治少阴病, 得之二, 三日以上, 心中烦不得卧.
黄连四两 黄芩一两 芍药二两 鸡子黄二枚 阿胶三两, 右五味,
以水五升, 先煮三物, 取二升, 去滓, 纳胶烊尽, 小冷, 纳鸡子黄,
搅令相得, 温服七合, 日三服.
【集注】柯琴曰: 此少阴病之泻心汤也. 凡泻心必藉连, 芩, 而导引
有阴阳之别. 病在三阳, 胃中不和, 而心下痞硬者, 虚则加参, 甘补
之,实则加大黄下之. 病在少阳, 而心中烦不得卧者, 既不得用参,
甘以助阳, 亦不得用大黄以伤胃矣. 用芩, 连以直折心火, 用阿胶以
补肾阴, 鸡子黄佐芩, 连于泻心中补心血, 芍药佐阿胶于补阴中敛阴
气,斯则心肾交合, 水升火降. 是以扶阴泻阳之方, 变而为滋阴和阳
之剂也. 是则少阴之火, 各归其部, 心中之烦不得卧可除矣. 经曰:
阴平阳秘, 精神乃治. 斯方之谓欤!
治中气不运, 腹中不实, 口失滋味, 病久不食, 脏
腑不调, 与伤寒直中太阴, 自痢不渴, 寒多而呕等证.
人参三两 白术三两 甘草三两 干姜三两., 右四味, 捣筛为末,
蜜丸如鸡子黄大, 以沸汤数合和一丸, 研碎, 温服之. 日三, 四枚,
夜二枚; 腹中未热, 益至三, 四丸. 然不及汤, 汤法以四物根据两数切
,用水八升, 煮取三升, 去滓, 温服一升, 日三服. 若脐上筑者, 肾
气动也, 去术加桂四两. 多吐者, 去术加生姜三两. 下多者, 还用术
.悸者, 加茯苓二两. 渴欲得水者, 加术, 足前成四两半. 腹中痛者
,加人参, 足前成四两半. 寒者, 加干姜, 足前成四两半. 腹满者,
去术加附子一枚. 服汤后如食顷, 饮热粥一升许, 微自温勿发衣被.
【集注】程应旄曰: 阳之动始于温, 温气得而谷精运, 谷气升而中气
赡,故名曰理中, 实以燮理之功, 予中焦之阳也. 若胃阳虚, 则中气
失宰, 膻中无发宣之用, 六腑无洒陈之功, 犹如釜薪失焰, 故下致清
榖,上失滋味, 五脏凌夺, 诸证所由来也. 参, 术, 炙草, 所以守中
州,干姜辛以温中, 必假之以焰釜薪而腾阳气, 是以谷入于阴, 长气
于阳, 上输华盖, 下摄州都, 五脏六腑, 皆以受气, 此理中之旨也.
若水寒互胜, 即当脾肾双温, 加以附子, 则命门益土母温矣. 白术补
脾,得人参则壅气, 故脐下动气; 吐多腹满者, 去术也. 加桂以伐肾
邪,加生姜以止呕也. 加附子以消阴也. 下多者湿胜也 , 还用术燥
湿也. 渴欲饮水饮渴也, 加术使饮化津生也. 心下悸停水也, 加茯苓
导水也. 腹中痛倍人参, 虚痛也. 寒者加干姜, 寒甚也.
治疗少阴病,发病两三天以上,心中烦躁,无法安卧。
黄连四两 黄芩一两 芍药二两 鸡蛋黄两个 阿胶三两,以上五味药,
用水五升,先煮前三味药,取药液二升,去渣,加入阿胶使其完全溶化,稍冷却后,加入鸡蛋黄,
搅拌均匀,温服七合,每日三次服用。
【集注】柯琴说:这是治疗少阴病的泻心汤类方剂。凡是使用泻心法必须借助黄连、黄芩,但引导邪气的方法有阴阳的区别。病在三阳经,胃中不和,导致心下痞塞硬满的,虚证加人参、甘草来补益,实证加大黄来攻下。病在少阳经,出现心中烦躁无法安卧的,既不能用参、甘来助长阳气,也不能用大黄来损伤胃气。此处用黄芩、黄连来直折心火,用阿胶来补肾阴,鸡蛋黄辅助黄芩、黄连,在清泻心火的同时补益心血,芍药辅助阿胶,在滋补阴液的同时收敛阴气,这样就能使心肾相交,水升火降。因此,这是一个扶持阴液、清泻阳热的方剂,转变为滋阴调和阴阳的药剂。这样少阴的火热之气各归其位,心中的烦躁无法安卧的症状就可以消除了。经文说:阴气平和,阳气固秘,精神才能正常。说的就是这个方剂吧!
治疗中焦之气不运转,腹部感觉不实,口中失去滋味,病程长久不想进食,脏腑功能不调,以及伤寒邪气直接侵入太阴经,自发性腹泻且不口渴,寒气多而呕吐等症状。
人参三两 白术三两 甘草三两 干姜三两,以上四味药,捣碎过筛制成粉末,
用蜂蜜做成如鸡蛋黄大小的丸药,用沸水几合冲服一丸,研碎,温服。每日三次,每次四枚,夜间两次,每次两枚;如果腹部没有温热感,增加到每次三到四丸。然而,这不如汤剂效果好,汤剂的用法是将这四味药按照规定的重量切片,
用水八升,煮取三升药液,去渣,温服一升,每日三次服用。如果感到脐上跳动,是肾气动荡的表现,去掉白术,加入桂枝四两。呕吐多的,去掉白术,加入生姜三两。腹泻多的,仍使用白术。心悸的,加入茯苓二两。想喝水的,增加白术,使总量达到四两半。腹部疼痛的,增加人参,使总量达到四两半。寒象明显的,增加干姜,使总量达到四两半。腹部胀满的,去掉白术,加入附子一枚。服药后大约一顿饭的时间,喝热粥一升左右,使身体微微温暖,不要发汗或增减衣被。
【集注】程应旄说:阳气的活动始于温煦,温煦之气得到施展则谷精得以运化,谷气上升则中气充足,所以名叫理中,实际上是运用燮理的功效,给予中焦阳气。如果胃阳虚弱,则中气失去主宰,膻中失去宣发的作用,六腑失去洒陈(布散精气)的功能,就像锅灶失去了火焰,所以下面导致完谷不化的泄泻,上面失去味觉享受,五脏相互侵凌争夺,各种症状由此产生。人参、白术、炙甘草,用来守护中州(脾胃),干姜辛热以温中,必须借助它像给锅灶添柴一样腾起阳气,因此谷物进入体内,在阳分生长气机,向上输布至华盖(心肺),向下摄纳至州都(膀胱),五脏六腑都从中受气,这就是理中的宗旨。如果水寒互相胜复,就应当脾肾双温,加上附子,那么命门之火就能温煦土母(脾)。白术补脾,得人参则容易导致气机壅滞,所以出现脐下动气;呕吐多且腹部胀满的,要去掉白术。加入桂枝以伐除肾邪,加入生姜以止呕。加入附子以消除阴寒。腹泻多的是湿邪盛,仍用白术燥湿。想喝水的是津液不足,加白术使饮入之水化为津液。心下悸动是水饮停聚,加茯苓导利水湿。腹部疼痛加倍用人参,是虚痛。寒象明显加干姜,是寒邪严重。
Treat Shaoyin disease (Shaoyin syndrome), occurring two to three days or more after onset, characterized by vexation in the heart and inability to lie down.
Coptidis Rhizoma (Huanglian) four liang, Scutellariae Radix (Huangqin) one liang, Paeoniae Radix Alba (Shaoyao) two liang, Yolk of Chicken Egg (Jizihuang) two pieces, Euphorbiae Concretio (Ejiao) three liang. The above five herbs:
Boil the first three herbs in five sheng of water, reduce to two sheng, remove dregs, add Ejiao until completely melted, allow to cool slightly, add Yolk of Chicken Egg,
Stir well to mix, take seven ge warm, three times a day.
[Collected Notes] Ke Qin said: This is a Xixin Tang (Heart-Draining Decoction) formula for Shaoyin disease. Whenever Xixin methods are used, Huanglian and Huangqin are indispensable, but the guiding methods differ between Yin and Yang. When the disease is in the Three Yang meridians, with disharmony in the stomach leading to fullness and hardness below the heart, deficiency requires adding Ginseng Radix et Rhizoma (Renshen) and Glycyrrhizae Radix et Rhizoma Preparata (Gancao) to tonify, while excess requires Rhei Radix et Rhizoma (Dahuang) to purge. When the disease is in the Shaoyang meridian, presenting with vexation in the heart and inability to lie down, neither Renshen and Gancao should be used to assist Yang, nor Dahuang to damage the Stomach Qi. Here, Huangqin and Huanglian are used to directly subdue Heart Fire, Ejiao is used to tonify Kidney Yin, Yolk of Chicken Egg assists Huangqin and Huanglian to tonify Heart Blood while draining Heart Fire, and Shaoyao assists Ejiao to astringe Yin Qi while nourishing Yin. Thus, Heart and Kidney interact, Water ascends and Fire descends. Therefore, this formula, originally supporting Yin and draining Yang, transforms into an agent that nourishes Yin and harmonizes Yang. In this way, the Fire of Shaoyin returns to its proper place, and the vexation in the heart with inability to lie down can be eliminated. The Classic states: "When Yin is peaceful and Yang is secure, Spirit becomes regulated." Does not this formula exemplify this?
Treat dysfunction of Middle Jiao Qi transportation, feeling of emptiness in the abdomen, loss of taste, prolonged illness with anorexia, disharmony of Zang-Fu organs, as well as symptoms such as direct invasion of Taiyin by Cold Damage pathogens, spontaneous diarrhea without thirst, excessive cold with vomiting.
Ginseng Radix et Rhizoma (Renshen) three liang, Atractylodis Macrocephalae Rhizoma (Baizhu) three liang, Glycyrrhizae Radix et Rhizoma Preparata (Gancao) three liang, Zingiberis Rhizoma Recens (Ganjiang) three liang. The above four herbs:
Pulverize and sieve, make pills with honey the size of a Chicken Egg Yolk. Dissolve one pill in several he of boiling water, crush, and take warm. Three times a day, four pills each time; at night, two pills each time. If there is no warmth in the abdomen, increase to three or four pills per dose. However, this is inferior to the decoction method. The decoction method: slice the four herbs according to the specified weights,
Boil in eight sheng of water, reduce to three sheng, remove dregs, take one sheng warm, three times a day. If there is a pulsating sensation above the navel, indicating Kidney Qi movement, remove Baizhu and add Cinnamomi Ramulus (Guizhi) four liang. For excessive vomiting, remove Baizhu and add Zingiberis Rhizoma (Shengjiang) three liang. For excessive diarrhea, continue using Baizhu. For palpitations, add Poria (Fuling) two liang. For thirst desiring water, increase Baizhu to a total of four and a half liang. For abdominal pain, increase Renshen to a total of four and a half liang. For cold signs, increase Ganjiang to a total of four and a half liang. For abdominal fullness, remove Baizhu and add Aconiti Lateralis Radix Praeparata (Fuzi) one piece. After taking the decoction, approximately the time it takes to eat a meal, drink about one sheng of hot porridge to induce slight warmth; do not induce sweating or adjust clothing/bedding excessively.
[Collected Notes] Cheng Yingmao said: The activity of Yang begins with warming. When warming Qi is effective, grain essence is transported; when Grain Qi ascends, Middle Qi is sufficient. Hence it is named Lizhong (Regulating the Middle), actually employing the function of regulation to provide Yang Qi to the Middle Jiao. If Stomach Yang is deficient, Middle Qi loses its control, Danzhong (Conception Vessel area/Chest) loses its dispersing function, and the Six Fu organs lose their sprinkling and arranging function. It is like a stove losing its fire, thus leading below to undigested food in stool (Qingu) and above to loss of taste. The mutual encroachment of the Five Zang organs causes these various symptoms. Renshen, Baizhu, and Prepared Gancao guard the Central State (Middle Jiao); Ganjiang is pungent and warm to heat the middle. It must borrow its flame-like property to stoke the stove's fire and raise Yang Qi. Thus, grain enters the Yin, generates Qi in the Yang, transports upward to the Huagai (Lungs/Heart), and secures downward to the Zhoudou (Bladder). The Five Zang and Six Fu organs all receive Qi from this. This is the purport of Lizhong. If Water and Cold compete mutually, both Spleen and Kidney should be warmed simultaneously; adding Fuzi warms the Mother of Earth (Spleen) via the Mingmen Fire. Baizhu tonifies the Spleen; combined with Renshen, it may cause Qi stagnation, leading to Qi movement below the umbilicus. For excessive vomiting and abdominal fullness, Baizhu is removed. Guizhi is added to suppress Kidney pathogenic factors, Shengjiang is added to stop vomiting, and Fuzi is added to eliminate Yin-Cold. Excessive diarrhea indicates dampness excess, so Baizhu is used again to dry dampness. Thirst desiring water indicates fluid insufficiency; adding Baizhu helps transform fluids. Palpitations below the heart indicate water retention; Fuling is added to guide out water. Abdominal pain doubled with Renshen indicates deficiency pain. Cold signs require increased Ganjiang for severe cold.