11.谵语为实声长壮, 乱言无次数更端, 郑声为虚音短细, 频言重复
更呢喃. 同阳经见均属热, 同阴经见总为寒, 阳无可攻当清解, 阴不
能温清补痊.
【注】言语心主之也. 心气实热而神有余, 则发为谵语. 谵语为实,
故声长而壮, 乱言无次数数更端也. 心气虚热而神不足 , 则发为郑
声.郑声为虚, 故音短而细, 只将一言重复呢喃也. 盖神有余, 则能
机变而乱言. 神不足, 则无机变而只守一声也. 凡谵语, 郑声与阳经
同见者, 均属热证, 可以攻之; 与阴经同见者, 总为寒证, 可以温之
.若虽与阳经同见, 而无可攻之证, 不可攻之, 当清解也; 与阴经同
见而无可温之证, 不可温之, 当清补也.
12.三法伤津胃燥干, 阳往乘阴渴亦然, 渴欲饮水少少与, 莫使停留
饮病干. 太阳五苓尿不利, 阳明白虎饮连连, 少阳证具心烦渴, 小柴
去半粉加添.
【注】渴病, 多因或汗、 或吐、或下三法伤其津液, 致令胃中干燥,
故引饮也. 阳邪往乘三阴, 太阴则嗌干, 少阴则口燥, 厥阴则消渴.
渴在三阴, 阳邪亦属热伤津液, 故曰渴亦然也. 三阴之渴, 治法详于
三阴经内. 凡渴欲饮水者, 当少少与之, 以滋胃干, 胃和则愈, 若恣
意与饮之, 不但渴不能愈致水停留为病也. 太阳之渴用五苓散者, 以
水停下焦, 小便不利故也. 阳明之渴用白虎者, 以胃热饮水连连不巳
也.少阳寒热往来等证巳具, 心烦渴者, 用小柴胡汤以和解, 去半夏
以避燥, 加花粉以生津液也.
11. 谵语表现为声音洪亮壮实,胡言乱语且频繁更换话题;郑声表现为声音短促细微,反复重复同一句话并伴有低吟。若出现在阳经病证中,均属于热证;若出现在阴经病证中,总属于寒证。对于阳经病证,若无可攻下的指征,应当采用清热解表的方法;对于阴经病证,若无可温补的指征,则应采用清补的方法治愈。
【注】言语由心所主。心气实热而神气有余,就会引发谵语。谵语属于实证,所以声音长而壮实,胡言乱语且频繁更换话题。心气虚热而神气不足,就会引发郑声。郑声属于虚证,所以声音短而细微,只是将一句话反复低吟呢喃。大概是因为神气有余,就能随机应变而胡言乱语;神气不足,就没有随机应变的能力,只能固守一句话。凡是谵语、郑声与阳经病证同时出现的,都属于热证,可以采用攻下法;与阴经病证同时出现的,总属于寒证,可以采用温法。如果虽然与阳经病证同见,但没有可攻下的证候,不可使用攻下法,应当采用清热解表法;如果与阴经病证同见但没有可温补的证候,不可使用温补法,应当采用清补法。
12. 汗、吐、下三种治法损伤津液导致胃燥口干,阳邪侵犯三阴导致的口渴也是如此。口渴想喝水时,应少量多次给予,不要让水液停留体内形成饮病。太阳病口渴伴小便不利者,用五苓散治疗;阳明病口渴饮水连连不断者,用白虎汤治疗;少阳病证候具备且心烦口渴者,用小柴胡汤治疗,去掉半夏,加入天花粉。
【注】口渴病,多因汗、吐、下三种治法损伤津液,导致胃中干燥,所以引起饮水欲望。阳邪侵入三阴经,太阴经表现为咽干,少阴经表现为口燥,厥阴经表现为消渴。三阴经的口渴,也是阳邪热伤津液所致,所以说“渴亦然”。三阴经口渴的治疗方法在三阴经章节中有详细说明。凡是有口渴想喝水症状的人,应当少量多次给予饮水,以滋润胃燥,胃气调和则病愈;如果肆意大量给水饮用,不仅口渴不能痊愈,反而会导致水液停留体内成为疾病。太阳病的口渴使用五苓散,是因为水停下焦,导致小便不利。阳明病的口渴使用白虎汤,是因为胃热导致饮水连连不止。少阳病的寒热往来等证候已经具备,出现心烦口渴的,使用小柴胡汤来和解少阳,去掉半夏以避免其燥性,加入天花粉(Zhuafen, 天花粉)以生津液。
11. Delirious speech (Zhanyu) is characterized by a loud and robust voice, with incoherent rambling that frequently changes topics. Prostrate speech (Zhengsheng) is characterized by a short and faint voice, with frequent repetition of the same words accompanied by muttering. When appearing in Yang meridians (Yang Jing), both belong to Heat syndromes; when appearing in Yin meridians (Yin Jing), both generally belong to Cold syndromes. For Yang meridian conditions where purgation is not indicated, clear-heat and resolve the exterior should be employed; for Yin meridian conditions where warming and tonification are not indicated, clear-tonification should be used to cure the disease.
[Note] Speech is governed by the Heart. When Heart Qi is excess and hot, leading to an abundance of Shen (Spirit), delirious speech occurs. Delirious speech is an Excess condition, hence the long and robust voice, with incoherent rambling that frequently changes topics. When Heart Qi is deficient and hot, leading to a deficiency of Shen, prostrate speech occurs. Prostrate speech is a Deficiency condition, hence the short and faint voice, merely repeating one phrase in muttering. This is because an abundance of Shen allows for adaptability and thus incoherent rambling, while a deficiency of Shen lacks adaptability, resulting in sticking to a single phrase. Whenever delirious or prostrate speech appears concurrently with Yang meridian syndromes, it belongs to Heat syndromes and can be treated with purgation; when appearing concurrently with Yin meridian syndromes, it generally belongs to Cold syndromes and can be treated with warming methods. However, if it appears with Yang meridian syndromes but there are no indications for purgation, do not use purgation; instead, employ clear-heat and resolve the exterior. If it appears with Yin meridian syndromes but there are no indications for warming/tonifying, do not use warming/tonifying; instead, employ clear-tonification.
12. The three methods [sweating, vomiting, purging] damage body fluids, causing stomach dryness and thirst; thirst caused by Yang pathogens invading the Three Yin meridians is similar. When thirsty and desiring water, give small amounts frequently; do not allow fluid retention to cause illness due to drinking. For Taiyang syndrome with Wuling San (Five-Agaric Powder) indicating difficulty in urination, for Yangming syndrome with continuous drinking indicating Baihu Tang (White Tiger Decoction), and for Shaoyang syndrome presenting with irritability and thirst, use Xiaochaihu Tang (Minor Bupleurum Decoction), removing Banxia (Pinelliae Rhizoma) and adding Zhuafen (Trichosanthis Radix).
[Note] Thirst diseases are mostly caused by sweating, vomiting, or purging damaging body fluids, leading to dryness in the stomach, thus inducing the desire to drink. When Yang pathogens invade the Three Yin meridians, Taiyin manifests as dry throat, Shaoyin as dry mouth, and Jueyin as Xiao Ke (Wasting-Thirst Syndrome). Thirst in the Three Yin meridians is also caused by Yang pathogenic heat damaging body fluids, hence it is said "thirst is similar." The treatment methods for thirst in the Three Yin meridians are detailed in the chapters on the Three Yin meridians. For those desiring to drink water, it should be given in small amounts frequently to moisten stomach dryness; once the Stomach Qi harmonizes, the disease resolves. If water is given indiscriminately and excessively, not only will the thirst not resolve, but water may stagnate and cause illness. Thirst in Taiyang syndrome uses Wuling San because water stagnates in the Lower Jiao, causing difficulty in urination. Thirst in Yangming syndrome uses Baihu Tang because stomach heat causes continuous drinking without cessation. In Shaoyang syndrome, when symptoms such as alternating chills and fever are present along with irritability and thirst, Xiaochaihu Tang is used to harmonize the Shaoyang; Banxia is removed to avoid its drying nature, and Zhuafen is added to generate body fluids.