麻黄(去节汤泡)半两 甘草(炙)一两 薏苡仁半两 杏仁(去皮、尖,炒)十枚
右锉麻豆大,每服四钱,水盏半,煮八分,去滓,温服,有微汗,避风。
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风湿,脉浮,身重,汗出恶风者,防己黄耆汤主之。
【注】
脉浮,风也,身重,湿也,寒湿则脉沉,风湿则脉浮。若浮而汗不出恶风者,为实邪
,可与麻黄杏仁薏苡甘草汤汗之。浮而汗出恶风者,为虚邪,故以防已、白术以去湿
,黄耆、甘草以固表,生姜、大枣以和荣卫也。
【集注】
赵良曰:此证风湿皆从表受之,其病在外,故脉浮汗出。凡身重有肌肉痿而重者,有
骨痿而重者,此之身重,乃风湿在皮毛之表,故不作疼。虚其卫气,而湿□为身重,
故以黄耆实卫,甘草佐之,防己去湿,白术佐之。然则风湿二邪,独无散风之药何耶
?盖汗多,知其风已不留,以表虚而风出入乎其间,因之恶风尔。惟实其卫,正气壮
则风自退,此不治而治者也。
尤怡曰:风湿在表,法当从汗而解,乃汗不得发而自出,表尚未解而已虚,汗解之法
,不可守矣。故不用麻黄,出之皮毛之表,而用防己,驱之肌肤之里,服后如虫行皮
中及腰下如冰,皆湿下行之征也。然非耆、术、甘草,焉能使卫阳复振,而驱湿下行
哉。
麻黄(去掉节,用汤浸泡)半两 甘草(蜜炙)一两 薏苡仁半两 杏仁(去皮、尖,炒制)十枚
以上药材切碎如麻豆大小,每次服用四钱,用水一盏半,煮至八分满,滤去药渣,温服,以微微出汗为宜,注意避风。
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风湿病,脉象浮,身体沉重,汗出且怕风的,由防己黄芪汤主治。
【注】
脉浮,是风邪的表现;身体沉重,是湿邪的表现。寒湿证则脉象沉,风湿证则脉象浮。如果脉浮但无汗且怕风的,属于实证邪气,可以用麻黄杏仁薏苡甘草汤发汗治疗。如果脉浮且有汗且怕风的,属于虚证邪气,所以用防己、白术来祛湿,黄芪、甘草来固护体表,生姜、大枣来调和营卫。
【集注】
赵良说:此证的风湿都是从体表受邪的,病位在外部,所以脉浮且汗出。凡是身体沉重,有因肌肉痿废而沉重的,有因骨骼痿废而沉重的,这里的身体沉重,是因为风湿在皮毛之表,所以不疼痛。卫气虚弱,湿气滞留导致身体沉重,所以用黄芪充实卫气,甘草辅助它,防己祛除湿气,白术辅助它。那么风湿二邪,难道没有疏散风邪的药物吗?大概因为汗多,知道风邪已经不再停留,因为表虚而风邪出入其间,因此怕风。只有充实卫气,正气壮盛则风邪自然退去,这是不治风而风自除的方法。
尤怡说:风湿在体表,治法应当通过发汗来解除,但是汗不能发出反而自行流出,表证尚未解除而正气已虚,发汗解表的方法就不能再守用了。所以不用麻黄将邪气从皮毛之表排出,而用防己将邪气从肌肤之里驱除,服药后感觉像虫子在皮中爬行以及腰部以下像冰一样,都是湿气向下排出的征象。然而如果没有黄芪、白术、甘草,怎么能使卫阳重新振奋,从而驱赶湿气下行呢。
Ephedrae Herba (Mahuang, 麻黄) (remove nodes, soak in decoction) half tael; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) (honey-fried) one tael; Coicis Semen (Yiyiren, 薏苡仁) half tael; Armeniacae Semen Amarum (Xingren, 杏仁) (remove skin and tip, stir-fry) ten seeds.
The above herbs are chopped to the size of hemp seeds. For each dose of four qian, add one and a half cups of water, boil until reduced to eight-tenths, remove the dregs, and take warm. Aim for a slight sweat and avoid wind.
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For Wind-Dampness presenting with a floating pulse, heaviness of the body, sweating, and aversion to wind, Fangji Huangqi Tang (Acanthopanacis Senticosi and Astragali Decoction) is the primary treatment.
[Annotation]
A floating pulse indicates Wind; heaviness of the body indicates Dampness. In Cold-Dampness, the pulse is deep; in Wind-Dampness, the pulse is floating. If the pulse is floating but there is no sweating and there is aversion to wind, it is an Excess pathogen, and Mahuang Xingren Yiyi Gancao Tang (Ephedra, Apricot Seed, Coix Seed, and Licorice Decoction) can be used to induce sweating. If the pulse is floating with sweating and aversion to wind, it is a Deficiency pathogen; therefore, Fangji (Acanthopanacis Senticosi Cortex) and Baizhu (Atractylodis Macrocephalae Rhizome) are used to eliminate Dampness, Huangqi (Astragali Radix) and Gancao (Licorice Root) to secure the exterior, and Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) to harmonize Ying (Nutrient) and Wei (Defensive) Qi.
[Collected Notes]
Zhao Liang stated: This condition involves Wind and Dampness invading from the exterior, so the disease is external, hence the floating pulse and sweating. Generally, heaviness of the body can result from muscle wasting or bone wasting. The heaviness here is due to Wind-Dampness at the level of the skin and hair, so it does not cause pain. Because Wei Qi (Defensive Qi) is deficient and Dampness stagnates causing heaviness, Huangqi (Astragali Radix) is used to fortify Wei Qi, assisted by Gancao (Licorice Root); Fangji (Acanthopanacis Senticosi Cortex) eliminates Dampness, assisted by Baizhu (Atractylodis Macrocephalae Rhizome). Then, why are there no herbs to disperse Wind among the treatments for Wind-Dampness? It is because profuse sweating indicates that Wind has already dissipated; due to exterior deficiency, Wind enters and exits between the layers, causing aversion to wind. By fortifying Wei Qi, when Zheng Qi (Upright Qi) becomes strong, Wind retreats naturally. This is treating without directly treating the Wind.
You Yi stated: When Wind-Dampness is on the exterior, the method should be to resolve it through sweating. However, if sweat occurs spontaneously rather than being induced, and the exterior is not yet resolved while the interior is already deficient, the method of resolving via sweating cannot be strictly adhered to. Therefore, Mahuang (Ephedrae Herba) is not used to expel pathogens from the skin and hair, but Fangji (Acanthopanacis Senticosi Cortex) is used to drive them out from within the muscles and skin. After taking the medicine, sensations such as insects crawling under the skin or ice-cold feelings below the waist are signs of Dampness descending. However, without Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizome), and Gancao (Licorice Root), how could Wei Yang (Defensive Yang) be revitalized to drive the Dampness downward?