桔梗(三分) 贝母(三分) 巴豆(一分去皮煮研如脂)
上二味为末内巴豆更于臼中杵之以白饮和服强人半钱匕弱者减之病在膈上必吐在膈下必利不利进热粥一杯利过不止
进冷粥一杯身热皮粟不解欲引衣自覆者若以水 之洗之益令热不得去当汗而不汗则烦假令汗已出腹中痛与芍药三两如上
法(汗出腹痛者血亡而木燥也芍药清风木而润血燥)
风寒外感有上焦之热有下焦之热有气分之热有血分之热上焦气分之热白虎可清上焦血分之热承气可下而膀胱热结病
在下焦血分则于承气而加破血之药于是有桃核承气抵当汤丸之设伤寒之病在于卫气气郁则生寒中风之病在乎营血血郁则
生热热结血分是中风之证非伤寒之证也至于阳盛之人伤寒而有此则抵当用丸而不用汤以其下热不如中风之甚也
太阳病不解热结膀胱其人如狂血自下下者愈其外不解者尚未可攻当先解外外解已但小腹急结者乃可攻之宜桃核承气
汤
太阳病表证不解经热内蒸而结于膀胱膀胱者太阳之腑水腑不清膀胱素有湿热一因表郁腑热内发故表热随经而深结也
热结则其人如狂缘膀胱热结必入血室血者心所主胎君火而孕阳神血热则心神扰乱是以狂作也若使瘀血自下则热随血泄不
治而愈不下则宜攻之如其外证不解者尚未可攻攻之恐表阳内陷当先解外证外证已除但余小腹急结者乃可攻之宜桃核承气
汤桂枝桃仁通经而破血大黄芒硝下瘀而泄湿甘草保其中气也
文蛤(五两)
将以上一味药捣碎成散剂,用五合沸水调和一方寸匕的药粉服用。
桔梗(三分) 贝母(三分) 巴豆(一分,去皮后煮至研烂如脂状)
将前两味药研成细末,加入巴豆,再次在臼中捣匀,用米汤送服。体质强壮者服用半方寸匕,体弱者减量。病位在上焦膈膜以上的,服药后必然呕吐;病位在下焦膈膜以下的,服药后必然腹泻。如果服药后没有腹泻,可喝一杯热粥以助药力;如果腹泻不止,可喝一杯冷粥以止泻。若身体发热、皮肤起粟粒样鸡皮疙瘩仍未缓解,想要穿衣覆盖身体的,如果用冷水浇洗身体,只会让热气无法散去。应当发汗而未能发汗的,会出现烦躁症状。假如已经出汗但腹部疼痛,可用芍药三两,按照上述方法处理。(出汗后腹痛,是因为血液耗损导致肝木干燥;芍药能清泄风邪、舒缓肝木并滋润血燥。)
风寒外感,有的表现为上焦有热,有的表现为下焦有热,有的表现为气分有热,有的表现为血分有热。上焦和气分的实热,可用白虎汤清除;上焦和血分的实热,可用承气汤攻下。膀胱的热结病症,位于下焦血分,则在承气汤基础上加入破血药物,因此设立了桃核承气汤和抵当汤丸等方剂。伤寒这类疾病,病变在于卫气和营气。气机郁滞则产生寒象;中风这类疾病,病变在于营血。血行郁滞则产生热象。热结于血分,属于中风的证候,而非伤寒的证候。至于阳气旺盛的人,患伤寒而出现此类情况,则使用抵当丸而不使用抵当汤,因为其下部的热邪不如中风引起的热邪严重。
太阳病日久不愈,热邪结聚于膀胱,患者出现神志失常、似狂非狂的症状。如果瘀血能自行排出,病情就会痊愈。如果表证仍未解除,尚不可攻下,应当先解表。待表证解除后,仅见小腹部急迫结痛者,才可以攻下,适宜使用桃核承气汤。
太阳病表证未解,经热内蒸并结聚于膀胱。膀胱是太阳之腑,属水腑。若膀胱素有湿热,一旦因表邪郁闭导致腑热内发,表热便会随经脉深入结聚。热邪结聚,所以患者出现神志失常、似狂非狂的症状。因为膀胱热结必然波及血室。血由心所主,胎孕君火并孕育阳神,血热则会扰乱心神,因此出现狂躁症状。如果瘀血能自行排出,则热邪随血液泄出,不治自愈。如果不能自行排出,则宜攻下。如果外证未解,尚不可攻下,若强行攻下,恐怕会导致表阳内陷。应当先解除外证,待外证消除后,仅剩小腹急结者,才可以攻下,适宜使用桃核承气汤。方中桂枝、桃仁通经络而破瘀血,大黄、芒硝攻下瘀滞而泄湿热,甘草保护中气。
Wenli San (Clam Shell Powder)
Wenli [Lithotrix Aragonitica] (five liang)
Take the above single herb, pound it into a powder. Mix one fangcun bi (a measure of volume roughly equivalent to a square inch scoop) with five he (a unit of liquid volume) of boiling water and take orally.
Jiegeng [Platycodonis Radix] (three fen) Beimu [Fritillariae Bulbus] (three fen) Badou [Crotonis Fructus] (one fen, peeled, boiled, and ground into a paste-like consistency)
Take the first two herbs, grind them into fine powder. Add the Badou and pound again in a mortar. Take orally mixed with rice water. Strong individuals take half a fangcun bi; weak individuals reduce the dosage. If the pathology is located above the diaphragm, vomiting will inevitably occur after administration. If the pathology is located below the diaphragm, diarrhea will inevitably occur. If there is no diarrhea after administration, drink one cup of hot porridge to promote bowel movement. If diarrhea persists excessively, drink one cup of cold porridge to stop it. If body heat and cutaneous miliary eruptions persist without relief, and the patient desires to cover themselves with clothing, washing the body with cold water will only prevent the heat from dissipating. If sweating should occur but does not, restlessness will arise. If sweating has occurred but abdominal pain follows, use Shaoyao [Paeoniae Radix Alba] three liang, following the aforementioned method. (Abdominal pain after sweating indicates blood depletion leading to dryness of the Liver Wood; Shaoyao clears wind-heat, soothes the Liver Wood, and moistens blood dryness.)
Wind-cold external contraction may present with heat in the Upper Jiao, heat in the Lower Jiao, heat in the Qi level, or heat in the Blood level. Heat in the Upper Jiao and Qi level can be cleared by Baihu Tang (White Tiger Decoction). Heat in the Upper Jiao and Blood level can be purged downward by Chengqi Tang (Descending Qi Decoction). Bladder heat accumulation, located in the Blood level of the Lower Jiao, requires adding blood-breaking herbs to Chengqi Tang. Thus, formulas such as Taohe Chengqi Tang (Peach Kernel Descending Qi Decoction) and Didang Wan/Pills (Definitely Severe Pills) were established. In diseases of Shanghan (Cold Damage), the pathology lies in the Wei Qi (Defensive Qi) and Ying Qi (Nutritive Qi). Qi stagnation generates cold sensations; in Zhongfeng (Wind Stroke), the pathology lies in the Ying Blood. Blood stagnation generates heat. Heat accumulation in the Blood level characterizes a Zhongfeng syndrome, not a Shanghan syndrome. However, in individuals with abundant Yang energy who contract Shanghan and exhibit this pattern, Didang Wan (Pills) are used instead of Didang Tang (Decoction) because the lower heat is less severe than that caused by Zhongfeng.
In Taiyang disease (Taiyang Syndrome) that fails to resolve, heat accumulates in the Bladder. The patient exhibits a manic-like state (ru kuang). If stasis blood discharges spontaneously, the condition resolves. If the exterior syndrome remains unresolved, attack is contraindicated; one must first resolve the exterior. Once the exterior is resolved, if only urgency and binding sensation in the lower abdomen remain, attack is permissible. Taohe Chengqi Tang (Peach Kernel Descending Qi Decoction) is indicated.
In Taiyang disease, if the exterior syndrome is unresolved, internal steaming of meridian heat accumulates in the Bladder. The Bladder is the Fu organ of the Taiyang channel and belongs to the Water Fu organs. If the Bladder harbors pre-existing damp-heat, and due to exterior constraint, interior Fu heat erupts, the exterior heat penetrates deeply along the meridian and accumulates. Heat accumulation causes the manic-like state because Bladder heat accumulation necessarily affects the Blood Chamber. Blood is governed by the Heart; the fetal Emperor Fire nurtures the Yang Spirit. Blood heat disturbs the Heart Spirit, resulting in mania. If stasis blood discharges spontaneously, heat is expelled with the blood, and the condition heals without treatment. If it does not discharge, purgation is appropriate. If exterior symptoms are unresolved, attack is contraindicated; attacking prematurely risks the collapse of exterior Yang into the interior. One must first resolve the exterior symptoms. Once exterior symptoms are eliminated and only lower abdominal urgency and binding remain, attack is permissible. Taohe Chengqi Tang (Peach Kernel Descending Qi Decoction) is indicated. In this formula, Guizhi [Cinnamomi Ramulus] and Taoren [Persicae Semen] unblock meridians and break stasis; Dahuang [Rhei Radix et Rhizoma] and Mangxiao [Natrii Sulfas] purge stasis and drain damp-heat; Gancao [Glycyrrhizae Radix] protects the Middle Qi.