病发热头痛,身疼恶寒,上吐下利者,名曰霍乱。热多欲饮水者,五苓散主之∶寒多不用水者,理中丸主之。
理中丸
人参 甘草 白术 干姜
捣筛为末,蜜和丸,如鸡黄大。以沸汤数合,和一丸,研碎,温服之。日三四,夜二服。腹中未热,加至
三四丸。然不及汤,汤以水八升,煮取三升,去滓温服一升,日三服。
若脐上筑者,肾气动也,去术加桂。吐多者,去术加生姜三两。下多者还用术。悸者加茯苓。腹中痛,虚
者加人参。腹满者去术,加附子一枚。
少阴病二三日至四五日,腹痛,小便不利,下利不止,便脓血者,桃花汤主之。
本证与真武不同。彼以四肢沉重疼痛,是为有水气;此便脓血,是为有火气矣。盍不清火,反用温补?
盖治下焦水气,与心下水气不同法;下焦便脓血,与心下痛、心中烦,亦应异治也。心为离火,而真水居其中,
法当随其势之润下,故用苦寒以泄之;坎为水而真火居其中,法当从其性之炎上,故用苦温以发之。火郁于下,
则克庚金;火炎于上,则生戊土。五行之理,将来者进,已往者退。土得其令,则火退位矣∶水归其职,腹痛
自除、脓血自清、小便自利矣。故制此方,不清火,不利水,一惟培土,又全赖干姜转旋,而石脂、 米得收
平成之绩也。名桃花者,取春和之义,非徒以色言耳。
桃花汤∶
赤石脂(一斤,一半全用一半筛用) 干姜(一两) 粳米(一升)
石脂性涩以固脱,色赤以和血,味甘而酸。甘以补元气,酸以收逆气,辛以散邪气,故以为君。半为块而
半为散,使浊中清者,归心而入营,浊中浊者,入肠而止利。火曰炎上,又火空则发,得石脂以涩肠,可以遂其
炎上之性矣。炎上作苦,佐干姜之苦温,以从火化,火郁则发之也。火亢则不生土,臣以粳米之甘,使火有所生,
遂成有用之火。土中火用得宣,则水中火体得位,下陷者上达,妄行者归原,火自升而水自降矣。
少阴病,腹痛下利,是坎中阳虚。故真武有附子,桃花用干姜,不可以小便不利作热治。真武是引火归原法,
桃花是升阳散火法。
坎阳有余,能出形躯之表而发热,麻黄附子汤是矣。坎阳不虚,尚能发热于躯内之上焦,如口燥、舌干、咽
痛、心烦、胸满、心痛等证是矣。坎阳不足,不能发热于腰以上之阳,仅发热于腰以下之阴,如小便不利、下利
便脓血者是矣。此为伏阳屈伏之火,与升阳之火不同。
少阴病,便脓血者可刺。
便脓血,亦是热入血室所致,刺期门以泻之。病在少阴而刺厥阴,实则泻其子也。
患病后出现发热、头痛、身体疼痛、恶寒,并伴有上吐下泻的症状,这种病称为霍乱(以突发剧烈吐泻为主要特征的急性胃肠病)。如果热象明显且想喝水的,用五苓散主治;如果寒象明显且不渴不饮的,用理中丸主治。
理中丸
人参 甘草 白术 干姜
将上述药材捣碎过筛成粉末,用蜂蜜调和制成丸药,大小如鸡蛋黄。取几合沸水,放入一丸药,研碎后温服。每天白天服三四次,晚上服两次。如果腹部没有感到温热,可增加至三四丸。然而,这不如汤剂效果好。汤剂的用法是:用水八升,煮取三升,去渣后温服一升,每天服三次。
如果感觉脐上有跳动感,这是肾气动的表现,应去掉白术,加上桂枝。呕吐多的,去掉白术,加上三两生姜。腹泻严重的,仍需用白术。心中悸动的,加上茯苓。腹部疼痛,属虚证的,加上人参。腹部胀满的,去掉白术,加上一枚附子。
少阴病经过两三天到四五天,出现腹痛、小便不利、腹泻不止、大便带有脓血的症状,用桃花汤主治。
本证与真武汤证不同。真武汤证表现为四肢沉重疼痛,这是因为有水气停留;此证大便带脓血,是因为有火气(热邪)存在。为何不清除火邪,反而使用温补之法?
因为治疗下焦的水气,与心下(胃脘部)的水气治疗方法不同;下焦的大便脓血,与心下痛、心中烦闷,治疗方法也应有所区别。心属离卦为火,而真水居于其中,治法应当顺应其润下的趋势,所以用苦寒的药物来泄降;坎卦属水,而真火居于其中,治法应当顺应其炎上的特性,所以用苦温的药物来发散。火郁结在下焦,就会克制庚金(肺/大肠);火炎盛于上焦,就会生助戊土(脾/胃)。五行的道理是,将来者进,已往者退。土得到时令之令,火就会退位;水回归其职能,腹痛自然消除,脓血自然清解,小便自然通利。所以制定这个方子,不清火,不利水,只专注于培补脾胃(土),又全赖干姜的转旋作用,以及赤石脂和粳米收平成积的功效。命名为“桃花”,是取春天温和之意,不仅仅是因为颜色像桃花。
桃花汤:
赤石脂(一斤,一半整块使用,一半研细末使用) 干姜(一两) 粳米(一升)
赤石脂性涩能固脱止泻,色赤能和血,味甘兼酸。甘味能补元气,酸味能收敛逆气,辛味(指其质地或配伍后的效应)能散邪气,所以作为君药。一半做成块状,一半研成散状,使浊中之清者,归入心经而入营分;浊中之浊者,进入肠道而止住腹泻。火性炎上,且火遇空则发,得到赤石脂的涩肠作用,可以顺应其炎上的特性。炎上表现为苦味,佐以干姜的苦温之性,以顺从火的化气,火郁结则发散它。火亢盛则不生土,臣药用粳米的甘味,使火有所生化,从而成为有用的火。土中的火用得宣通,则水中的火体得以正位,下陷的阳气上达,妄行的阴血归原,火自升而水自降了。
少阴病,腹痛腹泻,是坎中(肾中)阳气虚弱。所以真武汤用附子,桃花汤用干姜,不可以因为小便不利就当作热证治疗。真武汤是引火归原的方法,桃花汤是升阳散火的方法。
坎阳有余,能够出于形体体表而发热,如麻黄附子汤证即是。坎阳不虚,尚能在躯体内上焦发热,如口燥、舌干、咽痛、心烦、胸满、心痛等症状即是。坎阳不足,不能在腰以上的阳分发热,仅在腰以下的阴分发热,如小便不利、腹泻便脓血等症状即是。这属于伏阳屈伏之火,与一般的升阳之火不同。
少阴病,大便带脓血的,可以针刺治疗。
大便带脓血,也是热邪侵入血室所致,针刺期门穴以泻除邪气。病在少阴却刺厥阴经,这是实则泻其子的治法。
The patient presents with fever, headache, body ache, aversion to cold, accompanied by vomiting and diarrhea. This condition is named Huoluan (Colic Disorder, characterized by sudden severe vomiting and diarrhea). If the heat syndrome is predominant and there is a desire to drink water, Wuling San (Five-Ingredient Poria Pill) is the primary treatment. If the cold syndrome is predominant and there is no desire for water, Lizhong Wan (Regulate the Middle Pill) is the primary treatment.
Lizhong Wan (Regulate the Middle Pill):
Renshen (Ginseng Radix), Gancao (Licorice Root), Baizhu (Atractylodis Macrocephalae Rhizoma), Ganjiang (Dried Ginger).
Crush and sieve into powder, mix with honey to form pills, each the size of a chicken egg yolk. Take several he of boiling water, dissolve one pill by grinding it in the water, and take warm. Administer three or four times during the day and twice at night. If warmth is not felt in the abdomen, increase the dosage to three or four pills. However, this method is inferior to the decoction. For the decoction: use eight sheng of water, boil down to three sheng, remove the dregs, and take one sheng warm, three times a day.
If there is a throbbing sensation above the umbilicus, it indicates movement of Kidney Qi; remove Baizhu and add Guizhi (Cinnamon Twig). If vomiting is excessive, remove Baizhu and add Shengjiang (Fresh Ginger), three liang. If diarrhea is severe, continue using Baizhu. If palpitations occur, add Fuling (Poria). If abdominal pain occurs due to deficiency, add Renshen. If abdominal fullness occurs, remove Baizhu and add Fuzi (Aconite Lateralis Radix Preparata), one piece.
In Shaoyin Disease (Lesser Yin Disease), after two to three days up to four to five days, if abdominal pain, difficulty in urination, persistent diarrhea, and passage of pus and blood in stool occur, Taohua Tang (Peach Blossom Decoction) is indicated.
This syndrome differs from Zhenwu Tang Syndrome. The latter presents with heaviness and pain in the four limbs, indicating the presence of Water Qi (fluid retention); this syndrome involves pus and blood in stool, indicating the presence of Fire Qi (heat pathogen). Why clear the fire instead of using warming tonification?
Because treating Water Qi in the Lower Jiao (Lower Burner) differs from treating Water Qi in the Heart/Stomach region; treating pus and blood in stool in the Lower Jiao also requires different methods compared to pain in the epigastrium or vexation in the heart. The Heart belongs to Li (Fire), with True Water residing within it; the treatment should follow its tendency to moisten and descend, thus using bitter-cold herbs to drain it. Kan (Water) belongs to Water, with True Fire residing within it; the treatment should follow its nature to flare upward, thus using bitter-warm herbs to disperse it. When Fire is depressed in the lower part, it overacts on Geng Metal (Lung/Large Intestine); when Fire flares upward, it generates Wu Earth (Spleen/Stomach). The principle of the Five Elements is that what is coming advances, and what is going recedes. When Earth receives its command, Fire retreats to its position; when Water returns to its function, abdominal pain is removed, pus and blood are cleared, and urination becomes smooth. Therefore, this formula does not clear fire or promote diuresis, but solely focuses on cultivating Earth (Spleen/Stomach). It relies entirely on Ganjiang's rotating action, along with Chishizhi (Halloysitum Rubrum) and Jingmi (Oryza Sativa Germen) to achieve consolidation and harmony. It is named "Taohua" (Peach Blossom) to symbolize the harmonious nature of Spring, not merely because of its color.
Taohua Tang (Peach Blossom Decoction):
Chishizhi (Halloysitum Rubrum), one jin (half used whole, half sifted into powder); Ganjiang (Dried Ginger), one liang; Jingmi (Oryza Sativa Germen), one sheng.
Chishizhi is astringent to secure collapse and stop leakage, red in color to harmonize blood, sweet and sour in taste. Sweetness tonifies Original Qi, sourness restrains rebellious Qi, and pungency disperses pathogenic Qi; thus, it serves as the Sovereign herb. Half is used in chunks and half in powder, so that the clear aspect within the turbid enters the Heart and nourishes the Ying (Nutritive) level, while the turbid aspect enters the intestines to stop diarrhea. Fire has the nature of flaming upward, and fire expands when empty. With Chishizhi's intestinal astringency, it can facilitate this upward-flaring nature. Flaming upward corresponds to the bitter flavor; assisted by the bitter-warm nature of Ganjiang, it follows the transformation of Fire, dispersing depressed Fire. If Fire is hyperactive, it fails to generate Earth; the Minister herb, Jingmi with its sweetness, allows Fire to have a source of generation, thereby forming useful Fire. When Fire within Earth is unobstructed, the Fire entity within Water assumes its proper position; sunken Yang ascends, erratic Yin Blood returns to its origin, Fire rises naturally, and Water descends naturally.
Shaoyin Disease with abdominal pain and diarrhea indicates deficiency of Yang in Kan (Kidney). Thus, Zhenwu Tang uses Fuzi, while Taohua Tang uses Ganjiang; one should not treat difficulty in urination as a heat syndrome. Zhenwu Tang employs the method of guiding Fire back to its source, whereas Taohua Tang employs the method of raising Yang and scattering Fire.
If Kan Yang is excessive, it can manifest as fever on the exterior of the body, as seen in Mahuang Fuzi Tang Syndrome. If Kan Yang is not deficient, it can still cause fever in the Upper Jiao within the body, such as dry mouth, dry tongue, sore throat, vexation, chest fullness, and heart pain. If Kan Yang is insufficient, it cannot generate heat in the Yang portion above the waist, but only manifests heat in the Yin portion below the waist, such as difficulty in urination and diarrhea with pus and blood. This is latent Yang, a suppressed fire, which differs from general rising-Yang fire.
In Shaoyin Disease, cases with pus and blood in stool may be treated with acupuncture.
Passage of pus and blood in stool is also caused by Heat entering the Blood Chamber; puncture Qimen (LR14) to drain the pathogen. Although the disease is in Shaoyin, puncturing Jueyin (Liver Meridian) applies the principle of "draining the son" in excess conditions.