(汤,《千金》)参附与干姜,甘草当归硝大黄。寒热并行治寒积,脐腹绞结痛非常。人
参、附子、甘草、芒硝各一两,大黄五两,当归、干姜各三两,煎服,日三。本方除当归、
芒硝,亦名温脾汤,治久痢赤白、脾胃冷、实不消。硝、黄以荡其积,姜、附以祛其寒,参、
草、当归以保其血气。按∶古人方中,多有硝、黄、柏、连与姜、茱、桂、附寒热并用者,
亦有参、术、硝、黄补泻并用者,亦有大黄、麻黄汗下兼行者,令人罕识其旨。姑录此方
,以见治疗之妙不一端也。)
(仲景用蜜熬如饴,捻作挺子,掺皂角末,乘热纳谷道中,或掺盐。)或将(猪)胆汁
灌肛中。(用猪胆汁醋和,以竹管插肛门中,将汁灌入,顷当大便,名猪胆汁导法,仲景)。
不欲苦寒伤胃府,阳明无热勿轻攻。(胃府无热而便秘者,为汗多津液不足,不宜用承气妄
攻。此仲景心法,后人罕识,故录三方于攻下之末。)
二首、附方六
汗、吐、下、和,乃治疗之四法。经曰∶在上者涌之,其高者因而越之,故古人治病,
用吐法者最多。朱丹溪曰∶吐中就有发散之义。张子和曰∶诸汗法古方多有之,惟以吐发汗
者,世罕知之。今人医疗,惟用汗、下、和,而吐法绝置不用,可见时师之缺略。特补涌吐
一门,方药虽简,而法不可废也。若丹溪用四物、四君引吐,又治小便不通,亦用吐法,是
又在用者之圆神矣。
(This formula is from *Qianjin Fang*). It consists of Renshen (Ginseng Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Xiaoshiren (Natrii Sulfas), and Dahuang (Rhei Radix et Rhizoma). Cold and hot herbs are used together to treat cold accumulation, manifesting as severe colicky pain in the umbilical and abdominal regions. The prescription is: Renshen, Fuzi, Gancao, and Xiaoshiren each 1 liang; Dahuang 5 liang; Danggui and Ganjiang each 3 liang. Decoct and take orally, three times a day. If Danggui and Xiaoshiren are removed, this formula is also called Wenpi Tang (Warming the Spleen Decoction), used to treat chronic dysentery with red and white stools, cold spleen and stomach, and indigestion. Here, Xiaoshiren and Dahuang are used to purge accumulations, Ganjiang and Fuzi to dispel cold, while Renshen, Gancao, and Danggui to protect qi and blood. Note: In ancient formulas, it was common to combine cold herbs like Xiaoshiren, Dahuang, Huangbai (Phellodendri Cortex), and Huanglian (Coptidis Rhizoma) with hot herbs like Ganjiang, Zhuyu (Evodiae Fructus), Guizhi (Cinnamomi Ramulus), and Fuzi; or to combine tonifying herbs like Renshen and Baizhu (Atractylodis Macrocephalae Rhizoma) with purgative herbs like Xiaoshiren and Dahuang; or to simultaneously employ sweating methods using Dahuang and Mahuang (Ephedrae Herba) and purgative methods. Few people understand the intent behind these combinations. This formula is recorded here merely to illustrate that therapeutic methods are diverse and ingenious.)
(Zhang Zhongjing used honey boiled until resembling maltose syrup, shaped into suppositories, mixed with powder of Genglei (Sinapis Semen) or Zaojiao (Gleditsiae Sinensis Fructus), and inserted into the anus while warm, or mixed with salt.) Alternatively, (pig) bile can be enema-administered into the anus. (Use pig bile mixed with vinegar, insert a bamboo tube into the anus, and pour the juice in; bowel movement should occur shortly after. This is known as the Pig Bile Suppository Method, from Zhang Zhongjing). One should avoid letting bitter-cold herbs damage the Stomach organ; if there is no heat in the Yangming channel, do not lightly use purgation. (Constipation due to lack of heat in the Stomach organ is caused by excessive sweating leading to insufficient body fluids; it is inappropriate to recklessly use Chengqi Tangs for purgation. This is Zhang Zhongjing’s clinical insight, rarely understood by later generations, hence these three formulas are recorded at the end of the purgative section.)
Two main verses, six supplementary formulas.
Sweating, vomiting, purging, and harmonizing are the four fundamental treatment methods. The Classics state: "For pathogens located above, use emesis; for those high up, induce upward dispersal." Therefore, in ancient times, emetic therapy was most frequently used. Zhu Danxi said: "Emesis contains the principle of dispersion." Zhang Hezi said: "While many ancient formulas employ sweating methods, few people know that emesis can also induce sweating." Modern medical practice only utilizes sweating, purging, and harmonizing methods, completely abandoning emesis, revealing the deficiencies of contemporary physicians. I have specifically supplemented this section on emetic therapy. Although the formulas are simple, the method must not be discarded. For instance, when Danxi used Siwu Tang (Four Substances Decoction) and Sijunzi Tang (Four Gentlemen Decoction) to induce emesis, or treated urinary retention with emesis, it demonstrates the flexibility and profound understanding required of the practitioner.