呕病因何属少阳?表入里拒故为殃,太阳之呕表不解,食谷欲呕在胃阳,太阴有吐
而无呕,厥阴涎沫吐蛔长,少阴呕利有水气,饮呕相因是水乡。
【注】呕病诸经皆有,因何属少阳也?因表邪入里,里气拒格,上逆作呕,故为殃属
少阳也,宜小柴胡汤。心下硬而烦,或不大便,宜大柴胡汤,表不解之呕属太阳也,宜
柴桂汤。食谷欲呕,属胃阳,胃阳,阳明也。属中寒,宜吴茱萸汤。得汤更呕属表热,宜
葛根加半夏汤,呕吐涎沫,或呕吐蛔,属厥阴也,宜吴茱萸汤。吐蛔者,宜乌梅丸。呕
而下利,是有水气,属少阴也,宜真武汤。饮而呕,呕而饮,饮呕相因不已,是停水也,宜
五苓散。
往来寒热少阳证,寒热相因小柴胡,如疟寒热三五发,太阳麻桂等汤除。
【注】寒而热,热而寒,寒热相因不已,故名曰往来寒热,为少阳主证,宜小柴胡汤。
寒热而有作止之常,一日一次,或隔日一次,谓之疟,属杂病也。寒热而无作止之常,日
三、五发,谓之如疟,属太阳经未尽之表邪也,宜麻桂各半汤。若热多寒少,宜桂枝二
越婢一汤。若有汗,宜桂枝二麻黄一汤。若无汗,亦宜麻桂各半汤。此皆治太阳未尽之
微邪法也。
少阳目眩神自正,诸逆昏乱不能生,重蝎耳聋湿温汗,不语面色变身青。
【注】目眩者,目黑不明也。耳聋者,耳无所闻也。皆少阳经主证,非死候也。其目
之明,其耳之聪,神自完整。若因三法失宜,致诸变逆坏证,目眩而神昏言乱,乃神散气
脱之候,故曰不能生也。若因误发湿温家汗而不能言语,耳聋无闻,身青面色变者,名
曰重 ,亦死证也。
呕吐的病因为何归属于少阳?是因为表邪入里,导致里气抗拒格拒,从而引发祸殃。太阳病的呕吐是由于表证未解;进食后想要呕吐,属于胃阳不足(中焦虚寒);太阴病只有吐而没有呕;厥阴病表现为吐出涎沫或蛔虫;少阴病呕吐伴下利且伴有水气,这是饮水与呕吐相互影响所致的水饮内停之象。
【注】呕吐一症各经都可能出现,为何特别归属于少阳呢?因为表邪进入体内,里气抗拒格拒,气机上逆导致呕吐,所以这种祸殃归属于少阳,适宜使用小柴胡汤。如果心下痞硬且烦躁,或者不大便,适宜使用大柴胡汤。表证未解引起的呕吐归属于太阳病,适宜使用柴桂汤。进食后想要呕吐,归属于胃阳不足,这里的胃阳指的是阳明经。如果属于中焦虚寒,适宜使用吴茱萸汤。服用吴茱萸汤后呕吐反而加重,说明属于表热,适宜使用葛根加半夏汤。呕吐涎沫,或者呕吐蛔虫,归属于厥阴病,适宜使用吴茱萸汤。如果是吐蛔虫,适宜使用乌梅丸。呕吐并伴有下利,是有水气存在,归属于少阴病,适宜使用真武汤。饮水后呕吐,呕吐后又想饮水,饮水和呕吐相互影响不停止,这是水饮停滞,适宜使用五苓散。
往来寒热是少阳病的典型证候,寒热交替出现应使用小柴胡汤治疗。如果像疟疾一样寒热发作三五次,这是太阳病未尽的表邪,应用麻黄汤、桂枝汤等方剂祛除。
【注】先冷后热,先热后冷,寒热交替不停止,所以称为“往来寒热”,这是少阳病的主证,适宜使用小柴胡汤。寒热发作有规律,一天一次,或者隔天一次,这称为疟疾,属于杂病范畴。寒热发作没有规律,一天发作三到五次,这称为“如疟”(类似疟疾),属于太阳经未尽的表邪,适宜使用麻桂各半汤。如果热多寒少,适宜使用桂枝二越婢一汤。如果有汗,适宜使用桂枝二麻黄一汤。如果没有汗,也适宜使用麻桂各半汤。这些都是治疗太阳病未尽微邪的方法。
少阳病出现目眩,神志自然保持端正;各种逆乱导致的昏乱则无法生存。误治湿温病发汗会导致耳聋、不语、面色变青的重证。
【注】目眩是指眼睛昏暗不明。耳聋是指耳朵听不见声音。这些都属于少阳经的主证,并非死证。只要眼睛能看清,耳朵能听见,神气就是完整的。如果因为误用汗、吐、下三法不当,导致各种变证坏证,出现目眩且神志昏迷、言语错乱,这是神气涣散、元气脱失的征象,所以说无法生存。如果因为误对湿温病患者发汗,导致不能言语、耳聋听不见、身体发青面色改变,这称为“重暝”(重证昏厥),也是死证。
Why is the etiology of vomiting attributed to Shaoyang (Lesser Yang)? It is because pathogenic factors from the exterior penetrate inward, causing rejection and obstruction by the interior Qi, leading to adverse consequences. Vomiting in Taiyang disease (Greater Yang) occurs when the exterior syndrome remains unresolved; desire to vomit after eating indicates deficiency of Stomach Yang (Middle Jiao Deficiency Cold); Taeyin disease presents with spitting but not retching; Jueyin disease manifests as vomiting saliva or roundworms; Shaoyin disease involves vomiting accompanied by diarrhea and fluid retention, where drinking and vomiting exacerbate each other, indicating internal water accumulation.
[Note] Vomiting can occur in various meridians; why is it specifically attributed to Shaoyang? Because exterior pathogens enter the interior, causing interior Qi to reject and obstruct, leading to upward rebellion and vomiting; thus, this adverse condition belongs to Shaoyang, and Xiao Chai Hu Tang (Minor Bupleurum Decoction) is appropriate. If there is epigastric hardness and irritability, or constipation, Da Chai Hu Tang (Major Bupleurum Decoction) is appropriate. Vomiting due to unresolved exterior syndrome belongs to Taiyang, and Chai Gui Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate. Desire to vomit after eating belongs to Stomach Yang deficiency; here, Stomach Yang refers to the Yangming meridian. If it belongs to Middle Jiao Deficiency Cold, Wu Zhu Yu Tang (Evodia Decoction) is appropriate. If vomiting worsens after taking Wu Zhu Yu Tang, it indicates exterior heat, and Gegen Banxia Tang (Kudzu Root and Pinellia Decoction) is appropriate. Vomiting saliva or roundworms belongs to Jueyin, and Wu Zhu Yu Tang (Evodia Decoction) is appropriate. For those vomiting roundworms, Wumei Wan (Mume Pill) is appropriate. Vomiting accompanied by diarrhea indicates the presence of fluid retention, belonging to Shaoyin, and Zhen Wu Tang (True Warrior Decoction) is appropriate. Drinking followed by vomiting, or vomiting followed by a desire to drink, where drinking and vomiting perpetuate each other, indicates stagnant water, and Wuling San (Five-Ingredient Powder with Poria) is appropriate.
Alternating chills and fever are the hallmark syndrome of Shaoyang; alternating chills and fever should be treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). If chills and fever occur like malaria, three to five times, it indicates residual exterior pathogens in Taiyang, which should be expelled using Mahuang Tang (Ephedra Decoction), Guizhi Tang (Cinnamon Twig Decoction), etc.
[Note] Chills followed by fever, or fever followed by chills, occurring incessantly, is named "alternating chills and fever," which is the principal syndrome of Shaoyang, and Xiao Chai Hu Tang (Minor Bupleurum Decoction) is appropriate. If chills and fever have a regular pattern of onset and cessation, occurring once a day or every other day, it is called malaria, which belongs to miscellaneous diseases. If chills and fever lack a regular pattern, occurring three to five times a day, it is called "like malaria," indicating residual mild exterior pathogens in the Taiyang meridian, and Mawei Gehan Tang (Half-Ma Huang Half-Gui Zhi Decoction) is appropriate. If heat predominates over cold, Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Minor Bupleurum and Gypsum Decoction) is appropriate. If there is sweating, Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction) is appropriate. If there is no sweating, Mawei Gehan Tang (Half-Ma Huang Half-Gui Zhi Decoction) is also appropriate. These are all methods for treating residual mild pathogens in Taiyang.
Shaoyang disease presents with vertigo/dizziness, while the spirit naturally remains upright; severe reversal and confusion lead to inability to survive. Mismanagement of damp-warmth disease through sweating leads to deafness, muteness, and cyanosis of the body and face.
[Note] Vertigo refers to dim and unclear vision. Deafness refers to the inability to hear sounds. Both are principal syndromes of the Shaoyang meridian and are not fatal signs. As long as vision is clear and hearing is acute, the spirit is intact. However, if improper use of sweating, purging, or emetic methods leads to various complicated and damaged syndromes, resulting in vertigo with coma and disordered speech, this is a sign of dissipating spirit and collapsing Qi, hence it is said that survival is impossible. If mistaking damp-warmth patients for treatment by inducing sweating results in muteness, deafness, cyanosis of the body, and altered facial color, this is termed "Zhong Ming" (Severe Coma), which is also a fatal condition.