宣明三乙承气汤治脏腑积热痞满燥实坚胀
甘草 枳实 浓朴 大黄 芒硝
上 咀入姜煎
按此足阳明例药也发明曰汉张仲景作伤寒论为邪自外入传于胃者谓之入腑腑之为言聚也胃为
水谷之海荣卫之源水谷会聚变化而为荣卫邪气入胃则胃中之气菀滞糟粕秘结而为实实则泻之
人所共知如缓急轻重之剂则临时消息焉不恶寒反恶热发渴谵语腹满而喘手足 然汗出者急下
之宜大承气汤如邪气未深恐有燥屎少服小承气汤试之腹中转失气者有燥屎也乃可攻之不转失
气者初硬后溏尚未可攻攻之则腹满不能食若腹满不通与小承气汤微和胃气勿令大泄如发汗后
不恶寒但热者胃实也当和胃气调胃承气汤主之成无己云大热结实者与大承气汤小热微结者与
小承气汤以热不太甚故于大承气汤中去芒硝又以结不至坚故减浓朴枳实也如不至大坚满邪热
甚而须攻下者亦未可投大承气汤必以轻缓之剂攻之于大承气汤减浓朴枳实加甘草乃轻缓之剂
以调胃也设若大承气反用调胃治之则邪气不服小承气证反用大承气下之则过伤正气而腹满不
能食故有勿大泄之戒此仲景所以分治之未尝越圣人制度后之医者以此三药合而为一且云通治
三药之证及无问伤寒杂证内外一切所伤若根据此说与仲景之方甚相违背及失轩岐缓急之旨由是
红紫眩乱迷惑世人一唱百和使病者暗受其弊将何诉哉倘有仁心审是者当于内经仲景方中求之
贵使药证相对以圣贤之心为心则方之真伪自可得而知矣
当归承气汤 治燥热里热火郁为病或皮肤枯燥或咽干鼻干或便溺结闷通宜用此
当归 大黄(各四钱) 甘草 芒硝(各三钱)
上 咀入姜煎
按此足太阴厥阴阳明药也凡血证下药详见仲景抵当诸汤例兹不备录但此与前方可见有气
血之分
宣明三乙承气汤,治疗脏腑积热导致的痞塞、胀满、燥结、实邪及坚胀。
药物组成:甘草、枳实、浓朴(厚朴)、大黄、芒硝。
制法与用法:将药材切碎,加入生姜煎煮服用。
按语:这是足阳明胃经的方药。《发明》篇中说道:汉代张仲景撰写《伤寒论》,认为邪气从体外侵入并传变至胃的,称为“入腑”。“腑”的意思是汇聚,胃是水谷汇聚之处,也是营卫之气的源头。水谷在此汇聚变化生成营卫,若邪气进入胃中,则导致胃气郁滞,糟粕秘结而成实证,“实则泻之”的道理人们都知晓。至于用药的缓急轻重,需根据病情临时斟酌。如果不恶寒反而恶热,口渴,胡言乱语,腹部胀满且喘息,手足濈然汗出者,应当紧急攻下,宜用大承气汤。如果邪气尚浅,担心有燥屎,可先少量服用小承气汤试探。服药后腹中转出矢气(放屁)的,说明有燥屎,才可以攻下;若不转矢气,说明大便初硬后溏,尚不可攻下,若强行攻下会导致腹部胀满、不能进食。若腹部胀满不通,可给予小承气汤轻微调和胃气,不要令其剧烈泄泻。如发汗后不恶寒但发热,属于胃实证,应当调和胃气,以调胃承气汤主治。成无己说:大热结实者,给予大承气汤;小热微结者,给予小承气汤。因为热势不太严重,所以在大承气汤中去掉芒硝;又因为结聚尚未坚硬,所以减少浓朴和枳实的用量。如果不至于大坚满,但邪热甚重需要攻下的,也不能投用大承气汤,必须用轻缓的药剂攻下,即在在大承气汤中减少浓朴、枳实,加入甘草,这才是轻缓之剂,用以调和胃气。倘若用调胃承气汤来治疗大承气汤证,则邪气不服;用小承气汤证反用大承气汤攻下,则会过度损伤正气而导致腹部胀满不能进食,所以有“勿令大泄”的告诫。这就是张仲景区分治疗的缘由,未曾超越圣人的法度。后来的医者将这三方合而为一,声称通治三方所主的证候,以及不问是伤寒还是杂病,内外一切所伤皆适用。如果依据这种说法,与张仲景的方义非常违背,也失去了黄帝内经中关于缓急的宗旨。因此造成红紫混淆,迷惑世人,一唱百和,使病人暗中受害,向谁申诉呢?如果有仁心且能审慎辨别的人,应当在《内经》和张仲景的方剂中寻找依据,贵在使药物与证候相对,以圣贤之心为心,那么方剂的真伪自然可以得知。
当归承气汤,治疗燥热内蕴、火郁致病,表现为皮肤枯燥,或咽干鼻干,或大小便结闷不通,适宜使用此方。
药物组成:当归、大黄(各四钱),甘草、芒硝(各三钱)。
制法与用法:将药材切碎,加入生姜煎煮服用。
按语:这是足太阴脾经、厥阴肝经和阳明胃经的药物。凡是血分证候使用下药的详细情况,详见张仲景抵当汤等方的体例,此处不再赘录。仅以此方与前一方相比,可见气血之分。
Xuanming San Yi Chengqi Decoction treats accumulation of heat in the zang-fu organs manifesting as fullness, distension, dryness, excess, hardness, and swelling.
Ingredients: Gancao (Licorice Root), Zhishi (Immature Bitter Orange), Nongpo (Thick Bark of Magnolia Officinalis), Dahuang (Rhubarb Root and Rhizome), Mangxiao (Mirabilite).
Preparation and Administration: Cut the herbs into small pieces, add fresh ginger, and decoct for oral administration.
Commentary: This is a formula for the Foot-Yangming Stomach Meridian. The *Faming* section states: Zhang Zhongjing of the Han Dynasty wrote the *Shanghan Lun* (Treatise on Cold Damage Diseases), stating that when pathogenic factors enter from the exterior and transmit to the stomach, it is called "entering the fu organ." The term "fu" implies gathering; the stomach is the sea of water and grain, the source of Ying and Wei (Nutritive and Defensive Qi). Water and grain gather here and transform into Ying and Wei. If pathogenic factors enter the stomach, the qi in the stomach becomes stagnant, and waste products become constipated, resulting in an Excess pattern. The principle of "treating excess by purging" is well known. However, the urgency and weight of the prescription must be adjusted according to the specific situation. If there is no aversion to cold but rather aversion to heat, thirst, delirious speech, abdominal fullness with panting, and continuous sweating on the hands and feet, urgent purgation is required, and Da Chengqi Tang (Major Order the Qi Decoction) should be used. If the pathogenic factor is not deep-seated and one fears dry feces, one may first administer a small dose of Xiao Chengqi Tang (Minor Order the Qi Decoction) as a test. If flatus occurs after taking the medicine, it indicates the presence of dry feces, and purgation can proceed. If no flatus occurs, it suggests the stool is hard at the beginning but loose at the end, and purgation should not yet be attempted; forcing purgation will lead to abdominal fullness and inability to eat. If abdominal fullness and obstruction persist, Xiao Chengqi Tang may be given to mildly harmonize the Stomach Qi, avoiding severe diarrhea. If, after sweating, there is no aversion to cold but only fever, this indicates a Stomach Excess pattern; the Stomach Qi should be harmonized using Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction). Cheng Wuji stated: For patterns of intense heat and solid accumulation, Da Chengqi Tang is administered; for patterns of mild heat and slight accumulation, Xiao Chengqi Tang is administered. Because the heat is not severe, Mangxiao (Mirabilite) is removed from Da Chengqi Tang; because the accumulation is not hard, the dosage of Nongpo (Thick Bark of Magnolia Officinalis) and Zhishi (Immature Bitter Orange) is reduced. If the condition does not present with severe hardness and fullness, but the pathogenic heat is significant requiring purgation, Da Chengqi Tang should not be used immediately. Instead, a milder purgative should be employed, which involves reducing Nongpo and Zhishi and adding Gancao (Licorice Root) to Da Chengqi Tang. This creates a mild agent to regulate the Stomach. Conversely, if Tiaowei Chengqi Tang is used for a Da Chengqi Tang pattern, the pathogenic factor will not be subdued; if Da Chengqi Tang is used for a Xiao Chengqi Tang pattern, it will excessively damage the healthy qi, leading to abdominal fullness and inability to eat, hence the warning against severe purgation. This is why Zhang Zhongjing differentiated treatments, adhering strictly to the standards of the Sages. Later physicians combined these three formulas into one, claiming they treat all indications of the three formulas, regardless of whether the disease is Shanghan or miscellaneous internal disorders, affecting both interior and exterior. Such claims contradict Zhang Zhongjing's original intent and lose the principles of urgency and moderation found in the *Huangdi Neijing*. This causes confusion between red and purple (true and false patterns), misleading the public, where one voice is echoed by hundreds, causing patients to suffer silently. Those with benevolent hearts and discernment should seek guidance in the *Neijing* and Zhang Zhongjing's formulas. It is crucial to match the medicine to the syndrome and adopt the mindset of the sages, so that the authenticity of the formulas can be discerned.
Danggui Chengqi Tang treats diseases caused by dry-heat accumulating internally and fire stagnation, manifesting as dry and rough skin, or dry throat and nose, or difficult and obstructed urination and defecation. This formula is appropriate for such conditions.
Ingredients: Danggui (Angelica Sinensis Root), Dahuang (Rhubarb Root and Rhizome) [each 4 qian], Gancao (Licorice Root), Mangxiao (Mirabilite) [each 3 qian].
Preparation and Administration: Cut the herbs into small pieces, add fresh ginger, and decoct for oral administration.
Commentary: These are herbs for the Foot-Taiyin Spleen Meridian, Jueyin Liver Meridian, and Yangming Stomach Meridian. For detailed examples of using purgatives in blood syndromes, refer to Zhang Zhongjing's Didang Tang and other formulas, which are not listed here. Comparing this formula with the previous one reveals the distinction between Qi and Blood syndromes.