治伤寒六七日,大下后,寸脉沉而迟,手足厥逆,下部脉不至,咽喉不利,唾脓血。泄
利不止者,为难治也。麻黄(二两半) 升麻 当归(各一两一分) 知母 黄芩 葳蕤(各
十八铢) 白术 石膏 干姜 芍药 天冬 桂枝 茯苓 甘草(各六铢) 水一斗,先煮
麻黄,去沫,纳诸药,煮取三升,分温三服。
麻黄升麻汤桂枝,芍草苓冬姜术知,玉竹黄芩归与石,辛温寒润互兼施。厥阴错杂邪难
解,阴中升阳用此宜。(此方升散寒润,收缓渗泄具备,推其所重,在阴中升阳,故麻黄、
升麻名汤也。膏、芩、知母苦辛清降上焦之津,芍药、天冬酸苦收引下焦之液,苓、草甘淡,
归、术甘温,玉竹甘寒,缓脾胃以致津液。独是十味之药,虽有生津泄热之功,不能提出阴
分热邪,故以麻、桂、升、姜,开入阴分,与寒凉药从化其热,庶几在上之燥气除,在下之
阴气坚,而厥阴错杂之邪可解。)吐血咽疼肢厥逆,泄利不止颇难医。此乃伤寒之坏病,下
寒上热涉危疑。(此乃伤寒之坏病,寒热互见,上下两伤,故药亦照证施治。病证之杂,药
味之杂,古方所仅见,观此可悟古人用药又有此一格。)
治咳而脉浮者。
浓朴(五两) 麻黄(四两去节) 石膏(鸡子大一块) 杏仁(去皮尖) 半夏 五
味子(各半升) 细辛 干姜(各二两) 小麦(一升) 水一斗二升,先煮小麦熟,去滓,
纳诸药,煮取三升,温服一升,日三服。
浓朴麻黄汤石膏,细辛杏半味姜邀,还加小麦宜先煮,下气祛邪止咳标。小麦甘平缓心
气,用医心咳法殊超。咳而心痛为心咳,仿此临时加减调。(《金匮》此方,不详见证,而但
云“脉浮”。浮为邪气居表,固宜驱之外散,然观其药品,泄热下气、散邪固本之功皆备,
或
并附及之。
治疗伤寒病经过六七天,经过猛烈攻下之后,出现寸部脉象沉而迟缓,手足冰冷逆冷,下部脉搏摸不到,咽喉不利索,咳唾脓血。腹泻不止的,属于难治之证。麻黄(二两半) 升麻 当归(各一两一分) 知母 黄芩 葳蕤(各十八铢) 白术 石膏 干姜 芍药 天冬 桂枝 茯苓 甘草(各六铢)。用水一斗,先煮麻黄,去掉浮沫,加入其余药物,煎煮取汁三升,分三次温服。
麻黄升麻汤包含桂枝、芍药、甘草、茯苓、天冬、干姜、白术、知母、玉竹(即葳蕤)、黄芩、当归和石膏,辛温与寒润之法同时施用。厥阴病错杂复杂的邪气难以解除,在阴分中提升阳气适宜使用此方。(这个方剂兼具升散、寒润、收敛、缓和、渗泄的功效,推究其重点,在于在阴分中提升阳气,所以用麻黄、升麻命名汤剂。石膏、黄芩、知母苦辛清降上焦的津液,芍药、天冬酸苦收引下焦的体液,茯苓、甘草甘淡,当归、白术甘温,玉竹甘寒,通过缓和脾胃来滋生津液。唯独这十味药,虽然有生津泄热的功效,但不能将阴分中的热邪提出,所以用麻黄、桂枝、升麻、干姜,开通进入阴分,与寒凉药物共同化解热邪,这样在上部的燥气得以清除,在下部的阴气得以坚固,从而解除厥阴病错杂的邪气。)吐血、咽痛、四肢厥冷逆乱,腹泻不止颇为难医。这是伤寒病的坏病(因误治导致的变证),下寒上热涉及危重疑难。(这是伤寒病的坏病,寒热症状互见,上下两部都受损,所以药物也按照证候施治。病证的复杂,药味的繁杂,是古方中仅见的,观察此方可领悟古人用药还有这一种格局。)
治疗咳嗽且脉象浮的。
浓朴(五两) 麻黄(四两,去节) 石膏(鸡蛋大小一块) 杏仁(去皮尖) 半夏 五味子(各半升) 细辛 干姜(各二两) 小麦(一升)。用水一斗二升,先煮小麦至熟,去掉渣滓,加入其余药物,煎煮取汁三升,每次温服一升,每日服用三次。
浓朴麻黄汤含有石膏、细辛、杏仁、半夏、五味子、干姜,还加上小麦适宜先煮,具有下气祛邪止咳治标的功效。小麦甘平能缓和心气,医生用心咳法非常高超。咳嗽伴心痛称为心咳,仿照此方临时加减调理。(《金匮要略》中这个方剂,不详述具体证候,只说“脉浮”。浮脉表示邪气停留在体表,本来适宜驱除向外发散,然而看它的药品组成,泄热下气、散邪固本的功效都具备,或许一并附注提及。)
Treats Taiyang disease (disease of the Taiyang channel) persisting for six or seven days, following a severe purgation. The pulse at the cun position is deep and slow; there is cold reversal in the hands and feet; the pulse at the lower part is imperceptible; the throat is obstructed and difficult to swallow, accompanied by spitting of pus and blood. If diarrhea persists without stopping, it is considered difficult to treat. Mahuang Tang with Shengma (Ephedra Decoction with Cimicifugae Rhizoma): Ephedrae Herba (Mahuang, 麻黄) [2 liang 5 qian], Cimicifugae Rhizoma (Shengma, 升麻), Angelicae Sinensis Radix (Danggui, 当归) [each 1 liang 1 qian], Anemarrhenae Rhizoma (Zhimu, 知母), Scutellariae Radix (Huangqin, 黄芩), Polygonati Odorati Rhizoma (Weirui, 葳蕤) [each 18 zhu], Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Gypsum Fibrosum (Shigao, 石膏), Zingiberis Rhizoma Recens (Ganjiang, 干姜), Paeoniae Radix Alba (Shaoyao, 芍药), Asparagi Radix (Tiandong, 天冬), Cinnamomi Ramulus (Guizhi, 桂枝), Poria (Fuling, 茯苓), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [each 6 zhu]. Use one dou of water. First decoct Ephedrae Herba, remove the foam, then add the remaining herbs. Decoct until three sheng remain. Divide into three warm doses.
Mahuang Shengma Tang contains Guizhi (Cinnamon Twig), Shaoyao (White Peony Root), Gancao (Licorice), Fuling (Poria), Tiandong (Asparagus Root), Ganjiang (Dried Ginger), Baizhu (Atractylodes), Zhimu (Anemarrhena), Yuzhu (Polygonatum Odoratum, i.e., Weirui), Huangqin (Scutellaria), Danggui (Angelica), and Shigao (Gypsum). It simultaneously employs acrid-warm and cool-moistening methods. Jueyin disease (disease of the Jueyin channel) involves complex and mixed pathogens that are difficult to resolve; this formula is suitable for raising yang within yin. (This formula possesses properties of ascending, dispersing, cooling, moistening, astringing, moderating, and draining. Its emphasis lies in raising yang within yin, hence Ephedrae Herba and Cimicifugae Rhizoma are named in the title. Gypsum, Scutellaria, and Anemarrhena use bitter-acridity to clear and descend fluids of the upper jiao; White Peony and Asparagus use sour-bitterness to draw in fluids of the lower jiao; Poria and Licorice are sweet-and-pale; Angelica and Atractylodes are sweet-warm; Polygonatum is sweet-cool. Together they moderate the spleen and stomach to generate fluids. However, these ten herbs, while having the merit of generating fluids and clearing heat, cannot extract heat pathogens from the yin level. Therefore, Ephedra, Cinnamon Twig, Cimicifuga, and Dried Ginger are used to open entry into the yin level, transforming heat together with cold-cooling herbs. Thus, dryness in the upper is removed, yin qi in the lower is solidified, and the complex pathogens of Jueyin can be resolved.) Hematemesis, sore throat, and cold reversal of limbs, along with persistent diarrhea, are颇 difficult to treat. This is a complicated disease (bad disease resulting from mis-treatment) of Taiyang disease, involving lower cold and upper heat, posing critical diagnostic challenges. (This is a complicated disease of Taiyang disease, where cold and heat coexist, damaging both upper and lower parts. Therefore, herbs are prescribed according to the syndrome. The complexity of the syndrome and the variety of herbs are unique among ancient formulas; observing this reveals another style of herb usage by the ancients.)
Treats cough with a floating pulse.
Magnoliae Officinalis Cortex (Houpo, 厚朴) [5 liang], Ephedrae Herba (Mahuang, 麻黄) [4 liang, nodes removed], Gypsum Fibrosum (Shigao, 石膏) [size of an egg], Armeniacae Semen Amarum (Xingren, 杏仁) [skin and tips removed], Pinelliae Rhizoma Preparatum (Banxia, 半夏), Schisandrae Fructus (Wuweizi, 五味子) [each half sheng], Asari Radix et Rhizoma (Xixin, 细辛), Zingiberis Rhizoma (Ganjiang, 干姜) [each 2 liang], Triticum aestivum (Xiaomai, 小麦) [1 sheng]. Use one dou two sheng of water. First decoct Triticum aestivum until cooked, remove the dregs, then add the remaining herbs. Decoct until three sheng remain. Take one sheng warm, three times daily.
Houpo Mahuang Tang contains Shigao (Gypsum), Xixin (Asarum), Xingren (Apricot Seed), Banxia (Pinellia), Wuweizi (Schisandra), and Ganjiang (Dried Ginger), supplemented by Xiaomai (Wheat) which should be decocted first. It has the effect of directing qi downward, dispelling pathogens, and relieving cough as a symptomatic treatment. Wheat is sweet and neutral, capable of calming heart qi; using this method for "heart cough" is highly advanced. Cough accompanied by heart pain is called heart cough; adjust temporarily by adding or subtracting herbs based on this formula. (In the *Jin Gui Yao Lue*, this formula does not detail the specific symptoms, stating only "floating pulse." A floating pulse indicates pathogenic factors residing in the exterior, suggesting they should be dispersed outward. However, examining its ingredients, it possesses merits of clearing heat, directing qi downward, dispersing pathogens, and consolidating the root. It may be mentioned here for reference.)