金匮大承气汤治 为强脑满口噤卧不着席脚挛急必 齿可与
见本方
按此阳明经药也阳明总宗筋以风寒湿热之邪入于胃津液不行宗筋无所养故急宜用此汤下
湿热
行津液宣明云 病目置口噤背强如弓卧摇动手足搐搦通宜三一承气汤下之亦此意也然非察
证之明的有内实热者不可轻用
难知防风当归散治发汗过多发热头面摇卒口噤背反张者宜去风养血
防风 当归 川芎 地黄(各一两)
上锉每服一两水煎服
谨按 证发汗过多与夫血气内虚之人自当随证用药古方于此等处多缺略姑叙此方以见意
尔至于发散风寒行经之药甚多及活人治阴痉诸温药难知分经络用药兹并不载用究本书
内经曰风气与太阳行诸脉俞散于分肉之间与卫气相干其道不利故使肌肉 而有疡卫气
有所
凝而不行故其肉有不仁也疠者有荣卫热腑其气不清故使鼻柱坏而色败皮肤疡溃风寒客于脉而
不去名曰疠风
内经云病大风骨节重须眉堕名曰大风刺肌肉间故汗出百日旺注泄卫气之怫热刺骨髓汗出
百日泄
荣气之怫热凡一百日须眉生而止针怫热屏退阴气内复故多汗出须眉生也灵枢云疠风者数刺其
肿上已刺以锐针针其处按出其恶气肿尽乃止常食方食勿食他食以犯其病
病机云内经云脉风成为疠俗云癞病也先桦皮散从少至多服五七日灸承浆穴七壮灸疮轻再
灸疮
愈三灸之后服二圣散泄热祛血中之风邪戒房室三年病愈药灸同止述类象形此治肺风之法也然
此疾非止肺脏有之以其病发于鼻俗呼为肺风也鼻肿准赤胀大而为疮乃血随气化也气既不施则
血为之聚血既聚则使肉烂而生虫也生虫者厥阴主之厥阴为风木主生五虫盖三焦相火热甚而制
金金衰故木来克侮宜泻火热利风之剂虫自不生也故此疾血热明矣当以药缓疏泄之煎局方升麻
汤下钱氏泻青丸余病各随经治
按疠风皮毛血脉先受病二者属荣卫所主故言肺风至于内坏生虫又阳明厥阴所属故其用药
皆疏泄肺气祛逐血分之邪热其灸承桨一穴乃阳明任脉之会所以宣通血脉以散风也
《金匮要略》中的大承气汤用于治疗:患者身体僵硬、头部胀满、口噤不能言语、卧床时背部无法接触床面(卧不着席)、双脚拘挛紧急、甚至上下牙齿格格作响,此时可以使用此方。
详见该方原文。
按语:这是治疗阳明经的药物。阳明经总司宗筋(全身筋膜),若风寒湿热之邪侵入胃腑,导致津液运行不畅,宗筋失去滋养,因此应当急用此汤剂攻下。
《宣明论方》中提到:患有眼目紧闭、口噤、背部强直如弓状、卧床时身体摇晃、手足抽搐的症状,通常适宜用三一承气汤攻下,这也是同样的道理。然而,如果不是仔细辨证,确认为内有实热者,不可轻易使用。
《难知》所载的防风当归散,用于治疗发汗过多后出现发热、头面部摇动、突然口噤、背部反张(角弓反张)的患者,适宜采用祛风养血的方法。
药物组成:防风、当归、川芎、地黄(各一两)。
制法与用法:将药材切碎,每次服用一两,加水煎煮后服用。
谨按:对于因发汗过多或气血内虚之人,应当根据具体证候用药。古方在此类情况下的记载多有缺漏,暂且叙述此方以见其意。至于发散风寒、通行经络的药物有很多,《活人书》中治疗阴痉的各种温药以及《难知》中分经络用药的方法,此处均不收录,旨在探究本书的本意。
《内经》说:风气随着太阳经运行于各脉俞穴,散布在分肉之间,与卫气相互干扰,导致其道不利,从而使肌肉溃烂生疮。卫气有所凝滞而不行,所以肌肉会出现麻木不仁的现象。疠风病是由于营卫热盛,其气不清,从而导致鼻梁塌陷、面色败坏、皮肤溃疡。风寒客居于脉中而不去,这种病称为疠风。
《内经》又说:患大风病,骨节沉重,须眉脱落,称为大风。针刺肌肉间,使汗出百日;刺骨髓,使汗出百日;泄营气中的郁热。凡一百日,须眉再生,即可停止针刺。这是因为郁热退去,阴气在内恢复,所以多汗出,须眉得以再生。《灵枢》说:患疠风的人,多次针刺肿胀处。已针刺后,用锐针针刺患处,按压排出恶气,直到肿胀消退为止。平时饮食要规律,不要食用其他食物以免诱发疾病。
《病机》引用《内经》说:脉中风成为疠病,俗称癞病。先服用桦皮散,从少到多服用五至七日,然后灸承浆穴七壮。灸疮轻微时再灸,待灸疮痊愈后再灸三次。之后服用二圣散,以泄热并祛除血中的风邪。戒除房事三年,病愈后停药和停止艾灸。《述类象形》记载这是治疗肺风的方法。然而,此疾并非只有肺脏有之,因其病发于鼻,俗呼为肺风。鼻子肿胀、鼻尖红赤、胀大而生疮,这是血随气化所致。气既不能施布,则血为之聚积;血既聚积,则使肌肉腐烂而生虫。生虫之事由厥阴肝木主之。厥阴属风木,主生五虫。盖因三焦相火火热甚盛而克制肺金,金衰故木来克侮,宜用泻火热、利风邪的药剂,虫自然不生。因此此疾的血热性质是明确的,应当用药缓缓疏泄。可用煎剂局方的升麻汤送服钱氏的泻青丸。其余病症各随经络治疗。
按语:疠风病的皮毛血脉先受病,二者属于营卫所主,所以说肺风。至于内部坏死生虫,又属于阳明和厥阴所属,所以其用药都是疏泄肺气、祛除血分之邪热。灸承浆这一穴位,乃是阳明经和任脉的交会穴,所以能宣通血脉以散风邪。
The Da Cheng Qi Tang (Great Order the Qi Decoction) from *Jin Gui Yao Lue* is used to treat: patients with stiff body, distended head, locked jaw unable to speak, inability to lie flat with back touching the bed (lying without back contact), cramped and urgent legs, and even teeth grinding together. In such cases, this formula may be administered.
See the original text of this formula for details.
Commentary: This is a medication for the Yangming channel. The Yangming channel governs all sinews (tendons and fascia). If pathogenic factors of wind, cold, dampness, or heat enter the Stomach, causing the failure of fluids to circulate, the sinews lose nourishment. Therefore, it is urgent to use this decoction to purge.
*Xuan Ming Lun Fang* states: For conditions presenting with eyes closed, locked jaw, back stiffness resembling a bow, body swaying while lying down, and convulsions of hands and feet, it is generally appropriate to purge using San Yi Cheng Qi Tang (Three-One Order the Qi Decoction). This follows the same principle. However, unless one carefully differentiates the syndrome and confirms the presence of interior excess-heat, it should not be used lightly.
Fang Feng Dang Gui San (Saposhnikovia and Angelica Decoction) from *Nan Zhi* is used to treat patients who, after excessive sweating, develop fever, shaking of the head and face, sudden locked jaw, and opisthotonos (back arching backward). It is appropriate to employ methods to dispel wind and nourish blood.
Ingredients: Fangfeng (*Radix Saposhnikoviae*), Danggui (*Radix Angelicae Sinensis*), Chuanxiong (*Rhizoma Chuanxiong*), Dihuang (*Radix Rehmanniae Praeparata*) (each 1 liang).
Preparation and Administration: Coarsely crush the herbs. Take 1 liang per dose, decoct in water, and drink.
Respectfully noted: For individuals suffering from excessive sweating or internal deficiency of qi and blood, medication should be prescribed according to the specific syndrome. Ancient formulas often lack detailed records for such situations. This formula is recorded here merely to illustrate the intent. As for drugs that disperse wind-cold and unblock meridians, there are many; various warming drugs for treating yin collapse in *Huo Ren Shu*, and meridian-specific prescriptions in *Nan Zhi*, are not included here, aiming to explore the original intent of this book.
*Nei Jing* states: Wind qi travels along the Taiyang channel through the various shu points, dispersing between the muscle intervals. It interferes with Wei Qi (Defensive Qi), obstructing its pathway, thereby causing muscles to ulcerate. When Wei Qi stagnates and fails to circulate, the flesh becomes insensible (numb). Leprosy (Li Feng) arises from excessive heat in Ying Qi (Nutritive Qi) and Wei Qi, leading to turbid qi. This causes the nasal bridge to collapse, complexion to deteriorate, and skin to ulcerate. When wind-cold lodges in the vessels and does not depart, the disease is called Li Feng (Leprosy).
*Nei Jing* also says: In severe wind diseases characterized by heavy joints and loss of eyebrows and beard, it is termed Da Feng (Great Wind). Acupuncture at the muscle spaces induces sweating for one hundred days; acupuncture into the bone marrow induces sweating for one hundred days; draining the stagnant heat of Ying Qi. After one hundred days, when eyebrows and beard regrow, needling should cease. This is because the stagnant heat has been cleared, Yin Qi has recovered internally, leading to profuse sweating and regeneration of hair. *Ling Shu* states: For patients with Li Feng, repeatedly prick the swollen areas. After initial pricking, use a sharp needle to puncture the site, pressing out evil qi until the swelling subsides. Maintain regular dietary habits and avoid foods that might trigger the disease.
*Bing Ji* cites *Nei Jing*: "Wind entering the pulse becomes Leprosy," commonly known as Lai Bing (Leprous Disease). First, consume Hua Pi San (Birch Bark Powder), increasing the dosage gradually over five to seven days. Then, moxa the Chengjiang point (CV24) seven times. If the moxibustion blister is mild, apply moxa again; wait for the blister to heal before applying moxa three more times. Thereafter, administer Er Sheng San (Two-Sages Powder) to clear heat and expel wind pathogens from the blood. Abstain from sexual activity for three years. Discontinue herbal medicine and moxibustion upon recovery. *Shu Lei Xiang Xing* describes this as a method for treating Lung Wind. However, this disease is not confined to the Lung organ; it is called Lung Wind because it manifests on the nose. Nasal swelling, redness of the tip, enlargement, and ulceration occur due to blood following qi transformation. When qi fails to distribute, blood accumulates; when blood accumulates, flesh rots and worms are generated. The generation of worms is governed by the Jueyin Liver Wood. Jueyin belongs to Wind-Wood and governs the production of five types of worms. This is because excessive fire in the Triple Burner Shaoyang controls Metal (Lung); when Metal is weak, Wood overacts upon it. One should use agents that drain fire and promote the flow of wind pathogens, so that worms will naturally not generate. Thus, the nature of blood-heat in this disease is evident. Treatment should involve gentle purgation and drainage. One may use Sheng Ma Tang (Cimicifuga Decoction) from the Bureau Formulary to deliver Qian Shi's Xie Qing Wan (Drain Green Pill). Other symptoms should be treated according to their respective meridians.
Commentary: In Leprosy, the skin, hair, blood, and vessels are affected first. These two aspects are governed by Ying and Wei Qi, hence it is referred to as Lung Wind. Regarding internal necrosis and worm generation, these belong to the Yangming and Jueyin systems. Therefore, the medications used primarily vent Lung Qi and eliminate heat pathogens in the blood level. Moxibustion on the Chengjiang point, which is the intersection of the Yangming and Ren Mai (Conception Vessel), serves to unblock blood vessels and disperse wind.