时疫周身红肿,风热溢于皮肤也。用羌、独、升、柴、葛、芷疏其皮肤之毛窍,石膏、黄芩、栀子、连
翘清其肌肉之热,赤芍、归尾、红花、生地活其毒热之瘀。兼里证与头肿诸条参治。
以上头肿诸条,列之表证者,以初起言也。若见于病后,曾经汗、下者,为余邪不尽,治法则小异。大约见于
初起,表邪盛实,用表散之药为主,清里之药为辅;见于病后,里邪留溢,用清里之药为主,表散之药为辅。以此
为权衡。思过半矣。
时疫发黄有四∶一宿食,二蓄水,三蓄血,四郁热。当疫证初转在表时,胸膈痞闷,目珠黄,面鼻正中黄,
宿食壅于胃脘也,于表药中加山楂、神曲、麦芽、莱菔子。传里时,小便不利,腹满而响,面、目、身俱黄,蓄
水也,四苓散加栀子、茵陈。胸腹有软痛处,小便自利,大便黑而发黄者,蓄血也,桃仁承气汤。热在下焦,大小
便俱不利而发黄者,郁热也,茵陈蒿汤。
凡发黄必以二便为辨。二便调,属上焦;小便不利属水;小便自利而大便黑润属血;大小便俱不利属热郁,乃
胃热移于膀胱,不必利其小便,但当通其大便,是以茵陈汤有专功也。
发黄当辨其色。上焦宿食发黄,只在面目,不及周身;蓄水发黄,周于身,兼微黑而黯淡,瘀血发黄亦
兼微黑而润泽;郁热发黄兼赤而鲜明。此即以黄辨黄之法也。
时疫导致周身红肿,是风热之邪溢于皮肤所致。治疗应使用羌活、独活、升麻、柴胡、葛根、白芷疏泄皮肤毛孔的闭塞,用石膏、黄芩、栀子、连翘清除肌肉层面的热邪,用赤芍、当归尾、红花、生地黄活血以化解毒热造成的瘀滞。若兼有里证,可参考头肿等相关条文进行综合治疗。
以上关于头肿的各条论述,之所以列在表证部分,是从疾病初起阶段而言的。如果这些症状出现在病后,且已经经过发汗或攻下治疗,则属于余邪未尽,治疗方法会有所不同。大致而言,若见于疾病初起,属表邪盛实,应以发散表邪的药物为主,清解里热的药物为辅;若见于病后,属里邪留滞溢出,应以清解里热的药物为主,发散表邪的药物为辅。以此作为权衡治疗的准则,思考便已过半了。
时疫出现发黄症状有四种情况:一是宿食停滞,二是蓄水停聚,三是蓄血瘀阻,四是郁热内蕴。当疫病证候初起尚在表时,若见胸膈痞闷,眼珠发黄,面鼻正中发黄,这是宿食壅塞于胃脘所致,应在解表药中加入山楂、神曲、麦芽、莱菔子。若病邪传里,出现小便不利,腹部胀满且肠鸣,面部、眼睛、全身均发黄,这是蓄水所致,可用四苓散加入栀子、茵陈。若胸腹部有柔软且按压疼痛之处,小便自利,大便色黑而身发黄,这是蓄血所致,可用桃仁承气汤。若热邪在下焦,大小便均不通利而发黄,这是郁热所致,可用茵陈蒿汤。
凡是出现发黄,必须通过二便(大、小便)来进行辨别。二便通畅,病位属上焦;小便不利,属水湿停聚;小便自利而大便黑润,属血瘀;大小便均不通利,属热邪郁结,这是胃热转移至膀胱,不需要专门通利小便,只应当通导大便,因此茵陈汤对此有专长功效。
发黄应当辨别其色泽。上焦宿食导致的发黄,仅局限于面目,不波及全身;蓄水导致的发黄,遍布全身,兼见微黑且色泽黯淡;瘀血导致的发黄也兼见微黑但色泽润泽;郁热导致的发黄兼见红色且色泽鲜明。这就是通过黄色特征来辨别发黄类型的方法。
In epidemic febrile diseases, generalized redness and swelling of the body are caused by wind-heat overflowing into the skin. Treatment should employ Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), and Baizhi (Angelicae Dahuricae Radix) to vent the hair follicles of the skin; Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Lianqiao (Forsythiae Fructus) to clear heat in the muscles; and Chishao (Paeoniae Radix Rubra), Guiwei (Radix Angelicae Sinensis Cauda), Honghua (Carthami Flos), and Shengdi Huang (Rehmanniae Radix Preparata) to invigorate blood and resolve stasis caused by toxic heat. If interior syndromes are concurrent, refer to the sections on head swelling for comprehensive treatment.
The aforementioned discussions on head swelling are listed under exterior syndromes because they describe the initial stage of the disease. If these symptoms appear after the illness has progressed and sweating or purging therapies have been used, it indicates residual pathogens that are not fully cleared, and the treatment principle differs slightly. Generally, if seen at the onset with excess exterior pathogens, dispersing exterior agents should be primary, while clearing interior heat agents secondary; if seen post-illness with lingering interior pathogens overflowing, clearing interior heat agents should be primary, while dispersing exterior agents secondary. Using this as a criterion for balance allows for more than half of the understanding to be grasped.
There are four types of jaundice in epidemic febrile diseases: one is retained food, two is water retention, three is blood stasis, and four is constrained heat. When the epidemic syndrome initially remains in the exterior, if chest and diaphragm oppression, yellowing of the eyeballs, and yellowing of the center of the face and nose occur, this is due to retained food obstructing the stomach region. Add Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), and Laifuzi (Raphani Semen) to the exterior-dispersing formula. When the pathogen transmits to the interior, presenting with difficulty in urination, abdominal fullness with borborygmus, and yellowing of the face, eyes, and entire body, this is water retention. Use Siling San (Four-Poria Powder) added with Zhizi (Gardeniae Fructus) and Yinchen (Artemisiae Scopariae Herba). If there are soft, tender areas in the chest and abdomen, free urination, and black stool accompanied by yellowing of the body, this is blood stasis. Use Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi). If heat is in the lower jiao, with both urination and defecation difficult and yellowing present, this is constrained heat. Use Yinyin Hao Tang (Artemisiae Scopariae and Gardeniae Decoction).
Jaundice must always be differentiated by the state of the bowels and urine. If both are regulated, the pathology belongs to the upper jiao; difficulty in urination indicates water; free urination with black, moist stool indicates blood; difficulty in both urination and defecation indicates heat constraint, which is stomach heat transferring to the bladder. It is unnecessary to specifically promote urination; rather, one should unblock the bowels. Therefore, Yinyin Tang (Artemisiae Scopariae Decoction) has specific efficacy.
Jaundice should also be differentiated by its color. Jaundice from upper jiao retained food appears only on the face and eyes, not spreading to the whole body; jaundice from water retention covers the whole body and is slightly dark and dull; jaundice from blood stasis is also slightly dark but lustrous; jaundice from constrained heat is reddish and bright. This is the method of distinguishing jaundice by its hue.