大人小儿感证,热入心胞,神昏谵语者,有犀角、羚羊角、连翘、金银花、元参、生地
、人
中黄、生甘草等味,送下至宝丹,往往获效,其有热邪深入发痉者,亦宜以此疗之。世人遇
小儿患此证者,妄谓惊风,用针挑之,走泄真气,阴阳乘逆,转至不救。
咸丰戊午秋日,仁和司训吴蓉峰之孙女,(十二岁),冒暑神昏谵语发痉,余以煎药投之
,蓉
峰之室人,复延女医视之,谓是惊风,以针挑之,次日病热转剧而殒,余甚讶药之无灵,深
以为歉。庚申秋日,避难北车塔村,村中陈氏儿发热神昏,谵语发痉,余仍以前药与之,服
药后酣睡汗出,似有转机,忽其戚某医来视,谓是惊风,以针挑其胸腹,其汗遂敛,病益加
重,至夜即毙。同时余又治二人病情相同,皆用前药得痊,则皆不用针挑者也,始知前二人
之死,非药之咎,实由误认惊风而用针挑耳,特志之以示戒。
《内经》疗疫小金丹古法,今不能用。近日所传治瘟之方,刘松峰之五瘟丹,制甘草(
年为君)、黄芩(乙庚年为君)、黄柏(丙辛年为君)、栀子(丁壬年为君)、黄连(戊癸年为君、
)香附(去净细毛)、苏叶(凤头者)、苍术(米泔浸)、陈皮(以上四味为臣)、明雄黄(另研细、
)朱砂(另研细),制甘草法∶(立冬日取大青竹,一头截去节,一头留节,纳生甘草于内,蜡
封口,浸粪坑中,冬至取出,晒干听用。)前甘草五味,当以某年为君者多臣数之半,如甘
草二两,则此外八味止用一两,雄、朱二味又减半,止用五钱,于冬至日将甘草等九味为末
,雄、朱另研,以一半入甘草等药末中为丸,留一半为衣,再用飞金为衣,大人服者丸如梧
子,小儿服者丸如黍米,雪水生蜜为丸。面东服五十丸,病轻日浅者一服愈,病深日久者,
三四服愈,忌一切浓味。此方兼治暑月一切热证,又解痘疹毒。有力之家,制丸施人,功德无
量。至于避瘟之法,用乳香、苍术、细辛、生甘草、芸香、白檀香为末,枣肉丸,焚之,又
以贯众浸厨房水缸用之,又雄黄二两,丹砂、鬼臼、石菖蒲各一两,共为末,井水调和,涂
五心及额上、鼻中、耳门,辟瘟甚验。若入瘟家,以麻油涂鼻孔,出再取嚏,则不染,皆善
法也。而握要之法,则如张景岳所云∶必节欲节劳,仍勿忍饥而迎其气。尤为得之。
常州余师愚霖客中州时,父染疫,为群医所误,及奔丧归,视诸方皆不外治伤寒之法,
思此
症必有以活人者,公之于世,稍释隐憾,因读《本草》言石膏性寒,大清胃热,味淡而薄,
能表肌热,体沉而降,能泄实热,恍然大悟,非此不足以治热疫。遇有此症,投之无不获效
,历三十年,活人不少,遂着《疫症一得》二卷,于乾隆五十九年自序刊行。大旨谓吴又可
辨论伤寒瘟疫甚晰,如头痛发热恶寒,不可认为伤寒表证,强为热汗,徒伤表气,热不退,
又
不可下,徒损胃气,斯证已得其奥妙,惟于从口鼻入不传于胃而传于膜原,此论似有语病,
至用达原、诸承气,犹有附会表里之意,惟熊任昭首用败毒散,去其瓜牙,继用桔梗汤,用
为舟楫之剂,退胸膈及六经之热,确系妙法。余采用其法,减去硝、黄,以疫乃无形之毒,
难以当其猛烈,重用石膏,直入戊己,先捣其窠巢之害,而十二经之患自易平矣。其方名清
瘟败毒散,药用生石膏(大剂六两至八两,中剂二两至四两,小剂八钱至一两二钱)、小生地
(大剂六钱至一两,中剂三钱至五钱,小剂二钱至四钱)、乌犀角(大剂六钱至八钱,中剂二
钱至四钱,小剂一钱至钱半)、真川连(大剂六钱至四钱,中剂二钱加至四钱,小剂一钱至钱
半)、生栀子、桔梗、黄芩、知母、赤芍、元参、连翘、竹叶、甘草、丹皮。以为疫症初起
,恶寒发热,头痛如劈,烦躁谵妄,身热肢冷,舌刺唇焦,上呕下泄,六脉沉细而数,即用
大剂;沉而数者,用中剂;浮大而数者,用小剂。如 一出,即用大青叶,量加升麻四五分
,引毒外透,此内化外解,浊降清升之法,治一得一,治十得十,以视升提发表而愈剧者异
矣。其所载治验,俱用石膏数两,犀角、黄连数钱。归安江《笔花医镜》载治一时疫发 ,
用石膏至十四斤而 始退,盖即用其法也。近陈载庵亦仿之而获效。王学权《重庆堂随笔》
云∶吴又可治疫主大黄,盖所论湿温为病,湿为地气,即仲圣所云浊邪中下之疫,浊邪乃有
形之湿秽,故宜下而不宜清。余师愚治疫主石膏,盖所论者暑热为病,暑为天气,即仲圣所
云清邪中上之疫,清邪乃无形之燥火,故宜清而不宜下。二公皆卓识,可为治疫两大法门。
允哉言乎?
无论是成人还是儿童,若感受疫疠之邪,热邪陷入心包络,出现神志昏迷、胡言乱语的症状,可用犀角、羚羊角、连翘、金银花、元参(玄参)、生地(生地黄)、人中黄、生甘草等药物煎汤,送服至宝丹,往往能取得疗效。对于热邪深入导致身体抽搐痉挛的患者,也适宜用此法治疗。世人遇到小儿患这种病证时,错误地认为是惊风,用针挑刺皮肤,导致真气耗散,阴阳之气逆乱,反而导致病情恶化无法救治。
咸丰八年(戊午年)秋天,仁和县的学官吴蓉峰的孙女(十二岁),因中暑而神志昏迷、胡言乱语并发生抽搐。我用之前提到的药方给她服用。吴蓉峰的妻子又请了一位女医生诊治,女医生说是惊风,便用针挑刺她的皮肤。第二天,孩子的病情加重并死亡。我对药效感到惊讶,内心深感愧疚。庚申年(咸丰十年)秋天,我避难在北车塔村,村里陈家的孩子发热、神志昏迷、胡言乱语并发生抽搐,我仍然用之前的药方给他服用。服药后,孩子酣睡并出汗,似乎有了好转的迹象。忽然,亲戚中一位姓某的医生来诊治,说是惊风,用针挑刺孩子的胸腹部,孩子的汗随即收敛,病情更加严重,当天夜里就去世了。同时,我又治疗了另外两个病情相同的孩子,都用了前面的药方痊愈,而且都没有经过针挑。这才知道前两个孩子死亡,不是药物的过错,实在是因为误认为是惊风而使用了针挑所致。特意记录此事以作为警示。
《黄帝内经》中治疗疫病的小金丹古法,现在已无法使用。近日流传的治疗瘟疫的方剂,有刘松峰的“五瘟丹”。其制法是:以当年天干对应的君药为君——甲己年为甘草(君药),乙庚年为黄芩(君药),丙辛年为黄柏(君药),丁壬年为栀子(君药),戊癸年为黄连(君药);香附(去净细毛)、苏叶(选用凤头者)、苍术(米泔水浸泡)、陈皮(以上四味为臣药);明雄黄(另研细粉)、朱砂(另研细粉)。制甘草的方法:在立冬之日,取大青竹,一头截去节,一头保留节,将生甘草放入竹内,用蜡封口,浸入粪坑中,冬至日取出,晒干备用。前述五味君药中,应以某年为君的药物用量加倍,作为臣药的辅助力量。例如甘草二两,则其余八味药只用一两,雄黄和朱砂再减半,只用五钱。在冬至日,将甘草等九味药研成粉末,雄黄和朱砂分别单独研磨,将其中一半混入甘草等药末中制成丸剂,留另一半作为丸衣,再用飞金包裹。成人服用者丸剂如梧桐子大小,小儿服用者如黍米大小,用雪水和蜂蜜制作丸剂。面向东方服用五十丸,病情轻浅的一天即可痊愈,病情深重日久者,三到四次服用即可痊愈。忌食一切浓腻厚味的食物。此方兼治暑月各种热证,又能解除痘疹之毒。富裕人家制作丸剂施舍给人,功德无量。至于预防瘟疫的方法,可用乳香、苍术、细辛、生甘草、芸香、白檀香研成粉末,用枣肉做成丸剂,焚烧烟雾熏蒸;又用贯众浸泡在厨房的水缸中使用;又或用雄黄二两,丹砂、鬼臼、石菖蒲各一两,共研成粉末,用井水调和,涂抹在手心、脚心、心口、额头、鼻孔、耳门等处,辟除瘟疫非常有效。如果进入瘟疫患者家中,用麻油涂抹鼻孔,出来后再打喷嚏,就不会被感染,这些都是好的方法。然而抓住要领的方法,就像张景岳所说:必须节制欲望、避免劳累,并且不要忍着饥饿去迎接疫气。这尤为得当。
常州人余师愚(名霖)客居中州时,父亲感染了疫病,被众多医生误治。等到他奔丧回家,查看各位医生的处方,都不外乎治疗伤寒的方法。他思考这种病症一定有能救活人的方法,于是公之于世,以稍微消除内心的遗憾。因为他阅读《本草》得知石膏性寒,能大清胃热,味道淡而薄,能透发肌表之热,质地沉重而沉降,能泄实热,恍然大悟,认为非石膏不足以治疗热疫。遇到此类病症,投用石膏无不获得疗效,历经三十年,救活的人不少,于是撰写《疫症一得》二卷,于乾隆五十九年自序刊行。其主要观点认为吴又可对伤寒和瘟疫的辨析非常清晰,如头痛、发热、恶寒,不能认为是伤寒表证,强行发汗,只会损伤表气,热不退,又不能攻下,只会损伤胃气,这一论点抓住了奥妙。只是关于病邪从口鼻而入,不传于胃而传于膜原的说法,似乎有语病。至于使用达原饮、诸承气汤,仍有附会表里之意。只有熊任昭首先使用败毒散,去掉其中的瓜蒂等牙药,继而又用桔梗汤,作为舟楫之剂,退去胸膈及六经的热邪,确实是妙法。余师愚采用这种方法,减去芒硝、大黄,因为疫病是无形的毒邪,难以承受猛烈的攻伐,重用石膏,直入脾胃(戊己属土/胃),先捣毁其巢穴的危害,那么十二经的病患自然容易平复。他的方剂名为清瘟败毒散,药用生石膏(大剂量六两至八两,中剂量二两至四两,小剂量八钱至一两二钱)、小生地(大剂量六钱至一两,中剂量三钱至五钱,小剂量二钱至四钱)、乌犀角(大剂量六钱至八钱,中剂量二钱至四钱,小剂量一钱至钱半)、真川连(大剂量六钱至四钱,中剂量二钱加至四钱,小剂量一钱至钱半)、生栀子、桔梗、黄芩、知母、赤芍、元参、连翘、竹叶、甘草、丹皮。他认为疫病初起,出现恶寒发热、头痛如劈、烦躁谵妄、身热肢冷、舌面生刺嘴唇焦裂、上吐下泻、六脉沉细而数等症状时,即使用大剂量;脉沉而数的,使用中剂量;脉浮大而数的,使用小剂量。如果斑疹一出,即用大青叶,适量加入升麻四五分,引导毒邪向外透发,这是内化外解、浊降清升的方法,治疗一个成功一个,治疗十个成功十个,与那些使用升提发表法导致病情加剧的情况截然不同。他所记载的治疗验证,都使用石膏数两,犀角、黄连数钱。归安江涵暾的《笔花医镜》记载治疗一时流行的疫病,使用石膏多达十四斤才使斑疹消退,大概也是采用的这种方法。最近陈载庵也仿效此法并获得疗效。王学权在《重庆堂随笔》中说:吴又可治疗疫病主要使用大黄,大概是因为他论述的是湿温病,湿是地气,即仲景所说的浊邪中下的疫病,浊邪是有形的湿秽,所以宜用攻下而不宜用清热。余师愚治疗疫病主要使用石膏,大概是因为他论述的是暑热病,暑是天气,即仲景所说的清邪中上的疫病,清邪是无形的燥火,所以宜用清热而不宜用攻下。两位先生都有卓越的见识,可以说是治疗疫病的两大法门。这话确实可信吗?
Whether in adults or children, if they contract epidemic pathogens and the heat pathogen enters the Pericardium (Heart Protector), resulting in coma and delirious speech, one can use Rhinoceros Horn (Xijiao), Antelope Horn (Lingyangjiao), Forsythia (Lianqiao), Honeysuckle (Jinyinhua), Scrophularia (Yuanshen/Shexuan), Rehmannia Root (Shengdihuang), Human Excrement Yellow (Renzhonghuang), and Raw Licorice (Shenggancao) to decoct a medicine, which is then taken with Zhibao Dan (Precious Treasure Pill). This often yields effective results. For those whose heat pathogen has penetrated deeply causing spasms, this method is also suitable. People today, encountering children suffering from this condition, wrongly attribute it to Wind-Convulsion (Jingfeng) and use needle pricking, which leaks the True Qi (Zhenqi) and causes Yin and Yang to rebel, leading to untreatable deterioration.
In the autumn of the Wuwu year of the Xianfeng reign, the granddaughter (aged twelve) of Wu Rongfeng, an instructor at Renhe County, contracted summerheat, resulting in coma, delirious speech, and spasms. I administered the aforementioned decoction. Wu’s wife subsequently invited a female physician, who diagnosed it as Wind-Convulsion and applied needle pricking. The next day, the child’s fever intensified, and she died. I was surprised by the lack of efficacy of the medicine and felt deeply remorseful. In the autumn of the Genshen year, while taking refuge in Beiche Tower Village, a child of the Chen family in the village presented with fever, coma, delirious speech, and spasms. I again used the previous prescription. After ingestion, the child slept soundly and sweated, showing signs of improvement. Suddenly, a relative who was a physician came to examine the child, diagnosed it as Wind-Convulsion, and pricked the chest and abdomen with needles. The sweating ceased immediately, the condition worsened, and the child died that night. At the same time, I treated two other patients with identical conditions using the same prescription, both recovered, and neither had undergone needle pricking. It was then realized that the deaths of the first two children were not due to the ineffectiveness of the medicine, but rather due to the misdiagnosis of Wind-Convulsion and the subsequent application of needle pricking. I record this specifically as a warning.
The ancient method for treating epidemics described in the *Neijing* (Inner Canon) using Xiaojindan (Little Golden Pill) cannot be employed today. Recently circulated prescriptions for treating plagues include Liu Songfeng’s *Wuwen Dan* (Five Plagues Pill). Its preparation involves designating a sovereign herb based on the heavenly stem of the year: Gancao (Licorice Root) for Jia/Ji years; Huangqin (Scutellaria Root) for Yi/Geng years; Huangbai (Phellodendron Bark) for Bing/Xin years; Zhizi (Gardenia Fruit) for Ding/Ren years; Huanglian (Coptis Rhizome) for Wu/Gui years. Ministers (assistant herbs) include Xiangfu (Cyperus Rhizome, cleaned of fine hairs), Zisuye (Perilla Leaf, selecting those with phoenix-head shape), Cangzhu (Atractylodes Rhizome, soaked in rice wash water), and Chenpi (Tangerine Peel). Additional ingredients include Mingxionghuang (Realgar, separately ground fine) and Zhusha (Cinnabar, separately ground fine). The method for preparing Gancao is as follows: On the Start of Winter (Lidong), take a large green bamboo stalk, cut off the nodes at one end, leave the node at the other end, insert raw Gancao inside, seal with wax, and immerse in a manure pit. Retrieve on the Winter Solstice (Dongzhi), dry, and set aside. Among the five sovereign herbs mentioned above, the one corresponding to the current year as sovereign should be doubled in quantity relative to the ministers. For example, if Gancao is 2 liang, the other eight herbs are used only 1 liang, and Realgar and Cinnabar are halved again to 5 qian. On the Winter Solstice, grind the nine herbs (including Gancao) into powder. Mix half of the Realgar and Cinnabar powders into the herbal powder to form pills, leaving the other half as the coating. Coat with gold leaf. Adult dosage: pills the size of wutong seeds. Pediatric dosage: pills the size of millet grains. Formulate with snow water and honey. Take 50 pills facing east. For mild and recent diseases, one dose suffices for cure; for deep-seated and chronic diseases, three to four doses suffice. Avoid all rich and greasy foods. This formula also treats various heat syndromes in summer months and resolves toxicity from smallpox/rashes. Wealthy families preparing these pills to distribute have boundless merit. As for plague prevention methods: grind Rush Xiang (Frankincense), Cangzhu, Xixin (Asarum), Sheng Gancao, Yunxiang (Rue), and Baitanxiang (White Sandalwood) into powder, form pills with jujube flesh, and burn them for fumigation. Also, soak Guanzhong (Cyathula Root) in kitchen water tanks. Alternatively, mix 2 liang of Realgar, 1 liang each of Dansha (Cinnabar), Guijiu (Podophyllum Rhizome), and Shichangpu (Acorus Rhizome) into powder, blend well with well water, and apply to the five centers (palms, soles, chest, abdomen), forehead, nostrils, and ear gates; this is very effective for repelling plague. If entering a plague-infested home, apply sesame oil to the nostrils; upon exiting, sneeze to expel pathogens, ensuring non-infection. These are all good methods. However, the essential principle is as Zhang Jingyue stated: One must regulate desires and avoid labor, and never endure hunger to welcome the qi. This is particularly appropriate.
When Yu Shiyu (name Lin) from Changzhou was residing in Zhongzhou, his father contracted an epidemic and was mistreated by many physicians. Upon returning for the funeral, he reviewed their prescriptions and found they all adhered to methods for treating Cold Damage (Shanghan). He pondered that there must be a way to save lives for this syndrome and published it to alleviate his hidden regret. Having read in the *Bencao* (Materia Medica) that Shigao (Gypsum Fibrosum) is cold in nature, clearly clearing Stomach heat, light and thin in flavor to release muscle heat, heavy and descending to drain excess heat, he suddenly realized that without Gypsum, one could not treat Heat Epidemics. Encountering such cases, his administration of Gypsum was invariably effective. Over thirty years, he saved many people, thus writing *Yizheng Yide* (One Gain in Treating Epidemic Diseases) in two volumes, preface dated and published in the 59th year of Qianlong. His main argument posits that Wu Keyou’s distinction between Cold Damage and Plague is clear: symptoms like headache, fever, and aversion to cold should not be mistaken for Cold Damage exterior syndromes; forcing sweat only damages exterior qi without reducing heat, and purging only damages Stomach qi. This captures the essence. However, the theory that pathogens enter via mouth/nose, do not transmit to the Stomach but to the Membrane Source (Moyuan), seems flawed. The use of Dayuan Yin and various Chengqi Decoctions still retains concepts of attaching interior/exterior dynamics. Only Xiong Renzhao’s initial use of Baidu San (Eliminate Toxin Powder), removing certain harsh ingredients, followed by Jiegeng Tang (Platycodon Decoction) as a carrier vessel to retreat heat from the chest/diaphragm and six channels, is indeed a brilliant method. Yu adopted this method, removing Mangxiao (Natrii Sulfas) and Dahuang (Rhubarb Root), because epidemic disease is a formless toxin, difficult to withstand猛烈 (violent) purgatives. By heavily using Gypsum, it directly enters the Earth element (Stomach/Spleen), destroying the nest of harm first, making the afflictions of the twelve channels easier to pacify. His formula is named Qingwen Baidu San (Clear Plague Eliminate Toxin Powder). Ingredients: Shigao (Large dose: 6-8 liang; Medium: 2-4 liang; Small: 8 qian - 1.2 liang); Xiaoshengdi (Small dose: 6 qian - 1 liang; Medium: 3-5 qian; Small: 2-4 qian); Wu Xijiao (Black Rhinoceros Horn) (Large: 6-8 qian; Medium: 2-4 qian; Small: 1-1.5 qian); Zhen Chuanlian (True Sichuan Coptis) (Large: 6-4 qian; Medium: 2-4 qian; Small: 1-1.5 qian); Sheng Zhizi, Jiegeng, Huangqin, Zhimu, Chi Shao, Yuanshen, Lianqiao, Zhuye (Bamboo Leaves), Gancao, Danpi. He believed that at the onset of epidemic disease, presenting with aversion to cold and fever, splitting headache, restlessness, delirium, body heat with cold limbs, prickly tongue, scorched lips, vomiting and diarrhea, and deep, fine, rapid pulse, one should use the large dose; if the pulse is deep and rapid, use the medium dose; if floating, large, and rapid, use the small dose. If macules/papules appear, use Daqingye (Isatis Leaf) with a small amount of Shengma (Cimicifuga Rhizome, 4-5 fen) to guide toxins outward. This is a method of internal resolution and external release, lowering turbidity and raising clarity. Treatment success rate is high, unlike lifting/releasing exterior methods which worsen the condition. His recorded cases all used several liang of Gypsum and several qian of Rhinoceros Horn and Coptis. Jiang Han Tun’s *Bihua Yijing* (Brush Flower Medical Mirror) records treating a contemporary epidemic using up to 14 jin of Gypsum before macules subsided, likely employing Yu’s method. Recently, Chen Zai’an also imitated this and achieved success. Wang Xuequan’s *Chongqing Tang Suibi* states: Wu Keyou treats epidemics primarily with Dahuang, discussing Wet-Warmth disease where dampness is earth qi, i.e., turbid pathogens attacking the lower jiao (formidable damp-turbidity), hence suitable for purgation rather than clearing. Yu Shiyu treats epidemics primarily with Shigao, discussing Summerheat-Heat disease where summerheat is heaven qi, i.e., clear pathogens attacking the upper jiao (formless dry-fire), hence suitable for clearing rather than purgation. Both gentlemen possess profound insight, representing two major schools for treating epidemics. Is this statement truly valid?