目疾有实热之证,其热屡服凉药不解,其目疾亦因之久不愈者,大抵皆因伏气化热之后,而移热于
目也。丙寅季春,李××,纺纱厂学徒,病目久不愈。眼睑红肿, 肉遮睛,觉目睛胀疼甚剧,又兼耳聋
鼻塞,见闻俱废,跬步须人扶持。其脉洪长甚实,左右皆然。其心中甚觉发热,舌有白苔,中心已黄,其从前
大便原燥,因屡服西药大便日行一次。知系冬有伏寒,感春阳而化热,其热上攻,目与耳鼻皆当其冲也。拟
用大剂白虎汤以清阳明之热,更加白芍、龙胆草兼清少阳之热。病患谓厂中原有西医,不令服外人药,今
因屡服其药不愈,偷来求治于先生,或服丸散犹可,断乎不能在厂中煎服汤药。愚曰∶“此易耳。我有自
制治眼妙药,送汝一包,服之眼可立愈。”遂将预轧生石膏细末两半与之,嘱其分作六次服,日服三次,开水
送下,服后又宜多喝开水,令微见汗方好。持药去后,隔三日复来,眼疾已愈十之八九,耳聋鼻塞皆愈,
心中已不觉热,脉已和平。复与以生石膏细末一两,俾仍作六次服。将药服尽全愈。至与以生石膏细末而
不明言者,恐其知之即不敢服也。后屡遇因伏气化热病目者,治以此方皆效。
河间天水散(即六一散),为清暑之妙药。究之南方用之最为适宜;若北方用之,原宜稍为变通。盖南方
之暑多挟湿,故宜重用滑石,利湿即以泻热。若在北方,病暑者多不挟湿,或更挟有燥气,若亦重用滑石以利
其湿,将湿去而燥愈甚,暑热转不易消也。愚因是拟得一方,用滑石四两,生石膏四两,粉甘草二两,朱砂
一两,薄荷冰一钱,共为细末,每服二钱,名之曰加味天水散。以治北方之暑病固效,以治南方之暑病,亦
无不效也。方中之义∶用滑石、生石膏以解暑病之热;而石膏解热兼能透表,有薄荷冰以助之,热可自肌肤散
出,滑石解热兼能利水,有甘草以和之(生甘草为末服之最善利水,且水利而不伤阴),热可自小便泻出,
又恐暑气内侵,心经为热所伤,故仿益元散之义加朱砂(天水散加朱砂名益元散)以凉心血,即以镇安神明,
使不至怔忡瞀乱也。
人受暑热未必即病,亦恒如冬令伏气伏于膜原,至秋深感凉气激薄而陡然暴发,腹疼作泻。其泻也,暴
注下迫,恒一点钟泻十余次。亦有吐泻交作者。其甚者,或两腿转筋。然身不凉,脉不闭,心中惟觉热甚,
急欲饮凉食冰者,此仍系暑热为病,实与霍乱不同。丁卯季夏,暑热异常,中秋节后发现此等证甚多,重
用生石膏煎汤送服益元散,其病即愈。腹中疼甚者,可用白芍、甘草(益元散中甘草甚少故加之)与石膏同煎
汤,送服益元散。若泻甚者,可用生山药、甘草与石膏同煎汤,送服益元散;或用拙拟滋阴清燥汤加生石膏两
余或二两,同煎服,病亦可愈。其欲食冰者,可即与之以冰,欲饮井泉凉水者,可即与之以井泉水,听其尽量
食之饮之无碍也。且凡吐不止者,若欲食冰,听其尽量食之,其吐即可止,腹疼下泻亦可并愈。其间有不并愈
者,而其吐既止,亦易用药为之调治也。
目疾中有实热证型,如果这种热症多次服用寒凉药物仍不能解除,且眼病也因此长久不愈,大抵都是因为伏气(潜藏体内的邪气)化热后,将热邪转移到了眼睛。丙寅年暮春三月,李××,是纺纱厂的学徒,患眼病很久没有痊愈。眼睑红肿,胬肉(增生组织)遮蔽瞳孔,感觉眼球胀痛非常剧烈,又兼有耳聋、鼻塞,视听功能全部丧失,走路都需要人搀扶。他的脉象洪大、长而非常有力,左右手都一样。他心中觉得非常发热,舌苔白,中间部分已经变黄,他以前大便原本干燥,因为多次服用西药,现在每天排便一次。我知道这是冬天潜伏了寒邪,感受了春天的阳气而化为热邪,热邪向上攻冲,眼睛和耳鼻都受到了冲击。我打算用大剂量的白虎汤(清热生津方剂)来清除阳明经的热邪,再加白芍、龙胆草同时清少阳经的热邪。病人说厂里原来有西医,不让服用外人的药,现在因为多次服用他们的药没好,偷偷来求先生诊治,或者服用丸药散剂还可以,绝对不能在厂里煎服汤药。我说:“这很容易。我有自己制作的治眼特效药,送你一包,服下后眼睛可以立刻痊愈。”于是就把预先轧好的生石膏细末一两半给他,嘱咐他分六次服用,每天三次,用开水送服,服完后宜多喝开水,让微微出汗才好。拿着药离开后,过了三天又回来,眼疾已经好了十之八九,耳聋鼻塞也都好了,心中已不觉发热,脉象已经平和。又给了他生石膏细末一两,让他仍然分六次服用。把药吃完后完全痊愈。之所以给他生石膏细末而不明说是治眼的药,是怕他知道后就不敢服用。后来多次遇到因伏气化热导致眼病的患者,用这个方子治疗都有效。
河间天水散(即六一散),是清除暑热的妙药。究其本质,在南方使用最为适宜;如果在北方使用,原本应该稍微变通一下。因为南方的暑气多夹杂湿气,所以宜重用滑石,通过利湿来泻热。如果在北方,患暑病的人大多不夹杂湿气,或者更夹杂燥气,如果也重用滑石来利湿,将会导致湿气去除而燥气更加严重,暑热反而不容易消除。我因此拟定了一个方子,用滑石四两,生石膏四两,粉甘草二两,朱砂一两,薄荷冰一钱,共研为细末,每次服用二钱,命名为加味天水散。用它治疗北方的暑病固然有效,治疗南方的暑病,也没有无效的。方中的意义:用滑石、生石膏来解除暑病的热邪;而生石膏解热的同时又能透达肌表,有薄荷冰来辅助它,热可以从肌肤散发出去;滑石解热的同时又能利水,有甘草来调和它(生甘草研末服用最善于利水,而且利水而不伤阴液),热可以从小便排出。又担心暑气内侵,心经被热邪所伤,所以仿照益元散(天水散加朱砂)的意义加入朱砂,以凉心血,进而镇安神明,使不至于出现心悸、神志昏乱等症状。
人受到暑热未必立即生病,也常常像冬天的伏气潜伏在膜原(半表半里的部位),到了秋天深受凉气激惹逼迫而突然爆发,腹痛腹泻。这种腹泻,表现为急骤的喷射状腹泻,通常一小时腹泻十几次。也有呕吐和腹泻交替发作的。严重的,甚至双腿抽筋。然而身体不凉,脉象不闭阻,心中只觉得非常热,急切想要喝凉水吃冰块,这仍然是暑热致病,实际上与霍乱不同。丁卯年夏末,暑热异常,中秋节后发现这类病症很多,重用生石膏煎汤送服益元散,病就好了。腹中疼痛严重的,可以用白芍、甘草(益元散中甘草很少所以加上)与石膏同煎汤,送服益元散。如果腹泻严重的,可以用生山药、甘草与石膏同煎汤,送服益元散;或者用我拟定的滋阴清燥汤加生石膏一两多或二两,同煎服用,病也可以好。那些想吃冰块的,可以直接给他们冰块,想喝井泉凉水的,可以直接给井泉水,听任他们尽量吃喝无妨。而且凡是呕吐不止的,如果想吃冰块,听任他们尽量吃,呕吐就可以停止,腹痛腹泻也可以一并痊愈。其中有不一起痊愈的,但既然呕吐停止了,也容易用药进行调理。
Ocular diseases may present with excess heat syndromes. If the heat persists despite repeated administration of cooling medicines, and the ocular disease remains chronic and unhealed, it is generally due to latent pathogenic factors (Fu Qi, hidden pathogens) transforming into heat and transferring this heat to the eyes. In the late spring of the Bingyin year, Li XX, an apprentice at a spinning mill, suffered from an eye condition that had not healed for a long time. The eyelids were red and swollen, pterygium (fleshy growth) obscured the pupil, and he felt severe distending pain in the eyeballs. Additionally, he experienced deafness and nasal congestion, resulting in the loss of vision and hearing, requiring assistance to walk. His pulse was surging, long, and very forceful on both sides. He felt intense heat in his heart/chest region. The tongue coating was white, but yellow in the center. Previously, his stools were dry; however, due to frequent use of Western medicine, he now defecated once daily. I determined this was caused by winter latent cold transforming into heat upon exposure to spring yang energy. This heat attacked upward, affecting the eyes, ears, and nose. I prescribed a large dose of Baihu Tang (White Tiger Decoction) to clear heat from the Yangming channel, adding Baishao (Radix Paeoniae Alba) and Longdancao (Herba Gentianae) to simultaneously clear heat from the Shaoyang channel. The patient stated that there was a Western doctor in the factory who prohibited taking medicine from outsiders. Since previous treatments failed, he secretly sought my treatment. He suggested that pills or powders would be acceptable, but decoctions could not be prepared in the factory. I said, "This is easy. I have a self-made miraculous eye remedy. I will give you one packet; your eyes will heal immediately after ingestion." Thus, I gave him 1.5 liang of finely ground raw Shigypsum (Gypsum Fibrosum), instructing him to divide it into six doses, taken three times daily with warm water. He should drink plenty of warm water afterward until a slight sweat appears. Three days later, he returned. The eye disease had improved by eighty to ninety percent, deafness and nasal congestion had resolved, the feeling of heat in the chest had subsided, and his pulse had normalized. I gave him another 1 liang of finely ground raw Shigypsum to be taken in six doses. After finishing the medication, he was completely cured. I did not explicitly state that the raw Shigypsum powder was for treating the eyes, fearing he might refuse to take it if he knew. Later, I frequently encountered patients with eye diseases caused by latent heat transforming from latent pathogens, and this prescription proved effective in all cases.
Hejian Tiansan San (i.e., Liuyi San / Six-to-One Powder) is an excellent remedy for clearing summerheat. However, its application varies by region: it is most suitable for the South. In the North, modifications are necessary. Southern summerheat often combines with dampness, so heavy use of Huashi (Talcum) is appropriate to drain dampness and thereby purge heat. In the North, summerheat illness rarely involves dampness, or may even involve dryness. Using heavy Huashi to drain dampness in such cases would remove moisture while exacerbating dryness, making the summerheat difficult to dissipate. Therefore, I formulated a modified prescription: Huashi (Talcum) 4 liang, raw Shigypsum (Gypsum Fibrosum) 4 liang, Fen Gancao (Radix Glycyrrhizae Preparata) 2 liang, Zhusha (Cinnabar) 1 liang, and Bohebing (Menthol) 1 qian. These are ground into a fine powder. Each dose is 2 qian, named Jiawei Tiansan San (Modified Tiansan San). It is effective for northern summerheat and equally effective for southern summerheat. The rationale of the formula: Huashi and Shigypsum resolve summerheat heat; Shigypsum clears heat and penetrates the exterior, assisted by Menthol, allowing heat to disperse through the skin. Huashi clears heat and promotes diuresis, harmonized by Gancao (Raw Radix Glycyrrhizae is best used as powder for diuresis without damaging Yin fluids), allowing heat to exit via urination. To prevent summerheat qi from invading internally and injuring the Heart channel with heat, I added Zhusha (Cinnabar), following the principle of Yi Yuan San (Tiansan San plus Cinnabar), to cool Heart blood and calm the Spirit, preventing palpitations and mental confusion.
Exposure to summerheat does not necessarily cause immediate illness. Often, like winter latent pathogens, it hides in the Membrane Source (Moyuan). In autumn, severe cold stimuli trigger a sudden outbreak, causing abdominal pain and diarrhea. This diarrhea is acute and urgent, occurring more than ten times per hour. Vomiting and diarrhea may also alternate. In severe cases, leg cramps may occur. However, the body is not cold, the pulse is not obstructed, and the patient feels intense internal heat, urgently desiring cold drinks and ice. This is still summerheat pathology, distinct from Cholera (Huoluan). In the late summer of the Dingmao year, summerheat was abnormal. Many such cases appeared after the Mid-Autumn Festival. Heavy doses of raw Shigypsum decoction administered with Yi Yuan San cured the illness. For severe abdominal pain, add Baishao (Radix Paeoniae Alba) and Gancao (since Yi Yuan San contains little Gancao) to the Shigypsum decoction, then administer Yi Yuan San. For severe diarrhea, add Shanyao (Rhizoma Dioscoreae Hypoglaucae) and Gancao to the Shigypsum decoction, then administer Yi Yuan San; or use my Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction) with over 1 liang or 2 liang of raw Shigypsum, decocted together. Those craving ice can be given ice directly; those craving well water can be given well water. Allow them to consume as much as they wish without hindrance. Furthermore, if vomiting persists, allowing the patient to eat ice as desired will stop the vomiting, and abdominal pain and diarrhea will also resolve. Even if other symptoms do not resolve simultaneously, once vomiting stops, the condition becomes easier to manage with medication.