读书之余,留意医学,幸得其传,颇识方脉,就辟入南,研究此证。谓南人凡病
,皆谓之瘴,率不服药,惟事鬼神。夫瘴之为病,犹伤寒之病也,岂可坐视而不药耶?每为
中医荏苒而致不救者有之。人过桂林以南无医药,且居南方之人,往往多汗,上盈下空,不
可用汗吐下三法。其业医者既鲜且庸,或妄用吐汗下者,是谓虚虚。方书皆谓南方天气温暑
,地气郁蒸,阴多闭固,阳多发泄,草木水泉皆禀恶气,人生其间,元气不固,感而为病,
是为之瘴。轻者,寒热往来,正类咳疟,谓之冷瘴。重者,蕴热沉沉,昼夜如卧灰火中
,谓之热瘴。最重者,一病便失音,莫知其所以然,谓之哑瘴。冷瘴必不死,热瘴久而死,
哑瘴无不死,此方书之说也。然以愚意观之,所谓哑瘴者,非伤寒失音之证乎?又岂中风失
语之证乎?治得其道,亦多可生,安得谓之无不死耶。若夫热瘴,乃是盛夏初秋,茅生狭道
,人行其间,热气蒸郁,无林木以蔽日,无水泉以解渴,伏暑至重,因而感疾。或有饮酒而
不节者,或食煎灸而积热者,偶成此证。其热昼夜不止,稍迟二三日,则血凝而不可救矣。
南中谓之中箭,亦谓之中草子。然有挑草子法,乃以针刺头额及上下唇,仍以楮叶擦舌,皆
令出血,徐以草药解其内热,应手而愈,安得谓之久而死耶。至于冷瘴,或寒多热少,或寒
少热多,亦有叠日间日之作,及其愈也。疮发于唇,验其证即是外方之疟。本非重病,然每
因误治而致祸,亦不可以必不死而忽之。但诊其脉息极微,见其元气果虚,即与附子汤而愈
;若误投寒药,所谓承气入胃,阴盛乃亡。若脉洪盛,证候实热,宜服和解药而徐治之;若
误投热药,所谓桂枝下咽,阳盛则毙也。要在切脉,审证之虚实寒热治之,无不愈也。人谓
岭南水泉草木地气之毒,故凡往来岭南之人,及宦而至者,无不病瘴而至危殆者也。又谓土
人生长其间,与水土之气相习,外人入南必一病,但有轻重之异,若久而与之俱化则免矣。
此说固若有理,但备之以将养之法,解之以平易之药,决保无病,纵病亦易愈矣。且瘴之为
病,土人反重,外人反轻者多。盖土人淫而下元虚,又浴于溪而多感冒,恣食生冷酒馔,全
不知节,所以重也。然则病瘴者,不可全咎风土之殊,皆人自失节养,有以致之耳。君子之
居是邦也,当慎起居,节饮食,适寒温,晨酒夜食,切忌大过,或有不快,即服正气散一二
剂,则脾胃自壮,气血通畅,微邪速散,又何瘴之有。
在研读医书之余,我留心于医学,有幸得到真传,颇通晓方剂与脉理。后来被征召前往南方,专门研究这一类病症。
当地人说,凡是生病,都称之为“瘴”,通常不服药,只信奉鬼神。
然而,“瘴”这种病,其实就像“伤寒”一样,怎么能坐视不管而不进行治疗呢?
我经常见到因为中医治疗拖延(荏苒)而导致无法救治的情况。
人们一旦过了桂林以南,就没有医药可用了。而且居住在南方的人,往往容易多汗,导致上实下虚(上部邪气盛,下部正气虚),因此不能使用发汗、催吐、泻下这三种治疗方法。
当地的医生既少又庸碌,有的胡乱使用汗、吐、下法,这就叫做“虚虚”(使虚者更虚)。
医书上都说,南方天气温热暑热,地气郁结蒸腾,阴气多闭固,阳气多发泄,草木泉水都禀受了恶劣之气,人生活在那里,元气不坚固,感受邪气而生病,这就是所谓的“瘴”。
重症的,蕴热深沉,昼夜感觉像躺在灰烬火堆中,称为“热瘴”。
医书上说:冷瘴必定不死,热瘴久了会死,哑瘴没有不死的。这是医书上的说法。
然而依我看来,所谓的“哑瘴”,难道不是伤寒导致的失音证吗?难道又不是中风导致的失语证吗?如果治疗得当,大多可以存活,怎么能说没有不死的呢?
至于“热瘴”,是在盛夏初秋时节,茅草生长在狭窄的道路上,人行走其间,热气蒸腾郁结,没有树木遮蔽阳光,没有泉水解渴,伏暑之邪极重,因而感疾。
有的人饮酒不节制,有的人吃了煎炸灸烤的食物积累内热,偶然形成此证。
其发热昼夜不止,如果稍微拖延两三天,血液就会凝滞而无法救治了。
南方人称此为“中箭”,也称为“中草子”。
但是有一种挑治“草子”的方法,是用针刺头额及上下嘴唇,仍然用楮叶擦拭舌头,都令其出血,然后慢慢用草药解除内热,应手而愈,怎么能说久了会死呢?
至于“冷瘴”,或者寒多热少,或者寒少热多,也有间日或隔日发作的,等到痊愈时,疮疡发于嘴唇,验证其症状,就是外地的疟疾。
本来不是重病,但常常因为误治而招致祸患,也不能因为说它必死就不重视。
只要诊察脉息极其微弱,看到元气确实虚弱,就给予附子汤治疗即可痊愈;如果误投寒凉药物,所谓“承气入胃,阴盛乃亡”(服用攻下药进入胃中,若阴寒过盛则会导致死亡)。
如果脉象洪大旺盛,证候属实热,适宜服用和解药物慢慢治疗;如果误投温热药物,所谓“桂枝下咽,阳盛则毙”(桂枝汤喝下去,若阳热过盛则会导致死亡)。
人们说岭南的水泉草木地气有毒,所以凡是往来岭南的人,以及做官到那里去的人,没有不得瘴病而危及生命的。
又说土著人生长在那里,与水土之气相习惯,外地人进入南方必定会生病,只是有轻重之分,如果时间久了与之同化就可以免除了。
这种说法固然似乎有理,但只要准备好调养的方法,用平和的药物来解毒,保证不会生病,即使生病也容易痊愈。
况且瘴病,土著人反而严重,外地人反而轻的多。
这是因为土著人纵欲导致下元虚弱,又在溪水中沐浴容易感冒,放纵饮食生冷酒肉,完全不知道节制,所以病情严重。
那么得瘴病的人,不能完全归咎于风土的不同,都是人自己失去了节制的养生之道,才导致这样的结果。
君子居住在这个地方,应当谨慎起居,节制饮食,适应寒温,早晨喝酒晚上吃饭(注:此处原文可能有误或特指某种习俗,按字面翻译),切忌过度,如果有不适,立即服用正气散一两剂,那么脾胃自然强壮,气血通畅,微邪迅速消散,又有什么瘴病可言呢。
After studying medical texts, I paid attention to medicine and fortunately received the true transmission, becoming quite familiar with formulas and pulse diagnosis. Later, I was summoned to the South to study this specific condition.
The local people say that any illness is called "Zhang" (Miasma), and they generally do not take medicine, but only worship spirits and gods.
However, "Zhang" as a disease is similar to "Shanghan" (Cold Damage); how can one sit idly by without treatment?
I have often seen cases where delayed or ineffective Traditional Chinese Medicine treatment led to untreatable conditions.
Once past Guilin to the south, medical resources are scarce. Moreover, people living in the South often sweat excessively, leading to a pattern of excess above and deficiency below (Shang Shi Xia Xu). Therefore, the three methods of sweating (Diaphoresis), vomiting (Emesis), and purging (Catharsis) cannot be used.
Local physicians are few and often incompetent; some recklessly use sweating, vomiting, or purging methods, which constitutes "making the deficient more deficient" (Xu Xu).
Medical books state that the southern climate is warm and humid, and the earth's qi is stagnant and steaming. Yin qi tends to be closed and solidified, while Yang qi tends to dissipate. Plants and water sources all absorb evil qi. Humans living there have unstable Yuan Qi (Original Qi), and upon contracting pathogens, they fall ill, which is called "Zhang".
In mild cases, there is alternating chills and fever, resembling malaria, called "Leng Zhang" (Cold Miasma).
In severe cases, there is deep-seated heat accumulation, feeling as if lying in ashes and embers day and night, called "Re Zhang" (Hot Miasma).
In the most severe cases, loss of voice occurs immediately upon onset, for unknown reasons, called "Ya Zhang" (Mute Miasma).
Medical books claim: Leng Zhang is never fatal; Re Zhang becomes fatal after a long time; Ya Zhang is always fatal. This is the view in medical literature.
However, in my opinion, what is called "Ya Zhang" is not merely the loss of voice due to Shanghan? Nor is it the aphasia due to Zhongfeng (Wind Stroke)? If treated correctly, many can survive; how can it be said that none survive?
As for "Re Zhang", it occurs in mid-summer and early autumn. Thorns grow on narrow paths; when people walk through them, heat steams and stagnates. Without trees to shade the sun or springs to quench thirst, latent summerheat becomes severe, leading to disease.
Some may drink alcohol without restraint, or consume fried and roasted foods accumulating internal heat, accidentally contracting this condition.
The fever persists day and night. If delayed by two or three days, blood coagulation occurs, making it untreatable.
Locals call this "Zhong Jian" (Arrow Strike) or "Zhong Cao Zi" (Grass Seed Strike).
However, there is a method to treat "Cao Zi": pricking the forehead, upper and lower lips with needles, and wiping the tongue with Broussonetia papyrifera leaves until bleeding occurs, followed by slowly using herbal medicine to resolve internal heat, resulting in immediate recovery. How can it be said to be fatal after a long time?
Regarding "Leng Zhang", there may be more chills than fever, or more fever than chills, or it may occur every other day. Upon recovery, sores may appear on the lips. Verifying the symptoms, it corresponds to malaria from other regions.
It is not originally a severe disease, but often leads to disaster due to misdiagnosis and mistreatment. It should not be ignored simply because it is said to be fatal.
If the pulse is extremely faint and Yuan Qi is indeed deficient, administering Fuzi Tang (Aconite Decoction) will lead to recovery. If cold-natured medicines are mistakenly administered, as stated, "Chengqi entering the stomach, yin excess leads to death."
If the pulse is洪盛 (surging and full) and the syndrome indicates excess heat, harmonizing medicines should be taken for gradual treatment. If hot-natured medicines are mistakenly administered, as stated, "Guizhi entering the throat, yang excess leads to death."
The key lies in palpating the pulse and examining the syndrome for deficiency/excess and cold/heat to treat accordingly; no case will fail to heal.
People say that the toxic earth qi of water, springs, plants, and grass in Lingnan causes anyone traveling or serving as an official there to contract Zhang and face danger.
It is also said that natives, having grown up there, are accustomed to the local earth and water qi. Outsiders entering the South will inevitably fall ill, though severity varies. If one stays long enough to adapt, one may avoid illness.
While this argument seems reasonable, if one prepares proper nourishing methods and uses mild herbs to detoxify, one can ensure no illness, or if ill, easy recovery.
Moreover, among those contracting Zhang, natives often suffer more severely, while outsiders often suffer less.
This is because natives indulge in sexual activity, weakening the Lower Yuan (Kidney essence), bathe in streams catching colds, and eat raw, cold, alcoholic, and rich foods without restraint. Thus, their condition is severe.
Therefore, those contracting Zhang should not solely blame the difference in wind and earth; rather, it is due to their own failure to maintain disciplined health preservation.
When a gentleman resides in such a region, he must be cautious with daily routines, moderate his diet, and adapt to temperature changes. Avoiding excess in morning wine and evening meals, if discomfort arises, taking one or two doses of Zhengqi San (Righteous Qi Powder) will strengthen the Spleen and Stomach, promote smooth flow of Qi and Blood, rapidly disperse minor pathogens, leaving no room for Zhang.