外证憎寒壮热,恶风自汗,胸满,气上冲咽不得息,但身不疼,项不强。若涎多者,亦隐隐头
疼。脉有寸浮者,亦有寸伏者,以意参之,柴胡半夏汤、金沸草散、大半夏汤。气上冲者,瓜蒂散
吐之。
亦头疼恶寒,身热,但左手脉平和,右手脉紧盛,知为食也,大橘皮汤、二陈汤。心腹满痛,大
柴胡汤下之;胸满呕吐,瓜蒂散吐之。
诸虚烦热与伤寒相似,但不恶寒,头不疼,身不痛为异耳。表既虚,不可汗;
里不实,不可下。叔和云∶虚烦有热,不可攻。
伤寒传足不传手,所以寒湿之气发于足,则类伤寒。其证头疼身热,肢节痛,大便秘,或呕,
但初病时起于脚膝屈弱,不能移动为异耳。感于寒,所患必冷,越婢、小续命汤入生姜汁最妙。感
于暑,所患是热,小续命去附子,减桂一半。脚肿,木瓜散、槟榔散。大便秘,脾约丸。
太阳身黄,小盒饭不利,今反自利,其人如狂,血证也,抵当汤。
伤寒有热,小腹满,应小便不利,今反自利,为有血也,抵当丸下之。尿血,延胡索汤∶延胡
索、朴硝二两,为末,每服四钱。水一盏,煎八分,温服。
阳明自汗,应小便不利而反自利,津液内竭也。屎虽硬,不可攻,宜蜜导煎、猪胆汁法。
少阴四逆,小便自利,虚寒也,四逆汤及真武汤去茯苓;小便秘或赤,知内有热也;小便自利,
其人如狂,小腹满,知不为热,乃蓄血也。若阳明津竭自利,与夫少阴自利,乃胞寒不禁,可不温
乎?
外感病表现为怕冷高热,恶风自汗,胸中胀满,气逆上冲至咽喉导致呼吸不畅,但身体不疼痛,颈部不强直。如果痰涎较多,也会隐隐感到头痛。脉象方面,有的寸脉浮,有的寸脉伏,需凭医者意会参详,可用柴胡半夏汤、金沸草散、大半夏汤。若气逆上冲明显,可用瓜蒂散催吐。
也有头痛恶寒、身热的情况,但左手脉象平和,右手脉象紧盛,可知是食积所致,可用大橘皮汤、二陈汤治疗。若心腹部胀满疼痛,用大柴胡汤攻下;若胸中胀满伴呕吐,用瓜蒂散催吐。
各种虚证引起的烦热与伤寒相似,区别在于不恶寒、头不痛、身体不痛。既然表虚,不可发汗;里不实,不可攻下。王叔和说:虚烦有热,不可攻下。
伤寒传变只传足经不传手经,所以寒湿之气发于足部,症状类似伤寒。其证候为头痛身热,肢节疼痛,大便秘结,或伴有呕吐,但初发病时以脚膝软弱无力,不能移动为特征。感受寒邪,患病必属冷证,越婢汤、小续命汤加入生姜汁最为适宜。感受暑邪,患病属热证,用小续命汤去掉附子,桂枝减半。脚肿,用木瓜散、槟榔散。大便秘结,用脾约丸。
太阳病出现身黄,本应小便不利,现在反而小便通利,其人如狂,这是蓄血证,用抵当汤治疗。
伤寒发热,小腹满,本应小便不利,现在反而小便通利,是有瘀血,用抵当丸攻下。尿血,用延胡索汤:延胡索、朴硝各二两,研为细末,每次服用四钱。用水一盏,煎至八分,温服。
阳明病自汗,本应小便不利而反见小便通利,这是津液内竭所致。大便虽硬,不可攻下,宜用蜜导煎、猪胆汁法(外用通便)。
少阴病四肢厥逆,小便自利,属虚寒证,用四逆汤及真武汤去茯苓;若小便短少或色赤,知体内有热;若小便自利,其人如狂,小腹满,知非热证,而是蓄血证。若是阳明津液枯竭导致的小便自利,以及少阴小便自利,乃胞宫寒冷失禁,难道可以不温补吗?
Exterior manifestations include aversion to cold with high fever, aversion to wind with spontaneous sweating, chest fullness, and Qi rushing upward to the throat causing dyspnea, yet without body pain or neck stiffness. If there is excessive phlegm-saliva, there may also be a dull headache. The pulse at the cun position may be floating or hidden; this should be discerned by clinical intuition. Formulas such as Chaihu Banxia Tang (Bupleurum and Pinellia Decoction), Jinfeicao San (Sparganium Powder), and Da Banxia Tang (Major Pinellia Decoction) may be used. If Qi rushes upward significantly, Gouti San (Melon Seed Powder) can be used to induce vomiting.
There are cases of headache, aversion to cold, and fever, where the left hand pulse is peaceful and the right hand pulse is tight and vigorous, indicating food retention. Daju Pi Tang (Major Citrus Peel Decoction) and Erchen Tang (Two Aged Substances Decoction) may be administered. If there is abdominal fullness and pain, Dachaihu Tang (Major Bupleurum Decoction) is used to purge; if there is chest fullness with vomiting, Gouti San is used to induce vomiting.
Various deficiency-type vexation-heat resembles Shaoyang disease (Taiyang disease in the context of *Shanghan Lun*), but differs in that there is no aversion to cold, headache, or body pain. Since the exterior is deficient, sweating methods are contraindicated; since the interior is not excess, purging methods are contraindicated. Shuhe stated: "Vexation-heat due to deficiency cannot be attacked by purgatives."
Shaoyang disease transmits only through the Foot meridians and not the Hand meridians. Therefore, when Cold-Dampness Qi originates in the feet, the symptoms resemble Shaoyang disease. Manifestations include headache, fever, joint pain, constipation, or vomiting. However, the distinguishing feature at onset is weakness in the legs and knees, making movement difficult. If contracted from Cold, the condition must be Cold-type; Yuebi Tang (Yuebi Decoction) or Xiaoxuming Tang (Minor Xubming Decoction) with ginger juice added is most appropriate. If contracted from Summerheat, the condition is Heat-type; use Xiaoxuming Tang removing Fuzi (Aconite Lateral Root Preparatio) and reducing Guizhi (Cinnamon Twig) by half. For swollen feet, Mugua San (Papaya Powder) or Binglang San (Areca Seed Powder) may be used. For constipation, Jiyue Wan (Splein-Restriction Pill) is indicated.
In Taiyang disease with jaundice, urination should be difficult; if it is instead free-flowing, and the patient exhibits manic behavior, this is a Blood-Stasis syndrome. Didang Tang (Didang Decoction) should be used.
In Shaoyang disease with fever and lower abdominal fullness, urination should be difficult; if it is instead free-flowing, this indicates Blood-Stasis. Didang Wan (Didang Pill) should be used to purge. For hematuria, Yansuogao Tang (Corydalis Decoction) is prescribed: Yanhusuo (Corydalis Rhizome) and Poxiao (Natrii Sulfas), each two liang, ground into powder. Take four qian per dose. Boil one sheng of water until reduced to eight fen, and take warm.
In Yangming disease with spontaneous sweating, urination should be difficult; if it is instead free-flowing, this indicates exhaustion of internal fluids. Although the stool is hard, purging is contraindicated. Honey suppositories or pig bile method should be used.
In Shaoyin disease with cold extremities (Sini), if urination is free-flowing, it indicates Deficiency-Cold. Si Ni Tang (Decoction for Extremity Reversal) and Zhen Wu Tang (True Warrior Decoction) with Fuling removed should be used. If urination is scanty or red, heat exists internally. If urination is free-flowing, the patient is manic, and the lower abdomen is full, this is not Heat but Blood-Stasis. If Yangming fluid exhaustion causes free-flowing urination, or Shaoyin free-flowing urination results from uterine cold and incontinence, warming treatment is necessary.