中暑烦心,脉虚自汗,燥气焚金,痿软无力者,皆不可温。又有阴虚,脉细数,阳乘而吐血者,亦不可温,温
之则为逆候;此所谓不当用温而温者也。然又有当温而温之不得其法者何也?假如冬令伤寒,则温而散之;冬
令伤风,则温而解之;寒痰壅闭,则温而开之;冷食所伤,则温而消之;至若中寒暴痛,大便反硬,温药不止
者,则以热剂下之;时当暑月,而纳凉饮冷,暴受寒侵者,亦当温之;体虚挟寒者,温而补之;寒客中焦,理
中汤温之;寒客下焦,四逆汤温之;又有阴盛格阳于外,温药不效者,则以白通汤加人尿猪胆汁反佐以取之;
《经》云‘热因寒用’是已。复有真虚挟寒,命门火衰者,必须补其真阳,太仆有言∶‘大寒而盛,热之不热,是
无火也,常补其心。’此心字指命门而言。更有表里皆寒之症,始用温药,里寒顿除,表邪不散,复传经络,
以致始为寒中,而其后转变为热中者,容或有之,藉非斟酌时宜,对症投剂,是先以温药救之者,继以温药贼
之矣。亦有三阴直中,初无表邪,而温剂太过,遂令寒退热生,初终异辙,是不可以不谨,所谓温之贵得其法
者此也。然又有温之不量其人者何也?夫以气虚无火之人,阳气素微,一旦客寒乘之,则温剂宜重,且多服亦
可无伤,若其人平素火旺,不喜辛温,或曾有阴虚失血之症,不能用温者,即中新寒,温药不宜太过,病退则
止,不必尽剂,斯为克当其人矣。若论其症,寒之重者微热不除,寒之轻者过热则亢,且温之与补,有相兼
者,有不必相兼者,虚而且寒,则兼用之,若寒而不虚,即专以温药主之;丹溪云∶‘客寒暴痛,兼有积食
者,可用桂附,不可遽用人参。’盖温即是补,予遵其法,先用姜桂温之,审其果虚,然后以参术补之,是以
屡用屡验,无有差忒,此温之贵量其症也。若论其时,盛夏之月,温剂宜轻,时值隆冬,温剂宜重,然亦有时
当盛暑,而得虚寒极重之症,曾用参附煎膏而治愈者,此舍时从症法也;譬如,霜降以后禁用白虎,然亦有阳
明症蒸热自汗,谵语烦躁,口渴饮冷者,虽当雨雪飘摇之际,亦曾用白虎治之而安痊,但不宜太过耳!此温之
贵量其时,而清剂可类推已。”
中暑导致心烦,脉象虚浮且自汗,燥气灼伤肺金(指肺脏),出现肢体痿软无力的症状,这些情况都不可使用温法。又有阴虚体质,脉象细数,阳气亢盛而引发吐血的患者,也不可使用温法;若误用温法,就会变成逆证;这就是所谓不应当用温法却用了温法的情况。
然而,又有应当使用温法却没有掌握正确方法的情况,这是为什么呢?假如是冬季感受寒邪,就应当用温法来发散;冬季感受风邪,就应当用温法来解表;寒痰壅塞闭阻,就应当用温法来开泄;因冷食损伤脾胃,就应当用温法来消导;至于中寒引起的剧烈疼痛,大便反而干硬,单用温药无效时,就用热性药物进行攻下;正值暑月,因为贪凉饮冷,突然遭受寒邪侵袭的,也应当用温法;身体虚弱兼有寒邪的,用温法来补益;寒邪客居在中焦,用理中汤来温中;寒邪客居在下焦,用四逆汤来温阳;又有阴寒内盛、格拒阳气于外部的,单用温药无效时,就用白通汤加入人尿和猪胆汁作为反佐药以引药入里;《黄帝内经》所说的“热因寒用”就是这个道理。
再有真元亏虚兼有寒邪,命门火衰的患者,必须补益其真阳。太仆(张景岳)曾说:“大寒之症严重,用热药治疗却不发热,这是无火的表现,应当常补心。”这里的“心”字指的是命门。更有表里皆寒的症状,起初使用温药,里寒顿时消除,但表邪未散,进而传入经络,导致开始是寒中,后来转变为热中的情况,或许会有发生;如果不是斟酌时机适宜,对症用药,而是先用温药救治,继而又用温药伤害正气,那就错了。也有三阴经直中寒邪,起初没有表邪,但温剂使用太过,致使寒退热生,初终病情不同,这种情况是不可以不谨慎的,这就是所谓温法贵在掌握正确方法的含义。
然而,又有使用温法不衡量患者体质的情况,这是为什么呢?那些气虚无火的人,阳气素来微弱,一旦客寒乘虚而入,那么温剂的用量应当重,而且多服也不会造成伤害;如果是其人平素火旺,不喜欢辛温药物,或者曾有阴虚失血的病症,不能用温法的,即使新近感受寒邪,温药也不宜太过,病愈就停止,不必服完所有药剂,这才是恰当适合患者的做法。
如果论述症状方面,寒邪重的,轻微温热不能去除病邪;寒邪轻的,过热则会导致亢盛。而且温法与补法,有相辅相成的,有不必相辅相成的;既虚又寒,就兼用温补;如果只寒不虚,就专门用温药主治。朱丹溪说:“客寒引起的剧烈疼痛,兼有积食的,可以用肉桂、附子,不可以立即用人参。”大概温法即是补法,我遵循他的方法,先用生姜、肉桂温中,审察确认确实为虚证后,然后用人参、白术补益,因此屡次使用屡次见效,没有差错,这就是温法贵在衡量症状的含义。
如果论述时节方面,盛夏月份,温剂用量宜轻;正值隆冬,温剂用量宜重。然而也有时候正值盛暑,却得了极度严重的虚寒症,曾用参附煎膏治愈的例子,这是舍去时令而从症状论治的方法;譬如,霜降以后禁用白虎汤,然而也有阳明病表现为蒸蒸发热、自汗、谵语烦躁、口渴想喝冷饮的患者,虽然正值雨雪纷飞的时候,也曾用过白虎汤治疗而痊愈,只是不宜太过而已!这就是温法贵在衡量时节,而清法也可以类推了。”
Heatstroke causing mental restlessness, a deficient pulse with spontaneous sweating, dryness burning the Metal (referring to the Lung organ), and flaccidity with weakness are all conditions where warming methods must not be used. Furthermore, patients with Yin deficiency, presenting with a fine and rapid pulse, and hematemesis due to Yang hyperactivity attacking, should also not be treated with warming; doing so would result in adverse outcomes. This is what is meant by "using warming when it is not indicated."
However, there are cases where warming is indicated but the method is not correctly applied. Why is this? For instance, if one contracts Cold in winter, one should use warming to disperse it; if one contracts Wind in winter, one should use warming to resolve the exterior; if Cold-Phlegm obstructs and blocks, one should use warming to open it; if injured by cold food, one should use warming to digest it. As for sudden severe pain from internal Cold, with stool that is paradoxically hard, if simple warming herbs fail, one should use hot purgatives. If it is summer, but one seeks coolness and drinks cold beverages, suddenly contracting Cold, warming should still be employed. For those with constitutional deficiency accompanied by Cold, warming should be used to tonify. If Cold resides in the Middle Jiao, Lizhong Tang (Regulate the Middle Decoction) should be used to warm it; if Cold resides in the Lower Jiao, Sini Tang (Frigid Extremities Decoction) should be used to warm it. In cases of extreme Yin Cold repelling Yang to the exterior, where warming herbs are ineffective, Baitong Tang (White Tongue Decoction) combined with human urine and pig bile should be used as counter-agents to guide the medicine. This corresponds to the *Jing* (Classic) saying: "Use heat with cold administration" (Re-using heat through cold means).
Furthermore, in cases of true deficiency with Cold and decline of the Fire of the Gate of Vitality (Mingmen), one must tonify the True Yang. Taipu (Zhang Jingyue) stated: "In severe Cold syndromes, if heat therapy does not produce warmth, it indicates a lack of Fire; one should frequently tonify the Heart." Here, the term "Heart" refers to the Mingmen. There are also cases where both interior and exterior are Cold. Initially using warming herbs may quickly resolve interior Cold, but if exterior pathogens remain unresolved, they may transmit into the meridians, transforming an initial Cold syndrome into a subsequent Heat syndrome. This can occur if one fails to weigh the timing and prescribe appropriately, first using warming herbs to rescue, and then inadvertently harming with further warming. Similarly, in direct transmission of Cold to the Three Yin channels without initial exterior symptoms, excessive use of warming agents may cause Cold to retreat and Heat to arise, leading to different outcomes at the beginning and end. One must be cautious, which illustrates why mastering the correct method is crucial for warming therapy.
Moreover, there are instances where warming is applied without considering the patient's constitution. For individuals with Qi deficiency and lack of Fire, whose Yang is inherently weak, if external Cold attacks, heavy doses of warming agents are appropriate and can be taken in quantity without harm. However, for those who naturally have excess Fire, dislike acrid-warm herbs, or have a history of Yin deficiency with bleeding, warming is contraindicated. Even if they recently contracted Cold, warming herbs should not be too strong; treatment should stop once symptoms improve, without necessarily finishing the prescription. This is considered appropriate for the individual.
Regarding symptoms: for severe Cold, mild warming may not suffice; for mild Cold, excessive heat may lead to hyperactivity. Warming and tonifying methods may be combined or used separately. When both deficiency and Cold exist, they are combined; when only Cold exists without deficiency, warming alone is sufficient. Danxi said: "For sudden severe pain due to external Cold with food stagnation, Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) may be used, but Renshen (Ginseng Root) should not be used immediately." Essentially, warming acts as tonification. Following this principle, I first use Shengjiang (Fresh Ginger Rhizome) and Rougui (Cinnamon Bark) to warm, and after confirming deficiency, I use Renshen and Baizhu (Atractylodes Macrocephala Rhizome) to tonify. Thus, it has been repeatedly effective without error, demonstrating the importance of weighing symptoms when applying warming.
Regarding timing: in midsummer, warming agents should be light; in deep winter, they should be heavy. Yet, there are cases in midsummer where extreme deficiency-Cold occurs, cured by Shenfu Paste (Ginseng and Aconite Paste), illustrating the principle of "abandoning the season to follow the syndrome." Conversely, while Baihu Tang (White Tiger Decoction) is generally contraindicated after Frost's Descent, there are cases of Yangming syndrome with steaming fever, spontaneous sweating, delirious speech, irritability, and thirst for cold drinks, where Baihu Tang was successfully used even during snowfall, provided it was not overused. This demonstrates the importance of weighing the season when using warming, and the same logic applies to cooling agents."