热入血室为阴虚,则夜不宁而病剧。汗下过多为亡阳,阳虚则昼不安。
【和解】妇人伤寒发热,昼则明了,暮则谵语,为热入血室,以阴虚而热邪乘虚
而入,故暮谵昼了,小柴胡加牡丹皮汤。
【温】下之后复发汗,昼则烦躁不得眠,夜而安静,不呕不渴,无表里证,脉沉微,
身无大热者,干姜附子汤。为下而复汗以亡阳,故昼烦而夜静。
伤寒时证,汗后和平,身凉安静,却因饮酒复剧,发热烦闷,干呕呻吟错语,不得
卧,黄连解毒汤。
伤寒瘥后十数日,或半月二十日,终不惺惺,常昏沉如失精神,言语错谬,似鬼祟,似
风非风,或无寒热,或潮热有寒热如疟,皆缘发汗未尽,余毒在心包络所致,知母麻黄汤。
出汗不均,为汗不流、是汗出盖覆不周,则汗出不均,致腰背手足搐搦,或冷或热,牛蒡
根散。
水气,大病瘥后从腰以下有水气者,牡蛎泽泻散。
伤寒病中又感寒暑燥湿风热异气,而成坏证。或经汗吐下温针仍不解,小柴胡汤证罢
亦成坏证。况病已过
经,热留脏腑,证候多变,久而不瘥,阴阳舛乱,无复纪纲,大率以表证多者,知母麻
黄汤。若诸药不效者,用鳖甲散。若柴胡证在,则不为逆。
谓不柔和,则痛痒寒热屈伸灸刺皆不自知,皮肤不荣谓之不仁。经曰∶虚邪乘寒,则
为郁冒不仁。盖其血气虚少,不能周流于身,是为邪气所伏,故肌体顽麻不知痛痒,又因
少阴肾气微,精血少,气逆心下,阳气退,热归阴,与阴相动,令身不仁,此为尸厥。其
乘寒之厥,郁冒不仁,即此尸厥可知矣。若脉浮而洪,身汗如油,喘而不仁,水浆不入,
即体不仁,此为命绝。
【温】《直指方》用甘草干姜汤、桂枝芍药加干姜各半汤。
【灸】中极穴。(一名玉泉。)
【针】昔越人入虢,太子病尸厥,以郁冒不仁为可治,刺之而得痊。
Heat entering the blood chamber causes Yin deficiency, resulting in restlessness at night and exacerbation of the disease. Excessive sweating and purgation lead to Yang collapse; Yang deficiency results in daytime unrest.
[Harmonizing Method] When a woman suffers from Shanghan (Cold Damage) with fever, she is lucid during the day but experiences delirium at dusk. This indicates heat entering the blood chamber. Due to Yin deficiency, pathogenic heat takes advantage of the deficiency to enter, causing delirium at dusk and lucidity during the day. Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Mu Dan Pi Tang (Moutan Cortex) is used.
[Warming Method] After purgation followed by sweating, the patient experiences irritability and insomnia during the day but remains quiet at night. There is no vomiting or thirst, no exterior or interior syndromes are evident, the pulse is deep and faint, and there is no significant heat on the body. Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Root Decoction) is prescribed. This occurs because purgation followed by sweating leads to Yang collapse, causing daytime irritability and nighttime quietness.
In seasonal Shanghan syndromes, after sweating, the condition becomes peaceful, the body cools down, and the patient is calm. However, if drinking alcohol causes the condition to worsen again, presenting with fever, vexation, stuffiness, dry heaving, groaning, confused speech, and inability to lie down, Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) is used.
More than ten days or half to twenty days after recovery from Shanghan, if the patient never fully regains alertness, often feeling drowsy as if losing their spirit, with erroneous speech, resembling possession by spirits or wind-stroke but not quite, or having no chills/fever or having tidal fever with chills/fever like malaria, this is due to incomplete sweating leaving residual toxins in the Pericardium Collateral. Zhi Mu Ma Huang Tang (Anemarrhena and Ephedra Decoction) is used. Uneven sweating, caused by lack of sweat flow or improper covering during sweating, leads to uneven perspiration, resulting in spasms of the waist, back, hands, and feet, alternating between cold and heat. Niu Bang Gen San (Arctium Root Powder) is used. For Water Qi (Fluid Retention), when fluid accumulation occurs below the waist after a major illness has healed, Lv Zhe Ze Xie San (Oyster Shell, Scutellaria, and Alisma Powder) is used.
During Shanghan, contracting other pathogenic factors such as cold, heat, dryness, dampness, wind, or heat can result in complex, deteriorated syndromes (Huai Zheng). Even if treated with sweating, emesis, purgation, or moxibustion without resolution, or if the Xiao Chai Hu Tang syndrome resolves yet the condition persists, it becomes a Huai Zheng. Moreover, if the disease has passed through the meridians, heat remains in the Zang-Fu organs, symptoms vary greatly, and chronic non-resolution leads to chaotic Yin and Yang without order, generally treating cases with predominant exterior symptoms using Zhi Mu Ma Huang Tang. If various medicines fail, Die Jia San (Turtle Shell Powder) is used. If the Xiao Chai Hu Tang syndrome persists, it is not considered a counterflow (Ni) condition.
"Bu Ren" (Insensibility) refers to a state where pain, itching, cold, heat, flexion, and extension are not perceived, and the skin lacks nourishment. The Classics state: "When deficient pathogens encounter cold, it leads to Yu Mao (depression and vertigo) and Bu Ren." Generally, this is because Qi and Blood are deficient and insufficient to circulate throughout the body, allowing pathogenic factors to hide. Thus, the muscles and body become numb and insensitive to pain and itch. Additionally, due to weak Kidney Qi of the Shao Yin channel and scant Essence and Blood, Qi rebels upwards to the epigastrium, Yang Qi retreats, Heat returns to Yin, and interacts with Yin, causing bodily insensibility. This is called Shi Jue (Corpse Trance). The Jue (cold extremities/reversal) caused by encountering cold, leading to Yu Mao and Bu Ren, is essentially this Shi Jue. If the pulse is floating and surging, sweat is like oil, there is panting and insensibility, and fluids cannot be ingested, indicating total bodily insensibility, this signifies the end of life (Ming Jue).
[Warming Method] *Zhizhi Fang* uses Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) and Gui Zhi Shao Yao Jia Gan Jiang Ge Ban Tang (Cinnamon Twig and Peony Decoction with Half Dose of Dried Ginger).
[Moxibustion Point] Zhong Ji (CV3) (Also known as Yu Quan/Jade Spring).
[Acupuncture Method] In ancient times, Bian Que (Yue Ren) entered the State of Guo when the Crown Prince suffered from Shi Jue. Diagnosing Yu Mao and Bu Ren as treatable, he cured him through acupuncture.