懊 者,心中懊懊 ,郁闷不舒之貌。盖由表证误下,正气内虚,阳邪内陷,结于心胸之间,
甚则为结胸也。邪在心胸则宜吐,热结胃腑则宜下,不可拘也。发汗、吐、下之后虚烦不得眠,甚
则反复颠倒,心中懊 ,栀子豉汤。舌上白苔,饥不能食,虚烦不眠,头汗懊 ,上同。
短气烦躁,咽硬,胸中懊 ,大陷胸汤。阳明病,下之后懊 而烦,中有燥屎,宜承气汤。阳明
无汗,小便不利,心中懊 者,必发黄,宜茵陈蒿汤。
身痛,太阳表证也。虽曰表邪未解,而有发汗温经先后之不同。自利脉沉,为阴病。身痛,其
身重者,属乎阳明,为有风也。又有阳邪内行,不荣于表,是又不可不知。
太阳身痛,脉浮紧,无汗,麻黄汤;或尺脉迟,为无血,先用小建中汤,候尺脉浮,却用麻黄
汤。
下利脉沉,身痛,宜四逆汤辈。
发汗后身痛,脉沉迟,桂枝芍药人参汤。一身尽痛,发热面黄,七八日后结热在里,乃攻其表。
温里,四逆汤;攻表,桂枝汤。
霍乱后身痛不休,桂枝汤。湿家身疼痛,不可发汗,发汗则成 ,葛根桂枝汤。
凡中湿身痛,有本条。
拘急者,手足不能自如,屈伸不便,如蜷卧恶风之貌。四肢者,诸阳之本。盖因发汗亡阳,阳
虚,是有其证也。
伤寒,脉浮,自汗出,小便数,心烦恶寒,脚挛急,芍药甘草汤;小便难者,桂枝加附子。
太阳病,发汗,遂不止,恶风,小便难,四肢微急,难以屈伸,桂枝加附子汤。
吐利汗出,发热恶寒,四肢拘急,手足厥冷,四逆汤。
懊憹,是指心中烦乱郁闷、难以舒展的状态。这通常是由于表证误用攻下法,导致正气内虚,阳热邪气内陷,结聚在心胸之间,严重时就会形成结胸证。邪气在心胸部位应当使用吐法,热邪结聚在胃腑则应当使用下法,治疗不可拘泥不变。发汗、催吐、攻下之后出现虚烦、无法入睡,甚至翻来覆去、心中烦闷懊憹的,用栀子豉汤。舌苔白,饥饿却不想进食,虚烦失眠,头部出汗且心中懊憹的,治法同上。呼吸短促、烦躁不安、咽喉干燥僵硬、胸中懊憹的,用大陷胸汤。阳明病,经过攻下后出现懊憹且心烦,体内有燥屎的,宜用承气汤。阳明病无汗、小便不利、心中懊憹的,必然会出现发黄的症状,宜用茵陈蒿汤。
身体疼痛,属于太阳表证。虽然说是表邪未解,但根据病情不同,发汗与温经的先后顺序也有区别。如果自下利且脉象沉,属于阴寒病。身体疼痛且身体沉重的,归属于阳明病,这是因为有风邪所致。又有阳热邪气内行,不能荣养体表的情况,这也是不可忽视的。
太阳病身体疼痛,脉象浮紧、无汗的,用麻黄汤;或者尺部脉象迟,提示血虚,先用小建中汤,等到尺脉转为浮象时,再用麻黄汤。
下利且脉象沉、身体疼痛的,宜用四逆汤类方剂。
发汗后身体疼痛,脉象沉迟的,用桂枝芍药人参汤。全身都疼痛,发热且面色发黄,七八天后热邪结聚在里,此时应先攻其表。温里用四逆汤;攻表用桂枝汤。
霍乱后身体疼痛不止的,用桂枝汤。平素多湿之人身体疼痛,不可发汗,若发汗则会变成痉病,用葛根桂枝汤。
凡是中湿引起的身体疼痛,在本篇中有专门论述。
拘急,是指手足不能自如活动,屈伸不便,像蜷缩卧倒、怕风的样子。四肢是诸阳经的根本。这通常是因为发汗过多导致亡阳,阳气虚弱,从而出现这种证候。
伤寒病,脉象浮,自汗出,小便频数,心烦怕冷,脚部挛急的,用芍药甘草汤;如果小便困难的,用桂枝加附子汤。
太阳病,发汗后汗出不止,怕风,小便困难,四肢轻微拘急,难以屈伸的,用桂枝加附子汤。
呕吐腹泻、汗出、发热怕冷、四肢拘急、手脚冰冷的,用四逆汤。
Ao Nao (Agitated Distress) refers to the appearance of mental agitation, depression, and discomfort. It generally arises from the mistaken use of purgation on exterior syndromes, leading to internal deficiency of healthy Qi and the inward sinking of Yang pathogenic factors, which knot in the chest and heart region; in severe cases, it becomes Jie Xiong (Chest Binding). When pathogens are in the chest and heart, emesis is indicated; when heat knots in the stomach fu organs, purgation is indicated; treatment should not be rigid. After sweating, vomiting, or purging, if there is empty irritability preventing sleep, or even tossing and turning with Agitated Distress in the heart, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is used. If there is a white coating on the tongue, hunger without desire to eat, empty irritability, insomnia, head sweating, and Agitated Distress, the treatment is the same as above. With shortness of breath, restlessness, hardness in the throat, and Agitated Distress in the chest, Da Xian Xiong Tang (Major Formula to Drain the Chest) is used. In Yang Ming disease, after purgation, if there is Agitated Distress and vexation with dry stool inside, Cheng Qi Tang (Order the Qi Decoction) is appropriate. In Yang Ming disease, if there is no sweating, difficulty in urination, and Agitated Distress in the heart, jaundice will inevitably occur, and Yin Chen Hao Tang (Artemisiae Scopariae Herba Decoction) is appropriate.
Body pain belongs to Tai Yang exterior syndromes. Although it is said that exterior pathogens have not yet resolved, the sequence of inducing sweating versus warming meridians differs according to the condition. If there is spontaneous diarrhea with a deep pulse, it is a Yin disease. Body pain accompanied by heaviness of the body belongs to Yang Ming, indicating the presence of wind. Furthermore, one must not ignore cases where Yang pathogens move internally and fail to nourish the exterior.
For Tai Yang body pain with a floating and tight pulse and no sweating, Ma Huang Tang (Ephedra Decoction) is used; or if the cun-kou pulse at the chi position is slow, indicating blood deficiency, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is used first, and once the chi pulse becomes floating, Ma Huang Tang is then used.
For diarrhea with a deep pulse and body pain, Si Ni Tang (Frigid Extremities Decoction) and similar formulas are appropriate.
After sweating, if body pain persists with a deep and slow pulse, Gui Zhi Shao Yao Ren Shen Tang (Cinnamon Twig, Peony, and Ginseng Decoction) is used. If the whole body hurts, accompanied by fever and yellow complexion, and after seven or eight days the heat knots internally, the exterior should be attacked. To warm the interior, Si Ni Tang is used; to attack the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is used.
If body pain persists after Huo Luan (Cholera-like disorder), Gui Zhi Tang is used. For those habitually damp who suffer body pain, sweating should not be induced; if induced, it will lead to Jing (Spasm), and Ge Gen Gui Zhi Tang (Pueraria and Cinnamon Twig Decoction) is used.
Regarding body pain caused by dampness, there is a specific section addressing this.
Ju Ji (Contraction and Cramping) refers to the inability of the hands and feet to move freely, with difficulty in flexion and extension, resembling a curled posture with aversion to wind. The four limbs are the root of all Yang channels. This syndrome occurs because excessive sweating leads to the loss of Yang, resulting in Yang deficiency.
In Shang Han (Cold Damage), if the pulse is floating, there is spontaneous sweating, frequent urination, heart vexation, aversion to cold, and cramping in the feet, Shao Yao Gan Cao Tang (Peony and Licorice Decoction) is used; if there is difficulty in urination, Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Added Aconite) is used.
In Tai Yang disease, if sweating continues excessively after inducing sweat, with aversion to wind, difficulty in urination, slight contraction of the four limbs, and difficulty in flexion and extension, Gui Zhi Jia Fu Zi Tang is used.
With vomiting and diarrhea, sweating, fever, aversion to cold, contraction of the four limbs, and cold extremities, Si Ni Tang is used.