(内有热者必喜饮水今欲水而不欲咽是热在经而里无热也此症属在阳明经
此经气血俱多经中热甚逼血妄行必将衄也 蓄血症燥而不渴多见此症 阴症发躁烦渴不能饮水或勉
强
不能饮也)
阳明身热。头痛。口燥。漱水不欲入咽。必衄血。脉微。(犀角地黄汤茅花汤)无表症。
不寒
丸)少阴脉沉细。厥逆。漱水不欲咽。(四逆汤)下利厥逆无脉。干呕烦渴。漱水不欲咽。(白
通汤加猪胆汁人尿)吐蛔口燥舌干。但欲凉水浸舌。及唇。不欲咽。(理中汤加乌梅)
(伤寒十三日不解谓之过经脉尺寸陷者大危)
过经不解。柴胡症未罢。(小柴胡汤和之)呕不止。心下郁郁微烦。(大柴胡汤)形弱脉虚
。(参胡三白汤)虚烦不眠。(温胆汤加人参柴胡)
坏病(汗吐下后仍不解者此名坏病桂枝不中与也审其脉症知犯何逆随症治之或因误汗或
因误吐或因误下皆不顺于理故曰逆也)
太阳病不解。转入少阳。胁下硬满。干呕。往来寒热。未吐下。脉沉紧。(小柴胡汤)汗
吐下后。柴胡症罢。此为坏症。知犯何逆。以法治之。
按伤寒既久。汗吐下后。邪气渐平。正气渐薄。阳亡于外。阴竭于内。自非大补。宁有
生机
屡屡回生。如有兼症。必以人参为主。随症调之。真良法也。
(体内有热的人通常喜欢喝水,现在想喝水却不想咽下,这是热邪在经络而脏腑内部没有热。此症属于阳明经病变。这一经络的气血都很丰富,经络中热势极盛,逼迫血液妄行,必然会导致鼻出血。蓄血症患者身体干燥但不口渴,也常见这种症状。阴证出现烦躁、烦渴但不能饮水,或者是勉强喝下去也无法吞咽。)
阳明病表现为身体发热、头痛、口燥,只想含水漱口而不愿咽下,必然会出现鼻衄,脉象微细。(可用犀角地黄汤或茅花汤治疗)。如果没有表证、不恶寒……(此处原文似有缺漏或排版错误,结合上下文及方剂推测为少阴病相关描述)少阴病脉象沉细,四肢厥冷,想含水漱口而不愿咽下。(可用四逆汤治疗)。腹泻、四肢厥冷且无脉,干呕、心烦口渴,想含水漱口而不愿咽下。(可用白通汤加猪胆汁和人尿治疗)。呕吐蛔虫、口燥舌干,只想用凉水浸湿舌头和嘴唇,不愿咽下。(可用理中汤加乌梅治疗)。
(伤寒病十三天仍未痊愈称为“过经”,如果寸关尺三部脉象陷入不起,情况非常危险。)
病已过经但病情未解,柴胡证候尚未消失。(用小柴胡汤和解)。呕吐不止,胃脘部郁郁不舒且轻微烦躁。(可用大柴胡汤治疗)。形体虚弱,脉象虚软。(可用参胡三白汤治疗)。虚烦导致失眠。(可用温胆汤加人参、柴胡治疗)。
坏病(经过发汗、催吐、泻下治疗后仍然不能痊愈的,称为坏病,此时不能再给桂枝汤。必须仔细审查脉象和症状,了解犯了什么错误,根据具体症状进行治疗。可能是因为误汗,或者误吐,或者误下,都不顺乎医理,所以称为“逆”。)
太阳病未愈,转入少阳经,胁下硬满,干呕,寒热往来,未经过催吐或泻下,脉象沉紧。(可用小柴胡汤治疗)。经过发汗、催吐、泻下后,柴胡证候消失,这属于坏症。需要查明犯了什么错误,按照相应的法则治疗。
按语:伤寒病程已久,经过发汗、催吐、泻下后,邪气逐渐平息,正气逐渐薄弱,阳气在外亡失,阴液在内枯竭。如果不是大补元气,怎么会有生机?屡次使病人起死回生,如果有兼夹症状,必须以人参为主药,随症状调整。这才是真正的好方法。
(Those with heat in the interior typically desire drinking water. Now, desiring water but unwilling to swallow indicates that the heat is in the meridians while there is no heat in the interior. This syndrome belongs to the Yangming Meridian. The Qi and Blood of this meridian are abundant; intense heat within the meridian forces blood to move recklessly, inevitably leading to epistaxis (nosebleed). Patients with blood stasis syndrome often present with dryness without thirst, frequently exhibiting this symptom. In Yin syndromes, restlessness and irritability with excessive thirst may occur, yet the patient cannot drink, or can only force it down without swallowing.)
Yangming disease presents with body heat, headache, dry mouth, desiring to rinse the mouth with water but not swallow, inevitably leading to epistaxis, with a faint pulse. (Treat with Xijiao Dihuang Tang [Rhinoceros Horn and Rehmannia Decoction] or Maohua Tang [Arenaria Decoction]). If there are no exterior symptoms and no aversion to cold... [Text appears fragmented here, context suggests Shaoyin pattern description follows] Shaoyin disease presents with a deep and fine pulse, cold extremities, desiring to rinse the mouth with water but not swallow. (Treat with Sini Tang [Frigid Extremities Decoction]). Diarrhea, cold extremities, absence of pulse, dry retching, irritability, and thirst, desiring to rinse the mouth with water but not swallow. (Treat with Baitong Tang [White Tongue Decoction] added with pig bile and human urine). Vomiting roundworms, dry mouth and tongue, desiring only to soak the tongue and lips with cool water, unwilling to swallow. (Treat with Lizhong Tang [Regulate the Middle Decoction] added with Wumei [Mume Fruit]).
(If Shanghan [Cold Damage] persists for thirteen days without resolution, it is called "passing the meridian." If the pulses at Cun, Guan, and Chi sink into depression, the condition is critical.)
The pathogen has passed the meridian but the condition remains unresolved, and the Chaihu [Bupleurum] syndrome has not ceased. (Harmonize with Xiaochaihu Tang [Minor Bupleurum Decoction]). Unceasing vomiting, oppression in the epigastrium with slight irritability. (Treat with Dachaihu Tang [Major Bupleurum Decoction]). Weak physique and deficient pulse. (Treat with Shenhu Sanbai Tang [Ginseng and Bupleurum Three Whites Decoction]). Deficient irritability and insomnia. (Treat with Wendan Tang [Warm Gallbladder Decoction] added with Renshen [Ginseng] and Chaihu [Bupleurum]).
Huaibing [Ruined Disease] (Conditions that remain unresolved after sweating, vomiting, or purging methods are termed Huaibing. Guizhi Tang [Cinnamon Twig Decoction] should not be administered. One must carefully examine the pulse and symptoms to determine what error was committed, and treat according to the specific presentation. This may result from erroneous sweating, vomiting, or purging, all of which violate proper medical principles, hence termed "adverse".)
Taiyang [Greater Yang] disease unresolved, transferring to Shaoyang [Lesser Yang]. Hardness and fullness under the hypochondrium, dry retching, alternating chills and fever, having undergone neither vomiting nor purging, with a deep and tight pulse. (Treat with Xiaochaihu Tang [Minor Bupleurum Decoction]). After sweating, vomiting, or purging, if the Chaihu syndrome ceases, this constitutes a Huaizheng [Ruined Syndrome]. Determine what error was committed and treat according to the appropriate method.
Commentary: When Shanghan [Cold Damage] has persisted for a long time, following sweating, vomiting, and purging, the pathogenic factors gradually subside, while the healthy Qi gradually weakens. Yang collapses on the exterior, and Yin is exhausted within. Unless substantial tonification is employed, how can there be any chance of survival? Repeatedly restoring life requires using Renshen [Ginseng] as the principal herb when accompanying symptoms exist, adjusting according to the clinical picture. This is indeed an excellent method.