治太阳病服桂枝汤或下之,仍头项强痛,翕翕发热,无汗,心下满痛,
桂枝汤去桂枝加茯苓、白术各三两。(此方宜入《五苓散类》。)
桂枝去桂加苓术(汤),约阴利水行阳缀。(苓、芍约阴利水,甘、枣培土制水,姜、术
行阳化水,为利中焦水气之法。)汗下亡津水饮停,胸满溺涩病之诀。以其无汗去桂枝,(头
痛发热,桂枝证仍在也,而去桂枝者何也?以解肌或下,邪未能去,而津液已伤,故反无汗,
则不宜更用桂枝辛温燥液以发其汗矣。心下满则加白术,小便不利则加茯苓,此乃亡津液而
有停饮者也。)小便通时汗斯彻。(凡表未解者,必当先解其表。此因小便不利,故专利其小
便,俾小便利则邪亦从而解矣。所谓发汗利小便为治太阳两大法门,以此夫!)
治伤寒发汗后身疼痛,脉沉迟者。
桂枝汤原方芍药、生姜各增一两,加人参三两。
桂枝新加人参汤,(曰“新加”者,申明表邪未解,无补中法,今因脉沉迟而始加,故
曰“新加”。更妙在姜、芍各加一两,不使人参有实邪之患,仍是和营卫法。仲景方一丝不
乱如
者,(气
而过汗者方可用。)
治太阳病项背强KT KT ,汗出恶风者。
桂枝汤原方加葛根四两(先煮)。
桂枝汤中加葛根,(名桂枝加葛根汤)太阳邪乍及阳明。(喻嘉言曰∶“太阳而略兼阳明,
则以方来之阳明为重,故加葛根。”)KT KT (音殊,引颈难伸之象。)汗出恶风者,断
入阳明是定评。(张元素曰∶“桂枝汤加葛根,所以断太阳入阳明之路,若太阳初病便服葛根,
是反
治疗太阳病,服用桂枝汤或经过攻下法治疗后,仍然出现头项强痛、像热气蒸腾一样的发热、无汗、胃脘部胀满疼痛的症状。
方剂:桂枝汤去掉桂枝,加入茯苓、白术各三两。(这个方剂适宜归入《五苓散类》中。)
桂枝去桂加苓术汤,具有收敛阴气、通利水湿、运行阳气以止渴的功效。(茯苓、芍药收敛阴气并通利水湿,甘草、大枣培补脾胃以制约水湿,生姜、白术运行阳气以化除水饮,这是治疗中焦水气的方法。)发汗和攻下导致津液亏损,水饮停聚,胸膈满闷、小便涩滞是此病的决断依据。因为患者没有汗出,所以去掉桂枝。(虽然有头痛发热,看似桂枝证仍在,但为何要去掉桂枝呢?这是因为经过解肌发表或攻下后,邪气未能去除,而津液已经受伤,反而导致无汗,此时不适宜再用桂枝的辛温之性燥伤津液来发汗了。如果胃脘部胀满则加入白术,如果小便不利则加入茯苓,这属于津液亏损而有停饮的情况。)等到小便通畅时,汗出才会彻底。(凡是表证未解除的,必定应当先解除表证。这里因为小便不利,所以专门通利小便,使得小便通利后,邪气也随之解除。这就是所说的发汗和利小便是治疗太阳病的两大法门,正是如此啊!)
桂枝新加人参汤,(称为“新加”,是申明表邪尚未解除,本无补中的治法,现在因为脉象沉迟才开始加入人参,所以叫“新加”。更妙之处在于生姜、芍药各增加一两,不使人参产生留滞实邪的隐患,仍然是调和营卫的方法。张仲景的方子严谨有序,只有气虚且因过汗导致的症状才可以使用。)
治疗太阳病,项背部僵硬不适,汗出怕风的病症。
在桂枝汤中加入葛根,(名为桂枝加葛根汤),太阳经邪气刚刚波及阳明经。(喻嘉言说:“太阳病略微兼有阳明病,则以即将传入的阳明病为重,所以加入葛根。”)项背强直(音同“殊”,形容颈部牵引难以伸展的样子),汗出怕风,判断为邪气将入阳明是确定的评价。(张元素说:“桂枝汤加葛根,是为了阻断太阳经邪气传入阳明经的道路,如果在太阳病初起时就服用葛根,反而是……”)
Treating Taiyang disease (Taiyang syndrome), after administering Guizhi Tang (Cinnamon Twig Decoction) or following purgation, if headache and stiffness of the head and neck persist, accompanied by a mild fever resembling steam rising (Xi Xi fa re), absence of sweating, fullness and pain in the epigastrium (Xin Xia man tong):
Formula: Remove Guizhi (Cinnamon Twig) from Guizhi Tang, add Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome), each 3 liang. (This formula is suitable to be classified under the Wuling San category.)
Guizhi Qu Gui Jia Ling Zhu Tang (Decoction of Cinnamon Twig Decoction with Cinnamon Twig Removed and Poria and Atractylodes Added) acts to constrain Yin, promote diuresis to resolve water retention, and move Yang to stop thirst. (Fuling and Shaoyao constrain Yin and promote diuresis; Gancao and Dazao strengthen the Spleen to control water; Shengjiang and Baizhu move Yang to transform water. This is a method for treating water qi stagnation in the Middle Jiao.) Sweating and purgation deplete body fluids, leading to fluid retention; chest fullness and dysuria are key indicators of this condition. Because there is no sweating, Guizhi is removed. (Although headache and fever suggest the Guizhi pattern persists, why remove Guizhi? Because after releasing the muscle layer or purging, the pathogenic factor remains, but body fluids are already damaged, resulting in an inability to sweat. It is therefore inappropriate to use the acrid-warm nature of Guizhi to dry up fluids and induce sweating again. Epigastric fullness indicates adding Baizhu; difficulty in urination indicates adding Fuling. This represents a condition of depleted fluids with retained water.) When urination becomes smooth, sweating will then occur thoroughly. (Generally, when the exterior is not resolved, it must be addressed first. Here, due to difficult urination, the focus is on promoting urination so that once urination is unobstructed, the pathogen resolves with it. Thus, inducing sweating and promoting urination are the two major approaches to treating Taiyang disease.)
Treating Shanghan (Cold Damage) where, after sweating therapy, body pain persists and the pulse is deep and slow (Chen Chi):
Formula: In the original Guizhi Tang, increase Shaoyao (White Peony Root) and Shengjiang (Fresh Ginger) by 1 liang each, and add Renshen (Ginseng Radix et Rhizoma) 3 liang.
Guizhi Xinjia Renshen Tang (Newly Added Ginseng Decoction with Cinnamon Twig), named "Newly Added" because it clarifies that the exterior pathogen has not yet resolved and there is typically no indication for tonifying the interior; however, due to the deep and slow pulse, Renshen is added now. The brilliance lies in increasing Shengjiang and Shaoyao by 1 liang each, preventing Renshen from causing stagnation of excess pathogens, thereby maintaining the method of harmonizing Ying and Wei (Nutritive and Defensive levels). Zhang Zhongjing's formulas are meticulous; this is applicable only when Qi deficiency exists alongside excessive sweating.
Treating Taiyang disease characterized by stiffness and discomfort in the nape and back (Jiang Bei Qiang Ke Ke), sweating, and aversion to wind:
Formula: Add Gegen (Kudzu Root) 4 liang to the original Guizhi Tang (boiled first).
Adding Gegen to Guizhi Tang creates Guizhi Jia Ge Gen Tang (Guizhi Decoction with Kudzu Root). This addresses the Taiyang pathogen slightly involving the Yangming channel. (Yu Jiayan stated: "When Taiyang disease slightly involves Yangming, the impending Yangming involvement takes precedence, hence Gegen is added.") "Ke Ke" (pronounced 'shu') describes the sensation of neck traction and difficulty extending the neck. Sweating and aversion to wind indicate that the pathogen is destined to enter Yangming, which is a definitive assessment. (Zhang Yuansu stated: "Adding Gegen to Guizhi Tang blocks the pathway for Taiyang pathogens to enter Yangming. If Gegen were taken at the very onset of Taiyang disease, it would instead...")