问曰∶自下利,何以是太阴证?答曰∶下利出于肠胃,热传脾脏,熏灼肠胃,故有下利
又问曰∶三阳合病,以及少阳阳明合病,俱有下利,何也?答曰∶三阳合病有下利者,外
合三阳之经,内合阳明之腑也。少阳阳明合病,自下利者,亦合阳明之腑也。阳明内主胃腑
故有下利。若不入腑,必无下利。今少阳之邪,传入太阴,太阴为脏,与腑相连,故有下
利也。但宜分传经、直中。传经则下利肠垢;直中则下利清谷。寒热之药,由此而分,不可
不谨。
问曰∶脉沉实,何以是太阴热证?答曰∶沉者,病脉也,主病在里;实者,有力也,主
病为热。今脉沉实,故知太阴经有实热也。
少阴经病有传、有中。今先举传经者言之,其见症也,口燥、咽干而渴,或咽痛,或下
利清水、色纯青,心下硬,或下利肠垢,目不明。大、小承气汤并主之。
治邪传少阴,口燥咽干而渴,或目不明,宜急下之。
大黄(酒洗,三钱) 浓朴(一钱) 枳实(一钱五分)
水煎服。加芒硝三钱,即大承气汤。
治少阴咽痛。
甘草(炙,三钱) 桔梗(三钱
水煎服。按本方加大力子(炒研,三钱),薄荷叶(五分),更效;若不瘥,对前小承气汤服
问曰∶口燥咽干而渴,何以属传经少阴也?答曰∶少阴之脉,循喉咙,挟舌本。热邪传
入少阴,消烁肾水,则真水不得上注于华池,故干燥异常,而渴之甚也。须急下之,以救肾
家将涸之水。又问曰∶肾气虚寒,而亦口渴者,何也?答曰∶肾者,水脏也,虚故引水自救
小便必色白,白者,因下焦虚有寒,不能制水,故令色白也。若传经热邪,则小便短涩而
赤。且传经证,口燥咽干,舌燥唇焦,而渴之甚;肾气虚寒,则无此等热症,惟见频饮热汤
以自灌而已,又或思饮冷而不能下咽,此内真寒而外假热之候,与口燥咽干而渴,相隔霄壤
问:自发性腹泻,为什么属于太阴病证?答:腹泻源于肠胃,热邪传入脾脏,熏蒸灼烧肠胃,所以出现腹泻。
又问:三阳合病,以及少阳与阳明合病,都有腹泻,这是为什么呢?答:三阳合病出现腹泻的,是外合三阳经气,内合阳明腑气。少阳与阳明合病而自发的腹泻,也是合于阳明腑气。阳明内部主管胃腑,所以有腹泻。如果病邪没有传入腑,必然不会有腹泻。现在少阳的病邪,传入太阴,太阴是脏,与腑相连通,所以有腹泻。但应当区分是传经所致还是直中脏腑。传经所致的腹泻,排泄物为肠垢(黏液脓血便);直中所致的腹泻,排泄物为完谷不化(清谷)。寒性药和热性药的使用,由此加以区分,不可不谨慎。
问:脉象沉实,为什么属于太阴热证?答:沉脉,是病脉,主病位在里;实脉,指脉搏有力,主病因为热。现在脉象沉实,所以知道太阴经有实热。
少阴经的病有传经和直中两种。现在先举传经的情况来说明,其表现症状为:口燥、咽干且渴,或者咽痛,或者下利清水、颜色纯青,心下硬满,或者下利肠垢,眼睛昏花看不清。大承气汤和小承气汤都主治此证。
治疗邪气传入少阴,出现口燥、咽干且渴,或者眼睛昏花,应当紧急攻下。
大黄(酒洗,三钱) 浓朴(一钱) 枳实(一钱五分)
用水煎服。加入芒硝三钱,就是大承气汤。
治疗少阴咽痛。
甘草(炙,三钱) 桔梗(三钱)
用水煎服。按此方加入大力子(炒后研碎,三钱),薄荷叶(五分),效果更佳;如果病情未愈,配合前文的小承气汤服用。
问:口燥、咽干且渴,为什么属于传经少阴病呢?答:少阴经脉,循行经过喉咙,挟持舌根。热邪传入少阴,消耗灼烁肾水,导致真水不能上注于口腔(华池),所以干燥异常,口渴非常严重。必须紧急攻下,以拯救肾脏即将枯竭的水液。又问:肾气虚寒,也会出现口渴,这是为什么呢?答:肾是水脏,肾虚故引水自救。小便颜色必定发白,白色是因为下焦虚寒,不能制约水液,所以使小便颜色发白。如果是传经的热邪,则小便短少涩滞且发红。而且传经证候,口燥咽干,舌燥唇焦,口渴非常严重;肾气虚寒,则没有这些热症,只见频繁饮用热汤来滋润身体,或者想喝冷水但不能咽下,这是内真寒而外假热的征候,与口燥咽干且渴的症状,相差极远。
Q: Why is spontaneous diarrhea considered a Taiyin syndrome? A: Diarrhea originates in the intestines and stomach. When heat pathogen transmits to the Spleen, it steams and scorches the intestines and stomach, thus causing diarrhea.
Another question: Both San Yang combined disease (disease involving the three Yang meridians) and Shaoyang-Yangming combined disease present with diarrhea; why is this so? A: In San Yang combined disease with diarrhea, the exterior combines with the channels of the three Yang, and the interior combines with the Fu organs of Yangming. In Shaoyang-Yangming combined disease with spontaneous diarrhea, it also involves the Fu organs of Yangming. The Yangming internally governs the Stomach Fu organ, hence there is diarrhea. If the pathogen does not enter the Fu organs, there will certainly be no diarrhea. Now, when the Shaoyang pathogen transmits to the Taiyin, since Taiyin is a Zang organ connected to the Fu organs, diarrhea occurs. However, one must distinguish between transmission along the meridians (Chuan Jing) and direct invasion (Zhi Zhong). Transmission along the meridians results in diarrhea with intestinal mucus (Chang Gou); direct invasion results in diarrhea with undigested food (Qing Gu). The use of cold-natured versus hot-natured medicines is distinguished by this, which requires great caution.
Q: Why is a deep and excess pulse indicative of a Taiyin heat syndrome? A: A deep pulse is a pathological pulse indicating the disease is in the interior; an excess pulse indicates strength and power, suggesting the pathology is heat. Given the deep and excess pulse, we know there is excess heat in the Taiyin channel.
Shaoyin channel diseases involve both transmission and direct invasion. Let us first discuss transmission. The presenting symptoms include dry mouth, dry throat with thirst, or sore throat, or diarrhea of clear water that is purely green, hardness below the heart, or diarrhea with intestinal mucus, and blurred vision. Da Cheng Qi Tang (Great Order the Qi Decoction) and Xiao Cheng Qi Tang (Minor Order the Qi Decoction) both treat these conditions.
To treat pathogen transmitting to the Shaoyin, presenting with dry mouth, dry throat, and thirst, or blurred vision, urgent purgation is indicated.
Da Huang (Rhubarb Root and Rhizome, washed with wine, 3 qian), Hou Po (Magnolia Bark, 1 qian), Zhi Shi (Immature Bitter Orange, 1.5 qian).
Decoct in water and take orally. Add Mang Xiao (Mirabilite, 3 qian) to form Da Cheng Qi Tang (Great Order the Qi Decoction).
To treat Shaoyin sore throat.
Gan Cao (Licorice Root, roasted, 3 qian), Jie Geng (Platycodon Root, 3 qian).
Decoct in water and take orally. Note: Adding Niu Bang Zi (Arctium Fruit, stir-fried and crushed, 3 qian) and Bo He Ye (Mint Leaf, 0.5 qian) to this formula yields better results; if the condition does not improve, administer concurrently with the previously mentioned Xiao Cheng Qi Tang (Minor Order the Qi Decoction).
Q: Why are dry mouth, dry throat, and thirst attributed to transmitted Shaoyin disease? A: The Shaoyin meridian runs along the throat and flanks the root of the tongue. When heat pathogen transmits into the Shaoyin, it consumes and scorches Kidney Water, preventing True Water from ascending to moisten the Hua Chi (oral cavity). Thus, extreme dryness and severe thirst occur. Urgent purgation is required to save the Kidney's nearly depleted water. Another question: Why does Kidney Qi deficiency and cold also cause thirst? A: The Kidney is the Water Organ; due to deficiency, it draws water to self-rescue. The urine color will necessarily be white. White urine indicates lower jiao deficiency-cold, which fails to control water metabolism, resulting in pale urine. In contrast, transmitted heat pathogens cause short, scanty, and reddish urine. Furthermore, in transmission syndromes, there is dry mouth and throat, dry tongue and scorching lips, with severe thirst; whereas Kidney Qi deficiency-cold lacks these heat signs, showing only frequent drinking of hot liquids for self-moistening, or desiring cold drinks but being unable to swallow them. This is a sign of true internal cold with false external heat, which is vastly different from dry mouth, dry throat, and thirst.