风疟者,脉浮、多汗、恶风,多于春时得之。经云∶以春病者,恶风是也。亦有发于秋
者,
经云∶夏暑汗不出者,秋成风疟是也。杨仁斋云∶风疟是感风而得,恶风自汗,烦躁头疼。
风,阳气也,故先热后寒,可与解散风邪。
瘟疟者,先热而后寒,与风疟大略则同,其但热而不寒者,经所谓得之冬中于风,寒气
藏于
骨髓之中,至春夏阳气大发,邪气与汗皆出。此病藏于肾,其气先从内出之于外也。《外台
》云∶病疟六七日,但见热者,温疟也。与夏伤暑而秋病疟者不同。又有先伤风而后伤寒者
,亦先热而后寒,名曰温疟,与此亦不同。
桂枝白虎汤
知母(六两) 甘草(炙,二两) 石膏(一斤,碎) 桂枝(三两) 粳米(六合)
上锉,每服五钱,水一盏半,煎至八分,去滓温服,汗出即愈。
延年疗温疟,壮热不能食,知母鳖甲汤
知母 鳖甲(炙) 骨皮(各三两) 常山(二两) 竹叶(一升) 石膏(四两)
水煎,分三服。
湿疟者,寒热身重,肢节烦疼,胀满,善呕,自汗。陈无择云∶因汗出复浴,湿舍皮肤
,及冒雨湿所致。当从太阴论治,除湿汤主之。寒多者必兼温,行阳气也。
除湿汤
半夏 浓朴 苍术(米泔制,各二两) 白术(生) 藿香 橘红 白茯苓(各一
两) 甘草(炙,七钱)
上 咀,每服四钱,姜七片,枣一枚,水煎食前温服。本方去白术,加人参、草果、水
姜、
乌梅煎,即《和剂》人参养胃汤。脉无力,寒多,加姜、附;脉有力,热多,加芩、连、柴
胡。朴、苍、藿、姜,发散也;半、果、茯、橘,劫痰也,人参惟虚人最宜。
风疟,表现为脉象浮、多汗、怕风,多在春季发生。《内经》说:在春季发病的疟疾,其特点是怕风。也有在秋季发作的,《内经》说:夏季暑热时不出汗的人,到了秋天会形成风疟。杨仁斋说:风疟是因为感受风邪而得病,症状为怕风、自汗、烦躁、头痛。风属于阳气,所以先发热后发冷,可以用解散风邪的方法治疗。
温疟,也是先发热而后发冷,与风疟大致相同。其中只有发热而没有发冷的情况,《内经》所说的原因是:冬天感受风邪,寒气潜伏在骨髓之中,到了春夏季节阳气大发,邪气随着汗液一起排出。这种病潜伏在肾,其气机先从体内发出到体表。《外台秘要》说:患疟疾六七天,只见到发热的,就是温疟。这与夏天伤暑而在秋天发病的疟疾不同。又有先感受风邪后又感受寒邪的,也是先发热后发冷,名叫温疟,这又与此不同。
桂枝白虎汤
知母(六两) 甘草(炙,二两) 石膏(一斤,碎) 桂枝(三两) 粳米(六合)
以上药材切碎,每次服用五钱,用水一盏半,煎至八分,去渣后温服,出汗即愈。
延年疗温疟,壮热不能进食,知母鳖甲汤
知母 鳖甲(炙) 地骨皮(各三两) 常山(二两) 竹叶(一升) 石膏(四两)
用水煎煮,分三次服用。
湿疟,表现为忽冷忽热、身体沉重、四肢关节烦痛、腹胀满、容易呕吐、自汗。陈无择说:因为出汗后洗澡,湿气停留在皮肤,以及冒雨受湿所致。应当从太阴经论治,用除湿汤为主方。如果寒多者必须兼用温法,以通行阳气。
除湿汤
半夏 厚朴 苍术(米泔水制,各二两) 白术(生) 藿香 橘红 白茯苓(各一两) 甘草(炙,七钱)
以上药材切碎,每次服用四钱,加生姜七片、大枣一枚,用水煎煮,饭前温服。本方去掉白术,加入人参、草果、生姜、乌梅煎煮,就是《太平惠民和剂局方》中的人参养胃汤。脉象无力、寒多者,加生姜、附子;脉象有力、热多者,加黄芩、黄连、柴胡。厚朴、苍术、藿香、生姜,作用是发散;半夏、草果、茯苓、橘红,作用是燥湿化痰,人参唯独对体虚之人最合适。
Wind Malaria (Feng Nüe) presents with a floating pulse (Mài Fú), profuse sweating, and aversion to wind, typically occurring in spring. The Classics state: "Those who fall ill in spring exhibit aversion to wind." It may also manifest in autumn; the Classics note: "Those who do not sweat during summer heat will develop Wind Malaria in autumn." Yang Renzhai stated: "Wind Malaria is contracted by feeling wind, characterized by aversion to wind, spontaneous sweating, irritability, and headache." Wind is a yang pathogen, thus fever precedes chills. Treatment should focus on dispersing wind pathogens.
Warm Malaria (Wen Nüe) also features fever preceding chills, largely similar to Wind Malaria. However, cases presenting with fever only and no chills are described in the Classics as resulting from wind invasion in winter, where cold qi hides within the bone marrow. When yang qi expands vigorously in spring and summer, the pathogenic qi exits along with sweat. This disease resides in the Kidney (Shèn), with its qi moving from the interior to the exterior. *Waitai Miyao* states: "If malaria persists for six or seven days and only fever is observed, it is Warm Malaria." This differs from malaria contracted by summer-heat injury in summer and manifesting in autumn. Another type involves initial wind invasion followed by cold invasion, also presenting with fever preceding chills, named Warm Malaria, which is distinct from the aforementioned types.
Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction)
*Anemarrhenae Rhizoma* (Zhimu, 6 liang)
*Glycyrrhizae Radix et Rhizoma Praeparata cum Melle* (Gancao, Zhi, 2 liang)
*Gypsum Fibrosum* (Shigao, 1 jin, crushed)
*Cinnamomi Ramulus* (Guizhi, 3 liang)
*Oryzae Fructus* (Jingmi, 6 he)
Crush the ingredients. For each dose of 5 qian, decoct with 1.5 sheng of water until reduced to 0.8 sheng. Strain and take warm. Recovery occurs upon sweating.
Yannian's Formula for Treating Warm Malaria with High Fever and Anorexia, Zhimu Biejia Tang
*Anemarrhenae Rhizoma* (Zhimu)
*Testudinis Carapax et Plastrum Praeparatum* (Biejia, Zhi)
*Lycii Cortex* (Gubie, 3 liang each)
*Dichroiae Radix* (Changshan, 2 liang)
*Bambusae Folium* (Zhuye, 1 sheng)
*Gypsum Fibrosum* (Shigao, 4 liang)
Decoct in water and divide into three doses.
Damp Malaria (Shi Nüe) presents with alternating chills and fever, heaviness of the body, vexing pain in the limbs and joints, abdominal distension, propensity to vomit, and spontaneous sweating. Chen Wuzhe stated: "It is caused by bathing after sweating, allowing dampness to lodge in the skin, or by exposure to rain and dampness." Treatment should follow the Taiyin (Spleen/Stomach) pattern, primarily using Chushi Tang. If chills predominate, warming methods must be added to promote the flow of yang qi.
Chushi Tang (Dampness-Dispersing Decoction)
*Pinelliae Rhizoma Preparatum* (Banxia)
*Magnoliae Officinalis Cortex* (Houpo)
*Atractylodis Macrocephalae Rhizoma Praeparata* (Cangzhu, prepared with rice wash water, 2 liang each)
*Atractylodis Macrocephalae Rhizoma Cruda* (Baizhu, raw)
*Agastaches Herba* (Huoxiang)
*Citri Reticulatae Pericarpium* (Juhong)
*Poria* (Fuling, 1 liang each)
*Glycyrrhizae Radix et Rhizoma Praeparata cum Melle* (Gancao, Zhi, 7 qian)
Cut the ingredients. For each dose of 4 qian, add 7 slices of fresh ginger and one jujube. Decoct in water and take warm before meals. If Baizhu is removed from this formula and replaced with *Ginseng Radix* (Renshen), *Tsaoko Fructus* (Caoguo), fresh ginger, and *Mume Fructus* (Wumei), it becomes *Renshen Yangwei Tang* (Ginseng Stomach-Nourishing Decoction) from *Tai Ping Hui Min He Ji Ju Fang*. If the pulse is weak and chills predominate, add fresh ginger and *Aconiti Lateralis Radix Praeparata* (Fuzi). If the pulse is forceful and heat predominates, add *Scutellariae Radix* (Huangqin), *Coptidis Rhizoma* (Huanglian), and *Bupleuri Radix* (Chaihu). Houpo, Cangzhu, Huoxiang, and ginger serve to disperse; Banxia, Caoguo, Fuling, and Juhong serve to resolve phlegm. Ginseng is most suitable for those with deficiency.