薄荷(一两) 葛根 人参 甘草(炙各半两) 防风(去芦二两)
上 咀。每服五钱。水一盏。煎至七分。去滓。热服。如三五服。寸脉力尚小。加薄荷二分。
琥按上方。亦足阳明手太阴发表之的剂。气虚人病风寒者。乃可服之。否则人参一味。勿轻用也。又前方后云。
寸脉力小加枣。此方则加薄荷者。何也。盖前方中辛药居多。故用大枣之甘以助之。此方中有人参。力大于枣。且辛药
又少。故又加薄荷二分。使辛甘相合。而成发散之功。
(一名连翘饮子)治伤寒表不解。半入于里。下证未全。下后燥热。怫结于内。烦心懊 。不得眠。脏腑积热。头
昏唇焦。咽燥喉闭。目赤。烦渴。口舌生疮。咳唾稠粘。谵语狂妄。肠胃燥涩。便溺秘结。风热壅滞等证。
连翘(一两) 山栀子 大黄 薄荷叶 黄芩(各半两) 甘草(一两半) 芒硝(一分)
上为末。每服二三钱。水一盏。蜜少许。(直格云。或无蜜亦可。旧用竹叶。或亦不须。)煎至七分。去滓。温服。
准绳云。加黄连五钱。名清心汤。
琥按上方。乃治内外三焦气血实热之剂。散名凉膈者。以胃居于膈。实清涤胃府风热壅滞之方也。又上主疗云。
表不解。乃表之而邪热不解。非表证仍在也。学人宜以意会之。
治伤寒杂病。内外所伤日数远近腹满咽干。烦渴谵妄。心下按之硬痛。小便赤涩。大便结滞。热甚喘咳闷乱惊狂等
证。脉数沉实者。并皆治之。
大黄(锦文者) 芒硝 浓朴(去皮) 枳实(各半两) 甘草(一两准绳方中甘草止五钱。四味皆一两)
上锉。如麻豆大。水一盏半。生姜三片。煎至七分。内硝煎一二沸。去滓。温服。
王宇泰云。此汤治伤寒大承气汤证。腹满实痛。调胃承气证。谵语下利。小承气汤证。内热不便三者合而为一。
此下剂也。
琥按云。岐子保命集云。凡治伤寒。发表有浅深。攻里有微甚。承气攻里。立法有三。大承气者。浓朴苦温去痞。
枳实苦寒泄满。芒硝咸寒而能软坚。大黄苦寒。能泄实。痞满燥实四证全。则可用。故曰大承气汤。小承气者。大黄苦
寒泄实。浓朴苦温去痞。痞实两全。可用也。故曰小承气汤。按此段。少枳实泄满句。调胃承气者。大黄苦寒泄实。芒
硝咸寒而能软坚。润燥。甘草甘平和其中。燥实坚三证全者。可用。故曰调胃承气汤。攻里之不同若此。又按王海藏。
此事难知云。假令调胃承气证。用大承气下之。则愈后元气不复。以其气药犯之也。大承气证。用调胃承气下之。则愈
后神痴不清。以其气药无之也。小承气证。若用芒硝下之。则或下利不止。变而成虚矣。三汤之不可乱投又若此。今宣
明方合而为一。犹曰此俱系泻阳明胃府实热之药。只须学人临证增损用之。不致大误。至陶氏杀车槌方。复加柴胡黄芩
芍药。改名六一顺气汤。而云用此以代三承气。及大柴胡。大陷胸等汤之神药。以致后医罔顾病患上中下三焦气血虚实。
一概合用。其流祸至今更甚。不亦悲夫。
薄荷(一两) 葛根 人参 炙甘草(各半两) 防风(去芦头二两)
以上药材切碎。每次服用五钱。用水一盏。煎煮至七分满。滤去药渣。趁热服用。如果服用三到五次后,寸脉力度仍然微弱,增加薄荷二分。
王琥按:上述方剂,也是治疗足阳明经和手太阴经表证的对症良方。只有气虚之人感受风寒时,才可以服用。否则,人参一味药,不要轻易使用。另外前一方后面说:“寸脉力小加枣”,此方则加薄荷,为什么呢?大概因为前一方中辛散药物居多,所以用大枣的甘味来辅助它;此方中有人参,力量大于大枣,且辛散药物又少,所以又加薄荷二分,使辛味与甘味相合,从而形成发散的功效。
(又名连翘饮子)治疗伤寒表证未解,邪气一半传入里部,下法指征尚未完全具备。攻下后出现燥热,郁结于体内,心烦懊恼,无法入睡。脏腑积热,头晕,嘴唇焦枯,咽喉干燥闭塞,眼睛发红,烦躁口渴,口舌生疮,咳嗽吐痰稠厚粘腻,胡言乱语,狂妄躁动,肠胃干燥涩滞,大小便秘结,风热壅滞等证候。
连翘(一两) 山栀子 大黄 薄荷叶 黄芩(各半两) 甘草(一两半) 芒硝(一分)
以上药材研为细末。每次服用二三钱。用水一盏,蜂蜜少许。(直格说,或者没有蜂蜜也可以。旧方用竹叶,或许也不需要。)煎煮至七分满,滤去药渣,温服。
准绳说,加入黄连五钱,名为清心汤。
王琥按:上述方剂,是治疗内外三焦气血实热的方剂。命名为“凉膈”,是因为胃位于膈下,这是清除涤荡胃腑风热壅滞的方剂。另外上述主治中说:“表不解”,是指经过发汗治疗后邪热仍未解除,并非表证仍然存在。学者应当用心领会其中的意旨。
治疗伤寒及杂病,因内外损伤时日远近导致的腹满咽干,烦躁口渴,胡言乱语,妄动,心下部按压时硬痛,小便赤红涩滞,大便结滞不通,热势严重导致气喘咳嗽,胸闷烦乱,惊悸狂躁等证候。脉象数而沉实的,都予以治疗。
大黄(选用锦文者) 芒硝 浓朴(去皮) 枳实(各半两) 甘草(一两,准绳方中甘草仅五钱,其余四味皆为一两)
以上药材锉碎,如麻豆大小。用水一盏半,生姜三片,煎煮至七分满。纳入芒硝,再煎一二沸,滤去药渣,温服。
王宇泰说:此汤治疗伤寒大承气汤证(腹满实痛)、调胃承气汤证(谵语下利)、小承气汤证(内热不便),将三者合而为一。这是攻下的方剂。
王琥按:岐伯之子《保命集》说:凡是治疗伤寒,发表有浅深之分,攻里有微甚之别。承气汤攻里,立法有三条。大承气汤:浓朴苦温以去除痞满,枳实苦寒以泄除胀满,芒硝咸寒而能软坚散结,大黄苦寒能泄除实热。痞、满、燥、实四证俱全,才可以使用,所以叫做大承气汤。小承气汤:大黄苦寒泄除实热,浓朴苦温去除痞满。痞证和实证两者俱全,可以使用,所以叫做小承气汤。按这段文字,缺少了“枳实泄满”一句。调胃承气汤:大黄苦寒泄除实热,芒硝咸寒而能软坚润燥,甘草甘平调和其中。燥、实、坚三证俱全者,可以使用,所以叫做调胃承气汤。攻里的方法不同竟至于如此。又按王海藏《此事难知》说:假如调胃承气汤证,却用大承气汤攻下,那么痊愈后元气不能恢复,因为使用了行气药侵犯了正气。大承气汤证,如果用调胃承气汤攻下,那么痊愈后神志痴呆不清,因为缺乏行气药。小承气汤证,如果使用芒硝攻下,那么可能导致腹泻不止,变证而成虚证。这三首汤剂不可乱投,竟至于如此。现在宣明方将它们合而为一,还说这些都是泻除阳明胃腑实热的药物,只需学者临证时增减使用,不至于造成大的误治。至于陶氏的杀车槌方,又加入柴胡、黄芩、芍药,改名为六一顺气汤,并声称用此方代替三承气汤以及大柴胡汤、大陷胸汤等神效药物,导致后世医生不顾病患上中下三焦气血的虚实,一概混合使用,其流弊造成的祸患至今更加严重,不也是可悲吗?
Bohe (Herba Menthae, one tael) Gegen (Radix Puerariae), Renshen (Radix Ginseng), Zhigancao (Radix Glycyrrhizae Preparata, each half tael), Fangfeng (Radix Saposhnikoviae, de-radicle two taels).
Crush the above herbs. Take five qian per dose. Add one zhan of water. Decoct until seven-tenths remains. Remove the dregs. Take hot. If after three to five doses the Cun pulse (pulse position at the wrist representing the upper jiao and exterior) is still weak, add Bohe (Herba Menthae) two fen.
Wang Hu notes: The above formula is also an accurate prescription for releasing the exterior of the Foot-Yangming and Hand-Taiyin meridians. It can only be taken by persons with Qi deficiency suffering from Wind-Cold. Otherwise, do not lightly use Renshen (Radix Ginseng). Furthermore, the previous formula states: "If the Cun pulse is weak, add Jujube." Why does this formula add Bohe (Herba Menthae)? Presumably because the previous formula contains mostly acrid drugs, so it uses the sweet nature of Dazao (Fructus Ziziphi Jujubae) to assist them. This formula contains Renshen (Radix Ginseng), which has greater strength than Jujube, and fewer acrid drugs; therefore, Bohe (Herba Menthae) two fen is added again, allowing acrid and sweet flavors to combine, thereby achieving the effect of dispersing and releasing.
(Also known as Lianqiao Yinzi) Treats Shanghan (Cold Damage) where the exterior is not resolved, half of the pathogenic factor has entered the interior, and the indications for purgation are not yet fully present. After purgation, dryness-heat arises and stagnates internally, causing vexation and restlessness (Fanxin Aonao), inability to sleep. Accumulated heat in the Zang-Fu organs, dizziness, chapped lips, dry throat with obstruction, red eyes, vexation and thirst, sores on the mouth and tongue, cough with thick sticky sputum, delirium and madness, dryness and astringency of the intestines and stomach, constipation of stool and urine, stagnation of Wind-Heat, etc.
Lianqiao (Fructus Forsythiae, one tael), Shanzhizi (Semen Gardenolia, half tael), Dahuang (Radix et Rhizoma Rhei, half tael), Boheye (Folium Menthae, half tael), Huangqin (Radix Scutellariae, half tael), Gancao (Radix Glycyrrhizae, one and a half taels), Mangxiao (Natrii Sulfas, one fen).
Pulverize the above herbs. Take two or three qian per dose. Add one zhan of water and a little honey. (Zhige says, honey may be omitted. Old formulas used Zhuye (Folium Bambusae), perhaps it is also unnecessary.) Decoct until seven-tenths remains. Remove the dregs. Take warm.
Zhunsheng states: Add Huanglian (Rhizoma Coptidis) five qian, named Qingxin Tang (Clear Heart Decoction).
Wang Hu notes: The above formula is a preparation for treating excess heat in the Qi and Blood of the internal and external Sanjiao (Triple Burner). It is named Liangge (Cooling the Diaphragm) because the Stomach resides below the diaphragm; it is a formula to clear and wash away Wind-Heat stagnation in the Stomach Fu organ. Furthermore, the aforementioned indications state: "Exterior not resolved," meaning that after sweating treatment, the pathogenic heat is not resolved, not that the exterior syndrome still exists. Scholars should comprehend this through their own understanding.
Treats Shanghan (Cold Damage) and miscellaneous diseases, abdominal fullness and dry throat caused by internal or external injury over varying durations, vexation and thirst, delirium and madness, hardness and pain upon pressing the epigastrium (Xinxia), dark and scanty urination, constipation, severe heat leading to panting and cough, chest oppression, mental confusion, fright, and mania. For those with a rapid and deep-solid pulse, all these conditions are treated.
Dahuang (Radix et Rhizoma Rhei, select those with brocade patterns), Mangxiao (Natrii Sulfas), Houpo (Cortex Magnoliae Officinalis, bark removed), Zhishi (Fructus Aurantii Immaturus, each half tael), Gancao (Radix Glycyrrhizae, one tael; Zhunsheng formula uses only five qian of Gancao, while the other four ingredients are one tael each).
Cut the herbs into pieces the size of hemp seeds. Add one and a half zhan of water and three slices of Shengjiang (Rhizoma Zingiberis Recens). Decoct until seven-tenths remains. Add Mangxiao (Natrii Sulfas) and boil for one or two boils. Remove the dregs. Take warm.
Wang Yutai says: This decoction treats the syndromes of Dachengqi Tang (abdominal fullness, solid pain), Tiaowei Chengqi Tang (delirium with diarrhea), and Xiao Chengqi Tang (internal heat with difficulty in defecation), combining them into one. This is a purgative formula.
Wang Hu notes: Qibo's son's *Baoming Ji* states: In treating Shanghan (Cold Damage), releasing the exterior has degrees of depth, and attacking the interior has degrees of severity. The Chengqi formulas attack the interior with three legislations. Dachengqi Tang: Houpo (Cortex Magnoliae Officinalis) is bitter and warm to remove palpitations/fullness; Zhishi (Fructus Aurantii Immaturus) is bitter and cold to drain distension; Mangxiao (Natrii Sulfas) is salty and cold to soften hardness; Dahuang (Radix et Rhizoma Rhei) is bitter and cold to drain excess. When Pi (palpitations), Man (distension), Zao (dryness), and Shi (excess) are all complete, it can be used; hence it is called Dachengqi Tang. Xiao Chengqi Tang: Dahuang (Radix et Rhizoma Rhei) is bitter and cold to drain excess; Houpo (Cortex Magnoliae Officinalis) is bitter and warm to remove palpitations. When Pi (palpitations) and Shi (excess) are both complete, it can be used; hence it is called Xiao Chengqi Tang. Regarding this passage, the phrase "Zhishi drains distension" is missing. Tiaowei Chengqi Tang: Dahuang (Radix et Rhizoma Rhei) is bitter and cold to drain excess; Mangxiao (Natrii Sulfas) is salty and cold to soften hardness and moisten dryness; Gancao (Radix Glycyrrhizae) is sweet and neutral to harmonize the middle. When Zao (dryness), Shi (excess), and Jian (hardness) are all complete, it can be used; hence it is called Tiaowei Chengqi Tang. The methods of attacking the interior differ thus. Furthermore, Wang Haicang's *Ci Shi Nan Zhi* states: Suppose a Tiaowei Chengqi Tang syndrome is treated with Dachengqi Tang; then post-recovery vitality will not recover because the Qi-moving drugs have attacked it. A Dachengqi Tang syndrome treated with Tiaowei Chengqi Tang will result in post-recovery mental dullness because the Qi-moving drugs are absent. A Xiao Chengqi Tang syndrome treated with Mangxiao (Natrii Sulfas) may lead to incessant diarrhea, transforming into deficiency. The prohibition against indiscriminately administering these three decoctions is such. Now, the Xuanming Formula combines them into one, stating they are all drugs that purge excess heat from the Yangming Stomach Fu organ, and scholars should adjust them according to clinical presentation to avoid major errors. As for Tao's Shechechui Formula, adding Chaihu (Radix Bupleuri), Huangqin (Radix Scutellariae), and Shaoyao (Radix Paeoniae Alba), renamed Liuyi Shunqi Tang, and claiming it replaces the divine drugs of the three Chengqi Tangs as well as Dachaihu Tang and Da Xiexiong Tang, causes later physicians to disregard the deficiency and excess of Qi and Blood in the Upper, Middle, and Lower Jiao, using them indiscriminately. The resulting disasters are even more severe today; is this not tragic?