治血痹阴阳俱微,寸口关上微,尺中小紧,外证身体不仁,如风痹状。
桂枝汤去甘草,加黄 三两,生姜加三两。
桂五物(汤)治血痹,黄 芍药桂姜枣。脉微细紧是阳虚,卧出风吹病之旨。(《素问·五
藏生成篇》曰∶“卧出而风吹之,血凝于肤者为痹。”)状若风痹身不仁,(风痹则走注疼痛
,血痹则不痛,而但不仁为异,所谓“营气虚则不仁”也。)因其脉细宜煎此。祛风固表和
营卫,阳气宣通痹自已。(旭高按∶此方以桂枝汤加重生姜,佐桂枝领黄 行阳通痹,既以
祛风,且以固表,庶几血中之风出,而血中之阳气不与之俱去。不用甘草者,欲诸药周卫于
身,不欲留顿于中也。然《金匮·血痹虚劳篇》又别出一条云∶“宜针引阳气,令脉和紧去
则愈。”盖血中之邪,始以阳气伤而得入,终必得阳气通而后出;而痹之为证,血既以风入
而痹于外,阳亦以血痹而止于中,故必针引阳气,令脉和紧去乃愈,以是知血分受痹,必以
宣通阳气为首务矣。此五物汤和营之滞,助卫之行,亦针引阳气之意。以脉阴阳俱微,故不
可针而可药,经所谓“阴阳形气俱不足者,勿刺以针,而调以甘药”也。)
治太阳病下之后,微喘者,表未解故也。
桂枝汤原方加浓朴二两(炙去皮),杏仁五十枚(去皮尖)。桂枝(加)朴杏(汤)治寒
喘,(麻黄汤治表寒之喘,此汤治里寒之喘。)下气消痰温散攒,寒气留中邪在表,(此因下
后寒气留中,肺气失降,犹幸表邪未解,故只微喘,仍用桂枝汤解表,但加浓朴温胃散寒,
杏仁定喘下气。)鼻鸣不渴始相安。(按∶此方治喘,必外有头痛鼻鸣、形寒畏冷、口无燥渴
等因,始可服之。)
治疗血痹证,表现为阴阳脉象均微弱,寸口和关部脉微,尺部脉稍紧,外在症状为身体麻木不仁,类似风痹的症状。
方用桂枝汤去掉甘草,加入黄芪三两,生姜增加至三两。
桂枝五物汤用于治疗血痹,方中包含黄芪、芍药、桂枝、生姜、大枣。脉象微细紧表明阳气虚弱,此病多因睡眠后受风吹袭所致。(《素问·五藏生成篇》记载:“睡眠后外出受风吹,血液凝滞于皮肤形成痹证。”)症状如同风痹导致身体麻木不仁,(风痹的特点是游走性疼痛,而血痹的特点是不痛,仅表现为麻木不仁,这就是所谓的“营气虚弱则麻木不仁”。)因为脉象细弱,适宜煎服此方。本方能祛风固表、调和营卫,使阳气宣通,痹证自然痊愈。(旭高按语:此方以桂枝汤为基础,加重生姜用量,辅助桂枝引领黄芪运行阳气以通痹,既能祛风,又能固表,使得血分中的风邪外出,而血中的阳气不会随之耗散。不用甘草的原因,是希望诸药能周流护卫全身,而不愿其停留中焦。然而,《金匮要略·血痹虚劳篇》另有一条指出:“适宜针刺引导阳气,使脉象平和、紧象消失即可痊愈。”大概是因为血中的邪气,起初因阳气受损而入,最终必须依靠阳气通畅才能排出;而痹证这一病症,血分因风邪侵入而在外部痹阻,阳气也因血痹而在内部停滞,所以必须通过针刺引导阳气,使脉象平和、紧象消失才能痊愈。由此可知,血分受痹,必须以宣通阳气为首要任务。这五物汤调和营分的郁滞,助卫分运行,也蕴含了针刺引导阳气的意旨。由于脉象阴阳俱微,所以不可针刺而宜用药调理,正如经典所说“阴阳形气都不足的,不要用针刺,而应用甘药调理”。)
治疗太阳病经过误下之后,出现轻微气喘的,这是因为表证未解的缘故。
方用桂枝汤原方加入厚朴二两(炙过去皮),杏仁五十枚(去皮尖)。
桂枝加厚朴杏子汤用于治疗寒性气喘,(麻黄汤治疗表寒引起的气喘,此汤治疗里寒引起的气喘。)具有降气、消痰、温散积聚的作用。寒气留滞于中焦,邪气仍在体表,(这是因误下后寒气留滞中焦,肺气失于肃降,幸好表邪未解,所以只是轻微气喘,仍用桂枝汤解表,但加入厚朴温胃散寒,杏仁定喘降气。)若伴有鼻鸣、口不渴,服用此方才相安无事。(按语:此方治疗气喘,必须具备外有头痛、鼻鸣、形寒畏冷、口中无燥渴等症状,才可以服用。)
Treats Blood Bi (Blood Stasis Obstruction) syndrome, characterized by both Yin and Yang pulse positions being weak, the Cun (inch) and Guan (bar) positions being faint, and the Chi (cubit) position being slightly tight. The external manifestation is numbness of the body, resembling Wind-Bi (Wind Arthralgia).
The formula is Guizhi Tang (Cinnamon Twig Decoction), with Gancao (Licorice Root) removed, Huangqi (Astragalus Root) added at 3 liang, and Shengjiang (Fresh Ginger) increased to 3 liang.
Guizhi Wuwu Tang (Cinnamon Twig Five-Ingredient Decoction) treats Blood Bi, containing Huangqi (Astragalus Root), Shaoyao (Peony Root), Guizhi (Cinnamon Twig), Shengjiang (Fresh Ginger), and Dazao (Jujube Fruit). A faint, fine, and tight pulse indicates Yang deficiency; this disease arises from exposure to wind after waking from sleep. (The *Suwen: Chapter on the Generation of the Five Zang Organs* states: "After sleeping, if exposed to wind, blood coagulates in the skin, resulting in Bi.") The condition resembles Wind-Bi with bodily numbness. (Wind-Bi is characterized by wandering pain, whereas Blood Bi is painless but presents only with numbness, which is referred to as "deficiency of Ying Qi leads to numbness".) Given the fine pulse, decocting this formula is appropriate. It dispels wind, consolidates the exterior, and harmonizes Ying and Wei Qi; once Yang Qi is unblocked, the Bi obstruction resolves naturally. (Xu Gao's commentary: This formula uses Guizhi Tang as a base, increasing the dosage of Shengjiang (Fresh Ginger) to assist Guizhi (Cinnamon Twig) in guiding Huangqi (Astragalus Root) to circulate Yang Qi and unblock Bi. It dispels wind and consolidates the exterior, allowing wind pathogens within the blood to exit without depleting the Yang Qi within the blood. Gancao (Licorice Root) is omitted so that the herbs may circulate throughout the body rather than stagnating in the Middle Jiao. However, the *Jinkui Yaolue: Chapter on Blood Bi and Deficiency Consumption* notes another approach: "Acupuncture should be used to guide Yang Qi; when the pulse becomes harmonious and the tightness disappears, the patient will recover." This is because pathogens in the blood enter due to initial Yang damage and must exit through the unblocking of Yang Qi. In Bi syndrome, blood is obstructed externally by wind, and Yang Qi is stagnant internally due to blood obstruction. Therefore, acupuncture must guide Yang Qi until the pulse is harmonious and tightness vanishes. Thus, for blood-level obstruction, unblocking Yang Qi is paramount. Guizhi Wuwu Tang harmonizes Ying stagnation and aids Wei circulation, embodying the principle of guiding Yang Qi akin to acupuncture. Since the Yin and Yang pulses are both weak, acupuncture is contraindicated in favor of herbal medicine, as stated in the classics: "When Yin, Yang, form, and Qi are all deficient, do not use needles; instead, regulate with sweet medicines.")
Treats Taiyang (Greater Yang) syndrome where, following inappropriate purgation, slight wheezing occurs because the exterior syndrome has not yet resolved.
The formula is the original Guizhi Tang (Cinnamon Twig Decoction) with Houpo (Magnolia Bark) added at 2 liang (roasted and peeled) and Xingren (Apricot Seed) added at 50 pieces (peeled and tips removed).
Guizhi Jia Houpo Xingren Tang (Cinnamon Twig Decoction with Magnolia Bark and Apricot Seed) treats cold-induced wheezing. (Mahuang Tang (Ephedra Decoction) treats wheezing caused by exterior cold, while this formula treats wheezing caused by interior cold.) It directs Qi downward, eliminates phlegm, and warms and disperses accumulation. Cold pathogen remains in the Middle Jiao while the pathogen persists in the exterior. (This results from cold pathogen lingering in the Middle Jiao after purgation, causing Lung Qi to fail to descend. Fortunately, since the exterior pathogen remains, there is only slight wheezing. Guizhi Tang (Cinnamon Twig Decoction) is still used to release the exterior, supplemented with Houpo (Magnolia Bark) to warm the stomach and disperse cold, and Xingren (Apricot Seed) to calm wheezing and direct Qi downward.) Relief is achieved if accompanied by nasal congestion and absence of thirst. (Commentary: To treat wheezing with this formula, external symptoms such as headache, nasal congestion, aversion to cold, and absence of dry thirst must be present before administration.)