专主东垣内外伤辨甚详,世之病此者为多。但有挟痰者,有挟外邪者,有郁于内而发者,皆以补元气为主,看其
所挟,而兼用药耳。挟痰以补中益气汤,多用半夏、姜汁以传送。
暑气或吐泻、霍乱,黄连香薷饮。挟痰加半夏;乘气虚加参 。或暑病内伤者,清暑益气汤。发渴者,生地
黄、麦门冬、川牛膝、炒黄柏、知母、干葛、生甘草。治一切暑玉龙丸∶赤亭、倭硫黄、硝石、滑石、明矾一两,好
面六两,末之,无根水丸。气虚少食,身热自汗倦怠,清暑益气汤;气虚少食,自热自汗,脉细弱或洪大者,补中益
气汤中加麦门冬、五味子、知母。暑气烦渴脉虚者,竹叶石膏汤;暑病日夜烦躁,饮水无度,至天明便止,浑身作
肿,胞囊水滴下,不渴,入夜要扇,冷香饮子治之。一人年五十余,六月间发热,大汗、恶寒、战栗不自禁,持且烦
渴,此暑病也。脉皆虚微,细弱而数。其人好赌,致劳而虚,遂以人参作汤,调人参四苓散,八帖而安。戴云∶暑
乃夏月炎暑也,盛热之气着人。有冒、有伤、有中,三者有轻重之分,虚实之辨。或腹痛水泻者,胃与大肠受也;恶心
者,胃口有痰饮也。此二者,冒暑也。可用黄连香薷饮,盖黄连退暑热,香薷消蓄水。或身热头疼,躁乱不宁者,或身
如针刺者,此为热伤在肉分也。当以解毒白虎汤加柴胡;气虚者加人参;或咳嗽发寒热,盗汗出,脉数不止,热着肺
经,用清肺汤、柴胡天水散之类。急治则可,迟则不可治矣。盛火乘金也,此为中暑。凡治病须要明白辨别,不可混
同施治,春秋间亦或有之,不可执一,随病处方为妙。一方香薷浓煎汁成膏丸,去暑利小水。暑有阳症,有阴症,
只用黄连香薷饮、清暑益气汤。五苓散等。有挟痰者,有乘虚者,挟痰加半夏,乘虚加参 之类。脉法微弱,按之无
力,又脉来隐伏,又脉虚。
朱震亨特别推崇李东垣关于内伤与外感辨别的论述,认为非常详尽,世间患此类疾病的人很多。但是,有的患者兼夹痰湿,有的兼夹外邪,有的是因内部气机郁滞而发病,治疗都应以补益元气为主,根据其所兼夹的病邪,再配合相应的药物使用。若兼夹痰湿,使用补中益气汤,并多加半夏、姜汁以助药力运行。
暑气所致或出现呕吐腹泻、霍乱症状的,用黄连香薷饮。若兼夹痰湿加半夏;若因气虚加重则加人参。如果是暑病兼有内伤的,用清暑益气汤。若出现口渴症状的,用生地黄、麦门冬、川牛膝、炒黄柏、知母、干葛、生甘草。治疗各种暑病的玉龙丸:赤石脂、倭硫黄、硝石、滑石、明矾各一两,好面粉六两,研成粉末,用无根水(如雨水、露水)制成丸剂。对于气虚导致食欲不振、身体发热、自汗、倦怠乏力的,用清暑益气汤;对于气虚导致食欲不振、自觉发热、自汗,脉象细弱或洪大的,在补中益气汤中加入麦门冬、五味子、知母。暑气导致心烦口渴、脉象虚弱的,用竹叶石膏汤;暑病表现为日夜烦躁、饮水无度,直到天亮才停止,全身浮肿,阴囊滴水下流,口不渴,入夜需要扇风,用冷香饮子治疗。有一人五十多岁,六月间发热,大汗淋漓、恶寒、战栗不能自控,并且心烦口渴,这是暑病。脉象皆虚微,细弱而数。此人喜好赌博,导致劳累而体虚,于是用人参煎汤,调服人参四苓散,服用八帖后痊愈。戴元礼说:暑是夏季炎热之气,盛热之气附着于人身上。有冒暑、伤暑、中暑三种,这三者有轻重之分,也有虚实之别。如果出现腹痛水样腹泻的,是胃与大肠受邪;出现恶心症状的,是胃口有痰饮停留。这两种情况属于冒暑。可以用黄连香薷饮,因为黄连能退暑热,香薷能消除蓄水。如果身体发热、头痛、躁动不安,或者身体感觉像针刺一样疼痛,这是热邪伤害在肌肉腠理之间。应当用解毒白虎汤加柴胡;气虚者加人参;或者咳嗽、发寒热、盗汗出、脉数不止,这是热邪附着于肺经,用清肺汤、柴胡天水散之类。急治则可以治愈,迟治则不可治了。这是盛火乘克肺金,称为中暑。凡治病必须明白辨别,不可混淆施治,春秋季节也可能发生,不可固执一端,随病处方才是妙法。一方:香薷浓煎汁熬成膏状制丸,可去暑利小便。暑病有阳证,有阴证,只用黄连香薷饮、清暑益气汤、五苓散等。有兼夹痰湿的,有加半夏;有因虚致病的,加人参之类。脉法见脉微弱,按之无力,又脉来隐伏,又脉虚。
Zhu Zhenheng specifically advocated Li Dongyuan's detailed differentiation between internal injury and external contraction, considering it very comprehensive, as many people in the world suffer from such diseases. However, some patients have phlegm accumulation, some have external pathogenic factors, and some develop due to internal qi stagnation; all should be treated primarily by tonifying primordial qi (Yuan Qi), and then combining appropriate herbs based on the accompanying pathogens. If accompanied by phlegm, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), adding more Banxia (Pinelliae Rhizoma) and Jiangzhi (Ginger Juice) to facilitate the transmission of medicinal effects.
For summer-heat causing vomiting, diarrhea, or cholera-like symptoms, use Huanglian Xiangru Yin (Coptis and Elsholtzia Decoction). Add Banxia if accompanied by phlegm; add Renshen (Ginseng Radix et Rhizoma) if exacerbated by qi deficiency. If it is a summer-heat disease with internal injury, use Qingshu Yiqi Tang (Clear Summer-Heat and Tonify Qi Decoction). For those presenting with thirst, use Shengdihuang (Rehmanniae Radix), Maimendong (Ophiopogonis Radix), Chuan Niuxi (Achyranthis Bidentatae Radix), Chao Huangbai (Phellodendri Cortex Preparata), Zhimu (Anemarrhenae Rhizoma), Gange (Puerariae Radix), and Sheng Gancao (Licorice Radix et Rhizoma). For treating various summer-heat conditions, Yulong Wan (Jade Dragon Pill): Chishizhi (Halloysitum Rubrum), Woliuhuang (Sulfur), Xiaoshi (Natrii Nitratis Crystal), Huashi (Talcum), Mingfan (Alumen) each 1 liang, and high-quality flour 6 liang, ground into powder, made into pills with Wugen Shui (water without roots, e.g., rain or dew water). For qi deficiency leading to poor appetite, body heat, spontaneous sweating, and fatigue, use Qingshu Yiqi Tang; for qi deficiency leading to poor appetite, subjective heat, spontaneous sweating, with pulse being fine and weak or large and forceful, add Maimendong, Wuweizi (Schisandrae Fructus), and Zhimu to Buzhong Yiqi Tang. For summer-heat causing irritability, thirst, and deficient pulse, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction); for summer-heat disease manifesting as day-and-night irritability, excessive drinking, stopping only at dawn, general edema, dripping fluid from the scrotum, no thirst, and needing fans at night, treat with Lengxiang Yin (Cold Fragrant Decoction). A man over fifty years old suffered fever in June, with profuse sweating, aversion to cold, uncontrollable shivering, and subsequent irritability and thirst; this was a summer-heat disease. The pulses were all deficient and faint, fine, weak, and rapid. He had a habit of gambling, leading to exhaustion and deficiency. Thus, Renshen decoction was used to administer Renshen Siling San (Ginseng and Four Ingredients Powder), and after eight doses, he recovered. Dai Yun said: Summer-heat is the intense heat of summer, where盛热之气 (intense heat qi) adheres to the person. There are Mao (encountering), Shang (injuring), and Zhong (smitten) types, which differ in severity and distinction between excess and deficiency. If there is abdominal pain and watery diarrhea, it is the stomach and large intestine affected; if there is nausea, it is phlegm-fluid retention in the stomach area. These two cases belong to Mao-shu (encountered summer-heat). Huanglian Xiangru Yin can be used, as Huanglian (Coptidis Rhizoma) clears summer-heat heat, and Xiangru (Elsholtviae Herba) eliminates accumulated water. If there is body heat, headache, restlessness, or sensation like needle pricks in the body, this indicates heat injuring the muscle layer (Roufen). One should use Jiedu Baihu Tang (Detoxifying White Tiger Decoction) plus Chaihu (Bupleuri Radix); add Renshen for qi deficiency; or if there is cough, alternating chills and fever, night sweats, and unceasing rapid pulse, indicating heat adhering to the Lung meridian, use Qingfei Tang (Clear the Lungs Decoction) or Chaihu Tianshui San (Bupleuri and Heavenly Water Powder). Prompt treatment can cure it; delayed treatment cannot. This is strong fire overcoming metal (Lung), called Zhong-shu (smitten by summer-heat). In treating diseases, one must clearly differentiate and not mix treatments indiscriminately; it may also occur in spring and autumn, so one should not adhere rigidly to one method but prescribe according to the disease. Another prescription: Xiangru decocted thickly into a paste for pills, removes summer-heat and promotes urination. Summer-heat has Yang syndromes and Yin syndromes, treated only with Huanglian Xiangru Yin, Qingshu Yiqi Tang, Wuling San (Five Ingredients Powder), etc. If accompanied by phlegm, add Banxia; if due to deficiency, add Renshen, etc. Pulse methods show weak and faint pulses, powerless upon pressing, hidden pulses, or deficient pulses.