九证
少阳之为病,口苦咽干目眩也。
少阳中风,两耳无所闻,目赤,胸中满而烦,不可吐下,吐下则悸而惊。
伤寒病,脉弦细,头痛而发热,此为属少阳。少阳不可发汗,发汗则谵语,为属胃。胃
和即愈,不和烦而悸。
太阳病不解,转入少阳,胁下坚满,干呕不能食饮,往来寒热,而未吐下,其脉沉紧,
可与小柴胡汤。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。
三阳脉浮大,上关上,但欲寐,目合则汗。
伤寒六七日,无大热,其人躁烦,此为阳去入阴故也。
伤寒三日,三阳为尽,三阴当受其邪,其人反能食而不呕,此为三阴不受其邪。
伤寒三日,少阳脉小,欲已。
少阳病,欲解时,从寅尽辰。《千金翼云》卷第九
八证 方二首
太阴之为病,腹满吐,食不下,下之益甚,时腹自痛,胸下坚结,太阴病,脉浮,可发
其汗。
太阴中风,四肢烦疼,阳微阴涩而长,为欲愈。
太阴病,欲解时,从亥尽丑。
自利不渴者,属太阴,其脏有寒故也,当温之,宜四逆辈。
伤寒脉浮而缓,手足温,是为系在太阴,太阴当发黄;小便自利,利者不能发黄,至七
八日,虽烦,暴利十余行,必自止,所以自止者,脾家实,腐秽当去故也。
本太阳病,医反下之,因腹满时痛,为属太阴,桂枝加芍药汤主之。其实痛,加大黄汤
主之。方∶
桂枝(三两) 芍药(六两) 生姜(三两,切) 甘草(二两,炙) 大枣(十二枚,
擘)
上五味,以水七升,煮取三升,去滓,分温三服。
加大黄汤方∶
大黄(二两)
上,于前方中加此大黄二两即是。
人无阳证,脉弱,其人续自便利,设当行大黄芍药者,减之,其人胃气弱,易动故也。
九证
少阳病的主要表现为:口苦、咽干、头晕目眩。
少阳经受风邪侵袭,出现两耳听力丧失、眼睛发红、胸中胀满且心烦意乱的症状。此时不可使用催吐或泻下的治法,若误用吐下法,会导致心悸和惊恐。
患伤寒病,脉象弦细,伴有头痛和发热,这属于少阳病。少阳病禁止发汗,若误用发汗法,会出现胡言乱语(谵语),病势转入胃经。若胃气调和则痊愈,若不调和则出现心烦和心悸。
太阳病未解,病邪传入少阳,出现胁下坚硬胀满、干呕不能进食饮水、寒热往来等症状,且此前未用过吐下法,脉象沉紧,可给予小柴胡汤治疗。如果已经经过吐、下、发汗或温针等治疗,出现谵语,且柴胡证候消失,这属于坏病。需查明犯了何种逆治错误,根据具体病情依法治疗。
三阳经脉象浮大,脉位上至关部,患者嗜睡,闭眼时出汗(盗汗)。
伤寒病程六七天,体表没有明显高热,但患者躁动烦乱,这是阳气退去、病邪入里的缘故。
伤寒三日,三阳经的病邪已尽,三阴经应当受邪,但患者反而能进食且不呕吐,这说明三阴经不受邪气侵犯。
伤寒三日,少阳脉象变小,表示病将要痊愈。
少阳病欲解除的时间段,是从寅时到辰时。《千金翼方》卷第九记载。
八证 方剂二首
太阴病的主要表现为:腹部胀满、呕吐、饮食不下,若误用泻下法症状会加重,时常腹部自发性疼痛,胸下部位坚硬结聚。太阴病若见脉浮,可用发汗法治疗。
太阴经受风邪侵袭,四肢烦扰疼痛,脉象微弱而涩且长,表示病将痊愈。
太阴病欲解除的时间段,是从亥时到丑时。
自发腹泻且不口渴的,属于太阴病,这是因为内脏有寒的缘故,应当采用温里法,适宜使用四逆汤类方剂。
伤寒脉象浮而缓,手足温暖,这是病系于太阴,太阴病应当发黄;若小便通畅自利,则不会发黄。到了七八天,即使心烦,若突然剧烈腹泻十几次,大便必然自行停止。之所以自行停止,是因为脾家正气恢复(脾家实),腐败秽浊之物得以排出的缘故。
原本患有太阳病,医生反而误用泻下法,导致腹部胀满、时而疼痛,这属于太阴病,主方为桂枝加芍药汤。若疼痛剧烈属实痛,则用加大黄汤主治。方剂组成如下:
桂枝(三两) 芍药(六两) 生姜(三两,切片) 甘草(二两,炙烤) 大枣(十二枚,掰开)
以上五味药,用水七升,煎煮至三升,滤去药渣,分三次温服。
加大黄汤方剂组成:
大黄(二两)
以上方法,即在前方基础上加入大黄二两即可。
若无阳证表现,脉象虚弱,患者持续自然排便通畅,假设需要使用大黄或芍药时,应减少用量,因为这类患者胃气虚弱,容易因药物刺激而动泄。
Nine Manifestations
The Shaoyang disease is characterized by bitter taste in the mouth, dryness of the throat, and dizziness.
When wind-pathogen invades the Shaoyang channel, symptoms include deafness in both ears, redness of the eyes, fullness and irritability in the chest. Purging or emesis must not be used; if mistakenly applied, palpitations and fright will occur.
In cold damage disease, with a wiry and fine pulse, headache, and fever, this belongs to Shaoyang. Shaoyang disease prohibits sweating therapy; if sweating is induced, delirium occurs, indicating the pathogen has entered the Stomach. If the Stomach harmonizes, recovery ensues; if not, irritability and palpitations result.
If Taiyang disease remains unresolved and transmits to Shaoyang, presenting with hardness and fullness below the costal region, dry retching, inability to eat or drink, alternating chills and fever, and without prior purging or emesis, with a deep and tight pulse, Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be administered. If vomiting, purging, sweating, or warm needle therapy have already been performed, resulting in delirium and the cessation of Chai Hu syndrome, this constitutes a damaged disease. One must identify the nature of the iatrogenic error and treat according to the specific condition.
When the pulses of the three Yang channels are floating and large, reaching above the Guan position, accompanied by somnolence and night sweats (sweating upon closing the eyes).
After six or seven days of cold damage, with no significant external heat but restlessness and irritability, this indicates the departure of Yang and entry of pathogen into Yin.
On the third day of cold damage, when the pathogen in the three Yang channels is exhausted, the three Yin channels should receive the pathogen. However, if the patient can eat and does not vomit, it indicates that the three Yin channels are not invaded.
On the third day of cold damage, if the Shaoyang pulse becomes small, the disease is about to resolve.
The time for Shaoyang disease to resolve is from Yin hour to Chen hour. Recorded in Volume Nine of *Qianjin Yi Fang*.
Eight Manifestations: Two Formulas
The Taiyin disease is characterized by abdominal fullness, vomiting, inability to ingest food, worsening symptoms after purging, spontaneous abdominal pain, and hardness/knotting below the chest. For Taiyin disease with a floating pulse, sweating therapy may be employed.
When wind-pathogen invades Taiyin, causing painful and heavy limbs, with a pulse that is faint, choppy, yet long, recovery is imminent.
The time for Taiyin disease to resolve is from Hai hour to Chou hour.
Spontaneous diarrhea without thirst belongs to Taiyin, caused by cold in the Zang organs. Warming therapy is indicated, preferably using Si Ni Tang (Four Counterflow Decoction) category formulas.
In cold damage, if the pulse is floating and slow, with warm hands and feet, the disease is associated with Taiyin, which typically leads to jaundice. However, if urination is free and unobstructed, jaundice will not develop. By the seventh or eighth day, even if there is irritability, sudden severe diarrhea more than ten times will cease spontaneously. This cessation occurs because the Spleen's healthy Qi has recovered (Spleen Excess), allowing foul turbid matter to be expelled.
Originally suffering from Taiyang disease, if the physician mistakenly uses purging, leading to abdominal fullness and intermittent pain, this belongs to Taiyin. Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction with Added Peony) is the primary formula. For severe pain indicating excess, Da Huang Tang (Rhubarb Decoction) is used. Formula composition:
Gui Zhi (Cinnamon Twig, 3 liang), Shao Yao (Peony Root, 6 liang), Sheng Jiang (Fresh Ginger, 3 liang, sliced), Zhi Gan Cao (Honey-fried Licorice Root, 2 liang), Da Zao (Jujube, 12 pieces, split).
These five ingredients are boiled in 7 sheng of water until reduced to 3 sheng. Strain and take warm in three divided doses.
Da Huang Tang (Rhubarb Decoction) Formula:
Da Huang (Rhubarb Root and Rhizome, 2 liang).
This is prepared by adding 2 liang of Da Huang to the previous formula.
In patients lacking Yang-excess signs, with a weak pulse and continuous spontaneous bowel movements, if Da Huang or Shao Yao were indicated, their dosages should be reduced because such patients have weak Stomach Qi and are prone to diarrhea.