邹氏论附子天雄乌头之性用颇精,为节其说曰,乌头老阴之生育已竟者也,天雄孤阳之
不能生育者也,附子即乌头天雄之种,含阴包阳者也。老阴生育已竟者,其中空,以气为用
。孤阳不能生育者,其中实,以精为用。气主发散,精主敛藏。发散者能外达腠理,敛藏者
能内入筋骨。附子则兼备二气,内充实,外强健,且其物不假系属,以气相贯而生,故上下
表理无乎不到。惟其中蓄二物之精,斯能兼擅二物之长,其用较二物为广尔。
本经附子主风寒咳逆邪气,后世缘此多以为治风之药,其实经文深奥,义别有在也。夫
风有伤与中之分,伤者伤于营卫,中者中于经络脏腑。伤营卫者,寒郁于表而易化热,宜麻
桂决不宜附子。中经络脏腑者,寒根于里而阳本虚,用麻桂又贵用附子。附子非风药,而本
经之主风寒,盖指中风之风寒言,非指伤风之风寒言也。
外台谓中风多从热起,故中风有寒亦有热。风引汤治热之方也,热不用附子,固不待言
。小续命汤治寒之方也,若附子即以驱风,何以附子外不少风药。其有附子无风药,如近效
术附汤治风虚者有之,未闻能散外入之邪风也。邹氏谓附子之治风寒,是阳气不荣,风寒侵
侮,阳振而风寒自退。似非不知附子治风寒之理者。乃又谓仲圣用生附子之方,皆兼有表证
,而其所引白通汤附子汤,则并无未解之表邪。夫白通所以用葱白者,因少阴下利一往不返
,失地道上行之德,葱白能入少阴而升之,非以表汗。附子汤证,是少阴受寒,而阳气不能
四周。表何尝有风,脉沉固不当汗,且其方伍以参术之补,苓芍之降,又岂足胜解表之任。
至仲圣附子生用,非属汗后,即是下利脉沉,汗后宜补表阳,下利脉沉宜挽其气,生用自胜
熟用,
或难予曰∶恶风加附子,越婢汤非明证乎?何说之 也!曰∶大青龙汗出恶风者不可服
,越婢汤加附子,则证为汗出恶风,若附子又从而汗之,独不畏厥逆筋惕肉 耶,盖加附子
正以其汗出。赵氏云∶恶风者阳虚,故加附子以入阳。然则舍附子则有亡阳之祸,岂果为驱
风哉。
用附子于中风风寒,原可不过分,故三生饮无风药,以阳气一充而邪即自消也。若他风
寒证,则定须分治。邹氏亦颇以附子与表药对举,暗中逗出,足见附子外尚有表药,其所引
桂枝加附子汤等八方皆是也。惟其中桂枝附子、白术附子、甘草附子,则为治风湿之方;桂
甘姜枣麻辛附子,则为治气分之方。夫风为阳邪,附子阳药,以其人阳虚而寒重,非扶阳则
风不能以徒驱,故扶阳与驱风并行。寒为阴邪,湿亦为阴邪,风湿之风,与伤风之风,亦致
不同,非阳虚不尔,故亦需附子。气分者,水寒之气,结于心下,证由少阴阳虚而来。故麻
辛附子,温少阴而发汗;桂甘姜枣,化上焦之阳而开结,此从表解。枳术汤则从中泄,病同
而治不同。水饮所作四字,赵氏本上下条皆有之,极是。又麻黄附子汤,以麻黄发表而少阴
脉沉用之,正赖有附子温少阴也,否则脉沉无发汗之理矣。
附子为温少阴专药,凡少阴病之宜温者,固取效甚捷。然如理中汤治腹满,黄土汤治下
血,附子泻心汤治心痞,甚至薏苡附子败酱散治肠痈,如此之类,亦无往不利。惟其挟纯阳
之性,奋至大之力,而阴寒遇之辄解,无他道也。
天雄,仲圣惟天雄散一方,附于桂枝加龙骨牡蛎汤后,不言所主何病。按此与上节离合
之间,必有窜乱,今细绎其文,自夫失精家至为清谷亡血失精,当是以天雄散主之,下以桂
枝加龙骨牡蛎汤主之,正为合宜。何以言之?两方于失精家原可通用。但脉为极虚芤迟,证
见清谷亡血失精,则已肾损及脾,不补脾则生精之源绝。故白术用至八两,少腹弦急、阴头
寒、目眩、发落,种种肾病,自非他补肾药所能胜任,故选用精气充实不外泄之天雄,而以
天雄名方。至其佐使之桂枝龙骨,尤微妙难言。桂枝汤桂枝只三两,而此乃倍之,欲其于太
阳之经府俱到以化气。其证阴既下泄,阳自上浮,而脾肾咸虚之阳,不当潜以咸寒之牡蛎;
得龙骨,则引火归土而亦不损其阳。且桂枝辅天雄则入肾释阴,辅白术则入脾温土;龙骨辅
天雄则固肾涩精,辅白术则固脾祛湿。以天雄散隶于是证,义实至精至确。若脉得诸芤动微
紧,虽天雄散亦可服,要不如桂枝加龙骨牡蛎汤为尤中 。盖脉芤动为阳,微紧为阴,阴阳
气争则表里失和。治之以此汤,桂枝生姜甘枣为阳,芍药为阴;龙骨为阳,牡蛎为阴;于祛
邪涩精之中,有表里相得阴阳互维之妙。此二方是于小建中汤肾气丸外,又别出良法者。就
天雄
乌头治风,亦惟阳虚而挟寒挟湿者宜之。以其中空以气为用,开发腠理,过于附子。故
古方中风证用乌头,较多于附子;抉壅通痹,亦过于附子。故仲圣治历节不可屈伸疼痛,及
逆冷手足不仁身疼痛灸刺诸药不能治,皆用乌头不用附子。乌头与附子,同为少阴药,而补
益以附子为优,发散以乌头为胜。故肾气丸有附子无乌头,大乌头煎有乌头无附子。因乌头
气散不收,故不解表之方,皆去滓纳蜜更煮以节其性。仲圣之用乌头附子,可谓各极其妙矣
。乃乌头赤石脂丸更二物并用,以治心痛彻背背痛彻心,取其母子相感以除内外之邪,此岂
寻常思议所及哉。
Zou’s discussion on the properties and uses of Fuzi (Prepared Aconite Lateralis Radix), Tianxiong (Radix Aconiti Lateralis Preparata), and Wutou (Radix Aconiti) is quite refined. He summarized his view as follows: Wutou is the product of Old Yin after its reproductive function has been completed; Tianxiong is the form of Solitary Yang that cannot reproduce; Fuzi is the seed of both Wutou and Tianxiong, containing Yin within and encompassing Yang externally. The one where Old Yin has completed reproduction is hollow inside and functions through Qi (Vital Energy); the one where Solitary Yang cannot reproduce is solid inside and functions through Jing (Essence). Qi primarily governs dispersion, while Jing primarily governs storage. The dispersive nature can reach outward to the Cou Li (interstitial spaces of the skin and muscles), and the storing nature can penetrate inward to the sinews and bones. Fuzi possesses both these energies; it is solid internally and robust externally. Moreover, this herb does not rely on external attachment but grows through the continuity of Qi, thus reaching everywhere from top to bottom and interior to exterior. Precisely because it accumulates the essence of both aforementioned herbs, it excels in both their strengths, making its scope of application broader than either alone.
The *Shennong Bencao Jing* records that Fuzi treats cough, counterflow qi, evil qi, and pathogenic factors caused by Wind-Cold. Later generations, based on this, often regarded it as a medicine for treating Wind diseases. In fact, the scriptural meaning is profound, with a different implication. Wind diseases are distinguished into "injury" (Shang) and "penetration" (Zhong). Injury refers to damage to Ying and Wei (Nutritive and Defensive Qi); penetration refers to pathogens entering the meridians and zang-fu organs. When Ying and Wei are injured, Cold stagnates at the exterior and easily transforms into Heat; Mahuang Tang or Guizhi Tang are appropriate, and Fuzi is strictly contraindicated. When meridians and zang-fu organs are penetrated, Cold roots in the interior and Yang is inherently deficient; using Mahuang Tang or Guizhi Tang requires the addition of Fuzi. Fuzi is not specifically a Wind-dispelling drug, yet the *Shennong Bencao Jing* states it treats Wind-Cold; here, "Wind" refers to Zhong Feng (Wind Stroke/Invasion of Organs), not Shang Feng (Common Cold/Injury of Surface).
The *Waitai Miyao* states that Zhong Feng often originates from Heat, so Zhong Feng can be either Cold or Heat patterns. Fengyin Tang is a formula for Heat patterns; Heat patterns do not use Fuzi, which goes without saying. Xiaoxuting Tang is a formula for Cold patterns. If Fuzi were a Wind-dispelling drug, why are there few Wind-dispelling herbs in formulas containing Fuzi? There are cases with Fuzi but no Wind-dispelling herbs, such as Jinxiao Shufu Tang treating Wind-Deficiency, but it is unheard of that it can disperse exogenous Wind pathogens. Zou stated that Fuzi treats Wind-Cold because Yang Qi fails to nourish, allowing Wind-Cold to invade; when Yang is revitalized, Wind-Cold recedes naturally. This seems to indicate an understanding of the principle behind Fuzi's treatment of Wind-Cold. However, he further claimed that all Zhang Zhongjing’s formulas using raw Fuzi involve exterior syndromes, whereas the Baitong Tang and Fuzi Tang he cited have no unresolved exterior pathogens. The reason Congbai (Scallion White) is used in Baitong Tang is that Shaoyin syndrome with unceasing diarrhea loses the virtue of Earth’s ascending function; Congbai enters the Shaoyin meridian to lift Qi, not to induce sweating for exterior release. The Fuzi Tang syndrome involves Shaoyin meridian cold invasion where Yang Qi cannot circulate throughout the body. Where is the Wind on the exterior? A deep pulse definitely does not warrant sweating. Furthermore, the formula combines the tonifying properties of Renshen and Baizhu with the descending properties of Fuling and Shaoyao; how could it suffice for the task of releasing the exterior? Regarding Zhang Zhongjing’s use of raw Fuzi, if not after sweating, then it is for diarrhea with a deep pulse. After sweating, tonifying exterior Yang is indicated; for diarrhea with a deep pulse, rescuing Qi is indicated. Raw usage naturally surpasses cooked usage.
A skeptic asked: "Adding Fuzi for aversion to wind—does not Yueshi Tang serve as clear proof? What is your explanation?" I replied: "For Da Qinglong Tang syndrome, if sweating and aversion to wind occur, it must not be taken. In Yueshi Tang plus Fuzi, the symptoms are already sweating and aversion to wind. If Fuzi were to induce further sweating, would one not fear Jue Ni (cold extremities) and Jin Ti Rou Yu (muscle twitching)? Adding Fuzi is precisely because sweating has already occurred. Zhao stated: 'Aversion to wind indicates Yang deficiency, hence Fuzi is added to warm Yang.' If so, abandoning Fuzi leads to Wang Yang (collapse of Yang); is this truly merely for dispelling Wind?"
Using Fuzi for Zhong Feng or Wind-Cold need not be excessive; thus, Sansheng Yin contains no Wind-dispelling herbs, as once Yang Qi is充盈 (replenished), pathogens dissipate spontaneously. For other Wind-Cold syndromes, distinct treatments are required. Zou also juxtaposed Fuzi with exterior-releasing drugs, subtly implying that besides Fuzi, there are exterior drugs; the eight formulas he cited, such as Guizhi Jia Fuzi Tang, are examples. Among them, Guizhi Fuzi Tang, Baizhu Fuzi Tang, and Gancao Fuzi Tang are formulas for treating Wind-Dampness; Guizhi Gancao Jiangzao Maxing Fuzi Tang (referring to a variation involving Ma Huang, Xi Xin, etc.) is a formula for treating Qi Fen (Qi Division/Water-Cold accumulation). Wind is a Yang pathogen, and Fuzi is a Yang drug. Because the patient has Yang deficiency and severe Cold, if Yang is not supported, Wind cannot be driven away merely by dispersing; thus, supporting Yang and dispelling Wind proceed together. Cold is a Yin pathogen, and Dampness is also a Yin pathogen. The "Wind" in Wind-Dampness differs significantly from the "Wind" in common cold; unless there is Yang deficiency, this pattern does not arise, hence Fuzi is needed. Qi Fen disease refers to Water-Cold Qi knotting below the heart, originating from Shaoyin Yang deficiency. Therefore, Mahuang Fuzi Xixin Tang warms Shaoyin and induces sweating; Guizhi Gancao Jiangzao Tang transforms Upper Jiao Yang to open knots, resolving from the exterior. Zhizhu Tang drains from the middle; although the disease is similar, the treatment differs. Zhao’s mention of "caused by water retention" in both upper and lower sections is highly accurate. Additionally, Mahuang Fuzi Tang uses Mahuang to release the exterior while the Shaoyin pulse is deep; this relies entirely on Fuzi warming Shaoyin. Otherwise, there is no rationale for sweating with a deep pulse.
Fuzi is the dedicated drug for warming Shaoyin. For any Shaoyin syndrome requiring warming, it indeed yields rapid results. However, formulas like Lizhong Tang for abdominal fullness, Huangtu Tang for hematochezia, Fuzi Xie Xin Tang for epigastric stuffiness, and even Yiyi Fuzi Baijiang San for intestinal abscess—all these prove effective. It is solely due to its pure Yang nature and immense power that Yin-Cold dissolves upon contact; no other method achieves this.
Tianxiong: Zhang Zhongjing only has one formula, Tianxiong San, appended after Guizhi Jia Longgu Muli Tang, without stating its primary indication. Considering the transition between the previous section, there must be textual corruption. Careful analysis suggests that from "those prone to seminal emission" to "clear stool, blood loss, and seminal emission," Tianxiong San should be the primary treatment, followed by Guizhi Jia Longgu Muli Tang, which is appropriate. Why? Both formulas can generally be used for those prone to seminal emission. But if the pulse is extremely deficient, knotted, and slow, and symptoms include clear stool, blood loss, and seminal emission, Kidney damage has extended to Spleen. Without tonifying Spleen, the source of Essence generation is cut off. Hence, Baizhu is used up to eight liang. For various Kidney diseases such as tension in the lower abdomen, cold in the genital area, dizziness, and hair loss, no other Kidney-tonifying drug can胜任 (handle) this case. Thus, Tianxiong, whose essence is solid and does not leak, is selected, and the formula is named after it. The assistant ministers Guizhi and Longgu are particularly subtle. In Guizhi Tang, Guizhi is only three liang, but here it is doubled to ensure it reaches both the Taiyang meridian and fu organs to transform Qi. Since Yin leaks downward, Yang floats upward; the Yang of both Spleen and Kidney, being deficient, should not be anchored with salty-cold Muli. With Longgu, Fire returns to Earth without damaging Yang. Furthermore, Guizhi assisting Tianxiong enters the Kidney to resolve Yin; assisting Baizhu enters the Spleen to warm Earth. Longgu assisting Tianxiong secures the Kidney and astringes Essence; assisting Baizhu secures the Spleen and expels Dampness. Classifying Tianxiong San under this syndrome is truly precise and accurate. If the pulse shows knotted, moving, fine, and tight qualities, Tianxiong San may still be taken, but Guizhi Jia Longgu Muli Tang is more targeted. Knotted and moving pulses indicate Yang; fine and tight pulses indicate Yin. Conflict between Yin and Yang Qi leads to disharmony between interior and exterior. Treating with this formula, Guizhi, Shengjiang, Gancao, and Dazao are Yang; Shaoyao is Yin; Longgu is Yang; Muli is Yin. Within dispelling pathogens and astringing Essence, there is the subtlety of interior-exterior harmony and mutual support of Yin and Yang. These two formulas represent another excellent method alongside Xiaojianzhong Tang and Shenqi Wan.
Regarding Tianxiong and Wutou treating Wind, they are suitable only for Yang deficiency with accompanying Cold and Dampness. Because they are hollow inside and function through Qi, their ability to open Cou Li exceeds that of Fuzi. Therefore, ancient formulas for Wind stroke used Wutou more frequently than Fuzi; for breaking stagnation and unblocking Bi obstruction, Wutou also surpasses Fuzi. Thus, Zhang Zhongjing used Wutou instead of Fuzi for Lijie syndrome (painful joint disease with immobility), and for cold extremities, numbness, body pain, and conditions unresponsive to moxibustion and acupuncture. Although Wutou and Fuzi are both Shaoyin drugs, Fuzi is superior for tonification, while Wutou excels in dispersion. Hence, Shenqi Wan contains Fuzu but no Wutou, while Dawutou Jian contains Wutou but no Fuzi. Because Wutou’s Qi scatters and does not retain, in formulas not intended for exterior release, the dregs are removed, honey is added, and it is boiled again to moderate its properties. Zhang Zhongjing’s use of Wutou and Fuzi was truly masterful. Wu Tou Chi Shi Zhi Wan uses both substances together to treat chest pain radiating to the back and back pain radiating to the chest, utilizing the mutual influence of mother and child elements to eliminate internal and external pathogens. This transcends ordinary reasoning.