茯苓 芍药 生姜(切,各三两) 白术(二两) 附子(一枚,炮去皮,破八片) 上五味,以水八升,煮取三
升,去渣,温服七合,日三服。若咳者,加五味子半升,细辛、干姜各一两;若小便利者,去茯苓;若
下利者,去芍药,加干姜二两;此即下利清谷之类,故去芍药加干姜;若热利,则芍药又为要药也,须审
之。若呕者,去附子,加生姜,足前为半斤。
太阳病,发汗,汗出不解,太阳病乃桂枝症也,其发汗当取微似汗,则卫气泄而不伤营。若发汗太
过,动其营血,大汗虽出而卫邪反内伏,所以病仍不
解,观前桂枝汤条下服法,可推而知也。其人仍发热,表邪仍在。心下悸,下焦肾水因心液不足,随阳而上
犯。头眩身 动,振振欲擗地者,阳气泄则虚浮无依着;真武汤主之。此方钲伏肾水,挽回阳气。
少阴病,二、三日不已,至四、五日,腹痛,小便不利,四肢沉重疼痛,自下利者,以上湿邪之症。
此为有水气,水亦湿也。其人或咳、或小便利、或下利、或呕者,此四症或有或无,方中加减法俱详。真
武汤主之。此方因发汗不合法,上焦之津液干枯,肾水上救,以此钲肾气,治逆水,不专为汗多亡阳而
设,治亡阳之方、诸四逆汤,乃正法也。
附子(二枚,炮去皮、破八片) 茯苓(三两) 人参(二两) 白术(四两) 芍药(三两) 上五味,以水八
升,煮取三升,去渣,温服一升,日三服。
少阴病,得之一、二日,口中和,寒邪已微。其背恶寒者,当灸之。但背恶寒,则寒邪聚于一处,故
用灸法。
按∶白虎加人参汤,亦有背微恶寒之症,乃彼用寒凉,此用温热,何也?盖恶寒既有微甚之不同,而
其相反处,全在口中和,与口燥渴之迥别。故欲知里症之寒热,全在渴不渴辨之,此伤寒之要诀也。附子
汤主之。此乃病已向愈,正气虚,而余寒尚存之证也。
少阴病,身体痛,手足寒,骨节痛,脉沉者,附子汤主之。此亦虚寒余症。
茯苓、芍药、生姜(切片,各三两)、白术(二两)、附子(一枚,炮制后去皮,破成八片)。以上五味药,用水八升,煮取三升,去渣滓,温服七合,每日三次。如果咳嗽的,加五味子半升,细辛、干姜各一两;如果小便通利的,去掉茯苓;如果下利的,去掉芍药,加干姜二两;这属于下利清谷之类的病证,所以去掉芍药加干姜;如果是热性下利,那么芍药又是重要药物,必须仔细审察。如果呕吐的,去掉附子,加生姜,总量达到前文所说的半斤。
太阳病,经过发汗治疗,汗出后病仍不解除。太阳病本是桂枝汤证,其发汗应当取得微微似有汗出的状态,这样卫气泄出而不损伤营血。如果发汗太过,扰动营血,虽然大汗排出,但卫分之邪反而内伏,所以病仍然不解除,参考前文桂枝汤条下的服药方法,可以推知这个道理。患者仍然发热,说明表邪仍在。心下悸动,是因为下焦肾水因心液不足,随阳气而上犯。头眩、身体动摇,振颤欲倒仆于地,是因为阳气泄越则虚浮无依着;用真武汤主治。此方镇伏肾水,挽回阳气。
少阴病,经过两三天未愈,到了四五天,出现腹痛,小便不利,四肢沉重疼痛,自发性下利,以上是湿邪的症状。这是有水气,水也属于湿。患者或者咳嗽、或者小便通利、或者下利、或者呕吐,这四个症状或有或无,方中的加减法都详细说明。用真武汤主治。此方因为发汗不合法度,导致上焦津液干枯,肾水上救,以此镇摄肾气,治疗逆乱之水,并非专为汗多亡阳而设,治疗亡阳的方剂如诸四逆汤,才是正法。
附子(二枚,炮制后去皮、破成八片)、茯苓(三两)、人参(二两)、白术(四两)、芍药(三两)。以上五味药,用水八升,煮取三升,去渣滓,温服一升,每日三次。
少阴病,得病一两天,口中平和(不苦不燥),说明寒邪已微。如果背部恶寒,应当施以灸法。仅仅背部恶寒,说明寒邪聚集在一处,所以用灸法。
按语:白虎加人参汤,也有背微恶寒的症状,那是用寒凉药,这里用温热药,为什么呢?大概恶寒既有轻微与严重的不同,而其相反之处,全在于口中平和与口燥渴的巨大区别。所以想要知道里证的寒热,全在于是否口渴来辨别,这是伤寒的要诀。用附子汤主治。这是病势已向愈,正气虚弱,而余寒尚存的证候。
Fuling (Poria), Shaoyao (White Peony Root), Shengjiang (Fresh Ginger, sliced, each 3 liang), Baizhu (Atractylodis Rhizoma, 2 liang), Fuzi (Prepared Aconite Lateralis Radix, one piece, processed, peeled, broken into eight pieces). The above five herbs are boiled in 8 sheng of water to obtain 3 sheng. Strain and take 7 ge warm, three times a day. If there is cough, add Wuweizi (Schisandrae Fructus, half sheng), Xixin (Asari Radix et Rhizoma, 1 liang), Ganjiang (Dried Ginger, 1 liang); if urination is free, remove Fuling; if there is diarrhea, remove Shaoyao and add Ganjiang (Dried Ginger, 2 liang); this belongs to the category of diarrhea with undigested food, hence Shaoyao is removed and Ganjiang added; if it is heat-type diarrhea, then Shaoyao becomes an important herb, which must be carefully examined. If there is vomiting, remove Fuzi and add Shengjiang (Fresh Ginger), totaling half jin as mentioned previously.
Taiyang disease (disease of the Taiyang channel), after sweating therapy, the condition remains unresolved despite perspiration. Taiyang disease is originally a Guizhi Tang (Cinnamon Twig Decoction) syndrome; sweating should result in a slight, continuous moisture on the skin, so that Wei Qi (Defensive Qi) dissipates without injuring Ying Qi (Nutritive Qi). If sweating is excessive, it disturbs Ying Blood; although profuse sweat is expelled, the pathogenic factor in the Wei level instead becomes internally trapped, thus the disease remains unresolved. This can be inferred by referring to the administration instructions under the previous Guizhi Tang section. The patient still has fever, indicating that exterior pathogens remain. Palpitations beneath the heart occur because Kidney Water from the lower jiao rises to invade due to insufficient Heart fluids. Dizziness and body tremors, shaking and desiring to fall to the ground, occur because Yang Qi leakage leads to floating deficiency without support; Zhenwu Tang (True Warrior Decoction) is the primary treatment. This formula suppresses Kidney Water and restores Yang Qi.
Shaoyin disease (disease of the Shaoyin channel), persisting for two or three days, progressing to four or five days, presents with abdominal pain, difficult urination, heavy and painful limbs, and spontaneous diarrhea; these are symptoms of dampness pathogens above. This indicates the presence of fluid retention, as water is also considered dampness. The patient may have cough, or free urination, or diarrhea, or vomiting; these four symptoms may or may not be present, and the modification methods in the formula are detailed. Zhenwu Tang (True Warrior Decoction) is the primary treatment. This formula is used because improper sweating led to dryness of upper jiao fluids, causing Kidney Water to rise in rescue; it regulates Kidney Qi and treats rebellious water, and is not specifically designed for Yang collapse due to excessive sweating. The formulas for treating Yang collapse, such as the various Sini Tang (Recover the Pulse Decoctions), are the orthodox methods.
Fuzi (Prepared Aconite Lateralis Radix, two pieces, processed, peeled, broken into eight pieces), Fuling (Poria, 3 liang), Renshen (Ginseng Radix et Rhizoma, 2 liang), Baizhu (Atractylodis Rhizoma, 4 liang), Shaoyao (White Peony Root, 3 liang). The above five herbs are boiled in 8 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm, three times a day.
Shaoyin disease, acquired one or two days ago, presents with a normal mouth (neither bitter nor dry), indicating that cold pathogens are minimal. If there is aversion to cold in the back, moxibustion should be applied. Since only the back exhibits aversion to cold, it indicates that cold pathogens are concentrated in one area, hence moxibustion is used.
Note: Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) also presents with slight aversion to cold in the back, but uses cold-cooling herbs, whereas here warm-heating herbs are used. Why? Generally, aversion to cold varies in degree, and the key difference lies entirely in the contrast between a normal mouth and extreme dryness/thirst. Therefore, to determine whether interior syndromes are cold or hot, one must distinguish based on thirst or lack thereof; this is a crucial principle in Shanghan (Cold Damage) diagnosis. Fuzi Tang (Aconite Decoction) is the primary treatment. This represents a condition trending toward recovery, where Zheng Qi (Upright Qi) is deficient and residual cold remains.
Shaoyin disease presenting with body pain, cold hands and feet, bone joint pain, and a deep pulse is treated with Fuzi Tang (Aconite Decoction). This is also a residual symptom of deficiency-cold.