胃苓汤
苍术(米泔浸炒,二钱) 浓朴(姜制) 陈皮 甘草(炙) 白术(炒,各一钱) 茯苓(一钱七分) 泽
泻木香 白芍药(炒,各一钱) 官桂(五分) 淡竹叶(二十片)
作一剂。水二盅,姜三片,枣二枚,煎八分,食前服。
按∶前证七恶中之五恶也。服而若脾气醒,湿气除,宜用参苓白术散之类,多服恐
导损津液。
参苓白术散
人参 茯苓 白术(炒) 莲肉(去心) 缩砂仁(炒,杵) 薏苡仁(炒) 山药(各二两)
桔梗(炒) 甘草(炙) 白扁豆(去皮,姜汁浸炒,各一两)
上为细末。每服二钱,用石菖蒲煎汤调下。
托里消毒散加减法 口苦寒热往来,肝火血虚也,去三味加柴胡、熟地。因怒寒热
往来,肝火气虚也,加柴胡、黄芩。如不应,暂用八珍汤,加炒山栀、炒酸枣仁、酒炒黑
龙胆草。体倦寒热往来,肝脾气滞也,去三味加参 、归术。如不应,暂用补中益气汤。
内热晡热,或寒热往来,阴血虚也,去三味加芎归、牡丹皮、柴胡。如不应,暂用八珍
汤,加牡丹皮。畏寒或寒热往来,胃气虚也,去三味加参苓、白术、升麻。如不应,暂用
补中益气汤。胁痛痞满,或寒热往来,肝气滞也,去三味加青皮、木香。如不应,属气
血虚也,更加芎归、参术。若妇人劳役恚怒,或适经行,发热谵语,或夜间热甚,乃热入
血室也,去三味加生地、丹皮、柴胡。如不应,暂用加味四物汤。
胃苓汤
苍术(用米泔水浸泡后炒制,二钱) 浓朴(姜汁炮制) 陈皮 甘草(炙烤) 白术(炒制,各一钱) 茯苓(一钱七分) 泽泻 木香 白芍药(炒制,各一钱) 官桂(五分) 淡竹叶(二十片)
作为一剂。加水两盅,生姜三片,大枣二枚,煎煮至剩余八分,饭前服用。
按语:上述证候属于“七恶”中的五种恶候。服药后如果脾气苏醒,湿气去除,适宜使用参苓白术散之类的方剂,多服恐怕会耗损津液。
参苓白术散
人参 茯苓 白术(炒制) 莲肉(去心) 缩砂仁(炒制,捣碎) 薏苡仁(炒制) 山药(各二两) 桔梗(炒制) 甘草(炙烤) 白扁豆(去皮,姜汁浸泡后炒制,各一两)
以上药材研为细末。每次服用二钱,用石菖蒲煎汤调服。
托里消毒散加减法:若出现口苦、寒热往来(忽冷忽热),属肝火兼血虚,去掉原方中三味药,加入柴胡、熟地黄。因愤怒导致寒热往来,属肝火兼气虚,加入柴胡、黄芩。如果无效,暂时使用八珍汤,加入炒山栀、炒酸枣仁、酒炒黑龙胆草。身体疲倦伴寒热往来,属肝脾气滞,去掉原方中三味药,加入人参、当归、白术。如果无效,暂时使用补中益气汤。体内发热、傍晚发热,或寒热往来,属阴血虚,去掉原方中三味药,加入川芎、当归、牡丹皮、柴胡。如果无效,暂时使用八珍汤,加入牡丹皮。畏寒或寒热往来,属胃气虚,去掉原方中三味药,加入人参、茯苓、白术、升麻。如果无效,暂时使用补中益气汤。胁痛、痞满,或寒热往来,属肝气滞,去掉原方中三味药,加入青皮、木香。如果无效,属于气血虚,再加川芎、当归、人参、白术。如果是妇女因劳累过度或恼怒,或正值月经期间,出现发热谵语,或夜间发热严重,这是热入血室(邪热陷入胞宫),去掉原方中三味药,加入生地黄、牡丹皮、柴胡。如果无效,暂时使用加味四物汤。
Guizhi Tang (Cinnamon Twig Decoction)
Cangzhu (Atractylodis Rhizoma, soaked in rice water and stir-fried, 2 qian) Houpo (Magnoliae Officinalis Cortex, processed with ginger juice) Chenpi (Citri Reticulatae Pericarpium) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, each 1 qian) Fuling (Poria, 1.7 qian) Zexie (Alismatis Rhizoma) Muxiang (Aucklandiae Radix) Baishaoyao (Paeoniae Radix Alba, stir-fried, each 1 qian) Guigui (Cinnamomi Ramulus, 0.5 qian) Danzhuyeh (Lophatheri Herba, 20 leaves)
As one dose. Add two zhong of water, three slices of ginger, and two jujubes. Decoct until eight fen remains. Take before meals.
Note: The aforementioned syndrome belongs to five of the "Seven Evils" (Qi E). After taking the medicine, if the Spleen Qi awakens and dampness is eliminated, it is appropriate to use formulas such as Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). Taking too much may damage body fluids.
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder)
Renshen (Panacis Ginseng Radix) Fuling (Poria) Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried) Lianrou (Nelumbinis Semen, heart removed) Suosharen (Amomi Fructus Rotundus, stir-fried and crushed) Yiyiren (Coicis Semen, stir-fried) Shanyao (Dioscoreae Rhizoma, each 2 liang) Jiegeng (Platycodonis Radix, stir-fried) Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) Baibiandou (Phaseoli Radiati Semen, skin removed, soaked in ginger juice and stir-fried, each 1 liang)
Grind the above ingredients into a fine powder. Take 2 qian per dose, mixed with decoction of Shichangpu (Acori Tatarinowii Rhizoma).
Modifications of Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Decoction): If there is bitter taste in the mouth and alternating chills and fever (Han Re Wang Lai), it indicates Liver Fire and Blood Deficiency; remove three ingredients and add Chaihu (Bupleuri Radix) and Shudi (Rehmanniae Radix Preparata). If alternating chills and fever are caused by anger, it indicates Liver Fire and Qi Deficiency; add Chaihu (Bupleuri Radix) and Huangqin (Scutellariae Radix). If ineffective, temporarily use Bazhen Tang (Eight-Treasure Decoction), adding Chao Zhizi (Gardeniae Fructus, stir-fried), Chao Suanzaoren (Ziziphi Spinosae Semen, stir-fried), and Jiuchao Hei Longdancao (Gentianae Radix, wine-fried and charred). If fatigue accompanies alternating chills and fever, it indicates Stagnation of Liver and Spleen Qi; remove three ingredients and add Renshen (Panacis Ginseng Radix), Guizhi (not Cinnamomum cassia here, likely referring to Danggui/Angelica sinensis based on context of Qi/Blood, but text says 'Gui', usually Danggui in this context or just Gui pi, assuming Danggui for blood tonification in this mix, however strictly 'Gui' often implies Danggui in internal medicine contexts like Ba Zhen, but let's stick to literal 'Gui' which might be Danggui or Rougui, given 'Can Gui Shu' follows, likely Danggui), Baizhu (Atractylodis Macrocephalae Rhizoma). If ineffective, temporarily use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If internal heat, afternoon fever, or alternating chills and fever occurs, it indicates Yin Blood Deficiency; remove three ingredients and add Xiong (Chuanxiong Rhizome), Gui (Angelicae Sinensis Radix), Mudanpi (Moutan Cortex), and Chaihu (Bupleuri Radix). If ineffective, temporarily use Bazhen Tang (Eight-Treasure Decoction), adding Mudanpi (Moutan Cortex). If aversion to cold or alternating chills and fever occurs, it indicates Stomach Qi Deficiency; remove three ingredients and add Renshen (Panacis Ginseng Radix), Ling (Fuling/Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), and Shengma (Cimicifugae Rhizoma). If ineffective, temporarily use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If hypochondriac pain, fullness, or alternating chills and fever occurs, it indicates Liver Qi Stagnation; remove three ingredients and add Qingpi (Citri Reticulatae Pericarpium Viride) and Muxiang (Aucklandiae Radix). If ineffective, it belongs to Qi and Blood Deficiency; additionally add Xiong (Chuanxiong Rhizome), Gui (Angelicae Sinensis Radix), Renshen (Panacis Ginseng Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma). If a woman suffers from overwork and resentment, or is menstruating, and presents with fever, delirious speech, or severe night fever, this is Heat Entering the Blood Chamber (Re Ru Xue Shi); remove three ingredients and add Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Chaihu (Bupleuri Radix). If ineffective, temporarily use Jiawei Siwu Tang (Modified Four Substances Decoction).