丁皮(一两) 干姜(二钱) 白术(二钱) 陈皮(二钱) 丁香(二钱) 浓朴(一两,姜制)
上为末,每服二钱,水一盏,葱白三寸,荆芥五穗,煎至七分,去滓热服。三服未快,
手足尚逆,呕吐,更加舶上丁皮二钱,干姜二钱,炮用。
陈皮(一两) 藿香(三钱) 白术(二钱) 葛根(二钱) 浓朴(一两,姜制)
上为末,每服二钱,水一盏,生姜一块,枣大破,同煎至七分,去滓,热服。如三
服未快,手足尚逆,呕吐不定,加半夏三钱,丁香、枝杖半两,每服加葱白三寸煎服。
白术(二钱) 干生姜(一钱) 人参(三钱) 桔梗(三钱) 葛根(三钱) 藿香叶(二钱)
上细末,炼蜜为丸弹子大。每服一丸,水一盏,煎至七分,和滓热服。如三服未快,手
足尚逆,呕者,加半夏二钱,干姜二钱,炮。
病患两手脉沉细无力,虽三部脉力停,亦是阴气盛也,更不须候寸脉短治之,或胸胁满
闷,身体拘急疼痛,手足逆冷,速宜温中药和之。
上此一条,不须候寸脉短一句。然当不若曰三部既沉,便是无寸口也。若立春以后至清明以前,
宜浓朴丸主之;清明以后至芒种以前,宜白术汤主之;芒种以
后至立秋以前,宜橘皮汤主之。
上此一条,李思训举和解因时一说,与韩氏相似。然汤液仲景四时之法,固以备矣,以
其后人不识,故韩、李为是丁宁也,此亦大概耳。若应见违时,只可随应见而治之。
海藏云∶仲景既言春为温病,夏为热病,长夏为大热病,随经之药,加减轻重,便为因
时和
解也。正治应见,便是活法,韩、李因时定药,是则然矣!证复违时,定药难用,若用定药
,却是不因时也。假令立春、清明、芒种、立秋,即岁之主气也。定时也,若岁之客气,司
天在泉,太过不及,胜复淫,至而不至,未至而至,岂可定时为则邪?主气为病,则只论主
气;客气为病,则只论客气;主客相胜,上下相召,有万不同之变。人之禀受虚实,亦犹是
也。以此言之,则仲景大经之言尽矣。但患世之医者不知耳!此亚圣言简而意有余也。后之
贤
者,辞多而意少,务救一时之弊,云此韩、李为是因时一说也。是说也,又为庸医执方疗病
者设,非敢为仲景别立一法也。噫!二公虽不足为汉之仲景,亦足以为今之仲景也。
丁皮(一两) 干姜(二钱) 白术(二钱) 陈皮(二钱) 丁香(二钱) 浓朴(一两,姜制)
以上药物研为细末,每次服用二钱,加水一盏,葱白三寸,荆芥五穗,煎煮至七分满,滤去药渣,趁热服用。若服三次后症状未缓解,手足仍然逆冷,伴有呕吐,再加舶上丁皮二钱,干姜二钱,炮制后使用。
陈皮(一两) 藿香(三钱) 白术(二钱) 葛根(二钱) 浓朴(一两,姜制)
以上药物研为细末,每次服用二钱,加水一盏,生姜一块(如枣大,掰破),一同煎煮至七分满,滤去药渣,趁热服用。如果服三次后症状未缓解,手足仍然逆冷,呕吐不止,加半夏三钱,丁香、枝杖半两,每次服用时加葱白三寸煎服。
白术(二钱) 干生姜(一钱) 人参(三钱) 桔梗(三钱) 葛根(三钱) 藿香叶(二钱)
以上药物研为细末,用炼蜜制成如弹子大小的丸剂。每次服用一丸,加水一盏,煎煮至七分满,连同药渣一起趁热服用。如果服三次后症状未缓解,手足仍然逆冷,呕吐的,加半夏二钱,干姜二钱,炮制。
病患两手脉象沉细无力,虽然三部脉力度相当,这也是阴气盛的表现,更不需要等待寸脉短促再治疗,或者胸胁胀满闷痛,身体拘急疼痛,手足逆冷,应当迅速用温中药来调和它。
上述这一条中,“不须候寸脉短”这句话。然而应当说不如说“三部脉既已沉伏,便是没有寸口脉”。如果在立春以后到清明以前,宜用浓朴丸主治;清明以后到芒种以前,宜用白术汤主治;芒种以后到立秋以前,宜用橘皮汤主治。
上述这一条,李思训提出了因时和解的说法,与韩氏相似。然而汤液仲景四时的治法,本来已经完备了,因为后人不懂,所以韩、李二人如此叮咛告诫,这也是一般的大概情况罢了。如果遇到违时(气候反常),只可随着应见的证候来治疗。
海藏说:仲景既然说了春为温病,夏为热病,长夏为大热病,根据经络用药,加减轻重,就是因时和解。正治应见,就是活法,韩、李因时定药,这固然正确!但证候又违时,定药难用,如果用定药,却是不因时了。假使立春、清明、芒种、立秋,是岁的主气。定时也,如果是岁的客气,司天在泉,太过不及,胜复淫,至而不至,未至而至,岂可把定时作为准则呢?主气为病,就只论主气;客气为病,就只论客气;主客相胜,上下相召,有万种不同的变化。人的禀受虚实,也是如此。由此而言,仲景大经的话都说尽了。只是担心世间的医者不知道罢了!这是亚圣言简而意有余啊。后来的贤者,辞多而意少,致力于挽救一时的弊病,说韩、李是因时一说。这个说法,又是为庸医执方疗病的人设立的,不敢为仲景另立一法。唉!这两位先生虽然不足以成为汉代的仲景,也足以成为当今的仲景了。
Dingpi (Pericarpium Citri Reticulatae Viride, one tael) Ganjiang (Dried Ginger, two qian) Baizhu (Atractylodis Macrocephalae Rhizoma, two qian) Chenpi (Pericarpium Citri Reticulatae, two qian) Dingxiang (Flos Caryophylli, two qian) Houpo (Cortex Magnoliae Officinalis, one tael, processed with ginger juice).
Grind the above herbs into powder. Take two qian per dose, add one cup of water, three cun of Congbai (Scallion White), and five spikes of Jingjie (Schizonepetae Herba). Decoct until reduced to seventy percent. Strain and take hot. If symptoms do not improve after three doses, and hands and feet remain cold with vomiting, add Ershang Dingpi (Imported Pericarpium Citri Reticulatae Viride, two qian) and Ganjiang (Dried Ginger, two qian), both processed by firing.
Chenpi (Pericarpium Citri Reticulatae, one tael) Huoxiang (Agastaches Herba, three qian) Baizhu (Atractylodis Macrocephalae Rhizoma, two qian) Gegen (Puerariae Lobatae Radix, two qian) Houpo (Cortex Magnoliae Officinalis, one tael, processed with ginger juice).
Grind the above herbs into powder. Take two qian per dose, add one cup of water, a piece of Shengjiang (Fresh Ginger, size of a jujube, broken), and decoct together until reduced to seventy percent. Strain and take hot. If symptoms do not improve after three doses, and hands and feet remain cold with intermittent vomiting, add Banxia (Pinelliae Tuber, three qian), Dingxiang (Flos Caryophylli), and Zhizhang (likely referring to a specific part or variant, half liang). Add three cun of Congbai (Scallion White) per dose for decoction.
Baizhu (Atractylodis Macrocephalae Rhizoma, two qian) Ganshengjiang (Dried Fresh Ginger, one qian) Renshen (Ginseng Radix et Rhizoma, three qian) Jiegeng (Platycodonis Radix, three qian) Gegen (Puerariae Lobatae Radix, three qian) Huoxiangye (Agastaches Folium, two qian).
Grind the above herbs into fine powder. Form pills using refined honey, sized like bullet seeds. Take one pill per dose, add one cup of water, decoct until reduced to seventy percent, and take hot including the dregs. If symptoms do not improve after three doses, and hands and feet remain cold with vomiting, add Banxia (Pinelliae Tuber, two qian) and Ganjiang (Dried Ginger, two qian), both processed by firing.
The patient's pulse in both hands is deep, thin, and weak. Although the pulses in the three positions are equally forceless, this indicates an excess of Yin Qi (Yin Pathogenic Factor). There is no need to wait for the Cun position pulse to be short before treating. Alternatively, if there is chest and hypochondriac fullness and oppression, body stiffness and pain, and cold extremities, one should quickly use Wenzhong Yao (Warm Middle Internal Medicine) to harmonize it.
Regarding the above statement, "no need to wait for the Cun position pulse to be short." However, it would be better to say, "If the pulses in the three positions are already deep, it means there is no Cun Kou (Radial Pulse at the Cun Position)." From Lichun (Start of Spring) to Qingming (Pure Brightness), Nongpo Wan (Magnolia Bark Pill) should be used as the primary treatment; from Qingming to Mangzhong (Start of Grain in Ear), Baizhu Tang (Atractylodes Macrocephala Decoction) should be used; from Mangzhong to Liqiu (Start of Autumn), Choupi Tang (Tangerine Peel Decoction) should be used.
In the above statement, Li Sixun proposed the theory of harmonizing according to the season, which is similar to Han's view. However, Zhang Zhongjing's methods for the four seasons in Shanghan Lun were already complete. Because later generations did not understand, Han and Li emphasized this point repeatedly. This is merely a general principle. If the climate contradicts the season, one should treat according to the manifested syndrome.
Haizang said: Zhang Zhongjing stated that spring brings Warm Disease (Wen Bing), summer brings Heat Disease (Re Bing), and long summer brings Great Heat Disease. Adjusting the dosage and weight of herbs according to the meridians constitutes harmonizing according to the season. Treating the correct manifestation is the living method. Han and Li determining herbs according to the season is indeed correct! But if the syndrome contradicts the season, fixed herbs are difficult to use. Using fixed herbs would mean not harmonizing according to the season. For example, Lichun, Qingming, Mangzhong, and Liqiu are the main Qi (Zhu Qi) of the year. Fixed time also refers to this. If it is the Guest Qi (Ke Qi), such as Si Tian (Heavenly Control) and Zai Quan (Earthly泉), whether excessive or deficient, winning and losing, overflowing, arriving late or early, how can fixed time be the standard? If the disease is caused by Main Qi, discuss only Main Qi; if caused by Guest Qi, discuss only Guest Qi. Main and Guest overcoming each other, upper and lower calling each other, result in myriad changes. Human constitution deficiency and excess are also like this. Speaking thus, all words of Zhang Zhongjing's classic are exhausted. It is just that physicians in the world do not know! This is what the Second Sage meant by concise words with abundant meaning. Later sages have many words but little meaning, striving to remedy contemporary flaws, claiming Han and Li proposed the theory of treating according to the season. This theory was set up for mediocre physicians who stick to formulas to treat diseases, not to establish a new method for Zhang Zhongjing. Alas! Although these two gentlemen are not sufficient to be the Zhang Zhongjing of the Han Dynasty, they are sufficient to be the Zhang Zhongjing of today.