瘴病无传经。治得其道。则有减病常期。治失其道。则至其时日而增剧。如瘴初起。轻则自间
断正类疟病。治之当一日一发者。十四日愈。或二十一日愈。二日一发者。七日愈。其故何也。
夫瘴多是元气不胜邪。一日一发。元气难复。
其愈迟。二日一发元气易复。其愈速。若三日一发。则与 疟无异。当以治瘴治 之方。斟酌合
用。必半年一年方可愈也。其次初发不间断。正气和解后。三日即间断七日可愈。或十日愈。又
有重者。直至七日方间断。十四日可愈。如不愈二十一日。才已有二十一日。犹未已者。虽未愈。
谨慎用药。再无变证。若不知治瘴之法。妄用药饵。不问轻重。如重犯发汗凉药。则三日变证。
七日死。有十日变症者。有十四日变症者。有二十一日变症者。若犯石膏大黄。则变症只在顷刻。
总之治失其道。七日内变症极多。十四日变症次之。二十一日内变症又次之。
南方阳浮阴闭。阳恒泄。阴恒固。男子以阳为主。故瘴病者多。女子以阴为主。故病瘴者十
中一二。治法与男子同。更加以豁痰调气降气为主。用四七汤。
乌沉散。佐以沉香间服。或加四物。惟胎前产后与男子异。在胎前以正气和解方。加大腹皮。
砂仁杜仲续断。安胎或兼四物。若见阴症。亦照姜附温中镇下方法。胎亦不落。即经所谓有故无
殒是也。或不幸而瘴毒深重。热极大。胎多虽保。胎下不变。 不作痉。脉不洪大无伦。鼓指
数八七至者。犹可治。设变 或脉七八至。虽参附亦无如之。何矣。在产后染瘴者。当大补气血
为主。佐以温中镇下。正气和解。不变 。脉不大。七至八至多有得生者。盖脉大鼓指七八至。
瘴脉之常。本可治。惟产后不见此。其大法不出于前三症中。参论临时斟酌可也。
Zhang disease (Miasma Disease) does not transmit through the meridians. If treated correctly, the disease will diminish within a fixed period; if treated incorrectly, the condition will worsen on the predicted days. For example, when zhang disease first begins, mild cases present with intermittent attacks, resembling malaria. In treatment, if the attack occurs once daily, recovery takes fourteen days or twenty-one days. If the attack occurs every two days, recovery takes seven days. Why is this? Zhang disease is mostly caused by deficient Yuan Qi (Primary Qi) failing to overcome the pathogenic factor. With daily attacks, it is difficult for Yuan Qi to recover, hence recovery is slow; with bi-daily attacks, Yuan Qi recovers easily, hence recovery is fast. If the attack occurs every three days, it is no different from malaria. One should carefully select and combine formulas used for treating zhang disease, and recovery may take half a year to one year.
Secondly, in initial continuous non-intermittent attacks, after the Righteous Qi (Zheng Qi) harmonizes, intermittency appears on the third day, leading to recovery in seven days or ten days. In more severe cases, intermittency may not appear until the seventh day, with recovery in fourteen days. If not recovered by fourteen days, and still persisting at twenty-one days, although not yet cured, careful medication will prevent further complications. If one does not know the methods for treating zhang disease and uses drugs recklessly without distinguishing severity—for instance, using diaphoretic or cold-natured medicines for severe cases—complications arise in three days, and death occurs in seven days. Some develop complications in ten days, some in fourteen days, and some in twenty-one days. If Gypsum Fibrosum (Shigao) and Rheum Palmatum (Dahuang) are misused, complications occur almost instantly. In summary, incorrect treatment leads to the most complications within seven days, fewer within fourteen days, and even fewer within twenty-one days.
In the southern regions, Yang Qi floats while Yin Qi is closed; Yang constantly leaks, and Yin remains solid. Men are governed by Yang, so they suffer from zhang disease frequently; women are governed by Yin, so only one or two out of ten suffer from it. The treatment method is the same as for men, but emphasis is placed more on resolving phlegm, regulating Qi, and descending Qi. Use Siqui Tang (Seven-Character Decoction) and Wuchen San (Wuchen Powder), assisted by Aquilariae Lignum Resinatum (Chenxiang) taken alternately, or combined with Siwu Tang (Four Substances Decoction). Only during pregnancy and postpartum differs from men. During pregnancy, use formulas that harmonize Zheng Qi, adding Arecae Pericarpium (Dafupi), Amomi Fructus Rotundus (Sharen), Eucommiae Cortex (Duzhong), and Dipsaci Radix (Xuduan) to calm the fetus, or combine with Siwu Tang. If Yin syndrome is observed, treat according to the method of warming the middle and anchoring the lower using Zingiberis Rhizoma Recens (Jiang) and Aconiti Lateralis Radix Praeparata (Fuzi); the fetus will not be lost. This is what the Classic states: "If there is a cause [pathology], there is no injury [to the healthy body]." If unfortunately the zhang toxin is deep and severe, and heat is extreme, although the fetus may mostly be preserved, after delivery, the body does not become rigid, spasm does not occur, and the pulse is not excessively surging, beating seven to eight times per breath cycle, it is still treatable. However, if the pulse beats seven to eight times per breath cycle accompanied by other critical signs, even Ginseng Radix et Rhizoma (Renshen) and Aconiti Lateralis Radix Praeparata (Fuzi) will be ineffective. For those who contract zhang disease postpartum, the main treatment should be greatly tonifying Qi and Blood, assisted by warming the middle, anchoring the lower, and harmonizing Zheng Qi, without developing complications. If the pulse is not large, beating seven to eight times per breath cycle, survival is likely. This is because a surging pulse beating seven to eight times per breath cycle is a common pulse pattern for zhang disease and is inherently treatable; however, this pulse pattern should not appear postpartum. The general principles do not exceed the aforementioned three scenarios; one should refer to them and adjust according to the specific situation.