伤寒传变大法, 已详『伤寒论注』及『心法要诀』中矣. 然近世治四时伤
寒者, 咸用河间两解等法, 每多神效, 诚治斯证之捷法也. 今复采双
解散, 防风通圣散诸经验名方, 编为歌诀, 附于心法之后, 俾后之学
者,知所变通, 庶几于伤寒一证, 经权常变, 有所遵循, 而无遗法云
.
31.双解通圣合六一, 四时温热正伤寒, 两许为剂葱姜豉, 汗下兼行
表里宜, 强者加倍弱减半, 不解连进自然安, 若因汗少麻倍入, 便硬
硝黄加倍添.
【注】名曰双解散者, 以其能发表攻里, 即防风通圣散, 六一散二方
合剂也. 河间制此, 解利四时冬温春温, 夏热秋热, 正令伤寒. 凡邪
在三阳表里不解者, 以两许为剂, 加葱, 姜, 淡豆豉煎服之, 候汗下
兼行, 表里即解. 形气强者, 两半为剂, 形气弱者, 五钱为剂. 若初
服因汗少不解, 则为表实, 倍加麻黄以汗之. 因便硬不解, 则为里实
,倍加硝黄以下之, 连进二, 三服, 必令汗出下利而解也. 今人不知
其妙, 以河间过用寒凉, 仲景伤寒初无下法, 弃而不用, 深可惜也.
不知其法神捷, 莫不应手取效, 从无寒中痞结之变, 即有一、二不解
者,非未尽法之善, 则必已传阳明, 故不解也. 防风通圣散详在后.
伤寒病的传变规律,已经在《伤寒论注》和《心法要诀》中详细论述过了。然而近代治疗四季伤寒的人,都使用河间(刘完素)的“两解”等方法,往往取得显著疗效,这确实是治疗这类病症的简便方法。现在我又采集了双解散、防风通圣散等经验有效的名方,编写成歌诀,附在《心法要诀》之后,以便后来的学者知道如何灵活变通,希望在伤寒这一病症上,对于经权常变的运用有所遵循,而不遗漏治疗方法。
31. 双解通圣合六一,四时温热正伤寒,两许为剂葱姜豉,汗下兼行表里宜,强者加倍弱减半,不解连进自然安,若因汗少麻倍入,便硬硝黄加倍添。
【注】名为双解散的原因,是因为它能发表攻里,即由防风通圣散和六一散两个方剂合并而成的药剂。河间(刘完素)制定此方,用于解除和治疗四季的冬温、春温、夏热、秋热以及当令的伤寒。凡是邪气在三阳经表里同病且未解的情况,用两许(约60克)作为剂量,加入葱、姜、淡豆豉煎服,等待汗法和下法同时发挥作用,表证和里证即可解除。体质强壮者,用一两半(约45克)作为剂量;体质虚弱者,用五钱(约15克)作为剂量。如果初次服用后因出汗少而未见效,说明是表实,应加倍加入麻黄以发汗。如果因大便干硬而未见效,说明是里实,应加倍加入芒硝、大黄以泻下,连续服用二至三剂,必定通过出汗或腹泻而痊愈。现在的人不知道其中的奥妙,认为河间过于使用寒凉药物,而张仲景治伤寒初期原本没有下法,于是抛弃不用,实在可惜。不知道这种方法神速便捷,没有不随手取效的,从未出现因寒致痞结的变证,即使有一两个未愈的,要么是没有用尽该法的精髓,要么是病邪已经传入阳明经,所以不能痊愈。防风通圣散的详细内容在后面。
The general principles of the transmission and transformation of Cold Damage (Shanghan) have been detailed in *Annotations on the Treatise on Cold Damage* (*Shanghan Lun Zhu*) and *Essentials of Medical Practice* (*Xinfa Yaojue*). However, contemporary practitioners treating Cold Damage occurring in all four seasons commonly employ methods such as Hejian's "Liangjie" (Dual Resolution), which often yield remarkable efficacy; this is indeed a swift method for treating such conditions. Herein, I have collected renowned empirical formulas such as Shuangjie San (Double-Resolution Powder) and Fangfeng Tongsheng San (Wind-Protecting Universal-Health Powder), compiled them into mnemonic verses, and appended them after *Xinfa Yaojue*, so that future students may know how to adapt flexibly. It is hoped that regarding Cold Damage, there will be guidelines for following the constant principles and adapting to changing circumstances, ensuring no therapeutic methods are omitted.
31. Shuangjie Tongsheng combined with Liuyi, [treats] Warmth-Cold and proper Cold Damage in all four seasons; two xu (approx. 60g) as the dose with scallion, ginger, and fermented soybean; both sweating and purging act simultaneously, suitable for resolving exterior and interior. For strong constitutions, double the dose; for weak ones, halve it. If unresolved, continuous administration brings natural peace. If due to insufficient sweating, double the Ephedrae Herba (Mahuang); if due to hard stool, add doubled Natrii Sulfas (Mangxiao) and Rheum Palmatum Radix et Rhizoma (Dahuang).
[Note] It is named Shuangjie San (Double-Resolution Powder) because it can release the exterior and purge the interior; it is a compound of Fangfeng Tongsheng San (Wind-Protecting Universal-Health Powder) and Liuyi San (Six-to-One Powder). Hejian (Liu Wansu) formulated this to resolve and treat Winter-Warmth, Spring-Warmth, Summer-Heat, Autumn-Heat, and proper Cold Damage occurring in their respective seasons. Whenever pathogenic factors remain unresolved in the Taiyang, Yangming, and Shaoyang meridians involving both exterior and interior, use two xu (approx. 60g) as the dose, decoct with scallion stem, fresh ginger, and Glycine Max Seed Preparata (Danshichihao), and administer orally. Wait for both sweating and purging to occur simultaneously, at which point the exterior and interior will be resolved. For those with robust constitution and qi, use one liang and half qian (approx. 45g) as the dose; for those with weak constitution and qi, use five qian (approx. 15g) as the dose. If the initial dose fails to resolve symptoms due to insufficient sweating, it indicates Exterior Excess; double the amount of Ephedrae Herba (Mahuang) to induce sweating. If it fails due to hard stool, it indicates Interior Excess; double the amounts of Natrii Sulfas (Mangxiao) and Rheum Palmatum Radix et Rhizoma (Dahuang) to purge. Administer continuously for two or three doses, and resolution will surely come through sweating or diarrhea. Contemporary practitioners do not understand its subtlety; believing that Hejian overuses cold and cool herbs, and that Zhang Zhongjing originally had no purging method for early-stage Cold Damage, they discard and do not use it, which is deeply regrettable. They fail to realize that this method is divine and swift, yielding results upon application without fail, and never produces complications such as cold-induced epigastric fullness. Even in the rare cases where one or two patients do not recover, it is either because the full potential of the method was not utilized, or because the disease has already transmitted to the Yangming stage, hence the lack of resolution. The details of Fangfeng Tongsheng San (Wind-Protecting Universal-Health Powder) are provided later.