桂枝(三两) 芍药(三两) 甘草(二两) 大枣(十二枚) 附子(一枚炮破八片) 生姜(三两)
于桂枝汤内加附子一枚破八片余根据前法
发汗病不解反恶寒者虚故也芍药甘草附子汤主之
汗泄血中温气木郁阳陷故表病不解而反加恶寒芍药甘草附子汤芍药清风而敛营血甘草培土而荣木气附子暖水以补温
气也
芍药(三两) 甘草(三两炙) 附子(一枚炮破八片)
以上三味以水五升煮取一升五合去滓温服
下之后复发汗必振寒脉微细所以然者以内外俱虚故也
申明上章恶寒之义汗下亡阳必身体振寒而经脉细微所以然者以下伤其内汗泄其外内外之阳俱虚故也
伤寒若吐若下后心下逆满气上冲胸起则头眩脉沉紧发汗则动经身为振振摇者茯苓桂枝白术甘草汤主之
吐伤胃阳则病上逆浊气冲塞故心逆满阳气浮升而无根故起则头眩下泄脾阳则病下陷风木抑郁故脉沉紧木愈郁而愈升
升发太过而不得平故气上冲胸又复发汗以亡经中之阳温气脱泄木枯风动于是身体振摇势如悬旌此缘于水旺土湿而风木郁
动也苓桂术甘汤苓术泄水桂枝疏木而甘草补中也
茯苓(四两) 甘草(二两炙) 桂枝(二两) 白术(二两)
上四味以水六升煮取三升去滓分温三服
太阳病发汗汗出不解其人仍发热心下悸头眩身 动振振欲擗地者真武汤主之(方在少阴十九)
阳虚之人发汗过多土败阳飞则头目眩晕风木动摇则心悸肉 盖木生于水而长于土水寒土湿木郁风生是以悸动根本摇
撼则悸在脐间枝叶振摇则悸在心下振振欲擗地者风动神摇欲穴地以自安也木郁风动原于土湿而水寒真武汤生姜降浊而止
呕苓术泄水而燥土芍药清风而安振摇附子温肾水以培阳根也(真武汤治少阴病内有水气腹痛下利小便不利四肢沉重疼痛
或呕者)
桂枝(三两) 芍药(三两) 甘草(二两) 大枣(十二枚) 附子(一枚,炮制后破开成八片) 生姜(三两)
在桂枝汤的基础上加入一枚附子,破开成八片,其余按照前法煎服。
发汗后病证未解,反而出现恶寒症状,这是虚证的表现,应当用芍药甘草附子汤主治。
汗出导致血中的温气外泄,肝木郁结、阳气下陷,所以表证未解反而加重恶寒。芍药甘草附子汤中,芍药清散风邪并收敛营血,甘草培补脾胃以滋养肝木之气,附子温暖肾水以补充温气。
芍药(三两) 甘草(三两,炙) 附子(一枚,炮制后破开成八片)
以上三味药,用水五升,煮取一升五合,去渣,温服。
经过泻下治疗后再次发汗,必定出现身体颤抖畏寒,脉象微细。之所以这样,是因为内外俱虚的缘故。
申明上一章恶寒的含义:汗法和下法导致亡阳,必然引起身体颤抖畏寒且经脉细微。之所以如此,是因为下法损伤了体内的阳气,汗法耗散了体表的阳气,内外的阳气都虚弱了。
伤寒病如果经过催吐或泻下后,出现心下逆满(胃脘部胀满且有气上逆感),气向上冲至胸部,起身时头晕目眩,脉象沉紧;若再发汗则会扰动经络,导致身体震颤摇晃。这种情况应用茯苓桂枝白术甘草汤主治。
催吐损伤胃阳,导致病症上逆,浊气冲塞,所以心下逆满;阳气浮升而无根,所以起身时头晕目眩;泻下损伤脾阳,导致病症下陷,风木之气抑郁,所以脉象沉紧。风木越郁结就越容易升发,升发太过而不能平抑,所以气向上冲至胸部。此时如果再发汗以耗伤经络中的阳气,温气脱失,肝木枯槁而生风动,于是身体震颤摇晃,态势如悬挂的旌旗般飘摇不定。这缘于水湿旺盛、脾土湿困而风木郁动所致。茯苓桂枝白术甘草汤中,茯苓和白术渗泄水湿,桂枝疏达肝木,甘草补益中气。
茯苓(四两) 甘草(二两,炙) 桂枝(二两) 白术(二两)
以上四味药,用水六升,煮取三升,去渣,分三次温服。
太阳病发汗后,汗出但病证未解,患者仍然发热,心下悸动,头晕目眩,身体震颤动摇,甚至欲倒地者,应用真武汤主治。(方剂见少阴篇第十九节)
阳气虚弱之人,发汗过多导致脾土败坏、阳气飞越,则头目眩晕;肝木动摇则心悸。肌肉跳动,盖因肝木生于肾水而长于脾土,水寒土湿导致肝木郁结而生风,因此根本动摇则在脐间悸动,枝叶振摇则在心下悸动。“振振欲擗地”是指风动神摇,想要趴在地上以求安稳。肝木郁结生风,根源在于土湿和水寒。真武汤中,生姜降浊止呕,茯苓和白术渗泄水湿并燥湿健脾,芍药清散风邪并安定震颤,附子温补肾水以培育阳气的根本。(真武汤治疗少阴病,内有水气,表现为腹痛、下利、小便不利、四肢沉重疼痛,或有呕吐者。)
Cinnamon Twig (Guizhi, 3 liang), White Peony Root (Shaoyao, 3 liang), Licorice Root (Gancao, 2 liang), Jujube (Dazao, 12 pieces), Prepared Aconite Root (Fuzi, 1 piece, prepared and broken into eight slices), Fresh Ginger (Shengjiang, 3 liang).
Add one piece of Prepared Aconite Root, broken into eight slices, to the Guizhi Tang (Cinnamon Twig Decoction); prepare and administer the remaining ingredients according to the previous method.
If the disease condition remains unresolved after sweating, but chills instead worsen, this indicates deficiency; Shaoyao Gancao Fuzi Tang (White Peony and Licorice with Prepared Aconite Decoction) is indicated.
Sweating causes the warming Qi within the blood to leak out, leading to stagnation of Liver Wood and sinking of Yang Qi. Thus, the exterior syndrome remains unresolved while chills intensify. In Shaoyao Gancao Fuzi Tang, Shaoyao (White Peony Root) clears wind and astringes Ying Blood; Gancao (Licorice Root) nourishes Earth to benefit Wood Qi; and Fuzi (Prepared Aconite Root) warms Water to replenish Warming Qi.
White Peony Root (Shaoyao, 3 liang), Licorice Root (Gancao, 3 liang, honey-fried), Prepared Aconite Root (Fuzi, 1 piece, prepared and broken into eight slices).
Take the above three herbs, decoct in five sheng of water, reduce to one sheng and five he, remove the dregs, and take warm.
After purgation followed by re-sweating, there will inevitably be trembling chills and a faint, fine pulse. The reason for this is that both the interior and exterior are deficient.
This clarifies the meaning of chills mentioned in the previous chapter: Sweating and purging lead to the loss of Yang Qi, inevitably causing bodily tremors and chills along with fine meridians. This occurs because purgation damages the interior Yang, while sweating depletes the exterior Yang, resulting in deficiency of Yang Qi in both the interior and exterior.
In Taiyang Cold Damage, if emesis or purgation has been used, symptoms such as fullness and rebellious Qi below the heart, Qi rushing upward to the chest, dizziness upon rising, and a deep, tight pulse may appear. If sweating is then induced, it disturbs the meridians, causing the body to tremble and shake. In such cases, Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is indicated.
Emesis damages Stomach Yang, causing pathology to rebel upward with turbid Qi blocking, resulting in fullness and rebellious Qi below the heart. Floating Yang without root causes dizziness upon rising. Purgation damages Spleen Yang, causing pathology to sink and Liver Wood to become depressed, leading to a deep, tight pulse. As Wood becomes more depressed, it rises excessively and cannot be balanced, causing Qi to rush upward to the chest. Inducing sweating again depletes the Yang within the meridians; as Warming Qi escapes and Wood withers, Wind moves, causing the body to tremble and sway like a hanging banner. This stems from excessive Water, damp Earth, and agitated Liver Wood. In Linggui Zhugan Tang, Poria (Fuling) and Atractylodes (Baizhu) drain Water; Cinnamon Twig (Guizhi) soothes Wood; and Licorice (Gancao) tonifies the Middle.
Poria (Fuling, 4 liang), Licorice Root (Gancao, 2 liang, honey-fried), Cinnamon Twig (Guizhi, 2 liang), Atractylodes Macrocephala Rhizome (Baizhu, 2 liang).
Take the above four herbs, decoct in six sheng of water, reduce to three sheng, remove the dregs, and divide into three warm doses.
In Taiyang disease, after inducing sweating, if the condition remains unresolved despite sweating, and the patient still has fever, palpitations below the heart, dizziness, and severe trembling/shaking such that they wish to fall to the ground, Zhenwu Tang (True Warrior Decoction) is indicated. (Formula see Shaoyin Chapter 19).
In individuals with deficient Yang, excessive sweating leads to failure of Earth and floating Yang, causing dizziness and vertigo. Agitation of Liver Wood causes palpitations. Muscle twitching occurs because Liver Wood originates in Kidney Water and grows in Spleen Earth; cold Water and damp Earth cause Wood depression and Wind generation. When the root shakes, palpitations occur around the umbilicus; when the branches tremble, palpitations occur below the heart. "Trembling and wishing to fall to the ground" refers to Wind movement and spirit agitation, where the patient wishes to lie flat on the ground for stability. Wood depression and Wind movement originate from damp Earth and cold Water. In Zhenwu Tang, Fresh Ginger (Shengjiang) descends turbidity and stops vomiting; Poria (Fuling) and Atractylodes (Baizhu) drain Water and dry Earth; White Peony Root (Shaoyao) clears Wind and stabilizes trembling; and Prepared Aconite Root (Fuzi) warms Kidney Water to cultivate the root of Yang. (Zhenwu Tang treats Shaoyin disease with internal Water retention, presenting with abdominal pain, diarrhea, difficulty in urination, heavy/painful limbs, or vomiting.)