即前方木香易当归,苍术换白术。
脾阳不调者,常作肠鸣、飧泄、膨胀诸症。脾阴不中者,会有神倦、目暗、言微等事。甘温能补衰弱,故用
参、 、甘草。苦燥能平敦阜,故用苍术、升麻。轻清举陷下抑郁,柴胡是已。芬芳辟留中陈腐,橘皮是已。夫
陈腐辟,敦阜平,陷下举,衰弱补,宁复有不益之气,不调之中乎?于以名汤,谅哉。
飧泄一名肠风。盖风邪伤人,必入空窍,而空窍唯肠胃为最。风既居于其中,引导之机如顺流扬帆,不俟脾
之运化,食入即出,以故餐已随泄。不知者以为脾虚完谷不化,急作长夏寒中、洞泄及冬月飧泄之泄而治。热剂
大补,风益刚劲,有加无已,每至束手无策。其实用此方倍加桂枝,领风从肌表而出,一二剂随瘥。再者,肺伤
于燥,亦害飧泄,所谓肺移热于大肠,久为肠辟是也。肺清则泄立止矣。倘想到脾虚,以燥益燥,则一转为痢,
再转为秘,欲泄不得其泄,奈何?偶有所触,附注于此,学人记之。本方加五味、芍药,发中有收,亦名调中。
诗曰∶补中益气许参 ,橘草升柴术与归,白术易苍归易术,调中益气又须知。
地黄 附子(略漂去辣性,用生姜夹扎,蒸极熟) 白术(略漂净油,蜜炒) 五味子 人参 麦门冬(去心) 怀
牛膝
上方地黄、白术,先后天首选之品。功专补脾阳肾阴,但性质燥湿不协。妙在五味、麦冬、牛膝引入肺金,
则纳气而滋化源,相克正所以相成。再有人参、附子驱驾药力,助益真元,自然火交于下,水布于上。既济之象
一得,燥涸偏胜之势敛矣。诚土中藏阳,水中补火之良方也。一切虚劳发热,喘嗽吐衄,服清热消痰等剂致目赤
痛如锥,进此不惟对症,而病本可冀潜除。
诗曰∶全真方意本归藏,术附人参配地黄,妙入麦冬牛膝味,相生相胜济坤阳。
脾阳失调者,常出现肠鸣、飧泄(完谷不化的腹泻)、腹胀等病症。脾阴不足者,会出现精神疲倦、视力昏暗、声音低微等症状。甘温的药物能够补益虚衰,所以用人参、地黄、甘草。苦燥的药物能够平抑过盛的湿气,所以用苍术、升麻。轻清之品能够提升下陷的阳气,柴胡正是此类。芳香之气能够驱散停滞在中焦的陈腐之气,橘皮正是此类。既然陈腐之气得以驱散,过盛的湿气得以平抑,下陷的阳气得以提升,虚衰的状态得以补益,难道还会有不调和中气、不益元气的情况吗?以此命名此汤,确实恰当。
飧泄又名肠风。大概是因为风邪伤人,必定侵入空窍,而人体空窍中,以肠胃最为显著。风邪既居于其中,引导病势发展的机制就像顺流扬帆一样,不需要等待脾脏的运化功能,食物吃下去随即排出,因此进食后随即发生腹泻。不了解的人认为是脾虚导致完谷不化,急忙按照长夏季节寒邪中阻、洞泄(水样直下的腹泻)以及冬季飧泄的方法来治疗。使用热性药物大补元气,风邪更加刚劲猛烈,病情加重没有止境,常常导致束手无策。其实使用此方并加倍桂枝用量,引领风邪从肌表排出,服用一两剂即可痊愈。再者,肺脏受到燥邪损伤,也会危害导致飧泄,这就是所说的“肺移热于大肠,久则成为肠辟(痢疾)”。肺气清肃则腹泻立刻停止。如果只想到脾虚,用燥药进一步增加燥性,那么病情就会转变为痢疾,再转变为便秘,想要腹泻却得不到宣泄,该怎么办呢?偶然有所感触,附注于此,学习中医的人要记住。本方加入五味子、芍药,发散中有收敛之意,也命名为调中益气汤。
诗曰:补中益气许参 [此处原文似有脱漏或指代不明,结合下文应为具体药材],橘草升柴术与归,白术易苍归易术,调中益气又须知。
地黄、附子(略加漂洗去除辛辣性,用生姜夹住扎好,蒸至极熟)、白术(略加漂洗去净油分,用蜜炒制)、五味子、人参、麦门冬(去掉心)、怀牛膝。
上方中的地黄、白术,是先后天之本首选的药物。功效专门在于补脾阳和肾阴,但性质上燥湿不协调。妙处在于五味子、麦冬、牛膝引入肺金,从而纳气并滋生化之源,相克的关系正所以相辅相成。再加上人参、附子驾驭药力,助益真元,自然使火交于下,水布于上。既济卦的象意一旦得到,燥涸偏胜的态势就收敛了。这确实是土中藏阳、水中补火的良方。一切虚劳发热、喘咳吐衄(吐血、鼻出血),服用清热消痰等药剂导致眼睛红痛如锥刺般,进服此方不仅对症,而且病根有望被潜移默化地消除。
Substitute Mu Xiang (Aucklandiae Radix) with Dang Gui (Angelicae Sinensis Radix), and Cang Zhu (Atractylodis Rhizoma) with Bai Zhu (Atractylodis Macrocephalae Rhizoma).
When Spleen Yang (Spleen Yang) is disordered, symptoms such as borborygmus (intestinal rumbling), Sun Xie (diarrhea with undigested food), and abdominal distension often occur. When Spleen Yin (Spleen Yin) is insufficient, manifestations include mental fatigue, dim vision, and a weak voice. Sweet and warm substances can tonify deficiency and weakness; therefore, Ren Shen (Ginseng Radix et Rhizoma), Di Huang (Rehmanniae Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) are used. Bitter and drying substances can level excessive dampness; thus, Cang Zhu (Atractylodis Rhizoma) and Sheng Ma (Cimicifugae Rhizoma) are employed. Light and clear herbs can lift sunken Qi depression; Chai Hu (Bupleuri Radix) serves this purpose. Aromatic substances can dispel stagnant and stale Qi in the middle jiao; Ju Pi (Citri Reticulatae Pericarpium) fulfills this role. Since stale Qi is dispelled, excess is leveled, sunken Qi is lifted, and deficiency is tonified, how could there be any failure to benefit Qi or harmonize the Middle Jiao? Hence the name of the decoction is indeed appropriate.
Sun Xie is also known as Chang Feng (Intestinal Wind). Generally, when Wind Pathogen (Wind) injures the body, it must enter the empty cavities, among which the intestines and stomach are most prominent. Once Wind resides within, the mechanism of guiding the pathology is like sailing with the current; it does not wait for the Spleen's transformation and transportation function. Food enters and immediately exits, resulting in defecation shortly after eating. Those who do not understand this mistake it for Spleen Deficiency causing undigested food in stool, and hastily treat it as Cold invading the Middle during late summer causing Dong Xie (profuse watery diarrhea) or Winter Sun Xie using hot formulas to greatly tonify. This makes the Wind pathogen more vigorous, leading to worsening conditions without end, often leaving one helpless. In fact, by adding Gui Zhi (Cinnamomi Ramulus) in double dosage to this formula, the Wind is led out from the muscle layer, and recovery occurs after one or two doses. Furthermore, Lung Dryness (Lung Dryness) damaging the Lungs also harms against Sun Xie, which is what is meant by "Lung transferring Heat to the Large Intestine, long-term becoming Chang Pi (Dysentery)." When Lung Qi becomes clear, diarrhea stops immediately. If one only considers Spleen Deficiency and uses drying herbs to increase dryness, the condition will transform into Dysentery, then into Constipation, where one desires defecation but cannot achieve it, what then? Occasionally having some thoughts, I add this note here; students should remember it. Adding Wu Wei Zi (Schisandrae Fructus) and Shao Yao (Paeoniae Radix) to this formula introduces restraint within dispersion, also named Tiao Zhong Yi Qi Tang (Regulate the Middle and Boost Qi Decoction).
Poem: For Bu Zhong Yi Qi, Ginseng is permitted, [Note: Original text seems to imply specific ingredients], Orange peel, Licorice, Sheng Ma, Chai Hu, Atractylodes, and Angelica; Swapping Bai Zhu for Cang Zhu and Angelica for Atractylodes, one must know Tiao Zhong Yi Qi well.
Di Huang (Rehmanniae Radix), Fu Zi (Aconiti Lateralis Radix Praeparata - slightly washed to remove pungency, wrapped with Sheng Jiang (Zingiberis Rhizoma Recens) and steamed until very soft), Bai Zhu (Atractylodis Macrocephalae Rhizoma - slightly washed to remove oil, stir-fried with honey), Wu Wei Zi (Schisandrae Fructus), Ren Shen (Ginseng Radix et Rhizoma), Mai Men Dong (Ophiopogonis Radix - heart removed), Huai Niu Xi (Achyranthis Bidentatae Radix).
Among the above, Di Huang (Rehmanniae Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) are premier choices for the Pre-Heaven and Post-Heaven roots. Their functions specialize in tonifying Spleen Yang and Kidney Yin, but their properties are uncoordinated regarding dryness and dampness. The brilliance lies in Wu Wei Zi (Schisandrae Fructus), Mai Men Dong (Ophiopogonis Radix), and Niu Xi (Achyranthis Bidentatae Radix) guiding the action into Lung Metal, thereby grasping Qi and nourishing the source of transformation. Mutual restriction actually facilitates mutual completion. Additionally, Ren Shen (Ginseng Radix et Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) drive the medicinal power, assisting True Yuan (True Primordial Qi), naturally causing Fire to interact below and Water to distribute above. Once the image of Ji Ji (Completed Transition) is achieved, the tendency of excessive dryness and depletion recedes. Indeed, this is an excellent formula for hiding Yang within Earth and tonifying Fire within Water. It is suitable for all cases of Deficiency-Labor fever, panting, coughing, hematemesis, and epistaxis, especially when taking heat-clearing and phlegm-resolving agents causes red, painful eyes like needle pricks. Taking this formula not only addresses the symptoms but also hopes to eliminate the root cause subtly.
Poem: The intent of Quan Zhen Formula originates from Gui Zang, Atractylodes, Aconite, Ginseng paired with Rehmannia; Ingeniously entering Ophiopogon, Achyranthes, and Schisandra, Mutual generation and restriction nourish Kun Yang.