三阳合病,脉浮大「弦」〔上〕关上,但欲眠睡,目合则汗。
【按】
浮大上之「上」字,当是「弦」字,始合论中三阳合病之脉,若是「上」字,则经论
中从无两寸脉主三阳病之理,当改之。
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
。若太阳证不罢者,不可下,下之为逆,如此可小发汗。设面色缘缘正赤者,阳气怫
郁在表,当解之「以汗」〔熏之〕。若发汗不彻,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。
【按】
「熏之」二字,当是「以汗」二字,始与上下文义相属,当改之 。
本太阳病不解,转入少阳者,□下□满,干呕。不能食,往来寒热,尚未吐下,脉沉
「弦」〔紧〕者,与小柴胡汤。若已吐、下、发汗、温针,谵语,柴胡证罢,此为坏
病,知犯何逆,以法治之。
【按】
脉沉紧当是「脉沉弦」,若是沉紧,是寒实在胸,当吐之诊也。惟「脉沉弦」方与上
文之义相属,始可与小柴胡汤,当改之。
伤寒吐下后,发汗,虚烦,脉甚微,〔八、九日心下痞□,□下痛,气上冲咽喉〕眩
冒,经脉动惕者,久而成痿。
【按】
「八、九日心下痞□,□下痛,气上冲咽喉」三句,与上下文义不属。注家皆因有此
三句,不得不支离蔓衍,牵强解释。每见此病总因汗出过多,大伤津液而成,当用补
气补血益筋壮骨之药,经年始愈。此三句必是错简,当删之。
汗家重发汗,必恍惚心乱,小便已,阴疼。〔与禹余粮丸〕
【按】
禹余粮丸,为涩痢之药,与此证不合,「与禹余粮丸」五字,衍文也,当删之。
形作伤寒,其脉不弦紧而「数」〔弱〕,「数」〔弱〕者必渴,被火者必□语,「数
」〔弱〕者发热,脉浮,解之当汗出愈。
【按】
三「弱」字,当俱是「数」字,若是「弱」字,热从何有?不但文义不属,论中并无
此说,当改之。
三阳合病,脉象在关部浮大且弦,患者只想睡觉,闭上眼睛就出汗。
【按语】
原文中“浮大上之‘上’字”,应当是“弦”字,这才符合《伤寒论》中关于三阳合病的脉象描述;如果是“上”字,则医经和理论中从来没有两寸脉主三阳病的道理,应当改正。
二阳并病,太阳病初起时,用发汗法治疗,但汗出得不透彻,因此病邪转属阳明,接着出现微微自汗出,不再怕冷。如果太阳表证尚未解除,不可使用下法,误用下法属于逆治,这种情况下可以轻微发汗。假如病人面色持续通红,这是阳气郁结在体表,应当用熏蒸的方法解表(或:应当用发汗的方法解表)。如果发汗不彻底,不足以说明问题,阳气郁结不能宣发,该出汗而没出汗,病人烦躁不安,不知道疼痛的具体位置,有时在腹部,有时在四肢,按压又找不到痛点,病人呼吸短促,只能坐着,这都是因为汗出不彻底的缘故,再次发汗就会痊愈。怎么知道汗出不彻底呢?通过脉象涩就可以知道。
【按语】
原文中“熏之”二字,应当是“以汗”二字,这样才与上下文义连贯,应当改正。
本为太阳病未解,转入少阳的,出现心下痞满,干呕,不能进食,寒热往来,尚未经过吐法、下法,脉象沉而弦的,给予小柴胡汤。如果已经经过吐、下、发汗、温针等治疗,出现谵语,柴胡证已消失,这称为坏病,需查明犯了什么错误,根据具体情况施治。
【按语】
原文中“脉沉紧”应当是“脉沉弦”,如果是沉紧脉,那是寒邪实于胸中,应当用吐法的诊断依据。只有“脉沉弦”才与上文之义相属,才可以与小柴胡汤,应当改正。
伤寒经过吐、下之后,又发汗,导致虚烦,脉象非常微弱,(八、九天后心下痞塞,胁下痛,气上冲咽喉)头晕目眩,经脉跳动惕动,时间久了会形成痿证。
【按语】
原文中“八、九日心下痞□,□下痛,气上冲咽喉”这三句,与上下文义不连贯。注家都因为有三句存在,不得不支离破碎地引申,牵强解释。我常见这种病总因出汗过多,大伤津液而成,应当使用补气补血、益筋壮骨的药物,经过一年才能痊愈。这三句必定是错简,应当删除。
平素多汗的人,如果再重发其汗,必然出现心神恍惚、心中扰乱,小便结束后,阴部疼痛。(给予禹余粮丸)
【按语】
禹余粮丸,是治疗滑脱痢疾的药物,与此证不合,“与禹余粮丸”五字,是衍文,应当删除。
症状表现像伤寒,但其脉象不弦紧而数(或弱),数(或弱)脉者必然口渴,被火疗者必然出现谵语,数(或弱)脉者发热,脉浮,解表应当通过发汗使病愈。
【按语】
文中三个“弱”字,应当都是“数”字,如果是“弱”字,热从何而来?不但文义不连贯,理论中也无此说法,应当改正。
San Yang He Bing (Combined Disease of the Three Yang Channels), the pulse is floating, large, and wiry at the Guan position; the patient desires sleep, and sweats when closing the eyes.
[Commentary]
The character "Shang" (Upper) in "Floating, Large, Shang" should be "Xian" (Wiry); this aligns with the pulse description for San Yang He Bing in the Treatise. If it were "Shang," there would be no theoretical basis in medical classics for both Cun positions governing diseases of the Three Yang channels; thus, it should be corrected.
Er Yang Bing Bing (Concurrent Disease of the Two Yang Channels). When Tai Yang disease is first contracted, diaphoresis is induced, but the sweat is not thorough. Consequently, the pathogen transfers to Yang Ming, followed by continuous slight spontaneous sweating and absence of aversion to cold. If the Tai Yang syndrome has not yet resolved, purgation must not be used; using purgation in this case is a contraindication (Ni). In such situations, mild diaphoresis may be employed. If the patient's face is persistently red, this indicates Yang Qi stagnation in the exterior; it should be resolved via fumigation (or: via diaphoresis). If diaphoresis is incomplete, it is insufficient to explain the condition; Yang Qi is stagnated and cannot vent. The appropriate sweating mechanism fails to occur, causing restlessness and irritability. The patient does not know where the pain is located; it shifts between the abdomen and the limbs, and pressing yields no specific tender point. The patient experiences shortness of breath and can only sit upright. This is due to incomplete sweating. Re-inducing diaphoresis will lead to recovery. How do we know the sweating was incomplete? We know this from the choppy pulse.
[Commentary]
The characters "Xun Zhi" (Fumigate) should be "Yi Han" (Via Diaphoresis) to maintain coherence with the context; thus, it should be corrected.
Originally a Tai Yang disease that did not resolve and transferred to Shao Yang, presenting with fullness and hardness below the heart, dry retching, inability to eat, alternating chills and fever. If emesis, purgation, diaphoresis, or warm needle therapy have not yet been applied, and the pulse is deep and wiry, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If emesis, purgation, diaphoresis, or warm needle therapy have already been applied, resulting in delirium, and the Chai Hu syndrome has ceased, this is termed Huai Bing (Ruined Disease). One must determine what error was committed and treat according to the specific pathology.
[Commentary]
"Pulse Deep and Tight" should be "Pulse Deep and Wiry." A deep and tight pulse indicates cold excess in the chest, which warrants an emetic diagnosis. Only a "deep and wiry" pulse aligns with the preceding text and justifies the use of Xiao Chai Hu Tang; thus, it should be corrected.
After Shang Han (Cold Damage) treated with emesis and purgation, followed by diaphoresis, leading to deficiency-related irritability and a very faint pulse. [After eight or nine days, epigastric stuffiness, pain below the ribs, qi rushing up to the throat], dizziness, palpitations of the meridians, if prolonged, will result in Wei Syndrome (Flaccidity Syndrome).
[Commentary]
The three sentences "[After eight or nine days, epigastric stuffiness, pain below the ribs, qi rushing up to the throat]" do not fit the context. Commentators, forced by their presence, offer disjointed and forced explanations. I observe that this condition generally arises from excessive sweating damaging body fluids significantly. It should be treated with herbs that tonify Qi and Blood, benefit sinews, and strengthen bones, taking a year to recover. These three sentences are likely misplaced bamboo slips (Cuo Jian) and should be deleted.
Individuals who habitually sweat, if subjected to heavy diaphoresis again, will inevitably suffer from mental confusion and agitation. After urination, there is pain in the genitalia. [Administer Yu Yu Liang Wan].
[Commentary]
Yu Yu Liang Wan is an astringent formula for dysentery, which is incompatible with this syndrome. The five characters "Yu Yu Liang Wan" are interpolated text (Yan Wen) and should be deleted.
The presentation resembles Shang Han, but the pulse is not wiry and tight, but rapid (or weak). A rapid (or weak) pulse indicates thirst. If fire therapy is applied, delirium will ensue. For a rapid (or weak) pulse with fever and floating characteristics, resolution requires diaphoresis to induce sweating and cure the disease.
[Commentary]
All three instances of "Ruo" (Weak) should be "Shu" (Rapid). If they were "Weak," where would the heat come from? This not only disrupts the textual logic but also lacks support in the theory; thus, it should be corrected.