中气、中痰,虽然中之异,而实皆中于气之虚也。气虚自然多痰,痰多必然耗气,虽分而实合耳。方用∶
人参(一两) 半夏(三钱) 南星(三钱) 茯苓(三钱) 附子(一钱) 甘草(一钱)
水煎服。
盖人参原是气分之神剂,而亦消痰之妙药;半夏、南星虽是逐痰之神品,而亦扶气之正药;附子、甘草,一仁
一勇,相济而成,〔用之于三味之中,扶正必致祛邪,荡痰必然益气,分合而无分合之形,奇绝而有神化之妙,又
不可不知也〕。
头痛、目痛、耳红、腮肿,一切上焦等症,除清凉发散正治外,人即束手无策,而不知更有三法∶
如大便结,脉沉实者,用酒蒸大黄三钱,微下之,此名斧底抽薪之法。
如大便泄,脉沉,足冷者,宜六味地黄汤加牛膝、车前、肉桂;足冷甚者,加熟附子。是冷极于下,迫其浮火
上升也。此名导龙入海之法。
大便如常,脉无力者,用车前子、牛膝行之下行,此名引火归源之法也。
凡治下焦病,用药不效者,须从上治之∶
如足痛、足肿,无力软弱,膝疮红肿,用木瓜、薏仁、牛膝、防己、黄柏、苍术之品不效者,定是中气下
陷,湿热下流,用补中益气汤升提之。
如足软不能行而能食,名曰痿症,宜清肺热。
如治泄泻,用实脾利水之剂不效者,亦用补中益气汤去当归,加炮姜、苍术;脉迟,加肉蔻、故纸。
如尿血,用凉血利水药不效,用清心莲子饮。若清心不止,再加升麻。
如治便血,用止涩之药不效,或兼泄泻,须察其脉,如右关微、或数大无力,是脾虚不摄血,宜六君子汤加
炮姜。若右关沉紧,是饮食伤脾,不能摄血,加沉香二分。右寸洪数,是实热在肺,宜清肺,用麦冬、花粉、元参、
枯芩、桔梗、五味子、枳壳等味。
中气(因情绪剧烈波动导致的气机逆乱)和中痰(因痰浊蒙蔽清窍导致的昏厥),虽然病名不同,但实质上都是因为正气虚弱所致。气虚自然容易产生痰湿,痰湿过多必然耗伤正气,这两者虽然分开论述,但实际上是相互关联的。方剂组成如下:
人参(一两) 半夏(三钱) 南星(三钱) 茯苓(三钱) 附子(一钱) 甘草(一钱)
用水煎服。
人参原本是补气分的神效药物,同时也是消除痰湿的妙药;半夏、南星虽然是驱逐痰湿的神品,同时也是扶助正气的良药;附子、甘草,一个温和仁厚,一个刚猛有力,相辅相成。(在这三味药中加入它们,扶助正气必然能祛除邪气,荡涤痰湿必然能益气,看似分用实则不分,奇妙绝伦且神化莫测,这一点又不可不知道。)
头痛、眼痛、耳朵发红、腮部肿胀,以及一切上焦部位的病症,除了使用清凉发散的药物进行常规治疗外,人们往往束手无策,却不知道还有三种治疗方法:
如果大便干结,脉象沉而有力,使用酒蒸大黄三钱,轻微通便,这叫做“釜底抽薪”法。
如果大便稀溏,脉象沉,脚冷,适宜使用六味地黄汤加牛膝、车前子、肉桂;如果脚冷严重,加熟附子。这是因为寒气极盛于下部,逼迫浮火上升。这叫做“导龙入海”法。
大便正常,脉象无力的,用车前子、牛膝引导药力下行,这叫做“引火归源”法。
凡是治疗下焦疾病,用药无效时,必须从上部进行治疗:
如果足痛、足肿,无力软弱,膝盖疮疡红肿,使用木瓜、薏苡仁、牛膝、防己、黄柏、苍术等药物无效时,必定是中气下陷,湿热下注,应使用补中益气汤升提中气。
如果足软不能行走但食欲正常,称为痿症(肢体萎弱无力之证),应当清肺热。
如果治疗泄泻,使用健脾利水的药物无效时,也使用补中益气汤去掉当归,加炮姜、苍术;脉象迟缓,加肉豆蔻、补骨脂。
如果尿血,使用凉血利水的药物无效,使用清心莲子饮。如果清心火不止,再加升麻。
如果治疗便血,使用收敛止涩的药物无效,或者兼有泄泻,必须观察其脉象,如果右关脉微弱,或数大无力,这是脾虚不能统摄血液,适宜使用六君子汤加炮姜。如果右关脉沉紧,这是饮食损伤脾胃,不能统摄血液,加沉香二分。右寸脉洪数,这是实热在肺,应当清肺热,使用麦冬、天花粉、玄参、枯芩、桔梗、五味子、枳壳等药物。
Zhongqi (Qi strike, a condition caused by sudden emotional disturbance leading to rebellious Qi flow) and Zhongtan (Phlegm strike, syncope caused by phlegm turbidity obscuring the clear orifices), although differing in name, are essentially both due to Qi deficiency. Qi deficiency naturally leads to excessive phlegm, and excessive phlegm inevitably consumes Qi; although discussed separately, they are actually united. The prescription is as follows:
Renshen (Ginseng Radix et Rhizoma, 1 liang) Banxia (Pinelliae Tuber, 3 qian) Nanxing (Arisaematis Cum Bile, 3 qian) Fuling (Poria, 3 qian) Fuzi (Aconiti Lateralis Radix Praeparata, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian)
Decoct with water and take orally.
Renshen is originally a divine agent for tonifying Qi, and also a wonderful medicine for eliminating phlegm; Banxia and Nanxing, although they are divine products for expelling phlegm, are also correct medicines for supporting Qi; Fuzi and Gancao, one benevolent and mild, the other brave and potent, complement each other to form efficacy. [When used among these three ingredients, supporting the righteous Qi inevitably expels the pathogenic factor, sweeping away phlegm necessarily benefits Qi; they appear separate yet inseparable, extraordinarily ingenious and divinely effective, which must not be overlooked.]
Headache, eye pain, red ears, swollen cheeks, and all symptoms of the Upper Jiao (Upper Burner), besides standard treatment with cooling and dispersing methods, often leave practitioners helpless, unaware of three additional methods:
If stool is constipated and the pulse is deep and solid, use Jiuzheng Dahuang (Wine-processed Rheum Palmatum Root and Rhizome, 3 qian) to mildly induce bowel movement; this is called the "Removing Firewood from Under the Cauldron" method.
If stool is loose, the pulse is deep, and feet are cold, Liujunzi Tang (Six Gentlemen Decoction) should be modified with Niuxi (Achyranthis Bidentatae Radix), Cheqianzi (Plantaginis Semen), and Rougui (Cinnamomi Cortex); if foot coldness is severe, add Shu Fuzi (Prepared Aconiti Lateralis Radix). This occurs when extreme cold at the lower part forces floating fire to rise upward; this is called the "Guiding the Dragon into the Sea" method.
If stool is normal and the pulse is weak, use Cheqianzi and Niuxi to guide the action downward; this is called the "Guiding Fire Back to its Source" method.
Whenever treating diseases of the Lower Jiao (Lower Burner) where medication is ineffective, one must treat from the upper part:
If there is foot pain, swelling, weakness, and redness/swelling of knee ulcers, and treatments with Mugua (Chaenomelis Fructus), Yiren (Coicis Semen), Niuxi, Fangji (Stephaniae Tetrandrae Radix), Huangbai (Phellodendri Cortex), and Cangzhu (Atractylodis Rhizoma) are ineffective, it is definitely due to Sinking of Middle Qi (Middle Jiao Qi Deficiency) and downward flow of damp-heat; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to raise and lift.
If feet are weak and unable to walk but appetite is normal, it is named Wei Syndrome (Flaccidity Syndrome); one should clear Lung Heat.
If treating Diarrhea (Loose Stool) and spleen-fortifying and diuretic agents are ineffective, use Buzhong Yiqi Tang removing Danggui (Angelicae Sinensis Radix), adding Paojiang (Prepared Zingiberis Rhizoma) and Cangzhu; if the pulse is slow, add Roudoukou (Myristicae Semen) and Guzhi (Psoraleae Fructus).
If there is Hematuria (Blood in Urine) and cooling-blood and diuretic drugs are ineffective, use Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction). If clearing Heart heat does not stop it, add Shengma (Cimicifugae Rhizoma).
If treating Rectal Bleeding (Hematochezia) and astringent hemostatic drugs are ineffective, or if accompanied by diarrhea, one must examine the pulse. If the Right Guan (Radial Artery Position corresponding to Spleen/Stomach) pulse is faint, or rapid and large but weak, it is Spleen Qi Deficiency failing to control blood; use Liujunzi Tang (Six Gentlemen Decoction) adding Paojiang. If the Right Guan pulse is deep and tight, it is dietary injury to the Spleen failing to control blood; add Chenxiang (Aquilariae Lignum Resinatum, 2 fen). If the Right Cun (Radial Artery Position corresponding to Lung/Heart) pulse is surging and rapid, it is Excess Heat in the Lung; one should clear Lung Heat using Maidong (Ophiopogonis Radix), Huafen (Trichosanthis Radix), Yuanshen (Scrophulariae Radix), Kuqin (Scutellariae Radix), Jiegeng (Platycodonis Radix), Wuweizi (Schisandrae Fructus), and Zhike (Aurantii Fructus Immaturus).