又曰。阳明病。发热。汗多者。急下之。宜大承气汤。(一云大柴
胡汤)
又曰。发汗不解。腹满痛者。急下之。宜大承气汤。
又曰。腹满不减。减不足言。当下之。宜大承气汤。
又曰。阳明少阳合病。必下利。其脉不负者顺也。负者失也。互
相克贼。名为负也。
又曰。脉滑而数者。有宿食也。当下之。宜大承气汤。雍曰。此本
文与前证相连。恐是合病脉滑数者。更详之。
又曰。病患无表里证。发热七八日。虽脉浮数者。可下之。假令
已下。脉数不解。合热则消谷善饥。至六七日不大便者。有瘀血也。
宜抵当汤。
又曰。若脉数不解。而下不止。必协热而便脓血也。常氏云。可
白头翁汤。千金方通前证合为一证。
又曰。伤寒发汗已。身目为黄。所以然者。以寒湿在里。不解故
也。以为不可下也。于寒湿中求之。常氏云。可五苓散。
又曰。伤寒七八日。身黄如桔子色。小便不利。腹微满者。茵陈蒿汤主之。
又曰。伤寒。身黄发热。栀子柏皮汤主之。
又曰。伤寒。瘀热在里。身必发黄。麻黄连轺赤小豆汤主之。
仲景曰。脉尺寸俱弦者。少阳受病也。当三四日发。其脉循
胁。络于耳。故胸胁痛而耳聋。三阳皆受病。未入于府者。可汗而
已。
又曰。少阳之为病。口苦咽干目眩也。
又曰。少阳中风。两耳无所闻。目赤。胸中满而烦者。不可吐下。
吐下则悸而惊。庞氏云。可小柴胡汤。常氏云。吐下惊而悸者。可桂
枝去芍药加龙骨牡蛎汤。雍曰。此证当服柴胡加龙骨牡蛎汤。用桂
枝非也。
又曰。伤寒脉弦细。头痛发热者。属少阳。少阳不可发汗。发汗
则谵语。此属胃。胃和则愈。胃不和则烦而悸。(一作躁)庞氏云。多
少阳者宜调胃承气汤。此属少阳阳明证。少阳宜和表。鲜有汗证。仲
景少阳和表。宜小柴胡汤。
又曰。本太阳病不解。转入少阳。胁下硬满。干呕不能食。往来
寒热。尚未吐下。脉沉紧者。与小柴胡汤。庞氏云。脉紧者。与小柴胡
加牡蛎汤。
又曰。若已吐下发汗温针。 语。柴胡汤证罢。此为坏病。知犯
何逆。以法治之。庞氏曰。犯何逆。犯四温病。坏病也。雍曰。千金方
通前合为一证。则小柴胡首尾备见为当。温针谵语。亦宜桂枝甘草
龙骨牡蛎汤。
又曰。三阳合病。脉浮大。上关上。但欲眠睡。目合则汗。常氏
云。可柴胡桂枝汤。庞氏云。不言弦者。隐于长大也。
又曰。伤寒六七日。无大热。其人躁烦者。此为阳去入阴故也。
常氏云。可八石散、茯苓汤。庞氏云。四五日或七八日。
又云。伤寒三日。三阳为尽。三阴当受邪。其人反能食而不呕。
此为三阴不受邪也。庞氏云。病到阴。必吐利也。
又曰。伤寒三日。少阳脉小者。欲已也。庞氏云。谓小而平匀
也。
又曰。少阳病欲解时。从寅至辰上。
又说:阳明病,出现发热、汗出多的症状,应当紧急使用攻下法治疗,适宜用大承气汤。(另一种说法是大柴胡汤)
又说:经过发汗治疗后病情未解,且腹部胀满疼痛的,应当紧急使用攻下法治疗,适宜用大承气汤。
又说:腹部胀满持续不减,即使有轻微减轻也不足为道的,应当使用攻下法治疗,适宜用大承气汤。
又说:阳明经与少阳经同时发病(合病),必然出现腹泻。脉象没有相克现象的是顺证;出现相克现象的是逆证。相互克制贼害,称为“负”。
又说:脉象滑而数的,是有积食停滞,应当使用攻下法治疗,适宜用大承气汤。郭雍说:这原本与前文证候相连,恐怕是指合病且脉象滑数的情况,请进一步详查。
又说:患者既无表证也无里证,发热七八天,虽然脉象浮数,也可以使用攻下法。假如已经使用了攻下法,但脉数仍未解除,邪热与胃热相合导致消化食物过快、容易饥饿,到了六七天不大便的,是有瘀血阻滞,适宜用抵当汤。
又说:如果脉数仍未解除,且腹泻不止,必定是伴随热邪而排泄脓血。常氏说:可以用白头翁汤。《千金方》将前文证候合并为一个证候。
又说:伤寒发汗后,身体和眼睛发黄。之所以这样,是因为寒湿在体内,未能解除的缘故。认为这种情况不可使用攻下法,应当在寒湿证中寻求治疗方法。常氏说:可以用五苓散。
又说:伤寒七八天,身体发黄像橘子皮的颜色,小便不通畅,腹部微微胀满的,由茵陈蒿汤主治。
又说:伤寒,瘀热郁结在体内,身体必然发黄,由麻黄连轺赤小豆汤主治。
张仲景说:寸口和尺部脉象都呈现弦象的,是少阳经受邪。通常在第三四天发作。其经脉循行于胁肋,联络耳朵,所以会出现胸胁疼痛和耳聋。三阳经都受邪气侵袭,但尚未传入腑脏的,可以通过发汗法治疗而已。
又说:少阳经感受风邪,双耳听不见,眼睛发红,胸中满闷且烦躁的,不可使用催吐或攻下法。如果使用吐下法,会导致心悸和惊骇。庞氏说:可以用小柴胡汤。常氏说:因吐下导致惊悸的,可以用桂枝去芍药加龙骨牡蛎汤。郭雍说:此证应当服用柴胡加龙骨牡蛎汤,使用桂枝是不对的。
又说:伤寒脉象弦细,头痛发热的,属于少阳病。少阳病不可发汗,发汗就会导致胡言乱语(谵语)。这属于胃家实证,胃气和顺则痊愈,胃气不和则烦躁且心悸。(另一版本作“躁”)庞氏说:偏重于少阳的适宜用调胃承气汤。这属于少阳阳明合病证。少阳病适宜和解表里,很少有单纯发汗的证型。张仲景对于少阳和解表里,适宜用小柴胡汤。
又说:原本的太阳病未解,转入少阳,胁下硬满,干呕不能进食,忽冷忽热(往来寒热),尚未使用过催吐或攻下法,脉象沉紧的,给予小柴胡汤。庞氏说:脉紧的,给予小柴胡加牡蛎汤。
又说:如果已经使用了催吐、攻下、温针等治法,出现胡言乱语,柴胡汤证已消失,这称为坏病。需要查明犯了什么错误,根据具体情况依法治疗。庞氏说:犯何逆,是指犯了四种温病的错误,导致成为坏病。郭雍说:《千金方》将前文合并为一个证候,那么小柴胡汤首尾完备地见到是恰当的。温针导致谵语,也适宜用桂枝甘草龙骨牡蛎汤。
又说:三阳经合病,脉象浮大,关部以上明显,只想睡觉,闭上眼睛就出汗的。常氏说:可以用柴胡桂枝汤。庞氏说:不说脉弦,是因为隐含在脉象长大之中。
又说:伤寒六七天,体表没有大热,其人却烦躁不安的,这是阳气离去、邪气入阴的缘故。常氏说:可以用八石散、茯苓汤。庞氏说:四五天或七八天。
又说:伤寒三天,三阳经的病邪已尽,三阴经应当受邪。如果病人反而能进食且不呕吐,这说明三阴经不受邪气侵犯。庞氏说:病邪到达阴经,必然出现呕吐和下利。
又说:伤寒三天,少阳脉象变小的,是病将要痊愈的表现。庞氏说:指脉象小而平和均匀。
又说:少阳病欲解的时间,从寅时到辰时这段时间。
It is also said: In Yangming disease, if there is fever and profuse sweating, urgent purgation should be employed. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. (Another version suggests Xiao Chai Hu Tang).
It is also said: If sweating fails to resolve the condition and abdominal fullness with pain occurs, urgent purgation should be employed. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
It is also said: If abdominal fullness does not decrease, or any decrease is negligible, purgation should be employed. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
It is also said: In combined diseases of Yangming and Shaoyang channels (He Bing), diarrhea will inevitably occur. A pulse that does not show mutual overcoming is a favorable sign; one that shows overcoming is unfavorable. Mutual overcoming and damaging are termed "Fu" (Negative/Overcoming).
It is also said: A slippery and rapid pulse indicates retained food stagnation. Purgation should be employed. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated. Guo Yong states: This originally connects with the preceding syndrome; it likely refers to combined diseases with a slippery and rapid pulse. Please examine further.
It is also said: If a patient presents with neither exterior nor interior syndromes but has had fever for seven or eight days, even if the pulse is floating and rapid, purgation may be used. Suppose purgation has already been applied, yet the rapid pulse persists. The combination of heat leads to excessive digestion and hunger. If after six or seven days there is no bowel movement, this indicates blood stasis. Di Dang Tang (Resist the Pill) is indicated.
It is also said: If the rapid pulse persists and diarrhea continues unceasingly, pus and blood will inevitably appear in the stool due to heat. Chang Shi states: Bai Tou Weng Tang (Pulsatilla Decoction) can be used. *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) combines the preceding syndromes into one.
It is also said: After sweating for cold damage, the body and eyes turn yellow. The reason is that cold-dampness remains inside and cannot resolve. It is considered inadvisable to use purgation; instead, treatment should seek methods suitable for cold-dampness. Chang Shi states: Wu Ling San (Five-Ingredient Powder with Poria) can be used.
It is also said: After cold damage for seven or eight days, if the body is yellow like an orange peel, urination is difficult, and there is slight abdominal fullness, Yin Chen Hao Tang (Artemisia Capillaris Decoction) is the primary treatment.
It is also said: In cold damage, if the body is yellow with fever, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Bark Decoction) is the primary treatment.
It is also said: In cold damage, if stagnant heat is trapped inside, the body will inevitably turn yellow. Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction) is the primary treatment.
Zhang Zhongjing says: When both the Cun (Inch) and Chi (Cubit) pulses are wiry (Xian), Shaoyang disease is present. It typically manifests on the third or fourth day. The channel traverses the hypochondrium and connects to the ears; therefore, there is pain in the chest and hypochondrium and deafness. When all three Yang channels are affected but have not entered the Fu organs, sweating therapy alone is sufficient.
It is also said: The defining symptoms of Shaoyang disease are bitter taste in the mouth, dry throat, and vertigo/dizziness.
It is also said: In Shaoyang wind-strike, if there is bilateral hearing loss, red eyes, chest fullness, and irritability, emetics and purgatives must not be used. Using them will cause palpitations and fright. Pang Shi states: Xiao Chai Hu Tang (Minor Order the Gallbladder Decoction) can be used. Chang Shi states: For palpitations and fright caused by emesis/purgation, Gui Zhi Qu Shao Yao Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction without Peony plus Dragon Bone and Oyster Shell) can be used. Guo Yong states: This syndrome should be treated with Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell); using Gui Zhi Tang (Cinnamon Twig Decoction) alone is incorrect.
It is also said: In cold damage, if the pulse is wiry and thin, accompanied by headache and fever, it belongs to Shaoyang. Shaoyang disease should not be treated with sweating. Sweating will lead to delirious speech (Chan Yu). This then involves the Stomach. If the Stomach harmonizes, recovery occurs; if not, irritability and palpitations ensue. (Another version reads "restlessness"). Pang Shi states: Cases leaning towards Shaoyang should use Tiao Wei Cheng Qi Tang (Regulate the Stomach Major Order the Qi Decoction). This belongs to Shaoyang-Yangming combined disease. Shaoyang requires harmonizing the exterior; pure sweating syndromes are rare. For harmonizing the exterior in Shaoyang, Zhang Zhongjing indicates Xiao Chai Hu Tang (Minor Order the Gallbladder Decoction).
It is also said: If the original Taiyang disease does not resolve and transfers to Shaoyang, presenting with hardness and fullness under the ribs, dry retching, inability to eat, alternating chills and fever, and if no emesis, purgation, or acupuncture has been used, and the pulse is deep and tight, Xiao Chai Hu Tang (Minor Order the Gallbladder Decoction) is given. Pang Shi states: If the pulse is tight, Xiao Chai Hu Tang plus Mu Li (Oyster Shell) is given.
It is also said: If emesis, purgation, or warm needle therapy has already been used, leading to delirious speech, and the Chai Hu syndrome has ceased, this is termed a "Huai Bing" (Ruined/Damaged Disease). One must determine what error was committed and treat according to the law. Pang Shi states: "What error" refers to errors involving four types of warm diseases, resulting in a ruined disease. Guo Yong states: *Qian Jin Fang* combines the preceding cases into one; thus, seeing Xiao Chai Hu Tang (Minor Order the Gallbladder Decoction) at the beginning and end is appropriate. For delirium caused by warm needles, Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig and Licorice Decoction plus Dragon Bone and Oyster Shell) is also indicated.
It is also said: In combined diseases of the three Yang channels, if the pulse is floating and large, prominent above the Guan (Bar) position, and the patient desires sleep, sweating occurring when closing the eyes, Chang Shi states: Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) can be used. Pang Shi states: The absence of "wiry" implies it is hidden within the floating and large quality.
It is also said: In cold damage, after six or seven days, if there is no significant external heat but the person is restless and irritable, this indicates the departure of Yang and entry into Yin. Chang Shi states: Ba Shi San (Eight Minerals Powder) and Fu Ling Tang (Poria Decoction) can be used. Pang Shi states: Four to five days or seven to eight days.
It is also said: After three days of cold damage, the pathogenic factors in the three Yang channels are exhausted, and the three Yin channels should receive the pathogen. If the person can eat and does not vomit, this indicates the three Yin channels do not receive the pathogen. Pang Shi states: Once the disease reaches Yin, vomiting and diarrhea must occur.
It is also said: In cold damage, if the Shaoyang pulse becomes small, the disease is about to resolve. Pang Shi states: This means the pulse is small, calm, and uniform.
It is also said: The time when Shaoyang disease tends to resolve is from Yin hour to Chen hour.