雍曰。活人书论痰症、食积、虚烦、香港脚四者。皆与伤寒相似。而
实非伤寒。医者见其发热恶寒。多作伤寒治之。因兹夭横甚多。故特
立此名。使览者知其非伤寒也。雍取此论而广之。然虚烦一症。已置
之前卷者。仲景言病。有本是霍乱。今是伤寒者。孙真人言伤寒后虚
烦。故以霍乱虚烦二病次于前卷 湿 之后。今独取朱氏之说。继
之以疮毒。虫毒、溪水、瘴雾诸症类伤寒者。皆当辨症而后用药也。
活人书曰。病有憎寒发热者。恶风自汗。寸口脉浮。胸膈痞满。
气上冲咽喉不得息。而头不疼。项不强者。此为有痰也。虽类伤寒。
但头不疼。项不强为异。宜服柴胡半夏汤、金沸草散、大半夏汤。若
气上冲咽喉不得息者。用瓜蒂散吐之。古法服瓜蒂散用一钱匕。药
下便卧。欲吐且忍之。良久不吐。以三钱匕。汤二合和服。以手指
之。便吐。不吐。复稍增之。以吐为度。若吐少病不除。明日如前法再
服之。但不可令人虚也。药力过时不吐。饮热汤一升以助药力。吐
讫。便可食。无复余毒。若服药过多者。饮水解之。雍曰。凡吐后。须
服糜粥二三日。忌生冷油腻物。
又曰。头疼脉数。发热恶寒。而身不疼痛。左手脉平和者。食积
也。虽类伤寒。而左手人迎脉平和。身不疼痛者是也。甲乙经云。人
迎紧盛伤于寒。气口紧盛伤于食。盖气口主中。人迎主外。以此别
之。伤食之症。由脾胃伏热。因食不消发热。故似伤寒。若膈实吐呕
者。食在上脘。宜吐之。若心腹满。宜下之。治中汤、五积散、黑神丸。
可选用也。雍曰。巢氏言脾胃有伏热。因食不消。所以发热。状似伤
寒。但身不疼。头不痛为异。
又曰。食积病。亦类时行。但发热头疼。食病当速下之。时行病
当待六七日下之。
又曰。伤寒头疼身热。支节痛。大便秘。或呕逆而脚屈弱者。脚
气也。伤寒只传六经。故症与香港脚相似。然终不同者。孙真人云。卒
起。脚屈弱不能转动者。此为异耳。其脉弦而浮者起于风。濡而弱者
起于湿。洪而数者起于热。迟而涩者起于寒。风者汗而愈。湿者温而
愈。热者下而愈。寒者熨而愈。香港脚之病。始得不觉。由他病乃知。毒
气入腹。则少腹顽痹不仁。令人吐呕。死在旦夕矣。然香港脚之候。必
先从脚起。或先缓弱疼痛。（寒胜为痛痹）或行起忽倒。或两胫肿满。
或不肿。脚膝枯细。或心中忪悸。或少腹不仁。（病久入深。营卫不
荣。故为不仁。不仁者皮肤顽木不知是也。）或举体转筋。或见食吐。
遂恶闻食气。或胸满气急。或遍体酸疼。皆香港脚候。黄帝所谓缓风痹
是也。顽弱名缓风。疼痛为湿风痹。（痹者。闭也。闭而不仁。故名
痹。）宿患瘴毒。得热更增。虽形候旺盛。犹在于表。未入肠胃。不妨
温而汗之。已入内者。不妨吐而下之。又本有冷。今得温瘴。虽暴壮
热烦满秘塞。正须温药汗之。汗之不散。不妨寒药下之。若服利药不
瘥。成黄胆。不瘥。为尸疸。病前热而后寒者发于阳。无热而恶寒者
发于阴。发于阳者攻其外。发于阴者攻其内。一日二日。发汗必愈。
三日以上。宜吐之。五日以上。当下之。雍曰。要方参千金翼方十卷。
皆有方宜用。
问曰。瘴作疟何如。巢氏曰。此病生于岭南一带。山瘴之气。其
状发寒热。休作有时。皆由山溪源岭瘴湿毒瓦斯故也。其病重于伤寒
暑之疟。鲮鲤汤主之。此又休作无时。其初皆类伤寒也。
问曰。雾气如何。千金三十九卷曰。患雾气者。心内烦闷。少气。
头痛项急。起则眼眩。又身微热。战掉不安。时复憎寒。心中欲吐。吐
时无物者。猪清汤主之。雍曰。头痛项急。身热憎寒。皆伤寒类也。
问曰。温疟类伤寒。何如。素问三十三篇曰。温疟者。得之冬中
于风寒。气藏于骨髓之中。至春则阳气大发。邪气不能自出。因遇大
暑。脑髓烁。肌肉消。腠理发泄。或因有所用力。邪气与汗皆出。此病
藏于肾。其气先从内出之于外。雍曰。温疟始感之气。与伤寒同。及
其发出之时。与伤寒异。故不为伤寒而为疟也。温疟之症。寒中三
阳。所患必热。小续命汤去附子。减桂一半主之。大烦躁者。紫雪最
良。大便秘者。脾约丸、神效丸、五柔丸、大三脘散、木瓜散主之。头
痛身热。肢体痛而脚屈弱者。是其人素有香港脚。此时发动也。脚肿
者。槟榔散主之。香港脚方论。千金外台最详。大热。越婢汤、小续命
汤、薏苡仁酒、脾约丸、神效丸皆要药。仍针灸为佳。用补药与汤淋
洗。皆大禁也。雍曰。此其大致也。前言闭而不仁。故名痹。不仁者。
痹之一症。非痹皆不仁也。香港脚与痹。各详本症论之。
雍曰。凡射工毒、水毒、瘴雾、疮疡、斑豆等症。其初如伤寒。故
孙真人于伤寒后附溪毒一症。溪毒即射工。今详其状类以明其症。
与伤寒别。是亦疑而辨之也。
孙真人曰。江南有射工毒虫。一名短狐溪毒。一名蜮。其虫形如
甲虫。无目而利耳。有一长角在口前。如弩担其角端。曲如上弩。以
气为矢。因水势以射人。人或闻其在水中铋铋作声。要须得水没其
口。便以口中毒射人。此虫畏鹅。鹅能食之。其初始症候。先要寒噤。
寒热筋急。仍似伤寒。亦如中风。便不能语。朝苏晡剧。寒热闷乱。是
其症也。始得三四日。急治之。稍迟者。七日死。
又曰。中人疮有三
等。（巢云四等）
又曰。其虫小毒轻者。及相逐者。射着人影者。皆不
即作疮。先病寒热。自非其地之人不知其症。便谓伤寒。作治乖谬。
是以致祸。（方见千金二十及第十卷第五卷）雍曰。巢言含沙射人影
便成病。此取杜元凯之说。
又曰。中人头面尤急。腰以上去人心近。
多死。腰以下小腹。不治亦死。
孙真人曰。凡山水有毒虫。人涉水之时。中人。似射工而无物。
其诊法。初得之。恶寒。微似头疼。巢云。偏头痛。目眶痛。心中烦懊。
四肢振掀。腰背百节皆强。两膝痛。或翕翕而热。但欲眠。旦醒暮剧。
手足逆冷至肘膝。二三日腹中生虫。蚀人下部。肛中有疮。不痛不
痒。令人不觉。不急治之。六七日上蚀五脏。下利不禁。良工不能治
矣。水毒有阴阳。觉之。急视其下部。若有疮正赤如截肉者。为阳毒。
最急。疮如鲤鱼鳞者。为阴毒。犹小缓。要皆杀人。不过二十日也。初
中水毒时。当以小蒜作汤试之。方治详见千金。巢氏曰。东南郡县山
谷溪源有水毒病。亦名溪温。以其病与射工诊候相似。故通呼溪病。
其实有疮是射工。无疮是溪毒也。
又曰。水毒有雌雄。脉洪大而数者
为阳。是雄溪。易治。宜先发汗及浴。脉沉细而迟者为阴。是雌溪。难
治。欲审知是中水毒者。手足指冷为是。不冷非也。又呼为KT 病。
巢氏曰。岭南从仲春至仲夏。行青草瘴。季夏至孟冬。行黄芒
瘴。先热后寒。自余诸疟疾见本病门。
问曰。伤寒亦变疟乎。千金三十五卷曰。时行后变成瘴疟者。大
五补汤主之。
问曰。酒病似伤寒。何如。巢氏曰。酒有毒而性尤热。饮之过多。
故毒热气流溢经络。浸淫腑脏而生诸病也。或烦躁壮热而似伤寒。
或洒淅恶寒有同温疟。或吐利不安。或呕逆烦闷。随脏气虚寒而生
病焉。雍曰。凡痈疽病。及豌豆 疮之类。初症多类伤寒。各见本门。更不重出。
郭雍说：《活人书》论述痰症、食积、虚烦、香港脚（脚气病）这四种病症，都与伤寒相似，但实际上并非伤寒。医生见到患者发热恶寒，大多当作伤寒来治疗，因此导致很多无辜死亡。所以特别设立这个名称，使阅读的人知道它们不是伤寒。我采纳这一论述并加以扩充。然而，“虚烦”这一病症，已经放在前卷了。张仲景说过，有的病本是霍乱，现在是伤寒；孙思邈说过伤寒后的虚烦，所以将霍乱和虚烦两种病列在前卷“湿”字之后。现在单独选取朱氏的说法，接着列举疮毒、虫毒、溪水、瘴雾等类似伤寒的病症，都应当辨别症状后再用药。
《活人书》说：患病者憎寒发热，恶风自汗，寸口脉浮，胸膈痞满，气上冲咽喉导致呼吸不畅，但头不疼，项不强，这是有痰。虽然像伤寒，但头不疼、项不强是不同之处。适宜服用柴胡半夏汤、金沸草散、大半夏汤。如果气上冲咽喉导致呼吸不畅的，用瓜蒂散催吐。古法服用瓜蒂散用一钱匕的药量，药下后便躺下，想吐时且忍住它。很久不吐，再加三钱匕，与二合汤水混合服用，用手指探喉催吐，就会吐出。如果不吐，再稍微增加药量，以吐出为限度。如果吐得少病未除，第二天按前面的方法再服一次。只是不可让人体虚弱。药力过时仍不吐，喝热汤一升以助药力。吐完后，就可以进食，没有残留毒素。如果服药过多，喝水解毒。郭雍说：凡是吐后，必须吃糜粥两三天，忌食生冷油腻食物。
又说：头疼脉数，发热恶寒，而身体不疼痛，左手脉平和的，是食积。虽然像伤寒，但左手人迎脉平和，身体不疼痛就是证据。《甲乙经》说：人迎脉紧盛是伤于寒，气口脉紧盛是伤于食。大概气口主内，人迎主外，以此区别。伤食的病症，是由于脾胃伏热，因为食物不消化而发热，所以像伤寒。如果膈实呕吐的，是食在上脘，适宜催吐。如果心腹满胀，适宜泻下。治中汤、五积散、黑神丸，可以选择使用。郭雍说：巢元方说脾胃有伏热，因为食物不消化，所以发热，状似伤寒，但身体不疼、头不痛是不同之处。
又说：食积病，也类似时行病。但发热头疼，食积病应当迅速泻下，时行病应当等到六七天后再泻下。
又说：伤寒头疼身热，肢节痛，大便秘结，或呕逆而脚屈弱无力，是脚气病。伤寒只传变六经，所以症状与香港脚（脚气病）相似。然而终究不同的地方，孙思邈说：突然起身，脚屈弱不能转动，这是不同之处。其脉弦而浮的起于风，濡而弱的起于湿，洪而数的起于热，迟而涩的起于寒。风邪致病发汗可愈，湿邪致病温补可愈，热邪致病泻下可愈，寒邪致病熨烫可愈。香港脚（脚气病）这种病，刚开始不觉察，通过其他病症才知道。毒气入腹，则小腹部顽痹不知痛痒，令人呕吐，死在旦夕之间。然而香港脚（脚气病）的症状，必定先从脚开始，或者先缓弱疼痛（寒胜则为痛痹），或者行走突然跌倒，或者两小腿肿满，或者不肿，脚膝枯细，或者心中悸动，或者小腹部不知痛痒（病久入深，营卫不荣，所以为不仁。不仁是指皮肤顽木无知）。或者全身转筋，或者见食物就吐，于是厌恶闻食物的气味，或者胸满气急，或者遍体酸疼，都是香港脚（脚气病）的症状。黄帝所说的缓风痹就是这类。顽弱称为缓风，疼痛称为湿风痹。（痹，是闭塞的意思。闭而不仁，所以叫痹。）宿患瘴毒，遇到热更增加，虽然形候旺盛，仍然在表，未入肠胃，不妨碍用温药发汗。已经入内的，不妨碍用吐法和下法。又原本有冷证，现在得了温瘴，虽然暴壮热烦满秘塞，正须用温药发汗。发汗不散，不妨碍用寒药泻下。如果服利药不愈，成黄疸，不愈，成为尸疸。病前热而后寒的，发于阳；无热而恶寒的，发于阴。发于阳的攻其外，发于阴的攻其内。一日二日，发汗必愈。三日以上，宜用吐法。五日以上，当下法。郭雍说：《要方》参考《千金翼方》十卷，都有方剂适宜使用。
问：瘴气发作的疟疾怎么样？巢元方说：此病生于岭南一带，山瘴之气，其状发作寒热，休作有时，都是由山溪源岭瘴湿毒瓦斯造成的。此病重于伤寒暑之疟，用鲮鲤汤主治。这又是休作无时的，起初都像伤寒。
问：雾气怎么样？《千金方》三十九卷说：患雾气病的，心内烦闷，少气，头痛项急，起则眼眩，又身微热，战栗不安，时常憎寒，心中欲吐，吐时无物的，用猪清汤主治。郭雍说：头痛项急，身热憎寒，都像伤寒。
问：温疟类伤寒，怎么样？《素问》三十三篇说：温疟，得之于冬天受风寒，气藏于骨髓之中，到春天阳气大发，邪气不能自出，因遇大暑，脑髓销烁，肌肉消瘦，腠理发泄，或因有所用力，邪气与汗皆出。此病藏于肾，其气先从内出之于外。郭雍说：温疟初始感受的气，与伤寒相同，等到其发出之时，与伤寒不同，所以不为伤寒而为疟。温疟的症状，寒中三阳，所患必定热，用小续命汤去附子，减桂枝一半量主治。大烦躁的，紫雪最好。大便秘的，脾约丸、神效丸、五柔丸、大三脘散、木瓜散主治。头痛身热，肢体痛而脚屈弱无力的，是其人素有香港脚（脚气病），此时发动。脚肿的，槟榔散主治。香港脚（脚气病）方论，《千金方》《外台秘要》最详细。大热的，越婢汤、小续命汤、薏苡仁酒、脾约丸、神效丸都是要药。仍针灸为佳。用补药与汤淋洗，都是大禁忌。郭雍说：这是大致情况。前面说闭而不仁，所以叫痹。不仁，是痹的一种症状，并非所有痹都不仁。香港脚（脚气病）与痹，各自详述在本症论中。
郭雍说：凡是射工毒、水毒、瘴雾、疮疡、斑豆等病症，其初起都像伤寒。所以孙思邈在伤寒后附录溪毒一症。溪毒即射工。现在详细其形状类别以明确其症状，与伤寒区别，这也是疑惑而辨别它。
孙思邈说：江南有射工毒虫，一名短狐溪毒，一名蜮。其虫形如甲虫，无目而利耳，有一长角在口前，如弩担其角端，曲如上弩，以气为矢，因水势以射人。人或闻其在水中铋铋作响，必须要得水没其口，便以口中毒射人。此虫畏鹅，鹅能食之。其初始症状，先要寒噤，寒热筋急，仍像伤寒，也像中风，便不能语，朝苏晡剧，寒热闷乱，是其症状。始得三四日，急治之，稍迟者，七日死。
又说：中人疮有三等。（巢元方说是四等）
又说：其虫小毒轻的，以及相互追逐的，射着人影的，都不立即作疮，先病寒热，如果不是当地人不知道此症，便谓伤寒，治疗乖谬，以致招祸。（方剂见《千金方》二十及第十卷第五卷）郭雍说：巢元方说含沙射人影便成病，这是取杜预的说法。
又说：中人头面尤其紧急，腰以上离人心近，多死。腰以下小腹，不治亦死。
孙思邈说：凡山水有毒虫，人涉水之时，中人，似射工而无物。其诊法，初得之，恶寒，微似头疼，巢元方说偏头痛，目眶痛，心中烦懊，四肢振掀，腰背百节皆强，两膝痛，或翕翕而热，但欲眠，旦醒暮剧，手足逆冷至肘膝，二三日腹中生虫，蚀人下部，肛中有疮，不痛不痒，令人不觉，不急治之，六七日上蚀五脏，下利不禁，良工不能治矣。水毒有阴阳，觉之，急视其下部，若有疮正赤如截肉者，为阳毒，最急。疮如鲤鱼鳞者，为阴毒，犹小缓。要皆杀人，不过二十日也。初中水毒时，当以小蒜作汤试之。方治详见《千金方》。巢元方说：东南郡县山谷溪源有水毒病，亦名溪温。以其病与射工诊候相似，故通呼溪病。其实有疮是射工，无疮是溪毒也。
又说：水毒有雌雄，脉洪大而数为阳，是雄溪，易治，宜先发汗及浴。脉沉细而迟者为阴，是雌溪，难治。欲审知是中水毒者，手足指冷为是，不冷非也。又呼为KT病。
巢元方说：岭南从仲春至仲夏，行青草瘴，季夏至孟冬，行黄芒瘴。先热后寒，其余诸疟疾见本病门。
问：伤寒也变疟吗？《千金方》三十五卷说：时行后变成瘴疟的，大五补汤主治。
问：酒病似伤寒，怎么样？巢元方说：酒有毒而性尤热，饮之过多，故毒热气流溢经络，浸淫腑脏而生诸病也。或烦躁壮热而似伤寒，或洒淅恶寒有同温疟，或吐利不安，或呕逆烦闷，随脏气虚寒而生病焉。郭雍说：凡是痈疽病，及豌豆疮之类，初症多类伤寒，各见本门，更不重出。
Guo Yong said: The *Huoren Shu* (Book of Vitality) discusses four conditions—phlegm disorder (Tan Zheng), food stagnation (Shi Ji), deficiency vexation (Xu Fan), and Hong Kong foot (Hong Kong Jiao, i.e., Beriberi)—all of which resemble Taiyang disease (Taiyang Bing, a syndrome caused by pathogenic invasion of the Taiyang channel) but are actually not Taiyang disease. Physicians, seeing patients with fever and aversion to cold, often treat them as Taiyang disease, resulting in many unnecessary deaths. Therefore, this name is specifically established to make readers aware that they are not Taiyang disease. I adopt this discussion and expand upon it. However, the condition of "deficiency vexation" has already been placed in the previous volume. Zhang Zhongjing stated that some diseases originate as Huoluan (Cholera-like disease) but present as Taiyang disease; Sun Simiao discussed deficiency vexation after Taiyang disease. Thus, Huoluan and deficiency vexation are listed after the section on "Dampness" in the previous volume. Now, I selectively adopt Zhu's theory, followed by listing conditions resembling Taiyang disease such as sore toxicity, insect toxicity, stream water toxicity, and miasma fog. In all these cases, one must differentiate symptoms before administering medication.
The *Huoren Shu* states: When a patient experiences aversion to cold with fever, aversion to wind with spontaneous sweating, floating pulse at the Cunkou position, fullness and obstruction in the chest and diaphragm, Qi rushing up to the throat causing difficulty in breathing, yet without headache or neck stiffness, this indicates the presence of phlegm. Although it resembles Taiyang disease, the absence of headache and neck stiffness distinguishes it. It is appropriate to administer Chaihu Banxia Tang (Bupleurum and Pinellia Decoction), Jinfeicao San (Spinacia Seed Powder), or Dabanxia Tang (Major Pinellia Decoction). If Qi rushes up to the throat causing difficulty in breathing, use Gouti San (Melon Seed Powder) to induce vomiting. Ancient methods prescribed one Qianbi (a small measure) of Gouti San. After taking the medicine, lie down immediately. If the urge to vomit arises, restrain it for a while. If vomiting does not occur after a long time, add three Qianbi mixed with two He (a liquid measure) of warm water, and use a finger to stimulate the throat to induce vomiting. If vomiting occurs, stop. If not, slightly increase the dosage until vomiting is achieved. If little is vomited and the illness persists, repeat the method the next day. Do not cause excessive weakness. If the medicinal force passes without inducing vomiting, drink one Sheng (a liquid measure) of hot water to assist the medicinal effect. After vomiting, eating is permitted, and no residual toxin remains. If too much medicine is taken, drink water to detoxify. Guo Yong added: After vomiting, one must consume millet porridge for two to three days and avoid raw, cold, and greasy foods.
It further states: Headache with rapid pulse, fever with aversion to cold, but without body pain, and a peaceful pulse on the left hand indicates food stagnation. Although it resembles Taiyang disease, the peaceful Renying pulse on the left hand and lack of body pain are distinguishing features. The *Jia Yi Jing* (Classic of Jia Yi) states: A tight and full Renying pulse indicates injury by cold, while a tight and full Qikou pulse indicates injury by food. Generally, Qikou governs the interior, and Renying governs the exterior, allowing differentiation. Food injury symptoms arise from latent heat in the Spleen and Stomach due to undigested food causing fever, thus resembling Taiyang disease. If there is fullness in the diaphragm with vomiting, the food is in the upper Jiao, and inducing vomiting is appropriate. If there is abdominal fullness, purging is appropriate. Zhizhong Tang (Regulate the Middle Decoction), Wuji San (Five Accumulations Powder), and Heishen Wan (Black Divine Pill) can be selected. Guo Yong added: Chao Yuanfang stated that latent heat in the Spleen and Stomach due to undigested food causes fever, resembling Taiyang disease, but the lack of body pain and headache distinguishes it.
It further states: Food stagnation also resembles epidemic disorders. However, in food stagnation with fever and headache, purging should be performed quickly. In epidemic disorders, purging should wait until the sixth or seventh day.
It further states: Taiyang disease presents with headache, body heat, joint pain, constipation, or vomiting with weak and flexed feet, indicating Beriberi (Hong Kong Jiao). Taiyang disease transmits through the Six Channels, so its symptoms resemble Beriberi. However, they are ultimately different. Sun Simiao said: Sudden onset of weak and flexed feet unable to move is the distinction. A wiry and floating pulse originates from Wind; a soggy and weak pulse originates from Dampness; a surging and rapid pulse originates from Heat; a slow and choppy pulse originates from Cold. Wind-induced illnesses are cured by sweating; Dampness-induced by warming; Heat-induced by purging; Cold-induced by moxibustion/warming therapy. Beriberi is initially unnoticed and recognized through other symptoms. If toxic Qi enters the abdomen, the lower abdomen becomes numb and insensible, causing vomiting, leading to death within a day or night. However, Beriberi symptoms always start from the feet, either starting with weakness and pain (Cold excess causes painful obstruction), or sudden collapse while walking, or swelling of both calves, or no swelling with withered knees and feet, or palpitations, or insensibility in the lower abdomen (prolonged disease enters deep, Ying and Wei fail to nourish, hence insensibility; insensibility means skin is hard and numb), or whole-body cramps, or vomiting upon seeing food and aversion to food odor, or chest fullness and shortness of breath, or generalized body ache. These are all symptoms of Beriberi, referred to by the Yellow Emperor as Huan Feng Bi (Slow Wind Obstruction). Numbness and weakness are called Huan Feng; pain is called Shi Feng Bi (Damp Wind Obstruction). "Bi" means closure; closed and insensible, hence named Bi. Chronic Miasma toxicity worsens with heat. Although manifestations are vigorous, the pathogen remains in the exterior, not entering the intestines and stomach, so warming and sweating therapies are permissible. If it has entered the interior, vomiting and purging are permissible. If there was pre-existing cold and now warm miasma occurs, despite sudden high fever, irritability, fullness, and constipation, warming herbs for sweating are still required. If sweating fails to resolve it, cold herbs for purging are permissible. If purgatives fail and jaundice develops, or if it fails and becomes Corpse Jaundice, one must differentiate. Fever preceding chills indicates Yang onset; absence of fever with aversion to cold indicates Yin onset. Yang onset attacks the exterior; Yin onset attacks the interior. On the first or second day, sweating will cure it. After three days, vomiting is appropriate. After five days, purging is appropriate. Guo Yong added: *Yao Fang* references ten volumes of *Qianjin Yifang*, all containing suitable prescriptions.
Question: How about malaria caused by miasma? Chao Yuanfang said: This disease arises in the Lingnan region due to mountain miasma Qi. Its presentation involves alternating chills and fever with periodic intervals, caused by damp-toxic vapors from mountain streams and ridges. This disease is more severe than malaria caused by Taiyang disease or Summerheat. Lingli Tang (Pangolin Scale Decoction) is the primary treatment. This type has irregular intervals and initially resembles Taiyang disease.
Question: How about fog-related illness? Volume 39 of *Qianjin Fang* states: Patients suffering from fog illness experience internal irritability, shortness of Qi, headache with neck stiffness, dizziness upon rising, slight body heat, trembling and restlessness, frequent aversion to cold, and nausea with empty retching. Zhuqing Tang (Pig Clearing Decoction) is the primary treatment. Guo Yong added: Headache with neck stiffness, body heat, and aversion to cold all resemble Taiyang disease.
Question: How does Warm Malaria resemble Taiyang disease? Chapter 33 of *Suwen* states: Warm Malaria results from Wind-Cold contracted in winter, stored in the bone marrow. By spring, Yang Qi expands vigorously, but the pathogen cannot exit spontaneously. Due to extreme summer heat, brain marrow melts, muscles waste, pores open, and exertion forces the pathogen out with sweat. This pathogen resides in the Kidney, and its Qi moves from the interior to the exterior. Guo Yong added: The initial Qi contracted in Warm Malaria is the same as in Taiyang disease, but its manifestation differs, hence it is Malaria, not Taiyang disease. Symptoms of Warm Malaria involve Cold affecting the Three Yang channels, resulting in Heat. Xiaoxuming Tang (Minor Continuation Life Decoction) without Fuzi (Aconite Root), with half the amount of Guizhi (Cinnamon Twig), is used. For severe irritability, Zixue (Purple Snow) is best. For severe constipation, Xiyue Wan (Spleen Restriction Pill), Shenxiao Wan (Divine Efficacy Pill), Wuro Wan (Five Softness Pill), Da Sanwan San (Great Triple Burner Powder), and Mugua San (Papaya Powder) are used. Headache, body heat, limb pain with weak feet indicate pre-existing Beriberi flaring up. For swollen feet, Banglang San (Areca Seed Powder) is used. Discussions on Beriberi formulas are most detailed in *Qianjin Fang* and *Waitai Miyao*. For high fever, Yebipro Tang (Tiger Skin Decoction), Xiaoxuming Tang, Yiyiren Jiu (Coix Seed Wine), Xiyue Wan, and Shenxiao Wan are essential medicines. Acupuncture and moxibustion are preferred. Using tonifying herbs and herbal baths are strictly contraindicated. Guo Yong added: This is the general principle. Previously mentioned that closure and insensibility constitute Bi. Insensibility is a symptom of Bi, but not all Bi cases present with insensibility. Beriberi and Bi are detailed in their respective sections.
Guo Yong said: Conditions such as Shegong (Crossbowman) toxicity, Water toxicity, Miasma fog, Sores/Ulcers, and Smallpox/Chickenpox initially resemble Taiyang disease. Therefore, Sun Simiao appended Stream Toxicity (Xidu) after Taiyang disease. Xidu is equivalent to Shegong. I now detail their shapes and categories to clarify symptoms and distinguish them from Taiyang disease, resolving doubts through differentiation.
Sun Simiao said: In Jiangnan, there is a Shegong toxic insect, also known as Duanhu Xidu (Short Fox Stream Toxicity) or Yu (Hidden One). It resembles a beetle, has no eyes but keen hearing, and possesses a long horn in front of its mouth like a crossbow trigger, curved upward. It shoots air as arrows using water currents. People may hear a rustling sound in the water. It must submerge its mouth in water to shoot poison into people. This insect fears geese, which eat it. Initial symptoms include shivering, alternating chills and fever, muscle stiffness, resembling Taiyang disease or Stroke (Zhongfeng), leading to inability to speak. Symptoms worsen in the afternoon/evening with chaotic chills and fever. This is the clinical picture. Treat urgently within three to four days; delay leads to death in seven days.
It further states: Human affliction by sores has three grades (Chao Yuanfang says four).
It further states: Those with mild toxicity, those chasing each other, or those shooting shadows do not immediately cause sores. They first cause chills and fever. Non-locals unaware of the condition mistake it for Taiyang disease, leading to erroneous treatment and disaster. (Formulas are found in *Qianjin Fang* Vol. 20, 10, and 5). Guo Yong added: Chao Yuanfang stated that shooting shadows causes illness, adopting Du Yu's interpretation.
It further states: Affliction on the head and face is especially urgent. Areas above the waist are close to the Heart, often fatal. Areas below the waist and lower abdomen are also fatal if untreated.
Sun Simiao said: Waters and mountains contain toxic insects. When people wade in water, they are afflicted. It resembles Shegong but lacks physical projectiles. Diagnosis: Initially, aversion to cold, slight headache (Chao Yuanfang says unilateral headache), orbital pain, internal irritability, limb tremors, stiffness in back and joints, knee pain, slight heat, sleepiness, worsening in evening, cold extremities up to elbows and knees. Within two to three days, worms breed in the abdomen, eroding the lower body, causing anal sores that are painless and itchless, going unnoticed. If not treated urgently, within six to seven days, the Five Zang organs are eroded, leading to uncontrollable diarrhea, incurable even by skilled physicians. Water toxicity has Yin and Yang types. Examine the lower body urgently. Red sores like cut meat indicate Yang Toxicity, most urgent. Scales like carp indicate Yin Toxicity, slightly less urgent. Both are fatal within twenty days. Upon initial water toxicity, test with garlic decoction. Formulas are detailed in *Qianjin Fang*. Chao Yuanfang said: Eastern and southern counties have Water Toxicity disease, also called Xi Wen (Stream Warmth). Due to similarity with Shegong diagnosis, it is collectively called Xi Bing (Stream Disease). Actually, sores indicate Shegong; no sores indicate Water Toxicity.
It further states: Water toxicity has male and female types. Surging, large, and rapid pulses indicate Yang (Male Stream), easy to treat, suitable for sweating and bathing. Deep, fine, and slow pulses indicate Yin (Female Stream), difficult to treat. To confirm water toxicity, cold fingers and toes are indicative; warmth excludes it. Also called KT Bing.
Chao Yuanfang said: Lingnan experiences Green Grass Miasma from mid-spring to mid-summer, and Yellow芒 Miasma from late summer to early winter. Preceded by heat then chills. Other malaria types are seen in the Malaria section.
Question: Can Taiyang disease transform into Malaria? Volume 35 of *Qianjin Fang* states: Epidemic disorders transforming into Miasma Malaria are treated with Da Wubu Tang (Great Five Tonics Decoction).
Question: How does Alcohol Illness resemble Taiyang disease? Chao Yuanfang said: Alcohol is toxic and particularly hot. Excessive consumption causes toxic heat to overflow meridians, infiltrate Zang-Fu organs, and generate various diseases. It may present as irritability and high fever resembling Taiyang disease, or shivering and aversion to cold resembling Warm Malaria, or vomiting/diarrhea with unrest, or nausea and irritability, depending on organ deficiency and cold. Guo Yong added: Sores/Ulcers and Pea Pox initially resemble Taiyang disease, detailed in their respective sections, not repeated here.