答曰。五脏阴也。所主皆有形。骨肉筋血皮毛是也。此五脏皆阴足。是为实热。阴足而
热不
能起理也。阴足而热反胜之。是为实热。若骨痿肉烁筋缓血枯皮聚毛落。五阴不足。而为热
病。是虚热。
妇人先病恶寒手足冷。全不发热。脉八至两胁微痛治者便作少阳治之。或曰
是则然矣论犹未也。至如无寒热无胁痛当作何经治或者不敢对恶寒为太阳。脉八至且作阳治
。当不从标本从乎中也。治此者少阳也。若曰脉八至作相火。亦少阳也。兼又从内而之外
也是又当先少阳也。此不必论两胁痛与不痛脉弦与不弦。盒饭作少阳治之。
答曰。为阳在内侵于骨髓。阴在外致使发寒。治当不从内外从乎中治也。宜(小
柴胡汤)调之。倍加姜枣。
热在行阴之分。肾气主之。故用地骨皮饮。以泻血中之火。
(白虎汤)其脉洪。故抑之。使秋气得以下降也。(地骨皮)饮其脉弦。故举之。使春气得以上升
也。
肺气石膏辛 肾气 知母 肺 血黄芩苦 肾血 黄柏
地骨皮泻肾火。总治热在外。地为阴。骨为里。皮为表。
牡丹皮治胞中火。无汗而骨蒸。牝牡乃天地之称也。牡为群花之首。叶为阳发生也。
花为阴成实也。丹者赤也。火也。能泻阴中之火。(四物汤)加上二味。治妇人骨蒸知母泻肾火有汗而骨
蒸。
回答说:五脏属于阴,所主管的都是有形质的组织,如骨、肉、筋、血、皮毛。如果这五脏的阴气充足,就会形成实热证。这是因为阴气充足而热气不能透达于腠理(皮肤纹理和汗孔),阴气充足而热气反而亢盛,这就称为实热。如果是骨痿软无力、肌肉消瘦、筋脉弛缓、血液枯竭、皮肤皱缩、毛发脱落,这是五脏阴气不足而引发的热病,属于虚热。
妇女先患有恶寒、手足冰冷的症状,完全不发发热,脉搏达到每息八至(极快),伴有两胁轻微疼痛。治疗者便将其作为少阳病来治疗。有人问:“虽然情况如此,但理论依据尚不充分。”接着说:“如果没有恶寒发热、没有胁痛,又该归属于哪一经进行治疗呢?”提问者不敢回答。认为恶寒属于太阳病,脉搏极快且当作阳证治疗,应当不遵循标本原则,而应从中治法考虑。治疗此症的关键在于少阳。如果说脉搏极快是相火妄动,也属于少阳范畴。而且病势是从内部向外发展的,因此更应当先治疗少阳。这里不必讨论是否有两胁疼痛或脉象是否弦硬,都应当作为少阳病来治疗。
回答说:阳气在内侵扰骨髓,阴气在外导致发寒。治疗应当不从内外着手,而从中间调理。适宜用小柴胡汤进行调和,并加倍使用生姜和大枣。
热气在运行于阳分的阶段,由肺气所主。所以说用白虎汤来清泻气分中的火热。
热气在运行于阴分的阶段,由肾气所主。所以用地骨皮饮来清泻血分中的火热。
白虎汤适用于脉象洪大的情况,因此采用抑制的方法,使秋金之气得以下降。地骨皮饮适用于脉象弦细的情况,因此采用升举的方法,使春木之气得以上升。
肺气的药物是石膏,味辛;肾气的药物是知母。肺对应血分的是黄芩,味苦;肾血的药物是黄柏。
地骨皮能清泻肾火,总治热邪在外的病症。“地”代表阴,“骨”代表里,“皮”代表表。
牡丹皮能清泻胞宫中的火热,适用于无汗而骨蒸潮热的症状。“牝牡”是天地的称呼。牡为群花之首,叶子代表阳气的发生,花朵代表阴气的成实。丹代表红色,即火性。牡丹皮能清泻阴分中的火热。四物汤加上这两味药,用于治疗妇女骨蒸潮热。知母能清泻肾火,适用于有汗而骨蒸潮热的症状。
Answer: The five zang organs belong to Yin, and they govern all tangible structures, namely bone, flesh, sinew, blood, and skin/hair. When the Yin of these five zang organs is sufficient, it results in Excess Heat (Shi Re). This occurs because sufficient Yin prevents heat from venting through the li (collaterals/skin texture), and when sufficient Yin is overcome by excessive heat, it is termed Excess Heat. Conversely, if there is bone flaccidity, emaciated flesh, relaxed sinews, withered blood, contracted skin, and fallen hair, this indicates insufficiency of the five Yin organs leading to a heat disease, which is termed Deficient Heat (Xu Re).
In women who first present with aversion to cold and cold extremities, without any fever, a pulse rate of eight beats per respiration (extremely rapid), and slight pain in the hypochondrium, the practitioner treats it as Shaoyang syndrome (Lesser Yang disorder). One might ask, "Although the clinical presentation is so, the theoretical basis remains unclarified." Furthermore, "If there is no aversion to cold or fever, and no hypochondriac pain, which meridian should be treated?" The questioner dared not answer. Aversion to cold is attributed to Taiyang (Greater Yang), while a rapid pulse is treated as a Yang syndrome. In such cases, one should not follow the standard biao-ben (root-branch) principles but rather treat from the center (zhong). The treatment focuses on Shaoyang. If the rapid pulse is interpreted as ministerial fire (Xiang Huo) hyperactivity, it also falls under Shaoyang. Moreover, since the pathology moves from the interior to the exterior, priority must be given to treating Shaoyang. It is unnecessary to debate the presence or absence of hypochondriac pain or whether the pulse is wiry (xian); it should always be treated as Shaoyang syndrome.
Answer: When Yang qi invades the marrow from within, and Yin manifests externally causing chills, treatment should not target the interior or exterior directly but should regulate from the middle. Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable for harmonization, with increased doses of Shengjiang (Fresh Ginger Rhizome) and Dazao (Jujube Fruit).
When heat resides in the portion circulating through Yang, it is governed by Lung Qi. Therefore, Baihu Tang (White Tiger Decoction) is used to purge fire from the Qi level.
When heat resides in the portion circulating through Yin, it is governed by Kidney Qi. Therefore, Digupi Yin (Anchore Bark Decoction) is used to purge fire from the Blood level.
Baihu Tang is indicated for a洪 (Hong) or surging pulse; thus, suppression is employed to allow the Qi of Autumn (Metal) to descend. Digupi Yin is indicated for a弦 (Xian) or wiry pulse; thus, elevation is employed to allow the Qi of Spring (Wood) to ascend.
For Lung Qi: Shigao (Gypsum Fibrosum), acrid. For Kidney Qi: Zhimu (Anemarrhenae Rhizoma). For Lung Blood: Huangqin (Scutellariae Radix), bitter. For Kidney Blood: Huangbai (Phellodendri Cortex).
Digupi (Lycii Cortex) clears Kidney fire and generally treats heat externalized. 'Di' (Earth) represents Yin; 'Gu' (Bone) represents the interior; 'Pi' (Skin/Cortex) represents the exterior.
Mudanpi (Moutan Cortex) clears fire in the Baozhong (Uterus/Sea of Blood), indicated for bone-steaming tidal fever without sweating. 'Pin' and 'Mu' are terms for Heaven and Earth. 'Mu' (Male/Yang) is the head of flowers; leaves represent the generation of Yang; flowers represent the completion of Yin. 'Dan' (Cinnabar/Red) represents Fire. Mudanpi can clear fire within Yin. Siwu Tang (Four Substances Decoction) added with these two herbs treats bone-steaming in women. Zhimu (Anemarrhenae Rhizoma) clears Kidney fire, indicated for bone-steaming tidal fever with sweating.