柴胡加龙骨牡蛎汤方Prescription of Chaihu Jia Longgu Muli Tang:
柴胡四两 龙骨 黄芩 生姜(切) 铅丹 人参 桂枝(去皮) 茯苓各一两半 半夏二合半(洗) 大黄二两 牡蛎一两半(熬) 大枣六枚(擘)Four liang of Bupleurum chinense; one and a half liang each of Dragon Bone, Scutellaria baicalensis, fresh Ginger (cut), Cinnabar (processed), Ginseng, Cinnamon Twig (with peel removed), and Poria cocos; two and a half ge of Pinellia ternata (washed); two liang of Rheum palmatum; one and a half liang of Oyster Shell (roasted); six pieces of Chinese Date (broken).
上十二味，以水八升，煮取四升，内大黄，切如棋子，更煮一两沸，去滓，温服一升。本云柴胡汤，今加龙骨等。Use eight sheng of water to decoct the above twelve ingredients. After boiling down to four sheng, add Rheum palmatum cut into pieces like chess pieces. Boil for another one or two more times. Remove the dregs and take one sheng of the decoction warm. Originally, it was Chaihu Tang, and now Dragon Bone and other ingredients are added.
我们读《伤寒论》经常会看到汗后如何如何，下之后如何如何。其实这是仲景以外感病为例，从现象教你怎么治病。When reading Treatise on Cold Damage, we often see descriptions like what happens after sweating or after purgation. In fact, Zhang Zhongjing took exogenous diseases as examples to teach us how to treat diseases from the phenomena.
若要真正读懂这本书，就要理解现象后面的本质。汗下后的实质含义是津血虚，所以不管有没有汗下，只要是津液虚就可以同用来论治。To truly understand this book, one must understand the essence behind the phenomena. The essence of the state after sweating and purgation is deficiency of body fluids and blood. Therefore, regardless of whether there has been sweating or purgation, as long as there is deficiency of body fluids, the same treatment principles can be applied.
《伤寒论》基本上都在讲外感病。那所谓的内伤病慢性病怎么治呢？我们开篇便说过，中医是治人体的，而不是治病的，既然不是治病，那就不分什么外感病内伤病。Treatise on Cold Damage mainly focuses on exogenous diseases. Then how to treat so-called internal diseases and chronic diseases? As we mentioned at the beginning, traditional Chinese medicine treats the human body, not the disease itself. Since it is not about treating the disease, there is no distinction between exogenous and internal diseases.
《伤寒论》治病的依据是人体显现出来的证，证是人体排病的反应，而非病本身，只要有相应的证，就用相应的方子，一切病就都可以治。The basis for treating diseases in Treatise on Cold Damage is the syndrome manifested by the human body. The syndrome is the body's reaction to expel the disease, not the disease itself. As long as there is a corresponding syndrome, the corresponding prescription can be used, and all diseases can be treated.
所以，桂枝汤也好，柴胡汤也好，可以治相应的无论外感内伤的一切病。Therefore, whether it is Guizhi Tang or Chaihu Tang, they can treat all diseases with corresponding syndromes, whether exogenous or internal.
我们后面学《金匮要略》就会发现，那些所谓的内伤病，也还是用《伤寒》里这些方子来治疗，无非随证略施加减而已。所以《伤寒论》事实上是以外感病为例在教你治万病。When we study Essentials from the Golden Cabinet later, we will find that those so-called internal diseases are still treated with the prescriptions in Treatise on Cold Damage, with just some slight modifications according to the syndromes. So, in fact, Treatise on Cold Damage uses exogenous diseases as examples to teach us how to treat all diseases.
这一条就是这样，首先是下后“胸满烦惊”。“胸满”是柴胡证；“烦惊”呢？实证虚证？一时不好下结论，继续往下辩证。This is the case with this item. First, after purgation, there are "fullness in the chest, restlessness, and fright". "Fullness in the chest" is a syndrome of Chaihu. What about "restlessness and fright"? Is it an excess syndrome or a deficiency syndrome? It's hard to draw a conclusion for a moment. So, continue to make a differential diagnosis.
“小便不利”，湿证还是津液虚，还是不好下结论，继续往下辩证。"Difficult urination", is it a damp-syndrome or deficiency of body fluids? It's still hard to draw a conclusion. Continue to make a differential diagnosis.
“谵语”，这是阳明实热证的津液虚引起，那前面的就都有结论了，“烦惊”是有热。"Delirium" is caused by deficiency of body fluids in the Yangming excess-heat syndrome. Then, we can draw conclusions about the previous symptoms. "Restlessness and fright" are due to heat.
那“小便不利”是津液虚吗？后面还有“一身尽重”，这个小便不利就是湿气郁于外的小便不利。那这个情况就是外有湿，内有热。Is "difficult urination" caused by deficiency of body fluids? There is also "heaviness all over the body" later. This difficult urination is due to dampness stagnating externally. So, in this case, there is dampness externally and heat internally.
这个和津液虚矛不矛盾？不矛盾。湿郁也会津虚，因为水湿不气化不循环。所以我一直说真正的古中医治病就像破案，一条条排查比对综合分析，知道找出确切的证据。Is this contradictory to deficiency of body fluids? No. Stagnation of dampness can also lead to deficiency of body fluids because water-dampness does not transform and circulate. So, I always say that treating diseases in true ancient traditional Chinese medicine is like solving a case, checking and comparing item by item, and making a comprehensive analysis until definite evidence is found.
“不可转侧”是躺在床上翻身困难，前面学过有津液虚引起的，这里兼有“一身尽重”，那这个翻身困难就是因为湿气郁于肌肉了。"Inability to turn sides easily" means difficulty in turning over in bed. We learned before that it can be caused by deficiency of body fluids. Here, combined with "heaviness all over the body", this difficulty in turning over is because dampness is stagnating in the muscles.
这是三阳并病，自然治从少阳，那就是用柴胡汤做主方。然后就是加减之法了。This is a case of combined diseases of the three Yang meridians. Naturally, the treatment should start from the Shaoyang meridian, so Chaihu Tang is used as the main prescription. Then, there are methods of modification.
首先是用大黄下热存津；然后龙骨牡蛎铅丹安神定惊，铅丹是取其金属重坠之性以镇定，有毒，所以我们现在用得少了；外有湿，用桂枝茯苓。First, use Rheum palmatum to purge heat and preserve body fluids. Then, use Dragon Bone, Oyster Shell, and Cinnabar to calm the mind and relieve fright. Cinnabar is used for its heavy-dropping property of metals to calm the mind. It is toxic, so we use it less now. For external dampness, use Cinnamon Twig and Poria cocos.
为什么不直接用大柴胡呢？因为这个情况津液虚明显，所以用小柴胡加减，小柴胡里有人参炙甘草，更能救津液。Why not use Da Chaihu Tang directly? Because the deficiency of body fluids is obvious in this case, so Xiao Chaihu Tang is modified. There are Ginseng and honey-fried Licorice Root in Xiao Chaihu Tang, which can better rescue body fluids.
从这里可以看出，《伤寒论》教我们的是治病的原则和方法，灵活应对人体的方法，不可拘泥。方子相对在初级阶段是可以的，想要到更高阶段就要突破这一层。From this, we can see that Treatise on Cold Damage teaches us the principles and methods of treating diseases, and how to respond flexibly to the human body. We should not be rigid. Using prescriptions is acceptable at the primary stage, but to reach a higher level, we need to break through this layer.
《伤寒论》用药精简，我们前面学过的就已经涵盖大部分主要了。这一条再讲两样常用药：龙骨、牡蛎。The medication in Treatise on Cold Damage is concise. Most of the main aspects have been covered by what we learned before. In this item, two commonly used herbs are introduced: Dragon Bone and Oyster Shell.
龙骨是原始动物的化石，取其镇定收摄之性。这个药安神敛精很管用，也很常用。Dragon Bone is the fossil of primitive animals. It is used for its calming and astringent properties. This herb is very effective and commonly used in calming the mind and astringing essence.
我现在却用得少，现在龙骨造假的多，一般我宁可重用些牡蛎，至少牡蛎是真的。However, I use it less now because there are many fakes. Generally, I would rather use more Oyster Shell, at least Oyster Shell is real.
真正远古化石的龙骨我单味煎来尝过，那种味道很难言说，可以做一个譬喻：I have tasted the real ancient fossil Dragon Bone decocted alone. The taste is hard to describe. I can make an analogy:
它的能量场让人有一种瞬间置身于一座古庙之中的感觉；又比如古建筑的大殿，不管外面如何燥热，心情如何烦乱，一进去人就宁静了，被镇摄住了，就是这种能量。Its energy field gives people a feeling of suddenly being in an ancient temple. Or like in the main hall of an ancient building, no matter how hot and dry it is outside and how restless one's mood is, once entering, people will feel calm and be subdued. It's this kind of energy.
牡蛎是海中的牡蛎壳，取其燥涩镇敛之性。Oyster Shell is the shell of oysters in the sea. It is used for its dry-astringent and calming properties.
这两样药经方里同时用的时候很多，用在惊、狂、卧起不安这一类的证。临证上治失眠烦躁多思多虑，效果也很好。These two herbs are often used together in classical prescriptions for syndromes such as fright, mania, restlessness in lying down and getting up. Clinically, it is also very effective in treating insomnia, restlessness, over-thinking, and worry.
这两药还可以用于治遗精阳痿，所以有医术说这两样药是补肾的。其实这两样药只是毫无滋养之性的钙化物而已，哪能补什么肾呢？These two herbs can also be used to treat spermatorrhea and impotence. So, some medical books say that these two herbs can tonify the kidney. In fact, these two herbs are just calcium compounds without any nourishing properties. How can they tonify the kidney?
本身补肾这个概念于药物对人体的真实作用还有待商榷。应该说是其镇敛的作用能收精气趋下，精气下自然肾气足。The concept of tonifying the kidney in terms of the real effect of drugs on the human body is still debatable. It should be said that their astringent and calming effects can make the essence qi move downward. When the essence qi moves downward, the kidney qi will naturally be sufficient.
也正是因为这两样药无滋养之性，亦不热不寒，所以寒热虚实皆能用。Also, because these two herbs have no nourishing properties, are neither hot nor cold, they can be used for syndromes of cold, heat, deficiency, and excess.
同为收敛药，芍药微苦酸寒，性质温和均衡，敛津液，亦能泻实；五味子温燥而酸泻，主要用于咳嗽水饮；As astringent herbs, Paeonia lactiflora is slightly bitter, sour, and cold, with a mild and balanced nature. It can astringe body fluids and also reduce excess. Schisandra chinensis is warm, dry, and sour-purging, mainly used for cough and fluid retention.
山萸肉酸温固脱，主要用于元气不固；Cornus officinalis is sour, warm, and used for preventing collapse, mainly for cases of unconsolidated original qi.
乌梅则酸而轻升，无温补之性，可用于温病之虚浮，暑月之收敛，也主肌体赘疣；Dark Plum is sour and slightly ascending, without warm-tonifying properties. It can be used for cases of deficiency-floating in warm-pathogen diseases, for astringency in summer, and also for treating skin warts.
龙骨牡蛎煎水接近于无色无味，因其为骨壳之钙化物，秉重镇收涩之性，他们不是靠酸味和黏质来收敛的，和前面那些收敛药都不一样。The decoction of Dragon Bone and Oyster Shell is almost colorless and tasteless. Because they are calcium compounds of bones and shells, they have the properties of being heavy-descending and astringent. They do not astringe by their sour taste and viscous texture, which is different from the above-mentioned astringent herbs.
牡蛎这味药用途很广泛，除敛涩之外，还可用于燥痰湿和化坚结。痰湿和坚结虽然叫法不一样，无非都是瘀滞凝结之物而已。牡蛎在肿瘤、结节增生类疾病上运用很多。Oyster Shell has a wide range of uses. Besides astringency, it can also be used to dry damp - phlegm and resolve hard lumps. Although damp - phlegm and hard lumps have different names, they are all stagnant and congealed substances. Oyster Shell is often used in diseases such as tumors and nodular hyperplasia.
108．伤寒，腹满、谵语、寸口脉浮而紧，此肝乘脾也，名曰纵，刺期门。In cases of cold damage with abdominal fullness, delirium, and a floating and tight pulse at the Cun kou (radial artery), this is the liver overpowering the spleen, called "longitudinal". Acupuncture at Qimen (LR14) is indicated.
109．伤寒发热，啬啬恶寒、大渴欲饮水，其腹必满、自汗出、小便利、其病欲解，此肝乘肺也，名曰横，刺期门。In cases of cold damage with fever, aversion to cold, intense thirst with a desire to drink water, abdominal fullness is bound to occur. If there is spontaneous sweating, unobstructed urination, the disease is about to resolve. This is the liver overpowering the lung, called "transverse". Acupuncture at Qimen (LR14) is indicated.
此二条讲针灸，以五行生克论病，且新出“纵横”之概念，疑为后人所加。These two items discuss acupuncture and moxibustion, analyzing diseases based on the theory of the generation and restriction of the five elements, and a new concept of "longitudinal and transverse" appears. It is suspected to be added by later generations.
110.太阳病，二日反躁，凡熨其背而大汗出，大热入胃，胃中水竭，躁烦必发谵语；In Taiyang disease, on the second day, there is restlessness instead. If the patient's back is ironed, leading to profuse sweating, intense heat enters the stomach. The body fluids in the stomach are exhausted, restlessness and delirium will surely occur.
十余日振栗自下利者，此为欲解也。If after more than ten days, there is trembling and self-induced diarrhea, this indicates that the disease is about to resolve.
故其汗从腰以下不得汗，欲小便不得，反呕、欲失溲、足下恶风、大便硬，小便当数，而反不数及不多；Therefore, there is no sweating from the waist down, difficulty in urinating, vomiting instead, a feeling of urinary incontinence, aversion to wind on the feet, hard stools. Normally, urination should be frequent, but instead, it is not frequent and the amount is not much.
大便已，头卓然而痛，其人足心必热，谷气下流故也。After defecation, there is a sudden headache, and the patient's sole of the foot must be warm. This is because the qi of grains descends.
这一条是以津液为原则，讲人体对疾病的一些反应。This item, based on the principle of body fluids, describes some reactions of the human body to diseases.
太阳病到了第二日烦躁，是有化热的迹象。这时候反用熨法熨烫患者的背部，以至于大汗出，于是热证加重了。When there is restlessness on the second day of Taiyang disease, there are signs of heat transformation. At this time, if the patient's back is ironed, causing profuse sweating, the heat syndrome is aggravated.
“大热入胃”，胃中的津液干了，人烦躁，谵语，也就是有阳明证了。"Intense heat enters the stomach", the body fluids in the stomach dry up, the person becomes restless and delirious, that is, there are Yangming syndromes.
如此过了十来天，如果患者“振慄而下利”，振慄是人体自己调津液解表的行为，类似于喷嚏和寒战；表气通了，里也就能通了，于是下利了。里热下来了，病也要解了。After about ten days, if the patient has "trembling and diarrhea", trembling is the body's self-regulation of body fluids to relieve the exterior, similar to sneezing and shivering. When the qi of the exterior is unobstructed, the interior can also be unobstructed, so diarrhea occurs. The interior heat is relieved, and the disease is about to resolve.
这时候出现一个困境，就是阳明证十来天了，津液消耗严重，这时候再下利必定津液更耗，于是腰以下不出汗了，小便也没了，这是下焦津液虚了；At this time, a difficult situation occurs. Since the Yangming syndrome has lasted for more than ten days, the body fluids are severely consumed. Diarrhea at this time will surely further consume the body fluids. So, there is no sweating from the waist down, and there is no urine. This is deficiency of body fluids in the lower jiao.
呕吐，胃也弱了；“欲失溲”，膀胱的结缔组织缺少津液，于是约束尿液的能力弱了，感觉小便要失禁；“足下恶风”，这也是下焦津液虚的反应。这就是从阳明证转为阴证了。Vomiting indicates that the stomach is weak. "A feeling of urinary incontinence" means that the connective tissues of the bladder lack body fluids, so the ability to restrain urine is weakened. "Aversion to wind on the feet" is also a reaction of deficiency of body fluids in the lower jiao. This is the transformation from Yangming syndrome to Yin syndrome.
津液如此之虚，病必反复，于是这时候再次发生大便硬的情况。按常理来说，大便赢了，小便就应该多起来，结果小便没有多，因为津液太少了。With such a deficiency of body fluids, the disease is bound to relapse. So, hard stools occur again. Logically, when the stools are hard, urination should increase. But the urine does not increase because there is too little body fluid.
这时候又会发生一些新的证：大便完头会痛，足心却会热一点，这是因为大便的时候津液往下走，所谓“谷气下流”，头部津液就不够了，足部却能暂时地热起来。总之都是津液不够分配的反应。At this time, some new syndromes will occur: headache after defecation, and the sole of the foot will be a little warmer. This is because when defecating, the body fluids move downward. As the so-called "qi of grains descends", there is not enough body fluid in the head, while the feet can be temporarily warmed. In short, these are all reactions of insufficient distribution of body fluids.
