伤寒脉浮,自汗出,小便数,心烦,微恶寒,脚挛急,反与桂枝汤,欲攻其表,此误
也,得之便厥。咽中干,烦躁,吐逆者,作甘草干姜汤与之,以复其阳;若厥愈足温
者,更作芍药甘草汤与之,其脚即伸;若胃气不和,谵语者,少与调胃承气汤;若重
发汗,复加烧针者,四逆汤主之。
问曰:证象阳旦,按法治之而增剧,厥逆,咽中干,两胫拘急而谵语,师言,夜半手
足当温,两脚当伸,后如师言,何以知此?答曰:寸口脉浮而大,浮为风,大为虚,
风则生微热,虚则两胫挛,病形象桂枝,因加附子参其间,增桂令汗出,附子温经,
亡阳故也。厥逆,咽中干,烦躁,阳明内结,谵语烦乱,更饮甘草干姜汤,夜半阳气
还,两足当热,胫尚微拘急,重与芍药甘草汤,尔乃胫伸,以承气汤微溏,则止其谵
语,故知病可愈。
伤寒六、七日,大下后,寸脉沉而迟,手足厥逆,下部脉不至,咽喉不利,唾脓血,
泄利不止者,为难治,麻黄升麻汤主之。
伤寒八、九日,下之,胸满烦惊,小便不利,谵语,一身尽重,不可转侧者,柴胡加
龙骨牡蛎汤主之。
微数之脉,慎不可灸,因火为邪,则为烦逆,追虚逐实,血散脉中,火气虽微,内攻
有力,焦骨伤筋,血难复也。
脉浮宜以汗解,用火灸之,邪无从出,因火而盛,病从腰以下必重而痹,名火逆也。
伤寒脉浮,医以火逼劫之,亡阳,必惊狂,起卧不安者,桂枝去芍药,加蜀漆龙骨牡
蛎救逆汤主之。
少阴病,出现呕吐、腹泻,手足冰冷,烦躁得快要死去的情况,用吴茱萸汤主治。
伤寒病,脉象浮,自汗出,小便频数,心烦,轻微怕冷,脚部拘挛急迫,反而给予桂枝汤,想要攻解表邪,这是误治。患病后立刻出现四肢厥冷。咽喉干燥,烦躁,呕吐逆气的,给予甘草干姜汤,以恢复其阳气;如果四肢厥冷痊愈、足部变温的,再给予芍药甘草汤,其脚部就能伸直;如果胃气不和,出现谵语的,少量给予调胃承气汤;如果再次发汗,又加上烧针治疗的,用四逆汤主治。
问:证候表现像阳旦证(即桂枝汤证),按照常规法治疗却病情加重,出现四肢厥逆,咽喉干燥,两小腿拘挛急迫且说胡话,老师说,半夜时手脚应当变暖,双脚应当伸直,后来果然如老师所说,为什么能预知这一点?回答说:寸口脉浮而大,浮主风邪,大主虚损,风邪则产生微热,虚损则导致两小腿拘挛。病形象似桂枝汤证,因此在方中加入附子,增加桂枝用量令其出汗,附子温通经脉,这是因为亡阳的缘故。出现四肢厥逆,咽喉干燥,烦躁,阳明内结,谵语烦乱,再饮用甘草干姜汤,夜半阳气回复,两脚应当发热,小腿尚且轻微拘挛急迫,再次给予芍药甘草汤,然后小腿才能伸直,再用承气汤使大便微溏,就能停止谵语,所以知道病可以痊愈。
伤寒六七天,经过大力泻下后,寸脉沉而迟,手足厥冷,下部脉搏摸不到,咽喉不利,吐脓血,泄泻不止的,属于难治之症,用麻黄升麻汤主治。
伤寒八九天,经过泻下治疗后,胸中满闷,烦躁惊悸,小便不利,谵语,全身沉重,不能转侧的,用柴胡加龙骨牡蛎汤主治。
脉象微而数的,千万不可施灸,因为火邪成为致病因素,就会导致烦闷逆乱,追补虚损的同时追逐实邪,血液散乱于脉中,火气虽然微弱,但内攻的力量很大,会焦灼骨骼、损伤筋脉,血液难以恢复。
脉浮适宜用发汗法解除,如果用火灸治疗,邪气无从排出,因火而邪气更盛,病从腰部以下必定沉重且麻木不仁,这叫火逆。
伤寒脉浮,医生用火法逼迫劫夺汗液,导致亡阳,必定出现惊狂,坐卧不安的,用桂枝去芍药加蜀漆龙骨牡蛎救逆汤主治。
Shaoyin disease, characterized by vomiting and diarrhea, cold extremities, and severe irritability bordering on death, is primarily treated with Wuzhuyu Tang (Evodia Decoction).
In Shaoyang disease, if the pulse is floating, there is spontaneous sweating, frequent urination, mental restlessness, slight aversion to cold, and cramping of the feet, administering Guizhi Tang (Cinnamon Twig Decoction) in an attempt to attack the exterior is a mistake. This leads immediately to Jue (cold extremities). If accompanied by dryness in the throat, irritability, and vomiting/reversal of Qi, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be given to restore Yang Qi. Once the Jue resolves and the feet become warm, Shaoyao Gancao Tang (Peony and Licorice Decoction) should be administered next, which will allow the legs to extend. If there is disharmony of Stomach Qi manifesting as delirious speech, a small amount of Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) should be given. If excessive sweating was previously induced and burning needle therapy was added, Sini Tang (Frigid Extremities Decoction) is indicated.
Question: The symptoms resemble Yangdan syndrome (Guizhi Tang pattern), yet treatment according to standard methods exacerbates the condition, leading to cold extremities, dry throat, cramping of both calves, and delirium. The Master stated that by midnight, the hands and feet would warm up, and the feet would extend. Later, this indeed happened. How could this be predicted? Answer: A floating and large pulse at Cun Kou indicates Wind and Deficiency respectively. Wind generates slight heat, while deficiency causes calf cramping. Although the presentation resembles a Guizhi Tang pattern, Fuzi (Aconite Lateral Root) was added, and the dosage of Guizhi was increased to induce sweating. Fuzi warms the meridians because of Yang collapse. With cold extremities, dry throat, irritability, internal binding of Yangming, and delirious confusion, administering Gancao Ganjiang Tang again allows Yang Qi to return by midnight, warming the feet. Since the calves remain slightly cramped, administering Shaoyao Gancao Tang again allows the legs to extend. Using Chengqi Tang to induce slight stooling stops the delirium. Thus, it is known that the disease can be cured.
After six or seven days of Shaoyang disease, following drastic purgation, if the Cun pulse is deep and slow, extremities are cold, pulses at the lower body are imperceptible, the throat is obstructed, pus and blood are expectorated, and diarrhea persists uncontrollably, it is difficult to treat. Mahuang Shengma Tang (Ephedra and Ma Huang Shen Decoction) is indicated.
After eight or nine days of Shaoyang disease, following purgation, if there is chest fullness, irritability, fright, difficulty in urination, delirium, heaviness of the entire body, and inability to turn over, Chaihu Jia Longgu Muli Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) is indicated.
For a pulse that is slightly rapid, moxibustion must be strictly avoided. Fire becomes a pathogenic factor, causing irritability and reversal. It pursues deficiency and drives out reality, scattering blood within the vessels. Although fire energy is subtle, its internal attack is powerful, scorching bones and damaging sinews, making blood recovery difficult.
When the pulse is floating, sweating should be used for resolution. If moxibustion is applied instead, the pathogen has no outlet and flourishes due to fire. The disease from the waist down will certainly become heavy and numb, termed Huoni (Fire Reversal).
In Shaoyang disease with a floating pulse, if the physician uses fire methods to force sweating, resulting in Yang collapse, it inevitably leads to fright, mania, and restlessness. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang (Cinnamon Twig Decoction Without Peony Plus Dodder Seed, Dragon Bone, and Oyster Shell to Rescue Reversal) is indicated.