11.里实自然寻浚佑, 里虚实脾四君香, 木瓜附子大腹子, 厚朴草果
炒干姜, 投诸温补俱无验, 欲诸攻下又难当, 须行九补一攻法, 缓求
淡食命多昌.
【注】里实二便涩者, 直用浚川散, 神佑丸. 里虚二便通者, 宜用实
脾饮, 即人参, 白术, 茯苓, 炙草, 木香, 木瓜, 川附子, 大腹子,
厚朴, 草果, 炒干姜也. 肿胀之病属虚寒者, 自宜投诸温补之药, 而
用之俱无效验者, 虚中必有实邪也. 欲投诸攻下之药, 而又难堪, 然
不攻之终无法也, 须行九补一攻之法. 是用补养之药九日, 俟其有可
攻之机, 而一日用泻下之药攻之. 然攻药亦须初起少少与之, 不胜病
,渐加之, 必审其药与元气当, 逐邪而不伤正, 始为法也. 其后或补
七日, 攻一日, 补五日, 攻一日, 补三日, 攻一日, 缓缓求之, 以愈
为度. 若能戒盐酱, 淡食百日, 多有生者.
医宗金鉴 四十二卷
1.夏伤于暑舍营内, 秋感寒风并卫居, 比时或为外邪束, 暑汗无出
病疟疾.
【注】经曰: 痎疟皆生于风. 谓四时病疟, 未有不因风寒外束, 暑邪
内伏者也. 又曰: 疟者, 风寒之气不常也. 此言比时病疟者也. 又曰
:夏伤于暑, 秋为病疟. 又曰: 夏暑汗不出者, 秋成风疟. 谓夏伤于
暑,其邪甚者即病暑, 其邪微者则舍于营, 复感秋气寒风, 与卫并居
,则暑与风寒合邪, 始成疟病也. 其不即病伤寒者, 亦以有暑邪预伏
于营中也. 盖有风无暑, 惟病风, 有暑无风, 惟病暑, 必风暑合邪,
始病疟也.
11. 若体内实邪壅盛,自然应当选用浚川散(峻下逐水方剂)或神佑丸(甘遂、大戟等组成的泻下剂);若体内正气虚弱,则应使用实脾饮(温阳健脾、行气利水的方剂),该方由人参、白术、茯苓、炙甘草、木香、木瓜、川附子、大腹子、厚朴、草果、炒干姜组成。如果投用各种温补药物均无效验,想要使用攻下之法又难以承受,就必须采用“九补一攻”的方法,通过缓慢调理并清淡饮食,生命多能保全。
【注释】所谓“里实”,指大小便涩滞不通的患者,直接应用浚川散、神佑丸。“里虚”指大小便通畅的患者,适宜使用实脾饮,即由人参、白术、茯苓、炙甘草、木香、木瓜、川附子、大腹子、厚朴、草果、炒干姜组成的方剂。肿胀之病属于虚寒性质的,自然适宜投用各种温补药物,但如果使用了都无效验,说明在虚证中必定夹杂有实邪。想要投用攻下药物,但患者身体难以承受,然而如果不攻邪终究没有办法,所以必须实行“九补一攻”的方法。这是指先服用补养药物九天,等待出现可以攻下的时机,然后一天使用泻下药物进行攻逐。然而攻下的药物也必须从少量开始给予,如果患者不能耐受,再逐渐增加剂量,必须仔细审查药物与元气是否相称,做到驱逐邪气而不损伤正气,这才是正确的方法。之后或者补七天攻一天,或者补五天攻一天,或者补三天攻一天,缓缓求治,以痊愈为限度。如果能戒除盐酱,清淡饮食一百天,大多能够存活。
1. 夏季感受暑邪,邪气潜伏于营分(营养之气运行的通道)内部;秋季感受寒风,邪气并与卫分(防御之气运行的通道)同居。此时如果被外邪束缚,暑热不得随汗排出,从而引发疟疾(一种以寒战高热、间歇发作为特征的疾病)。
【注释】《内经》说:“痎疟(泛指各种疟疾)皆生于风。”意思是四季发生的疟疾,没有不是因为风寒外束、暑邪内伏的。又说:“疟疾,是风寒之气不常所致。”这是指当时发生的疟疾。又说:“夏伤于暑,秋为病疟。”又说:“夏天暑热出汗不出的人,秋天会形成风疟。”意思是夏天被暑邪所伤,邪气严重的当即发病称为暑病,邪气轻微的则潜伏在营分,再次感受秋天的寒风,与卫分并居,这样暑邪与风寒合而为邪,才形成疟病。那些没有立即患伤寒病的,也是因为暑邪预先潜伏在营分中。大概只有风邪没有暑邪,只病风病;只有暑邪没有风邪,只病暑病;必须风邪与暑邪结合,才会得疟病。
11. If there is excess pathogenic factor in the interior, one should naturally seek to use Jun Chuan San (Jun Chuan Powder) or Shen You Wan (Shen You Pill). If there is deficiency in the interior, one should use Shi Pi Yin (Realize the Spleen Decoction), which consists of Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Zhigancao (Prepared Licorice Root), Muxiang (Aucklandiae Radix), Mugua (Chaenomelis Fructus), Chuan Fuzi (Aconiti Lateralis Radix Praeparata), Dafuzi (Arecae Semen), Houpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), and Chao Ganjiang (Stir-fried Zingiberis Rhizoma). If various warming and tonifying treatments yield no effect, yet purgative treatments are too harsh for the patient to bear, one must employ the "nine parts tonification, one part attack" method. Seeking recovery slowly and maintaining a bland diet will often preserve life.
[Note] "Interior excess" refers to cases where both stool and urine are obstructed; in such cases, directly apply Jun Chuan San and Shen You Wan. "Interior deficiency" refers to cases where stool and urine are unobstructed; these patients are suitable for Shi Pi Yin, composed of Renshen, Baizhu, Fuling, Zhigancao, Muxiang, Mugua, Chuan Fuzi, Dafuzi, Houpo, Caoguo, and Chao Ganjiang. Edema diseases belonging to deficiency-cold patterns naturally warrant the use of warming and tonifying medicines. However, if these prove ineffective, it indicates that there must be excess pathogenic factors amidst the deficiency. While one wishes to use purgatives, the patient's constitution may not tolerate them; yet without attacking the pathogen, there is no other solution. Therefore, the "nine parts tonification, one part attack" method must be employed. This involves administering tonifying medicines for nine days, waiting for an opportunity to purge, and then using laxatives for one day to attack the pathogen. However, purgative medicines should initially be given in small doses; if the patient cannot tolerate them, the dose should be gradually increased. One must carefully examine whether the medicine matches the patient's Yuan Qi (Original Qi), ensuring that the pathogen is expelled without damaging the healthy qi; this constitutes the correct method. Subsequently, one might tonify for seven days and attack for one day, or tonify for five days and attack for one day, or tonify for three days and attack for one day, seeking recovery gradually until痊愈 (cure) is achieved. If one can abstain from salt and soy sauce and maintain a bland diet for one hundred days, many patients will survive.
1. In summer, injury by Shu heat (Summerheat) causes the pathogen to reside within the Ying (Nutritive) level; in autumn, exposure to cold wind allows the pathogen to dwell with the Wei (Defensive) level. At this time, if bound by external pathogens, Shu sweat cannot exit, leading to the disease known as Nue (Malaria).
[Note] The Classics state: "All types of Nue arise from Wind." This means that malaria occurring in any season invariably results from external constriction by Wind-Cold and internal retention of Shu heat. It is also said: "Nue is caused by the irregularity of Wind-Cold qi." This refers to malaria contracted at the specific time. Furthermore: "Injury by Shu in summer leads to Nue in autumn." And: "Those who do not sweat out Shu in summer develop Wind-Nue in autumn." This implies that when injured by Shu in summer, those with severe pathogens fall ill immediately with Shu disease, while those with mild pathogens lodge within the Ying level. Upon re-exposure to autumn cold wind, which resides with the Wei level, the Shu and Wind-Cold combine to form the pathogenic factor, resulting in Nue disease. Those who do not immediately contract Shanghan (Cold Damage) do so because Shu pathogen was previously latent in the Ying level. Generally, with only Wind and no Shu, only Wind disease occurs; with only Shu and no Wind, only Shu disease occurs. Only when Wind and Shu combine does Nue disease manifest.