本事曲 丸治中风或中风湿脏腑滑泻
川芎 附子(炮) 神曲 白术(等分)
上为细末面糊丸桐子大每服三五十丸温米饮下此药亦治飧泄
按此出太阴例药也
止涩之剂(按诸方论并见滞下门)
本事温脾汤治痼冷在肠胃间泄泻腹痛宜先取去然后调治不可畏虚以养病也
浓朴 干姜 甘草 桂心 附子(生各二两) 大黄(生四钱碎切汤一盏渍半日搦去滓煎
汤时和滓下)
上细锉水二升半煎八合后下大黄汁再煎六合去滓服
按泄痢腹痛其证多种有积滞者固宜取去岂但痼冷一端而已须详证虚实寒热随其所宜以调
之
东垣升阳除湿汤自下而上者引而竭之
升麻 柴胡 防风 神曲 泽泻 猪苓(各半两) 陈皮(三钱) 苍术(一两) 大麦 面
甘草(炙各三钱) 如胃寒肠鸣加益智仁半夏各半钱姜枣同煎非肠鸣不得而用之
上作一服水煎早饭后热服之
升阳除湿防风汤如大便闭塞或里急后重数至圊而不能便或有白脓或血慎勿利之利之则必
致重病及郁结而不通也以此汤举其阳则阴气自降矣
苍术(泔浸去皮干净四两) 防风(二钱) 白术 白茯苓 白芍药(各一钱)
上咀除苍术另作片子水一碗半煎至二盏内诸药同煎至一大盏热服食前
按饮食入胃气上升输精心肺然后下降若脾胃有伤不能上升反下流肾肝而成泄痢者法宜填
补中气升之举之不可疏下此东垣发前人所未论也
【本事方】曲丸:治疗中风或中风湿邪气导致的脏腑滑脱泄泻。
川芎、附子(炮制)、神曲、白术(各等分)。
将上述药材研成细末,用面糊制成如梧桐子大小的丸剂。每次服用三五十丸,用温热的米汤送服。此药也能治疗完谷不化的飧泄。
按语:此方出自太阴病的治疗法则。
止涩之剂(按:各种方论均见载于“滞下”门类,即痢疾类疾病)。
【本事方】温脾汤:治疗顽固性寒邪滞留于肠胃之间引起的泄泻和腹痛。应当先攻逐去除积滞,然后再进行调理治疗,不可因为畏惧虚弱而迁延养病。
浓朴、干姜、甘草、桂心、附子(生用,各二两)、大黄(生用,四钱,切碎,用一碗汤浸泡半天,挤压去渣,煎煮汤药时连同药渣一起放入)。
将药材细细切碎,加水二升半,煎至八合,然后加入大黄的汁液,再煎至六合,去渣服用。
按语:泄泻和痢疾伴有腹痛,证候有多种情况。如果有积滞,固然适宜攻逐去除,但岂止是顽固性寒邪这一种情况呢?必须详细辨证虚实寒热,根据适宜的方法进行调理。
【东垣方】升阳除湿汤:针对病势自下而上者,采用引导其向上宣泄的方法(引而竭之)。
升麻、柴胡、防风、神曲、泽泻、猪苓(各半两)、陈皮(三钱)、苍术(一两)、大麦、面粉、甘草(炙用,各三钱)。如果胃寒且肠鸣,加益智仁、半夏各半钱,与生姜、大枣同煎;如果不是肠鸣,则不得使用此加减法。
将上述药材作为一剂,加水煎煮,早饭后趁热服用。
升阳除湿防风汤:如果大便闭塞不通,或者出现里急后重(腹痛窘迫,时时欲便,肛门重坠,便出不爽),多次去厕所却不能排便,或者大便中有白色脓液或血液,千万不要使用通利之法。如果使用通利法,必然导致重病以及郁结不通的后果。使用此汤提升阳气,则阴气自然下降。
苍术(用淘米水浸泡,去皮,洗净,四两)、防风(二钱)、白术、白茯苓、白芍药(各一钱)。
将药材捣碎,除苍术另切成片外,加水一碗半,煎至两盏,其他药物一同煎至一大盏,饭前趁热服用。
按语:饮食进入胃中,清气上升输送到心肺,然后浊气下降。如果脾胃受损,清气不能上升反而下流注入肾肝,从而形成泄泻和痢疾,治疗方法应当填补中焦之气,提升并举扬阳气,不可使用疏泄通下的方法。这是李东垣阐发前人未曾论述的理论。
Ben Shi Fang (Formulas from the Hand of a Master) Qu Wan: Treats wind-stroke or wind-dampness invading the zang-fu organs, resulting in slipping diarrhea.
Chuanxiong Rhizome (Chuanxiong), Prepared Aconite Root (Fuzi), Medicated Leaven (Shenqu), Atractylodis Macrocephalae Rhizoma (Baizhu) (equal parts).
Grind the above into a fine powder, use wheat paste to make pills the size of paulownia seeds. Take 30-50 pills each time, with warm rice water. This medicine also treats undigested food diarrhea (Sun-xie).
Note: This formula is derived from the treatment principles of the Taiyin syndrome.
Astringent Formulas (Note: Various formulas and discussions are found in the "Dysentery" category).
Ben Shi Fang Wen Pi Tang: Treats chronic cold lodged between the intestines and stomach, causing diarrhea and abdominal pain. One should first purge and remove the accumulation, then proceed with regulation and treatment; one must not fear deficiency and thereby nurture the disease.
Magnolia Bark (Houpo), Dried Ginger (Ganjiang), Licorice Root (Gancao), Cinnamon Twig (Guixin), Raw Aconite Root (Fuzi, raw, 2 liang each), Raw Rhubarb (Dahuang, raw, 4 qian, crushed, soaked in one bowl of decoction for half a day, squeezed to extract the juice, and added back with the dregs when boiling the decoction).
Finely chop the herbs, add two and a half sheng of water, boil down to eight ge, then add the Rhubarb juice, boil further down to six ge, strain, and take.
Note: Diarrhea and dysentery with abdominal pain present various syndromes. If there is accumulation, it is indeed appropriate to purge and remove it. But it is not limited to chronic cold alone. One must carefully differentiate the excess/deficiency and cold/heat, and regulate according to what is suitable.
Dong Yuan Sheng Yang Chu Shi Tang: For conditions where the pathogenic factor rises from below upwards, guide it out by lifting (Yin er jie zhi).
Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Medicated Leaven (Shenqu), Alisma Rhizoma (Zexie), Polyporus (Zuling), Citrus Reticulata Pericarpium (Chenpi), Atractylodis Rhizoma (Cangzhu), Hordeum Vulgare (Damai), Wheat Flour (Mian), Roasted Licorice Root (Gancao, roasted, 3 qian each). If there is stomach cold with borborygmus, add Alpinia Oxyphylla Fruit (Yizhiren) and Pinellia Tuber (Banxia), half a qian each, decocted together with ginger and jujube. Do not use this modification unless there is borborygmus.
Take as one dose, decoct with water, drink hot after breakfast.
Sheng Yang Chu Shi Fangfeng Tang: If there is fecal impaction or tenesmus (feeling of incomplete evacuation), frequent trips to the toilet but inability to defecate, or presence of white pus or blood in stool, do not use purgatives/laxatives. Using purgatives will inevitably lead to severe illness and stagnation/blockage. By using this formula to raise the yang qi, the yin qi will naturally descend.
Atractylodis Rhizoma (Cangzhu, soaked in rice water, peeled, cleaned, 4 liang), Saposhnikoviae Radix (Fangfeng, 2 qian), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Baifuling), White Peony Root (Baishao) (1 qian each).
Crush the herbs. Except for Cangzhu which is sliced separately, add one and a half bowls of water, boil down to two bowls. Add the other herbs and boil down to one large bowl. Drink hot before meals.
Note: When food enters the stomach, clear qi rises and is transported to the heart and lungs, then turbid qi descends. If the spleen and stomach are damaged, clear qi cannot rise but instead flows downward into the liver and kidneys, resulting in diarrhea and dysentery. The treatment method should be to tonify the middle qi and lift and raise it; one must not use draining and descending methods. This is Dong Yuan's theory that elucidates points not previously discussed by predecessors.