海藏大羌活汤
羌活 独活 防己 防风 黄芩 黄连 苍术 白术 甘草(炙) 川芎 细辛(各三钱)
知母 生地黄(各一两)
上 咀每半两水煎热服未解再服一二剂若有余证并根据仲景法
按此出太阳例药也然伤寒两感亦有兼风兼湿不同或表里俱虚俱实之异保命集云两感可治
者感
异气也使表中于风内伤于寒可治者宜加味小青龙汤表热内寒宜和解之此方宜治表中于风内有
热者则表湿里寒表寒里湿表里证俱见者宜扩充也大抵两感多表里俱虚是以易老曰当切脉逆从
知其吉凶两感之邪三阴三阳皆有之脉从阳可治从阴难治阳生阴死之谓也
回生神膏治阴毒伤寒
牡蛎 炼粉 干姜(等分)
上为末男病用女唾调手内擦热紧掩二卵上得汗出愈女病用男唾调掩二乳取汗
代灸涂脐膏
附子 马蔺子 蛇床子 木香 肉桂 吴茱萸
上六味等分为末用白面相和生姜汁 成膏纸上圆三寸许贴脐下关元气海自晚至晓贴之
阴毒伤寒四肢逆者
吴茱萸(不拘多少)
上为末温酒和匀生绢袋盛之热熨脚心令通畅愈若以为汤煎洗接四肢亦可
灰包熨法治下焦积寒冷上焦阳盛更难投温药者用灰二三升许入好醋拌和干湿得所铫内炒
令
灰热以帛包裹置脐下熨之频换灰包令常热以腹不满痛为度如得利三两行或小便行或微似有汗
此阴气外出也
灸法(附灸法论)
气海穴在脐下一寸五分治阴厥脉微绝者
石关一穴在脐下二寸
关元一穴在脐下三寸治脏结不可攻者及阴汗不止腹胀肠鸣面黑指甲青者宜灸百壮
阳陵泉二穴在膝下一寸洁古曰烦满囊缩宜灸此太溪二穴在足内踝后跟骨上动脉陷中灸七
壮治少阴吐利手足不冷反热脉不至者
按伤寒灸穴详见资生经故不备录大抵不可刺者宜灸之一则沉寒痼冷二则无脉知阳绝也三
则腹皮急而阳陷也舍此三者余皆不可灸盖恐致逆也今附炙法于下
医学发明曰针经云陷下则灸之天地间无他惟阴与阳二气而已阳在外在上阴在内在下今言
陷下
者阳气下陷入阴血之中是阴反居其上而覆其阳脉证俱见寒在外者则灸之异法方宜论云北方之
人宜灸KT 也为冬寒大旺伏阳在内皆宜灸之以至理论则肾主脏藏阳气在内冬三月主闭藏是也若
太过则病固宜灸KT 此阳明陷入阴水之中是也难
经云热病在内取会之气穴为阳陷入阴中取阳气通天之窍穴以火引火而导之此宜灸KT 也若将有
病者一概灸之岂不误哉仲景云微数之脉慎不可灸因火为邪则为烦逆追虚逐实血散脉中火气虽
微内攻有力焦骨伤筋血难复也又云脉浮宜以汗解用火灸之邪无从出因火而盛病从腰以下必重
而痹名火逆也脉浮热甚而灸之此为实实而虚治因火而动必咽燥唾血又云身之穴三百六十有五
其三十穴灸之有害七十九穴刺之为灾并中髓也仲景伤寒例
按明堂针经各条下所说禁忌明矣内经云脉之所见邪之所在脉沉者邪气在内脉浮者邪气在
表世
医只知脉之说不知病证之禁忌若表见寒证身汗出身常清数栗而寒不渴欲覆浓衣常恶寒手足厥
皮肤干枯其脉必沉细而迟但有一二证皆宜灸之阳气下陷故也若身热恶热时见燥作或面赤面黄
咽干嗌干口干舌上黄赤渴咽嗌痛皆热在外也但有一二证皆不宜灸其脉必浮数或但数而不浮不
可灸灸之灾害立生若有鼻不闻香臭鼻流清涕眼脸时痒或欠或嚏恶寒其脉必沉是脉证相应也或
轻手得弦紧者是阴伏其阳也虽面赤宜灸之不可拘于面赤色而禁之也
海藏大羌活汤
组成:羌活、独活、防己、防风、黄芩、黄连、苍术、白术、甘草(炙)、川芎、细辛(各三钱);知母、生地黄(各一两)。
用法:将药材切碎,每次取半两,加水煎煮,热服。若病邪未解,再服用一二剂。若有残留症状,均依据张仲景的法则处理。
按语:此方出自太阳病的示例用药。然而,伤寒“两感”(表里两经同时受邪)也有兼夹风邪或湿邪的不同,以及表里俱虚或俱实的差异。《保命集》记载:“两感证可治,是因为感受的气机不同。”例如,外感风邪、内伤寒邪者,可治,适宜加味小青龙汤;表热内寒者,适宜和解之法。本方适宜治疗外感风邪、内有热邪的情况。至于表湿里寒、表寒里湿、表里证候同时出现的情况,则应当扩充方义。大抵而言,“两感”多表现为表里俱虚,因此易老(李东垣)说:“应当仔细切脉,辨别顺逆,以判断吉凶。”“两感”之邪在三阴三阳各经中皆有发生,脉象从阳者可治,从阴者难治,这就是所谓的“阳生阴死”。
回生神膏 治疗阴毒伤寒
组成:牡蛎、炼粉(米粉)、干姜(等分)。
用法:将药物研为细末。男性患者用女性唾液调和,涂于手中搓热,紧紧覆盖在两个睾丸上,待出汗即愈。女性患者用男性唾液调和,覆盖在两个乳房上,取汗而愈。
代灸涂脐膏
组成:附子、马蔺子、蛇床子、木香、肉桂、吴茱萸。
用法:以上六味药等分为末,用白面和生姜汁调成膏状,摊在纸上,直径约三寸,贴敷于脐下关元穴和气海穴,从晚上贴到早晨。
阴毒伤寒导致四肢厥逆者
组成:吴茱萸(不拘多少)。
用法:研为细末,用温酒调匀,装入生绢袋中,加热后熨烫脚心,使气血通畅即愈。如果将其煎汤洗脚,接续四肢阳气也可以。
灰包熨法治下焦积寒冷、上焦阳盛更难投温药者
用法:取二三升好醋拌和草木灰,干湿适中,放入铛中炒至灰热,用布包裹,置于脐下熨烫。频繁更换灰包,使其保持常热,以腹部不胀满疼痛为度。如果大便通利行三两次,或小便利,或微微似有汗出,这是阴气外出的表现。
灸法(附灸法论)
气海穴:位于脐下一寸五分,主治阴厥、脉微绝者。
石关穴:一穴,位于脐下二寸。
关元穴:一穴,位于脐下三寸,主治脏结不可攻下者,以及阴汗不止、腹胀、肠鸣、面色黑、指甲青紫者,宜灸百壮。
阳陵泉穴:二穴,位于膝下一寸。洁古(张元素)说:烦闷、囊缩者,宜灸此穴。
太溪穴:二穴,位于足内踝后方跟骨上的动脉凹陷处,灸七壮,主治少阴病吐利、手足不冷反热、脉不至者。
按语:伤寒灸穴详见《资生经》,故不全部收录。大抵而言,不可针刺者宜用灸法。原因有三:一是沉寒痼冷;二是无脉,说明阳气已绝;三是腹皮紧急,说明阳气下陷。除了这三种情况,其余皆不可灸,恐怕会导致变证。现将灸法附于下方。
《医学发明》引用《针经》说:“陷下则灸之。”天地间无非阴阳二气而已。阳在外、在上,阴在内、在下。所谓“陷下”,是指阳气下陷陷入阴血之中,是阴反居其上而覆盖其阳,脉证都表现出寒象在外,所以用灸法。《异法方宜论》说:“北方之人宜灸KT(此处原文可能有误,通常指艾灸或特定疗法),因为冬季寒气大旺,伏阳在内,皆宜灸之。”从《至真要大论》的理论来看,肾主脏,藏阳气在内,冬三月主闭藏,这是正确的。如果阳气太过,生病固宜灸KT。这是阳明陷入阴水之中,难以治疗。《难经》说:“热病在内,取会之气穴,为阳陷入阴中,取阳气通天之窍穴,以火引火而导之,此宜灸KT也。”如果将有病的人一概施灸,难道不是错误吗?张仲景说:“脉微数者,慎不可灸。因火为邪,则为烦逆,追虚逐实,血散脉中,火气虽微,内攻有力,焦骨伤筋,血难复也。”又说:“脉浮,宜以汗解,用火灸之,邪无从出,因火而盛,病从腰以下必重而痹,名火逆也。”脉浮热甚而灸之,这是“实实”而“虚治”,因火而动,必致咽燥唾血。又说:“身上的穴位共有三百六十五个,其中三十穴灸之有害,七十九穴刺之为灾,并中髓也。”这是张仲景《伤寒例》中的观点。
按《明堂针经》各条下所说的禁忌已经很明确了。《内经》说:“脉之所见,邪之所在。脉沉者,邪气在内;脉浮者,邪气在表。”世间的医生只知道脉象的说法,不知道病证的禁忌。如果表证见寒证,身体出汗,身体常常清冷,频繁战栗发冷,口不渴,想要盖厚衣服,经常怕冷,手足厥冷,皮肤干枯,其脉必然沉细而迟。只要有一两个证候,都宜灸之,这是阳气下陷的缘故。如果身热、恶热,时常烦躁发作,或者面赤、面黄,咽干、嗌干、口干、舌上黄赤,口渴、咽嗌痛,这些都是热邪在外。只要有一两个证候,都不宜灸。其脉必然浮数,或者但数而不浮,不可灸。灸之灾害立生。如果有鼻子闻不到香臭、流清涕、眼睑时痒,或者呵欠、打喷嚏、怕冷,其脉必然沉,这是脉证相应。或者轻手可得弦紧脉,这是阴伏其阳,虽然面赤,宜灸之,不可拘泥于面赤色而禁止灸法。
Da Qianghuo Tang (Great Notopterygia Decoction) by Haizang
Ingredients: Qianghuo (Rhizoma et Radix Notopterygii), Duhuo (Radix Angelicae Pubescentis), Fangji (Radix Stephaniae Tetrandrae), Fangfeng (Radix Saposhnikoviae), Huangqin (Radix Scutellariae), Huanglian (Rhizoma Coptidis), Cangzhu (Rhizoma Atractylodis Chinensis), Baizhu (Rhizoma Atractylodis Macrocephalae), Gancao (Radix Glycyrrhizae Preparata, roasted), Chuanxiong (Rhizoma Chuanxiong), Xixin (Herba Asari) — each 3 qian; Zhimu (Rhizoma Anemarrhenae), Shengdihuang (Radix Rehmanniae Preparata) — each 1 liang.
Preparation and Administration: The herbs are cut into small pieces. Each dose of half liang is decocted in water and taken hot. If the pathogen is not resolved, take one or two more doses. Any residual symptoms should be managed according to the methods of Zhang Zhongjing.
Commentary: This prescription originates from examples for Taiyang disease (disease of the Taiyang channel). However, Lianggan (simultaneous involvement of exterior and interior channels) in Shanghan (Cold Damage) may also involve wind or dampness, and present with differences such as both exterior and interior being deficient or excess. *Baoming Ji* states: "Lianggan can be treated because the qi affected is different." For instance, those with wind attacking the exterior and cold injuring the interior can be treated with Jiawei Xiao Qinglong Tang (Modified Minor Blue Dragon Decoction); those with exterior heat and interior cold should be treated with harmonizing methods. This formula is suitable for cases with wind attacking the exterior and heat inside. For cases with dampness on the exterior and cold inside, cold on the exterior and dampness inside, or simultaneous exterior and interior syndromes, the formula's scope should be expanded. Generally, Lianggan often presents with both exterior and interior deficiency. Therefore, Yilao (Li Dongyuan) said: "One must carefully palpate the pulse to discern compliance or rebellion, thereby predicting auspiciousness or misfortune." The pathogenic factors of Lianggan exist in all three Yin and three Yang channels. If the pulse follows Yang, it is treatable; if it follows Yin, it is difficult to treat. This refers to "Yang generates life, Yin leads to death."
Huisheng Shengao (Resuscitating Divine Ointment) for treating Yindu Shanghan (Yin Toxin Cold Damage)
Ingredients: Muli (Concha Ostreae), Lianfen (Refined Rice Flour), Jiangjiang (Sliced Ginger Rhizome) — equal parts.
Preparation and Administration: Grind the ingredients into a fine powder. For male patients, mix with female saliva, rub between hands until warm, and tightly cover both testicles. Cure upon sweating. For female patients, mix with male saliva and cover both breasts to induce sweating.
Daijiu Tuni Gao (Moxibustion-Substitute Umbilical Paste)
Ingredients: Fuzi (Radix Aconiti Lateralis Preparata), Malizi (Fructus Iris Pseudacorus), Shechuangzi (Fructus Cnidii), Muxiang (Radix Aucklandiae), Rougui (Cortex Cinnamomi), Wuzhuyu (Fructus Evodiae).
Preparation and Administration: Grind the six herbs into equal parts powder. Mix with white flour paste and fresh ginger juice to form a ointment. Spread on paper in circles approximately 3 cun in diameter. Apply to Guan Yuan (CV4) and Qi Hai (CV6) below the umbilicus, from evening until morning.
For Yindu Shanghan causing cold limbs (Si Zhi Ni):
Ingredients: Wuzhuyu (Fructus Evodiae) — any amount.
Preparation and Administration: Grind into powder, mix evenly with warm wine, place in a raw silk bag, heat, and moxa-compress the soles of the feet until circulation is smooth and cured. Alternatively, decoct for washing the feet to restore limb warmth.
Ash Bag Compress Method for Lower Jiao Accumulated Cold with Upper Jiao Excess Heat, where warming herbs are difficult to administer:
Preparation and Administration: Take about 2-3 sheng of good vinegar mixed with plant ash, adjusting moisture content appropriately. Stir-fry in a pan until the ash is hot. Wrap in cloth and compress below the umbilicus. Frequently replace the ash bags to maintain constant heat. Continue until the abdomen is no longer distended or painful. If bowel movements occur 2-3 times, urination increases, or slight sweating occurs, this indicates the outward expulsion of Yin pathogenic factors.
Moxibustion Methods (with Commentary on Moxibustion Theory)
Qi Hai (CV6): Located 1.5 cun below the umbilicus. Treats Yin Jue (cold extremities due to Yin excess) and faint/absent pulses.
Shi Guan (ST25? Note: Text says Shi Guan, likely referring to a specific point or typo, but strictly translating text): One point, located 2 cun below the umbilicus.
Guan Yuan (CV4): One point, located 3 cun below the umbilicus. Treats Zang Jie (Zang organ knotting) which cannot be purged, as well as continuous Yin sweating, abdominal distension, borborygmus, dark complexion, and cyanotic fingernails. Moxa 100 zhuang.
Yang Ling Quan (GB34): Two points, located 1 cun below the knee joint. Jiegu (Zhang Yuansu) stated: For irritability, fullness, and retraction of the scrotum, moxa this point.
Tai Xi (KI3): Two points, located in the depression anterior to the medial malleolus and posterior to the calcaneus, where the arterial pulse is felt. Moxa 7 zhuang. Treats Shaoyin syndrome with vomiting and diarrhea, cold limbs turning warm, and absent pulse.
Commentary: Details on Shanghan moxibustion points are found in *Zisheng Jing*, so they are not fully recorded here. Generally, points unsuitable for needling are suitable for moxibustion. There are three reasons: first, deep-seated cold and stubborn cold; second, absence of pulse indicating Yang exhaustion; third, tight abdominal skin indicating sinking of Yang. Apart from these three conditions, moxibustion should generally be avoided to prevent adverse reactions. The following moxibustion methods are appended.
*Yixue Faming* cites *Zhen Jing*: "When vessels sink, apply moxibustion." In heaven and earth, there is nothing but Yin and Yang Qi. Yang is outside and above; Yin is inside and below. "Sinking" refers to Yang Qi sinking into Yin Blood, where Yin erroneously occupies the upper position and covers Yang. When pulse and symptoms indicate cold on the exterior, moxibustion is applied. *Yifa Fangyi Lun* states: "People in the North are suited for moxibustion KT [textual error/abbreviation], because winter cold is vigorous, hiding Yang inside; thus, moxibustion is suitable." According to *Zhi Li Lun*, the Kidney governs the Zang organs and stores Yang Qi internally; the three winter months govern closure and storage. This is correct. If Yang is excessive, illness indeed requires moxibustion KT. This describes Yang sinking into Yin Water, which is difficult to treat. *Nan Jing* states: "For internal heat diseases, select Hui points to access Qi, as Yang has sunk into Yin. Select acupoints connecting Yang to Heaven, using fire to guide fire and lead it out. This is suitable for moxibustion KT." If all sick people are indiscriminately moxa-ed, would this not be an error? Zhang Zhongjing said: "With a faint and rapid pulse, moxibustion must be cautious. Fire becomes a pathogen, causing irritability and rebellion, chasing deficiency and pursuing excess, scattering blood in the vessels. Although the fire energy is slight, its internal attack is powerful, scorching bones and damaging sinews, making blood restoration difficult." He also said: "If the pulse is floating, resolution via sweating is appropriate. Using fire/moxa prevents the pathogen from exiting; due to fire, the condition worsens, and heaviness and bi-syndrome occur from the waist down, named Huoni (Fire Rebellion)." If the pulse is floating with severe heat and moxa is applied, this is "treating excess with excess" and "deficiency with deficiency," causing fire to move, leading to dry throat and spitting blood. He also said: "The body has 365 acupoints. Thirty are harmful if moxa-ed; seventy-nine are disastrous if needled, potentially piercing the marrow." This is from Zhang Zhongjing's *Shanghan Li*.
According to *Mingtang Zhen Jing*, the contraindications under each entry are clear. *Nei Jing* states: "Where the pulse is seen, there is the pathogen. Deep pulse indicates pathogen inside; floating pulse indicates pathogen on the exterior." Physicians of the world know only pulse theory but ignore symptom contraindications. If exterior cold syndrome is present, with sweating, frequent chills/cold sensation, thirstlessness, desire for thick clothing, aversion to cold, cold limbs, and dry skin, the pulse will be deep, thin, and slow. If one or two of these symptoms appear, moxibustion is suitable due to sinking Yang. If there is body heat, aversion to heat, occasional irritability, red or yellow face, dry throat/mouth, yellow-red tongue, thirst, and sore throat, these are heat pathogens on the exterior. If one or two of these appear, moxibustion is unsuitable. The pulse will be floating and rapid, or merely rapid without floating; do not moxa. Disaster will arise immediately. If there is anosmia, clear nasal discharge, itchy eyelids, yawning, sneezing, and aversion to cold, the pulse will be deep, indicating correspondence between pulse and symptoms. Or, if a light touch reveals string-tight pulse, this is Yin suppressing Yang. Even with a red face, moxibustion is suitable; do not restrict moxibustion solely based on facial redness.