考 证
芍药甘草汤证曰∶脚挛急。
甘草干姜汤证曰∶厥,咽中干,烦躁。
甘草泻心汤证曰∶心烦不得安。
甘姜甘草汤证曰∶咽燥而渴。
桂枝人参汤证曰∶利下不止。
以上五方,甘草皆四两。
芍药甘草附子汤证,不具也,(说在互考中)
甘麦大枣汤证曰∶藏躁喜悲伤欲哭。
以上二方,甘草皆三两。
甘草汤证曰∶咽痛者。
桔梗汤证,不具也。(说在互考中)
桂枝甘草汤证曰∶叉手自冒心。
桂枝甘草龙骨牡蛎汤证曰∶烦躁。
四逆汤证曰∶四肢拘急厥逆。
甘草粉蜜汤证曰∶令人吐涎、心痛发作有时,毒药不止。
以上六方,甘草皆二两。
上八方,甘草二两三两,而亦四两之例。
苓桂甘枣汤证曰∶脐下悸。
苓桂五味甘草汤证曰∶气从小腹上冲胸咽。
小建中汤证曰∶里急。
半夏泻心汤证曰∶心下痞。
小柴胡汤证曰∶心烦。又云∶胸中烦。
小青龙汤证曰∶咳逆倚息。
黄连汤证曰∶腹中痛。
人参汤证曰∶逆抢心。
旋复花代赭石汤证曰∶心下痞硬、噫气不除。
乌头汤证曰∶疼痛不可屈伸。又云∶拘急不得转侧。
以上十方,甘草皆三两。
排脓汤证。阙。(说在桔梗部)
谓胃承气汤证曰∶不吐、不下、心烦。
桃核承气汤证曰∶其人如狂。又云∶少腹急结。
桂枝加桂汤证曰∶奔豚,气从少腹上冲心。
桂枝去芍药加蜀漆龙骨牡蛎汤证曰∶惊狂、起卧不安。
以上五方,甘草皆二两。
上历观此诸方。无论急迫,其他曰痛、曰厥、曰烦、曰悸、曰咳、曰上逆、曰惊狂、曰
悲伤、曰痞硬、曰利下,皆甘草所主。而有所急迫者也,仲景用甘草也;其急迫剧者,则用
甘草亦多。不剧者,则用甘草亦少。由是观之,甘草之治急迫也明矣。古语曰∶病者苦急,
急食甘以缓之。其斯甘草之谓乎?仲景用甘草之方甚多,然其所用者,不巡前证,故不枚举
焉。
凡征多而证明者,不枚举其征,下皆效之。
互 考
甘草汤证曰∶咽痛者,可与甘草汤。不差者,与桔梗汤。凡其急迫而痛者,甘草治之。
其有脓者,桔梗治之。今以其急迫而痛,故与甘草汤。而其不差者,已有脓也。故与桔梗汤,
据
芍药甘草附子汤,其证不具也。为则按其章曰∶发汗病不解,反恶寒。是恶寒者,附子
主之。而芍药、甘草,则无主证也。故此章之义,以芍药甘草汤。脚挛急者,而随此恶寒,
则此证始备矣。为则按∶调胃承气汤、桃核承气汤,俱有甘草。而大小承气汤、浓朴三物汤,
皆无甘草也。
汤证曰∶或如狂、或少腹急结,是虽有结实。然狂与急结,此皆为急迫,故用甘草也。大小
承气汤、浓朴三物汤、大黄黄连泻心汤,俱解其结毒耳。故无甘草也,学人详诸。
辨 误
陶弘景曰∶此草最为众药之主。孙思邈曰∶解百药之毒。甄权曰∶诸药中,甘草为君,
治七十二种金石毒,解一千二百般草木毒,调和众药有功。呜呼?此说一出,而天下无复知
甘草之本功,不亦悲哉?若从三子之说,则诸凡解毒,唯须此一味而足矣!今必不能,然则
其说之非也可以知已。夫欲知诸药本功,则就长沙方中,推历其有无多少。与其去加,引之
于其证。则其本功,可得而知也。而长沙方中,无甘草者居半,不可谡众药之主也,亦可以
见已。古语曰∶攻病以毒药,药皆毒,毒即能。若解其毒,何功之有?不思之甚矣。学人察
诸。夫陶弘景、孙思邈者,医家之俊杰,博治之君子也。故后世尊奉之至矣。而谓甘草众药
之主,谓解百药之毒,岂得无征乎?考之长沙方中,半夏泻心汤本甘草三两,而甘草泻心汤
更加一两,是足前为四两,而误药后用之,陶、孙盖卒尔见之,谓为解药毒也。呜呼?夫人
之过也,各于其党。故观二子之过,斯知尊信仲景之至矣。向使陶、孙知仲景误药后,所以
用甘草,与不必改其过何也?陶、孙诚俊杰也,俊杰何为文其过乎?由是观之,陶、孙实不
知甘草之本功也,亦后世之不幸哉!
东垣李氏曰∶生用则补脾胃不足,而大泻心火;炙之则补三焦元气,而散表寒。是仲景
所不言也。五藏浮说,战国以降,今欲为疾医乎?则不可言五藏也。五藏浮说,战国以降,
不可从也。
品 考
甘草 华产上品,本邦所产者,不堪用也。余家唯锉用之也。
考证
芍药甘草汤证表现为:脚部痉挛拘急。
甘草干姜汤证表现为:四肢厥冷,咽喉干燥,烦躁不安。
甘草泻心汤证表现为:心烦意乱,无法安宁。
甘姜甘草汤证表现为:咽喉干燥且口渴。
桂枝人参汤证表现为:腹泻不止。
以上五个方剂中,甘草的用量均为四两。
芍药甘草附子汤证,原文未完整列出(详见互考部分)。
甘麦大枣汤证表现为:脏躁,情绪悲伤想哭。
以上两个方剂中,甘草的用量均为三两。
甘草汤证表现为:咽喉疼痛。
桔梗汤证,原文未完整列出(详见互考部分)。
桂枝甘草汤证表现为:双手交叉按压在心口部位。
桂枝甘草龙骨牡蛎汤证表现为:烦躁不安。
四逆汤证表现为:四肢拘挛紧急且厥冷。
甘草粉蜜汤证表现为:使人吐涎水,心痛发作有定时,服用毒药无效。
以上六个方剂中,甘草的用量均为二两。
上述八方中,甘草用量为二两或三两,但也存在四两的情况。
苓桂甘枣汤证表现为:脐下悸动。
苓桂五味甘草汤证表现为:气从小腹上冲至胸咽。
小建中汤证表现为:腹部拘急疼痛。
半夏泻心汤证表现为:胃脘部痞塞胀满。
小柴胡汤证表现为:心烦。又说:胸中烦闷。
小青龙汤证表现为:咳嗽气逆,倚靠呼吸。
黄连汤证表现为:腹中疼痛。
人参汤证表现为:气逆上冲心胸。
旋复花代赭石汤证表现为:胃脘部痞硬,嗳气不除。
乌头汤证表现为:疼痛剧烈,不能屈伸。又说:拘急不能翻身侧卧。
以上十个方剂中,甘草的用量均为三两。
排脓汤证,原文缺失(详见桔梗部)。
谓胃承气汤证表现为:既无呕吐也无排便,但心烦。
桃核承气汤证表现为:患者神志如狂。又说:少腹部急结。
桂枝加桂汤证表现为:奔豚病,气从少腹上冲心脏。
桂枝去芍药加蜀漆龙骨牡蛎汤证表现为:惊狂,坐卧不安。
以上五个方剂中,甘草的用量均为二两。
综上所述观察这些方剂。无论病情急迫与否,其他如痛、厥、烦、悸、咳、上逆、惊狂、悲伤、痞硬、腹泻等症状,都是甘草主治的范围。凡是病情急迫的,张仲景使用甘草;病情急迫剧烈的,则多用甘草;不剧烈的,则少用甘草。由此看来,甘草治疗急迫病症的功效是明确的。古语说:“病人感到苦于急迫,吃甘味食物可以缓解它。”说的就是甘草吧?张仲景使用甘草的方剂很多,然而其所用的依据并非仅仅针对前述症状,因此不再一一列举。
凡是征象多且证据确凿的,不再列举其征象,下文皆以此类推。
互考
甘草汤证表现为:咽喉疼痛者,可给予甘草汤。若不好转,给予桔梗汤。凡是急迫且疼痛的,由甘草治疗。如果有脓液的,由桔梗治疗。现在因为急迫且疼痛,所以给予甘草汤。如果服药后不好转,说明已经有脓了。所以给予桔梗汤。
芍药甘草附子汤,其证候不全备。根据条文分析:发汗后病不解,反而恶寒。恶寒是由附子主治。而芍药和甘草,在此处没有明确的主治证候。因此这一章的意义,是以芍药甘草汤治疗脚挛急为基础,伴随出现上述恶寒症状,此证候才完备。
另外分析:调胃承气汤、桃核承气汤都含有甘草。而大承气汤、小承气汤、厚朴三物汤都不含甘草。
汤证表现为:或者如狂,或者少腹急结,这说明虽然有结实阻滞。但是“如狂”与“急结”都属于急迫之症,所以使用甘草。大承气汤、小承气汤、厚朴三物汤、大黄黄连泻心汤,都是用来解除结实毒邪的。所以不含甘草。学者请仔细考察。
辨误
陶弘景说:这种草是众药之主。孙思邈说:能解百药之毒。甄权说:在诸药中,甘草为君药,能治七十二种金石毒,解一千二百般草木毒,调和众药有功。唉!这种说法一出,天下人就不再知道甘草的本功了,难道不可悲吗?如果听从这三人的说法,那么凡是需要解毒,只需这一味药就够了!但这显然不可能,由此可见他们的说法是错误的。想要了解各药的本功,就应当从长沙方(指《伤寒杂病论》)中,推究其有无及多少的变化,结合药物的加减来联系其主治证候,这样就能知道其本功了。而在长沙方中,没有甘草的方剂占了一半,所以说它是众药之主是不可以的,这也可见一斑。古语说:攻病用毒药,药都有毒,毒即能治病。如果要解其毒,又有什么功劳呢?这真是思考得太少了。学者请明察。陶弘景、孙思邈是医家中的俊杰,博学君子。所以后世对他们尊崇至极。然而说甘草是众药之主,说它能解百药之毒,难道没有证据吗?考察长沙方中,半夏泻心汤原本甘草用三两,而甘草泻心汤多加了一两,总共为四两,这是误用药物后的补救措施。陶弘景、孙思邈大概是仓促间看到这一点,便认为是解药毒。唉!人的过错,往往在其同类中显现。所以观察这两人的过错,就知道尊崇信奉张仲景到了什么程度。假如陶弘景、孙思邈知道张仲景在误用药物后之所以用甘草,以及不必改正这个错误的原因是什么?陶弘景、孙思邈确实是俊杰,俊杰为什么要掩饰过错呢?由此看来,陶弘景、孙思邈确实不知道甘草的本功,这也是后世的幸事中的不幸啊!
东垣李氏说:生用则补脾胃不足,而大泻心火;炙之则补三焦元气,而散表寒。这是张仲景所没有论述过的。五脏浮泛之说,自战国以来流传至今,如今若想成为疾医(医生),就不能谈论五脏。五脏浮泛之说,自战国以来流传至今,不可遵从。
品考
甘草:中国产的上等品,本国(日本)所产的,不堪使用。我家只锉碎使用。
Verification
The syndrome of Shaoyao Gancao Tang (Peony and Licorice Decoction) presents as: cramping and stiffness of the legs.
The syndrome of Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) presents as: cold extremities, dryness in the throat, and restlessness.
The syndrome of Gancao Xiexin Tang (Licorice Heart-Draining Decoction) presents as: vexation and inability to find peace.
The syndrome of Gan Jiang Gancao Tang (Ginger and Licorice Decoction) presents as: dryness of the throat and thirst.
The syndrome of Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) presents as: unceasing diarrhea.
In the above five formulas, the dosage of Gancao (Radix Glycyrrhizae, Licorice Root) is four liang.
The syndrome of Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction) is not fully specified (discussed in Mutual Verification).
The syndrome of Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) presents as: Zang Zao (Visceral Agitation), with a tendency toward sadness and weeping.
In the above two formulas, the dosage of Gancao is three liang.
The syndrome of Gancao Tang (Licorice Decoction) presents as: sore throat.
The syndrome of Jiegeng Tang (Platycodon Decoction) is not fully specified (discussed in Mutual Verification).
The syndrome of Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction) presents as: crossing hands over the heart area.
The syndrome of Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) presents as: restlessness.
The syndrome of Sini Tang (Counterflow Toxin Decoction) presents as: stiff and cold extremities.
The syndrome of Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction) presents as: salivation, intermittent cardiac pain, and ineffectiveness of toxic drugs.
In the above six formulas, the dosage of Gancao is two liang.
Among the aforementioned eight formulas, the dosages of Gancao are two or three liang, yet there are also instances of four liang.
The syndrome of Ling Gui Gan Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) presents as: palpitations below the umbilicus.
The syndrome of Ling Gui Wuwei Gancao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction) presents as: Qi rushing from the lower abdomen up to the chest and throat.
The syndrome of Xiao Jianzhong Tang (Minor Construct the Middle Decoction) presents as: abdominal urgency and pain.
The syndrome of Banxia Xiexin Tang (Pinellia Heart-Draining Decoction) presents as: epigastric fullness and obstruction.
The syndrome of Xiao Chaihu Tang (Minor Bupleurum Decoction) presents as: vexation. It also states: vexation in the chest.
The syndrome of Xiao Qinglong Tang (Minor Blue Green Dragon Decoction) presents as: coughing and wheezing requiring leaning forward for breath.
The syndrome of Huanglian Tang (Coptis Decoction) presents as: abdominal pain.
The syndrome of Renshen Tang (Ginseng Decoction) presents as: rebellious Qi rushing to the heart.
The syndrome of Xuanfuhua Daizheshi Tang (Inula, Hematite, and Gastrodia Decoction) presents as: epigastric hardness and persistent belching.
The syndrome of Wutou Tang (Aconite Decoction) presents as: severe pain preventing flexion and extension. It also states: stiffness preventing turning to the side.
In the above ten formulas, the dosage of Gancao is three liang.
The syndrome of Paimong Tang (Pus-Discharging Decoction) is missing (discussed in the Platycodon section).
The syndrome of Wei Chengqi Tang (Stomach Purging Decoction) presents as: neither vomiting nor defecating, yet vexation.
The syndrome of Taohé Chengqi Tang (Peach Kernel Purging Decoction) presents as: the patient behaving like one possessed. It also states: urgency and binding in the lower abdomen.
The syndrome of Guizhi Jia Gui Tang (Cinnamon Twig Plus Cinnamon Twig Decoction) presents as: Ben Tun (Running Piglet), with Qi rushing from the lower abdomen to the heart.
The syndrome of Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Tang (Cinnamon Twig Minus Peony Plus Clivia, Dragon Bone, and Oyster Shell Decoction) presents as: fright and madness, with inability to sit or lie still.
In the above five formulas, the dosage of Gancao is two liang.
Having observed these formulas comprehensively: regardless of whether the condition is urgent, other symptoms such as pain, cold extremities, vexation, palpitations, cough, rebellious Qi, fright and madness, sadness, epigastric hardness, and diarrhea are all within the purview of Gancao. When conditions are urgent, Zhang Zhongjing uses Gancao; when the urgency is severe, he uses it more frequently; when not severe, he uses it less. From this, it is clear that Gancao treats urgent conditions. The ancient saying goes: "When patients suffer from urgency, sweet foods should be eaten to缓 (relieve) it." This refers to Gancao. Zhang Zhongjing uses Gancao in many formulas, but his usage is not limited to the aforementioned symptoms, so they are not enumerated here.
Where indications are numerous and evidence is clear, the indications are not enumerated; the following examples serve as proof.
Mutual Verification
The syndrome of Gancao Tang presents as: those with sore throat may be given Gancao Tang. If there is no improvement, give Jiegeng Tang. For conditions that are urgent and painful, Gancao treats them. If pus is present, Jiegeng treats it. Now, because of the urgency and pain, Gancao Tang is given. If there is no improvement, it indicates that pus has already formed. Therefore, Jiegeng Tang is given.
Regarding Shaoyao Gancao Fuzi Tang, its syndrome is not complete. Analyzing the chapter: after sweating, the disease does not resolve, and instead, aversion to cold appears. Aversion to cold is treated by Fuzi (Aconite Lateral Root). However, Shaoyao (Peony Root) and Gancao have no specific main syndrome here. Thus, the meaning of this chapter is based on Shaoyao Gancao Tang treating leg cramps, accompanied by the aversion to cold, making the syndrome complete.
Furthermore, Tiaowei Chengqi Tang (Regulate the Stomach Purging Decoction) and Taohé Chengqi Tang both contain Gancao. However, Dachengqi Tang (Major Purging Decoction), Xiaochengqi Tang (Minor Purging Decoction), and Houpo Sanwu Tang (Magnolia Bark Three-Ingredient Decoction) do not contain Gancao.
The syndrome presents as: either behaving like one possessed, or urgency and binding in the lower abdomen. Although there is accumulation and binding, "behaving like one possessed" and "urgency and binding" are both forms of urgency, hence Gancao is used. Dachengqi Tang, Xiaochengqi Tang, Houpo Sanwu Tang, and Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Heart-Draining Decoction) are used to resolve accumulation and toxicity. Therefore, they do not contain Gancao. Scholars should examine this carefully.
Correction of Errors
Tao Hongjing said: This herb is the master of all medicines. Sun Simiao said: It can detoxify hundred medicines. Zhen Quan said: Among all medicines, Gancao is the sovereign, treating seventy-two kinds of mineral poisons and detoxifying one thousand two hundred kinds of herbal poisons, with merit in harmonizing various medicines. Alas! Once this view was expressed, the world no longer knew the true function of Gancao, is this not sad? If one follows the words of these three, then for all detoxification needs, this single herb would suffice! But this is clearly impossible, thus their statement is known to be incorrect. To know the true function of medicines, one must deduce from Changsha Formulas (referring to *Shanghan Zabing Lun*), observing their presence or absence and variations in dosage, and linking additions or removals to specific syndromes. Then the true function can be known. In Changsha Formulas, half do not contain Gancao, so it cannot be considered the master of all medicines; this is evident. The ancient saying goes: "To attack disease with toxic drugs, since all drugs are toxic, toxicity itself is efficacy." If it were to detoxify, what merit would it have? This is a profound lack of thought. Scholars should observe this. Tao Hongjing and Sun Simiao were outstanding physicians and learned gentlemen, hence revered by later generations. Yet to claim Gancao is the master of all medicines and can detoxify hundred medicines, is there no evidence? Examining Changsha Formulas, Banxia Xiexin Tang originally uses three liang of Gancao, while Gancao Xiexin Tang adds one more liang, totaling four liang. This is used after an error in medication. Tao and Sun likely saw this hastily and concluded it was for detoxification. Alas! Human errors often manifest among one's peers. Observing the errors of these two reveals the extent to which Zhang Zhongjing should be revered. Had Tao and Sun understood why Zhang Zhongjing used Gancao after erroneous medication, and why correcting this error was unnecessary, would they have truly been outstanding? Why did outstanding individuals cover up errors? From this, it is seen that Tao and Sun indeed did not know the true function of Gancao, which is an unfortunate circumstance for later generations.
Li Dongyuan said: Raw Gancao tonifies the deficiency of the Spleen and Stomach and greatly drains Heart Fire; roasted Gancao tonifies the Primordial Qi of the Triple Burner and disperses exterior Cold. This is not discussed by Zhang Zhongjing. The floating theories of the Five Zang Organs have circulated since the Warring States period. If one wishes to become a physician today, one cannot speak of the Five Zang Organs. These floating theories from the Warring States period should not be followed.
Product Examination
Gancao: The Chinese product is of superior grade. The product from our country (Japan) is unsuitable for use. My family only uses it after being sliced/crushed.