（附鼻如烟煤 鼻如扇张）
太阳中风。鼻鸣干呕。鼻鸣者。风邪干肺也。肺主皮毛。风邪袭于皮毛之间。未经深入
。故
但取轻扬之剂。解散其皮毛之邪。则鼻鸣自已矣。若挟热者。则鼻鸣而干。宜兼清肺胃之热
。然此犹浅焉者也。至邪热烁肺。则鼻如烟煤。是肺气将绝。亟与大剂甘寒。生津泻热
。犹
恐不及矣。更有鼻孔扇张者。或由痰郁。或由热郁。其病亦尚浅而可治。倘因虚竭。鼻中之
气出入皆微。或出多入少。亦属败证。百难救一。
耳聋属少阳证。少阳当半里半表。邪入少阳。挟痰上升。清窍为蒙。治当清解少阳。则
耳
聋自罢。又有发汗太过。因虚而致耳聋者。经云。未持脉时。病患叉手自冒心。师因教试令
咳而不咳者。此必两耳聋无闻也。所以然者。以重发汗虚故如此。又曰。病患两
耳无所闻者。以虚故也。既责其为虚。不但不宜再发其汗。而且不宜妄下。惟有以轻清之剂
。通调表里。使邪气渐退。粥食渐加。正气渐复。自然而愈。不能强治。
咽痛一证。阴阳寒热所因不同。最难辨认。大凡阳热之证。多起于太阳。而阳明与少阳
亦互
见之。阴寒之病。多中于少阴。而太阴与厥阴亦牵及之。其间温凉异治。倘辨证先错。率意
投剂。召变甚捷。可不慎诸。
风邪从皮毛而入。首犯太阳。肺先受邪。与痰涎互结。则咽痛而梗。与以驱风利咽。其
邪尚
浅而易疗。其结之甚者。则加以红肿。则当参用破结消肿之品。又甚者。热浮之气弥满三阳
。与毒涎恶血两相胶结。顷刻之间。胀塞咽喉
。致气不得通而死。或用吐法以宣其痰涎。或用刺法。以去其恶血。救之不容须臾缓矣。
凡阳热之证。虽至险极恶。人犹易识。至少阴咽痛。人多不识。即识之而温里之剂。又
多畏
而不敢轻投。殊不知阴寒之甚。格阳于上。乃致咽痛。真寒假热。非温不办。而温法又各有
别。不容概施。如经云。少阴病二三日咽痛者。可与甘草汤。不瘥者与桔梗汤。又云。少阴
病咽中痛。半夏散及汤主之。又云少阴病咽中伤。生疮不能语言声不出者。苦酒汤主之。此
虽
少阴病。以尚无下利逆冷诸变。而证有轻重。方亦有缓急。其不取寒凉直折。一也。若咽痛
而复下利。则如经云。少阴病下利清谷。里寒外热。手足厥逆。脉微欲绝。身反不恶寒。其
人
咽痛者。通脉四逆加桔梗汤主之。此因阴寒气盛。元阳将脱。故宜亟使阳气归根。是非峻温
不可矣。
凡咽痛之宜用温药者。仲景原为真寒假热者之立法。若辨证不的。为祸甚速。倘非阴盛
阳衰
之候。即不得施回阳胜阴之法。故仲景又曰。少阴病下利咽痛。胸满心烦者。猪肤汤主之。
盖彼因下利而阳亡此因下利而阴涸。治又不同也。更有阳热炽甚。痰涎涌结。其脉反迟。而
协热下利者。此又属阳证似阴之候。此惟吐法为最善。经云。病胸上诸实胸中郁郁而痛。不
能食。欲使人按之。而反有涎唾。下利日十余行。其脉反迟。寸口脉微滑。此可吐之。吐之
则利止。盖胸中闭塞者不可汗。又胸中闭塞者不
可下。仲景已有深戒。而病当胸中当吐之。且吐中自寓发散之义。则可使结开而利止也。
（附注：鼻孔如烟煤色、鼻孔扇张）
太阳中风证。出现鼻鸣和干呕的症状。鼻鸣的原因，是风邪干扰肺脏。肺主司皮毛，风邪侵袭于皮毛之间，尚未深入体内。因此只需选用性质轻扬的药物，解散皮毛间的邪气，鼻鸣自然就会停止。如果兼有热象，则表现为鼻鸣且鼻腔干燥，应当同时清泄肺胃之热。但这仍属于病位较浅的情况。至于邪热灼伤肺脏，导致鼻孔颜色像烟煤一样黑，这是肺气即将衰竭的危重征象，必须紧急使用大剂量的甘寒药物，以生津液、泻实热，即便如此，恐怕也难以挽回。还有鼻孔扇张的情况，可能是由于痰湿郁滞，也可能是热邪郁滞所致，这类病情尚属浅表，是可以治疗的；但如果是因为正气虚竭，导致呼吸之气出入微弱，或者出多入少，这也属于败坏之证，百人中难救一人。
耳聋属于少阳病证。少阳经位于半表半里之间，邪气侵入少阳，挟带痰浊向上冲逆，蒙蔽了耳部的清窍，治疗应当清解少阳经的邪气，耳聋自然消除。又有因发汗太过，导致身体虚弱而引发耳聋的情况。《伤寒论》中说：“在未切脉时，病人双手交叉按在心口部位，医生教他咳嗽，他却不能咳，这一定是双耳失聪听不见声音。”之所以这样，是因为过度发汗导致正气亏虚的缘故。又说：“病人双耳完全听不到声音，是由于正气虚弱。”既然认定是虚证，不仅不能再发汗，也不宜妄用攻下法，只有选用性质轻清的方剂，通调表里，使邪气逐渐消退，饮食逐渐增加，正气逐渐恢复，疾病自然会痊愈，不能强行治疗。
咽痛这一症状，其病因有阴阳寒热的不同，最难辨别。大凡阳热性质的证候，多起于太阳经，阳明经与少阳经也常同时见到；阴寒性质的疾病，多侵犯少阴经，太阴经与厥阴经也常牵连其中。其间温凉治法各异，如果辨证先出错，随意投药，病情变化迅速，怎能不谨慎呢？
风邪从皮毛而入，首先侵犯太阳经，肺脏先受邪气，与痰涎相互结聚，就会导致咽痛且有梗塞感，给予驱风利咽的药物，邪气尚浅，容易治疗。如果结聚严重的，会出现红肿，此时应当参用破结消肿的药物。更严重的情况，热浮之气弥漫三阳经，与毒涎、恶血相互胶结，顷刻之间，咽喉胀塞，导致气息不通而死。这时可用吐法来宣通痰涎，或用刺法去除恶血，抢救不容片刻迟缓。
凡是阳热性质的证候，即使到了极其危险恶劣的地步，人们还容易识别。至于少阴经的咽痛，人们大多不认识。即使认识了，对于温里药物也多畏惧而不敢轻易使用。殊不知阴寒极盛，格拒阳气于上，才导致咽痛，这是真寒假热之证，非用温法不能治愈。而且温法也有区别，不能一概施用。如经文所说：“少阴病两三天出现咽痛的，可给予甘草汤；无效的用桔梗汤。”又说：“少阴病咽中疼痛，用半夏散及汤主治。”又说：“少阴病咽部受伤，生疮，不能说话，声音出不来的，用苦酒汤主治。”这些虽然都是少阴病，但尚无下利、四肢逆冷等变证，只是证情有轻重，方剂也有缓急之分。这里不采用寒凉药物直折火势，原因之一。如果咽痛又伴有下利，则如经文所说：“少阴病下利完谷不化，里有寒外有热，手足厥冷，脉微欲绝，身体反而不怕冷，其人咽痛的，用通脉四逆加桔梗汤主治。”这是因为阴寒气盛，元阳即将脱失，所以应当紧急使阳气回归根本，非峻猛的温阳药不可。
凡是咽痛适宜用温药的，张仲景原本是为真寒假热者设立的法则。如果辨证不确切，祸患发生很快。如果不是阴盛阳衰的证候，就不能施用回阳胜阴的方法。所以张仲景又说：“少阴病下利、咽痛、胸满、心烦的，用猪肤汤主治。”那是因下利导致阳气亡失，这里是因下利导致阴液枯竭，治法又有所不同。更有阳热炽盛，痰涎涌结，脉象反而迟，并伴有协热下利的情况，这又属于阳证似阴的证候。这种情况唯有吐法最为妥善。经文说：“病在胸上有诸种实邪，胸中郁郁而痛，不能进食，想要让人按压胸部，却反有涎唾流出，下利一天十多次，脉象反而迟，寸口脉微滑，这可以用吐法。吐之后下利就会停止。”因为胸中闭塞者不可发汗，胸中闭塞者也不可攻下，张仲景已有深刻的告诫。而病邪当在胸中时应用吐法，且吐法中自寓发散之意，这样可使结滞开通而下利停止。
(Attached: Nostrils resembling soot, nostrils flaring)
Taiyang wind-stroke syndrome. Symptoms include nasal congestion with roaring sounds (Bi Ming) and dry retching. The cause of Bi Ming is wind pathogen interfering with the Lung. The Lung governs the skin and hair; when wind pathogen invades between the skin and hair without penetrating deeply, only light and ascending agents are needed to dissipate the pathogen from the skin and hair, after which Bi Ming will resolve spontaneously. If accompanied by heat, presenting as Bi Ming with nasal dryness, one should simultaneously clear heat from the Lung and Stomach. This remains a superficial condition. However, if pathogenic heat scorches the Lung, causing the nostrils to appear black like soot, this indicates impending exhaustion of Lung Qi. Urgent administration of large doses of sweet-cold herbs to generate fluids and purge heat is required, yet even then, recovery may be unlikely. In cases of nostril flaring, it may result from phlegm stagnation or heat stagnation; these conditions are still superficial and treatable. Conversely, if due to deficiency and exhaustion, where breath entering and exiting is faint, or exhalation exceeds inhalation, this constitutes a collapse syndrome, with less than one in a hundred recoveries.
Deafness belongs to Shaoyang syndrome. Shaoyang resides at the half-exterior and half-interior level. When pathogen enters Shaoyang, carrying phlegm upward, it obscures the clear orifices of the ear. Treatment should focus on clearing and resolving Shaoyang, after which deafness will cease. Another cause of deafness is excessive sweating leading to deficiency. The Classic states: "When taking the pulse, if the patient crosses their hands over the heart, and upon instruction to cough, fails to do so, this indicates bilateral deafness." This occurs because heavy sweating has caused deficiency. It also states: "Patients who cannot hear in both ears suffer from deficiency." Since this is attributed to deficiency, not only should sweating not be repeated, but purging should also be avoided. Only light and clear agents should be used to regulate the exterior and interior, allowing pathogen to recede gradually, diet to increase, and healthy Qi to recover, leading to natural healing. Forced treatment is ineffective.
Sore throat varies in etiology between yin-yang and cold-heat, making it difficult to distinguish. Generally, yang-heat syndromes often originate in Taiyang, while Yangming and Shaoyang may also present. Yin-cold diseases often strike Shaoyin, involving Taiyin and Jueyin. Treatments differ significantly between warm and cool methods. If differentiation is erroneous and prescriptions are administered arbitrarily, complications arise rapidly; caution is essential.
Wind pathogen enters via the skin and hair, first attacking Taiyang, where the Lung suffers first. If combined with phlegm-saliva, it causes sore throat with a sensation of obstruction. Prescribing wind-dispelling and throat-relieving herbs treats this shallow pathogen easily. Severe accumulation presents with redness and swelling, requiring herbs that break stagnation and reduce swelling. More severely, floating heat fills the three yang channels, binding with toxic saliva and evil blood. Within moments, throat distension and blockage prevent breathing, leading to death. Emetic methods may be used to disperse phlegm-saliva, or pricking methods to remove evil blood; rescue must not be delayed.
Yang-heat syndromes, even when extremely dangerous, are relatively easy to identify. However, Shaoyin sore throat is often unrecognized. Even when recognized, physicians fear using warming interior agents. Yet, extreme yin-cold repels yang upward, causing sore throat—a true cold, false heat syndrome—requiring warming methods. Warming methods vary and cannot be applied uniformly. As stated in the Classic: "In Shaoyin disease, if sore throat appears within two to three days, Gancao Tang (Licorice Decoction) may be given; if ineffective, Jiegeng Tang (Platycodon Decoction) is indicated." Also: "For Shaoyin disease with pain in the throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is the primary treatment." And: "For Shaoyin disease with injury to the throat, ulceration, inability to speak, or loss of voice, Kujiu Tang (Bitter Wine Decoction) is indicated." Although these are Shaoyin diseases, lacking symptoms like diarrhea or cold limbs, they vary in severity and urgency. They avoid direct suppression with cold-cool herbs for one reason. If sore throat accompanies diarrhea, as stated: "In Shaoyin disease with diarrhea of undigested food, interior cold with exterior heat, cold limbs, faint pulse nearly imperceptible, body seemingly not afraid of cold, and sore throat, Tongmai Sini Jia Jiegeng Tang (Pulse-Restoring Four Reversals Plus Platycodon Decoction) is indicated." This is due to overwhelming yin-cold and impending depletion of primal yang, requiring urgent restoration of yang to its root, necessitating potent warming herbs.
Zhang Zhongjing established the use of warming medicines for sore throat specifically for true cold, false heat syndromes. Incorrect differentiation leads to rapid disaster. Without signs of yin excess and yang decline, methods to restore yang and overcome yin must not be used. Thus, Zhang Zhongjing also stated: "For Shaoyin disease with diarrhea, sore throat, chest fullness, and irritability, Zhufu Tang (Pig Skin Decoction) is indicated." Here, diarrhea caused yang depletion, whereas in the previous case, it caused yin exhaustion; treatments differ. Furthermore, in cases of intense yang-heat with surging phlegm-saliva, where the pulse is paradoxically slow and accompanied by heat-collapsing diarrhea, this represents a yang syndrome mimicking yin. Emesis is the best method here. The Classic states: "For various excess pathogens in the chest, with depression and pain in the chest, inability to eat, desire for pressure, presence of saliva/phlegm, frequent diarrhea (over ten times daily), slow pulse, and faint slippery cun position, emesis is indicated. Emesis stops the diarrhea." Because chest blockage contraindicates sweating and purging, Zhang Zhongjing warned against them. Emesis, containing dispersing properties, opens blockages and stops diarrhea.