《伤寒论》原文∶少阴病,吐利,手足厥冷,烦躁欲死者,吴茱萸汤主之。
柯韵伯曰∶少阴病,吐利、烦躁、四逆者死。四逆者四肢厥冷兼臂、胫而言也,此云手足是指掌而言,
四肢之阳犹在也。
【吴茱萸汤】吴茱萸一升汤洗七遍,人参三两切,生姜六两切,大枣十二枚擘。
上四味,以水七升,煮取二升,去滓,温服七合,日三服。
吴茱萸汤之实用,乃肝胃同治之剂也。至于此证烦躁欲死,非必因肝邪盛极,实因寒邪阻塞而心肾不
交也。盖人心肾之气,果分毫不交,其人即危不旋踵,至于烦躁欲死,其心肾几分毫不交矣。夫心肾之所
以相交者,实赖脾胃之气上下通行,是以少阴他方中皆用干姜,而吴茱萸汤中则重用生姜至六两,取其
温通之性,能升能降(生姜善发汗,是其能升,善止呕吐,是其能降),以开脾胃凝滞之寒邪,使脾
胃之气上下通行,则心肾自能随脾胃气化之升降而息息相通矣。
《伤寒论》原文∶少阴病,咽中伤,生疮,不能语言,声不
出者,苦酒汤主之。
【苦酒汤】半夏洗破如枣核十四枚,鸡子一枚去黄,内上苦酒,着鸡子壳中。
上两味,纳半夏,着苦酒中,以鸡子壳着刀环中,安火上,令三沸,去滓,少少含咽之,不瘥,更作三剂。
按∶苦酒即醋也,又方中枣核当作枣仁,不然,破半夏如枣
核大十四枚,即鸡子空壳亦不能容,况鸡子壳中犹有鸡子清与苦酒乎?
古用半夏皆用生者,汤洗七次即用,此方中半夏宜用生半夏先破之,后用汤洗,始能洗出毒涎。
唐容川曰∶此节所言生疮,即今之喉痈、喉蛾,肿塞不得出声,今有用刀针破之者,有用巴豆烧焦烙
之者,皆是攻破之使不壅塞也。仲景用生半夏正是破之也,余亲见治重舌敷生半夏立即消破,即知咽喉肿闭
亦能消而破之矣。且半夏为降痰要药,凡喉肿则痰塞,此仲景用半夏之妙。正是破之又能去痰,与后世刀针、
巴豆等方较见精密,况兼蛋清之润,苦酒之泻,真妙法也。
《伤寒论》原文:少阴病(少阴经受邪所致的病证),出现呕吐、下利,手足冰冷,烦躁得快要死去的情况,用吴茱萸汤主治。
柯韵伯说:少阴病,如果出现呕吐、下利、烦躁以及四肢厥冷(四逆,指四肢末端寒冷),属于死证。所谓“四逆”,是指手臂和小腿都发凉;这里所说的“手足”仅指手掌和脚掌而言,说明四肢的阳气尚存。
【吴茱萸汤】吴茱萸一升,用汤清洗七遍;人参三两,切片;生姜六两,切片;大枣十二枚,掰开。
以上四味药,用水七升,煮取二升药液,滤去药渣,每次温服七合,每日服用三次。
吴茱萸汤的实际应用,是肝胃同治的方剂。至于此证中出现的“烦躁欲死”,并非一定是因为肝邪盛极,实在是因为寒邪阻塞导致心肾不交(心火与肾水不能相互既济)。人的心气与肾气,如果分毫不相交,其人就会立刻陷入危险境地。到了“烦躁欲死”的程度,说明心肾之气已经几乎完全不交了。心肾之所以能够相交,确实依赖于脾胃之气的上下通行。因此在治疗少阴病的其他方剂中多用干姜,而吴茱萸汤中则重用生姜至六两,是取其温通之性,具有能升能降的作用(生姜善于发汗,体现其能升;善于止呕吐,体现其能降),以开通脾胃中凝滞的寒邪,使脾胃之气得以上下通行,那么心肾之气自然就能随着脾胃气化的升降而息息相通了。
《伤寒论》原文:少阴病,咽喉受伤,生疮,不能说话,声音出不来的情况,用苦酒汤主治。
【苦酒汤】半夏十四枚,洗净后破开如枣核大小;鸡蛋一枚,去掉蛋黄,将剩下的蛋清放入蛋壳中,加入苦酒(醋)。
以上两味药,将半夏放入苦酒中,把装有药液的蛋壳放在刀环上,置于火上,煮沸三次,滤去药渣,少量含咽。若未痊愈,再制作三剂服用。
按语:苦酒就是醋。另外,方中的“枣核”应当是“枣仁”之误,否则,将半夏破开如枣核大共十四枚,连鸡蛋的空壳都装不下,何况蛋壳中还有蛋清和苦酒呢?古时候使用半夏都用生半夏,用汤洗七次后立即使用。此方中的半夏宜用生半夏,先将其破开,然后用汤洗,才能洗出毒涎。
唐容川说:本节所说的“生疮”,即现在的喉痈、喉蛾(扁桃体炎),肿胀堵塞导致无法出声。现在有用刀针刺破的,有用巴豆烧焦后烙灼的,都是采用攻破的方法使其不壅塞。张仲景使用生半夏正是为了攻破肿块。我亲眼见到治疗重舌(双舌)时敷上生半夏,立即消肿破溃,由此可知咽喉肿痛闭塞也能通过生半夏消破。而且半夏是降痰的要药,凡是喉肿必然痰塞,这是张仲景使用半夏的精妙之处。这正是既能攻破又能祛痰,与后世使用刀针、巴豆等方剂相比更为精密,况且兼有蛋清的滋润和苦酒的泻热作用,真是奇妙的疗法啊。
Original text from *Shanghan Lun*: Shaoyin disease (a syndrome caused by pathogenic invasion of the Shaoyin meridians), characterized by vomiting, diarrhea, coldness of the hands and feet, and extreme restlessness bordering on death, is primarily treated with Wuzhuyu Tang (Evodia Decoction).
Ke Yunbo stated: In Shaoyin disease, if there are vomiting, diarrhea, restlessness, and Si Ni (cold extremities involving both arms and legs), it indicates a fatal prognosis. The term "Si Ni" refers to coldness extending to the arms and shins; here, the mention of "hands and feet" refers only to the palms and soles, indicating that the Yang Qi of the four limbs is still present.
[Wuzhuyu Tang] Evodiae Fructus (Wuzhuyu) one Sheng, washed seven times with hot water; Ren Shen (Ginseng Radix et Rhizoma) three Liang, sliced; Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) six Liang, sliced; Da Zao (Jujubae Fructus, Jujube) twelve pieces, split open.
The above four ingredients are boiled in seven Sheng of water until two Sheng remain. Strain the dregs. Take seven Ge warm per dose, three times daily.
The practical application of Wuzhuyu Tang is a formula that treats both the Liver and Stomach simultaneously. Regarding the symptom of "extreme restlessness bordering on death" in this syndrome, it is not necessarily due to excessive Liver Pathogen, but rather because Cold Pathogen obstruction prevents the communication between the Heart and Kidney (Heart-Kidney Non-Interaction). If the Qi of the Heart and Kidney fails to interact even slightly, the patient will face immediate danger. When reaching the state of "extreme restlessness bordering on death," it implies that the Heart and Kidney Qi have almost completely failed to interact. The reason for the interaction between the Heart and Kidney relies essentially on the free circulation of Spleen and Stomach Qi up and down. Therefore, in other formulas for Shaoyin disease, Gan Jiang (Dried Ginger) is commonly used, whereas Wuzhuyu Tang heavily uses Sheng Jiang (Fresh Ginger) up to six Liang, taking advantage of its warming and unblocking properties, which possess ascending and descending functions (Sheng Jiang promotes sweating, demonstrating its ascending nature; it stops vomiting, demonstrating its descending nature). This opens up the stagnant Cold Pathogen in the Spleen and Stomach, allowing Spleen and Stomach Qi to circulate freely up and down. Consequently, Heart and Kidney Qi can naturally communicate continuously through the ascending and descending movements of Spleen and Stomach Qi transformation.
Original text from *Shanghan Lun*: Shaoyin disease, where the throat is injured, sores develop, speech is impossible, and voice cannot be produced, is primarily treated with Kujie Tang (Vinegar Decoction).
[Kujie Tang] Ban Xia (Pinelliae Rhizoma, Pinellia Tuber) fourteen pieces, washed and broken open like the size of a jujube pit; Ji Zi (Galli Ovum, Chicken Egg) one piece, remove the yolk, place the white into the eggshell, add Ku Jiu (Vinegar).
Take the above two ingredients, put the Ban Xia into the Ku Jiu, place the eggshell containing the mixture into a knife ring, set over fire, boil three times, strain the dregs, and swallow slowly in small amounts. If not cured, prepare three more doses.
Note: Ku Jiu refers to vinegar. Furthermore, the "jujube pit" mentioned in the formula should likely be "jujube seed" (Zao Ren); otherwise, breaking fourteen pieces of Ban Xia to the size of a jujube pit would not fit even inside an empty eggshell, let alone accommodating the egg white and vinegar within the shell. Anciently, Ban Xia was always used raw, washed seven times with hot water and used immediately. For this formula, raw Ban Xia should be used; it should be broken first, then washed with hot water to effectively wash out the toxic saliva.
Tang Rongchuan said: The "sores" described in this section refer to what is now known as Hou Yong (throat abscess) or Hou E (tonsillitis), where swelling and blockage prevent speech. Currently, some use scalpels to lacerate, while others use scorched Crotonis Fructus (Ba Dou) for cauterization; all these methods aim to break open the blockage. Zhang Zhongjing's use of raw Ban Xia is precisely for breaking open the swelling. I have personally witnessed cases of Chong She (double tongue) being treated with topical raw Ban Xia, resulting in immediate reduction and rupture of the swelling; thus, I know that throat swelling and closure can also be reduced and ruptured by Ban Xia. Moreover, Ban Xia is a key herb for descending Phlegm. Whenever there is throat swelling, there is Phlegm obstruction; this is the brilliance of Zhang Zhongjing's use of Ban Xia. It breaks the swelling while simultaneously removing Phlegm, making it more precise compared to later methods using scalpels or Ba Dou. Additionally, combined with the moistening effect of egg white and the draining/heat-clearing action of vinegar, it is truly a wonderful method.