金匮崔氏八味丸治肾虚气乏下元冷惫腹脐疼痛夜多旋溺脚膝缓弱肢体倦怠面皮痿黄或黧
黑及虚劳不足渴欲饮水腰重疼痛小腹急痛小便不利并宜服之
前肾气丸加桂心(一两) 附子(炮一两)
上为细末炼蜜丸如桐子大每五七十丸温酒送下盐汤亦得空心食前妇人淡醋汤下
局方西川石刻安肾丸治真气虚惫脚膝弱缓夜梦遗积小便滑数而清
青盐(四两) 鹿茸(炙) 柏子仁(净) 石斛 附子 川乌(炮) 巴戟(去心) 肉桂 菟
丝子
苁蓉 韭子 葫芦巴 杜仲 破故纸(炒) 石枣 远志 赤石脂 茯苓 茯神 茴香(炒
各一两) 苍术 川楝 川椒 山药(各四两)
上为末山药酒糊丸如梧子大每七八十丸空心盐汤下
无比山药丸治诸虚百损五劳七伤肌体消瘦肤燥脉弱
赤石脂 茯神(各一两) 山药(三两) 苁蓉(四两酒浸) 巴戟 牛膝(酒浸) 泽泻 山
茱萸肉(各一两) 五味子(二两) 杜仲 菟丝子 熟地黄(各三两)
上石臼内杵为末炼蜜丸梧子大每四五十丸空心温酒下
杨氏还少丹大补真气虚损肌体瘦弱
肉苁蓉 远志 茴香 巴戟 山药 枸杞子 熟地黄 石菖蒲 山茱萸 牛膝 杜仲
楮实子 五味子 白茯苓
上石臼内捣为末炼蜜丸如梧子大每五十丸空心温酒送下
机要牛膝丸治肾肝损骨痿不能起于床宜益精筋缓不能自收持宜缓中此丸主之
牛膝(酒浸) 萆 杜仲(炒) 苁蓉(酒浸) 菟丝子 防风 葫芦巴(炒) 桂(减半)
补骨脂 沙苑蒺藜
上等分为细末酒煮猪腰子为丸每五七十丸空心温酒下
按此用防风以升发肝气非补肝也
地黄丸治阳盛阴虚肝肾不足房室虚损形瘦无力面多青黄而无常色宜此养荣血肾气
苍术(泔浸) 熟地黄(各一斤) 干姜(春七钱夏半两秋七钱冬一两)
上石臼杵为末蒸枣肉为丸桐子大每五七十丸至百丸诸饮下若加五味子为肾气丸述类像形
神品药也
按以上诸方少阴例药也盖谓肾为真水有补无泻故古人立肾气丸法后世俗因之以补阳然阳
虚者亦有之但不可例为常补尔
谨按虚损之证其源虽多莫不因胃气元气不足致气虚血虚阴阳俱虚或房劳精竭荣卫弱而腑
脏
气痿不能输养为疲极甚者变为劳瘵之疾但世俗处治昧此病机源委例用香燥或金石之剂往往误
人惟有宋钱仲阳建五脏虚方迥出前人之论我丹溪先生发挥局方之失示用补端绪言东垣所谓饮
食劳倦内伤元气则胃脘之阳不能升举并心肺之气陷入于中焦而用补中益气治之此实前人之所
无也然天不足于西北地不满于东南天阳而地阴西北之人阳气易降东南之人阴气易升苟不知此
而徒取其法则于气之降者固可以获效而于气之升者亦从而用之吾恐反增其病矣意此不可恃为
通行之法云人之虚者多是阴不足邵子谓天地自相根据附天根据形地附气其形也有涯其气也无涯人
之形质有涯者也天癸绝后则形衰矣苟不益阴以内守则阳亦无得以发扬为健运之能是天失所根据
也而为飘散飞荡如丧家之狗耳阳既飘散则地愈失所附也形气不相根据附则死矣人其补养残衰伤
朽之质又何云哉斯论虚衰与东垣制法虽证不同实本乎内经阴精所奉其人寿阳精所降其人夭之
旨盖谓人之寿夭比之经论南北二方亦自微甚不等升阳之例当为活法滋阴之剂义亦是焉必求的
在之虚合病机而行其法如此与世俗不明造化之理概用温补者天地悬隔故于诸书补剂而不详录
学人审是则思过半矣
金匮崔氏八味丸:治疗肾虚气弱、下元寒冷疲惫,出现腹脐部疼痛、夜间多尿、脚膝软弱无力、肢体倦怠、面色萎黄或黧黑,以及虚劳不足、口渴想喝水、腰部沉重疼痛、小腹部拘急疼痛、小便不利等症状,均宜服用此方。
配方:前肾气丸(原方)加桂心(一两)、附子(炮制,一两)。
制法与用法:将药物研为细末,用炼蜜制成如梧桐子大小的药丸。每次服用五七十丸,用温酒送服,盐汤也可以。空腹及饭前服用;妇女可用淡醋汤送服。
局方西川石刻安肾丸:治疗真气虚惫、脚膝软弱迟缓、夜间梦遗、小便滑数且清长。
配方:青盐(四两)、鹿茸(炙)、柏子仁(去净杂质)、石斛、附子、川乌(炮制)、巴戟天(去心)、肉桂、菟丝子、肉苁蓉、韭子、葫芦巴、杜仲、破故纸(炒)、石枣、远志、赤石脂、茯苓、茯神、茴香(炒,各一两)、苍术、川楝子、川椒、山药(各四两)。
制法与用法:将药物研为细末,用山药粉调酒糊制成如梧桐子大小的药丸。每次服用七八十丸,空腹时用盐汤送服。
无比山药丸:治疗各种虚损、五劳七伤导致的身体消瘦、皮肤干燥、脉象微弱。
配方:赤石脂、茯神(各一两)、山药(三两)、肉苁蓉(四两,酒浸)、巴戟天、牛膝(酒浸)、泽泻、山茱萸肉(各一两)、五味子(二两)、杜仲、菟丝子、熟地黄(各三两)。
制法与用法:在石臼中捣碎研为细末,用炼蜜制成如梧桐子大小的药丸。每次服用四五十丸,空腹时用温酒送服。
杨氏还少丹:大补真气虚损,适用于身体瘦弱的情况。
配方:肉苁蓉、远志、茴香、巴戟天、山药、枸杞子、熟地黄、石菖蒲、山茱萸、牛膝、杜仲、楮实子、五味子、白茯苓。
制法与用法:在石臼中捣碎研为细末,用炼蜜制成如梧桐子大小的药丸。每次服用五十丸,空腹时用温酒送服。
机要牛膝丸:治疗肾肝受损导致的骨痿,使人无法从床上起身;适宜用于精气亏损、筋脉弛缓不能自主收持的情况,宜用缓和之法,此丸主治此类病症。
配方:牛膝(酒浸)、萆薢、杜仲(炒)、肉苁蓉(酒浸)、菟丝子、防风、葫芦巴(炒)、桂枝(减半用量)、补骨脂、沙苑蒺藜。
制法与用法:将药物等分为细末,用酒煮猪腰子作为粘合剂制成药丸。每次服用五七十丸,空腹时用温酒送服。
按语:此处使用防风是为了升发肝气,并非直接补肝。
地黄丸:治疗阳盛阴虚、肝肾不足、房事过度导致的虚损,表现为形体消瘦、无力、面色青黄无常,宜用此方滋养营血、补肾气。
配方:苍术(泔水浸泡)、熟地黄(各一斤)、干姜(春季七钱,夏季半两,秋季七钱,冬季一两)。
制法与用法:在石臼中捣碎研为细末,用蒸熟的枣肉制成如梧桐子大小的药丸。每次服用五七十丸至一百丸,用各种饮品送服。如果加入五味子,则称为肾气丸,这是描述事物形态的神妙药物。
按语:以上诸方属于少阴经的用药范例。可以说,肾为真水,只宜补不宜泻,所以古人创立了肾气丸的法度。后世世俗之人因此用它来补阳,然而阳气虚者也有这种情况,但不能将其作为常规补益的方法。
谨按:虚损之证,其源头虽多,但无不因为胃气、元气不足,导致气虚、血虚、阴阳俱虚,或者因房劳导致精竭,营卫虚弱,脏腑之气痿废,不能输布营养,最终极度疲劳,甚至演变为劳瘵之疾。然而世俗医生诊治时不明此病机的源流,往往滥用香燥或金石类药物,常常误人。只有宋代钱乙(字仲阳)建立了五脏虚损的方剂,迥异于前人的论述。我的老师丹溪先生阐发了《局方》的弊端,指示使用补益的端绪。正如东垣先生所说,饮食劳倦内伤元气,导致胃脘之阳不能升举,心肺之气陷入中焦,因而使用补中益气汤治疗,这确实是前人所未有的创见。然而,天不足于西北,地不满于东南。天属阳,地属阴,西北之人阳气易降,东南之人阴气易升。如果不知道这一道理,而仅仅机械地效法某种法则,对于阳气应降者固然可以获效,但对于阳气应升者若也采用同样的方法,我担心反而会加重病情。因此,我认为不可将此视为通行的万全之法。
人的虚损多是阴不足。邵雍曾说,天地相互依附,天依据形,地依据气,其形有边界,其气无边界。人的形质是有边界的,天癸枯竭后形体就会衰败。如果不益阴以固守体内,那么阳也就无法发扬成为健运的功能,这就如同天失去了所依据的基础,变得飘散飞荡,像丧家之狗一样。阳既飘散,地也就更加失去依附。形与气不相依附就会死亡,人又该如何补养这残衰朽坏的身体呢?这种关于虚衰的论述,与东垣先生的制方虽然证候不同,但实际上都源于《内经》“阴精所奉其人寿,阳精所降其人夭”的宗旨。大概意思是说,人的寿夭相比经论中的南北两地,自然有轻重不等之分。升阳的例子应当作为灵活运用的法则,滋阴的药剂义理也是如此,必须求得确切的虚损所在,结合病机来施行治法。这样做与世俗不明造化之理、一概使用温补的做法,有着天壤之别。因此,在这些书籍的补剂中不予详细收录。学习者若能审察清楚这一点,便思过半矣。
[Formulas for Tonifying Deficiency and Strengthening Tendons and Bones]
**Jinkui Cui Shi Ba Wei Wan (Cui's Eight-Ingredient Pill from the Golden Cabinet)**: Treats Kidney deficiency with Qi insufficiency, coldness and exhaustion of the Lower Origin (Lower Jiao), presenting with pain in the abdomen and umbilical region, polyuria at night, weakness and flaccidity of the legs and knees, limb fatigue, sallow or dark complexion, as well as deficiency consumption with insufficient vitality, thirst with desire to drink, heavy sensation and pain in the lower back, urgency and pain in the lower abdomen, and difficulty in urination. It is suitable for all these conditions.
*Formula*: Qianshen Qi Wan (Former Kidney Qi Pill) plus Rougui Xin (Cinnamon Twig Heart) (1 liang), Fuzi (Prepared Aconite Root) (1 liang).
*Preparation and Administration*: Grind into fine powder, mix with refined honey to form pills the size of Chinese quince seeds. Take 50–70 pills per dose, administered with warm wine; salt water is also acceptable. Take on an empty stomach before meals. For women, administer with weak vinegar soup.
**Jufang Xichuan Shike Anshen Wan (Ancestral Formulation West Stone-Carved Kidney-Anchoring Pill)**: Treats depletion of True Qi, weakness and slowness of the legs and knees, nocturnal emissions during dreams, and slippery, frequent, clear urination.
*Formula*: Qingyan (Blue Salt) (4 liang), Lurong (Processed Deer Antler), Baiziren (Cleaned Biota Seed), Shihu (Dendrobium Stem), Fuzi (Aconite Root), Chuanwu (Prepared Sichuan Aconite Root), Bajitian (Morinda Root, dehearted), Rougui (Cinnamon Bark), Tusizi (Dodder Seed), Rongrong (Cistanche Stem), Jiu Zi (Chinese Chive Seed), Huluba (Fenugreek Seed), Duzhong (Eucommia Bark), Pozhuzi (Stir-fried Psoralea Fruit), Shizao (Ziziphus Jujube Kernel), Yuanzhi (Polygala Root), Chishizhi (Red Kaolin), Fuling (Poria), Fushen (Poria with Hostwood), Huixiang (Stir-fledged Star Anise, each 1 liang), Cangzhu (Atractylodes Rhizome), Chuanlianzzi (Sichuan Chinaberry Fruit), Chuanjiao (Sichuan Pepper), Shanyao (Dioscorea Rhizome, each 4 liang).
*Preparation and Administration*: Grind into powder, use Shan Yao (Dioscorea Rhizome) paste mixed with wine to form pills the size of Chinese quince seeds. Take 70–80 pills per dose on an empty stomach with salt water.
**Wubi Shanyao Wan (Peerless Yam Pill)**: Treats various deficiencies and damages, Wulao Qishang (Five Exhaustions and Seven Injuries), resulting in emaciation, dry skin, and weak pulse.
*Formula*: Chishizhi (Red Kaolin), Fushen (Poria with Hostwood, each 1 liang), Shanyao (Dioscorea Rhizome) (3 liang), Rongrong (Cistanche Stem, soaked in wine, 4 liang), Bajitian (Morinda Root), Niuxi (Achyranthes Root, soaked in wine), Zexie (Alisma Rhizome), Shanzhuyu Rou (Cornus Fruit Flesh, each 1 liang), Wuweizi (Schisandra Berry) (2 liang), Duzhong (Eucommia Bark), Tusizi (Dodder Seed), Shudihuang (Prepared Rehmannia Root, each 3 liang).
*Preparation and Administration*: Pound in a stone mortar into fine powder, mix with refined honey to form pills the size of Chinese quince seeds. Take 40–50 pills per dose on an empty stomach with warm wine.
**Yangshi Huan Shao Dan (Yang's Return to Youth Elixir)**: Greatly tonifies True Qi deficiency and damage, suitable for emaciated bodies.
*Formula*: Rourong (Cistanche Stem), Yuanzhi (Polygala Root), Huixiang (Star Anise), Bajitian (Morinda Root), Shanyao (Dioscorea Rhizome), Gouqizi (Goji Berry), Shudihuang (Prepared Rehmannia Root), Shichangpu (Acorus Rhizome), Shanzhuyu (Cornus Fruit), Niuxi (Achyranthes Root), Duzhong (Eucommia Bark), Chushizi (Broussonetia Fruit), Wuweizi (Schisandra Berry), Bai Fuling (White Poria).
*Preparation and Administration*: Pound in a stone mortar into fine powder, mix with refined honey to form pills the size of Chinese quince seeds. Take 50 pills per dose on an empty stomach with warm wine.
**Jiyao Niuxi Wan (Essentials Achyranthes Pill)**: Treats Kidney and Liver damage leading to bone flaccidity (Gu Wei), making it impossible to rise from bed; suitable for essence depletion and tendon laxity where self-control is lost. It employs a soothing method, and this pill is indicated for such cases.
*Formula*: Niuxi (Achyranthes Root, soaked in wine), Bibi (Dioscorea Hexandra Rhizome), Duzhong (Eucommia Bark, stir-fried), Rongrong (Cistanche Stem, soaked in wine), Tusizi (Dodder Seed), Fangfeng (Saposhnikovia Root), Huluba (Fenugreek Seed, stir-fried), Gui (Cinnamon Twig, halved dosage), Boguzhi (Psoralea Fruit), Shayuan Jili (Astragalus Complanatus Seed).
*Preparation and Administration*: Equal parts ground into fine powder, use wine-boiled pig kidney as the binder to form pills. Take 50–70 pills per dose on an empty stomach with warm wine.
*Note*: Fangfeng (Saposhnikovia Root) is used here to ascend and diffuse Liver Qi, not to directly tonify the Liver.
** Dihuang Wan (Rehmannia Pill)**: Treats Yang excess with Yin deficiency, Liver and Kidney insufficiency, sexual excess leading to deficiency, presenting with emaciation, weakness, and a mottled yellow-green complexion without consistent color. This formula nourishes Ying Blood and tonifies Kidney Qi.
*Formula*: Cangzhu (Atractylodes Rhizome, soaked in rice water), Shudihuang (Prepared Rehmannia Root, each 1 jin), Ganjiang (Dried Ginger) (Spring: 7 qian, Summer: 0.5 liang, Autumn: 7 qian, Winter: 1 liang).
*Preparation and Administration*: Pound in a stone mortar into fine powder, mix with steamed jujube flesh to form pills the size of Chinese quince seeds. Take 50–100 pills per dose with various beverages. If Wuweizi (Schisandra Berry) is added, it is called Shenqi Wan (Kidney Qi Pill); this is described as a divine medicine describing forms.
*Note*: The above formulas belong to the Shaoyin (Lesser Yin) category of medications. It is said that the Kidney is True Water, suitable only for tonification and not for purging. Thus, the ancients established the method of Shenqi Wan. Later secular practitioners used it to tonify Yang. However, Yang deficiency cases do exist, but it should not be used routinely as a standard tonic.
*Further Commentary*: Deficiency consumption syndromes have diverse origins, but none arise other than from insufficiency of Stomach Qi and Yuan Qi (Original Qi), leading to Qi deficiency, Blood deficiency, or simultaneous Yin and Yang deficiency. Alternatively, excessive sexual activity exhausts Essence, weakening Ying and Wei (Nutritive and Defensive Qi), causing Zang-Fu Qi to become flaccid and unable to transport and nourish, resulting in extreme fatigue, which may degenerate into Lao Zhai (Consumption Disease). However, secular physicians often fail to understand the etiology and pathogenesis, indiscriminately using aromatic-dry or mineral-metallic agents, frequently harming patients. Only Qian Zhongyang (Qian Yi) of the Song Dynasty established formulas for Five Zang deficiencies, surpassing previous theories. My teacher, Mr. Danxi, elucidated the faults of the *Jufang* (Imperial Formulary), indicating the beginnings of tonification methods. As Dongyuan stated, internal injury from diet and overwork damages Yuan Qi, preventing the Yang of the Stomach Middle Jiao from ascending, causing Lung and Heart Qi to sink into the Middle Jiao; thus, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used. This was indeed unprecedented.
However, Heaven is deficient in the Northwest, and Earth is incomplete in the Southeast. Heaven is Yang, Earth is Yin. In the Northwest, Yang Qi tends to descend; in the Southeast, Yin Qi tends to ascend. If one ignores this principle and mechanically applies a single method, while it may be effective for descending Qi, applying it to ascending Qi will likely exacerbate the condition. Therefore, this cannot be regarded as a universal method.
Human deficiency is mostly Yin insufficiency. Shaozi (Shao Yong) stated that Heaven and Earth rely on each other; Heaven relies on Form, Earth relies on Qi. Form has boundaries, Qi does not. Human physical substance is bounded; after Tian Gui (Heavenly Water/Reproductive Essence) ceases, the form declines. If Yin is not supplemented to maintain interior stability, Yang cannot flourish to perform vigorous functions. This is like Heaven losing its foundation, becoming scattered and drifting like a stray dog. Once Yang scatters, Earth loses its attachment further. When Form and Qi no longer support each other, death ensues. How can one then supplement such a decaying body?
This discussion on deficiency aligns with Dongyuan's methods, though the syndromes differ, both stem from the *Neijing* principle: "Those whose Yin Essence is offered up live long; those whose Yang Essence descends die young." Essentially, human longevity varies by region, just as North and South differ in classical texts. The method of ascending Yang should be applied flexibly; the principle of Yin-nourishing agents is similar. One must identify the specific location of deficiency and apply treatment according to pathogenesis. This approach differs vastly from secular practices that blindly use warming tonics due to ignorance of natural laws. Therefore, these are not detailed in general collections of tonifying formulas. Students who examine this carefully will have grasped more than half of the subject.