摇头,有摇头言者,里痛也,痛使之然。
有口噤背反张者, 也,风使之然。
螈 ,螈者,筋脉缩急也。 者,筋脉伸缓也,伸缩不止,俗曰发搐,并邪
热盛也,热盛则风搏并经络。风主动,四肢动而不宁,若以祛风涤热治之亦有可
生,若妄加灼火发表之药则死矣。
不仁,谓不柔和,不知痛痒,不知寒热也。
由气血虚少,邪气拥盛,正气不能通行而致也。
直视 视物而目睛不转动也,能转动者非也。
直视为不治之疾,由正气已脱,邪气极盛也。
有目中不了了,睛不和者,无表里证,大便难,身微热者,此内实也,可下之。
郁冒 昏迷也。郁则气不舒,冒则神不清。
由虚极而乘寒,如少阴病下痢止而头眩而冒者死,此虚极也。
动气 脐傍筑筑然动跳也。
由真脏之气虚发动也,虽有攻里发表之证,不可汗下。
肝内证,脐左有动气,肺脐右;心脐上;肾脐下,并按之牢,若痛,必待问而知。
自利 有热,肠垢也。有寒,鸭溏也。有湿毒,利脓血也。有合病自利。
太阳与阳明合病,必自利,在表也,以葛根汤发之。
太阳与少阳合病,必自利,在半表半里也,以黄芩汤和之,呕加半夏。
阳明与少阳合病,必自利,邪入府也,以承气下之。
有热利者,不应下而下,表邪乘虚入里,内虚协热遂自利。又下利欲饮水
者,热也。发热复重,泄色黄赤者,热也。大热内结,注泄不止,治宜寒疗,结
伏虽除,以寒下之,又热则分利之。
有寒利者,自利不渴属太阴,以藏寒故也。又小便色白,少阴病形悉俱,寒
也。又恶寒脉微,自利清谷,寒也。并宜理中温之。又大寒凝内,久痢溏泄,绵
历岁年,宜热下之。
有湿毒利,脓血,宜地榆散。
有结积利者。
少阴病自利清水,心下必痛,口干燥,必下利,三部皆平,按之心下硬,或
脉沉而滑,或不欲食而谵语,或作复年月,宜攻之、逐之。
治下利,虽有表证不可发汗,为邪内攻,走津液而胃虚,表之必胀满。
摇头,有因言语而摇头的,是里部疼痛所致,疼痛导致这种反应。
有口噤(牙关紧闭)、背反张(角弓反张)的,是痉病,风邪导致这种反应。
身体形态如烟熏色,头摇且两眼直视,这是心气绝的表现,属于阴寒至极、阳气无根的死证。
瘛疭(chì zòng),瘛是指筋脉收缩紧急,疭是指筋脉伸展松弛,伸缩不止,俗称发搐,这是由于邪热亢盛所致,热盛则风邪搏结于经络。风性主动,导致四肢躁动不安,如果用祛风涤热的方法治疗,还有生机;如果错误地加用灸火或发表的药物,就会死亡。
不仁,指感觉迟钝,不知痛痒,不知寒热。
这是由于气血虚弱,邪气壅盛,正气不能通行而导致的。
直视,指注视物体但眼球不转动,能转动的就不是直视。
直视属于不治之症,是由于正气已脱失,邪气极盛所致。
如果有眼中视物模糊不清、眼球运动失调的情况,没有表证和里证,大便困难,身体微热,这是内实(肠道积滞),可以用攻下法治疗。
郁冒,指昏迷状态。郁是指气机不畅,冒是指神志不清。
这是由于极度虚弱又感受寒邪所致,如少阴病下痢停止后出现头晕目眩甚至昏冒的,属于死证,这是因为虚损到了极点。
动气,指脐旁有筑筑然跳动的感觉。
这是由于真脏之气虚弱而发动所致,即使有应当攻里或发表的证候,也不可发汗或攻下。
肝内证,脐左侧有动气;肺在脐右侧;心在脐上;肾在脐下,按压时感觉坚硬或疼痛,必须通过问诊才能确认。
自利(自行腹泻),有热证的,排泄物为肠垢(黏液脓血);有寒证的,为鸭溏(稀薄如水);有湿毒的,排泄脓血;有合病引起的自利。
太阳与阳明合病,必然自利,病位在表,用葛根汤发散解表。
太阳与少阳合病,必然自利,病位在半表半里,用黄芩汤和解,若呕吐加半夏。
阳明与少阳合病,必然自利,邪气入腑,用承气汤攻下。
有热利者,本不应使用攻下法却误用了,导致表邪乘虚入里,内虚兼夹热邪而自利。另外,下利想喝水的,属热证。发热加重,排泄物色黄赤的,属热证。大热内结,泄泻不止,治疗宜用寒凉疗法,虽然结伏已除,但仍需用寒下法;若是热证,则采用分利小便的方法。
有寒利者,自利且不口渴,属于太阴病,是因为脏腑有寒。另外,小便颜色白,具备少阴病的症状,属寒证。另外,恶寒、脉微细、自利清谷(完谷不化),属寒证。这些情况都适宜用理中汤温中散寒。还有大寒凝结体内,久痢溏泄,绵延多年,适宜用热性药物攻下。
有湿毒利,排泄脓血,适宜用地榆散。
有结积利者(因积滞引起的腹泻)。
少阴病自利清水,心下必然疼痛,口干燥,必然下利,三部脉象平和,按压心下感觉硬,或者脉沉而滑,或者不欲饮食且谵语,或者病程反复经年,适宜用攻逐法治疗。
治疗下利,虽然有表证也不可以发汗,因为邪气内攻,会耗伤津液导致胃虚,强行发汗必然导致胀满。
Shaking of the head: There are cases where the head shakes while speaking, caused by interior pain; there are cases with lockjaw (trismus) and opisthotonos (back arching), caused by wind.
A body appearance resembling smoke staining, with shaking of the head and fixed gaze, indicates the exhaustion of Heart Qi, representing a fatal condition of extreme Yin cold with rootless Yang.
Chi Zong (spasms and relaxation): Chi refers to the contraction and tension of sinews and vessels, while Zong refers to their extension and relaxation. Continuous alternating contraction and extension is commonly known as convulsions, caused by excessive pathogenic heat. When heat is excessive, wind pathogens collide and merge into the meridians. Since wind governs movement, it causes restlessness in the four limbs. If treated with methods to dispel wind and clear heat, survival is possible; however, if cauterization or diaphoretic drugs are erroneously applied, death will ensue.
Numbness (Bu Ren): Refers to insensitivity, inability to perceive pain, itching, cold, or heat. It results from deficiency of Qi and Blood, excessive pathogenic stagnation, and the failure of righteous Qi to circulate freely.
Fixed Gaze (Zhi Shi): Refers to staring at objects without eye movement; those who can move their eyes do not have this condition. Fixed gaze is an incurable disease resulting from the depletion of righteous Qi and extreme excess of pathogenic factors. However, in cases where vision is blurred and eye movements are disordered, without exterior or interior syndromes, difficulty in defecation, and slight fever, this indicates interior excess (accumulation in the intestines), which can be treated with purgation.
Yu Mao (Dizziness and Fainting): Refers to a state of coma. Yu implies stagnant Qi that fails to flow smoothly, while Mao implies unclear spirit/consciousness. This occurs due to extreme deficiency compounded by cold invasion. For example, in Shaoyin disease, if dysentery stops but is followed by dizziness and fainting, it is a fatal sign indicating extreme deficiency.
Dong Qi (Pulsating Qi): Refers to a pulsating sensation beside the umbilicus. It arises from the activation of deficient Zang organs' true Qi. Even if symptoms suggest the need for purgation or diaphoresis, sweating and purging must be avoided.
- Liver internal syndrome: Pulsating Qi on the left side of the umbilicus.
- Lung: Right side of the umbilicus.
- Heart: Above the umbilicus.
- Kidney: Below the umbilicus.
In all cases, palpation reveals hardness or pain, and confirmation requires inquiry.
Spontaneous Diarrhea (Zi Li):
- Heat type: Stool contains intestinal mucus/pus.
- Cold type: Stool is watery like duck feces.
- Damp-toxin type: Passage of pus and blood.
- Combined disease type: Spontaneous diarrhea due to combined syndromes.
- Taiyang and Yangming combined disease: Spontaneous diarrhea occurs because the pathogen is in the exterior; treat with Gegen Tang (Kudzu Decoction) to release the exterior.
- Taiyang and Shaoyang combined disease: Spontaneous diarrhea occurs because the pathogen is in the half-exterior/half-interior; treat with Huangqin Tang (Scutellaria Decoction) to harmonize, adding Banxia (Pinellia) if vomiting is present.
- Yangming and Shaoyang combined disease: Spontaneous diarrhea occurs because the pathogen has entered the Fu organs; treat with Chengqi Tang (Gastrointestinal Releasing Decoction) to purge.
- Mismanaged Heat Diarrhea: If purgatives were incorrectly used when not indicated, exterior pathogens may enter the interior due to deficiency, causing spontaneous diarrhea with internal deficiency and heat. Additionally, diarrhea accompanied by thirst indicates heat. Fever worsening with yellow-red stool indicates heat. Severe internal heat binding with continuous diarrhea should be treated with cold therapies; although binding may be resolved, cold purgatives may still be needed. Alternatively, for heat, promote urination to separate fluids.
- Cold Diarrhea: Spontaneous diarrhea without thirst belongs to Taiyin disease due to interior cold. White urine with full manifestation of Shaoyin disease symptoms indicates cold. Aversion to cold, thready/faint pulse, and diarrhea with undigested food indicate cold. These should be treated with Lizhong Tang (Central Restoring Decoction) to warm the middle. Severe internal cold凝 (congealing) with chronic loose stools over years requires hot purgatives.
- Damp-Toxin Diarrhea: Passage of pus and blood should be treated with Diyü San (Sanguisorba Powder).
- Accumulation Diarrhea: Diarrhea caused by accumulated masses.
- Shaoyin Disease with Clear Water Diarrhea: Spontaneous passage of clear water, abdominal pain, dry mouth, and diarrhea. If the three pulse positions are level, but the epigastrium is hard upon palpation, or the pulse is deep and slippery, or there is anorexia with delirium, or the condition persists for years, aggressive expulsion methods are indicated.
- General Rule for Treating Diarrhea: Even if exterior signs are present, do not induce sweating, as pathogens have moved inward, consuming fluids and weakening the Stomach. Inducing sweating will inevitably lead to abdominal distension.