循衣摸床,危恶之极也。一因太阳火劫取汗,致阳盛伤阴,阴若未竭,则小便利多生。阴若已竭,则小
便难多死。一因阳明热极,汗吐下三法失宜,致成坏证,其热弥深。脉实者堪下,则可治。脉弱者不堪下,
则难治。此已成危恶坏证,往往阴阳虚实,医莫能辨,无下手处。当以大剂独参、六味、干地黄汤,时时与
之,每获生也。
太阳中风,有渴欲饮水,水入即吐者,名曰水逆。饮水多而小便少者,名曰消渴。如发热汗出心烦,小便
不利,水入则吐,脉浮而数者,均宜五苓散,多服暖水,令微汗出,外解太阳,内利停水,其病自愈。若不能
饮暖水,欲饮冷水者,是热盛也,以五苓散加寒水石、石膏、滑石可也。
太阳伤寒,表不解,发热无汗,兼有干呕而咳,微喘,饮病之主证,宜以小青龙汤外发寒邪、内散寒饮,
则病可愈矣。或小便不利,少腹满,或下利、或噎、或喘、或渴,此饮病或有之证,亦以青龙汤主之。少腹满
,小便不利,是水停下焦;大便下利,是水走大肠,俱去麻黄入茯苓,专渗利也。噎为内寒益甚,以麻黄易附
子,散内寒也;喘气上逆,加杏仁以降逆也;渴加花粉去半夏,以避燥生津也。
循衣摸床(手指无意识地摸弄衣襟和床沿),是极其危重的症状。一种情况是因为太阳病误用火法劫取汗液,导致阳气过盛而损伤阴液。如果阴液尚未枯竭,则小便通利且量多,预后较好;如果阴液已经枯竭,则小便困难,死亡率很高。另一种情况是因为阳明病热势极盛,汗、吐、下三种治法使用不当,导致病情恶化成为坏证,热邪更加深入。脉象实大的可以攻下治疗,尚可治愈;脉象虚弱的不能攻下,则难以治疗。这已经成为危重恶性的坏证,往往阴阳虚实难辨,医生不知从何下手。此时应当用大剂量的独参汤、六味地黄汤或干地黄汤,频繁给予服用,常能获救。
太阳中风证,如果有口渴想喝水,但水喝进去就吐出来的情况,称为“水逆”。饮水多而小便少的情况,称为“消渴”。如果出现发热、出汗、心烦、小便不利、喝水即吐、脉象浮而数的症状,都适宜使用五苓散,并多喝温热水,使其微微出汗,从而外解太阳表邪,内利停聚之水饮,疾病自然痊愈。如果不能喝温水,只想喝冷水,说明热势亢盛,可以在五苓散中加入寒水石、石膏、滑石。
太阳伤寒证,表证未解,发热无汗,兼有干呕、咳嗽、轻微气喘,这是寒饮病的典型主证,适宜用小青龙汤外发寒邪、内散寒饮,疾病即可痊愈。或者出现小便不利、小腹胀满,或者腹泻、噎膈、气喘、口渴等症状,这些也是寒饮病可能出现的伴随症状,同样以小青龙汤为主方治疗。如果小腹胀满、小便不利,是水停下焦;大便腹泻,是水走大肠,都应去掉麻黄,加入茯苓,专门用于渗湿利水。如果伴有噎膈,说明内部寒气更甚,应将麻黄替换为附子,以发散内部寒气;如果气喘气逆,加入杏仁以降逆平喘;如果口渴,加入天花粉并去掉半夏,以避免燥性伤津而生津液。
少阴病,通常表现为想睡觉,到了第六七天,反而心烦不得安眠,这是少阴热证。如果伴有腹泻、口渴、咳嗽呕吐、小便不利,这是水饮停聚所致,适宜使用猪苓汤清热利水。
Xun yi mo chuang (fingers unconsciously touching clothes and bed rails) is an extremely critical symptom. One cause is the misuse of fire therapy to force sweating in Taiyang disease, leading to excessive Yang qi damaging Yin fluids. If Yin fluids are not yet exhausted, urination will be unobstructed and copious, indicating a better prognosis; if Yin fluids are already exhausted, urination will be difficult, carrying a high mortality rate. Another cause is extreme heat in Yangming disease, where improper use of sweating, vomiting, or purging methods leads to a deteriorated condition (Huai Zheng), with heat penetrating deeper. A solid pulse indicates suitability for purgation, suggesting treatability; a weak pulse indicates unsuitability for purgation, making treatment difficult. This has become a critical and malignant deteriorated condition, often making it hard for physicians to distinguish between Yin/Yang deficiency/excess, leaving them without a clear approach. At this stage, large doses of Du Shen Tang (Single Ginseng Decoction), Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), or Gan Di Huang Tang (Dried Rehmannia Decoction) should be administered frequently, which often results in survival.
In Taiyang Wind Strike syndrome, if there is thirst with desire to drink water but immediate vomiting after ingestion, it is named "Water Reversal" (Shui Ni). If there is excessive drinking but scanty urination, it is named "Xiao Ke" (Wasting-Thirst). If accompanied by fever, sweating, irritability, dysuria, vomiting upon drinking, and a floating and rapid pulse, Wu Ling San (Five-Ingredient Powder with Poria) is appropriate. Patients should drink plenty of warm water to induce slight sweating, thereby releasing the exterior Taiyang pathogen and promoting diuresis of retained water, leading to spontaneous recovery. If the patient cannot tolerate warm water and desires cold water, it indicates excess heat; Shui Hua Shi (Halloysitum Rubrum), Shi Gao (Gypsum Fibrosum), and Hua Shi (Talcum) can be added to Wu Ling San.
In Taiyang Cold Damage syndrome, if the exterior pattern remains unresolved with fever and absence of sweating, accompanied by dry retching, cough, and mild wheezing, these are principal signs of Cold-Fluid Retention. Xiao Qing Long Tang (Minor Blue Dragon Decoction) is suitable to release exterior Cold pathogens and disperse interior Cold-fluids, leading to recovery. Alternatively, symptoms such as dysuria, hypogastric fullness, diarrhea, dysphagia, wheezing, or thirst may occur as accompanying signs of fluid retention diseases, also primarily treated with Qing Long Tang (Blue Dragon Decoction). For hypogastric fullness and dysuria, indicating water stagnating in the Lower Jiao; or for diarrhea, indicating water moving through the Large Intestine, Ephedrae Herba (Mahuang, 麻黄) should be removed and Poria (Fuling, 茯苓) added to focus on leaching out dampness and promoting urination. For dysphagia, indicating severe internal cold, replace Mahuang with Fu Zi (Aconiti Lateralis Radix Praeparata) to scatter internal cold; for wheezing and rebellious Qi, add Xing Ren (Armeniacae Semen Amarum) to direct rebellious Qi downward; for thirst, add Tian Hua Fen (Trichosanthis Radix) and remove Ban Xia (Pinelliae Rhizoma) to avoid drying properties and generate fluids.
Shaoyin disease typically presents with drowsiness. By the sixth or seventh day, if the patient instead experiences irritability and insomnia, it indicates Shaoyin Heat. If accompanied by diarrhea, thirst, cough, vomiting, and dysuria, it indicates stagnation of Water-Fluids. Zhu Ling Tang (Polyporus Decoction) is suitable to clear heat and promote diuresis.