子和曰(云云)
谨按厥证寒热亦有阴阳虚实不同如形气稍实者宜从子和之法吐下之虚甚者惟宜随其所因
而调
理之可也陈氏论脏气相刑或与外邪相忤气遏不行闭经络脉伏昏不知人至为尸厥今世俗多作风
治鲜不致毙如传引华陀治虢太子尸厥为阳脉下坠阴脉上争会气闭而不通上有绝阳之络下有破
阴之纽破阴绝阳之色已发脉乱故形静如死状此与经言阴阳之气盛衰为厥之旨甚微后人安能得
证治之仿佛乎而以阴阳证治之可验者较之若伤寒手足厥逆昏不知人邪正已极温上之间稍或迟
缓祸不旋踵或汗不解暴衄不知人而厥或杂病得吐衄血而厥不知人者一二日或三日必间间则为
愈矣盖阴气尚实必身不热热则不厥厥则为血温身热主死矣暴气厥而形实者七情所致痰饮内郁
而厥必半日或一二时必间形虚而气逆甚者多致不救此又可见气血为厥阴阳暴逆之甚也故不可
断作风治
苏合香丸治卒暴厥不知人未辩风痰气厥宜与此膏化浓汤灌之惺后却议脉证用药
吐剂
瓜蒂散
方见痰饮门口噤者或先用搐鼻药
三因追魂汤治卒厥暴死及主客忤鬼击飞尸气绝不觉口噤
麻黄汤 方见寒门
上 咀水煎灌之不下者分病患发左右捉搦按肩引之令服取效千金方加桂
按此治感中邪气之剂也
四逆汤治寒厥表热里寒下利清谷食入则吐脉沉伏手足冷
方见寒门
按此治寒热之剂并出寒暑例然内因气血之剂详见各门宜对证选用兹不详录
和剂局(指宋代官方药局,此处代指前人观点或通用说法)说(省略具体内容)。
仔细考察厥证,寒热属性也有阴阳虚实的不同。如果患者形体与正气稍显充实者,适宜采用和氏的方法,使用涌吐或攻下法;若虚损严重,则只宜根据其病因进行调理即可。
陈氏论述脏腑之气相互克制,或与外邪相冲突,导致气机阻滞不行,经络脉道闭塞,出现昏厥不知人事的症状,这被称为“尸厥”。如今世俗多将其当作风病治疗,很少有不导致死亡的。例如引用华佗治疗虢太子尸厥的案例:阳脉下沉,阴脉上争,气血闭阻不通。上部有断绝之阳络,下部有破损之阴纽。呈现破阴绝阳的面色,脉象紊乱,所以身体静止如同死亡状态。这与《内经》所言阴阳之气盛衰导致厥证的旨意非常微妙,后人怎能得到其证治的仿佛呢?以阴阳辨证来治疗是可以验证的。
相比之下,伤寒所致的手足厥逆、昏不知人,是邪气与正气斗争到了极点。如果在温补阳气之间稍有迟缓,灾祸就会立刻发生。或者发汗后不能解除,突然鼻出血、昏不知人且厥逆;或者杂病中出现呕吐、鼻衄血而厥逆、昏不知人的情况,一二日或三日必会间歇缓解,间歇则为痊愈。这是因为阴气尚实,必定身体不发热,若发热则不会厥逆。厥逆则是血液温煦不足,身体发热主死。
突发的气厥且形体充实者,多由七情所致;痰饮内郁导致的厥逆,必须经过半天或一两个时辰才会间歇缓解。形体虚弱而气逆严重者,多导致无法救治。这又可见气血为患致厥,以及阴阳暴逆的严重程度。因此不可断定为风病治疗。
苏合香丸:治疗卒然暴厥、不知人事,尚未辨别是风痰还是气厥时,适宜将此药与膏方用浓汤化开灌服。待苏醒后,再根据脉证用药。
涌吐剂:瓜蒂散。(方剂见痰饮门)。口噤不开者,可先用搐鼻药。
三因追魂汤:治疗卒然暴厥假死及主客忤、鬼击、飞尸等导致气绝不觉、口噤不开。
麻黄汤:(方剂见寒门)。
以上药物切碎,用水煎煮灌服。若药液不下,可分别让病人仰卧左右侧,捉拿按压肩膀牵引,使其服药取效。《千金方》加桂枝。
按语:这是治疗感受中邪气的方剂。
四逆汤:治疗寒厥,表现为表热里寒、下利清谷、食入则吐、脉沉伏、手足冷。
(方剂见寒门)。
He (referring to He Hanzhong or a general reference to previous authorities) stated (details omitted).
Upon careful examination, Jue syndrome (syncope with cold limbs) involving cold and heat also presents differences in Yin-Yang deficiency and excess. If the patient's physical constitution and Zheng Qi (Upright Qi) are slightly robust, it is appropriate to adopt He's method of inducing vomiting or purging. If the deficiency is severe, one should only regulate according to the specific etiology.
Chen discussed that when Zang-Fu Qi mutually overcomes each other or conflicts with external pathogens, Qi stagnation occurs, blocking meridians and vessels, leading to coma and unconsciousness, known as "Shi Jue" (Corpse Syncope). Currently, the common practice often treats this as Wind disease, rarely avoiding fatal outcomes. For instance, citing Hua Tuo's treatment of the Crown Prince of Guo for Shi Jue: Yang pulses sink downward, Yin pulses surge upward, causing Qi and Blood obstruction. There are severed Yang collaterals above and broken Yin tendons below. The complexion reflects broken Yin and severed Yang, pulse chaos ensues, thus the body appears still as if dead. This aligns subtly with the principle in the *Classic of Difficult Issues* regarding Jue caused by Yin-Yang Qi imbalance. How can later generations grasp its diagnostic and therapeutic nuances? Treating based on Yin-Yang differentiation is verifiable.
In contrast, in Shanghan (Cold Damage), hand-foot Jue with coma indicates extreme struggle between pathogenic factors and healthy Qi. Slight delay in warming Yang may lead to immediate disaster. Post-sweating failure to resolve, sudden epistaxis with coma and Jue; or miscellaneous diseases presenting with vomiting, epistaxis, coma, and Jue, will likely show intermittent relief after one to three days. Intermittency indicates recovery. This is because Yin Qi is still substantial; absence of fever implies no Jue. If fever occurs, Jue does not happen. Jue implies lack of blood warmth; body fever indicates death.
Sudden Qi Jue with robust physique is often caused by Seven Emotions; Jue due to internal retention of Phlegm-Fluids requires half a day or one to two hours for intermittent relief. Those with weak physique and severe Qi rebellion often prove incurable. This demonstrates the severity of Qi-Blood pathology causing Jue and violent Yin-Yang rebellion. Therefore, it must not be diagnosed merely as Wind disease.
Suhe Xiang Wan (Styrax Pill): Treats sudden Jue with unconsciousness before distinguishing between Wind-Phlegm or Qi Jue. It is suitable to administer this pill mixed with ointment dissolved in thick decoction. After regaining consciousness, prescribe medication based on pulse and symptoms.
Emetic Formula: Gudi San (Melon Seed Powder). (See Phlegm-Fluid section). For patients with locked jaw, use nasal insufflation medicine first.
Sanyin Zhuihun Tang (Three Causes Soul-Chasing Decoction): Treats sudden Jue appearing as death, as well as attacks from Guest/Host interactions, Guiji (Ghost Strike), Feishi (Flying Corpse) causing Qi cessation, unconsciousness, and locked jaw.
Mahuang Tang (Ephedra Decoction). (See Cold section).
The above herbs should be coarse-chopped, decocted in water, and administered. If swallowing is difficult, have the patient lie on their left or right side, hold and press the shoulders to guide administration for efficacy. *Qianjin Fang* adds Guizhi (Cinnamon Twig).
Note: This is a formula for treating invasion by evil Qi.
Sini Tang (Frigid Extremities Decoction): Treats Han Jue (Cold Jue) manifesting as exterior heat and interior cold, diarrhea with undigested food, vomiting upon eating, deep and hidden pulse, and cold hands and feet.
(See Cold section).
Note: This is a formula for treating cold and heat, categorized under Cold and Summerheat examples. However, formulas for internal causes related to Qi and Blood are detailed in respective sections and should be selected according to syndrome differentiation; they are not recorded here in detail.