阴黄多缘转属成,脾湿肾寒两亏生,温脾茵陈理中治,温肾茵陈四逆灵。
【注】阴黄者,乃脾湿、肾寒,两虚而成,此最为危候。温脾去黄,以理中汤加茵陈主
之;温肾去黄,以茵陈四逆汤主之。
茵陈理中汤(方见理中汤加茵陈)
茵陈四逆汤
附子(制) 干姜 茵陈蒿 甘草(炙)
水煎服。
【方歌】茵陈四逆汤,附子共干姜,茵陈炙甘草,黄消病渐康。
水肿俱属脾肺经,肺喘脾胀要分明。上肿属风宜汗散,下肿属湿利水灵,通身肿者兼汗利,喘则逐饮
胀则攻。再辨阳水与阴水,攻泻温补贵变通。
【注】小儿水肿,皆因水停于脾、肺二经。水停胸中则喘,水停膈下则胀,其间所肿部
位,不可不察∶如肿在腰以上者,属风,法宜发汗;肿在腰以下者,属湿,法宜利水;有
通身上下皆肿者,系风湿两伤,法宜汗利兼施。肿而喘不得卧,宜逐肺饮;肿而胀满便
秘,宜攻脾水。肿从腹起至四肢者,可治;肿从四肢起至腹者,不可治。然又有阳水、阴
水之分,宜详别焉。阳水属实,法宜攻泄,阴水属虚,法宜温补。应证而施,自无不效也。
肿在上者因风起,急宜发汗莫从容,越婢汤中加苍术,汗后全消病即宁。
【注】上身肿者,头面、肩臂至腰间皆肿也。病因外感风邪,法宜发汗则愈,经所谓
开鬼门是也。以越婢加苍术汤治之。
越婢汤
麻黄 石膏( ) 甘草(生) 苍术(米泔水浸)
水煎服。
【方歌】越婢汤治风水肿,麻黄甘草共石膏,再加苍术水煎服,能使儿童肿即消。
阴黄多因病情转化归属而成,由脾脏湿邪与肾脏寒邪共同导致正气亏损而生。治疗上,温补脾脏可用茵陈理中汤,温补肾阳可用茵陈四逆汤,疗效显著。
【注】所谓阴黄,是由于脾湿、肾寒,两脏虚损而形成的,这是最为危急的病候。想要通过温补脾脏来消除黄疸,应以理中汤加入茵陈为主方;想要通过温补肾阳来消除黄疸,应以茵陈四逆汤为主方。
茵陈四逆汤
附子(炮制过的) 干姜 茵陈蒿 甘草(炙烤过的)
用水煎煮后服用。
【方歌】茵陈四逆汤,由附子和干姜组成,加上茵陈和炙甘草,黄疸消退,疾病逐渐康复。
水肿病症都归属于脾经和肺经,需要明确区分肺气上逆导致的喘促和脾气不运导致的胀满。上半身肿胀属于风邪侵袭,适宜用发汗法疏散;下半身肿胀属于湿邪困阻,利水法效果灵验;全身肿胀则需发汗与利水并用,伴有喘促则逐除饮邪,伴有胀满则攻逐水气。此外还要辨别阳水和阴水,攻泻或温补贵在灵活变通。
【注】小儿水肿,都是因为水液停滞在脾、肺二经所致。水液停滞在胸中就会引起喘促,水液停滞在膈下就会引起胀满,其中肿胀的部位,不可不仔细考察:比如肿胀在腰部以上的,属于风邪,治法适宜发汗;肿胀在腰部以下的,属于湿邪,治法适宜利水;有全身上下都肿胀的,是风湿两邪共同伤害所致,治法适宜发汗与利水同时使用。肿胀且喘促不能平卧的,适宜逐除肺中的饮邪;肿胀且胀满便秘的,适宜攻逐脾中的水气。肿胀从腹部开始蔓延至四肢的,可以治愈;肿胀从四肢开始蔓延至腹部的,难以治愈。然而又有阳水、阴水的区别,应当详细辨别。阳水属实证,治法适宜攻逐泄下;阴水属虚证,治法适宜温补。根据证候施治,自然没有不生效的。
肿胀在上部是因为风邪引起,应当立即发汗,不可从容迟缓,在越婢汤中加入苍术,发汗之后肿胀全消,疾病即刻安宁。
【注】上身肿胀,是指头面、肩臂直到腰间都肿胀。病因是外感风邪,治法适宜发汗即可痊愈,正如经典所说“开鬼门”(即发汗)的方法。用越婢加苍术汤来治疗。
Yin jaundice (Yin Huang) often arises from disease transformation and attribution, generated by the dual deficiency of spleen dampness (Pi Shi) and kidney cold (Shen Han). To warm the spleen, Yinchen Lizhong Tang (Artemisiae Scopariae and Gastrodia Decoction) is used; to warm the kidney, Yinchen Sini Tang (Artemisiae Scopariae and Four Reversal Decoction) is effective.
[Note] Yin jaundice is formed by spleen dampness and kidney cold, representing a dual deficiency, which is the most critical condition. To eliminate jaundice by warming the spleen, Lizhong Tang (Regulate the Middle Decoction) added with Yinchen (Artemisiae Scopariae Herba) is the primary formula; to eliminate jaundice by warming the kidney, Yinchen Sini Tang (Artemisiae Scopariae and Four Reversal Decoction) is the primary formula.
Yinchen Lizhong Tang (See formula under Lizhong Tang Added with Yinchen)
Yinchen Sini Tang
Prepared Fuzi (Aconiti Lateralis Radix Praeparata)
Dried Ginger (Zingiberis Rhizoma)
Artemisiae Scopariae Herba (Yinchen Hao)
Honey-fried Licorice Root (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle)
Decoct in water and take orally.
[Formula Song] Yinchen Sini Tang, combined with Aconite and Dried Ginger, plus Artemisiae Scopariae Herba and Honey-fried Licorice Root, jaundice dissipates and health gradually returns.
Edema generally belongs to the Spleen and Lung meridians; it is essential to distinguish between lung-related wheezing and spleen-related distension. Swelling in the upper body is attributed to wind and should be treated with diaphoresis (sweating method); swelling in the lower body is attributed to dampness and responds well to diuresis. Generalized edema requires both diaphoresis and diuresis; if accompanied by wheezing, dispel fluid retention; if accompanied by distension, attack the water accumulation. Furthermore, one must differentiate between Yang edema and Yin edema, applying purgation or tonification with flexibility.
[Note] Pediatric edema is caused by water retention in the Spleen and Lung meridians. Water retained in the chest causes wheezing; water retained below the diaphragm causes distension. The location of swelling must be carefully observed: swelling above the waist is due to wind, suitable for diaphoresis; swelling below the waist is due to dampness, suitable for diuresis; generalized swelling throughout the body indicates injury by both wind and dampness, requiring simultaneous diaphoresis and diuresis. Edema with wheezing preventing lying flat requires dispelling pulmonary fluid retention; edema with distension and constipation requires attacking splenic water. Edema starting from the abdomen and spreading to the limbs is treatable; edema starting from the limbs and spreading to the abdomen is difficult to treat. However, there is a distinction between Yang edema and Yin edema, which must be detailed. Yang edema is excess type, treated with purgation and draining; Yin edema is deficiency type, treated with warming and tonifying. Applying treatment according to the syndrome ensures efficacy.
Swelling in the upper part is caused by wind; immediate diaphoresis is required without delay. Adding Cangzhu (Atractylodis Rhizoma) to Yeshibang Tang (Yashibi Decoction) allows the swelling to completely disappear after sweating, bringing peace to the illness.
[Note] Upper body swelling refers to swelling of the head, face, shoulders, arms, down to the waist. The cause is external wind pathogen invasion; the treatment method is diaphoresis for recovery, as stated in the classics regarding "opening the ghost gate" (diaphoresis). It is treated with Yeshibang Jia Cangzhu Tang (Yashibi Decoction Added with Atractylodis Rhizoma).
Yeshibang Tang
Ephedrae Herba (Mahuang)
Gypsum Fibrosum (Shigao)
Raw Licorice Root (Glycyrrhizae Radix et Rhizoma)
Cangzhu (Atractylodis Rhizoma, soaked in rice wash water)
Decoct in water and take orally.
[Formula Song] Yeshibang Tang treats Wind-Water Edema, combining Ephedrae Herba, Licorice Root, and Gypsum Fibrosum; adding Atractylodis Rhizoma and decocting in water can make children's swelling disappear immediately.