口糜者,因心脾受热,郁火熏蒸。治宜清理心脾,其脉则洪大有力,而为实热者
也。更有脾元中气不足,不能按纳下焦阴火,以致口糜生疮,宜服附子理中者,不可
不知。至于喉肿者,有阳毒,有阴毒,如面赤脉洪或吐脓血,是火气上冲,心肺受热,
是为阳毒。加四肢冷,而脉沉细,是寒结于肺,寒极生热,湿热熏蒸,此为阴毒。治阳
以清肺化毒,治阴用引火归源。
凡足有三阳三阴,阳脉在五指,阴脉聚足心,集于膝下膝上,故《经》曰∶阳气衰
于下,则为寒厥,阴气衰于下,则为热厥,盖阳气衰则阴气胜,故自足心上至膝而俱
冷,是谓阴厥。然过膝者,不治。阴气衰则阳气胜,故必热,自五指而至足心,是谓阳
厥,然热极反兼寒化,即所谓热深厥亦深,故阳厥必热极而发厥,兼以烦渴脉数,身复
时温,便秘尿赤,谵语昏愦者是也,宜承气汤下之。阴厥必身不热,而便不秘,脉迟微
细而口不渴,引衣自盖,下利者是也,宜四逆汤治之。然阳厥极深,至于身冷脉微欲
绝,为热极而将死矣,急以大承气下之,则厥愈者,所谓寒药反能生脉,而令身暖也。
若误以热药,助其阳,则阴气暴绝,阳亦绝而死矣。若阴已先绝,而阳亦将绝,于此时
而复下之,则阴阳俱竭,而亦死矣,可不细辨欤!
口糜,是由于心脾受热,郁结之火熏蒸所致。治疗应当清理心脾,其脉象洪大有力,属于实热证。也有因脾元中气不足,不能制约下焦阴火,导致口糜生疮的,适宜服用附子理中汤,这一点不可不知道。至于喉肿,有阳毒和阴毒之分。如面部发红、脉象洪大或吐出脓血,这是火气上冲,心肺受热,称为阳毒。如果加上四肢发冷,脉象沉细,这是寒邪结聚于肺,寒极生热,湿热熏蒸,称为阴毒。治疗阳毒用清肺解毒的方法,治疗阴毒用引火归源的方法。
足部有三阳经和三阴经,阳脉分布在五指,阴脉汇聚于足心,聚集在膝下和膝上。所以《内经》说:阳气衰微于下部,就会发生寒厥;阴气衰微于下部,就会发生热厥。大概阳气衰微则阴气亢盛,所以从足心向上至膝盖都寒冷,这叫做阴厥。然而病情超过膝盖的,难以治愈。阴气衰微则阳气亢盛,所以必然发热,热度从五指蔓延至足心,这叫做阳厥。然而热极时反而兼有寒化的表现,即所谓“热深厥亦深”,所以阳厥必定是热极而引发厥逆,兼见烦躁口渴、脉数、身体时而温暖、便秘、尿赤、胡言乱语、神志昏沉等症状,适宜用承气汤攻下。阴厥必定身体不发热,大便不通秘(此处原文为“便不秘”,结合语境及四逆汤证通常指下利清谷,故译为下利/腹泻),脉象迟细微弱且口不渴,喜欢裹衣自盖,伴有下利的症状,适宜用四逆汤治疗。然而阳厥发展到极点,以至于身体冰冷、脉象微弱欲绝,这是热极将死的征兆,此时急用大承气汤攻下,若能使厥逆痊愈,这就是所谓的“寒药反能生脉”,使身体回暖。如果误用热药,助长阳气,则阴气会突然断绝,阳气也随之断绝而死。如果阴气已经先绝,而阳气也将绝,在这个时候如果再使用攻下法,则阴阳俱竭,也会死亡,这难道可以不仔细辨别吗!
Mouth ulcers (Koumi) result from heat in the Heart and Spleen, with stagnant fire steaming upwards. Treatment should focus on clearing and purifying the Heart and Spleen; the pulse is typically surging and forceful, indicating an excess-heat pattern. In other cases, due to insufficiency of the Spleen's Yuan Qi and Middle Qi, which fails to anchor the Yin Fire from the Lower Jiao, mouth ulcers may also occur. In such instances, Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) is appropriate; this distinction must not be overlooked. Regarding throat swelling, there are Yang Toxicity and Yin Toxicity. If the face is red, the pulse is surging, or pus and blood are vomited, it indicates Fire Qi rushing upward with heat in the Heart and Lungs, termed Yang Toxicity. If accompanied by cold limbs and a deep, fine pulse, it indicates Cold binding in the Lungs, where extreme Cold generates Heat and Damp-Heat steams upwards, termed Yin Toxicity. Yang Toxicity is treated by clearing the Lungs and resolving toxicity, while Yin Toxicity is treated by guiding Fire back to its source.
The feet contain three Yang meridians and three Yin meridians. Yang pulses are located at the five toes, while Yin pulses converge at the sole of the foot and gather below and above the knee. Thus, the *Classic* states: "When Yang Qi declines in the lower part, Cold Jue occurs; when Yin Qi declines in the lower part, Hot Jue occurs." Generally, when Yang Qi declines, Yin Qi prevails, causing coldness from the sole up to the knee, known as Yin Jue (Cold Reversal). However, if the condition extends beyond the knee, it is difficult to treat. When Yin Qi declines, Yang Qi prevails, resulting in heat that spreads from the five toes to the sole, known as Yang Jue (Hot Reversal). However, extreme heat may manifest with cold-like symptoms, i.e., "the deeper the heat, the deeper the reversal." Therefore, Yang Jue involves extreme heat leading to reversal, accompanied by irritability, thirst, rapid pulse, intermittent warmth of the body, constipation, dark urine, delirium, and confusion. It should be treated with Chengqi Tang (Gut-Purging Decoction) to purge downwards. Yin Jue involves no fever, diarrhea (as opposed to constipation), a slow, faint, and fine pulse, no thirst, a desire to cover oneself with clothes, and diarrhea. It should be treated with Sini Tang (Frigid Extremities Decoction). However, if Yang Jue reaches an extreme depth, causing cold body and a pulse so faint it seems about to cease, this indicates extreme heat approaching death. Urgently using Dachengqi Tang (Major Gut-Purging Decoction) to purge may reverse the Jue and restore life; this is what is meant by "cold medicines can paradoxically generate the pulse and warm the body." If hot medicines are mistakenly used to assist Yang, Yin Qi will abruptly perish, and Yang will also perish, leading to death. If Yin has already perished first, and Yang is also about to perish, using purgatives at this time will cause both Yin and Yang to exhaust, also leading to death. Can one fail to distinguish these carefully!