附子(炮,去皮,破)三枚 白术四两 生姜(切)三两 大枣(擘)十二枚 甘草
(炙)二两
右五味,以水六升,煮取二升,去滓,分温三服。初一服,其人身如痹,半日许,复
服之,三服都尽,其人如冒状,勿怪。此以附子、术,并走皮肉,逐水气未得除,故
使之耳,法当加桂四两。此本一方二法,以大便□、小便自利去桂也。以大便不□、
小便不利,当加桂。附子三枚,恐多也。虚弱家及产妇,宜减服之。
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风湿相抟,骨节疼烦,掣痛不得屈伸,近之则痛剧,汗出短气,小便不利,恶风不欲
去衣,或身微肿者,甘草附子汤主之。
【注】
风湿相抟,骨节疼烦,重着不能转侧,湿胜风也。掣痛不可屈伸,风胜湿也。今掣痛
不可屈伸,近之则痛剧,汗出、短气,恶风不欲去衣,皆风邪壅盛,伤肌表也。小便
不利,湿内蓄也。身微肿者,湿外薄也。以甘草附子汤微汗之,祛风为主,除湿次之
也。以上二条,皆详风湿之义,以明风湿之治也。
【集注】
方有执曰:抟,掜聚也。言风与湿掜合抟聚,共为一家之病也。烦,风也。痛、湿也
。风淫则掣,湿淫则痛,风湿之邪注经络,流关节,渗骨髓,身体所以烦痛、掣痛而
不利也。近之则痛剧者,外邪客于内,迕之则逆也。短气者,汗多亡阳而气伤也。恶
风不欲去衣者,以重伤,故恶甚也,甘草益气和中,附子温经散湿,术能胜湿燥脾,
桂枝祛风固卫,此四物者,所以为风湿相抟之的药也。
吴人驹曰:必脉之沉而细者,若浮大而盛,则风多而湿少,附子须在审之。
附子(炮制,去皮,破开)三枚 白术四两 生姜(切片)三两 大枣(掰开)十二枚 甘草
(炙烤)二两
以上五味药,用水六升,煮取二升药液,去掉药渣,分三次温服。第一次服用后,患者身体感觉像麻木一样,约半天时间,再服用第二次,三次药全部服完后,患者出现像头昏目眩的样子,不要惊慌。这是因为附子、白术共同作用于皮肉之间,驱逐水湿之气尚未去除的缘故,所以会出现这种情况,按照法则应当加入桂枝四两。这原本是一个方剂两种用法,因为大便通畅、小便自利而去掉桂枝。如果大便不通畅、小便不利,就应当加入桂枝。附子用三枚,恐怕剂量偏大。体质虚弱的人及产妇,应当减少服用量。
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风邪与湿邪相互搏结,骨节疼痛烦扰,牵掣样疼痛不能屈伸,触碰则疼痛剧烈,出汗且气短,小便不利,怕风不想脱衣,或者身体轻微浮肿的,用甘草附子汤主治。
【注】
风邪与湿邪相互搏结,骨节疼痛烦扰,沉重得不能翻身转动,这是湿邪胜过风邪。牵掣样疼痛不能屈伸,这是风邪胜过湿邪。现在牵掣疼痛不能屈伸,触碰则疼痛剧烈,出汗、气短,怕风不想脱衣,都是风邪壅盛,损伤肌表的表现。小便不利,是湿邪内蓄的表现。身体轻微浮肿,是湿邪外迫肌表的表现。用甘草附子汤使其微微出汗,以祛风为主,除湿为辅。以上两条条文,都详细阐述了风湿病的含义,以阐明风湿病的治疗方法。
【集注】
方有执说:抟,意为捏聚。指风与湿邪捏合聚集,共同构成一种疾病。烦,指风邪。痛,指湿邪。风邪淫溢则导致掣痛,湿邪淫溢则导致疼痛,风湿之邪注入经络,流注关节,渗入骨髓,身体因此出现烦痛、掣痛以及活动不利。触碰则疼痛加剧,是因为外邪客居体内,违逆它就会导致病情加重。气短,是因为汗多亡阳而气受损。怕风不想脱衣,是因为重伤,所以恶风症状严重。甘草益气和中,附子温经散湿,白术能胜湿燥脾,桂枝祛风固卫,这四味药,就是治疗风湿相抟的药物。
吴人驹说:必须脉象沉而细的,如果脉象浮大而盛,则是风多湿少,使用附子必须审慎。
Radix Aconiti Lateralis Preparata (Prepared Lateral Root of Monkshood, peeled and broken) 3 pieces; Rhizoma Atractylodis Macrocephalae (Atractylodes Macrocephala Rhizome) 4 liang; Rhizoma Zingiberis Recens (Fresh Ginger Rhizome, sliced) 3 liang; Fructus Jujubae (Jujube Fruit, torn open) 12 pieces; Radix Glycyrrhizae Preparata (Prepared Licorice Root, honey-fried) 2 liang.
The above five herbs are boiled in six sheng of water to obtain two sheng of decoction. The dregs are removed, and the liquid is divided into three warm doses. After the first dose, the patient's body may feel numblike. After about half a day, the second dose is administered. When all three doses are consumed, the patient may experience a sensation similar to dizziness or confusion; do not be alarmed. This occurs because Radix Aconiti Lateralis Preparata (Prepared Lateral Root of Monkshood) and Rhizoma Atractylodis Macrocephalae (Atractylodes Macrocephala Rhizome) act together on the skin and flesh to expel pathogenic water-dampness that has not yet been eliminated. According to the method, Cinnamomi Ramulus (Cinnamon Twig) four liang should be added. This prescription originally had two variations: Cinnamomi Ramulus (Cinnamon Twig) is omitted when the stool is normal and urination is free; it should be added when the stool is difficult and urination is obstructed. Using three pieces of Radix Aconiti Lateralis Preparata (Prepared Lateral Root of Monkshood) may be excessive. Patients with weak constitutions and postpartum women should reduce the dosage.
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When Wind-Dampness (Wind-Damp Pathogen) interlocks, causing painful and vexatious joint pain, pulling pain preventing flexion and extension, severe pain upon touch, sweating with shortness of breath, obstructed urination, aversion to wind with reluctance to remove clothing, or slight bodily swelling, Gancao Fuzi Tang (Licorice and Prepared Monkshood Decoction) is the primary treatment.
[Annotation]
When Wind-Dampness (Wind-Damp Pathogen) interlocks, causing painful and vexatious joint pain and heaviness preventing turning over, this indicates Dampness exceeding Wind. Pulling pain preventing flexion and extension indicates Wind exceeding Dampness. Currently, the pulling pain prevents flexion and extension, and pain intensifies upon touch; sweating, shortness of breath, and aversion to wind with reluctance to remove clothing all indicate Exuberant Wind-Evil damaging the muscle and exterior. Obstructed urination indicates internal accumulation of Dampness. Slight bodily swelling indicates external pressure of Dampness. Gancao Fuzi Tang (Licorice and Prepared Monkshood Decoction) is used to induce mild sweating, primarily to dispel Wind and secondarily to eliminate Dampness. These two clauses detail the meaning of Wind-Dampness (Wind-Damp Pathogen) to clarify its treatment.
[Collected Annotations]
Fang Youzhi states: "Tuan" means kneading and gathering. It refers to Wind and Dampness combining and gathering to form a single disease entity. "Fan" (vexation) relates to Wind. "Tong" (pain) relates to Dampness. Exuberant Wind causes pulling pain; exuberant Dampness causes pain. The Wind-Damp pathogens penetrate the meridians and collaterals, flow into the joints, and seep into the bone marrow, causing the body to suffer from vexatious pain, pulling pain, and immobility. Pain intensifying upon touch occurs because external pathogens lodge internally; opposing them causes rebellion and worsening symptoms. Shortness of breath results from profuse sweating leading to Yang collapse and Qi injury. Aversion to wind with reluctance to remove clothing occurs due to severe injury, hence the intense aversion. Gancao Fuzi Tang (Licorice and Prepared Monkshood Decoction) uses Radix Glycyrrhizae (Licorice Root) to tonify Qi and harmonize the middle, Radix Aconiti Lateralis Preparata (Prepared Lateral Root of Monkshood) to warm the channels and dissipate Dampness, Rhizoma Atractylodis Macrocephalae (Atractylodes Macrocephala Rhizome) to overcome Dampness and dry the Spleen, and Cinnamomi Ramulus (Cinnamon Twig) to dispel Wind and secure the Wei. These four herbs constitute the specific medicine for Wind-Dampness (Wind-Damp Pathogen) interlocking.
Wu Renju states: One must examine if the pulse is deep and fine. If the pulse is floating, large, and vigorous, it indicates more Wind than Dampness, and the use of Radix Aconiti Lateralis Preparata (Prepared Lateral Root of Monkshood) requires careful consideration.