钱仲阳云∶肝主风,实则目直大叫,项急烦闷,虚则切牙呵欠,气热则外生风,气温则内生
风,大青膏散之。若能食饮水不止,用大黄丸微下之,肝热则目直不搐,手寻衣领及乱捻物
,泻青丸主之。壮热饮水喘闷,泻白散主之。肝病秋见,肺怯不能胜肝也,当用益黄散补脾
,泻青丸治肝。肝有风则目连眨,得心热则搐,用泻青丸治肝,导赤散治心。甚则身反张,
目直不搐,心不受热也,当用地黄丸补肾,泻青丸治肝,唇白者不治。又张洁古云∶肝主风
,自病则风搐拘急,若心乘肝为实邪,肺乘肝为贼邪,肾乘肝为虚邪。凡肝得病必先察其肺
肾,肾者肝之母,肺者肝之贼,今肝之得病,若非肾水不能相生,必是肺金鬼邪来克,故其
来在肺,先治其肺,攻其鬼也。其来在肾,先补其肾,滋其源也。然后审其本脏之虚实而寒
温之。窃谓前症,若肝经实热而外生风者,宜用大青膏散之。若既服而前症仍作或益甚者,
此邪气已去而脾气亏损也,宜用异功散加芎、归补之。若肝经虚热,或因克伐而内生风者,
宜用异功散、地黄丸补之。若风邪入脏,能食饮冷,大便秘结者,此邪气内实也,宜用大黄
丸下之。若既下而食少饮汤,或腹作胀者,此脾气内虚也,宜用白术散补之。气血素弱,或
因病后,或服攻伐之剂,而手寻衣领,切牙呵欠,目淡青者乃肝经虚甚也,急用地黄丸以补
肾肝。哽气、短气、长出气,乃肺经虚甚也,急用异功散以补脾肺。若申、酉时叫哭直视,
呵欠顿闷,项急惊悸,手足摇动,发热饮水者,此风火相搏而胜肺金也,用柴胡栀子散以治
肝火生肝血;用异功散补脾土生肺金,若唇白者为脾绝,不治。夫婴童之症,多因妊娠浓味
七情,或儿乳哺失宜,或乳母饮食郁怒所致。病气既见,形气已虚,当推其所因用药,加漏
芦以治其母,儿饮一二匙。后仿此。
大青膏 治伤风痰热发搐。
天麻 青黛(各一钱) 白附子 乌蛇(酒浸取肉焙) 蝎尾(各五分) 天竺黄(煨) 麝香(各一字)
上为末,生蜜丸豆大。每用半粒,薄荷汤化下。
大黄丸 治风热里实,口中气热,二便秘赤,饮水不止。
黑牵牛(一半生,一半炒) 川芎(各半两) 甘草(一钱) 大黄(一两,酒洗饭上蒸)
上为末,糊丸麻子大。每服数丸,温蜜水乳后服,以溏利为度,大小用。
愚按前症,既属里实二便秘,法当疏下,若初服虽未通利,而病势已退,不可再服。如二便
未利,病势未退,当减数丸研化服之,恐过剂则元气伤而变病也。
泻青丸 治急惊发搐,眼赤睛疼。
当归 龙胆草(炒) 川芎 防风 大黄(炒) 羌活 栀仁(各等分)
上为末,炼蜜丸芡实大。每服一丸,砂糖汤化下。
愚按∶前方足厥阴经解散肌表,疏通内热之药也。若大便秘结,烦渴饮冷,饮食如常者,属
形病俱实,宜用此以泻之。若大便调和,烦渴饮冷,目淡青色,属病气实而形气虚,宜用抑
肝散平之。若大便不实,作渴饮汤,饮食少思,肢体倦怠者,属形病俱虚,宜用地黄丸补之
。大抵前症,若因肝经血虚风热,先用四物汤加钩藤钩以生肝血;次用四君子汤以补脾土。
若因肝经血燥痰盛,用地黄丸滋肾水生肝木,四君加芍药实脾土以平肝木。若因攻伐而致脾
土虚寒者,急用六君子汤加丁香、木香温补脾土,否则必变慢脾风也。
抑肝散 治肝经虚热发搐,或痰热切牙,或惊悸寒热,或木乘土而呕吐痰涎,腹胀少食,睡
卧不安。
软柴胡 甘草(各五分) 川芎(八分) 当归 白术(炒) 茯苓 钩藤钩(各一钱)
上水煎,子母同服。如蜜丸,名抑青丸。
小柴胡汤(加山栀、牡丹皮,名加味小柴胡) 治肝胆经风热瘰 ,寒热往来,口晡发热,潮热
身热,不欲饮食,或怒火口苦,耳聋咳嗽,或胁痛胸满,小便不利,或泄泻吐酸苦水,或肢
体搐动,唇目抽札,并宜用之。(方见变蒸)
异功散(方见天钓)
地黄丸(方见脏腑)
白术散(方见积滞)
柴胡栀子散(方见诸热)
导赤散(方见心脏)
四物汤(方见急惊)
四君子汤
六君子汤(二方见内钓)
加味清胃散(方见天钓)
补中益气汤(方见虚羸)
钱乙说:肝主风,实证表现为两眼直视、大声呼叫、颈项强直、烦躁闷乱;虚证表现为咬牙、打哈欠。气热则外生风,气温则内生风,用大青膏疏散治疗。如果能进食且饮水不止,用大黄丸轻微通下治疗。肝热导致两眼直视但不抽搐,手抓衣领及乱捻物品,用泻青丸主治。壮热、饮水、气喘闷乱,用泻白散主治。肝病在秋季出现,是肺气怯弱不能克制肝木,应当用益黄散补脾,用泻青丸治肝。肝有风邪则眼睛连连眨动,得心热则抽搐,用泻青丸治肝,导赤散治心。病情严重则身体反张,两眼直视不抽搐,这是心不受热的表现,应当用地黄丸补肾,用泻青丸治肝,嘴唇发白的属于不治之症。
另外张元素说:肝主风,自病则出现风搐拘急。如果心乘克肝为实邪,肺乘克肝为贼邪,肾乘克肝为虚邪。凡是肝病必须先察视肺肾的情况。肾是肝之母,肺是肝之贼(此处指金克木的病理关系,或指肺金过亢克伐肝木),现在肝得病,如果不是肾水不能相生,必定是肺金鬼邪来克伐,所以病源在肺,先治其肺,攻其鬼邪;病源在肾,先补其肾,滋其本源。然后审察本脏的虚实而进行寒温调理。
我认为上述病症,如果是肝经实热而外生风的,宜用大青膏疏散。如果服用后前症仍发作或更严重的,这是邪气已去而脾气亏损,宜用异功散加川芎、当归补益。如果是肝经虚热,或因攻伐药物损伤而内生风的,宜用异功散、地黄丸补益。如果风邪入脏,能进食但喜冷饮,大便秘结,这是邪气内实,宜用大黄丸攻下。如果攻下后食少饮汤,或腹部胀满,这是脾气内虚,宜用白术散补益。气血素来虚弱,或因病后,或服用攻伐药剂,而出现手抓衣领、咬牙、打哈欠、目色淡青的,乃是肝经极度虚弱,急用地黄丸以补肝肾。哽气、短气、长出气,乃是肺经极度虚弱,急用异功散以补脾肺。如果在申时、酉时叫哭、直视、打哈欠突然闷乱、颈项强直、惊悸、手足摇动、发热饮水的,这是风火相搏而胜肺金,用柴胡栀子散以治肝火、生肝血;用异功散补脾土以生肺金,如果嘴唇发白的是脾绝,不治。
婴儿儿童的病症,多因妊娠期间浓味饮食、七情刺激,或婴儿哺乳失宜,或乳母饮食郁怒所致。病气既见,形气已虚,应当推究病因用药,加漏芦以治疗母亲,让婴儿饮用一两个茶匙。之后仿照此法。
大青膏:治疗伤风痰热引起的抽搐。
天麻、青黛(各一钱);白附子、乌蛇(酒浸取肉焙干)、蝎尾(各五分);天竺黄(煨制)、麝香(各一字)。
以上研为末,用生蜜制成如豆大的丸剂。每次用半粒,薄荷汤化开服用。
大黄丸:治疗风热里实,口中气热,大小便赤涩,饮水不止。
黑牵牛(一半生用,一半炒用)、川芎(各半两);甘草(一钱);大黄(一两,酒洗后放在饭上蒸熟)。
以上研为末,糊丸如麻子大。每次服数丸,温蜜水或乳汁送服,以大便溏利为度,根据年龄大小调整用量。
我按语:前述病症,既然属于里实导致的大小便不通,治法应当疏下。如果初服虽然未通利,但病势已退,不可再服。如果二便未通利,病势未退,应当减少丸药数量研化服用,恐怕过量则损伤元气而变生他病。
泻青丸:治疗急惊风引起的抽搐,眼睛红赤、睛疼。
当归、龙胆草(炒)、川芎、防风、大黄(炒)、羌活、栀仁(各等分)。
以上研为末,炼蜜制成如芡实大的丸剂。每次服一丸,砂糖汤化开服用。
我按语:前方是足厥阴肝经解散肌表、疏通内热的药物。如果大便秘结,烦渴饮冷,饮食如常,属于形病俱实,宜用此方泻之。如果大便调和,烦渴饮冷,目色淡青,属于病气实而形气虚,宜用抑肝散平之。如果大便不实,作渴饮汤,饮食少思,肢体倦怠,属于形病俱虚,宜用地黄丸补之。大抵上述病症,如果因肝经血虚风热,先用四物汤加钩藤钩以生肝血;次用四君子汤以补脾土。如果因肝经血燥痰盛,用地黄丸滋肾水生肝木,四君加芍药实脾土以平肝木。如果因攻伐药物导致脾土虚寒者,急用六君子汤加丁香、木香温补脾土,否则必变为慢脾风。
抑肝散:治疗肝经虚热引起的抽搐,或痰热咬牙,或惊悸寒热,或木乘土而呕吐痰涎,腹胀少食,睡卧不安。
软柴胡、甘草(各五分);川芎(八分);当归、白术(炒)、茯苓、钩藤钩(各一钱)。
以上用水煎煮,母子同服。如果做成蜜丸,名叫抑青丸。
小柴胡汤(加山栀、牡丹皮,名叫加味小柴胡):治疗肝胆经风热瘰疬,寒热往来,口晡发热,潮热身热,不欲饮食,或怒火口苦,耳聋咳嗽,或胁痛胸满,小便不利,或泄泻吐酸苦水,或肢体搐动,唇目抽札,都适宜使用。(方剂见“变蒸”章节)
异功散(方剂见“天钓”章节)
地黄丸(方剂见“脏腑”章节)
白术散(方剂见“积滞”章节)
柴胡栀子散(方剂见“诸热”章节)
导赤散(方剂见“心脏”章节)
四物汤(方剂见“急惊”章节)
四君子汤
六君子汤(二方见“内钓”章节)
加味清胃散(方剂见“天钓”章节)
补中益气汤(方剂见“虚羸”章节)
Qian Yi stated: The Liver governs Wind. In excess patterns, symptoms include eyes staring straight, loud crying, neck stiffness, and irritability; in deficiency patterns, symptoms include teeth grinding and yawning. When Qi is hot, external Wind is generated; when Qi is warm, internal Wind is generated. Daqing Gao (Great Blue Paste) should be used to dissipate it. If the patient can eat and has unquenchable thirst, Dahuang Wan (Rhubarb Pill) should be used for mild purgation. If Liver Heat causes eyes to stare straight without convulsions, and the hands seek the collar or pick at objects aimlessly, Xieqing Wan (Drain the Green Pill) is indicated. For high fever, thirst, wheezing, and chest oppression, Xiebai San (Drain the White Powder) is indicated. If Liver disease appears in autumn, it indicates that Lung Qi is weak and cannot control Liver Wood. Yihuang San (Benefit Yellow Powder) should be used to tonify the Spleen, and Xieqing Wan to treat the Liver. If the Liver has Wind, the eyes blink repeatedly; if Heart Heat is present, convulsions occur. Xieqing Wan treats the Liver, and Daochi San (Guide Out Red Powder) treats the Heart. In severe cases, opisthotonos occurs, with eyes staring straight but no convulsions; this indicates the Heart does not accept Heat. Dihuang Wan (Rehmannia Pill) should be used to tonify the Kidney, and Xieqing Wan to treat the Liver. If the lips are white, the condition is untreatable.
Zhang Jiegu further stated: The Liver governs Wind. Self-disease manifests as wind-convulsions and spasms. If the Heart overacts on the Liver, it is an Excess pathogen; if the Lung overacts on the Liver, it is a Robber pathogen; if the Kidney overacts on the Liver, it is a Deficiency pathogen. In any Liver disease, one must first examine the Lung and Kidney. The Kidney is the Mother of the Liver; the Lung is the Robber of the Liver (Metal controls Wood). When the Liver is diseased, if it is not due to the failure of Kidney Water to generate Liver Wood, it must be due to Lung Metal acting as a Ghost pathogen to overcome it. Therefore, if the source is in the Lung, treat the Lung first to attack the Ghost pathogen. If the source is in the Kidney, tonify the Kidney first to nourish the source. Then, assess the excess or deficiency of the primary organ and apply appropriate warming or cooling methods.
I suggest that for the aforementioned symptoms, if caused by Excess Heat in the Liver channel generating external Wind, Daqing Gao should be used to dissipate it. If symptoms persist or worsen after administration, this indicates that the pathogen has been expelled but Spleen Qi is damaged; Yigong San (Extraordinary Efficacy Powder) added with Chuanxiong and Danggui should be used to tonify. If caused by Deficiency Heat in the Liver channel or internal Wind due to harsh purgatives, Yigong San and Dihuang Wan should be used to tonify. If Wind pathogens enter the Zang organs, the patient eats well but craves cold drinks, and suffers from constipation, this indicates internal Excess of pathogens; Dahuang Wan should be used to purge. If after purging, food intake decreases, only warm fluids are desired, or abdominal distension occurs, this indicates internal Spleen Qi deficiency; Baizhu San (Atractylodes Macrocephala Powder) should be used to tonify. If Qi and Blood are inherently weak, or following illness, or after taking harsh purgatives, symptoms such as hands seeking the collar, teeth grinding, yawning, and pale blue eyes indicate extreme Liver channel deficiency; Dihuang Wan should be urgently used to tonify the Liver and Kidney. Stifled breathing, shortness of breath, and sighing indicate extreme Lung channel deficiency; Yigong San should be urgently used to tonify the Spleen and Lung. If crying, staring, sudden yawning and oppression, neck stiffness, palpitations, limb tremors, fever, and thirst occur during the Shen (3-5 PM) and You (5-7 PM) hours, this indicates Wind and Fire combusting and overcoming Lung Metal. Chaihu Zhizi San (Bupleurum and Gardenia Powder) should be used to treat Liver Fire and generate Liver Blood; Yigong San should be used to tonify Spleen Earth to generate Lung Metal. If the lips are white, it indicates Spleen exhaustion, which is untreatable.
Infants' diseases often arise from rich foods and emotional disturbances during pregnancy, improper breastfeeding, or maternal dietary stagnation and anger. Once pathological signs appear and form/Qi is already deficient, one must deduce the cause and prescribe medication, adding Lulu to treat the mother, allowing the infant to drink one or two spoonfuls. Subsequent treatments follow this pattern.
Daqing Gao (Great Blue Paste): Treats convulsions caused by Wind-Cold with Phlegm-Heat.
Tianma (Gastrodiae Rhizoma), Qingdai (Indigo Naturalis) (each 1 qian); Baifuzi (Typhonii Rhizoma), Wushe (Agkistrodon), Xiewei (Scorpio tail) (each 0.5 qian); Tianzhuhuang (Calamiform Spathe Spike), Shexiang (Moschus) (each 1 zi).
Grind into powder, mix with raw honey to make pills the size of beans. Use half a pill per dose, dissolved in Bohe Tang (Mint Decoction).
Dahuang Wan (Rhubarb Pill): Treats internal Excess of Wind-Heat, hot breath, red urine and stool, and unquenchable thirst.
Heiqianniu (Pharbitidis Semen), Chuanxiong (Ligustici Chuanxiong Rhizoma) (each 0.5 liang); Gancao (Glycyrrhizae Radix et Rhizoma) (1 qian); Dahuang (Rhei Radix et Rhizoma) (1 liang, washed with wine and steamed on rice).
Grind into powder, bind with paste to make pills the size of sesame seeds. Take several pills per dose, administered with warm honey water or milk after meals. Stop when loose stools occur. Dosage varies by age.
My commentary: Regarding the aforementioned symptoms, since they belong to internal Excess with blocked urination and defecation, the method should involve purgation. If initial doses do not produce bowel movements but the disease trend subsides, do not administer further doses. If urination and defecation remain blocked and the disease trend persists, reduce the number of pills and crush them for administration, to avoid excessive dosage damaging Yuan Qi and causing complications.
Xieqing Wan (Drain the Green Pill): Treats convulsions in acute infantile epilepsy, red eyes, and eye pain.
Danggui (Angelicae Sinensis Radix), Longdancao (Gentianae Radix, stir-fried), Chuanxiong, Fangfeng (Saposhnikoviae Radix), Dahuang (Rhei Radix et Rhizoma, stir-fried), Qianghuo (Notopterygii Rhizoma et Radix), Zhiren (Gardeniae Fructus) (equal parts).
Grind into powder, bind with refined honey to make pills the size of Chinese bayberry seeds. Take one pill per dose, dissolved in sugar water.
My commentary: The preceding formula acts on the Foot Jueyin Liver channel to dissipate the exterior and clear internal heat. If accompanied by constipation, irritability, thirst for cold drinks, and normal appetite, it indicates both Form and Pathogen are Excess; use this formula to drain. If bowel movements are normal, with irritability, thirst for cold drinks, and pale blue eyes, it indicates Pathogen Excess but Form Deficiency; use Yigan San (Calm the Liver Powder) to level. If stools are loose, with thirst for warm drinks, poor appetite, and limb fatigue, it indicates both Form and Pathogen are Deficient; use Dihuang Wan to tonify. Generally, if due to Liver channel Blood deficiency and Wind-Heat, first use Siwu Tang (Four Substances Decoction) plus Goutenggou (Uncariae Ramulus cum Uncis) to generate Liver Blood; then use Sijunzi Tang (Four Gentlemen Decoction) to tonify Spleen Earth. If due to Liver channel Blood dryness and abundant Phlegm, use Dihuang Wan to nourish Kidney Water to generate Liver Wood, and Sijunzi Tang added with Shaoyao to solidify Spleen Earth to level Liver Wood. If Spleen Earth deficiency and Cold result from harsh purgatives, urgently use Liujunzi Tang (Six Gentlemen Decoction) added with Dingxiang (Caryophylli Flos) and Muxiang (Aucklandiae Radix) to warm and tonify Spleen Earth; otherwise, Manpi Feng (Slow Spleen Wind) will develop.
Yigan San (Calm the Liver Powder): Treats convulsions due to Liver channel Deficiency Heat, or teeth grinding due to Phlegm-Heat, or palpitations with alternating chills and fever, or Liver Wood overacting on Spleen Earth causing vomiting of phlegm-saliva, abdominal distension, poor appetite, and restless sleep.
Ruan Chaihu (Bupleuri Radix), Gancao (Glycyrrhizae Radix et Rhizoma) (each 0.5 qian); Chuanxiong (0.8 qian); Danggui, Baizhu (Atractodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria), Goutenggou (each 1 qian).
Decoct in water, taken by both mother and infant. If made into honey pills, it is named Yiqing Wan (Calm Green Pill).
Xiao Chaihu Tang (Minor Bupleurum Decoction) (added Zhizi and Mudanpi, named Jiawei Xiao Chaihu): Treats scrofula due to Wind-Heat in the Liver and Gallbladder channels, alternating chills and fever, afternoon fever, tidal fever, loss of appetite, bitter taste in mouth due to anger, deafness, cough, hypochondriac pain, chest fullness, difficult urination, diarrhea with vomiting of sour/bitter fluid, limb tremors, and twitching of lips and eyes. (Formula see "Bian Zheng" chapter)
Yigong San (Formula see "Tian Diao" chapter)
Dihuang Wan (Formula see "Zang Fu" chapter)
Baizhu San (Formula see "Ji Zhi" chapter)
Chaihu Zhizi San (Formula see "Zhu Re" chapter)
Daochi San (Formula see "Xin Zang" chapter)
Siwu Tang (Formula see "Ji Jing" chapter)
Sijunzi Tang (Four Gentlemen Decoction)
Liujunzi Tang (Six Gentlemen Decoction) (Both formulas see "Nei Diao" chapter)
Jiawei Qingwei San (Added Flavor Clear Stomach Powder) (Formula see "Tian Diao" chapter)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (Formula see "Xu Lei" chapter)