尺寸俱浮者,太阳受病也。当一二日发,以其脉上连风府,故头项痛而腰脊强。(此是太阳膀
胱经,属水,《病源》云∶小肠者,非也。)
太阳病,发热,汗出,恶风,其脉缓者,名为中风。太阳病,或已发热,未发热,必恶寒,体
痛,脉阴阳俱紧者,名为伤寒。
伤寒一日,太阳受之,脉若静者,为不传;颇欲吐,若烦躁,脉数急者,为传也。
伤寒二三日,阳明少阳证不见者,为不传也。病发热而恶寒,邪发于阳也;不热而恶寒者,邪
发于阴也。发于阳者,七日愈;发于阴者,六日愈,阳数七,阴数六故也。(发于阳者,随证用汗
药攻其外;发于阴者,用四逆辈温其内。)
太阳病,头痛至七日以上自愈者,其经竟故也。若欲作再经者,针足阳明,使经不传。(补足
阳明土,三里穴也。)
风者,解表而不了了者,十二日愈。(《方言》曰∶南楚疾愈或谓之瘥,或谓之了。)
太阳病,初服桂枝汤,反烦不解,先刺风池、风府,却与桂枝汤则愈。
太阳病,自汗,四肢难以屈伸,若小便难者,可与阳旦汤内加附子一枚,炮,去皮尖,八破,
同煎服之。(阳旦即桂枝汤异名。)若小便数者,慎不可行此汤,宜用芍药甘草汤。若误行桂枝附
子汤攻表,则咽干、烦躁、厥逆、呕吐者,作甘草干姜汤与之,以复阳气;若厥愈足温,更与芍药
甘草汤,其脚即伸;若胃气不和,谵语者,少与调胃承气汤,微溏则谵语止。
芍药甘草汤 主脉浮而自汗,小便数,寸口脉浮大。浮为风,大为虚,风则生微
热,虚则两胫挛。小便数,仍汗出,为津液少,不可误用桂枝汤,宜补虚退热,通治误服汤后病证
仍存者。(按古之三两,准今之一两。古之三升,今之一升。若以古方裁剪,以合今升秤,则铢两
升合之分毫难以从俗。莫若以古今升秤均等,而减半为一剂,稍增其枚粒,乃便于俗尔。且仲景方
云,一剂尽,病证犹在者,更作减半之剂,此古方一剂又加其半,庶可防病未尽而服之也。有不禁
大汤剂者,再减半亦得。《肘后》所谓或以一分为两,或以二铢为两,以盏当升可也。贫家难办,
或临时抄撮皆可。粗末每抄五钱,水二平盏,煎八分服之。有姜枣者,每服入姜三片,枣三枚,
一日三服,未中病可六七服也。有不可作煮散者,是病势大,宜根据古方行之。凡汤一剂,有附子一
枚,增半之剂,合用附子一枚半。古方不析枚者,是枚力要完也。半两以上大附子,可当一枚半;
四钱以上者,可用一枚为准。枚伤多不妨,仲景云强人可加附子成一枚是也。)
芍药 甘草(各一两半)
细锉,水一升半,煎七合半,去滓,温温分再服。
甘草干姜汤
甘草(二两) 干姜(一两)
煎如前方。
调胃承气汤
大黄(一两) 甘草(半两) 芒硝(一大合)
细锉,水一升,煎上二味至五合,去滓,下芒硝烊化,暖服一盏,微溏为度。如难利者,再与
一剂。
太阳病汗证,反下之,遂利不止,脉促,表未解也;喘而汗出者,葛根黄芩汤主之。
黄芩(三钱) 黄连(三两) 甘草(半两) 干葛(二两)
细锉,水一升半,煎七合半,去滓,温饮一盏,日三服。
寸脉和尺脉都呈现浮象的,是太阳经受邪。通常在发病后一到两天出现症状,因为该经脉向上连接风府穴,所以会出现头痛、项部僵硬以及腰脊强直的症状。(这是太阳膀胱经,五行属水,《诸病源候论》中说是小肠经,这是错误的。)
太阳病,表现为发热、出汗、怕风,且脉搏缓弱的,称为中风证。太阳病,无论是否已经发热,必定伴有怕冷,身体疼痛,且寸关尺三部脉象都紧的,称为伤寒证。
伤寒第一天,邪气在太阳经,如果脉象平静(没有变化),说明病邪没有传变;如果病人很想呕吐,或者感到烦躁,且脉象数而急促,说明病邪正在传变。
伤寒第二三天,如果没有出现阳明病或少阳病的症状,说明病邪没有传变。生病时发热且怕冷的,是邪气发于阳经;不发热但怕冷的,是邪气发于阴经。发于阳经的,七天痊愈;发于阴经的,六天痊愈,这是因为阳数为七,阴数为六的缘故。(发于阳经的,根据具体证候使用发汗药来攻逐体表的邪气;发于阴经的,使用四逆汤类方剂来温补体内阳气。)
太阳病,头痛持续七天以上自行痊愈的,是因为太阳经的气血运行周期已满。(如果担心病邪传入下一经,即阳明经,可以针刺足阳明胃经的穴位,以防止病邪传变。)(这是为了补足阳明土气,针刺的是足三里穴。)
如果是风邪致病,经过解表治疗后病情仍未完全消除的,通常需要十二天才能痊愈。(《方言》记载:南楚地区称病愈为“瘥”或“了”。)
太阳病,初次服用桂枝汤后,反而出现烦闷不解的症状,应当先针刺风池穴和风府穴,然后再给予桂枝汤服用,病即可痊愈。
太阳病,自汗出,四肢难以屈伸,如果伴有小便困难的,可以给予阳旦汤内加一枚附子,炮制过,去皮去尖,切成八块,同煎后服用。(阳旦汤即桂枝汤的异名。)如果小便频数的,千万不要使用此汤,适宜使用芍药甘草汤。如果误用桂枝加附子汤攻表,导致咽干、烦躁、四肢厥冷、呕吐的,给予甘草干姜汤,以恢复阳气;如果四肢厥冷缓解、脚变暖,再给予芍药甘草汤,脚就能伸直;如果胃气不和,出现说胡话(谵语)的情况,少量给予调胃承气汤,大便微溏则谵语停止。
芍药甘草汤 主治脉浮且自汗,小便频数,寸口脉浮大。脉浮表示有风邪,脉大表示正气虚,风邪会导致轻微发热,正气虚会导致两小腿抽筋。小便频数且仍出汗,说明津液不足,不可误用桂枝汤,应当补虚退热,通治误服汤药后病证仍存在的患者。(按古代度量衡,三两相当于现在的一两。古代的三升相当于现在的一升。如果用古方裁剪来适应现在的升秤,那么铢两升合的分毫差异很难顺应习俗。不如将古今升秤视为相等,将剂量减半作为一剂,稍微增加药材的枚粒数量,这样更便于世俗操作。况且张仲景方中说,一剂服完,病证仍在的,再制作减半的剂量,这是古方一剂又增加了半剂,以防病邪未尽而服药也。对于不能耐受大方剂的,再减半也可以。《肘后备急方》所谓有的以一分为两,有的以二铢为两,用盏代替升也是可以的。贫寒人家难以备齐,或临时采集都可以。粗末药每份取五钱,水两平盏,煎至八分服用。有生姜大枣的,每次服用加入生姜三片,大枣三枚,一天三次服用,未见效可服用六七次。有不适合煮成散剂的,是病势较重,适宜按照古方执行。凡是汤剂一剂,有一枚附子的,增加半剂,合计使用附子一枚半。古方不拆分枚数的,是因为需要保持单枚附子的完整效力。半两以上的大附子,可以充当一枚半;四钱以上的,可以用一枚为标准。附子切片多并不妨碍药效,张仲景说强壮的人可以加附子成一枚就是这个意思。)
芍药、甘草(各一两半)
细切,用水一升半,煎至七合半,去渣,温服,分两次服用。
调胃承气汤
大黄(一两) 甘草(半两) 芒硝(一大合)
细切,用水一升,先煎大黄和甘草至五合,去渣,下芒硝溶化,暖服一盏,以大便微溏为度。如果难以通便,再给一剂。
If both the Cun (inch) and Chi (cubit) pulses are floating, it indicates that the Taiyang (Greater Yang) channel is affected. Symptoms typically manifest within one to two days because this channel connects upward to the Fengfu (GV16) acupoint, resulting in headache, stiffness of the neck and occiput, and rigidity of the lower back and spine. (This refers to the Taiyang Bladder Channel, which belongs to Water; *Zhu Bing Yuan Hou Lun* claims it is the Small Intestine Channel, which is incorrect.)
In Taiyang disease, if there is fever, sweating, aversion to wind, and a slow pulse, it is named Wind Strike (Zhongfeng). In Taiyang disease, whether fever has already appeared or not, there must be aversion to cold, body pain, and a tight pulse at all three positions (Yin and Yang), which is named Cold Damage (Shanghan).
On the first day of Cold Damage, when the pathogen is in the Taiyang channel, if the pulse remains calm (unchanged), it indicates no transmission; however, if the patient desires to vomit, feels irritable, and the pulse is rapid and urgent, it indicates transmission.
On the second or third day of Cold Damage, if symptoms of Yangming (Yang Brightness) or Shaoyang (Lesser Yang) diseases do not appear, it indicates no transmission. Fever accompanied by aversion to cold indicates the pathogen originating from the Yang channels; absence of fever but presence of aversion to cold indicates the pathogen originating from the Yin channels. Those originating from Yang channels recover in seven days; those originating from Yin channels recover in six days, due to the numerical attributes of Yang being seven and Yin being six. (For pathogens originating from Yang channels, diaphoretic agents are used according to the syndrome to attack the exterior; for those originating from Yin channels, Si Ni Tang (Four Counterflow Decoction) type formulas are used to warm the interior.)
In Taiyang disease, if headache persists for more than seven days and resolves spontaneously, it is because the cycle of the channel has completed. If there is a concern about transmission to the next channel (Yangming), needling the Foot-Yangming Stomach Channel can prevent transmission. (This supplements the Earth of Yangming, specifically the Zusanli (ST36) acupoint.)
If caused by Wind pathogen, and after using exterior-releasing methods the condition is not fully resolved, recovery takes twelve days. (*Fangyan* states: In southern Chu, recovery from illness is called "chai" or "liao".)
In Taiyang disease, if Gui Zhi Tang (Cinnamon Twig Decoction) is administered initially but results in increased irritability without relief, one should first needle Fengchi (GB20) and Fengfu (GV16), then administer Gui Zhi Tang again for cure.
In Taiyang disease, with spontaneous sweating and difficulty bending/extending the limbs, if accompanied by difficult urination, Yang Dan Tang (Morning Sun Decoction) with one processed Fuzi (Aconiti Lateralis Radix Preparata) added is appropriate. The Fuzi should be processed, skin and tip removed, cut into eight pieces, and decocted together. (Yang Dan Tang is an alternative name for Gui Zhi Tang.) If urination is frequent, this formula must be avoided; instead, Shao Yao Gan Cao Tang (Peony and Licorice Decoction) is suitable. If Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is mistakenly used to attack the exterior, leading to dry throat, irritability, cold extremities, and vomiting, Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) should be given to restore Yang Qi. Once cold extremities resolve and feet become warm, Shao Yao Gan Cao Tang should be given again to extend the legs. If stomach Qi is disharmonious and delirium occurs, a small amount of Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward the Qi Decoction) should be given; slight loose stools will stop the delirium.
Shao Yao Gan Cao Tang (Peony and Licorice Decoction) primarily treats floating pulse with spontaneous sweating, frequent urination, and a large, floating pulse at the Cun position. Floating indicates Wind, Large indicates Deficiency. Wind generates slight heat, while Deficiency causes cramping in both calves. Frequent urination with continued sweating indicates depletion of Body Fluids; Gui Zhi Tang must not be used erroneously. One should tonify deficiency and clear heat, treating cases where symptoms persist after erroneous medication. (Note on dosage: Ancient three liang equals modern one liang; ancient three sheng equals modern one sheng. To adapt ancient prescriptions to modern measures is difficult regarding fractional units. It is better to equate ancient and modern measures, halve the dose per administration, slightly increase the number of pieces, for practical convenience. Zhang Zhongjing stated that if symptoms persist after one dose, prepare half a dose again. This implies adding half to the original dose to ensure complete resolution. For those who cannot tolerate large doses, halving further is acceptable. *Zhou Hou Bei Ji Fang* mentions dividing one fen into two, or two zhu as one liang, using a cup instead of a sheng. Poor families may gather herbs temporarily. Coarse powder of five qian, decocted in two level cups of water to eight parts, is taken warm. With ginger and jujube, add three slices of ginger and three jujubes per dose, taken three times daily; up to six or seven doses if ineffective. Some conditions require full decoctions rather than powders due to severe pathology. Regarding Fuzi: one piece in a standard dose becomes one and a half pieces in a half-dose addition. Ancient texts did not split pieces to maintain potency. Large Fuzi over half a liang can serve as one and a half pieces; those over four qian can be standardized as one piece. Multiple slices are acceptable, as Zhang Zhongjing noted stronger individuals could take up to one whole piece.)
Shao Yao (Paeoniae Radix Alba) and Gan Cao (Glycyrrhizae Radix et Rhizoma) (each one and a half liang).
Finely chop, decoct in one and a half sheng of water until seven and a half he remain, strain, and take warm in two divided doses.
Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction)
Gan Cao (Glycyrrhizae Radix et Rhizoma) (two liang), Gan Jiang (Zingiberis Rhizoma) (one liang).
Decoct as described above.
Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward the Qi Decoction)
Da Huang (Rhei Radix et Rhizoma) (one liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (half liang), Mang Xiao (Natrii Sulfas) (one large he).
Finely chop Da Huang and Gan Cao, decoct in one sheng of water until five he remain, strain, add Mang Xiao and dissolve, take warm in one cup. Stop when slight loose stools occur. If difficult to pass stool, administer another dose.
In Taiyang disease, if purgation is mistakenly used instead of diaphoresis, leading to unceasing diarrhea and a hurried pulse (Cu Mai), indicating the exterior pathogen remains, accompanied by wheezing and sweating, Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) is the primary treatment.
Huang Qin (Scutellariae Radix) (three qian), Huang Lian (Coptidis Rhizoma) (three liang), Gan Cao (Glycyrrhizae Radix et Rhizoma) (half liang), Gan Ge (Puerariae Radix) (two liang).
Finely chop, decoct in one and a half sheng of water until seven and a half he remain, strain, take warm in one cup, three times daily.