凡病皆标也,而必有其本,本者所以致病之根源也。盖惟人之病也,有一标必有一致标之本。是以医之治
也,有一本必有一拔本之方。不获乎致标之本,处方必不能对其症也。不投以对症之方,治病必不能拔其本也。
临症者,欲决群医莫决之疑,则内因外因,致病须审其原;欲中各症必中之的,则正治从治,验方务求其谛。
用辑主症诸方,以列验舌之次。
凡舌见青色而坚敛苍老者,肝胆两经邪气盛也,泻火清肝饮主之。
柴胡(酒炒) 黄芩(酒炒) 山栀(酒炒各一钱) 生地(酒浸三钱) 当归(酒
洗二钱) 生甘草(一钱)
按∶上方主治肝胆两经实邪,以致胁痛耳聋,胆溢口苦,筋痿阴汗,阴肿阴痛,白浊溲血等症。
凡舌见青色而浮胖娇嫩者,肝胆两经精气虚也,滋水生肝饮主之。
熟地(四钱) 山药(二钱) 萸肉(二钱) 丹皮(钱半) 茯苓(钱半) 泽
泻(钱半) 五味(一钱) 归身(钱半) 柴胡(一钱) 甘草(一钱) 白术(二钱半)
上方主治小便淋漓不利,妇女月经不调,两胁胀闷,少腹作痛,寒热往来,胸乳作痛,左关弦洪,右
关弦数,此郁怒伤肝,脾血虚气滞为患也。用六味双对减半分两,加柴胡、白术、甘草、当归、五味,合
逍遥而去白芍、加五味者,合都气意也,以生肝。故去白芍而留白术、甘草,以补脾。补脾者,生金以制木也。
以制为生,天地自然之理也。
凡舌见青色而干燥,属胆腑阴虚火郁者,用逍遥散加生地、薄荷主之。
凡是疾病都表现为表象(标),但必然有其根本,所谓“本”,就是导致疾病的根源。大抵人的疾病,有一个表象就必然有一个导致该表象的根本原因。因此医生治疗疾病,有一个根本原因就必然有一个拔除该根本原因的方剂。如果不找到导致表象的根本原因,开出的处方就一定不能针对病症。如果不投用对症的方剂,治疗疾病就一定不能拔除病根。
临证时,想要解决众医无法决断的疑难,就必须审察内因和外因,探究致病的源头;想要使针对各种症状的治疗必中要害,无论是正治法还是从治法,所采用的验方务必探求其真谛。
因此辑录主要症状对应的各方,排列在验舌诊法的后面。
凡是舌象呈现青色且质地坚硬收敛、苍老粗糙的,是肝胆两经邪气亢盛的表现,主用泻火清肝饮治疗。
柴胡(酒炒) 黄芩(酒炒) 山栀(酒炒各一钱) 生地(酒浸三钱) 当归(酒洗二钱) 生甘草(一钱)
按语:上述方剂主治肝胆两经实邪,导致胁痛、耳聋、胆气上溢口苦、筋脉痿软、阴部汗出、阴肿阴痛、白浊、尿血等症状。
凡是舌象呈现青色且浮胖娇嫩的,是肝胆两经精气虚弱的表现,主用滋水生肝饮治疗。
熟地(四钱) 山药(二钱) 萸肉(二钱) 丹皮(钱半) 茯苓(钱半) 泽泻(钱半) 五味子(一钱) 归身(钱半) 柴胡(一钱) 甘草(一钱) 白术(二钱半)
上方主治小便淋漓不畅,妇女月经不调,两胁胀闷,少腹疼痛,寒热往来,胸部和乳房疼痛,左关脉弦洪,右关脉弦数。这是由郁怒损伤肝脏,脾血虚弱、气机阻滞引起的病变。使用六味地黄丸剂量减半,加入柴胡、白术、甘草、当归、五味子,结合逍遥散去掉白芍、加入五味子的用法,意在融合都气丸之意以滋养肝脏。所以去掉白芍而保留白术、甘草,用以补益脾气。补益脾土,是为了通过“培土生金”来制约肝木。以“制”为“生”,这是天地自然的道理。
All diseases manifest as symptoms (biao, superficial manifestations), but they must have a root (ben, fundamental cause). The "root" is the source that causes the disease. Generally, for any human disease, there is one symptom and necessarily one root that leads to that symptom. Therefore, in medical treatment, for every root, there is a prescription designed to eliminate that root. If one does not identify the root causing the symptom, the prescribed formula will certainly not address the condition. If one does not administer a formula appropriate to the condition, treating the disease will certainly fail to eliminate its root.
When attending to clinical cases, if one wishes to resolve doubts that other physicians cannot decide, one must examine internal and external causes and investigate the origin of the disease. If one wishes to hit the mark precisely in treating various symptoms, whether using direct treatment (zheng zhi) or contrary treatment (cong zhi), one must strive to ascertain the truth of the empirical formulas.
Therefore, I have compiled formulas for main symptoms and listed them following the section on tongue diagnosis.
Whenever the tongue appears cyanotic with a firm, contracted, and aged/coarse texture, it indicates an excess of pathogenic factors in the Liver and Gallbladder meridians. Xie Huo Qing Gan Yin (Fire-Draining Liver-Clearing Decoction) is the primary prescription.
Chai Hu (Bupleuri Radix, stir-fried with wine), Huang Qin (Scutellariae Radix, stir-fried with wine), Shan Zhi (Gardeniae Fructus, stir-fried with wine, each 1 qian), Sheng Di (Rehmanniae Radix, soaked in wine, 3 qian), Dang Gui (Angelicae Sinensis Radix, washed with wine, 2 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian).
Note: The above formula primarily treats excess pathogens in the Liver and Gallbladder meridians, resulting in hypochondriac pain, deafness, bitter taste in the mouth due to bile overflow, flaccidity of sinews, sweating in the genital area, swelling and pain in the genitals, white turbid discharge, and hematuria.
Whenever the tongue appears cyanotic with a puffy, tender, and delicate texture, it indicates a deficiency of essence and qi in the Liver and Gallbladder meridians. Zi Shui Sheng Gan Yin (Nourishing Water to Generate Liver Decoction) is the primary prescription.
Shu Di (Rehmanniae Radix Preparata, 4 qian), Shan Yao (Dioscoreae Rhizoma, 2 qian), Yu Rou (Corni Fructus, 2 qian), Dan Pi (Moutan Cortex, 1.5 qian), Fu Ling (Poria, 1.5 qian), Ze Xie (Alismatis Rhizoma, 1.5 qian), Wu Wei Zi (Schisandrae Fructus, 1 qian), Gui Shen (Angelicae Sinensis Radix, 1.5 qian), Chai Hu (Bupleuri Radix, 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 qian), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 2.5 qian).
The above formula primarily treats dribbling and difficult urination, irregular menstruation in women, distension and stuffiness in both hypochondria, pain in the lower abdomen, alternating chills and fever, pain in the chest and breasts, a wiry and surging pulse at the left guan position, and a wiry and rapid pulse at the right guan position. This pathology arises from depression and anger injuring the Liver, leading to deficiency of Spleen blood and stagnation of qi. It uses Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) with halved dosages, adding Chai Hu, Bai Zhu, Gan Cao, Dang Gui, and Wu Wei Zi. Combining Xiao Yao San (Free and Easy Wanderer Powder) by removing Bai Shao and adding Wu Wei Zi implies integrating the intent of Du Qi Wan (All-Qi Pill) to nourish the Liver. Thus, Bai Shao is removed while Bai Zhu and Gan Cao are retained to tonify the Spleen. Tonifying the Spleen serves to generate Metal to control Wood. Using "control" as "generation" is the natural principle of heaven and earth.
Whenever the tongue appears cyanotic and dry, it belongs to yin deficiency and fire stagnation in the Gallbladder organ. Xiao Yao San (Free and Easy Wanderer Powder) added with Sheng Di and Bo He (Menthae Haplocalycis Herba) is the primary prescription.