一十证,方三首
问曰∶病有霍乱者,何也?答曰∶呕吐而利,此为霍乱。
问曰∶病有发热,头痛,身体疼痛,恶寒,而复吐利,当属何病?答曰∶当为霍乱,
霍乱吐下,利止,复更发热也。
伤寒,其脉微涩,本是霍乱,今是伤寒,却四五日,至阴经上,转入阴当利,本素呕下
利者,不治。若其人即欲大便,但反失气,而不利者,是为属阳明,必坚,十二日愈,所以
然者,经竟故也。
下利后,当坚,坚能食者愈,今反不能食,到后经中,颇能食,复一经能食,过之一日
当愈,若不愈,不属阳明也。恶寒脉微而复利,利止必亡血,四逆加人参汤主之。方∶
四逆汤中加人参一两即是。
霍乱而头痛发热,身体疼痛,热多欲饮水,五苓散主之;寒多不用水者,理中汤主之。
方(五苓散见结胸门∶)
人参 干姜 甘草(炙) 白术(各三两)
上四味,以水八升,煮取三升,去滓,温服一升,日三服。脐上筑者,为肾气动,去术
加桂四两;吐多者,去术加生姜三两;下利多者,复用术;悸者,加茯苓二两;渴者,加术
至四两半;腹中痛者,加人参至四两半;寒者加干姜至四两半;腹满者,去术加附子一枚。
服药后,如食顷,饮热粥一升,微自温暖,勿发揭衣被。
一方蜜和丸如鸡黄许大,以沸汤数合和一丸,研碎,温服,日三夜二,腹中未热,益至
三四丸,然不及汤。
吐利止而身体痛不休,当消息和解其外,宜桂枝汤小和之。
吐利汗出,发热恶寒,四肢拘急,手足厥,四逆汤主之。既吐且利,小便复利,而大汗
出,下利清谷,里寒外热,脉微欲绝,四逆汤主之。
吐已下断,汗出而厥,四肢不解,脉微欲绝,通脉四逆加猪胆汤主之。方∶
于通脉四逆汤中加猪胆汁半合即是,服之其脉即出,无猪胆以羊胆代之。
吐利发汗,其人脉平,而小烦,此新虚不胜谷气故也。
十个证候,三首方剂。
问:患有霍乱的病证,是怎么回事?答:呕吐并且腹泻,这就是霍乱。
问:有的病人出现发热、头痛、身体疼痛、怕冷,同时又发生呕吐和腹泻,这属于什么病?答:应当是霍乱。霍乱在呕吐和下利停止后,又再次出现发热。
伤寒病,脉象微而涩,原本就是霍乱,现在诊断为伤寒。过了四五日,病邪传入阴经,转入阴经应当出现下利。如果病人素来就有呕吐和下利的症状,则难以治愈。如果病人此时想要大便,却反而只是放屁而不排便,这是病属阳明经,大便必然干硬,十二天会痊愈。之所以这样,是因为经气运行完毕的缘故。
下利停止后,大便应当变硬,大便变硬且能进食的就会痊愈。现在反而不能进食,等到下一个经气运行的周期中,稍微能进食了,再过一个周期又能进食,超过这一天就会痊愈。如果不能痊愈,说明病不属于阳明经。如果怕冷、脉象微弱而又下利,下利停止后必定是亡血(津液枯竭),用四逆加人参汤主治。方剂组成:在四逆汤中加入人参一两即可。
霍乱伴有头痛、发热、身体疼痛,热象明显想喝水的,用五苓散主治;寒象明显不想喝水的,用理中汤主治。
方剂(五苓散见结胸门):
理中汤方:人参、干姜、甘草(炙)、白术(各三两)。
以上四味药,用水八升,煮取三升,去渣,温服一升,每日三次服用。如果脐上跳动不安,是肾气动,去掉白术,加入桂枝四两;呕吐多的,去掉白术,加入生姜三两;下利多的,重新使用白术;心悸的,加入茯苓二两;口渴的,将白术加至四两半;腹中痛的,将人参加至四两半;寒重的,将干姜加至四两半;腹部胀满的,去掉白术,加入附子一枚。
服药后,约一顿饭的时间,喝热粥一升,使身体微微温暖,不要掀开衣被。
另一方法:用蜂蜜调和做成如鸡卵大小的丸药,用几合沸水化开一丸,研碎,温服,白天三次,夜间两次。如果腹中未感到温热,增加到三四丸,但效果不如汤剂。
呕吐和下利停止后,身体疼痛不止,应当斟酌情况解表调和,适宜用小剂量的桂枝汤调和。
呕吐下利伴汗出,发热怕冷,四肢拘挛紧急,手足冰冷,用四逆汤主治。既吐又利,小便反而通利,大汗出,下利完谷不化,内寒外热,脉象微弱几乎摸不到,用四逆汤主治。
呕吐下利停止,汗出且手脚厥冷,四肢不能舒展,脉象微弱几乎摸不到,用通脉四逆加猪胆汁汤主治。方剂组成:在通脉四逆汤中加入猪胆汁半合即可,服用后脉象就会复出,如果没有猪胆,可以用羊胆代替。
Ten syndromes, three prescriptions.
Question: What is the condition known as Huoluan (Colic and Diarrhea)? Answer: Vomiting accompanied by diarrhea constitutes Huoluan.
Question: If a patient presents with fever, headache, body pain, aversion to cold, along with vomiting and diarrhea, what disease does this belong to? Answer: This should be diagnosed as Huoluan. In Huoluan, after vomiting and diarrhea cease, fever may recur.
In Shaoyin Cold Damage (Taiyang Cold Damage), if the pulse is faint and choppy, it was originally Huoluan; now it is diagnosed as Taiyang Cold Damage. After four or five days, when the pathogen enters the Yin meridians and transitions into the Yin stage, diarrhea should occur. If the patient has a history of chronic vomiting and diarrhea, the prognosis is poor. If the patient feels the urge to defecate but only passes flatus without stool, this indicates involvement of the Yangming stage; the stool will likely be hard, and recovery will occur in twelve days. This is because the meridian cycle has completed its course.
After diarrhea ceases, the stool should become hard. If the patient can eat, they will recover. If they cannot eat now, but later, during the next meridian cycle, begin to eat slightly, and then eat normally in the subsequent cycle, they will recover one day after that. If they do not recover, the disease does not belong to the Yangming stage. If there is aversion to cold, a faint pulse, and diarrhea, and the diarrhea subsequently stops, this indicates exhaustion of blood/fluids. Si Ni Jia Ren Shen Tang (Four Reversal Decoction plus Ginseng) is indicated. Prescription: Add one qian of Renshen (Ginseng Radix et Rhizoma) to Si Ni Tang (Four Reversal Decoction).
For Huoluan accompanied by headache, fever, and body pain, if heat signs are prominent and the patient desires water, Wu Ling San (Five-Ingredient Powder with Poria) is indicated. If cold signs are prominent and the patient does not desire water, Li Zhong Tang (Regulate the Middle Decoction) is indicated.
Prescription (Wu Ling San is found in the Jie Xiong [Chest Binding] section):
Li Zhong Tang: Renshen (Ginseng Radix et Rhizoma), Gan Jiang (Dried Ginger Rhizome), Zhi Gan Cao (Prepared Licorice Root), Bai Zhu (Atractylodis Macrocephalae Rhizoma) — each 3 liang.
These four ingredients are boiled in eight sheng of water until three sheng remain. The dregs are removed, and one sheng is taken warm, three times daily. If there is palpitation above the navel indicating Kidney Qi movement, remove Bai Zhu and add Gui Zhi (Cinnamon Twig) 4 liang. For excessive vomiting, remove Bai Zhu and add Sheng Jiang (Fresh Ginger Rhizome) 3 liang. For severe diarrhea, retain/use Bai Zhu. For palpitations, add Fu Ling (Poria) 2 liang. For thirst, increase Bai Zhu to 4.5 liang. For abdominal pain, increase Renshen to 4.5 liang. For cold conditions, increase Gan Jiang to 4.5 liang. For abdominal fullness, remove Bai Zhu and add one Fu Zi (Prepared Aconite Lateralis Radix).
After taking the medicine, wait about the time it takes to eat a meal, then drink one sheng of hot porridge to induce slight warmth. Do not uncover clothes or blankets.
Another method: Mix with honey to form pills the size of a chicken egg. Dissolve one pill in several he of boiling water, crush, and take warm. Take three times during the day and twice at night. If warmth is not felt in the abdomen, increase to three or four pills, though this is less effective than the decoction.
If vomiting and diarrhea cease but body pain persists, adjust the treatment to harmonize the exterior; Gui Zhi Tang (Cinnamon Twig Decoction) in a small dose is appropriate.
If vomiting and diarrhea are accompanied by sweating, fever, aversion to cold, tetanic spasms of the limbs, and cold extremities, Si Ni Tang (Four Reversal Decoction) is indicated. If there is simultaneous vomiting and diarrhea, frequent urination, profuse sweating, undigested food in the stool (Qing Gu Xia Li), internal cold with external heat, and a faint pulse nearly imperceptible, Si Ni Tang (Four Reversal Decoction) is indicated.
If vomiting and diarrhea have stopped, but there is sweating and cold extremities, limbs that do not relax, and a faint pulse nearly imperceptible, Tong Mai Si Ni Jia Zhu Dan Tang (Pulse-Restoring Four Reversal Decoction plus Pig Bile) is indicated. Prescription: Add half he of Zhu Dan (Pig Gallbladder Bile) to Tong Mai Si Ni Tang (Pulse-Restoring Four Reversal Decoction). After administration, the pulse will reappear. If pig bile is unavailable, sheep gallbladder bile may be substituted.
After vomiting and diarrhea, if sweating occurs and the pulse becomes normal but slight irritability remains, this is due to recent deficiency being unable to tolerate the qi of food (impaired digestive capacity).