结胸者,盖太阳证,自汗,当服桂枝汤而误用承气下之而成结胸。不按自痛,
连脐腹边,手不可近者,大结胸,大陷胸汤。按之方痛,心下硬,小结胸,小陷胸汤。懊 烦渴,
心下痛者,热结胸,少与大陷胸汤。懊 满闷,身无热者,寒结胸,三物白汤。心下怔怔,头汗出,
无大热,为水结胸,小半夏茯苓汤。若未经下者,非结胸也,属半表半里证,宜小柴胡枳、桔以和
之。已经下者,为结胸也。结胸,脉浮大者,未可下,犹带表证。若结胸证,烦躁悉具者,必死矣。
痞者,因太阳证当服麻黄汤而误用承气下之,而成痞满。此因虚邪留滞,若欲下之,必待表证
罢而后可,宜小柴胡加枳桔汤。若恶寒汗出,痞满者,附子泻心汤。服后小便不利者,五苓散。表
未解,心下妨闷者,曰支结,柴胡桂枝汤。表未解而数下之,遂协热而利,心下痞硬,为表里俱病,
桂枝人参汤为当也。
腹满者,邪入太阴脾土也。当痛,为里实,须下之,承气汤;时减者,为里
虚,当温之,理中汤。若表解内不消,非大满,犹生寒热,亦未可下,是邪全未入腑。若大满大实,
坚有燥屎,虽日数少,亦当下之,谓邪已入腑也。太阳证,误下,因时腹满而痛,桂枝加芍药汤;
痛甚者,桂枝加大黄汤。阳明病,发热腹满,微喘口干,不大便,小柴胡汤;哕而小便难,加茯苓。
三阳合病,腹满,身重难转侧,谵语,口中不仁,小柴胡汤。太阴腹满,吐,食不下,枳实理中汤。
少阴咽干腹满,不大便,急下之,大承气汤。下利腹满,身痛,先温其里,四逆汤,后解其表,桂
枝汤。汗后腹满,当温,浓朴半夏生姜人参汤。吐后腹满,少与调胃承气汤。下后腹满,栀子豉汤。
腹满大抵阳热为邪,则腹满而咽干。阴寒为邪,则腹满而吐利,食不下。若曾经吐、汗、下后腹满
者,治各不同也。
结胸证,是太阳病证,患者自汗,本应服用桂枝汤,却误用了承气汤攻下,从而形成了结胸。如果按压腹部不痛,疼痛牵连到肚脐及腹部边缘,手不能触碰的,属于大结胸,用大陷胸汤治疗。如果按压才感到疼痛,心窝部硬满的,属于小结胸,用小陷胸汤治疗。心中懊恼、烦躁、口渴,心下部疼痛的,属于热结胸,少量给予大陷胸汤。心中懊恼、胀闷,身体没有发热的,属于寒结胸,用三物白散治疗。心下部悸动不安,头部出汗,身体没有大热,属于水结胸,用小半夏茯苓汤治疗。如果没有经过攻下治疗的,就不是结胸,属于半表半里证,适宜用小柴胡汤加枳实、桔梗来调和它。已经经过攻下的,才是结胸。结胸证,脉象浮大的,不可立即攻下,因为还带有表证。如果结胸证,烦躁症状完全具备的,必定死亡。
痞证,是因为太阳病证本应服用麻黄汤,却误用了承气汤攻下,从而形成了痞满。这是因为虚邪留滞,如果想要攻下,必须等到表证解除之后才可以,适宜用小柴胡汤加枳实、桔梗汤。如果有恶寒、出汗,且伴有痞满的,用附子泻心汤。服药后小便不利的,用五苓散。表证未解,心下部感觉堵塞闷胀的,称为支结,用柴胡桂枝汤。表证未解而多次攻下,导致协热下利,心下部痞硬,这是表里同病,应当用桂枝人参汤。
腹满证,是邪气侵入太阴脾土所致。如果腹痛,属于里实证,需要攻下,用承气汤;如果腹胀时轻时重,属于里虚证,应当温补,用理中汤。如果表证已解但内部积滞未消,但不是大满,仍然有寒热往来,也不可攻下,说明邪气完全没有进入腑。如果大满大实,坚硬且有燥屎,即使发病天数少,也应当攻下,这叫邪气已经进入腑了。太阳病证,误用攻下法,导致当时腹部胀满而痛,用桂枝加芍药汤;疼痛严重的,用桂枝加大黄汤。阳明病,发热、腹满、轻微气喘、口干、大便不通,用小柴胡汤;如果出现呃逆且小便困难,加茯苓。三阳合病,腹满、身体沉重难以转侧、说胡话、口中味觉失灵,用小柴胡汤。太阴病腹满、呕吐、进食不下,用枳实理中汤。少阴病咽干、腹满、大便不通,需急下,用大承气汤。下利伴腹满、身体疼痛,先温其里,用四逆汤,后解其表,用桂枝汤。发汗后出现腹满,应当温中,用浓朴半夏生姜人参汤。呕吐后出现腹满,少量给予调胃承气汤。攻下后出现腹满,用栀子豉汤。腹满大多由阳热邪气引起,则腹满且咽干。由阴寒邪气引起,则腹满且吐利、进食不下。如果曾经经过吐、汗、下法治疗后出现腹满的,治疗方法各不相同。
Jie Xiong (Chest Binding) syndrome arises from Tai Yang disease (disease of the Tai Yang channel), where the patient has spontaneous sweating and should have taken Guizhi Tang (Cinnamon Twig Decoction), but was mistakenly treated with Chengqi Tang (Gut-Draining Decoction) via purgation, resulting in Jie Xiong. If palpation does not cause pain, but pain radiates to the umbilicus and lateral abdomen, and the area is intolerable to touch, it is Da Jie Xiong (Major Chest Binding), treated with Da Xian Xiong Tang (Major Trap the Chest Decoction). If pain occurs only upon palpation, with hardness below the heart, it is Xiao Jie Xiong (Minor Chest Binding), treated with Xiao Xian Xiong Tang (Minor Trap the Chest Decoction). If there is mental restlessness (Ao Nao), irritability, thirst, and pain in the epigastrium, it is Re Jie Xiong (Heat Chest Binding), treated with a small dose of Da Xian Xiong Tang. If there is mental restlessness and fullness/distension without fever, it is Han Jie Xiong (Cold Chest Binding), treated with San Wu Bai San (Three-Ingredient White Powder). If there is palpitations in the epigastrium, sweating on the head, and no significant heat in the body, it is Shui Jie Xiong (Water Chest Binding), treated with Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction). If purgation has not been performed, it is not Jie Xiong, but rather a Half-Exterior Half-Interior syndrome, suitable for harmonization with Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Zhi Shi (Immature Bitter Orange) and Jie Geng (Platycodon Root). If purgation has already been performed, it is Jie Xiong. In Jie Xiong, if the pulse is floating and large, purgation should not be used immediately, as exterior signs still persist. If all symptoms of irritability are present in Jie Xiong, death is inevitable.
Pi (Glomus) syndrome results from Tai Yang disease where Mahuang Tang (Ephedra Decoction) was indicated but mistakenly treated with Chengqi Tang via purgation, leading to Pi Man (Glomus Fullness). This is due to the stagnation of deficient pathogenic factors; if purgation is desired, one must wait until the exterior syndrome resolves before proceeding, suitable for Xiao Chai Hu Tang added with Zhi Shi and Jie Geng. If there is aversion to cold, sweating, and glomus fullness, Fuzi Xi Xin Tang (Aconite and Coptis Decoction) is used. If urination becomes difficult after taking the medicine, Wu Ling San (Five-Ingredient Powder with Poria) is used. If the exterior syndrome remains unresolved and there is a sensation of obstruction and stuffiness in the epigastrium, it is called Zhi Jie (Branching Binding), treated with Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction). If the exterior syndrome is unresolved and multiple purgations are performed, leading to diarrhea accompanying heat and hardness in the epigastrium, this indicates simultaneous exterior and interior pathology, and Gui Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) is appropriate.
Fu Man (Abdominal Fullness) occurs when pathogens enter the Tai Yin Spleen Earth. If accompanied by pain, it is a Interior Excess syndrome requiring purgation, using Chengqi Tang; if the fullness decreases intermittently, it is an Interior Deficiency syndrome requiring warming, using Li Zhong Tang. If the exterior syndrome is resolved but internal accumulation persists, yet it is not severe fullness, and chills and fever still occur, purgation is contraindicated, indicating the pathogen has not fully entered the Fu organs. If there is severe fullness and excess, with hard dry feces, even if few days have passed, purgation is required, indicating the pathogen has entered the Fu organs. In Tai Yang disease, mistaken purgation may cause abdominal fullness and pain at that time, treated with Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction plus Peony); if pain is severe, Gui Zhi Jia Da Huang Tang (Cinnamon Twig Decoction plus Rhubarb) is used. In Yang Ming disease, with fever, abdominal fullness, slight wheezing, dry mouth, and constipation, Xiao Chai Hu Tang is used; if hiccups occur with difficult urination, add Fu Ling (Poria). In combined Three-Yang disease, with abdominal fullness, heavy body difficult to turn, delirium, and numbness/loss of taste in the mouth, Xiao Chai Hu Tang is used. In Tai Yin disease, with abdominal fullness, vomiting, and inability to eat, Zhi Shi Li Zhong Tang (Immature Bitter Orange and Middle-Warming Decoction) is used. In Shao Yin disease, with dry throat, abdominal fullness, and constipation, urgent purgation is needed using Da Cheng Qi Tang (Major Gut-Draining Decoction). In diarrhea with abdominal fullness and body pain, first warm the interior with Si Ni Tang (Frigid Extremities Decoction), then release the exterior with Gui Zhi Tang. After sweating, if abdominal fullness occurs, warming is needed with Hou Po Ban Xia Sheng Jiang Ren Shen Tang (Magnolia Bark, Pinellia, Fresh Ginger, and Ginseng Decoction). After vomiting, if abdominal fullness occurs, a small amount of Tiao Wei Cheng Qi Tang (Regulate the Stomach Gut-Draining Decoction) is given. After purgation, if abdominal fullness occurs, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is used. Generally, abdominal fullness caused by Yang-Heat pathogens presents with fullness and dry throat; caused by Yin-Cold pathogens, it presents with fullness, vomiting, diarrhea, and inability to eat. If abdominal fullness occurs after previous emesis, sweating, or purgation, treatments vary accordingly.