Conditions against the use of bowel-cleansing therapy

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 医宗金鉴十五卷

<<Yi Zong Jin Jian>>  Chapter 15

辨不可下病脉证篇

Conditions against the use of bowel-cleansing therapy

01   脉濡而弱,弱反在关,濡反在巅,微反在上,涩反在下,微则阳气不足,涩则无血,阳气反微,中风汗出,而反躁烦,涩则无血,厥而且寒,阳微则不可下,下之则心下痞硬。

If the pulse is Ru when pressed slightly on the pulse, weak at the Guan position, Se in the Chi position, it indicates Yang and Blood deficiency conditions. Neither sweat therapy or bowel-cleansing therapy should be used. Otherwise, it causes Cold and Weakness inside, hard and fullness in the upper abdomen, and Taiyin diarrhea and hard abdomen syndrome.

02   脉濡而弱,弱反在关,濡反在巅,弦反在上,微反在下,弦为阳运,微为阴寒,上实下虚,意欲得温,微弦为虚,虚者不可下也。

If the pulse is Ru when pressed slightly on the pulse, weak at the Guan position, string pulse Chun position and weak in the Chi position, it indicates Fullness condition in the upper part of the body and a weakness condition in the lower part of the body. For such weakness condition, bowel-cleansing therapy should not be used.

03   脉濡而弱,弱反在关,濡反在巅,浮反在上,数反在下,浮为阳虚,数为无血,浮为虚,数生热,浮为虚,自汗出而恶寒,数为痛,振而寒栗,微弱在关,胸下为急,喘汗而不得呼吸,呼吸之中,痛在於肋,振寒相抟,形如疟状,医反下之,故令脉数发热,狂走见鬼,心下为痞,小便淋漓 ,少腹甚僐,小便则尿血也。

If the pulse is Ru in the Chun position (weak pulse when presses slightly), Ruo in the Guan position (weak when presses deep), floating in the Chun position and frequent in the Chi position, the floating means Yang deficiency, and frequent pulse suggests Blood deficiency. Floating is weak condition, and frequent means hot. Floating is weak and the person feels sweat and chilly; frequent pulse suggests pain, the person shaking in the body and chilly. Weak pulse is at the Guan position, the person feels urgent feeling in the upper abdomen, asthma and sweat and hard to breath, pain on the ribs when breath. The chilly happens as a malaria condition. If a bowel-cleansing therapy is used, the person will have frequent pulse, fever, mad as see a ghost, hard in the upper abdomen, frequent and pain in the urine, hard in the lower stomach, bleeding in the urine.  

04 脉濡而紧,濡则卫气微,紧则荣中寒,阳微卫中风,发热而恶寒,荣紧卫气冷,微呕心内烦,医为有大热,解肌而发汗,亡阳虚烦躁,心下苦痞坚。表 俱虚竭,卒起而头眩,客热在皮肤,怅怏不得眠,不知胃气冷,紧寒在关元,技巧无所施,汲水灌其身,客热因时罢,栗栗而振寒,重被而覆之,汗出而冒巅,体惕而又振,小便为微难,寒气因水发,清谷不容间,呕变反肠出,颠倒不得安,手足为微逆,身冷而内烦,迟欲从後救,安可复追还。

The pulse is Ru when presses slight and tight when presses deep. Ru pulse suggests the body surface Weiqi is weak, tight pulse suggests inside Rongqi cold. The person has hot and sweat and chilly in body surface and mild nausea and annoyed/impatience inside. If it is believed to have Taiyang condition so he is given sweat therapy, he will has more weak in the body surface Weiqi, so he will have more annoyed feeling, more chilly, hard in the upper abdomen. Body surface is weak and inside is cold, so he feels dizziness when lift his body (from lie down to sit up) and feels annoyed/unhappy/sadness. In such hot in the body surface but cold in the inside condition, he is given cold water shaver, the hot may disappear for a movement, but he will feel more chilly, willing to cover much more. When he has sweat, he will has jumping, tingling in the muscles, shaking in the body, Jue condition, diarrhea with non-digested food in stool, annoyed to die. This is because the Yangqi is depleted in both body surface and inside.  

05   脉浮而大,浮为气实,大为血虚,血虚为无阴,孤阳独下阴部者,小便当赤而难,胞中当虚,今反小便利而大汗出,法应卫家当微,今反更实,津液四射,荣竭血尽,乾烦而不得眠,血薄肉消,而成暴液,医复以毒药攻其胃,此为重虚,客阳去有期,必下如污泥而死。

If the pulse is floating and big, the floating means Qi fullness condition, big means Blood deficiency. Blood deficiency suggests no Yin condition, so the lonely Yangqi moves down to the lower part of the body to cause red and hot in urine. In this condition, the urine bladder should be empty, but now the person has more urine and more sweat. Also in this condition, the person should have weak in the body surface Weiqi, but now he has more sweat to deplete the Rongqi then the blood. The body is therefore in a dryness condition and hard to fall into sleep. If the doctor fails to recognize this condition and give bowel-cleansing therapy, the person will be weaker to die. [1]

06   伤寒脉,阴阳俱紧,恶寒发热,则脉欲厥;厥者脉初来大,渐渐小,更来渐大,是其候也。如此者,恶寒甚者,翕翕汗出,喉中痛;若热多者,目赤脉多,睛不慧,医复发之,咽中则伤;若复下之,则两目闭,寒多便清谷,热多便脓血;若 之则身发黄;若熨之则咽燥;若小便利者,可救之;若小便难者,为危殆。

If the pulse is tight when presses slight or deep, the person feels chilly and hot, it is Shanghan Taiyang stage. If the floating-tight pulse is big and strong in the beginning, but becomes weaker later, it indicates a trend to have Jue condition. In this case, if the person ahs strong chilly, mild sweat and pain the throat, it is Shaoyin Cold Jue condition. If the person has stronger fever, red color in eyes, staring eyes, it is Yangming Hot Jue condition. For the Cold Jue condition, sweat therapy will cause the more damage on the throat; bowel-cleansing therapy causes close of eyes. If the body has more Cold, he will have diarrhea with non-digested food in the stool. If he has more Hot, he will have diarrhea with more pus and blood in the stool. This is another way to distinguish the Cold or Hot Jue condition. If he is given a fire-roasting treatment, he will have jaundice. If his body is covered with hot covering, he will have dry throat. In this condition, if he has normal urine, his condition may be saved, otherwise it will be difficult. [2]

07  伤寒发热,口中勃勃气出,头痛目黄,衄不可制,贪水者必呕,恶水者厥。若下之,咽中生疮,假令手足温者,必下重便脓血。头痛目黄者,若下之,则目闭。贪水者,若下之,其脉必厥,其声嘤,咽喉塞;若发汗,则战栗,阴阳俱虚。恶水者,若下之,则里冷不嗜食,大便完谷出;若发汗,则口中伤,舌上白胎,烦躁,脉数实,不大便六、七日,後必便血;若发汗,则小便自利也。

In a Shanghan disease, the person feels air-burping from mouth, headache, yellow in the eyes, continuous nose bleeding, it is due to the overwhelming of a Xieqi of Yang nature. If he drinks more water, the water and Hot will combined to cause nausea. If he refuses to drink water, he will have Jue condition. In this case, bowel-cleansing therapy causes loss of voice, close in throat and esophagus. Over-sweat therapy causes depletion of Yangqi, so the body shakes and chilly. If his hands and feet is warm, he will has heavy diarrhea with pus and blood in stool. If he has headache and jaundice in eyes, bowel-cleansing therapy causes close of eyes. For person drinks more water, bowel-cleansing causes Jue condition and harsh in voice, close in throat and espophagus; and sweat therapy results in chilly and depletion of both Yinye and Yangqi. For person dislikes or refuses to drink water, bowel-cleansing therapy causes Cold inside, loses appetite, with non-digested food in the stool; sweat therapy causes damage and sour in mouth, heavy white tongue covering, annoyed, frequent pulse. If he has no bowel movement for six to seven days, he will has bleeding later. In such condition, sweat therapy causes more depletion of  the Yinye and Yangqi, the urine becomes more frequent.  

08   微则为咳,咳则吐涎,下之则咳止,而利因不休,利不休,则胸中如虫啮,粥入则出,小便不利,两肋拘急,喘息为难,颈背相引,臂则不仁,极寒反汗出,身冷若冰,眼睛不慧,语言不休,而谷气多入,此为除中 ,口虽欲言,舌不得前。

If the pulse is weak, the person cough and then spit saliva. Bowel-cleansing therapy can stop the cough, but causes continuous diarrhea and the person feels as bitten by worms. He is easy to vomit right after eating, has difficult urine, spasm and tightness on the side of abdomen, has asthma and hard in breath, spasm and contract on the neck and back, uncomfortable in the arms, feels very cold but still has sweat, blurring vision, continuous chattering but he can eat lots. This condition is termed as a Chuzhong condition. He may want to speak, but cannot since the tongue is shrinking short.

09   脉数者,久数不止,止则邪结,正气不能复,正气却结于藏,故邪气浮之,与皮毛相得,脉数者,不可下,下之必烦,利不止。

If the person has frequent pulse, the frequent pulse continuous without stop. If the frequent pulse stops, Xieqi in the body will stick, and becomes condensed, and the body defense Qi cannot recover but condensed in the organs, and the Xieqi floats in the body surface layer to bind with the skin and hair. In this case with frequent pulse, bowel-cleansing therapy should not be used. Otherwise he will feel annoyed and has no-end diarrhea.   

10   脉浮大,应发汗,医反下之,此为大逆。

If the pulse is floating and big, the sweat therapy should be used, but not a bowel-cleansing therapy.

11   动气在右,不可下,下之则津液内竭,咽燥鼻乾,头眩心悸也。动气在左,不可下,下之则腹内拘急,食不下,动气更剧,虽有身热,卧则欲倦。动气在上,不可下,下之则掌握热烦,身上浮冷,热汗自泄,欲得水自灌。动气在下,不可下,下之则腹胀满,卒起头眩,食则下清谷,心下痞也。

 

If the person feels jumping and tingling feeling in the right side of the abdomen, bowel-cleansing therapy should not be used. If it is given, the person will have depletion of Jingye in the body, resulting in dry nose and throat, dizziness and palpitation. If such jumping and tingling feeling is on the left side, the bowel-cleansing therapy will cause spasm in the abdomen, hard to eat and to swallow, and have more jumping feelings. Though he has hot in the body, but tends to lie down and feels very tired. If the jumping feeling is in the upper part of the abdomen, bowel-cleansing therapy could result in palm and sole hot, cold in the body skin, hot sweat, willing to drink water. If the jumping feeling is in the lower abdomen, bowel-cleansing therapy causes fullness in the abdomen, dizziness when the body shifts from lying down to sit up. He will has non-digested food in the stool after he starts to eat, and has fullness in the stomach. [3]

12   咽中闭塞,不可下,下之则上轻下重,水浆不下,卧则欲倦,身急痛,下利日数十行。

If the person has close in the throat, bowel-cleansing therapy should not be used.[4] Otherwise the bowel-cleansing therapy will result in a lightness in the upper part of the body, but a heaviness in the lower part of the body. He cannot drink water at all, wiling to lie down, feels acute pain in whole body, and has diarrhea several times a day.

13   诸外实者,不可下,下之则发微热,亡脉厥者,当脐握热。

If the person has fullness condition in the body surface layer, the bowel-cleansing therapy should not be used. Otherwise, it will result in mild fever and Jue condition.

14  太阳病,有外证未解,不可下,下之为逆。

Similar as mentioned in above paragraph, in Taiyang stage, if the person still has Taiyang condition, the bowel-cleansing therapy shouldn’t be used.  

15   病欲吐者,不可下。呕多虽有阳明证,不可攻之。

If the person has a wiling to vomit, bowel-cleansing therapy should not be used. The person with vomiting may be more in the Yangming stage, but can also be in a Shaoyang stage. In the Shaoyang stage, the bowel-cleansing therapy is forbidden.  

16   夫病阳多者热,下之则硬。

If the person is in a Yang condition with more fever, bowel-cleansing therapy could result in hard in the abdomen.

17   无阳,阴强大,便硬者,下之必清谷腹满。

If the person has little Yangqi, and relatively more overwhelming Yinqi in the body, bowel-cleansing therapy should not be used, even if he may have hard and difficult stool movement. Otherwise, bowel-cleansing therapy may cause fullness in the abdomen and has non-digested food in the stool.

18   伤寒发热。头痛,微汗出,发汗则不识人, 熏之则喘,不得小便,心腹满;下之则短气,小便难,头痛背强;加温针则衄。

If the person has Shanghan disease with fever, headache, mild sweat[5], sweat therapy causes loss of consciousnessfire-roasting to his body causes asthma, hard in urine and fullness in abdomen; bowel-cleansing therapy causes short of breath, hard in urine, pain and tightness in the head and neck; warm-needle acupuncture causes nose bleeding.

19 下利脉大者里虚也,以强下之故也。设脉浮革,因尔肠鸣者,属当归四逆汤。

If the person has diarrhea but has big pulse, it indicates weakness inside of the body, caused by a strong bowel-cleansing therapy. If his pulse is floating and Ge[6], and has noise in the abdomen, use Danggui Sini Tang.

 


[1] This paragraph tells that the bowel-cleansing therapy should not be used if the person has sweat but frequent urine.

[2] This paragraph indicates that if the person is invaded by Cold Xieqi, resulting in a Shi-Hot condition, the sweat therapy, bowel-cleansing therapy, fire-toasting and hot-covering therapy all should not be used.

[3] This paragraph tells that the bowel-cleansing therapy should not be used if the person has jumping, beating, or tingling feeling in the abdomen.

[4] If the person has dryness, pain and swelling in the throat, it is Shaoyin Yangxie, the bowel-cleansing therapy should be used. Here, the person has no pain, no dryness, and no swelling in the throat, so the bowel-cleansing therapy should not be used.

[5] For such a condition, it is Wenbing, or Shanghan Yangming meridian stage, so the sweat therapy should not be used.

[6] Ge pulse: a pulse feels hollow inside of the pulse. Ge pulse suggests Cold.