Wrong-treated condition, diagnosis and treatment

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医宗金鉴卷十一

<<Yi Zong Jin Jian>>  Chapter 11

辨坏病脉证并治篇

Wrong-treated condition, diagnosis and treatment

坏病者,谓不当汗,而汗,不当吐而吐,不当下而下,即当汗、吐、下而过甚,或当汗、吐、下而失时,皆为施治失宜,所以成坏病也。凡三阴三阳,若汗、若吐、若下,若温 、火熏、火熨、火灸、火劫等法,致诸坏病者,有汗後亡阳,眩冒振惕,魄汗不收;有下後虚中,结胸痞僐,下利不止;有吐後烦乱腹满,有温针失血惊狂,甚至阳毒斑狂,阴躁欲死,神昏谵语,循衣摸床之类是也。其论散见诸篇,今合为一集,以便後学。其中或有挂漏,是在能三反者。

Wrongly-treated condition means the clinic conditions that happen when the person shouldn’t have sweat therapy but has sweat therapy; he shouldn’t have bowel-cleansing therapy but has bowel-cleansing therapy; or he shouldn’t have a vomiting therapy but has a vomiting therapy; that happen when the sweat therapy, vomiting therapy, or bowel-cleansing therapy are performed too much extent; or they are used during a improper time of the disease. In clinic, the person may have depletion of Yangqi after heavy sweat, dizziness or cloudy mode, or shaking, spasm of muscles, scaring or a phobia feeling; or Jiexiong, hard and pain in the chest or abdomen or continuous diarrhea after a bowel-cleansing therapy; or annoyed/impatience, fullness and pain in abdomen after a vomiting therapy; or bleeding, phobia/scaring/mad, skin hot and bruise/bleeding, extremely irritable physically, Chattering syndrome, loss of consciousness, cloudy mind/mod, after a warm acupuncture. The clinic conditions or symptoms have been described among previous chapters. Now we collect them all here for the readers to study easier.

 

01  太阳病三日,已发汗,若吐、若下、若温针仍不解者,此为坏病,桂枝不中与也。观其脉证,知犯何逆,随证治之。

In Taiyang stage for three days, the person has been given sweat therapy, vomiting therapy, bowel-cleansing therapy or warm-acupuncture therapy but the clinic condition remains. This condition now belongs to wrong-treated condition. The use of Guizhi Tang doesn’t work. Doctor has to organize herbal formula depending on the exact clinic syndrome in the person.

02  本太阳病不解,转入少阳者,胁下硬满,乾呕不能食,往来寒热,尚未吐下,脉沉弦[1]者,与小柴胡汤。若已吐、下、发汗、温针,谵语,柴胡汤证罢,此为坏病,知犯何逆,以法治之。

The Xieqi in the Taiyang stage has not been fully depleted but also develops into the Shaoyang stage. The person feels hard and fullness in the side of upper abdomen, dry nausea and hard to eat, has cold-hot shift. If he has not been given vomiting or bowel-cleansing therapy, and if his pulse is deep and string, use Xiao Chaihu Tang. If he has been given vomiting therapy, bowel-cleansing therapy, sweat therapy, warm-acupuncture therapy, and if he has Chattering syndrome, the use of Xiao Chaihu Tang doesn’t work. This condition now belongs to wrong-treated condition.

03  太阳病中风,以火劫发汗,邪风被火热,血气流溢,失其常度,两阳相灼,其身发黄,阳盛则欲衄,阴虚则小便难,阴阳俱虚竭,身体则枯燥,但头汗出,剂颈而还,腹满微喘,口乾咽烂,或不大便,久则谵语,甚者至哕,手足躁扰,捻衣摸床,小便利者,其人可治。(此际,欲治风而火势沸腾,欲治火而风邪壅遏,何从治之?惟利小便一法。如猪苓汤类,可以导热滋乾,使小便得利,则太阳之邪亦从膀胱为去路,尚可治也。倘利之而不利,火无从出,危矣。)

In Wind-invasion Taiyang stage, the person was put in front of a fire to warm up the body with the aim to create sweat, the Xieqi (the Windxie) is disturbed by the fire, that makes the blood and Qi move without order, makes the body develops jaundice. If the person has overwhelming Yangqi, he may have bleeding in nose[2]; if he has Yin deficiency, he may have difficulty in urine. If both the Yin and Yang is weak and short, the body is dry[3] but there is sweat on the head (not down to neck), has fullness in abdomen, slight asthma, dry mouth and ulcer in throat[4], or stop the bowel movement, or has Chattering syndrome after a long time. The person even has Yu syndrome[5], irritable in the hands and feet (jumping and spasm), loss of mind to touch the bed or clothes[6]. If the person has easy urine, he still has chance to recover.[7]   

04  太阳病,医发汗,遂发热恶寒,因复下之,心下痞,表里俱虚,阴阳气并竭,无阳则阴独,复加烧针。因胸烦,面色青黄,肌肤俽动而不宁者,难治;今色微黄,手足温者,易愈。

In Taiyang stage, the person was given sweat therapy. He starts to have fever and chilly. He was then given bowel-cleansing therapy again. It makes him feel fullness in upper stomach. In this condition, his Yinqi and Yangqi both are depleted. If there is no Yangqi, the Yinqi is overwhelming. He was given warm-acupuncture again. Now he feels annoyed in chest, blue-yellow color in face[8], movement and tingling in skin. This condition is difficult to treat. If his skin is slight yellow only and has warm hands and feet, his condition may be relatively easier to cure.

05  伤寒脉浮,自汗出,小便数,心烦,微恶寒,脚挛急, (当与桂枝增桂加附子汤,以温经止汗) 反与桂枝汤,欲攻其表,此误也,得之便厥。咽中乾,烦燥吐逆者,作甘草乾姜汤与之,以复其阳。若厥愈足温者,更作芍药甘草汤与之,其脚即伸;若胃气不和,谵语者,少与调胃承气汤;若重发汗,复加烧 者,四逆汤主之。

With Shanghan disease, the pulse is floating and the person has sweat and frequent urine, annoyed/impatience, slight chilly, spasm in feet[9]. (It should use Guizhi jia Guizhi jia Fuzi Tang to warm up the body and stop the sweat). If Guizhi Tang aloe is given to deplete the Xieqi from the body surface, it is a wrong treatment. It will cause reverse Jue condition (cold hands and feet). If the person feels dry in mouth, annoyed/impatience, vomiting, give Gancao Ganjiang Tang to restore his Yangqi. If his hands and feet return to warm, give Shaoyao Gancao Tang to release feet spasm. If the person has non-harmonized stomach, has Chattering syndrome, give Tiaowei Chengqi Tang. If he was given repeated sweat therapy and warm-acupuncture, use Sini Tang.

06  问曰:证象阳旦,按法治之而增剧,厥逆,咽中乾,两胫拘急而谵语。师言夜半手足当温,两脚当伸。後如师言,何以如此?答曰:寸口脉浮而大,浮为风,大为虚,风则生微热,虚则两胫挛,病形象桂枝,因加附子叁其间,增桂令汗出,附子温经,亡阳故也。厥逆,咽中乾,烦躁,阳明内结,谵语烦乱,更饮甘草乾姜汤,夜半阳气还,两足当热,胫尚微拘急,重与芍药甘草汤,尔乃胫伸,以承气汤微溏,则止其谵语,故知病可愈。

The person’s condition is similar to Yangdan (Guizhi Tang) condition. However his condition becomes worse when the Guizhi Tang is used. He feels Jue condition, dry in mouth, spasm in legs and has Chattering syndrome. The Master said the hands and feet will be warm at night and the leg will be easy to move again. Later it happens exactly as the Master predicted. How come? Answer: The pulse is floating and big in the Chun position, floating means Wind and big means weak. The Wind causes slight hot and the weak causes spasm in legs. Since the overall condition is similar to Yangdan condition, herb Fuzi is added in the formula to improve the sweat ability of the Guizhi Tang. The use of the Fuzi is due to the Yang depletion condition here. The condition of Jue Condition, dry mouth, annoyed/impatience suggest Yangming stage with Xieqi condensed. For Chattering syndrome and annoyed, use the Gancao Ganjiang Tang to improve the Yangqi restore. At middle night, the Yangqi comes back and feet should be warm. Since the feet is slight spasm, the Shaoyao Gancao Tang is used. Finally use Chengqi Tang to clear the Xieqi in the Yangming to stop Chattering syndrome, so it is predicted it will be recovered.

阳旦汤方(补)

Yangdan Tang (supply)

桂枝 三钱, 芍药(酒焙)二钱, 甘草(炙)二钱, 黄芩(酒炒)三钱, 生姜 三片, 大枣(擘)二枚

Guizhi 9 gram, Shaoyao (wine processed) 6 gram, Gancao (processed) 6 gram, Huangqin (wine fried) 9 gram, Fresh ginger three peieces, Chinese date 2 badges.

右水煎,去滓温服,无时,日二、三服。本方加乾姜,名阴旦汤。

Add the herbs and water to cook the herbal tea. Collect the herbal tea to drink. Two to three times a day. If the Ganjiang is used in the formula, it is called Yindan Tang.

甘草乾姜汤方

Gancao Ganjiang Tang

甘草(炙)四两, 乾姜(炮)二两

Gancao (processed) 60 gram, Ganjiang (processed) 30 gram.

右二味,以水三升,煮取一升五合,去滓,分温再服。

Add the herbs and 750 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 300 ml herbal tea left. Collect the tea, separate it into several parts. Drink one part of the tea each time, repeat every 2 to 3 hours.

芍药甘草汤方

Shaoyao Gancao Tang

芍药 四两, 甘草(炙)四两

Shaoyao 60 gram, Gancao (processed) 60 gram.

右二味,以水三升,煮取一升五合,去滓,分温再服。

Add the herbs and 750 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 300 ml herbal tea left. Collect the tea, separate it into several parts. Drink one part of the tea each time, repeat every 2 to 3 hours.

07 伤寒吐、下後,发汗,虚烦,脉甚微,(八、九日心下痞硬,胁下痛,气上冲咽喉)[10],眩冒,经脉动惕者,久而成痿。

With Shanghan disease, the person is given vomiting therapy and bowel-cleansing therapy, but given sweat therapy again. The person feels annoyed/impatience with very weak pulse. After eight to nine days, he feels hard and fullness in the upper stomach, feels pain in the side of upper abdomen, air up-pushing feeling to the throat, cloudy mind/mode, of dizziness, and his muscle feels tingling. After a long time, he will have a Wei syndrome[11].

08 伤寒六、七日,大下後,寸脉沉而迟,手足厥逆,下部脉不至,咽喉不利,唾脓血,泄利不止者,为难治,麻黄升麻汤主之。

With Shanghan disease for six to seven days, the person has been given bowel-cleansing therapy and now feels Jue syndrome, spit pus and blood, has continuous diarrhea, harsh in throat. His pulse is deep and slow in the Chun position and no pulse in the Chi position. This condition is hard to improve. Mahuang Shengma Tang is used.[12]

麻黄升麻汤方

Mahuang Shenma Tang

麻黄(去节)二两半, 升麻一两一分, 当归一两一分, 知母十八铢, 黄芩十八铢, 萎蕤十八铢, 石膏(碎绵裹)六铢, 白术六铢, 乾姜六铢, 芍药六铢, 天冬(去心)六铢, 桂枝六铢, 茯苓六铢, 甘草(炙)六铢,

Mahuang 40 gram, Shengma 17 gram, Dangui 17 gram, Zhimu 12.6 gram, Huangqin 12.6 gram, Weishen 12.6 gram, Shaogao 4.2 gram, Baishu 4.2 gram, Ganjiang 4.2 gram, Shaoyao 4.2 gram, Tianmendong 4.2 gram, Guizhi 4.2 gram, Fuing 4.2 gram, Gancao (processed) 4.2 gram.

右十四味,以水一斗,先煮麻黄一、二沸,去上 ,内诸药,煮取三升,去滓,分温三服,相去如炊三升米顷,令尽。汗出愈。

Add Mahuang and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling for several minutes. Remove the upper floating bubble and herbal residues. Add the rest of the herbs in, keep in mild boiling until there is about 750 ml liquid left in the pot. Collect the herbal tea. Drink one third of the tea each time, repeat every 2 hours to finish all of the tea, until the person has sweat to cure.

09  伤寒八、九,下之,胸满烦惊,小便不利,谵语,一身尽重,不可转侧者,柴胡加龙骨牡蛎汤主之。

With Shanghan disease for eight to nine days, the bowel-cleansing therapy is give. The person feels fullness in chest, scared/phobia feeling, hard in urine, Chattering syndrome, feels heavy in the whole body so that it is hard to turn the body. In this case, use Chaihu jia Longgu Muli Tang. [13]

柴胡加龙骨牡蛎汤方

Chaihu jia Longgu Muli Tang

柴胡 四两, 半夏(洗)二合, 龙骨 一两半, 人参 一两半, 大黄 二两, 牡蛎 一两半, 茯苓 一两半, 铅丹 一两半, 桂枝 一两半, 生姜 一两半, 大枣(擘)二枚

Chaihu 60 gram, Banxia (washed) 26 gram, Longgu 23 gram, Renshen 23 gram, Dahuang 30 gram, Muli 23 gram, Fuling 23 gram, Qiandan 23 gram, Guizhi 23 gram, Fresh ginger 23 gram, Chinese date 2 badges.

右十一味,以水八升,煮取四升,内大黄切如棋子,更煮一、二沸,去滓,温服一升。

Add the herbs (except Dahuang) and 2000 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid in the pot is half of the volume. Add the Dahuang in. Continue to cook for several minutes. Collect the herbal tea. Drink one quarter of the tea.

10  汗家重发汗,必恍惚心乱,小便已阴痛,(与禹馀粮丸) (有人认为该方不应在此应用)

If a person is easy to have sweat, now he is given a sweat therapy again and feels cloudy and irritable in mind/spirit/emotion, and feels pain in the urine tract after urine.

11  衄家不可发汗,汗出必额上陷,脉紧急,目直视,目不能闭合 ,不得眠。

If a person is easy to have nose bleeding, a sweat therapy is forbidden to use. Otherwise, the sweat therapy may cause shrink in his side of head, staring eyes, hard to close eye lids, hard to fall into sleep. His pulse is tight and fast. 

12  亡血家不可发汗,发汗则寒栗而振。

If a person has lost blood frequently and easily, sweat therapy is forbidden. Otherwise, he will have chilly and body shaking.

13  咽喉乾燥者,不可发汗。

If a person has dry throat, the sweat therapy is forbidden.

14  淋家不可发汗,发汗则便血。

If a person has pain, hot in the urine bladder and urine tract, sweat therapy is forbidden. Otherwise, he will have bleeding in urine. [14]

15  疮家虽身疼痛,不可发汗,发汗则痉。

If the person has ulcer in the skin very easily and he have skin ulcer again and again, the sweat therapy is forbidden. Sweat therapy may cause spasm in muscle to produce a Jin syndrome. [15]

16  太阳伤寒者,加温针必惊也。烧针令其汗,针处被寒,核起而赤者,必发奔豚,气从少腹上冲心者,先灸核上各一壮,与桂枝加桂汤,更加桂。

In Cold-invasion Shanghan disease, Hot-needle therapy may cause scaring/phobia/irritable. Hot-needle causes sweat, and causes cold feeling in the needle position. The needle spot appears rising up and turns to red in color. The person will develop a Bentun[16] condition, feeling air pushing up to the chest. In this case, use moxibustion on the needle spot, then give him Gizhi jia Gui Tang.

桂枝加桂汤方

Guizhi jia Gui Tang

於桂枝汤方内,更加桂二两,成五两,馀依桂枝汤法。

Add additional 30 gram of Guizhi into standard Guizhi Tang. Cook and drink the tea as for Guizhi Tang.  

17  太阳病,以火熏之,不得汗,其人必躁,到经不解,必圊血,名为火邪。

In Taiyang stage, the person was given fire to roast to warm up the body. If he has not sweat, he will have irritable physically. The Xieqi was not depleted out of the body, accumulated in the body to cause bleeding from urine.

18  脉浮热甚,反灸之,此为实,实以虚治,因火而动,故咽燥而吐血。

If the person has floating pulse and strong hot, he is given moxibustion again. His original condition belongs to Shi condition but treated as a weak condition. The Fire causes dry throat and vomiting blood.  

19  微数之脉,甚不可灸,因火为邪,则为烦逆,追虚逐实,血散脉中,火气虽微,内攻有力,焦骨伤筋,血难复也。

If the person has slight frequent pulse, the moxibustion therapy should not be given. Otherwise the Fire from the moxibustion may cause annoyed/impatience. The Fire makes the weak condition much weaker, attacks the bone and tendons so the blood is hard to be restored.[17]

20  荣气微者,加烧针,则血留不行,更发热而躁烦也。

If a person has weak Rongqi condition[18], the fire-needle therapy should not be used. Otherwise, the person will be more hot and more annoyed/impatience. 

21  脉浮,宜以汗解,用火灸之,邪无从出,因火而盛,病从腰以下,必重而痹,名火逆也。

If the person has floating pulse, he should be given sweat therapy. If a moxibustion is given, the Xieqi has no way to deplete and becomes more overwhelming and causes heaviness and Bi syndrome[19] from the lower back down. This condition is also called Fire-reverse condition.

22  形作伤寒,其脉不弦紧而数,数者必渴,被火者必谵语,数者,发热脉浮,解之当汗出愈[20](【注】若脉浮数,发热,解之当以汗,汗出可愈,宜大青龙汤。脉沉数发热,解之当以下,下之可愈,宜调胃承气汤。若脉数无表 证,惟发热而渴谵语者,不可汗下,宜白虎汤、黄连解毒汤,清之可也。)

The person’s condition appears as Shanghan disease. The pulse is not string and tight, but frequent. Person with a frequent pulse must have thirsty. The person will have also Chattering syndrome if he is roasted with fire. Person with the frequent pulse has hot and floating pulse too. Use sweat therapy. If the pulse is floating and frequent, the person has hot, use Da Qinglong Tang to create sweat therapy; if the pulse is deep and frequent, the person has hot, use Tiaowei Chengqi Tang to create a bowel-cleansing therapy; if the pulse is frequent but no Taiyang or Yangming inside condition, the person has only hot and thirsty and Chattering syndrome, use Baihu Tang, Huanglian Jiexu Tang to clear the Xieqi).

23  伤寒脉浮,医以火逼劫之,亡阳,必惊狂,起卧不安者,桂枝去芍药加蜀漆龙骨牡蛎救逆汤主之。

With Shanghan disease, the person has floating pulse. He is however given Fire therapy so it causes depletion of Yangqi in the body[21]. The person will feel scaring/phobia/madness, heavy irritable physically. In this case, use Guizhi que Shaoyao, jia Shuqi, Longgu, Muli Tang.

桂枝去芍药加蜀漆龙骨牡蛎救逆汤方

Guizhi que Shaoyao, jia Shuqi, Longgu, Muli Tang.

桂枝 三两, 甘草(炙)二两, 生姜(切)三两, 牡蛎(熬)五两, 龙骨 四两, 大枣(擘)十二枚, 蜀漆(洗去脚)三两

Guizhi 45 gram, Gancao (processed) 30 gram, Fresh ginger 45 gram, Muli (processed) 75 gram, Longgu 60 gram, Chinese date 12 dadges, Shuqi (wash away the foot) 45 gram.

右为末,以水一斗二升,先煮蜀漆,减二升,内诸药,煮取三升,去滓,温服。

Add the Shuqi and 3000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 2500 ml liquid left. Add the rest of the herbs in, keep in mild boiling until there is about 750 ml left. Collect the herbal tea. Drink.

24  火逆下之,因烧针烦躁者,桂枝甘草龙骨牡蛎汤主之。

If the person was given a bowel-cleansing therapy and then a fire-needle therapy, he has a Fire-reverse condition and feels annoyed/impatience. Use Guizhi Gancao Longgu Muli Tang.

桂枝甘草龙骨牡蛎汤方

Guizhi Gancao Longgu Muli Tang.

桂枝 一两, 甘草(炙)二两, 龙骨 二两, 牡蛎(熬)二两

Guizhi 15 gram, Gancao (processed) 30 gram, Longgu 30 gram, Muli (processed) 30 gram.

右四味,为末,以水五升,煮取二升半,去滓,温服八合,日三服。

Add the herbs and 1250 ml water into a herbal pot. Bring to boil and keep in mild boiling until the liquid volume in the pot is about 625 ml. Collect the herbal tea, one third each time, three times a day.  



[1] In original version, the pulse is deep and tight.

[2] If there is nose bleeding, the Xieqi will deplete from the bleeding and the person should have no sweat. If the person has sweat on the head, he should have no nose bleeding. The Xieqi will deplete from the sweat.

[3] The dry body is due to the Fire moves deep in the body.

[4] Dry mouth and ulcer in throat indicates the Fire in the head. If the Fire does not move down, the person will have no hard stool. If the Fire moves down into the abdomen to burn the Weiye (liquid in the stomach), the person will have hard stool. Chattering syndrome is due to the disturbance of the spirit.

[5] When the Yu syndrome comes, it suggests the Xieqi has developed very deep. The Fire presses the Weiqi pushing up.

[6] Arm and leg, hands and feet are the base of Yangqi in the body. Overwhelming Yangqi stirs the aim and leg, the hands and feet to move, to jump, to touch or to shake. 

[7] Easy urine suggests the Yinye in the body has not been depleted, so there is chance to cure.

[8] Blue: the color of Liver; yellow, the color of Spleen. If the blue and yellow come together, it suggests the Liver (blue) attacks the Spleen (yellow).

[9] Chilly and feet spasm suggest the Cold Xieqi is invading to the lower part of the body.

[10] There is an opinion that the words in the paralysis should be deleted.

[11] Wei syndrome refers to a clinic condition in which the person feels weakness and shrink in muscle mass.

[12] For a condition of upper Fire but lower body Cold, if there is no Taiyang surface condition, Huanglian Tang is used. Here, the person has body surface condition, so use the Mahuang Shengma Tang.

[13]  This is a Shaoyang condition. The heavy body in this case is due to Wet-Hot Xieqi accumulation in the body. The herbs here, as well as Baihu Tang can be used. If it is due to Cold-Wet condition, the herb Zhenqu Tang, Guizhi Fuzi Tang are used.

[14] Such condition is due to the accumulation of Wet-Fire in the bladder. Sweat therapy removes the Wet away, remains the Fire in the bladder. The Fire burns the blood vessels in the bladder to cause bleeding.

[15] Jin syndrome: the person has spasm in muscle, such as a epilepsy.

[16] Bentun syndrome/condition: the person feels as there is a pig running in the abdomen.

[17] Slight frequent pulse suggests Yin deficiency with short of blood.

[18] Rongqi is weak so the blood is also in deficiency. The is a condition that tends to be Yin deficiency. 

[19] Bi syndrome: the part of body becomes heavy, pain, or stiffness to affect the joint movement. It is similar to arthritis conditions.

[20] 【按】三「弱」字,当俱是「数」字,若是「弱」字,热从何有?不但文义不属,且论中并无此说。

 

[21] There is different ways to cause depletion of Yangqi from the body. If Da Qinglong Tang is mis-used to cause heavey sweat so the Yangqi is depleted, use Zhenwu Tang to solve the problem. Here, the Yangqi depletion is caused due to Fire invasion, that disturbs the Heart to floating and disappear. The Guizhi que Shaoyao, jia Shuqi Longgu Muli Tang is used.