宣明人参白术散,治遍身燥湿相搏,玄府致密,遂致忪悸,发渴,饮食减少,不为肌肤
。方
以人参、甘草,甘以益虚也;生地黄润以滋燥;石膏、黄芩、滑石,寒以除热也;白术、茯
苓,燥以除湿也。而意特在湿热,故白术、滑石、石膏数独多焉。其用参、地、甘草者,热
积则真气消,湿聚则坚燥生也。尤妙在薄荷、藿香以行表气,缩砂仁以行里气,表里气通,
而后温可行,热可去,此画龙点睛法也。白术汤方论,与此略同,学人宜究心焉。
风劳骨蒸,久而咳嗽吐血,脉来弦数者,柴胡梅连散主之。盖邪气既久积于表里之间而
不退,非
可一汗而去者,故用柴胡之辛散,必兼乌梅之酸收;而久积之风内蕴骨髓者,已变风之体而
为
热,则宜用胡黄连之苦寒以清之。然兵无向导则不达贼境,药无引使则不通病所。新病且然
,况伏邪乎?故胆以合胆,髓以合骨,薤白之通阳,童便之通怕,而表里肌骨之邪,庶尽出
欤!
罗氏秦艽鳖甲散,与柴胡梅连同意,亦治风劳骨蒸肌热之症。然减前胡之泄气,而加当
归
之和血,去黄连之苦寒,而用青蒿之辛凉,气味为较和矣。久病之人,未必不宜缓法也。
阳虚者,气多陷而不举,故补中益气多用参、 、术、草,甘温益气,而以升、柴辛平
助以
上升;阴虚者,气每上而不下,故六味地黄丸多用熟地、萸肉、山药,味浓体重者,补阴益
精
,而以茯苓、泽泻之甘淡助之下降。气陷者多滞,陈皮之辛所以和滞气;气浮者多热,牡丹
之寒所以清浮热。然六味之有苓、泽,犹补中之有升、柴也;补中之有陈皮,犹六味之有丹
皮也。其参、 、归、术、甘草,犹地黄、茱萸、山药也。法虽不同而理可通也。
宣明人参白术散,用于治疗遍身燥湿相搏(全身燥邪与湿邪相互纠结),玄府致密(汗孔闭塞不通),从而导致心悸忡动、口渴、饮食减少、身体消瘦不丰。方中用人参、甘草,是利用其甘味来补益虚损;生地黄利用其润性来滋养燥邪;石膏、黄芩、滑石利用其寒性来清除热邪;白术、茯苓利用其燥性来祛除湿邪。而本方的用意特别侧重于湿热,所以白术、滑石、石膏的用量独多。使用人参、生地黄、甘草的原因在于:热邪积聚则真气消耗,湿邪聚积则导致坚结和燥生。尤其巧妙之处在于用薄荷、藿香来运行表气,用缩砂仁来运行里气,表里之气通畅后,温阳可行,热邪可去,这是画龙点睛之法。白术汤方论,与此大致相同,学习的人应当深入研究。
风劳骨蒸(因风邪久留导致的虚劳发热,状如骨蒸),日久出现咳嗽吐血,脉象弦数的,以柴胡梅连散主治。因为邪气既已长久积聚在表里之间而不退散,不是通过一次发汗就能去除的,所以用柴胡的辛散之性,必须兼用乌梅的酸收之性;而长久积聚的风邪内蕴于骨髓,已经改变了风的本体而化为热,则适宜用胡黄连的苦寒之性来清解它。然而,军队没有向导就不能到达贼寇境内,药物没有引经报使就不能通达病所。新病尚且如此,何况是潜伏的邪气呢?所以用胆(此处指代引药入胆或相关配伍逻辑,原文“胆以合胆”疑为衍文或特定语境下的引经说法,通常指引药入胆经或类似逻辑,结合下文“髓以合骨”,意指引药直达病所)配合胆经,髓配合骨,薤白的通阳作用,童便的通淋(原文“通怕”应为“通淋”或“通窍”之误,结合语境及童便功效,此处译为通利或引导下行)作用,使得表里肌骨的邪气,差不多都能排出体外!
罗氏秦艽鳖甲散,与柴胡梅连散的立意相同,也是治疗风劳骨蒸肌肉发热的症状。然而减去前胡的泄气作用,而加入当归的和血作用,去掉黄连的苦寒性质,而改用青蒿的辛凉性质,药性气味较为平和了。久病之人,未必不适合缓治的方法。
阳气虚弱的人,气机多下陷而不能升举,所以补中益气汤多用党参、白术、甘草,利用甘温之性来补益元气,并用升麻、柴胡的辛平之性辅助上升;阴液亏虚的人,气机往往上逆而不能下行,所以六味地黄丸多用熟地黄、山茱萸、山药等味道浓厚、质地沉重的药物,来补益阴精,并用茯苓、泽泻的甘淡之性辅助下降。气陷的人多有阻滞,陈皮辛散所以能调和滞气;气浮的人多有热象,牡丹皮寒凉所以能清解浮热。然而六味地黄丸中有茯苓、泽泻,就像补中益气汤中有升麻、柴胡一样;补中益气汤中有陈皮,就像六味地黄丸中有牡丹皮一样。其中的党参、白术、当归、甘草,就像熟地黄、山茱萸、山药一样。虽然治法不同,但医理是相通的。
Xuanming Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Decoction of Xuanming) is used to treat conditions where dryness and dampness struggle against each other throughout the body, causing the Xuanku (pores/sweat orifices) to become dense and closed. This leads to palpitations (Xiongji), thirst, reduced appetite, and emaciation. The formula uses Ginseng and Licorice for their sweet nature to tonify deficiency; Rehmannia Root for its moistening nature to nourish dryness; Gypsum, Scutellaria Root, and Talcum for their cold nature to clear heat; Atractylodes Macrocephala Rhizome and Poria for their drying nature to remove dampness. The specific intent lies in addressing damp-heat; therefore, the dosages of Atractylodes Macrocephala Rhizome, Talcum, and Gypsum are particularly high. The use of Ginseng, Rehmannia Root, and Licorice is because accumulated heat consumes true Qi, and accumulated dampness generates hardness and dryness. What is especially ingenious is the use of Mint and Patchouli to circulate exterior Qi, and Amomum Fruit to circulate interior Qi. Once the Qi of the interior and exterior is unblocked, warmth can be promoted, and heat can be eliminated; this is the "finishing touch" method. The discussion on the Baizhu Tang (Atractylodes Macrocephala Decoction) is similar to this; students should study it carefully.
For wind-lao (wind-related consumptive disease) with bone-steaming fever, accompanied by chronic cough and hemoptysis, and a wiry and rapid pulse, Chaihu Meilian San (Bupleurum, Sour Plum, and Coptis Powder) is the primary treatment. Since pathogenic factors have long been accumulated between the exterior and interior without receding, they cannot be expelled by a single sweating therapy. Therefore, the acrid-dispersing nature of Bupleurum must be combined with the sour-astringent nature of Sour Plum. Furthermore, wind that has long been accumulated and harbored within the marrow has transformed from the nature of wind into heat; thus, the bitter-cold nature of Picrorhiza Rhizome (Huhuanglian) is suitable for clearing it. However, just as an army without a guide cannot reach the enemy's territory, medicine without guiding herbs cannot reach the site of the disease. This applies even to new diseases, let alone latent pathogens. Therefore, using Gallbladder-targeting agents to harmonize the Gallbladder, and marrow-targeting agents to harmonize the bones, along with the Yang-unblocking property of Shallot Stalk and the downward-guiding property of Child's Urine, allows the pathogens in the exterior, interior, muscles, and bones to be largely expelled!
Luo Shi Qinjiao Biejia San (Qin Jiao and Turtle Shell Decoction by Master Luo) shares the same intent as Chaihu Meilian San and is also used to treat symptoms of wind-lao, bone-steaming fever, and muscular heat. However, it reduces the Qi-draining effect of Peucedanum Root, adds Angelica Sinensis Root to harmonize blood, removes the bitter-cold Coptis Rhizome, and uses Artemisia Annua for its acrid-cool nature, resulting in a milder flavor and nature. For patients with chronic illness, a gentle treatment method may well be appropriate.
In cases of Yang deficiency, Qi tends to sink and fail to rise; therefore, Buzhong Yiqi Tang (Decoction to Tonify the Middle and Augment the Qi) uses Codonopsis, Atractylodes Macrocephala Rhizome, and Licorice, employing sweet-warm properties to tonify Qi, while using Cimicifuga Rhizome and Bupleurum Root (with acrid-ping properties) to assist in ascending. In cases of Yin deficiency, Qi often floats upward and fails to descend; therefore, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) uses cooked Rehmannia Root, Cornus Fruit, and Chinese Yam—substances with rich flavors and heavy weights—to tonify Yin and benefit essence, while using Alisma Rhizome and Alisma Fruit (with sweet-bland properties) to assist in descending. Those with sinking Qi often experience stagnation; the acrid nature of Tangerine Peel helps harmonize stagnant Qi. Those with floating Qi often have heat; the cold nature of Moutan Bark helps clear floating heat. Thus, the presence of Alisma Rhizome and Alisma Fruit in Liuwei Dihuang Wan is analogous to the presence of Cimicifuga Rhizome and Bupleurum Root in Buzhong Yiqi Tang; the presence of Tangerine Peel in Buzhong Yiqi Tang is analogous to the presence of Moutan Bark in Liuwei Dihuang Wan. The Codonopsis, Atractylodes Macrocephala Rhizome, Angelica Sinensis Root, and Licorice in Buzhong Yiqi Tang correspond to the Rehmannia Root, Cornus Fruit, and Chinese Yam in Liuwei Dihuang Wan. Although the methods differ, the underlying principles are interconnected.