二阳并病,太阳初得病时,发其汗,汗先出不彻,因转属阳明,续自微汗出,不恶寒,若太阳症不罢者,
不可下之,下之为逆,如此可小发汗。设面色缘缘正赤色者,阳气怫郁在表,当解之熏之。若发汗不出,出不
足言,阳气怫郁不得越,当汗不汗,其人躁烦,不知痛处,乍在腹中,乍在四肢,按之不可得,其人短
气但坐,以汗出不彻故也,更发汗则愈。何以知汗出不彻,以脉涩故知也。(因发不透彻而面赤躁烦短气者,
不足言阳气怫郁,止是当汗不汗也,故更发汗则愈。)脉浮而迟,面热赤而战惕者,六七日当汗出而解,
反发热者,瘥。迟为无阳,不能作汗,其身必痒也。太阳病如疟状,若脉微恶寒,面反有热色而身痒者,
桂枝麻黄各半汤小汗之。(论见发热。)
身热足寒,面赤,卒口噤,背反张者, 病。
阳毒面赤,斑斑如锦纹,咽喉痛,唾脓血者,宜升麻鳖甲汤。(方论见阳毒。)
少阴病,下利清谷,手足厥逆,脉微欲绝,身反不恶寒,面赤色者,通脉四逆汤加葱白。(论见下
利。)下利清谷,脉沉迟,面少赤,手足微厥者,必郁冒,汗出解。(论见下利。)
阳明病,面合赤色者,不可攻之。(论见便难。)
二阳并病,是指太阳病初起时,医生误用发汗法治疗,但汗出得不透彻,导致病邪转入阳明经,出现持续微汗出、不恶寒的症状。如果此时太阳表证仍未解除,不可使用泻下法,因为泻下属于逆治;这种情况下,应当采用轻微的发汗法。
如果患者面色通红且色泽均匀,这是阳气郁结在体表所致,应当通过解表散邪和熏蒸的方法来治疗。如果发汗后仍无汗,或汗出不畅,说明阳气郁结无法宣发,本该出汗却未能出汗,患者会出现烦躁不安、疼痛部位游走不定(有时在腹部,有时在四肢),按压又找不到固定痛点,呼吸短促只能端坐的症状。这是因为汗出不透彻造成的,再次适当发汗即可痊愈。如何判断汗出不透彻呢?可以通过脉象涩滞来确认。(因发汗不彻底而导致面赤、烦躁、短气的情况,并非单纯的阳气怫郁,而是当汗未汗所致,所以再次发汗即可痊愈。)
脉象浮而迟,面部发热发红且身体战栗的,通常在六七日时会通过出汗而病愈;如果反而发热,则病情难以痊愈。脉迟表示阳气不足,不能化生汗液,身体必然会有瘙痒感。
太阳病症状类似疟疾,如果脉象微弱、恶寒,面部反而有热色且身体瘙痒的,宜用小剂量的桂枝麻黄各半汤发汗。(相关论述见“发热”篇。)
身体发热、足部寒冷、面部发红、突然牙关紧闭、角弓反张的,是痉病(此处原文似缺字,根据语境推测为痉病或类似强直性疾病)。
阳毒证表现为面部发红,皮肤出现如锦纹般的斑疹,咽喉疼痛,咳吐脓血的,适宜使用升麻鳖甲汤。(方剂论述见“阳毒”篇。)
少阴病,出现下利清谷(腹泻完谷不化)、手足厥冷、脉微细几乎摸不到的症状,但身体反而不恶寒、面部发红的,适宜使用通脉四逆汤加葱白。(相关论述见“下利”篇。)
下利清谷,脉象沉迟,面部微微发红,手足轻微厥冷的,必定会出现头目昏眩(郁冒),通过出汗而病愈。(相关论述见“下利”篇。)
阳明病,面部呈现全面发红的,不可使用攻下法。(相关论述见“大便困难”篇。)
太阳病经过三天,已经发过汗,或者用过催吐、泻下、温针等治疗方法,病仍然没有解除的,这称为坏病。此时不能再单纯使用桂枝汤,必须观察患者的脉象和症状,分析犯了什么错误,然后依据当前的证候进行治疗。
Two-Yang concurrent disease refers to a condition where, at the initial stage of Taiyang (Greater Yang) disease, the physician mistakenly employed sweating therapy. However, the sweat was not thorough, causing the pathogenic factor to transfer to Yangming (Yang Brightness), resulting in continuous slight sweating and aversion to cold ceasing. If the Taiyang exterior syndrome has not yet resolved, purgation must not be used, as it constitutes a contraindicated treatment; in such cases, mild sweating should be induced.
If the patient's face is uniformly and intensely red, this indicates Yang Qi stagnation in the exterior. Treatment should involve resolving the exterior and employing fumigation methods. If sweating fails to occur or is insufficient, it signifies that Yang Qi is stagnant and cannot diffuse. The failure to sweat when it should leads to restlessness, pain that migrates (sometimes in the abdomen, sometimes in the limbs) with no fixed point upon palpation, shortness of breath requiring an upright sitting posture, and other symptoms. This is due to incomplete sweating; inducing sweating again will lead to recovery. How do we know the sweating was incomplete? By observing a choppy pulse. (Note: Cases of facial redness, restlessness, and shortness of breath due to incomplete sweating are not merely due to Yang Qi stagnation but rather the failure to sweat when indicated; thus, inducing sweating again resolves the condition.)
If the pulse is floating and slow, accompanied by facial heat and redness along with body tremors, resolution through sweating is expected on the sixth or seventh day. If fever persists instead, the disease will not heal. A slow pulse indicates a deficiency of Yang Qi, which cannot generate sweat, leading to bodily itching.
When Taiyang disease presents like malaria, if the pulse is faint, there is aversion to cold, the face shows a reddish hue, and the body itches, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) should be administered in small doses to induce mild sweating. (See discussion under "Fever".)
Symptoms of body heat, cold feet, facial redness, sudden lockjaw, and opisthotonos indicate Jing Disease (Spasm Disease).
In Yang Du (Yang Toxin) syndrome, characterized by facial redness, mottled rashes resembling brocade patterns, sore throat, and expectoration of pus and blood, Shengma Biejia Tang (Anemarrhena and Turtle Shell Decoction) is appropriate. (See discussion under "Yang Toxin".)
In Shaoyin (Lesser Yin) disease, presenting with diarrhea of undigested food, cold extremities, and a faint pulse nearly imperceptible, yet without aversion to cold and with facial redness, Tongmai Sini Tang (Pulse-Restoring Four Reversal Decoction) with scallion white is indicated. (See discussion under "Diarrhea".)
In cases of diarrhea with undigested food, a deep and slow pulse, slight facial redness, and mildly cold extremities, the patient will likely experience dizziness and vertigo (Yu Mao), followed by resolution through sweating. (See discussion under "Diarrhea".)
In Yangming disease, if the entire face is red, purgation is contraindicated. (See discussion under "Difficult Defecation".)
If Taiyang disease persists for three days, and after sweating, vomiting, purging, or warm needle therapy, the condition remains unresolved, it is termed Huai Bing (Ruined Disease). In this state, Guizhi Tang (Cinnamon Twig Decoction) is no longer suitable. One must observe the pulse and symptoms, determine what error was made, and treat according to the current syndrome.