身有微热。下利清谷者。必郁冒。汗出而解。病患必微厥。所以然者。其面戴阳。下虚故也。
【目】柯琴曰。此比上条脉症皆轻。热微厥亦微。此阴阳相等。寒热自和。故易愈。
【纲】仲景曰。吐已下断。汗出而厥。四肢拘急。不解。脉微欲绝者。通脉四逆加猪胆汁汤主
之。
【目】杨士瀛曰。加猪胆汁于通脉汤中者。反佐之法也。必有阴盛格阳之症。故用之。观白通
汤可知。
【纲】仲景曰。伤寒六七日。大下后。寸脉沉而迟。手足厥冷。下部脉不至。咽喉不利。吐脓
血。泄利不止者。为难治。伤寒六七日。脉微。手足厥冷。烦躁。灸厥阴。厥不还者死。下利。手
足逆冷。无脉者。灸之。不温。若脉不还。微喘者死。下利后。脉绝。手足厥逆。 时脉还。手足
温者生。脉不还者死。
【目】柯琴曰。寸脉沉迟。气口脉平矣。下部脉不至。根本已绝矣。诸症皆内外。水谷之道俱
绝。故此为下厥上竭。阴阳离决之候。生气将绝于内也。厥阴。肝脉也。应春生之气。故灸其五俞
而阳可回也。
三条四条两症。不呕不烦。反佐而服白通。外灸丹田气海。或可救于万一。
鳌按。三四条之生死。总以脉为凭
【纲】仲景曰。手足厥冷。脉细欲绝者。当归四逆汤主之。
下后。复发汗。昼日烦躁。不得眠。夜而安静。不呕不渴。无表症。
脉沉微。身无大热者。干姜附子汤主之。下之后。复发汗。必振寒。脉微细。所以然者。内外俱虚
故也。
【目】柯琴曰。首条。虽无外卫之微阳。亦未见内寒诸险症。二条。当汗而反下。下后又发汗。
以至纯阴无阳。而脉沉微。此四逆之变剂也。三条。内阳虚。故脉微细。外阳虚。故振栗恶寒。亦
即干姜附子症。
【纲】仲景曰。伤寒五六日。不结胸。腹濡。脉虚。复厥者。不可下。此为亡血。下之死。伤
寒脉促。手足厥者。可灸之。
【目】鳌按。脉象空虚。故为亡血。促为阳脉。阳虚而促。理固然矣。然阴气太盛。亦往往见
促脉者。总之促结代。皆是虚脉非灸不可。
【纲】仲景曰。少阴病。下利。脉微者。与白通汤。利不止。厥逆。无脉。干呕烦者。白通加
猪胆汁汤主之。服汤。脉暴出者死。微续者生。
【目】喻昌曰。与白通反至厥无脉。干呕而烦。此非药之不胜病也。以无向导之力。宜其不入
耳。故复加人尿猪胆汁之阴。以引阳药深入。然脉暴出死。微续生。亦危矣哉。
The body has slight fever. If there is diarrhea with undigested food, there will inevitably be "Yu Mao" (a sensation of dizziness and heaviness as if covered by a cloth), which will resolve through sweating. The patient must have slight coldness in the extremities. The reason for this is that the face shows "Dai Yang" (floating yang, characterized by a red flush on the face while the lower body is cold) due to deficiency in the lower jiao.
[Mu] Ke Qin said: Compared with the previous clause, both the pulse and symptoms here are milder. The heat is slight, and the coldness is also slight; this indicates an equality of yin and yang, where cold and heat naturally harmonize, so it is easy to cure.
[Gang] Zhang Zhongjing said: When vomiting and diarrhea have ceased, but sweating occurs accompanied by cold extremities, and the limbs are cramped and rigid without relief, and the pulse is faint and nearly imperceptible, Tongmai Sini Jia Zhu Danzhi Tang (Pulse-Returning Decoction of Radix Aconiti Lateralis Preparata plus Porcine Bile) should be administered.
[Mu] Yang Shiy ing said: Adding porcine bile to Tongmai Tang is a method of "fan zuo" (counter-assistance). It is used when there are symptoms of excessive yin rejecting yang. This can be understood by observing the use of Baotong Tang.
[Gang] Zhang Zhongjing said: In cold damage after six or seven days, following severe purgation, if the cun (inch) pulse is deep and slow, the hands and feet are cold, the pulses at the lower part (chi position) are absent, there is throat obstruction, hemoptysis with pus and blood, and unceasing diarrhea, it is difficult to treat. In cold damage after six or seven days, if the pulse is faint, the hands and feet are cold, and there is irritability, moxibustion should be applied to the Jueyin meridian. If the coldness does not return after moxibustion, death ensues. With diarrhea, cold reversal of the hands and feet, and absence of pulse, moxibustion should be applied. If warmth does not return and the pulse does not reappear, accompanied by slight asthma, death ensues. After diarrhea, if the pulse vanishes and the hands and feet are cold and reversed, but the pulse occasionally returns and the hands and feet become warm, life is possible; if the pulse does not return, death ensues.
[Mu] Ke Qin said: The deep and slow cun pulse suggests the qi mouth pulse appears level, but the absence of the lower pulse indicates the root is exhausted. All symptoms indicate that both internal and external pathways, including the passage of water and grain, are cut off. Thus, this is a condition of "lower coldness and upper exhaustion," a sign of separation of yin and yang, where the vital energy is about to perish within. Jueyin is the liver meridian, corresponding to the spring generating qi. Therefore, moxibustion on its five shu points can restore yang.
For the two conditions in clauses three and four, where there is no vomiting or irritability, administering Baotong Tang using the counter-assistance method, combined with external moxibustion on Qihai (CV-12) and Shenque (CV-8), might save one in ten thousand cases.
Shen Jin'ao noted: The determination of life and death in clauses three and four relies entirely on the pulse.
[Gang] Zhang Zhongjing said: For cold extremities and a pulse that is fine and nearly imperceptible, Danggui Sini Tang (Angelica Sinensis Decoction for Cold Extremities) should be administered.
After purgation, followed by re-induction of sweating, if there is irritability during the day and inability to sleep, but quietness at night, without vomiting or thirst, and without exterior symptoms, and the pulse is deep and faint, with no significant heat in the body, Ganjiang Fuzi Tang (Dried Ginger and Prepared Aconite Root Decoction) should be administered. After purgation, followed by re-induction of sweating, there will inevitably be chills and tremors, and the pulse will be faint and fine. The reason is that both interior and exterior are deficient.
[Mu] Ke Qin said: In the first clause, although there is no slight yang protecting the exterior, there are also no severe signs of interior cold. In the second clause, sweating was indicated but purgation was used instead; after purgation, sweating was induced again, leading to pure yin without yang, and a deep, faint pulse. This is a variant formula of Sini Tang. In the third clause, interior yang deficiency causes a faint and fine pulse; exterior yang deficiency causes trembling and aversion to cold. This is also the syndrome for Ganjiang Fuzi Tang.
[Gang] Zhang Zhongjing said: In cold damage after five or six days, if there is no chest binding, the abdomen is soft, the pulse is deficient, and coldness recurs, purgation is contraindicated. This is due to loss of blood; purgation will cause death. In cold damage, if the pulse is rapid (cu) and the hands and feet are cold, moxibustion may be applied.
[Mu] Shen Jin'ao noted: An empty pulse indicates loss of blood. Cu (rapid) is a yang pulse; it is logical for a deficient yang to present with a cu pulse. However, excessive yin qi often also presents with a cu pulse. In summary, cu, jie (knotted), and dai (intermittent) pulses are all deficiency pulses, requiring moxibustion.
[Gang] Zhang Zhongjing said: In Shaoyin disease, with diarrhea and a faint pulse, administer Baotong Tang. If diarrhea continues, accompanied by cold reversal, absence of pulse, dry heaving, and irritability, Baotong Jia Zhu Danzhi Tang (Baotong Decoction plus Porcine Bile) should be administered. If, after taking the decoction, the pulse suddenly emerges violently, death ensues; if the pulse gradually and continuously returns, life is possible.
[Mu] Yu Chang said: Administering Baotong Tang results in cold reversal, absence of pulse, dry heaving, and irritability. This is not because the medicine is insufficient for the disease, but because there is no guiding force, so the medicine fails to enter. Therefore, adding the yin substances of human urine and porcine bile guides the yang medicine deeply into the interior. However, a sudden violent emergence of the pulse leads to death, while a gradual continuation leads to survival; this is indeed critical.