热到膀胱,小便赤色;邪到膀胱,干于气分,小便胶浊;干于血分,溺血蓄血
;留邪欲出,小便数急;膀胱不约,小便自遗;膀胱热结,小便闭塞。
热到膀胱者,其邪在胃,胃热灼于下焦,在膀胱但有热而无邪,惟令小便赤色而已,其治在
胃。
邪到膀胱者,乃疫邪分布下焦,膀胱实有之邪,不一于热也,从胃家来,治在胃,兼治膀胱
。若纯治膀胱,胃气乘势捅入膀胱,非其治也。若肠胃无邪,独小便急数,或白膏如马遗,
其治在膀胱,宜猪苓汤。
猪苓汤 邪干气分者宜之。
猪苓(二钱) 泽泻(一钱) 滑石(五分) 甘草(八分) 木通(一钱) 车前(二钱)
灯心煎服。
桃仁汤 邪干血分者宜之。
桃仁(三钱,研如泥) 丹皮(一钱) 当归(一钱) 赤芍(一钱) 阿胶(二钱) 滑石(二钱)
照常煎服。小腹痛,按之硬痛,小便自调,有蓄血也,加大黄三钱,甚则抵当汤。药分三等
,随其病之轻重而施治。
病有先虚后实者,宜先补而后泻;先实而后虚者,宜先泻而后补。假令先虚后实
者,或因他病先亏,或因年高血弱,或因先有劳倦之极,或因新产下血过多,或旧有吐血及
崩漏之证,时疫将发,即触动旧疫,或吐血,或崩漏,以致亡血过多,然后疫气渐渐加重,
以上并宜先补而后泻。泻者谓疏导之剂,并承气下药,概而言之也。凡遇先虚后实者,此
万
不得已而投补剂一、二帖后,虚证少退,便宜治疫。若补剂连进,必助疫邪,祸害随至。假
令
先实而后虚者,疫邪应下失下,血液为热搏尽,原邪尚在,宜急下之,邪退六七,急宜补之
,虚回五六,慎勿再补。多服则前邪复起。下后必竟加添虚证者方补,若以意揣度其虚,不
加虚证,误用补剂,贻害不浅。
热邪传入膀胱,小便颜色发红;疫邪传入膀胱,若干扰气分,小便浑浊如胶;若干扰血分,则出现尿血或蓄血;若留滞之邪欲从下排出,小便频数且急迫;若膀胱约束无力,小便自行遗出;若膀胱热结不通,小便闭塞不通。
所谓“热到膀胱”,是指病邪在胃,胃中热邪灼烧下焦,此时膀胱仅有热象而无实邪,仅导致小便发红,治疗重点在于清胃热。
所谓“邪到膀胱”,是指疫邪分布在下焦,膀胱内有真实的病邪,不仅仅是热邪,这些邪气来自胃肠,治疗应兼顾胃和膀胱。如果只治疗膀胱,胃中的邪气会趁势侵入膀胱,这不是正确的治法。如果肠胃没有病邪,仅表现为小便急迫频数,或者尿液像马尿一样白浊如膏,治疗重点在膀胱,适宜使用猪苓汤。
猪苓汤适用于邪气干扰气分的情况。
组成:猪苓(二钱)、泽泻(一钱)、滑石(五分)、甘草(八分)、木通(一钱)、车前子(二钱)。用灯心草煎汤送服。
桃仁汤适用于邪气干扰血分的情况。
组成:桃仁(三钱,研成泥状)、牡丹皮(一钱)、当归(一钱)、赤芍(一钱)、阿胶(二钱)、滑石(二钱)。按常规方法煎服。如果小腹部疼痛,按压时硬痛,但小便正常,这是蓄血证,需加大黄三钱;病情严重者,使用抵当汤。药物分为三个等级,根据病情的轻重来施治。
疾病有先虚后实的,应当先补益而后攻下;先实后虚的,应当先攻下而后补益。假如是先虚后实的情况,可能是因为其他疾病导致正气先亏损,或者因为年老血弱,或者因为过度劳累,或者因为新产后失血过多,或者有既往吐血及崩漏病史,当时疫气将要发作,触动旧疾,导致吐血或崩漏,致使亡血过多,然后疫气逐渐加重,以上情况都适宜先补益而后攻下。“泻”指的是疏导的药剂以及承气汤类下药,概括而言。凡是遇到先虚后实的情况,这是万不得已才投用一两帖补剂,待虚证稍退,就应立即治疗疫病。如果连续服用补剂,必定助长疫邪,祸害随即到来。假如是先实后虚的情况,疫邪本应攻下却未攻下,血液被热邪搏结耗尽,原发病邪仍在,应当紧急攻下,待邪气消退六七成,立即进行补益,待虚损恢复五六成,务必不要再继续补益。多服补药会导致之前的邪气复发。只有在攻下后确实增加了虚证表现时才进行补益,如果是凭主观推测认为有虚证,而没有实际的虚证表现,误用补剂,危害不浅。
When heat reaches the Bladder (Bladder), the urine is red; when pathogenic factors reach the Bladder (Bladder) and interfere with the Qi level (Qi level, the functional aspect of life), the urine becomes turbid and gelatinous; if they interfere with the Blood level (Blood level, the material aspect of life), hematuria (blood in urine) or blood stasis (accumulation of stagnant blood) occurs; if lingering pathogens attempt to exit, there is urinary frequency and urgency; if the Bladder (Bladder) fails to maintain control, spontaneous urinary incontinence (involuntary leakage of urine) occurs; if there is heat binding in the Bladder (Bladder), urinary retention (inability to urinate) occurs.
"Heat reaching the Bladder" refers to the pathogen being in the Stomach (Stomach); stomach heat scorching the Lower Jiao (Lower Jiao, the lower part of the torso containing the digestive, urinary, and reproductive organs). In this case, the Bladder (Bladder) has only heat without excess pathogen, causing merely red urine. The treatment focuses on the Stomach (Stomach).
"Pathogens reaching the Bladder" refers to epidemic pathogens distributing to the Lower Jiao (Lower Jiao), where the Bladder (Bladder) contains actual pathogens, not just heat. These pathogens come from the Stomach and Intestines (Stomach and Intestines). Treatment should address both the Stomach (Stomach) and the Bladder (Bladder). If one treats only the Bladder (Bladder), the pathogen in the Stomach (Stomach) will invade the Bladder (Bladder) by force, which is incorrect. If there are no pathogens in the Stomach and Intestines (Stomach and Intestines), but only urinary urgency and frequency, or urine that is white and turbid like horse semen, the treatment focuses on the Bladder (Bladder), and Zhu Ling Tang (Polyporus Decoction) is appropriate.
Zhu Ling Tang (Polyporus Decoction) is suitable for pathogens interfering with the Qi level (Qi level).
Ingredients: Zhu Ling (Polypori Umbellati Sclerotium, 2 qian), Ze Xie (Alismatis Rhizoma, 1 qian), Hua Shi (Talcum, 0.5 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 0.8 qian), Mu Tong (Akebiae Caulis, 1 qian), Che Qian (Plantaginis Semen, 2 qian). Decoct with Deng Xin Cao (Junci Medullae) and take orally.
Tao Ren Tang (Peach Kernel Decoction) is suitable for pathogens interfering with the Blood level (Blood level).
Ingredients: Tao Ren (Persicae Semen, 3 qian, ground into paste), Dan Pi (Moutan Cortex, 1 qian), Dang Gui (Angelicae Sinensis Radix, 1 qian), Chi Shao (Paeoniae Radix Rubra, 1 qian), E Jiao (Colla Corii Asini, 2 qian), Hua Shi (Talcum, 2 qian). Decoct and take according to standard methods. If there is lower abdominal pain, hardness and tenderness upon pressure, but normal urination, this indicates blood stasis (accumulation of stagnant blood). Add Da Huang (Rhei Radix et Rhizoma, 3 qian). For severe cases, use Di Dang Tang (Di Dang Decoction). Medications are classified into three grades, applied according to the severity of the disease.
Diseases may present as deficiency first followed by excess; in such cases, tonification should precede purgation. Diseases presenting as excess first followed by deficiency require purgation before tonification. For example, in cases of deficiency first followed by excess, it may be due to prior depletion from other diseases, weak blood due to old age, extreme fatigue, excessive blood loss after childbirth, or a history of hematemesis (vomiting blood) or metrorrhagia (uterine bleeding). When an epidemic is about to erupt, it may trigger these old conditions, leading to hematemesis or metrorrhagia, causing excessive blood loss, after which the epidemic qi gradually intensifies. All such cases are suitable for tonification followed by purgation. "Purgation" refers generally to draining agents and Cheng Qi Xia Yao (purgative herbs like those in Cheng Qi Tang). Whenever encountering deficiency first followed by excess, one must reluctantly administer one or two doses of tonifying agents; once the deficiency symptoms subside slightly, treat the epidemic immediately. Continuous administration of tonics will inevitably aid the epidemic pathogen, bringing disaster. Conversely, in cases of excess first followed by deficiency, if the epidemic pathogen required purgation but was not purged, the blood may be exhausted by heat binding while the original pathogen remains. Urgent purgation is needed. Once the pathogen recedes by 60-70%, immediate tonification is required. When deficiency recovers by 50-60%, do not continue tonifying. Overuse leads to the recurrence of previous pathogens. Tonification should only be added after purgation if deficiency symptoms actually appear. Do not guess deficiency based on intuition; misusing tonics without actual deficiency signs causes significant harm.