桂枝五两 芍药三两 甘草(炙)二两 生姜三两 大枣十二枚
右五味,以水七升,微火煮取三升,去滓,温服一升。
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奔豚,气上冲胸,腹痛,往来寒热,奔豚汤主之。
【注】
奔豚气上冲咽喉,发作欲死,是奔豚之甚者也。气上冲胸腹痛,往来寒热,是奔豚之
微者也。甚者以桂枝加桂汤,从肾逐阴降逆也;微者以奔豚汤,从心调血散逆也。
甘草 芎藭 当归各二两 半夏四两 黄芩二两 生葛五两 芍药二两 生姜四两
甘李根白皮一升
右九味,以水二斗,煮取五升,温服一升,日三夜一服。
【集解】
沈明宗曰:用芎、归、白芍、甘草,调养厥阴、少阳血气之正,而邪自外出;以生葛
、黄芩、半夏、生姜、佐李根,解半表半里之寒热,而逆可散。盖奔豚虽属肾病,然
兼厥阴、少阳之邪而发者有之。仲景用此方,明非仅寒邪一端致然也。
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发汗后,脐下悸者,欲作奔豚,茯苓桂枝甘草大枣汤主之。
【注】
发汗后,心下悸者,心阳虚,本经自病也。脐下悸者,肾邪乘虚上干心病也。奔豚者
,脐下气动而上冲也。欲作奔豚者,有似奔豚之状而将作未作也。茯苓桂枝甘草大枣
汤,所以补火土而伐水邪也。上条发明外感寒邪,能病奔豚,此条更申明内有水气,
亦能病奔豚也。
【集注】
徐彬曰:仲景论证,每合数条以尽其变,言奔豚由于惊,又言其从少腹冲至咽喉,又
言其兼腹痛,而往来寒热,又言其兼核起,而无他病,又言汗后脐下悸,欲作奔豚而
未成者,其浅深了然。用和解,用伐肾,用桂不用桂,酌治微妙。奔豚一证,病因证
治,无复剩义,苟不会仲景立方之意,则峻药畏用,平剂寡效,岂古方不宜于今哉。
周扬俊曰:汗本心之液,发汗而脐下病悸者,心气虚而肾气动也。
Cinnamon Twig (Guizhi) 5 liang, White Peony Root (Shaoyao) 3 liang, Licorice Root (Gancao), roasted, 2 liang, Fresh Ginger (Shengjiang) 3 liang, Jujube (Dazao) 12 pieces.
The above five herbs are boiled with seven sheng of water over a gentle fire until three sheng remain. The dregs are removed, and one sheng is taken warm per dose.
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Ben Tun (Rushing Pig Syndrome) manifests as Qi rushing up to the chest, abdominal pain, and alternating chills and fever; Ben Tun Tang (Rushing Pig Decoction) is the primary formula for treatment.
[Annotation]
When Ben Tun Qi rushes up to the throat, causing severe suffering that feels like impending death, this is severe Ben Tun. When Qi rushes up to the chest accompanied by abdominal pain and alternating chills and fever, this is mild Ben Tun. Severe cases are treated with Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Cinnamon Twig) to expel Yin pathogenic factors from the Kidney and descend rebellious Qi. Mild cases are treated with Ben Tun Tang to harmonize Blood from the Heart and dissipate rebellious Qi.
Licorice Root (Gancao) 2 liang, Szechuan Lovage Rhizome (Xiongqiong/Chuanxiong) 2 liang, Angelica Sinensis Root (Danggui) 2 liang, Pinellia Tuber (Banxia) 4 liang, Scutellaria Root (Huangqin) 2 liang, Kudzu Root (Shengge/Gegen) 5 liang, White Peony Root (Shaoyao) 2 liang, Fresh Ginger (Shengjiang) 4 liang, Almond Tree Root Bark (Ganligen Baipi) 1 sheng.
The above nine herbs are boiled with two dou of water until five sheng remain. One sheng is taken warm per dose, administered three times daily and once at night.
[Collected Exegesis]
Shen Mingzong stated: Using Chuanxiong, Danggui, Bai Shao, and Gancao nourishes the righteous Ying and Wei of the Jueyin and Shaoyang channels, causing pathogens to exit outwardly. Combined with Gegen, Huangqin, Banxia, and Shengjiang assisting Liggen Baipi, it resolves half-exterior half-interior chills and fever, allowing rebellious Qi to dissipate. Although Ben Tun belongs to Kidney pathology, there are instances where it arises concurrent with Jueyin and Shaoyang pathogens. Zhang Zhongjing’s use of this formula clearly indicates that it is not caused solely by Cold pathogens.
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After sweating therapy, if palpitations occur below the umbilicus, indicating impending Ben Tun, Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) is the primary formula.
[Annotation]
After sweating therapy, palpitations in the epigastrium indicate deficiency of Heart Yang and disease within the channel itself. Palpitations below the umbilicus indicate Kidney pathogens invading the Heart due to deficiency. Ben Tun refers to Qi moving below the umbilicus and rushing upward. "Impending Ben Tun" refers to symptoms resembling Ben Tun that are about to manifest but have not yet fully developed. Fuling Guizhi Gancao Dazao Tang supplements Fire (Heart/Spleen Yang) to suppress Water pathogens. The previous paragraph elucidated that external Cold pathogens can cause Ben Tun; this paragraph further clarifies that internal Water dampness can also cause Ben Tun.
[Collected Annotations]
Xu Bin stated: Zhang Zhongjing often combines several paragraphs to exhaust variations in argumentation. He discusses Ben Tun arising from fright, Qi rushing from the lower abdomen to the throat, accompanying abdominal pain and alternating chills and fever, accompanying scrofula nodules without other diseases, and post-sweating palpitations below the umbilicus indicating impending but unformed Ben Tun, thereby clarifying the depth and progression of the disease. Treatments include harmonizing methods, suppressing Kidney pathogens, and the nuanced choice between using or not using Cinnamon Twig. For the syndrome of Ben Tun, etiology, symptoms, and treatments are comprehensively covered without omission. If one fails to comprehend Zhang Zhongjing’s intent in formulating these prescriptions, one may fear using potent medicines or find mild agents ineffective. Is it truly that ancient formulas are unsuitable for modern times?
Zhou Yangjun stated: Sweat is the fluid of the Heart. Palpitations in the lower abdomen after sweating indicate Heart Qi deficiency and reckless movement of Kidney Qi.