凡疟者寒热如期而发,余时脉静身凉,此常疟也,以疟法治之。设传胃者,必现
里证,名为温疟,以疫法治者生,以疟法治者死。里证者下证也,下后里证除,寒热独存者
,是温疫减,疟证在也。疟邪未去者,宜疏,邪去而疟势在者宜截,势在而挟虚者宜补。疏以
清脾饮,截以不二饮,补以四君子,方见疟门,仍恐杂乱,此不附载。
下痢脓血,更加发热而渴,心腹痞满,呕而不食,此疫痢兼证,最为危急。夫疫
者胃家事也,盖疫邪传胃十常八九,既传入胃,必从下解,疫邪不能自出,必藉大肠之气传
送而下,而疫方愈。夫痢者,大肠内事也,大肠既病,失其传送之职,故正粪不行,纯乎下
痢脓血而已,所以向来谷食停积在胃,直须大肠邪气将退,胃气通行,正粪自此而下,今
大肠失职,正粪尚自不行,又何能与胃载毒而出?毒既不前,羁留在胃,最能败坏真气,在
胃一日,有一日之害,一时有一时之害,耗气搏血,神脱气尽而死。凡遇疫痢兼证者,在痢
尤为吃紧,疫痢俱急者,宜槟芍顺气汤,诚为一举两得。
槟芍顺气汤 专治下痢频数,里急后
槟榔 芍药 枳实 浓朴 大黄
生姜煎服。
妇人伤寒时疫,与男子无二,惟经水适断适来,及崩漏产后,与男子稍有不同。
夫经水之来,乃诸经血满,归注于血室,下泄为月水。血室者一名血海,即冲任脉也,为诸
经之总任。经水适来,疫邪不入于胃,乘势入于血室,故夜发热谵语。盖卫气昼行于阳,不
与
热入血室,因有轻重之分,不必拘于谵语也。经曰∶无犯胃气,及上二焦必自愈。胸膈并胃无
邪,勿以谵语为胃实而妄攻之,但热随血下,故自愈。若有如结胸状者,血因邪结也,当刺
期门以通其结,治之以柴胡汤,治之不若刺者功捷。
经水适断,血室空虚,其邪乘虚传入,邪胜
正亏,经气不振,不能鼓散其邪,为难治,且不从血泄,邪气何由即解?与适来之义,有血虚
血实之分,宜柴胡养荣汤。新产后亡血过多,冲任空虚,与夫素善崩漏,经气久虚,皆能受邪
,与经水适断同法。
凡是疟疾,都是寒热症状按时发作,其余时间脉象平静、身体凉爽,这是普通的疟疾,用治疗疟疾的方法处理。如果病邪传入胃中,必然出现里证,称为温疟,用治疗疫病的方法救治能活命,用治疗疟疾的方法则会导致死亡。所谓的里证,就是需要使用下法(泻下)的证候。使用下法后,里证消除,只剩下寒热往来,这说明温疫之邪已减,但疟疾的病邪仍在。对于疟邪未除的情况,应当采用疏解的方法;对于邪气已去但疟疾发作之势仍在的情况,应当采用截断的方法;对于发作之势仍在且夹杂虚证的情况,应当采用补益的方法。疏解可用清脾饮,截断可用不二饮,补益可用四君子汤,这些方剂详见疟疾章节,这里为了避免内容杂乱,不再重复列出。
痢疾排出脓血,又加上发热口渴,心腹部痞塞胀满,呕吐不能进食,这是疫痢兼证,最为危急。疫病是胃腑的疾病,大概疫邪传入胃中的占十之八九,既然传入胃中,必然通过大便排出,疫邪不能自行排出,必须借助大肠的传导功能向下排泄,疫病才能痊愈。痢疾是大肠内部的疾病,大肠既已患病,失去了传导的功能,所以正常的粪便无法下行,纯粹只是下痢脓血罢了。因此,以往谷食停滞在胃中,一定要等到大肠的邪气消退,胃气通畅,正常粪便才能由此而下。现在大肠失职,正常粪便尚且不能下行,又怎么能帮助胃将毒素载出呢?毒素既然不能前行,羁留在胃中,最能败坏真气,在胃停留一天,就有一天的危害,一时有一时的危害,耗伤气血,导致神志涣散、元气耗尽而死。凡是遇到疫痢兼证的情况,重点在于痢疾。如果疫邪和痢疾都急迫,宜用槟芍顺气汤,这确实是一举两得的好办法。
槟芍顺气汤 专门治疗痢疾频繁,里急后重。
槟榔、芍药、枳实、厚朴、大黄,生姜煎服。
妇女患伤寒或时疫,与男子没有太大区别,只有月经刚好停止或刚来潮,以及崩漏、产后等情况,与男子稍有不同。
月经来潮,是因为各经血液充盈,汇聚于血室,向下泄出成为月经。血室又名血海,即冲脉和任脉,是各经血液的总汇。月经刚来潮时,疫邪不进入胃中,而是乘势侵入血室,所以夜间发热并说胡话。卫气白天行于阳分,不与邪热相争……(注:原文此处有缺漏,根据上下文意译)热入血室,因病情轻重不同,不一定表现为说胡话。医经说:不要损伤胃气,也不要攻伐上焦和中焦,病必自愈。如果胸膈和胃中没有邪气,不要因为说胡话就认为是胃实证而妄用攻下法,只要热随血液下行,病就会自愈。如果出现类似结胸的症状,是因为血液被邪气凝结,应当针刺期门穴以疏通其凝结,并用柴胡汤治疗,治疗效果不如针刺迅速。
月经刚好停止时,血室空虚,邪气乘虚传入,邪气盛而正气亏虚,经气不振奋,不能鼓动消散邪气,属于难治的情况,而且邪气不从血液排出,邪气凭什么立即解除?这与月经刚来潮的情况,有血虚和血实的区别,宜用柴胡养荣汤。新产后失血过多,冲任二脉空虚,以及平时容易崩漏、经气长期虚弱的人,都能感受邪气,治疗方法与月经刚停止时相同。
Regarding malaria, the chills and fever occur at regular intervals, while during other times the pulse is calm and the body temperature is normal; this is ordinary malaria, which should be treated with methods for malaria. If the pathogen transmits to the stomach, interior syndromes (Interior Syndromes) must manifest, termed warm malaria (Warm Malaria). Treatment with epidemic disease methods leads to survival, whereas treatment with malaria methods leads to death. The so-called interior syndrome refers to syndromes requiring purgation (Purgation). After purgation, if the interior syndrome resolves but chills and fever persist, it indicates that the epidemic pathogen has diminished, but the malaria pathogen remains. For remaining malaria pathogens, dispersing (Dispersing) methods are appropriate; for cases where the pathogen is gone but the momentum of malaria persists, intercepting (Intercepting) methods are appropriate; for cases where the momentum persists and is accompanied by deficiency, tonifying (Tonifying) methods are appropriate. Dispersing can be achieved with Qingpi Yin (Clear Spleen Decoction), intercepting with Bu'er Yin (Two-Not-Drink), and tonifying with Sijunzi Tang (Four Gentlemen Decoction); these formulas are detailed in the malaria section. To avoid clutter, they are not listed here.
Dysentery with pus and blood, accompanied by fever, thirst, epigastric and abdominal fullness and stuffiness, vomiting, and inability to eat, constitutes a combined syndrome of epidemic dysentery (Epidemic Dysentery), which is extremely critical. Epidemic diseases are disorders of the Stomach (Stomach); approximately eight or nine out of ten epidemic pathogens transmit to the stomach. Once transmitted to the stomach, they must resolve through the lower pathway. Since the epidemic pathogen cannot exit on its own, it relies on the conduction function of the Large Intestine (Large Intestine) to move downward for the epidemic to heal. Dysentery, however, is an internal matter of the Large Intestine. When the Large Intestine is diseased, it loses its conduction function, causing normal stool not to pass, resulting purely in dysenteric discharge of pus and blood. Therefore, previously accumulated food in the stomach requires the decline of Large Intestine pathogens and the smooth flow of Stomach Qi before normal stool can pass. Now, with the Large Intestine failing in its duty and normal stool unable to pass, how can it assist the Stomach in carrying toxins out? Since the toxins cannot advance and remain lodged in the Stomach, they severely damage true Qi. Each day spent in the Stomach brings daily harm, each moment brings momentary harm, consuming Qi and Blood until Spirit dissipates and Qi exhausts, leading to death. In cases of combined epidemic dysentery, the focus is particularly on the dysentery. When both epidemic pathogens and dysentery are urgent, Binshao Shunqi Tang (Areca Seed and Peony Regulating Qi Decoction) is indicated, achieving two goals with one action.
Binshao Shunqi Tang specifically treats frequent dysentery with tenesmus (Tenesmus).
Areca Seed (Binglang), Peony Root (Shaoyao), Immature Bitter Orange (Zhishi), Magnolia Bark (Houpo), Rhubarb (Dahuang), decocted with Fresh Ginger (Shengjiang).
Women suffering from Cold Damage (Cold Damage) or seasonal epidemics are generally no different from men, except regarding menstruation (Menstruation) that has just ceased or just begun, as well as metrorrhagia (Metrorrhagia) and postpartum states, which differ slightly from men. Menstruation occurs when blood from various meridians fills and gathers in the Blood Chamber (Blood Chamber), also known as the Sea of Blood, which corresponds to the Chong and Ren meridians (Chong and Ren Meridians), serving as the general reservoir for blood from all meridians. When menstruation just begins, epidemic pathogens do not enter the Stomach but instead invade the Blood Chamber along with the trend, causing night fever and delirium (Delirium). Wei Qi circulates in the Yang aspects during the day... [Text gap inferred] Heat entering the Blood Chamber varies in severity and does not necessarily present as delirium. The classics state: Do not violate Stomach Qi, nor attack the Upper and Middle Jiao (Upper and Middle Jiao); the disease will heal itself. If there is no pathogen in the chest, diaphragm, or Stomach, do not assume gastric excess due to delirium and use reckless purgation. Instead, as heat follows the blood downward, the disease heals spontaneously. If symptoms resemble Chest Binding (Chest Binding), it is because blood is bound by pathogens; one should puncture the Qimen acupoint (Qimen, LR14) to unblock the binding and treat with Chaihu Tang (Bupleurum Decoction). However, treatment efficacy is faster with acupuncture than with herbs.
When menstruation just ceases, the Blood Chamber is empty, allowing pathogens to enter due to deficiency. Pathogens prevail while healthy Qi declines, meridian Qi fails to rise, and it cannot drive out the pathogens, making it difficult to treat. Moreover, since pathogens do not exit via blood, how can they resolve immediately? This differs from the case of menstruation just beginning, involving distinctions between blood deficiency and blood excess; Chaihu Yangrong Tang (Bupleurum Nourishing Prosperity Decoction) is appropriate. Following recent childbirth, excessive blood loss empties the Chong and Ren meridians. Similarly, those prone to metrorrhagia with long-term deficiency of meridian Qi are susceptible to pathogens and should be treated similarly to the case of menstruation just ceasing.