浓朴苦温散湿满,其气向表;枳实苦寒泄坚满,其气向下。二物皆胃家气药。阳明病胃
中燥结在血分,自宜以涤热逐实之大黄血药为君。然非气药为之前驱,则不能锐师直入,此
三物并用之故。大承气又加芒硝者,芒硝亦血药而微兼治上,犹浓朴气药而微兼治表,余邪
不至少留而咸寒尤能速下,不止如小承气之和胃已也。
枳朴主治多在中焦,故为承气要药。然枳实薤白桂枝汤枳朴并用,其证为胸痹与胁下逆
抢心,则又何说?盖二物虽有温散寒泄之不同,而皆苦中有辛,苦多辛少。惟其为气药而兼
辛,故心肺之部亦其所到。苦多则不能久停心肺,而可倚以散逆下气。枳实又为胁痛要药,
与浓朴先煮多煮,所以平胸胁之逆满;内薤白等数沸,所以开心胸之阳痹。分之各尽厥职,
合之则同建奇勋。方名出枳实不出浓朴者,以胁逆非浓朴所主也。
夫浓朴非所云气向表者欤,虽非表药而表证亦兼有可资,如浓朴麻黄汤治咳而脉浮,以
浓朴
然则半夏浓朴汤,治妇人咽中如有炙脔,非胸满非腹满亦无表邪,又何以用浓朴哉?夫
咽中者心肺之部,千金此证,又点出胸满心下坚五字,非心胸间有湿痰凝阻,不至如是。半
夏苓姜,有蠲饮之能,擅泻心之用,佐以苏叶之宣气理血,心胸间可由是旷然矣。不知千金
谓咽中帖帖,吐之不出,吞之不下,其窃据之势,岂易遽拔。夫浓朴者,消痰下气,力浓气
雄,于四物外别树一帜。盖四物以功胜而浓朴以力胜,合以成剂,奏效乃神,此浓朴所以匹
半夏而并标之欤。
厚朴味苦性温,能疏散湿邪引起的胀满,其药气趋向体表;枳实味苦性寒,能攻泄坚硬痞满,其药气趋向体内下行。这两味药都是调理胃腑气机的药物。阳明病中,若胃中燥热结聚在血分,自然适宜以具有荡涤热邪、攻逐实邪作用的大黄这味血分药作为君药。然而,如果没有气分药在前面开路引导,大黄就不能率领军队直入病所,这就是三味药(大黄、厚朴、枳实)并用的原因。大承气汤又加入了芒硝,是因为芒硝也是血分药,但略微兼治上部,就像厚朴是气分药却略微兼治表证一样;其余的邪气不至于少量残留,且咸寒之性能使大便迅速通下,其功效不止像小承气汤那样调和胃气罢了。
枳实和厚朴的主治部位多在中焦,所以它们是承气汤类方的重要药物。然而,枳实薤白桂枝汤中枳实和厚朴并用,其所治疗的病症是胸痹以及胁下有气逆上冲心胸,这又该如何解释呢?大概这两味药虽然一个偏于温散、一个偏于寒泄有所不同,但都具备苦味中带有辛味的特点,且苦味多于辛味。正因为它们既是气分药又兼有辛味,所以药力也能到达心和肺所在的部位。由于苦味居多,药物不能在心肺部位久留,反而可以依靠它来疏散逆气、降气下行。枳实又是治疗胁痛的要药,与厚朴一起先煎、久煎,是为了平抑胸胁部的逆气胀满;而加入薤白等药材仅煮沸几沸,是为了开通心胸部位的阳气痹阻。分开使用时各自发挥其专长,合用时则共同建立奇效。方剂名称只列出枳实而不列出厚朴,是因为胁部气逆并非厚朴的主要主治范围。
难道厚朴不是所谓的“药气趋向体表”吗?虽然它不是专门的解表药,但在表证兼夹的情况下也可以借助其力,例如厚朴麻黄汤治疗咳嗽且脉象浮,就是利用厚朴……(原文此处似有缺漏,依文意补全逻辑:利用厚朴宣散表邪)。
那么半夏厚朴汤,治疗妇女咽喉中有如烤肉块堵塞的感觉,既没有胸满也没有腹满,也没有表邪,为什么还要使用厚朴呢?咽喉部位是心和肺所属的区域,《千金方》对此证的描述,又特别点出“胸满心下坚”五个字,如果不是心胸之间有湿痰凝结阻滞,不会达到这种程度。半夏、茯苓、生姜具有祛除饮邪的能力,擅长泻除心下痞满,辅以紫苏叶宣通气机、调理血液,心胸之间的郁滞就可以由此变得通畅开阔了。如果不了解《千金方》所说的咽喉中感觉贴帖不适,吐不出来也吞不下去,这种邪气窃据占据的态势,哪里容易轻易拔除呢?厚朴这味药,消痰下气,药力浓厚、气势雄壮,在四物汤(注:此处指代常规理气或化痰组合,原文语境特指半夏厚朴汤中的其他配伍或对比)之外独树一帜。可以说四物汤是以功效取胜,而厚朴是以药力强劲取胜,两者配合组成方剂,疗效神奇,这就是厚朴之所以与半夏并列标注的原因吧。
Cortex Magnoliae Officinalis (Houpo, 厚朴) is bitter and warm; it disperses dampness-induced fullness, and its qi tends toward the exterior. Rhizoma Zingiberis Recens (Zhishi, 枳实 - *Note: Standard Pinyin for Zhishi is Zhishi, Latin is Fructus Trichosanthis*) is bitter and cold; it purges hardness and fullness, and its qi tends downward. Both herbs are Qi-regulating agents for the Stomach organ. In Yangming disease, when dryness and heat accumulate in the blood aspect of the Stomach, it is appropriate to use Radix et Rhizoma Rhei (Dahuang, 大黄), a Blood-invigorating agent with the function of washing away heat and driving out excess, as the sovereign herb. However, without Qi-regulating agents leading the way, Dahuang cannot penetrate directly into the pathogenic site; this explains why these three herbs are used together. Da Chengqi Tang (Major Order the Qi Decoction) adds Natrii Sulfas (Mangxiao, 芒硝) because Mangxiao is also a Blood-agent but slightly addresses the upper jiao, just as Houpo is a Qi-agent but slightly addresses the exterior. The remaining pathogens will not linger in small amounts, and the salty-cold nature enables rapid evacuation, achieving effects beyond merely harmonizing the Stomach as Xiao Chengqi Tang (Minor Order the Qi Decoction) does.
The main indications for Zhishi and Houpo are mostly in the Middle Jiao, making them essential herbs for Chengqi formulas. However, in Zhishi Xiebai Guizhi Tang (Trichosanthes Fruit, Macrostemon Rhizome, and Cinnamon Twig Decoction), Zhishi and Houpo are used together to treat Chest Bi (Thoracic Obstruction) and rebellious Qi rushing from the hypochondrium to the heart. How should this be explained? Although one is warm-dispersing and the other cold-purging, both possess a bitter flavor with a hint of pungency, where bitterness predominates over pungency. Because they are Qi-agents that also contain pungency, their action extends to the regions of the Heart and Lungs. Since bitterness is predominant, the herbs do not stay long in the Heart and Lung regions but can be relied upon to disperse rebellious Qi and direct it downward. Zhishi is also a key herb for treating hypochondriac pain. Boiling Zhishi and Houpo extensively helps calm rebellious fullness in the chest and hypochondrium, while briefly boiling Macrostemon Rhizome (Xiebai) and others opens Yang obstruction in the chest. Separately, each fulfills its specific role; combined, they achieve remarkable synergy. The formula is named after Zhishi rather than Houpo because hypochondriac rebellion is not primarily governed by Houpo.
Is Houpo not described as having qi tending toward the exterior? Although it is not a dedicated exterior-releasing herb, it can assist in cases involving exterior symptoms, such as in Houpo Mahuang Tang (Magnolia Bark and Ephedra Decoction) which treats cough with a floating pulse, utilizing Houpo... [Text fragment implies using Houpo to address exterior/dampness].
Then, Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction) treats women feeling as if there were a roasted meat piece stuck in the throat, without chest fullness, abdominal fullness, or exterior pathogens. Why is Houpo used here? The throat is the region of the Heart and Lungs. Qianjin Fang (Prescriptions Worth a Thousand Gold) highlights "chest fullness and epigastric hardness," indicating that wet-phlegm stagnation in the Heart and Chest regions causes this condition. Pinellia Tuber (Banxia), Poria (Fuling), and Zingiberis Rhizoma (Shengjiang, 生姜) have the ability to drain fluid retention and excel at draining epigastric fullness. Assisted by Perilla Leaf (Zisuye, 紫苏叶) to circulate Qi and regulate Blood, the stagnation in the Heart and Chest can become clear and open. If one does not understand that Qianjin describes the sensation as "stuck fast," neither vomitable nor swallowable, representing a pathogen firmly entrenched, it is not easily expelled. Houpo eliminates phlegm and directs Qi downward; its power is thick and its qi is vigorous, standing alone among other combinations. While other formulas may win by efficacy, Houpo wins by sheer force. Combined to form a prescription, the effect is miraculous. This is why Houpo is listed alongside Banxia.