归脾汤兼补心脾,而意专治脾。观于甘温补养药中,而加木香醒脾行气,可以见矣。龙
眼、
远志,虽曰补火,实以培土。盖欲使心火下通脾土,而脾益治,五脏受气以其所生也,故曰
归脾。
凤髓丹为太阴湿热下注,少阴遗浊者设。黄柏苦能燥湿,寒能除热,故以为君,湿热易
成壅
滞,砂仁之辛香可以利之;脾邪不独伤肾,亦且自伤,炙甘草之甘温可以益之。然诸治湿热
药不用,而独取黄柏、砂仁者,以其气味兼通少阴也。
上气有热者,麻杏甘石汤;无热者,小投杯汤,盖即麻杏甘石而以桂心易石膏。同一通
肺下气,而寒温易用,法斯备矣。
清暑益气汤,盖谓其人元气本虚,而又伤于暑湿,脾得湿而不行,肺得暑而不肃,以致
四肢
倦怠,精神短少,懒于动作,胸气短促,不思饮食,脉浮缓而迟者设。故用人参、黄 、白
术、甘草、归身,甘温气味,以补中益气;苍术、黄柏、泽泻,以除湿热;升麻、葛根,以
除客热;而肺喜清肃,得热则烦,故以麦冬、五味清而收之;脾喜疏通,得湿则壅,故以炒
曲
、青皮、陈皮温而行之。此正治脾肺气虚而受暑湿,若体实脉盛,或虽虚而不甚,及津
涸烦渴多火者,则不可混投也。清燥汤亦治长夏湿热蒸人,气体困倦,腰足痿软之症,故比
清暑益气多黄连、茯苓、猪苓、柴胡,无泽泻、葛根、青皮,则清利之力差多,疏滞之力差
少。是名清燥,清以降逆,燥以胜湿也。
归脾汤兼具补益心脾的作用,但其用意专门在于治疗脾脏。从甘温补养的方药中加入木香以醒脾行气,就可以看出这一点。龙眼肉、远志,虽然说是补心火(此处指补益心阴/心血以制心火),实际上是为了培补脾土。大概是想让心火下通于脾土,从而使脾脏功能更加健全,因为五脏之气是相生传递的,所以称为“归脾”。
凤髓丹是为太阴脾经湿热下注、少阴肾经遗精滑浊的病证而设立的。黄柏味苦能燥湿,性寒能清热,所以作为君药;湿热容易形成壅滞,砂仁的辛香之性可以疏通它;脾脏的病邪不仅会伤害肾脏,也会自我损伤,炙甘草的甘温之性可以补益它。然而治疗湿热的药物众多,却独取黄柏和砂仁,是因为它们的气味能够兼通少阴肾经。
上焦有热气的,用麻杏甘石汤;没有热气的,少量投予杯汤,这其实就是麻杏甘石汤,只是用桂心替换了石膏。同样是通肺降气的方法,但寒温用药易于区分,治法这就完备了。
清暑益气汤,大概是针对那些元气本来虚弱,又受到暑湿伤害的人所设立的。脾脏得到湿气则运化不行,肺脏得到暑气则肃降失职,从而导致四肢倦怠,精神短少,懒得动作,胸中气短急促,不想饮食,脉象浮缓而迟。所以用人参、黄芪、白术、甘草、当归身,利用其甘温的气味,来补中益气;用苍术、黄柏、泽泻,来清除湿热;用升麻、葛根,来清除客热;而肺脏喜欢清肃,受热则烦躁,所以用麦冬、五味子来清润收敛;脾脏喜欢疏通,受湿则壅滞,所以用炒神曲、青皮、陈皮来温通行气。这是正治脾肺气虚而感受暑湿的方法,如果体质壮实脉象盛大,或者虽然虚弱但不严重,以及津液枯竭、烦躁口渴火旺的人,则不可以混用投服。清燥汤也是治疗长夏季节湿热熏蒸人体,导致身体困倦,腰足痿软的症状,所以比清暑益气汤多了黄连、茯苓、猪苓、柴胡,少了泽泻、葛根、青皮,那么清利的作用就差不多,疏滞的力量也差不多。之所以名叫清燥,是用“清”来降逆,用“燥”来胜湿。
Gui Pi Tang (Restore the Spleen Decoction) simultaneously tonifies both the Heart and the Spleen, but its intention is specifically to treat the Spleen. This can be seen from the addition of Xiang Guo (Aucklandiae Radix) to awaken the Spleen and move Qi within the sweet-warm nourishing herbs. Long Yan Rou (Longan Aril) and Yuan Zhi (Polygalae Radix), although said to tonify Fire (here referring to tonifying Heart Yin/Blood to control Heart Fire), are in reality used to cultivate Earth (Spleen). The idea is likely to allow Heart Fire to descend and communicate with Spleen Earth, thereby enhancing Spleen function; since the Qi of the Five Zang organs is transmitted through mutual generation, it is called "Gui Pi" (Returning to the Spleen).
Feng Sui Dan (Phoenix Marrow Pill) is prescribed for conditions where Damp-Heat of the Taiyin Spleen channel pours downward, accompanied by turbid discharge or spermatorrhea due to Shaoyin Kidney deficiency. Huang Bo (Phellodendri Cortex) is bitter and can dry Dampness, cold and can eliminate Heat, thus serving as the Sovereign herb. Damp-Heat easily becomes stagnant; the pungent and aromatic nature of Sha Ren (Amomi Fructus Rotundus) can facilitate its movement. Pathogenic factors of the Spleen not only injure the Kidney but also self-injure; Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) is sweet and warm and can benefit them. However, among various herbs treating Damp-Heat, only Huang Bo and Sha Ren are selected because their flavors and aromas can penetrate the Shaoyin Kidney channel.
For upper Jiao Heat, Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is used; for cases without Heat, Bei Tang (Cup Decoction) is administered in small doses. Bei Tang is essentially Ma Xing Gan Shi Tang with Gui Xin (Cinnamomi Ramulus Cortex) substituting Shi Gao (Gypsum Fibrosum). Both methods unblock the Lung and direct Qi downward, distinguishing clearly between Cold and Warm treatments, thus making the therapeutic methods complete.
Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction) is designed for individuals whose Original Qi is inherently deficient and who have been injured by Summerheat-Dampness. When the Spleen encounters Dampness, its transport fails; when the Lung encounters Summerheat, its descending function is impaired. This leads to fatigue in the four limbs, shortness of spirit, reluctance to move, shortness of breath in the chest, loss of appetite, and a floating, slow, and moderate pulse. Therefore, Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao (Licorice Root), and Dang Gui Shen (Angelicae Sinensis Radix Radicula) are used for their sweet-warm properties to tonify the Middle and boost Qi; Cang Zhu (Atractylodis Rhizoma), Huang Bo (Phellodendri Cortex), and Ze Xie (Alismatis Rhizoma) are used to eliminate Damp-Heat; Sheng Ma (Cimicifugae Rhizoma) and Ge Gen (Puerariae Lobatae Radix) are used to clear exogenous Heat. Since the Lung prefers clarity and desiccation and becomes irritable when heated, Mai Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Fructus) are used to clear and astringe. Since the Spleen prefers smooth flow and becomes obstructed by Dampness, Chao Qu (Fermented Wheat Mass), Qing Pi (Citri Reticulatae Pericarpium Viride), and Chen Pi (Citri Reticulatae Pericarpium) are used to warm and promote movement. This is the standard treatment for Spleen-Lung Qi deficiency complicated by Summerheat-Dampness. It should not be mixed indiscriminately for those with robust constitutions and strong pulses, or mild deficiency, or those with dried fluids, irritability, thirst, and excessive Fire. Qing Zao Tang (Clear Dryness Decoction) also treats symptoms during late summer where damp-heat steams the body, causing physical fatigue and weakness/heaviness in the waist and legs. Compared to Qing Shu Yi Qi Tang, it contains more Huang Lian (Coptidis Rhizoma), Fu Ling (Poria), Zhu Ling (Polyporus), and Chai Hu (Bupleuri Radix), and lacks Ze Xie, Ge Gen, and Qing Pi. Thus, its clearing and draining power is similar, and its ability to relieve stagnation is comparable. Hence named "Clear Dryness," using "Clear" to direct rebellious Qi downward and "Dry" to overcome Dampness.