(外台崔氏)疗伤寒一日至三日。可汗。度瘴散方
麻黄(十分去节) 桔梗 蜀椒(汗) 细辛 白术 吴茱萸 防风(各四分) 乌头(炮) 干姜 桂心(各五分)
上十味。捣筛为散。温酒服方寸匕。服后。覆取汗。或数服。得汗。即止。若得病一二日而轻者。服此药。皆得汗
解。若得便重者。颇不能解也。然可以三大豆许。着鼻孔中。觉燥涕出。一日可三四着。必愈。兼辟天行病。
琥按上方。治太阴病吐利。少阴病反发热。厥阴病头痛厥逆等。真正阴证。用之辄效。
又疗伤寒敕(作赤)色。恶寒发热。体疼。发汗神丹丸方。
人参(五分) 乌头(四分炮) 半夏(洗五分) 茯苓(五分) 朱砂(一分研) 附子(四分炮)
上六味。捣为末。蜜和丸。如大豆。每服三丸。生姜汤下。发汗。出令体中 然。如汗未出。更以热粥投之。令
汗出。若汗少不解。复如前法。若得汗足不解。当服桂枝汤。此药多毒。饮水解其热。愈周护军子期。自说天行用之甚
良。故记之。
琥按上主疗云。伤寒敕色。恶寒发热体痛。全似阳证。及观方中药味。皆系辛甘温热补剂。乃知面赤色。反发热。
本少阴中寒证。上方专温少阴。兼补太阴之药也。方名神丹者。即仲景论例中所云。神丹甘遂。合而饮之之谓。相传神
丹为解表药。意即此欤。
活人总括云。厥冷蜷默。自利烦躁。而无身热头疼。是为阴证可温。脉沉而微细缓弱者。此阴病也。阴经受邪。是
为脏病。而温阴之药皆热。未可遽温者。且安其中。前所谓阴证伤寒。初病以来。便见脉沉厥冷恶寒。更无头痛。即是
少阴受病之证。医法以干姜附子辈温之。又不可以三阴传次。先太阴而后少阴也。
愚按上论云。且安其中者。是温足太阴阳明脾与胃也。
又云。阴证唇青舌黑。或白苔。或卷强者用生姜频擦唇口。续又易之。姜能回阳。生胃解毒。温血散气。擦之后。
阴消阳长。黑转而红。最为良法。
琥按姜擦法。今医但用以治阳证舌黑者甚误。上论云阴证舌黑。用之以擦唇口。使先开胃家之寒。乃正治之法也。
又云。阴盛隔阳。脉细沉疾。身冷。大烦躁。嗜卧泥水之中。欲饮水而不欲入口者。若饮水者非。可服霹雳散。火
焰散。丹砂丸亦效。孙用和以半两黑附子一枚。烧存性。候冷为末。入真腊茶一大钱匕。和为二服。每服水一盏。蜜半
匙。煎六分。冷服。躁止。得睡。汗出。皆药之验也。
琥按上孙用和法。即活人书霹雳散也。方用附子以回寒极之阴。腊茶以调拒隔之阳。白蜜以止烦润燥。使阴阳调和。
而病自愈矣。
(《外台秘要》引崔氏方)治疗伤寒发病一日至三日。可以采用发汗法。度瘴散方:
麻黄(十分,去节) 桔梗 蜀椒(出汗用) 细辛 白术 吴茱萸 防风(各四分) 乌头(炮制) 干姜 桂心(各五分)
以上十味药,捣碎过筛制成散剂。用温酒送服一方寸匕。服药后,覆盖身体以取汗。或者服用数次,一旦得汗,即停止服药。如果是患病一二日且病情较轻者,服用此药,都能通过发汗而解。如果病情较重者,则很难通过发汗治愈。然而可以将大约三颗大豆大小的药末塞入鼻孔中,感觉鼻腔干燥、流出鼻涕即可。一天可塞三四次,必定痊愈。兼有预防时行疫病的作用。
琥按:上述方子,用于治疗太阴病出现的呕吐下利、少阴病反见发热、厥阴病出现的头痛四肢厥逆等真正的阴证,使用往往有效。
又治疗伤寒面色发红(赤色),恶寒发热,身体疼痛的发汗神丹丸方:
人参(五分) 乌头(四分,炮制) 半夏(洗,五分) 茯苓(五分) 朱砂(一分,研细) 附子(四分,炮制)
以上六味药,捣成粉末,用蜂蜜和丸,如大豆大小。每次服用三丸,生姜汤送下以发汗。令身体微微湿润。如果汗未出,再用热粥饮用,促使出汗。如果汗少病不解,再照前面的方法。如果汗出充足病仍不解,应当服用桂枝汤(Cinnamon Twig Decoction)。此药毒性较大,饮水可以缓解其热毒。周护军之子周子期自己说,治疗时行疫病使用此方效果很好,所以记录下来。
琥按:上述主治描述中提到“伤寒面色发红,恶寒发热,身体疼痛”,完全像是阳证。但观察方中的药物,都是辛甘温热的补益药剂,由此可知,面赤色、反发热,本是少阴病中寒证。上方是专门温补少阴,兼补太阴的药物。方名“神丹”,就是张仲景论述中所说的“神丹”与甘遂合饮的意思。相传神丹是解表药,意思大概就在这里吧。
《活人书》总括说:四肢厥冷、蜷缩静默、自发性下利、烦躁,而没有身热头疼,这是阴证,可以用温法。脉象沉而微细缓弱的,这是阴病。阴经受邪,称为脏病。而温补阴经的药都是热性的,不可急于温补,暂且安顿其中气。前文所说的阴证伤寒,从初病以来,就出现脉沉、四肢厥冷、恶寒,更没有头痛,这就是少阴经受病的证候。医法用干姜、附子类药物治疗。又不可以按照三阴传变的次序,认为先太阴而后少阴。
愚按:上述论述中说“暂且安顿其中气”,是指温补足太阴脾经和足阳明胃经的脾与胃。
又说:阴证出现嘴唇青紫、舌色黑或白苔,或舌体卷曲强硬者,用生姜频繁擦拭唇口,随后更换新的生姜。生姜能回阳,生胃解毒,温血散气。擦拭之后,阴气消退阳气增长,黑色转为红色,是最好的方法。
琥按:生姜擦拭法,现在的医生只用来治疗阳证舌黑者,非常错误。上述论述说阴证舌黑,用它来擦拭唇口,是为了先开通胃家的寒气,这才是正治之法。
又说:阴盛格阳,脉象细沉疾速,身体寒冷,极度烦躁,想睡在泥水中,想喝水但不愿入口者,如果强行饮水是不对的,可以服用霹雳散、火焰散,丹砂丸也有效。孙用和用半两重的一枚黑附子,烧至存性,冷却后研末,加入真腊茶一大钱匕,调和为两次服量。每次用水一盏,蜜半匙,煎至六分,冷服。烦躁停止,入睡,出汗,都是药效的验证。
琥按:上述孙用和的方法,就是《活人书》中的霹雳散。方中使用附子以挽回极寒之阴,腊茶以调理格拒之阳,白蜜以止烦润燥,使阴阳调和,病自然痊愈。
(Wai Tai Mi Yao citing Cui Shi) Treats Shanghan (Cold Damage) from one to three days after onset. Sweating method can be employed. Duzhang San (Dampness-Dispelling Powder) Formula:
Ephedrae Herba (Mahuang, 麻黄) (10 fen, remove nodes), Platycodonis Radix (Jiegeng, 桔梗), Zanthoxyli Pericarpium (Shujiao, 蜀椒 - for sweating), Asari Radix et Rhizoma (Xixin, 细辛), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Evodiae Fructus (Wuzhuyu, 吴茱萸), Saposhnikoviae Radix (Fangfeng, 防风) (each 4 fen), Aconiti Lateralis Radix Preparata (Wutou, 乌头 - processed), Zingiberis Rhizoma Recens (Ganjiang, 干姜), Cinnamomi Ramulus (Guixin, 桂心) (each 5 fen).
The above ten ingredients are pounded and sifted into a powder. Take one cun bi (a square-inch measure) with warm wine. After taking the medicine, cover the body to induce sweating. Or take several doses; once sweating occurs, stop immediately. If the illness is mild and has lasted only one or two days, taking this medicine will resolve the condition through sweating. If the illness is severe, it may not resolve easily through sweating. However, place approximately the amount of three soybeans of the powder into the nostrils. When dryness is felt and nasal discharge occurs, do this three to four times a day; it will surely cure. It also helps prevent epidemic diseases.
Hu notes: The above formula treats true Yin syndromes such as vomiting and diarrhea in Taiyin syndrome (Taiyin Disease), fever appearing contrary to expectation in Shaoyin syndrome (Shaoyin Disease), and headache with cold extremities in Jueyin syndrome (Jueyin Disease); its use is often effective.
Another formula for treating Shanghan (Cold Damage) presenting with red complexion, aversion to cold, fever, and body pain, inducing sweating: Shendan Wan (Divine Elixir Pill) Formula:
Ginseng Radix (Renshen, 人参) (5 fen), Aconiti Lateralis Radix Preparata (Wutou, 乌头) (4 fen, processed), Pinelliae Rhizoma Preparatum (Banxia, 半夏 - washed), Poria (Fuling, 茯苓) (5 fen), Cinnabaris (Zhusha, 朱砂) (1 fen, ground), Aconiti Radix Preparata (Fuzi, 附子) (4 fen, processed).
The above six ingredients are pounded into powder, mixed with honey, and formed into pills the size of soybeans. Take three pills each time, administered with Ginger Decoction to induce sweating. The goal is for the body to become slightly moist. If sweat does not appear, drink hot porridge water to promote sweating. If the sweat is insufficient and the disease persists, repeat the previous method. If sufficient sweat appears but the disease does not resolve, administer Guizhi Tang (Cinnamon Twig Decoction). This medicine is highly toxic; drinking water can alleviate its heat toxicity. Zhou Hu Jun's son, Zhou Ziqi, stated that it was very effective for epidemic diseases, so it is recorded here.
Hu notes: The aforementioned indications mention "Shanghan with red complexion, aversion to cold, fever, and body pain," which resembles a Yang syndrome. However, observing the ingredients, they are all acrid, sweet, warm, and tonifying agents. Thus, we know that red face and contrary fever originate from a Shaoyin Cold Syndrome. The above formula specializes in warming Shaoyin and supplementing Taiyin. The name "Shendan" refers to what Zhang Zhongjing mentioned in his treatise: the combination of Shendan and Kansui (Kansui Radix, Gan Sui, 甘遂) drunk together. It is said that Shendan is an exterior-releasing medicine; the meaning likely lies here.
Huo Ren Shu (Book of Vitality) summarizes: Cold limbs, curled up posture, silence, spontaneous diarrhea, irritability, without fever or headache, indicates a Yin syndrome suitable for warming treatment. Pulse sinking, minute, fine, slow, and weak indicates a Yin disease. Pathogens affecting the Yin meridians constitute Zang organ diseases. Since medicines for warming Yin are hot in nature, one should not rush to warm; instead, stabilize the Middle Jiao first. The previously mentioned Yin syndrome Shanghan, characterized by sinking pulse, cold limbs, and aversion to cold from the onset, without headache, is a Shaoyin meridian disease. Medical treatment uses drugs like dried ginger and prepared aconite. One should not assume transmission follows the sequence of Three Yin, starting with Taiyin then Shaoyin.
I note: The statement "stabilize the Middle Jiao" refers to warming the Foot-Taiyin Spleen and Foot-Yangming Stomach.
It also states: For Yin syndrome with blue lips, black or white tongue coating, or stiff/curled tongue, frequently wipe the lips and mouth with fresh ginger. Replace the ginger as needed. Ginger returns Yang, generates Stomach Qi, detoxifies, warms blood, and disperses Qi. After wiping, Yin declines and Yang grows, black turns red; this is an excellent method.
Hu notes: The ginger-wiping method is currently misused by physicians only for black tongue in Yang syndromes. The text specifies using it for Yin syndrome black tongue to wipe the lips and mouth, thereby opening cold in the Stomach; this is the correct treatment.
It further states: In Yin excess blocking Yang, with fine, sinking, rapid pulse, cold body, extreme irritability, desire to lie in mud/water, and thirst without desire to swallow, forcing fluids is incorrect. Instead, use Pili San (Thunderbolt Powder), Yanlian San (Flame Powder), or Dansha Wan (Cinnabar Pill). Sun Yonghe used one half-li Black Prepared Aconite Root, calcined until charred inside remains, cooled and powdered, mixed with one large qian-bi of true La Tea. Divided into two doses. Each dose is decocted with one cup of water and half a spoonful of honey to reduce to sixty percent volume, taken cold. Cessation of irritability, sleep, and sweating are signs of efficacy.
Hu notes: Sun Yonghe's method is equivalent to Pili San in Huo Ren Shu. The formula uses Aconite to rescue extreme Yin-cold, La Tea to regulate blocked Yang, and White Honey to stop irritability and moisten dryness, harmonizing Yin and Yang so the disease heals itself.