46.百合百脉合一病, 如寒似热药无灵, 饮食起居皆忽忽, 如神若鬼
附其形. 脉数溺时辄头痛, 溺时不痛淅淅风, 溺时快然但头眩, 六四
二十病方宁.
【注】百合病者, 谓伤寒过期, 留连不解, 不分经络百脉, 悉合为一
病也. 如寒似热, 诸药无灵, 欲饮不能饮, 欲食不能食, 欲卧不能卧
,欲行不能行, 精神忽忽, 如神若鬼附其形体, 而莫知所适从也. 如
脉数、溺尿时辄头痛者, 六十日乃愈. 若溺尿时头不痛, 惟淅淅然恶
风寒者, 四十日乃愈. 若溺时快然, 但头眩者, 二十日乃愈. 故曰:
六四二十日病方宁也.
47.妇人伤寒同一治, 胎产经来热入室, 昼日明了夜谵妄, 小柴生地
牡丹皮, 无汗加麻有汗桂, 汗后不解再加枝. 寒热如疟加麻桂, 中寒
姜附不须疑, 渴热白虎花粉葛, 瘀血桃仁承气俱. 产后胎前虽多证,
不外阴阳表里医.
【注】妇人伤寒, 与男子治法同也. 惟产后经来, 邪热乘虚而入血室
,另有治法. 热入血室之证, 书日明了, 夜则谵语妄见鬼状, 宜小柴
胡汤加生地丹皮. 若无汗则为表实, 加麻黄汗之. 有汗则为表虚, 加
桂枝解之. 若有发热恶寒之表, 巳经发汗, 虽无汗不加麻黄, 再加桂
枝以解之, 不可复用麻黄也. 若有如疟之寒热, 加麻黄桂枝两解之.
若厥而下痢, 则为中寒, 去黄芩加姜, 附, 不须疑也. 若发热烦渴,
则为里热, 去半夏合白虎, 或加花粉葛根. 胸胁少腹或满硬、或作痛
,则为瘀血, 宜合桃仁承气汤攻之. 产后胎前虽有多证, 不能尽述,
总不外阴阳表里之治, 在临证者以意消息之耳.
46. The Baihe disease (Lily Disease) is a condition where the hundred vessels unite into one pathology. Its symptoms resemble cold but are not true cold, and resemble heat but are not true heat; various medications prove ineffective. The patient's diet, daily activities, and mental state are erratic and fluctuating, feeling as if possessed by spirits or ghosts. If the pulse is rapid and headache occurs immediately upon urination, the illness will subside after sixty days. If there is no pain during urination but only a sensation of chilliness and aversion to wind and cold, it will subside after forty days. If urination feels comfortable but dizziness persists, it will subside after twenty days. Thus it is said: "Six times four [twenty-four] days, the illness calms down" (referring to the prognosis based on symptom patterns).
[Note] Baihe disease refers to a condition where, following a Taiyang cold damage syndrome that has passed its expected duration, the pathogenic factor lingers unresolved. It does not distinguish between meridians, causing the qi of all hundred vessels to congregate into a single pathological presentation. Symptoms include resembling cold or heat while resisting treatment with various drugs; desire to drink but inability to swallow, desire to eat but inability to consume, desire to sleep but inability to rest, desire to walk but inability to move. The spirit is erratic and fluctuating, feeling as though spirits or ghosts have attached themselves to the body, leaving the patient unsure of what to do. If the pulse is rapid and headache accompanies urination, recovery occurs in sixty days. If the head does not hurt during urination but there is only a shivering sensation of aversion to wind and cold, recovery occurs in forty days. If urination brings relief but only dizziness remains, recovery occurs in twenty days. Hence it is stated: "Six times four [twenty-four] days, the illness calms down."
47. Women suffering from cold damage are treated similarly to men. However, if heat enters the Blood Chamber during pregnancy, postpartum periods, or menstruation, distinct therapeutic methods apply. In cases of Heat Entering the Blood Chamber, the patient is lucid during the day but delirious at night, hallucinating ghostly figures. The appropriate formula is Xiao Chai Hu Tang (Minor Bupleurum Decoction) supplemented with Sheng Di Huang (Rehmanniae Radix) and Mu Dan Pi (Moutan Cortex). If there is no sweating, indicating Excess at the Exterior, add Ma Huang (Ephedrae Herba) to induce sweating. If there is sweating, indicating Deficiency at the Exterior, add Gui Zhi (Cinnamomi Ramulus) to resolve the exterior. If exterior signs of fever and aversion to cold exist and sweating therapy has already been administered, even if no sweat is present, do not add Ma Huang again; instead, add Gui Zhi to resolve the exterior, avoiding the repeated use of Ma Huang. If chills and fever alternate like malaria, add both Ma Huang and Gui Zhi to resolve both aspects. If there is cold extremities with diarrhea, this indicates Interior Cold; remove Huang Qin (Scutellariae Radix), add Gan Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata), without hesitation. If there is fever with irritability and thirst, this indicates Interior Heat; remove Ban Xia (Pinelliae Tuber), combine with Bai Hu Tang (White Tiger Decoction), or add Hua Fen (Trichosanthis Radix) and Ge Gen (Puerariae Lobatae Radix). If there is fullness, hardness, or pain in the chest, hypochondrium, or lower abdomen, this indicates Blood Stasis; combine with Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) to purge the stasis. Although conditions before and after childbirth are numerous and cannot be exhaustively listed, they ultimately fall within the scope of treating Yin/Yang and Exterior/Interior patterns. The key lies in the clinician's ability to discern and adapt appropriately.
[Note] The treatment for women with cold damage is the same as for men. Only when pathogenic heat enters the Blood Chamber due to deficiency during the postpartum period or menstruation are there special treatments. For Heat Entering the Blood Chamber, texts state that the patient is clear-minded during the day but experiences delirium and visual hallucinations of ghosts at night. The indicated prescription is Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Sheng Di Huang (Rehmanniae Radix) and Mu Dan Pi (Moutan Cortex). Absence of sweating indicates Exterior Excess; add Ma Huang (Ephedrae Herba) to induce sweating. Presence of sweating indicates Exterior Deficiency; add Gui Zhi (Cinnamomi Ramulus) to release the exterior. If exterior signs of fever and aversion to cold are present and sweating has already been induced, even in the absence of subsequent sweating, do not add Ma Huang again; rather, add Gui Zhi (Cinnamomi Ramulus) to resolve the exterior, and avoid reusing Ma Huang (Ephedrae Herba). If chills and fever alternate like malaria, add Ma Huang (Ephedrae Herba) and Gui Zhi (Cinnamomi Ramulus) to resolve both. If cold extremities and dysentery occur, this signifies Interior Cold; remove Huang Qin (Scutellariae Radix), add Gan Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata), without doubt. If fever, vexation, and thirst occur, this signifies Interior Heat; remove Ban Xia (Pinelliae Tuber), combine with Bai Hu Tang (White Tiger Decoction), or add Hua Fen (Trichosanthis Radix) and Ge Gen (Puerariae Lobatae Radix). If fullness, hardness, or pain occurs in the chest, hypochondrium, or lower abdomen, this signifies Blood Stasis; combine with Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) to attack the stasis. Although there are many syndromes related to pregnancy and the postpartum period that cannot be fully enumerated, they generally do not exceed the principles of treating Yin/Yang and Exterior/Interior. It depends on the practitioner's discretion during clinical practice.