治瘴病。十四日外。寒热不已。不潮时。脉弦数者。
柴胡(一两去芦) 半夏(五钱汤泡)
桂心(五钱去皮) 白芍(五钱炒炙) 甘草(三钱)
上 散。姜七片。枣一枚。水煎温服。寒热。
得退。便止此药。
瘴病十四日外。已过经矣。病虽未愈。元气稍苏。更兼其脉。热不潮时。亦弦数。此正疟脉弦数多热之证。
况寒热脉弦。是邪在半表半里。足少阳实主之。故用柴胡为君。本经药也。木得桂而枯。故用以散
少阳之邪。半夏生姜之辛。以散邪气。
兼能燥湿利痰。治之瘴本若白芍之酸。甲味也。大枣甘草之甘。己味也。甲己化土。养脾之妙法也。
是方李待制立。以治瘴扶脾利痰。以退半表半里之邪热。用以桂心。佐以柴胡。使柴胡之寒不能为柄。非
神于用药者。不可同语也。
治瘴疟头痛。身疼寒热。脉浮弦。
草果(去壳) 良姜 青皮(去穣) 川芎 白芷 苏叶 甘草
上各等分 散。水煎热服。当发日前连进一服。不拘时候。
四时治要方。云风疟。食疟。疟即瘴也。多生于东南。谓东南乃鱼盐之地。及多暴
风。风疟宜草果饮。此方用川芎。青皮。白芷。发散风邪。良姜。苏叶。发散寒热。今咳痰脉浮紧。
头痛身疼。恶风寒。乃感乎凛冽暴风也。正宜草果饮。因食生冷肥腻。中脘生痰。呕逆遂成食疟。
宜服二陈汤。三因方。治食疟用红丸子。亦为极妙。
治疗瘴病。病程超过十四天,寒热症状持续不愈,且在非定时发作时,脉象呈现弦数特征。
柴胡(一两,去芦头) 半夏(五钱,用汤浸泡)
桂心(五钱,去皮) 白芍(五钱,炒炙) 甘草(三钱)
以上药材制成散剂。加入生姜七片、大枣一枚,用水煎煮,温服。若寒热症状消退,即停止服用此药。
瘴病病程超过十四天,说明病邪已离开原来的经络(已过经)。虽然疾病尚未痊愈,但元气略有恢复。再加上脉象显示,在不定时发热时,脉象依然弦数。这正是疟疾中脉弦数且多热的证候。
况且寒热往来且脉象弦,表明邪气位于半表半里之间,由足少阳胆经(足少阳)主要主管。因此使用柴胡作为君药(主药),这是《神农本草经》记载的药物。木遇到桂会枯萎,所以用桂心来疏散少阳经的邪气。半夏和生姜的辛味,能够发散邪气,同时也能燥湿化痰。
治疗瘴病本应如此,白芍的酸味对应甲(天干之甲,五行属木),大枣和甘草的甘味对应己(天干之己,五行属土)。甲己相合化土,这是滋养脾脏的巧妙方法。
这个方剂由李待制创立,用于治疗瘴病,通过扶持脾气、利化痰浊,来退却半表半里的邪热。使用桂心为佐药,配合柴胡,使得柴胡的寒性不至于成为弊端。这不是精通用药的人,无法与之谈论其中的奥妙。
治疗瘴疟引起的头痛、身体疼痛、寒热往来,脉象浮弦。
草果(去壳) 良姜 青皮(去瓤) 川芎 白芷 苏叶 甘草
以上各等分,制成散剂。用水煎煮,热服。应当在预计发病的前一天连续服用一剂。不限具体时间。
《四时治要方》中提到风疟、食疟,疟疾即属于瘴病一类。这类病多发生在东南地区,因为东南是鱼盐之地,且常有暴风袭击。对于风疟适宜使用草果饮。此方中使用川芎、青皮、白芷来发散风邪;良姜、苏叶来发散寒热。如果现在出现咳嗽痰多、脉象浮紧、头痛身疼、怕冷怕风,这是由于感受了凛冽的暴风所致,正适宜使用草果饮。如果是因食用生冷肥腻食物,导致中脘部位生痰,呕吐逆乱从而形成食疟,则适宜服用二陈汤。《三因方》治疗食疟使用红丸子,也非常精妙。
Treatment for miasma disease (Zhang Bing). After fourteen days, if chills and fever persist without a regular pattern, and the pulse is wiry and rapid (Xian Shu), use:
Chai Hu (Bupleuri Radix) - one liang, remove rhizome; Ban Xia (Pinelliae Rhizoma Preparatum) - five qian, soak in hot water; Gui Xin (Cinnamomi Cortex) - five qian, remove bark; Bai Shao (Paeoniae Radix Alba) - five qian, stir-fry with heat; Gan Cao (Glycyrrhizae Radix et Rhizoma) - three qian.
Process these into a powder. Add seven slices of fresh ginger (Sheng Jiang) and one jujube (Da Zao). Decoct in water and take warm. Stop this medication once the chills and fever subside.
When miasma disease exceeds fourteen days, the pathogen has passed beyond the original meridian stage (Guo Jing). Although the illness is not yet cured, the healthy qi (Yuan Qi) has slightly recovered. Furthermore, the pulse remains wiry and rapid even when fever does not occur at fixed times. This corresponds to the syndrome of malaria characterized by a wiry and rapid pulse with predominant heat.
Moreover, chills alternating with fever accompanied by a wiry pulse indicate that the pathogenic factor is located in the half-exterior and half-interior region, primarily governed by the Foot-Shaoyang Gallbladder Meridian (Zu Shao Yang). Therefore, Chai Hu is used as the sovereign drug (Jun Yao), as recorded in the *Shennong Bencao Jing*. Since wood withers when combined with cinnamon, Gui Xin is employed to disperse pathogens in the Shaoyang meridian. The pungency of Ban Xia and Sheng Jiang disperses pathogenic factors and simultaneously dries dampness and resolves phlegm.
Regarding the treatment of miasma, the sour taste of Bai Shao corresponds to Jia (Wood), while the sweet taste of Da Zao and Gan Cao corresponds to Ji (Earth). The combination of Jia and Ji transforms into Earth, which is an ingenious method for nourishing the Spleen.
This formula was established by Li Daizhi to treat miasma by supporting the spleen, promoting the resolution of phlegm, and clearing heat from the half-exterior and half-interior. By using Gui Xin as an assistant drug alongside Chai Hu, it prevents the cold nature of Chai Hu from becoming detrimental. Such subtleties in herbal prescription cannot be discussed with those unskilled in materia medica.
For miasma malaria presenting with headache, body pain, chills and fever, and a floating, wiry pulse:
Cao Guo (Tsaoko Fructus) - remove shell; Liang Jiang (Alpiniae Officinarum Rhizoma); Qing Pi (Citri Reticulatae Pericarpium Viride) - remove pith; Chuan Xiong (Ligustici Chuanxiong Rhizoma); Bai Zhi (Angelicae Dahuricae Radix); Su Ye (Perillae Folium); Gan Cao (Glycyrrhizae Radix et Rhizoma).
Grind all ingredients in equal proportions into a powder. Decoct in water and take hot. Administer one dose continuously on the day preceding the expected onset of symptoms. Time of administration is unrestricted.
The *Si Shi Zhi Yao Fang* mentions wind malaria and food stagnation malaria; malaria belongs to the category of miasma diseases. These commonly arise in the southeast regions, which are areas abundant in fish and salt and subject to violent winds. For wind malaria, the Caoguo Yin (Tsaoko Drink) is appropriate. This formula uses Chuan Xiong, Qing Pi, and Bai Zhi to disperse wind pathogens; Liang Jiang and Su Ye to disperse cold and heat. If the patient currently presents with coughing, profuse phlegm, a floating and tight pulse, headache, body ache, aversion to cold and wind, it indicates contraction of biting cold winds, making Caoguo Yin the correct choice. However, if excessive consumption of raw, cold, fatty, or greasy foods leads to phlegm accumulation in the middle jiao (Zhong Wan), resulting in vomiting and regurgitation forming food stagnation malaria, then Er Chen Tang (Two-Aged Decoction) is indicated. The *San Yin Fang* recommends Hong Wan Zi (Red Pill) for treating food stagnation malaria, which is also highly effective.