阴黄多缘转属成,脾湿肾寒两亏生,温脾茵陈理中治,温肾茵陈四逆灵。
[注]
阴黄者,乃脾湿肾寒,两虚而成,此最为危候,
温脾去黄,以理中汤加茵陈主之,
温肾去黄,以茵陈四逆汤主之。
(茵陈理中汤) 方见不乳
(茵陈四逆汤) 附子制 干姜 茵陈蒿 甘草炙 水煎服。
(方歌)茵陈四逆汤,附子共干姜,茵陈炙甘草,黄消病渐康。
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水肿俱属脾肺经,肺喘脾胀要分明,上肿属风宜汗散,下肿属湿利冰灵,
通身肿者兼汗利,喘则逐饮胀则攻,再辨阳水与阴水,攻泻温补贵变通。
[注]
小儿水肿,皆因水停于脾肺二经,水停胸中则喘,水停膈中则胀,
其间所肿部位,不可不察,
如肿在腰以上者,属风,法宜发汗,
肿在腰以下者,属湿,法宜利水,
有通身上下皆肿者,系风湿两伤,法宜汗利兼施,
肿而喘不得卧,宜逐肺饮,
肿而胀满便秘,宜攻脾水,
肿从腹起至四肢者,可治,
肿从四肢起至腹者,不可治,
然又有阳水阴水之分,
直详别焉,阳水属实,法宜攻泄,阴水属虚,法宜温补,
应证而施,自无不效也。
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水肿门
肿在上者因风起,急宜发汗莫从容,越婢汤中加苍术,汗后全消病即宁。
[注]
上身肿者,头面肩臂至腰间皆肿也,病因外感风邪,法宜发汗则愈,
经所谓开鬼门是也,以越婢加苍术汤治之。
(越婢汤) 麻黄 石膏煆 甘草生 苍术米泔水浸 水煎服。
(方歌)
越婢汤治风水肿,麻贲甘草共石膏,再加苍术水煎服,能使儿童肿即消。
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水肿门
阴黄多因病情转化而来,由脾湿与肾寒同时亏虚所致。治疗上,温补脾脏用茵陈理中汤,温补肾脏用茵陈四逆汤效果显著。
[注]
阴黄,是由于脾湿和肾寒,两者虚损共同形成的,这是最为危急的证候。
温补脾脏以消除黄疸,以理中汤加入茵陈为主方;
温补肾脏以消除黄疸,以茵陈四逆汤为主方。
(茵陈理中汤)方剂见“不乳”篇。
(茵陈四逆汤)制附子、干姜、茵陈蒿、炙甘草,水煎服。
(方歌)茵陈四逆汤,由附子和干姜组成,加上茵陈和炙甘草,黄疸消退,疾病逐渐康复。
水肿均属于脾经和肺经的病变,肺气喘促和脾腹胀满需要区分清楚。上半身肿属风邪,适宜用发汗法疏散;下半身肿属湿邪,适宜用利水法通利。全身皆肿者需兼用发汗和利水法,有喘症则逐除饮邪,有胀满则攻下积水。还要辨别是阳水还是阴水,攻泻或温补贵在灵活变通。
[注]
小儿水肿,都是因为水液停滞在脾经和肺经。水停在胸中就会气喘,水停在膈中就会腹胀。
其中肿胀的部位,不可不仔细考察。
如肿胀在腰部以上者,属于风邪,治法宜发汗;
肿胀在腰部以下者,属于湿邪,治法宜利水;
有通身上下都肿的,是风湿两伤,治法宜发汗和利水并用;
肿胀且气喘不能平卧的,宜逐除肺中的饮邪;
肿胀且腹胀满、便秘的,宜攻下脾中的水湿;
肿胀从腹部起蔓延至四肢的,可治;
肿胀从四肢起蔓延至腹部的,不可治。
然而又有阳水和阴水的区别,
必须详细辨别。阳水属实证,治法宜攻泄;阴水属虚证,治法宜温补。
根据证候施治,自然没有不有效的。
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水肿门
肿胀在上部是因为风邪引起,急宜发汗,不可从容迟缓。在越婢汤中加入苍术,发汗后肿胀全消,疾病即安宁。
[注]
上身肿,指头面、肩臂直至腰间都肿胀。病因是外感风邪,治法宜发汗则痊愈。
这就是《内经》所说的“开鬼门”(发汗)。用越婢加苍术汤治疗。
(越婢汤)麻黄、煅石膏、生甘草、苍术(米泔水浸泡),水煎服。
(方歌)
越婢汤治疗风水肿,麻黄、石膏、甘草一起用,再加苍术水煎服,能使儿童肿胀即刻消除。
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水肿门
Yin Jaundice (Yin Huang) often arises from disease transformation, resulting from the simultaneous deficiency of Spleen Dampness (Pi Shi) and Kidney Cold (Shen Han). To warm the Spleen and treat jaundice, Yinchen Lizhong Tang (Artemisiae Scopariae Decoction Modified with Bupleuri and Atractylodis Macrocephalae Decoction) is used; to warm the Kidney and treat jaundice, Yinchen Sini Tang (Artemisiae Scopariae Decoction Modified with Aconiti Lateralis Preparata Decoction) is effective.
[Note]
Yin Jaundice is formed by the dual deficiency of Spleen Dampness and Kidney Cold, representing a critical condition.
To warm the Spleen and resolve jaundice, Lizhong Tang (Bupleuri and Atractylodis Macrocephalae Decoction) added with Yinchen (Herba Artemisiae Scopariae) is the primary formula.
To warm the Kidney and resolve jaundice, Yinchen Sini Tang (Artemisiae Scopariae Decoction Modified with Aconiti Lateralis Preparata Decoction) is the primary formula.
(Yinchen Lizhong Tang) See the section on "Failure to Thrive" (Bu Ru).
(Yinchen Sini Tang) Prepared Aconiti Lateralis Radix (Fuzi, 附子), Zingiberis Rhizoma (Ganjiang, 干姜), Herba Artemisiae Scopariae (Yinchenhao, 茵陈蒿), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhigancao, 甘草炙). Decoct in water and take orally.
(Verse for Formula) Yinchen Sini Tang, composed of Fuzi and Ganjiang, plus Yinchen and Zhigancao; as jaundice fades, the illness gradually recovers.
Edema generally belongs to the Spleen and Lung meridians; pulmonary wheezing and splenic distension must be clearly distinguished. Edema in the upper body due to Wind is suitable for diaphoresis (sweating method); edema in the lower body due to Dampness is suitable for promoting urination. For generalized edema, both diaphoresis and diuresis should be combined. If accompanied by wheezing, eliminate fluid retention; if accompanied by distension, purge accumulation. Furthermore, distinguish between Yang Edema and Yin Edema; purging or warming and tonifying requires flexibility.
[Note]
Pediatric edema is caused by water stagnation in the Spleen and Lung meridians. Water stagnating in the chest causes wheezing; water stagnating in the diaphragm causes distension.
The location of swelling must be carefully observed.
If swelling is above the waist, it is due to Wind, and the treatment method should be diaphoresis.
If swelling is below the waist, it is due to Dampness, and the treatment method should be diuresis.
If the entire body is swollen, it is due to injury by both Wind and Dampness, and the treatment method should combine diaphoresis and diuresis.
If swelling is accompanied by wheezing and inability to lie flat, expel lung fluid retention.
If swelling is accompanied by abdominal fullness and constipation, purge spleen water.
Swelling starting from the abdomen and spreading to the limbs is treatable.
Swelling starting from the limbs and spreading to the abdomen is untreatable.
However, there is a distinction between Yang Edema and Yin Edema, which must be detailed. Yang Edema is excess, treated by purging and draining; Yin Edema is deficiency, treated by warming and tonifying.
Applying treatment according to the syndrome will naturally yield efficacy.
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Section on Edema
Swelling in the upper part is caused by Wind; diaphoresis should be applied urgently without delay. Add Cangzhu (Atractylodis Rhizoma) to Yeshibiao Tang (Yepingbiao Decoction); after sweating, the swelling disappears completely, and the patient becomes peaceful.
[Note]
Upper body swelling refers to swelling of the head, face, shoulders, arms, down to the waist. The cause is external contraction of Wind pathogen, and the treatment method is diaphoresis for recovery.
This corresponds to the classic saying "open the ghost gate" (kai guimen, i.e., induce sweating). Treat with Yeshibiao Jia Cangzhu Tang (Yepingbiao Decoction Added with Atractylodis Rhizoma).
(Yeshibiao Tang) Ephedrae Herba (Mahuang, 麻黄), Gypsum Fibrosum (Shigao, 石膏) calcined, Glycyrrhizae Radix et Rhizoma Cruda (Shenggancao, 甘草生), Atractylodis Rhizoma (Cangzhu, 苍术) soaked in rice wash water. Decoct in water and take orally.
(Verse for Formula)
Yeshibiao Tang treats Wind-Water Edema, combining Mahuang, Shigao, and Gancao; adding Cangzhu and decocting in water can make children's swelling disappear immediately.
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Section on Edema