I. Indications for Ephedra Tang
Ma Huang Tang is the main formula for treating solar typhoid fever. Sun typhoid, refers to the external attack of cold, in the sun disease on the syllabus of evidence, and body pain, back pain, bone pain, vicious cold, fever, no sweat and wheezing and other evidence is called the sun typhoid evidence. So it is different from the “intestinal typhoid” in modern medicine. Cold, among the six evil spirits, is a yin evil, invading the human body, most likely to damage Yang Qi. The body’s yang energy is injured by cold. The normal warming effect is lost, so it must see the evil cold. The bad cold of solar typhoid is very serious, even if more clothes, more covers, or fire for warmth, but often no relief.
The main cold stagnation, the main pain, and the main collection and attraction, so in addition to the cold, but also see a variety of pain evidence. The external cold, the Ying and Wei coagulation is not conducive, the skin and hair couples astringent closed, so the body does not sweat. That is, the skin burning hot hands, but not the slightest sweat to speak of, which is very valuable in the diagnosis of health. “The lung is also the skin, its glorious hair also”, skin and hair sweat hole is closed by the cold evil, the lung qi is not allowed to promote, the lung qi is not appropriate, the qi rebellion for asthma; if it affects the stomach qi and descending, can also see vomiting rebellion.
This evidence is not sweating and the table is real, and the cold is injured, so the pulse is tight and strong, so the pulse is floating and tight and different from the floating and slow in stroke. Gui Zhi evidence and ephedra evidence, both belong to the Sun disease, so the pulse floating, head and strong pain, and evil wind and cold is their common witness. But Gui Zhi evidence for table deficiency, to sweating, evil wind, pulse floating slow; Ephedra evidence for table solid, to no sweat, evil cold, body pain, pulse floating tight, the two are different, not to be confused.
Ephedra soup is composed of four herbs: ephedra, cinnamon stick, almond and roasted licorice. Ephedra is pungent and warm, can disperse wind and cold, open the coup and sweat, suitable for the lung and asthma, cinnamon branch, help ephedra to disperse wind and cold, almond is bitter and warm to benefit the lung, help ephedra to promote the lung and asthma, licorice is to harmonize all drugs and protect the right. This formula is a pungent and warm sweating dose, but the ratio of ephedra to licorice dose, to three to one, so that the effect of sweating can be achieved.
Clinical application of Ephedra Tang
Ephedra soup is not only a sweating remedy, but also a holy medicine for asthma. Doctors all over the world know that ephedra can cure asthma, but they do not know that the first one who proposed ephedra to cure asthma was Zhang Zhongjing of the Later Han Dynasty. This also shows that Chinese medicine is indeed a great treasure trove. In addition to sweating to relieve asthma, ephedra also treats “paralysis” and various cold pains, so it is conceivable that ephedra is indispensable for treating paralysis and pain in later times. This formula has had a great impact on later generations and is still of practical value and should not be ignored.
In 1967, I went to Gansu Province with a medical team in the middle of winter, suffering from “typhoid fever” due to wind chill in the stomach, with pain in the joints all over the body, a bad chill, a body temperature of 39.8℃, no sweat, cough, and a floating and tight pulse. I prescribed a prescription for ephedra soup, and after taking the medicine, I lay down on the fire and sweated for about a moment. According to the medical case, ‘this formula also has the effect of inducing labor, because in the cold of winter, the mother is cold, and the contraction of qi and blood makes the labor difficult. If you take Ephedra Tang, the cold will be dispersed and the blood will flow, and achieve the purpose of treatment.
The application of adding and subtracting Ephedra Tang
The application of the addition and subtraction of Ephedra Tang is set up for the treatment of various concurrent evidence of typhoid fever, but if extended, it can also treat various miscellaneous diseases. For example, in terms of the concurrent evidence of typhoid fever, it includes the evidence of Xiao Qing Long Tang, which is used for coughing and wheezing with watery drink in typhoid fever, the evidence of Da Qing Long Tang, which is used for irritability due to Yang depression, and the evidence of Ge Gen Tang, which is used for unfavorable transmission of the Sun meridian. In terms of miscellaneous diseases, Xiao Qing Long Tang can treat branching drinks; Da Qing Long Tang can treat overflowing drinks; and Ge Gen Tang can treat “just spasms” and other symptoms.
(A) Xiao Qing Long Tang
This formula treats typhoid fever with watery drink. The “Treatise on Typhoid Fever” summarizes its pathogenesis as “typhoid fever with no relief of the table and watery qi under the heart”. The “typhoid fever table is not relieved, it means that there is vicious cold, fever, no sweating, body pain and other sun typhoid fever table evidence; “water qi under the heart”, it means that there is water drink in the stomach, the stomach qi does not descend, then upward rebellious vomiting, external cold internal drink, upward shooting in the lungs, the lungs do not declare and descend then coughing and wheezing.
As the water evil changes, it can be everywhere with the qi lift, so it can be seen in the water cold stop in the lower urine is not good, less abdominal full, water cold congestion in the upper, obstructing the qi choke; water drink within the stop, the qi does not turn fluid thirst and so may see the evidence. Because it is a cold drink disease, the pulse is stringent and the coating is white and lubricated. If the evidence is identified from the phlegm: more coughing and spitting thin foam-like phlegm, falling into water; or phlegm cold and bright, such as egg white. These pulse evidence is important for the identification of this evidence. The treatment is Xiao Qing Long Tang, which relieves wind and cold externally and disperses watery drinks internally.
Xiao Qing Long Tang is composed of Ephedra, Gui Zhi, Paeonia, Hsio Xin, Gan Jiang, Han Xia, Roasted Licorice, and Wu Wei Zi. The formula uses ephedra to dispel wind and cold, calm asthma and water; with cinnamon branch, can enhance the function of the Yang to promote dispersion; dry ginger, paeoniae, can disperse cold and drink, half ansia to remove phlegm and lower the rebellion, roasted licorice to support and neutralize; afraid of too much pungency, but depleted the right qi, so with Wu Wei Zi acid collection, in order to protect the lung and kidney qi, and paeoniae acid bitter slightly cold, converge Ying Yin and prevent blood. This combination can make the evil go away without hurting the vital energy.
This formula is not limited to the treatment of superficial cold and internal drinking, even if there is no superficial evidence, but as long as it belongs to cold drinking and coughing, it can be used. If the cold drink has the tendency to turn into heat, such as irritability and asthma, raw gypsum can be added to the formula. As long as the identification is accurate, the clinical use of this formula can be effective. However, because it not only disperses Yang Qi, but also hurts Yin and moves blood, although there are Wu Wei Zi and Peony to protect the right, it should not be taken for a long time, and should be used with caution for certain heart disease and tuberculosis cough and wheeze.
I remember once taking a student to practice in an outpatient clinic and treating a male patient who was coughing, wheezing and unable to lie down. His face was sallow, his tongue was white and smooth, his pulse was stringent, and he was spitting thin white foamy sputum. The patient was identified as having cold drinks shooting at the lungs. It was winter and the weather was bitterly cold, so the patient was given two doses of the original formula of Xiao Qing Long Tang and did not come back afterwards. The following spring, the patient came back to the clinic and asked Yu to consult him. Seeing that his face was not lustrous and his body was weak, he asked the reason.
The patient said: Last winter, he took the medicine and was able to lie down at night, and his phlegm and asthma were all reduced. After the winter solstice, epistaxis suddenly occurred, and it was so violent that it could not be stopped by itself, so he was electrocautery at Tong Ren Hospital to stop the bleeding. However, he lost too much blood and was so fatigued that he came back for treatment. I said: The medicine taken before is Xiao Qing Long Tang, which can disperse cold drinks but also move Yang Qi. After taking it for a long time, the lower cut the root, and make Shaoyin essence does not hide, so the injury to Yin and move blood, it is inevitable. It is with ginseng nourishing glory soup plus dragon bone, oyster and other drugs, take dozens of doses, physical strength side gradually recovered.
(B) Da Qing Long Tang
This formula is used to treat the symptoms of superficial cold and internal heat, which are caused by the fact that the surface cold is not relieved and the surface evil is not relieved, resulting in the transformation of Yang into heat. As the superficial cold is not relieved, the pulse is floating and tight, fever, vicious cold and body pain are all present. When sweating without sweating, Wei-Yang is suppressed and turns into heat, and Yang-Heat is internally disturbed, so irritability is seen. Here the surface cold and internal heat, although they are two different pathological changes, but there is a close internal connection between the two.
The “Theory of Typhoid” says “irritability without sweating”, which points out that irritability is due to the inability to sweat and the failure to promote Yang depression. If the surface cold alone is not relieved, sweating with ephedra soup is sufficient. This evidence is external cold and internal heat, so Ephedra Tang is no longer applicable, but should be used to relieve wind-cold and clear internal irritability.
Da Qing Long Tang is made by doubling Ephedra from Ephedra Tang and adding ginger, jujube and gypsum, so it can be said to be an addition to Ephedra Tang. The formula is based on the use of ephedra, with the help of cinnamon branch and ginger to relieve the surface of the sweat; almonds are used to benefit the lung qi and help the propagation of ephedra; raw gypsum is pungent, sweet and cold, with ephedra to release the muscle to open the depression of yang qi, and can clear heat and eliminate annoyance; licorice and jujube can harmonize the middle and support the righteousness, and have the function of financing the source of sweat in sweating agents.
The dazhonglong tang is a sweating agent, available for those with strong constitution, but not for those with weak constitution. If the patient has a weak pulse and sweats with bad wind, it should not be used if the patient is suffering from a deficiency of the surface of the stroke. If it is misused, the sweating can be too much, resulting in the death of the Yang change of the limbs, muscle jumping. In order to prevent the death of Yang from sweating, Zhang Zhongjing especially in the formula after the note: “sweating more, warm powder puff. A serving of sweat, stop after serving”. Warm powder, that is, rice flour fried warm, pounced on the body to stop sweating.
A doctor surnamed Qiu, in our hospital to listen to the “Theory of Typhoid Fever” class, when talking about the evidence of the big green dragon soup, he introduced a case with this formula: his hometown a strong social worker, in the fight against the morning and, in the case of sweating all over the body like a wash, let down the rope down the well. At the bottom of the well, the cold was forced, and the sweat immediately disappeared, followed by the disease. The symptoms include fever, cold, pain, and irritability. Qiu thought it was a case of Da Qing Long Tang, but he did not dare to take any medicine in view of the summer heat. Later, with the encouragement and assistance of other doctors, he prescribed the patient a prescription for Da Qing Long Yang. After taking only one decoction, the patient sweated all over his body, the fever subsided and his body cooled, and he was at peace.
A woman, 32 years old, from Beijing. She suffered from swelling of the hands and pain in the arms for a long time and thought she was suffering. When she came to the clinic, she found it hard to lift her hand to check her pulse. After various treatments, all were ineffective. His pulse was floating and stringent, his tongue was red and his fur was slippery, his bowel movements were fine, and his menstrual flow was also regulated. When asked about the cause of his illness, he said that the water was cold and his hands were cold when he did laundry.
The evidence: the evil of water cold, depression of Yang Qi, can not be released, so the Qi stagnation and water knot, and the evidence of “zhi drink”. As his tongue is red and vivid, and his body is strong, he can sweat and clear the heat to dispel the drink.
Prescription: The original formula of Da Qing Long Tang.
Take one dose and sweat out and be at peace.
(C) Ge Gen Tang
This formula is used for treating Sun injury caused by cold evil, which leads to unfavorable meridians, such as “strong neck and back, no sweating and bad wind”.
Ge Gen Tang is composed of Ge Gen, Ephedra, Cinnamomum, Ginger, Paeonia, Radix et Rhizoma and Jujube. The formula uses Pueraria Mirifica, which can not only relieve the evil of the muscular surface, but also promote the fluids and moisten the tendons and veins to slow down the constriction of the collar and back, while Ephedra, Cinnamomum, and Ginger are pungent and warm to disperse cold, which can generate sweat and relieve the surface, and Paeonia lactiflora is used with Pueraria Mirifica, which can benefit the blood vessels to slow down the tendons and veins; Glycyrrhiza glabra and jujube can also restrain the overdispersion of hemp and Gui. After taking this formula, there is often a fever in the back, followed by sweating on the back, then throughout the body, and the strong urgency of the neck and back is cured.
Sun disease for the evil in the table, in the table when the sweat and hair, so to have sweat for the table deficiency, treatment with Gui Zhi Tang class, no sweat for the table real, treatment with Ephedra Tang class. Although not all sweat law of the whole, can be a corner and three.
The seventh lecture tries to discuss the addition and reduction of Ling Gui medicine
Ling Gui refers to the formulae in the Treatise on Typhoid Fever with Fu Ling and Gui Ji as the main medicines, including Ling Gui Zhu Gan Tang, Ling Gui Jiang Gan Tang, Wu Ling San and other formulae. In order to make the content of this lecture more complete, the linggui medicine and homemade prescriptions in “The Essentials of the Golden Horoscope” are also added in. Ling Gui is mainly used for the treatment of water qi upwash, which is a common and frequent disease and has been paid more attention by medical practitioners for many generations and has been developed in clinical treatment.
The evidence of water qi rushing upward is scattered in the “Treatise on Typhoid and Cold” and the “Treatise on the Essential Formula of the Golden Horoscope”, and Zhang Zhongjing proposed a class of formulas with ling gui as the main medicine for the corresponding treatment. However, the formulae and evidence of Ling Gui in the text are divided into different disease chapters, lacking systematic summarization and organic connection, making it difficult to grasp the comprehensive. For this reason, the synthesis of the relevant formula evidence, combined with individual clinical experience, the Ling Gui agent in the clinical use of additions and subtractions to discuss, in order to treat various diseases related to water qi, including sun disease, including the evidence of the internal organs.
I. The concept of water qi
Ancient people on the concept of water qi, understanding is also quite inconsistent, some people believe that water qi is the cold of water, such as Cheng Wuji note water qi upward impulse said: “water cold phase fight, lung cold qi reverse”; also think that water qi is water drink, such as Qian Tianlai note: “water qi, water drink of the genus also”. I think the above two different views, it seems that each said half, Zhou for water and cold, water and drink, often synergistic pathogenesis, water refers to its shape, cold refers to its gas, drink refers to its evil, the two are due to each other, so they can not be divided.
The concept of water and gas, should be both water and drink, and cold, so to understand, it is more appropriate.
Second, the evidence of water qi rushing up the machine
The evidence of water qi rushing upward is related to the heart, spleen and kidney yang deficiency attack, and the heart yang should fail, and the key to the onset.
The heart is fire, the yang of the yang organs, up in the chest, can perform the yang order and control the yin in the lower. If the heart yang is insufficient, sitting on the power, can not subdue the lower yin, so that the cold water floods, and the development of water rushing up. At the same time, the spleen qi deficiency, can not rule the water in the lower, water has no control, but also prone to upward rushing and for the problem. In addition, the kidney is the master of water and has the role of mastering water qi, if the kidney yang is not enough, qi transformation does not have the power to master water in the lower, it can also lead to water qi upflow. This shows that the upward rush of water qi is actually related to the deficiency of Yang Qi in the heart, spleen and kidneys, especially the heart Yang deficiency cannot subdue the lower yin and is a prerequisite.
There are two starting points for the upward rush of water qi: one is from the “lower heart” qi to the upward rush, and the other is from the “lower umbilicus” qi to the upward rush. If the Qi under the heart rushes upward, it is mostly due to deficiency of Qi in the heart and spleen; if the Qi under the umbilicus rushes upward, it is mostly due to deficiency of Qi in the heart and kidney. As for the identification of this evidence, the typical ones can show the obvious feeling of qi rushing upward from the bottom, while the atypical ones do not show the obvious feeling of qi rushing upward, but the testimonies of swelling, fullness, or palpitation from the bottom to the top are very clear, so it is not difficult to identify the evidence of water qi rushing upward.
If the water-cold qi rushes upward to the chest, because the chest is the heart’s citadel and the meeting of Yang qi, now it is suppressed by water-cold, it will be suffocating; the chest is the place where the heart and lungs live, if the water-cold qi rushes upward to the chest, the heart and lungs will be harmed, if the lung qi is obstructed, it will cough and be short of breath; if the heart yang is overridden, it will be palpitating, if the water qi rushes upward to the throat, it will become paralysis. If water qi rushes upward to the throat, it will cover the qi of the clear yang, and the evidence will be dizziness of the head and eyes, and it is even worse when moving.
The eyes, ears, nose and tongue of the head and face are all clear orifices, and by relying on the warmth of the qi of the clear yang, the ears are clear and the eyes are clear, the nose smells fragrant and the mouth knows the taste. Now the turbid yin gas cover the clear yang, the clear yang gas can not warm the clear orifices, then often appear deaf, blind, nasal congestion, mouth loss of taste and other evidence. Therefore, it is important to pay attention to the fact that every time water qi rushes upward, evidence of eye, ear, nose and throat appears.
Water qi upcharged under the umbilicus: The deficiency of the heart and kidney yang of the son causes the water-cold qi to succeed, which results in the evidence of water qi upcharged. This evidence is due to the fight between water and qi, the first symptoms must be seen in the umbilical palpitation, and urinary inconvenience. If not treated in time, the gas will rush upward from the umbilicus to the pharynx, coming suddenly and very fast, and wherever the gas passes, there will be signs of distension, palpitation, or suffocation, which the ancients called Ao “running dolphin gas”. If it rushes to the throat, it makes people suffocate, choke, sweat, and have a sense of terror as if facing death, but less items will be qi decay downward, and its evidence is reduced.
In addition to the above two characteristics of water qi rushing upward, but also from the color diagnosis, pulse diagnosis, diagnosis, which is also very necessary.