甘露饮 治胃热善食,不生肌肉。
生地 熟地 天冬 麦冬 片苓 石斛 甘草 枇杷叶 枳壳 茵陈(各等分
水煎服三钱。
理中汤(见心腹痛
建中汤
芍药(六钱) 桂枝(三钱) 甘草(二钱) 生姜(三钱) 饴糖(一合) 大枣(四枚
上六味,以水三杯,煮取一杯,去滓,纳饴糖,更上微火消解,温服,日三服。
茵陈蒿汤 治阳明病,发热汗出,此为热越不能发黄也,但头汗出,身无汗,剂颈而还
,小便不利,渴欲饮水浆者,此为瘀热在里,身必发黄,此方主之。
茵陈蒿(六钱) 栀子(三钱) 大黄(二钱,去皮
上三味,以水三杯,先煮茵陈,减一杯半,纳二味,煎八分,去滓,温服,日三服。小
盒饭利,尿如皂角汁状,色正赤,一宿腹减,黄从小便去也。
栀子柏皮汤 治伤寒,身发黄发热。
栀子(三钱) 甘草(一钱) 黄柏(二钱
上三味,以水二杯半,煎八分服,日再。
理中汤 通脉四逆汤加猪胆汁(见《伤寒论》
五苓散 治霍乱吐泻而渴者,太阳症悉具,口渴呕逆,小便不通等症,水肿症借用颇验
。
泽泻(二两) 白术 茯苓 猪苓(各一两) 桂枝(七钱
共为末,以米饮调下三钱,多饮暖水以出汗。今人作小剂,水煎服。
胃苓散(见泄泻
圣术煎 治脾虚作胀,及久患吐泻等症。
白术(微炒,一两) 陈皮(二钱) 干姜(三钱) 肉桂(二钱
水煎服。虚甚,加附子。
白术补脾,脾得补则善运,善运则食消而胀去。欲其运多于补,则生用;欲其补多于运
则熟用。凡药生则行速,熟则行缓,自然之理也。若炒焦,则全失其本性,反令损脾增胀。
陈皮达结气于外,干姜祛寒气于中,肉桂化太阳之气于下。下焦气化,而上中二焦之气亦治
,此景岳新方中之第一方也。
连理丸 治腹胀如箕,时吐酸水者,又治久泻如神。
人参 白术 干姜 川连(各二两) 炙草(一两
蜜丸,每服三钱,米汤送下,日两服。
喻嘉言云∶“酸水时吐时生,为单腹膨胀,及心、胸、腹、胁俱痛,不用八味地黄丸,
为柔中之刚,而用此丸为刚中之柔,取其大苦大辛,能变胃而不为胃变也。”愚按∶以白术
易苍术,其力更大。
桂甘姜枣麻辛附子汤 治气分,心下坚大能如盘,边如旋杯。
桂枝 生姜(各三钱) 炙草 麻黄 细辛(各二钱) 附子(一钱) 大枣(四枚)
水三杯二分,先煮麻黄至二杯二分,去沫,入诸药,煎八分温服,日夜三服,汗出如虫
行皮中即愈。
此症是心肾交病,上不能降,下不能升,日积月累,如铁石难破。方中桂枝、甘草、生
姜、大枣以和其上;而复用麻黄、附子、细辛少阴的剂,以治其下;庶上下交通而病愈,所
谓大气一转,其结乃散也。
枳术汤 治心下坚大如盘,(边如旋盘,而不如旋杯,邪尚散漫未结,虽坚大而不满痛也
,水饮所作(《金匮》特提水饮,所以别于气分也。
枳实(二钱) 白术(四钱
水煎服,日三服,腹中 即当散也。言水饮所以别于气分也,气无形以辛甘散之,水有
形以苦泄之,方中取白术之温以健运,枳实之寒以消导,意深哉。胃为阳,阳常有余;脾为
阴,阴常不足;胃强脾弱,则阳与阴绝矣。脾不能为胃行其津液,则水饮作矣。方中用术以
补脾,用枳以抑胃,脏腑分理,所以治水饮之原易,老逞其庸浅之见,变汤为丸,只认为一
补一消之法,学人切勿述此陋语,为有识者笑。
四七汤 胀而属七情所致者,宜此汤主之。
半夏 茯苓(各三钱) 浓朴(二钱) 苏叶(一钱) 生姜(三片
水煎服。
此方妙在紫苏叶一味以散结,香以醒脾,而顺气消胀行水乃其余事。
甘露饮:治疗胃热导致食欲旺盛,但肌肉不生长的病症。
生地、熟地、天冬、麦冬、黄芩(片苓)、石斛、甘草、枇杷叶、枳壳、茵陈(各等分)。
用水煎服,每次三钱。
理中汤(参见心腹痛章节)
建中汤
芍药(六钱) 桂枝(三钱) 甘草(二钱) 生姜(三钱) 饴糖(一合) 大枣(四枚)
以上六味药,用水三杯,煮取一杯,滤去药渣,加入饴糖,再用微火加热使其溶解,温服,每日三次。
茵陈蒿汤:治疗阳明病,发热出汗,这是热邪外越,不会发黄;但如果仅头部出汗,身体无汗,汗水只到颈部为止,小便不利,想喝水浆,这是瘀热在体内,身体一定会发黄,此方主治。
茵陈蒿(六钱) 栀子(三钱) 大黄(二钱,去皮)
以上三味药,用水三杯,先煮茵陈,水量减少一杯半,再加入另外两味药,煎至八分,滤去药渣,温服,每日三次。小便利,尿色像皂角汁一样红赤,过一夜腹部减轻,黄色从小便排出。
栀子柏皮汤:治疗伤寒,身体发黄且发热。
栀子(三钱) 甘草(一钱) 黄柏(二钱)
以上三味药,用水二杯半,煎至八分服用,每日两次。
五苓散:治疗霍乱吐泻且口渴的病症,具备太阳病的所有症状,如口渴、呕吐逆气、小便不通等症,水肿症借用此方颇为有效。
泽泻(二两) 白术、茯苓、猪苓(各一两) 桂枝(七钱)
共研为末,用米汤调服三钱,多喝暖水以出汗。现在的人用小剂量,用水煎服。
圣术煎:治疗脾虚引起的腹胀,以及长期患有吐泻等症状。
白术(微炒,一两) 陈皮(二钱) 干姜(三钱) 肉桂(二钱)
用水煎服。如果虚损严重,加附子。
白术补脾,脾得到补益则运化功能良好,运化良好则食物消化而胀满消除。想要其运化作用多于补益作用,则生用白术;想要其补益作用多于运化作用,则熟用白术。凡是药物,生用时行效迅速,熟用时行效缓慢,这是自然之理。如果炒焦,则完全失去其本性,反而损伤脾脏增加胀满。
陈皮向外疏导郁结之气,干姜在中焦祛除寒气,肉桂在下焦化生太阳之气。下焦气化正常,上焦和中焦的气机也随之调理,这是张景岳新方中的第一方。
连理丸:治疗腹胀大如箕状,时常吐出酸水的病症,又治疗久泻效果神奇。
人参、白术、干姜、川连(各二两) 炙甘草(一两)
蜜制为丸,每次服用三钱,用米汤送下,每日两次。
喻嘉言说:“酸水时吐时生,是单腹膨胀,以及心、胸、腹、胁部都疼痛,不用八味地黄丸作为柔中之刚,而用此丸作为刚中之柔,取其大苦大辛,能改变胃的状态而不被胃所改变。”我按语:用白术代替苍术,其力量更大。
桂甘姜枣麻辛附子汤:治疗气分病,心下坚硬大如盘,边缘像旋转的杯子。
桂枝、生姜(各三钱) 炙甘草、麻黄、细辛(各二钱) 附子(一钱) 大枣(四枚)
水三杯二分,先煮麻黄至二杯二分,去掉浮沫,加入其他药物,煎至八分,温服,日夜三次,汗出感觉像虫子在皮肤中爬行即痊愈。
此症是心和肾同时患病,上部不能下降,下部不能上升,日积月累,像铁石一样难以攻破。方中桂枝、甘草、生姜、大枣来调和上部;又用麻黄、附子、细辛针对少阴病的剂量,来治疗下部;这样上下交通而病愈,所谓大气一转,其结乃散。
枳术汤:治疗心下坚硬大如盘,(边缘像旋转的盘子,而不是旋转的杯子,邪气尚散漫未凝结,虽然坚硬大但不满痛,这是水饮所作(《金匮要略》特别提出水饮,所以区别于气分病)。
枳实(二钱) 白术(四钱)
用水煎服,每日三次,腹中肠鸣即当消散。说水饮所以区别于气分病,气无形用辛甘药发散它,水有形用苦泄药攻下它,方中取白术的温性以健运脾胃,枳实的寒性以消导积滞,用意深远啊。胃属阳,阳气常有余;脾属阴,阴气常不足;胃强脾弱,则阴阳隔绝了。脾不能为胃输送津液,则水饮产生。方中用白术补脾,用枳实抑制胃气,脏腑分理,所以治疗水饮的根源容易。那些老朽逞其庸浅之见,将汤剂改为丸剂,只认为是一补一消的方法,学人切勿沿袭这种陋语,被有识之士嘲笑。
四七汤:胀满属于七情所致者,宜用此汤主治。
半夏、茯苓(各三钱) 浓朴(二钱) 苏叶(一钱) 生姜(三片)
用水煎服。
此方妙在紫苏叶一味药以散结,香气以醒脾,而顺气消胀行水只是其余的事。
Ganlu Yin (Sweet Dew Decoction): Treats Stomach Heat with excessive appetite but failure to build muscle tissue.
Shengdi Huang (Rehmanniae Radix), Shudi Huang (Rehmanniae Radix Preparata), Tiandong (Asparagi Rhizoma), Maidong (Ophiopogonis Radix), Pianling (Scutellariae Radix, i.e., Huangqin), Shihu (Dendrobii Caulis), Gancao (Glycyrrhizae Radix et Rhizoma), Pipaye (Loquat Leaf), Zhike (Aurantii Fructus Immaturus), Yichen (Artemisiae Scopariae Herba) (equal parts).
Decoct in water and take 3 qian per dose.
Lizhong Tang (Cinnamon Twig and Ginger Decoction) (see section on Heart and Abdominal Pain)
Jianzhong Tang (Acupuncture Point: Jianzhong is not a formula name here, likely referring to Guizhi Jia Huangqi Tang or similar variations in context, but literally "Establish Middle Decoction")
Shaoyao (Paeoniae Radix Alba) (6 qian), Guizhi (Cinnamomi Ramulus) (3 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (2 qian), Shengjiang (Zingiberis Rhizoma Recens) (3 qian), Yitang (Maltose), Dazao (Jujubae Fructus) (4 pieces).
Take the above six ingredients, add three cups of water, boil to obtain one cup, remove dregs, add Yitang, heat gently over low fire until dissolved, take warm, three times daily.
Yinchen Hao Tang (Artemisia Scoparia and Soybean Decoction): Treats Yangming Disease with fever and sweating; this indicates heat dispersing outward, so jaundice will not occur. However, if there is only sweating on the head, no sweating on the body, stopping at the neck, dysuria, and thirst for fluids, this indicates stagnant heat inside the interior, leading to jaundice; this formula governs it.
Yinchen Hao (Artemisiae Scopariae Herba) (6 qian), Zhizi (Gardeniae Fructus) (3 qian), Dahuang (Rhei Radix et Rhizoma) (2 qian, peeled).
Take the above three ingredients, add three cups of water, first decoct Yinchen Hao until the volume reduces by one and a half cups, then add the other two ingredients, decoct to eight-tenths strength, remove dregs, take warm, three times daily. When urine flows freely, appearing dark red like soapberry juice, after one night the abdomen will reduce, and the yellow pigment will exit via the urine.
Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction): Treats Cold Damage with jaundice and fever.
Zhizi (Gardeniae Fructus) (3 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (1 qian), Huangbai (Phellodendri Cortex) (2 qian).
Take the above three ingredients, add two and a half cups of water, decoct to eight-tenths strength, take twice daily.
Lizhong Tang Tongmai Sini Tang plus Porcine Bile (see *Shanghan Lun*)
Wuling San (Five-Ingredient Powder with Poria): Treats Huoluan (Cholera-like syndrome) with vomiting, diarrhea, and thirst; presents all symptoms of Taiyang Disease, such as thirst, vomiting, dysuria, etc.; borrowed for Edema (Water Swelling) with good efficacy.
Zexie (Alismatis Rhizoma) (2 liang), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Zhuling (Polypori Umbellati Mycelium) (each 1 liang), Guizhi (Cinnamomi Ramulus) (7 qian).
Grind into powder, mix with rice drink and take 3 qian; drink plenty of warm water to induce sweating. Modern practitioners use small doses, decocted in water.
Weiling San (Stomach and Cinnamon Powder) (see section on Diarrhea)
Shengzhu Jian (Sage Atractylodes Decoction): Treats abdominal distension due to Spleen Deficiency, and chronic vomiting and diarrhea.
Baizhu (Atractylodis Macrocephalae Rhizoma) (lightly stir-fried, 1 liang), Chenpi (Citri Reticulatae Pericarpium) (2 qian), Ganjiang (Zingiberis Rhizoma) (3 qian), Rougui (Cinnamomi Cortex) (2 qian).
Decoct in water and take. If deficiency is severe, add Fuzi (Aconiti Lateralis Radix Preparata).
Baizhu tonifies the Spleen; when the Spleen is tonified, its transportation function improves, digestion occurs, and distension resolves. To emphasize transportation over tonification, use raw Baizhu; to emphasize tonification over transportation, use prepared Baizhu. Generally, herbs act quickly when raw and slowly when processed/cooked; this is natural law. If charred, they lose their nature and damage the Spleen, increasing distension.
Chenpi directs stagnant Qi outward; Ganjiang dispels cold from the middle Jiao; Rougui transforms Taiyang Qi in the lower Jiao. When lower Jiao Qi transformation functions, Qi in the upper and middle Jiao is also regulated. This is the premier formula among Zhang Jingyue's new prescriptions.
Lianli Wan (Lotus Root and Licorice Pill): Treats abdominal distension large as a basket with occasional regurgitation of sour fluid; also treats chronic diarrhea with miraculous effect.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Zingiberis Rhizoma), Chuanlian (Coptidis Rhizoma) (each 2 liang), Zhi Cao (Honey-processed Glycyrrhizae Radix et Rhizoma) (1 liang).
Make pills with honey, take 3 qian per dose, swallow with rice soup, twice daily.
Yu Jiayan said: "Sour fluid appearing intermittently indicates single-abdomen distension, and pain in the heart, chest, abdomen, and hypochondrium. Do not use Bawei Dihuang Wan as 'soft within hard,' but use this pill as 'hard within soft,' utilizing its great bitterness and pungency to transform the Stomach without being transformed by it." I note: Substituting Baizhu for Cangzhu increases potency.
Guigan Jiangzao Maxinfu Zi Tang (Cinnamon Twig, Licorice, Ginger, Jujube, Ephedra, Asarum, and Prepared Aconite Decoction): Treats Qi Division disease, hardness and fullness below the heart large as a plate, with edges like a rotating cup.
Guizhi (Cinnamomi Ramulus), Shengjiang (Zingiberis Rhizoma Recens) (each 3 qian), Zhi Cao (Honey-processed Glycyrrhizae Radix et Rhizoma), Mahuang (Ephedrae Herba), Xixin (Asari Radix et Rhizoma) (each 2 qian), Fuzi (Aconiti Lateralis Radix Preparata) (1 qian), Dazao (Jujubae Fructus) (4 pieces).
Add three cups and two fen of water, first decoct Mahuang to two cups and two fen, remove foam, add other herbs, decoct to eight-tenths strength, take warm, three times day and night. Recovery occurs when sweat feels like insects crawling under the skin.
This condition involves simultaneous pathology of the Heart and Kidney; Upper Qi cannot descend, Lower Qi cannot ascend. Accumulating over time, it becomes as hard to break as iron or stone. In the formula, Guizhi, Gancao, Shengjiang, and Dazao harmonize the Upper; additionally, Mahuang, Fuzi, and Xixin are used in dosages targeting Shaoyin to treat the Lower. Thus, Upper and Lower communicate, and the disease resolves, as stated: "When the Great Qi rotates, the stagnation dissipates."
Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction): Treats hardness and fullness below the heart large as a plate (edges like a rotating plate, not a cup; pathogenic factors are scattered and not yet condensed; though hard and large, there is no fullness or pain; caused by Fluid Retention (*Jinkui* specifically highlights Fluid Retention to distinguish from Qi Division disease).
Zhishi (Aurantii Fructus Immaturus) (2 qian), Baizhu (Atractylodis Macrocephalae Rhizoma) (4 qian).
Decoct in water and take, three times daily. Intestinal sounds in the abdomen indicate dissipation. The distinction between Fluid Retention and Qi Division is that Qi is formless and dispersed by acrid-sweet herbs, while Fluids have form and are drained by bitter-purgative herbs. The formula uses the warmth of Baizhu to strengthen transportation and the cold nature of Zhishi to guide out stagnation; the intent is profound. The Stomach is Yang, often in excess; the Spleen is Yin, often deficient. Strong Stomach and weak Spleen lead to separation of Yin and Yang. If the Spleen cannot transport fluids for the Stomach, Fluid Retention arises. Using Baizhu to tonify the Spleen and Zhishi to subdue the Stomach separates the organs' functions, making it easier to address the root of Fluid Retention. Old practitioners with shallow views changed the decoction to pills, viewing it merely as a combination of tonification and purgation. Students must not repeat this vulgar error and be laughed at by experts.
Siqi Tang (Four-Seven Decoction): For distension caused by Seven Emotions, this formula should be used.
Banxia (Pinelliae Rhizoma), Fuling (Poria) (each 3 qian), Houpo (Magnoliae Officinalis Cortex) (2 qian), Zisu Ye (Perillae Leaf) (1 qian), Shengjiang (Zingiberis Rhizoma Recens) (3 slices).
Decoct in water and take.
The brilliance of this formula lies in the single herb Zisu Ye to scatter nodules and awaken the Spleen with its aroma; regulating Qi, reducing distension, and promoting diuresis are secondary effects.