礞石滚痰丸 治实热老痰之峻剂,虚寒者不宜用。
黄芩(八两) 大黄(酒蒸,八两) 沉香(忌火,五钱) 礞石(焰消 过,埋地内七日用,一两)
上四味为细末,水丸,川椒大,量人大小用之。用温水一口,送过咽即仰卧,令药
徐徐而下,半日不可饮食,勿起身行动言语,待药气自胃口渐下二肠,然后动作饮食。服
后喉间稠粘壅滞不快,此药力相攻,故痰气泛上也。少顷药力至,而渐逐恶物人腹下肠,效如附应。
指迷茯苓丸 治中焦停痰伏饮。
半夏(制,二两) 茯苓(一两) 枳壳(五钱) 风化硝(二钱半)
上四味,姜汁糊为丸。
【注】经曰∶饮入于胃,游溢精气,上输于脾。游者,营运也;溢者,渗溢也;输者,
输布也;精气者,水化之精气也。言入于胃营运水化之精气,渗溢于肠胃之外,而上输
布于脾也。又曰∶脾气散精,上归于肺。言水之清者上升,犹天之雨露也。又曰∶通调
水道,下输膀胱。言水之浊者下降,犹地之江河也。此皆言水自浊化清,由腑输脏;自
清分浊,由脏输腑,水之营运循环也。又曰∶水精四布,五经并行。言水发源于脾,周布
四脏,并行五经也。此皆言水内养脏腑,外滋百骸,水之变化精微也。如是者,何痰之
有?若饮食失度不和于中,水精不渗溢于外,直下走大、小肠而为泄泻矣。若三焦失运,气
不蒸化,水之清者不升,水之浊者不降,精化为水,则内停作胀,外泛作肿,上攻喘呼,
下蓄淋 矣。若上焦气不清肃,不能输布,留于胸中,水之精者悉变为浊,阳盛煎灼成痰,
阴盛凝蓄为饮也。故治痰者,以清火为主,实者利之,虚者化之。治饮者,以燥湿为主,实
者逐之,虚者温之。所以古人治饮有温补之法,而治痰则无之也。王隐君制礞石滚痰丸,
治老痰一方,用黄芩清胸中无形诸热,大黄泻肠胃有质实火,此治痰必须清火也。以礞
石之燥悍,此治痰必须除湿也。以沉香之速降,此治痰必须利气也。二黄得礞石、沉香,
则能迅扫直攻老痰巢穴,浊腻之垢而不少留,滚痰之所由名也。若阳气不盛,痰饮兼作,又
非此方所宜,当以指迷茯苓丸合而治之,用半夏燥湿,茯苓渗湿,风硝软坚,枳壳利气。
别于二陈之甘缓,远于大黄、礞石之峻悍,殆攻中之平剂欤!
金匮枳术汤 治心下硬如大盘,边旋如杯,水饮所作。
枳实(七枚) 白术(二两)
上二味,以水五升,煮取三升,分温三服,腹中软即散。
【注】心下,胃之上脘也。上脘结硬如盘,边旋如杯,谓时大时小,水气所作,非有形
食滞也。用枳实以破结气,白术以除水湿,温服三服,则腹软结开而硬消矣。李杲法仲景
以此方倍白术,是以补为主也,此方君枳实,是以泻为主也。然一缓一急,一补一泻,其
用不同,只此多寡转换之间耳。
桂苓甘术汤 治心下有痰饮,胸胁支满目眩。又曰∶短气有微饮,当从小便去之,桂
苓甘术汤主之;肾气丸亦主之。
茯苓(四两) 桂枝(三两) 白术(三两) 甘草(三两)
上四味,以水六升,煮取三升,分温三服,小便则利。
【集注】赵良曰∶《灵枢》谓心胞络之脉动则病胸胁支满者,谓痰饮积于心胞,其病
则必若是也。目眩者,痰饮阻其胸中之阳,不能布精于上也。茯苓淡渗,遂饮出下窍,因
利而去,故用以为君。桂枝通阳输水走皮毛,从汗而解,故以为臣。白术燥湿,佐茯苓消
痰以除支满。甘草补中,佐桂枝建土以制水邪也。夫短气有微饮,此水饮停蓄,呼吸不
利而然也。《金匮》并出二方,妙义益彰。呼气之短,用苓桂术甘汤之轻清以通其阳,阳
化气则小便能出矣。吸气之短,用肾气丸之重降以通其阴,肾气通则关门自利矣。
【按】风水,阳水也;石水,阴水也。阳水多实,阴水多虚。阳水在上,故多喘,阴
水在下,故多满。所以治阳水用散用攻,治阴水用温用补。然阴中必有阳,此方治阴水
在阳而上者也,肾气丸治阴水之在阴而下者也。于此推之,阳中亦必有阴,故有小青龙
汤、五苓散之治法也。今举世不分阴阳虚实,皆以金匮肾气汤治之,服之不效,终不改辙,
每至吐血而死,良可叹也。
疏凿饮子 治遍身水肿,喘呼口渴,大小便秘。
羌活 秦艽 槟榔 大腹皮 商陆 茯苓皮 椒目 木通 泽泻 赤小豆(等分)
加姜皮,水煎服。
【注】经曰∶三焦者,决渎之官,水道出焉。若水饮阻于内,风寒束于外,则三焦之
气化不行,上焦之如雾,中焦之如沤,同为下焦之如渎也。以致水气外泛,皮肤作肿,内
停腹里作胀,上攻喘咳呕逆,下蓄小便不利,种种诸证,而治法总不外乎表里也。小青龙
汤、真武汤、越婢汤、五苓散、疏凿饮子五方,皆治有水气兼表里证之药也。小青龙汤
治表里寒实,中有水气。真武汤治里有虚寒,中兼水气。二证俱内不作胀,外不作肿,故
一以麻、桂辈散寒以行水;一以姜、附辈温寒以制水也。越婢汤治表里实热,中有水气,
五苓散治表里虚热,中有水气。故一以麻黄、石膏,散肤之水,清肌之热,以消肿也;一
以桂、苓、术、泽,解肌表热,利所停水,以止吐也。疏凿饮子治表里俱实,不偏寒热而
水湿过盛,遍身水肿喘胀便秘者。故以商陆为君,专行诸水。佐羌活、秦艽、腹皮、苓
皮、姜皮,行在表之水,从皮肤而散;佐槟榔、赤豆、椒目、泽泻、木通,行在里之水,
从二便而出。上下、内外,分消其势,亦犹神禹疏凿江河之意也。至于越婢汤加半夏者,
因喘气上逆,用之降逆也,加附子者,因汗出恶风,散表固阳也。小青龙汤加石膏者,因
喘而烦躁,用之兼清胃热也。五苓散以术、桂易滑石、阿胶,名猪苓汤,专清阴兼治水也。
真武汤,去生姜加人参,名附子汤,专温阳不治水也。由此可知仲景用方,于群温剂中,
加以大寒之品;大寒剂中,加以辛热之品。去桂枝加滑石,则不走外;去生姜加人参,则
不治水。其转换变化,神妙如此,拘拘之士,不足语也。
葶苈大枣泻肺汤 治肺痈喘不得卧及水饮攻肺喘急者。
葶苈(苦,一两) 大枣(十枚)
以水五盅,先煮枣三盅,去枣内葶苈,煮取一盅半,顿服,弱者减服。戒盐酱。
苏葶定喘丸 治饮停上焦,攻肺喘满不得卧,面身水肿,小便不利者。
苦葶苈子(研泥) 南苏子(研泥)
各等分,合均,用枣肉为小丸,阴干,瓷罐盛之,恐渗去油性,减去药力。每服三钱,
于夜三更时白汤下,以利四五次为度,利多则减服之,利少则加服之。次日身软,则隔
一日、或隔二日服之。形气弱者,先减半服之,俟可渐加。戒盐酱,服之即奏奇功,如
不严戒一切咸物,即对证用药,万元一生。
舟车神 丸(又名净府丸) 治水肿水胀,形气俱实。
黑牵牛(炒,四两) 大黄(酒浸,二两) 甘遂(面裹煨,一两) 大戟(面裹煨,一两) 芫花
(醋炒,一两) 青皮(炒,一两) 橘红(一两) 木香(五钱) 槟榔(五钱) 轻粉(一钱)
上为末,水丸,每服五分,五更白滚水下,大便利三次为度。若一二次不通利,次
日仍服。或六分七分,渐加至一钱,若服后大便利四五次,或形气不支,则减其服,三
分二分俱可,或隔一、二、三日服一次,以愈为度。甚者忌盐酱百日。
【注】草苈大枣汤、苏葶定喘丸、舟车神 丸,三方皆治肿胀之剂。然葶苈大枣汤,治
水停胸中,肺满喘急不得卧,皮肤浮肿,中满不急者,故独用葶苈之苦,先泻肺中之水
气,佐大枣恐苦甚伤胃也。苏葶定喘丸,即前方加苏子以降气,气降则水降,气降则输
水之上源,水降则开水之下流也。舟车神 丸,治水停诸里,上攻喘咳难卧,下蓄小便
不利,外薄作肿,中停胀急者,故备举甘遂、大戟,芫花、牵牛、大黄,直攻水之巢穴,使
从大、小二便而出,佐青皮、陈皮、木香以行气,使气行则水行,肿胀两消,其尤峻厉
之处,又在少加轻粉,使诸攻水行气之药,迅烈莫当,无微不入,无穷不达。用之若当,功
效神奇,百发百中。然非形实或邪盛者,不可轻试,苟徒利其有劫病之能,消而旋肿,用者慎之!
实脾饮 治身重懒食,肢体浮肿,口中不渴,二便不实。
白术(土炒) 茯苓 甘草(炙) 浓朴(姜炒) 大腹子 草果仁 木香 木瓜 附子 干姜
加姜枣煎服。气虚者加人参。
【注】脾胃虚,则土不能制水,水妄行肌表,故身重浮肿。用白术、甘草、生姜、大
枣,以实脾胃之虚也。脾胃寒,则中寒不能化水,水停肠胃,故懒食不渴,二便不实。用
姜、附、草果,以温脾胃之寒。更佐大腹、茯苓、浓朴、木香、木瓜者,以导水利气。盖
气者水之母也,土得水之防也,气行则水行,土实则水治,故名曰实脾也。然此方导水利
气之力有余,阴水寒胜而气不虚者,固所宜也,若气少声微,则必以理中汤加附子,数
倍茯苓以君之,温补元气以行水,为万当也。
【按】苓桂术甘汤、实脾饮、肾气丸,皆治阳虚水气之证。苓桂术甘汤,治上焦阳虚
不能输布,水留于上,心下逆满,气上冲胸故用苓、桂、术、甘之品,扶阳通气输水道
也。实脾饮,治中焦阳虚不能蒸化,水渍于中,外泛作肿,二便通利,故用姜、附、苓、
术之剂,培土温中,胜寒湿也。肾气丸,治下焦阳虚,不能行水,小便不利,肢体浮肿。
喘急腹胀,故用桂、附、地、苓之辈,温而补之,以行水也。
清脾饮 治痰积成疟,无表里证者。
青皮 浓朴 草果 半夏 柴胡 白术 甘草 茯苓 黄芩
水煎服。
【注】疟为少阳病兼太阳表者,麻桂各半汤汗之;兼阳明里者,大柴胡汤下之;若不
兼表里,或已汗、下而仍作者,当从少阳和解法也。是方以小柴胡、四君二汤合剂,清
少阳而顾及于脾,故名曰清脾也。减人参者,以气不虚也,加草果、浓朴气味俱浓之品,取
以输胃之积。加青皮、佐茯苓、半夏,用以破痰之原。先哲云∶无痰不成疟,无积不成
疟,此汤是也。若夫气虚者仍加人参,气实者更加槟榔,热多者加石膏,汗多者加桂枝,
自当临病斟酌也。
芍药汤 治滞下赤白,便脓血,后重窘痛。
芍药(二两) 当归(五钱) 黄连(五钱) 黄芩(五
钱) 槟榔(三钱) 木香(三钱) 甘草(三钱)
每服半两,水煎服。痢不减,加大黄。
【注】滞下起于夏秋,非外因湿暑,即内因生冷,湿蒸热郁酿成。初起腑病,久则传
脏,腑病易治,脏病难治。腑者何?病在大肠则从金化,故其色白;病在小肠则从火化,
故其色赤。所以赤痢多噤口,以小肠近胃,秽气易于上攻,而为呕逆不食也。脏者何?传
心则热不休,下利血水;传肾则利不止,如屋漏水;传脾则水浆不入,吵逆不食。此汤
治初病在腑之方也,用当归、白芍以调血,木得、槟榔以调气,血和则脓血可除,气调则
后重自止,芩、连燥湿而清热,甘草调中而和药。若窘迫痛甚,或服后痢不减者加大黄,通因通用也。
温脾汤 主治锢冷在肠胃间,泄泻腹痛,宜先取去,然后调治,不可谓虚以养病也。
浓朴(二两) 干姜(二两) 甘草(二两) 桂心(二两) 附子(二两) 大黄(四钱)
上 咀,取一两,水二盅,煎六分,顿服。
【集注】喻昌曰∶许叔微制此方,深合仲景以温药下之之法,其大黄止用四钱,更为
有见。夫锢冷在肠胃而泄泻矣,即温药中宁敢用大黄之猛重困之乎?减五之一,乃知许
叔微之得于仲景深也。仲景云∶病患旧微溏者,栀子汤不可与服。又云∶太阴病,脉弱
便利,设当行大黄、芍药者,宜减之,以其人胃气弱易动故也,即是观之,肠胃锢冷之
泄泻,而可恣用大黄耶?不用则温药恐不能制,而洞下之势或至转增。裁酌用之,真足法矣。
大黄附子汤 主治胁下偏痛发热,其脉紧弦,此寒也,以温药下之。
大黄(二两) 附子(炮,二枚) 细辛(二两)
上三味,以水五升,煮取二升,分温三服。若强人取二升半,分三服,服后如人行
四、五里,再进。
【集注】喻昌曰∶仲景治伤寒热邪痞聚心下,而挟阳虚阴盛之证,用附子泻心汤之法
矣。其杂证胁下偏痛发热为阳,其脉弦紧为阴;是则知阳中阴邪上逆也,复立此温药下
之一法。然仲景谆谆传心,后世领略者鲜。《金匮》又别出一条云∶其脉数而紧,乃弦状
如弓弦,按之不移,数脉弦者,当下其寒;脉紧而迟者,必心下坚;脉大而紧者,阳中有
阴,可下之。读者罔识其旨,讵知皆以温药下之之法耶!其曰当下其寒,谓阳中有阴实
之邪可下,其金针不跃跃乎?
张璐曰∶三承气汤,为寒下之柔剂;白散、备急丸,为热下之刚剂;附子泻心汤、大
黄附子汤,为寒热互结,刚柔并济之和剂。近世但知寒下一途,绝不知有温下一法。盖暴
Mengshi Guntan Wan (Lapis Aureus Rolling Phlegm Pill) is a drastic formula for treating severe phlegm due to excess heat; it should not be used in cases of deficiency-cold.
Huangqin (Scutellariae Radix, 8 liang), Dahuang (Rhei Radix et Rhizoma, steamed with wine, 8 liang), Chenxiang (Aquilariae Lignum Resinatum, avoid fire, 5 qian), Mengshi (Calamina, calcined with saltpeter, buried in the ground for seven days, 1 liang).
Grind the above four herbs into fine powder, make pills with water, size like Sichuan pepper seeds. Use according to the patient's constitution. Take one mouthful of warm water to swallow, then lie supine immediately, allowing the medicine to descend slowly. Do not eat, drink, rise, move, or speak for half a day. Wait until the medicinal qi gradually descends from the stomach to the large and small intestines before resuming activity and diet. After taking the medicine, if there is a feeling of thick, sticky obstruction in the throat, this is due to the conflict between the medicinal power and the pathogen, causing phlegm-qi to surge upward. Shortly after, when the medicinal power reaches its destination, it will gradually expel the foul matter into the abdomen and intestines, with efficacy as swift as an echo.
Zhimi Fuling Wan (Finger-Confusing Poria Pill) treats retained phlegm and hidden fluid retention in the Middle Jiao.
Banxia (Pinelliae Rhizoma, processed, 2 liang), Fuling (Poria, 1 liang), Zhike (Aurantii Fructus Immaturus, 5 qian), Fenghuaxiao (Natrii Sulfas Exsiccatus, 2.5 qian).
Grind the above four herbs into powder, use ginger juice to make paste for pills.
[Note] The Classic says: "When fluids enter the Stomach, their essence circulates and overflows, moving upward to the Spleen." "Circulate" refers to operation; "overflow" refers to seepage; "move upward" refers to distribution; "essence" refers to the essence transformed from water. This means that the essence of water transformed in the Stomach circulates, seeps outside the intestines and stomach, and moves upward to be distributed by the Spleen. It also says: "The Spleen scatters essence, which returns upward to the Lung." This means the clear part of water rises, like rain and dew in the sky. It also says: "Regulating the water passages, sending downward to the Bladder." This means the turbid part of water descends, like rivers on earth. All these describe water transforming from turbid to clear, moving from Fu organs to Zang organs; from clear to turbid, moving from Zang organs to Fu organs, representing the circulation of water. It also says: "Water essence distributes in four directions, running through the five meridians." This means water originates from the Spleen, distributes around the four Zang organs, and runs parallel through the five meridians. All these describe water nourishing internal Zang and Fu organs externally and moistening the hundred bones, showing the subtle transformation of water. If this were the case, how could there be phlegm? If dietary habits are irregular and the Middle Jiao is disharmonious, water essence does not seep outward but goes directly down to the Large and Small Intestines, causing diarrhea. If the Sanjiao fails to transport, and Qi fails to steam and transform, the clear part of water does not ascend, and the turbid part does not descend. Essence transforms into water, leading to internal retention causing distension, external flooding causing edema, upward attacking causing panting, and downward accumulation causing strangury. If the Upper Jiao Qi is not clear and肃 (solemn/clear), failing to distribute, remaining in the chest, the essence of water all becomes turbid. Yang excess frying and burning creates phlegm; Yin excess condensing and storing creates fluid retention. Therefore, treating phlegm focuses on clearing fire: excess patterns use draining methods, deficiency patterns using resolving methods. Treating fluid retention focuses on drying dampness: excess patterns using purging methods, deficiency patterns using warming methods. Thus, ancients had warming and tonifying methods for treating fluid retention, but none for treating phlegm. Wang Yinjun created Mengshi Guntan Wan as a formula for old phlegm, using Huangqin to clear formless heat in the chest, Dahuang to purge solid fire in the intestines and stomach. This shows that treating phlegm requires clearing fire. Using the dry and fierce nature of Mengshi shows that treating phlegm requires removing dampness. Using the rapid descending nature of Chenxiang shows that treating phlegm requires promoting Qi movement. With Mengshi and Chenxiang, Huangqin and Dahuang can swiftly sweep and attack the nests of old phlegm, leaving no turbid and greasy filth behind, which is why it is named "Rolling Phlegm." If Yang Qi is not abundant and phlegm-fluid retention occurs together, this formula is not suitable; instead, combine with Zhimi Fuling Wan. Use Banxia to dry dampness, Fuling to渗 (percolate/drain) dampness, Fenghuaxiao to soften hardness, and Zhike to promote Qi movement. Different from the sweet and緩 (slow/gentle) nature of Erchen Tang, and far from the drastic nature of Dahuang and Mengshi, this is likely a moderate formula among purgatives!
Jingui Zhizhu Tang (Golden Cabinet Aurantium and Atractylodes Decoction) treats hardness below the heart like a large plate, rotating at the edges like a cup, caused by fluid retention.
Zhishi (Aurantii Fructus Immaturus, 7 pieces), Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang).
Take the above two herbs, add five sheng of water, boil to obtain three sheng, divide into three warm doses. The abdomen softens and the condition resolves.
[Note] "Below the heart" refers to the upper part of the Stomach (Shangwan). Hardness in Shangwan like a plate, rotating at the edges like a cup, indicates fluctuating size due to water qi, not solid food stagnation. Use Zhishi to break stagnant Qi, Baizhu to remove water-dampness. Taking three warm doses will soften the abdomen, open knots, and resolve hardness. Li Gao followed Zhang Zhongjing's method by doubling Baizhu in this formula, making it primarily tonifying; this formula uses Zhishi as the sovereign herb, making it primarily purgative. However, one is slow and one is rapid, one tonifies and one purges, their uses differ only in the balance of quantities.
Guiling Gan Zhu Tang (Cinnamon Twig, Poria, Licorice, and Atractylodes Decoction) treats phlegm-fluid retention in the chest with fullness and distension in the hypochondrium and dizziness. It also states: "Shortness of breath with slight fluid retention should be eliminated via urination; Guiling Gan Zhu Tang governs; Shenqi Wan also governs."
Fuling (Poria, 4 liang), Guizhi (Cinnamomi Ramulus, 3 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang).
Take the above four herbs, add six sheng of water, boil to obtain three sheng, divide into three warm doses. Urination will become smooth.
[Collected Notes] Zhao Liang said: The Ling Shu states that pulsation of the Pericardium Meridian causes chest and hypochondriac fullness and distension, indicating phlegm-fluid retention accumulating in the Pericardium. Dizziness occurs because phlegm-fluid retention obstructs Yang Qi in the chest, preventing it from distributing essence upward. Fuling is light and percolating, allowing fluid retention to exit via the lower orifices through urination, hence used as the sovereign herb. Guizhi unblocks Yang, transports water to the skin and hair, resolving via sweating, hence used as the minister herb. Baizhu dries dampness, assisting Fuling to eliminate phlegm and relieve fullness. Gancao tonifies the Middle, assisting Guizhi to establish Earth to control Water evil. Shortness of breath with slight fluid retention is caused by water-fluid retention hindering respiration. The Jingui Yaolue presents both formulas, highlighting their profound meaning. Shortness of breath upon exhalation is treated with the light and clear Guiling Gan Zhu Tang to unblock Yang; when Yang transforms Qi, urine can be discharged. Shortness of breath upon inhalation is treated with the heavy and descending Shenqi Wan to unblock Yin; when Kidney Qi flows, the gate opens naturally.
[Commentary] Fengshui (Wind Edema) is Yang Water; Shishui (Stone Edema) is Yin Water. Yang Water is mostly excess, Yin Water is mostly deficiency. Yang Water is located superiorly, thus often causing panting; Yin Water is located inferiorly, thus often causing fullness. Therefore, treating Yang Water uses dispersing and purging methods, while treating Yin Water uses warming and tonifying methods. However, within Yin there must be Yang. This formula treats Yin Water located in the Yang position and superiorly; Shenqi Wan treats Yin Water located in the Yin position and inferiorly. Inferring from this, within Yang there must also be Yin, hence the treatment methods of Xiao Qinglong Tang and Wuling San. Nowadays, people fail to distinguish between Yin/Yang and excess/deficiency, treating everyone with Jingui Shenqi Tang. When ineffective, they persist without changing course, often leading to hematemesis and death, which is truly lamentable.
Shuozao Yinzi (Draining and Scouring Decoction) treats generalized edema, panting, thirst, and constipation of both bowels.
Qianghuo (Notopterygii Rhizoma et Radix), Qinjiao (Gentianae Macrophyllae Radix), Binglang (Arecae Semen), Dafupi (Tangerinae Pericarpium Rubrum), Shanglu (Phytolaccae Radix), Fulingpi (Poria Peel), Jiaomu (Zanthoxyli Semen), Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), Chixiaodou (Phaseoli Semen Rubrum) (equal parts).
Add Jiangpi (Zingiberis Pericarpium), decoct in water and take.
[Note] The Classic says: "The Sanjiao is the official of irrigation, where water passages emerge." If water retention blocks internally and wind-cold binds externally, the Qi transformation of the Sanjiao fails. The Upper Jiao like mist, the Middle Jiao like fermentation, all become like the Lower Jiao like a ditch. This leads to water qi flooding externally causing skin edema, retaining internally causing abdominal distension, attacking upward causing panting, coughing, and vomiting, accumulating downward causing difficult urination, and various other symptoms. The treatment method ultimately revolves around the Exterior and Interior. Xiao Qinglong Tang, Zhenwu Tang, Yebibo Tang, Wuling San, and Shuozao Yinzi are all formulas treating water qi with combined Exterior and Interior syndromes. Xiao Qinglong Tang treats Exterior-Interior Cold-Excess with water qi inside. Zhenwu Tang treats Interior Deficiency-Cold with water qi inside. Both syndromes do not present with internal distension or external edema. Thus, one uses Mahuang and Guizhi to disperse cold and move water; the other uses Jiang and Fuzi to warm cold and control water. Yebibo Tang treats Exterior-Interior Heat-Excess with water qi inside. Wuling San treats Exterior-Interior Heat-Deficiency with water qi inside. Thus, one uses Mahuang and Shigao to disperse water in the skin and clear heat in the muscles to reduce swelling; the other uses Guizhi, Fuling, Baizhu, and Zexie to resolve muscle-surface heat and promote diuresis of retained water to stop vomiting. Shuozao Yinzi treats combined Exterior-Interior Excess, neither leaning towards Cold nor Heat, but with excessive water-dampness, causing generalized edema, panting, distension, and constipation. Thus, Shanglu is used as the sovereign herb to specifically move all waters. Assisted by Qianghuo, Qinjiao, Dafupi, Fulingpi, and Jiangpi to move water in the Exterior, dispersing through the skin; assisted by Binglang, Chixiaodou, Jiaomu, Zexie, and Mutong to move water in the Interior, exiting via the two bowels. Distributing and eliminating the pathogenic factor from top/bottom and inside/outside, similar to the intent of Yu the Great dredging rivers. Regarding Yebibo Tang adding Banxia, it is for rebellious Qi causing panting, using it to direct rebellion downward; adding Fuzi is for sweating and aversion to wind, using it to disperse the Exterior and secure Yang. Adding Shigao to Xiao Qinglong Tang is for panting with restlessness, using it to clear Stomach heat concurrently. Replacing Baizhu and Guizhi with Huashi and Ejiao in Wuling San creates Zhuling Tang, specifically clearing Yin and treating water. Removing Jiang and adding Renshen to Zhenwu Tang creates Fuzi Tang, specifically warming Yang and not treating water. From this, we see Zhang Zhongjing's prescription skills: adding major cold herbs to groups of warm herbs; adding acrid-hot herbs to major cold herbs. Removing Guizhi and adding Huashi prevents exterior dispersion; removing Jiang and adding Renshen shifts focus from treating water. Such transformative changes are divine; rigid scholars cannot discuss this.
Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) treats lung abscess with panting unable to lie down, and acute panting due to water-fluid attacking the Lung.
Tingli (Descurainiae Semen seu Lepidii Semen, bitter, 1 liang), Dazao (Zizyphi Fructus, 10 pieces).
Use five zhong of water, first boil dates until three zhong remain, remove dates, add Tingli, boil to obtain one and a half zhong, take in one dose. Reduce dose for weak patients. Avoid salt and soy sauce.
Suting Dingchuan Wan (Perilla Seed and Descurainia Seed Calming Panting Pill) treats fluid retention in the Upper Jiao attacking the Lung causing panting, fullness, inability to lie down, facial and body edema, and difficult urination.
Kutinglizi (Descurainiae Semen, ground into paste), Nanzisu (Perillae Fructus, ground into paste).
Equal parts, mix evenly, use date pulp to make small pills, dry in shade, store in porcelain jars to prevent loss of oiliness which reduces efficacy. Take 3 qian each time, at midnight (third watch) with warm water. Aim for 4-5 bowel movements; reduce dose if too many, increase if too few. If the body feels soft the next day, take every other day or every two days. For weak constitution, start with half dose, gradually increase as tolerated. Avoid salt and soy sauce. Immediate miraculous effects are expected. If strict avoidance of salty foods is not observed, even correct prescriptions may fail.
Zhouche Shenwan (Boat Cart Divine Pill, also known as Jingfu Wan) treats edema and water distension with robust constitution and strong Qi.
Heiqianniu (Pharbitidis Semen, fried, 4 liang), Dahuang (Rhei Radix et Rhizoma, wine-soaked, 2 liang), Gansui (Kansui Radix, wrapped in flour and roasted, 1 liang), Daji (Euphorbiae Pekinensis Radix, wrapped in flour and roasted, 1 liang), Yuanhua (Genkwa Flos, vinegar-fried, 1 liang), Qingpi (Citri Reticulatae Pericarpium Viride, fried, 1 liang), Juhong (Citri Reticulatae Pericarpium, 1 liang), Muxiang (Aucklandiae Radix, 5 qian), Binglang (Arecae Semen, 5 qian), Qingfen (Calomelas, 1 qian).
Grind into powder, make pills with water. Take 5 fen each time, at dawn (fifth watch) with boiling water. Stop when bowel movements occur three times. If no relief after one or two times, continue the next day. Gradually increase from 6-7 fen to 1 qian. If bowel movements occur 4-5 times or constitution weakens, reduce dose to 2-3 fen, or take every 1-3 days until cured. Severe cases should avoid salt and soy sauce for 100 days.
[Note] Tingli Dazao Tang, Suting Dingchuan Wan, and Zhouche Shenwan are all formulas for treating swelling. Tingli Dazao Tang treats water retention in the chest, lung fullness, panting, inability to lie down, skin edema, and mild central fullness. It uses the bitterness of Tingli alone to first drain water qi from the Lung, assisted by Dazao to prevent bitterness from damaging the Stomach. Suting Dingchuan Wan adds Nanzisu to the previous formula to direct Qi downward; when Qi descends, water descends. Directing Qi downward regulates the source of water transmission, allowing water to flow downstream. Zhouche Shenwan treats water retention in various interior locations, attacking upward causing panting and difficulty lying down, accumulating downward causing difficult urination, pressing externally causing edema, and stopping centrally causing urgent distension. It employs Gansui, Daji, Yuanhua, Qian Niu, and Dahuang to directly attack the nests of water, expelling it via the two bowels. Assisted by Qingpi, Chenpi, and Muxiang to move Qi; when Qi moves, water moves, resolving both swelling and distension. Its particularly drastic aspect lies in adding Qingfen, making the water-moving and Qi-moving herbs swift and irresistible, penetrating everywhere, reaching infinitely. Used correctly, its efficacy is magical, hitting the mark every time. However, it should not be lightly tried unless the constitution is robust or pathogenic factors are strong. Greed for its ability to forcibly eliminate disease may lead to recurring swelling after reduction; users must be cautious!
Shipi Yin (Solidify the Spleen Decoction) treats heaviness of the body, poor appetite, limb edema, lack of thirst in the mouth, and loose stools and urine.
Baizhu (Soil-fried), Fuling, Gancao (Roasted), Houpo (Ginger-fried), Fuzi (Prepared), Ganjiang (Dried Ginger), Caoguo Ren (Tsao-ko Seed), Muxiang, Mugua, Dafuzi (Areca Catechu Seed).
Decoct with Ginger and Jujube. Add Renshen for Qi deficiency.
[Note] Spleen-Stomach deficiency means Earth cannot control Water, so Water wanders onto the muscle surface, causing heaviness and edema. Baizhu, Gancao, Shengjiang, and Dazao are used to solidify Spleen-Stomach deficiency. Spleen-Stomach cold means Middle-Jiao cold cannot transform water, so water retains in the intestines and stomach, causing poor appetite, lack of thirst, and loose stools/urine. Jiang, Fuzi, and Caoguo are used to warm Spleen-Stomach cold. Assisted by Dafu, Fuling, Houpo, Muxiang, and Mugua to guide water and move Qi. Qi is the mother of Water; Earth is the defense against Water. When Qi moves, Water moves; when Earth is solid, Water is controlled. Hence named "Solidify the Spleen." However, this formula has sufficient power to guide water and move Qi. It is suitable for Yin Water with Cold excess and no Qi deficiency. If Qi is scant and voice is faint, Lizhong Tang plus Fuzi, with multiple times the amount of Fuling as the sovereign herb, should be used to warm and tonify Yuan Qi to move water, which is the ultimate solution.
[Commentary] Linggui Zhugan Tang, Shipi Yin, and Shenqi Wan all treat syndromes of Yang deficiency with water qi. Linggui Zhugan Tang treats Upper Jiao Yang deficiency failing to distribute, water staying superiorly, causing reverse fullness below the heart and Qi rushing to the chest. Thus, Ling, Gui, Zhu, and Gan are used to support Yang, unblock Qi, and regulate water passages. Shipi Yin treats Middle Jiao Yang deficiency failing to steam and transform, water soaking in the Middle, flooding externally causing edema, with free urination and defecation. Thus, Jiang, Fuzi, Ling, and Zhu are used to cultivate Earth, warm the Middle, and overcome cold-dampness. Shenqi Wan treats Lower Jiao Yang deficiency failing to move water, causing difficult urination, limb edema, panting, and abdominal distension. Thus, Gui, Fuzi, Di, and Ling are used to warm and tonify to move water.
Qingpi Yin (Clear the Spleen Decoction) treats malaria formed by phlegm accumulation, without Exterior or Interior syndromes.
Qingpi, Houpo, Caoguo, Banxia, Chaihu, Baizhu, Gancao, Fuling, Huangqin.
Decoct in water and take.
[Note] Malaria involving Shaoyang with Taiyang Exterior is treated with Ma Gui Ge Ban Tang (half dose of Ma Huang Tang and Gui Zhi Tang) to induce sweating; involving Yangming Interior is treated with Da Chaihu Tang to purge. If not involving Exterior/Interior, or recurring after sweating/purging, treat via Shaoyang harmonizing method. This formula combines Xiao Chaihu Tang and Si Jun Zi Tang to clear Shaoyang while attending to the Spleen, hence named "Clear the Spleen." Ginseng is reduced because Qi is not deficient; Caoguo and Houpo with strong aromas are added to transport Stomach accumulation. Qingpi, assisted by Fuling and Banxia, is used to break the origin of phlegm. Ancients said: "No phlegm, no malaria; no accumulation, no malaria." This formula exemplifies this. For Qi deficiency, add Ginseng; for Qi excess, add Binglang; for more heat, add Shigao; for more sweating, add Guizhi. Adjustments should be made based on the specific case.
Shaoyao Tang (Peony Decoction) treats dysentery with red and white discharge, pus and blood in stool, tenesmus, and painful urgency.
Shaoyao (Paeoniae Radix Alba, 2 liang), Danggui (Angelicae Sinensis Radix, 5 qian), Huanglian (Coptidis Rhizoma, 5 qian), Huangqin (Scutellariae Radix, 5 qian), Binglang (Arecae Semen, 3 qian), Muxiang (Aucklandiae Radix, 3 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian).
Take 0.5 liang each time, decoct in water. If dysentery does not cease, add Dahuang.
[Note] Dysentery arises in summer and autumn, caused either by external damp-heat or internal raw/cold food, fermenting and郁 (stagnating) into heat. Initially affecting Fu organs, later transmitting to Zang organs. Fu organ diseases are easy to treat; Zang organ diseases are difficult. What are Fu organs? Disease in the Large Intestine transforms according to Metal, hence white color; disease in the Small Intestine transforms according to Fire, hence red color. Red dysentery often involves "Jinkou" (lockjaw/inability to eat) because the Small Intestine is close to the Stomach, allowing foul qi to attack upward, causing vomiting and anorexia. What are Zang organs? Transmission to the Heart causes unremitting heat and bloody diarrhea; transmission to the Kidney causes incessant diarrhea like a leaking roof; transmission to the Spleen causes inability to ingest liquids and hiccups/anorexia. This formula treats early-stage Fu organ disease. Danggui and Baishao regulate Blood; Muxiang and Binglang regulate Qi. Harmonized Blood removes pus and blood; regulated Qi stops tenesmus. Huangqin and Huanglian dry dampness and clear heat; Gancao harmonizes the Middle and the herbs. If pain and urgency are severe, or dysentery persists after taking the medicine, add Dahuang to use "treat obstruction with unblocking" (tonification of excess via purgation).
Wenpi Tang (Warm the Spleen Decoction) mainly treats entrenched cold in the intestines and stomach causing diarrhea and abdominal pain. It should be removed first, then regulated. One should not assume deficiency and merely nourish the disease.
Houpo (Magnoliae Officinalis Cortex, 2 liang), Ganjiang (Zingiberis Rhizoma, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Guixin (Cinnamomi Cortex, 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 2 liang), Dahuang (Rhei Radix et Rhizoma, 4 qian).
Chop the above, take 1 liang, add two zhong of water, decoct to six tenths, take in one dose.
[Collected Notes] Yu Chang said: Xu Shumi created this formula, deeply aligning with Zhang Zhongjing's method of purging with warm herbs. Using only 4 qian of Dahuang shows great insight. If entrenched cold in the intestines and stomach causes diarrhea, how dare one use the fierce strength of Dahuang in warm herbs to further distress? Reducing it by one-fifth reveals Xu Shumi's deep understanding of Zhang Zhongjing. Zhang Zhongjing said: "Patients with chronic loose stools should not take Zizhi Tang." He also said: "Taiyin disease, weak pulse, free passage; if Dahuang or Shaoyao should be used, reduce the dose, because the person's Stomach Qi is weak and easily disturbed." From this, can one recklessly use Dahuang for diarrhea caused by intestinal cold? Not using it, warm herbs may fail to control it, and the tendency toward profuse diarrhea may worsen. Careful consideration and use are truly worthy of emulation.
Dahuang Fuzi Tang (Rhubarb and Prepared Aconite Decoction) treats unilateral pain under the ribs with fever, tight and string-like pulse, indicating cold, to be treated with warm purgatives.
Dahuang (Rhei Radix et Rhizoma, 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 2 pieces, prepared), Xixin (Asari Radix et Rhizoma, 2 liang).
The above three herbs, add five sheng of water, boil to obtain two sheng, divide into three warm doses. For strong individuals, take two and a half sheng, divided into three doses. After taking, wait the time it takes for a person to walk four or five li, then administer again.
[Collected Notes] Yu Chang said: Zhang Zhongjing treated Shaoyang heat pathogen stagnating in the chest with Yang deficiency and Yin excess using the method of Fuzi Xie Xin Tang. In miscellaneous diseases, unilateral rib pain and fever are Yang, while tight/string-like pulse is Yin; thus, Yin pathogen counterattacking within Yang is known. He established this method of purging with warm herbs. However, Zhang Zhongjing earnestly transmitted his core teachings, yet few in later generations grasped them. The Jingui Yaolue adds another clause: "If the pulse is rapid and tight, resembling a bowstring, unyielding to pressure, rapid and string-like pulse indicates cold should be purged; tight and slow pulse indicates hardness in the epigastrium; large and tight pulse indicates Yin within Yang, purging is possible." Readers fail to understand this purging with warm herbs method. "Purge the cold" means Yin-excess pathogens within Yang can be purged; is not the golden needle jumping forth?
Zhang Lu said: San Chengqi Tang are gentle purgatives for cold; Baisan and Beiji Wan are harsh purgatives for heat; Fuzi Xie Xin Tang and Dahuang Fuzi Tang are harmonizing agents for cold-heat binding, combining harsh and gentle. Modern practitioners only know cold purging, completely unaware of warm purging. Because sudden...