夫我崇俗,所谓麻痧者,是果有诸。盖东南方卑
气湿,或岭南气暖,沿江濒海,雾露飓潮,较别处尤
甚,每交夏令,天之暑热一动,地之湿浊自腾,故山
岚海瘴阴霾晦蔽之邪,乘时窃发,人在此蒸淫热逼之
中,正气有亏,则邪浊(1)自口鼻直据膜原。夫膜原者
胃络也。前吴又可制达原饮一方,即此意也。盖邪既
内伏。乘时发动,先觉胸腹胀闷,懊侬似痛,欲吐不
吐,欲泻不泻,此暑湿秽浊阻遏中腕,致阳明气机壅
塞,脉络俱闭,四肢麻木,甚至筋挛拘急,此属痧
胀,实系闭症,即方书所谓绞肠痧,干霍乱是也。此与
吐泻后,转筋麻木,冷汗阳脱之症,相去径庭,用药
(1)浊:原作乍"触",据文光书局本改。
亦有霄壤之殊,夫脱症宜温宜补,闭症宜疏宜通,而
其仓促危险,大约相等。若痧胀不得吐泻,而懊侬闷
乱异常,以致脉伏肢冷,甚则麻木拘攀,此阳症似
阴,闭症似脱,例宜宣通。但以栀豉汤服下,以指探
吐,俾气机得宣,邪能泄越,即可向愈。考方书有烧
红食盐,童便调服,得吐而愈者,试之极验。或用白
矾含化,觉味甜如冷糖者,痧胀无疑,即任意咽下
涩口得吐亦愈。若已经吐泻者,气已宣通,不可再
用,徒伤胃气,如或胃中仍有不和,腹中烦满,恶逆
不食,犹恐余邪未尽,更以藿香正气散和之,亦可全
愈。故近俗所谓麻痧者,即此是也。若云冷麻痧者,
殊属可笑,并有莽卤之医,竟不顾名思义,妄认为
痧,而以疏泄解表之药,施于阳气欲脱之候,定(1)不
为投井下石乎!草菅人命,莫此为甚,谨之戒之。
我们当地的风俗,所谓的“麻痧”,确实存在。大概是因为东南地区地势低洼潮湿,或者岭南气候温暖,沿江沿海地带,雾气、露水、飓风、海潮等湿气比别处更为严重。每当进入夏季,天上的暑热一动,地上的湿浊之气自然升腾,因此山岚海瘴中阴霾晦蔽的邪气,趁着时令发作。人处于这种湿热蒸逼的环境中,如果正气亏损,那么邪浊之气就会从口鼻直接占据膜原(半表半里的部位)。所谓膜原,就是胃的络脉。以前吴又可制定了达原饮一方,就是基于这个意思。
既然邪气已经内伏,趁着时令发动,起初会感到胸腹胀闷,心中烦乱似痛,想吐吐不出来,想拉拉不出来,这是暑湿秽浊之气阻遏中焦,导致阳明经气机壅塞,脉络全部闭塞,四肢麻木,甚至筋脉痉挛拘急,这属于痧胀,实际上是闭证,也就是医书中所谓的绞肠痧、干霍乱。这与吐泻之后,出现转筋麻木、冷汗淋漓、阳气脱失的症状,截然不同。用药也有天壤之别:脱证适宜温补,闭证适宜疏泄通利,而它们的仓促危险程度,大致相等。
如果是痧胀不能吐泻,且心中烦乱异常,以至于脉象沉伏、四肢冰冷,甚至麻木拘挛,这是阳证似阴,闭证似脱,按照例法应当宣通。可以先服用栀豉汤,然后用手指探喉催吐,使气机得以宣通,邪气能够宣泄排出,就可以趋向痊愈。考察医书中有用烧红的食盐,用童便调服,能吐出而痊愈的方法,尝试起来极其灵验。或者用白矾含在口中化开,觉得味道甜如冷糖的,无疑是痧胀,即使任意咽下,只要涩口引起呕吐也能痊愈。
如果已经发生吐泻,说明气机已经宣通,不可再用催吐之法,否则会徒然损伤胃气。如果此时胃中仍然不和,腹中烦闷胀满,恶心反逆不想进食,还担心余邪未尽,可以用藿香正气散调和,也可以完全痊愈。所以近代世俗所说的麻痧,就是指这种情况。如果说有“冷麻痧”,实在可笑。更有粗鲁无知的医生,竟然不顾名思义,妄认为是痧症,而在阳气即将脱失的时候,使用疏泄解表的药物,这难道不是落井下石吗!草菅人命,没有比这更严重的了,务必谨慎戒除。
In our local customs, the so-called "Ma Sha" (Plague-like distension) indeed exists. This is largely because the southeastern regions are low-lying and damp, or Lingnan has a warm climate; along rivers and coasts, fog, dew, hurricanes, and sea tides are more severe than elsewhere. Whenever summer arrives, as the heavenly heat rises, the earthly damp turbidity naturally ascends. Thus, the evil pathogens of mountain miasma and sea pestilence, characterized by gloom and obscurity, take advantage of the season to erupt. When humans are subjected to this steaming and humid heat, if their righteous qi (Vital Energy) is deficient, the turbid evil pathogens will directly occupy the Mo Yuan (Membrane Source, a location between the exterior and interior) through the mouth and nose. The Mo Yuan is the collateral network of the Stomach. In the past, Wu Youke formulated the Da Yuan Yin (Reach the Original Decoction), which was based on this concept.
Once the pathogens have潜伏 internally and are activated by the season, one initially feels chest and abdominal fullness and oppression, with a sense of restlessness and pain, desire to vomit but unable to do so, and desire to defecate but unable to do so. This is due to summer-heat, dampness, and foul turbidity obstructing the Middle Jiao (Middle Burner), causing stagnation of the Qi mechanism of the Yangming channel, closure of all collaterals, numbness of the four limbs, and even muscle spasms and contractures. This belongs to Sha Distension (Plague Distension), which is actually a Bi Syndrome (Obstruction Syndrome), also known in medical texts as Jiao Chang Sha (Intestinal Twisting Plague) or Gan Huo Luan (Dry Cholera). This is vastly different from symptoms occurring after vomiting and diarrhea, such as muscle twitching, numbness, cold sweat, and Yang collapse. The medication differs as much as heaven and earth: Collapse Syndromes require warming and tonifying, while Obstruction Syndromes require dispersing and unblocking, though their sudden danger is roughly equal.
If Sha Distension prevents vomiting and diarrhea, accompanied by extreme restlessness and confusion, leading to a submerged pulse and cold limbs, or even numbness and contracture, this is a Yang Syndrome resembling Yin, or an Obstruction Syndrome resembling Collapse. According to standard practice, it should be treated with dispersion and unblocking. One may administer Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) and induce vomiting by probing the throat with a finger, allowing the Qi mechanism to open and the pathogens to vent, leading to recovery. Medical texts record that using salt heated until red, mixed with child's urine, can induce vomiting and cure the condition; this method is extremely effective when tested. Alternatively, holding Bai Fan (Alum) in the mouth to dissolve it; if the taste becomes sweet like cold candy, it is undoubtedly Sha Distension. Even if swallowed arbitrarily, inducing vomiting due to the astringent sensation will lead to recovery.
If vomiting and diarrhea have already occurred, the Qi mechanism is already unblocked, and inducing vomiting again should be avoided, as it would merely damage Stomach Qi. If there is still disharmony in the Stomach, abdominal烦满 (fullness and distress), nausea, aversion to food, and concern that residual pathogens remain, one can harmonize with Huo Xiang Zheng Qi San (Patchouli Powder for Rectifying the Qi), which can also lead to complete recovery. Therefore, what modern folk call "Ma Sha" refers to this condition. To speak of "Cold Ma Sha" is ridiculous. Moreover, some reckless physicians, failing to understand the name, mistakenly diagnose it as Sha and administer dispersing and releasing-the-exterior herbs to patients whose Yang Qi is on the verge of collapse. Is this not adding fuel to the fire? There is no greater disregard for human life than this. One must be cautious and beware.