31. 阴证身重息短冷, 目不了了色不红, 无热欲卧厥吐痢, 小便白兮
爪甲青.
【注】阴证, 谓阴寒之证也. 不论三阴, 三阳, 凡见是证者, 均为阴
寒不足也. 阴主静, 故身重也. 阴主寐, 故目不了了但欲卧也. 阳气
虚寒, 故息短口鼻气冷也. 阴淫于外, 故面无红色, 四肢厥冷爪甲青
也. 阴邪入内, 故呕吐, 下痢清谷, 小便清白也. 以上皆三阴寒证,
临证者以附子、 四逆、理中、吴茱萸等汤, 择其宜而与之可也. 详三
阴篇.
32. 阳盛格阴身肢厥, 恶热烦渴大便难, 沉滑爪赤小便赤, 汗下清宜
阴自完.
【注】经曰: 阳气太盛, 阴气不得相营也. 不相营者, 不相入也. 既
不相入, 则格阴于外, 故曰阳盛格阴也. 其外证虽身肢厥冷, 颇似阴
寒,而内则烦渴, 大便难, 小便赤, 恶热不欲近衣, 爪甲赤, 脉沉滑,
一派阳实热证. 汗下清三法得宜, 则阳得以消, 阴得以完全也. 表实
无汗, 三黄石膏汤. 里实不便, 三承气汤. 热盛无表里证, 宜解毒白
虎汤.
【集注】刘完素曰: 蓄热内甚, 脉须疾数, 以其极热蓄甚而脉道不利,
反致脉沉细欲绝, 俗未明造化之理, 反谓传为寒极阴毒者. 或始得之,
阳热暴甚, 而便有此证候者; 或两感热甚者, 通宜解毒加大承气汤下
之. 后热稍退而未愈者, 黄连解毒汤调之. 或微热未除者, 凉膈散调
之. 或失下热极, 以至身冷脉微而昏冒将死, 若急下之, 则残阴暴绝
必死, 盖阳后竭而然也. 不下亦死, 宜凉膈散或黄连解毒汤, 养阴退
阳,积热渐以消散, 则心胸再暖而脉渐以生也.
31. 阴证表现为身体沉重、呼吸短促、四肢发冷,眼神呆滞无神、面色不红,没有发热感而想躺卧,出现四肢厥逆、呕吐或下痢,小便颜色清白,指甲青紫。
【注】所谓阴证,是指阴寒性质的病证。无论是三阴经还是三阳经的病证,凡是出现上述症状的,都属于阴寒不足(阳气虚衰)。阴气主静,所以身体沉重;阴气主寐,所以眼神呆滞只想躺卧。阳气虚衰寒冷,所以呼吸短促且口鼻呼出之气寒冷。阴邪盛于体表,所以面色无红润之色,四肢厥冷、指甲青紫。阴邪侵入体内,所以出现呕吐、下利清谷(大便中有未消化的食物)、小便清白。以上皆属三阴经的寒证,临床医生可根据具体情况选择附子汤、四逆汤、理中汤、吴茱萸汤等方剂适宜者给予治疗。详见三阴篇。
32. 阳盛格阴证表现为身体和四肢厥冷,怕热、心烦口渴、大便困难,脉象沉滑、指甲发红、小便赤黄,若汗法、下法、清热法运用得当,阴液自然得以保全。
【注】《内经》说:阳气过盛,阴气无法与之相互营卫协调。所谓不相营,就是不能相互交融。既然不能交融,就会将阴气格拒于外,所以称为“阳盛格阴”。其外在表现虽然是身体和四肢厥冷,颇似阴寒证,但内部却有烦渴、大便困难、小便赤黄、怕热不想穿衣、指甲发红、脉象沉滑等一系列阳证实热证的表现。汗法、下法、清热法如果运用得当,阳气得以消退,阴液得以完全恢复。表实无汗者,用三黄石膏汤;里实便秘者,用三承气汤;热盛而无表里实证者,宜用解毒白虎汤。
【集注】刘完素说:内热蓄积严重,脉搏应当疾数,但因为极热蓄积严重导致脉道不利,反而出现脉沉细欲绝的现象。世俗之人不明白造化之理,反而误认为是传变为寒极阴毒证。或者发病之初,阳热突然亢盛,而出现此证候的;或者两感病热势严重的,通宜使用解毒加大承气汤攻下。后来热势稍退但未痊愈的,用黄连解毒汤调理。或者微热未除的,用凉膈散调理。或者因失于攻下导致热极,以至身体冰冷、脉微、昏冒即将死亡的情况,如果急于攻下,则残存的阴液会暴绝而死,这是因为阳气先竭所致。如果不攻下也会死,宜用凉膈散或黄连解毒汤,滋养阴液、退抑阳气,积聚的热邪逐渐消散,心胸再回暖,脉搏逐渐恢复。
31. Yin syndrome is characterized by heavy body, shortness of breath, cold limbs, dull eyes with lack of spirit, non-red complexion, absence of fever desire to lie down, cold extremities (Jue), vomiting or dysentery, clear urine, and cyanotic nails.
[Note] The term "Yin syndrome" refers to a pathogenic pattern of Yin-cold. Regardless of whether it involves the Three Yin meridians or the Three Yang meridians, any presentation of these symptoms indicates deficiency of Yin-cold (deficiency of Yang Qi). Yin governs stillness, hence the heavy body; Yin governs sleep, hence the dull gaze and desire to lie down. Deficiency and cold of Yang Qi result in shortness of breath and cold air exhaled from the mouth and nose. Excess Yin evil on the exterior leads to a lack of ruddy color in the face, cold extremities, and cyanotic nails. Yin evil entering the interior causes vomiting and diarrhea with undigested food (Qing Gu) and clear white urine. All the above belong to Cold syndromes of the Three Yin meridians. Clinicians should select appropriate formulas such as Fuzi Tang (Aconite Decoction), Sini Tang (Recover the Reversed Decoction), Lizhong Tang (Regulate the Middle Decoction), or Wuzhuyu Tang (Evodia Decoction) based on the specific condition. For details, refer to the chapter on the Three Yin meridians.
32. Yang-excess repelling Yin syndrome presents with cold extremities, aversion to heat, irritability, thirst, difficulty in defecation, deep and slippery pulse, red nails, and red urine. If sweating, purging, and clearing methods are applied appropriately, Yin fluids will naturally be preserved.
[Note] The Classic states: "When Yang Qi is excessively abundant, Yin Qi cannot circulate harmoniously." The inability to circulate harmoniously means they cannot interpenetrate. Since they cannot interpenetrate, Yin is repelled to the exterior, hence the term "Yang-excess repelling Yin." Although the external manifestations include cold body and extremities, resembling a Yin-cold pattern, internally there is a cluster of Yang-excess heat signs: irritability, thirst, difficulty in defecation, red urine, aversion to heat and reluctance to wear clothes, red nails, and a deep, slippery pulse. If the methods of sweating, purging, and clearing are applied correctly, Yang can be diminished, and Yin can be fully restored. For exterior excess with no sweat, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction); for interior excess with constipation, use the Three Chengqi Decoctions; for intense heat without exterior or interior excess signs, Jiedu Baizhu Tang (Detoxifying White Tiger Decoction) is indicated.
[Collected Notes] Liu Wusu stated: When internal heat is severely accumulated, the pulse should be rapid and frequent. However, due to extreme heat accumulation causing obstruction in the pulse vessels, the pulse may instead appear deep, fine, and nearly absent. Laypeople, failing to understand the principles of nature, often mistakenly diagnose this as transmission to extreme cold or Yin-toxin syndrome. In cases where Yang-heat suddenly becomes severe at onset, presenting with these symptoms; or in cases of simultaneous contraction of exterior and interior with severe heat, one should generally use Jiedu Plus Dachengqi Tang (Detoxifying plus Great Order the Qi Decoction) to purge. If heat subsides slightly but recovery is incomplete, Huanglian Jiedu Tang (Coptis Detoxification Decoction) should be used for regulation. If slight heat remains, Liangge San (Cool the Diaphragm Powder) is suitable. In cases where failure to purge led to extreme heat, resulting in cold body, faint pulse, coma, and impending death, immediate purging would cause the residual Yin to abruptly perish, leading to death because Yang had already exhausted. Not purging also leads to death; in such cases, Liangge San or Huanglian Jiedu Tang should be used to nourish Yin and retreat Yang. As the accumulated heat gradually dissipates, the chest and heart will warm again, and the pulse will gradually return.