3a. 麻黄系列 Mahuang series

 学习伤寒论有多种方法。可以按照原文一条一条来理解，可以参照古往今来多家中医大师的临床应用经验，还可以将伤寒论书中所有的方剂按照主要组成药物重新编排，比如说麻黄系列，桂枝系列，石膏系列，葛根系列等等。这样，从方剂的组成来理解伤寒论用药思路。实践证明这是一种很好的学习方法。

There are many ways to learn Chinese herbal therapy. We can learn it one paragraph after another. We can learn from the clinic experience of the famous TCM doctor in history. We can also learn it from the herbal formula by separating the formula into different groups according to their similar functions. We can also separate the formula according to the main ingredients in the formula. Based on the later classification, we can separate the herbal formula into Mahuang series, Guizhi series, Shigao series, Gegeng series, etc. Our experience tells us this is one of the best ways to learn Chinese herbal therapy.

伤寒论的方剂大致可以分为以下几大类：

The major herbal series in the Shanghan Lun are the followings:

麻黄系列, 桂枝系列, 石膏系列, 附子系列, 茯苓系列, 葛根系列, 栀子系列, 大黄系列, 柴胡系列, 黄连系列, 及半夏系列等等。

Mahuang series, Guizhi series, Shigao series, Fuzi series, Fuling series, Gegeng series, Zhizi series, Dahuang series, Chaihu series, Huangliang series, Banxia series, et.

麻黄系列，包括麻黄汤，麻黄加术汤， 小青龙汤，大青龙汤，越婢汤，越婢加术汤，越婢加半夏汤， 麻杏石甘汤， 麻杏薏甘汤，麻黄附子细辛汤，麻黄附子甘草汤，续命汤等。

The Mahuang series includes the herbal formula of Mahuang Tang, Mahuang puls Zhu Tang, Xiao Qinglong Tang, Da Qinglong Tang, Yue Bi Tang, Yue Bi plus Zhu Tang, Yue Bi plus Banxia Tang, Ma Xing Shi Gan Tang, Ma Xing Yi Gan Tang, Mahuang Fuzi Xixin Tang, Mahuang Fuzi Gancao Tang, and Xu Ming Tang, etc.

麻黄汤

From now on, we talk about the Mahuang Tang in this newsletter.

1. 组成：

1. Ingredients:

伤寒论：麻黄去节，三两[45g]　桂枝二两[30g]　甘草炙，一两［15g］　杏仁七十个，去皮尖［20g］

Shanghan Lun: Mahuang (remove the stems) 45 grams, Guizhi 30 grams, Zhigancao 15 grams, Xiren 20 grams (remove the skin and tips).

中医教材：麻黄 9克， 桂枝 6克， 杏仁 6克， 灸甘草 3克。

TCM text book: Mahuang 9 grams, Guizhi 6 grams, Xinren 6 grams, Zhigancao 3 grams.   

按照度量衡考古研究，东汉时期一两应当为现在的 15.625 克。这样，麻黄汤原方中的三两麻黄就应该至少是现在的45 克。而按照现在的中医教材，麻黄仅仅为9克。仅仅为原方的 1/5量。所以，按照现在中医教材使用麻黄汤的疗效就很让人怀疑了。这是否是现在的中医医生使用经方疗效不佳的原因之一呢？

According to the current study on the measurement scales in history, one liang in East Han dynasty equals to current 15.625 grams. If so, the amount of the Mahuang (and most of other herbs), e.g. the three liang, used in the Shanghan Lun should be 45 grams. But according to the current TCM text book, the amount of Mahuang should be only 9 grams, which is one fifth of the amount suggested in the Shanghan Lun! There is a strong arguing that the less amount of herbs used currently is one of major reasons for poor clinic healing effect in the use of Shanghan formula in nowadays.

2, 【用法】水煎，先煮麻黄一二沸，去上沫，再内余药煎取一杯，温服。服药后盖棉被取微似汗。

2. Cook the Mahuang in water in a clay pot first for one to two boiling. Remove the upper floating foam. Add the rest of the herbs in, continue to cook until the total liquid volume in the pot is only about 200 to 250 ml. Drink all once when it is warm. Cover the body after drink so as to get slight sweat. Strong sweat is not desired.

3. 【方解】麻黄为一有力的发汗药，佐以桂枝再宜致汗。杏仁定喘，甘草缓急，故治太阳病表实无汗、身疼痛而喘者。

The herb Mahuang is a strong sweat-stimulating ingredient. The addition of Guizhi makes it easier to get sweat. The Xinren is to solve the asthma (and to bring the Lung Qi downwards to prevent over-rising of the Lung Qi due to the Mahuang). The Gancao works to buffer all other herbs effect, making them not work so aggressive. Therefore, the whole formula work to solve the Taiyang stage of Shanhan disease with body surface strong syndrome, no sweat, with body pain and asthma.

4. 治疗作用：

4. Healing effects:

《伤寒论》第35条：太阳病，头痛、发热、身疼、腰痛。骨节疼痛、恶风、无汗而喘者，麻黄汤主之。

Shanghan Lun, paragraph 35: In Taiyang stage, the patient has headache, fever, pain in the body and in the lower back, has pain in the joints, dislikes wind, has no sweat but asthma (short of breath), use Mahuang Tang as the main formula for the treatment.

《伤寒论》第36条：太阳与阳明合病，喘而胸满者，不可下，宜麻黄汤。

Shanghan Lun, paragraph 36: In the co-exist of Taiyang and Yangming, the patient has asthma, fullness in the chest, do not use colon-cleansing therapy, but use Mahuang Tang.

《伤寒论》第37条：太阳病，十日已去，脉浮细而嗜卧者，外已解也。设胸满胁痛者，与小柴胡汤；脉但浮者，与麻黄汤。

Shanghan Lun, paragraph 37: Taiyang stage has lasted for about ten days. The patient feels desire to lie down with floating-thin pulse. This condition suggests that the body surface syndrome has been solved. If at this time, the patient feels fullness in the chest and pain in the upper side of the stomach, use Xiao Chaihu Tang. If only the pulse is floating feeling, use Mahuang Tang.

《伤寒论》第46条：太阳病，脉浮紧、无汗、发热、身疼痛，八九日不解，表证仍在，此当发其汗。服药已微除，其人发烦目暝，剧者必衄，衄乃解，所以然者，阳气重故也。麻黄汤主之。

Shanghan Lun, paragraph 46:

《伤寒论》第51条：脉浮者，病在表，可发汗，宜麻黄汤。

If a person has floating pulse, his disease is in Taiyang stage, and a healing sweat is needed. Mahuang Tang is recommended.

《伤寒论》第52条：脉浮而数者，可发汗，宜麻黄汤。

If the pulse is floating and fast, the healing sweat with Mahuang Tang is still recommended.

《伤寒论》第55条：伤寒脉浮紧，不发汗，因致衄者，麻黄汤主之。

For Cold-invasion Taiyang stage, if the person has floating and tight pulse, but no sweat therapy is given, he may have bleeding in nose. To promote sweat, Mahuang Tang should be used. 

《伤寒论》第235条：阳明病，脉浮、无汗而喘者，发汗则愈，宜麻黄汤。

In the Yangming stage, the pulse is floating; the patient has no sweat but asthma, sweat therapy works. Use Mahuang Tang.

5. 药理作用：

5. Pharmocology effects:

《本经》：主中风、伤寒头痛，温疟。发表出汗，去邪热气，止咳逆上气，除寒热，破坚积聚。

Ben Jing：Dominate the healing of Wind-attack, headache due to Cold-attack, Wen malaria. Works to stimulate sweat, remove Xieqi and fever, to stop cough and to reverse the up-rising Qi, to remove Cold or Hotness, and break hard mass and accumulation in the body.

《纲目》：散赤口肿痛，水肿，风肿，产后血滞。

Ben Cao Gang Mu：Works to solve red eye, swelling and pain in the eyes, swelling, Wind swelling, and blood stasis after birth delivery.

《中医教材》：发汗散寒；宣肺平喘；行水消肿；散阴疽，消症结。

TCM text book：Stimulate sweat and to expel cold; to release the bronchi so as to solve asthma; to direct water metabolism so as to solve swelling; to solve Cold-mass, or Cold-tumor in the body.

6. 应用麻黄汤注意事项:

6. Attention need to pay when use the Mahuang Tang:

 (1). 鉴别诊断

(1a). 麻黄汤为太阳中寒主方，故主要用于脉浮，头项强痛而恶寒。

(1a). The Mahuang Tang is the main formula used in the Taiyang stage of Shanghan disease. It is mostly used when the pulse is floating, the patient feels strong headache in the head and neck and feels chilly (dislikes cold environment). The Taiyang stage of Shanghan disease must be distinguished with other disease conditions, such as followings:

(1b). 温病初期：身热汗出，不恶寒，反恶热。用麻杏石甘汤， 葛根汤等。

(1b). In the early stage of a Wen disease, the patient feels hot and fever, has sweat, no cold-dislike feeling but hot-disliking feeling, use Ma Xing Shi Gan Tang, Da Qinglong Tang or Gegen Tang, etc.

(1c). 太阳中风：脉浮，身痛，汗出。用桂枝汤。

(1c). In the Wind-attack Taiyang stage, if the pulse is floating, body feels pain and the person has sweat, use Guizhi Tang.

(1d). 寒中少阴：头痛，身痛，恶寒，但脉沉。用麻黄附子细辛汤，麻黄附子甘草汤。

(1d). When the Cold attacks the Shaoyin phase of the body, the patient feels also headache and pain in the body, and feels chilly and dislikes cold, but the pulse is deep. In this case, use Mahuang Fuzi Xixing Tang, or Mahuang Fuzi Gancao Tang.

(2). 脉浮：脉必须是浮，有力，不可为沉；脉沉要用麻黄附子细辛汤。脉浮不可与脉大脉硬混淆。

(2). Floating pulse: the pulse must feel as floating, e.g. you can feel the pulse once you put your finger on the wrist of the patient. The pulse should not be deep. If the pulse is deep, it indicates the Taiyin stage and the herbal formula that should be used is Mahuang Fuzi Xixing Tang, or Mahuang Fuzi Gancao Tang.

(3). 头项强痛：从头，项， 背部，下肢后方，足跟，足外侧，沿太阳经走向，局部或较长一线之僵硬或痛都可，只要不是外伤所致。

(3). Strong pain on the head and neck: the patient feels pain on the head, neck, back, back of legs, back of the heel. It can be pain anywhere along the Taiyang meridian. It can be pain or stiffness, or sour.

(4). 恶寒：全身发冷，或后项部，或仅仅后背部冷。不是指手脚冷。

(4). Chilly feeling or cold-dislike feeling. The patient feels cold and wants warm and more cover on the body. Such chilly or fold feeling can be whole body, or only on the neck, on the back, but not means the cold feeling on the fingers or toes.

(5). 适合麻黄剂治疗的病人多有特异体质：身体块头偏敦厚，肌肉偏软；身上多有局部水液储留，如下眼睑肿胀，或单侧或双侧膝或小腿常肿胀.

(5). Actually, the person who is suitable to use the Mahuang-containing herbs for the treatment has special body constitution. They are usually those of people whose body looks strong but the muscle is soft. They could have local swelling here or there on the body, for example, water bag under the eyes, or swelling on the knee on one side or on both sides of the knee. Such person usually is hard to sweat.  

7. 麻黄汤用于哮喘治疗:

7. For the treatment of asthma by the use of Mahuang Tang:

(1). 麻黄汤: 表实无汗而喘. 可伴有腹胀便难 (伴有阳明腑证).

(1). Mahuang Tang: it is used for no-sweat asthma. The patient can have bloating feeling on the stomach and difficulty in bowel movement (e.g. there is Yangming organ phase).

(2). 桂枝加厚朴杏子汤: 表虚有汗而喘.

(2). Guizhi jia Houpu Xingren Tang: it is used for those patients with sweat and asthma.

(3). 麻杏石甘汤: 表虚汗出而喘, 无大热 (里有微热).

(3). Ma Xing Shi Gan Tang: it is used to asthma. The patient has sweat, and may have dry mouth, or hard in bowel movement, e.g. there is no strong hotness in the body but may has slight hotness inside.

(4). 葛根芩连汤: 表虚汗出而喘, 下利不止, 脉促.

(4). Gegen Qin Liang Tang: it is used also for asthma with sweat, but the patient may have continuous diarrhea. The pulse feels urgent.

(5). 小青龙汤: 表寒里有饮而喘, 痰涎清稀而多.

(5). Xiao Qinglong Tang: the body has cold outside and water accumulation inside of the body. It is used for asthma with large amount of water-like phlegm or saliva.

(6). 大青龙汤: 表寒里有热而喘, 烦躁明显.

(6). Da Qinglong Tang: the body has cold outside but hotness inside of the body. It is used for asthma with annoying feeling and dry mouth and/or dry throat.

(7). 越婢加半夏汤: 咳逆喘急, 目如脱状.

(7). Juebi Jia Banxia Tang: “Jia” means to add in. It means to add herb Banxia into the formula Juebi Tang. It is used for asthma with very urgent breath, so much so that the eyes of the patients seem to fall off.

(8). 射干麻黄汤: 咳逆上气, 咽中不利, 喉中水鸡声.

(8). Shegan Mahuang Tang: it is used for asthma, short of breath, stroke feeling in throat, with water noise in the throat.

服用麻黄类方后鼻出血者, 不必惊慌, 鼻出血为阳气重, 将愈表现. 但如果出现头昏头晕，多提示肾气不足，需要补肾气。

After drink of the Mahuang Tang, and if the patient has bleeding from nose, no worry about it. It would indicate that the disease is to get cured, since it indicates that the body Yang Qi is sufficient to struggle against the Xieqi (disease-causing energy). However, if the patient feels dizzy or cloudy mind after drink of the Mahuang Tang, it may suggest that the Kidney Qi is insufficient in the body. Supply of Kidney Qi, for example use Jing Kui Shen Qi Wang, needs to be considered.

8. 麻黄汤用于咳嗽治疗:

8. Use of Mahuang Tang for the treatment of cough:

(1). 麻黄汤: 表实无汗而咳嗽.

(1). Mahuang Tang: it is used for cough without sweat.

(2). 三拗汤: 表实仅仅以咳嗽为主, 其它表证不明显.

(2). San Ao Tang: the patient has no sweat, only cough.

(3). 麻杏石甘汤: 表虚汗出而咳嗽或喘, 口干, 喜欢凉饮 (里有微热).

(3). Ma Xing Shi Gan Tang: the patient has sweat, cough or asthma, dry mouth, likes to drink cold water (there is slight hotness inside of the body).

(4). 小青龙汤: 表寒里有饮而咳嗽, 痰涎清稀而多.

(4). Xiao Qinglong Tang: patient feels chilly or cold, bloating feeling in stomach (or water noise in stomach), cough with more water-like phlegm.

(5). 小青龙汤加石膏：小青龙汤证伴有心烦口干或便秘。

(5). Xiao Qinglong Tang plus Shigao: the patient has the syndrome as the condition for Xiao Qinglong Tang, and irritated feeling, dry mouth, and/or constipation.

(6). 大青龙汤: 表寒里有热而咳嗽, 烦躁明显.

(6). Da Qinglong Tang: the patient has surface-cold syndrome (chilly, muscle pain without sweat), and also inside hotness (dry mouth or throat, irritated, and/or constipation).

(7). 小柴胡汤去生姜参枣加干姜五味子: 咳嗽时间较长, 有寒热往来, 口苦咽干目眩. 临床上多有耳痛, 耳闷或堵塞感, 咽喉刺激感 (非痛感). 

(7). Xiao Chaihu Tang without Shengjiang, Rensheng and Dazao, but with Ganjiang and Wuweizi: it is used for long term cough. The patient may have hot-cold shift feeling, bitter taste in mouth, dry throat, dizziness. The patient may also has block feeling or pain in the ears, or tingling feeling in throat.

(8). 麦门冬汤：少阳病偏虚证，气上逆而出现刺激性咳嗽，多为夜间痉挛性持续性咳嗽。痰少难出，声音嘶哑。

(8). Maimendong Tang: it belongs to Shaoyang stage with little weakness condition. The patient has stimulating cough due to Qi up-rushing. The cough is usually continuous, as spasm-like, and more at night. Phlegm is not much and it is hard to spit out. The voice is harsh.

(9). 柴陷汤加竹茹：燥痰，痰难出而连续咳嗽，气急。

(9). Chai Xian Tang plus Zhuru: it is used for cough with dryness phlegm. The phlegm is hard to spit out so the patient has continuous cough and short of breath.

---------------

(10) 瓜蒌枳实汤：用于除寒痰外所有咳嗽咯痰，特别适合于燥痰者， 晨起至午前咳嗽剧烈者。喘急有热 （小便黄赤），不能仰卧者。多有胸闷，心下腹直肌明显挛急者。多为长期吸烟者。

(10). Gualu Zhishi Tang: it is used for all kinds of cough except for the cold-phlegm cough. It is much more suitable for dry-phlegm cough. The cough starts in the early morning and stop after noon. The patient has short of breath and inside hotness (such as yellow-red urine), hard to lien evenly on the bed, usually has bloating feeling in the chest. The patient is usually a long term smoker. The application of this formula is similar to the Chai Xian Tang plus Zhuru above.

(11). 《万病回春》清肺汤：肺热，痰粘难出，需剧烈咳嗽方出。咽喉长期疼痛或痒，声嘎。身偏热。

(11). Qing Fei Tang: The lung is with hotness inside. The phlegm is sticky and hard to spit out, so that the patient has to cough heavily to spit out the phlegm. The throat is pain, or itch, or the voice is harsh for a long term. The body tends to be hot.

9. 临床上, 麻黄汤还常用于下列疾病中:

9. In clinic, the Mahuang Tang is also used in the following conditions:

(1). 热性病初期: 即感冒, 流感, 肠伤寒, 肺炎, 麻疹等属于表实证;

(1). The early stage of other diseases, such as common cold, flu, pneumonia, measles, and typhoid fever, etc.

(2). 小儿鼻塞;

(2). Nose stiffness in children.

(3). 流感无汗衄血者;

(3). Common cold without sweat but with nose bleeding.

(4). 感冒引起喘息, 脉浮紧而无汗者;

(4). Asthma due to common cold. The pulse is floating and tight but no sweat.  

(5). 夜尿症;

(5).  Nocturia.

(6). 乳汁分泌不足;

(6). Insufficient breast milk secretion.

(7). 关节病初期;

(7). Early stage of an arthritis

(8). 支气管喘息;

(8). Bronchi asthma.

(9). 卒中发作气绝, 急性假死;

(9). Stroke onset almost without breath; acute false death.

(10). 难产等.

(10). Difficult labor.

 -----------------------------

 Millwoods Acupuncture Center is located in Edmonton, Alberta, Canada and serves Edmonton and its surrounding area, including: St. Albert, Big Lake, Spruce Grove, Stony Plain, Devon, Beaumont, Sherwood Park, Calgary, Red Deer and Whitecourt, Barrhead, Westlock, Wetaskiwin, Camrose, Fort Saskatchewan, Grande Prairie. Our clients also come from Vancouver and Saskatoon.