大黄(二两) 黄连(一两) 上二味,以麻沸汤二升渍之,须臾,绞去渣,分温再服。此又法之最奇者,不
取煎而取泡,欲其轻扬清淡,以涤上焦之邪。
脉浮而紧,而复下之,紧反入里,则作痞,紧脉为阴,此所谓病发于阴,下之作痞是也。按之自濡,
但气痞耳。并无胁下之水。心下痞,按之濡,其脉关上浮者,邪气甚高。大黄黄连泻心汤主之。
伤寒大下后,复发汗,再误。心下痞。恶寒者,表未解也,不可攻痞,当先解表,表解乃可攻痞。解
表宜桂枝汤;攻痞宜大黄黄连泻心汤。详见前桂枝类中。
大黄(二两,酒浸) 黄连(炒) 黄芩(炒,各一两) 附子(一两,去皮别煮取汁) 上四味,切三味,以麻
沸汤二升渍之,须臾,绞去渣,纳附子汁,分温再服。此法更精,附子用煎,三味用泡,扶阳欲其熟而性重;开
痞欲其生而性轻也。
心下痞,而复恶寒汗出者,附子泻心汤主之。此条不过二语,而妙理无穷,前条发汗之后恶寒,则
用桂枝;此条汗出恶寒,则用附子,盖发汗之后,汗已止而犹恶寒,乃表邪未尽,故先用桂枝,以去表邪,
此恶寒而仍汗出,则亡阳在即,故加入附子以回阳气,又彼先后分二方,此并一方者,何也?盖彼有表,
复有里;此则只有里病,故有分有合也。
大黄(二两)黄连(一两)以上两味药,用滚开的沸水二升浸泡它们,片刻之后,滤去药渣,分两次温服。这是方法中最奇特的地方,不采用煎煮而采用浸泡,想要药性轻扬清淡,以清除上焦的邪气。
脉象浮而紧,如果误用攻下法,紧脉反而入里,就会形成痞证。紧脉属阴,这就是所说的病发于阴经,误用下法导致痞证的情况。按压时感觉柔软,只是气机阻滞形成的痞证罢了。并没有胁下的停水。心下部痞满,按压时柔软,关部脉象浮的,说明邪气位置很高。应用大黄黄连泻心汤主治。
伤寒经过猛烈攻下后,又再次发汗,这是再次误治。出现心下部痞满。如果有恶寒症状,说明表证未解,不可直接攻逐痞证,应当先解除表证,表证解除后才能攻逐痞证。解除表证适宜用桂枝汤;攻逐痞证适宜用大黄黄连泻心汤。详细内容见前文桂枝类方中。
大黄(二两,酒浸)黄连(炒制)黄芩(炒制,各一两)附子(一两,去皮另煮取汁液)以上四味药,将大黄、黄连、黄芩三味切碎,用滚开的沸水二升浸泡它们,片刻之后,滤去药渣,加入附子的汁液,分两次温服。这种方法更加精妙,附子采用煎煮,其余三味采用浸泡,扶持阳气希望其药性熟透而厚重;开通痞结希望其药性生发而轻清。
心下部痞满,并且伴有恶寒、汗出的症状,应用附子泻心汤主治。这一条仅用两句话,但蕴含无穷妙理。前一条在发汗之后出现恶寒,所以用桂枝汤;这一条出现汗出且恶寒,所以用附子。因为发汗之后,汗已停止但仍然恶寒,是表邪未尽,所以先用桂枝汤去除表邪;这一条恶寒而且仍然汗出,则是阳气即将亡失,所以加入附子来回复阳气。另外,前一种情况是分两个方剂先后使用,这一种情况是合在一个方剂中使用,为什么呢?因为前一种情况既有表证又有里证;这一种情况只有里证,所以有分有合。
Da Huang (2 liang) and Huang Lian (1 liang). Take the above two herbs, soak them in 2 sheng of boiling water (Ma Fei Tang), wait for a moment, strain off the dregs, and divide into two doses to be taken warm. This is the most unique method: not decocting but soaking, intending to keep the medicinal properties light and clear, thereby purging the pathogenic factors from the Upper Jiao (Upper Burner).
If the pulse is floating and tight, and a purgative method is mistakenly applied, the tight pulse enters the interior, resulting in Pi syndrome (epigastric fullness and obstruction). The tight pulse belongs to Yin; this is what is referred to as "disease originating from Yin," where applying purgatives leads to Pi. Upon palpation, it feels soft; this is merely Qi Pi (Qi stagnation Pi). There is no fluid retention under the hypochondrium. When there is epigastric fullness, palpation reveals softness, and the Guan position pulse is floating, the pathogenic factor is located very high. Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium) should be used.
After severe purgation in Shanghan (Cold Damage), followed by another sweating treatment, this constitutes a second error. The patient presents with epigastric fullness. If there is aversion to cold, the exterior pattern has not yet resolved; one must not attack the Pi directly. One should first resolve the exterior, and only after the exterior is resolved can one attack the Pi. To resolve the exterior, Gui Zhi Tang (Cinnamon Twig Decoction) is suitable; to attack the Pi, Da Huang Huang Lian Xie Xin Tang (Rhubarb and Coptis Decoction to Drain the Epigastrium) is suitable. See details in the preceding Gui Zhi category.
Da Huang (2 liang, soaked in wine), Huang Lian (stir-fried), Huang Qin (Bupleuri Radix, stir-fried, each 1 liang), Fu Zi (Aconiti Lateralis Radix Praeparata, 1 liang, skin removed and separately decocted to extract juice). Take the above four herbs. Cut the three herbs (Da Huang, Huang Lian, Huang Qin), soak them in 2 sheng of boiling water, wait for a moment, strain off the dregs, add the Fu Zi juice, and divide into two doses to be taken warm. This method is even more refined: Fu Zi is decocted, while the other three are soaked. To support Yang, we desire the properties to be cooked and heavy; to open Pi, we desire the properties to be raw and light.
When there is epigastric fullness accompanied by aversion to cold and sweating, Fu Zi Xie Xin Tang (Aconite Decoction to Drain the Epigastrium) should be used. This clause contains only two sentences but holds infinite profound principles. In the previous clause, aversion to cold appeared after sweating, so Gui Zhi Tang was used; in this clause, sweating and aversion to cold appear together, so Fu Zi is used. After sweating, if sweating has stopped but aversion to cold persists, it indicates that exterior pathogens remain, hence Gui Zhi Tang is used first to expel exterior pathogens. Here, aversion to cold persists with continued sweating, indicating imminent collapse of Yang, hence Fu Zi is added to restore Yang qi. Furthermore, why were two separate formulas used sequentially in the former case, while they are combined into one formula here? Because in the former case, there were both exterior and interior patterns; in this case, there is only an interior pattern. Thus, there is separation and combination.