脏结者,脏气闭结而不复流布也。外证如结胸状,但欲食,腹满如故,下利,
舌上白苔者为异。其脉寸浮关沉紧,痛引阴筋,脐腹胀痛者,难治也。
咽喉不利而痛,或成疮,不纳谷食,皆邪热毒瓦斯上冲而痛,甘桔苦酒汤。咽喉不利,吐脓血,
手足厥冷不止者,难治,升麻六物汤主之。
头眩者,少阳半表里之间,表邪传里,表中阳虚,故头眩。又有汗下后而眩冒者,亦阳虚所致。
少阴下利止,时头眩,时时自冒,此虚极而脱也。太阳病,若下之,因复发汗,以此表里俱虚,其
人必冒,冒家汗自出而愈。阳明病,头眩,不恶寒,能食而饮,茯苓白术甘草生姜汤。少阳证,目
眩,小柴胡汤。太阳病,发汗后汗出不解,心下悸,头眩,身 筋惕,振擗地者,真武汤。吐、汗、
下后虚而脉沉数,心下痞,胁痛,气冲咽喉不得息,身振摇,筋肉惕,久则成痿,茯苓白术桂
枝甘草汤是也。
鼻衄者,经络热盛,迫血妄行于鼻者,为衄也。是虽热盛,邪犹在经,然亦不可发汗。经曰以
桂枝、麻黄治衄,非治衄也,乃欲散经中邪气耳。其衄血固欲解,若衄不止而头面汗出,其身无汗,
及发热,汗不至足者,难治。太阳证,衄血,及服桂枝汤后致衄者,为欲解,犀角地黄汤。无汗而
衄,脉浮紧,再与麻黄汤。有汗而衄,脉浮缓,再与桂枝汤。节 曰∶此二者,盖为脉浮而设也。
若衄而成流者,不须服药,少刻自解。若点滴不成流者,必用服药无疑。经曰∶夺血者无汗,夺汗
者无血。俗人以血为红汗,厥有旨哉!衄家不可大汗,汗之必额上陷,脉紧,目直视不能 ,不眠,
芍药地黄汤。阳明漱水不欲咽,犀角地黄汤。衄而烦渴欲水,水入即吐,先服五苓散,次服竹叶石
膏汤。若少阴但厥无汗,强发之,必动其血,或从口、鼻、耳、目中出,名下厥上竭,为难治,当
归四逆汤是也。
脏结,是指脏腑之气闭塞郁结,不能正常流布运行。其外部症状与结胸证相似,但患者能进食,腹部依然胀满,伴有腹泻,舌面上有白色苔垢,这是它与结胸证的不同之处。如果脉象寸部浮、关部沉紧,疼痛牵引至阴部筋脉,脐腹部位胀痛,则属于难治之症。
咽喉部感觉不利索且疼痛,或者形成疮疡,无法进食,这都是由于邪热毒气上冲所致,可用甘桔苦酒汤治疗。若咽喉不利,吐出脓血,且手足厥冷持续不止的,属于难治之症,应以升麻六物汤为主进行治疗。
头晕目眩,多因少阳病处于半表半里之间,表邪传入体内,导致体表阳气虚弱,从而引起头晕目眩。另外,在发汗或攻下之后出现眩晕昏冒的,也是由阳气虚弱所导致。少阴病下利停止后,偶尔出现头晕,时常感到眼前发黑(自冒),这是正气极度虚弱即将脱失的表现。太阳病,如果误用攻下法,接着又重复发汗,导致表里两虚,病人必然会出现昏冒症状;这类昏冒的病人,通过自然出汗即可痊愈。阳明病,出现头晕目眩,不恶寒,能够进食并饮水,可用茯苓白术甘草生姜汤治疗。少阳病证,出现目眩,用小柴胡汤治疗。太阳病,发汗后汗出而病不解,出现心下悸动、头晕目眩、身体筋肉跳动、震颤倒地等症状,应用真武汤治疗。经过吐、汗、下法治疗后,身体虚弱且脉象沉数,心下痞塞,胁肋疼痛,气逆冲撞咽喉导致呼吸困难,身体震颤摇晃,筋肉跳动,日久可能发展为痿证,此时应使用茯苓白术桂枝甘草汤。
鼻出血,是由于经络中热势亢盛,逼迫血液妄行于鼻腔所致,称为衄血。虽然热势亢盛,但邪气仍在经络之中,然而也不可使用发汗法。经书说使用桂枝汤、麻黄汤治疗衄血,并非直接治疗衄血本身,而是为了疏散经络中的邪气。如果鼻血流出后病情自然解除,但若鼻血不止且头面部出汗,身体其他部位无汗,以及发热、汗液达不到足部的,属于难治之症。太阳病证,出现鼻出血,以及服用桂枝汤后导致鼻出血的,是病情将要解除的征兆,可用犀角地黄汤治疗。无汗且鼻出血,脉象浮紧的,再次给予麻黄汤。有汗且鼻出血,脉象浮缓的,再次给予桂枝汤。陶节庵说:这两种情况,大概是针对脉象浮的情况而设立的。如果鼻血像水流一样连续不断,不需要服药,片刻之后自然会缓解。如果是点滴不成流的,必须服药无疑。经书说:大量失血的人不宜发汗,大量出汗的人不宜耗血。世俗之人将血称为“红汗”,这确实很有深意!经常鼻出血的人不可大汗,若强行发汗必导致额部凹陷、脉象紧、两眼直视不能转动、失眠,此时应用芍药地黄汤。阳明病表现为想含水漱口但不欲吞咽的,用犀角地黄汤。鼻出血且烦躁口渴想喝水,但水入即吐的,先服用五苓散,随后服用竹叶石膏汤。如果是少阴病仅见四肢厥冷而无汗,强行发汗,必定扰动血液,导致血液从口、鼻、耳、眼中流出,这种病症名为“下厥上竭”,属于难治之症,应当使用当归四逆汤。
Zangjie (Organ Knotting) refers to the condition where the qi of the zang organs is blocked and knotted, failing to circulate freely. The external manifestations resemble those of Juxiong (Chest Binding), but the patient is able to eat, abdominal distension persists, diarrhea occurs, and there is a white coating on the tongue; these are the distinguishing features from Juxiong. If the pulse is floating at the cun position and deep-tight at the guan position, with pain radiating to the yin tendons and distending pain in the umbilical and abdominal regions, it is difficult to treat.
If the throat feels obstructed and painful, or sores form, preventing the intake of food, this is caused by pathogenic heat and toxic vapors rushing upward. Ganju Kujiu Tang (Licorice and Honey Decoction) should be used. If the throat is obstructed, pus and blood are expectorated, and coldness of the hands and feet persists without stopping, it is difficult to treat; Shengma Liuwu Tang (Rhizoma Cimicifugae Six-Ingredient Decoction) is the primary treatment.
Dizziness (Xuan) often occurs when Shaoyang disease is between the exterior and interior. When exterior pathogens transmit inward, deficiency of yang qi in the exterior leads to dizziness. Additionally, dizziness and vertigo occurring after sweating or purging methods are also caused by yang deficiency. In Shaoyin disease, if diarrhea stops but dizziness occurs occasionally, accompanied by frequent sensations of faintness or blacking out (Zimao), this indicates extreme deficiency and impending collapse. In Taiyang disease, if purging is mistakenly applied followed by repeated sweating, causing deficiency in both the interior and exterior, the patient will inevitably experience faintness. Patients with such faintness will recover through spontaneous sweating. In Yangming disease, if dizziness occurs without aversion to cold, and the patient can eat and drink, Fuling Baizhu Gancao Shengjiang Tang (Poria, Atractylodes Macrocephala, Licorice, and Fresh Ginger Decoction) should be used. For Shaoyang syndrome with dizziness of the eyes, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated. In Taiyang disease, if after sweating the illness does not resolve, and symptoms include palpitations below the heart, dizziness, twitching of muscles, and trembling falling to the ground, Zhenwu Tang (True Warrior Decoction) should be administered. After vomiting, sweating, or purging, if the body is weak with a deep-rapid pulse, epigastric fullness (Pi), hypochondriac pain, qi rushing to the throat causing dyspnea, body tremors, and muscle twitching, which may eventually develop into Wei syndrome (flaccidity syndrome), Fuling Baizhu Guizhi Gancao Tang (Poria, Atractylodes Macrocephala, Cinnamon Twig, and Licorice Decoction) is appropriate.
Nosebleed (Nu) occurs when excessive heat in the meridians forces blood to flow recklessly into the nasal cavity. Although heat is excessive and pathogens remain in the meridians, sweating methods must not be used. The classics state that using Guizhi Tang (Cinnamon Twig Decoction) or Mahuang Tang (Ephedra Decoction) for nosebleed is not to treat the bleeding itself, but to disperse pathogenic qi in the meridians. If nosebleeding resolves spontaneously, it indicates recovery. However, if bleeding continues with sweating only on the head and face, no sweat on the body, fever, and sweat failing to reach the feet, it is difficult to treat. In Taiyang syndrome, nosebleeding, or nosebleeding induced after taking Guizhi Tang, indicates that the disease is about to resolve; Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used. If there is no sweat and nosebleeding occurs with a floating-tight pulse, administer Mahuang Tang again. If there is sweat and nosebleeding with a floating-slow pulse, administer Guizhi Tang again. Tao Jie'an stated: These two scenarios are set for cases with a floating pulse. If the nosebleed flows continuously like water, medication is unnecessary as it will resolve spontaneously in a short time. If it drips drop by drop without forming a stream, medication is undoubtedly required. The classics say: "Those who have lost blood should not sweat; those who have lost sweat should not lose blood." Laypeople refer to blood as "red sweat," which holds profound meaning. Patients prone to nosebleeds should not undergo heavy sweating; forcing sweat will lead to sunken temples, tight pulse, fixed staring gaze, inability to turn the eyes, and insomnia; Shaoyao Dihuang Tang (Peony and Rehmannia Decoction) should be used. In Yangming disease, if the patient rinses their mouth with water but does not wish to swallow, Xijiao Dihuang Tang is indicated. If nosebleeding is accompanied by irritability, thirst, desire for water, but regurgitation immediately upon drinking, first administer Wuling San (Five-Ingredient Powder with Poria), followed by Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). In Shaoyin disease, if there is only cold limbs without sweat, and sweating is forced, it will disturb the blood, causing bleeding from the mouth, nose, ears, or eyes. This condition is named Xiajue Shangjie (Lower Cold and Upper Exhaustion) and is difficult to treat; Danggui Sini Tang (Angelica Sinensis and Cinnamon Twig Decoction) should be used.