治太阳病下之微喘者。表未解也。
桂枝(三两) 甘草(二两) 芍药(三两) 大枣(十二枚) 杏仁(五十枚) 浓
朴(
上七味。以水七升。微火煮取三升。去滓。温服一升。覆取微似汗。
歌曰 下后喘生(桂枝证下之微喘。)及喘家。(素有喘名喘家。)桂枝汤外更须加。朴
加二
太阳表病未解而下之。气不因下
表。加浓朴以宽之。杏仁以降之。表解而喘平矣。与太阳病下之后。其气上冲者。可与桂枝
汤参看。
治下之后复发汗。昼日烦躁不得眠。夜安静。不渴不呕。无表证。脉沉微。
此方主之。
干姜(一两) 附子(一枚 生用。去皮。破八片)
上二味。以水五升。煮取一升。去滓。顿服。
歌曰 生附一枚一两姜。昼间烦躁夜安常。脉微无表身无热。幸藉残阳未尽亡。
蔚按。太阳底面便是少阴。太阳证误下之。则少阴之阳既虚。又发其汗。则一线之阳难以自
主。阳王于昼。阳虚欲援同气之救助而不可得。故烦躁不得眠。阴王于夜。阳虚必俯首不敢
争。故夜则安静。又申之曰。不呕不渴。脉沉微。无表证。身无大热。辨其烦躁之绝非外邪
。而为少阴阳虚之的证也。证既的则以回阳之姜、附顿服。何疑。
治发汗后身疼痛脉沉迟者。
桂枝(三两) 芍药(四两) 甘草(二两 炙。) 人参(三两) 大枣(十二枚) 生
姜
上六味。以水一斗二升。微火煮取三升。去滓。分温服一升。余如桂枝汤法。(按内台
云。
歌曰 汗后身疼脉反沉。新加方法轶医林。方中姜芍还增一。三两人参义蕴深。
蔚按。此言太阳证发汗后。邪已净而营虚也。身疼痛证虽似外邪。而血虚不能养营者必
痛也
方用桂枝汤取其专行营分。加人参以滋补血液生始之源。加生姜以通血脉循行之滞。加芍药
之苦平。欲领姜、桂之辛。不走于肌腠而作汗。潜行于经脉而定痛也。曰新加者。言邪盛忌
用人参。今因邪净而新加之。注家谓有余邪者。误也。
治疗太阳病经过误用泻下法后出现轻微气喘的,说明表证尚未解除。
桂枝(三两) 甘草(二两) 芍药(三两) 大枣(十二枚) 杏仁(五十枚) 浓朴(二两)
以上七味药,用水七升,用小火煮取三升,去掉药渣,温服一升,服药后覆盖衣被使身体微微出汗。
歌诀说:误下后产生气喘(是桂枝汤证的误下导致微喘),以及素有喘疾的人(平素有喘息病史称为喘家),在桂枝汤基础上必须再加味。加浓朴二两、杏仁五十枚。
太阳表证未解而误用泻下法,气机不因下法而内陷,反而上逆作喘。加入浓朴以宽胸理气,加入杏仁以降气平喘。表证解除而气喘平息。这与太阳病误下后,其气上冲者,可以使用桂枝汤的情况参看对照。
治疗误用泻下法后又误发汗,白天烦躁不能入睡,夜间安静,口不渴,无呕吐,无表证,脉象沉微。
此方主治。
以上两味药,用水五升,煮取一升,去掉药渣,一次性服用。
歌诀说:生附子一枚配一两干姜,白天烦躁夜间安宁正常。脉象微弱且无表证身体无热,幸好借助残存的阳气尚未完全亡失。
陈蔚按语:太阳病的根本在于少阴。太阳证误用泻下法,则少阴之阳已经虚弱,如果再发汗,则一线之阳难以自主维持。阳气旺于白天,阳虚想要求助于同气相求的力量却不可得,所以烦躁不能入睡。阴气旺于夜晚,阳虚必然俯首不敢抗争,所以夜间安静。又补充说明:不呕不渴,脉象沉微,无表证,身体没有大热,以此辨别其烦躁绝非外邪所致,而是少阴阳虚的确切证候。既然证候确切,就用回阳救逆的干姜、附子一次性服用,有什么可怀疑的呢?
治疗发汗后身体疼痛且脉象沉迟的。
桂枝(三两) 芍药(四两) 甘草(二两,炙) 人参(三两) 大枣(十二枚) 生姜(三两)
以上六味药,用水一斗二升,用小火煮取三升,去掉药渣,分三次温服,每次一升。其余如桂枝汤的方法。(按《内台方议》记载:)
歌诀说:发汗后身体疼痛脉象反而沉,新加汤方法超越医林。方中姜、芍还增加一味,三两人参义蕴深长。
陈蔚按语:这是说太阳证发汗后,邪气已净但营血虚弱。身体疼痛的症状虽然看似外邪,但血虚不能滋养营卫的人必定疼痛。方中使用桂枝汤取其专门运行营分的作用,加入人参以滋补血液生成的源头,加入生姜以疏通血脉运行的滞涩,加入芍药的苦平之性,想要引导姜、桂的辛散之气,不向肌腠发散而作汗,而是潜行于经脉之中以定痛。称为“新加”,是说邪气盛时忌用人参,现在因为邪气已净而新近加入。注家认为有余邪的,是错误的。
Treats Taiyang disease (Taiyang disease, a syndrome caused by pathogenic factors affecting the Taiyang channel) where mild wheezing occurs after inappropriate purgation. This indicates that the exterior syndrome has not yet resolved.
Guizhi Tang (Cinnamon Twig Decoction): Guizhi (Cinnamomi Ramulus, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Shaoyao (Paeoniae Radix, 3 liang), Dazao (Ziziphi Jujubae Fructus, 12 pieces), Xingren (Armeniacae Semen Amarum, 50 seeds), Nongpo (Magnoliae Officinalis Cortex, 2 liang).
Take the above seven ingredients, add seven sheng of water, and decoct over low heat to obtain three sheng. Remove the dregs. Take one sheng warm. Cover with blankets to induce a slight sweat.
The verse states: Wheezing arising after purgation (mild wheezing due to purgation in a Guizhi Tang pattern) and the "wheezing family" (those who have a chronic history of wheezing). In addition to Guizhi Tang, further additions are required. Add Nongpo (Magnoliae Officinalis Cortex) two liang and Xingren (Armeniacae Semen Amarum) fifty seeds.
When the Taiyang exterior syndrome is unresolved and purgation is incorrectly applied, the qi does not sink inward but rebels upward causing wheezing. Add Nongpo (Magnoliae Officinalis Cortex) to broaden the chest and regulate qi, and add Xingren (Armeniacae Semen Amarum) to descend qi and calm wheezing. Once the exterior resolves, the wheezing subsides. Compare this with the case of Taiyang disease after purgation where qi rushes upward, for which Guizhi Tang (Cinnamon Twig Decoction) may be used.
Treats cases where purgation was incorrectly applied followed by sweating, resulting in restlessness during the day preventing sleep, while quiet at night, without thirst or vomiting, no exterior syndrome, and a deep, faint pulse.
This formula is indicated.
Ganjiang (Zingiberis Rhizoma, 1 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, raw, skin removed, broken into eight pieces).
Take the above two ingredients, add five sheng of water, and decoct to obtain one sheng. Remove the dregs. Take all at once.
The verse states: One piece of raw Fuzi (Aconiti Lateralis Radix Praeparata) and one liang of Ganjiang (Zingiberis Rhizoma). Restless by day, peaceful by night. Pulse is faint, no exterior syndrome, body lacks heat. Fortunately, the residual yang has not yet perished.
Chen Wei comments: The root of Taiyang lies in Shaoyin. If Taiyang syndrome is incorrectly purged, the Yang of Shaoyin becomes deficient. If sweating is then induced, that single thread of Yang cannot sustain itself. Yang dominates the day; when Yang is deficient, it seeks assistance from its like but cannot obtain it, hence restlessness and insomnia. Yin dominates the night; when Yang is deficient, it submits and dares not contend, hence quietness at night. Furthermore: No vomiting, no thirst, deep and faint pulse, no exterior syndrome, no significant heat in the body. These distinguish the restlessness as definitely not due to external pathogens, but as a definitive syndrome of Shaoyin Yang deficiency. Since the syndrome is definitive, use Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) to restore Yang, taken all at once. What doubt remains?
Treats body pain and a deep, slow pulse after sweating.
Guizhi (Cinnamomi Ramulus, 3 liang), Shaoyao (Paeoniae Radix, 4 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang, honey-fried), Renshen (Ginseng Radix, 3 liang), Dazao (Ziziphi Jujubae Fructus, 12 pieces), Shengjiang (Zingiberis Rhizoma Recens, 3 liang).
Take the above six ingredients, add twelve dou of water, and decoct over low heat to obtain three sheng. Remove the dregs. Divide into three warm doses, taking one sheng each time. Follow the method of Guizhi Tang (Cinnamon Twig Decoction) otherwise. (According to *Neitai Fangyi*:)
The verse states: After sweating, body pain persists and the pulse becomes deep. The Xinjia method surpasses medical circles. In the formula, Ginger and Peony are added, along with Ginseng, whose profound meaning is deep.
Chen Wei comments: This refers to Taiyang syndrome after sweating, where the pathogen is cleared but Ying (Nutritive) blood is deficient. Although body pain resembles an external pathogen, pain in those with blood deficiency failing to nourish the Ying level is inevitable. The formula uses Guizhi Tang (Cinnamon Twig Decoction) for its ability to specifically circulate in the Ying level. Add Renshen (Ginseng Radix) to tonify the source of blood generation. Add Shengjiang (Zingiberis Rhizoma Recens) to unblock stagnation in blood vessel circulation. Add Shaoyao (Paeoniae Radix) for its bitter and neutral nature, intending to guide the acridity of Ginger and Cinnamon so that it does not disperse to the muscle layer to induce sweat, but instead penetrates deeply into the meridians to alleviate pain. It is called "New Addition" because Ginseng is contraindicated when pathogenic factors are abundant; here, it is newly added because the pathogen is already cleared. Commentators who believe there is residual pathogen are mistaken.