治寒气冷食, 稽留胃中, 心腹满痛, 大便不通者.
大黄二两 干姜二两 巴豆 ( 去皮, 研如脂 ) 一两先捣大黄, 干姜
为末, 纳巴豆合捣千杵, 和蜜丸, 如豆大, 藏密器中, 勿泄气, 候用
.每服三, 四丸, 暖水或酒下. 『金匮』主中恶心腹胀满, 猝痛如锥
刺,气急口噤如猝死者, 捧头起, 灌令下咽, 须臾当瘥, 不瘥更与三
丸,当腹中鸣, 即吐利便瘥. 若口噤者, 须化开, 从鼻孔用苇管吹入
,自下于咽.
【集注】柯琴曰: 大便不通, 当分阳结阴结. 阳结有承气, 更衣之剂
,阴结又制备急, 白散之方. 『金匮』用此治中恶, 当知寒邪猝中者
宜之, 若用于温暑热邪, 速其死矣. 是方允为阴结者立, 干姜散中焦
寒邪, 巴豆逐肠胃冷积, 大黄通地道, 又能解巴豆毒, 是有制之师也
.然白散治寒结在胸, 故用桔梗佐巴豆, 用吐下两解法. 此则治寒结
肠胃, 故用大黄佐姜, 巴, 以直攻其寒. 世徒知有温补之法, 而不知
有温下之法, 所以但讲寒虚, 不议及寒实也.
【按】世人之情, 惟知畏贫, 不知畏祸, 因其贫遗有祸. 病人之情亦
多如是, 惟知畏虚, 不知畏病, 因其虚忘其病. 殊不知虚犹贫也, 病
犹祸也. 虚而有病, 犹夫贫者有祸也, 去其祸而但贫, 犹可安也. 实
而有病, 犹夫富者有祸也, 不去其祸, 而其富未可保也. 最可笑者,
近世之医临诊病家, 外饬小心, 中存不决. 且诿言虚不可攻, 纵使病
去,正气难复. 病人畏惧, 自然乐从, 受病浅者幸而自愈, 设不愈者
,另延医至. 讵病者先意难入, 攻病之药尚未入口, 众议咻咻, 致明
通之士, 拂袖而去, 坐而待毙, 终不悟为庸工之所误也. 医者久擅其
术, 初心原为自全, 恬不知耻, 久之亦竟以为养病为能, 攻病为拙,
而举世之病者, 皆昧昧于治病也. 尝考孙思邈以仲景麻黄, 桂, 杏,
甘草之还魂汤, 治猝中昏冒, 口噤握固; 李杲以仲景巴豆, 大黄, 干
姜之备急丸, 治猝中暴死, 腹痛满闭, 下咽立效. 岂二人不知虚实耶
?盖上工之医, 未诊病时, 并不先存意见, 亦不生心自全, 有是病但
用是药耳. 柯琴曰: 备急丸治寒结肠胃, 白散治寒结在胸. 于此又可
知还魂汤治寒结在胸之表, 以散无形之邪气也; 白散治寒结在胸之里
,以攻有形之痰饮也; 备急丸治寒结在肠胃, 以攻不化之糟粕也.
Treats conditions caused by cold pathogenic qi and cold food stagnating in the stomach, resulting in fullness and pain in the heart and abdomen, and constipation.
Formula: Rhizoma et Radix Rhei (Dahuang) 2 liang, Rhizoma Zingiberis Recens (Ganjiang) 2 liang, Semen Crotonis (Badou), peeled and ground into a paste, 1 liang. First pound Dahuang and Ganjiang into powder, add Badou and pound together for one thousand strokes. Mix with honey to make pills, size of beans. Store in a sealed container to prevent leakage of gas, ready for use. Take three or four pills each time, administered with warm water or wine. *Jinkui Yaolue* states this formula treats Zhong'e (sudden attack by noxious pathogens), characterized by abdominal distension and fullness, sudden pain like needle pricks, dyspnea, and trismus (lockjaw) resembling sudden death. In such cases, support the patient's head, pour the medicine down their throat; they should recover shortly. If not recovered, administer another three pills. The patient will hear borborygmus, followed by vomiting and diarrhea, leading to recovery. If the patient has trismus and cannot swallow, dissolve the pill and blow it into the nostril using a reed tube, allowing it to flow down to the pharynx.
[Collected Annotations] Ke Qin stated: Constipation should be differentiated into Yang Jie (Yang binding) and Yin Jie (Yin binding). For Yang Jie, there are Chengqi Tang (Coptis Decoction) and Gengyi Wan (Clothing Change Pill) as purgatives. For Yin Jie, there are Beiji Wan (Emergency-Ready Pill) and Baisan (White Powder). *Jinkui Yaolue* uses this formula for Zhong'e; one must know it is suitable for sudden invasion by cold pathogenic qi. If used for warm-summer heat pathogens, it would hasten death. This formula is indeed established for Yin Jie. Ganjiang disperses cold pathogenic qi in the Middle Jiao; Badou expels cold accumulation in the intestines and stomach; Dahuang unblocks the "Earthly Path" (intestines) and can also detoxify Badou. It is an army with restraint. However, Baisan treats cold binding in the chest/epigastrium, so it uses Jiegeng (Platycodon Root) to assist Badou, employing both emetic and purgative methods. This formula treats cold binding in the intestines and stomach, so it uses Dahuang to assist Ganjiang and Badou to directly attack the cold. People only know of warming and tonifying methods, but do not know of warming and purging methods. Thus, they only discuss cold deficiency patterns and do not discuss cold excess patterns.
[Commentary] The mindset of common people is that they fear poverty but do not fear disaster, leaving them vulnerable due to poverty. Patients' mindsets are often similar; they fear deficiency but do not fear disease, ignoring the disease due to their perceived weakness. Yet, deficiency is like poverty, and disease is like disaster. Being deficient yet diseased is like a poor person having a disaster; removing the disaster while remaining poor still allows for peace. Being excess yet diseased is like a rich person having a disaster; if the disaster is not removed, their wealth cannot be preserved. Most laughable are modern physicians who, when consulting patients, appear cautious externally but are indecisive internally. They claim that deficiency patterns cannot be attacked, arguing that even if the disease is removed, the Zheng Qi (Upright Qi) will be hard to restore. Patients, fearing this, naturally comply. Those with shallow disease may recover spontaneously; if not, another doctor is summoned. By the time the disease is deep and difficult to enter, and before the attacking medicine enters the mouth, public opinion clamors, causing enlightened doctors to leave in disgust, sitting and waiting for death, never realizing they were misled by incompetent practitioners. Physicians who have long specialized in certain techniques originally did so for self-preservation, shamelessly believing that nurturing illness is skill and attacking disease is clumsiness. Consequently, all patients in the world are ignorant of how to treat disease. I have examined Sun Simiao using Huanhun Tang (Resurrection Soul Decoction), composed of Mahuang (Ephedra Herb), Guizhi (Cinnamon Twig), Xingren (Apricot Seed), and Gancao (Licorice Root) from Zhang Zhongjing, to treat sudden collapse, coma, trismus, and clenched fists; and Li Gao using Beiji Wan from Zhang Zhongjing, composed of Badou, Dahuang, and Ganjiang, to treat sudden collapse, death, abdominal pain, fullness, and obstruction, which takes effect immediately upon swallowing. Did these two men not understand deficiency and excess? Truly, superior physicians, before diagnosing, hold no preconceived notions nor thoughts of self-preservation; they simply use the appropriate medicine for the disease. Ke Qin said: Beiji Wan treats cold binding in the intestines and stomach; Baisan treats cold binding in the chest. From this, we can also know that Huanhun Tang treats cold binding at the exterior of the chest, to dissipate formless pathogenic qi; Baisan treats cold binding at the interior of the chest, to attack有形 (form-shaped) phlegm-fluids; and Beiji Wan treats cold binding in the intestines and stomach, to attack undigested residue.