麦冬形象,合之本经主治,自是胃家正药。徐氏云,麦冬甘平滋润,为纯补胃阴之药。
后人以为肺药者,盖土能生金,肺气全恃胃阴以生,胃气润,肺自资其益也。邹氏云,麦冬
之功,在提曳胃家阴精,润泽心肺,以通脉道,以下逆气,以除烦热,若非上焦之证,则与
之断不相宜。观此可以正李东垣但谓入手太阴而不及足阳明之非。
前人谓麦冬复脉通心者不一,大都其胸中先有本经胃络脉绝之见,而更征之以复脉汤生
脉散。窃谓胃之大络,内通于脉,脉绝乃胃络之不贯,非真脉绝。麦冬补胃阴以通络,而脉
得所资则有之,亦非能径复其脉。能径复其脉者,厥惟人参,熟玩伤寒金匮两书自知。且心
腹结气伤中伤饱,若非胃络脉绝,亦岂麦冬所能治。下文之羸瘦短气,即胃络脉绝之征。本
经无一字虚设,而又上下相照应如此,愿与治本经者一质之。
徐氏极诋以麦冬治咳嗽,然千金外台治咳嗽诸方多有之,而实权舆于仲圣之麦门冬汤。
麦门
瞿麦本淋药,而栝萎瞿麦丸之小便不利,与淋证有间,何以用瞿麦,乃是方之微旨,则
有可窥见者在焉。小便不利而有水气,其为下焦阳虚,显然易见。阳虚于下而热浮于上,所
以又渴。薯蓣附子能温肾补虚而不能止渴导水,故辅以栝蒌根之生津,茯苓之化气。然小便
不利而用薯附,岂无封蛰之虞。栝苓又和缓有余而勇健不足。然则排决之任,自当属之瞿麦
。此以淋药治小便不利而恰如其当,仲圣真神化无方矣。
麦冬的形态特征,结合《神农本草经》中的主治功效来看,它确实是调理胃部的正药。徐氏说,麦冬味甘性平且滋润,是专门补益胃阴的药物。
后人认为它是入肺经的药,大概是因为五行中土能生金,肺气的生成完全依赖胃阴的支持,胃气滋润,肺气自然得到益处。邹氏说,麦冬的功效在于提升和牵引胃中的阴精,润泽心肺,疏通脉道,降逆气,清除烦热,如果不是上焦的病证,那么使用它就完全不适宜。看这些论述就可以纠正李东垣只说麦冬入手太阴肺经而不及足阳明胃经的错误观点。
前人说不止一次提到麦冬能恢复脉搏、通心脉,大多是因为他们心中先有了《本经》中“胃之大络脉绝”的概念,然后用复脉汤、生脉散来验证这一点。我认为,胃的大络内通于血脉,所谓的“脉绝”其实是胃络气血不通贯,并不是真正的脉搏停止跳动。麦冬通过补益胃阴来疏通络脉,从而使血脉得到滋养从而恢复搏动,但这并非它能直接让停止的脉搏复活。真正能让脉搏直接复活的,只有人参,仔细研读《伤寒论》和《金匮要略》两本书就会明白。况且,如果是心腹结气、损伤中气或饱食过度导致的病症,如果不是因为胃络脉绝,又怎么可能是麦冬所能治疗的?下文提到的身体消瘦、短气,就是胃络脉绝的表现。《本经》中没有一字是虚设的,而且上下文如此相互照应,希望与研究《本经》的人一起探讨。
徐氏极力反对用麦冬治疗咳嗽,然而《千金方》和《外台秘要》中治疗咳嗽的方剂里有很多含有麦冬,这实际上起源于张仲景的麦门冬汤。
瞿麦本是治疗淋证(小便涩痛)的药物,但栝楼瞿麦丸所治的小便不利,与典型的淋证有所区别,为什么这里要用瞿麦呢?这里面蕴含着该方的精妙旨意,是可以窥探到的。小便不利且伴有水气停留,这是因为下焦阳气虚弱,这是明显容易看到的。下焦阳虚而上焦有浮热,所以患者又会感到口渴。山药和附子能温补肾阳、补虚,但不能止渴并引导水液代谢,所以辅以栝楼根生津,茯苓化气行水。然而,小便不利却使用山药和附子,难道没有封藏闭阻的担忧吗?栝楼和茯苓虽然调和缓和有余,但攻坚破积之力不足。那么,决堤排水的重任,自然应该归属于瞿麦。这是用治疗淋证的药物来治疗小便不利,恰好恰当其分,张仲景真是神妙变化、无固定法度啊。
The morphological characteristics of Ophiopogonis Radix (Maidong), when combined with the indications in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica), clearly indicate that it is a principal herb for treating the Stomach. Xu stated that Maidong, being sweet, neutral, and moistening, is a pure tonic for Stomach Yin.
Later practitioners considered it an herb for the Lungs, likely because Earth generates Metal in Five-Phase theory; Lung Qi relies entirely on Stomach Yin for its generation. When Stomach Qi is moistened, Lung Qi naturally benefits. Zou stated that the efficacy of Maidong lies in lifting and drawing up the Yin essence of the Stomach, moistening the Heart and Lungs, unblocking the vessels, descending rebellious Qi, and eliminating vexation and heat. If the condition is not located in the Upper Jiao, then its use is entirely inappropriate. Observing this can correct Li Dongyuan's error of stating that Maidong enters only the Hand-Taiyin Lung Meridian while neglecting the Foot-Yangming Stomach Meridian.
Predecessors frequently mentioned that Maidong restores the pulse and unblocks the Heart. This largely stems from their prior concept of "interruption of the Great Luo vessel of the Stomach" as described in the *Bencao Jing*, which they further validated using formulas like Fumai Tang (Pulse-Restoring Decoction) and Shengmai San (Generate Pulse Powder). I posit that the Great Luo vessel of the Stomach internally connects to the blood vessels; what is termed "pulse interruption" is actually the lack of penetration through the Stomach Luo vessels, not a true cessation of the pulse. Maidong tonifies Stomach Yin to unblock the collaterals, thereby allowing the vessels to receive nourishment and resume pulsation, but it does not directly restore a ceased pulse. The only herb capable of directly restoring the pulse is Ginseng Radix et Rhizoma (Renshen); careful study of both the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) will reveal this. Furthermore, regarding chest and abdominal qi stagnation, damage to the Middle Jiao, or injury from overeating, if these are not due to the interruption of the Stomach Luo vessels, how could they be treated by Maidong? The emaciation and shortness of breath mentioned later are signs of the interruption of the Stomach Luo vessels. Not a single word in the *Bencao Jing* is superfluous, and the text corresponds so well with itself above and below; I wish to discuss this with those who study the *Bencao Jing*.
Xu strongly criticized the use of Maidong for treating coughs. However, many prescriptions in the *Qianjin Fang* (Prescriptions Worth a Thousand Gold) and *Waitai Miyao* (Secret Essentials of the Outer Library) for coughs contain it, originating essentially from Zhang Zhongjing's Maidong Tang (Ophiopogon Decoction).
Dianthus Herba (Qumai) is primarily an herb for treating Lin syndrome (dysuria). However, the urinary difficulty treated by Gualou Qumai Wan (Trichosanthes Root and Dianthus Herb Pill) differs from typical Lin syndrome. Why is Qumai used here? This reveals the subtle purport of the formula, which can be glimpsed. Urinary difficulty accompanied by water retention indicates deficiency of Yang in the Lower Jiao, which is obvious and easy to see. With Yang deficiency in the lower part and floating heat in the upper part, thirst occurs. Dioscoreae Rhizoma (Shanyao) and Aconiti Lateralis Radix Praeparata (Fuzi) can warm the Kidney and tonify deficiency, but cannot stop thirst or guide water metabolism. Therefore, Trichosanthis Radix (Gualougen) is added to generate fluids, and Poria (Fuling) to transform Qi. Yet, using Shanyao and Fuzi for urinary difficulty raises concerns about excessive sealing and storing. Although Gualou and Fuling are harmonious and gentle, they lack vigorous strength. Thus, the task of breaking through and draining must fall to Dianthus Herba (Qumai). Using an herb for Lin syndrome to treat urinary difficulty is precisely appropriate; Zhang Zhongjing was truly divine in his transformation and devoid of fixed methods.