论曰∶寒则伤形,热则伤气,何以言之?人与天地同一橐龠,夏月天之气浮于地表,则人之气浮于肌表,况被
盛暑所伤,肤腠疏豁,气液为汗发泄于外,是表里之气俱虚矣。不善摄生者,暑热伤于外,生冷戕于中,若之何而
能运化也?是以水谷停积而为湿热,发为呕吐,为泄泻,甚则吐泻俱作,而挥霍闷乱也。若不即病,湿热怫郁于内,
他日为疟为痢之所由矣。今大顺散,非治暑热之药,乃治暑月饮凉过多为病之剂也欤。
按∶此论精当,但大顺散不可轻用。
论曰∶夏至日后病热为暑,暑者相火行令也。夏月人感之,自口齿而入,伤心包络之经,其脉虚,或浮大而散,
或弦细芤迟,盖热伤气,则气消而脉虚弱,其为证汗烦则喘渴,静则多言,身热而烦,心痛大渴引饮,头疼自汗,
倦怠少气,或下血发黄生斑,甚者火热制金,不能平木,搐搦不省人事。治暑之法,清心利小便最好。暑伤气,宜补
真气为要。又有恶寒或四肢逆冷,甚者迷闷不省,而为霍乱,吐利痰滞,呕逆腹痛泻痢,此则非暑伤人,乃因暑而
自致之病也。以其因暑而得,故亦谓之暑病。然治法不同也。
按∶节斋此论,气脉证方俱备,种种精妙,暑月可录一通于座右,古庵、节斋,以世代不宜列此,因原系丹溪附
余,姑附之。
霖按∶节斋此论,似是而非。夫天之六气,风寒暑湿燥火,应地之五行,则木水火土金火,君火以明,相火以位,
暑为君火,在卦为离,离中虚,乃明两作之义,故曰暑中多挟湿也。暑先入心,应乎君火,包络主手厥阴相火,其气
与心相通,其脉与心相连。心病每治包络者,以心为君主之宫藏,义不受邪也,不得舍君火而言相火,是六气尚不能
明,岂可录之座右哉!
论说:寒邪损伤形体,热邪损伤气机,为什么这样说?人与天地如同一个风箱(橐龠),夏季天气浮越于地表,则人体的气也浮越于肌表,何况遭受盛暑伤害,皮肤腠理疏松开泄,气与津液化为汗液发泄于体外,这样体表和体内的气都虚弱了。不善于养生的人,外受暑热伤害,内因生冷食物戕害脾胃,身体怎能正常运化呢?因此水谷停滞积聚而化为湿热,引发呕吐、泄泻,严重时吐泻同时发作,出现腹部急剧绞痛、烦闷扰乱的症状。如果不立即发病,湿热郁结于体内,日后可能发展为疟疾或痢疾。现在的“大顺散”,并不是治疗暑热证的药物,而是治疗暑月因饮用过多凉饮致病的方剂吧。
按语:这段论述精当确切,但“大顺散”不可轻易使用。
论说:夏至日后发生的发热病症称为暑病,暑属于相火当令。夏季人感受暑邪,邪气从口齿进入,侵犯心包络的经脉,脉象表现为虚,或者浮大而散,或者弦细芤迟,这是因为热伤气,导致气消损而脉象虚弱。其症状表现为出汗、烦躁、气喘、口渴,安静时多言,身体发热且烦躁,心痛、极度口渴想饮水,头痛、自汗,倦怠乏力、少气懒言,或者便血、发黄、生斑疹,严重时火热克制肺金(金),不能制约肝木(木),出现抽搐、痉挛、不省人事。治疗暑病的方法,清心火、利小便最好。暑邪伤气,以补益真气为关键。又有恶寒或四肢逆冷,严重时昏迷不省人事,以及霍乱,吐泻痰滞,呕逆腹痛、下痢等症状,这些并非暑邪直接伤人,而是因为暑天自身导致的疾病。因为因暑天而得病,所以也称为暑病。然而治疗方法不同。
按语:节斋的这段论述,气、脉、证、方都具备,种种精妙,暑月可以抄录一通放在座位旁边。古庵、节斋,因为世代久远不宜列入此篇,因原本就是丹溪先生的附余内容,姑且附在这里。
霖按语:节斋的这段论述,似是而非。天的六气(风寒暑湿燥火),对应地的五行(木水火土金火),君火以明照为主,相火以位置为辅,暑属于君火,在八卦中为离卦,离卦中间是虚的,体现了明两作(光明双重作用)的含义,所以说暑邪中常夹杂湿气。暑邪先入心,对应君火,心包络主管手厥阴相火,其气与心相通,其脉与心相连。治疗心病往往通过治疗心包络,是因为心是君主之官,藏神,义理上不受邪气直接侵犯,不能舍弃君火而言相火,连六气的道理尚且没有弄明白,怎么可以抄录放在座位旁边呢!
Commentary states: Cold damages the form, heat damages the Qi. Why is this so? Humans and Heaven-Earth are like a bellows (Tuoyue). In summer, the Qi of Heaven floats on the earth's surface, thus the Qi of humans floats on the muscle-surface. Moreover, when injured by intense summer heat, the skin pores become loose and open, and Qi and fluids are excreted as sweat to the exterior. Thus, both the exterior and interior Qi are deficient. Those who fail to preserve their health properly suffer external injury from summer heat and internal damage from raw and cold foods; how can the body transform and transport them effectively? Consequently, food and water stagnate and accumulate, transforming into damp-heat, leading to vomiting and diarrhea. In severe cases, both vomiting and diarrhea occur simultaneously, accompanied by sudden abdominal pain and mental confusion. If illness does not manifest immediately, damp-heat may remain constrained internally, potentially developing into malaria or dysentery later. The present Dashun San (Greatly Prosperous Powder) is not a medicine for treating summer-heat syndrome, but rather a formula for treating illnesses caused by excessive consumption of cold drinks during summer.
Note: This commentary is precise and appropriate, but Dashun San should not be used lightly.
Commentary states: Febrile diseases occurring after the Summer Solstice are termed summer-heat. Summer-heat belongs to the phase fire (Xiang Huo) in command. When humans contract it in summer, the pathogen enters through the mouth and teeth, affecting the Pericardium Meridian of Hand-Jueyin. The pulse may be deficient, or floating, large, and scattered, or wiry, thin, hollow, and slow. This is because heat damages Qi, causing Qi depletion and resulting in a weak pulse. Symptoms include sweating, irritability, panting, thirst; if quiet, there is excessive talking; body heat with irritability, heart pain, extreme thirst desiring drink, headache, spontaneous sweating, fatigue, shortness of breath, or lower bleeding, jaundice, and macules. In severe cases, fire-heat controls Metal (Lung), failing to subdue Wood (Liver), leading to spasms, convulsions, and loss of consciousness. The method for treating summer-heat is best to clear Heart fire and promote urination. Since summer-heat damages Qi, tonifying True Qi is essential. There are also cases of aversion to cold or cold limbs, severe coma and unconsciousness, Huoluan (cholera-like disorder), vomiting and diarrhea with phlegm-stasis, retching, abdominal pain, and dysentery. These are not injuries directly caused by summer-heat, but diseases self-induced due to summer conditions. Because they arise from summer conditions, they are also called summer-heat diseases. However, the treatment methods differ.
Note: Jiezhai’s commentary covers Qi, pulse, symptoms, and formulas comprehensively and exquisitely. It is worth copying and keeping by one’s side during summer. Guyan and Jiezhai are omitted here due to generational distance, but since they originally belong to Danxi’s supplementary remarks, they are attached tentatively.
Lin notes: Jiezhai’s commentary seems plausible but is actually incorrect. The Six Qi of Heaven (Wind, Cold, Summer-Heat, Dampness, Dryness, Fire) correspond to the Five Elements of Earth (Wood, Fire, Water, Earth, Metal, Fire). Jun Huo (Monarch Fire) illuminates, while Xiang Huo (Ministerial Fire) takes its place. Summer-heat corresponds to Jun Huo and the Li Trigram (Fire). Li is empty in the middle, symbolizing dual illumination. Therefore, it is said that summer-heat often carries dampness. Summer-heat enters the Heart first, corresponding to Jun Huo. The Pericardium governs the Hand-Jueyin Ministerial Fire. Its Qi connects with the Heart, and its pulse links to the Heart. Treating Heart diseases often involves treating the Pericardium because the Heart is the Palace of the Monarch and, by principle, does not accept pathogens directly. One cannot discard Jun Huo to speak only of Xiang Huo. If one cannot even clarify the Six Qi, how can such text be recommended for study?