治一切失血过多, 阴亏气弱, 烦热作渴, 睡卧不宁等证
.
四物汤加人参, 黄耆 ( 一方去芍药 ) 水煎服.
【集注】柯琴曰: 经云: 阴在内, 阳之守也; 汤在外, 阴之使也. 故
阳中无阴, 谓之孤阳; 阴中无阳, 谓之死阴. 朱震亨曰, 四物皆阴,
行夫地闭塞之令, 非长养万物者也. 故四物加知柏, 久服便能绝孕,
谓嫌于无阳耳. 此方取参, 耆配四物, 以治阴虚血脱等证. 盖阴阳互
为其根, 阴虚则阳无所附, 所以烦热燥渴; 气血相为表里, 血脱则气
无所归, 所以睡卧不宁. 然阴虚无骤补之法, 计在培阴以藏阳, 血脱
有生血之机, 必先补气, 此阳生阴长, 血随气行之理也. 故曰: 阴虚
则无气, 无气则死矣. 此方得仲景白虎加人参之义而扩充者乎. 前辈
治阴虚, 用八珍, 十全, 卒不获效者, 因甘草之甘, 不达下焦, 白术
之燥, 不利肾阴, 茯苓渗泄, 碍乎生升, 肉桂辛热, 动其虚火. 此六
味皆醇厚和平而滋润, 服之则气血疏通, 内外调和, 合于圣度矣.
治阴虚火旺, 骨蒸发热, 日静夜剧者; 妇人热入血室
,胎前发热者.
四物汤加 地骨皮 牡丹皮各三钱, 水煎服.
【集注】柯琴曰: 阴虚者阳往乘之, 发热也. 当分三阴而治之. 阳邪
乘入太阴脾部, 当补中益气以升举之, 清阳复位而火自熄也. 若乘入
少阴肾部, 当六味地黄丸以对待之, 壮水之主而火自平也. 乘入厥阴
肝部, 当地骨皮饮以凉补之, 血有所藏而火自安也. 四物汤为肝家滋
阴调血之剂, 加地骨皮清志中之火以安肾, 补其母也; 加牡丹皮清神
中之火以凉心, 泻其子也. 二皮凉而润, 但清肝火不伤脾胃, 与四物
加知柏之湿润而苦寒者不同也. 故逍遥散治肝火之郁于本脏者也, 木
郁达之, 顺其性也; 地骨皮饮, 治阳邪之乘于肝脏者也, 客者除之,
勿纵寇以遗患也. 二方皆肝家得力之剂.
治疗各种因失血过多,导致阴液亏损、气机虚弱,出现烦热口渴、睡眠不安等症状。
四物汤加入人参、黄芪(另一种方子去掉芍药),用水煎煮后服用。
【集注】柯琴说:《内经》云:“阴在内,是阳的守持者;阳在外,是阴的役使者。”所以,阳中如果没有阴,就称为孤阳;阴中如果没有阳,就称为死阴。朱震亨说,四物汤全是阴药,执行的是大地闭塞收敛的命令,不能起到长养万物的作用。因此,四物汤加上知母、黄柏,长期服用就能导致绝育,这是因为它嫌恶没有阳气罢了。这个方子取用人参、黄芪配合四物汤,用来治疗阴虚血脱等证候。大概阴阳互为根本,阴虚则阳无所依附,所以出现烦热燥渴;气血互为表里,血脱则气无所归依,所以出现睡卧不宁。然而,阴虚没有急速补益的方法,关键在于培补阴液以潜藏阳气;血脱有生血的机理,必须先补气,这是“阳生阴长”、血液随气运行的道理。所以说:阴虚就没有气,没有气就会死亡。这个方子大概是得到了张仲景白虎加人参汤的意义并加以扩充吧。前辈们治疗阴虚,使用八珍汤、十全大补汤,最终没有获得疗效,是因为甘草的甘缓之性,不能到达下焦;白术的燥性,不利于肾阴;茯苓的渗泄作用,妨碍了生发之气;肉桂的辛热之性,会扰动虚火。而这六味药(指本方组成)都是醇厚和平且滋润的,服用后则气血疏通,内外调和,符合圣人的法度。
治疗阴虚火旺,骨蒸潮热,白天安静夜晚加剧的情况;妇女热邪陷入血室;孕妇发热等情况。
四物汤加入地骨皮、牡丹皮各三钱,用水煎煮后服用。
【集注】柯琴说:阴虚则阳气往而乘袭之,表现为发热。应当分三阴经来治疗。如果阳邪乘入太阴脾部,应当用补中益气汤来升举阳气,清阳复位而火自然熄灭。如果乘入少阴肾部,应当用六味地黄丸来应对,壮水之主以制阳光,火自然平息。如果乘入厥阴肝部,应当用地骨皮饮来凉补,使血有所藏而火自然安宁。四物汤是肝脏滋阴调血的方剂,加入地骨皮清除志中之火以安肾,这是补其母脏;加入牡丹皮清除神中之火以凉心,这是泻其子脏。这两味皮类药性凉而润,只清肝火而不伤脾胃,与四物汤加知母、黄柏那种湿润而苦寒的性质不同。所以逍遥散治疗肝火郁结在本脏的情况,木郁则通达之,顺应其本性;地骨皮饮治疗阳邪乘袭肝脏的情况,客邪则去除之,不要放纵寇贼留下后患。这两个方子都是肝脏得力的方剂。
Treats all conditions resulting from excessive blood loss, leading to Yin deficiency and Qi weakness, manifesting as irritability, heat sensation, thirst, restlessness during sleep, etc.
Siwu Decoction (Four Substances Decoction) with added Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix). In another prescription, Shaoyao (Paeoniae Radix Alba) is omitted. Decoct in water and take orally.
[Collected Annotations] Ke Qin stated: The *Neijing* (Classic of Internal Medicine) says: "Yin resides within, serving as the guardian of Yang; Yang resides without, serving as the envoy of Yin." Therefore, if Yang lacks Yin, it is called Solitary Yang; if Yin lacks Yang, it is called Dead Yin. Zhu Zhenheng said that Siwu Decoction consists entirely of Yin-nourishing herbs, executing the command of Earth's closure and storage, rather than fostering growth. Thus, adding Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) to Siwu Decoction, when taken for a long time, can lead to sterility, because it is deemed lacking in Yang. This formula uses Renshen and Huangqi combined with Siwu Decoction to treat conditions such as Yin deficiency and blood collapse. Essentially, Yin and Yang are mutually rooted; when Yin is deficient, Yang has no attachment, resulting in irritability, heat, dryness, and thirst; Qi and Blood are exterior-interior counterparts; when Blood collapses, Qi has no return, resulting in restlessness during sleep. However, there is no method for rapid tonification of Yin deficiency; the strategy lies in cultivating Yin to store Yang. For blood collapse, there is a mechanism for generating blood, but one must first tonify Qi. This follows the principle of "Yang generation leads to Yin growth" and "Blood follows Qi circulation." Hence it is said: "Yin deficiency results in lack of Qi; lack of Qi leads to death." Is this formula an expansion of the meaning found in Zhang Zhongjing's Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng)? Predecessors treating Yin deficiency using Bazhen Tang (Eight Treasures Decoction) or Shiquan Dabu Tang (Ten Significant Tonifying Decoction) often failed to achieve efficacy because Gancao (Licorice Radix et Rhizoma)'s sweet nature does not reach the Lower Jiao (Lower Burner); Baizhu (Atractylodis Macrocephalae Rhizoma)'s dryness is unfavorable to Kidney Yin; Fuling (Poria) promotes leaching and drainage, hindering the ascending and generating functions; Rougui (Cinnamon Bark) is acrid and hot, stirring up deficient fire. These ingredients in the current formula are mellow, mild, and moistening. Upon ingestion, Qi and Blood become unobstructed, interior and exterior harmonize, conforming to the Sage's standards.
Treats Yin deficiency with hyperactive fire, bone-steaming fever (fever originating from deep within the bones), which is quiet during the day and severe at night; women suffering from Heat entering the Blood Chamber (Xueshi); pregnant women with fever.
Siwu Decoction with added Digupi (Lycii Cortex) and Mudanpi (Moutan Cortex), each 3 qian. Decoct in water and take orally.
[Collected Annotations] Ke Qin stated: When Yin is deficient, Yang invades and overcomes it, causing fever. Treatment should be differentiated according to the Three Yin meridians. If Yang pathogenic factors invade the Taiyin Spleen region, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used to raise and lift, restoring clear Yang so that fire extinguishes itself. If they invade the Shaoyin Kidney region, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) should be used to strengthen the source of Water, thereby calming fire. If they invade the Jueyin Liver region, Digupi Yin (Digupi Decoction) should be used for cooling and tonifying, allowing Blood to be stored so that fire settles. Siwu Decoction is a formula for nourishing Yin and regulating Blood in the Liver. Adding Digupi clears fire from the Will (Zhi) to calm the Kidney, which is tonifying its Mother organ; adding Mudanpi clears fire from the Spirit (Shen) to cool the Heart, which is draining its Child organ. These two bark herbs are cool and moistening, clearing Liver fire without damaging the Spleen and Stomach, differing from the moist and bitter-cold nature of Siwu Decoction plus Zhimu and Huangbai. Therefore, Xiaoyao San (Free and Easy Wanderer Powder) treats Liver fire depressed in its own organ, where Wood depression is resolved by promoting free flow, following its nature; Digupi Yin treats Yang pathogenic factors invading the Liver organ, where intruders are expelled, preventing the bandit from leaving trouble behind. Both formulas are effective agents for the Liver.