发黄 由湿热相交也,主在脾经。
有热盛而黄者 身黄色如橘子,甚者染衣如柏。
阳明病无汗,小便不利,必发黄。
又头汗,身无汗,小便不利,渴饮水浆,此为瘀热在里也,茵陈汤、五苓散。
又有内热已盛,被火者,亦发黄也。
邪风被火热,两阳相熏灼,其身黄也。
伤寒身黄发热者,此外热也,宜栀子柏皮汤以散之。
有湿黄者 身如熏黄,虽黄而色暗不明也。
伤寒发汗后,身目为黄者,寒湿在里不解故也。
有蓄血下焦,身黄者 脉沉结,小腹硬,而小便自利,如狂,宜抵当汤下之。
寸口无脉,鼻气出冷者死。
体如烟熏,直视摇头,为心绝也死。
环口黧黑,柔汗发黄,为脾绝也死。
狂 谓少卧不饥而自高贤也,自辨智也。曰重阳者狂,重阴者癫,由邪热至
极也,宜大下之。
又有热在下焦膀胱,如狂而未至于狂,但卧起不安耳。
又狂见蓄血,下焦蓄血亦狂也。
狂言目反直视,肾绝也,死。
汗出复热,狂言,不食,为失志,死。
霍乱,谓邪在上焦则吐,邪在下焦则下利,邪在中焦,胃气不治,为邪所
伤,阴阳乖鬲,遂上吐而下利。若呕吐而利,谓之吐利;躁扰烦乱,谓之霍乱。
伤寒吐利者,邪气所伤也。霍乱吐利者,饮食所伤也。其有兼伤寒之邪,内
外不和者,加之头痛发热,热多欲饮水者,五苓散主之。寒多不欲饮水者,理中
汤主之,理中加减。脐上动者,肾气动也,去术加桂;吐多者,去术加生姜辛散
也;悸者,加茯苓,以导其气也;寒加干姜温也;腹痛加参以补之;腹满者,此
胃虚气壅也,去术甘人人满也,加附辛以散壅;吐利止而身痛者,宜桂枝汤,
以和之;吐利寒热,手足冷与下利清谷,脉微,四逆汤主之。
发黄(黄疸)是由于湿热邪气交结所致,病位主要在脾经。
有热邪炽盛而致发黄者,身体黄色像橘子皮一样,严重的甚至能把衣服染得像柏树汁那样深。
阳明病无汗,小便不通利,必然会导致发黄。
又有头面部出汗,身体无汗,小便不通利,口渴想喝汤水,这是瘀热郁结在体内的表现,可用茵陈汤、五苓散治疗。
又有体内热邪已经炽盛,又被火法误治的,也会导致发黄。
风邪被火热之气熏灼,两阳相合熏蒸,身体就会发黄。
伤寒病出现身黄且发热的,这是外热所致,适宜用栀子柏皮汤来疏散它。
有湿邪导致发黄者,身体颜色像被烟熏过一样,虽然发黄但色泽晦暗不明亮。
伤寒发汗后,身体和眼睛都变黄的,这是因为寒湿邪气在体内未能解除的缘故。
有瘀血蓄积在下焦导致身黄者,脉象沉涩有力,小腹部硬满,小便自利,神志如狂,适宜用抵当汤攻下瘀血。
寸口脉搏摸不到,鼻中呼出冷气的是死证。
身体颜色像被烟熏黑,两眼直视且摇头的,是心气绝的表现,会死亡。
口唇周围发黑,出冷汗且发黄的,是脾气绝的表现,会死亡。
狂证,表现为睡眠少、不觉得饥饿却自视甚高贤能,自以为明智。称为重阳则狂,重阴则癫,这是由于邪热达到极点所致,适宜用峻下法治疗。
又有热邪在下焦膀胱,表现为似狂而非狂,只是睡卧起立不安罢了。
又有狂证伴有瘀血的,下焦蓄血也会导致狂证。
胡言乱语、两眼上翻直视,是肾气绝的表现,会死亡。
出汗后再次发热,胡言乱语,不吃东西,这是失志的表现,会死亡。
霍乱,是指邪气在上焦则呕吐,邪气在下焦则腹泻,邪气在中焦,胃气失调,为邪气所伤,阴阳之气乖违阻隔,于是向上呕吐向下腹泻。如果既有呕吐又有腹泻,称为吐利;如果烦躁扰乱,称为霍乱。
伤寒引起的吐利,是邪气损伤所致。霍乱引起的吐利,是饮食损伤所致。如果有兼夹伤寒邪气,内外不和的情况,加上头痛发热,热多想要喝水的,用五苓散主治。寒多不想喝水的,用理中汤主治,并根据情况加减。脐上跳动的,是肾气动,去掉白术,加入桂枝;呕吐多的,去掉白术,加入生姜以辛散止呕;心悸的,加入茯苓,以引导气机;寒重的,加入干姜以温中;腹痛的,加入人参以补益;腹满的,这是胃虚气壅滞,去掉白术和甘草以免加重胀满,加入附子以辛散壅滞;吐利停止但身体疼痛的,适宜用桂枝汤调和;吐利伴寒热,手足冰冷且下利清谷,脉微弱的,用四逆汤主治。
Jaundice (Huang) is caused by the interaction of damp-heat pathogens, with its primary location in the Spleen Meridian.
In cases where heat is flourishing leading to jaundice, the body appears yellow like an orange peel; in severe cases, it may stain clothing as dark as cypress sap.
In Yangming disease, if there is no sweating and urination is difficult, jaundice will inevitably occur.
If there is sweating only on the head but not on the body, accompanied by difficult urination and thirst for drinking fluids, this indicates stagnant heat trapped inside; Yinchen Tang (Artemisiae Scopariae Decoction) or Wuling San (Five-Ingredient Powder with Poria) are indicated.
If internal heat is already flourishing and fire therapy is applied, jaundice will also result.
When wind pathogen is scorched by fire heat, the two yangs mutually fumigate and burn, causing the body to turn yellow.
In cold damage diseases, if jaundice occurs with fever, this is due to external heat; Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction) should be used to disperse it.
In cases of dampness-induced jaundice, the body color resembles being smoked; although yellow, the hue is dull and obscure.
After sweating treatment for cold damage, if the body and eyes turn yellow, it is because cold-dampness remains unresolved internally.
If blood stasis accumulates in the lower jiao causing jaundice, the pulse is deep and knotted, the lower abdomen is hard, urination is normal, and the patient acts like a madman; Didang Tang (Hit-and-Die Decoction) should be used to purge the stasis.
If the cunkou pulse is imperceptible and breath from the nose is cold, death ensues.
If the body looks like it has been smoked, with fixed staring gaze and head shaking, this indicates exhaustion of Heart Qi, leading to death.
If the area around the mouth turns dark black, with soft sweat and jaundice, this indicates exhaustion of Spleen Qi, leading to death.
Mania (Kuang) refers to sleeping little, feeling no hunger yet considering oneself superior and wise, claiming intelligence. It is said that excessive Yang leads to mania, while excessive Yin leads to epilepsy (Dian), caused by extreme evil heat; vigorous purging is appropriate.
If heat resides in the lower jiao Bladder, the patient may appear manic but not fully so, merely restless in lying down and rising.
If mania presents with blood stasis, accumulation of blood in the lower jiao can also cause mania.
Delirious speech with eyes rolling upward and fixed staring indicates exhaustion of Kidney Qi, leading to death.
Sweating followed by recurrent fever, delirium, and refusal to eat indicates loss of Zhi (Will), leading to death.
Huoluan (Colic with Vomiting and Diarrhea) occurs when pathogens are in the upper jiao causing vomiting, in the lower jiao causing diarrhea, or in the middle jiao where Stomach Qi fails due to pathogenic injury, causing Yin and Yang to become disjointed, resulting in upward vomiting and downward diarrhea. If both vomiting and diarrhea occur, it is called Tuli (Vomiting and Diarrhea); if accompanied by restlessness and agitation, it is called Huoluan.
Vomiting and diarrhea caused by cold damage result from pathogenic injury. Vomiting and diarrhea in Huoluan result from dietary injury. If there is concurrent cold damage pathogen with internal-external disharmony, accompanied by headache, fever, and a preference for drinking water, Wuling San (Five-Ingredient Powder with Poria) is the main formula. If there is cold predominance with no desire to drink water, Lizhong Tang (Regulate the Middle Decoction) is the main formula, with modifications. If there is pulsation above the umbilicus, indicating Kidney Qi movement, remove Atractylodis Macrocephalae Rhizoma (Baizhu) and add Cinnamomi Ramulus (Guizhi). If vomiting is profuse, remove Baizhu and add Zingiberis Recens Rhizoma (Shengjiang) for acrid dispersal. If palpitations occur, add Poria (Fuling) to guide Qi. If cold is severe, add Zingiberis Radix Preparata (Ganjiang) for warming. If abdominal pain occurs, add Ginseng Radix et Rhizoma (Renshen) for tonification. If abdominal fullness occurs, this is due to Stomach deficiency and Qi stagnation; remove Baizhu and Glycyrrhizae Radix et Rhizoma (Gancao) to avoid exacerbating fullness, and add Aconiti Lateralis Radix Preparata (Fuzi) for acrid dispersal of stagnation. If vomiting and diarrhea cease but body pain persists, Guizhi Tang (Cinnamon Twig Decoction) is suitable to harmonize. If vomiting and diarrhea are accompanied by alternating chills and fever, cold extremities, clear undigested food in stool, and a faint pulse, Sini Tang (Frigid Extremities Decoction) is the main formula.