葛根(半斤) 乌梅(十四枚) 葱白(一握) 豉(一升绵裹)
上四味。切。以水九升。煮取三升。分为三服。初一服。便浓覆取汗。汗出粉傅之。(崔氏取名葛根汤。方中无乌梅。
琥按上主疗云。伤寒一日至三日。是初起即入阳明。至三日为应汗之时。故以葛根葱白之甘辛。以解肌发汗。豆豉之苦
甘。以泄热除烦。乃阳明经发表之神剂。但方中乌梅一味。味酸收敛为不可用也。)
又石膏汤。疗伤寒病已八九日。三焦热。其脉滑数。昏愦。身体壮热。沉重拘挛。或时呼呻。而已攻内。体犹沉重
拘挛由表未解。今直用解毒汤。则挛急不瘥。直用汗药。则毒因加剧。而方无表里。疗者意思以三黄汤以救其内。有所
增加以解其外。故名石膏汤方。
石膏 黄连 黄柏 黄芩(各二两) 香豉(一升绵裹) 栀子(十枚擘) 麻黄(三两去节)
上七味。切。以水一斗。煮取三升。分为三服。一日并服。出汗。初服一剂。小汗其后。更合一剂。分两日服。常
令微汗出。拘挛烦愦即瘥。得数行利心开。令语毒折也。
琥按上方。即三黄石膏汤也。虽云疗三焦热。实则阳明经府齐热。但表邪尚在。里未结实。故不可下。此方为清解
最重之剂。愚意以方中栀子太少。麻黄太多。石膏宜倍用。其效更神。
葛根(半斤) 乌梅(十四枚) 葱白(一握) 豉(一升,用绵布包裹)
以上四味药。切碎。用水九升,煎煮至三升。分三次服用。第一次服用后,立即用厚被覆盖以取汗。出汗后用粉扑敷身体。(崔氏将此方命名为葛根汤,但该方中不含乌梅。)
王琥按:上述主治说明提到,伤寒发病一日至三日,这是病邪初起即传入阳明经。到了第三天是应当发汗的时候。因此使用葛根、葱白的甘辛之性,来解除肌表邪气并发汗;豆豉的苦甘之性,来泄热除烦。这是治疗阳明经发表的神效方剂。但是方中的乌梅一味,味道酸涩具有收敛作用,因此不可使用。)
另外有石膏汤,治疗伤寒病已经八九日,三焦(上、中、下三焦的热证)热盛,脉象滑数,神志昏沉迷糊,身体高热,沉重且肢体拘挛抽搐。有时呼喊呻吟。此时如果直接攻里,身体仍然沉重拘挛,这是因为表邪未解。现在如果直接用解毒汤,则拘急不能缓解;如果直接用发汗药,则毒邪会因发汗而加剧。此方没有明确的表里侧重,治疗者的意图是用三黄汤(黄连、黄芩、黄柏)来救其内热,有所增加药物以解其外邪,所以命名为石膏汤方。
石膏 黄连 黄柏 黄芩(各二两) 香豉(一升,用绵布包裹) 栀子(十枚,掰开) 麻黄(三两,去节)
以上七味药。切碎。用水一斗,煎煮至三升。分三次服用。一天内服完。出汗。初次服用一剂,微微出汗之后,再合为一剂,分两天服用。经常保持微微出汗的状态,拘挛烦闷即可痊愈。得到几次腹泻后心神开朗,这是让毒邪折损消散的意思。
王琥按:上方即是三黄石膏汤。虽然说是治疗三焦热,实际上是阳明经和腑同时热盛。但是表邪还在,里实未结实,所以不可用泻下法。此方是清热解表最重的方剂。我个人的意见认为方中栀子太少,麻黄太多,石膏应该加倍使用,疗效会更神奇。
Ge Gen (Radix Puerariae, half jin) Wu Mei (Fructus Mume, fourteen pieces) Cong Bai (Bulbus Allii Cepae, one handful) Chi (Folium Sojae Preparatum, one sheng, wrapped in silk)
The above four herbs. Cut into pieces. Boil with nine sheng of water until three sheng remain. Divide into three doses. After the first dose, immediately cover thickly to induce sweating. Apply powder to the body after sweating. (Cui Shi named this formula Gegen Tang [Pueraria Decoction], but this formula does not contain Wu Mei.)
Wang Hu notes: The aforementioned indications state that Shanghan (Cold Damage) from day one to day three indicates that the pathogen has entered the Yangming channel upon onset. By the third day, it is time for diaphoresis. Therefore, the sweet and acrid properties of Ge Gen and Cong Bai are used to release the muscle layer and induce sweating; the bitter and sweet properties of Chi are used to drain heat and relieve irritability. This is a divine agent for releasing the exterior in the Yangming channel. However, Wu Mei in the formula has an sour and astringent nature, which prevents its use.)
Additionally, there is Shigao Tang [Gypsum Decoction], which treats Shanghan disease persisting for eight or nine days, with heat in the Sanjiao (Triple Burner), slippery and rapid pulse, confusion and lethargy, high fever, heaviness, and stiffness or spasms. Sometimes accompanied by shouting or groaning. If internal purging is applied directly, the body remains heavy and stiff because the exterior pathogen has not been resolved. If detoxifying agents are used directly, the spasms will not improve; if diaphoretic drugs are used directly, the toxin will worsen due to sweating. This formula lacks a clear focus on either interior or exterior. The practitioner's intent was to use Sanhuang Tang [Three Yellows Decoction] to rescue the interior heat, adding ingredients to resolve the exterior, hence named Shigao Tang.
Shi Gao (Gypsum Fibrosum) Huang Lian (Rhizoma Coptidis) Huang Bo (Cortex Phellodendri) Huang Qin (Radix Scutellariae) (each two liang) Xiang Chi (Folium Sojae Preparatum, one sheng, wrapped in silk) Zhi Zi (Fructus Gardeniae, ten pieces, broken) Ma Huang (Herba Ephedrae, three liang, nodes removed)
The above seven herbs. Cut into pieces. Boil with one dou of water until three sheng remain. Divide into three doses. Take all within one day. Induce sweating. After the initial dose, slight sweating occurs. Then combine the remaining dosage to be taken over two days. Maintain a state of slight sweating continuously. Stiffness, spasms, and irritability will then heal. Several episodes of diarrhea lead to mental clarity, indicating the reduction and dispersion of toxins.
Wang Hu notes: The above formula is essentially Sanhuang Shigao Tang [Three Yellows and Gypsum Decoction]. Although it claims to treat Sanjiao heat, it actually addresses simultaneous heat in the Yangming channel and fu organs. However, since exterior pathogens remain and interior excess is not yet solidified, purgation is contraindicated. This formula is the heaviest agent for clearing heat and resolving the exterior. In my opinion, the amount of Zhi Zi in the formula is too little, and Ma Huang is too much. Shi Gao should be doubled for more miraculous efficacy.