丹溪曰人之七情浓味停痰瘀血互相纠缠日积月深郁结成聚甚者如桃核之穣诸般奇形之虫
成于中形于外发为瘫痪为劳瘵为蛊胀为癞疾为无名奇病宜行此法
用黄牡牛肉择肥者买一二十斤长流水煮糜烂融入汤中为液以布滤出渣滓取净汁再入锅文
武火
熬成琥珀色则成矣每饮一钟少时又饮如此者积十数钟寒月则重汤温而饮之病在上者欲其吐多
病在下者欲其利多病在中者欲其吐利俱多全在活法而为缓急多寡也须晴明日早于一室明快不
通风处以安病患视所出之物可尽病根则止吐利后或渴不得与汤水其小便必长取以饮病者名曰
轮回酒与一二碗非惟可以止渴抑且可涤灌余垢睡一二日觉饥甚乃与粥淡食之待三日后始与少
菜羹自养半月觉精神涣发形体轻健沉 悉除其后须五年忌牛肉
御药院方助气丸治三焦痞闭胸膈满闷气不流通蕴结成积 癖气块并皆治之
京三棱 莪术(各炮二斤) 青皮 陈皮(并去白) 白术(各十五两) 槟榔 枳壳 木香
(各十两)
上为末糊丸如梧子大每五十丸煎水下
按此治诸气积药也然世俗治积之方多兼气药欲其气化而积易散殊不知气虚者何以抵受中
夹热
者岂不助火反伤气耶故用者宜分虚实寒热选使况此方杂削气之药过半而云助气恐未必然也
三因散聚汤治久气积聚状如 瘕随气上下发作有时心腹绞痛攻刺腰胁小腹 胀大小便不
利
半夏 槟榔 当归(各三分) 陈皮 杏仁(去皮夹炒) 桂(各二两) 茯苓 甘草(炙)
附子(炮) 川芎 枳壳(炒) 浓朴(制) 吴茱萸(汤泡洗各一两) 大黄(大便利去之)
上 咀每服四钱水煎
济生大七气汤治积聚状如 瘕随气上下发作有时心腹 痛上气窒塞小腹胀满
桔梗 肉桂 藿香叶 甘草(炙) 青皮(各二分) 益智仁 京三棱 陈皮 蓬术 香附
子(炒各一两半)
上 咀每服五钱水煎
按此二方治聚之剂也然聚瘕用汤荡涤之意亦要随脏气虚实寒热而增损之可也
东垣草豆蔻丸治酒积或伤寒冷物胃脘痛咽膈不通
草豆蔻(煨) 白术(各一两) 大麦 神曲(各炒) 黄芩 半夏(各半两) 枳实(炒二
两) 炒盐(半钱) 陈皮 青皮 干生姜(各二钱)
上为极细末汤浸蒸饼丸如绿豆大每服百丸煎水下
按此治酒积饮积药也入气血之分
广术溃坚汤治有积块坚硬如石形如袢大令人坐卧不安中满腹胀
方见腹胀门
宝鉴香壳丸破痰癖消 块及冷积
木香 丁香(各五钱) 京三棱(锉酒浸一宿) 青皮 广术(锉酒浸一宿用去皮巴豆三十
粒同炒巴豆黄色)
枳壳(炒) 川楝子 茴香(炒各一两)
上末醋糊丸如梧子大朱砂为衣每服二十丸姜盐汤下
按此治气积寒积之剂下焦药也
丹溪阿魏丸治肉积
连翘(半两) 糖球子(一两) 黄连(六钱半) 阿魏(一两醋煮作糊)
上为末用阿魏糊丸如梧子大每二三十丸白汤下
保和丸治食积
糖球子(三两) 半夏 茯苓(各一两) 神曲(二两) 陈皮 连翘 萝卜子(各半两)
上为末粥糊丸如梧子大每三四十丸白汤下
按此二方食积药也又此方治痰积饮积之剂丹溪曰脾虚者须以补脾药下之切不可独用虚虚
之祸疾如反掌益慎之也气实新病宜于攻下诸方选用又不必拘此
宣明三棱汤治 瘕 癖积聚不散坚满痞膈食不下腹胀
蓬术 当归(各半两) 京三棱(二两) 白术(一两) 槟榔 木香(各三分)
上为末每三钱沸汤调下
按此治 瘕之剂气血药也然瘕者虽硬而忽聚散即聚也属阳气也经云血不流而寒薄故血内
凝而瘕益又属血尔固当兼治之此方亦可以推其变从虚实加减而轻重之可也
谨按针经备阴络伤汁血相搏并合成积或脏气传受及子和论七情为郁皆元气自病不系伤诸
饮食
致者当先调理不可妄下故以上五脏方消导法宜选用气虚弱甚者又宜消息此养正积自除之意若
伤诸饮食致者元气未病初非下之削之不可然治之不早元气日减正气日偷方用下削而能获安者
实侥幸焉至是者亦宜上法先补后攻可也医反是之多致误尔若积郁在身形气饮食如常者则以下
削坚之方或吐或下的在选用衰其太半宜渐除之否则失机后时而不救者多矣然有除之未尽元气
未复而使内纵口味恣七情病遂复起者亦不鲜矣呜呼世道不古人之不谨致积又不能归罪于已安
心调理卒致殒没不得以尽其天年者固不足惜然医之不能精明其道误人生命者岂无所报耶
朱丹溪说:人的七情(喜、怒、忧、思、悲、恐、惊)过浓,加上厚味饮食停滞,导致痰湿和瘀血互相纠缠,日积月深,郁结形成积聚。严重的像桃核的果肉一样,体内生出各种奇形怪状的虫,表现在外,引发瘫痪、劳瘵(消耗性疾病)、蛊胀(腹部胀大如鼓的病证)、癞疾(皮肤顽疾)、无名奇病等,适宜采用这种方法治疗。
使用黄牡牛肉,选择肥壮的买一二十斤,用长流水煮至糜烂,融入汤中成为液体,用布滤出渣滓,取纯净的汁液再次放入锅中,用文武火熬制成琥珀色即可。每次饮用一杯,稍后又饮一杯,如此累计饮用十几杯。寒冷月份则隔水加热后饮用。病位在上部的,希望呕吐多;病位在下部的,希望腹泻多;病位在中间的,希望吐泻都多。全凭灵活掌握缓急和多寡。必须在晴朗的日子,早晨在一间明亮且不通风的房间内安置病人。观察排出的物质,若能除尽病根就停止。吐泻后如果口渴,不能给喝汤水,其小便必然变长,取来让病人饮用,名叫“轮回酒”,喝一两碗,不仅能止渴,而且可以涤荡残留的污垢。睡一两日后,感到饥饿,才给喝粥和淡食。等到三天后才给少量的菜羹自养。半个月后,感觉精神焕发,身体轻健,沉疴悉除。此后必须五年忌食牛肉。
御药院方的助气丸,治疗三焦痞闭、胸膈满闷、气机不流通、蕴结形成的积癖和气块,都能治疗。
京三棱、莪术(各炮制二斤)、青皮、陈皮(均去白)、白术(各十五两)、槟榔、枳壳、木香(各十两)。
以上药物研为细末,用糊剂制成梧桐子大小的丸药。每次五十丸,煎汤送服。
按语:这是治疗各种气积的药物。然而世俗治疗积滞的方子大多兼用理气药,想要通过气化使积滞容易消散。却不知道气虚的人怎么能承受得住?其中夹杂热邪的,岂不是助火反而伤气吗?所以使用者应当分辨虚实寒热来选择使用。况且这个方子中削减气机的药物超过一半,却说是“助气”,恐怕未必如此。
三因散聚汤,治疗久积的气聚,形状像瘕(腹内结块,聚散无常),随气机上下移动,发作有定时,心腹绞痛,攻刺腰胁小腹,胀满,大小便不利。
半夏、槟榔、当归(各三分)、陈皮、杏仁(去皮夹炒)、桂枝(各二两)、茯苓、甘草(炙)、附子(炮制)、川芎、枳壳(炒)、浓朴(制)、吴茱萸(汤泡洗,各一两)、大黄(大便通畅者去掉)。
以上药物切碎,每次服用四钱,水煎服。
济生大七气汤,治疗积聚,形状像瘕,随气机上下移动,发作有定时,心腹疼痛,上气窒塞,小腹胀满。
桔梗、肉桂、藿香叶、甘草(炙)、青皮(各二分)、益智仁、京三棱、陈皮、蓬术、香附子(炒,各一两半)。
以上药物切碎,每次服用五钱,水煎服。
按语:这两个方子是治疗聚证的药剂。然而对于聚和瘕,用汤剂荡涤的意思,也要根据脏腑之气的虚实寒热进行增减,是可以的。
东垣草豆蔻丸,治疗酒积或损伤寒冷食物导致的胃脘痛、咽膈不通。
草豆蔻(煨)、白术(各一两)、大麦、神曲(各炒)、黄芩、半夏(各半两)、枳实(炒,二两)、炒盐(半钱)、陈皮、青皮、干生姜(各二钱)。
以上药物研为极细末,用汤浸蒸饼制成绿豆大小的丸药。每次服用一百丸,煎汤送服。
广术溃坚汤,治疗有积块坚硬如石,形状像袢(一种古代头饰,形容形状),令人坐卧不安,中满腹胀。
方见腹胀门(参见腹胀章节)。
宝鉴香壳丸,破除痰癖,消除瘕块及冷积。
木香、丁香(各五钱)、京三棱(锉碎,酒浸一夜)、青皮、广术(锉碎,酒浸一夜,用去皮巴豆三十粒同炒,至巴豆呈黄色)、枳壳(炒)、川楝子、茴香(炒,各一两)。
以上研为细末,醋糊制成梧桐子大小的丸药,朱砂为衣。每次服用二十丸,姜盐汤送服。
按语:这是治疗气积、寒积的药剂,属于下焦药。
丹溪阿魏丸,治疗肉积。
连翘(半两)、糖球子(一两)、黄连(六钱半)、阿魏(一两,醋煮成糊状)。
以上研为细末,用阿魏糊制成梧桐子大小的丸药。每次二三十丸,白开水送服。
保和丸,治疗食积。
糖球子(三两)、半夏、茯苓(各一两)、神曲(二两)、陈皮、连翘、萝卜子(各半两)。
以上研为细末,粥糊制成梧桐子大小的丸药。每次三四十丸,白开水送服。
按语:这两个方子是治疗食积的药物。另外,此方也是治疗痰积、饮积的药剂。朱丹溪说:脾虚的人必须用补脾药送服,切不可单独使用,否则会造成虚上加虚的祸患,疾病变化迅速,务必谨慎。气实新病适宜在攻下方剂中选择使用,又不必拘泥于此。
宣明三棱汤,治疗瘕、癖、积聚不散,坚硬痞满,膈部不适,饮食不下,腹胀。
蓬术、当归(各半两)、京三棱(二两)、白术(一两)、槟榔、木香(各三分)。
以上研为细末,每次三钱,沸水调服。
按语:这是治疗瘕的药剂,属于气血药。然而瘕虽然坚硬,但忽聚忽散,即聚也,属于阳气。经书说:血不流动而寒气薄迫,所以血液内部凝结而形成瘕,又属于血。所以应当兼治。这个方子也可以推演其变化,从虚实加减并决定轻重,是可以的。
谨按:《针经》记载阴络受伤,汁与血相搏,并合成积;或者脏气传受,以及子和论七情为郁,都是元气自病,不系于损伤各种饮食所致。这种情况应当先调理,不可妄用攻下。所以上面五脏方的消导法宜选用。气虚弱甚者,又应斟酌“养正积自除”的意思。如果是损伤各种饮食致病的,元气未病,起初非攻下削积不可。然而治疗不早,元气日渐减少,正气日渐衰弱,此时再用攻下削积而能获安的,实在是侥幸。到了这种地步,也宜用上法,先补后攻。医生反其道而行,多导致误治。如果积郁在身体,形体、气机、饮食如常,则以下削坚硬的方剂,或吐或下,由患者选用,宜逐渐削弱其势,慢慢去除。否则失机过时而不能救治的很多了。然而有积滞未除尽,元气未恢复,而使内心放纵口味、恣意七情,病遂复起的,也不少见。唉!世道不如古时,人不够谨慎,导致积滞又不能归咎于自己,安心调理,最终致死,不能尽享天年,固然不值得惋惜。然而医生不能精通其道,误人性命,难道没有报应吗?
Zhu Danxi said: When the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) are excessive and rich flavors of food stagnate, phlegm-dampness and blood stasis entangle each other. Over time, they accumulate and form masses. In severe cases, like the flesh of a peach pit, various bizarrely shaped parasites form within and manifest externally, leading to paralysis, Lao Zhai (consumptive disease), Gu Zhang (abdominal distension resembling drum), Lai Ji (skin diseases), and nameless strange illnesses. It is appropriate to employ this method.
Use yellow ox beef, selecting fat pieces, purchasing ten to twenty jin. Boil in running water until tender and mushy, blending into the broth to form a liquid. Strain through cloth to remove dregs, taking only the clear juice. Return the juice to the pot and simmer with mild heat until it turns amber-colored; then it is ready. Drink one cup at a time, followed by another shortly after, accumulating to more than ten cups. In cold months, warm it in a double boiler before drinking. For diseases located in the upper body, induce more vomiting; for those in the lower body, induce more diarrhea; for those in the middle, induce both vomiting and diarrhea. The speed and quantity depend on flexible application. This must be done on a sunny day, early in the morning, in a bright room without drafts, where the patient is placed. Observe the expelled substances; stop when the root cause of the disease is cleared. If thirsty after vomiting and diarrhea, do not give soup or water. The urine will necessarily become long and abundant; collect it for the patient to drink, named "Lunhui Jiu" (Wheel-turning Wine). Drinking one or two bowls can quench thirst and also cleanse residual filth. Sleep for one or two days; when feeling very hungry, provide porridge and bland food. After three days, provide small amounts of vegetable soup for self-nourishment. After half a month, feel refreshed spirit and light, healthy body, with chronic ailments completely removed. Thereafter, avoid beef for five years.
Yuyuan Yuan Fang's Zhuqi Wan (Qi-Assisting Pill) treats Sanjiao (Triple Burner) blockage, chest and diaphragm fullness, stagnant Qi flow, and accumulated masses,癖 (fixed lumps), and Qi blocks.
Jingsanleng (Rhizoma Sparganii), Ezhu (Rhizoma Curcumae) (each processed, 2 jin); Qingpi (Pericarpium Citri Reticulatae Viride), Chenpi (Pericarpium Citri Reticulatae) (both pith removed); Baizhu (Rhizoma Atractylodis Macrocephalae) (each 15 liang); Binglang (Arecae Semen), Zhike (Fructus Aurantii), Muxiang (Radix Aucklandiae) (each 10 liang).
Grind into powder, make pills with paste the size of mulberry seeds. Take 50 pills per dose, washed down with decoction.
Note: This is a formula treating various Qi accumulations. However, secular formulas for treating accumulation often include Qi-regulating herbs, hoping that Qi transformation will easily disperse accumulation. They fail to realize how Qi-deficient patients can endure it? If heat is involved, does it not aid fire and damage Qi instead? Therefore, users should distinguish between deficiency/excess and cold/heat to select usage. Moreover, since more than half of this formula consists of Qi-reducing herbs, claiming it "assists Qi" is likely incorrect.
Sanyin Sanju Tang (Three Causes Scattering Accumulation Decoction) treats long-standing Qi accumulation, forming masses like Xia (mobile lumps), moving up and down with Qi, occurring at fixed times, with colicky heart and abdominal pain radiating to waist, hypochondrium, and lower abdomen, distension, and difficulty in urination and defecation.
Banxia (Rhizoma Pinelliae), Binglang (Arecae Semen), Danggui (Radix Angelicae Sinensis) (each 3 fen); Chenpi (Pericarpium Citri Reticulatae), Xingren (Semen Armeniacae Amarum, peeled and stir-fried), Guizhi (Ramulus Cinnamomi) (each 2 liang); Fuling (Poria), Gancao (Radix Glycyrrhizae, honey-fried), Fuzi (Radix Aconiti Lateralis Preparata), Chuanxiong (Rhizoma Chuanxiong), Zhike (Fructus Aurantii, stir-fried), Houpo (Cortex Magnoliae Officinalis, processed), Wuzhuyu (Fructus Evodiae, soaked in hot water and washed) (each 1 liang); Dahuang (Radix et Rhizoma Rhei, omit if bowels are loose).
Chop ingredients. Take 4 qian per dose, decoct in water.
Jisheng Daqiji Tang (Jisheng Great Seven-Qi Decoction) treats accumulation and mass formation, resembling Xia, moving with Qi, occurring at fixed times, with heart and abdominal pain, suffocating sensation in the upper body, and lower abdominal distension.
Jiegeng (Radix Platycodonis), Rougui (Cortex Cinnamomi), Huoxiangye (Folium Agastaches), Gancao (Radix Glycyrrhizae, honey-fried), Qingpi (Pericarpium Citri Reticulatae Viride) (each 2 fen); Yizhiren (Semen Alpiniae Oxyphyllae), Jingsanleng (Rhizoma Sparganii), Chenpi (Pericarpium Citri Reticulatae), Pengzhu (Rhizoma Curcumae), Xiangfuzi (Fructus Cyperi Rotundi, stir-fried) (each 1.5 liang).
Chop ingredients. Take 5 qian per dose, decoct in water.
Note: These two formulas are agents for treating Ju (gathering/migratory masses). For Ju and Xia, using decoctions to scour implies adjusting based on the deficiency/excess and cold/heat of Zang-Fu Qi, which is acceptable.
Dongyuan Caodoukou Wan (Caodoukou Pill) treats Jiuji (wine accumulation) or stomach ache due to cold injury, with blocked throat and diaphragm.
Caodoukou (Fructus Alpiniae Katsumadai, baked), Baizhu (Rhizoma Atractylodis Macrocephalae) (each 1 liang); Damai (Fructus Hordei Vulgaris Germinatus), Shenqu (Massa Medicata Fermentata, stir-fried) (each stir-fried); Huangqin (Radix Scutellariae), Banxia (Rhizoma Pinelliae) (each 0.5 liang); Zhishi (Fructus Aurantii Immaturus, stir-fried, 2 liang); Chaoyan (Stir-fried salt, 0.5 qian); Chenpi (Pericarpium Citri Reticulatae), Qingpi (Pericarpium Citri Reticulatae Viride), Ganshengjiang (Rhizoma Zingiberis Recens, dried) (each 2 qian).
Grind into extremely fine powder. Soak in water, steam with steamed dough, make pills the size of mung beans. Take 100 pills per dose, washed down with decoction.
Note: This is a medicine for treating wine and fluid accumulation, involving the Qi and Blood levels.
Guangshu Kuijian Tang (Guangshu Hardness-Softening Decoction) treats hard masses like stone, shaped like Pan (a type of head ornament), causing restlessness, central fullness, and abdominal distension.
See Abdominal Distension section.
Baojian Xiangke Wan (Xiangke Pill) breaks up Tanpi (phlegm-parasites), eliminates Xia masses and cold accumulation.
Muxiang (Radix Aucklandiae), Dingxiang (Flos Caryophylli) (each 5 qian); Jingsanleng (Rhizoma Sparganii, chopped and soaked in wine overnight); Qingpi (Pericarpium Citri Reticulatae Viride), Guangzhu (Rhizoma Curcumae Longae, chopped and soaked in wine overnight, stir-fried together with 30 grains of desiccated Baiduo (Fructus Crotonis Tiglii) until Baiduo turns yellow); Zhike (Fructus Aurantii, stir-fried), Chuanlianzi (Semen Toosendan), Huixiang (Fructus Foeniculi, stir-fried) (each 1 liang).
Grind into powder, make pills with vinegar paste the size of mulberry seeds, coat with Zhusha (Cinnabar). Take 20 pills per dose, washed down with ginger-salt water.
Note: This is an agent for treating Qi accumulation and Cold accumulation, acting on the Lower Jiao.
Danxi Awie Wan (Awie Pill) treats Rouji (meat accumulation).
Lianqiao (Fructus Forsythiae, 0.5 liang); Tangqiuzi (likely referring to a specific fruit seed or ingredient, 1 liang); Huanglian (Rhizoma Coptidis, 6.5 qian); Awie (Resina Ferulae, 1 liang, boiled in vinegar to form paste).
Grind into powder, use Awie paste to make pills the size of mulberry seeds. Take 20-30 pills per dose, washed down with plain water.
Baohe Wan (Harmony-Preserving Pill) treats Shiji (food accumulation).
Tangqiuzi (3 liang); Banxia (Rhizoma Pinelliae), Fuling (Poria) (each 1 liang); Shenqu (Massa Medicata Fermentata, 2 liang); Chenpi (Pericarpium Citri Reticulatae), Lianqiao (Fructus Forsythiae), Luobozhi (Semen Raphani) (each 0.5 liang).
Grind into powder, make pills with porridge paste the size of mulberry seeds. Take 30-40 pills per dose, washed down with plain water.
Note: These two formulas are medicines for food accumulation. Additionally, this formula is also an agent for treating Phlegm accumulation and Fluid accumulation. Zhu Danxi said: For Spleen deficiency, one must administer tonifying Spleen medicines along with it. Do not use them alone, lest disaster of "deficiency adding to deficiency" occur rapidly. Be cautious. For Qi excess and new diseases, suitable for selection among purgative formulas, but do not rigidly adhere to these.
Xuanming Sanleng Tang (Sanleng Decoction) treats Xia, Pi, accumulation and gathering that do not dissipate, hardness and fullness, blockage in the diaphragm, inability to eat, and abdominal distension.
Pengzhu (Rhizoma Curcumae), Danggui (Radix Angelicae Sinensis) (each 0.5 liang); Jingsanleng (Rhizoma Sparganii, 2 liang); Baizhu (Rhizoma Atractylodis Macrocephalae, 1 liang); Binglang (Arecae Semen), Muxiang (Radix Aucklandiae) (each 3 fen).
Grind into powder. Take 3 qian per dose, mix with boiling water.
Note: This is an agent for treating Xia, involving Qi and Blood. Although Xia is hard, it gathers and scatters suddenly, belonging to Yang Qi. The Classics state: When blood does not flow and cold presses upon it, blood coagulates internally forming Xia, thus it also belongs to Blood. Therefore, it should be treated jointly. This formula can also be extrapolated for variations, adjusting dosage based on deficiency/excess and severity, which is acceptable.
Respectfully note: The *Zhenjing* (Needle Classic) records that injury to Yin collaterals causes juices and blood to contend, combining to form accumulation; or transmission of Zang-Fu Qi, and Hezi's discussion of Seven Emotions as depression, all indicate Yuan Qi (Original Qi) illness itself, not caused by damaging various foods. Such cases require prior regulation and should not be blindly purged. Therefore, the above five-Zang formulas' digestion methods should be selected. For severe Qi deficiency, consider the principle that "nourishing righteousness removes accumulation naturally." If caused by damaging various foods, where Yuan Qi is initially unaffected, purging and reducing accumulation is necessary from the start. However, if treatment is delayed, Yuan Qi decreases daily, Righteous Qi weakens daily; using purgatives and reducers at this stage to achieve safety is merely luck. At such stages, the above method of tonifying first, then attacking, is advisable. Doctors who act oppositely often cause errors. If accumulation exists in the body, but physique, Qi mechanism, and diet remain normal, then use formulas to soften hardness via purgation or emesis, chosen by the patient, aiming to gradually reduce the pathogen by half and eliminate it slowly. Otherwise, missing the opportunity leads to untreatable conditions frequently. Yet, there are cases where accumulation is not fully cleared, Yuan Qi has not recovered, leading to indulgence in taste and Seven Emotions, causing disease recurrence, which is common. Alas! The world is not like antiquity; people are not prudent. Causing accumulation yet blaming no one, failing to regulate mindfully, ultimately dying prematurely, unable to fulfill their natural lifespan—such cases are indeed not worth pity. But doctors who cannot master their art, mistaking lives, surely face retribution?