治因服寒药过多以致脾胃虚损胃脘疼痛
人参 甘草 缩砂仁 浓朴(各二钱) 白豆蔻 姜黄 干生姜 泽泻(各三钱) 益智仁
(六钱) 黄 陈皮(各七钱)
上为粗末每服三钱水二盏生姜五片煎至一盏去相食前温服
易水张先生常戒不可峻利食药下咽未至药丸施化其标皮之力始开便言快也所伤之物已去
若更
待一两时辰许药尽化开其药峻利必有情性病去之后脾胃既损是真气元气败坏促人之寿当时设
下一药枳实一两麸炒黄色为度白术二两只此二味荷叶裹烧饭为丸以白术甘温甘温补脾胃之元
气其
苦味除胃中之湿热利腰脐间血故先补脾胃之弱过于枳实克化之药一倍枳实味苦寒泄心下之痞
闷
消化胃中所伤此一药下胃其所伤不能即去须侍一两时辰许食则消化是先补其虚而后化其所伤
则不峻利矣当是之时未悟用荷叶烧饭为丸之理老年味之始得可谓奇矣荷叶之物中央空象震卦
之体震者动也人感之生足少阳甲胆者风也生化万物之根蒂也内经云履端于始序则不愆人之饮
食入胃营气上行即少阳甲胆之气也其手少阳三焦经人之元气也手足经同法便是少阳元气生发
也胃气谷气元气甲胆上升之气一也异名虽多止是胃气上升者也荷叶之体生于水土之下出于
污秽之中不为所染挺然独立其色青形乃空青而象风木者也食药感此气之化胃气何由不上升乎
其主意用此一味为引用可谓远识深虑合于道者也更以烧饭和药与白术协力滋养谷气而补令胃
浓再不至内伤其利广矣大矣若内伤脾胃辛热之物酒肉之类自觉不快觅药于医医者亦不问所伤
敷之集香丸小丁香丸巴豆大热药之类下之大便下则物去遗留食之热性药之热性重伤元气则七
神不炽经云热伤气正谓此也其人必无气以动而热困四肢不举传变诸疾不可胜数使人真气自此
衰矣若伤生冷硬物世医或用大黄牵牛二味大寒药投之随药下所伤去矣遗留食之寒性药之寒性
重泻其阳阳去则皮肤筋肉血脉无所根据倚便为虚损之证论言及此令人寒心夫辛辣薄味之药无故
不可乱服非止牵牛而已至真要大论云五味入口各先逐其所喜攻攻者克伐泻也辛味下咽先攻泻
肺之五气气者真气元气也其牵牛之辛辣猛烈伤人尤甚饮食所伤肠胃邪当以苦泄其肠胃可也肺
与元气何罪之有用牵牛大罪有五此其一也况胃主血所生病为物所伤物者有形之物也皆是血病
泻其气其罪二也且饮食伤之于中焦止合克化消导其食重泻上焦肺中已虚之气其罪三也食伤肠
胃
当塞因塞用又曰塞因塞用枳实大黄苦寒之物以泄有形是也反以辛辣牵牛散泻真气大禁四也殊
不知针经有云外来客邪风寒伤人五脏若误泻胃气必死误补亦死其死也无气以动故静若内伤肠
胃而反泻五脏必死误补亦死其死也阴气有余故躁今内伤肠胃是谓六腑不足之病反泻上焦虚无
肺气肺者五脏之一数也虽不即死若更旬日之间必暗损人寿数谓如人寿应百岁为牵牛之类朝损
暮
损其元气消耗不得终其天年但人不觉耳将为天年已尽此乃暗里折人寿数大禁五也故特着此论
并方庶令四海闻而行之不至夭横耳此老夫之用心也胃气不可不养复明养胃之理内经云安谷者
昌
绝谷者亡水去则荣散谷消则卫亡荣散卫亡神无所根据仲景云水入于经其血乃成谷入于胃脉道乃
行
故血不可不养胃不可不温血养胃温荣卫将行常有天命谷者身之大柄也书与周礼皆云金木水火
土谷惟修以奉养五脏者也内伤饮食固非细事苟妄服食药而轻生殒命其可乎哉黄帝针经有说胃
恶热而喜清冷大肠恶清冷而喜热两者不和何以调之岐伯曰调此者食饮衣服亦欲适寒温寒无凄
怆暑无出汗饮食热无灼灼寒无凄凄寒温中适故气将持乃不致邪僻也是必有因用岂可用俱寒俱
热之药仓卒致损与以刃杀人者何异内经说内伤者其气口脉反大于人迎一倍二倍三倍分经用药
又曰
上部有脉下部无脉其人当吐不吐者死如但食不纳恶心欲吐者不问一倍二倍不当正与瓜蒂散
吐之但以指或以物探去之若所伤之物去不尽者更诊其脉问其所伤以食药去之以应塞因塞用又
谓又寒因寒用泄而下降乃应太阴之用其中更加升发之药令其元气上升塞因通用因曲而为直何
为曲内伤胃气是也何为直因而升发胃气是也因其饮食之内伤而使生气增益胃气完复此乃因曲
而为之直也若分经用药其所伤之物寒热温凉生硬柔软所伤不一难立定一法只随所伤之物不同
各立治法临时加减用之其用药又当问病患从来禀气盛衰所伤寒物热物是喜食而食之耶不可服
破气药若乘饥因而伤之耶当益胃气或为人所勉劝强食之宜损血而益气也诊其脉候伤在何脏可
与对病之药岂可妄泻天真元气以轻丧身宝乎且如先食热物而不伤继之以寒物因后食致前食亦
不消化而伤者当问热食寒食孰多孰少斟酌与药无不当矣喻如伤热物二分寒物一分则当用寒药
二分热药一分相合而与之则荣卫之气必得周流更有或先饮酒而后伤寒冷之食及伤热食冷水与
冰如此不等皆当验其节次所伤之物酌量寒热之剂分数各各对证与之无不取效自忖所定药方未
敢便谓能尽药性之理姑用指迷辩惑
治疗因服用寒凉药物过多而导致脾胃虚损、胃脘疼痛的方剂:
人参、甘草、缩砂仁、浓朴(各二钱),白豆蔻、姜黄、干生姜、泽泻(各三钱),益智仁(六钱),黄芪、陈皮(各七钱)。
以上药材捣成粗末,每次服用三钱,加水两盏,生姜五片,煎煮至一盏,滤去药渣,在进食前温服。
易水派的张先生经常告诫:不可使用峻猛利下的药物。服药后,药液尚未完全化开,其表面的药效力量刚刚显现,患者便说感觉畅快。此时,所伤之物虽然已去,但如果再等待一两个时辰,待药物完全化开,其峻猛的利下作用必然存在。这会导致情志性病邪去除后,脾胃已经受损,真气和元气败坏,缩短人的寿命。当时我设下一个方子:枳实一两(麸炒至黄色为度),白术二两。只用这两味药,用荷叶包裹烧饭制成丸药。因为白术味甘性温,甘温可以补益脾胃的元气;枳实味苦,能清除胃中的湿热,疏通腰脐间的血络。所以先补益脾胃的虚弱,其效力超过枳实克伐消化药物的两倍。枳实味苦寒,能泄除心下的痞闷,消化胃中所伤的食物。这一药下去,胃中所伤之物不能立即去除,必须等待一两个时辰,食物才能消化。这是先补其虚,而后化解其所伤,就不会峻猛利下了。当时我没有领悟使用荷叶烧饭制丸的道理,直到老年品味其中含义才有所得,可谓奇妙啊。荷叶这种植物,中央空灵,象征震卦的形体。震者,动也。人感受它而生出足少阳甲胆之气,甲胆属风,是生化万物的根蒂。《内经》说:“履端于始,序则不愆。”人的饮食入胃,营气上行,就是少阳甲胆之气。手少阳三焦经,是人体的元气。手足经脉同理,这就是少阳元气的生发。胃气、谷气、元气、甲胆上升之气,本质上是一回事,名称虽多,只是指胃气上升罢了。荷叶的形体,生于水土之下,出于污秽之中而不被污染,挺然独立,其色青,形状中空,象征风木。服用食药之人,感受这种气化,胃气怎么能不上升呢?主治思想使用这一味药作为引经药,可谓远见卓识,合乎大道。再用烧饭和药,与白术协力滋养谷气,并补益使胃气浓厚,不再导致内伤,其利益广大深远啊。如果内伤脾胃,食用辛辣之物、酒肉之类,自觉不快,找医生看病,医生也不问所伤之物,就敷上集香丸、小丁香丸、巴豆等大热药物来攻下。大便通下则物去,但遗留食物的热性和药物的热性会重伤元气,导致七神不炽。《内经》说:“热伤气”,正是说的这种情况。此人必定无气以动,而热困四肢,不能举动,传变诸疾不可胜数,使人真气从此衰败。如果损伤生冷硬物,世医有时用大黄、牵牛这两味大寒药物投服。随药而下,所伤之物虽去,但遗留食物的寒性和药物的寒性重泻其阳气。阳气离去,则皮肤、筋肉、血脉无所依附,便成为虚损之证。论述到此处,令人寒心。辛辣淡薄的药物,无故不可乱服,不仅仅是牵牛而已。《素问·至真要大论》说:“五味入口,各先归其所喜。”攻者,克伐泻也。辛味下咽,先攻泻肺的五气。气者,真气、元气也。牵牛的辛辣猛烈,伤人尤其严重。饮食所伤,肠胃邪气应当以苦味泄除肠胃即可。肺与元气有什么罪过?使用牵牛有大罪五条,这是其一。况且胃主血,所生病是因为物体所伤。物体是有形之物,都是血病。泻其气,这是其二。且饮食损伤在中焦,只适合克化消导其食,重泻上焦肺中已虚之气,这是其三。食伤肠胃,应当“塞因塞用”。又说“塞因塞用”,是指用枳实、大黄等苦寒之物以泄有形之邪。反而用辛辣的牵牛散泻真气,是大禁第四条。殊不知《针经》有云:“外来客邪风寒伤人五脏,若误泻胃气必死,误补亦死。其死也,无气以动故静。”若内伤肠胃而反泻五脏,必死,误补亦死。其死也,阴气有余故躁。如今内伤肠胃,这是六腑不足之病,反而泻上焦虚无的肺气。肺是五脏之一,虽不立即死亡,如果再经过旬日之间,必定暗中折损人的寿命。比如人寿应百岁,被牵牛之类药物朝损暮损,元气消耗,不得终其天年,只是人不觉察罢了,以为天年已尽,这乃是暗中折损人的寿命,是大禁第五条。所以特别撰写此论及方剂,希望让四海之人听闻并施行,不至于夭折横死。这是我的用心啊。胃气不可不养护,再次阐明养胃的道理。《内经》说:“安谷者昌,绝谷者亡。水去则荣散,谷消则卫亡。荣散卫亡,神无所根据。”张仲景说:“水入于经,其血乃成;谷入于胃,脉道乃行。”所以血不可不养,胃不可不温。血养胃,温荣卫,将行常有天命。谷,是身体的大柄。《尚书》与《周礼》都说:“金木水火土,谷惟修,以奉养五脏者也。”内伤饮食固非小事,如果妄服食药而轻生殒命,可以吗?《黄帝针经》有说:胃恶热而喜清冷,大肠恶清冷而喜热。两者不和,何以调之?岐伯曰:“调此者,食饮衣服,亦欲适寒温。寒无凄怆,暑无出汗。饮食热无灼灼,寒无凄凄。寒温中适,故气将持,乃不致邪僻也。”这必定是有原因的,岂可用俱寒俱热的药物仓促造成损害?这与用刀刃杀人有什么区别?《内经》说内伤者,其气口脉反大于人迎一倍、二倍、三倍,分经用药。又说:“上部有脉,下部无脉,其人当吐,不吐者死。”如但食不纳,恶心欲吐者,不问一倍二倍,不当正与瓜蒂散吐之,但以指或以物探去之。若所伤之物去不尽者,更诊其脉,问其所伤,以食药去之,以应“塞因塞用”。又谓“寒因寒用”,泄而下降,乃应太阴之用。其中更加升发之药,令其元气上升。“塞因通用”,因曲而为直。何为曲?内伤胃气是也。何为直?因而升发胃气是也。因其饮食之内伤而使生气增益,胃气完复,此乃因曲而为之直也。若分经用药,其所伤之物寒热温凉、生硬柔软,所伤不一,难立定一法,只随所伤之物不同,各立治法,临时加减用之。其用药又当问病患从来禀气盛衰,所伤寒物热物,是喜食而食之耶?不可服破气药。若乘饥因而伤之耶?当益胃气。或为人所勉劝强食之,宜损血而益气也。诊其脉候,伤在何脏,可与对病之药,岂可妄泻天真元气以轻丧身宝乎?且如先食热物而不伤,继之以寒物,因后食致前食亦不消化而伤者,当问热食寒食孰多孰少,斟酌与药,无不当矣。喻如伤热物二分,寒物一分,则当用寒药二分,热药一分,相合而与之,则荣卫之气必得周流。更有或先饮酒而后伤寒冷之食,及伤热食冷水与冰,如此不等,皆当验其节次所伤之物,酌量寒热之剂分数,各各对证与之,无不取效。自忖所定药方,未敢便谓能尽药性之理,姑用指迷辩惑。
Treatment for spleen and stomach deficiency damage and epigastric pain caused by excessive intake of cold-natured medicines:
Renshen (Ginseng Radix), Gancao (Licorice Root), Suosharen (Amomi Fructus), Nongpo (Magnoliae Officinalis Cortex) (each 2 qian), Baidoukou (Cardamomi Fructus), Jianghuang (Curcumae Longae Rhizoma), Ganshengjiang (Zingiberis Rhizoma Recens), Zexie (Alismatis Rhizoma) (each 3 qian), Yizhiren (Alpiniae Oxyphyllae Semen) (6 qian), Huangqi (Astragali Membranacei Radix), Chenpi (Citri Reticulatae Pericarpium) (each 7 qian).
The above herbs are ground into a coarse powder. Each dose is 3 qian, boiled with two zhan of water and five slices of fresh ginger until reduced to one zhan. Strain the dregs and take warm before meals.
Mr. Zhang from the Yishui School often warned against using harsh purgative medicines. After swallowing the medicine, before it has fully dissolved, its superficial efficacy just begins to act, and the patient says they feel relieved. At this moment, although the injured food has been expelled, if one waits another one or two hours for the medicine to fully dissolve, its harsh purgative effect will inevitably manifest. This will cause the pathogenic factors of emotional nature to be removed, but the spleen and stomach will already be damaged, leading to the deterioration of True Qi (Zhen Qi) and Yuan Qi (Primordial Qi), shortening the person's lifespan. At that time, I prescribed a formula: Zhishi (Immature Bitter Orange Fruit) 1 liang (stir-fried with bran until yellow), Baizhu (Atractylodis Macrocephalae Rhizoma) 2 liang. Only these two herbs were used, wrapped in lotus leaves and mixed with cooked rice to form pills. Because Baizhu is sweet and warm; sweet and warm can tonify the primordial Qi of the spleen and stomach. Zhishi is bitter; it can clear damp-heat in the stomach and promote blood circulation in the waist and umbilical region. Therefore, first tonify the weakness of the spleen and stomach; its efficacy exceeds that of Zhishi's attacking and digesting properties by double. Zhishi is bitter and cold; it can drain the fullness and oppression in the heart region and digest the food injured in the stomach. When this medicine is taken, the injured food in the stomach cannot be removed immediately; one must wait one or two hours for the food to digest. This is first tonifying the deficiency, then resolving the injury, so it will not be harshly purgative. At that time, I did not understand the principle of using lotus leaves and cooked rice to form pills. It was only when I reflected on it in old age that I grasped it, which can be called wonderful. The lotus leaf grows below the water and soil, emerges from filth without being stained, stands tall and independent, is green in color, and hollow in shape, symbolizing the Wind-Wood element. For those who have ingested harmful substances, feeling this qi transformation, how can the Stomach Qi not ascend? Using this single herb as a guiding agent shows profound foresight and harmony with the Dao. Furthermore, mixing it with cooked rice cooperates with Baizhu to nourish Gu Qi (Grain Qi) and tonify the Stomach Qi to prevent internal injury, bringing great benefits. If there is internal injury to the spleen and stomach from spicy foods, alcohol, or meat, and one feels uncomfortable, seeking medical help, doctors often do not ask about the specific injury but apply Ji Xiang Wan (Collection of Fragrant Pills), Xiao Dingxiang Wan (Small Clove Pills), or large amounts of hot medicines like Badou (Croton Seed) to purge. Although the food is expelled through bowel movements, the residual heat of the food and the heat of the medicine severely damage the Yuan Qi, causing the Seven Spirits (Shen Hun Po Yi Zhi Yi) to become weak. The *Neijing* states: "Heat injures Qi," which refers precisely to this. Such a person will certainly lack Qi to move, suffer from heat trapping the limbs, inability to raise them, and countless transmitted diseases, causing their True Qi to decline from this point. If injured by raw, cold, or hard foods, some physicians use Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen), two large cold medicines. The injured food is expelled with the medicine, but the residual cold of the food and the cold of the medicine heavily purge Yang Qi. With Yang Qi gone, the skin, muscles, tendons, and blood vessels lose their foundation, resulting in deficiency and damage syndromes. Discussing this makes one shudder. Spicy and bland medicines should not be taken indiscriminately without cause, not just Qianniu. The *Suwen: Zhizhen Yao Lun* states: "When the five flavors enter the mouth, they first go to their preferred organs." Attacking means overcoming and purging. When pungent flavor enters, it first attacks and purges the Five Qi of the Lung. Qi refers to True Qi and Yuan Qi. The pungency and ferocity of Qianniu harm people especially severely. For injuries caused by diet, the pathogenic factors in the intestines and stomach should be drained using bitter flavors to benefit the intestines and stomach. What crime have the Lung and Yuan Qi committed? Using Qianniu has five major sins, this is the first. Moreover, the Stomach governs Blood, and diseases caused by foreign objects involve有形 (tangible) matter, which are all Blood disorders. Purging Qi is the second sin. Furthermore, dietary injuries occur in the Middle Jiao; it is appropriate to overcome, transform, and guide the food. Heavily purging the already deficient Qi of the Upper Jiao Lung is the third sin. Food injuring the intestines and stomach should be treated with "treating obstruction with obstruction" (Sai Yin Sai Yong). It is also said "treating obstruction with obstruction," referring to using bitter-cold substances like Zhishi and Dahuang to drain tangible pathogens. Instead, using pungent Qianniu to scatter and purge True Qi is a major prohibition, the fourth sin. One fails to realize that the *Zhenjing* states: "When external guest pathogens like wind and cold injure the five zang organs, mistakenly purging Stomach Qi leads to death; mistakenly tonifying also leads to death. Death occurs because there is no Qi to move, hence stillness." If internal injury to the intestines and stomach is treated by purging the five zang organs, it leads to death; mistakenly tonifying also leads to death. Death occurs because Yin Qi is in excess, hence restlessness. Now, internal injury to the intestines and stomach is a disease of insufficiency of the six fu organs, yet we mistakenly purge the empty Lung Qi of the Upper Jiao. The Lung is one of the five zang organs. Although death may not be immediate, within ten days, it will secretly shorten the person's lifespan. For example, if a person's natural lifespan should be one hundred years, daily damage from Qianniu consumes Yuan Qi, preventing them from completing their natural years, though people are unaware, thinking their time has come. This is secretly shortening the human lifespan, a major prohibition, the fifth sin. Therefore, I specially wrote this treatise and prescription, hoping that people everywhere will hear and practice it, avoiding premature death. This is my intention. Stomach Qi must not fail to be nurtured; let us reclarify the principle of nurturing the Stomach. The *Neijing* states: "Those who can digest grain prosper; those who cannot digest grain perish. When water goes, Ying Qi (Nutritive Qi) scatters; when grain disappears, Wei Qi (Defensive Qi) perishes. When Ying and Wei Qi scatter and perish, Shen (Spirit) has no basis." Zhang Zhongjing stated: "When water enters the meridians, blood is formed; when grain enters the stomach, the pulse channels flow." Therefore, blood must not fail to be nourished, and the Stomach must not fail to be warmed. Blood nourishes the Stomach; warming Ying and Wei Qi ensures their proper movement, aligning with Heavenly Mandate. Grain is the great handle of the body. Both the *Shangshu* and *Zhouli* state: "Metal, Wood, Water, Fire, Earth, Grain is cultivated to nourish the five zang organs." Internal injury from diet is indeed no small matter; recklessly taking medicines and endangering life—is this acceptable? The *Huangdi Zhenjing* says: The Stomach dislikes heat and likes coolness; the Large Intestine dislikes coolness and likes heat. When the two are discordant, how to regulate them? Qibo said: "To regulate this, food, drink, clothing, and living conditions should also suit the cold and heat. Do not be chilling in the cold; do not sweat excessively in the heat. Food and drink should not be scorching hot nor chillingly cold. Cold and heat should be moderate, so Qi will be maintained, and evil deviations will not arise." This must have reasons; how can one use uniformly cold or hot medicines hastily causing damage? How is this different from killing someone with a blade? The *Neijing* states that for internal injuries, the Qi Kou pulse is larger than the Ren Ying pulse by one, two, or three times; prescribe according to the meridian. It also says: "If there is pulse in the upper part but none in the lower part, the person should vomit; if they do not vomit, they die." If they eat but do not accept it, feel nauseous and want to vomit, regardless of whether the pulse difference is one or two times, do not directly give Guiti San (Melon Twig Powder) to induce vomiting; instead, use fingers or objects to stimulate vomiting. If the injured food is not completely expelled, re-examine the pulse, ask about the injury, and use food or medicine to remove it, responding to "treating obstruction with obstruction." Also referred to as "treating cold with cold," draining and descending corresponds to the function of Taiyin. Add ascending and dispersing herbs to make Yuan Qi ascend. "Treating obstruction universally," turning the crooked into straight. What is crooked? Internal injury to Stomach Qi. What is straight? Ascending and dispersing Stomach Qi accordingly. Due to internal injury from diet, Sheng Qi (Vital Qi) increases, and Stomach Qi recovers completely; this is turning the crooked into straight. If prescribing by meridian, the injured substances vary in cold, heat, warmth, coolness, hardness, and softness, making it difficult to establish a fixed method. One should establish different treatment methods based on the specific injury and adjust temporarily. When prescribing, one must ask about the patient's innate constitution strength or weakness, whether the cold or hot food was consumed due to preference, and avoid Qi-breaking medicines. Was it consumed while hungry? Then tonify Stomach Qi. Was it forced by others? Then reduce Blood and tonify Qi. Examine the pulse to determine which zang organ is injured and prescribe corresponding medicines. How can one recklessly purge Tianzhen Yuan Qi (Innate Primordial Qi) and lightly sacrifice the treasure of the body? For example, if one eats hot food without injury, followed by cold food, causing the previous food to not digest due to the latter, one should ask which was more abundant, hot or cold food, and carefully prescribe medication accordingly. For instance, if injured by two parts hot food and one part cold food, use two parts cold medicine and one part hot medicine, combined and given, so that Ying and Wei Qi will surely circulate. Similarly, if one drinks alcohol first and then injures themselves with cold food, or eats hot food with cold water or ice, such cases should be verified by the sequence of injury, and the proportions of cold and hot agents should be measured and prescribed correspondingly, achieving effectiveness without exception. Regarding the prescriptions I have determined, I dare not claim to fully understand the principles of drug properties; I merely use this to guide the lost and resolve confusion.