19.中寒吐食不能食, 不渴而厥吐寒虚, 得食吐渴火为逆, 饮吐相因
水病居.
【注】中寒吐食, 谓中寒吐食不能食也. 凡不渴而厥吐, 是寒虚吐也
,宜理中、吴茱萸辈. 凡渴而得食即吐, 是火吐也, 热实宜黄连解毒
汤.热虚宜干姜黄连黄芩汤, 或竹叶石膏汤. 渴而饮, 饮而吐, 吐而
复渴, 水逆病也, 宜五苓散.
20.热痢尿红渴粘秽, 寒痢澄清小便白, 理中不应宜固涩, 仍然不应
利之瘥.
【注】自痢不渴者, 属太阴寒也. 下痢欲饮水者, 以有热故也. 此以
渴辨寒热也. 小便黄赤, 秽气稠粘者, 皆热痢也. 小便清白, 澄彻清
谷,皆寒痢也. 热痢有表证, 轻者升麻葛根汤, 重者葛根汤汗之. 有
里证者, 量以三承气汤下之. 无表里证, 轻者宜黄芩汤, 重者宜葛根
黄连黄芩汤清之. 寒痢宜理中汤温而补之. 若服理中汤不应者, 此属
下焦滑脱, 宜赤石脂禹余粮汤固涩. 仍然不应, 此为清浊不分, 水走
大肠, 宜五芩散或猪苓汤利之, 可瘥也.
21.行阴嗜卧无表里, 呼醒复睡不须惊, 风温脉浮热汗出, 多眠身重
息鼾鸣.
【注】行阴欲寐嗜卧, 少阴证也. 若欲寐嗜卧无表里证, 身和脉小,
知已解也. 然解后之睡, 呼之则醒, 醒而又睡, 是阴气来复, 非阴盛
困阳, 不须惊也. 风温亦欲寐多眠, 则有脉浮发热, 汗出身重, 鼻息
鼾鸣之别也.
19. 中寒导致呕吐食物且不能进食,口不渴且四肢厥冷、呕吐,属于寒性虚证;若进食后呕吐且口渴,则是火邪上逆;饮水即吐,呕吐与饮水互为因果,是水饮病停留于体内。
【注】所谓“中寒吐食”,是指因感受寒邪而呕吐食物、无法进食。凡是口不渴且出现四肢厥冷和呕吐的,属于寒性虚证呕吐,适宜使用理中汤、吴茱萸汤之类的方剂。凡是口渴且进食后立即呕吐的,属于火邪呕吐,热实证适宜用黄连解毒汤;热虚证适宜用干姜黄连黄芩人参汤,或者竹叶石膏汤。如果口渴想喝水,喝了水又呕吐,吐完又觉得口渴,这是水逆病,适宜用五苓散。
20. 热痢疾表现为小便红赤、口渴、分泌物黏稠秽臭;寒痢疾表现为大便清稀澄澈、小便清白。若服用理中汤无效,宜采用固涩法治疗;如果仍然无效,则宜采用利水渗湿法治疗,疾病即可痊愈。
【注】自下痢(腹泻)且不口渴的,属于太阴寒证。下痢想要喝水的,是因为体内有热。这里是通过是否口渴来辨别寒热。小便黄赤、气味秽浊黏稠的,都是热痢。小便清白、大便澄澈夹杂未消化食物(完谷不化)的,都是寒痢。热痢如果有表证,轻症用升麻葛根汤,重症用葛根汤发汗解表。有里证的,酌情用三承气汤攻下。没有表里证的,轻症适宜用黄芩汤,重症适宜用葛根黄连黄芩汤清热。寒痢适宜用理中汤温补。如果服用理中汤无效的,这属于下焦滑脱不禁,适宜用赤石脂禹余粮汤固涩止泻。如果仍然无效,这是因为清浊不分,水液走窜大肠,适宜用五苓散或猪苓汤利水渗湿,疾病即可痊愈。
21. 少阴病嗜睡卧,无表证也无里证,叫醒后又睡着,不必惊慌;风温病脉浮、发热、出汗,多眠且身体沉重、呼吸鼾鸣。
【注】少阴病的欲寐、嗜卧,是少阴证的表现。如果想要睡觉、嗜卧,但没有表证和里证,身体调和、脉象细小,说明病已解除。然而病解后的睡眠,叫他能醒,醒了又睡,这是阴气恢复,并非阴盛困阳,不必惊慌。风温病也会欲寐、多眠,但有脉浮、发热、出汗、身体沉重、鼻息鼾鸣的区别。
19. Cold invasion causing vomiting of food and inability to eat; absence of thirst with cold extremities and vomiting indicates a cold-deficiency pattern; vomiting after eating with thirst indicates rebellious fire; vomiting immediately after drinking, where vomiting and drinking cause each other, indicates water retention disease.
[Note] "Cold invasion causing vomiting of food" refers to vomiting food and inability to eat due to cold invasion. Whenever there is an absence of thirst accompanied by cold extremities and vomiting, it is a cold-deficiency type of vomiting, for which Lizhong Tang (Regulate the Middle Decoction) or Wuzhuyu Tang (Evodia Decoction) are appropriate. Whenever there is thirst accompanied by immediate vomiting after eating, it is a fire-type vomiting; for heat-excess patterns, Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) is suitable; for heat-deficiency patterns, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) or Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) are suitable. If one feels thirsty and drinks, vomits after drinking, and then feels thirsty again, this is Water Reversal Disease (Shui Ni), for which Wuling San (Five-Ingredient Powder with Poria) is appropriate.
20. Heat dysentery presents with red urine, thirst, and sticky, foul-smelling discharge; cold dysentery presents with clear, watery stools and clear white urine. If Lizhong Tang yields no effect, astringent methods should be used; if there is still no effect, draining methods should be used, and the disease will heal.
[Note] Spontaneous diarrhea without thirst belongs to Taiyin cold syndrome. Diarrhea accompanied by desire to drink water is due to heat. Here, the presence or absence of thirst is used to distinguish between cold and heat. Yellow-red urine with foul odor and sticky consistency all indicate heat dysentery. Clear-white urine with clear stools containing undigested food (Wan Gu Bu Hua) all indicate cold dysentery. For heat dysentery with exterior signs, mild cases use Shengma Gegen Tang (Kudzu and Cimicifuga Decoction), and severe cases use Gegen Tang (Kudzu Decoction) to induce sweating. For those with interior signs, San Chengqi Tangs (Three Major Purging Formulas) should be used appropriately to purge. For those without exterior or interior signs, mild cases use Huangqin Tang (Scutellaria Decoction), and severe cases use Gegen Huanglian Huangqin Tang (Kudzu, Coptis, and Scutellaria Decoction) to clear heat. Cold dysentery should be treated with Lizhong Tang to warm and tonify. If Lizhong Tang yields no effect, this belongs to slipping and uncontrolled descent of the Lower Jiao, for which Chishizhi Yuyuliang Tang (Red Halloysite and Hematite Decoction) is appropriate to astringe. If there is still no effect, this is due to the failure to separate clear from turbid, with water flowing into the Large Intestine; Wuling San (Five-Ingredient Powder with Poria) or Zhu Ling Tang (Polyporus Decoction) should be used to promote urination, and the disease will heal.
21. Shaoyin disease involves lethargy and desire to lie down without exterior or interior signs; waking up only to fall back asleep requires no alarm. Wind-warmth disease presents with floating pulse, fever, sweating, excessive sleepiness, heavy body, and snoring breath.
[Note] The desire to sleep and lethargy in Shaoyin disease are manifestations of Shaoyin syndrome. If one desires to sleep and is lethargic but has neither exterior nor interior signs, and the body is harmonious with a fine pulse, it indicates that the disease has resolved. However, sleep after resolution, where one wakes upon being called and falls back asleep, indicates the recovery of Yin Qi, not Yin excess confining Yang, so there is no need for alarm. Wind-warmth disease also involves desire to sleep and excessive sleepiness, but it is distinguished by floating pulse, fever, sweating, heavy body, and snoring breath.