风湿之病,其证头痛、发热,微汗、恶风,骨节烦疼,体重微肿,小便欠利,脉来浮缓是也。罗谦甫云∶
春夏之交,人病如伤寒,为风湿证也,宜用五苓散自愈。由是观之,风湿之邪,多伤于太阳者,不待言矣!
宜用两解太阳法疏其膀胱之经,复利其膀胱之腑也。如风胜者,多用羌、防;湿胜者,多加苓、泽;阴
虚之体,脉中兼数,宜加黄柏、车前;阳虚之体,脉内兼迟,宜入戟天、附片。医者总宜分其风胜湿胜,
辨其阴虚阳虚,庶无贻误。
喻嘉言曰∶风湿之中人也,风则上先受之,湿则下先受之,俱从太阳膀胱而入。风伤其卫,湿留关节,
风邪从阳而亲上,湿邪从阴而亲下,风邪无形而居外,湿邪有形而居内,上下内外之间,邪相搏击,故显
汗出、恶风、短气、发热、头痛、骨节烦疼、身重微肿等证,此固宜从汗解。第汗法与常法不同,贵
徐不贵骤,骤则风去湿存,徐则风湿俱去也。
丰按∶论风湿,惟嘉言先生为白眉,明出上下表里,可谓
批却导窍矣,更妙论汗之法,贵徐不贵骤,此五字诚为治风湿之金针,学人不可以其近而忽之也。
叔和《序例》曰∶从春分以后,至秋分节前,天气暴寒者,皆为时行寒疫也。考之《金鉴》,又谓∶春
应温而反寒,名曰寒疫。据此而论,春有是病,而夏秋无是病也,其实夏令之寒,是为阴暑之病,秋月之寒,
是为秋凉燥气,此分明夏秋不病寒疫,当宗《金鉴》之训,寒疫在乎春令也。盖疫者役也,若役使
然,大概众人之病相似者,皆可以疫名之。此又与瘟疫之疫,相悬霄壤,须知瘟疫乃天地之厉气,寒疫乃
反常之变气也。其初起头痛、身疼,寒热无汗,或作呕逆,人迎之脉浮紧者,宜用辛温解表法治之。观此
见证,与冬令伤寒初客太阳无异,因在春令,所以不名伤寒,又因众人之病相同,所以名为寒疫,然其
治法,又与伤寒相去不远矣。如有变证,可仿伤寒法治之。
或问曰∶先生谓夏令之寒,是为阴暑之病,倘未交小暑、大暑之令,而受立夏、小满、芒种、夏至之寒,
可以名寒疫否?答曰∶可也。昔贤谓夏应热而反凉,是为非时之气,若果见证与寒疫相合,不妨用寒疫之方,
此所谓超乎规矩之外,仍不离乎规矩之中也。
风湿之病,其症状表现为头痛、发热,伴有微汗、怕风,骨节烦扰疼痛,身体沉重且轻微浮肿,小便不畅利,脉象浮而缓。罗谦甫说:在春夏交替之际,人们患病如同伤寒,这属于风湿证,适宜使用五苓散即可自愈。由此看来,风湿之邪,大多损伤太阳经,这是不言而喻的!治疗上适宜采用两解太阳法,以疏通膀胱之经络,同时通利膀胱之腑脏。如果风邪偏胜,多选用羌活、防风;如果湿邪偏胜,多加用茯苓、泽泻;如果是阴虚体质,脉象中兼有数象,适宜加入黄柏、车前子;如果是阳虚体质,脉象中兼有迟象,适宜加入仙灵脾(淫羊藿)、附片。医生总应当分辨是风胜还是湿胜,辨别是阴虚还是阳虚,这样才不至于造成误治。
喻嘉言说:风湿邪气侵袭人体,风邪则先从上受之,湿邪则先从下受之,都从太阳膀胱经而入。风邪伤及卫分,湿邪留滞关节,风邪属阳而趋向于上,湿邪属阴而趋向于下,风邪无形而居表外,湿邪有形而居体内,上下内外之间,邪气相互搏击,所以显现出汗出、恶风、短气、发热、头痛、骨节烦疼、身体沉重微肿等症状,这种情况固然适宜通过发汗来解除。只是发汗的方法与常规方法不同,贵在缓慢而不贵在急骤,急骤则风去而湿存,缓慢则风湿俱去。
雷丰按语:论述风湿,只有喻嘉言先生最为出色,明确指出了上下表里的病机,可谓切中要害。更妙的是他关于发汗方法的论述,贵在缓慢而不贵在急骤,这五个字确实是治疗风湿的关键秘诀,学习的人不可以因为它浅近而忽视它。
王叔和《序例》中说:从春分以后,到秋分节前,天气突然变寒的,都属于时行寒疫。考证《医宗金鉴》,又说:春天应该温暖却反而寒冷,名叫寒疫。据此而论,春天有这个病,而夏秋没有这个病,其实夏令的寒冷,是属于阴暑的病,秋月时的寒冷,是属于秋凉燥气,这分明说明夏秋不患寒疫,应当遵从《医宗金鉴》的教导,寒疫发生在春季。大概“疫”就是“役”的意思,像服役一样,大抵众人所患病情相似的,都可以称为疫。这又与瘟疫的“疫”,相差极远,必须知道瘟疫乃是天地间的厉气,寒疫乃是反常的变化之气。其初起时头痛、身疼,寒热往来无汗,或者出现呕吐逆气,人迎脉浮紧的,适宜用辛温解表法治疗。看这些见证,与冬季伤寒初客太阳无异,因为是在春季,所以不叫伤寒,又因为众人的病情相同,所以名为寒疫,然而其治疗方法,又与伤寒相差不远。如果有变证,可仿照伤寒法治之。
有人问:先生说夏令的寒冷,是阴暑的病,倘若还未交小暑、大暑的时令,而受到立夏、小满、芒种、夏至期间的寒冷,可以称为寒疫吗?回答说:可以。以前的贤人说夏天应该热却反而凉,这是非时之气,如果确实见证与寒疫相符合,不妨使用治疗寒疫的方剂,这就是所说的超乎规矩之外,仍不离乎规矩之中。
The disease of Wind-Dampness presents with symptoms such as headache, fever, slight sweating, aversion to wind, vexatious pain in the bone joints, heaviness of the body with slight edema, impaired urination, and a floating and moderate pulse. Luo Qianfu stated: During the transition between spring and summer, when people fall ill resembling Cold Damage (Shanghan), it is a syndrome of Wind-Dampness, and it is appropriate to use Wuling San (Five-Ingredient Poria Decoction) for self-healing. From this perspective, it goes without saying that the pathogenic factors of Wind-Dampness mostly injure the Taiyang (Greater Yang) channel. Treatment should employ the method of resolving both aspects of Taiyang to unblock the Bladder meridian and promote the fu-function of the Bladder organ. If Wind predominates, Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) should be used more frequently; if Dampness predominates, Lingzhi (Poria) and Zexie (Alismatis Rhizoma) should be added. For individuals with Yin deficiency presenting with a rapid pulse, Huangbai (Phellodendri Cortex) and Cheqianzi (Plantaginis Semen) are suitable; for those with Yang deficiency presenting with a slow pulse, Xintian (Epimedii Folium) and Fupian (Aconiti Lateralis Radix Praeparata) should be included. Physicians must always differentiate whether Wind or Dampness predominates, and distinguish between Yin deficiency and Yang deficiency, thereby avoiding therapeutic errors.
Yu Jiayan stated: When Wind-Dampness invades the human body, Wind affects the upper part first, while Dampness affects the lower part first, both entering through the Taiyang Bladder channel. Wind injures the Wei (Defensive) level, while Dampness remains in the joints. Wind, being Yang, tends upward; Dampness, being Yin, tends downward. Wind is formless and resides externally, while Dampness has form and resides internally. Between the upper and lower, inside and outside, the pathogens clash, manifesting as sweating, aversion to wind, shortness of breath, fever, headache, vexatious pain in the bone joints, and body heaviness with slight edema. This condition is indeed suitable for resolution through sweating. However, the method of inducing sweat differs from the routine method; it values slowness over haste. Haste causes Wind to leave but Dampness to remain, whereas slowness allows both Wind and Dampness to be expelled.
Lei Feng noted: In discussing Wind-Dampness, Mr. Yu Jiayan stands out as the foremost authority, clearly elucidating the pathology of the upper/lower and exterior/interior levels, effectively addressing the core issue. His discussion on the method of sweating, emphasizing slowness over haste, is truly the golden key to treating Wind-Dampness. Students should not neglect it because it seems simple.
Wang Shuhe's "Preface to Examples" states: After the Spring Equinox until before the Autumn Equinox, if the weather becomes suddenly cold, it belongs to the seasonal Cold Plague (Han Yi). Consulting the "Yi Zong Jin Jian" (Golden Mirror of Medicine), it is also stated: When spring should be warm but turns cold, it is named Cold Plague. Based on this, one might argue that this disease occurs in spring but not in summer or autumn. In fact, the coldness in summer belongs to the disease of Yin-Shu (Yin Summerheat), and the coldness in autumn belongs to the dry qi of autumn coolness. It is clear that summer and autumn do not suffer from Cold Plague; one should follow the instruction of "Yi Zong Jin Jian," which places Cold Plague in the spring season. Generally, "Yi" (Plague) implies "Yi" (Service/Labor), like being conscripted; roughly speaking, when many people suffer from similar illnesses, they can all be named Plague. This is vastly different from the "Yi" in Wen Yi (Warm Plague); one must know that Wen Yi is the fierce qi of heaven and earth, whereas Han Yi is an abnormal changing qi. At its onset, with headache, body pain, alternating chills and fever without sweating, or vomiting and regurgitation, and a floating-tight Renying (Carotid Artery) pulse, it is appropriate to treat with Acrid-Warm Exterior-Resolving methods. Observing these manifestations, they are no different from Winter Cold Damage initially affecting the Taiyang channel. Because it occurs in spring, it is not called Cold Damage; because the illness among the masses is identical, it is named Cold Plague. However, its treatment method is not far removed from that of Cold Damage. If complicated syndromes arise, one may imitate the treatment of Cold Damage.
A question was asked: The master stated that the coldness in summer is a disease of Yin-Shu. If, before the arrival of Minor Heat and Major Heat solar terms, one is exposed to the cold during Li Xia (Start of Summer), Xiao Man (Grain Buds), Mang Zhong (Grain in Ear), or Xia Zhi (Summer Solstice), can it be named Cold Plague? The answer is: Yes. Former sages said that when summer should be hot but turns cool, it is non-seasonal qi. If the manifestations indeed match those of Cold Plague, there is no harm in using formulas for Cold Plague. This is what is meant by going beyond the rules yet remaining within them.