口吐涎沫不作渴。呕逆腹疼四肢厥。爪唇青黑是真寒。回阳救急功尤捷。(此足厥
阴直中寒症也。其脉沉迟无力宜温之)
回阳救急半甘苓。熟附干姜肉桂参。白术陈皮五味子。治寒直中厥阴经。
夫伤寒三阴有传经之热症。有直中之寒邪。自是两途。岂容混治。其可用不可用之理。
果何哉。若能辨其因。正其名。察其形。治法焉有不当者乎。
结胸五种须分别。大小结胸并水结。热实结胸烦躁多。寒实结胸浑不热。
按伤寒太阳经症。表未解而医遽下之。表邪乘虚入里。在五六日便坚口渴。日晡
潮热
。上至心下。下至小腹硬满而痛不可按者。乃大结胸也。宜大陷胸汤主之。或心下硬满。
按之则痛。是必待按。然后作痛。况止在心下。则小腹之不硬痛可知矣。热征于前。故曰小
结胸也。宜小陷胸汤主之。或水饮停胸。水结胸也。小半夏加茯苓汤主之。或热多烦躁。热
实结胸也。如大柴胡六一顺气汤。皆可选用也。或寒多无热。寒实结胸也。枳实理中汤主之
。
大陷胸汤大黄硝。甘遂同煎力更饶。邪在胸中宜陷下。体虚胃弱漫轻调。小陷胸汤半夏
连。
栝蒌实共水同煎。苦能泄热辛能散。利下黄涎即便安。小半夏加茯苓汤。行水散痞有生姜。
加桂去夏治悸厥。茯苓甘草汤名彰。
口吐涎沫且不口渴。呕吐逆气、腹痛、四肢厥冷。指甲和嘴唇呈现青黑色,这是真正的寒证。使用回阳救急汤功效尤为迅速。(这是足厥阴经直中寒邪的病证。其脉象沉迟无力,适宜用温法治疗)
回阳救急汤由半夏、甘草、茯苓组成。加上熟附子、干姜、肉桂、人参。再加入白术、陈皮、五味子。用于治疗寒邪直中厥阴经。
伤寒在三阴经有传经而来的热证,也有直中的寒邪。这原本是两条不同的路径,怎么可以混淆治疗呢?其中可用与不可用的道理,究竟是什么呢?如果能辨别病因,端正病名,观察症状表现,治疗方法哪里会有不恰当的?
结胸分为五种需要分别对待:大结胸、小结胸以及水结胸。热实结胸表现为烦躁较多。寒实结胸则完全没有发热。
根据伤寒太阳经的病症,如果表证未解而医生急于使用下法,表邪就会乘虚进入体内。如果在五六天后大便坚硬、口渴,并且潮热在日晡时发作,疼痛从心下向上延伸至胸部,向下至小腹硬满且疼痛拒按的,这就是大结胸。应当以大陷胸汤为主治方剂。或者只是心下硬满,只有按压时才疼痛,必须等待按压后才产生疼痛,况且疼痛仅在心下部位,那么小腹不硬不痛的情况就可以推知了。热象征见于前部,所以称为小结胸。应当以小陷胸汤为主治方剂。或者是水饮停留在胸中,即水结胸。应当用小半夏加茯苓汤主治。或者是热多烦躁,即热实结胸。如大柴胡汤、六一顺气汤等,都可以选择使用。或者是寒多无热,即寒实结胸。应当以枳实理中汤主治。
大陷胸汤包含大黄、芒硝,与甘遂同煎,力量更加雄厚。邪气在胸中适宜用陷下之法,但体质虚弱、胃气弱者切勿轻易调理。小陷胸汤由半夏、黄连、栝蒌实共同与水同煎。苦味能泄热,辛味能散结,排出黄涎后病情即可安定。小半夏加茯苓汤,具有行水、消散痞块的作用,并加入生姜。若加入桂枝、去掉半夏则是治疗悸动和厥冷的方剂,名为茯苓甘草汤,名声显赫。
Saliva is vomited out without thirst. Vomiting, epigastric pain, and cold limbs. Cyanosis of the nails and lips indicates true Cold syndrome. Huayang Jiujii Tang (Decoction for Restoring Yang and Saving from Crisis) offers particularly rapid efficacy. (This refers to the direct invasion of Cold pathogen into the Foot Jueyin Meridian. The pulse is deep, slow, and forceless, indicating that warming therapy is appropriate.)
Huayang Jiujii Tang consists of Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), and Fuling (Poria). It includes Shu Fuzi (Prepared Aconiti Lateralis Radix), Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), and Renshen (Ginseng Radix). Additionally, Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Wuweizi (Schisandrae Chinensis Fructus) are added. It treats Cold pathogen directly invading the Jueyin Meridian.
In Taiyang disease affecting the Three Yin meridians, there are heat syndromes transmitted via the meridians, and there are Cold pathogens invading directly. These are two distinct pathways; how can they be treated indiscriminately? What is the rationale for what is applicable and what is not? If one can distinguish the cause, correctly name the disease, and observe the manifestations, how could the treatment method be inappropriate?
Jie Xiong (Chest Binding) presents in five types that must be distinguished: Da Jie Xiong (Major Chest Binding), Xiao Jie Xiong (Minor Chest Binding), and Shui Jie Xiong (Water Chest Binding). Re Shi Jie Xiong (Heat-Excess Chest Binding) manifests with significant irritability. Han Shi Jie Xiong (Cold-Excess Chest Binding) presents without fever.
According to Taiyang Meridian symptoms of Shanghan (Cold Damage), if the exterior syndrome is unresolved and the physician hastily applies purgation, the exterior pathogen enters the interior due to deficiency. If after five or six days the stool becomes hard, thirst occurs, and tidal fever arises at Dingwu time (3-5 PM), with pain extending from the epigastrium upwards to the chest and downwards to the lower abdomen, characterized by hardness, fullness, and pain that cannot be pressed upon, this is Da Jie Xiong. It should be primarily treated with Daxiexiong Tang (Major Decoction to Sink the Chest). Alternatively, if there is only hardness and fullness in the epigastrium, and pain occurs only upon pressing, requiring pressure to elicit pain, and since the pain is confined to the epigastrium, it can be inferred that the lower abdomen is neither hard nor painful. Since heat signs appear anteriorly, it is called Xiao Jie Xiong. It should be primarily treated with Xiaoxiexiong Tang (Minor Decoction to Sink the Chest). Or, if fluid retention stops in the chest, it is Shui Jie Xiong. It should be primarily treated with Xiaobanxia Jia Fuling Tang (Minor Pinellia Decoction plus Poria). Or, if there is excess heat and irritability, it is Re Shi Jie Xiong. Such formulas as Dachaihu Tang (Major Bupleurum Decoction) and Liuyi Shunqi Tang (Six-One Regulating Qi Decoction) may be selected. Or, if there is excess cold without fever, it is Han Shi Jie Xiong. It should be primarily treated with Zhishi Lizhong Tang (Immature Bitter Orange Decoction to Regulate the Middle).
Daxiexiong Tang contains Dahuang (Rhei Radix et Rhizoma) and Xiaoshao (Natrii Sulfas), decocted together with Gansui (Kansui Radix), making its power even more potent. When the pathogen is in the chest, sinking methods are appropriate; however, do not lightly adjust treatment for those with weak constitution and stomach. Xiaoxiexiong Tang consists of Banxia (Pinelliae Rhizoma), Huanglian (Coptidis Rhizoma), and Gualou Shi (Trichosanthis Fructus), decocted together with water. Bitterness can drain heat, and pungency can disperse accumulation; expelling yellow saliva brings immediate relief. Xiaobanxia Jia Fuling Tang moves fluids and dissipates痞 (glomus/fullness) with the addition of Shengjiang (Zingiberis Rhizoma Recens). Adding Guizhi (Cinnamomi Ramulus) and removing Banxia treats palpitations and cold limbs; this is known as Fuling Jiangzhi Tang (Poria and Ginger Decoction), which is renowned.