劳倦发热者,积劳成倦,阳气下陷,则虚热内生也。其症身热心烦,头痛恶寒,懒言恶
食,
阳气和,自然汗出也。
补中益气汤
黄 (蜜炙,钱半) 人参 炙甘草(一钱) 白术(土炒) 陈皮 当归(各五分)
加姜三片,枣三枚,水煎。本方加芍药、五味,名调中益气汤。
火郁者,阳气为外寒所遏,不得宣行,郁而成火,或因胃中过食冷物,郁遏阳气于脾土
之中,令人心烦,手足心热,骨髓中热如火燎,此为郁热。经云∶火郁则发之。
东垣火郁汤
升麻 葛根 白芍药 柴胡根(各一两) 防风 炙草(各五钱)
上 咀,每服三四钱,水二大盏,入连须葱白三寸,煎去滓稍热服。
血虚发热,亦从劳倦得之。东垣云∶饥困劳役之后,肌热烦躁,困渴引饮,目赤面红,
昼夜
不息,其脉大而虚,按之无力。经云∶脉虚则血虚,血虚则发热,症象白虎,惟脉不长实为
辨也。误服白虎,旬日必变。
当归补血汤
黄 (一两) 当归(二钱) 生地黄(五钱) 生草(一钱)
上一服,水煎,温服食前。
阳气虚浮,其端有二。或脾胃气虚,阳浮于外,其症上见呕恶,下为溏泄,其脉大而不
实,
其症烦渴引饮,面赤舌刺唇黑,足心如烙,或冷如冰,其脉洪大无伦,按之微弱,宜八味肾
气丸之属,导火下行也。
理中汤
八味肾气丸(方见虚劳门。)
王肯堂云∶相火寄于命门。命门者,男子以藏精,女子以系胞,因嗜欲竭之,火无所附
,故
相求,火必降下矣。且火从肾出者,是水中之火也。火可以水折,而水中之火,不可以水折
,故巴蜀有火井焉,得水则炽,得火则熄,则桂附者,固治浮游相火正剂欤。
劳倦发热,是由于长期劳累导致身体疲倦,阳气下陷,从而产生虚热。其症状表现为身体发热、心烦意乱、头痛、怕冷、懒于说话、厌恶进食,当体内阳气调和时,自然会出汗。
补中益气汤
黄芪(用蜂蜜炙过,一钱半) 人参 炙甘草(一钱) 白术(用土炒) 陈皮 当归(各五分)
加入生姜三片,大枣三枚,加水煎煮。本方若加入芍药、五味子,则称为调中益气汤。
火郁证,是指阳气被外来的寒邪遏制,不能宣通运行,郁结而化火;或者因为胃中过量食用生冷食物,使阳气郁遏在脾土之中,导致人心烦、手心脚心发热、骨髓中感觉像火烧一样热,这属于郁热。医经说:“火郁证应当用发散的方法治疗。”
东垣火郁汤
升麻 葛根 白芍药 柴胡根(各一两) 防风 炙甘草(各五钱)
将药材切碎,每次服用三四钱,用水两大盏,加入带须的葱白三寸,煎煮后去渣,稍温热时服用。
血虚发热,也是从劳倦中得来的。李东垣说:在饥饿、困顿、劳累之后,出现肌肤发热、烦躁、困倦口渴想喝水、眼睛发红、面色红润,昼夜不停,脉象大而空虚,重按无力。医经说:“脉虚说明血虚,血虚就会发热,症状表现类似白虎汤证,只有脉象不长大坚实作为鉴别点。”如果误服白虎汤类药物,十天内必定发生变证。
当归补血汤
黄芪(一两) 当归(二钱) 生地黄(五钱) 生甘草(一钱)
以上为一服的量,加水煎煮,饭前温服。
阳气虚浮,其起因主要有两种。一种是脾胃气虚,阳气浮越于外,症状表现为上面呕吐恶心,下面腹泻便溏,脉象大但不实;另一种症状是烦渴想喝水,面红舌刺,嘴唇发黑,脚心像被烙铁烫过一样热,或者冷如冰,脉象洪大无比,但重按微弱,适宜使用八味肾气丸之类的药物,引导火气下行。
王肯堂说:相火寄居于命门。命门,男子用来藏精,女子用来系胞宫,如果因纵欲过度而耗竭精气,火就没有依附之所,所以相火会寻求依附,火必然下降。况且从肾出来的火,是水中之火。普通的火可以被水克制,但水中之火不能被水克制,所以巴蜀地区有火井,遇到水反而燃烧得更旺,遇到火反而熄灭,那么桂枝、附子,确实是治疗浮游相火的正对症药剂吗。
Heat fever due to fatigue and overexertion arises from accumulated labor leading to exhaustion, with the sinking of Yang Qi (vital energy), resulting in the internal generation of deficient heat. Its symptoms include body heat, restlessness, headache, aversion to cold, reluctance to speak, and anorexia; when the harmonious state of Yang Qi is restored, sweating occurs naturally.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)
Huangqi (Astragali Radix, honey-fried, 1.5 qian) Renshen (Ginseng Radix) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma, 1 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, soil-fried) Chenpi (Citri Reticulatae Pericarpium) Danggui (Angelicae Sinensis Radix) (each 0.5 qian)
Add three slices of Shengjiang (Zingiberis Rhizoma Recens) and three dates (Jujubae Fructus), decoct in water. If Shaoyao (Paeoniae Radix) and Wuweizi (Schisandrae Chinensis Fructus) are added to this formula, it is named Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction).
Fire stagnation refers to a condition where Yang Qi is constrained by external cold, preventing its free circulation, leading to stagnation and transformation into fire. Alternatively, excessive consumption of cold foods in the stomach may constrain Yang Qi within the Spleen Earth, causing mental restlessness, heat in the palms and soles, and a sensation of burning heat in the bone marrow; this is termed stagnant heat. The Classics state: "For stagnant fire, use dispersing methods."
Dongyuan Huoyu Tang (East Garden Fire Stagnation Decoction)
Shengma (Cimicifugae Rhizoma) Gegen (Puerariae Lobatae Radix) Baishaoyao (Paeoniae Radix Alba) Chaihu Gen (Bupleuri Radix) (each 1 liang) Fangfeng (Saposhnikoviae Radix) Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) (each 5 qian)
Grind the herbs into coarse powder. For each dose of 3-4 qian, decoct with two large cups of water and three cun of scallion white with roots (Congbai). Strain and take warm.
Deficient blood heat also originates from fatigue and overexertion. Li Dongyuan stated: After hunger, exhaustion, and physical labor, symptoms include skin heat, irritability, fatigue, thirst with desire to drink, red eyes, and flushed face, persisting day and night. The pulse is large and empty, weak upon pressure. The Classics state: "An empty pulse indicates deficient blood; deficient blood leads to heat. The clinical presentation resembles Baihu Tang syndrome, but the differentiation lies in the pulse not being large and solid." Misuse of Baihu Tang will inevitably lead to pathological changes within ten days.
Danggui Buxue Tang (Angelica Tonify Blood Decoction)
Huangqi (Astragali Radix, 1 liang) Danggui (Angelicae Sinensis Radix, 2 qian) Shengdihuang (Rehmanniae Radix Recens, 5 qian) Shenggancao (Raw Glycyrrhizae Radix et Rhizoma, 1 qian)
This constitutes one dose. Decoct in water and take warm before meals.
Floating of deficient Yang has two primary origins. One is deficiency of Spleen and Stomach Qi, causing Yang to float outward; symptoms include upper vomiting and nausea, lower loose stools, and a pulse that is large but empty. Another set of symptoms includes irritability, thirst with desire to drink, flushed face, prickling tongue, black lips, hot soles like branding iron or cold as ice, and a pulse that is excessively surging yet weak upon deep pressure. In such cases, formulas similar to Bawei Shenqi Wan (Eight-Ingredient Rehmannia Pill) should be used to guide fire downward.
Lizhong Tang (Regulate the Middle Decoction)
Bawei Shenqi Wan (See chapter on Deficiency Consumption for the formula.)
Wang Kentang stated: Ministerial Fire resides in the Mingmen (Gate of Life). The Mingmen stores essence in men and connects to the uterus in women. Due to excessive sexual desire depleting essence, the fire loses its attachment and thus seeks to descend. Furthermore, fire originating from the Kidney is fire within water. While ordinary fire can be subdued by water, fire within water cannot be subdued by water. Therefore, in Bashu there are fire wells; adding water makes them burn brighter, while adding fire extinguishes them. Thus, Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) are indeed the correct remedies for treating floating ministerial fire.