吐与利、下三门,并附入少阴病。盖此三门之病,本属太阴病,因在少阴者反多,故附入少阴也。
太阴之为病,腹满而吐,食不下,自利益甚,时腹自痛。若下之,必胸下结硬。太阴病脉浮者,可发汗,
宜桂枝汤。
本太阳病,医反下之,因小腹满时痛者,属太阴也,桂枝加芍药汤主之。大便实痛者,桂枝加大
黄汤主之。
桂枝加芍药汤
桂枝 生姜(各一两半) 甘草(一两) 芍药(三两) 大枣(六枚)
上 咀,每服五钱,水煎温服。
桂枝加大黄汤
桂枝(一两) 芍药(一两半) 甘草(炙,半两) 大黄(半两,大便实痛者,加一两,虚者减五钱)
上 咀,大枣三个,生姜四片,水煎温服。
太阴病脉弱,其人续自便利,设当用大黄、芍药者,宜减之。以其人胃气弱,易动故也。太阴中风,
四肢烦疼,阳微脉涩而长者,为欲愈。太阴病欲解时,从亥至丑。腹满时痛吐利者,为太阴。(论见前太阴条。)
霍乱吐利,头痛发热,身痛不渴而腹满者,理中丸加附子主之。(论见吐利霍乱条。)下利腹胀满身
痛者,四逆温里,后用桂枝攻表。(论见下利。)
哕而腹满,视前后部有不利者,利之则愈。(论见哕。)少阴腹满胀,不大便者,宜大承气汤。(论见
不大便。)
腹满,小便不利,身黄者,茵陈蒿汤。(论见黄。)若兼胁下痛,脉弦浮大者,宜小柴胡汤。(论见鼻干。)
腹满不减,减不足言,当下之,宜大承气汤。腹满时减复如故,此虚寒从下而上也,当以温药和之。
太阴病,腹满时痛,脉浮者,宜桂枝汤。(论见前太阴条。)阳明脉弦浮大,胁痛身黄而腹满者,小
柴胡汤。(论见鼻干。)伤寒腹满谵语,寸口脉浮而紧,此肝乘脾也,名曰纵,宜刺期门。阳明病,腹
满,脉浮紧,口苦咽干而痛,若其人发热恶寒者,下之则腹满,小便难。若其人发热汗出,不恶寒反恶热
者,下之则懊 ,汗之则谵语,加烧针则怵惕不眠。(论见胃家实。注云,当和解之。)
阳明病,腹满脉迟,苦头眩,小便难者,不可下;若潮热汗出不恶寒者,大承气主之。(论见胃实。)
三阳合病,腹满,身重难转侧,谵语遗尿,自汗者,宜白虎汤。(论见合病。)伤寒发热,脉涩恶寒,
大渴欲饮水,其腹必满,自汗出,小便利,其病欲解,此肝乘肺也,名曰横,宜刺期门。腹满汗出,不
恶寒而喘,若脉迟潮热者,大承气汤。若脉浮紧,口苦咽燥者,忌发汗,忌烧针,忌下。(论见腹满脉
浮迟条。)
发汗后腹胀满者,浓朴生姜人参甘草半夏汤主之。
浓朴生姜人参甘草半夏汤
浓朴 生姜(各二两) 半夏(六钱) 人参(一两) 甘草(五钱)
上 咀,每服五钱,水煎温服。
下利清谷,若发汗,必胀满。(论见下利。)伤寒吐后腹胀满者,与调胃承气汤。下后心烦,腹满,
卧起不安者,栀子浓朴汤。(论见烦。)极吐下后,温温欲吐,胸痛便溏,腹满而烦者,调胃承气汤。(论见呕。)
不大便六七日,少与小承气汤,不转矢气者,不可攻之,攻之则腹满不能食。(论见不大便。)腹
满吐利者忌下。
(论见太阴。)腹满,脉浮紧,口苦咽干者,忌汗、下、针。(论见自汗。)腹满脉迟者,忌下。(论见前脉
迟条。)腹满,脉弱,自利,设用大黄、芍药,宜减之。(论见太阴条中。)
呕吐、下利、攻下这三种治法,都附载在少阴病篇中。因为这三类病症,原本属于太阴病,但在少阴病中出现的情况反而更多,所以附载在少阴病篇里。
太阴病的典型症状是:腹部胀满,呕吐,饮食难以下咽,腹泻逐渐加重,时常出现腹部自发性疼痛。如果误用攻下法,必然导致胸膈下方结聚硬痛。太阴病若脉象浮,可以采用发汗法,适宜使用桂枝汤(Cinnamon Twig Decoction)。
原本是太阳病(Taiyang disease),医生反而误用攻下法,导致小腹满闷且时而疼痛的,属于太阴病范畴,应当以桂枝加芍药汤(Cinnamon Twig and Peony Decoction)为主治方剂。若大便干结且疼痛的,以桂枝加大黄汤(Cinnamon Twig and Rhubarb Decoction)为主治方剂。
桂枝加芍药汤
处方组成:桂枝(一两半)、生姜(各一两半)、甘草(一两)、芍药(三两)、大枣(六枚)。
制法与用法:将药物切碎,每次服用五钱,加水煎煮后温服。
桂枝加大黄汤
处方组成:桂枝(一两)、芍药(一两半)、甘草(炙,半两)、大黄(半两;若大便干结疼痛者,加至一两;体质虚弱者减去五钱)。
制法与用法:将药物切碎,加入大枣三个、生姜四片,加水煎煮后温服。
太阴病患者若脉象虚弱,其人持续自行排便通畅,即使病情需要用到大黄、芍药,也应当减少用量。这是因为患者胃气虚弱,容易受药物影响而变动。太阴病感受风邪,四肢烦扰疼痛,若脉象微涩且长,这是将要痊愈的征兆。太阴病欲缓解的时间段,是从亥时到丑时。出现腹部胀满、时而疼痛、呕吐下利的,归属于太阴病。(相关论述见前文太阴条。)
霍乱引起的呕吐下利,伴有头痛、发热、身体疼痛但不口渴且腹部胀满的,以理中丸加附子(Aconite)为主治方剂。(相关论述见吐利霍乱条。)下利导致腹胀、全身疼痛的,先用四逆汤(Four Reversal Decoction)温里,后用桂枝汤解表。(相关论述见下利条。)
呃逆且腹部胀满,观察前后二便如有不通利的情况,通利二便则病愈。(相关论述见呃逆条。)少阴病出现腹部胀满、大便不通的,适宜使用大承气汤(Major Order the Qi Decoction)。(相关论述见大便不通条。)
腹部胀满,小便不利,身体发黄者,使用茵陈蒿汤(Artemisiae Scopariae Decoction)。(相关论述见黄疸条。)若兼有胁下疼痛,脉象弦、浮、大的,适宜使用小柴胡汤(Minor Order the Qi Decoction)。(相关论述见鼻干条。)
腹部胀满持续不减,即使减轻也不足挂齿的,应当采用攻下法,适宜使用大承气汤。腹部胀满时而减轻,随后又恢复如初的,这是虚寒之气从下向上逆行所致,应当用温性药物调和。
太阴病,腹部胀满时而疼痛,脉象浮的,适宜使用桂枝汤。(相关论述见前文太阴条。)阳明病脉象弦、浮、大,伴有胁痛、身黄且腹部胀满的,使用小柴胡汤。(相关论述见鼻干条。)伤寒导致腹部胀满、谵语,寸口脉象浮而紧,这是肝气乘袭脾土,名为“纵”,适宜针刺期门穴。(相关论述见胃家实证。注云:应当和解。)
阳明病,腹部胀满,脉象浮紧,口苦、咽干且疼痛,若患者伴有发热恶寒,误用攻下法则会导致腹部胀满、小便困难。若患者发热汗出,不恶寒反而恶热,误用攻下法则会导致心中懊恼,误用发汗法则会导致谵语,误用烧针法则会导致惊恐不安、失眠。(相关论述见胃家实证。注云:应当和解。)
阳明病,腹部胀满,脉象迟,头目眩晕痛苦,小便困难的,不可攻下;若出现潮热、汗出、不恶寒的,以大承气汤为主治方剂。(相关论述见胃实证。)
三阳合病,出现腹部胀满,身体沉重难以转侧,谵语、遗尿、自汗的,适宜使用白虎汤(White Tiger Decoction)。(相关论述见合病条。)伤寒发热,脉涩恶寒,极度口渴想喝水,其腹部必然胀满,若自汗出、小便通利,这是病情将要解除的表现,此乃肝气乘袭肺金,名为“横”,适宜针刺期门穴。腹部胀满、汗出,不恶寒而气喘,若脉象迟且有潮热的,使用大承气汤。若脉象浮紧,口苦咽燥的,忌用发汗法,忌用烧针,忌用攻下法。(相关论述见腹满脉浮迟条。)
发汗后出现腹胀满的,以浓朴生姜人参甘草半夏汤(Magnolia Bark, Ginger, Ginseng, Licorice and Pinellia Decoction)为主治方剂。
浓朴生姜人参甘草半夏汤
处方组成:浓朴(二两)、生姜(二两)、半夏(六钱)、人参(一两)、甘草(五钱)。
制法与用法:将药物切碎,每次服用五钱,加水煎煮后温服。
下利排出未消化食物,若误用发汗法,必然导致腹胀满。(相关论述见下利条。)伤寒呕吐后出现腹胀满的,给予调胃承气汤(Harmonize the Stomach Major Order the Qi Decoction)。攻下后出现心烦、腹部胀满、卧起不安的,使用栀子浓朴汤(Gardenia and Magnolia Bark Decoction)。(相关论述见心烦条。)剧烈吐下之后,感到恶心欲吐,胸痛、大便溏薄,腹部胀满且烦躁的,使用调胃承气汤。(相关论述见呕吐条。)
大便不通六七天,少量给予小承气汤(Minor Order the Qi Decoction),若不转矢气(放屁),则不可攻下,攻下则会导致腹部胀满、不能进食。(相关论述见大便不通条。)腹部胀满伴有呕吐下利的,忌用攻下法。
(相关论述见太阴病篇。)腹部胀满,脉象浮紧,口苦咽干的,忌用发汗、攻下、针刺。(相关论述见自汗条。)腹部胀满脉象迟的,忌用攻下。(相关论述见前文脉迟条。)腹部胀满,脉象弱,自利,若需用大黄、芍药,应当减量。(相关论述见太阴病条中。)
Vomiting, diarrhea, and purgation are three treatment categories appended to the Shaoyin disease chapter. These conditions originally belong to Taiyin disease, but since they occur more frequently in Shaoyin disease, they are appended there.
The hallmark of Taiyin disease is abdominal fullness with vomiting, inability to eat, worsening spontaneous diarrhea, and occasional spontaneous abdominal pain. If purgation is mistakenly applied, it will inevitably lead to hardness and binding below the chest. In Taiyin disease, if the pulse is floating, sweating therapy may be employed, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
If a patient initially had Taiyang disease, but the physician mistakenly applied purgation, resulting in lower abdominal fullness and intermittent pain, this belongs to the category of Taiyin disease; Guizhi Jia Shaoyao Tang (Cinnamon Twig and Peony Decoction) should be used. If stool is hard and painful, Guizhi Jia Dahuang Tang (Cinnamon Twig and Rhubarb Decoction) should be used.
Guizhi Jia Shaoyao Tang (Cinnamon Twig and Peony Decoction)
Ingredients: Guizhi (Cinnamomi Ramulus, 1.5 liang), Shengjiang (Zingiberis Rhizoma Recens, 1.5 liang each), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang), Shaoyao (Paeoniae Radix Alba, 3 liang), Dazao (Jujubae Fructus, 6 pieces).
Preparation and Administration: Crush the herbs. Take 5 qian per dose, decoct in water, and take warm.
Guizhi Jia Dahuang Tang (Cinnamon Twig and Rhubarb Decoction)
Ingredients: Guizhi (Cinnamomi Ramulus, 1 liang), Shaoyao (Paeoniae Radix Alba, 1.5 liang), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 0.5 liang), Dahuang (Rhei Radix et Rhizoma, 0.5 liang; increase by 1 liang if stool is hard and painful; reduce by 5 qian if deficiency prevails).
Preparation and Administration: Crush the herbs. Add 3 Dazao (Jujubae Fructus) and 4 slices of Shengjiang (Zingiberis Rhizoma Recens). Decoct in water and take warm.
In Taiyin disease, if the pulse is weak and the patient continues to have spontaneous bowel movements, even if Dahuang (Rhei Radix et Rhizoma) or Shaoyao (Paeoniae Radix Alba) are indicated, their dosages should be reduced. This is because the patient's Stomach Qi is weak and easily disturbed. In Taiyin wind-stroke, with irritability and pain in the four limbs, if the pulse is micro, choppy, and long, recovery is imminent. The time when Taiyin disease tends to resolve is from Hai hour to Chou hour. Abdominal fullness, intermittent pain, vomiting, and diarrhea indicate Taiyin disease. (See Taiyin section above.)
For Huoluan (Huo-loan) with vomiting and diarrhea, accompanied by headache, fever, body pain, absence of thirst, and abdominal fullness, Lizhong Wan (Regulate the Middle Pill) with Fuzi (Aconiti Lateralis Radix Praeparata) is indicated. (See Huoluan section.) For diarrhea with abdominal distension and whole-body pain, use Sini Tang (Four Reversal Decoction) to warm the interior first, followed by Guizhi Tang (Cinnamon Twig Decoction) to release the exterior. (See Diarrhea section.)
For hiccups accompanied by abdominal fullness, observe the anterior and posterior orifices for obstruction; relieving the obstruction will cure the condition. (See Hiccups section.) In Shaoyin disease, abdominal fullness and bloating with constipation indicate Da Chengqi Tang (Major Order the Qi Decoction). (See Constipation section.)
Abdominal fullness with difficulty in urination and jaundice indicates Yinchen Hao Tang (Artemisiae Scopariae Decoction). (See Jaundice section.) If accompanied by hypochondriac pain and a string-taut, floating, and large pulse, Xiao Chaihu Tang (Minor Order the Qi Decoction) is appropriate. (See Dry Nose section.)
If abdominal fullness persists without relief, or even slight reduction is negligible, purgation is required, and Da Chengqi Tang (Major Order the Qi Decoction) is suitable. If abdominal fullness comes and goes, returning to normal afterwards, this is due to deficiency-cold rising from below; warming herbs should be used to harmonize.
In Taiyin disease, with abdominal fullness, intermittent pain, and a floating pulse, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. (See Taiyin section above.) In Yangming disease, with a string-taut, floating, and large pulse, hypochondriac pain, jaundice, and abdominal fullness, Xiao Chaihu Tang (Minor Order the Qi Decoction) is indicated. (See Dry Nose section.) In Shanghan (Cold Damage) with abdominal fullness and delirium, if the Cun position pulse is floating and tight, this is Liver Qi invading the Spleen, termed "Zong" (Vertical); acupuncture at Qimen (LR14) is appropriate. (See Stomach House Excess section. Note: Harmonization is indicated.)
In Yangming disease, with abdominal fullness and a slow pulse, suffering from vertigo and difficult urination, purgation is contraindicated; however, if tidal fever, sweating, and absence of aversion to cold are present, Da Chengqi Tang (Major Order the Qi Decoction) is indicated. (See Stomach Excess section.)
In combined disease of the Three Yang, with abdominal fullness, heavy body difficult to turn, delirium, enuresis, and spontaneous sweating, Baihu Tang (White Tiger Decoction) is appropriate. (See Combined Disease section.) In Shanghan with fever, choppy pulse, aversion to cold, extreme thirst for water, and inevitable abdominal fullness, if spontaneous sweating and free urination occur, the disease is resolving; this is Liver Qi invading Lung Metal, termed "Heng" (Horizontal); acupuncture at Qimen (LR14) is appropriate. With abdominal fullness, sweating, absence of aversion to cold, and wheezing, if the pulse is slow with tidal fever, Da Chengqi Tang (Major Order the Qi Decoction) is used. If the pulse is floating and tight with bitter taste and dry throat, sweating, moxibustion/cauterization, and purgation are all contraindicated. (See Abdominal Fullness with Floating and Slow Pulse section.)
After sweating therapy, if abdominal distension occurs, Nongpu Shengren Renshen Gancao Banxia Tang (Magnolia Bark, Ginger, Ginseng, Licorice and Pinellia Decoction) is indicated.
Nongpu Shengren Renshen Gancao Banxia Tang (Magnolia Bark, Ginger, Ginseng, Licorice and Pinellia Decoction)
Ingredients: Houpo (Magnoliae Officinalis Cortex, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 2 liang), Banxia (Pinelliae Rhizoma, 6 qian), Renshen (Ginseng Radix et Rhizoma, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 5 qian).
Preparation and Administration: Crush the herbs. Take 5 qian per dose, decoct in water, and take warm.
In diarrhea with undigested food, if sweating therapy is mistakenly applied, abdominal distension will inevitably result. (See Diarrhea section.) After Shanghan vomiting leads to abdominal fullness, Tiaowei Chengqi Tang (Harmonize the Stomach Major Order the Qi Decoction) is given. After purgation, if restlessness, abdominal fullness, and inability to lie or sit comfortably occur, Zhizi Nongpu Tang (Gardenia and Magnolia Bark Decoction) is indicated. (See Restlessness section.) After severe vomiting and purgation, if there is nausea, chest pain, loose stools, abdominal fullness, and irritability, Tiaowei Chengqi Tang (Harmonize the Stomach Major Order the Qi Decoction) is used. (See Vomiting section.)
If there is no bowel movement for six or seven days, administer a small amount of Xiao Chengqi Tang (Minor Order the Qi Decoction); if flatus does not pass, do not attack with purgatives, as this will cause abdominal fullness and anorexia. (See Constipation section.) Abdominal fullness with vomiting and diarrhea contraindicates purgation.
(About Taiyin.) Abdominal fullness with a floating-tight pulse and bitter taste/dry throat contraindicates sweating, purgation, and needling. (See Spontaneous Sweating section.) Abdominal fullness with a slow pulse contraindicates purgation. (See Slow Pulse section above.) Abdominal fullness with a weak pulse and spontaneous diarrhea: if Dahuang (Rhei Radix et Rhizoma) or Shaoyao (Paeoniae Radix Alba) are needed, reduce the dosage. (See Taiyin section.)