大黄(二两五钱) 滑石 牵牛(各一两五钱) 白术(一两) 羌活(五钱) 黄芩 白芷(各八钱)
气滞者不通,中实者不利。不有以治之,则亢阳上腾,害目之前驱也。乃以白芷、羌活辛利诸节行其滞,黄
芩、滑
石寒胜诸热去其实,大黄、牵牛苦泻二便利其中,亦逆攻之法。盖猛烈药也,虽有白术和胃,中病而仍与服,恐
大厦将倾,非一木所能支矣。一方用白牵牛末一两,四制香附子五钱,甘草二钱,米糊丸,量病虚实,下以钱数,
一切积聚,得之随去。且药甚平易,而又不损元神,功在利中、承气之上。一方制大黄、生白牵牛末各等分,薏
苡仁粉、皂角浓煎汁调,蒸熟杵为丸,亦佳。
诗曰∶芩炫大黄芷发馨,牵牛南过滑家亭,笑羌活为杯中物,种术频年两鬓星。
柴胡 半夏 大黄 枳实 黄芩 芍药 姜枣佐煎。
阳邪内传,表症未除,里症又急,此方主之。
表症未除者,寒热往来,胁痛口苦尚在也。故用柴胡、半夏、生姜、大枣以解之。里症又急者,大便结而解
难也。故用大黄、枳实、黄芩、芍药以攻之。
诗曰∶大柴胡芩白芍药,庄黄半夏小枳壳,表邪未罢里邪催,度量煎倾病合却。
大黄 芒硝 甘草
肉轮肿痛,大便秘,谵语,脉长大有力,头痛巨阳穴,及不恶寒,反恶热,齿痛作渴,此正阳明邪实之症。
始得应发汗,失治而传至其经,则热困数日矣,不下病必变。硝黄大寒可以荡实,炙草甘平可以和中。汤重性行,
则胃调而表
气承顺,故曰调胃承气。亦治阳症中消,善食而溲。总之汗无太晚,晚则致得上症。下无太早,早则多有结胸痞
气之患。
痢疾严重到仿佛吸尽骨髓,疟疾瘟疫严重到仿佛剥去皮肤,服用此药后倒入厕所(指排泄物),百姓的生命顿时得以挽救。汇总攻下类方剂如下:
大黄(二两五钱) 滑石 牵牛子(各一两五钱) 白术(一两) 羌活(五钱) 黄芩 白芷(各八钱)
气机阻滞导致不通畅,中焦实证导致排便不利。如果不加以治疗,那么亢盛的阳气就会向上冲腾,这是危害眼睛的前兆。于是用白芷、羌活的辛散通利之性疏通各处的滞塞,用黄芩、滑石的寒凉性质克制各种热邪并去除其实邪,用大黄、牵牛子的苦泄作用使二便通畅以疏导中焦,这也是“逆攻”的治疗方法。这毕竟是猛烈的药物,虽然有白术调和胃气,但如果病愈后仍然继续服用,恐怕就像大厦即将倒塌,不是单靠一根木头所能支撑的了。另一个方子用白牵牛子末一两,经过四种方法炮制的香附子五钱,甘草二钱,用米糊做成丸药,根据病情的虚实,按钱数决定剂量,所有的积聚病症,遇到它随即消除。而且药物非常平和平易,又不损伤元神,功效在利中汤和承气汤之上。又一个方子将制大黄、生白牵牛子末各取等分,用薏苡仁粉和皂角浓煎的汁液调和,蒸熟后捣碎做成丸药,也很好。
诗曰:黄芩如炫目,大黄猛烈,白芷散发馨香,牵牛子向南越过滑家亭,嘲笑羌活不过是杯中之物(指酒或次要角色),白术年年使用,两鬓已斑白如星。
柴胡 半夏 大黄 枳实 黄芩 芍药 生姜大枣辅助煎煮。
阳邪内传入里,表证尚未解除,里证又很紧急,此方主治。
所谓表证未解除,是指恶寒发热交替出现,胁痛口苦等症状仍然存在。所以用柴胡、半夏、生姜、大枣来解表。所谓里证又紧急,是指大便干结且难以排出。所以用大黄、枳实、黄芩、芍药来攻下里实。
诗曰:大柴胡汤中有黄芩和白芍药,庄重的大黄配半夏和小枳壳,表邪尚未罢休而里邪催促,衡量剂量煎煮倾倒,疾病便会消除。
大黄 芒硝 甘草
眼睑(肉轮)红肿疼痛,大便秘结,说胡话(谵语),脉象长大有力,头痛位于巨阳穴(此处指太阳经头部穴位或泛指头项强痛),以及不恶寒反而恶热,牙齿疼痛且口渴,这正是阳明经邪气实盛的证候。
刚开始应当发汗,因失治而传变至本经,则热邪困阻数日了,如果不攻下,病情必然发生变化。芒硝、大黄大寒可以荡涤实邪,炙甘草甘平可以调和胃气。汤剂药性走窜迅速,则胃气得调而表气顺承,所以称为调胃承气汤。也治疗阳症中的中消证,食欲旺盛但小便频多。总之,发汗不能太晚,晚了就会导致上部的病症;攻下不能太早,早了则多有结胸、痞气的祸患。
Dysentery severe enough to seem as if sucking out the marrow, malaria and plague severe enough to seem as if peeling off the skin; after administering this [decoction], when excreted into the toilet, people's lives are instantly saved. A compilation of purgative formulas follows:
Rhubarb (2 liang 5 qian) Talcum Stone (Huashi) Pharbitis Seed (Qianniu) (each 1 liang 5 qian) Atractylodes Macrocephala Rhizome (Baizhu) (1 liang) Notopterygium Root (Qianghuo) (5 qian) Scutellaria Root (Huangqin) Angelica Dahurica Root (Baizhi) (each 8 qian).
When Qi stagnation causes obstruction, and middle-jiao excess causes difficulty in defecation, if not treated, hyperactive Yang will surge upward, which is a precursor to harming the eyes. Therefore, the acrid and penetrating nature of Baizhi and Qianghuo is used to unblock stagnation in various segments; the cold-natured properties of Huangqin and Huashi are used to overcome heat and eliminate excess; the bitter-purgative action of Dahuang and Qianniu is used to facilitate both bowel movements and urination to drain the middle jiao. This is also a method of "counter-attack" (Ni Gong). These are indeed fierce medicines. Although Baizhu harmonizes the Stomach, if taken continuously even after the disease is cured, it would be like trying to support a collapsing mansion with a single piece of wood. Another formula uses 1 liang of powdered white Pharbitis Seed (Bai Qianniu), 5 qian of Xiangfu (Cyperi Rhizoma) processed by four methods, and 2 qian of Licorice Root (Gancao), formed into pills with rice paste. The dosage is determined by the deficiency or excess of the condition. All types of accumulations and masses are dispelled upon taking it. Moreover, the herbs are very mild and do not damage the Primordial Spirit (Yuan Shen); its efficacy surpasses that of Lizhong Tang and Chengqi Decoctions. Yet another formula uses equal parts of prepared Rhubarb (Zhi Dahuang) and raw Pharbitis Seed (Sheng Bai Qianniu), mixed with Coix Seed Powder (Yiyiren Fen) and a concentrated decoction of Soap Pod (Zaojiao), steamed until cooked, then pounded into pills, which is also excellent.
Poem says: Huangqin dazzles, Dahuang is potent, Baizhi emits fragrance, Qianniu passes south past Huashi's pavilion, laughing at Qianghuo as but a drink in the cup, while Baizhu is used year after year, turning temples starry gray.
Bupleurum Root (Chaihu) Pinellia Tuber (Banxia) Rhubarb (Dahuang) Immature Bitter Orange (Zhishi) Scutellaria Root (Huangqin) Peony Root (Shaoyao) Ginger (Jiang) and Jujube (Zao) assist in decoction.
When Yang pathogenic factors transmit inward, exterior symptoms have not yet resolved, and interior symptoms are urgent, this formula is indicated.
Exterior symptoms unresolved means alternating chills and fever, along with hypochondriac pain and bitter taste in the mouth persisting. Thus, Chaihu, Banxia, Shengjiang (Fresh Ginger), and Dazao (Jujube) are used to resolve the exterior. Interior symptoms being urgent means dry stool and difficult defecation. Thus, Dahuang, Zhishi, Huangqin, and Shaoyao are used to attack the interior excess.
Poem says: In Da Chaihu Tang there are Huangqin and Shaoyao, dignified Dahuang paired with Banxia and small Zhike, exterior pathogens not yet ceased while interior pathogens urge on, measure the dosage, decoct and pour, and the illness will be repelled.
Rhubarb (Dahuang) Mirabilite (Mangxiao) Licorice Root (Gancao)
Swelling and pain of the eyelids (Flesh Wheel), constipation, delirious speech, pulse large and long with force, headache located at Juyang acupoints (referring to Taiyang meridian head points or generally head/neck stiffness), aversion to cold absent but aversion to heat present, toothache, and thirst. This is precisely a syndrome of excess pathogenic factors in the Yangming channel.
Initially, sweating should have been induced; due to mismanagement, the pathogen transmitted to this channel, where heat has confined for several days. If not purged, the disease will inevitably change. Mangxiao and Dahuang, being greatly cold, can sweep away excess; roasted Gancao, being sweet and neutral, can harmonize the Middle Jiao. The soup form acts swiftly, regulating the Stomach and allowing exterior Qi to follow smoothly, hence it is called Tiaowei Chengqi Tang. It also treats Zhongxiao (Middle Wasting-Thirst) in Yang syndromes, characterized by good appetite but frequent urination. In summary, sweating should not be delayed too late, lest it lead to upper-jiao syndromes; purging should not be done too early, lest it cause complications such as Jie Xiong (Chest Binding) or Pi Qi (Epigastric Fullness).