(《外台》)用大黄硝,鳖甲常山巴豆邀。杏仁栀豉蜜丸服,汗吐下兼三法超。时气毒疠
及疟痢,一丸两服量病调。〔茵陈、芒硝、鳖甲(炙)、栀子各二两,大黄五两,常山、杏仁
(炒)各三两,巴豆一两(去心皮炒),豉五合,蜜丸梧子大。每服一丸,或吐或利,不应
再服。一丸不应,以热汤投之。栀子、淡豉,栀豉汤也,合常山可以涌吐,合杏仁可以解肌。
大黄、芒硝,承气汤也,可以荡热去实,合茵陈可以利湿退黄,加巴豆大热以祛脏腑积寒,
加鳖甲滋阴以退血分寒热。此方备汗、吐、下三法,虽云劫剂,实是佳方。〕
即九味,己独知连白术暨。(即九味羌活汤加防己、知母、独活、黄连、生地、川芎、
知母各一两,余药各三钱,每服五钱。)散热培阴表里和,伤寒两感瘥堪慰。(两感伤寒,一
曰太阳与少阴俱病,二曰阳明与太阴俱病,三曰少阳与厥阴俱病。阴阳表里,同时俱病,欲
汗则有里证,欲下则有表证。经曰∶其两感于寒者,必死。仲景无治法,洁古为制此方,间
有生者。羌、独、苍、防、细辛,以散寒发表;芩、连、防己、知母、芎、地,以清里培阴;
白术、甘草,以固中和表里。)
七首、附方六
(《局方》)是苍术朴,陈皮甘草四般药。〔苍术(泔浸)二钱,浓朴(姜汁炒)、陈皮(去
白)、甘草(炙)各一钱,姜、枣煎。〕除湿散满驱瘴岚,调胃诸方从此扩。(苍术燥湿强脾,
浓朴散满平胃,陈皮利气行痰,甘草和中补土,泄中有补也。)或合二陈(名平陈汤,治痰)
或五苓,(名胃苓汤,治泄。)硝黄麦曲均堪着。(加麦芽、神曲消食,加大黄、芒硝荡积。)
若合小柴(胡)名柴平(汤),煎加姜枣能除疟。又不换金正气散,即是此方加夏藿(半夏、
藿香。)
(出自《外台秘要》的)茵陈丸,由大黄、硝石、鳖甲、常山、巴豆组成。服用杏仁、栀子、淡豉制成的蜜丸,兼具发汗、催吐、泻下三种治法的高超之处。适用于时行疫气、毒疠以及疟疾、痢疾,根据病情轻重调整剂量,每次服用一丸或两丸。〔茵陈、芒硝、炙鳖甲、栀子各二两,大黄五两,炒常山、炒杏仁各三两,去心皮并炒制的巴豆一两,淡豆豉五合,用蜂蜜制成梧桐子大小的蜜丸。每次服用一丸,若出现呕吐或腹泻则停止;若无反应,可再服一丸。若服一丸仍无反应,可用热汤送服以助药力。栀子与淡豆豉即栀豉汤,配合常山可以涌吐痰实,配合杏仁可以解肌发表。大黄与芒硝即承气汤,可以荡涤热邪、攻逐积滞,配合茵陈可以利湿退黄;加入大热的巴豆以祛除脏腑内的积寒;加入鳖甲滋阴以消退血分中的寒热。此方备有汗、吐、下三法,虽然被称为峻猛之剂,实则是一个良方。〕
即九味羌活汤中加入防己、知母、独活、黄连、生地、川芎、知母各一两,其余药物各三钱,每次服用五钱。此方能散热并培补阴液,调和表里,对于伤寒“两感”证痊愈令人欣慰。(所谓伤寒两感,一是太阳经与少阴经同时发病,二是阳明经与太阴经同时发病,三是少阳经与厥阴经同时发病。阴阳表里同时受病,想发汗则有里证阻碍,想攻下则有表证未解。经文说:凡是感受寒邪而两感的,必死无疑。张仲景没有制定治疗方法,李东垣为此制定了这个方子,偶尔也有治愈的案例。羌活、独活、苍术、防风、细辛,用来散寒发表;黄芩、黄连、防己、知母、川芎、生地,用来清里热并培补阴液;白术、甘草,用来固护中焦并调和表里。)
七首、附方六
(出自《太平惠民和剂局方》的)平胃散,由苍术、厚朴、陈皮、甘草四味药组成。〔苍术(淘米水浸泡)二钱,姜汁炒厚朴、去白陈皮、炙甘草各一钱,加生姜、大枣煎服。〕此方能除湿气、消胀满、驱除瘴气,调理脾胃的各种方剂都由此方扩展而来。(苍术燥湿强脾,厚朴消除胀满并平调胃气,陈皮理气化痰,甘草和中补益脾胃,体现了泄中有补的原则。)或者合并二陈汤(名为平陈汤,治疗痰证),或者合并五苓散(名为胃苓汤,治疗泄泻),加入麦芽、神曲均适宜用于消食导滞,加入大黄、芒硝均适宜用于荡涤积滞。如果合并小柴胡汤,名为柴平汤,煎煮时加入生姜、大枣能治疗疟疾。不换金正气散,就是在这个方剂基础上加入半夏、藿香。
(Yinchen Wan, from *Waitai Miyao*) Composed of Dahuang (Rhei Radix et Rhizoma), Xiaoshi (Natrii Sulfas), Biejia (Testudinis Carapax et Plastrum), Changshan (Polygalae Radix), and Badou (Crotonis Fructus). Administered as honey pills made with Xingren (Armeniacae Semen Amarum), Zhizi (Gardeniae Fructus), and Chishi (Fermented Sojae Semen Praeparatum), it excellently combines the methods of inducing sweating, vomiting, and purging. It is indicated for seasonal epidemic toxins, pestilence, malaria, and dysentery; dosage is adjusted according to the severity of the disease, taking one or two pills per administration. [Yinchen (Artemisiae Scopariae Herba), Mangxiao (Natrii Sulfas), roasted Biejia (Testudinis Carapax et Plastrum), Zhizi (Gardeniae Fructus) each 2 liang; Dahuang (Rhei Radix et Rhizoma) 5 liang; Changshan (Polygalae Radix), fried Xingren (Armeniacae Semen Amarum) each 3 liang; Badou (Crotonis Fructus) 1 liang (heart and skin removed, fried); Chishi (Fermented Sojae Semen Praeparatum) 5 he. Honey is used to make pills the size of wutong seeds. Take one pill per dose. If vomiting or diarrhea occurs, stop administration. If there is no response, take another pill. If one pill yields no response, administer with hot water to enhance efficacy. Zhizi (Gardeniae Fructus) and Danchi (Fermented Sojae Semen Praeparatum) constitute Zhichi Tang (Gardenia and Fermented Soybean Decoction); combined with Changshan (Polygalae Radix), it induces vomiting; combined with Xingren (Armeniacae Semen Amarum), it releases the muscle layer. Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) constitute Chengqi Tang (Chengqi Decoction); they purge heat and remove excess; combined with Yinchen (Artemisiae Scopariae Herba), they promote dampness elimination and resolve jaundice; adding the hot-natured Badou (Crotonis Fructus) dispels accumulated cold in the zang-fu organs; adding Biejia (Testudinis Carapax et Plastrum) nourishes yin and resolves blood-level chills and fever. This formula encompasses the methods of sweating, vomiting, and purging. Although termed a drastic remedy, it is actually an excellent prescription.]
This refers to Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction) added with Fangji (Stephaniae Tetrandrae Radix), Zhimu (Anemarrhenae Rhizoma), Duhuo (Angelicae Pubescentis Radix), Huanglian (Coptidis Rhizoma), Shengdi (Rehmanniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Zhimu (Anemarrhenae Rhizoma) each 1 liang, while the remaining herbs are each 3 qian. Each dose is 5 qian. It clears heat, nourishes yin, and harmonizes the interior and exterior, bringing comfort in the recovery from "double-reception" shanghan (cold damage). ("Double-reception" shanghan refers to simultaneous involvement of exterior and interior meridians: first, Taiyang (Greater Yang) and Shaoyin (Lesser Yin); second, Yangming (Yang Brightness) and Taiyin (Greater Yin); third, Shaoyang (Lesser Yang) and Jueyin (Terminal Yin). When yin and yang, exterior and interior are simultaneously affected, inducing sweat is hindered by interior signs, and purging is hindered by exterior signs. The classic states: those who receive cold in a double-reception manner will surely die. Zhang Zhongjing provided no treatment method for this; Li Dongyuan formulated this prescription, and occasionally patients survive. Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), and Xixin (Asari Radix et Rhizoma) disperse cold and release the exterior; Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Fangji (Stephaniae Tetrandrae Radix), Zhimu (Anemarrhenae Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Shengdi (Rehmanniae Radix) clear the interior and nourish yin; Baizhu (Atractylodis Macrocephalae Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) secure the middle jiao and harmonize the interior and exterior.)
Seven formulas, Six supplementary formulas
(Pingwei San (Stomach-Pacifying Powder), from *Jufang*) Consists of four herbs: Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Chenpi (Citri Reticulatae Pericarpium), and Gancao (Glycyrrhizae Radix et Rhizoma). [Cangzhu (Atractylodis Rhizoma) soaked in rice water 2 qian; Houpo (Magnoliae Officinalis Cortex) stir-fried with ginger juice, Chenpi (Citri Reticulatae Pericarpium) without white pith, and roasted Gancao (Glycyrrhizae Radix et Rhizoma) each 1 qian; decocted with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus).] It eliminates dampness, reduces fullness, and drives away miasma; various formulas regulating the stomach expand from this base. (Cangzhu (Atractylodis Rhizoma) dries dampness and strengthens the spleen; Houpo (Magnoliae Officinalis Cortex) disperses fullness and pacifies the stomach; Chenpi (Citri Reticulatae Pericarpium) regulates qi and moves phlegm; Gancao (Glycyrrhizae Radix et Rhizoma) harmonizes the middle and tonifies earth, embodying the principle of draining within tonifying.) It can be combined with Erchen Tang (Two-Aged Decoction) to form Pingchen Tang (Pingchen Decoction, treating phlegm), or with Wuling San (Five-Ling Powder) to form Weiling Tang (Weiling Decoction, treating diarrhea). Adding Maiya (Hordei Fructus Germinatus) and Shenqu (Massa Medicata Fermentata) is suitable for digesting food; adding Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) is suitable for purging accumulation. If combined with Xiao Chaihu Tang (Minor Bupleurum Decoction), it is named Chai Ping Tang (Chai Ping Decoction); decocted with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), it can treat malaria. Bu Huan Jin Zhengqi San (Bu Huan Jin Qi-Regulating Powder) is simply this formula added with Banxia (Pinelliae Rhizoma) and Huoxiang (Pogostemonis Herba).