伤寒传里。发热口干。胸满。烦躁。甚则谵语揭衣。皆里实也。攻之无疑。又何
慎焉。不知攻里之法。宜缓不宜速。宜平不宜峻。宜专不宜杂。宜升不宜降。
宜润不宜燥。何以言之。饮食入胃。消之者脾。腐之者中焦易易者。唯一为
所阻。而藉药以化之。则不能朝饮夕效。部分有上中下。用药有深浅次第。
如邪在上中二焦而遽下之。成结胸痞气是也。所谓宜缓不宜速也。人之
所籍以生者胃气耳。既为风寒饮食所伤。而复药以克之。是重伤也。惟用
辛温苦平之剂。令其克化足矣。非比大积大聚。必得蓬术大黄等峻厉以
荡之。庶胃气不大坏。而完复可俟也。所谓宜平不宜峻也。既伤于食。必审
何物受伤。何药能制。如山楂制肉。莱菔制面与豆。陈皮制蛋。杏仁制粉。葛
根制酒。茗制谷气之类。一物一治。用的为君。以他药佐之。庶易见功。不然
泛投取应。岂可得乎。所谓宜专不宜杂也。凡物之理。有升必有降。若降令
太过。则壅塞而不行。胃气喜升。葛根能鼓舞之。胆气欲升。柴胡能条达之。
而后加以内消之药。则升降之道得。而物易以化矣。所谓宜升不宜降也。
大肠主津。小肠主液。肾为胃关。又主五液。其所以能变化传导者赖此耳。
若辛热躁烈之药。有以竭之。则烦躁斑黄谵妄之所由作也。如平胃散中。
浓朴。苦温者也。同以葛根则润。青皮枳实。苦而下降也。缓以甘桔则不峻。
楂肉味酸。能调五味而化油腻。广皮枳壳。能理气而快膈。若妇人多怒。加
香附以调之。故伤寒里药。发表在前。汗液外泄。不可又用苍术木香草果
豆蔻之属。复竭其液也。观其燥结。独用胆汁蜜导。又可知矣。所谓宜润不宜燥也。
枳朴汤
枳壳(麸炒) 浓朴(姜汁炒) 桔梗 柴胡 广皮(各一钱)
山楂 葛根(各一钱五分) 甘草(二分炙)
加砂仁生姜。水煎。如寒未除。加紫苏一钱。伤面。加卜子一钱。邪在下。加
青皮枳实各一钱。去枳壳服四五剂。邪已变化。如未大便。用猪胆或蜜煎导之。
按上表里二法。最为稳当。惟不竭其津液也。岂待清火而后愈乎。盖寒
凉一早。食便不消。其热愈炽。所谓点沸不如抽薪也。
When pathogenic cold transmits to the interior (Li), symptoms such as fever, dry mouth, chest fullness, irritability, and even delirium with uncovering of clothes appear; these all indicate Interior Excess (Li Shi). Attack is undoubtedly indicated, so why hesitate? However, one must not be unaware that the method of attacking the interior should be slow rather than rapid, mild rather than severe, focused rather than mixed, ascending rather than descending, and moistening rather than drying. Why is this so? When food enters the stomach, its digestion is managed by the Spleen (Pi), and its decomposition occurs in the Middle Jiao (Zhong Jiao), which is inherently easy. Once obstructed, relying on herbs to resolve it cannot yield results from morning to evening. The body is divided into Upper, Middle, and Lower Jiao, and the use of medicine has degrees of depth and sequence. If pathogens are in the Upper and Middle Jiao but purgatives are used hastily, conditions like Jie Xiong (Chest Binding) or Pi Qi (Stagnant Qi) will form. This illustrates "slow rather than rapid." What sustains human life is Stomach Qi (Wei Qi). Having already been injured by wind-cold and dietary factors, using drugs to attack it further causes double injury. Only by using acrid-warm and bitter-neutral formulas can sufficient transformation be achieved. This differs from large accumulations, which require harsh agents like Euphorbiae Lathyris Radix (Pengzhu) and Rheum Palmatum Radix et Rhizoma (Dahuang) to sweep them away. Thus, Stomach Qi is not severely damaged, and complete recovery can be awaited. This illustrates "mild rather than severe." Since the injury is due to food, one must examine what was ingested and what herb can counteract it. For instance, Crataegi Fructus (Shanzha) resolves meat; Raphani Semen (Laifu) resolves wheat and beans; Citri Reticulatae Pericarpium (Chenpi) resolves eggs; Armeniacae Semen Amarum (Xingren) resolves starches; Puerariae Lobatae Radix (Gegen) resolves alcohol; and Camellia Sinensis Folium (Cha) resolves grain qi. Each substance has a specific treatment; determine the Sovereign (Jun) herb accordingly, assisted by other herbs, to ensure efficacy. Otherwise, indiscriminate prescribing cannot succeed. This illustrates "focused rather than mixed." Generally, for every ascending force, there is a descending one. If descending is excessive, stagnation and obstruction occur. Stomach Qi prefers ascending; Puerariae Lobatae Radix (Gegen) can inspire it. Gallbladder Qi desires ascending; Bupleuri Radix (Chaihu) can smooth it. Then, adding internal resolving herbs allows the pathways of ascending and descending to function, facilitating digestion. This illustrates "ascending rather than descending." The Large Intestine governs Jin Ye (Jin fluids); the Small Intestine governs Ye (Ye fluids); the Kidney (Shen) is the gate of the Stomach and governs the five fluids. Their ability to transform and conduct relies on these. If acrid-hot and drying drugs are used, they deplete fluids, leading to irritability, macules, jaundice, and delirium. For example, in Ping Wei San, Magnoliae Officinalis Cortex (Houpo) is bitter-warm; combined with Gegen, it becomes moistening; Qingpi and Zhi Shi are bitter and descending; when moderated with Glycyrrhizae Radix et Rhizoma (Gancao) and Platycodonis Radix (Jiegeng), they become less harsh; Hawthorn Fruit (Shanzha) is sour, harmonizes the five flavors, and resolves greasiness; Citri Reticulatae Pericarpium (Guangpi) and Aurantii Fructus Immaturus (Zhiqiao) regulate Qi and relieve chest oppression. If women suffer from anger, Cyperi Rhizoma (Xiangfu) is added to regulate. Therefore, in treating Interior Cold Damage, after releasing the exterior and sweating, one must not use Atractylodis Rhizoma (Cangzhu), Costi Radix (Muxiang), Tsaoko Fructus (Caoguo), or Cardamomi Fructus (Doukou) to further deplete fluids. Observing cases of dryness and constipation treated solely with Porcini Bile (Zhichuang) or Honey Suppositories demonstrates this. This illustrates "moistening rather than drying."
Zhi Po Tang (Bitter Orange and Magnolia Decoction)
Aurantii Fructus Immaturus (Zhiqiao, 麸炒 - bran-fried) [1 qian]
Magnoliae Officinalis Cortex (Houpo, 姜汁炒 - ginger-juice fried) [1 qian]
Platycodonis Radix (Jiegeng) [1 qian]
Bupleuri Radix (Chaihu) [1 qian]
Citri Reticulatae Pericarpium (Guangpi, 广皮) [1 qian]
Crataegi Fructus (Shanzha) [1.5 qian]
Puerariae Lobatae Radix (Gegen) [1.5 qian]
Glycyrrhizae Radix et Rhizoma (Gancao, 炙 - honey-fried) [2 fen]
Add Amomi Fructus Rotundus (Sharen) and Zingiberis Rhizoma Recens (Shengjiang). Decoct in water. If cold remains, add Perillae Folium (Zisu) 1 qian. If injured by noodles, add Raphani Semen (Bozi/Laifu) 1 qian. If pathogen is in the lower part, add Qingpi and Zhi Shi 1 qian each; remove Zhiqiao and take for four to five doses. If the pathogen has transformed but constipation persists, use Porcine Bile or Honey Suppository.
According to the above methods for Exterior and Interior, the approach is most stable, provided fluids are not depleted. Why wait for clearing heat to achieve cure? Early use of cold-cooling herbs prevents digestion of food and stool, causing heat to flare up more fiercely. This is akin to "removing the firewood from under the boiling pot" rather than just blowing on the flames.