【纲】仲景曰。脉浮而洪。身汗如油。喘而不休。水浆不下。形体不仁。乍静乍乱。此为命绝
也。
【目】张云岐曰。不仁。谓不柔和。痛痒不知。任其屈伸。灸刺亦不知。是谓不仁也。由邪
气壅盛。正气为邪气所闭。伏郁而不发。血气虚少。不能通行故也。内经曰。荣气虚则不仁。针经
曰。卫气不行则为不仁。经曰。营卫不能相将。三焦无所仰。身体痹不仁。即此知营卫血气虚少。
不能通行为不仁。明矣。又谓诸乘寒者则为厥。郁冒不仁。言此厥者。是正气为寒气所乘而为厥气。
非四肢逆冷之厥也。何也。郁冒为昏冒。不仁为不知痛痒。是为尸厥。经曰。少阴脉不至。肾气
微。少精血。奔气促逼。上入胸膈。宗气反聚。血结心下。阳气退下。热归阴股。与阴相动。令身
不仁。此为尸厥。其乘寒之厥。郁冒不仁者。即此可知矣。昔越人入虢。诊太子为尸厥。以郁冒不
仁为可治。刺之而得痊。实神医也。若如本条命绝。虽越人其能救之耶。
陶华曰。螈则急而缩。 则缓而伸。热则生风。风主乎动。故筋脉相引而伸缩。伤寒至此死症
也。能去风涤热治之。幸有生者。治法与痉病略同。不仁。谓不柔和。诸虚乘寒。为郁冒不仁。血
气虚弱。不能周流一身。于是正气为邪气所伏。故肢体顽麻不仁。厥如死尸。用麻桂合半汤。不愈。
补中益气汤入姜汁。
李中梓曰。螈 者。或缩或伸。动而不定。汗出时盖覆不周。腰背手足搐搦。牛蒡根汤。脉浮
数有风热。防风通圣散。血不养筋。大秦艽汤。
【纲】张仲景说:脉象浮而洪大,身体出汗如油般黏腻,喘息不止,水浆无法入口,肢体麻木不仁,时而安静时而躁乱,这是生命终结的征象。
【目】张云岐说:“不仁”,是指肢体不柔和,痛痒感觉丧失,任由肢体屈伸,即使施以艾灸或针刺也毫无知觉,这就叫作“不仁”。这是由于邪气壅盛,正气被邪气闭阻,伏郁而不能发越,导致血气虚少,不能通行周身所致。《内经》说:营气虚弱则会出现不仁。《针经》说:卫气运行不畅则为不仁。经文又说:营卫不能相互协调,三焦无所依赖,身体就会出现痹症而不仁。由此可知,营卫和血气虚少,不能通行周身而导致不仁,是显而易见的。又说道:凡是受寒邪侵袭就会发生厥证,出现郁冒(昏蒙眩晕)和不仁。这里所说的“厥”,是指正气被寒气侵袭而形成的厥气,并不是指四肢逆冷的厥证。为什么呢?因为“郁冒”表现为昏蒙,“不仁”表现为不知痛痒,这属于“尸厥”。经文说:少阴脉不至,肾气微弱,精血亏少,奔豚之气急促逼迫,向上冲入胸膈,宗气反聚于此处,血液凝结于心下,阳气退居下行,热邪归于阴股,与阴气相互激荡,致使身体不仁,这就是尸厥。那些因受寒邪导致的厥证、郁冒和不仁,通过上述分析就可以明白了。从前扁鹊进入虢国,诊断太子患的是尸厥,认为这种由郁冒和不仁引起的病症是可以治疗的,通过针刺使太子痊愈,真是神医啊。如果像本条文中所述的“命绝”之症,即使是扁鹊又能救得了吗?
陶华说:抽搐时筋脉紧急收缩,舒缓时筋脉伸长。热邪会产生风,风性主动,所以筋脉相互牵引而发生伸缩。伤寒病发展到这一步已是死症。如果能祛风清热进行治疗,或许还有生还的希望。治疗方法与痉病大致相同。“不仁”,是指肢体不柔和,各种虚证兼受寒邪,导致郁冒和不仁,血气虚弱,不能周流全身,于是正气被邪气伏留,导致肢体顽麻不仁,厥冷如同死尸。使用麻桂合半汤治疗;若无效,可用补中益气汤加入姜汁。
李中梓说:抽搐(螈疭),有时收缩有时伸展,动作不定。如果是汗出时覆盖不周全,导致腰背手足搐搦,可用牛蒡根汤。如果脉象浮数且有风热,用防风通圣散。如果是血不养筋,用大秦艽汤。
[General Principle] Zhang Zhongjing stated: When the pulse is floating and surging, the body sweats like oil, panting does not cease, fluids cannot be taken in, the body is insensible (numbness), alternating between stillness and agitation, this indicates the exhaustion of life.
[Detailed Commentary] Zhang Yunqi said: "Insensibility" refers to a lack of flexibility, where pain and itch are unknown, and limbs can be bent or extended at will; even with moxibustion or acupuncture, there is no sensation. This is called "insensibility." It arises because pathogenic factors are abundant and excess, while righteous qi is blocked by these pathogens, becoming stagnant and unable to manifest. Consequently, blood and qi become deficient and fail to circulate. The *Neijing* states: "When Ying Qi (Nutritive Qi) is deficient, insensibility occurs." The *Zhenjing* (Classic of Acupuncture) states: "When Wei Qi (Defensive Qi) does not flow, insensibility occurs." Another classic says: "When Ying and Wei cannot coordinate, and the San Jiao (Triple Burner) has nothing to rely upon, the body suffers from Bi syndrome and insensibility." From this, it is clear that deficiency of Ying, Wei, blood, and qi, leading to failure of circulation, causes insensibility. Furthermore, it is said: "All conditions caused by cold invasion result in Jue (reversal/collapse), accompanied by Yu Mao (depression and dizziness) and insensibility." The "Jue" mentioned here refers to Qi reversal caused by righteous qi being overcome by cold, not the cold extremities seen in typical Jue syndromes. Why? Because "Yu Mao" implies mental confusion/dizziness, and "insensibility" implies loss of pain/itch sensation; together they constitute "Shi Jue" (Corpse-like Jue). The classics state: "When the Shaoyin pulse is absent, Kidney Qi is weak, and essence and blood are scant, rushing Qi forces its way up into the chest and diaphragm, Zong Qi (Gathering Qi) gathers inversely, blood coagulates below the heart, Yang Qi retreats downward, heat returns to the inner thighs, interacting with Yin, causing the body to become insensible. This is Shi Jue." Thus, the Jue, Yu Mao, and insensibility caused by cold invasion can be understood through this explanation. In the past, Bian Que entered the State of Guo and diagnosed the Crown Prince as suffering from Shi Jue. He considered the condition characterized by Yu Mao and insensibility treatable, cured him via acupuncture, proving himself a divine physician. However, if the condition were truly "exhaustion of life" as described in the main text, could even Bian Que save him?
Tao Hua said: During spasms, muscles contract tightly; during relaxation, they extend. Heat generates wind, and wind governs movement, causing muscle tendons to pull and cause contraction and extension. When Shanghan (Cold Damage) reaches this stage, it is a fatal syndrome. If one can dispel wind and purge heat, there may be a chance of survival. The treatment method is similar to that for Jing Bing (Spasm Disease). "Insensibility" refers to lack of flexibility. Various deficiency patterns combined with cold invasion lead to Yu Mao and insensibility. Due to deficiency of blood and qi, circulation throughout the body fails, allowing righteous qi to be subdued by pathogens, resulting in numbness and insensibility of the limbs, with cold reversal resembling a corpse. Use Mahui Banxia Tang (Cinnamon Twig, Ephedra, and Pinellia Decoction); if ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with ginger juice.
Li Zhongzi said: Spasms (Yong Zhong) involve alternating contraction and extension, with irregular movements. If sweating occurs due to inadequate covering, leading to spasms of the waist, back, hands, and feet, use Niubanggen Tang (Arctium Root Decoction). If the pulse is floating and rapid indicating wind-heat, use Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder). If blood fails to nourish the tendons, use Da Qinjiao Tang (Large Gentian Decoction).