葳蕤 石膏 干葛(各一钱) 白薇 羌活 杏仁 甘草 川芎(各六分) 防风(七分,用此以
代麻黄为稳当) 青木香(五分)
水煎服。
伤寒邪热未除,复感风邪,变为温疟。温疟之状,寒热根据时而作,大抵热多寒少,或先
热后寒,每致神昏谵语,与时行正疟不同。治用小柴胡汤,去半夏,加黄连、知母、贝母以
清之。然温疟寒热以时,又与少阳病寒热往来无定时者,自是不同。
身重大都属寒,然亦有热者。经曰∶风湿相搏,骨节烦疼,不能自转侧,不呕不渴,脉
虚浮而涩者,桂枝附子汤主之,此表寒也。经曰∶少阴病,腹痛,四肢沉重疼痛,下利者,
治以真武汤,此里寒也。经曰∶发汗已,身犹灼热,名曰风温,其证脉浮汗出,身重多眠,
鼻息鼾,治以葳蕤汤,此表寒束其里热也。经曰∶三阳合病,腹满,身重,口不仁,面垢,
谵语,遗尿,自汗出,白虎汤主之,此表里皆热也。又阴阳易病,身重,少气,少腹里急,
气上冲胸,眼中生花,宜用附子理中汤主之,此里虚且寒也。
真武汤 (见筋惕肉 )。
湿热俱盛,则发身黄,伤寒至于发黄,为病亦甚矣。热而兼湿,如 曲相似,日久
则变为黄也。然不特湿热发黄,而寒湿亦令人发黄。但寒湿之黄,身如熏黄,色暗而不明;
湿热之黄,黄如橘色,出染着衣,正黄如柏也。又如瘀血发黄,亦湿热所致,瘀血与积热熏
蒸,故见黄色也,去瘀生新,而黄自退矣。
葳蕤(玉竹)、石膏、干葛(葛根,各一钱),白薇、羌活、杏仁、甘草、川芎(各六分),防风(七分,用此药代替麻黄更为稳妥),青木香(五分)。
用水煎煮后服用。
伤寒病的邪热尚未清除,又感受了风邪,演变为温疟。温疟的症状是寒热交替定时发作,大体上是热多寒少,或者先发热后发冷,常常导致神志昏迷、胡言乱语,这与时行正疟有所不同。治疗用小柴胡汤,去掉半夏,加入黄连、知母、贝母来清热。然而温疟的寒热按时发作,又与少阳病寒热往来没有固定时间的情况,自然是不同的。
身体沉重大多属于寒证,但也有属于热的情况。《内经》说:风湿相互搏结,骨节烦痛,不能自行翻身转动,不呕吐不口渴,脉象虚浮而涩的,用桂枝附子汤主治,这是表寒证。《内经》说:少阴病,腹痛,四肢沉重疼痛,下利的,用真武汤治疗,这是里寒证。《内经》说:发汗之后,身体仍然灼热,名叫风温,其症状是脉浮、出汗、身体沉重、嗜睡,鼻息有鼾声,用葳蕤汤治疗,这是表寒束缚住里热。《内经》说:三阳合病,腹部胀满,身体沉重,口舌不知五味,面部污垢,胡言乱语,遗尿,自汗出,用白虎汤主治,这是表里皆热证。又有阴阳易病,身体沉重,气短,小腹部拘急,气向上冲撞胸部,眼前发黑视物模糊,宜用附子理中汤主治,这是里虚且寒证。
真武汤(参见筋惕肉瞤条)。
湿热俱盛,就会发生身黄,伤寒发展到发黄,病情也很严重了。热兼夹湿,就像酒曲一样,时间久了就会变成黄色。然而不仅湿热会导致发黄,寒湿也会使人发黄。但是寒湿导致的黄,身体像被烟熏过的黄色,颜色晦暗而不明亮;湿热导致的黄,黄得像橘子皮的颜色,沾染衣物,纯正如柏树汁染成的黄色。又如瘀血导致的发黄,也是由湿热引起的,瘀血与积热熏蒸,所以出现黄色,去除瘀血生成新血,黄疸自然消退。
Rhizoma Polygonati (Yuzhu), Gypsum Fibrosum (Shigao), Radix Puerariae Lobatae (Gegen) (each 1 qian), Caulis Anemones Raddeanae (Baiwei), Rhizoma Notopterygii (Qianghuo), Semen Armeniacae Amarum (Xingren), Radix Glycyrrhizae (Gancao), Radix Chuanxiong (each 6 fen), Radix Saposhnikoviae (Fangfeng) (7 fen, using this herb instead of Ephedrae Herba is more prudent), Fructus Aromatische Schisandrae (Qingmuxiang) (5 fen).
Decoct in water and take orally.
When the pathogenic heat of Cold Damage (Shanghan) has not been eliminated, and wind pathogen is contracted again, it transforms into Warm Malaria (Wen Nue). The manifestation of Warm Malaria involves alternating chills and fever occurring at regular intervals; generally, there is more heat than cold, or fever precedes chills. This often leads to coma and delirium, which differs from typical seasonal malaria. Treatment utilizes Xiao Chai Hu Tang (Minor Bupleurum Decoction), removing Pinelliae Tuber (Banxia), and adding Coptidis Rhizoma (Huanglian), Anemarrhenae Rhizoma (Zhimu), and Fritillariae Thunbergii Bulbus (Beimu) to clear heat. However, the timed alternation of chills and fever in Warm Malaria is naturally distinct from the irregular alternating chills and fever seen in Shaoyang disease (Shaoyang Bing).
Heaviness of the body mostly belongs to cold patterns, but there are also cases involving heat. The Classics state: When wind-dampness combats each other, causing severe pain in the bones and joints, inability to turn over independently, without vomiting or thirst, and with a deficient, floating, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Root Decoction) should be used; this is exterior cold. The Classics state: In Shaoyin disease, with abdominal pain, heaviness and pain in the four limbs, and diarrhea, Zhen Wu Tang (True Warrior Decoction) should be used; this is interior cold. The Classics state: After sweating therapy, if the body remains burning hot, it is named Wind-Warmth (Feng Wen). Its symptoms include a floating pulse, sweating, bodily heaviness, excessive sleepiness, snoring breath, and it is treated with Weirui Tang (Polygonatum Decoction); this is exterior cold binding interior heat. The Classics state: In combined disease of the three Yang channels, with abdominal fullness, bodily heaviness, insensitivity of the mouth and tongue, facial greasiness, delirium, urinary incontinence, and spontaneous sweating, Baihu Tang (White Tiger Decoction) should be used; this is heat in both exterior and interior. Furthermore, for Yin-Yang Exchange disease (Yin Yang Yi Bing), characterized by bodily heaviness, shortness of breath, urgency and tightness in the lower abdomen, qi rushing up to the chest, and visual disturbances (seeing spots), Fuzi Lizhong Tang (Aconite and Licorice Center-Regulating Decoction) should be used; this is interior deficiency and cold.
Zhen Wu Tang (See entry on Muscle Twitching).
When damp-heat is abundant, jaundice develops. In Cold Damage, progression to jaundice indicates a severe condition. Heat combined with dampness is like yeast/ferment; over time, it turns yellow. However, not only damp-heat causes jaundice, but cold-dampness can also cause yellowing. The yellow caused by cold-dampness resembles a smoked hue, dark and dull; the yellow caused by damp-heat resembles the color of an orange peel, staining clothes with a pure yellow akin to indigo dye. Additionally, jaundice caused by blood stasis is also induced by damp-heat; blood stasis steamed by accumulated heat results in yellow discoloration. Removing stasis and generating new blood will cause the jaundice to recede naturally.