治妇女经闭不行或产后恶露不尽,结为 瘕,以致阴虚作热,阳虚作冷,食少劳嗽,虚证沓来。服此汤十余
剂后,虚证自退,三十剂后,瘀血可尽消。亦治室女月闭血枯。并治男子劳瘵,一切脏腑 瘕、积聚、气郁、
脾弱、满闷、痞胀、不能饮食。
生黄 (三钱) 党参(二钱) 于术(二钱) 生山药(五钱) 天花粉(四钱) 知母(四钱)
三棱(三钱) 莪术(三钱) 生鸡内金(三钱,黄者)
用水三盅,煎至将成,加好醋少许,滚数沸服。
服之觉闷者,减去于术。觉气弱者,减三棱、莪术各一钱。泻者,以白芍代知母,于术改用四钱。热者,
加生地、天冬各数钱。凉者,知母、花粉各减半,或皆不用。凉甚者,加肉桂(捣细冲服)、乌附子各二钱。
瘀血坚甚者,加生水蛭(不用炙)二钱。若其人坚壮无他病,惟用以消 瘕积聚者,宜去山药。室女与妇人
未产育者,若用此方,三棱、莪术宜斟酌少用,减知母之半,加生地黄数钱,以濡血分之枯。若其人血分虽瘀,
而未见 瘕或月信犹未闭者,虽在已产育之妇人,亦少用三棱、莪术。若病患身体羸弱,脉象虚数者,去三棱、
莪术,将鸡内金改用四钱,因此药能化瘀血,又不伤气分也。迨气血渐壮,瘀血未尽消者,再用三棱、莪术未
晚。若男子劳瘵,三棱、莪术亦宜少用或用鸡内金代之亦可。初拟此方时,原专治产后瘀血成 瘕,后以治室女月
闭血枯亦效,又间用以治男子劳瘵亦效验,大有开胃进食,扶羸起衰之功。《内经》有四乌 鱼骨一茹芦丸,
原是男女并治,为调血补虚之良方。此方窃师《内经》之意也。
从来医者调气行血,习用香附,而不习用三棱、莪术。盖以其能破 瘕,遂疑其过于猛烈。而不知能破症
瘕者,三棱、莪术之良能,非二药之性烈于香附也。愚精心考验多年,凡习用之药,皆确知其性情能力。若论
耗散气血,香附犹甚于三棱、莪术。若论消磨 瘕,十倍香附亦不及三棱、莪术也。且此方中,用三棱、莪术以
消冲中瘀血,而即用参、 诸药,以保护气血,则瘀血去而气血不至伤损。且参、 能补气,得三棱、莪术以
流通之,则补而不滞,而元气愈旺。元气既旺,愈能鼓舞三棱、莪术之力以消 瘕,此其所以效也。
人之脏腑,一气贯通,若营垒联系,互为犄角。一处受攻,则他处可为之救应。故用药攻病,宜确审病根
结聚之处,用对证之药一二味,专攻其处。即其处气血偶有伤损,他脏腑气血犹可为之输将贯注,亦犹相连营
垒之相救应也。又加补药以为之佐使,是以邪去正气无伤损。世俗医者,不知此理,见有专确攻病之方,若拙
拟理冲汤者,初不审方中用意何如,但见方中有三棱、莪术,即望而生畏,不敢试用。自流俗观之,亦似慎重,
及观其临证调方,漫不知病根结于何处,惟是混开混破。恒集若香附、木香、陈皮、砂仁、枳壳、浓朴、延胡、
灵脂诸药,或十余味或数十味为一方。服之令人脏腑之气皆乱,常有病本可治,服此等药数十剂而竟至不治者。
更或见有浮火虚热,而加芩、栀、蒌实之属,则开破与寒凉并用,虽脾胃坚壮者,亦断不能久服,此其贻害尤甚也。
一妇人,年三十余。 瘕起于少腹,渐长而上。其当年长者稍软,隔年即硬如石。七年之间,上至心口,
旁塞两肋,饮食减
少,时觉昏愦,剧时昏睡一昼夜,不饮不食,屡次服药竟分毫无效。后愚为诊视,脉虽虚弱,至数不数,许为
治愈,授以此方。病患自揣其病,断无可治之理,竟置不服。次年病益进,昏睡四日不醒。愚用药救醒之,遂
恳切告之曰∶去岁若用愚方,病愈已久,何至危困若斯。然此病尚可为,甚勿再迟延也,仍为开前方。病患喜,
信愚言,连服三十余剂,磊块皆消。惟最初所结之病根,大如核桃之巨者尚在。又加生水蛭(不宜炙)一钱,
服数剂全愈。
一妇人,年二十余。 瘕结于上脘,其大如橘,按之甚硬,时时上攻作疼,妨碍饮食。医者皆以为不可
消。后愚诊视,治以此汤,连服四十余剂,消无芥蒂。
一媪,年六旬。气弱而且郁,心腹满闷,不能饮食,一日所进谷食,不过两许,如此已月余矣。愚诊视
之,其脉甚微细,犹喜至数调匀,知其可治。遂用此汤,将三棱、莪术各减一钱,连服数剂,即能进饮食。又
服数剂,病遂全愈。
奉天孙姓妇,年四十许。自幼时有 瘕结于下脘,历二十余年。 瘕之积,竟至满腹,常常作疼,心中
怔忡,不能饮食,求为延医。因思此证,久而且剧,非轻剂所能疗。幸脉有根柢,犹可调治。遂投以理冲汤,
加水蛭三钱。恐开破之力太过,参、 又各加一钱,又加天冬三钱,以解参、 之热。数剂后,遂能进食。服
至四十余剂,下瘀积若干, 瘕消有强半。因有事还籍,药遂停止。阅一载,腹中之积,又将复旧,复来院求
为延医。仍照前方加减,俾其补破凉热之间,与病体适宜。仍服四十余剂,积下数块。又继服三十余剂,瘀积
大下。其中或片或块且有膜甚浓,若胞形。此时身体觉弱,而腹中甚松畅。恐瘀犹未净,又调以补正活血之药,
以善其后。
王××妻,来院求为治 瘕。自言瘀积十九年矣,满腹皆系
硬块。亦治以理冲汤,为其平素气虚,将方中参、 加重,三棱、莪术减半。服数剂,饮食增加,将三棱、莪
术渐增至原定分量。又服数剂,气力较壮,又加水蛭二钱、樗鸡(俗名红娘)十枚。又服二十余剂,届行经之
期,随经下紫黑血块若干,病愈其半。又继服三十剂,届经期,瘀血遂大下,满腹积块皆消。又俾服生新化瘀
之药,以善其后。
一少年,因治吐血,服药失宜, 癖结于少腹(在女子为 瘕在男子为 癖)大如锦瓜。按
之甚坚硬,其上相连有如瓜蔓一条,斜冲心口,饮食减少,形体羸弱。其脉微细稍数。治以此汤,服十余剂
癖全消。
附录∶
广西柳州宾××来函∶
一妇人,十七岁,自二七出嫁,未见行经。先因腹、胁作疼求为延医,投以活络效灵丹立愈。继欲调其月
事,投以理冲汤三剂,月经亦通,三日未止。犹恐瘀血未化,改用王清任少腹逐瘀汤,亦三剂,其人从此月事
调顺,身体强壮矣。
Treats women with amenorrhea (absence of menstruation) or incomplete discharge of lochia (postpartum uterine discharge) after childbirth, which condense to form masses (zheng jia), thereby leading to deficiency-yin generating heat, deficiency-yang generating cold, reduced appetite, consumptive cough, and a convergence of various deficiency syndromes. After taking this decoction for more than ten doses, the deficiency syndromes will naturally recede; after thirty doses, the blood stasis can be completely eliminated. It also treats amenorrhea and blood depletion in unmarried girls. Furthermore, it treats male consumptive tuberculosis (lao zhai), as well as all kinds of masses (zheng jia), accumulations (ji ju), qi stagnation, spleen weakness, abdominal fullness and stuffiness, and inability to eat.
Raw Huangqi (Astragali Radix) (3 qian) Dangshen (Codonopsis Radix) (2 qian) Zhuyu (Atractylodis Rhizoma preparatum) (2 qian) Raw Shanyao (Dioscoreae Rhizoma) (5 qian) Tianhuafen (Trichosanthis Radix) (4 qian) Zhiimu (Anemarrhenae Rhizoma) (4 qian)
Sanleng (Sparganii Rhizoma) (3 qian) Ezhu (Curcumae Rhizoma) (3 qian) Raw Jineijin (Galli Gigerii Endothelium Corneum) (3 qian, yellow ones)
Use three zhong of water, decoct until nearly finished, add a small amount of good vinegar, boil for several boils, then take.
If one feels stifling after taking it, reduce Zhuyu. If one feels weak in qi, reduce Sanleng and Ezhu by 1 qian each. If there is diarrhea, replace Zhiimu with Baishao (Paeoniae Radix Alba), and change Zhuyu to 4 qian. If there is heat, add raw Shengdi (Rehmanniae Radix) and Tiandong (Asparagi Radix) by several qian each. If there is cold, reduce Zhiimu and Tianhuafen by half, or do not use them at all. If the cold is severe, add Rougui (Cinnamomi Cortex) (crushed and taken with the decoction) and Wufuzi (Aconiti Lateralis Radix Preparata) by 2 qian each. If the blood stasis is extremely hard and severe, add raw Shuizhi (Hirudo) (not roasted) 2 qian. If the person is robust without other diseases, using this formula solely to eliminate masses and accumulations, Shanyao should be removed. For unmarried girls and women who have not yet given birth, if this formula is used, Sanleng and Ezhu should be used sparingly with caution, Zhiimu should be halved, and Shengdi (Rehmanniae Radix) added by several qian to moisten the dryness of the blood aspect. If the patient has blood stasis but no masses are seen, or menstruation has not yet ceased, even for married women, Sanleng and Ezhu should be used sparingly. If the patient is emaciated and the pulse is deficient and rapid, remove Sanleng and Ezhu, and change Jineijin to 4 qian, because this herb can resolve blood stasis without damaging qi. When qi and blood gradually strengthen, and blood stasis is not yet fully resolved, it is not too late to use Sanleng and Ezhu again. For male consumptive tuberculosis, Sanleng and Ezhu should also be used sparingly, or Jineijin can be substituted. When I first drafted this formula, it was originally intended specifically for postpartum blood stasis forming masses; later, I found it effective for treating amenorrhea and blood depletion in unmarried girls, and occasionally effective for treating male consumptive tuberculosis. It has great merit in opening the stomach, promoting eating, supporting the emaciated, and reviving the declining. The *Neijing* (*Yellow Emperor's Inner Classic*) contains the Si Wuie Gu Yi Lu Wan (Four Cuttlebone and Asparagus Pill), which was originally for both men and women, an excellent formula for regulating blood and tonifying deficiency. This formula secretly follows the intent of the *Neijing*.
Historically, physicians, when regulating qi and moving blood, have been accustomed to using Xiangfu (Cyperi Rhizoma) and not accustomed to using Sanleng and Ezhu. This is likely because they can break down masses, leading to suspicion that they are too harsh. However, they do not know that breaking down masses is the inherent capability of Sanleng and Ezhu, not that their nature is fiercer than Xiangfu. I have carefully tested and verified for many years; for commonly used herbs, I truly know their nature and capabilities. If discussing the consumption of qi and blood, Xiangfu is even more so than Sanleng and Ezhu. If discussing the dissolving of masses, ten times the amount of Xiangfu cannot compare to Sanleng and Ezhu. Moreover, in this formula, Sanleng and Ezhu are used to eliminate blood stasis in the Chong Mai (Penetrating Vessel), while simultaneously using Renshen (Ginseng Radix et Rhizoma) and other herbs to protect qi and blood, so that when blood stasis is removed, qi and blood are not damaged. Furthermore, Renshen tonifies qi; obtaining the circulating effect of Sanleng and Ezhu, the tonification does not become stagnant, and yuan qi (original qi) becomes stronger. Since yuan qi is strong, it can further encourage the power of Sanleng and Ezhu to eliminate masses; this is why it is effective.
The human organs and viscera are connected by a single qi, like linked camps, supporting each other. If one place is attacked, others can come to its rescue. Therefore, when using medicine to attack disease, one must accurately examine where the root of the disease is condensed, and use one or two herbs appropriate to the syndrome to attack that specific location. Even if qi and blood in that location are temporarily damaged, qi and blood from other organs and viscera can still supply and infuse it, just as connected camps support each other. Adding tonic herbs as assistants and guides ensures that when evil is expelled, righteous qi is not damaged. Secular doctors do not understand this principle. Seeing a formula that specifically and accurately attacks disease, such as my Li Chong Tang, they do not initially examine the intent of the formula; seeing only Sanleng and Ezhu in it, they are filled with dread and dare not try it. From the perspective of popular custom, this seems cautious. However, observing their prescription adjustments during clinical practice, they do not know where the disease root is located, merely scattering and breaking indiscriminately. They often gather herbs such as Xiangfu (Cyperi Rhizoma), Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium), Sharen (Amomi Fructus), Zhike (Aurantii Fructus Immaturus), Houpo (Magnoliae Officinalis Cortex), Yanhusuo (Corydalis Rhizoma), and Lingzhi (Trogopterori Faeces), composing a formula of ten or dozens of herbs. Taking these causes the qi of the organs and viscera to become chaotic. Often, a disease that could have been cured becomes incurable after taking such medicines for dozens of doses. Even worse, upon seeing floating fire and deficiency heat, they add herbs like Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), and Guashui (Benincasae Semen), combining dispersing/breaking agents with cold-cooling herbs. Even for those with strong spleen and stomach, long-term use is impossible; the harm caused is particularly severe.
A woman, over thirty years old. A mass began in the lower abdomen and gradually grew upward. The part grown in the current year was slightly soft, but hardened like stone after one year. Within seven years, it reached the heart region, blocking both hypochondria. Appetite decreased, and she often felt dizzy and confused. At its worst, she fell into a coma for a day and night, drinking and eating nothing. Multiple medications yielded no effect. Later, I examined her; although the pulse was weak, the rate was not rapid, and I promised a cure, prescribing this formula. The patient judged her condition as incurable and refused to take it. The following year, the condition worsened, and she was comatose for four days. I used medicine to revive her, then earnestly told her: "If you had taken my formula last year, you would have recovered long ago; how could you have reached such a critical state? However, this disease is still treatable; please do not delay any longer." I prescribed the same formula again. The patient was pleased, believed me, and took it continuously for over thirty doses, causing the lumps to dissipate. Only the original root of the disease, large as a walnut, remained. I added 1 qian of raw Shuizhi (Hirudo) (not roasted). After several doses, she was completely cured.
A woman, over twenty years old. A mass formed in the upper epigastrium, the size of an orange, very hard to the touch, frequently attacking upwards causing pain, interfering with eating. Doctors all thought it could not be eliminated. Later, I examined her and treated her with this decoction. After taking it continuously for over forty doses, it was eliminated completely without a trace.
An elderly woman, sixty years old. Weak qi and depressed qi, fullness and stuffiness in the heart and abdomen, unable to eat. She consumed only about one liang of grain food per day, which had lasted for over a month. I examined her; the pulse was very fine and minute, fortunately regular in rate, indicating it was treatable. I used this decoction, reducing Sanleng and Ezhu by 1 qian each. After several doses, she could eat. After a few more doses, the disease was completely cured.
A woman surnamed Sun from Fengtian, around forty years old. Since childhood, a mass had formed in the lower epigastrium, lasting over twenty years. The accumulation of the mass eventually filled the entire abdomen, causing frequent pain, palpitations, and inability to eat. She sought medical treatment. I considered this condition chronic and severe, not treatable by mild formulas. Fortunately, the pulse had a root, so it could still be regulated. I administered Li Chong Tang, adding 3 qian of Shuizhi (Hirudo). Fearing the dispersing and breaking power might be too strong, I added 1 qian each of Renshen (Ginseng Radix et Rhizoma) and Dangshen (Codonopsis Radix), and added 3 qian of Tiandong (Asparagi Radix) to counteract the heat of the tonics. After several doses, she could eat. After taking it for over forty doses, significant amounts of accumulated stasis were discharged, and the mass was reduced by more than half. Due to family matters, she returned to her hometown, and medication stopped. After a year, the abdominal accumulation returned to its previous state, and she came to the clinic again. I adjusted the previous formula to balance tonification, breaking, cooling, and warming according to her condition. She continued taking it for over forty doses, passing several blocks of accumulation. After another thirty doses, large amounts of stasis were discharged. Some were sheets, some were blocks, and some had thick membranes resembling the placenta. At this time, her body felt weak, but her abdomen felt very loose and comfortable. Fearing the stasis was not yet clean, I adjusted with herbs to tonify righteousness and invigorate blood to conclude the treatment.
Wang XX's wife came to the clinic seeking treatment for a mass. She stated she had had the accumulation for nineteen years, with the entire abdomen filled with hard lumps. I treated her with Li Chong Tang. Because she usually had qi deficiency, I increased the dosage of Renshen (Ginseng Radix et Rhizoma) and Dangshen (Codonopsis Radix) in the formula, and halved Sanleng (Sparganii Rhizoma) and Ezhu (Curcumae Rhizoma). After several doses, her appetite increased, and I gradually increased Sanleng and Ezhu back to the original dosage. After a few more doses, her strength improved, and I added 2 qian of Shuizhi (Hirudo) and ten Chuanji (Phallus Mastoporus) (commonly known as Hongniang). After taking it for over twenty doses, during her menstrual period, she passed several purple-black blood clots with her menses, and the disease was half cured. After continuing for thirty doses, during the next menstrual period, a large amount of stasis was discharged, and all abdominal lumps disappeared. I then had her take herbs to generate new blood and resolve stasis to conclude the treatment.
A young man, due to improper medication for treating hematemesis (vomiting blood), developed a pi mass (a type of abdominal mass) in the lower abdomen (called zheng jia in women, pi in men), the size of a large melon. It was very hard to the touch, with a vine-like connection extending diagonally towards the heart region. Appetite decreased, and his physique was emaciated. His pulse was fine, minute, and slightly rapid. I treated him with this decoction. After taking it for over ten doses, the pi mass was completely eliminated.
Appendix:
Letter from Bin XX in Binyang, Liuzhou, Guangxi:
A woman, seventeen years old, had never menstruated since marrying at fourteen. Initially, due to abdominal and hypochondriac pain, she sought treatment and was immediately cured by Huoluo Xiaoling Dan (Collaterals-Activating Efficacious Spirit Pill). Subsequently, to regulate her menstruation, she took Li Chong Tang for three doses, and her menstruation started, lasting three days without stopping. Still fearing the stasis was not dissolved, she switched to Wang Qingren's Shaofu Zhuyu Tang (Lower Abdomen Blood-Stasis Resolving Decoction) for three doses. From then on, her menstruation became regular, and her body became strong.