热。而此言外邪郁令火而成中 也。若是邪郁令火。比类而推其因。殆有不可
胜言者焉。如取风凉者。感雾湿者。食生冷者。素有积热者。阴血素虚不胜夫热
者。宿邪感动者。处阴地者。凡是之因。皆足以郁其令火。为中 之病。或轻或重。
或表或里。或虚或实。随证发现若论其治邪退热。较量权衡。又可一言尽哉。诸
集类方论。徒多其证。聚其方。未有明言其脉证属于何因。害于何经用何药为
君以治之。苟不潜心于仲景书者。吾未信其泛然从方论者。果切于病情乎。瓜
蒂本草谓其主胸腹邪气。皆吐下之。此以夏伤冷水。水行皮中。而皮中者。岂非
属表。何乃用是药去胸中之水乎。盖内经有形寒饮冷则伤肺。况皮乃肺之所
合。内外相应。且瓜蒂又治四肢浮肿下水。而冷水之在皮中者。不惟灌洗得散。
而饮冷停水者。亦得散于皮中。故两者皆得而用之。嘉言合论治 。用白虎加人参汤瓜蒂汤二方。
〔补注〕金匮治 病。只出二方。一者白虎加人参汤。专治其热。以夏月之热淫。必
僭而犯上。伤其肺金。耗其津液。用之以救肺金。存津液也。孙思邈之生脉散。李
东垣之清暑益气汤。亦既祖之矣。一者瓜蒂散。专治其湿。以夏月之湿淫。上甚
为热。亦先伤其肺金。故外渍之水。得以聚于皮间。皮者。肺之合也。用以搐其胸
中之水。或吐或泻而出。则肺气得以不壅。而皮间之水。得以下趋也。何后人但
宗仲景五苓散为例。如河间之通苓散。子和之桂苓甘露汤。非不得导湿消暑
之意。求其引伸瓜蒂汤之制。以治上焦湿热而清肺金。则绝无一方矣。抑知无
形之热。伤其肺金。则用白虎加人参汤救之。有形之湿。伤其肺金。则用瓜蒂汤救之。各有所主也。
热邪。而这里说的是外邪郁结导致火邪产生于中焦。如果是邪气郁结化火，类比推究其成因，大概有说不完的情况。比如贪取风凉的人，感受雾湿之气的人，食用生冷食物的人，平素就有积热的人，阴血素来虚弱不能耐受热邪的人，宿有的邪气被触动的人，居住在阴冷潮湿地方的人。凡是这些原因，都足以使令火郁结，从而形成痓病（以项背强直、口噤不开甚至角弓反张为特征的疾病）。病情或轻或重，或在表或在里，或虚或实，随着证候显现出来。如果讨论治疗，邪退热清，权衡利弊，又岂是一句话能概括尽的？各类方书论述，只是增加了病症描述，聚集了方剂，却没有明确说明其脉证属于何种病因，损害了哪条经络，使用什么药物作为君药来治疗。如果不潜心研究仲景著作的人，我不相信他们随意跟随方论者，真的切合病情吗？《本草》记载瓜蒂主治胸腹邪气，都能通过吐下法去除。这是因为夏天损伤了冷水，水气运行在皮肤之中，而皮肤部位，难道不属于表证吗？为何反而用这种药物去清除胸中的水饮呢？大概《内经》说形寒饮冷则伤肺，况且皮肤是肺所合的部位，内外相应。而且瓜蒂又能治疗四肢浮肿、下行水气，那么停留在皮肤中的冷水，不仅可以通过灌洗消散，而且饮用冷饮停聚的水气，也能消散在皮肤中。所以这两种情况都可以使用。嘉言综合论述治疗方法，使用白虎加人参汤和瓜蒂汤两个方剂。
〔补注〕《金匮要略》治疗痓病，只列出两个方剂。一个是白虎加人参汤，专门治疗热邪，因为夏季的热邪淫溢，必定僭越而上犯，损伤肺金，耗伤津液，使用它来救助肺金，保存津液。孙思邈的生脉散，李东垣的清暑益气汤，也已经以此为基础了。另一个是瓜蒂散，专门治疗湿邪，因为夏季的湿邪淫溢，上部尤其表现为热，也先损伤肺金，所以外部浸渍的水气，得以聚集在皮间。皮肤，是肺所合的部位，用它来搐引胸中的水气，或者通过呕吐或者通过泻下排出，那么肺气得以不壅滞，而皮间的水气，得以向下流趋。为什么后人只尊崇仲景的五苓散作为范例，如刘河间的通苓散，张子和的桂苓甘露汤，并非没有引导湿邪、消暑的意思，但寻求引申瓜蒂汤的制方原理，来治疗上焦湿热而清肃肺金的，却完全没有一方。殊不知无形之热邪，损伤肺金，就用白虎加人参汤来救助；有形之湿邪，损伤肺金，就用瓜蒂汤来救助。各自有所主司。
Heat. Here it refers to external pathogens stagnating and transforming into fire within the Middle Jiao (middle burner). If pathogens stagnate and transform into fire, by analogy and deduction of their causes, there are countless situations that cannot be fully enumerated. For instance, those who seek wind and coolness, those exposed to mist and dampness, those who consume raw and cold foods, those with pre-existing accumulated heat, those whose Yin blood is inherently deficient and unable to withstand heat, those whose latent pathogens are stirred, and those dwelling in yin-cold places. All these factors are sufficient to cause the stagnation of "ling-fire" (regulatory fire), leading to Jing disease (a condition characterized by stiffness of the neck and back, trismus, and opisthotonos). The severity may vary from mild to severe; the location may be exterior or interior; the nature may be deficiency or excess, manifesting according to the specific syndrome. Regarding treatment, to eliminate pathogens and clear heat, weighing all factors, can this be summarized in a single statement? Various collections of formulas and discussions merely add more symptoms and gather more prescriptions, without clearly stating which etiology the pulse and symptoms belong to, which meridians are harmed, or what herb should serve as the Jun (Emperor) drug for treatment. Unless one has deeply studied Zhang Zhongjing's works, I do not believe that those who casually follow formula discussions truly grasp the clinical condition. Bencao states that Geng Ti (Thunberg Fritillary Bulb) treats evil qi in the chest and abdomen, eliminating it through vomiting and purging. This applies when cold water is injured in summer, and water flows within the skin. Since the skin belongs to the Exterior, why use such a drug to remove water from the chest? The Neijing states that exposure to cold and consumption of cold drinks injure the Lung. Moreover, the skin is the exterior correspondence of the Lung, with internal-external resonance. Furthermore, Geng Ti also treats edema of the four limbs and promotes the downward flow of water. Thus, cold water retained in the skin can be dispersed not only by washing but also by drinking cold water causing stagnation, which can disperse within the skin. Therefore, both conditions can utilize this remedy. Jiayan, in his comprehensive discussion on treatment, employs two formulas: Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) and Geng Ti Tang (Thunberg Fritillary Bulb Decoction).
[Supplementary Note] The Jin Gui Yao Lue treats Jing disease with only two formulas. One is Baihu Jia Renshen Tang, specifically treating heat. In summer, excessive heat tends to rebel upward, injuring Lung Metal and consuming body fluids; this formula is used to rescue Lung Metal and preserve fluids. Sun Simiao's Shengmai San (Generate Pulse Powder) and Li Dongyuan's Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) are derived from this principle. The other is Geng Ti San (Thunberg Fritillary Bulb Powder), specifically treating dampness. In summer, excessive dampness, particularly severe in the upper Jiao, first injures Lung Metal. Consequently, externally infiltrated water accumulates between the skin layers. As the skin is the exterior correspondence of the Lung, this formula is used to induce expulsion of water from the chest via vomiting or purging, thereby preventing Lung Qi obstruction and allowing water in the skin layers to drain downward. Why do later practitioners solely revere Zhang Zhongjing's Wuling San (Five-Ingredient Poria Pill) as the model? While Liu Hejian's Tongling San and Zhang Ziheng's Guiling Ganlu Tang (Cinnamon Twig, Poria, and Dew Sweetener) aim to guide out dampness and dissipate summerheat, none extend the formulation logic of Geng Ti Tang to treat Upper Jiao damp-heat and clear Lung Metal. It must be understood that when formless heat injures Lung Metal, Baihu Jia Renshen Tang is used for rescue; when formed dampness injures Lung Metal, Geng Ti Tang is used. Each has its specific indication.