《肘后》辨脾胃所伤变易形法∶凡诸脾脉,微洪伤苦涩物,经云∶咸胜苦。微涩伤辣
辛物,经云∶苦胜辛。微滑伤腥咸物,经云∶甘胜咸。洪缓伤甜烂物,经云∶酸胜甘。弦紧
伤酸硬物,经云∶辛胜酸。微弦伤冷硬物,经云∶温以克之。微迟伤冷痰积恶物
,经云∶温胃化痰。饮食过多,胀痞不下,寻常率以破气之药投之。(伤食恶食,必有噫腐
吞酸
之候。)是食物既伤之前,药剂又攻之于后,脾气安得而健畅也。必须以平补之药为主,佐
以他药,一升一降,使脾肾交通,而水火既济,自然腐化矣。
治积之法,理气为先,气既升降,津液流畅,积聚何由而生。丹溪乃谓气无形而不能
作块成
聚,只一消痰破血为主误矣。天地间有形之物,每自无中生,何止积聚也。戴复庵以一味
大七气汤,(调气和血,使其升降自如,津液周流,灌溉脏腑,无滞窒则积聚不攻而自化
矣。)治一
切积聚,其知此道欤。肝积肥气,用前汤煎熟待冷,却以铁器烧通红,以药淋之,乘热服。
肺积息
贲,用前汤加桑白皮、半夏、杏仁各五分。心积伏梁,用前汤加石菖蒲半夏各五分
。脾之积痞气,用前汤下红丸子。肾之积奔豚,用前汤倍桂加茴香炒楝子肉各五分。
今人治一切气疾,止知求之脾肺,而不知求之肾,所以鲜效。夫肾间动气,为五脏六腑
之本,十
二经脉之根,呼吸之门,三焦之原。房劳过度,或禀受素弱,肾经不足,气无管束,遂多
郁滞
,是生诸疾。(诸气 郁,皆属于肺。气主煦之,若郁结不舒,气机凝滞,血亦因之痹塞,
则诸
病生矣,故百病皆生于郁,是其明证)。医者以为是当理气,壳朴、香附、乌药之类,杂然
而前陈,
而气愈不可理矣。宣之泄之,以快药下之,而人之死者过半矣。于是医之中见稍高者,以为
脾虚不能运化精微之故,而从事于补脾。然仅可以苟延岁月,而多至于因循蹉跎而不救。此
不知补肾之过也。宜以破故纸、茴香子、葫芦巴之类主之。气药内须兼用和血之药佐之,盖
未有气滞而血能和者,血不和则气益滞矣。
The *Zhou Hou Bei Ji Fang* (Emergency Prescriptions Kept Up the Sleeve) describes methods for distinguishing changes in form due to spleen and stomach injury: Whenever the spleen pulse presents as slightly flooding (Hong), it indicates injury from bitter/astringent substances; the Classics state that salty flavors overcome bitter. A slightly choppy (Se) pulse indicates injury from pungent/spicy substances; the Classics state that bitter flavors overcome pungent. A slightly slippery (Hua) pulse indicates injury from fishy/salty substances; the Classics state that sweet flavors overcome salty. A flooding and slow (Hong-Huan) pulse indicates injury from sweet/rotten substances; the Classics state that sour flavors overcome sweet. A string-tight (Xian-Jin) pulse indicates injury from sour/hard substances; the Classics state that pungent flavors overcome sour. A slightly string-like (Xian) pulse indicates injury from cold/hard substances; the Classics state that warm properties overcome them. A slightly slow (Chi) pulse indicates injury from cold-phlegm accumulation or foul substances; the Classics state to warm the stomach and resolve phlegm. When food intake is excessive, leading to abdominal distension, fullness, and inability to eat, people usually administer Qi-breaking medicines. (Food injury with aversion to food must present with belching of putrid odor and acid regurgitation.) Before the food is injured, medications are subsequently used to attack, so how can Spleen Qi remain healthy and unobstructed? One must primarily use mild tonifying medicines, assisted by others, promoting one ascending and one descending, allowing communication between Spleen and Kidney, and achieving mutual interaction of Water and Fire, so that digestion and transformation occur naturally.
The method for treating accumulations (Ji Ju) prioritizes regulating Qi. Once Qi ascends and descends properly, and body fluids flow smoothly, how can accumulations arise? Danxi claimed that Qi is formless and cannot form masses or accumulations, focusing solely on resolving phlegm and breaking blood stasis, which is erroneous. Formidable objects in the world often arise from formlessness; why should accumulations be an exception? Dai Fu'an used a single formula, Da Qi Qi Tang (Great Seven Qi Decoction) (to harmonize Qi and Blood, enabling free ascent and descent, circulating body fluids to nourish organs, eliminating stagnation so that accumulations dissolve without direct attack), to treat all types of accumulations. He understood this principle. For Liver Accumulation named Fei Qi (Fatty Qi), decoct the aforementioned soup, let it cool, then pour it over a red-hot iron vessel, and drink while hot. For Lung Accumulation named Xi Ben (Panting Oppression), add Bai Sang Pi (Morus Cortex), Ban Xia (Pinellia Rhizoma), and Xing Ren (Prunus Semen) each 5 fen to the aforementioned soup. For Heart Accumulation named Fu Liang (Hidden Beam), add Shi Chang Pu (Acori Tatarinowii Rhizoma) and Ban Xia each 5 fen. For Spleen Accumulation named Pi Qi (Stagnant Qi), administer Hong Wan Zi (Red Pill) with the aforementioned soup. For Kidney Accumulation named Ben Tun (Rushing Pig), double the Gui Zhi (Cinnamon Twig) in the aforementioned soup, and add Hui Xiang (Foeniculum Fructus) stir-fried with Lian Zi Rou (Meliae Semen) each 5 fen.
Contemporary physicians treating various Qi disorders only seek treatment in the Spleen and Lung, neglecting the Kidney, hence efficacy is rare. The Moving Qi in the Kidney region is the root of the Five Zang and Six Fu organs, the source of the Twelve Meridians, the gate of respiration, and the origin of the San Jiao (Triple Burner). Excessive sexual activity or innate constitutional weakness leads to insufficiency of the Kidney Meridian; Qi loses its control, resulting in frequent stagnation and the generation of various diseases. (All Qi stagnations belong to the Lung. Qi provides warmth; if stagnant and unrelieved, Qi mechanism condenses, and Blood becomes obstructed, giving rise to various diseases. Thus, "all diseases arise from stagnation" is clear evidence.) Physicians believe they should regulate Qi, presenting Hou Po (Magnoliae Officinalis Cortex), Xiang Fu (Cyperi Rhizoma), Wu Yao (Linderae Radix), etc., yet Qi becomes even more difficult to regulate. Using dispersing and purging methods, administering drastic laxatives, results in more than half of patients dying. Subsequently, slightly more skilled physicians attribute the condition to Spleen deficiency failing to transport and transform essence, and thus focus on tonifying the Spleen. However, this merely prolongs life temporarily, often leading to delay and untreatable conditions. This is due to ignorance of the need to tonify the Kidney. One should primarily use Po Gu Zhi (Psoraleae Fructus), Hui Xiang Zi (Foeniculum Fructus), and Hu Lu Ba (Trigonellae Semens). Within Qi-regulating medicines, one must simultaneously use Blood-harmonizing medicines as assistants, for there is no case where Qi is stagnant but Blood is harmonious; if Blood is not harmonious, Qi becomes even more stagnant.