风寒暑湿燥火。为六淫之正病。亦属四时之常病。选药制方。分际最宜清析。举其要而条列之。
风为百病之长。善行数变。自外而入。先郁肺气。肺主卫。故治风多宣气泄卫药。轻则薄荷、荆芥。
重则羌活、防风。而杏、蔻、橘、桔。尤为宣气之通用。且风郁久变热。热能生痰。故又宜用化痰药。轻
则蜜炙陈皮。重则栝蒌、川贝。及胆星、竺黄、蛤粉、枳实、荆沥、海粉之属。而竹沥、姜汁。尤为化痰之通用。但
风既变热。善能烁液。故又宜用润燥药。轻则梨汁、花露。重则知母、花粉。而鲜地、鲜斛。尤为生津
增液之良药。至主治各经风药。如肺经主用薄荷。心经主用桂枝。
脾经主用升麻。肝经主用天麻、川芎。肾经主用独活、细辛。胃经主用白芷。小肠经主用 本。
大肠经主用防风。三焦经主用柴胡。膀胱经主用羌活。前哲虽有此分别。其实不必拘执也。
外寒宜汗。宜用太阳汗剂药。里寒宜温。宜用太阴温剂药。固已。惟上焦可佐生姜、蔻仁。中焦可佐川朴、
草果。或佐丁香、花椒。下焦可佐小茴、沉香。或佐吴萸、乌药。随症均可酌入。
张凤逵《治暑全书》曰。暑病首用辛凉。继用甘寒。终用酸泄敛津。虽已得治暑之要。而暑必挟湿。名曰暑湿。
亦多挟秽。名曰暑秽。俗曰热痧。炎风如箭。名曰暑风。病多晕厥。名曰暑厥。亦多咳血。名曰暑瘵。至于外生
暑疖热疮。内则霍乱吐利。尤数见不鲜者也。故喻西昌谓夏月病最繁苛。洵不诬焉。用药极宜慎重。切不可一见暑病。
不审其有无兼症夹症。擅用清凉也。以予所验。辛凉宣上药。轻则薄荷、连翘、竹叶、荷钱。重则香薷、青蒿。而芦根、
细辛。尤为辛凉疏达之能品。甘寒清中药。轻则茅根、菰根、梨汁、竹沥。重则石膏、知母、西参、生甘。而西瓜汁、
绿豆清。尤为甘寒清暑之良品。酸泄敛津药。轻则梅干、冰糖。重则五味、沙参、麦冬。而梅浆泡汤。尤为敛津固气之
常品。若暑湿乃浊热粘腻之邪。最难骤愈。初用芳淡。轻则藿梗、佩兰、苡仁、通草。重则苍术、石膏、草果、知母、
蔻仁、滑石。而炒香枇杷叶。鲜冬瓜皮瓤。尤为芳淡清泄之良药。继用苦辛通降。轻则栀、芩、橘、半。重则连、朴、香、
楝。佐以芦根、灯草而五苓配三石。尤为辛通清泄之重剂。暑秽尤为繁重。辄致闷乱烦躁。呕恶肢冷。甚则耳聋神昏。
急用芳香辟秽药。轻则葱、豉、菖蒲、紫金片锭。重则蒜头绛雪。而鲜青蒿、鲜薄荷、鲜佩兰、鲜银花。尤为清芬辟秽
之良药。外用通关取嚏。执痧挑痧诸法。急救得法。庶能速愈。暑风多挟秽浊。先郁肺气。首用辛凉轻清宣解。如芥穗、薄荷、栀皮、香豉、连翘、牛蒡、栝蒌
皮、鲜茅根、绿豆皮、鲜竹叶等品。均可随证选用。身痛肢软者。佐络石、秦艽、桑枝、蜈蚣草、淡竹茹、
等一二味可也。继用清凉芳烈药。泄热辟秽。如青蒿、茵陈、桑叶、池菊、山栀、郁金、芦根、菰根、芽茶、
青萍、灯心等品。秽毒重者。如金汁甘中黄、大青叶、鲜石菖蒲等。亦可随加。如识蒙窍阻。神昏苔腻者。轻则紫金
锭片。重则至宝丹等。尤宜急进。暑厥乃中暑之至急证。其人面垢肢冷。神识昏厥。急用芳香开窍药。如
行军散、紫雪等最效。神苏后、宜辨兼证夹证。随证
用药。暑瘵。乃热劫、络伤之暴证。急用甘凉咸降药。西瓜汁和热童便服。历验如神。鲜茅根煎汤磨犀角汁。投无不
效。暑疖。乃热袭皮肤之轻证。但用天荷叶、满天星杵汁。调糊生军末搽上。屡多奏效。惟热霍乱最为夏月之急证。
急进调剂阴阳药。阴阳水磨紫金锭汁一二锭。和中气以辟暑秽。继用分利清浊药。地浆水澄清、调来复丹灌服
一二钱。解暑毒以定淆乱。最良。次辨其有否夹食夹气。食滞者消滞。如神曲、楂炭、枳实、青皮、陈佛手、陈香团
皮、焦
鸡金、嫩桑枝等选用。气郁者疏气。如香附、郁金、陈皮、枳壳、白蔻仁、青木香等选用。若干霍乱证。其人吐泻
不得。腹痛昏闷。俗名绞肠痧。病虽险急而易愈。急用涌吐法。川椒五七粒和食盐拌炒微黄。开水泡汤。调入飞马
金丹十四五粒。作速灌服。使其上吐下泻。急祛其邪以安正。历验如神。
Wind, cold, summerheat, dampness, dryness, and fire are the primary pathogens of the Six Excesses (Liu Yin) and also common diseases of the four seasons. When selecting herbs and formulating prescriptions, the boundaries must be clear and precise. The key points are listed below.
Wind is the leader of a hundred diseases; it moves swiftly and changes rapidly, entering from the exterior and first stagnating Lung Qi. Since the Lung governs Defensive Qi (Wei Qi), treatments for wind often employ herbs that diffuse Lung Qi and vent the Defensive level. For mild cases, Bohe (Menthae Haplocalycis Herba) and Jingjie (Schizonepetae Spica) are used; for severe cases, Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) are employed. Xingren (Armeniacae Semen Amarum), Kouren (Amomi Fructus Rotundus), Juqiao (Citri Reticulatae Pericarpium), and Jiegeng (Platycodonis Radix) are particularly universal for diffusing Qi. Furthermore, since wind stagnation eventually transforms into heat, and heat generates phlegm, phlegm-resolving herbs are also appropriate. For mild cases, honey-fried Chenpi (Citri Reticulatae Pericarpium) is used; for severe cases, Gualou (Trichosanthis Fructus) and Chuanbei (Fritillariae Cirrhosae Bulbus) are employed, along with Dansheng (Arisaematis Cum Bile), Zhuhuang (Bambusae Calamus), Ge Fen (Concha Meretricis et Cydoniae), Zhishi (Aurantii Fructus Immaturus), Jingli (Calami Juice), and Haifen (Pondosia). Zhu Li (Bambusae Succus) and Jiang Zhi (Zingiberis Rhizoma Recens Sucus) are particularly universal for resolving phlegm. However, since wind-transformed heat scorches body fluids, drying-moistening herbs are also suitable. For mild cases, Li Zhi (Pyrus Sinkiangensis Fructus) juice and Hua Lu (Floral Dew) are used; for severe cases, Zhimu (Anemarrhenae Rhizoma) and Huafen (Trichosanthis Radix) are employed. Xian Di Huang (Rehmanniae Radix Recens) and Xian Shi Hu (Dendrobii Caulis Recens) are particularly excellent for generating fluids and increasing body liquids. Regarding specific wind herbs for each meridian: Bohe is primarily used for the Lung meridian; Guizhi (Cinnamomi Ramulus) for the Heart meridian; Shengma (Cimicifugae Rhizoma) for the Spleen meridian; Tianma (Gastrodiae Rhizoma) and Chuanxiong (Ligustici Chuanxiong Rhizoma) for the Liver meridian; Duhuo (Angelicae Pubescentis Radix) and Xixin (Asari Radix et Rhizoma) for the Kidney meridian; Baizhi (Angelicae Dahuricae Radix) for the Stomach meridian; Gaoben (Ligustici Sinensis Rhizoma et Radix) for the Small Intestine meridian; Fangfeng for the Large Intestine meridian; Chaihu (Bupleuri Radix) for the Sanjiao (Triple Burner) meridian; and Qianghuo for the Bladder meridian. Although ancient physicians made such distinctions, one should not rigidly adhere to them.
Exterior cold requires sweating methods and appropriate Taiyang (Greater Yang) diaphoretic formulas. Interior cold requires warming methods and appropriate Taiyin (Lesser Yin) interior-warming formulas; this is established. However, for the Upper Jiao, fresh Ginger (Shengjiang) and Cardamom (Kouren) may be added as assistants; for the Middle Jiao, Magnolia Bark (Chuanpu) and Tsaoko Fruit (Caoguo), or Clove (Dingxiang) and Sichuan Pepper (Huajiao); for the Lower Jiao, Fennel (Xiaohui) and Agarwood (Chenxiang), or Evodia (Wuyu) and Lindera (Wuyao) may be added according to symptoms.
Zhang Fengkui stated in *Zhi Shu Quan Shu* (Complete Book on Treating Summerheat): "Summerheat disease begins with acrid-cool herbs, continues with sweet-cold herbs, and concludes with sour herbs to drain heat and astringe fluids." While this captures the essence of treating summerheat, summerheat invariably carries dampness, termed Summerheat-Dampness (Shushi); it often carries turbid miasma, termed Summerheat-Miasma (Shuhui), commonly known as Heat Sha (Resha); scorching winds like arrows are termed Summerwind (Shufeng); conditions involving fainting are termed Summer Syncope (Shujue); conditions involving hemoptysis are termed Summer Consumption (Shuzhai). External boils and hot sores caused by summerheat, and internal cholera-like vomiting and diarrhea, are extremely common. Therefore, Yu Chang (Yu Xichang) said that diseases in summer are most numerous and complex, which is indeed true. Medication must be handled with extreme caution. One must not simply see a case of summerheat and indiscriminately use cooling herbs without examining for accompanying or complicating syndromes. Based on my experience: Acrid-cool herbs for dispersing the Upper Jiao include, for mild cases, Bohe, Lianqiao (Forsythiae Fructus), Zhuye (Bambusae Folium), and Heyeqian (Nelumbinis Folium); for severe cases, Xiangru (Elsholtziae Herba) and Qinghao (Artemisiae Annuae Herba). Lugeng (Phragmitis Rhizoma) and Xixin are particularly effective for acrid-cool dispersion. Sweet-cold herbs for clearing the Middle Jiao include, for mild cases, Maogen (Imperatae Rhizoma), Gugen (Zizaniae Radix), Li Zhi, and Zhu Li; for severe cases, Shigao (Gypsum Fibrosum), Zhimu, Xishen (Panacis Quinquefolii Radix), and Sheng Gancao (Glycyrrhizae Radix et Rhizoma). Watermelon juice (Xiguazhi) and Mung Bean Soup (Lvdouqing) are particularly good for sweet-cold clearing of summerheat. Sour-draining herbs for astringing fluids include, for mild cases, Meigan (Prunii Mume Fructus) and Bingtang (Saccharum); for severe cases, Wuwei Zi (Schisandrae Fructus), Shashen (Glehniae Radix), and Maidong (Ophiopogonis Tuber). Plum syrup tea (Meijiang Paotang) is a common preparation for astringing fluids and consolidating Qi. If it is Summerheat-Dampness, a turbid, hot, sticky pathogen difficult to cure quickly, initially use aromatic and bland-draining herbs: for mild cases, Huojing (Agastaches Herba), Peilan (Plagiorchidis Herba), Yiren (Coicis Semen), and Tongcao (Tetrapanacis Medulla); for severe cases, Cangzhu (Atractylodis Rhizoma), Shigao, Caoguo, Zhimu, Kouren, and Huashi (Turmalinum). Fried Loquat Leaf (Pipaye) and fresh Winter Melon Peel/Rind (Dongguapi Rang) are particularly good aromatic-bland clearing agents. Subsequently, use bitter-acrid descending herbs: for mild cases, Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Juqiao, and Banxia (Pinelliae Rhizoma); for severe cases, Lianhua (Coptidis Rhizoma), Chuanpu, Xiangfu (Cyperi Rhizoma), and Chuanlianzi (Meliae Fructus). Assisted by Lugeng and Dengxin (Junci Medulla), Wuling San (Five-Ingredient Powder with Poria) combined with Sanshi (Three Stones: Shigao, Huashi, Hanshuishi) is a heavy formula for acrid-clearing. Summerheat-Miasma is particularly severe, causing oppression, restlessness, irritability, nausea, cold limbs, and even deafness and coma. Immediately use aromatic miasma-dispelling herbs: for mild cases, Congbai (Allii Fistulosi Bulbus), Chidou (Sojae Semen Praeparatum), Changpu (Acori Tatarinowii Rhizoma), and Zijinding (Purple Treasure Pill); for severe cases, Suantou (Allii Sativi Bulbus) and Jiangxue. Fresh Qinghao, Bohe, Peilan, and Yinhua (Lonicerae Japonicae Flos) are particularly good for clearing fragrance and dispelling miasma. External methods for opening orifices, inducing sneezing, scraping Sha, and puncturing Sha can lead to rapid recovery if emergency treatment is correct.
Summerwind often carries turbid miasma, first stagnating Lung Qi. Initially use acrid-cool, light, and clear dispersing herbs such as Jiesui (Schizonepetae Spica), Bohe, Zhipi (Gardeniae Pericarpium), Xiangchi (Fermented Sojae Semen), Lianqiao, Niubangzi (Arctii Fructus), Gualoupi (Trichosanthis Pericarpium), fresh Maogen, Lv dou pi (Vigna radiata Testa), and fresh Zhuye. These can be selected according to the syndrome. For body pain and limb weakness, assist with Luoshi Teng (Ancistrocladae Caulis), Qinjiao (Gentianae Macrophyllae Radix), Sangzhi (Mori Ramulus), Wugongcao (Centipedae Herba), and Danzhuru (Bambusae Succus Recens), one or two items. Subsequently use cool, aromatic, and potent herbs to vent heat and dispel miasma, such as Qinghao, Yinchen (Artemisiae Scopariae Herba), Sangye (Mori Folium), Chiju (Chrysanthemi Indici Flos), Shanzhi (Gardeniae Fructus), Yujin (Curcumae Radix), Lugeng, Gugen, Yacha (Camelliae Sinensis Germinatio), Qingping (Pistiae Herba), and Dengxin. For heavy miasma-toxins, add Jinzhi (Gold Juice), Ganzhonghuang (Yellow Mud from Honeycomb), Daqingye (Isatidis Folium), or fresh Changpu. If confusion and blocked orifices cause coma and greasy coating, use Zijinding pian (tablets) for mild cases, or Zhibao Dan (Treasure of Ultimate Life Pill) for severe cases; these should be administered urgently.
Summer Syncope (Shujue) is an acute critical condition of heatstroke. The patient has a dirty complexion, cold limbs, and loss of consciousness. Immediately use aromatic orifice-opening herbs; Xingjun San (Marching Army Powder) and Zixue San (Purple Snow Powder) are most effective. After consciousness returns, differentiate accompanying syndromes and treat accordingly.
Summer Consumption (Shuzhai) is a sudden condition of heat damaging collaterals. Immediately use sweet-cool and salty-descending herbs. Take watermelon juice mixed with warm child's urine; this has proven miraculous. Decoct fresh Maogen and mix with ground Rhinoceros Horn (Xijiao - note: substitute with Buffalo Horn in modern practice) juice; it is invariably effective.
Summer Boils (Shujie) are mild conditions where heat attacks the skin. Use juice pounded from Tianheyeh (Nelumbinis Nelumbo) and Mantianxing (Galii Verum), mixed with raw Dahuang (Rhei Radix et Rhizoma) powder, applied topically; this frequently succeeds.
Hot Cholera (Re Huoluan) is the most urgent summer condition. Immediately administer harmonizing Yin-Yang medicine. Grind Zijinding in Yin-Yang Water (half boiled, half cold water) to make juice, take 1-2 pills, to harmonize Middle Qi and dispel summer miasma. Subsequently use separating turbidity and clearing clarity medicine. Clarify Earth Slurry Water (Dijiangshui), mix with Laifu Dan (Restoring Vitality Pill), and administer 1-2 qian to resolve summer toxin and stabilize chaos; this is best. Next, differentiate whether there is food retention or Qi stagnation. For food retention, use digestion-promoting herbs such as Shenqu (Massae Fermentatae Medicinalis), Zhatan (Crataegi Fructus Carbonis), Zhishi, Qingpi (Citri Reticulatae Pericarpium Viride), Chen Foshou (Citri Sarcodactylis Fructus), Chen Xiangtuanpi, Jiao Jijin (Gallae Gallinae Digestiva Carbonisata), and Nen Sangzhi. For Qi stagnation, use Qi-regulating herbs such as Xiangfu (Cyperi Rhizoma), Yujin, Chenpi, Zhike (Aurantii Fructus), Baokouren, and Qingmuxiang.
For Dry Cholera (Gan Huoluan), where there is no vomiting or diarrhea, abdominal pain, and dizziness (commonly called Intestinal Cramping Sha), although dangerous and urgent, it is easy to cure. Immediately use emetic methods. Stir-fry 5-7 Sichuan Peppercorns (Chuanjiao) with salt until slightly yellow, steep in boiling water, and mix with 14-15 Feima Jindan (Flying Horse Golden Pills). Administer rapidly to induce vomiting and diarrhea, expelling the pathogen urgently to protect healthy Qi; this has proven miraculous.