发斑,下证未全,凉膈散(二十三)。未曾下,胃热发斑,白虎汤(二十二)加人参、白术。
阳明胃热发斑,脉沉须下者,三一承气汤(十三)下之。伤寒胃热发斑,凉膈散加滑石调五苓散(二十四)
甚妙。伤寒七、八日,发黄有斑,微热、腹满者,或痰实壅上,虽诸承气汤不过者,仲景曰∶寸脉浮滑
者可用瓜蒂散(二十六)吐之。
伤寒,发狂奔走,骂詈不避亲疏,此阳有余、阴不足,三一承气汤(十三)加当归、姜、枣名当
归承气汤,以利数行,候微缓以三圣散(二十七)吐之,后用凉膈散(二十三),黄连解毒汤(二十一)
调之。谵妄发狂,逾垣上屋,赴井投河,皆
为阳热极甚,用三一承气合解毒下之。惊悸癫狂,三一承气汤。发狂极甚,投河入井者,三下不过,
不可攻下,盒饭涌之,以瓜蒂散(二十六),吐出痰涎、宿物,一扫而愈,后以甘露饮(三十四)之类调之。
凡热病大汗将出而反寒战者,表之正气与邪气并甚于里,火热亢极而反兼水化制之,反为寒战,脉
微欲绝者,三一承气汤(十三)或十枣汤(三十一)下之。凡欲作汗,无问病之微甚,或已经新下者,或
下证未全者,但以凉膈散(二十三)调之;甚者黄连解毒汤(二十一)。或下后二、三日,或未经下,腹满
烦渴,脉沉实而有里证者,三一承气汤下之,势恶者加黄连解毒汤。或战不快者,或战后汗出
不快者,或战数次,经大战而汗不当者,乃并之太甚,而法之不达,通宜三一承
气汤,或更加黄连解毒汤下之,以解怫热而开郁结也。
发斑,若攻下证候尚未完全具备,使用凉膈散(方剂编号二十三)。如果未曾经过攻下治疗,因胃热导致发斑,在白虎汤(方剂编号二十二)中加入人参、白术。
阳明经胃热导致的发斑,脉象沉伏且必须攻下的,使用三一承气汤(方剂编号十三)进行攻下。伤寒病中因胃热发斑,使用凉膈散加滑石,并配合调服五苓散(方剂编号二十四),效果极佳。伤寒发病七至八日,出现发黄且有发斑,伴有轻微发热、腹部胀满的,或者痰实壅滞于上焦,即使各种承气汤无效的情况,张仲景说:寸脉浮滑的,可以使用瓜蒂散(方剂编号二十六)进行涌吐。
伤寒病中,患者发狂奔走,辱骂他人而不避亲疏,这是由于阳气有余、阴气不足所致,使用三一承气汤(方剂编号十三)加入当归、生姜、大枣,名为当归承气汤,以通利大便数次,待病情稍微缓和后,使用三圣散(方剂编号二十七)进行涌吐,之后再用凉膈散(方剂编号二十三)、黄连解毒汤(方剂编号二十一)调理。谵语妄言、发狂,跨越墙垣、登上屋顶、跳入井河等行为,都是因为阳热极盛所致,使用三一承气汤合用解毒汤进行攻下。惊悸癫狂,使用三一承气汤。发狂极其严重,甚至跳入井河的,如果三次攻下无效,不可继续攻下,应当采用涌吐法,使用瓜蒂散(方剂编号二十六),吐出痰涎和宿积之物,即可一扫而愈,之后用甘露饮(方剂编号三十四)之类的方剂调理。
凡是热病大汗即将发出时反而出现寒战的,是体表的正气与邪气在体内剧烈交争,火热亢盛到了极点反而兼有水的化制作用,从而表现为寒战,脉象微弱几乎摸不到的,使用三一承气汤(方剂编号十三)或十枣汤(方剂编号三十一)进行攻下。凡是准备出汗的,无论病情轻重,或者已经经过新近攻下的,或者攻下证候尚未完全的,都只用凉膈散(方剂编号二十三)来调理;严重的用黄连解毒汤(方剂编号二十一)。或者攻下后两三天,或者未经过攻下,出现腹部胀满、烦躁口渴,脉象沉实且有里证的,使用三一承气汤攻下,病情凶险的加用黄连解毒汤。或者寒战不能缓解的,或者战后出汗不畅的,或者寒战多次,经历大战后汗出异常的,这是因为正邪交争过于剧烈,而治法未能通达,通常适宜使用三一承气汤,或者再加黄连解毒汤进行攻下,以解除郁热并开通郁结。
Maculae (skin eruptions) occur when the indications for purgation are not yet complete; use Liangge San (Cooling the Diaphragm Powder). If no purgation has been performed previously, and maculae arise due to Stomach heat, add Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma) to Baihu Tang (White Tiger Decoction).
For maculae caused by Yangming Stomach heat, if the pulse is deep and purgation is required, use Sanyi Chengqi Tang (Three-One Purging Decoction) to purge. For maculae in cold damage due to Stomach heat, Liangge San added with Hua Shi (Talcum) combined with Wuling San (Five-Ingredient Powder with Poria) regulates effectively. In cold damage lasting seven or eight days, with jaundice and maculae, slight fever, and abdominal fullness, or if phlegm-solidity obstructs the upper jiao and various Chengqi Decoctions fail, Zhang Zhongjing states: if the cun (inch) pulse is floating and slippery, Gouti San (Melon Seed Powder) may be used to induce vomiting.
In cold damage, manic running away, cursing without distinction between kin and stranger indicates excess Yang and deficient Yin. Use Sanyi Chengqi Tang (Three-One Purging Decoction) added with Dang Gui (Angelica Sinensis Radix), Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus), named Danggui Chengqi Tang (Dang Gui Purging Decoction), to promote defecation several times. Wait until symptoms slightly ease, then use Sansheng San (Three-Sage Powder) to induce vomiting, followed by regulation with Liangge San (Cooling the Diaphragm Powder) and Huanglian Jiedu Tang (Coptis Decoction for Detoxification). Delirium and mania, such as climbing over walls, roofs, or jumping into wells and rivers, all result from extreme Yang heat. Use Sanyi Chengqi Tang combined with a detoxifying decoction to purge. Palpitations, epilepsy, and mania are treated with Sanyi Chengqi Tang. For extreme mania involving jumping into wells or rivers, if three purgations fail, do not continue purging; instead, induce vomiting using Gouti San (Melon Seed Powder) to expel phlegm-saliva and retained pathogenic factors, leading to immediate recovery, followed by regulation with Ganlu Yin (Sweet Dew Drink) or similar formulas.
In febrile diseases, if chills occur just before profuse sweating, it indicates that the healthy Qi on the exterior and the pathogenic factor are intensely conflicting within the interior. Extreme fire heat counteracts with water transformation, manifesting as chills. If the pulse is faint and nearly imperceptible, use Sanyi Chengqi Tang (Three-One Purging Decoction) or Shizao Tang (Ten-Jujube Decoction) to purge. For any case preparing to sweat, regardless of severity, whether recently purged or purgative indications are incomplete, regulate with Liangge San (Cooling the Diaphragm Powder); for severe cases, use Huanglian Jiedu Tang (Coptis Decoction for Detoxification). If two or three days after purgation, or without prior purgation, abdominal fullness, irritability, and thirst occur with a deep, solid pulse indicating interior syndrome, purge with Sanyi Chengqi Tang; for critical conditions, add Huanglian Jiedu Tang (Coptis Decoction for Detoxification). If shivering does not resolve, or sweating is inadequate post-shiver, or multiple shivers occur with abnormal sweating after intense conflict, this results from excessive conflict and ineffective therapeutic methods. Generally, use Sanyi Chengqi Tang, or add Huanglian Jiedu Tang (Coptis Decoction for Detoxification) to purge, thereby resolving constrained heat and opening stagnation.