郭稽中云产后汗出多而变 者由产后血虚肉理不密故多汗因遇风邪搏之则变 宜灌小续
命汤稍缓即汗出如雨手拭不及不可治也
按此既云产后则血气本虚矣汗出既多则卫气亦虚纵有风邪乘之小续命用麻黄辈其可服乎
况有虚象而实非风者哉陈无择虽尝论其失所用大豆
紫汤大圣散亦未尽善也
谨按伤寒 病活人以太阳中风又感寒湿而致则专于外邪所伤然仲景亦有汗下过多之戒则
又出
于坏证所成矣盖外邪所伤者通宜解散仲景言刚柔活人分阴阳难知论经络等诸方详矣至于治坏
证补虚救失之法诸方则亡也又千金谓温病热入肾中亦为 小儿病痫热盛亦为 若此治法俱未
之见也况此二者之外又有血气本虚之人如产后汗出多而变 者或因七情怒气而发 者或因湿
热内盛痰涎壅遏经络而作 者治各不同也大抵伤寒有外邪之可解宜用风药发散风寒又风药亦
能胜湿耳至于邪热入肾亦非风药之所能疗也其内证作 本无外邪前人岂仍用风药处治惟宜补
虚降火敦土平木清痰去湿随证而用不可不察也 证治法
金匮栝蒌桂枝汤治太阳病其谨备身体强几几然脉反沉迟此为 病
栝蒌根 甘草(炙各二两) 桂枝 芍药 生姜(各三两) 大枣(十二枚)
上六味以水九升煮取三升分温三服取微汗汗不出食顷啜热粥发之
按此出太阳例药也
葛根汤治太阳病无汗而小便反少气上冲胸口噤不得语欲作刚
方见伤寒门
海藏神术汤治刚
加羌活 独活 麻黄
白术汤治柔
加桂心 黄 白术
活人举卿举败散治新产血虚 者汗后中风发搐亦然荆芥穗不以多少微炒为末大豆黄卷熟
以酒沃之去黄卷取汁调细末三五钱和渣饮之其效如神一方只以好酒调服
按此太阳厥阴经药也按本草荆芥能发汗破结气下瘀血除风湿痹亦是攻邪之药若血气果虚
之人亦非所宜也
郭稽中说:产后出汗多而出现痉挛变证,是因为产后血虚、腠理(皮肤毛孔及皮下组织)不致密,所以容易出汗。如果此时遇到风邪侵袭搏结,就会导致痉挛变证,适宜灌服小续命汤。如果病情稍加缓解,就会汗出如雨,手巾擦拭不及,这就不可治了。
按语:这里既然说是产后,那么气血本来就已经虚弱了。出汗既多,卫气(行于脉外,具有防御外邪作用的气)也虚弱。纵然有风邪乘虚而入,小续命汤中使用的麻黄等发汗药,怎么可以服用呢?况且那些表现为虚象而实际上并非真正中风的情况呢?陈无择虽然曾经论述过这种失误,但他所用的大豆紫汤、大圣散也不算是尽善尽美。
谨按:伤寒论中的痉病,活人书认为是太阳中风又感受寒湿所致,则专门针对外邪所伤。然而张仲景也有因汗法、下法使用过多而导致坏证(误治后形成的复杂危重病症)的告诫,这又是由于坏证造成的。大概外邪所伤的,通宜用解散法;张仲景关于刚痉、柔痉,活人书关于分阴阳、难知论、经络等各方论述得很详细了。至于治疗坏证、补虚救失的方法,其他方书中已经失传了。另外,《千金方》说温病热入肾中也会引起痉挛,小儿病痫热盛也会引起痉挛。像这样的治疗方法,都没有见到过。况且在这两种情况之外,又有气血本已虚弱的人,比如产后出汗多而引发痉挛的,或者因为七情怒气而引发痉挛的,或者因为湿热内盛、痰涎壅遏经络而引发痉挛的,治疗方法各不相同。大抵伤寒有外邪可以解散,适宜用风药发散风寒,而且风药也能胜湿。至于邪热入肾,也不是风药所能治疗的。那些内证引起的痉挛,本来就没有外邪,前人难道还继续使用风药处理吗?只适宜补虚、降火、敦土(健脾)、平木(平肝)、清痰、去湿,随证施用,不可不仔细考察。这是痉挛证的治疗方法。
《金匮要略》栝蒌桂枝汤:治疗太阳病,身体强直几几然(形容颈项强直不舒),脉象反而沉迟,这是痉病。
药物组成:栝蒌根、甘草(炙,各二两)、桂枝、芍药、生姜(各三两)、大枣(十二枚)。
煎服法:以上六味药,用水九升,煮取三升,分三次温服。服药后取微汗;如果汗不出,喝热粥一会儿以助发汗。
按语:此方出自太阳病例,是解表药。
葛根汤:治疗太阳病,无汗而小便反而少,气上冲胸口,牙关紧闭不能说话,想要发作刚痉。
(方剂见伤寒门)
《活人书》举卿举败散:治疗新产血虚导致的痉挛,汗后中风引发的抽搐也一样。荆芥穗不拘多少,微炒后研为细末。大豆黄卷煮熟,用酒浸泡,去掉豆卷,取汁液调服细末三五钱,连同药渣一起喝下,效果如神。另一方法只用好酒调服。
按语:这是太阳经和厥阴经的药。按《本草》记载,荆芥能发汗、破结气、下瘀血、除风湿痹,也是攻邪的药物。如果气血确实虚弱的人,也不适宜使用。
Guo Jizhong stated: Postpartum sweating leading to spasmodic changes occurs because postpartum blood deficiency and loose cou li (skin pores and subcutaneous tissue) cause excessive sweating. If wind pathogen invades and combats with the body during this time, it leads to spasmodic changes; it is appropriate to administer Xiao Xuming Tang (Minor Continuation of Life Decoction). If the condition slightly relieves, sweat will pour out like rain, too fast for a handkerchief to wipe, which becomes incurable.
Commentary: Since this refers to postpartum, Qi and Blood are originally deficient. Excessive sweating further depletes Wei Qi (Defensive Qi). Even if wind pathogen takes advantage of the deficiency, how can one take Mahuang (Ephedra) and similar diaphoretic herbs found in Xiao Xuming Tang? Moreover, what about cases that present as deficiency but are not true Wind stroke? Although Chen Wuzhai once discussed this error, his use of Dazao ZiTang (Soybean Purple Decoction) and Dasheng San (Great Sage Powder) was not entirely sound.
Respectfully noted: In Shanghan Lun (Treatise on Cold Damage), Jingzhui disease (Spasm) is caused by Taiyang Wind Strike compounded by Cold-Dampness, specifically targeting external pathogen injury. However, Zhang Zhongjing also warned against damage syndromes (Huai Zheng) resulting from excessive sweating or purging methods, which arise from mismanagement complications. Generally, injuries by external pathogens are treated with dispersing methods. Zhang Zhongjing’s discussions on Gang-Jing (Rigid Spasm) and Rou-Jing (Flaccid Spasm), along with Huorenbian’s theories on Yin-Yang differentiation and meridians, are detailed. Methods for treating damage syndromes, tonifying deficiency, and correcting errors have been lost in other formularies. Additionally, Qianjin Fang states that Warm Disease heat entering the Kidney causes spasm, and pediatric epilepsy with intense heat also causes spasm. Such treatment methods have not been seen. Furthermore, beyond these two categories, there are individuals with original Qi-Blood deficiency, such as those developing spasm due to excessive postpartum sweating, or due to Seven Emotions/Anger, or due to internal excess Heat-Dampness obstructing collaterals with Phlegm-Saliva. Treatments vary greatly. Generally, Shanghan with external pathogens is resolved using Wind herbs to disperse Cold-Wind, which also overcome Dampness. However, Heat entering the Kidney cannot be treated with Wind herbs. Internal spasm without external pathogens should not be treated with Wind herbs by predecessors; instead, one should tonify deficiency, descend Fire, strengthen Earth (Spleen), calm Wood (Liver), clear Phlegm, and remove Dampness according to symptoms. Careful observation is required. This describes the treatment method for Jingzhui disease.
Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet): Gualou Guizhi Tang treats Taiyang disease where the body is stiff and rigid, with a sinking and slow pulse, indicating Jingzhui disease.
Ingredients: Gualou Gen (Trichosanthes Root), Gancao (Licorice Root, honey-fried, 2 liang each); Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Shengjiang (Fresh Ginger, 3 liang each); Dazao (Jujube, 12 pieces).
Preparation: The above six ingredients are boiled in 9 sheng of water to obtain 3 sheng. Divide into three warm doses. Aim for slight sweating; if no sweat, drink hot porridge shortly after administration to induce sweating.
Commentary: This formula belongs to the Taiyang category, utilizing exterior-releasing herbs.
Gegen Tang (Kudzu Decoction): Treats Taiyang disease with no sweating, reduced urination, Qi rushing to the chest, trismus (lockjaw), and inability to speak, indicating impending Gang-Jing (Rigid Spasm).
(See Shanghan section for formula details)
Haizang Shenji Tang (Sea Storehouse Divine Skill Decoction): Treats Gang-Jing.
Add: Qianghuo (Notopterygium Rhizome), Duhuo (Angelica Pubescens Root), Mahuang (Ephedra Herb).
Baizhu Tang (Atractylodes Macrocephala Decoction): Treats Rou-Jing (Flaccid Spasm).
Add: Guixin (Cinnamon Bark), Huangqi (Astragalus Root), Baizhu (Atractylodes Macrocephala Rhizome).
Huorenbian Juqing Jubai San (Living People's "Lifting Minister" Defeat Decay Powder): Treats postpartum blood deficiency causing spasm, or convulsions following wind strike after sweating. Jingjie Sui (Schizonepeta Spike, amount unspecified) is lightly fried and ground to powder. Dahuangjuan (Fermented Soybean) is cooked, soaked in wine, the beans removed, and the juice used to mix 3-5 qian of the fine powder. Drink with the dregs; efficacy is miraculous. Another method uses good wine alone for mixing.
Commentary: These are herbs for the Taiyang and Jueyin meridians. According to Ben Cao materia medica, Jingjie (Schizonepeta) induces sweating, breaks stagnation, expels stasis, and removes Wind-Damp Bi syndrome; it is an herb for attacking pathogens. It is not suitable for those with genuine Qi-Blood deficiency.