治心火上盛, 中焦燥实, 烦躁口渴, 目赤头眩, 口疮唇
裂, 吐血衄血, 大小便秘, 诸风瘛瘲, 胃热发斑发狂, 及小儿惊急,
痘疮黑陷.
连翘四两 大黄 ( 酒浸 ) 黄芩 ( 酒炒 ) 薄荷一两 甘草二两
栀子 ( 炒 ) 芒硝上为末, 每服三钱, 加竹叶, 生蜜煎.
【集注】汪昂曰: 此上, 中二焦, 泻实火药也. 热淫于内, 治以咸寒
,佐以苦甘. 故以连翘, 黄芩, 竹叶, 薄荷散火于上, 而以大黄, 芒
硝之猛利, 荡热于中, 使上升下行, 而膈自清矣. 用甘草, 生蜜者,
病在膈, 甘以缓之也. 古方用凉膈散居多. 本方加菖蒲, 远志, 名转
舌膏, 治心经蕴热. 加青黛, 蓝根, 名活命金丹, 治肝经风热. 张洁
古减去硝, 黄, 加桔梗为之舟楫, 浮而上行, 治上焦诸热, 便不实者
宜之, 不可以此方过泻而轻訾之也.
治消渴, 气血虚, 胃火盛而作渴.
淡竹叶 生地黄各二钱 黄耆 麦冬 当归 川芎 黄芩 甘草 芍
药 人参 半夏 石膏 各一钱, 右水煎服.
【集注】柯琴曰: 气血皆虚, 胃火独盛, 善治者补泻兼施; 寒之而不
至损阳, 温之而不至助火, 扶正而邪却矣. 四君子气药也, 加黄耆而
去芩, 术者, 恐火就燥也. 四物汤血药也, 倍地黄而用生者, 正取其
寒也. 人参, 黄耆, 甘草治烦热之圣药, 是补中有泻矣. 且地黄之甘
寒, 泻心肾之火, 竹叶助芍药清肝胆之火, 石膏佐芍药清脾胃之火,
麦冬同黄芩清肺肠之火, 则胃火不得独盛, 而气血之得补可知. 惟半
夏一味温中辛散, 用之大寒剂中, 欲其通阴阳之路也. 岐伯治阴虚而
目不瞑者, 饮以半夏汤, 覆杯则卧, 今人以为燥而渴者禁用, 是不明
阴阳之理耳.
【按】是方即竹叶石膏汤加生地, 当归, 白芍, 川芎, 黄耆, 黄芩也
.彼则治伤寒解后, 烦渴少气, 气逆欲吐. 此则治消渴, 气血虚,
胃火盛. 因其气虚, 故加黄耆佐人参, 甘草以补气; 因其血虚, 故加
归,芎, 芍, 地以补血; 因其胃火盛, 故加黄芩佐石膏以清胃火. 其
烦渴则一, 故余药皆同也. 于此二方推之, 用半夏之意, 自可知矣.
故脾者为胃行其津液也, 脾湿胃燥, 津液不行, 得火则化痰, 得寒则
成饮. 胃火清, 脾湿燥, 其痰饮自除矣. 半夏消痰破饮, 使未化痰之
津液回清, 而已成痰之浊液自化, 非他药所可比伦也, 故二方于胃火
盛燥渴中同用之.
【凉膈散】治疗心火亢盛于上,中焦燥结实证,表现为烦躁、口渴、眼睛发红、头晕目眩、口腔溃疡、嘴唇破裂、吐血、鼻出血、大小便不通、各种风证引起的抽搐痉挛、胃热导致的皮肤发斑或狂躁,以及小儿惊风急症、痘疮颜色黑陷。
连翘四两,大黄(用酒浸泡),黄芩(用酒炒制),薄荷一两,甘草二两,栀子(炒制),芒硝。以上药物研为细末,每次服用三钱,加入竹叶和生蜂蜜煎煮服用。
【集注】汪昂说:这是治疗上、中二焦实火的方剂。热邪蕴积在体内,用咸寒性质的药物来治疗,辅以苦甘性质的药物。因此用连翘、黄芩、竹叶、薄荷在上部疏散火热,而用大黄、芒硝的猛烈药性在中部荡涤热邪,使气机上升下行,胸膈自然清利。使用甘草和生蜂蜜,是因为病位在膈,甘味药物可以缓急。古方中使用凉膈散的情况很多。本方加入石菖蒲、远志,名为转舌膏,治疗心经蕴藏的热邪;加入青黛、板蓝根,名为活命金丹,治疗肝经的风热。张洁古减去芒硝、大黄,加入桔梗作为舟楫之药,使其药性上浮上行,治疗上焦的各种热证,适合大便不实的人使用,不能因为这个方子泻下作用强就轻视它。
【竹叶黄芪汤】治疗消渴病,气血虚弱,胃火旺盛导致口渴。
淡竹叶、生地黄各二钱,黄芪、麦冬、当归、川芎、黄芩、甘草、芍药、人参、半夏、石膏各一钱。以上药物加水煎煮后服用。
【集注】柯琴说:气血都虚弱,唯独胃火旺盛,善于治病的人会补益与泻实兼施;用寒凉药不至于损伤阳气,用温补药不至于助长火势,扶助正气而邪气自退。四君子汤是补气药,加入黄芪而去掉白术、黄芩,是担心火热依附于燥性。四物汤是补血药,加倍使用生地黄并采用生品,正是取其寒凉性质。人参、黄芪、甘草是治疗烦热的圣药,这是在补益中包含着泻实。而且地黄的甘寒,能泻心肾之火;竹叶辅助芍药清肝胆之火;石膏辅助芍药清脾胃之火;麦冬配合黄芩清肺肠之火,这样胃火就不能单独旺盛,而气血得到补益也就显而易见了。只有半夏一味药性温中辛散,在大寒的方剂中使用,是想用它来疏通阴阳的道路。岐伯治疗阴虚导致眼睛无法闭合失眠的人,让他喝半夏汤,喝完一杯就能入睡,现在的人认为燥渴者禁用半夏,这是不明白阴阳道理的表现。
【按语】这个方子就是竹叶石膏汤加生地、当归、白芍、川芎、黄芪、黄芩。原方治疗伤寒病愈后,烦渴、气短、气逆想吐。此方治疗消渴病,气血虚弱,胃火旺盛。因为气虚,所以加黄芪辅助人参、甘草来补气;因为血虚,所以加当归、川芎、芍药、地黄来补血;因为胃火旺盛,所以加黄芩辅助石膏来清胃火。两者的烦渴症状相同,所以其余药物都一样。从这两个方子的对比中可以推知,使用半夏的用意了。所以说脾脏是为胃输送津液的,脾湿胃燥,津液运行不畅,遇到火就会变成痰,遇到寒就会变成饮。胃火清了,脾湿干了,痰饮自然消除。半夏能消痰破饮,使尚未化为痰的津液恢复清澈,已经形成的痰浊液体自然化解,这不是其他药物能比拟的,所以在两个治疗胃火旺盛燥渴的方子中都使用了它。
[Liangge San (Cooling the Diaphragm Powder)] Treats hyperactivity of Heart Fire in the upper jiao, and dryness-excess syndrome in the middle jiao. Symptoms include irritability, thirst, red eyes, dizziness, oral ulcers, cracked lips, hematemesis (vomiting blood), epistaxis (nosebleed), constipation of both stool and urine, various wind syndromes causing clonic spasms (Chi Zong, 瘛疭), skin macules or mania caused by Stomach Heat, as well as infantile convulsive emergencies and black depression of smallpox lesions.
Lianqiao (Forsythiae Fructus) 4 liang, Dahuang (Rhei Radix et Rhizoma) soaked in wine, Huangqin (Scutellariae Radix) stir-fried with wine, Bohe (Menthae Haplocalycis Herba) 1 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang, Zhizi (Gardeniae Fructus) stir-fried, Mangxiao (Natrii Sulfas). Grind all ingredients into fine powder. Take 3 qian per dose, decoct with Zhuye (Bambusae Folium) and raw honey.
[Collected Annotations] Wang Ang stated: This is a formula for purging excess fire from the upper and middle jiao. When heat invades internally, it is treated with salty-cold substances, assisted by bitter-sweet substances. Therefore, Lianqiao, Huangqin, Zhuye, and Bohe are used to dissipate fire upwards, while the potent properties of Dahuang and Mangxiao purge heat downwards in the middle, allowing qi to ascend and descend, thereby clearing the diaphragm naturally. Gancao and raw honey are used because the pathology is located at the diaphragm; sweet flavors soothe and relieve urgency. In ancient prescriptions, Liangge San was frequently used. Adding Shichangpu (Acori Tatarinowii Rhizoma) and Yuanzhi (Polygalae Radix) to this base formula creates Zhuan She Gao (Tongue-Turning Paste), which treats latent heat in the Heart meridian. Adding Qingdai (Indigo Naturalis) and Lan Gen (Isatidis Radix) creates Huo Ming Jin Dan (Life-Saving Golden Pill), which treats Wind-Heat in the Liver meridian. Zhang Jiegu removed Mangxiao and Dahuang, adding Jiegeng (Platycodonis Radix) as a carrier to float the medicinal action upward, treating various heats in the upper jiao; it is suitable for those with loose stools. One should not disparage this formula due to its strong purgative nature.
[Zhu Ye Huang Qi Tang (Bamboo Leaf and Astragalus Decoction)] Treats Xiao Ke (Wasting and Thirsting Syndrome), deficiency of Qi and Blood, and thirst caused by hyperactive Stomach Fire.
Dan Zhu Ye (Lophatheri Herba) and Sheng Di Huang (Rehmanniae Radix Recens) each 2 qian; Huang Qi (Astragali Radix), Mai Dong (Ophiopogonis Radix), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Huang Qin (Scutellariae Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Shaoyao (Paeoniae Radix), Renshen (Ginseng Radix), Banxia (Pinelliae Rhizoma), Shigao (Gypsum Fibrosum) each 1 qian. Decoct these ingredients in water and take orally.
[Collected Annotations] Ke Qin stated: When both Qi and Blood are deficient but Stomach Fire is exclusively hyperactive, skilled practitioners employ simultaneous tonification and purgation. Using cold herbs does not damage Yang Qi, and using warm herbs does not aid Fire; thus, Righteous Qi is supported while Pathogenic factors recede. Si Jun Zi Tang (Four Gentlemen Decoction) consists of Qi-tonifying herbs. Adding Huang Qi while removing Bai Zhu and Huang Qin prevents Fire from adhering to dryness. Si Wu Tang (Four Substances Decoction) consists of Blood-tonifying herbs. Doubling the dosage of Sheng Di Huang and using it fresh takes advantage of its cold nature. Renshen, Huang Qi, and Gancao are supreme remedies for treating irritability and heat; this represents purgation within tonification. Furthermore, the sweet-cold nature of Di Huang purges Fire from the Heart and Kidney; Zhu Ye assists Shaoyao in clearing Fire from the Liver and Gallbladder; Shigao assists Shaoyao in clearing Fire from the Spleen and Stomach; Mai Dong combined with Huang Qin clears Fire from the Lungs and Intestines. Thus, Stomach Fire cannot remain exclusively hyperactive, and the benefit to Qi and Blood becomes evident. Only Banxia possesses warm, middle-jiao harmonizing, and acrid-dispersing properties. Its use in a strongly cold formula aims to unblock the pathways of Yin and Yang. Qibo treated insomnia due to Yin deficiency by prescribing Banxia Tang; sleep was achieved after one cup. Modern practitioners forbid its use in cases of dryness and thirst, demonstrating a lack of understanding of Yin-Yang principles.
[Commentary] This formula is essentially Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) supplemented with Sheng Di Huang, Dang Gui, Bai Shao, Chuan Xiong, Huang Qi, and Huang Qin. The original formula treats irritability, thirst, shortness of breath, and nausea following the resolution of Shang Han (Cold Damage). This formula treats Xiao Ke (Wasting and Thirsting Syndrome) characterized by Qi and Blood deficiency and hyperactive Stomach Fire. Due to Qi deficiency, Huang Qi is added to assist Renshen and Gancao in tonifying Qi; due to Blood deficiency, Dang Gui, Chuan Xiong, Shao Yao, and Di Huang are added to tonify Blood; due to hyperactive Stomach Fire, Huang Qin is added to assist Shigao in clearing Stomach Fire. Since the symptom of irritability and thirst is common to both, the remaining herbs are identical. By comparing these two formulas, the rationale for using Banxia becomes clear. The Spleen transports fluids for the Stomach. When Spleen dampness and Stomach dryness impede fluid circulation, heat transforms fluids into Phlegm, while cold transforms them into Fluid Retention (Yin). Once Stomach Fire is cleared and Spleen dampness dried, Phlegm and Fluid Retention are naturally eliminated. Banxia resolves Phlegm and breaks up Fluid Retention, clarifying fluids that have not yet transformed into Phlegm and resolving existing turbid fluids; no other herb can compare. Therefore, both formulas utilize Banxia in cases of hyperactive Stomach Fire and dryness-thirst.