举阳证,伤寒外感,四肢微厥,邪热入里,大便燥,小便赤而涩少,是谓热也。
惟阴证内感,阳走于外,虚热在皮毛之间,肺气受邪,下输于膀胱,故令小便如灰汁,兼胃虚不
能食。戊与癸合,虚邪所化,赤如灰汁,色虽如此,但溺时或剂茎中不涩而快利也。
病患服温热之药,时有下气者,知阴气出也。韩氏治下焦寒,用灰包熨法,得下利一两
行,小便一两次,及少有汗,阴气出而下泄,知其为必解也。予以是知服调中、理中及诸附子等
药
谵语,阳证者当去盖覆,令胸臆两手微露见风,以手按执之,久之肌肉骨间不热者,即非阳
证,真阴证也。
上此一条,后辨谵语形状。
恍惚狂言,若有所遗,妄闻妄见,意有所期,及从而叩,或忘或知,神去而溃,命将何
根据!
神者亡。正谓是也。
问∶内感阴证,有汗而解,有无汗而解者,何也?
答曰∶有汗而解者,或壮年津液尚全,或温之早而得治,或传不逆而顺经,或素得养而
强本,所以俱汗而解也。无汗而解者,或老年血气俱衰,或温之迟而失治,或经过期而不传,或素
无养而亏本,所以俱无汗而解也。有汗而解者,间有所遗;无汗而解者,邪岂能尽?故神痴
而弱,不能复旧,须待饮食渐增,因食微润,然后定其中外,各守其乡。医者不可不知!
《衍义》曰∶太阴元精石合他药,涂大风疾,别有法。阴证伤寒,指甲面色青黑,六脉
沉细而疾,心下胀满结硬,躁渴,虚汗不止,或时狂言,四肢逆冷,咽喉不利,腹疼痛,亦须佐
他药兼之。《图经本草》已有法,惟出解州者良。
古方不用,今《活人伤寒》其着者,治伤寒三日,头痛壮热,四肢不利,正阳丹。
太阴元精石 硝石 硫黄(各二两) 砂(一两)
四物都细研,入瓦瓶子固济,以火半斤,于瓶子周一寸
协之,约近半日,令药青紫色,住火待冷,取出,用腊月雪水拌匀,湿入瓷瓶子中,屋后北
阴下阴干,又入地埋二七日,取出细研,以面糊为丸鸡头实大。先用热水浴,后以艾汤研下
一丸,以衣盖取汗出为瘥。
列举阳证,即伤寒外感病,表现为四肢轻微厥冷,邪热内传入里,导致大便干燥,小便色赤且排尿涩滞量少,这属于热证。
唯有阴证,由内伤引起,阳气浮越于体表,形成虚热停留于皮毛之间,肺气受邪气侵袭,病气下传至膀胱,因此导致小便颜色像灰汁一样,同时伴有胃气虚弱、不能进食的症状。戊(土)与癸(水)相合,由虚邪转化而成,小便色赤如灰汁,虽然颜色如此,但排尿时尿道口并不涩痛,反而感觉通畅爽快。
病患服用温热性质的药物后,有时会出现排气(放屁)的情况,这是阴寒之气排出的表现。韩氏治疗下焦寒证,采用将药灰包裹后熨烫的方法,患者出现一两次腹泻,小便排出两三次,以及少量出汗,这说明阴寒之气已经排出并向下泄出,可知病情必将痊愈。由此我得知,服用调中汤、理中汤以及各类附子等药物后……
谵语(胡言乱语),若是阳证,应当去掉被盖,让胸部和双手微微露出接触风凉,用手按压固定,过一段时间后,如果肌肉骨骼间不再发热,这就不是阳证,而是真正的阴证。
以上这一条,后面将辨析谵语的具体形态。
神情恍惚,胡言乱语,好像丢失了什么东西,胡乱听到或看到不存在的事物,心中有所期待,等到询问时,有时忘记有时知道,神气离散溃败,生命还有什么依靠呢!
神气消亡,正是说的这种情况。
问:内伤引起的阴证,有通过出汗而痊愈的,也有无汗而痊愈的,为什么呢?
答:通过出汗而痊愈的,或者是壮年人津液尚且充足,或者是温补治疗及时得当,或者是病邪传变没有逆乱而是顺经而行,或者是平时注重调养使根本强健,所以都能通过出汗而痊愈。无汗而痊愈的,或者是老年人气血都衰弱,或者是温补治疗太迟而错失良机,或者是病邪经过一定时期而没有传变,或者是平时缺乏调养导致根本亏虚,所以都能在没有出汗的情况下痊愈。通过出汗而痊愈的,中间可能还有余邪遗留;无汗而痊愈的,邪气难道能完全清除吗?因此患者会精神痴呆而虚弱,无法恢复到以前的状态,必须等待饮食逐渐增加,借着食物的轻微滋润作用,然后才能安定体内和体表的平衡,各守其位。医生不可不知道这一点!
《衍义》说:太阴元精石配合其他药物,涂抹治疗大风疾(麻风病等严重皮肤病),另有特殊方法。对于阴证伤寒,若出现指甲和面色青黑,六脉沉细且急促,心下(胃脘部)胀满结硬,烦躁口渴,虚汗不止,有时胡言乱语,四肢逆冷,咽喉不利,腹部疼痛,也必须佐以其他药物兼治。《图经本草》中已有相关记载,只有出自解州的药材品质优良。
古方不使用,现在《活人伤寒书》中记载的著名方剂是正阳丹。用于治疗伤寒三天后,出现头痛、高热、四肢活动不利的症状。
组成:太阴元精石、硝石、硫黄(各二两)、砂(一两)。
将四味药都研成细末,放入瓦制瓶子中密封坚固,用半斤火炭在瓶子周围一寸处煅烧,大约半天时间,使药变成青紫色,停止加热待冷却后取出,用腊月雪水拌匀,湿润后装入瓷瓶,放在屋后北面的阴凉处阴干,再埋入地下二十七天,取出后细细研磨,用面糊制成如鸡头实大小的丸药。先用热水洗澡,然后用艾叶汤送服一丸,盖上衣服取汗出作为痊愈的标准。
Citing Yang syndromes, such as cold damage (Shanghan) and external contraction, presenting with slight coldness of the four limbs, pathogenic heat entering the interior, dry stools, and red, scanty, and difficult urination, this is defined as Heat.
Only in Yin syndromes caused by internal injury, when Yang floats to the exterior, deficient heat remains between the skin and hair, and the Lung Qi is affected by pathogens, transmitting downward to the Bladder, causing urine to resemble ash-water, accompanied by Spleen/Stomach deficiency and inability to eat. Wu (Earth) combines with Gui (Water), transformed by deficient pathogens; although the urine is red like ash-water, there is no astringency or pain in the urethra during urination, but rather a sensation of smooth flow.
When patients take warm-tonifying medicines, they sometimes pass gas, indicating the expulsion of Yin-cold qi. Han Shi treated lower-jiao Cold using a method of wrapping hot ashes for moxibustion-like warming; after one or two bowel movements, one or two urinations, and slight sweating, it is known that Yin-cold qi has been expelled downward, signifying inevitable recovery. From this, I know that after taking Zhongtang Decoction, Lizhong Decoction, and various Aconite preparations...
Delirious speech (Zhenyu): If it is a Yang syndrome, one should remove blankets, allowing the chest and hands to be slightly exposed to wind, and press them firmly. After a long time, if the muscles and bones are no longer hot, it is not a Yang syndrome, but a true Yin syndrome.
The above paragraph will later differentiate the manifestations of delirium.
Mental confusion, delirious speech, feeling as if something is lost, hallucinating sights and sounds, having expectations, and upon inquiry, sometimes forgetting, sometimes knowing; the Spirit scatters and disintegrates, on what can life rely?
The loss of Spirit is precisely what is meant here.
Question: In Yin syndromes from internal injury, some resolve with sweating, while others resolve without sweating. Why?
Answer: Those resolving with sweating may be young adults whose fluids are still intact, or those treated early with warmth, or where transmission followed the meridians smoothly without reversal, or those who maintained their constitution through daily care; thus, all resolve via sweating. Those resolving without sweating may be elderly individuals with depleted Qi and Blood, or those treated too late missing the optimal window, or where pathogens lingered without transmitting, or those with weak constitutions due to lack of nourishment; thus, all resolve without sweating. Cases resolving with sweating may leave residual pathogens; cases resolving without sweating, how could pathogens be completely eliminated? Therefore, the patient becomes dull-witted and weak, unable to return to normal health. One must wait for dietary intake to gradually increase, relying on the mild moistening effect of food, to stabilize the interior and exterior, each maintaining its proper position. Physicians must understand this!
*Yanyi* states: Taiyin Yuansheng Stone combined with other herbs, applied topically for treating severe dermatological diseases (like leprosy), follows specific methods. For Yin syndrome cold damage, if fingernails and complexion appear cyanotic/black, six pulses are deep, fine, and rapid, epigastric fullness and hardness occur, restlessness and thirst arise, spontaneous sweating persists, delirium occurs intermittently, four limbs are cold, throat feels obstructed, and abdominal pain exists, auxiliary herbs must also be used. *Tujing Bencao* already records these methods, noting that stones from Jiezhou are of superior quality.
Ancient formulas do not use this; however, the famous formula "Zhengyang Dan" in *Huoren Shanghan* treats cold damage after three days, characterized by headache, high fever, and limb immobility.
Ingredients: Taiyin Yuansheng Stone, Niter (Xiaoshi), Sulfur (Liu Huang) (each 2 liang), Sand (1 liang).
Grind all four substances into fine powder, place in a clay bottle, seal tightly, and calcine around the bottle with half a jin of fire embers at a distance of one inch for about half a day, until the medicine turns blue-purple. Stop heating, let cool, and remove. Mix evenly with snow water collected in the twelfth lunar month, moisten, and place in a porcelain bottle. Dry in the shade under the north side of the house, then bury underground for twenty-seven days. Remove, grind finely, and make pills using wheat paste, sized like corn kernels. First, take a hot bath, then swallow one pill with Artemisia decoction, cover with clothes to induce sweating, which indicates recovery.