附子(去皮脐,一枚) 大黄(酒浸) 黄连(去毛,炒) 黄芩(炒,各一两)
伤寒心下痞,汗出恶寒者,此方主之。
心下痞,故用三黄以泻痞;恶寒,汗出,故用附子以回阳。无三黄,则不能以去痞热;
无附子,恐三黄益损其阳。热有附子,寒有三黄,寒热并用,斯为有制之兵矣,张机氏谓
医家之善将将者也。俗医用寒则不用热,用热则不用寒,何以异于胶柱而鼓瑟乎?
生姜四两 甘草(炙) 人参(去芦) 黄芩(炒,各三两) 半夏(半升,制) 黄
连(去毛)
伤寒中风,医反下之,其人下利日数十行,谷不化,腹中雷鸣,心下痞硬而满,干呕,
心烦不得安者,此方主之。
病在表而反下之,则逆矣。下面虚其中气,则表邪乘之而入,虚不任邪,故不利日数十
行,今人谓之挟热利也。火性急速,谷虽入而未及化,故谷不化;虚阳奔迫,故令腹中雷鸣;
中
胃虚之圣药也。生姜、半夏、干姜,呕逆之圣药也;黄连、黄芩,痞热之圣药也。
芫花(熬) 甘遂 大戟(各五分) 大枣(十枚)
伤寒表证已去,其人 汗出,心下痞硬,胁痛,干呕,短气者,此邪热内蓄而有伏饮
也,本方主之。
芫花之辛能散饮,戟、遂之苦能泄水。又曰∶甘遂能直达水饮所结之处。三物皆峻利,
故用大枣以益土,此戎衣之后而发巨桥之意也。是方也,惟壮实者能用之,虚羸之人,未可
轻与也。
附子(去皮和脐,一枚) 大黄(用酒浸泡) 黄连(去毛,炒制) 黄芩(炒制,各一两)
伤寒病导致心下痞塞,伴有出汗且怕冷的症状,此方主治。
心下痞塞,所以使用三黄(黄连、黄芩、大黄)来泻除痞热;怕冷、出汗,所以使用附子来回阳救逆。没有三黄,就不能去除痞热;没有附子,恐怕三黄会进一步损伤阳气。热证有附子配合,寒证有三黄配合,寒热药物并用,这才是有节制的用兵之道,张机(张仲景)被称为善于统帅将领的医生。庸俗的医生用药时,用寒凉药就不配伍温热药,用温热药就不配伍寒凉药,这与胶住琴柱却想弹奏出美妙音乐有什么区别呢?
生姜四两 甘草(炙烤) 人参(去芦头) 黄芩(炒制,各三两) 半夏(半升,经炮制) 黄连(去毛)
伤寒或中风病,医生反而使用了攻下法,患者每天腹泻数十次,食物不消化,肠中雷鸣般作响,心下痞塞坚硬且胀满,干呕,心烦意乱不得安宁,此方主治。
病邪在表而医生反而攻下,这是误治。攻下导致中气虚弱,表邪乘虚而入,正气虚弱不能抵御邪气,所以每天腹泻数十次,现在人称之为挟热利。火性急迫快速,谷物虽然进入胃中但来不及消化,所以出现完谷不化;虚阳奔迫,所以导致腹中雷鸣;(此处原文似有缺漏,结合后文推测意为:人参是补益中气的圣药)。生姜、半夏、干姜,是治疗呕吐逆气的圣药;黄连、黄芩,是治疗痞热的圣药。
芫花(熬制) 甘遂 大戟(各五分) 大枣(十枚)
伤寒表证已经解除,患者出汗,心下痞塞坚硬,胁肋疼痛,干呕,呼吸短促,这是邪热内蓄且有伏饮(潜伏的水饮邪气),本方主治。
芫花的辛味能发散水饮,大戟、甘遂的苦味能泄下水湿。又说:甘遂能直达水饮结聚之处。这三味药都药性峻猛猛烈,所以使用大枣来补益脾胃(土),这好比是在战争结束后发放粮食救济百姓的意思。这个方剂,只有身体壮实的人才能使用,身体虚弱消瘦的人,不可轻易给予。
Fuzi (Aconiti Lateralis Radix Praeparata, peeled and de-navelled, one piece) Dahuang (Rhei Radix et Rhizoma, soaked in wine) Huanglian (Coptidis Rhizoma, de-fuzzed, stir-fried) Huangqin (Scutellariae Radix, stir-fried, each 1 liang)
For Taiyang disease presenting with fullness and oppression in the epigastrium (Xin Xia Pi), sweating, and aversion to cold, this formula is indicated.
Fullness and oppression in the epigastrium is treated by Sanhuang (the "Three Yellows": Coptidis Rhizoma, Scutellariae Radix, and Rhei Radix et Rhizoma) to drain the heat causing the obstruction; aversion to cold and sweating are treated by Fuzi to restore Yang Qi. Without Sanhuang, the heat of the obstruction cannot be removed; without Fuzi, there is a fear that Sanhuang will further damage Yang Qi. With Fuzi addressing the heat aspect and Sanhuang addressing the cold aspect, the simultaneous use of cold and hot herbs constitutes disciplined military strategy. Zhang Ji (Zhang Zhongjing) was known as a physician skilled in commanding generals. Vulgar physicians, when using cold-natured herbs, do not combine them with hot-natured ones, and vice versa. How is this different from gluing the bridges of a zither and attempting to play music?
Shengjiang (Zingiberis Rhizoma Recens, four liang) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) Renshen (Ginseng Radix, de-rhizome) Huangqin (Scutellariae Radix, stir-fried, each 3 liang) Banxia (Pinelliae Tuber, half sheng, processed) Huanglian (Coptidis Rhizoma, de-fuzzed)
For Taiyang disease or Wind-stroke where the physician erroneously applied purgation, resulting in diarrhea occurring dozens of times a day, undigested food in the stool, borborygmus (rumbling in the abdomen), hardness and fullness in the epigastrium, dry heaving, irritability, and inability to find peace, this formula is indicated.
When the pathogen is at the exterior level but the physician erroneously applies purgation, it creates an adverse situation. Purgation empties the Middle Jiao (Zhong Qi), allowing exterior pathogens to penetrate inward. Due to deficiency and inability to resist the pathogen, diarrhea occurs dozens of times daily, a condition now referred to as Diarrhea with Heat (Xie Re Li). Fire nature is rapid and urgent; although grain enters the stomach, it fails to digest in time, hence undigested food in stool. Rushing deficient Yang causes borborygmus. (Note: The original text implies Ren Shen is the holy medicine for Spleen/Stomach deficiency). Shengjiang, Banxia, and Ganjiang (Zingiberis Rhizoma) are the holy medicines for vomiting and rebellious Qi; Huanglian and Huangqin are the holy medicines for Pi-heat (fullness-heat).
Yuanhua (Genkwa Flos, boiled) Gansui (Kansui Radix) Daji (Euphorbiae Pekinensis Radix, each 5 fen) Dazao (Jujubae Fructus, ten pieces)
When the exterior syndrome of Taiyang disease has resolved, yet the patient presents with sweating, hardness and fullness in the epigastrium, hypochondriac pain, dry heaving, and shortness of breath, this indicates internal accumulation of evil heat and latent fluid retention (Fu Yin). This formula is indicated.
The pungency of Yuanhua can dissipate fluid retention; the bitterness of Daji and Gansui can drain water-dampness. It is also said that Gansui can reach directly to the site where water-dampness is knotted. These three substances are all峻利 (pungent and drastic/strongly purgative); therefore, Dazao is used to tonify Earth (Spleen/Stomach). This is analogous to the policy of distributing grain after a war. This formula should only be used in robust and strong individuals; those who are weak and emaciated should not be lightly administered this prescription.