(此散本和剂局方。制小其服也。)
苍术(二钱去皮) 浓朴(姜汁炙) 陈皮 甘草 本 桔梗(各一钱)
上为粗末。水一盏半。姜三片。枣二个。煎七分。不拘时热服。温覆取汗。
琥按上主疗云。太阳经伤寒。而方中有 本者。乃手太阳引经药也。此可见伤寒不专病足经矣。余药兼走足阳明
太阴二经。乃宽中解表散寒湿之剂。
王宇泰治一刻字工人。新婚。冬月冒寒。表证悉具。令以人参 紫苏茎叶(各一两) 煎汤。饮之汗出而愈(上按
见准绳伤寒发热例中)
琥按上主疗云。冬月冒寒。表证悉具。则知病家必头疼恶寒。身发热而无汗。据其时其证。可谓正伤寒矣。仲景
法。当以麻黄汤汗之。然王以刻字匠。乃工苦之人。又系新婚。若发汗过剂。恐阳亡。而津液不堪重耗。因用紫苏茎叶
之辛温。以代麻。桂杏仁。复用人参之甘温。以代炙甘草。乃护虚发表之轻剂也。后学如徒读仲景书。用仲景法。恐其
误亦不少。
缪仲淳云。太阳病。其证发热。恶寒恶风。头痛项强。腰脊强。遍身骨痛。脉浮洪。宜先发汗。以解表邪。其药以
羌活汤为主。
羌活(三钱) 前胡(二钱) 甘草(八分) 葛根(二钱) 生姜(三片) 大枣(二枚) 杏人(九粒去皮尖
研烂) 水煎服。
秋深。冬月。应用此方。亦可量加紫苏葱白。如冬月天气严寒。感邪即病服此药。不得汗。本方加麻黄一钱。生姜
四片。共前七片。得汗。勿再服。
琥按上论云。脉浮而洪。则知太阳病。当兼阳明经矣。所以上汤中用葛根。加葱白也。
琥又按此方。乃仲景麻黄葛根二汤。稍变其制。而汤中既用前胡。复加紫苏者。兼入手太阴经。而散风寒。下逆
气也。谁谓寒邪。不兼伤手经者邪。学人当由是而起悟。则用药治病。庶几可十全矣。
(琥)总按上古今诸名家。治太阳病方论。虽各不同。要皆辅翼仲景者也。愚以治伤寒者。不读仲景论。则所学不
精。读矣。复恐其泥于古方也。所以不读诸家书。则所见又不广。惟能合而读之。于其方论各别之处。必晓暮参究。斯
一旦豁然贯通。知医道之源。实后先祖述。其论虽异。而皆相通。其方虽殊。百而皆可用者也。余东南人也。窃见东南
时医。不解仲景之论。不识诸家之方。徒执陶氏书。以治伤寒。夫伤寒者。大病也。彼陶氏一家之说。岂足以尽其变邪。
是为虚窃济生之名。实以害人之生。犹之乡愿乱德。娄氏所云。医之贼也。暗损阴 。神明不佑。可不谨哉。
(此散剂原本出自和剂局方。此处将其剂量缩小以适应病情。)
苍术(二钱,去皮) 浓朴(用姜汁炙烤) 陈皮 甘草 藁本 桔梗(各一钱)
以上药材捣成粗末。加水一盏半,生姜三片,大枣二个,煎至七分满。不拘时间,趁热服用。服药后覆盖衣被以取汗。
琥按:上述主治功效提到,这是太阳经受伤寒侵袭,但方剂中含有藁本,藁本是手太阳经的引经药。由此可见,伤寒并不专门只侵犯足经。其余药物兼走足阳明、足太阴二经,这是一副宽中解表、散寒湿的方剂。
王宇泰治疗一位刻字工人。此人新婚,冬季冒犯寒气,表证全部具备。让他用人参、紫苏茎叶(各一两)煎汤饮用,出汗后痊愈。(上述案例见《准绳》伤寒发热例中)
琥按:上述主治功效提到,冬季冒犯寒气,表证全部具备,则可知病人必定头痛、恶寒、身体发热且无汗。根据当时的症状,这可以说是典型的伤寒。按照张仲景的法度,应当用麻黄汤发汗。然而王宇泰认为这位刻字匠是做工辛苦之人,又刚新婚,如果发汗过度,恐怕会导致阳气亡失,而津液不堪重耗。因此使用紫苏茎叶的辛温之性,来代替麻黄、桂枝、杏仁;又用人参的甘温之性,来代替炙甘草。这是一副保护虚损、解除表邪的轻剂。后世学者如果只读张仲景的书,只用张仲景的方法,恐怕误人也不少。
缪仲淳说:太阳病,其症状表现为发热、恶寒、恶风、头痛项强、腰脊僵硬、全身骨痛、脉象浮洪。应当先发汗,以解除表邪。用药以羌活汤为主。
羌活(三钱) 前胡(二钱) 甘草(八分) 葛根(二钱) 生姜(三片) 大枣(二枚) 杏仁(九粒,去皮尖,研烂) 水煎服。
深秋、冬季,应用此方。也可以酌情加入紫苏、葱白。如冬季天气严寒,感邪即病,服用此药后不得汗出,在本方基础上加麻黄一钱,生姜四片,共前七片。若得汗,不要再服。
琥按:上述论述提到,脉象浮而洪,则知太阳病应当兼有阳明经的症状。所以上述汤剂中使用葛根,并加入葱白。
琥又按:此方乃是张仲景的麻黄汤、葛根汤稍变其制而成,而汤中既用前胡,又加紫苏,是兼入手太阴经,以散风寒、降逆气。谁说寒邪不兼伤手经呢?学医的人应当由此领悟,那么用药治病,差不多可以十全十美了。
(琥)总按:上述古今各位名家治疗太阳病的方论,虽然各不相同,但都是辅助和补充张仲景理论的。我认为治疗伤寒者,如果不读张仲景的著作,则所学不精;读了之后,又恐怕拘泥于古方。所以如果不读诸家之书,则所见又不广。只有能将它们合起来阅读,对其方论各自不同的地方,早晚深入探究,那么一旦豁然贯通,就知道医道的源头,确实是后辈继承前辈的阐述。他们的理论虽然不同,但都相通;他们的方剂虽然殊异,但百种皆可用。我是东南人,私下见到东南地区的时医,不懂张仲景的理论,不识诸家的方剂,只执着于陶华(陶节庵)的书来治疗伤寒。伤寒是大病啊,陶氏一家的学说,哪里足以穷尽其变化呢?这是窃取济世救人的名声,实际上却害人性命。就像乡愿扰乱道德一样,娄全善所说的“医之贼”。暗中损害阴德,神明不会保佑,能不谨慎吗?
(This powder originally comes from the Heji Bureau Formulary. Here, the dosage is reduced to suit the condition.)
Cangzhu (Atractylodis Rhizoma, 2 qian, peeled) Houpo (Magnoliae Officinalis Cortex, stir-baked with ginger juice) Chenpi (Citri Reticulatae Pericarpium) Gancao (Glycyrrhizae Radix et Rhizoma) Gaoben (Ligustici Rhizoma et Radix) Jiegeng (Platycodonis Radix) (each 1 qian).
The above herbs are ground into a coarse powder. Add one and a half cups of water, three slices of Shengjiang (Zingiberis Rhizoma), and two Zao (Jujubae Fructus). Decoct until seven-tenths remains. Take hot at any time. Cover with warm clothing to induce sweating.
Hu notes: The aforementioned indications mention that this is Taiyang disease caused by cold pathogen invasion. However, the formula contains Gaoben, which is the guiding herb for the Hand-Taiyang meridian. This shows that Shanghan (Cold Damage) does not exclusively affect the Foot meridians. The remaining herbs also traverse the Foot-Yangming and Foot-Taiyin meridians. This is a formula that broadens the middle, releases the exterior, and disperses cold-dampness.
Wang Yutai treated a woodblock carver. The patient had recently married and was exposed to cold in winter, presenting with complete exterior symptoms. Wang prescribed a decoction of Renshen (Ginseng Radix et Rhizoma) and Zisu Jingye (Perillae Folium, each 1 liang). After drinking it, the patient sweated and recovered (This case is cited in the "Shanghan Fever" section of *Zhunsheng*).
Hu notes: The aforementioned indications state that exposure to cold in winter with complete exterior symptoms implies the patient must have headache, aversion to cold, fever, and anhidrosis. Based on the timing and symptoms, this can be considered typical Shanghan. According to Zhang Zhongjing's method, Mahuang Tang (Ephedra Decoction) should be used to induce sweating. However, Wang reasoned that as a laborer who had recently married, excessive sweating might lead to Yang collapse and severe depletion of Jin-Ye (Body Fluids). Therefore, he used the acrid-warm nature of Zisu Ye to replace Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), and Xingren (Armeniacae Semen Amarum). He also used the sweet-warm nature of Renshen to replace Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma). This is a mild formula that protects deficiency while releasing the exterior. If later scholars only read Zhang Zhongjing's books and strictly apply his methods, they may cause many errors.
Miao Zhongchun said: In Taiyang disease, symptoms include fever, aversion to cold, aversion to wind, headache, stiffness of the neck and back, stiffness of the waist and spine, generalized bone pain, and a floating, surging pulse. Sweating should be induced first to release the exterior pathogen. The primary medication is Qianghuo Tang (Notopterygii Decoction).
Qianghuo (Notopterygii Rhizoma et Radix, 3 qian) Qianhu (Peucedani Radix, 2 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 8 fen) Gegen (Puerariae Lobatae Radix, 2 qian) Shengjiang (Zingiberis Rhizoma Recens, 3 slices) Dazao (Jujubae Fructus, 2 pieces) Xingren (Armeniacae Semen Amarum, 9 grains, peeled and crushed). Decoct in water and take orally.
In late autumn and winter, this formula should be used. Zi Su (Perillae Folium) and Congbai (Allii Fistulosi Bulbus) can be added as appropriate. If in severe winter weather, illness occurs immediately upon pathogen invasion, and no sweat is produced after taking this medicine, add Mahuang (Ephedrae Herba, 1 qian) and four slices of Shengjiang (Zingiberis Rhizoma Recens) to the base formula, totaling seven slices of ginger. Once sweat is produced, do not take further doses.
Hu notes: The aforementioned discussion states that a floating and surging pulse indicates that Taiyang disease involves the Yangming meridian. Hence, Gegen (Puerariae Lobatae Radix) and Congbai (Allii Fistulosi Bulbus) are used in the aforementioned decoction.
Hu further notes: This formula is a slight modification of Zhang Zhongjing's Mahuang Tang (Ephedra Decoction) and Gegen Tang (Pueraria Decoction). The inclusion of Qianhu (Peucedani Radix) and Zisu (Perillae Folium) targets the Hand-Taiyin meridian to disperse wind-cold and direct rebellious Qi downward. Who says cold pathogens do not simultaneously injure the Hand meridians? Scholars should gain insight from this, and their medical treatments will likely achieve near-perfect results.
(Hu) General Note: The formulas and theories of various ancient and modern masters for treating Taiyang disease differ, yet all serve to supplement Zhang Zhongjing's work. I believe that those treating Shanghan must study Zhang Zhongjing's treatises to refine their knowledge; otherwise, their learning is incomplete. However, after studying them, one must fear becoming dogmatic about ancient formulas. Thus, without reading other schools' works, one's perspective remains narrow. Only by integrating these readings and thoroughly investigating the differences in their formulas and theories day and night can one eventually achieve sudden enlightenment. One will then understand that the source of medical Dao is indeed the inheritance and elaboration by later generations upon ancestral teachings. Although their theories differ, they are interconnected; although their formulas vary, all are applicable. As someone from the Southeast, I observe that contemporary physicians there fail to understand Zhang Zhongjing's theories or recognize the formulas of various schools. They blindly adhere to Tao Hua's (Tao Jian'an) books to treat Shanghan. Shanghan is a major disease; how can Tao's single school of thought suffice to cover its complexities? This is stealing the name of saving lives while actually harming them. Like the "hypocrite" who disrupts virtue, as Lou Quanshan described, they are "thieves of medicine." They secretly damage Yin virtue, and divine spirits will not bless them. Can one not be cautious?