桂枝(一两十七铢) 芍药(一两六铢) 麻黄(十六铢去节) 生姜(一两六铢切) 杏仁(
十六个去皮尖) 甘草(一两二铢炙) 大枣(五枚擘)
上七味。以水五升。先煮麻黄一二沸。去上沫。纳诸药。煮取二升。去滓。温服一升
。日三服。
此条与桂枝麻黄各半汤证相类。经云服桂枝汤大汗出脉洪大者。与桂枝汤如前法。若形
如疟
。日再发者。汗出必解。宜用此汤。彼以阳气怫郁在表。故主桂麻并用。此属大汗出之后。
故桂枝略重而麻黄略轻。
桂枝(去皮) 芍药 甘草(各十八铢炙) 生姜(一两三钱切) 大枣(四枚擘) 麻黄(十
八铢去节) 石膏(二十四铢碎绵裹)
上七味。 咀。以水五升。先煮麻黄一二沸。去上沫。纳诸药。煮取二升。去滓。温服
一升。本方当裁为越婢汤桂枝汤合饮一升。今合为一方。桂枝二。越婢一。
经云太阳病。发热恶寒。热多寒少。脉微弱者。此无阳也。不可更汗。宜桂枝二越婢一
汤。
按无阳何以用石膏。因此诸家诠释。不得其解。或谓无阳乃无津液之义。与亡阳有别。并与
阳虚不同。或谓阳邪来乘。正阳为其所夺。至柯韵伯谓此条必有错简。愚按无阳二字。乃谓
无阳邪也。发热恶寒。热多寒少。疑属阳邪为患。但脉见微弱。知邪不在阳分也。既无阳邪
。不当更汗。文义便明白易晓。故主以桂枝之二。越婢之一。以和阴而宣阳也。
按越婢二字之义。喻嘉言谓化热生津。柔缓之性。比女婢尤为过之。恐仲景命名取义。
当不
若是之远也。外台方作越脾。内经言脾不濡。脾不能为胃行其津液。此起太阴之津。以滋阳
明之液。成无己亦作发越脾气解。
桂枝(一两十七铢) 芍药(一两六铢) 麻黄(十六铢,去节) 生姜(一两六铢,切片) 杏仁(十六个,去皮尖) 甘草(一两二铢,炙) 大枣(五枚,掰开)
以上七味药。用水五升。先煮麻黄一二沸。去掉上面的浮沫。加入其他药物。煮取二升。去掉药渣。温服一升。每日服用三次。
这一条与桂枝麻黄各半汤证相似。经文说:服用桂枝汤后大汗出,脉象洪大的,给予桂枝汤,用法如前。如果症状像疟疾一样,一天发作两次,汗出后必然痊愈,适宜使用此汤。彼方是因为阳气怫郁在表,所以主治用桂枝和麻黄并用。此方属于大汗出之后,所以桂枝略重而麻黄略轻。
桂枝(去皮) 芍药 甘草(各十八铢,炙) 生姜(一两三钱,切片) 大枣(四枚,掰开) 麻黄(十八铢,去节) 石膏(二十四铢,捣碎,用绵布包裹)
以上七味药。切碎。用水五升。先煮麻黄一二沸。去掉上面的浮沫。加入其他药物。煮取二升。去掉药渣。温服一升。本方应当裁减为越婢汤和桂枝汤合饮一升。现在合并为一个方剂。桂枝占两份,越婢占一份。
经文说:太阳病(太阳经受邪所致的病证),发热恶寒(发热且怕冷),热多寒少。脉象微弱者,这是无阳(指没有阳邪或津液不足,此处特指无阳邪)的意思。不可以再发汗。适宜用桂枝二越婢一汤。
按语:为什么说“无阳”却要用石膏?因为各家解释,没能得到满意的解答。有的认为“无阳”是“无津液”的意思,与亡阳(阳气极度衰竭)不同,也与阳虚(阳气虚弱)不同。有的认为是阳邪来乘,正气中的真阳被其夺走。直到柯韵伯认为这一条必定有错简(文字顺序错误)。我按:“无阳”二字,是说没有阳邪。发热恶寒,热多寒少,怀疑是阳邪为患。但脉象见微弱,知道邪气不在阳分。既然没有阳邪,不应当再发汗。文义就明白易懂了。所以主治以桂枝的二份,越婢的一份,来调和阴气而宣通阳气。
按语:关于“越婢”二字的含义,喻嘉言认为是指化热生津,性质柔缓,比女婢还要过分。恐怕仲景命名取义,不会是这样遥远的解释。《外台秘要》中作“越脾”。《内经》说脾不濡润,脾不能为胃行其津液,这是起太阴之津,以滋润阳明之液。成无己也作发越脾气解。
Guizhi (Cinnamon Twig, *Ramulus Cinnamomi*) [1 liang 17 zhu], Shaoyao (White Peony Root, *Radix Paeoniae Alba*) [1 liang 6 zhu], Mahuang (Ephedra Herb, *Herba Ephedrae*) [16 zhu, nodes removed], Shengjiang (Fresh Ginger Rhizome, *Rhizoma Zingiberis Recens*) [1 liang 6 zhu, sliced], Xingren (Apricot Seed, *Semen Armeniacae Amarum*) [16 pieces, skin and tips removed], Gancao (Licorice Root, *Radix Glycyrrhizae Uralensis*) [1 liang 2 zhu, honey-fried], Dazao (Jujube Fruit, *Fructus Jujubae*) [5 pieces, split open].
The above seven ingredients. Use five sheng of water. First boil Mahuang for one or two boils. Remove the foam on the surface. Add the remaining herbs. Boil until two sheng remain. Strain off the dregs. Take one sheng warm. Three times a day.
This clause is similar to the syndrome of Guizhi Mahuang Ban Tang (Half Guizhi Half Ephedra Decoction). The classic states: After taking Guizhi Tang (Cinnamon Twig Decoction), if there is profuse sweating and a flooding pulse, administer Guizhi Tang as before. If the condition resembles malaria, occurring twice a day, it will resolve with sweating; this decoction is suitable. That formula addresses yang qi stagnation in the exterior, hence using both Guizhi and Mahuang. This formula applies after profuse sweating, therefore Guizhi is slightly heavier and Mahuang slightly lighter.
Guizhi (Cinnamon Twig, *Ramulus Cinnamomi*) (peeled), Shaoyao (White Peony Root, *Radix Paeoniae Alba*), Gancao (Licorice Root, *Radix Glycyrrhizae Uralensis*) (each 18 zhu, honey-fried), Shengjiang (Fresh Ginger Rhizome, *Rhizoma Zingiberis Recens*) (1 liang 3 qian, sliced), Dazao (Jujube Fruit, *Fructus Jujubae*) (4 pieces, split open), Mahuang (Ephedra Herb, *Herba Ephedrae*) (18 zhu, nodes removed), Shigao (Gypsum Fibrosum, *Gypsum Fibrosum*) (24 zhu, crushed, wrapped in cotton cloth).
The above seven ingredients. Chew/crush them. Use five sheng of water. First boil Mahuang for one or two boils. Remove the foam on the surface. Add the remaining herbs. Boil until two sheng remain. Strain off the dregs. Take one sheng warm. Originally, this formula should be adjusted to drink one sheng of a combination of Yuebi Tang (Yuebi Decoction) and Guizhi Tang (Cinnamon Twig Decoction). Now they are combined into one formula. Guizhi constitutes two parts, Yuebi constitutes one part.
The classic states: In Taiyang disease (disease pattern caused by pathogenic invasion of the Taiyang channel), with fever and aversion to cold, where heat predominates over cold, and the pulse is faint/weak, this indicates "wu yang" (absence of yang pathogen/fluid deficiency). Sweating should not be induced further. Gui Zhi Er Yue Bi Yi Tang (Two Parts Guizhi One Part Yuebi Decoction) is appropriate.
Commentary: Why use Shigao (Gypsum Fibrosum) when it says "wu yang"? Various interpretations have failed to provide a satisfactory explanation. Some argue that "wu yang" means lack of body fluids, distinct from wang yang (collapse of yang) and yang xu (deficiency of yang). Others suggest yang pathogen has invaded, depriving the true yang. Ke Yunbo argued that this clause must contain textual errors (cuo jian). I interpret "wu yang" as meaning absence of yang pathogen. Fever and aversion to cold, with heat predominating over cold, suspectably involve yang pathogen. However, the weak pulse indicates the pathogen is not in the yang division. Since there is no yang pathogen, sweating should not be induced. The text becomes clear and understandable. Hence, the treatment uses two parts Guizhi and one part Yuebi to harmonize yin and disseminate yang.
Commentary: Regarding the meaning of "Yuebi", Yu Jiayan suggested it refers to transforming heat and generating fluids, with a softening and moderating nature, surpassing even that of a female servant. It is unlikely Zhongjing's naming intention was so remote. *Waitai Miyao* (Essential Prescriptions Worth a Thousand Gold for Emergencies) writes it as "Yue Pi". The *Neijing* (Inner Canon) states that if the spleen is not moistened, it cannot transport fluids for the stomach. This initiates fluids from the Taiyin to nourish the Yangming fluids. Cheng Wuji also interpreted it as stimulating the spleen qi.