防风通圣散去朴硝麻黄加人参寒水石甘菊砂仁
上为末水煎
按此乃通圣散加减药法刘张此等方极多兹不详录
机要大秦艽汤治中风外无六经之形证内无便溺之阻隔知是血弱不能养于筋手足不能运口
强不能语言宜养血而筋自荣也
秦艽 石膏(各二两) 甘草 川芎 当归 芍药 羌活 独活 防风 黄芩 白芷 生
地黄 熟地黄 白茯苓 白术(各一两) 细辛(半两) 春夏加知母一两
上锉每服一两水煎天阴雨加生姜七片
羌活愈风汤疗肾肝虚筋骨弱语言难精神昏愦此药安心养神调阴阳无偏胜治中风内外无邪
服此药以行中道
羌活 甘草(炙) 防风 蔓荆子 川芎 熟地黄 细辛 枳壳 人参 麻黄 甘菊 薄
荷
枸杞 当归 知母 地骨皮 黄 独活 白芷 杜仲 秦艽 柴胡 半夏 前胡 浓朴
防己(各二两) 白茯苓 黄芩 芍药(各三两) 桂(一两) 生地黄 石膏 苍术(各四两)
天阴雨加生姜
上每服一两水煎如微汗加麻黄如通利加大黄更有四时加减法
就以此汤咽下四白丹清肺养魄二丹元安神定志和血是动以安神静以清肺
天麻丸治风因热而生热胜则动宜以静胜其躁是养血也此药行荣卫壮筋骨
天麻 牛膝(各六两同酒浸三日焙干) 萆 (另研细) 玄参(各六两) 附子(一两炮)
杜仲(七两) 羌活(十四两或十五两) 生地黄(一斤) 当归(十两)
一方有独活五两去肾间风
上为细末蜜丸桐子大常服五七十丸病大至百丸空心食前温酒或白汤下良久则食服药半月
后觉壅塞以七宣丸疏之
按以上三方东垣云调经养血安神之剂然风而挟虚理宜补养仲景治风虚香港脚用八味丸略露
端绪
而世人莫能扩充之也局方骨碎补丸治肝肾风虚换腿丸治足三阴经虚专用疏通燥疾之药既失之
矣此三方较之局方虽优亦所得不偿所失也何以为然秦艽汤愈风汤虽皆有补血之药而行经散风
之剂居其大半将何以养血而益筋骨也天麻丸养血壮筋骨庶几近理
防风通圣散去掉朴硝、麻黄,加入人参、寒水石、甘菊、砂仁。
将上述药物研为细末,用水煎服。
按语:这是通圣散的加减用药方法,刘完素、张元素等医家此类方剂极多,此处不再详细收录。
机要大秦艽汤治疗中风,外在没有六经病的形证,内在没有大小便不通的阻隔,知道这是血虚不能濡养筋脉,导致手足不能运动、口强直不能言语,应当养血则筋脉自然荣润。
秦艽、石膏(各二两)、甘草、川芎、当归、芍药、羌活、独活、防风、黄芩、白芷、生地黄、熟地黄、白茯苓、白术(各一两)、细辛(半两),春夏季节加知母一两。
将药物捣碎,每次服用一两,用水煎服;若遇阴雨天气,加生姜七片。
羌活愈风汤治疗肾肝虚损、筋骨软弱、语言困难、精神昏沉困倦。此药能安心养神、调和阴阳、无偏胜之弊,治疗中风内外无邪气,服用此药以行于中道。
羌活、甘草(炙)、防风、蔓荆子、川芎、熟地黄、细辛、枳壳、人参、麻黄、甘菊、薄荷、枸杞、当归、知母、地骨皮、黄芪、独活、白芷、杜仲、秦艽、柴胡、半夏、前胡、厚朴、防己(各二两)、白茯苓、黄芩、芍药(各三两)、桂枝(一两)、生地黄、石膏、苍术(各四两)。遇阴雨天气加生姜。
每次服用一两,用水煎服。若微微出汗则加麻黄,若大便通畅则加大黄。另有四季加减法。
就以此汤送服四白丹、清肺养魄二丹元,以安神定志、和血。动则安神,静则清肺。
天麻丸治疗因风而生热,热盛则动,宜以静制动其躁动,这是养血的方法。此药能运行营卫、强壮筋骨。
天麻、牛膝(各六两,同酒浸泡三日,焙干)、萆薢(另研细)、玄参(各六两)、附子(一两,炮制)、杜仲(七两)、羌活(十四两或十五两)、生地黄(一斤)、当归(十两)。
一方中有独活五两,以去除肾间的风邪。
将药物研为细末,用蜂蜜制成梧桐子大小的丸剂。常服五七十丸,病重者至一百丸。空腹、食前用温酒或白开水送下,过一会儿再进食。服药半月后,若感觉壅塞,用七宣丸疏通。
按语:以上三方,李东垣说是调经养血安神的方剂。然而风邪挟带虚证,理应补养。张仲景治疗风虚脚气用八味丸,略微露出端倪,但世人未能加以扩充。局方的骨碎补丸治疗肝肾风虚,换腿丸治疗足三阴经虚损,专门使用疏通燥疾的药物,这就失之偏颇了。这三方与局方相比虽然优越,但也算是所得不偿所失。为什么这样说呢?大秦艽汤、愈风汤虽然都有补血药物,但通行经络、疏散风邪的药物占大多数,靠什么来养血并益助筋骨呢?天麻丸养血壮筋骨,稍微接近道理。
Feng Tong Sheng San (Wind-Blocking Universal Powder) with Puxiao (Mirabilite) and Mahuang (Ephedrae Herba) removed, and Renshen (Ginseng Radix), Hanshuishi (Calcitum), Ganju (Chrysanthemi Flos), and Sharen (Amomi Fructus) added.
The above ingredients are ground into powder and decocted in water for administration.
Note: This is a modified prescription based on Feng Tong Sheng San. There are numerous such formulas by Liu Wansu and Zhang Yuansu; they are not recorded in detail here.
Ji Yao Da Qin Jiao Tang (Major Gentian Decoction from the Essentials) treats Stroke (Zhong Feng). When there are no exterior manifestations of the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) and no interior obstruction of urination or defecation, it is known that blood deficiency fails to nourish the sinews, resulting in immobility of the limbs and stiffness of the mouth preventing speech. It is appropriate to nourish the blood so that the sinews may naturally flourish.
Da Qin Jiao (Gentianae Macrophyllae Radix), Shigao (Gypsum Fibrosum) (each 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Huangqin (Scutellariae Radix), Baizhi (Angelicae Dahuricae Radix), Sheng Dihuang (Rehmanniae Radix), Shu Dihuang (Rehmanniae Radix Preparata), Bai Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 1 liang), Xixin (Asari Radix et Rhizoma) (0.5 liang). In spring and summer, add Zhimu (Anemarrhenae Rhizoma) 1 liang.
Crush the herbs. Take 1 liang per dose, decoct in water. On cloudy or rainy days, add 7 slices of Shengjiang (Zingiberis Rhizoma Recens).
Qiang Huo Yu Feng Tang (Notopterygium Wind-Dispelling Decoction) treats Kidney and Liver deficiency with weak sinews and bones, difficulty in speech, and mental confusion. This medicine calms the heart and nourishes the spirit, harmonizes Yin and Yang without excess or deficiency, and treats stroke where there is no pathogenic factor inside or outside. Taking this medicine allows one to walk the middle path.
Qianghuo, Gancao (prepared with honey), Fangfeng, Manjingzi (Viticis Semen), Chuanxiong, Shu Dihuang, Xixin, Zhiqiao (Aurantii Fructus), Renshen, Mahuang, Ganju, Bohe (Menthae Haplocalycis Herba), Gouqi (Lycii Fructus), Danggui, Zhimu, Digupi (Lycii Cortex), Huangqi (Astragali Radix), Duhuo, Baizhi, Duzhong (Eucommiae Cortex), Da Qin Jiao, Chaihu (Bupleuri Radix), Banxia (Pinelliae Rhizoma), Qianhu (Peucedani Radix), Houpo (Magnoliae Officinalis Cortex), Fangji (Stephaniae Tetrandrae Radix) (each 2 liang), Bai Fuling, Huangqin, Shaoyao (each 3 liang), Guizhi (Cinnamomi Ramulus) (1 liang), Sheng Dihuang, Shigao, Cangzhu (Atractylodis Lanceae Rhizoma) (each 4 liang). Add Shengjiang on cloudy or rainy days.
Take 1 liang per dose, decoct in water. If slight sweating occurs, add Mahuang; if bowel movement is unobstructed, add Dahuang (Rhei Radix et Rhizoma). There are also seasonal modifications.
Swallow these pills with Si Bai Dan (Four White Pill), Qing Fei Yang Po Er Dan Yuan (Two Pills for Clearing Lung and Nourishing the Corporeal Soul), to calm the mind and stabilize the will, and harmonize the blood. Movement calms the mind; stillness clears the lung.
Tian Ma Wan (Gastrodia Pill) treats wind generating heat; when heat prevails, movement occurs. One should use stillness to overcome restlessness; this is the method of nourishing blood. This medicine regulates Ying and Wei (Nutritive and Defensive Qi) and strengthens sinews and bones.
Tianma (Gastrodiae Rhizoma), Niuxi (Achyranthis Bidentatae Radix) (each 6 liang, soaked in wine for three days, then dried by baking), Bibo (Dioscoreae Hypoglaucae Rhizoma, separately ground fine), Xuanshen (Scrophulariae Radix) (each 6 liang), Fuzi (Aconiti Lateralis Radix Preparata, processed) (1 liang), Duzhong (7 liang), Qianghuo (14 or 15 liang), Sheng Dihuang (1 jin), Danggui (10 liang).
Another formula includes Duhuo 5 liang to dispel wind from the kidney region.
Grind the herbs into a fine powder and make pills with honey, sized like paulownia seeds. For regular use, take 50–70 pills; for severe conditions, up to 100 pills. Take on an empty stomach before meals with warm wine or plain water. Eat some time later. After half a month of taking the medicine, if one feels congested, use Qi Xuan Wan (Seven Unblocking Pills) to dredge the channels.
Note: Li Dongyuan considered the above three formulas as those regulating menstruation, nourishing blood, and calming the spirit. However, when wind is accompanied by deficiency, tonification and nourishment are appropriate. Zhang Zhongjing used Ba Wei Wan (Eight-Ingredient Pill) to treat wind deficiency and Hong Kong Foot (podagra/jambs), slightly revealing the principle, but people have failed to expand upon it.
The Ju Fang (Prescriptions of the Bureau) Gu Sui Bu Wan (Drynaria Pill) treats Liver and Kidney wind deficiency; Huan Tui Wan (Leg-Changing Pill) treats deficiency of the Three Yin meridians of the foot, specifically using drugs to dredge and dry dampness. This approach is flawed. Although these three formulas are superior to those in Ju Fang, the gains do not compensate for the losses. Why? Da Qin Jiao Tang and Qiang Huo Yu Feng Tang, although containing blood-nourishing herbs, consist mostly of herbs that circulate channels and disperse wind. How can they nourish blood and benefit sinews and bones? Tian Ma Wan nourishes blood and strengthens sinews and bones, which is closer to the correct principle.