麻黄(三两去节味甘温) 桂枝(二两去皮味辛热) 甘草(一两炙味甘平)
杏仁(七十个汤炮去皮尖味辛温)
上四味。以水九升。先煮麻黄。减二升。去上沫内诸药。煮取二升半。去滓。温服
八合。覆取微似汗。不须啜粥。余如桂枝法将息。
内经曰。寒淫于内。治以甘热。佐以苦辛。麻黄甘草。开肌发汗。桂枝杏仁。散寒
下气。
太阳与阳明合病。喘而胸满者。不可下。宜麻黄汤主之。
阳受气于胸中。喘而胸满者。阳气不宣发。壅而逆也。心下满。腹满。皆为实。当
下之。此以为胸满。非里实。故不可下。虽有阳明。然与太阳合病。为属表。是与麻黄
汤发汗。
太阳病。十日以去。脉浮细而嗜卧者。外已解也。设胸满胁痛者。与小柴胡汤。脉
但浮者。与麻黄汤。
十日以去。向解之时也。脉浮细而嗜卧者。表邪已罢也。病虽已和解之。若脉但浮
而不细者。则邪气但在表也。与麻黄汤发散之。
太阳中风。脉浮紧。发热、恶寒。身疼痛不汗出而烦躁者。大青龙汤主之。若脉微
弱。
汗出、恶风者。不可服。服之、则厥逆、筋惕、肉 、此为逆也。
此中风见寒脉也。浮则为风。风则伤卫。紧则为寒。寒则伤荣。荣卫俱病。故发热、
恶寒。身疼痛也。风并于卫者。为荣弱卫强。寒并于荣者。为荣强卫弱。今风寒两伤则荣卫
俱实。故不汗出而烦躁也。与大青龙汤发汗。以除荣卫风寒。若脉微弱汗出恶风者。为
荣卫俱虚。反服青龙汤。则必亡阳。或生厥逆、筋惕、肉 。此治之逆也。
麻黄(三两,去节,味甘、性温) 桂枝(二两,去皮,味辛、性热) 甘草(一两,炙用,味甘、性平)
杏仁(七十枚,汤浸后炮制,去皮尖,味辛、性温)
以上四味药。用水九升。先煮麻黄,水量减少二升,撇去水面上的浮沫,然后加入其余药物。继续煎煮至取药液二升半,滤去药渣。每次温服八合。服药后覆盖衣被以取得微微似有汗出的效果。不需要喝热粥来助药力。其余调养方法参照桂枝汤的法度进行。
《内经》说:寒邪内侵,治疗应用甘热之品为主,辅以苦辛之品。麻黄和甘草,能开泄肌表、发汗解表;桂枝和杏仁,能散寒降气。
太阳经与阳明经同时发病,出现气喘且胸部胀满的,不可使用攻下法。适宜用麻黄汤主治。
阳气在胸中受纳宣发。气喘且胸部胀满,是阳气不能宣发,郁滞而上逆所致。心下部胀满、腹部胀满,都属于里实证,应当使用攻下法。此处所说的胸满,并非里实,所以不可攻下。虽然涉及阳明病,但因为是太阳与阳明合病,属于表证。因此用麻黄汤发汗解表。
太阳病,经过十天后,脉象浮而细弱,且病人喜欢躺卧休息的,说明表邪已经解除。如果此时出现胸部胀满、胁肋疼痛的,给予小柴胡汤。如果脉象仅仅表现为浮象的,给予麻黄汤。
十天以后,是病情趋向痊愈的时候。脉象浮细且嗜睡,说明表邪已罢。病势虽然已有和解之机,但如果脉象仅浮而不细,则说明邪气仍在体表。给予麻黄汤发散表邪。
太阳中风证,若见脉浮紧,发热、恶寒,身体疼痛且无汗并伴有烦躁的,用大青龙汤主治。如果脉象微弱,
有汗出、怕风的,不可服用大青龙汤。如果误服,则会出现四肢厥冷、筋脉跳动、肌肉瞤动,这是治疗错误导致的变证。
这是中风证却出现了寒邪致病的脉象。脉浮表示风邪,风邪伤及卫气;脉紧表示寒邪,寒邪伤及营血。营气和卫气都受到侵害,所以出现发热、恶寒、身体疼痛。风邪偏盛于卫分,导致营弱卫强;寒邪偏盛于营分,导致营强卫弱。如今风寒两邪共同伤人,导致营卫俱实,所以无汗且烦躁。给予大青龙汤发汗,以祛除营卫中的风寒邪气。如果脉象微弱、汗出、怕风,说明营卫俱虚,反而服用青龙汤,则必然导致亡阳,或者产生四肢厥冷、筋脉跳动、肌肉瞤动。这是治疗方法的逆乱。
Ephedrae Herba (Mahuang, 麻黄) [3 liang, nodes removed, sweet flavor, warm nature]
Cinnamomi Ramulus (Guizhi, 桂枝) [2 liang, bark removed, pungent flavor, hot nature]
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [1 liang, honey-fried, sweet flavor, neutral nature]
Pruni Semen (Xingren, 杏仁) [70 seeds, blanched and processed, skin and tips removed, pungent flavor, warm nature]
The above four ingredients. Use nine sheng of water. First decoct Ephedrae Herba, reducing the volume by two sheng, remove the foam on the surface, then add the remaining herbs. Decoct until two and a half sheng remains, filter out the dregs. Take eight he of the liquid warm. Cover with blankets to induce a slight sweating. There is no need to drink hot porridge. Rest and care should follow the regimen of Guizhi Tang (Cinnamon Twig Decoction).
The *Neijing* states: When cold invades internally, treat with sweet-hot substances, assisted by bitter-pungent substances. Ephedrae Herba and Glycyrrhizae Radix open the muscle layer and induce sweating; Cinnamomi Ramulus and Pruni Semen disperse cold and direct qi downward.
When Taiyang (Sun Yang) disease combines with Yangming disease, presenting with wheezing and chest fullness, purgation is contraindicated. Mahuang Tang (Ephedra Decoction) is indicated.
Yang qi receives its source in the chest. Wheezing with chest fullness indicates that yang qi fails to diffuse, leading to stagnation and rebellion. Fullness below the heart or abdominal fullness constitutes excess conditions requiring purgation. However, the chest fullness described here is not due to interior excess, hence purgation is contraindicated. Although Yangming is involved, the combination with Taiyang classifies it as an exterior syndrome. Therefore, Mahuang Tang is used to induce sweating and release the exterior.
In Taiyang disease, after ten days, if the pulse is floating and fine, and the patient desires to lie down, the exterior pathogen has resolved. If chest fullness and hypochondriac pain are present, Xiaochaihu Tang (Minor Bupleurum Decoction) is administered. If the pulse is merely floating, Mahuang Tang is administered.
After ten days, the time for resolution approaches. A floating and fine pulse with somnolence indicates the exterior pathogen has ceased. Although the condition shows signs of harmonization, if the pulse is only floating without being fine, the pathogen remains at the exterior. Mahuang Tang is given to disperse the exterior pathogen.
In Taiyang Wind Strike, if the pulse is floating and tight, accompanied by fever, aversion to cold, body pain, absence of sweating, and irritability, Daqinglong Tang (Major Blue-Green Dragon Decoction) is indicated. If the pulse is faint and weak,
with sweating and aversion to wind, it must not be taken. Administration would lead to cold limbs, twitching of sinews, and tremors of muscles, which constitutes a therapeutic error.
This represents a Wind Strike presentation with Cold pulse characteristics. Floating indicates wind; wind injures Wei (Defensive) qi. Tight indicates cold; cold injures Ying (Nutritive) blood. Both Ying and Wei are diseased, causing fever, aversion to cold, and body pain. When wind predominates in Wei, Ying becomes weak and Wei strong. When cold predominates in Ying, Ying becomes strong and Wei weak. Now, with both wind and cold injuring simultaneously, Ying and Wei become excessive, resulting in anhidrosis and irritability. Daqinglong Tang is given to induce sweating and eliminate wind-cold from Ying and Wei. If the pulse is faint and weak, with sweating and aversion to wind, it indicates deficiency of both Ying and Wei. Taking Qinglong Tang in this case will inevitably cause loss of Yang, potentially leading to cold limbs, sinew twitching, and muscle tremors. This is a reversal in treatment strategy.