三阳合病腹满身重难转侧汗出者白虎汤(论见身重)下后胸满烦惊小便不利谵语身重不可转侧者柴胡牡蛎汤(论见
惊)风湿相搏身体烦疼不能自转侧不呕不渴脉浮虚而涩者桂枝附子汤(论详身体痛)
(面垢 目赤 面青)
太阳病面反有热色二阳并病面色缘缘正赤阳明面合赤色是皆表邪必发散解肌而愈少阳目赤和解而安少阴面赤色厥
阴面少赤带阳二日必四逆而后可也面赤虽由阳热而生然各经俱无可下之证在少阴厥阴者正证有下利厥逆脉微实为阴寒
之病纵面赤似阳只是兼化而已
太阳病 如疟状若脉微恶寒面反有热色而身痒者桂枝麻黄各半汤小汗之(方论见发热)脉浮而迟面热赤而战惕者六
七日当汗出而解反发热者瘥迟为无阳不能作汗其身必痒也
二阳并病 太阳初得病时发其汗汗先出不彻因转属阳明续自微汗出不恶寒若太阳证不罢者不可下之下之为逆如此
可小发汗设面色缘缘正赤者阳气怫郁在表当解之熏之若发汗不出出不足或阳气怫郁不得越当汗不汗其人躁烦不知痛处
乍在腹中乍在四肢按之不可得其人短气但坐以汗出不彻故也更发汗则愈何以知汗出不彻以脉涩故知也(因发不透彻而面
赤躁烦短气者不足言阳气怫郁止是当汗不汗也故更发汗则愈)阳明 病面合赤色不可攻(葛根汤)少阴病下利清谷里寒
外热手足厥逆脉微欲绝身反不恶寒其人面赤色或腹痛或干呕或咽痛或利止脉不出者通脉四逆汤加葱白(详下利)厥阴下
利清谷脉沉而迟其人面少赤身有微热者必郁冒汗出而解病患必微厥所以然者其面戴阳下虚故也(详下利)面赤而身热足
寒而口噤及背反张者痉病也(详杂病痉门)面赤而斑斑如锦纹咽喉痛唾脓血者阳毒也(详阳毒)
面垢
三阳合病腹满身重难转侧口不仁谵语面垢遗尿不可汗下
面青
太阳病汗后遂发热恶寒复加烧针因胸痞面青肤润者难治色微黄身足温者易愈
目赤
少阳中风两耳无闻目赤胸满而烦者不可吐下(小柴胡汤)
附
面黄 孙兆口诀云工部郎中郑浓忠患伤寒胸腹满面黄如金色诸翰林医官商议略不定推让曰胸满可下恐脉浮虚召
孙
至曰诸公虽疑不用下药郑之福也下之必死某有一二服药服之必瘥遂下小陷胸汤寻利其病遂良愈明日面色改白京师入称
服
三阳经同时受病,出现腹部胀满、身体沉重、难以翻身转动、出汗的症状,使用白虎汤(相关论述见“身重”条目)。经过泻下治疗后,出现胸部胀满、烦躁惊悸、小便不利、说胡话、身体沉重且无法转侧的症状,使用柴胡牡蛎汤(相关论述见“惊悸”条目)。风湿之邪相互搏结,导致身体剧烈疼痛、不能自行翻身转动,没有呕吐、没有口渴、脉象浮虚而涩的症状,使用桂枝附子汤(详细论述见“身体痛”条目)。
(面部污垢 眼睛发红 面色发青)
太阳病时,面色反而带有热色;两阳经并病时,面色持续通红;阳明病时,面色整体发红,这些都是表邪所致,必须通过发散解肌的方法才能痊愈。少阳病表现为眼睛发红,需通过和解法使病情安定;少阴病表现为面色发红伴四肢厥冷;厥阴病表现为面色微红带阳热,若过两天必定出现四肢逆冷,之后才可治疗。面色发红虽然由阳热引起,但各经都没有可以使用攻下法的证候。在少阴和厥阴经中,真正的证候伴有腹泻、四肢厥冷、脉微,这实际上是阴寒性质的疾病,即使面色发红看似阳热,也只是兼夹的化热现象而已。
太阳病,症状像疟疾一样,如果脉象微弱、恶寒、面色反有热色且身体瘙痒的,使用桂枝麻黄各半汤进行小量发汗(方剂论述见“发热”条目)。脉象浮而迟,面部发热发红且战栗恐惧的,通常在六七日时会通过出汗而解除,但如果反而发热,说明病愈迟缓,这是因为阳气不足,不能作汗,身体必然瘙痒。
二阳经并病,太阳病初起时,发汗不彻底,因此转为属阳明病,继续有轻微出汗且不恶寒。如果太阳病的证候还没有消失,不可使用攻下法,否则为误治。此时可以小量发汗。如果面色持续通红,这是阳气郁结在体表,应当用解表或熏蒸的方法。如果发汗不出,或者汗出不够,或者阳气郁结不得宣泄,应当发汗而未发汗,病人会出现烦躁不安,不知道疼痛的具体位置,有时在腹部,有时在四肢,按压也找不到痛点,病人呼吸短促,只能坐着,这是因为汗出不彻底造成的。再次发汗就会痊愈。怎么知道是汗出不彻底呢?从脉象涩就可以知道。(因为发汗不透彻而导致面赤、烦躁、短气的,不属于阳气怫郁,只是应当发汗而没有发汗,所以再次发汗就会痊愈。)阳明病,面色整体发红,不可攻下(可用葛根汤)。少阴病,腹泻排出未消化的食物,体内寒冷体外发热,手足厥冷,脉象微弱几乎摸不到,身体反而不恶寒,病人面色发红,或者腹痛,或者干呕,或者咽痛,或者腹泻停止但脉搏摸不到的,使用通脉四逆汤加葱白(详见“腹泻”条目)。厥阴病,腹泻排出未消化的食物,脉象沉而迟,病人面色微红,身体有轻微发热,一定会出现郁冒(头晕目眩如物蒙蔽)并出汗而痊愈。病人必定会有轻微的厥冷,之所以这样,是因为病人面色戴阳(下部虚寒,虚阳上浮),属于下虚的缘故(详见“腹泻”条目)。面色发红且身体发热、脚冷、口噤(牙关紧闭)及背部反张的,是痉病(详见杂病痉门)。面色发红且斑斑如锦纹、咽喉痛、吐脓血的,是阳毒(详见阳毒)。
面垢
三阳合病,腹部胀满、身体沉重、难以翻身转动、口中麻木不清爽、说胡话、面部污垢、遗尿,不可使用发汗或攻下法。
面青
太阳病发汗后,随即发热恶寒,又加上烧针治疗,导致胸中痞塞、面色发青、皮肤润泽的,难治;如果面色微黄、手脚温暖的,容易痊愈。
目赤
少阳中风,双耳听不见、眼睛发红、胸部胀满且烦躁的,不可使用催吐或攻下法(可用小柴胡汤)。
附录
面黄:孙兆口诀记载,工部郎中郑浓忠患伤寒,胸腹满面黄如金色。各位翰林医官商议不定,互相推让说:“胸满可以用攻下法,但恐怕脉象浮虚。”于是请孙兆来。孙兆说:“各位虽然怀疑但不敢用下药,这是郑某的福气。如果用下药必死。我有一两种药,服用后必定痊愈。”于是给予小陷胸汤,随后通便,病就好了。第二天面色变为白色,京城里的人都称赞他。
When the three yang meridians are simultaneously affected, presenting with abdominal fullness, heaviness of the body, difficulty in turning the side, and sweating, Baihu Tang (White Tiger Decoction) is used (see "Heaviness of Body" for discussion). After purgation, if chest fullness, irritability, fright, dysuria, delirium, heaviness of the body, and inability to turn the side occur, Chaihu Muli Tang (Bupleurum and Oyster Shell Decoction) is used (see "Fright" for discussion). When wind-dampness pathogens contend with each other, causing severe bodily pain and inability to turn over independently, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is used (see "Body Pain" for detailed discussion).
(Facial dirtiness Red eyes Greenish face color)
In Taiyang disease (Taiyang Disease), the face may show a heat-like color; in Bingbing of two yangs (Combined Pathogenesis of Two Yang Meridians), the face may be persistently red; in Yangming disease (Yangming Disease), the entire face may be red. These are all caused by exterior pathogens and must be resolved through releasing the exterior and resolving the muscle layer. Shaoyang disease (Shaoyang Disease) presents with red eyes and requires harmonizing methods to bring peace; Shaoyin disease (Shaoyin Disease) presents with facial redness accompanied by cold limbs; Jueyin disease (Jueyin Disease) presents with slight facial redness carrying yang heat. If this persists for two days, cold limbs will definitely appear, and treatment can only proceed thereafter. Although facial redness arises from yang heat, there are no syndromes in any meridian suitable for purgation. In Shaoyin and Jueyin, the true syndromes involve diarrhea, cold limbs, and a faint pulse, which are actually yin-cold diseases. Even if the face appears red like yang, it is merely a combined transformational heat.
In Taiyang disease, presenting like malaria, if the pulse is faint, there is aversion to cold, the face has a heat-like color, and the body itches, Guizhi Mahuang Ge Ban Tang (Half-and-Half Decoction of Cinnamon Twig and Ephedra) should be used for mild sweating (see "Fever" for formula discussion). If the pulse is floating and slow, the face is hot and red, and there is trembling and fear, resolution through sweating usually occurs on the sixth or seventh day. If fever instead returns, recovery is delayed because yang qi is insufficient to produce sweat, and the body will inevitably itch.
In Bingbing of two yangs, when Taiyang disease first begins, if sweating is initiated but not thorough, it transitions to Yangming. Continued slight sweating without aversion to cold occurs. If the Taiyang syndrome has not ceased, purgation is contraindicated as it constitutes an error. At this time, mild sweating may be induced. If the face is persistently bright red, this indicates yang qi stagnation at the exterior, requiring release via sweating or fumigation. If sweating does not occur, or is insufficient, or if yang qi is stagnant and cannot vent, and sweating was indicated but not performed, the patient becomes irritable, unable to locate pain, sometimes in the abdomen, sometimes in the limbs, unresponsive to pressure, short of breath, and able only to sit. This is due to incomplete sweating. Re-inducing sweating will lead to recovery. How do we know sweating was incomplete? From the choppy pulse. (Facial redness, irritability, and shortness of breath due to incomplete sweating do not constitute yang qi stagnation; they simply indicate that sweating was indicated but not performed, so re-sweating leads to recovery.) In Yangming disease, if the entire face is red, purgation is contraindicated (Ge Gen Tang may be used). In Shaoyin disease, if there is diarrhea with undigested food, interior cold with exterior heat, cold limbs, a faint pulse nearly imperceptible, the body is not averse to cold, the face is red, or there is abdominal pain, dry retching, sore throat, or cessation of diarrhea with an absent pulse, Tongmai Sini Tang (Pulse-Returning Four Reversals Decoction) with scallion white is used (see "Diarrhea"). In Jueyin disease, if there is diarrhea with undigested food, a deep and slow pulse, slight facial redness, and slight body heat, the patient will experience dizziness and clouding of vision (Yu Mao) followed by sweating and recovery. The patient will likely have slight cold limbs. This is because the face shows Daiyang (floating yang due to lower deficiency), indicating lower deficiency (see "Diarrhea"). Facial redness with body heat, cold feet, locked jaw, and opisthotonos indicates Jing disease (Spasm Disease) (see Miscellaneous Diseases - Spasm Section). Facial redness with mottled patterns like brocade, sore throat, and spitting pus and blood indicates Yang Du (Yang Toxin) (see Yang Toxin).
Facial Dirtiness
In Bingbing of three yangs, with abdominal fullness, body heaviness, difficulty turning, oral numbness, delirium, facial dirtiness, and enuresis, neither sweating nor purgation is permitted.
Greenish Face Color
After sweating in Taiyang disease, if fever and aversion to cold ensue, and moxibustion/cauterization is added, leading to chest stuffiness, greenish face color, and moist skin, the prognosis is difficult. If the face is slightly yellow and hands/feet are warm, recovery is easy.
Red Eyes
In Shaoyang Wind Strike, if both ears lose hearing, eyes are red, chest is full, and there is irritability, emesis and purgation are contraindicated (Xiao Chaihu Tang may be used).
Appendix
Yellow Face: Sun Zhao's Manual records that Zheng Nongzhong, Vice Director of the Ministry of Works, suffered from Shanghan (Cold Damage) with a yellow face like gold across the chest and abdomen. The Hanlin physicians could not agree, debating whether chest fullness warranted purgation despite a floating-deficient pulse. Sun Zhao was summoned and said, "Although you doubt using purgatives, this is Zheng's fortune. Purgation would cause death. I have one or two prescriptions that will cure him." He prescribed Xiaoxianxiong Tang (Minor Trapped Chest Decoction). Following bowel movement, the illness cured. The next day, his face turned white, and people in the capital praised the treatment.