甘草(二两,炙) 白术(二两) 桂枝(四两,去皮) 附子(二枚,炮去皮,破) 上四味,以水六升,煮取
三升,去渣,温服一升,日三服,初服得微汗则解。即服桂枝汤。《论》中所云∶风湿发汗,汗大出者,但风气
去,湿气在,是故不愈也。治风湿者发其汗,但微微似欲出汗者,风湿俱去也,能食汗出,复烦者,尚有余
邪郁而未尽。服五合,恐一升多者,服六、七合为始。此言初服之始。
风湿相搏,骨节疼烦,掣痛不得屈伸,近之则痛剧,汗出短气,小便不利,恶风不欲去衣,或身微肿
者,甘草附子汤主之。此段形容风湿之状,病情略备。
桂枝(四两,去皮) 附子(三枚,炮去皮切八片) 甘草(二两,炙) 生姜(三两,切) 大枣(十二枚,擘)
上五味,以水六升,煮取二升,去渣,分温三服。按∶此即桂枝,去芍药加附子汤,但彼桂枝用三两,附子用
一枚,以治下后脉促胸满之症。此桂枝加一两,附子加二枚以治风湿身疼脉浮涩之症,一方而治病迥殊,方名
亦异,彼编入桂枝汤类,此编入理中汤类,细思之各当其理,分两之不可忽如此,义亦精矣。后人何得以古
方,轻于加减也。
白术(四两) 甘草(二两) 附子(三枚,炮去皮,破) 生姜(三两,切) 大枣(十二枚,擘) 上五味,
以水六升,煮取二升,去渣,分温三服,初一服,其人身如痹,半日许,复服之,三服都尽,其人如冒状,勿怪,
此以附子、术并走皮内,逐水气,附术并力,则逐水之功愈大。未得除,故使之耳,法当加桂四两。
此即前桂枝附子汤。此本一方二法,以大便硬,小便自利,去桂也。以大便不硬,小便不利,当加桂,观
此条知桂枝能通小便,故五苓散用之。附子三枚恐多也,虚弱家及产妇,宜减服之。附子能劫阴气。
伤寒八、九日,风湿相搏,身体疼烦,不能自转侧,湿则身重。不呕不渴,湿而兼寒。脉浮虚而涩
者,内外之阳俱虚。桂枝附子汤主之。若其人大便硬,小便自利者,去桂加白术汤主之。白术生肠胃之津液。
Gancao (Licorice Root, two liang, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma, two liang) Guizhi (Cinnamon Twig, four liang, bark removed) Fuzi (Prepared Aconite Lateralis Radix, two pieces, processed, bark removed, broken). The above four ingredients are boiled in six sheng of water until reduced to three sheng. The dregs are removed, and one sheng is taken warm, three times a day. After the initial dose, if slight sweating occurs, the condition resolves. At this point, Guizhi Tang (Cinnamon Twig Decoction) should be administered. As stated in the *Treatise on Cold Pathogenic Diseases*: When inducing sweating for wind-dampness, if sweat pours out profusely, only the wind pathogen is expelled while the dampness remains, thus the disease does not heal. To treat wind-dampness, sweating should be induced, but only to the extent that the patient appears slightly sweaty; only then will both wind and dampness pathogens be eliminated. If sweating occurs after eating and irritability returns, it indicates that residual pathogens remain郁 (stagnant) and unexhausted. If one sheng is considered too much, start with five he; if one sheng is still too much, start with six or seven he. This refers to the precautions for the initial dose.
When wind-dampness pathogens contend with each other, causing severe joint pain and distress, pulling pain preventing flexion and extension, exacerbation upon touch, accompanied by sweating, shortness of breath, difficulty in urination, aversion to wind with reluctance to remove clothing, or slight bodily swelling, Gancao Fuzi Tang (Licorice and Prepared Aconite Decoction) is the primary formula. This section describes the manifestations of wind-dampness, presenting a comprehensive picture of the condition.
Guizhi (Cinnamon Twig, four liang, bark removed) Fuzi (Prepared Aconite Lateralis Radix, three pieces, processed, bark removed, cut into eight slices) Gancao (Licorice Root, two liang, honey-fried) Shengjiang (Fresh Ginger Rhizome, three liang, sliced) Dazao (Jujube Fruit, twelve pieces, torn open). The above five ingredients are boiled in six sheng of water until reduced to two sheng. The dregs are removed, and the decoction is divided into three warm doses. Note: This formula is essentially Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without Paeonia with Added Prepared Aconite), except that in that formula, Guizhi is used in an amount of three liang and Fuzi in one piece, treating symptoms of rapid pulse and chest fullness following erroneous purgation. In this formula, Guizhi is increased by one liang and Fuzi by two pieces to treat body pain and floating, choppy pulse caused by wind-dampness. Although sharing a similar lineage, they treat vastly different conditions and have distinct names; the former is classified under Guizhi Tang categories, while the latter is classified under Lizhong Tang categories. Upon careful consideration, each has its own rationale. The importance of dosage cannot be overlooked, and the principles are profound. How can later generations lightly modify ancient formulas?
Baizhu (Atractylodis Macrocephalae Rhizoma, four liang) Gancao (Licorice Root, two liang, honey-fried) Fuzi (Prepared Aconite Lateralis Radix, three pieces, processed, bark removed, broken) Shengjiang (Fresh Ginger Rhizome, three liang, sliced) Dazao (Jujube Fruit, twelve pieces, torn open). The above five ingredients are boiled in six sheng of water until reduced to two sheng. The dregs are removed, and the decoction is divided into three warm doses. After the first dose, the patient may experience numbness. After about half a day, administer the next dose. After all three doses are consumed, the patient may feel dizzy as if covered by something; do not be alarmed. This is because Fuzi and Baizhu act together within the skin layers to drive out water-dampness qi. With their combined force, the effect of expelling water is greater. Since the water-dampness has not yet been fully eliminated, this reaction occurs. According to the method, Guizhi (Cinnamon Twig) should be added in an amount of four liang.
This is the same as the previously mentioned Guizhi Fuzi Tang. Originally, this was one formula with two methods. Because the stool was hard and urination was normal, Guizhi was removed. Because the stool was not hard and urination was difficult, Guizhi should be added. Observing this clause reveals that Guizhi can promote urination, which is why it is used in Wuling San (Five-Ingredient Powder with Poria). Three pieces of Fuzi might be excessive; for frail individuals and postpartum women, the dosage should be reduced. Fuzi can deplete yin qi.
After eight or nine days of Shanghan (Cold Damage), wind-dampness pathogens contend with each other, causing body pain and distress, inability to turn over independently, and heaviness due to dampness. There is no vomiting or thirst, indicating dampness combined with cold. The pulse is floating, deficient, and choppy, indicating deficiency of yang qi both internally and externally. Guizhi Fuzi Tang (Cinnamon Twig and Prepared Aconite Decoction) is the primary formula. If the person has hard stool and normal urination, Qu Gui Jia Baizhu Tang (Remove Cinnamon Twig and Add Atractylodes Macrocephala Decoction) is the primary formula. Baizhu generates fluids in the stomach and intestines.