(见前)
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假令瘦人脐下有悸,吐涎沫而癫眩,此水也,五苓散主之。
【按】
瘦人之「瘦」字,当是「病」字;癫眩之「癫」字,当是「巅」字,巅者头也,文义
相属,此传写之□。
【注】
悸者,筑筑然跳动病也。上条心下有悸,是水停心下为病也;此条脐下有悸,是水停
脐下为病也。若欲作奔豚,则为阳虚,当以茯苓桂枝甘草大枣汤主之;今吐涎沫,水
逆胃也,巅眩水阻阳也,则为水盛,故以五苓散主之也。
泽泻一两一分 猪苓(去皮)三分 茯苓三分 白术三分 桂(去皮)二分
右五味,为末,白饮服方寸匕,日三服,多饮暖水,汗出愈。
@@@
夫短气有微饮,当从小便去之,芩桂术甘汤主之。肾气丸亦主之。
【注】
水停心下,甚者病悸,已明其治矣。微者短气,其治有二:气虚短气,是气少不能长
息而短也;微饮短气,是水停阻碍呼吸而短也。若呼之气短,是心肺之阳有碍也,用
芩桂术甘汤以通其阳,阳气通则膀胱之窍利矣。吸之气短,是肝肾之阴有碍也,用肾
气丸以通其阴,阴气通,则小便之关开矣。故曰:苓桂术甘汤主之,肾丸亦主之也。
(见前文)
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假设一个形体消瘦的人,感到脐下跳动不安,呕吐涎沫并出现头顶眩晕的症状,这是水饮为患,应当用五苓散主治。
【按语】
此处“瘦人”的“瘦”字,应当是“病”字;“癫眩”的“癫”字,应当是“巅”字,“巅”指头部,这样文义才连贯,这是传抄过程中的脱误。
【注解】
悸,是指心脏筑筑然跳动的病症。上一条文中提到心下有悸动,是水饮停聚在心下导致的疾病;这一条文中提到脐下有悸动,是水饮停聚在脐下导致的疾病。如果想要发作奔豚(一种自觉气从少腹上冲胸咽的病证),则属于阳虚,应当用茯苓桂枝甘草大枣汤主治;如今出现呕吐涎沫,是水饮逆犯胃腑,头顶眩晕是水饮阻遏阳气,这属于水饮盛实,所以用五苓散主治。
泽泻一两一分 猪苓(去皮)三分 茯苓三分 白术三分 桂枝(去皮)二分
以上五味药,研成粉末,用米汤送服一方寸匕,每日三次服药,服药后多喝暖水,以出汗为痊愈的标志。
@@@
对于呼吸短促且有轻微水饮停留的患者,应当通过小便将其排出,用苓桂术甘汤主治。肾气丸也可以主治。
【注解】
水饮停聚在心下,严重的会导致心悸,其治疗方法已经阐明。轻微的表现为呼吸短促,其治疗方法有两种:如果是气虚导致的短气,是因为气少不能深长呼吸而显得短促;如果是微饮导致的短气,是因为水饮停聚阻碍了呼吸而显得短促。如果呼气时感觉气短,说明心肺的阳气受到阻碍,使用苓桂术甘汤来通调阳气,阳气通畅则膀胱的气化功能正常,小便通利。如果吸气时感觉气短,说明肝肾的阴气受到阻碍,使用肾气丸来通调阴气,阴气通畅则小便的排泄关口打开。所以说:苓桂术甘汤主治,肾气丸也主治。
(See previous text)
@@@
Suppose a person with a thin physique experiences palpitations below the umbilicus, vomits saliva and froth, and suffers from vertigo affecting the vertex (top of the head). This is caused by fluid retention, and Wuling San (Five-Ingredient Powder with Poria) should be used as the primary treatment.
[Commentary]
The character "thin" (Shou) in "thin person" should likely be "sick" or "ill" (Bing); the character "dian" (Dian) in "dian xuan" should be "dian" (Dian), meaning the vertex or top of the head. With this correction, the textual meaning becomes coherent; this discrepancy is due to a transcription error.
[Annotation]
Palpitation (Ji) refers to the sensation of the heart beating vigorously. In the preceding clause, palpitations below the heart indicate that fluid retention has occurred in the epigastrium. In this clause, palpitations below the umbilicus indicate that fluid retention has occurred below the umbilicus. If there were a tendency for Ben Tun (a condition characterized by the sensation of Qi rushing upward from the lower abdomen to the chest and throat) to develop, it would be due to Yang deficiency, and Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) would be indicated. However, since there is vomiting of saliva and froth, indicating fluid rebellion against the Stomach, and vertigo of the vertex, indicating obstruction of Yang by fluid, this represents an excess of fluid. Therefore, Wuling San (Five-Ingredient Powder with Poria) is indicated.
Alisma Rhizoma (Zexie) 1 liang 1 fen, Polyporus (with skin removed) 3 fen, Poria (Fuling) 3 fen, Atractylodis Macrocephalae Rhizoma (Baizhu) 3 fen, Cinnamomi Ramulus (Guizhi, with skin removed) 2 fen.
Grind these five ingredients into powder. Take one fangcun bi (a square-inch measure) with warm rice water decoction, three times daily. Drink plenty of warm water after administration; recovery is indicated by sweating.
@@@
In cases of shortness of breath accompanied by slight fluid retention, the fluid should be eliminated via urination. Lingui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is the primary formula. Shenqi Wan (Kidney Qi Pill) may also be used.
[Annotation]
When fluid retention occurs in the epigastrium, severe cases result in palpitations, the treatment for which has already been explained. Mild cases manifest as shortness of breath, which has two treatment approaches: Shortness of breath due to Qi deficiency arises because there is insufficient Qi to sustain deep breathing. Shortness of breath due to slight fluid retention arises because retained fluid obstructs respiration. If shortness of breath occurs during exhalation, it indicates an obstruction of the Yang Qi of the Heart and Lungs; Lingui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is used to unblock Yang Qi. Once Yang Qi is unblocked, the orifices of the Bladder become patent. If shortness of breath occurs during inhalation, it indicates an obstruction of the Yin Qi of the Liver and Kidneys; Shenqi Wan (Kidney Qi Pill) is used to unblock Yin Qi. Once Yin Qi is unblocked, the gates of urine excretion open. Thus, it is stated that Lingui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is indicated, and Shenqi Wan (Kidney Qi Pill) is also indicated.
Poria (Fuling) 4 liang, Cinnamomi Ramulus (Guizhi) 3 liang, Atractylodis Macrocephalae Rhizoma (Baizhu) 3 liang, Glycyrrhizae Radix et Rhizoma (Gancao) 2 liang.
Take these four ingredients, add six sheng of water, and decoct to obtain three sheng of liquid. Divide into three warm doses. Urination will ensue upon efficacy.