茯苓(六两) 人参(一两) 甘草(二两) 干姜(一两半) 附子(一枚生用去皮破八片)
上五味。以水五升。煮取三升。去滓。温服七合。日三服。
发汗若下之。病仍不解。烦躁者。茯苓四逆汤主之。按未经汗下而烦躁属阳盛。既经
汗下后而烦躁属阳虚。且汗下之后。津液告竭。故于四逆汤中。加茯苓以安下。人参以补虚
也。
柴胡 枳实(炙) 甘草(炙) 芍药
上四味。各十分。捣筛。白饮和服。方寸匕。日三服。
加减法。咳者。加五味子干姜各五分。并主下。身体疼。手足寒。骨节痛。脉沉者。此汤主之。沉为在里。只宜温里
。此
全以脉沉为辨。又云。少阴病得之一二日口中和其背恶寒者当灸之。此汤主之。此又以口中
和为辨。口中和而背恶寒。则非阳邪怫郁之恶寒。乃可主以此汤而无疑。
此少阴病温经散寒正治之法。主附子之雄烈。下消肾中之水寒。上资君主之热化。人参
助阳
。芍药和阴。茯苓利窍以逐水。白术燥湿以燠土。并力温托。绝不加入一毫升散之药。但使
元阳得振而病自解。
柯韵伯曰。此与真武汤似同而实异。倍术附。去生姜。加人参。是温补以壮元阳。真武
汤还是温散而利胃水也。此辨明真武附子。界限却清。
甘草(二两炙) 附子(二枚炮去皮破八片) 白术(二两) 桂枝(四两去皮)
上四味。以水六升。煮取三升。去滓。温服一升。日三服。初服得微汗则解。能食汗出
复烦者服五合。恐一升多者。宜服六七合为始。
经云。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。按此段形容风湿相搏之病状最着。湿壅于经。故身肿痛剧而
小
便不利。风淫于卫。故汗出短气而恶风不欲去衣。附子白术。宣太阴以驱湿。甘草桂枝。通
太阳以散风。凡风湿证大发其汗。病必不解。此方亦是不欲发汗之意。当取微汗为佳。
茯苓(六两) 人参(一两) 甘草(二两) 干姜(一两半) 附子(一枚,生用,去皮,破成八片)
以上五味药。用水五升,煮取三升药液。滤去药渣。温服七合,每日三次服用。
经过发汗或攻下治疗后,病邪仍未解除,出现烦躁症状的,由茯苓四逆汤主治。按:未经过发汗、攻下而出现的烦躁属于阳热亢盛;既经发汗、攻下之后出现的烦躁属于阳气虚衰。且发汗、攻下之后,津液耗竭,所以在四逆汤中加入茯苓以安神定志于下焦,加入人参以补益虚损。
柴胡 枳实(炙) 甘草(炙) 芍药
以上四味药。各取十分比例,捣碎过筛。用米汤调和服用一方寸匕,每日三次服用。
加减法:咳嗽者,加五味子、干姜各五分,同时主治下利。身体疼痛,手足寒冷,骨节疼痛,脉象沉的,此汤主治。脉沉表示病在里,只宜温补里气。这里完全以脉沉作为辨证依据。又说:少阴病得之一二日,口中平和无苦燥感,背部恶寒的,应当施灸,此汤主治。这里又以口中平和作为辨证依据。口中平和而背部恶寒,则不是阳邪郁闭导致的恶寒,可以确定使用此汤无疑。
这是少阴病温经散寒的正治之法。主要依靠附子的雄烈之性,下消肾中的水寒之气,上资助心主的温热化育。人参辅助阳气。芍药调和阴血。茯苓通利窍道以驱逐水湿。白术燥湿以温暖脾土。合力温补托举,绝不加入一味发散的药物。只要使元阳得以振奋,疾病自然解除。
柯韵伯说:此方与真武汤看似相同实则不同。加倍白术、附子,去掉生姜,加入人参,是温补以壮大元阳。真武汤还是温散并利胃中水饮的方法。这样辨明真武汤与附子汤的界限,却非常清晰。
甘草(二两,炙) 附子(二枚,炮制,去皮,破成八片) 白术(二两) 桂枝(四两,去皮)
以上四味药。用水六升,煮取三升药液。滤去药渣。温服一升,每日三次服用。初次服用后若得到微微出汗则病解。若能进食但出汗后又出现烦热的,服用五合。恐怕一升药量过多的,适宜从六七合开始服用。
经典记载:风湿相互搏结,骨节烦痛,牵引作痛不能屈伸,靠近患处则疼痛加剧。出汗,短气,小便不利,怕风不想脱衣。
或者身体轻微浮肿的,由甘草附子汤主治。按:这段文字形容风湿相搏的病状最为显著。湿气壅滞于经脉,所以身体肿痛剧烈而小便不利。风邪淫溢于卫分,所以出汗、短气且怕风不想脱衣。附子、白术,宣通太阴脾经以驱除湿邪。甘草、桂枝,通达太阳膀胱经以疏散风邪。凡是风湿证大发其汗,病必定不能解除。此方也是不希望大发汗的意思。应当取微微出汗为佳。
Fuling (Poria, 6 liang) Renshen (Ginseng Radix et Rhizoma, 1 liang) Gancao (Licorice Root, 2 liang) Ganjiang (Dried Ginger, 1.5 liang) Fuzi (Prepared Aconite Lateralis Radix, 1 piece, raw, peeled, broken into eight pieces)
The above five herbs. Boil with five sheng of water until three sheng remain. Strain the dregs. Take seven ge warm, three times a day.
After sweating or purging therapies, if the disease remains unresolved and irritability (Fan Zao, restlessness and agitation) occurs, it is primarily treated with Fuling Sini Tang (Poria Decoction for Four Inversion). Note: Irritability occurring without prior sweating or purging belongs to excess Yang heat; irritability occurring after sweating and purging belongs to Yang deficiency. Furthermore, after sweating and purging, body fluids are exhausted. Therefore, Fuling is added to Sini Tang to calm the spirit in the lower jiao, and Renshen is added to tonify deficiency.
Chaihu (Bupleuri Radix) Zhishi (Immature Bitter Orange, stir-baked) Gancao (Licorice Root, stir-baked) Shaoyao (White Peony Root)
The above four herbs. Each in ten parts. Crush and sieve. Mix with rice water and take one fangcun bi (a measure approx. 20-30ml), three times a day.
Modifications: For cough, add Wuweizi (Schisandra Fruit) and Ganjiang each in five parts; also primarily treats diarrhea. For body pain, cold hands and feet, bone and joint pain, and a deep pulse (Chen Mai), this decoction is indicated. A deep pulse indicates the pathogen is in the interior; only warming the interior is appropriate. Here, differentiation relies entirely on the deep pulse. It is also stated: In Shaoyin disease, within one or two days, if the mouth feels neutral (no bitter or dry taste) and there is aversion to cold in the back, moxibustion should be applied, and this decoction is indicated. Here, differentiation relies on the neutral mouth feeling. A neutral mouth with back aversion to cold indicates that this is not aversion to cold caused by constrained Yang pathogens; thus, using this decoction is undoubtedly correct.
This is the standard treatment method for warming meridians and dispersing cold in Shaoyin disease. It mainly relies on the potent nature of Fuzi to dissipate cold-water in the kidney below and assist the heart's heat transformation above. Renshen assists Yang. Shaoyao harmonizes Yin. Fuling promotes diuresis to expel water-dampness. Baizhu (Atractylodis Macrocephalae Rhizoma) dries dampness to warm the spleen-earth. They work together to warm and support, absolutely avoiding any dispersing herbs. As long as the primal Yang is revitalized, the disease will resolve naturally.
Ke Yunbo said: This formula appears similar to but is actually different from Zhenwu Tang (True Warrior Decoction). Doubling Baizhu and Fuzi, removing Shengjiang (Fresh Ginger), and adding Renshen constitutes warming and tonifying to strengthen primal Yang. Zhenwu Tang still focuses on warming, dispersing, and promoting diuresis for stomach water retention. This clarifies the boundary between Zhenwu Tang and Fuzi Tang clearly.
Gancao (Licorice Root, 2 liang, stir-baked) Fuzi (Prepared Aconite Lateralis Radix, 2 pieces, processed, peeled, broken into eight pieces) Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang) Guizhi (Cinnamon Twig, 4 liang, peeled)
The above four herbs. Boil with six sheng of water until three sheng remain. Strain the dregs. Take one sheng warm, three times a day. If mild sweating occurs after the first dose, the condition resolves. If eating leads to sweating followed by irritability, take five ge. If one sheng is feared to be too much, start with six or seven ge.
The classics state: Wind-dampness combats each other, causing vexing pain in bone joints, pulling pain preventing flexion and extension, severe pain upon touch. Sweating, shortness of breath, dysuria, aversion to wind, reluctance to remove clothes.
Or slight swelling of the body: Ganyao Fuzi Tang (Licorice and Aconite Decoction) is indicated. Note: This passage describes the symptoms of wind-dampness combatting most vividly. Dampness obstructs the meridians, hence severe body swelling/pain and dysuria. Wind invades the Wei (defensive) level, hence sweating, shortness of breath, and aversion to wind with reluctance to remove clothes. Fuzi and Baizhu unblock the Taiyin spleen to drive out dampness. Gancao and Guizhi connect the Taiyang bladder to disperse wind. Generally, inducing heavy sweating in wind-dampness cases will not resolve the disease. This formula also implies an intention not to induce heavy sweating. Mild sweating is ideal.