治疟总要不过吐、汗、下而已,当下而下不尽,腹中尚有余痛,或大便一泄之后不复再
泄,但时时点滴而出者,须再下之,大黄以佐常山可也。当汗而汗不匝,或头汗至胸而手足
无汗者,须周浃一身而汗之,青皮以佐紫苏可也。所谓吐者,须出尽其水饮,若作吐剂,常
山岂容辍哉?能于三者究竟焉,收效必矣。
疟之为厉,大抵连绵,有病瘥以后,或饮食失节,或恚怒伤中,或梳洗感风又再发者,
何以处之?曰∶热多者,二陈东加青皮、甘草;热少者,二陈东加青皮、草果坚守胃气而
二药并用生姜、乌梅、蜜
水同煎,空心进剂。其间斡运,更用巴豆丸子药疏利大便,以
泄毒瓦斯,其何厉之有?或服巴药过多,以致腹痛,可用生姜、甘草煎汤,温和解之。甘草、
生姜解诸药毒。
退热用凉药,不可十分尽,或余热些少未去,不足关心,自然无事,否则热去则寒起,
古人戒之。一方多用川芎、茯苓、甘草,少用白术,粗末水煎,病后和胃,收敛浮阳,屡试
得效。
若药弗瞑眩,厥病弗瘳。世俗治热,例用柴胡,最为稳当。至若黄芩一辈,则指为大寒,
不敢用之,不思药病不相当,鲜克有济,继今退热而热不去者,须用黄芩。
凡壮热烦躁,用柴胡、黄芩、大黄解利之。其热乍轻而不退,盍用黄芩、川芎、甘草、
乌梅作剂,或用黄连、生地黄、赤茯苓同煎,临熟入灯心一捻主之,其效亦速。盖川芎、生
地黄皆能调血,心血一调,其热自退。
治疗疟疾的关键,不过在于吐法、汗法、下法这三种手段罢了。如果应当使用下法却未能彻底攻下,腹部仍有残留疼痛,或者大便虽然排泄了一次之后不再继续排泄,只是时时点滴排出少量粪便的,必须再次使用下法,可以用大黄辅助常山来治疗。如果应当使用汗法却汗出不透,或者只有头部出汗直到胸部,而手足没有汗出的,必须让全身均匀出汗,可以用青皮辅助紫苏来治疗。所谓的吐法,必须将体内的水饮痰涎彻底吐出,如果要制作催吐药剂,怎么能停止使用常山呢?如果能透彻理解并运用这三种方法,收效必定显著。
疟疾作为一种疫病,大多缠绵难愈。有的患者在病愈之后,因为饮食不节制,或因愤怒损伤脾胃,或因梳洗时感受风邪而再次发作,这种情况该如何处理呢?回答说:热象明显的,在二陈汤基础上加入青皮、甘草;热象轻微的,在二陈汤基础上加入青皮、草果,以固守胃气,这两味药并用生姜、乌梅、蜜水共同煎煮,空腹服用。在此期间调理气机,还可以用巴豆制成的丸药疏通利导大便,以排泄毒气,这样又有什么可怕的疫病呢?或者服用巴豆类药物过多,导致腹痛,可以用生姜、甘草煎汤,温和地解除其毒性。甘草和生姜能解各种药物的毒性。
退热时使用凉性药物,不可完全用尽,如果还有少许余热未去,不必过于担心,自然会平安无事,否则热邪退去后寒邪就会兴起,古人对此有告诫。有一个方子多用川芎、茯苓、甘草,少用白术,切成粗末用水煎煮,用于病后调和胃气,收敛浮越的阳气,多次尝试都取得了疗效。
如果服药后没有出现瞑眩反应(指服药后病情暂时加重或出现剧烈反应,随后病愈的现象),重病就不会痊愈。世俗医生治疗热证,惯例使用柴胡,被认为是最稳妥的。至于像黄芩这一类药物,则被指责为大寒之药,不敢使用,却不思考药物与病症是否相适宜,很少能有成效。从今以后,如果退热而热势不退的,必须使用黄芩。
凡是高热烦躁的,使用柴胡、黄芩、大黄来解表清热。如果热势暂时减轻但不消退,为何不使用黄芩、川芎、甘草、乌梅作为药剂,或者使用黄连、生地黄、赤茯苓共同煎煮,临熟时加入一撮灯心草来主治它,其疗效也很快。因为川芎、生地黄都能调理血液,心血一旦得到调理,热势自然消退。
The key to treating malaria lies merely in the three methods of emesis (vomiting), diaphoresis (sweating), and purgation. If purgation is indicated but not thoroughly executed, leaving residual abdominal pain, or if after one bowel movement there is no further defecation, only occasional dripping discharge, another purgative treatment is required; Dahuang (Rhei Radix et Rhizoma) can be used to assist Changshan (Polygalae Radix). If diaphoresis is indicated but sweat does not circulate fully, or if sweating occurs only from the head down to the chest while the hands and feet remain dry, it is necessary to induce uniform sweating over the whole body; Qingpi (Citri Reticulatae Pericarpium Viride) can be used to assist Zisu (Perillae Folium). The so-called emesis method requires expelling all phlegm-fluid retention; if preparing an emetic formula, how could one omit Changshan (Polygalae Radix)? If one thoroughly comprehends these three methods, efficacy will surely be achieved.
Malaria, as a pestilential disease, tends to be lingering. After recovery, relapses may occur due to irregular diet, anger injuring the middle jiao, or catching wind during washing/combing. How should this be managed? It is said: For cases with predominant heat, add Qingpi (Citri Reticulatae Pericarpium Viride) and Gancao (Glycyrrhizae Radix et Rhizoma) to Erchen Tang (Two-Cured Decoction); for cases with less heat, add Qingpi (Citri Reticulatae Pericarpium Viride) and Caoguo (Tsaoko Fructus) to Erchen Tang (Two-Cured Decoction) to protect stomach qi, using both herbs decocted together with Shengjiang (Zingiberis Rhizoma Recens), Wumei (Mume Fructus), and honey-water, taken on an empty stomach. In between, to regulate qi dynamics, Baidu Wanzi (Crotonis Fructus Pills) can be used to unblock and promote bowel movements, thereby draining toxic vapors; what harm could such a pestilence do? If excessive use of Baidu (Crotonis Fructus) causes abdominal pain, decocting Shengjiang (Zingiberis Rhizoma Recens) and Gancao (Glycyrrhizae Radix et Rhizoma) in water can gently resolve the toxicity. Gancao (Glycyrrhizae Radix et Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) can detoxify various medicines.
When using cooling herbs to reduce fever, they should not be used to their full extent. A small amount of residual heat remaining is not concerning and will naturally resolve; otherwise, when heat dissipates, cold may arise, as warned by ancient physicians. One formula uses more Chuanxiong (Ligustici Chuanxiong Rhizoma), Fuling (Poria), and Gancao (Glycyrrhizae Radix et Rhizoma), with less Baizhu (Atractylodis Macrocephalae Rhizoma), cut into coarse pieces and decocted in water. This is used post-illness to harmonize the stomach and consolidate floating yang, having proven effective in repeated trials.
"If the medicine does not cause mingxuan reaction (a state of dizziness or severe discomfort indicating the drug is acting against the pathogen), the serious illness will not heal." Secular doctors treating heat conditions routinely use Chaihu (Bupleuri Radix), considering it safest. However, herbs like Huangqin (Scutellariae Radix) are labeled as excessively cold and avoided. They fail to consider that if the herb's nature does not match the disease, little benefit is gained. Henceforth, for fever reduction where heat persists, Huangqin (Scutellariae Radix) must be used.
For high fever and restlessness, use Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), and Dahuang (Rhei Radix et Rhizoma) to relieve and clear heat. If the fever temporarily subsides but does not disappear, why not use Huangqin (Scutellariae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), and Wumei (Mume Fructus) as a formula? Alternatively, decoct Huanglian (Coptidis Rhizoma), Shengdihuang (Rehmanniae Radix), and Chi Fuling (Poria cum Rubro), adding Dengxincao (Junci Medullia) near the end of boiling. Its effect is also rapid. This is because Chuanxiong (Ligustici Chuanxiong Rhizoma) and Shengdihuang (Rehmanniae Radix) both regulate blood; once heart blood is regulated, the heat naturally recedes.