伤寒病六经分治之外,又有不分经之病,附载于伤寒分经之
后者,又宜择其紧要者,详为诠解,而后学治伤寒者,自能应变
无穷也。
《伤寒论》原文∶大病瘥后,喜唾,久不了了者,胸上有寒,当以丸药温之,宜理中丸。
【理中丸方】人参、甘草、白术、干姜各三两。
上四味,捣筛为末,蜜丸如鸡子黄大,以沸汤数合,和一丸,研碎,温服之,日三服,夜二服,腹
中未热,益至三、四丸,然不及汤。汤法以四物根据两数切,用水八升,煮取三升,去滓,温服一升,日三服。
附加减法∶若脐上筑者,肾气动也,去术,加桂四两,吐多者,去术,加生姜三两;下多者,还用术;悸
者,加茯苓二两;渴欲饮水者,加术,足前成四两半;腹中疼者,加人参,足前成四两半;寒者,加干姜,
足前成四两半;腹满者,去术,加附子一枚。服汤后如食顷,饮热粥一升许,微自温,勿发揭衣被。
此病时服凉药太过,伤其胃中之阳,致胃阳虚损不能运化脾脏之湿,是以痰饮上溢而喜唾,久不了了
也。故方中用人参以回胃中之阳,其补益之力,且能助胃之 动加数,自能运化脾中之湿使之下行。而又
辅以白术,能健脾又能渗湿。干姜以能暖胃又能助相火以生土。且又加甘草以调和诸药,使药力之猛者,得甘
草之缓而猛力悉化,使药性之热者,得甘草之甘而热力愈长也。至于方后诸多加减,又皆各具精义,随诸证
之变化,而遵其加减诸法,用之自能奏效无误也。
《伤寒论》原文∶伤寒解后,虚羸少气,气逆欲吐者,竹叶石膏汤主之。
【竹叶石膏汤方】竹叶二把,石膏一斤,半夏半升洗,麦门冬一升,人参三两,甘草二两炙,粳米半升。
上七味,以水一斗,煮取六升,去滓,纳粳米,煮米熟汤成去米,温服一升,日三服。
前节是病时过用凉药,伤其阳分;此节是病时不能急用凉药以清外感之热,致耗阴分。且其大热虽退,
仍有余热未清,是以虚羸少气,气逆欲吐,此乃阴虚不能恋阳之象,又兼有外感之余热为之助虐也。故方
中用竹叶、石膏以清外感之热,又加人参、麦冬协同石膏以滋阴分之亏,盖石膏与人参并用,原有化合
之妙,能于余热未清之际立复真阴也。用半夏者,降逆气以止吐也。用甘草、粳米者,调和胃气以缓石药下
侵也。自常情观之,伤寒解后之余热,何必重用石膏,以生地、玄参、天冬、麦冬诸药,亦
可胜任,然而甘寒留邪,可默酿痨瘵之基础,此又不可不知也。
在伤寒病六经分治之外,还有不分经络的病证。这些内容附载于伤寒分经论述之后,应当选择其中紧要的病症,详细加以解释,这样后学治疗伤寒的人,自然能够灵活应对,变化无穷。
《伤寒论》原文:大病痊愈后,喜欢吐唾沫,长久不能好的,是胸中有寒邪,应当用丸药温补,适宜使用理中丸。
以上四味药,捣碎过筛成粉末,用蜂蜜制成如鸡蛋黄大小的丸药。用几合沸水调和一丸,研碎,温服。每日服三次,夜间服两次。如果腹中没有温热感,增加到三到四丸。然而,这不如汤剂效果好。汤剂的用法是将四味药按照原方剂量切好,用水八升,煮取三升,去渣,温服一升,每日三次。
附加加减法:如果脐上跳动不安,是肾气发动,去掉白术,加桂枝四两;呕吐多者,去掉白术,加生姜三两;腹泻多者,仍用白术;心悸者,加茯苓二两;口渴想喝水者,增加白术,使总量达到四两半;腹中疼痛者,增加人参,使总量达到四两半;体内有寒者,增加干姜,使总量达到四两半;腹部胀满者,去掉白术,加附子一枚。服用汤药后大约一顿饭的时间,喝热粥一升左右,使身体微微温暖,不要掀开衣被。
这种病是因为服药时凉药太过,损伤了胃中的阳气,导致胃阳虚损,不能运化脾脏的湿气,因此痰饮上溢而喜欢吐唾沫,长久不好。所以方中使用人参来恢复胃中的阳气,其补益之力,还能帮助胃气的运动加快,自然能运化脾中的湿气使其下行。又辅以白术,既能健脾又能渗湿。干姜能暖胃又能助相火以生土(脾胃)。并且加入甘草来调和诸药,使药力猛烈的药物,得到甘草的缓和而猛烈之力完全化解,使药性热的药物,得到甘草的甘味而热力更加持久。至于方后的多种加减法,都各具精义,随着各种证候的变化,遵循这些加减方法,使用自然能奏效无误。
《伤寒论》原文:伤寒病解除后,身体虚弱消瘦,气息短少,气逆想要呕吐的,用竹叶石膏汤主治。
【竹叶石膏汤方】竹叶二把,石膏一斤,半夏半升(洗),麦门冬一升,人参三两,甘草二两(炙),粳米半升。
以上七味药,用水一斗,煮取六升,去渣,放入粳米,煮至米熟汤成,去掉米粒,温服一升,每日三次。
前一段讲的是患病时过度使用凉药,损伤了阳气;这一段讲的是患病时不能及时使用凉药清除外感的发热,导致耗伤阴液。而且虽然大热已退,但仍有余热未清,因此出现身体虚弱消瘦、气息短少、气逆欲吐的症状,这是阴虚不能留住阳气的表现,又兼有外感之余热在其中助长病势。所以方中使用竹叶、石膏来清除外感的余热,又加入人参、麦冬协同石膏来滋阴液的亏损。盖因石膏与人参并用,原有化合的妙处,能在余热未清之际立即恢复真阴。使用半夏,是为了降逆气以止呕吐。使用甘草、粳米,是为了调和胃气以缓和矿物药(石膏)的下侵伤害。从常情来看,伤寒解除后的余热,何必重用石膏,用生地、玄参、天冬、麦冬等药物也可以胜任,然而甘寒之药容易留滞邪气,可能默默酿成痨瘵(肺结核类疾病)的基础,这一点不可不知道。
Beyond the treatment of Shaoyang diseases according to the Six Meridians, there are also pathologies not divided by meridians. These are appended after the discussions on meridian-specific treatments. It is necessary to select the critical cases among them and explain them in detail, so that students learning to treat Shaoyang diseases can naturally respond with infinite flexibility.
Original text from *Shanghan Lun* (Treatise on Cold Damage Diseases): After a major illness has convalesced, if the patient frequently spits saliva and this condition persists for a long time without resolving, it indicates cold in the chest. One should use pill medicine to warm it; Lizhong Wan (Regulate the Middle Pill) is suitable.
[Formula for Lizhong Wan (Regulate the Middle Pill)] Renshen (Ginseng Radix et Rhizoma), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma), and Ganjiang (Dried Ginger) each three liang.
The above four ingredients are crushed, sifted into powder, and formed into pills using honey, sized like a chicken egg yolk. Take one pill, mix with several he of boiling water, crush it, and take it warm. Take three times daily and twice at night. If there is no feeling of warmth in the abdomen, increase to three or four pills. However, this is inferior to the decoction method. For the decoction, cut the four ingredients according to the original dosage, add eight sheng of water, boil to obtain three sheng, remove the dregs, and take one sheng warm, three times daily.
Additional modifications: If there is throbbing above the navel, indicating kidney qi movement, remove Baizhu and add Guizhi (Cinnamon Twig) four liang. If vomiting is frequent, remove Baizhu and add Shengjiang (Fresh Ginger) three liang. If diarrhea is frequent, continue using Baizhu. If palpitations occur, add Fuling (Poria) two liang. If thirsty and desiring to drink water, increase Baizhu so the total becomes four and a half liang. If there is abdominal pain, increase Renshen so the total becomes four and a half liang. If there is internal cold, increase Ganjiang so the total becomes four and a half liang. If there is abdominal fullness, remove Baizhu and add one Fuzi (Prepared Aconite Lateralis Radix). About the time of a meal after taking the decoction, drink about one sheng of hot porridge to induce slight warmth; do not uncover clothes or blankets.
This pathology arises because excessive use of cooling medicines during the illness damaged the yang qi in the stomach, leading to deficiency of stomach yang which cannot transform dampness in the spleen. Consequently, phlegm-fluid overflows upward causing frequent spitting and persistent symptoms. Therefore, Renshen is used in the formula to restore stomach yang. Its tonifying power also aids in accelerating stomach qi movement, naturally transforming spleen dampness and directing it downward. Baizhu is added as an assistant to strengthen the spleen and leach out dampness. Ganjiang warms the stomach and assists ministerial fire to generate earth (spleen/stomach). Gancao is added to harmonize the various herbs, such that the potent force of strong herbs is mitigated by Gancao’s moderating nature, and the heat of hot-natured herbs is prolonged by Gancao’s sweetness. The numerous modifications listed after the formula each possess profound meaning; following these modification methods according to changes in syndromes will ensure efficacy without error.
Original text from *Shanghan Lun*: After Shaoyang disease has resolved, if the patient is emaciated and weak, has shortness of breath, and experiences rebellious qi with a desire to vomit, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) governs.
[Formula for Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction)] Zhuye (Bamboo Leaves) two handfuls, Shigao (Gypsum Fibrosum) one jin, Banxia (Pinelliae Rhizoma) half sheng (washed), Maidong (Ophiopogonis Radix) one sheng, Renshen three liang, Zhi Gancao (Honey-fried Licorice Root) two liang, Jingmi (Rice) half sheng.
The above seven ingredients are boiled in ten dou of water to obtain six sheng. Remove the dregs, add Jingmi, and boil until the rice is cooked and the decoction is ready. Remove the rice grains. Take one sheng warm, three times daily.
The previous section discussed how excessive use of cooling medicines during illness damaged yang qi; this section discusses how failure to promptly use cooling medicines to clear external heat led to consumption of yin fluids. Although the major fever has subsided, residual heat remains unclarified. Hence, the symptoms of emaciation, weakness, shortness of breath, and rebellious qi with nausea arise. This is a sign of yin deficiency failing to anchor yang, compounded by residual external heat exacerbating the condition. Therefore, Zhuye and Shigao are used to clear residual external heat. Renshen and Maidong are added to synergize with Shigao in nourishing yin fluid deficiency. The combination of Shigao and Renshen possesses a subtle chemical interaction, capable of immediately restoring true yin amidst residual heat. Banxia is used to descend rebellious qi and stop vomiting. Gancao and Jingmi are used to harmonize stomach qi and mitigate the downward invasion of mineral drugs (Shigao). From common perspective, why use heavy doses of Shigao for residual heat after Shaoyang resolution? Medicines such as Shengdi Huang (Rehmanniae Radix), Xuanshen (Scrophulariae Radix), Tiandong (Asparagi Radix), and Maidong could suffice. However, sweet-cold herbs may retain pathogens, potentially silently brewing the foundation for Laozai (consumption/tuberculosis); this must be known.