风湿者。先伤于湿。而后伤于风也。其症一身尽痛。比之伤寒身痛。殆有甚焉。因知其为风湿也。风从上受。湿
从下受。殆至两相抟聚。注经络。流关节。渗骨体躯壳之间。无处不到。是以无处不痛也。其症有轻有重。轻者脉浮
弦细。浑身酸软无力。宜用加减柴葛汤。风在外而湿在内。不可大汗。恐风去而湿仍存。惟此轻解之剂。内外之邪俱去。
若汗出短气。恶风不欲去衣。脉沉细缓无力者。宜用桂枝白术汤。助阳以驱湿。不易之法也。重者周身
大痛。脉浮洪数。亦用加减柴葛汤。若头面目赤。身热足寒阳气不能下通
于阴者。宜用柴陈汤加枳壳大黄以下之。如发散之后。上体已愈。下体疼痛不止者。宜用柴苓二妙汤。
加减柴葛汤
柴胡 黄芩 半夏 甘草 干葛 赤芍 紫苏 川芎 山栀 苍术
续断 枳壳 木瓜
治风湿之法。固宜散风行湿。而清热利气之药。亦不可少。盖以湿邪在经。气滞不行。郁而成火故也。
桂枝白术汤
桂枝 白芍 甘草 白术 木瓜 续断 陈皮
加减柴陈汤
柴胡 黄芩 半夏 甘草 陈皮 白茯 枳壳 大黄
柴苓二妙汤
柴胡 黄芩 半夏 甘草 赤茯 赤芍 泽泻 苍术 黄柏 木瓜 续断 牛膝 杜仲
风温者。先伤于风。而后伤于热也。凡人先伤于风。经络之间。已自有热。又感时令之热。饮食入胃。气滞不
行。变成浓痰浊饮。胶固不散。又遇新谷裹结成病。其症喘渴多睡。四肢不收。宜用柴胡化滞汤。但清其胃。其病
自愈。然不但风温互感后有此症。凡天令久暖。素有痰火者。每有此恙。仲景恐人误认寒症。妄用发汗。故辨于伤
寒门中。其实非伤寒也。
柴胡化滞汤
柴胡 黄芩 半夏 甘草 枳实 浓朴 山楂 杏仁 赤芍 陈皮
便闭宜加大黄。
风湿病,是先感受湿邪,而后又感受风邪所致。其症状表现为全身疼痛,比起伤寒引起的身体疼痛,程度更为严重。因此可以判断这是风湿病。风邪从上部侵入,湿邪从下部侵入,两者相互搏结,流注于经络,流窜于关节,渗透于骨骼、躯体与皮壳之间,无处不到,所以全身没有不痛的地方。其病情有轻有重:轻症者脉象浮弦细,浑身酸软无力,适宜使用加减柴葛汤。此证为风邪在表而湿邪在里,不可大发汗,恐怕风邪虽去而湿邪仍存,只有这种轻清解表的方剂,才能使内外的邪气一同去除。如果出汗后出现短气、恶风且不想脱衣,脉象沉细缓弱无力的,适宜使用桂枝白术汤,以助阳气来驱除湿邪,这是不易改变的治疗法则。重症者周身剧烈疼痛,脉象浮洪数,也使用加减柴葛汤。如果出现头面眼睛发红,身体发热但脚部寒冷,这是阳气不能下行通达于阴分的表现,适宜使用柴陈汤加入枳壳和大黄来通下泄热。如果在发散治疗后,上半身病症已愈,但下半身疼痛不止的,适宜使用柴苓二妙汤。
加减柴葛汤
组成:柴胡、黄芩、半夏、甘草、干葛(葛根)、赤芍、紫苏、川芎、山栀(栀子)、苍术、续断、枳壳、木瓜。
治疗风湿的方法,固然应当疏散风邪、祛除湿邪,但清热利气的药物也不可缺少。因为湿邪滞留于经络,导致气机阻滞不行,郁结而化火。
加减柴陈汤
组成:柴胡、黄芩、半夏、甘草、陈皮、白茯(茯苓)、枳壳、大黄。
柴苓二妙汤
组成:柴胡、黄芩、半夏、甘草、赤茯(赤茯苓)、赤芍、泽泻、苍术、黄柏、木瓜、续断、牛膝、杜仲。
风温病,是先感受风邪,而后又感受热邪所致。大凡人先感受风邪,经络之间就已经产生热象,如果再感受时令的热邪,加上饮食入胃后气机阻滞不行,变成浓痰浊饮,胶固不散,又遇到新谷之气裹挟结成疾病。其症状表现为气喘口渴、嗜睡,四肢弛缓不收,适宜使用柴胡化滞汤。只要清解胃部的热邪,病自然痊愈。然而,不仅仅是风温互感之后会出现这种症状,凡是天气长久温暖,素有痰火体质的人,常常会有这种毛病。张仲景担心人们误认为寒症,妄用发汗法,所以在伤寒篇中加以辨析,其实这并非伤寒。
Rheumatism is caused by first being injured by dampness, and subsequently by wind. Its symptoms include pain throughout the entire body, which is even more severe than the body pain caused by Cold Damage (Shanghan). Therefore, it can be known as rheumatism. Wind pathogen enters from the upper part, while dampness pathogen enters from the lower part. Eventually, they condense together, pouring into the meridians and collaterals, flowing through the joints, and seeping between the bones, trunk, and body surface, reaching everywhere; thus, there is no place that does not hurt. The severity of the condition varies. In mild cases, the pulse is floating, wiry, and thin, with general soreness, weakness, and lack of strength in the whole body. It is appropriate to use Jiajian Chaige Tang (Modified Kudzu and Bupleurum Decoction). Since wind is on the exterior and dampness is on the interior, profuse sweating should be avoided, lest the wind dissipates but the dampness remains. Only this mild resolving agent can eliminate both exterior and interior pathogens. If sweating is followed by shortness of breath, aversion to wind, and a reluctance to remove clothing, with a pulse that is deep, fine, slow, and weak, it is appropriate to use Guizhi Baizhu Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction) to assist Yang Qi to expel dampness; this is an unchangeable method. In severe cases, there is intense pain throughout the body, and the pulse is floating, surging, and rapid; Jiajian Chaige Tang is also used here. If the head, face, and eyes are red, the body is hot, but the feet are cold, indicating that Yang Qi cannot descend to communicate with Yin, it is appropriate to use Chaichen Tang (Bupleurum and Pinellia Decoction) added with Zhike (Aurantii Fructus) and Dahuang (Rhei Radix et Rhizoma) to purge downward. If, after dispersing treatment, the upper body has healed but pain in the lower body persists, Chailing Ermiao Tang (Bupleurum, Poria, and Two Marvels Decoction) is appropriate.
Jiajian Chaige Tang (Modified Kudzu and Bupleurum Decoction)
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Gange (Puerariae Lobatae Radix), Chishao (Paeoniae Radix Rubra), Zisu (Perillae Folium), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shanzhi (Gardeniae Fructus), Cangzhu (Atractylodis Rhizoma), Xuduan (Dipsaci Radix), Zhike (Aurantii Fructus), Mugua (Chaenomelis Fructus).
The method for treating rheumatism indeed involves dispersing wind and eliminating dampness, but herbs that clear heat and promote Qi circulation are indispensable. This is because dampness pathogen stagnates in the meridians, causing Qi stagnation, which郁 (condenses) and transforms into fire.
Guizhi Baizhu Tang (Cinnamon Twig and Atractylodes Macrocephala Decoction)
Ingredients: Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Mugua (Chaenomelis Fructus), Xuduan (Dipsaci Radix), Chenpi (Citri Reticulatae Pericarpium).
Jiajian Chaichen Tang (Modified Bupleurum and Pinellia Decoction)
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Baifu (Poria), Zhike (Aurantii Fructus), Dahuang (Rhei Radix et Rhizoma).
Chailing Ermiao Tang (Bupleurum, Poria, and Two Marvels Decoction)
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Chifu (Poria cum Rosa), Chishao (Paeoniae Radix Rubra), Zexie (Alismatis Rhizoma), Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Mugua (Chaenomelis Fructus), Xuduan (Dipsaci Radix), Niuxi (Achyranthis Bidentatae Radix), Duzhong (Eucommiae Cortex).
Wind-Warmth disease is caused by first being injured by wind, and subsequently by heat. Generally, when a person is first injured by wind, heat already exists within the meridians and collaterals. If one then contracts seasonal heat, and food entering the stomach causes Qi stagnation, transforming into thick phlegm and turbid fluids that adhere firmly and do not disperse, combined with new grain qi binding together to form disease, the symptoms include panting, thirst, excessive sleepiness, and flaccidity of the four limbs. It is appropriate to use Chaihu Huazhi Tang (Bupleurum Stagnation-Resolving Decoction). By simply clearing the Stomach heat, the disease will heal itself. However, this symptom is not only present after the mutual contraction of wind and warmth; whenever the weather remains warm for a long time, individuals who habitually have phlegm-fire often suffer from this ailment. Zhang Zhongjing feared that people would mistakenly identify this as a Cold pattern and recklessly use diaphoresis (sweating methods); therefore, he differentiated it within the Shanghan (Cold Damage) section. In reality, it is not Shanghan.
Chaihu Huazhi Tang (Bupleurum Stagnation-Resolving Decoction)
Ingredients: Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Banxia (Pinelliae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), Shanzha (Crataegi Fructus), Xingren (Armeniacae Semen Amarum), Chishao (Paeoniae Radix Rubra), Chenpi (Citri Reticulatae Pericarpium).
If constipation is present, it is appropriate to add Dahuang (Rhei Radix et Rhizoma).