《病源》,夫天行时气病者,是春时应暖而反大寒,夏时应热而反大凉,秋时应凉而反
大热,冬时应寒而反大温者,此非其时而有其气,是以一岁之中,病无长少,率多相似者,
此则时行之气也。从立春节后,其中无暴大寒,又不冰雪,而人有壮热为病者,此属春时阳
气发于冬时,伏寒变为温病也;从春分以后至秋分节前,天有暴寒者,皆为时行寒疫也。一
名时行伤寒,此是节候有寒伤于人,非触冒之过也。若三月四月或有暴寒,其时阳气尚弱,
为寒所折,病热犹小轻也。五月六月,阳气已盛,为寒所折,病热则重也。七月八月,阳气
已衰,为寒所折,病热亦小微也。其病与温及暑病相似,但治有殊耳。然得时行病,一日在
皮毛,当摩膏火灸愈;不解者,二日在肤,可法针,服解肌散,汗出愈;不解,三日复发汗
,若大汗则愈,不解者止,勿复发汗也;四日在胸,服藜芦丸,微吐之愈,若病固,服藜芦
丸不吐者,服赤小豆瓜蒂散吐之即愈,视病者尚未了了,复一法针之,当解;不愈者,六日
热已入胃,乃与利汤下之愈,百无不如意,但当谛视节度与病耳。若食不消病,亦与时行病
,俱发热头痛,食病当速下之,时行病当待六七日下之。时行病始得,一日在皮、二日在肤
、三日在肌、四日在胸、五日入胃,入胃乃可下也。热在胃外而下之,则热乘虚便入胃,然
病要当复下去之,不得留于胃中也。胃若实热,致此为病,三死一生,此辈皆多不愈,胃虚
热入烂胃也。其热微者赤斑出,剧者黑斑出,赤斑出者五死一生,黑斑出者十死一生,但论
人有强弱、病有难易,功效相倍耳。病者过日,不以时下之,热不得泄,亦胃烂斑出矣。若
得病无热,但狂言烦躁不安,精采言语与人不相主当者,勿以火迫之,但以猪苓散一方寸匕
,水和服之,当以新汲冷水令强饮一升,若一升半可至二升,益佳,以指刺喉中吐之,随手
愈,不即吐者,此病辈多不善,勿强与水,水停即结心下也,更当以余药吐之,皆令相主当
者,不尔必危。若此病不急以猪苓散吐解之者,其死殆速矣,亦可先以去毒物及法针之,尤
佳。其汤熨针石,别有正方,补养宣导,今附于后。
《养生方》导引法云,清旦初起,以左右手交互从头上挽两耳,举,又引鬓发,即流通
,令头不白、耳不聋。又摩手掌令热,以摩面,从上下二七止,去汗气,令面有光。又摩手
令热,从体上下,名曰干浴,令人胜风寒时气,寒热头痛,百病皆愈。又时气病,一日太阳
受病,太阳为三阳之首,主于头项,故得病一日,头项腰脊痛。
又时气二日,阳明受病,阳明主于肌肉,其脉络鼻入目,故病二日,内热鼻干不得眠。
夫诸阳为表,表始受病皮肤之间,故可摩膏火灸,发汗而愈。
又时气病三日,少阳受病,少阳脉循于胁,上于颈耳,故得病三日,胸胁热而耳聋也。
三阳经络始相传,病未入于脏,故可汗之而愈。
又时气四日,太阴受病,太阴为三阴之首,是知三日以后,诸阳受病讫,即传之于阴,
而太阴受病焉。其脉主于咽嗌,故得病四日,腹满而嗌干,其病在胸膈,故可吐而愈也。
又云∶夫得病四日,毒在胸膈,故宜取吐。有得病二三日便心胸烦满,此为毒瓦斯已入,
或有五六日以上,毒瓦斯犹在上焦者,其人有痰实故也,所以复宜取吐也。
又时气病五日,少阴受病,少阴脉贯肾络肺,系于舌本,故得病五日,口热舌干,渴而
引饮,其病在腹,故可下而愈。
又时气病六日,厥阴受病,厥阴脉循阴器、络于肝,故得病六日,烦满而囊缩也,此为
三阴三阳俱受病,毒瓦斯入于肠胃,故可下而愈。
又时气病七日,法当小愈,所以然者,阴阳诸经传病竟故也,今病不除者,欲为再经病
,再经病者,谓阴阳诸经重受病也。
又时气病八九日以上不解者,或者阴阳诸经重受于病,或已发汗吐下之后,毒瓦斯未尽,
所以病不能除,或一经受病,未即相传,致使停滞,累日病证不改者,故皆当察其证候而治
之。(并出第九卷中。士弱氏曰,七日传经尽,再传经必七日,盖剥复之义耳)
《广济》天行壮热,烦闷发汗。麻黄汤方。
麻黄(五两去节) 葛根(四两) 栀子(二七枚擘) 葱(切一升) 香豉(一升绵
裹)
上五味 咀。以水八升,先煮麻黄、葛根三两沸,去沫,纳诸药,煎取二升五合,绞去
滓,分为三服,服别相去如人行五六里,更进一服。不利,覆取汗,后以粉粉身,忌风及诸
热食。(出第一卷中)
《肘后》疗天行一二日。麻黄解肌汤方。
麻黄(一两去节) 升麻(一两) 甘草(一两炙) 芍药(一两) 石膏(一两碎,
绵裹)
杏仁(三十枚去尖、双仁) 贝齿(三枚末)
上七味,细切,以水三升,煮取一升,顿服。覆取汗,汗出则愈,便食豉粥补虚也。忌
海藻、菘菜。(《千金》同)
又方
麻黄(二两) 黄芩 桂心(各一两) 生姜(三两)
上四味,切,以水六升,煮取二升,分三服。忌生葱。(张文仲同)
又葛根解肌汤方
葛根(四两) 芍药(二两) 麻黄(一两去节) 大青(一两) 甘草(一两炙) 黄
芩(一两) 石膏(一两碎) 大枣(四枚擘) 桂心(一两)
上九味,切,以水五升,煮取二升,分温三服,相次服之。覆取汗,瘥。忌海藻、菘菜、
生葱、炙肉等。(张文仲同)
又疗二三日以上至七八日不解者。可服小柴胡汤方。
柴胡(八两) 人参(三两) 甘草(三两炙) 黄芩(三两) 生姜(三两) 半夏
(半升洗) 大枣(十二枚擘)
上七味,切,以水一斗二升,煮取六升,去滓,更煎取三升,分三服。微覆取汗,半日
便瘥。如不除,更服一剂。忌海藻、菘菜、羊肉饧。(范汪、张文仲同,此张仲景《伤寒论
》方)
又若有热实,得汗不解,腹胀痛,烦躁欲狂语者。可服大柴胡汤方。
柴胡(半斤) 大黄(二两) 黄芩(二两) 芍药(二两) 枳实(四枚炙) 半夏
(五两洗)
上八味,切,以水一斗二升,煮取六升,去滓,更煎取三升,温服一升,日三服。当微
利,忌羊肉、饧。此方四首最第一,急疾须预,有幸可得药处,便不可不营之,保无伤死,
诸小疗为以防穷极者耳。忌羊肉、饧。(出第二卷中,同上)
《删繁》疗天行三日外,至七日不歇,肉热令人更相染着。大青消毒汤方。
大青(四两) 香豉(八合熬,绵裹) 干葛 栀子(各四两) 生干地黄(一升切) 芒
硝
(三两)
上六味,切,以水五升,煮诸药味,取二升五合,去滓,下芒硝,分三服。忌芜荑、热
面、酒、蒜等物。(一方有石膏八两)
又疗天行五日不歇,未至七日,皮肉毒热,四肢疼痛强。苦参吐毒热汤方。
苦参(八分) 乌梅(七枚) 鸡子(三枚取白)
上三味,以苦酒三升煮二物,取一升,去滓澄清,下鸡子白搅调,温去沫,分再服之,
当吐毒热气出愈。
又疗天行七日至二七日,脏腑阴阳毒瓦斯,天行病欲歇而未歇,或因食饮劳复,心下胀满
烦热。生地黄汤方。
生地黄(切一升) 黄芩(三两) 桂心(二两) 甘草(二两炙) 竹叶(切一升洗)
香
豉(一升绵别裹) 心(一升) 芒硝(三两) 尖鼠屎(三七枚) 干葛(一两) 麻
黄(三两去
节) 石膏(八两碎,绵裹)
上十二味,切,以水九升,煮取三升,去滓,下芒硝,分三服。忌芜荑、海藻、菘菜、
生葱等。
又疗天行二七日外,至三七日不歇,或寒或热,来去吸吸,四肢羸瘦,饮食不能,腹中
虚满,热毒不安。生地黄汤方。
生地黄(汁一升) 生麦门冬(汁一升) 赤蜜(一升) 人参(二两) 白术(三两)
桂心(
一两) 甘草(二两炙) 生地骨皮(四两) 升麻(三两) 石膏(八两碎,绵裹)
心(一升)
上十一味,细切,以水九升,煮诸药味,取二升,去滓,下地黄汁,更煎三两沸,分温
五服,昼四夜一服。忌芜荑、生葱、海藻、菘菜、桃、李、雀肉等物。
又疗天行三七日至四七日,劳 不歇,热毒不止,乍寒乍热,乍剧乍瘥,发动如疟。鳖
甲汤方。
鳖甲(三两炙) 大青(二两) 石膏(八两碎,绵裹) 牡丹皮(一两) 乌梅肉(一
两) 常
山(三两) 竹叶(切一升) 牛膝根(三两) 甘草(一两) 香豉(一升熬,绵裹)
上十味,切,以水九升,煮取三升,分温三服,日三。忌生葱、生菜、鲤鱼、海藻、菘
菜、苋菜、芜荑。(一方有生天门冬、生地黄各切一升)
《千金》疗天行热病五六日以上。宜服苦参汤方。
苦参(三两) 黄芩(二两) 生地黄(八两)
上三味,切,以水八升,煎至二升,去滓,温服半升,日再。忌芜荑。(出第九卷中)
又凝雪汤 疗天行毒病七八日,热积胸中,烦乱欲死,起死 汤方。
芫花(一升)
上一味,以水三升,煮取一升半,渍故布薄胸上,不过再三薄,热则除,当温四肢护厥
逆也。(张文仲、《备急》、《古今录验》、《深师》、《范汪》并同。出第十卷中。通按∶ 音
腊,折也,推也,又折也。以故布折方,渍而答胸上也)
《千金翼》疗天行脉浮紧,无汗而发热,其身疼痛,八九日不解,其表证续在,此当发
其汗,服药已微除,发烦目瞑,剧者必衄,衄乃解,所以然者,阳气重故也。宜服麻黄汤方
。(《千金翼》不疗天行)
麻黄(三两去节) 桂心(二两) 甘草(一两炙) 杏仁(七十枚去尖、皮、两仁)
上四味,切,以水九升,先煎麻黄减二升,去上沫,纳诸药,煮取二升半,分服八合
取汗,不须饮粥,投此汤易得汗。忌菘菜、海藻、生葱。(《深师》同。出第九卷中,此张
仲景《伤寒论》方)
崔氏疗时行数日而大下,热痢时作,白通诸药多不得止,吾思旧方多疗伤寒后下痢耳,
未有尚在数日,便兼除热止下者也,四顺汤热,白通苦温,故吾思作此汤,以救数十人,兼
主伤寒。黄连龙骨汤方。
黄连(三两止利除热) 黄柏(三两止利除热) 熟艾(如鸡子一枚除热毒止利) 龙
骨(二
两止利除热)
上四味,切,以水六升,煮取二升半,分三服,无不断者。忌猪肉、冷水。
又其年时行四五日,大下后或不下,皆患心中结满,两胁痞塞,胸中气急,厥逆欲绝,
心胸高起,手不得近,不过二三日,辄便死殁,诸医用泻心汤,余用大小陷胸汤,并不得疗
。重思此或者下后虚逆,而气已不理,而毒复上攻,毒瓦斯相搏,结于胸中,纵不下者,毒已
入胃,胃中不通,毒还冲上,复搏于气,气毒相激,故致此病。疗之当先理其气,次下诸疾
,思与增损理中丸方。
人参(二两) 白术(二两) 甘草(二两炙) 干姜(六分炮) 栝蒌根(二两) 枳
实(四枚) 茯苓(二两) 牡蛎(二两熬)
上八味,末之,以蜜和为丸。服如弹子一丸,熟水下,不歇复服。余时用此,效的神速
,下喉即折,续复与之,不过服五六丸,胸中豁然矣,用药之速,未尝见此。然渴者当加栝
蒌,不渴除之;下者当加牡蛎,不下勿用。余因以告领军韩康伯,右卫毛仲祖,光禄王道豫
,灵台郎顾君苗,著作商仲堪诸人,并悉用之,咸叹其应速。于时枳实乃为之贵,难者曰,
伤寒热病,理中温药,今不解之以冷,而救之以温,其可论乎?余应之曰,夫今诊时行,始
于项强敕色,次于失眠发热,中于烦躁思水,终于生疮下痢,大齐于此耳。忌海藻、菘菜、
酢物、桃、李、雀肉等。(《深师方》同)
又阮河南疗天行七八日,热盛不解。艾汤方。
苦酒(三升) 葶苈子(二合熬,捣) 生艾(汁取一升,无生艾,熟艾、干艾亦可用,
无
艾,可艾根捣取汁)
上三味,煎得一升,顿服,愈。若有牛黄,纳一刀圭尤良。此宜疗内有大热也。阮河南
曰∶疗天行,凡除热解毒,无过苦醋之物,故多用苦参、青葙、艾、葶苈、苦酒、乌梅之属
,此其要也。夫热盛,非苦醋之物则不能愈,热在身中,既不时治,治之又不用苦酢之药,
如救火不以水,必不可得脱免也。又曰,今诸疗多用辛甜姜桂人参之属,此皆贵价,难得常
有,比行求之,转以失时,而苦参、青葙、葶苈子、艾之属,所在尽有,除热解毒最良,胜
于向贵价药也。前后数参并用之,得病内热者,不必按常药次也,便以青葙、苦参、艾、苦
酒疗之,但稍与,促其间耳,无不解。(《千金》、《集验》同,并出于第一卷中)
又茵陈丸 疗瘴气、时气及黄病、 疟等方。
茵陈(二两) 大黄(五两) 豉(五合熬令香) 常山(三两) 栀子仁(二两) 鳖
甲(二两
炙) 芒硝(二两) 杏仁(三两去尖、皮,熬) 巴豆(一两去心、皮,熬)
《诸病源候论》指出,所谓天行时气病,是指春季本该温暖却反而大寒,夏季本该炎热却反而大凉,秋季本该凉爽却反而大热,冬季本该寒冷却反而大温的情况。这种非其时而有的气候现象,导致一年之中无论老少,大多患上相似的疾病,这就是时行之气。从立春之后,如果没有突然的大寒,也没有冰雪,而有人患壮热病的,这属于春时阳气在冬时伏藏的寒气发作,变为温病;从春分以后到秋分节前,天空有突发寒冷的,都属于时行寒疫。又名时行伤寒,这是节令的寒气伤人,并非因为触犯冒犯所致。如果在三月四月有突发寒冷,此时阳气尚弱,被寒气挫伤,发病的热势较轻小。五月六月,阳气已盛,被寒气挫伤,发病的热势则重。七月八月,阳气已衰,被寒气挫伤,发病的热势也轻微。这些病症与温病及暑病相似,但治疗方法不同。然而得了时行病,第一天邪气在皮毛,应当涂抹药膏、火灸即可痊愈;如果不愈,第二天邪气在肤表,可以效仿针刺法,服用解肌散,出汗即愈;仍不愈,第三天再次发汗,如果大汗出则愈,若不愈就停止,不要再发汗了;第四天邪气在胸中,服用藜芦丸,使其微吐即愈,如果病顽固,服用藜芦丸不吐的,服用赤小豆瓜蒂散催吐即愈,观察病人神志尚未清醒的,再用针刺法,应当解除;若不愈,第六天热邪已入胃,给予利汤攻下即愈,百无一失,只要仔细审视节气度数和病情即可。如果是食积不消的病,也与时行病一样,都发热头痛,食积病应当迅速攻下,时行病应当等到六七天后再攻下。时行病刚开始,第一天在皮、第二天在肤、第三天在肌、第四天在胸、第五天入胃,入胃才可以攻下。热邪在胃外而攻下,则热邪乘虚进入胃中,然而病终究要再攻下去,不能让热邪留在胃中。如果胃中有实热,导致这样的病,十死一生,这类病大多不能痊愈,是胃虚热入导致胃烂。热邪轻微的出赤斑,严重的出黑斑,出赤斑的十死一生,出黑斑的十死一生,只是论述人的体质强弱、病的难易,功效相差一倍罢了。病人过了日子,不及时攻下,热邪不得泄出,也会胃烂出斑。如果得病没有热象,只是胡言乱语、烦躁不安,精神言语与人不相协调的,不要用火法逼迫,只服用猪苓散一方寸匕,用水送服,应当用新汲冷水让病人强饮一升,如果一升半可至二升,更好,用手指刺激喉咙催吐,随手即愈,如果不立即吐出的,这类病大多预后不良,不要强行给水,水停结在心下,更应当用其他药物催吐,都要达到神志相协调的状态,否则必然危险。如果此病不及时用猪苓散催吐解除,死亡大概很快了,也可以先用去毒物及针刺法,尤其好。那些汤熨针石,另有正方的记载,补养宣导,现在附在后面。
《养生方》中的导引法说,清晨刚起床,用左右手交互从头上挽住两耳,举起,又牵引鬓发,这样就能流通气血,使头不白、耳不聋。又搓手掌使其发热,用来按摩面部,从上到下做十四次为止,去除汗气,使面部有光泽。又搓手使其发热,从身体上下按摩,名叫干浴,使人能胜风寒时气,治愈寒热头痛,各种病都能痊愈。另外时气病,第一天太阳经受病,太阳经是三阳之首,主司头项,所以得病第一天,头项腰脊痛。
另外时气病第二天,阳明经受病,阳明经主司肌肉,其脉络鼻入目,所以得病第二天,内热鼻干不得眠。
凡是诸阳经为表,表始受病在皮肤之间,所以可以涂抹药膏、火灸,发汗而愈。
另外时气病第三天,少阳经受病,少阳经脉循行于胁肋,上于颈耳,所以得病第三天,胸胁热而耳聋。
另外时气病第四天,太阴经受病,太阴经是三阴之首,由此可知三天以后,诸阳经受病完毕,就传之于阴,而太阴经受病。其脉主司咽嗌,所以得病第四天,腹满而咽干,病在胸膈,所以可以催吐而愈。
又说:得病四天,毒在胸膈,所以适宜取吐。有得病二三天便心胸烦满的,这是毒瓦斯已入,或者有五六日以上,毒瓦斯仍在上焦的,是因为人有痰实的原因,所以又适宜取吐。
另外时气病第五天,少阴经受病,少阴经脉贯穿肾络肺,系于舌本,所以得病第五天,口热舌干,渴而引饮,病在腹,所以可以攻下而愈。
另外时气病第六天,厥阴经受病,厥阴经脉循行阴器、络于肝,所以得病第六天,烦满而囊缩,这是三阴三阳俱受病,毒瓦斯入于肠胃,所以可以攻下而愈。
另外时气病第七天,按法应当小愈,之所以这样,是因为阴阳诸经传病结束了,现在病不除的,想要成为再经病,再经病,是说阴阳诸经重新受病。
另外时气病八九日以上不愈的,或许是阴阳诸经重新受病,或者已经发汗吐下之后,毒瓦斯未尽,所以病不能除,或者一经受病,未即相传,致使停滞,多日病证不改的,所以都应当察其证候而治之。(均出自第九卷中。士弱氏说,七日传经尽,再传经必七日,大概是剥复的道理罢了)
《广济方》治疗天行壮热,烦闷发汗。麻黄汤方。
麻黄(五两去节) 葛根(四两) 栀子(十四枚掰开) 葱(切一升) 香豉(一升绵裹)
以上五味药切碎。用水八升,先煮麻黄、葛根,沸后去掉浮沫,加入其他药物,煎取二升五合,绞去渣滓,分为三服,服药间隔如人行走五六里的时间,再进一服。不利大便,盖被子取汗,后用粉扑身,忌风及诸热食。(出自第一卷中)
《肘后备急方》治疗天行一二日。麻黄解肌汤方。
麻黄(一两去节) 升麻(一两) 甘草(一两炙) 芍药(一两) 石膏(一两碎,绵裹)
杏仁(三十枚去尖、双仁) 贝齿(三枚研末)
以上七味药,细切,用水三升,煮取一升,顿服。盖被子取汗,汗出则愈,随即吃豆粥补虚。忌海藻、菘菜。(《千金方》相同)
又一方
麻黄(二两) 黄芩 桂心(各一两) 生姜(三两)
以上四味药,切,用水六升,煮取二升,分三服。忌生葱。(张文仲相同)
又葛根解肌汤方
葛根(四两) 芍药(二两) 麻黄(一两去节) 大青(一两) 甘草(一两炙) 黄芩(一两) 石膏(一两碎) 大枣(四枚掰开) 桂心(一两)
以上九味药,切,用水五升,煮取二升,分温三服,依次服用。盖被子取汗,病愈。忌海藻、菘菜、生葱、炙肉等。(张文仲相同)
又治疗二三日以上至七八日不愈的。可服小柴胡汤方。
柴胡(八两) 人参(三两) 甘草(三两炙) 黄芩(三两) 生姜(三两) 半夏(半升洗) 大枣(十二枚掰开)
以上七味药,切,用水一斗二升,煮取六升,去渣滓,再煎取三升,分三服。微盖被子取汗,半天即愈。如果不除,再服一剂。忌海藻、菘菜、羊肉饧。(范汪、张文仲相同,此张仲景《伤寒论》方)
又如果有热实,得汗不解,腹胀痛,烦躁欲狂语的。可服大柴胡汤方。
柴胡(半斤) 大黄(二两) 黄芩(二两) 芍药(二两) 枳实(四枚炙) 半夏(五两洗)
以上八味药,切,用水一斗二升,煮取六升,去渣滓,再煎取三升,温服一升,日三服。应当微利,忌羊肉、饧。此方四首最为第一,急疾须预先准备,有幸可得药处,便不可不经营,保证无伤死,各种小疗法以防穷极者罢了。忌羊肉、饧。(出自第二卷中,同上)
《删繁方》治疗天行三日外,至七日不歇,肉热令人互相传染。大青消毒汤方。
大青(四两) 香豉(八合熬,绵裹) 干葛 栀子(各四两) 生干地黄(一升切) 芒硝
(三两)
以上六味药,切,用水五升,煮诸药味,取二升五合,去渣滓,下芒硝,分三服。忌芜荑、热面、酒、蒜等物。(一方有石膏八两)
又治疗天行五日不歇,未至七日,皮肉毒热,四肢疼痛强。苦参吐毒热汤方。
苦参(八分) 乌梅(七枚) 鸡子(三枚取白)
以上三味药,用苦酒三升煮前二物,取一升,去渣滓澄清,下鸡子白搅调,温去沫,分两次服之,应当吐毒热气出而愈。
又治疗天行七日至二七日,脏腑阴阳毒瓦斯,天行病欲歇而未歇,或因食饮劳复,心下胀满烦热。生地黄汤方。
生地黄(切一升) 黄芩(三两) 桂心(二两) 甘草(二两炙) 竹叶(切一升洗)
香豉(一升绵别裹) 心(一升) 芒硝(三两) 尖鼠屎(三七枚) 干葛(一两) 麻黄(三两去节) 石膏(八两碎,绵裹)
以上十二味药,切,用水九升,煮取三升,去渣滓,下芒硝,分三服。忌芜荑、海藻、菘菜、生葱等。
又治疗天行二七日外,至三七日不歇,或寒或热,来去吸吸,四肢羸瘦,饮食不能,腹中虚满,热毒不安。生地黄汤方。
生地黄(汁一升) 生麦门冬(汁一升) 赤蜜(一升) 人参(二两) 白术(三两)
桂心(一两) 甘草(二两炙) 生地骨皮(四两) 升麻(三两) 石膏(八两碎,绵裹)
心(一升)
以上十一味药,细切,用水九升,煮诸药味,取二升,去渣滓,下地黄汁,再煎三两沸,分温五服,昼四夜一服。忌芜荑、生葱、海藻、菘菜、桃、李、雀肉等物。
又治疗天行三七日至四七日,劳复不歇,热毒不止,乍寒乍热,乍剧乍瘥,发动如疟。鳖甲汤方。
鳖甲(三两炙) 大青(二两) 石膏(八两碎,绵裹) 牡丹皮(一两) 乌梅肉(一两) 常山(三两) 竹叶(切一升) 牛膝根(三两) 甘草(一两) 香豉(一升熬,绵裹)
以上十味药,切,用水九升,煮取三升,分温三服,日三。忌生葱、生菜、鲤鱼、海藻、菘菜、苋菜、芜荑。(一方有生天门冬、生地黄各切一升)
《千金方》治疗天行热病五六日以上。宜服苦参汤方。
苦参(三两) 黄芩(二两) 生地黄(八两)
以上三味药,切,用水八升,煎至二升,去渣滓,温服半升,日再。忌芜荑。(出自第九卷中)
又凝雪汤 治疗天行毒病七八日,热积胸中,烦乱欲死,起死回生汤方。
芫花(一升)
以上一味药,用水三升,煮取一升半,浸湿旧布薄敷胸上,不过再三薄,热则除去,应当温四肢护厥逆也。(张文仲、《备急方》、《古今录验方》、《深师方》、《范汪方》并同。出自第十卷中。通按:音腊,折也,推也,又折也。以旧布折叠,浸渍后拍打胸上也)
《千金翼方》治疗天行脉浮紧,无汗而发热,其身疼痛,八九日不解,其表证续在,此当发其汗,服药已微除,发烦目瞑,剧者必衄,衄乃解,所以然者,阳气重故也。宜服麻黄汤方。(《千金翼方》不疗天行)
麻黄(三两去节) 桂心(二两) 甘草(一两炙) 杏仁(七十枚去尖、皮、两仁)
以上四味药,切,用水九升,先煎麻黄减二升,去上沫,纳诸药,煮取二升半,分服八合取汗,不须饮粥,投此汤易得汗。忌菘菜、海藻、生葱。(《深师方》同。出自第九卷中,此张仲景《伤寒论》方)
崔氏治疗时行数日而大下,热痢时作,白通诸药多不得止,我思旧方多疗伤寒后下痢耳,未有尚在数日,便兼除热止下者也,四顺汤热,白通苦温,故我思作此汤,以救数十人,兼主伤寒。黄连龙骨汤方。
黄连(三两止利除热) 黄柏(三两止利除热) 熟艾(如鸡子一枚除热毒止利) 龙骨(二两止利除热)
以上四味药,切,用水六升,煮取二升半,分三服,无不断者。忌猪肉、冷水。
又那年时行四五日,大下后或不下,皆患心中结满,两胁痞塞,胸中气急,厥逆欲绝,心胸高起,手不得近,不过二三日,辄便死殁,诸医用泻心汤,我用大小陷胸汤,并不得疗。重思此或许下后虚逆,而气已不理,而毒复上攻,毒瓦斯相搏,结于胸中,纵不下者,毒已入胃,胃中不通,毒还冲上,复搏于气,气毒相激,故致此病。疗之当先理其气,次下诸疾,思与增损理中丸方。
人参(二两) 白术(二两) 甘草(二两炙) 干姜(六分炮) 栝蒌根(二两) 枳实(四枚) 茯苓(二两) 牡蛎(二两熬)
以上八味药,末之,以蜜和为丸。服如弹子一丸,熟水下,不歇复服。我时用此,效的神速,下喉即折,续复与之,不过服五六丸,胸中豁然矣,用药之速,未尝见此。然渴者当加栝蒌,不渴除之;下者当加牡蛎,不下勿用。我因以告领军韩康伯,右卫毛仲祖,光禄王道豫,灵台郎顾君苗,著作商仲堪诸人,并悉用之,咸叹其应速。于时枳实乃为之贵,难者曰,伤寒热病,理中温药,今不解之以冷,而救之以温,其可论乎?我应之曰,夫今诊时行,始于项强敕色,次于失眠发热,中于烦躁思水,终于生疮下痢,大齐于此耳。忌海藻、菘菜、酢物、桃、李、雀肉等。(《深师方》同)
又阮河南治疗天行七八日,热盛不解。艾汤方。
苦酒(三升) 葶苈子(二合熬,捣) 生艾(汁取一升,无生艾,熟艾、干艾亦可用,无艾,可艾根捣取汁)
以上三味药,煎得一升,顿服,愈。若有牛黄,纳一刀圭尤良。此宜疗内有大热也。阮河南说:治疗天行,凡除热解毒,无过苦醋之物,故多用苦参、青葙、艾、葶苈、苦酒、乌梅之类,此其要也。夫热盛,非苦醋之物则不能愈,热在身中,既不时治,治之又不用苦酢之药,如救火不以水,必不可得脱免也。又说,今诸疗多用辛甜姜桂人参之类,此皆贵价,难得常有,比行求之,转以失时,而苦参、青葙、葶苈子、艾之类,所在尽有,除热解毒最良,胜于向贵价药也。前后数参并用之,得病内热者,不必按常药次也,便以青葙、苦参、艾、苦酒疗之,但稍与,促其间耳,无不解。(《千金方》、《集验方》同,并出于第一卷中)
又茵陈丸 治疗瘴气、时气及黄病、疟等方。
茵陈(二两) 大黄(五两) 豉(五合熬令香) 常山(三两) 栀子仁(二两) 鳖甲(二两炙) 芒硝(二两) 杏仁(三两去尖、皮,熬) 巴豆(一两去心、皮,熬)
According to *Zhu Bing Yuan Hou Lun* (Treatise on the Pathogenesis and Symptoms of All Diseases), so-called "Tianxing Shiqi Bing" (Epidemic Seasonal Diseases) refers to situations where spring should be warm but is instead severely cold, summer should be hot but is instead severely cool, autumn should be cool but is instead severely hot, and winter should be cold but is instead severely warm. This phenomenon of having the climate of one season in another leads to a year in which people of all ages suffer from similar illnesses; this is known as the Qi of the Time Epidemic (Shixing Zhi Qi). After the Start of Spring, if there is no sudden severe cold or ice/snow, yet someone suffers from high fever, this belongs to the Yang Qi of spring erupting from the latent Cold of winter, transforming into a Warm Disease (Wenbing). From after the Spring Equinox to before the Autumn Equinox, if there is sudden cold weather, it is all classified as a Time Epidemic Cold Yi (Shixing Hanyi), also known as Time Epidemic Shanghan (Shixing Shanghan). This is caused by the seasonal Cold injuring humans, not by personal negligence. If there is sudden cold in March or April, when Yang Qi is still weak and suppressed by Cold, the resulting heat illness is mild. In May or June, when Yang Qi is abundant but suppressed by Cold, the heat illness is severe. In July or August, when Yang Qi is declining and suppressed by Cold, the heat illness is also mild. These illnesses resemble Warm Diseases and Summerheat Diseases, but their treatments differ.
Regarding the treatment of Time Epidemic diseases: On the first day, the pathogen is in the skin and hair; applying medicated ointments and moxibustion can cure it. If unresolved, on the second day, the pathogen is in the flesh; acupuncture and taking Jieji San (Muscle-Resolving Powder) to induce sweating can cure it. If still unresolved, on the third day, induce sweating again; profuse sweating leads to recovery, but if unresolved, stop and do not sweat again. On the fourth day, the pathogen is in the chest; taking Lili Wan (Veratrum Pill) to induce mild vomiting can cure it. If the disease is stubborn and Lili Wan does not induce vomiting, take Chixiaodou Gouti San (Red Bean and Melon Seed Powder) to induce vomiting. If the patient's consciousness is not clear, use acupuncture to resolve it. If unresolved by the sixth day, the heat has entered the Stomach; administering Litang (Purgative Decoction) to purge it will cure it, with near-perfect success, provided one carefully observes the seasonal stages and condition. Food stagnation presents similarly with fever and headache; food stagnation requires immediate purging, whereas Time Epidemic diseases require waiting until the sixth or seventh day for purging. The progression is: Day 1 in skin, Day 2 in flesh, Day 3 in muscle, Day 4 in chest, Day 5 enters Stomach; purging is only appropriate once it enters the Stomach. Purging while heat is outside the Stomach allows heat to enter the empty Stomach; however, the heat must eventually be purged and cannot remain in the Stomach. If the Stomach has Excess Heat causing this, mortality is high (one survives out of ten); most such cases are incurable due to Stomach rot from deficiency-heat entering. Mild heat manifests as red macules; severe heat manifests as black macules. Red macules indicate high mortality (one survives out of five); black macules indicate extreme mortality (one survives out of ten). This depends on the strength of the person and the difficulty of the disease. If days pass without timely purging, heat cannot escape, leading to Stomach rot and macules. If the patient has no fever but delirates, is irritable, and speaks incoherently, do not use fire therapy. Instead, administer Zhuling San (Polyporus Powder) mixed with water. Force drink one sheng (approx. 200ml) of fresh cold water, up to two shengs if possible, then stimulate the throat to induce vomiting; recovery is immediate. If vomiting does not occur immediately, the prognosis is poor; do not force water as it may accumulate in the epigastrium. Use other emetics to restore coherence; otherwise, danger is imminent. Delaying emesis with Zhuling San accelerates death. Alternatively, remove toxins and use acupuncture. Methods for decoctions, warming, and needles are recorded elsewhere; nourishing and guiding methods are appended below.
The *Yangsheng Fang* (Prescriptions for Nourishing Life) describes Daoyin (Guiding and Pulling) exercises: Upon waking, interlace hands and pull both ears upward from the head, then pull the sideburns to promote circulation, preventing white hair and deafness. Rub palms until hot and massage the face up and down fourteen times to remove sweat and brighten the complexion. Rub hands until hot and massage the body up and down, called "Dry Bathing," which protects against Wind-Cold and seasonal epidemics, curing chills, fever, headaches, and various ailments.
For seasonal epidemic diseases: On Day 1, the Taiyang Meridian (Taiyang Jing) is affected. As the head of the Three Yang meridians governing the head and neck, pain occurs in the head, neck, lower back, and spine. On Day 2, the Yangming Meridian (Yangming Jing) is affected. Governing muscles and connecting to the nose and eyes, symptoms include internal heat, dry nose, and insomnia. Since Yang meridians represent the exterior, early pathology in the skin can be treated with ointments and moxibustion to induce sweating. On Day 3, the Shaoyang Meridian (Shaoyang Jing) is affected. Its pathway runs along the flanks to the neck and ears, causing heat in the chest/flanks and deafness. As the Three Yang meridians transmit sequentially without entering the Zang organs, sweating can cure it. On Day 4, the Taiyin Meridian (Taiyin Jing) is affected. As the head of the Three Yin meridians, it receives pathogens after the Yang meridians. Its pathway governs the throat; symptoms include abdominal fullness and dry throat. Since the disease is in the chest/diaphragm, vomiting can cure it. Toxin in the chest/diaphragm on Day 4 warrants emesis. Chest/heart irritability on Days 2-3 indicates toxin entry; toxin remaining in the Upper Jiao after Days 5-6 is due to phlegm-solidity, warranting emesis. On Day 5, the Shaoyin Meridian (Shaoyin Jing) is affected. Connecting Kidney, Lung, and tongue base, symptoms include hot mouth, dry tongue, thirst, and drinking preference. Since the disease is in the abdomen, purging can cure it. On Day 6, the Jueyin Meridian (Jueyin Jing) is affected. Circulating around the genitalia and connecting to the Liver, symptoms include irritability, fullness, and retraction of the scrotum. With all Six Meridians affected and toxin in intestines/stomach, purging can cure it. On Day 7, the disease should mildly improve as transmission through Yin-Yang meridians ends. If unresolved, it becomes a "Re-Jing" (Repeat Meridian) disease, meaning meridions are re-infected. If unresolved after Days 8-9, it may be re-infection, incomplete toxin removal after sweating/vomiting/purging, or stagnation in one meridian; treat based on syndrome differentiation. (From Vol 9. Shi Ruoshi notes: Seven days complete transmission; repeat transmission takes seven days, reflecting the principle of decline and recovery.)
*Guangji Fang* treats Tianxing with high fever, irritability, and need for sweating. **Mahuang Tang** (Ephedra Decoction): Mahuang (5 liang, nodes removed), Gegen (4 liang), Zhizi (14 seeds, split), Congbai (1 sheng, sliced), Xiangchi (1 sheng, wrapped in silk). Chop ingredients. Boil in 8 sheng water; boil Mahuang and Gegen first, skim foam, add others, boil to 2.5 sheng, strain. Divide into three doses, taken at intervals equivalent to walking 5-6 li. Cover to induce sweat; apply powder to body. Avoid wind and hot foods. (From Vol 1)
*Zhouhou Fang* treats Tianxing on Days 1-2. **Mahuang Jieji Tang** (Ephedra Muscle-Resolving Decoction): Mahuang (1 liang), Shengma (1 liang), Gancao (1 liang, honey-fried), Shaoyao (1 liang), Shigao (1 liang, crushed, wrapped), Xingren (30 seeds, tips removed), Beichi (3 pieces, powdered). Chop finely. Boil in 3 sheng water to 1 sheng, take in one dose. Cover to sweat; recover. Eat millet porridge to tonify deficiency. Avoid Seaweed and Chinese Cabbage. (*Qianjin Fang* agrees).
Another formula: Mahuang (2 liang), Huangqin (1 liang), Guixin (1 liang), Shengjiang (3 liang). Chop. Boil in 6 sheng water to 2 sheng, divide into three doses. Avoid raw green onion. (Zhang Wenzhong agrees).
Another **Gegen Jieji Tang** (Pueraria Muscle-Resolving Decoction): Gegen (4 liang), Shaoyao (2 liang), Mahuang (1 liang), Daqing (1 liang), Gancao (1 liang, honey-fried), Huangqin (1 liang), Shigao (1 liang, crushed), Dazao (4 seeds, split), Guixin (1 liang). Chop. Boil in 5 sheng water to 2 sheng, divide into three warm doses. Cover to sweat. Avoid Seaweed, Chinese Cabbage, raw green onion, roasted meat. (Zhang Wenzhong agrees).
For unresolved cases from Days 2-3 to 7-8, take **Xiaochaihu Tang** (Minor Bupleurum Decoction): Chaihu (8 liang), Renshen (3 liang), Gancao (3 liang, honey-fried), Huangqin (3 liang), Shengjiang (3 liang), Banxia (0.5 sheng, washed), Dazao (12 seeds, split). Chop. Boil in 12 dou water to 6 sheng, strain, boil again to 3 sheng. Divide into three doses. Lightly cover to sweat; recover in half a day. If unresolved, take another dose. Avoid Seaweed, Chinese Cabbage, mutton, malt sugar. (Fan Wang, Zhang Wenzhong agree; this is Zhang Zhongjing's *Shanghan Lun* formula).
For Excess Heat with unresolved sweating, abdominal distension/pain, irritability, and delirium, take **Dachaihu Tang** (Major Bupleurum Decoction): Chaihu (0.5 jin), Dahuang (2 liang), Huangqin (2 liang), Shaoyao (2 liang), Zhishi (4 pieces, honey-fried), Banxia (5 liang, washed). Chop. Boil in 12 dou water to 6 sheng, strain, boil again to 3 sheng. Take 1 sheng warm, three times daily. Expect mild diarrhea. Avoid mutton and malt sugar. This formula is premier; prepare it urgently. It prevents death. Avoid mutton and malt sugar. (From Vol 2).
*Shanfan Fang* treats Tianxing from Day 3 to Day 7 with continuous flesh heat and contagion. **Daqing Xiaodu Tang** (Isatis Detoxification Decoction): Daqing (4 liang), Xiangchi (8 he, fried, wrapped), Gan Ge (4 liang), Zhizi (4 liang), Sheng Gan Dihuang (1 sheng, cut), Mangxiao (3 liang). Chop. Boil in 5 sheng water to 2.5 sheng, strain, add Mangxiao. Divide into three doses. Avoid Baliospermum, hot noodles, wine, garlic. (One version adds 8 liang Shigao).
Another treats Tianxing from Day 5 to Day 7 with skin/flesh toxic heat and limb pain/stiffness. **Kushen Tu Du Re Tang** (Sophora Vomiting-Toxic-Heat Decoction): Kushen (8 fen), Wumei (7 seeds), Ji Zi (3 eggs, whites only). Boil Kushen and Wumei in 3 sheng Kujiu (bitter vinegar) to 1 sheng, strain, clarify, mix in egg whites, remove foam, take twice. Induces vomiting of toxic heat.
Another treats Tianxing from Day 7 to Day 14, or relapse from diet/labor with epigastric fullness/heat. **Shengdihuang Tang**: Shengdihuang (1 sheng, cut), Huangqin (3 liang), Guixin (2 liang), Gancao (2 liang, honey-fried), Zhuye (1 sheng, cut/washed), Xiangchi (1 sheng, wrapped separately), Xin (1 sheng, Heart), Mangxiao (3 liang), Jianshushi (37 pellets), Gan Ge (1 liang), Mahuang (3 liang, nodes removed), Shigao (8 liang, crushed/wrapped). Chop. Boil in 9 sheng water to 3 sheng, strain, add Mangxiao. Divide into three doses. Avoid Baliospermum, Seaweed, Chinese Cabbage, raw green onion.
Another treats Tianxing from Day 14 to Day 21 with alternating chills/fever, emaciation, anorexia, abdominal fullness, and restlessness. **Shengdihuang Tang**: Shengdihuang juice (1 sheng), Sheng Maidong juice (1 sheng), Chi Mi (1 sheng), Renshen (2 liang), Baizhu (3 liang), Guixin (1 liang), Gancao (2 liang, honey-fried), Shengdi Gupi (4 liang), Shengma (3 liang), Shigao (8 liang, crushed/wrapped), Xin (1 sheng). Chop. Boil in 9 sheng water to 2 sheng, strain, add juices, boil briefly. Divide into five doses (four by day, one by night). Avoid Baliospermum, raw green onion, Seaweed, Chinese Cabbage, peach, plum, sparrow meat.
Another treats Tianxing from Day 21 to Day 28 with labor-relapse, persistent toxic heat, alternating chills/fever, and malaria-like attacks. **Biejia Tang**: Biejia (3 liang, honey-fried), Daqing (2 liang), Shigao (8 liang, crushed/wrapped), Mudanpi (1 liang), Wumei Rou (1 liang), Changshan (3 liang), Zhuye (1 sheng, cut), Niuxigen (3 liang), Gancao (1 liang), Xiangchi (1 sheng, fried/wrapped). Chop. Boil in 9 sheng water to 3 sheng, divide into three warm doses, three times daily. Avoid raw green onion, raw vegetables, carp, Seaweed, Chinese Cabbage, amaranth, Baliospermum. (One version adds Sheng Tianmendong and Sheng Dihuang).
*Qianjin Fang* treats Tianxing heat illness after Days 5-6. **Kushen Tang**: Kushen (3 liang), Huangqin (2 liang), Shengdihuang (8 liang). Chop. Boil in 8 sheng water to 2 sheng, strain. Take 0.5 sheng warm, twice daily. Avoid Baliospermum. (From Vol 9).
Another **Ningxue Tang** (Snow-Coagulating Decoction) / **Qisi Huisheng Tang** (Reviving-the-Dead Resurrection Decoction) treats Tianxing toxic illness after Days 7-8 with heat accumulation in chest and severe irritability. Yuanhua (1 sheng). Boil in 3 sheng water to 1.5 sheng. Soak old cloth, apply thinly to chest. Repeat until heat subsides. Protect limbs from cold reversal. (Zhang Wenzhong, *Beiji*, *Gujin Luyan*, *Shenshi*, *Fan Wang* agree. From Vol 10. Note: "La" means fold/push; fold cloth, soak, and pat chest).
*Qianjin Yi Fang* treats Tianxing with floating-tight pulse, no sweat, fever, body pain, unresolved after 8-9 days, with persistent exterior signs. Induce sweating. After medication, slight relief, irritability, dizziness, or severe epistaxis resolving the condition, due to heavy Yang Qi. Take **Mahuang Tang**: Mahuang (3 liang, nodes removed), Guixin (2 liang), Gancao (1 liang, honey-fried), Xingren (70 seeds, tips/skin removed). Chop. Boil in 9 sheng water; boil Mahuang first to reduce by 2 sheng, skim foam, add others, boil to 2.5 sheng. Take 0.8 sheng to induce sweat. No porridge needed; this formula induces sweat easily. Avoid Chinese Cabbage, Seaweed, raw green onion. (*Shenshi Fang* agrees. From Vol 9; Zhang Zhongjing's *Shanghan Lun* formula).
Cui Shi treats Time Epidemic with severe purging after several days, intermittent hot dysentery, unresponsive to Baitong formulas. Old formulas treat post-Shanghan dysentery, not concurrent heat/dysentery in early days. Sijun Tang is hot; Baitong is bitter-warm. Thus, I created this formula to save dozens, treating Shanghan. **Huanglian Longgu Tang** (Coptis Dragon Bone Decoction): Huanglian (3 liang, stops diarrhea/removes heat), Huangbai (3 liang, stops diarrhea/removes heat), Shuai Ai (1 chicken-egg size, removes heat/toxin/stops diarrhea), Longgu (2 liang, stops diarrhea/removes heat). Chop. Boil in 6 sheng water to 2.5 sheng, divide into three doses. Invariably effective. Avoid pork, cold water.
Another case: Time Epidemic Days 4-5, after severe purging (or lack thereof), patients have chest constriction, hypochondriac stuffiness, breathlessness, impending collapse, elevated chest/tenderness, dying within 2-3 days. Xixin Tang and Daxiao Xianxiong Tang failed. I reasoned that purging causes deficiency/reversal, Qi disorder, and toxin attacking upward, binding in the chest/Stomach. Treat by regulating Qi first, then purging. **Zengsun Lizhong Wan** (Modified Center-Regulating Pills): Renshen (2 liang), Baizhu (2 liang), Gancao (2 liang, honey-fried), Jiangjiang (6 fen, roasted), Gualougen (2 liang), Zhishi (4 pieces), Fuling (2 liang), Muli (2 liang, fried). Powder, mix with honey into pills. Take one pill size of a bullet with cooked water. Repeat if necessary. Effect was rapid; chest cleared after 5-6 pills. For thirst, add Gualou; if no thirst, remove. For downward tendency, add Muli; if not, omit. I shared this with Han Kangbo, Mao Zhongzu, Wang Daoyu, Gu Junmiao, Shang Zhengan, etc., who all used it successfully. Zhishi became expensive. Critics asked why use warm Lizhong for heat illness instead of cold. I replied: Diagnosing Time Epidemic starts with stiff neck/rash, progresses to insomnia/fever, then irritability/thirst, finally sores/dysentery. Avoid Seaweed, Chinese Cabbage, vinegar, peach, plum, sparrow meat. (*Shenshi Fang* agrees).
Ruan Henan treats Tianxing after Days 7-8 with severe unresolved heat. **Ai Tang**: Kujiu (3 sheng), Tinglizi (2 he, fried/crushed), Sheng Ai (juice 1 sheng; if unavailable, ripe/dry Ai or root juice). Boil to 1 sheng, take in one dose. Add Niuhuang (one Dao gui) for better effect. Treats internal severe heat. Ruan Henan states: For clearing heat/toxin in Tianxing, bitter-sour substances are best (Kushen, Qingxiang, Ai, Tinglizi, Kujiu, Wumei). Severe heat requires these; using sweet/acrid herbs like Ginger/Cinnamon/Ginseng is costly and hard to find, often delaying treatment. Local bitter herbs are superior. Use Qingxiang, Kushen, Ai, Kujiu directly for internal heat. (*Qianjin Fang*, *Jiyan Fang* agree. From Vol 1).
Another **Yinchen Wan** (Artemisia Pill) treats Zhangqi (Miasma), Shiqi, Jaundice, and Malaria. Yinchen (2 liang), Dahuang (5 liang), Chi (5 he, fried fragrant), Changshan (3 liang), Zhizi Ren (2 liang), Biejia (2 liang, honey-fried), Mangxiao (2 liang), Xingren (3 liang, tips/skin removed, fried), Badou (1 liang, heart/skin removed, fried).