治风水恶风,一身悉肿,面目肿,大有热色,发热无汗,脉洪浮而渴,续自汗出,无大
热者。
麻黄(六两去节) 石膏(半斤打) 甘草(炙) 生姜(各二两) 大枣(十二枚) 以
水六升,先煮麻黄,去上沫,纳诸药,煮取三升,分温三服。
治里水一身面目黄肿,脉沉,小便自利而渴者;并治风寒客于脉而不去,营气热腐而肉
极热,则身体津脱,腠理开,汗大泄,疠风气,下焦脚弱。
越脾汤原方加白术四两。
治肺胀咳喘脉浮大者。越脾汤原方枣加三枚,姜加一两,加半夏半升。
越脾汤越脾中气,发汗生津凉散委。(越脾者,发越脾中之津气而为汗,是凉散法也。)
麻石甘草枣生姜,《金匮》以之治风水。恶风身肿脉洪浮,面赤热渴乃堪使。(旭高按∶《金
匮
是风水者,乃肺、脾、胃三经受风热之阳邪,痹其营卫之气,升降不得自如,斯水饮入胃,
不能输脾归肺,下达膀胱,而反外溢肌肤,故一身悉肿。其证恶风发热,脉洪浮而渴,故知
为风热,亦尝验之矣。然必兼有无汗而喘见象,与此汤一服,亦未必汗出,其水反从小便去,
真匪夷所思者。)里水黄肿其脉沉,便利亡津加术饵。(名越脾加术汤 旭高按∶水在里,当
不渴,渴则可征水去。今渴而黄肿不去,是水未去也。水未去,何以渴?小便自利,亡津液
故也。盖脾气实者,小便利则水去;脾气虚者,小便利则亡津,亡津令渴。病虽始于里水,
其实里已无水,水只在皮肤中,故亦用越脾,使从表解。但加白术一味,补脾气生津液,以
固其里,则意无不到矣。)营气热腐为疠风,俗号“大麻疯”即是。清疏营卫最相宜,加术
缘其脚弱尔。(按∶疠风因风客久而化热,营气被其煽灼,血肉腐坏,故使鼻柱坏而色败,
皮肤疡溃,即俗所谓“大麻疯”是也。喻嘉言有见及此,故曰“汗宜频发,血宜频刺”,但
未有其方。旭高观此汤清疏营卫,与嘉言之说合符。石膏清热生津液,麻黄疏风通血脉,甘
草解热毒,姜、枣和营卫,若不脚弱,则白术亦可不加。后人遇此证,绝不知用此汤,何也?)
温邪挟饮填肺中,为胀为喘加半治。散邪清热越脾佳,蠲饮消痰半姜美。(名越脾加半夏汤 肺
胀咳喘,为外邪内饮相搏之证。越脾汤散邪清热之功多,蠲饮消痰之力少,故加半夏辅其未
逮,更加姜一两以助半夏之功,周密之至矣。)此与青龙加石膏,佐使寒温相对峙。(此与小
青龙加石膏汤相为对峙。小青龙汤中有半夏无石膏,越脾汤中有石膏无半夏,观二方所加之
意,全重在石膏、半夏二物协力建功。石膏清热,借辛温亦能豁痰,半夏豁痰,借辛凉亦能
清热。前越脾加术汤生津止渴,借白术入清热药中;此越脾加半夏汤下气定喘,又借半夏入
清热药中。仲景加减成方,无非化裁后学矣。)又与越脾加术汤,下气生津分彼此。千古医
方仰仲师,一加一减皆精义。
治疗风水病,症见恶风,全身浮肿,面目肿胀,面色红赤有热色,发热无汗,脉象洪大浮取而口渴,随后出现自汗出,体表无明显大热的情况。
麻黄(六两,去节) 石膏(半斤,捣碎) 甘草(炙) 生姜(各二两) 大枣(十二枚)。用水六升,先煮麻黄,去掉水面上的泡沫,加入其余药物,煮取三升药液,分三次温服。
治疗里水病,症见全身及面目黄肿,脉象沉,小便自利且口渴的情况;同时也治疗风寒之邪客于经脉而不离去,营气郁热腐败导致肌肉极度发热,致使身体津液脱失,腠理开泄,大汗淋漓,以及疠风气引起的下焦脚部软弱无力。
越婢汤原方加白术四两。
治疗肺胀,症见咳嗽气喘,脉象浮大的情况。越婢汤原方大枣增加三枚,生姜增加一两,加半夏半升。
越婢汤能发越脾中之气,发汗生津,具有凉散作用。(所谓越婢,是指发越脾脏中的津气以化为汗,属于凉散法。)
麻黄、石膏、甘草、大枣、生姜,《金匮要略》用此方治疗风水病。恶风、身肿、脉洪浮,面赤、发热、口渴才适宜使用。(旭高按:《金匮要略》中所述的风水病,是肺、脾、胃三经受风热阳邪侵袭,痹阻了营卫之气,导致升降功能失常。这样水饮进入胃后,不能输布至脾并归肺,下达膀胱,反而外溢肌肤,所以全身都浮肿。其症状表现为恶风、发热、脉洪浮而口渴,因此知道是风热所致,我也曾验证过这一点。然而必须兼有无汗而喘的症状,服用此汤一次,未必会出汗,但水饮反而从小便排出,真是匪夷所思。)里水黄肿脉象沉,小便通利津液亡则加白术服用。(名为越婢加术汤。旭高按:水在体内,通常不应口渴,若口渴则可证明津液已伤。如今既口渴又黄肿不退,说明水饮未去。水未去为何会渴?是因为小便自利,导致津液耗损的缘故。一般来说,脾气实的人,小便通利则水饮去;脾气虚的人,小便通利则津液亡,津液亡故口渴。病虽始于里水,但实际上体内已无水,水仅在皮肤之中,所以也用越婢汤,使水从表解。但加一味白术,补脾气生津液,以固护里气,则用意周全了。)营气郁热腐败成为疠风,俗称“大麻疯”即是。清疏营卫最为适宜,加白术是因为脚部软弱罢了。(按:疠风因风邪久留化热,营气被其煽动灼烧,血肉腐坏,所以导致鼻柱塌陷、面色败坏、皮肤溃疡,即俗话所说的“大麻疯”。喻嘉言有此见解,所以说“汗宜频发,血宜频刺”,但当时没有相应的方剂。旭高观察此汤清疏营卫的功效,与喻嘉言的说法相符。石膏清热生津液,麻黄疏风通血脉,甘草解热毒,姜、枣调和营卫,如果不伴有脚弱,那么白术也可以不加。后人遇到这种证候,绝不知道使用此汤,为什么呢?)温热邪气挟带痰饮填塞肺中,导致肺胀咳嗽气喘,加半夏治疗。疏散邪气、清热,越婢汤为佳;祛除痰饮、消化痰浊,半夏和生姜配合甚妙。(名为越婢加半夏汤。肺胀咳嗽气喘,是外邪与内饮相互搏结的证候。越婢汤发散邪气、清热的功效较多,祛除痰饮、消化痰浊的力量较少,所以加半夏辅助其不足之处,再加生姜一两以助半夏之功,考虑得非常周密。)此方与小青龙加石膏汤,佐使之药寒温相对峙。(此方与小青龙加石膏汤相对立。小青龙汤中有半夏而无石膏,越婢汤中有石膏而无半夏,观察两方所加药物的意图,全重在石膏和半夏两味药协力建功。石膏清热,借助辛温之性也能豁痰;半夏豁痰,借助辛凉之性也能清热。前一个越婢加术汤生津止渴,借助白术进入清热药中;这个越婢加半夏汤降气定喘,又借助半夏进入清热药中。张仲景加减成方,无非是化裁变化以供后世学习。)又与越婢加术汤相比,降气生津各有侧重。千古医方敬仰张仲景,一加一减皆含精义。
Treats Wind-Water (Feng Shui) with aversion to wind, generalized edema of the whole body, swelling of the face and eyes, a red and hot complexion, fever without sweat, a surging and floating pulse with thirst, followed by spontaneous sweating, and no significant heat on the surface.
Ephedrae Herba (Mahuang, 麻黄) six liang, remove joints; Gypsum Fibrosum (Shigao, 石膏) half jin, crushed; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), prepared; Zingiberis Rhizoma Recens (Shengjiang, 生姜) two liang each; Zizyphi Fructus (Dazao, 大枣) twelve pieces. Use six sheng of water, first decoct Ephedrae Herba, remove the foam on the surface, then add the remaining herbs, decoct to obtain three sheng of liquid, divide into three warm doses.
Treats Interior Water (Li Shui) with yellowish swelling of the whole body and face, a deep pulse, free urination accompanied by thirst; also treats Cold-Wind pathogenic factors lodging in the meridians and not departing, where Ying-Qi (Nutritive Qi) becomes hot and corrupts, causing extreme heat in the flesh, leading to depletion of body fluids, opening of the interstices (Cou Li), profuse sweating, Leprosy Wind (Li Feng Qi), and weakness of the lower limbs due to deficiency in the Lower Jiao.
Yuebi Decoction (Yuebi Tang) original formula plus Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) four liang.
Treats Lung Distension (Fei Zhang) with cough, wheezing, and a floating and large pulse. Yuebi Decoction (Yuebi Tang) original formula: increase Zizyphi Fructus (Dazao, 大枣) by three pieces, increase Zingiberis Rhizoma Recens (Shengjiang, 生姜) by one liang, add Pinelliae Rhizoma (Banxia, 半夏) half sheng.
Yuebi Decoction (Yuebi Tang) venting Spleen Qi, inducing sweat and generating fluids, cooling and dispersing. (Yuebi means venting the fluids and Qi of the Spleen to induce sweat; this is a cooling and dispersing method.)
Ephedrae Herba (Mahuang, 麻黄), Gypsum Fibrosum (Shigao, 石膏), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), Zizyphi Fructus (Dazao, 大枣), Zingiberis Rhizoma Recens (Shengjiang, 生姜); *Jin Gui Yao Lue* uses this for Wind-Water. Aversion to wind, body swelling, surging and floating pulse, red face, heat, and thirst indicate its suitability. (Xu Gao's note: The Wind-Water described in *Jin Gui Yao Lue* is caused by Wind-Heat Yang pathogens affecting the Lung, Spleen, and Stomach meridians, obstructing Ying-Qi (Nutritive Qi) and Wei-Qi (Defensive Qi), impairing their ascending and descending functions. Thus, when fluid enters the Stomach, it cannot be transported to the Spleen and returned to the Lung, nor descend to the Bladder, but instead overflows into the skin and muscles, causing generalized edema. Its symptoms include aversion to wind, fever, surging and floating pulse, and thirst, indicating Wind-Heat, which I have verified. However, it must be accompanied by absence of sweat and wheezing. After one dose of this decoction, sweat may not occur, yet the fluid will pass through the urine, which is truly astonishing.) Interior Water presents with yellowish swelling and a deep pulse; if urination is free and fluids are depleted, add Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) for administration. (Named Yuebi Plus Baizhu Decoction. Xu Gao's note: When water is in the interior, thirst should not occur; thirst indicates fluid loss. Now, with thirst and persistent yellowish swelling, the water has not left. Why thirst if water remains? It is because free urination depletes fluids. Generally, if Spleen Qi is solid, free urination expels water; if Spleen Qi is deficient, free urination depletes fluids, causing thirst. Although the disease starts as Interior Water, the interior is actually dry, with water only in the skin. Thus, Yuebi Decoction is used to resolve water from the exterior. Adding Baizhu tonifies Spleen Qi and generates fluids to secure the interior, making the treatment comprehensive.) Ying-Qi (Nutritive Qi) heat and corruption lead to Leprosy Wind (Li Feng), commonly known as "Big Leprosy" (Da Ma Feng). Clearing and dispersing Ying-Qi and Wei-Qi is most appropriate; adding Baizhu addresses limb weakness. (Note: Leprosy Wind results from Wind pathogen lingering and transforming into Heat, scorching Ying-Qi and corrupting flesh and blood, causing collapse of the nasal bridge, deterioration of complexion, and skin ulcers, i.e., "Big Leprosy." Yu Jiayan recognized this, stating "sweat should be frequently induced, blood should be frequently pricked," but lacked a formula. Observing this decoction clears and disperses Ying-Qi and Wei-Qi, aligning with Jiayan's theory. Gypsum Fibrosum (Shigao, 石膏) clears heat and generates fluids; Ephedrae Herba (Mahuang, 麻黄) disperses wind and unblocks vessels; Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) resolves heat toxins; Ginger and Dates harmonize Ying-Qi and Wei-Qi. If limb weakness is absent, Baizhu may be omitted. Why do later practitioners rarely use this decoction for such cases?) Warm pathogens combined with fluid retention filling the Lungs cause distension and wheezing; treat with added Banxia (Pinelliae Rhizoma, 半夏). Dispersing pathogens and clearing heat, Yuebi Decoction is excellent; resolving fluid retention and eliminating phlegm, Banxia and Ginger work well together. (Named Yuebi Plus Banxia Decoction. Lung distension with cough and wheezing is a condition of external pathogens and internal fluid retention clashing. Yuebi Decoction excels at dispersing pathogens and clearing heat but lacks strength in resolving fluid retention and eliminating phlegm; thus, Banxia is added to supplement this deficiency, along with an extra liang of Ginger to enhance Banxia's effect, ensuring thoroughness.) This stands in opposition to Xiao Qing Long Plus Shigao Decoction regarding the balance of cold and warm properties. (This decoction opposes Xiao Qing Long Plus Shigao Decoction. Xiao Qing Long Decoction contains Banxia but no Shigao; Yuebi Decoction contains Shigao but no Banxia. The intent of adding these ingredients highlights the synergistic efficacy of Shigao and Banxia. Shigao clears heat and, aided by acrid-warm properties, can resolve phlegm; Banxia resolves phlegm and, aided by acrid-cool properties, can clear heat. The previous Yuebi Plus Baizhu Decoction generates fluids and stops thirst by incorporating Baizhu into heat-clearing herbs; this Yuebi Plus Banxia Decoction directs Qi downward and calms wheezing by incorporating Banxia into heat-clearing herbs. Zhang Zhongjing's modifications of established formulas are merely adaptations for future generations.) Compared with Yuebi Plus Baizhu Decoction, they differ in directing Qi downward versus generating fluids. Since ancient times, medical formulas have revered Master Zhongjing; every addition and subtraction contains profound principles.