太阳阳明同合病。仲景法中有三证。自利宜服葛根汤。但呕却加半夏应。喘而胸满属麻黄。慎勿下之轻性命。循规
守矩治为宜。要使冲和自安静。(仲景三证。一者太阳与阳明合病。则自利。葛根汤主之。二者合病。不下利。但呕者。
葛根加半夏汤主之。三者太阳阳明合病。喘而胸满者不可下。宜麻黄汤。)
太阳少阳合病时。亦须下利更何疑。下利黄芩汤可用。若呕还加半夏奇。(仲景云。太阳少阳合病。自下利者。与黄
芩汤。若呕者。黄芩加半夏生姜汤。)
腹满身重难转侧。面垢遗尿谵语极。三阳合病口不仁。白虎汤功更奇特。(仲景云。三阳合病。腹满身重。难以转侧。
口中不仁谵语遗溺。发汗则谵语。下之则额上生汗。手足厥冷。自汗。白虎汤主之。)
太少并病证有二。汗下差之皆致毙。头痛眩冒如结胸。误若汗时谵语至。肺俞肝俞皆可刺。谵语却刺期门是。(仲景
一证云。太阳少阳并病。头痛眩冒。时如结胸。心下痞硬。当刺肺俞肝俞。不可发汗。发汗则谵语脉弦。五日谵语不止。
当刺期门。)颈项强时刺大椎。此候在心当切记。(一证云。太少并病。心下硬。颈强而眩者。当刺大椎。肺俞。肝俞。
慎勿下。)
烦燥面赤身微热。脉至沉微阴作孽。(脉来沉微者阴也。阴极生热。故烦躁面赤身热。)阴证似阳医者疑。但以脉凭
斯要诀。(但以脉为据。不必守证也。)身热里寒阴躁盛。面戴阳兮下虚证。(身热也。里寒也。烦躁者阴盛也。面戴阳者。
下虚故也。此皆阴证似阳也。)阴发躁兮热发厥。物极则反皆理性。(阴极则生躁热极则发厥。物极则反。皆物之理性也。)
太阳病与阳明病同时发病的合病情况。张仲景的法度中有三种证型。出现自发性腹泻的,适宜服用葛根汤。如果只有呕吐症状,则应在方中加入半夏来应对。出现气喘且胸部胀满的,属于麻黄汤证。切记不可使用泻下法,以免轻率地危及生命。遵循规矩进行治疗是适宜的,要使人体气机冲和自然安静。(张仲景提到的三种证型:第一种是太阳与阳明合病,出现自发性腹泻,用葛根汤主治;第二种是合病但不腹泻,仅有呕吐的,用葛根加半夏汤主治;第三种是太阳与阳明合病,出现气喘且胸部胀满的,不可使用泻下法,适宜用麻黄汤。)
太阳病与少阳病同时发病时,也常常伴有腹泻,这还有什么可怀疑的呢?对于这种腹泻,可以使用黄芩汤。如果伴有呕吐,再加半夏效果奇特。(张仲景说:太阳与少阳合病,出现自发性腹泻的,给予黄芩汤治疗;如果伴有呕吐的,给予黄芩加半夏生姜汤治疗。)
腹部胀满,身体沉重,难以翻身侧卧,面色垢浊,遗尿,谵语严重。这是三阳合病,口中感觉麻木不仁(口不仁)。白虎汤的功效更加奇特。(张仲景说:三阳合病,表现为腹部胀满、身体沉重、难以翻身侧卧、口中麻木不仁、谵语、遗溺。如果误用发汗法,会导致谵语加重;误用泻下法,会导致额头出汗、手足厥冷、自汗。此时应用白虎汤主治。)
太阳与少阳并病的证候有两种,如果汗法和下法使用不当,都会导致死亡。头痛、眩晕昏冒,症状类似结胸。如果误用发汗法,会出现谵语。肺俞穴和肝俞穴都可以针刺。如果出现谵语,则应针刺期门穴。(张仲景的一个证候描述:太阳与少阳并病,出现头痛、眩晕昏冒,时常感觉像结胸一样,心下部痞塞坚硬。应当针刺肺俞穴和肝俞穴,不可发汗。如果发汗,则会出现谵语、脉弦。如果五天后谵语仍不止,应当针刺期门穴。)颈部僵硬时,应针刺大椎穴。这种情况关乎心脏,应当牢记。(另一个证候描述:太阳与少阳并病,心下部硬满,颈部僵硬且眩晕的,应当针刺大椎穴、肺俞穴、肝俞穴。切记不可使用泻下法。)
烦躁,面色发红,身体轻微发热,脉搏沉微,这是阴邪作祟。(脉搏来势沉微,属于阴证。阴极则生热,所以出现烦躁、面色发红、身体发热。)阴证表现出类似阳证的特征,医生容易产生疑惑。但只要以脉象为依据,就是关键诀窍。(只要以脉象为判断依据,不必拘泥于表面症状。)身体发热而内部寒冷,阴寒躁动旺盛。面色泛红如戴阳,这是下元虚损的证候。(身体发热,内部寒冷。烦躁是因为阴盛。面色泛红如戴阳,是因为下焦虚损。这些都是阴证似阳的表现。)阴证发作时会躁动,热极发作时会厥逆。事物发展到极端就会反向转化,这都是事物的本性规律。(阴极则产生躁热,热极则发生厥逆。物极必反,都是事物的本性规律。)
Taiyang and Yangming diseases occurring simultaneously as a combined disease. In Zhang Zhongjing's methods, there are three types of syndromes. For spontaneous diarrhea, Gegen Tang (Pueraria Decoction) is appropriate. If only vomiting occurs, Banxia (Pinelliae Rhizoma) should be added accordingly. For wheezing accompanied by chest fullness, it belongs to Mahuang Tang (Ephedra Decoction). One must strictly avoid purgation to prevent endangering life lightly. Adhering to rules and regulations for treatment is suitable, aiming to restore the harmonious flow of Qi and achieve natural tranquility. (Zhang Zhongjing's three syndromes: First, Taiyang and Yangming combined disease with spontaneous diarrhea, treated primarily with Gegen Tang; Second, combined disease without diarrhea but with vomiting, treated primarily with Gegen Jia Banxia Tang [Pueraria Decoction plus Pinellia]; Third, Taiyang and Yangming combined disease with wheezing and chest fullness, where purgation is contraindicated, and Mahuang Tang is suitable.)
When Taiyang and Shaoyang diseases occur simultaneously, diarrhea is also present, leaving no room for doubt. Huangqin Tang (Scutellaria Decoction) can be used for this diarrhea. If vomiting is present, adding Banxia yields remarkable results. (Zhang Zhongjing stated: For Taiyang and Shaoyang combined disease with spontaneous diarrhea, administer Huangqin Tang. If vomiting occurs, administer Huangqin Jia Banxia Shengjiang Tang [Scutellaria Decoction plus Pinellia and Fresh Ginger].)
Abdominal fullness, body heaviness, difficulty in turning over, greasy facial complexion, enuresis, and severe delirium. This is a combined disease of the Three Yang channels, characterized by numbness and loss of taste in the mouth (Kou Bu Ren). Baihu Tang (White Tiger Decoction) has even more miraculous efficacy. (Zhang Zhongjing stated: Combined disease of the Three Yang channels presents with abdominal fullness, body heaviness, difficulty in turning over, numbness in the mouth, delirium, and enuresis. Misapplication of sweating therapy leads to aggravated delirium; misapplication of purgation leads to sweat on the forehead, cold limbs, and spontaneous sweating. Baihu Tang is indicated here.)
There are two types of Bingbing (concurrent disease) involving Taiyang and Shaoyang. Errors in using sweating or purgation therapies can both lead to death. Headache, dizziness, and vertigo resembling Jie Xiong (Chest Binding) occur. If sweating is mistakenly applied, delirium ensues. Feishu (BL13) and Ganshu (BL18) acupoints can both be needled. If delirium occurs, Qimen (LR14) should be needled. (One syndrome described by Zhang Zhongjing: Taiyang and Shaoyang concurrent disease presents with headache, dizziness, and vertigo, often feeling like Chest Binding, with epigastric stiffness and hardness. One should needle Feishu and Ganshu. Sweating is contraindicated. If sweating is applied, delirium and wiry pulse appear. If delirium persists for five days, Qimen should be needled.) When neck stiffness occurs, Dazhui (GV14) should be needled. This condition relates to the Heart and must be remembered clearly. (Another syndrome description: Taiyang and Shaoyang concurrent disease with epigastric hardness, neck stiffness, and dizziness requires needling of Dazhui, Feishu, and Ganshu. Purgation must be strictly avoided.)
Irritability, red face, slight body heat, and a deep, faint pulse indicate Yin pathogenic factors causing mischief. (A deep and faint pulse indicates Yin. Extreme Yin generates heat, hence irritability, red face, and body heat.) Physicians may hesitate when Yin syndromes mimic Yang manifestations. The key principle lies solely in relying on the pulse. (Rely on the pulse as evidence; do not adhere rigidly to symptoms.) Body heat with interior cold indicates severe Yin irritability. A red face floating upward (Dai Yang) signifies deficiency at the lower origin. (Body heat, interior cold. Irritability stems from Yin excess. Red face floating upward stems from lower jiao deficiency. These are all cases of Yin syndromes mimicking Yang.) Yin syndromes manifest as irritability, while extreme heat manifests as Jue Ni (Cold Extremities). When things reach an extreme, they reverse; this is the inherent nature of all things. (Extreme Yin produces irritability and heat; extreme heat produces cold extremities. Things reverse when reaching extremes; this is the rational nature of phenomena.)