(仲景)
治伤寒误下,小结胸正在心下,按之则痛,脉浮滑者;及痰热塞胸(前证上下俱硬,此
则正在心下;前证痛不可近,此则按之则痛。结胸,脉沉紧,或寸浮关沉,或脉浮滑,知热
未深,
黄连(一两) 半夏(半升) 栝蒌(大者一枚。)
此足少阳药也。黄连之苦寒以泄热,栝蒌之寒润以涤垢,半夏之辛温以散结。结胸多由
痰热结聚,故用三物以除痰去热也(王海藏曰∶大陷胸汤,太阳本药也;大陷胸丸,阳明药
也;小
(仲景)
治伤寒结胸,项强如柔痉状(有汗为柔痉。胸膈实满,故项强而不能俯,项属太阳部位)。
大黄(八两) 芒硝 葶苈(炒) 杏仁(去皮尖。各半升。)合研。取如弹丸一枚。
别捣甘
此足太阳、阳明药也。大黄之苦寒以泄热,芒硝之咸寒以软坚,杏仁之苦甘以降气,葶
苈、甘遂取其行水而直达,白蜜取其润滑而甘缓。
(仲景)
治太阳中风,下利呕逆,表解者乃可攻之,其人 汗出,头痛,心下痞 ,引胁下痛
,干呕,短气,汗出,不恶寒,表解而里未和,邪热内蓄,有伏饮者(下利呕逆,里受邪也;
汗出不
逆,呕
攻与结
芫花(炒黑) 甘遂 大戟(等分) 大枣(十枚。)先煮枣去渣,内前药末,强人服
一钱,虚人五分。或枣肉为丸。病不除者,再服,得快下后,糜粥自养。
此足太阳药也。芫花、大戟之辛苦以逐水饮;甘遂苦寒,能直达水气所结之处,以攻决
为用;三药过峻,故用大枣之甘以缓之,益土所以胜水,使邪从二便而出也(十枣汤、小青
龙汤主水气干呕;桂枝汤主太阳汗出干呕;姜附汤主少阴下利干呕;吴茱萸汤主厥阴吐涎沫
干呕。王海藏曰∶表有水用小青龙,里有水用十枣。或问十枣汤、桂枝去桂加茯苓白术汤,
皆属饮家,俱有头痛项强之证,何也。张兼善曰∶太阳经多血少气,病患表热微渴,恣饮水
浆,为水多气弱,不能施化,本经血气,因而凝滞,致有头痛项强之患,不须攻表,但宜逐
饮,饮尽则自安。杜壬曰∶里未和者,盖痰与燥气壅于中焦,故头痛干呕,汗出短气,是痰
膈也,
本方除大枣,加大黄、黑丑、轻粉,水丸,名三花神佑丸(河间)∶治壮实人风痰郁热,
支
此痰涎壅塞,顿攻不开,再加二丸,快利则止(加牵牛、大黄、大泻气血之湿;加轻粉,无
窍不入,以去痰积。虚人不可轻用)。本方各五钱,加黄柏(三两酒炒)、大黄(煨两半),
粥丸,名小胃丹(
(Zhang Zhongjing)
Treats complications from incorrect purgation in Cold Damage (Shanghan), specifically Xiao Xianxiong Tang syndrome where the pathogen is located exactly at the epigastrium (heart below), causing pain upon pressure, with a floating and slippery pulse; as well as phlegm-heat obstructing the chest (the previous condition involves hardness throughout the upper and lower abdomen, whereas this condition is localized to the epigastrium; the previous condition involves severe pain with aversion to touch, whereas this condition involves pain only upon pressure. In Jie Xiong [Knotted Chest] syndrome, the pulse is typically deep and tight, or floating at the cun position and sunken at the guan position, or floating and slippery, indicating that the heat has not yet penetrated deeply).
Huanglian (Coptidis Rhizoma, 1 liang) Banxia (Pinelliae Tuber, half sheng) Gualou (Trichosanthis Fructus, one large fruit).
These are herbs for the Foot-Shaoyang channel. Huanglian's bitter cold nature clears and drains heat; Gualou's cold and moistening nature washes away turbidity; Banxia's acrid warm nature disperses knots. Jie Xiong is mostly caused by the accumulation of phlegm-heat, so these three substances are used to eliminate phlegm and clear heat (Wang Haicang stated: Da Xianxiong Tang is the primary formula for the Taiyang channel; Da Xianxiong Wan is for the Yangming channel; Xiao...)
(Zhang Zhongjing)
Treats Jie Xiong from Cold Damage, characterized by stiffness of the neck resembling Rou Ji (Soft Spasm) (Rou Ji is defined by the presence of sweating. The fullness and excess in the chest and diaphragm cause neck stiffness preventing flexion; the neck region belongs to the Taiyang area).
Dahuang (Rhei Radix et Rhizoma, 8 liang) Mangxiao (Natrii Sulfas) Tingli (Semen Lepidii/Descurainiae, stir-fried) Xingren (Semen Armeniacae Amarum, skin and tips removed. Each half sheng.) Grind together. Take an amount equivalent to one pill the size of a bullet.
Separately grind Gansui...
These are herbs for the Foot-Taiyang and Foot-Yangming channels. Dahuang's bitter cold nature drains heat; Mangxiao's salty cold nature softens hardness; Xingren's bitter and sweet nature descends qi; Tingli and Gansui are utilized for their ability to promote water metabolism and reach the site directly; Bai Mi (White Honey) is used for its lubricating and sweet-slowing properties.
(Zhang Zhongjing)
Treats Sunwind (Taiyang Fengzhong) presenting with diarrhea and retching. Purging may be employed only after the exterior syndrome has resolved. The patient exhibits sweating, headache, epigastric stuffiness (Pi), pain radiating from the hypochondrium, dry retching, shortness of breath, sweating, and absence of aversion to cold. The exterior is resolved but the interior is not harmonized; evil heat accumulates internally, accompanied by latent fluid retention (Diarrhea and retching indicate pathogenic invasion of the interior; sweating without... retching... purging and knotting...).
Yuanhua (Genkwa Flos, stir-fried until black) Gansui (Radix Kansui) Daji (Radix Euphorbiae Pekinensis) (Equal parts) Dazao (Jujubae Fructus, ten fruits.) Boil the dates first, remove the dregs, and add the powdered herbs. Strong individuals take 1 qian; weak individuals take 0.5 qian. Alternatively, form pills using date pulp. If the disease persists, administer again. After achieving rapid purgation, nourish oneself with millet porridge.
This is a formula for the Foot-Taiyang channel. Yuanhua and Daji, being acrid and bitter, expel fluid retention; Gansui is bitter and cold, capable of reaching the site where fluid qi is knotted, acting through aggressive resolution; since these three drugs are overly harsh, Dazao's sweetness is used to moderate them. Tonifying Earth (Spleen/Stomach) overcomes Water, allowing the pathogen to exit via the two bowels (Shizao Tang and Xiao Qinglong Tang treat dry retching due to fluid qi invading the stomach; Guizhi Tang treats dry retching with sweating in the Taiyang channel; Jiangfu Tang treats dry retching with diarrhea in the Shaoyin channel; Wuzhuyu Tang treats dry retching with salivary froth in the Jueyin channel. Wang Haicang said: For exterior fluid, use Xiao Qinglong; for interior fluid, use Shizao. One might ask why both Shizao Tang and Guizhi Qu Gui Jia Fuling Baizhu Tang, which belong to fluid-retention patterns, present with headache and neck stiffness? Zhang Jianshan stated: The Taiyang channel has abundant blood but deficient qi. When patients have slight exterior heat and thirst, they may drink excessively. Due to excessive water and weak qi, transformation fails, causing stagnation of blood and qi in the primary channel, leading to headache and neck stiffness. There is no need to attack the exterior; one should only expel fluid. Once the fluid is cleared, peace returns. Du Ren stated: "Interior not harmonized" refers to phlegm and dry qi obstructing the middle jiao, causing headache, dry retching, sweating, and shortness of breath; this is Phlegm Ge syndrome...).
Removing Dazao from this formula and adding Dahuang, Heiqiu (Semen Phaseoli Mungo/Ferrugineous Semen Phaseoli), and Qingfen (Calomelas), made into water pills, is named Sanhua Shenyao Wan (Hejian): Treats wind-phlegm and stagnant heat in robust individuals, causing...
When phlegm-fluid obstruction is sudden and resistant to opening, add two more pills; stop when rapid evacuation occurs (Adding Qianniu and Dahuang greatly drains dampness from qi and blood; adding Qingfen penetrates all orifices to remove phlegm accumulation. Do not use lightly in deficient individuals). Taking five qian of each ingredient from the base formula, plus Huangbai (3 liang, wine-fried) and Dahuang (1.5 liang, stir-baked), made into pills with millet porridge, is named Xiaowei Dan (...