糠痧 艄温疹。其实属麻一证名。方语原来各有别。治同一例应如神。
麻证之名。各方不同。在京师呼为温疹。在河南呼为 疮。山西、陕西呼为糠疮。山东、福建、
广东、广西、云南、贵州、四川俱呼为疹子。江南呼为痧疹。浙江呼为 子。湖广、江西俱呼为麻
疹。又呼为艄子。闻人氏呼为肤疹。虽四方之命名有别。其实皆一麻也。调治之法。原无异耳。
麻疹须明岁气先。勿轻汗下作伤寒。察人虚实施良剂。无伐天和损寿元。
麻疹之证。其初发热。与伤寒相似。但麻则面颇红。咳嗽喷嚏。鼻流清涕。目中泪出。呵欠喜
睡。或吐或泻。或手掐眉目鼻而之为异耳。不可误作伤寒施治。而妄用汗下也。妄汗则增其热。
而为衄、为咳嗽、为口疮咽痛、为目赤痛、为烦躁、为大小便不通。妄下则虚其里。为滑泄、为滞
下。经曰。必先岁气。毋伐天和。言不可妄汗下也。是以治麻者。务须先明岁气。如时令温暖。以辛
发之药发之。用防风败毒散(见第五条)。如时令暄热。以寒凉之药发之。用白虎解毒汤(见二十
六条)。或黄连解毒汤。如时令大寒。以辛热之药发之。用桂枝解毒汤或葛根桂枝汤。如时令时寒
时暖。以辛平之药发之。用荆防败毒散或葛根解毒汤。倘兼疫疠之气。则以人参败毒散主之。又
要看人之虚实。如吐泻不止。以人参之类补之。如便秘烦躁。以酒蒸大黄微利之。无实实。无虚
虚。倘损不足而补有余。夭人性命。非关天数。医杀之也。能知损有余而补不足者。方为良工。
朱曰 麻疹之候。有下列八证。见数证即是。不必全具。
黄连解毒汤
黄连 黄柏 黄芩 栀仁 荆芥 知母 石膏 大青 元参 木通 防风 桔梗 甘草 水煎服。
桂枝解毒汤
荆芥 防风 牛蒡子 麻黄 桔梗 人参 川芎 赤芍 羌活 甘草 桂枝 生姜引。
葛根桂枝汤
葛根 防风 甘草 桂枝 赤芍 升麻 姜三片 淡豆豉一钱引。
荆防败毒散
荆芥 防风 茯苓 枳壳 前胡 柴胡 桔梗 川芎 羌活 独活 甘草 薄荷五叶
引。(除荆、防。加人参。名人参败毒散)。
葛根解毒汤
葛根 荆芥 前胡 牛蒡子 防风 连翘 淡竹叶 人参 柴胡 桔梗 赤芍药 羌活
升麻 甘草 水煎服。
糠痧,即艄温疹。其实质属于麻疹这一病证名称。各地方的方言原本各有区别。但治疗原则相同,效果应如神助般灵验。
麻疹的名称,各地不同。在京城称为“温疹”,在河南称为“疮”(注:此处原文可能有缺字或通假,通常指麻疮),山西、陕西称为“糠疮”。山东、福建、广东、广西、云南、贵州、四川都称为“疹子”。江南地区称为“痧疹”。浙江称为“[缺字]子”(注:原文此处似有脱漏,结合语境多指“麻子”或类似称呼)。湖广、江西都称为“麻疹”,又被称为“艄子”。闻人氏称为“肤疹”。虽然四方命名有别,但其实都是同一种麻疹。调治的方法,原本没有差异。
治疗麻疹必须首先明了当年的岁气(气候运气)。不要轻易使用发汗或攻下法,以免误当作伤寒治疗。要观察患者的虚实情况来施用良方。不要违背自然规律,以免损害寿命根本。
麻疹的病症,初期发热,与伤寒相似。但麻疹患者面部颇红,伴有咳嗽、喷嚏,鼻流清涕,眼中流泪,呵欠喜睡,或者呕吐腹泻,或者用手抓挠眉目鼻子等表现,这是其特异之处。不可误作伤寒施治,而妄用发汗或攻下法。妄用发汗会增加热势,导致鼻出血、咳嗽加重、口舌生疮咽喉痛、眼睛红肿疼痛、烦躁不安、大小便不通。妄用攻下会损伤体内正气,导致滑泄不止或痢疾滞下。《内经》说:“必先岁气,毋伐天和。”意思是不可妄用汗下法。因此,治疗麻疹的人,务必先明了岁气。如果时令温暖,用辛散发表的药物来发散,使用防风败毒散(见第五条)。如果时令炎热,用寒凉药物来发散,使用白虎解毒汤(见二十六条)或黄连解毒汤。如果时令大寒,用辛热药物来发散,使用桂枝解毒汤或葛根桂枝汤。如果时令时寒时暖,用辛平药物来发散,使用荆防败毒散或葛根解毒汤。倘若兼夹疫疠之气,则以人参败毒散为主治方剂。还要看人的虚实情况。如果吐泻不止,用人参之类的药物补益。如果便秘烦躁,用酒蒸大黄轻微通便。不要对实证用补法造成实实之误,也不要对虚证用泻法造成虚虚之误。如果损伤不足的正气而补益有余的邪气,会导致人死亡,这不是天命,而是医生害死的。能够知道损有余而补不足的,才算是高明的医生。朱氏说:麻疹的证候,有下列八种证型。见到其中几种证候即可诊断,不必全部具备。
黄连解毒汤
组成:黄连、黄柏、黄芩、栀子仁、荆芥、知母、石膏、大青叶、玄参、木通、防风、桔梗、甘草。水煎服。
桂枝解毒汤
组成:荆芥、防风、牛蒡子、麻黄、桔梗、人参、川芎、赤芍、羌活、甘草。加生姜为引。
葛根桂枝汤
组成:葛根、防风、甘草、桂枝、赤芍、升麻。加生姜三片、淡豆豉一钱为引。
荆防败毒散
组成:荆芥、防风、茯苓、枳壳、前胡、柴胡、桔梗、川芎、羌活、独活、甘草。加薄荷五叶为引。(若去除荆芥、防风,加入人参,称为人参败毒散)。
Fangsha (Chaff Rash), also known as Shaowen Zhen, is essentially a name for the disease of Measles (Rubeola). The local dialects originally have different names. However, the treatment principles are the same, and the efficacy should be as miraculous as divine assistance.
The name for Measles varies by region. In the capital, it is called "Wenzhen" (Warm Rash); in Henan, it is referred to as "Chuang" (Sore/Sores); in Shanxi and Shaanxi, it is called "Kuangchuang" (Chaff Sore). In Shandong, Fujian, Guangdong, Guangxi, Yunnan, Guizhou, and Sichuan, it is called "Zhenzi" (Rash). In the Jiangnan region, it is called "Shazhen" (Sha Rash). In Zhejiang, it is called "[Missing Character]zi". In Huguang and Jiangxi, it is called "Mazhen" (Measles), also referred to as "Shaozi". Wen Ren Shi calls it "Fuzhen" (Skin Rash). Although the naming differs across regions, they are all essentially the same disease of Measles. The methods of regulation and treatment are originally identical.
In treating Measles, one must first understand the Suiqi (Annual Climate Influence/Qi of the Year). Do not lightly employ sweating or purging methods, lest it be mistaken for Shanghan (Cold Damage). Observe the patient's deficiency and excess to apply appropriate formulas. Do not violate the harmony of Heaven (natural laws), lest you damage the foundation of longevity.
The initial fever of Measles resembles that of Shanghan. However, in Measles, the face is notably red, accompanied by coughing, sneezing, clear nasal discharge, tearing from the eyes, yawning, drowsiness, vomiting, diarrhea, or scratching the eyebrows, eyes, and nose. These are its distinctive features. It must not be mistakenly treated as Shanghan with reckless sweating or purging. Reckless sweating will increase heat, leading to epistaxis, worsening cough, mouth sores, sore throat, red and painful eyes, restlessness, and obstruction of urination and defecation. Reckless purging will weaken the interior, leading to slippery diarrhea or tenesmus (dysentery-like stagnation). The Classic says: "First understand the Suiqi; do not violate the Harmony of Heaven." This means one must not recklessly use sweating or purging. Therefore, those who treat Measles must first clarify the Suiqi. If the season is warm, use acrid-releasing herbs to disperse the pathogen, such as Fangfeng Baidu San (see Article 5). If the season is hot, use cold-cooling herbs to disperse, such as Baihu Jiedu Tang (see Article 26) or Huanglian Jiedu Tang. If the season is severely cold, use acrid-warm herbs to disperse, such as Guizhi Jiedu Tang or Gegen Guizhi Tang. If the season fluctuates between cold and warm, use acrid-neutral herbs to disperse, such as Jingfang Baidu San or Gegen Jiedu Tang. If there is an epidemic pestilence qi involved, then Renshen Baidu San should be the primary formula. One must also assess the patient's deficiency and excess. If vomiting and diarrhea persist, tonify with herbs like Renshen. If constipation and restlessness occur, slightly purge with Jiuzheng Dahuang (Wine-processed Rhubarb). Do not reinforce the excess (Shi-Shi error) nor deplete the deficiency (Xu-Xu error). If you damage the insufficient and tonify the excessive, you will cause death. This is not fate, but medical malpractice. Only those who know how to reduce the excess and tonify the deficiency can be considered skilled physicians. Zhu stated: The manifestations of Measles include the following eight syndromes. Seeing several of these syndromes is sufficient for diagnosis; it is not necessary for all to be present.
Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity)
Ingredients: Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix), Zhiren (Gardeniae Semen), Jingjie (Schizonepetae Herba), Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum Fibrosum), Daqingye (Isatidis Folium), Yuan Shen (Scrophulariae Radix), Mutong (Akebiae Caulis), Fangfeng (Saposhnikoviae Radix), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
Guizhi Jiedu Tang (Cinnamon Twig Decoction to Relieve Toxicity)
Ingredients: Jingjie, Fangfeng, Niubangzi (Arctii Fructus), Mahuang (Ephedrae Herba), Jiegeng, Renshen (Ginseng Radix et Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Chishao (Paeoniae Radix Rubra), Qianghuo (Notopterygii Rhizoma et Radix), Gancao, Guizhi (Cinnamomi Ramulus). Use Shengjiang (Zingiberis Rhizoma Recens) as a guide.
Gegen Guizhi Tang (Puerariae Radix and Cinnamon Twig Decoction)
Ingredients: Gegen (Puerariae Lobatae Radix), Fangfeng, Gancao, Guizhi, Chishao, Shengma (Cimicifugae Rhizoma). Use three slices of Shengjiang and one qian of Danshidou (Fermented Soybean) as guides.
Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Pathogenic Factors)
Ingredients: Jingjie, Fangfeng, Fuling (Poria), Zhike (Aurantii Fructus Immaturus), Qianhu (Peucedani Radix), Chaihu (Bupleuri Radix), Jiegeng, Chuanxiong, Qianghuo, Duhuo (Angelicae Pubescentis Radix), Gancao. Use five leaves of Bohe (Menthae Haplocalycis Herba) as a guide. (If Jingjie and Fangfeng are removed and Renshen is added, it is called Renshen Baidu San).
Gegen Jiedu Tang (Puerariae Radix Decoction to Relieve Toxicity)
Ingredients: Gegen, Jingjie, Qianhu, Niubangzi, Fangfeng, Lianqiao (Forsythiae Fructus), Danzhuye (Lophatheri Herba), Renshen, Chaihu, Jiegeng, Chishao Yao, Qianghuo, Shengma, Gancao. Decoct in water and take orally.