贾元良曰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外证头疼口干面垢
自汗
倦怠少气或背寒恶热气甚者迷闷不省而为霍乱吐利痰滞呕逆腹痛泻痢下血发黄生斑皆是其证
甚者
火热制金不能平木搐搦不省人事其脉虚浮一曰浮者风也虚者暑也俗名暑风证者皆是相火甚而
行令也先以温水化苏合香丸次进黄连香薷饮加羌活只用双解加香薷尤良大抵治暑之法清心利
小便甚好若自汗甚者不可利小便宜白虎汤清解之次分表里治之如在表头疼恶寒双解散加香薷
及二香散十味香薷散之类解之如在半表半里泄泻烦渴饮水吐逆五苓散治之热甚烦渴者益元散
清之若表解里热甚宜半夏解毒汤下神芎丸酒蒸黄连丸等或人平生素弱及老人冒暑脉微下痢渴
而喜温或厥冷不省人事宜竹叶石膏汤加熟附半个冷冻饮料次以来复丹五苓散治之凡夏月暑证不可
服诸热燥剂致斑毒发黄小水不通闷乱而死矣
按此言治暑之法可谓详备然云暑风相火为病而先用苏合香丸至用双解皆当审谛脉证施治
不可
少有差失详苏合香但可用于阴寒所遏或内伤生冷太过及气中或中恶者此等又不可谓之暑风相
火之证矣盖暑证有阴阳二者不同治法寒热霄壤之隔学人慎之
局方香薷饮治一切暑热腹痛霍乱吐利烦心等证
香薷(一斤) 浓朴(制) 白扁豆(各半斤)
上 咀每服三四钱水煎
按此手足太阴药也世俗用于暑月中煎饮然气虚者不可过多盖浓朴乃泄气下气药也虽活人
书用后方亦只是治暑火清心而已故例不可不分
黄连香薷饮
香薷(一斤) 浓朴(制半斤) 黄连(四两)
上 咀每二三钱水煎
按此手太阴少阴药也
贾元良说:暑邪是相火行使权令的产物。夏季人们感受了暑邪,病邪从口齿进入,损伤心包络的经脉。其脉象虚弱,外在证候表现为头痛、口干、面部污垢、自汗、倦怠乏力、气短;或者背部发冷、恶热;病情严重的出现神志昏迷、不省人事,以及霍乱、呕吐腹泻、痰湿停滞、呕逆、腹痛、泻痢、便血、发黄、生斑等,这些都是暑证的临床表现。
如果病情更重,火热之邪克制肺金(金),导致不能制约肝木(木),出现抽搐、惊厥、神志不清。其脉象虚浮。有一种说法认为:脉浮代表风邪,脉虚代表暑邪。俗称“暑风证”的情况,都是由于相火旺盛而行使权令所致。治疗时,先用温水化开苏合香丸服用,随后给予黄连香薷饮,加入羌活;如果只用双解散加香薷,效果也良好。
大抵治疗暑邪的方法,清心火、利小便很好。但是如果自汗严重的,不可以使用利尿药,否则应当用白虎汤来清热解表。其次根据病位在表或在里分别治疗。如果病邪在表,出现头痛、恶寒,可用双解散加香薷,以及二香散、十味香薷散之类方剂来解表。如果病邪在半表半里,出现泄泻、烦渴、饮水、吐逆,用五苓散治疗。如果热盛、烦渴严重,用益元散清热。如果表证已解,但里热甚重,宜用半夏解毒汤,或服用神芎丸、酒蒸黄连丸等。
如果是平时体质虚弱的人,或者老人冒受暑邪,脉象微弱,下痢且口渴喜欢温热饮食,或者四肢厥冷、神志不清,宜用竹叶石膏汤加半个熟附子,放凉后饮用;随后以来复丹、五苓散治疗。凡是夏季的暑证,不可服用各种热燥的药物,否则会导致发斑、毒气、发黄、小便不通、胸闷烦躁而死。
按语:这段话论述治疗暑邪的方法可谓详尽完备。然而其中提到“暑风”、“相火”为病,却先用苏合香丸,进而使用双解散,这些都应当仔细审察脉证来施治,不能有丝毫差错。详细分析,苏合香丸只适用于阴寒被遏制,或者内伤生冷太过,以及中气郁结或中恶的情况。这些情况又不可以称为“暑风相火”的证候。大概暑证有阴暑和阳暑两种,治疗方法寒热相差如天地之别,学习中医的人务必谨慎。
《局方》香薷饮治疗一切暑热引起的腹痛、霍乱、呕吐腹泻、心烦等证候。
香薷(一斤)、浓朴(制过)、白扁豆(各半斤)。
以上药材切碎,每次服用三四钱,水煎服。
按语:这是作用于手足太阴经的药物。世俗之人用于中暑时煎服,但是气虚的人不可多用。因为浓朴是泄气、下气的药物。虽然《活人书》使用后方(指加味香薷饮等),也只是治疗暑火、清心而已。所以常规用法不可不加以区分。
Jia Yuanliang stated: Summerheat (Shu) is the manifestation of Ministerial Fire (Xianghuo) exercising its authority. In summer, when humans contract this pathogen, it enters through the mouth and teeth, damaging the Pericardium Meridian (Xinbaoluojing). The pulse is deficient. Externally, symptoms include headache, dry mouth, facial grime, spontaneous sweating, fatigue, shortness of breath; or coldness in the back, aversion to heat. In severe cases, there is coma, loss of consciousness, cholera-like vomiting and diarrhea, phlegm stagnation, retching, abdominal pain, dysentery, bloody stools, jaundice, and macules. These are all manifestations of summerheat syndrome.
If the condition worsens, excessive Heat/Fire controls Metal (Lung), failing to restrain Wood (Liver), leading to convulsions, twitching, and unconsciousness. The pulse is deficient and floating. One theory states: a floating pulse indicates Wind, while a deficient pulse indicates Summerheat. Conditions commonly known as "Summerheat Wind Syndrome" (Shufeng Zheng) are all due to excessive Ministerial Fire exercising its authority. Initially, dissolve Suhexiang Wan (Styrax Pills) with warm water for administration, followed by Huanglian Xiangru Yin (Coptis and Mosla Decoction) with added Qianghuo (Notopterygium Rhizome). Using Shuangjie San (Double-Resolution Powder) with Xiangru alone is also effective.
Generally, the method for treating summerheat involves clearing Heart Fire and promoting urination, which is beneficial. However, if spontaneous sweating is severe, diuretics should not be used; instead, Baihu Tang (White Tiger Decoction) should be used to clear heat and resolve the exterior. Subsequently, treatment should differentiate between exterior and interior locations. If the pathogen is at the exterior, presenting with headache and aversion to cold, use Shuangjie San with Xiangru, or formulas such as Erxiang San (Two-Fragrance Powder) and Shiwei Xiangru San (Ten-Ingredient Mosla Powder) to release the exterior. If the pathogen is at the half-exterior/half-interior level, presenting with diarrhea, vexatious thirst, drinking water, and vomiting, treat with Wuling San (Five-Ingredient Poria Powder). If heat is severe with vexatious thirst, use Yiyuan San (Benefit Origin Powder) to clear heat. If the exterior is resolved but interior heat is severe, use Banxia Jiedu Tang (Pinellia Detoxification Decoction), or administer Shenxiong Wan (Shenxiong Pills), Jiuzheng Huanglian Wan (Wine-Steamed Coptis Pills), etc.
For individuals with chronic weakness or the elderly who contract summerheat, presenting with a faint pulse, dysentery, thirst preferring warm drinks, or cold limbs and unconsciousness, use Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction) with half a prepared Fuzi (Prepared Aconite Root), served chilled. Follow up with Laifu Dan (Revival Pill) and Wuling San. In summer heat syndromes, one must never administer hot and drying agents, lest they cause macules, toxic heat, jaundice, urinary retention, chest oppression, and death.
Commentary: This text details methods for treating summerheat comprehensively. However, it mentions "Summerheat Wind" and "Ministerial Fire" pathology yet prescribes Suhexiang Wan initially, followed by Shuangjie San. These must be applied only after careful examination of the pulse and symptoms, without error. Specifically, Suhexiang Wan is indicated only for obstruction by Yin-Cold, excessive internal injury from raw/cold foods, Qi stagnation, or sudden evil invasion. Such conditions cannot be classified as "Summerheat Wind/Ministerial Fire" syndromes. Summerheat syndromes are divided into Yin-Summerheat and Yang-Summerheat; their treatments differ as vastly as cold and heat. Students must exercise caution.
Ju Fang Xiangru Yin (Formulary Mosla Decoction) treats various syndromes caused by summerheat-heat, including abdominal pain, cholera, vomiting/diarrhea, and heart vexation.
Xiangru (Moslae Herba, 1 jin), Zhi Houpo (Prepared Magnolia Bark, 0.5 jin), Bai Biandou (Prepared White Hyacinth Bean, 0.5 jin).
Crush the herbs. Take 3–4 qian per dose, decoct in water.
Commentary: These herbs act on the Hand-Taiyin and Foot-Taiyin meridians. Laypeople often decoct and drink them for midsummer heatstroke, but those with Qi deficiency should not consume too much, as Houpo is a Qi-draining and descending agent. Although *Ren Shu* (The Book of Human Life) uses modified versions, they primarily treat summerheat-fire and clear the Heart. Therefore, standard applications must be distinguished carefully.
Huanglian Xiangru Yin (Coptis and Mosla Decoction)
Xiangru (Moslae Herba, 1 jin), Zhi Houpo (Prepared Magnolia Bark, 0.5 jin), Huanglian (Coptidis Rhizoma, 4 liang).
Crush the herbs. Take 2–3 qian per dose, decoct in water.
Commentary: These herbs act on the Hand-Taiyin Lung Meridian and Hand-Shaoyin Heart Meridian.