(俱见中寒论中)
(重出例)太阳病寸缓关浮尺弱(云云至)渴者。宜五苓散(上条证见前第三卷五苓散方之下)
脉阳微而汗出少者。为自和也。汗出多者。为太过(此条系阳明经自汗出之证。脉阳微者。寸关以前之脉。微而无
力也。阳明病。原当有汗。今者汗出少。成注云脉阳微者。邪气少。汗出亦少。为适当。故自和。汗出多者。反损正气。
是为太过。脉经云。脉阳微者。当自汗出。愚以其汗出少。而自和者。邪由汗解也。其汗出多者。邪不因汗而解。且失
于救治。故为太过也。)
阳脉实因发其汗。出多者亦为太过。太过为阳绝于里。亡津液。大便因硬也。(此承上文而言。阳明病阳脉不微而实。
实者。按之搏指而有力也。阳脉既实。则邪实。虽有汗当更发其汗。汗出多者。因用药过剂。以故汗出多。亦为太过。
凡汗出太过者。皆为阳绝于里。阳绝者。成注即云。亡阳。阳亡。则津液外泄。仲景云。阳绝于里者。即津液绝于里也。
津液既亡。则肠胃干燥。大便因硬。按此条论。仲景无治法。愚意云。总于后条。用麻仁丸以主之。补亡论议用小柴胡
汤。又柴胡桂枝汤。以通津液。如大便益坚。议用承气等汤。大误之极。)
脉浮而芤。浮为阳。芤为阴。浮芤相搏。胃气生热。其阳则绝。(此又承上文而申言阳绝之脉也。浮为阳之阳。言阳
邪。其阳之阳。言人身真阳之气。真阳气积于里。即成津液。今者。脉轻取之则浮。浮为阳邪独盛于外。重按之则芤。
芤为津液已亡于中。阳邪乘津液之亡而相搏。则胃中之气。皆郁而变热。热则津液愈竭。其真阳之气因绝。而不能复生
津液也。所谓阳绝于里者。有如此。)
趺阳脉浮而涩。浮则胃气强。涩则小便数。浮涩相搏。大便则难。其脾为约。麻仁丸主之(此条病系脾约。乃麻仁
丸正治之证。趺阳者。胃脉也。在足趺上五寸骨间。去陷谷三寸。即足阳明经冲阳二穴。按之。其脉应指而起。盖古人
切脉。必通身诊视。如人迎脉之出于结喉两旁。可以类推。浮为阳盛。故主胃强。涩为阴虚。故小便数。二脉既相搏击。
则水愈亏。火愈炽。肠胃燥结。因大便难。而成脾约之证。脾约义。已见前与麻仁丸者。以通肠胃。而润燥结也。按成
注以胃强脾弱。为脾约作解。推其意。以胃中之邪热盛为阳强。故见脉浮。脾家之津液少为阴弱。故见脉涩。仲景用麻
仁丸者。以泻胃之阳。而扶脾之阴也。)
(以上内容均见于《中寒论》中)
(重复出现的条文示例)太阳病,寸脉缓、关脉浮、尺脉弱(……直至)口渴的。适宜使用五苓散(上一条证候见前第三卷五苓散方之下)
脉象阳部微细且汗出少的。这是机体自我调和的表现。汗出多的。则是太过分了(此条属于阳明经自汗出的证候。脉象阳部微细,指寸口及关部之前的脉象,微弱而无力。阳明病,原本应当有汗,现在汗出少,成无己注解说:脉象阳部微细,说明邪气少,汗出也少,这是恰当的,所以称为自我调和。汗出多的人,反而损伤正气,这称为太过。《脉经》说:脉象阳部微细的,应当自汗出。我认为因为汗出少而能自我调和,是因为邪气随汗而解;那些汗出多的人,邪气不因汗而解,且因失于救治,所以称为太过。)
阳脉实,因发其汗,汗出多的也是太过。太过会导致阳气在体内枯竭,津液亡失,大便因此坚硬。(此条承接上文而言,阳明病的阳脉不微细而是实脉。实脉,指按之搏指有力。既然阳脉实,则邪气实,虽然有汗,本应再发其汗,但汗出过多,是因为用药过量,所以汗出多,这也称为太过。凡是汗出太过的人,都是阳气在体内枯竭。阳气枯竭,成无己注解说即亡阳。阳气亡失,则津液外泄。张仲景说:阳气在体内枯竭,即津液在体内枯竭。津液既已亡失,则肠胃干燥,大便因此坚硬。根据此条论述,张仲景没有给出治法。我个人的意见是,总括到后一条,用麻子仁丸来主治。《补亡论》议论用小柴胡汤,以及柴胡桂枝汤,以通利津液。如果大便更加坚硬,议论使用承气汤等方剂,这是极其错误的。)
脉象浮而芤。浮脉属阳,芤脉属阴。浮脉与芤脉相互搏结,胃气生热,其真阳之气因而枯竭。(此条又承接上文而进一步阐述阳气枯竭的脉象。浮脉为阳中之阳,指阳邪;其“阳”指人身真阳之气。真阳之气积聚于体内,即形成津液。现在轻取脉象则浮,浮表示阳邪独盛于体表;重按脉象则芤,芤表示津液已在体内亡失。阳邪乘着津液亡失而相互搏结,则胃中的气机全部郁滞而化热。热则津液更加枯竭,其真阳之气因而枯竭,而不能再生津液。所谓阳气在体内枯竭,就是像这样。)
趺阳脉浮而涩。浮则胃气强,涩则小便频数。浮脉与涩脉相互搏结,大便则困难,其脾脏被约束,用麻子仁丸主治(此条病证属于脾约,是麻子仁丸的正治证候。趺阳脉,是胃脉,位于足背上方五寸骨间,距离陷谷穴三寸,即足阳明经的冲阳穴。按压时,脉象应指而起。大概古人切脉,必定全身诊察,如人迎脉出于结喉两旁,可以类推。浮脉为阳盛,所以主胃气强;涩脉为阴虚,所以主小便频数。这两种脉象既相搏击,则水液更加亏虚,火气更加炽盛,肠胃燥结,因而大便难,形成脾约的证候。脾约的含义,已见于前文。与麻子仁丸,是为了通利肠胃,润燥结。按成无己注解说,以胃强脾弱解释脾约,推测他的意思,是以胃中的邪热盛为阳强,所以见到脉浮;脾家的津液少为阴弱,所以见到脉涩。张仲景使用麻子仁丸,是为了泻胃之阳,而扶助脾之阴。)
(The above content is all found in *Zhong Han Lun* [Treatise on Cold Damage])
(Example of repeated clauses) Taiyang disease (Disease of the Taiyang channel), with a slow pulse at the Cun position, floating pulse at the Guan position, and weak pulse at the Chi position (...until) those who are thirsty. Wuling San (Five Ingredient Powder with Poria) is appropriate. (The syndrome of the previous clause is seen below the formula for Wuling San in Volume 3 of the preceding text.)
When the pulse is faint at the Yang positions and sweating is scanty, this indicates self-harmonization. When sweating is profuse, it indicates excessiveness. (This clause pertains to spontaneous sweating of the Yangming channel. "Pulse faint at the Yang positions" refers to the pulse before the Cun and Guan positions, which is faint and forceless. Yangming disease originally should present with sweating; now that sweating is scanty, Cheng Wuji's commentary states: "A faint pulse at the Yang positions means pathogenic qi is scanty, and sweating is also scanty, which is appropriate; hence, self-harmonization." For those with profuse sweating, it instead damages righteous qi, which is termed "excessiveness." The *Mai Jing* [Classic of Pulse Diagnosis] states: "Those with a faint pulse at the Yang positions should have spontaneous sweating." I believe that because sweating is scanty and self-harmonization occurs, it is because pathogenic qi resolves through sweating. For those with profuse sweating, pathogenic qi does not resolve through sweating, and due to lack of timely treatment, it is termed "excessiveness.")
If the Yang pulse is solid, and diaphoresis is induced, resulting in profuse sweating, this is also excessiveness. Excessiveness leads to the exhaustion of Yang within the interior, loss of body fluids, and consequently, hard stool. (This clause continues from the previous text, stating that in Yangming disease, the Yang pulse is not faint but solid. A solid pulse feels firm and forceless upon pressure. Since the Yang pulse is solid, pathogenic qi is solid; although sweating exists, diaphoresis should theoretically be induced again. However, if sweating becomes profuse due to excessive dosage of medication, this is also termed "excessiveness." In all cases of excessive sweating, there is exhaustion of Yang within the interior. Cheng Wuji notes that "exhaustion of Yang" implies loss of Yang. When Yang is lost, body fluids leak outward. Zhang Zhongjing states: "Exhaustion of Yang within the interior" means exhaustion of body fluids within the interior. Once body fluids are lost, the intestines and stomach become dry, leading to hard stool. Regarding the treatment method in this clause, Zhang Zhongjing provides none. My opinion is that it generally refers to the following clause, where Maren Wan (Pill of Hemp Seeds) is used as the primary treatment. The *Bu Wang Lun Yi* [Supplementary Lost Discussions] suggests Xiaochaihu Tang (Minor Bupleurum Decoction) or Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) to unblock body fluids. If the stool becomes even harder, suggesting the use of Chengqi Tang formulas is extremely erroneous.)
The pulse is floating and knotted (Kou). Floating belongs to Yang, and Kou belongs to Yin. The interaction between floating and Kou pulses causes Stomach Qi to generate heat, leading to the exhaustion of its true Yang. (This clause further elaborates on the pulse of Yang exhaustion mentioned above. "Floating" is Yang within Yang, referring to pathogenic Yang; "its Yang" refers to the body's true Yang Qi. True Yang Qi accumulates in the interior and transforms into body fluids. Now, light palpation reveals a floating pulse, indicating that pathogenic Yang alone is abundant on the exterior; heavy palpation reveals a Kou pulse, indicating that body fluids have been lost in the interior. Pathogenic Yang takes advantage of the loss of body fluids to interact aggressively, causing the Qi in the Stomach to stagnate and transform into heat. Heat causes body fluids to deplete further, and the true Yang Qi becomes exhausted, unable to regenerate body fluids. This is what is meant by "exhaustion of Yang within the interior.")
The Duyang pulse is floating and choppy. Floating indicates strong Stomach Qi; choppy indicates frequent urination. The interaction between floating and choppy pulses makes defecation difficult, resulting in the constraint of the Spleen; Maren Wan (Pill of Hemp Seeds) is indicated. (This disease pertains to Spleen Constraint, which is the correct indication for Maren Wan. The Duyang pulse is the Stomach pulse, located five cun above the dorsum of the foot in the interosseous space, three cun from the Xangu point, specifically the Chongyang acupoint of the Foot-Yangming channel. Upon pressing, the pulse rises in response. Ancient practitioners likely examined the entire body for pulses; for example, the Renying pulse appears beside the larynx, which can be inferred similarly. A floating pulse indicates Yang abundance, thus governing strong Stomach Qi; a choppy pulse indicates Yin deficiency, thus governing frequent urination. Since these two pulses interact, water becomes more deficient and fire becomes more intense, leading to dryness and binding in the intestines and stomach, causing difficulty in defecation and forming the syndrome of Spleen Constraint. The meaning of Spleen Constraint has been explained previously. Maren Wan is used to unblock the intestines and stomach and moisten dryness. According to Cheng Wuji's commentary, he interprets Spleen Constraint as strong Stomach and weak Spleen. Inferring his intent, he considers the abundance of pathogenic heat in the Stomach as strong Yang, hence the floating pulse; and the scarcity of fluids in the Spleen as weak Yin, hence the choppy pulse. Zhang Zhongjing uses Maren Wan to drain the Yang of the Stomach and support the Yin of the Spleen.)