桂枝(一两去皮) 甘草(二两炙) 牡蛎(二两炙) 龙骨(二两)
上为末。以水五升。煮取二升。去滓。温服八合。日三服。
经云。火逆下之。因烧针烦躁者。此汤主之。此证较上条稍轻。以元阳尚未至飞越。故
无取
蜀漆迅疾之性。急追以滋扰。但下后烧针误而再误因致烦躁。则此烦躁。非太阳病汗不出之
烦躁。又非少阴病吐利后之烦躁。是已具起卧不安之象。而为惊狂之渐。即伏亡阳之机。故
主桂枝入心助阳。而加甘草龙骨牡蛎。以安中而镇逆也。
桂枝(一两十六铢去皮) 芍药 生姜 甘草 麻黄(各一两去节) 杏仁(二十四枚汤浸
去皮尖及双仁者) 大枣(四枚擘)
上七味。以水五升。先煮麻黄一二沸。去上沫。纳诸药。煮取一升八合。去滓。温服。
按太阳病。得之八九日如疟状。发热恶寒。热多寒少。此当正邪胜复之关。一则虑其邪
之转
属。一则虑其正之已虚。不可不细辨矣。若其人不呕。清便欲自可。是邪不属里。一日二三
度发。是邪已外向。脉又微缓。则胃气足以敌邪。乃为欲愈之征。倘脉微而恶寒甚。此阴阳
俱虚
。不可更发汗更下更吐。恐误治伤阳。反生他变。若其人面色反有热色者。是为欲解未解之
象。以其不能得小汗以宣助阳气。致阳气虽不内扰。却怫郁于皮肤肌肉之间。其身必痒。此
明证也。故主桂麻而小其制。但得汗出而邪尽解矣。
桂枝(一两,去皮) 甘草(二两,炙) 牡蛎(二两,炙) 龙骨(二两)
以上四味药捣成粉末。用水五升,煮取二升药液,滤去药渣。每次温服八合,每日服用三次。
经典著作中说:因误用火疗导致逆证,又用攻下法,随后再用烧针治疗而出现烦躁症状的,此汤主治。这个证候比上一条所述的情况稍轻,因为元阳之气尚未至飞越散失的程度,所以不需要蜀漆那种迅疾猛烈的药性来急追以滋扰心神。只是由于先误用攻下、后又误用烧针,一再失误才导致烦躁。那么这种烦躁,不是太阳病无汗的那种烦躁,也不是少阴病吐利之后的那种烦躁,而是已经具备坐卧不安的现象,并发展为惊狂的开端,即潜伏着亡阳的危险机制。因此,主用桂枝入心经以助阳气,并加入甘草、龙骨、牡蛎,以安定中焦而镇降逆气。
桂枝(一两十六铢,去皮) 芍药 生姜 甘草 麻黄(各一两,去节) 杏仁(二十四枚,热水浸泡后去皮尖及双仁者) 大枣(四枚,掰开)
以上七味药,用水五升,先煮麻黄一两次沸腾,去掉水面上的浮沫,然后加入其他药物,煮取一升八合药液,滤去药渣,温服。
按语:太阳病,患病八九日,症状像疟疾一样,发热恶寒,热多寒少。这正处于正气与邪气胜负交替的关键时刻。一方面要担心邪气转入他经,另一方面要担心正气已经虚弱,不可不仔细辨别。如果病人没有呕吐,大小便基本正常,说明邪气未传入里;一天发作两三次,说明邪气已有向外透达的趋势;脉象又微缓,说明胃气足以抵御邪气,这是将要痊愈的征兆。倘若脉象微细且恶寒严重,这是阴阳俱虚的表现,不可再发汗、攻下或催吐,恐怕误治损伤阳气,反而产生其他变证。如果病人面色反现红赤,这是欲解而未解的现象。因为不能通过微微出汗来宣通助长阳气,致使阳气虽然不在体内扰乱,却怫郁在皮肤肌肉之间,身体必然瘙痒,这是明显的证据。因此,主用桂枝麻黄各半汤而减小其剂量,只要得到汗出,邪气就能完全解除。
Guizhi (Cinnamon Twig, 1 liang, bark removed) Gancao (Licorice Root, 2 liang, honey-fried) Muli (Oyster Shell, 2 liang, calcined) Longgu (Fossilized Bone, 2 liang)
Crush the above four herbs into powder. Add five sheng of water, boil to obtain two sheng of decoction, remove the dregs. Take eight ge warm per dose, three times a day.
The classics state: In cases where fire therapy caused adverse reactions, followed by purgation, and then burning needle therapy resulted in restlessness (Fan Zao), this decoction is indicated. This syndrome is slightly milder than the previous clause because the Primordial Yang (Yuan Yang) has not yet flown away and scattered, thus there is no need for the swift and violent nature of Shuqi (Coenogonium) to urgently pursue and disturb [the mind]. It is merely that errors in purgation and subsequent burning needle therapy led to restlessness through repeated mistakes. Therefore, this restlessness is not the restlessness without sweating seen in Taiyang disease, nor is it the restlessness after vomiting and diarrhea seen in Shaoyin disease; rather, it already exhibits signs of inability to sit or lie still, serving as a precursor to fright and mania (Jing Kuang), implying a latent mechanism of Yang collapse (Wang Yang). Hence, Guizhi is used as the chief herb to enter the Heart and assist Yang, supplemented with Gancao, Longgu, and Muli to calm the Middle Jiao and subdue rebellious Qi.
Guizhi (Cinnamon Twig, 1 liang 16 zhu, bark removed) Shaoyao (Peony Root) Shengjiang (Fresh Ginger) Gancao (Licorice Root) Mahuang (Ephedrae Herba, each 1 liang, nodes removed) Xingren (Prunus Armeniaca Seed, 24 seeds, soaked in hot water, skin and tips removed, excluding double-kernel ones) Dazao (Jujube Fruit, 4 pieces, torn open)
Take the above seven herbs, add five sheng of water, first boil Mahuang for one or two boils, remove the foam on the surface, then add the remaining herbs. Boil to obtain 1.8 sheng of decoction, remove the dregs, take warm.
Commentary: In Taiyang disease, after eight or nine days, the condition resembles malaria (Nue), with fever and aversion to cold, where heat predominates over cold. This occurs at a critical juncture of alternating victory and defeat between healthy Qi (Zheng Qi) and pathogenic factors (Xie Qi). One must worry about the pathogen transferring to other meridians, and also worry that the healthy Qi may be depleted; careful differentiation is essential. If the patient does not vomit and bowel movements are relatively normal, it indicates the pathogen has not entered the interior. If it occurs two or three times a day, it suggests the pathogen is moving outward. If the pulse is slightly slow (Wei Huan), it indicates sufficient Stomach Qi to resist the pathogen, which is a sign of impending recovery. However, if the pulse is fine (Wei) and aversion to cold is severe, this indicates deficiency of both Yin and Yang; one must not induce sweating, purge, or provoke vomiting, lest mis-treatment damage Yang and cause further complications. If the patient's face appears reddish, this is a sign of resolution that is incomplete. Because slight sweating cannot be achieved to ventilate and assist Yang Qi, causing Yang Qi, though not disturbing internally, to become constrained (Fu Yu) between the skin and muscles, the body will inevitably itch; this is clear evidence. Therefore, Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is used with a reduced dosage, so that upon achieving sweating, the pathogen will be completely resolved.