热证脉主数。浮细而数为风热。其热轻。宜散之。(如升阳散火汤之类。)浮洪而数。按指有力。或沉而
牢实为实火。其热重。宜下之。(如清咽利膈汤之类。)不拘浮数沉数。但按指无力。乃是假热。宜散
而兼清。(如甘桔汤之类)
寒证脉主紧。浮细而紧。为风寒。其寒轻。宜表散。(如荆防败毒散之类。)沉细而弦紧。其寒重。宜
温散。(如参桂饮之类)若重按不见。为虚寒。宜温补。(如理中汤之类。)
一治白喉者。时医各有忌药。有忌升麻者。忌细辛者。忌麻黄者。忌白术者。忌地黄者。并全忌表药者。
种种恶习。深可慨叹。若舍证而言药。何药不忌。
一热证误服寒证尚轻各方者。虽不愈。尚不死。误服寒证渐重各方。及补方者。必死。寒证误服热证渐
重各方者。必死。虚寒证过服表剂。或误服下药者。必死。寒热二证。判若冰炭。此之不审。杀人反掌。可不慎与。
一表药不过宣发内邪。使无遏抑。原不能取急效。治者不可因其无效而过服。或凉或温。急宜转方。
盖表药多辛窜。过服则耗散真气。必至气壅也。
一白喉服药。与吹药并重。盖寒热伏于内。非服药不能治其本。而毒瓦斯壅于喉。非吹药不能解其标也。若危险之
证。必先吹药。扫去痰涎。而后可以服药。至轻证初起。则吹药一二次即愈矣。并无庸服药也。故
吹药尤炼之宜精。备之宜豫。
一白喉不无传染。非因热证而传染者。即为热证。因寒证而传染者。即为寒证也。宜视人之秉赋强弱。气血虚实用
药。
一患白喉者。必兼感杂证。若有万难兼理者。只治白喉证。不理杂病。而杂病亦自可愈。何也。病未有不相因
者也。即或白喉已愈。而杂病未愈。或白喉已愈。而杂病又生。则在医者变而通之。神而明之。古方俱在。不能备述。
热证的脉象以数脉为主。若脉浮细而数,属于风热证,病情较轻,适宜采用发散法治疗。(例如升阳散火汤之类的方剂。)若脉浮洪而数,重按指下有力,或者脉沉而牢实,属于实火证,病情较重,适宜采用泻下法治疗。(例如清咽利膈汤之类的方剂。)无论是浮数还是沉数,只要重按指下无力,便是假热证,适宜采用发散兼清热的治法。(例如甘桔汤之类的方剂。)
寒证的脉象以紧脉为主。若脉浮细而紧,属于风寒证,病情较轻,适宜采用解表发散法治疗。(例如荆防败毒散之类的方剂。)若脉沉细而弦紧,属于寒证较重,适宜采用温通发散法治疗。(例如参桂饮之类的方剂。)如果重按脉搏消失不见,属于虚寒证,适宜采用温补法治疗。(例如理中汤之类的方剂。)
在治疗白喉时,当时的医生各自有忌讳使用的药物。有的忌讳升麻,有的忌讳细辛,有的忌讳麻黄,有的忌讳白术,有的忌讳地黄,甚至完全忌讳使用解表药。种种不良习气,令人深深感叹。如果抛开证候而言用药,还有什么药是不忌讳的呢?
热证误服了针对寒证且病情较轻的各方,虽然不能痊愈,但尚不会死亡;误服了针对寒证且病情较重的各方及补益方,则必然导致死亡。寒证误服了针对热证且病情渐重的各方,必然导致死亡。虚寒证过度服用解表剂,或误服泻下药,必然导致死亡。寒证与热证,判若冰炭之别。对此若不审慎辨别,杀人只在反掌之间,能不谨慎吗?
解表药的作用不过是为了宣发内伏之邪,使其不受遏制压抑,原本就不能追求急效。医者不可因为见效慢而过量服用。无论药性偏凉还是偏温,都应及时更换方剂。因为解表药多具辛散走窜之性,过量服用则会耗散真气,必然导致气机壅滞。
治疗白喉,服药与吹药(将药粉吹入咽喉)同等重要。因为寒热之邪伏于体内,不服药不能治其根本;而毒瓦斯壅塞于咽喉,不吹药不能解除其标症。若是危重证候,必须先吹药,清除痰涎,然后才可以服药。至于轻证初起,吹药一两次即可痊愈,并无必要再服药。因此,吹药的制作尤其应当精炼,准备应当提前。
白喉并非没有传染性。不是因热证传染的,就是热证;因寒证传染的,就是寒证。应当根据患者的体质强弱、气血虚实来用药。
患白喉的人,必定兼感其他杂病。如果有万难兼顾的情况,只治疗白喉证,不理睬杂病,而杂病也会自然痊愈。为什么呢?疾病未有不相牵连的。即使白喉已愈,而杂病未愈,或者白喉已愈,而杂病又生,这就要靠医者灵活变通,神妙明察。古方俱在,不能一一详述。
The pulse of Heat syndromes is predominantly rapid (Shu, rapid). A floating, fine, and rapid pulse indicates Wind-Heat syndrome; the heat is mild, and dispersing treatment is appropriate (e.g., formulas such as Shengyang Sanhuo Tang [Ascending Yang to Disperse Fire Decoction]). A floating, surging, and rapid pulse, which feels forceful upon deep pressure, or a deep, firm, and solid pulse indicates Excess Fire syndrome; the heat is severe, and purgative treatment is appropriate (e.g., formulas such as Qingyan Lige Tang [Clearing Throat and Benefiting Diaphragm Decoction]). Regardless of whether the pulse is floating-rapid or deep-rapid, if it feels weak upon deep pressure, it is False Heat syndrome. Treatment should involve dispersing combined with clearing (e.g., formulas such as Ganjie Tang [Licorice and Platycodon Decoction]).
The pulse of Cold syndromes is predominantly tight (Jin, tight). A floating, fine, and tight pulse indicates Wind-Cold syndrome; the cold is mild, and exterior-releasing dispersing treatment is appropriate (e.g., formulas such as Jingfang Baidu San [Schizonepeta and Saposhnikovia Powder to Overcome Toxins]). A deep, fine, wiry, and tight pulse indicates severe Cold syndrome; warming and dispersing treatment is appropriate (e.g., formulas such as Shen Gui Yin [Ginseng and Cinnamon Twig Drink]). If the pulse disappears upon deep pressure, it is Deficiency-Cold syndrome; warming and tonifying treatment is appropriate (e.g., formulas such as Lizhong Tang [Regulate the Middle Decoction]).
In treating Diphtheria (Baihou), contemporary physicians each have taboos regarding certain herbs. Some taboo Shengma (Rhizoma Cimicifugae), some taboo Xixin (Radix Asari), some taboo Mahuang (Herba Ephedrae), some taboo Baizhu (Rhizoma Atractylodis Macrocephalae), some taboo Dihuang (Radix Rehmanniae Preparata), and some completely taboo exterior-releasing herbs. Such various bad habits are deeply lamentable. If one discusses medication without considering the syndrome, what herb would not be taboo?
If a Heat syndrome patient mistakenly takes formulas for Cold syndromes that are mild, although they may not recover, they will not die. If they mistakenly take formulas for severe Cold syndromes or tonic formulas, death is inevitable. If a Cold syndrome patient mistakenly takes formulas for Heat syndromes that are progressively severe, death is inevitable. If a Deficiency-Cold syndrome patient overdoses on exterior-releasing agents or mistakenly takes purgatives, death is inevitable. Cold and Heat syndromes are as different as ice and charcoal. Failure to examine this carefully can lead to death in the flip of a hand; must one not be cautious?
Exterior-releasing herbs function merely to ventilate and release internal pathogens, preventing their suppression. They inherently cannot produce immediate effects. Physicians must not overdose them simply because they lack quick efficacy. Whether the herbs are cooling or warming, the formula should be changed promptly. Since exterior-releasing herbs are mostly pungent and penetrating, overdosing consumes True Qi, inevitably leading to Qi stagnation.
In treating Diphtheria, oral medication and throat insufflation (Chuiyao) are equally important. Because Cold and Heat pathogens lie latent within, oral medication is required to treat the root. Because toxic vapors obstruct the throat, insufflation is required to address the branch. In critical cases, insufflation must be performed first to clear phlegm and saliva before administering oral medication. For mild cases at onset, one or two applications of insufflation may suffice for recovery, making oral medication unnecessary. Therefore, the preparation of insufflation powders should be refined, and supplies prepared in advance.
Diphtheria is indeed contagious. Transmission not caused by Heat syndromes results in Heat syndromes; transmission caused by Cold syndromes results in Cold syndromes. Medication should be prescribed according to the patient’s constitutional strength and the deficiency or excess of Qi and Blood.
Patients with Diphtheria invariably contract concurrent miscellaneous diseases. If there are circumstances where both cannot be addressed simultaneously, only the Diphtheria syndrome should be treated, ignoring the miscellaneous diseases, which will then resolve spontaneously. Why? Diseases do not arise independently. Even if Diphtheria has healed but the miscellaneous disease persists, or if Diphtheria has healed but a new miscellaneous disease arises, it depends on the physician to adapt and apply wisdom flexibly. Ancient formulas exist, but they cannot all be listed here.