岭表之俗。多食槟榔。盖谓瘴疟之作。率由饮食过度。气痞痰结。而槟榔最能下气。消食去痰。
故土人狃于近利。而暗于远害。此谓北人之饮酥酪塞北地
寒。食酥酪肤理缜密。一旦病疫。当汗则寒塞而汗不得出。南方地热。食槟榔不得。槟榔味辛。
能下泄元气。大泄胸中至高之气。久食槟榔。脏气疏泄。一旦病瘴。元气已自虚羸。故不能堪。
所以南方多体瘠色黄。夫岂全是气候所致。盖亦槟榔为患。殆不思耳。
卫生方云。重阳必阴。重阴必阳。寒热之变。物极则反。今瘴病或始寒战而终大热。或连
日极热而后作寒。正谓此也。第伤寒以不饮水为内寒。瘴则内寒者也。亦饮水甚。则欲坐水中取水。
以渍其心。胸盖炎方受病。气专炎上。心肺焦熬。华盖干涸。所以多渴。若其脉浮而虚。按之
无力。又或病潮时。脉洪数。病不潮时。脉微弱。其症则心烦躁。额上极热。面色多赤。舌多黑。
头或痛或不痛。小便或频或赤。大便或泄。腰腿沉重。两足不热。其有寒厥或疼。误服凉药。则
渴转甚。燥转急。治此者。当引上焦热气。降于下焦。正宜用大附子。及灸丹田气海足三里等穴。
使下元暖。阴阳交泰。而病自和解矣。或曰口渴心烦。面赤舌黑。小便赤。脉数。明是热症。而子
谓治此病者。宜用大附子。附子乃大热药也。以之治大热之病。是以火济火。甚骇耳目。吾子其
有说以通之乎。余曰方书有云。凡间之火得木则炎。得水则伏。其疾之小者似之。故立方有正治。
龙雷之火。得木则燔。得水则炎。日出则灭。其疾之大者似之。故立方有从治。复佐以热因寒用之。
寒因热用之之理。今人染瘴。或哑而不能言。或热而精神昏乱。如卧炭火之中。去死一间。不谓
之火病可乎。所以立从治之方。有姜附汤。干姜附子汤。沉附汤。附子冷汤。附子理中汤。真武汤。
冷香汤。七枣汤。极重三建汤。虽各有主对。俱系温剂。合冷服之。或佐以凉药。乃寒因热用也。
或曰以热治之之法。既闻命矣。而三建汤用川乌附子天雄乃一物也。何以别之。
余曰以春月采小者。为川乌。主除寒湿去痰。冬月采大而有小子附于旁者。为附子。主回阳反本。
补下焦之阳虚。大而旁无小子者。为天雄。取之雄不孕子之意。其力全无分散。补上焦之阳虚。
以三物同一本出于建平。故名曰三建。瘴虚因医者误用凉药。以致四肢厥冷。头额虚汗。发哕。脉
数而促。症甚急。用之能收心液。能止真阳。多有得生者。
岭南地区的习俗，人们多食用槟榔。大概认为瘴疟的发生，大多是由于饮食过度，导致气机阻滞、痰湿凝结，而槟榔最能下气、消食、去痰。
因此当地人拘泥于眼前的利益，却忽视了长远的危害。这就像北方人饮用酥酪一样：北方地寒，人们食用酥酪使得皮肤纹理紧密；一旦遭遇疫病，应当发汗时，寒气闭塞导致汗液无法排出。南方地热，人们食用槟榔，槟榔味辛，能泄降元气，大量泄掉胸中至高之气。长期食用槟榔，导致脏腑之气疏泄太过，一旦染上瘴病，元气已经虚弱羸弱，所以难以承受。
因此南方人多身体瘦弱、面色发黄，这难道全是气候造成的吗？恐怕也是槟榔带来的祸患，只是人们不曾深思罢了。
《卫生方》说：“重阳必阴，重阴必阳。”寒热的变化，事物发展到极点就会向反面转化。现在的瘴病，有的开始寒战最后变成大热，有的连续几天极热之后又出现寒战，正是说的这个道理。
伤寒以不饮水为内寒，而瘴病则是内有实热（注：原文“瘴则内寒者也”结合上下文“亦饮水甚”及后文描述，此处逻辑似有矛盾或特指某种寒热错杂/真寒假热之变，但根据后文“欲坐水中”、“胸盖炎”、“心肺焦熬”等描述，此处应理解为瘴病虽有寒象或误治致寒，本质或伴随严重热毒/津伤，或者原文意指瘴病与伤寒在寒热表现上的区别，伤寒禁饮，瘴病虽似寒实则渴饮无度。*修正理解*：原文“第伤寒以不饮水为内寒。瘴则内寒者也。亦饮水甚。” 这句话在中医古籍中常有争议或传抄错误。通常伤寒少阴病不渴，阳明病大渴。若按字面“瘴则内寒”，后文又说“饮水甚”、“心烦躁”、“额上极热”，这是典型的热证或真热假寒。结合下文“误服凉药...渴转甚”，说明患者本有热或阴虚。此处翻译需忠实原文文字，但需理顺逻辑：伤寒表现为不饮水（属内寒），而瘴病（此处可能指某种特定类型的瘴病或误读）也表现为内寒？不，后文紧接着说“亦饮水甚”，说明瘴病患者口渴想喝水。让我们仔细看原文：“第伤寒以不饮水为内寒。瘴则内寒者也。亦饮水甚。” 这里的“内寒”可能是笔误，或者是说“瘴则[非]内寒”？或者是指瘴病初期有寒象？鉴于后文大篇幅描述热象和用附子回阳救逆（针对厥冷、脉促），这属于“真寒假热”或“阴盛格阳”。
重新梳理逻辑：
1. 前段批评槟榔耗气。
2. 引用《卫生方》讲阴阳转化。
3. 对比伤寒与瘴病：伤寒不饮水（内寒）；瘴病... 这里原文“瘴则内寒者也”非常奇怪，因为后面紧接“亦饮水甚”。如果瘴病是内寒，为何饮水甚？通常内寒不渴。
*另一种解读*：也许原文是“瘴则[非]内寒”？或者“瘴则[热]内[结]”？
*再看后文*：“胸盖炎方受病... 所以多渴”。这说明瘴病本质是有热的，或者至少是燥热的。
*再看治疗*：“当引上焦热气，降于下焦... 正宜用大附子... 使下元暖... 阴阳交泰”。这是治疗“戴阳”或“格阳”证，即下元虚寒，虚阳上浮。
*再看问答*：“曰口渴心烦... 明是热症... 宜用大附子... 是以火济火”。对方认为是热症，作者坚持用热药。
*结论*：这是一种特殊的瘴病类型，表现为“真寒假热”或“阴盛格阳”。下焦真寒，上焦假热。
*回到那句难懂的话*：“第伤寒以不饮水为内寒。瘴则内寒者也。亦饮水甚。”
如果按照“真寒假热”的逻辑，下焦是寒的（内寒），但因为虚阳上浮或津液不布，导致口渴饮水甚。所以“瘴则内寒”指的是病根在下焦虚寒，“亦饮水甚”是因为虚阳浮越或津不上承导致的假热/渴症。这样逻辑就通了。
翻译如下：
至于伤寒，以不饮水作为内寒的表现；而瘴病（此型）的病根在于下焦内寒，但患者却极度口渴想喝水，甚至想坐在冷水里取水来浇淋心胸。这是因为胸膈受热邪（或虚火）侵袭，气机专向上炎，导致心肺焦灼，华盖（肺）干枯，所以多口渴。
如果脉象浮而虚，重按无力，或者在发热间歇期脉洪数，而在不发热时脉微弱，症状表现为心中烦躁、额头极热、面色多红、舌苔多黑、头部有时痛有时不痛、小便有时频数有时色赤、大便有时泄泻、腰腿沉重、两脚不热。如果有寒厥或疼痛，误服凉药，那么口渴会更严重，燥热感更急迫。
治疗这种情况，应当引导上焦的热气下降至下焦，正适宜使用大附子，并艾灸丹田、气海、足三里等穴位，使下元温暖，达到阴阳交泰，疾病自然和解。
有人问：口渴、心烦、面赤、舌黑、小便赤、脉数，明明是热症，您却说治疗此病宜用大附子。附子是大热药，用它来治大热之病，这是以火救火，令人惊骇。您有什么说法来解释呢？
我说：医书上有云：“凡间之火，得木则炎，得水则伏”，这种小疾类似于此，所以立方有正治法。“龙雷之火，得木则燔，得水则炎，日出则灭”，这种大疾类似于此，所以立方有从治法。再辅以“热因寒用”、“寒因热用”的道理。
现在人感染瘴气，有的哑巴不能说话，有的发热且精神昏乱，如同躺在炭火之中，离死只有一步之遥，这难道不是火病吗？
所以制定从治的方剂，如姜附汤、干姜附子汤、沉附汤、附子冷汤、附子理中汤、真武汤、冷香汤、七枣汤、极重三建汤。虽然各有主治对应，但都属于温剂，配合冷服，或者佐以凉药，这就是“寒因热用”。
有人问：用热药治疗的方法，我已经听明白了。但是三建汤中使用川乌、附子、天雄，它们本是同一物，如何区分？
我说：春季采集小的，称为川乌，主要功效是除寒湿、去痰；冬季采集大的，旁边有小附子依附的，称为附子，主要功效是回阳反本，补下焦之阳虚；大而旁边没有小附子的，称为天雄，取“雄性不生子”之意，其力完全集中不散，用于补上焦之阳虚。
这三物同出一源，产于建平，所以名叫“三建”。
瘴病导致的虚损，往往因为医生误用凉药，以致四肢厥冷、额头出虚汗、呃逆、脉数而急促，症状非常危急。使用这些药物能收敛心液，能固摄真阳，多有获救生还者。
The customs in the Lingnan region involve the frequent consumption of Areca Nut (Binglang, 槟榔). It is generally believed that the onset of Malaria due to Miasma (Zhang Nue, 瘴疟) is mostly caused by excessive diet, leading to Qi stagnation and Phlegm accumulation. Areca Nut is particularly effective in directing Qi downward, digesting food, and resolving phlegm.
Therefore, locals are bound by short-term benefits while ignoring long-term harm. This is analogous to northerners consuming butter and milk: In the cold northern lands, consuming butter and milk makes the skin texture dense. When an epidemic strikes, if sweating should be induced, the cold pathogen blocks the pores, preventing sweat from being released. In the hot southern lands, people consume Areca Nut. Areca Nut has a pungent flavor and can drain Yuan Qi (Original Qi, 元气), excessively draining the supreme Qi in the chest. Long-term consumption causes the internal organs' Qi to become dispersed and leaking. Once infected with Miasma, the Yuan Qi is already deficient and emaciated, making the body unable to withstand the disease.
Thus, people in the south are often physically frail and have a sallow complexion. Is this entirely due to climate? It is likely also a disaster caused by Areca Nut, which people fail to ponder deeply.
The *Weisheng Fang* (Health Preservation Formula) states: "Extreme Yang transforms into Yin, extreme Yin transforms into Yang." Changes between cold and heat occur when things reach their extremity. Current cases of Miasma disease may start with chills and end with high fever, or experience intense heat for several days before developing chills. This precisely illustrates the principle mentioned above.
In contrast, Taiyang Cold Damage (Shanghan, 伤寒) presents with no desire to drink water, indicating internal cold. However, in this type of Miasma disease, although the root pathology involves internal cold (specifically lower Jiao deficiency cold), the patient exhibits extreme thirst and desires to drink copiously, even wishing to sit in water to cool the heart. This is because the upper burner (chest) is affected by inflammatory heat (or deflected fire), causing Qi to flare upward exclusively, scorching the Heart and Lungs, and drying up the "Huagai" (Metaphor for the Lungs). Hence, there is much thirst.
If the pulse is floating and deficient, feeling weak upon deep pressure, or if the pulse is surging and rapid during fever episodes but weak and faint when the fever subsides, the symptoms include mental restlessness, extreme heat on the forehead, reddish complexion, blackish tongue coating, occasional headache or no headache, urinary frequency or red urine, occasional diarrhea, heavy sensation in the waist and legs, and cold feet. If there are cold tetany or pain, and cooling medicines are mistakenly administered, the thirst will worsen, and dryness/intolerance to heat will intensify.
To treat this condition, one must guide the heat from the Upper Jiao down to the Lower Jiao. It is appropriate to use large doses of Prepared Aconite Root (Fuzi, 附子) and moxa points such as Shendian (CV-4, 丹田), Qihai (CV-6, 气海), and Zusanli (ST-36, 足三里). This warms the Lower Yuan (Root of Lower Jiao), promotes the interaction of Yin and Yang, and allows the disease to resolve harmoniously.
Someone asked: Thirst, mental restlessness, reddish face, black tongue, red urine, and rapid pulse clearly indicate a Heat syndrome. Yet you suggest using large Prepared Aconite Root. Aconite is a major hot medicine; using it to treat a major heat disease is like adding fire to fire, which is shocking. Do you have an explanation?
I reply: Medical texts state: "Ordinary fire flares up with wood and submerges with water." Small diseases resemble this, hence the method of direct treatment (Zheng Zhi, 正治). "Dragon and Thunder Fire flares up with wood and burns with water, extinguishing at sunrise." Major diseases resemble this, hence the method of following treatment (Cong Zhi, 从治). This is supplemented by the principles of "treating heat with cold administration" (Re Yin Han Yong, 热因寒用) and "treating cold with heat administration" (Han Yin Re Yong, 寒因热用).
Now, people infected with Miasma may become mute or suffer from fever with mental confusion, lying as if on charcoal fire, perilously close to death. Can this not be called a Fire disease?
Therefore, formulas for following treatment are established, such as Ginger and Aconite Decoction (Jiang Fu Tang, 姜附汤), Dried Ginger and Aconite Decoction (Gan Jiang Fu Zi Tang, 干姜附子汤), Chen Fu Tang (沉附汤), Cold Aconite Decoction (Fu Zi Leng Tang, 附子冷汤), Aconite and Magnolia Bark Decoction (Fu Zi Li Zhong Tang, 附子理中汤), True Warrior Decoction (Zhen Wu Tang, 真武汤), Cold Fragrance Decoction (Leng Xiang Tang, 冷香汤), Seven Date Decoction (Qi Zao Tang, 七枣汤), and Extreme Heavy San Jian Decoction (Ji Zhong San Jian Tang, 极重三建汤). Although each has specific indications, they are all warming agents. They are combined with cold administration or assisted with cooling medicines. This is the application of "treating cold with heat administration" (Han Yin Re Yong - *Note: The text says 'Han Yin Re Yong' here referring to the method of giving hot meds cold, or treating the false heat symptom*).
Someone asked: I have heard the method of using hot medicines. But San Jian Decoction uses Sichuan Aconite (Chuan Wu, 川乌), Aconite (Fu Zi, 附子), and Tianxiong (Tian Xiong, 天雄). Are they not the same substance? How are they distinguished?
I say: Those harvested small in spring are called Chuan Wu, primarily used to dispel cold-dampness and resolve phlegm. Those harvested large in winter, with smaller buds attached beside them, are called Fu Zi, primarily used to restore Yang and return to the origin, tonifying deficiency of Yang in the Lower Jiao. Those that are large without smaller buds beside them are called Tian Xiong, taking the meaning of "male without offspring," with power concentrated and undispersed, used to tonify deficiency of Yang in the Upper Jiao.
These three substances originate from the same root in Jianping, hence named "San Jian" (Three Establishments).
Miasma-induced deficiency, often caused by physicians mistakenly using cooling medicines, results in cold tetany of the four limbs, empty sweat on the head and forehead, hiccups, rapid and hurried pulse, and critical symptoms. Using these [warming/aconite] preparations can collect Heart fluids, secure True Yang, and many patients survive.