吐蛔,此胃热也,必非脏寒。乌梅丸、理中汤万不可用,但用调胃承气,蛔自愈。
蓄血。疫久失下,血为热搏,败为紫黑,溢于肠胃,漱水不咽,小便利,大便
黑,是其候也。宜桃仁承气汤∶大黄、芒硝、桃仁、当归、芍药、丹皮。服此药热
除为愈。若余热尚存者,宜犀角地黄汤∶地黄(五钱,捣烂加水绞汁,其渣入锅煎)、白芍(一钱半)、
丹皮(一钱)、犀角(一钱)、同地黄汁服。
发黄。疫邪传里,移热下焦,小便不利,邪无输泄,经气郁滞而发黄,身目如
金,宜茵陈汤∶菌陈(一钱)、山栀(二钱)、大黄(五钱)、姜煎服。
循衣摸床,撮空理线,筋惕肉 ,肢体振战,目睛不了了,皆为耽搁失下,或
用缓药 迟之故,此元神将脱也。补之则毒甚,攻之则气已虚,危证也。不得已,
勉用黄龙汤∶大黄、浓朴、枳实、芒硝、人参、地黄、当归。或用人参养荣汤亦可,
但虚候少退即宜屏去,勿久用也。
服药不受,额汗,肢冷振战,心烦,坐卧不安,此中气亏,不能胜药也,名药
烦。急投姜汤立已,或药中多加生姜煎服,则无此状矣。更宜均药为两三次服,以防呕吐。
服承气汤全不行,或次日方行,或半日仍吐原药,此因中气亏不能运药也,大
凶之兆,宜加生姜、人参,以助胃气。然有病重剂轻,亦致不行,不在此例。
思冷冻饮料,热渴甚也。勿论四时,宜量与之。若尽意饮,则水停心下矣。
虚烦,坐卧不安,手足不定,六脉不显,尺脉不至,此元气不能主持,法当大补。
神虚谵语。未下之前谵语,必有内热烦渴之证,此为实病,宜下。既下之后,
数日内谵语不止,此元神未复也,急宜清燥养荣汤。
协热下利,泄泻稀粪,色必赤黄,或焦黄,此胃不留邪也。一二日利止热退为
病愈,利不止者宜小承下之,而利自止。若利止一二日,忽烦渴,又泄,此伏邪又
发也,仍照前治。
大便闭结,内热故也,宜下之,诸病如失。
呃逆有寒有热,以本证参之。热则白虎、承气,寒则四逆汤。
热结旁流。先便闭后纯利清水,全无粪,此粪结于内也,宜承气汤下结粪而利
自止。若服药后,结粪不下,仍利臭水,邪犹在也,病必不减,再下之。
大肠胶闭,极臭如粘胶,而却不结,此热极也,不下即死。
小便赤色,胃热也,宜调胃承气汤。
小便急数白膏如马遗,膀胱热也,宜猪苓汤∶猪苓(二钱)、泽泻(一钱)、滑石(五分)、甘
草(八分)、木通(一钱)、车前(二钱)。
小腹按之硬痛,小便自调,此蓄血也,桃仁汤∶桃仁(三钱)、丹皮、当归、赤芍、
(各一钱)。阿胶(二钱)、滑石(五分)。
脉厥,神色不败,言动自如,别无怪证,忽六脉如丝,甚至于无,或一手先伏,
此失下气闭故也,宜承气汤缓缓下之,六脉自复,忌生脉散。
吐蛔,这是胃中有热,必定不是脏寒。乌梅丸、理中汤万万不可使用,只需使用调胃承气汤,蛔虫自然就会停止上逆。
蓄血证。瘟疫病程长久且未及时攻下,血液被热邪搏结,腐败变为紫黑色,溢出到肠胃之中,表现为想漱口但不吞咽,小便通畅,大便颜色发黑,这就是其征候。适宜使用桃仁承气汤:大黄、芒硝、桃仁、当归、芍药、丹皮。服用此药后热邪清除即为痊愈。如果余热尚存,适宜使用犀角地黄汤:地黄(五钱,捣烂后加水绞取汁液,药渣放入锅中煎煮)、白芍(一钱半)、丹皮(一钱)、犀角(一钱),与地黄汁混合服用。
发黄。疫邪传入体内,移热于下焦,导致小便不利,邪气没有排泄途径,经气郁滞而发黄,身体和眼睛像金子一样黄,适宜使用茵陈汤:茵陈(一钱)、山栀(二钱)、大黄(五钱),用生姜煎服。
循衣摸床(手指无意识地抓摸衣物边缘)、撮空理线(手在空中虚抓,似在整理线条)、筋惕肉瞤(肌肉跳动)、肢体振战(身体颤抖)、目睛不了了(视物模糊不清),这些都是因为延误了攻下的时机,或者使用了缓和的药物导致病情拖延的缘故,这是元神即将脱失的表现。此时若用补法则毒邪更盛,若用攻法则正气已虚,属于危重证候。不得已的情况下,勉强使用黄龙汤:大黄、浓朴、枳实、芒硝、人参、地黄、当归。或者使用人参养荣汤也可以,但一旦虚弱的征候稍微减退就应当停用,不要长期使用。
服药后无法受纳,额头出汗,四肢冰冷并伴有颤抖,心烦意乱,坐卧不安,这是中气亏损,不能承受药力的表现,称为“药烦”。急需投予姜汤即可立刻缓解,或者在药方中多加生姜煎服,就不会出现这种状况了。更适宜将药物分量均分为两三次服用,以防呕吐。
服用承气汤后完全不通便,或者第二天才通便,或者半天后又吐出原本喝下的药,这是因为中气亏损不能运化药力所致,是大凶的征兆,适宜加入生姜、人参,以辅助胃气。然而也有因病势沉重而药力轻浅,导致药效不行的情况,这不属于上述例子。
想要喝冷冻饮料,是因为热渴非常严重。不论什么季节,都适宜适量给予。如果让其尽情饮用,就会导致水饮停滞在心下。
虚烦,坐卧不安,手足躁动不定,六脉隐伏不显,尺脉摸不到,这是元气不能主持全身的表现,治法应当大补元气。
神虚谵语。在未攻下之前出现的谵语,必然伴有内热烦渴的症状,这属于实证,适宜攻下。在已经攻下之后,数日内谵语仍不止息,这是元神尚未恢复的表现,急需使用清燥养荣汤。
协热下利,泄泻稀粪,颜色必定是赤黄色,或者是焦黄色,这说明胃中没有留滞邪气。一二日后腹泻停止、热退即为病愈;如果腹泻不止,适宜用小承气汤轻微攻下,腹泻自然会停止。如果腹泻停止一两天后,突然感到烦渴,又再次泄泻,这是伏邪再次发作,仍然按照前面的方法治疗。
呃逆有寒证和热证两种,需结合本证进行参详。属热的用白虎汤、承气汤,属寒的用四逆汤。
热结旁流。先是大便闭结,随后只排出清水,完全没有粪便,这是因为粪便结聚在内部所致,适宜用承气汤攻下结粪,腹泻自然停止。如果服药后,结粪仍未排出,仍然排出臭水,说明邪气仍在,病情必然不会减轻,需要再次攻下。
大肠胶闭,排泄物极臭且粘稠如胶状,但并不干结,这是热极的表现,如果不攻下就会死亡。
小便急迫频数,尿液浑浊如白色膏脂,类似马尿,这是膀胱有热,适宜使用猪苓汤:猪苓(二钱)、泽泻(一钱)、滑石(五分)、甘草(八分)、木通(一钱)、车前子(二钱)。
小腹按压时硬痛,小便正常,这是蓄血证,适宜使用桃仁汤:桃仁(三钱)、丹皮、当归、赤芍(各一钱)、阿胶(二钱)、滑石(五分)。
脉厥,神色没有败坏,言语动作自如,没有其他怪异症状,忽然六脉细如丝线,甚至摸不到,或者一只手先出现脉搏伏匿,这是由于延误攻下导致气机闭塞的缘故,适宜用承气汤缓缓攻下,六脉自然恢复,忌用生脉散。
Vomiting roundworms indicates heat in the Stomach, definitely not cold in the Zang organs. Wu Mei Wan (Mume Pill) and Lizhong Tang (Regulate the Middle Decoction) must absolutely not be used; only Tiaowei Chengqi Tang (Harmonize the Stomach and Order the Qi Decoction) should be employed, after which the roundworms will naturally cease their upward movement.
Blood Accumulation. If an epidemic disease persists for a long time without timely purgation, blood is constrained by heat, becomes corrupted and turns purple-black, overflowing into the intestines and stomach. Symptoms include rinsing the mouth with water but not swallowing it, free urination, and black stools. This is the characteristic presentation. Tao Ren Chengqi Tang (Peach Kernel to Order the Qi Decoction) is indicated: Dahuang (Rhubarb Root), Mangxiao (Mirabilite), Taoren (Peach Seed), Danggui (Angelicae Sinensis Radix), Shaoyao (Peony Root), Danpi (Moutan Cortex). After taking this medicine, when the heat is eliminated, the patient recovers. If residual heat remains, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is appropriate: Dihuang (Rehmanniae Radix Preparata, 5 qian, pounded and mixed with water to extract juice, dregs boiled separately), Baishao (White Peony Root, 1.5 qian), Danpi (Moutan Cortex, 1 qian), Xijiao (Rhino Cornu, 1 qian), taken together with the Dihuang juice.
Jaundice. The epidemic pathogen transmits inward, transferring heat to the Lower Jiao. Urination is difficult, so the pathogen has no outlet, causing stagnation of the meridians and resulting in jaundice. The body and eyes appear golden yellow. Yinchin Tang (Artemisiae Scopariae Decoction) is indicated: Yinchin (Artemisiae Scopariae Herba, 1 qian), Shanzhi (Gardeniae Fructus, 2 qian), Dahuang (Rhubarb Root, 5 qian), decocted with fresh ginger.
Clutching at clothes and picking at empty air, grasping at imaginary threads, muscle twitching, limb tremors, and blurred vision are all due to delayed purgation or the use of mild medicines that prolonged the condition. This signifies the impending collapse of the Primordial Spirit. Tonification will exacerbate the toxicity, while purgation will deplete the already deficient Qi; this is a critical condition. As a last resort, Huanglong Tang (Yellow Dragon Decoction) may be tentatively used: Dahuang (Rhubarb Root), Nongpo (Magnolia Bark), Zhishi (Immature Bitter Orange), Mangxiao (Mirabilite), Renshen (Ginseng Root), Dihuang (Rehmanniae Radix Preparata), Danggui (Angelicae Sinensis Radix). Alternatively, Renshen Yangrong Tang (Ginseng to Nourish the Vigor Decoction) can be used, but it should be discontinued as soon as the deficiency signs subside slightly; do not use it for long.
Inability to tolerate medication, sweating on the forehead, cold limbs with tremors, irritability, and restlessness indicate that the Middle Qi is deficient and cannot bear the medicinal force. This is termed "Medication Irritation." Immediately administer Ginger Decoction to resolve it instantly, or add more fresh ginger to the herbal decoction to prevent these symptoms. It is also advisable to divide the dose into two or three administrations to prevent vomiting.
If, after administering Chengqi Tang, there is no bowel movement, or if movement occurs only the next day, or if the original medicine is vomited up within half a day, this is because the deficient Middle Qi cannot transport the medicine. This is a sign of great peril. Add fresh ginger and Renshen (Ginseng Root) to support the Stomach Qi. However, cases where the disease is severe but the dosage is too light, resulting in lack of effect, are not included in this category.
Craving cold drinks indicates severe heat and thirst. Regardless of the season, provide them in moderation. If allowed to drink excessively, water will accumulate under the Heart.
Empty irritability, restlessness, restless hands and feet, invisible six pulses, and absent Chi pulse indicate that the Primordial Qi cannot govern the body. The treatment method should be major tonification.
Spiritual Deficiency with Delirious Speech. Delirium before purgation must be accompanied by internal heat, irritability, and thirst; this is an Excess pattern suitable for purgation. Delirium persisting for several days after purgation indicates that the Primordial Spirit has not yet recovered; Qingzao Yangrong Tang (Clear Dryness and Nourish Vigor Decoction) should be urgently administered.
Collateral Heat with Diarrhea. Loose stools with red-yellow or scorched-yellow color indicate that the Stomach does not retain pathogens. If diarrhea stops and heat subsides within one or two days, the disease is cured. If diarrhea persists, Xiaochengqi Tang (Minor Order the Qi Decoction) should be used mildly to stop the diarrhea. If diarrhea stops for one or two days and then sudden irritability, thirst, and renewed diarrhea occur, this indicates the re-emergence of latent pathogens; treat according to the previous methods.
Constipation is due to internal heat; purgation is indicated, after which all diseases will vanish.
Hiccups can be Cold or Heat patterns; refer to the primary syndrome. For Heat, use Baihu Tang (White Tiger Decoction) or Chengqi Tang; for Cold, use Sini Tang (Frigid Extremities Decoction).
Heat Binding with Peripheral Flow. First constipation, followed by pure watery discharge without feces, indicates fecal impaction inside. Chengqi Tang should be used to purge the impacted feces, after which the diarrhea will stop. If, after medication, the impaction is not expelled and foul-smelling water continues to flow, the pathogen remains, and the disease will not diminish; purge again.
Large Intestine Glue Closure. Excretion is extremely foul and sticky like glue but not dry/hard; this indicates extreme heat. Without purgation, death will ensue.
Red urine indicates Stomach heat; Tiaowei Chengqi Tang (Harmonize the Stomach and Order the Qi Decoction) is indicated.
Urgent and frequent urination with turbid white fluid resembling horse urine indicates Bladder heat; Zhuling Tang (Polyporus Decoction) is indicated: Zhuling (Polyporus, 2 qian), Zexie (Alisma Rhizome, 1 qian), Huashi (Talcum, 0.5 qian), Gancao (Licorice Root, 0.8 qian), Mutong (Akebia Caulis, 1 qian), Cheqian (Plantago Seed, 2 qian).
Hardness and pain upon pressing the lower abdomen, with normal urination, indicates Blood Accumulation. Tao Ren Tang (Peach Kernel Decoction) is indicated: Taoren (Peach Seed, 3 qian), Danpi (Moutan Cortex, 1 qian), Danggui (Angelicae Sinensis Radix, 1 qian), Chishao (Red Peony Root, 1 qian), Ejiao (Donkey-Hide Gelatin, 2 qian), Huashi (Talcum, 0.5 qian).
Pulse Jue. The spirit and complexion are not ruined, speech and movement are normal, with no other strange symptoms, yet suddenly the six pulses become thread-like or imperceptible, or one hand's pulse vanishes first. This is due to Qi closure from delayed purgation. Chengqi Tang should be used gently to purge, after which the pulses will recover. Shengmai San (Generate the Pulse Powder) is contraindicated.