大黄(蒸)十分 黄芩二两 杏仁一升 桃仁一升 干地黄十两 干漆一两 虻虫一升,
水蛭
上十二味,末之,炼蜜和丸,如小豆大,酒饮服五丸,日三服。
《金匮》血痹虚劳脉证九条,首条是汗出而风吹之,血凝于肤而为痹,然痹未至于干血,
后
五劳
饮食
于肺
房劳
喘息
者,
痹血
本文
之血
者几
清
性
功,
舒润
虫二十枚(去足) 桃仁二十粒 大黄三两
上三味末之,炼蜜和为丸,每以一丸,酒一升,煮一丸,取八合,频服之。新血下如豚
肝。
《金匮》云∶产妇腹痛,内有干血着脐下,用三味为方。盖因瘀积未久,荣卫经络血亦
未必固
劳之用
当归一钱 乳香一钱(去油) 没药一钱(去油) 虻虫十四个 人参二钱 大黄四钱 水
蛭十
上为细末,炼蜜为丸,桐子大,都作一服,可百丸,五更用百劳水下,取恶物为度,服
白粥
百劳丸,许州陈大夫流传,出自仲景方。治一切痨瘵积滞,未经药坏证者。细绎是方,
无非
用百
良治
蛇含石(本草名蛇黄,大者三两,以新铁铫盛,入炭火中,烧蛇黄与铫子一般红,用钳
取蛇
如
蒲黄
子
同二
以上三物为主,其次量人虚实,入下项药。(喻嘉言曰∶治水多取转,推此方三物,既
非大
羌活 川芎 京三棱(炮) 蓬莪术 白豆蔻 白蒺藜 陈皮 青皮 木香 大茴香
(炒)
牛
上为末,入前药拌匀,以汤浸神曲,捩去水,为糊和药,再杵极匀。丸如桐子大,食
前温酒
于小便
禹余粮丸用三物治肝脾胃之药为主者,以水病莫不本之于三脏也;蛇黄得蛇性之走窜灵
异,
之气
青皮
三
占
使
之
【大黄蛰虫丸】
大黄(蒸制)十分,黄芩二两,杏仁一升,桃仁一升,干地黄十两,干漆一两,虻虫一升,水蛭、蛴螬各一升,䗪虫半升,干漆一两。
以上十二味药,研成细末,用炼蜜调和制成丸药,大小如小豆,每次用酒送服五丸,每日三次服用。
《金匮要略》中关于血痹虚劳的脉证有九条,第一条指出:出汗时受风吹,血液凝滞于皮肤而形成痹证,然而此痹证尚未发展到干血的程度。
后文提到的五劳(久视伤血、久卧伤气、久坐伤肉、久立伤骨、久行伤筋)、七伤(大饱伤脾、大怒气逆伤肝、强力举重、久坐湿地伤肾、形寒寒饮伤肺、忧愁思虑伤心、风雨寒暑伤形),以及饮食不节损伤脾胃、房劳过度损伤肾脏等导致的喘息等症状,属于瘀血阻滞。
本文所论述的此类血证患者,其病情较重,多属干血内结。
方中大黄、蛰虫等药具有破血逐瘀、润燥舒筋的功效。
【大黄䗪虫丸】
䗪虫二十枚(去足),桃仁二十粒,大黄三两。
以上三味药研成细末,用炼蜜调和制成丸药,每取一丸,用一升酒煎煮该丸,取八合药液,频频服用。服药后排出新血,状如猪肝。
《金匮要略》记载:产妇腹痛,因内有干血附着于脐下,使用这三味药组成方剂。这是因为瘀积时间尚短,营卫经络中的血液未必完全固结,故可用此法治疗虚劳之证。
【百劳丸】
当归一钱,乳香一钱(去油),没药一钱(去油),虻虫十四个,人参二钱,大黄四钱,水蛭十个(熬)。
以上药物研为细末,用炼蜜制成丸药,大小如梧桐子,共制成一次服用的量,约一百丸。在五更天用百劳水送服,以排出恶物为度,服药后喝白粥调养。
百劳丸由许州陈大夫流传,源自张仲景的方子。主治各种痨瘵积滞,且未经药物误治变证的病人。仔细推敲此方,无非是利用大黄、虻虫、水蛭等药的攻逐之力,配合人参、当归等补益之品,达到攻补兼施的效果。
【禹余粮丸】
蛇含石(本草中称为蛇黄,大的三两,用新的铁锅盛放,放入炭火中烧至蛇黄与铁锅同样红热,用钳子取出,研磨成粉),禹余粮(煅),赤石脂(煅)。
以上三味药为主,其次根据病人的虚实情况,加入以下药物。(喻嘉言说:治水病多取旋转之意,推究此方的三味主药,既非大发汗,也非大泻下,而是通过调理脏腑气机来治病。)
羌活、川芎、京三棱(炮制)、蓬莪术、白豆蔻、白蒺藜、陈皮、青皮、木香、大茴香(炒)、牛膝、杜仲、续断、茯苓、泽泻、车前子、防己、桂枝、附子、干姜、甘草。
以上药物研为细末,与前药拌匀,用汤浸神曲,拧去水分,做成糊状调和药粉,再捣极均匀。制成如梧桐子大小的丸药,饭前温酒送服。
禹余粮丸以治疗肝、脾、胃三脏的药物为主,因为水病无不源于这三脏;蛇含石得蛇性之走窜灵异,能通络散结;禹余粮、赤石脂能收敛固涩。青皮疏肝破气,三棱、莪术破血行气。此方旨在通过调理肝脾胃之气,使水湿得以运化。
[Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill)]
Da Huang (Rhizoma et Radix Rhei, steamed) 10 fen, Huang Qin (Caulis Scutellariae, two liang), Xing Ren (Semen Armeniacae Amarum, one sheng), Tao Ren (Semen Persicae, one sheng), Gan Di Huang (Radix Rehmanniae Preparata, ten liang), Gan Qi (Resina Taxodi, one liang), Meng Chong (Asio, one sheng), Shui Zhi (Hirudo, one sheng), Si Cao (Silkworm, one sheng), Zhe Chong (Eupolyphaga Steleophaga, half sheng), Gan Qi (Resina Taxodi, one liang).
The above twelve ingredients are ground into fine powder, mixed with refined honey to form pills the size of small beans. Take five pills at a time, washed down with wine, three times daily.
In *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), there are nine pulse and symptom patterns regarding Blood Bi (Blood Stasis Obstruction) and Xu Lao (Deficiency Consumption). The first pattern states: sweating followed by wind exposure causes blood to coagulate in the skin, forming Bi syndrome; however, this Bi has not yet progressed to Dry Blood (Chronic Blood Stasis).
Subsequent texts mention Wu Lao (Five Strains: prolonged vision damages blood, prolonged lying damages qi, prolonged sitting damages flesh, prolonged standing damages bones, prolonged walking damages tendons), Qi Shang (Seven Injuries: overeating damages spleen, anger damages liver, heavy lifting dampness damages kidney, cold food damages lung, sorrow damages heart, wind/cold/damp damages form), dietary irregularities damaging Spleen/Stomach, and sexual excess damaging Kidney, leading to symptoms such as panting. These belong to Blood Stasis obstruction.
The blood disorders discussed in this text involve patients with severe conditions, mostly characterized by internal accumulation of Dry Blood.
Ingredients such as Da Huang and Zhe Chong possess the functions of breaking blood stasis, driving out clots, moistening dryness, and relaxing sinews.
[Da Huang Zhe Chong Wan (Variation)]
Zhe Chong (Eupolyphaga Steleophaga, twenty pieces, feet removed), Tao Ren (Semen Persicae, twenty grains), Da Huang (Rhizoma et Radix Rhei, three liang).
The above three ingredients are ground into fine powder, mixed with refined honey to form pills. Take one pill at a time, boil it in one sheng of wine until reduced to eight he, and take frequently. After taking the medicine, fresh blood is discharged resembling pig liver.
*Jin Gui Yao Lue* records: For postpartum abdominal pain caused by Dry Blood adhering below the umbilicus, use these three ingredients to form a prescription. This is because the blood stasis has not accumulated for long, and the blood in Ying and Wei meridians may not be firmly consolidated, thus this method can be used to treat Deficiency Consumption due to stasis.
[Bai Lao Wan (Hundred Fatigue Pill)]
Dang Gui (Radix Angelicae Sinensis), one qian; Ru Xiang (Olibanum, one qian, oil removed); Mo Yao (Myrrha, one qian, oil removed); Meng Chong (Asio, fourteen pieces); Ren Shen (Radix Ginseng, two qian); Da Huang (Rhizoma et Radix Rhei, four qian); Shui Zhi (Hirudo, ten pieces, processed).
Grind the above medicines into fine powder, mix with refined honey to form pills the size of paulownia seeds. Prepare enough for one dose, approximately one hundred pills. At the third watch of the night (Wu Geng), take with Bai Lao Water, stopping when foul matter is expelled. Follow with white porridge for nourishment.
Bai Lao Wan was transmitted by Physician Chen from Xuzhou, originating from Zhang Zhongjing's prescriptions. It treats all types of consumption with stagnation, provided the condition has not been worsened by improper medication. Careful analysis of this formula reveals it utilizes the purging power of Da Huang, Meng Chong, and Shui Zhi, combined with tonifying agents like Ren Shen and Dang Gui, achieving both evacuation and supplementation.
[Yu Yu Liang Wan (Halloysitum Pill)]
She Han Shi (also known as She Huang in Materia Medica, large pieces weighing three liang, placed in a new iron pot, heated in charcoal fire until red hot like the pot, removed with tongs, and powdered), Yu Yu Liang (Halloysitum, calcined), Chi Shi Zhi (Halloysitum Rubrum, calcined).
These three ingredients serve as the main components. Secondly, based on the patient's deficiency or excess, add the following herbs: (Yu Jiayan stated: Treating water diseases often involves the concept of rotation; deducing from these three main ingredients, neither induces heavy sweating nor severe purging, but treats disease by regulating organ qi mechanisms.)
Qiang Huo (Radix Notopterygii), Chuan Xiong (Rhizoma Chuanxiong), Jing San Leng (Rhizoma Sparganii, processed), Peng E Zhu (Rhizoma Curcumae, processed), Bai Dou Kou (Fructus Cardamomi Rotundus), Bai Ji Li (Fructus Tribuli), Chen Pi (Pericarpium Citri Reticulatae), Qing Pi (Pericarpium Citri Reticulatae Viride), Mu Xiang (Radix Aucklandiae), Da Hui Xiang (Fructus Foeniculi, stir-fried), Niu Xi (Radix Achyranthis Bidentatae), Du Zhong (Cortex Eucommiae), Xu Duan (Radix Datiscae), Fu Ling (Sclerotium Poriae), Ze Xie (Rhizoma Alismatis), Che Qian Zi (Semen Plantaginis), Fang Ji (Radix Stephaniae Tetrandrae), Gui Zhi (Ramulus Cinnamomi), Fu Zi (Radix Aconiti Lateralis Preparata), Gan Jiang (Rhizoma Zingiberis), Gan Cao (Radix Glycyrrhizae).
Grind the above medicines into powder, mix evenly with the previous ingredients. Soak Shen Qu (Massa Medicata Fermentata) in water, wring out excess moisture, make a paste to bind the powder, and pound thoroughly. Form into pills the size of paulownia seeds. Take before meals with warm wine.
Yu Yu Liang Wan primarily uses herbs treating Liver, Spleen, and Stomach, as water diseases invariably originate from these three organs; She Han Shi inherits the penetrating nature of snakes, capable of unblocking collaterals and dissipating nodules; Yu Yu Liang and Chi Shi Zhi have astringent properties. Qing Pi soothes Liver and breaks Qi, while San Leng and E Zhu break blood and move Qi. This formula aims to transform dampness through regulating the Qi of Liver, Spleen, and Stomach.