疫痢疟三症最多。肿最难治。故合提而论。疫有由天时者。有由人染者。由天时则邪从经络
入。为头痛发热咳嗽。颈肿发颐。大头天行之类。用香苏散、普济消毒饮治之。由人染则邪从
口鼻入。为憎寒壮热。胸膈满闷。口吐黄涎之类。用神术散、藿香正气散治之。此两路之邪。若
传入脏腑。渐至谵语腹胀。唇焦口渴者。宜治疫清凉散、承气汤治之。总不越乎发散解秽清
中攻下四法而已。痢症则生死所关。良由夏秋之际。暑热在中。而为风寒生冷所遏。火不得
舒。迫而为痢也。热者为赤。寒者为白。热伤血分者为赤。寒伤气分者为白。初起时不宜妄攻。
宜葛根治痢散以解之。余邪未已。里急后重。则用治痢奇方以清之。腹胀痛。有坚积。则用朴
黄丸下之。日久脾虚。五味异功散加白芍、黄连、木香清补之。气虚下陷者。补中益气汤升提
之。如邪秽塞胃。呕逆不食者。开噤散启之。此一定之治法也。疟则轻于痢矣。寒邪入内。阴阳
相搏。初起寒热往来。用香苏散逐之。随用小柴胡汤和之。三四发后。止疟丹加白蔻仁、醋炒
鳖甲以截之。久疟元虚。六君子汤加柴胡补之。中气下陷。补中益气汤举之。此易治也。唯肿
胀一症。目胞与足先肿者。水也。先腹大后四肢肿者。臌胀也。鼓胀症用和中丸。虚者白术丸。
水肿症四肢肿而腹不肿者。表也。腹亦肿者。里也。腰以上肿。邪在表也。宜汗。五皮饮加苏叶、
素艽、防风、荆芥。腰以下肿。邪在里也。宜利小便。五皮饮加赤小豆、赤苓、泽泻、车前、萆 、防己。
且烦渴便闭者阳水。热也。五皮饮加连翘、黄柏、黄芩。不烦渴者阴水。寒也。五皮饮加附子、干
姜、肉桂。先肿而后喘。或但肿而不喘者。胃经蓄水也。五皮饮照前加减治之。若先喘而后肿
者。肾经聚水也。金匮肾气丸治之。此症最难收功。慎勿误治。更有中风后热伤经络。足不任
地。腿肿胀痛者。此脉痿也。用苍术、黄柏、芩、连、冬、斛、当归、地黄、苡仁、牛膝、寄生、
萆、丹参之类。又有肿痛在脚。名曰香港脚。风湿胜也。用槟榔、防己、秦艽、天麻、独活、牛
膝、桑枝、木瓜之类。
Epidemic dysentery and malaria are the most common conditions. Swelling is the most difficult to treat. Therefore, they are discussed together here. Epidemics may arise from climatic factors or from interpersonal infection. When caused by climatic factors, pathogenic factors enter through the meridians, manifesting as headache, fever, cough, neck swelling, parotitis (inflammation of the parotid gland), and epidemic大头瘟 (epidemic mumps or facial cellulitis). These are treated with Xiangsu San (Perilla and Liquorice Powder) and Puji Xiaodu Yin (Universal Rescue Decoction for Detoxification). When caused by interpersonal infection, pathogenic factors enter through the mouth and nose, manifesting as aversion to cold with high fever, chest and diaphragm fullness and oppression, and vomiting of yellow saliva. These are treated with Shenzhu San (Divine Efficacy Powder) and Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi). If these pathogens from either route transmit to the Zang-Fu organs, gradually leading to delirium, abdominal distension, dry cracked lips, and thirst, Zhiji Qingliang San (Antiepidemic Cooling Powder) and Chengqi Tang (Descending the Excess Decoction) should be used. The treatment generally does not exceed the four methods: dispersing and releasing, resolving turbidity, clearing the middle, and purging downward.
Dysentery involves life and death. It is indeed due to summer-heat and heat accumulating in the interior during summer and autumn, being constrained by wind-cold and raw/cold foods, preventing fire from venting freely, thereby forcing the intestines into dysentery. Heat patterns present with red stools; cold patterns present with white stools. Heat damaging the blood level results in bloody dysentery; cold damaging the qi level results in white mucous dysentery. In the early stage, aggressive purging is inappropriate; Gegen Zhili San (Kudzu Root Dysentery Powder) should be used to resolve the exterior. If residual pathogens remain, causing tenesmus (urgent desire to defecate with a feeling of incomplete evacuation), Zhili Qifang (Miraculous Formula for Dysentery) should be used to clear the heat. If there is abdominal distension and pain with hard accumulations, Puhuang Wan (Cortex Magnoliae and Rhizoma Rhei Pill) should be used to purge. For chronic cases involving Spleen deficiency, Wuli Yigong San (Five Ingredients Extraordinary Efficacy Powder) added with Baishao (White Peony Root), Huanglian (Rhizoma Coptidis), and Muxiang (Radix Aucklandiae) should be used for clearing and tonifying. For Qi deficiency with sinking, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) should be used to lift. If turbid pathogens block the Stomach, causing vomiting and inability to eat, Kaijin San (Formula to Open the Jaw) should be used to open the stomach. This is a fixed method of treatment.
Malaria is milder than dysentery. Cold pathogens enter the interior, where Yin and Yang contend. Initially, alternating chills and fever occur; Xiangsu San is used to expel the pathogen, followed by Xiaochaihu Tang (Minor Bupleurum Decoction) to harmonize. After three or four attacks, Zhinie Dan (Antimalarial Pill) added with Baokouren (Cardamom Seed) and Vinegar-fried Biejia (Carapax Trionycis) is used to intercept the malaria. Chronic malaria with primordial deficiency is treated with Liujunzi Tang (Six Gentlemen Decoction) added with Chaihu (Bupleuri Radix) to tonify. For sinking of Middle Qi, Buzhong Yiqi Tang is used to raise it. This is easy to treat.
Regarding swelling: if the eyelids and feet swell first, it is edema (Shui). If the abdomen enlarges first followed by limb swelling, it is鼓胀 (Drum Distension). Drum distension is treated with Hezhong Wan (Harmonizing Middle Pill); deficiency patterns are treated with Baizhu Wan (Atractylodes Macrocephala Pill). In edema, if limbs swell but the abdomen does not, the pathogen is at the Exterior; if the abdomen also swells, the pathogen is at the Interior. Swelling above the waist indicates pathogen at the Exterior, requiring sweating; Wupi Yin (Five-Bark Decoction) added with Ziye (Perilla Leaf), Suqiong (Notopterygii Rhizoma et Radix - note: text says 素艽 likely referring to Qin Jiao or similar), Fangfeng (Saposhnikoviae Radix), and Jingjie (Schizonepetae Spica) is used. Swelling below the waist indicates pathogen at the Interior, requiring promoting urination; Wupi Yin added with Chixiaodou (Adzuki Bean), Chiling (Poria with Red Mycelium), Zexie (Alisma Rhizome), Cheqian (Plantaginis Semen), Bibi (Dioscoreae Hypoglaucae Rhizoma), and Fangji (Stephaniae Tetrandrae Radix) is used. If accompanied by irritability, thirst, and constipation, it is Yang Water (Heat pattern); Wupi Yin added with Lianqiao (Forsythiae Fructus), Huangbai (Phellodendri Cortex), and Huangqin (Scutellariae Radix) is used. Without irritability or thirst, it is Yin Water (Cold pattern); Wupi Yin added with Fuzi (Aconiti Lateralis Radix Praeparata), Ganjiang (Zingiberis Rhizoma), and Rougui (Cinnamomi Cortex) is used. Swelling followed by asthma, or swelling without asthma, indicates water accumulation in the Stomach Meridian; Wupi Yin is modified accordingly. Asthma preceding swelling indicates water accumulation in the Kidney Meridian; Jin Gui Shenqi Wan (Golden Cabinet Kidney Qi Pill) is used. This condition is the most difficult to cure; caution must be exercised to avoid misdiagnosis.
Furthermore, after stroke, if heat damages the meridians, rendering the legs unable to support the body, with leg swelling and pain, this is Maiwei (Meridian Flaccidity). It is treated with herbs such as Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Qin (Scutellariae Radix), Lian (Coptidis Rhizoma), Dong (Ophiopogonis Tuber), Hu (Dendrobii Caulis), Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Yiren (Coicis Semen), Niuxi (Achyranthis Bidentatae Radix), Jisheng (Taxilli Herba), Bibi (Dioscoreae Hypoglaucae Rhizoma), and Danshen (Salviae Miltiorrhizae Radix). Additionally, swelling and pain in the feet known as Hongkongjiao (Beriberi/Foot Rot) is caused by prevailing wind-dampness. It is treated with herbs such as Binglang (Arecae Semen), Fangji (Stephaniae Tetrandrae Radix), Qin Jiao (Gentianae Macrophyllae Radix), Tianma (Gastrodiae Rhizoma), Duhuo (Angelicae Pubescentis Radix), Niuxi (Achyranthis Bidentatae Radix), Sangzhi (Mori Ramulus), and Mugua (Chaenomelis Fructus).