不仁,谓不柔和也。经曰∶诸虚承寒,则为郁冒不仁。盖其血气虚少,不能周流于身,是为邪
气所伏,故肌体顽麻不知痛痒,寒过厥如尸,而郁且冒也。设或脉浮而洪,身汗如油,喘而不休,
水浆不下,形体不仁,又此为命绝也。
经曰∶少阴脉不至,肾气微、精血少,寒气上奔,血结心下,阳气退下,热归阴股,与阴相动,
人之身不仁,此为尸厥。以郁冒不仁为可刺之而得痊者,实神医之诊也。甘草干姜汤、桂枝芍药汤
加干姜、桂枝麻黄各半汤,宜消息选用之。
霍乱者,上吐下利,挥霍而撩乱者是也。邪在上焦,吐而不利。邪在下焦,则利而不吐。邪在
中焦,既吐且利。然胃气为邪气所伤,阴阳乖隔,遂上吐而利也,乃谓霍乱。其余但称吐利者,有
以异也。故以干霍乱死者多,湿霍乱死者少。吐利则所伤之物得以泄出,胃中水谷尽也。
伤寒瘥后半月以来,十余日终不惺惺,错语少神,或寒热似疟,或潮热颊赤,医以风温治之,
非也,是由发汗不透,寒热在心包络间也。
瘥后昏沉不醒,知母麻黄汤取微汗;胃脘有热,虚烦而呕,竹叶石膏汤加生姜;呕吐不已,膈
上有寒,理中丸。
瘥后从腰以下有水,牡蛎泽泻散。瘥后日暮微烦,以其病方瘥,强与谷食不消也,损谷则愈矣。
不仁,指的是肢体失去柔和灵活的感觉。经典医籍记载:各种虚证感受寒邪,就会导致郁闭昏冒、肢体麻木不仁。这是因为气血虚弱不足,无法周流全身,致使邪气潜伏体内,所以肌肉皮肤僵硬麻木,不知痛痒;若寒邪极盛导致四肢厥冷如尸体一般,且伴有郁闭昏蒙的症状。如果脉象浮大而洪数,身体出汗如油,气喘不停,饮食水浆无法咽下,形体麻木不仁,这属于命绝的危候。
经典医籍又记载:少阴脉不至,肾气微弱,精血亏少,寒气上冲,血液凝结于心下,阳气退居下部,热气归于大腿内侧,与阴气相互激荡,导致人身麻木不仁,这称为尸厥。对于因郁闭昏冒导致的不仁,可以通过针刺治疗而痊愈的情况,确实是神医的诊断水平。此时宜选用甘草干姜汤、桂枝芍药汤加干姜,或桂枝麻黄各半汤,应根据病情斟酌选用。
霍乱,是指突然发生呕吐和腹泻,挥霍撩乱的一种病证。邪气在上焦,表现为只吐不泻;邪气在下焦,表现为只泻不吐;邪气在中焦,则既吐又泻。然而胃气被邪气所伤,阴阳之气乖违阻隔,于是出现上吐下泻,这就叫做霍乱。其余单纯称为“吐利”的病证,与此是有区别的。因此,患干霍乱(欲吐不得吐,欲泻不得泻)而死的人较多,患湿霍乱(有吐有泻)而死的人较少。因为吐泻能使受损的食物排出体外,使胃中积滞的水谷得以排空。
伤寒病初愈半个月以来,经过十余天仍然神志不清,言语错乱,精神萎靡,或者出现类似疟疾的寒热往来,或者午后潮热、两颊发红。医生若按风温病治疗,是错误的。这是由于发汗不透,寒热之邪留连心包络所致。
病后昏沉不醒,可用知母麻黄汤取微汗以解表;若胃脘有热,虚烦且呕吐,可用竹叶石膏汤加生姜;若呕吐不止,膈上有寒饮,可用理中丸。
病后腰部以下有水气浮肿,可用牡蛎泽泻散。病后傍晚时分轻微烦躁,是因为病刚痊愈,强行进食导致食物不消化,减少饮食即可痊愈。
Bu Ren (Numbness), refers to the loss of flexibility and sensation in the limbs. The Classics state: "In cases of various deficiency patterns contracting cold pathogenic factors, there occurs depression, dizziness, and numbness." This is because Qi and Blood are deficient and insufficient to circulate throughout the body, allowing pathogenic factors to lie dormant within. Consequently, the muscles and skin become stiff and numb, devoid of pain or itch sensation; if Cold becomes extreme causing the four extremities to be cold as a corpse, accompanied by symptoms of depression and dizziness. If the pulse is floating and surging, the body sweats like oil, panting does not cease, fluids and food cannot be swallowed, and the body is numb, this indicates the exhaustion of Life Force (Ming Jue).
The Classics further state: "When the Shaoyin pulse is absent, Kidney Qi is weak, Essence and Blood are scant, Cold Qi rushes upward, Blood coagulates below the Heart, Yang Qi retreats downward, Heat returns to the inner thighs, interacting with Yin Qi, causing the person's body to become numb; this is called Shi Jue (Corpse-like Fainting)." For numbness caused by depression and dizziness that can be cured through acupuncture, this indeed reflects the diagnostic skill of a divine physician. In such cases, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), Guizhi Shaoyao Tang (Cinnamon Twig and Peony Decoction) with added Ganjiang (Dried Ginger), or Guizhi Mahuang Ban Ge Tang (Half-Cinnamon Twig and Ephedra Decoction) should be selected based on careful consideration of the condition.
Huo Luan (Cholera-like Syndrome) refers to a syndrome characterized by sudden onset of vomiting and diarrhea, causing chaotic turmoil. If the pathogen is in the Upper Jiao (Upper Burner), there is vomiting without diarrhea. If the pathogen is in the Lower Jiao (Lower Burner), there is diarrhea without vomiting. If the pathogen is in the Middle Jiao (Middle Burner), there is both vomiting and diarrhea. However, when Stomach Qi is injured by pathogenic factors, leading to a disruption and separation of Yin and Yang Qi, resulting in upper vomiting and lower diarrhea, it is termed Huo Luan. Other conditions simply referred to as "vomiting and diarrhea" differ from this. Therefore, more deaths occur from Gan Huo Luan (Dry Cholera, where one wishes to vomit but cannot, and wishes to defecate but cannot) than from Shi Huo Luan (Wet Cholera, with both vomiting and diarrhea). Because vomiting and diarrhea allow the damaged substances to be expelled, emptying the water and grain accumulated in the Stomach.
Regarding sequelae of Shang Han (Cold Damage) disease, after half a month has passed since recovery, if for over ten days the patient remains unrefreshed, speaks confusedly, lacks spirit, or experiences chills and fever resembling malaria, or tidal fever with red cheeks, treating it as Feng Wen (Wind-Warmth) by physicians is incorrect. This arises because sweating was not thorough, leaving chills and heat trapped between the Heart and the Pericardium Collateral (Xin Bao Luo).
For post-illness lethargy and unconsciousness, Zhimu Mahuang Tang (Anemarrhena and Ephedra Decoction) should be used to induce mild sweating; if there is heat in the epigastrium with emptiness vexation and vomiting, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with added Shengjiang (Fresh Ginger) is indicated; if vomiting persists due to cold fluid retention above the diaphragm, Lizhong Wan (Regulate the Middle Pill) is appropriate.
For post-illness edema/water accumulation below the waist, Musi Ze Xie San (Oyster Shell and Alisma Powder) is used. For slight irritability at dusk after illness, this occurs because the disease has just resolved, and forcing food intake leads to indigestion; reducing food intake will lead to recovery.