治伤寒汗下后不解,或投药错误,致困重垂死昏沉,或阴阳二症不明,七日以后皆可服。
人参一两,为片,水二钟,于银石器内,熬至一钟,温服。病患喜冷,以新水沉
冷服之,渣再煎服,连进数服,服至鼻尖上润汗出,是其应也。
治久病呃逆,因于寒者。
丁香柿蒂(各二钱) 人参(去芦,一钱) 生姜(五片) 水煎服。
呕为火气上冲,呃为寒气阻塞,亦有中气不续而呃者,洁古老人以丁姜之辛温正
治,以柿蒂之涩寒从治,人参为佐,俾真气得以展布耳,呃在中焦,谷气不运,其声短
小,得食乃发。呃在下焦,真气不足,其声长大,不食亦然,临症者,不可不辨也。
治阳明病汗下后,体虚气弱,津液枯竭,脏腑闭塞,大便不行,须宜密导之。蜜
二两铜器中微火煎之,凝如饴状,搅之勿令焦,入皂角末,盐少许,捻作挺子,如指
许,长二寸头锐,纳谷道中,以手握住,欲大便时去之。
以大猪胆一枚,和醋少许,套芦管上,灌谷道中,挤汁入之。如一食顷,当大便矣。
凡过用大黄,以致泻利不止者,用乌梅二枚,炒粳米一撮,干姜三钱,人参(炒)、
白术各五钱,生附子皮一钱五分,炙甘草一钱,升麻少许,灯心一握,水二大钟,煎之
去渣后,入炒陈壁土一匙,调服即愈。
以上麻黄、承气、陷胸诸方,皆前贤为当时人禀强壮,且感触重邪,冬月正伤寒而
设也。东垣曰∶世间内伤者多,外感者,间亦有之。独不思《经》曰∶邪之所凑,其正
必虚乎?养葵曰∶此间字,当作五百年间出之间,甚言其无也。况流传既久,天气人气
气化转薄,更难同年而语矣。凡早晚有寒热感触,及伤食伤酒诸病,皆有头疼发热口渴
等候,岂可即谓太阳阳明之证?投以古方峻削,非其病而服其药,即有其病,以今人之
弱质,用古方之猛剂,势必被其夭杵者多矣。故存古人传经之论者,以便知其伤寒局
方之原,立法之所始也。遵列古方先后汗下次第及按者,以便知其用药立方之体,而备
于仿也。继集诸贤之说者,以便明其古今变化之理而慎于用也。张有评伤寒一论,谨陈
于一卷之内,幸高明详之,勿以人之性命生死大关,轻徇旧方,桂麻硝黄之小试,阳亡
阴竭犹水覆难收,而断者不可续,此张不揣固陋,反复痛陈,阐明积弊,勿敢附和,有
误将来破先贤之定例,或冒微愆全后人之生命,谅有小补,幸尊生者鉴诸!
治疗伤寒经过发汗或攻下治疗后病邪仍未解除,或者用药错误,导致病情沉重、濒临死亡、神志昏沉,或者是阴阳症状不明确,发病七日以后都可以服用。
人参一两,切成薄片,加水两碗,在银器或石器中煎煮至一碗,温服。如果病人喜欢冷饮,可以用新汲凉水冷却后服用;药渣再次煎煮服用,连续服用几剂,直到鼻尖出现湿润的汗出,这是药效应验的表现。
治疗久病呃逆,属于寒证引起的。
丁香、柿蒂(各二钱),人参(去芦头,一钱),生姜(五片),水煎服。
呕吐是因为火气上冲,呃逆是因为寒气阻塞,也有因为中气不接续而引发呃逆的。金元时期医家洁古老人认为,用丁香和生姜的辛温之性作为正治法,用柿蒂的涩寒之性作为从治法,佐以人参,使真气得以舒展布散。呃逆发生在中焦,是谷气运行不畅,声音短小,进食后发作;呃逆发生在下焦,是真气不足,声音洪亮长大,不吃东西也会发作,临证诊治时,不可不加以辨别。
治疗阳明病经过发汗或攻下治疗后,身体虚弱、气力微弱、津液枯竭、脏腑闭塞、大便不通,适宜采用蜜导法通便。蜂蜜二两放入铜器中,用微火煎煮,凝固如饴糖状,搅拌时不要让它烧焦,加入皂角末和少许盐,捏成条状,粗细如手指,长二寸,一头尖锐,纳入肛门中,用手握住,想要大便时取出。
取一个大猪胆,加少许醋,套在芦管上,灌入肛门中,挤出胆汁进入体内。大约一顿饭的时间,应当就能大便了。
凡是过度使用大黄,导致腹泻不止的,用乌梅两枚,炒粳米一撮,干姜三钱,人参(炒)、白术各五钱,生附子皮一钱五分,炙甘草一钱,升麻少许,灯心草一握,加水两大碗,煎煮后去渣,加入炒过的陈壁土一匙,调匀服用即可痊愈。
以上提到的麻黄汤、承气汤、陷胸汤等方剂,都是前贤针对当时人体质强壮,且感受重邪,冬季正患伤寒的情况而设立的。李东垣说:世间内伤的病人多,外感病的病人间或有之。只是没想过《内经》说过:邪气聚集的地方,正气必定虚弱吗?养葵说:这个“间”字,应当理解为“五百年间偶尔出现”,是极力强调其罕见。况且流传既久,天气和人气、气化都变得薄弱,更难与古代相提并论了。凡是早晚有寒热感触,以及伤食、伤酒等各种疾病,都有头痛、发热、口渴等症状,怎么可以立即就说是太阳病或阳明病呢?投用古方峻猛的药物,如果不是这个病却吃了这种药,即使是这个病,以今人体质虚弱,使用古方猛烈的药剂,势必会导致夭折的人很多。所以保留古人传经的理论,是为了了解伤寒局方的起源和立法初衷;遵循排列古方先后发汗、攻下的次序及按语,是为了了解用药立方的体制,以备仿效;接着收集各位贤人的学说,是为了阐明古今变化的道理从而谨慎使用。张有评论伤寒的一番言论,谨呈于一卷之内,希望高明之士详细审察,不要因为性命生死的大关,轻率地顺从旧方,桂枝、麻黄、硝石、大黄的小试,一旦阳气亡失、阴液枯竭就像泼出去的水难以收回,断绝的生命无法续接。这是张氏不顾自己浅陋,反复痛切陈述,阐明积弊,不敢附和,以免误导将来。打破先贤的定例,或许冒着微小的过失,保全后人的生命,想必会有小小的补益,希望尊重生命者明鉴!
Treats cases where Shaoyang disease (diseases caused by pathogenic factors in the Shaoyang channel) remains unresolved after sweating or purging therapies, or due to incorrect medication administration, leading to severe debility, near-death coma, or unclear differentiation between Yin and Yang syndromes. It can be administered seven days or more after onset.
Ren Shen (Ginseng Radix et Rhizoma), 1 liang (approx. 37.5g), sliced. Add 2 zhong (approx. 400ml) of water. Decoct in a silver or ceramic vessel until reduced to 1 zhong. Take warm. If the patient prefers cold drinks, cool with fresh water and take cold. Re-decoct the dregs and take again. Administer continuously for several doses. The therapeutic effect is indicated when moist sweat appears on the tip of the nose.
Treats chronic hiccups caused by Cold.
Ding Xiang (Caryophylli Flos, Clove), Shi Di (Diospyri Fructus, Persimmon Calyx), each 2 qian (approx. 7.5g); Ren Shen (Ginseng Radix et Rhizoma), de-lusted, 1 qian (approx. 3.75g); Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger), 5 slices. Decoct in water and take.
Vomiting is caused by Fire Qi rushing upward; hiccups are caused by Cold Qi obstruction. There are also cases of hiccups due to discontinuation of Middle Qi. Master Jieguo (Li Dongyuan's teacher, Zhang Congzheng's contemporary, often referring to Liu Wansu or Li Gao depending on context, here likely referring to Liu Wansu or general Jin-Yuan theory attributed to 'Jieguo') posits that the acrid-warm nature of Ding Xiang and Sheng Jiang serves as the direct treatment (Zheng Zhi), while the astringent-cold nature of Shi Di serves as the indirect treatment (Cong Zhi). Ren Shen acts as an assistant herb, allowing True Qi to spread freely. Hiccups originating in the Middle Jiao (Middle Burner) result from impaired Grain Qi transport; the sound is short and small, triggered by eating. Hiccups originating in the Lower Jiao (Lower Burner) result from deficiency of True Qi; the sound is loud and long, occurring even without eating. Clinicians must distinguish between these.
Treats Yangming disease (Yangming Channel Disease) where, after sweating or purging, the body is weak, Qi is deficient, Body Fluids are exhausted, Zang-Fu organs are blocked, and defecation does not occur. A honey suppository method is suitable.
Honey, 2 liang. Simmer gently in a copper vessel until it congeals like malt sugar. Stir constantly to prevent burning. Add powder of Zao Jiao (Gleditsiae Sinensis Spina, Chinese Honeylocust Thorn) and a little salt. Shape into suppositories, finger-thick, 2 cun (approx. 6-7cm) long, with one sharp end. Insert into the anus. Hold in place with hand. Remove when the urge to defecate arises.
Take one large pig gallbladder. Mix with a little vinegar. Attach to a reed tube. Enema into the anus. Squeeze the juice into the body. After approximately one meal's time, defecation should occur.
For cases of continuous diarrhea due to overuse of Da Huang (Rhei Radix et Rhizoma, Rhubarb Root):
Wu Mei (Mume Fructus, Smoked Plum), 2 pieces; Chao Jing Mi (Stir-fried Oryza Sativa Semen, Fried Rice), one tuohui (pinch); Gan Jiang (Zingiberis Rhizoma, Dried Ginger), 3 qian; Ren Shen (Ginseng Radix et Rhizoma), stir-fried, 5 qian; Bai Zhu (Atractylodis Macrocephalae Rhizoma, Large-headed Atractylodes Rhizome), 5 qian; Sheng Fu Zi Pi (Radix Aconiti Lateralis Preparata Cortex, Bark of Prepared Lateral Root of Aconite), 1.5 qian; Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata, Prepared Licorice Root), 1 qian; Sheng Ma (Cimicifugae Rhizoma, Black Cohosh Rhizome), a small amount; Deng Xin Cao (Junci Medulla, Rush Pith), one handful. Add 2 da zhong (large bowls) of water. Decoct, strain, and add 1 spoonful of Chao Chen Bi Tu (Stir-fried Old Wall Soil). Mix and take. Cure follows.
The aforementioned formulas, including Ma Huang Tang (Ephedra Decoction), Cheng Qi Tang (Ordering the Qi Decoction), and Xian Xiong Tang (Depress the Chest Decoction), were established by former sages for people of strong constitution at that time, who contracted heavy pathogens and suffered from true Cold Damage (Shang Han) in winter. Li Dongyuan stated: "Among the sick today, those with internal injury are numerous; those with external contraction are rare." Did he not consider the Classic saying: "Where pathogenic factors gather, the Righteous Qi must be deficient"? Yangkai stated: This word "rare" (jian) should be interpreted as "occurring once in five hundred years," emphasizing its extreme rarity. Moreover, as time has passed, the Heavenly Qi, Human Qi, and Qi transformation have become thinner and weaker, making comparison with ancient times impossible. Any illness involving morning/evening chills and fever due to pathogenic contact, or food stagnation and alcohol injury, all present symptoms such as headache, fever, and thirst. How can one immediately diagnose them as Taiyang (Taiyang Channel Disease) or Yangming syndromes? Administering harsh ancient formulas is inappropriate. If the disease does not match the medicine, taking it is harmful; even if the disease matches, using potent ancient formulas on the weak constitutions of modern people will inevitably lead to many premature deaths. Therefore, preserving the ancients' theories on transmitted heat diseases helps understand the origin of Shanghan protocols and the inception of their legislative principles. Listing the sequence of sweating and purging methods in ancient formulas helps understand the framework of prescription formulation for imitation. Collecting the words of various sages clarifies the principles of change between ancient and modern times for cautious application. Zhang You's commentary on Shanghan is presented in this volume. I hope learned scholars examine it carefully. Do not lightly follow old formulas regarding the critical matter of life and death. Small trials of Gui Zhi (Cinnamon Twig), Ma Huang, Xiao Ming (Mirabilite), and Huang Qin/Huang Lian/Rhubarb may seem harmless, but once Yang collapses and Yin is exhausted, it is like spilt water that cannot be recovered, and severed life cannot be renewed. This Zhang, disregarding his own ignorance, repeatedly states these painful truths to expose entrenched abuses, daring not to conform, lest he mislead future generations. Breaking the fixed examples of former sages might incur minor blame, but saving the lives of later generations offers slight benefit. I trust those who respect life will discern this!