桂枝汤原方加浓朴二两(炙去皮),杏仁五十枚(去皮尖)。上七味,以水七升,微火煮取三升,温服一
升,覆取微似汗。
喘家作桂枝汤,加浓朴杏仁佳。《别录》∶浓朴主消痰下气。《本经》∶杏仁主咳逆上气。
太阳病,下之微喘者,表未解故也。桂枝加浓朴杏仁汤主之。前条乃本然之喘,此乃误下之喘,因
殊而法一。
桂枝汤原方加胶饴一升。上六味,以水七升,煮取三升,去渣,纳饴,更上微火消解,温服一升,日
三服。呕家不可用建中汤,以甜故也。
伤寒阳脉涩,阴脉弦,中宫之阳气虚,则木来乘土,故阳涩而阴弦也,法当腹中急痛,先与小建中汤。
胶饴大甘,以助中宫。不瘥者,与小柴胡汤主之。治太阴不愈,变而治少阳,所以疏土中之木也,以脉弦
故用此法。
伤寒二、三日,心中悸而烦者,小建中汤主之。悸而烦,其为虚烦可知,故用建中汤,以补心脾之气,盖
栀子汤治有热之虚烦,此治无热之虚烦也。
桂枝汤原方芍药、生姜各增一两,加人参三两。
上六味,以水一斗二升,煮取三升,去渣,温服一升。此以多煎为妙,取其味浓入阴也。
发汗后,身疼痛,表未尽。脉沉迟,气虚已甚。桂枝加芍药生姜各一两人参三两新加汤主之。邪未
尽,宜表,而气虚不能胜散药,故用人参。凡素体虚而过汗者,方可用。
桂枝加浓朴杏仁汤:在桂枝汤原方的基础上,加入炙过并去皮的两两厚朴,以及去皮去尖的五十枚杏仁。以上七味药,用七升水,以小火煎煮至剩余三升药液,每次温服一升,服药后覆盖衣被使身体微微出汗。
素有喘疾的人如果患上了桂枝汤证,使用桂枝汤加厚朴、杏仁效果最佳。《名医别录》记载:厚朴主要功效是消除痰饮、降逆下气。《神农本草经》记载:杏仁主要功效是治疗咳嗽气逆。
太阳病经过误用泻下法治疗后出现轻微气喘的,是因为表证尚未解除的缘故。应当使用桂枝加浓朴杏仁汤主治。前一条所述的是原本就有的喘症,这一条是由于误用下法导致的喘症,虽然病因不同,但治疗方法一致。
小建中汤:在桂枝汤原方的基础上,加入一升胶饴(麦芽糖)。以上六味药,用七升水,煎煮至剩余三升药液,滤去药渣,加入胶饴,再用微火加热使其溶解,每次温服一升,每日服用三次。呕吐频繁的人不能使用建中汤,因为胶饴味甘甜,容易助湿生呕。
伤寒病中,阳脉涩滞、阴脉弦紧的,是中焦脾胃阳气虚弱,导致肝木乘袭脾土,所以表现为阳脉涩而阴脉弦,按照治法应当出现腹部拘急疼痛的症状,此时应先给予小建中汤。胶饴味道大甘,用来补助中焦脾胃之气。如果服药后病情没有好转,则改用小柴胡汤主治。这是治疗太阴病未愈,转而治疗少阳病的方法,目的是疏解脾土中的肝木郁结,因为脉象弦紧,所以采用这种方法。
伤寒发病二三天,心中悸动且烦躁的,使用小建中汤主治。既心悸又烦躁,说明属于虚性烦躁,因此使用建中汤,来补益心脾之气。大概栀子豉汤治疗的是有热的虚烦,而这里治疗的是无热的虚烦。
桂枝新加汤:在桂枝汤原方中,将芍药和生姜各增加一两,再加入三两人参。
以上六味药,用一斗二升水,煎煮至剩余三升药液,滤去药渣,温服一升。这种煎煮方法以多煎为佳,取其药味浓厚以入阴分。
发汗之后,身体仍然疼痛,说明表邪未尽。脉象沉迟,表明气血已经非常虚弱。应当使用桂枝加芍药生姜各一两人参三两新加汤主治。邪气未尽,本应解表,但因为气血虚弱不能耐受发散药物,所以加入人参。只有平时体质虚弱而又过度发汗的人,才可以使用此方。
Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed): To the original Guizhi Tang (Cinnamon Twig Decoction), add two liang of Zhi Houpo (Pseudocinnamomi Cortex, processed with honey and peeled) and fifty Mei of Qu Pi Jian Xingren (Semen Armeniacae Amarum, peeled and de-veined). Take these seven ingredients, boil them in seven sheng of water, simmer until three sheng remain. Warmly administer one sheng per dose. Cover the patient to induce a slight sweat.
For individuals with a chronic history of asthma who contract a syndrome indicated for Guizhi Tang (Cinnamon Twig Decoction), it is best to use Guizhi Tang (Cinnamon Twig Decoction) supplemented with Houpo (Magnolia Bark) and Xingren (Apricot Seed). *Bie Lu* (Recorded by Famous Physicians) states: Houpo (Magnolia Bark) primarily eliminates phlegm and directs rebellious Qi downward. *Ben Jing* (Shennong's Classic of Materia Medica) states: Xingren (Apricot Seed) primarily treats cough and rebellious Qi ascending.
In Taiyang disease (Disease of the Taiyang Channel), if mild wheezing occurs after mistaken purgation, it is because the exterior pathogenic factor has not yet been resolved. Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed) should be used as the primary treatment. The previous clause refers to inherent wheezing, whereas this clause refers to wheezing caused by mistaken purgation; although the causes differ, the therapeutic method remains the same.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction): To the original Guizhi Tang (Cinnamon Twig Decoction), add one sheng of Jiaoyi (Malt Sugar). Take these six ingredients, boil them in seven sheng of water until three sheng remain. Strain the dregs, add the Jiaoyi (Malt Sugar), and heat gently over a low fire until dissolved. Warmly administer one sheng per dose, three times daily. Patients prone to vomiting should not use Jianzhong Tang (Construct the Middle Decoction) because of its sweet nature.
In Shanghan (Cold Damage), if the Yang pulse is choppy and the Yin pulse is wiry, it indicates deficiency of Yang Qi in the Middle Jiao (Middle Burner), leading to Liver Wood overacting on Spleen Earth. Hence, the Yang pulse is choppy and the Yin pulse is wiry. According to the treatment principle, there should be acute abdominal pain. First, administer Xiao Jianzhong Tang (Minor Construct the Middle Decoction). Jiaoyi (Malt Sugar) is very sweet and assists the Middle Jiao (Middle Burner). If the condition does not improve, treat with Xiao Chaihu Tang (Minor Bupleurum Decoction). This approach treats Shaoyang (Lesser Yang) when Taiyin (Greater Yin) treatment fails, aiming to soothe the Liver Wood within the Spleen Earth, utilizing this method due to the wiry pulse.
In Shanghan (Cold Damage), if palpitations and irritability occur two or three days into the illness, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) should be used. Palpitations accompanied by irritability indicate deficiency-type irritability. Therefore, Jianzhong Tang (Construct the Middle Decoction) is used to tonify the Qi of the Heart and Spleen. Generally, Zhizi Tang (Gardenia Decoction) treats deficiency irritability with heat, whereas here it treats deficiency irritability without heat.
Guizhi Xinjia Tang (Newly Added Cinnamon Twig Decoction): In the original Guizhi Tang (Cinnamon Twig Decoction), increase Shaoyao (Peony Root) and Shengjiang (Fresh Ginger) by one liang each, and add Sansheng Ren Shen (Three Liang of Ginseng Radix et Rhizoma).
Take these six ingredients, boil them in twelve sheng of water until three sheng remain. Strain the dregs and warm-administer one sheng. It is advantageous to decoct for a longer time to obtain a concentrated flavor that enters the Yin level. After excessive sweating, if body pain persists, it indicates that the exterior pathogenic factor is not fully resolved. A deep and slow pulse indicates severe Qi and Blood deficiency. Guizhi Jia Shaoyao Shengjiang Ge Yi Ren Sanliang Xinjia Tang (Newly Added Cinnamon Twig Decoction with Increased Shaoyao and Shengjiang and Added Ren Shen) should be used. Since the pathogen is not fully resolved, releasing the exterior is appropriate, but due to Qi and Blood deficiency, the body cannot tolerate dispersing herbs; thus, Ren Shen (Ginseng) is added. This formula is suitable only for those with constitutive weakness who have undergone excessive sweating.