晚发者,亦由冬令受寒,当时未发,发于来年清明之后,夏至以前,较之温病晚发一节,故名晚发
病也。其证头痛发热,或恶风恶寒,或有汗无汗,或烦躁,或口渴,脉来洪数者是也。
亦当先辨其因寒因风而触发者,始可定辛温辛凉之法治之。但其曩受之伏寒,必较温热之伏气稍轻,峻剂不宜
孟浪。如无风寒所触者,仍归温病论治。此宜清凉透邪法,加蝉衣、栀、壳、治之。如有变证,可仿诸温门
中及热病之法治之。但是病与秋时之晚发,相去云泥,彼则夏令之伏暑而发于秋,此则冬
时之伏气而发于春,慎勿以晚发同名,而误同一治耳。
或问曰∶细考风温、春温,发于大寒至惊蛰;温病、温毒,发于春分至立夏,界限虽分,然与《内经》
先夏至日为病温,不相符节。何独晚发一病,发于清明之后,夏至以前,偏与《内经》拍合何也?答曰∶大
寒至惊蛰,乃厥阴风木司权,风邪触之发为风温;初春尚有余寒,寒邪触之发为春温;春分至立夏,
少阴君火司令,阳气正升之时,伏气自内而出,发为温病、温毒;晚发仍是温病,不过较诸温晚发一节也。
以上五证,总在乎夏至之先,诚与《内经》先夏至日为病温,皆不枘凿矣。
辛温解表法∶治春温初起,风寒寒疫,及阴暑秋凉等证。
防风(一钱五分) 桔梗(一钱五分) 杏仁(一钱五分,去皮尖,研) 广
陈皮(一钱) 淡豆豉(三钱)
加葱白五寸煎。
是法也,以防风、桔梗,祛其在表之寒邪;杏子、陈皮,开其上中之气分;淡豉、葱白,即葱豉汤,
乃《肘后》之良方,用代麻黄,通治寒伤于表。表邪得解,即有伏气,亦冀其随解耳。
凉解里热法∶治温热内炽,外无风寒,及暑温冬温之证。
鲜芦根(五钱) 大豆卷(三钱) 天花粉(二钱) 生石膏(四钱) 生甘草(六分)
新汲水煎服。
温热之邪,初入于胃者,宜此法也。盖胃为阳土,得凉则安。故以芦根为君,其味甘,其性凉,其中
空,不但能去胃中之热,抑且能透肌表之邪,诚凉而不滞之妙品,大胜寻常寒药;佐豆卷之甘平,花粉之甘
凉,并能清胃除热;更佐石膏,凉而不苦,甘草泻而能和,景岳名为玉泉饮,以其治阳明胃热有功。
凡寒凉之药,每多败胃,惟此法则不然。
清热解毒法∶治温毒深入阳明,劫伤津液,舌绛齿燥。
西洋参(三钱) 大麦冬(三钱,去心) 细生地(三钱) 元参(一钱五分) 金银花(二钱)
连翘(二钱,去心)
加绿豆三钱,煎服。
此法治温热成毒,毒即火邪也。温热既化为火,火未有不
伤津液者,故用银、翘、绿豆,以清其火而解其毒;洋参、麦冬,以保其津;元参、细地,以保其液也。
却热息风法∶治温热不解,劫液动风,手足螈 。
大麦冬(五钱,去心) 细生地(四钱) 甘菊花(一钱) 羚羊角(二钱) 钩藤钩(五钱)
先将羚羊角煎一炷香,再入诸药煎。
凡温热之病,动肝风者,惟此法最宜。首用麦冬、细地,清
其热以滋津液;菊花、羚角,定其风而宁抽搐;佐钩藤者,取其
舒筋之用也。
祛热宣窍法∶治温热、湿温、冬温之邪,窜入心包,神昏 语,或不语,舌苔焦黑,或笑或痉。
连翘(三钱,去心) 犀角(一钱) 川贝母(三钱,去心) 鲜石菖蒲(一钱)
加牛黄至宝丹一颗,去蜡壳化冲。
是法治邪入心包之证也。连翘苦寒,苦入心,寒胜热,故泻心经之火邪;经曰∶“火淫于内,治以咸
寒,”故兼犀角咸寒之品,亦能泻心经之火邪;凡邪入心包者,非特一火,且有痰随火升,蒙其清窍,故用贝
母清心化痰,菖蒲入心开窍∶更用牛黄至宝之大力,以期救急扶危于俄顷耳。
辛凉解表法∶治风温初起,风热新感,冬温袭肺咳嗽。
薄荷(一钱五分) 蝉蜕(一钱,去足翅) 前胡(一钱五分) 淡豆豉(四钱)
栝蒌壳(二钱) 牛蒡子(一钱五分)
煎服。如有口渴,再加花粉。
此法取乎辛凉,以治风温初起,无论有无伏气,皆可先施。用薄荷、蝉蜕,轻透其表;前胡、淡豉,
宣解其风;叶香岩云∶温邪上受,首先犯肺。故佐蒌壳、牛蒡开其肺气,气分舒畅,则新邪伏气,均透达矣。
清凉透邪法∶治温病无汗,温疟渴饮,冬温之邪内陷。
鲜芦根(五钱) 石膏(六钱,煨) 连翘(三钱,去心) 竹叶(一钱五分)
淡豆豉(三钱) 绿豆衣(三钱)
水煎服。
此治温病无汗之主方,其伏气虽不因风寒所触而发,然亦有有汗无汗之分。无汗者宜透邪,有汗者宜
保津,一定之理也。凡清凉之剂,凉而不透者居多,惟此法清凉且透。芦根中
空透药也,石膏气轻透药也,连翘之性升浮,竹叶生于枝上,淡
豆豉之宣解,绿豆衣之轻清,皆透热也。伏邪得透,汗出微微。温热自然达解耳。
清热保津法∶治温热有汗,风热化火,热病伤津,温疟舌苔变黑。
连翘(三钱,去心) 天花粉(二钱) 鲜石斛(三钱) 鲜生地(四钱) 麦冬(四钱,去心)
参叶(八分)
水煎服。
此治温热有汗之主方。汗多者,因于里热熏蒸,恐其伤津损液,故用连翘、花粉,清其上中之热;鲜斛、
鲜地,保其中下之阴;麦冬退热除烦;参叶生津降火。
清凉荡热法∶治三焦温热,脉洪大而数,热渴谵妄。
连翘(四钱,去心) 西洋参(二钱) 石膏(五钱,煨) 生甘草(八分) 知
母(二钱,盐水炒) 细生地(五钱)
加粳米一撮,煎服。
是法也,以仲圣白虎汤为主,治其三焦之温热也。连翘、洋参,清上焦之热以保津;膏、甘、粳米,清
中焦之热以养胃;知母、细地,泻下焦之热以养阴。
润下救津法∶治热在胃腑,脉沉实有力,壮热口渴,舌苔黄燥。
熟大黄(四钱) 元明粉(二钱) 粉甘草(八分) 元参(三钱) 麦冬(四钱,去心) 细生地(五钱)
流水煎服。
阳明实热之证,当用大小承气,急下以存津液,但受温热之病,弱体居多,虽有是证,不能遽用是药,故
以仲圣调胃承气为稳,且芒硝改为元明粉,取其性稍缓耳,合用鞠通增液汤方,
更在存阴养液之意。
清凉透斑法∶治阳明温毒发斑。
石膏(五钱,煨用) 生甘草(五分) 银花(三钱) 连翘(三钱,去心) 鲜
芦根(四钱) 豆卷(三钱,井水发)
加新荷钱一枚,煎服,如无,用干荷叶三钱亦可。
凡温热发斑者,治宜清胃解毒为主。膏、甘治之以清胃,银、翘治之以解毒。更以芦根、豆卷,透
发阳明之热;荷钱者即初发之小荷叶也,亦取其轻升透发之意。热势一透,则斑自得化矣。
Late-onset (Wanfa) also results from contracting cold in winter, which did not manifest at the time but appears after Qingming Festival and before Summer Solstice of the following year. It is named "late-onset" because it occurs slightly later than the late-onset type of warm diseases.
Its symptoms include headache and fever, aversion to wind or cold, with or without sweating, irritability, thirst, and a surging and rapid pulse.
One must first distinguish whether it was triggered by cold or wind pathogens to determine whether to treat it with acrid-warm or acrid-cool methods. However, the latent cold contracted previously is likely milder than the latent qi of warm-heat pathogens; thus, harsh medications should not be used rashly. If there is no triggering factor of wind-cold, it should still be treated according to warm disease principles. This condition is suitable for the Clearing-Cooling and Expelling Pathogens Method, adding Cicada Slough (Chan Yi), Gardenia Fruit (Zhi Zi), and Bitter Orange Peel (Zhi Ke). If complications arise, one may follow the treatment methods for various warm diseases and febrile diseases. However, this disease differs vastly from late-onset autumnal diseases: the latter involves latent summer-heat manifesting in autumn, whereas this involves latent winter-cold manifesting in spring. One must not mistakenly apply the same treatment simply because they share the name "late-onset."
A question arises: Careful examination shows that Wind-Warmth (Fengwen) and Spring-Warmth (Chunwen) appear from Major Cold to Awakening of Insects; Warm Diseases (Wenbing) and Warm Toxins (Wendu) appear from Spring Equinox to Start of Summer. Although boundaries are distinct, this does not align with the *Neijing* statement, "Diseases occurring before Summer Solstice are called Warmth." Why does only late-onset disease, appearing after Qingming and before Summer Solstice, perfectly match the *Neijing*? The answer is: From Major Cold to Awakening of Insects, Jueyin Wind-Wood governs; wind pathogens trigger Wind-Warmth. Early spring retains residual cold; cold pathogens trigger Spring-Warmth. From Spring Equinox to Start of Summer, Shaoyin Sovereign Fire governs when yang qi is rising; latent qi emerges from within, causing Warm Diseases and Warm Toxins. Late-onset is essentially a warm disease, merely appearing slightly later than typical warm diseases. All five aforementioned syndromes occur before Summer Solstice, truly aligning with the *Neijing*'s principle that "diseases before Summer Solstice are Warmth," without contradiction.
Acrid-Warm Exterior-Releasing Method: Treats early-stage Spring-Warmth, wind-cold pestilence, and yin-summerheat/autumn-coolness syndromes.
Saposhnikovia Root (Fang Feng, 1.5 qian), Platycodon Root (Jie Geng, 1.5 qian), Apricot Seed (Xing Ren, 1.5 qian, skin and tips removed, crushed), Tangerine Peel (Guang Chen Pi, 1 qian), Fermented Soybean (Dan Dou Chi, 3 qian).
Decoct with 5 cun of Scallion White (Cong Bai).
This method uses Saposhnikovia and Platycodon to dispel exterior cold pathogens; Apricot Seed and Tangerine Peel to open qi in the upper and middle jiao; Fermented Soybean and Scallion White constitute Congchi Decoction, a fine prescription from *Zhouhou Beiji Fang*, used as a substitute for Ephedra to universally treat exterior cold injury. Once exterior pathogens are resolved, any latent qi is expected to resolve with them.
Cooling Interior-Heat Resolving Method: Treats interior blazing heat without exterior wind-cold, and summer-warmth or winter-warmth syndromes.
Fresh Reed Rhizome (Xian Lu Gen, 5 qian), Soybean Hull (Da Dou Juan, 3 qian), Trichosanthes Root (Tian Hua Fen, 2 qian), Raw Gypsum (Sheng Shi Gao, 4 qian), Raw Licorice Root (Sheng Gan Cao, 0.6 fen).
Decoct and take with fresh drawn water.
For warm-heat pathogens newly entering the Stomach, this method is appropriate. The Stomach is Yang Earth, which finds peace with cooling agents. Thus, Fresh Reed Rhizome serves as the sovereign herb; its flavor is sweet, nature cool, and structure hollow. It not only clears stomach heat but also penetrates muscle-surface pathogens, making it a wonderful product that cools without stagnation, greatly surpassing ordinary cold herbs. It is assisted by the sweet-pure Soybean Hull and sweet-cool Trichosanthes Root, both clearing stomach heat. Further assisted by Gypsum (cool but not bitter) and Licorice Root (draining yet harmonizing), known as Yuquan Yin by Jingyue, effective for Yangming Stomach heat. Unlike most cold herbs that damage the stomach, this method does not.
Clearing Heat and Resolving Toxicity Method: Treats warm toxins deeply invading Yangming, consuming fluids, presenting with crimson tongue and dry teeth.
American Ginseng (Xi Yang Shen, 3 qian), Large Ophiopogon Tuber (Da Mai Dong, 3 qian, heart removed), Fine Rehmannia Root (Xi Sheng Di, 3 qian), Scrophularia Root (Yuan Shen, 1.5 qian), Honeysuckle Flower (Jin Yin Hua, 2 qian), Forsythia Fruit (Lian Qiao, 2 qian, heart removed).
Add Mung Bean (Lu Dou, 3 qian) and decoct.
This method treats warm-heat transforming into toxicity, where toxicity is fire pathogen. Since warm-heat becomes fire, and fire inevitably damages fluids, Honeysuckle, Forsythia, and Mung Bean clear fire and resolve toxicity; American Ginseng and Ophiopogon protect fluids; Scrophularia and Fine Rehmannia nourish yin fluids.
Extinguishing Heat and Calming Wind Method: Treats unresolved warm-heat consuming fluids and stirring wind, presenting with convulsions of hands and feet.
Large Ophiopogon Tuber (Da Mai Dong, 5 qian, heart removed), Fine Rehmannia Root (Xi Sheng Di, 4 qian), Chrysanthemum Flower (Gan Ju Hua, 1 qian), Antelope Horn (Ling Yang Jiao, 2 qian), Uncaria Hook (Gou Teng Gou, 5 qian).
First decoct Antelope Horn for the time it takes to burn one incense stick, then add other herbs.
For warm-heat diseases stirring Liver Wind, this method is most suitable. First, Ophiopogon and Fine Rehmannia clear heat and nourish fluids; Chrysanthemum and Antelope Horn calm wind and stop convulsions; Uncaria Hook is added for its tendon-relaxing properties.
Expelling Heat and Opening Orifices Method: Treats warm-heat, damp-warmth, or winter-warmth pathogens intruding into the Pericardium, presenting with coma, delirious speech, mutism, scorched-black tongue coating, laughter, or spasms.
Forsythia Fruit (Lian Qiao, 3 qian, heart removed), Rhino Horn (Xi Jiao, 1 qian), Fritillaria Bulb (Chuan Bei Mu, 3 qian, heart removed), Fresh Acorus Rhizome (Xian Shi Chang Pu, 1 qian).
Add one pill of Niuhuang Zhibao Dan, remove wax shell, dissolve, and take.
This method treats pathogens entering the Pericardium. Forsythia is bitter and cold; bitterness enters the Heart, and cold overcomes heat, thus draining Heart fire. As stated in the classics: "When fire floods internally, treat with salty-cold." Therefore, Salty-Cold Rhino Horn also drains Heart fire. When pathogens enter the Pericardium, it is not just fire, but phlegm rising with fire, clouding clear orifices. Thus, Fritillaria clears Heart and transforms phlegm; Acorus enters the Heart to open orifices. Niuhuang Zhibao Dan provides powerful urgent rescue.
Acrid-Cool Exterior-Releasing Method: Treats early-stage Wind-Warmth, new contraction of wind-heat, and winter-warmth attacking the Lung causing cough.
Mint (Bo He, 1.5 qian), Cicada Slough (Chan Tui, 1 qian, legs and wings removed), Peucedanum Root (Qian Hu, 1.5 qian), Fermented Soybean (Dan Dou Chi, 4 qian), Bitter Melon Rind (Gua Lou Qiao, 2 qian), Arnebia Seed (Niu Bang Zi, 1.5 qian).
Decoct. Add Trichosanthes Root if thirst is present.
This method utilizes acrid-cool properties to treat early Wind-Warmth, applicable regardless of latent qi. Mint and Cicada Slough lightly penetrate the exterior; Peucedanum and Fermented Soybean disperse wind. Ye Tianshi stated: "Warm pathogens enter from above, first attacking the Lung." Thus, Bitter Melon Rind and Arnebia Seed open Lung qi. With smooth qi dynamics, new pathogens and latent qi are all expelled.
Clearing-Cooling and Expelling Pathogens Method: Treats warm disease with no sweat, warm malaria with thirst/drinking, and winter-warmth pathogens sinking inward.
Fresh Reed Rhizome (Xian Lu Gen, 5 qian), Calcined Gypsum (Shi Gao, 6 qian, calcined), Forsythia Fruit (Lian Qiao, 3 qian, heart removed), Bamboo Leaf (Zhu Ye, 1.5 qian), Fermented Soybean (Dan Dou Chi, 3 qian), Mung Bean Coat (Lu Dou Yi, 3 qian).
Decoct with water.
This is the principal formula for warm disease without sweat. Although latent qi may not be triggered by wind-cold, there is still a distinction between sweating and non-sweating. Non-sweating requires expelling pathogens; sweating requires preserving fluids—a fixed principle. Most cooling agents are cooling but not penetrating; this method is both cooling and penetrating. Fresh Reed Rhizome is hollow and penetrating; Gypsum has light qi and is penetrating; Forsythia rises and floats; Bamboo Leaf grows on branches; Fermented Soybean disperses; Mung Bean Coat is light and pure—all penetrating heat. Once latent pathogens are penetrated, slight sweating occurs, and warm-heat naturally resolves.
Clearing Heat and Preserving Fluids Method: Treats warm-heat with sweating, wind-heat transforming into fire, febrile disease damaging fluids, and warm malaria with black tongue coating.
Forsythia Fruit (Lian Qiao, 3 qian, heart removed), Trichosanthes Root (Tian Hua Fen, 2 qian), Fresh Dendrobium Stem (Xian Shi Hu, 3 qian), Fresh Rehmannia Root (Xian Sheng Di, 4 qian), Ophiopogon Tuber (Mai Dong, 4 qian, heart removed), Ginseng Leaf (Shen Ye, 0.8 fen).
Decoct with water.
This is the principal formula for warm-heat with sweating. Excessive sweating results from interior heat steaming, risking fluid damage. Forsythia and Trichosanthes clear upper/middle heat; Fresh Dendrobium and Fresh Rehmannia preserve lower/middle yin; Ophiopogon reduces heat and relieves vexation; Ginseng Leaf generates fluids and descends fire.
Clearing-Cooling and Sweeping Heat Method: Treats Sanjiao warm-heat with surging-rapid pulse, heat-thirst, and delirium.
Forsythia Fruit (Lian Qiao, 4 qian, heart removed), American Ginseng (Xi Yang Shen, 2 qian), Calcined Gypsum (Shi Gao, 5 qian, calcined), Raw Licorice Root (Sheng Gan Cao, 0.8 fen), Anemarrhena Rhizome (Zhi Mu, 2 qian, stir-fried with salt water), Fine Rehmannia Root (Xi Sheng Di, 5 qian).
Add a pinch of Coix Seed (Jing Mi) and decoct.
This method uses Zhang Zhongjing's Baihu Tang as the base to treat Sanjiao warm-heat. Forsythia and American Ginseng clear Upper Jiao heat to preserve fluids; Gypsum, Licorice, and Coix Seed clear Middle Jiao heat to nourish the Stomach; Anemarrhena and Fine Rehmannia drain Lower Jiao heat to nourish yin.
Moistening-Downward-Purging and Saving Fluids Method: Treats heat in the Stomach Fu organ with deep-solid-forceful pulse, high fever, thirst, and yellow-dry tongue coating.
Prepared Rhubarb (Shu Da Huang, 4 qian), Mirabilite (Yuan Ming Fen, 2 qian), Powdered Licorice Root (Fen Gan Cao, 0.8 fen), Scrophularia Root (Yuan Shen, 3 qian), Ophiopogon Tuber (Mai Dong, 4 qian, heart removed), Fine Rehmannia Root (Xi Sheng Di, 5 qian).
Decoct with flowing water.
Yangming excess-heat syndromes typically require Dachengqi or Xiaochengqi Decoctions for urgent purging to save fluids. However, patients with warm-heat diseases are often weak; even with these signs, strong purgatives cannot be used immediately. Thus, Zhang Zhongjing's Tiaowei Chengqi Tang is safer. Replacing Mirabilite (Mang Xiao) with Yuan Ming Fen makes it milder. Combined with Ju Tong's Zengye Tang, it emphasizes preserving yin and nourishing fluids.
Clearing-Cooling and Expelling Maculae Method: Treats Yangming warm-toxin causing maculae eruption.
Calcined Gypsum (Shi Gao, 5 qian, calcined), Raw Licorice Root (Sheng Gan Cao, 0.5 fen), Honeysuckle Flower (Yin Hua, 3 qian), Forsythia Fruit (Lian Qiao, 3 qian, heart removed), Fresh Reed Rhizome (Xian Lu Gen, 4 qian), Soybean Hull (Dou Juan, 3 qian, sprouted well water).
Add one fresh lotus coin (young lotus leaf) and decoct; if unavailable, use 3 qian dried lotus leaf.
For warm-heat causing maculae, treatment should focus on clearing the Stomach and resolving toxicity. Gypsum and Licorice clear the Stomach; Honeysuckle and Forsythia resolve toxicity. Reed Rhizome and Soybean Hull help expel Yangming heat; Lotus Coin (young lotus leaf) aids light ascending expulsion. Once heat is expelled, maculae will naturally resolve.