葛根(四两) 麻黄(二两去节) 桂枝(二两去皮) 芍药(二两酒洗) 甘草(二两炙) 生
姜(三两切) 大枣(十二枚擘)
上七味。 咀。以水一斗。先煮麻黄葛根。减二升。去沫。纳诸药。煮取三升。去滓。
温服
一升。覆取微似汗不须啜粥。余如桂枝法将息。及禁忌。此治太阳伤寒。传入阳明。未离太
阳
。故以葛根为君。并加麻黄于桂枝汤中。仍属太阳与阳明同治。并非阳明经之主方也。故经
云。太阳病。项背强KT KT 。反汗出恶风者。桂枝加葛根汤主之。太阳病。
项背强KT KT 。无汗
恶风者。葛根汤主之。此明以有汗无汗。辨邪之或自中风而来。或自伤寒而来。但见阳明一
证
。即用葛根一味。亟伐阳明之邪。而太阳未尽之邪。仍不离桂枝麻黄。分别风寒主治。其有
太阳阳明。同时病发。不分先后者。则太阳之邪。合阳明胃中之水谷而下奔。必自下利。仍
以葛根汤主治。以葛根汤中自有麻桂。并伐太阳之邪也。今人误以葛根汤为阳明经药。大
谬。
葛根汤原方。加半夏半升。洗煎服法同。
太阳与阳明合病者。必自下利。葛根汤主之。不下利。但呕者。葛根加半夏汤主之。此
合病
中亦有主风主寒之不同。喻嘉言曰。风者阳也。阳性上行。故合阳明胃中之水饮而上逆。寒
者阴也。阴性下行。故合阳明胃中之水谷而下奔。下奔则利。但用葛根。已足解邪而止利上
逆则呕。必加半夏。方能涤饮而止呕。此以见先圣制方。一药不苟处。
葛根(四两) 麻黄(二两,去节) 桂枝(二两,去皮) 芍药(二两,酒洗) 甘草(二两,炙) 生姜(三两,切) 大枣(十二枚,掰开)
以上七味药。切碎。用水一斗。先煮麻黄和葛根。减少二升水量。去掉浮沫。加入其余药物。煮取三升药液。去掉药渣。温服一升。服药后覆盖衣被使身体微微出汗,不需要喝热粥。其余调养方法和禁忌事项,参照桂枝汤(Cinnamon Twig Decoction)的方法进行。这是治疗太阳伤寒(Cold Damage of the Taiyang Channel),病邪传入阳明(Yangming),但未离开太阳经。因此以葛根为君药(主药)。并在桂枝汤中加入麻黄,仍然属于太阳与阳明同治,并非阳明经的主方。所以经典中说:太阳病,项背强直不舒(KT KT指拘急不舒之貌),反而汗出恶风者,用桂枝加葛根汤主治。太阳病,项背强直不舒,无汗恶风者,用葛根汤主治。这是明确通过有汗无汗,辨别病邪是自中风而来,还是自伤寒而来。只要见到阳明证,就用葛根一味,急切地攻伐阳明的病邪,而太阳未尽的病邪,仍然不离桂枝、麻黄,分别针对风寒主治。如果有太阳阳明同时发病,不分先后的,那么太阳的病邪,会合着阳明胃中的水谷一起向下奔注,必然导致下利(腹泻)。仍然用葛根汤主治,因为葛根汤中自有麻黄、桂枝,能共同攻伐太阳的病邪。现在的人错误地把葛根汤当作阳明经的药,是大错特错的。
葛根汤原方,加上半夏半升,清洗煎服方法相同。
太阳与阳明合病(Two channels affected simultaneously)的,必然自下利,用葛根汤主治。不下利,只是呕吐的,用葛根加半夏汤(Gegen Tang with Pinellia Decoction)主治。这合病中也有主风主寒的不同。喻嘉言说:风属阳,阳性上行,所以合病阳明胃中的水饮而上逆;寒属阴,阴性下行,所以合病阳明胃中的水谷而下奔。下奔则导致下利,只用葛根,已足以解邪而止利。上逆则导致呕吐,必须加半夏,才能涤除痰饮而止呕。由此可以看出,古代圣人所制定的方剂,每一味药都不随意使用。
Ge Gen (Radix Puerariae, 4 liang) Ma Huang (Herba Ephedrae, 2 liang, removed nodes) Gui Zhi (Ramulus Cinnamomi, 2 liang, removed bark) Shao Yao (Radix Paeoniae Rubra or Radix Paeoniae Alba, 2 liang, washed with wine) Gan Cao (Radix Glycyrrhizae, 2 liang, honey-fried) Sheng Jiang (Rhizoma Zingiberis Recens, 3 liang, sliced) Da Zao (Fructus Jujubae, 12 pieces, torn open).
The above seven ingredients. Coarsely crushed. Boil in ten dou of water. First decoct Ma Huang and Ge Gen, reduce by two dou, skim off the foam. Add the remaining herbs. Decoct to obtain three sheng of liquid. Strain off the dregs. Take one sheng warm. Cover with blankets to induce a slight sweat; there is no need to drink hot porridge. The rest of the nursing care and dietary restrictions follow the method of Guizhi Tang (Cinnamon Twig Decoction). This treats Taiyang Shang Han (Cold Damage of the Taiyang Channel), where the pathogen has transmitted to Yangming but has not yet left Taiyang. Therefore, Ge Gen is used as the Jun herb (sovereign herb). Ma Huang is added to Guizhi Tang, still belonging to the simultaneous treatment of Taiyang and Yangming, and is not the principal formula for the Yangming channel. Thus, the classic states: In Taiyang Bing (Disease of the Taiyang Channel), if there is stiffness and discomfort in the nape and back, accompanied by sweating and aversion to wind, Guizhi Jia Ge Gen Tang (Decoction of Cinnamon Twig plus Pueraria) is indicated. If there is stiffness and discomfort in the nape and back, without sweating and with aversion to wind, Gegen Tang (Pueraria Decoction) is indicated. This clearly distinguishes whether the pathogen comes from Wind (Zhong Feng) or Cold (Shang Han) based on the presence or absence of sweating. Whenever a Yangming symptom appears, Ge Gen alone is used to urgently attack the Yangming pathogen, while the residual Taiyang pathogen is still treated with Gui Zhi and Ma Huang, distinguishing between Wind and Cold. If Taiyang and Yangming are affected simultaneously without distinction of priority, the Taiyang pathogen merges with the food and fluids in the Stomach (Yangming) and rushes downward, inevitably causing Xia Li (diarrhea). Gegen Tang is still indicated because it contains Ma Huang and Gui Zhi, which jointly attack the Taiyang pathogen. It is a great error for modern practitioners to mistakenly regard Gegen Tang as a medicine for the Yangming channel.
To the original Gegen Tang formula, add Ban Xia (Fructus Pinelliae Preparatus, half sheng). The washing and decoction methods remain the same.
When Taiyang and Yangming are affected simultaneously (He Bing), diarrhea will inevitably occur; Gegen Tang is indicated. If there is no diarrhea but only vomiting, Gegen Jia Ban Xia Tang (Pueraria Decoction plus Pinellia) is indicated. Among these simultaneous affections, there are differences between those dominated by Wind and those dominated by Cold. Yu Jiayan stated: Wind is Yang, and Yang nature tends to ascend; thus, when affecting Yangming, the fluids in the Stomach rebel upward. Cold is Yin, and Yin nature tends to descend; thus, when affecting Yangming, the food and fluids in the Stomach rush downward. Rushing downward causes diarrhea; using only Ge Gen is sufficient to resolve the pathogen and stop the diarrhea. Rebelling upward causes vomiting; adding Ban Xia is necessary to clear phlegm-fluids and stop vomiting. This demonstrates that the formulas formulated by the ancient Sages do not use any herb arbitrarily.