柴胡 芍药 栀子仁 知母(各四两) 香豉(一升绵裹) 石膏(八两碎) 黄芩 大青 升麻 杏人(去双人
皮尖各三两)
上十味。切。以水九升。煮取二升七合。分三服。若热盛者。加大黄四两。
琥按上方。乃疗少阳阳明经中有郁热。兼清肺胃燥热之剂。其曰头痛。乃火热上攻而痛。非寒邪中于经也。曰百
节疼痛。乃热蒸骨节而疼痛。亦非寒邪束于表也。据上方后云。若热盛者。加大黄。则知经中之热尽入于胃矣。此方与
仲景大柴胡汤同义。但大柴胡治里实湿热。此汤治里实燥热为少异耳。
崔尚书疗伤寒六七日不解。寒热往来。胸胁苦满。默默不欲饮食。心烦喜呕。寒疝腹痛。
前胡(八两) 半夏(半升洗) 生姜(五两) 黄芩 人参 甘草(炙各三两) 干枣(十二枚擘)
上七味。以水一斗。煮取三升。分四服。
琥按上方。即仲景小柴胡汤。去柴胡而易前胡也。陶弘景云。前胡与柴胡同功。愚以治证虽同。然柴胡纯阳而能
上升。此则阳中之阴。其功长于下气耳。据上主疗云云。皆系少阳经病。但其云。寒疝腹痛。病属厥阴。恐非上汤所能
兼疗也。
又疗伤寒八九日不解。心腹坚满。身体疼痛。内外有热。烦呕不安。
前胡(半斤) 半夏(半升) 生姜(五两) 枳实(八片当是八枚炙) 芍药(四两) 黄芩(三两) 干枣(十
二枚擘)
上七味。以水一斗。煮取三升。分四服。日三。夜一。
琥按上方。又即仲景大柴胡汤方。去柴胡而易前胡也。仲景原方中本无大黄。王叔和云。若不加大黄。恐不名大
柴胡汤。今崔氏名大前胡。恐亦当加大黄二两也。况上主疗云。心腹坚满。烦呕不安。此即大柴胡汤证云。心下急。痞
硬。呕不止。郁郁微烦同也。表既不解。里证又急。其当加大黄无疑。
柴胡、芍药、栀子仁、知母(各四两),香豉(一升,用绵布包裹),石膏(八两,打碎),黄芩、大青、升麻、杏仁(去皮尖及双仁者,各三两)。
以上十味药,切碎。用水九升,煎煮至二升七合。分三次服用。如果热势炽盛,加大黄四两。
琥按:上述方剂,是用于治疗少阳经和阳明经中有郁积之热,兼清肺胃燥热的方剂。文中所说的“头痛”,是因为火热之气上攻头部所致,并非寒邪侵袭经脉。所说的“百节疼痛”(全身关节疼痛),是因为热气蒸腾骨节所致,也并非寒邪束缚于体表。根据该方后注说:“若热势炽盛,加大黄”,由此可知,经络中的热邪已经完全传入胃腑。此方与张仲景的大柴胡汤义理相同,只是大柴胡汤治疗的是里实湿热证,而此汤治疗的是里实燥热证,二者仅有细微差别。
崔尚书治疗伤寒六七天未解,出现寒热往来(忽冷忽热)、胸胁部苦闷胀满、沉默寡言不想进食、心烦且喜欢呕吐、寒疝腹痛等症状。
前胡(八两),半夏(半升,洗净),生姜(五两),黄芩、人参、甘草(炙,各三两),干枣(十二枚,掰开)。
以上七味药,用水一斗,煎煮至三升。分四次服用。
琥按:上述方剂,就是张仲景的小柴胡汤,去掉柴胡而改用前胡。陶弘景说:前胡与柴胡功效相同。我认为虽然治疗的证候相似,但柴胡属纯阳之性,能向上宣散;前胡则是阳中之阴,其功效长于降气。根据上述主治症状来看,都属于少阳经的病证,但其中提到的“寒疝腹痛”,病属厥阴经,恐怕不是上方所能兼顾治疗的。
又治伤寒八九天未解,心腹部坚硬胀满,身体疼痛,体内体外都有热象,烦躁呕吐、心神不安。
前胡(半斤),半夏(半升),生姜(五两),枳实(八片,应当是八枚,炙),芍药(四两),黄芩(三两),干枣(十二枚,掰开)。
以上七味药,用水一斗,煎煮至三升。分四次服用,白天服三次,晚上服一次。
琥按:上述方剂,又是张仲景的大柴胡汤方,去掉柴胡而改用前胡。张仲景的原方中本来没有大黄。王叔和说:如果不加大黄,恐怕不能称为大柴胡汤。现在崔氏命名为“大前胡汤”,恐怕也应当加入大黄二两。况且上述主治症状说:“心腹坚满,烦呕不安”,这与《伤寒论》中大柴胡汤证所说的“心下急,痞硬,呕不止,郁郁微烦”是相同的。表证既未解除,里证又很急迫,当加大黄无疑。
[Qianjin Fang] Decoction for Treating Shanghan (Cold Damage) with Headache, High Fever, and Pain in All Joints
Chaihu (Bupleuri Radix), Shaoyao (Paeoniae Radix Alba), Zhizi Ren (Gardeniae Fructus), Zhi Mu (Anemarrhenae Rhizoma) (each 4 liang), Xiangchi (Fermented Soybean Meal) (1 sheng, wrapped in silk gauze), Shigao (Gypsum Fibrosum) (8 liang, crushed), Huangqin (Scutellariae Radix), Daqing (Indigo Naturalis), Shengma (Cimicifugae Rhizoma), Xingren (Armeniacae Semen Amarum) (skin, tips, and twin kernels removed, each 3 liang).
The above ten medicinal materials are sliced. Boil in 9 sheng of water until reduced to 2.7 sheng. Divide into three doses. If the heat is severe, add Dahuang (Rhei Radix et Rhizoma) 4 liang.
Hu notes: The above formula is used to treat stagnant heat within the Shaoyang (Lesser Yang) and Yangming (Yang Brightness) meridians, while simultaneously clearing dry-heat from the Lung and Stomach. The "headache" mentioned is caused by fire-heat attacking upwards, not by cold pathogen invading the meridians. The "pain in all joints" is caused by heat steaming the bone joints, not by cold pathogen binding the exterior. According to the postscript of the formula stating "if heat is severe, add Dahuang," it can be known that the heat in the meridians has fully entered the Stomach. This formula shares the same principle as Zhang Zhongjing's Daxiehu Tang (Major Bupleurum Decoction), but whereas Daxiehu Tang treats interior excess damp-heat, this decoction treats interior excess dry-heat; they differ only slightly.
Supervisor Cui treated Shanghan persisting for six or seven days without resolution, presenting with alternating chills and fever, fullness and oppression in the chest and hypochondrium, silence with loss of appetite, irritability and frequent vomiting, and abdominal pain due to cold hernia.
Qianhu (Peucedani Radix) (8 liang), Banxia (Pinelliae Rhizoma Preparatum) (0.5 sheng, washed), Shengjiang (Zingiberis Rhizoma Recens) (5 liang), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (roasted, each 3 liang), Dazao (Jujubae Fructus) (12 pieces, split open).
The above seven medicinal materials are boiled in 1 dou of water until reduced to 3 sheng. Divide into four doses.
Hu notes: The above formula is essentially Zhang Zhongjing's Xiaochaihu Tang (Minor Bupleurum Decoction), with Chaihu removed and replaced by Qianhu. Tao Hongjing stated that Qianhu and Chaihu have similar functions. I believe that although the treated syndromes are similar, Chaihu is purely yang in nature and promotes ascending movement, whereas Qianhu is yin within yang, and its function excels at directing qi downward. Based on the aforementioned indications, these all belong to Shaoyang meridian diseases. However, the mention of "abdominal pain due to cold hernia" indicates a disease belonging to the Jueyin (Terminal Yin) meridian, which is likely beyond the scope of the aforementioned decoction to treat comprehensively.
It also treats Shanghan persisting for eight or nine days without resolution, presenting with hardness and fullness in the heart and abdomen, body pain, internal and external heat, irritability, vomiting, and restlessness.
Qianhu (Peucedani Radix) (0.5 jin), Banxia (Pinelliae Rhizoma Preparatum) (0.5 sheng), Shengjiang (Zingiberis Rhizoma Recens) (5 liang), Zhishi (Aurantii Fructus Immaturus) (8 slices, presumably 8 pieces, roasted), Shaoyao (Paeoniae Radix Alba) (4 liang), Huangqin (Scutellariae Radix) (3 liang), Dazao (Jujubae Fructus) (12 pieces, split open).
The above seven medicinal materials are boiled in 1 dou of water until reduced to 3 sheng. Divide into four doses: taken three times during the day and once at night.
Hu notes: The above formula is again Zhang Zhongjing's Daxiehu Tang (Major Bupleurum Decoction), with Chaihu removed and replaced by Qianhu. Zhang Zhongjing's original formula did not originally contain Dahuang. Wang Shuhe stated: "If Dahuang is not added, it cannot properly be called Daxiehu Tang." Since Cui named it "Da Qianhu Tang," it is likely that Dahuang should also be added, perhaps 2 liang. Moreover, the aforementioned indications state "hardness and fullness in the heart and abdomen, irritability and vomiting with restlessness," which corresponds exactly to the Daxiehu Tang syndrome described in the Shanghan Lun: "urgency under the heart, epigastric stiffness, incessant vomiting, and slight depression/irritability." Since the exterior syndrome remains unresolved and the interior syndrome is urgent, the addition of Dahuang is undoubtedly necessary.