治妇人室女伤寒发热。经水适来适断。昼日明了。夜则谵语。如见鬼状。亦治产后恶露方来。忽然断绝欲死。
柴胡(一两二钱半) 人参 半夏(汤泡七次) 黄芩 甘草(炙) 生地黄(酒洗各七钱)云岐子方用牡丹皮二
两无生地黄
上六味。 咀。每服五钱。水二盏。生姜三片。枣子一个。煎至一盏。去渣。温服不拘时。
琥按上方。即仲景小柴胡汤。加生地黄也。妇人热入血室。系血虚且瘀者。宜此方。必经水既来而适断也。若欲
来而忽断者。为热入而血实证。还宜加当归。赤芍。桃仁红花等药。若热入而经水过多者。为血虚而不瘀。又宜加川芎。
白芍。发灰等药。此云岐子法也。
治少阳胆经受证。耳聋胁痛。寒热呕而口苦。脉来弦数。属半表半里。宜和解。此经胆无出入。有三禁。不可汗下
吐也。止有小柴胡一汤随病加减。再无别汤。
柴胡 黄芩 半夏 甘草 人参 陈皮 芍药(近本上七味。无分两)
水二钟。姜一片。枣二枚。槌法。入生艾汁三匙。煎之温服。
琥按上方。即仲景小柴胡汤内。加陈皮芍药也。方后入生艾汁三匙者。以生艾气温味苦辛。肘后方用以治时气温
疫。头痛壮热。脉盛。故陶氏加之耳。若云。加入上汤中。如杀车槌之有力。此亦甚形其功。吾不信也。
附陶氏加减法
本经证小便不利者。加茯苓。本经呕者。入姜汁。竹茹。胁痛。加青皮。痰多。加瓜蒌仁贝母(愚以贝母力缓。不
如改用枳实。)寒热往来似疟者。加桂枝。渴者加天花粉。知母。去半夏。齿燥无津液。加石膏。嗽者。加五味。金沸草。
(愚以五味宜用南产黄色者。)
坏证。加鳖甲。本经证心下饱闷。未经下者。非结胸。乃表邪传至胸中。未入于府证。虽满闷。尚为在表。只须小
柴胡。加枳桔。未效。就以本方对小陷胸加枳桔。一服豁然。其妙如神。虚烦。类伤寒证。本方加竹叶。炒粳米。(愚以
方中。无石膏粳米。不须加也。)
本经与阳明合病。本方加葛根。芍药如拾芥。(言不须多用也。)妇人热入血室。加当归。红花。男子热入血室。加
生地黄(愚按血室义。已见前小柴胡附例之后。即血海也。男子妇人皆有之。但男子之血。不能充于血室。血不充。则
不盈。不盈。亦不去也。不去则血无所亏。无所亏。则热亦不能入。所以在男子。从无热入血室之证。今陶氏不读书。
不明理。止知男子之身。亦有血室。因取巧而造立病名。令人喷饭。)
老弱人伤寒无表证。其热胜者。本方加大黄甚者。加芒硝。
(琥)总按上古今诸名家。治少阳病方论。实与仲景之旨互相参合者。医人不可以不知也。
【宝鉴】小柴胡加地黄汤方
治疗妇女及未婚女子患伤寒发热。月经适来或刚断绝。白天神志清醒,夜间则胡言乱语,如同看见鬼怪一样。也用于治疗产后恶露刚开始流出,突然中断导致患者濒临死亡的情况。
药材:柴胡(一两二钱半)、人参、半夏(用开水浸泡七次)、黄芩、甘草(炙烤)、生地黄(用酒清洗,各七钱)。云岐子的方子使用牡丹皮二两,不用生地黄。
以上六味药。切碎。每次服用五钱。加水两盏,生姜三片,大枣一个。煎煮至一盏量,去渣滓。随时温服。
琥按:上面的方子,就是张仲景的小柴胡汤,加入生地黄而成。妇女热邪陷入血室,属于血虚且伴有瘀滞的,适宜用此方。必须是月经已经来潮而后突然断绝的情况。如果是月经将要来潮却忽然断绝的,属于热邪陷入而血实证,还应当加入当归、赤芍、桃仁、红花等药物。如果热邪陷入而月经量过多的,属于血虚而没有瘀滞,又应当加入川芎、白芍、发灰等药物。这是云岐子的治法。
治疗少阳胆经受邪所致的病证。耳聋胁痛,寒热往来,呕吐且口苦。脉象弦数。属于半表半里证,适宜和解。这一经的胆腑没有出入之邪,有三项禁忌,不可使用发汗、攻下、催吐的方法。只有小柴胡汤一方可随病情加减,再无其他方剂。
药材:柴胡、黄芩、半夏、甘草、人参、陈皮、芍药(近本记载为以上七味,无具体分量)。
加水两钟,生姜一片,大枣两枚。捣碎。加入生艾汁三匙,煎煮后温服。
琥按:上面的方子,就是在张仲景的小柴胡汤内,加入陈皮和芍药而成。方后加入生艾汁三匙的原因,是因为生艾气温味苦辛,《肘后方》用它来治疗时行温疫,头痛壮热,脉象盛大,所以陶氏将其加入其中。如果说,加入上述汤剂中,像杀车槌那样有力,这也是极力形容其功效,我并不相信。
附陶氏加减法
本经证见小便不利的,加茯苓。本经证见呕吐的,加入姜汁、竹茹。胁痛的,加青皮。痰多的,加瓜蒌仁、贝母(我认为贝母药力缓和,不如改用枳实)。寒热往来似疟疾的,加桂枝。口渴的,加天花粉、知母,去掉半夏。牙齿干燥无津液的,加石膏。咳嗽的,加五味子、金沸草(我认为五味子宜选用南方产的黄色者)。
坏证(误治后的变证),加鳖甲。本经证见心下痞满闷胀,未经过攻下的,不是结胸证,而是表邪传至胸中,未入于腑证。虽然满闷,尚属在表,只需小柴胡汤,加入枳壳、桔梗。若无效,就用本方配合小陷胸汤,加入枳壳、桔梗,一服药后豁然开朗,其妙如神。虚烦,类似伤寒证,本方加竹叶、炒粳米(我认为方中若无石膏、粳米,不必添加)。
本经与阳明合病,本方加葛根、芍药,效果如拾取芥子般容易(意指不需多用)。妇女热邪陷入血室,加当归、红花。男子热邪陷入血室,加生地黄(我按:血室的含义,已见于前文小柴胡汤附例之后,即血海。男女皆有。但男子的血,不能充盈于血室,血不充盈,则不满溢,不满溢,也就不会排出。若不排出,则血无所亏损,无所亏损,则热邪也不能陷入。所以在男子,从未有热邪陷入血室的病证。如今陶氏不读书,不明理,只知道男子身体也有血室,便取巧而造立病名,令人喷饭。)
[From Baojian] Xiao Chai Hu Tang with Sheng Di Huang Decoction
Indicated for women and unmarried girls suffering from Shanghan (Cold Damage) with fever. When menstruation is just beginning or has just ceased, the patient is clear-minded during the day but experiences delirium at night, as if seeing ghosts. It is also indicated for postpartum cases where lochia (postpartum discharge) begins to flow but suddenly stops, causing the patient to be on the verge of death.
Ingredients: Chai Hu (Bupleuri Radix) (1 liang 2 qian 5 fen), Ren Shen (Ginseng Radix et Rhizoma), Ban Xia (Pinelliae Tuber), Huang Qin (Scutellariae Radix), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Sheng Di Huang (Rehmanniae Radix Praeparata) (washed with wine, each 7 qian). The formula by Yun Qi Zi uses Mu Dan Pi (Moutan Cortex) 2 liang instead of Sheng Di Huang.
Process these six herbs. Coarsely crush them. Take 5 qian per dose. Add 2 zhan of water, 3 slices of fresh ginger, and 1 jujube. Decoct until 1 zhan remains. Strain and take warm at any time.
Hu notes: The above formula is Zhong Jing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) with the addition of Sheng Di Huang. For women with heat entering the Blood Chamber (Xue Shi - a concept referring to the uterus/blood sea in gynecological contexts), characterized by blood deficiency and stasis, this formula is appropriate. This applies specifically when menstruation has started and then abruptly stopped. If menstruation was about to start but suddenly stopped, it indicates heat entering with blood excess; one should additionally add Dang Gui (Angelicae Sinensis Radix), Chi Shao (Paeoniae Radix Rubra), Tao Ren (Persicae Semen), and Hong Hua (Carthami Flos). If heat enters and menstruation is excessive, it indicates blood deficiency without stasis; one should additionally add Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba), and Fa Hui (Ash of Hair). This is the method of Yun Qi Zi.
[Tao's] Chai Hu Shuang Jie Yin
Indicated for Shaoyang Gallbladder Channel syndrome. Symptoms include deafness, hypochondriac pain, alternating chills and fever, vomiting, bitter taste in the mouth, and a wiry-rapid pulse. This belongs to the half-exterior half-interior stage, suitable for harmonizing. The Gallbladder channel has no exit or entry pathogens in the same way as others, and there are three prohibitions: sweating, purging, and emesis are forbidden. Only Xiao Chai Hu Tang (Minor Bupleurum Decoction) can be used with modifications based on the disease; no other decoction is suitable.
Ingredients: Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix), Ban Xia (Pinelliae Tuber), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix et Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Shao Yao (Paeoniae Radix). (Jin Ben records seven ingredients above, without specific dosages).
Add 2 zhong of water, 1 slice of ginger, and 2 jujubes. Pound/crush. Add 3 spoons of fresh Ai Ye juice (Artemisiae Argyi Folium juice). Decoct and take warm.
Hu notes: The above formula is Zhong Jing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) with the addition of Chen Pi (Citri Reticulatae Pericarpium) and Shao Yao (Paeoniae Radix). The reason for adding 3 spoons of fresh Ai Ye juice (Artemisiae Argyi Folium juice) in the formula is that fresh Ai Ye (Artemisiae Argyi Folium) has a warm temperature and bitter-pungent flavor. The *Zhou Hou Fang* uses it to treat seasonal warm epidemics, headache with high fever, and full pulses. Thus, Tao added it. To say that adding it to the above decoction makes it powerful like a "chariot-beating pestle" is an exaggeration of its efficacy, which I do not believe.
Appendix: Tao's Modification Methods
For primary symptoms with difficulty in urination, add Fu Ling (Poria). For primary symptoms with vomiting, add Jiang Zhi (Fresh Ginger Juice) and Zhu Ru (Bambusae Caulis in Taenia). For hypochondriac pain, add Qing Pi (Citri Reticulatae Pericarpium Viride). For excessive phlegm, add Gua Lou Ren (Trichosanthis Semen) and Bei Mu (Fritillariae Bulbus) (I consider Bei Mu (Fritillariae Bulbus) too mild; better to use Zhi Shi (Aurantii Fructus Immaturus)). For alternating chills and fever resembling malaria, add Gui Zhi (Cinnamomi Ramulus). For thirst, add Tian Hua Fen (Trichosanthis Radix) and Zhi Mu (Anemarrhenae Rhizoma); remove Ban Xia (Pinelliae Tuber). For dry teeth without saliva, add Shi Gao (Gypsum Fibrosum). For cough, add Wu Wei Zi (Schisandrae Chinensis Fructus) and Jin Fei Cao (Boehmeriae Folium) (I consider Nan Chan Wu Wei Zi (Schisandrae Chinensis Fructus) preferable).
For complicated/ruined syndromes (due to mis-treatment), add Bie Jia (Testudinis Carapax et Plastrum). For primary symptoms with epigastric fullness and oppression, without prior purgation, this is not Jie Xiong (Chest Binding) syndrome, but exterior pathogen transmitted to the chest, not yet entering the fu organs. Although full and oppressed, it is still considered exterior. Use only Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix). If ineffective, combine this formula with Xiao Xian Xiong Tang (Minor Sinking Chest Decoction) plus Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix). One dose brings sudden relief, miraculous as spirit. For empty irritability resembling Shanghan (Cold Damage), add Zhu Ye (Bambusae Folium) and Chao Jing Mi (Stir-fried Oryzae Fructus Glutinosa) (I consider that since the formula lacks Shi Gao (Gypsum Fibrosum) and Jing Mi (Oryzae Fructus Glutinosa), they need not be added).
When primary channel syndrome combines with Yangming syndrome, add Ge Gen (Puerariae Lobatae Radix) and Shao Yao (Paeoniae Radix); the effect is as easy as picking up a mustard seed (meaning little quantity is needed). For women with heat entering the Blood Chamber (Xue Shi), add Dang Gui (Angelicae Sinensis Radix) and Hong Hua (Carthami Flos). For men with heat entering the Blood Chamber (Xue Shi), add Sheng Di Huang (Rehmanniae Radix Praeparata). (My note: The meaning of Blood Chamber (Xue Shi) is seen after the examples of Xiao Chai Hu Tang (Minor Bupleurum Decoction) earlier; it is the Sea of Blood. Both men and women have it. However, men's blood cannot fully fill the Blood Chamber (Xue Shi); if not full, it does not overflow; if it does not overflow, it is not expelled. If not expelled, blood is not depleted; if not depleted, heat cannot enter. Therefore, in men, there is never a case of heat entering the Blood Chamber (Xue Shi). Today, Tao does not read books or understand principles, knowing only that men's bodies also have a Blood Chamber (Xue Shi), so he cleverly fabricates disease names, making people laugh.)
For elderly and weak persons with Shanghan (Cold Damage) lacking exterior signs, where heat is predominant, add Da Huang (Rhei Radix et Rhizoma) to the base formula; for severe cases, add Mang Xiao (Natrii Sulfas).
(Hu) General Note: The above ancient and modern experts' discussions on formulas for treating Shaoyang (Lesser Yang) diseases indeed complement the principles of Zhong Jing. Physicians must know this.