一瘴病初起热大。不语至二三日。热微神清脉和。惟不作声。此真 瘴不治。
一瘴病上吐下泄。精神昏乱。脉微迟无力。二三日决死勿治。
一瘴病因食生冷过多。至四五日作泄。手足冷者。决死勿治。
一瘴病热退时。脉亦七八至。无神者。决死勿治。
一瘴病脉大而散。无胃气者不治。
一瘴病阳症见阴脉。无胃气不治。有胃气者生。
一瘴病误服麻黄发汗药。及柴胡黄芩苦寒药而变 者。决死不治。
一因误服麻黄。而筋惕肉 者死。
一因误服麻黄。而目赤喘急者死。
一因误服麻黄。汗出不止。发寒而哕者死。
一因误服寒凉。自利而手足厥冷。渐及肘膝者死。
一因误服寒凉。而发哕者不治。
一因误服寒凉。狂起乱搏人者不治。
一因胎前染瘴。胎落而变 者不治。
一产后染瘴。脉洪大如竹管。鼓指七至者不治。
瘴病之脉。不可不细察。假如其脉沉细而迟。此元气虚寒之脉外症。虽见纯阳。当急用沉附等药。
苟误投以寒剂。其逝即在顷刻。正所谓承气入胃。阴盛乃亡也。在伤寒。阳症见阴脉。为必死之症。
瘴疟为上热下寒。外热内寒之病。阳症见阳脉为真病脉。见有胃气者反为易治。万不失一。
如其脉弦带数。六七至有力而不散大。此元气不虚寒。外症无阴症。具于隐
微之中。只宜正气散。和解汤等药。苟误投以姜附亦难收功。正所谓桂枝下咽。阳盛则毙。或间
有阴症。见有阳脉。亦不宜例用姜附。且与和解正气。守之若苦寒之药。不可以脉见阳而妄用也。
如其脉洪大无伦。七八至按之鼓指者。或无力者。此元阳气尽泄于外之脉。不可谓之阳脉。
盖脉只以六七至为数为热。若七八至为元气已飞越。而邪气独盛。正不胜邪。故见是脉。以浮而
无力为洪。若洪大通筋似指则为元气不固于内。反泄于外。故见是脉。正内经。所谓脉大为虚是也。
鼓指者。更虚于无力。二脉兼见。似内伤火不归经之症。方书谓龙雷之火。其外症决见大热之病。
细察之必有阴症。具于隐微之中。急宜用姜附等大热之药。冷冻饮料之。其效可必。倘误投凉药。祸如反掌。
在他症脉至七八至。为七极八脱。决死之脉。在瘴疟如治以法者。永保无虞。
如脉代而不散者。当问大便如溲。小便调为元气不足。宜参附之剂补之。元气实。代脉去矣。
若数日未更衣。更宜和解正气。使大便利。黑屎去。则代脉去矣。若代而兼散。则为不治之脉。
如脉瘴作时。七八至。温中固下。正气和解后。热退去时。一呼一吸只来二至。在他症为
二败必死之脉。在瘴疟为邪气尽退。正气将复之脉。其外症决见浑身冰冷。困倦乏力。惟口中所
出之气略温。或大汗如雨。恶寒之极。斯时惟宜调养。内服补脾之药。一日则前症俱退。二三
日脉复。四五至矣。
【背景信息】
书名：瘴疟指南 作者：郑全望 朝代：明 章节：不治症 / 脉 类别：综合
【待处理原文翻译】
有一种瘴病，初起时发热严重。到两三天后，虽然热势减轻、神志清醒、脉象平和，但患者依然不能说话。这是真元败绝的瘴病，属于不治之症。
有一种瘴病，出现上吐下泻的症状，精神昏乱，脉象微细迟缓且无力。这种情况在两三天内必然死亡，不可治疗。
有一种瘴病，因为食用过多生冷食物，导致四五日后发生泄泻，手足冰冷。这种情况必然死亡，不可治疗。
有一种瘴病，在热退的时候，脉搏仍然达到每呼吸一次七八次跳动（极数），且脉无神气。这种情况必然死亡，不可治疗。
有一种瘴病，脉象大而散漫，没有胃气（指脉象柔和从容之象），属于不治之症。
有一种瘴病，阳证却见到阴脉，如果没有胃气则不治；如果有胃气则可以生存。
有一种瘴病，误服了麻黄等发汗药，以及柴胡、黄芩等苦寒药物而导致病情变化的，必然死亡，不可治疗。
有一种情况，因误服麻黄，导致筋惕肉瞤（肌肉跳动抽搐）而死亡。
有一种情况，因误服麻黄，导致汗出不止，发作寒战并呃逆（哕）而死亡。
有一种情况，因误服寒凉药物，导致自发性腹泻且手足厥冷，逐渐蔓延至肘部和膝盖而死亡。
有一种情况，因误服寒凉药物，导致发生呃逆（哕），属于不治之症。
有一种情况，因误服寒凉药物，导致狂躁起来胡乱打人，属于不治之症。
有一种情况，因怀孕前感染瘴气，胎儿堕落后病情变化，属于不治之症。
有一种情况，产后感染瘴气，脉象洪大如竹管，搏动有力直达手指，每呼吸一次七次跳动，属于不治之症。
瘴病的脉象，不可以不仔细诊察。假如脉象沉细而迟缓，这是元气虚寒的脉象及外在症状表现。即使外表见到纯阳的热象，也应当紧急使用附子等温热药物。
如果错误地投用寒凉药剂，患者的生命即刻就会终结。这正是所谓的“承气汤入胃，阴盛则亡”的道理。在伤寒病中，阳证见到阴脉，是必死的病症。
瘴疟是一种上热下寒、外热内寒的疾病。阳证见到阳脉才是真正的病脉，见到有胃气的脉象反而容易治疗，万无一失。
如果脉象弦急且带数象，每呼吸一次六七次跳动，有力但不散大，这说明元气不虚寒，外在症状也没有阴证的表现，只是隐藏在细微之处。此时只适宜使用正气散、和解汤等药物。如果错误地投用干姜、附子等大热药物，也难以收到功效。这正是所谓的“桂枝汤下咽，阳盛则毙”。或者间或有阴证，却见到阳脉，也不宜例行使用干姜、附子。应当给予和解正气的药物，坚守原则，即使是苦寒的药物，也不可以根据脉象见阳就妄加使用。
如果脉象洪大无比，每呼吸一次七八次跳动，按之搏动有力直达手指，或者无力的。这是元气阳气完全外泄的脉象，不能称之为正常的阳脉。
一般来说，脉搏每呼吸一次六七次跳动算是数脉为热证。如果达到七八次跳动，说明元气已经飞越，而邪气独盛，正气不胜邪气，所以出现这种脉象。以浮取无力为洪脉。如果洪大通达，搏动像击打筋脉或手指一样强劲，则是元气不能固守于内，反而外泄，所以出现这种脉象。这符合《内经》所说的“脉大为虚”。
搏动有力直达手指的情况，比无力的情况更加虚弱。这两种脉象兼见，类似于内伤火不归经的症状。医书称为龙雷之火。其外在症状必然表现为大热的病状。仔细诊察，必定有隐藏的阴证表现。应当紧急使用干姜、附子等大热药物，并用冷冻饮料送服，疗效可以肯定。如果错误地投用凉药，灾祸如在反掌之间迅速到来。
在其他病症中，脉搏达到每呼吸一次七八次跳动，称为七极八脱，是必死的脉象。但在瘴疟中，如果治疗方法得当，可以永远保证安全无忧。
如果脉象代（间歇）而不散，应当询问大便是否像小便一样频数，小便是否正常。如果是元气不足，应当使用人参、附子的药剂来补益。元气充实后，代脉就会消失。
如果几天没有排便，更应当使用和解正气的药物，使大便通畅，黑便排出，那么代脉就会消失。如果脉象代而且兼见散象，就是不治的脉象。
如果在瘴病发作时，脉搏每呼吸一次七八次跳动，采用温中固下的方法，待正气调和后，热退去时，一呼一吸脉搏只来两次跳动。在其他病症中，这是二败必死的脉象；但在瘴疟中，这是邪气全部消退，正气即将恢复的脉象。其外在症状必然表现为浑身冰冷，困倦乏力，只有口中呼出的气体略微温暖，或者大汗如雨，极度恶寒。此时只适宜调养，内服补脾的药物。一天之内前面的症状都会消退，两三天后脉象恢复，变为每呼吸一次四五次跳动。
[Background Information]
Book: *Zhang Nue Zhi Nan* (Guide to Malaria/Chong Disease)
Author: Zheng Quanwang
Dynasty: Ming
Chapter: Incurable Symptoms / Pulse
Category: Comprehensive
[English Translation]
There is a type of Chong disease where, upon initial onset, the fever is severe. By the second or third day, although the heat subsides, consciousness clears, and the pulse becomes harmonious, the patient remains unable to speak. This indicates the collapse of true Yuan Qi (Primordial Vital Energy) in Chong disease and is considered incurable.
In another type of Chong disease, the patient experiences vomiting above and diarrhea below, with mental confusion. The pulse is faint, slow, and weak. Death will inevitably occur within two or three days; it is untreatable.
In another case, due to excessive consumption of raw and cold foods, diarrhea occurs after four or five days, accompanied by cold hands and feet. This is also inevitably fatal and untreatable.
In another case, when the fever subsides, the pulse beats seven or eight times per respiration (extremely rapid), lacking Shen (Spirit/Vitality). This is inevitably fatal and untreatable.
In another case, the pulse is large and scattered, lacking Wei Qi (Stomach Qi, indicating a gentle and moderate quality in the pulse). This is incurable.
In another case, Yang syndromes present with Yin pulses. If there is no Wei Qi, it is incurable; if Wei Qi is present, survival is possible.
If Chong disease is mismanaged by administering Ma Huang Tang (Ephedra Decoction) for sweating, or bitter-cold herbs such as Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix), leading to pathological changes, death is inevitable and treatment is futile.
Misadministration of Ma Huang (Ephedrae Herba) can lead to Jin Ti Rou Dong (muscle twitching and tremors), resulting in death.
Misadministration of Ma Huang (Ephedrae Herba) can cause red eyes and urgent panting, resulting in death.
Misadministration of Ma Huang (Ephedrae Herba) can cause incessant sweating, followed by chills and Yue (hiccups/belching), resulting in death.
Misadministration of cold-cooling medicines can cause spontaneous diarrhea and cold extremities that gradually extend to the elbows and knees, resulting in death.
Misadministration of cold-cooling medicines causing Yue (hiccups/belching) is incurable.
Misadministration of cold-cooling medicines causing manic behavior and violent striking of others is incurable.
If one contracts Chong disease before pregnancy, and the fetus is expelled with subsequent pathological changes, it is incurable.
If one contracts Chong disease postpartum, and the pulse is surging and large like a bamboo tube, beating strongly against the fingers seven times per respiration, it is incurable.
The pulse of Chong disease must be examined meticulously. For instance, if the pulse is deep, fine, and slow, this indicates a pulse and external symptoms of Yuan Qi deficiency and cold. Even if pure Yang heat signs are visible externally, one must urgently use warm herbs such as Fu Zi (Aconiti Lateralis Radix Praeparata).
If cold agents are mistakenly administered, life will end instantly. This corresponds to the principle: "When Cheng Qi Tang enters the stomach, extreme Yin leads to death." In Shang Han (Cold Damage) diseases, Yang syndromes presenting with Yin pulses indicate a fatal condition.
Zhang Nue (Malaria/Chong Disease) is a disease characterized by upper heat and lower cold, and external heat with internal cold. When Yang syndromes present with Yang pulses, it is the true disease pulse. If the pulse shows Wei Qi (Stomach Qi), it is actually easier to treat, with near-perfect success rates.
If the pulse is wiry and rapid, beating six or seven times per respiration, forceful but not scattered, this indicates that Yuan Qi is not deficient or cold, and there are no Yin syndrome symptoms externally, though they may be hidden subtly. In such cases, only formulas such as Zheng Qi San (Regular Qi Powder) or He Jie Tang (Harmonizing Decoction) should be used. Mistakenly administering hot herbs like Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) will yield little effect. This aligns with the saying: "When Gui Zhi Tang enters the throat, extreme Yang leads to death." Occasionally, Yin syndromes may present with Yang pulses; even then, one should not routinely use Jiang and Fu Zi. Instead, one should administer harmonizing and Regular Qi-supporting formulas. One must adhere to principles; even if the pulse appears Yang, one must not recklessly use cold-bitter medicines based solely on the pulse.
If the pulse is excessively surging and large, beating seven or eight times per respiration, forceful against the fingers upon pressure, or conversely, forceless, this indicates that Yuan Yang Qi has completely leaked outward. This cannot be called a normal Yang pulse. Generally, a pulse beating six or seven times per respiration is considered rapid and indicative of heat. However, seven or eight beats per respiration indicates that Yuan Qi has flown away, while pathogenic factors are exclusively strong, and righteous Qi fails to overcome pathogens. Thus, this pulse appears. A floating and forceless quality is defined as Hong (Surging). If the pulse is surging and large, beating strongly against the tendons or fingers, it indicates that Yuan Qi is not consolidated internally but leaks outward, hence this pulse appears. This conforms to the *Nei Jing* (Inner Canon): "A large pulse indicates deficiency."
A pulse that beats strongly against the fingers indicates greater deficiency than a forceless pulse. These two pulse qualities appearing together resemble symptoms of internal injury with fire failing to return to its source, known in medical texts as Long Lei Zhi Huo (Dragon-Thunder Fire). Externally, these patients exhibit severe heat symptoms. Careful examination will reveal hidden Yin symptoms. One must urgently use hot herbs like Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata), administered with frozen beverages. The efficacy is assured. Mistakenly using cooling medicines will bring disaster swiftly.
In other diseases, a pulse beating seven or eight times per respiration is termed "Qi Ji Ba Tuo" (Seven Extremes, Eight Depletion), a fatal pulse. However, in Zhang Nue, if treated correctly, one can remain safe indefinitely.
If the pulse is Dai (Intermittent) but not scattered, one should inquire about bowel movements. If stool frequency resembles urination and urination is regulated, it indicates insufficient Yuan Qi. One should tonify with Ren Shen (Ginseng Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata). Once Yuan Qi is restored, the Dai pulse will disappear.
If there has been no bowel movement for several days, one should further use harmonizing and Regular Qi-supporting methods to promote bowel movement. Once black stool is passed, the Dai pulse will disappear. If the pulse is Dai and combined with Scattered characteristics, it is an incurable pulse.
During the onset of Chong disease, if the pulse beats seven or eight times per respiration, employ warming the middle and securing the lower jiao methods. After Zheng Qi (Righteous Qi) is harmonized and heat subsides, if the pulse slows to only two beats per respiration, this is a fatal "two failures" pulse in other diseases. However, in Zhang Nue, it indicates that pathogenic factors have entirely retreated and Zheng Qi is about to recover. External symptoms will likely include whole-body coldness, fatigue, and weakness, with only slightly warm breath exhaled from the mouth, or profuse sweating like rain, and extreme aversion to cold. At this time, only rest and nourishment are appropriate. Internally, administer Spleen-tonifying medicines. Within one day, previous symptoms will recede. Within two to three days, the pulse will recover to four or five beats per respiration.