注云∶血出也。污,浊也。心火热极,则血有余∶热气上甚,则为血溢。热势亢
极,则燥而污浊;亢则害,承乃制,则色兼黑而为紫也。
湿者,太阴湿土,乃脾胃之气也。
〔诸痉强直,积饮痞隔中满,霍乱吐下,体重 肿,肉如泥,按之不起,皆属于
湿〕。
注云∶筋劲强直,而不柔〔和〕也,〔土主〕安静故也。阴痉曰柔痉,阳痉曰刚
痉,亢则害,承乃制,故湿过极,则反兼风化制之。然,兼化者,虚象也,实非
风也,治风则误。
注云∶留饮积蓄而不散也。〔水〕得燥则消散,湿则不消,以为积饮,土湿主
痞故也。
注云∶与否同,不通泰也,谓纹理闭密,而为痞也。
注云∶阻滞也,谓肠胃隔绝,而传化失常也。
注云∶湿为积聚痞隔,而土主形体,位在中央,故中满也。
注云∶湿为留饮,为痞隔,而传化失常,故甚则霍乱吐〔泻〕也。大法曰∶若利
色青者,肝木之色,由火甚制金,使金不能平木,则肝自甚,故色青也。或言利色青为
寒〔者〕,误也。(则)如仲景曰∶少阴病,下利清水,色纯青者,热在里也,大承
气汤下之。及小儿热甚急惊,利色多青,为热明矣。利色黄〔者〕,由火甚则水必衰,
而脾土自旺,故色黄也。利色红者为热,心火之色也;或赤者,热深也。利色黑而反为
热者,由火盛过极,而反兼水化制之,故色黑也。(则)如伤寒阳明热病,则日晡潮
热,甚则不识人,循衣摸床,如见鬼状,独语,法当大承〔气〕汤下之。大便不黑者
易治,黑则难治也。诸痢同法。然辨痢色以明〔寒〕热者,更当审其〔饮食〕药物之
色也。(则)〔如〕小儿病热,吐利霍乱,其乳未及消化,而痢尚白者,不可便言是
寒,当以脉证别之。又法曰∶凡泄利,小便清白,不涩为寒,赤涩者为热也。又法曰∶
完谷不化,而色不变,吐利腥秽,澄澈清冷,小便不涩,身凉不渴,脉迟细而微者,寒
证也。谷虽不化,其色变〔非〕白,烦渴,小便赤黄而或涩者,热证也。凡谷消化
者,无问他证,便为热也。
注释说:血出为衄。污,指浊液。心火极度亢盛,则血液有余;热气上冲过甚,就会导致血液溢出。热势亢极,则使血液干燥而变得浑浊;根据“亢则害,承乃制”的原理,热极反兼水化,所以颜色夹杂黑色而呈现紫色。
湿,对应太阴湿土,即脾胃之气。
【凡是出现筋脉痉挛强直、体内有停饮积聚导致胸膈痞塞胀满、霍乱吐泻、身体沉重浮肿、肌肉松软如泥、按压后凹陷不起等症状,都归属于湿邪】。
注释说:筋脉劲急强直,不能柔和,是因为土性主安静所致。阴痉称为柔痉,阳痉称为刚痉。遵循“亢则害,承乃制”的规律,当湿邪过极时,会反过来兼夹风象来制约它。然而,这种兼夹之象是虚象,并非真正的风邪,若按治风法治疗就会出错。
注释说:留饮是指水饮停留积聚而不消散。水遇到燥气则消散,遇到湿气则不消,从而形成积饮,这是因为土湿主导了痞塞的缘故。
注释说:“否”与“痞”同义,指不通泰,即纹理闭密,从而形成痞证。
注释说:阻滞,指肠胃隔绝,传导和消化功能失常。
注释说:湿邪导致积聚痞塞,而土主形体,位居中央,所以表现为中焦胀满。
注释说:湿邪导致留饮、痞塞,且传导消化失常,严重时就会出现霍乱吐泻。大法指出:如果腹泻颜色发青,这是肝木的颜色。由于火气过盛克制了金(肺),使金不能平抑木(肝),导致肝气自盛,所以颜色发青。有人说腹泻色青属于寒证,这是错误的。正如张仲景所说:少阴病,下利清水,颜色纯青,这是热邪在里,应用大承气汤攻下。以及小儿热盛引起的急惊风,腹泻颜色多青,这明显是热证。腹泻颜色发黄,是由于火气过盛导致水气衰弱,脾土自然旺盛,所以颜色发黄。腹泻颜色发红属于热证,是心火的色泽;如果颜色深红或赤色,说明热邪更深。腹泻颜色发黑反而属于热证,是由于火气盛极,反过来兼有水化来制约它,所以颜色发黑。正如伤寒阳明热病,会出现日晡时分潮热,严重时神志不清,循衣摸床,像见到鬼怪一样胡言乱语,应当用大承气汤攻下。大便不发黑的容易治疗,发黑的则难治。各种痢疾都遵循此法。然而辨别痢疾颜色以明确寒热性质时,更应当仔细审查患者饮食和药物的颜色。例如小儿患热病,发生吐泻霍乱,乳汁尚未消化,而大便尚白,不可立即断定为寒证,应当通过脉象和证候来区分。又一种法则说:凡是泄泻,小便清亮白色,排尿不涩滞的属于寒证;小便赤黄且涩滞的属于热证。又一种法则说:完谷不化,颜色未变白,呕吐物气味腥秽,排泄物清澈寒冷,小便不涩滞,身体凉爽不口渴,脉象迟细而微弱的,属于寒证。谷物虽然未消化,但颜色变为非白色,伴有烦躁口渴,小便赤黄且可能涩滞的,属于热证。凡是谷物能够消化的,不问其他症状,都判定为热证。
The annotation states: "Nu" (epistaxis/nasal bleeding) refers to blood discharge. "Wu" (turbid) refers to turbid fluids. When Heart Fire is extremely hyperactive, there is an excess of blood; when heat qi ascends excessively, it leads to blood溢 (overflow/bleeding). When the heat pathogen reaches extreme hyperactivity, it dries and turbidifies the blood; according to the principle of "Hyperactivity brings harm, succession brings control," extreme heat may counteract with water transformation, resulting in a color mixed with black and appearing purple.
"Dampness" corresponds to Taiyin Damp Earth, which is the Qi of the Spleen and Stomach.
[All cases involving spasmodic rigidity of tendons, accumulation of retained fluid causing chest diaphragm obstruction and fullness, cholera-like vomiting and diarrhea, heavy body with edema, muscles soft like mud that do not rebound upon pressure, all belong to Dampness].
The annotation states: Tendons are stiff and rigid, lacking flexibility, because the nature of Earth is quiet. Yin spasm is called Rigid Spasm (Rou Jing), while Yang spasm is called Stiff Spasm (Gang Jing). Following the rule of "Hyperactivity brings harm, succession brings control," when Dampness becomes excessive, it counteracts itself by assuming Wind characteristics to exert control. However, this assumed characteristic is a false image (deficiency pattern), not true Wind; treating it as Wind would be a mistake.
The annotation states: Retained fluid refers to water-dampness accumulating and failing to dissipate. Water dissipates when meeting Dryness but fails to resolve when meeting Dampness, thereby forming accumulated retained fluid, primarily due to Earth-Dampness leading to obstruction.
The annotation states: "Pi" (obstruction/stuffiness) is synonymous with "Pi" (unsmoothness), referring to closed and dense textures leading to a Pi syndrome (obstructive sensation).
The annotation states: "Zhi" (blockage) refers to the isolation of the intestines and stomach, resulting in abnormal transmission and digestion functions.
The annotation states: Dampness causes accumulation and obstruction; since Earth governs the physical form and resides in the center, it manifests as central fullness.
The annotation states: Dampness causes retained fluid and obstruction, disrupting transmission and digestion; severely, this leads to cholera-like vomiting and diarrhea. The Great Law states: If the stool is green, this is the color of Liver Wood. This occurs because excessive Fire controls Metal (Lung), preventing Metal from balancing Wood (Liver), causing Liver Qi to become excessive, hence the green color. Some claim green stool indicates Cold; this is incorrect. As Zhang Zhongjing stated: In Shaoyin disease, if there is purging of clear water with pure green color, the heat is in the interior, and Da Cheng Qi Tang should be used to purge. Similarly, in children with severe heat causing acute convulsions, stools are often green, clearly indicating Heat. Yellow stool occurs because excessive Fire weakens Water, allowing Spleen Earth to prosper naturally, resulting in yellow color. Red stool indicates Heat, the color of Heart Fire; dark red or crimson indicates deeper heat. Black stool, conversely, can indicate Heat; this happens when Fire is extremely excessive and counteracts with Water transformation, resulting in black color. For instance, in Yangming heat disease of Cold Damage, there is tidal fever at dusk, severe confusion, picking at clothes and bedrails, hallucinations, and muttering alone; Da Cheng Qi Tang should be used. Stools that are not black are easier to treat; those that are black are difficult. All types of dysentery follow this method. However, when distinguishing cold and heat by stool color, one must carefully examine the colors of diet and medication. For example, if a child with heat disease suffers from vomiting, diarrhea, and cholera, and the milk has not yet digested, resulting in white stool, one cannot immediately diagnose it as Cold; pulse and symptoms must be differentiated. Another method states: In all cases of diarrhea, clear white urine without difficulty indicates Cold; red/yellow urine with difficulty indicates Heat. Another method states: Undigested food in stool with unchanged color, foul-smelling vomit, clear and cold excrement, non-astringent urine, cool body without thirst, and slow, fine, and faint pulse indicate a Cold pattern. Although food is undigested, if the color changes to non-white, accompanied by irritability, thirst, red/yellow possibly astringent urine, it indicates a Heat pattern. Any case where food is digested normally, regardless of other symptoms, is classified as Heat.