黄耆五两 芍药三两 桂枝三两
右三味,以苦酒一升,水七升相和,煮取三升,温服一升,当心烦,服至六七日乃解
。若心烦不止者,以苦酒阻故也。
【方解】
服后心烦者,以苦酒止汗太急也,盖汗出于心,急止之,则不得出,故心烦也。至六
、七日乃解者,正复而邪自退也。
【集解】
魏荔彤曰:古人称醋为苦酒,非另有所谓苦酒也。美酒醯,即人家所制社醋,即镇江
红醋是也。又醋之劣者,即白酒醋,各处皆是,总以社醋入药。
尤怡曰:苦酒阻者,欲行而未得遽行,久积药力乃自行耳。故曰:服至六、七日乃解
。
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黄汗之病,两胫自冷,假令发热,此属历节。食已汗出,又身常暮卧盗汗出者,此劳
气也。若汗出已,反发热者,久久其身必甲错,发热不止者,必生恶疮。若身重,汗
出已辄轻者,久久必身□,□即胸中痛,又从腰以上,必汗出,下无汗,腰髋弛痛,
如有物在皮中状,剧者不能食,身疼重,烦躁,小便不利,此为黄汗,桂枝加黄耆汤
主之。
【按】
此承黄汗详申其证也。但文义未属,必是错简,不释。
桂枝 芍药各二两 甘草二两 生姜三两 大枣十二枚 黄耆二两
右六味,以水八升,煮取三升,温服一升,须臾,饮热稀粥一升余,以助药力,温覆
取微汗,若不汗更服。
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寸口脉浮而迟,浮脉则热,迟脉则潜,热潜相搏,名曰沉。趺阳脉浮而数,浮脉即热
,数脉即止,热止相搏,名曰伏。沉伏相搏,名曰水。沉则络脉虚,伏则小便难,虚
难相搏,水走皮肤,即为水矣。
【按】
此条文义不属,不释。
@@@
寸口脉弦而紧,弦则卫气不行,即恶寒,水不沾流,走于肠间。
【按】
此条必有脱简,不释。
@@@
问曰:病者苦水,面目身体四肢皆肿,小便不利,脉之不言水,反言胸中痛,气上冲
咽,状如炙肉,当微欬喘,审如师言,其脉何类?师曰:寸口脉沉而紧,沉则为水,
紧则为寒,沉紧相搏,结在关元,始时当微,年盛不觉,阳衰之后,荣卫相干,阳损
阴盛,结寒微动,肾气上冲,咽喉塞噎,□下急痛。医以为流饮,而大下之,气击不
去,其病不除;后重吐之,胃家虚烦,咽燥欲饮水,小便不利,水谷不化,面目手足
浮肿,又与葶苈圆下水,当时如小差,食饮过度,肿复如前,胸□苦痛,状若奔豚,
其水扬溢,则浮欬喘逆。当先攻击冲气,令止,乃治欬,欬止其喘自差,先治新病,
病当在后。
【按】
此条文义不属,不释。
黄耆五两,芍药三两,桂枝三两。
以上三味药,用苦酒(醋)一升、水七升混合,煎煮至剩余三升,每次温服一升。服药后应当出现心烦的症状,服用六到七天后方可解除。如果心烦不止,是因为苦酒阻滞的缘故。
【方解】
服药后出现心烦,是因为苦酒止汗过于急迫所致。因为汗由心所主,若急于止汗,则汗液不得排出,故而心烦。经过六、七天才能解除,是因为正气恢复而邪气自然退去。
【集解】
魏荔彤说:古人称醋为苦酒,并非另外有所谓的苦酒。美酒醯,就是民间制作的社醋,也就是镇江红醋。又劣质的醋,即白酒醋,各地都有,总之以社醋入药。
尤怡说:所谓“苦酒阻”,是指药力想要运行却未能立即通行,积聚久了药力自然会自行运行。所以说,服用六、七天方可解除。
@@@
黄汗病,双小腿自然发冷;假如发热,这属于历节病。饭后出汗,且身体常在傍晚卧时盗汗的,这属于劳气病。如果出汗后反而发热,久而久之身体必然会出现肌肤甲错(皮肤干燥粗糙如鳞甲),发热不止的人,一定会生恶疮。如果身体沉重,出汗后随即感觉轻快,久而久之必然身体麻木不仁(原文缺字,据义补),麻木不仁即是胸中痛,并且从腰部以上必然出汗,腰部以下无汗,腰髋弛缓疼痛,好像有东西在皮中一样,病情严重的不能进食,身体疼痛沉重,烦躁,小便不利,这是黄汗病,用桂枝加黄耆汤主治。
【按】
此段承接黄汗详细申述其证候。但文义不通顺,必定是简册错乱,不予解释。
桂枝二两,芍药二两,甘草二两,生姜三两,大枣十二枚,黄耆二两。
以上六味药,用水八升,煎煮至剩余三升,每次温服一升。片刻之后,喝热稀粥一升多,以助药力,覆盖衣被使微微出汗。如果不出汗,再服用。
@@@
寸口脉浮而迟,浮脉代表热,迟脉代表潜藏,热与潜相互搏结,称为沉。趺阳脉浮而数,浮脉即热,数脉即止(此处指热势被遏制或脉象变化),热与止相互搏结,称为伏。沉与伏相互搏结,称为水病。沉则络脉虚,伏则小便难,虚与难相互搏结,水湿走窜于皮肤,即为水肿。
【按】
此条文义不通顺,不予解释。
@@@
寸口脉弦而紧,弦则卫气不行,所以恶寒,水液不循常道流注,走窜于肠间。
【按】
此条必定有脱简,不予解释。
@@@
问曰:病人痛苦于水饮,面目身体四肢都浮肿,小便不利,诊脉时不说水病,反而说胸中痛,气上冲咽喉,感觉像有烤肉梗在喉间,应当伴有轻微咳嗽气喘。确实像老师所说,他的脉象是什么样的?老师说:寸口脉沉而紧,沉则为水,紧则为寒,沉紧相互搏结,结聚在关元穴处。开始时症状轻微,年富力强时不觉察,阳气衰退之后,营卫相互干扰,阳损阴盛,结聚之寒微动,肾气上冲,咽喉堵塞噎塞,下颌下急痛。医生误认为是流饮(痰饮流动),而用峻下药攻下,气逆不去,病不消除;后来再次用催吐法,导致胃家虚烦,咽燥想喝水,小便不利,水谷不化,面目手足浮肿,又给予葶苈丸攻下水饮,当时稍微好转,饮食过度,肿胀又回到从前,胸膈苦痛,状如奔豚,水气扬溢,则出现浮肿、咳嗽、气喘、逆气。应当先攻击冲气,使其停止,然后再治咳嗽,咳嗽止了气喘自然好转,先治新病,旧病当在后处理。
【按】
此条文义不通顺,不予解释。
Huangqi (Radix Astragali) 5 liang, Shaoyao (Radix Paeoniae Rubra/Alba) 3 liang, Guizhi (Ramulus Cinnamomi) 3 liang.
The above three herbs are mixed with one sheng of Kujiu (Vinegar) and seven sheng of water, decocted until three sheng remain. Take one sheng warm. Heart vexation should occur after ingestion; it will resolve after six to seven days of administration. If heart vexation persists, it is due to the obstruction by Kujiu.
[Formula Analysis]
Heart vexation after taking the medicine occurs because Kujiu stops sweating too abruptly. Since sweat is governed by the Heart, stopping it abruptly prevents its discharge, causing heart vexation. It takes six or seven days to resolve because when the healthy qi recovers, the pathogenic factors retreat naturally.
[Collected Explanations]
Wei Litong said: The ancients called vinegar "Kujiu"; there is no other substance referred to as Kujiu. Fine wine vinegar, which is the she-cu made in households, is the same as Zhenjiang red vinegar. Inferior vinegar, such as Baijiu vinegar, is available everywhere, but she-cu is generally used for medicinal purposes.
You Yi said: What is meant by "obstruction by Kujiu" is that the drug's power desires to move but cannot immediately do so; only after accumulating over time does it move freely. Hence it is said that it resolves after six or seven days of administration.
@@@
In the disease of Huanghan (Yellow Sweat), the calves are naturally cold. If fever occurs, this belongs to Lijie (Periarthritis). Sweating after eating, along with spontaneous night sweats while lying down in the evening, indicates Laoqi (Consumptive Qi disorder). If fever occurs after sweating, the skin will eventually become scaly and rough like fish scales (Jiacuo); if fever persists, malignant sores will definitely develop. If the body feels heavy and becomes lighter after sweating, eventually the body will become numb (text missing, inferred as Ma Mu). Numbness implies chest pain. There will be sweating from above the waist but no sweating below the waist, with flaccid pain in the loins and hips, feeling as if something is under the skin. In severe cases, there is inability to eat, body pain and heaviness, irritability, and difficult urination. This is Huanghan (Yellow Sweat), treated primarily with Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus).
[Commentary]
This passage elaborates on the symptoms of Huanghan. However, the textual coherence is lacking, indicating likely bamboo slip disarray; therefore, it is not explained.
Guizhi (Ramulus Cinnamomi) 2 liang, Shaoyao (Radix Paeoniae Rubra/Alba) 2 liang, Gancao (Radix Glycyrrhizae) 2 liang, Shengjiang (Rhizoma Zingiberis Recens) 3 liang, Dazao (Fructus Jujubae) 12 pieces, Huangqi (Radix Astragali) 2 liang.
The above six herbs are decocted in eight sheng of water until three sheng remain. Take one sheng warm. Shortly after, drink more than one sheng of hot thin porridge to assist the medicinal power. Cover warmly to induce slight sweating. If sweating does not occur, administer again.
@@@
The Cun Kou (Radial artery at the wrist) pulse is floating and slow. A floating pulse indicates heat; a slow pulse indicates潛藏 (submergence/retention). The interaction of heat and submergence is named Chen (Sinking). The Zu Yang (Dorsalis pedis artery) pulse is floating and rapid. A floating pulse indicates heat; a rapid pulse indicates restriction/stopping. The interaction of heat and restriction is named Fu (Hidden). The interaction of Sinking and Hidden is named Shui (Water/Edition). Sinking implies deficiency in the collaterals; Hidden implies difficulty in urination. The interaction of deficiency and difficulty causes water to flow into the skin, resulting in edema.
[Commentary]
The textual meaning here is incoherent; therefore, it is not explained.
@@@
The Cun Kou pulse is wiry and tight. Wiry indicates that Wei Qi (Defensive Qi) does not circulate, leading to aversion to cold. Water fails to follow its normal channels and flows into the intestines.
[Commentary]
This passage must have missing slips; therefore, it is not explained.
@@@
Question: A patient suffers from water retention, with swelling of the face, eyes, body, and limbs, and difficult urination. Upon palpation, instead of mentioning water disease, the patient complains of chest pain, Qi rushing up to the throat, feeling as if a piece of roasted meat is stuck, accompanied by slight cough and wheezing. If this matches what the Master said, what kind of pulse would it be?
Master said: The Cun Kou pulse is sinking and tight. Sinking indicates water; tight indicates cold. The interaction of sinking and tight binds at the Guan Yuan point. Initially, it was mild, unnoticed in youth. After the decline of Yang, Ying and Wei interfere with each other. Yang is damaged and Yin becomes excessive. The bound cold moves slightly, and Kidney Qi rushes upward, causing throat blockage and pain below the chin. Physicians mistook it for Liu Yin (flowing phlegm-fluids) and used harsh purgatives. The rebellious Qi did not cease, and the disease remained. Later, emetics were used again, causing stomach deficiency and vexation, dry throat with desire for water, difficult urination, indigestion, and swelling of the face, eyes, hands, and feet. Then Tingli Wan (Descurainiae Semen/Papaveris Fructus Pill) was given to drain water. The condition improved slightly at first, but after overeating, the swelling returned. There was bitter pain in the chest/diaphragm, resembling Ben Tun (Running Piglet). The overflowing water caused floating, cough, wheezing, and counterflow Qi. One should first attack the rebellious Qi to stop it, then treat the cough. Once the cough stops, the wheezing will improve naturally. Treat the new disease first; the old disease will follow later.
[Commentary]
The textual meaning here is incoherent; therefore, it is not explained.