知母六两 甘草(炙)二两 石膏一斤 粳米二合 桂枝三两
右剂,每五钱,水一盏半,煎至八分,去滓,温服,汗出愈。
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疟多寒者,名曰牝疟,蜀漆散主之。
【按】
此言牝疟,其文脱简,『内经』已详,不复释。
蜀漆(洗去腥) 云母(烧二日夜) 龙骨等分
右三味,杵为散,未发前,以浆水服半钱匕。温疟加蜀漆半分,临发时服一钱七分。
【集注】
李□曰:牝疟证多阴寒,治宜助阳温散为主。云母之根为阳起石,下有云母,上多云
气,性温气升,乃升发阳气之物;龙骨属阳,能逐阴邪而起阳气;蜀漆乃常山之苗,
功能治疟,不用根而用苗者,取其性多升发,能透达阳气于上之义也。温疟加蜀漆,
亦取其升散之功。
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夫风之为病,当半身不遂,或但臂不遂者,此为痹,脉微而数,中风使然。
【注】
风病,『内经』论之详矣。但往往与痹合论,后人惑之,故仲景复言之曰:风之为病
,当半身不遂,即经所谓偏枯也,或但两臂不遂者,非中风也,即痹病也。盖痹为阴
病,脉多沉涩,风为阳病,脉多浮缓,今脉微而数,中风使然。其脉微者,正气虚也
,数者,邪气胜也。故病风中之人,因虚而召风者,未有不见微弱之脉者也;因热而
生风者,未有不见数急之脉者也。
【集注】
沈明宗曰:此分中风与痹也。风之为病,非伤于卫,即浸于荣,故当半身不遂,谓半
身之气伤而不用也。若但臂不遂,此为痹;痹者,闭也,谓一节之气,闭而不仁也。
于是诊之于脉,必微而数;微者,阳之微也;数者,风之数也,此中风使然,谓风乘
虚入,而后使半身不遂也。
@@@
寸口脉浮而紧,紧则为寒,浮则为虚,寒虚相抟,邪在皮肤,浮者血虚,络脉空虚,
贼邪不泻,或左或右,邪气反缓,正气即急,正气引邪,喎僻不遂。邪在于络,肌肤
不仁;邪在于经,即重不胜;邪入于府,即不识人;邪入于藏,舌则难言,口吐涎。
【按】
「寸口脉浮而紧,紧则为寒,浮则为虚,寒虚相抟,邪在皮肤,」此五句与本条文义
不属,当在后条之首。后条「寸口脉迟而缓,迟则为寒,缓则为虚;荣缓则为亡血,
卫缓则为中风;邪气中经,」此六句亦与本条文义不属,当在此条之首,文气相属,
必是错简。其中有「浮者血虚」一句,必是衍文。浮则为虚,寒虚相抟,二「虚」字
当是「风」字,是传写之□。
【注】
中风虚邪之脉,皆当浮缓,以浮主风,缓主虚也。荣分见缓,经络之血亡也;卫分见
缓,经络之气空也,盖邪风中人,未有不由经络血气空虚而中也。贼邪不泻,留而不
去,在左则病左,在右则病右,浅则病经络,深则病藏府。邪在于络,则为病肌肤,
麻木不仁也;邪在于经,则为病身肢偏重,喎斜不遂也;邪入于府,则为病九窍闭不
识人也;邪入于藏,则为病舌瘖难言唇缓吐涎也。
@@@
寸口脉迟而缓,迟则为寒,缓为为虚;荣缓则为亡血,卫缓则为中风;邪气中经,则
身痒而瘾疹;心气不足,邪气入中,则胸满而气短。
【按】
寸口脉迟而缓,迟则为寒,二「迟」字当是「浮」字,「寒」字当是「风」字,始得
文义了然,且迟、缓二脉不能并见,必是传写之□。
【注】
上条发明虚邪贼风之为病,此条发明荣卫风寒之为病也。寸口脉浮而紧,紧则为寒,
浮则为风,风寒之邪,相搏于表,郁于皮肤经络,则令人身痒而发瘾疹也。若其人心
气不足,谓心胸之气不足,而邪气入心胸,故令人胸满而短气也。
@@@
寸口脉沉而弱,沉即主骨,弱即主筋,沉即为肾,弱即为肝,汗出入水中,如水伤心
,历节黄汗出,故曰历节。
【注】
寸口脉沉而弱,肝肾之气不足也。盖肝主筋,肾主骨,肝肾不足,筋骨痿缓,一为风
寒湿邪所乘,即病筋骨关节交会之处。夫人汗出时,腠理开,风尚易入,况入水中浴
,焉得不致寒耶!水伤心,心主汗,汗郁成湿,故风胜为历节,湿胜为黄汗出也。
【集注】
赵良曰:肾主水,骨与之合,故脉沉者,病在骨也。肝藏血,筋与之合,血虚则脉弱
,故病在筋也。心主汗,汗出入水,其汗为水所阻,水汗相抟,聚以成湿,久变为热
,湿热相蒸,是以历节发出黄汗也。
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味酸则伤筋,筋伤则缓,名曰泄,咸则伤骨,骨伤则痿,名曰枯;枯泄相搏,名曰断
泄。荣气不通,卫不独行,荣卫俱微,三焦无所御,四属断绝,身体羸瘦,独足肿大
,黄汗出,胫冷,假令发热,便为历节也。病历节,不可屈伸,疼痛,乌头汤主之。
【按】
名曰断泄之「泄」字,当是「绝」字,始与下文相属,必是传写之□。
【注】
此详申上条,互发其义,以明其治也。历节之病,属肝、肾虚,肝、肾不足于内,筋
骨不荣于外,客邪始得乘之而为是病也。究其所以致虚之由,不止一端也。如饮食之
味过伤,日久亦为是病也。味过于酸则伤肝,肝伤则筋伤,筋伤则缓不收持,名曰泄
也。味过于咸则伤肾,伤肾则骨伤,骨伤则枯不能立,名曰枯也。枯泄相搏,名曰断
绝,断绝者,即荣气不通,卫不独行,荣卫俱虚,三焦失所,四维断绝,身体羸瘦也
。若独足肿胫冷,寒胜凝于下也;黄汗自出,湿胜发于中也。假令发热,则属风,便
为历节也。病历节者,历节疼痛不能屈伸也,故主之以乌头汤,通荣行卫,并驱风寒
湿之邪也。以蜜制乌头,亦缓毒法耳!
【集注】
沈明宗曰:『金匮』补示饮食内伤脾、胃、心、肺、肝、肾致病,名曰历节。然出脉
证,皆因饮酒,湿壅内热而招外邪合病。谓饮酒汗出当风所致,即邪之所凑,其气必
虚是矣。或外风而合内湿,外寒而合内湿,内寒而招外湿,内热而招外湿,此等关头
,不可不晓。又当分别风、寒、湿气,偏多偏少,而处发表、温中、行阳、补虚、散
邪之法,故治此当与『灵素』、『金匮』合看则备,若泛用成方,则非良工所为之事
也。
Rhizoma Anemarrhenae (Zhimu) 6 liang, Radix Glycyrrhizae Preparata (Zhigancao) 2 liang, Fructus Coicis (Shigao) 1 jin, Oryza Sativa (Jingmi) 2 he, Ramulus Cinnamomi (Guizhi) 3 liang.
The above five ingredients: take 5 qian per dose, add 1.5 sheng of water, decoct until 0.8 sheng remains, strain the dregs, and take warm orally. Recovery occurs with sweating.
In malaria where chills predominate over fever, it is called Pin Malaria (Malaria with predominant cold pathogen), treated with Shuqi San.
[Commentary]
This discusses Pin Malaria; the original text has lacunae and bamboo slip errors. It is detailed in Huangdi Neijing (The Yellow Emperor's Inner Canon), so no further explanation is given here.
Herba Descurainiae (Shuqi) (washed to remove fishy odor), Natrii Molybdate (Yunmu) (calcined for two days and nights), Os Draconis (Longgu), equal parts.
The above three ingredients are pounded into a powder. Before the onset of malaria, administer half a Qianbi (ancient measure) with Jiangshui (fermented grain water). For Wen Malaria (Warm Malaria), add half a Qianbi of Shuqi, administered at the time of onset, one Qian and seven fen.
[Collected Notes]
Li [Name missing] stated: The symptoms of Pin Malaria are predominantly Yin-cold; treatment should primarily focus on assisting Yang and warming to disperse. Yunmu's root is Yangqishi (Radix Actinolithi); below Yunmu lies Yangqishi, and above Yunmu there is often cloud vapor. Its nature is warm and its Qi ascends; it is a substance that raises and develops Yang Qi. Longgu belongs to Yang, can expel Yin pathogens and raise Yang Qi. Shuqi is the sprout of Changshan (Rhizoma Dichroae), whose function is to treat malaria. Using the sprout instead of the root is to take advantage of its ascending nature, which can penetrate and reach Yang Qi upwards. Adding Shuqi to Warm Malaria also utilizes its ascending and dispersing efficacy.
Wind disease manifests as hemiplegia (half-body paralysis), or only arm paralysis; this is Bi Syndrome (Obstruction Syndrome). The pulse is faint and rapid; this is caused by Zhongfeng (Wind Stroke).
[Annotation]
Wind diseases were discussed in detail in Huangdi Neijing. However, they were often discussed together with Bi Syndrome, confusing later generations. Therefore, Zhang Zhongjing reiterated: Wind disease should manifest as hemiplegia, which is what the classics call Pianku (Hemiplegia). If only both arms are paralyzed, it is not Zhongfeng, but Bi disease. Bi is a Yin disease, with pulses mostly deep and choppy; Wind is a Yang disease, with pulses mostly floating and relaxed. Now the pulse is faint and rapid, which is due to Zhongfeng. A faint pulse indicates deficiency of Righteous Qi (Zhengqi); a rapid pulse indicates excess of Pathogenic Qi. Thus, patients suffering from wind invasion due to deficiency invariably show a faint pulse; those developing wind due to heat invariably show a rapid and urgent pulse.
[Collected Notes]
Shen Mingzong stated: This distinguishes between Zhongfeng and Bi. Wind disease either injures Wei Qi (Defensive Qi) or permeates Ying Qi (Nutritive Qi), hence hemiplegia occurs, meaning the Qi of half the body is injured and non-functional. If only the arms are paralyzed, this is Bi; Bi means obstruction, referring to the obstruction of Qi in a specific segment leading to insensitivity. Upon pulse diagnosis, it must be faint and rapid; faintness indicates weak Yang; rapidity indicates frequent Wind. This is caused by Zhongfeng, meaning Wind enters due to deficiency, subsequently causing hemiplegia.
At the Cun Kou (Radial artery) position, the pulse is floating and tight. Tightness indicates Cold; Floating indicates Deficiency. Cold and Deficiency contend with each other; the pathogen is in the skin. Floating indicates Blood deficiency; collateral vessels are empty. The thief pathogen (external evil) cannot be discharged. It may affect the left or the right. Where the pathogen resides, muscles become flaccid; where Righteous Qi resides, muscles become tense. Righteous Qi pulls the pathogen, resulting in facial deviation (Kwai Pi) and inability to move freely. If the pathogen is in the collaterals, the skin and flesh are numb and insensitive. If the pathogen is in the meridians, the body feels heavy and difficult to lift. If the pathogen enters the Fu organs, consciousness is lost and the person does not recognize others. If the pathogen enters the Zang organs, speech becomes difficult, and saliva dribbles from the mouth.
[Commentary]
"The Cun Kou pulse is floating and tight, tightness indicates Cold, floating indicates Deficiency, Cold and Deficiency contend, the pathogen is in the skin" – these five sentences do not belong to the context of this article and should be placed at the beginning of the next article. "Cun Kou pulse is slow and relaxed, slowness indicates Cold, relaxation indicates Deficiency; Relaxation in Ying leads to Blood loss, Relaxation in Wei leads to Zhongfeng; Pathogen strikes the meridian" – these six sentences also do not belong to the context of this article and should be placed at the beginning of this article, so that the textual flow is coherent. This must be a result of bamboo slip disorder. The phrase "Floating indicates Blood deficiency" is likely an interpolation. In "Floating indicates Deficiency" and "Cold and Deficiency contend," the two characters "Deficiency" should be "Wind," which is a transcription error.
[Annotation]
The pulses for Zhongfeng and deficient pathogens should all be floating and relaxed, as Floating governs Wind and Relaxed governs Deficiency. Seeing a relaxed pulse in the Ying aspect indicates depletion of blood in the meridians; seeing a relaxed pulse in the Wei aspect indicates emptiness of Qi in the meridians. Generally, when Wind pathogen invades humans, it does so through empty meridians, blood, and Qi. When the thief pathogen cannot be discharged and stays without leaving, if on the left, the left side suffers; if on the right, the right side suffers. Superficially, it affects meridians and collaterals; deeply, it affects Zang and Fu organs. If the pathogen is in the collaterals, it causes numbness and insensitivity of the skin and flesh; if in the meridians, it causes heaviness of the limbs, facial deviation, and inability to move freely; if entering the Fu organs, it causes closure of the nine orifices and unconsciousness; if entering the Zang organs, it causes aphasia and drooling.
At the Cun Kou position, the pulse is slow and relaxed. Slowness indicates Cold; relaxation indicates Deficiency. Relaxation in Ying indicates Blood loss; relaxation in Wei indicates Zhongfeng. If the pathogen strikes the meridians, the body itches and urticaria (wind wheals) appear. If Heart Qi is insufficient, and the pathogen enters the center, chest fullness and shortness of breath occur.
[Commentary]
"Cun Kou pulse is slow and relaxed, slowness indicates Cold." The two characters "Slow" should be "Floating," and the character "Cold" should be "Wind," so that the meaning becomes clear. Moreover, Slow and Relaxed pulses cannot coexist; this must be a transcription error.
[Annotation]
The previous article elucidated diseases caused by deficient and thief winds; this article elucidates diseases caused by Ying-Wei, Wind, and Cold. Cun Kou pulse floating and tight: tightness indicates Cold, floating indicates Wind. Wind and Cold pathogens contend at the exterior, stagnating in the skin and meridians, causing body itching and urticaria. If the person has insufficient Heart Qi, meaning insufficiency of Qi in the heart and chest, and the pathogen enters the heart and chest, it causes chest fullness and shortness of breath.
At the Cun Kou position, the pulse is deep and weak. Deepness governs bones; weakness governs sinews. Deepness corresponds to Kidney; weakness corresponds to Liver. Sweating and then entering water, as if water injures the Heart, Lijie (Periarthritis/Joint Pain) presents with yellow sweat, thus it is called Lijie.
[Annotation]
Cun Kou pulse deep and weak indicates insufficiency of Liver and Kidney Qi. The Liver governs sinews, and the Kidney governs bones. Insufficiency of Liver and Kidney leads to flaccidity and weakness of sinews and bones. Once attacked by Wind-Cold-Damp pathogens, disease occurs at the junctions of sinews, bones, and joints. When a person sweats, the pores are open, and Wind easily enters. How much more so when bathing in water, inevitably leading to Cold! Water injuring the Heart: the Heart governs sweat. Sweat stagnates and transforms into Dampness. Thus, Wind dominance causes Lijie, and Damp dominance causes yellow sweat.
[Collected Notes]
Zhao Liang said: The Kidney governs Water and combines with Bones, so a deep pulse indicates disease in the bones. The Liver stores Blood and combines with Sinews; Blood deficiency leads to a weak pulse, so disease is in the sinews. The Heart governs sweat. Entering water while sweating, the sweat is obstructed by water. Water and sweat contend, gathering to form Dampness. Over time, it transforms into Heat. Heat and Dampness steam each other, causing yellow sweat in Lijie.
Sour taste injures sinews; sinew injury leads to flaccidity, called Xie (Leakage). Salty taste injures bones; bone injury leads to atrophy, called Ku (Withered). Withered and Leakage contend, called Duanxie (Severance and Leakage). Ying Qi circulation is blocked, Wei Qi cannot circulate independently. Ying and Wei are both diminished, the San Jiao (Triple Burner) loses control, the four extremities are severed, the body becomes emaciated, only the feet swell, yellow sweat appears, calves are cold. If fever occurs, it becomes Lijie disease. Patients with Lijie cannot flex or extend, experiencing pain; Wutou Tang is indicated.
[Commentary]
The character "Xie" in "Duanxie" should be "Jue" (Severance), to connect with the following text; this must be a transcription error.
[Annotation]
This elaborates on the previous article, mutually explaining the meaning to clarify treatment. Lijie disease belongs to Liver and Kidney deficiency. Insufficiency of Liver and Kidney internally leads to lack of nourishment of sinews and bones externally, allowing exogenous pathogens to invade and cause this disease. The reasons for this deficiency are manifold. Prolonged excessive consumption of flavors can also cause this disease. Excessive sour flavor injures the Liver; Liver injury injures sinews; sinew injury leads to flaccidity and inability to hold, called Xie. Excessive salty flavor injures the Kidney; Kidney injury injures bones; bone injury leads to withering and inability to stand, called Ku. Withered and Xie contend, called Duanjue (Severance). Duanjue means Ying Qi is blocked, Wei Qi cannot circulate independently, Ying and Wei are both deficient, the San Jiao loses its domain, the four limbs are severed, and the body is emaciated. If only the feet swell and calves are cold, it is Cold dominance congealing below. If yellow sweat spontaneously appears, it is Damp dominance manifesting in the middle. If fever occurs, it belongs to Wind, becoming Lijie. Lijie is characterized by joint pain and inability to flex or extend; therefore, Wutou Tang is used to unblock Ying, promote Wei, and drive out Wind, Cold, and Damp pathogens. Processing Wutou (Radix Aconiti Lateralis Preparata) with honey is a method to mitigate its toxicity.
[Collected Notes]
Shen Mingzong stated: Jingui Yaolue supplements that dietary internal injury to Spleen, Stomach, Heart, Lung, Liver, and Kidney causes disease, called Lijie. However, the presented pulse and symptoms are all due to alcohol consumption, internal dampness and heat attracting external pathogens to combine. It is said that sweating after drinking and exposing oneself to wind causes it, illustrating that "where the pathogen gathers, the Qi must be deficient." Whether external Wind combines with internal Damp, external Cold combines with internal Damp, internal Cold attracts external Damp, or internal Heat attracts external Damp, these critical junctures must be understood. One must distinguish whether Wind, Cold, or Dampness predominates, and formulate methods for releasing the exterior, warming the interior, promoting Yang, tonifying deficiency, and dispersing pathogens. Therefore, treating this requires consulting Ling Shu, Su Wen, and Jingui Yaolue together for completeness. Blindly using established formulas is not the work of a skilled physician.