茯苓(去皮) 芍药(炒) 生姜(各三两) 白术(二两,炒) 附子(一枚,制)
伤寒发汗过多,其人心下悸,头眩身 ,振振欲擗地者,此方主之。
汗多而心下悸,此心亡津液,肾气欲上而凌心也;头眩身 ,振振欲擗地者,此汗多亡
阳,虚邪内动也。真武,北方之神,司水火者也。今肾气凌心,虚邪内动,有水火奔腾之象,
故名此汤以主之。茯苓、白术,补土利水之物也,可以伐肾而疗心悸;生姜、附子,益卫回
阳之物也,可以壮火而祛虚邪;芍药之酸,收阴气也,可以和荣而生津液。
人参(去芦) 白术(炒) 干姜(炮) 甘草(炮)
太阴自利不渴,寒多而呕,腹痛,鸭溏,霍乱,此太阴有真寒也,本方主之。
太阴者,脾也。自利渴者为热,不渴者为寒。脾喜温而恶寒,寒多故令呕;寒者,肃杀
之气,故令腹痛;鸭溏者,后便如鸭之溏,亦是虚寒所致;霍乱者,邪在中焦,令人上吐下
泻,手足挥霍而目了乱也。霍乱有阴阳二证,此则由寒而致故耳。病因于寒,故用干姜之温;
邪之所凑,其气必虚,故用人参、白术、甘草之补。
吴茱萸(一升,泡过) 人参(三两,去芦) 生姜(六两) 大枣(十二枚)
伤寒食谷欲呕者,属阳明也,此汤主之;得汤反剧者,属上焦,此非所宜也。少阴犯真
寒,吐利,手足厥冷,烦躁欲死者,此汤主之。厥阴干呕吐沫,头痛者,亦此汤主之。
阳明,胃也。为仓廪之官,主纳水谷,有寒,故令食谷欲呕,吴茱萸汤温之宜矣。若得
汤反剧,便非胃中寒,乃是上焦火,宜用凉剂,而吴茱萸非宜矣。少阴犯真寒者,足少阴肾
脏中寒,与传来阳证不同也。肾间阴寒盛,则上格乎阳而为吐。经曰∶肾主二便。故肾寒则
大便不禁而为利,手足得阳而温,受气于内者也;内有阴寒,故令手足厥逆而冷。烦躁者,
阴盛格阳,阳气内争,故令阳烦而阴躁,斯其为证亦危矣,故欲死。厥阴者,肝也,寒气内
格,故干呕吐沫;厥阴与督脉会于巅,故头痛。吴茱萸辛热而味浓,经曰味为阴,味浓为阴
中之阴,故走下焦而温少阴、厥阴;佐以生姜,散其寒也;佐以人参、大枣,补中虚也。虽
然,张机氏立是方,以治少阴、厥阴之寒也固矣,不又曰少阴病吐利烦躁四逆者死乎?厥冷
之与四逆,无相违也。临病之工,乌可不慎!
茯苓(去皮) 芍药(炒) 生姜(各三两) 白术(二两,炒) 附子(一枚,制)
伤寒病发汗过多,导致患者心下部悸动不安,头晕目眩,身体颤抖,摇摇欲倒似要扑倒在地,此证由真武汤主治。
汗出过多而致心下悸动,这是因为心阴津液耗亡,肾气上逆凌犯心脏;头晕目眩、身体颤抖、摇摇欲倒,这是因为汗多导致阳气亡失,虚邪在体内扰动。真武是北方之神,掌管水火。如今肾气凌犯心脏,虚邪在内扰动,呈现出水火奔腾之象,因此将此汤命名为真武汤以主治此证。茯苓、白术,是补益脾土、利水渗湿的药物,可以制约肾水并治疗心悸;生姜、附子,是护卫卫阳、回阳救逆的药物,可以壮火祛散虚邪;芍药的酸味,能收敛阴气,可以调和营血并滋生津液。
太阴病自发性腹泻且不口渴,寒邪较重且伴有呕吐,腹痛,大便如鸭粪稀溏,霍乱,这是太阴脏有真寒证,由理中汤主治。
太阴经对应脾脏。自发性腹泻且口渴的属于热证,不口渴的属于寒证。脾脏喜欢温暖而厌恶寒冷,寒邪重故导致呕吐;寒邪属于肃杀之气,故导致腹痛;鸭溏是指排便时粪便像鸭子排泄物那样稀薄,这也是由虚寒所致;霍乱是指邪气在中焦,使人上吐下泻,手足挥霍无度且视线模糊混乱。霍乱分为阴证和阳证两种,此处是由寒邪引起的。病因在于寒邪,所以使用干姜的温性;邪气聚集之处,正气必然虚弱,所以使用人参、白术、甘草来补益正气。
吴茱萸(一升,浸泡过) 人参(三两,去芦头) 生姜(六两) 大枣(十二枚)
伤寒病中,进食后想要呕吐的,属于阳明病,此汤主治;如果服用此汤后病情反而加重,则属于上焦病变,此方就不适宜了。少阴病侵犯真寒,出现呕吐腹泻,手足冰冷,烦躁痛苦欲死,此汤主治。厥阴病出现干呕、吐涎沫、头痛的,也以此汤主治。
阳明经对应胃腑。胃作为仓廪之官,主管接纳水谷,如果有寒邪,就会导致进食后想呕吐,用吴茱萸汤温中散寒是适宜的。如果服药后病情反而加重,那就不是胃中寒证,而是上焦有火,应当使用凉剂,而吴茱萸汤就不适宜了。少阴病侵犯真寒,是指足少阴肾脏中有寒邪,这与传变而来的阳证不同。肾间阴寒盛极,就会向上格拒阳气而导致呕吐。医经说:肾主管大小便。所以肾寒会导致大便失禁而腹泻,手足得到阳气才能温暖,因为阳气来源于内部;内部有阴寒,所以导致手足厥冷。烦躁是因为阴寒盛极格拒阳气,阳气在内抗争,所以表现为阳烦阴躁,这种证候非常危险,所以患者感觉痛苦欲死。厥阴经对应肝脏,寒气在内部格拒,所以导致干呕吐涎沫;厥阴经与督脉会合于头顶,所以导致头痛。吴茱萸辛热且气味浓厚,医经说味道属阴,气味浓厚属于阴中之阴,所以能走窜下焦而温补少阴、厥阴;辅以生姜,以散除寒邪;辅佐人参、大枣,以补益中焦虚损。虽然如此,张机(张仲景)创立此方,原本是为了治疗少阴、厥阴的寒证,但他又说过“少阴病,呕吐腹泻,烦躁,四肢逆冷者死”吗?厥冷与四逆并没有矛盾。临证施治的医生,怎能不谨慎呢!
Poria (Cortex removed) Paeoniae Radix Alba (Stir-fried) Zingiberis Rhizoma Recens (3 liang each) Atractylodis Macrocephalae Rhizoma (2 liang, stir-fried) Aconiti Lateralis Radix Praeparata (1 piece, processed)
In Cold Damage (Shanghan), excessive sweating leads to palpitations in the epigastrium, dizziness, tremors of the body, and a sensation of tottering as if about to fall to the ground. This formula is indicated for such conditions.
Excessive sweating causing palpitations in the epigastrium indicates the depletion of Heart fluids and the upward rebellion of Kidney Qi assaulting the Heart; dizziness, body tremors, and the sensation of tottering indicate the loss of Yang due to excessive sweating and internal movement of deficient pathogenic factors. Zhenwu (True Warrior) is the deity of the North, governing Water and Fire. Now that Kidney Qi assaults the Heart and deficient pathogens move internally, there is an image of surging Water and Fire; hence this decoction is named Zhenwu Tang to treat it. Poria and Atractylodis Macrocephalae Rhizoma are substances that tonify Earth and promote urination, capable of subduing Kidney Water and treating palpitations; Zingiberis Rhizoma Recens and Aconiti Lateralis Radix Praeparata are substances that protect Wei Yang and restore Yang, capable of strengthening Fire and dispelling deficient pathogens; the sour nature of Paeoniae Radix Alba collects Yin Qi, harmonizes Ying Blood, and generates fluids.
Ginseng Radix et Rhizoma (Apothegmata removed) Atractylodis Macrocephalae Rhizoma (Stir-fried) Zingiberis Rhizoma (Processed) Glycyrrhizae Radix et Rhizoma (Processed)
Spontaneous diarrhea without thirst in Taiyin disease, accompanied by abundant cold and vomiting, abdominal pain, duck-like loose stools, and Huoluan (cholera-like syndrome), indicates True Cold in the Taiyin organ, treated by this formula.
Taiyin corresponds to the Spleen. Spontaneous diarrhea with thirst belongs to Heat; without thirst, it belongs to Cold. The Spleen prefers warmth and dislikes cold; abundant cold causes vomiting; Cold is a肃杀 (severing/drying) Qi, thus causing abdominal pain; "duck-like loose stools" refers to stool resembling duck excrement, also caused by deficiency-cold; Huoluan involves pathogens in the Middle Jiao causing upper vomiting and lower diarrhea, with chaotic hand and foot movements and blurred vision. Huoluan has Yin and Yang syndromes; this case arises from Cold. Since the cause is Cold, the warming property of Zingiberis Rhizoma is used; where pathogens gather, Qi must be deficient, so Ginseng Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, and Glycyrrhizae Radix et Rhizoma are used to tonify.
Evodiae Fructus (1 sheng, soaked) Ginseng Radix et Rhizoma (3 liang, apothegmata removed) Zingiberis Rhizoma Recens (6 liang) Jujubae Fructus (12 pieces)
In Cold Damage, desire to vomit after eating grain belongs to Yangming, treated by this decoction; if symptoms worsen after taking the decoction, it belongs to the Upper Jiao, and this formula is not suitable. When Shaoyin is invaded by True Cold, presenting with vomiting and diarrhea, cold limbs, and severe restlessness desiring death, this decoction is indicated. For Jueyin presenting with dry heaving, spitting saliva/froth, and headache, this decoction is also indicated.
Yangming corresponds to the Stomach. As the official of granaries, it governs the reception of water and grain; with Cold, it causes desire to vomit after eating, making Wuzhuyu Tang appropriate for warming. If symptoms worsen after taking the decoction, it is not Stomach Cold but Upper Jiao Fire, requiring cooling agents, rendering Wuzhuyu Tang unsuitable. Shaoyin invaded by True Cold refers to Cold in the Foot-Shaoyin Kidney channel, distinct from transmitted Yang syndromes. Excess Yin-Cold in the Kidney rebels upward against Yang, causing vomiting. The Classics state: The Kidney governs the two orifices. Thus, Kidney Cold causes involuntary defecation and diarrhea; limbs receive Yang to become warm, as Qi originates internally; internal Yin-Cold causes cold limbs (Jue Ni). Restlessness occurs because excess Yin repels Yang, leading to internal struggle of Yang, manifesting as Yang vexation and Yin agitation; this syndrome is critical, hence the feeling of desiring death. Jueyin corresponds to the Liver; internal rebellious Cold causes dry heaving and spitting froth; Jueyin meets the Du Mai at the vertex, causing headache. Evodiae Fructus is acrid-hot and pungent; the Classics state flavor belongs to Yin, and strong flavor is Yin within Yin, thus it travels to the Lower Jiao to warm Shaoyin and Jueyin; assisted by Zingiberis Rhizoma Recens to disperse Cold; assisted by Ginseng Radix et Rhizoma and Jujubae Fructus to tonify Middle Deficiency. Although Zhang Zhongjing established this formula to treat Cold in Shaoyin and Jueyin, did he not also say, "Shaoyin disease with vomiting, diarrhea, restlessness, and four-inverse is fatal"? Cold limbs and Si Ni (four-inverse) do not contradict each other. Physicians dealing with diseases must be cautious!