〔薛〕脾为太阴,位属坤土,喜燥而恶湿,故凡脾胃之气不足者,遇长夏润溽之
令,则不能升举清阳,健运中气,又复少阳相火之时,热伤元气,则肢体怠惰不收,
两脚痿弱,嗜卧发热,精神不足,饮食少思,口中无味,呼吸短乏气促,目中视物
,小便赤数,大便不调,名曰注夏。此皆禀赋阴虚,元气不足之证,丹溪补阴
论言之详矣,育子者,其可不知冬月养阳之道乎。治法,用补中益气汤去升麻、柴
胡,加炒黑黄柏主之。若因劳役发热,血虚脉大者,用当归补血汤。气血两虚者,
八珍汤。肝肾阴亏者,地黄丸。大便作泻者,人参理中汤。若乳母肝火乘脾,寒热
少食者,柴胡栀子散。胃火作渴者,竹叶石膏汤。小儿多因乳母之气不调而致,当
戒怒气,调饮食,适寒温,则可以远病矣。又如今人夏月皆以香薷汤浸冷,代茶饮
之,殊不知香薷利水,大损元阳,浓朴克伐,大泻真气,况脾性喜温而恶寒,夏月
阴盛于内,冷啜伤脾,若胃强有火,湿热为病之人,固无大害,其脾胃虚弱,中气
不足者,必为腹痛少食,泄泻寒中之疾矣,此大人亦所当戒者,况小儿乎。慎之
慎之。
补中益气汤(虚热) 当归补血汤(虚热) 八珍汤(虚羸) 地黄丸(肾)
人参理中汤(吐泻) 柴胡栀子散(发热) 竹叶石膏汤(发热)
清暑益气汤 治暑邪干卫,身热自汗。
黄 苍术(泔浸,去皮。各一钱) 升麻(七分) 人参 白术 陈皮(炒) 神曲(炒)
泽泻(各五分) 甘草 黄柏(酒浸,炒) 当归身 麦门冬(去心) 青皮(炒) 葛根(各三分)
五味子(九粒,杵)
上,水煎服。
清燥汤 治小儿自汗,或因热伤元气,大小便秘涩。
黄 (炒) 苍术(各五分) 白术 陈皮 泽泻 人参 白茯苓 升麻 麦门冬(去心) 当
归身 生地黄 神曲(炒) 猪苓 黄柏(酒拌,炒。各三分) 五味子(五粒,杵) 黄连(炒) 甘
草(炙。各二分)
上,姜一片,水一钟,煎服。
【薛己按语】脾脏属于太阴经,在五行中归属于坤土,性质喜欢干燥而厌恶潮湿。因此,凡是脾胃之气虚弱的人,遇到长夏季节湿润闷热的时令,就不能升举清阳之气,也不能健运中焦之气;再加上此时正值少阳相火旺盛之时,热邪损伤元气,就会出现肢体倦怠无力、两脚痿弱、嗜睡发热、精神不足、饮食减少且无味、呼吸短促气急、视物模糊、小便赤黄频数、大便不调等症状,这被称为“注夏”。这些都是先天禀赋阴虚、元气不足的证候,朱丹溪在《补阴论》中已经论述得很详细了,养育子女的人,难道不知道冬季养阳的道理吗?
治疗方法:使用补中益气汤,去掉升麻、柴胡,加入炒黑黄柏来主治。如果是因劳累过度导致发热,且血虚脉大的,使用当归补血汤。气血两虚的,使用八珍汤。肝肾阴亏的,使用地黄丸。大便泄泻的,使用人参理中汤。如果是乳母肝火乘袭脾土,出现寒热往来、食欲减退的,使用柴胡栀子散。胃火炽盛导致口渴的,使用竹叶石膏汤。小儿多因乳母气息不调而导致患病,应当戒除怒气,调节饮食,适应寒温变化,这样就可以远离疾病了。
另外,现在人们在夏季都用香薷汤浸泡后放冷,代替茶水饮用,却不知道香薷利水会大损元阳,厚朴克伐会大泻真气。况且脾性喜温恶寒,夏季体内阴气盛,冷饮伤脾,如果是胃强有火、湿热为病的人,确实没有大害;但对于脾胃虚弱、中气不足的人,一定会导致腹痛、食欲不振、泄泻等寒中之疾。这也是大人应当戒除的,何况是小儿呢?务必谨慎,务必谨慎。
补中益气汤(适用于虚热) 当归补血汤(适用于虚热) 八珍汤(适用于身体羸弱) 地黄丸(适用于肾) 人参理中汤(适用于吐泻) 柴胡栀子散(适用于发热) 竹叶石膏汤(适用于发热)
清暑益气汤:治疗暑邪侵犯卫分,身体发热、自汗。
药材:苍术(用米泔水浸泡,去皮,各一钱)、升麻(七分)、人参、白术、陈皮(炒)、神曲(炒)、泽泻(各五分)、甘草、黄柏(酒浸,炒)、当归身、麦门冬(去心)、青皮(炒)、葛根(各三分)、五味子(九粒,捣碎)。
以上药材,加水煎服。
清燥汤:治疗小儿自汗,或因热邪损伤元气,导致大小便便秘涩滞。
药材:黄芪(炒)、苍术(各五分)、白术、陈皮、泽泻、人参、白茯苓、升麻、麦门冬(去心)、当归身、生地黄、神曲(炒)、猪苓、黄柏(酒拌,炒,各三分)、五味子(五粒,捣碎)、黄连(炒)、甘草(炙,各二分)。
以上药材,加生姜一片,水一碗,煎服。
[Commentary by Xue Ji] The Spleen belongs to the Taiyin Meridian and corresponds to Kun Earth in the Five Elements. Its nature favors dryness and dislikes dampness. Therefore, for those with insufficient Qi of the Spleen and Stomach, when encountering the humid and muggy weather of late summer, they are unable to raise the Clear Yang or fortify the Middle Jiao Qi. Furthermore, during this time when the Ministerial Fire of Shaoyang is prevalent, heat damages the Original Qi, resulting in symptoms such as limb fatigue and flaccidity, weakness in both legs, lethargy with fever, lack of spirit, reduced appetite with tastelessness, shortness of breath and rapid respiration, blurred vision, red and frequent urination, and irregular bowel movements. This condition is termed "Zhu Xia" (Summer Malaise). These are all syndromes of congenital Yin deficiency and insufficient Original Qi, which Zhu Danxi discussed in detail in his *Treatise on Tonifying Yin*. Those who rear children should not fail to understand the principle of nourishing Yang in winter.
Treatment method: Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri), and adding stir-fried black Huangbai (Cortex Phellodendri). If fever is caused by overwork and blood deficiency with a large pulse, use Danggui Buxue Tang (Decoction for Tonifying Blood). For simultaneous deficiency of Qi and Blood, use Bazhen Tang (Eight Treasure Decoction). For deficiency of Liver and Kidney Yin, use Dihuang Wan (Rehmannia Pill). For loose stools/diarrhea, use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If the wet nurse has Liver Fire invading the Spleen, presenting with alternating chills and fever and poor appetite, use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If Stomach Fire causes thirst, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). Children often suffer from illness due to the disharmony of the wet nurse's Qi; one must guard against anger, regulate diet, and adapt to temperature changes to avoid disease.
Furthermore, nowadays people soak Xiangru Tang (Mosla Decoction) in cold water during summer to drink as tea. They do not realize that Xiangru promotes diuresis and severely damages Original Yang, and Houpo (Magnolia Bark) suppresses and severely drains True Qi. Moreover, the Spleen favors warmth and dislikes cold. In summer, Yin is abundant internally; cold drinks injure the Spleen. For those with strong Stomach fire and damp-heat pathology, there may be no major harm; but for those with weak Spleen and Stomach and insufficient Middle Qi, it will inevitably cause abdominal pain, anorexia, diarrhea, and other Cold-in-the-Middle diseases. This is something adults should also avoid, let alone children. Be cautious, be very cautious.
Buzhong Yiqi Tang (for Deficient Heat) | Danggui Buxue Tang (for Deficient Heat) | Bazhen Tang (for Emaciation) | Dihuang Wan (for Kidney) | Renshen Lizhong Tang (for Vomiting and Diarrhea) | Chaihu Zhizi San (for Fever) | Zhuye Shigao Tang (for Fever)
Qingshu Yiqi Tang: Treats Summer-Heat pathogen affecting the Wei (Defensive) level, presenting with body fever and spontaneous sweating.
Ingredients: Cangzhu (Atractylodis Rhizoma, soaked in rice wash, peeled, 1 qian each), Shengma (Rhizoma Cimicifugae, 0.7 qian), Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium, stir-fried), Shenqu (Massa Medicata Fermentata, stir-fried), Zexie (Alismatis Rhizoma, 0.5 qian each), Gancao (Glycyrrhizae Radix et Rhizoma), Huangbai (Phellodendri Cortex, wine-soaked, stir-fried), Dangguishen (Angelicae Sinensis Radix), Maidong (Ophiopogonis Radix, heart removed), Qingpi (Citri Reticulatae Pericarpium Viride, stir-fried), Gegen (Puerariae Lobatae Radix, 0.3 qian each), Wuweizi (Schisandrae Fructus, 9 grains, crushed).
Take the above ingredients, decoct in water, and take orally.
Qingzao Tang: Treats pediatric spontaneous sweating, or damage to Original Qi by heat, leading to constipation and difficulty in urination and defecation.
Ingredients: Huangqi (Astragali Radix, stir-fried), Cangzhu (Atractylodis Rhizoma, 0.5 qian each), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Zexie (Alismatis Rhizoma), Renshen (Ginseng Radix), Baifuling (Poria, white), Shengma (Rhizoma Cimicifugae), Maidong (Ophiopogonis Radix, heart removed), Dangguishen (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix), Shenqu (Massa Medicata Fermentata, stir-fried), Zhuling (Polyporus), Huangbai (Phellodendri Cortex, wine-mixed, stir-fried, 0.3 qian each), Wuweizi (Schisandrae Fructus, 5 grains, crushed), Huanglian (Coptidis Rhizoma, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted, 0.2 qian each).
Take the above ingredients, add one slice of fresh ginger, one zhong of water, decoct, and take orally.