柴胡(四两) 黄芩(一两五钱) 人参(一两五钱) 半夏(二合五勺) 大枣(六枚) 生姜(一两五钱) 桂
枝(一两五钱) 芍药(一两五钱) 甘草(一两炙)
上九味以水七升煮三升温服
太阳病十日已去脉浮细而嗜卧者外已解也设胸满腹痛者与小柴胡汤脉但浮者与麻黄汤(方在太阳二十)
太阳病十日以外脉浮细而嗜卧者是太阳之外证已解也表邪离太阳而入少阳故浮紧变而为浮细少阳之脉弦细也胆热者
善眠是其嗜卧必入少阳设其胸满胁痛者又见少阳经证宜与小柴胡汤若脉但浮而不细者则未入少阳而犹是太阳宜与麻黄汤
也
伤寒阳脉涩阴脉弦法当腹中急痛者先用小建中汤不瘥者与小柴胡汤主之
甲乙同气甲木不降则寸脉涩乙木不升则尺脉弦甲木上逆而克戊土法当痛见于胸膈乙木下陷而克己土法当痛见于腹胁
木气枯燥是以其痛迫急肝胆合邪风火郁发中气被贼势难延缓宜先用小建中汤胶饴甘枣补脾精而缓急痛姜桂芍药达木郁而
清风火若不瘥者仍与柴胡再泄其相火也此申明首章腹痛者加芍药之义
桂枝(三两) 芍药(六两) 甘草(二两炙) 大枣(十二枚) 生姜(三两) 胶饴(一升)
上六味以水七升煮三升去滓内胶饴更上微火消解温服一升日三服
柴胡(四两) 黄芩(一两五钱) 人参(一两五钱) 半夏(二合五勺) 大枣(六枚) 生姜(一两五钱) 桂枝(一两五钱) 芍药(一两五钱) 甘草(一两,炙用)
以上九味药,用水七升,煮取三升,每次温服。
太阳病(太阳经受邪所致的病证)病程已过十日,脉象浮而细,且患者想躺卧休息,这是体表邪气已经解除的表现。如果此时出现胸胁满闷、腹痛的症状,给予小柴胡汤(和解少阳的代表方剂)。如果脉象仅见浮象,则给予麻黄汤(发汗解表峻剂,方剂在太阳病篇第二十节)。
太阳病病程超过十日,脉象浮而细,且患者嗜睡懒动,这是太阳经的外在证候已经解除的表现。因为表邪离开太阳经而传入少阳经(少阳经受邪所致的病证),所以脉象由紧变为浮细(少阳病的典型脉象为弦细)。胆腑有热的人容易嗜睡,这里的“嗜卧”表明邪气已入少阳。如果同时伴有胸胁满痛,又出现了少阳经的证候,适宜给予小柴胡汤。如果脉象仅见浮而不细,说明邪气未入少阳,仍然停留在太阳经,适宜给予麻黄汤。
伤寒病中,阳脉(寸脉)涩滞,阴脉(尺脉)弦紧,按照法度应当出现腹中拘急疼痛的症状。此时应先用小建中汤(温中补虚、和里缓急之剂)治疗;若无效,再给予小柴胡汤主治。
甲木(肝/胆)与乙木同属一气。甲木不降,则寸脉涩滞;乙木不升,则尺脉弦紧。甲木上逆克制戊土(胃),疼痛通常出现在胸膈部位;乙木下陷克制己土(脾),疼痛通常出现在腹部和胁肋部位。由于木气枯燥,所以疼痛表现为迫急。肝胆合邪,风火郁结发作,中气被贼邪所伤,病情难以延缓。因此宜先用小建中汤,利用饴糖、甘草、大枣甘润之性来补充脾精并缓解急痛,利用生姜、桂枝、芍药通达木郁并清散风火。如果服药后症状未消除,仍给予柴胡剂以再次疏泄相火。此处阐明了首章中提到腹痛时加用芍药的意义。
桂枝(三两) 芍药(六两) 甘草(二两,炙用) 大枣(十二枚) 生姜(三两) 胶饴(一升)
以上六味药,用水七升,煮取三升,去渣,加入胶饴,再用微火加热使其溶解,每次温服一升,每日三次。
Chaihu (Radix Bupleuri, 4 liang), Huangqin (Radix Scutellariae, 1.5 liang), Renshen (Radix Ginseng, 1.5 liang), Banxia (Rhizoma Pinelliae, 2 he and 5 shao), Dazao (Fructus Jujubae, 6 pieces), Shengjiang (Rhizoma Zingiberis Recens, 1.5 liang), Guizhi (Ramulus Cinnamomi, 1.5 liang), Shaoyao (Radix Paeoniae Alba, 1.5 liang), Gancao (Radix Glycyrrhizae, 1 liang, prepared with honey).
Take the above nine herbs, decoct in seven sheng of water until three sheng remain, and take warm.
In Taiyang disease (disease syndrome caused by pathogenic factors invading the Taiyang meridian), if ten days have passed since onset, the pulse is floating and fine, and the patient desires to lie down, this indicates that the exterior pathogens have been resolved. If chest fullness and abdominal pain are present, administer Xiaochaihu Tang (Minor Bupleurum Decoction, a representative formula for harmonizing Shaoyang). If the pulse is merely floating, administer Mahuang Tang (Ephedra Decoction, a potent diaphoretic formula; see Taiyang Chapter 20).
When Taiyang disease has persisted for more than ten days, and the pulse is floating and fine with somnolence, it signifies that the exterior syndromes of the Taiyang meridian have resolved. This occurs because the exterior pathogen leaves the Taiyang meridian and enters the Shaoyang meridian (Shaoyang meridian disease syndrome); thus, the pulse changes from tight to floating and fine (the typical pulse for Shaoyang disease is wiry and fine). Gallbladder heat tends to cause sleepiness; here, "desiring to lie down" indicates the pathogen has entered Shaoyang. If accompanied by chest and hypochondriac fullness and pain, which are Shaoyang meridian symptoms, Xiaochaihu Tang is appropriate. If the pulse is merely floating without being fine, the pathogen has not entered Shaoyang but remains in Taiyang, so Mahuang Tang is indicated.
In Shanghan (Cold Damage disease), if the Yang pulse (Cun position) is choppy and the Yin pulse (Chi position) is wiry, according to the method, there should be acute abdominal pain. First, treat with Xiao Jianzhong Tang (Minor Construct the Middle Decoction, a formula for warming the middle, tonifying deficiency, harmonizing the interior, and relieving urgency); if ineffective, then treat with Xiaochaihu Tang as the primary remedy.
Jia Wood (Liver/Gallbladder) and Yi Wood share the same Qi. If Jia Wood fails to descend, the Cun pulse becomes choppy; if Yi Wood fails to ascend, the Chi pulse becomes wiry. When Jia Wood rebels upward and overacts on Wu Earth (Stomach), pain manifests in the chest and diaphragm; when Yi Wood sinks downward and overacts on Ji Earth (Spleen), pain manifests in the abdomen and hypochondrium. Due to the dryness of Wood Qi, the pain is urgent. The combination of Liver and Gallbladder pathogens leads to the郁 (stagnation) and eruption of Wind and Fire, damaging the Middle Qi; the condition cannot be delayed. Therefore, one should first use Xiao Jianzhong Tang: the sweet properties of Yitang (Maltose), Gancao, and Dazao nourish Spleen essence and relieve urgency; Shengjiang, Guizhi, and Shaoyao unblock Wood stagnation and clear Wind-Fire. If symptoms persist, Chaihu formulas are used again to vent Ministerial Fire. This clarifies the rationale for adding Shaoyao in cases of abdominal pain mentioned in the first chapter.
Guizhi (3 liang), Shaoyao (6 liang), Gancao (2 liang, prepared), Dazao (12 pieces), Shengjiang (3 liang), Jiaoyi (Maltose, 1 sheng).
Take the above six herbs, decoct in seven sheng of water until three sheng remain, remove the dregs, add Jiaoyi, and melt gently over low fire. Take one sheng warm, three times daily.
Patients prone to vomiting should not receive Xiao Jianzhong Tang because sweetness exacerbates vomiting.
Individuals with a history of habitual vomiting should not take Xiao Jianzhong Tang, as the sweetness of Guizhi, Gancao, Jiaoyi, and Dazao easily triggers vomiting.