治病之法,不外汗下二端而已。下之害人,其危立见,故医者、病者,皆不敢轻投。至
于汗
凉,病者亦重加覆护,医者亦云服药,必须汗出而解。故病患之求得汗,人人以为当然也。
秋冬之时,过暖尚无大害;至于盛夏初秋,天时暑燥,卫气开而易泄 ,更加闭户重衾,复
投发散之剂,必至大汗不止而阳亡矣。又外存这徉,汗未出之时,必烦闷恶热;及汗大出之
后,卫气尽泄,必阳衰而畏寒。始之暖覆,犹属勉强,至此时虽欲不覆而不能,愈覆愈汗,
愈汗愈寒,直至汗出如油,手足厥冷,而病不可为矣。其死也,神气甚清,亦无痛苦。病者
、医者,及同之人,皆不解其何故而忽死,惟有相顾噩然可已。我见甚多,不可不察也。总
之有病之人,不可过凉,亦不宜太暖,无事不可令汗出,惟服药之时,宜令小汗。仲景服桂
枝汤法云∶服汤已,温覆令微似汗,不可如水淋漓。此其法也。至于亡阳未剧,尤可挽回,
《伤寒论》中真武、理中、四逆等法可考。若已脱尽,无可补救矣。又盛暑之时,病者或居
楼上,或卧近灶之所。无病之人,一立其处,汗出如雨,患病者必至时时出汗,既吵亡阳,
亦必阴竭而死。虽无移徙之处,必择一席稍凉之地而处之,否则神丹不救也。
凡人偶感风寒,头痛发热,咳嗽涕出,俗语谓之伤风。非《伤寒论》中所云之伤风,乃
时行
之杂感也。人皆忽之,不知此乃至难治之疾,生死之所关也。盖伤风之疾,由皮毛以入于肺
,肺为娇脏,寒热皆所不宜。太寒则邪气凝而不出;太热则火烁金而动血。太润则生痰饮;
太燥则耗精液。太泄则汗出而阳虚;太涩则气闭而邪结。并有视为微疾,不避风寒,不慎饮
食,经年累月,病机日深,或成血证,或成肺痿,或成哮喘,或成怯弱,比比皆然。误治之
害,不可胜数。谚云∶伤风不醒变成劳。至言也。然则,治之何如?一驱风,苏叶、荆芥之
类。二消痰,半夏、象贝之类。三降气,苏子、前胡之类。四和荣卫,桂枝、白芍之类。五
润津液,蒌仁、元参之类。六养血,当归,阿胶之类。七清火,黄芩、山栀之类。八理肺,
桑皮、大力子之类。八者随其症之轻重而加减之,更加以避风寒,戒辛酸,则庶几渐愈,否
则必成大病。医者又加以升提辛燥之品,如桔梗、干姜之类。不效,即加以酸收,如五味子
之类,则必见血,及见血。随用熟地、麦冬,以实其肺,即成劳而死。四十年以来,我见以
千计矣,伤哉!
治疗疾病的方法,不外乎发汗和攻下两种途径而已。攻下法伤害人体,其危险立即显现,所以医生和患者都不敢轻易使用。至于发汗法,患者也重视加盖厚被保暖,医生也说服药后,必须出汗才能痊愈。因此,患者寻求出汗,人人都认为是理所当然的。
在秋冬季节,过度保暖尚且没有大害;到了盛夏初秋,天气暑热干燥,卫气(行于体表、具有防御作用的气)开泄而容易流失,如果再紧闭门窗、盖上多重被子,又服用发散表邪的药物,必然导致大汗不止而阳气亡失。另外,外表看似正常,但在汗未出之时,必定感到烦闷恶热;等到汗大量流出之后,卫气完全泄露,必然阳气衰微而畏寒。起初的暖覆,还属于勉强为之,到了这个时候,即使想不盖被子也不能了,越盖被子汗越多,汗越多越觉得寒冷,直到汗出如油,手足冰冷,病情就无法挽回了。死亡时,神志清明,也没有痛苦。患者、医生以及周围的人,都不明白为什么突然死亡,只有面面相觑,惊恐不已。我见过的案例很多,不能不仔细考察。总之,患病之人,不可过度保暖,也不宜太冷,没有必要让身体出汗,只有在服药的时候,应该让身体微微出汗。张仲景服用桂枝汤的方法说:“服药后,温覆使身体微微似有汗意,不可像水流淋漓那样。”这就是正确的法则。至于阳气亡失还不严重,尤其可以挽回,《伤寒论》中的真武汤、理中汤、四逆汤等方法可以参考。如果已经脱尽,就没有办法补救了。又在盛暑之时,患者有的住在楼上,有的睡在近灶的地方。没有病的人,一站在那里,就汗出如雨,患病者必然时时出汗,这既会导致亡阳,也必然因阴液枯竭而死。虽然没有地方可搬移,也必须选择一个稍微凉爽的地方居住,否则即使是神丹妙药也无法救治。
凡人偶然感受风寒,出现头痛发热、咳嗽流涕,俗语称为伤风。这不是《伤寒论》中所说的伤风,而是时令流行的杂感病。人们都忽视它,不知道这是极难治疗的疾病,关乎生死。因为伤风之疾,由皮毛侵入肺脏,肺是娇嫩的脏器,寒热都不适宜。太寒则邪气凝结而不能排出;太热则火灼伤肺金而动血。太润则生痰饮;太燥则耗损精液。太泄则出汗而阳气虚;太涩则气机闭塞而邪气结聚。并且有人将其视为小病,不避风寒,不慎饮食,经年累月,病机日益深入,或形成血证,或形成肺痿,或形成哮喘,或形成怯弱症,比比皆是。误治的危害,数不胜数。谚语说:“伤风不醒变成劳损。”这是至理名言。那么,如何治疗呢?一驱风,用苏叶、荆芥之类。二消痰,用半夏、象贝母之类。三降气,用苏子、前胡之类。四调和营卫,用桂枝、白芍之类。五滋润津液,用瓜蒌仁、玄参之类。六养血,用当归、阿胶之类。七清火,用黄芩、山栀之类。八理肺,用桑白皮、牛大力子之类。这八种方法根据症状的轻重进行加减,再加上避免风寒,戒除辛辣酸味食物,则差不多会逐渐痊愈,否则必然成为大病。医生又加上升提辛燥的药物,如桔梗、干姜之类。如果不效,再加酸收药物,如五味子之类,则必然见血,一旦见血,随即用熟地黄、麦冬来补益肺气,就会形成劳损而死。四十年来,我见到的案例以千计,真是悲哀啊!
The methods for treating diseases are nothing more than sweating (inducing perspiration) and purging (drastic evacuation). Purging harms the body, and its danger is immediately apparent; therefore, both physicians and patients dare not administer it lightly. Regarding sweating, patients also emphasize covering themselves with thick quilts to keep warm, and physicians state that after taking medicine, recovery must occur through perspiration. Thus, patients seeking perspiration consider this a matter of course.
During autumn and winter, excessive warmth causes little harm; however, in midsummer and early autumn, when the weather is hot and dry, Wei Qi (defensive Qi circulating on the surface) opens and leaks easily. If one further closes doors and windows, wears multiple layers of quilts, and takes diaphoretic agents to disperse exterior pathogens, it will inevitably lead to incessant profuse sweating and the collapse of Yang Qi. Furthermore, although outwardly appearing normal, before perspiration occurs, there is invariably irritability and aversion to heat; after profuse sweating, as Wei Qi is completely exhausted, Yang deficiency and cold intolerance inevitably follow. The initial warming and covering were merely forced measures; at this stage, even if one wishes to remove the covers, it is impossible. The more one covers up, the more one sweats; the more one sweats, the colder one feels, until the sweat becomes like oil and the extremities become cold, rendering the condition incurable. Death occurs with clear consciousness and without pain. Patients, physicians, and bystanders do not understand why death occurred suddenly, only staring at each other in shock. I have seen many such cases and must examine them carefully. In summary, those who are ill should not be kept too warm, nor too cold, and should not be made to sweat unnecessarily. Only when taking medicine should slight perspiration be induced. Zhang Zhongjing’s method for administering Guizhi Tang (Cinnamon Twig Decoction) states: "After taking the decoction, cover warmly to induce a slight perspiration resembling mist, but not dripping like water." This is the correct method. As long as Yang collapse is not severe, it can still be reversed; methods such as Zhenwu Tang (True Warrior Decoction), Lizhong Tang (Regulate the Middle Decoction), and Sini Tang (Frigid Extremities Decoction) in the Shanghan Lun (Treatise on Cold Damage Disorders) can be consulted. If collapse is complete, no remedy remains. Moreover, during peak summer heat, patients may reside upstairs or sleep near a stove. A healthy person standing in such a place would sweat profusely like rain; an ill person will inevitably sweat constantly, leading to Yang collapse and eventually death due to Yin exhaustion. Even if relocation is impossible, one must choose a slightly cooler place to stay; otherwise, even miraculous medicines cannot save them.
When ordinary people accidentally contract wind-cold, presenting with headache, fever, cough, and runny nose, it is colloquially called "Shangfeng" (Wind Injury). This is not the "Shangfeng" described in the Shanghan Lun, but rather miscellaneous infections prevalent in the season. People often neglect it, unaware that it is a difficult-to-treat disease concerning life and death. Wind injury enters the Lungs via the skin and hair. The Lung is a delicate organ, unsuited to either extreme cold or heat. Excessive cold causes pathogenic factors to coagulate and remain trapped; excessive heat scorches Metal (Lung) and disturbs blood. Excessive moisture generates phlegm-fluids; excessive dryness consumes essence and fluids. Excessive leakage leads to sweating and Yang deficiency; excessive stagnation causes Qi obstruction and pathogenic binding. Many regard it as a minor ailment, failing to avoid wind and cold or regulate diet. Over months and years, the pathological mechanism deepens, potentially developing into Blood Syndromes, Fei Wei (Lung Withering), Asthma, or Qie Ruo (Debility), which are common occurrences. The harm of misdiagnosis and mistreatment is countless. The proverb says, "If Wind Injury is not cured, it transforms into Consumption (Lao)." This is a profound truth. So, how should it be treated? 1. Dispel Wind, using herbs like Perilla Leaf (Suye) and Schizonepeta (Jingjie). 2. Resolve Phlegm, using Pinellia (Banxia) and Fritillaria Thunbergii Bulb (Xiangbei). 3. Descend Qi, using Perilla Seed (Su Zi) and Peucedanum Root (Qianhu). 4. Harmonize Ying and Wei (Nutritive and Defensive Qi), using Cinnamon Twig (Guizhi) and White Peony Root (Baishao). 5. Moisten Fluids, using Trichosanthes Seed (Gualou Ren) and Scrophularia Root (Xuanshen). 6. Nourish Blood, using Angelica Sinensis (Danggui) and Donkey-Hide Gelatin (Ejiao). 7. Clear Fire, using Scutellaria Root (Huangqin) and Gardenia Fruit (Shanzhi). 8. Regulate the Lung, using Mulberry Root Bark (Sangpi) and Arctium Fruit (Niubangzi). These eight methods are modified according to the severity of symptoms. Combined with avoiding wind and cold and abstaining from pungent and sour foods, gradual recovery is possible; otherwise, major illness will ensue. Physicians often add ascending and acrid-drying agents, such as Platycodon Root (Jiegeng) and Dried Ginger (Ganjiang). If ineffective, they add astringents like Schisandra Berry (Wuweizi), which inevitably leads to hemoptysis. Once bleeding appears, they subsequently use Rehmannia Root (Shudi) and Ophiopogon Tuber (Maidong) to tonify the Lung, resulting in Consumption and death. Over the past forty years, I have witnessed thousands of such cases. How tragic!