温疫初起,先憎寒而后发热,日后但热而无憎寒也。初得之二三日,其脉不浮不
沉而数,昼夜发热,日晡益甚,头疼身痛。其时邪在伏脊之前,肠胃之后,虽有头疼身
痛,
此邪热浮越于经,不可认为伤寒表证,辄用麻黄桂枝之类强发其汗。此邪不在经,汗之徒伤
表气,热亦不减。又不可下,此邪不在里,下之徒伤胃气,其渴愈甚。宜达原饮。
达原饮
槟榔(二钱) 浓朴(一钱) 草果仁(五分) 知母(一钱) 芍药(一钱) 黄芩(一钱) 甘草(五分)
上用水二钟,煎八分,午后温服。
按∶槟榔能消能磨,除伏邪,为疏利之药,又除岭南瘴气;浓朴破戾气所结;草果辛烈气雄
,除伏邪盘踞;三味协力,直达其巢穴,使邪气溃败,速离膜原,是以为达原也。热伤津液
,加知母以滋阴;热伤营血,加白芍以和血;黄芩清燥热之余;甘草为和中之用;以后四味
,不
过调和之剂,如渴与饮,非拔病之药也。凡疫邪游溢诸经,当随经引用,以助升泄,如胁痛
、耳聋、寒热、呕而口苦,此邪热溢于少阳经也,本方加柴胡一钱;如腰背项痛,此邪热溢
于
太阳经也,本方加羌活一钱;如目痛、眉棱骨痛、眼眶痛、鼻干不眠,此邪热溢于阳明经也
,本方加干葛一钱。证有迟速轻重不等,药有多寡缓急之分,务在临时斟酌,所定分两,
大
略而已,不可执滞。间有感之轻者,舌上白苔亦薄,热亦不甚,而无数脉,其不传里者,一
二剂自解,稍重者,必从汗解,如不能汗,乃邪气盘踞于膜原,内外隔绝,表气不能通于内
,里气不能达于外,不可强汗。或者见加发散之药,便欲求汗,误用衣被壅遏,或将汤火熨
蒸,甚非法也。然表里隔绝,此时无游溢之邪在经,三阳加法不必用,宜照本方可也
。感之重
者,舌上苔如积粉,满布无隙,服汤后不从汗解,而从内陷者,舌根先黄,渐至中央,邪
渐入胃,此三消饮证。若脉长洪而数,大汗多渴,此邪气适离膜原,欲表未表,此白虎汤
证。
如舌上纯黄色,兼之里证,为邪已入胃,此又承气汤证也。有二三日即溃而离膜原者,有半
月十数日不传者,有初得之四五日,淹淹摄摄,五六日后陡然势张者。凡元气胜者毒易传
化,元气薄者邪不易化,即不易传。设遇他病久亏,适又染疫能感不能化,安望其传?不传
则邪不去,邪不去则病不瘳,延缠日久,愈沉愈伏,多致不起,时师误认怯证,日进参 ,
愈壅愈固,不死不休也。
In the initial stage of warm epidemic (Wenyi), the patient first experiences aversion to cold followed by fever. After a few days, only fever remains without aversion to cold. Within two or three days of onset, the pulse is neither floating nor deep but rapid (Shu). There is fever day and night, worsening in the late afternoon (Ribu), accompanied by headache and body pain. At this time, the pathogenic factor is located anterior to the hidden spine and posterior to the stomach and intestines. Although there are headache and body pain, these are caused by pathogenic heat floating and overflowing into the meridians. It should not be mistaken for a Taiyang exterior syndrome of Cold Damage (Shanghan); therefore, one should not arbitrarily use Ma Huang Tang (Ephedra Decoction) or Gui Zhi Tang (Cinnamon Twig Decoction) to forcibly induce sweating. Since the pathogen is not in the exterior meridians, sweating will vainly damage the defensive Qi (Wei Qi) without reducing the fever. Furthermore, purgation should not be used because the pathogen is not in the interior; purging will vainly damage Stomach Qi and worsen thirst. The appropriate treatment is Da Yuan Yin (Reach the Origin Decoction).
Da Yuan Yin Composition: Bing Lang (Arecae Semen, 2 qian), Nong Po (Magnoliae Officinalis Cortex, 1 qian), Cao Guo Ren (Tsaoko Fructus Seed, 0.5 qian), Zhi Mu (Anemarrhenae Rhizoma, 1 qian), Shao Yao (Paeoniae Radix Alba, 1 qian), Huang Qin (Scutellariae Radix, 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 0.5 qian).
Take two cups of water, decoct until reduced to eight-tenths, and take warm in the afternoon.
Commentary: Bing Lang has the ability to digest and grind, eliminating latent pathogens; it is a疏利 (dispersing and promoting) herb that also removes miasma from Lingnan. Nong Po breaks up the accumulation of Li Qi (pestilential qi). Cao Guo, with its pungent, acrid, and vigorous aroma, eliminates entrenched latent pathogens. These three herbs work together to reach the nest of the pathogen, causing the pathogenic factor to collapse and quickly leave the Mo Yuan (Membrane Source). This is why it is called "Reaching the Origin." Heat injures body fluids, so Zhi Mu is added to nourish Yin; heat injures Ying Blood, so Bai Shao (White Peony Root) is added to harmonize blood; Huang Qin clears residual dry-heat; Gan Cao harmonizes the Middle Jiao. The latter four herbs are merely harmonizing agents, like drinking water when thirsty, not drugs that extract the disease. Whenever epidemic pathogens overflow into various meridians, one should add meridian-guiding herbs to assist in ascending and venting. For example, hypochondriac pain, deafness, alternating chills and fever, vomiting with bitter taste indicate pathogenic heat overflowing into the Shaoyang Meridian; add Chai Hu (Bupleuri Radix) 1 qian to this formula. If there is pain in the lower back, neck, and occiput, indicating overflow into the Taiyang Meridian, add Qiang Huo (Notopterygii Rhizoma et Radix) 1 qian. If there is eye pain, supraorbital pain, orbital pain, dry nose, and insomnia, indicating overflow into the Yangming Meridian, add Gan Ge (Puerariae Lobatae Radix) 1 qian. Cases vary in speed and severity; drug dosages vary in quantity and urgency. One must always exercise discretion based on the situation. The specified dosages are rough guidelines and should not be applied rigidly. In mild cases, the tongue coating is thin and white, fever is not severe, and the pulse is not rapid. If the pathogen does not transmit inward, one or two doses will resolve it. Slightly more severe cases must resolve through sweating. If sweating cannot occur, it is because the pathogen is entrenched in the Mo Yuan, causing separation between interior and exterior. Defensive Qi cannot penetrate inward, and Interior Qi cannot reach outward. Forced sweating is contraindicated. Some practitioners see the need for dispersing herbs and desire sweating, mistakenly using heavy blankets to obstruct or applying hot compresses/steam, which is highly inappropriate. However, at this stage of interior-exterior separation, there are no overflowing pathogens in the meridians, so the modifications for the Three Yang meridians are unnecessary; follow the original formula. In severe cases, the tongue coating resembles accumulated powder, covering the surface without gaps. After taking the decoction, if the pathogen does not resolve via sweating but sinks inward, the root of the tongue turns yellow first, gradually spreading to the center, indicating the pathogen is entering the Stomach. This indicates San Xiao Yin (Three Eliminations Decoction). If the pulse is long, surging, and rapid, with profuse sweating and extreme thirst, the pathogen has just left the Mo Yuan and desires to vent but has not yet done so; this indicates Bai Hu Tang (White Tiger Decoction). If the tongue is purely yellow with interior excess signs, the pathogen has entered the Stomach; this indicates Cheng Qi Tang (Order the Qi Decoction). Some patients may disperse and leave the Mo Yuan within two or three days; some may not transmit for half a month or more; some may appear lethargic for four or five days after onset, then suddenly intensify on the sixth day. Generally, those with strong Yuan Qi (Primal Qi) find toxins easier to transmit and transform; those with weak Yuan Qi find pathogens difficult to transform and thus difficult to transmit. If a person suffers from chronic deficiency due to other diseases and then contracts an epidemic, they can contract the pathogen but cannot transform it. How can one expect transmission? Without transmission, the pathogen is not expelled; without expulsion, the disease does not heal. Prolonged entanglement leads to deeper sinking and hiding of the pathogen, often resulting in death. Contemporary physicians mistakenly diagnose this as Deficiency Consumption (Qie Zheng) and administer Ginseng daily, causing further stagnation and consolidation of the pathogen, leading to death.