甘草(四两炙味甘平) 干姜(二两炮味辛热)
上 咀。以水三升。煮取一升五合。去滓、分温再服。
内经曰。辛甘发散为阳。甘草干姜相合。以复阳气。
白芍药(四两味酸微寒) 甘草(四两炙甘平)
上二味。 咀。以水三升。煮取一升半。去滓。分温再服之。
芍药白补而赤泻。白收而赤散也。酸以收之。甘以缓之。酸甘相合。用补阴血。
大黄(四两去皮清酒浸) 甘草(二两炙味甘平) 芒硝(半斤味咸苦大寒)
上三味。 咀。以水三升。煮取一升。去滓。内芒硝。更上火。微煮令沸。少少温服。
内经曰。热淫于内。治以咸寒。佐以苦甘。芒硝咸寒以除热。大黄苦寒以荡实。甘
草甘平。助二物。推陈而缓中。
甘草(二两炙味甘平) 干姜(一两半味辛热) 附子(一枚生用去皮破八片辛大
热)
上三味。 咀。以水三升。煮取一升二合。去滓。分温再服。强人可大附子一枚。
干姜三两。
内经曰。寒淫于内。治以甘热。又曰。寒淫所胜。平以辛热甘草姜附相合。为甘辛
大热之剂。乃可发散阴阳之气。
问曰。证象阳旦。按法治之而增剧。厥逆、咽中干。两胫拘急而谵语。师曰。言夜
半手足当温。两脚当伸。后如师言。何以知此。答曰。寸口脉浮而大。浮则为风。大则
为虚。风则生微热。虚则两胫挛。病证象桂枝。因加附子参其间。增桂。令汗出。附子
温经。亡阳故也。厥逆。咽中干。烦躁。阳明内结。谵语烦乱。更饮甘草干姜汤。夜半
阳气还。两足当热。胫尚微拘急。重与芍药甘草汤。尔乃胫伸。以承气汤微溏。则止其
谵语。故知病可愈。
阳旦。桂枝汤别名也。前证脉浮。自汗出。小便数。心烦。微恶寒。脚挛急。与桂
枝汤
证相似。是证象阳旦也。与桂枝汤而增剧。得寸口脉浮大。浮为风邪。大为血虚。即于
桂枝汤。加附子温经以补虚。增桂令汗出以祛风。其有治之之逆而增厥者。与甘草
干姜汤。阳复而足温。更与芍药甘草汤。阴和而胫伸。表邪已解。阴阳已复。而有阳
明内结谵语烦乱。少与调胃承气汤。微溏泄以和其胃。则阴阳之气皆和。内外之邪悉去。
故知病可愈。
张卿子云。此二条见伤寒随症用药。如转圜法也。表里寒热。意尽于此。则昔贤所云。
用药宜寒者为传邪。宜温者为直中。未为确论。
甘草(四两,炙,味甘平) 干姜(二两,炮,味辛热)
以上两味药。切碎。用水三升。煮取一升五合。滤去药渣。分两次温服。
《内经》说:辛甘发散为阳。甘草与干姜相配合,用以恢复阳气。
白芍药(四两,味酸微寒) 甘草(四两,炙,味甘平)
以上两味药。切碎。用水三升。煮取一升半。滤去药渣。分两次温服。
白芍药具有补益作用而赤芍药具有泻下作用;白色收敛而红色发散。酸味以收敛,甘味以缓急。酸味与甘味相配合,用于补益阴血。
大黄(四两,去皮,用清酒浸泡) 甘草(二两,炙,味甘平) 芒硝(半斤,味咸苦大寒)
以上三味药。切碎。用水三升。煮取一升。滤去药渣。加入芒硝。再次上火。微煮至沸腾。少量多次温服。
《内经》说:热邪蕴结于内,用咸寒之品治疗,辅以苦甘之品。芒硝咸寒以清除热邪,大黄苦寒以荡涤实邪,甘草甘平,辅助这两味药,推陈出新并缓和药性。
甘草(二两,炙,味甘平) 干姜(一两半,味辛热) 附子(一枚,生用,去皮,破成八片,味辛大热)
以上三味药。切碎。用水三升。煮取一升二合。滤去药渣。分两次温服。体质强壮的人可用大附子一枚,干姜三两。
《内经》说:寒邪蕴结于内,用甘热之品治疗。又说:寒邪偏胜,用辛热之品平抑。甘草、干姜、附子相配合,成为甘辛大热的方剂,才能发散阴阳之气。
问曰:症状像阳旦证(桂枝汤证),按照常规法治疗反而加重,出现四肢厥冷、咽喉干燥、双腿拘挛急促且胡言乱语。老师说:预计半夜手足会变暖,双脚会伸直。后来果然如老师所说。为什么能知道这一点?回答说:寸口脉浮而大,浮则代表风邪,大则代表虚证。风邪导致轻微发热,虚证导致双腿拘挛。病症表现像桂枝汤证,因此在其中加入附子,增加桂枝用量,令其出汗。附子温通经脉,因为阳气亡失所致四肢厥冷。咽喉干燥,烦躁,阳明腑实内结,胡言乱语心烦意乱。再服用甘草干姜汤,半夜阳气回复,双脚当觉温暖,小腿尚且轻微拘挛急促,再次给予芍药甘草汤,然后小腿伸直。再用承气汤轻微通便,则停止其胡言乱语。所以知道病可痊愈。
阳旦是桂枝汤的别名。前面的症状脉浮,自汗出,小便频数,心烦,轻微恶寒,脚部拘挛急促,与桂枝汤证相似,这是症状像阳旦证。给予桂枝汤后病情加重,诊得寸口脉浮大,浮为风邪,大为血虚,即在桂枝汤中加入附子温经以补虚,增加桂枝令其出汗以祛风。对于因治疗不当而导致厥逆加重的,给予甘草干姜汤,阳气回复而足温。再给予芍药甘草汤,阴液调和而小腿伸直。表邪已解,阴阳已复,但仍有阳明内结导致的胡言乱语心烦意乱,少量给予调胃承气汤,轻微通便泄热以调和胃气,则阴阳之气皆和,内外之邪悉去。所以知道病可痊愈。
张卿子说:这两条条文展示了伤寒随症用药,如同转动圆环般灵活。表里寒热,意旨尽在于此。那么过去贤者所说的“用药宜寒者为传邪,宜温者为直中”,并非确论。
Gancao (Radix Glycyrrhizae Preparata, four liang, roasted, sweet and neutral in nature) Ganjiang (Rhizoma Zingiberis Preparatum, two liang, processed, pungent and hot in nature).
The above two ingredients are crushed. Boil with three sheng of water to obtain one sheng five he. Strain the dregs. Divide into two doses and take warm.
The *Neijing* states: Pungent and sweet disperse and generate Yang. The combination of Gancao and Ganjiang is used to restore Yang Qi.
Baishao (Radix Paeoniae Alba, four liang, sour and slightly cold in nature) Gancao (Radix Glycyrrhizae Preparata, four liang, roasted, sweet and neutral in nature).
The above two ingredients are crushed. Boil with three sheng of water to obtain one sheng half. Strain the dregs. Divide into two doses and take warm.
Baishao has a tonifying effect, whereas Chishao (Radix Paeoniae Rubra) has a purgative effect; white enters to astringe, while red enters to disperse. Sour flavor astringes, sweet flavor moderates. The combination of sour and sweet flavors is used to tonify Yin blood.
Dahuang (Radix et Rhizoma Rhei Preparated, four liang, skin removed, soaked in clear wine) Gancao (Radix Glycyrrhizae Preparata, two liang, roasted, sweet and neutral in nature) Mangxiao (Natrii Sulfas, half jin, salty, bitter, and extremely cold in nature).
The above three ingredients are crushed. Boil with three sheng of water to obtain one sheng. Strain the dregs. Add Mangxiao. Apply heat again, boil slightly until bubbling. Take small amounts warm.
The *Neijing* states: When heat invades internally, treat with salty-cold substances, assisted by bitter-sweet ones. Mangxiao is salty-cold to eliminate heat; Dahuang is bitter-cold to purge excess accumulation; Gancao is sweet and neutral, assisting these two substances to push out the old and moderate the middle jiao.
Gancao (Radix Glycyrrhizae Preparata, two liang, roasted, sweet and neutral in nature) Ganjiang (Rhizoma Zingiberis Preparatum, one liang half, pungent and hot in nature) Fuzi (Radix Aconiti Lateralis Preparata, one piece, raw, skin removed, broken into eight pieces, pungent and extremely hot in nature).
The above three ingredients are crushed. Boil with three sheng of water to obtain one sheng two he. Strain the dregs. Divide into two doses and take warm. For robust individuals, use one large piece of Fuzi and three liang of Ganjiang.
The *Neijing* states: When cold invades internally, treat with sweet-hot substances. It also states: When cold prevails, pacify with pungent-hot substances. The combination of Gancao, Ganjiang, and Fuzi forms a sweet-pungent and extremely hot formula, capable of dispersing the Qi of Yin and Yang.
Question: The symptoms resemble Yangdan syndrome (Gui Zhi Tang syndrome). Following standard treatment, the condition worsened, presenting with cold extremities (Jue Ni), dry throat, cramped calves, and delirium. The Master said: "Expect the hands and feet to become warm at midnight, and the legs to extend." Later, this proved true. How did you know this? Answer: The pulse at Cun Kou is floating and large. Floating indicates Wind, large indicates Deficiency. Wind generates slight fever; Deficiency causes calf cramping. The presentation resembles Gui Zhi Tang syndrome, so Fuzi was added to warm the channels, and Gui Zhi was increased to induce sweating. Fuzi warms the channels due to Yang collapse causing cold extremities. Dry throat, irritability, internal binding in the Yangming channel, delirious speech, and restlessness were treated with Gancao Ganjiang Tang. At midnight, Yang Qi returned, and the feet became warm. With calves still slightly cramped, Shaoyao Gancao Tang was administered again, leading to leg extension. Finally, Chengqi Tang was used mildly to soften stools, stopping the delirium. Thus, it was known that the disease could be cured.
Yangdan is an alias for Gui Zhi Tang. The previous case involved a floating pulse, spontaneous sweating, frequent urination, heart vexation, slight aversion to cold, and foot cramping, resembling Gui Zhi Tang syndrome; hence, it was described as resembling Yangdan. After administering Gui Zhi Tang, the condition worsened, revealing a floating and large pulse at Cun Kou. Floating indicates Wind pathogen, large indicates Blood deficiency. Therefore, Fuzi was added to Gui Zhi Tang to warm the channels and tonify deficiency, and Gui Zhi was increased to induce sweating and dispel Wind. For those whose Jue Ni worsened due to improper treatment, Gancao Ganjiang Tang was given to restore Yang and warm the feet. Then, Shaoyao Gancao Tang was given to harmonize Yin and extend the calves. Once the exterior pathogen was resolved and Yin-Yang restored, but internal Yangming binding with delirium and restlessness persisted, a small amount of Tiaowei Chengqi Tang was given to mildly purge and harmonize the Stomach. Thus, Yin and Yang Qi harmonized, and external and internal pathogens were eliminated. Hence, it was known that the disease could be cured.
Zhang Qingzi stated: These two clauses demonstrate treating Shanghan according to symptoms, like turning a wheel. The principles of interior/exterior and cold/heat are fully expressed here. Thus, the past sages' claim that "using cold herbs indicates transmitted pathogenic factors, while using warm herbs indicates direct invasion" is not an accurate theory.