柴胡升麻汤治头痛壮热恶风体疼鼻塞咽干痰盛咳嗽涕唾稠粘
柴胡 前胡 黄芩(各六两半) 荆芥(七两半) 赤芍 石膏(各十两) 升麻(五两) 桑
白皮 干葛
上咀姜三片豉十粒水煎
按此足少阳阳明经药也
钱氏大青膏发散风邪
天麻(一钱) 麝(一字匕) 白附子末(生用一钱半) 朱砂(研一字) 青黛(研一钱) 天
竺黄(一字匕) 蝎尾(去毒生半钱) 乌梢蛇肉(半钱)
上同再研细生蜜和成膏每服半皂子大至一皂子大月中儿粳米大大人弹子大同牛黄膏温薄
荷水化下一处服之
宣明防风通圣散 方见中风门
谨按伤风诸方俱是解表之剂盖以风从外入之邪也其所挟有寒热温凉之不同故此分辛温辛
平辛
凉之异然风虽外邪传变入里亦宜随证施治钱仲阳论伤风当发散者用大青膏解不散有下证者用
大黄丸可谓得仲景之奥矣诸方于此俱未曾论及也又前论表虚受风与内挟痰热之方亦未详备学
者当自求之所谓大黄丸亦附于后
大黄 黄芩
二味各等分水丸
要略云脉双弦者寒也皆大下后善虚脉偏弦者饮也肺饮不弦但苦喘气短 又云脉浮而细滑
者伤饮脉弦数有寒饮冬夏难治 脉沉而弦者悬饮内痛
其人短气四支历节痛脉沉者有留饮
陈无择云饮脉皆弦微沉滑 或云左右关脉大者膈上有痰也可吐之
病患百药不效关上脉伏而大者痰也眼皮及眼下如灰烟黑者痰也
柴胡升麻汤治疗头痛、高热、恶风、身体疼痛、鼻塞、咽喉干燥、痰多、咳嗽以及鼻涕和唾液粘稠。
药材:柴胡、前胡、黄芩(各六两半)、荆芥(七两半)、赤芍、石膏(各十两)、升麻(五两)、桑白皮、干葛。
制法:将上述药材切碎,加入生姜三片、豆豉十粒,用水煎煮。
按语:这是足少阳胆经和足阳明胃经的药物。
钱乙的大青膏用于发散风邪。
药材:天麻(一钱)、麝香(一字匕)、白附子末(生用一钱半)、朱砂(研细,一字)、青黛(研细,一钱)、天竺黄(一字匕)、蝎尾(去毒,生用半钱)、乌梢蛇肉(半钱)。
制法:将上述药材共同研磨成细粉,用生蜜调和成膏剂。每次服用半个皂荚子大小至一个皂荚子大小;中等的婴儿用粳米大小的量,成人用弹子大小的量。用牛黄膏配合温薄的薄荷水化开送服。
《宣明论方》中的防风通圣散,方剂见中风门。
谨按:治疗伤风的各方剂都是解表剂,因为风是从外部侵入的邪气。由于风邪夹杂寒、热、温、凉的不同性质,因此分为辛温、辛平、辛凉等不同类别。然而,风邪虽然是外邪,但传入体内后也会发生传变入里,此时也应当根据证候进行治疗。钱仲阳论述伤风时,对于应当发散的情况使用大青膏;如果解表不散且有下焦实证者,则使用大黄丸,这可以说是深得张仲景的奥妙之处。其他方剂在此方面未曾论及。另外,前文关于表虚受风与内挟痰热的方剂也未详细完备,学者应当自行探求。所谓的大黄丸也附在后面。
药材:大黄、黄芩。
制法:两味药各等分,用水泛为丸。
《金匮要略》说:脉象双弦的是寒证,多见于峻下之后导致正气虚弱;脉象偏弦的是饮证。肺中有饮邪不一定表现为弦脉,但患者会感到气喘、气短。又说:脉浮而细滑的是伤饮(感受水饮之邪)。脉弦数且伴有寒饮,在冬季和夏季都难以治疗。脉沉而弦的是悬饮,伴有内部疼痛。
患者气短,四肢关节疼痛,脉沉的有留饮(停留的水饮)。
陈无择说:饮证的脉象大多呈弦象,或微沉滑。有人说:左右关脉大的,说明膈上有痰,可以用吐法治疗。
如果病人服用多种药物无效,且关上脉伏大而有力的,是痰证;眼皮及眼下部位颜色如灰烟黑色,也是痰证。
Chaihu Shengma Decoction treats headache, high fever, aversion to wind, body pain, nasal congestion, dry throat, abundant phlegm, cough, and thick, sticky sputum and nasal discharge.
Herbs: Bupleuri Radix (Chaihu), Peucedani Radix (Qianhu), Scutellariae Radix (Huangqin) (each 6.5 liang), Schizonepetae Spica (Jingjie) (7.5 liang), Paeoniae Radix Rubra (Chishao), Gypsum Fibrosum (Shigao) (each 10 liang), Cimicifugae Rhizoma (Shengma) (5 liang), Morus Cortex (Sangbaipi), Puerariae Radix (Gegen).
Preparation: Coarsely crush the above herbs, add three slices of Zingiberis Rhizoma Recens (fresh ginger) and ten grains of Soja Preparata (douchi), and decoct in water.
Note: These are herbs for the Foot-Shaoyang Gallbladder and Foot-Yangming Stomach meridians.
Qian’s Daqing Ointment disperses wind pathogenic factors.
Herbs: Gastrodiae Rhizoma (Tianma) (1 qian), Moschus (She) (1 zi bi), Bai Fuzi powder (raw use, 1.5 qian), Cinnabar (Zhu Sha) (ground, 1 zi), Qingdai (ground, 1 qian), Tianshuhuang (1 zi bi), Scorpio (Xiewei) (de-venomed, raw use, 0.5 qian), Zaocys Carapax et Squama (Wushaoshe Rou) (0.5 qian).
Preparation: Grind all ingredients together into a fine powder, mix with raw honey to form an ointment. Take half the size of a soap pod to one soap pod per dose; for medium-sized infants, take the size of a rice grain; for adults, take the size of a bullet. Dissolve with Niuhuang Gao using warm, thin mint water and administer together.
Fangfeng Tongsheng San from *Xuanming Lun Fang*, see the Stroke section for the formula.
Comment: All formulas for treating wind-cold are exterior-resolving agents because wind is an external pathogenic factor invading from outside. Due to the different combinations of cold, heat, warmth, and coolness associated with the wind, they are classified into acrid-warm, acrid-neutral, and acrid-cool categories. However, although wind is an external pathogen, it can transmit inward after entering the body; thus, treatment should be administered according to the syndrome. Qian Zhongyang discussed that for wind-cold requiring dispersion, Daqing Ointment should be used; if the exterior is not resolved and there are interior excess signs, Dahuang Wan should be used. This truly captures the profound principles of Zhang Zhongjing. Other formulas have not discussed this aspect. Furthermore, the previous discussion on formulas for exterior deficiency with wind invasion and internal accumulation of phlegm-heat was not detailed enough; scholars should seek them out themselves. The so-called Dahuang Wan is attached below.
Herbs: Rhei Radix et Rhizoma (Dahuang), Scutellariae Radix (Huangqin).
Preparation: Equal parts of both herbs, made into pills using water as a binder.
*Jingui Yaolue* states: A pulse that is double-string-like indicates cold, often occurring after severe purgation leading to deficiency; a pulse that is single-string-like indicates fluid retention. Fluid retention in the lungs may not present with a string-like pulse, but the patient will suffer from wheezing and shortness of breath. It also states: A floating, fine, and slippery pulse indicates injury by fluids. A wiry and rapid pulse accompanied by cold-fluid retention is difficult to treat in winter and summer. A deep and wiry pulse indicates suspended fluid retention with internal pain.
The patient experiences shortness of breath, pain in the four limbs and joints; a deep pulse indicates retained fluid retention.
Chen Wuyue stated: Pulses of fluid retention are generally wiry, or slightly deep and slippery. Some say: If the left and right Guan positions are large, there is phlegm above the diaphragm, which can be treated with emesis.
If a patient has taken many medicines without effect, and the Guan position pulse is hidden yet large and forceful, it is a phlegm syndrome; if the eyelids and the area under the eyes are dark like gray smoke, it is also a phlegm syndrome.