中山王知府次子薛里。年十三岁。六月十三日豪雨方过。池水泛溢。因而戏水。衣服尽湿。其
母责之。至晚觉精神昏愦。怠惰嗜卧。次日。病头痛身热。腿脚沉重。一女医用和解散发之。闭户
塞牖。覆以重衾。以致苦热不胜禁。遂发狂言。欲去其衾。明日。寻衣撮空。又以承气汤下之。下
后语言渐不出。四肢不能收持。有时项强。手足螈 。搐急而挛。目左视而白睛多。口唇肌肉蠕动
。饮食减少。形体羸瘦。命予治之。具说前由。予详之。盖伤湿而失于过汗也。且人之元气。起于
脐下肾间。动气周于身。通行百脉。今盛暑之时。大发其汗。汗多则亡阳。百脉行涩。故三焦之气
。不能上荣心肺。心火旺而肺气焦。况因惊恐内蓄。内经曰。恐则气下。阳主声。阳既亡而声不出
也。阳气者精则养神。柔则养筋。又曰。夺血无汗。夺汗无血。今发汗过多。气血俱衰。筋无所养
。其病为痉。则项强手足螈 。搐急而挛。目通于肝。肝者筋、之合也。筋既燥而无润。故目左视
而白睛多。肌肉者、脾也。脾热则肌肉蠕动。故口唇蠕动。有时而作。经云。肉痿者、得之湿地也
。脾热者、肌肉不仁。发为肉痿、痿者、痿弱无力。运动久而不仁。阳主于动。今气欲竭。热留于
脾。故四肢不用。此伤湿过汗而成坏证明矣。当治时之热。益水之原救其逆。补上升生发之气。黄
帝针经曰。上气不足。推而扬之。此之谓也。以人参益气汤治之。内经曰。热淫所胜。治以甘寒。
以酸收之。人参、黄 之甘温。补其不足之气而缓其急搐。故以为君。肾恶燥。急食辛以润之。生
甘草甘微寒。黄柏苦辛寒以救肾水而生津液。故以为臣。当
归辛温和血脉。橘皮苦辛。白术苦甘。炙甘草甘温。益脾胃。进饮食。肺欲收。急食酸以收之。白
芍药之酸微寒。以收耗散之气。而补肺金。故以为佐。升麻、柴胡苦平。上升生发不足之气。故以
为使。乃从阴引阳之谓也。
【人参益气汤】
黄 （五分） 人参 黄柏（去皮） 升麻
柴胡 白芍药（各三分） 当归 白术
炙甘草（各二分） 陈皮（三分） 生甘草（二分）
上十一味 咀。都为一服。水二盏半。先浸两时辰。煎至一盏。去渣热服。早食后。午饭前
。各一服。投之三日后。语声渐出。少能行步。四肢柔和。食饮渐进。至秋而愈。
中山王知府（地方行政长官）的次子薛里，十三岁。六月十三日大雨刚停，池水泛滥，他因此在水中嬉戏，衣服全部湿透。他的母亲责备了他。到了晚上，他觉得精神昏沉困倦，懈怠懒惰想睡觉。第二天，出现头痛、身体发热、腿脚沉重的症状。一位女医生用和解散（调和表里的方剂）给他发汗治疗，让他关紧门窗，盖上厚重的被子，导致他因苦热难耐而极度烦躁，于是开始胡言乱语，想要掀掉被子。第二天，他出现“寻衣撮空”（意识模糊，手在空中摸索抓物）的症状。医生又用承气汤（攻下实热的方剂）给他泻下。泻下之后，他逐渐无法说话，四肢不能自主收持控制，有时颈部僵硬，手足抽搐拘挛，眼睛向左看且眼白多露，口唇肌肉蠕动，饮食减少，形体消瘦。
他请我诊治，详细讲述了之前的经过。我仔细分析病情，认为这是感受湿气后，错误地使用了过度发汗的治疗方法。人的元气，起源于脐下肾间动气，周流全身，通行百脉。如今正值盛暑之时，大发其汗，汗出过多则导致亡阳（阳气耗脱），百脉运行涩滞，所以三焦之气不能上荣养心肺，导致心火亢盛而肺气焦枯。况且因为惊恐情绪内郁，《内经》说：“恐则气下”。阳气主发声，阳气既已亡失，声音自然无法发出。《内经》又说：“阳气者，精则养神，柔则养筋。”还曰：“夺血者无汗，夺汗者无血。”如今发汗过多，气血俱衰，筋脉失去滋养，这种病称为痉病，表现为项强、手足抽搐拘挛。目通于肝，肝主筋，筋既然干燥缺乏滋润，所以眼睛左视而白睛多露。肌肉属于脾，脾有热则肌肉蠕动，所以口唇有时蠕动。经云：“肉痿者，得之湿地也。”脾热则肌肉麻木不仁，发展为肉痿，痿是指痿弱无力，运动久了感觉迟钝。阳气主司运动，如今气欲枯竭，热邪留滞于脾，所以四肢不能运用。这显然是伤湿后过汗导致的坏证（变证）。
治疗时应当清解当时的热邪，滋补肾水之源以挽救逆乱，补益上升生发之气。《黄帝针经》说：“上气不足，推而扬之”，说的就是这种情况。用人参益气汤来治疗。《内经》说：“热淫所胜，治以甘寒，以酸收之。”人参、黄芪的甘温之性，补益不足之气并缓解紧急抽搐，所以作为君药。肾恶燥，急食辛以润之。生甘草甘微寒，黄柏苦辛寒，用以救肾水而生津液，所以作为臣药。当归辛温，和血脉；橘皮苦辛，白术苦甘，炙甘草甘温，用以益脾胃，增进饮食。肺欲收，急食酸以收之。白芍药酸微寒，用以收敛耗散之气，补益肺金，所以作为佐药。升麻、柴胡苦平，用以提升生发不足之气，所以作为使药。这就是所谓的“从阴引阳”。
【人参益气汤】
黄芪（五分） 人参 黄柏（去皮） 升麻
柴胡 白芍药（各三分） 当归 白术
炙甘草（各二分） 陈皮（三分） 生甘草（二分）
以上十一味药，捣碎成粗末。作为一服剂量，用水二盏半，先浸泡两个时辰（四小时），煎煮至一盏，去渣，趁热服用。早饭后、午饭前，各服一次。服药三天后，声音逐渐恢复，能稍微行走，四肢柔和，饮食逐渐增加，到秋天痊愈。
The second son of Xue Li, Vice Prefect of Zhongshan, was thirteen years old. On June 13th, after a heavy rainstorm, the pond water overflowed. He played in the water, getting his clothes completely wet. His mother reprimanded him. By evening, he felt mentally confused and lethargic, desiring to lie down. The next day, he developed headache, feverish body sensation, and heaviness in the legs and feet. A female physician administered Jiehe San (Harmonizing Decoction) to induce sweating. She had him close the doors and windows and cover him with heavy quilts. This resulted in unbearable heat and distress, leading to delirious speech and attempts to remove the quilts. The following day, he exhibited "seeking clothes and grasping at empty air" (a sign of severe mental confusion). Another physician then administered Chengqi Tang (Bowel-Draining Decoction) to purge the bowels. After purging, he gradually lost his voice, could not control his limbs, occasionally experienced neck stiffness, and suffered from spasms and contractures of the hands and feet. His eyes deviated to the left with excessive sclera showing, his lips and facial muscles twitched, food intake decreased, and his physique became emaciated.
He requested my treatment and recounted the previous history. Upon detailed examination, I determined this was an injury from dampness compounded by improper excessive sweating. Human Yuan Qi (Original Qi) originates from the Qi movement between the kidneys below the navel, circulates throughout the body, and flows through all vessels. At this time of peak summer heat, inducing excessive sweating caused Wang Yang (Loss of Yang Qi), leading to sluggish circulation in the vessels. Consequently, the Qi of the Sanjiao (Triple Burner) could not ascend to nourish the Heart and Lungs, resulting in hyperactive Heart Fire and scorched Lung Qi. Furthermore, due to internal accumulation of fright and fear, as stated in the *Neijing* (Inner Canon): "Fear causes Qi to sink." Yang Qi governs voice; since Yang Qi is lost, the voice cannot emerge. The *Neijing* also states: "Yang Qi, when refined, nourishes the Shen (Spirit); when soft, it nourishes the Jin (Tendons)." It further says: "Those who lose blood should not sweat; those who lose sweat should not lose blood." Now, excessive sweating has depleted both Qi and Blood. Without nourishment, the tendons develop Jing Disease (Spasm Disease), characterized by neck stiffness and limb spasms. The eyes connect to the Liver, which governs the tendons. Since the tendons are dry and lack moisture, the eyes deviate to the left with excessive sclera. Muscles belong to the Spleen; Spleen Heat causes muscle twitching, hence the lip movements. The classics state: "Flesh Wei (Flaccidity) arises from damp places." Spleen Heat causes muscle numbness, developing into Rou Wei (Muscle Flaccidity), where weakness and prolonged immobility lead to insensitivity. Yang Qi governs movement; now Qi is exhausted, and Heat lingers in the Spleen, rendering the limbs useless. This clearly indicates a Huai Zheng (Complication/Failed Syndrome) resulting from dampness injury and excessive sweating.
Treatment should focus on clearing the current Heat, replenishing the source of Kidney Water to rescue the reversal, and tonifying the ascending and generating Qi. The *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture) states: "When Upper Qi is insufficient, push and elevate it." This applies here. I treated him with Renshen Yiqi Tang (Ginseng Qi-Tonifying Decoction). The *Neijing* states: "For excessive Heat, treat with Sweet-Cold herbs and use Sour herbs to astringe." Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root) have Sweet-Warm properties that tonify deficient Qi and relieve urgent spasms, serving as the Jun (Monarch) herb. The Kidney dislikes dryness; urgently eat Pungent herbs to moisten it. Sheng Gan Cao (Raw Licorice Root) is Sweet-Slightly Cold, and Huang Bo (Phellodendron Bark) is Bitter-Pungent-Cold, used to rescue Kidney Water and generate fluids, serving as the Chen (Minister) herbs. Dang Gui (Angelica Sinensis Root) is Pungent-Warm to harmonize the vessels; Ju Pi (Citrus Peel) is Bitter-Pungent, Bai Zhu (Atractylodes Rhizome) is Bitter-Sweet, and Zhi Gan Cao (Honey-Fried Licorice Root) is Sweet-Warm, used to benefit the Spleen and Stomach and promote appetite. The Lung desires astringency; urgently eat Sour herbs to collect it. Bai Shao Yao (White Peony Root) is Sour-Slightly Cold, used to astringe dissipating Qi and tonify Lung Metal, serving as the Zuo (Assistant) herb. Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root) are Bitter-Ping, used to ascend and generate insufficient Qi, serving as the Shi (Envoy) herb. This is what is meant by "drawing Yang from Yin."
[Ginseng Qi-Tonifying Decoction]
Huang Qi (5 fen) | Ren Shen | Huang Bo (peeled) | Sheng Ma
Chai Hu | Bai Shao Yao (each 3 fen) | Dang Gui | Bai Zhu
Zhi Gan Cao (each 2 fen) | Chen Pi (3 fen) | Sheng Gan Cao (2 fen)
These eleven ingredients are coarsely crushed. One dose is prepared with 2.5 cups of water, soaked for two shichen (4 hours), then decocted until 1 cup remains. Strain and take hot. One dose after morning meal, one dose before noon meal. After three days of administration, his voice gradually returned, he could walk slightly, limbs became supple, and food intake increased. He recovered by autumn.