大黄 芒硝 浓朴 枳实
土郁者,痞、满、燥、实、坚全俱,脉来有力而实,此方主之。
土,脾胃土也,为仓廪之官,无物不受,喜传化而恶停滞。若里邪作实,则令人痞、满
、燥、实、坚全俱。脉来实者为里实。是方也,浓朴苦温以去痞,枳实苦寒以泻满,芒硝咸
寒以润燥软坚,大黄苦寒以泻实去热。经曰∶土郁则夺之。此之谓也。
麻黄(去节) 赤芍药(各三钱) 葛根(一钱五分) 淡豉(半合)
金郁者,喘满,脉浮,此方主之。
金,肺金也,为清虚之脏,皮毛之合,喜清虚而恶壅塞。塞之则气自实,令人喘满。肺
主皮毛,故令脉浮。是方也,麻黄、干葛之轻,可以去实。淡豆豉之腐,可以推陈。赤芍药
之酸,可以泻壅。经曰∶金郁则泄之。此之谓也。
黄柏一味,炒褐色作丸。
水郁者,腰股痛,足下热,此方主之。
水,肾也。水郁者,肾部有郁火也。腰者,肾之府,故令腰痛。肾脉斜走足心,上股内
后廉故股内亦痛,而足心热。黄柏苦而润,润能益水,苦能降下。经曰∶水郁则折之。此之
谓也。
叙曰∶疸,黄疾也,初学易谈之,此未遇盘根错节耳,以故芒利不若干将,鲜有不断其
锋者。今即名人之方十三首而考之,疸证之难易,概可见矣!
黄芩(炒) 黄连(炒) 栀子(炒黑) 茵陈 猪苓 泽泻 苍术(制) 青皮(去
穣,炒)
草龙胆(各五分)
谷疸加三棱、莪术、缩砂、陈皮、神曲。
丹溪云∶疸证不必分五,同是湿热。故以此方主之。
疸,病黄之名也。五疸者,黄汗、黄胆、酒疸、谷疸、女劳疸也。疸分五证,始于仲景
之《金匮要略》,此先圣示人以博也。不必分五,同是湿热,此后贤示人以略也。是方也,
芩、连、栀子、龙胆之苦,所以去热。猪苓、泽泻之淡,所以去湿。茵陈蒿气微寒而味苦平,
为
疸诸品之加,乃推陈致新之意也。虽然,丹溪翁之言不能无弊,使后之学人宗其言,至于举
一而废百,宜乎视仲景之堂,若登天也。故古方治疸有吐者,有汗者,有下者,有寒者,有
温者,有润者,有燥者,有软坚者,有消导者,有逐血者。今曰不必分五,则仲景之门犹不
入,奈何而窥百家之奥乎?
大黄、芒硝、厚朴、枳实。
土气郁结(指脾胃功能受阻)的情况,表现为痞塞、胀满、干燥、结实、坚硬等症状全部具备,脉象有力而坚实,此方主治。
“土”指的是脾胃之土,它是掌管仓储的器官,没有东西不接受,喜欢传导消化而厌恶停滞。如果体内的邪气导致实证,就会让人出现痞、满、燥、实、坚全部具备的症状。脉象坚实属于里实证。这个方子中,厚朴味苦性温,用来消除痞塞;枳实味苦性寒,用来泻除胀满;芒硝味咸性寒,用来润燥并软化坚硬;大黄味苦性寒,用来泻下结实并清除热邪。《内经》说:“土气郁结就要用攻夺的方法。”说的就是这种情况。
麻黄(去节)、赤芍药(各三钱)、葛根(一钱五分)、淡豆豉(半合)。
金气郁结(指肺气受阻)的情况,表现为气喘胸满,脉象浮,此方主治。
“金”指的是肺金,它是清虚的脏器,与皮毛相合,喜欢清虚而厌恶壅塞。被壅塞则气自盛,导致人喘促胸满。肺主皮毛,所以导致脉象浮。这个方子中,麻黄、葛根药性轻扬,可以去除实邪;淡豆豉气味腐熟,可以推陈出新;赤芍药味酸,可以泻除壅滞。《内经》说:“金气郁结就要用宣泄的方法。”说的就是这种情况。
黄柏一味,炒至褐色后制成丸剂。
水气郁结(指肾气受阻)的情况,表现为腰部和股部疼痛,足心发热,此方主治。
“水”指的是肾。水气郁结,是指肾部有郁积的火邪。腰部是肾的府邸,所以导致腰痛。肾脉斜行走向足心,上行经过大腿内侧后缘,所以大腿内侧也痛,且足心发热。黄柏味苦而滋润,滋润能益水,苦味能降泄下行。《内经》说:“水气郁结就要用折损(制约)的方法。”说的就是这种情况。
序言说:黄疸,是一种发黄的疾病,初学者容易谈论它,这是因为还没有遇到盘根错节的复杂情况罢了,因此锋利的芒刃不如干将剑锋利,很少有不能切断锋刃的。现在我就对名家的十三首治疗黄疸的方剂进行考证,黄疸病症的难易程度,大概就可以看清楚了!
黄芩(炒)、黄连(炒)、栀子(炒黑)、茵陈、猪苓、泽泻、苍术(制)、青皮(去瓤,炒)、草龙胆(各五分)。
如果是谷疸,加用三棱、莪术、缩砂仁、陈皮、神曲。
朱丹溪说:黄疸病症不必分为五种,都是湿热所致。所以用这个方子来主治。
黄疸,是病体发黄的名目。五疸,即黄汗、黄疸、酒疸、谷疸、女劳疸。黄疸分为五种证型,始于张仲景的《金匮要略》,这是先圣教导人们要广泛了解病情。说不必分为五种,认为都是湿热,这是后世贤者教导人们要抓住主要矛盾。这个方子中,黄芩、黄连、栀子、龙胆的苦味,是用来清除热邪的。猪苓、泽泻的淡味,是用来渗湿利水的。茵陈蒿气微寒而味道苦平,作为治疗黄疸诸药中的加味,体现了推陈致新的意思。虽然如此,朱丹溪先生的话也不能没有弊端,如果后学的医者尊崇他的话,以至于举其一端而废弃其他方面,那么想要进入张仲景医学殿堂的人,简直就像登天一样困难啊。所以古代方剂治疗黄疸,有的用吐法,有的用汗法,有的用下法,有的用寒凉,有的用温热,有的用滋润,有的用燥湿,有的用软坚散结,有的用消食导滞,有的用逐瘀活血。现在说不必分为五种,那么连张仲景的门径都还没进去,又怎么能窥探百家医理的深奥呢?
Rhubarb (Da Huang), Mirabilite (Mang Xiao), Magnolia Bark (Hou Po), Immature Bitter Orange (Zhi Shi).
When Earth Qi stagnation (referring to the obstruction of Spleen and Stomach function) occurs, symptoms such as fullness (Pi), distension (Man), dryness (Zao), solidity (Shi), and hardness (Jian) all present together, and the pulse is forceful and solid. This formula is indicated.
"Earth" refers to the Earth of the Spleen and Stomach, which serves as the official in charge of granaries, accepting all substances, favoring transmission and transformation while disliking stagnation. If pathogenic factors inside the body lead to excess conditions, it causes the simultaneous presence of Pi, Man, Zao, Shi, and Jian. A solid pulse indicates an Interior Excess condition. In this formula, Hou Po (Magnolia Bark), bitter and warm, eliminates Pi; Zhi Shi (Immature Bitter Orange), bitter and cold, drains Man; Mang Xiao (Mirabilite), salty and cold, moistens dryness and softens hardness; Da Huang (Rhubarb), bitter and cold, drains Shi and clears heat. The Classic says: "When Earth is stagnant, use the method of purging." This is what is meant.
Ephedra Herb (Mahuang, removed nodes), Red Peony Root (Chishao) (each 3 qian), Kudzu Root (Gegen) (1.5 qian), Fermented Soybean (Danshi).
When Metal Qi stagnation (referring to the obstruction of Lung Qi) occurs, characterized by wheezing and chest fullness, with a floating pulse, this formula is indicated.
"Metal" refers to Lung Metal, a clear and empty organ, associated with the skin and hair, favoring clarity and emptiness while disliking congestion. Congestion leads to Qi becoming excessive, causing wheezing and chest fullness. The Lung governs the skin and hair, hence the pulse becomes floating. In this formula, Mahuang (Ephedra Herb) and Gegen (Kudzu Root) are light and ascending, capable of removing excess; Danshi (Fermented Soybean) has a fermented nature, capable of pushing out the old; Chishao (Red Peony Root) is sour, capable of draining congestion. The Classic says: "When Metal is stagnant, use the method of venting." This is what is meant.
Phellodendron Bark (Huangbai), one ingredient, stir-fried until brown and made into pills.
When Water Qi stagnation (referring to the obstruction of Kidney Qi) occurs, characterized by pain in the waist and thighs, and heat in the soles of the feet, this formula is indicated.
"Water" refers to the Kidney. Water Qi stagnation implies the presence of stagnant fire in the Kidney region. The waist is the mansion of the Kidney, hence waist pain. The Kidney meridian slants towards the sole of the foot and ascends along the posterior medial aspect of the thigh, hence pain in the inner thigh and heat in the sole. Huangbai (Phellodendron Bark) is bitter and moistening; moistening benefits Water, and bitterness directs downward. The Classic says: "When Water is stagnant, use the method of restraining." This is what is meant.
Preface states: Jaundice is a disease characterized by yellowing. Beginners may easily discuss it, but they have not yet encountered complex and tangled cases. Therefore, a sharp blade is not as effective as the Ganjiang sword; few can cut through the edge without difficulty. Now, I will examine thirteen formulas for jaundice from famous physicians, and the severity and difficulty of jaundice syndromes can be generally understood!
Scutellaria Root (Huangqin, fried), Coptis Rhizome (Huanglian, fried), Gardenia Fruit (Zhizi, fried black), Artemisia Capillari Spore (Yinchen), Polyporus (Zuling), Alisma Rhizome (Zexie), Atractylodes Macrocephala Rhizome (Cangzhu, processed), Green Tangerine Peel (Qingpi, pith removed, fried), Gentiana Scabra Root (Caolongdan) (each 0.5 qian).
For Gu Dan (Grain Jaundice), add Burreed Tuber (Sanleng), Curcuma Wenyujin Rhizome (Ezhu), Amomum Villosum Fruit (Suosha), Tangerine Peel (Chenpi), Medicated Leaven (Shenqu).
Zhu Danxi said: Jaundice syndromes need not be divided into five types; they are all caused by Damp-Heat. Therefore, this formula is used to treat them.
Jaundice is the name for diseases manifesting with yellowing. The Five Jaundices are Huanghan (Yellow Sweat), Huangdan (Jaundice), Jiudan (Wine Jaundice), Gudan (Grain Jaundice), and Nulaodan (Sexual Exhaustion Jaundice). The classification of jaundice into five syndromes originated from Zhang Zhongjing's *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), showing that the ancient sages taught people to understand broadly. Saying there is no need to divide them into five, asserting they are all Damp-Heat, shows that later scholars taught people to grasp the essentials. In this formula, the bitterness of Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit), and Longdan (Gentiana Root) is used to clear heat. The blandness of Zuling (Polyporus) and Zexie (Alisma Rhizome) is used to drain dampness. Yinchenhao (Artemisia Capillari Spore) has a slightly cold qi and a bitter-pungent taste; added among various herbs for jaundice, it embodies the intention of eliminating the old and generating the new. Nevertheless, Zhu Danxi's words cannot be without flaws. If later practitioners revere his words to the extent of focusing on one aspect while neglecting others, then entering the hall of Zhang Zhongjing's medical teachings would be like climbing to heaven. Thus, ancient formulas for treating jaundice include methods of vomiting, sweating, purging, cooling, warming, moistening, drying, softening hardness, promoting digestion, and dispelling blood stasis. To say now that there is no need to divide them into five means one has not even entered Zhang Zhongjing's gate, let alone fathom the profundities of the hundred schools of medicine.