麻黄 杏仁 人参 黄芩 芎 芍药 甘草 防风 桂枝 附子 当归 防己
古人以此方混治中风,不无精义。盖麻黄、杏仁,麻黄汤也,仲景以治太阳症之伤寒。桂枝、芍药,桂枝汤
也,仲景以治太阳症之伤风。如此言之,则中风而有头痛、身热、脊强者,皆在所必用也。人参、甘草,四君子
之二也,局方收以补气。当归、芎 ,四物汤之二也,局方拣以养血。如此言之,则中风而有气虚、血虚者,固
在所必需也。风淫末疾,佐以防风。湿淫腹疾,佐以防己。阴淫寒疾,附子佐之。阳淫热疾,黄芩佐之。夫疾不
单来,故使药亦兼该也。然当根据易老六经减增,尤为稳便。药行病去,性天自若。故乎为小续命云。
诗曰∶芎桂秋高芩草黄,药炉归制杏麻霜,辽人恭己防风中,附子煎充续命汤。
秦艽 石膏 当归 芍药 羌活 防风 黄芩 生地 熟地 甘草 芎 白芷 白术 茯苓 独活 细辛
风邪散见,不拘一经,故用驱风散热兼而治之。羌活理游风,得防风可以去太阳肢节之风痛。独活理伏风,
协甘草可以疗太阴表里之风湿。三阳数变之风,责在细辛秦艽。三阴内淫之风,责在茯苓、白术。阳明之风,白
芷驱之。厥阴之风,芎 行之。风热干乎气,清以枯芩、石膏,风热干乎血,养以归、芍、二地。若中风暴仆,
痰响气粗,此浊邪壅塞咽喉,先以稀涎散吐其痰沫。盖牙皂开关,白矾去污,药只二味,固夺门之神帅也。然能
进汤液便止,不可过多。不观凡病患易箦时必有痰,务欲尽逐而去,顷刻毙矣。
诗曰∶大秦艽,羌独防,芎芷辛芩二地黄,归芍石膏苓草术,风邪散见号通方。
麻黄、杏仁、人参、黄芩、川芎、芍药、甘草、防风、桂枝、附子、当归、防己。
古人用这个方子混合治疗中风病,并非没有精妙之处。麻黄和杏仁,是麻黄汤(发汗解表、宣肺平喘的方剂)的成分,张仲景用它来治疗太阳病(太阳经受邪所致的病证)中的伤寒(外感寒邪)。桂枝和芍药,是桂枝汤(解肌发表、调和营卫的方剂)的成分,张仲景用它来治疗太阳病中的伤风(外感风邪)。这样说来,如果中风病出现头痛、身体发热、脊柱强直的症状,这些药物都是必须使用的。人参和甘草,是四君子汤(益气健脾的基础方剂)中的两味药,局方(《太平惠民和剂局方》)收录它们以补益元气。当归和川芎,是四物汤(补血调血的基础方剂)中的两味药,局方选取它们以滋养血液。这样说来,如果中风病伴有气虚、血虚的情况,这些药物自然是必需的。风邪侵袭四肢末端导致疾病,辅助使用防风;湿邪侵袭腹部导致疾病,辅助使用防己;阴邪导致寒性疾病,辅助使用附子;阳邪导致热性疾病,辅助使用黄芩。疾病往往不是单独到来的,所以药物的配伍也兼及多方面。然而应当根据易老(刘完素,号通玄处士,世称刘河间,此处指其六经辨证加减法)的六经辨证进行增减,尤为稳妥方便。药力发挥作用,病邪去除,人的自然本性就能恢复常态。所以称之为“小续命汤”。
诗曰:川芎、桂枝、秋高(指黄芪或泛指补气药,此处依原文音韵或版本差异,通常指黄芪或特定炮制,此处保留原意)、黄芩、甘草、黄柏(或指代黄色药材),药炉回归制作杏仁、麻黄霜,辽地之人恭敬地配合防风、中(可能指中药或方位,此处依原文直译),附子煎煮充作续命汤。
秦艽、石膏、当归、芍药、羌活、防风、黄芩、生地黄、熟地黄、甘草、川芎、白芷、白术、茯苓、独活、细辛。
风邪散在出现,不拘泥于某一经络,所以采用驱散风邪、清散热邪并兼治的方法。羌活调理游走之风,配合防风可以祛除太阳经肢节的风痛。独活调理潜伏之风,配合甘草可以治疗太阴经表里的风湿。三阳经多变的風邪,责任在于细辛和秦艽。三阴经内侵的风邪,责任在于茯苓和白术。阳明经的风邪,由白芷驱除。厥阴经的风邪,由川芎行散。风热侵犯气分,用枯黄芩、石膏清热;风热侵犯血分,用当归、芍药、生地黄、熟地黄养血。如果是中风突然仆倒,痰鸣气粗,这是浊邪壅塞咽喉,先用稀涎散(涌吐痰涎的方剂)吐出痰沫。因为牙皂(皂角)能开关开窍,白矾能去污涤痰,药只有两味,确实是夺取门户的神帅。然而如果能喝下汤药就应停止,不可过量。没见那些病人临终前必然有痰,务必想要彻底清除,结果顷刻间就死亡了。
诗曰:大秦艽,羌活、独活、防风,川芎、白芷、细辛、黄芩、生地黄、熟地黄,当归、芍药、石膏、茯苓、甘草、白术,风邪散在出现号称通治之方。
Ephedrae Herba (Mahuang, 麻黄), Armeniacae Semen Amarum (Xingren, 杏仁), Ginseng Radix (Renshen, 人参), Scutellariae Radix (Huangqin, 黄芩), Ligustici Chuanxiong Rhizoma (Chuanxiong, 川芎), Paeoniae Radix Alba (Baishao, 芍药), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Saposhnikoviae Radix (Fangfeng, 防风), Cinnamomi Ramulus (Guizhi, 桂枝), Aconiti Lateralis Radix Praeparata (Fuzi, 附子), Angelicae Sinensis Radix (Danggui, 当归), Stephaniae Tetrandrae Radix (Fangji, 防己).
Ancients used this formula to treat stroke broadly, which is not without profound meaning. Ephedrae Herba and Armeniacae Semen Amarum constitute Mahuang Tang (Decoction for Dispersing Cold), which Zhang Zhongjing used to treat Taiyang disease (diseases of the Taiyang channel) caused by cold invasion. Cinnamomi Ramulus and Paeoniae Radix Alba constitute Guizhi Tang (Decoction for Harmonizing Ying and Wei), which Zhang Zhongjing used to treat Taiyang disease caused by wind invasion. Thus, if stroke presents with headache, fever, and spinal rigidity, these herbs are indispensable. Ginseng Radix and Glycyrrhizae Radix et Rhizoma are two ingredients of Sijunzi Tang (Four Gentlemen Decoction), included in the Bureau Formulary (Taiping Huimin Heji Jufang) to tonify Qi. Angelicae Sinensis Radix and Ligustici Chuanxiong Rhizoma are two ingredients of Siwu Tang (Four Substance Decoction), selected by the Bureau Formulary to nourish Blood. Therefore, if stroke is accompanied by Qi deficiency and Blood deficiency, these herbs are certainly necessary. Wind pathogen invading the extremities causes disease, assisted by Saposhnikoviae Radix; Dampness pathogen invading the abdomen causes disease, assisted by Stephaniae Tetrandrae Radix; Yin pathogen causing cold diseases, assisted by Aconiti Lateralis Radix Praeparata; Yang pathogen causing heat diseases, assisted by Scutellariae Radix. Diseases rarely come alone, so the herbal combination covers multiple aspects. However, it should be modified according to Liu Wansu’s Six Channel differentiation, which is particularly safe and convenient. When the medicinal action takes effect and the pathogen departs, one's natural constitution returns to normal. Hence it is called "Xiao Xuming Tang" (Minor Continuation of Life Decoction).
Poem: Chuanxiong, Guizhi, Qiu Gao (likely referring to Astragali Radix or a specific preparation), Huangqin, Gancao, Huang Bo (or yellow herbs), the medicine stove returns to prepare Xingren and Mahuang frost; Liaoning people respectfully combine Fangfeng, Fuzi decocted to fill the Xuming Tang.
Qinjiao (Gentianae Macrophyllae Radix), Gypsum Fibrosum (Shigao), Danggui, Baishao, Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng, Huangqin, Shengdi Huang (Rehmanniae Radix Recens), Shudi Huang (Rehmanniae Radix Praeparata), Gancao, Chuanxiong, Baizhi (Angelicae Dahuricae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Duhuo (Angelicae Pubescentis Radix), Xixin (Asari Radix et Rhizoma).
Wind pathogens appear scatteredly, not confined to a single channel, so the method uses dispersing wind and clearing heat simultaneously. Qianghuo regulates wandering wind; combined with Fangfeng, it can dispel wind-pain in the Taiyang channel limbs and joints. Duhuo regulates latent wind; combined with Gancao, it can treat wind-dampness in the interior and exterior of the Taiyin channel. Wind pathogens changing frequently in the Three Yang channels are addressed by Xixin and Qinjiao. Wind pathogens invading internally from the Three Yin channels are addressed by Fuling and Baizhu. Wind in the Yangming channel is dispelled by Baizhi. Wind in the Jueyin channel is circulated by Chuanxiong. If wind-heat affects the Qi level, clear it with Ku Huangqin (Scutellariae Radix) and Shigao; if wind-heat affects the Blood level, nourish it with Danggui, Baishao, Shengdi Huang, and Shudi Huang. In cases of sudden stroke collapse with phlegm rattle and coarse breathing, this indicates turbid pathogen obstructing the throat; first use Xixian San (Thin Saliva Powder) to induce vomiting and expel phlegm. Zaojiao (Gleditsiae Sinensis Spina) opens orifices, and Bai Fan (Alumen) removes filth; with only two ingredients, it acts as a divine commander seizing the gate. However, stop once decoction can be taken; do not overdose. Have you not seen that patients at the point of death inevitably have phlegm; attempting to completely expel it leads to instant death.
Poem: Da Qinjiao, Qianghuo, Duhuo, Fangfeng, Chuanxiong, Baizhi, Xixin, Huangqin, Er Di (Shengdi and Shudi), Danggui, Baishao, Shigao, Fuling, Gancao, Baizhu; a universal formula for scattered wind pathogens.