(论一首 方三十一首 灸刺法十九首 禳疟法一首 符二首)
论曰∶夫疟者皆生于风,夏伤于暑,秋为 疟也。问曰∶疟先寒而后热者何也?对曰
∶夫寒者阴气也,风者阳气也,先伤于寒而后伤于风,故先寒而后热也,病以时作,名曰寒
疟。问曰∶先热而后寒者何也?对曰∶先伤于风而后伤于寒,故先热而后寒也,亦以时伤,
名曰温疟。其但热而不寒者,阴气先绝,阳气独发,则少气烦闷,手足热而欲呕,名曰瘅疟。
问曰∶夫病温疟与寒疟,而皆安舍,舍于何脏?对曰∶温疟者,得之冬中于风寒,气藏于骨
髓之中,至春则阳气独发,邪气不能自出,因遇大暑,脑髓铄,肌肉消,腠理发泄,因有所
用力,邪气与汗皆出,此病邪气先藏于肾,其气先从内出之于外也。如是则阴虚而阳盛,盛
则病矣。衰则气复反入,入则阳虚,虚则寒矣。故先热而后寒,名曰温疟。问曰∶瘅疟何如?
对曰∶瘅疟者,肺素有热,气盛于身,厥逆上冲,中气实而不外泄。因有所用力,腠理开,
风寒舍于皮肤之内分肉之间,发则阳气盛,阳气盛而不衰则病矣。其气不及于阴,故但热而
不寒,气内藏于心而外舍于分肉之间,令人消烁脱肉,故命曰瘅疟。夫疟之旦发也,阴阳之
且移也,必从四肢始也。阳已伤阴从之,故气未并,先其时一食顷用细左索紧束其手足十指,
令邪气不得入,阴气不得出,过时乃解。
夫疟脉自弦也,弦数者多热,弦迟者多寒,弦小紧者可下之,弦迟者可温之。若脉紧数
者可发汗,针灸之。脉浮大者吐之瘥。脉弦数者风发也,以饮食消息止之。
疟岁岁发至三岁,或连月发不解者,以胁下有痞也。治之不得攻其痞,但得虚其津液。
先其时发其汗,服汤已,先小寒者引衣自覆,汗出小便利即愈。疟者,病患形瘦,皮上必粟
起也。病疟以月一日发,当以十五日愈。设不瘥当月尽解也,今不愈当云何?师曰∶此病结
为瘕名曰疟母,急当治之。
(论述一篇,方剂三十一首,灸刺法十九首,禳疟法一篇,符咒二首)
论述说:凡是疟疾,都是由于风邪引起的。夏季感受暑热之邪,到了秋季就发为疟疾。有人问:为什么有的疟疾先出现寒战,随后才发热呢?回答说:寒属于阴气,风属于阳气。如果先感受寒邪,后感受风邪,所以先出现寒战而后发热。这种病按时发作,称为寒疟。有人问:为什么有的疟疾先发热,随后才出现寒战呢?回答说:如果先感受风邪,后感受寒邪,所以先发热而后出现寒战。这也是按时发作,称为温疟。如果只有发热而没有寒战的,是因为阴气先已枯竭,阳气独自亢盛,就会出现气短、心烦闷乱、手足发热且想呕吐的症状,称为瘅疟(但热不寒的疟疾)。
有人问:温疟和寒疟这两种病,病邪停留在哪里?依附于哪个脏腑?回答说:温疟,是由于冬季受了风寒,邪气潜伏在骨髓之中。到了春季,阳气独发,邪气不能自行排出。如果遇到大暑天气,脑髓受热消减,肌肉消瘦,腠理(皮肤毛孔)开泄,再加上用力劳作,邪气随着汗液一起外出。这是因为病邪先藏匿于肾,其气先从体内发出到体表。像这样就会导致阴虚而阳盛,阳盛就会发病。当邪气衰退时,气机又会反向内入,内入则导致阳虚,阳虚就会产生寒象。所以先发热而后发冷,称为温疟。
有人问:瘅疟是怎么回事?回答说:瘅疟患者,肺中素有热邪,热气充斥全身,气机厥逆向上冲撞,中焦之气充实而不能向外宣泄。因为用力劳作,腠理开放,风寒之邪停留在皮肤之内、分肉(肌肉间隙)之间。发作时阳气亢盛,如果阳气亢盛而不衰减,就会发病。因为邪气没有波及阴分,所以只发热而不发冷。气机内藏于心,外在于分肉之间,使人身体消瘦枯槁,所以命名为瘅疟。
凡是疟疾在早晨发作的,是阴阳之气即将转移的时候,必然从四肢开始。阳气已经受伤,阴气随之受累。所以在邪气尚未合并之前,在发作前一顿饭的时间里,用细麻绳紧紧束缚手脚十个手指,使邪气不得进入,阴气不得外出,过了时间再解开。
疟疾的脉象自然呈现弦脉。弦而数的脉象多表现为热证,弦而迟的脉象多表现为寒证。弦小紧的脉象可以用攻下法治疗,弦迟的脉象可以用温法治疗。如果脉象紧数,可以用发汗法或针灸治疗。脉象浮大的,可以用吐法治疗,病就好了。脉象弦数的,属于风邪引发的热证,可以通过饮食调理来制止它。
疟疾每年发作,连续三年,或者连月发作不能缓解的,是因为胁下有痞块(积聚)。治疗时不能直接攻伐痞块,只能使其津液虚弱。在发作前发汗,服药之后,如果感到轻微寒冷,就拉过衣服自己覆盖保暖,等到出汗且小便通利,病就好了。患疟疾的人,形体消瘦,皮肤上一定会有鸡皮疙瘩样的粟粒突起。如果在农历初一发病,应当在十五天痊愈。如果不好转,应当在当月月底解除。现在如果不好转,该怎么办?老师说:这种病结聚成瘕,叫做疟母,应当紧急治疗。
(One treatise, thirty-one prescriptions, nineteen moxibustion and acupuncture methods, one exorcism method for malaria, two talismans)
The treatise states: All cases of malaria arise from wind pathogens. If one is injured by summer heat in the summer season, malaria will manifest in autumn. It is asked: Why does some malaria present with chills first followed by fever? The answer is: Chills belong to Yin qi, while wind belongs to Yang qi. If one is first injured by cold and subsequently by wind, chills appear first followed by fever. This disease occurs at regular intervals and is named Cold Malaria (Han Nue). It is asked: Why does some malaria present with fever first followed by chills? The answer is: If one is first injured by wind and subsequently by cold, fever appears first followed by chills. This also occurs at regular intervals and is named Warm Malaria (Wen Nue). If there is only fever without chills, it is because the Yin qi has been exhausted first, and the Yang qi acts alone in hyperactivity. This results in shortness of breath, mental restlessness, heat in the hands and feet, and a desire to vomit; this is named Dan Malaria (Dan Nue, characterized by fever without chills).
It is asked: Where do the pathogens of Warm Malaria and Cold Malaria reside, and which Zang organs do they attach to? The answer is: Warm Malaria originates from contracting wind-cold in winter. The pathogen hides within the bone marrow. When spring arrives, the Yang qi erupts alone, but the pathogen cannot exit spontaneously. If encountered with intense summer heat, the brain marrow is scorched, muscles waste away, and the Couli (pores) open. Due to physical exertion, the pathogen exits along with the sweat. This indicates that the pathogen first concealed itself in the Kidney, and its Qi moves from the interior to the exterior. In this manner, Yin deficiency and Yang excess occur; when Yang is excessive, disease ensues. When the pathogen declines, the Qi reverses and re-enters. Upon entering, Yang becomes deficient; when Yang is deficient, cold manifests. Thus, fever appears first followed by chills, named Warm Malaria.
It is asked: What about Dan Malaria? The answer is: Patients with Dan Malaria have chronic heat in the Lungs, with Qi abundant throughout the body. There is rebellious Qi rushing upward, and the Middle Jiao Qi is full but fails to vent outward. Due to physical exertion, the Couli open, and wind-cold pathogens lodge between the skin and the Fenrou (muscle interspaces). Upon onset, Yang Qi becomes excessive. If Yang Qi remains excessive without declining, disease ensues. Because the pathogen does not affect the Yin, there is only fever without chills. The Qi conceals internally in the Heart and resides externally in the muscle interspaces, causing the body to waste away and emaciate; hence it is named Dan Malaria.
When malaria attacks in the morning, it signifies the shifting of Yin and Yang Qi, which necessarily begins at the four limbs. Since Yang has already been injured and Yin follows suit, before the Qi merges, one should use a fine hemp rope to tightly bind the ten fingers of the hands and feet for the duration of one meal, prior to the attack. This prevents the pathogen from entering and the Yin Qi from exiting. After the time has passed, the binding is released.
The pulse in malaria is naturally wiry (Xian). A wiry and rapid pulse indicates mostly heat; a wiry and slow pulse indicates mostly cold. A wiry, small, and tight pulse may be treated with purgation; a wiry and slow pulse may be treated with warming methods. If the pulse is tight and rapid, diaphoresis or acupuncture/moxibustion may be used. If the pulse is floating and large, emesis may be used, and the patient will recover. A wiry and rapid pulse indicates heat caused by wind; this can be controlled through dietary management.
If malaria recurs annually for three years, or persists month after month without resolution, it is due to a mass (Pi) under the hypochondrium. Treatment should not directly attack the mass, but rather deplete the fluids. Induce sweating before the attack. After taking the decoction, if the patient feels slightly cold, cover oneself with clothing. Once sweating occurs and urination becomes smooth, the disease resolves. Patients suffering from malaria are emaciated, and their skin must exhibit gooseflesh-like papules. If malaria begins on the first day of the lunar month, it should heal within fifteen days. If it does not heal, it should resolve by the end of the month. Now, if it does not heal, what should be done? The Master says: This condition forms a fixed mass called Nu Mu (Malaria Mother), and it must be treated urgently.