腹满「身」〔舌〕痿黄,躁不得睡,属黄家。
【按】
舌痿黄之「舌」字,当是「身」字,当改之。
黄疸病,「小便不利者,」茵陈五苓散主之。
【按】
黄疸病之下,当有「小便不利者」五字,茵陈五苓散方有着落,当补之。
吐后渴欲得水而贪饮者,〔文蛤汤主之,〕兼〔主〕微风,脉紧头痛「,文蛤汤主之
」。
【按】
「文蛤汤主之」五字,当在头痛之下,文义始属,当移之。兼主之「主」字,衍文也
。
〔问曰:病人脉数,数为热,当消谷引食,而反吐者,何也?师曰:以发其汗,令阳
气微,膈气虚,脉乃数,数为客热,不能消谷,胃中虚冷故也。〕脉弦者虚也,胃气
无余,朝食暮吐,变为胃反,寒在于上,医反下之,今脉反弦,故名曰虚。
【按】
「问曰:病人脉数」,至「胃中虚冷故也」等句,已详『伤寒论·阳明篇』内,错简
在此,且与脉弦者虚也,文义不属。
趺阳脉浮而涩,浮则为虚,「涩」〔虚〕则伤脾,脾伤则不磨,朝食暮吐,暮食朝吐
,宿谷不化,名曰胃反,脉紧而涩,其病难治。
【按】
虚则伤脾之「虚」字,应是「涩」字,当改之。
下利,手足厥冷,无脉者,灸之不温,若脉不还,反微喘者,死。〔少阴负趺阳者,
为顺也。〕
【按】
此条反微喘者死之下,有「少阴负趺阳者为顺也」一句,文义不属,其注已详见『伤
寒论辨脉篇』内,不复释。
下利清谷,不可攻其表,汗出必胀满。
【按】
此条注详见『伤寒论·太阴篇』内,故不复释。
下利脉沉而迟,其人面少赤,身有微热,下利清谷者,必郁冒,汗出而解,病人必微
厥,所以然者,其面戴阳,下虚故也。
【按】
此条注详见『伤寒论·厥阴篇』内,故不复释。
下利腹胀满,身体疼痛者,先温其里,乃攻其表,温里宜四逆汤,攻表宜桂枝汤。
【按】
此条注详见『伤寒论·太阴篇』内,故不复释。
下利后更烦,按之心下濡者,为虚烦也,栀子豉汤主之。
【按】
此条注详见『伤寒论·太阳中篇』,故不复释。
腹部胀满,身体萎黄,烦躁无法入睡,属于黄疸病的范畴。
【按语】
“舌痿黄”中的“舌”字,应当是“身”字,应当改正。
黄疸病中,小便不利的患者,用茵陈五苓散主治。
【按语】
在“黄疸病”之下,应当有“小便不利者”这五个字,这样茵陈五苓散的方证才有依据,应当补入。
呕吐之后,口渴想喝水且大量饮水的,(文蛤汤主治,)兼治微风,脉紧头痛。(文蛤汤主治。)
【按语】
“文蛤汤主之”这五个字,应当移到“头痛”之下,文义才通顺,应当移动。兼治的“主”字,是衍文(多余的字)。
〔问:病人的脉象数,数脉主热,应当消谷善饥,反而呕吐,为什么呢?老师说:因为发汗,导致阳气微弱,膈气虚弱,脉象才表现为数,这种数是客热,不能消化食物,是因为胃中虚寒的缘故。〕脉象弦的是虚证,胃气没有余留,早上吃晚上吐,变为胃反病,寒气在上部,医生反而用攻下法,现在脉象反而弦,所以叫作虚。
【按语】
“问:病人脉数”,到“胃中虚冷故也”等句,已经在《伤寒论·阳明篇》内详细论述过,此处是错简(竹简顺序错乱),而且与“脉弦者虚也”文义不连贯。
趺阳脉浮而涩,浮则代表虚,“涩”〔虚〕则损伤脾脏,脾脏受损则不能磨化水谷,早上吃晚上吐,晚上吃早上吐,宿食不消化,名叫胃反病,脉紧而涩,这种病难治。
【按语】
“虚则伤脾”的“虚”字,应当是“涩”字,应当改正。
腹泻,手足厥冷,无脉的病人,艾灸后不温暖,如果脉搏不还复,反而轻微喘息的,死。〔少阴脉弱于趺阳脉的,为顺证。〕
【按语】
这一条在“反微喘者死”之下,有“少阴负趺阳者为顺也”一句,文义不连贯,其注解已在《伤寒论辨脉篇》内详细论述,不再解释。
腹泻完谷不化,不可攻表,发汗必然导致腹胀满。
【按语】
这一条的注解详见《伤寒论·太阴篇》内,所以不再解释。
腹泻脉沉而迟,病人面部微红,身体有微热,腹泻完谷不化的,必定会出现郁冒(头目昏眩如物蒙蔽),出汗后痊愈,病人必定手脚微凉,之所以这样,是因为面戴阳(虚阳上浮),下焦虚寒的缘故。
【按语】
这一条的注解详见《伤寒论·厥阴篇》内,所以不再解释。
腹泻伴腹部胀满,身体疼痛的,先温里,再解表,温里适宜用四逆汤,解表适宜用桂枝汤。
【按语】
这一条的注解详见《伤寒论·太阴篇》内,所以不再解释。
腹泻后更加心烦,按压心下部柔软的,是虚烦,栀子豉汤主治。
【按语】
这一条的注解详见《伤寒论·太阳中篇》,所以不再解释。
Abdominal fullness, withering yellow of the body, restlessness and inability to sleep, belong to the category of Huang Jia (Jaundice Disease).
[Commentary]
The character "tongue" in "withering yellow tongue" should be "body", and it ought to be corrected.
In Jaundice Disease, for those with difficult urination, Yinchen Wuling San (Artemisiae Scopariae Decoction) is the primary treatment.
[Commentary]
Below "Jaundice Disease", the five characters "those with difficult urination" should be added, so that the prescription of Yinchen Wuling San has a basis; this should be supplemented.
After vomiting, if there is thirst and a desire to drink water greedily, (Wenge Tang [Clam Shell Decoction] is the treatment,) which also treats mild wind, tight pulse, and headache. (Wenge Tang [Clam Shell Decoction] is the treatment.)
[Commentary]
The five characters "Wenge Tang [Clam Shell Decoction] is the treatment" should be moved below "headache" for the text to make sense; this should be relocated. The character "treats" in "also treats" is a superfluous character (interpolation).
[Question: The patient's pulse is rapid. Rapid pulse indicates heat, which should lead to digestion of food and increased appetite, yet vomiting occurs instead. Why?] Master said: This is due to sweating, which caused Yang Qi to become weak and Diaphragm Qi to become deficient, resulting in a rapid pulse. This rapidness represents guest heat, which cannot digest food; it is because of cold deficiency in the Stomach.] A string-like pulse indicates deficiency. There is no surplus of Stomach Qi. Food eaten in the morning is vomited in the evening, transforming into Wei Fan (Stomantic Reversal). Cold is located in the upper part, but the physician incorrectly used purgation. Now the pulse is string-like, hence it is named deficiency.
[Commentary]
From "Question: The patient's pulse is rapid" to "it is because of cold deficiency in the Stomach," these sentences have already been detailed in the *Shanghan Lun* (Treatise on Cold Damage) · Yangming Chapter. This is a misplaced slip (cuojian), and it does not connect logically with "A string-like pulse indicates deficiency."
The Fuyang pulse is floating and choppy. Floating indicates deficiency; choppy [deficiency] injures the Spleen. When the Spleen is injured, it fails to grind and transform. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning; undigested grain remains, named Wei Fan (Stomantic Reversal). If the pulse is tight and choppy, the disease is difficult to treat.
[Commentary]
The character "deficiency" in "deficiency injures the Spleen" should be "choppy"; this should be corrected.
Diarrhea with cold extremities and absent pulse: if moxibustion does not warm the body, and if the pulse does not return, accompanied by slight panting, death ensues. [If Shaoyin pulse is weaker than Fuyang pulse, it is a favorable sign.]
[Commentary]
Below "accompanied by slight panting, death ensues" in this clause, the sentence "If Shaoyin pulse is weaker than Fuyang pulse, it is a favorable sign" appears, but the meaning does not fit here. Its commentary is already detailed in the *Shanghan Lun Bianmai Pian* (Pulse Differentiation Chapter), so it will not be explained again.
Diarrhea with undigested food: do not attack the exterior. Sweating will inevitably cause abdominal fullness.
[Commentary]
The commentary for this clause is detailed in the *Shanghan Lun* · Taiyin Chapter, so it will not be explained again.
Diarrhea with deep and slow pulse, the person has a slightly red face and slight body heat. With diarrhea of undigested food, there must be Yu Mao (depressive dizziness/heaviness); sweating will lead to resolution. The patient will likely have slightly cold extremities. The reason for this is Dai Yang (floating yang on the face) due to lower jiao deficiency.
[Commentary]
The commentary for this clause is detailed in the *Shanghan Lun* · Jueyin Chapter, so it will not be explained again.
Diarrhea with abdominal fullness and body pain: first warm the interior, then attack the exterior. For warming the interior, Si Ni Tang (Frigid Extremities Decoction) is suitable; for attacking the exterior, Guizhi Tang (Cinnamon Twig Decoction) is suitable.
[Commentary]
The commentary for this clause is detailed in the *Shanghan Lun* · Taiyin Chapter, so it will not be explained again.
After diarrhea, if irritability increases, and pressing the epigastrium feels soft, it is empty irritability (Xu Fan). Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is the treatment.
[Commentary]
The commentary for this clause is detailed in the *Shanghan Lun* · Taiyang Middle Chapter, so it will not be explained again.