治发汗过多, 其人叉手自冒心, 心下悸, 欲得按者.
桂枝四两 甘草 ( 炙 ) 二两, 右二味, 水三升, 煮取一升, 顿服.
【集注】柯琴曰: 汗出多, 则心液虚, 中气馁, 故悸. 叉手自冒, 则
外有所卫, 得按则内有所根据, 如此不堪之状, 望之而知其虚矣. 桂枝
本营分药, 得麻黄, 则令营气外发而为汗, 从辛也; 得芍药, 则收敛
营气而止汗, 从酸也; 得甘草, 则补中气而养血, 从甘也. 故此方以
桂枝为君, 独任甘草为佐, 以补阳气生心液. 甘温相得, 斯气血和而
悸自平. 不须附子者, 以汗虽多而未至于阳亡. 不须芍药者, 以汗已
止而嫌其阴敛也.
本太阳病, 医反下之, 因而腹满时痛者,
属太阴也, 桂枝加芍药汤主之. 大实痛者, 桂枝加大黄汤主之.
于桂枝汤方内, 更加芍药三两, 随前共六两,余根据桂枝汤法.
即桂枝加芍药汤方内, 更加大黄一两
【集注】柯琴曰: 腹痛为太阴, 阳明俱有之证, 然位同而职异. 太阴
主出, 太阴病则腐秽之出不痢, 故满而时痛; 阳明主内, 阳明病则腐
秽燥而不行, 故大实而痛; 大实痛是阳明病, 不是太阴病. 仲景因表
证未解, 阳邪已陷入于太阴, 故倍芍药以益脾调中, 而除腹满时痛,
此用阴和阳法也. 若表邪未解, 而阳邪陷入于阳明, 则加大黄以润胃
通结, 而除其大实痛, 此双解表里法也. 凡妄下必伤胃气, 胃气虚则
阳邪袭阴, 故转属太阴; 胃液涸则两阳相搏, 故转属阳明. 属太阴则
腹满时痛而不实, 阴道虚也; 属阳明则腹满大实而痛, 阳道实也. 满
而时痛, 是下痢之兆, 大实而痛, 是燥屎之征. 故倍加芍药, 小变建
中之剂, 稍加大黄, 微示调胃之方.
治疗因发汗过多,导致患者双手交叉按压心前区,心中悸动不安,且喜欢被按压的情况。
桂枝四两,甘草(炙)二两,以上两味药,用水三升,煎煮至一升,一次性服用。
【集注】柯琴说:出汗过多,会导致心液亏虚,中气虚弱,所以出现心悸。双手交叉按压心前区,是为了在外有所护卫,得到按压则在内有所依托,这种不堪忍受的状态,从外观上就能看出是虚证。桂枝本是调理营分的药物,遇到麻黄,则使营气向外发散而成为汗,这是取其辛味的作用;遇到芍药,则收敛营气而止汗,这是取其酸味的作用;遇到甘草,则补益中气而养血,这是取其甘味的作用。因此这个方子以桂枝为君药,单独任用甘草作为佐药,用来补益阳气、滋生心液。甘味与温性相互协调,气血调和,心悸自然平息。不需要使用附子的原因,是因为虽然出汗多,但尚未达到阳气亡脱的程度。不需要使用芍药的原因,是因为汗已经停止,担心其阴敛作用会阻碍气机。
原本患太阳病,医生反而使用了攻下法,因而导致腹部胀满、时时疼痛的,
属于太阴病,用桂枝加芍药汤主治。如果腹部胀满且剧烈疼痛的,用桂枝加大黄汤主治。
在桂枝汤的配方基础上,再增加芍药三两,连同之前的总共六两,其余按照桂枝汤的方法煎服。
【集注】柯琴说:腹痛是太阴病和阳明病都有的症状,然而部位相同而功能不同。太阴主出,太阴生病则腐秽之物排出表现为下痢,所以表现为胀满且时时疼痛;阳明主内,阳明生病则腐秽之物燥结而不通,所以表现为大实且疼痛;“大实痛”是阳明病,不是太阴病。张仲景因为表证未解,阳邪已经陷入太阴,所以加倍使用芍药来益脾调中,从而消除腹部胀满和时时疼痛,这是运用“用阴和阳”的方法。如果表邪未解,而阳邪陷入阳明,则增加大黄来润胃通便,从而消除大实痛,这是运用“双解表里”的方法。凡是误用攻下法必然损伤胃气,胃气虚弱则阳邪侵袭阴分,所以转属太阴;胃液枯竭则两阳相搏结,所以转属阳明。转属太阴则腹部胀满、时时疼痛且不坚硬,这是阴道虚的表现;转属阳明则腹部胀满、大实且疼痛,这是阳道实的表现。胀满且时时疼痛,是下痢的先兆;大实且疼痛,是燥屎内结的迹象。所以加倍增加芍药,是对小建中汤的微小变化;稍微增加大黄,是微示调胃承气汤的方义。
Treats the condition caused by excessive sweating, where the patient crosses their hands over the heart area, experiences palpitations in the epigastrium (heart region), and desires to be pressed upon.
Guizhi Tang (Cinnamon Twig Decoction) - Cinnamon Twig (Rougui/Cassiae Ramulus) 4 liang, Licorice Root (Gancao/Glycyrrhizae Radix et Rhizoma) [roasted] 2 liang. The above two ingredients are boiled in 3 sheng of water until reduced to 1 sheng, taken in one dose.
[Collected Annotations] Ke Qin stated: Excessive sweating depletes Heart Fluid (Xin Ye) and weakens Middle Qi (Zhong Qi), leading to palpitations. Crossing hands over the chest provides external protection, while pressing upon it provides internal support; such unbearable symptoms clearly indicate a deficiency pattern from observation. Guizhi (Cinnamon Twig) is primarily a herb for regulating Ying Qi (Nutritive Qi). When combined with Mahuang (Ephedra Herb), it promotes the outward release of Ying Qi as sweat, utilizing its pungent property; when combined with Shaoyao (Peony Root), it astringes Ying Qi to stop sweating, utilizing its sour property; when combined with Gancao (Licorice Root), it tonifies Middle Qi and nourishes Blood, utilizing its sweet property. Therefore, in this formula, Guizhi serves as the Sovereign herb, with Gancao acting alone as an Assistant to tonify Yang Qi and generate Heart Fluid. The harmony between sweet and warm properties harmonizes Qi and Blood, thereby calming palpitations naturally. Fuzi (Aconite Lateralis Radix Preparata) is not required because, although sweating is excessive, Yang collapse has not yet occurred. Shaoyao is not required because sweating has ceased, and its yin-astringing property might be contraindicated.
In cases originally presenting as Taiyang Disease (Taiyang Syndrome), if the physician erroneously applied purgation, resulting in abdominal fullness and intermittent pain,
it belongs to Taiyin Disease (Taiyin Syndrome), and Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root) is the primary treatment. If there is severe fullness and pain, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rheum Root) is the primary treatment.
To the prescription of Guizhi Tang (Cinnamon Twig Decoction), add an additional 3 liang of Shaoyao (Peony Root), bringing the total to 6 liang. Prepare and administer according to the standard method for Guizhi Tang (Cinnamon Twig Decoction).
To the prescription of Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root), add an additional 1 liang of Dahuang (Rhubarb Root).
[Collected Annotations] Ke Qin stated: Abdominal pain is a symptom present in both Taiyin Disease (Taiyin Syndrome) and Yangming Disease (Yangming Syndrome), yet their locations are similar while their functions differ. Taiyin governs expulsion; in Taiyin disease, putrid filth is expelled via diarrhea, hence presenting as fullness with intermittent pain; Yangming governs reception/retention; in Yangming disease, putrid filth becomes dry and obstructed, hence presenting as severe excess and pain. "Severe excess and pain" indicates Yangming Disease (Yangming Syndrome), not Taiyin Disease (Taiyin Syndrome). Zhang Zhongjing addressed this because the exterior syndrome remained unresolved while Yang pathogenic factors had sunk into the Taiyin channel; thus, doubling the dosage of Shaoyao (Peony Root) benefits the Spleen and regulates the Middle Jiao to relieve abdominal fullness and intermittent pain. This employs the method of "using Yin to harmonize Yang." If exterior pathogens remain unresolved while Yang pathogenic factors sink into the Yangming channel, adding Dahuang (Rhubarb Root) moistens the Stomach and unblocks accumulation to relieve severe excess and pain. This employs the method of "simultaneously resolving the exterior and interior." Erroneous purgation inevitably damages Stomach Qi; when Stomach Qi is deficient, Yang pathogens invade the Yin, causing a shift to Taiyin Disease (Taiyin Syndrome); when Stomach fluids are depleted, dual Yang pathogens contend, causing a shift to Yangming Disease (Yangming Syndrome). Shifting to Taiyin presents as abdominal fullness and intermittent pain without hardness, reflecting the deficiency of the Yin pathway; shifting to Yangming presents as abdominal fullness, severe excess, and pain, reflecting the excess of the Yang pathway. Fullness with intermittent pain is a precursor to diarrhea; severe excess with pain is a sign of dry fecal impaction. Therefore, doubling Shaoyao (Peony Root) represents a slight modification of Xiaojianzhong Tang (Minor Construct the Middle Decoction), while slightly adding Dahuang (Rhubarb Root) subtly indicates the principle of Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction).