少阴病,得之二三日,口燥干者,宜下之,大承气汤。少阴病,自利纯青色水,心下痛,口燥干者,宜大
承气汤。(论见下利。)伤寒无大热,口燥渴,背恶寒者,白虎加人参汤。阳明病,发热汗出,不恶寒反
恶热,若口干舌燥者,白虎加人参汤。(方论见渴表解条。)
太阳病,下后不大便,日晡潮热,心下满痛,而舌上燥渴者,宜大陷胸汤。
阳明病,口燥,但欲漱水不咽者,必衄。(海藏云∶漱水不咽,胸满,心下手不可近者,桃仁承气主之。)
病患默默欲眠,目不能闭,起居不安,声嗄,或咽干者,当作狐惑治之。咽喉干燥者,不可发汗。
少阴病二三日,咽痛,可与甘草汤,不瘥,桔梗汤。
甘草汤 用甘草二两, 咀,每服四钱,水煎,去渣温服,日三服。
桔梗汤 用甘草二两,桔梗一两, 咀,每服五钱,水煎温服。
少阴病,咽中痛,半夏散及汤主之。
半夏(制) 桂枝 甘草(炙。各等分)
上 咀,水煎服,少少咽之为散,白汤调服方寸匕,亦效,日三服。(仲景法为散调服,不 咀。)
〔成〕甘草汤主少阴客热,咽痛。桔梗汤,主少阴寒热相搏,咽痛。半夏散及汤,主少阴客寒咽痛。
少阴病,咽中生疮,不能言语,声不出者,苦酒汤主之。
半夏(制,十四枚) 鸡子(一个,去黄,纳半夏、苦酒于鸡子壳中)
上二味,纳半夏,着苦酒,以鸡子壳置刀 中,安火上,令三沸,去渣,少少含咽之。不瘥,更
作三剂。
脉紧当无汗,反汗出者,亡阳也。此属少阴,法当咽痛而复吐利。(论见吐利。)师曰∶伏气之病,
以意候之,今月之内,欲有伏气,假令旧有伏气,当须脉之,若脉微弱者,当喉中痛似伤寒,非喉痹也。病患
云∶实咽中痛,虽尔,今复欲下利。(见后《活人》续法)
咽痛下利兼胸满者,猪肤汤。厥逆面赤者,通脉四逆汤。下后复厥逆,下部脉不至者,麻黄升麻汤。
(并见下利。)
阳毒咽痛,面赤斑斑如锦纹,唾脓血,五日可治,七日不可治,宜升麻鳖甲汤。(《活人》云∶阳毒
升麻汤主之。论见阳毒条。)
阴毒咽痛,面目青,身痛如被杖,五日可治,七日不可治,升麻鳖甲去雄黄蜀椒汤。(《活人》云∶
阴毒甘草汤主之。论见阴毒条。)
太阳病,下后脉紧者,必咽痛。(论见大法。)阳明病,头眩而咳者,必咽痛。若不咳者,咽不痛。
先厥后热者,下利必自止,止而反汗出者,其喉为痹。发热无汗者,下利必自止。若不止者,必便脓血,
其喉不痹。(论见下利。)
咽中闭塞,不可发汗,发汗则吐血,气欲绝,手足厥冷,欲得蜷卧,不能自温。咽中闭塞,不可下,
下之则上轻下重,水浆不下,卧则欲蜷,身急头眩,下利日数十行。
少阴病,发病两三天后,出现口燥咽干症状的,适宜采用泻下法治疗,方用大承气汤。少阴病,自发腹泻排出纯青色水样便,心窝部疼痛,且伴有口燥咽干的,适宜使用大承气汤。(相关论述见“下利”篇。)伤寒病,体表没有明显高热,但口燥渴,背部感觉恶寒的,方用白虎加人参汤。阳明病,发热出汗,不恶寒反而怕热,如果口干舌燥的,方用白虎加人参汤。(方剂论述见“渴表解”条。)
太阳病,经过泻下治疗后出现不大便,傍晚时分定时发热(日晡潮热),心窝部胀满疼痛,且舌上干燥口渴的,适宜使用大陷胸汤。
阳明病,口燥,只想含水漱口而不愿咽下的,必然会出现鼻衄(流鼻血)。(海藏说:若表现为想漱口但不吞咽,胸部胀满,心下部按压时疼痛拒按的,主方为桃仁承气汤。)
病人神情沉默想睡觉,但眼睛又无法闭合,起居不安稳,声音嘶哑,或者咽喉干燥的,应当当作狐惑病来治疗。咽喉干燥的,不可使用发汗法。
少阴病两三天后出现咽痛,可以给予甘草汤治疗;若无效,改用桔梗汤。
甘草汤 使用甘草二两,切碎,每次服用四钱,加水煎煮,去渣后温服,每日三次。
桔梗汤 使用甘草二两,桔梗一两,切碎,每次服用五钱,加水煎煮后温服。
少阴病,咽喉中疼痛,由半夏散及汤主治。
半夏(制) 桂枝 甘草(炙。各等分)
以上药物切碎,加水煎服,少量多次咽下;或者制成散剂,用白开水调服一方寸匕,也有效,每日三次。(张仲景的方法是将药制成散剂调服,不需要切碎煎煮。)
〔成无己注〕甘草汤主治少阴经受客热引起的咽痛。桔梗汤,主治少阴经受寒热邪气搏结引起的咽痛。半夏散及汤,主治少阴经受客寒引起的咽痛。
少阴病,咽喉部长疮,不能说话,声音发不出来的,由苦酒汤主治。
半夏(制,十四枚) 鸡蛋(一个,去掉蛋黄,将半夏、醋放入蛋壳中)
以上两味药,将半夏放入蛋壳,加入醋,把蛋壳放在刀柄或类似容器中,置于火上,煮沸三次,去渣,少量含在口中慢慢咽下。若未痊愈,再制作三剂服用。
脉象紧应当无汗,反而出汗的,是亡阳证。这属于少阴病,按照法则应当出现咽痛并伴有呕吐和腹泻。(相关论述见“吐利”篇。)老师说:伏气病,需要用心意去揣测候诊,如果在当月之内,可能有伏气潜伏,假如原本就有伏气,必须通过脉诊来判断,如果脉象微弱,应当感到喉咙痛类似伤寒,而不是喉痹。病人说:确实是咽喉剧烈疼痛,虽然如此,现在又想腹泻。(见于后世《活人书》续法)
咽痛伴有腹泻兼有胸部胀满的,用猪肤汤。四肢厥冷且面色发红的,用通脉四逆汤。泻下后又出现四肢厥冷,下部脉搏摸不到的,用麻黄升麻汤。(均见于“下利”篇。)
阳毒引起的咽痛,面部红赤且有如锦纹般的斑疹,咳唾脓血,第五天还可以治疗,第七天则不可治,适宜用升麻鳖甲汤。(《活人书》说:阳毒用升麻汤主治。相关论述见“阳毒”条。)
阴毒引起的咽痛,面目青黑,身体疼痛如同被棍棒打过一样,第五天还可以治疗,第七天则不可治,用升麻鳖甲汤去掉雄黄和蜀椒。(《活人书》说:阴毒用甘草汤主治。相关论述见“阴毒”条。)
太阳病,经过泻下治疗后脉象变紧的,必然出现咽痛。(相关论述见“大法”篇。)阳明病,头晕目眩且咳嗽的,必然出现咽痛。如果不咳嗽,就不会咽痛。
先出现四肢厥冷后出现发热的,腹泻必然会自行停止,停止后反而出汗的,其咽喉会发生闭塞(痹)。发热无汗的,腹泻必然会自行停止。如果不停止的,必然大便带脓血,其咽喉不会发生闭塞。(相关论述见“下利”篇。)
咽喉闭塞感,不可使用发汗法,发汗会导致吐血,气息将要断绝,手足冰冷,想要蜷缩而卧,无法自我温暖。咽喉闭塞感,不可使用泻下法,泻下会导致上部虚弱下部沉重,饮食难进,躺下时想要蜷缩,身体拘急头晕,腹泻一天数十次。
Shaoyin disease, occurring two to three days after onset, presenting with dry mouth and throat, is suitable for purgation treatment, using Dachengqi Tang (Major Order the Qi Decoction). Shaoyin disease, presenting with spontaneous diarrhea of pure green watery stool, pain in the epigastrium, and accompanied by dry mouth and throat, is suitable for Dachengqi Tang (Major Order the Qi Decoction). (The discussion is found under "Diarrhea".) In Cold Damage disease, without significant fever on the exterior, but with dry mouth and thirst, and aversion to cold in the back, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used. Yangming disease, presenting with fever and sweating, no aversion to cold but rather aversion to heat, if accompanied by dry mouth and tongue, Baihu Jianshen Tang (White Tiger Decoction plus Ginseng) should be used. (The formula discussion is found under "Thirst and Exterior Resolution" section.)
Taiyang disease, following purgation therapy, presents with constipation, tidal fever at dusk (Ribang Chaore), fullness and pain in the epigastrium, and dry mouth with thirst on the tongue; Datianxiong Tang (Major Trap the Chest Decoction) is indicated.
Yangming disease, presenting with dry mouth, where the patient desires to rinse water in the mouth but does not swallow it, will inevitably develop epistaxis (nosebleed). (Haizang stated: If the presentation involves desiring to rinse but not swallowing, chest fullness, and tenderness upon pressure in the epigastrium, Taoren Chengqi Tang (Peach Kernel Order the Qi Decoction) is the primary formula.)
The patient appears silent and sleepy, yet cannot close their eyes, is restless in daily activities, has hoarseness, or dry throat; this should be treated as Huhuo Disease (Fox-Secretion Disease, often corresponding to Behçet's disease). Dry throat contraindicates diaphoresis (sweating method).
In Shaoyin disease, two to three days after onset, if sore throat occurs, Gancao Tang (Licorice Decoction) may be given; if not cured, Jiegeng Tang (Platycodon Decoction) should be used.
Gancao Tang uses two liang of Gancao (Radix Glycyrrhizae Preparata), chopped, taken four qian per dose, decocted in water, strained, and taken warm, three times a day.
Jiegeng Tang uses two liang of Gancao (Radix Glycyrrhizae Preparata) and one liang of Jiegeng (Radix Platycodi), chopped, taken five qian per dose, decocted in water and taken warm.
For Shaoyin disease with pain in the throat, Banxia San Ji Tang (Pinellia Powder and Decoction) is the main treatment.
Banxia (Prepared) Guizhi (Ramulus Cinnamomi) Gancao (Roasted). Each in equal parts.
Chop the above ingredients, decoct in water, and take orally in small amounts repeatedly. Alternatively, prepare as a powder, mix with plain water, and take one cunbi (a measure roughly equivalent to a spoonful) per dose; this is also effective, taken three times a day. (Zhang Zhongjing's method was to prepare as a powder mixed with water, not to chop and decoct.)
[Cheng Wuji's Commentary] Gancao Tang (Licorice Decoction) treats sore throat caused by exogenous heat invading Shaoyin. Jiegeng Tang (Platycodon Decoction) treats sore throat caused by the struggle between cold and heat in Shaoyin. Banxia San Ji Tang (Pinellia Powder and Decoction) treats sore throat caused by exogenous cold in Shaoyin.
In Shaoyin disease, if sores form in the throat, preventing speech and voice production, Kujiu Tang (Bitter Wine Decoction) is the main treatment.
Banxia (Prepared, fourteen pieces) Ji Zi (one egg, remove yolk, place Banxia and Kujiu [vinegar] into the eggshell).
Place the two ingredients together, putting Banxia into the shell with Kujiu. Place the eggshell in a knife handle or similar container, set over fire, boil three times, strain, and hold in the mouth to swallow slowly in small amounts. If not cured, prepare three more doses.
A tight pulse usually indicates absence of sweating; if sweating occurs instead, it signifies collapse of Yang (Wangyang). This belongs to Shaoyin disease; according to the law, it should present with sore throat accompanied by vomiting and diarrhea. (The discussion is found under "Vomiting and Diarrhea".) The Master said: Bingfuqi (Dormant Qi disease) requires intuitive observation. Within the current month, if dormant qi is suspected, and if there is a history of dormant qi, pulse diagnosis is necessary. If the pulse is weak, the patient should feel throat pain resembling Cold Damage, rather than Hou Bi (throat obstruction). The patient states: "Indeed, there is severe throat pain," although now they also desire diarrhea. (See later "Huo Ren" continuation methods).
Sore throat accompanied by diarrhea and chest fullness is treated with Zhufu Tang (Swine Skin Decoction). Cold limbs with red face are treated with Tongmai Sini Tang (Pulse-Reviving Four Reversals Decoction). Post-purgation recurrence of cold limbs with absent lower limb pulses is treated with Mahuang Shengma Tang (Ephedra and Ma Huang Shen Decoction). (All found under "Diarrhea".)
Yang Du (Yang Toxin) causing sore throat, with a red face and mottled rash like brocade patterns, expectoration of pus and blood, is treatable on the fifth day but untreatable on the seventh day. Shengma Biejia Tang (Cimicifuga and Turtle Shell Decoction) is indicated. (The "Huo Ren" book states: Yang Du is treated with Shengma Tang. The discussion is found under "Yang Du" section.)
Yin Du (Yin Toxin) causing sore throat, with blue-green complexion and body pain as if beaten by a club, is treatable on the fifth day but untreatable on the seventh day. Shengma Biejia Tang minus Xionghuang (Realgar) and Shujiao (Sichuan Pepper) is used. (The "Huo Ren" book states: Yin Du is treated with Gancao Tang. The discussion is found under "Yin Du" section.)
Taiyang disease, following purgation, if the pulse becomes tight, sore throat will inevitably occur. (The discussion is found under "General Principles".) Yangming disease, with dizziness and cough, will inevitably cause sore throat. If there is no cough, there will be no sore throat.
If cold limbs precede fever, diarrhea will stop spontaneously. If it stops but sweating ensues, the throat will become obstructed (Bi). If fever occurs without sweating, diarrhea will stop spontaneously. If it does not stop, pus and blood will appear in the stool, and the throat will not become obstructed. (The discussion is found under "Diarrhea".)
Throat obstruction contraindicates diaphoresis; diaphoresis will lead to hematemesis (vomiting blood), near-death of Qi, cold limbs, desire to curl up, and inability to self-warm. Throat obstruction contraindicates purgation; purgation will lead to upper deficiency and lower excess, inability to ingest food and drink, desire to curl up when lying down, bodily stiffness, dizziness, and diarrhea dozens of times a day.