伤寒发汗。若吐若下。解后。心下痞硬。噫气不除者。旋覆代赭石汤主之。
伤寒发汗。或吐或下。邪气则解。而心下痞硬。噫气不除者。胃气弱而未和。痰气动而上逆也
。旋覆花咸温。行水下气。代赭石味苦质重。能坠痰降气。半夏、生姜、辛温。人参、大枣、甘草
甘温。合而用之。所以和胃气而止虚逆也。
旋覆代赭石汤方
旋覆花(三两) 人参(二两) 炙甘草(三两) 生姜(五两切) 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。去滓。再煎取三升。温服一升。日三服。
伤寒若吐若下后。心下逆满。气上冲胸。起则头眩。脉沉紧。发汗则动经。身为振振摇者。
茯苓桂枝白术甘草汤主之。
此伤寒邪解而饮发之证。饮停于中则满。逆于上则气冲而头眩。入于经则身振振而动摇。金匮
云、膈间支饮。其人喘满。心下痞坚。其脉沉紧。又云、心下有痰饮。胸胁支满。目眩。又云、其人
振振身 剧。必有伏饮是也。发汗则动经者。无邪可发。而反动其经气。故与茯苓、白术。以蠲饮
气。桂枝、甘草。以生阳气。所谓病痰饮者。当以温药和之也。
茯苓桂枝白术甘草汤方
茯苓(四两) 桂枝(三两) 白术 炙甘草(各二两)
上四味。以水六升。煮取三升。分温三服。
凡病若发汗。若吐。若下。若亡津液。阴阳自和者。必自愈。
阴阳自和者。不偏于阴。不偏于阳。汗液自出。便溺自调之谓。汗吐下亡津液后。邪气既微。
正气得守。故必自愈。
伤寒病经过发汗治疗后,如果又用了催吐或泻下的方法,在表邪解除之后,出现胃脘部痞塞胀硬、嗳气持续不缓解的症状,应当用旋覆代赭石汤来主治。
伤寒病经过发汗,或者催吐,或者泻下,虽然邪气已经解除,但依然出现胃脘部痞塞胀硬、嗳气持续不缓解的情况,这是因为胃气虚弱且未能调和,痰饮之气上逆所致。
旋覆花性味咸温,能行水降气;代赭石性味苦而质地沉重,能坠痰降气;半夏和生姜性味辛温;人参、大枣和甘草性味甘温。将这些药物配合使用,是为了调和胃气并制止虚性的气逆。
旋覆代赭石汤方剂组成:
旋覆花(三两) 人参(二两) 炙甘草(三两) 生姜(五两,切片) 半夏(半升,洗净)
代赭石(一两) 大枣(十二枚,掰开)
以上七味药,用水一斗,煎煮至六升,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。
伤寒病如果在催吐或泻下之后,出现胃脘部逆满感,气向上冲撞至胸部,起身时感到头晕目眩,脉象沉紧,此时若再误用发汗法,就会扰动经脉,导致身体震颤摇晃不定,这种情况应当用茯苓桂枝白术甘草汤来主治。
这是伤寒邪气已解但水饮内发的证候。水饮停滞在中焦则导致胀满,逆冲于上焦则导致气冲胸膈和头晕目眩,侵入经脉则导致身体震颤动摇。《金匮要略》中说:“膈间有支饮的人,会出现喘息胀满,胃脘部痞塞坚硬,脉象沉紧。”又说:“心下有痰饮,会导致胸胁部支撑胀满,头晕目眩。”还说:“如果人身体剧烈震颤动摇,必定是有潜伏的水饮。”所谓“发汗则动经”,是因为没有表邪可发,反而动摇了经气,所以给予茯苓和白术以祛除水饮之气,桂枝和甘草以生发阳气。这就是所说的治疗痰饮病,应当用温性药物来调和的原则。
茯苓桂枝白术甘草汤方剂组成:
茯苓(四两) 桂枝(三两) 白术 炙甘草(各二两)
以上四味药,用水六升,煎煮至三升,分三次温服。
凡是疾病,如果经过发汗、催吐、泻下,或者导致津液耗损,只要阴阳能够自行调和,就一定会自愈。
所谓“阴阳自和”,是指不偏于阴,也不偏于阳,汗液自然排出,大小便自然调畅的状态。在发汗、催吐、泻下导致津液耗损后,邪气已经微弱,正气得以固守,所以一定会自愈。
After the treatment of sweating for a cold damage disease, if vomiting or purging methods are also applied, and after the exterior pathogenic factor has resolved, symptoms of epigastric fullness and hardness, along with persistent belching (hiccough), occur. In such cases, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is the primary prescription.
After sweating, or vomiting, or purging for a cold damage disease, although the pathogenic factor has resolved, if epigastric fullness and hardness persist along with unrelenting belching, it indicates that the Stomach Qi is weak and disharmonious, causing phlegm-fluids to move upward and reverse.
Xuanfu Hua (Inulae Flos) is salty and warm, capable of moving fluids and descending Qi. Daizhe Shi (Hematitum) is bitter and heavy in texture, capable of sinking phlegm and descending Qi. Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) are acrid and warm. Renshen (Ginseng Radix), Dazao (Jujubae Fructus), and Gancao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle) are sweet and warm. Used in combination, they harmonize Stomach Qi and stop deficiency-type rebellious Qi.
Formula: Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction)
Xuanfu Hua (Inulae Flos) (3 liang)
Renshen (Ginseng Radix) (2 liang)
Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) (3 liang)
Shengjiang (Fresh Zingiberis Rhizoma) (5 liang, sliced)
Banxia (Pinelliae Rhizoma) (0.5 sheng, washed)
Daizhe Shi (Hematitum) (1 liang)
Dazao (Jujubae Fructus) (12 pieces, split)
Take the above seven ingredients, add 1 dou of water, decoct to obtain 6 sheng, remove the dregs, and decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.
After vomiting or purging for a cold damage disease, if there is a sensation of rebellious fullness in the epigastrium, Qi rushing up to the chest, dizziness upon rising, and a deep, tight pulse, further sweating will disturb the meridians, causing the body to tremble and shake uncontrollably. In such cases, Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction) is the primary prescription.
This is a syndrome where the cold damage pathogen has resolved but fluid retention arises. Fluid retention stagnating in the middle causes fullness; reversing upward causes Qi rushing to the chest and dizziness; entering the meridians causes trembling and shaking. The *Jin Gui Yao Lue* states: "For patients with fluid retention between the diaphragm, there is wheezing and fullness, epigastric stiffness and hardness, and a deep, tight pulse." It also states: "With phlegm-fluids in the heart region, there is distending fullness in the chest and hypochondrium, and dizziness." It further states: "If the person trembles violently, there must be latent fluid retention." The phrase "sweating disturbs the meridians" implies that since there is no exterior pathogen to release, sweating instead disturbs the meridian Qi. Therefore, Poria and Atractylodes Macrocephala are used to eliminate fluid retention, while Cinnamon Twig and Licorice are used to generate Yang Qi. This aligns with the principle that for diseases involving phlegm-fluids, one should use warm herbs to harmonize.
Formula: Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction)
Fuling (Poria) (4 liang)
Guizhi (Cinnamomi Ramulus) (3 liang)
Baizhu (Atractylodis Macrocephalae Rhizoma)
Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma) (each 2 liang)
Take the above four ingredients, add 6 sheng of water, decoct to obtain 3 sheng, and divide into three warm doses.
Generally, for any disease, whether treated with sweating, vomiting, purging, or resulting in the loss of Body Fluids, if Yin and Yang can naturally harmonize, the disease will surely resolve on its own.
"Naturally harmonizing Yin and Yang" refers to a state where there is no bias toward Yin or Yang, sweat excretes naturally, and urination and defecation regulate themselves. After sweating, vomiting, or purging leads to the loss of Body Fluids, the pathogenic factor becomes slight, and the Healthy Qi is preserved; thus, self-healing is inevitable.