(见上。) 咳逆倚息不得卧。此方主之。
元犀按。十枣汤专主内饮而不及外邪。此方散外邪。涤内饮。为内外合邪之的方也。以
下五
治青龙汤下已。多唾口燥。寸脉沉。尺脉微。手足厥逆。气从少腹上冲胸
其面翕热如醉状。因复下流阴股。小便难。时复冒者。与此汤治其气冲。(按
痹面如醉气冲时复冒。似少阴阴阳不交之症。学人可于临症时参辨之则可。)
桂枝 茯苓(各四两。) 五味(半升。) 甘草(三两。炙。)
上四味。以水八升。煮取三升。去滓。分温三服。
歌曰 青龙却碍肾元亏。(肾元亏而误服之。则动冲任之火。致变为以下诸证。)上逆下
流又
下。在阳无主。如电光之闪烁无定。)味用半升苓桂四。甘三扶土镇冲宜。
男元犀按。仲师五味子必与干姜同用。独此方不用者。以误服青龙之后冲气大动。取其
静以制动。故暂停不用也。尤云。苓、桂能抑冲气使之下行。然逆气非敛不降。故以五味之
酸敛其气。土浓则阴火自伏。故以甘草之甘补其中也。
治(服前药)冲气即低。而反更咳胸满者。此汤主之。
茯苓(四两。) 甘草 干姜 细辛(各三两。) 五味子(半升。)
上五味。以水八升。煮取三升。去滓。温服半升。日三服。
歌曰 冲气低时(得桂苓之力而低。)咳(寒饮渍肺则咳。)满(寒饮贮胸则满。)频。
前方去桂
得干姜细辛大辛大热。方能泄胸中之满而止咳也。)姜辛三两根据原法。原法通微便出新。
(见上文。)咳嗽气逆,倚靠呼吸,不能平卧。此方主治。
元犀按:十枣汤专门主治体内停饮而不顾及外邪。此方疏散外邪,涤荡内饮,是治疗内外合邪的对症之方。以下五首方剂……
治疗服用小青龙汤后,出现多唾、口燥,寸脉沉,尺脉微,手足厥冷,气从少腹上冲至胸,面部潮红如醉酒状,随后热气下行流注于大腿内侧,小便困难,时常头晕目眩者,给予此汤治疗其气上冲。(按语:面赤如醉、气上冲、时常头晕,类似少阴病阴阳不交的症状,学者可在临证时参考辨析即可。)
以上四味药,用水八升,煮取三升,去渣,分三次温服。
歌诀曰:小青龙汤若碍肾元亏虚。(因肾元亏虚而误服小青龙汤,则会触动冲任之火,导致变为以下诸种证候。)气机上逆下流,在阳分无主,如同电光闪烁不定。用五味子半升,茯苓、桂枝各四两,甘草三两以扶助中土、镇摄冲气为宜。
男元犀按:仲景使用五味子必定与干姜同用,唯独此方不用,是因为误服小青龙汤后冲气大动,取其静以制动之意,所以暂时停用。尤在泾说:茯苓、桂枝能抑制冲气使其下行。然而逆气非收敛不能下降,故用五味子的酸味来收敛气机;中土厚实则阴火自然潜伏,故用甘草的甘味来补益中焦。
治疗(服用前药后)冲气已降,反而又出现咳嗽、胸满者,此汤主治。
以上五味药,用水八升,煮取三升,去渣,每次温服半升,每日三次。
歌诀曰:冲气降低时(得桂苓之力而降低),咳嗽(寒饮浸渍肺脏则咳),胸满(寒饮贮留胸中则满)频繁。前方去掉桂枝,得到干姜、细辛的大辛大热之性,方能宣泄胸中之满而止咳。姜、细辛各三两依据原法,原法通晓微妙便出新意。
(See above.) Cough and asthma with inability to lie flat. This formula is indicated.
Yu Xi notes: Shizao Tang (Ten Date Decoction) specifically treats internal fluid retention without addressing external pathogens. This formula disperses external pathogens and clears internal fluid retention, making it the specific prescription for conditions where external and internal pathogenic factors combine. The following five formulas...
After administering Xiao Qinglong Tang (Minor Blue Dragon Decoction), if symptoms such as excessive salivation, dry mouth, deep pulse at the cun position, faint pulse at the chi position, cold extremities, qi rushing from the lower abdomen up to the chest, facial flushing resembling drunkenness, followed by heat flowing down into the inner thighs, difficult urination, and occasional dizziness occur, administer this formula to treat the qi rushing upward. (Note: Facial flushing like drunkenness, qi rushing upward, and occasional dizziness resemble symptoms of Shaoyin disease involving failure of yin and yang interaction. Scholars may refer to this during clinical practice for differentiation.)
Guizhi Twig (Cinnamon Twig) [4 liang], Poria [4 liang], Schisandra Fruit [0.5 sheng], Licorice Root [3 liang, honey-fried].
Take the above four ingredients, add eight sheng of water, decoct to obtain three sheng, remove the dregs, and divide into three warm doses.
Rhyme says: If Xiao Qinglong Tang is used when Kidney Yuan is deficient, (if taken mistakenly due to Kidney Yuan deficiency, it will stir up fire in the Chong and Ren vessels, leading to the subsequent syndromes described below). Qi rushes upward and downward, lacking mastery in the Yang aspect, flickering like lightning. Use 0.5 sheng of Schisandra, 4 liang each of Poria and Guizhi Twig, and 3 liang of Licorice to strengthen Earth and suppress the rushing Qi.
Yu Xi notes: Zhong Jing always uses Schisandra together with Dried Ginger. The reason it is omitted in this formula is that after the mistaken use of Xiao Qinglong Tang, the rushing Qi moves violently; thus, its calming effect to control movement is desired, so it is temporarily withheld. You Zaijing states: Poria and Guizhi Twig can suppress the rushing Qi and guide it downward. However, rebellious Qi cannot descend without astringency; therefore, the sour nature of Schisandra is used to astringe the Qi. When Earth is thick, Yin Fire naturally subsides; therefore, the sweet nature of Licorice is used to tonify the Middle Jiao.
If, after taking the previous medicine, the rushing Qi has subsided but cough and chest fullness recur, this formula is indicated.
Poria [4 liang], Licorice, Dried Ginger, Asarum [3 liang each], Schisandra [0.5 sheng].
Take the above five ingredients, add eight sheng of water, decoct to obtain three sheng, remove the dregs, and take 0.5 sheng warm per dose, three times daily.
Rhyme says: When the rushing Qi subsides (subdued by the power of Poria and Guizhi Twig), cough occurs (caused by cold-fluid soaking the Lungs), and chest fullness recurs frequently (caused by cold-fluid storing in the Chest). By removing Guizhi Twig from the previous formula, one utilizes the great pungent and hot nature of Dried Ginger and Asarum to vent the fullness in the Chest and stop coughing. Dried Ginger and Asarum, 3 liang each, follow the original method; understanding the subtleties of the original method yields new insights.