畜血者,瘀血立细结于内也。盖因邪热相攻,血留不行,故成此症也。经曰、太阳随经瘀血在里,血为热
搏结而不行,畜于下焦所致也。然血畜于上,则为善妄。血畜于下,则为如狂。若少腹急满,小盒饭不
利,令反利而大便黑者,血症谛也。宜用咸寒苦泄胜血之剂,或抵当汤之类。若小便不利,则津液留
结,可利其小便。若小便自利,则是畜血之症,可下其瘀血也。
膀胱不利为癃,不约为遗溺。若肾虚,则膀胱之气不约,故小便出而不自知也。其治法有阴阳虚实
之别。若阳邪谵妄,神昏热甚而遗尿者,当清心解热。若阴邪厥逆,脉微寒极而遗尿者,当温肾散寒。
设或狂言直视而遗尿者,又为肾绝而不可治也。
头者诸阳之会,诸阳脉皆上于头,阳脉不治,则头为之摇矣。然摇有三。一曰、摇头言者,里病也,以里
有痛,语言则剧,欲言而头摇矣。二曰、独头摇,卒口噤,背反张者,痉病。以风盛于上,风主动摇,故头摇
也。然里病、非邪病也,痛使之然。痉病、非厥逆也,风使之然。至于阳反独留,形体如烟熏,直视而摇头
者,又为心绝也。
怫郁者,盖因表邪发热汗出,覆盖不周,汗出不彻,或甲遏风邪,是以阳气郁于肌肤,蒸于头面,聚而
不散也。若阴盛而面赤者,其色黯而不光。阳盛而面赤者,其色明而且润。治须察其虚实,不可见面
红便作阳火治之。
畜血证,是指瘀血在体内凝结成块。这通常是因为邪热与血液相互搏结,导致血液停滞不行,从而形成此症。《内经》说:“太阳病邪气随经入里,瘀血留在体内,血被热邪搏结而运行不畅,蓄积在下焦所致。”然而,如果瘀血蓄积在上部,就会出现神志狂乱、胡言乱语的症状;如果瘀血蓄积在下部,就会出现像发狂一样的症状。如果小腹部拘急胀满,小便不通利,或者虽然小便通畅但大便颜色发黑,这就是确诊为蓄血证的依据。适宜使用咸寒苦泄、破血逐瘀的方剂,如抵当汤之类。如果小便不利,说明津液停留凝结,应当通利小便。如果小便自利(正常通畅),则是蓄血证的表现,可以使用攻下法来祛除瘀血。
膀胱气化不利称为癃闭,约束无力称为遗尿。如果肾气虚弱,膀胱的气机不能固摄,就会导致小便流出而患者自己不知道。治疗这种病症需要区分阴阳虚实。如果是阳邪引起的谵妄,神志昏迷且热势严重并伴有遗尿的,应当清心泻火解毒。如果是阴邪导致的厥逆,脉象微弱、极度寒冷并伴有遗尿的,应当温补肾阳、散寒。假如出现胡言乱语、眼睛直视且遗尿的情况,这是肾气绝灭的表现,属于不可治愈的危重症。
头部是诸阳经汇聚的地方,所有阳经的脉气都上行至头部。如果阳经之气失调,头部就会发生摇动。头摇有三种情况:第一种是说话时摇头,这是因为体内有疼痛,说话时疼痛加剧,想要说话却因痛而摇头。第二种是单独头部摇动,突然牙关紧闭,背部反张,这是痉病。因为风邪盛于上部,风性主动,所以导致头摇。这里的“里病”并非外邪致病,而是疼痛导致的;“痉病”并非厥逆,而是风邪导致的。至于阳气独留于上,身体形态如烟熏般晦暗,眼睛直视且摇头的,这是心气绝灭的表现。
怫郁证,大概是因为体表受邪发热出汗,覆盖衣物不周全,导致汗出不透彻,或者被风邪遏制,使得阳气郁滞在肌肤之间,蒸腾于头面部,聚集而不能发散。如果是因为阴寒内盛而导致的面部发红,其面色晦暗而无光泽。如果是因为阳热亢盛而导致的面部发红,其面色明亮而且润泽。治疗时必须仔细辨别虚实,不能一见面红就当作阳火证来治疗。
Blood accumulation (Xue Xu) refers to the condensation of blood stasis within the interior. This condition arises because pathogenic heat and blood contend with each other, causing blood to stagnate and fail to circulate, thereby forming this syndrome. The Classics state: "In Taiyang disease, pathogens follow the meridians into the interior; blood stasis remains inside. Blood is contended by heat, fails to move, and accumulates in the Lower Jiao." However, if blood accumulates in the upper part, it leads to manic delirious speech; if blood accumulates in the lower part, it leads to a state resembling mania. If there is urgency and fullness in the lower abdomen, difficulty in urination, or conversely, free urination accompanied by black stools, these are definitive signs of blood accumulation. It is appropriate to use agents that are salty, cold, bitter, and purgative to overcome blood stasis, such as Didang Tang (Vital Force Decoction). If urination is difficult, it indicates that body fluids are stagnant and condensed; one should promote urination. If urination is normal and free, it indicates a blood accumulation syndrome, and purgative methods can be used to evacuate the blood stasis.
Impaired bladder function leading to urinary retention is called Long (Ling), while loss of control leading to enuresis is called Yiniao. If Kidney Qi is deficient, the Bladder's Qi lacks restraint, resulting in involuntary urination without the patient's awareness. The treatment method must distinguish between Yin/Yang and Deficiency/Excess. If Excess Yang pathogens cause delirium, severe heat, coma, and enuresis, one should clear the Heart and resolve heat. If Yin pathogens cause Jue (cold extremities/reversal), a faint pulse, extreme cold, and enuresis, one should warm the Kidney and disperse cold. If there is manic talking, fixed staring, and enuresis, this indicates the exhaustion of Kidney Qi and is incurable.
The head is the convergence point of all Yang meridians, and the Qi of all Yang channels ascends to the head. If Yang channel Qi is disordered, the head will tremble. There are three types of head tremors: First, shaking the head while speaking indicates an interior pathology; due to internal pain, speaking exacerbates the pain, causing the head to shake when attempting to speak. Second, isolated head tremor, sudden lockjaw, and opisthotonos indicate Jing Disease (Spasm Disorder). This occurs because Wind pathogen is abundant in the upper part; since Wind is characterized by movement, it causes head tremor. Here, "interior pathology" is not caused by external pathogens but by pain; "Jing Disease" is not Jue reversal but caused by Wind. Third, if Yang Qi remains exclusively in the upper part, the body appears dark like smoke, with fixed staring and head tremor, this indicates the exhaustion of Heart Qi.
Fu Yu (Depression/Stagnation) generally arises from exterior pathogens causing fever and sweating. Incomplete covering during sweating prevents thorough perspiration, or wind pathogens obstruct the surface, causing Yang Qi to stagnate in the skin and muscles, steaming towards the head and face, where it gathers and fails to dissipate. If facial redness is caused by Yin excess, the complexion is dull and lacks luster. If facial redness is caused by Yang excess, the complexion is bright and moist. Treatment requires careful examination of Deficiency and Excess; one must not treat facial redness simply as Yang Fire based on appearance alone.