夏月伤寒是为热病,发热头痛,肢体重痛,恶寒恶热,其脉洪盛。用药不可太温,
如桂枝麻黄青龙,其性
颇热,须加芩连凉剂,不然则有黄斑之变也,惟九味羌活汤最当。凡热病,脉三日后仍
数,邪充在经,宜用桂枝石膏汤。或值淫雨,或病患有湿,苍术白虎汤。夏至后谓之脱
发,栀子升麻汤。
发于春三月及夏至以前是也。发热咳嗽,头痛身痛口渴,脉来浮数,温病当分治。
【解肌】热甚者,升麻葛根汤、解肌汤。
【和】不渴者,小柴胡汤加桂。咳者,小柴胡加五味子。渴者,去半夏加栝蒌根人参。
虚烦者,竹叶石膏汤。
【下】发渴烦躁大便秘,大柴胡汤利之。
重感于寒,变为温疟。脉尺寸俱盛,兼弦而数。
【和解】先热后寒,小柴胡汤,或白虎加桂汤。
【清热】但热不寒,止用白虎汤。
阴脉实大,阳脉洪数,发热发斑隐疹,咳兼心闷。
【清热】玄参升麻汤。
【凉血】黑膏。
【发汗】败毒散、独活汤,许氏用续命汤减麻黄附子。
【解肌】柴胡桂枝汤、白术汤。
【清热】汗后发热,无下证,知母石膏汤。
【疏风】头目昏眩,四肢烦痛,荆芥散、金匮引风汤。
湿温
其人伤湿,因而中暑,名曰湿温。发热头疼,胸间多汗,两胫冷,妄言,脉阳濡而
弱,阴小而急,病类伤寒。不可发汗,汗出必不能言,耳聋,不知痛在,身青面色变,名
曰重 ,必死。
【清暑热】东垣清暑益气汤、白虎加苍术汤。
【分利】五苓散。
【温】冷香饮子、茯苓白术汤。
【降痰】消暑丸、橘皮汤。
夏季感受寒邪所致的疾病称为热病,症状包括发热、头痛、肢体沉重疼痛、既怕冷又怕热,脉象洪大旺盛。用药不宜过于温热,如桂枝汤、麻黄汤、青龙汤,这些方剂药性颇热,必须加入黄芩、黄连等凉性药物,否则会出现皮肤发黄发斑的变证,只有九味羌活汤最为适宜。凡是热病,如果脉象在三天后仍然快速,说明邪气充斥在经络中,适宜使用桂枝石膏汤。如果遇到连绵阴雨,或者患者体内有湿气,则用苍术白虎汤。夏至之后出现的特定热病称为“脱发”(注:此处原文可能为脱阳或特定称谓,依原文直译),用栀子升麻汤治疗。
这种病发生在春季三个月以及夏至之前。症状表现为发热、咳嗽、头痛、身体疼痛、口渴,脉象浮而数,温病应当分别施治。
【解肌】热势严重的,用升麻葛根汤、解肌汤。
【和解】不口渴的,用小柴胡汤加桂枝。咳嗽的,用小柴胡汤加五味子。口渴的,去掉半夏,加入栝蒌根和人参。虚烦不安的,用竹叶石膏汤。
【攻下】出现口渴、烦躁、大便秘结的,用大柴胡汤通利大便。
再次感受寒邪,转变为温疟。寸脉和尺脉都盛大,兼见弦而数的脉象。
【和解】先发热后发冷的,用小柴胡汤,或者白虎加桂枝汤。
【清热】只发热不发冷的,只用白虎汤。
阴脉实大,阳脉洪大且数,出现发热、皮肤隐现斑疹,咳嗽伴随心胸闷痛。
【清热】用玄参升麻汤。
【凉血】用黑膏。
【发汗】用败毒散、独活汤,许叔微曾用续命汤减去麻黄和附子。
【解肌】用柴胡桂枝汤、白术汤。
【清热】发汗后仍发热,没有可攻下的证候,用知母石膏汤。
【疏风】头目昏眩,四肢烦扰疼痛,用荆芥散、金匮引风汤。
湿温
人体损伤于湿气,因而又中暑热,名叫湿温。症状为发热、头痛,胸部出汗多,两小腿发冷,胡言乱语,脉象阳部濡软而弱,阴部细小而急,病症类似伤寒。不可发汗,如果发汗必然导致不能说话、耳聋、不知疼痛所在、身体青紫、面色改变,名叫重暍(zhòng yē),必定死亡。
【清暑热】用东垣清暑益气汤、白虎加苍术汤。
【分利】用五苓散。
【温中】用冷香饮子、茯苓白术汤。
【降痰】用消暑丸、橘皮汤。
Heat disease caused by cold pathogen in summer is characterized by fever, headache, heavy and painful limbs, aversion to both cold and heat, and a surging and vigorous pulse. Medications should not be too warming; formulas such as Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), and Qinglong Tang (Azure Dragon Decoction) have rather hot properties. One must add cooling agents like Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma); otherwise, there will be changes manifesting as yellow spots on the skin. Only Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) is most appropriate. For all heat diseases, if the pulse remains rapid after three days, it indicates that the pathogenic factor fills the meridians, and Guizhi Shigao Tang (Cinnamon Twig and Gypsum Decoction) should be used. If there is continuous rain or the patient has dampness, Cangzhu Baizhu Tang (Atractylodes Macrocephala and White Tiger Decoction) is indicated. After the Summer Solstice, a condition referred to as "Tuofa" (Hair Loss/Depletion) occurs, treated with Zhizi Shengma Tang (Gardenia and Cimicifugae Decoction).
This occurs during the three months of spring and before the Summer Solstice. Symptoms include fever, cough, headache, body pain, thirst, and a floating and rapid pulse. Warm diseases should be treated differently based on presentation.
[Relaxing the Muscle Layer] For severe heat, Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) or Jiiji Tang (Muscle-Releasing Decoction) is used.
[Harmonizing] For those without thirst, Xiaochaihu Tang (Minor Bupleurum Decoction) with added Guizhi (Cinnamon Twig) is used. For cough, Xiaochaihu Tang with added Wuweizi (Schisandrae Fructus) is used. For thirst, Banxia (Pinelliae Rhizoma) is removed, and Gualougen (Trichosanthis Radix) and Renshen (Ginseng Radix) are added. For deficiency irritability, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used.
[Purgation] For cases with thirst, irritability, and constipation, Daxiehu Tang (Major Bupleurum Decoction) is used to promote bowel movement.
Secondary exposure to cold transforms into Wen Nue (Warm Malaria). The pulses at both Cun (Inch) and Chi (Cubit) positions are full and large, accompanied by wiry and rapid qualities.
[Harmonizing] For alternating fever and chills (fever first, then chills), Xiaochaihu Tang or Baihu Jia Gui Tang (White Tiger Decoction with Added Cinnamon Twig) is used.
[Clearing Heat] For fever without chills, only Baihu Tang (White Tiger Decoction) is used.
Yin pulse is solid and large; Yang pulse is surging and rapid. Symptoms include fever, hidden macules and rashes on the skin, cough, and chest oppression.
[Clearing Heat] Xuanshen Shengma Tang (Scrophulariae and Cimicifugae Decoction) is used.
[Cooling Blood] Hei Gao (Black Plaster) is used.
[Sweating] Baidu San (Hundred-Rescue Powder) or Duhuo Tang (Angelica Pubescens Decoction) are used. Xu Shuwei (Xu Shuwei, a physician) once used Xuming Tang (Continuing Life Decoction) minus Mahuang (Ephedrae Herba) and Fuzi (Aconiti Lateralis Radix Praeparata).
[Relaxing the Muscle Layer] Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) or Baizhu Tang (Atractylodes Macrocephala Decoction) are used.
[Clearing Heat] For fever persisting after sweating, without signs requiring purgation, Zhimu Shigao Tang (Anemarrhenae and Gypsum Decoction) is used.
[Dispersing Wind] For dizziness of head and eyes, and vexatious pain in the four limbs, Jingjie San (Schizonepeta Powder) or Jingui Yinfeng Tang (Golden Cabinet Wind-Dispelling Decoction) are used.
Damp-Warmth
When the body is injured by dampness and subsequently suffers from summerheat, it is called Shiwen (Damp-Warmth). Symptoms include fever, headache, excessive sweating in the chest, coldness in the lower legs, delirium, a weak and soggy Yang pulse, and a small and urgent Yin pulse. The disease resembles Shanghan (Cold Damage). Sweating must not be induced; if sweating occurs, the patient will inevitably lose speech ability, suffer deafness, fail to perceive pain, develop cyanosis of the body, and change facial color. This is called Zhong Ye (Severe Heat Stroke), which is fatal.
[Clearing Summerheat] Dongyuan Qingshu Yiqi Tang (Dongyuan's Summerheat-Clearing and Qi-Nourishing Decoction) or Baizhu Cangzhu Tang (White Tiger Decoction with Added Atractylodes) are used.
[Separating and Draining] Wuling San (Five-Ingredient Powder for Alleviating Urinary Difficulties) is used.
[Warming] Lengxiang Yinzi (Cold-Fragrance Drink Formula) or Fuling Baizhu Tang (Poria and Atractylodes Macrocephala Decoction) are used.
[Descending Phlegm] Xiaoshu Wan (Summerheat-Relieving Pill) or Jupi Tang (Tangerine Peel Decoction) are used.