(卫气者昼则行阳夜则行阴行阳则寤行阴则寐阳气虚阴气强盛则目瞑乃邪传于
阴不在阳也昏昏闭目者阴主关也但欲寐是少阴本病然亦有热者)
太阳病十日。脉浮细嗜卧。外已解也。胸满胁痛者。(小柴胡汤按此条当是太阳少阳合
病)少阴但欲寐。口燥咽干。急下之。(大承气汤)少阴欲吐不吐。但欲寐。五六日自利而渴。少阴
虚。故引水自救。小便白者。下焦虚寒。(四逆汤若小便黄赤而渴者白头翁汤)风温。汗出身
重。鼾睡。语言难出。(葳蕤汤)
按嗜卧亦有阴阳之殊。少阴脉微细。但欲寐。或蜷卧。或向壁卧。四肢逆冷。身体沉重
。皆阴症也。附子汤温之。如热气内伏。神气昏倦。令人多眠。小柴胡汤。诚为要剂。
(气从少腹上冲心而痛如豕突之状必脐下筑筑而动一由误汗一由烧针)
太阳发汗后。脐下悸者。欲作奔豚。(茯苓桂枝甘草大枣汤)烧针令汗。针处被寒。核起
而赤。必发奔豚。气从少腹上冲心。灸核上各一壮。(桂枝加桂汤)
按奔豚为少阴之气。非肉桂能泄其邪也。
脉迟厥冷。下利当不能食。若反能食者。名曰除中。不可治。其症有二。一由误服黄芩
汤。凉药而致者。必死。一则热少厥多。胃气在者。可治。此不因药故也。
(卫气在白天运行于阳经,夜晚运行于阴经。运行于阳经时人清醒,运行于阴经时人入睡。如果阳气虚弱而阴气强盛,人就会闭眼睡觉,这是邪气传入阴经而非停留在阳经的表现。昏昏欲睡、闭目是由于阴气主收敛所致。“但欲寐”是少阴病(少阴经受邪所致的病证)的本证,但也有属于热证的情况。)
太阳病(太阳经受邪所致的病证)持续十天,脉象浮而细,嗜睡,说明表证已经解除。如果出现胸满胁痛的症状,应使用小柴胡汤(此处按语认为此条应为太阳病与少阳病合病)。少阴病表现为但欲寐、口燥咽干,应当急用下法治疗,方用大承气汤。少阴病出现想吐又吐不出来、但欲寐,五六天后出现自发性腹泻且口渴,这是因为少阴虚损,所以患者饮水以自救。如果小便颜色清白,说明下焦虚寒,方用四逆汤;若小便黄赤且口渴,则用白头翁汤。风温病表现为出汗、身体沉重、打鼾睡眠、言语困难,方用葳蕤汤。
按语:嗜睡也有阴阳的区别。少阴病脉象微细,但欲寐,或者蜷缩而卧,或者面向墙壁而卧,四肢厥冷,身体沉重,这些都是阴证。应用附子汤温补。如果是热气内伏,神气昏倦,导致人多眠,小柴胡汤确实是重要的方剂。
(气从少腹向上冲击心脏并疼痛,状如野猪冲撞,必然感到脐下悸动不安。这种情况多由误用发汗法或烧针疗法引起。)
太阳病发汗后,脐下悸动的,是欲作奔豚(一种气从少腹上冲心胸的病症),方用茯苓桂枝甘草大枣汤。烧针强迫发汗,针孔处受寒,出现红肿硬结,必然引发奔豚,气从少腹上冲至心,应在红肿硬结上各灸一壮(艾灸单位),方用桂枝加桂汤。
脉迟、四肢厥冷,下利(腹泻)时应当不能进食。如果反而能进食,称为“除中”(胃气将绝的假象),属于不可治之症。这种症状有两种情况:一种是由误服黄芩汤等凉药导致的,必定死亡;另一种是热少厥多,胃气尚存,可以治愈。这种情况不是由药物引起的。
(顽痹指不知痛痒的病症,因出汗太多导致营气与卫气俱虚,血气不和,肌肉失养所致。)
发汗后,虽然靠近棉絮保暖,仍然感觉肌肉跳动或抽搐(原文缺字,据语境推测为肉瞤或类似症状),方用羌活冲和汤加桂枝、当归、木香主治。
(Wei Qi (Defensive Qi) travels through the Yang meridians during the day and the Yin meridians at night. When traveling through the Yang, one is awake; when traveling through the Yin, one sleeps. If Yang Qi is deficient and Yin Qi is exuberant, the eyes close in sleep, indicating that the pathogenic factor has transmitted to the Yin rather than remaining in the Yang. The state of drowsiness with closed eyes is due to the Yin's function of closure. "Dan Yu Mei" (Desire to sleep but unable to stay fully awake) is the fundamental manifestation of Shaoyin disease (disease pattern of the Shaoyin channel), although there are also cases involving Heat.)
In Taiyang disease (disease pattern of the Taiyang channel) persisting for ten days, if the pulse is floating and fine and the patient desires to lie down, it indicates that the exterior syndrome has resolved. If chest fullness and hypochondriac pain occur, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used (Note: This clause likely represents a combined Taiyang and Shaoyang disease). In Shaoyin disease, if there is "Dan Yu Mei," dry mouth, and dry throat, urgent purgation is required, using Da Cheng Qi Tang (Major Order the Qi Decoction). In Shaoyin disease, if there is a desire to vomit without actual vomiting, "Dan Yu Mei," spontaneous diarrhea after five or six days accompanied by thirst, it is due to Shaoyin deficiency, causing the patient to seek water for self-rescue. If the urine is clear and white, it indicates deficiency-cold in the Lower Jiao (Lower Burner), treated with Si Ni Tang (Frigid Extremities Decoction); if the urine is yellow-red and accompanied by thirst, Bai Tou Weng Tang (Pulsatilla Decoction) is used. In Feng Wen (Wind-Warmth disease), symptoms include sweating, heaviness of the body, snoring sleep, and difficulty speaking, treated with Wei Rui Tang (Polygonatum Decoction).
Note: Desire to lie down differs between Yin and Yang patterns. In Shaoyin disease, the pulse is faint and fine, with "Dan Yu Mei," curling up while lying, lying facing the wall, cold extremities, and heavy body; these are all Yin syndromes. Fu Zi Tang (Aconite Decoction) should be used to warm them. If heat is concealed internally, causing mental fatigue and drowsiness, Xiao Chai Hu Tang is indeed an essential formula.
(Qi rushes upward from the lower abdomen to the heart causing pain, resembling the charge of a wild boar, accompanied by palpitations below the umbilicus. This is often caused by improper sweating methods or moxibustion with needles.)
After inducing sweating in Taiyang disease, if there is palpitation below the umbilicus, it indicates impending Ben Tun (Rushing Pig - a condition where Qi rushes from the lower abdomen to the chest/heart), treated with Fu Ling Gui Zhi Gan Cao Da Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction). If moxibustion with needles was used to induce sweating, and the needle site became cold, resulting in red nodules, Ben Tun will definitely occur, with Qi rushing from the lower abdomen to the heart. Apply one moxa cone on each nodule, treated with Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon Twig).
Note: Ben Tun is caused by the rebellious Qi of Shaoyin; it is not cured by simply using Rou Gui (Cinnamon Bark) to drain the pathogen.
If the pulse is slow and extremities are cold, diarrhea usually implies inability to eat. If the patient can unexpectedly eat, it is called Chu Zhong (Elimination of the Middle - a sign of stomach Qi exhaustion), which is incurable. There are two types of this symptom: one results from taking Huang Qin Tang (Scutellaria Decoction) or other cooling medicines improperly, leading to death; the other involves less heat and more cold extremities, where stomach Qi remains, making it treatable. This latter case is not caused by medication.
(Wan Bi refers to numbness without pain or itch sensation, caused by excessive sweating leading to deficiency of Ying Qi (Nutritive Qi) and Wei Qi, disharmony of Blood and Qi, and malnutrition of muscles.)
After sweating, even if near cotton wadding for warmth, the patient still experiences muscle twitching/spasms [text missing in original, inferred context], treated with Qiang Huo Chong He Tang (Notopterygium Harmonizing Decoction) added with Gui Zhi (Cinnamon Twig), Dang Gui (Angelica Sinensis), and Mu Xiang (Aucklandia Root).