治太阳病下之后,脉促胸满而微恶寒者。
桂枝汤去芍药,加附子一枚(炮)。
桂枝去芍汤和阳,误下中焦阳气伤。(芍药专益阴气,桂枝汤去芍药者,误下阳虚,浊
阴必僭于中焦,故去芍药之酸寒,存一片阳和甘缓之性,得以载还中焦阳气,成清化之功。)
胸满脉促邪犹在,(中虚而表邪仍在,故仍用桂枝。)微恶寒加附子良(名桂枝去芍药加附子
汤微恶寒则阳亦虚矣,故加附子,以杜亡阳之机。)
治太阳病身体强KT KT 然,脉反沉迟,此为痉也,宜此主之。
桂枝汤原方加栝蒌根二两。(喻嘉言谓“栝蒌为君,分两当重,桂枝为臣,分两当减”,
其意颇通。)栝蒌桂枝汤治痉,桂枝汤内栝蒌进。太阳证备项背强,脉反沉迟痉将振。太阳
之脉本浮,今脉沉迟,故曰“反”。沉迟非内寒,乃营卫之行不利,津液少而经脉滞,(故知
将欲作痉也。)痉为风病亦津伤,(古称“痉”为“风强病”,然风行必燥,津液必伤。)风自
宜驱津必润。(桂枝汤和营卫以驱风,栝蒌根濡津液而治痉。按∶伤寒项背强KT KT ,
汗出恶风者,用桂枝加葛根汤,其脉必浮数,为邪风盛于外也;此身强KT KT 然,脉反
沉迟,为风淫于外,而津伤于内,故用桂枝则同,而一加葛根以散表,一加栝蒌根以滋内,
则不同也。)
治发汗过多,其人叉手自冒心,心下悸,欲得按者。
桂枝(四两去皮) 甘草(二两炙) 水三升,煮取一升,顿服。
桂枝甘草(汤)补心阳,止汗除烦功独良。(此方采取桂枝之半,便另有精义。桂枝复
甘草,是辛从甘化,为阳中有阴,故治胸中阳气欲失;且桂枝轻扬走表,佐以甘草,留恋中
宫,载还阳气,仍寓一表一里,故得外止汗而内除烦。)发汗过多心下悸,悸而欲按是阳亡。
(发汗不误,误在过多。汗为心之液,多则心气虚,故悸而欲按,此乃阳虚之轻者;甚而振
振欲擗地,则当用真武汤矣。)
治疗太阳病经过误用攻下法后,出现脉象急促、胸部胀满的症状。
使用桂枝汤原方,去掉芍药。
治疗太阳病经过误用攻下法后,出现脉象急促、胸部胀满且伴有轻微恶寒症状的。
使用桂枝汤去掉芍药,加上一枚炮制的附子。
桂枝去芍药汤能够调和阳气,误用攻下法会损伤中焦的阳气。(芍药专门补益阴气,桂枝汤去掉芍药的原因在于:误用攻下导致阳气虚弱,浊阴之气必然僭越于中焦,因此去掉芍药的酸寒之性,保留其甘缓温和的特性,从而能够承载并恢复中焦的阳气,达成清化之功。)
胸部胀满、脉象急促说明邪气仍在体表,(因为中气虚而表邪依然存在,所以仍然使用桂枝。)轻微恶寒加上附子效果良好(此方名为桂枝去芍药加附子汤,出现轻微恶寒说明阳气也已虚弱,因此加入附子,以防止阳气脱失的危险局面。)
治疗太阳病患者身体强直僵硬不舒,脉象反而呈现沉迟,这是痉病(以项背强直、口噤不开甚至角弓反张为特征的疾病),适宜用本方主治。
桂枝汤原方加入栝蒌根二两。(喻嘉言认为“栝蒌作为君药,用量应当加重,桂枝作为臣药,用量应当减少”,这个观点颇为通达。)栝蒌桂枝汤用于治疗痉病,在桂枝汤中加入栝蒌。太阳病的证候具备,项背部强直不舒,脉象反而沉迟,提示痉病即将发作。太阳病的脉象本应是浮脉,现在脉象沉迟,所以称为“反”。沉迟脉并非内寒,而是营卫运行不利,津液不足导致经脉滞涩,(因此知道将要发生痉病。)痉病属于风病范畴,也是由于津液受伤所致,(古代称“痉”为“风强病”,然而风性燥烈,必然导致津液受损。)风气适宜驱散,津液必须滋润。(桂枝汤调和营卫以驱散风邪,栝蒌根濡润津液以治疗痉病。按语:伤寒症见项背部强直不舒,汗出恶风的,使用桂枝加葛根汤,其脉象必为浮数,这是因为邪风盛于体表;此症身体强直不舒,脉象反而沉迟,是因为风邪淫溢于外,而体内津液已伤,所以虽然都用桂枝,但一方加葛根以发散表邪,一方加栝蒌根以滋养内在,则有所不同。)
治疗因发汗过多,患者双手交叉按压在心前区,感到心下悸动不安,喜欢被按压的情况。
桂枝(四两,去皮) 甘草(二两,炙) 用水三升,煮取一升,一次性服用。
桂枝甘草汤能够补益心阳,止汗除烦的功效独特良好。(此方只采用了一半剂量的桂枝,便另有精妙之处。桂枝配合甘草,辛味从甘味转化而来,形成阳中有阴的特性,因此能治疗胸中阳气欲脱之症;而且桂枝轻扬走表,佐以甘草留恋中宫,承载并恢复阳气,依然蕴含一表一里的配伍意义,所以能在外止汗,在内除烦。)发汗过多导致心下悸动,悸动且喜欢按压是阳气亡失的表现。(发汗本身没有错误,错误在于过量。汗为心之液,出汗过多则心气虚弱,所以悸动且喜欢按压,这属于较轻的阳虚证;如果严重到身体震颤想要倒地,则应当使用真武汤了。)
To treat Taiyang disease (Disease of the Taiyang/Bladder Channel) after inappropriate purgation, presenting with a rapid pulse and chest fullness.
Use the original Guizhi Tang (Cinnamon Twig Decoction), removing Shaoyao (Paeonia Root).
To treat Taiyang disease after inappropriate purgation, presenting with a rapid pulse, chest fullness, and slight aversion to cold.
Use Guizhi Tang (Cinnamon Twig Decoction) removing Shaoyao (Paeonia Root), adding one prepared Fuzi (Prepared Aconite Lateral Root).
Guizhi Qushaoyao Tang (Decoction of Cinnamon Twig without Paeonia) harmonizes Yang Qi; inappropriate purgation damages the Yang Qi of the Middle Jiao (Middle Burner). (Shaoyao (Paeonia Root) specifically nourishes Yin Qi. The reason for removing Shaoyao from Guizhi Tang is that when purgation causes Yang deficiency, turbid Yin pathogens inevitably rebel in the Middle Jiao. Therefore, removing the sour-cold nature of Shaoyao preserves its sweet-warm and gentle properties, allowing it to carry and restore the Yang Qi of the Middle Jiao, achieving the effect of clear transformation.)
Chest fullness and a rapid pulse indicate the pathogen remains on the exterior, (because the interior is deficient while the exterior pathogen persists, Guizhi (Cinnamon Twig) is still used.) Slight aversion to cold is well treated by adding Fuzi (Aconite). (Named Guizhi Qushaoyao Jia Fuzi Tang (Decoction of Cinnamon Twig without Paeonia plus Aconite); slight aversion to cold indicates Yang is also deficient, so Fuzi is added to prevent the crisis of Yang collapse.)
To treat Taiyang disease where the body is stiff and rigid, and the pulse is surprisingly deep and slow; this is Jing Disease (Spasm Disease, characterized by stiffness and spasms). This formula should be used as the main treatment.
Add two liang of Gualou Gen (Trichosanthes Root) to the original Guizhi Tang (Cinnamon Twig Decoction). (Yu Jiayan stated that "Gualou should be the sovereign herb with a heavier dosage, and Guizhi the minister herb with a reduced dosage," which is a reasonable interpretation.) Gualou Guizhi Tang treats Spasm Disease; Gualou is added to Guizhi Tang. When Taiyang symptoms are complete with stiffness in the neck and back, and the pulse is surprisingly deep and slow, Spasm Disease is about to manifest. The pulse of Taiyang should originally be floating; now that it is deep and slow, it is called "surprisingly" (fan). Deep and slow does not indicate internal cold, but rather unfavorable circulation of Ying and Wei (Nutritive and Defensive Qi), insufficient Jin-Ye (Body Fluids), and stagnation of the meridians, (thus knowing that Spasm Disease will occur.) Spasm is a Wind disease also caused by injury to Body Fluids, (anciently called "Wind-Stiffness Disease"; however, Wind movement leads to dryness, inevitably injuring Body Fluids.) Wind should be expelled, and Body Fluids must be moistened. (Guizhi Tang harmonizes Ying and Wei to expel Wind, while Gualou Gen (Trichosanthes Root) moistens Body Fluids to treat Spasm. Note: In Shanghan (Cold Damage) cases with stiffness in the neck and back, sweating, and aversion to wind, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction plus Kudzuvine Root) is used, where the pulse is necessarily floating and rapid, indicating strong Wind-Pathogen on the exterior; here, the body is stiff with a surprisingly deep and slow pulse, indicating Wind excess on the exterior and injury to Body Fluids internally. Thus, although both use Guizhi, one adds Gegen (Kudzuvine Root) to disperse the exterior, while the other adds Gualou Gen (Trichosanthes Root) to nourish the interior, making them different.)
To treat cases of excessive sweating, where the patient crosses their hands over the heart region, experiences palpitations in the epigastrium, and desires pressure.
Guizhi (Cinnamon Twig) (4 liang, bark removed) Gancao (Licorice Root) (2 liang, honey-fried). Use three sheng of water, boil to obtain one sheng, take all at once.
Guizhi Gancao Tang (Decoction of Cinnamon Twig and Licorice) tonifies Heart Yang; its efficacy in stopping sweating and relieving irritability is uniquely excellent. (This formula uses only half the dosage of Guizhi, revealing profound meaning. Guizhi combined with Gancao transforms the pungent flavor into sweetness, creating Yang containing Yin, thus treating the loss of Yang Qi in the chest; furthermore, Guizhi is light and ascending moving to the exterior, assisted by Gancao which lingers in the Middle Palace (Spleen/Stomach) to carry and restore Yang Qi, embodying a relationship between exterior and interior, thereby stopping sweating externally and relieving irritability internally.) Excessive sweating leads to epigastric palpitations; palpitations with desire for pressure indicate Yang collapse. (Sweating itself is not wrong; the error lies in excess. Sweat is the fluid of the Heart; excessive sweating depletes Heart Qi, causing palpitations and a desire for pressure, which represents mild Yang deficiency; if severe enough to cause trembling and a desire to fall to the ground, Zhenwu Tang (True Warrior Decoction) should be used.)