始而脚痛,继以头疼。陡然昏不知人,手振肉 ,动气故。筑牙关与两目上视,面黄颧
红,唇上色青,其下亦然,呼吸痰声。左关已无脉,寸部甚微,右尺亦绝,关前独大且滑。其人
不吐,鼻且不煽,汗亦不出,四肢厥冷,诸医束手,都以真珠母丸法应酬而剧,此痰祟附于肝
经,扰乱不宁,以致地水火风无不上加于天也,古来无此成方,以意逆之,一剂而活动,二
剂而舌伸,三剂而能言。归语门人。
茯神(五钱,朱砂拌) 沉香(三分) 金器(四钱) 磁石(四钱) 獭肝(一钱) 人参(一钱)
竹沥(一钱五分,人姜汁一匙冲) 甘菊(一钱五分,炒)
先以乌梅肉擦开牙关。
将欲施药施医施棺于郡邑之中,则必先解囊后劝善,劳心劳力,日费经营,乃可以有
为也,然而求活人甚众之举不易得焉。备其药得医省其棺,昔之所难者,今于是乎见之,元
和实推为善之乡。当年赈济尚有余赀,仍思设法以公诸贫民,有绅士焉忧上天之疫疠,有富
贵者焉患生人之夭札。时维初夏,正暑湿热三气将蒸,又值乙运之岁金不及,亥年之风木偏
淫。不惟木寡于畏,反侮其金,而且凶年秽乱之气亦被其扇动于中,人在气交,无隙可避,
是一人中其气则为湿温、一方染其气即为时疫之候也。周邑尊既理荒政之余,望其气而异
之,集医问乃病,答曰∶乙为从革,炎火盛行,亥属厥阴,风淫所胜,风火相煽,则吴又可瘟
疫论之见证,不一邪之盘踞于膜原者,势必从九窍传而出,即外起之因内兼之证,以末治之
亦不能出此范围也。况吴又可论瘟疫及张石顽论时行疫气、周禹载论湿热暑疫,均值大挠
甲子以来第七十三甲子,厥阴司天,少阳在泉,风火用事之时。后先阐发精义入神,会元
之司天如斯,值之司天亦未必不如斯。于是邑庙为局,病者接踵而至,门庭若市,内外分科,
大小异位。余时切一脉浮不沉而数,望一舌白苔满布,问其所苦,则凛寒发热,昏昏不爽,余
曰∶达原病。旁一后生曰∶如用此法治之,苔必转黄,而邪达矣。服之果然。及问后生为谁,
曰徐淡安先生之高弟徐铁峰也。伊芳父雪峰本属老医,家学渊源从于局中,可谓好学不倦者
矣!可谓与人为善者矣!当如同善者如管佛容吴云门先生,冀百数十人分手而治,论表里
分界者有人,大剂清凉者有人,下而再下者有人。或湿多而仿湿热混淆之治,或气异而采芳
香逐秽之品,或败毒,或消毒,或解毒,粲乎隐隐,各得其所,畴不仰体, 环在抱之心,共相
逐疫,效技于堂庑之中哉!外之往视,诸徒一如局中论治,死生若判霍然而愈者,实不胜枚
举已。乃设席延医,继以观剧,成赞且贺曰∶见公之作,知公之志。爱民如子,岂不欲救民于
衽席?绅之积善余庆,岂不欲周急而扶危?富之好义施财,岂不欲博施而济众?医之婆心一
片,岂不欲起死而回心夫?然设是局也,岂博乐善好施之名欤?将使继公之理者,见其实惠
知其真心也。
起初出现脚痛,随后发展为头痛。突然昏迷不省人事,手足震颤,肌肉跳动,这是元气虚动的表现。牙关紧闭,双眼上翻,面色发黄而颧骨处发红,嘴唇颜色发青,下巴下方也是如此,呼吸时伴有痰鸣声。左关脉已摸不到,寸部脉象非常微弱,右尺脉也消失了,唯独关前部位脉象盛大且滑利。患者没有呕吐,鼻孔也没有煽动,汗液也未排出,四肢冰冷,各位医生都束手无策,都用真珠母丸的方法敷衍治疗,导致病情加重。这是痰邪附着于肝经,扰乱心神导致不安,致使地、水、火、风四大本源之气无不上冲侵犯头部(天)。自古以来没有现成的成方可用,我根据病机推测处方,服用一剂后患者肢体开始活动,两剂后舌头能伸出,三剂后能够说话。事后我将此经验告诉门人弟子。
药物组成:茯神(五钱,用朱砂拌制)、沉香(三分)、金器(四钱)、磁石(四钱)、獭肝(一钱)、人参(一钱)、竹沥(一钱五分,加入姜汁一匙冲服)、甘菊(一钱五分,炒制)。
先用乌梅肉擦拭打开牙关。
想要在郡县之中实施施药、施医甚至准备棺木的善举,就必须先解开钱袋然后劝导行善,费尽心思和力气,每天经营筹划,这样才能有所作为,然而这样大规模救人的举动是不容易得到的。准备好药品,请医生诊治,节省下棺材费用,过去难以做到的事,如今在这里看到了,元和地区确实被推崇为行善之乡。当年赈济还有剩余的资金,仍然想办法设法让贫民受益。有绅士担忧上天降下的瘟疫,有富贵人家担心百姓早逝。正值初夏,暑气、湿气、热气三种邪气即将蒸腾,又逢乙亥年,岁运金气不足,亥年风气偏盛。不仅木气缺乏制约,反而反侮金气,而且凶年污秽混乱之气也被其煽动于中,人在天地气交之中,无处可躲避,是一个人感染这种气就变成湿温病,一方的人感染这种气就成为时疫的症状。周邑尊在处理完荒政之余,观察疫病之气觉得异常,召集医生询问病因,回答说:乙年为从革之运,炎火盛行,亥年属厥阴,风邪偏胜,风火相煽,这就符合吴又可《瘟疫论》中的见证,并非单一邪气盘踞在膜原,势必会从九窍传变而出,即使是外感起因兼有内伤证候,以末节治法也不能超出这个范围。况且吴又可论述瘟疫,张石顽论述时行疫气,周禹载论述湿热暑疫,都正值大挠甲子以来第七十三甲子,厥阴司天,少阳在泉,风火当令之时。前后阐发精义入神,会元之司天如此,值之司天也未必不如斯。于是将县城庙宇设为防疫局,病人接踵而至,门庭若市,内外分科,大小异位。我当时切脉发现脉浮而不沉且数,望诊见舌苔白满布,询问病人的痛苦,则是恶寒发热,昏昏沉沉不爽快,我说:这是达原饮证。旁边一个年轻人说:如果用这种方法治疗,舌苔必然转黄,邪气就能透达。服药后果然如此。后来问那年轻人是谁,说是徐淡安先生的高徒徐铁峰。他的父亲雪峰本是老医生,家学渊源,跟随在局中,可以说是好学不倦啊!可以说是与人为善啊!当时如同管佛容、吴云门先生一样,希望百数十位医生分开治疗,论述表里分界的人有,使用大剂量清凉药的人有,攻下再攻下的人有。有的湿气重而仿照湿热混淆的治疗方法,有的气异而采用芳香逐秽的药物,有的败毒,有的消毒,有的解毒,灿烂隐约,各得其所,谁不仰体上级关怀百姓之心,共同驱逐瘟疫,在厅堂廊庑中施展医术呢?对外往视诊,各位徒弟一如局中讨论治疗,生死判若两人,霍然而愈者,实在不胜枚举。于是设宴延请医生,接着观看戏剧,成就赞美并祝贺说:看到您的作品,知道您的志向。爱民如子,难道不是想拯救百姓于安乐吗?绅士积善余庆,难道不是想救济急难扶持危难吗?富人好义施财,难道不是想广施恩惠救济众人吗?医生的一片婆心,难道不是想让死者复生、回心转意吗?然而设立这个防疫局,难道是博取乐善好施的名声吗?是希望继任治理的人,看到实际利益,知道您的真心。
Initially, there was pain in the feet, followed by headache. Suddenly, the patient fell into a coma and lost consciousness, with trembling of the hands and twitching of muscles, which is due to the movement of Yuan Qi (Original Qi). The jaw was clenched, eyes rolled upward, complexion yellow with red malar flush, lips cyanotic, and the area below the chin similarly affected, with phlegm-rattling sounds during respiration. The pulse at the left Guan position was imperceptible, the Cun position was very faint, and the right Chi position was absent; only the area anterior to the Guan was surging and slippery. The patient did not vomit, the nostrils were not flaring, and no sweat was excreted; the four limbs were cold. All physicians were at a loss, resorting to Zhenzhu Mu Wan (Pearl Mother Pill) methods perfunctorily, which aggravated the condition. This was phlegm-demon attaching to the Liver Meridian, disturbing the mind and causing restlessness, leading to the Four Elements (Earth, Water, Fire, Wind) all ascending to attack the Head (Heaven). There has been no established prescription for this in ancient times. I inferred the treatment based on the pathogenesis: after one dose, limb movement resumed; after two doses, the tongue could extend; after three doses, speech was restored. I later recounted this experience to my disciples.
Prescription: Fushen (Poria with Hostwood, 5 qian, processed with Cinnabar), Chenxiang (Aquilaria Wood, 3 fen), Jinqi (Gold Artifact, 4 qian), Cishi (Magnetite, 4 qian), Tagan (Rabbit Liver, 1 qian), Renshen (Ginseng Root, 1 qian), Zhuli (Bamboo Sap, 1.5 qian, mixed with one spoonful of Ginger Juice), Ganju (Chrysanthemum Flower, 1.5 qian, stir-fried).
First, use sour plum flesh to wipe open the clenched jaw.
To implement charitable acts such as distributing medicine, providing medical care, or preparing coffins within the commandery and counties, one must first open the purse and then advocate for goodness, expending heart and labor, and managing affairs daily, so that achievements can be made. However, such large-scale efforts to save lives are not easy to come by. Preparing medicines, engaging doctors to treat patients, and thereby saving the cost of coffins—what was difficult in the past is now seen here; Yuanhe is indeed praised as a hometown of virtue. During the famine relief, there were still surplus funds, which were still thoughtfully used to benefit the poor. Some gentry worried about the epidemics sent by Heaven, and some wealthy people feared the premature death of the populace. It was early summer, when heat, dampness, and turbid qi were about to steam up. Furthermore, it was the year of Yi Hai, where the Metal transport was insufficient, and the wind of the Hai year was excessive. Not only was Wood lacking restraint, but it also insulted Metal; moreover, the foul and chaotic qi of the disastrous year was stirred up within. Humans exist in the intersection of Qi, with no gap to avoid it. Thus, if one person contracts this qi, it becomes Damp-Warmth disease; if a region contracts it, it becomes a Seasonal Epidemic. After handling the disaster relief, Prefect Zhou observed the epidemic qi and found it abnormal. He gathered physicians to ask about the disease. The answer was: Yi corresponds to the transformation of metal, with rampant fire; Hai belongs to Jueyin, with excessive wind. Wind and fire fanning each other aligns with the manifestations described in Wu Youke’s *Treatise on Pestilence*. It is not merely a single pathogen lodged in the Membrane Source (Mo Yuan); inevitably, it will transmit out through the nine orifices. Even if the cause is external and the symptoms involve internal complications, treating the branches cannot escape this scope. Moreover, Wu Youke’s discussion on pestilence, Zhang Shiweng’s discussion on seasonal epidemic qi, and Zhou Yuza’s discussion on damp-heat and summer-heat epidemics all coincide with the 73rd Jiazi cycle since Da Nao created the Jiazi system, where Jueyin governs the Heaven (Si Tian) and Shaoyang governs the Earth (Zai Quan), a time when wind and fire are active. They elucidated the profound principles with divine insight. If the Si Tian of Huiyuan is like this, the Si Tian of the current year may well be similar. Thus, the county temple was converted into an epidemic bureau. Patients arrived in succession, the courtyard was as busy as a market, with internal and external departments separated, and different positions for severity. At that time, I palpated the pulse and found it floating, not sinking, and rapid. I observed the tongue and saw white coating covering the entire surface. Asking about their suffering, they reported aversion to cold, fever, and mental confusion. I said: This is Da Yuan Yin (Reach the Origin Decoction) syndrome. A young man nearby said: If treated with this method, the coating will surely turn yellow, and the pathogen will be reached. Indeed, it happened as predicted. Later, asking who the young man was, he was identified as Xu Tiefeng, a senior disciple of Mr. Xu Dan’an. His father, Xuefeng, was an old physician with deep family learning, following in the bureau, truly tireless in study! Truly benevolent! At that time, like Mr. Guan Focong and Mr. Wu Yunmen, we hoped for over a hundred doctors to treat patients separately. There were those discussing the boundary between exterior and interior, those using large doses of cooling herbs, and those using purgatives repeatedly. For cases with more dampness, treatments imitating the confusion of damp-heat were used; for cases with different qi, aromatic substances to drive away filth were adopted; some defeated toxicity, some disinfectated, some detoxified. Brilliant and subtle, each found their place. Who does not look up to the superior’s heart embracing the ring of compassion, jointly driving away the epidemic, and displaying skills in the halls and corridors? Visiting externally, the disciples followed the same treatment discussions as in the bureau. Life and death were judged clearly, and those who recovered suddenly were too numerous to count. Then, banquets were held to invite doctors, followed by opera performances. Achievements were praised and congratulated: Seeing your work, we know your ambition. Loving the people as children, do you not wish to save them from hardship? The accumulated good fortune of the gentry, do you not wish to relieve urgency and support the precarious? The wealth of the rich, do you not wish to bestow broadly and assist the masses? The doctor’s compassionate heart, do you not wish to raise the dead and return the heart? However, establishing this bureau, is it merely to gain the name of being fond of doing good and generous? It is to make those who succeed you see the actual benefits and know your true heart.