三、本编分类:依据方剂类型,分为桂枝汤类、麻黄汤类等共十二类,使读者不但便于查阅,而且便于集中体会用药的具体法则。(整理者按:此次重新编排方序有所调整。)
四、本编每一方下分为方义、主治、药品、加减法、煎服法、用药大意、禁忌证、类似方剂参考等栏目,其用意如下:
“方义” 系说明本方对各种疾病的主要作用;
“主治” 系说明主治疾病和具体症状,并根据实践指出在使用时必须注意的关键现象,以便易于掌握,并避免发生错误。
“药物” 列出原方的组成药品,并根据经验定出一般使用范围,以便临床斟酌采用。
“加减法” 以原有的加减药品为限,有的略加解释和用量,以便临床易于引申。
“煎服法” 本栏介绍一般用水的数量和服法的大概轮廓,不可能做到十分精确.
“用药大意” 本栏只根据各种药品的共同作用分类集中在一起,说明各类药物的治疗方向,一般不涉及其他不同之处。各药详细部分另详《药物编》.,
“禁忌证” 本栏只举出与主治疾病相反的关键证,是为了从反面进一步审查应用方剂是否正确,以避免看法片面的错误。
“类似方剂参考” 本栏是为了加强用方的准确性,只介绍两种情况:一系有关禁忌证的类似方剂, 一系有关主治证或轻或重的类似方剂。
李翰卿于1960年
桂枝汤方第一
[方义]
此太阳病解肌和荣卫之主方。所谓解肌,亦属于辛温发汗范围内的一种方法。不过这种发汗是在有汗时进行的,所以不叫作发汗而叫作解肌。从“和荣卫”三字体会,说明这种方法有时候不完全以出汗为目的。
[主治]
(1)太阳病中风,头痛,项强,恶风寒,汗出,脉浮缓。
(2)时发热,自汗出。
(3)常自汗出。
(4)身疼痛。
(5)气上冲。
以上五证,都是荣卫不和的证候,凡见一证,即可使用本方。但必须兼有舌无苔或苔淡白而薄、不喜冷性饮食、咽喉不干燥、小便清白等症方为妥善。
[药品]
桂枝二至三钱 生杭芍二至三钱 炙草一至二钱 生姜一至三钱 大枣二至四枚
[加减法]
(1)兼背强者,加葛根(即桂枝加葛根汤)。
(2)兼气喘者,加厚朴、杏仁(即桂枝加厚朴杏仁汤)。
(3)发汗过多,桂枝证仍在,恶风,小便难,四肢微急,难以屈伸者,加附子(即桂枝加附子汤)。
(4)兼腹痛,不拒按者,倍加芍药(即桂枝加芍药汤).
(5)兼腹痛,拒按者,倍加芍药,更加大黄(即桂枝加大黄汤)。
(6)桂枝证误下后,兼脉促胸满者,去芍药(即桂枝去芍药汤)。
(7)桂枝证误下后,兼胸满,脉微,恶寒者,去芍约加附子(即桂枝去芍药加附子汤)。
[煎服法]
水三茶杯,煎至多半茶杯,去滓温服。服后少停一二分钟,饮热稀粥一碗,以助药力。并用被子温覆取汗。以遍体湿润为度。不可如水淋漓,恐汗出过多,不但病不能除,且容易重感风寒。若一服病已愈,不必再服。如不愈,仍可照前法服之.此药必须早午晚连续服用,时间不可拉长。每服一次,必须检查病情有无变化,最要紧的是必须注意口渴与不渴,或喜冷性饮食与否。如果有口渴,或喜冷现象,可以马㈠巴药停止,或配合石膏一类的寒性药品,以免误犯阳盛之戒。如病情没有变化,可以继续服用,虽二三剂也可。除此以外,注意避风,饮食方面可吃些有营养的流动性食物。忌食生冷、油腻、酒肉、五辛、臭恶等不易消化或带刺激性的食物,以免影响疗效。
[用药大意]
桂枝发汗解肌,芍药活血敛汗,二药配合起来,有解肌和荣卫的作用。但二药仍嫌力量不足,故加生姜助桂枝以散邪,加大枣、甘草调胃气以补正。更服热粥以助之,覆被以温之,使患者得微汗,邪祛而正不伤。此诚治中风表虚有汗,调和荣卫之主方。
[禁忌证]
(1)口渴喜冷.
(2)酒客及湿热证的身热汗出。
(3)小便数,心烦,脚挛急。
(4)鼻衄。
(5)脉浮紧,无汗。
门渴喜冷是最主要的禁忌证, 占人所谓“桂枝下咽,阳盛则毙”的“阳盛” 二字,正是指这些证候而言(\我的经验,不但有口渴喜冷之症不可用.就是有口干咽燥之症,也不可用,因为这些症状都是有热的现象.除此以外,季节的春夏,我国地区的南方,都应该慎重考虑,因为这些季节和地区热性病较多,或转变为热证较为容易。至于酒客及湿热证,都不是太阳风寒之病,故不用。小便数,心烦:脚挛急。属于阴阳两虚的太阳证。鼻衄不是阴虚,便是内热,所以也不能用。此外,表实无汗之证,绝不可用。
[类似方剂参考]
(1)麻黄汤:此治太阳证无汗之方。
(2)九味羌活汤:此治四时感冒,兼有湿热,有汗加桂枝,无汗加麻黄之方。
(3)神术散:此治内伤冷饮,外感寒邪,有汗用白术,无汗用苍术之方。
以上是主治第一项病证参考之方。
(4)白虎汤:此治阳明病,发热,汗出,兼口渴饮冷之方。
(5)雷少逸清热保津法:此治温病发热,有汗之方。
以上是主治第二项病证参考之方。
(6)参附汤:此治肾阳不足白汗之方。
(7)芪附汤:此治卫阳不足自汗之方。
(8)术附汤:此治脾阳不足自汗之方。
以上是主治第三项病证参考之方。
(9)桂枝加芍药生姜人参新加汤:此治汗后身疼痛之方。
(1O)桂枝附子汤:此治阳虚,风寒湿身体疼痛之方。
(11)桂枝附子汤去桂加白术汤(白术附子汤):此治阳虚、寒湿身体疼痛之方。
(12)甘草附子汤:此治风寒湿骨节疼痛,偏于寒湿之方。
(13)附子汤:此治少阴病,身体疼痛,脉沉而微细之方。
以上是主治第四项病证参考之方。
(14)桂枝加桂汤:此治寒性奔豚气上冲之方。
(15)烧裈散:此治男女劳复气上冲之方。
(16)乌梅丸:此治厥阴证,上热下寒,气上冲之方。
以上是主治第五项病证参考之方。
桂枝麻黄各半汤方第二
[方义]
此治风寒客于肌表,其症较轻,为日较久,辛温发汗之轻剂。
[主治]
太阳病,微发热恶寒,一日二三度发,脉较微,有欲汗的趋势。兼面有热色,或身痒等症。没有口渴喜冷的内热现象。
[药品]
桂枝一钱至钱牛 生杭芍一钱至钱半 生姜五分至.钱炙草五至六分 麻黄一钱至钱半 大枣一至二枚 杏仁一钱至钱半
[煎服法]
水一至二茶杯,煎至半茶杯,去滓温服。
[用药大意]
桂枝汤解肌肉中风寒,麻黄汤散皮肤中风寒。因前此未汗。故不得不汗,但日数颇久,病势也轻,所以小发其汗。
[禁忌证]
(1)寒热似疟,病势较重,脉较有力,适用重剂治疗者.不宜用。恐药轻不能胜任.
(2)兼有口渴、喜冷等内热现象者忌之。恐以火益火,犯阳盛之戒。
(3)由于汗后形成寒热如疟者,不宜用。因此方麻黄用量较多,恐发汗太过也。
III. Classification of this section: Based on the types of formulas, they are divided into twelve categories, such as Guizhi Tang (Cinnamon Twig Decoction) category and Mahuang Tang (Ephedra Decoction) category, so that readers can not only consult them conveniently but also concentrate on understanding the specific principles of medication. (Editor's note: The order of formulas has been adjusted in this reorganization.)
IV. Under each formula in this section, there are columns for "Formula Meaning," "Indications," "Medicinal Ingredients," "Modifications," "Decoction and Administration Method," "General Principles of Medication," "Contraindications," and "Reference to Similar Formulas." Their purposes are as follows:
"Formula Meaning" explains the main effects of this formula on various diseases;
"Indications" explains the indicated diseases and specific symptoms, and points out key phenomena to be noted during use based on practice, to facilitate mastery and avoid errors.
"Medicinal Ingredients" lists the original composition of the formula and defines a general scope of use based on experience, for clinical consideration.
"Modifications" is limited to the original modified ingredients, with some brief explanations and dosages provided to facilitate clinical extension.
"Decoction and Administration Method" introduces the general amount of water used and the rough outline of administration methods; it cannot be extremely precise.
"General Principles of Medication" categorizes and groups medicines according to their common actions, explaining the therapeutic direction of each category, generally not involving other differences. Detailed information on each herb is provided separately in the "Herbal Materia Medica Section."
"Contraindications" lists key syndromes opposite to the indicated disease, to further review from the reverse perspective whether the application of the formula is correct, avoiding one-sided errors in judgment.
"Reference to Similar Formulas" aims to strengthen the accuracy of formula usage, introducing only two situations: similar formulas related to contraindications, and similar formulas related to indications that are either milder or more severe.
Li Hanqing, 1960
Guizhi Tang (Cinnamon Twig Decoction) Formula No. 1
[Formula Meaning]
This is the primary formula for resolving the muscle layer and harmonizing Ying and Wei (Nutritive and Defensive Qi) in Taiyang Disease (disease of the Taiyang channel). "Resolving the muscle layer" is also a method within the scope of acrid-warm diaphoresis. However, this sweating occurs when sweat is already present, so it is called "resolving the muscle layer" rather than "diaphoresis." Understanding the phrase "harmonizing Ying and Wei" indicates that this method does not always aim solely at inducing sweat.
[Indications]
(1) Taiyang Disease Wind Strike (Taiyang Zhong Feng), headache, stiff neck, aversion to wind and cold, sweating, floating and moderate pulse.
(2) Intermittent fever with spontaneous sweating.
(3) Chronic spontaneous sweating.
(4) Body pain.
(5) Qi rushing upward.
The above five syndromes are all manifestations of disharmony between Ying and Wei. If any one syndrome is present, this formula can be used. However, it must be accompanied by a tongue without coating or with a pale white and thin coating, no preference for cold food and drink, non-dry throat, and clear urine for proper application.
[Medicinal Ingredients]
Guizhi (Cinnamomi Ramulus) 2-3 qian, Sheng Hangshao (Raw Paeoniae Radix Alba) 2-3 qian, Zhi Cao (Prepared Glycyrrhizae Radix et Rhizoma) 1-2 qian, Shengjiang (Zingiberis Rhizoma Recens) 1-3 qian, Dazao (Jujubae Fructus) 2-4 pieces.
[Modifications]
(1) Accompanied by stiffness in the back, add Gegen (Puerariae Radix) (i.e., Guizhi Jia Gegen Tang [Cinnamon Twig Plus Kudzu Root Decoction]).
(2) Accompanied by asthma/wheezing, add Houpo (Magnoliae Officinalis Cortex) and Xingren (Armeniacae Semen Amarum) (i.e., Guizhi Jia Houpo Xingren Tang [Cinnamon Twig Plus Magnolia Bark and Apricot Seed Decoction]).
(3) After excessive sweating, if Guizhi Syndrome persists with aversion to wind, difficulty urinating, slight tightness in the four limbs, and difficulty bending and extending, add Fuzi (Aconiti Lateralis Radix Praeparata) (i.e., Guizhi Jia Fuzi Tang [Cinnamon Twig Plus Prepared Aconite Root Decoction]).
(4) Accompanied by abdominal pain that does not resist pressure, double the dosage of Shaoyao (Paeoniae Radix) (i.e., Guizhi Jia Shaoyao Tang [Cinnamon Twig Plus Peony Root Decoction]).
(5) Accompanied by abdominal pain that resists pressure, double the dosage of Shaoyao and add Dahuang (Rhei Radix et Rhizoma) (i.e., Guizhi Jia Dahuang Tang [Cinnamon Twig Plus Rhubarb Decoction]).
(6) After incorrect purgation in Guizhi Syndrome, accompanied by rapid pulse and chest fullness, remove Shaoyao (i.e., Guizhi Qu Shaoyao Tang [Cinnamon Twig Decoction Without Peony Root]).
(7) After incorrect purgation in Guizhi Syndrome, accompanied by chest fullness, faint pulse, and aversion to cold, remove Shaoyao and add Fuzi (i.e., Guizhi Qu Shaoyao Jia Fuzi Tang [Cinnamon Twig Decoction Without Peony Root Plus Prepared Aconite Root]).
[Decoction and Administration Method]
Use three teacups of water, decoct until slightly more than half a teacup remains, strain, and take warm. After taking, wait one or two minutes, then drink a bowl of hot thin porridge to assist the medicinal power. Cover with a blanket to induce sweating. The degree should be moistening over the whole body. Do not let sweat drip like water, lest excessive sweating fail to eliminate the disease and easily cause reinfection with wind-cold. If the disease is cured after one dose, no need to take more. If not cured, continue following the previous method. This medicine must be taken continuously morning, noon, and evening; the interval should not be prolonged. Each time before taking, check for changes in the condition. Most importantly, pay attention to thirst or lack thereof, and preference for cold food/drink or not. If there is thirst or preference for cold, stop the medicine immediately or combine with cold-natured herbs like Shigao (Gypsi Fibrosus), to avoid violating the prohibition against Yang excess. If the condition has not changed, continue taking it, even for two or three doses. In addition, avoid wind. Diet can include nutritious liquid foods. Avoid raw, cold, greasy, meat, alcohol, five pungent spices, and foul-smelling foods that are hard to digest or irritating, to avoid affecting efficacy.
[General Principles of Medication]
Guizhi induces sweating and resolves the muscle layer; Shaoyao invigorates blood and astringes sweat. Together, they resolve the muscle layer and harmonize Ying and Wei. However, these two herbs alone are considered insufficient in strength, so Shengjiang is added to assist Guizhi in dispersing pathogens, and Dazao and Gancao are added to regulate Stomach Qi and tonify healthy Qi. Drinking hot porridge assists this process, and covering with a blanket warms the patient, allowing them to achieve slight sweating, expelling pathogens without damaging healthy Qi. This is indeed the primary formula for treating Wind Strike with exterior deficiency and sweating, harmonizing Ying and Wei.
[Contraindications]
(1) Thirst with preference for cold.
(2) Fever and sweating in drinkers and those with Damp-Heat syndrome.
(3) Frequent urination, mental restlessness, and leg cramps.
(4) Epistaxis (nosebleed).
(5) Floating and tight pulse without sweating.
Thirst with preference for cold is the most important contraindication. The term "Yang Excess" in the ancient saying "When Guizhi enters the throat, Yang Excess leads to death" refers precisely to these syndromes. In my experience, not only should it not be used for thirst with preference for cold, but also for dry mouth and throat, as these are signs of heat. Furthermore, in the seasons of spring and summer, and in southern regions of China, caution should be exercised, as heat diseases are more common in these seasons and regions, or tend to transform into heat syndromes easily. As for drinkers and Damp-Heat syndromes, they are not Taiyang Wind-Cold diseases, so this formula is not used. Frequent urination, mental restlessness, and leg cramps belong to Taiyang syndrome with both Yin and Yang deficiency. Epistaxis is either due to Yin deficiency or internal heat, so it cannot be used. Additionally, exterior excess syndrome without sweating is absolutely contraindicated.
[Reference to Similar Formulas]
(1) Mahuang Tang (Ephedra Decoction): This formula treats Taiyang syndrome without sweating.
(2) Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction): This formula treats seasonal colds complicated by Damp-Heat; add Guizhi if sweating is present, add Mahuang if sweating is absent.
(3) Shenzhu San (Divine Efficacy Powder): This formula treats internal injury from cold drinks and external contraction of cold pathogen; use Baizhu (Atractylodis Macrocephalae Rhizoma) if sweating is present, use Cangzhu (Atractylodis Rhizoma) if sweating is absent.
These are reference formulas for the first indicated symptom.
(4) Baihu Tang (White Tiger Decoction): This formula treats Yangming Disease with fever, sweating, and thirst with preference for cold drinks.
(5) Lei Shaoyi's Clearing Heat and Preserving Fluids Method: This formula treats Warm Disease with fever and sweating.
These are reference formulas for the second indicated symptom.
(6) Shenfu Tang (Ginseng and Aconite Decoction): This formula treats spontaneous sweating due to Kidney Yang deficiency.
(7) Qifu Tang (Astragalus and Aconite Decoction): This formula treats spontaneous sweating due to Wei Yang deficiency.
(8) Shufu Tang (Atractylodes and Aconite Decoction): This formula treats spontaneous sweating due to Spleen Yang deficiency.
These are reference formulas for the third indicated symptom.
(9) Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang (Newly Added Cinnamon Twig Plus Peony, Ginger, and Ginseng Decoction): This formula treats body pain after sweating.
(10) Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction): This formula treats body pain due to Wind-Cold-Dampness in Yang deficiency.
(11) Guizhi Fuzi Tang Qu Gui Jia Baizhu Tang (Baizhu Fuzi Tang / Atractylodes and Aconite Decoction): This formula treats body pain due to Cold-Dampness in Yang deficiency.
(12) Gancao Fuzi Tang (Licorice and Aconite Decoction): This formula treats bone and joint pain due to Wind-Cold-Dampness, leaning towards Cold-Dampness.
(13) Fuzi Tang (Aconite Decoction): This formula treats Shaoyin Disease with body pain, deep and fine pulse.
These are reference formulas for the fourth indicated symptom.
(14) Guizhi Jia Gui Tang (Cinnamon Twig Plus Cinnamon Twig Decoction): This formula treats cold-type Ben Tun (running piglet) with Qi rushing upward.
(15) Shao Kun San (Burnt Underwear Powder): This formula treats Qi rushing upward due to labor relapse in men and women.
(16) Wumei Wan (Mume Pill): This formula treats Jueyin Syndrome with upper heat and lower cold, with Qi rushing upward.
These are reference formulas for the fifth indicated symptom.
Guizhi Mahuang Gehan Tang (Half-Half Cinnamon Twig and Ephedra Decoction) Formula No. 2
[Formula Meaning]
This is a mild agent for acrid-warm diaphoresis, treating Wind-Cold invading the muscle and skin surface, with mild symptoms and a longer duration.
[Indications]
Taiyang Disease, slight fever and aversion to cold, occurring two or three times a day, relatively faint pulse, with a tendency to sweat. Accompanied by a flushed face or body itching. There is no internal heat phenomenon such as thirst with preference for cold.
[Medicinal Ingredients]
Guizhi 1 qian to 1.5 qian, Sheng Hangshao 1 qian to 1.5 qian, Shengjiang 0.5 qian to 1 qian, Zhi Cao 0.5-0.6 qian, Mahuang 1 qian to 1.5 qian, Dazao 1-2 pieces, Xingren 1 qian to 1.5 qian.
[Decoction and Administration Method]
Use one to two teacups of water, decoct until half a teacup remains, strain, and take warm.
[General Principles of Medication]
Guizhi Tang resolves Wind-Cold in the muscles; Mahuang Tang disperses Wind-Cold in the skin. Since there was no prior sweating, sweating is necessary, but since the duration has been long and the pathology is mild, only slight sweating is induced.
[Contraindications]
(1) Alternating chills and fever resembling malaria, with heavier pathology and stronger pulse, requiring heavy agents for treatment, should not use this. Fear that the light agent will be ineffective.
(2) Contraindicated for those with internal heat phenomena such as thirst and preference for cold. Fear of adding fire to fire, violating the prohibition against Yang excess.
(3) Not suitable for alternating chills and fever resembling malaria resulting from post-sweating conditions. Because this formula contains a larger amount of Mahuang, fear of excessive sweating.