唐容川曰∶噤口者,下痢不食,是火热浊攻,胃气被伤而不开,各书俱遵丹溪,用石莲汤,《金鉴》谓内热盛,
上冲心作呕。噤口者,用大黄黄连好酒煎服以攻之。按肠胃所以能食者,以胃有津液,清和润泽,是以思食。西洋
医虽滞于迹,亦间有可信处。言谷入于胃,即有胃津注之,将谷浑化如糜,常探胃津搅饭,顷刻亦化为糜。据此谓
说,则胃之思食,全是胃津使然。试观犬欲得肉,则涎出于口,此液即欲食之本也。人之胃津,其思食之情,亦类
乎此。今胃为邪热浊气所攻踞,其清和之津,尽化而为浊滞,下注于大肠,则为痢,停聚胃中,则拒不纳食。丹溪
石莲汤,虽知清火补胃,然石莲是莲米有黑壳者,今医用石莲子,不知何物,断不可用。即莲米,性亦带涩,痢症
宜滑以去着,涩乃所忌。且胃中浊滞非洗涤变化不为功,此方虽寒热未瘥,然未洗涤其滞,变化其浊,非起死回生方
也。清瘟败毒饮、竹叶石膏汤、人参白虎汤、麦冬养荣汤出入加减,庶可以洗胃变津,为开胃进食之良法。至呕不
思食,《金鉴》用二黄好酒,取其峻快以攻逆。然治逆洵为得法,而不知化生胃津,终未得进食之本也。吾意以为
宜用大柴胡汤,加石膏、花粉、人参,则攻逆生津,开胃进食,两面俱到。治噤口者,从无此论,吾今悟出切实之
理,为斯人大声疾呼。海始欲以文章报国,今己自分不能,庶几发明此道,稍有补于斯民欤。
又补论曰∶凡噤口痢,上噤下痢,法宜和中。此与霍乱对看自明,霍乱上吐下泻,必以和中而愈,则知噤口痢,
上噤下痢,亦必以和中而愈。第霍乱是中寒而发,为上下俱脱之症,法主理中汤以温之。噤口痢,上噤下滞,其
为中热可知。热结于中,上下不开。和中之法,宜反理中汤诸药,以寒凉治之,生姜泻心汤,去干姜为宜,人参
白虎汤亦佳。
石莲汤方
人参(一钱) 黄芩(一钱) 黄连(一钱) 石莲(一钱,即莲米有黑壳者)
竹叶石膏汤
淡竹叶(一钱) 石膏(一钱) 人参(一钱) 甘草(一钱) 寸冬(一钱) 半夏(七分) 生姜(一钱) 粳
米(一钱)
涂蔚生曰∶生姜半夏俱辛燥,于是症宜酌用,即有石膏寸冬之寒,亦恐其消耗津液。因此症原系一种热症也。
清瘟败毒散
石膏(一钱) 知母(一钱) 生地(一钱) 犀角(五分) 黄连(一钱) 栀子(一钱) 桔梗(一钱) 黄
芩(一钱)
赤芍(一钱) 玄参(一钱) 连翘(一钱) 丹皮(一钱) 甘草(一钱) 竹叶(一钱)
大柴胡汤
柴胡(一钱) 黄芩(一钱) 人参(一钱) 半夏(七分) 大黄(一钱) 枳实(七分) 生姜(一钱)
大枣(一枚)
人参白虎汤 见前温病方内
麦冬养荣汤
人参(一钱) 知母(一钱) 寸冬(一钱) 甘草(一钱) 五味子(一钱) 当归(一钱) 白芍(一钱)
陈皮(六分) 黄 (一钱) 生地(一钱)
Tang Rongchuan stated: "Jinkou Li" (Dysentery with inability to eat) refers to a condition where the patient suffers from dysentery and cannot eat. This is caused by pathogenic fire and turbid qi attacking, damaging the Stomach Qi, which fails to diffuse. Most medical texts follow Zhu Danxi's view and use Shilian Tang (Lotus Seed Decoction). *Yizong Jinjian* (Golden Mirror of Medical Tradition) states that excessive internal heat rushes upward to the Heart, causing vomiting. For Jinkou Li, Dahuang Huanglian Tang (Rhubarb and Coptis Decoction) should be used, decocted in high-quality yellow wine to attack the pathogen.
I believe that the reason the intestines and stomach can accept food is that the Stomach contains fluids (Jin Ye), maintaining a clear, harmonious, moist, and nourishing state, thereby generating appetite. Western medicine, though sometimes rigid in its observations, has credible aspects. They state that when food enters the Stomach, Stomach fluids are immediately secreted to mix with it, digesting the food into a mushy consistency. If one were to constantly probe for Stomach fluids to stir rice, it would turn into mush almost instantly. Based on this, the desire to eat is entirely dependent on Stomach fluids. Observe a dog desiring meat; saliva flows from its mouth. This fluid is the root of the desire to eat. Similarly, human Stomach fluids drive the emotion of wanting to eat. Currently, the Stomach is occupied by pathogenic heat and turbid qi. Its clear and harmonious fluids are transformed into turbid stagnation. When flowing downward into the Large Intestine, it becomes dysentery; when stagnating in the Stomach, it rejects food intake.
Although Zhu Danxi's Shilian Tang aims to clear fire and tonify the Stomach, "Shilian" refers to lotus seeds with black shells. Modern physicians use "Shilianzi," but it is unclear what substance this actually is, so it must not be used. Even if using lotus seeds, their nature is astringent. Dysentery requires slippery methods to remove adherent pathogens; astringency is contraindicated. Moreover, turbid stagnation in the Stomach cannot be resolved without cleansing and transforming it. This formula, while addressing cold and heat, fails to cleanse the stagnation or transform the turbidity; thus, it is not a life-saving prescription. Using Qingwen Baidu Yin (Plague-Dispersing Toxin-Resolving Decoction), Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), Renshen Baihu Tang (Ginseng White Tiger Decoction), or Maidong Yangrong Tang (Ophiopogon Nourishing Harmony Decoction) with appropriate modifications can cleanse the Stomach and transform fluids, serving as an excellent method to open the Stomach and promote eating. Regarding vomiting and loss of appetite, *Yizong Jinjian* uses Dahuang and Huanglian with good wine, relying on their rapid and potent action to counteract rebellion. While treating rebellion is indeed correct, it neglects the generation of Stomach fluids, failing to address the root of eating.
My opinion is that Dachaihu Tang (Minor Bupleurum Decoction) should be used, supplemented with Shigao (Gypsum), Huafen (Trichosanthes Root), and Renshen (Ginseng). This approach attacks rebellion and generates fluids simultaneously, benefiting both the Stomach opening and food intake. There has never been such a discussion on treating Jinkou Li before. I have now realized the practical principle and am shouting loudly for these patients. I originally intended to serve the country through literature, but now consider myself incapable; perhaps by elucidating this path, I may offer some benefit to the people.
Supplementary discussion: Generally, for Jinkou Li, characterized by upper obstruction (inability to eat) and lower dysentery, the treatment method should focus on harmonizing the Middle Jiao. Comparing this with Huoluan (Cholera-like disorder) makes it clear: Huoluan involves upper vomiting and lower diarrhea, and must be cured by harmonizing the Middle Jiao. Therefore, Jinkou Li, with upper obstruction and lower dysentery, must also be cured by harmonizing the Middle Jiao. However, Huoluan arises from Cold invading the Middle and represents a syndrome of collapse of both upper and lower aspects, so the treatment primarily uses Lizhong Tang (Regulate the Middle Decoction) to warm. Jinkou Li, with upper obstruction and lower stagnation, indicates Heat in the Middle. Heat knots in the Middle, blocking the upper and lower openings. The method of harmonizing the Middle should reverse the approach of Lizhong Tang and other warming herbs, instead using cold/cool herbs. Shengjiang Xiexin Tang (Ginger Heart-Draining Decoction) with Ganjiang (Dried Ginger) removed is suitable; Renshen Baihu Tang is also excellent.
Shilian Tang Formula: Renshen (1 qian), Huangqin (1 qian), Huanglian (1 qian), Shilian (1 qian, i.e., lotus seed with black shell).
Zhuye Shigao Tang: Danshuye (1 qian), Shigao (1 qian), Renshen (1 qian), Gancao (1 qian), Cundong (1 qian), Banxia (0.7 qian), Shengjiang (1 qian), Jingmi (1 qian).
Tu Weisheng stated: Shengjiang and Banxia are both acrid and drying; they should be used cautiously in this condition. Even with the cooling properties of Shigao and Cundong, there is still a fear of consuming body fluids, as this condition is essentially a type of Heat syndrome.
Qingwen Baidu San: Shigao (1 qian), Zhimu (1 qian), Shengdi (1 qian), Xijiao (0.5 qian), Huanglian (1 qian), Zhizi (1 qian), Jiegeng (1 qian), Huangqin (1 qian), Chishao (1 qian), Xuanshen (1 qian), Lianqiao (1 qian), Danpi (1 qian), Gancao (1 qian), Zhuye (1 qian).
Dachaihu Tang: Chaihu (1 qian), Huangqin (1 qian), Renshen (1 qian), Banxia (0.7 qian), Dahuang (1 qian), Zhishi (0.7 qian), Shengjiang (1 qian), Dazao (1 piece).
Renshen Baihu Tang: See previous Warm Disease formulas.
Maidong Yangrong Tang: Renshen (1 qian), Zhimu (1 qian), Cundong (1 qian), Gancao (1 qian), Wuweizi (1 qian), Danggui (1 qian), Baishao (1 qian), Chenpi (0.6 qian), Huangqi (1 qian), Shengdi (1 qian).