者,先太阳中风,重感寒湿所致。经曰∶身热足寒,颈项强急,恶寒,时
时头热,面赤目赤,独头面摇,卒口噤,背反张者, 病也,桂枝加栝蒌汤主之。伤风头痛,常自
汗出而呕者,若汗之,必发 。大发湿家汗,亦作 。新产血虚,汗出伤风,亦作 。若其脉沉弦
而迟,或带紧,或散于指外,皆恶候也。
发热无汗,恶寒,为刚 ,葛根汤或麻黄葛根汤。发热有汗,不恶寒,为柔 ,桂枝加葛根汤、
桂枝栝蒌葛根汤。二 通用小续命汤,刚 为阳,去附子;柔 为阴,去麻黄。刚 ,胸满,口噤
切牙,脚挛,卧不着席,大承气汤下之。柔 ,桂心白术汤、附子防风汤、白术散、桂枝煮散选用。
风温,尺寸俱浮,素伤于风,因而伤热,风与热搏,即为风温。其外证四肢不收,身热自汗,
头疼喘息,发渴昏睡,或体重不仁。慎勿发汗,汗之,则谵语烦躁,目无精彩,病在少阴、厥阴二
经,葳蕤汤、人参败毒散、葛根龙胆汤、小柴胡汤选用。未醒者,柴胡桂枝汤。
发汗已,身灼热,知母葛根汤;渴甚,栝蒌根汤。脉浮身重,汗出,汉防己汤。
误汗风温,防己黄 汤。
湿温,寸濡而弱,尺小而急,素伤于湿,因而中暑,湿与热搏,即为湿温。其状胸腹满,目痛,
壮热妄言,自汗,两胫逆冷挛急,恶寒。若发其汗,使人不能言,耳聋,不知痛处,其身青而色变,
医杀人耳。
湿温在太阴经,用白虎苍术汤加桂枝。湿胜,则一身尽痛,发热身黄,小便不利,大便反快,五
苓散加茵陈。脏腑虚,自利甚,理中汤、术附汤。
所谓刚痉,是先患太阳中风证,又重感寒湿之邪所致。《内经》说:身体发热而足部发冷,颈项强直拘急,恶寒,时常头部发热,面色和眼睛发红,只有头面部摇动,突然牙关紧闭,角弓反张的,这是刚痉病,用桂枝加栝蒌汤主治。伤风引起的头痛,经常自汗出并伴有呕吐的,如果误用发汗法,必定会引发痉病。大发湿家(素患湿病者)之汗,也会引发痉病。新产后血虚,汗出受风,也会引发痉病。如果脉象沉弦而迟,或带紧象,或散乱于指外,都是恶候。
发热无汗,恶寒,属于刚痉,用葛根汤或麻黄葛根汤。发热有汗,不恶寒,属于柔痉,用桂枝加葛根汤、桂枝栝蒌葛根汤。两种痉病通用小续命汤治疗,刚痉属阳,去掉附子;柔痉属阴,去掉麻黄。刚痉,出现胸满,牙关紧闭咬齿,脚部挛急,卧时背部不能着席,用大承气汤攻下。柔痉,选用桂心白术汤、附子防风汤、白术散、桂枝煮散。
风温,寸脉和尺脉都浮,素来伤于风邪,因而又伤热邪,风与热搏结,就形成风温。其外在证候为四肢弛缓不收,身体发热自汗,头痛喘息,口渴昏睡,或者身体沉重麻木。千万不要发汗,如果发汗,就会出现谵语烦躁,目光无神,病位在少阴、厥阴二经,可选用葳蕤汤、人参败毒散、葛根龙胆汤、小柴胡汤。尚未清醒的,用柴胡桂枝汤。
已经发过汗,身体灼热,用知母葛根汤;口渴严重,用栝蒌根汤。脉浮身重,汗出,用汉防己汤。
误用发汗法治疗风温,用防己黄芪汤。
湿温,寸脉濡弱,尺脉小而急,素来伤于湿邪,因而又中暑邪,湿与热搏结,就形成湿温。其症状表现为胸腹胀满,目痛,高热胡言乱语,自汗,两小腿逆冷挛急,恶寒。如果误用发汗法,会导致病人不能说话,耳聋,不知疼痛部位,身体发青且肤色改变,这是医生杀人啊。
湿温在太阴经,用白虎苍术汤加桂枝。湿邪偏胜,则全身疼痛,发热身黄,小便不利,大便反而通畅,用五苓散加茵陈。脏腑虚寒,下利严重,用理中汤、术附汤。
The so-called Gang-Jing (Stiff-Spasm Disease) is caused by first contracting Wind-Strike in the Taiyang channel, and then being heavily affected by Cold-Dampness. The Classics state: "Body heat with cold feet, stiffness and tension of the neck and nape, aversion to cold, intermittent heat in the head, redness of the face and eyes, shaking of only the head, sudden lockjaw, and opisthotonos" constitute the disease of Gang-Jing, which is primarily treated with Guizhi Jia Gualou Tang (Cinnamon Twig Decoction plus Trichosanthes Root). Headache due to Wind-Strike, accompanied by spontaneous sweating and vomiting, if treated with diaphoresis, will inevitably lead to Jing (Spasm). Excessive sweating of patients with chronic Dampness will also induce Jing. Postpartum blood deficiency with sweating and wind exposure will also induce Jing. If the pulse is deep, wiry, and slow, or tight, or scattered beyond the fingers, these are all ominous signs.
Fever without sweat and aversion to cold indicate Gang-Jing (Yang-type Spasm), treated with Gegen Tang (Kudzu Decoction) or Mahuang Gegen Tang (Ephedra and Kudzu Decoction). Fever with sweat and no aversion to cold indicate Rou-Jing (Yin-type Spasm), treated with Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) or Guizhi Gualou Gegen Tang (Cinnamon Twig, Trichosanthes Root, and Kudzu Decoction). Both types of Jing can generally use Xiao Xuming Tang (Minor Continuation of Life Decoction); for Gang-Jing (Yang), remove Fuzi (Prepared Aconite Root); for Rou-Jing (Yin), remove Mahuang (Ephedra Herb). In Gang-Jing, symptoms include chest fullness, lockjaw with teeth grinding, leg cramps, inability to lie flat with the back touching the bed, treated by purging with Dachengqi Tang (Major Order the Qi Decoction). For Rou-Jing, select from Guixin Baizhu Tang (Cinnamon Heart and Atractylodes Macrocephala Decoction), Fuzi Fangfeng Tang (Aconite and Saposhnikovia Decoction), Baizhu San (Atractylodes Powder), or Guizhi Zhusan (Cinnamon Twig Boiled Dispersion).
Fengwen (Wind-Warmth) presents with floating pulses at both the Cun (Inch) and Chi (Cubit) positions. It arises when one is constitutionally injured by Wind, subsequently injured by Heat; the binding of Wind and Heat constitutes Fengwen. External manifestations include flaccidity and inability to control the limbs, fever with spontaneous sweating, headache, panting, thirst, drowsiness, or body heaviness and numbness. Do not induce sweating; doing so will cause delirium and irritability, and loss of luster in the eyes. The pathology lies in the Shaoyin and Jueyin channels. Select from Weiyu Tang (Polygonatum Decoction), Renshen Baidu San (Ginseng Detoxification Powder), Gegen Longdan Tang (Kudzu and Gentian Decoction), or Xiaochaihu Tang (Minor Bupleurum Decoction). If the patient has not regained consciousness, use Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction).
After inducing sweating, if the body becomes burning hot, use Zhimu Gegen Tang (Anemarrhena and Kudzu Decoction); if thirst is severe, use Gualougen Tang (Trichosanthes Root Decoction). If the pulse is floating, the body feels heavy, and there is sweating, use Hanfangji Tang (Stephania Tetrandra Decoction).
If Fengwen is mistakenly treated with diaphoresis, use Fangji Huangqi Tang (Stephania and Astragalus Decoction).
Shiwen (Damp-Warmth) presents with a soggy and weak pulse at the Cun position, and a small and rapid pulse at the Chi position. It arises when one is constitutionally injured by Dampness, subsequently injured by Summerheat; the binding of Dampness and Heat constitutes Shiwen. Symptoms include chest and abdominal fullness, eye pain, high fever with incoherent speech, spontaneous sweating, reverse coldness and cramping of the lower legs, and aversion to cold. If diaphoresis is induced, it will render the patient mute, deaf, unaware of pain locations, with bluish skin and color changes; this is medical malpractice leading to death.
When Shiwen is in the Taiyin channel, use Baihu Cangzhu Tang (White Tiger and Atractylodes Lancea Decoction) added with Guizhi (Cinnamon Twig). If Dampness prevails, causing whole-body pain, fever, jaundice, difficult urination, and loose stools, use Wuling San (Five-Ingredient Poria Powder) added with Yinchen (Artemisia Capillaris Herba). For deficiency-cold of the Zang-Fu organs with severe diarrhea, use Lizhong Tang (Regulate the Middle Decoction) or Shufu Tang (Atractylodes and Aconite Decoction).