一忽又一忽,终日睡着沉沉不醒,惟狐惑二证有之,乃因下利后,内热乘虚
生虫,杀人甚急,宜桃仁汤,黄连犀角汤。
终日终夜常眠不寤,惟少阴下后,心肾虚寒,宜四逆温之。
有欲幽静而但不能眠熟,惟百合、风温二症有之。百合因汗下后,内外俱
虚,气无以守,心神不宁,汗后成者,百合知母汤;下后成者,滑石代赭汤。吐
后成者,鸡子汤。不曾汗吐下,自成者,百合地黄汤。
热也,津液结搏为膜在舌上。
白滑者,邪气初传入里,客于胸中,栀子豉汤主之。
又阳明误下,白胎者,同治。
半表半里者,小柴胡汤主之。
不滑而涩,是结热在里,表里俱热,口大干,舌上干燥,白虎汤加参主之。
黄者热邪入里,可下之。
黑者热极也死。
衄,头汗出,身无汗,死。及汗出不至足者死。
发衄家汗,则额上陷,脉紧急,直视不得 ,不得眠。
少阴病,但厥无汗,强汗之,因致衄者,难治,名曰下厥上竭。
KT 者,但胸喉间气塞不得下通然,而无声也。
哕者,吃吃然有声也。二者皆胃受疾也,趺阳浮为KT ,滑为哕。KT 者,胃虚
水寒相搏,宜小青龙去麻黄加附子;哕者,因大吐大下,胃虚之极也,此妄下之过,多不治。
又有热气拥,郁气不得通而成轻者,有和解之证,重者有攻下之候,非比大下后。
每隔一会儿就打一次嗝,整天昏昏沉沉地睡着不醒,只有狐惑病(一种以口腔、咽喉及生殖器溃疡为特征的疾病)和干霍乱(一种以腹中绞痛、欲吐不得、欲泻不能为特征的急症)会出现这种情况。这是由于腹泻之后,体内余热乘虚而入滋生虫邪,病情发展迅速且致命,适宜使用桃仁汤或黄连犀角汤治疗。
整天整夜常常昏睡而不醒来,只有少阴病在误用攻下法后,导致心肾阳气虚寒的情况会出现,适宜用四逆汤来温补阳气。
想要安静却无法熟睡的,只有百合病(一种以精神恍惚、饮食行为失常为特征的情志病)和风温病(一种感受风热之邪所致的外感热病)会出现。百合病是因为发汗或攻下之后,内外气血俱虚,气无法固守,心神不安;如果是发汗后形成的,用百合知母汤治疗;如果是攻下后形成的,用滑石代赭汤治疗;如果是呕吐后形成的,用鸡子黄汤治疗;如果没有经过发汗、催吐或攻下,自然形成的,用百合地黄汤治疗。
舌苔白而干燥,是热邪导致津液凝结成膜覆盖在舌面上。
舌苔白而滑润的,是邪气刚刚传入体内,停留在胸中,主治方剂为栀子豉汤。
舌苔不滑而涩滞的,说明热邪结聚在体内,表里都发热,口大渴,舌面干燥,主治方剂为加人参的白虎汤。
舌苔黄的,是热邪深入体内,可以采用攻下法治疗。
舌苔黑的,是热极的表现,预后不良,多致死。
脏结病出现白苔且滑润的,预后不良,其症状表现类似结胸病(邪热与痰水互结于胸膈),但饮食如常,只是时常腹泻。
热邪在体表,这是经络热盛,阳气壅滞,严重逼迫血液妄行,通过鼻出血可以自行缓解,此时禁忌使用发汗法。
出现鼻出血,头部出汗而身体无汗的,预后不良,多致死。以及出汗不到足部的,也预后不良,多致死。
对素有鼻出血的人强行发汗,会导致额头凹陷,脉象紧急,两眼直视不能转动,无法入睡。
少阴病,只有四肢厥冷而没有汗,如果强行发汗,导致鼻出血的,难以治疗,这种病症称为“下厥上竭”(下部阳气衰竭,上部阴血枯竭)。
噫气(打饱嗝),仅仅是胸喉间气机堵塞不能向下通畅,但是没有声音。
哕(呃逆),发出吃吃有声的声音。这两种病都是胃受到疾患引起的,趺阳脉浮主噫气,滑主哕。噫气是因为胃气虚弱,水饮与寒气相互搏结,适宜用小青龙汤去掉麻黄加上附子治疗;哕是因为剧烈呕吐和攻下,导致胃气极度虚弱,这是误用攻下法的过错,大多难以治愈。
Every so often, the patient hiccups or belches, sleeping heavily and unroused throughout the day. This occurs only in *Huo Huo* (Foxes Disease, characterized by ulcers of the mouth, throat, and genitals) and *Gan Huo Luan* (Dry Cholera, an acute condition with abdominal pain, inability to vomit or defecate). It arises from intestinal worms generated by internal heat taking advantage of deficiency after diarrhea; it is fatal if not treated promptly. The appropriate formulas are *Taoren Tang* (Peach Kernel Decoction) or *Huanglian Xijiao Tang* (Coptis and Rhinoceros Horn Decoction).
Sleeping constantly throughout the day and night without waking occurs only in *Shaoyin* disease after improper purgation, where heart and kidney yang are deficient and cold. The appropriate treatment is to warm with *Sini Tang* (Frigid Extremities Decoction).
Desiring quietness but unable to sleep soundly occurs only in *Baihe Bing* (Lily Disease, a psychosomatic disorder characterized by mental restlessness and sensory disturbances) and *Fengwen* (Wind-Warmth, an exogenous febrile disease caused by wind-heat pathogens). *Baihe Bing* results from excessive sweating or purgation leading to deficiency in both interior and exterior, causing qi to fail in anchoring and the mind-spirit to become unsettled. If formed after sweating, treat with *Baihe Zhimu Tang* (Lily and Anemarrhena Decoction); if formed after purgation, treat with *Huashi Daizhe Tang* (Talcum and Hematite Decoction); if formed after vomiting, treat with *Jizi Huang Tang* (Egg Yolk Decoction); if formed naturally without prior sweating, vomiting, or purgation, treat with *Baihe Dihuang Tang* (Lily and Rehmannia Decoction).
A white coating that is dry indicates heat condensing body fluids into a membrane on the tongue.
A white and slippery coating indicates pathogenic factors just entering the interior and lodging in the chest; treat primarily with *Zhizi Chi Tang* (Gardenia and Fermented Soybean Decoction).
Additionally, if a white coating appears after improper purgation in *Yangming* disease, the same treatment applies.
For conditions located at the half-exterior and half-interior, treat primarily with *Xiao Chaihu Tang* (Minor Bupleurum Decoction).
If the coating is not slippery but rough/astringent, it indicates heat binding in the interior with fever in both exterior and interior, severe thirst, and a dry tongue; treat primarily with *Baihu Tang* (White Tiger Decoction) added with Ginseng (*Renshen*).
A yellow coating indicates heat pathogens entering the interior; purgation may be used.
A black coating indicates extreme heat and is often fatal.
In *Zang Jie* (Organ Binding), a white and slippery coating indicates death. The presentation resembles *Jie Xiong* (Binding Chest syndrome), with normal appetite but frequent diarrhea.
Heat in the exterior indicates excessive heat in the meridians and collaterals, with yang qi congestion forcing blood to move recklessly. Epistaxis (nosebleed) allows for self-resolution; sweating methods are contraindicated.
Epistaxis accompanied by sweating only on the head and no sweating on the body indicates death. Similarly, sweating that does not reach the feet indicates death.
Inducing sweating in patients prone to epistaxis leads to sunken temples, urgent pulse, fixed gaze, and insomnia.
In *Shaoyin* disease, if there are only cold extremities without sweat, and forced sweating induces epistaxis, the condition is difficult to treat and is named *Xia Jue Shang Jie* (Lower Cold and Upper Exhaustion).
*Yi Qi* (belching) is characterized by a sensation of qi blockage in the chest and throat without sound. *Yue* (hiccup/hiccough) is characterized by audible "chi chi" sounds. Both are diseases of the stomach. A floating pulse at the *Duyang* position indicates *Yi Qi*; a slippery pulse indicates *Yue*. *Yi Qi* is caused by stomach deficiency with water-cold binding; treat with *Xiao Qinglong Tang* (Minor Green Dragon Decoction) minus *Mahuang* (Ephedrae Herba) plus *Fuzi* (Aconiti Lateralis Radix Praeparata). *Yue* results from extreme stomach deficiency due to severe vomiting and purgation, often caused by erroneous purgation, and is mostly incurable.
There are also mild cases caused by heat qi congestion and stagnant qi failing to circulate, presenting as harmonization syndromes; severe cases present with signs requiring purgation. These differ from conditions following major purgation.