押班都知潘元从,喉闭急。召孙至,于夹袋中取药末吹喉中,少顷,潘吐出脓血,立
愈。潘因赠金一百,愿求方,以济非常之急。孙以其授之,用猪牙皂、白矾、黄连等分,新
瓦上焙干为末,用一钱,因曰神方无价,安用以利易哉?遂不受所赠。文潞公一日喉肿,因
三日愈甚,上召孙治之。孙曰∶病得相公判笔一管治,用笔尖点药入喉,孙遂藏针于笔尖,
随手便刺,相公昏仆,左右惊愕。孙曰∶非我不能救相公之急,须臾吐出脓血升余,旬日平
复,见上,喜曰∶孙真良医也。由是观之,喉痹以恶血不散故也。凡治此疾暴者,必先发散
,发散不愈,次取痰,取痰不愈,次去污血也。
杨立之知广州,一日喉痛溃烂,饮食不进,命吏召吉老诊之。曰∶不必服药,但食生姜
一片,方可救也。其子有难色,以喉痛安能复食辛辣?立之曰∶吉老神医,但食不妨。遂取
一片食之,觉香味异常,渐食加至半斤余,喉肿顿消,饮食如故。召吉老而谢之,问病所以
。吉老曰∶相公平日多食鹧鸪肉,此物喜食半夏苗,盖中其毒也。惟姜可解,故尔获效之
泄泻之证有五,脾、胃、大肠、小肠、大瘕是也。然溯其源,大概脾病湿渍所致,约
其治,无乃健脾渗湿为先。若夫痰火病,此则属脾肾两虚,何也?盖肾衰不能摄,脾弱不能
运,脾气虚,则阑门之气亦虚,是以不能泌别清浊,致水液渣滓,混入大肠。故或溏而或
泄也。法当君以实土,臣以益水,佐以清金,使以兜涩。所谓实土,土者,白术、白芍、山药
也。所谓益水者,故纸、五味是也。所谓清金者,五味、二冬、沙参是也。所谓兜涩者,
诃子、肉蔻、莲肉、芡实是也。盖肾气实则自能摄,脾气实则自能运,金气清肃,自能施化
矣。虽有外寒内热,饮食积滞,但宜解散消导,不可妄攻。盖攻邪则妨正,恐触滑滑之热
,即未易遏。
愚谓泄泻一症,为亡阴脱液之肇端,痰火病此,犹败叶经霜,鲜不凋坠,何也?以阴虚
故动火,而复以亡其阴,则清阳之气益陷,相火之焰益炎,下而窘迫,上而咽痛,诸证蜂起
矣。当此之际,欲实土则妨肺,欲清金则碍脾,医者能不掣其肘乎?姑以敦土清金之品,末
之为丸,徐徐缓服,此无伐天和之意,班固曰∶有病不医得中工,正此谓耳。
押班都知潘元从,突发喉闭急症。孙思邈被召去诊治,他从衣袋中取出药末吹入患者喉中,片刻之后,潘元从吐出脓血,病立刻痊愈。潘元从因此赠送一百两金子,希望能求得药方,以备不时之需。孙思邈将药方传授给他,该方由猪牙皂、白矾、黄连各等分组成,在新瓦上焙干后研为细末,每次服用一钱。孙思邈说:“神方无价,怎能用利益来交换呢?”于是拒收了馈赠的金子。
文潞公(文彦博)有一天喉咙肿胀,病情三天内加重,皇帝召孙思邈诊治。孙思邈说:“这病得靠相公的一管笔来治。”他用笔尖蘸药点入喉中,并将针藏在笔尖里,随手便刺向患处。文潞公昏倒,左右侍从惊恐愕然。孙思邈说:“不是我不能救相公的急症,须臾之间他会吐出脓血数升,十天即可康复。”后来见到皇帝,皇帝高兴地说:“孙思邈真是良医啊。”由此看来,喉痹是因为恶血不散所致。凡是治疗这种急性疾病,必须先发散邪气;发散后若未愈,再祛除痰浊;祛痰后若未愈,再去除恶血。
杨立之任广州知州时,一天喉咙疼痛溃烂,无法进食,派官吏召吉老前来诊视。吉老说:“不必服药,只需吃一片生姜,才可以救治。”杨立之的儿子面露难色,认为喉咙痛怎么能再吃辛辣之物?杨立之说:“吉老是神医,吃了也无妨。”于是取出一片生姜食用,觉得香味异常,逐渐吃到半斤多,喉咙肿胀顿时消退,饮食恢复如常。杨立之召见吉老表示感谢,并询问病因。吉老说:“相公平日多吃鹧鸪肉,这种鸟喜欢吃半夏苗,大概是中了半夏的毒。只有生姜可以解毒,所以获得疗效。”
泄泻这一证候有五种,分别是脾泄、胃泄、大肠泄、小肠泄和大瘕泄。然而追溯其源头,大都是脾病导致湿邪浸渍所致。概括其治疗原则,没有比健脾渗湿更重要的了。至于痰火病引起的泄泻,这属于脾肾两虚。为什么呢?因为肾衰不能固摄,脾弱不能运化。脾气虚弱,则阑门之气也虚弱,因此不能分别清浊,导致水液和渣滓混杂进入大肠。所以有时大便溏薄,有时泄泻。治疗方法应当以实土(补脾)为主药,益水(补肾)为辅药,清金(润肺)为佐药,兜涩(收敛止泻)为使药。所谓实土,指的是白术、白芍、山药。所谓益水,指的是故纸(补骨脂)、五味子。所谓清金,指的是五味子、天冬、麦冬、沙参。所谓兜涩,指的是诃子、肉豆蔻、莲子肉、芡实。因为肾气充实自然能固摄,脾气充实自然能运化,金气清肃自然能施化。即使有外寒内热、饮食积滞的情况,也只宜解散表邪、消导积滞,不可妄用攻下之法。因为攻邪会损伤正气,恐怕触动滑利之热,就难以遏制了。
我认为泄泻一症,是亡阴脱液的开端。患痰火病又兼泄泻的人,就像经霜的败叶,很少有不凋落的。为什么呢?因为阴虚导致动火,而又因泄泻耗伤阴液,使得清阳之气更加下陷,相火之焰更加炎上,下部窘迫,上部咽痛,各种症状蜂拥而起。在这种情况下,想要实土(补脾)则会妨碍肺金,想要清金(润肺)则会碍脾,医者能不感到掣肘吗?暂且用敦土(健脾)清金的药物,研末制成丸剂,慢慢缓服,这是不违背天和之意。班固说:“有病不医而得中工(中等水平的医生),正是这个意思。”
Pan Yuancong, the Supervisor of the Guard, suffered from acute throat obstruction (Hou Bi). Sun Simiao was summoned. He took powder from his pocket and blew it into the patient's throat. After a short while, Pan vomited pus and blood, and recovered immediately. Pan offered one hundred taels of gold as a reward and wished to obtain the prescription for emergencies. Sun Simiao imparted the formula to him: equal parts of Zhi Ya Zao (Gleditsia Sinensis Fruit with Spines), Bai Fan (Alum), and Huang Lian (Coptis Chinensis Rhizome), dried on a new tile and ground into powder. One qian was taken per dose. Sun said, "A divine prescription is priceless; how can it be exchanged for profit?" Thus, he refused the gift.
Wen Lubgong (Wen Yanbo) once suffered from throat swelling, which worsened over three days. The Emperor summoned Sun Simiao to treat him. Sun said, "This illness requires a brush from the Chancellor to cure." He dipped the brush tip in medicine and touched it to the throat, concealing a needle within the brush tip, and pricked the area at will. Wen fainted, and his attendants were shocked. Sun said, "It is not that I cannot save the Chancellor from this emergency; in an instant, he will vomit several sheng of pus and blood, and recover in ten days." Upon meeting the Emperor later, the Emperor rejoiced, saying, "Sun Simiao is truly a good physician." From this, we see that throat obstruction is caused by the stagnation of evil blood. In treating such acute conditions, one must first disperse the pathogen; if ineffective, then resolve phlegm; if still ineffective, then remove stagnant blood.
Yang Lizhi, Prefect of Guangzhou, suffered from painful ulceration of the throat and could not eat. He sent an official to summon Ji Lao for diagnosis. Ji Lao said, "No medicine is needed; simply eat one slice of fresh ginger, and you will be saved." Yang's son showed reluctance, asking how one could consume spicy food with a sore throat. Yang said, "Ji Lao is a divine physician; eating it will do no harm." So, he ate one slice, found the flavor extraordinary, and gradually consumed more than half a jin. The throat swelling subsided instantly, and his appetite returned. Yang thanked Ji Lao and asked for the explanation. Ji Lao said, "The Chancellor often eats partridge meat. Partridges like to eat Pinellia ternata seedlings, so he likely ingested their toxicity. Only ginger can detoxify this, hence the efficacy."
There are five types of diarrhea (Xie Xie): Pi Xie (Spleen Diarrhea), Wei Xie (Stomach Diarrhea), Da Chang Xie (Large Intestine Diarrhea), Xiao Chang Xie (Small Intestine Diarrhea), and Da Jia Xie (Large Constriction Diarrhea). However, tracing the source, it is generally caused by dampness infiltrating due to Spleen disease. Summarizing the treatment principle, nothing is more important than strengthening the Spleen and leaching out dampness. As for diarrhea associated with Phlegm-Fire disease, this belongs to deficiency of both Spleen and Kidney. Why? Because Kidney decline fails to secure, and Spleen weakness fails to transform. When Spleen Qi is deficient, the Qi of the Lanmen (gate separating clear and turbid fluids) is also deficient, thus failing to separate clear from turbid, causing water and dregs to mix into the Large Intestine. Hence, stools may be loose or diarrheic. The method should use Shi Tu (Solidifying Earth/Spleen tonification) as the sovereign herb, Yi Shui (Benefiting Water/Kidney tonification) as the minister, Qing Jin (Clearing Metal/Lung clearing) as the assistant, and Dou Se (Astringing/Stopping diarrhea) as the courier. "Shi Tu" refers to Bai Zhu (Atractylodes Macrocephala Rhizome), Bai Shao (White Peony Root), and Shan Yao (Dioscorea Opposita Tuber). "Yi Shui" refers to Guo Zhi (Psoralea Fructus/Bu Gu Zhi) and Wu Wei Zi (Schisandra Berry). "Qing Jin" refers to Wu Wei Zi, Dong Hua Tian (Asparagus Cochinchinensis Root/Tian Dong), Dong Hua Mai (Ophiopogon Japonicus Tuber/Mai Dong), and Sha Shen (Glehnia Root). "Dou Se" refers to He Zi (Chebula Fruit), Rou Kou (Nutmeg), Lian Rou (Lotus Seed Cotyledon), and Qian Shi (Euryale Seed). When Kidney Qi is solid, it secures naturally; when Spleen Qi is solid, it transforms naturally; when Metal Qi is clear and肃 (solemn/clear), it functions naturally. Even if there is external cold and internal heat, or food stagnation, one should only disperse and guide digestion, never blindly attack with purgatives. Attacking pathogens harms righteous Qi, and might stir up slippery heat, making it difficult to control.
I believe diarrhea is the beginning of Yin loss and fluid depletion. For those with Phlegm-Fire disease suffering from diarrhea, it is like dead leaves after frost, rarely failing to wither and fall. Why? Because Yin deficiency generates fire, and diarrhea further depletes Yin, causing Clear Yang Qi to sink further and Ministerial Fire flames to rise higher. This leads to lower urgency and upper throat pain, with various symptoms arising. At this moment, trying to strengthen the Earth (Spleen) hinders the Lung (Metal), and trying to clear the Metal (Lung) obstructs the Spleen. Can physicians avoid being hindered? Temporarily use herbs that fortify Earth and clear Metal, grind them into powder, make pills, and take them slowly. This follows the intent of not violating the Harmony of Heaven. Ban Gu said, "Having an illness but not seeking medical help yields a 'middle doctor' (average outcome); this is exactly what is meant."