热自外生者宜表宜散。热自内生者宜清宜泻。热自外生而未尽至于内者宜表宜散。热自
内成
而
全无表症者宜攻宜下。凡人感冒风寒。审其邪未深入。即当急撤其表。俾热仍从表解。不得
谓热已成。有清无散。而不用表外出也。第热之论乎散者。其法不一。有止就热以言散者。
如升麻之升诸阳引热外出。干葛之升阳明胃气引热外出。柴胡之升少阳胆热外出。淡豆豉
之升膈热外出。夏枯草之散肝热外出。野菊花之散肝肺热外出也。有合风热以言散者。如辛
夷能散肺经风热。冰片能散骨蒸风热。木贼能散肝胆风热。蕤仁决明子炉甘石薄荷能散肝经
风热也。有合湿热而言散者。如芜荑能散皮肤骨节湿热。香薷能散肺胃心湿热是也。有就风
火热毒而言散者。如蟾蜍蟾酥之能升拔风火热毒外出是也。有就血热而言散者。如锻石能散
骨肉皮肤血热。谷精草能散肝经血热也。至于热结为痰。有藉吐散。如木鳖则能引其热痰成
毒结于胸膈而出。瓜蒂则能引其热痰结于肺膈而出。胆矾则能引其风热之痰亦结在膈而出也
。若使表症既罢。内症已备。则又另有法在。似无庸于琐赘。
（山草）升阳散热
升麻（专入脾胃。兼入肺大肠）。似与葛根一类。但此辛甘微苦。能引葱白入肺。发散
风寒出
汗。引石膏能治阳明顶巅头痛齿痛。引参耆能入脾胃补脾。且同柴胡能引归耆白术甘温之药
。以补卫气之散。而实其表。并治一切风陷下痢。（后重里急。症不一端。有应用承气大下
者。有应用升柴上升者。要在辨症明确。以识升降之宜耳。不得概以升举为事也！）久泄（经
曰
。清气在下。则生飧泄）。脱肛。足寒阴痿。暨蛊毒精鬼。（阳升则阴散。）与一切风热斑疹
。（斑疹有虚有实。须审兼症以治。汪昂曰。成朵如锦纹者为斑。隐隐见红点者为疹。盖胃
热失下。冲入少阳。则助相火而成斑。冲入少阴。则助君火而成疹。）疮毒靡不随手辄应。
以升其阳而散其热。俾邪尽从外解。而浊自克下降。故又曰能以解毒。不似葛根功专入胃
升津解肌。而不能引诸药以实卫气也。但升麻佐于葛根。则入阳明升津解肌有效。同柴胡升
气。则柴能升少阳肝经之阳。升麻能升阳明胃经之阳。一左一右。相需而成。（时珍曰。大
抵人年五十以后。其气消者多。长者少。降者多。升者少。秋冬之令多。而春夏之令少。若
禀受弱而有诸般阳虚等症者。并宜以升阳等药活法治之。）但阴火动。及气虚汗出切忌。（朱
肱活人书言犀角地黄汤。如无犀角。可用升麻以代。意在引药以入阳明耳。朱二允言犀角地
黄汤不宜用升麻以代犀角。意在升麻能引阴血上涌。二者见解俱是。但须察其病气浅深。
脏气偏纯。以明治之得失。）里白外黑。紧实者良。名鬼脸升麻。细削。皮青绿色。谓鸡骨
升麻。去须芦。蒸曝用。入补剂。蜜水炒用。
热邪由外感而生的，适宜用解表发散的方法。热邪由内生发的，适宜用清热泻下的方法。热邪由外感而来但尚未完全入里的，适宜用解表发散的方法。热邪由内生成且完全没有表证的，适宜用攻下法。凡是人感受风寒之邪，审查其病邪尚未深入体内，就应当紧急解除在表的邪气，使热邪仍然从体表解散。不能因为热邪已经形成，就认为只有清热而没有发散，从而不使用解表外出之法。然而论述热邪宜于散法的，其方法不止一种。有仅就热邪而言散法的，如升麻能提升阳气引导热邪外出，干葛（葛根）能提升阳明胃气引导热邪外出，柴胡能提升少阳胆经热邪外出，淡豆豉能提升膈间热邪外出，夏枯草能疏散肝经热邪外出，野菊花能疏散肝肺二经热邪外出。有结合风热而言散法的，如辛夷能疏散肺经风热，冰片能疏散骨蒸风热，木贼能疏散肝胆风热，蕤仁、决明子、炉甘石、薄荷能疏散肝经风热。有结合湿热而言散法的，如芜荑能疏散皮肤骨节的湿热，香薷能疏散肺、胃、心三经的湿热。有针对风火热毒而言散法的，如蟾蜍、蟾酥能拔引风火热毒外出。有针对血热而言散法的，如锻石能疏散骨肉皮肤的血热，谷精草能疏散肝经血热。至于热邪凝结成痰，有借助涌吐来消散的，如木鳖子能引导热痰结成毒邪结于胸膈而吐出，瓜蒂能引导热痰结于肺膈而吐出，胆矾能引导风热之痰亦结在膈部而吐出。如果表证已经解除，里证已经完全具备，那么又有另外的治疗方法，似乎无需在此琐碎赘述。
【山草类】升阳散热药
升麻（专门进入脾胃经，兼入肺经和大肠经）。看起来与葛根属于一类，但此药味辛、甘、微苦，能引导葱白入肺，发散风寒促使出汗；能引导石膏治疗阳明经顶巅头痛和齿痛；能引导人参、黄芪进入脾胃补益脾气；并且同柴胡配合，能引导当归、黄芪、白术等甘温药物，以补益卫气的耗散，从而充实肌表，并治疗一切因风邪陷下导致的痢疾。（后重里急，症状有多种情况，有的应用承气汤大下，有的应用升麻、柴胡上升提举，关键在于辨证明确，以识别升降的适宜性罢了，不能一概以升举为事！）对于久泄（《内经》说：清气在下，则产生飧泄）、脱肛、足寒、阴痿，以及蛊毒、精鬼作祟（阳气上升则阴邪消散），和一切风热引起的斑疹。（斑疹有虚证和实证之分，必须审查兼夹症状来治疗。汪昂说：成片如锦纹的是斑，隐隐可见红点的是疹。大概是因为胃热失于通下，冲入少阳，则助长相火而成斑；冲入少阴，则助长君火而成疹。）疮毒无不随手应验，通过提升阳气来散发热邪，使邪气全部从外部解散，而浊气自然下降。所以又说它能解毒，不像葛根功效专入胃经，提升津液、解除肌表邪气，而不能引导诸药以充实卫气。但是升麻辅助葛根，则进入阳明经提升津液、解除肌表邪气有效；同柴胡一起提升气机，则柴胡能升发少阳肝经的阳气，升麻能升发阳明胃经的阳气，一左一右，相互依赖而成效。（李时珍说：大致人到了五十岁以后，消耗的气多，生长的气少，下降的多，上升的少，秋冬的时令多，而春夏的时令少。如果禀赋虚弱而有各种阳虚等症状的，都适宜用升阳等药物的活法治之。）但是如果是阴火妄动，以及气虚汗出者切忌使用。（朱肱《活人书》中说犀角地黄汤，如果没有犀角，可以用升麻代替，意在引导药物进入阳明经。朱二允说犀角地黄汤不宜用升麻代替犀角，意在升麻能引导阴血上涌，两者的见解都是正确的，但必须考察病气的浅深，脏气的偏纯，以确定治疗的得失。）根部内部白色外部黑色，紧密结实的是上品，名叫鬼脸升麻；细削的，皮呈青绿色，叫做鸡骨升麻。去掉须和芦头，蒸晒后使用。入补益剂中，用蜜水炒制。
Heat originating from external pathogens is suitable for release and dispersion. Heat originating from internal generation is suitable for clearing and purging. Heat originating externally but not yet fully entering the interior is suitable for release and dispersion. Heat generated internally with no exterior symptoms at all is suitable for attacking and purging downward. When a person contracts wind-cold, if it is determined that the pathogen has not deeply penetrated, one should urgently resolve the exterior, allowing the heat to still be resolved from the surface. One must not claim that because heat has formed, only clearing is needed without dispersion, thereby neglecting methods to release it outward. However, regarding the discussion of dispersing heat, there are various methods. Some discuss dispersion solely in terms of heat: such as Shengma (Rhizoma Cimicifugae) raising yang to guide heat outwards; Gan Ge (Radix Puerariae) raising Yangming Stomach qi to guide heat outwards; Chaihu (Radix Bupleuri) raising Shaoyang Gallbladder heat outwards; Dan Dou Chi (Semen Sojae Praeparatum) raising intercostal heat outwards; Xiakucao (Herba Prunellae) dispersing Liver heat outwards; Ye Juhua (Flos Chrysanthemi Indici) dispersing Liver and Lung heat outwards. Some discuss dispersion in combination with wind-heat: such as Xin Yi (Fructus Magnoliae Biondii) dispersing Lung meridian wind-heat; Bing Pian (Borneolum Syntheticum) dispersing bone-steaming wind-heat; Mu Zei (Hermosetum Japonicum); Rui Ren (Semen Pruni Armeniacae); Jue Ming Zi (Fructus Cassiae); Lu Gan Shi (Calamina); Bo He (Herba Menthae) dispersing Liver meridian wind-heat. Some discuss dispersion in combination with damp-heat: such as Wu Yi (Fructus Tsoo Po) dispersing skin and joint damp-heat; Xiang Ru (Herba Elsholtziae) dispersing Lung, Stomach, and Heart damp-heat. Some discuss dispersion in terms of wind-fire-toxin: such as Chan Chu (Bufonis Venenum) and Chan Su (Venenum Bufonis) extracting wind-fire-toxin outwards. Some discuss dispersion in terms of blood-heat: such as Duan Shi (Lapis Ferri Oxydati Ruber) dispersing bone, flesh, and skin blood-heat; Gu Jing Cao (Herba Glehniae) dispersing Liver meridian blood-heat. As for heat condensing into phlegm, some rely on emesis to disperse: such as Mu Bie Zi (Semen Strychnos) guiding hot-phlegm toxic knots in the chest and diaphragm to emerge; Gua Di (Fructus Trichosanthis) guiding hot-phlegm knots in the lungs and diaphragm to emerge; Dan Fan (Alumen) guiding wind-heat phlegm also knotted in the diaphragm to emerge. If the exterior syndrome has ceased and the interior syndrome is fully established, then there are other methods, seemingly requiring no further trivial elaboration here.
[Mountain Herbs] Yang-Raising and Heat-Dispersing Agents
Shengma (Rhizoma Cimicifugae) (Specifically enters the Spleen and Stomach meridians, and additionally enters the Lung and Large Intestine meridians). It appears similar to Ge Gen (Radix Puerariae), but this herb is pungent, sweet, and slightly bitter. It can guide Cong Bai (Caulis Allii Macrostemonis) into the Lung to disperse wind-cold and induce sweating; it can guide Shi Gao (Gypsum Fibrosum) to treat Yangming vertex headache and toothache; it can guide Ren Shen (Radix Ginseng) and Huang Qi (Radix Astragali) to enter the Spleen and Stomach to tonify Spleen qi; and together with Chai Hu (Radix Bupleuri), it can guide Gui (Radix Angelicae Sinensis), Huang Qi (Radix Astragali), Bai Zhu (Rhizoma Atractylodis Macrocephalae), and other sweet-warm herbs to tonify the dispersion of Wei Qi (Defensive Qi) and solidify the exterior, treating all types of dysentery caused by wind sinking. (Tenesmus and urgency have various presentations; some require Da Xia (severe purgation) with Cheng Qi Decoctions, while others require rising with Sheng Ma and Chai Hu. The key lies in clear differentiation to identify the appropriateness of ascending and descending; one must not indiscriminately focus on lifting.) For chronic diarrhea (The Classic states: "When clear qi sinks below, sun-digestion diarrhea occurs"), rectal prolapse, cold feet, impotence, and gu poison or spirit disturbances (Yang rising causes Yin to dissipate), and all wind-heat macules and rashes. (Macules and rashes can be deficiency or excess; treatment must examine accompanying syndromes. Wang Ang stated: Those appearing in patches like brocade patterns are macules (ban); those faintly visible as red dots are rashes (zhen). Generally, if Stomach heat is not purged, it rushes into Shaoyang, assisting Minister Fire to form macules; rushing into Shaoyin, it assists Lord Fire to form rashes.) It responds instantly to sores and toxins by raising yang to disperse heat, allowing pathogens to resolve entirely from the exterior, while turbid qi naturally descends. Thus, it is said to detoxify, unlike Ge Gen, whose function is specifically to enter the Stomach, raise fluids, and relieve the muscle layer, without guiding other herbs to solidify Wei Qi. However, when Sheng Ma assists Ge Gen, it effectively enters the Yangming to raise fluids and relieve the muscle layer; when combined with Chai Hu to raise qi, Chai Hu raises the Yang of the Shaoyang Liver meridian, and Sheng Ma raises the Yang of the Yangming Stomach meridian, one left and one right, mutually dependent to achieve effect. (Li Shizhen said: Generally, after age fifty, people consume more qi than they generate, descend more than they ascend, and experience more autumn/winter conditions than spring/summer. Those with weak constitution and various yang-deficiency symptoms should be treated with living methods using yang-raising herbs.) However, it is strictly contraindicated for moving Yin fire and spontaneous sweating due to qi deficiency. (Zhu Gong's *Huoren Shu* states that for Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction), if Xi Jiao (Cornu Rhinocerotis) is unavailable, Sheng Ma can substitute it, intending to guide medicine into the Yangming meridian. Zhu Eryun stated that Xi Jiao Di Huang Tang should not use Sheng Ma to replace Xi Jiao, intending that Sheng Ma can guide Yin blood upward. Both views are correct, but one must observe the depth of the disease and the purity of the organ qi to determine the success or failure of treatment.) The root interior is white and exterior black, tight and solid, named Gui Lian Sheng Ma (Ghost Face Sheng Ma); thin and slender with greenish-blue skin is called Ji Gu Sheng Ma (Chicken Bone Sheng Ma). Remove roots and rhizome heads, steam and dry before use. For tonifying formulas, stir-fry with honey water.