冲脉为血之海,即血室也。男女均有此血气,均有此冲脉。冲之得热,血必妄行。在男子,则
为下血谵语;在妇人,则为寒热似疟。皆为热入血室,逼血下行,则血热而利也。挟血之脉,乍涩
乍数,或伏或沉。血热交并,则脉洪盛。大抵男多于左手,女多于右手见之。又有阴寒为病,下利
便脓血者,乃下焦虚寒,肠胃坚固,清浊不分而利下脓血也。二者一为挟血,一为阴寒,临病宜精
别焉。
太阳病不解,热结膀胱,其人如狂而血自下者,愈;不愈,用桂枝汤、《明理论》抵当汤。
阳明病,下血谵语,胸胁满如结胸,夜则见鬼,此为热入血室,小柴胡汤。
少阴病,下利便脓血者,桃花汤。
腹满身热,下如鱼脑,曰湿毒,桃花汤、地榆散、黄连阿胶汤。
下后无表里证,脉数不解散,消谷易饥,多日不大便,此为瘀血,桃仁承气汤、抵当汤,或小
柴胡汤加桃仁、大黄。
下焦蓄血,其人如狂,小腹急结,小便必利,抵当丸。
手足不温,谓之四逆。邪在表,则手足热,邪在表里之间,则手足温。至于邪传少阴,则手足
有逆冷之证,与厥阴又相远也。然自热而至温,自温而至厥,乃传经之邪,轻则四逆散,重则承气
汤下之。非若得病,手足便逆而不温者,四逆汤温之,则为阴经受邪,而阳气不足也。其或吐利烦
躁,厥逆蜷卧,皆属少阴,又为不治之证。
少阴病,四逆,其人或咳或悸,或小便不利,或腹中痛满,或利下重,并四逆
散。初病以来,厥冷四逆,即四逆汤。
手足逆冷,大便闭,小便赤,或大便黑色,脉沉而滑,此为阳证,以白虎汤;甚者,大承气汤。
冲脉是血的汇聚之处,也就是血室。男性和女性都有这种血气,也都有冲脉。冲脉受热,血液必定妄行。在男子身上,表现为下部出血和胡言乱语;在女子身上,表现为像疟疾一样的寒热交替。这都是因为热邪进入血室,逼迫血液下行,导致血热而引发痢疾。挟带血液的脉象,时而涩滞时而快速,或者潜伏或沉伏。血与热相互搏结,脉象就会洪大旺盛。大致来说,男性多在左手脉象上显现,女性多在右手脉象上显现。又有因阴寒致病,出现下利并伴有脓血的情况,这是由于下焦虚寒,肠胃功能固结,清浊之气不分而导致下利脓血。这两种情况,一种是挟带瘀血,一种是阴寒内盛,临证时应当仔细辨别。
太阳病(太阳经受邪所致的病证)未能解除,热邪结聚于膀胱,患者神志如狂且自行下血的,病可痊愈;若未痊愈,使用桂枝汤(Cinnamon Twig Decoction)、《明理论》中的抵当汤(Dangdang Decoction)。
阳明病(阳明经受邪所致的病证),出现下部出血、胡言乱语,胸部和胁部胀满如同结胸证,夜间看见鬼怪,这是热邪进入血室,用小柴胡汤(Minor Bupleurum Decoction)。
少阴病(少阴经受邪所致的病证),出现下利并伴有脓血的,用桃花汤(Peach Blossom Decoction)。
腹部胀满、身体发热,大便排出物像鱼脑一样,称为湿毒,可用桃花汤、地榆散(Sanguisorba Powder)、黄连阿胶汤(Coptis and Porcine Heart Blood Decoction)。
经过泻下治疗后,没有表证也没有里证,但脉数不解,食欲亢进容易饥饿,多日不大便,这是有瘀血,用桃仁承气汤(Tao Ren Cheng Qi Decoction)、抵当汤,或者小柴胡汤加桃仁(Persicae Semen)、大黄(Rhei Radix et Rhizoma)。
下焦蓄血(瘀血积聚在下焦),患者神志如狂,小腹拘急硬结,小便必然通利,用抵当丸(Dangdang Pill)。
手脚不温暖,称为四逆(Cold Extremities)。邪气在体表,则手脚发热;邪气在半表半里之间,则手脚温暖。至于邪气传入少阴经,则会出现手脚逆冷的症状,这与厥阴经的病证又有所不同。然而,从发热到温暖,从温暖到厥冷,这是传经之邪,轻症用四逆散(Si Ni San),重症用承气汤(Cheng Qi Decoction)攻下。不像刚得病就手脚逆冷而不温暖的,那是四逆汤(Si Ni Tang)温补的对象,属于阴经受邪,阳气不足所致。如果出现呕吐、下利、烦躁、四肢厥冷、蜷缩而卧,都属于少阴病,又是难以治愈的证候。
少阴病,出现四逆,如果患者伴有咳嗽或心悸,或小便不利,或腹中疼痛胀满,或下利伴肛门重坠感,均用四逆散。从发病开始就四肢厥冷、四逆的,立即用四逆汤。
手脚逆冷,大便闭塞,小便色赤,或者大便呈黑色,脉象沉而滑,这是阳证,用白虎汤(White Tiger Decoction);病情严重的,用大承气汤(Major Cheng Qi Decoction)。
The Chong vessel (Chong Mai) is the sea of blood, also known as the Blood Chamber (Xue Shi). Both men and women possess this blood qi and the Chong vessel. When the Chong vessel is affected by heat, the blood will inevitably flow recklessly. In men, this manifests as lower bleeding and delirium; in women, it presents as alternating chills and fever resembling malaria. These are all cases where heat enters the Blood Chamber, forcing blood downward, resulting in dysentery due to blood-heat. The pulse associated with blood involvement may be intermittently choppy or rapid, or deep and hidden. When blood and heat intertwine, the pulse becomes surging and vigorous. Generally, this is more commonly seen in the left hand of men and the right hand of women. There are also cases of illness caused by yin-cold, presenting with dysentery and pus-blood in the stool; these arise from deficiency-cold in the lower jiao, with firmness in the intestines and stomach, leading to a failure to separate the clear from the turbid, resulting in the discharge of pus and blood. The former involves blood stasis, while the latter involves yin-cold; one must carefully distinguish between them during clinical practice.
If Taiyang disease (Taiyang syndrome) remains unresolved and heat accumulates in the Bladder, causing the patient to exhibit a manic state and spontaneous bleeding, the condition may resolve on its own; if it does not resolve, Guizhi Tang (Cinnamon Twig Decoction) or Dangdang Tang (Dangdang Decoction) from *Mingli Lun* should be used.
In Yangming disease (Yangming syndrome), if there is lower bleeding, delirium, chest and hypochondriac fullness resembling Chest Bind (Jie Xiong), and visual hallucinations at night, this indicates heat entering the Blood Chamber; Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be used.
In Shaoyin disease (Shaoyin syndrome), if there is dysentery with pus and blood, Tao Hua Tang (Peach Blossom Decoction) should be used.
If the abdomen is distended, the body is hot, and the stool resembles fish brains, this is termed Damp-Toxin; Tao Hua Tang, Di Yu San (Sanguisorba Powder), or Huang Lian E Jiao Tang (Coptis and Porcine Heart Blood Decoction) may be used.
After purgation, if there are neither exterior nor interior signs, but the pulse remains rapid, appetite is excessive with easy hunger, and there has been no bowel movement for many days, this indicates blood stasis; Tao Ren Cheng Qi Tang (Tao Ren Cheng Qi Decoction), Dangdang Tang, or Xiao Chai Hu Tang added with Tao Ren (Persicae Semen) and Da Huang (Rhei Radix et Rhizoma) should be used.
When blood stagnates in the Lower Jiao, the patient may exhibit a manic state, tightness and hardness in the lower abdomen, and patent urination; Dangdang Wan (Dangdang Pill) should be used.
Cold extremities refer to Si Ni (Cold Extremities). When pathogenic factors are in the exterior, the hands and feet are hot; when they are between the exterior and interior, the hands and feet are warm. However, when pathogens transmit to the Shaoyin channel, symptoms of cold extremities occur, which differ significantly from Jueyin conditions. Nevertheless, a progression from heat to warmth, and from warmth to cold extremities, indicates pathogenic transmission through the channels; mild cases are treated with Si Ni San (Four Counterflow Powder), while severe cases are treated with Cheng Qi Tang (Ordering the Qi Decoction) to purge downwards. This differs from cases where cold extremities appear immediately upon onset without warming; those are treated with Si Ni Tang (Four Counterflow Decoction) to warm, indicating pathogenic invasion of the Yin channels with insufficiency of Yang qi. If vomiting, diarrhea, restlessness, cold extremities, and curling up in bed occur, these belong to Shaoyin disease and are considered intractable conditions.
In Shaoyin disease, if Si Ni occurs, and the patient additionally experiences cough or palpitations, or difficulty urinating, or abdominal pain and fullness, or tenesmus during diarrhea, Si Ni San should be used throughout. If cold extremities and Si Ni have been present since the initial onset of illness, Si Ni Tang should be administered immediately.
If there are cold extremities, constipation, red urine, or black stools, accompanied by a deep and slippery pulse, this is a Yang syndrome; Bai Hu Tang (White Tiger Decoction) should be used. In severe cases, Da Cheng Qi Tang (Major Ordering the Qi Decoction) should be used.