少阳之(赵本医统本皆有“为”字)病,口苦、咽干、目眩也。
足少阳胆经也。《内经》曰∶有病口苦者,名曰胆瘅。《甲乙经》曰∶胆者中精之府,五脏取决于胆,
咽为之使。少阳之脉,起于目锐 。少阳受邪,故口苦、咽干、目眩。
少阳中风,两耳无所闻,目赤,胸中满而烦者,不可吐下,吐下则悸而惊。
少阳之脉,起于目 ,走于耳中;其支者,下胸中贯膈。风伤气,风则为热。少阳中风,气壅而热,
故耳聋,目赤,胸满而烦。邪在少阳,为半表半里。以吐除烦,吐则伤气,气虚者悸;
以下除满,下则亡血,血虚者惊。
伤寒,脉弦细,头痛,发热者,属少阳。少阳不可发汗,发汗则谵语。此属胃,胃和则愈,胃不和,
则(赵本无“则”字)烦而悸。(赵本注∶“一云躁”)
经曰∶三部俱弦者,少阳受病。脉细者,邪渐传里,虽头痛、发热,为表未解。以邪客少阳,为半在表
半在里,则不可发汗,发汗亡津液,胃中干燥。少阳之邪,因传入胃,必发谵语,当与调胃承气汤下之,胃和
则愈;不下,则胃为少阳木邪干之,故烦而悸。
本太阳病不解,转入少阳者,胁下硬满,干呕不能食,往来寒热,尚未吐下,脉沉紧者,与小柴胡汤。(
赵本有“小柴胡汤方”详见卷三)
太阳转入少阳,是表邪入于里。胁下硬满,不能食,往来寒热者,邪在半表半里之间。若已经吐下,脉
沉紧者,邪陷入腑为里实;尚未经吐下,而脉沉紧为传里,虽深,未全入腑,外
犹未解也,与小柴胡汤以和解之。
若已吐、下、发汗、温针,谵语,柴胡汤证罢,此为坏病,知犯何逆,以法治之。
少阳之邪,在表里之间,若妄吐、下、发汗、温针,损耗津液,胃中干燥,木邪干胃,必发谵语。若柴
胡证不罢者,则不为逆;柴胡证罢者,坏病也,详其因何治之逆,以法救之。
三阳合病,脉浮大,上关上,但欲眠睡,目合则汗。
关脉,以候少阳之气,太阳之脉浮,阳明之脉大。脉浮大,上关上,知三阳合病。胆热则睡,少阴病
但欲眠睡,目合则无汗,以阴不得有汗。但欲眠睡,目合则汗,知三阳合病,胆有热也。
伤寒六七日,无大热,其人躁烦者,此为阳去入阴
故也。
表为阳,里为阴。邪在表则外有热。六七日,邪气入里之时,外无大热,内有躁烦者,表邪传里也,故曰阳
去入阴。
伤寒三日,三阳为尽,三阴当受邪。其人反能食而不呕,此为三阴不受邪也。
伤寒四日,表邪传里,里不和,则不能食而呕;今反能食而不呕,是邪不传阴,但在阳也。
伤寒三日,少阳脉小者,欲已也。
《内经》曰∶大则邪至,小则平。伤寒三日,邪传少阳,脉当弦紧;今脉小者,邪气微而欲已也。
少阳病,欲解时,从寅至辰上。
《内经》曰∶阳中之少阳,通于春气。寅、卯、辰,少阳木王之时。
少阳病,表现为口苦、咽干、目眩。
这是足少阳胆经受邪。《内经》说:患有口苦病的,名叫胆瘅(胆热)。《甲乙经》说:胆是中精之府,五脏六腑的决断取决于胆,咽喉是胆气通达的通道。少阳经脉,起于目外角。少阳经受邪,所以出现口苦、咽干、目眩的症状。
少阳中风证,表现为两耳听不见,眼睛发红,胸中满闷而心烦,不可用吐法或下法治疗,如果用吐法或下法,会导致心悸和惊骇。
少阳经脉,起于目外角,进入耳中;其分支,下行穿过胸中贯通膈肌。风邪伤及气分,风邪化热。少阳中风,气机壅滞而生热,所以耳聋,目赤,胸满而烦。邪气在少阳,属于半表半里证。用吐法来消除烦热,吐则损伤正气,气虚则心悸;用下法来消除满闷,下则耗伤阴血,血虚则惊骇。
伤寒病,脉象弦细,头痛,发热,属于少阳病。少阳病不可发汗,发汗则会出现谵语(神志不清,胡言乱语)。这涉及胃腑,胃气和顺则痊愈,胃气不和,则出现心烦和心悸。(赵本注:“一说为躁动不安”)
经文说:三部脉都呈弦象的,是少阳受病。脉细,说明邪气逐渐传入里部,虽然还有头痛、发热,表明表证未解。因为邪气客居少阳,处于半表半里的位置,所以不可发汗,发汗会耗伤津液,导致胃中干燥。少阳的邪气,因此传入胃中,必然引发谵语,应当给予调胃承气汤攻下,胃气和顺则痊愈;如果不攻下,则胃会被少阳木邪所克制,所以出现心烦和心悸。
原本太阳病未解,转入少阳的,表现为胁下硬满,干呕不能进食,寒热往来,尚未经过吐法或下法治疗,脉象沉紧的,给予小柴胡汤。(赵本有“小柴胡汤方”,详见卷三)
太阳病转入少阳,是表邪入于里部。胁下硬满,不能进食,寒热往来,是邪气在半表半里之间。如果已经经过吐法或下法,脉象沉紧的,是邪气陷入腑中成为里实证;尚未经过吐法或下法,而脉象沉紧,是邪气传里,虽然病位较深,但未完全入腑,外部表证仍未解除,给予小柴胡汤以和解少阳。
如果已经经过吐法、下法、发汗、温针等误治,出现谵语,且柴胡汤证已消失,这称为坏病,需要查明犯了什么错误,按照相应的法治疗。
少阳的邪气,位于表里之间,如果妄用吐法、下法、发汗、温针,损耗津液,导致胃中干燥,木邪克制胃土,必然引发谵语。如果柴胡证没有消失,则不属于误治逆证;如果柴胡证消失了,就是坏病,详细考察因何种治疗失误,采用相应的方法救治。
三阳合病,脉象浮大,关脉部位明显,只想睡觉,闭上眼睛就出汗。
关脉,用来候察少阳之气,太阳脉浮,阳明脉大。脉象浮大,且在关脉部位明显,可知是三阳合病。胆热则嗜睡,少阴病也是只想睡觉,但闭上眼睛不出汗,因为阴证不得有汗。只想睡觉,闭上眼睛就出汗,可知是三阳合病,胆中有热。
伤寒六七天,身体没有大热,其人却躁扰烦乱的,这是阳气去而入阴的缘故。
体表为阳,体内为阴。邪气在表则体外发热。六七天,是邪气入里的时期,体外没有大热,体内却有躁扰烦乱,是表邪传入了里部,所以说阳气去而入阴。
伤寒三天,三阳经的病邪已尽,三阴经应当受邪。那人反而能吃饭且不呕吐,这是三阴经不受邪气的表现。
伤寒第四天,表邪传入里部,里气不和,就不能吃饭而呕吐;现在反而能吃饭且不呕吐,说明邪气不传入阴经,只在阳经。
伤寒三天,少阳脉象变小的,是病欲愈的表现。
《内经》说:脉大则邪气盛,脉小则平和。伤寒三天,邪气传至少阳,脉应当弦紧;现在脉象变小,说明邪气微弱,病将要痊愈。
Shaoyang disease manifests as bitter taste in the mouth, dryness of the throat, and dizziness.
This involves the Foot-Shaoyang Gallbladder Meridian (Zu Shao Yang Dan Jing). The *Neijing* states: "A person suffering from bitter taste in the mouth is diagnosed with Dan Fan (Gallbladder Heat)." The *Jiayi Jing* states: "The Gallbladder is the storehouse of essence; the decisions of the five zang organs depend on the Gallbladder, and the pharynx serves as its conduit." The Shaoyang meridian originates at the outer canthus of the eye. When the Shaoyang meridian is invaded by pathogenic factors, symptoms such as bitter taste in the mouth, dryness of the throat, and dizziness occur.
In Shaoyyang wind-strike syndrome, there is deafness in both ears, redness of the eyes, fullness in the chest accompanied by vexation. Purging or emesis must not be used; if employed, palpitations and fright will ensue.
The Shaoyang meridian originates at the outer canthus of the eye and enters the ear; its branch descends through the chest, piercing the diaphragm. Wind pathogens damage qi, and wind transforms into heat. In Shaoyang wind-strike, qi becomes congested and generates heat, resulting in deafness, red eyes, chest fullness, and vexation. The pathogen resides in the Shaoyang stage, which is a half-exterior, half-interior condition. Using emesis to remove vexation damages qi; qi deficiency leads to palpitations. Using purgatives to remove fullness depletes blood; blood deficiency leads to fright.
In cold damage, if the pulse is wiry and fine, accompanied by headache and fever, it belongs to Shaoyang disease. Shaoyang disease should not be treated with sweating methods; if sweated, delirium may occur. This condition involves the Stomach; if the Stomach harmonizes, recovery occurs; if the Stomach does not harmonize, vexation and palpitations result. (Zhao's edition notes: "Alternatively described as restlessness.")
The classic states: "When the pulses at all three positions are wiry, the Shaoyang is diseased." A fine pulse indicates that the pathogen is gradually transmitting inward. Although headache and fever persist, indicating the exterior is not yet resolved, because the pathogen lodges in the Shaoyang stage—half-exterior, half-interior—sweating is contraindicated. Sweating depletes body fluids, causing dryness in the Stomach. The Shaoyang pathogen, having transmitted to the Stomach, inevitably causes delirium. Tiaowei Chengqi Decoction (Regulate the Stomach and Downbear Excess Pill) should be administered to purge; if the Stomach harmonizes, recovery occurs. If not purged, the Stomach will be constrained by the Wood pathogen of Shaoyang, leading to vexation and palpitations.
If a pre-existing Taiyang disease fails to resolve and transmits to Shaoyang, presenting with hardness and fullness below the costal margin, dry retching, inability to eat, alternating chills and fever, and if no emesis or purging has yet been performed, but the pulse is deep and tight, Xiaochaihu Tang (Minor Bupleurum Decoction) should be given. (Zhao's edition includes the formula for Xiaochaihu Tang, detailed in Volume 3.)
Transmission from Taiyang to Shaoyang signifies the exterior pathogen entering the interior. Hardness and fullness below the costal margin, inability to eat, and alternating chills and fever indicate the pathogen is between the exterior and interior. If emesis or purging has already been performed and the pulse is deep and tight, the pathogen has sunk into the fu organs, constituting an interior excess syndrome. If emesis or purging has not yet been performed, and the pulse is deep and tight, although transmission to the interior has occurred, it has not fully entered the fu organs, and the exterior remains unresolved. Xiaochaihu Tang (Minor Bupleurum Decoction) should be given to harmonize.
If emesis, purging, sweating, or warm needle therapy have already been applied, resulting in delirium, and the indications for Chaihu Tang (Bupleurum Decoction) have ceased, this is termed a damaged disease. One must determine the nature of the iatrogenic error and treat accordingly.
The Shaoyang pathogen resides between the exterior and interior. Improper use of emesis, purging, sweating, or warm needles depletes body fluids, causing dryness in the Stomach. The Wood pathogen then constrains the Stomach, inevitably causing delirium. If the Chaihu indications persist, it is not considered an adverse reaction; if they cease, it is a damaged disease. One must investigate the cause of the therapeutic error and apply appropriate remedial methods.
In combined disease of the three yang meridians, the pulse is floating and large, prominent at the Guan position. The patient desires sleep, and sweating occurs when closing the eyes.
The Guan pulse reflects Shaoyang qi; the Taiyang pulse is floating, and the Yangming pulse is large. A floating and large pulse, prominent at the Guan position, indicates combined disease of the three yang meridians. Gallbladder heat causes somnolence. In Shaoyin disease, the patient also desires sleep, but there is no sweating upon closing the eyes, as yin conditions do not typically present with sweating. Desire for sleep accompanied by sweating upon closing the eyes indicates combined disease of the three yang meridians and heat in the Gallbladder.
In cold damage lasting six or seven days, with no significant external heat, yet the patient exhibits restlessness and vexation, this indicates the departure of yang and entry into yin.
The exterior is yang, and the interior is yin. When the pathogen is in the exterior, there is external heat. At six or seven days, it is the time for the pathogen to enter the interior. The absence of significant external heat, coupled with internal restlessness and vexation, indicates that the exterior pathogen has transmitted to the interior. Thus, it is said that yang departs and enters yin.
In cold damage after three days, the three yang meridians' pathogenic influence is exhausted, and the three yin meridians should be affected. However, if the patient can eat and does not vomit, this indicates that the three yin meridians are not affected by the pathogen.
On the fourth day of cold damage, if the exterior pathogen transmits to the interior and the interior is disharmonious, the patient cannot eat and will vomit. The fact that the patient can eat and does not vomit indicates that the pathogen does not transmit to the yin meridians but remains in the yang meridians.
In cold damage after three days, if the Shaoyang pulse becomes small, the disease is about to resolve.
The *Neijing* states: "A large pulse indicates the presence of pathogenic factors; a small pulse indicates peace/health." After three days of cold damage, when the pathogen transmits to Shaoyang, the pulse should be wiry and tight. A small pulse now indicates that the pathogenic factor is weak and the disease is nearing resolution.
Shaoyang disease tends to resolve during the hours of Yin to Chen (03:00–07:00).
The *Neijing* states: "Shaoyang among the yang meridians corresponds to the Qi of Spring." The hours of Yin, Mao, and Chen are when the Wood energy of Shaoyang is prosperous.