鳖甲(炙)十二分 乌扇(烧)三分 黄芩三分 柴胡三分 鼠妇(熬)三分 干姜
三分大黄三分 芍药五分 桂枝三分 葶苈(熬)一分 石苇(去毛)三分 厚朴三
分牡丹(去心)五分 瞿麦二分 紫葳三分 半夏一分 人参一分 □虫(熬)五
分阿胶三分蜂巢(炙)四分 赤硝十二分 蜣螂(熬)六分 桃仁二分
右二十三味为末,取锻灶下灰一斗,清酒一斛五斗,浸灰,候酒尽一半,着□甲于中
,煮令泛烂如胶漆,绞取汁 ,内诸药,煎为丸,如梧子大,空心服七丸,日三服。
【集注】
徐彬曰:药用□甲煎者,□甲入肝,除邪养正,合煆灶灰所浸酒,去瘕,故以为君。
小柴胡汤、桂枝汤、大承气汤为三阳主药,故以为臣。但甘草嫌柔缓,而减药力,枳
实嫌破气而直下,故去之,外加干姜、阿胶、助人参、白术温养为佐。瘕必假血根据痰
,故以四虫、桃仁合半夏消血化痰;凡积必由气结,气利而积消,故以乌扇、葶苈、
利肺气,合石苇、瞿麦,清邪热而化气散结血。因邪聚则热,故以牡丹、紫葳去血中
伏火,膈中实热,为使。『千金方』去鼠妇、赤硝,而加海藻、大戟,以软坚化水更
妙。
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师曰:阴气孤绝,阳气独发,则热而少气、烦冤,手足热而欲呕,名曰瘅疟;若但热
不寒者,邪气内藏于心,外舍分肉之间,令人消铄肌肉。
【按】
此言瘅疟,其文脱简 ,『内经』已详,不复释。
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温疟者,其脉如平 ,身无寒,但热,骨节疼烦,时呕,白虎加桂枝汤主之。
【按】
此言温疟,其文脱简,『内经』已详,不复释。
Biejia (Zosterae Fructus, fire-roasted) 12 fen, Wushan (Iris Tectorii Rhizoma, burned) 3 fen, Huangqin (Scutellariae Radix) 3 fen, Chaihu (Bupleuri Radix) 3 fen, Shufu (Lithobii Faecus, stir-fried) 3 fen, Ganjiang (Zingiberis Rhizoma) 3 fen, Dahuang (Rhei Radix et Rhizoma) 3 fen, Shaoyao (Paeoniae Radix Alba) 5 fen, Guizhi (Cinnamomi Ramulus) 3 fen, Tingli (Semen Lepidii seu Descurainiae, stir-fried) 1 fen, Shiwei (Pyrrosiae Folium, hairs removed) 3 fen, Houpo (Magnoliae Officinalis Cortex) 3 fen, Mudanpi (Moutan Cortex, heart removed) 5 fen, Qumai (Dianthi Herba) 2 fen, Ziwei (Lagerstroemiae Indicae Flos) 3 fen, Banxia (Pinelliae Rhizoma Preparatum) 1 fen, Renshen (Ginseng Radix et Rhizoma) 1 fen, Jinchong (Eupolyphaga seu Steleophaga, roasted) 5 fen, Ejiao (Colla Corii Asini) 3 fen, Fengchao (Apis Nidi) 4 fen, Chixiao (Natrii Sulfas) 12 fen, Qianglang (Scarabaeus, roasted) 6 fen, Taoren (Persicae Semen) 2 fen.
The above twenty-three ingredients are ground into fine powder. Take one dou of ash from a forged stove, and one hu five dou of clear wine. Soak the ash in the wine. When half of the wine has been consumed, place Biejia into the mixture and boil until it becomes soft and glutinous like glue or lacquer. Strain to obtain the juice, add all other medicines, and decoct to form pills the size of wu-tzu (smartweed seeds). Take seven pills on an empty stomach, three times a day.
[Collected Annotations]
Xu Bin stated: The use of Biejia as the principal ingredient in this decoction is because Biejia enters the Liver channel, dispels pathogenic factors, and nourishes healthy qi. Combined with wine soaked in stove ash, it eliminates mass accumulations (Jia), thus serving as the Sovereign drug. Xiao Chai Hu Tang (Minor Jueyang Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), and Da Cheng Qi Tang (Major Order the Qi Decoction) are the primary formulas for treating the Three Yang stages, so they serve as the Minister drugs. However, Gancao (Licorice Root) is considered too soft and slow-acting, potentially reducing efficacy; Zhishi (Immature Bitter Orange) is considered too disruptive to qi and acting too directly downward, so they are omitted. Instead, Ganjiang (Dried Ginger) and Ejiao (Donkey-Hide Gelatin) are added to assist Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma) in warming and nourishing, serving as Assistant drugs. Mass accumulations (Jia) necessarily rely on blood stasis and phlegm accumulation; therefore, four types of insect drugs, Taoren (Peach Seed), and Banxia (Pinellia Tuber) are used to resolve blood stasis and transform phlegm. Since all accumulations arise from qi stagnation, and when qi flows smoothly, accumulations dissipate, Wushan (Iris Tectorii Rhizoma) and Tingli (Semen Lepidii seu Descurainiae) are used to benefit Lung qi. Combined with Shiwei (Pyrrosia Leaf) and Qumai (Dianthus Herb), they clear pathogenic heat, move qi, and dissipate blood nodules. Because pathogen aggregation generates heat, Mudanpi (Tree Peony Bark) and Ziwei (Crape Myrtle Flower) are used to remove latent fire in the blood and excess heat in the diaphragm, serving as Guide drugs. In the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), Shufu (Lithobii Faecus) and Chixiao (Natrii Sulfas) were removed, while Haizao (Sargassum Thallus) and Daji (Euphorbiae Pekinensis Radix) were added to soften hardness and resolve water retention, which is even more ingenious.
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The Master said: When Yin qi is isolated and exhausted, and Yang qi acts alone, fever, shortness of breath, and vexatious discomfort occur, accompanied by hot hands and feet and a desire to vomit. This is called Dan Nu (Febrile Malaria); if there is only fever without chills, it indicates that the pathogenic factor is stored internally in the Heart and resides externally between the muscles, causing emaciation and wasting of the flesh.
[Commentary]
This passage discusses Dan Nu (Febrile Malaria). The original text has missing sections. The *Neijing* (Inner Canon) has already detailed this condition thoroughly, so no further explanation is provided here.
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Wen Nu (Warm Malaria) presents with a pulse similar to a normal pulse, absence of chills, presence of only fever, pain and irritability in the bone joints, and occasional vomiting. Bai Hu Jia Gui Zhi Tang (White Tiger Plus Cinnamon Twig Decoction) is the principal treatment.
[Commentary]
This passage discusses Wen Nu (Warm Malaria). The original text has missing sections. The *Neijing* (Inner Canon) has already detailed this condition thoroughly, so no further explanation is provided here.