪。故初起虽有头痛发热恶寒之表症,忽
而大汗淋漓,遂致阳随汗泄,肾真亦越,呼吸气促,将脱之
兆以着。斯时纵有微邪,难与疏散。急宜熟地、茯神填下
焦,麦冬、玉竹清虚热,杏仁、川贝肃肺气,车前、牛膝驱
下焦之浊饮,桑叶、地骨泄上焦之余邪,再审其邪已尽泄,
则用黄祗、五味敛之,气逆不返,更加青铅镇之。至汗多气
喘,脉软肢冷,表证既无,乃气脱之候。即于前药中去桑
叶、枇杷叶,加五味、黄祗、淡附、牡蛎,大剂频迸,或可
挽回也。喻嘉言(寓意草)中,伤风亦有载阳之症,则先得
我心之同然也。
夫风者天之阳气,温者天之热气,若非其时而见
之,即为戾气,人或染之,即为病气。都由冬春久
暖,雨泽愆期,风阳化燥,鼓荡寰宇,而人于气交之
中,素禀阴亏者,最易凑袭。故风温一症,良由先伏
温邪,后再感风,风与温合,是为风温。然温则应
火,风则应木,二气相煽,化为壮火,动辄伤肺。故
其见症,必面赤舌干,身热神迷,鼻鼾多寐,默默不
语,不思饮食,却与中风相似。过一二日后,神志反
清,语言反出,似乎欲解,但口渴喜饮,舌干烦热,
较甚者何也?以风由外解,而热自内蒸也。故初起即
宜外疏风邪,内清温热,须步步照顾阴液,勿泛泛治
风而已。倘治失其宜,传变最速,较诸温热则尤险
也。
伤风导致头痛,伴有发热和恶寒,咳嗽咳痰且痰中带血,如果突然增加气喘急促、大汗淋漓的症状,脉象虚而快(数),这是患者肾阴素来亏虚,正气不能战胜邪气的表现。适宜使用熟地黄、茯神、麦冬、桑叶、杏仁、川贝母、地骨皮、鲜玉竹、牛膝、车前子、枇杷叶、清铅等药物,以镇逆气、化解邪气。
凡是情欲没有节制,就会先导致肾水亏虚;操劳过度,就会导致阳气疏泄。如果再感受风邪,那么正气就不能战胜邪气。所以初起时虽然有头痛、发热、恶寒这些表证,但突然大汗淋漓,致使阳气随着汗液外泄,肾中真阳也随之外越,呼吸气促,这是阳气将脱的征兆显现出来。此时即使有微弱的邪气,也难以用疏散的方法治疗。急需使用熟地黄、茯神填补下焦,麦冬、玉竹清除虚热,杏仁、川贝母肃降肺气,车前子、牛膝驱除下焦的浊饮,桑叶、地骨皮宣泄上焦的残余邪气。再观察邪气是否已经全部宣泄,如果邪气已尽,则使用黄芪、五味子收敛正气;如果气逆不返,再加用清铅镇压。到了汗多气喘、脉象软弱、四肢发冷,表证已经消失的时候,这是气脱的证候。就在前面的药方中去掉桑叶、枇杷叶,加入五味子、黄芪、淡附子、牡蛎,大剂量频繁服用,或许可以挽回生机。喻嘉言在《寓意草》中,记载了伤风也有阳脱的证候,这与我的观点是相同的。
风,是天的阳气;温,是天的热气。如果不是在这个季节出现,就称为戾气,人感染了它,就成为病气。这都是由于冬春季节长久温暖,雨水缺乏,风阳化为燥气,鼓荡于天地之间,而人在气交之中,素体阴亏的人,最容易受到侵袭。所以风温这一病症,确实是由于先伏藏了温邪,后来又感受风邪,风与温相结合,就称为风温。然而温对应火,风对应木,二气相互煽动,化为壮火,动辄损伤肺脏。所以其症状表现,一定是面色红赤、舌干、身体发热、神志昏迷、鼻鼾声重、嗜睡、沉默不语、不想饮食,这与中风相似。过了一两天后,神志反而清醒,语言反而能说出,似乎想要痊愈,但是口渴喜欢饮水,舌干烦热,比较严重的情况为什么呢?这是因为风邪从外部解除,而热邪从内部蒸腾的缘故。所以初起时就应当外部疏解风邪,内部清解温热,必须步步照顾阴液,不要仅仅泛泛地治疗风邪而已。如果治疗失当,传变速度最快,比一般的温热病更加危险。
Wind-cold (Shangfeng) causing headache, accompanied by fever and aversion to cold, cough with sputum containing blood. If suddenly shortness of breath and profuse sweating occur, with a deficient and rapid pulse, this indicates that the patient's Kidney Yin has been chronically deficient, and the Healthy Qi (Zhengqi) is unable to overcome the Pathogenic Factor. It is appropriate to use Shu Di Huang (Prepared Rehmannia Root), Fu Shen (Poria with Hostwood), Mai Dong (Ophiopogon Tuber), Sang Ye (Mulberry Leaf), Xing Ren (Apricot Seed), Chuan Bei Mu (Fritillaria Cirrhosa Bulb), Di Gu Pi (Cortex Lycii), Xian Yu Zhu (Fresh Polygonatum Rhizome), Niu Xi (Achyranthes Root), Che Qian Zi (Plantago Seed), Pi Pa Ye (Loquat Leaf), and Qing Qian (Refined Lead) to subdue rebellious Qi and resolve pathogenic factors.
Whenever sexual desires are not regulated, Kidney Water (Jing/Essence) is first depleted; excessive labor causes Yang Qi to leak. If wind is contracted subsequently, Healthy Qi cannot overcome the pathogen. Thus, although there are initial exterior symptoms such as headache, fever, and aversion to cold, sudden profuse sweating leads to Yang Qi escaping with the sweat, and the True Yang of the Kidneys also escapes outward. Rapid breathing appears, signaling impending collapse. At this time, even slight pathogens are difficult to disperse. Urgently use Shu Di Huang and Fu Shen to tonify the Lower Jiao (Lower Burner); Mai Dong and Yu Zhu to clear deficiency heat; Xing Ren and Chuan Bei Mu to descend Lung Qi; Che Qian Zi and Niu Xi to drive out turbid fluid from the Lower Jiao; Sang Ye and Di Gu Pi to vent residual pathogens from the Upper Jiao (Upper Burner). Once it is confirmed that pathogens have been fully vented, use Huang Qi (Astragalus Root) and Wu Wei Zi (Schisandra Berry) to astringe; if rebellious Qi does not return, add Qing Qian to suppress it. When sweating is profuse, panting occurs, the pulse is soft, limbs are cold, and exterior signs have vanished, this is a sign of Qi collapse. Remove Sang Ye and Pi Pa Ye from the previous prescription, add Wu Wei Zi, Huang Qi, Dan Fu Zi (Processed Aconite Root), and Mu Li (Oyster Shell), administer large doses frequently, and recovery may be possible. Yu Jiayan, in *Yuyi Cao*, recorded cases of Yang collapse due to wind-cold, which aligns with my own views.
Wind is the Yang Qi of Heaven; Warmth is the hot Qi of Heaven. If these appear out of season, they become Pestilential Qi (Li Qi). If humans contract them, they become Disease Qi. This results from prolonged warmth in winter and spring, lack of rain, where Wind-Yang transforms into Dryness, agitating the universe. Humans living in the interaction of Qi and Blood are most susceptible if their constitution is inherently Yin-deficient. Therefore, Wind-Warmth (Fengwen) arises primarily from latent Warmth pathogens followed by wind contraction; wind combines with warmth, termed Wind-Warmth. Since warmth corresponds to Fire and wind corresponds to Wood, these two energies fan each other, transforming into Blazing Fire, easily damaging the Lungs. Symptoms must include red face, dry tongue, body heat, confusion/coma, snoring, drowsiness, silence, and anorexia, resembling Stroke (Zhong Feng). After one or two days, consciousness clears, speech returns, seemingly indicating resolution. However, thirst with desire to drink, dry tongue, and irritability/heat persist. Why? Because wind resolves externally while heat steams internally. Thus, initially, one should disperse wind externally and clear warmth internally, carefully protecting Yin fluids at every step, rather than treating wind generically. If treatment is inappropriate, transmission is fastest, more dangerous than ordinary Warmth diseases.