茯苓 桂枝(各二两去皮) 生姜(三两切) 甘草(一两)
上四味。以水四升。煮取二升。分温三服。
此即桂枝汤去芍药大枣而加茯苓。防水渍入胃而预杜其变也。水停心下因致悸。故主茯
苓为治水
之主药。甘草载桂枝入心以固阳。生姜佐茯苓温中心散寒。俾水之停于心下者。得桂姜之辛
温而解。而茯苓乃得建利水之功。
五苓散用白术。理脾气以输精。故渴者宜之。此方用桂姜。散水寒而逐饮。故不渴者宜
之。
再按此方及五苓散。并茯苓桂枝甘草大枣汤。茯苓桂枝白术甘草汤。俱相类。五苓散。
散太
阳之水停。苓桂术甘汤。泄太阴之水蓄。茯苓桂枝甘草大枣汤。防少阴之水逆。此方堵阳明
之水渍。数方增减。不过一二味。而主治各别。能解此。自不敢孟浪处方矣。
大黄(四两) 浓朴(二两炙去皮) 枳实(三枚熬)
上三味。以水四升。煮取一升二合。去滓。分温三服。初服汤当更衣。不尔者尽饮之。
若更衣者勿服之。
小承气以大黄为君。微加枳朴以开气结。不用芒硝迅走下焦。经所谓微和胃气。勿令大
泄
下也。故曰小。凡矢未定成硬。未可与大承气者。可先以小承气试之。腹中转矢气者。大便
已硬。乃可攻也。不转矢气者。但初头硬。后必溏也。同一承气而有大小之分者。大承气枳
朴重而益用芒硝以峻攻。小承气枳朴轻而不用芒硝以亟下。故里证急者宜大承气。里证不甚
急者宜小承气。是当细辨。
茯苓、桂枝(各二两,去皮)、生姜(三两,切片)、甘草(一两)。
以上四味药。用四升水,煎煮至剩余二升药液。分三次温服。
此方即是桂枝汤去掉芍药和大枣,加上茯苓。目的是防止水气浸渍入胃,预先杜绝病情变化。水饮停聚在心下导致心悸,所以以茯苓为主药来治疗水饮。甘草引导桂枝进入心脏以巩固阳气。生姜辅助茯苓温暖中焦并驱散寒邪。使得停聚在心下的水饮,借助桂枝和生姜的辛温之性得以化解,而茯苓从而能够发挥其利水的作用。
五苓散使用白术,调理脾气以输布精微,所以口渴者适宜使用。本方使用桂枝和生姜,发散水寒之气并驱逐饮邪,所以不口渴者适宜使用。
再按:此方以及五苓散、茯苓桂枝甘草大枣汤、茯苓桂枝白术甘草汤,都性质相似。五苓散,疏散太阳经的水饮停聚;茯苓桂枝白术甘草汤,泄除太阴经的水饮蓄积;茯苓桂枝甘草大枣汤,预防少阴经的水气上逆;本方堵塞阳明经的水气浸渍。这几首方剂增减不过一二味药,但主治各不相同。能理解这一点,自然就不敢草率开方了。
大黄(四两)、浓朴(二两,炙后去皮)、枳实(三枚,熬制)。
以上三味药。用四升水,煎煮至剩余一升二合药液。去除药渣。分三次温服。初次服用汤药应当排便。如果不排便,则喝完剩余的药。如果已经排便,则不要继续服用。
小承气汤以大黄为君药,轻微加入枳实和厚朴以开通气机郁结。不使用芒硝迅速走窜下焦。正如经典所说,微微调和胃气,不让其发生剧烈泻下。所以称为“小”。凡是粪便尚未完全变硬,不能与大承气汤的情况,可以先用小承气汤试探。服药后腹部有转矢气(放屁)现象的,说明大便已经变硬,才可以攻下。如果没有转矢气现象的,只是开头大便硬,后面必定稀溏。同样叫承气汤而有大小之分的原因在于:大承气汤中枳实、厚朴用量重,且加用芒硝以峻猛攻下;小承气汤中枳实、厚朴用量轻,且不用芒硝以急切泻下。所以里证急重的适宜用大承气汤,里证不那么急重的适宜用小承气汤。这是应当仔细辨别的。
Fuling (Poria), Guizhi (Cinnamon Twig) (each 2 liang, bark removed), Shengjiang (Fresh Ginger) (3 liang, sliced), Gancao (Licorice Root) (1 liang).
The above four herbs. Use 4 sheng of water, decoct to obtain 2 sheng of liquid. Divide into three warm doses.
This formula is essentially Guizhi Tang (Cinnamon Twig Decoction) with Shaoyao (Peony Root) and Dazao (Jujube Fruit) removed and Fuling (Poria) added. Its purpose is to prevent water dampness from infiltrating the Stomach, thereby preemptively averting complications. Palpitations caused by fluid retention in the epigastrium are treated primarily with Fuling (Poria), which is the chief herb for managing water fluids. Gancao (Licorice Root) guides Guizhi (Cinnamon Twig) into the Heart to secure Yang Qi. Shengjiang (Fresh Ginger) assists Fuling (Poria) in warming the Middle Jiao and dispersing Cold. Thus, the fluid stagnating in the epigastrium is resolved by the acrid-warm nature of Guizhi (Cinnamon Twig) and Shengjiang (Fresh Ginger), allowing Fuling (Poria) to establish its diuretic function.
Wuling San (Five-Ingredient Powder with Poria) uses Baizhu (Atractylodes Macrocephala Rhizome) to regulate Spleen Qi and transport essence; therefore, it is suitable for cases with thirst. This formula uses Guizhi (Cinnamon Twig) and Shengjiang (Fresh Ginger) to disperse cold-fluid and drive out retained fluid; therefore, it is suitable for cases without thirst.
Further analysis: This formula, along with Wuling San (Five-Ingredient Powder with Poria), Linggui Zhigan Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction), and Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction), are all similar in nature. Wuling San (Five-Ingredient Powder with Poria) dissipates water stagnation in the Taiyang (Greater Yang) channel; Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) drains water accumulation in the Taiyin (Greater Yin) channel; Linggui Zhigan Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) prevents water counterflow in the Shaoyin (Lesser Yin) channel; this formula blocks water infiltration in the Yangming (Bright Yang) channel. These formulas differ by only one or two herbs, yet their primary indications vary distinctly. Understanding this principle ensures one does not prescribe rashly.
Dahuang (Rhubarb Root and Rhizome) (4 liang), Houpo (Magnolia Bark) (2 liang, processed with bran and bark removed), Zhishi (Immature Bitter Orange) (3 pieces, roasted).
The above three herbs. Use 4 sheng of water, decoct to obtain 1 sheng and 2 he of liquid. Remove the dregs. Divide into three warm doses. Upon the first dose, defecation should occur. If it does not, consume the remainder. If defecation has already occurred, do not take further doses.
Xiao Chengqi Tang (Minor Order the Yang Decoction) takes Dahuang (Rhubarb Root and Rhizome) as the Sovereign herb, slightly adding Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) to open qi stagnation. It does not use Mangxiao (Mirabilite) to rapidly purge the Lower Jiao. As stated in the classics, it merely harmonizes Stomach Qi gently, avoiding severe purgation. Hence, it is termed "Minor." When feces have not yet hardened completely, making Da Chengqi Tang (Major Order the Yang Decoction) unsuitable, Xiao Chengqi Tang (Minor Order the Yang Decoction) can be used as a test. If abdominal borborygmi (gas passing) occurs after administration, the stool has hardened, and purgation is indicated. If no abdominal borborygmi occurs, the stool is likely hard at the beginning but loose later. The distinction between Major and Minor lies in the dosage and composition: Da Chengqi Tang (Major Order the Yang Decoction) uses heavier doses of Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) plus Mangxiao (Mirabilite) for vigorous purgation, whereas Xiao Chengqi Tang (Minor Order the Yang Decoction) uses lighter doses of Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark) without Mangxiao (Mirabilite) for prompt but milder purgation. Therefore, urgent interior excess syndromes suit Da Chengqi Tang (Major Order the Yang Decoction), while less urgent interior excess syndromes suit Xiao Chengqi Tang (Minor Order the Yang Decoction). This distinction requires careful differentiation.