风温舌黄尖绎,神昏烦躁,目赤齿枯,此气血燔
蒸。宜用玉女煎加元参、连翘、人中黄、牛黄丸等
味,两清气血也。
目赤齿枯,神昏烦躁,邪已入血。故舌尖色绎,但苔仍
带黄,气热未尽。未可专凉血分,恐滋腻难清。务得玉女煎
合连翘、元参两清气血,人中黄、牛黄丸清营透邪,庶无遗
漏之弊。
风温舌绛干焦,神清脉数,而热不肯解,此热劫
胃阴。宜用复脉汤去姜桂,加鲜斛、白芍、地骨皮、
梨汁、蔗浆等味,甘凉养阴也。
神清脉数,病退之象。然热不解,而舌绛焦黑,并无苔
腻,是为无地之黑,乃热灼伤阴,胃津消烁,非甘凉濡润,
充养胃阴,则热何以清。故用复脉汤去姜、桂者,恐增热
耳,加蔗、梨者,助甘寒焉。若舌苔黄而焦黑,或老黄如沈
香色者,此为有地之黑,因热瘀在腑,宿垢未清,大便闭
结,昏宜下之。即用大黄、元明粉,生首乌,鲜生地,鲜石
斛、鲜稻根等味,养阴攻热,不必过虑。近时医辈,一见攻
下,不问应否,众口交咻,咸为诧异,此不过沽名盗利,以
图虚声。殊不知仲景先师,汗,吐、下、和、温、清、补,
泻,皆有一定之理。又有急下、微下,先攻、后攻之戒。故
命后人云:有是症,投是药,方为良医。若恐招是惹非,有
是症而不敢投是药,以致因循贻误,坐失机宜,岂得谓之良
哉。
In wind-heat disease, if the tongue coating is yellow with a crimson tip, accompanied by coma, irritability, red eyes, and dry teeth, this indicates **Qi-Blood Blazing Steaming** (simultaneous blazing steaming of Qi and Blood levels). It is appropriate to use **Yunü Decoction** (Jade Maiden Decoction) added with *Scrophulariae Radix* (Xuanshen), *Forsythiae Fructus* (Lianqiao), *Hao Ren Zhong Huang* (Human Middle Yellow), and **Niuhuang Wan** (Calculus Bovis Pill), etc., to clear both the Qi level and the Blood level simultaneously.
Red eyes, dry teeth, coma, and irritability indicate that the pathogenic factor has entered the Blood level. Therefore, the tongue tip appears crimson, yet the coating remains yellow, suggesting that heat in the Qi level is not yet fully cleared. One should not solely employ blood-cooling methods, as cloying and greasy substances may hinder the clearance of heat. It is essential to combine **Yunü Decoction** with *Forsythiae Fructus* and *Scrophulariae Radix* to clear both Qi and Blood levels, while using *Hao Ren Zhong Huang* and **Niuhuang Wan** to clear the Ying level and vent the pathogen, thereby avoiding omissions in treatment.
In wind-heat disease, if the tongue body is crimson, dry, and scorched, with clear consciousness and a rapid pulse, but the fever persists, this indicates that heat is devouring the Stomach Yin. It is appropriate to use **Fumai Decoction** (Restore the Pulse Decoction) without *Zingiberis Rhizoma Recens* (Shengjiang) and *Cinnamomi Ramulus* (Guizhi), adding fresh *Dendrobii Caulis* (Xianhu), *Paeoniae Radix Alba* (Baishao), *Lycii Cortex* (Digupi), pear juice, and sugarcane juice, etc., to nourish Yin with sweet and cool properties.
Clear consciousness and a rapid pulse are signs of disease regression. However, since the fever does not subside and the tongue is crimson and scorched black without a greasy coating, this is termed "blackness without ground" (no coating base), caused by heat scorching and injuring Yin, consuming Stomach fluids. If one does not use sweet, cool, and moistening methods to replenish Stomach Yin, how can the heat be cleared? Thus, removing *Zingiberis Rhizoma Recens* and *Cinnamomi Ramulus* from **Fumai Decoction** is to avoid increasing heat; adding sugarcane and pear juice assists in sweet-cold clearing. If the tongue coating is yellow and scorched black, or dark yellow like agarwood color, this is termed "blackness with ground" (coating present), indicating heat stagnation in the Fu organs, uneliminated fecal accumulation, constipation, and coma, which require purgation. One may use *Rhei Radix et Rhizoma* (Dahuang), *Natrii Sulfas* (Yuanmingfen), raw *Polygoni Multiflori Preparata Radix* (Sheng Shouwu), fresh *Rehmanniae Radix* (Xian Shengdi), fresh *Dendrobii Caulis* (Xian Shihu), and fresh rice roots, etc., to nourish Yin and attack heat, without excessive worry. Contemporary physicians, upon seeing purgative methods, often criticize indiscriminately regardless of indication, expressing astonishment. This is merely seeking fame and illicit profit for empty reputation. They fail to realize that Master Zhang Zhongjing established fixed principles for sweating, vomiting, purging, harmonizing, warming, clearing, tonifying, and draining. There are also warnings regarding urgent purgation, mild purgation, and the sequence of attacking. Hence, he instructed later generations: "When there are corresponding symptoms, administer corresponding medicines; this constitutes a good physician." If one fears attracting trouble and dares not administer corresponding medicines despite their presence, leading to procrastination, missed opportunities, and延误 of treatment, how can such a person be called a good physician?