。甘草倍桂枝者,并益中气而和三物也。曰枳实薤白桂枝汤。胸痹是病名,下乃详言其证,
以胸痹有不同也。气至于结,胸至于满,薤栝力有不逮矣。故更以桂枝佐薤白散结,浓朴佐
栝蒌泄满。枳实用为君者,所以平胁逆也。曰竹叶汤。此中风由寒化热,将由太阳入阳明而
真阳适虚之证。桂枝解表化气,以铲寒邪之根。只用一两者,以病本无汗,多则侵葛防发散
之权也。
桂枝用二两之方,曰麻黄汤。桂枝所到之处,皆麻黄所到之处。既用麻黄又加桂枝,愚
于麻黄已略着其说,试更申之∶伤寒之邪,锢闭营卫,至于头痛身痛腰痛骨节痛,发之既暴
而所及复广,非得横厉无前之麻黄,不足以戡定祸乱。非得从容不迫之桂枝,不足以搜捕余
孽。且麻黄性刚,桂枝性柔,以刚遇柔,并能少节其性,不致直前罔顾。桂枝只二两者,以
倚重在麻黄也。曰桂枝加黄 汤。此段叙黄汗之证甚杂,注家亦颇颟顸。大抵营卫之间,水
与热交蒸而滞其行度,非挟寒挟虚不尔。欲温经化气以泄黄汗而取正汗,自惟桂枝汤为当。
第桂枝汤所治为卫强,此则卫弱,故加黄 益卫气而疏之。更减桂芍以节其内向而外交于卫,
斯邪不能容而正乃复矣。桂芍黄 三味,为黄汗必需之药。彼 芍桂酒汤,多其数而又重加
苦酒者,以脉沉非此不能泄邪也。曰浓朴七物汤。桂只二两加生姜用至五两,则散寒之力优,
不致因桂留邪矣。表里兼治,故以大枣安中,甘草和之。草不炙者,以有小承气攻里,不宜
过守也。姜多枣少者,病非自汗,不以补表也。曰茯苓甘草汤。伤寒汗出而渴者,五苓散主
之。汗出属表邪未尽,渴则太阳之邪已由标传本,以五苓散表里两解之,其小便不利可知。
此与脉浮小便不利微热消渴与五苓散者,正复无异。下云不渴者茯苓甘草汤主之,是明指尚
有表邪而言。不渴则胃不热而水停于上,又与真武汤及茯苓桂枝白术甘草汤之汗出液虚,肾
水上救相似,不过有微甚之分耳。彼甚此微,故但以茯苓一味消心下之水,桂甘生姜解其表
邪,即无他虑。桂甘少用者,并辅其扶心阳治悸也。无芍药者,邪已传本,若再敛之,则表
不解也。无大枣者,茯苓少则肾不伤,不必滋液也。曰茯苓泽泻汤。胃反由胃中虚冷,桂枝
协生姜散寒,协甘草温中。以治在上焦,故只用二两。余详茯苓。曰桃核承气汤。此于外解
后用之,桂枝岂为解表而。设太阳传本,热与血结而为少腹急结,桃仁黄硝,皆所以攻之。
气为血帅,气行而血乃行,故以桂枝入膀胱化气。甘草则甘以缓急也。桂只二两,何以能入
膀胱?以大黄辈得之则与俱下,且多则助膀胱之热也。曰桂枝加葛根汤。葛根治项背强
KTKT ,义详葛根。葛根汤与此只麻黄一味有无之分,以彼为无汗恶风,此为汗出恶风
也。
太阳病汗出恶风,桂枝汤正其所宜。惟加葛根以治项背强KT KT ,则以解肌起阴气为重,
和营卫次之,故桂芍减桂枝汤各一两。曰温经汤。桂枝少则疏通经脉,约以芍药,则能入下
焦化气。用姜不用枣者,不以补表也,余详吴茱萸。曰木防己汤。膈属肺胃肾三焦之脉所历。
支饮横于膈间,滞其肺胃之气,则喘、则满、则心下痞坚;下与肾相感召,则肾气上乘,而
面色黧黑;脉得沉紧,病固不独在上也。防己外白内黄,有黑纹如车辐,气味辛平,能行膈
间之水,由三焦以下输于肾,肾得之则气平。佐以桂枝,一苦一辛以散结,则心下之痞坚去。
然停饮至数十日之久,肺胃已郁而成热,非泄热则喘满不止,故又佐以石膏。吐下之后,中
气与津液大亏,故又佐以人参。又云虚者即愈,实者三日复发,虚与实皆指肾气而言。肾虚
则肺降而肾安,实则非咸寒以利之,淡渗以伐之,气必复上。注家不知其证之关肾,好为影
响之谈,那得于药证有合。
桂枝用二两半之方,曰薯蓣丸。风气百疾,盖即风虚之证,久踞于肌肉筋节间,而非初
感之可以汗解者也。虚劳诸不足,乃其病根所在。方以补虚为主,驱风次之。薯蓣人参白术
甘草地黄麦冬阿胶大枣,填补者也。余十三味,疏瘀郁、调阴阳,以补虚而驱风者也。其真
正风药,只防风一味耳。填补中兼能驱风者,以薯蓣为最,故君之。
桂枝用三两之方,曰桂枝生姜枳实汤。心中痞悬痛,与胸痹痛有别,故不用瓜栝薤白。
悬痛由下有逆上之气,使痛不得下,如物之空悬,其为心阳不布,阴邪得以窃据无疑。故用
姜桂各三两,以伸阳而散邪。诸逆不离乎肝,枳实酸入肝而苦降逆,逆降则痛除而心阳得复
矣。曰防己茯苓汤。桂枝得防己黄 ,则能行皮肤之水。重加茯苓者,引三物下降,使由小
便去也。水在皮肤,下之速则有遗邪,故加甘草以缓之。曰苓桂术甘汤。痰饮者寒饮也,心
阳不足,痰饮得以窃据膈间,故胸满。木得水而风动,土不能为之防,故胁满而目亦眩。满
曰支者,明满之由肝来也。以桂甘益心阳而化气,白术崇脾土而燥湿,茯苓则自心下导饮而
泄之,此治寒饮之主方也。曰桂枝去芍药加蜀漆龙骨牡蛎救逆汤。此与桂枝龙骨牡蛎汤治无
大异。惟惊狂起卧不安,较烦躁尤重,故桂甘龙牡皆倍增之。彼无表邪,而此则脉浮,故加
蜀漆协桂枝以散邪。既解其表,必补其表,故加姜枣以和营卫。用桂枝汤而必去芍药者,以
不汗出也。曰栝蒌桂枝汤。仲圣于桂枝加葛根汤,云反汗出恶风,此云脉反沉迟,反字自宜
着眼。盖太阳证备,必身热头痛汗出,脉不应沉迟而沉迟,故云反。柔痉原有沉迟之脉,故
又以此为痉而申明之。证皆桂枝汤所有,故用桂枝汤全方,身体强KT KT 然,则非痉不
尔。加栝蒌不加葛根者,即体强与项强之别。其濡养筋脉以治强直,则二物一也。曰乌头桂
枝汤。寒疝、腹中痛、逆冷、手足不仁、若身疼痛,若者及也,非或然之词,以身疼痛为表
证,故加一若字以别之。此表里伤于寒邪之重者,乌头驱表里之寒,桂枝汤化表里之气,互
相为用。乌头以蜜煎,则毒解而性和。桂枝汤用治腹痛亦散表邪,故芍药不再加。桂枝汤与
乌头均浓煎,而得蜜之甘润,则补中缓急,处处皆弥纶无间。故其知也如醉状,而邪则吐之,
岂灸刺诸药所能及欤。曰黄 桂枝五物汤。血痹阴阳俱微,桂枝汤调阴阳有余而通痹不足。
故加黄 以疏卫,增生姜以宣阳。义主理虚,而守补太过,则非血痹所宜,故甘草去之。无
表邪,故不取汗不温复。与桂枝加黄 汤,似同而实异者此也。曰泽漆汤。此与浓朴麻黄汤,
皆外寒与内饮相搏而咳者。脉浮者表邪方盛,故重与解表。此咳而脉沉,非无表邪,但轻微
耳。彼用麻杏,此用桂姜,犹麻黄汤桂枝汤之分伤寒中风也。饮亦彼重此轻,故彼用半夏六
升,此用半升。彼热邪在肺,故加石膏,此热邪较下,故加黄芩。彼治咳用姜辛五味,即小
青龙成法,水停在上。此水不上乘,故但以泽漆紫参白前降逆导饮而咳亦止。邹氏释泽漆至
精,谓能使水气还归于肾,是用泽漆亦与用五味有微似之处。然则彼无人参何为?彼所治皆
一气外散。人参乃止咳善后之策,于散寒蠲饮无与也。此则表里分投,上下背驰,安得不以
人参调和之。曰白虎加桂枝汤。尤氏释此方极当。惟以桂枝为因而达之,颇涉颟顸,不如赵
氏疗骨节痹痛之说。然不发明伏气,亦犹之泛也。盖寒邪伏于肾脏,至春夏发出,虽已无寒
但热,而骨节烦疼,则仍是根株未拔。肝主筋,诸筋皆属于节,桂枝亦肝药,故加桂枝以搜
骨节烦疼之伏邪。否则但以白虎治热,疟终不服也。曰侯氏黑散。大风有菊花防风辈任之,
桂枝是与川芎当归治心中恶寒。曰当归四逆汤。厥阴病血虚而寒中之,故手足厥寒脉细欲绝。
当
邪已及肾,故加细辛以驱肾寒,犹少阴病之兼肝药也。用桂枝汤而无姜者,恶其发散以伤阴
也。曰炙甘草汤。脉结代,是营血虚衰。心主营而生脉,故动悸。地麦胶麻,所以养营阴。
桂枝甘草,所以扶心阳。人参所以生脉。姜枣所以和营卫。然甘草协参枣,则又能补中。生
姜协桂草,则又能宣壅。枣草皆多于姜者,不使过散以伤神也。清酒煮者,欲引诸药以通络
也。曰桂枝加附子汤。此与桂枝去芍药加附子汤,只争芍药一味之出入。彼去芍药,为下后
脉促胸满。加附子为微恶寒。此四肢微急,难以屈伸,亦阳虚之象,不可无附子。汗漏不止
小便难,则表邪未尽而津液又亏矣。桂枝汤正治自汗和营卫之方,芍药极要,何可去之。曰
桂枝加浓朴杏仁汤。说详杏仁。曰防己地黄汤。说详防己。曰桂枝加芍药汤。此条注家泥于
太阳病医反下之句,又但以桂枝汤为太阳病解表之方。或云非脾脏之寒,或云和太阴之经,
或云发太阳之邪,或云越外入之邪,或云举误陷之邪,皆于是证是方,不关痛痒。太阳病误
下之后,至于腹满时痛,是已入太阴之脏矣。太阴为阴之至,决无升理。就证论证,焉得不
先救其药误。夫桂枝汤之为用甚多,或以本方略为增减,或只选二三味,或只用桂枝,以及
桂枝汤再加他药之或多或少,即证治悬殊,不得执太阳表邪为例。况以桂枝解表,遇无汗者
概不用芍药。今以芍药为少而再加一倍,岂尚存解表之见耶。大痛实者于此汤再加大黄一两
,宁非太阳病之陷入者,而得谓举邪使出耶。然则桂枝加芍药汤,断不必于解表致思。更有
可比例以明之者,小建中汤比桂枝加芍药汤,只多饴糖一味耳。千金再加当归,名内补当归
建中汤,其芍药亦仍是此数。前圣后贤,心心相印,未闻此两方亦发其表邪。夫太阴者阴脏
也,统血者也。为下药所苦,致阴气结而不舒,腹满时痛,芍药虽寒,而能破脾家血中之气
结,善治腹痛。然结固破矣,非有桂枝,则黍谷之春,终不得回。以桂枝有外心无内心,重
加芍药以敛之,则能入脾而不走表。且桂枝得生姜则散寒,得甘草大枣则补中,皆赖芍药为
之前导,故非用加一倍不可。结破中补而阳亦复,腹满时痛,恶能不愈,此满痛之治法。急
痛非小建中不可,以饴能缓急亦能助满,方剂自各有当也。徐忠可谓自究心金匮,用桂枝取
效,变幻出奇,不可方物。旨哉言乎。曰桂枝加龙骨牡蛎汤。愚以此为专治脉得诸芤动微紧
,男子失精、女子梦交之方,已于解天雄略及之。按用桂枝汤原方,必于桂枝汤所治有吻合
之处。脉芤动微紧,有阴阳乖迕之象。桂枝汤正所以和阴阳,阴阳乖迕,则精不守,神不藏
。龙牡能召阳敛阴,涩精安神,故加之也。
桂枝用四两之方,曰桂苓五味甘草汤。此支饮渍肺而咳,引动肾气,从下上冲,复从上
下流阴股,其多唾口燥及小便难时复冒诸端,皆因是而致。治以茯苓消饮,桂枝下冲,甘草
培中土以杜肾水之上乘,五味摄肾阴以召肺气之下降,证甚繁而药甚简,所谓握要以图也。
凡仲圣治寒饮之咳,无不以姜辛五味并用。兹有五味无姜辛,以姜辛助面热故去之,五味补
尺微故取之也。桂枝为下冲专药,虽助阳不得而避也。迨服之而冲气果低,反更咳胸满,正
当以桂枝治胸满矣。而转去桂加姜辛曷故,盖姜辛与五味本不能偏废,咳而胸满,咳治则胸
满亦治。加姜辛为与五味治咳也,面热本不宜桂枝,冲气低则去之便也。若茯苓蠲肺饮伐肾
邪,则断无可去之理矣。曰桂枝附子汤。伤寒至八九日,风寒之邪未尽,适遇阳虚之体,里
湿与外风相搏,遂致身体疼烦不能自转侧。脉浮为风,涩与虚为阳虚挟湿,阳虚而无别因,
故不呕不渴,此桂枝汤为解表必需之剂。阳虚则非附子扶阳不可,协桂枝又足以并驱风湿,
故加之。脉浮无汗则不宜敛,故去芍药。桂枝加桂枝汤一两者,重则能达下利小便也。曰甘
草附子汤。桂枝与附子,皆风寒风湿并治,惟附子尤能扶阳。此风湿相搏,阳虚之甚,非附
子不胜其任,故方名隐桂枝而标附子。以甘草冠首者,湿不宜人参,身肿又不宜姜枣,甘草
补中缓外,功不可没也。附子化湿而不能御湿,加白术者,崇土以御湿也。小便不利,并以
桂枝利小便,故多其数也。曰桂枝人参汤。此理中汤加桂枝也。理中为治霍乱寒多之方。此
数下致虚,虽挟热而利,脉必微弱(说本金鉴),当以寒多论治。干姜甘术,温中补虚,即
理中之成法。彼兼呕吐,故甘草生用以和胃;此利下虚甚,宜于守补,故甘草炙之而又多其
数。桂枝后煎而必用四两者,欲其解表而并散心下痞硬也。霍乱为上下不和,此为表里不和,
故均用人参以和之。曰桂枝甘草汤。发汗过多,伤其心气,致叉手冒心心悸欲按,与真武汤
汗后肾水上乘有他证者不同,只须补其心气,桂枝汤桂甘二味即属妙法。桂枝不以利小便而
亦用四两者,心气虚甚,非多不济,且轻扬之性,上虚则即归上,势固然也。曰茯苓桂枝甘
草大枣汤。桂枝甘草汤为汗后心悸欲按,此为汗后脐下悸,因同而证不同。彼必心气素亏,
甘草用量加倍于桂枝的方剂,是为了同时补益中气并调和这三味药。这里提到的是枳实薤白桂枝汤。“胸痹”是病名,下文详细叙述其证候,是因为胸痹有不同的表现。当气机郁结至极点,胸部胀满严重,仅靠薤白和瓜蒌的力量已经不足以胜任。因此,再用桂枝辅助薤白以散结,厚朴辅助瓜蒌以泄满。枳实作为君药,是用来平抑胁肋部的气逆。
这里提到竹叶汤。这是中风由寒邪转化为热邪,即将从太阳经传入阳明经,而患者真阳恰好虚弱的证候。桂枝能解表化气,以铲除寒邪的根本。这里只用一两桂枝,是因为病本无汗,如果用量过多,会侵夺葛根、防风发散的功效。
桂枝用二两的方剂,如麻黄汤。桂枝所到达的地方,都是麻黄所到达的地方。既然用了麻黄又加上桂枝,我此前在论述麻黄时已略作说明,现在再进一步阐述:伤寒之邪,束缚闭塞营卫,导致头痛、身痛、腰痛、骨节疼痛,发病既猛烈又波及广泛,非得气势横厉、一往无前的麻黄,不足以平定祸乱;非得从容不迫的桂枝,不足以搜捕残余的病邪。而且麻黄性刚烈,桂枝性柔和,以刚遇柔,能够稍微节制它们的药性,不至于直冲向前而不顾后果。桂枝只用二两,是因为主要倚重麻黄的作用。
这里提到桂枝加黄芪汤。这段文字叙述的黄汗证候非常繁杂,注家也颇为糊涂。大抵是在营卫之间,水湿与热邪交蒸,阻滞了运行通道,如果不是夹杂寒邪或虚证,不会这样。想要温通经脉、化气行水以排出黄汗而取得正常的汗液,自然只有桂枝汤最合适。只是桂枝汤所治疗的是“卫强”,而此证则是“卫弱”,所以加入黄芪来补益卫气并疏利它。再减少桂枝和白芍的用量,以节制其向内收敛的趋势,转而向外通达于卫分,这样邪气就无法容留,正气就能恢复。桂枝、白芍、黄芪三味药,是治疗黄汗必需的药物。至于芍药桂枝酒汤,增加了药量又重加苦酒(醋),是因为脉象沉伏,不用这些药物不能泄出邪气。
这里提到厚朴七物汤。桂枝只用二两,生姜用到五两,那么散寒的力量就优越了,不至于因为桂枝而留滞邪气。这是表里兼治的方子,所以用大枣安护中焦,甘草调和诸药。甘草不炙,是因为有小承气汤攻下里实,不宜过于守中。生姜多、大枣少,是因为病非自汗,不需要用来补益表分。
这里提到茯苓甘草汤。伤寒汗出且口渴的,用五苓散主治。汗出属于表邪未尽,口渴则说明太阳之邪已由标传本,用五苓散表里双解,由此可知小便不利。这与前文提到的脉浮、小便不利、微热、消渴而用五苓散的证候,正完全相同。下文说“不渴的,用茯苓甘草汤主治”,这是明确指尚有表邪存在。不渴则胃中没有热邪而水饮停聚在上焦,这又与真武汤及茯苓桂枝白术甘草汤证的汗出津液亏虚、肾水上凌相似,只不过有轻重之分罢了。彼证重此证轻,所以只用茯苓一味来消除心下的水饮,桂枝、甘草、生姜来解除表邪,就没有其他顾虑了。桂枝、甘草少量使用,是为了辅助扶助心阳以治疗心悸。没有芍药,是因为邪气已传入里,如果再收敛,表邪就不能解了。没有大枣,是因为茯苓量少则不伤肾,不必滋阴生津。
这里提到茯苓泽泻汤。胃反(呕吐反胃)是由于胃中虚冷,桂枝协同生姜散寒,协同甘草温中。因为病位在上焦,所以桂枝只用二两。其余详情参考茯苓条。
这里提到桃核承气汤。这是在表证已解之后使用的方剂,桂枝难道是为了解表吗?假设太阳经邪气传入里,热邪与瘀血结聚在下腹部,导致少腹急结,桃仁、大黄、芒硝,都是用来攻逐瘀热的。气为血之帅,气行则血行,所以用桂枝入膀胱经以化气。甘草则是利用其甘缓之性来缓解急迫。桂枝只用二两,怎么能入膀胱呢?因为大黄等药得到桂枝的引导就能随之下行,而且用量多了会助长膀胱的热邪。
这里提到桂枝加葛根汤。葛根治疗项背强几几(僵硬不舒),义理详见葛根条。葛根汤与此方只有一味麻黄的有无区别,前者是无汗恶风,后者是有汗恶风。
太阳病出现汗出、恶风,桂枝汤正是适宜的方剂。只是加入葛根来治疗项背强几几,是以解肌、升发阴气为主,调和营卫为辅,所以桂枝和白芍比桂枝汤各减少一两。
这里提到温经汤。桂枝用量少,可以疏通经脉,配合芍药,就能进入下焦化气。用生姜不用大枣,不是为了补益表分,其余详情参考吴茱萸条。
这里提到木防己汤。膈部是肺、胃、肾、三焦经脉经过的地方。支饮横亘在膈间,阻滞了肺胃之气,就会出现喘促、胀满、心下痞塞坚硬;向下与肾气相互感召,肾气就会上乘,导致面色黧黑;脉象沉紧,说明病固然是不仅仅在上焦。防己外白内黄,有像车轮辐条一样的黑色纹理,气味辛平,能行膈间的水饮,通过三焦向下输送到肾,肾得到它则气机平和。佐以桂枝,一苦一辛以散结,心下的痞塞坚硬就能消除。然而停饮长达数十日,肺胃已经郁滞而成热,如果不泄热,喘满就不会停止,所以又佐以石膏。吐下之后,中气和津液大亏,所以又佐以人参。又说“虚证即愈,实证三日复发”,这里的虚与实都是指肾气而言。肾虚则肺气下降而肾气安宁,实证则非用咸寒以利之、淡渗以伐之,气必然会上复。注家不知道这个证候的关键在于肾,喜欢说些牵强附会的言论,怎么能符合药证呢?
桂枝用二两半的方剂,是薯蓣丸。风气百疾,大概也就是风虚的证候,长久盘踞在肌肉筋节之间,不是初感风寒可以用汗法解决的。虚劳诸不足,是它的病根所在。方子以补虚为主,驱风次之。薯蓣、人参、白术、甘草、地黄、麦冬、阿胶、大枣,是用来填补虚损的。其余十三味药,是疏解瘀滞郁结、调和阴阳,以补虚而驱风的。其中真正的风药,只有防风一味而已。在填补之中兼能驱风的,以薯蓣最为擅长,所以作为君药。
桂枝用三两的方剂,是桂枝生姜枳实汤。心中痞塞悬痛,与胸痹的疼痛不同,所以不用瓜蒌、薤白。悬痛是由下有上逆之气,使疼痛不得下行,如同物体空悬一样,这显然是心阳不布,阴邪得以窃据所致。所以用生姜、桂枝各三两,以伸展阳气而散除邪气。各种逆气都离不开肝,枳实酸入肝而苦降逆气,逆气降则疼痛消除而心阳得以恢复。
这里提到防己茯苓汤。桂枝得到防己、黄芪,就能运行皮肤间的水饮。重用茯苓,是引导这三味药下行,使水饮从小便排出。水在皮肤,攻下太速则会遗留邪气,所以加甘草来缓和它。
这里提到苓桂术甘汤。痰饮就是寒饮,心阳不足,痰饮得以窃据膈间,所以胸部胀满。木得水则风动,土不能为之防备,所以胁部胀满且眼睛眩晕。胀满称为“支”,明确说明胀满是由肝引起的。用桂枝、甘草补益心阳而化气,白术崇厚脾土而燥湿,茯苓则从心下引导饮邪而泄出,这是治疗寒饮的主方。
这里提到桂枝去芍药加蜀漆龙骨牡蛎救逆汤。这与桂枝龙骨牡蛎汤治疗上没有太大差异。只是惊狂、起卧不安,比烦躁更严重,所以桂枝、甘草、龙骨、牡蛎都加倍使用。彼方无表邪,而此方脉浮,所以加蜀漆协同桂枝以散邪。既然解除了表邪,必须补益表分,所以加生姜、大枣以调和营卫。用桂枝汤但必须去掉芍药,是因为无汗出。
这里提到栝楼桂枝汤。仲景在桂枝加葛根汤条文中,说“反汗出恶风”,这里说“脉反沉迟”,“反”字应当着重体会。大概是太阳证具备,必定身体发热、头痛、汗出,脉象不应沉迟却沉迟,所以说“反”。柔痉原本就有沉迟的脉象,所以又以此解释为痉病并加以申明。证候都是桂枝汤所有的,所以用桂枝汤全方,身体强直不舒,就不是痉病不会这样。加栝楼不加葛根,就是身体强直与项背强直的区别。它们濡养筋脉以治疗强直,作用是一样的。
这里提到乌头桂枝汤。寒疝、腹中痛、四肢逆冷、手足麻木不仁,以及身体疼痛,“若”字表示涉及,不是或者的意思,因为身体疼痛是表证,所以加一个“若”字来区别。这是表里都受到严重寒邪损伤的情况,乌头驱散表里的寒邪,桂枝汤化解表里的气机,互相为用。乌头用蜜煎煮,则毒性解除而药性和缓。桂枝汤用于治疗腹痛也能散除表邪,所以芍药不再添加。桂枝汤与乌头都浓煎,再加上蜂蜜的甘润,就能补中缓急,处处都严密无间。所以服药后感觉像喝醉了一样,而邪气则通过呕吐排出,难道是灸刺和其他药物所能达到的吗?
这里提到黄芪桂枝五物汤。血痹阴阳俱微,桂枝汤调理阴阳有余但通痹不足。所以加黄芪以疏利卫气,增生姜以宣通阳气。义理主在调理虚损,但如果守补太过,就不适合血痹,所以去掉甘草。没有表邪,所以不发汗、不温覆。这与桂枝加黄芪汤,看似相同实则不同,就是这个原因。
这里提到泽漆汤。这与厚朴麻黄汤,都是外寒与内饮相搏结而咳嗽的。脉浮说明表邪正盛,所以重用解表药。此方咳嗽而脉沉,并非没有表邪,只是轻微罢了。彼方用麻黄、杏仁,此方用桂枝、生姜,就像麻黄汤与桂枝汤区分伤寒与中风一样。饮邪也是彼重此轻,所以彼方用半夏六升,此方用半升。彼方热邪在肺,所以加石膏,此方热邪位置较低,所以加黄芩。彼方治疗咳嗽用生姜、细辛、五味子,就是小青龙汤的成法,水饮停在上焦。此方水饮不上乘,所以只用泽漆、紫参、白前降逆导饮,咳嗽也就停止了。邹氏对泽漆的解释非常精辟,认为能使水气还归于肾,是用泽漆也与用五味子有微小的相似之处。然而彼方为什么没有人参呢?彼方所治疗的都是一气外散。人参是止咳善后的策略,与散寒蠲饮没有关系。此方则表里分投,上下背离,怎能不用人参来调和呢?
这里提到白虎加桂枝汤。尤氏对此方的解释极为恰当。只是把桂枝当作病因来通达它,颇有些糊涂,不如赵氏治疗骨节痹痛的说法。然而如果不阐明伏气的概念,也显得泛泛。大概是寒邪潜伏在肾脏,到了春夏季发出,虽然已经没有寒邪只有热邪,但骨节烦疼,仍然是病根未除。肝主筋,诸筋都归属于节,桂枝也是入肝的药,所以加桂枝来搜剔骨节烦疼的伏邪。否则只用白虎汤治疗热邪,疟疾终究不会痊愈。
这里提到侯氏黑散。大风病有菊花、防风等药负责,桂枝是与川芎、当归一起治疗心中的恶寒。
这里提到当归四逆汤。厥阴病血虚而寒邪侵入,所以手足厥冷、脉细欲绝。当邪气已经波及肾脏,所以加细辛以驱散肾寒,就像少阴病兼用肝药一样。用桂枝汤但没有生姜,是厌恶它发散而损伤阴血。
这里提到炙甘草汤。脉结代,是营血虚衰。心主营而生脉,所以动悸。地黄、麦冬、阿胶、麻黄(此处原文可能有误,通常指麦冬、阿胶、生地、麻仁等养阴血之品,或指麻黄在此处非主药,依原文翻译),是用来滋养营阴的。桂枝、甘草,是用来扶助心阳的。人参是用来生脉的。生姜、大枣是用来调和营卫的。然而甘草配合人参、大枣,又能补益中气。生姜配合桂枝、甘草,又能宣通壅滞。大枣、甘草多于生姜,是不使其过度发散而损伤神气。用清酒煎煮,是想引导诸药以通络脉。
这里提到桂枝加附子汤。这与桂枝去芍药加附子汤,只差一味芍药的出入。彼方去芍药,是因为下法后脉促、胸满。加附子是因为微恶寒。此方四肢微急,难以屈伸,也是阳虚的表现,不可没有附子。汗漏不止、小便难,则表邪未尽而津液又亏损了。桂枝汤正是治疗自汗、调和营卫的方子,芍药非常重要,怎么能去掉呢?
这里提到桂枝加厚朴杏子汤。详细说明见杏仁条。
这里提到桂枝加芍药汤。这一条注家拘泥于“太阳病医反下之”这句话,又仅仅把桂枝汤看作太阳病解表的方子。有人说不是脾脏的寒证,有人说调和太阴经,有人说发越太阳之邪,有人说举出外入之邪,有人说举起误陷之邪,都对这种证候和方剂无关痛痒。太阳病误下之后,出现腹满时痛,已经是进入太阴脏了。太阴是阴之极,决没有上升的道理。就证候论证候,怎么能不先救治药物的错误呢?桂枝汤的运用非常广泛,有的在原方基础上稍作增减,有的只选两三味药,有的只用桂枝,以及桂枝汤再加其他药物或多或少的变化,即使证治悬殊,也不能执着于太阳表邪为例。况且用桂枝解表,遇到无汗者一概不用芍药。现在因为芍药量少而再加一倍,难道还存有解表的想法吗?大痛属实者在这个方子上再加大黄一两,岂不是太阳病陷入的邪气,而能说举邪外出吗?既然如此,桂枝加芍药汤,断不必在解表上费心思。更有可以类比来说明的,小建中汤比桂枝加芍药汤,只多饴糖一味而已。千金方再加当归,名叫内补当归建中汤,其中的芍药数量也还是这个数。前圣后贤,心心相印,没听说这两个方子也是发其表邪。太阴是阴脏,统摄血液。被下药所苦,导致阴气结聚而不舒展,腹满时痛,芍药虽然性寒,但能破除脾家血中的气结,善于治疗腹痛。然而结聚固然破除了,如果没有桂枝,就像没有春天的温暖,终究无法回春。因为桂枝有心外无心内(意指桂枝主要走表、走外),重用芍药来收敛它,就能进入脾脏而不走表。而且桂枝得到生姜则散寒,得到甘草、大枣则补中,都依赖芍药作为前导,所以非要用加倍的量不可。在破除结聚的同时补益,阳气也能恢复,腹满时痛,怎么能不好呢?这是治疗满痛的方法。急痛非小建中汤不可,因为饴糖能缓急也能助满,方剂自然各有适宜之处。徐忠可真是用心研究《金匮要略》,使用桂枝取得疗效,变幻出奇,不可估量。这话真是深刻啊。
这里提到桂枝加龙骨牡蛎汤。我认为这是专门治疗脉象出现芤、动、微、紧,男子失精、女子梦交的方子,此前在解说天雄时已略加提及。按使用桂枝汤原方,必定与桂枝汤所治疗的证候有吻合之处。脉象芤、动、微、紧,有阴阳乖违不顺的现象。桂枝汤正是用来调和阴阳的,阴阳乖违,则精不守,神不藏。龙骨、牡蛎能召阳敛阴,涩精安神,所以加入它们。
桂枝用四两的方剂,是桂苓五味甘草汤。这是支饮浸渍肺部而咳嗽,引动肾气,从下向上冲逆,又从上向下流注于阴股,其多唾、口燥以及小便困难、时常头晕等各种症状,都是因为这个原因导致的。治疗用茯苓消除饮邪,桂枝平降冲逆,甘草培补中土以杜绝肾水之上凌,五味子摄纳肾阴以召唤肺气之下降,证候很繁杂但用药很简单,这就是所谓抓住关键来谋划。凡是仲景治疗寒饮咳嗽,无不使用生姜、细辛、五味子并用。这里只有五味子而没有姜、辛,是因为姜、辛助面部发热所以去掉,五味子补尺脉微弱所以取用。桂枝是治疗冲逆的专药,虽然助阳也不得避开它。等到服用后冲气果然降低,反而又出现咳嗽、胸满,正当用桂枝治疗胸满的时候。却转而去掉桂枝加上姜、辛,为什么呢?大概姜、辛与五味子本来不能偏废,咳嗽而胸满,治好了咳嗽胸满也就好了。加姜、辛是为了与五味子配合治疗咳嗽,面部发热本来不宜用桂枝,冲气降低后去掉它就方便了。如果茯苓蠲除肺饮、伐除肾邪,那就绝对没有去掉的道理了。
这里提到桂枝附子汤。伤寒到了八九天,风寒之邪未尽,恰好遇到阳虚体质的人,里湿与外风相搏结,导致身体疼痛烦扰,不能自行转侧。脉浮为风,涩与虚为阳虚挟湿,阳虚而没有其他原因,所以不呕不渴,这是桂枝汤为解表必需的药剂。阳虚则非附子扶阳不可,配合桂枝又足以并驱风湿,所以加入附子。脉浮无汗则不宜收敛,所以去掉芍药。桂枝汤中增加桂枝一两,重用则能下达利小便。
这里提到甘草附子汤。桂枝与附子,都能治疗风寒风湿,惟独附子更能扶阳。这是风湿相搏,阳虚得很厉害,非附子不胜任,所以方名隐去桂枝而标榜附子。以甘草冠首,是因为湿邪不宜用人参,身体肿胀又不宜用姜、枣,甘草补中缓外,功劳不可磨灭。附子化湿但不能御湿,加白术,是崇厚脾土以御湿。小便不利,并用桂枝利小便,所以增加了桂枝的数量。
这里提到桂枝人参汤。这是理中汤加桂枝。理中汤是治疗霍乱寒多的方子。这里多次攻下导致虚损,虽然挟热而利,脉必微弱(说法源自《金鉴》),应当按寒多论治。干姜、甘草、白术,温中补虚,就是理中汤的成法。彼方兼呕吐,所以甘草生用以和胃;此方利下虚甚,宜于守补,所以甘草炙过而又增加了数量。桂枝后煎而必须用四两,是想让它解表并散除心下的痞硬。霍乱是上下不和,此方是表里不和,所以都用参人来调和它。
这里提到桂枝甘草汤。发汗过多,损伤了心气,导致双手交叉冒心、心悸想按压,与真武汤汗后肾水上凌有其他证候的不同,只需补其心气,桂枝汤中的桂枝、甘草两味就是妙法。桂枝不以利小便为目的也用四两,是因为心气虚得很厉害,不多用不行,而且桂枝性质轻扬,上部虚则自然归于上部,这是势所必然的。
这里提到茯苓桂枝甘草大枣汤。桂枝甘草汤是汗后心悸想按压,此方是汗后脐下悸,因为同是汗后但证候不同。彼方必定心气素来亏虚,
In formulas where the dosage of Glycyrrhizae Radix et Rhizoma (Gancao) is doubled that of Cinnamomi Ramulus (Guizhi), it is to simultaneously tonify Middle Qi and harmonize the three herbs. This refers to Zhishi Xiebai Guizhi Tang (Aucklandiae and Macleaya Decoction with Cinnamon Twig). "Xiongbi" (Chest Bi Syndrome) is a disease name; the following text details its symptoms because Xiongbi presents differently. When Qi stagnation reaches its limit and chest fullness becomes severe, the power of Allii Tuberosi (Xiebai) and Trichosanthis Fructus (Gualou) is insufficient. Therefore, Cinnamomi Ramulus (Guizhi) is added to assist Allii Tuberosi (Xiebai) in dissipating nodulation, and Magnoliae Officinalis Cortex (Houpo) is added to assist Trichosanthis Fructus (Gualou) in draining fullness. Zizyphi Fructus (Zhishi) serves as the Sovereign herb to pacify rebellious Qi in the hypochondrium.
This refers to Zhuye Tang (Bamboo Leaf Decoction). This is a syndrome of Wind-Stroke transforming from Cold to Heat, about to transmit from the Taiyang (Greater Yang) channel to the Yangming (Bright Yang) channel, while the True Yang happens to be deficient. Cinnamomi Ramulus (Guizhi) releases the exterior and transforms Qi, thereby eliminating the root of Cold pathogenic factors. Only one liang is used because the underlying condition involves no sweating; excessive use would encroach upon the dispersing authority of Puerariae Radix (Gege) and Saposhnikoviae Radix (Fangfeng).
Formulas using two liang of Cinnamomi Ramulus (Guizhi) include Mahuang Tang (Ephedra Decoction). Wherever Cinnamomi Ramulus (Guizhi) reaches, Ephedrae Herba (Mahuang) also reaches. Since both Ephedrae Herba (Mahuang) and Cinnamomi Ramulus (Guizhi) are used, I have briefly explained this in my discussion on Ephedrae Herba (Mahuang); let me elaborate further: The pathogenic factor of Shanghan (Cold Damage) binds and closes Ying (Nutritive) and Wei (Defensive) levels, leading to headache, body pain, lower back pain, and joint pain. The onset is violent and widespread; only Ephedrae Herba (Mahuang), which charges forward relentlessly, is sufficient to quell the turmoil. Only Cinnamomi Ramulus (Guizhi), which acts calmly and composedly, is sufficient to hunt down residual pathogens. Moreover, Ephedrae Herba (Mahuang) has a rigid nature, while Cinnamomi Ramulus (Guizhi) has a soft nature. Meeting rigidity with softness allows them to slightly moderate each other's properties, preventing reckless advance without regard for consequences. Cinnamomi Ramulus (Guizhi) is used in a small dose (two liang) because reliance is placed primarily on Ephedrae Herba (Mahuang).
This refers to Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus). The description of Huanghan (Yellow Sweat) syndrome here is very complex, and commentators have been quite muddled. Generally, between Ying (Nutritive) and Wei (Defensive) levels, Water and Heat steam each other and obstruct their flow. This does not occur unless accompanied by Cold or Deficiency. To warm the meridians, transform Qi, drain Yellow Sweat, and obtain normal sweating, Guizhi Tang (Cinnamon Twig Decoction) is naturally the most appropriate. However, Guizhi Tang treats "Wei Excess," whereas this case involves "Wei Deficiency." Therefore, Astragali Radix (Huangqi) is added to tonify and disperse Wei Qi. The dosages of Cinnamomi Ramulus (Guizhi) and Paeoniae Radix Alba (Baishao) are reduced to restrain their inward direction and facilitate outward communication with Wei Qi, so that pathogens cannot reside and Zheng Qi (Upright Qi) can recover. Cinnamomi Ramulus (Guizhi), Paeoniae Radix Alba (Baishao), and Astragali Radix (Huangqi) are essential herbs for treating Yellow Sweat. In Shaoyao Guizhi Jiu Tang (Peony and Cinnamon Twig Wine Decoction), the quantities are increased and Vinegar (Ku Jiu) is heavily added because a deep pulse requires these to drain pathogens.
This refers to Houpo Qiwu Tang (Magnolia Bark Seven-Ingredient Decoction). Cinnamomi Ramulus (Guizhi) is used in two liang, while Zingiberis Recens Rhizoma (Shengjiang) is used up to five liang, making the cold-dispersing power superior and preventing pathogen retention due to Cinnamomi Ramulus (Guizhi). This treats both exterior and interior, so Jujubae Fructus (Dazao) is used to calm the Middle, and Glycyrrhizae Radix et Rhizoma (Gancao) to harmonize. Gancao is unroasted because Xiao Chengqi Tang (Minor Order the Yang Decoction) attacks the interior, making it unsuitable to be too retaining. More Ginger and fewer Dates are used because the condition is not spontaneous sweating, so it is not treated by tonifying the exterior.
This refers to Fuling Gancao Tang (Poria and Licorice Decoction). In Shanghan (Cold Damage), if there is sweating and thirst, Wuling San (Five-Ingredient Powder with Poria) is the primary treatment. Sweating indicates incomplete resolution of exterior pathogens; thirst indicates that the Taiyang pathogen has transmitted from the Biao (Mark) to the Ben (Root). Wuling San resolves both exterior and interior, implying urinary difficulty. This is identical to the previous case of floating pulse, urinary difficulty, slight fever, and thirst treated with Wuling San. The text below states, "If there is no thirst, Fuling Gancao Tang is used," clearly indicating that exterior pathogens remain. No thirst means the Stomach is not hot, and Water accumulates in the Upper Jiao. This resembles the syndromes of Zhenwu Tang (True Warrior Decoction) and Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) involving sweating, fluid deficiency, and Kidney Water rising, differing only in severity. The latter is severe, this one is mild. Thus, only Poria (Fuling) is used to eliminate Water under the heart, while Cinnamomi Ramulus (Guizhi), Glycyrrhizae Radix et Rhizoma (Gancao), and Zingiberis Recens Rhizoma (Shengjiang) resolve exterior pathogens, leaving no other concerns. Small doses of Guizhi and Gancao assist in supporting Heart Yang to treat palpitations. Paeoniae Radix Alba (Baishao) is absent because the pathogen has transmitted to the interior; further astringency would prevent exterior resolution. Jujubae Fructus (Dazao) is absent because a small amount of Poria does not injure the Kidney, so nourishing fluids is unnecessary.
This refers to Fuling Zexie Tang (Poria and Alisma Decoction). Weifan (Stomantic Regurgitation) is caused by Cold deficiency in the Stomach. Cinnamomi Ramulus (Guizhi) assists Zingiberis Recens Rhizoma (Shengjiang) in dispersing Cold and assists Glycyrrhizae Radix et Rhizoma (Gancao) in warming the Middle. Because the pathology is in the Upper Jiao, only two liang of Guizhi are used. For details, see Poria.
This refers to Taoheng Chengqi Tang (Peach Kernel Decoction to Order the Yang). This is used after the exterior is resolved. Is Cinnamomi Ramulus (Guizhi) for releasing the exterior? Assuming Taiyang transmits to the interior, Heat and Blood bind causing urgency and binding in the lower abdomen, Tao Ren (Peach Kernel), Dahuang (Rhubarb), and Mangxiao (Mirabilite) are used to attack. Qi is the commander of Blood; when Qi moves, Blood moves. Thus, Cinnamomi Ramulus (Guizhi) enters the Bladder meridian to transform Qi. Glycyrrhizae Radix et Rhizoma (Gancao) uses its sweet property to relieve urgency. Why does two liang of Guizhi enter the Bladder? Because Da Huang (Rhubarb) and similar herbs descend with it, and excessive use would assist Bladder Heat.
This refers to Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzu Root). Gegen (Kudzu Root) treats stiffness and tension in the neck and back; principles are detailed under Gegen. Gegen Tang differs from this formula only by the presence or absence of Ephedrae Herba (Mahuang). The former is for no-sweating aversion to wind; this one is for sweating aversion to wind.
For Taiyang disease with sweating and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is appropriate. Adding Gegen (Kudzu Root) to treat neck/back stiffness prioritizes releasing the muscle layer and raising Yin Qi, with harmonizing Ying and Wei as secondary. Thus, Guizhi and Baishao are each reduced by one liang compared to standard Guizhi Tang.
This refers to Wenjing Tang (Warming the Meridians Decoction). A small dose of Guizhi unblocks meridians; combined with Baishao, it enters the Lower Jiao to transform Qi. Shengjiang is used instead of Dazao because it is not for tonifying the exterior. See Evodiae Fructus (Wuzhuyu) for details.
This refers to Mufangji Tang (Stephania Tetrandra Decoction). The Diaphragm is traversed by meridians of the Lung, Stomach, Kidney, and Sanjiao. Zhiyin (Fluid Retention in the Diaphragm) obstructs Lung and Stomach Qi, causing wheezing, fullness, and epigastric hardness. Downward interaction with the Kidney causes Kidney Qi to rise, resulting in dark complexion. A deep, tight pulse indicates the disease is not solely in the upper part. Fangji (Stephania Tetrandra) is white outside and yellow inside with black radial lines, has a pungent and neutral taste, and can move Water in the diaphragm, transporting it via Sanjiao to the Kidney, calming Qi. Assisted by Guizhi, one bitter and one pungent to dissipate nodulation, epigastric hardness resolves. However, fluid retention lasting dozens of days causes Lung and Stomach stagnation turning into Heat; without clearing Heat, wheezing and fullness persist, hence Shigypsum Fibrosum (Shigao) is added. After vomiting and purging, Middle Qi and Body Fluids are severely depleted, hence Renshen (Ginseng) is added. "Deficient cases heal, excess cases relapse in three days": Deficiency and Excess refer to Kidney Qi. Kidney Deficiency allows Lung Qi to descend and Kidney Qi to settle; Excess requires salty-cold to drain and bland-leaching to attack, otherwise Qi will rebound upward. Commentators fail to recognize the Kidney connection, offering vague theories incompatible with the formula.
Formulas using two and a half liang of Cinnamomi Ramulus (Guizhi) include Shuyu Wan (Dioscorea Pill). Fengqi Baiji (Wind Pathogens causing Hundred Diseases) refers to Wind-Deficiency syndromes lingering in muscles and joints, not initial exterior patterns resolvable by sweating. Xu Lao Zhu Bu Zu (Various Deficiencies of Chronic Debility) is the root cause. The formula focuses on tonifying deficiency,其次 on dispelling wind. Shuyu (Dioscorea), Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), Gancao (Licorice), Dihuang (Rehmannia), Maidong (Ophiopogon), Ejiao (Donkey-hide Gelatin), and Dazao (Jujube) fill deficiencies. The remaining thirteen herbs resolve stasis, regulate Yin and Yang, tonify deficiency, and dispel wind. The true Wind-dispelling herb is only Fangfeng (Saposhnikovia). Among filling herbs that also dispel wind, Shuyu (Dioscorea) is best, serving as the Sovereign.
Formulas using three liang of Cinnamomi Ramulus (Guizhi) include Guizhi Shengjiang Zhishi Tang (Cinnamon Twig, Ginger, and Aucklandia Decoction). Epigastric blocking and hanging pain differ from Xiongbi pain, hence Gualou (Trichosanthes) and Xiebai (Allium) are not used. Hanging pain is caused by rebellious Qi from below preventing pain from descending, like a suspended object. This indicates Heart Yang failure allowing Yin pathogens to occupy. Thus, Shengjiang (Fresh Ginger) and Guizhi (Cinnamon Twig) at three liang each extend Yang and disperse pathogens. Rebellious Qi relates to the Liver; Zhishi (Zizyphi Fructus) enters the Liver via sourness and descends via bitterness. Descending rebellious Qi removes pain and restores Heart Yang.
This refers to Fangji Fuling Tang (Stephania and Poria Decoction). Guizhi combined with Fangji and Huangqi moves Water in the skin. Heavy use of Fuling (Poria) guides the three herbs downward for excretion via urine. Water in the skin, if attacked too quickly, leaves pathogens; thus Gancao (Licorice) is added to moderate.
This refers to Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). Phlegm-Fluid is Cold-Fluid. Insufficient Heart Yang allows Phlegm-Fluid to occupy the diaphragm, causing chest fullness. Wood encountering water generates Wind; Earth fails to contain it, causing hypochondriac fullness and dizziness. "Zhi" (supporting) fullness indicates origin from the Liver. Guizhi and Gancao tonify Heart Yang and transform Qi; Baizhu (Atractylodes Macrocephala) strengthens Spleen Earth and dries Dampness; Fuling (Poria) drains Fluid from below the heart. This is the main formula for Cold-Fluid.
This refers to Guizhi Qu Shaoyao Jia Shuji Longgu Muli Jiuni Tang (Cinnamon Twig Decoction minus Peony plus Coscinium, Dragon Bone, and Oyster Shell Rescue Decoction). Similar to Guizhi Longgu Muli Tang, but Jingkuang (panic and mania) and restlessness are more severe than Fanza (irritability). Thus, Guizhi, Gancao, Longgu (Dragon Bone), and Muli (Oyster Shell) are doubled. The former lacks exterior pathogens; this one has a floating pulse, so Shuji (Coscinium) is added with Guizhi to disperse pathogens. After resolving the exterior, the exterior must be tonified, so Shengjiang (Ginger) and Dazao (Date) harmonize Ying and Wei. Shaoyao (Peony) is removed because there is no sweating.
This refers to Gualou Guizhi Tang (Trichosanthes and Cinnamon Twig Decoction). Zhang Zhongjing noted "reverse sweating and aversion to wind" in Guizhi Jia Gegen Tang. Here, "reverse deep and slow pulse" emphasizes the word "reverse." Taiyang syndrome typically presents with fever, headache, and sweating; a deep/slow pulse is abnormal, hence "reverse." Roujing (Soft Spasm) inherently has a deep/slow pulse, explaining the diagnosis. The syndrome matches Guizhi Tang, so the full formula is used. Body stiffness indicates spasm. Adding Gualou instead of Gegen distinguishes body stiffness from neck stiffness. Both nourish sinews to treat stiffness.
This refers to Wutou Guizhi Tang (Aconite and Cinnamon Twig Decoction). Hanhan (Cold Cramp), abdominal pain, cold limbs, numbness, and body pain: "Ruo" (if/also) indicates inclusion, not possibility. Body pain is an exterior sign, distinguished by "Ruo." This is severe Cold damaging both interior and exterior. Wutou (Aconite) drives out Cold from both; Guizhi Tang transforms Qi from both. Honey-cooked Wutou reduces toxicity and moderates nature. Guizhi Tang treats abdominal pain and disperses exterior pathogens, so Shaoyao is not added. Guizhi Tang and Wutou are decocted strongly with honey for sweetness and moistening, tonifying the Middle and relieving urgency seamlessly. The patient feels drunk, and pathogens are vomited out, surpassing moxibustion or other drugs.
This refers to Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction). Xuebi (Blood Bi) involves deficiency of both Yin and Yang. Guizhi Tang regulates Yin/Yang excess but lacks efficacy for Bi obstruction. Huangqi (Astragalus) disperses Wei Qi; extra Shengjiang (Ginger) promotes Yang. The principle addresses deficiency; excessive tonification suits Blood Bi poorly, so Gancao is removed. No exterior pathogens mean no sweating or warming covers. This differs from Guizhi Jia Huangqi Tang.
This refers to Zeqi Tang (Codonopsis Decoction). Like Houpo Mahuang Tang, this treats cough from exterior Cold and interior Fluid conflict. Floating pulse indicates strong exterior pathogens, requiring heavy exterior release. This cough has a deep pulse, indicating mild exterior pathogens. The former uses Mahuang/Xingren; this uses Guizhi/Shengjiang, distinguishing Shanghan/Windstroke like Mahuang/Guizhi Tangs. Fluid retention is heavier in the former (Banxia 6 sheng vs. 0.5 sheng). Heat in Lung uses Shigao; lower heat uses Huangqin (Scutellaria). Former uses Jiang/Xin/Wuweizi (Xiao Qinglong method) for upper Fluid retention. This uses Zeqi, Zishen, Baiqian to direct Fluid downward, stopping cough. Zou's interpretation that Zeqi returns Water Qi to the Kidney is similar to Wuweizi. Why no Renshen in the former? It treats dispersed Qi; Renshen is for post-cough recovery, not Cold/Fluid dispersion. This formula targets both interior/exterior and upper/lower, requiring Renshen for harmony.
This refers to Baihu Jia Guizhi Tang (White Tiger Plus Cinnamon Twig Decoction). You's explanation is apt. Viewing Guizhi as a cause is muddled; Zhao's view on treating joint Bi is better. Without clarifying Fuqi (Latent Pathogen), it remains superficial. Cold latent in the Kidney emerges in Spring/Summer. Though only Heat remains, joint pain indicates unresolved roots. Liver governs sinews connected to joints; Guizhi enters the Liver, searching latent pathogens from joints. Otherwise, Baihu Tang alone won't cure malaria.
This refers to Houshi Heisan (Marquis Hou's Black Powder). Large Wind is handled by Juhua (Chrysanthemum) and Fangfeng. Guizhi, with Chuanxiong and Danggui, treats coldness in the heart.
This refers to Danggui Sini Tang (Angelica Decoction for Cold Extremities). Jueyin disease with Blood Deficiency and Cold invasion causes cold extremities and faint pulse. When pathogens reach the Kidney, Xixin (Asarum) drives Kidney Cold, similar to Shaoyin using Liver herbs. Guizhi Tang without Shengjiang avoids dispersing and injuring Yin.
This refers to Zhigancao Tang (Roasted Licorice Decoction). Jiedai (knotted and intermittent) pulse indicates Ying Blood deficiency. Heart governs Ying and generates pulse, causing palpitations. Dihuang, Maidong, Ejiao, and Mahuang nourish Ying Yin. Guizhi and Gancao support Heart Yang. Renshen generates pulse. Shengjiang and Dazao harmonize Ying and Wei. Gancao with Renshen/Dazao tonifies the Middle. Shengjiang with Guizhi/Gancao unblocks congestion. More Dates/Licorice than Ginger prevents excessive dispersal injuring Shen. Cooking with Qingjiu (Clear Wine) guides herbs to unblock collaterals.
This refers to Guizhi Jia Fuzi Tang (Cinnamon Twig Plus Aconite Decoction). Differs from Guizhi Qu Shaoyao Jia Fuzi Tang only by Shaoyao. The latter removes Shaoyao for post-purging rapid pulse and chest fullness, adding Fuzi for slight aversion to cold. This case has stiff limbs and difficulty bending, indicating Yang Deficiency requiring Fuzi. Unceasing sweating and difficult urination indicate incomplete exterior resolution and fluid depletion. Guizhi Tang treats spontaneous sweating and harmonizes Ying/Wei; Shaoyao is crucial and should not be removed.
This refers to Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Plus Magnolia Bark and Apricot Seed Decoction). See Xingzi for details.
This refers to Fangji Dihuang Tang (Stephania and Rehmannia Decoction). See Fangji for details.
This refers to Guizhi Jia Shaoyao Tang (Cinnamon Twig Plus Peony Decoction). Commentators cling to "Taiyang disease incorrectly purged" and view Guizhi Tang solely as an exterior-releasing formula. Views vary (not Spleen Cold, harmonizing Taiyin, releasing Taiyang, etc.), missing the point. Post-purging abdominal fullness and periodic pain indicate transmission to the Taiyin Zang. Taiyin is extreme Yin, incapable of ascending. Addressing the error first is necessary. Guizhi Tang applications vary widely; one cannot insist on Taiyang exterior principles. Exterior release with Guizhi excludes Shaoyao in no-sweat cases. Doubling Shaoyao here abandons exterior concepts. Adding Dahuang treats excess pain, confirming interior transmission rather than expelling exterior pathogens. Thus, this formula is not for exterior release. Comparing to Xiaojianzhong Tang (which adds Yitang/Maltose) and Neibu Danggui Jianzhong Tang (adding Danggui), neither releases the exterior. Taiyin is a Yin Zang governing Blood. Purging causes Yin Qi stagnation, abdominal fullness/pain. Although Shaoyao is cold, it breaks Qi stagnation in Spleen Blood, treating abdominal pain. Without Guizhi, recovery is impossible. Guizhi acts outwardly; heavy Shaoyao directs it inward to the Spleen. Guizhi with Ginger disperses Cold; with Gancao/Dazao tonifies the Middle. Shaoyao leads this process, necessitating double dosage. Breaking stagnation while tonifying restores Yang, curing fullness/pain. Acute pain requires Xiaojianzhong Tang because Yitang relieves urgency but may increase fullness; formulas have specific indications. Xu Zhongke's mastery of Guizhi in Jin Gui is remarkable.
This refers to Guizhi Jia Longgu Muli Tang (Cinnamon Twig Plus Dragon Bone and Oyster Shell Decoction). This treats Kun/Dong/Wei/Jin pulses, seminal emission in men, and nocturnal emissions in women. Using original Guizhi Tang implies matching its indications. These pulses indicate Yin-Yang discordance. Guizhi Tang harmonizes Yin-Yang; discordance causes loss of Essence and Spirit. Longgu and Muli gather Yang, astringe Yin, secure Essence, and calm Spirit.
Formulas using four liang of Cinnamomi Ramulus (Guizhi) include Guiling Wudi Gancao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction). Zhiyin soaking the Lung causes cough, stirring Kidney Qi to rush upward and flow down to the inner thighs. Symptoms include salivation, dry mouth, urinary difficulty, and dizziness. Fuling drains Fluid; Guizhi directs downward rebellion; Gancao supports Earth to prevent Kidney Water ascent; Wuweizi secures Kidney Yin to call Lung Qi down. Complex syndrome, simple prescription, grasping the key. Zhang Zhongjing always uses Jiang/Xin/Wuweizi for Cold-Fluid cough. Here, only Wuweizi is used because Jiang/Xin aggravate facial heat, while Wuweizi treats weak Chi pulse. Guizhi is specific for rebellion; although it aids Yang, it is indispensable. If rebellion subsides but cough/fullness return, Guizhi should treat fullness. Instead, Guizhi is removed and Jiang/Xin added. Jiang/Xin and Wuweizi are complementary; treating cough treats fullness. Jiang/Xin aid Wuweizi in cough. Facial heat contraindicates Guizhi; removing it after rebellion subsides is convenient. Fuling and Wuweizi remain essential.
This refers to Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction). After 8-9 days of Shanghan, Wind-Cold remains. In Yang-deficient constitutions, Interior Dampness and Exterior Wind collide, causing painful body stiffness. Floating pulse indicates Wind; choppy/deficient pulses indicate Yang Deficiency with Dampness. No vomiting/thirst confirms Yang Deficiency without other causes. Guizhi Tang is essential for exterior release. Fuzi is needed to support Yang and drive Wind-Damp. Floating pulse without sweating precludes astringents, so Shaoyao is removed. Increasing Guizhi by one liang enhances downward action and diuresis.
This refers to Gancao Fuzi Tang (Licorice and Aconite Decoction). Guizhi and Fuzi treat Wind-Cold/Damp, but Fuzio excels in supporting Yang. Severe Wind-Damp with extreme Yang Deficiency requires Fuzio. The formula highlights Fuzio over Guizhi. Gancao heads the formula because Ren Shen is unsuitable for Dampness, and Jiang/Dazao are unsuitable for edema. Gancao tonifies the Middle and moderates the exterior. Fuzio transforms but doesn't repel Dampness; Baizhu strengthens Earth to repel Dampness. Guizhi is increased to promote urination.
This refers to Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction). This is Lizhong Tang plus Guizhi. Lizhong Tang treats Huoluan with predominant Cold. Frequent purging causes deficiency; despite heat, the pulse is weak, treated as Cold-dominant. Ganjiang, Gancao, Baizhu warm and tonify the Middle. Vomiting cases use raw Gancao to harmonize the Stomach; diarrhea cases use roasted Gancao in larger doses for retaining tonification. Guizhi is decocted last in four liang to release the exterior and dissipate epigastric hardness. Huoluan is Upper/Lower disharmony; this is Exterior/Interior disharmony, requiring Renshen for harmony.
This refers to Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction). Excessive sweating damages Heart Qi, causing hand-over-heart palpitations needing pressure. Unlike Zhenwu Tang's Kidney Water rising with other signs, this requires only Heart Qi tonification. Guizhi and Gancao are effective. Four liang of Guizhi is used not for diuresis but because severe Heart Qi deficiency requires large doses; its light nature rises to the deficient upper jiao naturally.
This refers to Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Date Decoction). Guizhi Gancao Tang treats post-sweating palpitations needing pressure; this treats post-sweating umbilical palpitations. Same cause, different syndrome. The former implies chronic Heart Qi deficiency.