赤石脂(一斤碎味甘温) 禹余粮(一斤碎味甘平)
以上二味。以水六升。煮取二升。去滓。三服。
本草云。涩可去脱。石脂之涩。以收敛之。重可去怯。余粮之重。以镇固之。
伤寒吐下后发汗。虚烦。脉甚微。八九日。心下痞硬。胁下痛。气上冲咽喉。眩冒。
经脉动惕者。久而成痿。
伤寒吐下后。发汗。则表里之气俱虚。虚烦。脉甚微。为正气内虚。邪气独在。至
七八日。正气当复。邪气当罢。而心下痞。胁下痛。气上冲咽喉。眩冒者。正气内虚而
不复。邪气留结而不去。经脉动惕者。经络之气虚极。久则热气还经。必成痿弱。
伤寒发
汗。若吐若下。解后。心下痞硬。噫气不除者。旋复代赭石汤主之。
大邪虽解。以曾发汗吐下。胃气弱而未和。虚气上逆。故心下痞硬。噫气不除。与
旋复代赭石汤。降虚气而和胃。
旋复花(三两味咸温) 人参(二两味甘温) 生姜(五两切味辛温) 半夏(半
升洗味辛温) 代赭石(一两味苦寒) 大枣(十二枚擘甘平) 甘草(三两炙味甘平)
上件七味。以水一斗。煮取六升。去滓、再煎。取三升。温服一升。日三服。
硬则气坚。咸味可以软之。旋复之咸。以软痞硬。虚则气浮。重剂可以镇之。代赭
石之重。以镇虚逆。辛者散也。生姜半夏之辛。以散虚痞。甘者缓也。人参甘草大枣之
甘。以补胃弱。
娄氏云。病解后。心下痞硬。噫气。若不下利者。此条旋复代赭石汤也。若下利者。
前条生姜泻心汤也。
下后。不可更行桂枝汤。若汗出而喘。无大热者。可与麻黄杏仁甘草石膏汤。
前第三卷十六证云。发汗后。不可更行桂枝汤。汗出而喘。无大热者。为与此证治法
同。汗下虽殊。既不当损正气。则一邪气所传既同。遂用一法治之。经所谓若发汗。若
下若吐后是矣。
太阳病。外证未除。而数下之。遂协热而利。利下不止。心下痞硬。表里不解者。桂
枝
人参汤主之。
外证未除。而数下之。为重虚其里。邪热乘虚而入。里虚协热。遂利不止。而心下
痞。若表解而下利。心下痞者。可与泻心汤。若不下利。表不解。而心下痞者。可先解
表而后攻痞。以表里不解。故与桂枝人参汤。和里解表。
赤石脂(一斤,捣碎,味甘,性温) 禹余粮(一斤,捣碎,味甘,性平)
以上两味药。用水六升。煮取二升药液。滤去药渣。分三次服用。
《本草》说:涩味可以去除滑脱之症。赤石脂的涩味,用来收敛固摄。重味可以去怯,禹余粮的重质,用来镇固正气。
伤寒病经过催吐、泻下后,又发汗,导致虚烦,脉象非常微弱。过了八九天,出现胃脘部痞塞坚硬,胁肋部疼痛,气向上冲至咽喉,头晕目眩。
经脉跳动震颤的,时间久了会形成痿证。
伤寒病经过催吐、泻下后,再发汗,则表里之气都虚弱。虚烦,脉象非常微弱,是因为正气内部虚弱,邪气独自留存。到了七八天,正气应当恢复,邪气应当罢退。然而出现心下痞塞,胁肋疼痛,气上冲咽喉,头晕目眩,这是因为正气内部虚弱而不能恢复,邪气留结而不散去。经脉跳动震颤,是经络之气极度虚弱,时间久了热气返还经络,必定形成痿弱。
伤寒病发汗,或者催吐,或者泻下,病解之后,出现胃脘部痞塞坚硬,嗳气不止的,用旋复代赭石汤主治。
大邪气虽然已解,但因为曾经发汗、催吐、泻下,胃气虚弱而未调和,虚气上逆,所以心下痞塞坚硬,嗳气不止。给予旋复代赭石汤,以降虚气而调和胃气。
旋复花(三两,味咸,性温) 人参(二两,味甘,性温) 生姜(五两,切片,味辛,性温) 半夏(半升,洗净,味辛,性温) 代赭石(一两,味苦,性寒) 大枣(十二枚,掰开,味甘,性平) 甘草(三两,炙过,味甘,性平)
以上七味药。用水一斗。煮取六升药液。滤去药渣,再次煎煮。取三升药液。每次温服一升。每天服用三次。
痞硬则是气机坚结,咸味可以软化它。旋复花的咸味,用来软化痞硬。虚弱则是气机浮越,重剂可以镇潜它。代赭石的沉重,用来镇潜虚逆之气。辛味具有发散作用。生姜、半夏的辛味,用来消散虚痞。甘味具有缓急作用。人参、甘草、大枣的甘味,用来补益胃气的虚弱。
娄氏说:病解之后,出现心下痞塞坚硬,嗳气,如果不伴有腹泻的,这是本条所述的旋复代赭石汤证。如果伴有腹泻的,是前条所述的生姜泻心汤证。
泻下之后,不可再用桂枝汤。如果出现汗出且气喘,没有大热的,可以与麻黄杏仁甘草石膏汤。
前第三卷第十六证中说:发汗之后,不可再用桂枝汤。出现汗出且气喘,没有大热的,与此证的治法相同。发汗与泻下虽然不同,既然都不应当损伤正气,那么同一邪气所传变的病机既相同,就用同一种法治之。经书所说的“若发汗,若下,若吐后”就是这种情况。
太阳病,外证未除,却多次使用泻下法,于是导致协热利,下利不止,胃脘部痞塞坚硬,表里同病的,用桂枝人参汤主治。
外证未除,却多次使用泻下法,是为了使里气更加虚弱,邪热乘虚而入,里虚兼夹热邪,于是下利不止,并且心下痞塞。如果表证已解而下利,心下痞塞的,可与泻心汤。如果不下利,表证未解,而心下痞塞的,可先解表而后攻痞。因为表里同病不解,所以给予桂枝人参汤,以调和里气并解除表邪。
Chihishi (Lapis Kaolin, one jin, crushed, sweet flavor, warm nature) Yuyulianggyao (Halloysitum Rubrum, one jin, crushed, sweet flavor, neutral nature)
The above two ingredients. Boil in six sheng of water. Reduce to two sheng of liquid. Remove the dregs. Divide into three doses.
Bencao states: Astringent flavors can treat slippage/loss of control. The astringency of Chihishi is used for convergence and consolidation. Heavy substances can treat timidity/fear; the heaviness of Yuyulianggyao is used to stabilize and secure.
After Shaoyang disease has undergone emesis and purgation, followed by sweating, deficiency vexation occurs, and the pulse is extremely faint. After eight or nine days, epigastric fullness and hardness appear, pain in the hypochondrium, Qi rushing up to the throat, dizziness, and vertigo.
If the meridians tremble and twitch, prolonged duration will lead to Wei syndrome (flaccidity syndrome).
After Shaoyang disease has undergone emesis and purgation, followed by sweating, both exterior and interior Qi become deficient. Deficiency vexation and an extremely faint pulse indicate internal deficiency of healthy Qi with pathogenic factors remaining alone. By the seventh or eighth day, healthy Qi should recover and pathogenic factors should cease. However, if epigastric fullness, hypochondriac pain, Qi rushing to the throat, and dizziness occur, it is because internal healthy Qi is deficient and fails to recover, while pathogenic factors remain knotted and do not disperse. Trembling and twitching of the meridians indicate extreme deficiency of Qi in the collaterals; over time, heat Qi returns to the meridians, inevitably resulting in flaccidity and weakness.
After Shaoyang disease undergoes sweating, or emesis, or purgation, and the pathogen is resolved, but epigastric fullness and hardness persist with persistent belching, Xuanfu Daizhe Shi Tang (Cassia Flower and Hematite Decoction) is the primary treatment.
Although the major pathogen has been resolved, due to previous sweating, emesis, and purgation, Stomach Qi is weak and unharmonized, causing deficient Qi to rebel upward. Thus, there is epigastric fullness and hardness with persistent belching. Administer Xuanfu Daizhe Shi Tang to descend deficient Qi and harmonize the Stomach.
Xuanfuhua (Flos Inulae, three liang, salty flavor, warm nature) Renshen (Radix Ginseng, two liang, sweet flavor, warm nature) Shengjiang (Rhizoma Zingiberis Recens, five liang, sliced, pungent flavor, warm nature) Banxia (Rhizoma Pinelliae Preparatum, half sheng, washed, pungent flavor, warm nature) Daizheshi (Hematitum, one liang, bitter flavor, cold nature) Dazao (Fructus Jujubae, twelve pieces, broken open, sweet flavor, neutral nature) Gancao (Radix Glycyrrhizae Preparata, three liang, honey-fried, sweet flavor, neutral nature)
The above seven ingredients. Boil in ten dou of water. Reduce to six sheng of liquid. Remove the dregs and decoct again. Obtain three sheng of liquid. Take one sheng warm per dose. Three times daily.
Fullness and hardness imply firm Qi; salty flavor can soften it. The salinity of Xuanfuhua softens epigastric fullness. Deficiency implies floating Qi; heavy agents can anchor it. The heaviness of Daizheshi anchors rebellious deficient Qi. Pungent flavors disperse; the pungency of Shengjiang and Banxia disperses deficient fullness. Sweet flavors moderate; the sweetness of Renshen, Gancao, and Dazao tonifies weak Stomach Qi.
Lou氏 stated: After resolution of the disease, if there is epigastric fullness and hardness with belching, and no diarrhea, this is the Xuanfu Daizhe Shi Tang pattern described in this clause. If there is diarrhea, it is the Shengjiang Xiexin Tang (Fresh Ginger Heart-Draining Decoction) pattern described in the previous clause.
After purgation, Guizhi Tang (Cinnamon Twig Decoction) must not be administered again. If sweating and wheezing occur without high fever, Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.
In Volume 3, Clause 16, it was stated: After sweating, Guizhi Tang must not be administered again. If sweating and wheezing occur without high fever, the treatment method is the same as this case. Although sweating and purgation differ, since neither should damage healthy Qi, and the transmission of the pathogenic factor is the same, the same treatment method is applied. This corresponds to the classic text stating "after sweating, purgation, or emesis."
Taiyang disease (Disease of the Taiyang Channel), where exterior symptoms have not resolved, yet multiple purgations have been performed, leading to Liège Re Er Li (Diarrhea accompanying heat), with incessant diarrhea, epigastric fullness and hardness, and unresolved exterior and interior conditions, is treated with Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction).
Exterior symptoms unresolved, yet multiple purgations performed, further deficiences the interior. Pathogenic heat enters due to deficiency. Interior deficiency with accompanying heat leads to incessant diarrhea and epigastric fullness. If the exterior is resolved but diarrhea persists with epigastric fullness, Xiexin Tang (Heart-Draining Decoction) may be given. If there is no diarrhea, the exterior is unresolved, and there is epigastric fullness, the exterior should first be resolved before treating the fullness. Because both exterior and interior are unresolved, Guizhi Renshen Tang is administered to harmonize the interior and resolve the exterior.