即桂枝、麻黄汤加石膏而除芍药也。夫桂枝主中风,麻黄主伤寒。今比人头痛身热,无汗恶寒,脉来不紧而
缓,为伤寒且中风矣。欲以桂枝解肌驱风,而不能已其寒。欲以麻黄发汗散寒,而不能去其风。仲景所以合二方
而两治之。风寒外感,人身之阳必郁为内热、非质重气轻之物,不足以 其化成。此芍药之所以出,而石膏之所
以加也。名曰大青龙,其嘘气成云,泮涣而游天池之意乎。
诗曰∶桂枝芍药生姜枣;麻黄杏仁仍桂草;二方相合杏枣除,半辛味入青龙小;大青龙合又不同,去芍加膏
功用好。
就二物再用芍药、甘草。
伤寒目痛鼻干,无汗恶寒,发热不眠,阳明经症也,此方主之。
阳明经脉抵目挟鼻,故目痛鼻干。又经属于胃,寒邪伤则气血为之壅滞,故无汗恶寒,而不能安卧。阳明之
药,凉平可使达表,葛根、甘草凉平者也。苦寒可使去热,升麻、芍药苦寒者也。小儿发热壮盛,为痘疹、为风
寒莫能的辨,此方亦稳。
柴胡 葛根 羌活 白芷 黄芩 芍药 桔梗 甘草 石膏 姜枣煎。
头目肿痛,鼻干不眠,恶寒无汗,脉微大,此阳明太阳合病。节庵制此方以代葛根,用亦有效者,盖羌、芷、
柴、葛,皆能升提清阳,而散在经之风寒。寒将变热,石膏、芩、桔以清之。风将越经,芍药、甘草以平之。
诗曰∶升麻葛根芍草辅,柴葛解肌羌芷助,桔芩草芍石膏烧,或入枣姜防药误。
这就是桂枝汤和麻黄汤合并,加入石膏并去除芍药。桂枝主治中风证,麻黄主治伤寒证。如今病人头痛身热,无汗且恶寒,脉象不紧反而缓,这是既患伤寒又患中风。想用桂枝解肌祛风,却无法消除寒邪;想用麻黄发汗散寒,却无法祛除风邪。张仲景因此将这两个方剂合并以同时治疗风寒两感。风寒外感人体,人体的阳气必然郁结化为内热,如果不是质地重而气味轻的药物,不足以促成其化生。这就是为什么要用芍药,以及为什么要加石膏的原因。命名为“大青龙”,大概取其气息如龙嘘气成云,浩瀚游弋于天池之意吧。
诗曰:桂枝、芍药、生姜、大枣;麻黄、杏仁仍配桂枝、甘草;两个方子相合去掉杏仁和大枣,辛味减半进入小青龙(此处指代大青龙汤的组方逻辑);大青龙汤组合又不同,去掉芍药加入石膏,功效显著。
就这两类药物再次使用芍药、甘草。
伤寒导致目痛鼻干,无汗恶寒,发热失眠,这是阳明经的症状,此方主治。
阳明经脉抵达眼部并挟持鼻部,所以出现目痛鼻干。该经又归属于胃,寒邪侵袭则气血为之壅滞,所以无汗恶寒,不能安卧。治疗阳明的药物,性凉平可使药力达表,葛根、甘草属于凉平之品;性苦寒可清除热邪,升麻、芍药属于苦寒之品。小儿发热壮盛,若是痘疹还是风寒难以辨别时,此方也稳妥有效。
柴胡、葛根、羌活、白芷、黄芩、芍药、桔梗、甘草、石膏,加生姜、大枣煎服。
头目肿痛,鼻干失眠,恶寒无汗,脉象微大,这是阳明病与太阳病合病。节庵制作此方以替代葛根汤,使用也有效,因为羌活、白芷、柴胡、葛根,都能升提清阳,并疏散在经络中的风寒。寒邪将要化热,用石膏、黄芩、桔梗来清热。风邪将要越过经络传变,用芍药、甘草来平抑。
诗曰:升麻、葛根、芍药、甘草辅助,柴胡、葛根、解肌、羌活、白芷协助,桔梗、黄芩、甘草、芍药、石膏烧煮,或者加入大枣、生姜防止药物偏误。
This is the combination of Guizhi Tang (Cinnamon Twig Decoction) and Mahuang Tang (Ephedra Decoction), with Shigao (Gypsum Fibrosum) added and Shaoyao (Paeoniae Radix Alba) removed. Guizhi (Cinnamon Twig) primarily treats Fengzhong (Wind Strike/Exterior Deficiency Syndrome), while Mahuang (Ephedra) primarily treats Shanghan (Cold Damage/Exterior Excess Syndrome). Currently, the patient presents with headache, body heat, absence of sweating, aversion to cold, and a pulse that is neither tight but rather slow. This indicates a condition involving both Shanghan and Fengzhong. One might wish to use Guizhi to resolve the muscle layer and expel wind, yet it cannot eliminate the cold; one might wish to use Mahuang to induce sweating and disperse cold, yet it cannot remove the wind. Therefore, Zhang Zhongjing combined these two formulas to treat both simultaneously. When Wind-Cold invades from the exterior, the body's Yang Qi must become stagnant and transform into internal heat. Only substances with heavy texture and light aroma are sufficient to facilitate this transformation. This explains the introduction of Shaoyao (Paeoniae Radix Alba) and the addition of Shigao (Gypsum Fibrosum). Named "Da Qinglong" (Great Azure Dragon Decoction), it likely implies the imagery of the dragon exhaling air to form clouds, vast and roaming in the Heavenly Pool.
The poem states: Guizhi (Cinnamon Twig), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Fresh), and Dazao (Jujubae Fructus); Mahuang (Ephedrae Herba) and Xingren (Armeniacae Semen Amarum) still paired with Guizhi (Cinnamon Twig) and Gancao (Glycyrrhizae Radix et Rhizoma); Combining the two formulas, remove Xingren (Armeniacae Semen Amarum) and Dazao (Jujubae Fructus), reducing the pungent flavor by half for the Qinglong formula; The Great Azure Dragon combination differs again, removing Shaoyao (Paeoniae Radix Alba) and adding Shigao (Gypsum Fibrosum), yielding excellent efficacy.
Regarding these two categories of drugs, Shaoyao (Paeoniae Radix Alba) and Gancao (Glycyrrhizae Radix et Rhizoma) are used again.
Shanghan (Cold Damage) causing eye pain and nasal dryness, absence of sweating, aversion to cold, fever, and insomnia, constitutes symptoms of the Yangming Channel (Yangming Meridian). This formula is indicated for such conditions.
The Yangming Channel reaches the eyes and flanks the nose, hence the eye pain and nasal dryness. Furthermore, as the channel belongs to the Stomach (Wei Zang), when injured by Cold Pathogens (Han Xie), Qi and Blood become congested and stagnant, resulting in absence of sweating, aversion to cold, and inability to lie down peacefully. Medicinals for Yangming that are cool and neutral can reach the exterior; Gegen (Puerariae Lobatae Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) are of cool and neutral nature. Medicinals that are bitter and cold can clear heat; Shengma (Cimicifugae Rhizoma) and Shaoyao (Paeoniae Radix Alba) are of bitter and cold nature. In children with intense fever, whether due to Douzhen (Smallpox/Chickenpox) or Fenghan (Wind-Cold) may be difficult to distinguish; this formula is also stable and effective.
Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix Alba), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shigao (Gypsum Fibrosum), decocted with Shengjiang (Zingiberis Rhizoma Fresh) and Dazao (Jujubae Fructus).
Head and eye swelling and pain, nasal dryness, insomnia, aversion to cold, absence of sweating, and a slightly large pulse indicate a concurrent disease of Yangming (Yangming Syndrome) and Taiyang (Taiyang Syndrome). Jie'an formulated this prescription to substitute Gegen Tang (Kudzu Decoction), which is also effective, because Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix) can all ascend and raise Clear Yang, and disperse Wind-Cold residing in the channels. As Cold is about to transform into Heat, Shigao (Gypsum Fibrosum), Huangqin (Scutellariae Radix), and Jiegeng (Platycodonis Radix) are used to clear it. As Wind is about to cross channels, Shaoyao (Paeoniae Radix Alba) and Gancao (Glycyrrhizae Radix et Rhizoma) are used to pacify it.
The poem states: Shengma (Cimicifugae Rhizoma), Gegen (Puerariae Lobatae Radix), Shaoyao (Paeoniae Radix Alba), and Gancao (Glycyrrhizae Radix et Rhizoma) assist; Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix), Jiemo (Resolving Muscle), Qianghuo (Notopterygii Rhizoma et Radix), and Baizhi (Angelicae Dahuricae Radix) support; Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shaoyao (Paeoniae Radix Alba), and Shigao (Gypsum Fibrosum) are boiled; alternatively, add Dazao (Jujubae Fructus) and Shengjiang (Zingiberis Rhizoma Fresh) to prevent medicinal errors.