儒者读书十年,穷理十年,自谓于医,已通三昧。及其视病,两相龃龉,不归责药肆之假,便诿咎染病之
真,与之强辩,无庸也,请试之治疟。夫疟病之浅而显者也,最易足以验医之得失。世之用劫药而侥幸以取功
者,不在此论。如果堂堂之阵,正正之师,而百战百胜焉,庶可悬壶都市(《后汉书》∶费长房者,汝南人
也。为市椽,市中有老翁卖药,悬一壶于肆头,及市罢,辄跳入壶中,市人莫之见,惟长房于楼上观之,异焉,
因往再拜,翁乃与俱入壶中。惟见玉堂严丽,旨酒甘肴,盈衍其中,共饮毕而出。后乃就楼上候长房曰∶“
我神仙中人,以过见责,今事毕当去”)。负笼乡邦。犹是投之罔效,屡易其方。古籍 糠,空披万卷,寒窗
灯案,辜负十年。经曰∶“邪气客于风府,循膂而下(背脊骨两旁曰膂,并顶骨三椎,至尾 骨二十四
椎),其气上行(由尾 骨上行),九日出于缺盆(肩下
横骨陷中)。”余读经文,而知疟脉之所以弦也。躯壳之内,脏腑之外,属半表半里,而邪居之宜,脉之弦,
与少阳同。是放风无常府,以所中处为府。其中顶骨也,三阳之脉皆上于头,阳明之脉循发际至额颅,邪气并
于阳明,令人头痛,洒淅寒甚,久乃热,则为阳明之疟;少阳之脉,上抵头角,下耳后,邪气并于少阳,令人
头痛,寒不甚,热不甚,恶见人,则为少阳之疟;至于太阳之脉,从巅入络脑,还出别下项,正过风府处,故
头痛、腰痛、体重,寒从背起。所以中于阳者,太阳之疟居多。其中 骨也,三阴之脉皆发于足。太阴之脉上
膝股,内入腹,邪气并入太阴,令人足软,不嗜饮食,多寒热,则为太阴之疟;厥阴之脉入毛中,绕阴器,邪
气并入厥阴,令人足软,小腹满,小便不利,则为厥阴之疟,至于少阴之脉,上股后廉直贯膂,正当风府处,
故足软,呕吐甚,多寒热,热多寒少。所以中于阴者,少阴之疟居多。其中于阳也,阳气渐入于阴分,日下一
节,其行也迟,故其作也,日晏一日,难愈;其中于阴也,阴气转入阳分,日上二节,其行也速,故其作也,
日早一日,易愈。治之之法,疟在三阳,则以三阳治之(阳明经症∶葛根、升麻、黄芩、芍药、草果、炙草、
姜枣引。阳明腑症∶大黄、芒硝、槟榔、浓朴、炙草、姜枣引。少阳症,青皮饮∶青皮、浓朴、柴胡、黄芩、
法夏、云苓、白术、草果、炙草、姜枣引。太阳经症∶麻黄、桂枝、杏仁、炙草、姜枣引。太阳腑症∶焦术、
茯苓、猪苓、桂枝、泽泻、草果、炙草、姜枣引);疟在三阴,则以三阴治之(附子理中汤加草果统治三阴∶
玉竹、焦术、干姜、草果、炙草、附片、姜枣引)。倘弦化脉虚有汗,但辅其正气而邪自除,则统阴阳而温补
之(经验方∶黄 、焦术、附子,首乌、秦归、玉竹、草果、
云苓、炙草、姜枣引),未有不随手而效者。《机要》曰∶“疟有中三阳者,有中三阴者,其症各殊,同《伤
寒论》,知治伤寒,则知治疟。”余谓第知治伤寒,犹不足以治疟,知伤寒矣,而知邪客风府,则足以治疟矣。
所同于伤寒者,症;所异于伤寒者,脉。伤寒之脉,随阴阳变迁;疟症之脉,一弦字贯彻。知所以治伤寒,而
于阴阳胜复之理,邪正交战之时,脏腑行经之穴,无不灼知之矣。业医者,欲验一己之功修,请自试之治疟。
读书人苦读十年,探究医理十年,自认为对医学已经精通三昧。等到他们诊治疾病时,却往往与病情不符,不是责怪药铺卖假药,就是推卸责任给病人染病真实(指病情复杂或误诊),如果与他们强行争辩,也是无用的,请让我试着谈谈治疗疟疾的方法。
疟疾是浅显而明显的病症,最容易用来验证医生医术的得失。世上那些使用劫夺正气之药而侥幸取得成功的人,不在本文讨论之列。如果是堂堂正正的阵容,正规严谨的军队,能够百战百胜,才配得上在都市中悬壶行医(《后汉书》记载:费长房是汝南人。担任市椽时,集市中有个老翁卖药,在店铺门口挂着一个葫芦。集市结束后,老翁就跳进葫芦里,市井之人看不见他,只有费长房在楼上看到了,觉得很奇异,于是前去拜见,老翁便带他一起进入葫芦中。只见玉堂庄严华丽,美酒佳肴充满其中,两人共饮完毕后出来。后来老翁在楼上等候费长房说:“我是神仙中人,因为过错受到责罚,现在事情结束应当离去”)。如果背着药笼回到家乡,还是投药无效,屡次更换处方。古籍像糠秕一样被抛弃,空读了万卷书,寒窗灯下,辜负了十年的光阴。
经文说:“邪气客居于风府穴,沿着膂脉向下(背脊骨两旁称为膂,从顶骨第三椎开始,至尾骨第二十四椎结束),其气向上行(由尾骨上行),九日后出于缺盆穴(肩下横骨凹陷处)。”我阅读经文,从而知道疟疾脉象之所以呈弦脉的原因。躯壳之内,脏腑之外,属于半表半里,邪气居住于此,脉象呈现弦脉,这与少阳经的病机相同。因此风邪没有固定的府邸,以所侵犯的部位为府。
如果邪气侵犯顶骨部位,三阳经脉都上行至头部。阳明经的脉络循行发际至额颅,邪气并入阳明经,导致头痛,洒淅恶寒严重,时间久了发热,这就是阳明疟;少阳经的脉络上抵头角,下行至耳后,邪气并入少阳经,导致头痛,恶寒不重,发热也不重,怕见人,这就是少阳疟;至于太阳经的脉络,从头顶入络于脑,复出别下行至项部,正好经过风府穴,所以出现头痛、腰痛、身体沉重,寒冷从背部发起。因此,侵犯阳经的,多为太阳疟。
如果邪气侵犯尾骨部位,三阴经脉都发源于足部。太阴经的脉络上行至膝股,向内进入腹部,邪气并入太阴经,导致两脚软弱,不喜欢饮食,多寒热交替,这就是太阴疟;厥阴经的脉络进入毛际,环绕阴器,邪气并入厥阴经,导致两脚软弱,小腹胀满,小便不利,这就是厥阴疟;至于少阴经的脉络,沿大腿后侧直贯膂脉,正当风府穴处,所以出现两脚软弱,呕吐严重,多寒热交替,热多寒少。因此,侵犯阴经的,多为少阴疟。
邪气侵犯阳经,阳气逐渐进入阴分,每天下降一节,运行缓慢,所以发作时间一天比一天晚,难以痊愈;邪气侵犯阴经,阴气转入阳分,每天上升二节,运行迅速,所以发作时间一天比一天早,容易痊愈。
治疗的方法:疟疾在三阳经,就用三阳经的方法治疗(阳明经证候:葛根、升麻、黄芩、芍药、草果、炙甘草、生姜大枣引经。阳明腑证候:大黄、芒硝、槟榔、厚朴、炙甘草、生姜大枣引经。少阳证候,青皮饮:青皮、厚朴、柴胡、黄芩、法半夏、云茯苓、白术、草果、炙甘草、生姜大枣引经。太阳经证候:麻黄、桂枝、杏仁、炙甘草、生姜大枣引经。太阳腑证候:焦白术、茯苓、猪苓、桂枝、泽泻、草果、炙甘草、生姜大枣引经);疟疾在三阴经,就用三阴经的方法治疗(附子理中汤加草果统治三阴:玉竹、焦白术、干姜、草果、炙甘草、附片、生姜大枣引经)。
如果弦脉化为虚脉且有汗出,只需辅助正气而邪气自然消除,则统摄阴阳进行温补(经验方:黄芪、焦白术、附子、首乌、秦归、玉竹、草果、云茯苓、炙甘草、生姜大枣引经),没有不随手见效的。《机要》说:“疟疾有中三阳的,有中三阴的,症状各不相同,同《伤寒论》一样,懂得治疗伤寒,就懂得治疗疟疾。”我认为仅仅知道治疗伤寒,还不足以治疗疟疾,知道了伤寒,并且知道邪气客居风府穴,就足以治疗疟疾了。疟疾与伤寒相同的是症状,不同的是脉象。伤寒的脉象,随着阴阳变化而变化;疟疾的症状脉象,一个“弦”字贯穿始终。懂得如何治疗伤寒,对于阴阳胜复的道理,邪正交战的时候,脏腑行经的穴位,没有不透彻知晓的。从事医疗工作的人,想要验证自己的功修,请从尝试治疗疟疾开始。
A scholar who has studied for ten years and explored medical principles for another ten years may consider himself to have mastered the essence of medicine. However, when he treats patients, his diagnosis often conflicts with the actual condition. Instead of blaming counterfeit drugs from pharmacies or acknowledging the complexity of the disease, he might argue fiercely, which is futile. Let us discuss the treatment of malaria (Nue Ji, Malaria) instead. Malaria is a superficial and obvious disease, making it an ideal test for verifying a physician's skill. This discussion does not apply to those who use harsh "plundering" medicines to achieve lucky results. Only those who command a dignified army and win every battle deserve to practice medicine in the city (as recorded in *Book of Later Han*: Fei Changfang was from Runan. While serving as a market official, he saw an old man selling medicine at the market, hanging a gourd at the shop entrance. After the market closed, the old man jumped into the gourd. The townspeople could not see him, but Fei Changfang observed this from a tower, found it strange, and visited him. The old man invited him into the gourd, revealing a magnificent jade hall filled with fine wine and food. After drinking together, they emerged. The old man later said, "I am a celestial being, punished for my faults; now that my task is done, I must leave."). If one returns home with a medicine basket but fails to cure, constantly changing prescriptions, ancient texts are discarded like chaff, and ten years of study by the cold window and lamp desk are wasted.
The classic states: "Pathogenic factors lodge in Fengfu (GV16, Wind Palace), traveling downward along the Lü vessels (the muscles flanking the spine, from the third cervical vertebra to the twenty-fourth sacral/coccygeal vertebra). The qi ascends (from the coccyx upwards) and emerges from Quepen (GB12, Shoulder Well) after nine days." Reading this, I understand why the pulse in malaria is wiry (Xian Mai, Wiry Pulse). Located inside the body shell but outside the zang-fu organs, this area belongs to the Half-Exterior and Half-Interior (Ban Biao Ban Li). Pathogens residing here cause a wiry pulse, similar to Shaoyang (Lesser Yang) disorders. Thus, wind pathogens have no fixed abode; the site of invasion becomes their abode.
If pathogens invade the vertex, all three Yang meridians ascend to the head. The Yangming (Stomach/Large Intestine) meridian runs along the hairline to the forehead. When pathogens merge with Yangming, causing headache, severe aversion to cold, followed by fever, it is Yangming Malaria. The Shaoyang (Gallbladder/San Jiao) meridian ascends to the corner of the head and descends behind the ear. When pathogens merge with Shaoyang, causing headache, mild aversion to cold, mild fever, and fear of people, it is Shaoyang Malaria. The Taiyang (Bladder/Small Intestine) meridian enters the brain from the crown, exits, and descends to the nape, passing exactly through Fengfu. Thus, it causes headache, lower back pain, heavy body, and cold starting from the back. Therefore, invasions of the Yang meridians are mostly Taiyang Malaria.
If pathogens invade the coccyx region, all three Yin meridians originate from the feet. The Taiyin (Spleen/Lung) meridian ascends to the knee and thigh, entering the abdomen. When pathogens merge with Taiyin, causing weak legs, poor appetite, and alternating chills and fever, it is Taiyin Malaria. The Jueyin (Liver/Pericardium) meridian enters the pubic region and surrounds the genitals. When pathogens merge with Jueyin, causing weak legs, lower abdominal fullness, and difficult urination, it is Jueyin Malaria. The Shaoyin (Kidney/Heart) meridian runs up the posterior thigh, straight through the Lü vessels, right at Fengfu. Thus, it causes weak legs, severe vomiting, and alternating chills and fever (more heat than cold). Therefore, invasions of the Yin meridians are mostly Shaoyin Malaria.
When pathogens invade the Yang, Yang qi gradually enters the Yin division, descending one segment daily. Its movement is slow, so attacks occur later each day, making it hard to cure. When pathogens invade the Yin, Yin qi turns into the Yang division, ascending two segments daily. Its movement is fast, so attacks occur earlier each day, making it easier to cure.
Treatment methods: For malaria in the Three Yang meridians, treat according to the Three Yang meridians (Yangming Meridian syndrome: Gegen, Shengma, Huangqin, Shaoyao, Caoguo, Zhi Gancao, Ginger and Jujube as guides. Yangming Fu syndrome: Dahuang, Mangxiao, Binglang, Houpo, Zhi Gancao, Ginger and Jujube as guides. Shaoyang syndrome, Qingpi Yin: Qingpi, Houpo, Chaihu, Huangqin, Fa Xia, Yun Ling, Baizhu, Caoguo, Zhi Gancao, Ginger and Jujube as guides. Taiyang Meridian syndrome: Mahuang, Guizhi, Xingren, Zhi Gancao, Ginger and Jujube as guides. Taiyang Fu syndrome: Jiao Baizhu, Fuling, Zhuling, Guizhi, Zexie, Caoguo, Zhi Gancao, Ginger and Jujube as guides); For malaria in the Three Yin meridians, treat according to the Three Yin meridians (Fuzi Lizhong Tang plus Caoguo to govern all Three Yins: Yuzhu, Jiao Baizhu, Ganjiang, Caoguo, Zhi Gancao, Fupian, Ginger and Jujube as guides).
If the wiry pulse transforms into a deficient pulse with sweating, only assist the Righteous Qi (Zheng Qi), and the pathogen will naturally be eliminated. Then, govern both Yin and Yang with warming and tonification (Empirical Formula: Huangqi, Jiao Baizhu, Fuzi, Shouwu, Qin Gui, Yuzhu, Caoguo, Yun Ling, Zhi Gancao, Ginger and Jujube as guide). There will be no case without immediate efficacy. *Jiyao* states: "Malaria can involve the Three Yang or the Three Yin, with distinct symptoms. Like *Shanghan Lun*, knowing how to treat Shanghan allows one to know how to treat malaria." I say that merely knowing how to treat Shanghan is insufficient for treating malaria. Knowing Shanghan, and understanding that pathogens lodge in Fengfu, is sufficient to treat malaria. What is common between them is the symptoms; what differs is the pulse. The pulse in Shanghan changes with Yin-Yang transformations; the pulse in malaria is consistently wiry throughout. Knowing how to treat Shanghan implies thorough knowledge of the principles of Yin-Yang victory and defeat, the timing of pathogen-righteous qi battles, and the acupoints of meridian circulation. Physicians wishing to verify their own cultivation should start by attempting to treat malaria.