春温汗多,头仍痛;而烦热口渴,舌黄脉洪,此
邪在阳明气分。宜用白虎汤加葛根;连翅、元参、杏
仁等味,清气化热也。
前条汗后,头额痛,发热,脉弦长,乃阳明经病 自宜
透表,今汗多,则表邪己解,反烦热口渴,舌黄脉洪,则邪
不在经,而传及气分,非表散历能退。故用白虎汤之石膏、
知母、连翘、元参清肺胃,杏仁、葛根透经邪,甘草、粳米
养胃津。特葛根为阳明经病主药,石膏为阳明气熟主药,犀
角为阳明血热主药,邪既在气;仍兼经药者,以冀由气转
经,由经达表,仍从汗泄耳。
春温烦热口渴,舌黄尖绛,昏谵脉洪,此阳明气
血燔蒸。宜用玉女煎加连翘、元参、鲜百斛、鲜菖
蒲、青竹叶等味,两清气血也。
上条烦热口渴,舌黄脉洪,乃阳明气热,例宜清气。此
乃舌黄尖绛,神昏谵语,血分已热,心营被灼,非两清之,
病必不解。故用玉女煎之石膏,知母以清气,生地、元参以
凉血,连翘、菖莆、竹叶以清心营,甘草、粳米、石斛以养
胃阴,庶不热灼津伤,而成全痉厥为要。
春温热不解,舌赤尖绛,神昏谵妄,口渴脉数,
斑疹隐隐,此热传心营。宜用鲜生地,鲜石斛,鲜玉
竹、元参心、连翘心,鲜菖蒲、竹叶、牛黄丸等味,
清营透邪也。
上条舌黄尖绛,谵语脉洪,乃气热传营。此条舌赤尖
绛;"神昏脉数,热已入营,将延血分。故以生地、元参凉
血,连翘、玉竹清热,菖蒲,竹叶清营,牛黄丸宧窍,不致
入血成痉·便是回生之兆。
春温病汗出较多,头部仍然疼痛;同时伴有烦躁发热、口渴,舌苔黄,脉象洪大,这是邪气在阳明经气分。适宜使用白虎汤加葛根、连翘、元参、杏仁等药物,以清泄气分之热并化解热邪。
前一条所述,发汗后出现头额部疼痛、发热、脉象弦长,属于阳明经病,自然应当透达表邪。如今汗出很多,说明表邪已经解除,反而出现烦躁发热、口渴、舌苔黄、脉象洪大,则邪气不在经络,而是传入气分,单纯用解表发散的方法不能退热。因此使用白虎汤中的石膏、知母,配合连翘、元参清泄肺胃之热,杏仁、葛根透达经络之邪,甘草、粳米滋养胃中津液。特别指出,葛根是治疗阳明经病的主药,石膏是治疗阳明气分热盛的主药,犀角是治疗阳明血分热盛的主药。既然邪气已在气分,仍兼用透经的药物,是希望邪气由气分转出至经络,再由经络达于体表,最终通过汗液排出体外。
春温病出现烦躁发热、口渴,舌苔黄且舌尖红绛,神志昏沉、胡言乱语,脉象洪大,这是阳明经气血两燔(气血受热邪猛烈熏蒸)。适宜使用玉女煎加连翘、元参、鲜石斛、鲜石菖蒲、青竹叶等药物,以同时清泄气和血分之热。
上一条所述烦热口渴、舌苔黄、脉象洪大,是阳明气分热盛,按照常规应当清泄气分。此处则是舌苔黄且舌尖红绛,神志昏迷、胡言乱语,说明血分已有热邪,心营被热邪灼伤,如果不采用气血两清的方法,病情必然无法解除。因此使用玉女煎中的石膏、知母来清泄气分热,生地、元参来凉血清热,连翘、石菖蒲、竹叶来清泄心营之热,甘草、粳米、石斛来滋养胃阴,这样才不会因热邪灼伤津液而导致全身抽搐、厥逆,这是治疗的关键。
春温病热势不退,舌质红赤、舌尖红绛,神志昏迷、胡言乱语,口渴、脉象数疾,斑疹隐约可见,这是热邪传入心营。适宜使用鲜生地、鲜石斛、鲜玉竹、元参心、连翘心、鲜石菖蒲、竹叶、牛黄丸等药物,以清泄营分热邪并透达外出的邪气。
上一条所述舌苔黄、舌尖红绛、胡言乱语、脉象洪大,是气分热邪传入营分。这一条所述舌质红赤、舌尖红绛,神志昏迷、脉象数疾,说明热邪已深入营分,即将蔓延至血分。因此使用生地、元参凉血,连翘、玉竹清热,石菖蒲、竹叶清泄营分,牛黄丸开窍醒神,防止热邪进入血分导致抽搐,这便是使病人起死回生的征兆。
In Spring-Warmth disease, with profuse sweating and persistent headache; accompanied by irritability, fever, thirst, yellow tongue coating, and a flooding pulse, this indicates the pathogen is in the Qi level of the Yangming channel. It is appropriate to use Baihu Tang (White Tiger Decoction) added with Gegen (Puerariae Radix), Lianqiao (Forsythiae Fructus), Yuanshen (Scrophulariae Radix), Xingren (Armeniacae Semen Amarum), etc., to clear heat from the Qi level and transform heat pathogens.
In the previous clause, after sweating, there was pain in the forehead and head, fever, and a string-long pulse, which constitutes a disease of the Yangming channel, naturally requiring the venting of exterior pathogens. Now, with profuse sweating, the exterior pathogens have already been resolved; conversely, irritability, fever, thirst, yellow tongue coating, and flooding pulse indicate that the pathogen is no longer in the channels but has transmitted to the Qi level. Simple exterior-releasing methods cannot reduce the heat. Therefore, Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma) in Baihu Tang, combined with Lianqiao and Yuanshen, clear lung and stomach heat; Xingren and Gegen vent channel pathogens; Gancao (Glycyrrhizae Radix et Rhizoma) and Jingmi (Oryzae Fructus) nourish stomach fluids. Specifically, Gegen is the principal herb for Yangming channel diseases, Shigao is the principal herb for Yangming Qi-level heat, and Xijiao (Rhinocerotis Cornu) is the principal herb for Yangming blood-heat. Since the pathogen is already in the Qi level, using channel-venting herbs alongside is to hope that the pathogen will move from the Qi level to the channels, and from the channels to the exterior, ultimately being discharged through sweat.
Spring-Warmth disease presenting with irritability, fever, thirst, yellow tongue coating with crimson tip, mental confusion, delirium, and a flooding pulse, indicates simultaneous burning of Qi and Blood in the Yangming channel. It is appropriate to use Yinvu Jian (Jade Woman Decoction) added with Lianqiao, Yuanshen, Xian Shihu (Dendrobii Caulis), Xian Changpu (Acori Tatarinowii Rhizoma), Qing Zhuye (Phyllostachidis Folium), etc., to simultaneously clear heat from both Qi and Blood levels.
The previous clause described irritability, thirst, yellow tongue coating, and flooding pulse, indicating Yangming Qi-level heat, which typically requires clearing the Qi level. Here, however, the yellow tongue coating with crimson tip, mental confusion, and delirium indicate heat in the Blood level and scorching of the Heart Ying (Nutritive Level). Without simultaneous clearing of Qi and Blood, the condition will not resolve. Therefore, Shigao and Zhimu in Yinvu Jian clear Qi-level heat; Shengdi (Rehmanniae Radix) and Yuanshen cool Blood; Lianqiao, Changpu, and Zhuye clear Heart Ying heat; Gancao, Jingmi, and Shihu nourish Stomach Yin. This prevents the scorching of fluids by heat, thereby avoiding the onset of general convulsions and厥逆 (cold extremities/coma), which is crucial for treatment.
Spring-Warmth disease with unresolved heat, crimson tongue body with crimson tip, mental confusion, delirium, thirst, rapid pulse, and faint macules and papules, indicates heat transmitting to the Heart Ying (Nutritive Level). It is appropriate to use Xian Shengdi (Fresh Rehmanniae Radix), Xian Shihu (Fresh Dendrobii Caulis), Xian Yuzhu (Fresh Polygonati Odorati Rhizoma), Yuanshenxin (Scrophulariae Radix Core), Lianqiaoxin (Forsythiae Fructus Core), Xian Changpu (Fresh Acori Tatarinowii Rhizoma), Zhuye (Phyllostachidis Folium), Niuhuang Wan (Calculus Bovis Pill), etc., to clear Ying-level heat and vent pathogens outward.
The previous clause described yellow tongue coating, crimson tip, delirium, and flooding pulse, indicating Qi-level heat transmitting to the Ying level. This clause describes a crimson tongue body, crimson tip, mental confusion, and rapid pulse, indicating heat has entered the Ying level and is about to spread to the Blood level. Therefore, Shengdi and Yuanshen are used to cool Blood; Lianqiao and Yuzhu to clear heat; Changpu and Zhuye to clear Ying level; and Niuhuang Wan to open orifices, preventing heat from entering the Blood level and causing convulsions. This signifies a chance for recovery.