此即越婢汤加杏仁也。
麻黄(四两,去节) 杏仁(五十个,去皮尖) 甘草(二两,炙) 石膏(半斤,碎绵裹) 上四味,以水七升,
先煮麻黄,减二升,去上沫,纳诸药,煮取二升,去渣,温服一升。
发汗后,不可更行桂枝汤,既汗不可再汗,津液不得重伤。汗出而喘,尚有留邪在肺,故汗出而喘。
无大热者,邪已轻也。可与麻黄杏仁甘草石膏汤。汗出故用石膏,喘故用麻杏。
发汗后,饮水多者,必喘,以水灌之亦喘。此二句明致喘之所由,盖喘未必皆由于水,而饮水则无
有不喘者。戒之!
下后,不可更行桂枝汤,既下不可复汗,津液不得两伤。若汗出而喘,无大热者,可与麻黄杏仁甘草
石膏汤。
此合麻黄、桂枝、越婢三方为一方而无芍药。
麻黄(六两,去节) 桂枝(二两,去皮) 甘草(二两,炙) 杏仁(四十枚,去皮尖) 生姜(三两,切) 大
枣(十二枚,擘) 石膏(碎如鸡子大一块) 上七味,以水九升,先煮麻黄,减二升,去上沫,纳诸药,煮取三
升,去渣,温服一升,取微似汗,
汗出多者,温粉扑之。此外治之法,论中无温粉方。《明理论》载白术, 本、川芎、白芷各等分,入米粉
和匀扑之。无 本亦得。后人用牡蛎,麻黄根、铅粉、龙骨亦可。一服汗者,停后服,汗多亡阳,遂虚,恶
风烦躁,不得眠也。
太阳中风,脉浮紧,紧为阴脉,故汗不易出。发热恶寒,非恶风。身疼痛,不汗出,而烦躁者,邪深热
郁。大青龙汤主之。若脉微弱,汗出恶风者,不可服,服之则厥逆,筋惕肉 ,此为逆也。恶风乃桂枝
症,误服此则汗不止,而有亡阳之象矣。立此方即垂此戒,圣人之意深矣。按此方合麻桂而用石膏,何以发
汗,如是之烈?盖麻黄汤,麻黄用二两,而此用六两;越婢汤石膏用半斤,而此用鸡子大一块。一剂之药,除
大枣,约共十六两,以今秤计之,亦重三两有余,则发汗之重剂矣!虽少加石膏,终不足以相制也。
少阴篇云∶脉阴阳俱紧,反汗出者,亡阳也。
伤寒脉浮缓,身不疼,但重,乍有轻时,无少阴证者,大青龙汤主之。脉不沉紧,身有轻时,为无
少阴外症;不厥利吐逆,为无少阴里症,此邪气俱在外也,故以大青龙发其汗。
按∶此条必有误,脉浮缓,邪轻易散;身不疼,外邪已退;乍有轻时,病未入阴,又别无少阴等症,此
病之最轻者。何必投以青龙险峻之剂?此必另有主方,而误以大青龙当之者也。
这就是越婢汤加入杏仁。
麻黄(四两,去掉节) 杏仁(五十个,去掉皮和尖) 甘草(二两,蜜炙) 石膏(半斤,打碎用绵布包裹) 以上四味药,用水七升,
先煮麻黄,减少二升水,去掉水面上的浮沫,放入其他药物,煮取二升药液,去掉药渣,温服一升。
发汗之后,不可再用桂枝汤,既然已经发过汗,就不能再次发汗,以免津液受到严重损伤。出汗且气喘,说明还有残留的病邪在肺,所以出现出汗且气喘的症状。
没有明显高热的,说明病邪已经减轻。可以给予麻黄杏仁甘草石膏汤。因为出汗所以使用石膏,因为气喘所以使用麻黄和杏仁。
发汗之后,如果饮水过多,必然会导致气喘,用水浇洗身体也会导致气喘。这两句说明了导致气喘的原因,大概气喘未必都是由水饮引起的,但饮水过多则无不引起气喘的。要警惕这一点!
泻下之后,不可再用桂枝汤,既然已经泻下,就不能再发汗,以免津液受到双重损伤。如果出现出汗且气喘,没有明显高热的,可以给予麻黄杏仁甘草石膏汤。
这个方子结合了麻黄汤、桂枝汤、越婢汤三方合为一剂,但不含芍药。
麻黄(六两,去掉节) 桂枝(二两,去掉皮) 甘草(二两,蜜炙) 杏仁(四十枚,去掉皮和尖) 生姜(三两,切片) 大
枣(十二枚,掰开) 石膏(打碎如鸡蛋大小的一块) 以上七味药,用水九升,先煮麻黄,减少二升水,去掉水面上的浮沫,放入其他药物,煮取三升药液,去掉药渣,温服一升,以求微微似有汗出,
如果出汗过多,用温粉扑在身上。这是外治的方法,原文中没有温粉的配方。《明理论》记载白术、本(藁本)、川芎、白芷各等分,加入米粉混合均匀扑在身上。没有藁本也可以。后人有用牡蛎、麻黄根、铅粉、龙骨的。服用一次后若已出汗,就停止后续服药,如果出汗过多导致亡阳,身体就会虚弱,出现怕风、烦躁、无法入睡等症状。
太阳中风证,脉象浮紧,紧属于阴脉,所以汗不易排出。发热恶寒,不是恶风。身体疼痛,无汗,且烦躁的,是邪气深入、热郁于内。以大青龙汤主治。如果脉象微弱,出汗且怕风的,不可服用,服用了就会出现四肢厥冷,筋肉跳动抽搐,这是误治。怕风是桂枝汤证,误服此方则会导致汗出不止,出现亡阳的现象。设立此方即立下此戒律,圣人的用意深远啊。按:此方结合了麻黄汤、桂枝汤并加入石膏,为何发汗如此猛烈?原来麻黄汤中麻黄用二两,而此处用六两;越婢汤中石膏用半斤,而此处用鸡蛋大的一块。一剂药,除去大枣,大约共十六两,以现在的秤计算,也有三两多,这属于发汗的重剂!虽然少加了石膏,终究不足以制约其烈性。
《少阴篇》说:脉阴阳俱紧,反而出汗的,是亡阳的表现。
伤寒脉浮缓,身体不疼,只是沉重,偶尔有轻的时候,没有少阴证的,以大青龙汤主治。脉不沉紧,身体有轻松的时候,是没有少阴的外症;没有四肢厥冷、下利、呕吐逆乱,是没有少阴的内症,这说明邪气都在体表,所以用大青龙汤发汗。
按:这一条必定有误,脉浮缓,邪气轻浅容易消散;身体不疼,说明外邪已退;偶尔有轻的时候,说明病未入阴经,又别无少阴等症,这是最轻微的病。何必投以大青龙这样险峻的药剂?这必定另有主方,而误用大青龙来代替的。
This is Yu Bi Tang (Carpenter's Decoction) with the addition of Xingren (Apricot Seed).
Mahuang (Ephedrae Herba, four liang, nodes removed), Xingren (Armeniacae Semen Amarum, fifty kernels, skin and tips removed), Gancao (Glycyrrhizae Radix et Rhizoma, two liang, honey-fried), Shigao (Gypsum Fibrosum, half a jin, crushed and wrapped in cotton gauze). The above four ingredients are boiled in seven sheng of water. First, boil Mahuang until the volume reduces by two sheng, remove the foam on the surface, then add the remaining herbs. Boil until two sheng remain, strain, and take one sheng warm.
After inducing sweating, Guizhi Tang (Cinnamon Twig Decoction) should not be used again. Since sweating has already occurred, it must not be repeated, to avoid severe injury to the body fluids. Sweating accompanied by wheezing indicates that residual pathogenic factors remain in the Lung; hence, sweating and wheezing occur.
The absence of significant heat indicates that the pathogen has weakened. Mafe Huang Xing Gan Shi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be administered. Shigao is used because of the sweating, while Mahuang and Xingren are used because of the wheezing.
After inducing sweating, if the patient drinks excessive amounts of water, wheezing will inevitably occur; bathing or washing with water also induces wheezing. These two sentences clarify the cause of wheezing. Generally, wheezing does not always stem from water retention, but excessive drinking invariably causes wheezing. One must beware!
After purgation, Guizhi Tang (Cinnamon Twig Decoction) should not be used again. Since purgation has been performed, sweating must not be induced again, to avoid dual injury to the body fluids. If sweating and wheezing occur without significant heat, Mafe Huang Xing Gan Shi Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be administered.
This formula combines Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), and Yue Bi Tang (Carpenter's Decoction) into one, excluding Shaoyao (Peony Root).
Mahuang (Ephedrae Herba, six liang, nodes removed), Guizhi (Cinnamomi Ramulus, two liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, two liang, honey-fried), Xingren (Armeniacae Semen Amarum, forty kernels, skin and tips removed), Shengjiang (Zingiberis Rhizoma Recens, three liang, sliced), Dazao (Jujubae Fructus, twelve pieces, torn open), Shigao (Gypsum Fibrosum, one piece crushed to the size of a chicken egg). The above seven ingredients are boiled in nine sheng of water. First, boil Mahuang until the volume reduces by two sheng, remove the foam on the surface, then add the remaining herbs. Boil until three sheng remain, strain, and take one sheng warm, aiming for a slight perspiration.
If sweating is excessive, apply warm powder externally. This is an external treatment method; the original text does not provide the formula for the warm powder. *Ming Li Lun* records equal parts of Baizhu (Atractylodis Macrocephalae Rhizoma), Bencao (Ligustici Chuanxiong Rhizoma or Kadsurae Caulis? Note: Text says "Ben", likely referring to Ligusticum or similar aromatic root, often interpreted as Gaoben/Ligustici Wallichii Rhizoma in this context, but strictly "Ben" here), Chuanxiong (Chuanxiong Rhizoma), and Baizhi (Angelicae Dahuricae Radix), mixed evenly with rice flour for application. Absence of Bencao is acceptable. Later practitioners used Musli (Ostreae Concha), Mahuanggen (Ephedrae Radix et Rhizoma), Qianfen (Plumbi Carbonas), and Longgu (Fossilia Ossis Mastodi et Scapulae). If sweating occurs after one dose, stop subsequent doses. Excessive sweating leads to Yang collapse, resulting in deficiency, aversion to wind, restlessness, and inability to sleep.
In Taiyang Wind Strike syndrome, if the pulse is floating and tight, tightness being a Yin pulse, sweat is difficult to expel. Fever and aversion to cold (not merely aversion to wind), body pain, absence of sweating, and irritability indicate deep-seated pathogen and郁 heat. Da Qing Long Tang (Major Blue Dragon Decoction) is indicated. If the pulse is weak and thready, with sweating and aversion to wind, it must not be taken. Taking it would lead to cold extremities and muscle twitching/spasms, which constitutes a therapeutic error. Aversion to wind is a symptom of Guizhi Tang syndrome; misusing this formula would cause unceasing sweating and signs of Yang collapse. Establishing this formula serves as a warning; the Sage's intent is profound. Note: This formula combines Ma Huang Tang (Ephedra Decoction) and Gui Zhi Tang (Cinnamon Twig Decoction) with Shigao (Gypsum Fibrosum). Why does it induce such intense sweating? In Ma Huang Tang (Ephedra Decoction), Mahuang (Ephedrae Herba) is used in two liang, whereas here six liang are used; in Yue Bi Tang (Carpenter's Decoction), Shigao (Gypsum Fibrosum) is half a jin, whereas here a piece the size of a chicken egg is used. Excluding Dazao (Jujubae Fructus), the total weight of the herbs in one dose is approximately sixteen liang, which exceeds three liang by modern standards, making it a heavy sweating agent! Although a small amount of Shigao (Gypsum Fibrosum) is added, it is ultimately insufficient to counteract its potency.
The Shaoyin Chapter states: When both Yin and Yang pulses are tight, yet sweating occurs, it indicates Yang collapse.
In Shanghan (Cold Damage), if the pulse is floating and slow, the body is not painful but heavy, occasionally feeling lighter, and there are no Shaoyin symptoms, Da Qing Long Tang (Major Blue Dragon Decoction) is indicated. The pulse is not sinking and tight, and the body feels lighter at times, indicating the absence of Shaoyin exterior symptoms; absence of cold extremities, diarrhea, vomiting, and regurgitation indicates the absence of Shaoyin interior symptoms. This means the pathogenic factor is entirely in the exterior, so Da Qing Long Tang (Major Blue Dragon Decoction) is used to induce sweating.
Note: This clause must contain an error. A floating and slow pulse suggests light pathogen that disperses easily; absence of body pain indicates the exterior pathogen has receded; occasional lightness indicates the disease has not entered the Yin stage, and without other Shaoyin symptoms, this is the mildest form of illness. Why administer the dangerous and potent Da Qing Long Tang (Major Blue Dragon Decoction)? There must have been another primary formula, which was mistakenly replaced by Da Qing Long Tang (Major Blue Dragon Decoction).