论曰太阳病发汗过多,因致 ,其状令人摇头发热,颈项强急,腰身反张,或螈 口噤,
但谓之刚 者,特以其无汗而反恶寒故也。
治太阳病无汗,而小便反少,气上冲胸,口噤不得语,欲作刚 。葛根汤方
葛根(锉四两) 麻黄(去根节) 煎掠(去沫焙) 芍药(各三两) 桂(去粗皮) 甘
草(炙各二两)
上五味, 咀,如麻豆大,每服五钱匕,水一盏半,生姜五片,枣二枚劈破,同煎至七
分,去滓温服,取微汗。
治刚 胸满口噤,卧不着席,两脚挛急 齿。大承气汤方
大黄(锉四两) 浓朴(去粗皮生姜汁炙半斤) 枳实(去瓤麸炒一两)
上三味, 咀,如麻豆大,每服五钱匕,水一盏半,煎至七分,去滓入芒硝末半钱匕,
再煎一两沸、温服。
治伤寒刚 ,身热仰目,头痛项强。石膏汤方
石膏(碎) 前胡(去芦头各一两) 犀角(镑) 防风(去叉) 芍药(各半两) 龙
齿(研三分) 牛黄(研一钱)
上七味,粗捣筛,每服五钱匕,水一盏半,入豉一百粒,葱白五寸,煎至八分去滓,不
以时温服。
治伤寒刚 ,浑身壮热,头疼口噤,筋脉拘急,心神躁闷。羚羊角汤方
羚羊角(镑) 百合 芎 木通(锉) 葛根(锉) 升麻 黄芩(去黑心各半两) 石
膏(碎一两) 龙齿 防风(去叉各三分)
上一十味,粗捣筛,每服五钱匕,水一盏半,煎至一盏,去滓不拘时温服、日再。
治伤寒刚 ,仰目壮热,筋脉不舒,牙关紧急,不欲见食。羚羊角升麻汤方
羚羊角(镑) 升麻 白藓皮 龙齿(各半两) 木通(锉) 百合 防风(去叉各一
分) 石膏(一两)
上八味,粗捣筛,每服五钱匕,水一盏半,豉一百粒,葱白五寸,煎至一盏,去滓不拘
时温服。
治伤寒刚 ,身热不渴,烦闷头疼。龙齿汤方
龙齿(捣) 前胡(去芦头各半两) 犀角(镑) 木通(锉) 黄芩(去黑心各一分)
牛黄(研半钱)
上六味,除牛黄外,各细锉,分作二服,每服用水一盏半,煎至八分去滓,入牛黄一字
搅匀,不拘时温服。
治伤寒刚 ,闭目合面,肢节急强,身热头疼。羌活汤方
羌活(去芦头) 王不留行 桂(去粗皮) 黄松节(炒各一两) 当归(切焙) 茯
神(去木各三分) 防风(去叉) 荆芥穗(各半两) 麻黄(去根节) 石膏(各一两半)
上一十味,粗捣筛,每服五钱匕,水一盏半,煎至八分,去滓不拘时温服,良久以葱豉
粥投之出汗,未汗再服,以瘥为度。
治伤寒刚 ,通身壮热,龙齿犀角汤方
龙齿 犀角(镑) 前胡(去芦头各一两) 牛黄(一钱半)
上四味,将三味粗捣筛,每服五钱匕,水一盏半,煎至八分,去滓入牛黄少许,不拘时
温服。
治伤寒刚 ,壮热头痛,筋脉不能舒展。犀角大黄散方
犀角(镑) 大黄(锉炒各一两) 芎 (半两) 石膏(二两) 牛黄(研半分)
上五味,捣罗四味为散,入牛黄同研令匀,每服一钱匕,不拘时煎淡竹叶汤调下。
治伤寒刚 ,无汗恶寒,口噤背强。小续命汤方
麻黄(去根节煎掠去沫) 桂(去粗皮) 甘草(炙各半两) 防风(去叉一分半) 芍
药白术 人参 芎 附子(生去皮脐) 防己 黄芩(去黑心各一分)
上一十一味,锉如麻豆,每服五钱匕,水一盏半,煎至一盏,去滓入生姜汁少许,再煎
一二沸,温服日三夜二,若柔 自汗者,去麻黄,夏病及病觉热甚者,减桂枝一半,冬及初
春病去黄芩。
论述说:太阳病发汗过多,因而导致刚痓(以项背强直、角弓反张为特征的痉病),其症状表现为摇头发热,颈项强急,腰身向后反张,或出现抽搐、牙关紧闭。之所以称为“刚痓”,特别是因为患者无汗且反而恶寒的缘故。
治疗太阳病无汗,小便反而量少,气向上冲至胸部,牙关紧闭不能说话,即将发作刚痓的证候。葛根汤方:
葛根(锉碎四两) 麻黄(去除根和节) 煎掠(去除浮沫后焙干) 芍药(各三两) 桂枝(去除粗皮) 甘草(炙制各二两)
以上五味药,切碎如麻豆大小,每次服用五钱匕,用水一盏半,生姜五片,大枣二枚劈破,一同煎煮至七分满,去渣温服,取微汗。
治疗刚痓胸满、牙关紧闭,卧床时背部不能着席,两脚拘挛紧急并磨牙的症状。大承气汤方:
大黄(锉碎四两) 厚朴(去除粗皮,用生姜汁炙制半斤) 枳实(去除瓤,麸炒一两)
以上三味药,切碎如麻豆大小,每次服用五钱匕,用水一盏半,煎煮至七分满,去渣后加入芒硝末半钱匕,再煎一二沸,温服。
治疗伤寒刚痓,身体发热,眼睛上视,头痛项强的症状。石膏汤方:
石膏(打碎) 前胡(去除芦头各一两) 犀角(镑片) 防风(去除叉枝) 芍药(各半两) 龙齿(研细三分) 牛黄(研细一钱)
以上七味药,粗捣筛过,每次服用五钱匕,用水一盏半,加入豆豉一百粒,葱白五寸,煎煮至八分满,去渣,不拘时候温服。
治疗伤寒刚痓,浑身壮热,头痛牙关紧闭,筋脉拘急,心神烦躁闷乱的症状。羚羊角汤方:
羚羊角(镑片) 百合 川芎 木通(锉碎) 葛根(锉碎) 升麻 黄芩(去除黑心各半两) 石膏(打碎一两) 龙齿 防风(去除叉枝各三分)
以上十味药,粗捣筛过,每次服用五钱匕,用水一盏半,煎煮至一盏满,去渣,不拘时候温服,每日两次。
治疗伤寒刚痓,眼睛上视,壮热,筋脉不舒展,牙关紧急,不想进食的症状。羚羊角升麻汤方:
羚羊角(镑片) 升麻 白鲜皮 龙齿(各半两) 木通(锉碎) 百合 防风(去除叉枝各一分) 石膏(一两)
以上八味药,粗捣筛过,每次服用五钱匕,用水一盏半,豆豉一百粒,葱白五寸,煎煮至一盏满,去渣,不拘时候温服。
治疗伤寒刚痓,身体发热但不口渴,烦闷头疼的症状。龙齿汤方:
龙齿(捣碎) 前胡(去除芦头各半两) 犀角(镑片) 木通(锉碎) 黄芩(去除黑心各一分) 牛黄(研细半钱)
以上六味药,除牛黄外,其余各细锉,分为两份服用,每份用水一盏半,煎煮至八分满,去渣,加入牛黄一字量搅匀,不拘时候温服。
治疗伤寒刚痓,闭目合面,肢节急强,身体发热头疼的症状。羌活汤方:
羌活(去除芦头) 王不留行 桂枝(去除粗皮) 黄松节(炒制各一两) 当归(切后焙干) 茯神(去除木心各三分) 防风(去除叉枝) 荆芥穗(各半两) 麻黄(去除根节) 石膏(各一两半)
以上十味药,粗捣筛过,每次服用五钱匕,用水一盏半,煎煮至八分满,去渣,不拘时候温服,过一段时间后喝葱豉粥助出汗,若未出汗再服,以病愈为度。
治疗伤寒刚痓,全身壮热的症状。龙齿犀角汤方:
龙齿 犀角(镑片) 前胡(去除芦头各一两) 牛黄(一钱半)
以上四味药,将前三味粗捣筛过,每次服用五钱匕,用水一盏半,煎煮至八分满,去渣,加入少许牛黄,不拘时候温服。
治疗伤寒刚痓,壮热头痛,筋脉不能舒展的症状。犀角大黄散方:
犀角(镑片) 大黄(锉碎炒制各一两) 川芎(半两) 石膏(二两) 牛黄(研细半分)
以上五味药,将前四味捣罗成散,加入牛黄同研均匀,每次服用一钱匕,不拘时候用淡竹叶汤调服。
治疗伤寒刚痓,无汗恶寒,牙关紧闭背部强直的症状。小续命汤方:
麻黄(去除根节,煎煮掠去浮沫) 桂枝(去除粗皮) 甘草(炙制各半两) 防风(去除叉枝一分半) 芍药 白术 人参 川芎 附子(生用,去皮脐) 防己 黄芩(去除黑心各一分)
以上十一味药,锉碎如麻豆大小,每次服用五钱匕,用水一盏半,煎煮至一盏满,去渣,加入少许生姜汁,再煎一二沸,温服,日三次夜二次。若是柔痓自汗者,去掉麻黄;夏季患病及自觉热甚者,减去一半桂枝;冬季及初春患病,去掉黄芩。
Commentary states: When the Taiyang disease (disease of the Taiyang channel) is treated with excessive sweating, it may lead to Gang Ji (a type of spasm characterized by stiffness of the neck and back, and opisthotonos). Its manifestations include shaking of the head with fever, stiffness and tension of the neck and nape, hyperextension of the waist and body, or convulsions and trismus (lockjaw). It is specifically termed "Gang Ji" because the patient has no sweat and exhibits aversion to cold.
For treating Taiyang disease presenting with no sweat, abnormally scanty urination, qi rushing upward to the chest, trismus preventing speech, and impending onset of Gang Ji: Gegen Tang (Kudzu Decoction).
Gegen (Puerariae Lobatae Radix, crushed, 4 liang), Mahuang (Ephedrae Herba, roots and joints removed), Shaoyao (Paeoniae Radix Alba, each 3 liang), Guizhi (Cinnamomi Ramulus, outer bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 2 liang). Note: The text mentions "Jian lve" which refers to processing Mahuang by boiling and skimming foam.
Crush the above five herbs into pieces the size of hemp seeds. Take 5 qian bi per dose. Add 1.5 zhan of water, 5 slices of Shengjiang (Zingiberis Rhizoma Recens), and 2 broken Zao (Jujubae Fructus). Decoct until reduced to 70%. Strain and take warm. Aim for a slight sweat.
For treating Gang Ji with chest fullness, trismus, inability to lie flat on the back (back cannot touch the bed), spasms and cramps in both legs, and teeth grinding: Dachengqi Tang (Major Order the Qi Decoction).
Dahuang (Rhei Radix et Rhizoma, crushed, 4 liang), Houpo (Magnoliae Officinalis Cortex, outer bark removed, stir-baked with Shengjiang juice, 8 liang), Zhishi (Immature Bitter Orange Fruit, placenta removed, stir-broiled with bran, 1 liang).
Crush the above three herbs into pieces the size of hemp seeds. Take 5 qian bi per dose. Add 1.5 zhan of water. Decoct until reduced to 70%. Strain, add Ban qian bi of Mangxiao (Natrii Sulfas) powder, boil for one or two more boils, and take warm.
For treating Shanghan (Cold Damage) Gang Ji with body heat, upward gaze, headache, and neck stiffness: Shigao Tang (Gypsum Decoction).
Shigao (Gypsum Fibrosum, crushed), Qianhu (Peucedani Radix, radix end removed, each 1 liang), Xijiao (Rhinocerotis Cornu, shaved flakes), Fangfeng (Saposhnikoviae Radix, forked branches removed), Shaoyao (Paeoniae Radix Alba, each 0.5 liang), Longchi (Dentis Fossl Mammoth, ground, 3 fen), Niuhuang (Bovis Calculus, ground, 1 qian).
Coarsely crush and sieve the above seven herbs. Take 5 qian bi per dose. Add 1.5 zhan of water, 100 grains of Chi Dou (Sojae Semen Praeparatum), and 5 cun of Congbai (Allii Fistulosi Bulbus). Decoct until reduced to 80%. Strain and take warm at any time.
For treating Shanghan Gang Ji with generalized severe heat, headache, trismus, tendon and vessel spasms, and restless mind: Lingyangjiao Tang (Saiga Antelope Horn Decoction).
Lingyangjiao (Saigae Tataricae Cornu, shaved flakes), Baihe (Lilii Bulbus), Xiongqiong (Ligustici Chuanxiong Rhizoma), Mutong (Akebiae Caulis, crushed), Gegen (Puerariae Lobatae Radix, crushed), Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix, black heart removed, each 0.5 liang), Shigao (Gypsum Fibrosum, crushed, 1 liang), Longchi (Dentis Fossl Mammoth), Fangfeng (Saposhnikoviae Radix, forked branches removed, each 3 fen).
Coarsely crush and sieve the above ten herbs. Take 5 qian bi per dose. Add 1.5 zhan of water. Decoct until reduced to 1 zhan. Strain and take warm at any time, twice daily.
For treating Shanghan Gang Ji with upward gaze, severe heat, unrelaxed tendons and vessels, tight jaw, and loss of appetite: Lingyangjiao Shengma Tang (Saiga Antelope Horn and Cimicifuga Decoction).
Lingyangjiao (Saigae Tataricae Cornu, shaved flakes), Shengma (Cimicifugae Rhizoma), Baixianpi (Dictamni Cortex), Longchi (Dentis Fossl Mammoth, each 0.5 liang), Mutong (Akebiae Caulis, crushed), Baihe (Lilii Bulbus), Fangfeng (Saposhnikoviae Radix, forked branches removed, each 1 fen), Shigao (Gypsum Fibrosum, 1 liang).
Coarsely crush and sieve the above eight herbs. Take 5 qian bi per dose. Add 1.5 zhan of water, 100 grains of Chi Dou (Sojae Semen Praeparatum), and 5 cun of Congbai (Allii Fistulosi Bulbus). Decoct until reduced to 1 zhan. Strain and take warm at any time.
For treating Shanghan Gang Ji with body heat but no thirst, irritability, and headache: Longchi Tang (Mammoth Tooth Decoction).
Longchi (Dentis Fossl Mammoth, pounded), Qianhu (Peucedani Radix, radix end removed, each 0.5 liang), Xijiao (Rhinocerotis Cornu, shaved flakes), Mutong (Akebiae Caulis, crushed), Huangqin (Scutellariae Radix, black heart removed, each 1 fen), Niuhuang (Bovis Calculus, ground, half a qian).
Except for Niuhuang (Bovis Calculus), finely crush the other herbs. Divide into two doses. For each dose, use 1.5 zhan of water, decoct until reduced to 80%, strain, add Yi zi (approx. 0.1-0.2 g) of Niuhuang (Bovis Calculus), mix well, and take warm at any time.
For treating Shanghan Gang Ji with eyes closed and face covered, acute stiffness of limbs and joints, body heat, and headache: Qianghuo Tang (Notopterygii Rhizoma et Radix Decoction).
Qianghuo (Notopterygii Rhizoma et Radix, radix end removed), Wangbuliuxing (Vaccariae Semen), Guizhi (Cinnamomi Ramulus, outer bark removed), Huangsongjie (Pinus Massoniana Stem Joint, stir-fried, each 1 liang), Danggui (Angelicae Sinensis Radix, sliced and baked), Fushen (Poria Cum Pinodia, wood removed, each 3 fen), Fangfeng (Saposhnikoviae Radix, forked branches removed), Jingjisui (Schizonepetae Spica, each 0.5 liang), Mahuang (Ephedrae Herba, roots and joints removed), Shigao (Gypsum Fibrosum, each 1.5 liang).
Coarsely crush and sieve the above ten herbs. Take 5 qian bi per dose. Add 1.5 zhan of water. Decoct until reduced to 80%. Strain and take warm at any time. After some time, administer Congchi Zhou (Scallion and Fermented Soybean Porridge) to induce sweating. If no sweat occurs, take again. Continue until recovery.
For treating Shanghan Gang Ji with generalized severe heat: Longchi Xijiao Tang (Mammoth Tooth and Rhinoceros Horn Decoction).
Longchi (Dentis Fossl Mammoth), Xijiao (Rhinocerotis Cornu, shaved flakes), Qianhu (Peucedani Radix, radix end removed, each 1 liang), Niuhuang (Bovis Calculus, 1.5 qian).
Coarsely crush and sieve the first three herbs. Take 5 qian bi per dose. Add 1.5 zhan of water. Decoct until reduced to 80%. Strain, add a small amount of Niuhuang (Bovis Calculus), and take warm at any time.
For treating Shanghan Gang Ji with severe heat, headache, and inability of tendons and vessels to relax: Xijiao Dahuang San (Rhino Horn and Rhubarb Powder).
Xijiao (Rhinocerotis Cornu, shaved flakes), Dahuang (Rhei Radix et Rhizoma, crushed and stir-fried, each 1 liang), Xiongqiong (Ligustici Chuanxiong Rhizoma, 0.5 liang), Shigao (Gypsum Fibrosum, 2 liang), Niuhuang (Bovis Calculus, ground, half a fen).
Grind the first four herbs into a powder. Mix thoroughly with Niuhuang (Bovis Calculus). Take 1 qian bi per dose. Administer at any time, mixed with Danzhuye Tang (Lophatheri Decoction).
For treating Shanghan Gang Ji with no sweat, aversion to cold, trismus, and back stiffness: Xiao Xuming Tang (Minor Continuation Life Decoction).
Mahuang (Ephedrae Herba, roots and joints removed, boiled and skimmed), Guizhi (Cinnamomi Ramulus, outer bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 0.5 liang), Fangfeng (Saposhnikoviae Radix, forked branches removed, 1.5 fen), Shaoyao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix), Xiongqiong (Ligustici Chuanxiong Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata, raw, skin and umbilicus removed), Fangji (Stephaniae Tetrandrae Radix), Huangqin (Scutellariae Radix, black heart removed, each 1 fen).
Crush the above eleven herbs into pieces the size of hemp seeds. Take 5 qian bi per dose. Add 1.5 zhan of water. Decoct until reduced to 1 zhan. Strain, add a little Shengjiangzhi (Zingiberis Rhizoma Recens Juice), boil for one or two more boils, and take warm. Take three times during the day and twice at night. If Rou Ji (Soft Spasm) with spontaneous sweating occurs, remove Mahuang (Ephedrae Herba). In summer cases or when heat sensation is severe, reduce Guizhi (Cinnamomi Ramulus) by half. In winter and early spring cases, remove Huangqin (Scutellariae Radix).