太阳发汗用青龙。误服之时肾气空。厥逆身 何药救。方名真武可收功。
发汗者。谓发汗过多。乃误服大青龙汤所致。仲景曰。若脉微弱。汗出恶风。不可服此
。服
之则厥逆筋惕肉 。此为逆也。此亦少阴过汗亡阳之症。故俱用真武汤以救其误。盖取固肾
为义也。
战动于身栗动心。二邪胜负两般寻。振振汗出将全愈。鼓颔虚寒四逆平。
战者。身为之摇也。栗者。心战而惕也。此伤寒欲解。将汗之时。邪正相争。故战振而
股栗
也。然战栗有属阳者。真气来复。正气鼓动。外争而胜。故身为振摇。遂大汗而解也。有属
阴者。阳微阴胜。邪气内争。而正不胜。故心寒足蜷。鼓颔厥冷。而一身战摇也。宜四逆汤
温之。
太阳合胃脉浮长。若是浮弦合少阳。胆合胃时弦不短。黄芩承气葛根详。
合病者。谓二阳经。或三阳经同病。病之不传者也。凡三阳合病。必互相下利。如太阳
阳明
合病下利。脉浮长者。葛根汤主之。如太阳少阳合病下利。脉浮弦者。黄芩汤主之。如少阳
阳明合病下利。脉弦长者。小承气汤主之。若脉长大而弦。利不止。不食。病名曰负。负者
失也。土败木贼则死也。
太阳原与阳明并。复病归来作一家。尚有太阳宜各半。太阳症罢大承瘥。
并病者。谓一经先受病。又过一经病之传者也。如太阳阳明若并而未尽。是谓未过。仲景所谓太阳
病不
罢。面赤。阳气怫郁。在表不得越。烦躁短气是也。犹当汗之以各半汤。若并之已尽。是谓
传过。仲景所谓太阳病罢。潮热。手足汗出。大便硬而谵语是也。法当下之。以大承气汤。
是知传则入腑。不传则不入腑。并病传变有如此。
太阳病发汗,应使用大青龙汤。若误服此药,会导致肾气空虚。出现四肢厥冷、身体震颤等症状时,用什么药物来救治?方剂名为真武汤可以取得疗效。
所谓“发汗过多”,是指发汗太过,这是误服大青龙汤所导致的后果。张仲景说:如果脉象微弱,出汗且怕风,不可服用大青龙汤。如果服用了,就会出现四肢厥冷、筋脉跳动、肌肉抽搐的症状,这属于逆证(治疗错误导致的坏病)。这也是少阴病过汗导致亡阳的症候,所以都使用真武汤来补救其失误。这是因为取用真武汤旨在固护肾脏阳气。
身体颤抖是外在表现,心中战栗是内在感受,这两种邪气的胜负情况需要分别探寻。如果是振颤伴有大汗出,即将痊愈;如果是咬牙鼓颔、虚寒症状,需用四逆汤平复。
“战”是指身体摇动,“栗”是指内心战栗惊恐。这是伤寒病将要解除、准备出汗的时候,邪气与正气相互争斗,所以出现身体振颤和大腿肌肉抽搐。然而,战栗有属阳和属阴两种情况。属阳者,是真气恢复,正气鼓动,与外邪抗争并获胜,所以身体振摇,随后大汗出而病解。属阴者,是阳气微衰、阴气盛极,邪气在内争斗,正气不能胜任,所以心中寒冷、双脚蜷缩、咬牙鼓颔、四肢厥冷,全身战摇。这种情况适宜用四逆汤温补。
太阳病兼见胃经症状时,脉象浮长;如果是浮弦脉,则是兼见少阳经。胆经与胃经同病时,脉象弦而不短促,可用黄芩承气汤或葛根汤详细辨证施治。
所谓“合病”,是指两条阳经,或三条阳经同时发病,病情没有传变的情况。凡是三阳合病,必定互相影响出现下利。例如太阳阳明合病出现下利,脉象浮长的,用葛根汤主治。例如太阳少阳合病出现下利,脉象浮弦的,用黄芩汤主治。例如少阳阳明合病出现下利,脉象弦长的,用小承气汤主治。如果脉象长大而弦,下利不止,不能进食,这种病名叫“负”。“负”意味着失败,脾土败坏被肝木克制就会死亡。
太阳病原本与阳明病并见,再次发病归来如同一家。如果还有太阳表证未解,宜用桂枝二越婢一汤(注:原文作各半汤,通常指桂枝二越婢一汤或柴胡桂枝干姜汤等,此处依原文译);如果太阳病症已罢,出现大承气汤证则病愈。
所谓“并病”,是指一条经先受病,又传入另一条经,病情发生传变。例如太阳阳明并病如果并未完全传尽,这叫“未过”。正如张仲景所说:太阳病未罢,面部发红,阳气怫郁在表不得发散,出现烦躁、短气等症状,此时仍应当用汗法,使用桂枝二越婢一汤(各半汤)。如果并病已经完全传变,这叫“传过”。正如张仲景所说:太阳病已罢,出现潮热、手足汗出、大便硬结且谵语等症状,此时法治应当用下法,使用大承气汤。由此可知,传变则入腑,不传变则不入腑。并病的传变规律就是这样。
Taiyang (Sun) disease requiring diaphoresis should utilize Da Qing Long Tang (Great Blue Dragon Decoction). If taken erroneously, Kidney Qi (Vital Energy of the Kidney) becomes empty. When limb coldness (Jue Ni) and body tremors occur, what medicine can save the patient? The formula named Zhen Wu Tang (True Warrior Decoction) can achieve success.
"Excessive sweating" refers to sweating too much, which is caused by the erroneous administration of Da Qing Long Tang. Zhang Zhongjing stated: If the pulse is weak and faint, with spontaneous sweating and aversion to wind, this formula must not be taken. If taken, it leads to limb coldness, twitching of sinews, and trembling of muscles; this constitutes a "Ni" (adverse/rebellious condition). This is also a syndrome of Yang collapse due to excessive sweating in Shaoyin (Lesser Yin) disease. Therefore, Zhen Wu Tang is used to remedy the error, aiming to secure and consolidate the Kidney.
Trembling of the body indicates external shaking, while shivering of the heart indicates internal fear and palpitations. One must seek to distinguish between these two types of pathogenic factors regarding their victory or defeat. If trembling is accompanied by profuse sweating, recovery is imminent. If there is gnashing of teeth and chattering due to deficiency-cold, Si Ni Tang (Frigid Extremities Decoction) should be used to calm the condition.
"Trembling" (Zhan) refers to the shaking of the body, while "shivering" (Li) refers to the heart's trembling and fright. This occurs when a Shang Han (Cold Damage) disease is about to resolve and sweat is about to emerge; the pathogenic factor and righteous Qi contend with each other, causing body tremors and thigh muscle spasms. However, trembling and shivering can belong to Yang or Yin. In Yang cases, true Qi returns, righteous Qi stirs, contends externally, and wins; thus the body shakes, followed by profuse sweating and resolution. In Yin cases, Yang is weak and Yin prevails; the pathogen contends internally, and righteous Qi cannot prevail; thus there is coldness in the heart, curling up of the feet, gnashing of teeth, cold limbs, and whole-body trembling. In such cases, Si Ni Tang should be used to warm the interior.
When Taiyang combines with the Stomach channel, the pulse is floating and long. If the pulse is floating and wiry, it combines with Shaoyang (Lesser Yang). When the Gallbladder combines with the Stomach, the pulse is wiry but not short. Huang Qin Cheng Qi Tang (Scutellaria and Rhubarb Decoction) and Ge Gen Tang (Kudzu Decoction) should be examined in detail.
"Combined Disease" (He Bing) refers to two Yang channels, or three Yang channels, suffering from disease simultaneously, without transmission. Whenever three Yang channels combine, diarrhea inevitably occurs. For example, if Taiyang and Yangming combine with diarrhea and the pulse is floating and long, Ge Gen Tang governs. If Taiyang and Shaoyang combine with diarrhea and the pulse is floating and wiry, Huang Qin Tang governs. If Shaoyang and Yangming combine with diarrhea and the pulse is wiry and long, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) governs. If the pulse is large, long, and wiry, with unceasing diarrhea and inability to eat, the disease is named "Fu" (Defeat/Negative). "Fu" implies failure; if Earth (Spleen/Stomach) fails and Wood (Liver/Gallbladder) attacks, death ensues.
Taiyang originally combined with Yangming. If the disease returns and acts as one entity, yet Taiyang symptoms remain, Ge Ban Tang (Half-Half Decoction, likely referring to Gui Zhi Er Yue Bi Yi Tang) should be used. If Taiyang symptoms cease and Da Cheng Qi Tang (Major Order the Qi Decoction) indications appear, the illness resolves.
"Concurrent Disease" (Bing Bing) refers to one channel being diseased first, then transmitting to another channel. For instance, if Taiyang and Yangming are concurrent but not fully transmitted, it is called "Wei Guo" (Not Yet Transmitted). As Zhang Zhongjing said: Taiyang disease has not ceased, face is red, Yang Qi is constrained and郁 (stagnant) in the exterior unable to vent, accompanied by irritability and shortness of breath. At this stage, diaphoresis should still be employed using Ge Ban Tang. If the concurrency is fully transmitted, it is called "Chuan Guo" (Transmitted). As Zhang Zhongjing said: Taiyang disease has ceased, tidal fever occurs, hands and feet sweat, stool is hard, and delirium appears. The method requires purgation using Da Cheng Qi Tang. Thus, we know that transmission leads to entering the Fu organs, while non-transmission means not entering the Fu organs. Such is the variation in Concurrent Diseases.