一瘴病初起热大。不语至二三日。热微神清脉和。惟不作声。此真 瘴不治。
一瘴病上吐下泄。精神昏乱。脉微迟无力。二三日决死勿治。
一瘴病因食生冷过多。至四五日作泄。手足冷者。决死勿治。
一瘴病热退时。脉亦七八至。无神者。决死勿治。
一瘴病脉大而散。无胃气者不治。
一瘴病阳症见阴脉。无胃气不治。有胃气者生。
一瘴病误服麻黄发汗药。及柴胡黄芩苦寒药而变 者。决死不治。
一因误服麻黄。而筋惕肉 者死。
一因误服麻黄。而目赤喘急者死。
一因误服麻黄。汗出不止。发寒而哕者死。
一因误服寒凉。自利而手足厥冷。渐及肘膝者死。
一因误服寒凉。而发哕者不治。
一因误服寒凉。狂起乱搏人者不治。
一因胎前染瘴。胎落而变 者不治。
一产后染瘴。脉洪大如竹管。鼓指七至者不治。
瘴病之脉。不可不细察。假如其脉沉细而迟。此元气虚寒之脉外症。虽见纯阳。当急用沉附等药。
苟误投以寒剂。其逝即在顷刻。正所谓承气入胃。阴盛乃亡也。在伤寒。阳症见阴脉。为必死之症。
瘴疟为上热下寒。外热内寒之病。阳症见阳脉为真病脉。见有胃气者反为易治。万不失一。
如其脉弦带数。六七至有力而不散大。此元气不虚寒。外症无阴症。具于隐
微之中。只宜正气散。和解汤等药。苟误投以姜附亦难收功。正所谓桂枝下咽。阳盛则毙。或间
有阴症。见有阳脉。亦不宜例用姜附。且与和解正气。守之若苦寒之药。不可以脉见阳而妄用也。
如其脉洪大无伦。七八至按之鼓指者。或无力者。此元阳气尽泄于外之脉。不可谓之阳脉。
盖脉只以六七至为数为热。若七八至为元气已飞越。而邪气独盛。正不胜邪。故见是脉。以浮而
无力为洪。若洪大通筋似指则为元气不固于内。反泄于外。故见是脉。正内经。所谓脉大为虚是也。
鼓指者。更虚于无力。二脉兼见。似内伤火不归经之症。方书谓龙雷之火。其外症决见大热之病。
细察之必有阴症。具于隐微之中。急宜用姜附等大热之药。冷冻饮料之。其效可必。倘误投凉药。祸如反掌。
在他症脉至七八至。为七极八脱。决死之脉。在瘴疟如治以法者。永保无虞。
如脉代而不散者。当问大便如溲。小便调为元气不足。宜参附之剂补之。元气实。代脉去矣。
若数日未更衣。更宜和解正气。使大便利。黑屎去。则代脉去矣。若代而兼散。则为不治之脉。
如脉瘴作时。七八至。温中固下。正气和解后。热退去时。一呼一吸只来二至。在他症为
二败必死之脉。在瘴疟为邪气尽退。正气将复之脉。其外症决见浑身冰冷。困倦乏力。惟口中所
出之气略温。或大汗如雨。恶寒之极。斯时惟宜调养。内服补脾之药。一日则前症俱退。二三
日脉复。四五至矣。
[Background Information]
Book: *Zhang Nue Zhi Nan* (Guide to Malaria/Chong Disease)
Author: Zheng Quanwang
Dynasty: Ming
Chapter: Incurable Symptoms / Pulse
Category: Comprehensive
[English Translation]
There is a type of Chong disease where, upon initial onset, the fever is severe. By the second or third day, although the heat subsides, consciousness clears, and the pulse becomes harmonious, the patient remains unable to speak. This indicates the collapse of true Yuan Qi (Primordial Vital Energy) in Chong disease and is considered incurable.
In another type of Chong disease, the patient experiences vomiting above and diarrhea below, with mental confusion. The pulse is faint, slow, and weak. Death will inevitably occur within two or three days; it is untreatable.
In another case, due to excessive consumption of raw and cold foods, diarrhea occurs after four or five days, accompanied by cold hands and feet. This is also inevitably fatal and untreatable.
In another case, when the fever subsides, the pulse beats seven or eight times per respiration (extremely rapid), lacking Shen (Spirit/Vitality). This is inevitably fatal and untreatable.
In another case, the pulse is large and scattered, lacking Wei Qi (Stomach Qi, indicating a gentle and moderate quality in the pulse). This is incurable.
In another case, Yang syndromes present with Yin pulses. If there is no Wei Qi, it is incurable; if Wei Qi is present, survival is possible.
If Chong disease is mismanaged by administering Ma Huang Tang (Ephedra Decoction) for sweating, or bitter-cold herbs such as Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix), leading to pathological changes, death is inevitable and treatment is futile.
Misadministration of Ma Huang (Ephedrae Herba) can lead to Jin Ti Rou Dong (muscle twitching and tremors), resulting in death.
Misadministration of Ma Huang (Ephedrae Herba) can cause red eyes and urgent panting, resulting in death.
Misadministration of Ma Huang (Ephedrae Herba) can cause incessant sweating, followed by chills and Yue (hiccups/belching), resulting in death.
Misadministration of cold-cooling medicines can cause spontaneous diarrhea and cold extremities that gradually extend to the elbows and knees, resulting in death.
Misadministration of cold-cooling medicines causing Yue (hiccups/belching) is incurable.
Misadministration of cold-cooling medicines causing manic behavior and violent striking of others is incurable.
If one contracts Chong disease before pregnancy, and the fetus is expelled with subsequent pathological changes, it is incurable.
If one contracts Chong disease postpartum, and the pulse is surging and large like a bamboo tube, beating strongly against the fingers seven times per respiration, it is incurable.
The pulse of Chong disease must be examined meticulously. For instance, if the pulse is deep, fine, and slow, this indicates a pulse and external symptoms of Yuan Qi deficiency and cold. Even if pure Yang heat signs are visible externally, one must urgently use warm herbs such as Fu Zi (Aconiti Lateralis Radix Praeparata).
If cold agents are mistakenly administered, life will end instantly. This corresponds to the principle: "When Cheng Qi Tang enters the stomach, extreme Yin leads to death." In Shang Han (Cold Damage) diseases, Yang syndromes presenting with Yin pulses indicate a fatal condition.
Zhang Nue (Malaria/Chong Disease) is a disease characterized by upper heat and lower cold, and external heat with internal cold. When Yang syndromes present with Yang pulses, it is the true disease pulse. If the pulse shows Wei Qi (Stomach Qi), it is actually easier to treat, with near-perfect success rates.
If the pulse is wiry and rapid, beating six or seven times per respiration, forceful but not scattered, this indicates that Yuan Qi is not deficient or cold, and there are no Yin syndrome symptoms externally, though they may be hidden subtly. In such cases, only formulas such as Zheng Qi San (Regular Qi Powder) or He Jie Tang (Harmonizing Decoction) should be used. Mistakenly administering hot herbs like Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) will yield little effect. This aligns with the saying: "When Gui Zhi Tang enters the throat, extreme Yang leads to death." Occasionally, Yin syndromes may present with Yang pulses; even then, one should not routinely use Jiang and Fu Zi. Instead, one should administer harmonizing and Regular Qi-supporting formulas. One must adhere to principles; even if the pulse appears Yang, one must not recklessly use cold-bitter medicines based solely on the pulse.
If the pulse is excessively surging and large, beating seven or eight times per respiration, forceful against the fingers upon pressure, or conversely, forceless, this indicates that Yuan Yang Qi has completely leaked outward. This cannot be called a normal Yang pulse. Generally, a pulse beating six or seven times per respiration is considered rapid and indicative of heat. However, seven or eight beats per respiration indicates that Yuan Qi has flown away, while pathogenic factors are exclusively strong, and righteous Qi fails to overcome pathogens. Thus, this pulse appears. A floating and forceless quality is defined as Hong (Surging). If the pulse is surging and large, beating strongly against the tendons or fingers, it indicates that Yuan Qi is not consolidated internally but leaks outward, hence this pulse appears. This conforms to the *Nei Jing* (Inner Canon): "A large pulse indicates deficiency."
A pulse that beats strongly against the fingers indicates greater deficiency than a forceless pulse. These two pulse qualities appearing together resemble symptoms of internal injury with fire failing to return to its source, known in medical texts as Long Lei Zhi Huo (Dragon-Thunder Fire). Externally, these patients exhibit severe heat symptoms. Careful examination will reveal hidden Yin symptoms. One must urgently use hot herbs like Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata), administered with frozen beverages. The efficacy is assured. Mistakenly using cooling medicines will bring disaster swiftly.
In other diseases, a pulse beating seven or eight times per respiration is termed "Qi Ji Ba Tuo" (Seven Extremes, Eight Depletion), a fatal pulse. However, in Zhang Nue, if treated correctly, one can remain safe indefinitely.
If the pulse is Dai (Intermittent) but not scattered, one should inquire about bowel movements. If stool frequency resembles urination and urination is regulated, it indicates insufficient Yuan Qi. One should tonify with Ren Shen (Ginseng Radix) and Fu Zi (Aconiti Lateralis Radix Praeparata). Once Yuan Qi is restored, the Dai pulse will disappear.
If there has been no bowel movement for several days, one should further use harmonizing and Regular Qi-supporting methods to promote bowel movement. Once black stool is passed, the Dai pulse will disappear. If the pulse is Dai and combined with Scattered characteristics, it is an incurable pulse.
During the onset of Chong disease, if the pulse beats seven or eight times per respiration, employ warming the middle and securing the lower jiao methods. After Zheng Qi (Righteous Qi) is harmonized and heat subsides, if the pulse slows to only two beats per respiration, this is a fatal "two failures" pulse in other diseases. However, in Zhang Nue, it indicates that pathogenic factors have entirely retreated and Zheng Qi is about to recover. External symptoms will likely include whole-body coldness, fatigue, and weakness, with only slightly warm breath exhaled from the mouth, or profuse sweating like rain, and extreme aversion to cold. At this time, only rest and nourishment are appropriate. Internally, administer Spleen-tonifying medicines. Within one day, previous symptoms will recede. Within two to three days, the pulse will recover to four or five beats per respiration.