时疫头眩有三。其一风热头眩,乃时疫本病。寸口脉多浮而发热,荆、防、芎、薄、天麻为主,黄芩为辅,烦
渴加石膏。其一痰水头眩,乃时疫兼证。脉沉而弦滑,兼呕,胸胁满,悸动,前胡为主,半夏、茯苓、枳、桔、
胆星、莱菔、苏子为辅。然必视时疫大势属表属里,于应用本方中加此数味可也。其一虚证头眩,乃时疫变证,多
见于汗、下、清解后,或素有怯证者。如上虚,寸口脉不及关、尺,多汗,少气不足以息,心悸,参、 为主。中
虚,关脉不及寸、尺,多从呕利太过而来,不思食,苓、术为主。下虚,尺脉不及寸、关,腰膝萎厥,二便清滑,
六味地黄为主。三虚皆可加天麻,或虚证已见,仍夹有邪疫燥热,则不妨兼用清热之品;或补后脉气稍
实,再为清解亦可。
大抵时疫头眩多属热,少属虚,治须斟酌。若伤寒亡阳头眩,又当遵仲景法治之。
时疫头胀者,乃胃热上蒸也,下之则愈。兼表者,防风通圣散、大柴胡汤、吴氏三消饮;无表证者,三承气选
用。病后虚胀,与头眩参看。
时疫头重者,湿热上壅也,于清凉解表药中加苍术或利水药。病后虚重亦与头眩参看。又有表里无病,病在头
中者,其目必黄,当遵仲景法,用瓜蒂散搐鼻,出黄水即愈。
时疫目珠胀者,阳明经病也。兼表证,葛根葱白汤加石膏。若胸满,舌有黄苔,宿食也。盖食壅阳明,其脉不
下行而上逆,故目珠胀。宜平胃散加山楂、麦芽、枳壳,消导之则愈。至屡经清解,而目珠胀痛不愈者,当消息其
肝脏,以养阴滋血和肝之法治之。如再不愈,则当进而滋肾,乃乙癸同源之治也。
时疫引起的头眩(头晕目眩)有三种情况。第一种是风热头眩,这是时疫的本病。寸口脉多呈浮象且伴有发热,治疗以荆芥、防风、川芎、薄荷、天麻为主药,黄芩为辅药,若见烦躁口渴则加用石膏。第二种是痰水头眩,这是时疫的兼证。脉象沉而弦滑,伴有呕吐,胸胁部胀满,心悸,治疗以前胡为主药,半夏、茯苓、枳实、桔梗、胆南星、莱菔子、苏子为辅药。然而必须根据时疫的大势判断病位在表还是在里,在应用本方的基础上加入这几味药即可。第三种是虚证头眩,这是时疫的变证,多见于发汗、攻下或清热解表之后,或者患者素体虚弱者。如属上虚,寸口脉弱于关脉和尺脉,多汗,气短不足以息,心悸,用人参、黄芪为主药。如属中虚,关脉弱于寸脉和尺脉,多因呕吐腹泻太过所致,不思饮食,用茯苓、白术为主药。如下虚,尺脉弱于寸脉和关脉,腰膝痿软厥冷,二便清稀滑利,用六味地黄丸为主药。三种虚证均可加用天麻;或者虚证已现,但仍夹杂有疫邪燥热,则不妨兼用清热之品;或者补益后脉气稍显充实,再进行清热解表亦可。
大抵时疫头眩多属于热证,少数属于虚证,治疗须仔细斟酌。如果是伤寒导致的亡阳头眩,又应当遵循张仲景的方法治疗。
时疫引起的头胀(头部胀痛),是胃热上蒸所致,使用攻下法即可痊愈。兼有表证的,选用防风通圣散、大柴胡汤、吴氏三消饮;无表证的,在三承气汤中选用。病后出现的虚性头胀,可参考头眩的治疗。
时疫引起的头重(头部沉重感),是湿热上壅所致,在清凉解表的药物中加入苍术或利水药。病后的虚性头重也可参考头眩的治疗。又有表里均无病,病位在头部本身的,其眼睛必然发黄,应当遵循张仲景的方法,用瓜蒂散搐鼻,排出黄水即愈。
时疫引起的眼球胀痛,是阳明经病。兼有表证的,用葛根葱白汤加石膏。如果胸胁胀满,舌苔黄,是宿食停滞。因为食物壅滞于阳明经,脉气不能下行反而上逆,所以导致眼球胀痛。宜用平胃散加山楂、麦芽、枳壳,通过消食导滞的方法即可痊愈。至于经过多次清热解表治疗后,眼球胀痛仍不愈的,应当审察肝脏的情况,采用养阴滋血、调和肝气的法治之。如果仍然不愈,则应当进一步滋补肾阴,这是乙癸同源(肝肾同源)的治疗方法。
There are three types of vertigo (dizziness) caused by epidemic febrile diseases. The first is vertigo due to wind-heat, which is the primary manifestation of the epidemic disease. The pulse at the cunkou (radial artery) is mostly floating accompanied by fever; the treatment primarily uses Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Bohe (Menthae Haplocalycis Herba), and Tianma (Gastrodiae Rhizoma), with Huangqin (Scutellariae Radix) as an adjuvant; if irritability and thirst are present, Shigao (Gypsum Fibrosum) is added. The second is vertigo due to phlegm-fluid retention, which is a concurrent syndrome of the epidemic disease. The pulse is deep, wiry, and slippery, accompanied by vomiting, fullness in the chest and hypochondrium, and palpitations; the treatment primarily uses Qianhu (Peucedani Radix), with Banxia (Pinelliae Rhizoma), Fuling (Poria), Zhishi (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Danningxing (Arisaematis Cum Bile), Laifuzi (Raphini Semen), and Suzi (Perillae Fructus) as adjuvants. However, one must determine whether the general trend of the epidemic disease is exterior or interior, and add these few herbs to the indicated base formula. The third is vertigo due to deficiency, which is a transformed syndrome of the epidemic disease, often seen after sweating, purging, or clearing heat and resolving toxicity, or in patients with a constitutionally weak state. If it is upper deficiency, the cunkou pulse is weaker than the guan and chi pulses, with profuse sweating, shortness of breath insufficient for respiration, and palpitations; Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) are used as primary agents. If it is middle deficiency, the guan pulse is weaker than the cun and chi pulses, often resulting from excessive vomiting and diarrhea, with loss of appetite; Fuling (Poria) and Baizhu (Atractylodis Macrocephalae Rhizoma) are used as primary agents. If it is lower deficiency, the chi pulse is weaker than the cun and guan pulses, with flaccidity and coldness of the waist and knees, and clear, slippery urination and defecation; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used as the primary agent. All three types of deficiency can be treated with the addition of Tianma (Gastrodiae Rhizoma); or if deficiency signs are already present but still complicated by epidemic dry-heat, it is acceptable to concurrently use heat-clearing agents; or if the pulse qi becomes slightly solid after tonification, heat-clearing and resolving methods may then be applied.
Generally, vertigo in epidemic febrile diseases belongs mostly to heat patterns, and rarely to deficiency patterns; treatment requires careful consideration. If the vertigo is due to yang collapse from cold damage, one should follow the methods of Zhang Zhongjing.
Head distension (distending pain in the head) in epidemic febrile diseases is caused by stomach heat steaming upward; purgation will cure it. If accompanied by exterior syndromes, Fengtang Tongsheng San (Wind-Protecting Universal Benefit Powder), Da Chaihu Tang (Major Bupleurum Decoction), or Wu Shi San Xiao Yin (Wu's Three Eliminations Drink) are selected; if there are no exterior syndromes, one of the Three Chengqi Decoctions is chosen. Post-illness distension due to deficiency should be referred to the treatment of vertigo.
Heaviness of the head in epidemic febrile diseases is caused by damp-heat obstructing upward; Cangzhu (Atractylodis Rhizoma) or diuretic herbs should be added to cooling exterior-resolving formulas. Post-illness heaviness due to deficiency should also be referred to the treatment of vertigo. In cases where there is no exterior or interior disease, but the pathology is located in the head itself, the eyes will necessarily be yellow; one should follow Zhang Zhongjing's method and use Guiti San (Melon Seed Powder) insufflated into the nose; recovery occurs when yellow fluid is discharged.
Distension and pain of the eyeballs in epidemic febrile diseases is a disease of the Yangming channel. If accompanied by exterior syndromes, Gegen Congbai Tang (Kudzu and Scallion Decoction) with Shigao (Gypsum Fibrosum) is used. If there is chest fullness and a yellow tongue coating, it indicates retained food stagnation. Because food stagnation obstructs the Yangming channel, the pulse qi fails to descend and instead rebels upward, causing distension and pain of the eyeballs. Pingwei San (Maintain the Stomach Powder) with Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), and Zhiqiao (Aurantii Fructus) should be used; resolution of stagnation leads to cure. For those whose eyeball distension and pain persist despite repeated heat-clearing and resolving treatments, the liver system should be examined, and treatment should employ methods to nourish yin, enrich blood, and harmonize the liver. If this still fails, kidney yin should then be nourished further, which is the treatment based on the principle that Liver and Kidney share the same source (Yi-Gui Tong Yuan).