治虚劳,筋脉拘挛,腰膝疼痛。
防风 五加皮 薏苡仁 赤芍药 萆 海桐皮 枳壳(麸炒) 熟地黄 黄 桂心
(
上各三分
上锉散,每服四钱,水一盏,生姜三片,煎服。
治虚劳伤筋,风引筋脉,拘挛疼痛,肢节浮肿,手指不可拳。
蔓荆子 酸枣仁(微炒) 防风(去芦) 枳实(麸炒) 桂心(以上各一两) 木通
(一两半)
上 咀,每服三钱,水一中盏,入生姜半分,煎至六分,去滓,食前温服。
治虚劳,手足烦疼,羸瘦无力,不能饮食,小便数。
石斛(一两半) 桑螵蛸(微炒) 黄 人参(去芦) 牛膝(去苗) 鸡 (微
炒) 熟地
上 咀,每服四钱,水一中盏,入生姜半分,枣三枚,煎至六分,去滓,不拘时温服
治虚劳,膝冷阴痿,四肢羸弱。
川椒(去目并合口者,微炒出汗) 山茱萸 肉苁蓉(酒浸,去皮,炙干) 附子(炮
裂,
各二两) 牛膝(去
上为细末,炼蜜和丸,如梧桐子大,每服三十丸,食前用温酒送下。
治虚劳膝冷。
附子(半斤,以新汲水浸,一日一度换水,浸经七日,刮去黑皮,切片焙干) 补骨脂
上为细末,炼蜜和,捣千余下,丸如梧桐子大,每服三十丸,食前用温酒送下。
《内经》云∶岁金太过咳逆,金郁之发咳逆,少阴二气咳逆。《活人书》云∶咳逆,仲
景所谓哕是也。胃寒所生,伤寒本虚,攻其热必哕。《难知》云∶夫咳逆证,《活人》断为
哕逆,其说似是而非。盖哕者干呕也,若有物直出,则为吐也,物旋出则为呕也,呕无物出
则为哕也。咳逆者,或水渍于肺,而心下痞,或连续不已而气逆,或喜笑过多而气噎,或咽
饮而错喉而气抢,或急食干物而气塞,皆能作咳逆之声,连续不绝,俗谓之吃忒是也。大抵
咳逆者,不顺之义;吃忒者,差错之义,二者皆气不得下,为火热托之而使上,至咽喉中噎
而止也。人或以纸按鼻,嚏而止,或诈冤盗贼,因恐而止,或鼻热闻食香而止,皆抑之骇之
而使气下也。《千金》以咳逆上气者为病肺,脉散者死,是心火刑于肺金也。《格致余论》
云∶吃病气逆也,气自脐下直冲,上出于口,而作声之名也。书曰∶火炎上,东垣谓火与元
气不两立,又谓元气之贼,古方悉以胃弱言之,而不及火,且以丁香柿蒂竹茹陈皮等剂治之
,未审孰为降火,孰为补虚。人之阴气,根据胃而养,胃土伤损,则木气侮之矣,此土败木贼
也。阴为火所乘,不得内守,木挟相火乘之,故直冲清道而上。言胃弱者,阴弱也,虚之甚
也,病患见此,以为危证,然亦有实者,今以治验略言之。有一弱人,暑月因大饥大怒,得
滞下疾,渴饮蜜水,滞下缓而吃作,倦甚,知其因下久而阴火盛,以人参白术煎汤,调益原
散与之,数日而止。又有一膏粱老人,久喘病而作止不常,新秋患滞下,食大减,至五七日
后,吃作脉大,众以为难,以形瘦观之,尚可以人参白术汤下大补丸以补血,不数日获安。
此二人虚之为也,又一女子,性躁味浓,暑月因大怒而吃作,每作则举身跳动,神昏不知,
问之乃暴病,视其形气俱实,遂以人参芦煎汤饮一碗,大吐顽痰数碗,大汗昏睡,一日而安
。此曝怒气上,肝主怒,肺主气。经曰∶怒则气逆。因怒逆肝木,乘火侮肺,故吃大作而神
昏,参芦善吐,痰尽气降而火衰,金气复位,胃气得和而解矣。《难知》云∶《活人》以咳
逆为哕,谓可下之,宜调胃承气汤,是邪气在胃,故断之为哕,是则然矣。抑不思咳逆者,
是足阳明失下,传手太阴,活人但言其火之本,不言其火之标,炎上至极高之分而咳逆也。
合而观之,哕与咳逆,同一热也;分而言之,哕为本为胆,为胃为中,咳逆为标为心,为
肺为上。若标病应见,止当治标,不必名哕,若言作哕,使后人只见胆胃本,而不见心肺标
也。《三因》云∶咳逆之病,古人以为哕耳。多因吐利之后,胃中虚寒,遂成此疾。亦有胃
中虚,膈上热,哕至八九声相连,收气不回者。大抵伤寒久病后,老人虚人及妇人产后,多
有此证者,皆病深之候也。亦有哕而心下痞悸者,有痰水所谓别无恶候者也。丹溪云∶吃病
者,气逆也。气自脐下直冲,上出于口而作声也。书曰∶火炎上。《内经》曰∶诸逆冲上,
皆属于心。朱奉议首论热降,而以下岂无超颖之士,而极言者,孰不谓之热而有此乎?至于
海藏,深发前人所未发,故犹有阴证发之说,但形证少瘥耳。大抵治法,虚则补之,补中须
分寒热,或因汗吐下误服寒凉过剂,当以温而补之。如脾胃阴虚,火逆冲上,当以平而补之
。挟热者凉而补之,若夫实者,如伤寒失下,地道不通,因而咳逆,当以下之。如痰饮停蓄
心下,曝怒气逆痰厥,此等必形气俱实,别无恶候,皆当随其邪之所在,而涌之泄之,清之
利之也。诸论具详,皆前人所述,学人当守规矩以治之。
治疗虚劳病,筋脉拘挛,腰膝疼痛。
防风、五加皮、薏苡仁、赤芍药、萆薢、海桐皮、枳壳(麸炒)、熟地黄、黄芪、桂心。
以上各三分。
将上述药材捣碎成散剂,每次服用四钱,加水一盏,生姜三片,煎煮后服用。
治疗虚劳损伤筋脉,风邪引动筋脉,导致拘挛疼痛,肢节浮肿,手指无法握拳。
蔓荆子、酸枣仁(微炒)、防风(去芦头)、枳实(麸炒)、桂心(以上各一两)、木通(一两半)。
将上述药材切碎,每次服用三钱,加水一中盏,加入生姜半分,煎至六分,滤去药渣,饭前温服。
治疗虚劳病,手足烦热疼痛,身体消瘦无力,不能进食,小便频数。
石斛(一两半)、桑螵蛸(微炒)、黄芪、人参(去芦头)、牛膝(去苗)、鸡内金(微炒)、熟地黄。
将上述药材切碎,每次服用四钱,加水一中盏,加入生姜半分、大枣三枚,煎至六分,滤去药渣,不拘时间温服。
治疗虚劳病,膝盖发冷,阳痿,四肢消瘦虚弱。
川椒(去除目及合口者,微炒至出汗)、山茱萸、肉苁蓉(酒浸,去皮,炙干)、附子(炮裂,各二两)、牛膝(去苗)。
将上述药材研为细末,用炼蜜调和制成丸药,如梧桐子大小,每次服用三十丸,饭前用温酒送下。
治疗虚劳病,膝盖发冷。
附子(半斤,用新汲水浸泡,每天换一次水,浸泡七天,刮去黑皮,切片焙干)、补骨脂。
将上述药材研为细末,用炼蜜调和,捣千余下,制成如梧桐子大小的丸药,每次服用三十丸,饭前用温酒送下。
《内经》说:岁运金气太过则发生咳逆,金气郁结发作时也会咳逆,少阴君火与相火二气失调也会引起咳逆。《活人书》说:咳逆,就是张仲景所说的哕。这是由胃寒产生的,伤寒病患者本身体虚,如果攻伐其热邪必然会导致哕。《难知》说:关于咳逆的证候,《活人书》将其断定为哕逆,这种说法似是而非。大概哕是指干呕,如果有物体直接吐出,那就是吐;物体旋转而出则是呕;呕而没有物体吐出就是哕。咳逆,有的是因为水饮渍于肺中,导致心下痞满;有的是连续不断而气机上逆;有的是因为喜笑过多而导致气机噎塞;有的是吞咽饮水时误入咽喉导致气机抢促;有的是急食干物导致气机堵塞,这些都能发出咳逆的声音,连续不绝,俗称“吃忒”。大抵来说,咳逆是不顺的意思;吃忒是差错的意思,两者都是气不得下行,被火热托举而上行,到达咽喉处噎住而停止。有人用纸按住鼻子,打喷嚏而止住;或者假装受冤屈或盗贼惊吓,因恐惧而止住;或者是鼻部受热闻到食物香味而止住,这些都是通过抑制和惊吓使气机下行。《千金方》认为咳逆上气是肺的病,脉象散乱的会死亡,这是心火克制肺金的表现。《格致余论》说:吃忒是气逆,气从脐下直冲,出于口而发声的名称。书上说:火性炎上。李东垣说火与元气不两立,又称其为元气的贼寇,古方都用胃弱来解释,而不提及火,并且用丁香、柿蒂、竹茹、陈皮等药剂治疗,不知道哪一个是降火,哪一个是补虚。人的阴气依靠胃土来滋养,胃土受损,则肝木之气就会侮犯它,这就是土败木贼。阴气被火热所乘,不能在内守持,肝木挟带相火侵犯,所以直冲清道而上。说胃弱,其实是指阴气弱,是非常虚弱的表现,病人见到这种情况,认为是危重证候,然而也有实证,现在简要谈谈治疗验证。有一个体弱的人,在暑月因为极度饥饿和愤怒,得了痢疾,口渴喝蜜水,痢疾稍缓但吃忒发作,非常疲倦,知道他是因为久泻导致阴火旺盛,用人参、白术煎汤,调益原散给他服用,几天后停止。又有一个富贵老人,长期患有喘病,发作和停止没有规律,初秋患痢疾,饮食大减,到了五七天后,吃忒发作,脉象大,众人认为难治,但从形体消瘦来看,还可以用人参、白术汤送服大补丸以补血,不久便痊愈了。这两个人都是虚证所致。又有一个女子,性情急躁口味浓重,暑月因为大怒而吃忒发作,每次发作全身跳动,神志昏迷不知人事,询问得知是突发疾病,观察她的形气都属实,于是用人参芦煎汤让她喝一碗,吐出顽痰数碗,大汗淋漓昏睡,一天后痊愈。这是因为暴怒导致气机上逆,肝主怒,肺主气。经书说:怒则气逆。因为愤怒导致肝木之气上逆,挟火侮肺,所以吃忒大作且神志昏迷,人参芦善于催吐,痰尽则气降而火衰,肺金之气复位,胃气得和而病解。《难知》说:《活人书》将咳逆视为哕,认为可以用下法,适宜用调胃承气汤,这是认为邪气在胃,所以断定为哕,这倒是正确的。但是没考虑到咳逆,是足阳明胃经失于通下,传变到手太阴肺经,《活人书》只说了火的根本,没说火的标象,火热炎上至极高处而发生咳逆。综合来看,哕与咳逆,本质都是热;分开来说,哕是本,属胆、属胃、属中焦;咳逆是标,属心、属肺、属上焦。如果是标病应当显现,只应当治标,不必命名为哕,如果说成是哕,会让后人只见胆胃之本,而不见心肺之标。《三因极一病证方论》说:咳逆这个病,古人认为是哕。多是因为呕吐腹泻之后,胃中虚寒,遂成此疾。也有胃中虚,膈上有热,哕声连续八九声,吸气不能回纳的情况。大抵伤寒久病后,老人、虚人以及妇人产后,多有此证,都是病深的征候。也有哕伴有心下痞满悸动的,有痰水停滞所谓没有其他恶候的情况。朱丹溪说:吃忒是气逆,气从脐下直冲,出于口而发声。书上说:火性炎上。《内经》说:各种逆气冲上,都属于心。朱奉议首先论述热降,但难道没有超群出众的人士,极力阐述这一点吗?谁不认为这是热证而有此表现呢?至于王海藏,深刻阐发了前人未发现的理论,所以还有阴证发热的说法,只是形证稍微减轻罢了。大抵治疗方法,虚证则补之,补益中须分清寒热,或者因为汗、吐、下误服寒凉过剂,应当用温补的方法。如脾胃阴虚,火逆冲上,应当用平补的方法。挟热者用凉补,如果是实证,如伤寒失于通下,地道不通,因而咳逆,应当用下法。如痰饮停蓄心下,暴怒气逆痰厥,这些情况必定形气俱实,没有其他恶候,都应当随着邪气所在之处,采用涌吐、泄下、清热、利湿等方法。诸种论述详细记载,都是前人所述,学习者应当遵守规矩来治疗。
Treats deficiency consumption (Xu Lao), tendon and vessel spasms, pain in the lower back and knees.
Fangfeng (Saposhnikoviae Radix), Wujiapi (Acanthopanacis Cortex), Yiyiren (Coicis Semen), Chishao Yao (Paeoniae Radix Rubra), Bixie (Dioscoreae Hypoglaucae Rhizoma), Haitongpi (Spatholobi Caulis), Zhike (Aurantii Fructus Immaturus, stir-baked with bran), Shudihuang (Rehmanniae Radix Preparata), Huangqi (Astragali Radix), Guixin (Cinnamomi Ramulus).
Each ingredient is three fen.
Crush the above ingredients into a powder. Take four qian per dose, add one zhan of water and three slices of fresh ginger, decoct and take orally.
Treats deficiency consumption damaging the tendons, wind pathogen stirring the tendons and vessels, causing spasms and pain, edema of limbs and joints, inability to make a fist with fingers.
Manjingzi (Viticis Semen), Suanzaoren (Ziziphi Spinosae Semen, slightly stir-fried), Fangfeng (Saposhnikoviae Radix, remove rhizome), Zhishi (Aurantii Fructus Immaturus, stir-baked with bran), Guixin (Cinnamomi Ramulus) (each one liang above), Mutong (Akebiae Caulis, one and a half liang).
Chop the above ingredients. Take three qian per dose, add one zhong zhan of water and half a fen of fresh ginger, decoct until six parts remain, strain off the dregs, and take warm before meals.
Treats deficiency consumption, vexing heat and pain in hands and feet, emaciation and weakness, inability to eat, frequent urination.
Shihu (Dendrobii Caulis, one and a half liang), Sangpiaoxiao (Mantidis Oötheea, slightly stir-fried), Huangqi (Astragali Radix), Renshen (Panacis Ginseng Radix et Rhizoma, remove rhizome), Niuxi (Achyranthis Bidentatae Radix, remove sprouts), Jineijin (Galli Gigerii Endothelium Corneum, slightly stir-fried), Shudihuang (Rehmanniae Radix Preparata).
Chop the above ingredients. Take four qian per dose, add one zhong zhan of water, half a fen of fresh ginger, and three jujubes, decoct until six parts remain, strain off the dregs, and take warm at any time.
Treats deficiency consumption, cold knees, impotence, emaciated and weak limbs.
Chuanjiao (Zanthoxyli Pericarpium, remove eyes and closed ones, slightly stir-fried until sweat appears), Shanzhuyu (Corni Fructus), Rongcongrou (Cistanche Deserticola, soaked in wine, peel removed, dried by roasting), Fuzi (Aconiti Lateralis Radix Preparata, cracked by frying, each two liang), Niuxi (Achyranthis Bidentatae Radix, remove sprouts).
Grind the above ingredients into a fine powder, mix with refined honey to form pills the size of paulownia seeds. Take thirty pills per dose, swallow with warm wine before meals.
Treats deficiency consumption, cold knees.
Fuzi (Aconiti Lateralis Radix Preparata, eight taels, soak in newly drawn water, change water once a day for seven days, scrape off black skin, slice and dry by baking), Buguzhi (Psoraleae Fructus).
Grind the above ingredients into a fine powder, mix with refined honey, pound over a thousand times, form pills the size of paulownia seeds. Take thirty pills per dose, swallow with warm wine before meals.
The *Neijing* states: When the metal qi of the year is excessive, hiccups (Ke Ni) occur; when metal qi is stagnant and erupts, hiccups occur; when Shaoyin (Kidney/Heart) qi is disordered, hiccups occur. The *Huoren Shu* states: Hiccups (Ke Ni) are what Zhang Zhongjing referred to as Yue (dry heaves/hiccup). This arises from stomach cold. In typhoid diseases, the body is originally deficient; attacking the heat will inevitably cause Yue. The *Nan Zhi* states: Regarding the syndrome of Ke Ni, the *Huoren Shu* diagnoses it as Yue Ni, which seems plausible but is actually incorrect. Generally, Yue refers to dry heaving; if matter is directly expelled, it is vomiting (Tu); if matter is expelled rotatingly, it is retching (Ou); if nothing is expelled during retching, it is Yue. Ke Ni may be caused by water dampness soaking the lungs, leading to epigastric fullness; or continuous upward rebellion of qi; or excessive laughter causing qi obstruction; or swallowing drinks incorrectly entering the throat causing qi snatching; or eating dry food hastily causing qi blockage. All these can produce the sound of Ke Ni, continuous and unceasing, commonly known as "Chi Te" (hiccups). Broadly speaking, Ke Ni means disorderliness; Chi Te means error. Both involve qi failing to descend, pushed upward by fire-heat, stopping at the throat. Some people stop it by pressing paper on the nose to induce sneezing, or by feigning injustice or fear of thieves to stop it due to fright, or by having nasal heat and smelling food fragrance to stop it. These methods all suppress and startle to force the qi downward. The *Qianjin Fang* considers Ke Ni with upward rushing qi as a lung disease; if the pulse is scattered, death ensues, indicating Heart Fire punishing Lung Metal. The *Gezhi Yulun* states: Chi Te is qi rebellion, named so because qi rushes straight up from below the navel, exits the mouth, and makes sound. Books state: Fire flares upward. Li Dongyuan stated that Fire and Yuan Qi cannot coexist, calling Fire the thief of Yuan Qi. Ancient formulas attributed this to weak Stomach, ignoring Fire, and treated it with agents like Dingxiang (Caryophylli Flos), Shidi (Diospyri Fructus), Zhuru (Bambusae Caulis in Taeniam), and Chenpi (Citri Reticulatae Pericarpium), without clarifying which reduces Fire and which tonifies Deficiency. Human Yin Qi is nourished according to the Stomach Earth; if Stomach Earth is damaged, Wood Qi will insult it, which is Earth failure and Wood aggression. Yin is overwhelmed by Fire, unable to guard internally; Wood carries Ministerial Fire to attack, thus rushing straight up the clear pathways. Saying "Stomach Weak" actually means Yin is weak, extremely deficient. Patients seeing this consider it a critical syndrome, yet there are also Excess cases. I will briefly discuss treatment verification. A weak person, in summer due to extreme hunger and anger, contracted dysentery. Thirsty, they drank honey water. Dysentery eased but hiccups started, with great fatigue. Knowing it was due to prolonged diarrhea causing Yin Fire to flourish, I gave them a decoction of Renshen (Panacis Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma), mixed with Yiyuan San. It stopped after several days. Another elderly man of rich diet had chronic asthma with irregular onset and remission. In early autumn, he suffered dysentery with greatly reduced appetite. After five to seven days, hiccups started with a large pulse. Everyone thought it difficult to treat, but observing his emaciation, I believed he could still benefit from Dabu Wan (Great Tonifying Pill) administered with Renshen-Baizhu decoction to nourish Blood. He recovered in a few days. These two were due to Deficiency. Another woman, irritable with strong tastes, developed hiccups in summer after a fit of rage. Each episode involved whole-body trembling and unconsciousness. Inquiry revealed it was an acute illness. Observing her form and qi were both Excess, I gave her a decoction of Renshen Lu (Panacis Ginseng Radix et Rhizoma Stolon) to drink one bowl. She vomited several bowls of stubborn phlegm, sweated profusely, slept deeply, and recovered in one day. This was due to sudden anger causing qi to rush upward. Liver governs anger, Lung governs qi. Classics state: Anger causes qi to rebel. Due to anger, Liver Wood rebels, carrying Fire to insult Lung, causing severe hiccups and unconsciousness. Renshen Lu induces vomiting well; with phlegm gone, qi descends, Fire declines, Lung Metal qi returns to position, Stomach Qi harmonizes, and the disease resolves. The *Nan Zhi* states: The *Huoren Shu* regards Ke Ni as Yue, suggesting purgation, suitable using Tiaowei Chengqi Tang. This assumes pathogenic factors are in the Stomach, thus diagnosing Yue, which is correct. However, it fails to consider that Ke Ni results from Foot Yangming (Stomach) failing to descend, transmitting to Hand Taiyin (Lung). The *Huoren Shu* only mentions the root of Fire, not its branch. Fire flares upward to the highest point, causing Ke Ni. Viewing them together, Yue and Ke Ni share the same Heat nature; distinguishing them, Yue is Root, belonging to Gallbladder, Stomach, Middle Jiao; Ke Ni is Branch, belonging to Heart, Lung, Upper Jiao. If Branch symptoms appear, treat the Branch; do not name it Yue. Calling it Yue leads later generations to see only Gallbladder/Stomach Root, missing Heart/Lung Branch. The *Sanyin Fang* states: The ancients considered Ke Ni to be Yue. It often occurs after vomiting and diarrhea, where Stomach interior becomes deficient and cold, forming this disease. There are also cases of Stomach deficiency with Heat above the diaphragm, where Yue sounds connect for eight or nine times, with inhalation failing to return. Generally, after long-term typhoid or chronic illness, in the elderly, deficient persons, and postpartum women, this syndrome is common, indicating deep disease. There are also cases of Yue with epigastric fullness and palpitations, or phlegm-water retention, considered free of other malignant signs. Zhu Danxi stated: Chi Te is qi rebellion, where qi rushes straight up from below the navel, exits the mouth, and makes sound. Books state: Fire flares upward. The *Neijing* states: All rebellious qi rushing upward belongs to the Heart. Zhu Fengyi first discussed Heat descending, but surely there are outstanding scholars who expounded this extensively? Who would not call this Heat and have such manifestations? As for Wang Haizang, he profoundly developed insights not previously mentioned by predecessors, hence the theory of Yin syndromes manifesting as Heat, though the physical signs are milder. Generally, treatment principles: For Deficiency, tonify; within tonification, distinguish Cold and Heat. If due to misusing cold-cooling agents after sweating, vomiting, or purging, use Warm tonification. If Spleen-Stomach Yin is deficient with Fire rebelling upward, use Neutral tonification. If accompanied by Heat, use Cool tonification. For Excess, such as typhoid failing to purge, bowel obstruction, leading to Ke Ni, use Purging. If phlegm-fluid retention is stored in the epigastrium, or sudden anger rebellion causes phlegm syncope, these cases must have both form and qi Excess, without other malignant signs. Treat according to the location of the pathogen, using Emesis, Purging, Clearing, or Draining methods. All theories are detailed here, described by predecessors. Students should adhere to rules for treatment.