半夏(半升洗净辛平) 黄芩(苦寒) 干姜(辛热) 人参(以上各三两甘温)
黄连(一两苦寒) 大枣(十二枚擘温甘) 甘草(三两炙甘平)
上七味。以水一斗。煮取六升。去滓。再煮。取三升。温服一升。日三服。
辛入肺而散气。半夏之辛。以散结气。苦入心而泄热。黄芩黄连之苦。以泻痞热。
脾欲缓。急食甘以缓之。人参甘草大枣之甘以缓之。
太阳少阳并病。而反下之。成结胸。心下硬。下利不止。水浆不下。其人心烦。
太阳少阳并病。为邪气在半表半里也。而反下之。二经之邪。乘虚而入太阳。表邪
入里结于胸中为结胸。心下硬。少阳里邪。乘虚下于肠胃。遂利不止。若邪结阴分。则
饮食如故。而为脏结。此为阳邪内结。故水浆不下而心烦。
脉浮而紧。而复下之。紧反入里。则作痞。按之自濡。但气痞耳。
浮而紧。浮为伤阳。紧为伤阴。当发其汗而反下之。若浮入里。为阳邪入里。则作结
胸。浮不入里。而紧入里者。阴邪入里。则作痞。
太阳中风。下利。呕逆表解者。乃可攻之。其人 汗出。发作有时头痛。心下痞。
硬
满。引胁下痛。干呕短气。汗出。不恶寒者。此表解里未和也。十枣汤主之。
下利呕逆。里受邪也。邪在里者可下。亦须待表解者。乃可攻之。其人 汗出。
发作有时。不恶寒者。表已解也。头痛心下痞。硬满引胁下痛。干呕。短气者。邪热内
蓄而有伏饮。是里未和也。与十枣汤。下热逐饮。
半夏(半升,洗净,性味辛平) 黄芩(苦寒) 干姜(辛热) 人参(以上各三两,甘温)
黄连(一两,苦寒) 大枣(十二枚,掰开,性温甘) 甘草(三两,蜜炙,性甘平)
以上七味药。用水一斗。煎煮至六升。滤去药渣。再次煎煮。取三升药液。每次温服一升。每日服用三次。
辛味入肺而能发散气机。半夏的辛味,用来消散结聚之气。苦味入心而能泄热。黄芩、黄连的苦味,用来泻除痞塞之热。
脾脏喜好缓和。紧急时用甘味食物来缓和它。人参、甘草、大枣的甘味,用来缓和脾急。
太阳病与少阳病同时存在(并病),反而使用攻下法。导致形成结胸证。心下部坚硬。腹泻不止。水浆无法入口。病人心中烦躁。
太阳病与少阳病同时存在,是因为邪气在半表半里之间。反而使用攻下法。两经的邪气,乘虚而入太阳经。表邪进入体内,结聚于胸中,形成结胸证,表现为心下部坚硬。少阳里的邪气,乘虚下行至肠胃,于是导致腹泻不止。如果邪气结聚在阴分,则饮食如常,而形成脏结证。这是阳邪内结,所以水浆不能入口且心中烦躁。
脉象浮而紧,又反而使用攻下法。紧脉反转入里,则形成痞证。触摸时感觉柔软,只是气机痞塞而已。
浮脉和紧脉,浮脉代表伤阳,紧脉代表伤阴。应当发汗却反而使用攻下法。如果浮脉所代表的邪气入里,为阳邪入里,则形成结胸证。如果浮脉所代表的邪气不入里,而紧脉所代表的邪气入里,为阴邪入里,则形成痞证。
太阳中风证,伴有腹泻、呕吐逆乱。表证解除后,才可以攻逐里实。病人出汗。发作有定时。头痛。心下部痞塞。坚硬胀满。牵引胁下疼痛。干呕。呼吸短促。出汗。不恶寒。这是表证已解,但里气未和。用十枣汤主治。
腹泻、呕吐逆乱,是里部受邪。邪气在里者可以攻下。但也必须等待表证解除后,才可以攻逐。病人出汗。发作有定时。不恶寒,说明表证已解。头痛、心下部痞塞、坚硬胀满、牵引胁下疼痛、干呕、呼吸短促,是邪热内蓄且有伏留的水饮。这是里气未和。给予十枣汤。以泻热逐饮。
Banxia (Pinelliae Rhizoma, half sheng, washed; acrid and neutral) Huangqin (Scutellariae Radix; bitter and cold) Ganjiang (Zingiberis Rhizoma; acrid and hot) Renshen (Ginseng Radix et Rhizoma; above three each san liang; sweet and warm)
Huanglian (Coptidis Rhizoma; one liang; bitter and cold) Dazao (Jujubae Fructus; twelve pieces, split; warm and sweet) Gancao (Glycyrrhizae Radix et Rhizoma; san liang, honey-fried; sweet and neutral)
The above seven herbs. Use ten dou of water. Boil to obtain six sheng. Remove the dregs. Boil again. Obtain three sheng. Take one sheng warm. Three times daily.
Acrid substances enter the Lung and disperse qi. The acridity of Banxia disperses knotted qi. Bitter substances enter the Heart and drain heat. The bitterness of Huangqin and Huanglian drains the heat of pi syndrome (epigastric fullness and stuffiness).
The Spleen desires relaxation. In urgency, eat sweet substances to relax it. The sweetness of Renshen, Gancao, and Dazao relaxes it.
Taiyang and Shaoyang Bingbing (concurrent disease of Taiyang and Shaoyang channels), yet contrary to indications, purgation was used. This resulted in Jie Xiong (chest binding syndrome). The epigastrium is hard. Diarrhea continues incessantly. Food and drink cannot be taken. The patient is vexed.
Taiyang and Shaoyang Bingbing indicates pathogenic factors are at the half-exterior and half-interior. Yet contrary to indications, purgation was used. The pathogens of both channels entered the Taiyang channel by taking advantage of the deficiency. Exterior pathogens entered the interior and knotted in the chest, forming Jie Xiong, with hardness in the epigastrium. Interior pathogens of Shaoyang descended into the intestines and stomach by taking advantage of the deficiency, leading to incessant diarrhea. If pathogens knot in the Yin aspect, diet remains normal, forming Zang Jie (zang binding syndrome). This is Yang pathogens knotting internally, hence inability to take food/drink and mental vexation.
Pulse is floating and tight. Yet contrary to indications, purgation was used. The tightness reverses and enters the interior, forming Pi syndrome (stagnation syndrome). Palpation reveals softness; it is merely Qi stagnation.
Floating and tight: floating indicates injury to Yang, tight indicates injury to Yin. Sweating should have been induced, but purgation was used contrary to indications. If the floating (Yang pathogen) enters the interior, Yang pathogens entering the interior form Jie Xiong. If the floating does not enter the interior, but the tight (Yin pathogen) enters the interior, Yin pathogens entering the interior form Pi syndrome.
Taiyang Wind Strike syndrome, with diarrhea and vomiting/reversal. Only after the exterior syndrome resolves can attack (purgation) be used. The patient sweats. Episodes occur at fixed times. Headache. Epigastric pi and hardness/fullness. Pain radiating to the hypochondrium. Dry retching. Shortness of breath. Sweating. No aversion to cold. This indicates the exterior has resolved but the interior is not harmonized. Shizao Tang (Ten Date Decoction) is indicated.
Diarrhea and vomiting/reversal indicate the interior is affected by pathogens. Pathogens in the interior may be purged. However, one must wait for the exterior to resolve before attacking. The patient sweats. Episodes occur at fixed times. No aversion to cold indicates the exterior has resolved. Headache, epigastric pi, hardness/fullness, pain radiating to the hypochondrium, dry retching, and shortness of breath indicate internal accumulation of pathogenic heat and latent fluid retention. This means the interior is not harmonized. Administer Shizao Tang to purge heat and drive out fluid retention.