茯苓(四两一本作六两) 人参(一两) 附子(一枚,生用破八片) 甘草(二两,炙) 干姜(一两半) 上
五味,以水五升,煮取三升,去渣,温服七合,日三服。
发汗,若下之,病仍不解,烦躁者,此阳气不摄而烦,所谓阴烦也。然亦必参以他症,方不误认为栀
子汤症。茯苓四逆汤主之。《本草》∶茯苓治逆气烦满。
甘草(炙) 枳实(破,水渍,炙干) 柴胡 芍药
上四味,各十分,捣筛,白饮和服方寸匕,日三服。咳者,加五味子、干姜各五分,并主下利;悸者
加桂枝五分;小便不利者,加茯苓五分;腹中痛者,
加附子一枚,炮令坼;泄利下重者,先以水五升,煮薤白取三升,去渣,以散三方寸匕,纳汤中,煮取
一升半,分温再服。《别录》∶薤白,主温中散结。
少阴病,四逆,其人或咳;或悸;或小便不利;或腹中痛;或泄利下重者。此乃少阴传经之热邪,并
无脉微恶寒等阴症。即下利一端,并非清谷,而反下重,故不得用温热。四逆散主之,疏邪通气。同名四
逆,与前诸法迥殊。诸兼症皆在加减中。
治利极神。
当归 桂枝 芍药 细辛(各三两) 甘草 通草(各二两) 大枣(二十五枚) 上七味,以水八升,煮取三
升,温服一升,日三服。
当归(三两) 甘草 通草(各二两) 芍药 桂枝 细辛(各三两) 大枣(二十五枚) 吴茱萸(二升) 生
姜(半斤) 上九味,以水六升,清酒六升,和煮,取五升,去渣,分温五服。
手足厥寒,脉细欲绝者,当归四逆汤主之。此四
逆乃太阳传经之邪,而表症犹未罢,因阳气已虚,故用桂枝汤加当归和血;细辛温散,以和表里之阳也。
若其人内有久寒者,宜当归四逆加吴茱萸生姜汤主之。内有久寒,指平素言。必从问而得之,或另有现
症,乃为可据。吴茱萸温中散寒,其性更烈。
按∶前四逆诸法,皆主于温,此二方则温中兼通阳和阴之法。下利脉大者,虚也。凡症虚而脉反大
者,皆元气不固也。以其强下之故也。惟求所以致虚之故。设脉浮革,辨脉法篇云∶脉弦而大。弦则为
减,大则为芤,减则为寒;芤则为虚,虚寒相搏,此名为革。因而肠鸣者,肠鸣亦气不通和之故。属当
归四逆汤主之。
茯苓(四两,有的版本作六两) 人参(一两) 附子(一枚,生用,破成八片) 甘草(二两,蜜炙) 干姜(一两半) 以上
五味药,用水五升,煮取三升药液,去掉药渣,每次温服七合,每天服用三次。
经过发汗或攻下治疗后,病邪仍未解除,出现烦躁症状的,这是阳气不能固摄导致的烦,也就是所谓的“阴烦”。但也必须结合其他症状来综合判断,才不会误认为是栀子豉汤证。应当使用茯苓四逆汤主治。《本草》记载:茯苓能治疗气逆、烦闷胀满。
甘草(蜜炙) 枳实(打破,用水浸泡,再蜜炙至干) 柴胡 芍药
以上四味药,各取十分比例,捣碎过筛,用米汤调和,每次服用一方寸匕的药散,每天服用三次。如果咳嗽的,加五味子、干姜各五分,同时也主治腹泻;如果心悸的,加桂枝五分;如果小便不利的,加茯苓五分;如果腹中疼痛的,加附子一枚,炮制后掰开;如果腹泻伴有肛门坠胀感的,先用水五升,煮薤白取三升药液,去掉药渣,将三方寸匕的药散放入汤中,再煮取一升半,分两次温热服用。《名医别录》记载:薤白,主要功效是温中散结。
少阴病,出现四肢厥冷,或者伴有咳嗽;或者心悸;或者小便不利;或者腹中疼痛;或者腹泻伴有肛门坠胀感的。这是少阴病传经而来的热邪,并没有脉微、恶寒等阴寒症状。即使是腹泻这一种情况,也不是完谷不化,反而出现肛门坠重感,所以不能使用温热药物。应当使用四逆散主治,以疏解邪气、通畅气机。虽然同名“四逆”,但与前文所述的治法截然不同。各种兼夹症状都在加减法中体现。
治疗腹泻极其有效。
当归 桂枝 芍药 细辛(各三两) 甘草 通草(各二两) 大枣(二十五枚) 以上七味药,用水八升,煮取三升药液,每次温服一升,每天服用三次。
当归(三两) 甘草 通草(各二两) 芍药 桂枝 细辛(各三两) 大枣(二十五枚) 吴茱萸(二升) 生姜(半斤) 以上九味药,用水六升,清酒六升,混合煎煮,取五升药液,去掉药渣,分五次温热服用。
手足寒冷,脉搏细微几乎摸不到的,应当使用当归四逆汤主治。这种四逆是由于太阳病传经而来的邪气,且表证尚未解除,因为阳气已经虚弱,所以使用桂枝汤加入当归以调和血液;细辛具有温散作用,用来调和表里之阳气。如果患者体内有久存的寒邪,适宜使用当归四逆加吴茱萸生姜汤主治。所谓“内有久寒”,是指平素体质而言。必须通过问诊得知,或者另有现症,才能作为依据。吴茱萸能温中散寒,其药性更为猛烈。
按语:前文所述的四逆诸法,都以温补为主,这两个方剂则是温中兼有通阳和阴的方法。腹泻而脉大的,属于虚证。凡是症状表现为虚而脉象反而大的,都是元气不固的表现。这是因为强行攻下的缘故。只要求出导致虚损的原因。假如脉象浮而革,《辨脉法》篇说:脉弦而大。弦脉表示阳气减少,大脉表示中空如芤,阳气减少则为寒;中空则为虚,虚与寒相互搏结,这就叫做革脉。如果因此出现肠鸣,肠鸣也是气机不通畅的缘故。应当属于当归四逆汤的主治范围。
Fuling (Poria, 4 liang; some editions state 6 liang) Renshen (Ginseng Radix et Rhizoma, 1 liang) Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, used raw, broken into eight pieces) Gancao (Licorice Root, 2 liang, honey-fried) Ganjiang (Zingiberis Rhizoma, 1.5 liang) The above
five herbs are boiled in five sheng of water to obtain three sheng of decoction. The dregs are removed, and the liquid is taken warm, seven ge per dose, three times a day.
After sweating or purging therapies, if the disease remains unresolved and irritability (fan zao) occurs, this is irritability caused by yang qi failing to secure, known as "yin irritability." However, other symptoms must be considered to avoid misdiagnosing it as Zhizi Chi Tang syndrome. It should be treated with Fuling Sini Decoction. *Bencao* states: Fuling treats rebellious qi, irritability, and fullness.
Gancao (honey-fried) Zhishi (Immature Bitter Orange Fruit, broken, soaked in water, then honey-fried dry) Chaihu (Bupleuri Radix) Shaoyao (Paeoniae Radix Alba)
The above four herbs, each in ten parts, are crushed, sifted, mixed with rice water, and administered as one fangcun bi of powder per dose, three times a day. If coughing occurs, add Wuweizi (Schisandrae Fructus) and Ganjiang (Zingiberis Rhizoma), each five parts; this also treats diarrhea. If palpitations occur, add Guizhi (Cinnamomi Ramulus), five parts. If urination is difficult, add Fuling (Poria), five parts. If abdominal pain occurs, add one Fuzi (Aconiti Lateralis Radix Praeparata), processed until cracked. If diarrhea is accompanied by a sensation of heaviness in the rectum, first boil Xiebai (Allii Macrostemonis Bulbus) in five sheng of water to obtain three sheng, remove the dregs, add three fangcun bi of the powder to the liquid, boil to obtain one and a half sheng, and divide into two warm doses. *Bielu* states: Xiebai primarily warms the middle and dissipates nodulation.
Shaoyin disease presenting with cold extremities (sini), where the patient may have coughing; or palpitations; or difficult urination; or abdominal pain; or diarrhea with rectal heaviness. This is heat pathogen transmitted from the shaoyin channel, without yin symptoms such as faint pulse or aversion to cold. Even regarding diarrhea, it is not undigested food, but rather rectal heaviness, so warming herbs should not be used. It should be treated with Sini San to disperse pathogenic factors and unblock qi. Although named "Sini," it differs significantly from previous methods. All accompanying symptoms are addressed through modifications.
Highly effective for treating diarrhea.
Danggui (Angelicae Sinensis Radix) Guizhi (Cinnamomi Ramulus) Shaoyao (Paeoniae Radix Alba) Xixin (Asari Radix et Rhizoma) (each 3 liang) Gancao (Licorice Root) Tongcao (Tetrapanacis Medulla) (each 2 liang) Dazao (Jujubae Fructus) (25 pieces) The above
seven herbs are boiled in eight sheng of water to obtain three sheng. Take one sheng warm per dose, three times a day.
Danggui (Angelicae Sinensis Radix, 3 liang) Gancao (Licorice Root) Tongcao (Tetrapanacis Medulla) (each 2 liang) Shaoyao (Paeoniae Radix Alba) Guizhi (Cinnamomi Ramulus) Xixin (Asari Radix et Rhizoma) (each 3 liang) Dazao (Jujubae Fructus) (25 pieces) Wuzhuyu (Evodiae Fructus, 2 sheng) Shengjiang (Zingiberis Rhizoma Recens, half jin) The above
nine herbs are boiled together with six sheng of water and six sheng of clear wine to obtain five sheng. Remove the dregs and divide into five warm doses.
Cold hands and feet with a fine pulse nearly imperceptible should be treated with Danggui Sini Decoction. This sini is due to pathogen transmitted from the taiyang channel, while exterior symptoms remain unresolved. Because yang qi is deficient, Guizhi Tang (Cinnamon Twig Decoction) is used with Danggui (Angelicae Sinensis Radix) to harmonize blood; Xixin (Asari Radix et Rhizoma) warms and disperses to harmonize interior and exterior yang. If the person has chronic internal cold, Danggui Sini Decoction plus Wuzhuyu and Shengjiang should be used. "Chronic internal cold" refers to the constitution. It must be confirmed through inquiry or other current symptoms. Wuzhuyu (Evodiae Fructus) warms the middle and dispels cold, with a more potent nature.
Note: The previous sini methods all focus on warming. These two formulas combine warming the middle with unblocking yang and harmonizing yin. Diarrhea with a large pulse indicates deficiency. Whenever symptoms indicate deficiency but the pulse is large, it signifies insecure primordial qi, often due to forced purging. One must seek the cause of the deficiency. If the pulse is floating and革 (ge), the *Bian Mai Fa* chapter states: A pulse that is xian (string-like) and da (large). Xian indicates reduction; da indicates khou (hollow). Reduction implies cold; hollow implies deficiency. Cold and deficiency interacting is called ge pulse. If intestinal rumbling occurs, it is due to blocked qi movement. It belongs to the indication for Danggui Sini Decoction.