脉弱小便复利,身有微热,见厥者死。
脉紧而涩者难治。
趺阳脉浮,胃虚不食,恐怖,死;宽,缓生。
脉涩小,血不足。大而弱,气不足。又脉同胃反。
盖因脉虚火起,气虚火炽,血液既耗,肠胃津涸,传化失宜。或因痰隔,妨
碍升降,气不交通,皆令食而复出也。大概因津血俱耗,胃脘亦槁,在上近咽之
下,水饮可行,食物难入,间或可入,入亦不多,曰噎。其槁在下,与胃为近,食
虽可进,难尽入胃,良久复出,曰膈,即翻胃也。大便秘如羊屎,小便热,
各虽不同,病则一也。三阳结,谓之膈(三阳,大肠、小肠、膀胱也。)小肠结热则
血脉燥;大肠结热则后不通;膀胱结热则津液涸。三阳既结,前后闭,必反而上。
治宜润血降火解结。牛羊乳、韭汁、竹沥、童便、蜜(润燥),姜汁(去秽,)甘蔗汁(解
酒毒),气虚以四君子为君,血虚四物为君。或加桃仁、红花,驴溺(防其生虫)。
三因有五噎五膈
气噎者,心悸上下不通,噫哕不彻,胸背痛。
忧噎者,遇天阴冷,手足厥冷不能自温。
劳噎者,气上鬲,胁下支满,胸中填塞,攻背痛。
思噎者,心怔忡,喜忘,目视慌慌。
食噎者,食无多少,胃中苦寒痛,不得喘息。
忧膈者,胸中气结,津液不通,饮食不下,羸瘦短气。
思膈者,中脘逆满,噫则酸心,饮食不消,大便不便。
怒膈者,胸膈逆满,噫塞不通,呕则筋急,恶闻食臭。
喜膈者,五心烦热,口舌生疮,四肢倦重,身常发热,胸痹引背,食少。
恐膈者,心腹胀满,咳嗽气逆,腹中逆冷雷鸣绕脐痛,不能食。
有人血耗,便如羊屎,病胃反半年,脉涩不匀,先服六君子汤,加甘蔗汁、
附子、大黄、童便。便润,服牛乳愈。
脉象虚弱且小便频多,身体伴有轻微发热,出现四肢厥冷的症状,预后不良,属于死证。
脉象紧而涩滞的,难以治疗。
趺阳脉(足背动脉,反映胃气盛衰)浮取有力,提示胃气虚弱不能进食,伴有惊恐情绪,预后为死;若脉象宽大舒缓,则病情有望好转并痊愈。
脉象涩而小,是血液不足的表现。脉象大而弱,是气虚的表现。这种脉象也常见于“胃反”病(指朝食暮吐或暮食朝吐的反胃病症)。
这大概是因为脉虚导致虚火内生,气虚导致火势炽盛,血液已经耗损,肠胃津液枯竭,传导消化功能失常。或者因为痰浊阻隔,妨碍了气机的升降,气机不通畅,都导致食物吃下去后又吐出来。大抵是因为津液和血液双重耗损,胃脘部也变得干枯萎缩。如果病变部位在上,靠近咽喉下方,水饮尚能下行,但固体食物难以下咽,偶尔能进一点,进去的量也不多,这叫“噎”。如果病变部位在下,靠近胃部,食物虽然可以勉强进入,但难以完全进入胃中,过很久又吐出来,这叫“膈”,也就是翻胃。大便干结像羊屎一样,小便灼热,虽然症状表现不同,但病机是一致的。“三阳”(大肠、小肠、膀胱)经络郁结,就称为“膈”。小肠郁结有热则血脉干燥;大肠郁结有热则大便不通;膀胱郁结有热则津液枯竭。三阳经络既已郁结,前后二便闭塞,气机必然上逆呕吐。治疗应当采用滋润血液、降火、解郁结的方法。可以使用牛羊乳、韭菜汁、竹沥、童便、蜂蜜来润燥;姜汁用来去除秽浊;甘蔗汁用来解除酒毒。如果是气虚,以四君子汤为主方;血虚则以四物汤为主方。或者加入桃仁、红花,以及驴尿(防止生虫)。
因三种病因(内因、外因、不内外因)导致的有五噎五膈:
气噎:心悸,气机上下不通畅,打嗝呃逆不彻底,胸背部疼痛。
忧噎:遇到阴天寒冷天气,手足厥冷,无法自行温暖。
劳噎:气机上逆至膈部,胁下胀满支撑感,胸中堵塞感,牵引背部疼痛。
思噎:心中悸动不安,容易遗忘,视物模糊不清。
食噎:无论进食多少,胃中感到寒冷疼痛,呼吸困难不得喘息。
忧膈:胸中气机郁结,津液运行不畅,饮食难以下咽,身体消瘦,气息短促。
思膈:中脘部位气逆胀满,打嗝时感觉酸味上涌,饮食不消化,大便不通畅。
怒膈:胸膈部位气逆胀满,打嗝堵塞不通,呕吐时筋脉拘急,厌恶闻到食物的气味。
喜膈:五心烦热(手心、脚心及心胸烦热),口舌生疮,四肢倦怠沉重,身体经常发热,胸痹牵引背部疼痛,食欲减少。
恐膈:心腹胀满,咳嗽气逆,腹中逆冷,肠鸣音如雷响,脐周疼痛,不能进食。
曾有一人血液耗损,大便像羊屎一样干结,患胃反病半年,脉象涩而不均匀,先服用六君子汤,加入甘蔗汁、附子、大黄、童便。待大便变润后,再服用牛乳治愈。
If the pulse is weak and urination is frequent, accompanied by slight fever and cold extremities (Jue), it indicates a fatal prognosis.
A tight and choppy pulse is difficult to treat.
A floating Fu Yang pulse (pulse at the dorsum pedis, reflecting Stomach Qi) indicates deficient Stomach Qi leading to anorexia and fear; this is fatal. A broad and slow pulse indicates recovery.
A choppy and small pulse indicates insufficient Blood. A large and weak pulse indicates insufficient Qi. Such pulses are also seen in Wei Fan (Stomach Reversal, characterized by vomiting of undigested food).
This is generally due to deficiency fire arising from a deficient pulse, or blazing fire from Qi deficiency. After the Blood has been consumed and the fluids of the intestines and stomach have dried up, transportation and transformation become disordered. Alternatively, phlegm obstruction may hinder the ascending and descending of Qi, preventing Qi communication, all of which cause food to be vomited after ingestion. Generally, when both fluids and Blood are depleted, the epigastrium becomes withered. If the lesion is upper, near the throat below the pharynx, liquids can pass, but solid food enters with difficulty, and even if it does, the amount is small; this is called "Ye" (Dysphagia). If the lesion is lower, near the Stomach, although food can enter, it cannot fully reach the Stomach and is vomited out after a long time; this is called "Ge" (Regurgitation), also known as Fan Wei (Reversal Stomach). Constipation resembling sheep droppings and hot urination differ in symptoms but share the same pathology. "San Yang" (Large Intestine, Small Intestine, Bladder) knotting is called Ge. Heat knotting in the Small Intestine causes dryness of blood vessels; heat knotting in the Large Intestine causes constipation; heat knotting in the Bladder depletes body fluids. Once San Yang are knotted, both anterior and posterior orifices are blocked, causing Qi to reverse upward. Treatment should focus on nourishing Blood, descending Fire, and resolving knots. Use cow/sheep milk, chive juice, bamboo sap, child's urine, and honey to moisten dryness; ginger juice to remove turbidity; sugarcane juice to resolve alcohol toxicity. For Qi deficiency, use Si Jun Zi Tang (Four Gentlemen Decoction) as the base; for Blood deficiency, use Si Wu Tang (Four Substance Decoction) as the base. Peach kernel (Tao Ren) and Safflower (Hong Hua) may be added, along with donkey urine (to prevent parasitic infection).
There are five types of Ye and five types of Ge caused by the Three Causes:
Qi Ye: Palpitations, blockage of Qi flow up and down, incomplete belching and hiccups, chest and back pain.
You Ye (Worry Ye): Cold hands and feet that cannot warm themselves during cloudy or cold weather.
Lao Ye (Labor Ye): Qi rising to the diaphragm, fullness and distension under the ribs, sensation of filling in the chest, radiating back pain.
Si Ye (Thinking Ye): Heart palpitations, forgetfulness, blurred vision.
Shi Ye (Food Ye): Cold pain in the stomach regardless of food intake, inability to breathe easily.
You Ge (Worry Ge): Knotting of Qi in the chest, blockage of fluids, inability to swallow food, emaciation, and shortness of breath.
Si Ge (Thinking Ge): Reverse Qi and fullness in the Zhong Wan region, sour taste upon belching, indigestion, and constipation.
Nu Ge (Anger Ge): Reverse Qi and fullness in the chest and diaphragm, blocked belching, muscle spasms during vomiting, aversion to the smell of food.
Xi Ge (Joy Ge): Five-center heat (heat in palms, soles, and chest), mouth and tongue ulcers, heavy and fatigued limbs, constant low-grade fever, chest bi syndrome radiating to the back, and poor appetite.
Kong Ge (Fear Ge): Abdominal distension and fullness, coughing with reverse Qi, cold sensations in the abdomen, borborygmus like thunder around the umbilicus, and inability to eat.
A case: A patient with depleted Blood had stool resembling sheep droppings and suffered from Wei Fan for half a year. The pulse was choppy and irregular. Initially, Liu Jun Zi Tang (Six Gentlemen Decoction) was administered with added sugarcane juice, Prepared Aconite Root (Fu Zi), Rhubarb (Da Huang), and child's urine. After the stool became moist, Cow Milk cured the condition.