少阴病,腹痛,四肢沉重疼痛,大便自利,小便不利,是阴寒兼有水气,宜真武汤温中利水。饮病或有
之证,或咳,或小便利,或呕,或下利。咳加细辛、生姜、五味子,小便若利,去茯苓,呕去附子、倍加生
姜,利去芍药入干姜。
息气急喝喝,而数张口、抬肩、欠肚者喘也。短气则似喘非喘,而不张口、抬肩、欠肚。二证皆胸中气
病,属肺也。无论喘急、短气,若气促壅塞,不能布息,为有余之实证。若气短空乏,不能续息,为不足之
虚证。内因饮冷伤肺,或因痰热,外因形寒伤表,皮毛受邪,其次及肤,及肌,及胸,及腹入胃,皆令病
喘。当审阴阳表里,从化主治。喘急、短气,兼直视神昏,汗出润发,脉微,四肢厥冷,皆死候也。与三阴寒
证同见,是为阴喘,宜四逆汤加杏仁、五味子,虚者倍加人参。与三阳热证同见,是为阳喘,宜白虎葛根黄
芩黄连汤。与太阳表证同见,是为表喘。无汗者,麻黄汤,兼烦躁者大青龙汤,有汗者桂枝加浓朴杏仁汤。与
阳明里证同见者,是为里喘,宜大承气汤,兼结胸者宜大陷胸丸,若兼水气表实者。宜小青龙汤,表虚及小
便不利者,均宜五苓散加葶苈子。里实者,宜葶苈大枣汤,兼腹胁硬痛者,宜十枣汤。里寒者,宜真武汤。若
脉微细,口鼻
气短喘乏,而无阴阳表里证,此气虚喘也,宜保元汤加五味子、杏仁。若喘而唾痰稠粘,喉间漉漉有声,此
痰喘也,重者宜瓜蒂散,轻者宜二陈汤加苦苈子、苏子。(注∶苦苈子即苦葶苈,性峻。)
少阴病,出现腹痛、四肢沉重疼痛、大便自行通畅(自利)、小便不通利的症状,这是阴寒之邪兼有水气内停所致,适宜使用真武汤来温补中阳并利水。痰饮病也可能出现上述证候,或者伴有咳嗽,或者小便通利,或者呕吐,或者腹泻。若伴有咳嗽,可加入细辛、生姜、五味子;若小便通利,则去掉茯苓;若呕吐,则去掉附子,加倍增加生姜用量;若腹泻,则去掉芍药,加入干姜。
呼吸急促、喉间有声、频繁张口、耸肩、腹部起伏明显的称为“喘”。短气则类似喘但并非如此,表现为不张口、不耸肩、腹部无明显起伏。这两种证候都属于胸中的气机病变,归属于肺脏。无论是喘急还是短气,如果气息急促壅塞,无法顺畅呼吸,属于有余的实证。如果气息短促空乏,无法接续呼吸,属于不足的虚证。内因方面,因饮用冷饮损伤肺气,或因痰热阻滞;外因方面,因形体受寒损伤体表,皮毛感受邪气,其次邪气由皮肤传入肌肉,再传入胸腹进而入胃,都会导致气喘。应当审察阴阳表里,根据病机转化确定主治原则。喘急、短气,如果兼见直视、神志昏迷、汗出如油润发、脉象微弱、四肢厥冷,都是死亡的征候。如果与三阴经寒证同时出现,称为阴喘,适宜使用四逆汤加杏仁、五味子,体质虚弱者加倍加入人参。如果与三阳经热证同时出现,称为阳喘,适宜使用白虎葛根黄芩黄连汤。如果与太阳经表证同时出现,称为表喘。无汗者,使用麻黄汤;兼有烦躁者,使用大青龙汤;有汗者,使用桂枝加厚朴杏子汤。如果与阳明经里证同时出现,称为里喘,适宜使用大承气汤;兼有结胸者,适宜使用大陷胸丸;如果兼有水气且表实者,适宜使用小青龙汤;表虚及小便不利者,均适宜使用五苓散加葶苈子。里实者,适宜使用葶苈大枣汤;兼有腹部和胁部硬痛者,适宜使用十枣汤。里寒者,适宜使用真武汤。如果脉象微细,口鼻气息短促喘乏,而没有阴阳表里的其他证候,这是气虚喘,适宜使用保元汤加五味子、杏仁。如果喘息且咳吐粘稠痰液,喉间有漉漉的水声,这是痰喘,重症适宜使用瓜蒂散,轻症适宜使用二陈汤加苦葶苈子、苏子。(注:苦葶苈子即苦葶苈,药性峻烈。)
Shaoyin disease, presenting with abdominal pain, heaviness and pain in the four limbs, spontaneous diarrhea (Zili), and dysuria, indicates cold-yin combined with water qi retention. It is appropriate to use Zhenwu Tang (True Warrior Decoction) to warm the middle and promote diuresis. Phlegm-fluid diseases may present with these symptoms, or alternatively cough, clear urination, vomiting, or diarrhea. If cough is present, add Xixin (Asari Radix), Shengjiang (Fresh Ginger Rhizome), and Wuweizi (Schisandrae Fructus). If urination is clear, remove Fuling (Poria); if vomiting occurs, remove Fuzi (Aconiti Lateralis Radix Praeparata) and double the dosage of Shengjiang; if diarrhea occurs, remove Shaoyao (Paeoniae Radix Alba) and add Ganjiang (Zingiberis Rhizoma).
Rapid breathing with audible sounds, frequent opening of the mouth, shrugging of shoulders, and abdominal distension/retraction characterizes "Chuan" (Wheezing/Asthma). Shortness of breath (Duanqi) resembles wheezing but differs by the absence of mouth-opening, shoulder-shrugging, or significant abdominal movement. Both conditions involve Qi pathology in the chest and are attributed to the Lung. Whether wheezing or shortness of breath, if the Qi is rapid and obstructed, preventing normal respiration, it is an excess-type solid syndrome. If the Qi is short and empty, unable to sustain respiration, it is a deficiency-type empty syndrome. Internally, drinking cold beverages may injure the Lung Qi, or phlegm-heat may cause obstruction. Externally, exposure to cold may injure the exterior, allowing pathogens to enter through the skin and hair follicles, then progressing to the flesh, chest, abdomen, and stomach, all leading to asthma. One must examine Yin-Yang and Exterior-Interior to determine treatment based on pathogenesis transformation. Wheezing and shortness of breath, when accompanied by fixed gaze, coma, sweating that moistens the hair, faint pulse, and cold extremities, are signs of death. When seen concurrently with Three-Yin cold syndromes, it is called Yin-Wheezing, treated with Sini Tang (Frigid Extremities Decoction) plus Xingren (Armeniacae Semen Amarum) and Wuweizi; for deficiency patterns, increase Renshen (Ginseng Radix et Rhizoma) dosage. When seen concurrently with Three-Yang heat syndromes, it is called Yang-Wheezing, treated with Baihu Gegen Huangqin Huanglian Tang (White Tiger, Kudzu Root, Scutellaria, Coptis Decoction). When seen concurrently with Taiyang exterior syndromes, it is called Exterior-Wheezing. For no-sweat patterns, use Mahuang Tang (Ephedra Decoction); for patterns with irritability, use Da Qinglong Tang (Major Green Dragon Decoction); for sweating patterns, use Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction augmented with Magnolia Bark and Apricot Seed). When seen concurrently with Yangming interior syndromes, it is called Interior-Wheezing, treated with Dachengqi Tang (Major Order the Qi Decoction); for patterns with Chest Bind, use Daxianxiong Wan (Major Draining the Chest Pill); for patterns with water qi and exterior excess, use Xiao Qinglong Tang (Minor Green Dragon Decoction); for exterior deficiency and dysuria, use Wuling San (Five-Ling Powder) plus Tinglizi (Lepidii Semen). For interior excess, use Tingli Dazao Tang (Lepidium and Jujube Decoction); for patterns with hardness and pain in the abdomen and hypochondrium, use Shizao Tang (Ten Dates Decoction). For interior cold, use Zhenwu Tang. If the pulse is faint and fine, with shortness of breath and fatigue at the nose and mouth, without other Yin-Yang or Exterior-Interior signs, this is Qi-Deficiency Wheezing, treated with Baoyuan Tang (Preserve Origin Decoction) plus Wuweizi and Xingren. If wheezing is accompanied by expectoration of thick, sticky phlegm and gurgling sounds in the throat, this is Phlegm-Wheezing. For severe cases, use Guiti San (Melon Trichosanthes Powder); for mild cases, use Erchen Tang (Two-Aged Decoction) plus Kuli Zi (Bitter Lepidium Seed) and Suzi (Perillae Fructus). (Note: Kuli Zi refers to bitter Tinglizi, which has a harsh nature.)