狂汗者,伏邪中溃,欲作汗解,因其人禀赋充盛,阳气冲击,不能顿开,故忽然
坐卧不安,且狂且躁,少顷大汗淋漓,狂躁顿止,脉静身凉,霍然而愈。
邪留血分,里气壅闭,则伏邪不得外透而为斑。若下之,内壅一通,则卫气亦从
而疏畅,或出表为斑,则毒邪亦从而外解矣。若下后斑渐出,不可更大下,设有下证,少与
承气缓缓下之。若复大下,中气不振,斑毒内陷则危,宜托里举斑汤。
托里举斑汤
白芍 当归(各一钱) 升麻(五分) 白芷 柴胡(各七分) 穿山甲(二钱,炙黄)
水姜煎服。下后斑渐出,复大下,斑毒复隐,反加循衣摸床,撮空理线,脉渐微者危,本方
加人参一钱,补不及者死。若未下而先发斑者,设有下证,少与承气,须从缓下。
下证以邪未尽,不得已而数下之,间有两目加涩、舌反枯干、津不到咽、唇口燥
裂,缘其人所禀阳脏,素多火而阴亏。今重亡津液,宜清燥养荣汤。设热渴未除,里证仍在
,宜承气养荣汤。
夫疫乃热病也,邪气内郁,阳气不得宣布,积阳为火,阴血每为热搏,暴解之
后,余焰尚在,阴血未复,大忌参、 、白术,得之反助其壅郁,余邪留伏,不惟目下淹缠
,日后必变生异证,或周身痛痹,或四肢挛急,或流火结痰,或遍身疮
疡,或两腿攒痛,或劳嗽涌痰,或气毒流注。或痰核穿漏,皆骤补之为害也。凡有阴枯血燥者,
宜清燥养荣汤。若素多痰,及少年平时肥盛者,投之恐有腻膈之弊,亦宜斟酌。大抵时疫愈
后,调理之剂,投之不当,莫如静养节饮食为第一。
清燥养荣汤
知母 天花粉 当归身 白芍 地黄汁 陈皮 甘草
加灯心煎服。表有余热,宜柴胡养荣汤。
柴胡养荣汤
柴胡 黄芩 陈皮 甘草 当归 白芍 生地 知母 天花粉
姜枣煎服。里证未尽,宜承气养荣汤。
承气养荣汤
知母 当归 芍药 生地 大黄 枳实 浓朴
水姜煎服。痰涎涌甚,胸膈不清者,宜蒌贝养荣汤。
蒌贝养荣汤
知母 花粉 贝母 栝蒌实 橘红 白芍 当归 紫苏子
水姜煎服。
狂汗,是指伏匿的邪气在体内溃散,正气试图通过发汗来解除病邪。由于患者体质充盛,阳气冲击力强,但腠理(皮肤毛孔)不能立即开通,所以患者突然坐卧不宁,既疯狂又烦躁。过了一会儿,大汗淋漓,狂躁症状立刻停止,脉搏变得平静,身体转凉,霍然痊愈。
如果邪气停留在血分,导致里气壅塞闭阻,那么伏匿的邪气就不能向外透发而形成斑疹。如果使用泻下法,内部的壅塞得以疏通,卫气也随之疏畅,邪气可能透出体表形成斑疹,毒邪也就随之从体外解除了。如果在泻下后斑疹逐渐透出,不可再次使用峻猛的泻下法;即使仍有可下的证候,也应少量给予承气汤类方剂,缓缓通下。如果再次大剂量泻下,会导致中气不振,斑毒内陷,病情就会危险,适宜使用托里举斑汤。
托里举斑汤:白芍、当归(各一钱),升麻(五分),白芷、柴胡(各七分),穿山甲(二钱,炙黄)。用水和生姜煎服。如果在泻下后斑疹逐渐透出,又再次大剂量泻下,导致斑毒重新隐没,反而出现循衣摸床(手指无意识地抓摸衣物)、撮空理线(手在空中虚抓线条)等症状,脉搏逐渐微弱,这是危重之象,应在本方中加入人参一钱;如果正气补益不及,则会导致死亡。如果尚未使用泻下法而先发斑疹,即使有可下的证候,也应少量给予承气汤,必须缓缓通下。
如果有可下的证候是因为邪气未尽,不得已而多次使用泻下法,期间出现两眼干涩、舌面反而枯干、津液不到咽喉、嘴唇口角干燥开裂,这是因为患者禀赋属于阳脏,平时多火且阴液亏虚。现在因为多次泻下严重耗伤津液,适宜使用清燥养荣汤。如果热渴症状未除,里证仍然存在,适宜使用承气养荣汤。
瘟疫属于热病,邪气在内郁结,阳气不能宣通布散,积聚的阳气化为火邪,阴血常被热邪搏结。在暴烈解除之后,余焰尚存,阴血尚未恢复,此时最忌用人参、[此处原文缺字,通常指麦冬或五味子等滋阴药,依语境暂略]、白术,用了这些药反而会助长壅滞郁结,使余邪留伏。不仅眼下病情缠绵,日后必定变生其他病症,如周身疼痛痹阻,或四肢拘挛抽搐,或流火凝结成痰,或遍身疮疡,或双腿攒聚疼痛,或劳嗽涌出痰涎,或气毒流注。或痰核穿破漏出,这些都是骤然进补带来的危害。凡是有阴液枯竭、血液燥热者,适宜使用清燥养荣汤。如果患者平时多痰,以及少年时期平时身体肥胖壮实的人,服用此方恐怕有滋腻碍胃的弊端,也应当斟酌使用。大抵时疫痊愈后,调理的药剂,投用不当,不如安静休养、节制饮食为第一要务。
清燥养荣汤:知母、天花粉、当归身、白芍、地黄汁、陈皮、甘草。加灯心草煎服。如果表证有余热,适宜使用柴胡养荣汤。
柴胡养荣汤:柴胡、黄芩、陈皮、甘草、当归、白芍、生地、知母、天花粉。用姜、枣煎服。如果里证未尽,适宜使用承气养荣汤。
Kuang Han (Manic Sweating) refers to the situation where latent pathogens are disintegrating within the body, and the healthy Qi attempts to resolve the disease through sweating. Because the patient's constitution is robust and the Yang Qi has strong impulsive power, but the Cou Li (skin pores) cannot open immediately, the patient suddenly becomes restless in sitting or lying down, exhibiting manic and irritable behavior. After a short while, profuse sweating occurs, the manic and irritable symptoms cease instantly, the pulse becomes calm, the body turns cool, and the patient recovers abruptly.
If pathogens remain in the Blood level, causing stagnation and closure of the interior Qi, the latent pathogens cannot penetrate outward to form macules (ban). If purgatives are used, the internal stagnation is unblocked, and the Wei Qi (Defensive Qi) also becomes smooth and free-flowing. The pathogens may then emerge from the exterior as macules, and the toxic pathogens will thereby be resolved from the outside. If macules gradually appear after purgation, one must not use harsh purgatives again; even if there are indications for purgation, only a small amount of Chengqi Tang (Cathartic Decoction) should be given to gently promote bowel movement. If heavy purgation is repeated, the Middle Qi will fail, macule toxins will sink inward, and the condition will become critical. In such cases, Tuoli Jubang Tang (Interior-Supporting Macule-Raising Decoction) is appropriate.
Tuoli Jubang Tang: Baishao (Radix Paeoniae Alba), Danggui (Radix Angelicae Sinensis) (each 1 qian), Shengma (Rhizoma Cimicifugae) (0.5 qian), Baizhi (Radix Angelicae Dahuricae), Chaihu (Radix Bupleuri) (each 0.7 qian), Chuanshanjia (Squama Manis) (2 qian, stir-fried until yellow). Decoct with water and fresh ginger. If macules gradually appear after purgation, but heavy purgation is repeated, causing the macule toxins to re-conceal, and symptoms such as Xun Yi Mo Chuang (involuntarily grasping at bedclothes) and Cuo Kong Li Xian (fingers picking at empty air as if tracing lines) appear, with the pulse gradually becoming faint, this is a critical sign. Add 1 qian of Renshen (Radix Ginseng) to this formula; if the deficiency cannot be adequately replenished, death will ensue. If macules appear first without prior purgation, and there are still indications for purgation, give a small amount of Chengqi Tang, ensuring gentle purgation.
When purgation is necessary due to incomplete elimination of pathogens, it may be performed multiple times. During this process, if the eyes become dry and gritty, the tongue becomes dry and withered, fluids fail to reach the throat, and lips and mouth crack due to dryness, it is because the patient’s constitution is of the "Yang Zang" type, prone to fire and Yin deficiency. Heavy loss of body fluids from repeated purgation necessitates the use of Qingzao Yangrong Tang (Dryness-Clearing and Nutritive-Qi-Enriching Decoction). If heat and thirst persist and interior signs remain, Chengqi Yangrong Tang (Cathartic and Nutritive-Qi-Enriching Decoction) is appropriate.
Yiwen (Plague) is a heat disease. Pathogens are internally constrained, preventing the proper distribution of Yang Qi. Accumulated Yang transforms into fire, and Yin blood is often combated by heat. After abrupt resolution, residual heat remains, and Yin blood has not yet recovered. It is strictly forbidden to use Renshen (Radix Ginseng), [text missing, likely referring to Yin-nourishing herbs], and Baizhu (Rhizoma Atractylodis Macrocephalae); using them will instead exacerbate stagnation and constraint, allowing residual pathogens to linger. This not only prolongs the current illness but will inevitably lead to other complications later, such as generalized pain and bi-syndrome, limb spasms and cramps, flowing fire condensing into phlegm, widespread sores and ulcers, severe pain in both legs, chronic cough with copious sputum, or qi-toxicity flowing and accumulating. Or phlegm nodules may perforate and leak. All these are harms caused by sudden tonification. For those with Yin exhaustion and blood dryness, Qingzao Yangrong Tang is appropriate. However, for patients who generally have much phlegm, or for youths who were previously obese and robust, this formula may cause greasiness and obstruct the diaphragm/stomach; thus, its use requires careful consideration. Generally, after recovery from epidemic diseases, regarding conditioning agents, improper prescription is less harmful than failing to rest quietly and regulate diet, which is the primary measure.
Qingzao Yangrong Tang: Zhimu (Rhizoma Anemarrhenae), Tianhuafen (Radix Trichosanthis), Dangguishen (Corpus Radix Angelicae Sinensis), Baishao (Radix Paeoniae Alba), Dihuangzhi (Jus Rhizomatis Rehmanniae Recens), Chenpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae). Decoct with Dengxincao (Medulla Junci). If residual heat remains in the exterior, Chaihu Yangrong Tang (Bupleurum and Nutritive-Qi-Enriching Decoction) is appropriate.
Chaihu Yangrong Tang: Chaihu (Radix Bupleuri), Huangqin (Radix Scutellariae), Chenpi (Pericarpium Citri Reticulatae), Gancao (Radix Glycyrrhizae), Danggui (Radix Angelicae Sinensis), Baishao (Radix Paeoniae Alba), Shengdi (Radix Rehmanniae Preparata), Zhimu (Rhizoma Anemarrhenae), Tianhuafen (Radix Trichosanthis). Decoct with fresh ginger and jujube. If interior signs are not fully resolved, Chengqi Yangrong Tang (Cathartic and Nutritive-Qi-Enriching Decoction) is appropriate.
Chengqi Yangrong Tang: Zhimu (Rhizoma Anemarrhenae), Danggui (Radix Angelicae Sinensis), Shaoyao (Radix Paeoniae), Shengdi (Radix Rehmanniae Preparata), Dahuang (Radix et Rhizoma Rhei), Zhishi (Fructus Aurantii Immaturus), Nongpu (Rhizoma Magnoliae Officinalis). Decoct with water and fresh ginger. If phlegm-fluids surge excessively and the chest and epigastrium feel unclear, Loubei Yangrong Tang (Trichosanthes and Fritillaria and Nutritive-Qi-Enriching Decoction) is appropriate.
Loubei Yangrong Tang: Zhimu (Rhizoma Anemarrhenae), Huafen (Radix Trichosanthis), Beimu (Flos Fritillariae Cirrhosae), Gualoushi (Fructus Trichosanthis), Juhong (Exocarpium Citri Reticulatae Rubrum), Baishao (Radix Paeoniae Alba), Danggui (Radix Angelicae Sinensis), Zisuzi (Semen Perillae). Decoct with water and fresh ginger.