人参 黄耆 白术 茯苓 当归 川芎 白芍 金银花 白芷 甘草
连翘 水煎服.
【注】参, 耆, 术, 苓, 草以益气分, 归, 芎, 芍以滋血分, 银花,
白芷, 连翘以解毒.
医宗金鉴 三十一卷
删补名医方论 六卷
鼻鸣干呕等证, 及杂证自汗, 盗汗, 虚损, 虚疟亦可用. 若脉浮紧,
汗不出者, 酒客病风寒而汗出者, 禁用.
桂枝三两 芍药三两 生姜三两 甘草 ( 炙 ) 二两 大枣十二枚,
右五味, 以水七升, 煮取三升, 服一升, 覆令微汗, 不可令如水流漓
病必不除. 若服一升, 汗出病痊, 不必尽剂. 服已, 更啜稀粥一盏 ,
以助药力.
【注】凡风寒在表, 脉浮弱自汗出者, 皆属表虚, 宜桂枝汤主之. 名
曰桂枝汤者, 君以桂枝也. 桂枝辛温, 辛能散邪, 温从阳而扶卫. 芍
药酸寒, 酸能敛汗 , 寒走阴而益营. 桂枝君芍药, 是于发散中寓敛
汗之意; 芍药臣桂枝, 是于固表中有微汗之道焉. 生姜之辛, 佐桂枝
以解肌表. 且大枣之甘, 佐芍药以和营里. 甘草甘平, 有安内攘外之
能,用以调和中气, 即以调和表里调和诸药矣. 以桂, 芍之相需, 姜
,枣之相得, 藉甘草之调和阳表阴里, 气卫血营, 并行而不悖, 是刚
柔相济以为和也. 而精义在服后须臾啜热稀粥以助药力. 盖谷气内充
,不但易为酿汗, 更使已入之邪不能稍留, 将来之邪不得复入也. 又
妙在温服令一时许, 微似有汗, 是授人以微汗之法. 不可令如水流漓
,病必不除, 禁人以不可过汗之意也. 此方为仲景群方之冠, 乃解肌
,发汗, 调和营卫之第一方也. 凡中风, 伤寒, 脉浮弱汗自出而表不
解,皆得而主之. 其他但见一, 二证即是, 不必悉具. 故麻, 葛, 青
龙发汗诸剂, 咸用之也. 若汗不出麻黄证也, 脉浮紧者麻黄脉也, 固
不可与桂枝汤. 然初起无汗, 当用麻黄发汗, 如汗解后复烦, 脉浮数
者,与下后脉仍浮, 气上冲者, 及下后下痢止而身痛不休者, 皆用此
以解外. 何也 ? 盖此时表虽不解, 腠理已疏, 邪不在皮毛而在肌肉,
且经汗下, 津液已伤, 故脉证虽同麻黄而主治当属桂枝矣. 粗工妄谓
桂枝汤专治中风, 不治伤寒, 使人疑而不用; 又谓专发肌表不治他病
.不知此汤倍芍药, 生姜加人参, 名桂枝新加汤, 用以治营表虚寒,
肢体疼痛; 倍芍药加饴糖, 名小建中汤, 用以治里虚心悸, 腹中急痛
;再加黄耆, 名黄耆建中汤, 用以治虚损虚热, 自汗盗汗. 因知仲景
之方, 可通治百病也.
【方剂组成】人参、黄耆(黄芪)、白术、茯苓、当归、川芎、白芍、金银花、白芷、甘草、连翘。以上药材用水煎煮后服用。
【注释】人参、黄耆、白术、茯苓、甘草用于补益气分;当归、川芎、白芍用于滋养血分;金银花、白芷、连翘用于解毒。
《医宗金鉴》第三十一卷,删补名医方论第六卷。
桂枝汤还可治疗鼻鸣、干呕等症状,以及杂病引起的自汗、盗汗、虚损、虚疟等证候。如果脉象浮紧、无汗者,或嗜酒之人患风寒而有汗出者,禁用此方。
桂枝三两、芍药三两、生姜三两、甘草(炙)二两、大枣十二枚。以上五味药,用水七升,煮取三升,每次服用一升,服药后覆盖衣被使身体微微出汗,不可让汗水像水流一样淋漓不止,否则病邪必然无法去除。如果服用一升后,汗出而病愈,则不必服完剩余的药液。服药后,再喝一碗稀粥,以助药力。
【注释】凡是风寒在表,脉象浮弱且自汗出的情况,都属于表虚证,适宜用桂枝汤主治。命名为桂枝汤,是因为以桂枝为君药。桂枝性味辛温,辛能发散邪气,温能顺从阳气而扶助卫气。芍药性味酸寒,酸能收敛止汗,寒能入阴而滋养营气。桂枝作为君药配合芍药,是在发散之中蕴含收敛止汗的意图;芍药作为臣药辅助桂枝,是在固护体表的同时提供微汗的途径。生姜的辛味,辅助桂枝来解除肌表之邪。大枣的甘味,辅助芍药来调和营气于内部。甘草味甘性平,具有安定内里、攘除外邪的能力,用来调和中气,进而调和表里、调和诸药。由于桂枝与芍药的相互依存,生姜与大枣的相得益彰,借助甘草的调和作用,协调阳表与阴里、气卫与血营,并行而不违背,这是刚柔相济以达到和谐的状态。而其中的精妙之处在于服药后须臾之间喝热稀粥以助药力。因为谷气在内充实,不仅容易酿生汗液,更能使已经侵入的邪气不能稍作停留,未来的邪气不得再次进入。又妙在温服约一小时左右,微微似有汗出,这是传授给人微汗的方法。不可让汗水像水流一样淋漓不止,否则病必不除,这是告诫人们不可过度发汗的意思。此方是张仲景众多方剂中的冠首之作,是解肌、发汗、调和营卫的第一方。凡是中风、伤寒,脉象浮弱、自汗出而表证不解的情况,都可以用它来主治。其他情况只要见到一两个相关症状即可使用,不必所有症状都具备。所以麻黄汤、葛根汤、青龙汤等发汗方剂中,也都含有此方的成分。如果没有汗出,那是麻黄汤证;脉象浮紧,那是麻黄汤的脉象,当然不可以给予桂枝汤。然而初起无汗时,应当用麻黄汤发汗;如果汗解之后又出现烦闷,脉象浮数者,或者经过攻下治疗后脉仍然浮,气上冲者,以及攻下治疗后腹泻停止但身体疼痛不休者,都使用此方来解决表证。为什么呢?因为此时虽然表证未解,但腠理已经疏松,邪气不在皮毛而在肌肉,且经过发汗和攻下,津液已经受损,所以虽然脉证与麻黄汤证相似,但主治应当归属桂枝汤了。庸医错误地认为桂枝汤专门治疗中风,不治疗伤寒,使人怀疑而不使用;又认为它专门发散肌表之邪,不治疗其他疾病。他们不知道将此汤中的芍药加倍,生姜加入人参,名为桂枝新加汤,用来治疗营卫表虚寒导致的肢体疼痛;将芍药加倍并加入饴糖,名为小建中汤,用来治疗里虚导致的心悸、腹中急痛;再加入黄耆,名为黄耆建中汤,用来治疗虚损、虚热、自汗盗汗。由此可知,张仲景的方剂可以通治百病。
[Composition] Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Rhizoma), Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba), Yin Hua (Lonicerae Japonicae Flos), Bai Zhi (Angelicae Dahuricae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Lian Qiao (Forsythiae Fructus). Decoct with water and take orally.
[Annotation] Ren Shen, Huang Qi, Bai Zhu, Fu Ling, and Gan Cao are used to tonify the Qi aspect; Dang Gui, Chuan Xiong, and Bai Shao are used to nourish the Blood aspect; Yin Hua, Bai Zhi, and Lian Qiao are used to resolve toxicity.
*Yi Zong Jin Jian*, Volume 31, *Shan Bu Ming Yi Fang Lun*, Volume 6.
Gui Zhi Tang can also be used for symptoms such as nasal congestion with roaring sounds (Bi Ming) and dry retching (Gan Ou), as well as spontaneous sweating (Zi Han), night sweating (Dao Han), deficiency consumptive disease (Xu Sun), and deficient malaria (Xu Nue) arising from miscellaneous diseases. It is strictly contraindicated in cases of floating-tight pulse (Mai Fu Jin) with no sweating, or in habitual drinkers suffering from wind-cold with sweating.
Gui Zhi (Cinnamon Twig) 3 liang, Shao Yao (Paeonia Root) 3 liang, Sheng Jiang (Fresh Ginger) 3 liang, Gan Cao (Licorice Root, honey-fried) 2 liang, Da Zao (Jujube Fruit) 12 pieces. The above five ingredients are boiled in 7 sheng of water until 3 sheng remain. Take 1 sheng per dose. After taking the medicine, cover with blankets to induce a slight sweat. Do not allow profuse sweating like flowing water, otherwise the disease will certainly not be resolved. If after taking 1 sheng, sweating occurs and the disease is cured, there is no need to finish the remaining decoction. After taking the medicine, drink one bowl of thin porridge to assist the medicinal power.
[Annotation] In all cases where wind-cold is on the exterior, with a floating-weak pulse and spontaneous sweating, these belong to Exterior Deficiency (Biao Xu) syndrome, which should primarily be treated with Gui Zhi Tang. It is named Gui Zhi Tang because Gui Zhi serves as the Sovereign (Jun) herb. Gui Zhi is acrid and warm; acridity can disperse pathogens, and warmth follows Yang to support Wei Qi (Defensive Qi). Shao Yao is sour and cold; sourness can astringe sweat, and cold enters Yin to nourish Ying Qi (Nutritive Qi). With Gui Zhi as Sovereign accompanying Shao Yao, there is an intention to astringe sweat within dispersion; with Shao Yao as Minister assisting Gui Zhi, there is a pathway for slight sweating within the consolidation of the exterior. The acridity of Sheng Jiang assists Gui Zhi in resolving the muscle layer and exterior. Furthermore, the sweetness of Da Zao assists Shao Yao in harmonizing Ying Qi within. Gan Cao is sweet and neutral, possessing the ability to stabilize the interior and repel the exterior; it is used to harmonize the Middle Qi, thereby harmonizing the exterior and interior, and harmonizing the various herbs. Due to the mutual dependence of Gui Zhi and Shao Yao, and the synergy of Sheng Jiang and Da Zao, relying on Gan Cao's harmonizing function to coordinate the Yang exterior and Yin interior, Qi Wei and Blood Ying, they proceed together without contradiction. This is the integration of rigidity and softness to achieve harmony. The essence lies in drinking hot thin porridge shortly after administration to assist the medicinal power. Since grain qi fills the interior, it not only facilitates the brewing of sweat but also prevents any pathogen that has entered from lingering slightly, and prevents future pathogens from re-entering. Another subtlety lies in taking the medicine warm for about an hour, resulting in a slight apparent sweating; this teaches the method of inducing slight sweating. One must not allow profuse sweating like flowing water, as the disease will certainly not be removed; this prohibits excessive sweating. This formula is the crown among Zhang Zhongjing's formulas, being the primary formula for resolving the muscle layer, inducing sweating, and harmonizing Ying and Wei. For all cases of Wind Strike (Zhong Feng) or Cold Damage (Shang Han) with a floating-weak pulse, spontaneous sweating, and unresolved exterior syndrome, this formula may serve as the principal treatment. In other instances, if one or two symptoms are present, it is indicated; it is not necessary for all symptoms to be present. Therefore, sweating formulas such as Ma Huang Tang (Ephedra Decoction), Ge Gen Tang (Kudzu Decoction), and Qing Long Tang (Green Dragon Decoction) all incorporate its components. If there is no sweating, it is a Ma Huang Tang syndrome; if the pulse is floating-tight, it is a Ma Huang Tang pulse, so Gui Zhi Tang should certainly not be given. However, at the initial stage with no sweating, Ma Huang Tang should be used for sweating. If after sweating resolves, restlessness recurs with a floating-numerous pulse, or after purgation the pulse remains floating with Qi rushing upward, or after purgation diarrhea stops but body pain persists, this formula is used to resolve the exterior. Why? Because although the exterior is not yet resolved, the couli (pores) have become loose, the pathogen is no longer in the skin and hair but in the muscles, and after sweating and purging, body fluids are damaged. Thus, although the pulse and symptoms resemble those of Ma Huang Tang, the primary treatment should belong to Gui Zhi Tang. Unskilled physicians erroneously claim that Gui Zhi Tang treats only Wind Strike and not Cold Damage, causing people to doubt and not use it; they also claim it only disperses the muscle layer and does not treat other diseases. They do not know that by doubling Shao Yao and adding Ren Shen to Sheng Jiang in this decoction, it becomes Gui Zhi Xin Jia Tang (Newly Added Cinnamon Twig Decoction), used to treat Ying-Exterior deficiency cold causing limb pain; by doubling Shao Yao and adding Yi Tang (Maltose), it becomes Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), used to treat Interior deficiency causing palpitations and acute abdominal pain; by further adding Huang Qi, it becomes Huang Qi Jian Zhong Tang (Astragalus Construct the Middle Decoction), used to treat deficiency consumptive disease, deficient heat, spontaneous sweating, and night sweating. From this, we know that Zhang Zhongjing's formulas can treat hundreds of diseases.