太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。发作有时。头痛。心下痞硬。满引胁
下痛。干呕短气。汗出不恶寒者。此表解里未和也。十枣汤主之。
此外中风寒。内有悬饮之证。下利呕逆。饮之上攻而复下注也。然必风邪已解。而后可攻其
饮。若其人 汗出。而不恶寒。为表已解。心下痞硬。满引胁下痛。干呕短气。为里未和。虽头
痛而发作有时。知非风邪在经。而是饮气上攻也。故宜十枣汤下气逐饮。
十枣汤方
芫花(熬) 甘遂 大戟 大枣(十枚)
上三味等分。各别捣为散。以水一升半。先煮大枣肥者十枚。取八合。去滓。纳诸药末。
强人服一钱匕。羸人服半钱。温服之。平旦服。若下少。病不除者。明日更服。加半钱。得快下利后。糜粥自
养。
按金匮云、饮后水流在胁下。咳吐引痛。谓之悬饮。又云、病悬饮者。十枣汤主之。此心下痞
硬。满引胁下痛。所以知其为悬饮也。悬饮非攻不去。芫花、甘遂、大戟。并逐饮之峻药。而欲攻
其饮。必顾其正。大枣甘温以益中气。使不受药毒也。
中风发热。六七日不解而烦。有表里证。渴欲饮水。水入则吐者。名曰水逆。五苓散主之。
太阳风邪。至六七日之久而不解。则风变热而传里。故烦而渴。有表里证。即身热烦渴之谓。
渴欲饮水。水气不行。而反上逆则吐。名水逆者。言因水气而逆。非火逆气逆之谓。故当以五苓散辛甘淡药。
导水而泄热也。
五苓散方
猪苓 茯苓 白术(各十八铢) 桂枝(半两) 泽泻(一两六铢)
上五味。为末。以白饮和服方寸匕。日三服。多饮暖水。汗出愈。
太阳中风证。出现下利、呕吐逆气等症状。只有当表证解除后,才可以攻逐里邪。如果患者汗出,且发作有定时,伴有头痛,胃脘部痞塞硬满,胀满牵引胁肋下部疼痛,干呕,呼吸短促,出汗且不恶寒,这是表证已解而里气未和的表现。应当用十枣汤主治。
这是外感风邪寒气,体内有悬饮的证候。下利和呕吐逆气,是因为水饮向上攻冲又向下流注所致。然而必须等风邪已经解除,之后才能攻逐水饮。如果患者汗出且不恶寒,说明表证已解;胃脘部痞塞硬满,胀满牵引胁肋下部疼痛,干呕,呼吸短促,说明里气未和。虽然头痛,但发作有定时,可知不是风邪在经络,而是水饮之气上攻所致。因此适宜用十枣汤来下气逐饮。
以上三味药(芫花、甘遂、大戟)等分,分别捣碎成散剂。用水一升半,先煮肥大红枣十枚,取汁八合,去渣,加入上述三种药末。体质强壮的人服用一方寸匕的药量,体弱的人服用半方寸匕。温服。清晨空腹服用。如果泻下较少,病邪未除,第二天继续服用,增加半方寸匕的量。待得到畅快的腹泻后,喝稀粥来自养身体。
按《金匮要略》记载:“饮水后水流停留在胁下,咳嗽吐痰时牵引疼痛,称为悬饮。”又说:“患悬饮病的,用十枣汤主治。”这里心下痞塞硬满,胀满牵引胁肋下部疼痛,所以知道它是悬饮。悬饮非攻逐不能去除,芫花、甘遂、大戟都是逐饮的峻猛药物,而要攻逐水饮,必须顾护正气。大枣味甘性温,可以补益中气,使身体不受药毒伤害。
中风发热,经过六七天仍未解除并出现烦躁,既有表证又有里证,口渴想喝水,但水喝进去就吐出来,这叫做水逆。用五苓散主治。
太阳风邪,到了六七天之久仍不解除,则风邪转化为热邪并传入里部,所以出现烦躁和口渴。所谓“有表里证”,指的就是身体发热、烦躁口渴。口渴想喝水,但水气运行不畅,反而向上逆冲导致呕吐。称为“水逆”,是指因水气上逆,而不是火逆或气逆。因此应当用五苓散这种辛、甘、淡味的药物,引导水液排出并泄除热邪。
五苓散方剂组成:
猪苓、茯苓、白术(各十八铢)、桂枝(半两)、泽泻(一两六铢)
以上五味药,研成粉末。用米汤调和,每次服用一方寸匕。每天服用三次。服药后多喝暖水,以微微出汗为痊愈。
Taiyang wind-stroke (Taiyang syndrome due to wind pathogen). There is diarrhea and vomiting with counterflow qi. Only when the exterior syndrome is resolved can one proceed to attack the interior. If the person sweats, with attacks occurring at specific times, headache, fullness and hardness in the epigastrium, distension radiating to the hypochondriac region, dry retching, shortness of breath, sweating without aversion to cold, this indicates that the exterior is resolved but the interior is not harmonized. Shi Zao Tang (Ten Jujube Decoction) should be administered.
This is an external contraction of wind-cold with internal suspension of fluid (xuan yin). The diarrhea and vomiting with counterflow qi result from the fluid attacking upward and then draining downward. However, one must wait until the wind pathogen has been resolved before attacking the fluid. If the person sweats and has no aversion to cold, it signifies that the exterior is resolved; fullness and hardness in the epigastrium, distension radiating to the hypochondriac region, dry retching, and shortness of breath signify that the interior is not harmonized. Although there is a headache, since it occurs at specific times, it is known not to be wind pathogen in the meridians, but rather fluid qi attacking upward. Therefore, Shi Zao Tang (Ten Jujube Decoction) is suitable to descend qi and expel fluid.
Shi Zao Tang (Ten Jujube Decoction) Formula:
Yuan Hua (Genkwa Flos), Gan Sui (Kansui Radix), Da Ji (Euphorbiae Pekinensis Radix), Da Zao (Jujubae Fructus, ten pieces).
The above three herbs (Yuan Hua, Gan Sui, Da Ji) are of equal parts, each separately pounded into powder. Use one sheng and half of water, first decoct ten fat jujubes (Da Zao) until eight ge of liquid remains, remove the dregs, and add the powders of the other herbs. Strong individuals take one fang cun bi (a measure for powder); weak individuals take half a fang cun bi. Take warm. Administer on an empty stomach in the morning. If the purgation is slight and the disease persists, administer again the next day, increasing by half a fang cun bi. After obtaining free and profuse purgation, nourish oneself with millet porridge.
According to the Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet): "After drinking, if water flows and stays in the hypochondriac region, causing pain upon coughing and expectoration, it is called suspension of fluid (xuan yin)." It also states: "For those suffering from suspension of fluid, Shi Zao Tang (Ten Jujube Decoction) should be administered." Here, the fullness and hardness in the epigastrium with distension radiating to the hypochondriac region indicate suspension of fluid. Suspension of fluid cannot be removed without purgation. Yuan Hua (Genkwa Flos), Gan Sui (Kansui Radix), and Da Ji (Euphorbiae Pekinensis Radix) are harsh drugs for expelling fluid. To attack the fluid, one must protect the healthy qi. Da Zao (Jujubae Fructus) is sweet and warm, benefiting middle qi, thereby preventing damage from the toxicity of the medicine.
Wind-stroke with fever, unresolved after six or seven days, accompanied by vexation, presenting both exterior and interior syndromes, thirst desire to drink water, but vomiting immediately after ingestion, is named water counterflow (shui ni). Wu Ling San (Five-Ingredient Powder with Poria) should be administered.
Taiyang wind pathogen, persisting for six or seven days without resolution, transforms into heat and transmits to the interior, causing vexation and thirst. "Presenting both exterior and interior syndromes" refers to body heat, vexation, and thirst. Thirst desire to drink water, but the water qi fails to circulate and instead counterflows upward causing vomiting. Named "water counterflow," it means counterflow due to water qi, not fire counterflow or qi counterflow. Therefore, one should use Wu Ling San (Five-Ingredient Powder with Poria), a formula with acrid, sweet, and bland properties, to guide out water and drain heat.
Wu Ling San (Five-Ingredient Powder with Poria) Formula:
Zhu Ling (Polyporus), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 18 zhu each), Gui Zhi (Cinnamomi Ramulus, half liang), Ze Xie (Alismatis Rhizoma, 1 liang 6 zhu).
The above five herbs are pounded into powder. Mix with white rice drink (congee water) and take one fang cun bi per dose. Take three times daily. Drink plenty of warm water afterwards; recovery occurs with sweating.