《三時(shi)伏氣外感》是(shi)王(wang)(wang)孟英葉(xie)氏(shi)(shi)《幼(you)科(ke)要略(lve)》中有(you)(you)關(guan)溫(wen)(wen)病的(de)(de)一(yi)些內(nei)容(rong)編輯而成。這些內(nei)容(rong),在王(wang)(wang)氏(shi)(shi)之前醫家不(bu)(bu)甚(shen)重(zhong)視(shi),原因是(shi)“大(da)方家視(shi)為(wei)幼(you)科(ke)治法,不(bu)(bu)過附(fu)庸于(yu)此集,皆(jie)不(bu)(bu)甚(shen)留意;而習幼(you)科(ke)者(zhe),謂此書為(wei)大(da)方之指南,更不(bu)(bu)過問也(ye)”,王(wang)(wang)氏(shi)(shi)有(you)(you)鑒于(yu)此,故(gu)在編著《溫(wen)(wen)熱經緯》時(shi),“于(yu)溫(wen)(wen)熱論(lun)后,附(fu)載(zai)春溫(wen)(wen)夏暑秋燥諸條”,目的(de)(de)在彰葉(xie)氏(shi)(shi)溫(wen)(wen)熱之學,嗣后也(ye)確實引(yin)起(qi)了(le)醫界對它的(de)(de)注重(zhong)。因此,王(wang)(wang)氏(shi)(shi)此舉,是(shi)確有(you)(you)成績,值(zhi)得肯定的(de)(de)。但也(ye)有(you)(you)一(yi)些欠(qian)當之處,應當提出商(shang)榷(que)。
一、刪冬時伏氣外(wai)感之欠當
《幼(you)科(ke)(ke)要略》著重論(lun)兩(liang)個方面(mian)的(de)(de)(de)(de)(de)內(nei)容(rong),一(yi)論(lun)四(si)(si)(si)(si)時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)病(bing),一(yi)論(lun)疹痘驚疳(gan)等(deng)兒科(ke)(ke)病(bing)。誠(cheng)如近(jin)人(ren)(ren)(ren)所說(shuo):“葉氏在(zai)這(zhe)(zhe)篇著作(zuo)中(zhong)(zhong),詳(xiang)細地論(lun)述了(le)四(si)(si)(si)(si)時(shi)(shi)溫(wen)(wen)病(bing)的(de)(de)(de)(de)(de)辨證論(lun)治(zhi)(zhi)法(fa)(fa)(fa),充分(fen)反映了(le)他豐(feng)富的(de)(de)(de)(de)(de)實踐經驗,這(zhe)(zhe)是十分(fen)可貴的(de)(de)(de)(de)(de)。”徐(xu)靈胎、王(wang)孟(meng)英諸家,對(dui)《幼(you)科(ke)(ke)要略》評(ping)價(jia)甚高,徐(xu)氏說(shuo)它“和平(ping)精切(qie),字字金(jin)玉,可法(fa)(fa)(fa)可傳(chuan)。”王(wang)氏說(shuo)它“為(wei)先生手定”,雖(sui)為(wei)小(xiao)兒說(shuo)法(fa)(fa)(fa),大人(ren)(ren)(ren)亦(yi)可借鑒。既然(ran)如此(ci),將詳(xiang)細論(lun)述四(si)(si)(si)(si)時(shi)(shi)溫(wen)(wen)病(bing)之(zhi)(zhi)(zhi)(zhi)作(zuo),刪去(qu)冬時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)的(de)(de)(de)(de)(de)內(nei)容(rong),編后定名(ming)為(wei)《三(san)(san)時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)》,是顯然(ran)欠當的(de)(de)(de)(de)(de)。《幼(you)科(ke)(ke)要略》中(zhong)(zhong),“夫春溫(wen)(wen)夏(xia)熱,秋涼冬寒,四(si)(si)(si)(si)時(shi)(shi)之(zhi)(zhi)(zhi)(zhi)序(xu)也(ye)”至“茲以(yi)四(si)(si)(si)(si)氣(qi)(qi)(qi)(qi)(qi)常法(fa)(fa)(fa)列左(zuo)。”一(yi)段(duan)文(wen)字,是論(lun)四(si)(si)(si)(si)時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)病(bing)之(zhi)(zhi)(zhi)(zhi)概(gai)論(lun),王(wang)氏為(wei)了(le)符合把(ba)“四(si)(si)(si)(si)時(shi)(shi)”改(gai)(gai)成為(wei)“三(san)(san)時(shi)(shi)”的(de)(de)(de)(de)(de)編法(fa)(fa)(fa),這(zhe)(zhe)段(duan)概(gai)論(lun)自然(ran)只(zhi)好(hao)一(yi)并(bing)刪去(qu)。這(zhe)(zhe)樣做,誤使后人(ren)(ren)(ren)以(yi)為(wei)《幼(you)科(ke)(ke)要略〗原(yuan)只(zhi)論(lun)三(san)(san)時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)病(bing)而(er)(er)(er)(er)不(bu)(bu)(bu)及于冬時(shi)(shi),是極不(bu)(bu)(bu)妥當的(de)(de)(de)(de)(de)。后人(ren)(ren)(ren)率(lv)多(duo)沿用其篇名(ming),置冬時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)之(zhi)(zhi)(zhi)(zhi)文(wen)而(er)(er)(er)(er)不(bu)(bu)(bu)論(lun),使葉氏論(lun)冬溫(wen)(wen)之(zhi)(zhi)(zhi)(zhi)文(wen)泯滅而(er)(er)(er)(er)不(bu)(bu)(bu)彰,王(wang)氏難辭作(zuo)俑之(zhi)(zhi)(zhi)(zhi)咎。但近(jin)人(ren)(ren)(ren)竟曲為(wei)辯飾,說(shuo)“改(gai)(gai)名(ming)為(wei)《三(san)(san)時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)外(wai)感(gan)》這(zhe)(zhe)是有原(yuan)因(yin)的(de)(de)(de)(de)(de)。其一(yi),王(wang)氏曾(ceng)說(shuo):‘奈大方家視為(wei)幼(you)科(ke)(ke)治(zhi)(zhi)法(fa)(fa)(fa),不(bu)(bu)(bu)過附庸(yong)于此(ci)集,皆不(bu)(bu)(bu)甚留(liu)意(yi)(yi);而(er)(er)(er)(er)習幼(you)科(ke)(ke)者(zhe),謂此(ci)書為(wei)大方之(zhi)(zhi)(zhi)(zhi)指南,更(geng)不(bu)(bu)(bu)過問焉。將闡(chan)發葉氏之(zhi)(zhi)(zhi)(zhi)東扶、鞠通(tong)、虛(xu)谷(gu)者(zhe),亦(yi)皆忽略而(er)(er)(er)(er)未之(zhi)(zhi)(zhi)(zhi)及也(ye)。予謂雖(sui)為(wei)小(xiao)兒說(shuo)法(fa)(fa)(fa),大人(ren)(ren)(ren)豈有他殊(shu),故于溫(wen)(wen)熱論(lun)后,附載春溫(wen)(wen)、夏(xia)暑、秋燥諸條,舉一(yi)反三(san)(san),不(bu)(bu)(bu)僅為(wei)活幼(you)之(zhi)(zhi)(zhi)(zhi)慈航矣。’這(zhe)(zhe)是王(wang)氏改(gai)(gai)名(ming)的(de)(de)(de)(de)(de)理(li)(li)(li)由之(zhi)(zhi)(zhi)(zhi)一(yi)。其二,華(hua)岫(xiu)云注(zhu)《溫(wen)(wen)熱論(lun)》說(shuo):‘邪從口(kou)鼻而(er)(er)(er)(er)入(ru),故曰(yue)上(shang)受,但春溫(wen)(wen)冬時(shi)(shi)伏(fu)(fu)(fu)(fu)寒,藏于少陰,遇春時(shi)(shi)溫(wen)(wen)氣(qi)(qi)(qi)(qi)(qi)而(er)(er)(er)(er)發,非(fei)必上(shang)受上(shang)邪也(ye);。王(wang)孟(meng)英引沈堯封云:‘溫(wen)(wen)亦(yi)火(huo)(huo)之(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)(qi)(qi)(qi)也(ye),蓋火(huo)(huo)之(zhi)(zhi)(zhi)(zhi)微者(zhe)曰(yue)溫(wen)(wen),火(huo)(huo)之(zhi)(zhi)(zhi)(zhi)甚者(zhe)日熱,三(san)(san)時(shi)(shi)皆有,惟暑為(wei)天上(shang)之(zhi)(zhi)(zhi)(zhi)火(huo)(huo),獨甚于夏(xia)令耳。’認(ren)為(wei)這(zhe)(zhe)就是王(wang)孟(meng)英稱三(san)(san)時(shi)(shi)伏(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)(qi)(qi)而(er)(er)(er)(er)不(bu)(bu)(bu)稱四(si)(si)(si)(si)時(shi)(shi)的(de)(de)(de)(de)(de)理(li)(li)(li)由。”筆者(zhe)以(yi)為(wei),醫界不(bu)(bu)(bu)重視《幼(you)科(ke)(ke)要略》,根(gen)本不(bu)(bu)(bu)成為(wei)改(gai)(gai)四(si)(si)(si)(si)時(shi)(shi)為(wei)三(san)(san)時(shi)(shi)的(de)(de)(de)(de)(de)理(li)(li)(li)由,此(ci)實無須多(duo)辯,華(hua)氏注(zhu)亦(yi)然(ran)。至于沈氏所云,原(yuan)意(yi)(yi)為(wei)溫(wen)(wen)熱病(bing)春秋冬三(san)(san)時(shi)(shi)皆有,惟暑病(bing)獨甚于夏(xia)令,引此(ci)作(zuo)為(wei)改(gai)(gai)四(si)(si)(si)(si)時(shi)(shi)為(wei)三(san)(san)時(shi)(shi)之(zhi)(zhi)(zhi)(zhi)理(li)(li)(li)由,尤(you)見荒謬。
二、辨冬時外(wai)感伏氣文之不當刪
由于王氏(shi)改四時(shi)(shi)為(wei)三時(shi)(shi)的(de)做(zuo)法(fa)醫多不(bu)辯(bian)其(qi)(qi)失,咸(xian)為(wei)承襲,甚加曲釋。加上(shang)葉(xie)(xie)氏(shi)論(lun)(lun)(lun)四時(shi)(shi)伏(fu)氣(qi)(qi)外(wai)(wai)感(gan)(gan),以(yi)(yi)春(chun)(chun)溫(wen)(wen)、夏(xia)熱(re)、秋(qiu)(qiu)燥、冬(dong)(dong)寒(han)標目,而冬(dong)(dong)寒(han)(即(ji)(ji)正(zheng)傷(shang)寒(han))不(bu)屬(shu)(shu)于溫(wen)(wen)病(bing)。致人莫知(zhi)王氏(shi)改四時(shi)(shi)為(wei)三時(shi)(shi)之(zhi)非,故冬(dong)(dong)時(shi)(shi)外(wai)(wai)感(gan)(gan)伏(fu)氣(qi)(qi)文(wen)(wen)不(bu)當(dang)刪之(zhi)理由,尚(shang)須加以(yi)(yi)申說(shuo)(shuo)。葉(xie)(xie)氏(shi)論(lun)(lun)(lun)四時(shi)(shi)外(wai)(wai)感(gan)(gan)以(yi)(yi)新(xin)(xin)感(gan)(gan)伏(fu)氣(qi)(qi)為(wei)大綱,《幼科要略(lve)》亦(yi)然,葉(xie)(xie)氏(shi)論(lun)(lun)(lun)春(chun)(chun)季(ji)(ji)外(wai)(wai)感(gan)(gan),于伏(fu)氣(qi)(qi)則有(you)春(chun)(chun)溫(wen)(wen)之(zhi)論(lun)(lun)(lun),于新(xin)(xin)感(gan)(gan)則有(you)風(feng)溫(wen)(wen)之(zhi)說(shuo)(shuo);論(lun)(lun)(lun)夏(xia)季(ji)(ji)外(wai)(wai)感(gan)(gan),于伏(fu)氣(qi)(qi)則有(you)“發(fa)自陽(yang)明”、“伏(fu)熱(re)煩渴(ke)”諸論(lun)(lun)(lun),于新(xin)(xin)感(gan)(gan)則有(you)“夏(xia)季(ji)(ji)溫(wen)(wen)熱(re)上(shang)受(shou),首先(xian)入(ru)肺”,“穢(hui)暑(shu)吸入(ru),內結募原”等說(shuo)(shuo)(唯《溫(wen)(wen)熱(re)論(lun)(lun)(lun)》專論(lun)(lun)(lun)新(xin)(xin)感(gan)(gan)。《幼科要略(lve)》著重論(lun)(lun)(lun)伏(fu)氣(qi)(qi),于新(xin)(xin)感(gan)(gan)暑(shu)病(bing)文(wen)(wen)略(lve),須取有(you)關案互(hu)參);論(lun)(lun)(lun)秋(qiu)(qiu)季(ji)(ji)外(wai)(wai)感(gan)(gan),于伏(fu)氣(qi)(qi)則有(you)伏(fu)暑(shu)諸案,于新(xin)(xin)感(gan)(gan)則有(you)秋(qiu)(qiu)燥之(zhi)條;其(qi)(qi)論(lun)(lun)(lun)冬(dong)(dong)季(ji)(ji)外(wai)(wai)感(gan)(gan)亦(yi)然。冬(dong)(dong)季(ji)(ji)新(xin)(xin)感(gan)(gan)病(bing)若系“暴冷折陽(yang),外(wai)(wai)感(gan)(gan)發(fa)熱(re),頭痛身痛,嘔惡,必(bi)從太陽(yang)”,此即(ji)(ji)正(zheng)傷(shang)寒(han),此固不(bu)屬(shu)(shu)于溫(wen)(wen)病(bing)。但(dan)“若冬(dong)(dong)令應寒(han),氣(qi)(qi)候(hou)溫(wen)(wen)暖,當(dang)藏反泄,即(ji)(ji)能致病(bing),名曰冬(dong)(dong)溫(wen)(wen)。”冬(dong)(dong)溫(wen)(wen)為(wei)病(bing),亦(yi)有(you)新(xin)(xin)感(gan)(gan)、伏(fu)氣(qi)(qi)兩種(zhong),新(xin)(xin)感(gan)(gan)冬(dong)(dong)溫(wen)(wen),邪自外(wai)(wai)入(ru),首先(xian)犯肺,與風(feng)溫(wen)(wen)不(bu)殊;若伏(fu)氣(qi)(qi)冬(dong)(dong)溫(wen)(wen),即(ji)(ji)系新(xin)(xin)感(gan)(gan)引發(fa),亦(yi)以(yi)(yi)里(li)熱(re)為(wei)主,故葉(xie)(xie)氏(shi)云:“若涉(she)表邪一(yi)二,里(li)熱(re)必(bi)兼七八。”此種(zhong)冬(dong)(dong)溫(wen)(wen),因“里(li)熱(re)熾烈”,故葉(xie)(xie)氏(shi)明文(wen)(wen)指出(chu):“其(qi)(qi)治法(fa)按癥(zheng),必(bi)以(yi)(yi)里(li)癥(zheng)為(wei)主。”然因孟英獨舍(she)棄有(you)關論(lun)(lun)(lun)冬(dong)(dong)溫(wen)(wen)文(wen)(wen),后人誤會冬(dong)(dong)季(ji)(ji)無(wu)伏(fu)氣(qi)(qi)溫(wen)(wen)病(bing),遂(sui)使葉(xie)(xie)氏(shi)溫(wen)(wen)熱(re)之(zhi)學殘缺而不(bu)全,故欲為(wei)葉(xie)(xie)氏(shi)溫(wen)(wen)熱(re)學說(shuo)(shuo)存真,尚(shang)須就有(you)關冬(dong)(dong)溫(wen)(wen)之(zhi)文(wen)(wen)結合(he)其(qi)(qi)醫案探究(jiu)之(zhi)。
三(san)、葉氏(shi)伏氣冬溫(wen)案析評
《幼科要略》有議論(lun),有醫案,但以(yi)議論(lun)為(wei)主(zhu),且論(lun)亦不全,故(gu)欲研究葉(xie)氏四時(shi)伏(fu)氣外(wai)感治法,尚須結合有關醫案參考之(zhi)(zhi)。今為(wei)明葉(xie)氏治冬溫之(zhi)(zhi)法以(yi)證孟英刪冬時(shi)伏(fu)氣外(wai)感文之(zhi)(zhi)欠(qian)當(dang),特舉(ju)有代表性(xing)之(zhi)(zhi)冬溫醫案數則析(xi)評之(zhi)(zhi)。
(一)、冬溫火(huo)化(hua)(hua),熱毒(du)內(nei)(nei)陷(xian)案(an)某,溫邪發痧不透(tou),熱毒(du)內(nei)(nei)陷(xian)深藏(zang),上薰肺為(wei)喘,下攻(gong)腸則(ze)利(li),皆冬溫化(hua)(hua)火(huo)之(zhi)癥(zheng),《經》云:火(huo)淫于內(nei)(nei),治(zhi)以(yi)苦寒。幼科(ke)(ke)不究病(bing)(bing)本,不明藥中(zhong)氣味(wei),愈治(zhi)愈危,至此兇危。川(chuan)連、黃芩(qin)、飛(fei)滑(hua)石、炒銀花、連翹、甘草、丹(dan)皮、地骨(gu)皮(《幼科(ke)(ke)要略-痧疹門》)。按(an)(an):麻疹為(wei)過去(qu)幼科(ke)(ke)中(zhong)最為(wei)常(chang)見的伏氣溫病(bing)(bing),故占兒(er)科(ke)(ke)四大癥(zheng)之(zhi)首。此病(bing)(bing)是伏溫熱毒(du)從(cong)血分發出氣分,故即由外感風寒引發,亦切忌只(zhi)治(zhi)外不治(zhi)里,故葉氏(shi)說:“癮疹丹(dan)痧,非徒(tu)風寒”,“……即有(you)腹痛下利(li)諸癥(zheng),其治(zhi)法按(an)(an)癥(zheng),必以(yi)里癥(zheng)為(wei)主(zhu),稍兼清(qing)(qing)散為(wei)主(zhu),設(she)用辛溫,禍不旋踵矣。”上案(an)伏氣不能順利(li)外透(tou)、化(hua)(hua)火(huo)內(nei)(nei)陷(xian)故病(bing)(bing)變兇危,但病(bing)(bing)癥(zheng)屬實,故治(zhi)療從(cong)清(qing)(qing)熱解(jie)毒(du)、透(tou)邪涼血入(ru)手(shou)。孟英編(bian)改“要略”,于兒(er)科(ke)(ke)四大證無取乎痧、驚、痘,唯取疳、脹、瘧(nve)、痢諸癥(zheng),就溫病(bing)(bing)角度言(yan),亦是取舍失當。
(二(er))、冬(dong)溫下(xia)虛(xu),伏熱(re)內(nei)發案(an)(an)積(ji)勞(lao)伏熱(re),值初(chu)冬(dong)溫暖,天地氣(qi)不(bu)(bu)(bu)收(shou)降(jiang),伏邪因之(zhi)而發,是(shi)為(wei)冬(dong)溫,實非暴感,表散無謂,其痰喘氣(qi)促,左脅刺痛(tong),系身中(zhong)左升不(bu)(bu)(bu)已,右(you)降(jiang)失職,高年五液已衰,炎上之(zhi)威莫制,脈現左細右(you)博,尤屬陰(yin)氣(qi)先傷,煩勞(lao)兼(jian)以(yi)嗔(chen)怒,亦主七情動陽(yang),從來(lai)內(nei)傷兼(jian)癥(zheng),不(bu)(bu)(bu)與外感同(tong)法(fa),苦辛劫燥胃津,陰(yin)液日就枯杭(hang),故(gu)仲景(jing)凡于(yu)老(lao)人(ren)虛(xu)體,必(bi)以(yi)甘藥調之(zhi),夫喘咳之(zhi)來(lai),固(gu)是(shi)肺熱(re),以(yi)診脈面色論(lun)之(zhi),為(wei)下(xia)虛(xu),正氣(qi)不(bu)(bu)(bu)主攝納,腎(shen)病何疑,即初(chu)起熱(re)利(li),亦是(shi)陰(yin)不(bu)(bu)(bu)固(gu),擬用復脈湯。炙(zhi)甘草、細生地、炒(chao)麥冬(dong)、生白芍、麻仁,蔗漿(《清代(dai)名醫醫案(an)(an)大全-葉天士(shi)醫案(an)(an)》)。按:葉氏治(zhi)冬(dong)溫,有(you)實熱(re)證、虛(xu)熱(re)證、外寒(han)內(nei)熱(re)癥(zheng)、虛(xu)實兼(jian)夾癥(zheng)之(zhi)辨,上某案(an)(an)為(wei)實熱(re)癥(zheng),故(gu)立(li)(li)法(fa)苦寒(han)以(yi)瀉火,本(ben)案(an)(an)為(wei)虛(xu)熱(re)癥(zheng),故(gu)立(li)(li)法(fa)甘寒(han)以(yi)養陰(yin),此可對勘。
(三)、陰(yin)(yin)虛感(gan)邪,虛實(shi)挾雜案胡,脈(mo)數舌赤(chi),耳(er)聾胸悶,素有(you)痰火,近(jin)日冬(dong)溫(wen)(wen)引動復病(bing),加(jia)以勞復,小溲不利,議治(zhi)胞(bao)絡之熱(re)(re)。鮮生地五錢(qian),竹(zhu)葉心一(yi)(yi)錢(qian),丹(dan)參錢(qian)半(ban)、元參錢(qian)半(ban),石菖蒲根(gen)六分、陳膽星(xing)六分(《臨癥指南(nan)醫案-溫(wen)(wen)熱(re)(re)門》)。按:冬(dong)溫(wen)(wen)的虛實(shi)兼(jian)挾癥,有(you)體虛感(gan)邪者,亦有(you)熱(re)(re)灼陰(yin)(yin)傷者。后者可撤熱(re)(re)保陰(yin)(yin)、苦寒(han)堅陰(yin)(yin),或清(qing)熱(re)(re)養陰(yin)(yin)、相(xiang)機(ji)并用。前(qian)者則須一(yi)(yi)面(mian)養陰(yin)(yin)斂陽,一(yi)(yi)面(mian)清(qing)透溫(wen)(wen)邪,本案治(zhi)法(fa),正(zheng)是如(ru)此,故方以生地、玄參、竹(zhu)葉滋陰(yin)(yin)清(qing)透為主,此與(yu)黑膏(gao)方藥(yao)雖(sui)異而法(fa)實(shi)同(tong);其用丹(dan)參、菖蒲、膽星(xing),旨在(zai)通血分之瘀,疏氣分之滯,以利邪機(ji)之透達,且(qie)可防(fang)痰火之蒙閉(bi)。
(四(si))、冬溫(wen)咳(ke)嗽,外寒內(nei)熱(re)案(an)(an)(an)冬溫(wen)咳(ke)嗽,忽值暴冷,外寒內(nei)熱(re),引動宿痰伏飲(yin),夜(ye)臥氣沖欲坐(zuo),喉(hou)咽氣息有聲,宜(yi)暖護安居,從痰飲(yin)門(men)(men)越婢(bi)法。麻黃(huang)、甘草、石膏、生姜、大棗(《清代(dai)名醫醫案(an)(an)(an)大全(quan)-葉(xie)(xie)天士醫案(an)(an)(an)》)。按(an):《臨癥指南醫案(an)(an)(an)-咳(ke)嗽門(men)(men)》吳四(si)一(yi)案(an)(an)(an)、某二(er)八案(an)(an)(an)、某三(san)十(shi)案(an)(an)(an),失音門(men)(men)吳三(san)六案(an)(an)(an)、宋三(san)十(shi)案(an)(an)(an)等有關醫案(an)(an)(an)來(lai)看,葉(xie)(xie)氏治外寒內(nei)熱(re)之感癥,習用麻杏甘石湯、越婢(bi)湯諸(zhu)方,鞠(ju)通著《溫(wen)病(bing)條辨》,雖(sui)旨在發(fa)揚葉(xie)(xie)氏溫(wen)熱(re)之學(xue),但忽視了(le)葉(xie)(xie)氏這一(yi)藥(yao)法,致有桂枝(zhi)(倍桂)湯治溫(wen)病(bing)之謬。
結語
《幼科(ke)要略》是論幼科(ke)常(chang)見(jian)病(bing)(bing)之作,不(bu)是論溫(wen)之專(zhuan)著(zhu)。從(cong)溫(wen)病(bing)(bing)學角(jiao)度(du)看,此著(zhu)含有不(bu)少有關溫(wen)病(bing)(bing)的(de)內容,但因為(wei)非(fei)專(zhuan)著(zhu),故不(bu)可能完(wan)善無缺(que)。孟英(ying)為(wei)了(le)揚葉(xie)氏(shi)伏(fu)溫(wen)之學,特從(cong)溫(wen)病(bing)(bing)這角(jiao)度(du)進行(xing)重(zhong)編(bian)注(zhu)釋,其成(cheng)績(ji)和貢獻,應予肯定。但取舍欠當,編(bian)排亦亂,特別是刪(shan)去有關冬(dong)溫(wen)的(de)內容,使一本(ben)(ben)四(si)時伏(fu)氣外感并論之書變成(cheng)了(le)《三(san)時伏(fu)氣外感篇(pian)》,殊(shu)覺失當,筆(bi)者有鑒于(yu)此,已重(zhong)訂(ding)《幼科(ke)要略》,詳(xiang)為(wei)注(zhu)釋,但書甫成(cheng)而尚未售,現述緣起為(wei)本(ben)(ben)文,獻呈醫界(jie),期與賢(xian)達共(gong)研討。
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