大法,冬宜服温热药及灸。
师曰∶病发热头痛,脉反沉。若不瘥,身体更疼痛,当救其里,宜温药,四逆汤。
下利,腹满,身体疼痛,先温其里,宜四逆汤。自利,不渴者,属太阴,其脏有寒故也。当温之,宜四逆辈。
少阴病,其人饮食入则吐,心中温温欲吐,复不能吐。始得之,手足寒,脉弦迟。若膈上有寒饮,干呕者,不可吐,
当温之,宜四逆汤。
少阴病,脉沉者,急当温之,宜四逆汤。
下利,欲食者,就当温之。
下利,脉迟紧,为痛未欲止,当温之。得冷者满,而便肠垢。
下利,其脉浮大,此为虚,以强下之故也。设脉浮革,因尔肠鸣,当温之,宜当归四逆汤。
少阴病,下利,脉微涩者,即呕汗出,必数更衣,反少,当温之。
伤寒,医下之,续得下利,清谷不止,身体疼痛,急当救里,宜温之,以四逆汤。
微数之脉,慎不可灸,因火为邪,则为烦逆,追虚逐实,血散脉中,火气虽微,内攻有力,焦骨伤筋,血难复也。
脉浮,当以汗解,而反灸之,邪无从去,因火而盛,病从腰以下,必当重而痹,此为火逆。若欲自解,当先烦,烦乃有
汗,随汗而解。何以知之?脉浮,故知汗出当解。脉浮,热甚,而灸之,此为实,实以虚治,因火而动,咽燥必唾血。
烧针令其汗,针处被寒,核起而赤者,必发贲豚。气从少腹上撞者,灸其核上一壮(一本作各一壮),与桂枝加桂汤。
少阴病,得之一、二日,口中和,其背恶寒者,当灸之。
少阴病,其人吐利,手足不逆,反发热,不死。脉不至者,灸其少阴七壮。
少阴病,下利,脉微涩者,即呕汗出,必数更衣,反少,当温其上,灸之(一云灸厥阴可五十壮)。诸下利,皆可灸
足大都五壮(一云七壮),商丘、阴陵泉皆三壮。
下利,手足厥,无脉,灸之不温,反微喘者,死。少阴负趺阳者,为顺也。
伤寒六、七日,其脉微,手足厥,烦躁,灸其厥阴,厥不还者,死。
伤寒,脉促,手足厥逆,可灸之,为可灸少阴,厥阴主逆。
一般原则是,冬季适宜服用温热性质的药物并进行艾灸。
老师说:患病出现发热、头痛,但脉象反而沉细。如果病情没有好转,身体更加疼痛,应当先救治里证,适宜使用温热药物,如四逆汤。
出现腹泻、腹部胀满、身体疼痛的症状,应当先温补里气,适宜使用四逆汤。如果是自发性腹泻且不口渴的,属于太阴病,这是因为脏腑内有寒邪所致。应当采用温法治疗,适宜使用四逆汤类方剂。
少阴病,患者进食后即呕吐,心中感觉温暖且想吐,但又吐不出来。刚发病时,手足寒冷,脉象弦而迟。如果膈上有寒饮停留,导致干呕的,不可使用催吐法,应当使用温法治疗,适宜使用四逆汤。
出现腹泻,但有食欲的,就应当使用温法治疗。
出现腹泻,脉象迟而紧的,说明疼痛尚未停止,应当使用温法治疗。如果是因受冷导致的腹胀,并排出黏液脓血便。
出现腹泻,脉象浮大的,这是虚证,是因为强行使用泻下法造成的。如果脉象浮而革(外坚中空),因此出现肠鸣音,应当使用温法治疗,适宜使用当归四逆汤。
少阴病,出现腹泻,脉象微细涩的,随即出现呕吐、出汗,必定频繁上厕所,但排便量反而很少,应当使用温法治疗。
伤寒病,医生误用泻下法,随后出现腹泻不止,排出未消化的食物,身体疼痛,应当紧急救治里证,适宜使用温法,以四逆汤为主。
脉象微数(微弱而快)的,千万不要使用艾灸,因为火邪会成为致病因素,导致烦躁和气逆,这会追逐正气之虚和邪气之实,导致血液散乱于脉中。火气虽然微小,但内攻的力量很强,会焦枯骨骼、损伤筋脉,使血液难以恢复。
脉象浮的,应当通过发汗来解除表邪,却反而使用艾灸,导致邪气无处可去,借助火势而亢盛,疾病从腰部以下必然沉重且麻木不仁,这称为火逆证。如果想要自行缓解,应当先感到烦闷,烦闷之后才会出汗,随着汗出而病解。怎么知道呢?因为脉象浮,所以知道出汗后应当病解。脉象浮,热势很盛,却使用艾灸,这属于实证,却按虚证治疗,借助火势扰动,咽喉干燥必定咳唾带血。
使用烧针(温针灸)令其出汗,针刺部位受寒,起核状红肿的,必定引发奔豚病(气从少腹上冲心胸)。如果感觉气从少腹向上冲撞,应在红肿处各灸一壮(另一版本作每处一壮),并服用桂枝加桂汤。
少阴病,得病一两天,口中平和不苦不燥,背部恶寒的,应当进行艾灸。
少阴病,患者呕吐腹泻,手足不冰冷,反而发热,不会死亡。如果脉搏摸不到的,应灸少阴经穴位七壮。
少阴病,出现腹泻,脉象微细涩的,随即出现呕吐、出汗,必定频繁上厕所,但排便量反而很少,应当温灸上部穴位(一说灸厥阴穴五十壮)。所有类型的腹泻,都可以灸足大敦穴五壮(一说七壮),商丘穴、阴陵泉穴各三壮。
出现腹泻,手足厥冷,无脉,施灸后手脚仍不温暖,反而轻微喘息的,为死证。少阴脉弱于趺阳脉的,为顺证。
General principles state that in winter, it is appropriate to administer warm-natured herbs and perform moxibustion.
The Master said: When a patient presents with fever and headache, but the pulse is surprisingly deep (Chen). If the condition does not improve and body pain intensifies, one should rescue the interior (Ji) first, using warm formulas such as Sini Tang (Four Reversal Decoction).
In cases of diarrhea (Xia Li), abdominal fullness, and body pain, one should first warm the interior, preferably with Sini Tang. Spontaneous diarrhea without thirst belongs to Taiyin disease, caused by cold in the zang organs. It should be treated with warming methods, suitable for Sini Tang-type formulas.
In Shaoyin disease, if the patient vomits immediately after eating, feels a warm sensation in the heart region with an urge to vomit but cannot, and initially presents with cold hands and feet and a wiry-chi (slow) pulse: if there is cold-fluid retention above the diaphragm causing dry heaving, vomiting-inducing methods are contraindicated; instead, warming methods should be used, suitable for Sini Tang.
In Shaoyin disease, if the pulse is deep, immediate warming treatment is required, suitable for Sini Tang.
In cases of diarrhea where the patient has an appetite, warming treatment should be applied.
In cases of diarrhea with a slow-tight pulse, pain persists; warming treatment is indicated. If caused by cold, there is abdominal fullness and passage of mucus-like stool.
In cases of diarrhea with a floating-large pulse, this indicates deficiency, often resulting from aggressive purgation. If the pulse becomes floating-leather (Ge) accompanied by borborygmus, warming treatment is indicated, suitable for Danggui Sini Tang (Angelica Sinensis Decoction for Cold Reversal).
In Shaoyin disease with diarrhea, if the pulse is faint-thin-slippery, followed by vomiting, sweating, frequent defecation attempts with little output, warming treatment is indicated.
In Shanghan (Cold Damage) disease, if a physician mistakenly uses purgatives, leading to persistent diarrhea with undigested food and body pain, urgent rescue of the interior is needed, using warming methods, specifically Sini Tang.
A faint-rapid (Wei Shu) pulse is strictly contraindicated for moxibustion. Fire pathogenic factors can cause irritability and rebellious qi, exacerbating both deficiency and excess. This scatters blood within the vessels. Although fire energy is subtle, its internal attack is powerful, potentially charring bones and damaging sinews, making blood recovery difficult.
If the pulse is floating, the exterior should be resolved via sweating. However, if moxibustion is incorrectly applied, the pathogen has no exit and flourishes due to fire. The lower body will become heavy and numb, known as "Fire Rebellion" (Huo Ni). Spontaneous resolution may occur if the patient first feels irritability, followed by sweating. This is inferred from the floating pulse indicating impending sweat resolution. If the pulse is floating with intense heat, applying moxibustion treats an excess pattern as deficiency. The fire agitates the body, leading to dry throat and hemoptysis.
When burning needles (Wen Zhen) induce sweating, if the needle site is exposed to cold and develops nodular redness, Ben Tun (Flying Pig) disease may develop, characterized by qi rushing from the lower abdomen upward. In such cases, apply one moxa cone (Zhuang) to each nodule and administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon).
In Shaoyin disease, within one or two days, if the mouth feels neutral (not bitter or dry) and the back feels aversion to cold, moxibustion is indicated.
In Shaoyin disease, if the patient experiences vomiting and diarrhea, but hands and feet are not cold and fever is present, death is unlikely. If the pulse is imperceptible, moxibustion should be applied to Shaoyin points for seven cones.
In Shaoyin disease with diarrhea, faint-thin-slippery pulse, vomiting, sweating, and frequent small bowel movements, warming moxibustion should be applied to upper body points (or fifty cones to Jueyin points). For all types of diarrhea, moxibustion may be applied to Dadun (LR1, 5 cones or 7 cones), Shangqiu (SP5, 3 cones), and Yinlingquan (SP9, 3 cones).
In cases of diarrhea with cold extremities and absent pulse, if the extremities remain cold after moxibustion and slight wheezing occurs, the prognosis is fatal. A weak Shaoyin pulse relative to the Duyang pulse indicates a favorable course.
In Shanghan disease lasting six or seven days, if the pulse is faint, extremities are cold, and the patient is irritable, moxibustion should be applied to Jueyin points. If cold reversal does not occur, the prognosis is fatal.
In Shanghan disease, if the pulse is rapid-forcible (Cu) with cold extremities, moxibustion is permissible, particularly targeting Shaoyin, as Jueyin governs rebellious qi.