白术 白茯苓 白芍药(俱中) 人参(上) 生姜(三片) 大枣(二枚)
上煎法同前。脉沉足冷。加附子半个。
琥按上方。本系温补脾胃之剂。加附子。则兼暖下焦虚寒矣。吴氏云云。必其人不但服凉药太过。兼受攻克已极。
中气虚冷。故暂用热补以取效。因有伏火。余热不清。仍用黄连石膏等药调之。则知前加姜附。亦为太过。非正治之法
也。学人倘遇此等证。还当细审。不可乱投汤药也。
准绳云。阴黄。身冷汗出。脉沉而黄。乃太阴经中湿亦有体痛发热者。身如熏黄。终不如阳黄之明如橘子色也。当
叩其小便之利与不利。小便自利。术附汤。小便不利。大便反快者。五苓散。
略例云。伤寒病遇太阳太阴司天若下之太过。往往变成阴黄。一则寒水太过。水来犯土。一则土气不及。水来侵之。
多变此疾。一则茵陈茯苓汤。加当归桂枝。二则茵陈橘皮汤。加姜术半夏。三则茵陈附子汤。四则茵陈四逆汤。五则茵
陈姜附汤。六则茵陈吴茱萸汤。
赵宗颜因下之太过。生黄。脉沉细迟。无力。次第用药。至茵陈附子汤大效。
赵秀才因下之早。黄病脉寸微尺弱。身冷。次第用药。至茵陈四逆汤大效。
准绳按海藏次第用药者。谓先投茵陈茯苓汤。次投茵陈陈皮汤。又次投茵陈附子汤也。赵秀才次第仿此。
白术、白茯苓、白芍药(均选用中部药材)、人参(选用上部药材)、生姜(三片)、大枣(两枚)。
以上药物的煎煮方法同前文所述。若脉象沉细且足部发冷,加入半个附子。
琥按:上述方剂,原本是温补脾胃的药剂。加入附子后,便兼具温暖下焦虚寒的功效。吴氏说……必定是患者不仅服用凉药太过,而且攻伐克削已至极点。中气虚弱寒冷,所以暂时使用热性补益药物以取得疗效。因为体内有伏火,余热未清,仍需用黄连、石膏等药物来调理。由此可知,先前加入干姜、附子也是太过分了,这不是正治的方法。学习中医的人如果遇到这类证候,还应当仔细审察,不可胡乱投用汤药。
《医学准绳六要》说:阴黄,身体冷汗出,脉象沉而色黄,这是太阴经中的湿邪所致,也有身体疼痛、发热的情况。身体颜色像熏黄一样,终究不如阳黄那样明亮如橘子色。应当询问小便通利与否。若小便自利,用术附汤;若小便不利,大便反而通畅的,用五苓散。
《伤寒论略例》说:伤寒病遇到太阳、太阴司天之年,如果泻下太过,往往变成阴黄。一则是因为寒水之气太过,水来犯土;二则是土气不足,水来侵之。容易多变生此疾。一则用茵陈茯苓汤,加当归、桂枝;二则用茵陈橘皮汤,加干姜、白术、半夏;三则用茵陈附子汤;四则用茵陈四逆汤;五则用茵陈姜附汤;六则用茵陈吴茱萸汤。
赵宗颜因为泻下太过,生出黄疸,脉象沉细迟,无力。依次用药,到了茵陈附子汤时效果显著。
赵秀才因为泻下过早,患黄疸病,脉象寸微尺弱,身体发冷。依次用药,到了茵陈四逆汤时效果显著。
《医学准绳六要》按语:海藏所说的依次用药,是指先投茵陈茯苓汤,次投茵陈陈皮汤,又次投茵陈附子汤。赵秀才依次仿效这种做法。
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Bai Fu Ling (Poria), Bai Shao Yao (Paeoniae Radix Alba) (all selected from the middle part of the plant), Ren Shen (Ginseng Radix) (selected from the upper part), Sheng Jiang (Zingiberis Rhizoma Recens) (three slices), Da Zao (Jujubae Fructus) (two pieces).
The decoction method for the above ingredients is the same as described previously. If the pulse is deep and the feet are cold, add Ban Ge Fu Zi (half a prepared Aconiti Lateralis Radix Praeparata).
Hu notes: The aforementioned formula is originally a preparation to warm and tonify the Spleen and Stomach. By adding Fu Zi (Aconiti Lateralis Radix Praeparata), it also warms the deficiency-cold of the Lower Jiao. Wu stated... it must be that the patient not only took cooling medicines excessively but also underwent extreme purgative treatment. The Middle Qi is deficient and cold, so hot-tonifying medicines are temporarily used to achieve efficacy. Because there is latent fire and residual heat remains unclear, medicines such as Huang Lian (Coptidis Rhizoma) and Shi Gao (Gypsum Fibrosum) are still used to regulate it. Thus, it can be known that the previous addition of Gan Jiang (Zingiberis Rhizoma) and Fu Zi was excessive and not the correct method of treatment. Students encountering such syndromes should examine them carefully and not indiscriminately administer herbal decoctions.
*Zhun Sheng* states: Yin Jaundice presents with cold sweat on the body and a deep, yellowish pulse. This is dampness in the Taiyin Meridian, which may also present with body pain and fever. The body color resembles smoky yellow, ultimately not as bright as the orange-yellow color seen in Yang Jaundice. One should inquire about the freeness or obstruction of urination. If urination is free, use Shu Fu Tang (Atractylodes and Aconite Decoction); if urination is obstructed and the stool is loose, use Wu Ling San (Five-Ingredient Powder with Poria).
*Lue Li* states: In Shaoyang disease, if the year is governed by Taiyang or Taiyin, excessive purgation often transforms into Yin Jaundice. On one hand, Cold Water is excessive, and Water attacks Earth; on the other hand, Earth Qi is insufficient, and Water invades it. This condition frequently changes into this disease. First, use Yin Chen Fu Ling Tang (Yin Chen and Poria Decoction) with Dang Gui (Angelicae Sinensis Radix) and Gui Zhi (Cinnamomi Ramulus); second, use Yin Chen Ju Pi Tang (Yin Chen and Tangerine Peel Decoction) with Gan Jiang (Zingiberis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Ban Xia (Pinelliae Rhizoma); third, use Yin Chen Fu Zi Tang (Yin Chen and Aconite Decoction); fourth, use Yin Chen Si Ni Tang (Yin Chen and Four-Reversal Decoction); fifth, use Yin Chen Jiang Fu Tang (Yin Chen, Ginger, and Aconite Decoction); sixth, use Yin Chen Wu Zhu Yu Tang (Yin Chen and Evodia Decoction).
Zhao Zhongyan, due to excessive purgation, developed jaundice. The pulse was deep, fine, slow, and forceless. Medicines were administered sequentially, achieving great efficacy with Yin Chen Fu Zi Tang.
Scholar Zhao, due to premature purgation, suffered from jaundice. The pulse was faint at the Cun position and weak at the Chi position, with a cold body. Medicines were administered sequentially, achieving great efficacy with Yin Chen Si Ni Tang.
*Zhun Sheng* commentary: Hai Cang's mention of "sequential medication" refers to first administering Yin Chen Fu Ling Tang, then Yin Chen Chen Pi Tang, and subsequently Yin Chen Fu Zi Tang. Scholar Zhao followed this sequence.