医学衷中参西录:治疟疾方

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第二十七章.治疟疾方

Chapter 27. herbs for malaria

 

加味小柴胡汤

Jiawei Xiao Chaihu Tang

 

治久疟不愈,脉象弦而无力。
This formula is used for malaria, which has last for a long time with string and weak pulse.

 

柴胡(三钱) 黄芩(二钱) 知母(三钱) 潞参(三钱) 鳖甲(三钱,醋炙) 半夏(二钱)常山(钱半,酒炒) 草果(一钱) 甘草(一钱) 酒曲(三钱) 生姜(三钱) 大枣(两枚,捭开)
Chaihu 9 gram, Huangqin 6 gram, Zhimu 9 gram, Dangshen 9 gram, Biejia 9 gram (processed with venigar), Banxia 6 gram, Changshan 4.5 gram (fry with liqor), Caoguo 3 gram, Gancao 3 gram, wine ferment agent 9 gram, fresh ginger 9 gram, Chinese date two (open it).

 

疟初起者减潞参、鳖甲。热甚者,加生石膏五六钱或至一两。寒甚者,再加草果五分或至一钱。(神曲皆发不好故方中用酒曲)
If the malaria has shot history, remove the Dangshen and Biejia. If the Hotness is severe, add Shigao up to 30 gram. If the Cold is severe, add additional Caoguo 3 gram.

 

疟邪不专在少阳,而实以少阳为主,故其六脉恒露弦象。其先寒者,少阳之邪外与太阳并也,其后热者,少阳之邪内与阳明并也。故方中用柴胡以升少阳之邪,草果生姜以祛太阳之寒,黄芩知母以清阳明之热。又疟之成也,多挟痰挟食,故用半夏常山以豁痰,酒曲以消食也。用人参,因其疟久气虚,扶其正即所以逐邪外出。用鳖甲者,因疟久则胁下结有痞积(方书名疟母实由肝脾胀大),消其痞积,然后能断疟根株。用甘草大枣者,所以化常山之猛烈而服之不至瞑眩也。


The malaria does not only stay in the Shaoyang meridian, but it indeed focuses on the Shaoyang meridian. Therefore the pulse in all positions shows string feeling. If the person feels cold first, then hot, it means the Shaoyang Xie Qi is combined with the Taiyang; if the person feels hot first, then cold, it means the Shaoyang Xie Qi is combined with the Yangming. The herb Chaihu is to raise the Shaoyang Xie Qi to the body surface; the Caoguo and fresh ginger are to expel the Taiyang Coldness; and the herb Huangqin and Zhimu are to clear the Yangming Hotness. The mature malaria usually combines phlegm and food. So, the herb Banxia and Changshan are sued to clear the phlegm; the wine ferment agent is to dissolve accumulated, non-digested food. The Renshen is to support the body defense Qi in weak person due to long term of the malaria exhausting, so to allow the body to expel the Xie Qi out. After a long time of malaria, the person may have mass (enlarged spleen and liver). The Biejia is used to dissolve the mass, and to kill the root of the malaria. The Cancao and the Chinese date work to dissolve the side effect of the Changshan, the dizziness, due to the strong function of the Changshan.

 

或问:叶天士医案,其治疟之方,多不用柴胡。其门人又有根传之说,谓不宜用柴胡治疟。若误用之,实足偾事。其说果可信乎?答曰:叶氏当日声价甚高,疟原小疾,初起之时,鲜有延之延医者。迨至疟久,而虚证歧出,恒有疟邪反轻,而他病转重,但将其病之重者治愈,而疟亦可随愈,此乃临证通变之法,非治疟之正法也。至于病在厥阴,亦有先寒后热,出汗少愈,形状类疟之证。此系肝气虚极将脱,若误认为疟,用柴胡升之,凶危立见。此当重用山萸肉,以敛而补之,是以《神农本草经》山茱萸,亦主寒热也。叶氏门人所谓,误用柴胡足偾事者,大抵指此类耳。
It might be asked: in the case reports from Dr. Ye Tianshi, most of his formulas for the malaria did not use herb Chaihu. His followers said they were educated from generation to generation that Chaihu is not good in the treatment of malaria. If it is used, the treatment would fail and cause trouble. Can this theory be believed? Answer: the reputation of Dr. Ye was very high at that time. The malaria was originally small disease. When it was in early stage, it was easy to solve. It was rare that the patient needed to change doctor. If the disease had been delayed for a long time, various ashenic conditions developed, while the original malaria per se usually became less severe than those asthenic conditions. When the asthenic conditions were solved, the malaria was also cured at the same time. This is the therapy based on the person’s body condition and the disease situation. It is not a formal or a routine way for the treatment of malaria. If a Shanghan disease is in the Yuejin stage, the person could also have a first cold, then hot condition, in which the hot can be slightly reduced after a sweat, which is similar to the malaria. This is a condition, in which the Liver Qi is extremely weak and is to escape. If it is mis-diagnosed as malaria, and use Chaihu for the treatment, the life would be in very danger to loss. For this condition, large amount of Shanyurou should be used to restrain and to nourish the Liver. This is as indicated in the book
Shennong Bencao Jingthat the herb Shanyurou can dominate the treatment for cold and hot. The followers of Dr. Ye, saying that to use herb Chaihu in the treatment of malaria might cause problem, might mean this.

 

或问:叶氏治疟,遇其人阴虚燥热者,恒以青蒿柴胡。后之论者,皆赞其用药,得化裁通变之妙。不知青蒿果可以代柴胡乎?答曰:疟邪伏于胁下两板油中,乃足少阳经之大都会。柴胡之力,能入其中,升提疟邪透膈上出,而青蒿无斯力也。若遇阴虚者,或热入于血分者,不妨多用滋阴凉血之药佐之。若遇燥热者,或热盛于气分者,不妨多用清燥散火之药佐之。曾治一人,疟间日一发,热时若燔,即不发疟之日,亦觉心中发热,舌燥口干,脉象弦长(凡疟脉皆弦)重按甚实,知其阳明火盛也。投以大剂白虎汤,加柴胡三钱。服后顿觉心中清爽,翌晨疟即未发。又煎前剂之半,加生姜三钱,服之而愈。
It might be also asked: When Dr. Ye treated malaria, if the patient was with dry-hot in Yin deficiency, he always used Qinghao to replace the Chaihu. Later doctors also admired his such herbal therapy as very smart way. Would the Chaihu be replaced by the herb Qinghao? Answer: the malaria Xie Qi hided in the oil layer in the side of abdomen, which is the capital place for the Shaoyang meridian. The herb Chaihu can go in the oil layer, bring the Xie Qi up, over the diagram, and out of the body, but the herb Qinghao however has no such effect. If the person has Yin deficiency with Hot in the blood, it is better to use more Yin-nourishing herbs to cool the fire in the blood. If the person has Dry-Hot condition, or the Hot is overwhelming in the Qi portion of the body, it is better to use herbs that work to clear the Dryness and to clear the Fire. I treated a man. He had malaria once every other day. When he felt hot, the hot was very high. Even if it was the day without the outbreak of the malaria, he still felt hot in the heart, dry tongue and mouth. His pulse was string and long (the malaria pulse is always string), which is shenic when pressed harder. It was considered as Fire overwhelming in the Yangming stage. He was given large amount of Baihu Tang, with addition of Chaihu 9 gram. After the drink of the herbal tea, he felt very clear and nicely cool in the heart. The next day, the malaria had no outbreak. The herbal formula was again used in half dose, and cooked, with addition of fresh ginger 9 gram. It solved his malaria completely. 

 

又尝治一人得温病,热入阳明之府,舌苔黄浓,脉象洪长,又间日一作寒热,此温而兼疟也。然其人素有鸦片嗜好,病虽实,而身体素虚。投以拙拟白虎加人参麦冬知母山药代粳米汤,亦少加柴胡,两剂而愈。
I also treated a man who had Wen disease. The hotness was in the Yangming stage. His tongue was yellow in color and thick; his pulse was waving and long. He had also felt cold-hot shift once every other day. This is the co-exist of the Wen disease and malaria. This man had also craving for opium. The disease is sthenic, but his body is very weak (asthenic). He was given the Baihu Jia Renshen Tang, with the Maimendong to replace the Zhimu, and Shanyao to replace the Genmin, and with addition of little Chaihu. Two doses solved his all problems.

 

西人治疟,恒用金鸡纳霜,于未发疟之日,午间、晚间各服半瓦,白糖水送下。至翌晨又如此服一次,其疟即愈。
In the treatment of malaria, western medicine used quinine. It was taken half tablet on the noon, and half tablet in the evening, with the help of the white sugar water fro swallow, on the day without the outbreak of the malaria. It is repeated the next morning. The malaria was cured.

 

方书谓冬冷多温病,夏热多疟疾。此言冬日过冷,人身有伏寒,至春随春阳化热,即多成温病;夏日过热,人身有伏暑,至秋为薄寒所激发,即多生疟疾也。丁卯季夏,暑热异常,京津一带因热而死者甚多,至秋果多疟疾。服西药金鸡纳霜亦可愈,而愈后恒屡次反复。姻家王姓少年,寄居津门,服金鸡纳霜愈疟三次后,又反复。连服前药数次,竟毫无效验。诊其脉,左右皆弦长有力。夫弦为疟脉,其长而有力者,显系有伏暑之热也。为开白虎汤方,重用生石膏二两,又加柴胡何首乌各二钱,一剂而疟愈。恐未除根,即原方又服一剂,从此而病不反复矣。此方用白虎汤以解伏暑,而又加柴胡何首乌者,凡外感之证其脉有弦象者,必兼有少阳之病,宜用柴胡清之;而外邪久在少阳,其经必虚,又宜用何首乌补之。二药并用,一扶正,一逐邪也。少阳与阳明并治,是以伏暑愈而疟亦随愈也。
In medical books, it said that, if the winter is very cold, there would have Wen disease. If the summer is very hot, there would have malaria. It means that if the winter is too cold, the Cold will hide inside the body. The Cold will develop int Hot in spring with the Yang Qi raising in the spring, so to develop into a Wen disease. If the summer is too hot, the Hotness will invade in the body to hide. In the following autumn, the hidden Hotness would be triggered out by the slight cold in the autumn, so as to develop into the malaria. One year, it was very hot in summer. There were many people died from the hot weather. In that autumn, indeed, there were many malarias cases. The malaria could be cured with quinine too. However, the malaria usually recurred again and again. A youth, Mr. Wang, who lived in the home of his relatives in Tianjing city, had malaria and were treated with quinine three times. His malaria recurred and it could not be cured after taking of the quinine several times. His pulse was string and long on both sides. String pulse suggests the malaria and the long and strong pulse indicates the hidden hot. He was given the Baihu Tang, in which the Shigao was 60 gram, with addition of Chaihu 6 gram, and Heshouwu 6 gram. One dose cured the malaria. For worrying that the malaria might not be cured from the root, this formula was repeated again once. The malaria never came back. For him, the Baihu Tang was to clear the hidden Fire. The reason for addition of Chaihu and Heshouwu is that the string pulse showed in a common cold indicates the Xie Qi in the Shaoyang stage. The herb Chaihu was used to clear the Xie Qi in the Shaoyang. If the Xie Qi remained in the Shaoyang meridian for a long time, the Shaoyang meridian must be asthenic (weak), the Heshouwu was used to nourish the Shaoyang meridian. So, the Chaihu is to clear the Xie Qi, and the Heshouwu is to nourish the body. The Shaoyang and the Yangming were treated the same time, so that the disease is cured in a short time.