麻黄(去节) 柴胡(去芦) 泽泻(各三钱)
此治疟之套剂也,时行之疟,长幼相似者,主之神良。
病有三在∶在表,在里,在半表半里也。人在气交之中,鼻受无形之气,藏于分肉之间
,邪正分争,并于表则在表,并于里则在里,未有所并,则在半表半里。是方也,麻黄之辛,
能散表邪,由汗而泄;泽泻之咸,能引里邪,由溺而泄;柴胡之温,能使半表半里之邪,由
中以解。则病之三在,此方率治之矣。虽然,此方但可以泻实耳,虚者犹当辨其气血而补之,
所谓虚者十补,勿一泻也。
常山 浓朴 青皮 陈皮 甘草 槟榔 草果(等分)
先期用水、酒各一种煎熟,以丝绵裹之,露一宿,于当发之早温服。
疟疾三、四发后,寸口脉来弦滑浮大者,此方吐之。
三、四发后,可截之时也。脉弦为饮,滑为实,浮为表,大为阳,故在可吐。师云∶无
痰不作疟。疟痰为患,常山善吐,槟榔善坠,草果善消,浓朴、青皮亦理气行痰之要药;陈
皮、甘草乃消痰调胃之上材也。是方也,惟脉来浮大弦滑者可用,若脉来沉涩细微者,与之
则逆矣。慎之。
鳖甲(十三片) 蜂窠(四分,炙) 蜣螂(炙) 柴胡(各六分) 乌羽 瞿麦 桃
仁干姜
(各二分) 牡丹皮 芍药 虫(各五分) 赤硝(十二分) 黄芩 鼠妇(炙) 桂枝 石
苇
(去毛) 浓朴 紫盛 阿胶(炒) 大黄(各三分) 葶苈(熬) 半夏 人参(各一分)
上二十三味,取 灶下灰一斗,清洒一斛五斗,浸灰,候酒尽一半,着鳖甲于中,煮令
泛烂如胶漆,绞取汁,内诸药煎,为丸如梧子大。空心服七丸。日三。
疟疾久不愈,内结 瘕,欲成劳瘵者,名曰疟母,此丸主之。
凡疟疾寒热,皆是邪气与正气分争,久之不愈,则邪正之气结而不散,按之有形,名曰
疟母。始虽邪正二气,及其固结之久,则顽痰、死血皆有之矣。然其为患,或在肠胃之中,
或薄肠胃之外,不易攻去,仲景公先取灰酒,便是妙处。盖灰从火化,能消万物,今人取十
灰膏以作烂药,其性可知;渍之以酒,取其善行。若鳖甲、鼠妇、 虫、蜣螂、蜂窠者,皆
善攻结而有小毒,以其为血气之属,用之以攻血气之凝结,同气相求,功成易易耳。乃柴胡、
浓朴、半夏,皆所以散结气;而桂枝、丹皮、桃仁,皆所以破滞血;水谷之气结,则大黄、
葶苈、石苇、瞿麦可以平之;寒热之气交,则干姜、黄芩可以调之。人参者,所以固元于克
伐之场;阿胶、芍药者,所以养阴于峻厉之队也。乌羽、赤硝、紫盛,隋唐医哲,皆不知之,
故以乌羽作乌扇,赤硝更海藻,紫盛更紫葳、紫菀。今详四物,亦皆攻顽散结之品,更之未
为不可,然依旧本,仍录乌羽、赤硝、紫盛者,不欲遽然去之,盖曰爱礼存羊云尔。
麻黄(去除节段) 柴胡(去除芦头) 泽泻(各三钱)
这是治疗疟疾的通用方剂,对于时行疟疾,无论老少症状相似者,服用此方效果神妙良佳。
病邪有三种所在:在表、在里、在半表半里。人处于天地气交之中,鼻吸入无形之气,藏于肌肉纹理之间,邪气与正气相互争斗,若邪气并合于表则表现为表证,并合于里则表现为里证,尚未完全并合,则处于半表半里。本方中,麻黄的辛味,能发散表邪,通过汗液排出;泽泻的咸味,能引导里邪,通过尿液排出;柴胡的温性,能使半表半里的邪气,从中焦得以解散。这样,病邪在三处的情况,本方都能统率治疗。虽然如此,此方只能用于泻实,虚证还应当辨别气血进行补益,这就是所说的“虚证应当十次补益,不要一次泻下”。
常山 厚朴 青皮 陈皮 甘草 槟榔 草果(等分)
先用水和酒各一份煎煮至熟,用丝绵包裹药渣,暴露过夜,在疟疾发作前温热服用。
疟疾发作三、四次后,寸口脉象呈现弦、滑、浮、大者,可用此方催吐。
发作三、四次后,是可以截断疟疾的时候。脉弦主饮邪,滑主实证,浮主表证,大主阳证,因此属于可吐的范围。老师说:“无痰不作疟”。疟疾之痰为患,常山善于催吐,槟榔善于降气下行,草果善于消积化滞,厚朴、青皮也是理气行痰的重要药物;陈皮、甘草是消除痰浊调和胃气的上等药材。本方仅适用于脉象浮大弦滑者,如果脉象沉涩细微,使用此方则是逆治。务必谨慎。
鳖甲(十三片) 蜂窠(四分,炙烤) 蜣螂(炙烤) 柴胡(各六分) 乌羽 瞿麦 桃仁 干姜(各二分) 牡丹皮 芍药 䗪虫(各五分) 赤硝(十二分) 黄芩 鼠妇(炙烤) 桂枝 石苇(去毛) 厚朴 紫葳 阿胶(炒制) 大黄(各三分) 葶苈子(熬制) 半夏 人参(各一分)
以上二十三味药,取灶下的灰一斗,清酒一斛五斗,浸泡灰,等待酒消耗掉一半,将鳖甲放入其中,煮至烂如胶漆状,绞取汁液,加入其他药物煎煮,制成梧桐子大小的丸药。空腹服用七丸,每日三次。
疟疾久治不愈,体内结聚成瘕块,想要形成劳瘵病的,称为疟母,此丸主治。
凡是疟疾寒热往来,都是邪气与正气相互争斗,时间久了不愈,则邪正之气结聚不散,按压有形状,称为疟母。起初虽是邪正二气,等到固结时间长久,则有顽痰、死血夹杂其中。然而其病患,有的在肠胃之中,有的逼近肠胃之外,不易攻逐去除,张仲景先生先用灰酒,就是妙处所在。因为灰由火化,能消化万物,现在的人取十灰膏来制作腐蚀药物,其性质可知;用酒浸泡,取其善于通行的特性。至于鳖甲、鼠妇、䗪虫、蜣螂、蜂窠,都善于攻破结聚且有小毒,因为它们属于血气之物,用来攻逐血气的凝结,同气相求,功效容易达成。至于柴胡、厚朴、半夏,都是用来疏散结气的;而桂枝、丹皮、桃仁,都是用来破除瘀滞血的;水谷之气结聚,则大黄、葶苈子、石苇、瞿麦可以平复它;寒热之气交错,则干姜、黄芩可以调和它。人参,是在攻伐之中巩固元气;阿胶、芍药,是在峻烈队伍中滋养阴液。乌羽、赤硝、紫葳,隋唐时期的医学家都不了解,所以把乌羽当作乌扇,赤硝改为海藻,紫葳改为紫菀。如今详细考察这四味药,也都是攻破顽疾消散结聚的物品,更改它们也未尝不可,但依照原本版本,仍然记录乌羽、赤硝、紫葳的原因,是不想轻易去掉它们,说是为了爱护礼制而保留形式罢了。
Ephedrae Herba (Mahuang, 麻黄) [de-segmented], Bupleuri Radix (Chaihu, 柴胡) [de-radicle], Alismatis Rhizoma (Zexie, 泽泻) [each 3 qian]
This is a standard formula for treating malaria. For epidemic malaria where symptoms are similar across all ages, this formula yields miraculous and excellent results.
Pathogenic factors reside in three locations: exterior, interior, and half-exterior half-interior. Humans exist within the intersection of Qi; the nose receives formless Qi, which stores between the muscle layers. When pathogenic factors and healthy Qi contend, if they merge with the exterior, it manifests as an exterior syndrome; if they merge with the interior, it manifests as an interior syndrome; if they have not yet fully merged, they remain in the half-exterior half-interior. In this formula, the pungent nature of Mahuang disperses exterior pathogens, expelling them through sweat; the salty nature of Zexie guides interior pathogens, expelling them through urine; the warm nature of Chaihu resolves pathogens in the half-exterior half-interior from the middle jiao. Thus, this formula addresses pathogens in all three locations. Nevertheless, this formula is only suitable for draining excess; deficiency syndromes require differentiation of Qi and Blood followed by tonification, adhering to the principle that "deficiency should be tonified ten times, never drained once."
Dichroae Radix (Changshan), Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium Viride (Qingpi), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao), Arecae Semen (Binglang), Tsaoko Fructus (Caoguo) [equal parts]
Decoct first with one part water and one part wine until cooked. Wrap in silk gauze, expose overnight, and take warm before the onset of malaria attacks.
After three or four attacks of malaria, if the radial pulse at the cunkou position is wiry, slippery, floating, and large, this formula can induce vomiting.
Three or four attacks mark the time when malaria can be intercepted. A wiry pulse indicates fluid retention, slippery indicates excess, floating indicates exterior involvement, and large indicates Yang. Therefore, vomiting is indicated. The Master stated: "No phlegm, no malaria." Regarding malaria caused by phlegm, Dichroae Radix excels at inducing vomiting; Arecae Semen excels at descending Qi; Tsaoko Fructus excels at resolving accumulation; Magnoliae Officinalis Cortex and Citri Reticulatae Pericarpium Viride are essential herbs for regulating Qi and moving phlegm; Citri Reticulatae Pericarpium and Glycyrrhizae Radix et Rhizoma are superior materials for eliminating phlegm and harmonizing the Stomach. This formula is applicable only when the pulse is floating, large, wiry, and slippery. If the pulse is deep, choppy, fine, and minute, using this formula would be contraindicated. Exercise caution.
Testudinis Carapax et Plastrum (Biejia, 鳖甲) [13 pieces], Vespa Nidus (Fengke, 蜂窠) [4 fen, roasted], Scarabaei Siccus (Qiángláng, 蜣螂) [roasted], Bupleuri Radix (Chaihu, 柴胡) [each 6 fen], Corvi Penis (Wuyu, 乌羽), Urticae Flos (Qumai, 瞿麦), Persicae Semen (Taoren, 桃仁), Zingiberis Rhizoma Recens (Ganjiang, 干姜) [each 2 fen], Moutan Cortex (Mudanpi, 牡丹皮), Paeoniae Radix Alba (Shaoyao, 芍药), Mylabris (Chong, 䗪虫) [each 5 fen], Natrii Sulfas Crude (Chixiao, 赤硝) [12 fen], Scutellariae Radix (Huangqin, 黄芩), Psoraleae Semen? No, Paederidae (Shufu, 鼠妇) [roasted], Cinnamomi Ramulus (Guizhi, 桂枝), Epimedii Folium? No, Holoschwiellae Herba (Shiwei, 石苇) [de-hairy], Magnoliae Officinalis Cortex (Houpo, 厚朴), Catalpae Speciosae Cortex (Zisheng, 紫盛), Colla Corii Asini (Ejiao, 阿胶) [stir-fried], Rhei Radix et Rhizoma (Dahuang, 大黄) [each 3 fen], Lepidii Semen (Tingli, 葶苈) [processed], Pinelliae Rhizoma Preparatum (Banxia, 半夏), Ginseng Radix et Rhizoma (Renshen, 人参) [each 1 fen]
Take the above twenty-three ingredients. Use one dou of ash from the kitchen stove and one hu five dou of clear liquor. Soak the ash in the liquor. Wait until half the liquor is consumed. Place the Testudinis Carapax et Plastrum into the mixture and boil until it becomes gelatinous like lacquer. Strain to extract the juice. Add the remaining herbs and decoct. Form pills the size of wu zi (smartweed seeds). Take seven pills on an empty stomach. Three times daily.
For malaria that persists for a long time without healing, forming internal masses (zhang/jia) and potentially developing into consumptive disease (lao zhai), known as malaria mother (nuo mu), this pill is indicated.
Generally, the chills and fever of malaria result from the contention between pathogenic factors and healthy Qi. If unresolved for a long time, the Qi of both pathogen and host knots and does not disperse. Palpable masses are called malaria mother. Initially involving only pathogenic and healthy Qi, prolonged knotting leads to the presence of stubborn phlegm and dead blood. However, the pathology may lie within the intestines and stomach or adjacent to them, making it difficult to attack directly. Mr. Zhang Zhongjing’s use of ash and liquor first is ingenious. Ash, transformed by fire, can dissolve all things; modern use of Ten Ash Paste for cauterization illustrates its nature. Soaking in liquor utilizes its property of promoting circulation. Testudinis Carapax et Plastrum, Paederidae, Mylabris, Scarabaei Siccus, and Vespa Nidus are all capable of breaking up knots and possess slight toxicity. Being substances of blood and Qi, they target the knotting of blood and Qi through sympathetic resonance, achieving success easily. Bupleuri Radix, Magnoliae Officinalis Cortex, and Pinelliae Rhizoma Preparatum dissipate knotted Qi; Cinnamomi Ramulus, Moutan Cortex, and Persicae Semen break stagnant blood; Dahuang, Lepidii Semen, Holoschwiellae Herba, and Urticae Flos level the knotting of food and fluid Qi; Zingiberis Rhizoma Recens and Scutellariae Radix harmonize the intermingling of cold and heat Qi. Ginseng Radix et Rhizoma consolidates primal Qi amidst attacking agents; Colla Corii Asini and Paeoniae Radix Alba nourishes Yin within harsh formulations. Corvi Penis, Natrii Sulfas Crude, and Catalpae Speciosae Cortex were unknown to physicians of the Sui and Tang dynasties; thus, Corvi Penis was substituted for Iris Tectorii Rhizoma (Wushan), Natrii Sulfas Crude for Sargassum (Haizao), and Catalpae Speciosae Cortex for Wisteriae Flos (Ziwēi) or Asteris Radix (Ziwan). Upon detailed examination, these four items are also agents for attacking stubbornness and scattering knots; substituting them is not inadvisable. However, following the original text, I record Corvi Penis, Natrii Sulfas Crude, and Catalpae Speciosae Cortex because I do not wish to discard them abruptly, citing the idiom "preserving the ritual by keeping the sheep" (valuing tradition).