黄 (五分。病甚。劳役热甚者。一钱) 当归身(二钱。酒焙干。或日干。以和血脉。) 人参(去芦三钱有嗽。
去之) 白术(三分以补中气。○薛氏医按。用一钱五分。) 柴胡(二分引清气上升。行少阳之经。) 炙甘草(五分)
升麻(二分引胃气上腾。而复其本位。便是行春升之令。) 橘皮(三分以导滞气。又能益元气。得诸甘药乃可。若独
用。泻胃气。)
上件 咀。都作一服。水二盏。煎至一盏。去渣。大温。服食远。○薛氏医按。有姜枣。空心午前服。
琥按上方。本治饮食劳倦。内伤发热等证。而丹溪以之治中寒。以伤寒多实热。宜泻。中寒多虚寒。宜补。故用上
汤加发散药。愚以中寒身受寒气者。固宜补发。若口食寒物者。尚当温中消导。上汤之用。未免过于补也。全在医者。
临证。出入加减用之。
戴院使云。中寒之证。人身体强直。口噤不语。或四肢战掉。或洒洒恶寒。或翕翕发热。或卒然眩晕。身无汗者。
此为寒毒所中。宜先用酒调苏合香丸。轻则进五积散。加香附一钱。麝香少许。重则用姜附汤。若人渐苏。身体回暖。
稍能言语。须臾。问其别有何证。挟气攻刺。姜附汤。加木香半钱。挟风不仁。加防风一钱。挟湿而肿痛者。加白术一
钱。筋脉牵急者。加木瓜一钱。肢节疼痛者。加桂二钱。
黄(五分。若病情严重,劳役所致热象显著者,用一钱)当归身(二钱。酒焙干,或日晒干燥,用以调和血脉。)人参(去芦头三钱。若有咳嗽,去掉不用。)白术(三分,用以补益中气。○薛氏《医宗必读》中,用量为一钱五分。)柴胡(二分,引导清气上升,运行于少阳经脉。)炙甘草(五分)升麻(二分,引导胃气上腾,恢复其原本位置,这便是施行春季升发之令。)陈皮(三分,用以疏导滞气,又能补益元气,需配合各种甘味药物使用。若单独使用,会泻损胃气。)
以上药材切碎,混合为一剂。加水两盏,煎煮至一盏,滤去药渣。趁大温热服,与进食时间间隔较远时服用。○薛氏《医宗必读》记载,方中有生姜、大枣,宜在空心、午前服用。
琥按:上述方剂,原本用于治疗饮食不节、劳倦内伤导致的发热等证候。而丹溪先生用它来治疗中寒证,是因为伤寒多属实热证,适宜用泻法;中寒多属虚寒证,适宜用补法。因此使用上方并加入发散药物。我认为,中寒证因身体感受寒气者,固然适宜补益兼以发散;但若因口食寒凉之物致病者,尚且应当温中焦、消积导滞。上方之用,未免过于偏重补益。全凭医生临证时,灵活出入加减使用。
戴院使说:中寒的证候,人体身体强直,口噤不能言语,或四肢颤抖,或阵阵恶寒,或微微发热,或突然眩晕,身体无汗者,这是被寒毒所中。适宜先用酒调服苏合香丸,轻症则进服五积散,加香附一钱,少许麝香;重症则用姜附汤。若患者逐渐苏醒,身体回暖,稍能言语,须臾之后,询问其还有何其他证候。若挟气攻刺疼痛,姜附汤中加木香半钱;若挟风导致麻木不仁,加防风一钱;若挟湿导致肿痛者,加白术一钱;若筋脉牵拉拘急者,加木瓜一钱;若肢节疼痛者,加桂枝二钱。
Huang (5 fen. If the condition is severe, or if there is significant heat due to overwork and fatigue, use 1 qian.) Danggui Shen (2 qian. Baked with wine or dried in the sun, to harmonize the blood vessels.) Renshen (3 qian, remove the rhizome. If cough is present, do not use.) Baizhu (3 fen, to tonify Middle Qi. ○ Xue Shi Yi An uses 1.5 qian.) Chaihu (2 fen, to guide clear Qi upward, acting on the Shaoyang meridian.) Zhi Gancao (5 fen) Shengma (2 fen, to guide Stomach Qi upward and restore its original position; this constitutes the execution of the Spring ascending command.) Chenpi (3 fen, to direct stagnant Qi, and can also benefit Yuan Qi. It must be used with various sweet herbs. If used alone, it drains Stomach Qi.)
The above ingredients are cut into small pieces, combined as one dose. Add two zhan of water, decoct until one zhan remains, remove the dregs. Take warm when very hot, far from meals. ○ Xue Shi Yi An notes: add fresh ginger and jujube, take on an empty stomach before noon.
Hu comments: The above formula originally treats conditions such as internal injury fever caused by improper diet and fatigue. However, Danxi used it to treat Zhonghan (Cold Stroke), reasoning that Shanghan (Cold Damage) often involves excess-heat, suitable for purging, whereas Zhonghan often involves deficiency-cold, suitable for tonifying. Thus, the above formula was used with added dispersing herbs. I believe that for Zhonghan caused by external cold invasion, tonification combined with dispersion is indeed appropriate. However, for cases caused by ingesting cold substances, warming the Middle and promoting digestion are still necessary. The use of the above formula may be overly tonifying. Its application depends entirely on the physician's flexible modification based on clinical presentation.
Dai Yuanshi stated: In Zhonghan syndrome, the body becomes stiff and rigid, the mouth is locked and speechless, or there is trembling of the four limbs, or shivering aversion to cold, or slight fever, or sudden vertigo, with no sweat on the body. This indicates being struck by Cold Toxin. Initially, Suhe Xiang Wan should be taken mixed with wine. For mild cases, Wuji San is administered, adding 1 qian of Xiangfu and a small amount of Shexiang. For severe cases, Jiang Fu Tang is used. If the patient gradually revives, the body warms up, and speech returns slightly, after a moment, inquire about other symptoms. If accompanied by Qi attack causing stabbing pain, add Ban qian of Muxiang to Jiang Fu Tang. If accompanied by Wind causing numbness, add 1 qian of Fangfeng. If accompanied by Dampness causing swelling and pain, add 1 qian of Baizhu. If tendons and vessels are pulled tight, add 1 qian of Mugua. If limb joints are painful, add 2 qian of Guizhi.