黄 建中汤(见第二十一)
仲景小青龙汤(见第十六)
仲景炙甘草汤 《伤寒论》云∶伤寒脉结代,心动悸,炙甘草汤主之。
甘草(炙,四两) 生姜(切,三两) 桂枝(去皮,三两) 人参(二两) 生地黄(一斤)
阿胶(二两) 麦门冬(去心,半升) 麻子仁(半升) 大枣(擘,十二枚)
上九味,以清酒七升,水八升,先煮八味,取三升。去滓,内胶烊消尽。温服
一升,日三服。一名复脉汤。《圣济经》曰∶津耗散为枯。五脏痿弱,营卫涸流,
湿剂所以润之。麻仁、阿胶、麦门冬、地黄之甘,润经益血,复脉通心也。
脉之主病,有宜不宜。阴阳顺逆,吉凶可推。
有是病,则有是脉,如影之随形也。与病相宜则顺,不相宜则逆。逆之与顺,何从
区别,是又在阴阳耳。如表病见表脉、里病见里脉、实病见实脉、虚病见虚脉、阳病见阳
脉、阴病见阴脉之类,皆顺而相宜者也。反此则逆。逆顺一分,而病之吉凶,从可推矣。
中风浮缓,急实则忌。浮滑中痰,沉迟中气。
尸厥沉滑,卒不知人。入脏身冷,入腑身温。
风性空疏,中之于表,浮缓是其宜也。(宜千金小续命汤,轻则仲景桂枝汤加减用之。)急强而
实,略无柔和,邪气太甚,正气何堪?故忌。若浮而滑,带有物象,非浮缓比,此
则中痰之如中风者。(宜二陈汤、防风、竹沥、生姜之类。甚则探吐。)若沉而迟,则不在表而在里,
亦非中风,名曰中风,七情之所为也。(宜和剂四七汤、易简星香汤、苏合香丸之类。)尸厥亦类中
风,卒然僵仆,昏不知人。其脉沉滑者,沉为里,滑为邪。邪入于里,与血气相并。
邪入正虚,搏入脏腑。入脏则邪干神舍,气陷从阴,故身冷。脏不受邪,仅入于腑,
气出从阳,故身温。即《金匮要略》所谓唇口青,身冷,为入脏即死;如身和汗自
出,为入腑即愈者是也。(宜苏合香丸、仲景备急丸、本事胜金丸、千金返魂汤之类,并万氏灸百会法。)
黄耆建中汤(见第二十一)
张仲景的小青龙汤(见第十六)
张仲景的炙甘草汤 《伤寒论》说:伤寒病出现脉象结代、心中悸动不安,用炙甘草汤主治。
甘草(蜜炙,四两) 生姜(切片,三两) 桂枝(去皮,三两) 人参(二两) 生地黄(一斤)
阿胶(二两) 麦门冬(去心,半升) 麻子仁(半升) 大枣(掰开,十二枚)
以上九味药,用清酒七升、水八升,先煎煮前八味药,取汁三升。滤去药渣,加入阿胶加热使其完全溶化。每次温服一升,每日服用三次。又名复脉汤。《圣济经》说:津液耗散导致干枯。五脏痿弱,营卫之气枯竭流动停滞,需要用湿剂(滋润之剂)来润泽它。麻仁、阿胶、麦门冬、地黄的甘味,能润泽经脉、补益血液,恢复脉象、通利心气。
脉象所主疾病,有适宜与不适宜之分。阴阳顺逆,可以推断吉凶。
有病证,就有相应的脉象,就像影子跟随形体一样。脉象与病证相适宜就是“顺”,不相适宜就是“逆”。如何区别逆与顺?这又在于阴阳。例如表病见到表脉、里病见到里脉、实证见到实脉、虚证见到虚脉、阳病见到阳脉、阴病见到阴脉等情况,都属于顺而相宜的。与此相反的就是逆。逆与顺这一区分,疾病的吉凶就可以推断了。
中风病见浮缓脉是适宜的,急强实脉则忌讳。浮滑脉多见于中痰,沉迟脉多见于中气。
尸厥病见沉滑脉,突然昏迷不知人事。邪入脏则身体寒冷,邪入腑则身体温暖。
风性空疏,侵犯体表,浮缓脉是其适宜的脉象。(适宜使用千金小续命汤,轻症则使用张仲景桂枝汤加减应用。)如果脉象急强而实,完全没有柔和之象,说明邪气太盛,正气怎能承受?所以忌讳。如果脉浮而滑,带有物象特征,不同于浮缓脉,这是中痰类似中风的情况。(适宜使用二陈汤、防风、竹沥、生姜之类。严重时采用探吐法。)如果脉沉而迟,则病不在表而在里,也不是真正的中风,名为中风,是由七情(喜、怒、忧、思、悲、恐、惊)引起的。(适宜使用和剂局方四七汤、易简星香汤、苏合香丸之类。)尸厥也类似中风,突然僵倒昏仆,昏迷不知人事。其脉象沉滑的,沉主里,滑主邪。邪气入里,与血气相搏结。邪气侵入正气虚弱之处,搏入脏腑。邪入脏则干扰神志居所,气陷从阴,所以身体寒冷。若脏不受邪,仅入于腑,气出从阳,所以身体温暖。这就是《金匮要略》所说的嘴唇口角发青、身体寒冷,为邪入脏即死;如果身体温和、汗自出,为邪入腑即愈的情况。(适宜使用苏合香丸、张仲景备急丸、本事胜金丸、千金返魂汤之类,以及万全灸百会穴的方法。)
Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) (See Chapter 21)
Zhang Zhongjing's Xiao Qinglong Tang (Minor Blue Dragon Decoction) (See Chapter 16)
Zhang Zhongjing's Zhigancao Tang (Roasted Licorice Decoction) The *Shanghan Lun* (Treatise on Cold Damage Disorders) states: In cold damage disorders, if the pulse is knotted and intermittent (Jiedai Mai), accompanied by palpitations of the heart, Zhigancao Tang should be administered.
Gancao (Licorizia Radix et Rhizoma Praeparata cum Melle, four liang) Shengjiang (Zingiberis Rhizoma Recens, sliced, three liang) Guizhi (Cinnamomi Ramulus, bark removed, three liang) Renshen (Ginseng Radix, two liang) Shengdihuang (Rehmanniae Radix, one jin)
Ejiao (Asini Corii Colla, two liang) Maimendong (Ophiopogonis Radix, core removed, half sheng) Maziren (Cannabis Semen, half sheng) Dazao (Ziziphi Jujubae Fructus, broken open, twelve pieces)
The above nine ingredients are decocted with seven sheng of clear wine and eight sheng of water. First, boil the first eight ingredients to obtain three sheng of liquid. Strain out the dregs, add Ejiao, and heat until completely dissolved. Take one sheng warm, three times a day. Also known as Fumai Tang (Pulse-Restoring Decoction). The *Shengji Jing* (Classic of Holy Healing) states: When body fluids are consumed and scattered, dryness ensues. With atrophy and weakness of the five zang organs, and depletion and stagnation of Ying (Nutritive) and Wei (Defensive) qi, moistening agents (Shi Ji) are used to lubricate. The sweetness of Maziren, Ejiao, Maimendong, and Dihuang nourishes the meridians, benefits blood, restores the pulse, and unblocks the heart.
The pulse indicates diseases, having both suitable and unsuitable presentations. Through the smoothness or reversal of Yin and Yang, auspiciousness or inauspiciousness can be deduced.
Where there is a disease pattern, there is a corresponding pulse, just as a shadow follows the form. If the pulse suits the disease, it is "Shun" (Smooth/Favorable); if not, it is "Ni" (Reversed/Unfavorable). How to distinguish between Ni and Shun? This lies again in Yin and Yang. For example, exterior patterns presenting with exterior pulses, interior patterns with interior pulses, excess patterns with excess pulses, deficiency patterns with deficiency pulses, Yang patterns with Yang pulses, and Yin patterns with Yin pulses are all considered Shun and suitable. The opposite constitutes Ni. Once this distinction between Ni and Shun is made, the prognosis of the disease can be deduced.
In Wind-Stroke (Zhongfeng), floating and moderate pulses are favorable; rapid, forceful, and full pulses are contraindicated. Floating and slippery pulses indicate Phlegm-Stroke; deep and slow pulses indicate Qi-Stroke.
In Corpse-like Coma (Shijue), the pulse is deep and slippery, with sudden loss of consciousness. If pathogens enter the Zang organs, the body becomes cold; if they enter the Fu organs, the body remains warm.
Wind has an empty and loose nature; when it attacks the exterior, a floating and moderate pulse is appropriate. (Qianjin Xiaoxuming Tang from *Qianjin Fang* is suitable; for mild cases, Zhang Zhongjing's Guizhi Tang modified may be used.) If the pulse is rapid, forceful, and full, lacking any softness, the pathogenic factor is too severe, and how can the healthy Qi endure? Hence, it is contraindicated. If the pulse is floating and slippery, carrying a tangible quality, it differs from the floating-moderate type; this indicates Phlegm-Stroke resembling Wind-Stroke. (Erchen Tang, Fangfeng, Zhuli, and Shengjiang are suitable. In severe cases, emesis-inducing methods may be used.) If the pulse is deep and slow, the pathology is interior rather than exterior, and it is not true Wind-Stroke but named so due to being caused by the Seven Emotions. (Siji Tang from *Heji Juzheng Fang*, Yijian Xingxiang Tang, and Suhexiang Wan are suitable.) Shijue also resembles Wind-Stroke, characterized by sudden collapse and unconsciousness. A deep and slippery pulse indicates that deep signifies interior and slippery signifies pathogen. The pathogen enters the interior, merging with Blood and Qi. Entering where Healthy Qi is deficient, it clashes with the Zang-Fu organs. Entering the Zang organs disrupts the residence of the Spirit, causing Qi to sink via Yin, resulting in a cold body. If the Zang organs do not receive the pathogen and it only enters the Fu organs, Qi exits via Yang, resulting in a warm body. This corresponds to what is stated in *Jinkui Yaolue*: blue lips and mouth with a cold body indicate entry into the Zang organs, which is fatal; a harmonious body with spontaneous sweating indicates entry into the Fu organs, which leads to recovery. (Suhexiang Wan, Zhang Zhongjing's Beiji Wan, Benshi Shengjin Wan, Qianjin Hunhun Tang, and Wan Quan's moxibustion method for Baihui [DU20] are suitable.)