论阳明胃火 论治各经之火
天师曰∶火治者，治火之有余也。火症甚多，惟阳明一经最难治。前论虽悉，尚有未尽之议也。
知治阳明之法，则五脏之火，各腑之火，无难专治矣。阳明本胃土也，如何有火？此火乃生于心包。心
包之火，乃相火也。君火失权，则心包欺之，以自逞其炎赫之势。是必以辛凉大寒之品，大剂投之，恣其
快饮。斯火得寒而少息，热得凉而略停，然必添入健胃之药，始可奏功。盖胃火之沸腾，终由于肾气之
不足，去胃火，必须补胃土，然而徒补胃土，而不去水湿之痰，亦不得也。方用石膏一两。或二两，或三
两，看火势之盛衰，用石膏之多寡，知母三钱，麦冬五钱，甘草一钱，糯米一合，竹叶百片，人参三钱，
水煎服。方则人参竹叶石膏汤也。胃火之盛，非此汤不能平。还问其人必大渴饮水，见其有汗如雨者，始
可放胆用之，否则不可轻用。盖无汗而渴，亦有似此症者，不可不辨也。此方纯是降胃火之药，所以急救
先天之肾水也。此症一日不治，即熬干肾水而不救。故不得已用此霸道之药也。倘无汗而渴，明是肾火有
余而肾水不足，又乌可复用石膏汤。以重伤其肾水乎。然则又当何方以治之？用熟地三两，山茱萸二两，
北五味三钱，麦冬二两，元参一两。此方乃治似白虎症，而非胃火之热者。人更宜知之也。其余心火用
黄连，肝火用栀子，肺火用黄芩，前言悉之矣，
兹不再赘。
张公曰∶不意吾方，得真人阐发至此，大快也，然予更有说，阳明之火虽起于心包，实成于肝木
之克之也。肝木旺则木中有火，不特木来克土，而转来助焰。肝木之火，半是雷火，一发则震地轰天。
阳明得心包之火而沸腾，又借肝木龙雷之火以震动，如何可以止遏。故轻则大渴，重则发狂也。予治此
症，往往白芍加至数两，未曾传世，世所以不能发明之也。先用石膏汤以去火，随加白芍以平木，木平
而火无以助焰，自然胃火孤立无援。又加麦冬以平肺金之气，则金有水润，不必取给于胃土，而胃土可
以自救，况又有石膏、知母之降火哉。此狂之所以定，而热之所以除也。方用石膏一两，知母三钱，麦
冬一两，半夏三钱，甘草一钱，竹叶一百片，糯米一合，先煎四碗，又加白芍二两同煎。（〔批〕法制
白虎汤。）此方之妙，不在石膏、知母之降胃火，妙在白芍之平肝木，使木气有养不来克土，并不使木郁
生火，以助胃火也。又妙在麦冬以清肺金，使金中有水，胃火难炎，且去制肝，无令克土也。
华君曰∶予方又不同。传远公乃专论阳明，传予乃论各经之火也。有方并传子。栀子三钱，白芍五
钱，甘草一钱，丹皮三钱，元参三钱，水煎服。（〔批〕泻火圣神汤。）心火，加黄连一钱；肺火，加黄
芩一钱；胃火，加石膏三钱∶肾火，加知母一钱，黄柏一钱；大肠火，加地榆一钱∶小肠火，加麦冬三
钱，天冬三钱；膀胱火，加泽泻三钱。治火何以独治肝经也？盖肝属木，木易生火，故治火者首治肝，肝
火一散，而诸经之火俱散。所以，加一味去火之药，即可以去各经之火
也。
陈士铎曰：所谓“火治法”，是指治疗体内火邪过盛的方法。火证种类繁多，其中阳明经的火证最难治疗。前文虽然论述详尽，但仍有未尽之处。
若能掌握治疗阳明胃火的方法，那么五脏之火、六腑之火，便不难单独施治了。阳明经本属胃土，怎么会有火呢？这火实际上产生于心包络。心包络之火，属于相火。当君火（心火）失去主导权时，心包络便会趁机逞强，展现出炽热炎上的态势。此时必须使用辛凉且大寒的药物，以大剂量投服，让其尽情饮用。这样，火得寒凉而稍减，热得清凉而略停。然而，必须加入健胃的药物，才能奏效。因为胃火的沸腾，归根结底是由于肾气不足所致。清除胃火的同时，必须补益胃土；但如果只补胃土而不去除水湿之痰，也是不行的。方剂用石膏一两，或二两，或三两，根据火势的盛衰来决定石膏用量的多少；知母三钱，麦冬五钱，甘草一钱，糯米一合，竹叶一百片，人参三钱，加水煎服。此方即是人参竹叶石膏汤。胃火炽盛，非此汤不能平息。还要观察患者是否出现极度口渴想喝水、出汗如雨的症状，才可以放心大胆地使用，否则不可轻易使用。因为无汗而口渴的情况，也有类似此症的表现，不可不加以辨别。此方纯是降胃火的药物，所以能急救先天的肾水。此症若一天不治疗，就会熬干肾水而导致无法救治。因此不得已才使用这种霸道猛烈的药物。如果无汗而口渴，明显是肾火有余而肾水不足，又怎可再复用石膏汤，从而严重损伤肾水呢？那么又应当用什么方子来治疗呢？用熟地黄三两，山茱萸二两，北五味子三钱，麦冬二两，玄参一两。此方乃是治疗类似白虎汤证，但并非胃火炽热的情况。人们更应当知晓这一点。至于其余的心火用黄连，肝火用栀子，肺火用黄芩，前文已详细论述，此处不再赘述。
张公曰：没想到我的方子，能得到真人如此阐发，真是痛快！然而我还有补充之说：阳明之火虽起于心包，实则成于肝木的克制。肝木旺盛则木中蕴火，不仅木来克土，反而转过来助长火势。肝木之火，一半是雷火，一旦发作便震地轰天。阳明胃经受心包之火影响而沸腾，又借助肝木龙雷之火来震动，如何可以遏制？所以轻者表现为极度口渴，重者则发狂。我治疗此症，往往将白芍加至数两，未曾流传于世，世人因此未能发明此法。先用石膏汤以去火，随后加入白芍以平抑肝木，肝木平和则火无所助，自然胃火孤立无援。再加入麦冬以平抑肺金之气，则金有水润，不必向胃土索取津液，胃土得以自救，况且又有石膏、知母来降火呢。这就是狂躁得以安定、热邪得以消除的原因。方剂用石膏一两，知母三钱，麦冬一两，半夏三钱，甘草一钱，竹叶一百片，糯米一合，先煎四碗，再加入白芍二两同煎。（批注：法制白虎汤。）此方的妙处，不在于石膏、知母降胃火，而在于白芍平抑肝木，使木气得养而不克土，也不使木郁生火以助胃火。又妙在麦冬清肺金，使金中有水，胃火难燃，且能制约肝木，不让其克土。
华君曰：我的方子又不同。传远公专门论述阳明经，而我则是论述各经之火。有一个方子一并传授给您。栀子三钱，白芍五钱，甘草一钱，丹皮三钱，玄参三钱，加水煎服。（批注：泻火圣神汤。）心火，加黄连一钱；肺火，加黄芩一钱；胃火，加石膏三钱；肾火，加知母一钱，黄柏一钱；大肠火，加地榆一钱；小肠火，加麦冬三钱，天冬三钱；膀胱火，加泽泻三钱。治疗火证为何独独治理肝经呢？因为肝属木，木易生火，所以治火者首先治肝，肝火一散，各经之火随之俱散。因此，每加一味去火之药，就可以去除各经之火。
Chen Shiduo said: The so-called "Fire Treatment Method" refers to the treatment of excessive fire pathogens in the body. Fire syndromes are numerous, among which the fire syndrome of the Yangming channel is the most difficult to treat. Although previous discussions have been thorough, there remain unexplored aspects.
Once the method for treating Yangming stomach fire is mastered, the fire of the five zang organs and the six fu organs can be treated individually without difficulty. The Yangming channel belongs to Stomach Earth; how can it have fire? This fire actually originates from the Pericardium (Pericardium). The fire of the Pericardium is Ministerial Fire (Xiang Huo). When Sovereign Fire (Heart Fire) loses its authority, the Pericardium takes advantage to assert itself, displaying a blazing and intense heat. At this time, one must use pungent-cool and severely cold herbs, administering them in large doses for unrestricted consumption. In this way, the fire subsides slightly with cold, and the heat pauses briefly with coolness. However, herbs that strengthen the Stomach must be added to achieve efficacy. The boiling of Stomach fire ultimately stems from insufficient Kidney Qi. To clear Stomach fire, one must tonify Stomach Earth; yet, merely tonifying Stomach Earth without removing phlegm caused by water-dampness is also ineffective. The prescription uses Gypsum (Shi Gao) 1 liang, or 2 liang, or 3 liang, depending on the severity of the fire; Anemarrhena Rhizome (Zhi Mu) 3 qian, Ophiopogon Tuber (Mai Dong) 5 qian, Licorice Root (Gan Cao) 1 qian, Rice (Nuomi) 1 he, Bamboo Leaves (Zhu Ye) 100 leaves, Ginseng Root (Ren Shen) 3 qian. Decoct with water and take orally. This prescription is Ren Shen Zhu Ye Shi Gao Tang (Ginseng, Bamboo Leaf, and Gypsum Decoction). For severe Stomach fire, only this decoction can pacify it. One must observe whether the patient exhibits extreme thirst with desire to drink water and profuse sweating like rain before daring to use it; otherwise, it should not be used lightly. Because thirst without sweating can present symptoms similar to this syndrome, differentiation is essential. This prescription consists purely of herbs that descend Stomach fire, thereby urgently rescuing the congenital Kidney Water. If this syndrome is not treated for a day, the Kidney Water will be boiled dry, leading to untreatable conditions. Therefore, such potent and aggressive drugs are used as a last resort. If there is no sweat but there is thirst, it clearly indicates excess Kidney Fire and insufficiency of Kidney Water; how could one reuse Gypsum Decoction to further injure the Kidney Water? Then what prescription should be used instead? Use Prepared Rehmannia Root (Shu Di Huang) 3 liang, Cornus Fruit (Shan Zhu Yu) 2 liang, Schisandra Berry (Bei Wu Wei Zi) 3 qian, Ophiopogon Tuber (Mai Dong) 2 liang, Scrophularia Root (Xuan Shen) 1 liang. This prescription treats conditions resembling Bai Hu Tang syndrome but is not for Stomach Fire heat. People should understand this distinction. As for Heart Fire, use Coptis Rhizome (Huang Lian); Liver Fire, use Gardenia Fruit (Zhi Zi); Lung Fire, use Scutellaria Root (Huang Qin). These were fully discussed previously and need not be repeated here.
Master Zhang said: I did not expect my prescription to be elucidated to this extent by the True Person; it is truly gratifying. However, I have more to say: Although Yangming fire originates from the Pericardium, it is actually formed by the overcoming action of Liver Wood. When Liver Wood is vigorous, fire resides within the wood; not only does Wood overcome Earth, but it also turns to assist the flames. The fire of Liver Wood is half Thunder Fire; once unleashed, it shakes the earth and thunders in the sky. Yangming, affected by Pericardium fire, boils vigorously, and further agitated by Liver Wood's Dragon-Thunder fire, how can it be restrained? Thus, mild cases manifest as extreme thirst, while severe cases result in mania. In treating this syndrome, I often increase the dosage of White Peony Root (Bai Shao) to several liang, but it has not been passed down, which is why the world has not discovered it. First, use Gypsum Decoction to remove fire, then add White Peony Root to pacify Liver Wood. Once Liver Wood is pacified, fire has no support, and naturally, Stomach fire stands isolated and unsupported. Add Ophiopogon Tuber to pacify Lung Metal qi, so that Metal is moistened by Water and does not need to draw fluids from Stomach Earth, allowing Stomach Earth to save itself. Moreover, there are Gypsum and Anemarrhena Rhizome to descend fire. This is why mania is stabilized and heat is eliminated. The prescription uses Gypsum 1 liang, Anemarrhena Rhizome 3 qian, Ophiopogon Tuber 1 liang, Pinellia Tuber (Ban Xia) 3 qian, Licorice Root 1 qian, Bamboo Leaves 100 pieces, Rice 1 he. Decoct first with four bowls of water, then add White Peony Root 2 liang and decoct together. (Commentary: Formulated Bai Hu Tang.) The brilliance of this prescription lies not in Gypsum and Anemarrhena Rhizome descending Stomach fire, but in White Peony Root pacifying Liver Wood, nourishing Wood qi so it does not overcome Earth, and preventing Wood stagnation from generating fire to assist Stomach fire. It is also brilliant because Ophiopogon Tuber clears Lung Metal, ensuring Metal contains Water, making it difficult for Stomach fire to blaze, and simultaneously restraining Liver Wood to prevent it from overcoming Earth.
Master Hua said: My prescription is different. Chuanyuan Gong specifically discusses Yangming, whereas I discuss fire in all channels. I transmit one prescription along with this. Gardenia Fruit 3 qian, White Peony Root 5 qian, Licorice Root 1 qian, Moutan Cortex (Dan Pi) 3 qian, Scrophularia Root 3 qian. Decoct with water and take orally. (Commentary: Xie Huo Sheng Shen Tang - Sacred Divine Fire-Draining Decoction.) For Heart Fire, add Coptis Rhizome 1 qian; for Lung Fire, add Scutellaria Root 1 qian; for Stomach Fire, add Gypsum 3 qian; for Kidney Fire, add Anemarrhena Rhizome 1 qian, Phellodendron Bark (Huang Bo) 1 qian; for Large Intestine Fire, add Sanguisorba Root (Di Yu) 1 qian; for Small Intestine Fire, add Ophiopogon Tuber 3 qian, Asparagus Tuber (Tian Dong) 3 qian; for Bladder Fire, add Alisma Rhizome (Ze Xie) 3 qian. Why treat the Liver channel exclusively when treating fire? Because Liver belongs to Wood, and Wood easily generates fire. Therefore, those who treat fire must first treat the Liver. Once Liver fire dissipates, fire in all other channels dissipates accordingly. Thus, adding one herb to drain fire can eliminate fire in all channels.