一曰发 发则重。解肌者为表之表,药用辛甘,言腠理致密,非辛甘不能开发,故
曰发。发者,发正表也。(寒伤营无汗麻黄汤。风伤卫有汗桂枝汤。)
二曰解 解则轻于发。为表之轻,药用辛凉,言腠理将疏,恶寒已罢,邪将化
而为热,但表病里和,非辛不能散表,非凉不能解热,故曰解。解肌肉也。(升麻葛根汤主之。)
三曰和 和又轻于解。表将罢,药用辛者少,凉者重,言邪将入腑而未深入,腑
曰表,不可曰里,不可发于解,俱难施于表里之中,故曰和。和者和其半表半里也。(小柴胡汤主之。)
四曰攻 攻则重于和。为表已罢,邪气入腑,药用苦寒,言邪自三阳经入结于
肠胃,非苦寒不能攻,故曰攻。攻者,攻其实热也。(承气汤主之。)
五曰救 救则与攻大异。热则攻,寒则救,药有温热,言邪不由阳经而入,竟
中三阴,名曰直中。内寒盛极,阳气已危,故曰救。救者,急救危阳也。(寒客中焦理中汤。阴证厥逆四逆汤。)
五法独不言吐者,盖仲景有汗、吐、下三法,为皮毛胃腑而设。汗之言邪在皮毛,
吐之言邪在胃之上脘,下之言邪在胃腑凝结。今人用吐法,用在半表半里,所害非
浅。盖少阳胆经汗、吐、下三法皆禁,误吐之遂变为坏证,则吐不施于半表半里明
矣。若胃上脘痰涎胸痞者,方敢议吐。(实邪用瓜蒂赤小豆吐之,虚烦用栀子淡豆豉吐之,虚痰以人
参芦吐之,风痰以皂角、白矾吐之,干霍乱以烧盐、热童便吐之。)
一曰“发”,其力度较重。所谓“解肌”属于表证的浅层,用药多用辛味和甘味药,这是因为腠理致密,非辛甘之品不能开发宣散,所以称为“发”。所谓“发”,是指发散正邪在体表。(寒邪伤及营分导致无汗者,用麻黄汤;风邪伤及卫分导致有汗者,用桂枝汤。)
二曰“解”,其力度轻于“发”。这是针对表证较轻的情况,用药多用辛凉之品,意指腠理即将疏泄,恶寒症状已经解除,邪气将要化热,此时仅是表病而里气调和,非辛味不能疏散表邪,非凉性不能解除热邪,所以称为“解”。所谓“解”,是解除肌肉层面的邪气。(用升麻葛根汤主治。)
三曰“和”,其力度又轻于“解”。此时表证即将解除,用药中辛味药较少,凉味药较多,意指邪气将要传入腑但未深入,腑相对于脏而言仍属表(此处指半表半里),不可称为里,既不能用“发”法,也不能用“解”法,都难以施用于单纯的表或里之间,所以称为“和”。所谓“和”,是调和半表半里的邪气。(用小柴胡汤主治。)
四曰“攻”,其力度重于“和”。此时表证已解,邪气传入腑,用药多用苦寒之品,意指邪气从三阳经传入并结聚于肠胃,非苦寒之品不能攻逐,所以称为“攻”。所谓“攻”,是攻逐实热邪气。(用承气汤主治。)
五曰“救”,这与“攻”法大不相同。热证用攻法,寒证用救法,用药多用温热之品,意指邪气不通过阳经传入,直接侵犯三阴经,称为“直中”。体内寒邪极盛,阳气已经危殆,所以称为“救”。所谓“救”,是急救危亡的阳气。(寒邪客居中焦用理中汤;阴证出现四肢厥逆用四逆汤。)
这五种方法唯独没有提到“吐”法,大概是因为张仲景提出的汗、吐、下三法,是为皮毛和胃腑的病证而设立的。汗法是针对邪气在皮毛,吐法是针对邪气在胃的上脘,下法是针对邪气在胃腑凝结。现在的人使用吐法,却用在半表半里的病位,危害不小。因为少阳胆经禁用汗、吐、下三法,误用吐法会导致病情恶化变为坏证,由此可见吐法不适用于半表半里。只有当胃的上脘有痰涎停滞、胸膈痞闷时,才敢讨论使用吐法。(实证邪气用瓜蒂和赤小豆催吐,虚烦用栀子和淡豆豉催吐,虚痰用人参芦催吐,风痰用皂角和白矾催吐,干霍乱用烧盐和田间清晨的热小便催吐。)
First is "Fa" (Expelling), which is forceful. "Jie Ji" (Resolving the muscle layer) pertains to the superficial aspect of exterior syndromes, utilizing acrid and sweet herbs. This is because when the Cou Li (pores and interstices) are dense, only acrid and sweet properties can open and disperse them; hence it is called "Fa". "Fa" refers to expelling pathogens from the correct exterior level. (For cold damaging the Ying [Nutritive] level resulting in anhidrosis, use Mahuang Tang [Ephedra Decoction]; for wind damaging the Wei [Defensive] level resulting in diaphoresis, use Guizhi Tang [Cinnamon Twig Decoction].)
Second is "Jie" (Resolving), which is lighter than "Fa". It addresses mild exterior syndromes, utilizing acrid-cool herbs. This implies that the Cou Li are about to open, aversion to cold has ceased, and pathogens are transforming into heat. At this stage, there is only exterior pathology with interior harmony; acrid properties are needed to scatter exterior pathogens, and cool properties are needed to resolve heat; hence it is called "Jie". "Jie" refers to resolving pathogens at the muscle level. (Shengma Gegen Tang [Kudzu Root and Cimicifuga Decoction] is used.)
Third is "He" (Harmonizing), which is lighter than "Jie". The exterior syndrome is nearly resolved; the prescription contains fewer acrid herbs and more cool herbs. This indicates that pathogens are about to enter the Fu organs but have not penetrated deeply. The Fu organs, in this context, are considered part of the exterior spectrum rather than the interior; neither "Fa" nor "Jie" methods are applicable as they cannot be applied between the exterior and interior levels; hence it is called "He". "He" refers to harmonizing the Shaoyang [Half-Exterior Half-Interior] level. (Xiao Chaihu Tang [Minor Bupleurum Decoction] is used.)
Fourth is "Gong" (Attacking/Purging), which is heavier than "He". The exterior syndrome has resolved, and pathogens have entered the Fu organs. The prescription utilizes bitter-cold herbs. This indicates that pathogens have transferred from the Three Yang meridians and condensed in the intestines and stomach; only bitter-cold properties can purge them; hence it is called "Gong". "Gong" refers to attacking excess heat. (Chengqi Tang [Ordering the Qi Decoction] is used.)
Fifth is "Jiu" (Saving/Rescuing), which differs significantly from "Gong". Heat syndromes are treated with "Gong", while cold syndromes are treated with "Jiu", utilizing warm-hot herbs. This indicates that pathogens did not enter via the Yang meridians but directly attacked the Three Yin meridians, termed "Zhi Zhong" (Direct Transmission). Internal cold is extreme, and Yang Qi is critical; hence it is called "Jiu". "Jiu" refers to urgently rescuing critical Yang Qi. (For cold invading the Middle Jiao, use Lizhong Tang [Regulate the Middle Decoction]; for Yin syndromes with cold extremities, use Sini Tang [Frigid Extremities Decoction].)
These five methods do not mention "Tu" (Emesis). This is likely because Zhang Zhongjing's three methods—Han (Sweating), Tu (Emesis), and Xia (Purging)—were established for pathologies of the skin/hair and the stomach/intestines. "Han" addresses pathogens in the skin/hair; "Tu" addresses pathogens in the upper epigastrium of the stomach; "Xia" addresses pathogens condensed in the stomach and intestines. Modern practitioners often apply emesis to the Shaoyang [Half-Exterior Half-Interior] level, causing significant harm. The Shaoyang Gallbladder meridian strictly prohibits sweating, emesis, and purging; erroneous use of emesis leads to complicated syndromes (Huai Zheng), clearly indicating that emesis is not applicable to the Shaoyang level. Emesis should only be considered when phlegm-fluids cause chest fullness and obstruction in the upper epigastrium. (For excess pathogens, use Genti and Chixiaodou [Culantro and Adzuki Bean] to induce vomiting; for deficiency-heat irritability, use Zhizi and Danshichu [Gardenia and Fermented Soybean] to induce vomiting; for deficiency-phlegm, use Ren Shen Lu [Ginseng Rhizome Stalk] to induce vomiting; for wind-phlegm, use Zaojiao and Baifan [Tamarisk Seed Pod and Alum] to induce vomiting; for Gan Huoluan [Dry Cholera], use Shao Yan [Burnt Salt] and Re Tongbian [Hot Fresh Urine] to induce vomiting.)