(足太阳属腑)
膀胱者。州都之官。津液藏焉。气化则能出矣。然肾气足则化。肾气不足则不化。入气不化。则
水归大肠而为泄泻。出气不化。则闭塞下焦而为癃肿。小便之利。膀胱主之。实肾气主之也。
伤寒传经之邪。每自膀胱入。一见太阳头痛等症。即宜发散。不使邪气入为诸经害。则膀胱
为第一关隘矣。
膀胱为太阳腑。有表症。左尺脉必浮。其症为头痛。为项脊强。为身痛。四肢拘急。为发热。为恶
寒无汗。为喘嗽。
头痛者。头脑痛而连项脊也。加味香苏散主之。甚者加羌活、葱白。项脊强者。太阳经所过之地也。香
苏散主之。身痛四肢拘急者。风伤卫。寒伤营。寒主收引也。桂枝汤主之。发热者。腠理闭塞也。香苏
散主之。恶寒无汗者。寒乘表也。麻黄汤主之。喘嗽者。寒邪客于皮毛。肺气不得升降也。麻黄汤主
之。轻者。止嗽散。
膀胱之虚。肾气不化也。脉左尺必细沉。其症为小便不禁。为劳淋。为老淋。
小便不禁者。气虚不能统摄也。十补汤主之。劳淋者。劳力辛苦。气虚不化也。补中益气汤主之。老
淋者。老人思色。精不出而内败。大小便牵痛如淋。宜萆 厘清饮。去黄柏。加菟丝、远志以去其精。再服
六味地黄丸。
膀胱之实。脉左尺必洪大。其症为气淋。为血淋。为关格。为膀胱气。
气淋者。气滞。水道阻塞。脐下胀痛也。假苏散主之。血淋者。蓄瘀茎中。割痛难忍也。生地四物汤加红
花、桃仁、花蕊石主之。关格者。溺闭而吐逆也。假苏散主之。膀胱气者。一名胞痹。气结膀胱少腹。热
涩于小便也。橘核丸主之。
膀胱之寒。左尺必沉迟。其症为冷淋。
冷淋者。寒气坚闭水道。肢冷喜热也。金匮肾气丸主之。
膀胱之热。左尺必数。其症为小便不通。为膏淋。为石淋。为便脓血。为发狂。
小便不通者。渴则热在上焦。四苓散加山栀、黄芩。不渴则热在下焦。滋肾丸主之。膏淋者。滴液如膏
也。萆 厘清饮主之。石淋者。下如沙石也。益元散加琥珀主之。便脓血者。心气移热于膀胱也。阿
胶散主之。发狂者。伤寒热结膀胱。下焦蓄血。少腹硬满也。调胃承气汤主之。
(足太阳经与膀胱腑相属)
膀胱,是津液汇聚的器官。津液贮藏于此,经过气化作用才能排出体外。然而,肾气充足则能气化,肾气不足则无法气化。如果入气不能气化,水液就会流入大肠导致泄泻;如果出气不能气化,就会闭塞下焦导致小便不通或肿胀。小便的通利,由膀胱主管,但根本在于肾气的调控。
伤寒病传经之邪,往往从膀胱侵入。一旦见到太阳病的头痛等症状,就应当立即使用发散法治疗,防止邪气深入危害其他经络,因此膀胱是第一道关隘。
膀胱作为太阳腑,若有表证,左尺脉必然浮象。其症状表现为:头痛、项背僵硬、身体疼痛、四肢拘挛紧急、发热、恶寒无汗、气喘咳嗽。
所谓头痛,是指头脑疼痛并牵连到项背部。用加味香苏散主治。严重的加羌活、葱白。
所谓项背僵硬,是足太阳经脉所经过的部位。用香苏散主治。
所谓身体疼痛、四肢拘挛紧急,是因为风邪伤及卫气,寒邪伤及营血,寒性主收引。用桂枝汤主治。
所谓发热,是因为腠理闭塞所致。用香苏散主治。
所谓恶寒无汗,是因为寒邪侵袭体表。用麻黄汤主治。
所谓气喘咳嗽,是因为寒邪客居皮毛,肺气无法正常升降。用麻黄汤主治。轻症用止嗽散。
膀胱虚证,是由于肾气不化。脉象左尺必细沉。其症状表现为:小便失禁、劳淋、老淋。
所谓小便失禁,是气虚不能统摄固摄。用十补汤主治。
所谓劳淋,是因劳累辛苦,气虚无法气化所致。用补中益气汤主治。
所谓老淋,是老人思慕色欲而精液不出导致内部败坏,大小便牵引疼痛如同淋病。宜用萆薢分清饮,去掉黄柏,加入菟丝子、远志以清除败精。再服用六味地黄丸。
膀胱实证,脉象左尺必洪大。其症状表现为:气淋、血淋、关格、膀胱气。
所谓气淋,是气机阻滞,水道阻塞,脐下胀痛。用假苏散主治。
所谓血淋,是瘀血蓄积在尿道,刺痛难以忍受。用地黄四物汤加红花、桃仁、花蕊石主治。
所谓关格,是小便闭塞且伴有呕吐逆乱。用假苏散主治。
所谓膀胱气,又名胞痹,是气结于膀胱少腹部,小便热涩不畅。用橘核丸主治。
膀胱寒证,左尺脉必沉迟。其症状表现为冷淋。
所谓冷淋,是寒气坚闭水道,四肢冰冷喜暖。用金匮肾气丸主治。
膀胱热证,左尺脉必数。其症状表现为:小便不通、膏淋、石淋、便脓血、发狂。
所谓小便不通,若口渴则是热在上焦,用四苓散加山栀、黄芩;若不渴则是热在下焦,用滋肾丸主治。
所谓膏淋,是尿液滴沥如膏脂状。用萆薢分清饮主治。
所谓石淋,是尿下如沙石状。用益元散加琥珀主治。
所谓便脓血,是心气移热于膀胱所致。用阿胶散主治。
所谓发狂,是伤寒热邪结于膀胱,下焦蓄血,少腹硬满。用调胃承气汤主治。
(Bladder is associated with the Foot-Taiyang Meridian)
The Bladder (Pang Guang) is the official of the reservoir, where body fluids (Jin Ye) are stored. Through Qi transformation (Qi Hua), they can be excreted. However, sufficient Kidney Qi (Shen Qi) enables transformation; insufficient Kidney Qi prevents it. If the intake Qi fails to transform, water returns to the Large Intestine causing diarrhea; if the output Qi fails to transform, the Lower Jiao becomes obstructed leading to urinary retention or swelling. The free flow of urine is governed by the Bladder, but fundamentally controlled by the Kidney Qi.
Pathogenic factors from Shaoyang transmission in Cold Damage diseases often enter via the Bladder. Upon observing symptoms such as headache characteristic of Taiyang disease, dispersing methods should be applied immediately to prevent pathogens from harming other meridians; thus, the Bladder serves as the first defensive barrier.
As the Fu organ of Taiyang, if exterior syndrome is present, the left Chi pulse will definitely be floating. Symptoms include: headache, stiffness of the neck and spine, body pain, spasticity and tightness of the four limbs, fever, aversion to cold without sweating, wheezing, and cough.
Headache refers to pain in the head extending to the neck and spine. It is primarily treated with Jiawei Xiang Su San (Modified Fragrant Perilla Powder). For severe cases, add Qiang Huo (Notopterygii Rhizoma et Radix) and Cong Bai (Allii Fistulosi Bulbus).
Stiffness of the neck and spine occurs in the area traversed by the Taiyang meridian. It is primarily treated with Xiang Su San (Fragrant Perilla Powder).
Body pain and spasticity of the four limbs result from Wind injuring the Defensive Qi (Wei Qi) and Cold injuring the Nutritive Qi (Ying Qi); Cold has a contracting nature. It is primarily treated with Guizhi Tang (Cinnamon Twig Decoction).
Fever results from the closure of interstices (Cou Li). It is primarily treated with Xiang Su San (Fragrant Perilla Powder).
Aversion to cold without sweating indicates Cold attacking the exterior. It is primarily treated with Mahuang Tang (Ephedra Decoction).
Wheezing and cough occur when Cold pathogens lodge in the skin and hair, preventing the Lung Qi from ascending and descending properly. It is primarily treated with Mahuang Tang (Ephedra Decoction). Mild cases are treated with Zhisou San (Stop Cough Powder).
Deficiency of the Bladder stems from the failure of Kidney Qi to transform. The left Chi pulse will be fine and deep. Symptoms include: urinary incontinence, Lao Lin (Fatigue Strangury), and Lao Lin (Elderly Strangury).
Urinary incontinence is due to Qi deficiency failing to control and secure. It is primarily treated with Shibu Tang (Ten Tonics Decoction).
Lao Lin (Fatigue Strangury) arises from physical exertion and hardship, where Qi deficiency prevents transformation. It is primarily treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Lao Lin (Elderly Strangury) refers to elderly individuals who desire sexual activity but do not ejaculate, leading to internal deterioration. There is pulling pain during urination and defecation resembling strangury. One should use Bixie Fenqing Yin (Grass Leaf Sedge Decoction for Clearing Separation), removing Huang Bo (Phellodendri Cortex), adding Tusizi (Cuscutae Semen) and Yuanzhi (Polygalae Radix) to eliminate stale essence. Subsequently, take Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).
Excess of the Bladder presents with a left Chi pulse that is surging and large. Symptoms include: Qi Lin (Qi Strangury), Xue Lin (Blood Strangury), Guan Ge (Obstruction and Reflux), and Bladder Qi disorder.
Qi Lin (Qi Strangury) involves Qi stagnation and obstruction of the water pathways, causing distending pain below the umbilicus. It is primarily treated with Jiasu San (Fake Mint Powder).
Xue Lin (Blood Strangury) involves accumulated blood stasis in the urethra, causing cutting pain that is unbearable. It is primarily treated with Shengdi Siwu Tang (Rehmannia Four Substance Decoction) added with Honghua (Carthami Flos), Taoren (Persicae Semen), and Huaruishishi (Tephrosiae Radix).
Guan Ge (Obstruction and Reflux) involves urinary retention accompanied by vomiting and reflux. It is primarily treated with Jiasu San (Fake Mint Powder).
Bladder Qi disorder, also known as Bao Bi (Bladder Obstruction), involves Qi knotting in the lower abdomen of the Bladder, causing heat and astringency in urination. It is primarily treated with Juhe Wan (Citrus Seed Pill).
Cold of the Bladder presents with a left Chi pulse that is deep and slow. Symptoms include Leng Lin (Cold Strangury).
Leng Lin (Cold Strangury) involves Cold pathogen firmly closing the water pathways, with cold limbs and preference for warmth. It is primarily treated with Jingui Shenqi Wan (Golden Cabinet Kidney Qi Pill).
Heat of the Bladder presents with a left Chi pulse that is rapid. Symptoms include: inability to urinate, Gao Lin (Paste Strangury), Shi Lin (Stone Strangury), passage of pus and blood in stool/urine, and mania.
Inability to urinate: If thirsty, heat is in the Upper Jiao; treat with Siling San (Four Ingredients Powder) added with Shanzhi (Gardeniae Fructus) and Huangqin (Scutellariae Radix). If not thirsty, heat is in the Lower Jiao; treat with Zishen Wan (Nourish Kidney Pill).
Gao Lin (Paste Strangury) involves urine dripping like paste. It is primarily treated with Bixie Fenqing Yin (Grass Leaf Sedge Decoction for Clearing Separation).
Shi Lin (Stone Strangury) involves passing sand-like stones. It is primarily treated with Yi Yuan San (Benefit Origin Powder) added with Hupo (Amber).
Passage of pus and blood results from Heart Qi transferring heat to the Bladder. It is primarily treated with Ejiao San (Donkey-Hide Gelatin Powder).
Mania results from Cold Damage heat knotting in the Bladder, with blood stasis in the Lower Jiao and hardness/fullness in the lower abdomen. It is primarily treated with Tiaowei Chengqi Tang (Regulate the Stomach and Purge the Qi Decoction).