风温舌黄尖绎,神昏烦躁,目赤齿枯,此气血燔
蒸。宜用玉女煎加元参、连翘、人中黄、牛黄丸等
味,两清气血也。
目赤齿枯,神昏烦躁,邪已入血。故舌尖色绎,但苔仍
带黄,气热未尽。未可专凉血分,恐滋腻难清。务得玉女煎
合连翘、元参两清气血,人中黄、牛黄丸清营透邪,庶无遗
漏之弊。
风温舌绛干焦,神清脉数,而热不肯解,此热劫
胃阴。宜用复脉汤去姜桂,加鲜斛、白芍、地骨皮、
梨汁、蔗浆等味,甘凉养阴也。
神清脉数,病退之象。然热不解,而舌绛焦黑,并无苔
腻,是为无地之黑,乃热灼伤阴,胃津消烁,非甘凉濡润,
充养胃阴,则热何以清。故用复脉汤去姜、桂者,恐增热
耳,加蔗、梨者,助甘寒焉。若舌苔黄而焦黑,或老黄如沈
香色者,此为有地之黑,因热瘀在腑,宿垢未清,大便闭
结,昏宜下之。即用大黄、元明粉,生首乌,鲜生地,鲜石
斛、鲜稻根等味,养阴攻热,不必过虑。近时医辈,一见攻
下,不问应否,众口交咻,咸为诧异,此不过沽名盗利,以
图虚声。殊不知仲景先师,汗,吐、下、和、温、清、补,
泻,皆有一定之理。又有急下、微下,先攻、后攻之戒。故
命后人云:有是症,投是药,方为良医。若恐招是惹非,有
是症而不敢投是药,以致因循贻误,坐失机宜,岂得谓之良
哉。
风温病出现舌苔黄、舌尖红绛,神志昏迷、烦躁不安,眼睛发红、牙齿干枯,这是气血两燔(气血受热邪炽盛熏蒸)的表现。适宜使用玉女煎加入玄参、连翘、人中黄、牛黄丸等药物,以同时清解气分和血分的热邪。
眼睛发红、牙齿干枯、神志昏迷、烦躁不安,说明邪气已经深入血分。所以舌尖呈现红绛色,但舌苔仍然带有黄色,表明气分的热邪尚未完全清除。此时不可以专门凉血,恐怕滋腻的药物难以清除热邪。务必采用玉女煎配合连翘、玄参来两清气血,用人中黄、牛黄丸清营透邪,这样才没有遗漏病情的弊端。
风温病出现舌质红绛且干燥焦枯,神志清醒、脉搏快,但热势不肯消退,这是热邪劫伤胃阴的表现。适宜使用复脉汤去掉生姜、桂枝,加入鲜石斛、白芍、地骨皮、梨汁、甘蔗浆等药物,以甘凉之性滋养阴液。
神志清醒、脉搏快,是病情好转的迹象。然而热势不退,且舌质红绛焦黑,并没有腻苔,这称为“无地之黑”,是因为热邪灼伤阴液,胃津消烁所致。如果不使用甘凉濡润的方法充养胃阴,热势怎么能清除呢?所以使用复脉汤去掉生姜、桂枝,是担心它们增加热势;加入甘蔗、梨汁,是为了辅助甘寒清热。如果舌苔黄而焦黑,或者像沉香色那样深黄焦黑,这称为“有地之黑”,是因为热邪瘀结在腑脏,宿便未清,大便闭结不通,神志昏沉时应当使用攻下法。即使用大黄、元明粉、生首乌、鲜生地、鲜石斛、鲜稻根等药物,养阴并攻逐热邪,不必过分担忧。近代一些医生,一见到攻下法,不问是否对症,就众口一词地指责,都感到诧异,这不过是沽名钓誉、盗取利益,以图虚名罢了。殊不知张仲景先师,汗、吐、下、和、温、清、补、泻,都有固定的道理。又有急下、微下,先攻、后攻的告诫。所以教导后人说:有这种症状,就用这种药,才是好医生。如果害怕招惹是非,有这种症状却不敢用这种药,以致因循拖延贻误病情,坐失治疗良机,难道能称之为好医生吗?
In wind-heat disease, if the tongue coating is yellow with a crimson tip, accompanied by coma, irritability, red eyes, and dry teeth, this indicates **Qi-Blood Blazing Steaming** (simultaneous blazing steaming of Qi and Blood levels). It is appropriate to use **Yunü Decoction** (Jade Maiden Decoction) added with *Scrophulariae Radix* (Xuanshen), *Forsythiae Fructus* (Lianqiao), *Hao Ren Zhong Huang* (Human Middle Yellow), and **Niuhuang Wan** (Calculus Bovis Pill), etc., to clear both the Qi level and the Blood level simultaneously.
Red eyes, dry teeth, coma, and irritability indicate that the pathogenic factor has entered the Blood level. Therefore, the tongue tip appears crimson, yet the coating remains yellow, suggesting that heat in the Qi level is not yet fully cleared. One should not solely employ blood-cooling methods, as cloying and greasy substances may hinder the clearance of heat. It is essential to combine **Yunü Decoction** with *Forsythiae Fructus* and *Scrophulariae Radix* to clear both Qi and Blood levels, while using *Hao Ren Zhong Huang* and **Niuhuang Wan** to clear the Ying level and vent the pathogen, thereby avoiding omissions in treatment.
In wind-heat disease, if the tongue body is crimson, dry, and scorched, with clear consciousness and a rapid pulse, but the fever persists, this indicates that heat is devouring the Stomach Yin. It is appropriate to use **Fumai Decoction** (Restore the Pulse Decoction) without *Zingiberis Rhizoma Recens* (Shengjiang) and *Cinnamomi Ramulus* (Guizhi), adding fresh *Dendrobii Caulis* (Xianhu), *Paeoniae Radix Alba* (Baishao), *Lycii Cortex* (Digupi), pear juice, and sugarcane juice, etc., to nourish Yin with sweet and cool properties.
Clear consciousness and a rapid pulse are signs of disease regression. However, since the fever does not subside and the tongue is crimson and scorched black without a greasy coating, this is termed "blackness without ground" (no coating base), caused by heat scorching and injuring Yin, consuming Stomach fluids. If one does not use sweet, cool, and moistening methods to replenish Stomach Yin, how can the heat be cleared? Thus, removing *Zingiberis Rhizoma Recens* and *Cinnamomi Ramulus* from **Fumai Decoction** is to avoid increasing heat; adding sugarcane and pear juice assists in sweet-cold clearing. If the tongue coating is yellow and scorched black, or dark yellow like agarwood color, this is termed "blackness with ground" (coating present), indicating heat stagnation in the Fu organs, uneliminated fecal accumulation, constipation, and coma, which require purgation. One may use *Rhei Radix et Rhizoma* (Dahuang), *Natrii Sulfas* (Yuanmingfen), raw *Polygoni Multiflori Preparata Radix* (Sheng Shouwu), fresh *Rehmanniae Radix* (Xian Shengdi), fresh *Dendrobii Caulis* (Xian Shihu), and fresh rice roots, etc., to nourish Yin and attack heat, without excessive worry. Contemporary physicians, upon seeing purgative methods, often criticize indiscriminately regardless of indication, expressing astonishment. This is merely seeking fame and illicit profit for empty reputation. They fail to realize that Master Zhang Zhongjing established fixed principles for sweating, vomiting, purging, harmonizing, warming, clearing, tonifying, and draining. There are also warnings regarding urgent purgation, mild purgation, and the sequence of attacking. Hence, he instructed later generations: "When there are corresponding symptoms, administer corresponding medicines; this constitutes a good physician." If one fears attracting trouble and dares not administer corresponding medicines despite their presence, leading to procrastination, missed opportunities, and延误 of treatment, how can such a person be called a good physician?