螈则急而缩。 则缓而伸。病至于螈 。热气极矣。盖热极生风。风主乎动。故筋脉相
引而
折螈
涤热如柴胡、栀子辈。祛风如防风、羌活辈是也。又风温证。妄以火熏必然发黄。剧
惊痫。时时螈 。经云。一逆尚引日。再逆促命期。设或为医所误。只得用金匮风引
邪用黑豆解。歌曰。螈为引缩 为伸。热极风生并在经。涤热祛风犹可望。火熏发表定归冥。
伤寒筋惕肉 者。盖伤寒头疼身痛。恶寒发热。必然之证也。其于筋惕肉 则非常常有
之者
阳气
大
是
益
寒
痿
治
歌曰。筋惕身 发汗多。酌量真武更无过。左边动气如轻汗。此证难医奈命何。
论云。汗出过多。津液涸少。阳气偏虚。筋肉失其所养。故惕惕 而跳动也。张氏特
设真
脾
气
脉
俱
则
自
子
其
散
下
者
伤寒懊 者。郁闷之貌。即心中懊 郁郁然不舒畅。愦愦然无奈何。比之烦闷为尤甚也。
由
胃中
其
与
于
阳
汤
热
歌曰。懊 心间用陷胸。舌间苔白脉俱洪。发黄须与茵陈辈。燥粪阳明承气攻。
又论云。懊 者。懊 郁闷之状。盖由表证误下。正气内虚。于是客气乘虚入而动膈。
胸烦懊 。心中微疼。特未如结胸之甚也。然由是而结胸亦不难矣。短气烦躁。胸中懊 。
心下
此邪
也。
后二
抽搐表现为筋脉紧急收缩。弛缓则表现为筋脉舒缓伸展。病情发展到抽搐阶段,说明热气已经极盛。因为热极生风,而风性主动,所以导致筋脉相互牵引、拘挛抽搐。清除热邪可用柴胡、栀子这类药物;祛除外风可用防风、羌活这类药物。又有风温证,如果错误地使用火熏法治疗,必然会导致发黄,严重时出现惊痫,并伴有间歇性的抽搐。经书说:“一次误治尚能拖延时日,再次误治则会加速死亡。”假如被医生误治,只能使用《金匮要略》中的风引汤来驱除邪气,并用黑豆来解毒。歌诀说:“抽搐为筋脉收缩,弛缓为筋脉伸展。热极生风并在经络之中。清除热邪、祛除外风还抱有希望;若用火熏和发表法,定会导致死亡。”
伤寒病中出现筋惕肉瞤(肌肉跳动)的情况,是因为伤寒引起的头痛身痛、恶寒发热是必然的证候。至于筋惕肉瞤,则不是经常出现的症状。这是因为阳气大虚……(原文此处有缺漏或错简,结合后文“汗出过多”推断,意指津液亏损,阳气虚弱)。歌诀说:“筋惕肉瞤因发汗过多。斟酌使用真武汤最为适宜。左侧动气如轻微出汗,此证难医,奈何天命如此。”论述说:出汗过多,津液枯竭稀少,阳气偏于虚弱,筋肉失去滋养,所以感到惕惕然跳动。张氏特别设立真武汤……(原文此处有缺漏)。
伤寒懊憹(ào náo),是指郁闷的样子,即心中懊恼郁结,郁郁不舒畅,烦闷无奈。这比一般的烦闷更为严重。由胃中……(原文此处有缺漏)。歌诀说:“心中懊憹用陷胸汤。舌苔白,脉象洪大。发黄需用茵陈蒿类药物治疗。燥屎在阳明经,用承气汤攻下。”又论述说:懊憹,是懊恼郁闷的状态。大概是由于表证误用下法,正气内虚,于是客气乘虚侵入并扰动膈膜。出现胸中烦闷懊憹,心中微痛,但还没有像结胸证那样严重。然而由此发展为结胸证也不难了。短气烦躁,胸中懊憹……(原文此处有缺漏)。
Tetany (spasms) manifests as tight contraction. Flaccidity manifests as relaxation and extension. When the disease progresses to tetany, it indicates that heat pathogen has reached its extreme. This is because extreme heat generates wind, and wind governs movement; thus, the sinews and vessels are drawn together, causing spasms and convulsions. To purge heat, herbs such as Bupleuri Radix (Chaihu) and Gardeniae Fructus (Zhizi) are used. To dispel wind, herbs such as Saposhnikoviae Radix (Fangfeng) and Notopterygii Rhizoma et Radix (Qianghuo) are employed. In cases of Wind-Warmth syndrome, if fire fumigation is mistakenly applied, jaundice will inevitably ensue. In severe cases, fright epilepsy occurs with intermittent tetany. The Classics state: "One misstep may prolong life for a day; two missteps will hasten death." If mistakenly treated by physicians, one must resort to Fengyin Decoction from *Jin Gui Yao Lue* to expel pathogens, and use Glycine Max Seed (Heidou, black beans) to resolve toxicity. The verse states: "Tetany involves contraction, flaccidity involves extension. Extreme heat generating wind affects the meridians. Purging heat and dispelling wind still holds hope. Fire fumigation and inducing sweating will surely lead to darkness (death)."
In typhoid fever, muscle twitching (Jinti Rouyun) occurs. Headache, body ache, aversion to cold, and fever are inevitable symptoms of typhoid fever. However, muscle twitching is not a constant symptom. It arises due to significant deficiency of Yang Qi... [Text fragment]. The verse states: "Muscle twitching results from excessive sweating. Zhenwu Decoction should be considered carefully without error. Left-sided qi movement resembling slight sweating makes this condition difficult to treat; alas, what can be done against fate?" The discussion states: Excessive sweating depletes fluids and reduces Yin essence, leading to relative deficiency of Yang Qi. The muscles and sinews lose their nourishment, resulting in palpitations and twitching. Zhang Zhongjing specifically established Zhenwu Decoction... [Text fragment].
Typhoid fever accompanied by Ao Nao (restlessness and depression) refers to a state of mental oppression. It describes a feeling of inner restlessness and郁结 (depression), where one feels unrefreshed and helpless. This is more severe than ordinary irritability. It originates from the stomach... [Text fragment]. The verse states: "For heart-centered Ao Nao, Xiongxiong Decoction is used. A white tongue coating and surging pulse indicate the pattern. For jaundice, Yichen (Artemisiae Scopariae Herba) type herbs are required. For dry feces in the Yangming stage, Chengqi Decoction is used to attack." Another discussion states: Ao Nao is a state of restlessness and depression. It generally arises from the mistaken use of purgatives for exterior syndromes, leading to internal deficiency of healthy Qi. Consequently, exogenous pathogens take advantage of the deficiency to enter and disturb the diaphragm. This causes chest irritability and Ao Nao, with slight pain in the heart region, though not as severe as Jie Xiong (chest binding). However, progression to Jie Xiong is not difficult. Shortness of breath, irritability, and chest Ao Nao... [Text fragment].