柴胡 半夏 黄芩 芍药 生姜 大枣 枳实 大黄
太阳过经。反二三下之。四五日柴胡症仍在。先与小柴胡汤。呕不止。心下急。微烦者
。与大柴胡汤。又曰。十余日热结在里。往来寒热。与大柴胡汤。夫大实大满。非驶剂不能泄。
当与大小承气汤。苟不至大满大实。惟热甚而须下者。必轻缓如大柴胡汤为当也。清热必以
苦为主。余邪必以解为先。故用柴胡之苦平解肌为君。黄芩之苦寒清热为臣。芍药佐黄芩祛
营中之热。枳实佐柴胡祛卫中之热。是以为佐。半夏姜枣。理胃气之逆。大黄荡涤。夺土
中之壅。是以为使。
柴胡 黄芩 甘草 人参 生姜 半夏 大枣 芒硝
十三日不解。胸胁满而呕。日晡潮热。已而微利。此本柴胡症。下之而不得利。今反利
者。以丸药下之。非其治也。潮热者实也。先宜小柴胡解外。后用此汤。 胸胁满。呕而潮热。
邪在半表半里。小柴胡汤为的当之剂。但下之失宜。则里邪未尽。非柴胡汤所能疗也。故加
芒硝以荡之。
桃仁 大黄 甘草 桂枝 芒硝
太阳病不解。热结膀胱。其人如狂。血自下者愈。外不解者。尚未可攻。当先解外。外
解已。但少腹急结者。乃可攻之。宜与此汤。按犀角地黄汤。治上血。吐血衄血是也。桃核承
气汤。治中血。蓄血中焦。下利脓血是也。抵当汤。治下焦血。如狂是也。少腹急结。缓以
桃仁之甘。下焦蓄血。行以桂枝之辛。热甚搏血。故加二物于调胃承气汤中也。以症状察之
。当是浓桂非是桂枝也。桂枝轻扬治上。浓桂重降治下。其为错误无疑也。
太阳病(太阳经受邪所致的病证)病程已过,反而被误用了二三次攻下法。过了四五天,柴胡证(少阳病的主要证候)仍然存在,先给予小柴胡汤(和解少阳的代表方剂)。如果呕吐不止,胃脘部拘急不适,心中微有烦闷,则给予大柴胡汤(和解少阳、内泻热结的方剂)。又说:十余日后,热邪结聚在体内,出现寒热往来(忽冷忽热),给予大柴胡汤。凡是病情严重、胀满明显的,必须用峻猛的药物才能泄下,应当给予大承气汤或小承气汤。如果并未达到极度胀满和实热的程度,只是热势很盛需要攻下的,那么选用药性较轻缓的大柴胡汤才是恰当的。清热必须以苦味药为主,清除余邪必须以解表为先。所以用柴胡的苦平之性来解除肌表之邪作为君药;黄芩的苦寒之性来清除热邪作为臣药;芍药辅助黄芩祛除营分中的热邪;枳实辅助柴胡祛除卫分中的热邪,这两者作为佐药;半夏、生姜、大枣调理胃气的上逆;大黄荡涤肠胃,去除脾胃中的壅滞,这两者作为使药。
十三天病情未解,胸胁部胀满且呕吐,傍晚时分发热如潮水般定时加重,随后出现轻微腹泻。这原本属于柴胡证,经过攻下治疗后并没有导致腹泻,现在反而出现腹泻,是因为之前使用了丸药攻下,这不是正确的治疗方法。傍晚潮热说明体内有实邪。应当先用小柴胡汤解除半表半里之邪,然后再使用此汤(柴胡加芒硝汤)。胸胁胀满、呕吐且伴有潮热,说明邪气在半表半里之间,小柴胡汤是确切的对症方剂。但是既然已经错误地使用了攻下法,导致里邪未能完全清除,单靠柴胡汤已无法治愈,所以加入芒硝来荡涤里实。
太阳病未愈,热邪结聚于膀胱部位。患者神志如狂乱一般,如果瘀血自行排出,病就会痊愈。如果体表症状仍未解除,尚不可使用攻逐瘀血的方法,应当先解除表邪。待表邪解除后,如果仅见少腹部拘急硬痛,才可以攻逐瘀血,适宜给予此汤(桃核承气汤)。按:犀角地黄汤治疗上部出血,如吐血、鼻衄等;桃核承气汤治疗中部出血,即蓄血在中焦,如下利脓血等;抵当汤治疗下焦瘀血,症见如狂等。少腹部拘急硬痛,用桃仁的甘润之性来缓和;下焦蓄血,用桂枝的辛散之性来通行血脉。由于热势甚盛并与血液搏结,所以在调胃承气汤中加入这两味药。从症状分析来看,这里用的应该是肉桂而非桂枝。桂枝轻扬上行治上焦,肉桂重浊下行治下焦,此处显然是错误的。
Chai Hu (Bupleuri Radix), Ban Xia (Pinelliae Rhizoma), Huang Qin (Scutellariae Radix), Shao Yao (Paeoniae Radix), Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus), Zhi Shi (Aurantii Fructus Immaturus), Da Huang (Rhei Radix et Rhizoma).
When the Taiyang disease (disease pattern caused by pathogenic invasion of the Taiyang meridian) has passed its course, but has been mistakenly treated with purgatives two or three times, and after four to five days the Chai Hu syndrome (main symptom pattern of Shaoyang disease) remains, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) first. If vomiting persists, there is a sense of urgency and distress in the epigastrium, and slight irritability, administer Da Chai Hu Tang (Major Bupleurum Decoction). It is also stated: After more than ten days, if heat is consolidated internally and there is alternating chills and fever, administer Da Chai Hu Tang. In cases of severe excess and fullness, only potent purgatives can drain the accumulation; thus, Da Cheng Qi Tang (Major Order the Qi Decoction) or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) should be given. However, if the condition does not reach the extent of extreme fullness and solid excess, but merely requires purging due to intense heat, then using the milder Da Chai Hu Tang is appropriate. To clear heat, bitter herbs are primary; to resolve residual pathogens, releasing the exterior is prioritized. Therefore, Chai Hu, with its bitter and neutral nature, resolves the muscle layer and serves as the Sovereign herb; Huang Qin, with its bitter and cold nature, clears heat and serves as the Minister herb; Shao Yao assists Huang Qin in dispelling heat from the Ying (Nutritive) level; Zhi Shi assists Chai Hu in dispelling heat from the Wei (Defensive) level; these serve as Assistant herbs. Ban Xia, Sheng Jiang, and Da Zao regulate the rebellion of Stomach Qi; Da Huang sweeps away accumulations and removes stagnation in the Spleen and Stomach; these serve as Envoy herbs.
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix), Sheng Jiang (Zingiberis Rhizoma Recens), Ban Xia (Pinelliae Rhizoma), Da Zao (Jujubae Fructus), Mang Xiao (Natrii Sulfas).
If the condition remains unresolved after thirteen days, with fullness and distension in the chest and hypochondrium accompanied by vomiting, and tidal fever (fever that worsens at a specific time each day, typically afternoon) followed by mild diarrhea, this originally belonged to the Chai Hu syndrome. It was treated with purgatives which failed to induce diarrhea, but now diarrhea occurs because pill-form purgatives were previously used, which was an incorrect treatment. Tidal fever indicates internal excess. One should first use Xiao Chai Hu Tang to resolve the exterior/Shaoyang aspect, and subsequently use this formula (Chai Hu Jia Mang Xiao Tang - Minor Bupleurum Decoction plus Natrii Sulfas). Fullness in the chest and hypochondrium, vomiting, and tidal fever indicate the pathogen is in the half-exterior, half-interior region; Xiao Chai Hu Tang is the precise indicated formula. However, since improper purgative therapy was used, the interior pathogens remain uneliminated, and Chai Hu Tang alone cannot cure it. Therefore, Mang Xiao is added to sweep away the interior excess.
Tao Ren (Persicae Semen), Da Huang (Rhei Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), Mang Xiao (Natrii Sulfas).
When Taiyang disease is not resolved, heat consolidates in the Bladder region. The patient exhibits a state resembling madness. If blood discharges spontaneously, the disease will heal. If the exterior symptoms are not yet resolved, attacking the interior with blood-invigorating agents is not yet permissible; one must first resolve the exterior. Once the exterior is resolved, if there is only urgency and binding pain in the lower abdomen, then attacking the interior is permissible, and this formula (Tao He Cheng Qi Tang - Peach Kernel Decoction to Order the Qi) is suitable. Note: Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) treats upper jiao bleeding, such as hematemesis and epistaxis. Tao He Cheng Qi Tang treats middle jiao blood stasis, such as bloody purulent stools. Di Dang Tang (Di Dang Decoction) treats lower jiao blood stasis, presenting with manic behavior. For urgency and binding pain in the lower abdomen, the sweet nature of Tao Ren is used to soften and relieve; for blood stasis in the lower jiao, the acrid nature of Gui Zhi is used to promote circulation. Because heat is intense and binds with blood, these two ingredients are added to Tiao Wei Cheng Qi Tang (Regulate the Waist and Order the Qi Decoction). Based on the symptoms, it should be Rou Gui (Cinnamomi Cortex) rather than Gui Zhi. Gui Zhi is light and ascending, treating the upper jiao; Rou Gui is heavy and descending, treating the lower jiao. This is undoubtedly an error in the text.