呕病,诸经皆有,因何属少阳也。因表邪入来,里气拒格,上逆作呕,故属少阳也,宜小柴胡汤。心下硬
而烦,或不大便,宜大柴胡汤。如表不解之呕,属太阳也,宜柴桂汤。食谷欲呕,属阳明也,主中寒,宜吴
茱萸汤。得汤更呕,主表热,宜葛根加半夏汤。呕吐涎沫,或呕吐蛔,属厥阴也。吐涎沫者,宜吴茱萸汤。吐
蛔者,宜乌梅丸。呕而下利,是有水气,属少阴也,宜真武汤。饮而呕,呕而饮,饮呕相因不已,是停水也,
宜五苓散。
寒而热,热而寒,寒热相因不已,故名往来寒热,为少阳主证,宜小柴胡汤。寒热而有作止之常,一日
一次,或隔日一次,谓之疟,属杂病也。寒热而无作止之常,日三五发,谓之如疟,属太阳经未尽之表邪
也,宜麻桂各半汤。若热多寒少,宜桂枝二越婢一汤。若有汗,宜桂枝二麻黄一汤。若无汗,亦宜麻桂
各半汤。此皆治太阳未尽之微邪法也。
目眩者,目黑不明也,耳聋者,耳无所闻也,皆少阳经主证,非死候也。若因汗吐下失宜,致诸变逆坏
证,目眩而神昏,言乱乃神散,气脱之候,故不能生也。若因误发湿温家汗,而不能言语,耳聋无闻,身青面
色变者,名曰重 ,亦死证也。
腹满时痛为不足,宜桂枝加芍药汤,不愈用理中汤。腹满大痛为有余,宜桂枝加大黄汤。此为误下,邪陷
太阴之里证也。若潮热自汗,大便难,则为太阴之邪,转属阳明也,宜大承气汤。
呕吐一病,各条经络都可能出现,为什么归属于少阳经呢?这是因为表邪侵入体内,里气抗拒格拒,导致气机上逆而作呕,所以归属于少阳经,适宜使用小柴胡汤。如果心下部位坚硬且烦闷,或者大便不通畅,适宜使用大柴胡汤。如果是表证未解引起的呕吐,归属于太阳经,适宜使用柴桂汤。进食后想要呕吐,归属于阳明经,主要病机是中焦虚寒,适宜使用吴茱萸汤。服用吴茱萸汤后呕吐反而加重,说明主要是表热,适宜使用葛根加半夏汤。呕吐涎沫,或者呕吐蛔虫,归属于厥阴经。呕吐涎沫的,适宜使用吴茱萸汤。呕吐蛔虫的,适宜使用乌梅丸。呕吐并伴有腹泻,这是有水饮之气,归属于少阴经,适宜使用真武汤。喝水就吐,吐了又想喝,水与呕吐相互因果不止,这是水饮停聚,适宜使用五苓散。
怕冷又发热,发热又怕冷,寒热交替发作不止,所以称为往来寒热,这是少阳经的主要证候,适宜使用小柴胡汤。寒热发作有规律性的停止和开始,一天发作一次,或者隔天发作一次,称为疟疾,属于杂病范畴。寒热发作没有规律性的停止和开始,一天发作三到五次,称为“如疟”(像疟疾一样的症状),属于太阳经未尽的表邪,适宜使用麻黄桂枝各半汤。如果热多寒少,适宜使用桂枝二越婢一汤。如果有汗出,适宜使用桂枝二麻黄一汤。如果没有汗出,也适宜使用麻黄桂枝各半汤。这些都是治疗太阳经未尽微邪的方法。
眼睛昏花不明,称为目眩;耳朵听不见声音,称为耳聋,这些都是少阳经的主要证候,不是死症。如果因为发汗、催吐、泻下等治疗方法不当,导致各种变证和坏证,出现眼睛昏花且神志昏迷,言语错乱则是神气涣散、气脱的征候,所以不能存活。如果因为误对湿温病患者发汗,导致不能说话、耳聋听不见、身体发青面色改变,称为“重暝”(重度昏迷),也是死症。
腹部胀满且时而疼痛,属于正气不足,适宜使用桂枝加芍药汤,如果无效再用理中汤。腹部胀满且剧烈疼痛,属于邪气有余,适宜使用桂枝加大黄汤。这是由于误用攻下法,邪气陷入太阴经的里证。如果出现潮热、自汗、大便困难,则是太阴经的邪气转属阳明经,适宜使用大承气汤。
Vomiting (Ou Bing) can occur in all meridians; why is it attributed to the Shaoyang (Lesser Yang) meridian? This is because exterior pathogens enter the interior, and the interior Qi resists and blocks them, causing Qi to rebel upward and induce vomiting; thus, it is attributed to the Shaoyang meridian. The appropriate formula is Xiaochaihu Tang (Minor Bupleurum Decoction). If there is hardness and irritability below the heart, or constipation, Dachaihu Tang (Major Bupleurum Decoction) is appropriate. If vomiting occurs due to unresolved exterior syndrome, it belongs to the Taiyang (Greater Yang) meridian, and Chaigui Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate. Desire to vomit after eating food indicates Yangming (Yang Brightness) meridian involvement, primarily due to middle Jiao cold (Zhong Han), and Wuzhuyu Tang (Evodia Decoction) is appropriate. If vomiting worsens after taking this decoction, it indicates exterior heat, and Gegen Banxia Tang (Kudzu and Pinellia Decoction) is appropriate. Vomiting saliva or phlegm, or vomiting roundworms, indicates Jueyin (Terminal Yin) meridian involvement. For those vomiting saliva or phlegm, Wuzhuyu Tang (Evodia Decoction) is appropriate. For those vomiting roundworms, Wumei Wan (Mume Pill) is appropriate. Vomiting accompanied by diarrhea indicates the presence of fluid retention (Shui Qi), belonging to the Shaoyin (Lesser Yin) meridian, and Zhenwu Tang (True Warrior Decoction) is appropriate. Drinking water leads to vomiting, and vomiting leads to a desire to drink; when drinking and vomiting cycle incessantly, this indicates stagnant water (Ting Shui), and Wuling San (Five-Ingredient Powder with Poria) is appropriate.
Chills alternating with fever, where chills and fever follow each other incessantly, are named "alternating chills and fever" (Wang Lai Han Re), which is the principal syndrome of the Shaoyang meridian; Xiaochaihu Tang (Minor Bupleurum Decoction) is appropriate. Chills and fever that have a regular pattern of onset and cessation, occurring once a day or every other day, are called malaria (Nüe), which belongs to miscellaneous diseases. Chills and fever without a regular pattern of onset and cessation, occurring three to five times a day, are called "like malaria" (Ru Nüe), indicating residual exterior pathogens from the Taiyang meridian; Mahuang Guizhi Ge Ban Tang (Half-Dose Combination of Ephedra and Cinnamon Twig Decoction) is appropriate. If heat predominates over chills, Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig and One Part Minor Bupleurum and Gypsum Decoction) is appropriate. If there is sweating, Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction) is appropriate. If there is no sweating, Mahuang Guizhi Ge Ban Tang (Half-Dose Combination of Ephedra and Cinnamon Twig Decoction) is also appropriate. These are all methods for treating residual mild pathogens of the Taiyang meridian.
Dizziness (Mu Xuan), characterized by blurred vision, and deafness (Er Long), characterized by inability to hear, are both principal syndromes of the Shaoyang meridian and are not fatal signs. However, if improper use of sweating, purging, or emesis methods leads to various transformation syndromes and deteriorated conditions, resulting in dizziness with unconsciousness, or speech disorder indicating dispersion of Shen (Spirit) and collapse of Qi, death is inevitable. If sweating is mistakenly induced in patients with damp-warmth disease, leading to inability to speak, deafness, cyanosis of the body, and discoloration of the face, it is called "chong ming" (severe coma/darkness), which is also a fatal sign.
Abdominal fullness with intermittent pain indicates deficiency (Bu Zu); Guizhi Ji Shaoyao Tang (Cinnamon Twig Decoction Augmented with Peony Root) is appropriate. If ineffective, Lizhong Tang (Regulate the Middle Decoction) should be used. Abdominal fullness with severe pain indicates excess (You Yu); Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction Augmented with Rhubarb) is appropriate. This results from mistaken purgation, causing pathogens to sink into the interior of the Taiyin (Tai Yin) meridian. If tidal fever, spontaneous sweating, and difficulty in defecation occur, it indicates that Taiyin pathogens have transferred to the Yangming meridian; Dachengqi Tang (Major Order the Qi Decoction) is appropriate.