【脉】 沉微而不数,谓之寒厥;沉伏而数,谓之热厥。
【因】 因虚,因痰,因热,因寒。
【证】 厥当分两种,次分五脏。寒厥,为手足寒也。阴气胜则寒。其由乃恃壮纵欲于秋冬之间,则阳夺于内,
精气下溢,邪气上行,阳衰精竭,阴独行,故为寒厥。热厥,为手足热也。阳气胜则热。其由乃醉饱入房,气聚于脾胃,
阴虚阳气入则胃不和,胃不和则精竭,精气竭则四肢不荣,酒气与谷气相搏,则内热而溺赤,肾气衰,阳独胜,故为热
厥
五心烦热,有小肠热者,有心虚而热者。
厥,亦有腹暴满不知人者,或一二日稍知人者,或卒然衰乱者。皆因邪气乱,阳气逆,
是少阴肾脉不至也。肾气衰少,精气奔逸,使风促迫,上入胃膈,宗气反结心下,阳气退下
,热归股腹,与阴相助,令人不仁。又五络皆会于身,五络俱绝,则令人身脉俱动,而形体
无所知,其状如尸,故曰尸厥。正由脏器相乱,或与外邪相忤,则气郁不行,闭于经络,诸
厥有痰如曳锯声在咽中,为痰厥;骨枯爪痛为骨厥;身直如椽为 厥;因醉而得为酒厥
;暴怒而得为气厥;手足搐搦为风厥;喘而狂走为阳明厥。此皆气逆之所为也。
【治】 李法∶痰用白术、竹沥;热用承气下之;气虚补气,四君子;血虚补血
张法∶降心火,益肾水。通血和气,必先涌之。
【脉象】 脉象沉细微弱且不快,称为寒厥;脉象沉伏且快,称为热厥。
【病因】 因虚损、因痰饮、因热邪、因寒邪所致。
【证候】 厥证应当分为两种(寒厥与热厥),再细分涉及五脏。寒厥,表现为手足寒冷。阴气盛则生寒。其成因往往是在秋冬季节倚仗身体强壮而纵欲,导致阳气被夺于体内,精气下泄,邪气上行,阳气衰微、精气枯竭,阴气独盛,所以形成寒厥。热厥,表现为手足发热。阳气盛则生热。其成因往往是醉酒后饱食或行房事,气机聚集在脾胃,阴虚导致阳气内入则胃气不和,胃气不和则精气枯竭,精气枯竭则四肢得不到濡养,酒气与谷气相互搏结,则产生内热且小便色赤,肾气衰败,阳气独盛,所以形成热厥。五心烦热,有的属于小肠有热,有的属于心气虚弱而有热。
厥证中,也有腹部突然胀满、不省人事的,或者一两天后稍微恢复意识的,或者突然衰弱混乱的。这都是因为邪气扰乱,阳气逆乱,这是少阴肾脉脉搏不至的原因。肾气衰少,精气奔逸散失,受风邪急促逼迫,向上进入胃膈部位,宗气反而结聚在心下,阳气退居下行,热气归于大腿和腹部,与阴气相助,使人肢体麻木不知痛痒。另外,五条络脉都交会于身体,如果五条络脉全部闭塞,就会使人全身脉搏跳动,但形体无知觉,其状态像尸体一样,所以称为尸厥。这正是由于脏腑功能相互紊乱,或与外邪相抵触,导致气机郁滞不行,闭阻于经络之中。各种厥证中,咽喉中有如拉锯般的痰声,为痰厥;骨骼枯槁、爪甲疼痛为骨厥;身体僵硬挺直如椽木为僵厥;因醉酒而得的为酒厥;因暴怒而得的为气厥;手足抽搐拘挛为风厥;气喘且狂乱奔跑为阳明厥。这些都是气机逆乱所造成的。
【治疗】 李氏治法:痰证用白术、竹沥;热证用承气汤攻下;气虚补气,用四君子汤;血虚补血……
张氏治法:降心火,益肾水。调和气血,必须先使用涌吐法。
[Pulse] A pulse that is deep, fine, weak, and not rapid is called Cold Jue (Cold Reversal Syndrome); a pulse that is deep, hidden, and rapid is called Heat Jue (Heat Reversal Syndrome).
[Etiology] Caused by deficiency, phlegm, heat pathogen, or cold pathogen.
[Symptoms] Jue syndrome should be divided into two types (Cold Jue and Heat Jue), and further differentiated by the five Zang organs. Cold Jue manifests as coldness in the hands and feet. When Yin Qi (Yin energy) prevails, cold arises. Its origin often lies in indulging desires during autumn and winter while relying on physical robustness, causing Yang Qi (Yang energy) to be seized internally, essence and Qi to leak downward, and pathogenic factors to ascend. With declining Yang Qi and exhausted essence, Yin operates alone, thus forming Cold Jue. Heat Jue manifests as heat in the hands and feet. When Yang Qi prevails, heat arises. Its origin often lies in sexual intercourse after drunkenness and overeating, causing Qi to gather in the Spleen and Stomach. Yin deficiency allows Yang Qi to enter inward, leading to disharmony of the Stomach; Stomach disharmony leads to exhaustion of essence; exhaustion of essence means the four limbs are not nourished. The Qi of alcohol and the Qi of grain contend with each other, generating internal heat and dark urine. With declining Kidney Qi and prevailing Yang Qi alone, Heat Jue is formed. Five-center heat may stem from heat in the Small Intestine or from deficiency-heat due to Heart Qi deficiency.
Among Jue syndromes, there are cases of sudden abdominal fullness and unconsciousness, or slight recovery of consciousness after one or two days, or sudden collapse and disorder. These are all caused by the disturbance of pathogenic factors and the rebellion of Yang Qi, resulting in the absence of the pulse at the Shao Yin (Lesser Yin) Kidney meridian point. With declining and scarce Kidney Qi, essence and Qi scatter recklessly, urged by wind pathogens, ascending into the Stomach and Diaphragm region. Zong Qi (Pectoral Qi) becomes knotted below the heart. Yang Qi retreats downward, heat returns to the thighs and abdomen, assisting Yin, causing insensitivity of the body. Furthermore, the five collaterals converge in the body; if all five collaterals are blocked, it causes pulsation throughout the body while the form remains unaware, resembling a corpse; hence it is called Corpse Jue (Shi Jue). This is precisely due to the mutual disorder of Zang organs or conflict with external pathogens, leading to stagnant Qi that cannot flow, closing off the meridians. Among various Jue syndromes: rattling phlegm sound in the throat like sawing wood indicates Phlegm Jue; withered bones and painful nails indicate Bone Jue; stiff and straight body like a rafter indicates Stiff Jue; acquired due to drunkenness indicates Wine Jue; acquired due to sudden anger indicates Qi Jue; spasms and convulsions of hands and feet indicate Wind Jue; panting with manic running indicates Yangming Jue. All these are caused by rebellious Qi.
[Treatment] Method of Li: For phlegm, use Baizhu (Atractylodis Macrocephalae Rhizoma) and Zhuli (Bambusae Caulis in Taenia); for heat, use Chengqi Tang (Stomach-Clearing Decoction) to purge downward; for Qi deficiency, tonify Qi using Sijunzi Tang (Four Gentlemen Decoction); for Blood deficiency, tonify Blood...
Method of Zhang: Descend Heart Fire, benefit Kidney Water. To harmonize Blood and Qi, one must first induce vomiting.