白术(二钱) 枳实 陈皮 麦芽 山楂 茯苓 神曲 连翘(各一钱) 茵陈 荷叶(各一钱五
分) 泽泻(五分
水煎服。
如兼伤酒,加葛根一钱;若便闭,去白术,加卜子、黄芩。
六君子汤(见类中。
有风寒食不消者,病气退而食自进。有积滞食不消者,祛其积而食自消。古方神术散、
保和汤、枳术丸,皆消积进食之法也。然有脾气虚弱不能消化者,有命门火衰,不能生脾土
而食不消者。东垣云∶胃中元气盛,则能食而不伤,过时而不饥。脾胃俱旺,则能食而肥
脾胃俱衰,则不能食而瘦。坤土虚弱不能消食,岂可更行克伐,宜用六君子、补中益气汤
补之。许学士云∶不能食者,未可专责之脾,肾经元阳不足,不能熏蒸腐化,譬如釜中水谷
底下无火,其何能熟?火为土母,虚则补其母,庶元气蒸腾,饮食增益,八味丸主之。世
俗每见不能食症,辄用枳、朴、黄连,实者当之犹可,虚人得之,祸不旋踵矣。大凡不能食
而吞酸嗳腐,胸膈满闷,未必尽属积食也,多有脾虚、肾弱而致此者,治者详之。
神术散(见类中。
保和汤(见心痛。
枳术丸(见鼓胀。
六君子汤 补中益气汤 八味丸(俱见类中。
有胃不和卧不安者,胃中胀闷疼痛,此食积也,保和汤主之。有心血空虚,卧不安者,
皆由思虑太过,神不藏也,归脾汤主之。有风寒邪热传心,或暑热乘心,以致躁扰不安者,
清之而神自定。有寒气在内而神不安者,温之而神自藏。有惊恐不安卧者,其人梦中惊跳怵
惕是也,安神定志丸主之。有湿痰壅遏,神不安者,其证呕恶气闷,胸膈不利,用二陈汤导
去其痰,其卧立至。更有被褥冷暖太过,天时寒热不匀,皆令不得安卧,非关于病,医家慎
保和汤 归脾汤(俱见心痛。
白术(二钱) 枳实 陈皮 麦芽 山楂 茯苓 神曲 连翘(各一钱) 茵陈 荷叶(各一钱五分) 泽泻(五分) 水煎服。
如果兼有饮酒损伤,加葛根一钱;如果大便闭塞,去掉白术,加莱菔子、黄芩。
六君子汤(参见类中篇)。
有因风寒导致食物不消化的,病气消退后食欲自然恢复。有因积滞导致食物不消化的,祛除积滞后食物自然消化。古方神术散、保和汤、枳术丸,都是消除积滞、增进食欲的方法。然而,有脾气虚弱不能消化的,有命门火衰,不能温煦脾土而导致食物不消化的。李东垣说:胃中元气旺盛,就能进食而不受伤,过了饭点也不会感到饥饿。脾胃都旺盛,就能进食且身体丰满;脾胃都衰弱,就不能进食且身体消瘦。坤土(脾)虚弱不能消化食物,怎么可以再使用攻伐药物,应该用六君子汤、补中益气汤来补益。许学士说:不能进食的病症,不能专门归咎于脾,肾经元阳不足,不能熏蒸腐熟水谷,就像锅里的水和粮食,底下没有火,怎么能煮熟呢?火是土的母脏,虚证则补其母脏,这样元气才能蒸腾,饮食得以增加,用八味丸主治。世俗之人常常看见不能进食的症状,就用枳实、厚朴、黄连,实证适用还可以,虚证的人用了,灾祸立刻就会到来。大凡不能进食而吞酸嗳气带有腐败气味,胸膈满闷,未必全都是属于食积,有很多是因为脾虚、肾虚而导致这种情况的,治疗者要仔细审察。
神术散(参见类中篇)。
保和汤(参见心痛篇)。
枳术丸(参见鼓胀篇)。
六君子汤 补中益气汤 八味丸(均参见类中篇)。
有因为胃不和导致睡眠不安的,胃中胀闷疼痛,这是食积,用保和汤主治。有心血空虚导致睡眠不安的,都是因为思虑过度,神志不能内藏,用归脾汤主治。有因风寒邪热传入心脏,或暑热侵犯心脏,导致烦躁扰乱不安的,清热治疗后神志自然安定。有寒气在内导致神志不安的,温里治疗后神志自然内藏。有因惊恐导致睡眠不安的,其人梦中惊跳恐惧就是这种表现,用安神定志丸主治。有湿痰壅塞阻碍,导致神志不安的,其症状为呕吐恶心气闷,胸膈不畅,用二陈汤引导排出痰浊,睡眠立刻就能安宁。更有因为被褥冷暖过度,天时寒热不均,都导致无法安卧,这不属于疾病,医生需谨慎辨别。
保和汤 归脾汤(均参见心痛篇)。
Bai Zhu (2 qian), Zhi Shi, Chen Pi, Mai Ya, Shan Zha, Fu Ling, Shen Qu, Lian Qiao (each 1 qian), Yin Chen, He Ye (each 1.5 qian), Ze Xie (0.5 qian). Decoct in water and take orally.
If accompanied by alcohol injury, add Ge Gen (1 qian); if constipation occurs, remove Bai Zhu, add Bo Le Zi and Huang Qin.
Liu Jun Zi Tang (see "Lei Zhong").
In cases where food fails to digest due to Wind-Cold, appetite returns naturally as the pathogenic qi recedes. In cases where food fails to digest due to stagnation, digestion resumes naturally after the stagnation is expelled. Ancient formulas such as Shen Shu San, Bao He Tang, and Zhi Zhu Wan are all methods for eliminating stagnation and promoting appetite. However, there are cases of inability to digest due to Spleen Qi deficiency, and cases of inability to digest due to decline of Ming Men Fire, which fails to warm and transform Spleen Earth. Li Dongyuan stated: "When Yuan Qi in the Stomach is abundant, one can eat without injury and not feel hungry past mealtime. When both Spleen and Stomach are robust, one can eat and become plump; when both Spleen and Stomach are depleted, one cannot eat and becomes emaciated." If Kun Earth (Spleen) is weak and unable to digest food, how can one further use attacking and reducing methods? One should use Liu Jun Zi Tang or Bu Zhong Yi Qi Tang to tonify. Scholar Xu stated: "Regarding the symptom of inability to eat, one cannot solely blame the Spleen. If the Original Yang of the Kidney Meridian is insufficient, it cannot steam and rot/cook [food]. It is like water and grain in a pot; without fire underneath, how can it be cooked?" Fire is the mother of Earth; in deficiency, tonify the mother, so that Yuan Qi steams upward and dietary intake increases. Ba Wei Wan is the primary formula. The common people often see the symptom of inability to eat and immediately use Zhi Shi, Hou Po, and Huang Lian. This may be acceptable for excess patterns, but for deficient persons, disaster will follow swiftly. Generally, inability to eat accompanied by acid regurgitation, belching with a putrid odor, and fullness/stuffiness in the chest and diaphragm does not necessarily belong entirely to food stagnation. Many such cases are caused by Spleen deficiency and Kidney weakness; practitioners must examine carefully.
Shen Shu San (see "Lei Zhong").
Bao He Tang (see "Xin Tong").
Zhi Zhu Wan (see "Gu Zhang").
Liu Jun Zi Tang, Bu Zhong Yi Qi Tang, Ba Wei Wan (all see "Lei Zhong").
In cases where disharmony of the Stomach leads to restless sleep, characterized by distension, stuffiness, and pain in the Stomach, this is Food Stagnation, treated primarily with Bao He Tang. In cases where emptiness of Heart Blood leads to restless sleep, it is all due to excessive overthinking, causing the Spirit (Shen) to fail to reside within; this is treated primarily with Gui Pi Tang. In cases where Wind-Cold pathogenic heat transmits to the Heart, or Summer-Heat invades the Heart, causing restlessness and agitation, clearing the heat will cause the Spirit to settle naturally. In cases where internal Cold causes the Spirit to be unsettled, warming the interior will cause the Spirit to reside naturally. In cases of restlessness due to fright and fear, the person jumps and feels terrified in dreams; this is treated primarily with An Shen Ding Zhi Wan. In cases where Phlegm-Dampness obstruction causes the Spirit to be unsettled, symptoms include vomiting, nausea, stifling sensation, and discomfort in the chest and diaphragm; using Er Chen Tang to guide out the phlegm will lead to immediate peaceful sleep. Furthermore, bedding that is too hot or cold, or uneven seasonal temperature changes, can also prevent peaceful sleep; these are not diseases, and physicians must exercise caution.
Bao He Tang, Gui Pi Tang (both see "Xin Tong").