饥不欲食,吐蛔厥逆,乃厥阴本证也。下后饥不能食,属阳明也。阳明病,则懊 心下烦甚,头上汗出
,是热在胃中,宜栀子豉汤涌之。厥阴病,脉微或不微而紧,更心烦者,非寒虚邪,是寒实邪而在胸中,宜
瓜蒂散吐之。
太阴经无厥逆,而有手足自温。少阴经有寒厥,而无热厥。厥阴经,有寒热二厥,寒厥者只寒而不热也
,热厥者由热而厥,由厥而热,热厥相因,无休歇也。当辨阴阳浅深,以当归四逆、承气等汤施治可也。
少腹满,按之痛。若四肢厥冷,小便清白者,是冷结膀胱,宜当归四逆加吴茱萸生姜汤。不厥冷,小便自
利者,是血蓄膀胱,宜桃仁承气汤。小便不利,是水蓄膀胱,宜五苓散。若大小便不利者,是水热蓄,宜八
正散。
神昏是胃经热极乘心也,热入于阳,是以狂乱神昏。狂乱表实无汗者,宜三黄石膏汤。里实不便者,宜
三承气汤。无表里证,而里极者,宜白虎汤。太阳蓄血发狂,则少腹硬痛,小便自利,若小便不利,是水热
蓄也,非血蓄也。阳明血蓄如狂,则喜忘,大便黑,若大便不黑,是热极也,非血蓄也。蓄血证轻者,桃仁承
气汤,重者抵当汤,择而用之可也。然发狂证,亦有阳盛阴虚之人,于作汗将解之时,奄然发狂, 然汗出而
解者,
当须识之,不可以药也。
饥饿但不想进食,呕吐蛔虫,四肢厥冷,这是厥阴经的本证。经过泻下治疗后出现饥饿感但不能进食,属于阳明病。阳明病会出现心中烦闷懊恼、心下部极度烦热、头部出汗的症状,这是因为热邪在胃中,适宜用栀子豉汤涌吐治疗。厥阴病,脉象微弱或不微弱但紧涩,如果更加心烦,这不是寒邪或虚邪,而是寒实邪气停留在胸中,适宜用瓜蒂散催吐。
太阴经不会出现四肢厥冷,而是手足自然温暖。少阴经有寒性厥冷,但没有热性厥冷。厥阴经既有寒性厥冷也有热性厥冷,寒性厥冷只是寒冷而不发热;热性厥冷是由热邪导致四肢厥冷,又由四肢厥冷转化为发热,热与厥相互因果,没有休止的时候。应当辨别阴阳的浅深,使用当归四逆汤、承气汤等方剂进行治疗即可。
小腹部胀满,按压时疼痛。如果四肢厥冷,小便颜色清白,这是冷邪结聚在膀胱,适宜用当归四逆加吴茱萸生姜汤。如果不四肢厥冷,小便自利通畅,这是瘀血蓄积在膀胱,适宜用桃仁承气汤。如果小便不利,这是水湿蓄积在膀胱,适宜用五苓散。如果大小便都不利,这是水热互结蓄积,适宜用八正散。
神志昏迷是胃经热极盛而乘袭心脏所致,热邪侵入阳分,所以出现狂乱和神志昏迷。如果是表实证且无汗的狂乱,适宜用三黄石膏汤。如果是里实证且大便不通的,适宜用三种承气汤。如果没有表证和里证的典型表现,但里热极盛的,适宜用白虎汤。太阳经蓄血导致的发狂,表现为小腹部坚硬疼痛,小便自利通畅;如果小便不利,则是水热互结,不是瘀血蓄积。阳明经血蓄导致的如狂状态,表现为健忘,大便黑色;如果大便不黑,则是热极,不是瘀血蓄积。蓄血证轻的,用桃仁承气汤,重的用抵当汤,选择使用即可。然而发狂证,也有阳气盛阴虚的人,在将要通过出汗解病的时候,突然发狂,随后大汗出而病愈的,应当识别这种情况,不需要用药治疗。
Hunger without desire to eat, vomiting of roundworms (Ascaris lumbricoides), and cold extremities constitute the fundamental syndrome of the Jueyin channel. Hunger without ability to eat after purgation belongs to the Yangming disease. In Yangming disease, one may experience mental restlessness and oppression, extreme vexation in the epigastrium, and sweating on the head; this indicates heat in the stomach, for which Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used to induce emesis. In Jueyin disease, if the pulse is faint or not faint but tight, accompanied by increased vexation, this is not due to cold deficiency pathogens, but rather cold excess pathogens lodged in the chest; Gengdi San (Melon Seed Powder) should be used to induce emesis.
The Taiyin channel does not present with cold extremities, but rather naturally warm hands and feet. The Shaoyin channel presents with cold jue (cold extremities) but not heat jue. The Jueyin channel presents with both cold and heat jue. Cold jue involves only coldness without heat; heat jue originates from heat leading to cold extremities, and from cold extremities transforming into heat, with heat and jue reciprocally causing each other without cessation. One must distinguish the depth and nature of yin and yang, treating with Danggui Sini Tang (Angelica Sinensis and Cinnamon Twig Decoction), Chengqi Tang (Purgative Decoctions), etc., as appropriate.
Fullness in the lower abdomen with pain upon palpation. If the limbs are cold and urine is clear and white, this is cold binding in the Bladder; Danggui Sini Tang plus Wuzhuyu and Shengjiang (Evodia and Fresh Ginger) should be used. If the limbs are not cold and urination is free, this is blood accumulation in the Bladder; Taoren Chengqi Tang (Peach Kernel and Rhubarb Purgative Decoction) should be used. If urination is difficult, this is water accumulation in the Bladder; Wuling San (Five-Ingredient Powder with Poria) should be used. If both defecation and urination are obstructed, this is water-heat accumulation; Bazen San (Eight-Ingredient Powder) should be used.
Mental confusion results from extreme heat in the Stomach channel assaulting the Heart. Heat entering the yang aspect causes mania and mental confusion. For mania with exterior excess and no sweating, Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction) is indicated. For interior excess with constipation, the three Chengqi Tangs (Purgative Decoctions) are indicated. Without exterior or interior syndromes, but with extreme interior heat, Baihu Tang (White Tiger Decoction) is indicated. Sunyang blood accumulation causing mania presents with hardness and pain in the lower abdomen and free urination; if urination is difficult, it is water-heat accumulation, not blood accumulation. Yangming blood accumulation causing manic-like behavior presents with forgetfulness and black stools; if stools are not black, it is extreme heat, not blood accumulation. For mild blood accumulation syndromes, Taoren Chengqi Tang is used; for severe cases, Didang Tang (Definite Attack Decoction) is used, selecting according to severity. However, some cases of mania occur in individuals with excessive yang and deficient yin; at the time when sweat is about to emerge to resolve the disease, sudden mania may occur, followed by profuse sweating and recovery. This pattern must be recognized and requires no medication.