中暑之后,舌淡不渴,身痛,脉软,不食,此邪
去阳伤。宜用黄只五物汤(1)加麦芽、谷芽,木瓜,藿
香等味,甘温扶阳也。
上条邪去阴伤,治以甘酸。此条邪去阳伤,主以甘温。
况身痛脉软,表阳亦伤,故用黄祗五物合藿香,益智,麦
芽、谷芽甘温之味固表扶阳,庶为合例。
中暑恶寒发热,肢节酸疼,头痛颈强,此暑风袭
表,防发痉。宜用桂枝、杏仁、黄祗、防风、蒺藜、
钩藤、海风藤、桑叶、防己、地龙等味,袪风宣络也。
夏间暑炎,汗多气泄,风邪易袭,以致头痛项强,恶寨
发热,骨节不和,乃虚中挟风。故宜桂枝、黄祗固表,防、
杏、二藤、地龙、桑叶祛风,俾表和风熄,则不致延为痉厥
之患。夫痉者,仲景原有刚痉、柔痉之异,犹恐后人虚实难
(1)黄祗五物汤,(金柜-血痹虚劳病脉证并治)原方作"黄祗桂枝五物汤"。
故,故以有汗,无汗为辨。然愚意言之,无汗恶寒 发热,头
项强痛,手足抽搞,角弓反张,此风自外来,即无汗为刚痉
也。更有吐泻之后,或产后血虚,或热极伤津,汗多液亏,
而身热口噤,头摇直视,抽搐反张,斯风自内作,即有汗为
柔痉也。是则风有内外,病有虚实。外来者,宜散宜清,内
作者,宜柔宜补。宜清宜散者,用小续命汤加减;宜柔宜补
者,用复脉汤加堿。此为治痉之权衡,明理者裁之。
中暑之后,舌色淡白且不口渴,身体疼痛,脉象软弱,不想进食,这是邪气已去但阳气受损的表现。适宜使用黄耆五物汤(1)加入麦芽、谷芽、木瓜、藿香等药物,采用甘温的方法扶助阳气。
上一条论述的是邪气已去但阴液受损,治疗以甘酸之法为主。这一条论述的是邪气已去但阳气受损,主以甘温之法。况且身体疼痛、脉象软弱,说明表阳也受到了损伤,因此使用黄耆五物汤配合藿香、益智仁、麦芽、谷芽等甘温性质的药物来固护肌表、扶助阳气,这才符合法度。
中暑后出现怕冷发热,四肢关节酸痛,头痛且颈部僵硬,这是暑风侵袭体表所致,需防止发展为痉病(肌肉痉挛)。适宜使用桂枝、杏仁、黄耆、防风、蒺藜、钩藤、海风藤、桑叶、防己、地龙等药物,以祛风通络。
夏季暑热炎炎,汗出过多导致气随汗泄,风邪容易侵袭,从而导致头痛项强、恶寒发热、骨节不适,这属于虚证中夹杂风邪。因此适宜用桂枝、黄耆固护肌表,用防风、杏仁、两种藤类药材(海风藤、钩藤)、地龙、桑叶祛除风邪,使表气和顺、风邪平息,就不会延变为痉厥的祸患。关于痉病,张仲景原本就有刚痉和柔痉的区别,恐怕后人难以辨别虚实,所以以有汗、无汗作为鉴别标准。然而依我之意来说,无汗、恶寒、发热、头项强痛、手足抽搐、角弓反张,这是风邪从外侵入,即无汗为刚痉。更有在吐泻之后,或产后血虚,或热极伤津、汗多液亏的情况下,出现身热、口噤不开、头摇、直视、抽搐反张,这是风邪从内生发,即有汗为柔痉。由此可见,风有内外之分,病有虚实之别。外来风邪,宜疏散宜清解;内生风邪,宜柔润宜补益。宜清解疏散的,用小续命汤加减;宜柔润补益的,用复脉汤加咸味药(如牡蛎等)。这是治疗痉病的权衡准则,明理之人自行裁断。
After suffering from heatstroke, the tongue is pale and there is no thirst, body pain, a soft pulse, and loss of appetite; this indicates that the pathogenic factor has departed but yang qi is damaged. It is appropriate to use Huangqi Wuwu Tang (Astragalus Five-Ingredient Decoction) [1] added with Maiya (Sprouted Barley), Guya (Sprouted Millet), Mugua (Chaenomeles Fruit), Huoxiang (Patchouli), etc., employing sweet-warm methods to support yang qi.
The preceding clause discussed yin damage after the departure of the pathogen, treated with sweet-sour methods. This clause discusses yang damage after the departure of the pathogen, primarily using sweet-warm methods. Furthermore, since body pain and a soft pulse indicate that exterior yang is also damaged, using Huangqi Wuwu Tang combined with Huoxiang, Yizhi (Alpinia Oxyphylla), Maiya, and Guya—substances with sweet-warm properties—to secure the exterior and support yang is indeed in accordance with proper principles.
Heatstroke accompanied by aversion to cold and fever, soreness and pain in the limbs and joints, headache, and neck stiffness indicates that summer-heat wind has attacked the exterior, with a risk of developing into spasm (jing). It is appropriate to use Guizhi (Cinnamon Twig), Xingren (Apricot Seed), Huangqi (Astragalus), Fangfeng (Saposhnikovia), Jili (Tribulus), Gouteng (Uncaria), Haifengteng (Trichosanthes Vine), Sangye (Mulberry Leaf), Fangji (Stephania), and Dilong (Earthworm) to dispel wind and unblock collaterals.
During summer, intense summer-heat causes excessive sweating and leakage of qi, making one susceptible to wind invasion. This leads to headache, neck stiffness, aversion to cold, fever, and disharmony in the bone joints, constituting a deficiency pattern complicated by wind. Therefore, it is appropriate to use Guizhi and Huangqi to secure the exterior, and Fangfeng, Xingren, the two vines (Haifengteng, Gouteng), Dilong, and Sangye to dispel wind, so that when the exterior harmonizes and wind subsides, it will not progress to the disaster of spasm and convulsion. Regarding jing (spasm), Zhang Zhongjing originally distinguished between Gang Jing (Stiff Spasm) and Rou Jing (Flexible Spasm), likely because later generations found it difficult to distinguish deficiency and excess; thus, the presence or absence of sweating serves as the criterion for differentiation. However, in my opinion: absence of sweating, aversion to cold, fever, headache and neck stiffness, twitching of the hands and feet, and opisthotonos constitute wind coming from outside, which is Gang Jing (Stiff Spasm) characterized by anhidrosis. Conversely, following vomiting and diarrhea, postpartum blood deficiency, or extreme heat injuring fluids leading to excessive sweating and fluid depletion, resulting in fever, trismus (lockjaw), head shaking, fixed gaze, twitching, and opisthotonos, constitutes wind arising from within, which is Rou Jing (Flexible Spasm) characterized by hyperhidrosis. Thus, wind has internal and external origins, and disease has deficiency and excess aspects. For externally acquired wind, dispersion and clearing are indicated; for internally generated wind, softening and tonification are indicated. For those requiring clearing and dispersion, Xiao Xuming Tang (Minor Continuation Life Decoction) with modifications is used; for those requiring softening and tonification, Fumai Tang (Restore Pulse Decoction) with salty substances is used. These represent the balancing principles for treating spasm, to be judged by those who understand the theory.
[1] Huangqi Wuwu Tang, originally named "Huangqi Guizhi Wuwu Tang" (Astragalus, Cinnamon Twig, and Five-Ingredient Decoction) in the *Jinkui Yaolue* chapter on Blood Bi and Deficiency Consumption Patterns.