(一百十三道○诸方之义本条注内已经疏明者此不复赘)
桂枝(三两) 芍药(三两酒洗) 甘草(二两炙) 生姜(三两切) 大枣(十二枚擘)
上五味 咀以水七升微火煮取三升。去滓适寒温服一升。服已须臾 稀粥一升余。以助药力。温覆令一时许。遍身
微似有汗者益佳不可令如水流漓病必不除。若一服汗出病瘥停后服。不必尽剂。若不汗再服。根据前法。又不汗。后
服小促役其间。半日许令三服尽若病重者。一日一夜服周时观之。服一剂尽病证犹在者。更作服。若汗不出者。乃服至
二三剂禁生冷粘滑肉面五辛酒酪臭恶等物。
此方专主卫受风邪之证。以其卫伤。不能外固而自汗。所以用桂枝之辛发其邪。即用芍药之酸助其阴然一散一收。
又须甘草以和其胃。况发汗必须辛甘以行阳。故复以生姜佐桂枝大枣佐甘草也。但方中芍药不言赤白。圣惠与节庵俱用
赤孙尚与叔微俱用白。然赤白补泻不同仲景云。病发热汗出。此为营弱卫强营虽不受邪。终非适平也。故卫强则营弱是
知必用白芍药也。营既弱而不能自固。岂可以赤芍药泻之乎。虽然。不可以一律论也。如太阳误下而传太阴因而腹满时
痛。则当倍白芍补营血之虚。若夫大实者必加大黄又宜赤芍以泻实也。至于湿热素盛之人与夫酒客辈感寒之初身寒恶热
者用桂枝汤。即当加黄芩以胜热则。不宜白芍以助阴。贵在临证活法也。○按桂枝入心。血药也。而仲景用以治风伤卫
之证。麻黄走肺气药也。而仲景用以治寒伤营之证皆气病用血药。血病用气药故许学士有脉浮而缓。风伤营浮紧兼涩寒
伤卫之误。殊不知风伤卫则卫受邪卫受邪。则不能内护于营。故营气不固而自汗。必以桂枝血药透达营卫又须芍药护营
固表。营卫和而自汗愈矣寒伤营则营受邪。营受邪。则不能外通于卫故气郁而无汗。必以麻黄气药开通腠理。又须桂枝
实营散邪。汗大泄而郁热散矣。
(第一百一十三条○各方剂的义理在本条注释中已经阐明,此处不再赘述)
桂枝(三两) 芍药(三两,用酒清洗) 甘草(二两,炙烤) 生姜(三两,切片) 大枣(十二枚,掰开)
以上五味药,切碎,用水七升,以微火煎煮至三升。滤去药渣,待温度适宜时服用一升。服药后不久,喝热稀粥一升多,以辅助药力。覆盖衣被约一顿饭的时间,使全身微微似有汗出为最佳,不可让汗出如水流漓,否则病必不能去除。如果服一次药后汗出且病愈,停止后续服药,不必服完全部药汁。如果没有出汗,再按前法服用。如果仍然不出汗,则缩短服药间隔时间,在半日左右让三次药服完。如果病情较重者,一日一夜连续服药,观察一个时辰(两小时)。如果服完一剂药后病症仍在,再重新配制服用。如果仍不出汗,可服用至二三剂。禁忌食用生冷、粘滑、肉类、面食、五辛、酒类、乳制品及气味恶臭等食物。
此方专门主治卫气感受风邪的证候。因为卫气受伤,不能在外固护而自汗,所以用桂枝的辛味发散邪气,同时用芍药的酸味资助阴液。然而一散一收,又需要甘草来调和胃气。况且发汗必须用辛甘之品以助行阳气,所以再用生姜佐助桂枝,大枣佐助甘草。但是方中芍药未说明是赤芍还是白芍,《圣惠方》与节庵都用赤芍,孙尚与叔微都用白芍。然而赤芍和白芍的补泻作用不同。张仲景说:“病人发热汗出,这是营弱卫强。营虽然不受邪,但终究不是平和状态。”所以卫强则导致营弱,由此可知必须用白芍药。既然营气虚弱而不能自固,怎么能用赤芍药来泻它呢?虽然如此,也不能一概而论。比如太阳病误用下法而传入太阴,因而出现腹部胀满、时时疼痛,则应当加倍使用白芍以补营血之虚。如果是大实证,必须加大黄,又宜用赤芍以泻实。至于湿热素盛之人以及嗜酒者,在感寒初期身体寒冷、厌恶热气时,使用桂枝汤,就应当加入黄芩以胜热,而不宜用白芍以助阴。贵在临证时灵活运用。○按:桂枝入心,属于血分药,而张仲景用它来治疗风伤卫气的证候;麻黄走肺经,属于气分药,而张仲景用它来治疗寒伤营血的证候。这都是气病用血药,血病用气药。所以许学士认为“脉浮而缓,风伤营;脉浮紧兼涩,寒伤卫”是错误的。殊不知风伤卫,则卫气受邪,卫气受邪,则不能在内护卫于营,所以营气不固而自汗,必须以桂枝这味血分药透达营卫,又须芍药保护营气、固护肌表,营卫调和而自汗自愈。寒伤营,则营气受邪,营气受邪,则不能在外通达于卫,所以气机郁滞而无汗,必须以麻黄这味气分药开通腠理,又须桂枝充实营气、发散邪气,大汗泄出而郁热消散。
(Paragraph 113 ○ The principles of various prescriptions have already been clarified in the notes of this clause, so no further repetition is made here.)
Guizhi (Cinnamon Twig) (3 liang), Shaoyao (Peony Root) (3 liang, washed with wine), Gancao (Licorice Root) (2 liang, honey-fried), Shengjiang (Fresh Ginger) (3 liang, sliced), Dazao (Jujube Fruit) (12 pieces, split open).
The above five herbs are coarsely crushed. Boil with 7 sheng of water over a gentle fire until 3 sheng remain. Strain the dregs. Take 1 sheng when the temperature is suitable. Shortly after taking the medicine, drink more than 1 sheng of thin rice porridge to assist the medicinal power. Cover with warm clothing for about one hour. It is best if there is a slight perspiration all over the body; do not let the sweat flow profusely, otherwise the disease will certainly not be eliminated. If sweating occurs after the first dose and the illness improves, stop subsequent doses; it is not necessary to finish the entire decoction. If there is no sweating, take another dose according to the previous method. If still no sweating, shorten the interval between doses slightly, allowing three doses to be taken within half a day. For severe cases, administer medicine continuously day and night, observing for one zhou period (two hours). If symptoms persist after finishing one ji (dose/decoction), prepare and take another. If there is still no sweating, continue up to two or three ji. Avoid cold, raw, sticky, slippery foods, meat, wheat products, the "five pungent spices," alcohol, dairy products, and foul-smelling foods.
This prescription specifically treats syndromes where the Wei Qi (Defensive Qi) is affected by Wind pathogen. Because the Wei Qi is injured and cannot secure the exterior, spontaneous sweating occurs. Therefore, the acrid nature of Guizhi (Cinnamon Twig) is used to disperse the pathogen, while the sour nature of Shaoyao (Peony Root) assists the Yin. However, since one disperses and one astringes, Gancao (Licorice Root) is needed to harmonize the Stomach. Moreover, inducing sweating requires acrid and sweet substances to promote Yang Qi; thus, Shengjiang (Fresh Ginger) assists Guizhi (Cinnamon Twig), and Dazao (Jujube Fruit) assists Gancao (Licorice Root). However, the prescription does not specify whether to use Chi Shaoyao (Red Peony Root) or Bai Shaoyao (White Peony Root). *Shenghui Fang* and Jie'an both use Chi Shaoyao (Red Peony Root), while Sun Shang and Shuwei both use Bai Shaoyao (White Peony Root). Yet, their tonifying and purging effects differ. Zhang Zhongjing stated: "When a patient has fever and sweating, this indicates Ying deficiency and Wei excess. Although Ying is not directly invaded by pathogens, it is not in a balanced state." Thus, Wei excess leads to Ying deficiency, indicating that Bai Shaoyao (White Peony Root) must be used. Since Ying is weak and unable to secure itself, how can Chi Shaoyao (Red Peony Root), which purges, be used? Nevertheless, one cannot apply a uniform rule. For example, if Taiyang syndrome is incorrectly treated with purgatives and transmits to Taiyin, resulting in abdominal fullness and occasional pain, Bai Shaoyao (White Peony Root) should be doubled to tonify Ying blood deficiency. In cases of severe excess, Dahuang (Rhubarb Root) must be added, and Chi Shaoyao (Red Peony Root) is appropriate to purge excess. For individuals with inherent damp-heat abundance or habitual drinkers, when initially contracting cold with symptoms of chills and aversion to heat, using Guizhi Tang (Cinnamon Twig Decoction) requires adding Huangqin (Scutellaria Root) to overcome heat, rather than using Bai Shaoyao (White Peony Root) to aid Yin. Flexibility in clinical practice is key. ○ Note: Guizhi (Cinnamon Twig) enters the Heart and is a Blood-invigorating herb, yet Zhang Zhongjing uses it to treat Wind affecting Wei Qi; Mahuang (Ephedra Herb) moves Lung Qi and is a Qi-moving herb, yet Zhang Zhongjing uses it to treat Cold affecting Ying Blood. These are examples of using Blood herbs for Qi diseases and Qi herbs for Blood diseases. Therefore, Xu Xueshi's assertion that "pulse floating and slow indicates Wind affecting Ying; pulse floating, tight, and choppy indicates Cold affecting Wei" is erroneous. One fails to realize that Wind affects Wei, causing Wei Qi to be invaded; when Wei Qi is invaded, it cannot internally protect Ying, leading to insecure Ying Qi and spontaneous sweating. Guizhi (Cinnamon Twig), a Blood herb, must penetrate and reach Ying and Wei, while Shaoyao (Peony Root) protects Ying and secures the exterior. When Ying and Wei harmonize, spontaneous sweating resolves. Cold affects Ying, causing Ying Qi to be invaded; when Ying Qi is invaded, it cannot externally communicate with Wei, leading to Qi stagnation and absence of sweating. Mahuang (Ephedra Herb), a Qi herb, must open the interstices (Couli), while Guizhi (Cinnamon Twig) strengthens Ying and disperses pathogens. Profuse sweating releases the stagnation and dissipates latent heat.