干姜(一两味辛热) 附子(一枚生用去皮破八片味辛热)
上二味。以水三升。煮取一升。去滓、顿服。
内经曰。寒淫所胜。平以辛热。虚寒大甚。是以辛热剂胜之也。
王海藏云。服姜附汤有二法。当热服。手少阴心也。水包火。热服以接心火。身表
寒盛。外火少也。寒从外生。热从内消。譬如冻死。寒在外也。一法当寒服。足少阴肾也。
寒邪入水。冷服以类肾水。身表微热。内水多也。热从外生。寒从内消。譬如饮冷。寒
在内也。
发汗后。身疼痛。脉沉迟者。桂枝加芍药生姜各一两。人参三两。新加汤主之。
汗后身疼痛。邪气未尽也。脉沉迟。荣血不足也。经曰。其脉沉者。荣气微也。又曰。
迟者荣气不足。血少故也。与桂枝汤。以解未尽之邪。加芍药、生姜、人参。以益不
足之血。
张兼善云。或谓经言表邪盛。脉浮而紧。法当身疼痛。宜以汗解之。况身疼皆系表
邪未尽。此又加人参、芍药、生姜、以益血。何也。余曰。表邪盛则身疼。血虚则身亦
疼。其脉浮紧者。邪盛也。其脉沉微者。血虚也。盛者损之则安。虚者益之则愈。
发汗后。不可更行桂枝汤。汗出而喘。无大热者。可与麻黄、杏仁、甘草、石膏、汤主之。
汗出而喘。身无大热。则所留之邪。止在上焦肺部。故用麻黄杏仁以散胸中之邪。甘草
石膏以助西方之令。
发汗后喘。当作桂枝加浓朴杏仁汤。汗出则喘愈。今汗出而喘。为邪气壅甚。桂枝
汤不能发散。故不可更行桂枝汤。汗出而喘有大热者。内热气甚也。无大热者。表邪必
甚也。与麻黄杏仁甘草石膏汤。以散其邪。
干姜(一两,味辛性热) 附子(一枚,生用,去皮,破成八片,味辛性热)
以上两味药。用水三升。煮取一升药液。去渣滓,一次性服下。
《内经》说:寒邪过盛时,用辛热之品来平抑它。虚寒极重,所以用辛热剂来克制它。
王海藏说:服用姜附汤有两种方法。应当热服。这是针对手少阴心经。水包火,热服可以接续心火。身体表面寒盛,外部的火气少。寒从外部产生,热从内部消散。就像冻死的人,寒气在外部。另一种方法是应当冷服。这是针对足少阴肾经。寒邪进入水中,冷服以类比肾水。身体表面微热,内部的水多。热从外部产生,寒从内部消散。就像喝冷饮,寒气在内部。
发汗后,身体疼痛,脉象沉迟的,用桂枝加芍药生姜各一两、人参三两的新加汤主治。
发汗后身体疼痛,是邪气未尽。脉象沉迟,是营血不足。经文说:脉象沉的,是营气微弱。又说:脉迟的是营气不足,因为血少。给予桂枝汤,以解除未尽的邪气;加入芍药、生姜、人参,以补益不足的血液。
张兼善说:有人问经文说表邪盛,脉浮而紧,法度上应当身体疼痛,适宜用发汗法解除。况且身体疼痛都关联表邪未尽,这里又加入人参、芍药、生姜,以补益血液,为什么呢?我说:表邪盛则身体疼,血虚则身体也疼。脉象浮紧的,是邪气盛。脉象沉微的,是血虚。盛的,损伤它就能安宁;虚的,补益它就能痊愈。
发汗后,不可再用桂枝汤。汗出且气喘,没有大热的,可以用麻黄、杏仁、甘草、石膏汤主治。
汗出且气喘,身体没有大热,那么残留的邪气,只在上焦肺部。所以用麻黄、杏仁来疏散胸中的邪气,用甘草、石膏来辅助西方(肺金)的令行。
发汗后气喘,应当用桂枝加厚朴杏子汤。汗出则气喘痊愈。现在汗出且气喘,是因为邪气壅盛,桂枝汤不能发散,所以不可再用桂枝汤。汗出且气喘有大热的,是内热气盛。没有大热的,是表邪必甚。给予麻黄杏仁甘草石膏汤,以疏散其邪气。
Dried Ginger and Aconite Decoction Formula (Ganjiang Fuzi Tang)
Dried Ginger (one tael, pungent and hot in nature) Raw Aconite Root (one piece, used raw, skin removed, broken into eight pieces, pungent and hot in nature)
The above two ingredients. With three sheng of water. Boil to obtain one sheng of decoction. Remove the dregs, take in one dose.
The *Neijing* states: When cold pathogen prevails excessively, use pungent and hot substances to level it. When deficiency-cold is extremely severe, therefore pungent and hot agents are used to overcome it.
Wang Haicang said: There are two methods for taking Jiangfu Tang. It should be taken hot. This relates to the Hand-Shaoyin Heart meridian. Water envelops fire; taking it hot connects with Heart Fire. The body surface has excessive cold, external fire is scant. Cold arises from outside, heat dissipates from inside. Like freezing to death, cold is on the outside. Another method is to take it cold. This relates to the Foot-Shaoyin Kidney meridian. Cold pathogen enters water; taking it cold mimics Kidney Water. The body surface has slight heat, internal water is abundant. Heat arises from outside, cold dissipates from inside. Like drinking cold liquids, cold is on the inside.
After sweating therapy, if there is body pain and a deep, slow pulse, Xinjia Tang (Newly Added Decoction), composed of Guizhi Tang (Cinnamon Twig Decoction) with additional one tael each of Shaoyao (Peony Root) and Shengjiang (Fresh Ginger), and three taels of Renshen (Ginseng Radix et Rhizoma), is the primary treatment.
Body pain after sweating indicates that pathogenic factors are not yet exhausted. A deep, slow pulse indicates insufficiency of Ying Blood (Nutritive Blood). The classics state: "A deep pulse indicates weak Ying Qi." Also: "A slow pulse indicates insufficient Ying Qi, due to blood deficiency." Administer Guizhi Tang (Cinnamon Twig Decoction) to resolve the remaining pathogens; add Shaoyao (Peony Root), Shengjiang (Fresh Ginger), and Renshen (Ginseng Radix et Rhizoma) to replenish the deficient blood.
Zhang Jianshan said: Some ask that the classics state when exterior pathogens are abundant, the pulse is floating and tight, and the method dictates body pain, suitable for resolution via sweating. Moreover, since body pain is associated with unexhausted exterior pathogens, why add Renshen (Ginseng Radix et Rhizoma), Shaoyao (Peony Root), and Shengjiang (Fresh Ginger) to nourish blood? I reply: Abundant exterior pathogens cause body pain; blood deficiency also causes body pain. A floating, tight pulse indicates pathogen abundance. A deep, faint pulse indicates blood deficiency. For abundance, reducing it brings peace; for deficiency, tonifying it brings recovery.
After sweating therapy, do not administer Guizhi Tang (Cinnamon Twig Decoction) again. If there is sweating and wheezing without significant heat, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) may be administered as the primary treatment.
Sweating with wheezing and no significant heat in the body indicates that the lingering pathogen is confined to the Upper Jiao Lung organ. Therefore, Mahuang (Ephedrae Herba) and Xingren (Armeniacae Semen Amarum) are used to disperse pathogens in the chest, while Gancao (Glycyrrhizae Radix et Rhizoma) and Shigao (Gypsum Fibrosum) assist the function of the Metal element (Lung).
Wheezing after sweating should be treated with Guizhi Jia Houpo Xingren Tang (Guizhi Tang Plus Magnolia Bark and Apricot Seed Decoction). Sweating resolves the wheezing. Now, sweating with wheezing indicates severe pathogenic congestion; Guizhi Tang (Cinnamon Twig Decoction) cannot disperse it, so it must not be used again. Sweating with wheezing and significant heat indicates excessive internal heat qi. Sweating with wheezing and no significant heat indicates that exterior pathogens are certainly severe. Administer Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) to disperse the pathogens.