(此系仲景原文)
少阳之为病。口苦咽干目眩也。(此少阳经病热之纲也。少阳者。胆经也。其脉起于目锐 。灵枢经云。足少阳之正
上挟咽。出颐颔中。又曰。是动。则病口苦。苦者。胆之味。苦味从火化。咽又为胆之使。故胆热则口苦。而并咽亦干
也。眩者。目旋晕也。少阳属木。为风。风主动摇。故其经病热。则目眩也。愚按上三证。不足以尽少阳病。故云。此
仅举其病热之大纲耳。)
少阳中风。两耳无所闻。目赤胸中满而烦者。不可吐下。吐下则悸而惊。(此节。辩少阳中风证。成注云少阳之脉。
起于目锐 。走于耳中。其支者。下胸中。贯膈。风伤气。风则为热。少阳中风。气壅而热。故耳聋目赤。胸满而烦。
邪在少阳。有吐下之禁。止因烦满。故误行吐下之法。成注又云。吐则伤气。气虚者。悸。下则亡血。血虚者。惊。愚
以惊悸皆主于心。胸满而烦者。邪已离表。未全入里。为半在表半在里之证。乃上焦病也。上焦与心相近。误吐且下。
则气血衰耗。而神明无主。以故忪然而悸。惕然而惊也。按此条论。仲景无治法。补亡论庞安时云。可小柴胡汤。吐下
悸而烦者。郭白云云。当服柴胡加龙骨牡蛎汤。)
伤寒脉弦细。头痛发热者属少阳。少阳不可发汗。发汗则谵语。此属胃。胃和则愈。胃不和。则烦而悸。(此节辩少
阳伤寒证。少阳属木。其脉当弦。脉细者成注云。邪渐传里也。少阳之脉。上抵头角。故曰头痛。寒郁则发热。此属少
阳伤寒证无疑矣。邪在少阳。发汗又所当禁。且其经多气少血。误发其汗谵语者。条辩云。夺其血液而胃干。以故心慌
而言乱也。此少阳之邪。已转属胃。胃和则愈者。言当用药以下胃中之热。而使之和平也。不下则胃不和。不但谵语。
更加烦扰忪悸。此言胃热亢极。而上犯于心肺。故藏神不自宁也。按此条论。仲景无和胃之药。成注云。与调胃承气汤。
此言少阳之邪已入胃。故可下也。愚以邪自少阳经传来。还须用大柴胡汤下之为妥。)
本太阳病。不解。转入少阳者。胁下硬满。干呕。不能食。往来寒热。尚未吐下。脉沉紧者。与小柴胡汤。(此条言
太阳病转入少阳之证。本太阳病不解。转入少阳。此但言邪所从来之路。医者止就少阳经议证可耳。足少阳之脉。循胁
里。邪入少阳。故胁下硬满。胆热气上逆而犯胃。以故干呕不能食。往来寒热者。邪在半表半里。明理论云。邪之客于
表者为寒邪与阳相争。则为寒。邪之入于里者。为热邪与阴相争。则为热。邪居表里之间。或出或入。以故寒热且往且
来也。尚未吐下者。治犹未误也。少阳之脉当弦。曰沉紧者。邪将传里。陈亮斯云。邪入胆府。故脉沉紧而不弦。此是
少阳经与府齐病也。胆府清净。无地容邪。故其邪仍结于经。而胁下硬满。止宜与小柴胡以和解之。)
(这是张仲景的原文)
少阳病的主要症状是:口苦、咽干、头晕目眩。(这是少阳经病热的纲领。少阳指的是胆经。其经脉起于眼外角。《灵枢经》说:足少阳的正脉上行挟持咽喉,出于下颌中间。又说:如果是经脉变动,就会发生口苦的症状。苦味是胆的味道,苦味是由火化生而来。咽喉也是胆气通达的部位,所以胆热就会导致口苦,并且伴随咽喉干燥。眩晕是指眼睛旋转晕眩。少阳在五行中属木,对应风,风具有主动摇的特性,所以该经受邪发热时,就会出现目眩。我认为以上三个症状不足以概括所有少阳病,所以说这只是列举了病热的大纲。)
少阳中风证表现为:两耳听不见声音,眼睛发红,胸中胀满且烦躁。这种情况下禁止使用催吐和泻下法。如果误用吐下法,会导致心悸和惊恐。(这一节辨析少阳中风证。成无己注解说:少阳的经脉,起于眼外角,走向耳中。其分支下行进入胸中,穿过膈肌。风邪伤及气分,风邪转化为热,少阳受风邪侵袭,气机壅滞而发热,所以出现耳聋、目赤、胸满和烦躁。病邪在少阳,有禁止使用吐下法的禁忌。仅仅因为烦闷胀满,就误用了吐下之法。成无己又注释说:催吐会损伤气,气虚则导致心悸;泻下会耗损血液,血虚则导致惊恐。我认为惊和悸都主要与心有关。胸中胀满且烦躁,说明病邪已经离开表证,但尚未完全入里,属于半表半里的证候,这是上焦的病证。上焦与心脏相近,误用吐法和下法,会导致气血衰败消耗,使得心神失去主宰,因此心中空虚而悸动,警惕而惊恐。按此条论述,张仲景没有给出治疗方法,《补亡论》中庞安时说:可以使用小柴胡汤。对于误用吐下后出现心悸和烦躁的情况,郭白云说:应当服用柴胡加龙骨牡蛎汤。)
伤寒脉象弦细,伴有头痛发热的,属于少阳病。少阳病禁止发汗。如果误发汗,会出现说胡话(谵语)的症状,这属于胃的问题。如果胃气调和就会痊愈,如果胃气不调和,就会出现烦躁和心悸。(这一节辨析少阳伤寒证。少阳属木,其脉象应当是弦脉。脉象细,成无己注解说:表示病邪逐渐传入里部。少阳的经脉上行到达头角,所以说会有头痛。寒邪郁结则发热,这毫无疑问属于少阳伤寒证。病邪在少阳,发汗也是应当禁止的。而且该经多气少血,误发汗导致谵语的,条辩解释说:这是因为夺去了血液导致胃干燥,所以心慌且言语错乱。这是少阳的病邪已经转属到胃,胃气调和就会痊愈,意思是应当用药来清泄胃中的热邪,使其恢复平和。如果不使用下法,胃气就不调和,不仅出现谵语,还会更加烦躁和心悸。这说明胃热亢盛到了极点,向上侵犯心肺,所以脏腑之神不能安宁。按此条论述,张仲景没有给出调和胃气的药物。成无己注解说:给予调胃承气汤。这是说少阳的病邪已经进入胃,所以可以使用下法。我认为病邪从少阳经传来,还是使用大柴胡汤进行攻下更为妥当。)
原本患有太阳病,未能解除,病邪转入少阳的,症状包括胁下硬满、干呕、不能进食、往来寒热。如果尚未使用过催吐或泻下法,脉象沉紧的,给予小柴胡汤治疗。(这一条讲述太阳病转入少阳的证候。原本是太阳病未能解除,病邪转入少阳,这里只是说明了病邪传来的路径,医生只需针对少阳经的证候进行议论即可。足少阳的经脉,循行于胁肋内部,病邪进入少阳,所以胁下感觉硬满。胆气热盛上逆侵犯胃腑,所以出现干呕、不能进食。往来寒热,是因为病邪在半表半里之间。《明理论》说:客居在表的邪气与阳气相争,表现为恶寒;进入里的邪气与阴气相争,表现为发热。病邪居于表里之间,有时出有时入,所以寒热交替往来。尚未使用吐下法,说明治疗还没有错误。少阳病的脉象应当是弦脉,现在说是沉紧脉,成无己认为这是病邪将要传入里部。陈亮斯说:病邪进入胆腑,所以脉象沉紧而不弦。这是少阳经和胆腑同时患病。胆腑性质清净,容不下邪气,所以病邪仍然结聚在经脉上,导致胁下硬满,只适宜用小柴胡汤来和解。)
(This is the original text by Zhang Zhongjing)
The defining symptoms of Shaoyang disease (Shaoyang Syndrome) are: bitter taste in the mouth, dryness of the throat, and vertigo/dizziness. (This is the general outline for heat pathologies of the Shaoyang channel. Shaoyang refers to the Gallbladder Channel. Its vessel originates at the outer canthus. The *Ling Shu* states: The regular pathway of Foot-Shaoyang ascends flanking the pharynx and emerges from the center of the mandible. It also states: If the channel is affected, it causes bitter taste. Bitterness is the flavor of the Gallbladder; bitterness arises from Fire transformation. The pharynx is also a passage for Gallbladder Qi; thus, Gallbladder heat causes bitter taste and concurrent dryness of the throat. Vertigo refers to the sensation of spinning dizziness. In Five-Phase theory, Shaoyang corresponds to Wood and Wind; Wind has the nature of movement and shaking. Therefore, when this channel is afflicted with heat, vertigo occurs. I observe that the above three symptoms are insufficient to encompass all Shaoyang diseases; hence, it is stated that this merely lists the general outline of heat pathology.)
In Shaoyyang wind-strike syndrome, there is deafness in both ears, redness of the eyes, fullness in the chest, and irritability. Vomiting and purging methods must not be used. If vomiting or purging is mistakenly applied, palpitations and fright will ensue. (This section analyzes Shaoyang wind-strike syndrome. Cheng Wuji's commentary notes: The Shaoyang vessel originates at the outer canthus and travels into the ear. Its branch descends into the chest, piercing through the diaphragm. Wind pathogen damages Qi; Wind transforms into Heat. In Shaoyang wind-strike, Qi becomes congested and generates heat, causing deafness, red eyes, chest fullness, and irritability. With the pathogen in Shaoyang, vomiting and purging are contraindicated. Mistakenly applying these methods due to irritability and fullness leads to complications. Cheng Wuji further comments: Vomiting injures Qi; Qi deficiency causes palpitations. Purging depletes Blood; Blood deficiency causes fright. I believe that fright and palpitations are primarily governed by the Heart. Chest fullness and irritability indicate that the pathogen has left the exterior but has not fully entered the interior, representing a half-exterior, half-interior syndrome, which is a disorder of the Upper Jiao. The Upper Jiao is close to the Heart. Mistaken vomiting and purging deplete Qi and Blood, causing the Shen (Spirit) to lose its master, resulting in empty-hearted palpitations and startled fright. Regarding this clause, Zhang Zhongjing provides no treatment method. Pang Anshi in the *Bu Wang Lun* suggests Xiao Chai Hu Tang (Minor Bupleurum Decoction). For cases where vomiting and purging lead to palpitations and irritability, Guo Baiyun suggests Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell).)
In cold damage, if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang. Shaoyang disease prohibits sweating therapy. If sweating is mistakenly induced, delirious speech (adynamic muttering) occurs, indicating involvement of the Stomach. If the Stomach harmonizes, recovery ensues; if the Stomach does not harmonize, irritability and palpitations result. (This section analyzes Shaoyang cold damage syndrome. Shaoyang corresponds to Wood, so its pulse should be wiry. A fine pulse, according to Cheng Wuji, indicates the pathogen gradually transmitting inward. The Shaoyang vessel ascends to the head angle, hence the headache. Cold stagnation generates fever; this undoubtedly belongs to Shaoyang cold damage. With the pathogen in Shaoyang, sweating is also prohibited. Moreover, this channel possesses abundant Qi but scarce Blood. Mistaken sweating leading to delirium is explained by *Tiao Bian*: Depletion of blood causes dryness of the Stomach, leading to heart panic and disordered speech. This indicates the Shaoyang pathogen has transferred to the Stomach. "Stomach harmonizes then recovers" means medication should be used to clear heat from the Stomach and restore harmony. Without purging, the Stomach fails to harmonize, causing not only delirium but also increased irritability and palpitations. This signifies extreme Stomach heat attacking upward to the Heart and Lungs, causing the Zang-shen to become unsettled. Regarding this clause, Zhang Zhongjing provides no formula to harmonize the Stomach. Cheng Wuji suggests Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction), stating that since the Shaoyang pathogen has entered the Stomach, purging is applicable. I believe that since the pathogen transmitted from the Shaoyang channel, Da Chai Hu Tang (Major Bupleurum Decoction) is more appropriate for purging.)
If a Taiyang disease remains unresolved and transmits to Shaoyang, presenting with hardness and fullness below the costal region, dry retching, inability to eat, and alternating chills and fever, and if vomiting or purging have not yet been used, and the pulse is deep and tight, administer Xiao Chai Hu Tang. (This clause describes the syndrome of Taiyang transmitting to Shaoyang. Originally a Taiyang disease that remained unresolved, the pathogen transmits to Shaoyang; this merely indicates the route of the pathogen. The physician should discuss the syndrome based on the Shaoyang channel. The Foot-Shaoyang vessel circulates within the hypochondrium; pathogen entering Shaoyang causes hardness and fullness below the costal region. Gallbladder heat steams upward, invading the Stomach, causing dry retching and anorexia. Alternating chills and fever occur because the pathogen resides between the exterior and interior. The *Ming Li Lun* states: Pathogens lodging in the exterior contend with Yang, manifesting as chills; pathogens entering the interior contend with Yin, manifesting as fever. The pathogen dwelling between exterior and interior moves in and out, hence the alternating chills and fever. "Not yet vomited or purged" implies the treatment has not been erroneous. The Shaoyang pulse should be wiry; a deep and tight pulse suggests the pathogen is about to transmit inward. Chen Liangsi states: Pathogen entering the Gallbladder Fu organ causes a deep and tight pulse rather than a wiry one. This indicates simultaneous disease of the Shaoyang channel and the Gallbladder Fu organ. The Gallbladder Fu is pure and clean, having no place for pathogens; thus, the pathogen remains bound to the channel, causing hardness and fullness below the costal region. Only Xiao Chai Hu Tang (Minor Bupleurum Decoction) is suitable to harmonize.)