治伤寒胸中有热,胃中有邪气,腹中痛,欲呕吐者。
黄连 甘草 干姜(各三两) 人参(二两) 桂枝(三两) 半夏(半斤) 大枣(十
二
枚)
上七味,以水一斗,煮取六升,去滓,温服一升,日三服,夜二服。
程郊倩曰∶热在胸中,有烦躁郁闷之症,可知胃中反有邪气,以寒邪被格在下故也。此
证寒
腹中痛
上下相
气,升
干姜,
成无己曰∶湿家下后,舌上如胎者,以丹田有热,胸中有寒,是邪气入里,而为下热上
寒也
治太阳中风,表解后里气不和,下利,呕逆,心中至胁痞满硬痛,汗出,短气,头痛,
不恶
大枣(十枚,掰) 甘遂 大戟 芫花(熬,各等分)
上三味,各别捣为散,以水一升半,先煮大枣肥者十枚,取八合,去滓,纳末药。强人
一钱
柯韵伯曰∶仲景利水之方,种种不同,此其最峻者也。凡水气为患,或喘,或咳,或悸,或
噎,或吐,或利,或无汗,病在一处而止;此则外走皮毛而汗出,上走咽喉而呕逆,下走肠
胃而下利,水邪之泛溢于外者,浩浩莫御矣。且头痛,短气,心腹胁下皆痞满而硬痛,是水
邪尚留结于中,三焦升降之气阻隔而难通矣。表邪已罢,非汗散之法所宜;里邪充斥,又非
淡渗之品所能胜。非选利水之所至峻者以直折之,中气不支,束手待毙耳。甘遂、芫花、大
戟三味,皆辛苦气寒而禀性最毒,并举而用之,气味合,相济相须,故可交相去邪之巢穴,
决其渎而大下之,一举而水患可平也。然水利所凑,其元气已虚,而毒药攻邪,必脾胃反弱
,使无健脾调胃之品为主宰,邪气尽,而大命亦随之矣。故选十枣之大而肥者以君之,一以
培脾土之虚,一以制水气之横,一以解诸药之毒。得一物而三善备,既不使邪气之盛而不制
,又不使元气之虚而不支,此仲景立法之尽善也。昧者惑于甘能中满之说而不敢用,岂知承
制之理乎?张子和窃此意而制浚川、禹功、神 等方,以治水肿、痰饮之病,而不知君补剂
以培本,但知任毒药以攻邪,所以善其后者鲜矣!
治疗伤寒病,胸中有热邪,胃中有寒邪气,腹部疼痛,想要呕吐的症状。
黄连、甘草、干姜(各三两)、人参(二两)、桂枝(三两)、半夏(半斤)、大枣(十二枚)。
以上七味药,用水一斗,煎煮至六升,滤去药渣,每次温服一升,白天服用三次,晚上服用两次。
程郊倩说:热邪在胸中,会有烦躁郁闷的症状,可知胃中反而有邪气,这是因为寒邪被格拒在下部的缘故。此证表现为腹部因寒而痛,上下之气不相顺接。用干姜来温中散寒。
成无己说:患湿病的人经过攻下治疗后,舌面上像有一层苔垢,这是因为丹田(下焦)有热,胸中有寒,是邪气入里,导致下热上寒的证候。
治疗太阳中风病,表证已解之后,里气不和,出现腹泻,呕吐逆气,从心窝到胁肋部痞塞胀满且硬痛,出汗,呼吸短促,头痛,不怕冷。
以上三味药,分别单独捣碎过筛成散剂。用水一升半,先煮肥大者大枣十枚,取八合药汁,滤去药渣,加入药末。体质强壮的人服用一钱匕。
柯韵伯说:张仲景利水的方剂,各种各样不同,这是其中最峻猛的方剂。凡是水气为患,有的喘,有的咳,有的心悸,有的噎阻,有的吐,有的泻,有的无汗,病邪局限在一处而停止;此方则使水邪外走皮毛而出汗,上走咽喉而呕吐逆气,下走肠胃而下利,水邪泛滥于体外,浩浩荡荡无法抵御。况且头痛,呼吸短促,心腹胁下都痞满而且硬痛,这是水邪仍然留结在中焦,三焦升降的气机阻隔而难以通畅。表邪已经解除,不适合用发汗疏散的方法;里邪充斥,又不是淡渗利湿的药物所能胜任。如果不选择利水作用最峻猛的药物来直接折服它,中气不支,只能束手待毙。甘遂、芫花、大戟三味药,都是辛苦气寒且禀性最毒的药物,同时使用,气味相合,相互辅助,所以可以交替去除邪气的巢穴,疏通水道而大力攻下,一举而水患可平。然而水邪聚集之处,人体元气已经虚弱,而毒药攻伐邪气,必然会使脾胃更加虚弱,如果没有健脾调胃的药物作为主宰,邪气虽然尽除,人的性命也会随之终结。所以选择大而肥的大枣作为君药,一来培补脾土的虚弱,二来制约水气的横逆,三来缓解诸药的毒性。得到这一味药而具备三种好处,既不让邪气盛极而无法控制,也不让元气虚弱而无法支撑,这是张仲景立法的尽善尽美之处。愚昧的人被“甘能致中满”的说法所迷惑而不敢使用,哪里懂得承制(五行相克以维持平衡)的道理呢?张子和窃取了这个意思而制定了浚川、禹功、神佑等方,用来治疗水肿、痰饮的病证,却不知道用补益剂作为君药来培补根本,只知道任用毒药来攻伐邪气,所以能够取得良好结局的很少啊!
Treats Shanghan (Cold Damage) where there is heat in the chest, pathogenic qi in the stomach, abdominal pain, and a desire to vomit.
Coptidis Rhizoma (Huanglian), Glycyrrhizae Radix et Rhizoma (Gancao), Zingiberis Rhizoma (Ganjiang) [each 3 liang], Ginseng Radix (Renshen) [2 liang], Cinnamomi Ramulus (Guizhi) [3 liang], Pinelliae Tuber (Banxia) [0.5 jin], Jujubae Fructus (Dazao) [12 pieces].
The above seven herbs are decocted with one dou of water until six sheng remain. Strain the dregs, and take one sheng warm as a dose, three times during the day and twice at night.
Cheng Jiaoqian states: Heat in the chest manifests with irritability and depression; thus, it can be known that there is pathogenic qi in the stomach because cold pathogen is rejected downward. This syndrome presents with abdominal pain due to cold, and the ascending and descending qi are disconnected. Ganjiang is used to warm the middle and dispel cold.
Cheng Wuji states: After purgation in a patient with dampness disease, if the tongue appears coated like moss, it indicates heat in the Dantian (lower jiao) and cold in the chest. This signifies pathogen entering the interior, resulting in lower heat and upper cold.
Treats Taiyang Wind Strike (Taiyang Zhongfeng). After the exterior syndrome has resolved, if the interior qi is disharmonious, presenting with diarrhea, vomiting and regurgitation, stuffiness, fullness, hardness, and pain from the epigastrium to the hypochondrium, sweating, shortness of breath, headache, and aversion to cold is absent.
Jujubae Fructus (Dazao) [10 pieces, torn apart], Kansui Radix (Gansui), Euphorbiae Pekinensis Radix (Daji), Genkwa Flos (Yuanhua) [roasted, equal parts].
The above three herbs are separately pounded into powder. Using 1.5 sheng of water, first decoct ten large Jujubae Fructus until 0.8 sheng remains. Strain the dregs, and add the herbal powder. For robust individuals, administer one qianbi (a spoonful measure).
Ke Yunbo states: Zhang Zhongjing’s formulas for draining water vary greatly; this is the most峻猛 (pungent and drastic) among them. Generally, when water qi causes pathology, symptoms may include wheezing, cough, palpitations, dysphagia, vomiting, diarrhea, or anhidrosis, with the pathogen confined to one area. However, this formula causes water pathogen to exit via the skin causing sweat, ascend to the throat causing vomiting and regurgitation, and descend to the intestines and stomach causing diarrhea. The overflowing water pathogen outside is vast and uncontrollable. Furthermore, headache, shortness of breath, and stuffiness, fullness, hardness, and pain in the heart, abdomen, and hypochondrium indicate that water pathogen remains bound in the middle jiao, blocking the ascending and descending qi of the Sanjiao (Triple Burner). Since the exterior pathogen has ceased, diaphoretic methods are inappropriate; since interior pathogen is rampant, mild diuretics are insufficient. One must select the most drastic water-draining agents to directly subdue it, otherwise, the Middle Qi will collapse, leading to helplessness and death. Gansui, Yuanhua, and Daji are all pungent, bitter, and cold in nature, possessing extreme toxicity. Used together, their flavors harmonize and mutually assist each other, allowing them to attack the nest of the pathogen, dredge the channels, and induce severe purgation, thereby leveling the water disaster in one stroke. However, where water accumulates, the original Qi is already deficient. Drastic drugs attacking pathogen inevitably weaken the Spleen and Stomach further. Without herbs that tonify the Spleen and regulate the Stomach as the sovereign, once the pathogen is eliminated, life itself may perish. Therefore, large and plump Jujubae Fructus is chosen as the Sovereign herb: to tonify the deficiency of Spleen Earth, to restrain the rampant Water Qi, and to detoxify the other herbs. One herb achieves three benefits, preventing both uncontrolled pathogen excess and unsupported Qi deficiency. This represents the perfection of Zhang Zhongjing’s legislative principles. Ignorant people, confused by the theory that "sweetness causes middle-fullness," dare not use it, failing to understand the principle of Chengzhi (restraining excessive elements through mutual control). Zhang Zihe borrowed this idea to formulate Jun Chuan, Yu Gong, and Shen You formulas to treat edema and phlegm-fluid retention, but failed to use tonic formulas as sovereign to nourish the root, relying solely on toxic drugs to attack the pathogen. Consequently, few achieved favorable outcomes.