治阴虚有火, 令人盗汗者.
当归 生地 熟地 黄耆 黄芩 黄连 黄柏, 右水煎服.
【注】寤而汗出曰自汗, 寐而汗出曰盗汗. 阴盛则阳虚不能外固, 故
自汗. 阳盛则阴虚不能中守, 故盗汗. 若阴阳平和之人, 卫气昼则行
阳而寤, 夜则行阴而寐, 阴阳既济, 病安从来? 惟阴虚有火之人, 寐
则卫气行阴, 阴虚不能济阳, 阳火因盛而争于阴, 故阴液失守外走而
出汗; 寤则卫气复行出于表, 阴得以静, 故汗止矣. 用当归以养液,
二地以滋阴, 令阴液得其养也. 用黄芩泻上焦火, 黄连泻中焦火, 黄
柏泻下焦火, 令三火得其平也. 又于诸寒药中加黄耆, 庸者不知, 以
为赘品, 且谓阳盛者不宜, 抑知其妙义正在于斯耶! 盖阳争于阴, 汗
出营虚, 则卫亦随之而虚. 故倍加黄耆者, 一以完已虚之表, 一以固
未定之阴. 经曰: 阴平阳秘, 精神乃治. 此之谓欤!
【集注】吴琨曰: 杂证盗汗, 与伤寒盗汗不同. 伤寒是半表半里之邪
未尽, 杂证则阴虚有火而已. 彼以和表为主, 此以救阴为急. 故以补
阴之品, 佐泻火之药, 明者辨之.
治虚劳里急, 悸, 衄, 腹中痛, 夜梦失精, 四肢酸
痛,手足烦热, 咽干口燥, 诸不足诸证.
黄耆 胶饴 白芍 甘草 桂枝 生姜 大枣, 右七味, 水煎服.
【集注】喻昌曰: 虚劳而至于亡血, 失精, 津液枯稿, 难为力矣! 『
内经』于针砭所莫治者, 调以甘药, 『金匮』遵之而立黄耆建中汤,
急建其中气, 俾饮食增而津液旺, 以至充血生精, 而复其真阴之不足
.但用稼穑作甘之本位, 而酸辛咸苦在所不用, 盖舍此别无良法也 .
然用法贵立于无过之地, 不独呕家不可用建中之甘, 即微觉气滞, 更
当虑甘药太过, 令人中满也. 至大建中则大建其中之阳, 小建中则小
小创建之义, 理中则燮理之义, 治中则分治之义, 补中, 温中, 何莫
非先中州之义. 缘伤寒外邪逼入于内, 法难尽用, 仲景但于方首以「
小」之一字, 微示其意, 至『金匮』始尽建中之义. 后人引伸触类,
制乐令建中汤, 十四味建中汤, 曲畅建中之旨. 学者心手之间, 所当
会其大义也.
治疗阴虚火旺,导致人在睡眠中出汗(盗汗)的病症。
当归、生地黄、熟地黄、黄耆、黄芩、黄连、黄柏,以上七味药,加水煎煮后服用。
【注释】清醒时出汗称为自汗,睡眠时出汗称为盗汗。阴气偏盛则阳气虚弱,不能固护体表,所以出现自汗。阳气偏盛则阴气虚弱,不能内守,所以出现盗汗。如果是阴阳平和的人,卫气白天运行于阳分而使人清醒,夜晚运行于阴分而使人入睡,阴阳相互协调,疾病从何而来?只有阴虚火旺的人,睡眠时卫气行于阴分,因阴虚不能济助阳气,阳气之火因而亢盛并与阴气相争,导致阴液失守向外流失而出汗;清醒时卫气重新运行出于体表,阴气得以宁静,所以汗止住了。使用当归来滋养津液,使用生地黄和熟地黄来滋阴,使阴液得到滋养。使用黄芩清泻上焦之火,黄连清泻中焦之火,黄柏清泻下焦之火,使三焦之火得到平衡。又在这些寒凉药中加入黄耆,庸医不知道其中的奥妙,认为它是多余的药材,并且说阳气盛的人不宜使用,殊不知其精妙之处正在于此!大概是因为阳气与阴气相争,汗出导致营血虚弱,那么卫气也随之虚弱。所以加倍使用黄耆的原因,一是为了补全已经虚弱的肌表,二是为了巩固尚未安定的阴气。《内经》说:阴气平顺,阳气固秘,精神才能正常。说的就是这个道理吧!
【集注】吴琨说:杂病中的盗汗,与伤寒中的盗汗不同。伤寒是半表半里的邪气未尽,杂病则是阴虚有火罢了。治疗伤寒以调和表气为主,治疗杂病则以救阴为急务。所以用补阴的药物,配合泻火的药物,明智的人应当辨别清楚。
治疗虚劳引起的腹中拘急疼痛、心悸、鼻出血、腹部疼痛、夜间梦遗滑精、四肢酸痛、手足心烦热、咽喉干燥口舌燥渴,以及诸般不足的各种证候。
黄耆、胶饴(麦芽糖)、白芍、甘草、桂枝、生姜、大枣,以上七味药,加水煎煮后服用。
【集注】喻昌说:虚劳发展到亡血、失精、津液枯竭的地步,就很难治疗了!《内经》对于针石砭灸无法治疗的病症,主张用甘味药物调理,《金匮要略》遵循这一原则创立了黄耆建中汤,急于建立中焦之气,使得饮食增加而津液旺盛,进而充血生精,恢复真阴的不足。只使用稼穑作甘的本位之性,而酸、辛、咸、苦不在使用之列,大概除了这种方法别无良策。然而用药贵在处于不过度的境地,不仅呕吐患者不可使用建中汤的甘味,即使稍微感觉气机阻滞,更应当担心甘味药物太过,导致胸脘痞满。至于大建中汤则是大力建立中焦之阳,小建中汤则是小小创建的意思,理中汤则是燮理的意思,治中汤则是分治的意思,补中、温中,无不都是先顾护中州(脾胃)的意义。因为伤寒外邪逼迫入里,治法难以完全照搬,张仲景仅在方名前加“小”字,微妙地暗示其意,到了《金匮要略》才完全阐发建中的含义。后人引申触类,制定了乐令建中汤、十四味建中汤,曲折畅达地阐发了建中的宗旨。学者在心手之间,应当领会其中的大义。
Treats Yin deficiency with fire, causing night sweats (Dao Han).
Dang Gui (Angelicae Sinensis Radix), Sheng Di Huang (Rehmanniae Radix Recens), Shu Di Huang (Rehmanniae Radix Preparata), Huang Qi (Astragali Radix), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Huang Bai (Phellodendri Cortex). The above seven ingredients are decocted in water and taken orally.
[Note] Sweating while awake is called spontaneous sweating (Zi Han); sweating while asleep is called night sweats (Dao Han). When Yin is excessive, Yang becomes deficient and cannot secure the exterior, resulting in spontaneous sweating. When Yang is excessive, Yin becomes deficient and cannot guard the interior, resulting in night sweats. In individuals with harmonious Yin and Yang, Wei Qi (Defensive Qi) travels through the Yang meridians during the day, keeping one awake, and through the Yin meridians at night, inducing sleep. With Yin and Yang mutually supporting, how could disease arise? Only in those with Yin deficiency and fire, when sleeping, Wei Qi enters the Yin. Due to Yin deficiency failing to nourish Yang, Yang fire becomes hyperactive and contends with Yin, causing Yin fluids to lose their hold and escape outward as sweat; upon waking, Wei Qi returns to the exterior, allowing Yin to rest, thus stopping the sweat. Dang Gui is used to nourish fluids, and Sheng Di Huang and Shu Di Huang are used to nourish Yin, so that Yin fluids receive nourishment. Huang Qin clears fire in the Upper Jiao, Huang Lian clears fire in the Middle Jiao, and Huang Bai clears fire in the Lower Jiao, bringing balance to the three fires. Furthermore, adding Huang Qi among these cold-natured herbs is misunderstood by mediocre physicians who consider it superfluous and claim it is unsuitable for those with excess Yang; they fail to realize its profound significance lies precisely here! Since Yang contends with Yin and sweating depletes Ying Blood (Nutritive Blood), Wei Qi also becomes deficient accordingly. Therefore, doubling the dose of Huang Qi serves two purposes: first, to restore the already deficient exterior, and second, to stabilize the unsettled Yin. The Classic says: "When Yin is peaceful and Yang is firm, spirit and vitality are regulated." This is what is meant!
[Collected Annotations] Wu Kun stated: Night sweats in miscellaneous diseases differ from those in Shang Han (Cold Damage). In Shang Han, it is due to pathogenic factors lingering in the Half-Exterior and Half-Interior; in miscellaneous diseases, it is merely Yin deficiency with fire. Treatment for Shang Han focuses on harmonizing the exterior, whereas treatment for miscellaneous diseases urgently seeks to rescue Yin. Thus, yin-nourishing herbs are combined with fire-clearing herbs; discerning practitioners should distinguish between them.
Treats Xu Lao (Consumptive Disease) presenting with abdominal urgency and pain, palpitations, epistaxis, abdominal pain, nocturnal seminal emission, soreness and pain in the four limbs, vexing heat in the hands and feet, dry throat and mouth, and various syndromes of insufficiency.
Huang Qi (Astragali Radix), Jiao Yi (Malt Sugar), Bai Shao (Paeoniae Radix Alba), Gan Cao (Glycyrrhizae Radix et Rhizoma), Gui Zhi (Cinnamomi Ramulus), Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus). The above seven ingredients are decocted in water and taken orally.
[Collected Annotations] Yu Chang stated: When Xu Lao progresses to loss of blood, loss of essence, and withered fluids, it is difficult to treat! The Nei Jing states that for conditions beyond the reach of acupuncture and moxibustion, one should regulate with sweet medicines. The Jin Gui Yao Lue follows this principle by establishing Huang Qi Jian Zhong Tang, urgently building the Qi of the Middle Jiao, so that dietary intake increases and fluids flourish, thereby generating blood and essence, and restoring the insufficiency of True Yin. It utilizes only the sweet nature inherent in grains (the element of Earth), excluding sour, acrid, salty, and bitter flavors, as there is no other effective method. However, medication must be applied without excess. Not only should patients with vomiting avoid the sweetness of Jian Zhong Tang, but even if slight Qi stagnation is perceived, one must worry that excessive sweet herbs may cause fullness in the middle jiao. Regarding Da Jian Zhong Tang, it greatly builds the Yang of the center; Xiao Jian Zhong Tang implies a minor creation; Li Zhong Tang implies regulation; Zhi Zhong Tang implies divided treatment; Bu Zhong and Wen Zhong all imply prioritizing the Central State (Spleen and Stomach). Because external pathogens in Shang Han force their way inward, standard methods cannot be fully applied. Zhang Zhongjing merely added the character "Xiao" (Small) to the formula name to subtly indicate his intent, until the Jin Gui Yao Lue fully expounded the meaning of building the center. Later generations extended this logic, creating Le Ling's Jian Zhong Tang and Shi Si Wei Jian Zhong Tang, elaborately unfolding the purport of building the center. Scholars should grasp the major principles in their minds and hands.