少阴病。脉微不可发汗。亡(音无)阳故也。阳已虚。尺脉弱涩者。复不可下之。
微者。细小软弱。似有若无之称也。脉微则阳气大虚。卫阳衰弱。故不可发汗以更竭其阳。以汗虽阴液。
为阳气所蒸而为汗。汗泄而阳气亦泄矣。今阳气已虚。故曰亡阳故也。若阳已虚。而其尺脉又弱涩者。
知命门之真火衰微。肾家之津液不足。不惟不可发汗。复不可下之。又竭其阴精阳气也。此条本为少阴禁汗
禁下而设。故不言治。然温经补阳之附子汤之类。即其治也。
少阴病。饮食入口即吐。心下温温欲吐。复不能吐。始得之。手足寒。脉弦迟者。此胸中实。不可下也。
当吐之。若膈上有寒饮。干呕者。不可吐也。急温之。宜四逆汤。
欲吐不吐之证。本属少阴。饮食入口即吐。心下温温欲吐而又复不能吐者。寒在胸膈也。此证于始得之时。
即手足寒者。乃本经直受之寒邪肆虐。阳气不达于四肢也。弦则为实。迟则为寒。脉弦而迟者。为寒邪实于
胸中。不可用苦寒攻下也。大凡热邪之实于胃者。方为可下。热邪在胸。已不可下。况寒邪乎。寒既在胸。因其近
而取之。以上出为功。当用高者因而越之之法。故云当吐之。若膈上素有寒饮停积而常作干呕者。是中气本寒。
胃气本虚。更不可用瓜蒂散等苦寒之药吐之。重伤胃脘之阳而致变逆也。当急温之。宜四逆汤。
少阴病。脉象微细,不可使用发汗法。这是因为阳气已经亡失的缘故。如果阳气已经虚弱,且尺部脉象弱而涩,则再次不可使用泻下法。
所谓“微”,是指脉象细小软弱,似有若无的状态。脉象微细说明阳气极度虚弱,卫外之阳衰弱,因此不可通过发汗来进一步耗竭其阳气。因为汗液虽然属于阴液,但它是依靠阳气的蒸腾作用才化为汗液的;汗液外泄的同时,阳气也随之耗散。如今阳气已经虚弱,所以说这是阳气亡失的缘故。如果阳气已经虚弱,而其尺部脉象又呈现弱涩之象,可知命门中的真火衰微,肾脏的津液不足。这不仅仅不可发汗,也不可使用泻下法,以免进一步耗竭阴精和阳气。这一条文原本是为了规定少阴病禁止发汗和禁止泻下而设立的,所以没有提及具体的治疗方法。然而,像附子汤这样温补经脉、扶助阳气的方剂,就是其治疗方法。
少阴病。饮食入口即呕吐,心中感觉温热且有想吐的感觉,却又吐不出来。在疾病初起时,出现手足寒冷,脉象弦而迟缓的,这是胸中有实邪阻滞,不可使用泻下法。应当使用涌吐法。如果是膈上有寒饮停滞,表现为干呕的,不可使用涌吐法。应当紧急温阳,适宜使用四逆汤。
想要呕吐却吐不出来的证候,本属于少阴病范畴。饮食入口即吐,心中感觉温热想吐却又吐不出的,是因为寒邪停留在胸膈部位。这个证候在刚发病时,就出现手足寒冷的,是本经直接感受寒邪肆虐,导致阳气不能通达于四肢。脉弦主实证,脉迟主寒证。脉象弦而迟缓,说明寒邪实结于胸中,不可使用苦寒性质的药物进行攻下。大凡热邪实结于胃部的,才可以考虑使用泻下法。热邪如果在胸中,尚且不可泻下,何况是寒邪呢?既然寒邪在胸中,因其病位靠近上焦,治疗应以促使邪气从上排出为功效,应当采用“其高者,因而越之”(病位在上,用涌吐法使邪气外出)的方法,所以说应当使用涌吐法。如果是膈上素来有寒饮停积,经常发生干呕的,这是中焦之气本虚寒,胃气本来虚弱,更不可使用瓜蒂散等苦寒性质的药物进行涌吐,否则会严重损伤胃脘部位的阳气而导致病情恶化变生逆证。应当紧急温阳,适宜使用四逆汤。
Shaoyin disease. The pulse is faint (Wei, 微), and sweating therapy must not be used. This is because Yang Qi has been lost. If Yang Qi is already deficient, and the Chi position pulse is weak and choppy (Ruose, 弱涩), purgation therapy must also not be used.
"Faint" refers to a pulse that is thin, small, and weak, appearing as if present or absent. A faint pulse indicates severe deficiency of Yang Qi and weakness of Wei Yang (Defensive Yang). Therefore, sweating therapy should not be employed to further exhaust Yang Qi. Although sweat is Yin fluid, it is formed by the steaming action of Yang Qi; when sweat is discharged, Yang Qi is also dissipated. Since Yang Qi is currently deficient, it is stated that this constitutes the loss of Yang Qi. If Yang Qi is already deficient and the Chi position pulse is weak and choppy, it indicates that the True Fire of the Mingmen (Gate of Life) is declining and the Kidney's Jin-Ye (Body Fluids) are insufficient. Not only is sweating contraindicated, but purgation is also forbidden, to avoid further exhausting Yin Essence and Yang Qi. This clause was originally established to prohibit sweating and purgation in Shaoyin disease; thus, no specific treatment is mentioned. However, formulas such as Fuzi Tang (Aconite Decoction), which warm the meridians and tonify Yang, constitute its treatment.
In Shaoyin disease, food and drink are vomited immediately upon entering the mouth; there is a sensation of warmth in the epigastrium with an urge to vomit, yet vomiting cannot occur. At the onset, accompanied by cold extremities and a string-taut (Xian, 弦) and slow (Chi, 迟) pulse, this indicates excess pathogenic factors in the chest. Purgation is contraindicated. Emesis (vomiting therapy) should be induced. If there is cold-fluid retention above the diaphragm presenting as dry retching, emesis is contraindicated. Urgent warming is required, and Sini Tang (Frigid Extremities Decoction) is indicated.
The syndrome of wanting to vomit but being unable to do so belongs to Shaoyin. Vomiting immediately after ingestion, with a warm sensation in the epigastrium and an urge to vomit that fails to materialize, indicates Cold pathogen lodged in the chest and diaphragm. When cold extremities appear at the very beginning of this syndrome, it signifies that the channel itself has directly received rampant Cold pathogen, preventing Yang Qi from reaching the four limbs. A string-taut pulse indicates excess; a slow pulse indicates Cold. A string-taut and slow pulse indicates Cold excess in the chest; bitter-cold purgatives must not be used. Generally, purgation is applicable only when Heat pathogen is excessive in the Stomach. Even if Heat pathogen is in the chest, purgation is contraindicated, let alone Cold pathogen. Since Cold is in the chest, and the pathogen is proximal to the upper jiao, the treatment goal is to expel it upwards. One should employ the method: "For pathogens high up, use emesis to disperse them." Hence, it is said that emesis should be used. If there is pre-existing cold-fluid retention above the diaphragm causing frequent dry retching, this indicates inherent deficiency-cold of the Middle Qi and inherent weakness of Stomach Qi. In such cases, bitter-cold emetic agents like Gengti San (Melon Seed Powder) must not be used, as they would severely damage the Yang Qi of the stomach wall and lead to adverse transformations. Urgent warming is required, and Sini Tang (Frigid Extremities Decoction) is indicated.