主治伤寒发热, 不发汗而反下之, 表热乘虚入于
胸中, 与不得为汗之水气结而不散, 令心下至少腹硬满而痛不可近,
其人身无大热, 但头汗出, 或潮热燥渴, 脉沉紧者. 如水肿, 肠澼,
初起形气俱实者, 亦可用.
大黄六两 芒硝 苦葶苈子 杏仁 ( 去皮 ) 各半升 甘遂 ( 为末
)一钱, 右五味, 以水先煮大黄, 杏, 苈, 去滓, 纳芒硝, 煮一, 二
沸,纳甘遂末, 温服, 得快痢止后服, 如未剧者, 加白蜜二合, 作丸
如弹子大, 水煮一丸, 服过宿乃下, 如不下更服.
【集注】柯琴曰: 胸中者, 宗气之所出, 故名气海. 气为阳, 故属太
阳之部. 气为水母, 气清则水精四布, 气热则水浊而壅结矣. 水结于
胸,则津液不下, 无以润肠胃, 故大便必燥, 不下输膀胱, 故水道不
通.大黄, 芒硝善涤肠胃之热实, 此病在胸中而亦用以为君者, 热淫
于内, 当治以苦寒, 且以润阳明之燥, 是实则泻子之法, 补膀胱之寒
,亦制之以其所畏也. 任甘遂之苦辛, 所以直攻其水结. 然水结因于
气结, 必佐杏仁之苦温, 以开其水中之气, 气行而水自利矣. 水结又
因于气热, 必佐葶苈之大寒, 以清其气分之热, 源清而流自洁矣. 若
胸中水结而未及中焦者, 当小其制, 而复以白蜜之甘以缓之, 使留恋
于胸中, 过宿乃下, 但解胸心之结滞, 而保肠胃之无伤, 是又以攻剂
为和剂也. 是方为利水攻积之剂, 故治水肿, 痢疾之初起者甚捷, 然
必视其人壮实, 可以一战成功, 如平昔素虚弱与病久而不任攻伐者,
当念虚虚之戒矣.
Indications: For Taiyang disease (Taiyang syndrome) presenting with fever, where sweating was not induced but purgation was mistakenly applied. This allows exterior heat to enter the chest cavity vacuously, where it knots and fails to disperse together with the fluid qi that cannot transform into sweat. This results in hardness, fullness, and severe pain from the epigastrium down to the lower abdomen, which is intolerant to pressure. It is indicated for patients who have no significant body heat, only sweating on the head, or who experience tidal fever, restlessness, and thirst, with a deep and tight pulse. It may also be used for edema or dysentery (intestinal discharge) in their early stages, provided the patient's constitution and pathogenic factor are both excess in nature.
Ingredients: Da Huang (Rhei Radix et Rhizoma) 6 liang; Mang Xiao (Natrii Sulfas); Ku Ting Li Zi (Semen Lepidii seu Descurainiae); Xing Ren (Semen Armeniacae Amarum, peeled) — each half sheng; Gan Sui (Radix Euphorbiae Kansui, powdered) 1 qian. Preparation: The five herbs are processed as follows: First, decoct Da Huang, Xing Ren, and Ting Li Zi in water, then strain to remove dregs. Add Mang Xiao and boil for one or two rolling boils. Then add the powdered Gan Sui. Take warm. Discontinue administration once a rapid bowel movement occurs. If the condition is severe, add Bai Mi (Mellis) 2 he, and form pills the size of quail eggs. Boil one pill in water and take it. Stool will be passed after overnight. If no stool is passed, administer another dose.
[Collected Annotations] Ke Qin stated: The chest is the origin of Zong Qi (Pectoral Qi), hence it is called the Sea of Qi. Qi belongs to Yang, thus it is associated with the Taiyang region. Qi is the mother of Water; when Qi is clear, Water Essence distributes throughout the body; when Qi is hot, Water becomes turbid and becomes obstructed and knotted. When Water knots in the chest, Body Fluids cannot descend to moisten the intestines and stomach, resulting in dry feces; they cannot transport downward to the Bladder, resulting in obstruction of the water passages. Da Huang and Mang Xiao are adept at cleansing heat and excess in the intestines and stomach. Although this pathology is located in the chest, they are used as the Sovereign herb because when Heat is rampant internally, it should be treated with Bitter-Cold substances. Furthermore, they moisten the dryness of the Yangming channel. This represents the method of "draining the son when the mother is excess," and supplementing the cold of the Bladder by utilizing what it fears. The bitter-pungent nature of Gan Sui is employed to directly attack the water knot. However, since the water knot stems from Qi knotting, it must be assisted by the bitter-warm nature of Xing Ren to open the Qi within the water; when Qi moves, Water flows freely. Since the water knot is also caused by Qi heat, it must be assisted by the great-cold nature of Ting Li Zi to clear the heat in the Qi level; when the source is clear, the flow becomes pure. If the water knot in the chest has not yet reached the Middle Jiao, the dosage should be reduced, and aided by the sweetness of Bai Mi to moderate its action, allowing it to linger in the chest and act overnight. This resolves the stagnation in the chest and heart while protecting the intestines and stomach from damage, thereby transforming an attacking formula into a harmonizing one. This formula is a diuretic and accumulative-expelling agent; therefore, it acts swiftly on early-stage edema and dysentery. However, one must assess whether the patient is robust enough to achieve success in a single strike. For those who are chronically deficient or have been ill for a long time and cannot withstand attacking therapies, one must heed the warning against "making deficiency more deficient."