若面黄或洁,或黄洁俱见,脉浮沉不一,缓而迟者,伤在太阴,脾之经也。
人参(一两,腹痛者倍之) 甘草(炙) 白术 干姜(各一两)
上细末,炼蜜和丸鸡子黄大。以汤数合,和丸,研碎,温服之,日三夜二。腹中未热,
益至三四丸,煎热粥饮投之,微温覆,勿揭衣。丸不及汤。
海藏云∶大便结者宜丸,大便软者宜汤。仲景云∶无阳阴强,大便硬者,不可下,下之则
清谷腹满。
以上三经脉皆云浮沉不一者,以其皆似孤亡之体也。
又云∶日三夜二,读之极无味,然仔细思之,利害非轻。恐人不识,故有阴阳寒热各从
类生一条。
假令附子与大黄合而服之,昼服则阳药,成功多于阴药,夜服则阴药成功于阳药,足从
其类
也。况人之疾,独不然乎!若病阳症,昼则增剧,夜则少宁;若病阴症,昼则少宁,夜则增
剧。是人之阴阳寒热,从天地之行阴行阳也,寒热之化,以此随之。故前人治阴证用阳药,
续于夜半之后者,所以却类化之阴,而接身与子所生之阳也。《通玄类证》云∶小建中汤后
亦举日三夜二,及尺脉不至者加黄 。
予尝云∶大便软者宜汤,大便结者宜丸,以丸蜜润也。仲景治霍乱吐下,脾湿大胜,而
用丸何也?
答曰∶以湿言之,岂有润之之理,此正湿已太过,津液极亡,所以转筋也。筋得血而养
,故
能屈伸。利下既多亡阴,失血反成枯燥,燥则所以不能屈伸也。故湿剂以润之,只用丸也,
与妇人血崩过极不止而用四物汤润剂同意。十剂之法,要当谨察。
如果面色发黄或洁净,或者黄而洁净同时出现,脉象浮沉不一致,且缓而迟的,是伤在太阴经,即脾经。
人参(一两,若腹痛则加倍使用) 甘草(炙烤) 白术 干姜(各一两)
将上述药材研成细末,用炼蜜调和制成如鸡蛋黄大小的丸剂。用几合汤水,将丸药溶化,研碎,温服,白天服三次,夜间服两次。如果腹中感觉不热,增加到三四丸,煎热粥送服,微微覆盖身体保暖,不要揭开衣服。丸药的效果不及汤药迅速。
海藏说:大便干燥结硬的适宜用丸药,大便稀软的适宜用汤药。仲景说:无阳证而阴寒内盛,大便硬结的,不可攻下,攻下则会导致完谷不化和腹部胀满。
以上三条经脉的脉象都提到浮沉不一,是因为这些病证看起来都像阳气孤绝亡失的状态。
又说:日三夜二(白天三次夜间两次服药),读起来极其乏味,但仔细思考其中的利害关系并不轻浅。恐怕人们不理解,所以有“阴阳寒热各从类生”这一条。
假使附子与大黄混合服用,白天服用则是阳药,其成功多于阴药;夜间服用则是阴药,其成功多于阳药,这是因为药物会顺应其同类属性。何况人的疾病,难道不是这样吗?如果是阳证,白天病情加重,夜间稍安宁;如果是阴证,白天稍安宁,夜间病情加重。这是人的阴阳寒热,随着天地运行阴行阳的变化而变化,寒热的转化,也由此随之改变。所以前人治疗阴证使用阳药,延续到半夜之后,是为了驱散与类相化的阴邪,而接续身体在子时(一阳初生之时)所生的阳气。《通玄类证》说:小建中汤后也列举了日三夜二的服法,以及尺脉不至的加黄芩。
我曾经说:大便稀软的适宜用汤药,大便干燥结硬的适宜用丸药,因为丸药含有蜂蜜具有润燥作用。仲景治疗霍乱吐泻,脾湿大胜,为什么使用丸药呢?
回答说:从湿的角度来说,哪有再用润燥的道理?这正是湿气已经太过,津液极度耗亡,所以导致转筋。筋得到血液滋养,才能屈伸自如。利下过多导致亡阴,失血反而造成枯燥,干燥则不能屈伸。所以用湿剂来润燥,只用丸药,这与妇人血崩过度不止而使用四物汤作为润剂的用意相同。十剂的方法,应当谨慎考察。
If the complexion is yellow or clean, or both yellow and clean are present simultaneously, and the pulse is inconsistent in floating and sunken levels, slow and delayed, the injury is in the Taiyin (Greater Yin) channel, which is the Spleen channel.
Renshen (Ginseng Radix et Rhizoma, one tael; double the dose if abdominal pain is present) Gancao (Prepared Licorice Root) Baizhu (Atractylodis Macrocephalae Rhizoma) Ganjiang (Dried Ginger, each one tael).
Grind the above herbs into a fine powder, mix with refined honey to form pills the size of a chicken egg yolk. Dissolve the pill in several he (a traditional unit of liquid measure) of decoction, grind until broken down, and take warm. Administer three times during the day and twice at night. If warmth is not felt in the abdomen, increase to three or four pills. Take with hot congee broth. Cover slightly for warmth, do not remove clothing. Pill preparations act slower than decoctions.
Haicang stated: For constipation, pills are suitable; for loose stools, decoctions are suitable. Zhang Zhongjing stated: In cases of "no Yang and strong Yin" where the stool is hard, purgatives should not be used; using them will result in undigested food in the stool and abdominal fullness.
The pulses mentioned in the above three channels as inconsistent in floating and sunken levels indicate that these conditions resemble a state of solitary Yang depletion.
It is also said: Taking medicine three times by day and twice by night seems extremely tedious when read, but upon careful consideration, the implications are significant. To prevent misunderstanding, there is a section on "Yin and Yang, Cold and Heat generating according to their kind."
Suppose Fuzi (Prepared Aconite Lateralis Radix) and Dahuang (Rhubarb Radix et Rhizoma) are taken together. Taken during the day, they act as Yang medicines, achieving success more through Yang action than Yin; taken at night, they act as Yin medicines, achieving success more through Yin action than Yang, because drugs follow their own kind. How much more so for human diseases! If it is a Yang syndrome, symptoms worsen during the day and ease at night; if it is a Yin syndrome, symptoms ease during the day and worsen at night. This is because human Yin and Yang, cold and heat, follow the movement of Heaven and Earth's Yin and Yang. The transformation of cold and heat follows this pattern. Therefore, ancients treating Yin syndromes with Yang medicines continued administration after midnight to dispel Yin that transforms according to its kind and to reconnect with the Yang generated in the body at Zi hour (11 PM - 1 AM). *Tongxuan Leizheng* states: After Xiaojianzhong Tang (Minor Construct the Middle Decoction), the regimen of three times by day and twice by night is also listed, and Huangqin (Scutellariae Radix) is added if the Chi pulse is absent.
I once stated: Loose stools suit decoctions; constipation suits pills, because pills contain honey which moistens. Why did Zhang Zhongjing use pills for Huoluan (Cholera-like disorder) with vomiting and diarrhea, where Spleen dampness is excessive?
The answer is: Regarding dampness, how could there be a rationale for further moistening? This indicates that dampness has become excessive, and body fluids are extremely depleted, leading to muscle cramps. Tendons require blood nourishment to flex and extend. Excessive purging leads to Yin loss; hemorrhage leads to dryness. Dryness prevents flexion and extension. Thus, using a moistening agent via pills is appropriate, consistent with using Siwu Tang (Four Substances Decoction) as a moistening agent for women with severe uterine bleeding that does not stop. The method of the Ten Categories of Medicines requires careful examination.