通气防风汤
1.通气太阳肩背痛, 羌独??草蔓防芎, 气滞加木陈香附, 气虚升柴
参耆同, 血虚当归白芍药, 血瘀姜黄五灵红, 风加灵仙湿二术, 研送
白丸治痰凝.
【注】李杲羌活胜湿汤, 又名通气防风汤, 治太阳经风湿肩背痛, 即
羌活, 独活, ??本, 甘草, 蔓荆子, 防风, 川芎也. 兼气郁滞痛者,
则常常作痛, 加木香, 陈皮, 香附也. 气虚郁痛者, 则时止时痛, 加
升麻, 柴胡, 人参, 黄耆也. 血虚郁痛者, 则夜甚时止, 加当归, 白
芍药也. 血瘀郁痛者, 则夜痛不止, 加姜黄, 五灵脂, 红花也. 风气
郁郁盛者, 痛则项肩强, 加威灵仙也. 湿气郁甚者, 痛则肩背重, 加
苍术, 白术也. 痰风凝郁者, 痛则呕眩, 用本汤研送青州白丸子也.
1.心痛岐骨陷处痛, 横满上胸下胃脘, 当脐脾腹连腰肾, 少腹小大
肠胁肝. 虫痛时止吐清水, 疰即中恶寒外干, 悸分停饮与思虑, 食即
停食冷内寒, 水停痰饮热胃火, 气即气滞血瘀缘, 随证分门检方治,
真心黑厥至节难.
【注】岐骨陷处痛, 名心痛. 横满连胸, 名肺心痛. 下连胃脘, 名胃
心痛. 连脐, 名脾心痛. 连腰, 名肾心痛. 连少腹, 名大肠小肠痛.
连胁, 名肝心痛. 时止吐清水, 名虫心痛. 中恶腹痛, 名疰痛. 寒邪
外干, 名中寒痛. 悸而痛, 名悸心痛. 水停心下, 属饮也. 思虑伤心
,属伤也. 停食痛, 停水痛, 停痰痛, 胃火痛, 气滞痛, 血瘀痛, 皆
不死之证也. 当分门施治, 惟真心痛, 面色黑, 四肢逆冷至节, 死证
也.
化滞丸 清中汤
2.攻湿积热求化滞, 攻寒积水备急丹, 火痛二陈栀连蔻, 虫用乌梅
饮控涎.
【注】化滞丸, 成方也. 清中汤, 即陈皮, 半夏, 茯苓, 甘草, 姜炒
山栀, 黄连, 草豆蔻也.
木香流气饮
3.七情郁结流气饮, 思虑悸痛归脾汤, 内寒理中外五积, 疰痛备急
血抵当.
小建中汤
4.木来乘土腹急痛, 缓肝和脾小建中, 血虚寒痛羊肉治, 气虚理中
加陈青.
【注】羊肉, 谓羊肉汤也.
乌头栀子汤
5.劫诸郁痛乌栀子, 劫而复痛入元明, 已经吐下或虚久, 急痛欲死
求鸦呜.
【注】诸郁, 谓诸寒火郁而痛也. 寒多炮川乌为主, 热多姜炒栀子为
主.元明, 元明粉也. 鸦呜, 谓以真鸦片末, 或加麝香少许, 饭丸如
桐子大, 每服三, 五丸引. 在本草名: 一粒金丹.
通气防风汤
1. 治疗太阳经引起的肩背疼痛,方剂由羌活、独活、藁本、甘草、蔓荆子、防风、川芎组成。若兼有气滞,加入木香、陈皮、香附;若兼有气虚,加入升麻、柴胡、人参、黄芪同用;若兼有血虚,加入当归、白芍药;若兼有血瘀,加入姜黄、五灵脂、红花;若风邪盛,加入威灵仙;若湿邪盛,加入苍术、白术;若为痰凝所致,可用本方研末送服青州白丸子以治痰凝。
【注】李杲的羌活胜湿汤,又名通气防风汤,用于治疗太阳经受风湿侵袭所致的肩背疼痛,其药物组成为羌活、独活、藁本、甘草、蔓荆子、防风、川芎。若兼有气机郁滞而痛者,则疼痛常作不休,需加木香、陈皮、香附。若因气虚导致郁滞而痛者,则疼痛时止时发,需加升麻、柴胡、人参、黄芪。若因血虚导致郁滞而痛者,则夜间疼痛加重且时止时发,需加当归、白芍药。若因血瘀导致郁滞而痛者,则夜间疼痛不止,需加姜黄、五灵脂、红花。若风气郁结旺盛者,疼痛伴有项部和肩部僵硬,需加威灵仙。若湿气郁结严重者,疼痛伴有肩背部沉重感,需加苍术、白术。若痰与风邪凝滞郁结者,疼痛伴有呕吐和眩晕,需用本方研末送服青州白丸子。
心痛(指歧骨陷处疼痛)位于两乳之间歧骨凹陷处,疼痛横向满布延伸至胸部及胃脘部,或连及肚脐、脾腹并牵连腰肾,或少腹部、大小肠及胁肋部(属肝)。虫痛表现为疼痛时止时作并呕吐清水;疰痛即中恶之证,外受寒邪内干脏腑;悸痛分为水饮停聚与思虑伤神两类;食痛即饮食停滞及内寒所致;水停、痰饮、胃火均致痛;气痛即气机阻滞,血痛即血行瘀阻。应根据证候分类,查阅相应方剂进行治疗。真心痛表现为面色黑、四肢厥冷至关节,属难治之死证。
【注】歧骨凹陷处的疼痛,称为心痛。疼痛横满连及胸部,称为肺心痛。疼痛向下连及胃脘,称为胃心痛。疼痛连及肚脐,称为脾心痛。疼痛连及腰部,称为肾心痛。疼痛连及少腹,称为大肠和小肠痛。疼痛连及胁肋,称为肝心痛。疼痛时止时作并呕吐清水,称为虫心痛。中恶腹痛,称为疰痛。寒邪外侵,称为中寒痛。心悸而痛,称为悸心痛。水饮停聚于心下,属于饮证。思虑过度伤心,属于伤证。饮食停滞之痛、水饮停聚之痛、痰浊停聚之痛、胃火炽盛之痛、气机阻滞之痛、血行瘀阻之痛,皆非死证。应当分门别类施治。唯有真心痛,面色发黑,四肢逆冷直至关节,属于死证。
化滞丸 清中汤
2. 攻逐湿积热邪求用化滞丸,攻逐寒邪积水备急丹,火热疼痛用二陈汤加栀子、黄连、豆蔻,虫痛用乌梅饮控涎。
【注】化滞丸是现成方剂。清中汤,即由陈皮、半夏、茯苓、甘草、姜炒山栀、黄连、草豆蔻组成。
木香流气饮
3. 七情郁结用流气饮,思虑所致悸痛用归脾汤,内寒证用理中汤合五积散,疰痛用备急丸或抵当汤。
小建中汤
4. 肝木乘脾土致腹部急痛,缓肝和脾用小建中汤;血虚寒痛用羊肉汤治疗;气虚证在理中汤基础上加陈皮、青皮。
【注】羊肉,指羊肉汤。
乌头栀子汤
5. 劫除各种郁结疼痛用乌头栀子汤,若劫后复发疼痛加入元明粉;若已经吐下或久病体虚,急痛欲死者求用鸦胆子(此处原文“鸦呜”实指鸦片类药物,但结合语境及本草名“一粒金丹”,通常指阿片制剂,此处依原文译作鸦呜/鸦片相关制剂,但在现代中医语境下需谨慎,此处忠实原文“鸦呜”并备注)。
【注】诸郁,指各种寒热郁结而导致的疼痛。寒邪多者以炮制过的川乌为主药;热邪多者以姜炒栀子为主药。元明,指元明粉。鸦呜,指真鸦片粉末,或加少许麝香,用饭制成如梧桐子大小的丸药,每次服用三至五丸,以特定引药送服。在本草中名为:一粒金丹。
Tongqi Fangfeng Decoction (Ventilation and Wind-Expelling Decoction)
1. Treats shoulder and back pain caused by the Taiyang channel (Taiyang channel disease). The formula consists of Qianghuo, Duhuo, Gaoben, Gancao, Manjingzi, Fangfeng, and Chuanxiong. If accompanied by Qi stagnation (Qi Stagnation), add Muxiang, Chenpi, and Xiangfu. If accompanied by Qi deficiency (Qi Deficiency), add Shengma, Chaihu, Renshen, and Huangqi together. If accompanied by Blood deficiency (Blood Deficiency), add Danggui and Baishao. If accompanied by Blood stasis (Blood Stasis), add Jianghuang, Wulingzhi, and Honghua. If Wind pathogen is prevalent, add Weilingxian. If Dampness pathogen is prevalent, add Cangzhu and Baizhu. If caused by Phlegm coagulation (Phlegm Coagulation), use this decoction to grind powder and administer Qingzhou Baiwanzi (Qingzhou White Pill) to treat Phlegm coagulation.
[Note] Li Gao's Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness), also known as Tongqi Fangfeng Tang, treats shoulder and back pain due to Wind-Dampness invading the Taiyang channel. Its ingredients are Qianghuo, Duhuo, Gaoben, Gancao, Manjingzi, Fangfeng, and Chuanxiong. If accompanied by Qi stagnation causing pain, the pain occurs frequently; add Muxiang, Chenpi, and Xiangfu. If caused by Qi deficiency leading to stagnation and pain, the pain stops and starts intermittently; add Shengma, Chaihu, Renshen, and Huangqi. If caused by Blood deficiency leading to stagnation and pain, the pain is worse at night and intermittent; add Danggui and Baishao. If caused by Blood stasis leading to stagnation and pain, the pain does not stop at night; add Jianghuang, Wulingzhi, and Honghua. If Wind Qi is severely stagnant, pain is accompanied by stiffness in the neck and shoulders; add Weilingxian. If Dampness is severely stagnant, pain is accompanied by heaviness in the shoulders and back; add Cangzhu and Baizhu. If Phlegm and Wind are coagulated and stagnant, pain is accompanied by vomiting and dizziness; use this decoction ground into powder to administer Qingzhou Baiwanzi.
Xintong (Heart Pain) refers to pain in the depression between the cartilaginous processes of the sternum. It may spread horizontally across the chest and lower epigastrium, connect to the umbilicus and spleen/abdomen extending to the waist and kidneys, or involve the lower abdomen, large and small intestines, and hypochondrium (associated with the Liver). Worm pain presents as intermittent pain with vomiting of clear fluid; Zhu pain (infectious/miasma pain) involves evil qi attacking externally and internally with cold palpitations; Palpitation pain is divided into fluid retention and excessive thinking; Food pain is due to food stagnation and internal cold; Fluid retention, Phlegm-fluid, and Stomach fire all cause pain; Qi pain is due to Qi stagnation, and Blood pain is due to Blood stasis. Treatment should be categorized according to symptoms and corresponding formulas consulted. Zhenxintong (True Heart Pain) presents with black complexion and cold limbs extending to the joints, which is a fatal condition.
[Note] Pain in the depression between the cartilaginous processes is named Heart Pain. Pain spreading horizontally to the chest is named Lung Heart Pain. Pain extending downward to the epigastrium is named Stomach Heart Pain. Pain connecting to the umbilicus is named Spleen Heart Pain. Pain connecting to the waist is named Kidney Heart Pain. Pain connecting to the lower abdomen is named Large Intestine and Small Intestine Pain. Pain connecting to the hypochondrium is named Liver Heart Pain. Intermittent pain with vomiting of clear fluid is named Worm Heart Pain. Abdominal pain from miasma attack is named Zhu Pain. Pain from external Cold pathogen invasion is named Cold Attack Pain. Palpitation accompanied by pain is named Palpitation Heart Pain. Fluid retention below the heart belongs to Fluid Retention syndrome. Excessive thinking damaging the Heart belongs to Injury syndrome. Pain from food stagnation, water retention, phlegm retention, Stomach fire, Qi stagnation, and Blood stasis are all non-fatal conditions. They should be treated by categorization. Only True Heart Pain, characterized by black complexion and cold limbs extending to the joints, is a fatal condition.
Huazhi Wan (Stagnation-Resolving Pill) Qingzhong Tang (Clear the Middle Decoction)
2. To attack dampness accumulation and heat, seek Huazhi Wan; to attack cold and accumulated water, prepare Bijidan (Emergency Preparation Pill); for Fire pain, use Erchen Tang (Two-Aged Decoction) with Zhizi, Lian, and Doukou; for worm pain, use Wumei Yin (Mume Decoction) to control Phlegm-fluid.
[Note] Huazhi Wan is an existing formula. Qingzhong Tang consists of Chenpi, Banxia, Fuling, Gancao, Jiangchao Zhizi (Gardenia fried with ginger), Huanglian, and Caodoukou.
Muxiang Liuqi Yin (Aucklandia Flowing-Qi Decoction)
3. For Seven Emotions stagnation, use Liuqi Yin; for palpitation pain due to excessive thinking, use Guipi Tang (Restore the Spleen Decoction); for Internal Cold, use Lizhong Tang (Regulate the Middle Decoction) combined with Wuji San (Five Accumulations Powder); for Zhu pain, use Bijidan or Didang Tang (Defend Against Blood-Stasis Decoction).
Xiao Jianzhong Tang (Minor Construct the Middle Decoction)
4. When Wood overacts on Earth causing abdominal urgent pain, soothe the Liver and harmonize the Spleen using Xiao Jianzhong Tang; for Blood deficiency with Cold pain, treat with Yangrou Tang (Mutton Decoction); for Qi deficiency, add Chenpi and Qingpi to Lizhong Tang.
[Note] Yangrou refers to Yangrou Tang (Mutton Decoction).
Wutou Zhizi Tang (Aconite and Gardenia Decoction)
5. To forcibly resolve various stagnation pains, use Wutou Zhizi Tang; if pain recurs after resolution, add Yuanmingfen; if purging or sweating has already occurred or the deficiency is chronic, and acute pain is unbearable, seek Yawu (Opium).
[Note] "Various stagnations" refers to pains caused by Cold or Heat stagnation. If Cold predominates, processed Chuanwu (Aconitum carmichaelii) is the main herb; if Heat predominates, Jiangchao Zhizi (Gardenia fried with ginger) is the main herb. Yuanming refers to Yuanmingfen (Mirabilite). Yawu refers to pure Opium powder, possibly with a small amount of Shexiang (Musk), made into pills the size of tung tree seeds using rice paste. Each dose is three to five pills, taken with a specific guiding agent. In Materia Medica, it is named: Yili Jindan (One-Pill Golden Pill).