发汗后,身疼痛,脉沉迟者,桂枝加芍药生姜人参新加汤主之。太阳病,外证未解,而数下之,遂协热而
利,利不止,心下痞硬,表里不解者,桂枝人参汤主之。本太阳病,医反下之,因而腹满时痛者,属太阴也,
桂枝芍药汤主之。
手足厥寒,脉细欲绝者,当归四逆汤主之。若其人内有久寒者,当归四逆加吴茱萸生姜汤主之。下利脉大
者虚也,以其强下之故也。设脉浮革,因而肠鸣者,属当归四逆汤。
按以上诸证,或身疼痛,脉沉迟,或下利有痞,或腹满时痛,或脉细欲绝,均系表邪未解,而里气已虚,
故以表实里虚证统之。
桂枝加芍药生姜人参新加汤
桂枝(二钱) 芍药(四钱) 甘草(二钱炙) 人参(三钱) 大枣(三
枚) 生姜(四钱) 水二杯半,
煎八分,温服,余同桂枝汤法。按汗泄血中温气,阳虚肝陷,经脉凝涩,风木郁遏,故用甘草补其脾精,桂
枝达其肝气,芍药清风木之燥,生姜行经络之瘀,人参补中气以充经脉也。
桂枝人参汤
桂枝(二钱) 人参(一钱五分) 白术(一钱五分) 干姜(一钱五分) 甘草(二钱
)水二杯半,先煮四味,取一杯半,去滓,入桂枝煮八分服。按表证不解而中气虚败,故用桂枝通经而解表
热,参术姜甘温补中气以转升降之机也。
桂枝加芍药汤
桂枝(三钱) 芍药(六钱) 甘草(二钱) 生姜(三钱) 大枣(四枚) 水煎服
。按表证不解,而反下之,脾败肝郁,因而腹满时痛,故用桂枝解太阳之表邪,芍药清乙木之风燥也。
当归四逆汤
当归(一钱五分) 桂枝(一钱五分) 芍药(一钱五分) 细辛(一钱五分) 大枣(四
枚) 木通(一钱) 甘草(一钱炙) 水煎温服。按厥阴温气亏败,营血寒涩,不能暖肢节而充经络,以致
手足厥寒,脉细欲绝。故用甘草、大枣补脾精以荣肝,当归、芍药养营血而复脉,桂枝、细辛、通草温行经络
之寒涩也。
当归四逆加吴茱萸生姜汤
当归(一钱五分) 桂枝(一钱五分) 芍药(一钱五分) 细辛(一钱五
分) 大枣(四枚) 甘草(一钱) 木通(一钱) 生姜(四钱) 吴茱萸(二钱) 酒水各一杯,煎温服。
按此方加吴茱萸、生姜者,温寒凝而行阴滞也。
发汗治疗后,身体仍然疼痛,脉象沉而迟缓的,用桂枝加芍药生姜人参新加汤主治。太阳病,表证未解,却多次使用攻下法,导致伴随发热而下利,腹泻不止,胃脘部痞塞坚硬,表里之邪均未解除的,用桂枝人参汤主治。原本患太阳病,医生反而误用攻下法,导致腹部胀满、时时作痛的,属于太阴病,用桂枝芍药汤主治。
手足厥冷,脉象细微几乎摸不到的,用当归四逆汤主治。如果患者体内素有久寒的,用当归四逆加吴茱萸生姜汤主治。下利(腹泻)而脉象大的,是虚证,因为强行攻下所致。假如脉象浮而革,并且出现肠鸣的,属于当归四逆汤的主治范围。
按以上各种证候,有的身体疼痛、脉沉迟,有的下利且伴有痞塞感,有的腹部胀满、时时作痛,有的脉细欲绝,这些都属于表邪未解而里气已虚,因此统称为表实里虚证。
桂枝加芍药生姜人参新加汤
桂枝(二钱) 芍药(四钱) 甘草(二钱,炙) 人参(三钱) 大枣(三枚) 生姜(四钱) 用水二杯半,煎至八分,温服,其余服用方法同桂枝汤。按:汗出泄去了血中的温气,导致阳虚肝气下陷,经脉凝滞涩涩不通,风木之气郁遏,所以用甘草补益脾精,桂枝疏达肝气,芍药清散风木之燥,生姜通行经络之瘀滞,人参补益中气以充盈经脉。
桂枝人参汤
桂枝(二钱) 人参(一钱五分) 白术(一钱五分) 干姜(一钱五分) 甘草(二钱) 用水二杯半,先煮前四味药,取汁一杯半,去渣,加入桂枝再煎至八分,服用。按:表证未解而中气虚弱败坏,所以用桂枝通经以解表热,人参、白术、干姜、甘草温补中气以恢复升降之机。
桂枝加芍药汤
桂枝(三钱) 芍药(六钱) 甘草(二钱) 生姜(三钱) 大枣(四枚) 用水煎服。按:表证未解,反而误用攻下法,导致脾败肝郁,因而腹部胀满、时时作痛,所以用桂枝解除太阳表的邪气,芍药清散乙木的风燥。
当归四逆汤
当归(一钱五分) 桂枝(一钱五分) 芍药(一钱五分) 细辛(一钱五分) 大枣(四枚) 木通(一钱) 甘草(一钱,炙) 用水煎后温服。按:厥阴经的温气亏损败坏,营血寒凝涩滞,不能温暖肢节和充盈经络,导致手足厥冷,脉象细微几乎摸不到。所以用甘草、大枣补益脾精以滋养肝脏,当归、芍药滋养营血以恢复脉象,桂枝、细辛、通草温通经络中的寒凝涩滞。
当归四逆加吴茱萸生姜汤
当归(一钱五分) 桂枝(一钱五分) 芍药(一钱五分) 细辛(一钱五分) 大枣(四枚) 甘草(一钱) 木通(一钱) 生姜(四钱) 吴茱萸(二钱) 用酒和水各一杯,煎后温服。按:此方加入吴茱萸、生姜,是为了温散寒凝并运行阴气的滞涩。
After inducing sweating, if body pain persists and the pulse is deep and slow, Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang (Cinnamon Twig Decoction with Added Peony, Fresh Ginger, and Ginseng) should be administered. In Taiyang disease (disease of the Exterior), if the exterior syndrome remains unresolved but purgatives are used repeatedly, leading to diarrhea accompanied by fever, unceasing diarrhea, epigastric fullness and hardness, and both interior and exterior pathogens remaining unresolved, Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) should be administered. Originally suffering from Taiyang disease, if the physician erroneously uses purgation, resulting in abdominal fullness and intermittent pain, it belongs to Taiyin disease (disease of the Interior/Spleen-Stomach deficiency-cold), and Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony) should be administered.
If the hands and feet are cold and the pulse is fine and nearly imperceptible, Danggui Sini Tang (Angelica Sinensis Decoction for Reversal Cold) should be administered. If the patient has chronic cold retained within, Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Reversal Cold with Added Evodia and Fresh Ginger) should be administered. Diarrhea with a large pulse indicates deficiency, caused by forceful purgation. If the pulse is floating and wiry, accompanied by borborygmus (intestinal rumbling), it falls under the indication for Danggui Sini Tang.
According to the above syndromes, whether presenting with body pain and a deep-slow pulse, diarrhea with epigastric stuffiness, abdominal fullness with intermittent pain, or a fine and nearly imperceptible pulse, all stem from unresolved exterior pathogens and deficient interior Qi. Therefore, they are collectively categorized as "Exterior Excess and Interior Deficiency Syndrome."
Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang (Cinnamon Twig Decoction with Added Peony, Fresh Ginger, and Ginseng)
Guizhi (Cinnamomi Ramulus, 2 qian), Shaoyao (Paeoniae Radix Alba, 4 qian), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 2 qian), Renshen (Panacis Ginseng Radix, 3 qian), Dazao (Ziziphi Jujubae Fructus, 3 pieces), Shengjiang (Zingiberis Rhizoma Recens, 4 qian). Decoct with 2.5 cups of water until reduced to 0.8 cup; take warm. The remaining administration method follows that of Guizhi Tang. Commentary: Sweating depletes the warming Qi within the blood, leading to Yang deficiency and sinking of Liver Qi, causing stagnation and涩ness (stasis) in the meridians and depression of Wind-Wood Qi. Therefore, Gancao tonifies Spleen Essence, Guizhi promotes Liver Qi, Shaoyao clears the dryness of Wind-Wood, Shengjiang circulates stasis in the collaterals, and Renshen tonifies Middle Qi to fill the meridians.
Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction)
Guizhi (Cinnamomi Ramulus, 2 qian), Renshen (Panacis Ginseng Radix, 1.5 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Ganjiang (Zingiberis Rhizoma, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian). Decoct the first four ingredients in 2.5 cups of water until reduced to 1.5 cups, strain, add Guizhi, and decoct until reduced to 0.8 cup; take warm. Commentary: Since the exterior syndrome is unresolved and Middle Qi is deficient and failing, Guizhi is used to unblock the meridians and resolve exterior heat, while Renshen, Baizhu, Ganjiang, and Gancao warm and tonify Middle Qi to restore the mechanism of ascending and descending.
Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction with Added Peony)
Guizhi (Cinnamomi Ramulus, 3 qian), Shaoyao (Paeoniae Radix Alba, 6 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Shengjiang (Zingiberis Rhizoma Recens, 3 qian), Dazao (Ziziphi Jujubae Fructus, 4 pieces). Decoct in water and take warm. Commentary: When the exterior syndrome is unresolved and purgation is erroneously applied, Spleen failure and Liver depression occur, leading to abdominal fullness and intermittent pain. Therefore, Guizhi is used to resolve the exterior pathogen of Taiyang, and Shaoyao clears the wind-dryness of Yi Wood (Liver).
Danggui Sini Tang (Angelica Sinensis Decoction for Reversal Cold)
Danggui (Angelicae Sinensis Radix, 1.5 qian), Guizhi (Cinnamomi Ramulus, 1.5 qian), Shaoyao (Paeoniae Radix Alba, 1.5 qian), Xixin (Asari Radix et Rhizoma, 1.5 qian), Dazao (Ziziphi Jujubae Fructus, 4 pieces), Mutong (Akebiae Caulis, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 1 qian). Decoct in water and take warm. Commentary: The warming Qi of Jueyin (Liver/Pericardium) is deficient and failing, causing Ying Blood (Nutritive Blood) to become cold and stagnant, unable to warm the limbs and fill the meridians, resulting in cold extremities and a fine, nearly imperceptible pulse. Therefore, Gancao and Dazao tonify Spleen Essence to nourish the Liver, Danggui and Shaoyao nourish Ying Blood to restore the pulse, and Guizhi, Xixin, and Tongcao (Mutong) warm and circulate the cold-stagnation in the meridians.
Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Reversal Cold with Added Evodia and Fresh Ginger)
Danggui (Angelicae Sinensis Radix, 1.5 qian), Guizhi (Cinnamomi Ramulus, 1.5 qian), Shaoyao (Paeoniae Radix Alba, 1.5 qian), Xixin (Asari Radix et Rhizoma, 1.5 qian), Dazao (Ziziphi Jujubae Fructus, 4 pieces), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian), Mutong (Akebiae Caulis, 1 qian), Shengjiang (Zingiberis Rhizoma Recens, 4 qian), Wuzhuyu (Evodiae Fructus, 2 qian). Decoct with one cup of wine and one cup of water; take warm. Commentary: The addition of Wuzhuyu and Shengjiang to this formula serves to warm the dispersion of cold coagulation and promote the circulation of Yin stagnation.