猪苓(去皮) 茯苓 泽泻 滑石(碎) 阿胶(各一两)
上五味以水四升先煎四味取二升去滓内下阿胶烊消温服七合日三服
发汗多若重发汗者亡其阳谵语脉短者死脉自和者不死
汗多亡阳神败而发谵语脉短者阳绝乃死脉自和者阳复则生此申明上章发汗则躁心愦愦反谵语之义
直视谵语喘满者死下利者亦死
直视谵语阳亡而神败也喘满则胃逆而阳上脱下利则脾陷而阳下脱是以皆死
夫实则谵语虚则郑声郑声重语也
阳实则为谵语阳虚则为郑声郑声之义语之繁絮重复者实者上编之胃家实是也虚者本篇之胃中虚冷是也此申明上亡阳
谵语之义
阳明病下之其外有热手足温不结胸心中懊 饥不能食但头汗出者栀子豉汤主之(方在太阳八十九)
下伤中气阳浮于表故外有热而手足温胃中空虚客气动膈故成结胸(义在结胸)今不成结胸只觉心中懊 饥不能饮食
者膈下之阴与膈上之阳逼迫郁蒸而生瘀浊故也膈热薰腾故头上汗出此宜栀子豉汤吐瘀浊而清烦热也此申明六十五章若下
之胃中空虚客气动膈心中懊 舌上苔者栀子豉汤主之一段之义
三阳合病腹满身重难以转侧口不仁而面垢谵语遗尿发汗则谵语下之则额上生汗手足逆冷(此阳明入太阴去路)若自
汗者白虎汤主之(方在太阳三十七此阳明承气初证)
六十五章脉浮而紧为太阳证咽燥口干为少阳证发热汗出不恶寒反恶热为阳明证是三阳合病也而其腹满身重以至难以
转侧则太阴证脾窍于口阳虚湿盛开阖蹇涩故口不仁木主五色土湿木郁气色晦暗是以面垢神明不慧是以谵语膀胱失约是以
遗尿(此补六十五章未详之义也)若发汗则为郑声之谵语(此复申明若发汗则心愦愦反谵语一段)若下之则额上生汗手
足厥冷阳泄而土败(此复申明上章手足温头汗出之义而推展之头汗肢温是阳虚而上热额汗肢冷是阳泄而外寒也)若汗不
止头额而通身自汗者则津亡而土燥宜白虎汤泄热而清金也此复申六十五章白虎汤之义
Zhu Ling (Polyporus, with skin removed), Fu Ling (Poria), Ze Xie (Alisma), Hua Shi (Talcum, crushed), E Jiao (Donkey-hide Gelatin) (each one tael).
Take the above five herbs, add four sheng of water, first decoct the first four herbs to obtain two sheng of liquid, remove the dregs, then add the E Jiao and melt it. Take seven ge warm each time, three times a day.
If sweating is excessive, or if sweating is induced again after initial sweating, Yang collapse (collapse of Yang qi) occurs, accompanied by delirium (incoherent speech due to mental confusion). If the pulse is short, death ensues; if the pulse is harmonious, survival is possible.
Excessive sweating leads to Yang collapse and deterioration of Shen (spirit), resulting in delirium. A short pulse indicates the exhaustion of Yang qi, hence death; a self-harmonious pulse indicates the recovery of Yang qi, hence life. This clarifies the meaning of the previous chapter: "Sweating induces restlessness, mental confusion, and conversely, delirium."
Staring fixedly, delirium, and wheezing with chest fullness indicate death; diarrhea also indicates death.
Staring fixedly and delirium signify the loss of Yang qi and deterioration of Shen. Wheezing and chest fullness indicate rebellious Stomach qi and the upward collapse of Yang; diarrhea indicates sinking Spleen qi and the downward collapse of Yang. Therefore, both conditions lead to death.
Excess patterns manifest as delirium; deficiency patterns manifest as Zheng Sheng (repetitive, low-voiced muttering). Zheng Sheng refers to verbose and repetitive speech.
Yang excess results in delirium; Yang deficiency results in Zheng Sheng. "Excess" refers to what was described in the upper volume as "Stomach House Excess" (fullness in the Stomach); "deficiency" refers to what is described in this chapter as "Cold Deficiency in the Stomach." This clarifies the meaning of the preceding discussion on Yang collapse and delirium.
In Yangming disease, after purgation, if there is heat on the exterior, warmth of the hands and feet, no formation of Jie Xiong (chest binding), mental agitation (Ao Nao), hunger but inability to eat, and only sweating on the head, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be administered. (Formula found in Taiyang Chapter 89).
Purgation damages Middle Qi, causing Yang to float to the exterior, hence external heat and warm hands and feet. The Stomach becomes empty, allowing hostile qi to disturb the diaphragm, which typically leads to Jie Xiong (see Jie Xiong section). However, since Jie Xiong has not formed here, but rather mental agitation, hunger without ability to eat, it is because Yin below the diaphragm and Yang above the diaphragm are forcing each other, leading to stagnation, steaming, and generation of turbid stasis. Heat steaming from the diaphragm causes sweating on the head. In this case, Zhi Zi Chi Tang is appropriate to induce vomiting of turbid stasis and clear烦热 (restless heat). This clarifies the meaning of the passage in Chapter 65: "If purged, the Stomach becomes empty, hostile qi disturbs the diaphragm, causing mental agitation and coating on the tongue; Zhi Zi Chi Tang should be administered."
San Yang He Bing (Concurrent disease of the Three Yang channels: Taiyang, Shaoyang, and Yangming): abdominal fullness, heaviness of the body, difficulty in turning over, numbness of the mouth (Kou Bu Ren) with a greasy facial appearance, delirium, and urinary incontinence. If sweating is induced, delirium worsens; if purgation is used, sweating appears only on the forehead with cold extremities (this is the pathway for Yangming disease transitioning to Taiyin). If there is spontaneous sweating of the whole body, Bai Hu Tang (White Tiger Decoction) should be administered. (Formula found in Taiyang Chapter 37; this is the initial stage of Yangming Cheng Qi Tang syndrome).
Chapter 65 states: Floating and tight pulse is a Taiyang syndrome; dry throat and mouth is a Shaoyang syndrome; fever, sweating, aversion to heat rather than cold is a Yangming syndrome. These constitute San Yang He Bing. The abdominal fullness and body heaviness, extending to difficulty in turning over, are Taiyin symptoms. The Spleen opens into the mouth; Yang deficiency with dampness abundance causes obstruction in opening and closing, leading to numbness of the mouth. Wood governs the five colors; Earth dampness stagnates Wood, causing dull complexion, hence the greasy face. Lack of clarity in Shen leads to delirium. Loss of control in the Bladder leads to urinary incontinence (this supplements the details omitted in Chapter 65). If sweating is induced, it results in Zheng Sheng-like delirium (reiterating "if sweated, mental confusion and delirium occur"). If purged, sweating on the forehead and cold extremities occur, indicating Yang leakage and failure of Earth (Spleen/Stomach) (reiterating and expanding upon the previous chapter's "warm hands/feet and head sweat": head sweat with warm limbs indicates Yang deficiency with upper heat; forehead sweat with cold limbs indicates Yang leakage with external cold). If sweating is not limited to the head and forehead but is spontaneous sweating of the entire body, it indicates loss of Jin Ye (body fluids) and dryness of Earth (Spleen/Stomach). Bai Hu Tang is suitable to drain heat and clear Metal (Lung). This reiterates the significance of Bai Hu Tang in Chapter 65.