痧感气分而毒在肌表者,或作胀作呕,或微眩微恶寒,不饥饿,宜急刮之,毒瓦斯不致内
攻则愈,是刮之不可不早也。若入血分而毒在血肉者,或痛或泻,或懊恼不安,或发热,或
两胁胀痛,宜急刺之,毒瓦斯得以外泄则愈。若深入而重者,毒滞于脏腑经络之内,直攻心腹
,呼之不应,扶之不起,危在须臾,虽经刮刺,仍不能不用药救之。但有风寒暑湿之宜分,
食积痰气之宜辨,所当因症而施治者也。且先灌凉水使痧气少降,或以阴阳水调白矾灌之而
后进药,庶可得生。最忌热汤热酒、粥饮米食。若不知禁,则轻者必重,重者必危,或结痧
块,以致变出奇症,尤必先行刮刺以泄其毒,用药方能取效。
闻江南溪涧有射工虫,含沙射人影,即寒热头痛,筋急体强,闷乱呻吟,涎流咳嗽。始
中便不能言,朝轻暮重。不识者,指为伤寒。土人曰∶此痧病也。用真正玉枢丹磨服一锭即
安。凡渡有毒虫处,先用竹竿击水面,急渡则无妨。
按∶射工溪毒中病者,状如伤寒,寒热发疮,偏在一处。用红苋茎叶捣汁饮一升,日再
服,以渣敷之。马齿苋同。惟鹅喜食此虫,故邻近家多畜鹅。
岭南烟瘴,尤多痧病,乃溪毒、沙虱、水弩、射工、蜮、短狐、虾须之类,俱能含沙射
人。被其毒者,憎寒壮热,百体分解,肢节痛酸,似伤寒初发状。彼土人治法,手扪痛处,
用角筒入肉以口吸出其砂,外以大蒜煨热捣膏封贴疮口,即愈。诸虫惟虾须最毒,若不早治
,十死八九。其毒入骨、状若虾须,疮类疔肿。彼地有 、 、 、 等鸟,专食诸虫,以
此鸟毛、粪 灰服之,及笼此鸟于被毒人身畔吸之,其痧闻气自出而愈,其余治法,详前后
各条。
瘟疫与痧胀皆气为之,或因风雨寒暖不时,山泽湿热蒸动,又兵荒积尸之气,随天地升
降流行,人在气交中无可逃避,转相渐染,故痧有触秽一症也。凡人尤忌夜行,多致犯痧,
以受阴浊之气故耳。
明末癸未京师大疫,有胸腹满生白毛者,有头大如斗,眼鼻俱没者,有两腮红肿痰喘壅
塞者,呼吸间,死以万计,皆痧类也。针挑血出随愈。顷之,变为嗽喘,症虽轻不半日随毙
,用前法挑之亦随愈。放痧之法,由来久矣。
按∶所谓大头瘟者,下非不病,特甚于上耳。疙瘩瘟,内非不病,特见于外耳。虾蟆瘟
,腹非不病,特痹于喉耳。症类多端,惟以清热解毒为主,治之先上先下,从内从外,自当
因症而施。以上诸症,用普济消毒饮,最好添加祛瘴辟瘟汤一方。
辛酉一妇,孕几八月,夫不在家,黄昏时忽饥不可忍,即炊米一升为饭,食尽而睡。少
顷,隔房听其啼叫三声,以为产矣,呼之不应,持灯照之,妇已死、腹内依然,如此怪症,
焉知非痧?然亦不及措手矣。
解 亦症,解者骨节解散, 者筋不收束,似寒似热,困怠烦懑,腹疼饮食不美,
呕吐酸水。或因伤酒中湿,或感风寒、房劳、女人经水不调、血气不和,皆成此症,即痧类
非伤寒也。宜先用热水蘸搭臂膊,以苎麻刮之,甚者刺十指、委中出血,或以香油灯照身背
有红点处烙之,使腠理开通,血气舒畅而愈。又宜服苏合香丸。
(汾)按∶解 不尽为痧,然暗痧、慢痧,每似解 ,人所当知。《名医类案》更解
以痧名,未为无见,但后附载杭氏说,力辨解 非痧,适与庸医之见同,勿为所误。
白虎病,凡太岁后一位为白虎,如太岁在已、则白虎辰,太岁在申则白虎在末。其神所
值之方,小儿出入居处,或有触犯则病。其身微热或冷,有时啼叫,屈指如数物状,以集香
汤治之,用沉、降、檀、乳四香,参、草、茯神、枣仁,水煎,临服入麝香少许,存滓房内
烧之。
至如小儿出 疹,一名麻、又名痧,散见于皮肤,与沙粒相似。小儿出疹,必先身热
咳嗽,或呕吐腹痛,时隐时现,三日乃平。今时痧症,亦有细粟红点,或隐或显,额上最多
,胸、胁、颈、项次之,手、足、腰、背又次之。在内则心腹胀疼,在外则肌肤芒刺。其原
皆因血热毒炽,故与小儿之痧疹同名。若小儿果系痧疹,必从本科正治,又不当混入此痧症
也。治痧当明杂症,其于兼痧、类痧等症,方能兼治无误。
缪仲醇曰∶绞肠痧属胃气虚,猝中邪秽,郁遏不得吐泻,以致绞肠异常,胸腹骤胀,遍
体紫黑。细寻头顶心必有红发,速拔去之,急以三棱馋针刺委中,挤出热血,可立苏,次用
新汲凉水入盐两许恣饮,得吐泻即止(蛇虫伤亦有红发)。
当痧毒之气侵入气分,而毒素停留在肌表时,患者可能出现腹胀、呕吐,或轻微眩晕、恶寒,且没有饥饿感。此时应当立即进行刮痧治疗,使毒气不致内攻入脏腑,病情即可痊愈,因此刮痧不可不及时进行。如果痧毒进入血分,毒素滞留于血肉之中,患者可能出现疼痛、腹泻,或心中烦闷不安,或发热,或两胁胀痛。此时应当立即进行刺络放血治疗,使毒气得以从体外泄出,病情即可痊愈。如果痧毒深入体内且病情严重,毒素阻滞在脏腑经络之内,直接攻击心腹部位,导致患者呼叫不应、扶持不起,生命垂危,即使经过刮痧和刺络放血,仍然必须用药来抢救。但需要根据风寒暑湿的不同情况进行区分,辨别食积和痰气的影响,应当根据具体症状施治。并且应先灌服凉水使痧气稍微下降,或者用阴阳水调和白矾灌服,然后再进服药,这样才可能存活。最忌讳饮用热汤、热酒以及食用粥饭米食。如果不遵守这些禁忌,轻症必转重,重症必危及生命,或者结成痧块,以致出现奇特的病症,尤其必须先进行刮痧和刺络放血以泄除毒气,用药才能见效。
听说江南地区的溪涧中有射工虫,它含沙射人的影子,人一旦被射中,就会感到寒热交替、头痛,筋脉拘急、身体强直,胸闷混乱、呻吟不止,流涎并咳嗽。刚被击中时就无法说话,早晨症状较轻,傍晚加重。不认识这种病的人,会将其误认为是伤寒。当地人说:“这是痧病。”服用真正的一锭玉枢丹磨碎后服下,即可安宁。凡是渡过有毒虫出没的地方,先用竹竿敲击水面,快速通过就没有妨碍。
按语:被射工溪毒所伤的患者,症状类似伤寒,表现为寒热交替、发疮,且疮疡偏于一侧。可用红苋菜的茎叶捣汁饮下一升,每天服用两次,并将药渣敷在患处。马齿苋也有同样的功效。因为鹅喜欢吃这种虫子,所以邻近人家大多饲养鹅。
岭南地区烟雾瘴气弥漫,尤其是痧病很多,这些都是由溪毒、沙虱、水弩、射工、蜮、短狐、虾须等虫类引起的,它们都能含沙射人。被其毒气所伤者,憎恨寒冷且高热,全身骨骼关节仿佛分解一般,四肢关节疼痛酸楚,症状类似伤寒初发时的样子。当地人的治疗方法是,用手触摸疼痛部位,用角筒插入皮肤,用口吸出其中的砂毒,外部将大蒜煨热后捣成膏状封贴在疮口上,即可痊愈。这些虫类中只有虾须毒性最强,如果不及时治疗,十个人中会有八九个死亡。其毒气侵入骨骼,形状如同虾须,疮疡类似疔肿。当地有几种鸟专门吃这些虫子,用这些鸟的羽毛、粪便烧成的灰内服,或者将这些鸟笼子放在被毒气侵袭的人身边让其吸入气味,痧毒闻到气味就会自行排出而痊愈,其余的治疗方法,详见前后各条。
瘟疫与痧胀都是由“气”引起的,可能是因为风雨冷暖不时,山泽湿热蒸腾发动,加上战乱饥荒堆积尸体的秽气,随着天地之气的升降流行,人在气交之中无处逃避,相互传染,所以痧病中有触秽这一症状。凡人尤其忌讳夜间行走,多因触犯痧气,是因为受到阴浊之气的影响。
明朝末年癸未年京城发生大瘟疫,有的患者胸腹部胀满长出白毛,有的头部肿大如斗,眼睛鼻子都陷没其中,有的两侧腮部红肿、痰喘壅塞,呼吸之间,死者数以万计,这些都是类似痧病的症状。通过针挑出血,随即痊愈。不久,转变为咳嗽气喘,虽然症状看似较轻,但不半天就会死亡,用前面的方法挑刺出血也能随即痊愈。放痧的方法,由来已久。
按语:所谓的大头瘟,下部并非没有病变,只是上部特别严重罢了。疙瘩瘟,内部并非没有病变,只是表现在外部罢了。虾蟆瘟,腹部并非没有病变,只是喉部痹阻罢了。症状种类繁多,只以清热解毒为主要原则,治疗时先治上部还是下部,从内治还是从外治,自然应当根据症状施治。以上各种症状,使用普济消毒饮效果最好,另外添加祛瘴辟瘟汤一方。
辛酉年,一位妇女怀孕将近八个月,丈夫不在家,黄昏时分忽然饥饿难忍,就煮了一升米做饭,吃完后睡觉。过了一会儿,隔着房间听到她叫了三声,以为是临产了,叫她不应,拿着灯照看,发现妇女已经死亡,但肚子里胎儿依然完好。如此怪异的病症,怎么知道不是痧病呢?然而也来不及施救了。
解㑊(jiě jí)也是一种病症,解㑊表现为骨节解散、筋脉不收束,症状似寒似热,困倦怠慢、烦躁郁闷,腹痛、食欲不振,呕吐酸水。这可能是由于饮酒伤湿,或感受风寒、房劳过度、女子月经不调、气血不和等原因造成的,这属于痧类疾病,而不是伤寒。应当先用热水浸湿布搭在胳膊上,用苎麻刮拭,严重的刺破十指、委中穴出血,或者用香油灯照射身体背部有红点的地方进行烙烫,使腠理开通,气血舒畅而痊愈。又适宜服用苏合香丸。
(汾州)按语:解㑊并不完全是痧病,但是暗痧、慢痧,常常像解㑊,人们应当知晓。《名医类案》更将解㑊命名为痧病,并非没有见解,但后面附载的杭氏说法,极力辩解说解㑊不是痧病,恰好与庸医的见识相同,不要被误导。
白虎病,凡是太岁后的下一个地支方位为白虎,例如太岁在巳,则白虎在辰;太岁在申,则白虎在未。其神值班的方位,小儿出入居住的地方,如果有触犯就会生病。其身体微热或发冷,有时啼哭叫喊,手指屈伸像是在数东西的样子,用集香汤治疗,使用沉香、降香、檀香、乳香四种香,配合人参、甘草、茯神、枣仁,水煎,临服用时加入少许麝香,保留药渣在房内焚烧。
至于小儿出疹子,一名麻,又名痧,散见于皮肤,与沙粒相似。小儿出疹子,必定先出现身体发热、咳嗽,或呕吐、腹痛,皮疹时隐时现,三天后才平复。现在的痧症,也有细小的粟米状红点,或隐或显,额头最多,胸部、胁部、颈部、项部次之,手部、足部、腰部、背部又次之。在内则心腹胀痛,在外则肌肤有芒刺感。其根源都是因为血热毒盛,所以与小儿的痧疹同名。如果小儿确实是痧疹,必须按照本病的正法治疗,又不应当混入此处的痧症讨论中。治疗痧症应当明白杂症的区别,对于兼夹痧症、类似痧症等情况,才能兼顾治疗无误。
缪仲醇说:绞肠痧属于胃气虚弱,突然中受邪秽之气,郁结遏制不能吐泻,导致肠道绞结异常,胸腹突然胀满,全身皮肤紫黑。仔细寻找头顶心必有红色头发,迅速拔去它,急忙用三棱针针刺委中穴,挤出热血,可以立刻苏醒,随后用新打的凉水加入约一两盐大量饮用,得到吐泻后就停止(蛇虫咬伤也有红色头发)。
When Sha toxin (Sha toxin, a pathogenic factor in TCM) enters the Qi level and the toxin remains on the muscle surface, patients may experience abdominal distension, vomiting, slight dizziness, aversion to cold, and lack of hunger. At this time, scraping therapy (Gua Sha) should be performed immediately to prevent the toxin from attacking the internal organs, and the condition will heal; therefore, scraping must not be delayed. If the Sha toxin enters the Blood level and the toxin stagnates in the flesh and blood, patients may experience pain, diarrhea, mental restlessness, fever, or distending pain in both hypochondria. In such cases, pricking therapy (bloodletting) should be performed immediately to allow the toxin to escape from the exterior, and the condition will heal. If the Sha toxin penetrates deeply and the condition is severe, with toxin stagnating within the Zang-Fu organs and meridians, directly attacking the heart and abdomen, causing unresponsiveness to calls and inability to stand even when supported, life is in imminent danger. Even after scraping and pricking, medication must still be used for rescue. However, differentiation among wind-cold, summerheat, and dampness is required, and food retention and phlegm-qi must be distinguished; treatment should be administered according to the specific symptoms. Furthermore, cool water should be poured into the mouth first to slightly reduce the Sha qi, or alum mixed with Yin-Yang water (a mixture of freshly drawn well water and boiled water) should be administered before giving other medicines, so that survival may be possible. Hot soups, hot wine, porridge, and rice foods are strictly contraindicated. Failure to observe these prohibitions will cause mild conditions to become severe and severe conditions to become critical, or lead to the formation of Sha masses, resulting in bizarre symptoms. Especially in such cases, scraping and pricking must be performed first to vent the toxin before medication can take effect.
It is heard that in the streams and creeks of Jiangnan, there are "She Gong" insects (archerfish-like mythical insects). They shoot sand at people's shadows. Once hit, one experiences alternating chills and fever, headache, tendon stiffness, body rigidity, chest oppression, confusion, groaning, salivation, and coughing. Immediately upon infection, speech becomes impossible, with symptoms being lighter in the morning and heavier in the evening. Those unfamiliar with it mistake it for Taiyang disease (Exterior syndrome characterized by aversion to cold and fever). Locals say: "This is Sha disease." Taking one tablet of genuine Yushu Dan (Jade Pivot Pill), ground and taken orally, brings immediate relief. When crossing areas with toxic insects, one should first strike the water surface with a bamboo pole and cross quickly to avoid harm.
Commentary: Patients infected by She Gong stream toxins present with symptoms similar to Taiyang disease, including alternating chills and fever and sores localized to one side. One may drink one sheng (approx. 200ml) of juice extracted from fresh Amaranthus tricolor stems and leaves, taken twice daily, and apply the residue topically. Portulaca oleracea has the same effect. Since geese favor eating these insects, households nearby often raise geese.
In the Lingnan region, where miasma is prevalent, Sha diseases are particularly common. These are caused by various insects such as stream toxins, sand lice, water bows, archer insects, hidden insects, short foxes, and shrimp-whiskers, all capable of shooting sand at humans. Those poisoned by them experience aversion to cold with high fever, a sensation of limbs disintegrating, soreness and pain in joints, resembling the initial stage of Taiyang disease. Local treatment involves palpating the painful area, inserting a horn tube into the skin, and sucking out the sand with the mouth. Externally, garlic is baked until hot, mashed into a paste, and applied to the wound, leading to recovery. Among these insects, the shrimp-whisker is the most toxic. If not treated early, eight or nine out of ten will die. The toxin entering the bone resembles shrimp whiskers, and the sores resemble Ding swellings (carbuncles). There are certain birds in that region that specifically eat these insects. Consuming ash made from their feathers and feces, or placing cages containing these birds near the infected person to inhale their scent, causes the Sha toxin to exit naturally upon smelling the odor. Other treatments are detailed in previous and subsequent sections.
Plague and Sha distension are both caused by "Qi". This may result from irregular wind, rain, cold, and warmth, steaming and moving damp-heat from mountains and marshes, or the foul air accumulated from corpses during war and famine. This air circulates with the ascending and descending of Heaven and Earth. Humans, existing within this Qi intersection, have no way to escape, leading to mutual transmission. Thus, Sha disease includes the symptom of touching foulness. People are especially advised against traveling at night, as this frequently leads to contracting Sha due to exposure to Yin-turbid Qi.
In the Guiwei year (1643) at the end of the Ming Dynasty, a great plague broke out in the capital. Some patients had full chests and abdomens with white hair growing on them; some had heads swollen like buckets, with eyes and noses submerged; others had red and swollen cheeks with obstructed phlegm and wheezing. Countless died within moments of breathing. All were types of Sha. Pricking to release blood resulted in immediate recovery. Later, symptoms transformed into coughing and wheezing. Although seemingly mild, death occurred within half a day. Pricking as previously described also led to immediate recovery. The method of releasing Sha has been practiced for a long time.
Commentary: What is called "Big Head Plague" implies pathology not only in the lower body but primarily severe in the upper body. "Bump Plague" implies internal pathology manifesting externally. "Toad Plague" implies abdominal pathology obstructing the throat. Symptoms vary widely, but the primary principle is clearing heat and detoxifying. Treatment may target the upper or lower, interior or exterior, depending on the symptoms. For the above conditions, Puji Xiaodu Yin (Universal Benefit Decoction to Eliminate Toxins) is best, supplemented by the formula Quzhang Biwen Tang (Miasma-Expelling and Plague-Averting Decoction).
In the Xinyou year, a woman nearly eight months pregnant was alone at home. At dusk, she felt unbearable hunger, cooked one sheng of rice, ate it all, and slept. Shortly after, three cries were heard from another room, suggesting labor. Calling her yielded no response. Lighting a lamp revealed she had died, yet the fetus remained intact in the womb. Such a bizarre condition—how could one know it was not Sha? Alas, it was too late to act.
Jie Ji (Joint Dissolution Syndrome) is also a condition. "Jie" refers to bones and joints feeling loose/dissolved; "Ji" refers to tendons failing to bind. Symptoms include sensations of cold and heat, fatigue, irritability, abdominal pain, poor appetite, and vomiting of sour fluid. Causes include alcohol injury with dampness, wind-cold invasion, sexual exhaustion, irregular menstruation in women, or disharmony of Qi and Blood. This belongs to the category of Sha diseases, not Taiyang disease. Initially, soak a cloth in hot water and apply it to the arms, then scrape with ramie fiber. In severe cases, prick the ten fingers and Weizhong (BL-40) to bleed. Alternatively, use an sesame oil lamp to cauterize red spots on the back, opening the pores and promoting smooth Qi and Blood flow for recovery. Suhe Xiang Wan (Styrax Pill) is also suitable.
(Fenzhou) Commentary: Jie Ji is not entirely Sha disease. However, hidden Sha and chronic Sha often resemble Jie Ji, which people should know. *Famous Doctors' Case Records* names Jie Ji as Sha disease, which is not without merit. However, the appended argument by Mr. Hang, insisting Jie Ji is not Sha, aligns with the views of mediocre physicians and should not mislead us.
Baihu Disease (White Tiger Disease): The position following the Tai Sui (Grand Duke Jupiter) is Baihu. For example, if Tai Sui is in Si, Baihu is in Chen; if Tai Sui is in Shen, Baihu is in Wei. If children enter or reside in the direction governed by this deity and offend it, they fall ill. Symptoms include slight fever or chill, occasional crying, and fingers curling as if counting objects. Treat with Jixiang Tang (Collective Fragrance Decoction): using Agarwood, Aquilaria, Sandalwood, and Olibanum, combined with Ginseng, Licorice, Poria, and Ziziphus Seed. Decoct in water, add a small amount of Musk before serving, and burn the dregs in the room.
Regarding infantile exanthems, known as Ma (Smallpox/Measles) or Sha, appearing scattered on the skin like sand grains. Infantile rash typically begins with fever and cough, or vomiting and abdominal pain. The rash appears intermittently and resolves in three days. Current Sha diseases also present with fine millet-like red spots, visible or hidden, most abundant on the forehead, followed by chest, hypochondria, neck, and nape, then hands, feet, waist, and back. Internally, there is heart and abdominal distension/pain; externally, the skin feels prickly. The root cause is excessive heat and toxicity in the blood, hence sharing the name with infantile Sha rashes. If an infant truly has Sha rash, it must be treated according to its own standard protocols and should not be confused with the Sha diseases discussed here. Treating Sha requires understanding miscellaneous diseases to correctly manage concurrent or mimicking conditions.
Miao Zhongchun stated: Jiaochang Sha (Intestine-Twisting Sha) belongs to deficiency of Stomach Qi, suddenly struck by evil foulness, leading to stagnation preventing vomiting or diarrhea, causing extreme intestinal twisting, sudden abdominal distension, and purple-black discoloration of the whole body. Carefully examine the vertex of the head for a red hair; pluck it out immediately. Quickly prick Weizhong (BL-40) with a three-edged needle to drain dark blood, which can restore consciousness instantly. Then, drink copious amounts of newly drawn cool water with about two qian (approx. 7.5g) of salt. Stop once vomiting or diarrhea occurs (snake or insect bites may also present with red hair).