里证下后,脉浮而微数,身微热,神思或不爽,此邪热浮于肌表,里无壅滞也。
虽无汗,宜白虎汤,邪从汗解。若大下后或数下后,脉空浮而数,按之豁然如无,宜白虎汤加
人参,覆杯则汗解。下后脉浮而数,原当汗解,迁延五六日脉证不改,
仍不得汗者,以其人或自利经久,或素有他病先亏,或本病日久不痊,或反复数下,以致周
身血液枯涸,故不得汗,白虎辛凉除肌表散漫之热邪,加人参以助周身之血液,于是经络润
泽,元气鼓舞,腠理开发,故得汗解。
里证脉沉而数,下后脉浮者,当得汗解。今不得汗,后二三日,脉复沉者,膜原
余邪复瘀到胃也,宜更下之。更下后,脉再浮者,仍当汗解,宜白虎汤。
里证下后,脉不浮,烦渴减,身热退,越四五日复发热者,此非关饮食劳复,乃
膜原尚有余邪隐匿,因而复发,此必然之理。不知者每每归咎于病患,误也。宜再下之即愈
。但当少与,慎勿过剂,以邪气微也。
应下之证,下后当脉静身凉,今反发热者,此内结开,正气通,郁阳暴伸也。即
如炉中伏火,拨开虽焰,不久自息,此与下后脉反数义同。若温疫将发,原当日渐加热,胃
本无邪,误用承气,更加发热,实非承气使然,乃邪气方张,分内之热也。但嫌下早之误,
徒伤胃气耳。日后传胃,再当下之。又有药烦者,与此悬绝,详载本条。
里证经过攻下治疗后,脉象浮而微数,身体有轻微发热,神志可能不清爽,这是邪热浮越于肌表,体内没有壅滞阻塞的表现。
虽然无汗,适宜使用白虎汤(石膏、知母、甘草、粳米组成的清热剂),使邪气随汗液排出而解除。如果在大幅攻下后或多次攻下后,脉象空浮且数,重按感觉豁然空虚如同没有脉搏,适宜在白虎汤中加入人参,服药片刻后即可出汗而解。攻下后脉象浮而数,原本应当通过发汗来解除病邪,如果拖延五六天脉象和症状没有改变,仍然无法出汗,这是因为患者或者长期腹泻,或者素来有其他疾病导致正气先已亏损,或者本病日久未愈,或者反复多次攻下,导致周身血液枯竭干涸,所以无法出汗。白虎汤中的辛凉药物可以清除肌表散漫的热邪,加入人参以资助周身的血液,于是经络得到润泽,元气被鼓舞振奋,腠理(皮肤毛孔及纹理)开发,因此能够出汗而解。
里证脉象沉而数,攻下后脉象转为浮的,应当通过出汗来解除病邪。现在却无法出汗,过两三天后,脉象再次变沉的,是膜原(半表半里的部位)残留的邪气重新瘀结到胃腑,适宜再次进行攻下治疗。再次攻下后,脉象再次变浮的,仍然应当通过发汗来解除,适宜使用白虎汤。
里证经过攻下治疗后,脉象不浮,烦渴减轻,身体发热消退,过了四五天又出现发热的,这与饮食不当或劳累导致的复发无关,而是膜原尚有余邪隐匿潜伏,因而再次发作,这是必然的道理。不了解这种情况的人往往归咎于病患自身护理不当,这是错误的。适宜再次进行攻下治疗即可痊愈。但应当少量给予药量,切勿过量用药,因为此时邪气已经微弱。
属于应当攻下的证候,攻下后应当脉象平静、身体凉爽,现在反而发热的,这是内部结滞已开,正气通畅,郁积的阳气突然伸展所致。这就好比炉中潜伏的火种,拨开后虽然火焰升起,但不久自然会熄灭,这与攻下后脉象反而数的道理相同。如果是温疫即将发作,原本应该日渐加重发热,胃中本来没有实邪,误用承气汤(大黄、芒硝等组成的泻下剂),导致更加发热,这确实不是承气汤造成的,而是邪气正盛,属于病情发展过程中固有的热象。只是可惜犯了过早攻下的错误,白白损伤了胃气罢了。日后邪气传入胃腑,再行攻下治疗。又有因药物引起的烦躁不安(药烦),与此情况截然不同,详细记载在本条文中。
After purgation for interior syndromes, if the pulse is floating and slightly rapid, with slight fever and mental cloudiness, this indicates pathogenic heat floating on the muscle surface (muscle layer), with no obstruction in the interior.
Although there is no sweating, Baihu Tang (White Tiger Decoction) should be used to resolve the pathogen through sweating. If after severe or multiple purgations, the pulse is empty, floating, and rapid, feeling hollow upon deep pressure as if absent, Ren Shen (Ginseng Radix et Rhizoma) should be added to Baihu Tang; sweating will occur shortly after taking the medicine. If the pulse is floating and rapid after purgation, it originally should have been resolved by sweating. If five or six days pass without change in pulse and symptoms, and sweating still does not occur, it is because the patient may have had chronic diarrhea, pre-existing deficiency from other diseases, prolonged illness without recovery, or repeated purgations, leading to exhaustion of blood throughout the body. Thus, sweating cannot occur. The acrid-cool herbs in Baihu Tang clear the diffuse heat on the muscle surface; adding Ren Shen (Ginseng Radix et Rhizoma) assists the blood throughout the body. Consequently, the meridians become moistened, Yuan Qi (Original Qi) is stimulated, and the Cou Li (skin pores and interstices) open, allowing resolution through sweating.
If the interior syndrome presents with a deep and rapid pulse, which becomes floating after purgation, sweating should resolve the condition. If sweating does not occur now, and after two or three days the pulse returns to being deep, residual pathogens from the Mo Yuan (Membrane Source) have re-stagnated in the Stomach. Another purgation is indicated. After subsequent purgation, if the pulse becomes floating again, it should still be resolved by sweating, using Baihu Tang (White Tiger Decoction).
After purgation for interior syndromes, if the pulse is not floating, irritability and thirst decrease, and fever subsides, but fever recurs after four or five days, this is not due to relapse from diet or overexertion. Rather, residual pathogens remain hidden in the Mo Yuan (Membrane Source), causing recurrence. This is an inevitable principle. Those who do not understand this often blame the patient, which is erroneous. Another purgation is appropriate for cure. However, the dose should be small, and excessive medication must be avoided, as the pathogenic factor is now weak.
For syndromes requiring purgation, the pulse should calm and the body cool after treatment. If fever persists instead, it indicates that internal stagnation has opened, Zheng Qi (Upright Qi) is unblocked, and constrained Yang suddenly extends. This is like embers in a stove: when stirred, flames rise briefly but extinguish soon after. This shares the same meaning as a rapid pulse appearing after purgation. If epidemic warmth is about to erupt, fever should gradually increase. If the Stomach originally lacks excess pathogens, misusing Chengqi Tang (Major Order the Qi Decoction) causes increased fever. This is not caused by Chengqi Tang (Major Order the Qi Decoction) itself, but rather by the flourishing pathogen and the inherent heat of the disease stage. The error lies only in premature purgation, which vainly damages Stomach Qi. When the pathogen later transmits to the Stomach, purgation can be performed again. There is also "medication-induced irritability" (Yao Fan), which is completely different from this scenario and is detailed in the relevant section.