论伤寒发斑 中暑火炽 伤暑吐血 阳症 火泻
天师曰∶阳治者，治阳症之病也。阳症甚多，不能概举，姑举一二症大者言之。伤寒内发斑，身
热心如火，口渴呼水，气喘舌燥，扬手出身者是；或中暑热之气，大渴饮水，数桶不止，汗如雨下，大
喊狂呼，日重夜轻是也。此皆阳火烧焚于胃口，烟腾势急。威猛不可止遏。皆阳症也。此时杯水实，不足
以胜之，非大剂寒凉，安能扑灭。即以用寒凉扑灭之矣，而余烟断火，微焰犹存。必得大雨滂沱，屋栋
沟渠，无非膏泽，则火气消亡，门庭可整。此阳症之治，难于阴症也。方用元参三两，升麻二钱，黄芩一
两，麦冬三两，防风三钱，天花粉三钱，苏叶一钱，青黛三钱，生甘草三钱，生地一两，桑白皮五钱。一剂
即消大半，二剂全愈。（〔批〕滂沱汤）。此方妙在元参为君，不特去其浮游之火，兼能清其胃中之热，
且性又滋润。发斑虽是火热不能外越，然亦因胸中水少不足润。故郁而不出也，今用元参润之，则火得润而
难居。况又有黄芩以大凉其胸膈，又加升麻、防风引散其火邪，更佐之麦冬、生地，凉血以清肺气，自然
清肃下行，而中焦之火，尽化为乌有也。
至于中暑之病，亦阳火邪炽也。法用青蒿五钱，石膏五钱，麦冬五钱，半夏一钱，黄连一钱，人参三
钱，甘草一钱，茯苓五钱，竹叶五十片，水煎服。（〔批）消暑至神汤。）此方妙在用青蒿去暑，再加二钱
香薷，则暑气自化；用石膏以平泻其胃中之邪火，邪火一去，胃气始转，水能下行，不蓄停于膀胱之内，
而散逸于四肢；况又有茯苓导其下行者乎；又虑火气伤心，复加黄连以救心。人参以救肺。各脏即
安，胃邪必遁，此治阳症之妙法也。
张公曰∶妙论出奇不穷。阳症固多，二症最急，故天师特举之以为法。予再广之，有二症在焉。
一则伤暑中之吐血也。凡人感伤暑气，忽然吐血倾盆，人皆谓是阴虚。不知阴虚吐血，与阳虚吐血不
同。阴虚吐血者，人必安静，不似阳虚之躁动不宁也。阳症必大热作渴，欲饮凉水，舌必有刺，不似
阴症之口不渴而舌胎滑也。法当清胃火，不必止其血。方用石膏三钱，青蒿五钱，香薷三钱、荆芥一钱，
当归三钱，人参三钱，水煎服。（〔批〕祛暑止血汤。）此方乃正阳症吐血之神剂也。方中虽有解暑
之味，然而补正多于解暑。去香薷一味，实可通治诸阳症之血也。但此方止可用一二剂，即宜改用六
味地黄汤，以滋其阴水，水足则阳火自消耳。一则阳症之火泻也。完谷不化，饮食下喉即出，一日或泻
十余次，或泻数十次，或昼夜泻数百次，人以为热也。然而热之生也何故？生于肾中之水衰不能制火，
使胃土关门不守于上下，所以直进而直出也。论其势之急迫奔崩，似乎宜治其标。然治其标。不能使火
之骤降，必须急补肾中之水，使火有可居之地，而后不至于上腾。方用熟地三两，山茱萸一两，车前子
一两，甘草一两，茯苓一两，白芍三两，肉桂三分、水煎服。此方乃补肾之汤，非止泻之药也，然而止
泻之妙，捷如桴鼓。盖肾水一生，肾火即降，顷刻应验。非好为奇谈，而不据实理也。若止作胃虚有火
治之，未尝无功，终不若此之捷。脾约丸亦佳，安
能及此方之神哉。
华君曰∶与余同，不必讲。
雷公曰∶无一论不奇妙。
陈士铎说：所谓阳治，是指治疗阳证疾病的方法。阳证种类繁多，无法一一列举，姑且选取其中几种重大的病症来阐述。
伤寒病体内发出斑疹，身体发热如火烧，口渴想喝水，气喘舌干，手舞足蹈、掀开衣被者是；或者是中暑热之气，极度口渴饮水，几桶水止不住，汗如雨下，大声喊叫狂呼，白天病情重晚上轻的是。这些都是阳火在胃脘部焚烧，烟气升腾，势头急迫，威猛不可遏制。这些都属于阳证。此时一杯水实在不足以战胜它，不用大剂量的寒凉药物，怎么能扑灭呢？即使使用了寒凉药物来扑灭，但余烟断火，微弱的火焰仍然存在。必须像大雨滂沱一样，屋檐和沟渠都是滋润的水泽，这样火气才能消亡，门户庭院才能整顿。这就是阳证的治疗，比阴证更难。方药用玄参三两，升麻二钱，黄芩一两，麦冬三两，防风三钱，天花粉三钱，苏叶一钱，青黛三钱，生甘草三钱，生地一两，桑白皮五钱。服用一剂症状消除大半，两剂完全痊愈。（批注：滂沱汤）。这个方子的妙处在于以玄参为君药，不仅能去除浮游之火，还能清解胃中的热邪，而且性质滋润。发斑虽然是火热之邪不能向外透发，但也因为胸中津液不足，无法滋润，所以郁结而不得出。现在用玄参滋润它，那么火得到滋润就难以停留。况且又有黄芩以大凉其胸膈，又加入升麻、防风引导疏散火邪，更辅助以麦冬、生地，凉血以清肺气，自然清肃下行，中焦的火气便全部化为乌有。
至于中暑的病，也是阳火邪气炽盛。治法用青蒿五钱，石膏五钱，麦冬五钱，半夏一钱，黄连一钱，人参三钱，甘草一钱，茯苓五钱，竹叶五十片，水煎服。（批注：消暑至神汤）。这个方子的妙处在于用青蒿去除暑气，再加二钱香薷，则暑气自然化解；用石膏来平泻胃中的邪火，邪火一去，胃气开始运转，水液能向下行，不蓄积在膀胱内，而是散逸于四肢；况且又有茯苓引导其下行吗？又担心火气伤心，所以加黄连以救心，人参以救肺。各个脏腑安宁，胃中的邪气必然退避，这是治疗阳证的妙法。
张公说：奇妙的论述层出不穷。阳证固然多，但这两种病症最紧急，所以陈士铎特意举出来作为法则。我再加以推广，还有两种病症存在。
一种是伤暑引起的吐血。凡人感受伤暑之气，忽然吐血如倾盆，人们都认为是阴虚。不知道阴虚吐血与阳虚（此处原文语境实指阳证或误判，结合下文对比，应指非阳热实证）吐血不同。阴虚吐血的人，必定安静，不像阳证那样躁动不安。阳证必定有大热口渴，想喝凉水，舌头上必有刺状物，不像阴证那样口不渴且舌苔滑润。治法应当清胃火，不必强行止血。方药用石膏三钱，青蒿五钱，香薷三钱，荆芥一钱，当归三钱，人参三钱，水煎服。（批注：祛暑止血汤）。这个方子是治疗正阳证吐血的特效药。方中虽然有解暑的药物，然而补益正气多于解暑。去掉香薷一味，实际上可以通治各种阳证的出血。但是这个方子只可用一二剂，之后就应当改用六味地黄汤，来滋补肾阴之水，水充足则阳火自然消退。
另一种是阳证引起的火泻。完谷不化，饮食刚进喉咙就排出，一天或者腹泻十几次，或者几十次，或者昼夜腹泻数百次，人们以为是热症。然而热的产生是什么原因呢？是因为肾中水衰不能制约火，使胃土的门关不能在上下守住，所以食物直进而直出。论其势头的急迫奔涌，似乎适宜治标。然而治标，不能使火骤然下降，必须紧急补肾中的水，使火有所居之处，然后不至于向上腾越。方药用熟地三两，山茱萸一两，车前子一两，甘草一两，茯苓一两，白芍三两，肉桂三分，水煎服。这个方子是补肾的汤剂，不是止泻的药，然而止泻的奇妙效果，迅速如击鼓响应。因为肾水一生成，肾火即下降，顷刻间见效。这不是喜欢奇谈怪论，而不依据实理。如果只当作胃虚有火来治疗，未尝没有功效，终究不如这个方子快捷。脾约丸也很好，怎能比得上这个方子的神奇呢？
华君说：与我想法相同，不必多讲。
雷公说：没有哪一条论述不奇妙。
Chen Shiduo states: The term "Yang treatment" refers to the therapeutic methods for Yang syndromes. There are numerous types of Yang syndromes, which cannot be exhaustively listed; therefore, I shall briefly discuss a few major ones.
In cases where *Shanghan* (Cold Damage) manifests as internal eruption of macules, accompanied by body heat burning like fire, intense thirst with a desire to drink water, panting, dry tongue, and restlessness such as waving hands and kicking off covers, this is one type. Alternatively, in cases of heatstroke caused by excessive summer-heat qi, characterized by extreme thirst requiring gallons of water without relief, profuse sweating like rain, loud shouting and狂呼 (frantic calling), with symptoms worsening during the day and improving at night, this is another type. These all result from Yang fire burning within the stomach region, with smoke rising and momentum urgent, fierce and unstoppable. These are all Yang syndromes. At this stage, even a cup of water is insufficient to overcome them; only large doses of cold-natured herbs can extinguish the fire. Even after using cold herbs to suppress the fire, residual embers and faint flames may remain. It requires torrential rain, filling eaves and ditches with nourishing moisture, so that the fire energy dissipates and the household can be restored. Thus, treating Yang syndromes is more difficult than treating Yin syndromes. The prescription uses Xuanshen (Scrophulariae Radix) 3 liang, Shengma (Cimicifugae Rhizoma) 2 qian, Huangqin (Scutellariae Radix) 1 liang, Maidong (Ophiopogonis Radix) 3 liang, Fangfeng (Saposhnikoviae Radix) 3 qian, Tianhuafen (Trichosanthis Radix) 3 qian, Zisuye (Perillae Folium) 1 qian, Qingdai (Indigo Naturalis) 3 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) 3 qian, Shengdi (Rehmanniae Radix) 1 liang, and Sangbaipi (Mori Cortex) 5 qian. One dose eliminates most symptoms, and two doses lead to complete recovery. (Annotation: Pangtuo Tang / Torrential Rain Decoction). The brilliance of this formula lies in Xuanshen acting as the sovereign herb; it not only clears floating fire but also purges heat in the stomach, while its moistening nature is key. Although macule eruption is due to heat-fire unable to vent outward, it is also because there is insufficient fluid in the chest to provide lubrication, causing stagnation and preventing emergence. By using Xuanshen to moisten, the fire finds it difficult to reside. Furthermore, Huangqin greatly cools the chest and diaphragm, while Shengma and Fangfeng guide and disperse the pathogenic fire. Assisted by Maidong and Shengdi to cool blood and clear lung qi, the energy naturally descends in clarity, and the fire in the middle jiao is completely eradicated.
Regarding heatstroke, it is also a condition of blazing Yang fire pathogens. The method employs Qinghao (Artemisiae Annuae Herba) 5 qian, Shigao (Gypsum Fibrosum) 5 qian, Maidong (Ophiopogonis Radix) 5 qian, Banxia (Pinelliae Rhizoma) 1 qian, Huanglian (Coptidis Rhizoma) 1 qian, Renshen (Ginseng Radix et Rhizoma) 3 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian, Fuling (Poria) 5 qian, and Zhuyeh (Bambusae Folium) 50 leaves, decocted in water and taken orally. (Annotation: Xiaoshu Zhishen Tang / Summer-Heat Eliminating Supreme Spirit Decoction). The efficacy of this formula lies in using Qinghao to remove summer-heat; adding 2 qian of Xiangru (Elsholtziae Herba) allows the summer-heat qi to transform naturally. Shigao pacifies and drains the pathogenic fire in the stomach; once the pathogenic fire is gone, Stomach qi begins to rotate, allowing fluids to descend rather than accumulating in the Bladder, instead dispersing into the four limbs. Moreover, does Fuling not guide this descent? Concerned that fire might damage the Heart, Huanglian is added to rescue the Heart, and Renshen to rescue the Lung. With each zang organ stabilized, the Stomach pathogens must retreat. This is a brilliant method for treating Yang syndromes.
Master Zhang says: Brilliant discussions are inexhaustible. While Yang syndromes are numerous, these two conditions are the most urgent, hence Chen Shiduo specifically highlights them as paradigms. I will further expand upon this, noting two additional conditions.
The first is hematemesis caused by summer-heat injury. When a person contracts summer-heat qi and suddenly vomits blood copiously, people often attribute it to Yin deficiency. However, hematemesis due to Yin deficiency differs from that due to Yang excess (note: text contrasts Yin def vs Yang heat patterns). In Yin deficiency hematemesis, the patient is necessarily quiet, unlike the restlessness seen in Yang syndromes. Yang syndromes present with high fever, thirst, desire for cold water, and prickles on the tongue, unlike Yin syndromes where there is no thirst and the tongue coating is slippery. The treatment should clear Stomach fire without forcibly stopping the bleeding. The prescription uses Shigao (Gypsum Fibrosum) 3 qian, Qinghao (Artemisiae Annuae Herba) 5 qian, Xiangru (Elsholtziae Herba) 3 qian, Jingjie (Schizonepetae Spica) 1 qian, Danggui (Angelicae Sinensis Radix) 3 qian, and Renshen (Ginseng Radix et Rhizoma) 3 qian, decocted in water and taken orally. (Annotation: Qushu Zhi Xue Tang / Summer-Heat Dispelling Blood-Stopping Decoction). This formula is a divine agent for treating hematemesis in true Yang syndromes. Although it contains herbs that resolve summer-heat, it tonifies righteous qi more than it resolves pathogens. Removing Xiangru, this formula can actually treat bleeding from various Yang syndromes. However, this formula should only be used for one or two doses, after which Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) should be switched to, to nourish Kidney Yin. Once fluids are sufficient, Yang fire will naturally subside.
The second is "fire diarrhea" resulting from Yang syndromes. Undigested food passes through immediately after swallowing, occurring ten, dozens, or even hundreds of times a day or night. People assume this is due to heat. However, why does this heat arise? It stems from the decline of Water in the Kidney failing to control Fire, causing the "gate" of the Stomach Earth to fail in guarding the upper and lower openings, leading to direct entry and exit. Given the urgency and rushing nature of the diarrhea, one might think symptomatic treatment (treating the branch) is appropriate. Yet, treating the branch cannot rapidly reduce the fire. One must urgently tonify the Water in the Kidney, providing a residence for the Fire so it does not ascend. The prescription uses Shudi (Prepared Rehmanniae Radix) 3 liang, Shanzhuyu (Corni Fructus) 1 liang, Cheqianzi (Plantaginis Semen) 1 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 1 liang, Fuling (Poria) 1 liang, Baishao (Paeoniae Radix Alba) 3 liang, and Rougui (Cinnamomi Cortex) 3 fen, decocted in water and taken orally. This is a Kidney-tonifying decoction, not an anti-diarrheal per se, yet its miracle in stopping diarrhea is as swift as a drumstick striking a drum. As soon as Kidney Water is generated, Kidney Fire descends, with effects seen instantly. This is not mere eccentric talk but based on solid principles. If treated merely as Stomach deficiency with fire, there may be some effect, but nothing compares to the speed of this formula. Jiyue Wan (Spley-Restriction Pill) is also good, but how can it match the divinity of this formula?
Master Hua says: It aligns with my views; no need for further discussion.
Lord Lei says: Every discussion is wonderful.