手足厥冷, 脉细欲绝者, 主之.
若其人内有久寒,加吴茱萸, 生姜.
当归三两 桂枝三两 芍药三两 细辛二两 通草二两 甘草 ( 炙
)二两 大枣 ( 擘 ) 二十五枚, 右七味, 以水八升 , 煮取三升,
去滓, 温服一升, 日三服.
于前汤内加吴茱萸半斤, 生姜三两., 右九味, 以水六升, 清酒六升
和煮, 取五升, 去滓, 分温五服.
【注】凡厥阴病则脉微而厥, 以厥阴为三阴之尽, 阴尽阳生, 若受其
邪,则阴阳之气不相顺接, 故脉微而厥也. 然厥阴之脏, 相火游行其
间,经虽受寒, 而脏不即寒, 故先厥者后必发热. 所以伤寒初起, 见
其手足厥冷, 脉细欲绝者, 不得遽认为虚寒而用姜, 附也. 此方取桂
枝汤 , 君以当归者, 厥阴主肝为血室也. 佐细辛味极辛, 能达三阴,
外温经而内温脏. 通草其性极通, 善开关节, 内通窍而外通营. 倍加
大枣, 即建中加饴用甘之法. 减去生姜, 恐辛过甚而迅散也. 肝之志
苦急, 肝之神欲散, 甘辛并举, 则志遂而神悦, 未有厥阴神志遂悦,
而脉微不出, 手足不温者也. 不须参, 苓之补, 不用姜, 附之峻, 此
厥阴厥逆与太少不同治也. 若其人内有久寒, 非辛温之品所能兼治,
则加吴茱萸, 生姜之辛热, 更用酒煎, 佐细辛直通厥阴之脏, 迅散内
外之寒, 是又救厥阴内外两伤于寒之法也.
手足冰冷,脉搏细微几乎要断绝的,用本方主治。
如果患者体内有陈久的寒邪,加入吴茱萸、生姜。
当归三两 桂枝三两 芍药三两 细辛二两 通草二两 甘草(炙)二两 大枣(掰开)二十五枚,以上七味药,用水八升,煎煮取三升,滤去药渣,温服一升,每日三次服用。
在前一方剂中加入吴茱萸半斤、生姜三两,以上九味药,用水六升、清酒六升混合煎煮,取五升,滤去药渣,分五次温服。
【注】凡是厥阴病,则脉象微弱且四肢厥冷,因为厥阴是三阴经的尽头,阴尽阳生,如果受到邪气侵袭,则阴阳之气不能顺接,所以出现脉微而四肢厥冷的症状。然而厥阴之脏,相火在其中游行,经脉虽然受寒,但脏腑不会立即变寒,所以先出现厥冷的之后必定会发热。因此伤寒初起时,见到手足冰冷、脉搏细微欲绝的,不能立刻认定为虚寒证而使用干姜、附子。此方选取桂枝汤为基础,以当归为君药,是因为厥阴主肝,肝为血室。佐以细辛,味道极辛,能通达三阴经,外温经脉内温脏腑。通草性质极通利,善于开通关节,内通窍道外通营气。加倍使用大枣,就是建立中气加饴糖用甘缓之法。减去生姜,是担心辛散太过而迅疾耗散。肝的情志苦于拘急,肝的神气喜好疏散,甘味与辛味并用,则情志得以舒展而神气愉悦,没有厥阴神志舒展愉悦,而脉微不出、手足不温的道理。不需要人参、茯苓的补益,不用干姜、附子的峻烈,这是厥阴厥逆与太阳、少阳不同治法的原因。如果患者体内有陈久的寒邪,不是辛温药物所能兼治的,则加入吴茱萸、生姜的辛热之性,再用酒煎煮,辅助细辛直通厥阴之脏,迅速消散内外的寒邪,这又是救治厥阴内外两伤于寒的方法。
Coldness of the hands and feet, with a fine pulse nearly imperceptible, is indicated for this formula.
If there is chronic cold within, add Evodiae Fructus (Wuzhuyu) and Zingiberis Rhizoma (Shengjiang).
Danggui Radix Angelicae Sinensis (3 liang), Guizhi Ramulus Cinnamomi (3 liang), Shaoyao Radix Paeoniae Alba (3 liang), Xixin Herba Asari (2 liang), Tongcao Caulis Tetrapanacis (2 liang), Ganzi Radix Glycyrrhizae Preparata (2 liang), Dazao Fructus Jujubae (25 pieces, split). The above seven ingredients are boiled in eight sheng of water to obtain three sheng. Strain and take one sheng warm, three times daily.
To the preceding decoction, add Wuzhuyu Fructus Evodiae (half jin) and Shengjiang Rhizoma Zingiberis Recens (3 liang). The above nine ingredients are boiled together with six sheng of water and six sheng of clear wine to obtain five sheng. Strain and divide into five warm doses.
[Annotation] In all cases of Jueyin disease, the pulse is faint and there is cold extremities, because Jueyin is the end of the three Yin meridians; where Yin ends, Yang generates. If affected by pathogenic factors, the Qi of Yin and Yang fails to connect smoothly, resulting in a faint pulse and cold extremities. However, in the Jueyin organ, Ministerial Fire circulates within. Although the meridians may be affected by cold, the organs do not immediately become cold; thus, those who first experience cold extremities will subsequently develop fever. Therefore, at the initial stage of Cold Damage, when cold extremities and a fine pulse nearly imperceptible are observed, one must not hastily diagnose it as deficiency-cold and use Shengjiang Rhizoma Zingiberis Recens or Fuzii Radix Aconiti Preparata. This formula selects Guizhi Tang (Cinnamon Twig Decoction) as the base, with Danggui Radix Angelicae Sinensis as the sovereign herb, because Jueyin governs the Liver, which is the repository of blood. Asari Herba (Xixin) is extremely pungent and can penetrate the three Yin meridians, warming the meridians externally and the organs internally. Tongcao Caulis Tetrapanacis is highly penetrating and good at opening joint spaces, connecting acupoints internally and nourishing Ying Qi externally. Doubling the amount of Dazao Fructus Jujubae follows the method of establishing the Middle Jiao by adding Yi Tang (Maltose) using sweet herbs. Removing Shengjiang Rhizoma Zingiberis Recens prevents excessive pungency from dispersing too rapidly. The will of the Liver suffers from tension, while the spirit of the Liver desires dispersion. Combining sweet and pungent flavors allows the will to be satisfied and the spirit to be joyful. It is impossible for the Jueyin spirit and will to be satisfied yet have a faint pulse that does not emerge and cold extremities. There is no need for tonification with Renshen Radix Ginseng or Poria Sclerotium, nor the harsh action of Shengjiang Rhizoma Zingiberis Recens and Fuzii Radix Aconiti Preparata; this distinguishes the treatment of Jueyin cold reversal from that of Taiyang and Shaoyang. If there is chronic cold within, which cannot be treated merely by pungent-warm substances, then the pungent-hot properties of Wuzhuyu Fructus Evodiae and Shengjiang Rhizoma Zingiberis Recens are added, and decocted with wine to assist Xixin Herba Asari in directly penetrating the Jueyin organ, swiftly dispersing cold inside and outside. This is another method for rescuing Jueyin from cold injury both internally and externally.