尺寸俱弦者,少阳受病也。当二三日发,以其脉上循胁,络于耳,故胸胁痛而耳聋。(足少阳
胆属木,弦者,细长如琴弦状。仲景云∶脉浮而紧曰弦。非谓此弦脉也,凡伤寒脉浮紧相载,皆属
弦之类也。有属太阳,有属阳明者。少阳正得弦脉,体是小弦长大脉也,多宜和表,鲜有汗证。)
少阳之证,口苦,咽干,目眩也。
此三阳经皆病,未入于脏,可汗而解。(仲景少阳证,唯小柴胡乃和表药耳。)
弦细,头痛发热,属少阳,宜小柴胡汤。不可发汗,发汗则谵语,此属胃,胃和则愈;不和则
烦而躁,宜调胃承气汤。此属少阳、阳明证也。(方在太阳证中。)
本太阳病不解,转入少阳者,胁下硬满,干呕不能食,往来寒热,尚未可吐下,脉紧者,小柴
胡汤主之。(少加牡蛎。)
若已吐下,发汗,温针,谵语,小柴胡汤证罢,此为坏病,知犯何逆,以法治之。(知犯何逆
者,犯四种温病,坏候也。)
少阳中风,两耳微闻,目赤,胸中满而烦,不可吐下,吐下则惊悸,小柴胡汤主之。(方在和
表证中。)
三阳合病,脉浮大,上关上,但欲眠睡,合目则汗。(不言弦者,隐于长大也。)
三阳合病,面垢谵语,腹满身重,不能转侧,遗尿。发汗则谵语,下之则额上生汗,手足逆冷。
若自汗者,宜白虎汤。(方在厥阴证中。)
伤寒四五日,或六七日,无大热,其人躁闷,此为阳去入阴也。
伤寒三日,三阳为尽,三阴当受邪,其人反能食而不呕,此为三阴不受邪也。(病到阴必吐利。)
伤寒三日,少阳脉小者,欲愈也。(小而平匀者也。)
寸脉和尺脉都呈现弦象,这是少阳经受邪所致。病症通常在发病后二三天出现,因为足少阳胆经的经脉向上沿着胁肋部,联络于耳部,所以会出现胸胁疼痛和耳聋的症状。(足少阳胆在五行中属木,弦脉的特征是细长如同琴弦。张仲景说:脉象浮而紧称为弦脉。这里指的不是那种弦脉,凡是伤寒病中脉象浮紧并见的,都属于弦脉的范畴。有的属于太阳病,有的属于阳明病。少阳病正对应弦脉,其脉体是小弦且长大的脉象,治疗多适宜和解表里,很少见到需要发汗的情况。)
这三阳经(太阳、阳明、少阳)都有病变,但病邪尚未传入五脏,可以采用发汗的方法解除。(张仲景认为少阳病证,只有小柴胡汤是和解表里的药物。)
脉象弦细,伴有头痛发热,属于少阳病,适宜使用小柴胡汤。不可使用发汗法,如果误用发汗法导致谵语(神志不清,胡言乱语),这属于胃家实热,胃气调和则痊愈;如果不调和,则会出现心烦和躁动,适宜使用调胃承气汤。这属于少阳病兼阳明病的证候。(方剂见太阳病章节。)
原本的太阳病没有解除,病邪转入少阳的,表现为胁下硬满,干呕不能进食,寒热往来,此时还不可以使用吐法或下法,如果脉象紧,以小柴胡汤为主治方。(可少量加入牡蛎。)
如果已经使用了吐法、下法、发汗法或温针疗法,导致出现谵语,且小柴胡汤证已消失,这属于坏病(因误治导致的变证),需要查明犯了什么错误,根据具体情况依法治疗。(所谓“知犯何逆”,是指犯了四种误治导致的温热病性质的坏证候。)
少阳中风,两耳听力轻微减退,眼睛发红,胸中胀满且烦躁,不可使用吐法或下法,如果使用吐下法会导致惊悸,以小柴胡汤为主治方。(方剂见和解表里证章节。)
三阳合病,脉象浮大,关部以上明显,患者只想睡觉,闭眼时出汗。(文中不说脉弦,是因为弦脉隐含在长大脉象之中。)
三阳合病,面色垢浊,谵语,腹部胀满,身体沉重,不能翻身转侧,遗尿。如果误用发汗法会导致谵语加重,误用下法会导致额头出汗,手足逆冷。如果患者自汗出,适宜使用白虎汤。(方剂见厥阴病章节。)
伤寒病四五日,或者六七日,体表没有大热,但病人烦躁闷乱,这是阳气退去、病邪入阴的表现。
伤寒三日,三阳经的病邪应当传尽,三阴经应当受邪,但病人反而能吃饭且不呕吐,这说明三阴经不受邪气侵犯。(病邪进入阴经必然会出现呕吐和下利。)
When both the Cun (inch) and Chi (cubit) pulses are Xian (String-like), it indicates that the Shaoyang (Lesser Yang) channel is affected. The disease typically manifests on the second or third day because the Foot-Shaoyang Gallbladder channel ascends along the hypochondrium and connects with the ears; therefore, there is pain in the chest and hypochondrium accompanied by deafness. (The Foot-Shaoyang Gallbladder belongs to Wood in the Five Elements. A Xian pulse is slender and long like a zither string. Zhang Zhongjing stated: "A pulse that is Floating and Tight is called Xian." This does not refer to this specific type of Xian pulse. Generally, in Shanghan (Cold Damage) diseases where Floating and Tight pulses coexist, they all belong to the category of Xian. Some belong to Taiyang (Greater Yang), some to Yangming (Yang Brightness). The authentic pulse for Shaoyang is Xian, specifically a small, slender, and long pulse. Treatment mostly favors harmonizing the exterior and interior, and sweating methods are rarely indicated.)
The manifestations of Shaoyang syndrome include bitter taste in the mouth, dryness of the throat, and vertigo/dizziness of the eyes.
When these three Yang channels (Taiyang, Yangming, Shaoyang) are diseased but the pathogen has not yet entered the Zang organs, it can be resolved through sweating. (Zhang Zhongjing considered Xiao Chaihu Tang as the formula for harmonizing the exterior and interior in Shaoyang syndromes.)
With a Xian and Fine pulse, headache, and fever, the condition belongs to Shaoyang and is suitable for treatment with Xiao Chaihu Tang (Minor Bupleurum Decoction). Sweating must not be induced; if sweating causes delirium, this indicates involvement of the Stomach. If the Stomach Qi harmonizes, the patient recovers; if not, irritability and restlessness ensue, and Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Magnolia Bark Decoction) is indicated. This represents a combination of Shaoyang and Yangming syndromes. (The formula is found in the Taiyang chapter.)
If an original Taiyang disease fails to resolve and transitions into Shaoyang, symptoms include hardness and fullness below the costal margin, dry retching, inability to eat, and alternating chills and fever. At this stage, emesis and purgation are not yet appropriate. If the pulse is Tight, Xiao Chaihu Tang (Minor Bupleurum Decoction) should be the primary treatment. (Oyster Shell may be added in a small amount.)
If emesis, purgation, sweating, or warm needle therapy have already been applied, leading to delirium and the disappearance of Xiao Chaihu Tang indications, this constitutes a Huabing (Ruined Disease/Complication due to Mismanagement). One must ascertain what error was committed and treat according to the specific pathology. ("Ascertaining what error was committed" refers to complications arising from four types of mismanagement resulting in heat-pathogen conditions.)
In Shaoyang Wind-Strike, there is slight hearing impairment in both ears, redness of the eyes, fullness and irritability in the chest. Emesis and purgation are contraindicated; inducing them will cause palpitations and fright. Xiao Chaihu Tang (Minor Bupleurum Decoction) should be administered. (The formula is found in the Harmonizing Exterior and Interior chapter.)
In San Yang He Bing (Combined Disease of the Three Yangs), the pulse is Floating and Large, prominent at the Guan (bar) position above. The patient desires sleep and sweats when closing their eyes. (The text does not mention a Xian pulse because it is implicit within the large and long pulse quality.)
In San Yang He Bing (Combined Disease of the Three Yangs), there is a greasy complexion, delirium, abdominal fullness, heaviness of the body, inability to turn over, and urinary incontinence. Inducing sweating worsens delirium; purging leads to sweat on the forehead and cold limbs. If there is spontaneous sweating, Baihu Tang (White Tiger Decoction) is indicated. (The formula is found in the Jueyin chapter.)
In Shanghan (Cold Damage) lasting four or five days, or six or seven days, without significant external heat, but with internal restlessness and oppression, this indicates the departure of Yang and entry of the pathogen into Yin.
On the third day of Shanghan (Cold Damage), the pathogen in the three Yang channels should be exhausted, and the three Yin channels should be affected. However, if the patient can still eat and does not vomit, it indicates that the three Yin channels are not affected by the pathogen. (When disease enters Yin, vomiting and diarrhea are inevitable.)
On the third day of Shanghan (Cold Damage), if the Shaoyang pulse becomes Small, recovery is desired. (The pulse is small, flat, and even.)