医书论厥互相讥,寒热攸分辨细微。里热三承(气汤)表四逆(散),内寒通脉(四逆汤)外当归(当
归四逆汤。)同中互异明标本,症上筹方别范围。最是追魂(汤)先圣法,白薇汤又重闺闱(治妇人
血厥如死人。
寒症有分经治者,有不必分经治者。桂枝麻黄驱表寒,干姜、附子温里寒,羌活、独活
祛表之风寒,吴茱萸、川乌温里之风寒,肉桂去血分之寒,香附佐姜附除气分之寒,一隅三
反可也。理中汤补中土以统治诸脏,中和之剂也。吴茱萸汤、大建中汤宣上焦之阳也。真武
汤扶下焦之阳,以行水也。附子汤回坎中之阳,以祛寒也。四逆汤救四肢之厥冷。白虎汤、
通脉四逆汤更有斩关夺命之奇能。寒甚脉绝,热药拒格不纳者,必用白通汤加人尿,胆汁,
寒甚格阳亦用之。痨伤下寒上热者,宜二加龙骨汤。若不宜刚燥之剂,小便不利者,可用桂
附八味丸。若巴戟天、肉苁蓉、小茴香、沉香、补骨脂,皆温补命门之善药,与痨伤症相宜
伤寒头痛项强,发热恶寒,身疼痛而喘、无汗而烦躁,用大青龙汤。温病发热不恶寒而
口渴,用麻杏甘石汤。四时感冒,时法用九味羌活汤,表热也。阳明经身热自汗而渴,或服
桂枝汤后,大渴饮水,用白虎人参汤,中热也。不恶寒但恶热,潮热,谵语,便闭用三承气
汤,里实而热也。发斑谵语,时法用三黄解毒汤、犀角地黄汤,里热也。头痛恶寒,发热而
谵语、小便短赤,大便闭者,用防风通圣散,表里俱实俱热也。法详伤寒门不赘。
医书中关于厥证的论述往往互相讥讽,寒证与热证的区别在于分辨其细微之处。里热证用三承气汤(调胃承气汤、小承气汤、大承气汤),表寒证用四逆散;内寒证用通脉四逆汤,外寒证用当归四逆汤。要在相同中辨析不同,明确病本的差异;在症状上筹划方剂,以区分治疗的范畴。最妙的是追魂汤这一先圣的法度,白薇汤又特别重视用于治疗妇女的血厥(症见如死人状)。
寒证有分经治疗的,也有不必分经治疗的。桂枝汤和麻黄汤驱散体表之寒,干姜和附子温补体内之寒,羌活和独活祛除体表之风寒,吴茱萸和川乌温补体内之风寒,肉桂去除血分之寒,香附辅助干姜和附子消除气分之寒,举一反三即可。理中汤补益中焦脾胃之气以统摄调节各脏腑,属于中和的方剂。吴茱萸汤和大建中汤宣通上焦之阳气。真武汤扶持下焦之阳气,以运行水液。附子汤挽回肾中(坎宫)之阳气,以祛除寒邪。四逆汤救治四肢厥冷。白虎汤和通脉四逆汤更有斩关夺命的神奇功效。寒邪极盛导致脉搏断绝,服用热药被格拒无法纳受者,必须使用白通汤加入人尿和胆汁;寒邪极盛导致格阳(真寒假热)也使用此法。虚劳损伤导致下寒上热者,适宜用二加龙骨汤。如果不适宜使用刚燥的药剂且小便不利者,可用桂附八味丸(金匮肾气丸)。若巴戟天、肉苁蓉、小茴香、沉香、补骨脂,都是温补命门的良药,与虚劳损伤的病症相适宜。
伤寒引起的头痛项强,发热恶寒,身体疼痛且气喘、无汗而烦躁,使用大青龙汤。温病引起的发热不恶寒而口渴,使用麻杏甘石汤。四季感冒,时令疗法使用九味羌活汤,针对表热证。阳明经证见身热自汗且口渴,或服用桂枝汤后出现大渴饮水,使用白虎人参汤,针对中热证。不恶寒但恶热,潮热,谵语,大便闭结,使用三承气汤,针对里实热证。发斑疹伴谵语,时令疗法使用三黄解毒汤、犀角地黄汤,针对里热证。头痛恶寒,发热伴谵语、小便短赤,大便闭结者,使用防风通圣散,针对表里俱实俱热证。具体法则详见伤寒门,此处不再赘述。
Discussions on Jue (cold extremities) in medical texts often criticize each other, while the distinction between Cold and Heat lies in discerning subtle differences. For interior Heat, the Three Chengqi Decoctions (Tiaowei Chengqi Tang, Xiao Chengqi Tang, Da Chengqi Tang) are used; for exterior Cold, Sini San (Four Reversal Powder) is applied. For internal Cold, Tongmai Sini Tang (Pulse-Reviving Four Reversal Decoction) is indicated, whereas for external Cold, Danggui Sini Tang (Angelica Sinensis Four Reversal Decoction) is employed. One must clarify the root cause by distinguishing similarities from differences, and plan prescriptions based on symptoms to delineate therapeutic scopes. Most notably, the method of Zhuihun Tang (Soul-Chasing Decoction) follows the sage's precedent, while Baiwei Tang (Anemone Root Decoction) is particularly emphasized for treating women's Blood Jue (manifesting as if dead).
Cold syndromes may be treated according to specific meridians or without such differentiation. Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction) dispel exterior cold; Ganjiang (Dried Ginger) and Fuzi (Prepared Aconite Root) warm interior cold; Qianghuo (Notopterygium Rhizome) and Duhuo (Angelica Pubescens Root) expel exterior wind-cold; Wuzhuyu (Evodia Fruit) and Chuanwu (Aconitum Carmichaelii Lateral Root) warm interior wind-cold; Rougui (Cinnamon Bark) removes blood-level cold; Xiangfu (Cyperi Rhizoma) assists Ganjiang and Fuzai to eliminate qi-level cold. Understanding one case allows inferring others. Lizhong Tang (Regulate the Middle Decoction) tonifies the middle Jiao (Spleen/Stomach) to regulate all zang organs, serving as a harmonizing formula. Wuzhuyu Tang (Evodia Decoction) and Da Jianzhong Tang (Great Construct the Middle Decoction) disseminate Yang Qi of the upper Jiao. Zhenwu Tang (True Warrior Decoction) supports the Yang Qi of the lower Jiao to promote water metabolism. Fuzi Tang (Aconite Decoction) restores the Yang Qi within the Kan Palace (Kidney) to dispel cold. Sini Tang (Four Reversal Decoction) rescues cold extremities. Baihu Tang (White Tiger Decoction) and Tongmai Sini Tang possess miraculous abilities to break through critical obstructions. In cases of extreme cold with absent pulse, where hot herbs are rejected and cannot be retained, Baitong Tang (White Pass Decoction) added with human urine and bovine gallbladder bile must be used; this is also applied in cases of extreme cold causing floating Yang (false heat). For consumptive injuries presenting with lower cold and upper heat, Erjia Longgu Tang (Two-Added Dragon Bone Decoction) is suitable. If harsh-drying agents are contraindicated and urination is difficult, Guifu Bawei Wan (Cinnamon and Aconite Eight-Ingredient Pill, i.e., Jin Gui Shen Qi Wan) may be used. Bajitian (Morinda Officinalis Root), Rongrong (Cistanche Stem), Xiaohuixiang (Fennel Fruit), Chenxiang (Aquilaria Wood), and Buguzhi (Psoralea Fruit) are all excellent medicines for warming and tonifying the Mingmen (Gate of Life), making them suitable for consumptive injury syndromes.
Shanghan (Cold Damage) manifesting as headache, neck stiffness, fever, aversion to cold, body pain, wheezing, absence of sweating, and irritability is treated with Da Qinglong Tang (Great Blue Green Dragon Decoction). Wenbing (Warm Disease) manifesting as fever without aversion to cold but with thirst is treated with Maxing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). For common colds occurring in any season, the seasonal method employs Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) for exterior heat syndromes. Yangming Meridian syndromes presenting with body heat, spontaneous sweating, and thirst, or excessive thirst and drinking after taking Guizhi Tang, are treated with Baihu Renshen Tang (White Tiger with Ginseng Decoction) for intermediate heat syndromes. Absence of aversion to cold but presence of aversion to heat, tidal fever, delirium, and constipation indicate interior excess-heat, treated with the Three Chengqi Decoctions. Appearance of macules and delirium indicates interior heat, treated with Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction) and Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) per seasonal methods. Headache, aversion to cold, fever accompanied by delirium, scanty dark urine, and constipation indicate simultaneous exterior and interior excess-heat, treated with Fangfeng Tongsheng San (Saposhnikovia Unblocking the Interior Powder). Detailed protocols are found in the Shanghan section and are not repeated here.