治伤寒表解, 心下痞, 恶寒汗出者.
大黄二两 黄连一两 黄芩一两 附子 ( 炮去皮, 别煮汁 ) 一枚,
,右四味, 切三味, 以麻沸汤二升渍之, 须臾绞去滓, 纳附子汁, 分
温再服.
【注】心下硬痛, 结胸也; 硬而不痛, 心下痞也. 恶寒而复汗出, 非
表不解, 乃表阳虚也. 故以大黄, 黄连, 黄芩泻痞之热, 附子温表之
阳,合内外而治之. 其妙在以麻沸汤渍三黄, 须臾绞去滓, 内别煮附
子汁, 义在泻痞之意轻, 扶阳之意重也.
治伤寒中风, 医反下之, 其人不痢, 日数十行,
谷不化, 腹中雷鸣, 心下痞硬而满, 干呕心烦不得安. 医见心下痞,
谓病不尽, 复下之, 其痞益甚, 止非结热, 但以胃中虚客气上逆, 故
使硬也.
甘草四两 黄芩三两 黄连一两 干姜三两 半夏 ( 洗 ) 半升 大
枣( 擘 ) 十二枚, 右六味, 以水一斗, 煮取六升, 去滓再煎, 取三
升,温服一升, 日三服.
【注】毋论伤寒, 中风, 表未解, 总不可下, 医反下之, 因而成痞.
其人下痢日数十行, 水谷不化, 腹中雷鸣者, 误下胃中空虚也. 心下
痞硬而满, 干呕心烦不得安者, 乘虚客邪上逆也. 医见心下痞硬, 谓
下之不尽, 又复下之, 其痞益甚. 但此非结热之痞, 亦非寒结之痞.
乃乘胃空虚, 客气上逆, 阳陷阴凝之痞也. 方以甘草命名者, 取和缓
之意. 用甘草, 大枣之甘温, 补中缓急, 治痞之益甚. 半夏之辛, 破
客逆之上从. 芩, 连泻阳陷之痞热, 干姜散阴凝之痞寒. 缓急破逆,
泻痞寒热, 备乎其治矣.
治疗伤寒表证已解,出现心下痞塞感,伴有恶寒且汗出的症状。
大黄二两 黄连一两 黄芩一两 附子(炮制、去皮,单独煎煮取汁)一枚,
以上四味药,将其中三味切碎,用滚开的麻沸汤二升浸泡片刻,随即绞去药渣,加入附子的药汁,分两次温服。
【注解】心下部位硬满且疼痛的,是结胸病;硬满但不疼痛的,是心下痞病。恶寒并且出汗,并非表邪未解,而是表阳虚损所致。因此使用大黄、黄连、黄芩来泻除心下的热邪,用附子温补表部的阳气,内外同治。其精妙之处在于用麻沸汤浸泡大黄、黄连、黄芩这三味药,短时间绞去药渣,而将附子另外煎煮取汁,其含义在于泻除痞热的力度较轻,扶助阳气的力度较重。
治疗伤寒或中风病,医生反而使用了攻下法,患者没有形成结胸,但每天腹泻数十次,食物不消化,肠中雷鸣作响,心下痞塞硬满,干呕,心烦意乱不得安宁。医生看到心下痞塞,认为病邪未尽,再次使用攻下法,导致痞塞更加严重。这并非实热结聚,而是因为胃气虚弱,客气上逆,所以使心下感觉硬满。
甘草四两 黄芩三两 黄连一两 干姜三两 半夏(清洗)半升 大枣(掰开)十二枚,以上六味药,用水一斗,煎煮至六升,去掉药渣后再煎,取三升药液,每次温服一升,每日服用三次。
【注解】无论是伤寒还是中风,在表证未解时,总不可使用攻下法,医生反而误用攻下,因而导致痞证。患者每天腹泻数十次,水谷不化,肠中雷鸣,这是误用攻下法导致胃中空虚的表现。心下痞塞硬满,干呕,心烦不得安宁,这是邪气乘虚客于上部并上逆的表现。医生见到心下痞硬,认为是攻下不彻底,又再次攻下,导致痞塞更加严重。但这并非实热结聚的痞证,也不是寒邪结聚的痞证。而是因胃气空虚,客气上逆,阳气下陷、阴气凝滞所导致的痞证。方剂以“甘草”命名,取其调和缓急之意。使用甘草、大枣的甘温之性,补益中焦、缓解急迫,以治疗日益严重的痞证。利用半夏的辛散之性,破除上逆的客气。黄芩、黄连泻除阳气下陷产生的痞热,干姜散除阴气凝滞产生的痞寒。通过缓急、破逆、泻痞、寒热并用,治疗方法完备了。
Treats cases where the exterior syndrome of Cold Damage (Shanghan) has resolved, presenting with epigastric fullness and obstruction (Xin Xia Pi), aversion to cold, and sweating.
Da Huang (Rhei Radix et Rhizoma) 2 liang, Huang Lian (Coptidis Rhizoma) 1 liang, Huang Qin (Scutellariae Radix) 1 liang, Fu Zi (Aconiti Lateralis Radix Praeparata) one piece (processed, skin removed, decocted separately for juice).
The above four herbs: chop three of them (Da Huang, Huang Lian, Huang Qin), soak them in two sheng of boiling water (Ma Fei Tang) for a short while, then strain out the dregs, add the juice of the separately decocted Fu Zi, and take half warm, divided into two doses.
[Annotation] Epigastric hardness accompanied by pain indicates Jie Xiong (Chest Binding); hardness without pain indicates Xin Xia Pi (Epigastric Obstruction). Aversion to cold combined with sweating indicates not that the exterior pathogen remains unresolved, but rather deficiency of Exterior Yang. Therefore, Da Huang, Huang Lian, and Huang Qin are used to drain the heat causing the obstruction, while Fu Zi is used to warm the Exterior Yang, treating both interior and exterior simultaneously. The subtlety lies in soaking the three yellow herbs (San Huang) in boiling water briefly and straining them, while decocting Fu Zi separately; this implies a lighter intention to drain the obstruction's heat and a heavier intention to support Yang.
Treats Cold Damage or Wind Strike where the physician erroneously applied purgation. The patient does not develop Chest Binding but suffers from diarrhea dozens of times a day, undigested food in stool, borborygmus (rumbling in the abdomen), epigastric fullness and hardness, dry retching, vexation, and restlessness. Seeing the epigastric obstruction, the physician assumes the pathogen is not fully eliminated and applies purgation again, making the obstruction more severe. This is not due to accumulated heat, but rather stomach deficiency allowing hostile Qi to rebel upward, causing the sensation of hardness.
Gan Cao (Glycyrrhizae Radix et Rhizoma) 4 liang, Huang Qin (Scutellariae Radix) 3 liang, Huang Lian (Coptidis Rhizoma) 1 liang, Gan Jiang (Zingiberis Rhizoma) 3 liang, Ban Xia (Pinelliae Tuber) half sheng (washed), Da Zao (Jujubae Fructus) twelve pieces (split).
The above six herbs: decoct in ten dou of water until six sheng remain, remove dregs, and decoct again until three sheng remain. Take one sheng warm, three times daily.
[Annotation] Regardless of whether it is Cold Damage or Wind Strike, if the exterior is unresolved, purgation must never be used. Erroneous purgation leads to obstruction. Diarrhea dozens of times daily with undigested food and borborygmus results from gastric emptiness caused by erroneous purgation. Epigastric fullness/hardness, dry retching, and vexation result from pathogenic factors invading due to deficiency and rebelling upward. Seeing epigastric hardness, the physician mistakenly believes incomplete purgation occurred and purges again, worsening the obstruction. However, this is neither an obstruction of accumulated heat nor one of cold accumulation. It is an obstruction caused by gastric emptiness, rebellious hostile Qi, sinking of Yang, and coagulation of Yin. The formula is named after Gan Cao (Licorice) to signify its harmonizing and moderating intent. Gan Cao and Da Zao use their sweet-warm nature to tonify the Middle and relieve urgency, addressing the worsening obstruction. Ban Xia uses its acrid nature to break the rebellion of hostile Qi. Huang Qin and Huang Lian drain the heat of the obstructed, sunken Yang, while Gan Jiang disperses the cold of coagulated Yin. By relieving urgency, breaking rebellion, draining obstruction, and addressing cold and heat, the treatment is comprehensive.