阳经分野,必用柴胡;太阴经分野,必用芍药、升麻;少阴经分野,必用独活;厥阴经
分野,必用青皮、柴胡,皆以桂佐之。身半以下者,必用酒、水多,熟煎之,空心服,使
药下行,身半以上者,必用酒、水少,带生煎之,临卧服,使药上行。脉细小无力,必
于本经药中加辛热剂,脉洪大有力,必于本经药中加苦寒剂。随证加减,活泼泼地,其
效如神,真良医也。
脉有力而数者,春夏者宜之。其药则前条东垣、谦甫、丹溪诸方(除托里温经汤) 皆是
也。
〔丹〕 吕孺人,恶寒发热,腹上有小疽,此血少有热,与此药。
白术 川芎(三钱) 赤芍药 连翘(二钱半) 陈皮 黄芩 防风(二钱) 木通(一钱半) 甘
草(五分) 分五帖,水煎服。
又治一好酒老媪脑疽,脉弦紧急且涩,用大黄,酒煨、细切,酒拌炒为末,又酒拌炒
人参,人姜煎调一钱重,过两时再与,得睡而上半身汗,睡觉病已,亦辛凉解表之意。
当归拈痛汤 治一切风湿热毒,浸淫疮疡,下注湿毒,脚膝生疮赤肿,里外兼疮,脓
水不绝,或痒或痛,脉沉紧实数动滑者,并宜服之。
羌活 人参 苦参(酒制) 升麻 葛根 苍术(各二钱) 甘草(炙) 黄芩(酒制)
茵陈叶(酒炒,半两) 防风 当归身 泽泻 知母(酒制) 猪苓(各三钱) 白术(一钱半)
上 咀,每服一两。水煎空心服,临睡再服之。
按∶此足太阳、阳明、三阴药也,东垣本处为治香港脚湿热之剂,然世人用治以上诸
疮甚验故录之。
缩毒全粉散(《鬼遗》) 治但疼痛,不急胀。
干葛 甘草 郁金 川芎 栝蒌根 白芷(各等分)
上并生为末。每服一钱,温酒入蜜调下,不拘时。此药大散五脏积毒凝滞,日三服。
复煎散 治痈疽,发背。
黄柏 黄芩 黄连 知母 生地黄(酒洗,各一钱) 防己 山栀 羌活 黄 麦门
冬甘草(炙) 独活 人参(各半钱) 当归尾(二钱) 陈皮 防风梢 甘草梢(生) 苏木 当归
身五味子 猪苓 本 连翘 桔梗(各一钱半)
上 咀,每服四钱。水一盏,煎至七分,去滓,随证上下食前后服。
羌活当归汤(脑疽) 黄柏当归汤(发背) 黄连消毒饮(脑疽) 内托升麻汤(乳痈) 散肿溃坚
汤升麻调经汤(并瘰 ) 东垣连羌散坚汤 消肿汤(并马刀) 柴胡通经汤(马刀) 郭氏升麻
牛蒡子散(时毒) 中和汤(时毒)
阳经所主的部位,必须使用柴胡;太阴经所主的部位,必须使用芍药、升麻;少阴经所主的部位,必须使用独活;厥阴经所主的部位,必须使用青皮、柴胡,这些药物都以桂枝作为辅助。身体下半部的病症,用药时酒和水要多,充分煎煮,空腹服用,以使药力下行;身体上半部的病症,用药时酒和水要少,轻微煎煮(保留生性),睡前服用,以使药力上行。脉象细小无力,必须在治疗本经的药物中加入辛热性质的药剂;脉象洪大有力,必须在治疗本经的药物中加入苦寒性质的药剂。根据证候灵活加减,运用自如,疗效神奇,这才是真正的良医。
脉象有力且数(快)的,在春夏季节适宜使用上述治法。所用的药物则是前条中李东垣、张元素(字谦甫)、朱丹溪等人的各方(除了托里温经汤之外)都适用。
〔丹溪〕吕孺人,出现恶寒发热症状,腹部有小疽疮,这是血虚而有热的表现,给予此方药。
白术 川芎(三钱) 赤芍药 连翘(二钱半) 陈皮 黄芩 防风(二钱) 木通(一钱半) 甘草(五分)
分为五帖,用水煎服。
又治疗一位爱喝酒的老妇人患脑疽,脉象弦急紧涩,使用大黄,用酒煨制、细切,再用酒拌炒成粉末;另用人参用酒拌炒,加入生姜煎煮,调服一钱重的药粉,过了两个时辰后再给一次,患者入睡后上半身出汗,醒来后病已痊愈,这也是辛凉解表的意思。
当归拈痛汤:治疗一切风湿热毒引起的浸淫疮疡,以及下注的湿毒导致脚膝生疮、红肿,内外兼有疮疡,脓水不绝,或痒或痛,脉象沉紧实数动滑的,都适宜服用。
羌活 人参 苦参(酒制) 升麻 葛根 苍术(各二钱) 甘草(炙) 黄芩(酒制) 茵陈叶(酒炒,半两) 防风 当归身 泽泻 知母(酒制) 猪苓(各三钱) 白术(一钱半)
以上药材切碎,每服一两。用水煎煮,空腹服用,临睡时再服一次。
按语:这是足太阳、阳明、三阴经的药物,李东垣原本将其作为治疗香港脚(脚气)湿热的方剂,然而世人用它来治疗上述各种疮疡非常有效,所以记录下来。
缩毒全粉散(出自《鬼遗科》):治疗只疼痛而不急需肿胀的情况。
干葛 甘草 郁金 川芎 栝蒌根 白芷(各等分)
以上全部研为生粉末。每服一钱,用温酒加蜂蜜调服,不拘时间。此药能大力消散五脏积聚的毒气和凝滞之气,每日服用三次。
复煎散:治疗痈疽、发背。
黄柏 黄芩 黄连 知母 生地黄(酒洗,各一钱) 防己 山栀 羌活 黄芪 麦门冬 甘草(炙) 独活 人参(各半钱) 当归尾(二钱) 陈皮 防风梢 甘草梢(生) 苏木 当归身 五味子 猪苓 藁本 连翘 桔梗(各一钱半)
以上药材切碎,每服四钱。用水一盏,煎至七分,去渣,根据病情上下部不同,在饭前或饭后服用。
羌活当归汤(治疗脑疽) 黄柏当归汤(治疗发背) 黄连消毒饮(治疗脑疽) 内托升麻汤(治疗乳痈) 散肿溃坚汤、升麻调经汤(均治疗瘰疬) 李东垣连羌散坚汤 消肿汤(均治疗马刀瘘) 柴胡通经汤(治疗马刀瘘) 郭氏升麻牛蒡子散(治疗时毒) 中和汤(治疗时毒)
The regions governed by the Yang meridians must use Chai Hu (Bupleuri Radix); the regions governed by the Taiyin meridians must use Shao Yao (Paeoniae Radix) and Sheng Ma (Cimicifugae Rhizoma); the regions governed by the Shaoyin meridians must use Du Huo (Angelicae Pubescentis Radix); the regions governed by the Jueyin meridians must use Qing Pi (Citri Reticulatae Pericarpium Viride) and Chai Hu, all assisted by Gui Zhi (Cinnamomi Ramulus). For conditions in the lower half of the body, decoctions should contain more wine and water, be thoroughly boiled, and taken on an empty stomach to direct the medicinal action downward; for conditions in the upper half of the body, decoctions should contain less wine and water, be lightly boiled (retaining their raw nature), and taken before sleep to direct the medicinal action upward. If the pulse is fine, small, and weak, acrid-hot agents must be added to the herbs treating the specific meridian; if the pulse is surging, large, and forceful, bitter-cold agents must be added to the herbs treating the specific meridian. Adjusting flexibly according to the syndrome with vibrant adaptability yields miraculous effects, which is the mark of a true excellent physician.
For pulses that are forceful and rapid (Shu), this approach is suitable in spring and summer. The herbs used are those from the formulas of Li Dongyuan, Zhang Yuansu (courtesy name Qianfu), and Zhu Danxi mentioned in the previous section (excluding Tuo Li Wen Jing Tang / Support Interior Warm Meridian Decoction).
[Danxi] Lady Lv presented with aversion to cold and fever, accompanied by a small carbuncle on the abdomen. This indicates blood deficiency with heat. Prescribe this formula:
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chuan Xiong (Chuanxiong Rhizoma) [3 qian], Chi Shao Yao (Red Paeoniae Radix), Lian Qiao (Forsythiae Fructum) [2.5 qian], Chen Pi (Citri Reticulatae Pericarpium), Huang Qin (Scutellariae Radix), Fang Feng (Saposhnikoviae Radix) [2 qian], Mu Tong (Akebiae Caulis) [1.5 qian], Gan Cao (Glycyrrhizae Radix et Rhizoma) [0.5 fen].
Divide into five doses, decoct in water, and take orally.
Also treated an elderly woman who loved alcohol suffering from a brain carbuncle (Nao Ju). Her pulse was wiry, urgent, tight, and choppy. Da Huang (Rhei Radix et Rhizoma) was prepared by wine-baking, finely cut, and stir-fried with wine into powder. Ren Shen (Ginseng Radix et Rhizoma) was also stir-fried with wine. One qian of the powder was mixed with ginger juice and decocted for administration. After two hours, it was administered again. The patient fell asleep, sweated from the upper half of the body, and upon waking, the illness had resolved. This also embodies the principle of releasing the exterior with acrid-cool methods.
Dang Gui Nian Tong Tang (Angelica Sinensis Pain-Relieving Decoction): Treats all types of wind-dampness-heat toxicity causing oozing sores, as well as damp-toxicity sinking downward causing sores, redness, and swelling in the feet and knees; internal and external sores simultaneously; continuous pus and fluid; itching or pain; and cases where the pulse is deep, tight, solid, rapid, moving, or slippery. It is suitable for all such conditions.
Qiang Huo (Notopterygii Rhizoma et Radix), Ren Shen, Ku Shen (Sophorae Flavescentis Radix) [wine-processed], Sheng Ma, Ge Gen (Puerariae Lobatae Radix), Cang Zhu (Atractylodis Rhizoma) [each 2 qian], Gan Cao (roasted), Huang Qin [wine-processed], Yin Chen Ye (Artemisiae Scopariae Herba) [wine-stir-fried, 0.5 liang], Fang Feng, Dang Gui Shen (Angelicae Sinensis Radix), Ze Xie (Alismatis Rhizoma), Zhi Mu (Anemarrhenae Rhizoma) [wine-processed], Zhu Ling (Polypori Sclerotium) [each 3 qian], Bai Zhu [1.5 qian].
Crush the herbs. Each dose is one liang. Decoct in water, take on an empty stomach, and take again before sleep.
Note: These are herbs for the Foot-Taiyang, Foot-Yangming, and Three Yin meridians. Li Dongyuan originally formulated this for treating damp-heat in Hong Kong foot (Jiao Qi/foot-qi). However, since people find it very effective for treating the aforementioned sores, it is recorded here.
Suo Du Quan Fen San (Total Poison-Contraction Powder) (from *Gui Yi Ke*): Treats conditions characterized by pain without urgent swelling.
Ge Gen, Gan Cao, Yu Jin (Curcumae Longae Radix), Chuan Xiong, Gua Lou Gen (Trichosanthis Radix), Bai Zhi (Angelicae Dahuricae Radix) [equal parts].
Grind all into raw powder. Take one qian each time, mixed with warm wine and honey, at any time. This herb strongly dissipates accumulated toxins and stagnation in the Five Zang organs. Take three times daily.
Fu Jian San (Double-Decoction Powder): Treats carbuncles, ulcers, and back abscesses (Fa Bei).
Huang Bo (Phellodendri Cortex), Huang Qin, Huang Lian (Coptidis Rhizoma), Zhi Mu, Sheng Di Huang (Rehmanniae Radix) [wine-washed, each 1 qian], Fang Ji (Stephaniae Tetrandrae Rhizoma), Shan Zhi (Gardeniae Fructum), Qiang Huo, Huang Qi (Astragali Radix), Mai Men Dong (Ophiopogonis Radix), Gan Cao (roasted), Du Huo, Ren Shen [each 0.5 qian], Dang Gui Wei (Angelicae Sinensis Radix tail) [2 qian], Chen Pi, Fang Feng Shao (tip of Saposhnikoviae Radix), Gan Cao Shao (tip of Glycyrrhizae Radix et Rhizoma, raw), Su Mu (Sappan Lignum), Dang Gui Shen, Wu Wei Zi (Schisandrae Chinensis Fructus), Zhu Ling, Ben Cao (Ligustici Wallichii Rhizoma et Radix), Lian Qiao, Jie Geng (Platycodonis Radix) [each 1.5 qian].
Crush the herbs. Each dose is four qian. Use one cup of water, boil until reduced to 70%, strain, and take before or after meals depending on whether the condition affects the upper or lower part of the body.
Qiang Huo Dang Gui Tang (for Brain Carbuncle), Huang Bo Dang Gui Tang (for Back Abscess), Huang Lian Xiao Du Yin (for Brain Carbuncle), Nei Tuo Sheng Ma Tang (for Breast Abscess), San Zhong Kui Jian Tang and Sheng Ma Tiao Jing Tang (both for Scrofula/Luo Li), Li Dongyuan's Lian Qiang San Jian Tang, Xiao Zhong Tang (both for Horse Knife Fistula/Ma Dao), Chai Hu Tong Jing Tang (for Horse Knife Fistula), Guo Shi Sheng Ma Niu Bang Zi San (for Seasonal Toxicity/Shi Du), Zhong He Tang (for Seasonal Toxicity).