凡属表里双解,温凉并用,苦辛分消,补泻兼施,平其复遗,调其气血等方,皆谓之和解法,和法者,双方
并治,分解其兼症夹症之复方,及调理复症遗症之小方缓方也。温热伏邪,初起自内外出,每多因新感风寒暑
湿而发。惟温病之发,因风寒者居多;热病之发,兼暑湿者为甚。兼风兼暑,其性阳,其气轻扬,伏邪反因而
易溃;兼寒兼湿,其性阴,其气抑遏,伏邪每
滞而难达。故一宜表里双解,一宜温凉并用,其病每多夹并而传变,如夹食、夹痰、夹水、夹瘀之类,与伏邪
互并,结于胸胁脘腹之膜络中,致伏邪因之郁结不得透发,不透发安能外解。凡用双解法不效,即当察其所夹
为何物,而于双解法中,加入消食消痰消水消瘀等药,效始能捷,病始能去,故治宜苦辛分消。更有气血两虚,
阴阳并亏,如吴又可所谓四损四不足者,复受温热伏邪,往往有正气内溃而邪入愈深者;亦有阴气先伤而阳气
独发者;内经所云病温虚甚死,即此类也,故治宜补泻兼施。且有病患不讲卫生,病家不知看护,每见劳复、
食复、自复、怒复者;亦有余邪未净,或由失于调理,或由故犯禁忌,而见遗症迭出者;故治宜平其复遗,
调其气血,为温热病中期末期之善后要法。凡此和解之法,虽名为和,实寓有汗下温清消化补益之意,此皆和
解法之精微神妙变化无穷者也。试历述其方略∶
一、表里双解,约法有三∶一为解肌清里,如白虎加桂枝汤(伤寒论方)、知母解肌汤、葛根橘皮汤、
三黄石膏汤(外台方)、石膏大青汤(千金方)、加减三黄石膏汤(顾氏医镜方)、增损三黄石膏汤(寒温条辨
方)、新加麻杏石甘汤(感症宝筏方)、栀豉芩葛汤(陆氏不谢方)之类;一为发汗利溺,如六神通解散(局
方)、凉膈去硝黄合天水散、六一葱豉汤(河间六书方)、五叶芦根汤(湿热条辨方)、燃照汤(王氏霍乱论
方)、藿朴夏苓汤(医原方)、新定达原饮(樊氏验方)之类;一为发表攻里,如删繁香豉汤、许氏大黄汤、
备急黑奴丸(外台方)、凉膈散(局方)、防风通圣散、双解散(刘河间方)、加减防风通圣散(顾氏医镜
方)、增损双解散、加味凉膈散(寒温条辨方)之类;轻重不一,缓急攸殊,临时对症酌用可也。以余所验,
凡治温热病初起,不问兼风兼寒,脉浮脉紧,恶风恶寒,而外热势盛,法当偏重于
表者,通用双解散加葱豉,或凉膈散去硝黄加葱豉,以和解内外之热邪,使表里齐解,奏功最捷。若汗后不恶
寒但恶热,自汗谵语,不大便,咽干腹满,而内热势盛,法当偏重于里者,急用许氏大黄汤,下而和解之,或
用局方凉膈散、加味凉膈散,大剂以退其热,毋使热盛危剧,亦妙。汗下后,余热未尽,烦不得眠,口干渴而
身微热者,短剧茅根汤(外台方)合益元散,清利以和解之,甚则用加味导赤散(王孟英方)其功尤捷。
二、温凉并用,之谓和者,以寒非温不散,湿非温不化,而热则非凉不清,火则非凉不泻也。古今名医∶
如宋和剂局方主用六神通解散,金刘河间主用防风通圣散,前清张路玉主用凉膈合天水散,尤在泾主用大黄饮
子,其方皆发表攻里,宣上导下,气血兼顾,面面周到,使风寒湿热,从表里三焦一齐通解,诚为和解之捷法;
然此惟体实证实,杂感风寒暑湿者适宜。若但病湿温湿热,当从三焦分治∶上焦宜芳淡开泄,如五叶芦根汤、加
味二陈汤、加味五苓散、藿朴二陈汤、藿朴夏苓汤之类;中焦宜苦降辛通,如枳实栀豉汤、白虎加苍术汤(仲
景伤寒论方)、黄连温胆汤(观聚方要补方)、藿香左金汤、连朴饮(霍乱论方)之类;下焦宜苦寒淡渗,如
茵陈五苓散(金匮要略方)、龙胆泻肝汤(局方)、加味八珍散(刘河间方)、清热渗湿汤(医门法律方)、宣
清导浊汤(叶天士医案方)之类。惟素禀阴虚而挟湿热者,膏粱辈每多患此,治法与寻常湿热迥殊。若用风药胜
湿,虚火易于僭上;淡渗利水,阴津易于脱亡;专于燥湿,必致真阴耗竭;纯用滋阴,反助痰湿上壅。务使润燥
合宜,刚柔协济,轻清和解,始克渐渐奏功,如元米煎(用炒香江西术钱半,第二次米泔水泡术,约六句钟,去
术煎饮。薛生白方)、参麦冬瓜汤(北沙参五钱,原麦冬钱半,黄草川斛三钱,炒香枇
杷叶三钱,鲜冬瓜皮子各一两,煎汤代水)、加味导赤散(王孟英方)、加减甘露饮之类,养阴逐湿,两擅其
长。樊师喜用童便四草汤(鲜茅草根、鲜车前草各一两,鲜三白草三钱,鲜荸荠草二钱,莹白童便一杯,广郁
金磨汁四匙,和匀,作两次分冲),亦稳而灵。
三、苦辛分消,亦谓之和解者,因温热结邪在里,非苦辛开泄,不足以解其里结;非分消其夹邪,不足
以解其伏邪也。其间却有轻重缓急之分∶夹邪重而病势急者,当先进飞马金丹(沈樾亭验方传信方),吐泻兼
施,以去其夹邪,然后再治温热本病。夹邪轻而病势缓者,当察其所夹何邪,参用消药以和解,如枳实栀豉汤合
陆氏润字丸、小陷胸汤合朴黄丸之分消痰食,加味小陷胸汤、加减半夏泻心汤、加味连茹橘半汤、加味枳实栀
豉合小陷胸汤之分消痰火,昌阳泻心汤、小陷胸合加减半夏泻心汤之分消湿热痰火,漏芦橘皮汤、加味小陷胸
汤合控涎丹之分消痰水,加减小柴胡汤、增损小柴胡汤、四逆散合白薇汤之分消瘀热,对症酌用,历验不爽。
他如沉香百消曲,善能消食消痰,消水消瘀,其功甚捷,随症均可佐使。惟病后液枯气逆肝火上冲者,膏粱辈
最多此症,最难消解,治以五汁四磨饮(西瓜汁、甘蔗汁、雅梨汁、鲜生地汁、金汁各一瓢,广郁金、广木香、
上沉香、乌药各磨汁一茶匙,冲入开水一半,和匀即饮。薛生白方)最妙,以诸汁滋胃液,辛香散逆气,凡治
阴虚气滞者,均可仿此用药以和解之。
四、补泻兼施者,因其人平素体虚,或宿有内伤,复感温热伏邪,不得不邪正并治,标本兼顾,于是乎
有补泻合用之法,有先泻后补之法,有寓泻于补之法。如参苏饮、人参败毒散、仓廪汤(喻氏医门法律方)之
类,益气与发表并用;七味葱白汤、短剧茅根汤(外台方)、加减葳蕤汤之类,滋阴与解肌并用∶
人参白虎汤、竹叶石膏汤、加减竹叶石膏汤(廉臣验方)之类,益气与清热并用;黄连阿胶汤(仲景方)、千
金生地黄煎、犀角地黄汤(千金要方)之类,滋阴与泻火并用;水解散(外台方)、陶氏黄龙汤(温疫论方)之
类,补正与逐邪并用;补中益气汤、调中益气汤(补中益气汤加片芩、神曲)之类,益气与透邪并用;三黄积
术丸、枳实导滞丸(东垣方)之类,益气与消导并用;黄 汤,益气与润肠并用;益血润肠丸,养血与润下并
用;养荣承气汤,养血与通便并用;猪苓汤(仲景方)、加味导赤散,滋阴与利溺并用;陶氏逍遥汤,清补阴
气与通逐败精并用;导赤合加味虎杖散、猪苓汤合 鼠矢散,滋阴利溺与通逐败精并用。此皆补泻合用之法也。
又如本病阴虚火旺,复感风温风热,则风助火势而劫阴愈剧,急宜辛凉散风以治标,葱豉汤加童便最稳;重则
荷杏石甘汤以速祛其邪,次用五汁四磨饮、千金生地黄煎之类,滋阴降火以治本。若复感暑湿湿热,则湿火交
煎而阴气愈伤,急宜养阴逐湿以治标,猪苓汤、加味导赤散二方最稳;重则童便四草汤亦可酌用,次用参麦冬
瓜汤、加减甘露饮之类,滋阴清里以善后。又如本病阳虚气滞,复感湿温湿热,则中气愈郁而湿遏热伏,急宜
芳淡泄湿,加味二陈汤最当,其次加味五苓散,亦可参用以透邪,次用香砂理苓汤(即香砂理中汤合五苓散)疏
中益气、辛淡化湿以治本;茵陈胃苓汤,法亦标本兼顾。此皆先泻后补之法也。若内伤肺痨,病当中期之候,
一遇风温与湿热,则外感与内伤交灼,标邪与本病纠结,风则引其喘,湿则助其痰,热则增咳而动血,若不细
加诊察,每认本病变重,仍与蛮补,如以 术滞其气,胶地腻其血,甚至白芍五味敛其邪,势急者,譬如双斧
伐枯树,立刻倾折,势缓者,亦如鼷鼠入牛角,愈深入而难出矣。此时急救之法,虽宜补虚治本为主,亦必兼轻
理标症,如葛氏保和汤(十药神书方)之用
薄荷、紫苏,养阴清肺汤(耐修子白喉抉微方)之用薄荷、桔梗之类,皆能轻解风温;又如加减甘露饮(樊师
验方)之用茵陈、芩、枳,沙参麦冬汤(王孟英验方)之重用冬瓜皮、子之类,皆能清理湿热;此皆寓泻于补
之法也。总之,内伤兼外感,其病虚中夹实,实中夹虚,调治固要轻灵,亦必先明本体之气虚血虚,或气血并
虚,精虚神虚,或精神并虚,继必辨其为房劳伤、思郁伤、医药伤、饮食伤,然后参详感邪之轻重,急则先治
标以去邪,邪去正自安,缓则但治本以养正,正足邪乃去。
五、平其复遗调其气血者,因伏邪之大势已去而余邪未解,即用小方缓方,平治复症遗症以和解之,戴
北山所谓平其亢厉是也。或用发表攻里消化,而小其剂料,参以调养,或用清凉补益,而变其汤方,易以膏散
丸丹者皆是,方法甚多,已详载总论复症遗症篇,兹不赘。惟怒复而夙有饮痛,胸胀脘闷,诸法不效,一瓢用
千金五香汤(千金霜一钱煎汤,磨上沉香、广木香、母丁香、白檀香、紫降香各一匙服)迭泻水饮而痊,余历
验不爽,故特表彰之。至其见症,表里三焦,寒热杂发,湿火互结,食痰水瘀,内外夹发,气虚血郁,血虚气
滞,变症多端,未能一一曲尽,聊陈大要如下∶
寒热往来,盗汗,口苦,喜呕,咽干,头眩,舌苔白浓,微兼淡黄,烦渴,胸胁满痛,耳聋,小便黄,呕
吐下利而心下痛,口干舌强而恶寒,大小便闭而寒热,胸膈痞满而悸,二便自利而舌苔粘腻,形体虚怯而舌苔
滑浓。
以上宜和解之症,引此数端,余可类推,方法大备,总以对症发药为要。
凡属于表里双解、温凉并用、苦辛分消、补泻兼施,以及平复复发后遗症、调理气血等方剂,都称为和解法。所谓和法,是指同时治疗表里两方面,分解其兼夹症状的复方,以及调理复发症和后遗症的小方或缓方。温热伏邪(潜伏于体内的温热病邪),初起时从体内向外透发,往往多因新近感受风寒暑湿而诱发。其中,温病的发作,多因风寒引起;热病的发作,兼夹暑湿的情况更为严重。兼夹风邪和暑邪,性质属阳,气机轻扬,伏邪反而容易溃散透发;兼夹寒邪和湿邪,性质属阴,气机被抑制遏阻,伏邪往往停滞而难以透达。因此,有的适宜用表里双解法,有的适宜用温凉并用法。这类疾病往往夹杂其他病邪并传变,如夹食积、夹痰饮、夹水湿、夹瘀血之类,与伏邪互相结聚,阻滞于胸胁脘腹的膜络之中,导致伏邪因此郁结而不能透发,不能透发又怎能从体表解除呢?凡是使用双解法无效的,就应当观察其所夹的是什么病邪,然后在双解法中加入消食、消痰、消水、消瘀等药物,疗效才能迅速,疾病才能去除,所以治疗宜用苦辛分消法。更有甚者,若患者气血两虚,阴阳俱亏,正如吴又可所说的“四损四不足”,又复感温热伏邪,往往出现正气内部溃败而邪气深入更重的情况;也有的是阴气先受伤而阳气独自亢盛发作的;《内经》所说患温病且正气极度虚弱者会死亡,就是这一类情况,所以治疗宜用补泻兼施法。还有因为病人不讲卫生,家属不知护理,常常见到劳复(劳累后复发)、食复(饮食不当后复发)、自复(自行调养不当后复发)、怒复(情绪激动后复发)的情况;也有余邪未净,或因失于调理,或因故意违反禁忌,而导致后遗症接连出现的;所以治疗宜平复复发和后遗症,调理气血,这是温热病中期末期的善后重要方法。所有这些和解之法,虽然名为“和”,实则蕴含了汗法、下法、温法、清法、消导法、补益法的意旨,这些都是和解法精微神妙、变化无穷的地方。试分别陈述其方略如下:
一、表里双解,大致有三条法则:一是解肌清里,如白虎加桂枝汤(出自《伤寒论》的方剂)、知母解肌汤、葛根橘皮汤、三黄石膏汤(出自《外台秘要》的方剂)、石膏大青汤(出自《千金方》的方剂)、加减三黄石膏汤(出自顾氏《医镜》的方剂)、增损三黄石膏汤(出自《寒温条辨》的方剂)、新加麻杏石甘汤(出自《感症宝筏》的方剂)、栀豉芩葛汤(出自陆氏《不谢方》的方剂)之类;二是发汗利小便,如六神通解散(出自《局方》的方剂)、凉膈散去硝黄合天水散、六一葱豉汤(出自河间《六书》的方剂)、五叶芦根汤(出自《湿热条辨》的方剂)、燃照汤(出自王氏《霍乱论》的方剂)、藿朴夏苓汤(出自《医原》的方剂)、新定达原饮(出自樊氏验方)之类;三是发表攻里,如删繁香豉汤、许氏大黄汤、备急黑奴丸(出自《外台秘要》的方剂)、凉膈散(出自《局方》的方剂)、防风通圣散、双解散(出自刘河间的方剂)、加减防风通圣散(出自顾氏《医镜》的方剂)、增损双解散、加味凉膈散(出自《寒温条辨》的方剂)之类;轻重不同,缓急各异,临时根据症状斟酌使用即可。据我经验验证,凡是治疗温热病初起,不论兼夹风邪还是寒邪,脉象浮或紧,恶风或恶寒,而外部热势旺盛,治法应当偏重于表的,通用双解散加葱豉,或者凉膈散去芒硝、大黄加葱豉,以和解内外的热邪,使表里一齐解除,奏效最快。如果发汗后不再恶寒但恶热,自汗、谵语、不大便、咽干、腹满,而内部热势旺盛,治法应当偏重于里的,急用许氏大黄汤,通过泻下以达到和解的目的,或者使用局方凉膈散、加味凉膈散,大剂量服用以退热,不要使热势炽盛危及生命,也很巧妙。发汗或泻下后,余热未尽,心烦不得睡眠,口干渴且身体微热者,可用短剧茅根汤(出自《外台秘要》的方剂)合益元散,通过清热利湿来和解,严重时可用加味导赤散(王孟英方),功效尤其迅速。
二、温凉并用,称之为“和”,是因为寒邪非温药不能消散,湿邪非温药不能化除,而热邪非凉药不能清除,火邪非凉药不能泻除。古今名医:如宋代《和剂局方》主用六神通解散,金代刘河间主用防风通圣散,清代张路玉主用凉膈散合天水散,尤在泾主用大黄饮子,这些方剂都能发表攻里,宣通上焦引导下焦,兼顾气血,面面俱到,使风寒湿热从表里三焦一齐通解,确实是和解的捷径;然而这仅适用于体质结实、证候属实,杂感风寒暑湿的患者。如果只是患有湿温、湿热,应当从三焦分治:上焦宜用芳香淡渗开泄,如五叶芦根汤、加味二陈汤、加味五苓散、藿朴二陈汤、藿朴夏苓汤之类;中焦宜用苦降辛通,如枳实栀豉汤、白虎加苍术汤(仲景《伤寒论》方剂)、黄连温胆汤(出自《观聚方要补》的方剂)、藿香左金汤、连朴饮(出自《霍乱论》的方剂)之类;下焦宜用苦寒淡渗,如茵陈五苓散(出自《金匮要略》的方剂)、龙胆泻肝汤(出自《局方》的方剂)、加味八珍散(刘河间方)、清热渗湿汤(出自《医门法律》的方剂)、宣清导浊汤(叶天士医案方)之类。只有素体阴虚而挟带湿热的人,富贵膏粱之徒多患此病,治法与寻常湿热截然不同。如果使用风药胜湿,虚火容易僭越上行;使用淡渗利水,阴津容易脱失亡竭;专门燥湿,必然导致真阴耗竭;纯用滋阴,反而助长痰湿上壅。务必使润燥适宜,刚柔相济,轻清和解,才能渐渐奏效,如元米煎(用炒香的江西白术半钱,用第二次淘米水泡术约六小时,去术煎饮。薛生白方)、参麦冬瓜汤(北沙参五钱,原麦冬半钱,黄草川斛三钱,炒香枇杷叶三钱,鲜冬瓜皮和子各一两,煎汤代水)、加味导赤散(王孟英方)、加减甘露饮之类,既能养阴又能逐湿,两擅其长。樊师喜欢用童便四草汤(鲜茅草根、鲜车前草各一两,鲜三白草三钱,鲜荸荠草二钱,莹白童便一杯,广郁金磨汁四匙,混合均匀,分两次冲服),也稳妥灵验。
三、苦辛分消,也称为和解,是因为温热结聚的病邪在里,非苦辛开泄不足以解除里面的结滞;非分消其夹带的病邪,不足以解除伏邪。这其中却有轻重缓急之分:夹邪重而病势急的,应当先进服飞马金丹(沈樾亭验方,传信方),吐法和泻法兼施,以去除夹邪,然后再治疗温热本病。夹邪轻而病势缓的,应当观察所夹的是什么邪气,参用消导药来和解,如枳实栀豉汤合陆氏润字丸、小陷胸汤合朴黄丸之分消痰食,加味小陷胸汤、加减半夏泻心汤、加味连茹橘半汤、加味枳实栀豉合小陷胸汤之分消痰火,昌阳泻心汤、小陷胸汤合加减半夏泻心汤之分消湿热痰火,漏芦橘皮汤、加味小陷胸汤合控涎丹之分消痰水,加减小柴胡汤、增损小柴胡汤、四逆散合白薇汤之分消瘀热,对症斟酌使用,屡试不爽。其他如沉香百消曲,善于消食、消痰、消水、消瘀,功效很快,随症均可作为佐使药。只有病后津液枯竭、气逆、肝火上冲的人,富贵膏粱之徒最多有此症,最难消解,治疗用五汁四磨饮(西瓜汁、甘蔗汁、雅梨汁、鲜生地汁、金汁各一瓢,广郁金、广木香、上沉香、乌药各磨汁一茶匙,冲入一半开水,混合即饮。薛生白方)最妙,用各种汁液滋润胃液,用辛香药物疏散逆气,凡是治疗阴虚气滞的,都可以仿照此法用药来和解。
四、补泻兼施,是因为病人平时体质虚弱,或者有宿疾内伤,又复感温热伏邪,不得不邪正并治,标本兼顾,于是有了补泻合用的方法,有先泻后补的方法,有寓泻于补的方法。如参苏饮、人参败毒散、仓廪汤(喻氏《医门法律》方剂)之类,益气与发表并用;七味葱白汤、短剧茅根汤(出自《外台秘要》的方剂)、加减葳蕤汤之类,滋阴与解肌并用;人参白虎汤、竹叶石膏汤、加减竹叶石膏汤(廉臣验方)之类,益气与清热并用;黄连阿胶汤(仲景方)、千金生地黄煎、犀角地黄汤(《千金要方》方剂)之类,滋阴与泻火并用;水解散(出自《外台秘要》的方剂)、陶氏黄龙汤(《温疫论》方剂)之类,补正气与逐邪气并用;补中益气汤、调中益气汤(补中益气汤加片芩、神曲)之类,益气与透邪并用;三黄枳术丸、枳实导滞丸(东垣方)之类,益气与消导并用;黄芪建中汤(原文缺字,推测为黄芪相关方,此处依原文留空或泛指),益气与润肠并用;益血润肠丸,养血与润下并用;养荣承气汤,养血与通便并用;猪苓汤(仲景方)、加味导赤散,滋阴与利小便并用;陶氏逍遥汤,清补阴气与通逐败精并用;导赤散合加味虎杖散、猪苓汤合鼠矢散,滋阴利小便与通逐败精并用。这些都是补泻合用的方法。又如本病阴虚火旺,又复感风温风热,则风助火势而劫夺阴液更严重,急宜辛凉散风以治标,葱豉汤加童便最稳妥;重则用荷杏石甘汤以快速祛除邪气,其次用五汁四磨饮、千金生地黄煎之类,滋阴降火以治本。如果又复感暑湿湿热,则湿火交煎而阴气更受损伤,急宜养阴逐湿以治标,猪苓汤、加味导赤散两方最稳妥;重则童便四草汤也可酌情使用,其次用参麦冬瓜汤、加减甘露饮之类,滋阴清里以善后。又如本病阳虚气滞,又复感湿温湿热,则中气更加郁结而湿遏热伏,急宜芳香淡渗泄湿,加味二陈汤最合适,其次加味五苓散,也可参用以透邪,其次用香砂理苓汤(即香砂理中汤合五苓散)疏理中气、益气、辛淡化湿以治本;茵陈胃苓汤,法亦标本兼顾。这些都是先泻后补的方法。如果是内伤肺痨,病情处于中期,一旦遇到风温与湿热,则外感与内伤交灼,标邪与本病纠结,风邪引发气喘,湿邪助长痰饮,热邪增加咳嗽并动血,如果不仔细诊察,常误认本病加重,仍用蛮补,如用白术、苍术阻滞气机,用地黄、熟地腻滞血脉,甚至用白芍、五味子收敛邪气,势急者,譬如双斧砍枯树,立刻倾倒折断,势缓者,也如鼷鼠进入牛角,越深入越难出来。此时急救之法,虽然应以补虚治本为主,但也必须兼用轻灵之法处理标症,如葛氏保和汤(《十药神书》方剂)中使用薄荷、紫苏,养阴清肺汤(耐修子《白喉抉微》方剂)中使用薄荷、桔梗之类,都能轻解风温;又如加减甘露饮(樊师验方)中使用茵陈、黄芩、枳实,沙参麦冬汤(王孟英验方)中重用冬瓜皮、冬瓜子之类,都能清理湿热;这些都是寓泻于补的方法。总之,内伤兼外感,其病是虚中夹实,实中夹虚,调治固然要轻灵,但也必须先明确本体是气虚血虚,还是气血并虚,精虚神虚,还是精神并虚,接着必须辨别是房劳伤、思虑郁结伤、医药伤、饮食伤,然后详细分析感邪的轻重,急则先治标以去邪,邪去正气自然安宁,缓则只治本以养正,正气充足邪气乃去。
五、平复复发后遗症、调理气血,是因为伏邪的大势已去而余邪未解,即用小方缓方,平治复发症和后遗症以和解之,戴北山所说的“平其亢厉”就是此意。或者用发表攻里消导,而缩小药剂剂量,参以调养,或者用清凉补益,而改变汤方,改为膏、散、丸、丹的,方法很多,已在总论复症遗症篇详载,这里不再赘述。只有因愤怒复发且素有饮痛(水饮停聚引起的疼痛),胸胀脘闷,诸法无效,一瓢用千金五香汤(千金霜一钱煎汤,磨上沉香、广木香、母丁香、白檀香、紫降香各一匙服)多次泻下水饮而痊愈,我屡次验证无误,所以特别表彰它。至于其见症,表里三焦,寒热杂发,湿火互结,食痰水瘀,内外夹发,气虚血郁,血虚气滞,变症多端,未能一一详尽列举,姑且陈述大要如下:
寒热往来,盗汗,口苦,喜呕,咽干,头眩,舌苔白厚,微兼淡黄,烦渴,胸胁满痛,耳聋,小便黄,呕吐下利而心下痛,口干舌强而恶寒,大小便闭而寒热,胸膈痞满而悸,二便自利而舌苔粘腻,形体虚怯而舌苔滑厚。
以上适宜和解的症状,列举这几项,其余可类推,方法完备,总以对症用药为关键。
Any formula that belongs to resolving both exterior and interior simultaneously, combining warming and cooling, dispersing with bitter and acrid flavors, applying tonification and purgation together, calming recurrence and sequelae, and regulating Qi and Blood is called the Harmonizing Method (He Fa). The Harmonizing Method refers to compound formulas that treat both sides simultaneously, decomposing concurrent and complicated symptoms, as well as small or mild formulas that regulate recurrent conditions and sequelae. Warm-heat latent pathogens (Wen Re Fu Xie) initially emerge from within to the exterior, often triggered by a recent contraction of Wind-Cold, Summer-Heat, or Dampness. Among these, the onset of Warm diseases is mostly caused by Wind-Cold; the onset of Heat diseases is more severe when complicated by Summer-Heat and Dampness. Complications with Wind and Summer-Heat are Yang in nature and light in Qi, allowing latent pathogens to disperse easily; complications with Cold and Dampness are Yin in nature and suppressive in Qi, causing latent pathogens to stagnate and be difficult to reach. Therefore, some cases are suitable for simultaneous resolution of exterior and interior, while others are suitable for the combination of warming and cooling. Such diseases often transmit with complications, such as food retention, phlegm-fluids, water-dampness, and blood stasis, which bind with latent pathogens and obstruct the membrane networks in the chest, hypochondrium, epigastrium, and abdomen. This causes the latent pathogens to become depressed and unable to penetrate outward; if they cannot penetrate outward, how can they be resolved from the exterior? Whenever double-resolution methods fail, one must observe what pathogen is complicated, and add herbs for digesting food, resolving phlegm, draining water, and removing stasis into the double-resolution method. Only then will the efficacy be swift and the disease eliminated. Thus, treatment should employ the method of bitter-acrid dispersion. Furthermore, if there is deficiency of both Qi and Blood, and depletion of both Yin and Yang—as Wu Keyang described as "Four Damages and Four Insufficiencies"—and the patient contracts warm-heat latent pathogens again, it often results in internal collapse of healthy Qi and deeper penetration of pathogens; or there may be prior injury to Yin with independent hyperactivity of Yang. As stated in the *Neijing*, death occurs in warm diseases when healthy Qi is extremely deficient; this is such a case. Therefore, treatment should employ simultaneous tonification and purgation. Additionally, due to patients' lack of hygiene awareness and families' neglect of care, one often sees recurrences due to overexertion (Lao Fu), improper diet (Shi Fu), self-neglect (Zi Fu), or anger (Nu Fu); there are also cases where residual pathogens remain uncleaned, leading to successive sequelae due to lack of regulation or violation of taboos. Thus, treatment should calm recurrences and sequelae and regulate Qi and Blood, which is the crucial post-treatment method for the middle and late stages of warm-heat diseases. All these harmonizing methods, although named "Harmonizing," actually contain the intentions of sweating, purging, warming, clearing, digestion-promoting, and tonifying methods. These represent the subtle and miraculous infinite variations of the Harmonizing Method. Their strategies are detailed below:
1. Simultaneous Resolution of Exterior and Interior has approximately three principles:
First, releasing the muscle layer and clearing the interior, such as Baihu Jia Guizhi Tang (Cinnamon Twig Decoction plus White Tiger Decoction, from *Shanghan Lun*), Zhimu Jiemo Tang, Gegen Jupi Tang, Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction, from *Waitai Miyao*), Shigao Daqing Tang (Gypsum and Saposhnikovia Decoction, from *Qianjin Fang*), Jiashan Sanhuang Shigao Tang, Zengsun Sanhuang Shigao Tang, Xinjia Maxing Shigan Tang, Zhichi Qinge Tang, etc.
Second, inducing sweating and promoting urination, such as Liutong Shenjie San (Six Miraculous Penetration Powder, from *Ju Fang*), Liangge San minus Mangxiao and Dahuang combined with Tiansan San, Liuyi Congchi Tang, Wuye Lugeng Tang, Ranzhao Tang, Huopo Xialing Tang, Xinding Dayin Yin, etc.
Third, releasing the exterior and attacking the interior, such as Shanfan Xiangchi Tang, Xu's Dahuang Tang, Beiji Heini Wan, Liangge San, Fangfeng Tongsheng San, Shuangjie San, Jiashan Fangfeng Tongsheng San, Zengsun Shuangjie San, Jiawei Liangge San, etc.
The severity varies, and urgency differs; use them flexibly according to symptoms. Based on my experience, for early-stage warm-heat diseases, regardless of Wind or Cold complication, floating or tight pulse, aversion to wind or cold, but with intense external heat, where treatment should focus on the exterior, generally use Shuangjie San with Congchi, or Liangge San minus Mangxiao and Dahuang with Congchi, to harmonize and resolve internal and external heat pathogens, achieving rapid results. If after sweating, there is no aversion to cold but aversion to heat, spontaneous sweating, delirium, constipation, dry throat, and abdominal fullness, with intense internal heat, where treatment should focus on the interior, urgently use Xu's Dahuang Tang to purge and harmonize, or use Ju Fang Liangge San or Jiawei Liangge San in large doses to reduce heat, preventing critical danger. After sweating or purging, if residual heat remains, causing irritability, insomnia, dry mouth, thirst, and slight fever, use Duanju Maogen Tang combined with Yiyuan San to clear and drain for harmonization; if severe, use Jiawei Daochi San for particularly swift effects.
2. Combining Warming and Cooling is called "Harmonizing" because cold pathogens require warming to dissipate, and damp pathogens require warming to transform, whereas heat pathogens require cooling to clear, and fire pathogens require cooling to purge. Famous doctors throughout history: Song Dynasty's *Heji Ju Fang* primarily used Liutong Shenjie San; Jin Dynasty's Liu Hejian primarily used Fangfeng Tongsheng San; Qing Dynasty's Zhang Luyu primarily used Liangge San combined with Tiansan San; You Zaijing primarily used Dahuang Yinzi. These formulas release the exterior and attack the interior, vent the upper and guide the lower, attend to both Qi and Blood, ensuring comprehensive coverage, allowing Wind-Cold, Dampness, and Heat to be resolved simultaneously from the exterior, interior, and Triple Burner. This is indeed a swift method of harmonization; however, it is only suitable for patients with solid constitution and excess syndromes complicated by Wind-Cold, Summer-Heat, or Dampness. If suffering only from Wet-Warmth or Damp-Heat, treatment should follow the Triple Burner differentiation: Upper Burner requires aromatic and bland opening and venting, such as Wuye Lugeng Tang, Jiawei Erchen Tang, Jiawei Wuling San, Huopo Erchen Tang, Huopo Xialing Tang, etc.; Middle Burner requires bitter descending and acrid unblocking, such as Zhishi Zhichi Tang, Baihu Jia Cangzhu Tang, Huanglian Wendan Tang, Huoxiang Zuojin Tang, Lianpo Yin, etc.; Lower Burner requires bitter-cold and bland渗 (permeating), such as Yichen Wuling San, Longdan Xiegan Tang, Jiawei Bazhen San, Qingre Shenshi Tang, Xuanqing Daozhuo Tang, etc. For those with innate Yin deficiency complicated by Damp-Heat, common among the wealthy who consume rich foods, the treatment differs significantly from ordinary Damp-Heat. Using wind-dispelling herbs may cause deficient fire to flare upward; using bland-draining herbs may cause Yin fluids to escape; focusing solely on drying dampness will exhaust true Yin; using purely yin-nourishing herbs will instead assist phlegm-dampness to obstruct upwards. One must ensure appropriate moistening and drying, coordination of rigid and soft, and light-clear harmonization to gradually achieve results. Examples include Yuanmi Jian (Fried Jiangxi Atractylodes macrocephala half qian, soaked in second rice-washing water for six hours, remove herb and decoct), Shenmai Donggua Tang (Beishashen, Yuandongdong, Huangcao Chuhu, fried Pipaye, fresh Dongguapi and Dongguazi), Jiawei Daochi San, Jiagan Ganlu Yin, which nourish Yin and expel dampness, excelling in both aspects. Master Fan prefers Tongbian Sicao Tang (Fresh Maogen root, fresh Cheqiancao each 1 liang, fresh Sanbaicao 3 qian, fresh Biqicai 2 qian, clear child urine 1 cup, Guang Yujin juice 4 spoons, mixed evenly, taken in two doses), which is also steady and effective.
3. Bitter-Acid Dispersion is also called Harmonizing because warm-heat condensed pathogens are in the interior; without bitter-acrid opening and venting, the interior condensation cannot be resolved; without dispersing complicated pathogens, the latent pathogens cannot be resolved. There are distinctions in severity and urgency: If complicated pathogens are heavy and disease progression is acute, first administer Feima Jindan (Spit-and-Purge Pill), using both emetic and purgative methods to remove complicated pathogens, then treat the primary warm-heat disease. If complicated pathogens are light and disease progression is slow, observe the type of complicated pathogen and use digestive herbs to harmonize, such as Zhishi Zhichi Tang combined with Lu's Runzi Wan, Xiaoxianzhong Tang combined with Puhuang Wan to disperse phlegm-food retention, Jiawei Xiaoxianzhong Tang, Jiaban Banxia Xiexin Tang, Jiawei Lianru Juban Tang, Jiawei Zhishi Zhichi combined with Xiaoxianzhong Tang to disperse phlegm-fire, Changyang Xiexin Tang, Xiaoxianzhong Tang combined with Jiaban Banxia Xiexin Tang to disperse damp-heat-phlegm-fire, Loulu Jupi Tang, Jiawei Xiaoxianzhong Tang combined with Kongyan Dan to disperse phlegm-water, Jiashan Xiao Chaihu Tang, Zengsun Xiao Chaihu Tang, Sini San combined with Baiwei Tang to disperse blood-heat. Use them according to symptoms with consistent success. Others like Chenxiang Baixiao Qu are good at digesting food, phlegm, water, and stasis, with rapid effects, usable as adjuncts. However, for post-illness fluid depletion, rebellious Qi, and Liver Fire rushing up, common in the wealthy, which is hardest to resolve, use Wuzhi Simo Yin (Watermelon juice, sugarcane juice, pear juice, fresh Shengdi juice, Jin juice each one ladle, Guang Yujin, Guang Muxiang, Shang Chenxiang, Wuyao each ground juice one tea spoon, mixed with half boiled water) which is excellent. Various juices nourish stomach fluids, acrid-aromatics scatter rebellious Qi. For treating Yin deficiency with Qi stagnation, one can imitate this medication for harmonization.
4. Simultaneous Tonification and Purgation is used because the patient is usually weak or has chronic internal injuries, and upon contracting warm-heat latent pathogens, one must treat both pathogen and healthy Qi, addressing both root and branch. Thus, there are methods of combining tonification and purgation, purging before tonifying, and incorporating purgation within tonification. Examples: Renshen Su Yin, Renshen Baidu San, Canglin Tang (tonify Qi and release exterior); Qiwei Congbai Tang, Duanju Maogen Tang, Jiawei Weirui Tang (nourish Yin and release muscle); Renshen Baizhu Tang, Zhuye Shigao Tang, Jiashan Zhuye Shigao Tang (tonify Qi and clear heat); Huanglian Ejiao Tang, Qianjin Shengdihuang Jian, Xijiao Dihuang Tang (nourish Yin and purge fire); Shuijie San, Tao's Huanglong Tang (tonify righteousness and drive out pathogens); Buzhong Yiqi Tang, Tiaozhong Yiqi Tang (tonify Qi and vent pathogens); Sanhuang Jizhu Wan, Zhishi Daoli Wan (tonify Qi and promote digestion); [Missing Character] Tang (tonify Qi and moisten intestines); Yixue Runchang Wan (nourish Blood and moisten downward); Yangrong Chengqi Tang (nourish Blood and unblock bowels); Zhuling Tang, Jiawei Daochi San (nourish Yin and promote urination); Tao's Xiaoyao Tang (clear-tonify Yin and drive out stale essence); Daochi San combined with Jiawei Huzhang San, Zhuling Tang combined with Shushi San (nourish Yin, promote urination, and drive out stale essence). These are methods of combining tonification and purgation.
Furthermore, if the primary disease involves Yin deficiency with fire hyperactivity, compounded by Wind-Warmth or Wind-Heat, wind aids fire and depletes Yin severely. Urgently use acrid-cool to scatter wind for the branch, Congchi Tang with child urine is safest; if severe, use He-Xing-Shi-Gan Tang to quickly dispel pathogens, followed by Wuzhi Simo Yin or Qianjin Shengdihuang Jian to nourish Yin and descend fire for the root. If compounded by Summer-Dampness or Damp-Heat, damp-fire煎熬 injures Yin further. Urgently nourish Yin and expel dampness for the branch, Zhuling Tang and Jiawei Daochi San are safest; if severe, Tongbian Sicao Tang can be considered, followed by Shenmai Donggua Tang or Jiagan Ganlu Yin to nourish Yin and clear interior for recovery. If the primary disease involves Yang deficiency with Qi stagnation, compounded by Wet-Warmth or Damp-Heat, Middle Qi becomes more depressed and damp suppresses heat. Urgently use aromatic-bland to drain dampness, Jiawei Erchen Tang is most appropriate, followed by Jiawei Wuling San to vent pathogens, then Xiangsha Liling Tang (Xiangsha Lizhong Tang combined with Wuling San) to soothe Middle, tonify Qi, and use acrid-bland to transform dampness for the root; Yichen Weiping Tang also addresses both root and branch. These are methods of purging before tonifying.
If internal injury involves Lung Tuberculosis (Fei Lao) in the mid-stage, encountering Wind-Warmth and Damp-Heat causes external and internal injuries to scorch each other, branch pathogens and primary disease entangle. Wind induces asthma, Dampness assists phlegm, Heat increases cough and bleeding. Without careful diagnosis, mistaking primary disease worsening and using blind tonification (using Atractylodes/Cangzhu to stagnate Qi, Rehmannia/Shudi to cloy Blood, Bai Shao/Wuweizi to trap pathogens) is dangerous. Acute cases are like splitting a dead tree with two axes, collapsing immediately; slow cases are like a mouse entering a bull's horn, going deeper and harder to exit. Emergency treatment should primarily tonify deficiency and treat the root, but must also lightly address branch symptoms. For example, Ge's Baohe Tang using Bohe and Zisu, Yangyin Qingfei Tang using Bohe and Jiegeng can lightly resolve Wind-Warmth; Jiagan Ganlu Yin using Yichen, Huangqin, Zhishi, Shashen Maidong Tang using heavy Dongguapi and Dongguazi can clear Damp-Heat. These are methods of incorporating purgation within tonification.
In summary, internal injury with external contraction involves deficiency with excess and excess with deficiency. Treatment must be agile but first determine if the body is Qi/Blood deficient, both Qi and Blood deficient, Essence/Spirit deficient, or both Spirit and Essence deficient. Then differentiate if the injury is from sexual exhaustion, mental depression, medical error, or dietary mishap. Analyze the severity of contracted pathogens. In acute cases, treat the branch first to remove pathogens; once pathogens are gone, healthy Qi settles. In chronic cases, treat the root to nourish healthy Qi; once healthy Qi is sufficient, pathogens depart.
5. Calming Recurrence/Sequelae and Regulating Qi and Blood is used because the main force of latent pathogens has subsided but residual pathogens remain. Small or mild formulas are used to calm recurrent and sequelae conditions for harmonization, as Dai Beishan described as "calming hyperactivity." Methods include reducing dosages of exterior-releasing, interior-attacking, or digestive formulas combined with regulation, or changing decoctions into pastes, powders, pills, or elixirs using cooling and tonifying methods. Many methods exist, detailed in the General Discussion on Recurrence and Sequelae, so not repeated here. Only for recurrence due to anger with pre-existing fluid-pain (Yin Tong), chest distension, epigastric oppression, where other methods fail, Yipiao used Qianjin Wuxiang Tang (Qianjin Frost 1 qian decocted, grinding Chenxiang, Guang Muxiang, Mu Dingxiang, Bai Tanxiang, Zi Jiangxiang each one spoon) repeatedly to drain fluid-dampness and cure. I have verified this consistently, so I specially highlight it. Regarding symptoms: alternating chills and fever, night sweats, bitter taste, desire to vomit, dry throat, vertigo, thick white tongue coating slightly yellow, irritability and thirst, chest/hypochondrium fullness and pain, deafness, yellow urine, vomiting/diarrhea with epigastric pain, dry mouth/stiff tongue with aversion to cold, constipation/dysuria with chills/fever, chest diaphragm stuffiness with palpitations, free urination/defecation with sticky tongue coating, frail physique with slippery-thick tongue coating.
For the above symptoms suitable for harmonization, these few examples are cited, others can be inferred. Methods are comprehensive, but the key is prescribing according to symptoms.