(属病后不表里证)
时疫大势已平,寒热已解,而面目肢体浮肿,有食滞中宫、水停心下、气复未归三种,当分别以施治。
食滞中宫者,乃病后脾胃大虚,不能消谷。病者胃中枯燥,偏欲多食,食停心下脐上,则水不得上输于肺,肺
亦不能通调水道,下输膀胱,故溢于肢体而为浮肿。其证以心下、脐上有硬处,按之则痛为异,小便或利或不利,
当用平胃散加枳实、山楂、麦芽、莱菔子、青皮、神曲为主,硬处消则肿自愈,或加苓、泽兼利水亦可。
水停心下者,乃脾虚不能消水也,与食滞异者,心腹
无硬痛,小便不利也。用苓、泽、车前、木通之类,利其小便而愈。
气复未归者,吴又可所谓病后气复血未复,气无所归,故作肿也,不可治肿,调其饮食,节其劳役,静养自
愈。其异于停水、食滞者,水停身重,小便不利;气肿身轻,小便自利;食滞腹中有结;气肿腹中自和也。
时疫愈后有发颐者,乃余热留于营血也,速以解毒、清热、活血、疏散为主,误则成脓不出,而牙关不开,咽
喉不利,多不能食而死,毒内陷而复舌燥、神昏亦死,出脓后气虚血脱亦死,故宜早治也。古方以普济消毒饮为
主∶发在耳后,以柴胡、川芎为君;在项下,以葛根为君,在项后或巅顶,加羌、防。此证不可轻补于未溃之
先,补早必成脓,尤不可纯用寒凉于将发之际,恐闭遏而毒不得发,故必兼疏散为要。外治,以葱水时时浴之。
(属于病后既无表证也无里证的阶段)
时行疫病的主要症状已经平息,寒热症状也已解除,但出现面目和肢体浮肿的情况。这主要有三种原因:食积停滞在中焦、水饮停聚在心下、以及气机恢复但未归位。应当分别情况进行治疗。
如果是食积停滞在中焦,是因为病后脾胃极度虚弱,无法消化谷物。患者胃中干燥,特别想吃东西,食物停滞在心窝下方至脐部上方,导致水液不能向上输送到肺脏,肺也不能通调水道,向下输送到膀胱,因此水液溢出到肢体而形成浮肿。其症状特点是心窝下方、脐部上方有硬块,按压时会疼痛,这是与其他情况不同的地方。小便可能通畅也可能不通畅。治疗应以平胃散为基础,加入枳实、山楂、麦芽、莱菔子、青皮、神曲为主药。硬块消散后,浮肿自然痊愈;或者加入茯苓、泽泻兼以利水也可以。
如果是水饮停聚在心下,是因为脾虚无法运化水湿。与食积不同的是,心腹部没有硬痛感,且小便不通畅。治疗应使用茯苓、泽泻、车前子、木通这类药物,通过利小便的方法使病情痊愈。
如果是气机恢复但未归位,是吴又可所说的病后气机恢复而血未恢复,气无所依附归属,从而造成浮肿。此时不可直接治疗浮肿,只需调理饮食,节制劳累,静养即可自愈。它与停水、食积的不同之处在于:停水者身体沉重,小便不通畅;气肿者身体轻快,小便自通畅;食积者腹中有结块;气肿者腹部自和缓舒适。
时行疫病痊愈后出现发颐(腮腺炎或颌下淋巴结炎等),是由于余热留存在营分和血分中。治疗应迅速以解毒、清热、活血、疏散为主要原则。如果误治,会导致脓液形成却无法排出,进而牙关紧闭,咽喉不利,多数因无法进食而死;毒邪内陷并再次出现舌燥、神志昏迷也会死亡;脓液排出后若气虚血脱也会死亡,所以应该尽早治疗。古方以普济消毒饮为主方:如果发病在耳后,以柴胡、川芎为君药;如果在颈部下方,以葛根为君药;如果在颈后或头顶,加入羌活、防风。此证在未溃破之前不可轻易进补,补益过早必然导致成脓;尤其不可在即将发作之际纯用寒凉药物,恐怕会闭遏邪气导致毒邪无法发散,所以必须兼顾疏散的重要性。外治法,用葱水经常洗浴患处。
(After the illness, presenting neither exterior nor interior syndromes)
When the major symptoms of an epidemic pestilence have subsided and the alternating chills and fever have resolved, edema of the face, eyes, and limbs may occur. There are three main causes: food stagnation in the middle jiao (middle burner), water retention under the heart (epigastric region), and qi recovery without returning to its proper place. Treatment should be administered according to specific differentiation.
In cases of food stagnation in the middle jiao, it is due to extreme deficiency of the Spleen and Stomach after the illness, leading to an inability to digest grains. The patient feels dryness in the Stomach and has a strong desire to eat excessively. Food remains stagnant below the heart pit down to above the umbilicus, preventing fluids from transporting upward to the Lung. Consequently, the Lung cannot regulate the water passages and transport them downward to the Bladder. Thus, fluids overflow into the limbs, causing edema. The distinguishing symptom is hardness below the heart pit and above the umbilicus, which is painful upon pressure. Urination may be either free or obstructed. The treatment should primarily use Pingwei San (Calm the Stomach Powder) added with Zhishi (Immature Bitter Orange), Shanzha (Hawthorn Fruit), Maiya (Sprouted Barley Seed), Laifuzi (Radish Seed), Qingpi (Green Tangerine Peel), and Shenqu (Medicated Leaven). Once the hardness dissipates, the edema will heal spontaneously. Alternatively, adding Lingzhi (Poria) and Zexie (Alisma) to promote diuresis is also acceptable.
In cases of water retention under the heart, it is due to Spleen deficiency failing to transform water. This differs from food stagnation in that there is no hardness or pain in the chest and abdomen, but rather obstructed urination. Treatment involves using herbs such as Fuling (Poria), Zexie (Alisma), Cheqianzi (Plantago Seed), and Mutong (Akebia Stem) to promote urination and achieve recovery.
In cases where qi recovers but fails to return to its proper place, as described by Wu Youke, it refers to the condition after illness where qi recovers while blood does not, leaving qi without a residence, thus causing edema. One should not directly treat the edema; instead, regulating diet, conserving energy, and resting quietly will lead to spontaneous recovery. The distinction from water retention and food stagnation is as follows: water retention presents with heavy body sensation and obstructed urination; qi edema presents with a light body sensation and free urination; food stagnation presents with knots in the abdomen; qi edema presents with a harmonious abdomen.
After recovery from an epidemic pestilence, "Fa Yi" (parotitis or submandibular abscess) may occur, caused by residual heat lingering in the Ying (Nutrient) and Xue (Blood) levels. Treatment must quickly focus on detoxification, clearing heat, invigorating blood, and dispersing pathogens. Mismanagement can lead to pus formation without discharge, resulting in trismus (lockjaw), dysphagia, and death due to inability to eat. If toxins sink inward, causing dry tongue and coma, death also ensues. After pus discharges, death may occur due to Qi deficiency and Blood exhaustion. Therefore, early treatment is essential. Ancient formulas prioritize Puji Xiaodu Yin (Universal Relief Detoxifying Decoction): if the swelling occurs behind the ear, Chaihu (Bupleurum Root) and Chuanxiong (Sichuan Lovage Rhizome) serve as the sovereign drugs; if it occurs below the neck, Gegen (Kudzu Root) serves as the sovereign drug; if it occurs at the back of the neck or vertex, Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root) are added. This condition should not be lightly tonified before ulceration; premature tonification will inevitably cause pus formation. Furthermore, one must not use purely cold-natured herbs when the condition is about to erupt, lest they block and suppress the pathogen, preventing toxin dispersion. Therefore, incorporating dispersing methods is crucial. For external treatment, frequently bathe the area with scallion water.