桂枝(十八铢) 芍药(十八铢) 甘草(十八铢) 大枣(四枚) 生姜(一两三钱) 麻黄(十八铢) 石膏
(十四铢)
上七味 咀以水五升先煮麻黄三沸去上沫内诸药煮取二升温服一升
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桂枝二麻黄一汤
此总申明上三章之义如服桂枝汤大汗出而表未解而脉又洪大(洪大即脉浮之变文)是表有寒而里有热此亦桂枝越婢
证可与桂枝汤如前法而加越婢也若前证之形如疟状而无洪大之脉寒热日仅再发不能二三度者是正气虚不能频与邪争也其
风邪多而寒邪少宜桂枝二麻黄一重泄营血而轻泄卫气乃为合法也此章是首章一日二三度发者一条治法以其不能二三度发
是为未欲愈故也 前章脉微脉弱脉浮脉微弱脉洪大总对弦紧言微弱即不弦紧洪大即浮意勿泥
桂枝(一两七铢) 芍药(一两六铢) 甘草(一两二铢) 大枣(五枚) 生姜(一两六铢) 麻黄(十六铢) 杏
仁(十六枚去皮尖)
上七味以水五升先煮麻黄一二沸去上沫内诸药煮取二升去滓温服一升日再服
太阳中风脉缓头痛汗出而不烦躁此其脉紧身痛无汗而烦躁者卫闭而营不能泄也故其脉证似伤寒太阳伤寒脉紧身疼此
其脉缓而身不疼者营闭而卫不能泄也故其脉证似中风中风卫闭而营郁阳盛者固宜青龙然当防其肾阴之旺故立真武之法伤
寒营闭而卫郁阴盛者固宜真武然当防其胃阳之旺故垂青龙之方灵通变化元妙无穷也首章名曰中风次章名曰伤寒俗手妄缪
以为风寒双感误世非小也
桂枝(十八铢) 芍药(十八铢) 甘草(十八铢) 大枣(四枚) 生姜(一两三钱) 麻黄(十八铢) 石膏(十四铢)
以上七味药,切碎,用五升水,先煮麻黄,煮沸三次后,撇去上面的浮沫,再加入其他药物,煎取二升药液,每次温服一升。
服用桂枝汤(Cinnamon Twig Decoction)后大汗出,脉象洪大者,仍给予桂枝汤,用法如前所述;若症状像疟疾一样,每天发作两次者,给予桂枝二麻黄一汤(Guizhi Er Mahuang Yi Tang)。
这一条总括地阐明了前三章的意义。如果服用桂枝汤后大汗出,但表证未解,且脉象又呈现洪大(洪大即脉浮的另一种表述),这是表有寒邪而里有热邪,这也属于桂枝越婢汤证,可以给予桂枝汤,用法如前,并加入越婢汤(Yebing Decoction)的成分。如果是前述症状,表现为像疟疾一样,但没有洪大的脉象,寒热症状每天仅发作两次,不能发作两三次,这是因为正气虚弱,不能频繁地与邪气抗争。此时风邪多而寒邪少,适宜使用桂枝二麻黄一汤,重在疏泄营血(Nutrient Blood),轻在疏泄卫气(Defensive Qi),这才是合法的治疗。本章对应首章中“一天发作两三次”的情况,治疗方法之所以不同,是因为病情未能达到一天发作两三次的程度,说明病势尚未完全解除。前一章提到的脉微、脉弱、脉浮、脉微弱、脉洪大,都是相对于弦紧脉而言的。微弱即表示不弦紧,洪大即表示浮意,不要拘泥于字面意思。
桂枝(一两七铢) 芍药(一两六铢) 甘草(一两二铢) 大枣(五枚) 生姜(一两六铢) 麻黄(十六铢) 杏仁(Apricot Seed, 去皮尖,十六枚)
以上七味药,用五升水,先煮麻黄一至二次沸,撇去上面的浮沫,再加入其他药物,煎取二升药液,滤去药渣,温服一升,每日服用两次。
太阳中风(Taiyang Wind Strike)脉缓、头痛、汗出而不烦躁,这是卫气闭郁而营血不能宣泄的表现;其脉紧身痛、无汗而烦躁者,是卫气闭塞而营血不能宣泄所致。所以其脉证看似伤寒(Cold Damage)。太阳伤寒脉紧身疼,其脉缓而身不疼者,是营血闭郁而卫气不能宣泄所致;所以其脉证看似中风。中风证见卫气闭郁而营血郁滞、阳气盛者,固然适宜使用大青龙汤(Major Green Dragon Decoction),但应当防止肾阴(Kidney Yin)过旺,故设立真武汤(Zhenwu Decoction)之法;伤寒证见营血闭郁而卫气郁滞、阴气盛者,固然适宜使用真武汤,但应当防止胃阳(Stomach Yang)过旺,故垂示大青龙汤之方。这种灵活通变的方法,奥妙无穷。首章名为中风,次章名为伤寒,世俗医生错误地认为这是风寒同时感受,误人非浅。
Ephedrae Herba (Mahuang, 麻黄) (18 zhu), Paeoniae Radix Alba (Baishao, 芍药) (18 zhu), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (18 zhu), Ziziphi Jujubae Fructus (Dazao, 大枣) (4 pieces), Zingiberis Rhizoma Recens (Shengjiang, 生姜) (1 liang 3 qian), Schizonepetae Herba (Jingjie, 荆芥 - *Note: Text says Guizhi but context implies formula composition, however strictly translating text: Cinnamomi Ramulus (Guizhi, 桂枝)* (18 zhu), Gypsum Fibrosum (Shigao, 石膏) (14 zhu).
The above seven herbs are coarsely crushed. Boil in five sheng of water. First boil Ephedrae Herba for three boils, then skim off the foam on the surface. Add the remaining herbs and decoct to obtain two sheng. Take one sheng warm.
If after taking Guizhi Tang (Cinnamon Twig Decoction) there is profuse sweating and the pulse is surging and large (Hongda), continue to administer Guizhi Tang as previously described. If the condition resembles malaria with symptoms occurring twice a day, administer Guizhi Er Mahuang Yi Tang (Guizhi Two-part, Ephedra One-part Decoction).
This section generally elucidates the meaning of the preceding three chapters. If after taking Guizhi Tang there is profuse sweating but the exterior syndrome remains unresolved, and the pulse becomes surging and large (Surging and Large is a variant expression of Floating pulse), this indicates cold at the exterior and heat at the interior. This also constitutes a Yebing Decoction syndrome; one may administer Guizhi Tang as before, combined with Yebing Decoction. If the previous condition presents like malaria without a surging and large pulse, and chills and fever occur only twice a day rather than multiple times, it is because the healthy qi is deficient and cannot frequently contend with the pathogenic factors. In this case, wind pathogen predominates over cold pathogen; it is appropriate to use Guizhi Er Mahuang Yi Tang to heavily release Ying blood (Nutrient Blood) and lightly release Wei qi (Defensive Qi), which is the correct method. This chapter corresponds to the first chapter's description of "occurring two or three times a day." The treatment differs because the condition has not reached that frequency, indicating the disease is not yet resolving. The pulses mentioned in the previous chapter—micro, weak, floating, micro-and-weak, surging-and-large—are contrasted with wiry-and-tight. Micro and weak imply not wiry-and-tight; surging and large imply floating. Do not adhere rigidly to the literal terms.
Cinnamomi Ramulus (Guizhi, 桂枝) (1 liang 7 zhu), Paeoniae Radix Alba (Baishao, 芍药) (1 liang 6 zhu), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (1 liang 2 zhu), Ziziphi Jujubae Fructus (Dazao, 大枣) (5 pieces), Zingiberis Rhizoma Recens (Shengjiang, 生姜) (1 liang 6 zhu), Ephedrae Herba (Mahuang, 麻黄) (16 zhu), Semen Armeniacae Amarum (Xingren, 杏仁) (16 pieces, peeled skin and tips).
The above seven herbs are boiled in five sheng of water. First boil Ephedrae Herba for one or two boils, skim off the foam, add the remaining herbs, and decoct to obtain two sheng. Strain and take one sheng warm, twice daily.
Taiyang Wind Strike (Taiyang Zhongfeng) presents with a slow pulse, headache, sweating, and no irritability. This is due to Wei qi (Defensive Qi) closure preventing Ying blood (Nutrient Blood) from venting. Conversely, if the pulse is tight, body painful, anhidrotic, and irritable, it is because Wei qi is blocked and Ying blood cannot vent. Thus, its pulse and symptoms resemble Cold Damage (Shanghan). Taiyang Cold Damage presents with a tight pulse and body pain; if the pulse is slow and the body is not painful, it is because Ying blood is closed and Wei qi cannot vent. Thus, its pulse and symptoms resemble Wind Strike. In Wind Strike, if Wei qi is closed and Ying blood is stagnant with excess Yang, Major Green Dragon Decoction (Da Qinglong Tang) is indeed suitable, but one must guard against excessive Kidney Yin (Shen Yin); hence, the method of Zhenwu Decoction (Zhenwu Tang) is established. In Cold Damage, if Ying blood is closed and Wei qi is stagnant with excess Yin, Zhenwu Decoction is indeed suitable, but one must guard against excessive Stomach Yang (Wei Yang); hence, the prescription of Major Green Dragon Decoction is provided. Such flexible and profound variations are infinitely subtle. The first chapter is named Wind Strike, and the second chapter is named Cold Damage. Unskilled physicians erroneously believe this represents simultaneous contraction of wind and cold, causing significant harm to the world.