暑证心烦脉已虚,溺红热渴自欷 ,轻宜天水(散,又名六一散)从便去,重则香薷饮取
汗
除。白虎沃焚征巨效(大汗,大渴不止者,白虎加人参汤,理中救逆鉴前车(夏中伏阴在内,多
霍乱多泻证,渴者五苓散,不渴理中汤,圣法也。余目击时医郑培斋自患吐泻证,上午服藿
香正气散,傍晚大汗淋漓而毙,可为前车之鉴。若急用理中汤,尚可救之,)有云膝冷为挟湿
,方见东垣李氏书(《东垣十书》有苍术白虎汤。
日中奔走劳形不病,而避暑于高堂大厦者反病也,须知人病皆其自取。吾身五运安和,六气均
平,虽日在暑中而不病。吾身五运有亏,六气不振,阴虚则阳盛而热证生,阳虚则阴盛而寒
证起。寒病暑病,随人身阴阳之气而化生者也。如寒邪伤阳而化病,寒亦为热,暑邪伤阴而
化病,暑亦为寒。苟不以人身气化之寒暑为凭,而以天气之寒暑而定,真杀人不用刃矣,且
夏月之时,人身上热下寒,一如天气虽暑,地下则寒。不观井中之水冷之极乎。人身丹田之气
,地下之水亦若是也。凡治病,必顾其本,惟夏月之病,当温补者十之七、八,宜凉泻者
十之二、三。凡人肾气有余,形体不劳,但感风暑,化为热病,则藿香白虎一剂而痊,西瓜
凉水,服之而愈。医见其痊愈也,遇暑邪入脏之症,亦以此药治之,则一剂而殂者比比矣。
酷暑炎炎,朝病夕死,人谓疫气流行而死者,皆以暑邪入脏病也。其病五、六日而死,亦因
阳气尽泄于外,谷气不入,肾气有亏,真气内脱而死也。如是之病,惟参 桂附可以疗之,
疗之而尽人皆愈也。人或信之,疗之而间有一、二不及疗者,人必疑之而非之矣。余尝思子
产论政云∶“夫火烈,民望而畏之,故鲜死焉,水弱,民狎而玩之,故多死焉。”今人恶热药
而喜寒凉,又何怪乎其多死哉(戒人当于暑热之中,须知兼杂虚寒之证,不可恣意凉散。然言
之未免太过,读者当识其大旨,勿以词害意可耳。
湿证脉缓,头重,四肢重痛,大便溏,宜二陈汤加苍术、白术,再随证加减。
(经义)《太阴阳明论》曰∶“伤于湿者,下先受之”。《拾遗》注之云∶阴湿邪也,人
身之下,阴分也。以阴从阴,故下体先受之,以次而及于上矣,一身尽痛,是其候也。《金
匮》用麻黄加白术汤,其论最详,宜熟读之。
暑病表现为心烦、脉象虚弱,小便红赤、发热口渴且伴有叹息,轻症宜用天水散(又名六一散)通过利小便来祛邪,重症则需用香薷饮发汗以除邪。白虎汤对于大汗不止、大渴不止者有显著疗效;理中汤可借鉴前例用于救治逆证(夏季体内伏藏阴气,多患霍乱及腹泻证,口渴者用五苓散,不渴者用理中汤,这是圣人的治法。我亲眼目睹时医郑培斋自己患上吐泻证,上午服用藿香正气散,傍晚因大汗淋漓而死亡,这可以作为前车之鉴。如果当时紧急使用理中汤,还可以挽救他的生命。)书中提到膝部发冷为兼夹湿邪,这一观点见于李东垣的著作(《东垣十书》中有苍术白虎汤)。
中午在烈日下奔走劳损身体的人反而不生病,而在高大宽敞的厅堂里避暑的人却生病了,要知道人的疾病大多是自己招致的。如果人体五运安和、六气平衡,即使身处暑热之中也不会生病。如果人体五运亏损、六气不振,阴虚则阳盛而产生热证,阳虚则阴盛而产生寒证。寒病和暑病,是随着人身阴阳之气转化而生成的。如寒邪损伤阳气而化生为病,寒也可转化为热;暑邪损伤阴气而化生为病,暑也可转化为寒。如果不以人身气化所产生的寒暑为依据,而以天气的寒暑来判定病情,那真是不用刀枪就能杀人了。况且在夏季,人体上身热下身寒,正如天气虽然炎热,地下却是寒冷的。没看过井水极冷吗?人体的丹田之气,就像地下的水一样。凡是治病,必须顾护根本,只有夏季的疾病,应当温补的占十分之七八,适宜凉泻的占十分之二三。凡是肾气充足、形体不劳累的人,只是感受风暑,化为热病,那么一剂藿香正气散或白虎汤即可痊愈,吃西瓜喝凉水也能好。医生见其痊愈,遇到暑邪入脏的症状,也以此药治疗,结果一服药就死亡的比比皆是。酷暑炎炎,早晨得病晚上就死,人们说是疫气流行致死,其实都是暑邪入脏的病。这种病在五、六天后死亡,也是因为阳气完全外泄,谷气不能摄入,肾气亏损,真气内脱而死。这样的病,只有人参、肉桂、附子可以治疗,治疗后所有人都能痊愈。如果有人相信这一点,治疗后偶尔有一两个没能救活的,人们一定会怀疑并非议它。我曾经思考子产论政时说:“火性猛烈,百姓望而生畏,所以很少死于火灾;水性柔弱,百姓亲近玩弄,所以很多人死于溺水。”现在的人厌恶热药而喜欢寒凉,又怎么能怪他们死亡众多呢(告诫人们在暑热之中,须知兼杂虚寒之证,不可肆意使用凉散药物。然而话说得未免太过,读者应当领会其主旨,不要因辞害意即可。)
湿证表现为脉缓、头重、四肢沉重疼痛、大便溏薄,宜用二陈汤加苍术、白术,再根据症状加减。
(经义)《太阴阳明论》说:“伤于湿邪,下部先受之。”《拾遗》注释道:阴湿邪气,人体下部属阴分。以阴从阴,所以下体先受邪,然后依次波及上部,全身疼痛,就是它的征候。《金匮要略》使用麻黄加白术汤,论述最为详细,应当熟读。
Summerheat disorders manifest as restlessness, a deficient pulse, red urine, fever, thirst, and sighing. For mild cases, Tianshui San (also known as Liuyi San) should be used to eliminate pathogens via urination; for severe cases, Xiangru Yin should be taken to induce sweating and remove pathogens. Baihu Tang demonstrates significant efficacy in cases of profuse sweating and unrelenting thirst. Lizhong Tang can be referenced from past precedents to treat counterflow syndromes (In summer, latent yin exists within the body, often leading to Huoluan [Cholera-like disease] and diarrhea syndromes. If thirsty, Wuling San is indicated; if not thirsty, Lizhong Tang is indicated. This is the method of the Sages. I witnessed personally the physician Zheng Peizai suffering from vomiting and diarrhea. He took Huoxiang Zhengqi San in the morning and died by evening due to profuse sweating. This serves as a warning from the past. If Lizhong Tang had been urgently administered, he could have been saved.) The text mentions that cold knees indicate the presence of dampness, a view found in the works of Li Dongyuan (Cangzhu Baihu Tang is recorded in *Dongyuan Shishu*).
Those who run and labor under the midday sun do not fall ill, whereas those who avoid summerheat in high halls and large mansions do. One must realize that human illnesses are often self-inflicted. If one's Five Movements are harmonious and Six Qi are balanced, one will not fall ill even amidst summerheat. If one's Five Movements are deficient and Six Qi fail to flourish, yin deficiency leads to yang excess and heat disorders arise, while yang deficiency leads to yin excess and cold disorders emerge. Cold and summerheat diseases are generated according to the transformation of the body's yin and yang qi. For instance, cold pathogenic factors damaging yang qi may transform into heat; conversely, summerheat pathogenic factors damaging yin qi may transform into cold. If treatment is not based on the cold and heat generated by the body's physiological transformation but rather determined solely by the weather's cold and heat, it would truly kill without using blades. Furthermore, during summer, the human body is hot above and cold below, just as the earth is cold beneath despite the hot weather. Have you not observed how extremely cold well water is? The qi of the Dantian in the human body is analogous to the water underground. In treating any disease, one must attend to the root. Specifically for summer diseases, seven or eight out of ten cases require warming and tonification, while only two or three out of ten are suitable for cooling and purging. Individuals with abundant Kidney qi and unexhausted physical strength who contract wind-summerheat transforming into heat disorders can recover with a single dose of Huoxiang Zhengqi San or Baihu Tang, or by consuming watermelon and cold water. Physicians, seeing such recoveries, may mistakenly apply these same remedies to cases where summerheat pathogens enter the Zang organs, resulting in death after a single dose being commonplace. During intense summer heat, patients may die from morning illness to evening death. People attribute this to epidemic qi, but it is actually caused by summerheat pathogens entering the Zang organs. Death occurring after five or six days results from the complete exhaustion of yang qi through external leakage, failure of grain qi to enter, depletion of Kidney qi, and internal collapse of true qi. Such diseases can only be treated with Renshen (Ginseng), Rougui (Cinnamon Bark), and Fuzi (Aconite Root); upon treatment, all patients recover. If people believe this, and occasionally one or two fail to recover despite treatment, others will inevitably doubt and criticize it. I once reflected on Zichan's discussion on governance: "Fire is fierce; people fear it, so few die from it. Water is weak; people play with it, so many die from it." Today, people detest warm medicines and prefer cold ones; no wonder their mortality rate is high. (This warns that amidst summer heat, one must recognize concurrent deficiency-cold syndromes and avoid indiscriminate use of cooling and dispersing agents. However, the statement may be somewhat exaggerated; readers should grasp the main intent and not let the wording obscure the meaning.)
Dampness disorders present with a slow pulse, heavy head, heavy and painful limbs, and loose stools. Erchen Tang combined with Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) is appropriate, with further modifications based on symptoms.
(Interpretation of Classics) *Taiyin Yangming Lun* states: "When injured by dampness, the lower part of the body receives it first." *Shiyi* annotates: "Yin-dampness pathogenic factor. The lower part of the human body belongs to the yin aspect. Yin follows yin, hence the lower body is affected first, subsequently spreading upward, causing pain throughout the body, which is its characteristic sign." *Jingui Yaolue* utilizes Mahuang Jia Baizhu Tang, with the most detailed discussion; it should be studied thoroughly.