凡疫邪留于气分,解以战汗;留于血分,解以发斑。气属阳而轻清,血属阴而重
浊。是以邪在气分则易疏透,邪在血分恒多胶滞,故阳主速而阴主迟,所以从战汗者,可使
顿解;从发斑者,当图渐愈。
疫邪先传表后传里,忽得战汗,经气输泄,当即脉静身凉,烦渴顿除。三五日后
,阳气渐积,不待饮食劳碌,或有反复者,盖表邪已解,里邪未去,才觉发热,下之即解。
疫邪表里分传,里气壅闭,非汗下不可。汗下之未尽,日后复热,当复下复汗。温疫下后,
烦渴减,腹满去,或思食而知味,里气和也。身热未除,脉近浮,此邪气拂郁于经,表未
解也,当得汗解。如未得汗,以柴胡清燥汤和之,复不得汗者,从渐解也,不可苛求其汗。
应下失下,气消血耗,既下欲作战汗,但战而不汗者危。以中气亏微,但能降陷,不能升发
也。次日当期复战,厥回汗出者生,厥不回,汗不出者死。以正气脱,不胜其邪也。战而厥
回无汗者,真阳尚在,表气枯涸也,可使渐愈。凡战而不复,忽痉者必死。痉者身如尸,牙
关紧,目上视。凡战不可扰动,但可温覆,扰动则战而中止,次日当期复战。战汗后复下,
后越二三日反腹痛不止者,欲作滞下也,无论已见积未见积,宜芍药汤。
芍药汤
白芍(一钱) 当归(一钱) 槟榔(二钱) 浓朴(一钱) 甘草(七分)
水姜煎服。里急后重,加大黄三钱;红积,倍芍药;白积,倍槟榔。
凡是疫邪停留在气分,通过战汗来解除;停留在血分,通过发斑来解除。气属于阳,性质轻清;血属于阴,性质重浊。因此,邪气在气分则容易疏泄透达,邪气在血分则往往胶着停滞。所以阳气主快速而阴气主迟缓,因此从战汗途径解除的,可以使病证立刻痊愈;从发斑途径解除的,应当谋求逐渐康复。
疫邪先传入体表,后传入体内,忽然出现战汗,经气得以输注宣泄,此时脉搏应该平静、身体凉爽,烦闷口渴立刻消除。三五天后,阳气逐渐积聚,不需要饮食劳累,病情可能有反复,这是因为表邪已经解除,里邪尚未去除,才刚觉得发热,使用下法即可解除。疫邪在表里同时传变,里气壅塞闭阻,非用汗法和下法不可。汗法和下法没有彻底清除病邪,日后再次发热,应当再次使用下法和汗法。温疫使用下法后,烦渴减轻,腹满消失,或者想吃东西且能尝出味道,说明里气调和了。如果身体发热仍未消除,脉象接近浮脉,这是邪气郁滞于经脉,表证未解,应当通过出汗来解除。如果没有出汗,用柴胡清燥汤(Chaihu Qingzao Tang)调和它,再不出汗的,是逐渐解除,不可强求出汗。应当使用下法却延误了下法,导致正气消损、血液耗伤,既已使用下法想要产生战汗,但只颤抖而不出汗的情况很危险。因为中气亏虚微弱,只能降陷,不能升发。第二天应当期待再次战汗,四肢回暖、出汗的会生还,四肢不回暖、不出汗的会死亡。因为正气脱失,无法抵御邪气。战汗后四肢回暖但没有出汗的,是真阳尚存,只是表气枯涸,可以使病情逐渐好转。凡是战汗后不再发作,突然发生痉病(Jingbing, convulsions/stiffness)的一定要死亡。痉病的表现是身体像尸体一样僵硬,牙关紧闭,眼睛向上翻。凡是战汗时不可扰动病人,只可给予温暖覆盖,扰动则战汗会中止,第二天应当期待再次战汗。战汗后又使用下法,之后过了两三天反而腹痛不止的,是想形成滞下(Zhixia, dysentery),无论是否已经见到脓血或尚未见到,适宜用芍药汤(Shaoyao Tang)。
芍药汤(Shaoyao Tang)
白芍(Bai Shao, White Peony Root)一钱
当归(Dang Gui, Angelica Sinensis)一钱
槟榔(Bing Lang, Areca Seed)二钱
浓朴(Nong Po, Magnolia Bark)一钱
甘草(Gan Cao, Licorice Root)七分
用水和生姜煎服。如果有里急后重(Li Ji Hou Zhong, tenesmus),加大黄(Da Huang, Rhubarb)三钱;如果是红积(红色脓血便),加倍白芍用量;如果是白积(白色黏液便),加倍槟榔用量。
When epidemic pathogens remain in the Qi level (Qi Fen), resolution occurs through chills and sweating (Zhan Han); when they remain in the Blood level (Xue Fen), resolution occurs through macules (Fa Ban). Qi belongs to Yang and is light and clear; Blood belongs to Yin and is heavy and turbid. Therefore, when pathogens are in the Qi level, they are easily dispersed and vented; when in the Blood level, they tend to be sticky and stagnant. Thus, Yang governs speed while Yin governs slowness. Consequently, those resolving via chills and sweating can experience immediate cure; those resolving via macules should seek gradual recovery.
Epidemic pathogens first transmit to the exterior and then to the interior. If chills and sweating occur suddenly, the meridional Qi is transported and excreted, resulting immediately in a calm pulse and cool body, with sudden relief of irritability and thirst. After three to five days, as Yang Qi gradually accumulates, recurrence may occur even without dietary indiscretion or overexertion. This is because the exterior pathogens have been resolved but the interior pathogens remain; once fever is felt again, purgation will resolve it. When epidemic pathogens transmit simultaneously to the exterior and interior, causing interior Qi stagnation and closure, neither diaphoresis nor purgation alone is sufficient; both are required. If diaphoresis and purgation do not fully eliminate the pathogens, fever may recur later, requiring repeated application of purgation and diaphoresis. After purgation for warm plague, if irritability and thirst decrease, abdominal fullness disappears, or appetite returns with the ability to taste, this indicates harmonization of the interior Qi. If body heat persists and the pulse approaches floating, this indicates pathogenic factors are constrained within the meridians and the exterior is not yet resolved; diaphoresis is indicated. If sweating does not occur, administer Chaihu Qingzao Tang (Bupleurum Decoction for Clearing Dryness) to harmonize. If sweating still does not occur, resolution will be gradual; do not insist on inducing sweating. Failure to purge when indicated leads to depletion of Qi and exhaustion of Blood. If purgation has been administered and chills and sweating are desired, but only chills occur without sweating, the condition is critical. This is due to deficiency and weakness of Middle Qi, which can descend but cannot ascend and emerge. On the next day, another episode of chills and sweating is expected; if cold extremities reverse and sweating occurs, life is preserved; if extremities remain cold and no sweating occurs, death ensues due to collapse of Righteous Qi unable to overcome the pathogens. If chills occur, extremities warm, but no sweating occurs, True Yang remains, but Exterior Qi is withered and dry; gradual recovery is possible. If chills cease and convulsions (Jing Bing) suddenly appear, death is certain. Convulsions manifest as a corpse-like stiff body, locked jaw, and upward staring eyes. During chills and sweating, disturbance must be avoided; only warm covering is permitted. Disturbance will interrupt the process, requiring expectation of chills and sweating again the next day. If purgation is applied after chills and sweating, and abdominal pain persists unremittingly two or three days later, it suggests impending dysentery (Zhi Xia). Regardless of whether bloody stools or mucous stools are present, Shaoyao Tang (Peony Decoction) is appropriate.
Shaoyao Tang (Peony Decoction):
Bai Shao (Paeoniae Radix Alba, White Peony Root) 1 qian
Dang Gui (Angelicae Sinensis Radix, Dong Quai) 1 qian
Bing Lang (Arecae Semen, Areca Nut) 2 qian
Nong Po (Magnoliae Officinalis Cortex, Magnolia Bark) 1 qian
Gan Cao (Glycyrrhizae Radix et Rhizoma, Licorice Root) 0.7 qian
Decoct with water and fresh ginger. For tenesmus (Li Ji Hou Zhong), add Da Huang (Rhei Radix et Rhizoma, Rhubarb) 3 qian. For red dysentery (bloody stools), double the dosage of Bai Shao. For white dysentery (mucous stools), double the dosage of Bing Lang.