热盛而烦,手足自温,脉浮而紧.此伤风见寒脉也。不烦少热,四肢微厥,脉浮而缓,此伤寒
见风脉也。二者为荣卫俱病,法用大青龙汤。然不可轻用,须风寒俱盛,又加烦躁,方可与之。一
法以桂枝、麻黄汤尤稳,今改羌活汤。
本太阳病,若汗,若下,若利小便,无津液,胃中燥,转属阳明,是为脾约。
若恶寒,用升麻葛根。不恶寒反恶热,大便难,白虎汤。谵语者,调胃承气汤下之。喘而胸满者,
不可下,麻黄汤。
太阳少阳,头项强急,胁下硬满,目眩,往来寒热,小柴胡汤。
少阳阳明,本少阳病,因为发汗,利小便后胃中燥,大便难,属调胃承气汤。
正阳阳明,乃本经风盛气实也,大柴胡汤、大小承气汤选用之。
三阳合病,腹满身重,谵语遗尿,口中不仁,属白虎汤。口干舌燥,不仁,背恶寒,同太阳阳
明、少阳阳明、正阳阳明无表证者,俱可下。惟恶寒者,为太阳阳明合病,未过经,为属表,可发
汗,桂枝麻黄各半汤。盖在经则汗,过经则下也。
本太阳病,发汗,则汗出不彻,因转属阳明,续自微汗出,不恶寒,是并归阳明也。太阳证尚
在,桂枝麻黄各半汤,太阳证也。大小承气汤,阳明证也。
温热病者,冬时感寒,偶不即发,寒毒藏于肌肤,至春变为温病,夏变为暑病。暑病者,热又
甚于温也。温病,发于春三月夏至前是也。发热咳嗽,头疼身痛,口燥渴,脉浮弦。热甚者,小柴胡
汤。热微者,升麻葛根汤、解肌汤。微热不渴,小柴胡加桂枝;渴者,加五味;渴者,去半夏,加
栝蒌、人参。脉实烦渴者,大柴胡汤微利之,以其脉实,必大便难也。虚烦者,竹叶石膏汤,然用
羌活汤解之为当;渴,加知母、石膏。
夏月热病,发热头疼,身体痛重,不恶寒而恶热,其脉洪,不可温,宜羌活汤;渴,加知母、
石膏。三月至夏,谓之晚发,栀子升麻汤。有少阳证者,小柴胡汤。更于前方内选用。若春夏有恶
风恶寒,类伤寒证者,盖当时暴中风寒之气新病,即非冬时受寒,通用羌活汤治之。
热势亢盛且心烦,手足自然温暖,脉象浮而紧。这是伤风病却出现了伤寒的脉象。心中不烦、发热轻微,四肢微有厥冷,脉象浮而缓。这是伤寒病却出现了伤风的脉象。这两种情况都属于营卫两经同病,按照治法应当使用大青龙汤。然而不可轻易使用,必须确认风寒邪气俱盛,并且伴有烦躁症状,才可以给予此方。另一种更稳妥的方法是使用桂枝汤和麻黄汤,现在改为使用羌活汤。
原本属于太阳病,如果经过发汗、攻下或利小便等治疗,导致体内津液枯竭,胃中干燥,从而转化为阳明病,这称为脾约证。
如果仍有恶寒症状,应使用升麻葛根汤;如果不恶寒反而怕热,大便困难,使用白虎汤;出现谵语(胡言乱语)者,用调胃承气汤攻下;气喘且胸部胀满者,不可攻下,使用麻黄汤。
太阳病与少阳病合病,表现为头项强直拘急,胁下硬满,头晕目眩,寒热往来,使用小柴胡汤。
少阳病与阳明病合病,原本是少阳病,因为经过发汗、利小便治疗后导致胃中干燥,大便困难,归属于调胃承气汤证。
正阳阳明病,是本经风邪盛而正气实所致,可选用大柴胡汤或大小承气汤。
三阳合病,表现为腹部胀满、身体沉重、谵语、遗尿,口中感觉迟钝麻木,归属于白虎汤证。若口干舌燥、口内麻木、背部恶寒,且如同太阳阳明、少阳阳明、正阳阳明那样没有表证者,均可使用攻下法。只有那些仍有恶寒症状的,属于太阳阳明合病,病邪尚未传变过经,仍属表证,可以使用发汗法,选用桂枝麻黄各半汤。大概是在经在表则用汗法,过经入里则用下法。
原本的太阳病,发汗后汗出不彻底,因而转属阳明病,继续出现微微出汗,不恶寒,这是病邪并归阳明。如果太阳证候仍然存在,使用桂枝麻黄各半汤,这是太阳病的治法。大小承气汤是阳明病的治法。
温热病,是指在冬季感受寒邪,偶然没有立即发作,寒毒潜伏在肌肤之间,到了春天变为温病,到了夏天变为暑病。暑病的热势比温病更严重。温病,发生在春季三个月,夏至之前。症状包括发热、咳嗽、头痛、身体疼痛、口燥渴,脉象浮弦。热势严重的,使用小柴胡汤;热势轻微的,使用升麻葛根汤或解肌汤;微热且不口渴的,用小柴胡汤加桂枝;口渴的,加五味子;若口渴,去掉半夏,加入栝蒌、人参。脉象实、心烦口渴的,用大柴胡汤轻微通利大便,因为其脉实,必然大便困难。虚烦的,使用竹叶石膏汤,然而使用羌活汤解表更为恰当;若口渴,加知母、石膏。
夏季的热病,表现为发热、头痛、身体疼痛沉重,不恶寒而恶热,脉象洪大,不可用温法,适宜使用羌活汤;若口渴,加知母、石膏。三月至夏季发病的,称为晚发,使用栀子升麻汤。如果有少阳证候的,使用小柴胡汤。在上述前方中酌情选用。如果在春夏季节出现恶风、恶寒,类似伤寒证候的,这是因为当时突然遭受风寒之气的新病,并非冬季受寒,通用羌活汤治疗。
Heat is exuberant accompanied by irritability, the hands and feet are naturally warm, and the pulse is floating and tight. This is a wind-injury presenting with a cold-injury pulse. There is no irritability, slight heat, slight coldness of the four limbs, and the pulse is floating and slow. This is a cold-injury presenting with a wind-injury pulse. Both conditions involve simultaneous disease of Ying (Nutritive) and Wei (Defensive), and according to treatment principles, Da Qing Long Tang (Great Blue Dragon Decoction) should be used. However, it must not be used lightly; it can only be administered when both wind and cold pathogens are abundant and accompanied by irritability. A more stable method is to use Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction); now it is changed to Qianghuo Tang (Notopterygium Decoction).
Originally a Taiyang disease (Disease of the Solar Channel), if treated with sweating, purging, or promoting urination, leading to depletion of body fluids, dryness in the Stomach, and transformation into Yangming disease (Disease of the Yang Brightness), this is called Pi Yue (Splee Constriction).
If there is aversion to cold, use Shengma Gegen Tang (Kudzu Root and Rhizoma Cimicifugae Decoction); if there is no aversion to cold but rather aversion to heat, with difficulty in defecation, use Baihu Tang (White Tiger Decoction). If delirium occurs, treat with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) by purging. If there is wheezing and chest fullness, do not purge; use Mahuang Tang (Ephedra Decoction).
Taiyang-Shaoyang combined disease (Combined Disease of the Solar and Lesser Yang Channels), characterized by stiffness and tension of the head and neck, hardness and fullness below the hypochondrium, dizziness, alternating chills and fever, is treated with Xiao Chaihu Tang (Minor Bupleurum Decoction).
Shaoyang-Yangming combined disease: originally a Shaoyang disease (Disease of the Lesser Yang Channel), which, after sweating and promoting urination, leads to dryness in the Stomach and difficulty in defecation, belongs to Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction).
Zhengyang Yangming (True Yang Yangming): caused by exuberance of Wind pathogen and excess of Qi in its own channel; Daxiehu Tang (Major Bupleurum Decoction) or Da/Xiao Chengqi Tang (Major/Minor Order the Qi Decoctions) are selected for use.
Three-Yang combined disease (Combined Disease of the Three Yang Channels), characterized by abdominal fullness, heaviness of the body, delirium, urinary incontinence, and numbness/unresponsiveness of the mouth, belongs to Baihu Tang (White Tiger Decoction). For cases with dry mouth and tongue, numbness, and aversion to cold on the back, similar to Taiyang-Yangming, Shaoyang-Yangming, and Zhengyang Yangming without exterior signs, purging may be applied. Only those with aversion to cold belong to Taiyang-Yangming combined disease, where the pathogen has not yet passed through the channels, remaining an exterior syndrome, so sweating can be induced using Guizhi Mahuang Banhen Tang (Guizhi and Mahuang Half-Size Decoction). Generally, if the pathogen is in the channels/exterior, use sweating; if it has passed into the interior, use purging.
Originally a Taiyang disease, if sweating is induced but sweat is not thorough, it transforms into Yangming disease, continuing with slight spontaneous sweating and no aversion to cold, indicating the pathogen has merged into Yangming. If Taiyang symptoms still exist, use Guizhi Mahuang Banhen Tang (Guizhi and Mahuang Half-Size Decoction), which treats Taiyang disease. Da/Xiao Chengqi Tang (Major/Minor Order the Qi Decoctions) treat Yangming disease.
Warm-heat diseases arise from contracting Cold in winter, which does not immediately manifest; Cold toxicity hides in the skin and muscles, transforming into Warm disease in spring and Summerheat disease in summer. Summerheat disease is hotter than Warm disease. Warm disease occurs during the three months of spring before the Summer Solstice. Symptoms include fever, cough, headache, body pain, dry mouth and thirst, and a floating-stringy pulse. For severe heat, use Xiao Chaihu Tang (Minor Bupleurum Decoction). For mild heat, use Shengma Gegen Tang (Kudzu Root and Rhizoma Cimicifugae Decoction) or Jieji Tang (Release the Muscle Decoction). For slight heat without thirst, use Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Guizhi (Cinnamon Twig); for thirst, add Wuweizi (Schisandra Berry); if thirsty, remove Banxia (Pinellia Tuber) and add Gualou (Trichosanthes Fruit) and Renshen (Ginseng Root). For solid pulse with irritability and thirst, use Daxiehu Tang (Major Bupleurum Decoction) to slightly promote bowel movement, as a solid pulse indicates inevitable difficulty in defecation. For deficiency irritability, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction); however, using Qianghuo Tang (Notopterygium Decoction) to release the exterior is more appropriate; for thirst, add Zhimu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum).
Summer heat diseases present with fever, headache, heavy body pain, no aversion to cold but aversion to heat, and a洪 (Flood/Surging) pulse; warming methods are contraindicated, and Qianghuo Tang (Notopterygium Decoction) is suitable. For thirst, add Zhimu (Anemarrhena Rhizome) and Shigao (Gypsum Fibrosum). Diseases occurring from March to summer are called late-onset, treated with Zhizi Shengma Tang (Gardenia and Rhizoma Cimicifugae Decoction). If Shaoyang symptoms exist, use Xiao Chaihu Tang (Minor Bupleurum Decoction), selecting from the aforementioned formulas. If aversion to wind and cold occur in spring and summer, resembling cold-injury symptoms, this is due to sudden exposure to wind-cold qi causing a new disease, not winter cold contraction; generally, treat with Qianghuo Tang (Notopterygium Decoction).