一人感疫,发热烦渴,思饮冰水,医者以为凡病须忌生冷,禁止甚严,病者苦索
勿
与,遂致两目火迸,咽喉焦燥,不时烟焰上腾,昼夜不寐,目中见鬼无数,病剧苦甚,自谓
但得冷冻饮料一滴下咽,虽死无恨。于是乘隙匍匐窃取井水一盆,置之枕旁,饮一杯,目顿清亮
,二杯,鬼物潜消,三杯,咽喉声出,四杯,筋骨舒畅,饮至六杯,不知盏落枕旁,竟尔熟
睡,俄而大汗如雨,衣被湿透,脱然而愈。盖因其人瘦而多火,素禀阳脏,始则加之以热,
经络枯燥,既而邪气传表,不能作正汗而解,误投升散,则病转剧,今得冷冻饮料,表里和润,所
谓除弊便是兴利,自然汗解宜矣。更有因食、因痰、因寒剂而致虚陷疾不愈者,皆当舍病求
弊,以此类推,可以应变于无穷矣。
凡客邪皆有轻重之分,惟疫邪感受轻者,人所不识,往往误治而成痼疾。假令患
痢,昼夜无度,水谷不进,人皆知其危痢也。其有感之轻者,昼夜虽行四五度,饮食如常,
起居如故,人亦知其轻痢,未尝误以他病治之者,凭有积滞耳。至如温疫感之重者,身热如
火、头疼身痛、胸腹胀满、苔刺谵语、斑黄狂躁,人皆知其危疫也。其有感之浅者,微有头
疼身痛,午后稍有潮热,饮食不甚减,但食后或觉胀满,或觉恶心,脉微数,如是之疫,最
易误认,即医家素以伤寒温疫为大病,今因证候不显,多有不觉其为疫也。且人感疫之际,
来而不觉,既感不知,最无凭据。又因所感之气薄,今发时故现证不甚,虽有头疼身痛,况饮
食
不绝,力可徒步,又焉得而知其疫也?病患无处追求,每每妄诉病原,医家不善审察,未免
随情错认,有如病前适遇小劳,病患不过以此道其根由,医家不辨是非,便引东垣劳倦伤脾
,
元气下陷,乃执甘温除大热之句,随用补中益气汤,壅补其邪,转壅转热,转热转瘦,转瘦
转补,多至危殆。或有妇人患此,适逢产后,医家便认为阴虚发热,血虚发痛,遂投四物汤
及
地黄丸,泥滞其邪,迁延日久,病邪益固,邀遍女科,无出滋阴养血,屡投不效,复更凉血
通瘀,不知原邪仍在,积热自是不除,日渐 羸,终成废痿。凡人未免七情劳郁,医者不
知
为疫,乃引丹溪五火相扇之说,或指为心火上炎,或指为肝火冲击,乃惟类聚寒凉,冀其直折
,而反凝泣其邪,徒伤胃气,疫邪不去,瘀热何清?延至骨立而毙。或尚有宿病淹缠,适逢微
疫
,未免身痛发热,医家病家同认为原病加重,仍用前药加减,有妨于疫,病益加重,至死不觉者
,如是种种,难以尽述。聊举一二,推而广之,可以应变于无穷矣。
有一位患者感染了疫气,出现发热、心烦口渴的症状,想要饮用冰水。医生认为所有疾病都必须忌讳生冷食物,因此禁止得非常严格,病人痛苦地索要却得不到给予,导致双眼如火焰般迸射,咽喉干燥焦枯,不时有烟焰向上腾涌,昼夜无法入睡,眼中看到无数鬼怪,病情严重且极度痛苦,病人自己说只要能得到一滴冷冻饮料咽下,即使死去也毫无遗憾。于是趁人不备,匍匐着偷偷窃取了一盆井水,放在枕头旁边,喝下一杯后,眼睛顿时变得清亮;喝了两杯,鬼物悄然消失;喝了三杯,咽喉恢复发声能力;喝了四杯,筋骨感到舒畅;饮至六杯时,甚至不知道杯子落在枕旁,竟然熟睡过去,不久之后大汗如雨,衣服和被褥湿透,随即轻松痊愈。这是因为该人体型消瘦且多火,素来体质属阳脏,起初又加上热邪,导致经络枯燥,随后邪气传入体表,不能通过正常的汗出而解除病邪,误用升散药物,则病情反而加重,如今得到冷冻饮料,表里调和滋润,这就是所谓的去除弊端便是兴利,自然应当通过出汗而解病。更有因为饮食停滞、痰湿阻滞、或误用寒凉药物而导致正气虚陷、疾病不愈的情况,都应当舍弃对表面病症的治疗而针对弊端进行处理,以此类推,就可以无穷无尽地应对变化了。
凡是外感邪气都有轻重的区别,只有感染疫邪较轻的人,人们难以识别,往往因误治而变成顽固性疾病。假如患有痢疾,昼夜无度,水谷不进,人们都知道这是危险的痢疾。那些感染较轻的,虽然昼夜排便四五次,但饮食如常,起居照旧,人们也知道这是轻症痢疾,未曾误当作其他疾病治疗,只是因为有积滞罢了。至于感染温疫较重的,身体发热如火、头痛身痛、胸腹胀满、舌苔生刺、胡言乱语、发斑发黄、狂躁不安,人们都知道这是危险的疫病。那些感染较浅的,仅有轻微的头痛身痛,午后稍有潮热,饮食没有明显减少,只是饭后有时觉得胀满,有时觉得恶心,脉象微数,这样的疫病,最容易误认,即使医生平时认为伤寒和温疫是大病,现在因为证候不明显,大多不觉得这是疫病。而且人在感染疫气的时候,来时不觉察,既已感染也不知道,最没有凭据。又因为所感染的疫气薄弱,所以发病时现出的证候也不甚严重,虽然有头痛身痛,况且饮食不绝,体力还可以徒步行走,又怎么能知道是疫病呢?病患无处追溯病因,常常胡乱诉说病原,医生不善于审察,难免随情错认,比如病前恰好遇到轻微劳累,病患不过以此说明根由,医生不辨是非,便引用李东垣“劳倦伤脾,元气下陷”的理论,于是执着于“甘温除大热”的说法,随即使用补中益气汤,壅补其邪气,越壅补越热,越热越消瘦,越消瘦越进补,多导致危殆。或者有妇人患此病,恰逢产后,医生便认为是阴虚发热,血虚发痛,于是投用四物汤及地黄丸,凝滞其邪气,迁延日久,病邪更加坚固,遍请妇科医生,无非是滋阴养血,屡次投药无效,再改为凉血通瘀,不知道原邪仍在,积热自然不能消除,日渐瘦弱,最终成为废痿之症。凡人难免有七情劳郁,医生不知道这是疫病,便引用朱丹溪“五火相扇”的说法,或者指为心火上炎,或者指为肝火冲击,于是只聚集寒凉药物,希望直接折服火势,反而凝滞了邪气,徒然损伤胃气,疫邪不去,瘀热如何清除?拖延至骨立而死。或者还有宿病纠缠,恰逢轻微疫病,难免身痛发热,医生和病患共同认为是原病加重,仍用前药加减,妨碍了对疫病的处理,病情更加加重,至死都不觉悟的,像这样种种情况,难以尽述。姑且列举一二,推而广之,就可以无穷无尽地应对变化了。
One person contracted an epidemic pathogen, presenting with fever, restlessness, and thirst, desiring to drink ice water. The physician believed that all diseases require avoiding cold and raw foods, thus prohibiting it strictly. The patient suffered greatly from the denial of this request, resulting in eyes bulging like fire, scorched and dry throat, frequent rising of smoke-like flames, insomnia day and night, visual hallucinations of numerous ghosts, severe illness with extreme suffering. The patient stated that if only a drop of frozen beverage could be swallowed, they would have no regrets even if they died. Seizing an opportunity, the patient crawled and secretly stole a basin of well water, placing it beside the pillow. After drinking one cup, the eyes suddenly became clear; after two cups, the ghostly visions vanished; after three cups, the voice returned to the throat; after four cups, the sinews and bones felt relaxed; upon drinking six cups, unaware of the cup falling beside the pillow, the patient fell into a deep sleep. Soon after, profuse sweating occurred like rain, soaking clothes and bedding, leading to a spontaneous recovery. This was because the individual was thin and prone to internal heat, possessing a constitution of Yang organ nature. Initially, heat was added, causing dryness of the meridians. Subsequently, the pathogenic factor transmitted to the exterior, preventing resolution through normal sweating. The mistaken use of acrid-warm dispersing agents aggravated the disease. Now, with the frozen beverage, the interior and exterior harmonized and moistened. As the saying goes, removing the detriment is equivalent to promoting the benefit; thus, natural resolution through sweating was appropriate. Furthermore, cases where deficiency sinking occurs due to food stagnation, phlegm obstruction, or the misuse of cold-natured medicines, resulting in non-healing diseases, should all adopt the strategy of "abandoning the disease to treat the detriment." By analogy, one can respond to infinite variations.
All external pathogens have degrees of severity. Only those who contract a mild epidemic pathogen are often unrecognized by people, frequently leading to misdiagnosis and transformation into chronic stubborn diseases. For example, consider dysentery occurring without restraint day and night, with inability to ingest food and fluids; everyone knows this is a critical form of dysentery. In milder cases, although defecation occurs four or five times daily, diet and daily activities remain normal. People recognize this as mild dysentery and do not mistakenly treat it as another disease, attributing it merely to accumulation and stagnation. Conversely, severe cases of warm epidemic present with body heat like fire, headache and body pain, chest and abdominal fullness, prickly tongue coating, delirious speech, macules, jaundice, and mania. Everyone recognizes this as a critical epidemic. However, in shallow infections, symptoms are mild: slight headache and body pain, low-grade afternoon tidal fever, minimal reduction in appetite, occasional postprandial fullness or nausea, and a slightly rapid pulse. Such epidemics are most easily misidentified. Even physicians who usually regard Taiyang syndrome (Taiyang Bing) and warm epidemics as major diseases may fail to recognize them when symptoms are inconspicuous. Moreover, during the initial infection, individuals are unaware of the onset and the presence of the pathogen, lacking objective evidence. Because the contracted qi is weak, the manifested symptoms at onset are not severe. Despite headache and body pain, the ability to eat continuously and walk unaided makes it difficult to identify as an epidemic. Patients, unable to trace the cause, often falsely claim origins. Physicians, failing to examine carefully, may erroneously attribute it to recent minor exertion. Citing Li Dongyuan’s theory of "exhaustion injuring the Spleen, causing Qi collapse," they might rigidly apply the principle of "sweet-warm to remove great heat," prescribing Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). This tonifies and obstructs the pathogen, leading to increased heat, emaciation, further unnecessary tonification, and potentially critical danger. If a woman contracts this around the time of childbirth, physicians might diagnose Yin deficiency fever or Blood deficiency pain, administering Siwu Tang (Four Substance Decoction) or Dihuang Wan (Rehmannia Pill), thereby stagnating the pathogen. Prolonged delay solidifies the pathogen. Consulting gynecologists yields only nourishing Yin and Blood strategies, which fail repeatedly. Switching to cooling Blood and moving Stasis treatments fails because the original pathogen remains, and accumulated heat cannot be cleared. The patient gradually becomes emaciated, eventually developing wasting syndromes. Individuals inevitably suffer from emotional stress and depression. Physicians, unaware it is an epidemic, might cite Zhu Danxi’s theory of "five fires fanning each other," diagnosing Heart Fire flaming upward or Liver Fire attacking. They gather cold-natured herbs hoping to directly suppress the fire, but this coagulates the pathogen and injures Stomach Qi. Without eliminating the epidemic pathogen, how can Stasis-Heat be cleared? Delay leads to skeletal emaciation and death. Or, if a patient has a lingering chronic disease and encounters a mild epidemic, presenting with body pain and fever, both physician and patient may assume the original disease has worsened, continuing previous modified prescriptions. This hinders the treatment of the epidemic, worsening the condition until death without realization. Such various scenarios are too numerous to recount. Briefly listing a few allows for extrapolation to handle infinite variations.