岭表之俗。多食槟榔。盖谓瘴疟之作。率由饮食过度。气痞痰结。而槟榔最能下气。消食去痰。
故土人狃于近利。而暗于远害。此谓北人之饮酥酪塞北地
寒。食酥酪肤理缜密。一旦病疫。当汗则寒塞而汗不得出。南方地热。食槟榔不得。槟榔味辛。
能下泄元气。大泄胸中至高之气。久食槟榔。脏气疏泄。一旦病瘴。元气已自虚羸。故不能堪。
所以南方多体瘠色黄。夫岂全是气候所致。盖亦槟榔为患。殆不思耳。
卫生方云。重阳必阴。重阴必阳。寒热之变。物极则反。今瘴病或始寒战而终大热。或连
日极热而后作寒。正谓此也。第伤寒以不饮水为内寒。瘴则内寒者也。亦饮水甚。则欲坐水中取水。
以渍其心。胸盖炎方受病。气专炎上。心肺焦熬。华盖干涸。所以多渴。若其脉浮而虚。按之
无力。又或病潮时。脉洪数。病不潮时。脉微弱。其症则心烦躁。额上极热。面色多赤。舌多黑。
头或痛或不痛。小便或频或赤。大便或泄。腰腿沉重。两足不热。其有寒厥或疼。误服凉药。则
渴转甚。燥转急。治此者。当引上焦热气。降于下焦。正宜用大附子。及灸丹田气海足三里等穴。
使下元暖。阴阳交泰。而病自和解矣。或曰口渴心烦。面赤舌黑。小便赤。脉数。明是热症。而子
谓治此病者。宜用大附子。附子乃大热药也。以之治大热之病。是以火济火。甚骇耳目。吾子其
有说以通之乎。余曰方书有云。凡间之火得木则炎。得水则伏。其疾之小者似之。故立方有正治。
龙雷之火。得木则燔。得水则炎。日出则灭。其疾之大者似之。故立方有从治。复佐以热因寒用之。
寒因热用之之理。今人染瘴。或哑而不能言。或热而精神昏乱。如卧炭火之中。去死一间。不谓
之火病可乎。所以立从治之方。有姜附汤。干姜附子汤。沉附汤。附子冷汤。附子理中汤。真武汤。
冷香汤。七枣汤。极重三建汤。虽各有主对。俱系温剂。合冷服之。或佐以凉药。乃寒因热用也。
或曰以热治之之法。既闻命矣。而三建汤用川乌附子天雄乃一物也。何以别之。
余曰以春月采小者。为川乌。主除寒湿去痰。冬月采大而有小子附于旁者。为附子。主回阳反本。
补下焦之阳虚。大而旁无小子者。为天雄。取之雄不孕子之意。其力全无分散。补上焦之阳虚。
以三物同一本出于建平。故名曰三建。瘴虚因医者误用凉药。以致四肢厥冷。头额虚汗。发哕。脉
数而促。症甚急。用之能收心液。能止真阳。多有得生者。
The customs in the Lingnan region involve the frequent consumption of Areca Nut (Binglang, 槟榔). It is generally believed that the onset of Malaria due to Miasma (Zhang Nue, 瘴疟) is mostly caused by excessive diet, leading to Qi stagnation and Phlegm accumulation. Areca Nut is particularly effective in directing Qi downward, digesting food, and resolving phlegm.
Therefore, locals are bound by short-term benefits while ignoring long-term harm. This is analogous to northerners consuming butter and milk: In the cold northern lands, consuming butter and milk makes the skin texture dense. When an epidemic strikes, if sweating should be induced, the cold pathogen blocks the pores, preventing sweat from being released. In the hot southern lands, people consume Areca Nut. Areca Nut has a pungent flavor and can drain Yuan Qi (Original Qi, 元气), excessively draining the supreme Qi in the chest. Long-term consumption causes the internal organs' Qi to become dispersed and leaking. Once infected with Miasma, the Yuan Qi is already deficient and emaciated, making the body unable to withstand the disease.
Thus, people in the south are often physically frail and have a sallow complexion. Is this entirely due to climate? It is likely also a disaster caused by Areca Nut, which people fail to ponder deeply.
The *Weisheng Fang* (Health Preservation Formula) states: "Extreme Yang transforms into Yin, extreme Yin transforms into Yang." Changes between cold and heat occur when things reach their extremity. Current cases of Miasma disease may start with chills and end with high fever, or experience intense heat for several days before developing chills. This precisely illustrates the principle mentioned above.
In contrast, Taiyang Cold Damage (Shanghan, 伤寒) presents with no desire to drink water, indicating internal cold. However, in this type of Miasma disease, although the root pathology involves internal cold (specifically lower Jiao deficiency cold), the patient exhibits extreme thirst and desires to drink copiously, even wishing to sit in water to cool the heart. This is because the upper burner (chest) is affected by inflammatory heat (or deflected fire), causing Qi to flare upward exclusively, scorching the Heart and Lungs, and drying up the "Huagai" (Metaphor for the Lungs). Hence, there is much thirst.
If the pulse is floating and deficient, feeling weak upon deep pressure, or if the pulse is surging and rapid during fever episodes but weak and faint when the fever subsides, the symptoms include mental restlessness, extreme heat on the forehead, reddish complexion, blackish tongue coating, occasional headache or no headache, urinary frequency or red urine, occasional diarrhea, heavy sensation in the waist and legs, and cold feet. If there are cold tetany or pain, and cooling medicines are mistakenly administered, the thirst will worsen, and dryness/intolerance to heat will intensify.
To treat this condition, one must guide the heat from the Upper Jiao down to the Lower Jiao. It is appropriate to use large doses of Prepared Aconite Root (Fuzi, 附子) and moxa points such as Shendian (CV-4, 丹田), Qihai (CV-6, 气海), and Zusanli (ST-36, 足三里). This warms the Lower Yuan (Root of Lower Jiao), promotes the interaction of Yin and Yang, and allows the disease to resolve harmoniously.
Someone asked: Thirst, mental restlessness, reddish face, black tongue, red urine, and rapid pulse clearly indicate a Heat syndrome. Yet you suggest using large Prepared Aconite Root. Aconite is a major hot medicine; using it to treat a major heat disease is like adding fire to fire, which is shocking. Do you have an explanation?
I reply: Medical texts state: "Ordinary fire flares up with wood and submerges with water." Small diseases resemble this, hence the method of direct treatment (Zheng Zhi, 正治). "Dragon and Thunder Fire flares up with wood and burns with water, extinguishing at sunrise." Major diseases resemble this, hence the method of following treatment (Cong Zhi, 从治). This is supplemented by the principles of "treating heat with cold administration" (Re Yin Han Yong, 热因寒用) and "treating cold with heat administration" (Han Yin Re Yong, 寒因热用).
Now, people infected with Miasma may become mute or suffer from fever with mental confusion, lying as if on charcoal fire, perilously close to death. Can this not be called a Fire disease?
Therefore, formulas for following treatment are established, such as Ginger and Aconite Decoction (Jiang Fu Tang, 姜附汤), Dried Ginger and Aconite Decoction (Gan Jiang Fu Zi Tang, 干姜附子汤), Chen Fu Tang (沉附汤), Cold Aconite Decoction (Fu Zi Leng Tang, 附子冷汤), Aconite and Magnolia Bark Decoction (Fu Zi Li Zhong Tang, 附子理中汤), True Warrior Decoction (Zhen Wu Tang, 真武汤), Cold Fragrance Decoction (Leng Xiang Tang, 冷香汤), Seven Date Decoction (Qi Zao Tang, 七枣汤), and Extreme Heavy San Jian Decoction (Ji Zhong San Jian Tang, 极重三建汤). Although each has specific indications, they are all warming agents. They are combined with cold administration or assisted with cooling medicines. This is the application of "treating cold with heat administration" (Han Yin Re Yong - *Note: The text says 'Han Yin Re Yong' here referring to the method of giving hot meds cold, or treating the false heat symptom*).
Someone asked: I have heard the method of using hot medicines. But San Jian Decoction uses Sichuan Aconite (Chuan Wu, 川乌), Aconite (Fu Zi, 附子), and Tianxiong (Tian Xiong, 天雄). Are they not the same substance? How are they distinguished?
I say: Those harvested small in spring are called Chuan Wu, primarily used to dispel cold-dampness and resolve phlegm. Those harvested large in winter, with smaller buds attached beside them, are called Fu Zi, primarily used to restore Yang and return to the origin, tonifying deficiency of Yang in the Lower Jiao. Those that are large without smaller buds beside them are called Tian Xiong, taking the meaning of "male without offspring," with power concentrated and undispersed, used to tonify deficiency of Yang in the Upper Jiao.
These three substances originate from the same root in Jianping, hence named "San Jian" (Three Establishments).
Miasma-induced deficiency, often caused by physicians mistakenly using cooling medicines, results in cold tetany of the four limbs, empty sweat on the head and forehead, hiccups, rapid and hurried pulse, and critical symptoms. Using these [warming/aconite] preparations can collect Heart fluids, secure True Yang, and many patients survive.