(改侄桂生稿)
凡人之病,有同类相应者,有似是实非者。今举温病与湿温而言,温即热之渐,湿乃阴之类。由温化热,
治之者自当以水制火。而湿生于脾,脾为阴土,温而夹湿,固明明湿而热,不若湿而寒者矣。然投以甘
寒,甘即动湿。是必明乎温乃阳气发泄而成,一起即热,或表里有所缚,亦不过初起时凛凛微寒,一二
日后便觉但热,表里一辙者是也。其烦也如天暑之极,而不可忍。其渴也,如天暑之极,饮凉辄尽。其神
昏也,神乱语错,或至狂越。其溲也赤而短,其便也结而硬其溏也迫而泄,其舌也绛而刺,其燥也焦而
裂,其舌黑也干而枯,其脉也洪而大。迥不若湿病于多日之后,依然凛寒湿之郁遏,里热而表不甚热。
其烦也,闷甚而非热甚,热则伤津,亦必索饮,而中究多湿,每饮不过沾唇,湿性善凝,特喜热饮以开凝
结。其神昏也梦寐迷沉,其溲也赤而浊,其便也泄而不注,其秘也结而不燥,间亦有燥者,脾湿不能鼓
舞运旋。其舌绛也只在边尖,其燥也质多润,其枯黑也底质多有白苔。或无底苔,舌必淡萎,甚至干枯
如镜。其脉也数而细,或滑而混。盖温病自有灼烁伤阴,燎原莫扑之见端。夹湿自有郁阻气机,弥漫熏
蒸之的据。执此而分温病湿温之名目,随证立法,虽曰未中,亦不远矣。
(改侄桂生手稿)
大凡人的疾病,有同类相互感应的,也有看似相似实则不同的。现在以温病和湿温为例来说明:温是热的渐进表现,湿属于阴的范畴。由温转化为热,治疗者自然应当用水来制约火邪。而湿气产生于脾,脾属阴土,温病夹带湿气,固然是明显的湿与热并存,但不如湿与寒并存的情况那样明显不同。然而如果投用甘寒药物,甘味反而会助长湿气。因此必须明白,温病是由于阳气发泄而形成的,一经发病即表现为热;或者因为表里气机有所束缚,也不过是在初起时感到轻微怕冷,一两天后便只觉得发热,表里症状一致的情况。其烦躁如同酷暑至极,难以忍受;其口渴如同酷暑至极,喝凉水能一饮而尽;其神志昏乱,言语错乱,甚至狂躁失常;其小便赤短,大便干结坚硬或急迫泄泻;舌质红绛且有刺状突起,干燥焦裂,舌黑干枯;脉象洪大。这与湿病在数日之后,依然感到寒冷、湿气郁遏阻滞,体内热而体表不太热的情况截然不同。湿病的烦躁是闷重而非热盛,热虽伤津液,也必然想喝水,但中焦多有湿气,每次饮水不过沾唇润喉即可,因为湿性善于凝滞,特别喜欢热饮来化解凝结。湿病的神志昏沉表现为梦境迷乱、意识深沉;小便赤浊,大便泄泻而不呈喷射状,便秘则干结但不燥烈,间或有干燥的情况,是因为脾湿不能鼓舞运化旋转所致。湿病舌质红绛仅见于边缘和尖端,舌面湿润度多,枯黑之处底部多有白苔;或者没有底苔,舌色淡萎,甚至干枯如镜面。脉象细数,或滑而浑浊。大概温病自有灼烧耗伤阴液、火势燎原无法扑灭的征象;夹湿的病证自有郁阻气机、弥漫熏蒸的确切依据。执守这些标准来区分温病和湿温的名称,随证立法,即使说不上完全准确,也相去不远了。
(Manuscript revised by nephew Guisheng)
Generally, human diseases include those that respond to similar categories and those that appear similar but are fundamentally different. Taking warm disease (Wen Bing, febrile disease caused by warm pathogenic factors) and damp-warm disease (Shi Wen, febrile disease complicated with dampness) as examples: Warmth is the gradual onset of heat, while dampness belongs to the category of Yin. As warmth transforms into heat, the practitioner should naturally employ water-natured methods to control fire. Dampness arises from the Spleen, which is a Yin Earth organ. In warm disease complicated with dampness, it is clearly a combination of dampness and heat, which differs distinctly from the combination of dampness and cold. However, administering sweet-cold herbs may promote dampness due to the sweet flavor's property. Therefore, one must understand that warm disease results from the discharge of Yang Qi; once it occurs, heat manifests immediately. Even if there is some constraint on the exterior or interior, it merely presents as slight chills at the initial stage, followed by feeling only heat after one or two days, where exterior and interior symptoms are consistent. The irritability is unbearable, like extreme summer heat. Thirst is intense, like extreme summer heat, where cool drinks are consumed in large quantities. Mental confusion involves disordered speech or even mania. Urine is red and scanty; stool is dry, hard, or urgently loose. The tongue is crimson with prickles, dry, cracked, black, and withered. The pulse is surging and large. This is completely different from damp disease, where after several days, there remains a sensation of cold and damp oppression, with internal heat but not significant external heat. The irritability in damp disease is stifling rather than intensely hot; although heat damages fluids and induces thirst, the presence of dampness in the middle jiao means patients often only moisten their lips when drinking, preferring hot drinks to resolve stagnation because dampness tends to congeal. Mental confusion in damp disease manifests as dream-disturbed lethargy. Urine is red and turbid; stool is loose without forceful expulsion, or constipated but not dry; occasionally dryness occurs due to the Spleen's dampness failing to promote transformation and rotation. Crimson tongue color in damp disease is limited to the edges and tip; the tongue body is mostly moist; areas of withered blackness often have white coating underneath; or if no coating exists, the tongue is pale and flaccid, even dry and mirror-like. The pulse is rapid and fine, or slippery and muddy. Warm disease inherently shows signs of burning and damaging Yin, resembling an uncontrollable prairie fire. Complicated dampness inherently shows evidence of obstructing Qi mechanism and pervasive steaming. By adhering to these distinctions to differentiate between warm disease and damp-warm disease, and formulating treatments according to symptoms, even if not perfectly accurate, it will be close to the truth.