阴阳相胜互争强。往来寒热亦何常。先寒后热为阴盛。先热后寒责在阳。(阴阳交争。故往来寒热。阴气胜。故先寒
后热。阳气胜。故先热后寒也。)此疾大约有三证。大小柴胡姜桂汤。中风胸满不欲食。心烦喜呕小柴良。(仲景云。中
风往来寒热。胸胁苦满。默默不欲食。心烦喜呕者。属小柴胡汤。)热结在里十余日。却是大柴胡克当。(仲景云。伤寒
十余日。热结在里。往来寒热者。宜大柴胡汤证。)已汗复下胸胁满。柴胡姜桂保安康。(仲景云。伤寒五六日。已汗而
复下之。胸胁满。微结。小便不利。渴而不呕。但头汗出。往来寒热者。柴胡桂枝干姜汤主之。)
已汗复下脉加躁。不食狂言谩祈祷。此证谓之阴阳交。死候难医不可道。(素问云。汗出而身复热。脉躁病不解。汗
衰狂言。不能食。病名为何也。曰病名阴阳交也。此其人所以汗出者。皆生于谷。谷生于精。今邪气隐藏于骨肉之间。
而得汗者。邪衰而精胜。则当食而不发热。热者邪气也。汗者胃气也。今汗出而狂言。不能食。邪盛也。死候可明矣。)
得汗脉静自然生。汗后复热命难保。(得汗而脉静者生。躁者死。)脉若浮数可再汗。沉实之时下为好。(不得已须当汗。
下之。浮尚可汗。沉实。尚可下之。)风温之候属葳蕤。(风温。自汗而热。属葳蕤汤。)虚烦竹叶汤为宝。(虚烦。自汗
出而热。不可下。宜竹叶汤。)更看虚实治为宜。可细斟量休草草。(淳于意诊齐中御府长信病。意称脉法热病阴阳交者
死。今切之不交。并阴阳者。脉顺清而愈。其热强未尽。犹活也。)
阴阳二气相互偏胜、激烈争持。寒热往来交替发作,没有固定的规律。(这是因为阴阳之气交相争斗,所以出现寒热往来的症状。阴气偏胜,所以先感到寒冷而后发热;阳气偏胜,所以先感到发热而后寒冷。)这种病症大致有三种证型:分别适用大小柴胡汤和姜桂汤。
若是中风病,表现为胸中胀满、不想进食、心烦且容易呕吐,这是小柴胡汤的良证。(张仲景说:中风病出现寒热往来、胸胁部苦闷胀满、神情沉默不欲饮食、心烦且喜呕吐的,属于小柴胡汤证。)
若热邪结聚在体内已十余日,应当用大柴胡汤来攻克治疗。(张仲景说:伤寒病十余日,热邪结聚在里,出现寒热往来的,适宜用大柴胡汤证。)
若已经发汗后又误用泻下法,导致胸胁胀满,应用柴胡桂枝干姜汤可保平安。(张仲景说:伤寒病五六天,已经发汗而又再次泻下,出现胸胁胀满、轻微结滞、小便不利、口渴但不呕吐、仅头部出汗、寒热往来的,主治方剂为柴胡桂枝干姜汤。)
若已经发汗后又误用泻下法,脉象更加躁动不安,患者不能进食、胡言乱语、盲目祈祷,这种证候称为“阴阳交”,属于死证,难以医治,不可言说。(《素问》说:出汗后身体又发热,脉象躁急而病不解除,出汗后精神狂乱、不能进食,这是什么病呢?回答说:病名叫做阴阳交。人之所以出汗,是因为水谷精微化生的精气。水谷精微生于肾精。现在邪气潜伏在骨肉之间,如果出汗后是邪气衰退而精气胜利,就应当能进食且不发热。发热的是邪气,出汗的是胃气。现在出汗后却胡言乱语、不能进食,说明邪气盛极。死征兆已经很明确了。)
若出汗后脉象平静,自然能够生存;出汗后再次发热,性命难保。(出汗后脉象平静的预后良好,脉象躁动的预后不良致死。)
若脉象浮数,可以再次使用发汗法;若脉象沉实,此时使用泻下法较好。(不得已必须发汗或泻下时,脉浮还可以发汗,脉沉实则还可以泻下。)
风温病的证候属于葳蕤汤(玉竹汤)的主治范围。(风温病,表现为自汗且发热,归属于葳蕤汤证。)
虚烦证以竹叶汤为宝。(虚烦证,表现为自汗出且发热,不可使用泻下法,适宜用竹叶汤。)
更要根据虚实情况进行辨证施治,仔细斟酌衡量,切勿草率行事。(淳于意诊治齐国中御府长信患病,依据脉法判断热病中的“阴阳交”证必死。如今切脉发现并非阴阳交,而是阴阳之气并见但脉象顺从清静,病情会痊愈。虽然热势强盛尚未完全消退,但病人仍然可以存活。)
Yin and Yang qi mutually overcome and fiercely contend. The alternating chills and fever occur without a fixed pattern. (This is because Yin and Yang Qi intermingle and struggle, thus causing alternating chills and fever. When Yin Qi prevails, chills precede fever; when Yang Qi prevails, fever precedes chills.) This illness generally presents in three syndromes, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), or Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction).
If Wind Strike (Zhong Feng) manifests with chest fullness, loss of appetite, irritability, and frequent vomiting, it is a favorable indication for Xiao Chai Hu Tang (Minor Bupleurum Decoction). (Zhang Zhongjing stated: In cases of Wind Strike presenting with alternating chills and fever, bitter fullness in the chest and hypochondrium, silent desire not to eat, irritability, and frequent vomiting, it belongs to the Xiao Chai Hu Tang syndrome.)
If heat accumulation remains internal for more than ten days, Da Chai Hu Tang (Major Bupleurum Decoction) should be used to resolve it. (Zhang Zhongjing stated: In Cold Damage lasting over ten days with heat accumulated internally and alternating chills and fever, the Da Chai Hu Tang syndrome is appropriate.)
If sweating has already been induced followed by purgation, resulting in chest and hypochondriac fullness, Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) ensures recovery. (Zhang Zhongjing stated: In Cold Damage after five or six days, where sweating was performed followed by purgation, leading to chest and hypochondriac fullness, slight binding, difficulty in urination, thirst without vomiting, only sweat on the head, and alternating chills and fever, the primary treatment is Chai Hu Gui Zhi Gan Jiang Tang.)
If sweating and purgation have both occurred, yet the pulse becomes more restless, accompanied by anorexia, delirious speech, and vain prayers, this syndrome is termed "Yin-Yang Jiao" (Yin-Yang Intersection), which is a critical death sign difficult to treat. (Su Wen states: If fever returns after sweating, the pulse is rapid and the disease does not resolve, and the patient exhibits delirium and inability to eat after sweating, what is the name of this disease? It is called Yin-Yang Jiao. The reason humans sweat is due to essence derived from grain/food, which originates from Kidney Essence. Now, pathogenic factors hide between flesh and bone. If sweating occurs because pathogens decline and essence prevails, the patient should be able to eat and not have fever. Fever represents pathogenic factors; sweating represents Stomach Qi. Now, sweating is accompanied by delirium and inability to eat, indicating excessive pathogens. The signs of death are clear.)
If the pulse becomes calm after sweating, life will naturally be preserved; if fever recurs after sweating, life is hard to save. (A calm pulse after sweating indicates survival; a restless pulse indicates death.)
If the pulse is floating and rapid, sweating may be applied again; if the pulse is deep and solid, purgation is preferable. (When sweating or purgation is unavoidable, a floating pulse still allows for sweating, while a deep and solid pulse allows for purgation.)
The presentation of Wind-Warmth (Feng Wen) belongs to Wei Rui Tang (Jade Bamboo Decoction). (Wind-Warmth, characterized by spontaneous sweating and fever, falls under the Wei Rui Tang syndrome.)
For deficiency vexation (Xu Fan), Zhu Ye Tang (Bamboo Leaf Decoction) is precious. (Deficiency vexation, characterized by spontaneous sweating and fever, should not be treated with purgation; Zhu Ye Tang is suitable.)
One must further examine deficiency and excess to determine appropriate treatment, carefully weighing the condition without being hasty. (Chunyu Yi diagnosed the illness of Chang Xin, the Imperial Envoy of Qi's Central Office. Yi cited the pulse method stating that Yin-Yang Jiao in heat diseases results in death. However, upon palpation, he found it was not Yin-Yang Jiao, but rather Yin and Yang pulses appearing together yet smooth and clear, indicating recovery. Although the heat is strong and not fully exhausted, the patient will survive.)