真武汤加减
By Karina • Jun 26th, 2008 • Category: formula, shanghanlun“少阴病，二三日不已，至四五日，腹痛，小便不利，四肢沉重疼痛，自下利者，此为有水气。其人或咳，或小便利，或下利，或呕者，真武汤主之。”
One way to interpret this is that you use 真武汤 only if on top of the 水气 problem, there is cough, urine passing smoothly, diarrhea, vomit. This makes sense because you can think of the 附子 in 真武汤 maintaining a high-enough level of arterial blood pressure, useful especially if you’ve just lost fluids via cough, diarrhea, vomit, passing of urine.
Another way is that you use 真武汤 for any version of 水气. In modern terms, you can use it to treat edema.
The add and subtract of it all:
- 久病致咳：add 五味子、细辛、干姜. Remember this type of cough stems from a chronic illness, and the lungs are probably weakened to, so we can treat the lungs like a 小青龙-type lung, where these three herbs can drive out the water lodged inside.
- 小便利：take away 茯苓. Don’t need further diuresis, which 茯苓 provides
- 下利：take away 芍药 & add干姜. See how this exemplifies his differentiation between 小建中汤 and 理中汤. The former has pain as the main highlight. The latter is a case where stuff is coming out through vomit or diarrhea.
- 呕：Take away 附 & add 生姜. 附子 is not appropriate when you have vomiting - it irritates the mucosa of the upper digestive tract.