半夏(洗) 桂枝 甘草(炙)各等分
右三味,各别捣筛已,合治之,白饮和服方寸匕,日三服。若不能散服者,以水一升
,煎七沸,内散两方寸匕,更煮三沸,下火令小冷,少少咽之。半夏有毒,似不当散
服。
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少阴病,咽中伤,生疮,不能语言,声不出者,苦酒汤主之。
【注】
少阴病,咽痛不愈,若剧者,咽中为痛所伤,渐乃生疮,不能言语,声音不出,所必
然也。以苦酒汤主之,用半夏涤涎,蛋清敛疮,苦酒消肿。则咽清而声出也。
【集注】
程知曰:咽痛忌汗、忌寒下、故甘草、桔梗、苦酒三方,皆用和解之法。惟半夏散及
汤,在前条为辛散温解之法也。
半夏(洗,破如枣核大)十四枚 鸡子(去黄,内上苦酒,着鸡子谷中)一枚
右二味,内半夏,着苦酒中,以鸡子壳置刀环中,安火上,令三沸,去滓,少少含咽
之,不差,更作三剂。
【集解】
李杲曰:大抵少阴多咽伤、咽痛之证,古方用醋煮鸡子,主咽喉失音,取其酸收,固
所宜也。半夏辛燥,何为用之?盖少阴多寒证,取其辛能发散,一发一敛,遂有理咽
之功也。
程知曰:按卵白象天,卵黄象地。前黄连阿胶汤用鸡子黄,义取入肾滋阴;此苦酒汤
用鸡子白,义取入肺润痰也。
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少阴病八、九日,一身手足尽热者,以热在膀胱,必便血也。
【注】
邪传少阴,不从阴化而见寒证,亦不从阳化而见热证,是其人肾气素充,所以藏虽受
邪,留连八、九日,仍复传府外散也。太阳主表,故一身手足尽热,若热还卫分,非
汗不解;热还荣分,非衄不解。热甚于上,则头痛、目瞑、衄血;热甚于下,则腹痛
,尿难、便血,理必然也。凡热少血多,瘀成血蓄;热多血少,热迫其血,血不得蓄
。今为少阴邪热。复转膀胱而伤荣分,迫走下窍,故便血也。
【集注】
程知曰:前少阴病,手足不逆冷,反发热者不死,阳未全亏也。此八九日,一身及手
足尽热,阴盛于里也。
张璐曰:少阴病难于得热,热则阴尽阳复;故少阴篇中谓手足不逆冷,反发热者不死
。然病至八九日,阴邪内解之时,反一身手足尽热,少阴必无此证,当是藏邪转府,
肾移热于膀胱,以膀胱主表,故一身及手足尽热也;膀胱之血为少阴之热所逼,其趋
必出阴窍,以阴主降故也。
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少阴病二三日,至四五日腹痛小便不利,下利不止便脓血者,桃花汤主之。
【注】
少阴病,二三日无阴邪之证,至四五日始腹痛小便不利,乃少阴阳邪攻里也。若腹痛
口燥咽干而从燥化,则为可下之证矣;今腹痛小便不利是热瘀于里,水无出路,势必
下迫大肠而作利也。倘利久热伤其荣,荣为火化,血腐为脓,则为可清之证也;今下
利昼夜不止,而便脓血,则其热已随利减,而下焦滑脱可知矣,故以桃花汤主之,益
中以固脱也。
【集注】
成无己曰:要略云,阳证内热,则溢出鲜血;阴证内寒,则下紫黑如豚肝也。
喻昌曰:治下必先固中,中气不下坠,则滑脱无源,而自止。注家见用干姜,谓是寒
邪伤胃,不知热邪挟少阴之气填塞胃中,故少佐干姜之辛以散之也。
程知曰:此下利脓血之治法也。腹痛小便不利,少阴热邪也;而下利不止,便脓血,
则证为伤血,且有中气下脱之虞矣,故用桃花汤固肠止利也。
魏荔彤曰:此证乃热在下焦,而熏蒸中焦,使气化因热郁而不行,大便因热盛而自利
也。久而下利不止,将肠胃秽浊之物,如脓带血,尽随大便而下;热一日不消,利一
日不止也。
沈明宗曰:此邪挟内湿凝滞血分,则便脓血也。
Banxia (washed) Guizhi (Cinnamon Twig) Gancao (Honey-fried Licorice Root) in equal parts.
The above three herbs are each separately pounded and sifted, then mixed together. Take one fangcun bi (square-inch spoonful) of the powder mixed with rice water, taken three times a day. If powder cannot be taken, boil one sheng (approx. 200ml) of water for seven boils, add two fangcun bi of the powder, boil for another three boils, remove from fire, let cool slightly, and swallow slowly in small amounts. Banxia (Pinellia Rhizome) is toxic and seemingly inappropriate for powder administration.
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Shaoyin disease (Disease of the Shaoyin channel/organ system), where the throat is injured, sores form, speech is impossible, and voice is lost, is primarily treated with Kujiu Tang (Vinegar Decoction).
[Note]
In Shaoyin disease, if sore throat persists and worsens, the pain injures the throat, gradually forming sores, leading to inability to speak and loss of voice; this is inevitable. Kujiu Tang is used: Banxia (Pinellia Rhizome) clears phlegm, egg white (Danqing) heals sores, and Kujiu (Vinegar) reduces swelling. Thus, the throat clears and voice returns.
[Collected Notes]
Cheng Zhi stated: Sore throat contraindicates sweating and cold purgation methods. Therefore, the formulas Gancao Tang (Licorice Decoction), Jiegeng Tang (Platycodon Decoction), and Kujiu Tang all employ harmonizing methods. Only Banxia San Ji Tang (Banxia Powder and Decoction) employs acrid-dispersing and warm-resolving methods as mentioned in the preceding clause.
Banxia (washed, broken like jujube pits) fourteen pieces. Ji Zi (Chicken Egg, remove yolk, place vinegar inside the shell) one piece.
Place the Banxia into the vinegar within the eggshell. Set the eggshell in a knife ring over fire, boil three times, strain, and hold/swallow slowly in small amounts. If not cured, prepare three more doses.
[Collected Explanations]
Li Gao stated: Generally, Shaoyin diseases often involve throat injury or sore throat. Ancient formulas use vinegar-boiled eggs to treat hoarseness, utilizing its sour-astringent property, which is appropriate. Banxia is acrid and drying; why use it? Since Shaoyin diseases are mostly cold patterns, its acridity allows dispersion. One dispersing and one astringing action achieves the benefit of regulating the throat.
Cheng Zhi stated: According to theory, egg white resembles Heaven, egg yolk resembles Earth. In the previous Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction), egg yolk was used to nourish Kidney Yin. In this Kujiu Tang, egg white is used to moisten Lung Phlegm.
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In Shaoyin disease on the eighth or ninth day, if the whole body and extremities are hot, it is because heat resides in the Bladder, and hematochezia (blood in stool) will certainly occur.
[Note]
Pathogenic factors transmit to Shaoyin but do not transform into Yin-cold patterns nor Yang-heat patterns. This indicates the person's Kidney Qi is originally robust. Although the Zang organ receives pathogenic factors, after lingering for eight or nine days, it transmits to the Fu organs and disperses outward. Taiyang governs the exterior, hence the whole body and extremities become hot. If heat remains in the Wei level, it requires sweating to resolve; if heat returns to the Ying level, it requires epistaxis to resolve. Heat severe in the upper part causes headache, dizziness, and epistaxis; heat severe in the lower part causes abdominal pain, difficulty urinating, and hematochezia; this is logical. When heat is slight and blood abundant, stasis forms blood accumulation; when heat is abundant and blood slight, heat forces blood movement, preventing accumulation. Here, Shaoyin pathogenic heat transfers to the Bladder, damaging the Ying level, forcing blood downward through the lower orifice, thus causing hematochezia.
[Collected Notes]
Cheng Zhi stated: In the previous Shaoyin disease clause, if hands and feet are not cold but rather hot, prognosis is good, indicating Yang Qi is not fully depleted. Here, on the eighth or ninth day, the whole body and extremities are hot, indicating Yin excess internally.
Zhang Lu stated: It is difficult for Shaoyin disease to present with heat; heat implies Yin exhaustion and Yang recovery. Hence, the Shaoyin chapter states that if hands and feet are not cold but hot, prognosis is good. However, by the eighth or ninth day, when Yin pathogens should resolve internally, sudden heat in the whole body and extremities suggests this is not a typical Shaoyin pattern. It likely represents Zang pathology transferring to Fu organs, with Kidney heat transferring to the Bladder. Since the Bladder governs the exterior, the whole body and extremities become hot. The blood in the Bladder is forced by Shaoyin heat to exit through the yin orifices, as Yin governs descending.
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In Shaoyin disease, from the second or third day to the fourth or fifth day, if abdominal pain, dysuria (difficulty urinating), continuous diarrhea, and bloody pus in stool occur, it is primarily treated with Taohua Tang (Peach Flower Decoction).
[Note]
In Shaoyin disease, there are no Yin-pathogen symptoms in the first two or three days. By the fourth or fifth day, abdominal pain and dysuria appear, indicating Shaoyang-Yang pathogenic factors attacking the interior. If abdominal pain were accompanied by dry mouth and throat, transforming into dryness, it would be a purgative indication. Now, abdominal pain and dysuria indicate heat stagnating internally with no outlet for fluids, inevitably pressing down on the Large Intestine causing diarrhea. If prolonged diarrhea damages the Ying level with heat, turning blood into pus, it would be a clearing indication. Now, continuous day-and-night diarrhea with bloody pus indicates heat has decreased with the discharge, revealing Lower Jiao sliding collapse. Thus, Taohua Tang is used to tonify the Middle and secure collapse.
[Collected Notes]
Cheng Wuji stated: In *Jin Gui Yao Lue*, Yang syndrome with internal heat results in fresh red blood; Yin syndrome with internal cold results in dark purple blood resembling pig liver.
Yu Chang stated: Treating diarrhea must first secure the Middle Jiao. If Middle Qi does not sink, sliding collapse has no source and stops naturally. Commentators see Dried Ginger (Ganjiang) used and assume Cold Pathogen injuring Stomach, failing to realize that Heat Pathogen combined with Shaoyin Qi fills the Stomach, hence a small amount of acrid Dried Ginger is added to disperse it.
Cheng Zhi stated: This is the treatment method for diarrhea with bloody pus. Abdominal pain and dysuria are Shaoyin Heat Pathogens; continuous diarrhea with bloody pus indicates blood damage and potential Middle Qi sinking collapse. Thus, Taohua Tang is used to consolidate intestines and stop diarrhea.
Wei Litong stated: This condition involves Heat in the Lower Jiao steaming the Middle Jiao, causing Qi transformation to stagnate due to heat, and loose stools due to excessive heat. Prolonged diarrhea expels turbid matter from intestines and stomach, such as pus and blood. As long as heat persists, diarrhea continues.
Shen Mingzong stated: This pathogen combines with internal dampness, stagnating in the Blood level, resulting in bloody pus in stool.