五色休息皆伤脏,涩早滞热蕴于中,补之不应脉有力,日久仍攻余法同。
【注】五色、休息二痢,皆因用止涩药早,或因滞热下之未尽,蕴于肠胃伤脏气也。用
一切补养之药不应,则可知初病非止涩太早,
即下之未尽也。诊其脉若有力,虽日久仍当攻也。其余治法,与诸痢同。
面目身黄欲安卧,小便浑黄胆病成,已食如饥饱烦眩,胃疸谷疸酒疸名,女劳额黑
少腹急,小便自利审瘀生,黄汗微肿皆湿热,阴黄重痛厥如冰。
【注】面目身黄,但欲安卧,小便黄浑,此黄胆病已成也。如已食如饥,食难用饱,饱
则心烦头眩,此欲作胃疸。胃疸者,即谷疸也。若已见黄色,疸已成矣,得之于胃有湿
热,大饥过食也。酒疸者,得之于饮酒无度,而发是病也。女劳疸者,疸而额黑,少腹急,
小便自利,得之于大劳大热与女交接也。瘀血发黄,亦少腹急,小便自利,但不额黑耳。
详在伤寒门。黄汗者,汗出黄色染衣,面目微肿,得之于素有湿热,汗出入水浴之也。此
皆湿热而成,惟阴黄则属湿寒。阴黄者,身重而痛,厥冷如冰,详在伤寒门。
疸过十日而反剧,色若烟熏目暗青,喘满渴烦如啖蒜,面黧汗冷及天行。
【注】仲景曰∶黄胆之病,当以十八日为期,治之十日以上宜差,反剧为难治也,色
若烟熏,目神暗青,阳黄死证也。喘满渴烦不已,心胸如啖蒜刺痛,黄毒入腹,死证也。
面色黧黑,冷汗 ,阴黄死证也。天行疫疠发黄,名曰瘟黄,死人最暴也。
麻黄茵陈醇酒汤 茵陈蒿汤 栀子柏皮汤 茵陈五苓散
表实麻黄茵陈酒,里实茵陈栀大黄,无证茵陈栀子柏,尿少茵陈五苓汤。
【注】诸疸表实无汗者,以麻黄、茵陈,无灰好酒煎服汗之。里实不便,以茵陈、栀
子、大黄下之。无表里证,以茵陈、栀子、柏皮清之。小便短少,以茵陈五苓散利之。
胃疸汤
谷疸热实宜乎下,不实宜用胃疸汤,茵陈胃苓减草朴,连栀防己葛秦方。
【注】胃疸汤,即茵陈、苍术、陈皮、白术、茯苓、猪苓、泽泻、黄连、栀子、防己、
葛根、秦艽也。
茵陈解酲汤 栀子大黄汤 蔓菁散 加味玉屏风散
酒疸虚茵解酲汤,实用栀豉枳大黄,黄汗一味蔓菁散,石膏茵陈 术防。
【注】酒疸虚者,用茵陈解酲汤,即葛花解酲汤加茵陈也。实者,用栀子大黄汤,即
栀子、淡豆豉、枳实、大黄也。黄汗宜用蔓菁子一味,为细末,每服二钱,日三,井华
水调服,小便白则愈。或用加味玉屏风散,即石膏、茵陈、黄 、白术、防风也。
石膏散 肾疸汤
女劳实者膏滑麦,女劳虚者肾疸医,升阳散火减去芍,加芩柏曲四苓俱。
【注】石膏散,即 石膏、飞滑石,各等分,每服二钱,大麦汤调服。肾疸汤,即升
阳散火汤减去芍药,乃升麻、苍术、防风、独活、柴胡、羌活、葛根、人参、甘草,加入
黄芩、黄柏、神曲、白术、茯苓、猪苓、泽泻也。
五色痢和休息痢都损伤了脏腑,(病因多为)过早使用收敛止涩药,或因湿热积滞攻下不彻底,导致邪气蕴结在肠胃中损伤脏气。如果采用补益药物无效且脉象有力,说明病久仍有实邪,仍应采用攻下法,其余治法与其他痢疾相同。
【注】五色痢和休息痢,都是因为过早使用止涩药,或者因湿热积滞攻下未尽,蕴结在肠胃损伤脏气所致。如果使用一切补养药物都无效,就可以知道初病时要么是因为止涩太早,要么是攻下不彻底。诊察脉象如果有力,即使病程日久仍应当采用攻下法。其余治疗方法,与各种痢疾相同。
面目身体发黄,想要安静躺卧,小便浑浊发黄,这是胆病(黄疸)已成。如果进食后感觉像饥饿一样,但吃不多,吃饱了就心烦头晕,这是将要发生胃疸。胃疸,就是谷疸。如果已经出现黄色,说明黄疸已成,这是由于胃中有湿热,在大饥之后过食所致。酒疸,是由于饮酒无度而引发的疾病。女劳疸,表现为黄疸且额头发黑,少腹拘急,小便自利,这是由于大劳大热之后与女子交合所致。瘀血发黄,也表现为少腹拘急,小便自利,只是额头不发黑罢了。详细情况参见《伤寒论》篇。黄汗,表现为出汗黄色染衣,面目轻微浮肿,这是由于素体有湿热,出汗后入水沐浴所致。这些大多由湿热引起,只有阴黄属于湿寒。阴黄,表现为身体沉重疼痛,四肢厥冷如冰,详细情况参见《伤寒论》篇。
黄疸超过十天反而加重,面色如烟熏般晦暗,眼睛昏暗青黑,气喘胸闷、口渴烦躁如同吃了大蒜,面色黧黑出冷汗,以及天行疫疠引起的发黄。
【注】张仲景说:黄疸病,以十八天为期限,治疗十天左右应该痊愈,如果反而加重就难以治疗。面色如烟熏,眼神昏暗青黑,是阳黄的死证。气喘胸闷、口渴烦躁不止,心胸刺痛如同吃了大蒜,这是黄毒入腹,属于死证。面色黧黑,出冷汗,是阴黄的死证。天行疫疠引起的发黄,称为瘟黄,致死最迅猛。
麻黄茵陈醇酒汤、茵陈蒿汤、栀子柏皮汤、茵陈五苓散。
表实无汗用麻黄茵陈酒,里实便秘用茵陈栀大黄,无表里证用茵陈栀子柏皮,尿少用茵陈五苓汤。
【注】各种黄疸若表实无汗的,用麻黄、茵陈,在无灰好酒中煎服以发汗。里实不便秘的,用茵陈、栀子、大黄以下之。没有表里证的,用茵陈、栀子、柏皮以清之。小便短少的,用茵陈五苓散以利之。
胃疸汤。
谷疸热实证适宜用攻下法,非实证适宜用胃疸汤,即茵陈胃苓汤减去甘草、厚朴,加上黄连、栀子、防己、葛根、秦艽。
【注】胃疸汤,即茵陈、苍术、陈皮、白术、茯苓、猪苓、泽泻、黄连、栀子、防己、葛根、秦艽组成。
茵陈解酲汤、栀子大黄汤、蔓菁散、加味玉屏风散。
酒疸虚证用茵陈解酲汤,实证用栀子大黄汤(含枳实、大黄),黄汗用一味蔓菁散,(阴黄/湿重)用石膏、茵陈、黄芪、白术、防风。
【注】酒疸虚证的,用茵陈解酲汤,即葛花解酲汤加茵陈。实证的,用栀子大黄汤,即栀子、淡豆豉、枳实、大黄。黄汗适宜用蔓菁子一味,研为细末,每次服用二钱,每日三次,用井华水调服,小便变白则痊愈。或者使用加味玉屏风散,即石膏、茵陈、黄芪、白术、防风组成。
石膏散、肾疸汤。
女劳疸实证用石膏滑石大麦汤,女劳疸虚证用肾疸汤医之,(肾疸汤即)升阳散火汤减去芍药,加入黄芩、黄柏、神曲、白术、茯苓、猪苓、泽泻。
【注】石膏散,即石膏、飞滑石各等分,每次服用二钱,用大麦汤调服。肾疸汤,即升阳散火汤减去芍药,乃升麻、苍术、防风、独活、柴胡、羌活、葛根、人参、甘草,加入黄芩、黄柏、神曲、白术、茯苓、猪苓、泽泻组成。
Wuse Dysentery (Five-Color Dysentery) and Xixie Dysentery (Intermittent Dysentery) both injure the Zang organs. The pathogenesis involves the premature use of astringent herbs to stop diarrhea, or incomplete purgation of stagnant heat, leading to the accumulation in the intestines and stomach and injury to the Qi of the Zang organs. If tonifying treatments are ineffective and the pulse is forceful, it indicates that residual excess pathogens remain even after a long duration; therefore, purgative methods should still be employed. The remaining treatment principles are the same as those for other types of dysentery.
[Note] Wuse Dysentery and Xixie Dysentery are caused by the premature use of astringent drugs or incomplete purgation of stagnant heat, which accumulates in the intestines and stomach, injuring the organ Qi. If all tonifying and nourishing medications prove ineffective, it can be deduced that either the astringents were used too early in the initial stage, or the purgation was incomplete. If the pulse is forceful upon diagnosis, purgation should still be applied despite the prolonged course of disease. Other treatment methods are consistent with those for various dysenteries.
Yellowing of the face, eyes, and body, accompanied by a desire to lie quietly, and turbid yellow urine, indicate that Dan Disease (Jaundice) has established itself. If one feels hungry after eating but cannot eat much, and experiences irritability and dizziness when full, this suggests the impending onset of Wei Dan (Stomach Jaundice). Wei Dan is also known as Gu Dan (Grain Jaundice). If yellow coloration is already present, the jaundice is established; it arises from damp-heat in the stomach, often due to overeating after severe hunger. Jiu Dan (Alcohol Jaundice) results from excessive drinking. Nu Lao Dan (Female Labor Jaundice) presents with jaundice, blackening of the forehead, urgency in the lower abdomen, and free urination; it is caused by severe exertion and heat followed by sexual intercourse. Yellowing due to blood stasis also presents with urgency in the lower abdomen and free urination, but without blackening of the forehead. Details are found in the Shanghan Lun (Treatise on Cold Damage) section. Huang Han (Yellow Sweat) presents with yellow sweat staining clothes and slight swelling of the face and eyes; it results from pre-existing damp-heat combined with bathing in water while sweating. These conditions are mostly caused by damp-heat, whereas Yin Huang (Yin Jaundice) belongs to damp-cold. Yin Huang presents with heavy and painful body, and cold extremities like ice; details are found in the Shanghan Lun section.
If jaundice persists beyond ten days and worsens, with a complexion darkened like soot, dull and bluish-black eyes, panting, chest fullness, thirst, irritability resembling the sensation of eating garlic, dark sallow complexion with cold sweats, or yellowing caused by epidemic pestilence (Tianxing), these are critical signs.
[Note] Zhang Zhongjing stated: For Dan Disease (Jaundice), the prognosis period is eighteen days; if treated within ten days, improvement should occur. If it worsens after this period, it is difficult to treat. A complexion like soot and dull, bluish-black eyes indicate a fatal syndrome of Yang Huang (Yang Jaundice). Persistent panting, chest fullness, thirst, and irritability, along with stabbing pain in the heart and chest resembling the sensation of eating garlic, indicate that the yellow toxin has entered the abdomen, constituting a fatal syndrome. Dark sallow complexion with cold sweats indicates a fatal syndrome of Yin Huang. Yellowing caused by epidemic pestilence is called Wen Huang (Plague Jaundice), which causes death most rapidly.
Mahuang Yinyin Chunjiu Tang (Ephedra and Yinchen Decoction in Mellow Wine), Yinchen Hao Tang (Artemisiae Scopariae Decoction), Zhizi Baipi Tang (Gardeniae and Phellodendri Bark Decoction), Yinchen Wuling San (Artemisiae Scopariae and Wuling Powder).
For exterior excess with no sweat, use Mahuang Yinyin Chunjiu Tang. For interior excess with constipation, use Yinchen Zhi Dahuang Tang (Artemisiae Scopariae, Gardeniae, and Rhubarb Decoction). For cases without exterior-interior syndromes, use Yinchen Zhizi Baipi Tang. For scanty urination, use Yinchen Wuling San.
[Note] For various jaundices presenting with exterior excess and anhidrosis, decoct Ephedrae Herba (Mahuang) and Artemisiae Scopariae Herba (Yinchen) in good wine without ash to induce sweating. For interior excess with constipation, use Artemisiae Scopariae Herba (Yinchen), Fructus Gardeniae (Zhizi), and Radix et Rhizoma Rhei (Dahuang) to purge. For cases lacking exterior-interior signs, use Artemisiae Scopariae Herba (Yinchen), Fructus Gardeniae (Zhizi), and Cortex Phellodendri (Baipi) to clear heat. For scanty urination, use Yinchen Wuling San to promote diuresis.
Weidan Tang (Stomach Jaundice Decoction).
For Gu Dan (Grain Jaundice) with heat-excess syndrome, purgation is appropriate; for non-excess syndromes, Weidan Tang is indicated. This formula is Yinchen Weiling Tang minus Gancao (Licorice Root) and Houpo (Magnolia Bark), plus Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit), Fangji (Stephania Root), Gegen (Pueraria Root), and Qinjiao (Gentiana Macrophylla Root).
[Note] Weidan Tang consists of Artemisiae Scopariae Herba (Yinchen), Atractylodis Rhizoma (Cangzhu), Citri Reticulatae Pericarpium (Chenpi), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Polyporus (Zuling), Alismatis Rhizoma (Zexie), Coptidis Rhizoma (Huanglian), Fructus Gardeniae (Zhizi), Stephaniae Tetrandrae Radix (Fangji), Puerariae Radix (Gegen), and Gentianae Macrophyllae Radix (Qinjiao).
Yinchen Jiecheng Tang (Artemisiae Scopariae and Resolving Intoxication Decoction), Zhizi Dahuang Tang (Gardeniae and Rhubarb Decoction), Manjing San (Brassica Napus Powder), Jiawei Yupingfeng San (Modified Jade Windscreen Powder).
For deficiency-type Jiu Dan (Alcohol Jaundice), use Yinchen Jiecheng Tang. For excess-type, use Zhizi Dahuang Tang (containing Zhizi, Douchi, Zhishi, Dahuang). For Huang Han (Yellow Sweat), use Manjing San (a single herb powder). For Yin Huang/Damp-Heat, use Shigao (Gypsum), Yinchen, Huangqi, Baizhu, and Fangfeng.
[Note] For deficiency-type Jiu Dan, use Yinchen Jiecheng Tang, which is Ge Hua Jie Cheng Tang (Kudzu Flower Decoction for Resolving Intoxication) plus Artemisiae Scopariae Herba (Yinchen). For excess-type, use Zhizi Dahuang Tang, consisting of Fructus Gardeniae (Zhizi), Fermented Soybean (Danshi/Douchi), Aurantii Fructus Immaturus (Zhishi), and Radix et Rhizoma Rhei (Dahuang). For Huang Han, use Manjingzi (Brassica Napus Seed) alone, ground into fine powder, taken two qian per dose, three times daily, mixed well water. Recovery is indicated when urine becomes white. Alternatively, use Jiawei Yupingfeng San, consisting of Gypsum (Shigao), Artemisiae Scopariae Herba (Yinchen), Astragali Radix (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), and Saposhnikoviae Radix (Fangfeng).
Shigao San (Gypsum Powder), Shendan Tang (Kidney Jaundice Decoction).
For excess-type Nu Lao Dan (Female Labor Jaundice), use Shigao Huashi Mai Tang (Gypsum, Talcum, and Barley Decoction). For deficiency-type, treat with Shendan Tang. Shendan Tang is derived from Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction) minus Shaoyao, adding Huangqin, Huangbai, Shenqu, Baizhu, Fuling, Zuling, and Zexie.
[Note] Shigao San consists of equal parts Gypsum (Shigao) and Talcum (Fei Huashi), taken two qian per dose, mixed with Barley Decoction (Damai Tang). Shendan Tang is Shengyang Sanhuo Tang minus Paeoniae Radix Alba (Shaoyao), comprising Cimicifugae Rhizoma (Shengma), Atractylodis Rhizoma (Cangzhu), Saposhnikoviae Radix (Fangfeng), Angelicae Dahuricae Radix (Duohuo), Bupleuri Radix (Chaihu), Notopterygii Rhizoma et Radix (Qianghuo), Puerariae Radix (Gegen), Ginseng Radix (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), plus Scutellariae Radix (Huangqin), Phellodendri Chinensis Cortex (Huangbai), Saccharomyces (Shenqu), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Polyporus (Zuling), and Alismatis Rhizoma (Zexie).