有汗。则能止之。
黄 白术 防风(各等分)
上 咀。水煎五七钱。饮清温。若汗多恶风甚者。加桂枝一二钱匕。
琥按上方。乃洁古用之。以代桂枝汤方者也。仲景用桂枝汤。虽云。主营弱卫强。要之风邪。并于卫而称强者。
是邪气之强。即卫气之弱也。所以成注亦云。自汗出。则皮肤缓。腠理疏。故见恶风恶寒之证。则是桂枝汤之用。虽主
营弱。实则治卫虚自汗。不任风寒之方也。内经曰。辛甘发散为阳。桂枝汤与上黄 汤。皆辛甘之剂。但桂枝汤辛甘而
热。黄 汤辛甘而温。惟其热。故惟冬月宜用。惟其温。故兼三时皆可用也。
或问桂枝汤。以桂枝为主。所以走太阳。今黄 汤中。以何药走太阳。余答云。防风治风。通用虽卒伍卑贱之职。
善能走太阳。疗周身百节苦疼。故上汤以之等分不可少也。要之此方。必正气虚而表邪微者。乃可用之。否则白术一味
过于温补。亦犹桂枝汤中之有大枣炙甘草。不轻用也。医者宜审证投之。
无汗则能发之。
川芎 羌活 制苍术(各等分)
上 咀。水煎五七钱。饮清热。若汗少(准绳作无汗。)
恶寒甚者。加麻黄一二钱匕。
琥按上方。乃洁古用以代麻黄汤方者也。仲景制麻黄汤。用以治太阳伤寒之的剂。伤寒无汗。麻黄汤以麻黄为君。
专入太阳。发皮肤之汗也。上汤中有羌活。亦能入太阳。透发皮肤之汗。又寒伤营。麻黄汤中有桂枝。以和营。上汤中
有川芎。亦营中药也。大抵上汤之用。辛甘苦平。不若麻桂之甘温辛热。但宜于冬月者也。所以洁古云。凡四时无汗证。
皆可用之。
琥又按上汤中有苍术。此与麻黄汤中之杏人。则大相反。术性燥烈。杏人苦润。所以洁古用川芎汤。伤寒惟挟湿邪
者宜之。倘春夏之时。有病发热无汗燥喘者。如用川芎汤。须减苍术加杏人为妥矣。医人捡取古方。当临证活变用之。
(对于)有汗的情况,(此方)能够止汗。
黄耆、白术、防风(各取等量)
将药材切碎。加水煎煮五至七钱药量。温服。如果出汗多且恶风严重的,加桂枝一两到二钱匕。
王琥按:上述上方,是洁古先生使用的,用来替代桂枝汤的方子。张仲景使用桂枝汤,虽然说是因为营气弱而卫气强,但关键在于风邪侵犯卫分并表现为强盛。
这实际上是邪气的强盛,也就是卫气的虚弱。所以成无己的注释也说:“自汗出,则皮肤松弛,腠理疏松,因此出现恶风恶寒的症状。”那么桂枝汤的作用,虽然主要调理营气弱,实际上却是治疗卫气虚导致自汗、不能耐受风寒的方剂。《内经》说:“辛甘发散为阳。”桂枝汤与上方的黄耆汤,都是辛甘性质的药剂。只是桂枝汤辛甘而热,黄耆汤辛甘而温。正因为其热性,所以只在冬季适宜使用;正因为其温性,所以在春、夏、秋三季都可以使用。
有人问:桂枝汤以桂枝为主药,所以能走太阳经。现在黄耆汤中,用什么药走太阳经?我回答说:防风治风,虽然地位如同士卒般卑微,但善于走太阳经,治疗周身关节剧烈疼痛,所以上方的黄耆汤中,防风作为等分药不可少。总之,这个方子,必须是正气虚而表邪轻微的人,才可以使用。否则白术一味药过于温补,也就像桂枝汤中的大枣和炙甘草一样,不能轻易使用。医生应当仔细辨证后投药。
(对于)无汗的情况,(此方)能够发汗。
川芎、羌活、制苍术(各取等量)
将药材切碎。加水煎煮五至七钱药量。清热服用。(若根据《准绳》记载为无汗。)
恶寒严重的,加麻黄一两到二钱匕。
王琥按:上述上方,是洁古先生使用的,用来替代麻黄汤的方子。张仲景制定麻黄汤,是用来治疗太阳伤寒的确切方剂。伤寒无汗,麻黄汤以麻黄为君药,专门入太阳经,发皮肤之汗。上方中有羌活,也能入太阳经,透发皮肤之汗。另外,寒伤营分,麻黄汤中有桂枝,用以调和营分;上方中有川芎,也是入营分的药物。大抵上方之用,辛甘苦平,不如麻黄、桂枝的甘温辛热,只适宜于冬季使用。所以洁古先生说:凡是四季无汗证,都可以使用它。
王琥又按:上方中有苍术,这与麻黄汤中的杏仁,性质大相径庭。苍术性燥烈,杏仁性苦润。所以洁古先生用川芎汤,认为伤寒只有夹杂湿邪者适宜使用。如果在春夏之时,有病发热无汗、燥渴气喘的,如果使用川芎汤,必须减少苍术加入杏仁才妥当。医生选取古方时,应当临证灵活变通使用。
(For cases with) sweating, this formula can stop sweating.
Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fangfeng (Saposhnikoviae Radix) (equal parts).
Crush the herbs. Decoct in water using 5 to 7 qian of the mixture. Drink warm. If sweating is profuse and aversion to wind is severe, add Guizhi (Cinnamomi Ramulus) 1 to 2 qian bi.
Wang Hu notes: The above formula was used by Jiegou (Zhang Congzheng) as a substitute for Guizhi Tang (Cinnamon Twig Decoction). Zhang Zhongjing used Guizhi Tang, ostensibly because Ying-nutrient Qi is weak and Wei-defensive Qi is strong, but the key point is that Wind-pathogen invades the Wei-level and manifests as strong.
This is actually the strength of the pathogenic factor, which implies the weakness of the Wei-protective Qi. Therefore, Cheng Wuji's commentary also states: "Spontaneous sweating leads to relaxed skin and loose interstices, thus manifesting symptoms of aversion to wind and cold." Thus, the function of Guizhi Tang, although primarily addressing weak Ying-nutrient Qi, is essentially a formula treating spontaneous sweating due to deficient Wei-protective Qi, rendering the patient unable to withstand Wind-Cold. The *Neijing* states: "Pungent and sweet agents disperse and are Yang." Both Guizhi Tang and the aforementioned Huangqi Tang are pungent-sweet agents. However, Guizhi Tang is pungent-sweet and hot, while Huangqi Tang is pungent-sweet and warm. Because it is hot, it is suitable only for winter; because it is warm, it can be used in spring, summer, and autumn.
One asks: Guizhi Tang uses Guizhi as the chief herb, so it travels to the Taiyang channel. In the current Huangqi Tang, which herb travels to the Taiyang channel? I answer: Fangfeng treats wind. Although its status is humble like that of a common soldier, it excels at traveling to the Taiyang channel and treating severe pain throughout the body and joints. Therefore, in the aforementioned Huangqi Tang, Fangfeng as an equal-part ingredient is indispensable. In summary, this formula is applicable only when righteous Qi is deficient and exterior pathogens are mild. Otherwise, the single herb Baizhu is too warming and tonifying, similar to how Dazao (Jujubae Fructus) and Zhi Gancao (Prepared Licorice Root) in Guizhi Tang should not be used lightly. Physicians should carefully differentiate syndromes before administering medication.
(For cases with) no sweating, this formula can induce sweating.
Chuanxiong (Ligustici Chuanxiong Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Zhi Cangzhu (Processed Atractylodis Rhizoma) (equal parts).
Crush the herbs. Decoct in water using 5 to 7 qian of the mixture. Take to clear heat. (If according to *Zhunsheng*, there is no sweating.)
If aversion to cold is severe, add Mahuang (Ephedrae Herba) 1 to 2 qian bi.
Wang Hu notes: The above formula was used by Jiegou as a substitute for Ma Huang Tang (Ephedra Decoction). Zhang Zhongjing formulated Ma Huang Tang as the precise formula for treating Taiyang Cold Damage. In Cold Damage with no sweating, Ma Huang Tang uses Mahuang as the sovereign herb, specifically entering the Taiyang channel to induce sweating from the skin. The aforementioned formula contains Qianghuo, which also enters the Taiyang channel and penetrates to induce sweating from the skin. Furthermore, when Cold damages the Ying-nutrient level, Ma Huang Tang contains Guizhi to harmonize the Ying-nutrient level; the aforementioned formula contains Chuanxiong, which is also an herb entering the Ying-nutrient level. Generally, the aforementioned formula is pungent, sweet, bitter, and neutral, unlike the sweet-warm and pungent-hot nature of Mahuang and Guizhi, making it suitable only for winter. Hence, Jiegou stated: "Any syndrome of no sweating in the four seasons can use it."
Wang Hu further notes: The aforementioned formula contains Cangzhu, which contrasts sharply with Xingren (Pruni Armeniaci Semen) in Ma Huang Tang. Cangzhu is drying and acrid, whereas Xingren is bitter and moistening. Therefore, Jiegou used Chuanxue Tang, stating that it is suitable for Cold Damage complicated by Dampness. If during spring or summer, a patient suffers from fever, no sweating, dryness, thirst, and panting, and one were to use Chuanxue Tang, it would be appropriate to reduce Cangzhu and add Xingren. When selecting ancient formulas, physicians should apply them flexibly according to clinical manifestations.