治风水恶风, 一身悉肿, 脉浮不渴, 续自汗出, 无大
热者. 又治里水, 一身面目黄肿, 其脉沉小便不利, 故令病水. 假令
小便自利, 此亡津液, 故令渴也. 越婢加术汤主之.
麻黄六两 石膏半斤 生姜 ( 切 ) 三两 大枣 ( 擘 ) 十五枚 甘
草一两恶风加附子一枚 ( 炮 )., 右五味, 以水六升, 煮麻黄, 去沫
,纳诸药, 煮取三升, 分三服.
【集注】喻昌曰: 越婢汤者, 示微发表于不发之方也, 大率取其通调
营卫. 麻黄, 石膏二物, 一甘热, 一甘寒, 合而用之, 脾偏于阴则和
以甘热, 胃偏于阳则和以甘寒. 乃至风热之阳, 水寒之阴, 凡不和于
中土者, 悉得用之何也? 中土不和, 则水谷不化其精悍之气以实营卫
.营卫虚, 则或寒, 或热之气, 皆得壅塞其隧道, 而不通于表里. 所
以在表之风水用之, 而在里之水兼渴, 而小便自利者, 咸必用之, 无
非欲其不害中土耳. 不害中土, 自足消患于方萌矣. 赵良曰: 五脏各
一其阴阳, 独脾胃居中而两属之. 故土不独成四气, 土亦从四维而后
成, 不惟火生而已. 于是四方有水寒之阴, 即应于脾, 风热之阳,
即应于胃, 饮食五味之寒热, 凡入于脾胃者亦然. 一有相干, 则脾气
不和, 胃气不清, 而水谷不化其精微, 以行营卫, 以实阴阳也. 甘者
,土之本味, 所以脾气不和, 和以甘热, 胃气不清, 清以甘寒. 麻黄
之甘热, 走手足太阴经, 连于皮肤, 行气于三阴, 以祛阴寒之邪; 石
膏之甘寒, 走手足阳明经, 达于肌肉, 行气于三阳, 以祛风热之邪.
既用其味甘以入土, 用其寒, 热以和阴阳, 用其性善走以发越脾气 ,
更以甘草和中缓急, 二药相协而成功. 大枣之甘, 补脾中之血; 生姜
之辛, 益胃中之气. 恶风者阳虚, 故加附子以益阳. 风水者, 则加术
以散皮肤间风水气, 发谷精以宣营卫, 与麻黄, 石膏为使, 引其入土
也.越婢之名, 不亦宜乎?
【按】喻昌所论明析, 赵良之说, 能细剖其理, 开悟后学, 故两录之
.
Indicated for Wind-Water syndrome presenting with aversion to wind, generalized edema, a floating pulse without thirst, continuous spontaneous sweating, and absence of significant external heat. It is also indicated for Interior Water retention presenting with yellowish swelling of the whole body and face, a deep pulse, and dysuria (difficulty in urination), which leads to water disease. If urination is normal and spontaneous, this indicates depletion of Body Fluids (Jin-Ye), hence the occurrence of thirst. For these conditions, Yuebi Jia Zhu Tang (Yuebi Decoction plus Atractylodis Macrocephalae Rhizoma) is the primary prescription.
Ephedrae Herba (Mahuang, 麻黄) 6 liang, Gypsum Fibrosum (Shigao, 石膏) 0.5 jin, Zingiberis Rhizoma Recens (Shengjiang, 生姜) [sliced] 3 liang, Zizyphi Fructus (Dazao, 大枣) [broken open] 15 pieces, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 1 liang. If aversion to wind is prominent, add one prepared Aconiti Lateralis Radix (Fuzi, 附子). The above five herbs are boiled in 6 sheng of water; first boil Ephedrae Herba, remove the foam, then add the remaining herbs. Boil until 3 sheng of liquid remains, and divide into three doses.
[Collected Annotations] Yu Chang stated: Yuebi Tang (Yuebi Decoction) demonstrates a method of mild diaphoresis without causing excessive sweating, primarily aiming to regulate Ying and Wei (Defensive and Nutritive Qi). Among the two herbs, Ephedrae Herba is sweet and warm, while Gypsum Fibrosum is sweet and cold. When used together, if the Spleen tends toward Yin excess, it is harmonized with sweet-warm substances; if the Stomach tends toward Yang excess, it is harmonized with sweet-cold substances. Why can this formula be used for Wind-Heat (Yang pathogens) and Water-Cold (Yin pathogens) that fail to harmonize in the Middle Jiao? Because when the Middle Jiao is disharmonious, it fails to transform the essence of food and drink into robust Qi to nourish Ying and Wei. When Ying and Wei are deficient, Cold or Heat pathogens can obstruct the meridians and collaterals, preventing communication between the interior and exterior. Therefore, it is used for Exterior Wind-Water, and also for Interior Water retention accompanied by thirst and spontaneous urination, not merely to avoid damaging the Middle Jiao. By protecting the Earth element, disasters can be eliminated at their inception.
Zhao Liang stated: Each of the Five Zang Organs has its own Yin and Yang, but only the Spleen and Stomach reside in the center and belong to both. Thus, Earth does not solely generate the Four Seasons' Qi, nor is it formed solely by the Four Dimensions; it is not just Fire generating Earth. Consequently, Water-Cold from the four directions corresponds to the Spleen, while Wind-Heat corresponds to the Stomach. Similarly, the cold and hot properties of the five flavors of food entering the Spleen and Stomach follow this pattern. Any interference leads to Spleen Qi disharmony and Stomach Qi turbidity, preventing the transformation of food and drink into essences to circulate Ying and Wei and fill Yin and Yang. Sweetness is the fundamental flavor of Earth; thus, Spleen disharmony is harmonized with sweet-warm agents, and Stomach turbidity is cleared with sweet-cold agents. The sweet-warm nature of Ephedrae Herba travels through the Hand and Foot Taiyin Meridians, connects with the skin, circulates Qi in the Three Yin meridians, and dispels Yin-Cold pathogens. The sweet-cold nature of Gypsum Fibrosum travels through the Hand and Foot Yangming Meridians, reaches the muscles, circulates Qi in the Three Yang meridians, and dispels Wind-Heat pathogens. By using their sweet flavor to enter the Earth element, their cold/warm nature to harmonize Yin and Yang, and their penetrating nature to stimulate Spleen Qi, combined with Glycyrrhizae Radix et Rhizoma to moderate and relieve urgency, the two herbs cooperate to achieve success. The sweetness of Zizyphi Fructus tonifies Blood in the Spleen; the pungency of Zingiberis Rhizoma Recens benefits Qi in the Stomach. Aversion to wind indicates Yang deficiency, so Aconiti Lateralis Radix is added to tonify Yang. For Wind-Water, Atractylodis Macrocephalae Rhizoma is added to dissipate Wind-Water Qi in the skin, release grain essences to vent Ying and Wei, and act as guides with Ephedrae Herba and Gypsum Fibrosum to lead the medicinal action into the Earth element. Is the name "Yuebi" not fitting?
[Commentary] Yu Chang's discussion is clear and explicit, and Zhao Liang's explanation meticulously analyzes the principles, enlightening later learners; therefore, both are recorded here.