西医谓∶人以疟死者,其肝体每大于常人二三倍,故病疟者,摸试肝大,即不治矣。夫
肝大
者,寒湿盛而血瘀之故也。寒湿内盛,又以逐日之忽寒忽热,血行一驶一澄,度数失常,遂
致瘀结矣。西医以为此即中医所谓疟母,其实非也。疟母不得为死证,且其部位,多在两乳
开下,与肝位甚远。窃以为肝大者,其外必有腰胁胀痛,不能转侧之证。仲景曰∶肝中风者
,头目 ,两胁痛,行常伛,令人嗜甘,如阻妇状。又曰∶肝水者,其腹大,不能自转侧,
胁下腹痛,时时津液微生,小便续通。盖肝之体,后近于脊,下藏于季胁,一经胀大,便僵
痛不能俯仰转侧矣,甚则腰不能伸而行伛矣;其败也,上下气绝,下为大便滑泄,注液五色
,小便脓血膏脂,时时欲起,烦躁不宁,少腹拘急不仁,两肋骨如殴伤,胁内胀极,欲人重
按其上,膝胫时时转筋,神昏谵语,呕哕不纳水谷,目直欲脱,不能见人,唇鼻青惨,或面
色紫浊,脉象牢坚,硬如铁箸,如此者,预之短期矣。所谓摸试者,揣其季胁空软之处,其
内坚硬胀急,即是也。吾得此义,凡治疟疾,必问其未发之先,与既止之后,腰胁胀痛不转
,是肝体已大矣;若正发之时,腰胁胀痛,疟止即愈者,是血尚未坏,即预加行血药于剂中
以疏之,往往默收奇效。时人不知用药之义,有指为怪僻支离者。
Western medicine posits that individuals who die from malaria often have livers two to three times larger than normal; thus, if a malaria patient presents with an enlarged liver upon palpation, the condition is deemed incurable. The enlargement of the liver is caused by the prevalence of cold-dampness leading to blood stasis. When cold-dampness abounds internally, combined with the daily alternation of chills and fever, blood circulation becomes erratic—alternating between rapid flow and stagnation—with its rhythm disrupted, thereby resulting in the accumulation of stasis. Western medicine considers this to be what Traditional Chinese Medicine (TCM) calls "malaria mother" (a mass associated with chronic malaria), but this is incorrect. "Malaria mother" is not necessarily a fatal syndrome, and its location is mostly below the mammary region, far from the actual anatomical position of the liver. I believe that patients with liver enlargement must exhibit external symptoms such as distending pain in the waist and hypochondrium, and an inability to turn or move their bodies. Zhang Zhongjing stated: In cases where wind-pathogen invades the Liver channel, there is dizziness and visual disturbance, pain in both hypochondriac regions, a stooped gait, a craving for sweet flavors, and a posture resembling pregnancy. He also stated: In Liver Water disease (fluid retention in the Liver), the abdomen is distended, the patient cannot turn over independently, there is pain in the hypochondrium and abdomen, slight generation of fluids occurs occasionally, and urination is intermittent. This is because the physical body of the Liver lies posteriorly near the spine and inferiorly within the costal margin; once it swells, it becomes stiff and painful, preventing flexion, extension, and rotation. In severe cases, the waist cannot straighten, leading to a stooped walk; when the Liver fails, Qi connection between upper and lower parts is severed, resulting in lower-body symptoms such as fecal incontinence, passage of five-colored fluids, pus, blood, and fatty substances in urine, frequent urges to rise accompanied by restlessness, spasticity and insensitivity in the lower abdomen, bilateral ribs feeling as if beaten, extreme distension in the hypochondrium relieved by firm pressure, spasms in the knees and shins, coma with delirious speech, vomiting and hiccups preventing food and water intake, eyes staring fixedly as if protruding, aversion to seeing people, cyanosis of lips and nose, or purple-turbid complexion, and a deep, firm pulse hard like an iron chopstick. Such conditions indicate a short life expectancy. The so-called "palpation test" refers to examining the hollow area of the costal margin; if the interior feels hard and tense, it indicates liver enlargement. Having grasped this principle, whenever treating malaria, I always inquire whether the patient experiences distending pain in the waist and hypochondrium with restricted movement before the onset or after the cessation of the attack; if so, the liver substance is already enlarged. If, during the active phase, there is hypochondriac pain that resolves immediately upon the cessation of malaria, it indicates that the blood has not yet deteriorated. In such cases, I preemptively add blood-invigorating herbs to the prescription to promote circulation, often achieving remarkable effects silently. People of the time, unaware of the rationale behind medication, sometimes criticize this approach as eccentric, fragmented, or unsound.