深师疗伤寒六七日。发汗不解。呕逆下利。小便不利。胸胁痞满。微热而烦。有黄芩汤方。
黄芩 桂心(各三两) 茯苓(四两) 前胡(八两) 半夏(半升洗)
上五味。切。以水一斗二升。煮取六升。分为六服。日三服。夜三服。间食生姜粥。投取小便利为瘥。
琥按上主疗云。发汗不解。邪入胸胁痞满者。少阳病也。其曰呕逆。曰小便不利。曰微热而烦。当是小柴胡加减
之证。但其曰下利。又当是太少合病。此方名黄芩汤。与仲景黄芩汤大不相同。然亦各尽其妙。方中用黄芩前胡者。治
胸胁烦热而痞满也。用半夏茯苓者。止呕逆而利小便也。小便利。而利自止矣。其用桂心有二义焉。一以佐前胡而散在
表不解之寒邪。一以导茯苓。而通膀胱不利之水湿。要之是方也。亦不可执。倘里热而阳盛。宜去桂也。愚以呕逆甚者。
加橘红。痞满甚者。加枳实。烦甚。加栝蒌实。下利腹痛。加白芍药。临证加减。全在以意会之而已。
姚氏集验疗伤寒七八日不解。默默烦闷腹中有干粪谵语。
柴胡 半夏(汤洗各八两) 生姜(四两) 知母 芍药 大黄 葳蕤(各二两) 甘草(炙)
一方加 枳实(四两) 黄芩(二两)
上十味。切以水一斗。煮取三升。去滓。温服一升。日三服。
琥按上方。即仲景大柴胡汤。少变其制仲景方。有大枣。无甘草。要之甘草与大枣。同一甘温也。又按上主疗云。
默默烦闷。当即是仲景大柴胡汤证中云。郁郁微烦义同。但烦闷者。其热已极。甚于微烦。所以大柴胡汤中。复加知母
葳蕤之苦寒甘润。以清解之也。
深师方治疗伤寒六七天。发汗后病邪未解。出现呕吐气逆、腹泻。小便不通畅。胸胁部痞塞胀满。轻微发热且心烦。此处有黄芩汤一方。
黄芩 桂心(各三两) 茯苓(四两) 前胡(八两) 半夏(半升,洗净)
以上五味药。切碎。用水一斗二升。煎煮至取药液六升。分为六次服用。白天服三次,晚上服三次。在两餐之间喝生姜粥。服药后以小便通利为痊愈标准。
琥按:上述主治功效说。发汗后病邪未解,邪气侵入胸胁导致痞塞胀满的,属于少阳病(少阳经受邪所致的病证)。文中提到的呕吐气逆、小便不利、轻微发热且心烦,应当是小柴胡汤(Minor Bupleurum Decoction)加减治疗的证候。但是文中提到腹泻,这又应当是太阴病(Taiyin Syndrome,脾虚寒湿证)与少阳病合病(Combined Disease of Taiyin and Shaoyang)。此方名为黄芩汤,与张仲景《伤寒论》中的黄芩汤大不相同。然而也各有其精妙之处。方中使用黄芩和前胡,是为了治疗胸胁部的烦热和痞塞胀满。使用半夏和茯苓,是为了止住呕吐气逆并通利小便。小便利了,腹泻自然就会停止。其中使用桂心的用意有两层含义:一是辅助前胡来发散在表未能解除的寒邪;二是引导茯苓,以通利膀胱中不利的水湿。总之,这个方剂也不可拘泥死板。如果体内有热且阳气偏盛,应当去掉桂心。我认为如果呕吐气逆严重的,加入橘红;痞塞胀满严重的,加入枳实;心烦严重的,加入栝蒌实;腹泻伴有腹痛的,加入白芍药。临证时加减变化,全在于医者用心领会罢了。
姚氏集验方治疗伤寒七八天病邪未解。神情沉默、心烦闷乱,腹中有燥屎,出现谵语(神志不清,胡言乱语)。
柴胡 半夏(汤洗,各八两) 生姜(四两) 知母 芍药 大黄 葳蕤(各二两) 甘草(炙)
另一版本加 枳实(四两) 黄芩(二两)
以上十味药。切碎,用水一斗。煎煮至取药液三升。滤去药渣。温服一升。每天服三次。
琥按:上方即是张仲景的大柴胡汤(Major Bupleurum Decoction),稍微改变了其制法。张仲景的原方有大枣,没有甘草。总之,甘草和大枣都是同一性质的甘温药物。又按上述主治功效说。神情沉默、心烦闷乱,应当就是张仲景大柴胡汤证中所述的“郁郁微烦”,意义相同。但这里的“烦闷”说明热势已经极重,比“微烦”更严重。所以在大柴胡汤中,又加入了知母和葳蕤的苦寒甘润之性,以清热解郁。
Shen Shi's formula treats cold damage after six or seven days. Sweating fails to resolve the pathogen. Symptoms include vomiting and rebellious qi, diarrhea, and dysuria (difficult urination). There is fullness and stuffiness in the chest and hypochondrium, slight fever, and vexation. Here is the Huangqin Tang (Scutellaria Decoction).
Huangqin (Scutellariae Radix), Guixin (Cinnamomi Cortex) (each 3 liang), Fuling (Poria), Qianhu (Peucedani Radix) (8 liang), Banxia (Pinelliae Rhizoma) (half sheng, washed).
The above five herbs are sliced. Boil with 12 dou of water until reduced to 6 sheng. Divide into six doses. Take three doses during the day and three at night. Consume ginger porridge between meals. The condition is considered cured when urination becomes smooth.
Hu notes: Regarding the aforementioned indications, "sweating fails to resolve the pathogen, and the pathogen enters the chest and hypochondrium causing fullness" indicates a Shaoyang disease (disease of the Shaoyang channel). The mentions of vomiting and rebellious qi, dysuria, slight fever, and vexation suggest a pattern suitable for modification of Xiaochaihu Tang (Minor Bupleurum Decoction). However, the mention of diarrhea suggests a combined disease of Taiyin and Shaoyang. This formula is named Huangqin Tang, which is significantly different from Zhang Zhongjing's Huangqin Tang. Nevertheless, each has its own brilliance. The use of Huangqin and Qianhu in this formula treats vexation, heat, and fullness in the chest and hypochondrium. The use of Banxia and Fuling stops vomiting and promotes urination. Once urination is smooth, diarrhea will cease naturally. The use of Guixin has two purposes: first, to assist Qianhu in dispersing cold pathogens lingering on the exterior; second, to guide Fuling to unblock damp-water retention in the Bladder. In summary, one should not adhere rigidly to this formula. If there is interior heat and excess Yang, Guixin should be removed. I believe that if vomiting is severe, add Juhong (Citri Reticulatae Pericarpium Rubrum); if fullness is severe, add Zhishi (Aurantii Fructus Immaturus); if vexation is severe, add Gualou Shi (Trichosanthis Fructus); if diarrhea with abdominal pain occurs, add Baishao (Paeoniae Radix Alba). Modifications in clinical practice depend entirely on the practitioner's understanding.
Yao Shi Ji Yan treats cold damage unresolved after seven or eight days. The patient is silent and feels internally vexed and stifled, with dry feces in the abdomen and delirium.
Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma, washed with decoction, each 8 liang), Shengjiang (Zingiberis Rhizoma Recens) (4 liang), Zhimu (Anemarrhenae Rhizoma), Shaoyao (Paeoniae Radix), Dahuang (Rhei Radix et Rhizoma), Weirui (Polygonati Odorati Rhizoma) (each 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried).
Another version adds Zhishi (Aurantii Fructus Immaturus) (4 liang) and Huangqin (Scutellariae Radix) (2 liang).
The above ten herbs are sliced and boiled with 1 dou of water until reduced to 3 sheng. Strain the dregs. Take 1 sheng warm, three times daily.
Hu notes: The above formula is essentially Zhang Zhongjing's Dachaihu Tang (Major Bupleurum Decoction), with slight modifications to its preparation. Zhang Zhongjing's original formula contains Dazao (Jujubae Fructus) but lacks Gancao. Essentially, Gancao and Dazao share similar sweet and warm properties. Furthermore, regarding the aforementioned indications, "silent and internally vexed/stifled" corresponds to the "depressed and slightly vexed" described in Zhang Zhongjing's Dachaihu Tang syndrome, with identical meaning. However, "vexation and stifling" here indicates extreme heat, more severe than "slight vexation." Therefore, in Dachaihu Tang, Zhimu and Weirui, with their bitter-cold and sweet-moistening properties, are added to clear and resolve the heat.