治产后中风续续数十日不解。头微疼。恶寒时时有热。心下闷。干呕汗出。虽久阳
旦症续在者。可与之。(即桂枝汤增桂加附。坊本谓加黄芩者。未知伤寒论太阳篇中已明其
方。孙真人及各家俱误。桂枝汤见妇人妊娠病。)
男元犀按。头痛发热恶寒汗出。太阳表症也。心下闷者。太阳水邪弥漫心下而作闷也。
阳旦
太阳
寒
人以
闷。则
少阴。
之苦。
阴邪。
治产后中风发热。面正赤。喘而头痛者。此汤主之。
竹叶(一把。) 葛根(三两。) 防风 桔梗 桂枝 人参 甘草(各一两。) 附子
(一枚。
右十味。以水一斗。煮取二升半。分温三服。温覆使汗出。 颈项强。用大附子一枚。
破之
歌曰 喘热头疼面正红。(势欲成痉。)一(两)防桔桂草参同。(同用一两。)葛(根)
三(两生)
加减歌曰 颈项强用大附抵。以大易小不同体。呕为气逆更议加。半夏半升七次洗。
程云来云。证中未至背反张。而发热面赤头痛。亦风痉之渐。故用竹叶主风痉。防风治内痉
。葛根疗刚痉。桂枝治柔痉。生姜散风邪。桔梗除风痹。辛以散之之剂也。又佐人参生液以
养筋。附子补火以致水。合之甘草以和诸药。大枣以助十二经。同诸风剂。则发中有补。为
产后中风之大剂也。
治疗产后感受风邪,病程持续数十日仍未痊愈。症状表现为头部轻微疼痛,时而恶寒,时而发热,胃脘部痞闷,干呕,出汗。即使病程较长,但阳旦证(即桂枝汤证)依然存在者,可以使用此方。(此方即桂枝汤增加桂枝用量并加入附子。坊间刻本称加入黄芩,这是错误的,因为《伤寒论·太阳篇》中已明确记载了该方的组成。孙思邈及各家医家都搞错了。桂枝汤的组成见《妇人妊娠病》篇。)
男元犀按语:头痛、发热、恶寒、出汗,属于太阳经表证。胃脘部痞闷,是因为太阳经水湿之邪弥漫于胃脘部位所致。
治疗产后感受风邪出现发热,面色正红,气喘且头痛者,用此汤主治。
竹叶(一把),葛根(三两),防风、桔梗、桂枝、人参、甘草(各一两),附子(一枚)。
以上十味药,用水一斗,煎煮至二升半,分三次温服。服药后覆盖衣被使身体微微出汗。若伴有颈项强直,使用大附子一枚。
歌诀曰:喘热头疼面正红(病情势将发展为痉病)。一防桔桂草参同(防风、桔梗、桂枝、甘草、人参各用一两)。葛根三两生用。
加减歌诀曰:颈项强直需用大附子抵当,以大易小体质不同。呕吐为气机上逆更应加味,半夏半升需七次洗制。
程云来说:病症中尚未发展到角弓反张的程度,但发热、面赤、头痛,也是风痉的征兆。所以用竹叶主治风痉,防风治疗内痉,葛根治疗刚痉,桂枝治疗柔痉,生姜疏散风邪,桔梗祛除风痹。这是一类辛散解表的方剂。又佐以人参滋生津液以濡养筋脉,附子补益命门之火以化生肾水,合用甘草调和诸药,大枣助益十二经脉。与各类治风方剂相比,此方发汗中有补益作用,是治疗产后中风的大剂方。
Treats postpartum wind-stroke that persists for dozens of days without resolution. Symptoms include slight headache, alternating aversion to cold and fever, epigastric fullness, dry retching, and sweating. Even if the duration is long, as long as Yangdan Syndrome (Guizhi Tang Syndrome) remains present, this formula may be administered. (This refers to Guizhi Tang with increased dosage of Cinnamon Twig and added Aconite. Commercial editions erroneously state the addition of Scutellaria Root; this is incorrect as the composition is clearly stated in the Taiyang Chapter of Shanghan Lun. Sun Simiao and other experts were mistaken. See Guizhi Tang under the chapter on Pregnancy Diseases.)
Commentary by Nan Yuanxi: Headache, fever, aversion to cold, and sweating are exterior symptoms of the Taiyang channel. Epigastric fullness arises from the diffusion of Taiyang water-damp pathogenic factors into the epigastrium.
For postpartum wind-stroke presenting with fever, a distinctly red face, wheezing, and headache, this decoction is indicated.
Zhu Ye (Bamboo Leaf, one handful), Gegen (Kudzu Root, three liang), Fangfeng (Saposhnikovia Root), Jiegeng (Platycodon Root), Guizhi (Cinnamon Twig), Renshen (Ginseng Root), Gancao (Licorice Root, each one liang), Fuzi (Aconite Lateralis Radix Praeparata, one piece).
The above ten ingredients are boiled in ten dou of water until two and a half sheng remain. Divide into three warm doses. Cover with blankets to induce mild sweating. If neck stiffness is present, use a large Fuzi (one piece).
Song verse:
Wheezing, heat, headache, and a red face indicate (the potential progression to Jing disease).
One liang each of Fangfeng, Jiegeng, Guizhi, Gancao, and Renshen are used together.
Gegen (three liang, raw) is added.
Modification song verse:
For neck stiffness, a large Fuzi is required; changing from small to large alters the nature.
For vomiting due to rebellious Qi, additional herbs should be considered: Banxia (Pinellia Tuber, half sheng, washed seven times).
Cheng Yunlai states: Although the condition has not yet progressed to opisthotonos (back arching), the presence of fever, flushed face, and headache indicates an early stage of Feng Jing (Wind-induced Spasm). Therefore, Zhu Ye is used to treat Wind Jing, Fangfeng treats internal spasm, Gegen treats Gang Jing (Stiff Spasm), Guizhi treats Rou Jing (Flaccid Spasm), Shengjiang (Fresh Ginger) disperses wind pathogens, and Jiegeng removes wind-bi obstruction. This is a formula utilizing acrid flavors to disperse. It is assisted by Renshen to generate fluids and nourish the sinews, and Fuzi to tonify Fire to facilitate Water transformation. Combined with Gancao to harmonize the various herbs, and Dazao (Jujube Fruit) to assist the twelve channels. Compared to other wind-dispelling formulas, this formula combines release with tonification, serving as a major prescription for postpartum wind-stroke.