仲景鳖甲煎丸治疟不瘥结为 瘕名曰疟母(方见金匮)
严氏鳖甲饮子治疟久不愈腹中结块名曰疟母
鳖甲(醋炙) 白术 黄 草果 槟榔 芎 橘红 白芍 甘草(炙) 浓朴(等分)
上咀生姜七片枣一枚乌梅少许煎
按 疟多成癖于左胁之下名曰疟母乃肝之积也疟属少阳病少阳东方之气故同归于肝又况
久疟病在血分血亦属肝所主也当以鳖甲君佐使之药随证虚实用之不必泥此也
三因红丸子专治食疟
蓬术 三棱(各二两醋煮一伏时) 胡椒(一两) 青皮(三两炒) 阿魏(一分醋化)
上为末别研苍术末用阿魏醋米糊为丸桐子大炒土朱为衣每服五十至百丸
按此出厥阴南星半夏例消积滞通郁气之温药也食疟既因饮食而得亦当随其所伤而治之
子和常山散吐疟
常山(二两水煮晒干)
上水煎空心服
机要梨芦散 雄黄散(方并见吐剂)
按疟因外感病属上焦又胸膈多结聚痰涎故用吐法以取效然常山砒霜之类发吐取涎纵使获
安脾胃不能不损能用无毒之药以取效者为佳
宝鉴温脾散治疟疾寒热发歇多时不瘥
紫河车 绿豆(各一两) 甘草(半两) 生砒(一两半另研子和作钱半)
上为末与砒一处研匀每服半钱新汲水少许调下须于发日隔夜夜深服药忌荤酒瓜果生冷鱼
腥肉
物三日孕妇勿服但至心合此药与人并不吐此虽有砒一味河车甘草绿豆三味性凉解得新水亦解
得
一剪金治疟疾乃是圣药也
信豆硫黄各等分
上作一处乳钵内杵为末用绯绢子捻药一捻在绢上裹如豆大细丝牢缠
定讫剪切每服一丸星宿全用新汲水送下空心服
毋令人知或先一日夜服之唇砂丹治疟
朱砂(一两五钱入药中留五钱为衣) 信 雄黄(各五钱另研)
上为末入白面六钱研匀滴水丸如绿豆大朱砂为衣星宿全时用无根水吞下
宣明辟邪丹治岚瘴鬼疟食疟
绿豆 雄黑豆(各四十九个) 信砒(半钱另研) 朱砂(二粒) 黄丹(一钱为衣)
上为末同入乳钵内滴水为丸分作三十粒每服一粒用东南桃心取七枝研汁将井花水于发日
早辰日欲出未出向日吞之醋汤亦得
三因红散子
黄丹(炒色变)
上入建茶合和二钱七白汤调下或温酒调下一方用蒜不以多少杵黄丹丸鸡头大每服一丸临
晨面东新水下
按疟丹多用砒霜大毒之药本草主诸疟风痰在胸膈可作吐药盖以其性之至燥大能燥痰也黄
丹本
草能主惊痫癫疾除热下气亦是胜痰去积之药大抵疟丹虽有燥痰之功大伤胃气脾胃虚者切宜戒
之
谨按治疟之方风暑外伤者解表之药机要详矣 疟之治宜从丹溪所论陈无择论湿疟有术附
汤此
不详载又机要有中三阴经之论而治法用药虽有 疟入血之一方然亦失于详悉严氏谓疟生于痰
三因疫疟食疟瘴疟七情感动等疟而诸方未有可取况亦多所缺略窃观其意盖以脾湿燥热之方可
以兼治诸疟故不详述此缺略之所由也学人知其名识其意苟能思之则可得而施治矣又何必待其
详也哉
张仲景的鳖甲煎丸治疗疟疾久治不愈,气血凝结形成痞块,称为“疟母”(方剂见《金匮要略》)。
严用和的鳖甲饮子治疗疟疾日久不愈,腹部出现结块,也称为“疟母”。
药物组成:鳖甲(醋炙)、白术、黄芩、草果、槟榔、川芎、橘红、白芍、甘草(炙)、浓朴(以上各等分)。
用法:将上述药材切碎,加入生姜七片、大枣一枚、乌梅少许,煎汤服用。
按语:疟疾多形成癖块在左胁之下,称为“疟母”,这是肝脏的积病。疟疾属于少阳病(少阳经病变),少阳对应东方木气,故与肝同归一类;况且久病疟疾病位在血分,血亦由肝所主。应当以鳖甲为君药,配合佐使药物,根据证候的虚实灵活使用,不必拘泥于这一固定方剂。
《三因极一病证方论》中的红丸子专门治疗食疟(因饮食停滞引起的疟疾)。
药物组成:蓬莪术、三棱(各二两,用醋煮一个时辰)、胡椒(一两)、青皮(三两,炒制)、阿魏(一分,用醋化开)。
用法:将上述药物研成细末,另外单独研磨苍术末,用阿魏醋和米糊作为粘合剂制成梧桐子大小的丸剂,外裹炒过的土朱色粉末。每次服用五十至一百丸。
按语:此方出自《局方》,遵循厥阴病用南星、半夏的例子,属于消除积滞、疏通郁气的温性药物。食疟既然因为饮食不当而得病,也应当根据所伤之物进行针对性治疗。
张子和的常山散用于催吐治疗疟疾。
药物组成:常山(二两,用水煮后晒干)。
用法:用水煎煮,空腹服用。
按语:疟疾因外感邪气致病,病位属上焦,且胸膈部位多有痰涎结聚,因此使用吐法以求疗效。然而像常山、砒霜这类药物引发呕吐以祛除痰涎,即使获得安宁,也会损伤脾胃。若能使用无毒的药物达到同样效果,则为更佳选择。
《卫生宝鉴》中的温脾散治疗疟疾寒热交替发作,持续时间较长且久治不愈。
药物组成:紫河车、绿豆(各一两)、甘草(半两)、生砒(一两半,另研细粉,张子和建议用量为钱半)。
用法:将除生砒外的药物研成细末,与生砒混合研匀。每次服用半钱,用少量新汲水调服。必须在发病前一天的深夜服药。忌食荤腥、酒、瓜果、生冷及鱼腥肉类食物三日。孕妇禁止服用。只要心诚符合此药的使用条件,与人服用并不引起呕吐。虽然含有砒霜一味毒药,但紫河车、甘草、绿豆三味药性凉,能解砒毒,新汲水也能解毒。
《一剪金》治疗疟疾,堪称圣药。
药物组成:信石、硫黄各等分。
用法:在一处乳钵内捣碎研成细末,用红色丝绢包裹药捻,如豆大小,用细丝牢固缠绕固定,然后剪切。每次服用一丸,需星宿齐全之时,用新汲水送服,空腹服用。不要让人知道。或者提前一天夜间服用。
唇砂丹治疗疟疾。
药物组成:朱砂(一两五钱,入药中留五钱作为包衣)、信石、雄黄(各五钱,另研细粉)。
用法:将上述药物研成细末,加入白面六钱,研匀,滴水泛丸如绿豆大小,用朱砂为衣。需在星宿齐全之时,用无根水吞服。
《宣明论方》中的辟邪丹治疗岚瘴、鬼疟、食疟。
药物组成:绿豆、黑大豆(各四十九个)、信石砒霜(半钱,另研细粉)、朱砂(二粒)、黄丹(一钱,作为包衣)。
用法:将上述药物研成细末,一同放入乳钵内,滴水泛丸,分为三十粒。每次服用一粒,取东南方向的桃心七枝,研磨取汁,在发病日早晨太阳将要出来尚未出来时,面向东方吞服。也可以用醋汤送服。
《三因方》中的红散子。
药物组成:黄丹(炒至颜色改变)。
用法:加入建茶调和,每次二钱七分,用白开水调服,或用温酒调服。另一处方用大蒜不限多少,捣烂黄丹,制成鸡头大小的丸剂。每次服用一丸,临晨面向东方用新水送下。
按语:治疗疟疾的丹药多使用砒霜这种大毒之药。本草记载其主治各种疟疾、风痰在胸膈,可作吐药,大概是因为其性质极度干燥,能强力燥湿化痰。黄丹在本草中能主治惊痫癫疾,清热降气,也是胜痰去积的药物。大抵疟丹虽有燥痰之功,但会严重损伤胃气,脾胃虚弱者务必戒慎。
谨按:治疗疟疾的方剂,对于风暑外感者,解表的方法在《机要》中已详述。疟疾的治疗宜遵从朱丹溪的论述。陈无择论述湿疟有用术附汤,此处未详细记载。另外,《机要》中有针对三阴经的论述,虽然治法用药有治疗疟疾入血的一首方剂,但也失于详尽。严用和认为疟疾生于痰,包括《三因方》中的疫疟、食疟、瘴疟、七情触动等疟疾,而这些方剂中未有可取之处,况且也有许多缺略。我推测其用意可能是认为脾湿、燥热的方剂可以兼治各种疟疾,所以不详加叙述。这就是产生这些缺略的原因。学习者只要知晓其名,理解其意,若能深思,则可获得施治的方法,又何必等待其详尽呢?
Zhang Zhongjing's Biejia Jian Wan (Oyster Shell Pill for Reducing Masses) treats malaria that has not resolved, where qi and blood stagnate to form a mass, known as "Nuomother" (Malaria Mother). (Formula see *Jingui Yaolue*).
Yan Yonghe's Biejia Yin Zi (Oyster Shell Decoction) treats long-standing malaria that does not heal, with masses forming in the abdomen, also called "Nuomother".
Ingredients: Bie Jia (Oyster Shell, prepared with vinegar), Bai Zhu (Atractylodis Rhizoma), Huang Qin (Scutellariae Radix), Cao Guo (Tsaoko Fructus), Bing Lang (Arecae Semen), Xiong Gui (Ligustici Chuanxiong Rhizoma), Ju Hong (Citri Reticulatae Pericarpium), Bai Shao (Paeoniae Radix Alba), Gan Cao (Glycyrrhizae Radix et Rhizoma, prepared), Hou Po (Magnoliae Officinalis Cortex) (all equal parts).
Preparation and Administration: Coarsely crush the above herbs, add seven slices of fresh ginger, one jujube, and a few smoked plums, decoct in water, and take.
Commentary: Malaria often forms癖 (masses) under the left hypochondrium, called "Nuomother", which is an accumulation of the Liver. Malaria belongs to Shaoyang disease (pathology of the Foot-Shaoyang Gallbladder channel); Shaoyang corresponds to the East element, thus returning to the Liver. Moreover, long-standing malaria affects the Blood level, which is also governed by the Liver. Therefore, one should use Bie Jia as the sovereign herb, assisted by minister and courier herbs, adjusting according to the deficiency or excess of the syndrome, without rigidly adhering to this specific formula.
Hong Wan Zi (Red Pill) from *San Yin Fang* specifically treats Shi Nue (Food Stagnation Malaria).
Ingredients: Peng Zhi (Curcumae Rhizoma), San Leng (Sparganii Rhizoma) (each two liang, boiled in vinegar for one shi), Hu Jiao (Piperis Longi Fructus) (one liang), Qing Pi (Citri Reticulatae Pericarpium Viride) (three liang, stir-fried), A Wei (Ferulae Resina) (one fen, dissolved in vinegar).
Preparation and Administration: Grind into fine powder. Separately grind Cang Zhu (Atractylodis Rhizoma) powder. Use A Wei vinegar and rice paste as binders to make pills the size of paulownia seeds. Coat with fried Tu Zhu (Earth Cinnabar). Take 50-100 pills per dose.
Commentary: This formula originates from the Jueyin chapter examples involving Nan Xing (Arisaematis Rhizoma Praeparatum) and Ban Xia (Pinelliae Rhizoma), belonging to warm herbs that eliminate accumulations and unblock stagnant qi. Since Food Stagnation Malaria arises from dietary injury, it should be treated according to the specific cause of injury.
Zhang Hezi's Chang Shan San (Dichroa Powder) induces vomiting to treat malaria.
Ingredients: Chang Shan (Dichroae Radix) (two liang, boiled in water then dried).
Preparation and Administration: Decoct in water, take on an empty stomach.
Also, Li Lu San (Pear and Asarum Powder) and Xiong Huang San (Realgar Powder) from *Jiyao* (see Vomiting Formulas section).
Commentary: Malaria is caused by external pathogens and involves the Upper Jiao; phlegm-saliva often accumulates in the chest and diaphragm. Thus, emesis is used for efficacy. However, herbs like Chang Shan and Pi Shuang (Arsenic) induce vomiting and expel phlegm; although they may bring temporary relief, they damage the Spleen and Stomach. It is better to use non-toxic herbs to achieve efficacy.
Wen Pi San (Warm the Spleen Powder) from *Weisheng Baojian* treats malaria with alternating chills and fever, prolonged intervals, and failure to resolve after a long time.
Ingredients: Zi He Che (Placenta Humana), Lv Dou (Phaseoli Vulgaris Semen) (each one liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (half liang), Sheng Pi (Raw Arsenic) (one and a half liang, separately ground finely; Zhang Hezi suggests using half qian).
Preparation and Administration: Grind the non-arsenic ingredients into powder, mix uniformly with the arsenic. Take half qian per dose, mixed with a small amount of fresh well-water. Must be taken late at night on the eve of the malaria attack. Avoid meat, alcohol, fruits, raw/cold foods, and fish/meat products for three days. Pregnant women must not take this. Even if taken sincerely by others, it will not cause vomiting. Although this formula contains toxic arsenic, the cooling properties of Placenta, Licorice, and Mung Bean, along with fresh water, can mitigate its toxicity.
Yi Jian Jin (One Cut Gold) treats malaria and is considered a sacred medicine.
Ingredients: Xin Shi (Arsenolite), Liu Huang (Sulfur), equal parts.
Preparation and Administration: Pound into powder in a mortar. Wrap a pinch of the powder in red silk cloth, roll into a pill the size of a bean, secure tightly with fine thread, and cut. Take one pill per dose. Use only when stars are auspicious. Swallow with fresh well-water on an empty stomach. Do not let others know. Alternatively, take the night before.
Chun Sha Dan (Cinnabar Lip Pill) treats malaria.
Ingredients: Zhu Sha (Cinnabar) (one liang five qian; reserve five qian for coating), Xin Shi (Arsenolite), Xiong Huang (Realgar) (each five qian, separately ground finely).
Preparation and Administration: Grind into powder, add six qian of white flour, mix well. Make pills the size of mung beans using water drops. Coat with Cinnabar. Swallow with "rootless water" (rainwater/snowmelt) when stars are auspicious.
Pi Xie Dan (Evil-Repelling Pill) from *Xuanming Fang* treats Lan Zhang (Mountain Miasma), Gui Nue (Ghost Malaria), and Shi Nue (Food Stagnation Malaria).
Ingredients: Lv Dou (Phaseoli Vulgaris Semen), Hei Da Dou (Black Soybean) (each 49 grains), Xin Pi (Arsenic) (half qian, separately ground), Zhu Sha (Cinnabar) (2 grains), Huang Dan (Lead Oxide) (one qian, for coating).
Preparation and Administration: Grind into powder, mix in a mortar, make pills using water drops, divide into 30 pills. Take one pill per dose. Take seven heartwood pieces from peach trees growing towards the southeast, grind them to extract juice. Swallow facing the east at dawn on the day of the attack, just before sunrise. Vinegar soup is also acceptable.
Hong San Zi (Red Scattered Particles) from *San Yin Fang*.
Ingredients: Huang Dan (Lead Oxide) (stir-fried until color changes).
Preparation and Administration: Mix with Jian Cha (Jian Tea), 2.7 qian per dose. Mix with white tea water or warm wine. Another prescription uses garlic (any amount) pounded with Huang Dan to make pills the size of corn kernels. Take one pill early in the morning, facing east, with fresh water.
Commentary: Malaria-dans often use Pi Shuang (Arsenic), a highly toxic substance. Materia Medica states it treats various malarias and wind-phlegm in the chest/diaphragm, serving as an emetic because its nature is extremely dry and strongly dries phlegm. Huang Dan (Lead Oxide) in Materia Medica treats convulsions, epilepsy, clears heat, and descends qi; it is also a drug to overcome phlegm and remove accumulations. Generally, while malaria-dans have the merit of drying phlegm, they severely damage Stomach Qi. Those with weak Spleen/Stomach must exercise extreme caution.
Respectfully noted: For treating malaria, formulas for exterior wind-heat/dampness are detailed in *Jiyao*. Treatment of malaria should follow Danxi's discussions. Chen Wuyue discussed Shi Nue (Damp Malaria) with Zhu Fu Tang (Aconite and Atractylodes Decoction), which is not detailed here. Also, *Jiyao* discusses involvement of the Three Yin channels; although there is one formula for malaria entering the blood, the methods and prescriptions are not sufficiently detailed. Yan Shi stated that malaria arises from phlegm. *San Yin Fang* lists Yi Nue (Epidemic Malaria), Shi Nue, Zhang Nue (Miasma Malaria), and emotions-induced malarias, but most listed formulas are not suitable, and there are many omissions. I speculate the author's intent was that formulas for Spleen Dampness and Dry Heat could treat various malarias generally, hence the lack of detailed description. This explains the omissions. Learners who understand the names and principles, and reflect upon them, can apply treatment. Why wait for exhaustive details?