太阳病,发汗,遂漏不止,其人恶风小便难,四肢微急,难以屈伸者,桂枝加附子汤主之。
按太阳证发汗太过,以致汗泄亡阳,表虚已极。但经络之阳,根于肾水,温肾阳即所以治表虚也。故
以表虚证属之。
桂枝加附子汤
桂枝(三钱) 芍药(三钱) 甘草(二钱) 生姜(三钱) 大枣(四枚) 附子(
一钱) 水煎服按肾气者,诸阳之本,汗漏不止,则肾中阳根泄而不藏,故用桂枝达肝木之郁陷,芍药
敛风气之疏泄,姜甘大枣补脾精,而和中气,附子暖肾水以益阳根也。
太阳病,得之八九日,如疟状,发热恶寒,热多寒少,其人不呕,清便欲自可,一日二三度发,脉浮
缓者,为欲愈也。脉微而恶寒者,此阴阳俱虚,不可更发汗、更下、更吐也。面色反有热色者,未欲
解也。以其人不得小汗出,身必痒,宜桂枝麻黄各半汤。服桂枝汤,大汗出,脉洪大者,与桂枝汤,如前法。
若形如疟,日再发者,桂枝二麻黄一汤。太阳病,项背强KT KT ,反汗出恶风者桂枝加葛根汤主之。伤寒
六七日,发热微恶寒,支节烦疼、微呕,心下支结,外证未去者,柴胡桂枝汤主之。伤寒五六日,已发汗,
而复下之,胸胁满微结,小便不利,渴而不呕,但头汗出,往来寒热,心烦者,此为末解也。柴胡桂枝干姜
汤主之。
按以上诸证,有太阳风寒双感者,有太阳阳明并病者,有少阳病尚连太阳之经者,有少阳病将传太
阴之脏者,而要总属实邪在表也,故以表实证统之。
桂枝麻黄各半汤
桂枝(一钱二分) 芍药(八分) 生姜(八分) 甘草(八分炙) 麻黄(八
分) 大枣(二枚半) 杏仁(七枚) 先煮麻黄去沫,入诸药煎,温服。按风寒双感,营卫并伤,故麻桂
并用以泄营卫也
桂枝二麻黄一汤
桂枝(一钱三分) 芍药(一钱) 麻黄(七分) 生姜(一钱) 杏仁(十六
枚) 甘草(七分) 大枣(一枚) 煎法同上。
按风寒双感,而风邪较多,寒邪较少,故重泄营血。而轻泄卫气,乃为合法也。
桂枝加葛根汤
桂枝(二钱) 芍药(二钱) 甘草(一钱五分) 生姜(二钱) 大枣(三枚)
葛根(四钱) 先煎葛根去沫,后入诸药同煎,温服,覆取微似汗,不须啜粥。按太阳表病不解,郁遏阳
明经府之气,方中加葛根者,泄阳明之经气,降逆而达郁也。
柴胡桂枝汤
柴胡(二钱) 黄芩(八分) 人参(一钱五分) 半夏(一钱) 甘草(五分) 桂
枝(八分) 芍药(八分) 生姜(八分) 大枣(二枚) 水煎服。按少阳之病,而微见恶寒,则太阳
之外证未去,故宜柴胡合桂枝双解太少之经邪也。
柴胡桂枝干姜汤
柴胡(四钱) 桂枝(一钱五分) 黄芩(一钱五分) 栝蒌根(二钱)
干姜(一钱) 牡蛎(一钱) 甘草(一钱炙) 水煎服。初服微烦,再服汗出而愈。按少阳之经,而传太阴
之脏,表里俱未解也,故用柴胡黄芩疏甲木而清相火,桂枝栝蒌达乙木而清燥金,姜甘温中而培土,牡蛎除
满而消结也。
Taiyang disease (disease of the Taiyang channel), after sweating therapy, continues to sweat profusely; the patient fears wind, has difficulty urinating, slight stiffness in the four limbs making flexion and extension difficult. Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite) is the primary treatment.
Note: In Taiyang syndrome, excessive sweating leads to loss of Yang Qi through sweat, resulting in extreme exterior deficiency. However, the Yang Qi of the meridians is rooted in Kidney Water; warming Kidney Yang is the method to treat exterior deficiency. Therefore, this is categorized under Exterior Deficiency Syndrome.
Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite)
Guizhi (Cinnamomi Ramulus, 3 qian), Shaoyao (Paeoniae Radix Alba, 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Shengjiang (Zingiberis Rhizoma Recens, 3 qian), Dazao (Jujubae Fructus, 4 pieces), Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian). Decoct in water and take warm. Note: Shen Qi (Kidney Qi) is the root of all Yang Qi. Profuse sweating causes the Yang root within the Kidney to leak and fail to store. Thus, Guizhi is used to unblock the depression of Liver Wood, Shaoyao to astringe the dispersal of Wind Qi, Shengjiang, Gancao, and Dazao to tonify Spleen Jing and harmonize Middle Qi, while Fuzi warms Kidney Water to benefit the Yang root.
Taiyang disease, developing over eight or nine days, resembles malaria with alternating fever and chills, where heat predominates over cold. The patient does not vomit, and bowel/bladder functions are relatively normal. If symptoms occur two or three times a day and the pulse is floating and moderate, it indicates impending recovery. If the pulse is faint and the patient fears cold, this indicates deficiency of both Yin and Yang; sweating, purging, or vomiting should not be employed again. If the face appears flushed with heat, the disease has not yet resolved because the patient cannot produce a slight sweat, leading to body itching. Guizhi Mahuang Ge Ban Tang (Half-Dose Combination Decoction of Cinnamon Twig and Ephedra) is appropriate. After taking Guizhi Tang, if profuse sweating occurs and the pulse becomes flooding, administer Guizhi Tang again according to the previous method. If the condition resembles malaria occurring twice a day, use Guizhi Er Mahuang Yi Tang (Two-Parts Cinnamon Twig and One-Part Ephedra Decoction). For Taiyang disease with stiffness in the neck and back, accompanied by sweating and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction with Pueraria) is the primary treatment. In Shanghan (Cold Damage) lasting six or seven days, with slight fever and aversion to cold, vexing pain in the joints, slight vomiting, and subcostal fullness/stagnation, with exterior signs unresolved, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is indicated. In Shanghan lasting five or six days, after prior sweating and subsequent purging, presenting with chest and hypochondriac fullness with slight stagnation, difficulty urinating, thirst without vomiting, only sweating on the head, alternating fever and chills, and irritability, the pathogen remains unresolved. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is the primary treatment.
Note: The above syndromes include cases of dual contraction of Wind-Cold in Taiyang, concurrent Taiyang and Yangming diseases, Shaoyang disease involving the Taiyang channel, and Shaoyang disease about to transmit to the Taiyin organ. Ultimately, they all belong to excess pathogens at the exterior, so they are collectively categorized under Exterior Excess Syndrome.
Guizhi Mahuang Ge Ban Tang (Half-Dose Combination Decoction of Cinnamon Twig and Ephedra)
Guizhi (Cinnamomi Ramulus, 1.2 qian), Shaoyao (Paeoniae Radix Alba, 8 fen), Shengjiang (Zingiberis Rhizoma Recens, 8 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 8 fen, honey-fried), Mahuang (Ephedrae Herba, 8 fen), Dazao (Jujubae Fructus, 2.5 pieces), Xingren (Armeniacae Semen Amarum, 7 pieces). First decoct Mahuang to remove foam, then add other herbs and decoct. Take warm. Note: Dual contraction of Wind-Cold injures both Ying (Nutritive) and Wei (Defensive) levels; thus, Mahuang and Guizhi are used together to vent Ying and Wei.
Guizhi Er Mahuang Yi Tang (Two-Parts Cinnamon Twig and One-Part Ephedra Decoction)
Guizhi (Cinnamomi Ramulus, 1.3 qian), Shaoyao (Paeoniae Radix Alba, 1 qian), Mahuang (Ephedrae Herba, 0.7 qian), Shengjiang (Zingiberis Rhizoma Recens, 1 qian), Xingren (Armeniacae Semen Amarum, 16 pieces), Gancao (Glycyrrhizae Radix et Rhizoma, 0.7 qian), Dazao (Jujubae Fructus, 1 piece). Decoct as above. Note: In dual contraction of Wind-Cold, Wind pathogen is predominant and Cold is minor; therefore, heavy emphasis is placed on venting Ying Blood, and light emphasis on venting Wei Qi, which is the correct approach.
Guizhi Jia Gegen Tang (Cinnamon Twig Decoction with Pueraria)
Guizhi (Cinnamomi Ramulus, 2 qian), Shaoyao (Paeoniae Radix Alba, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1.5 qian), Shengjiang (Zingiberis Rhizoma Recens, 2 qian), Dazao (Jujubae Fructus, 3 pieces), Gegen (Puerariae Radix, 4 qian). First decoct Gegen to remove foam, then add other herbs and decoct. Take warm, cover with blankets to induce slight sweating. No need to drink hot porridge. Note: When Taiyang exterior disease is unresolved, it obstructs the Qi of the Yangming channel and fu organs. Adding Gegen vents Yangming channel Qi, descends rebellion, and unblocks stagnation.
Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction)
Chaihu (Bupleuri Radix, 2 qian), Huangqin (Scutellariae Radix, 0.8 qian), Renshen (Ginseng Radix, 1.5 qian), Banxia (Pinelliae Rhizoma, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.5 qian), Guizhi (Cinnamomi Ramulus, 0.8 qian), Shaoyao (Paeoniae Radix Alba, 0.8 qian), Shengjiang (Zingiberis Rhizoma Recens, 0.8 qian), Dazao (Jujubae Fructus, 2 pieces). Decoct in water and take. Note: In Shaoyang disease, slight aversion to cold indicates that Taiyang exterior signs remain unresolved. Thus, combining Chaihu and Guizhi simultaneously resolves pathogens in both Taiyang and Shaoyang channels.
Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction)
Chaihu (Bupleuri Radix, 4 qian), Guizhi (Cinnamomi Ramulus, 1.5 qian), Huangqin (Scutellariae Radix, 1.5 qian), Gualougen (Trichosanthis Radix, 2 qian), Ganjiang (Zingiberis Rhizoma, 1 qian), Muli (Ostreae Concha, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian, honey-fried). Decoct in water and take. Mild irritability may occur after the first dose; upon the second dose, sweating occurs and the patient recovers. Note: When Shaoyang channel disease transmits to the Taiyin organ, both interior and exterior are unresolved. Chaihu and Huangqin soothe Jia Wood (Gallbladder) and clear Ministerial Fire; Guizhi and Gualougen reach Yi Wood (Liver) and clear Dry Metal; Ganjiang and Gancao warm the middle and cultivate Earth; Muli removes fullness and dissipates stagnation.