旋复花(三两) 人参(二两) 生姜(五两) 甘草(三两,炙) 半夏(半升,洗) 代赭石(一两) 大枣
(十二枚,擘) 上七味,以水一斗,煮取六升,去渣,再煎,取三升,温服─升,日三服。
伤寒发汗,若吐、若下,解后,病久治多,未必皆属误治。心下痞硬,噫气不除者,《灵枢·口问篇》
云∶寒气客于胃,厥逆从下上散,复出于胃,故为噫。
俗名嗳气。皆阴阳不和于中之故。旋复代赭汤主之。此乃病已向愈,中有留邪,在于心胃之间,与前诸泻
心法,大约相近。《本草》云∶旋复治结气、胁下满。代赭治腹中邪毒瓦斯。加此二物以治噫,余则散痞补虚之法也。
浓朴(半斤,炙去皮) 生姜(切) 半夏(洗,各半升) 甘草(二两) 人参(一两) 上五味,以水一斗,
煮取三升,去渣,温服一升,日三服。
发汗后,腹胀满者,浓朴生姜甘草半夏人参汤主之。发汗后,则邪气已去,而犹腹胀满,乃虚邪入
腹,故以浓朴除胀满,余则补虚助胃也。
知母(六两) 石膏(一斤,碎) 甘草(二两,炙) 粳米(六合) 上四味,以水一斗,煮,米熟汤成,火候。
去渣,温服一升,日三服。
伤寒脉浮滑,此表有热,里有寒、此寒热二字必倒误。乃表有寒,里有热也。观下条“脉滑而厥者,
里有热也。”凿凿可证。《活人书》作表里有热,亦未稳。白虎汤主之。
伤寒脉滑而厥者,热厥。里有热也,白虎汤主之。
三阳合病,腹满身重,难以转侧,口不仁而面垢,谵语遗尿,以上皆阳明热症之在经者,以三阳统于阳
明也。但身重腹满,则似风湿,宜用术附∶面垢谵语,则似胃实,宜用承气。此处一惑,生死立判,如何辨
别,全在参观脉症,使有显据,方不误投。发汗则谵语;阳从此越。下之则额上生汗,手足逆冷。阴从此
脱。若自汗出者,白虎汤主之。自汗则热气盛于经,非石膏不治。
按∶亡阳之症有二,下焦之阳虚飞越于外,而欲上脱,则用参附等药以回之;上焦之阳盛,逼阴于外,
而欲上泄,则用石膏以收之,同一亡阳,而治法迥殊,细审之自明,否则死生立判。
旋复花(三两) 人参(二两) 生姜(五两) 甘草(三两,炙) 半夏(半升,洗) 代赭石(一两) 大枣(十二枚,擘开) 以上七味药,用水一斗,煎煮至剩余六升,滤去药渣,再次煎煮,取三升药液,每次温服一升,每日服用三次。
伤寒病经过发汗、催吐或泻下治疗后,病情虽已缓解,但病程较长且治疗复杂,未必都是误治所致。若出现胃脘部痞塞胀硬、嗳气不止的症状,《灵枢·口问篇》记载:“寒气侵入胃部,厥逆之气从下向上散行,又出于胃,所以产生嗳气。”俗称为嗳气。这都是中焦阴阳不和的缘故。用旋复代赭汤主治。这是病情趋向痊愈,但体内有残留邪气,位于心与胃之间,与前文所述的各类泻心汤法大致相近。《本草》记载:旋复花能治疗结聚之气、胁下胀满;代赭石能治疗腹中的邪毒瓦斯。加入这两味药来治疗嗳气,其余药物则是消痞补虚的方法。
浓朴(半斤,炙后去皮) 生姜(切片) 半夏(洗净,各半升) 甘草(二两) 人参(一两) 以上五味药,用水一斗,煎煮至剩余三升,滤去药渣,温服一升,每日服用三次。
发汗后,出现腹部胀满的,用浓朴生姜甘草半夏人参汤主治。发汗后,邪气已经去除,但仍然腹胀满,这是因为虚邪进入腹部,所以用浓朴来消除胀满,其余药物则是补虚助胃的作用。
知母(六两) 石膏(一斤,打碎) 甘草(二两,炙) 粳米(六合) 以上四味药,用水一斗,煎煮,待米熟汤成时停止,注意火候。滤去药渣,温服一升,每日服用三次。
伤寒脉象浮滑,这表示表有热,里有寒——这里的“寒”和“热”二字必定是颠倒错误了。实际上是表有寒,里有热。参考下一条“脉滑而四肢厥冷的,是里有热”,证据确凿。《活人书》作“表里有热”,也不够稳妥。用白虎汤主治。
三阳经同时受病,出现腹部胀满、身体沉重、难以翻身转侧、口舌麻木不知滋味且面色垢浊、说胡话、遗尿等症状,以上这些都是阳明经热证的表现,因为三阳经统属于阳明经。但如果只是身体沉重、腹部胀满,则类似风湿,适宜用白术、附子等药;如果面色垢浊、说胡话,则类似胃实热证,适宜用承气汤类。此处一旦混淆,生死立判。如何辨别?全在于综合观察脉象和症状,使其有明确的依据,才不会误投药物。发汗会导致说胡话;阳气从此外越。攻下会导致额头出汗、手足逆冷;阴气从此脱失。如果是自汗出的,用白虎汤主治。自汗说明热气盛于经脉,非石膏不能治疗。
按语:亡阳的病症有两种,下焦阳气虚弱飞越于外,想要向上脱失,则用人参、附子等药来挽回;上焦阳气亢盛,逼迫阴气外泄,想要向上泄漏,则用石膏来收敛。同样是亡阳,但治疗方法截然不同,仔细审察自然明白,否则生死立判。
**Xuanfu Daizhe Decoction (Cinnamon Twig and Hematite Decoction)**
*Ingredients:* Xuanfuhua (Inulae Flos, 3 liang), Renshen (Ginseng Radix et Rhizoma, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 5 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang, honey-fried), Banxia (Pinelliae Rhizoma, half sheng, washed), Daizheshi (Hematitum, 1 liang), Dazao (Jujubae Fructus, 12 pieces, split).
*Preparation and Administration:* The above seven ingredients are decocted in ten dou of water until six sheng remain. The dregs are removed, and the liquid is further concentrated by boiling until three sheng remain. Take one sheng warm, three times a day.
After treating Taiyang disease (Taiyang Disease) with sweating, emesis, or purgation, if the pathogen is resolved but the condition persists for a long time and involves complex treatments, it does not necessarily imply medical error. If there is epigastric fullness and hardness accompanied by persistent belching (Yiqi, 噫气), *Ling Shu: Kou Wen Pian* states: "Cold qi lodges in the stomach, and rebellious qi rises from below and disperses upward, emerging again from the stomach, thus causing belching." This is commonly known as belching. It results from the disharmony of Yin and Yang in the middle jiao. Xuanfu Daizhe Tang is indicated. This indicates that the disease is tending towards recovery, but residual pathogenic factors remain between the heart and stomach, similar to the previous methods for treating Pi syndrome (Pi Syndrome, 痞证) using Xiexin formulas. *Ben Cao* records: Xuanfuhua treats stagnant qi and hypochondriac fullness; Daizheshi treats evil toxins and vapors in the abdomen. These two herbs are added to treat belching, while the others serve to dissipate stagnation and tonify deficiency.
**Nongpu Shengjiang Gancao Banxia Renshen Tang**
*Ingredients:* Nongpu (Magnoliae Officinalis Cortex, 8 liang, honey-fried and bark removed), Shengjiang (Zingiberis Rhizoma Recens, sliced), Banxia (Pinelliae Rhizoma, washed, half sheng each), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Renshen (Ginseng Radix et Rhizoma, 1 liang).
*Preparation and Administration:* The above five ingredients are decocted in ten dou of water until three sheng remain. The dregs are removed. Take one sheng warm, three times a day.
If abdominal fullness occurs after sweating, Nongpu Shengjiang Gancao Banxia Renshen Tang is indicated. After sweating, the pathogenic factor has been expelled, yet abdominal fullness persists because deficient pathogenic factors have entered the abdomen. Therefore, Nongpu is used to relieve fullness, while the remaining herbs tonify deficiency and assist the Stomach.
**Baihu Tang (White Tiger Decoction)**
*Ingredients:* Zhi mu (Anemarrhenae Rhizoma, 6 liang), Shigao (Gypsum Fibrosum, 1 jin, crushed), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), Jingmi (Oryza Sativa Germen, 6 he).
*Preparation and Administration:* The above four ingredients are decocted in ten dou of water. Boil until the rice is cooked and the decoction is ready, paying attention to heat control. Remove the dregs. Take one sheng warm, three times a day.
In Taiyang disease, if the pulse is floating and slippery, it indicates heat on the exterior and cold on the interior. However, the terms "cold" and "heat" here must be inverted errors; it should actually be cold on the exterior and heat on the interior. This is confirmed by the next clause: "When the pulse is slippery and there is cold extremities, there is heat on the interior." Baihu Tang is indicated. *Ren Shu* states "heat on both exterior and interior," which is also not entirely accurate.
If the pulse is slippery and there are cold extremities due to heat Jue (Rebellious Cold, 热厥), indicating heat on the interior, Baihu Tang is indicated.
In San Yang He Bing (Combined Disease of the Three Yang Channels), symptoms include abdominal fullness, heaviness of the body, difficulty in turning over, numbness of the mouth and face, delirium, and urinary incontinence. All these are heat syndromes of the Yangming Channel, as the Three Yang channels are governed by Yangming. If there is only body heaviness and abdominal fullness, it resembles Wind-Dampness, and Baizhu and Fuzi might be considered; if there is facial greasiness and delirium, it resembles Stomach Excess Heat, and Chengqi formulas might be considered. Confusion here leads to immediate life-or-death consequences. Differentiation relies entirely on observing the pulse and symptoms together to find clear evidence, avoiding misprescription. Sweating may lead to delirium as Yang escapes outward. Purging may cause sweating on the forehead and cold extremities as Yin collapses. If there is spontaneous sweating, Baihu Tang is indicated. Spontaneous sweating indicates excessive heat in the channels, which requires Shigao to treat.
Note: There are two types of Wang Yang (Collapse of Yang). When Yang Qi of the Lower Jiao is deficient and flies outward, threatening to escape upward, Renshen and Fuzi are used to restore it. When Yang Qi of the Upper Jiao is excessive, forcing Yin outward and threatening to leak upward, Shigao is used to consolidate. Although both are termed Wang Yang, the treatment methods are vastly different. Careful examination clarifies this; otherwise, life and death are decided immediately.