知母(六两味苦寒) 石膏(一斤碎味甘寒) 甘草(二两味甘平) 粳米(六合
味甘平)
上四味。以水一斗。煮米熟。汤成。去滓、温服一升。日三服。
内经曰。热淫所胜。佐以苦甘。知母石膏之苦甘以散热。热则伤气。甘以缓之。甘
草粳米之甘以益气。成氏云。白虎。西方金神也。应秋而归肺。热甚于内者以寒下之。
热甚于外者。以凉解之。其有中外俱热。内不得泄。外不得发。非是汤则不能解。暑
之气。得秋而止。故曰处暑。是汤以白虎名。谓能止热也。
李东垣云。身以前。胃之经也。胸胃、肺之室也。邪在阳明。肺受火制。故用辛寒
以清肺。所以号为白虎也。
王三阳云。经文寒字。当邪字解。亦热也。
伤寒脉结代。心动悸。炙甘草汤主之。
结代之脉。动而中止。能自还者。名曰结。不能自还者。名曰代。由血气虚衰。不
能相续也。心中悸动。知真气内虚也。与炙甘草汤。益虚补血气而复脉。
甘草(四两炙味甘平) 生姜(三两切味辛温) 桂枝(三两去皮味辛热) 人参
(二两味甘温) 生地黄(一斤味甘寒) 阿胶(二两味温甘) 麦门冬(半升去心味甘
平) 麻子仁(半升味甘平) 大枣(十二枚擘味甘温)
上九味。以清酒七升。水八升。先煮八味。取三升。去滓。内胶烊消尽。温服一升。
日三服。一名复脉汤。
补可以去弱。人参甘草大枣之甘。以补不足之气。桂枝生姜之辛。以益正气。圣济
经曰。津液耗散为枯。五脏痿弱。荣卫涸。流剂所以润之。麻仁阿胶麦门冬地黄之甘。
润经益血。复脉通心也。
脉按之来缓。而时一止。复来者。名曰结。又脉来动而中止。更来小数。中有还者
反
动。名曰结阴也。脉来动而中止。不能自还。因而复动。名曰代阴也。得此脉者必难治。
结代之脉。一为邪气留结。一为真气虚衰。脉来动而中止。若能自还。更来小数。
止是邪气留结。名曰结阴。若动而中止。不能自还。因其呼吸。阴阳相引。复动者。是
真气衰极。名曰代阴。为难治之脉。经曰。脉结者生。代者死。此之谓也。
知母(六两,味苦性寒) 石膏(一斤,捣碎,味甘性寒) 甘草(二两,味甘性平) 粳米(六合,味甘性平)
以上四味药。用水一斗。煮至米熟。汤剂即成。滤去药渣。每次温服一升。每日服用三次。
《内经》说:热邪过盛时,用苦甘味的药物来辅助治疗。知母和石膏的苦甘之性可以发散热邪。热邪会损伤正气,甘味药可以缓和这种损伤。甘草和粳米的甘味可以补益正气。成无己说:白虎是西方的金神。对应秋季,归属于肺脏。体内热势极盛的,用寒凉药攻下;体表热势极盛的,用清凉药解表。如果内外俱热,内部的热无法宣泄,外部的热无法发汗,如果不是这个方子就不能解除病邪。暑气的特性,遇到秋天就会停止。所以叫处暑。这个方子以“白虎”命名,意思是能够制止热邪。
李东垣说:身体前部是胃的经脉所过之处。胸中是胃和肺所在的部位。邪气在阳明经,肺受到火邪制约,所以用辛寒的药物来清肺。因此被称为白虎。
王三阳说:经文中的“寒”字,应当解释为“邪”字,也就是热邪。
伤寒病出现脉象结代,心跳悸动不安,用炙甘草汤主治。
结代脉,脉搏跳动时有中止。能自行恢复接续的,名叫结脉。不能自行恢复接续的,名叫代脉。这是由于气血虚衰,不能连续运行所致。心中悸动,说明真气内部虚弱。给予炙甘草汤,以补益虚损、补血气并恢复脉象。
甘草(四两,蜜炙,味甘性平) 生姜(三两,切片,味辛性温) 桂枝(三两,去皮,味辛性热) 人参(二两,味甘性温) 生地黄(一斤,味甘性寒) 阿胶(二两,味温性甘) 麦门冬(半升,去心,味甘性平) 麻子仁(半升,味甘性平) 大枣(十二枚,掰开,味甘性温)
以上九味药。用清酒七升,水八升。先煮前八味药。取汁三升。滤去药渣。加入阿胶,加热使其完全溶化。每次温服一升。每日服用三次。又名复脉汤。
补法可以用来治疗虚弱。人参、甘草、大枣的甘味,用来补益不足的正气。桂枝、生姜的辛味,用来增益正气。《圣济经》说:津液耗散导致干枯,五脏痿弱,营卫枯竭,流剂(滋润类药物)用来润泽它们。麻仁、阿胶、麦门冬、地黄的甘味,能够润泽经脉、补益血液,恢复脉象并通利心脏。
脉搏按下去感觉来势缓慢,并且偶尔有一次停顿,之后又继续跳动的,名叫结脉。另外,脉搏跳动时中止,随后再次跳动时稍快一些,中间有恢复跳动的,名叫结阴脉。脉搏跳动时中止,不能自行恢复,因而再次跳动,名叫代阴脉。得到这种脉象的人一定难以治疗。
结代脉,一种是邪气留滞凝结,一种是真气虚衰。脉搏跳动时中止,如果能自行恢复,随后跳动稍快,这只是邪气留滞凝结,名叫结阴脉。如果跳动中止,不能自行恢复,随着呼吸,阴阳相互牵引,再次跳动,这是真气极度衰弱,名叫代阴脉,属于难治的脉象。经书说:脉结的还能生存,脉代的会死亡。说的就是这个道理。
Rhizoma Anemarrhenae (Zhimu, 6 liang, bitter and cold in nature) Gypsum Fibrosum (Shigao, 1 jin, crushed, sweet and cold in nature) Radix Glycyrrhizae Preparata (Gancao, 2 liang, sweet and neutral in nature) Oryza Sativa (Jingmi, 6 he, sweet and neutral in nature)
The above four ingredients. Use one dou of water. Boil until the rice is cooked. The decoction is ready. Strain out the dregs. Take one sheng warm. Three times a day.
The *Neijing* states: When heat pathogen prevails excessively, assist with bitter and sweet substances. The bitter and sweet properties of Rhizoma Anemarrhenae and Gypsum Fibrosum dissipate heat. Heat damages Qi; sweet substances moderate this damage. The sweetness of Radix Glycyrrhizae and Oryza Sativa tonifies Qi. Cheng Wuji stated: Baihu (White Tiger) is the Metal Spirit of the West. It corresponds to Autumn and associates with the Lung Organ. For extreme internal heat, use cold purgatives. For extreme external heat, use cool resolving methods. If there is heat both inside and outside, with internal heat unable to vent and external heat unable to sweat, only this decoction can resolve it. The nature of Summerheat ceases when Autumn arrives. Hence it is called Chushu (End of Heat). This decoction is named Baihu, meaning it can stop heat.
Li Dongyuan stated: The anterior aspect of the body is the pathway of the Stomach Meridian. The chest is the chamber of the Stomach and Lung. When pathogenic factors are in the Yangming Channel, the Lung is constrained by Fire. Therefore, acrid-cold herbs are used to clear the Lung. Thus it is called Baihu.
Wang Sanyang stated: The character "Han" (Cold) in the classic text should be interpreted as "Xie" (Pathogen), which also refers to Heat Pathogen.
In Shaoyang disease, if the pulse is Knotted or Intermitting, and there is palpitations, Zhi Gancao Tang (Honey-fried Licorice Decoction) is indicated.
Knotted and Intermitting pulses involve an interruption in the beating. If it recovers on its own, it is called Jie (Knotted) pulse. If it does not recover on its own, it is called Dai (Intermitting) pulse. This is due to the deficiency and decline of Blood and Qi, which cannot continue smoothly. Palpitations in the heart indicate that True Qi is internally deficient. Administer Zhi Gancao Tang to tonify deficiency, nourish Blood and Qi, and restore the pulse.
Radix Glycyrrhizae Preparata (Gancao, 4 liang, honey-fried, sweet and neutral in nature) Zingiberis Rhizoma Recens (Shengjiang, 3 liang, sliced, acrid and warm in nature) Ramulus Cinnamomi (Guizhi, 3 liang, bark removed, acrid and hot in nature) Radix Ginseng (Renshen, 2 liang, sweet and warm in nature) Radix Rehmanniae Recens (Shengdihuang, 1 jin, sweet and cold in nature) Colla Corii Asini (Ejiao, 2 liang, warm and sweet in nature) Radix Ophiopogonis (Maimendong, half sheng, heart removed, sweet and neutral in nature) Semen Cannabis (Huozhiren, half sheng, sweet and neutral in nature) Fructus Jujubae (Dazao, 12 pieces, split, sweet and warm in nature)
The above nine ingredients. Use seven sheng of clear wine and eight sheng of water. First boil the first eight ingredients. Obtain three sheng of liquid. Strain out the dregs. Add Colla Corii Asini and melt it completely. Take one sheng warm. Three times a day. Also known as Fumai Tang (Pulse-Restoring Decoction).
Tonification methods can treat weakness. The sweetness of Radix Ginseng, Radix Glycyrrhizae Preparata, and Fructus Jujubae tonifies deficient Qi. The acridity of Ramulus Cinnamomi and Zingiberis Rhizoma Recens benefits Righteous Qi. The *Shengji Jing* states: Consumption and dispersion of Body Fluids lead to dryness; atrophy and weakness of the Five Viscera; exhaustion of Ying and Wei. Moistening agents are used to lubricate them. The sweetness of Semen Cannabis, Colla Corii Asini, Radix Ophiopogonis, and Radix Rehmanniae Recens moistens the Channels, benefits Blood, restores the pulse, and unblocks the Heart.
When pressed, the pulse feels slow, and occasionally stops once, then resumes, it is called Jie (Knotted) pulse. Additionally, if the pulse beats and stops, then resumes slightly faster, with recovery in between, it is called Jieyin (Knotted Yin) pulse. If the pulse beats and stops, cannot recover on its own, and thus resumes, it is called Daiyin (Intermitting Yin) pulse. Those obtaining this pulse are difficult to treat.
Knotted and Intermitting pulses: one type is due to pathogenic factors lingering and knotting; the other is due to the deficiency and decline of True Qi. When the pulse beats and stops, if it recovers on its own and resumes slightly faster, this is merely pathogenic factors lingering and knotting, called Jieyin pulse. If it beats and stops, cannot recover on its own, and due to respiration, Yin and Yang attract each other to resume, this is extreme deficiency of True Qi, called Daiyin pulse, which is a difficult-to-treat pulse. The classics state: Those with Knotted pulses survive; those with Intermitting pulses die. This is what is meant.