乌梅酸缓 主劳热虚烦,收肺气喘急,治下利不止,除口干好唾,故乌梅丸以安蛔厥。
蜀椒辛温大热 温中利关节,止利消宿食,开腠理发汗,逐寒湿通经,合和
于乌梅丸中温藏寒安蛔。
祖按∶伤寒方论一章,是据古方升降补泻以为主治之本,乃定局也。伤寒药性
一章,是详品味阴阳良毒,以为佐治加减之用,乃活机也。学人熟读而深省焉,治伤寒无余蕴矣。
日增夜静,是阳气病,而血不病;夜增日静,是阴血病,而气不病。
夜静日恶寒,是阴上溢于阳;夜静日热,是阳盛于本部;日静夜恶寒,是阴
旺于本部;日夜并恶寒是阴部太盛兼有其阳,当泻其寒,峻补其阳。
日安夜躁烦是阳气下陷于阴中,当泻其阳,峻补其阴。
日恶寒,夜躁烦,为阴阳交,饮食不入死。
阴盛格阳,目赤烦躁不渴,或渴不欲水,脉七八至,按之不鼓,姜附主之。
又伤寒二三日,身冷额上汗,面赤心烦者亦是。
阳盛拒阴,表凉身痛,四肢冷,脉沉数而有力,承气汤主之。
阳厥极深,或时郑声,指甲面色青黑,势困,脉附骨取之有,按之无,乃阳
气拂郁不能运于四肢,故身冷。先凉鬲,以待心胸微暖,可承气主之。
阴证 身重,语无声,气难布息,目睛不了了,口鼻气冷,水浆不入,二便不禁,面刺。
阳证 身轻动语有声,目睛了了,鼻中呼吸利,口鼻气热。
内伤 见于右手关前气口,躁作寒,已寒作躁,已不相并,但有间,晡时必减,潮作之时神倦。
外伤 见于左手关前人迎,无问,晡时必剧,潮作之时,精神有余。
乌梅味酸,具有缓和之性,主治劳热、虚烦,收敛肺气以平喘促气急,治疗下利不止,消除口干及多唾症状,因此乌梅丸用于安定蛔虫引起的厥证。
蜀椒味辛,性温而大热,能温中散寒、通利关节,止泻痢、消宿食,开发腠理以发汗,驱逐寒湿、疏通经络,在乌梅丸中与乌梅配合,温暖脏腑寒气以安定蛔虫。
朱丹溪按语:伤寒方论这一章,是依据古方中的升、降、补、泻作为治疗的根本原则,这是固定的法则。伤寒药性这一章,是详细阐述药物的品味、阴阳属性以及良毒之分,作为辅助治疗和加减变化的运用,这是灵活机变的法则。学者若能熟读并深刻反思,治疗伤寒就没有什么遗漏了。
白天加重、夜间安静,属于阳气病,而血分无病;夜间加重、白天安静,属于阴血病,而气分无病。
夜间安静、白天恶寒,是阴气上溢于阳分;夜间安静、白天发热,是阳气在本部(阳分)过盛;白天安静、夜间恶寒,是阴气在本部(阴分)旺盛;白天和夜间都恶寒,是阴部太盛且兼有阳气不足,应当泻其寒邪,峻补其阳气。
白天安适、夜间躁动烦乱,是阳气下陷于阴中,应当泻其阳热,峻补其阴液。
白天恶寒、夜间躁动烦乱,称为阴阳交争,若饮食不能进入则预后不良致死。
阴盛格阳证,表现为眼睛红赤、烦躁但不口渴,或者口渴却不想喝水,脉搏每呼吸七八次跳动一次,重按之下脉象不鼓指有力,应用干姜、附子为主治疗。
另外,伤寒发病二三天,出现身体寒冷、额头出汗、面色红赤、心烦的,也是阴盛格阳的表现。
阳盛拒阴证,表现为体表凉爽、身体疼痛、四肢冰冷,脉搏沉数而有力,应用承气汤为主治疗。
阳厥证病情极深,有时出现语言重复(郑声),指甲和面色青黑,势态危困,从骨骼深处取脉可触及脉象,但轻按则无,这是阳气拂郁不能运行到四肢,所以身体寒冷。先凉膈散以清胸膈之热,等待心胸微微回暖后,可用承气汤为主治疗。
阴证:身体沉重,说话声音低微,气息难以布达,眼神模糊不清,口鼻气息寒冷,水浆无法入口,大小便失禁,面部呈现青色刺色。
阳证:身体轻便,活动说话时有声音,眼神清晰明亮,鼻中呼吸通畅,口鼻气息温热。
内伤:脉象见于右手关前气口部位,表现为躁动时感到寒冷,寒冷时感到躁动,两者不相混杂,只是交替出现,傍晚时分症状必然减轻,潮作之时精神疲倦。
Wumei (Fructus Mume) is sour and mild, primarily treating labor-induced heat, deficiency-related irritability, astringing Lung Qi to relieve wheezing and急促 breathing, treating persistent diarrhea, and eliminating dry mouth and excessive salivation. Therefore, Wumei Wan (Mume Pill) is used to pacify Jue syndrome caused by roundworms.
Shujiao (Fructus Zanthoxyli) is pungent, warm, and greatly hot. It warms the Middle Jiao, benefits the joints, stops diarrhea, resolves retained food, opens the interstices to induce sweating, expels cold-dampness, and unblocks the meridians. In combination with Wumei in Wumei Wan, it warms the viscera to dispel cold and pacify roundworms.
Zhu Danxi's Note: The chapter on "Treatise on Cold Damage Formulas" bases its primary treatment on the ascending, descending, tonifying, and draining principles of ancient formulas; this represents fixed rules. The chapter on "Properties of Cold Damage Medicines" details the flavors, Yin-Yang attributes, and benign-toxic nature of herbs for auxiliary treatment and modification; this represents flexible mechanisms. If students study these thoroughly and reflect deeply, there will be no omissions in treating Cold Damage.
When symptoms worsen during the day and remain quiet at night, it is a disease of Yang Qi without involvement of Blood; when symptoms worsen at night and remain quiet during the day, it is a disease of Yin-Blood without involvement of Qi.
Quiet at night but aversion to cold during the day indicates Yin overflowing into Yang; quiet at night but fever during the day indicates excess Yang in its own sector; quiet during the day but aversion to cold at night indicates excess Yin in its own sector; aversion to cold both day and night indicates excessive Yin in the Yin sector accompanied by Yang deficiency, requiring purging of cold and vigorous tonification of Yang.
Peaceful during the day but restlessness and irritability at night indicate Yang Qi sinking into Yin, requiring purging of Yang and vigorous tonification of Yin.
Aversion to cold during the day and restlessness/irritability at night constitute "Yin-Yang Intertwining"; if food and drink cannot be taken, death ensues.
In Yin Excess Repelling Yang syndrome, there is redness of the eyes, irritability without thirst, or thirst without desire to drink water. The pulse beats seven or eight times per respiration, and upon deep pressure, it does not feel forceful. Ginger and Aconite should be the main treatments.
Furthermore, in Cold Damage occurring two to three days after onset, cold body, sweat on the forehead, red face, and heart irritability are also signs of this pattern.
In Yang Excess Rejecting Yin syndrome, the exterior feels cool, the body aches, the four limbs are cold, and the pulse is deep, rapid, and forceful. Chengqi Tang (Gut-Clearing Decoction) should be the main treatment.
In severe Yang Jue syndrome, there may be occasional repetition of words (Zhengsheng), cyanotic nails and complexion, and critical condition. The pulse is palpable only when pressed deeply against the bone but disappears with light pressure. This is due to Yang Qi being stifled and unable to circulate to the four limbs, causing cold body. First, use Liange San (Chest-Purging Powder) to clear the chest diaphragm; wait until the heart and chest become slightly warm, then administer Chengqi Tang as the main treatment.
Yin Syndrome: Heavy body, voiceless speech, difficulty in breath distribution, unclear vision, cold air from mouth and nose, inability to take fluids, incontinence of urine and feces, and cyanotic facial color.
Yang Syndrome: Light body, audible speech upon movement, clear vision, smooth nasal respiration, and warm air from mouth and nose.
Internal Injury: Manifested at the Qi Kou position anterior to the Guan point on the right wrist. Restlessness alternates with cold, and cold alternates with restlessness; they do not occur simultaneously but intermittently. Symptoms must decrease at dusk (Bushi), and spirit becomes fatigued during the tidal flare-up.
External Injury: Manifested at the Ren Ying position anterior to the Guan point on the left wrist. Regardless of other factors, symptoms must aggravate at dusk, and spirit appears hyperactive/excessive during the tidal flare-up.