金匮防己黄 汤治风湿脉浮身重汗出恶风或痛
防己(一两) 甘草(炙半两) 白术(七钱半) 黄 (一两一钱)
上 咀每服一两入姜枣煎 喘者加麻黄 胃气不和加芍药 气上冲加桂枝 下有寒加细
辛
按湿胜身重阳微中风则汗出恶风故用黄 炙草实表防己白术胜湿也足三阴例药
桂枝附子汤治风湿相搏身体疼烦不能自侧不呕不渴脉浮虚而涩者此汤主之
桂枝(八钱) 生姜(六钱) 附子(二钱) 甘草(炙四钱)
上 咀入大枣作二次煎若小便自利者去桂加白术汤主之服后其人如冒状勿怪
甘草附子汤治风湿相搏骨节疼烦掣痛不得屈伸近之则痛剧汗出短气小便不利恶风不欲去
衣或身微肿痛者
甘草(炙四钱) 附子(三钱) 白术(四钱) 桂枝(八钱)
上 咀水煎 金匮减桂枝加生姜大枣名白术附子汤
按此一方足太阳例药解肌之剂也
麻黄加术汤治湿胜身烦疼
麻黄(六钱) 桂枝(四钱) 甘草(炙二钱) 杏仁(二十五个) 白术(八钱)
上 咀水煎取微汗金匮减桂术加薏苡仁名麻黄杏仁薏苡甘草汤治湿胜身疼日晡所剧者
按此太阳发表例药以上诸方治风寒湿之剂
元戎加味五苓散治湿胜身痛小便不利体重发渴
本方加羌活
按此太阳解表渗利之剂治风湿寒湿药也
局方五积散治外感风寒冒寒湿身体重痛 见本方
按海藏云麻黄桂芍甘草即麻黄桂枝各半汤也苍术甘草陈皮浓朴即平胃散也枳壳桔梗陈皮
茯苓
半夏即桔梗半夏等汤也又川芎当归治血兼干姜浓朴散气此数药相合为解表温中泄湿之剂去痰
痞
消调经之方虽为内寒外感表里之分之所制实非仲景表里麻黄桂枝姜附之的方也主于积冷呕泄时
疫项背拘急加葱白豆豉厥逆加吴茱萸寒热咳
逆加枣妇人难产加醋始知用之非一途也惟知活法者其择之
东垣羌活汤治湿热自甚身重或眩晕麻木小便涩赤下焦痿弱无力行步不正
方见热门
按此胜湿升阳之剂也出太阳茯苓泽泻例
温散之剂
真武汤治寒少甚腹痛下痢四肢沉重
附子汤
方并见寒门
按此少阴例药也
局方渗湿汤治寒湿所伤身重腰冷如坐水中小便或涩大便溏泄皆坐卧湿地或阴雨所袭之也
苍术 白术 甘草(各一两) 干姜 茯苓(各二两) 陈皮 丁香(各二钱半)
上 咀每四钱入枣煎
按此足阳明太阴药也温中胜湿之剂
【玉机微义·解表之剂】
金匮防己黄芪汤:治疗风湿病,脉象浮,身体沉重,出汗,怕风,或者疼痛。
药材:防己(一两)、甘草(炙用半两)、白术(七钱半)、黄芪(一两一钱)。
制法与用法:将药物捣碎成粗末,每次服用一两,加入生姜、大枣煎煮。如果伴有气喘,加麻黄;如果胃气不和,加芍药;如果气上冲,加桂枝;如果下部有寒邪,加细辛。
按语:湿气偏胜则身体沉重,阳气微弱且中风则汗出、怕风,所以使用炙甘草和黄芪来固护肌表,使用防己和白术来祛除湿气。这是足三阴经的常规用药思路。
桂枝附子汤:治疗风湿相互搏结,身体疼痛烦躁,不能自行翻身,不呕吐,不口渴,脉象浮虚而涩滞的,此方主治。
药材:桂枝(八钱)、生姜(六钱)、附子(二钱)、甘草(炙用四钱)。
制法与用法:将药物捣碎成粗末,加入大枣,分两次煎煮。如果小便自然通畅,去掉桂枝,改用白术附子汤主治。服药后如果患者感觉头昏沉像被东西蒙住一样,不要奇怪。
甘草附子汤:治疗风湿相互搏结,骨节疼痛烦躁,牵掣样疼痛,不能屈伸,靠近时疼痛加剧,出汗,气短,小便不利,怕风,不想脱衣,或者身体轻微肿胀疼痛的。
药材:甘草(炙用四钱)、附子(三钱)、白术(四钱)、桂枝(八钱)。
制法与用法:将药物捣碎成粗末,用水煎煮。《金匮要略》中减去桂枝,加入生姜、大枣,名为白术附子汤。
按语:这一方是足太阳经的常规用药,属于解肌的药剂。
麻黄加术汤:治疗湿气偏胜,身体烦扰疼痛。
药材:麻黄(六钱)、桂枝(四钱)、甘草(炙用二钱)、杏仁(二十五个)、白术(八钱)。
制法与用法:将药物捣碎成粗末,用水煎煮,取微汗。《金匮要略》中减去桂枝、白术,加入薏苡仁,名为麻黄杏仁薏苡甘草汤,治疗湿气偏胜身体疼痛,且在傍晚时分加重的情况。
按语:这是太阳经发表法的常规用药。以上各方都是治疗风寒湿邪的药剂。
元戎加味五苓散:治疗湿气偏胜,身体疼痛,小便不利,身体沉重,口渴。
本方基础上加羌活。
按语:这是太阳经解表并渗湿利水的药剂,用于治疗风湿、寒湿。
局方五积散:治疗外感风寒,冒犯寒湿,身体沉重疼痛。(详见本方原文)
按语:海藏先生(张元素/李东垣学派医家)说:麻黄、桂枝、芍药、甘草即麻黄桂枝各半汤;苍术、甘草、陈皮、厚朴即平胃散;枳壳、桔梗、陈皮、茯苓、半夏即桔梗半夏等汤;又川芎、当归治疗血分兼证,干姜、厚朴行散气滞。这些药物配合,成为解表、温中、泄湿的药剂,能去痰、消痞、调经。虽然是为内寒外感、表里同病的特殊情况所制定,但实际上并非仲景治疗表里证的麻黄、桂枝、姜、附那样的确切方剂。主要用于积冷、呕吐腹泻、时疫、项背拘急,加葱白、豆豉;厥逆加吴茱萸;寒热咳嗽加枣;妇人难产加醋。可知其应用并非单一途径。只有懂得灵活变通的人,才会从中选择使用。
东垣羌活汤:治疗湿热自盛,身体沉重,或者眩晕麻木,小便涩赤,下焦痿弱无力,行走不正。
方剂见热门章节。
按语:这是胜湿升阳的药剂,出自太阳经茯苓泽泻汤的常规思路。
【温散之剂】
真武汤:治疗寒气极甚,腹痛,下痢,四肢沉重。
附子汤
方剂并见寒门章节。
按语:这是少阴经的常规用药。
局方渗湿汤:治疗寒湿所伤,身体沉重,腰部寒冷如坐水中,小便或涩滞,大便溏泄,这都是因为坐卧湿地或阴雨侵袭所致。
药材:苍术、白术、甘草(各一两)、干姜、茯苓(各二两)、陈皮、丁香(各二钱半)。
制法与用法:将药物捣碎成粗末,每次四钱,加入大枣煎煮。
按语:这是足阳明、足太阴经的药物,属于温中胜湿的药剂。
[Ji Yu Wei Yi · Formulas for Resolving the Exterior]
Jinkui Fangji Huangqi Tang (Acanthopanacis Senticosi and Astragali Decoction from the Golden Cabinet): Treats Wind-Dampness with a floating pulse, heavy body, sweating, aversion to wind, or pain.
Herbs: Fangji (Acanthopanacis Senticosi Radix, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.5 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 7 qian 2.5 fen), Huangqi (Astragali Radix, 1 liang 1 qian).
Preparation and Administration: Coarsely crush the herbs. For each dose of 1 liang, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus). If panting is present, add Mahuang (Ephedrae Herba); if Stomach Qi is disharmonious, add Shaoyao (Paeoniae Radix Alba); if Qi rushes upward, add Guizhi (Cinnamomi Ramulus); if cold exists below, add Xixin (Asari Radix et Rhizoma).
Commentary: When Dampness prevails, the body feels heavy; when Yang Qi is deficient and struck by Wind, sweating and aversion to wind occur. Therefore, honey-fried Gancao and Huangqi are used to secure the exterior, while Fangji and Baizhu are used to overcome Dampness. This follows the principle of formulas for the Three Yin Meridians of the Foot.
Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction): Treats Wind-Dampness interlocking, causing severe bodily pain and restlessness, inability to turn over independently, no vomiting, no thirst, and a floating, deficient, and choppy pulse. This formula is indicated.
Herbs: Guizhi (Cinnamomi Ramulus, 8 qian), Shengjiang (Zingiberis Rhizoma Recens, 6 qian), Fuzi (Aconiti Lateralis Radix Praeparata, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 4 qian).
Preparation and Administration: Coarsely crush the herbs, add Dazao (Jujubae Fructus), and decoct in two portions. If urination is naturally free, remove Guizhi and use Baizhu Fuzi Tang instead. After taking the medicine, if the patient experiences a sensation of dizziness as if covered by something, do not be alarmed.
Gancao Fuzi Tang (Licorice and Aconite Decoction): Treats Wind-Dampness interlocking, causing painful and restless joints, pulling pain, inability to flex or extend, exacerbation of pain upon touch, sweating, shortness of breath, difficulty in urination, aversion to wind, reluctance to remove clothing, or slight swelling and pain of the body.
Herbs: Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 4 qian), Fuzi (Aconiti Lateralis Radix Praeparata, 3 qian), Baizhu (Atractylodis Macrocephalae Rhizoma, 4 qian), Guizhi (Cinnamomi Ramulus, 8 qian).
Preparation and Administration: Coarsely crush the herbs and decoct with water. In the *Jinkui Yaolue*, Guizhi is reduced and Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) are added, naming it Baizhu Fuzi Tang (Atractylodis Macrocephalae and Aconite Decoction).
Commentary: This formula belongs to the standard approach for the Foot-Taiyang Bladder Meridian and is a muscle-relieving agent.
Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction): Treats Dampness prevailing, causing bodily restlessness and pain.
Herbs: Mahuang (Ephedrae Herba, 6 qian), Guizhi (Cinnamomi Ramulus, 4 qian), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 qian), Xingren (Armeniacae Semen Amarum, 25 seeds), Baizhu (Atractylodis Macrocephalae Rhizoma, 8 qian).
Preparation and Administration: Coarsely crush the herbs, decoct with water, and induce slight sweating. In the *Jinkui Yaolue*, Guizhi and Baizhu are removed and Yiyiren (Coicis Semen) is added, naming it Mahuang Xingren Yiyi Gancao Tang (Ephedra, Apricot Seed, Job's Tears, and Licorice Decoction), which treats Dampness prevailing with bodily pain that worsens at dusk.
Commentary: This is a standard exterior-releasing formula for the Taiyang stage. The above formulas are all agents for treating Wind-Cold-Dampness.
Yuanrong Jiawei Wuling San (Modified Five-Ling Powder by Yuanrong): Treats Dampness prevailing, causing body pain, difficult urination, heaviness of the body, and thirst.
Add Qianghuo (Notopterygii Rhizoma et Radix) to this base formula.
Commentary: This is a Taiyang exterior-resolving and damp-draining agent, used for Wind-Damp and Cold-Damp conditions.
Ju Fang Wuji San (Bureau Formula Five Accumulations Powder): Treats external contraction of Wind-Cold, exposure to Cold-Damp, resulting in heavy body and pain. (See the main text of this formula).
Commentary: Haizang (Zhang Congzheng/Li Dongyuan school physician) stated: Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), and Gancao (Glycyrrhizae Radix et Rhizoma) constitute Mahuang Guizhi Ge Ban Tang (Half-and-Half Ephedra and Cinnamon Twig Decoction); Cangzhu (Atractylodis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Houpo (Magnoliae Officinalis Cortex) constitute Pingwei San (Stomach-Pacifying Powder); Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), and Banxia (Pinelliae Rhizoma) constitute Jiegeng Banxia Deng Tang (Platycodon and Pinellia etc. Decoction); plus Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) to treat blood issues, and Ganjiang (Zingiberis Rhizoma) and Houpo (Magnoliae Officinalis Cortex) to dissipate Qi stagnation. The combination of these drugs forms an agent that resolves the exterior, warms the middle, and drains dampness, eliminating phlegm, removing fullness, and regulating menstruation. Although formulated for internal cold with external contraction and simultaneous interior-exterior involvement, it is not strictly the precise formula of Zhang Zhongjing using Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Jiang (Zingiberis Rhizoma), and Fu (Aconiti Radix) for exterior-interior patterns. It is primarily for accumulated cold, vomiting and diarrhea, seasonal epidemics, stiffness of the neck and back (add Congbai Allii Cepae Bulbus and Douchi Sojae Seminem Preparatum); cold extremities (add Wuzhuyu Evodiae Fructus); chills and fever with cough (add Zao Jujubae Fructus); difficult labor in women (add Cu Vinegar). Thus, its application is not limited to one path. Only those who understand flexible methods will select it appropriately.
Dongyuan Qianghuo Tang (Qianghuo Decoction by Li Dongyuan): Treats excessive internal Heat-Dampness, causing heaviness of the body, dizziness, numbness, astringent and red urine, weakness in the lower jiao, and unsteady gait.
Formula seen in the Hot Disease chapter.
Commentary: This is an agent to overcome dampness and raise Yang, derived from the Taiyang Fuling Zexie Tang (Poria and Alisma Decoction) principle.
[Agents for Warm Dispersion]
Zhenwu Tang (True Warrior Decoction): Treats extreme Cold, abdominal pain, dysentery, and heavy limbs.
Fuzi Tang (Aconite Decoction)
Formulas seen in the Cold chapter.
Commentary: This is a standard formula for the Shaoyin Kidney Meridian.
Ju Fang Shen Shi Tang (Bureau Formula Damp-Draining Decoction): Treats injury by Cold-Damp, causing heaviness of the body, coldness in the waist as if sitting in water, astringent or normal urination, loose stools. These result from sitting or lying on wet ground or being attacked by rainy weather.
Herbs: Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) (each 1 liang), Ganjiang (Zingiberis Rhizoma), Fuling (Poria) (each 2 liang), Chenpi (Citri Reticulatae Pericarpium), Dingxiang (Caryophylli Flos) (each 2.5 qian).
Preparation and Administration: Coarsely crush the herbs. For each dose of 4 qian, decoct with Zao (Jujubae Fructus).
Commentary: This consists of herbs for the Foot-Yangming Stomach and Foot-Taiyin Spleen meridians, forming an agent to warm the middle and overcome dampness.