腹满时减复如故,此是寒虚气上从,腹满不减不大便,转属阳明乃可攻。
【注】腹满时减,减复如故,谓腹时满时不满,而减复如常,此为太阴寒邪寒虚之气
上逆之满,乃可温之证也,宜浓朴生姜甘草半夏人参汤。腹满不减,谓常常而满,终日
不减,或不大便,此为转属阳明实热内壅之满,乃可攻之证也,宜大承气汤。详太阴篇。
少阴阴邪脉沉细,背寒欲寐口中和,咽痛腹痛骨节痛,厥利清谷四逆瘥。
【注】少阴阴邪,谓邪从阴化之寒证也。脉沉细,少阴阴邪之脉也。背寒,谓背恶寒,
阳气虚也。欲寐,谓但欲寐,阴气盛也。口中和,口中不干燥也。咽痛腹痛,下利清谷,
寒盛于中也。骨节疼痛,四肢厥冷,寒淫于外也,宜四逆汤,温中散寒也。详少阴篇。
少阴阳邪沉细数,口燥咽干大承汤,少阴心烦不得卧,黄连阿胶是主方。
【注】阳邪,谓少阴邪从阳化之热证也。少阴病但欲寐,阴邪则脉沉细无力,阳邪则
脉加数而有力矣。始病即口燥咽干,水不上升,热之甚也。宜大承气汤急下之,泻阳救
阴也。少阴病但欲寐,二、三日以上变生心烦不得眠,是阳邪乘阴,阴不能静也,宜黄
连阿胶汤,清阳益阴也。详少阴篇。
少阴脉沉反发热,麻黄附子细辛汤,若二三日无里证,减辛加草用之良。
【注】少阴病脉沉,为阴寒之证,当无热,今反发热,是兼有太阳表也。宜麻黄附子细
辛汤,急温而散之。若二、三日热仍不解,亦无里寒吐利之证,去细辛易甘草,缓温而和
之。详少阴篇。
腹部胀满,有时减轻,过后又恢复原状,这是寒邪与虚气上逆所致;若腹部胀满持续不减且伴有大便不通,则是病邪转入阳明经,此时才可采用攻下法。
【注释】腹部胀满时轻时重,减轻后又像往常一样,意思是腹部时而胀满、时而空虚,减轻后恢复常态,这是太阴经受寒邪及寒虚之气上逆引起的胀满,属于可以用温法治疗的证候,适宜使用浓朴生姜甘草半夏人参汤。若腹部胀满持续不减,意思是整天都胀满,终日不缓解,或者伴有不大便,这是病邪转入阳明经,因实热内结壅滞引起的胀满,属于可以用攻下法治疗的证候,适宜使用大承气汤。详细内容参见太阴篇。
少阴经受阴寒之邪侵袭,脉象沉细,背部恶寒,精神萎靡只想睡觉,口中感觉平和(不干燥),出现咽痛、腹痛、骨节疼痛,四肢厥冷、下利清谷等症状,使用四逆汤治疗可获痊愈。
【注释】少阴经受阴寒之邪,是指病邪从阴化寒的寒证。脉象沉细,是少阴经受阴寒之邪的典型脉象。背寒,即背部恶寒,说明阳气虚弱。欲寐,即只想睡觉,说明阴气盛极。口中和,指口中不干燥。咽痛、腹痛、下利清谷,是因为寒邪盛于中焦。骨节疼痛、四肢厥冷,是因为寒邪淫溢于体表,适宜使用四逆汤,以温中散寒。详细内容参见少阴篇。
少阴经受阳热之邪侵袭,脉象沉细而数,口干舌燥咽干,宜用大承气汤;若少阴病出现心烦、无法入睡,黄连阿胶汤是主要方剂。
【注释】阳邪,是指少阴病邪从阳化热的热证。少阴病通常表现为只想睡觉,若是阴邪则脉象沉细无力,若是阳邪则脉象更加数且有力。发病初期即出现口干舌燥咽干,是由于水液不能上承,表明热势严重。适宜使用大承气汤急下,以泻阳热救阴液。少阴病本应只想睡觉,若两三天以上转变为心烦不得眠,这是阳热之邪乘袭阴分,导致阴气不能宁静,适宜使用黄连阿胶汤,以清阳热益阴液。详细内容参见少阴篇。
少阴病脉象沉却反而发热,宜用麻黄附子细辛汤;若过了两三天没有里证,减少细辛用量并加入甘草,使用效果良好。
【注释】少阴病脉象沉,属于阴寒证,应当没有发热,现在反而发热,说明兼有太阳经表证。适宜使用麻黄附子细辛汤,急温其里并解散表邪。若两三天后热势仍未解除,同时也无里寒吐利的证候,去掉细辛改用甘草,以缓和温补调和之法。详细内容参见少阴篇。
Abdominal fullness that decreases intermittently and then returns to its original state indicates fullness caused by the upward reversal of cold pathogenic factors and deficiency qi; if abdominal fullness persists without reduction accompanied by constipation, the pathogen has transferred to the Yangming channel, and purgation may be employed at this time.
[Annotation] Abdominal fullness that fluctuates, decreasing and then returning to normal, means the abdomen is sometimes full and sometimes empty, reverting to a normal state after decrease. This type of fullness results from the upward reversal of cold pathogenic factors and cold-deficiency qi in the Taiyin channel, constituting a syndrome suitable for warming treatment. The appropriate formula is Nongpu Shengjiang Gancao Banxia Renshen Tang (Pinellia, Ginger, Licorice, and Ginseng Decoction). If abdominal fullness persists without reduction, meaning it is constant throughout the day and does not alleviate, or is accompanied by constipation, this indicates fullness due to internal stagnation of excess heat having transferred to the Yangming channel, constituting a syndrome suitable for purgation. The appropriate formula is Dachengqi Tang (Major Order the Qi Decoction). For details, refer to the Taiyin chapter.
When Shaoyin channel is invaded by Yin-cold pathogenic factors, the pulse is deep and fine, there is aversion to cold in the back, lethargy with a desire to sleep, and a neutral sensation in the mouth. Symptoms include sore throat, abdominal pain, bone and joint pain, cold extremities, and diarrhea with undigested food. Sini Tang (Frigid Extremities Decoction) can be used to achieve recovery.
[Annotation] "Shaoyin channel invaded by Yin-cold pathogenic factors" refers to a cold syndrome where the pathogen transforms into cold following the Yin nature. A deep and fine pulse is characteristic of Yin-cold pathogenic factors in the Shaoyin channel. Back cold, or aversion to cold in the back, indicates deficiency of Yang qi. Desire to sleep indicates excessive Yin qi. Neutral sensation in the mouth means the mouth is not dry. Sore throat, abdominal pain, and diarrhea with undigested food indicate excessive cold in the Middle Jiao. Bone and joint pain and cold extremities indicate cold pathogenic factors overflowing to the exterior. Sini Tang (Frigid Extremities Decoction) should be used to warm the middle and dispel cold. For details, refer to the Shaoyin chapter.
When Shaoyin channel is invaded by Yang-heat pathogenic factors, the pulse is deep, fine, and rapid, with dry mouth and throat; Dachengqi Tang (Major Order the Qi Decoction) should be used. If Shaoyin disease presents with irritability and inability to sleep, Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) is the primary formula.
[Annotation] "Yang pathogenic factor" refers to a heat syndrome where Shaoyin pathogenic factors transform into heat following the Yang nature. Shaoyin disease typically presents with a desire to sleep; if caused by Yin pathogenic factors, the pulse is deep, fine, and forceless; if caused by Yang pathogenic factors, the pulse becomes more rapid and forceful. Dry mouth and throat appearing immediately upon onset indicate that fluids fail to ascend, signifying severe heat. Dachengqi Tang (Major Order the Qi Decoction) should be used for urgent purgation to drain Yang heat and preserve Yin fluids. If Shaoyin disease, which normally involves a desire to sleep, evolves after two to three days into irritability and insomnia, it indicates Yang heat pathogenic factors invading the Yin aspect, causing Yin qi to lose tranquility. Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) should be used to clear Yang heat and nourish Yin fluids. For details, refer to the Shaoyin chapter.
If Shaoyin disease presents with a deep pulse but fever, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) should be used. If after two to three days there are no interior syndromes, reducing the dosage of Xixin (Asarum) and adding Gancao (Licorice) yields good results.
[Annotation] A deep pulse in Shaoyin disease indicates a Yin-cold syndrome, which should present without fever. The presence of fever indicates an concurrent Taiyin exterior syndrome. Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) should be used to urgently warm the interior and dissipate the exterior pathogen. If the fever persists after two to three days without accompanying interior cold symptoms such as vomiting or diarrhea, remove Xixin (Asarum) and substitute with Gancao (Licorice) to employ a mild warming and harmonizing method. For details, refer to the Shaoyin chapter.