《内经,》夏伤于暑,秋必病疟。谓疟疾由伤暑而汗出腠开,当风浴水受凄凉之水寒,
及秋
遇凉风束之,里邪不能外越,则随经络以内薄,舍于脏腑募原之间,与日行之卫气相值而疟
作焉。当其邪正交争,并于阴,则中外皆寒,并于阳,则内外皆热,极则阴阳俱衰,卫气相
离
,故病得体,卫气集则复作。治者于疟将发时与正发之际,切勿施治,治之则病愈甚,须在
未发前二、三时,迎而夺之,方为合法。小儿胎疟,不能服药,用黄丹五钱,生明矾三钱,
胡椒二钱五分,麝香少许,共研末,以好醋调敷手心,男左女右,以绢包手掌,药发自汗而
愈。如小儿未进谷食者,患疟久不止,用冰糖浓煎汤喂之,最验。
食疟。饮食不节,复感风暑,寒热交作,腹胀痞闷,面黄恶食,内治以养胃汤减参术主
之。
分阴阳,(二百遍。)推三关,(一百遍。)退六腑,(一百遍。)清天河水,(二百遍。)推
脾土
(二百遍。)推肾水补清,(各一百遍。)揉脐,(一百遍。)运八卦,(二十遍。)用熨法。(见
卷二,四十五页。)
痰疟。小儿素有痰饮,复因外邪凝结脾胃,胸闷欲吐,其证面黄目肿,内治以豁痰之药
主之。
分阴阳,(二百遍。)推三关,(一百遍。)退六腑,(一百遍。) 推清肺经,(二百遍。)
推四
横纹,(三十遍。)推脾土,(二百遍。)揉脐,(一百二十遍。)揉内劳宫,(三十遍。)运八卦
,(五十遍。)按弦搓摩,(二十四遍。)汗吐法先之。凡推法用姜汤,或桃叶汁亦可。另用桃
叶研饼,敷涌泉穴,用开闭法,(见卷二,三十九页。)引痰法。(见卷二,四十页。)
久疟。邪结血络,左胁胀满,牵连少腹,或肾虚脾虚皆有之。
分阴阳,(二百遍。)推三关,(二百遍。)退六腑,(一百遍。)清天河水,(二百遍。)推
补脾
土,(二百遍。)运八卦,(一百遍。)掐二人上马。(二十遍。)凡推用姜水,桃叶捶烂敷足心
瘅疟,但热不寒,由阴气先伤,阳气独发,壮热,少气,烦冤,手足热,欲呕,邪内藏
于心,外舍肌肉,令人消烁肌肉。内治以甘寒生津法。
分阴阳,(二百遍。)推三关,(二百遍。)推脾土,(一百遍。)运八卦,(五十遍。)推肺
经,
(五十遍。)退六腑,(一百遍。)推间使、内关,(一百遍。)天门入虎口,(五十遍。)摇斗肘
,(五十遍。)清里法。(见卷二,三十七页。)
按∶疟证,内伤痰食积滞,外感风寒暑湿。但感有浅深,故病有轻重,所期寒则温之,
热则
清之,食则消之,风痰则疏导之,务须缓以图治,不可期以速效。逐日行按摩等法三五次,
至三五日、五七日均可。婴儿如此,大人则次数加多,日期更久,方为合法。毋欲速以图功
,致生他证,是谓至要。勿谓徒恃手法而不求方药也。(惕厉子)
《黄帝内经》记载:“夏季感受暑邪,秋季必定发生疟疾。”这是说疟疾是由于伤于暑气而汗出,腠理(皮肤毛孔)开泄,此时若迎风或沐浴冷水,受到凄冷的水寒之气侵袭,到了秋天又遇凉风束缚体表,体内的邪气不能向外发散,于是顺着经络向内侵迫,停留在脏腑的募原(胸腹腔内膈膜之间的部位)之间,与每日循行运行的卫气相遇搏结,从而引发疟疾。当邪气与正气相互交争,如果邪气并入阴分,则身体内外都感到寒冷;如果并入阳分,则身体内外都感到发热;病情发展到极点时,阴阳两气都会衰弱,卫气暂时分离,所以病人体质得以缓解(症状暂停);待卫气重新聚集时,疾病又会发作。治疗者应在疟疾将要发作时以及正在发作之际,千万不要进行治疗,否则会使病情加重,必须在未发作前两三个小时,采取“迎而夺之”(在邪气初起时予以截断)的方法,才是合法的治疗原则。小儿患胎疟(先天遗传性或婴幼儿期发生的疟疾),无法服用汤药,可用黄丹五钱、生明矾三钱、胡椒二钱五分、麝香少许,共同研成细末,用优质醋调匀敷在手心,男性敷左手,女性敷右手,用丝绢包裹手掌,使药物通过发汗途径治愈。如果小儿尚未进食谷物,患疟疾日久不止,可用冰糖浓煎成汤喂服,效果极佳。
食疟:因饮食不节制,又感受风暑之邪,导致寒热交替发作,腹部胀满痞闷,面色萎黄,厌恶进食。内治以养胃汤减去人参、白术为主方。
操作手法:分阴阳(二百遍),推三关(一百遍),退六腑(一百遍),清天河水(二百遍),推脾土(二百遍),推肾水并配合清法(各一百遍),揉脐(一百遍),运八卦(二十遍)。使用熨法。(详见卷二第四十五页)
痰疟:小儿素来有痰饮停滞,又因外邪凝结脾胃,出现胸闷想吐的症状,证候表现为面色萎黄、眼睛浮肿。内治以豁痰的药物为主。
操作手法:分阴阳(二百遍),推三关(一百遍),退六腑(一百遍),推清肺经(二百遍),推四横纹(三十遍),推脾土(二百遍),揉脐(一百二十遍),揉内劳宫(三十遍),运八卦(五十遍),按弦搓摩(二十四遍)。先使用汗法和吐法。凡是推拿手法均用姜汤作为介质,或者使用桃叶汁也可以。另外用桃叶研成饼状,敷在涌泉穴,使用开闭法。(详见卷二第三十九页),引痰法。(详见卷二第四十页)
久疟:邪气结聚在血络中,左侧胁肋部胀满,牵连至少腹,或者肾虚、脾虚也会出现这种情况。
操作手法:分阴阳(二百遍),推三关(二百遍),退六腑(一百遍),清天河水(二百遍),推补脾土(二百遍),运八卦(一百遍),掐二人上马(二十遍)。凡推拿均用姜水作为介质,将桃叶捶烂敷在足心。
瘅疟:只发热不恶寒,由于阴气先受损,阳气单独亢盛,表现为高热、气短、心中烦闷郁结、手足发热、想要呕吐,邪气内藏于心,外舍于肌肉,使人肌肉消瘦枯槁。内治以甘寒生津的方法。
操作手法:分阴阳(二百遍),推三关(二百遍),推脾土(一百遍),运八卦(五十遍),推肺经(五十遍),退六腑(一百遍),推间使、内关(一百遍),天门入虎口(五十遍),摇斗肘(五十遍)。使用清里法。(详见卷二第三十七页)
按语:疟证的成因,内伤在于痰食积滞,外感在于风寒暑湿。只是感受邪气的深浅不同,所以病情有轻有重。治疗期望的原则是:寒证则温之,热证则清之,食积则消之,风痰则疏导之,务必缓慢图谋治疗,不可期望速效。每天进行按摩等方法三到五次,持续三到五天,或者五到七天都可以。婴儿如此,成人则次数要增加,日期更要延长,这才是合法的治疗。不要急于求成而导致产生其他病症,这是至关重要的。不要认为仅仅依靠手法而不寻求方药治疗。(惕厉子)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: "Summer injury by heat, autumn must suffer from malaria." This means that malaria arises from injury by summer-heat causing sweating and opening of the Couli (skin pores). When exposed to wind or bathing in water, one is affected by the chilling cold of water. In autumn, when cool winds bind the exterior, the pathogenic factors inside cannot escape outward. They follow the meridians to invade internally, lodging between the Zang-Fu organs and the Mu-Yuan (membranous origin between the viscera and the peritoneum), where they encounter the daily circulating Wei Qi (Defensive Qi), thus triggering malaria. When pathogens and healthy Qi contend, if they merge into the Yin aspect, both interior and exterior feel cold; if they merge into the Yang aspect, both interior and exterior feel hot. At the extreme, both Yin and Yang Qi decline, and Wei Qi separates, so the patient's condition temporarily alleviates. When Wei Qi gathers again, the disease recurs. The practitioner should absolutely avoid treating during the onset or peak of the malaria attack, as doing so will worsen the illness. Treatment must be conducted two to three hours before the expected onset, intercepting and seizing the pathogen ("Ying Er Duo Zhi"), which is the correct method. For infants suffering from fetal malaria who cannot take oral medicine, use 5 qian of Minium (Dan), 3 qian of raw Alum, 2.5 qian of Pepper, and a small amount of Moschus (Musk). Grind them into powder, mix with good vinegar, and apply to the palm. Apply to the left hand for males and the right hand for females. Wrap the palm with silk gauze; the medicine induces sweating and cures the disease. If an infant has not yet consumed solid food and suffers from prolonged malaria, administer thickly decocted rock sugar soup orally, which is highly effective.
Food Malaria: Caused by irregular diet combined with exposure to wind and summer-heat, resulting in alternating chills and fever, abdominal distension and fullness, sallow complexion, and aversion to food. Internal treatment is primarily based on Yangwei Tang (Stomach-Nourishing Decoction) with Ginseng and Atractylodes removed.
Manual techniques: Fen Yin Yang (Divide Yin and Yang) (200 repetitions), Tui San Guan (Push Three Gates) (100 repetitions), Tui Liu Fu (Push Six Bowels) (100 repetitions), Qing Tian He Shui (Clear River Water) (200 repetitions), Tui Pi Tu (Push Earth of Spleen) (200 repetitions), Tui Shen Shui Bu Qing (Push Water of Kidney with Tonification and Clearing methods) (100 repetitions each), Rou Qi (Rub Umbilicus) (100 repetitions), Yun Ba Gua (Move Eight Trigrams) (20 repetitions). Use the Ironing Method (see Volume 2, page 45).
Phlegm Malaria: Infants who inherently have phlegm-fluid retention, compounded by external pathogens condensing in the Spleen and Stomach, present with chest tightness and urge to vomit. Signs include sallow complexion and swollen eyes. Internal treatment is primarily based on phlegm-resolving medicines.
Manual techniques: Fen Yin Yang (200 reps), Tui San Guan (100 reps), Tui Liu Fu (100 reps), Tui Qing Fei Jing (Push and Clear Lung Meridian) (200 reps), Tui Si Heng Wen (Push Four Horizontal Lines) (30 reps), Tui Pi Tu (Push Spleen Earth) (200 reps), Rou Qi (Rub Umbilicus) (120 reps), Rou Nei Lao Gong (Rub Inner Laogong) (30 reps), Yun Ba Gua (Move Eight Trigrams) (50 reps), An Xian Cuo Mo (Press Strings and Rub) (24 reps). Employ Sweating and Vomiting methods first. All pushing techniques should use Ginger Soup or Peach Leaf Juice as medium. Additionally, grind peach leaves into a cake and apply to Yongquan (KI1) acupoint. Use Opening/Closing methods (see Volume 2, page 39) and Phlegm-Guiding methods (see Volume 2, page 40).
Chronic Malaria: Pathogens knot in the blood collaterals, causing distension and fullness in the left hypochondrium radiating to the lower abdomen. This may also occur due to Kidney Deficiency or Spleen Deficiency.
Manual techniques: Fen Yin Yang (200 reps), Tui San Guan (200 reps), Tui Liu Fu (100 reps), Qing Tian He Shui (Clear River Water) (200 reps), Tui Bu Pi Tu (Tonify Push Spleen Earth) (200 reps), Yun Ba Gua (Move Eight Trigrams) (100 reps), Qia Er Ren Shang Ma (Pinch Two Men Mounting Horse) (20 reps). All pushing techniques use Ginger Water as medium. Pound peach leaves and apply to the sole of the foot.
Dan Malaria (Intense Heat Malaria): Fever without chills. Caused by prior injury to Yin Qi, leaving Yang Qi to flare alone. Symptoms include high fever, shortness of breath, mental restlessness/oppression, heat in hands and feet, nausea. Pathogens hide internally in the Heart and externally lodge in the muscles, causing emaciation. Internal treatment uses Sweet-Cold methods to generate fluids.
Manual techniques: Fen Yin Yang (200 reps), Tui San Guan (200 reps), Tui Pi Tu (Push Spleen Earth) (100 reps), Yun Ba Gua (Move Eight Trigrams) (50 reps), Tui Fei Jing (Push Lung Meridian) (50 reps), Tui Liu Fu (Push Six Bowels) (100 reps), Tui Jian Shi (PC5) and Nei Guan (PC6) (100 reps), Tian Men Ru Hu Kou (Heaven's Gate Entering Tiger's Mouth) (50 reps), Yao Dou Zhou (Shake Bucket Elbow) (50 reps). Use Clearing Interior methods (see Volume 2, page 37).
Commentary: The etiology of malaria involves internal injury from phlegm and food stagnation, and external contraction of wind, cold, summer-heat, and dampness. The depth of pathogen invasion determines the severity. The therapeutic principle is: warm for cold patterns, clear for heat patterns, digest for food stagnation, and guide/disperse for wind-phlegm. Treatment must be gradual; do not expect rapid results. Perform massage and other methods 3-5 times daily for 3-5 days, or 5-7 days. For infants, this suffices; for adults, increase frequency and duration. Do not seek quick success to avoid inducing other diseases. This is crucial. Do not rely solely on manual therapy while neglecting herbal prescriptions. (Ti Li Zi)