干姜(一两) 附子(一枚,生用去皮切八片) 上二味,以水三升,煮取一升,去渣,顿服。
下之后,复发汗,先竭其阴,后竭其阳。昼日烦
躁不得眠,夜而安静,阳虚有二症,有喜阳者;有畏阳者。大抵阴亦虚者畏阳;阴不虚者喜阳。此因下后
阴亦虚,故反畏阳也。不呕不渴,无表证,脉沉微,身无大热者,此邪已退,而阳气衰弱,故止用姜附回
阳。干姜附子汤主之。
干姜附子汤原方加葱白四茎。煎服法照前。
少阴病,下利,白通汤主之。此专治少阴之利,用葱白所以通少阴之阳气。
白通汤原方加人尿五合,猪胆汁一合。上三味,以水三升,煮取一升,去渣,纳胆汁,人尿,和令相
得,分温再服,若无胆汁亦可。
少阴病,下利脉微者,与白通汤,利不止,厥逆无脉,干呕烦者,无脉厥逆,呕而且烦,则上下俱
不通。阴阳相格,故加猪胆、人尿,引阳药达于至阴而通之。《内经》所云∶“反佐以取之”是也。白通加猪
胆汁汤主之。服汤脉暴出者死,微续者生。暴出乃药
力所迫,药力尽则气乃绝。微续乃正气自复,故可生也。
少阴篇云∶少阴病,下利不止,恶寒而 卧,手足温者可治。则又当以手足之温,验其阳之有无也。
前云,其脉即出者愈。此云∶暴出者死。益暴出与即出不同。暴出,一时出尽,即出,言服药后,少
顷即徐徐微续也,须善会之。
干姜(一两) 附子(一枚,生用,去皮,切成八片) 以上两味药,用水三升,煮取一升药液,去掉药渣,一次性服用。
经过攻下法治疗后,又发汗,先耗竭了阴液,后耗竭了阳气。白天烦躁不安无法入睡,夜间却安静,阳虚有两种症状表现:有喜欢阳气(外界温暖或热象)的;有畏惧阳气(外界温暖或热象)的。大抵阴液也虚弱的患者会畏惧阳气;阴液不虚的患者则喜欢阳气。此证因攻下之后阴液也虚弱,所以反而畏惧阳气。没有呕吐、没有口渴、没有表证,脉象沉而微弱,身体没有大热的,这是邪气已退,但阳气衰弱,所以只用干姜和附子来回阳救逆。主方为干姜附子汤。
少阴病,出现下利症状,主方为白通汤。此方专门治疗少阴病的下利,使用葱白是为了通达少阴经的阳气。
白通汤原方中加入人尿五合,猪胆汁一合。以上三味药,用水三升,煮取一升药液,去掉药渣,纳入胆汁和人尿,调和均匀,分两次温服,如果没有胆汁也可以不用。
少阴病,下利且脉象微弱的,给予白通汤服用,如果下利不止,出现四肢厥冷、无脉、干呕、心烦的症状,无脉且四肢厥冷,又呕吐且心烦,说明上下气机都不通畅。阴阳相互格拒,所以加入猪胆和人尿,作为反佐,引导阳药到达至阴之地从而打通气机。这就是《内经》所说的“反佐以取之”。主方为白通加猪胆汁汤。服药后如果脉象突然暴出(突然出现且强劲),预后不良;如果脉象微微续接(逐渐恢复),则有生机。突然暴出是药力逼迫所致,药力耗尽后气息就会断绝。微微续接是正气自然恢复,所以可以存活。
《伤寒论·少阴篇》记载:“少阴病,下利不止,恶寒而蜷卧,手足温暖的可以治愈。”这又应当通过手足是否温暖来验证阳气的有无。前文说,“其脉即出者愈”(脉象随即缓缓出现的是痊愈)。这里说,“暴出者死”(脉象突然暴出的是死证)。可见“暴出”与“即出”不同。“暴出”,是一时之间全部冒出;“即出”,是指服药后,过一会儿就徐徐地微微续接。需要仔细体会其中的区别。
Dried Ginger (Sheng Jiang, Dried Ginger) [1 liang] and Aconite Root (Fu Zi, Prepared Aconite Lateral Root) [one piece, raw, peeled, cut into eight slices]. The above two ingredients are boiled in three sheng of water until one sheng remains. The dregs are removed, and the decoction is taken all at once.
After purgation followed by sweating, yin fluids are exhausted first, then yang qi is exhausted. During the day, there is irritability and restlessness with inability to sleep; at night, the patient is quiet. Yang deficiency presents with two types of symptoms: some patients prefer warmth/yang, while others fear it. Generally, those with concurrent yin deficiency fear warmth/yang, whereas those without yin deficiency prefer it. In this case, because purgation has also damaged yin, the patient fears warmth/yang. With no vomiting, no thirst, no exterior syndrome, a deep and faint pulse, and no significant fever on the body, the pathogenic factor has retreated, but yang qi is weak. Therefore, only Dried Ginger and Aconite Root are used to restore yang. The principal formula is Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction).
Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction): Add four stalks of Scallion White (Cong Bai, Allii Fistulosi Bulbus) to the original prescription. The decoction and administration method remain as described above.
Shaoyin disease (Shaoyin Syndrome) presenting with diarrhea is treated primarily with Baitong Tang (White Passage Decoction). This formula specifically treats Shaoyin diarrhea; Scallion White is used to unblock the yang qi of the Shaoyin channel.
Baitong Tang (White Passage Decoction): Add five he of Human Urine (Ren Niao, Urina Humana) and one he of Pig Gallbladder Juice (Zhu Dan Zhi, Bile Porci) to the original prescription. The above three ingredients are boiled in three sheng of water until one sheng remains. The dregs are removed, and the bile juice and human urine are added and mixed well. The mixture is divided into two doses and taken warm. If bile is unavailable, it may be omitted.
In Shaoyin disease with diarrhea and a faint pulse, administer Baitong Tang (White Passage Decoction). If diarrhea persists, accompanied by cold extremities, absence of pulse, dry heaving, and vexation, the condition indicates blockage of both upper and lower jiao due to the absence of pulse and cold extremities, along with vomiting and vexation. Yin and yang repel each other (mutual rejection); therefore, Pig Gallbladder Juice and Human Urine are added to guide the yang-tonifying herbs to the extreme yin level to unblock the flow. This corresponds to the principle stated in Neijing (The Inner Canon): "Use counter-assistance to obtain the desired effect." The principal formula is Baitong Jia Zhudanhui Tang (White Passage Decoction with Pig Gallbladder and Human Urine). If the pulse suddenly bursts forth after taking the medicine, death ensues; if the pulse gradually returns, life is preserved. A sudden burst is forced by the drug's potency; when the potency wears off, qi perishes. A gradual return indicates the natural recovery of righteous qi, thus survival is possible.
The Shaoyin Chapter states: "In Shaoyin disease, if diarrhea is unceasing, the patient feels aversion to cold and lies curled up, but the hands and feet are warm, the prognosis is favorable." Thus, the presence or absence of yang should be verified by whether the hands and feet are warm. Previously, it was stated that "if the pulse appears immediately, the patient recovers." Here, it is stated that "if the pulse bursts forth suddenly, the patient dies." It is evident that "sudden bursting" differs from "immediate appearance." "Sudden bursting" means emerging all at once; "immediate appearance" refers to the pulse slowly and gradually returning shortly after taking the medicine. These distinctions must be carefully understood.