桂枝(一两十六铢) 芍药(一两) 甘草(一两炙) 大枣(四枚) 生姜(一两) 麻黄(一两) 杏仁(三
十四枚去皮尖及两仁者)
上七味以水五升先煮麻黄一二沸去上沫内诸药煮取一升八合去滓温服八合
形作伤寒其脉不弦紧而弱弱者必渴被火者必谵语弱者发热脉浮解之当汗出愈
此申明上章之义前章发热恶寒发热多而恶寒少是形作伤寒也伤寒脉当弦紧乃脉微而恶寒(微即弱之变文)其脉不弦
紧而弱必缘血虚血虚脉弱者必满若被火薰愈烁其血不止渴也必作谵语脉弱是以发热偏多脉法诸弱发热是也发热是营气之
虚而恶寒是卫气亦虚也故上章谓之阴阳俱虚然虚而外见恶寒非无表证有表证脉必浮如其发热而脉浮则阴阳虽俱虚而解之
之法究当令其汗出而愈但发汗另有善方不可以他药发表耳下章桂枝二越婢一汤则美善而无弊矣
太阳病发热恶寒热多寒少脉微弱者此无阳也不可更汗宜桂枝二越婢一汤
此申明上二章之义前证发热恶寒热多寒少形作伤寒而其脉不弦紧而微弱者以血藏于肝而内胎君火实以阴质而抱阳气
血虚脉弱是无阳也其恶寒虽少不可不解发热既多不可不清但不可更以他药发汗宜桂枝二越婢一汤重泄营血轻泄卫气而兼
清内热则表里全瘳矣此无阳也即前章阴阳俱虚意此不可更汗发明前章不可更发汗更下更吐句义言寻常汗吐下法俱不可更
用当另有汗法桂枝越婢是也(此章包上发热脉浮意)二章是首章脉微恶寒一条治法
桂枝(一两十六铢) 芍药(一两) 甘草(一两,炙) 大枣(四枚) 生姜(一两) 麻黄(一两) 杏仁(三十四枚,去皮尖及双仁者)
以上七味药,用水五升,先煮麻黄,煮沸一两次后,撇去上面的浮沫,再加入其余药物,煎煮取汁一升八合,滤去药渣,温服八合。
症状表现类似伤寒,但脉象不弦紧而软弱;脉象软弱的人必定口渴;若被火疗熏灼,必定出现胡言乱语(谵语)。脉象软弱且发热,脉象浮的,应当通过发汗来解除病邪,出汗后即可痊愈。
这是阐明上一章的含义。上一章所述“发热、恶寒,发热多而恶寒少”,就是症状类似伤寒的情况。伤寒的脉象应当是弦紧的,现在脉象微弱且恶寒(“微”即“弱”的变文),其脉象不弦紧而软弱,必然是因为血虚。血虚导致脉象软弱,必然会出现胀满;如果被火疗熏灼,进一步煎熬血液,不仅会口渴不止,还一定会出现胡言乱语。脉象软弱所以发热偏多,这正是脉法中“诸弱发热”的道理。发热是因为营气(Ying Qi, Nutritive Qi)虚弱,恶寒是因为卫气(Wei Qi, Defensive Qi)也虚弱。所以上一章称之为阴阳俱虚。然而,虽然虚弱却外见恶寒,并非没有表证(Exterior Syndrome);有表证则脉象必浮。如果发热且脉象浮,那么即使阴阳俱虚,治疗的方法终究应当令其出汗而痊愈。但是发汗另有良方,不可以用其他药物来发表。下一章的桂枝二越婢一汤(Guizhi Er Yuebi Yi Tang)则是完美无弊的了。
太阳病(Taiyang Disease)表现为发热、恶寒,热多寒少,脉象微弱,这属于“无阳”(Wu Yang, Lack of Yang Qi)的状态,不可再用发汗法,适宜使用桂枝二越婢一汤。
这是阐明前两章的含义。前一种证候表现为发热、恶寒,热多寒少,症状类似伤寒,但其脉象不弦紧而微弱。这是因为血藏于肝,内寄君火,实质上是阴质包裹着阳气。血虚脉弱即是“无阳”。其恶寒虽少,也不可不解表;发热既多,也不可不清热。但不可再用其他药物发汗,适宜使用桂枝二越婢一汤。此方能重泄营血、轻泄卫气并兼清内热,从而使表里病症全部痊愈。“此无阳也”即前一章“阴阳俱虚”的意思。此处强调“不可更汗”,阐明了前一章“不可更发汗、更下、更吐”句子的含义,指出寻常的汗、吐、下法都不可再用,应当另有汗法,即桂枝二越婢一汤。(本章包含了上一章“发热、脉浮”的意思)。第二章是第一章节中“脉微、恶寒”这一条的治疗法则。
Cinnamon Twig (Liangshi Liuzhu) [1 liang 16 zhu], White Peony Root (Liang), Licorice Root and Rhizome (Liang, honey-fried), Jujube (4 pieces), Fresh Ginger (Liang), Ephedrae Herba (Mahuang, 麻黄) (Liang), Apricot Seed (34 pieces, skin and pointed ends removed, excluding those with two kernels).
The above seven ingredients are boiled in five sheng of water. First, boil the Ephedrae Herba for one or two boils, remove the foam on the surface, then add the remaining herbs. Boil until one sheng eight he of decoction remains. Strain the dregs and take eight he warm.
The presentation resembles Taiyang disease (Taiyang Bing, a syndrome characterized by exterior pathogenic invasion), but the pulse is not wiry and tight; rather, it is weak. A weak pulse indicates thirst. If treated with fire therapy, delirium will inevitably occur. In cases of weak pulse accompanied by fever and floating pulse, the treatment should induce sweating to resolve the condition, leading to recovery.
This passage elucidates the meaning of the previous chapter. The previous chapter described symptoms resembling Taiyang disease: fever and aversion to cold, with more fever than aversion to cold. Typically, Taiyang disease presents with a wiry and tight pulse. However, here the pulse is faint and there is aversion to cold ("faint" being a variant term for "weak"). The pulse is not wiry and tight but weak, indicating blood deficiency. Blood deficiency leads to a weak pulse and abdominal fullness. If subjected to fire therapy, which further scorches the blood, excessive thirst and delirium will ensue. The prevalence of fever with a weak pulse aligns with the pulse principle stating that "various weak pulses indicate fever." Fever arises from the deficiency of Ying Qi (Nutritive Qi), while aversion to cold stems from the deficiency of Wei Qi (Defensive Qi). Thus, the previous chapter referred to this as a simultaneous deficiency of Yin and Yang. Although there is aversion to cold due to deficiency, it does not mean the absence of an Exterior Syndrome (Biao Zheng); if an Exterior Syndrome exists, the pulse must be floating. If fever is present with a floating pulse, despite the dual deficiency of Yin and Yang, the resolution method ultimately requires inducing sweating for recovery. However, there are superior methods for inducing sweating; other drugs should not be used merely to release the exterior. The subsequent formula, Guizhi Er Yuebi Yi Tang (Two Parts Cinnamon Twig Decoction and One Part Daylily Decoction), is perfect without flaws.
In Taiyang disease, presenting with fever, aversion to cold, more heat than cold, and a faint pulse, this constitutes a state of "Wu Yang" (Absence of Yang Qi). Sweating should not be induced again; instead, Guizhi Er Yuebi Yi Tang is appropriate.
This passage elucidates the meanings of the preceding two chapters. The previous syndrome involved fever, aversion to cold, more heat than cold, resembling Taiyang disease, yet the pulse was not wiry and tight but faint. This is because blood resides in the Liver, harboring Ministerial Fire within, essentially consisting of Yin substance embracing Yang Qi. Blood deficiency and a weak pulse signify "Wu Yang." Although aversion to cold is slight, the exterior cannot fail to be resolved; since fever is prominent, internal heat cannot fail to be cleared. However, other drugs should not be used to induce sweating. Guizhi Er Yuebi Yi Tang is suitable. This formula heavily drains Ying blood, lightly drains Wei Qi, and simultaneously clears internal heat, thereby curing both interior and exterior conditions. "Wu Yang" here corresponds to the concept of simultaneous Yin and Yang deficiency mentioned in the previous chapter. The emphasis on "not inducing sweating again" clarifies the previous statement regarding the contraindication of further sweating, purging, or vomiting, indicating that standard sweating, vomiting, or purging methods are inappropriate, and a specific sweating method, namely Guizhi Er Yuebi Yi Tang, should be employed. (This chapter encompasses the concepts of fever and floating pulse from the previous chapter). Chapter Two provides the treatment principle for the "faint pulse and aversion to cold" clause in Chapter One.