其病身发大热。神气沉昏。昼夜如卧炭火中。腰痛脚弱。大渴欲饮冷水。上脘
痞闷。神昏妄语。头痛或不痛。或呕逆或不呕逆。小便赤涩或频数。或遗尿。大便或秘或自利。
舌黑面赤目红。或吐血衄血。兼见之症。不能尽述。惟以其单热不寒。谓之热瘴。其热多不间断。
因阳气尽发泄于外而然。谚云。热瘴久不死。此瘴之重者也。治得其道。得生者多。其脉洪弦数。
或来七八至。亦有见阴者。治法先刺之。
南人治热瘴。初起不用药。只挑草子之法。广中之处有人能之。凡有瘴发一二日。卷其上下
唇之里。以针刺其血。正中用手捻去紫血。又以楮业擦舌出
血。又令病患并足而立。于两足后腕横缝中。青脉刺之。出血如注。乃以青蒿水与服。应手而愈。
若冷瘴与杂病。决不可刺。热瘴之所以刺而得愈者。即太阳伤寒症。邪气在表。当汗之法也。刺出其血。
即是得汗而其效速于得汗。盖人身之上下唇。是阳明胃脉之所经。足后腕。是太阳膀胱脉之所经。
太阳受病三日。而阳明受病。南人之针。可谓暗合。若患热瘴而不即刺。及其三阳传遍。邪气入里。
虽刺而血已凝。非惟无益。或至重伤。又南人针法。别有不可晓者。发瘴过经已入里而将死。刺病
人阴茎而愈。窃意其通五脏。刺之或可去内腑之热耳。然少壮者。尚可用此法。苟施于怯弱者。岂不危哉。
按黄帝内经。九针从南方来。刺热论曰。病未见赤色而刺之。是谓治未病。然则南方挑草子之法。不
可废也。但南人未知辨赤色之道。愚谓热瘴初起。刺病患两足腕出血。又刺舌下出血。头痛两额
角脉胀者与两额角脉上刺之出血。其病势
果衰大半。次服不换金正气散。又服和解汤七八服。得间断一日一发。然后截之。若间断作二日一
发尤妙。不来之日。服和解汤七八服。和解后热势稍缓。服养胃汤吞截疟丸。酒送。日服六七次。
如未止。服四兽饮。此平常之法也。如变症不一。当与治冷瘴方法。互治之。
如其症未解。或疑有热。亦不宜服发汗及凉药。但取嘉禾散服之。若果蕴热但冷。服无害。
盖嘉禾散治下虚中满。能升降阴阳。正与秋冬作热之地为宜。服二三日则寒热之症自判矣。然
后随症调治。自无不效。
如呕逆以养胃汤。来复丹。治中汤。二陈汤。选而用之。
如兀兀欲吐而不吐者。二陈汤主之。
呕而热不退者。藿香正气散主之。
呕而膨胀二陈汤下感应丸。
呕而头痛。来复丹兼如圣饮子。
呕而胸膈不快。下虚中满。嘉禾散主之。
呕而大便秘。嘉禾散加蜜主之。
呕而腹痛。红丸子及乌沉散。
呕而痰逆。头痛身痛。脚痛脚弱。大汗多。烦躁引饮。大便自利。小便赤涩者。姜附汤主之。
吞养正丹。或灵砂散。
如发热烦躁。手足冷。鼻尖凉二症。病患因热大烦躁。多不自知。医者须以手扪其手足与鼻尖。
方知之。身重脚腰痛。舌生黑苔。大渴引饮。自利呕逆。自汗恶风者。干姜附子汤主之。
如大热咽嗌干渴。烦躁不解者。冷香汤主之。
如热大烦渴大作。饮水无度者。既济汤主之。
甚者合夺命散。
如热大神昏。不知人事。妄语遗尿。吐血衄血。舌黑面红。目赤烦渴。脉弦而七八至。以手
扪之。额上极热。胸腹热。腰以下不热而冷。虽狂言妄语。病患心蜷卧。叉手扪心。或引衣自盖。
阴症具于隐微之中。况脉只以五六至。为数。为实热。若七至八至是内阳尽出于外之脉。腹内则空
虚矣。若误用寒凉。攻外热。其毙也可立而待。急用沉附汤主之。吞黑锡丹。稍缓者。二陈汤合
沉附主之。
轻者养胃汤合沉附汤主之。
如热大烦渴闷乱逆泄泻。手足稍微冷者。附子理中汤主之。
如呕逆泄泻。脐腹刺痛。胁肋胀痛。引饮无度。胸膈不利者。冷香汤主之。
如发热腹痛。头目昏沉。四肢疼痛。大便自利。小便或利或涩。或呕或咳。自汗多者。真武汤主之。
如因误攻外热以至四肢厥冷。两足如无。头颅虚汗不止。或时发哕。脉数而
促。其危尤甚。急宜收心液。壮真阳。庶可更生。宜服三建汤。
如大便秘。其脉六至。兼弦而有力者。
和解汤主之。甚者用蜜导法。
如夏月冒暑。伏热即发热瘴。烦躁口渴。上吐下泄。心脾不调。 全不具。阴症其脉弦而六
七至有力。六和汤主之。
如热大便坚硬。其人平素脾胃壮实。而脉弦数有力者。和解汤加苏叶地骨皮主之。
如发热头疼。或眼睛疼。大便实。其脉举按皆弦数。全无阴症。其人平素宜凉剂者。参苏饮主
之。只可一二服。稍和即止。不可过用。须要详认。不可误人。
如已分为间日。脾胃已和。湿冷
已去。病退时。脉亦弦数者。养胃汤加柴胡主之。
如已服正气和解温中固下后。热已间断。截疟丸。不住者。十四日外可少与
柴平汤。或柴胡散。尤隐不可多服。参苏饮。柴平汤。柴胡散。三方。须细察。病患平素宜凉剂。胃气壮实。
及脉实而无阴症。具于隐微之中者。方可用之。如稍缓。不若和解汤加减守之。免致失手。
如已经七日。发热烦躁。引饮喜冷水。大便不通。小便赤涩。狂言内热。神昏不省者。药令黄
汤主之。若因上热未降者。尤宜沉附汤主之。
如无汗发热头痛小便涩。烦渴饮水水入即吐。五苓散主之。不可多服。
如瘴止后。犹狂言神昏者。因心经之阳尚未降于下焦故也。二陈汤加沉附主之。或养胃汤亦加沉附。
如瘴止后。腹痛肠鸣。大便溏而频。平胃散主之。
如瘴止后虚烦不眠。心胆虚怯。触事易惊。或梦不祥或异象。眩惑夜不安寝者。温胆汤主之。无多服。
如瘴止后。精神倦。不喜饮食者。异功散主之。
如瘴止后。腰痛脚痛。加减五积散。
如瘴止后。自汗多者。黄 建中汤主之。多痰体倦。六君子汤。
如瘴止后。易饥易饱者。香砂六君汤。吞以养脾丸。
The disease manifests as high fever throughout the body, with a sinking and confused spirit (Shen), feeling day and night as if lying in a bed of charcoal. Accompanied by lower back pain, weakness in the legs, extreme thirst desiring cold water, fullness and oppression in the upper epigastrium (Shangwan), confusion and delirious speech, headache or no headache, vomiting and regurgitation or none thereof, red and turbid urine or frequent urination, or enuresis, constipation or spontaneous diarrhea, black tongue coating, red face, red eyes, hematemesis, or epistaxis. The accompanying symptoms cannot be exhaustively listed; it is called "Heat Malaria" (Re Zhang) solely because there is heat without chills. This heat is mostly continuous, caused by Yang Qi fully venting to the exterior. As the proverb says, "Long-standing Heat Malaria does not kill," this is a severe type of miasma. If treated correctly, many survive. The pulse is surging (Hong), wiry (Xian), and rapid (Shu), or beating seven to eight times per respiration; Yin pulses may also appear. The treatment method involves acupuncturing first.
In southern regions, treating Heat Malaria at the onset does not involve herbal medicine but only the "Grass-Seed Picking" (Tiao Caozi) method. People in Guangdong are skilled in this. Whenever malaria occurs within one or two days, roll up the inner lining of the upper and lower lips and prick them with a needle to bleed. Pinch away the purple blood from the center. Then rub the tongue with paper mulberry leaves (Zhu Ye) until it bleeds. Have the patient stand with feet together and prick the transverse crease behind both ankles where the blue veins are, causing blood to flow like a stream. Then administer Artemisia annua (Qinghao) water, and recovery follows promptly. For Cold Malaria (Leng Zhang) and miscellaneous diseases, acupuncture must absolutely not be used. The reason Heat Malaria heals via acupuncture is that it resembles Taiyang Cold Damage (Taiyang Shanghan), where pathogenic factors are at the exterior, requiring diaphoresis (sweating). Acupuncture releasing blood is equivalent to sweating, yet its effect is faster than induced sweating. This is because the upper and lower lips are pathways of the Yangming Stomach Meridian, and the posterior ankle is the pathway of the Taiyang Bladder Meridian. After three days of Taiyang disease, Yangming disease ensues. The southern acupuncture method secretly aligns with medical principles. If Heat Malaria is not acupunctured immediately, and after the Three Yang meridians are traversed and pathogens enter the interior, even if acupunctured, the blood will have coagulated, doing no good and potentially causing serious harm. Furthermore, there are inexplicable aspects of southern acupuncture: when malaria has exceeded its course, entered the interior, and is near death, pricking the penis cures it. I speculate this unblocks the Five Zang organs, and pricking might remove internal heat. However, this method is suitable only for the young and strong; applying it to the weak would be dangerous.
According to the *Huangdi Neijing* (Yellow Emperor's Inner Canon), the Nine Needles originated from the South. The *Cire Lun* (Treatise on Acupuncture for Heat) states: "Pricking before redness appears is called treating disease before it arises." Thus, the southern "Grass-Seed Picking" method should not be discarded. But southerners do not know how to distinguish red signs. I believe that at the onset of Heat Malaria, one should prick the bilateral posterior ankles to bleed, and the sublingual area to bleed. If there is headache with distension of the vessels at the temporal angles, prick above these vessels to bleed. This will reduce the disease severity by more than half. Subsequently, administer Buhuanjin Zhengqi San (Unchanging Metal Upright Qi Powder), then Hejie Tang (Harmonizing Decoction) for seven to eight doses, until the fever becomes intermittent (occurring every other day), then apply antimalarial measures. Intermittence every two days is even better. On non-fever days, take Hejie Tang for seven to eight doses. After harmonization reduces the heat slightly, take Yangwei Tang (Stomach-Nourishing Decoction) swallowed with Jiemie Wan (Malaria-Cutting Pill), taken with wine, six to seven times daily. If it does not stop, take Sishou Yin (Four Beasts Drink). This is the standard method. If varied symptoms occur, refer to the methods for Cold Malaria and treat mutually.
If symptoms persist or heat is suspected, avoid diaphoretic and cooling medicines. Instead, use Jiahe San (Jiahe Powder). If there is concealed heat manifesting as cold, taking it is harmless. Because Jiahe San treats deficiency below and fullness in the middle, regulating the ascending and descending of Yin and Yang, it suits the hot conditions of autumn and winter. After two to three days, cold and heat symptoms will naturally differentiate. Then adjust treatment according to symptoms, ensuring efficacy.
For vomiting and regurgitation, select from Yangwei Tang, Laifu Dan, Zhizhong Tang, or Erchen Tang.
For nausea with inability to vomit, Erchen Tang (Two-Chen Decoction) is indicated.
For vomiting with persistent fever, Huoxiang Zhengqi San (Agarwood Upright Qi Powder) is indicated.
For vomiting with abdominal distension, administer Yinggan Wan (Inducing Response Pill) with Erchen Tang.
For vomiting with headache, combine Laifu Dan with Rusheng Yinzi.
For vomiting with chest/epigastric discomfort, deficiency below, and fullness in the middle, Jiahe San is indicated.
For vomiting with constipation, Jiahe San with honey is indicated.
For vomiting with abdominal pain, use Hongwanzi (Red Pills) and Wuchen San.
For vomiting with phlegm-regurgitation, accompanied by headache, body ache, leg pain/weakness, profuse sweating, irritability, desire to drink, spontaneous diarrhea, and red/turbid urine, Jiangfu Tang (Ginger and Aconite Decoction) is indicated. Swallow Yangzheng Dan or Lingsha San.
For fever with irritability, cold hands/feet, and cold nasal tip: Patients suffer extreme irritability due to heat but may not realize it. Physicians must palpate hands/feet and nasal tip to confirm. For heavy body, lower back/leg pain, black tongue coating, extreme thirst, spontaneous diarrhea/vomiting, spontaneous sweating, and aversion to wind, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) is indicated.
For intense heat, dry throat/thirst, and unresolved irritability, Lengxiang Tang (Cool Fragrance Decoction) is indicated.
For intense heat, severe irritability/thirst, and excessive drinking, Jiji Tang (Jiji Decoction) is indicated. Severe cases combine Duoming San.
For intense heat, coma, unconsciousness, delirium, enuresis, hematemesis, epistaxis, black tongue, red face, red eyes, irritability/thirst, wiry pulse beating 7-8 times, hot forehead/chest/abdomen but cold below the waist, despite delirium the patient curls up, crosses hands over heart, or covers self—Yin signs are hidden subtly. A pulse of 5-6 beats is considered rapid/Shu indicating excess heat. A pulse of 7-8 beats indicates Yang Qi completely exiting the interior, leaving the abdomen empty. Misusing cold/cooling herbs to attack external heat leads to immediate death. Urgently use Chenfu Tang (Chen Aconite Decoction), swallowing Heixi Dan. For milder cases, combine Erchen Tang with Chenfu Tang.
For mild cases, combine Yangwei Tang with Chenfu Tang.
For intense heat, irritability, restlessness, regurgitation, diarrhea, and slightly cold hands/feet, Fuzi Lizhong Tang (Aconite Regulate Middle Decoction) is indicated.
For vomiting/regurgitation, diarrhea, stabbing pain in umbilical/abdominal region, distending pain in hypochondrium, excessive drinking, and chest/epigastric obstruction, Lengxiang Tang is indicated.
For fever, abdominal pain, dizziness/heavy head, limb pain, spontaneous diarrhea, variable urination, vomiting/cough, and profuse sweating, Zhenwu Tang (True Warrior Decoction) is indicated.
If misusing cold/cooling herbs causes four extremities coldness, numbness in legs, profuse cranial sweating, occasional hiccups, and rapid/hesitant pulse, the condition is critically dangerous. Urgently collect Heart fluid and strengthen True Yang to allow regeneration. Sanjian Tang (Three Jian Decoction) is appropriate.
For constipation with a pulse of six beats, wiry and forceful, Hejie Tang is indicated. Severe cases use Honey Suppository method.
In summer, if exposed to summerheat, latent heat triggers Fever Malaria with irritability, thirst, vomiting/diarrhea, and Heart/Spleen disharmony, without Yin signs, and a wiry pulse of 6-7 beats forceful, Liuhe Tang (Six Harmonies Decoction) is indicated.
For intense heat with hard stool, in patients with robust Spleen/Stomach constitution and wiry/rapid/forceful pulse, Hejie Tang plus Perilla Leaf (Suye) and Groundsel Root Bark (Digupi) is indicated.
For fever/headache or eye pain, solid stool, wiry/rapid pulse upon lifting and pressing, no Yin signs, and a constitution suited to cooling agents, Rensu Yin (Ginseng and Perilla Drink) is indicated. Take only 1-2 doses; stop once harmonized. Do not overuse. Careful differentiation is required to avoid error.
If divided into tertian pattern, with harmonized Spleen/Stomach, removed damp-cold, and resolving phase with wiry/rapid pulse, Yangwei Tang plus Bupleurum (Chaihu) is indicated.
After using Zhengqi, Hejie, warming, and stabilizing formulas, if heat is intermittent but Jiemie Wan fails, after 14 days, give small amounts of Chai Ping Tang or Chaihu San. Especially caution against overuse if hidden signs exist. Rensu Yin, Chai Ping Tang, and Chaihu San require careful observation: usable only if the patient usually tolerates cooling agents, has robust Stomach Qi, and has a forceful pulse without hidden Yin signs. If milder, stick to modified Hejie Tang to avoid mishandling.
After seven days, with fever, irritability, preference for cold drinks, constipation, red/turbid urine, delirium/internal heat, and coma, Yaoling Huang Tang is indicated. If upper heat has not descended, Chenfu Tang is particularly appropriate.
For anhidrosis, fever, headache, urinary difficulty, irritability/thirst, and vomiting after drinking, Wuling San is indicated. Do not overuse.
After malaria stops, if delirium/coma persists, it is because Heart Yang has not descended to the Lower Jiao. Erchen Tang plus Chen Aconite is indicated. Or Yangwei Tang plus Chen Aconite.
After malaria stops, if abdominal pain/borborygmus, loose/frequent stools occur, Pingwei San is indicated.
After malaria stops, if restless insomnia, Heart/Gallbladder deficiency timidity, easily startled, bad dreams, dizziness, and sleep disturbance occur, Wendan Tang is indicated. Do not overuse.
After malaria stops, if mental fatigue and poor appetite occur, Yigong San is indicated.
After malaria stops, if lower back/leg pain occurs, Jiawei Wuji San (Modified Accumulation Dispelling Powder) is indicated.
After malaria stops, if profuse sweating occurs, Huangqi Jianzhong Tang (Astragalus Build the Middle Decoction) is indicated. For phlegm and fatigue, Liujunzi Tang (Six Gentlemen Decoction) is indicated.
After malaria stops, if prone to hunger and satiety, Xiangsha Liujun Tang (Aucklandia and Amomum Six Gentlemen Decoction) swallowed with Yangpi Wan is indicated.