9.疟疾已经汗吐下, 清解未尽寒热方, 清脾白术青朴果, 小柴参去
入苓姜, 气虚加参痰橘半, 饮多宜逐倍姜榔, 渴热知膏天花粉, 食滞
麦麴湿泽苍.
【注】疟疾已经或汗, 或吐, 或下, 表里无证, 法当清解, 宜用清脾
饮和之. 即白术, 青皮, 厚朴, 草果, 柴胡, 黄芩, 半夏, 甘草, 茯
苓,生姜也. 气虚者加人参. 痰多者加橘红倍半夏. 饮多者倍生姜加
槟榔. 渴热者加知母, 石膏, 天花粉. 食滞者加麦芽, 神麴. 湿盛者
加泽泻, 苍术.
9.疟疾已经汗吐下, 清解未尽寒热方, 清脾白术青朴果, 小柴参去
入苓姜, 气虚加参痰橘半, 饮多宜逐倍姜榔, 渴热知膏天花粉, 食滞
麦麴湿泽苍.
【注】疟疾已经或汗, 或吐, 或下, 表里无证, 法当清解, 宜用清脾
饮和之. 即白术, 青皮, 厚朴, 草果, 柴胡, 黄芩, 半夏, 甘草, 茯
苓,生姜也. 气虚者加人参. 痰多者加橘红倍半夏. 饮多者倍生姜加
槟榔. 渴热者加知母, 石膏, 天花粉. 食滞者加麦芽, 神麴. 湿盛者
加泽泻, 苍术.
12.痎疟经年久不愈, 疟母成块结癖症, 形实控涎或化滞, 攻后余法
与前同.
【注】痎疟, 经年不愈之老疟也. 疟母, 久疟腹中成块癖也. 形实宜
用控涎丹以攻痰饮, 或用化滞丸以攻积滞. 攻后之余法, 与前所治疟
法同也.
桂枝麻黄柴胡四物去杏仁加桃仁汤
13.疟在夜发三阴疟, 桂麻柴物杏易桃, 鬼疟尸注多恶梦, 恐怖苏合
效功高.
【注】疟在夜发, 名曰三阴疟疾. 初热宜用桂枝汤, 麻黄汤, 小柴胡
汤,四物汤方合剂, 以杏仁易桃仁, 增损汗之, 汗解之后, 余同前法
.鬼疟亦多在夜发, 由尸气注之, 比三阴疟疾, 则夜多恶梦, 时生恐
怖,宜用苏合香丸治之.
9. 疟疾经过发汗、催吐或泻下治疗后,寒热症状仍未完全清除的方剂:清脾饮由白术、青皮、厚朴、草果组成;在小柴胡汤(小柴胡汤)中去掉人参,加入茯苓和生姜。若患者气虚,加用人参;痰多者,加用橘红并加倍半夏用量;水饮停聚较多者,宜逐饮,加倍生姜并加入槟榔;口渴发热者,加用知母、石膏和天花粉;饮食积滞者,加用麦芽和神曲;湿气盛者,加用泽泻和苍术。
【注】疟疾如果已经经过发汗、催吐或泻下治疗,且表证和里证均不明显时,治法应当清热解邪,适宜使用清脾饮来调和。清脾饮的组成即白术、青皮、厚朴、草果、柴胡、黄芩、半夏、甘草、茯苓、生姜。气虚的患者加用人参。痰多的患者加用橘红并加倍半夏用量。水饮较多的患者加倍生姜并加入槟榔。口渴发热的患者加用知母、石膏、天花粉。饮食积滞的患者加用麦芽、神曲。湿气旺盛的患者加用泽泻、苍术。
12. 痎疟(慢性疟疾)经年久治不愈,形成疟母(疟疾日久形成的腹内肿块癖块),体质壮实者可先用控涎丹攻逐痰饮,或用化滞丸攻逐积滞,攻伐之后的后续治疗方法与前文所述相同。
【注】痎疟,是指经年不愈的顽固性疟疾。疟母,是指久患疟疾后腹部形成的肿块癖块。体质壮实的患者适宜使用控涎丹以攻逐痰饮,或者使用化滞丸以攻逐积滞。攻伐之后的余下治疗方法,与前面所论述的治疟方法相同。
桂枝麻黄柴胡四物去杏仁加桃仁汤(此方名用于第13条前文语境,此处作为独立条目列出)
13. 夜间发作的疟疾属于三阴疟,可用桂枝汤、麻黄汤、小柴胡汤、四物汤四方合剂,将杏仁替换为桃仁,增减药量以发汗,汗出病解之后,其余治法同前。鬼疟(一种伴有精神症状的疟疾)也多在夜间发作,由尸气侵袭所致,相比三阴疟疾,其特点是夜间多做恶梦,时常产生恐惧感,适宜使用苏合香丸治疗,疗效显著。
【注】疟疾在夜间发作,称为三阴疟疾。初期发热时适宜使用桂枝汤、麻黄汤、小柴胡汤、四物汤四方合剂,以杏仁代替桃仁,根据病情增减药量以发汗,汗解之后,其余治法同前。鬼疟也多在夜间发作,由尸气注袭引起,比三阴疟疾更严重,表现为夜间多做恶梦,时常产生恐怖感,适宜使用苏合香丸治疗。
9. Formula for clearing residual cold and heat after malaria has been treated with sweating, vomiting, or purging: Qingpi Yin (Clear the Spleen Decoction) consists of Atractylodis Rhizoma (Baizhu), Citri Reticulatae Pericarpium (Qingpi), Magnoliae Officinalis Cortex (Houpo), and Tsaoko Fructus (Caoguo). It is derived from Xiaochaihu Tang (Minor Bupleurum Decoction) by removing Ginseng Radix et Rhizoma (Renshen) and adding Poria (Fuling) and Zingiberis Recens Rhizoma (Shengjiang). If Qi deficiency is present, add Ginseng Radix et Rhizoma (Renshen); if phlegm is abundant, add Tangerine Peel (Juhong) and double the dosage of Pinelliae Rhizoma (Banxia); if fluid retention is significant, use it to drain fluids by doubling Zingiberis Recens Rhizoma (Shengjiang) and adding Arecae Semen (Binglang); if thirst and heat are present, add Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), and Trichosanthis Radix (Tianhuafen); if food stagnation is present, add Malto (Maiya) and Saccharomyces (Shenqu); if dampness is excessive, add Alismatis Rhizoma (Zexie) and Atractylodis Macrocephalae Rhizoma (Cangzhu).
[Note] If malaria has already been treated with sweating, vomiting, or purging, and there are no evident exterior or interior syndromes, the treatment method should be to clear heat and resolve pathogens. It is appropriate to use Qingpi Yin (Clear the Spleen Decoction) to harmonize. The composition of Qingpi Yin (Clear the Spleen Decoction) includes Atractylodis Rhizoma (Baizhu), Citri Reticulatae Pericarpium (Qingpi), Magnoliae Officinalis Cortex (Houpo), Tsaoko Fructus (Caoguo), Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Pinelliae Rhizoma (Banxia), Glycyrrhizae Radix et Rhizoma (Gancao), Poria (Fuling), and Zingiberis Recens Rhizoma (Shengjiang). For patients with Qi deficiency, add Ginseng Radix et Rhizoma (Renshen). For those with abundant phlegm, add Tangerine Peel (Juhong) and double the dosage of Pinelliae Rhizoma (Banxia). For those with significant fluid retention, double Zingiberis Recens Rhizoma (Shengjiang) and add Arecae Semen (Binglang). For those with thirst and heat, add Anemarrhenae Rhizoma (Zhimu), Gypsum Fibrosum (Shigao), and Trichosanthis Radix (Tianhuafen). For those with food stagnation, add Malto (Maiya) and Saccharomyces (Shenqu). For those with excessive dampness, add Alismatis Rhizoma (Zexie) and Atractylodis Macrocephalae Rhizoma (Cangzhu).
12. When Jiemai (chronic malaria) persists for years without cure, it may form Nuomu (a mass in the abdomen due to long-term malaria). For patients with a strong constitution, Kongxian Dan (Control Fluids Pill) can be used to attack phlegm-fluids, or Huazhi Wan (Resolve Stagnation Pill) can be used to attack accumulation. After the attacking treatment, the subsequent methods are the same as those described previously.
[Note] Jiemai refers to stubborn malaria that does not heal over years. Nuomu refers to abdominal masses or癖块 (fixed lumps) formed after long-term malaria. Patients with a strong constitution are suitable for using Kongxian Dan (Control Fluids Pill) to attack phlegm-fluids, or Huazhi Wan (Resolve Stagnation Pill) to attack accumulations. The remaining treatment methods after attacking are the same as the malaria treatments discussed earlier.
Guizhi Mahuang Chaihu Siwu Qu Xingren Jia Taoren Tang (Guizhi, Mahuang, Chaihu, and Siwu Decoction with Apricot Kernel removed and Peach Kernel added)
13. Malaria occurring at night belongs to Sanyin Mai (Three Yin Malaria). One can use a combined formula of Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), Xiaochaihu Tang (Minor Bupleurum Decoction), and Siwu Tang (Four Substance Decoction), replacing Xingren (Apricot Kernel) with Taoren (Peach Kernel), adjusting dosages to induce sweating. After sweating resolves the condition, the rest of the treatment is the same as before. Gui Mai (Ghost Malaria) also mostly occurs at night, caused by invasion of corpse-qi. Compared to Sanyin Mai (Three Yin Malaria), it is characterized by frequent nightmares and fear at night. It is appropriate to treat it with Suhexiang Wan (Styrax Pill), which yields high efficacy.
[Note] Malaria occurring at night is called Sanyin Mai (Three Yin Malaria). In the initial stage of fever, it is appropriate to use a combined formula of Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), Xiaochaihu Tang (Minor Bupleurum Decoction), and Siwu Tang (Four Substance Decoction), replacing Xingren (Apricot Kernel) with Taoren (Peach Kernel), adjusting dosages to induce sweating. After sweating resolves the condition, the rest of the treatment is the same as before. Gui Mai (Ghost Malaria) also mostly occurs at night, caused by invasion of corpse-qi. It is more severe than Sanyin Mai (Three Yin Malaria), manifesting as frequent nightmares and fear at night. It is appropriate to treat it with Suhexiang Wan (Styrax Pill).