治手足厥寒。脉细欲绝者。此方主之。
当归(三两) 桂枝(三两) 芍药(三两) 细辛(三两) 大枣(二十五枚) 甘
草(
上七味。以水八升。煮取三升。去滓。温服一升。日三服。当归四逆加吴茱萸生姜汤 治
手足厥寒脉细欲绝。其人内有久寒者。即前方加生姜(半斤) 吴茱萸(二升)上以水六升。
清酒六升。煮取五升。温分五服。
歌曰 三两辛归桂芍行。枣须廿五脉重生。甘通二两能回厥。寒入吴萸(二升。)姜(半
斤。)酒(六升。)烹。罗东逸曰。厥阴为三阴之尽。阴尽阳生。若受寒邪。则阴阳之气不相
顺接。故脉微而厥。然厥阴之脏。相火游行其间。经虽受寒。而脏不即寒。故先厥者后必发
热。所以伤寒初起。见其手足厥冷脉细欲绝者。不得遽认为寒而用姜、附也。此方取桂枝汤
君以当归者。厥阴主肝。肝为血室也。佐细辛。其味极辛。能达三阴。外温经而内温脏。通
草其性极通。善开关节。内通窍而外通荣。去生姜者。恐其过表也。倍大枣者。即建中加饴
之义。用二十五枚者。取五五之数也。肝之志苦急。肝之神欲散。辛甘并举。则志遂而神悦。
未有厥阴神志遂悦。
厥逆与太少不同治也。若其人内有久寒。非辛温之品不能兼治。则加吴萸、生姜之辛热。更
用酒煎。佐细辛。直通厥阴之脏。迅散内外之寒。是又救厥阴内外两伤于寒之法也。
Treats coldness of the hands and feet, with a fine pulse that is nearly imperceptible. This formula is indicated for such cases.
Danggui (Radix Angelicae Sinensis) (3 liang), Guizhi (Ramulus Cinnamomi) (3 liang), Shaoyao (Radix Paeoniae Alba) (3 liang), Xixin (Herba Asari) (3 liang), Dazao (Fructus Jujubae) (25 pieces), Gancao (Radix Glycyrrhizae Preparata) (2 liang).
Take the above seven ingredients, add eight sheng of water, decoct to obtain three sheng of liquid, remove the dregs, and take one sheng warm each time, three times a day.
Danggui Sini Tang plus Wuzhuyu and Shengjiang Decoction: Treats coldness of the hands and feet, with a fine pulse that is nearly imperceptible, in patients who have chronic cold within the interior. Add Shengjiang (Fresh Rhizoma Zingiberis) (0.5 jin) and Wuzhuyu (Fructus Evodiae) (2 sheng) to the previous formula. Take the above ingredients, add six sheng of water and six sheng of clear wine, decoct to obtain five sheng of liquid, and divide into five warm doses.
Song says: Three liang each of Xixin, Danggui, Guizhi, and Shaoyang circulate; twenty-five Dazao are needed to revive the pulse. Two liang each of Gancao and Tongcao can reverse coldness; if cold penetrates deeply, add Wuzhuyu (2 sheng) and Shengjiang (0.5 jin), cooked with wine (6 sheng).
Luo Dongyi stated: Jueyin is the end of the three Yin meridians. When Yin reaches its extreme, Yang begins to generate. If invaded by cold pathogenic factors, the Qi of Yin and Yang fails to connect smoothly, resulting in a faint pulse and cold extremities. However, within the Jueyin organ (Liver), Ministerial Fire (Xianghuo) circulates. Although the meridians are affected by cold, the organs do not immediately become cold. Therefore, those who initially experience cold extremities will subsequently develop fever. Thus, at the onset of Cold Damage (Shanghan), when cold extremities and a fine, nearly imperceptible pulse are observed, one should not hastily diagnose it as pure cold and use hot herbs like Ganjiang (Dried Rhizoma Zingiberis) and Fuzi (Radix Aconiti Lateralis Preparata). This formula takes Guizhi Tang as the base, with Danggui as the sovereign herb, because Jueyin governs the Liver, and the Liver is the repository of blood. Assisted by Xixin, which has an extremely pungent flavor, it can penetrate the three Yin meridians, warming the exterior meridians and interior organs. Tongcao (Medulla Tetrapanacis) has an extremely unblocking nature, good at opening joints, connecting internal orifices and external Ying (Nutritive) Qi. Ginger is omitted to prevent excessive dispersal of the exterior. The amount of Dazao is doubled, following the principle of Jianzhong (Establishing the Middle) with Yitang (Maltose). Twenty-five pieces are used to symbolize the number "five times five." The will of the Liver fears tension, and the spirit of the Liver desires dispersion. Combining pungent and sweet flavors allows the will to be satisfied and the spirit to be joyful. There is no case where the spirit and will of Jueyin are satisfied and joyful, yet cold extremities persist; the treatment differs from that of Taiyang and Shaoyang. If the patient has chronic cold within, only pungent-warm substances can treat it concurrently. Therefore, add the pungent-hot Wuzhuyu and Shengjiang, and decoct with wine to assist Xixin in directly penetrating the Jueyin organ, rapidly scattering cold from both interior and exterior. This is another method for rescuing Jueyin from simultaneous cold invasion of the interior and exterior.