治伤寒八九日。风湿相搏。身体疼烦。不能自转侧。不呕不渴。脉浮虚而涩者
之。若其人大便硬小便自利者。去桂加白术汤主之。
桂枝(四两) 附子(三枚 炮。) 大枣(十二枚) 生姜(三两) 甘草(二两)
上五味。以水六升。煮取二升。去滓。分温三服。
歌曰 三姜二草附枚三。四桂同投是指南。大枣方中十二粒。痛难转侧此方探。(此方
药品与桂枝去芍药加附子汤同。但分两之轻重不同。其主治亦别。仲景方法之严如此。)
按即上方加减。故论中云一方二法。
白术(四两) 甘草(二两) 附子(三枚 炮。) 大枣(十二枚) 生姜(三两)
上五味。以水六升。煮取二升。去滓。分温三服。初服其人身如痹。半日许。复服之。
三服尽。其人如冒状。勿怪。此以附子、术并走皮内逐水气。未得除。故使之尔。法当加桂
四两
歌曰 大便若硬小便通。脉涩虚浮湿胜风。即用前方须去桂。术加四两有神功。(身重
痛不能转侧。风湿病也。前方治风胜于湿。此方治湿胜于风。)
蔚按。师云。伤寒八九日风湿相搏。身体疼烦不能自转侧者。风湿之邪盛也。湿淫于中。
无
方主桂枝。为风胜于湿。风为天之阳邪。主桂枝之辛以化之。后方去桂加术。为湿胜于风。
湿为地之阴邪。主白术之苦以燥之。或问苦燥之品。不更令大便硬小便自利乎。曰。太阴湿
土喜燥而恶湿。湿伤脾土。则不能输其津液以入胃。师所以去解表之桂。而出补中之术也。
且湿既去而风亦无所恋而自除。经方无不面面周到也。
治疗伤寒病程已达八九日,风湿之邪相互搏结。患者身体疼痛且烦躁不安,无法自行翻身转动。没有呕吐,也没有口渴感,脉象浮而虚涩的,用桂枝附子汤主治。如果该患者大便干硬、小便通畅自利的,则去掉桂枝,加入白术,用桂枝附子去桂加白术汤主治。
桂枝(四两) 附子(三枚,炮制) 大枣(十二枚) 生姜(三两) 甘草(二两)
以上五味药,用水六升,煎煮至取药液二升,滤去药渣。分三次温服。
歌诀曰:三姜二草附枚三,四桂同投是指南。大枣方中十二粒,痛难转侧此方探。(此方的药品组成与桂枝去芍药加附子汤相同,只是药物分量轻重不同,其主治病症也有区别。张仲景的组方方法严谨如此。)
按语:即上方加减变化而来,故原文中说“一方二法”。
白术(四两) 甘草(二两) 附子(三枚,炮制) 大枣(十二枚) 生姜(三两)
以上五味药,用水六升,煎煮至取药液二升,滤去药渣。分三次温服。初次服用后,患者身体感觉麻木不仁;约半天时间后,再次服用。三次服完后,患者出现头昏目眩如蒙状的感觉,不要惊慌怪异。这是因为附子和白术共同作用于皮内,驱逐水湿之气,尚未完全去除,所以产生这种反应。按照法则应当加入桂枝四两。
歌诀曰:大便若硬小便通,脉涩虚浮湿胜风。即用前方须去桂,术加四两有神功。(身体沉重疼痛不能转动,是风湿病。前方治疗风邪胜于湿邪,此方治疗湿邪胜于风邪。)
蔚按:老师曾说,伤寒病程八九日,风湿相互搏结,身体疼痛烦躁不能自行翻身的,这是风湿之邪盛实。湿气淫溢于体内,原方主用桂枝,是因为风邪胜于湿邪。风属于天之阳邪,主要用桂枝的辛味来化解它。后方去掉桂枝加入白术,是因为湿邪胜于风邪。湿属于地之阴邪,主要用白术的苦味来燥湿。有人问:苦燥的药物,不是会让大便更干硬、小便更通畅吗?回答说:太阴湿土喜好干燥而厌恶潮湿。湿气损伤脾土,导致脾不能输送津液进入胃中。老师之所以去掉解表的桂枝,而改用补益中焦的白术。况且湿气既已去除,风邪也就无所依附而自然消除。经方无不面面俱到。
Treats Taiyang disease (disease of the Taiyang channel) that has persisted for eight or nine days, where Wind-Dampness (a pathogenic combination of wind and dampness) is intermingling. The patient experiences severe body pain and restlessness, unable to turn over independently. There is no vomiting and no thirst, and the pulse is floating, deficient, and choppy. Gui Zhi Fu Zi Tang (Cinnamon Twig and Aconite Decoction) is indicated. If the patient has hard stools and free urination, remove Gui Zhi (Cinnamon Twig) and add Bai Zhu (Atractylodis Rhizoma), treating with Gui Zhi Fu Zi Qu Gui Jia Bai Zhu Tang (Cinnamon Twig and Aconite Decoction minus Cinnamon Twig plus Atractylodis Rhizoma).
Gui Zhi (Cinnamon Twig) (4 liang) Fu Zi (Prepared Aconiti Lateralis Radix) (3 pieces, processed) Da Zao (Jujubae Fructus) (12 pieces) Sheng Jiang (Zingiberis Rhizoma Recens) (3 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma) (2 liang)
Take these five herbs. Add six sheng of water, decoct to obtain two sheng of liquid. Remove the dregs. Divide into three warm doses.
Song says: Three parts ginger, two parts licorice, three aconites; four parts cinnamon twig guides the way. Twelve jujubes in the formula; this formula explores cases of painful inability to turn. (The ingredients of this formula are the same as Gui Zhi Qu Shao Yao Jia Fu Zi Tang [Cinnamon Twig Decoction minus Peony plus Aconite], but the dosages differ, and thus the indications also differ. Zhang Zhongjing's prescription methods are so rigorous.)
Note: This is a modification of the above formula, hence the text mentions "one formula, two methods."
Bai Zhu (Atractylodis Rhizoma) (4 liang) Gan Cao (Glycyrrhizae Radix et Rhizoma) (2 liang) Fu Zi (Prepared Aconiti Lateralis Radix) (3 pieces, processed) Da Zao (Jujubae Fructus) (12 pieces) Sheng Jiang (Zingiberis Rhizoma Recens) (3 liang)
Take these five herbs. Add six sheng of water, decoct to obtain two sheng of liquid. Remove the dregs. Divide into three warm doses. After the first dose, the patient may feel numbness; after about half a day, administer the second dose. After all three doses are consumed, the patient may experience a sensation of dizziness or clouded consciousness; do not be alarmed. This occurs because Fu Zi (Aconite) and Bai Zhu (Atractylodis Rhizoma) act together within the skin to expel water-dampness, which has not yet been fully eliminated, causing this reaction. According to the method, Gui Zhi (Cinnamon Twig) 4 liang should be added.
Song says: If stools are hard and urination flows freely, and the pulse is choppy, floating, and deficient indicating dampness overcoming wind; use the previous formula but remove cinnamon twig, adding four liang of atractylodis rhizoma yields miraculous results. (Heavy body pain and inability to turn indicate Wind-Dampness disease. The previous formula treats wind-dominant dampness; this formula treats dampness-dominant wind.)
Wei Annotates: The Master said, when Taiyang disease persists for eight or nine days with intermingled Wind-Dampness, causing severe body pain and inability to turn, it indicates an excess of Wind-Dampness pathogens. Dampness invades internally. The original formula uses Gui Zhi (Cinnamon Twig) because wind dominates dampness. Wind is a Yang pathogen from Heaven, primarily resolved by the acridity of Gui Zhi (Cinnamon Twig). The latter formula removes Gui Zhi and adds Bai Zhu (Atractylodis Rhizoma) because dampness dominates wind. Dampness is a Yin pathogen from Earth, primarily dried by the bitter nature of Bai Zhu (Atractylodis Rhizoma). One might ask: Do not bitter-drying substances make stools harder and urination more frequent? The answer is: Taiyin Spleen Earth prefers dryness and dislikes dampness. When dampness injures Spleen Earth, it fails to transport fluids to the Stomach. Therefore, the Master removes the exterior-releasing Gui Zhi (Cinnamon Twig) and employs the middle-journey-nourishing Bai Zhu (Atractylodis Rhizoma). Moreover, once dampness is removed, wind has no attachment and dissipates naturally. Classical formulas are invariably comprehensive.