气病何以分上下也如有人气逆冲而上两胁饱满又不作喘又不咳嗽痰如核结欲吐不可欲下
甚难
谓非气之上症而何治之法又不可徒治其上也此等之症非忧郁而得之即恼怒而成之也方用逍遥
散最佳不必更立奇方耳如有人气崩迫于下两腹作胀欲泻不能不泻更急大便燥结小便短少脐下
作痛而不可忍或环脐而痛或两足俱肿谓非气之下症而何而治之法又不可徒治其下也此等之症
虽亦因忧郁恼怒而来然何以气不上而反下盖上焦无火其气无隙可乘见下有可下之机故随之而
下奔调其中而解其郁亦非难治故其势较上冲者反重而治之实易也亦用逍遥散和解之亦随手而
愈然则予又何必取而细辨之乎不知方可兼用而症不可混观辨明上下之症而于逍遥方中上病加
苏子降气之味下病增栀子泻火之品又何至临症之旷顾哉
痰症之分上下者其故何哉痰在胃中者上也痰在脾中者下也痰在肾中者下之下也世人谓肺
中有
痰者误盖肺乃娇藏一物不容如何有痰肺痰者因肺有病因谓之也其实皆胃中之痰耳若心亦有痰
肝亦有痰二皆因其病而命名而终不可谓心肝有痰不统之于胃中也故言胃而凡有在上之痰举皆
包之矣治上之痰奈何健其胃而清其痰补其气而利其湿治上焦之痰其庶几乎然而上痰终何以辨
之必感风寒而得之或黄或白或成 而胶结不开或呕吐而终朝不已或胸闷而作胀或鼻塞而气粗
或咳嗽而随吐或咯唾而难出或如败絮或如黄脓此皆上痰也我有一方可以通治之神效方名攻痰
散此方健胃补气又兼利湿消痰而去风也痰在下者虽有脾肾之别而症实相同脾气之虚而后肾水
之泛肾气之乏而后脾土之亏原相因而至也其症则有纯吐清水者盖命门无火则水寒命门无火则
土亦寒水土既寒又何有堤防之障哉势必狂润汹涌上腾泛滥而不可止遏方用返流汤一剂而痰静
再剂而痰消四剂而痰无矣此方妙在以白术为君健脾而佐之以补肾消痰之药引水归源而先坚其
土气侠水不能荡其土则土自然能制夫水也
攻痰散
白术(三钱) 茯苓(五钱) 柴胡(一钱) 白芍(五钱) 半夏(三钱) 神曲(一钱) 黄芩(一钱)
甘草(一钱) 天花粉(二钱)水煎服
返流汤
白术(一钱) 山药(五钱) 薏仁(五钱) 芡实(五钱) 山茱萸(五钱) 北五味(二钱) 肉桂(
二钱) 人参(三钱) 白芥子(五钱)水煎服
气病为什么要区分上部和下部呢?比如有人气逆向上冲,导致两胁饱满,但不气喘也不咳嗽,痰像核一样结聚,想吐吐不出,想拉拉不下,这难道不是气在上部的病症吗?治疗的方法又不能只治上部。这类病症,如果不是因忧郁所致,就是因恼怒而成。用逍遥散治疗最佳,不必另外设立奇特的方子。
又比如有人气崩迫于下腹部,两腹胀满,想泻不能泻,不想泻却更急迫,大便燥结,小便短少,脐下疼痛难以忍受,或者环绕肚脐疼痛,或者两脚都肿胀,这难道不是气在下部的病症吗?治疗的方法又不能只治下部。这类病症虽然也是因忧郁恼怒而来,但为什么气不上反而下呢?因为上焦没有火,气没有空隙可乘,见到下部有可下的机转,所以气随之而下奔。调理中部而解除郁结,也不是难治之症,所以其势头比上冲的反而重,但治疗起来其实更容易。也用逍遥散来和解,也能随手痊愈。
既然这样,那我何必取出来细细辨别呢?不知道方剂可以兼用,但病症不可混淆观察。辨明上下部的病症,而在逍遥方中,上部病症加入苏子等降气的药物,下部病症增加栀子等泻火的药材,又怎么会到临症时顾此失彼呢?
痰症区分上下的原因是什么呢?痰在胃中的属于上部;痰在脾中的属于下部;痰在肾中的属于下部的下部。世人说肺中有痰是错误的。盖肺是娇脏,不容许有任何异物,如果有“肺痰”,是因为肺有病因而命名的。其实都是胃中的痰罢了。如果心也有痰,肝也有痰,二者都是因为因病而命名,最终不能说是心肝有痰而不统归于胃中。所以说胃,那么凡是上部的痰都包含在内了。
治疗上部的痰怎么办?健运脾胃而清除痰浊,补益正气而利湿。治疗上焦的痰,大概就可以了。然而如何辨别上部的痰呢?一定是感受风寒而得的,痰色或黄或白,或者结成胶状不易化开,或者呕吐而整天不停,或者胸闷而发胀,或者鼻塞而呼吸粗重,或者咳嗽随痰吐出,或者咯唾而难出,或者像败絮,或者像黄脓。这些都是上部的痰。我有一个方子可以通治,神效,方名叫攻痰散。这个方子健胃补气,又兼有利湿消痰和祛风的作用。
痰在下部的,虽然有脾肾的区别,但症状实际上相同。脾气虚弱而后肾水泛滥,肾气匮乏而后脾土亏损,原本就相互影响而至。其症状则有纯吐清水的,这是因为命门无火则水寒,命门无火则土也寒。水土既已寒冷,哪里还有堤防的屏障呢?势必会狂润汹涌,上腾泛滥而不可止遏。方用返流汤,一剂而痰静,二剂而痰消,四剂而痰无。这个方子的妙处在于以白术为君药健脾,并佐以补肾消痰的药物,引水归源而先坚固其土。气挟水不能荡涤其土,则土自然能制约水。
攻痰散
白术(三钱) 茯苓(五钱) 柴胡(一钱) 白芍(五钱) 半夏(三钱) 神曲(一钱) 黄芩(一钱)
甘草(一钱) 天花粉(二钱) 水煎服
返流汤
白术(一钱) 山药(五钱) 薏仁(五钱) 芡实(五钱) 山茱萸(五钱) 北五味(二钱) 肉桂(二钱)
人参(三钱) 白芥子(五钱) 水煎服
Why should Qi disorders be distinguished into upper and lower sections? For instance, if a person experiences rebellious Qi rushing upward, causing fullness in both hypochondriac regions, without panting or coughing, and the phlegm is knotted like a nut, difficult to expectorate and difficult to evacuate, is this not a disorder of Qi in the upper section? The treatment method must not focus solely on the upper section. Such disorders arise either from melancholy or from anger. Xiaoyao San (Free and Easy Wanderer Powder) is the best prescription; there is no need to establish an extraordinary formula.
Conversely, if a person suffers from Qi collapsing and pressing downward, causing distension in both abdomen, with an urge to defecate that cannot be fulfilled, or an urgent desire to defecate despite no urge, accompanied by dry and hard stools, scanty urine, unbearable pain below the umbilicus, or pain circling the umbilicus, or swelling of both legs, is this not a disorder of Qi in the lower section? The treatment method must not focus solely on the lower section. Although such disorders also stem from melancholy and anger, why does the Qi descend rather than ascend? This is because there is no Fire in the Upper Jiao, leaving no gap for the Qi to exploit. Seeing an opportunity for descent in the lower part, the Qi follows and rushes downward. Regulating the middle and resolving the stagnation makes it not a difficult condition to treat; thus, although its momentum is heavier than upward rebellion, it is actually easier to treat. Xiaoyao San (Free and Easy Wanderer Powder) is also used to harmonize, resulting in immediate recovery.
Then why did I take the trouble to distinguish them in detail? It is because while prescriptions can be combined, symptoms must not be confused. By clearly distinguishing upper and lower symptoms, one can add herbs that direct Qi downward, such as Perilla Seed (Su Zi), to Xiaoyao San for upper disorders, and increase heat-clearing herbs, such as Gardenia (Zhi Zi), for lower disorders. How else could one avoid overlooking aspects when treating patients?
What is the reason for distinguishing Phlegm disorders into upper and lower? Phlegm in the Stomach belongs to the upper; Phlegm in the Spleen belongs to the lower; Phlegm in the Kidney belongs to the lower of the lower. People mistakenly say there is Phlegm in the Lung. The Lung is a delicate organ that tolerates no foreign matter. If "Lung Phlegm" is mentioned, it is named due to pathology in the Lung. In reality, it is all Phlegm from the Stomach. Even if there is Phlegm in the Heart or Liver, these are named according to their respective pathologies, but ultimately they cannot be considered independent of the Stomach's governance over Phlegm. Therefore, speaking of the Stomach encompasses all upper Phlegm.
How to treat upper Phlegm? Strengthen the Stomach and clear Phlegm, tonify Qi and promote dampness drainage. Treating Phlegm in the Upper Jiao in this manner should suffice. However, how to identify upper Phlegm? It is invariably caused by Wind-Cold invasion. The sputum may be yellow or white, or sticky and knotted, or vomited continuously throughout the day, or accompanied by chest tightness and distension, nasal congestion and coarse breathing, cough with expectoration, difficulty in spitting out saliva, resembling rotten cotton, or resembling yellow pus. All these are upper Phlegm. I have a formula that can treat them all universally with miraculous efficacy, named Gongtan San (Phlegm-Attacking Powder). This formula strengthens the Stomach, tonifies Qi, promotes dampness drainage, resolves Phlegm, and expels Wind.
For Phlegm in the lower section, although there are distinctions between the Spleen and Kidney, the symptoms are essentially the same. Deficiency of Spleen Qi leads to flooding of Kidney Water; deficiency of Kidney Qi leads to depletion of Spleen Earth; they naturally influence each other. Symptoms may include vomiting only clear water. This is because without Mingmen Fire, Water is cold; without Mingmen Fire, Earth is also cold. Once Water and Earth are cold, where is the barrier of the dike? Consequently, water will surge wildly, rise uncontrollably, and flood without restraint. Use Fanliu Tang (Reverse Flow Decoction): one dose calms the Phlegm, two doses eliminate the Phlegm, four doses remove the Phlegm entirely. The brilliance of this formula lies in using Atractylodis Macrocephalae Rhizoma (Baizhu) as the sovereign herb to strengthen the Spleen, assisted by herbs that tonify the Kidney and resolve Phlegm, guiding Water back to its source and first solidifying the Earth. When Qi carrying Water cannot wash away the Earth, the Earth naturally controls the Water.
Gongtan San (Phlegm-Attacking Powder)
Atractylodis Macrocephalae Rhizoma (Baizhu, 3 qian)
Poria (Fuling, 5 qian)
Bupleuri Radix (Chaihu, 1 qian)
Paeoniae Radix Alba (Baishao, 5 qian)
Pinelliae Tuber (Banxia, 3 qian)
Medicated Leaven (Shenqu, 1 qian)
Scutellariae Radix (Huangqin, 1 qian)
Licorice Root (Gancao, 1 qian)
Trichosanthis Radix (Tianhuafen, 2 qian)
Decoct with water and take orally.
Fanliu Tang (Reverse Flow Decoction)
Atractylodis Macrocephalae Rhizoma (Baizhu, 1 qian)
Dioscoreae Rhizoma (Shanyao, 5 qian)
Coicis Semen (Yiren, 5 qian)
Euryales Semen (Qianshi, 5 qian)
Corni Fruit (Shanzhuyu, 5 qian)
Schisandrae Fructus (Bei Wuwei, 2 qian)
Cinnamon Twig (Rougui, 2 qian)
Ginseng Radix et Rhizoma (Renshen, 3 qian)
Brassicae Semenis Albus (Baijiezi, 5 qian)
Decoct with water and take orally.