大黄 浓朴 枳实
小热微结。此汤主之。 小热微结者。示亚于大热坚结也。惟其热不大甚。故去芒硝。
结不至于坚。是以稍减枳朴也。
猪苓 茯苓 泽泻 滑石 阿胶
脉浮发热。渴欲饮水。小便不利者。此汤主之。 按浮字上应有不字。详见后释。 活
人云。脉浮者。五苓散。脉沉者。猪苓汤。则知此汤论中。脉字下脱一不字也。按太阳篇内五苓散
。乃猪苓泽泻茯苓三味中。加桂与白术也。阳明篇内猪苓汤。乃猪苓泽泻茯苓三味中。加阿
胶滑石也。桂与白术。味甘辛为阳主外。阿胶滑石。味甘寒为阴主内。南阳之言。可谓不失
仲景之旨矣。但竟以沉字易之。不若不浮为妥。
用蜜微火煎凝。如饴状。捻作挺。内谷道中。欲大便乃去。汗出小便自利。此津液内竭
。虽硬不可攻。待自欲大便。以此导之。
(治症同上)
大猪胆一枚。泻汁和醋少许。灌谷道中。如一食顷。当大便。
汗出。则津液枯于上。小便利。则津液竭于下。若强攻之。危症立见。如上二法导之。
为虚弱人立权巧法也。然此惟燥在直肠者宜之。若燥屎在上者。非其治也。
茵陈蒿 栀子 大黄
阳明病。发热。但头汗出。小便不利。渴饮水浆。腹微满。身发黄。如橘子色。汗出者
。热得以越。但头汗出而他处无汗。且小便不利。则热不得越。郁而发黄。黄如橘子色者。是热
甚于外。津液不行也。非大寒之品。不能彻其郁热。茵陈酸苦。栀子苦寒。二物之性。皆能
导丙丁之邪。屈曲下行者也。黄为土之本色。夺土郁而无壅滞者。大黄有专掌焉。夫三物
偕行。而水泉涌决。则发黄之症。可使遄已。
Rhubarb, Magnolia Bark, Immature Bitter Orange.
Indicated for the syndrome of slight heat and mild accumulation. This decoction is the primary treatment. "Slight heat and mild accumulation" indicates a condition inferior to severe heat and hard accumulation. Because the heat is not particularly intense, Niter (Mirabilite) is omitted.
Because the accumulation does not reach a state of hardness, the dosages of Immature Bitter Orange and Magnolia Bark are slightly reduced.
Polyporus, Poria, Alisma, Talcum, Donkey-hide Gelatin.
For cases with floating pulse, fever, thirst with desire to drink water, and dysuria, this decoction is indicated. Note: There should be a "not" character before "floating". See the explanation later. The *Liu Ren Shu* states: For a floating pulse, use Wuling San; for a sinking pulse, use Zhuling Tang. From this, it can be known that the character "pulse" in this discussion has a missing "not" character below it. In the Taiyang chapter, Wuling San consists of Polyporus, Alisma, and Poria, plus Cinnamon Twig and Atractylodes Macrocephala Rhizome. In the Yangming chapter, Zhuling Tang consists of Polyporus, Alisma, and Poria, plus Donkey-hide Gelatin and Talcum. Cinnamon Twig and Atractylodes Macrocephala Rhizome are sweet and pungent, belonging to Yang, governing the exterior. Donkey-hide Gelatin and Talcum are sweet and cold, belonging to Yin, governing the interior. The words of Mr. Nanyang [Zhang Zhongjing] can be said to have not deviated from the intent of Zhang Zhongjing. However, replacing it directly with "sinking" is less appropriate than using "not floating".
Honey is used to simmer over a gentle fire until it solidifies, resembling maltose syrup. It is shaped into suppositories and inserted into the anus. Remove only when defecation is desired. If there is sweating and spontaneous urination, this indicates depletion of body fluids internally. Although the stool is hard, purgative methods should not be used. Wait for the natural urge to defecate and use this method to guide evacuation.
(The symptoms treated are the same as above.)
Take one large pig gallbladder, extract the bile, mix with a small amount of vinegar, and instill into the anus. After approximately the time it takes to eat one meal, defecation should occur.
Sweating causes body fluids to dry up in the upper jiao; frequent urination causes body fluids to deplete in the lower jiao. If forced purgation is applied, critical conditions will appear immediately. The aforementioned two methods of guidance are established as expedient and clever measures for patients with deficiency. However, this is only suitable for dry feces located in the rectum. If dry feces are located in the upper intestines, this is not the appropriate treatment.
Artemisiae Scopariae Herba, Gardeniae Fructus, Rhubarb.
In Yangming disease, with fever, sweating only on the head, dysuria, thirst with desire to drink liquids, slight abdominal fullness, and jaundice where the skin turns yellow like the color of an orange. If sweating occurs, the heat can dissipate. If there is sweating only on the head and no sweating elsewhere, coupled with dysuria, the heat cannot dissipate. It stagnates and causes jaundice. The yellow color resembling an orange indicates that heat is prevalent on the exterior and body fluids are not circulating properly. Only potent cold-natured herbs can thoroughly clear this stagnant heat. Artemisiae Scopariae Herba is sour and bitter; Gardeniae Fructus is bitter and cold. The properties of both herbs can guide the pathogenic fire of Bing-Ding [Heart Fire/Heat] downward through tortuous pathways. Yellow is the true color of Earth. To remove the stagnation of Earth without causing obstruction, Rhubarb has a specific role. When these three herbs act together, they cause a surge like flowing springs, allowing the jaundice syndrome to resolve rapidly.