厥阴之为病,消渴,气上撞心,心中疼热,饥而不欲食,食即吐蛔,下之利不止。
太阴厥阴,皆以里证为提纲。太阴主寒,厥阴主热,太阴为阴中之至阴,厥阴为阴中之阳也。太阴腹满而吐
食不下,厥阴饥不欲食,食即吐蛔。同是不能食,而太阴则满、厥阴则饥,同是一吐,而太阴吐食、厥阴吐蛔,
此又主脾、主肝之别也。太阴病则气下陷,故腹时痛而自利,厥阴病则气上逆,故心疼热而消渴,此湿土、风木
之殊也。太阴主开,本自利而下之,则开折,胸下结硬者,开折反阖也。厥阴主阖,气上逆而下之,则阖折,利
不止者,阖折反开也。按两阴交尽,名曰厥阴,阴尽而阳生,故又名阴之绝阳,则厥阴为病,宜无病热矣。以厥阴
脉络于少阳,厥阴热症,皆相火化令耳。厥阴经脉,上膈贯肝,气旺故上撞心。气有余即是火,故消渴而心中疼
热。火能消物故饥。肝脉挟胃,肝气旺,故胃口闭塞而不欲食也。虫为风化,厥阴病则生蛔,蛔闻食臭,则上入于
膈而从口出也。病发于阴而反下之,则气无止息而利不止矣。乌梅丸主之,可以除蛔,亦可以止利。
伤寒腹满谵语,寸口脉浮而紧,此肝乘脾也,名曰纵,刺期门。
腹满谵语,得太阴阳明内证;脉浮而紧,得太阳阳明表脉。阴阳表里疑似难明,则证当详辨,脉宜类推。脉
法曰∶“脉浮而紧者,名曰弦也。”弦为肝脉。《内经》曰∶“诸腹胀大,皆属于热。”又曰∶“肝气甚则多
言。”是腹满由肝火,而谵语乃肝旺所发也。肝旺则侮其所胜,直犯脾土,故曰纵。刺期门以泻之,庶不犯厥
阴汗下禁。
上条是肝乘心,此条是肝乘脾,下条是肝乘肺。肝为相火,有泻无补者,此类是也。
伤寒发热,啬啬恶寒,大渴欲饮水,其腹必满,此肝乘肺也,名曰横。刺期门,自汗出,小便利,其病欲解。
发热恶寒,寒为在表;渴欲饮水,热为在里。其腹因饮多而满,非太阴之腹满,亦非厥阴之消渴矣。此肝邪
挟火而克金。脾精不上归于肺,故大渴;肺气不能通调水道,故腹满。是侮所不胜,寡于畏也,故名曰横,必
刺期门,随其实而泻之。得自汗,则恶寒发热自解;得小便利,则腹满自除矣。
厥阴病,渴欲饮水者,少少与之愈。
水能生木、能制火,故厥阴消渴最宜之。
厥阴中风,脉微浮为欲愈,不浮为未愈。
厥阴受病,则尺寸微缓而不浮。今微浮,是阴出之阳,亦阴病见阳脉也。
有厥阴中风欲愈脉,则应有未愈证。夫以风木之藏,值风木主气时,复中于风,则变端必有更甚他经者。
今不得一焉,不能无阙文之憾。
厥阴病,欲解时,从丑至卯上。
木克于丑,旺于寅、卯,故主此三时。
厥阴病的提纲证候是:口渴多饮,气向上冲撞心脏,心中嘈杂疼痛且有灼热感,虽然感到饥饿却不想进食,勉强进食则会吐出蛔虫,如果误用攻下法,会导致腹泻不止。
太阴病和厥阴病,都是以里证作为提纲。太阴主寒,厥阴主热;太阴属于阴中之至阴,厥阴属于阴中之阳。太阴病表现为腹部胀满、呕吐、饮食不下;厥阴病表现为感觉饥饿但不想进食,进食后则吐出蛔虫。同样都是不能进食,但太阴是腹胀,厥阴是饥饿感;同样都是呕吐,但太阴吐的是食物,厥阴吐的是蛔虫,这是脾与肝病变的区别所在。太阴病时气机下陷,所以时常腹痛且自发性腹泻;厥阴病时气机上逆,所以心中疼痛发热且口渴,这是湿土(脾)与风木(肝)性质不同的表现。太阴主“开”,本有腹泻,若误用攻下法,则导致“开”的功能衰竭,出现胸下结硬,这是“开折反阖”。厥阴主“阖”,气机上逆若误用攻下法,则导致“阖”的功能衰竭,出现腹泻不止,这是“阖折反开”。按两阴交尽,称为厥阴,阴气尽头而阳气初生,所以又被称为“阴之绝阳”,按理说厥阴病应该没有热证了。但因为厥阴经脉联络少阳,厥阴的热证,都是由相火化令所致。厥阴经脉,上行穿过膈肌贯穿肝脏,气机旺盛所以向上冲撞心脏。气有余就是火,所以出现口渴和心中疼痛灼热。火能消耗物质,所以感到饥饿。肝脉夹持胃腑,肝气旺盛,所以胃口闭塞而不想进食。虫类由风化而生,厥阴生病则产生蛔虫,蛔虫闻到食物的气味,就会向上进入膈部并从口中吐出。疾病发于阴经却反而误用攻下法,那么气机就不会停止,导致腹泻不止。应当使用乌梅丸主治,此方既可以驱除蛔虫,也可以止住腹泻。
伤寒病出现腹部胀满、胡言乱语,寸口脉象浮而紧,这是肝气乘袭脾脏,名叫“纵”,针刺期门穴治疗。
腹部胀满、胡言乱语,具备太阴和阳明病的内部证候;脉象浮而紧,具备太阳和阳明病的表证脉象。阴阳表里疑似难辨时,症状应当详细辨别,脉象适宜类推。脉法说:“脉浮而紧的,名叫弦脉。”弦脉是肝脉。《内经》说:“各种腹胀大,都归属于热。”又说:“肝气过盛则多言语。”这说明腹满是因肝火引起,而胡言乱语乃是肝旺所引发的。肝气旺盛则欺侮它所胜的脏腑,直接侵犯脾土,所以叫作“纵”。针刺期门穴以泻其邪气,这样才不会触犯厥阴汗法和下法的禁忌。
上一条条文是肝气乘袭心气,这一条是肝气乘袭脾气,下一条是肝气乘袭肺气。肝为相火,只有泻法而没有补法的情况,这类条文就是例子。
伤寒病出现发热,畏缩怕冷,极度口渴想要喝水,腹部必然胀满,这是肝气乘袭肺脏,名叫“横”。针刺期门穴,如果自然出汗,小便通利,病情就会痊愈。
发热恶寒,说明寒邪在表;口渴想喝水,说明热邪在里。因为饮水过多导致腹部胀满,这不是太阴病的腹满,也不是厥阴病的消渴。这是肝邪挟带火气克制肺金。脾的精微物质不能上归于肺,所以极度口渴;肺气不能通调水道,所以腹部胀满。这是欺侮它不能胜的脏腑(肺),无所畏惧,所以叫作“横”,必须针刺期门穴,根据其实证情况予以泻法。得到自然出汗,则恶寒发热自然解除;得到小便通利,则腹部胀满自然消除。
厥阴病,如果口渴想喝水的,少量给予水喝即可痊愈。
水能生木、能制约火,所以对于厥阴病的消渴症最适合用水来调理。
厥阴中风,脉象微微浮起是即将痊愈的表现,不浮起则是尚未痊愈。
厥阴受病,脉象通常是尺寸两部微缓而不浮。现在脉象微浮,是阴病转出阳经,也是阴病见到阳脉的表现。
既然有厥阴中风欲愈的脉象,就应该有未愈的症状。以风木之脏,正值风木主气之时,又再次中受风邪,那么变端必定比其他经络更为严重。如今原文中没有记载这些症状,不能不遗憾于存在缺文。
厥阴病,有望解时的时间段,是从丑时到卯时这段时间。
木气在丑时被克制,在寅、卯时旺盛,所以主管这三个时辰。
The general symptoms of Jueyin disease are: excessive thirst (Xiao Ke), Qi rushing up to strike the heart, pain and heat in the heart region, hunger without desire to eat, vomiting of roundworms upon eating, and if purgatives are misused, diarrhea that does not cease.
Both Taiyin and Jueyin diseases take interior syndromes as their guiding principles. Taiyin governs cold, while Jueyin governs heat; Taiyin is the extreme Yin within Yin, whereas Jueyin is Yang within Yin. In Taiyin disease, there is abdominal fullness, vomiting, and inability to eat; in Jueyin disease, there is a sensation of hunger but no desire to eat, and vomiting of roundworms occurs after eating. Although both present with an inability to eat, Taiyin presents with fullness, while Jueyin presents with hunger; although both present with vomiting, Taiyin vomits food, while Jueyin vomits roundworms. This distinguishes the pathology of the Spleen from that of the Liver. In Taiyin disease, Qi sinks downward, causing frequent abdominal pain and spontaneous diarrhea; in Jueyin disease, Qi rebels upward, causing pain and heat in the heart region and thirst. This reflects the difference between Wet Earth (Spleen) and Wind-Wood (Liver). Taiyin governs "opening"; it naturally has diarrhea, and if purgatives are misused, the "opening" function collapses, leading to hardness below the chest, which is "collapse of opening turning into closing." Jueyin governs "closing"; if Qi rebels upward and purgatives are misused, the "closing" function collapses, leading to unceasing diarrhea, which is "collapse of closing turning into opening." According to the concept that the convergence of two Yins is named Jueyin, where Yin ends and Yang begins, it is also called "Yang at the end of Yin." Therefore, theoretically, Jueyin disease should not involve heat. However, because the Jueyin meridian connects with Shaoyang, the heat syndromes of Jueyin are all generated by the transformation of Ministerial Fire (Xiang Huo). The Jueyin meridian ascends through the diaphragm and penetrates the Liver; when Qi is vigorous, it strikes upward against the heart. Excess Qi constitutes Fire, leading to thirst and pain/heat in the heart region. Fire consumes substances, causing hunger. The Liver meridian flanks the Stomach; when Liver Qi is vigorous, it blocks the stomach entrance, resulting in no desire to eat. Parasites are generated by Wind transformation; in Jueyin disease, roundworms arise. Roundworms smell food odor and ascend into the diaphragm, exiting through the mouth. If a disease originating in Yin channels is mistakenly treated with purgation, Qi will not cease, resulting in unceasing diarrhea. Wu Mei Wan (Mume Pill) should be used as the primary treatment; it can expel roundworms and also stop diarrhea.
In Shanghan (Cold Damage) disease, if there is abdominal fullness and delirious speech, with the Cun Kou pulse being floating and tight, this indicates Liver Qi invading the Spleen, named "Zong" (Vertical). It is treated by needling Qimen (LR14).
Abdominal fullness and delirious speech indicate interior syndromes of Taiyin and Yangming; a floating and tight pulse indicates exterior pulses of Taiyang and Yangming. When Yin/Yang and Exterior/Interior patterns are ambiguous and difficult to distinguish, symptoms must be carefully differentiated, and pulses should be inferred analogously. Pulse methodology states: "A floating and tight pulse is named Xian (Wiry)." Wiry is the Liver pulse. The *Neijing* states: "All cases of abdominal distension and enlargement belong to Heat." It also states: "When Liver Qi is excessive, there is much talking." Thus, abdominal fullness is caused by Liver Fire, and delirious speech is triggered by Liver excess. When Liver Qi is vigorous, it insults what it overcomes, directly attacking Spleen Earth, hence termed "Zong." Needling Qimen to drain the pathogen prevents violating the contraindications for sweating and purging in Jueyin disease.
The previous clause describes Liver invading Heart; this clause describes Liver invading Spleen; the next clause describes Liver invading Lung. The Liver is Ministerial Fire, characterized by draining rather than tonifying; these clauses are examples of such conditions.
In Shanghan disease, if there is fever, shivering aversion to cold, extreme thirst desiring water intake, and the abdomen becomes full, this indicates Liver Qi invading the Lung, named "Heng" (Horizontal). Needling Qimen allows the disease to resolve spontaneously through sweating and free urination.
Fever and aversion to cold indicate the pathogen is in the Exterior; thirst desiring water indicates heat is in the Interior. Abdominal fullness results from excessive water intake, not from Taiyin abdominal fullness nor Jueyin Xiao Ke. This represents Liver Evil carrying Fire to conquer Metal (Lung). Spleen Essence fails to ascend and nourish the Lung, causing extreme thirst; Lung Qi fails to regulate water passages, causing abdominal fullness. This is insulting what one cannot overcome (Lung), showing fearlessness, hence named "Heng." One must needle Qimen and drain according to the excess condition. Spontaneous sweating resolves aversion to cold and fever; free urination eliminates abdominal fullness.
In Jueyin disease, if the patient desires water, giving small amounts of water leads to recovery.
Water generates Wood and controls Fire, making it most suitable for treating Xiao Ke in Jueyin disease.
In Jueyin Wind-Strike, a slightly floating pulse indicates impending recovery; a non-floating pulse indicates no recovery.
When Jueyin is affected, the Chi and Cun positions typically show a slightly slow pulse without floating. A slight floating pulse now indicates Yin emerging into Yang, or seeing Yang pulses in a Yin disease.
If there is a pulse indicating recovery from Jueyin Wind-Strike, there should be symptoms indicating non-recovery. For a Wood-Wind organ, during the time when Wood-Wind governs the Qi, contracting Wind again would likely produce variations more severe than other meridians. Since none are recorded here, we regret the missing text.
Jueyin disease tends to resolve during the hours from Chou to Mao.
Wood is controlled in Chou and prospers in Yin and Mao, thus governing these three periods.