传尸者非一门相染而成也。人之血气衰弱。脏腑虚羸。中于鬼气。因感其邪。遂成其疾也。其候或咳嗽不
已。或胸膈妨闷。或肢体疼痛。或肌肤消瘦。或饮食不入。或吐利不定。或吐脓血。或嗜水浆。或好歌咏。或爱
悲愁。或癫风(一作狂。)发歇。或便溺艰难。或因酒食而遇。或因风雨而来。或问病吊丧而得。或朝走暮游而逢。
或因气聚。或因血行。或露卧于田野。或偶会于园林。钟此病死之气。染而为疾。故曰传尸也。治疗之方备
于篇末。
夫人有五脏六腑虚实、寒热、生死、逆顺。皆见于形证脉气。若非诊察无由识也。虚则补之。实则泻之。寒则
温之。热则凉之。不虚不实以经调之。此乃良医之大法也。其于脉证。具如篇末。
肝者与胆为表里。足厥阴少阳是其经也。旺于春。春乃万物之始生。其气嫩而软。虚而宽。故其脉弦。软不
可发汗。弱则不可下。弦长曰平。反此曰病。脉虚而弦。是谓太过。病在外。太过则令人善忘。忽忽眩冒。实而
微。是谓不及。病在内。不及则令人胸痛。引两胁。胀满。大凡肝实则引两胁。下痛引小腹。令人(本无此五字。)喜怒。
虚则如人将捕之。其气逆。则头痛。耳聋。颊赤。(一作肿。)其脉。沉之而急。浮之亦然。主胁肋(一作支。)满。小便
难。头痛。目眩。其脉。急甚恶言。微急。气在胸胁下。缓甚。呕逆。微缓。水痹。大急。内痈吐血。微大。筋痹。小
甚。多饮。微大(本作小。)消瘅。(本作痹。)滑甚、颓疝、微滑、遗溺、涩甚、流饮、微涩、 挛、变也。(本无此二
字。)又肝之积气在胁。久不发为咳逆。或为 疟也。虚则梦花草茸茸。实则梦山林茂盛。肝之病。旦喜。(一作慧。)晚
甚。夜静。肝病。则头痛胁痛。(本无此二字。)目眩。肢满。囊缩。小便不通。(一作利。)十日死。又身热。恶寒。四肢
不举。其脉当弦长而急。反短而涩。乃金刻木也。十死不治。又肝中寒。则两臂痛不能举。舌本燥。多太息。胸中痛。
不能转侧。其脉。左关上迟而涩者是也。肝中热。则喘满而多怒。目疼。腹胀满。不嗜食。所作不定。睡中惊悸。眼赤
视不明。其脉。左关阴实者是也。肝虚冷。则胁下坚痛。目盲臂痛。发寒热如疟状。不欲食妇。人则月水不来。而气急。
其脉左关上沉而弱者。是也。
传尸病(指具有传染性、消耗性的慢性虚损性疾病,类似现代的结核病等)并非通过一家一户相互传染而形成的。是因为人的血气衰弱,脏腑虚弱消瘦,受到鬼气(指致病邪气)侵袭,因而感应了这种邪气,最终形成了这种疾病。其症状表现有的咳嗽不止,有的胸膈部憋闷不适,有的肢体疼痛,有的肌肤消瘦,有的饮食无法进入,有的呕吐腹泻没有规律,有的吐出脓血,有的嗜喝水浆,有的喜欢唱歌吟咏,有的喜爱悲伤忧愁,有的癫痫或狂躁病症发作与间歇交替出现,有的大小便困难。有的因饮酒进食后遭遇邪气而得病,有的因风雨侵袭而来,有的因探问病人或参加丧事而感染,有的因早晚行走游玩而碰触到。有的因气机郁结,有的因血液运行异常,有的露天睡卧在田野间,有的偶然聚会于园林中,沾染了这种病死之气,从而染上疾病,所以称为“传尸”。治疗的方剂详见本篇末尾。
人有五脏六腑的虚、实、寒、热以及生死、逆顺的变化,这些都表现在形体征象和脉象气息上。如果不是通过诊察,就无法识别。虚证就用补法,实证就用泻法,寒证就用温法,热证就用凉法。不虚不实的病证则通过调理经脉来治疗。这是高明医生的基本法则。关于具体的脉象和证候,详细记载在本篇末尾。
肝脏与胆互为表里关系。足厥阴肝经和足少阳胆经是它们的经络。肝脏的气血在春季旺盛。春季是万物开始生长的季节,此时肝气嫩弱柔软,空虚而宽缓,所以脉象呈现弦象。脉象柔软不可使用发汗法,脉象微弱不可使用攻下法。脉象弦长是正常的,与此相反则是病态。脉象虚而弦,这叫做“太过”,病位在外。太过会导致人容易健忘,精神恍惚,头晕目眩。脉象实而微细,这叫做“不及”,病位在内。不及会导致人胸痛,牵引两侧胁肋,胀满。大凡肝实证会牵引两侧胁肋,向下疼痛牵引小腹,使人喜怒无常。肝虚证则感觉像被人追捕一样惊恐。肝气上逆,则头痛,耳聋,面颊发红(一说为肿胀)。其脉象,沉取时急迫,浮取时也如此,主症为胁肋胀满,小便困难,头痛,目眩。脉象急甚则厌恶说话,微急则气滞在胸胁下,缓甚则呕吐逆气,微缓则患水湿痹阻。脉象大急则内痈吐血,微大则筋痹,小甚则多饮,微大(原文本作小)则患消瘅(原文本作痹)。脉滑甚则患颓疝,微滑则遗尿,涩甚则流饮(水液停聚),微涩则拘挛。此外,肝的积气位于胁部,久不发作则为咳逆,或者为疟疾。肝虚则梦见花草茂盛,肝实则梦见山林繁茂。肝病,早晨病情好转(一说为清醒),晚上加重,夜间安静。肝病则头痛胁痛,目眩,四肢胀满,阴囊收缩,小便不通(一说为通利),十日死亡。另外身体发热,恶寒,四肢不能举动,其脉应当弦长而急,如果反而短而涩,这是金克木的相乘关系,十死无救,无法治愈。另外,肝受寒邪,则两臂疼痛不能举起,舌根干燥,经常叹气,胸中疼痛,不能翻身侧卧。其脉象,左关部迟而涩的就是肝中寒。肝受热邪,则气喘胀满且易怒,眼睛疼痛,腹部胀满,不想吃东西,行为不定,睡眠中惊悸,眼睛红赤视物不明。其脉象,左关部阴实的就是肝中热。肝虚冷,则胁下坚硬疼痛,眼睛失明手臂疼痛,发寒热像疟疾状,不想吃饭,如果是女性则月经不来,并且气急。其脉象左关部沉而弱的就是肝虚冷。
Chuan Shi (a contagious, consumptive chronic deficiency disease, similar to modern tuberculosis) does not form through transmission from one household to another. It arises because the person's blood and qi are weak, the zang-fu organs are deficient and emaciated, they are attacked by "ghost qi" (pathogenic factors), thereby sensing this evil, and finally developing the disease. Its manifestations include: persistent cough; chest and diaphragm oppression and stuffiness; limb pain; emaciation of skin and flesh; inability to take in food; irregular vomiting and diarrhea; expectoration of pus and blood; craving for water and fluids; fondness for singing and chanting; predisposition to sadness and sorrow; alternating episodes of epilepsy or mania; difficulty in urination and defecation. The disease may be contracted after encountering pathogens following alcohol consumption or meals; due to wind and rain invasion; by visiting patients or attending funerals; or by chance encounters during morning walks or evening strolls. It may result from qi stagnation or abnormal blood circulation; from sleeping exposed in fields; or from accidental gatherings in gardens. One contracts this qi of death and illness, becomes infected, and thus develops the disease, hence it is called "Chuan Shi". The treatment formulas are detailed at the end of this chapter.
The deficiency, excess, cold, and heat of the five zang and six fu organs, as well as their life-and-death and reversal-and-smooth states, are all manifested in physical signs and pulse/qi characteristics. Without diagnosis and examination, these cannot be recognized. For deficiency syndromes, use tonification; for excess syndromes, use purgation; for cold syndromes, use warming; for heat syndromes, use cooling. For syndromes that are neither deficient nor excess, regulate via the meridians. This is the fundamental principle of a skilled physician. Specific pulse patterns and clinical manifestations are detailed at the end of this chapter.
The Liver and Gallbladder are exterior-interiorly related. Their respective meridians are the Foot Jueyin Liver Meridian and the Foot Shaoyang Gallbladder Meridian. The Liver qi prospers in Spring. Spring is the beginning of the generation of all things; its qi is tender, soft, empty, and expansive. Therefore, the pulse is Xian (Wiry). If the pulse is soft, sweating therapy should not be used; if weak, purgative therapy should not be used. A Xian and long pulse indicates normality; deviation from this indicates pathology. A pulse that is deficient yet Xian is termed "Excessive" (Tai Guo), indicating an external disease. Excessiveness causes forgetfulness, mental confusion, dizziness, and vertigo. A pulse that is excess yet fine/thin is termed "Deficient" (Bu Ji), indicating an internal disease. Deficiency causes chest pain radiating to both hypochondriac regions, distension, and fullness. Generally, Liver excess causes pain radiating from both hypochondriac regions downward to the lower abdomen, leading to irritability and anger. Liver deficiency manifests as a sensation of being hunted or pursued. When Liver qi rebels upward, symptoms include headache, deafness, and red cheeks (or swelling). The pulse, when pressed deeply, is rapid/tense; superficially, it is also so. This primarily indicates hypochondriac fullness, difficult urination, headache, and dizziness. An extremely rapid/tense pulse indicates aversion to speech; slightly rapid/tense indicates qi stagnation in the chest and hypochondrium; extremely slack indicates vomiting and reflux; slightly slack indicates Water Bi (water-dampness obstruction). Extremely large indicates internal abscess with hematemesis; slightly large indicates Sinew Bi; very small indicates polydipsia; slightly large (original text says small) indicates Xiao Dan (wasting-thirst); slightly slippery indicates Tui Shan (scrotal hernia); very slippery indicates enuresis; very choppy indicates Liu Yin (flowing fluid retention); slightly choppy indicates spasms/cramping. Additionally, accumulated Qi in the Liver resides in the hypochondrium; if unmanifested for a long time, it causes cough and rebellion of Qi, or Malaria. Liver deficiency leads to dreams of lush grass and flowers; Liver excess leads to dreams of dense forests and mountains. In Liver diseases, the patient feels better in the morning (or lucid), worse in the evening, and quiet at night. Liver disease presents with headache and hypochondriac pain, dizziness, limb fullness, retraction of the scrotum, and urinary retention (or incontinence); death occurs within ten days. Furthermore, if there is body heat, aversion to cold, and immobility of the four limbs, the pulse should be Xian, long, and rapid. If it is instead short and choppy, this represents Metal overcoming Wood (Jin Ke Mu), which is incurable with a mortality rate of ten out of ten. Regarding Cold invading the Liver: bilateral arm pain preventing lifting, dryness at the root of the tongue, frequent sighing, chest pain, and inability to turn sideways. The pulse is slow and choppy at the Left Guan position, indicating Cold in the Liver. Regarding Heat invading the Liver: panting, fullness, irritability, eye pain, abdominal distension, anorexia, erratic behavior, nocturnal palpitations, red eyes, and blurred vision. The pulse is Yin-excess at the Left Guan position, indicating Heat in the Liver. Regarding Liver Deficiency-Cold: hardness and pain under the hypochondrium, blindness, arm pain, chills and fever resembling malaria, anorexia; in women, amenorrhea, and急促 breathing. The pulse is deep and weak at the Left Guan position, indicating Deficiency-Cold in the Liver.