(本论无方。此方列于太阳篇中。今补其方名。)
论以口苦咽干目眩为提纲。言少阳之上。相火主之。少阳为甲木。诸风掉眩。皆属于木。
主
论云。少阳中风。两耳无所闻。目赤。胸中满而烦。不可吐下。吐下则悸而惊。此言少
阳自
论云。脉弦细头痛发热者属少阳。少阳不可发汗。发汗则谵语。此属胃。胃和则愈。胃
不和
论云。本太阳病不解转入少阳者。胁下硬满。干呕不能食。往来寒热。尚未吐下。脉沉
紧者
论云。若已吐下发汗。温针谵语。柴胡证罢。此为坏病。知犯何逆。以法治之。此言当
审汗
少阳未列专方。当于太阳阳明篇求之。
论云。太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。若下之。必心下结硬。
此总
论又云。太阴病脉浮。可发汗。宜桂枝汤。
论云。自利不渴者。属太阴也。其脏有寒故也。当温之。宜四逆辈。此二节。言太阴病
在外
汤
论云。伤寒脉浮而缓手足自温者。系在太阴。太阴当发身黄。若小便自利者。不能发黄。
至七八日。虽暴烦下利日十余行。必自止。以脾家实腐秽当去故也。此言太阴寒证外亦有热
证也
过湿热相并。又为发黄之证。小便自利者不发黄。至七八日。骤得阳热之化故暴烦。阴湿在
内故
也。
论云。本太阳病医反下之。因而腹满时痛者。属太阴也。桂枝加芍药汤主之。大实痛。
桂枝
大黄、芍药者。宜减之。以其人胃弱易动故也。此承上节脾家实。宜芍药、大黄以行腐秽。
而脉弱者大便陆续而利出。宜减芍药、大黄以存胃气。甚矣。伤寒之治。首重在胃气也。
(《伤寒论》原文中无此方。此方列于太阳病篇中。现补上其方名。)
条文以口苦、咽干、目眩作为提纲。这是说明少阳经之上,由相火所主。少阳对应甲木,各种风邪引起的震颤和眩晕,都归属于木的病变。
条文说:少阳经受中风邪气,导致两耳听不见,眼睛发红,胸中胀满且心烦意乱。此时不可使用催吐或泻下的治法。如果误用吐下法,会导致心悸和惊恐。这是论述少阳病自身的证候特点。
条文说:脉象弦细,伴有头痛发热的,属于少阳病。少阳病不可使用发汗法。如果误用发汗,会导致胡言乱语(谵语)。这属于胃家实热。胃气调和则病愈,胃气不调和则病情加重。
条文说:原本患太阳病未解,转入少阳经的,表现为胁下硬满,干呕不能进食,寒热往来。如果尚未使用吐下法,脉象沉紧的……(此处原文截断,意指需结合上下文判断,通常指小柴胡汤证)。
条文说:如果已经使用了吐、下、发汗、温针等误治方法,出现胡言乱语,且柴胡汤证已消失,这称为“坏病”。应当审查犯了什么错误,根据具体情况依法治疗。这是说要审慎对待汗、吐、下等误治后的变证。
少阳病没有列出专门的方剂,应当在太阳病和阳明病的篇章中去寻找对应的方剂。
条文说:太阴病的主要表现是腹部胀满且呕吐,饮食不下,腹泻严重,时常腹部自痛。如果使用泻下法,必然导致心下部结块坚硬。这是对太阴病总纲的论述。
条文说:腹泻但不口渴的,属于太阴病。这是因为内脏有寒的缘故。应当采用温里法,适宜用四逆汤类的方剂。这两节经文,论述的是太阴病在外的证候……(此处原文截断,意指表里兼夹或特定病机)。
条文说:伤寒脉象浮而缓,手足自然温暖的,病系在太阴。太阴病本当发生身黄(黄疸),但如果小便自利通畅的,就不会发黄。到了七八天,虽然突然烦躁并腹泻一天十几次,必定会自行停止。这是因为脾家正气恢复,腐秽之物应当排出的缘故。这是论述太阴寒证之外也有热证的情况……(此处原文逻辑跳跃,实际是在解释湿热发黄与脾实腐秽去尽的区别)。
过湿热相合并见,又成为发黄的证候。小便自利的就不发黄。到了七八天,骤然得到阳热的化生,所以突然烦躁;阴湿在内……(此处原文截断,意指湿邪内蕴)。
条文说:原本患太阳病,医生反而误用泻下法,因而导致腹部胀满、时时作痛的,属于太阴病,由桂枝加芍药汤主治。如果疼痛剧烈且伴有便秘(大实痛),则……(此处原文截断,意指用桂枝加大黄汤)。
关于大黄、芍药的用量,应当减少。因为病人胃气虚弱,容易受药物影响。这是承接上一节关于脾家正气的论述:适宜用芍药、大黄来推动腐秽之物的排出;但如果脉象弱,大便陆续而出,则适宜减少芍药、大黄的用量以保存胃气。由此可见,伤寒的治疗,首要在于顾护胃气啊。
(The original text of *Shanghan Lun* does not contain this formula. This formula is listed in the Taiyang chapter. Here, its name is supplemented.)
The treatise takes bitter taste in the mouth, dryness of the throat, and dizziness as the guiding symptoms (提纲). This explains that above the Shaoyang channel, Ministerial Fire (Xianghuo) governs. Shaoyang corresponds to Jia Wood; all wind-induced tremors and dizziness belong to Wood pathologies.
The treatise states: When Shaoyang is struck by Wind pathogen, hearing is lost in both ears, eyes become red, and there is fullness and irritability in the chest. Purging (吐下) methods must not be used. If purging is mistakenly applied, palpitations and fright will occur. This discusses the intrinsic characteristics of Shaoyang disease.
The treatise states: A wiry and thin pulse accompanied by headache and fever belongs to Shaoyang. Sweating methods are contraindicated in Shaoyang disease. If sweating is mistakenly applied, delirium (Chan Yu) occurs. This pertains to the Stomach (Wei). If the Stomach harmonizes, the disease resolves; if it does not, the condition worsens.
The treatise states: When a pre-existing Taiyang disease fails to resolve and transfers to Shaoyang, manifestations include hardness and fullness below the costal margin, dry retching, inability to eat, alternating chills and fever. If purging has not yet been applied and the pulse is deep and tight... [Text truncated].
The treatise states: If purging, downward-draining, sweating, or warm needle therapy have already been mistakenly applied, resulting in delirium, and the Chai Hu syndrome has ceased, this is termed a "ruined disease" (Huai Bing). One must ascertain what error was committed and treat according to the law. This emphasizes the need for careful assessment of post-mistreatment complications.
Since no specific formula is listed for Shaoyang disease, one should seek corresponding formulas in the Taiyang and Yangming chapters.
The treatise states: The hallmark of Taiyin disease is abdominal fullness with vomiting, inability to eat, severe spontaneous diarrhea, and occasional spontaneous abdominal pain. If purging is applied, epigastric knotting and hardness will certainly result. This summarizes the general outline of Taiyin disease.
The treatise further states: In Taiyin disease, if the pulse is floating, sweating may be indicated, and Guizhi Tang (Cinnamon Twig Decoction) is appropriate.
The treatise states: Spontaneous diarrhea without thirst belongs to Taiyin. This is due to cold in the Zang organs. Warming treatment is required, and Sini Tang-type formulas (Sini Lei) are appropriate. These two sections discuss Taiyin disease manifesting externally... [Text truncated].
The treatise states: In Cold Damage, if the pulse is floating and slow, and the hands and feet are naturally warm, the disease is associated with Taiyin. Taiyin disease typically presents with jaundice; however, if urination is free and unobstructed, jaundice will not develop. By the seventh or eighth day, although sudden irritability and diarrhea occurring more than ten times a day may occur, it will necessarily stop spontaneously. This is because the Spleen's Qi has recovered, and the putrid filth is being expelled. This discusses how Taiyin cold patterns may also involve heat mechanisms... [Contextual interpretation regarding damp-heat vs. spleen recovery].
When dampness and heat combine, it becomes a pattern of jaundice. If urination is free, jaundice does not develop. By the seventh or eighth day, the sudden acquisition of Yang heat transformation causes sudden irritability; Yin-dampness remains internally... [Text truncated].
The treatise states: Originally suffering from Taiyang disease, if the physician mistakenly applies purging, leading to abdominal fullness and intermittent pain, this belongs to Taiyin, and Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus White Peony Root) is the primary formula. For severe excess pain (Da Shi Tong)... [Text truncated].
Regarding the dosage of Dahuang (Rhubarb Rhizome) and Shaoyao (White Peony Root), they should be reduced. This is because the patient's Stomach Qi is weak and easily disturbed. This follows up on the previous section regarding Spleen Qi: It is appropriate to use Shaoyao and Dahuang to move putrid filth; however, if the pulse is weak and stool passes gradually, it is appropriate to reduce Shaoyao and Dahuang to preserve Stomach Qi. Thus, in the treatment of Cold Damage, priority is always given to protecting Stomach Qi.