桂枝(三两去皮) 甘草(二两炙) 生姜(三两切) 牡蛎(五两熬味酸咸)
龙骨(四两味甘平) 大枣(十二枚擘) 蜀漆(三两洗去脚味辛平)
上为末。以水一斗二升。先煮蜀漆。减二升。内诸药。煮取三升。去滓。温服一升。
形作伤寒。其脉不弦紧而弱。弱者必渴。被火者。必谵语。弱者发热。脉浮。解之。
当汗
出愈。
形作伤寒。谓头痛身热也。脉不弦紧。则无伤寒表脉也。经曰。诸弱发热。则脉弱
为里热。故云弱者必渴。若被火气。两热相合。搏于胃中。胃中燥烦。必发谵语。脉弱
发热者。得脉浮。为邪气还表。当汗出而解矣。
王三阳云。此证固不须治。待其自汗。则愈。若脉不肯浮。酒炒芩连等。微解之可
也。
太阳病。以火熏之。不得汗。其人必躁。到经不解。必清血名为火邪。
此火邪迫血。而血下行者也。火阳病。用火熏之。不得汗。则热无从出。阴虚被火
必发躁也。六日传经尽。至七日再到太阳经。则热气当解。若不解。热气迫血下行。必
清血清厕也。
脉浮热甚。反灸之。此为实。实以虚治。因火而动。必咽燥唾血。
此火邪迫血而血上行者也。脉浮热甚为表实。医以脉浮为虚。用火灸之。因火气动
血。迫血上行。故咽燥唾血。
微数之脉。慎不可灸。因火为邪。则为烦逆。追虚逐实。血散脉中。火气虽微。内
攻有
力。焦骨伤筋。血难复也。
微数之脉。则为热也。灸则除寒不能散热。是慎不可灸也。若反灸之。热因火则甚。
遂为烦逆。灸本以追虚。而复逐热为实。热则伤血。又加火气。使血散脉中。气主 之。
血主濡之。气血消散。不能濡润筋骨。致骨焦筋伤。血散而难复也。
脉浮。宜以汗解。用火灸之。邪无从出。因火而盛。病从腰以下。必重而痹。名火
逆也。
脉浮在表。宜以汗解之。医以火灸取汗。而不得汗。邪无从出。又加火气相助。则
热愈甚。身半以上。同天之阳。身半以下。同地之阴。火性炎上。则腰以下。阴气独治。
故从腰以下。必重而痹也。
欲自解者。必当先烦。乃有汗而解。何以知之。脉浮。故知汗出解也。
烦热也。邪气还表。则为烦热。汗出而解。以脉浮。故为邪还表也。
烧针令其汗。针处被寒。核起而赤者。必发奔豚。气从少腹上冲心者。灸其核上各
一壮。与桂枝加桂汤。更加桂三两。
烧针发汗。则损阴血而惊动心气。针处被寒气聚而成核。心气因惊而虚。肾气乘寒
气而动。发为奔豚。金匮要略曰。病有奔豚。从惊发得之。肾气欲上乘心。故
其气从少腹上冲心也。先灸核上。以散其寒。与桂枝加桂汤。以泄奔豚之气。
桂枝(三两,去皮) 甘草(二两,炙) 生姜(三两,切) 牡蛎(五两,熬至味酸咸)
龙骨(四两,味甘平) 大枣(十二枚,掰开) 蜀漆(三两,洗去脚部泥沙,味辛平)
以上药材研为细末。用水一斗二升。先煮蜀漆,水量减少二升后,加入其余药物。继续煎煮取药液三升,滤去药渣。每次温服一升。
症状表现类似伤寒病,但脉象不弦紧而弱。脉弱者必然口渴。若误用火疗,必然出现胡言乱语(谵语)。脉弱且发热、脉浮者,应通过发汗的方法解除表邪。
所谓“形作伤寒”,是指头痛、身体发热。脉象不弦紧,说明没有典型的伤寒表证脉象。经典记载:“诸弱发热”,说明脉弱代表里有热,所以说脉弱者必然口渴。如果遭受火气熏灼,内外两热相合,搏结于胃中,导致胃中干燥烦扰,必然引发胡言乱语。脉弱发热者,若脉转为浮象,说明邪气回归体表,应当通过出汗而痊愈。
王三阳说:此证本来不需要特殊治疗,等待其自发出汗,即可痊愈。如果脉象不肯转浮,可用酒炒的黄芩、黄连等药物,轻微地清解里热即可。
太阳病(太阳经受邪所致的病证),用火熏法治疗,未能出汗,病人必然烦躁。到了传经周期仍未解除,必然出现便血,这称为火邪。
这是火邪逼迫血液下行所致。患火阳病时,用火熏法治疗,不能出汗,则热邪无从排出。阴液亏虚之人被火邪所伤,必然发生烦躁。六日传经结束,至七日再回到太阳经,热气应当解除。若未解除,热气逼迫血液下行,必然导致大便下血。
脉浮且热势严重,反而用灸法治疗。此为实证,却按虚证治疗,因火邪扰动,必然导致咽喉干燥、唾血。
这是火邪逼迫血液上行所致。脉浮热甚属于表实,医生误以为脉浮是虚证,用火灸法治疗,因火气带动血行,逼迫血液上行,所以出现咽喉干燥、唾血。
脉象微数者,千万不可施灸。因为火成为邪气,会导致心烦逆乱。追补虚损的同时又追逐实邪,导致血液散乱于脉中。火气虽然微弱,但内攻之力强大,会焦枯骨骼、损伤筋脉,血液难以恢复。
脉象微数,代表有热。灸法本用于除寒,不能散热,所以谨慎不可施灸。如果反而施灸,热因火而加重,随即产生心烦逆乱。灸法本意是追补虚损,却又追逐热邪使其变为实证。热邪伤血,再加上火气,使血液散乱于脉中。气主煦之,血主濡之。气血消散,不能濡润筋骨,导致骨骼焦枯、筋脉损伤,血液散乱而难以恢复。
脉浮,应当用发汗法解除表邪。若用火灸法,邪气无从排出,因火而盛,病症从腰部以下必然沉重且麻木不仁,这称为火逆。
脉浮在表,应当用发汗法解除。医生用火灸法取汗,却未能出汗,邪气无从排出,又加上火气相助,则热势更甚。身半以上,同天之阳气;身半以下,同地之阴气。火性炎上,则腰部以下,阴气独治。所以从腰部以下,必然沉重且麻木不仁。
想要自然解除病邪的,必然先出现烦躁,然后才有汗出而解。怎么知道呢?因为脉浮,所以知道是通过出汗而解除的。
这是烦热。邪气回归体表,则表现为烦热。汗出而解,是因为脉浮,所以判断为邪气回归体表。
烧针令其出汗,针孔处受寒,起核状红肿者,必然发作奔豚(一种气从少腹上冲心胸的病证)。气从少腹上冲心脏者,在红肿的核上各灸一壮,给予桂枝加桂汤,增加桂三两。
烧针发汗,会损伤阴血并惊动心气。针孔处受寒气聚集成核,心气因惊恐而虚弱,肾气乘寒气而动,发作奔豚。《金匮要略》说:奔豚病,是从惊恐引发的。肾气欲上乘于心,所以气从少腹上冲心脏。先在核上施灸,以散其寒,给予桂枝加桂汤,以泄奔豚之气。
Cinnamon Twig (Guizhi, 3 liang, bark removed) Licorice Root (Gancao, 2 liang, honey-fried) Fresh Ginger (Shengjiang, 3 liang, sliced) Oyster Shell (Muli, 5 liang, calcined until sour and salty in taste) Dragon Bone (Longgu, 4 liang, sweet and neutral in taste) Jujube (Dazao, 12 pieces, split open) Shuqi (Shuqi, 3 liang, washed to remove soil residue, pungent and neutral in taste)
Grind the above ingredients into a fine powder. Use 12 sheng of water. First decoct Shuqi until the volume reduces by 2 sheng. Then add the remaining herbs. Decoct until 3 sheng of liquid remains. Strain the dregs. Take 1 sheng warm.
The presentation resembles Taiyang disease (disease of the Taiyang channel), but the pulse is not wiry and tight; instead, it is weak. A weak pulse indicates thirst. If treated with fire therapy, delirium (Zhenyu) will inevitably occur. In cases of weak pulse with fever and floating pulse, the pathogen should be resolved through sweating.
"Resembling Taiyang disease" refers to headache and body heat. The absence of a wiry and tight pulse indicates the lack of typical exterior syndrome pulses for Taiyang disease. The classics state: "Weakness with fever," indicating that a weak pulse signifies interior heat; thus, those with a weak pulse must experience thirst. If subjected to fire qi, the internal and external heats combine and contend in the Stomach. Dryness and irritability in the Stomach will inevitably lead to delirium. When a patient presents with a weak pulse and fever, if the pulse becomes floating, it indicates the pathogen has returned to the exterior. Recovery will occur through perspiration.
Wang Sanyang stated: This condition does not strictly require treatment; waiting for spontaneous sweating will lead to recovery. If the pulse fails to become floating, mild clearing of heat using wine-fried Scutellaria Root (Huangqin) and Phellodendron Bark (Huanglian) is acceptable.
In Taiyang disease, if moxibustion or fire fumigation is applied and sweat is not produced, the patient will inevitably become restless. If the disease cycle passes without resolution, hematochezia (blood in stool) will occur, termed "Fire Pathogen."
This represents blood forced downward by the Fire Pathogen. In Fire Yang disease, if fire fumigation is used without producing sweat, the heat has no outlet. In patients with Yin deficiency subjected to fire, restlessness will inevitably ensue. After six days, when the transmission of channels is complete, and on the seventh day returning to the Taiyang channel, the heat should resolve. If it does not, the heat forces blood downward, resulting in bloody stools.
If the pulse is floating and heat is severe, applying moxibustion is contraindicated. This is an Excess pattern treated as Deficiency. Due to the disturbance caused by fire, dryness of the throat and hemoptysis (spitting blood) will inevitably occur.
This represents blood forced upward by the Fire Pathogen. A floating pulse with severe heat indicates Exterior Excess. If the physician mistakenly treats the floating pulse as Deficiency and applies moxibustion, the fire qi moves the blood, forcing it upward, causing dryness of the throat and hemoptysis.
For a pulse that is slightly rapid (Wei Shu), moxibustion must be strictly avoided. Fire becomes a pathogenic factor, leading to vexation and rebellious qi. It pursues Deficiency while simultaneously aggravating Excess, causing blood to scatter within the vessels. Although the fire qi may be slight, its internal attacking power is strong, potentially scorching bones and damaging sinews, making blood restoration difficult.
A slightly rapid pulse indicates Heat. Moxibustion dispels Cold but cannot dissipate Heat; therefore, it is strictly contraindicated. If moxibustion is incorrectly applied, the heat intensifies due to fire, leading to vexation and rebellious qi. Moxibustion is intended to tonify Deficiency, but here it exacerbates Heat into Excess. Heat injures blood, and combined with fire qi, causes blood to scatter within the vessels. Qi warms, and Blood moistens. With the dissipation of Qi and Blood, they can no longer nourish sinews and bones, resulting in scorched bones and damaged sinews, with scattered blood being difficult to restore.
When the pulse is floating, the exterior should be resolved through sweating. If moxibustion is used, the pathogen has no exit. Aggravated by fire, the condition below the waist will become heavy and numb, termed "Fire Reversal" (Huo Ni).
A floating pulse indicates the exterior; it should be resolved through sweating. If the physician uses moxibustion to induce sweat but fails to do so, the pathogen has no outlet. Assisted by fire qi, the heat intensifies. The upper half of the body corresponds to Heaven's Yang; the lower half corresponds to Earth's Yin. Fire nature flares upward. Consequently, in the lower half, Yin qi dominates exclusively. Thus, from the waist down, heaviness and numbness will inevitably occur.
Spontaneous resolution occurs first with vexation, followed by sweating and recovery. How do we know this? Because the pulse is floating, we know recovery comes through sweating.
Vexation and heat indicate the pathogen returning to the exterior. Sweating resolves the condition because the floating pulse signals the pathogen's return to the exterior.
If pricking needles induces sweating, and the needle site is exposed to cold, forming a nodule that turns red, Ben Tun (Rolling Pig, a condition where Qi rushes from the lower abdomen to the heart) will inevitably develop. If Qi rushes from the lower abdomen to the heart, apply one moxa cone directly on each nodule to disperse the cold, and administer Guizhi Jia Gui Tang (Cinnamon Twig Decoction with Added Cinnamon Twig), increasing the amount of Cinnamon Twig by 3 liang.
Pricking needles to induce sweating damages Yin Blood and startles Heart Qi. Cold gathers at the needle site, forming nodules. Heart Qi becomes deficient due to fright. Kidney Qi moves in conjunction with the cold pathogen, triggering Ben Tun. The *Jin Gui Yao Lue* states: "Ben Tun arises from fright." Kidney Qi attempts to ascend to the Heart, causing Qi to rush from the lower abdomen to the heart. First, moxa is applied to the nodules to disperse cold, and Guizhi Jia Gui Tang is given to drain the Qi of Ben Tun.