问曰∶咽痛何以属传经少阴证?答曰∶咽者,少阴经脉所过之地也,热邪攻之,则咽痛
又问曰∶寒证亦有咽痛,何也?答曰∶寒邪直中下焦,逼其无根失守之火,发扬于上,亦
令咽痛。然必有下利清谷,四肢厥冷等症,不若传经热邪,口燥咽干而渴之甚也。
问曰∶下利清水,何以是传经少阴证?答曰∶邪传少阴,热气熏灼,结粪如磊石在内。
所进汤水不能渗入,遂从结粪空中走出。按其腹,必硬痛,宜急下之。若直中证,下利清谷
俗名漏底伤寒。设误认此证为漏底,而用热药,是抱薪救火矣。仲景云∶少阴证,下利清
水,色纯青,心下硬痛,急下之,宜大承气汤。正谓此也。
问曰∶目不明,何以是传经少阴证?答曰∶目能照物,全在瞳人。瞳人属水,邪气熏灼
则肾水枯涸,不能照物,故知目不明,属少阴热邪,宜急下之,以救肾家将绝之水。又问
曰∶虚证亦有目不明,何也?答曰∶虚证目不明者,气弱也,血枯也。丹溪用人参膏,补气
也;六味地黄汤,补血也。此皆内伤之治法。若伤寒目不明,实为热邪消烁肾水,急宜清凉
攻下以救援也。如大便自利,腹无所苦,则用三黄解毒汤清之;大便不利,腹中硬痛,则用
承气下之,不可缓也。
厥阴经病亦有传、有中,今先举传经者言之。其见症也,少腹满、舌蜷、囊缩、烦
燥、厥逆、消渴,大承气汤主之。
大承气汤(见少阴)
问:为什么咽痛归属于传经的少阴证?答:咽喉是少阴经脉经过的地方,热邪侵袭此处,就会导致咽痛。
又问:寒证也会出现咽痛,这是为什么呢?答:寒邪直接中伤下焦,逼迫体内无根且失守的虚火向上发散,同样会导致咽痛。但是,这种情况必然伴有下利清谷(腹泻排出未消化的食物)、四肢厥冷等症状,不像传经的热邪那样,导致口燥、咽干且极度口渴。
问:下利清水,为什么也是传经的少阴证?答:邪气传入少阴,热气熏蒸灼烧,导致粪便结块如磊石般坚硬在肠道内。所饮用的汤水无法渗入结粪之中,只能从结粪的空隙中流出。按压腹部,必定感到硬痛,应当紧急使用泻下法治疗。如果是直中寒证,下利清谷俗称“漏底伤寒”。如果错误地将此证误认为“漏底”,而使用温热药物,那就是抱薪救火(越救越糟)。张仲景说:“少阴证,下利清水,颜色纯青,心下硬痛,应当紧急泻下,宜用大承气汤。”正是指这种情况。
问:眼睛视物不清,为什么也是传经的少阴证?答:眼睛能看清物体,完全依赖于瞳人。瞳人属水(肾水),邪气熏蒸灼烧导致肾水枯竭干枯,无法映照物体,因此知道眼睛视物不清属于少阴热邪所致,应当紧急泻下,以拯救即将枯竭的肾水。又问:虚证也会出现眼睛视物不清,这是为什么呢?答:虚证导致的眼睛视物不清,是因为气弱、血枯。朱丹溪用人参膏来补气;用六味地黄汤来补血。这些都是治疗内伤的方法。如果是伤寒导致的眼睛视物不清,实为热邪消烁肾水,应当紧急使用清凉攻下的方法来救援。如果大便自行通畅,腹部没有痛苦,则使用三黄解毒汤清热;如果大便不通畅,腹部硬痛,则使用承气汤泻下,不可迟缓。
厥阴经的病也有传经和直中的区别,现在先讨论传经的情况。其表现的症状有:小腹胀满、舌体卷缩、睾丸收缩、烦躁不安、四肢厥逆、消渴,以大承气汤为主治方剂。
大承气汤(见少阴篇)
Q: Why is sore throat attributed to the Shaoyin syndrome transmitted via meridians? A: The throat is the pathway through which the Shaoyin meridian passes. When pathogenic heat attacks this area, it results in sore throat.
Q: Can cold syndromes also present with sore throat? If so, why? A: Yes. When pathogenic cold directly strikes the lower jiao, it forces the rootless and unanchored fire (deficient fire) to rise and disperse upward, which can also cause sore throat. However, this condition must be accompanied by symptoms such as diarrhea with undigested food (xia li qing gu) and cold limbs (si zhi jue leng). This differs from the transmitted pathogenic heat, which causes extreme dryness of the mouth and throat accompanied by intense thirst.
Q: Why is diarrhea with clear water also considered a Shaoyin syndrome transmitted via meridians? A: When pathogens transmit to the Shaoyin, intense heat steams and scorches, causing feces to become hard and clumped like stones within the intestines. Ingested fluids cannot penetrate these hardened fecal masses but instead flow out through the gaps around them. Palpation of the abdomen will reveal hardness and pain; urgent purgation is indicated. If this were a direct strike of cold pathogens, the diarrhea with undigested food would be colloquially known as "Lou Di Shang Han" (Leaky Bottom Cold Damage). Mistaking this condition for "Lou Di" and using warming herbs would be akin to adding fuel to the fire. Zhang Zhongjing stated: "In Shaoyin syndrome, if there is diarrhea with clear water, pure green in color, and hardness and pain in the epigastrium, urgent purgation is required, preferably using Da Cheng Qi Tang." This precisely refers to this situation.
Q: Why is blurred vision also considered a Shaoyin syndrome transmitted via meridians? A: Clear vision depends entirely on the pupil. The pupil is associated with Water (Kidney Water). When pathogenic heat steams and scorches, it depletes Kidney Water until it dries up, rendering the eye unable to reflect images clearly. Therefore, blurred vision indicates Shaoyin pathogenic heat, requiring urgent purgation to save the nearly exhausted Kidney Water.
Q: Can deficiency syndromes also present with blurred vision? If so, why? A: Blurred vision in deficiency syndromes arises from weak Qi and depleted Blood. Zhu Danxi used Renshen Gao (Ginseng Paste) to tonify Qi, and Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) to nourish Blood. These are treatments for internal injury syndromes. However, blurred vision caused by Cold Damage is due to pathogenic heat consuming Kidney Water, necessitating urgent cooling and purgative methods for rescue. If the bowels move spontaneously without abdominal discomfort, use Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction) to clear heat. If the bowels are obstructed with abdominal hardness and pain, use Chengqi formulas to purge; delay is not an option.
Diseases of the Jueyin meridian also distinguish between transmitted patterns and direct strike patterns. We shall first discuss the transmitted patterns. The presenting symptoms include fullness in the lower abdomen, curled tongue, retraction of the testicles, irritability, cold extremities (jue ni), and excessive thirst (xiao ke). The primary formula is Da Cheng Qi Tang.
Da Cheng Qi Tang (See Shaoyin section)