治少阴伤寒,口中和,而背恶寒,反发热倦怠,自汗而渴,其脉尺寸
俱沉而紧者。
麻黄(去节) 细辛 附子(炮去皮脐,各半两)
上粗末。每服四钱,水一盏半,煎七分,去滓,食前服。手足厥冷者,去麻黄、细辛,
加干姜半两、甘草一分。或口燥舌干而渴,宜急下之。
足厥阴肝经伤寒,烦满,发热恶寒,往来如疟,或囊缩,小腹急痛。其脉流注,与伤风
同。(本论用小建中汤,方见九痛门,去远志即是)
治厥阴伤寒,烦满,发热恶寒,往来如疟;或囊缩,其脉尺寸俱微缓
者主之。若脉沉短,其囊必缩,急以大承气下之,可保五死一生。承气汤乃利阳明药耳,若
病到厥阴,其势已甚,盖阳明养宗筋,为热毒所攻,乃以承气泻其能养,故利阳以救阴,此
犹假虞伐虢、围魏救赵之意也。
桂心(四钱一字) 芍药 麻黄(去节) 杏仁(十二个,去皮尖) 甘草(炙,各半两)
上粗末。每服五钱,水一盏半,煎八分,去滓,食前服;入姜枣煎亦得。
大承气汤 (方见足阳明经)
小建中汤 (方见九痛门)
《内经·热论》论伤寒云∶太阳为诸阳主气,伤寒必先自太阳始。至汉诸师,凡外所因
,皆曰太阳病,未为了义。足太阳寒水,其位居辰,辰为六气化原,故丙辛遁起戊子,至辰
为壬辰水,而太阳正化居焉。在天为寒,在地为水,寒喜归水,故寒必首伤太阳。以此例
推,寒既自太阳入,风当自少阳入,湿当自阳明入。《经》曰∶阴为之主,阳与之正。别于
阳者,知病从来;别于阴者,知死生之期。此之谓也。或问传变次序,当如何耶?然阴阳流
行,出入次序,固有定说,及其中病,或喜入,或成虚,或成两感,或守一经,其可拘也?
但当以脉证分别阴阳表里盛衰为治,尤不可以日数期也。
Treat Shaoyin Cold Damage (Shaoyin Taiyang Cold Damage), where the patient's mouth feels neutral (no bitter or dry taste), with aversion to cold in the back, accompanied by fever, fatigue, spontaneous sweating, and thirst. The pulse at both the Cun (inch) and Chi (cubit) positions is deep (Chen) and tight (Jin).
Ephedrae Herba (Mahuang, 麻黄) [removed nodes], Asari Radix (Xixin, 细辛), Aconiti Lateralis Radix Praeparata (Fuzi, 附子) [processed, skin and umbilicus removed, each half tael].
Grind the above herbs into a coarse powder. Take four qian per dose, add one and a half zhan of water, decoct until seven parts remain, strain, and take before meals. If there is coldness in the hands and feet, remove Ephedrae Herba (Mahuang, 麻黄) and Asari Radix (Xixin, 细辛), and add Zingiberis Rhizoma (Ganjiang, 干姜) half a tael and Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) one fen. Alternatively, if there is dryness in the mouth and tongue with thirst, urgent purgation should be employed.
Cold Damage affecting the Foot Jueyin Liver Meridian presents with irritability and fullness, fever with aversion to cold, alternating chills and fever resembling malaria, or retraction of the scrotum, and acute pain in the lower abdomen. The pulse flow and distribution are similar to those of Wind Injury. (This treatise recommends using Xiaojianzhong Tang, see the Nine Pains section; removing Yuanzhi from that formula yields this prescription.)
Treat Jueyin Cold Damage characterized by irritability and fullness, fever with aversion to cold, alternating chills and fever resembling malaria; or retraction of the scrotum. This condition is primarily indicated when the pulses at both the Cun and Chi positions are faint and slow (Wei Huan). If the pulse is deep and short, the scrotum will certainly retract, and Da Chengqi Tang should be used urgently for purgation; this can save one life out of five fatal cases. Chengqi Tangs are medicines that benefit the Yangming channel. However, when the disease reaches Jueyin, the condition is already severe. Since the Yangming channel nourishes the Zongjin (general tendons/genitals), and is attacked by heat toxicity, using Chengqi Tang to purge Yangming heat preserves the function that nourishes the Zongjin. Thus, benefiting Yang to rescue Yin is employed. This concept is analogous to "borrowing a path to conquer Guo" or "besieging Wei to rescue Zhao."
Cinnamomi Cortex (Guixin, 桂心) [four qian and one zi], Paeoniae Radix Alba (Shaoyao, 芍药), Ephedrae Herba (Mahuang, 麻黄) [removed nodes], Armeniacae Semen Amarum (Xingren, 杏仁) [twelve seeds, skin and tips removed], Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [roasted, each half tael].
Grind the above herbs into a coarse powder. Take five qian per dose, add one and a half zhan of water, decoct until eight parts remain, strain, and take before meals; decocting with fresh ginger and jujube is also acceptable.
Da Chengqi Tang (See Foot Yangming Meridian section)
Xiaojianzhong Tang (See Nine Pains section)
The *Neijing·Re Lun* discusses Cold Damage stating: The Taiyang meridian is the master qi of all Yang meridians; Cold Damage must begin with the Taiyang meridian. By the time of the Han dynasty physicians, all external causes were termed Taiyang Disease, which did not fully elucidate the true principles. The Foot Taiyang Bladder Meridian belongs to Cold Water, its position corresponds to the Earthly Branch Chen. Chen is the origin of the transformation of the Six Qi. Therefore, in Bing-Xin years, the cycle starts at Wu-Zi, and upon reaching Chen, it becomes Ren-Chen Water, where the primary transformation of Taiyang resides. In Heaven it is Cold, on Earth it is Water. Cold favors returning to Water, so Cold inevitably injures the Taiyang first. By analogy, since Cold enters via Taiyang, Wind should enter via Shaoyang, and Dampness via Yangming. The Classics state: "Yin serves as the master, Yang provides the regulation." Distinguishing from Yang reveals the origin of the disease; distinguishing from Yin reveals the timing of death or survival. This is what is meant. One might ask, what is the order of transmission? Although the circulation of Yin and Yang and the sequence of entry and exit have fixed theories, once the disease takes hold, it may favor entering certain meridians, become deficient, become a Lianggan syndrome (simultaneous involvement of exterior and interior meridians), or remain confined to one meridian. How can these be rigidly constrained? One should only treat based on differentiating Yin/Yang, Exterior/Interior, and Excess/Deficiency through pulse and symptom analysis, and certainly not limit the course by days.