脉∶阳厥脉滑而沉实;阴厥脉细而沉伏。
厥者,其脉短也。逆者,手足厥冷也。其症不一,散之方书者甚多。今始撮其大概,且
如寒热厥逆者而为阴阳二厥也。阳厥者,是热深则厥深,盖阳极则发厥也。急宜六一顺气汤
治之。阴厥者,始得之身冷脉沉、四肢厥逆、足 卧、唇口青,或自利不渴、小便色白
,此其候也。治以四逆、理中之类,仍速灸关元百壮,鼻尖有汗为度。
凡初得病,身热头痛,大小便闭,或畏热,或饮水,或扬手掷足、烦躁不得安卧、谵语
昏愦而厥,此阳厥也。宜大柴胡、六一顺气汤治之。渴者,白虎汤主之。
如得病后,四肢厥冷,脉沉而细,足挛卧而恶寒,引衣盖覆不欲水,或下利清谷而厥者
,阴逆也,四逆汤;厥逆脉不至者,通脉四逆汤;手足指头微寒者,谓之清,理中汤;无热
症而厥,当归四逆汤加吴茱萸生姜汤;喘促脉伏而厥,五味子汤;吐利手足厥冷,烦躁欲死
,吴茱萸汤。
六一顺气汤、大柴胡汤、白虎汤(已上三方俱见伤寒)。四逆汤、理中汤(已上二方俱见
中寒)。
脉∶两尺脉洪数,必便浊遗精。心脉短小,因心虚所致,必遗精便浊。
浊者,小便去浊也。有赤浊、有白浊,其状漩面如油光彩不定,漩脚澄下凝如膏糊,小
便如米泔者,如粉糊者,如赤脓者,皆是湿热内伤,又肾经虚损而成浊也。瘦人是虚火,肥
人是湿痰流下渗入膀胱,犹如天气寒则水澄清,天气热则水混浊。浊之为病,湿热之本明矣
。
赤浊者,心虚有热也。
清心莲子饮 治心中烦躁,思虑忧愁抑郁,小便赤浊,或有沙漠,夜梦遗精、遗沥涩痛
,便赤,如或酒色过度,上盛下虚,心火上炎,肺金受克,故口苦咽干,渐成消渴,四肢倦
怠,男子五淋,妇人带下赤白、五心烦热。此药温平,清火养神秘精,大有奇效。
石莲肉 人参(各二钱半) 黄 (蜜炙) 赤茯苓(各二钱) 麦门冬(去心) 地骨皮 黄芩
车前子(各一钱半) 甘草上盛下虚,加酒炒黄柏、知母各一钱。
又方 治心经伏暑,小便赤浊。
人参(去芦,减半) 白术(去芦) 赤茯苓(去皮) 猪苓 泽泻 香薷 石莲肉 麦门冬
(去心,各等分)
上锉一剂。水煎,空心温服。
白浊者,肾虚有寒也。
萆 饮
川萆 益智仁 石菖蒲 乌药(各等分) 一方加茯苓、甘草。
上锉一剂。水煎,入盐一捻,空心服。
滋肾散 治白浊初起或半月者,极效。
川萆 麦门冬(去心) 远志(去心) 黄柏(酒炒) 菟丝子(酒炒) 五味子(酒炒,
各等分)
上锉一剂。竹叶三个,灯草一团,水煎,空心服。
赤白浊者,水火之不分也。
水火厘清饮 治赤白浊。
益智 萆 石菖蒲 赤茯苓 车前子 猪苓 泽泻 白术(去芦) 陈皮 枳壳(
麸炒) 麻黄(各等分) 甘草(三分)
上锉一剂。半酒半水煎,空心温服。久病,去麻黄,易升麻。
瘦人赤白浊者,是虚火也。
滋阴降火汤 治瘦人虚火,患赤白浊(方见虚劳);根据本方加白术、萆 、牛膝、山
栀、 蓄,去芍药。
肥人赤白浊者,是湿痰也。
二陈汤\x 治肥人湿痰赤白浊(方见痰症)。根据本方加苍术、白术、人参、当归、生地、麦
冬、山栀、黄柏、萆 、牛膝、 蓄。
一白浊,足三阴经主之。属浓味湿热所致者,用加味清胃散(方见牙齿);若肝肾虚热者
,用六味丸为主(方见补益),佐以逍遥散(方见妇人虚劳);若脾肾虚热者,用六味丸,佐以
六君子汤(方见补益);脾肝郁滞者,六味丸佐以归脾汤(方见健忘);脾肺气虚者,六味丸佐
以补中益气汤(方见补益);湿痰下注者,补中益气汤佐以六味丸(方见补益)。
汪少宰头晕白浊,余用补中益气加茯苓、半夏,愈。而后患腰痛,用山药、山茱萸、五
味、萆 、远志,顿愈。又因心劳,盗汗白浊,以归脾汤加五味而愈。后不时眩晕,用
八味丸痊愈。
脉象:阳厥的脉象滑利而沉实;阴厥的脉象细弱而沉伏。
厥证,其脉象短促。逆证,指手足冰冷。其症状不一,散见于各医书中的记载很多。现在仅摘录其大概情况,例如寒热厥逆分为阴阳两种厥证。阳厥,是热邪深入则厥逆也深,因为阳极则发厥。急宜用六一顺气汤治疗。阴厥,初起时身体寒冷、脉象沉、四肢厥冷、足部蜷缩卧倒、嘴唇和口唇发青,或者自发性腹泻且不口渴、小便颜色清白,这是其征候。治疗以四逆汤、理中汤之类为主,并迅速艾灸关元穴一百壮,直到鼻尖出汗为止。
凡是初得病,身体发热头痛,大小便闭塞,或者怕热,或者想喝水,或者扬手掷足、烦躁不安无法躺卧、说胡话、神志昏乱而厥逆,这是阳厥。宜用大柴胡汤、六一顺气汤治疗。口渴的,用白虎汤主治。
如果得病后,四肢厥冷,脉象沉而细,足部痉挛蜷缩且怕冷,拉衣被覆盖不想喝水,或者下利清谷(排出未消化的食物)而厥逆,这是阴逆,用四逆汤;厥逆脉象摸不到的,用通脉四逆汤;手指头微微发冷的,称为“清”,用理中汤;没有热症而厥逆的,用当归四逆汤加吴茱萸生姜汤;气喘急促、脉象伏匿而厥逆的,用五味子汤;呕吐腹泻、手足厥冷、烦躁欲死的,用吴茱萸汤。
六一顺气汤、大柴胡汤、白虎汤(以上三方均见载于《伤寒论》)。四逆汤、理中汤(以上二方均见载于《中寒》相关论述)。
脉象:两尺脉洪大数急,必然出现小便浑浊、遗精。心脉短小,因心气虚所致,必然出现遗精、小便浑浊。
浊证,指小便排出浑浊之物。有赤浊、白浊之分,其状如尿液表面有油光光彩不定,尿底沉淀凝结如膏糊,小便像米泔水一样的,像粉糊一样的,像红色脓液一样的,都是湿热内伤,加上肾经虚损而形成的浊证。瘦人多是虚火,肥人多属湿痰流注下行渗入膀胱,犹如天气寒冷则水澄清,天气炎热则水混浊。浊证这种病,湿热的本源是很明确的。
赤浊,是心虚有热。
清心莲子饮 治疗心中烦躁,思虑忧愁抑郁,小便赤浊,或者有沙石,夜间梦遗精、排尿淋漓涩痛,小便红赤,如果是酒色过度,上盛下虚,心火上炎,肺金受克,所以口苦咽干,逐渐形成消渴症,四肢倦怠,男子患五淋,妇人带下赤白、五心烦热。此药性温平,能清火养神秘精,大有奇效。
石莲肉 人参(各二钱半) 黄芪(蜜炙) 赤茯苓(各二钱) 麦门冬(去心) 地骨皮 黄芩 车前子(各一钱半) 甘草。上盛下虚者,加酒炒黄柏、知母各一钱。
又一方 治疗心经伏暑,小便赤浊。
人参(去芦,减半) 白术(去芦) 赤茯苓(去皮) 猪苓 泽泻 香薷 石莲肉 麦门冬(去心,各等分)
以上锉为一剂。用水煎煮,空腹温服。
白浊,是肾虚有寒。
萆薢分清饮
川萆薢 益智仁 石菖蒲 乌药(各等分) 一方加茯苓、甘草。
以上锉为一剂。用水煎煮,加入少许盐,空腹服用。
滋肾散 治疗白浊初起或半月内的,极有效。
川萆薢 麦门冬(去心) 远志(去心) 黄柏(酒炒) 菟丝子(酒炒) 五味子(酒炒,各等分)
以上锉为一剂。用竹叶三片,灯草一团,水煎,空腹服用。
赤白浊,是水火不分的表现。
水火厘清饮 治疗赤白浊。
益智仁 萆薢 石菖蒲 赤茯苓 车前子 猪苓 泽泻 白术(去芦) 陈皮 枳壳(麸炒) 麻黄(各等分) 甘草(三分)
以上锉为一剂。半酒半水煎煮,空腹温服。久病患者,去掉麻黄,改用升麻。
瘦人患赤白浊,是虚火所致。
滋阴降火汤 治疗瘦人虚火,患赤白浊(方剂见《虚劳》篇);根据本方加白术、萆薢、牛膝、山栀、瞿麦,去掉芍药。
肥人患赤白浊,是湿痰所致。
二陈汤 治疗肥人湿痰引起的赤白浊(方剂见《痰症》篇)。根据本方加苍术、白术、人参、当归、生地、麦冬、山栀、黄柏、萆薢、牛膝、瞿麦。
一般来说,白浊由足三阴经主管。属于厚味湿热所致者,用加味清胃散(方剂见《牙齿》篇);若属肝肾虚热者,以六味丸为主(方剂见《补益》篇),佐以逍遥散(方剂见《妇人虚劳》篇);若属脾肾虚热者,用六味丸,佐以六君子汤(方剂见《补益》篇);脾肝郁滞者,用六味丸佐以归脾汤(方剂见《健忘》篇);脾肺气虚者,用六味丸佐以补中益气汤(方剂见《补益》篇);湿痰下注者,用补中益气汤佐以六味丸(方剂见《补益》篇)。
汪少宰头晕伴白浊,我用补中益气汤加茯苓、半夏,治愈。后来患腰痛,用山药、山茱萸、五味子、萆薢、远志,顿时痊愈。又因心劳,盗汗伴白浊,用归脾汤加五味子而愈。后来不时眩晕,用八味丸痊愈。
Pulse: The pulse of Yang Jue (Yang Reversal Syndrome) is slippery and deep-solid; the pulse of Yin Jue (Yin Reversal Syndrome) is thin and deep-hidden.
Jue (Reversal Syndrome) is characterized by a short pulse. Ni (Reverse) refers to cold hands and feet. The symptoms vary, and there are many records scattered in medical books. Here we summarize the general situation. For example, cold-heat reversal is divided into Yin and Yang Jue. Yang Jue occurs when heat penetrates deeply, leading to deep reversal, as extreme Yang leads to reversal. It should be urgently treated with Liuyi Shunqi Tang (Six-One Harmonizing Qi Decoction). Yin Jue presents initially with cold body, deep pulse, cold limbs, curled legs while lying, cyan lips and mouth, or spontaneous diarrhea without thirst, and clear urine. This is its presentation. Treatment involves Si Ni Tang (Frigid Extremities Decoction), Lizhong Tang (Regulate the Middle Decoction), etc., along with rapid moxibustion on Guanyuan (CV-4) for one hundred moxa cones, until sweat appears on the tip of the nose.
Whenever a disease begins with fever, headache, constipation of both bowels and bladder, aversion to heat, desire for water, throwing hands and feet about, restlessness unable to lie down, delirium, confusion, and reversal, this is Yang Jue. Da Chaihu Tang (Major Bupleurum Decoction) and Liuyi Shunqi Tang should be used. If thirsty, Baihu Tang (White Tiger Decoction) is the main treatment.
If after contracting a disease, there are cold limbs, deep-thin pulse, leg cramps with curling and aversion to cold, pulling clothes to cover oneself, no desire for water, or diarrhea with undigested food and reversal, this is Yin Ni (Yin Reverse). Si Ni Tang is used; if the pulse is imperceptible during reversal, Tongmai Si Ni Tang (Unblocking the Pulse Si Ni Decoction) is used; if only the fingertips are slightly cold, it is called "Qing" (Clear/Cold), and Lizhong Tang is used; if there is reversal without heat signs, Danggui Sini Tang (Angelica Frigid Extremities Decoction) added with Wuzhuyu Shengjiang Tang (Evodia and Ginger Decoction) is used; if there is panting, hidden pulse, and reversal, Wuweizi Tang (Schisandra Decoction) is used; if there is vomiting, diarrhea, cold limbs, and severe restlessness, Wuzhuyu Tang (Evodia Decoction) is used.
Liuyi Shunqi Tang, Da Chaihu Tang, and Baihu Tang (the above three formulas are found in Shanghan Lun/Treatise on Cold Damage). Si Ni Tang and Lizhong Tang (the above two formulas are found in Zhonghan/Treatise on Interior Cold).
Pulse: If the pulses at both Chi positions (Cun-Guan-Chi) are surging and rapid, turbid urination and spermatorrhea will inevitably occur. If the Heart pulse is short and small, caused by Heart deficiency, spermatorrhea and turbid urination will inevitably occur.
Zhuo (Turbidity) refers to the discharge of turbid urine. There is Red Zhuo and White Zhuo. The appearance may show an oily sheen on the surface of the urine with unstable luster, or sediment at the bottom congealing like paste. Urine resembling rice wash water, flour paste, or red pus all indicate internal injury from Damp-Heat combined with Kidney channel deficiency, resulting in Turbidity. In thin individuals, it is due to Deficient Fire; in fat individuals, it is due to Phlegm-Damp flowing downward into the Bladder. Just as water clarifies in cold weather and becomes turbid in hot weather, the root of Turbidity disease is clearly Damp-Heat.
Red Zhuo is caused by Heart deficiency with Heat.
Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction) treats irritability in the heart, worry, sorrow, depression, red turbid urine, presence of sand/stones, nocturnal seminal emission, dribbling painful urination, and red urine. If caused by excess alcohol and sexual activity, leading to Upper Excess and Lower Deficiency, Heart Fire flaring up, and Lung Metal being suppressed, resulting in bitter taste, dry throat, gradual development of Xiao Ke (Wasting-Thirst), limb fatigue, men suffering from Wu Lin (Five Stranguries), women suffering from red and white leukorrhea, and five-palm heat. This medicine is warm and neutral, clearing fire, nourishing spirit, and preserving essence, with great efficacy.
Ingredients: Shi Lian Rou (Stone Lotus Meat), Renshen (Ginseng Root) (each 2.5 qian); Huangqi (Astragalus Root) (honey-fried); Chifuf Ling (Red Poria) (each 2 qian); Maidong (Ophiopogon Tuber) (core removed); Digupi (Lycium Bark); Huangqin (Scutellaria Root); Cheqianzi (Plantago Seed) (each 1.5 qian); Gancao (Licorice Root). For Upper Excess and Lower Deficiency, add Jiuhuangbai (Alcohol-fried Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) each 1 qian.
Another Prescription: Treats latent summer-heat in the Heart channel causing red turbid urine.
Renshen (Ginseng Root) (rhizome removed, halved); Baizhu (Atractylodes Macrocephala Rhizome) (rhizome removed); Chifuf Ling (Red Poria) (peel removed); Zhuling (Polyporus); Zexie (Alisma Rhizome); Xiangru (Elsholtzia Herb); Shi Lian Rou (Stone Lotus Meat); Maidong (Ophiopogon Tuber) (core removed, equal parts).
Grind into powder for one dose. Decoct in water, take warm on an empty stomach.
White Zhuo is caused by Kidney deficiency with Cold.
Bixie Fenqing Yin (Dioscorea Hypoglauca Clearing Turbidity Decoction)
Chuan Bixie (Dioscorea Hypoglauca Rhizome); Yizhiren (Biotae Semen); Shichangpu (Acorus Rhizome); Wuyao (Lindera Root) (equal parts). One formula adds Fuling (Poria) and Gancao (Licorice Root).
Grind into powder for one dose. Decoct in water, add a pinch of salt, take on an empty stomach.
Zishen San (Kidney-Nourishing Powder) is extremely effective for early-stage White Zhuo or those lasting half a month.
Chuan Bixie (Dioscorea Hypoglauca Rhizome); Maidong (Ophiopogon Tuber) (core removed); Yuanzhi (Polygala Root) (core removed); Huangbai (Phellodendron Bark) (wine-fried); Tusizi (Cuscuta Seed) (wine-fried); Wuweizi (Schisandra Fruit) (wine-fried, equal parts).
Grind into powder for one dose. Decoct with three bamboo leaves and a bundle of Juncus effusus (rush pith) in water, take on an empty stomach.
Red and White Zhuo indicates the failure of Water and Fire to separate.
Shuihuo Liqing Yin (Water-Fire Clarifying Decoction) treats Red and White Zhuo.
Yizhi (Alpinia Oxyphylla Fruit); Bixie (Dioscorea Hypoglauca Rhizome); Shichangpu (Acorus Rhizome); Chifuf Ling (Red Poria); Cheqianzi (Plantago Seed); Zhuling (Polyporus); Zexie (Alisma Rhizome); Baizhu (Atractylodes Macrocephala Rhizome) (rhizome removed); Chenpi (Citrus Reticulata Peel); Zhike (Aurantii Fructus Immaturus) (bran-fried); Mahuang (Ephedra Herba) (equal parts); Gancao (Licorice Root) (3 fen).
Grind into powder for one dose. Decoct in half wine and half water, take warm on an empty stomach. For chronic cases, remove Mahuang and substitute with Shengma (Cimicifugae Rhizoma).
In thin individuals, Red and White Zhuo is due to Deficient Fire.
Ziyin Jianghuo Tang (Nourishing Yin and Descending Fire Decoction) treats Deficient Fire in thin individuals suffering from Red and White Zhuo (formula see Xu Lao/Wasting-Thirst chapter); modify by adding Baizhu (Atractylodes Macrocephala Rhizome), Bixie (Dioscorea Hypoglauca Rhizome), Niuxi (Achyranthes Root), Shanzhi (Gardeniae Fructus), Qumai (Dianthus Herba), and removing Shaoyao (Paeonia Root).
In fat individuals, Red and White Zhuo is due to Phlegm-Damp.
Erchen Tang (Two-Aged Decoction) treats Phlegm-Damp Red and White Zhuo in fat individuals (formula see Tan Zheng/Phlegm Disease chapter). Modify by adding Cangzhu (Atractylodes Lancea Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Renshen (Ginseng Root), Danggui (Angelica Sinensis Root), Shengdi (Rehmannia Root), Maidong (Ophiopogon Tuber), Shanzhi (Gardeniae Fructus), Huangbai (Phellodendron Bark), Bixie (Dioscorea Hypoglauca Rhizome), Niuxi (Achyranthes Root), Qumai (Dianthus Herba).
Generally, White Zhuo is governed by the Three Foot-Yin meridians. If caused by rich flavors and Damp-Heat, use Jiawei Qingwei San (Modified Stomach-Clearing Powder) (formula see Ya Chi/Teeth chapter); if due to Liver-Kidney Deficient Heat, use Liuwei Wan (Six-Ingredient Pill) as the main formula (formula see Bu Yi/Nourishing Supplement chapter), assisted by Xiaoyao San (Free and Easy Wanderer Powder) (formula see Fu Ren Xu Lao/Female Wasting-Thirst chapter); if due to Spleen-Kidney Deficient Heat, use Liuwei Wan (Six-Ingredient Pill), assisted by Liujunzi Tang (Six-Gentlemen Decoction) (formula see Bu Yi/Nourishing Supplement chapter); if due to Spleen-Liver Qi Stagnation, use Liuwei Wan (Six-Ingredient Pill) assisted by Guipi Tang (Restore the Spleen Decoction) (formula see Jian Wang/Memory Loss chapter); if due to Spleen-Lung Qi Deficiency, use Liuwei Wan (Six-Ingredient Pill) assisted by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (formula see Bu Yi/Nourishing Supplement chapter); if due to Phlegm-Damp sinking downward, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) assisted by Liuwei Wan (Six-Ingredient Pill) (formula see Bu Yi/Nourishing Supplement chapter).
Vice Minister Wang suffered from dizziness and White Zhuo. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Tuber), which cured him. Later he suffered from lower back pain, which was instantly cured using Shanyao (Dioscorea Rhizome), Shanzhuyu (Cornus Fruit), Wuwei Zi (Schisandra Fruit), Bixie (Dioscorea Hypoglauca Rhizome), and Yuanzhi (Polygala Root). Later, due to mental exertion, he had night sweats and White Zhuo, which were cured using Guipi Tang (Restore the Spleen Decoction) added with Wuwei Zi (Schisandra Fruit). Subsequently, he suffered from intermittent vertigo, which was completely cured using Bawei Wan (Eight-Ingredient Pill).