治太阳病得之八九日。(过经。)如疟状。(与往来寒热不同。故曰如疟。)
发热恶寒。(现出太阳经真面目。)热多寒少。(太阳以阳为主。热多是主胜客负。为将
解之
之寒热有定候。此则或二或三。无定候也。太阳之阳气有权。则邪气有不能自容之象。) 脉
微缓者。(微则邪衰。缓则正复。)为欲愈也(自起句至此为一节。言邪轻欲自解。不药可愈
也。)脉微(上节以微与缓对举。此节但云微而不云缓者。以邪衰而正亦衰也。)而恶寒者。
(上
客负之兆。若寒多热少即为客胜主负之兆。况但寒无热之证乎,此阴阳俱虚。(阴阳认
作气
背恶寒
(自脉
法矣。师不出
不宜有热色。今反见热色者。以其人阴阳虽曰俱虚。而阳气尚能鼓郁热之气而见于面色。)
未欲解也。(欲字可味。太阳以阳为主。犹幸阳气未败。尚能鼓过经之邪见于面色。独恨阳
气已虚。不能遂其所欲。令作小汗而解。)以其不得小汗出。身必痒。(申上未欲解意,辨面
色之热。兼征之周身作痒。)宜桂枝麻黄各半汤。(邪欲出而不能自出。故藉此方以助之。自
面有热色至此。又是一节。通章以太阳病得之八九日一句为主。言过经之病也。下分三节。
节节相承。一层剥起一层。自有注伤寒论以来。千百余年无有一人道及。今特详注之。)
桂枝(一两十六铢) 芍药(一两) 生姜(一两) 甘草(一两 炙。) 麻黄(一
两去
上七味。以水五升。先煮麻黄一二沸。去上沫。纳诸药。煮取一升八合。去渣。温服六
合。
歌曰 桂枝一两十六铢。甘芍姜麻一两符。杏廿四枚枣四粒。面呈热色痒均驱。
蔚按。内台载此方。即桂枝汤原方分两。加麻黄三两。杏仁七十个。白水煎服。取微汗。
许
之。乃解其表不虚不实者也。
治疗太阳病经过八九日。(即邪气已离开本经,传入他经。)症状像疟疾一样。(与少阳病的往来寒热不同,所以说是“像”疟疾。)
发热恶寒。(这是太阳经病症的真实表现。)发热多而恶寒少。(太阳经以阳气为主。发热多是阳气胜而邪气负,是疾病将要解除的征兆。)
这种寒热发作有固定的时间规律。但此证有时两三次,没有固定规律。这是因为太阳经的阳气尚有权力,所以邪气有不能自容的迹象。)
脉象微缓的。(微表示邪气衰退,缓表示正气恢复。)这是将要痊愈的表现(从开头到这里是一节。说明邪气轻浅,想要自行解除,不吃药也可以痊愈。)
如果脉象微细且恶寒的。(上一节是将“微”与“缓”对举,这一节只说“微”而不说“缓”,是因为邪气衰退的同时正气也衰弱了。)
(这是邪气胜、正气负的征兆。如果寒多热少就是邪胜正负的征兆,何况只有寒冷而没有发热的情况呢?这是阴阳都虚弱。)
背部怕冷。(这是阴证的表现。)
老师没有给出方剂。(因为病情复杂,不宜轻易用药。)
面色不应该有热色。现在反而出现热色的,是因为这个人虽然阴阳俱虚,但阳气尚能鼓动郁积的热气反映在面色上。)
还没有完全解除。(“欲”字值得玩味。太阳经以阳气为主,幸好阳气尚未败坏,还能鼓动过经之邪反映在面色上。遗憾的是阳气已经虚弱,不能随心所欲地通过小汗来解除病邪。)
因为不能出小汗,身体必定发痒。(申述上面“未欲解”的意思,辨别面色的热,兼验周身作痒的症状。)适宜用桂枝麻黄各半汤。(邪气想要外出但不能自行排出,所以借助这个方剂来帮助它。从“面有热色”到这里,又是另一节。整篇文章以“太阳病得之八九日”一句为主旨,说的是过经的病证。下面分三节,节节相承,层层深入。自从注释《伤寒论》以来,千百年来没有人提到过这一点,今天特别详细地注释它。)
桂枝(一两十六铢) 芍药(一两) 生姜(一两) 甘草(一两,炙) 麻黄(一两,去节)
以上七味药,用水五升,先煮麻黄一二沸,去掉上面的浮沫,加入其他药物,煮取一升八合,去渣,温服六合。
歌诀曰:桂枝一两十六铢,甘芍姜麻一两符。杏廿四枚枣四粒,面呈热色痒均驱。
蔚按:《内台方议》记载此方,就是桂枝汤原方的分量,加上麻黄三两,杏仁七十个,白水煎服,取微汗。许叔微认为这样可以解除表证不虚不实的状态。
Treating Taiyang disease that has persisted for eight or nine days. (The pathogen has passed beyond the primary stage.) The symptoms resemble malaria. (Different from the alternating chills and fever of Shaoyang disease; hence described as "resembling" malaria.)
There is fever and aversion to cold. (This reveals the true nature of Taiyang channel pathology.) The heat sensation is more prominent than the cold sensation. (Taiyang is governed by Yang Qi. Prominent heat indicates that the host's Yang is prevailing over the invading pathogen, suggesting the disease is about to resolve.)
In typical cases, the chills and fever occur at fixed intervals. However, in this condition, they may occur two or three times without a fixed pattern. This indicates that the Taiyang Yang Qi still holds authority, creating an appearance where the pathogen cannot remain contained.)
If the pulse is slightly slow and relaxed. (Slightness indicates the decline of the pathogen; relaxation indicates the recovery of healthy Qi.) This signifies impending recovery. (From the beginning to here constitutes one section. It states that the pathogen is light and wishes to resolve spontaneously, allowing for healing without medication.)
If the pulse is slight and there is aversion to cold. (In the previous section, "slight" was contrasted with "relaxed." Here, only "slight" is mentioned, implying that while the pathogen declines, the healthy Qi also weakens.)
(This is a sign of the pathogen prevailing and healthy Qi being defeated. If cold predominates over heat, it signals pathogenic victory and healthy defeat; how much more so if there is only cold without heat? This indicates a deficiency of both Yin and Yang.)
Aversion to cold on the back. (This reflects a Yin-pattern manifestation.)
The Master did not prescribe a formula. (Because the condition is complex, hasty medication is inappropriate.)
Normally, there should not be a flushed complexion. The fact that a flushed color appears now is because, although both Yin and Yang are deficient, the Yang Qi is still able to stir up stagnant heat and manifest it on the face.)
The disease has not yet fully resolved. (The word "wishes" or "about to" is significant. Taiyang is governed by Yang Qi. Fortunately, the Yang Qi has not yet collapsed and can still drive the pathogen that has lingered past its original stage to manifest on the face. Regrettably, the Yang Qi is already deficient and cannot freely induce a slight sweating to resolve the illness.)
Because slight sweating cannot be achieved, the body will likely itch. (Elaborating on the meaning of "not yet resolved," distinguishing the facial flush and corroborating with generalized pruritus.) Guizhi Mahuang Ge Ban Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is appropriate. (The pathogen desires to exit but cannot do so independently; thus, this formula is borrowed to assist it. From "flushed face" to here constitutes another section. The entire passage centers on the phrase "Taiyang disease persisting for eight or nine days," addressing diseases that have passed beyond their initial stage. It is divided into three sections below, which follow sequentially and peel back layers of complexity. Since the commentary on Shanghan Lun began, no one has discussed this in thousands of years; today, I specifically annotate it in detail.)
Guizhi (Cinnamomi Ramulus) (1 liang 16 zhu), Shaoyao (Paeoniae Radix Alba) (1 liang), Shengjiang (Zingiberis Rhizoma Recens) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (1 liang, honey-fried), Mahuang (Ephedrae Herba) (1 liang, nodes removed).
Take these seven ingredients, add five sheng of water, first boil Mahuang for one or two boils, remove the foam on the surface, then add the remaining herbs. Boil until one sheng eight he remains, strain, and take six he warm.
Verse:
Guizhi one liang sixteen zhu,
Gancao, Shaoyao, Shengjiang, Mahuang each one liang match.
Xingren twenty-four seeds, Zao four fruits,
Flushed face and itching both dispelled.
Commentary by Wei: The Neitai Fangyi records this formula as the original dosage of Guizhi Tang, plus Sanliang of Mahuang and seventy Xingren, decocted in plain water to induce slight sweating. Xu Shimiao believed this resolves exterior conditions that are neither deficient nor excess.