伤寒若吐若下后七八日不解热结在里表里俱热时时恶风大渴舌上干燥而烦欲饮水数升者白虎加人参汤主之(方在太
阳三十九)
吐下之后气夺津伤七八日不解燥热内盛而自里达表表里俱热热蒸窍泄时时恶风舌上干燥而心内焦烦欲饮水数升之多
主以人参白虎清金而泄热化气而生津也
太阳病先下之而不愈因复发汗以此表里俱虚其人因致冒冒家汗出则自愈所以然者汗出表和故也得里未和然后下之
太阳病先下之而不愈伤其阴液因复发汗伤其阳津表阳里阴以此俱虚表阳虚则阴气外束里阴虚则阳气内郁阳气内郁而
不外达其人因致昏冒冒家汗出则自愈所以然者汗出则卫气外达经脉和畅阴退而阳宣也表和之后得里未和然后下之
发汗后恶寒者虚故也不恶寒反恶热者实也当和胃气与调胃承气汤(方在阳明二十)
阳虚之人汗则亡阳阴虚之人汗则亡阴汗后恶寒者气泄而阳虚故也故防入少阴不恶寒反恶热者津伤而阳实故也是已入
阳明将成大承气证宜早以调胃承气和其胃气预夺其实也
太阳病中风以火劫发汗邪风被火热血气流溢失其常度两阳相薰灼其身发黄阳盛则欲衄阴虚则小便难阴阳俱虚竭身体则枯燥但头汗出剂颈而还腹满微喘口干咽烂或不大便久则谵语甚者至哕手足躁扰捻衣摸床小便利者其人可治
太阳中风以火劫发汗邪风一被火热血气流溢而失其常度外劫之火与内郁之阳两相薰灼其身发黄上之阳盛则欲衄下之
阴虚则小便难阴液阳津俱至虚竭身体则枯燥不润阳气上燔但头汗出际颈而还里气 郁而为胀满肺气壅阻而为微喘火炎于
上口干而咽烂其时或不大便久则卫郁莫泄浊气薰心而为谵语甚者胃气冲逆而为呕哕或手足躁扰捻衣摸床凡此诸证总以表里壅遏热无泄路故郁闷懊 烦乱如是宜以辛凉之药双泄表里若小便利者是阴气未绝其人可治也 此证湿热郁蒸宜以麻黄
石膏泄其表热大黄芒硝泄其里热半夏生姜降其逆猪苓滑石渗其湿表里双清则神气慧爽矣
伤寒病经过催吐或泻下治疗后,过了七八天病情仍未解除,热邪结聚在体内,表里都有发热,时常感到怕风,极度口渴,舌面干燥且心烦,想要喝几升水,应当用白虎加人参汤主治(该方剂记载在太阳篇第三十九节)。
经过催吐或泻下后,正气受损、津液耗伤,过了七八天病情未解,燥热在体内旺盛并向外透达,导致表里俱热。热气蒸腾使腠理开泄,所以时常怕风;舌面干燥,心中焦躁烦乱,想要喝好几升水。治疗应以人参白虎汤为主,清肃肺气以泄热,化生元气以生津。
太阳病先用攻下法治疗但病未愈,接着又发汗,因为这样导致表里气血都虚弱,病人因此出现头昏目眩如物蒙蔽的症状(冒证)。患冒证的病人,待汗出之后就会自愈。之所以这样,是因为汗出后表气调和的缘故。等到表证已和,若里证仍未调和,然后再用攻下法治疗。
太阳病先用攻下法治疗但病未愈,损伤了阴液,接着又发汗,损伤了阳津。表阳虚则阴气外束,里阴虚则阳气内郁。阳气在内郁结而不能外达,病人因此出现昏冒。患冒证的病人,待汗出之后就会自愈。之所以这样,是因为汗出后卫气得以外达,经脉和畅,阴邪退去而阳气宣通。表气调和之后,若里证仍未调和,然后再用攻下法治疗。
发汗后如果感到怕冷,这是虚证的表现;如果不怕冷反而怕热,这是实证的表现。此时应当调和胃气,给予调胃承气汤主治(该方剂记载在阳明篇第二十节)。
阳气虚弱的人发汗会导致亡阳,阴液虚弱的人发汗会导致亡阴。发汗后怕冷,是因为气随汗泄导致阳虚,所以要防止病邪传入少阴经;不怕冷反而怕热,是因为津液受伤导致阳热实证,这说明病邪已经传入阳明经,即将形成大承气汤证。应当尽早使用调胃承气汤调和胃气,预先消除实热。
太阳病中风,用火法强行发汗,邪风被火热逼迫,血与气运行紊乱溢出,失去了正常的规律。风火两阳相互熏灼,身体发黄。阳热盛则想流鼻血,阴液虚则小便困难。阴阳俱虚竭,身体干枯无泽,只有头部出汗,齐颈而止,腹部胀满,轻微气喘,口干咽喉溃烂,或者大便不通。时间久了会出现胡言乱语(谵语),严重的甚至出现呃逆(哕),手足躁动不安,抓空摸床。如果小便通畅,说明其人还有生机,可以治愈。
太阳中风用火法强行发汗,邪风被火热逼迫,血气流溢而失去常度。外来的劫火与内部郁积的阳气两相熏灼,身体发黄。上部阳热盛则想流鼻血,下部阴液虚则小便困难。阴液和阳津都极度虚弱枯竭,身体干枯不润。阳气上炎,只有头部出汗,齐颈而止。里气郁结导致胀满,肺气壅阻导致轻微气喘。火炎于上,导致口干咽烂。此时可能大便不通,时间久了卫气郁闭无法宣泄,浊气熏心导致胡言乱语。严重的胃气冲逆导致呕吐呃逆,或者手足躁动,抓衣摸床。所有这些症状,总归是因为表里壅遏,热邪没有出路,所以郁闷懊恼,烦乱如此。应当用辛凉的药物同时清泄表里之热。如果小便通畅,说明阴气未绝,人可以治愈。此证属于湿热郁蒸,宜用麻黄、石膏泄除表热,大黄、芒硝泄除里热,半夏、生姜降逆止呕,猪苓、滑石渗利湿邪。表里双清,神气就能清爽了。
If after a Taiyang disease treated with emesis or purgation, for seven to eight days the condition remains unresolved, with heat accumulating internally and manifesting as fever in both the exterior and interior, occasional aversion to wind, extreme thirst, dryness on the tongue accompanied by vexation, and a desire to drink several liters of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) should be administered (see Taiyang 39).
Following emesis or purgation, qi is depleted and body fluids are injured. After seven to eight days, if the condition remains unresolved, dry-heat becomes excessive internally and radiates outward, causing fever in both the interior and exterior. The steaming heat causes the pores to open, leading to occasional aversion to wind. The tongue is dry, and there is internal scorching vexation with a desire to drink several liters of water. The treatment principle is to use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) to clear Metal (Lung) and drain heat, transform Qi, and generate fluids.
In a Taiyang disease, if initial purgation fails to resolve it, followed by sweating, this results in deficiency in both the exterior and interior. Consequently, the patient experiences "Mao" (a sensation of being hooded or dizzy/confusion). For patients with Mao syndrome, spontaneous sweating leads to self-healing. This is because sweating harmonizes the exterior. Only after the exterior is harmonized, if the interior remains unharmonized, should purgation be employed.
In a Taiyang disease, initial purgation injures Yin fluids, and subsequent sweating injures Yang fluids. Exterior Yang deficiency allows Yin Qi to bind externally, while Interior Yin deficiency causes Yang Qi to stagnate internally without reaching the exterior. This internal stagnation of Yang leads to dizziness/confusion (Mao). For patients with Mao syndrome, spontaneous sweating leads to healing because it allows Wei Qi (Defensive Qi) to reach the exterior, meridians to flow smoothly, Yin to recede, and Yang to disperse. After the exterior is harmonized, if the interior remains unharmonized, purgation should then be used.
After sweating, if aversion to cold occurs, it indicates deficiency; if there is no aversion to cold but rather aversion to heat, it indicates excess. In such cases, one should harmonize the Stomach Qi using Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) (see Yangming 20).
For those with deficient Yang, sweating leads to loss of Yang; for those with deficient Yin, sweating leads to loss of Yin. Aversion to cold after sweating indicates Qi leakage and Yang deficiency, requiring prevention of transmission to Shaoyin. Lack of aversion to cold with aversion to heat indicates fluid injury and Yang excess, indicating transmission to Yangming, potentially evolving into Da Chengqi Tang syndrome. Early administration of Tiaowei Chengqi Tang is appropriate to harmonize Stomach Qi and preemptively drain excess.
In Taiyang Wind Strike, if fire therapy is used to force sweating, pathogenic wind combined with fire disturbs the flow of blood and Qi, disrupting normal physiological patterns. The two Yang pathogens (wind and fire) scorch each other, causing jaundice. Excess Yang may lead to epistaxis; Yin deficiency leads to difficult urination. With both Yin and Yang exhausted, the body becomes dry and withered. Sweating is limited to the head up to the neck. Abdominal fullness, slight wheezing, dry mouth, and sore throat occur. Constipation may develop, leading to delirium over time. Severe cases present with hiccups, restlessness of hands and feet, and picking at clothes or beds. If urine flows freely, the prognosis is treatable.
Fire therapy forcing sweat in Taiyang Wind Strike causes pathogenic wind and fire to disrupt blood and Qi flow. External fire and internal stagnant Yang scorch each other, causing jaundice. Upper Yang excess suggests epistaxis; lower Yin deficiency suggests dysuria. Exhaustion of Yin fluids and Yang essence leads to a dry, unwashed appearance. Yang flaming upward causes head-only sweating up to the neck. Internal Qi stagnation causes abdominal fullness; Lung Qi obstruction causes slight wheezing. Fire flaming upward causes dry mouth and throat ulceration. Constipation may occur; prolonged stagnation of Wei Qi and turbid Qi harassing the Heart leads to delirium. Severe Stomach Qi rebellion causes vomiting and hiccups, or restless extremities and picking behaviors. These symptoms arise from exterior-interior blockage with no outlet for heat, causing deep depression and agitation. Treatment requires acrid-cool herbs to simultaneously clear exterior and interior heat. Free urination indicates intact Yin Qi and a treatable condition. This pattern involves damp-heat stagnation: use Mahuang (Ephedrae Herba) and Shigao (Gypsum Fibrosum) to release exterior heat; Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) to drain interior heat; Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) to descend rebellious Qi; Zhuling (Polyporus) and Huashi (Talcum) to leach out dampness. Clearing both exterior and interior restores mental clarity.