即桂枝汤内加黄芩,桂枝汤方见下利中。
@@@
产后中风,发热面正赤,喘而头痛,竹叶汤主之。
【按】
「产后中风」之下,当有「病痉者」之三字,始与方合。若无此三字,则人参、附子
施之于中风发热可乎?而又以竹叶命名者,何所谓也?且方内有颈项强用大附子之文
,本篇有证无方,则可知必有脱简。
【注】
产后汗多,表虚而中风邪病痉者,主之竹叶汤,发散太阳、阳明两经风邪。用竹叶为
君者,以发热,面正赤,有热也;用人参为臣者,以产后而喘,不足也;颈项强急,
风邪之甚,故佐附子;呕者气逆,故加半夏也。
【集注】
程林曰:产后血虚多汗出,喜中风,故令病痉,今证中未至背反张,而发热面赤头痛
,亦风痉之渐也。
竹叶一把 葛根三两 防风一两 桔梗 桂枝 人参 甘草各一两 附子(炮)一枚
大枣十五枚 生姜三两
右十味,以水一斗,煮取二升半,分温三服,温覆使汗出。颈项强,用大附子一枚,
破之如豆大,前药扬去沫。呕者,加大半夏半升洗。
@@@
妇人乳中虚,烦乱,呕逆,安中益气,竹皮大丸主之。
【按】
此条文义,证药未详。
生竹茹二分 石膏二分 桂枝一分 甘草七分 白薇一分
右五味,末之,枣肉和丸,弹子大,以饮服一丸,日二夜二服。有热者,倍白薇。喘
者,加柏实一分。
【集解】
『济阴纲目』云:中虚不可用石膏,烦乱不可用桂枝,此方以甘草七分,配众药六分
,又以枣肉为丸,仍以一丸饮下,可想其立方之微,用药之难,审虚实之不易也。仍
饮服者,尤虑夫虚虚之祸耳!用是方者,亦当深省。
@@@
产后下利及虚极,白头翁加甘草阿胶汤主之。
【按】
此条文义,证药不合,不释。
在桂枝汤中加入黄芩,即为阳旦汤。桂枝汤的方剂组成见下文“下利”章节中。
@@@
产后感受风邪,出现发热、面色正红、气喘且头痛的症状,应使用竹叶汤主治。
【按语】
在“产后中风”之后,应当有“病痉者”这三个字,才能与方剂相符合。如果没有这三个字,那么人参、附子用于中风发热证候合适吗?另外,以“竹叶”命名该方的原因又是什么呢?而且方中有“颈项强急用大附子”的文字说明,而本篇只有证候描述没有对应方剂,由此可知必然存在脱简(古籍文字脱落)的情况。
【注解】
产后汗出过多,导致表虚并感受风邪而引发痉病者,主治以竹叶汤,旨在发散太阳经和阳明经的风邪。使用竹叶作为君药,是因为患者发热、面色正红,表明体内有热;使用人参作为臣药,是因为产后气虚而致气喘,属于正气不足;颈项强急是风邪严重的表现,所以佐以附子;若有呕吐症状,是因气机上逆,所以加入半夏。
【集注】
程林说:产后血虚且多汗,容易感受风邪,因此导致痉病。现在的证候中尚未发展到角弓反张的程度,但发热、面赤、头痛,也是风痉的初期征兆。
竹叶一把 葛根三两 防风一两 桔梗 桂枝 人参 甘草各一两 附子(炮制)一枚 大枣十五枚 生姜三两
以上十味药,用水一斗,煎煮至二升半,分三次温服,服药后覆盖衣被使身体微微出汗。若颈项强急,使用大附子一枚,破碎成豆粒大小,先煎煮前几味药并扬去浮沫。若有呕吐症状,加大半夏半升并洗净。
@@@
妇女在哺乳期气血亏虚,出现心烦意乱、恶心呕吐等症状,宜采用安中益气的方法,竹皮大丸主治。
【按语】
此条文的文义及证候药物对应关系尚不明确。
以上五味药,研成细末,用枣肉调和制成丸剂,大小如弹丸,每次服用一丸,以温水送服,每日早晚各两次。若有热象,加倍使用白薇。若有气喘症状,增加柏实一分。
【集解】
《济阴纲目》记载:中焦虚弱不可使用石膏,心烦意乱不可使用桂枝。此方中甘草用量为七分,配合其他六味药的总量仅为六分,又以枣肉为丸,且仅以一丸饮服,可以想见其组方之精妙、用药之艰难,以及辨别虚实之不易。仍然采用饮服丸剂的方式,更是担心犯下“虚虚”(使虚者更虚)的错误!使用此方的人,也应当深思熟虑。
@@@
【按语】
此条文的文义、证候与药物之间不合逻辑,不予解释。
Yangdan Decoction (Cinnamon Twig and Scutellaria Decoction) is formed by adding Huangqin (Scutellariae Radix, 黄芩) to Guizhi Tang (Cinnamon Twig Decoction). The formula of Guizhi Tang can be found in the section on "Diarrhea" below.
@@@
For postpartum wind-stroke presenting with fever, a flushed red face, wheezing, and headache, Zhuye Tang (Bamboo Leaf Decoction) is the primary treatment.
[Commentary]
The phrase "bing jing zhe" (suffering from spasm/tetanus) should follow "chan hou zhong feng" (postpartum wind-stroke) for the prescription to match the syndrome. Without these three characters, would it be appropriate to use Renshen (Ginseng Radix et Rhizoma, 人参) and Fuzi (Aconiti Lateralis Radix Praeparata, 附子) for wind-stroke accompanied by fever? Furthermore, what is the rationale behind naming the decoction "Zhuye" (Bamboo Leaf)? Additionally, the text mentions using a large Fuzi for neck stiffness, yet this chapter presents symptoms without a corresponding formula, indicating that there must be missing text (tuojian, 脱简).
[Annotation]
When excessive sweating after childbirth leads to exterior deficiency and wind-stroke resulting in spasm, Zhuye Tang is indicated to disperse wind-pathogens from the Taiyang (Solar) and Yangming (Yang Brightness) meridians. Zhuye (Phyllostachys Bambusoides Leaf, 竹叶) is used as the Sovereign herb because fever and a flushed red face indicate heat. Renshen is used as the Minister herb because postpartum wheezing indicates deficiency. Neck stiffness and tension indicate severe wind-pathogen, so Fuzi is added as an Assistant. Vomiting results from rebellious Qi, so Banxia (Pinelliae Rhizoma, 半夏) is added.
[Collected Notes]
Cheng Lin stated: Postpartum blood deficiency and excessive sweating predispose one to wind-stroke, leading to spasm. Although the current symptoms have not progressed to opisthotonos (back arching), fever, facial flushing, and headache are early signs of wind-spasm.
Ingredients: Zhuye (Bamboo Leaf) one handful, Gegen (Puerariae Lobatae Radix, 葛根) three liang, Fangfeng (Saposhnikoviae Radix, 防风) one liang, Jiegeng (Platycodonis Radix, 桔梗), Guizhi (Cinnamomi Ramulus, 桂枝), Renshen, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) each one liang, Fuzi (prepared, 附子) one piece, Dazao (Ziziphus Jujuba Fruit, 大枣) fifteen pieces, Shengjiang (Zingiberis Rhizoma Recens, 生姜) three liang.
These ten ingredients are boiled in ten dou of water until two and a half sheng remain. Divide into three warm doses. After taking the medicine, cover with blankets to induce slight sweating. If neck stiffness is present, use one large Fuzi, broken into bean-sized pieces. Boil the previous medicines first and skim off the foam. If vomiting is present, add half a sheng of washed Banxia.
@@@
For women experiencing deficiency during lactation, manifesting as restlessness, irritability, nausea, and vomiting, the principle is to calm the middle and tonify Qi. Zhupi Dawan (Bamboo Peel Great Pill) is the primary treatment.
[Commentary]
The meaning of this clause, along with the correspondence between symptoms and herbs, is unclear.
Ingredients: Sheng Zhuru (Bambusa Textilis Internodium, 生竹茹) two fen, Shigao (Gypsum Fibrosum, 石膏) two fen, Guizhi one fen, Gancao seven fen, Baiwei (Anemarrhenae Rhizoma, 白薇) one fen.
Grind these five herbs into powder, mix with jujube paste to form pills the size of a bullet. Take one pill with water, twice daily and twice nightly. If heat signs are present, double the amount of Baiwei. If wheezing is present, add Baishi (Platycladi Semen, 柏实) one fen.
[Collected Explanations]
Ji Yin Gang Mu states: One cannot use Shigao for middle-jiao deficiency, nor Guizhi for restlessness. In this formula, Gancao is used in the proportion of seven parts, while the other six herbs total only six parts. Moreover, forming pills with jujube paste and administering only one pill at a time demonstrates the subtlety of the formulation and the difficulty of herb selection, highlighting the challenge of distinguishing deficiency and excess. The method of administering pills with water is particularly cautious to avoid the disaster of "deficiency making deficiency worse" (xu xu, 虚虚). Those using this formula should reflect deeply.
@@@
For postpartum diarrhea accompanied by extreme exhaustion, Baitouweng Jia Gancao Ejiao Tang (Baitouweng Decoction with Added Licorice and Donkey-Hide Gelatin) is the primary treatment.
[Commentary]
The logic between the text, symptoms, and herbs in this clause does not align; therefore, no explanation is provided.