治少阴病得之二三日。微发汗。以二三日无里证。故微发汗也。此方主之
麻黄(二两) 附子(一枚 炮。) 甘草(二两 炙。)
上三味。以水七升。先煮麻黄一两沸。去上沫。内诸药。煮取三升。去滓。温服一升。
日三
歌曰 甘草麻黄二两佳。一枚附子固根 。少阴得病二三日。里证全无汗岂乖。
蔚按。少阴病自始得以至二三日。无下利厥逆大寒之里证。又无心中烦不得卧热化之里
证。
解。而又恐过汗以伤心肾之真液。故于前方去细辛。加甘草之补中。取中焦水谷之津而为汗。
则内不伤阴。邪从汗解矣。须知此汤变交阴阳法。为微发汗法。
治少阴病得之二三日以上。心中烦。不得卧者主之。
黄连(四两) 黄芩(一两) 芍药(二两) 阿胶(三两) 鸡子黄(二枚)
上五味。以水六升。先煮三物。取二升。去滓。内胶烊尽。小冷。内鸡子黄搅令相得。
温服
歌曰 四两黄连三两胶。二枚鸡子取黄敲。一芩二芍心烦治。更治难眠睫不交。
男元犀按。少阴病但欲寐为提纲。此节云心中烦不得卧。是但欲寐之病情而变为心中烦。
可
此为少阴热化之证。方中用黄连、黄芩之苦寒以折之。芍药之苦平以降之。又以鸡子黄补离
中之气。阿胶补坎中之精。俾气血有情之物交媾其水火。斯心烦止而得卧矣。此回天手段。
治疗少阴病(少阴经受邪所致的病证)发病两三天。采用轻微发汗的方法。因为发病两三天后没有出现里证(病位在里的证候),所以采用轻微发汗的方法。此方主治这种情况。
以上三味药,用水七升,先煮麻黄,煮沸一次后,撇去浮沫,加入其他药物,煎煮至取药液三升,滤去药渣。每次温服一升,每日三次。
歌诀曰:甘草、麻黄各二两最为适宜,一枚附子可固护根本。少阴病发病两三天,完全没有里证,发汗难道有违常理吗?
蔚按语:少阴病从开始到发病两三天,既没有下利、四肢厥冷等大寒的里证,也没有心中烦乱、不得安卧的热化里证。既然需要解表,又担心过度发汗会损伤心肾的真阴津液,因此在前方的基础上去掉细辛,加入具有补益中焦作用的甘草,利用中焦水谷的精微津液化生为汗,这样内部就不会损伤阴液,邪气随汗而解了。须知此汤是变通阴阳交济之法,属于轻微发汗法。
治疗少阴病发病两三天以上,出现心中烦乱、无法安卧症状的患者,以此方主治。
黄连(四两) 黄芩(一两) 芍药(二两) 阿胶(三两) 鸡子黄(两个蛋黄)
以上五味药,用水六升,先煮前三味药,取药液二升,滤去药渣,加入阿胶使其完全溶化,待药液稍凉后,加入鸡子黄,搅拌均匀。温服。
歌诀曰:四两黄连配三两阿胶,敲开两个鸡蛋取蛋黄。一两黄芩、二两芍药治疗心烦,更能治疗难以入睡、眼睑闭合困难的症状。
男元犀按语:少阴病的提纲证是“但欲寐”(只想睡觉、精神萎靡)。这一节说心中烦乱、无法安卧,是“但欲寐”的病情转化为心中烦乱的表现。这属于少阴热化证。方中使用黄连、黄芩的苦寒之性以折降火热,芍药的苦平之性以降泄,再用鸡子黄补益离火(心)中的阳气,阿胶补益坎水(肾)中的精血。使这些有情之品的气血相互交媾,调和水火,这样心烦停止,就能安睡了。这是回天救逆的高超手段。
Treat Shaoyin disease (disease syndrome caused by pathogenic invasion of the Shaoyin meridian) occurring two to three days after onset. Employ a mild diaphoretic method. Because there are no interior syndromes (syndromes located in the interior) after two or three days, a mild diaphoretic method is used. This formula is indicated for this condition.
Ephedrae Herba (Mahuang, 麻黄) [two liang]
Aconiti Lateralis Radix Praeparata (Fuzi, 附子) [one piece, processed]
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [two liang, honey-fried]
Take the above three ingredients. Add seven sheng of water. First boil Ephedrae Herba until it boils once, then remove the foam on the surface. Add the remaining herbs. Boil until three sheng of liquid remain. Strain the dregs. Take one sheng warm each time, three times a day.
Song says: Gancao and Mahuang, two liang each, are best; one Fuzi solidifies the root. When Shaoyin disease occurs for two or three days, with no interior syndromes at all, how could sweating be inappropriate?
Commentary by Wei: From the onset of Shaoyin disease up to two or three days, there are no interior syndromes of severe cold such as diarrhea or cold extremities, nor are there interior syndromes of heat transformation such as mental restlessness and inability to sleep. Since exterior resolution is needed, yet excessive sweating might damage the true yin fluids of the Heart and Kidney, Xixin (Asari Radix) is removed from the previous formula, and Gancao (which tonifies the Middle Jiao) is added. By utilizing the fluids and grain essence of the Middle Jiao to generate sweat, the interior yin is not damaged, and the pathogen is resolved through sweating. It must be understood that this decoction varies the method of interacting Yin and Yang, serving as a mild diaphoretic method.
For Shaoyin disease occurring more than two or three days, presenting with mental restlessness and inability to sleep, this formula is indicated.
Coptidis Rhizoma (Huanglian, 黄连) [four liang]
Scutellariae Radix (Huangqin, 黄芩) [one liang]
Paeoniae Radix Alba (Shaoyao, 芍药) [two liang]
Asini Corii Colla (Ejiao, 阿胶) [three liang]
Ovi Galli Albumen (Jizihuang, 鸡子黄) [two yolks]
Take the above five ingredients. Add six sheng of water. First boil the first three ingredients to obtain two sheng of liquid. Strain the dregs. Add Ejiao and melt it completely. Let it cool slightly. Add the Ovi Galli Albumen and stir well to mix. Take warm.
Song says: Four liang Huanglian and three liang Ejiao; crack open two eggs to take the yellow. One qian Huangqin and two liang Shaoyao treat mental restlessness; further treating insomnia where eyelids cannot close.
Commentary by Nan Yuanxi: The guiding symptom of Shaoyin disease is "Dan Yu Mei" (desire to sleep/lethargy). This section states mental restlessness and inability to sleep, indicating that the condition of "Dan Yu Mei" has transformed into mental restlessness. This is a Shaoyin Heat Transformation Syndrome. In the formula, the bitter-cold nature of Huanglian and Huangqin is used to subdue the fire; the bitter-neutral nature of Shaoyao is used to descend; Ovi Galli Albumen tonifies the Qi within Li Fire (Heart); and Ejiao tonifies the Essence within Kan Water (Kidney). This allows these sentient substances to interact, harmonizing Water and Fire. Thus, mental restlessness ceases, and sleep is achieved. This is a miraculous method of restoring vital energy.