水蛭(二十个熬) 虻虫(二十五个去翅足熬) 桃仁(二十个去皮尖) 大黄(三两)
上四味。杵分为四丸。以水一升。煮一丸。取七合。服 时。当自下血。若不下。更服
。
同一抵当而变汤为丸。另有精义。经云。伤寒有热。少腹满。应小便不利。今反利者。
为有
血也。当下之。宜抵当丸。盖病从伤寒而得。寒主凝泣。血结必不易散。故煮而连滓服之。
俾有形质相着得以逗遛血所。并而逐之。以视汤之专取荡涤者。不同也。
芫花(熬) 甘遂 大戟 大枣(十枚擘)
上上三味等分。各别捣为散。以水一升半。先煮大枣肥者十枚。取八合。去滓。纳药末
。强
人服一钱匕。羸人服半钱。温服之。平旦服。若下少病不除者。明日更服加半钱。得快下利
后。糜粥自养。
太阳中风。下利呕逆。表解者乃可攻之。其人 汗出。发作有时。头痛。心下痞。硬
满引
胁下痛。干呕短气。汗出不恶寒者。此表解里未和也。十枣汤主之。按下利呕逆。明是水邪
为患。但病属太阳中风而来。必须表罢可攻。 汗出。有似表证。但发作有恶寒非表矣。
头痛
有似表证。但汗出不恶寒。则非表矣。而心下痞。硬满引胁下痛。干呕短气诸证。全是水邪
内壅之状。乃知汗出亦属水气外蒸头痛亦属水邪上逆。主里而不主表。里未和则宜攻下。但
邪在胸胁。与攻胃实不同法。胃实者邪劫津液。责其无水。此则邪搏胸胁。责其多水。若施
荡涤肠胃之药。诛伐无过。反滋变逆。故用芫花甘遂大戟三味。皆逐水之峻药。别捣为散。
而以大枣作汤。取其甘味载药入至高
之分。分逐水邪。从上而下。此法。今人多畏而不敢用。岂知不如此。水邪何由攻下耶。
水蛭(二十个,炒制) 虻虫(二十五个,去翅足后炒制) 桃仁(二十个,去皮尖) 大黄(三两)
以上四味药。捣碎并分成四丸。用水一升,煮其中一丸,取汁七合。服药时,应当自行排出瘀血。如果未排出,再服用。
同样是抵当汤,但改为丸剂,另有深意。《内经》说:伤寒发热,少腹部胀满,应该小便不利,现在反而小便通利,这是有瘀血的表现。应当攻下,适宜用抵当丸。因为病由伤寒而来,寒性主凝滞,血结必然不易消散,所以煮药连药渣一起服用,使有形质的药物能够停留于血结之处,共同驱逐瘀血,这与专门追求荡涤作用的汤剂不同。
芫花(炒制) 甘遂 大戟 大枣(十枚,掰开)
以上三味药等分,分别捣碎成散剂。用水一升半,先煮肥大的大枣十枚,取汁八合,去渣,纳入药末。体质强壮的人服一钱匕,体弱的人服半钱。温服。清晨空腹服用。如果泻下少且病邪未除,第二天再服,增加半钱。得到畅快腹泻后,喝稀粥自我调养。
太阳中风证,出现下利、呕吐逆气,表证解除后才可攻里。其人汗出,发作有时,头痛,心下部痞塞,硬满牵引胁下疼痛,干呕,短气,汗出且不恶寒的,这是表证已解而里气未和,宜用十枣汤主治。按:下利呕吐逆气,明确是水邪为患。但病属太阳中风而来,必须表证罢除才可攻里。汗出,看似表证,但发作有时且无恶寒,则不是表证。头痛,看似表证,但汗出不恶寒,则不是表证。而心下部痞塞,硬满牵引胁下疼痛,干呕短气诸证,完全是水邪内壅的状态。由此可知,汗出也属于水气外蒸,头痛也属于水邪上逆。治疗主里而不主表,里气未和则宜攻下。但邪气在胸胁,与攻下胃家实的方法不同。胃家实证是邪气劫夺津液,责其无水;此证则是邪气搏结胸胁,责其多水。如果使用荡涤肠胃的药物,会诛伐无辜,反而滋生变证逆症。因此使用芫花、甘遂、大戟三味药,都是逐水的峻猛之药,分别捣碎成散剂,而用大枣煎汤送服,取其甘味载药进入至高之分,分散驱逐水邪,从上而下。这种方法,如今许多人畏惧而不敢使用,哪里知道不如此,水邪如何能攻下呢?
Leech (Shuizhi, Hirudo) (20 pieces, processed by stir-frying)
Housefly larva (Mengchong, Ophrya) (25 pieces, wings and feet removed, processed by stir-frying)
Peach kernel (Taoren, Persicae Semen) (20 pieces, skin and tips removed)
Rhubarb root (Dahuang, Rheum palmatum) (3 liang)
The above four ingredients. Pound into powder, divide into four pills. Boil one pill in one sheng of water. Obtain seven ge of decoction. When taking the medicine, blood stasis should be discharged naturally. If not discharged, take again.
Although it is the same as Didang Tang, changing it to a pill has profound significance. The Classics state: In cold damage with fever, if the lower abdomen is full, urination should be difficult; now that it is actually free, this indicates blood stasis. It should be purged, and Didang Wan is suitable. Since the disease originates from cold damage, cold tends to cause coagulation and stagnation, so blood clumps are difficult to dissipate. Therefore, boiling the medicine and taking it with the dregs allows the tangible substance to linger at the site of blood stasis, jointly driving it out. This differs from tangs that focus solely on scouring and cleansing.
Genkwa flower (Yuanhua, Daphne genkwa) (processed by stir-frying)
Kansui root (Gansui, Kansui radix)
Kerria root (Daji, Euphorbia lathyris)
Jujube fruit (Dazao, Ziziphus jujuba) (10 pieces, split open)
The above three ingredients in equal parts. Each is separately pounded into powder. Use one and a half sheng of water to first boil ten large jujubes. Obtain eight ge of liquid, remove dregs, and add the medicinal powders. Strong individuals take one qianbi; frail individuals take half a qianbi. Take warm. Take on an empty stomach in the morning. If defecation is scant and the disease remains, take again the next day, increasing the dose by half a qianbi. After obtaining free diarrhea, nourish oneself with millet porridge.
In Taiyang wind-stroke syndrome, accompanied by diarrhea and vomiting/rebellious qi, only after the exterior syndrome is resolved can interior attack be performed. If the patient sweats, attacks occur at specific times, has headache, epigastric oppression, hardness and fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is disharmonious. Shizao Tang is the primary treatment. Note: Diarrhea and vomiting clearly indicate water pathogen pathology. However, since the disease stems from Taiyang wind-stroke, the exterior must be resolved before attacking. Sweating resembles an exterior syndrome, but since it occurs at intervals and lacks aversion to cold, it is not an exterior syndrome. Headache resembles an exterior syndrome, but sweating without aversion to cold indicates it is not an exterior syndrome. The symptoms of epigastric oppression, hardness/fullness radiating to the hypochondrium, dry retching, and shortness of breath are all signs of internal water pathogen congestion. Thus, sweating belongs to water vapor steaming externally, and headache belongs to water pathogen counterflow upward. Treatment focuses on the interior rather than the exterior; when the interior is disharmonious, purging is appropriate. However, the pathogen is in the chest and hypochondrium, differing from methods for purging Stomach excess. Stomach excess involves pathogen seizing fluids, resulting in fluid deficiency; this condition involves pathogen binding in the chest/hypochondrium, resulting in excessive water. Using drugs that scour the intestines and stomach would punish the innocent and cause adverse transformations. Therefore, Yuanhua, Gansui, and Daji are used, all harsh water-draining herbs, separately pounded into powder, while Jujube decoction is used to carry the medicine to the highest regions due to its sweet flavor, dispersing and draining water pathogens from top to bottom. This method is feared and unused by many today; how could they know that without this, how can water pathogens be purged?