时疫潮热而渴、舌黄身痛、心下满闷、腹时痛、脉数,此应下之症也。外有通身
及
面目浮肿,喘急不已,小便不利,此疫兼水肿,因三焦壅闭,水道不行也,但治在疫,水肿
自已,宜小承气汤。向有单腹胀而后疫者,治在疫。若先年曾患水肿,因疫而发者,治在疫
,水肿自愈。病患通身浮肿,下体益甚,脐凸阴囊及阴茎肿大色白,小便不利,此水肿也,
继又身大热,午后益甚,烦渴,心下满闷,喘急,大便不调,此又加疫也,因下之,下后胀不除,反
加腹满,宜承气加甘遂二分,弱人量减。盖先肿胀,续得时疫,此水肿兼疫,大水在表,微
疫在里也,故并治之。时疫愈后数日,先自足浮肿,小便不利,肿渐至心腹而喘,此水气也
,宜治在水。时疫愈后数日,先自足浮肿,小便如常,虽至通身浮肿而不喘,别无所苦,此气
复也,盖血乃气之根据归,夫气先血而生,无所归根据,故暂浮肿,但静养节饮食,不药自愈。时疫
身体羸弱,言不足以听,气不足以息,得下证少与承气,下证稍减,更与之,眩晕欲死,盖
不胜其攻也。绝谷期月,稍补则心腹满闷,攻不可,补不可,守之则元气不鼓,余邪沉
匿膜原,日惟水饮而已,以后心腹忽加肿满烦冤者,向来沉匿之邪,方悉分传于表里也,宜
承
气养荣汤,一服病已。设表肿未除,宜微汗之自愈。时疫得里证失下,以致面目浮肿及肢体
微肿,小便自利,此表里气滞,非兼水肿也,宜承气下之,里气一疏,表气亦顺,浮肿顿除
。或见绝谷期月,指为脾虚发肿,误补必剧,妊娠更多此证,治法同前,则子母俱安,但当
少与,慎无过剂。(共七法。)
时疫出现潮热且口渴、舌苔黄、身体疼痛、胃脘部胀满憋闷、腹部时常疼痛、脉象数,这是应当使用下法(泻下)的证候。如果同时伴有全身及面目浮肿、气喘急促不止、小便不通利,这是时疫兼夹水肿,原因是三焦气机壅塞闭阻,水道运行不畅所致,治疗重点在于治时疫,水肿自然痊愈,适宜用小承气汤。
以往有先患单腹胀病而后感染时疫的,治疗重点在于治时疫。如果是早年曾患过水肿病,因感染时疫而诱发的,治疗重点在于治时疫,水肿也会自愈。
患者全身浮肿,下肢更为严重,肚脐突出,阴囊及阴茎肿大且颜色发白,小便不通利,这是水肿病;随后又出现身体高热,午后加重,烦躁口渴,胃脘部胀满憋闷,气喘急促,大便不调,这是又兼有时疫,应当使用下法。若使用后下法,腹胀未消除,反而增加腹部胀满,适宜用承气汤加甘遂二分,体弱之人酌情减量。
这是因为先有肿胀,后得时疫,属于水肿兼时疫,大水邪在表,轻微时疫邪在里,所以并治之。
时疫痊愈后数日,先从足部开始浮肿,小便不通利,浮肿逐渐蔓延至心腹部位并出现气喘,这是水气病,适宜治疗水气。
时疫痊愈后数日,先从足部开始浮肿,小便如常,即使发展到全身浮肿也不气喘,没有其他痛苦,这是正气恢复的表现,因为血是气的依附根本,气先于血而生,若无血作为依附,故暂时出现浮肿,只需静养并节制饮食,不服药也能自愈。
时疫导致身体极度虚弱,说话声音低微不足以让人听清,气息微弱不足以喘息,出现可下的证候时,少量给予承气汤,待可下证候稍减,再次给予,却出现眩晕欲死的情况,这是因为身体无法承受攻伐。
绝食长达一个月,稍微进补则心腹胀满憋闷,既不能攻下,也不能进补,若固守原状则元气无法振奋,余留的邪气潜伏在膜原,每日只饮水,此后心腹突然加重肿满烦闷冤屈感的,是向来潜伏的邪气,现在全面传变到表里了,适宜用承气养荣汤,服用一次病即痊愈。
假设表部的浮肿未消除,适宜用微汗法使其自愈。
时疫出现里证但失于及时攻下,以致面目浮肿及肢体轻微浮肿,小便通利,这是表里气机阻滞,并非兼夹水肿,适宜用承气汤攻下,里气一旦疏通,表气也随之顺畅,浮肿顿时消除。
或者见到绝食长达一个月,将其指认为脾虚导致的浮肿,误用补法必然病情加剧,孕妇更多见此类证候,治疗方法同前,则母子俱安,但应当少量给药,务必谨慎不要过量。(共七种治法。)
When epidemic febrile disease presents with tidal fever and thirst, yellow tongue coating, body pain, fullness and oppression in the epigastrium, occasional abdominal pain, and a rapid pulse, this is a syndrome requiring purgation (Purgative Method). If accompanied by generalized edema of the whole body and face, incessant panting, and dysuria, this is epidemic disease complicated by edema, caused by obstruction and closure of the Sanjiao (Triple Burner), leading to impaired water passage. The treatment should focus on the epidemic disease, and the edema will resolve spontaneously; Xiao Chengqi Tang (Minor Order the Yang Decoction) is appropriate.
In cases where patients previously suffered from monastic abdominal distension (single abdominal bloating) and subsequently contracted an epidemic, the treatment should focus on the epidemic. If a patient had a history of edema in previous years and it was triggered by an epidemic, the treatment should focus on the epidemic, and the edema will resolve spontaneously.
If a patient presents with generalized edema, more severe in the lower body, with umbilical protrusion, swelling of the scrotum and penis with white discoloration, and dysuria, this is edema. If subsequently accompanied by high fever, worsening in the afternoon, irritability and thirst, epigastric fullness and oppression, panting, and irregular bowel movements, this indicates a complication with epidemic disease. Purgation should be employed. If purgation fails to relieve the distension and instead increases abdominal fullness, Chengqi Tang combined with 2 fen of Kansui Root (Kansui Radix) is appropriate, with dosage reduced for weak individuals.
This situation arises because swelling occurred first, followed by epidemic disease, representing edema complicated by epidemic. The substantial water pathogen is at the exterior, while the mild epidemic pathogen is at the interior; thus, both are treated simultaneously.
Several days after recovery from epidemic disease, if edema begins in the feet, accompanied by dysuria, and gradually spreads to the heart and abdomen with panting, this is water qi pathology, and treatment should focus on resolving water.
Several days after recovery from epidemic disease, if edema begins in the feet, urination remains normal, and even if it progresses to generalized edema without panting or other discomfort, this indicates the return of healthy qi. Since blood serves as the foundation for qi, and qi generates prior to blood, the lack of a basis for qi causes temporary edema. Rest and dietary moderation will lead to spontaneous recovery without medication.
If epidemic disease causes extreme physical debility, with speech too faint to hear and breathing too weak to sustain, and purgative indications appear, administer a small dose of Chengqi Tang. When the purgative indications subside slightly, administering it again may cause dizziness and near-death sensations due to the body's inability to withstand the attacking action.
After fasting for a month, slight tonification leads to epigastric and abdominal fullness and oppression. Neither attacking nor tonifying is suitable; maintaining the status quo prevents the vital qi from stirring. The residual pathogens, which were latent in the Membrane Source (Mo Yuan), now fully transmit to the interior and exterior, causing sudden worsening of abdominal swelling, fullness, and distress. Chengqi Yangying Tang (Order the Qi and Nourish the Ying Decoction) is appropriate, with one dose resolving the illness. If exterior edema persists, inducing mild sweating will lead to spontaneous recovery.
If epidemic disease presents with interior syndromes but fails to receive timely purgation, resulting in facial edema and slight limb edema with free urination, this is stagnation of qi in the interior and exterior, not complicated edema. Purging with Chengqi Tang is appropriate; once interior qi is unblocked, exterior qi becomes smooth, and edema disappears instantly.
Some may mistake prolonged fasting-induced swelling for spleen deficiency and erroneously use tonification, worsening the condition. This presentation is common in pregnancy; the treatment method is the same as above, ensuring safety for both mother and fetus, but the dosage must be small, and caution must be exercised against overdose. (Seven methods in total.)