桂枝(四两去皮) 附子(三枚炮去皮破八片) 生姜(三两切) 甘草(二两炙) 大枣(十二枚擘)
上五味。以水六升。煮取二升。去滓。分温三服。
成注云。风在表者。散以桂枝甘草之辛甘。湿在经者。逐以附子之辛热。姜枣辛甘。行营卫。通津液。以和表
也。○愚以风散湿逐。寒即随之而去矣。
内台方议云。与桂枝汤。去芍药以治风加附子以散表中之风湿寒邪。○愚以去芍药者。谓非中寒所宜也。
若其人大便硬。小便自利者。去桂枝。加白术汤主之。(此承上条而申言之。有如上条证全具矣。若其人大便
硬。小便自利者。后条辩云。此湿虽盛而津液自虚也。于上汤中去桂。以其能走津液。加术。以其能生津液。○或
问云。小便利。则湿去矣。何以犹言湿盛。余答云。湿热郁于里。则小便不利。寒湿搏于经。则小便自利。又有昧
理者云。大便溏。宜加白术。殊不知白术为脾家主药。后条辩云。燥湿以之。滋液亦以之。条辩以白术作苍术。以
其能益土燥湿误矣。)
(此方原论中无考。今照上方云云去桂枝。加白术也)
于上方内去桂枝。加白术四两余根据前法煎服风湿相搏。骨节烦疼。掣痛。不得屈伸。近之则痛剧汗出短气。小
便不利。恶风不欲去衣或身微肿者。甘草附子汤主之。(风湿相搏。最前条已明言之矣。风虽阳邪。然与湿相交结。
则纯是寒气为病。寒主收引。故烦疼比前条更甚。内入骨节之间。四肢掣痛。不得屈伸也。近之则痛剧者。申言病
邪之重。迕之则逆也。风伤卫。故汗出短气。恶风不欲去衣。湿内着。故小便不利。湿外薄。故或身微肿。或者未
定之辞。乃兼及之证。非主病也。与甘草附子汤。以温经散风湿。○愚按方注风湿相搏。有中风汗出过多。伤寒发
汗过多二证。夫中风伤寒。皆热病也。岂有反变而为寒之理。又其注短气。为汗多亡阳。注恶风不欲去衣。以重伤
故恶甚。大谬之极。)
桂枝(四两,去皮) 附子(三枚,炮制后去皮,破成八片) 生姜(三两,切片) 甘草(二两,蜜炙) 大枣(十二枚,掰开)
以上五味药。用水六升。煮取药液二升。滤去药渣。分三次温服。
成无己注解说:风邪在表,用桂枝、甘草的辛甘之性来发散;湿邪在经络,用附子的辛热之性来驱逐。生姜和大枣辛甘合化,运行营卫之气,通调津液,以调和体表。○我认为风散湿除,寒邪也就随之而去了。
《内台方议》议论说:此方即桂枝汤,去掉芍药以治风,加入附子以散发体表的的风湿寒邪。○我认为去掉芍药的原因,是因为它不适合中寒的病证。
如果病人大便干硬,小便自利(通畅),则用去桂枝加白术汤主治。(这是承接上一条条文进一步说明。如果有上述条文的证候全部具备,但病人大便干硬,小便通畅的,见下一条辨析说:这是因为湿气虽盛,但津液已经自虚。所以在上方中去掉桂枝,因为桂枝能走泄津液;加入白术,因为白术能生津液。○有人问:小便通利,湿气应该已去,为什么还说湿气旺盛?我回答:湿热郁结在里,会导致小便不利;寒湿搏结在经络,反而导致小便自利。又有不明事理的人说:大便溏薄,适宜加白术。殊不知白术是脾脏的主药。下一条辨析说:它能燥湿,也能滋液。辨析中将白术误作苍术,认为它能补益脾气、燥湿,这是错误的。)
(此方在原著中没有考证依据。现在按照上方说法,去掉桂枝,加入白术。)
在上述方剂中去掉桂枝,加入白术四两,其余根据前面的方法煎煮服用。风湿相搏(风邪与湿邪相互结合),骨节烦扰疼痛,牵引作痛,不能屈伸,靠近患处则疼痛加剧,出汗,气短,小便不利,怕风不想脱衣,或者身体轻微浮肿的,用甘草附子汤主治。(风湿相搏,在最前面的条文已经明确说明了。风虽然是阳邪,但与湿相交结,就纯变成寒邪致病。寒主收引,所以疼痛比前一条更严重。病邪深入骨节之间,四肢牵引疼痛,不能屈伸。靠近则痛剧,是申述病邪的重重,触碰则会逆乱。风伤卫气,所以汗出、气短、恶风不想脱衣;湿邪内着,所以小便不利;湿邪外迫,所以身体可能轻微浮肿。“或”字是不确定的语气,是兼及的证候,不是主病。用甘草附子汤,以温经散除湿邪。○我按语:方注中提到“风湿相搏”,有中风汗出过多、伤寒发汗过多两种证候。夫中风、伤寒,都是热病,难道反而会变成为寒证吗?另外,其注解认为短气是因为汗多亡阳,注解恶风不想脱衣是因为重伤所以恶风严重,这极其荒谬。)
Cinnamon Twig (Si Liang, peeled) Aconite Root (San Mei, processed, peeled, broken into eight pieces) Fresh Ginger (San Liang, sliced) Licorice Root (Liang, honey-fried) Jujube (Shi Er Mei, torn open)
The above five herbs. With water six Sheng. Boil to obtain two Sheng of decoction. Remove the dregs. Divide into three warm doses.
Cheng Wuji's commentary states: When wind pathogen is in the exterior, disperse it with the acrid-sweet nature of Guizhi Tang (Cinnamon Twig Decoction) and Gancao (Licorice). When dampness is in the meridians, expel it with the acrid-hot nature of Fuzi (Processed Aconite Root). The acrid-sweet combination of Shengjiang (Fresh Ginger) and Dazao (Jujube) circulates Ying and Wei (Nutritive and Defensive Qi), unblocks Jin Ye (Body Fluids), and harmonizes the exterior. ○ I believe that when wind is dispersed and dampness is expelled, cold pathogen will follow and depart.
Neitai Fangyi discusses: This formula is based on Guizhi Tang (Cinnamon Twig Decoction), removing Shaoyao (Peony Root) to treat wind, and adding Fuzi (Processed Aconite Root) to dissipate wind-damp-cold pathogens in the exterior. ○ I believe Shaoyao (Peony Root) is removed because it is not suitable for Zhonghan (Cold Damage).
If the patient has hard stools and free urination, use the formula with Cinnamon Twig removed and Atractylodes Macrocephala Rhizome added as the primary treatment. (This continues from the previous clause to elaborate. If all symptoms of the previous clause are present, but the patient has hard stools and free urination, the next clause analyzes: This indicates that although dampness is abundant, Body Fluids are deficient. Therefore, remove Guizhi (Cinnamon Twig) from the upper formula because it can deplete Body Fluids; add Baizhu (Atractylodes Macrocephala Rhizome) because it can generate Body Fluids. ○ Question: If urination is free, dampness should have left, why say dampness is still abundant? Answer: If damp-heat is stagnant internally, urination will be difficult; if cold-damp struggles in the meridians, urination will be free. Some who do not understand principles say: Loose stools suit adding Baizhu (Atractylodes Macrocephala Rhizome). They do not know Baizhu (Atractylodes Macrocephala Rhizome) is the master herb for the Spleen. The next clause analyzes: It can dry dampness and also moisten fluids. The analysis mistakenly identifies Baizhu (Atractylodes Macrocephala Rhizome) as Cangzhu (Atractylodis Rhizoma), thinking it tonifies Earth and dries dampness, which is an error.)
(This formula has no verification in the original theory. Now, following the above method, remove Guizhi (Cinnamon Twig) and add Baizhu (Atractylodes Macrocephala Rhizome).)
Remove Guizhi (Cinnamon Twig) from the above formula, add Baizhu (Atractylodes Macrocephala Rhizome) four Liang, and prepare and take according to the previous method. When Wind-Dampness Bi (Wind-Damp Obstruction) occurs, causing vexing pain in bone joints, pulling pain, inability to flex or extend, severe pain upon touch, sweating, shortness of breath, difficulty in urination, aversion to wind with reluctance to remove clothes, or slight swelling of the body, Gancao Fuzi Tang (Licorice and Aconite Decoction) is the primary treatment. (Wind-Dampness Bi was clearly stated in the earliest clauses. Although Wind is a Yang pathogen, when intertwined with Dampness, it becomes purely Cold pathogen disease. Cold governs contraction and drawing-in, so the vexing pain is more severe than in the previous clause. Entering between bone joints, limbs suffer pulling pain and cannot flex or extend. Severe pain upon touch reiterates the severity of the pathogen; disturbing it causes rebellion. Wind injures Wei (Defensive Qi), hence sweating, shortness of breath, aversion to wind, and reluctance to remove clothes; Dampness adheres internally, hence difficulty in urination; Dampness presses externally, hence possible slight swelling. "Or" is a term of uncertainty, indicating accompanying syndromes, not the main disease. Use Gancao Fuzi Tang (Licorice and Aconite Decoction) to warm the meridians and scatter Wind-Dampness. ○ My note: The formula commentary mentions "Wind-Dampness Bi" having two conditions: excessive sweating from Fengzhong (Wind Strike) and excessive sweating from Shanghan (Cold Damage). Both Fengzhong and Shanghan are heat diseases; how could they transform into cold? Furthermore, the commentary claims shortness of breath is due to sweating causing loss of Yang, and aversion to wind is due to severe injury causing extreme aversion to wind, which is extremely absurd.)