桂枝(去皮)四两 附子(炮,去皮,破八片)三枚 甘草(炙)二两 生姜(切)
三两大枣(擘)十二枚
右五味,以水六升,煮取二升,去滓,分温三服。
白术二两 附子(炮,去皮)一枚半 甘草(炙)一两 生姜(切)一两半 大枣(
擘)六枚
右五味,以水三升,煮取一升,去滓,分温三服。一服觉身痹,半日许再服,三服都
尽,其人如冒状勿怪,即是术附并走皮中,逐水气未得除故耳!
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风湿相搏,骨节疼烦,掣痛不得屈伸,近之则痛剧,汗出短气,小便不利,恶风不欲
去衣,或身微肿者,甘草附子汤主之。
【注】
风湿相搏,身体烦疼重□,不能转侧者,湿胜风也。今掣痛不可屈伸,风胜湿也。掣
痛不可屈伸,近之则痛剧,汗出、短气、恶风不欲去衣,皆风邪壅盛也。小便不利,
湿内蓄也。身微肿者,湿外搏也。以甘草附子汤微汗之,祛风为主,除湿次之也。此
上二条,皆详风湿之义,以明风湿之治也。
甘草(炙)二两 附子(炮,去皮)二枚 白术二两 桂枝(去皮)四两
右四味,以水六升,煮取三升,去滓,温服一升,日三服。初服得微汗,则解能食,
汗出复烦者,服五合,恐一升多者,宜服六、七合为妙。
【方解】
甘草附子汤,即桂枝附子汤去姜、枣加白术。去姜、枣者,畏过散也。加白术者,燥
中湿也。日三服,初服一升,不得汗,则仍服一升,若得微汗则解。解则能食,解已
彻也,可止再服。若汗出而复烦者,是解未彻,仍当服也,但不可服一升,恐已经汗
出而过汗也,服五合可也。如不解,再服六、七合为妙。似此服法,总是示人不可尽
剂之意,学者宜详求之。
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太阳中热者,暍是也,汗出恶寒,身热而渴,白虎加人参汤主之。
【注】
中暑热病,亦由太阳而入,故曰太阳中热者,暍是也。汗出恶寒,身热而渴,颇似太
阳温热之病。但温热无恶寒,以热从里生,故虽汗出而不恶寒也。中暍暑邪,由表而
入,故汗出恶寒也。究之于脉,温热之浮,浮而实;中暍之浮,浮而虚,以暑热伤气
也。究之于渴,温热之渴,初病不过欲饮;中暍之渴,初病即大引饮也。温热则传经
,变病不一,中暍则不传,不愈即死也。虽同为太阳经中之病,而虚实施治,自有不
同。用白虎加人参汤主之者,盖以益气为主,清暑热次之也。
【集注】
李□曰:热伤气,气泄则汗出,气虚则恶寒,热蒸肌腠则身热,热伤津液则作渴,此
恶寒身热,与伤寒相类。然所异者,伤寒初起无汗不渴,中暍初起即汗出而渴也。
桂枝(去掉外皮)四两 附子(炮制,去掉外皮,破成八片)三枚 甘草(炙烤)二两 生姜(切片)三两 大枣(掰开)十二枚
以上五味药,用水六升,煮取二升药液,去掉药渣,分三次温服。
白术二两 附子(炮制,去掉外皮)一枚半 甘草(炙烤)一两 生姜(切片)一两半 大枣(掰开)六枚
以上五味药,用水三升,煮取一升药液,去掉药渣,分三次温服。第一次服用后感觉身体麻木,大约半天后再服第二次,三次都服完后,病人出现像头昏目眩一样的症状不要奇怪,这是因为白术和附子共同作用于皮下,驱逐水气尚未排除的缘故!
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风湿邪气相互搏结,骨节疼痛烦扰,牵掣样疼痛导致不能屈伸,靠近患处则疼痛加剧,出汗、呼吸短促、怕风不想脱去衣服,或者身体轻微浮肿的,用甘草附子汤主治。
【注】
风湿邪气相互搏结,身体烦痛沉重,不能转侧的,是湿邪胜过风邪。现在出现牵掣样疼痛不可屈伸,是风邪胜过湿邪。牵掣样疼痛不可屈伸,靠近患处则疼痛加剧,出汗、呼吸短促、怕风不想脱去衣服,都是风邪壅盛的表现。小便不利,是湿邪内蓄积。身体轻微浮肿,是湿邪外搏结于肌表。用甘草附子汤使其微微出汗,以祛风为主,除湿为辅。这两条内容,都详细阐述了风湿的含义,以明确风湿病的治疗方法。
甘草(炙烤)二两 附子(炮制,去掉外皮)二枚 白术二两 桂枝(去掉外皮)四两
以上四味药,用水六升,煮取三升药液,去掉药渣,温服一升,每天服三次。初次服用后得到微微出汗,病症即可解除,能够进食;如果出汗后又感到烦躁,服用五合(约0.5升),恐怕一升剂量过多的话,适宜服用六、七合为妙。
【方解】
甘草附子汤,就是桂枝附子汤去掉生姜、大枣加上白术。去掉生姜、大枣的原因,是担心发散太过。加入白术的原因,是为了燥化中焦的湿气。每天服三次,初次服用一升,如果没有出汗,就继续服用一升;如果得到微微出汗则病愈。病愈则能进食,说明病邪已彻底清除,可以停止再服。如果出汗后又感到烦躁,这是病邪未彻底清除,仍然应当服药,但不可服用一升,恐怕已经出汗而致过汗,服用五合即可。如果病不解,再服用六、七合为妙。这样的服药方法,总是向人们展示不可将药剂全部服完的意思,学者们应该详细探究它。
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太阳经感受暑热邪气的病证,就是暍病(中暑),表现为出汗、怕冷、身体发热且口渴,用白虎加人参汤主治。
【注】
中暑热病,也是由太阳经传入,所以称为太阳中热者,就是暍病。出汗、怕冷、身体发热且口渴,颇似太阳温热病。但是温热病没有怕冷症状,因为热邪从体内产生,所以虽然出汗但不怕冷。中暍受暑邪侵袭,是由体表而入,所以会出汗且怕冷。究之于脉象,温热病的脉浮,是浮而有力(实);中暍病的脉浮,是浮而无力(虚),因为暑热耗伤正气。究之于口渴,温热病的口渴,初起不过想喝水;中暍病的口渴,初起即大量饮水。温热病则会传变经络,变证不一;中暍病则不传变,不痊愈就会死亡。虽然同为太阳经中的病证,但虚实不同,治疗方法自然有差异。使用白虎加人参汤主治,大概是以益气为主,清暑热为辅。
【集注】
李□说:热邪耗伤正气,气泄则出汗,气虚则怕冷,热邪蒸腾肌肉腠理则身体发热,热邪耗伤津液则产生口渴,这种怕冷、身体发热的症状,与伤寒相似。然而不同的是,伤寒初起无汗且不渴,中暍初起即出汗且口渴。
Guizhi (Cinnamon Twig,去皮) four liang, Fuzi (Prepared Aconite Root,炮,去皮,破八片) three pieces, Gancao (Prepared Licorice Root,炙) two liang, Shengjiang (Fresh Ginger,切) three liang, Dazao (Jujube Fruit,擘) twelve pieces.
The above five herbs are boiled in six sheng of water until two sheng remain. The dregs are removed, and the liquid is divided into three doses to be taken warm.
Baizhu (Atractylodis Rhizoma,白术) two liang, Fuzi (Prepared Aconite Root,炮,去皮) one and a half pieces, Gancao (Prepared Licorice Root,炙) one liang, Shengjiang (Fresh Ginger,切) one and a half liang, Dazao (Jujube Fruit,擘) six pieces.
The above five herbs are boiled in three sheng of water until one sheng remains. The dregs are removed, and the liquid is divided into three doses to be taken warm. If after the first dose the patient feels numbness in the body, take the second dose after about half a day. After all three doses are consumed, if the patient experiences a sensation resembling vertigo or dizziness, do not be alarmed; this occurs because Baizhu and Fuzi act together on the skin level to expel pathogenic water-dampness that has not yet been fully eliminated.
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When Wind-Dampness (Fengshi, 风湿) pathogens intermingle and obstruct, causing severe pain and distress in the bone joints, with pulling pain preventing flexion and extension, and pain intensifying upon touch, accompanied by sweating, shortness of breath, aversion to wind with reluctance to remove clothing, or slight edema of the body, Ganyao Fuzi Tang (Licorice and Prepared Aconite Decoction) is indicated.
[Annotation]
When Wind-Dampness intermingles causing bodily pain, heaviness, and inability to turn the body, it indicates Dampness prevailing over Wind. Currently, the pulling pain preventing flexion and extension indicates Wind prevailing over Dampness. The pulling pain preventing flexion and extension, pain intensifying upon touch, sweating, shortness of breath, and aversion to wind with reluctance to remove clothing, all indicate excessive accumulation of Wind pathogen. Inadequate urination indicates internal accumulation of Dampness. Slight edema indicates external obstruction by Dampness. Ganyao Fuzi Tang should be used to induce mild sweating; the treatment prioritizes dispelling Wind and secondarily eliminates Dampness. These two preceding sections detail the nature of Wind-Dampness to clarify its therapeutic approach.
Gancao (Prepared Licorice Root,炙) two liang, Fuzi (Prepared Aconite Root,炮,去皮) two pieces, Baizhu (Atractylodis Rhizoma,白术) two liang, Guizhi (Cinnamon Twig,去皮) four liang.
The above four herbs are boiled in six sheng of water until three sheng remain. The dregs are removed, and one sheng is taken warm, three times daily. Upon the initial dose, if mild sweating occurs, the condition resolves, and appetite returns. If sweating occurs followed by restlessness, administer five he (approx. 0.5 sheng). If one sheng is considered too much, administering six or seven he is optimal.
[Formula Analysis]
Ganyao Fuzi Tang is derived from Guizhi Fuzi Tang by removing Shengjiang (Fresh Ginger) and Dazao (Jujube Fruit) and adding Baizhu (Atractylodis Rhizoma). Shengjiang and Dazao are removed to prevent excessive dispersing action. Baizhu is added to dry dampness in the middle jiao. Administered three times daily: start with one sheng. If no sweat occurs, continue with another sheng. If mild sweating occurs, the condition resolves. Resolution allows for eating, indicating complete elimination of pathogens, at which point further administration may cease. If sweating is followed by restlessness, it indicates incomplete resolution, requiring continued medication, but avoid the full one-sheng dose to prevent excessive sweating; five he is sufficient. If unresolved, administering six or seven he is optimal. This dosing regimen demonstrates the principle of not necessarily consuming the entire prescription; students should study this carefully.
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Taiyang Heatstroke (Taiyang Zhongre, 太阳中热), also known as Ye (Heatstroke/Summerheat, 暍), presents with sweating, aversion to cold, fever, and thirst. Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated.
[Annotation]
Heatstroke is transmitted via the Taiyang channel, hence termed "Taiyang Heatstroke," i.e., Ye. Symptoms include sweating, aversion to cold, fever, and thirst, resembling Taiyang Warmth disease. However, Warmth disease lacks aversion to cold because heat arises internally; thus, despite sweating, there is no aversion to cold. Heatstroke involves Summerheat entering from the exterior, causing sweating and aversion to cold. Regarding pulse: Warmth disease presents with a floating and forceful (Shi, 实) pulse; Heatstroke presents with a floating and deficient (Xu, 虚) pulse due to Summerheat damaging Qi. Regarding thirst: Warmth disease causes mild desire to drink initially; Heatstroke causes intense craving for water initially. Warmth disease transmits through meridians with varied complications; Heatstroke does not transmit, and if unhealed, leads to death. Although both are Taiyang channel diseases, their deficiency/excess patterns dictate different treatments. Baihu Jia Renshen Tang is used primarily to tonify Qi and secondarily to clear Summerheat.
[Collected Annotations]
Li [Name Redacted] stated: Heat damages Qi; Qi leakage causes sweating; Qi deficiency causes aversion to cold; Heat steaming muscle and pores causes fever; Heat damaging fluids causes thirst. These symptoms of aversion to cold and fever resemble Cold Damage (Shanghan, 伤寒). However, unlike Cold Damage which initially presents without sweat and thirst, Heatstroke initially presents with sweating and thirst.