此由邪热客于肺也。上焦有热,其人必饮水,水停心下,则肺为之浮,肺主于咳,水气
乘之,故咳嗽。
伤寒病血衄者,此由五脏热结所为也。心主于血,肝藏于血,热邪伤于心肝,故衄血也
。衄者,鼻血出也。肺主于气,而开窍于鼻,血随气行,所以从鼻出。阳明病口燥,但欲漱
水,不欲咽者,必衄。衄家不可攻其表,汗出额上菹急而紧,直视而不能 ,不得眠。
亡血,不可攻其表,汗出则寒栗而振。脉浮紧,发热,其身无汗,自衄者愈。
此由诸阳受邪,热初在表,应发汗而汗不发,致使热毒入深,结于五脏,内有瘀积,故
吐血。
夫欲辨阴阳毒病者,始得病时,可看手足指,冷者是阴,不冷者是阳。若冷至一二三寸
病微,若至肘膝为病极,过此难治。阴阳毒病无常也,或初得病便有毒,或服汤药,经五
六日以上,或十余日后不瘥,变成毒者。其候身重背强,喉咽痛,糜粥不下,毒瓦斯攻心,心
腹烦痛,短气,四肢厥逆,呕吐;体如被打,发斑,此皆其候。重过三日则难治。阳毒者,
面目赤,或便脓血;阴毒者,面目青而体冷。若发赤斑,十生一死;若发黑斑,十死一生。
阳毒为病,面赤,斑斑如锦纹,喉咽痛,清便脓血,七日不治,五日可治,九日死,十一日
亦死。
此谓得病十二日以上,六经俱受病讫,或已发汗吐下,而病证不解,邪热留于腑脏,致
令病候多变,故曰坏伤寒。本太阳病不解,转入少阳,胁下牢满,干呕不能食,往来寒热,
尚未吐下,其脉沉紧,与小柴胡汤;若已吐下发汗温针,谵语,饮柴胡证罢,此为坏病。知
犯何逆,以法治之。寸口脉洪而大,数而滑,洪大荣气长,滑数胃气实,荣长阳即盛,郁怫
不得出,胃实即牢,大便难即干燥。三焦闭塞,津液不通,医发其汗,阳气盛不用,复重下
之,胃燥热蓄,大便遂傧,小便不利。荣卫相搏,烦心发热,两目如火,鼻干面正赤,舌燥
齿黄焦,大渴,故过经成坏病。
这是由于邪热侵袭肺部所致。上焦有热,患者必然想饮水,若水液停滞在心下(胃脘部),则会导致肺气上浮;肺主司咳嗽,水气乘虚侵犯肺脏,因此引发咳嗽。
伤寒病出现鼻出血(衄血)的情况,这是由五脏热邪郁结所导致的。心主血脉,肝藏血液,热邪损伤心肝二脏,所以导致鼻出血。所谓“衄”,是指鼻腔出血。肺主气,且开窍于鼻,血液随气运行,所以血液从鼻腔流出。阳明病口中干燥,只想含水漱口而不愿咽下的,必定会发生鼻出血。经常鼻出血的人不可使用发汗法解表,如果误用发汗导致额头出汗、汗出如油且紧束、两眼直视不能转动、无法入睡,这是危重征象。失血之人不可使用发汗法解表,如果误用发汗导致出汗,会出现寒战颤抖。脉象浮紧,发热,身体无汗,如果自然发生鼻出血,病情往往会痊愈。
这是由于诸阳经受邪,热邪初在体表,应当发汗却未发汗,致使热毒深入,郁结于五脏,体内产生瘀积,从而导致吐血。
想要辨别阴阳毒病的方法,在刚患病时,可以观察患者的手指和脚趾,发凉的是阴毒,不发凉的是阳毒。如果寒冷感延伸至一至三寸,病情较轻;如果寒冷感延伸至肘部和膝部,则是病情极重,超过这个程度就难以治疗。阴阳毒病的表现没有固定模式,有的刚患病就有毒邪,有的服用汤药后,经过五六天以上,或者十多天后病情未愈,转变为毒证。其症状表现为身体沉重、背部僵硬、咽喉疼痛、无法进食糜粥,毒邪攻心,导致心胸腹部烦闷疼痛、气短、四肢厥冷、呕吐;身体感觉像被殴打一样疼痛,出现斑疹,这些都是其症状。如果重症超过三天就难以治疗。阳毒病患者,面目发红,或者大便脓血;阴毒病患者,面目青暗且身体冰冷。如果发出红色斑疹,十人中有九人生还一人死亡;如果发出黑色斑疹,十人中有九人死亡一人生还。阳毒病,面色红赤,斑纹如锦缎花纹,咽喉疼痛,大小便脓血,七天不治疗会死,五天之内治疗尚可治愈,九天后死亡,十一日后也死亡。
这称为患病十二日以上,六经都受到病邪侵袭完毕,或者已经经过发汗、催吐、泻下等治疗,但病症仍未解除,邪热留滞于脏腑,导致病情变化多端,所以称为“坏伤寒”。原本太阳病未解,转入少阳经,胁下坚硬胀满,干呕不能进食,忽冷忽热,尚未进行催吐或泻下治疗,脉象沉紧,给予小柴胡汤治疗;如果已经进行过催吐、发汗、温针等治疗,出现谵语(胡言乱语),原本的柴胡证候已消失,这称为“坏病”。需要知道医生犯了什么错误,根据具体情况进行治疗。寸口脉象洪大而数且滑,洪大表示营气旺盛,滑数表示胃气充实,营气旺盛阳气即盛,郁结不得发散,胃气充实则肠道燥结,大便困难且干燥。三焦闭塞,津液不通,医生又发其汗,阳气盛而不用,再次重用泻下法,导致胃中燥热蓄积,大便遂致溏泄或异常,小便不利。营卫之气相互搏结,心烦发热,双眼如火烧,鼻干面红,舌燥齿黄焦枯,极度口渴,因此过经传变形成坏病。
This is caused by pathogenic heat lodging in the Lung. When there is heat in the Upper Jiao (Upper Burner), the person will necessarily desire to drink water. If water stagnates below the heart (epigastrium), it causes the Lung Qi to float upward. Since the Lung governs coughing, and the water qi takes advantage of this to invade, coughing ensues.
In Shaoyang disease (Taiyang Cold Damage), epistaxis (nosebleed) occurs due to the accumulation of heat in the five Zang organs. The Heart governs blood, and the Liver stores blood; when pathogenic heat injures the Heart and Liver, epistaxis results. "Nu" refers to bleeding from the nose. The Lung governs Qi and opens into the nose; since blood follows Qi in its circulation, it exits through the nose. In Yangming disease, dryness in the mouth with a desire only to rinse the mouth without swallowing indicates that epistaxis will certainly occur. Those prone to epistaxis should not be treated with diaphoresis (sweating methods) to release the exterior. If sweating leads to sweat on the forehead that is sticky and tight, fixed staring gaze, and inability to sleep, it is a critical sign. After loss of blood, one should not use diaphoresis; if sweating occurs, it leads to chills and trembling. With a floating and tight pulse, fever, and absence of sweating on the body, spontaneous epistaxis often leads to recovery.
This is caused by pathogens affecting the Yang meridians. Heat initially resides at the exterior; if diaphoresis should have been used but was not, pathogenic heat-toxin penetrates deeply, knotting within the five Zang organs, causing internal stasis and accumulation, thus leading to hematemesis (vomiting blood).
To distinguish Yin-Du (Yin Toxin) and Yang-Du (Yang Toxin) diseases: at the onset, observe the fingers and toes. Coldness indicates Yin-Du; warmth indicates Yang-Du. If coldness extends one to three cun, the disease is mild; if it reaches the elbows and knees, the disease is extreme, and beyond this point, it is difficult to treat. The manifestations of Yin-Yang Du are variable. Some have toxin upon onset; some develop toxicity after taking herbal decoctions for five or six days, or more than ten days without improvement. Symptoms include heavy body, stiff back, sore throat, inability to eat porridge, toxin attacking the Heart causing chest and abdominal irritability and pain, shortness of breath, cold limbs, vomiting; the body feels as if beaten, and macules appear. These are all symptoms. If severe cases persist beyond three days, they are difficult to treat. In Yang-Du, the face and eyes are red, or there is pus and blood in stool; in Yin-Du, the face and eyes are blue-green and the body is cold. If red macules appear, nine out of ten survive and one dies; if black macules appear, nine out of ten die and one survives. Yang-Du disease presents with a red face, macules like brocade patterns, sore throat, pus and blood in urine and stool. Untreated for seven days, death ensues; if treated within five days, it can be cured; after nine days, death occurs; after eleven days, death also occurs.
This refers to illness lasting twelve days or more, where all Six Meridians (Liu Jing) have been affected, or after treatments such as diaphoresis, emesis, or purgation have been applied but the syndrome remains unresolved. Pathogenic heat lingers in the Fu and Zang organs, causing variable clinical presentations, hence termed "Huai Shanghan" (Ruined/Complicated Cold Damage). Originally, Taiyang disease did not resolve but transferred to Shaoyang, presenting with hardness and fullness under the ribs, dry retching, inability to eat, alternating chills and fever. If no emesis or purgation has yet occurred and the pulse is deep and tight, Xiao Chai Hu Tang (Minor Bupleurum Decoction) should be given. If emesis, diaphoresis, or warm needle therapy have already been used, resulting in delirium and the resolution of typical Chai Hu syndromes, this is called "Huai Bing" (Ruined Disease). One must determine what error was made and treat according to the specific condition. At the Cun Kou (Radial artery) position, the pulse is surging, large, rapid, and slippery. Surging and large indicate abundant Ying Qi (Nutritive Qi); slippery and rapid indicate excess Wei Qi (Defensive Qi/Stomach Qi). Abundant Ying Qi means Yang is excessive, leading to depression and obstruction preventing outward expression. Excess Stomach Qi leads to firmness and difficulty with dry stools. The San Jiao (Triple Burner) becomes blocked, and body fluids do not circulate. If the physician induces sweating again while Yang Qi is excessive and unused, followed by repeated purgation, stomach dryness and heat accumulate, leading to abnormal bowel movements and difficult urination. Ying and Wei Qi clash, causing irritability, fever, eyes burning like fire, dry nose, red face, dry tongue, yellow and scorched teeth, and extreme thirst. Thus, passing through the meridians leads to complicated disease.