澹寮三棱煎丸治心腹坚胀胁下紧硬胸中痞塞喘满
京三棱(半斤为末以酒三升银器内熬成膏) 青皮 萝卜子(炒) 神曲(炒各二两) 麦
(炒三两) 砂(一两) 干漆(炒) 杏仁(炒各半两)
上为末以膏子丸如梧子大每三十丸食后温米饮下
导气丸治诸气痞塞关膈不通腹胀如鼓大便虚秘
青皮(用水蛭炒) 莪术(虻虫炒) 三棱(干漆炒) 槟榔(斑蝥炒) 茱萸(牵牛炒) 干姜
(KT 砂炒) 附子(盐炒) 赤芍(川椒炒) 胡椒(茴香炒) 石菖蒲(桃仁炒)
上各锉与所同炒药熟去水蛭等不用只以青皮等十件为末酒糊为丸如梧子大每五丸至七丸
空心紫苏汤下
塌肿神应丸治诸蛊毒腹胀
(方见积聚门)
按此并治积聚导气散郁之剂也又能入血分
谨按以上攻治诸方皆有轻重所宜之制宜对证选用不得少差致有实实虚虚之失也发明曰禁
服论
云约方犹约囊也囊满弗约则输泄方成弗约则神与气俱未满而知约之可以为工不可以为天下师
此圣人所以退太过而进不及以平为期也大凡气味者有毒无毒固宜常制矣是以大毒治病十去其
六常毒治病十去其七小毒治病十去其八无毒治病十去其九余以谷肉果菜食养尽之至如君一
臣二奇之制也君二臣四耦之制也近而奇耦制小其服远而奇耦制大其服大则数少小则数多矣多
则九之少则二之补上治上制以缓补下治下制以急急则气味浓缓则气味薄下不以耦汗不以奇随
其邪之所在高下浅深轻重虚实影响无间万举万全是谓中行故可为师也假如病大而汤剂小则邪
气少屈而药力已乏欲不复治其可得乎犹一杯之水救一车薪之火竟不能灭是谓不及故不可为师
而可以为工矣小而汤剂大则邪服已尽而药有余力欲不伤正何所容哉犹火炎昆冈玉石俱焚莫之
能止是谓太过此又不可以为工是乃粗医也三者之论惟中而已过与不及皆为偏废然而太过尤甚
于不及何以明之盖失之于姑息邪复胜正者止于劳而无益犹可勉而适中或失于苛暴则正气被伤
因而羸瘠者有之危殆者有之灭亡者有之非徒无益而又害之此所谓尤甚也可不戒哉尝见仲景之
书于承气条下攻里则曰若更衣止后服于桂枝汤后发表乃云 微汗益佳不可令如水淋漓本乎
轩岐之微旨有所得耳
《澹寮三棱煎丸》治疗心腹部坚硬胀满、胁肋下紧绷硬结、胸中痞闷堵塞、气喘胀满。
京三棱(半斤,研成粉末,用三升酒在银器中熬制成膏状)、青皮、萝卜子(炒制)、神曲(炒制,各二两)、麦芽(炒制三两)、砂仁(一两)、干漆(炒制)、杏仁(炒制,各半两)。
以上药材研成细末,用膏状物作为粘合剂,制成如梧桐子大小的药丸。每次服用三十丸,饭后用温热的米汤送服。
《导气丸》治疗各种气机痞闷堵塞、膈间不通、腹部胀大如鼓、大便虚性秘结。
青皮(用水蛭同炒)、莪术(用虻虫同炒)、三棱(用干漆同炒)、槟榔(用斑蝥同炒)、吴茱萸(用牵牛子同炒)、干姜(用砂仁同炒)、附子(用盐同炒)、赤芍(用川椒同炒)、胡椒(用茴香同炒)、石菖蒲(用桃仁同炒)。
以上药材分别切碎,与各自对应的同炒药物一起炒熟后,去掉水蛭等辅料,仅保留青皮等十味药材,研成细末,用酒调糊制成如梧桐子大小的药丸。每次服用五至七丸,空腹时用紫苏汤送服。
《塌肿神应丸》治疗各种蛊毒引起的腹部胀满。
(此方见“积聚”门类)
按语:以上诸方均为治疗积聚、疏导气机、疏散郁结的药剂,且能深入血分。
谨按:以上攻伐治疗的各方,均有轻重适宜的区别,应当根据证候选择使用,不得有丝毫差错,以免造成“实实虚虚”(使实证更实、虚证更虚)的错误。
《发明》篇引用《禁服论》说:“制定方剂就像约束口袋一样。口袋满了如果不约束,就会泄漏;方剂配好如果不加以节制,那么神气和正气就会随之耗散。如果已经知道如何节制,就可以成为医生;如果不能节制,就不能成为天下的老师。”
这就是圣人之所以抑制太过、扶持不及,以平和为准则的原因。
大凡药物的气味,无论有毒无毒,本来就应该有常规的限制。因此,用大毒药物治疗疾病,病去六成就停药;用常毒药物治疗疾病,病去七成就停药;用小毒药物治疗疾病,病去八成就停药;用无毒药物治疗疾病,病去九成就停药。剩下的余邪,用谷物、肉类、水果、蔬菜等食物来调养清除。
至于方剂的组成,君药一臣药二的称为“奇方”,君药二臣药四的称为“偶方”。
病位近而采用奇偶之法,则服药剂量小;病位远而采用奇偶之法,则服药剂量大。
剂量大则药味数量少,剂量小则药味数量多。
药味少则二味,药味多则九味。
补上焦或治上部疾病,制剂宜缓;补下焦或治下部疾病,制剂宜急。急则药气味浓厚,缓则药气味淡薄。
治下不应用偶方,发汗不应用奇方。
要随着邪气所在部位的高低、深浅、轻重、虚实,像影子跟随物体一样无间无隙,这样就能万举万全,这叫做“中行”,所以可以成为老师。
假如病情严重而汤剂药力微弱,那么邪气稍微屈服而药力已经匮乏,想要再次治疗,可能吗?这就好像一杯水去救一车柴草的火,最终不能熄灭,这叫“不及”,所以不能成为老师,但可以作为一般的医生。
假如病情轻微而汤剂药力过大,那么邪气已经被清除而药力还有剩余,想要不伤害正气,哪里还能容纳呢?这就好像火烧昆仑山,玉石一同被烧毁,没有人能阻止,这叫“太过”,这又不能作为医生,这是粗劣的医生。
这三种论述,只有适中才是最好的。过度和不足都属于偏废,然而过度比不足更为严重。
为什么这样说呢?因为失之于姑息宽容,邪气战胜正气,只是劳累而无益处,还可以勉强达到适中;但如果失之于苛刻暴烈,导致正气受伤,因而出现身体瘦弱的人有之,危险危急的人有之,甚至死亡的人也有之。这不仅没有益处,反而有害处。这就是所谓“更为严重”,能不警惕吗?
曾经看到张仲景的书,在承气汤条下,攻里时说:“如果大便通畅停止后续服药”;在桂枝汤后发表时说:“微微出汗最好,不可令汗水如水淋漓般流出”。这源于轩辕、岐伯的微奥旨意,是有所心得罢了。
**Danliao Sanleng Jian Wan** treats hardness and distension of the heart and abdomen, tightness and hardness under the hypochondrium, chest fullness and obstruction, wheezing, and distension.
*Sanleng* (Rhizoma Sparganii) (half a jin, ground into powder, boiled with three sheng of wine in a silver vessel until it becomes a paste), *Qingpi* (Pericarpium Citri Reticulatae Viride), *Luoboz* (Fructus Raphani Sativi) (stir-fried), *Shenqu* (Massa Medicata Fermentata) (stir-fried, two liang each), *Maiya* (Fructus Hordei Germinatus) (stir-fried, three liang), *Sharen* (Fructus Amomi Rotundus) (one liang), *Ganqi* (Resina Taxilli) (stir-fried), *Xingren* (Semen Pruni Armeniacae) (stir-fried, half a liang each).
Grind the above ingredients into fine powder, use the paste as a binder to form pills the size of a white walnut seed. Take thirty pills after meals, washed down with warm rice water.
**Daoqi Wan** treats various qi stagnations causing obstruction, blockage at the diaphragm, abdominal distension like a drum, and deficiency-type constipation.
*Qingpi* (stir-fried with *Shuizhi* [Hirudo]), *Ezhu* (Rhizoma Curcumae Zedoariae) (stir-fried with *Mengchong* [Bloodsucker]), *Sanleng* (Rhizoma Sparganii) (stir-fried with *Ganqi* [Resina Taxilli]), *Binglang* (Semen Arecae) (stir-fried with *Banmao* [Mylabris]), *Zhuyu* (Fructus Evodiae Officinalis) (stir-fried with *Qianniu* [Semen Pharbitidis]), *Ganjiang* (Rhizoma Zingiberis Recens) (stir-fried with *Sharen* [Fructus Amomi Rotundus]), *Fuzi* (Radix Aconiti Lateralis Preparata) (salt-stir-fried), *Chishao* (Radix Paeoniae Rubra) (stir-fried with *Chuanjiao* [Pericarpium Zanthoxyli]), *Hujiao* (Piperis Longi Fructus) (stir-fried with *Huixiang* [Fructus Foeniculi]), *Shichangpu* (Rhizoma Acori Tatarinowii) (stir-fried with *Taoren* [Semen Persicae]).
Cut each ingredient separately and stir-fry with its corresponding partner until cooked. Remove the *Shuizhi* etc., and keep only the ten main ingredients. Grind into powder, mix with wine paste to form pills the size of a white walnut seed. Take five to seven pills on an empty stomach, washed down with *Zisu* (Perilla Leaf) decoction.
**Tazhong Shenyin Wan** treats abdominal distension caused by various gu poisons.
(See this formula in the "Ji Ju" [Accumulation and Mass] section.)
Commentary: The above formulas are all agents for treating accumulations, guiding qi, and dispersing stagnation, and they can also enter the blood level.
Strictly speaking, the above attacking and treating formulas have appropriate degrees of intensity; one must select them according to the syndrome without any error, to avoid the mistake of "making excess more excess and deficiency more deficient."
The *Fa Ming* section cites the *Jin Fu Lun*: "Formulating a prescription is like tying a bag. If the bag is full but not tied, it will leak. If a prescription is made but not restrained, the spirit and qi will be exhausted together. If one knows how to restrain it, one can become a physician; if not, one cannot be a teacher for the world."
This is why the Sages suppress excess and support deficiency, aiming for balance.
Generally speaking, the flavors and properties of herbs, whether toxic or non-toxic, should have standard limitations. Therefore, when using highly toxic herbs to treat disease, stop when six-tenths of the disease is gone; when using commonly toxic herbs, stop when seven-tenths is gone; when using slightly toxic herbs, stop when eight-tenths is gone; when using non-toxic herbs, stop when nine-tenths is gone. Use grains, meats, fruits, and vegetables to nourish and eliminate the remainder.
Regarding prescription composition, one sovereign and two minister herbs constitute an "Odd" (Qi) formula; two sovereigns and four ministers constitute an "Even" (Ou) formula.
For diseases near the surface using Odd/Even methods, the dosage is small; for distant diseases using Odd/Even methods, the dosage is large.
Large dosage means fewer ingredients; small dosage means more ingredients. Fewer ingredients mean two; more ingredients mean nine.
Tonifying the upper or treating upper body disorders requires a slow-acting preparation; tonifying the lower or treating lower body disorders requires a rapid-acting preparation. Rapid action implies strong flavor and property; slow action implies weak flavor and property.
Treating the lower should not use Even formulas; inducing sweating should not use Odd formulas.
Follow the location of the pathogenic factor, whether high or low, shallow or deep, heavy or light, excess or deficiency, without gap, like a shadow following the object. This way, every attempt will succeed, which is called the "Middle Way," and thus one can be a teacher.
Suppose the disease is severe but the decoction is weak; the pathogenic qi yields slightly while the medicinal power is exhausted. Can one treat again? It is like saving a cartload of burning firewood with a cup of water; it cannot extinguish the fire. This is "insufficiency," so one cannot be a teacher but can be a practitioner.
Suppose the disease is mild but the decoction is too strong; the pathogenic qi is completely subdued while medicinal power remains. How can one avoid damaging the healthy qi? It is like fire burning Kunlun Mountain, destroying both jade and stone, unstoppable. This is "excess." This cannot even make one a practitioner; it is a crude doctor.
Among these three discussions, only the middle is correct. Both excess and insufficiency are deviations, yet excess is worse than insufficiency. Why? Because failing due to leniency allows pathogenic qi to overcome healthy qi, resulting in labor without benefit, which can still be corrected to moderation. However, failing due to harshness and brutality damages healthy qi, leading to emaciation, danger, or death. This brings no benefit but causes harm. This is what is meant by "worse." One must beware!
I have seen in Zhang Zhongjing's books that under the Chengqi Tang section regarding purging the interior, it says: "If bowel movement occurs, stop subsequent doses." After Guizhi Tang for releasing the exterior, it says: "A slight sweat is best; do not let it drip profusely." This stems from the subtle principles of Xuanyuan and Qibo, showing true understanding.