13. 表證 Exterior Pattern on 3rd volume of the book of living persons (活人書3-13-3)

 

 衄血, 下血
 nosebleed or blood descent

其人當汗, 而衄血, 下血者, 不可表也. 太陽病, 脈浮而緊, 發熱, 身無汗者, 衄者愈, 不可汗. 汗出, 必額上陷脈緊急, 直視不得瞬. 又云, 太陽病不解, 熱結膀胱, 其人如狂, 血自下, 下者愈, 不愈, 宜桂枝湯.

Even if one needs to sweat, if one has nosebleed or blood descent, this is not exterior pattern. When in Taiyang disease, the pulse is floating and tight, [and there is] heat effusion and absence of sweating, spontaneous external bleeding will bring about recovery. therefore inducing sweating is not appropriate. [if] sweat issues, the pulse in the depressions of the forehead will be tense and tight, the eyes will be staring straight and unable to move. And, ) When Taiyang disease is unresolved and heat binds in the bladder, the person is as if manic,  and spontaneous blood descent will bring recovery. But if it does not recover, Gui Zhi Tang should be used.

 

 壞病
An aggravated disease

壞病者, 不可表也. 太陽病三日, 己發汗, 若吐, 若下, 若溫針, 仍不解者, 爲壞病. 桂枝不中與也. 當犯何逆, 隨證治之. 又云, 太陽病不解, 傳入少陽者, 脇下鞭滿, 乾嘔不能食, 往來寒熱, 尙未吐下, 脈沈緊者, 與小柴胡湯. 若己吐下, 發汗, 柴胡證罷, 此爲壞病, 知犯何逆, 以法治之.

An aggravated disease cannot be treated by inducing sweating. When Taiyang disease has lasted for three days and sweating has already been promoted, if vomiting, or if precipitation, or if warm needling¹ has been used and still there is no resolution, this is an aggravated disease in which Cinnamon Twig Decoction (gui zhi tang) should not be given. it is necessary to distinguish which meridian is affected and treat it according to the signs. When originally [there was] greater yang disease that was unresolved and thereby shifted into the lesser yáng, there is hardness and fullness under the rib-side, dry retching and inability to eat, and alternating aversion to cold and heat effusion. When neither vomiting treatment nor precipitation has yet been used and the pulse is sunken and tight, one should give Minor Bupleurum Decoction (xiao chia hu tang). This is an aggravated disease, therefore, one should be aware of which meridian is affected and treat it according to the appropriate methods.,

 

 

Externally contracted disease during menstruation.

婦人, 經水適來者, 不可表也. 婦人病, 經水適下, 而發其汗, 則鬱冒不知人. 此爲表裏俱虛, 故令鬱冒也.

Even if a woman has contracted disease externally, it cannot be treated by promoting sweating. When a woman contracts cold damage and the menstrual flow happens to arrive, if sweating is promoted, she may feel as though she is wearing something on her head and confused. This is due to weakness both on the exterior and interior. Therefore, it feels as though something is on her head."

 

 

 風溫病
Wind warmth disease

風溫者, 不可表也. 脈尺寸俱浮, 頭疼, 身熱, 常自汗, 體重, 其息必喘, 其形不仁, 嘿嘿但欲眠者, 風溫證也. 復發其汗者, 死, 宜葳蕤湯.

Wind-warmth disease cannot be treated with therapy for exterior pattern. If both the cubit and inch pulses are floating, there is headache and generalized heat effusion, constant sweating, generalized heaviness, shortness of breath, numbness, and desire only to sleep, it is a wind-warmth syndrome. If sweating is promoted again, death may occur. Treatment with the Wei Rui Tang (葳蕤湯) is appropriate.

 濕溫病
Damp-warmth disease

濕溫者, 不可表也. 兩脛逆冷, 胸腹滿, 頭目痛苦, 妄言, 必多汗者, 濕溫證也, 不可發汗. 發汗者, 名曰, '重暍'. 如此死者, 醫殺之耳. 宜桂附湯, 白虎加蒼朮湯.

Damp-warmth disease cannot be treated with therapy for exterior pattern

If a person experiences coldness in the lower legs, fullness in the chest and abdomen, pain in the head and the eyes, raving, and excessive sweating, it is a damp-warmth syndrome. Sweating should not be promoted. If sweating is promoted, it is called 'severe heat thermoplegia.' If the condition is left untreated and the patient dies, it is the physician's fault. Appropriate treatments include the Gui Fu Tang decoction and the Bai Hu Jia Chai Hu Shu Tang decoction. Damp-warmth disease cannot be treated with therapy for exterior. Gui Fu Tang (Cinnamon Bark and Aconite Decoction) or the Bai Hu Jia Cang Zhu Tang ( White Tiger Decoction Plus Atractylodes ) is appropriate.

 

 虛煩
 Vacuity vexation

1.8.7

1

虛煩者, 不可表也. 諸虛煩熱, 與傷寒相似. 然不惡寒, 身不疼, 故知非傷寒也. 不可發汗. 頭不痛, 脈不緊, 故知非裏實也. 不可下. 宜服竹葉湯.

 

Vacuity vexation cannot be treated with therapy for exterior pattern. All vexation and heat effusion due to deficiency are similar to the signs of cold damge. However, the patient does not feel cold or have body aches, which distinguishes it from cold damage. Sweating should be avoided in this case. Also, since the patient does not have a headache and the pulse is not tight, it is not an replete interior pattern. Therefore, precipitating therapy cannot be used. Zhu Ye Tang (Lophatherum Decoction) is appropriate.

 動氣
 Stirring Qi

病人腹間, 左右上下, 有築觸動氣者, 不可表也. ○ 動氣在左, 不可發汗. 發汗則頭眩, 汗不止, 筋惕肉瞤. 此爲逆難治. 先服防風白朮牡蠣湯. 汗止, 次當服建中湯. ○ 動氣在右, 不可發汗. 發汗則衄而渴, 心苦煩, 飮則吐水. 先服五苓散一二服, 次服竹葉湯. ○ 動氣在下不可發汗. 發汗則氣上衝, 正在心端. 宜服李根湯. ○ 動氣在下, 不可發汗. 發汗則無汗, 心中大煩, 骨節疼煩, 目運, 惡寒, 食則反吐, 穀不得化. 先服大橘皮湯, 吐止, 後服小建中湯.

If the patient feels stirring qi in their abdomen in all directions, it cannot be treated as a exterior pattern. If stirring qi is on the left, sweating should be avoided. If sweating is pormoted, there will be dizziness, continuous sweating, muscle tension, and tremors. This is unfavorable pattern which is difficulty to treat. First, the patient should take Fangfeng Baizhu Muli Tang (防風白朮牡蠣湯), and after sweating stops, they should take Jianzhong Tang (建中湯). If stirring qi is on the right, sweating should be avoided. If sweating is promoted, there will be nosebleeds, thirst, heart vexation, and vomiting after drinking water. First, the patient should take Wuling San (五苓散) once or twice, and then take Zhuye Tang (竹葉湯).  If stirring qi is in the upper, sweating should be avoided. If sweating is promoted, qi surges up and the location is directly in the end of the heart. The patient should take Li Gun Tang (李根湯). If stirring qi is in the lower, sweating should be avoided. If sweating is promoted, there will be great vexation in the hearat, pain in the bone and joints, dizziness, aversion to cold, vomiting after eating, and indigestion. First, the patient should take Da Ju Pi Tang (大橘皮湯) to stop vomiting, and after vomiting stops, they should take Xiao Jian Zhong Tang (小建中湯.)

 

以此見, 古人愼用表藥如此.

       From this, it can be seen that the ancients were       cautious in using exterior-releasing medicines.