黄柏(炒褐色) 知母(蒸,各二两) 肉桂(去皮,一钱
炼蜜丸,如梧桐子大。每服七、八十丸,开水下。
金匮肾气丸 (见水肿。
假苏散 (见淋症。
补中益气汤 (见类中。
茯苓(赤、白,各五钱) 升麻(一钱五分) 当归(二钱) 川芎(一钱) 苎根(三钱
急流水煎服,或琥珀末二钱服,更佳。
(大小肠交 遗尿 脱肛
经曰∶北方黑色,入通于肾,开窍于二阴。是知肾主二便,肾经津液干枯,则大便闭结
矣。然有实闭、虚闭、热闭、冷闭之不同。如阳明胃实,燥渴、谵语,不大便者,实闭也,
小承气汤下之。若老弱人精血不足,新产妇人气血干枯,以致肠胃不润,此虚闭也,四物汤
加松子仁、柏子仁、肉苁蓉、枸杞、人乳之类以润之,或以蜜煎导而通之;若气血两虚,则
用八珍汤。热闭者,口燥、唇焦,舌苔黄,小便赤,喜冷、恶热,此名阳结,宜用清热攻
下之法,三黄枳术丸主之。冷闭者,唇淡、口和,舌苔白,小便清,喜热、恶寒,此名阴结
宜用温药而兼润燥之法,理中汤加归、芍主之。凡虚人不大便,未可勉强通之。大便虽闭
腹无所苦,但与润剂,积久自行,不比伤寒邪热,消烁津液,有不容刻缓之势也。予尝治
老人虚闭,数至圊而不能便者,用四物汤及滋润药加升麻,屡试屡验,此亦救急之良法也。
干枯,大肠结燥,便溺俱自前出,此非交肠,乃血液枯涸之征,气血衰败之候也。多服大剂
八珍汤,或可稍延岁月耳。
遗尿有二症,一因脾胃虚弱,仓禀不固,肠滑而遗者;一因火性急速,逼迫而遗者,宜
分别治之。脾虚,理中汤;火盛,芍药甘草汤加黄连。
脱肛也有二症,一因气虚下陷而脱者,补中益气汤;一因肠胃有火,肿胀下脱者,四
物加升麻、黄芩、荷叶之属。
小承气汤 (见伤寒少阴经证。
四物汤 (见虚劳。
蜜煎导法 (见伤寒。
八珍汤 (见虚劳)
三黄枳术丸 (见腹痛)
理中汤 (见伤寒中寒门。
五苓散 (见太阳腑病。
芍药甘草汤 (见腹痛。
补中益气汤 (见类中。
黄柏(炒至褐色) 知母(蒸制,各二两) 肉桂(去皮,一钱)
炼蜜制成丸药,大小如梧桐子。每次服用七、八十丸,用开水送服。
金匮肾气丸 (参见水肿章节)。
假苏散 (参见淋症章节)。
补中益气汤 (参见类中风章节)。
茯苓(赤茯苓、白茯苓,各五钱) 升麻(一钱五分) 当归(二钱) 川芎(一钱) 苎根(三钱)
急流水煎煮后服用,或者配合琥珀末二钱服用,效果更佳。
(关于大小肠交杂、遗尿、脱肛的论述)
《内经》说:北方对应黑色,内通于肾,开窍于前后二阴。由此可知肾主管大小便,若肾经津液干枯,就会导致大便闭结。然而有实闭、虚闭、热闭、冷闭的不同情况。如果是阳明胃腑实证,出现燥渴、谵语、不大便的情况,属于实闭,用小承气汤攻下。如果是年老体弱之人精血不足,或新产妇人气血干枯,导致肠胃失润,这属于虚闭,可用四物汤加入松子仁、柏子仁、肉苁蓉、枸杞、人乳等药物来滋润肠道,或者使用蜜煎导法通便;如果气血两虚,则使用八珍汤。热闭者,表现为口燥、唇焦、舌苔黄、小便赤红、喜冷恶热,这称为阳结,适宜采用清热攻下的方法,以三黄枳术丸为主方。冷闭者,表现为唇色淡、口中平和、舌苔白、小便清长、喜热恶寒,这称为阴结,适宜使用温药并兼以润燥的方法,以理中汤加当归、芍药为主方。凡是身体虚弱的人不大便,不可勉强使用通下法。虽然大便闭塞,但腹部没有痛苦,只需给予润肠药物,积久自然通畅,这与伤寒邪热消烁津液、病情危急不容片刻延缓的情况不同。我曾治疗一位老人因虚导致的大便闭塞,多次想排便却排不出的情况,使用四物汤及滋润药物加入升麻,屡试屡验,这也是救急的好方法。
如果大肠干枯结燥,大小便都从尿道排出,这不是大小肠交杂病,而是血液枯竭、气血衰败的征象。多服用大剂量的八珍汤,或许可以稍微延长寿命。
遗尿有两种症状,一种是因为脾胃虚弱,固摄无力,肠道滑脱而遗尿;另一种是因为火性急速,逼迫膀胱而遗尿,应当分别治疗。脾虚者,用理中汤;火盛者,用芍药甘草汤加黄连。
脱肛也有两种症状,一种是因为气虚下陷导致的脱出,用补中益气汤;一种是因为肠胃有火,肿胀而下脱,用四物汤加升麻、黄芩、荷叶等药物。
小承气汤 (参见伤寒少阴经证章节)。
四物汤 (参见虚劳章节)。
蜜煎导法 (参见伤寒章节)。
八珍汤 (参见虚劳章节)。
三黄枳术丸 (参见腹痛章节)。
理中汤 (参见伤寒中寒门章节)。
五苓散 (参见太阳腑病章节)。
芍药甘草汤 (参见腹痛章节)。
补中益气汤 (参见类中风章节)。
Huangbai (Cortex Phellodendri, stir-fried until brown) Zhimu (Rhizoma Anemarrhenae, steamed, each 2 liang) Rougui (Cortex Cinnamomi, bark removed, 1 qian)
Processed with refined honey into pills, sized like wutong seeds. Take 70-80 pills per dose, swallowed with warm water.
Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pill) (See section on Edema).
Jiasu San (Mint Powder) (See section on Lin Syndrome).
Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) (See section on Stroke-like Syndromes).
Fuling (Poria, both red and white varieties, each 5 qian) Shengma (Rhizoma Cimicifugae, 1.5 qian) Danggui (Radix Angelicae Sinensis, 2 qian) Chuanxiong (Rhizoma Chuanxiong, 1 qian) Zhu Gen (Root of Boehmeria nivea, 3 qian)
Decoct with rapidly flowing water and take orally. Alternatively, taking it with 2 qian of Hupo (Amber) powder is even better.
(Discussion on Intestinal Cross-over, Enuresis, and Rectal Prolapse)
The *Neijing* states: "The North corresponds to black, connects internally with the Kidney, and opens into the two yin orifices." From this, we know that the Kidney governs the two bowels. If the fluids of the Kidney meridian are dried up, fecal impaction occurs. However, there are differences among Excess Impaction (Shi Bi), Deficiency Impaction (Xu Bi), Heat Impaction (Re Bi), and Cold Impaction (Leng Bi). For instance, in Yangming Stomach Excess syndrome, characterized by dry thirst, delirious speech, and constipation, this is Excess Impaction; treat with Xiaochengqi Tang (Minor Order the Yellow Decoction) to purge. In elderly or weak individuals with insufficient essence and blood, or in postpartum women with dried-up qi and blood causing lack of lubrication in the intestines and stomach, this is Deficiency Impaction; treat with Siwu Tang (Four Substances Decoction) added with Songziren (Pine Seed Kernel), Baiziren (Biota Seed), Rousongrong (Cistanche), Gouqi (Goji Berry), Renru (Human Milk), etc., to moisten, or use Mi Jian Dao (Honey Suppository) method to promote evacuation. If there is a dual deficiency of qi and blood, use Bazhen Tang (Eight Treasures Decoction). Heat Impaction presents with dry mouth, scorched lips, yellow tongue coating, dark urine, preference for cold, and aversion to heat; this is called Yang Knotting. It is suitable to use clearing heat and purging methods, primarily Sanhuang Zhiyu Wan (Three Yellows and Atractylodes Pill). Cold Impaction presents with pale lips, neutral taste in the mouth, white tongue coating, clear urine, preference for heat, and aversion to cold; this is called Yin Knotting. It is suitable to use warming herbs combined with moistening-drying methods, primarily Lizhong Tang (Regulate the Middle Decoction) added with Danggui and Shaoyao. For deficient persons with constipation, one must not forcibly use purgatives. Although the stool is blocked, if the abdomen suffers no pain, simply providing moistening agents will allow natural evacuation over time. This differs from Shanghan (Cold Damage) where pathogenic heat consumes body fluids, creating an urgent situation that cannot be delayed. I once treated an elderly person with deficiency-induced constipation who felt the urge to defecate repeatedly but could not; using Siwu Tang and moistening herbs added with Shengma yielded consistent results. This is also an excellent emergency method.
If the Large Intestine is dried up and dry, causing both stool and urine to exit from the anterior orifice (urethra), this is not Intestinal Cross-over, but a sign of blood exhaustion and a state of qi and blood decline. Taking large doses of Bazhen Tang may slightly prolong life.
Enuresis has two syndromes: one caused by Spleen-Stomach weakness and insecure storage, leading to intestinal slipping and enuresis; the other caused by the rapid nature of Fire forcing urination. These should be treated differently. For Spleen deficiency, use Lizhong Tang; for excessive Fire, use Shaoyao Gancao Tang (Peony and Licorice Decoction) added with Huanglian.
Rectal prolapse also has two syndromes: one caused by qi deficiency and sinking, treated with Buzhong Yiqi Tang; the other caused by fire in the intestines and stomach leading to swelling and prolapse, treated with Siwu Tang added with Shengma, Huangqin, and He Ye (Lotus Leaf).
Xiaochengqi Tang (See section on Shaoyin Meridian Syndromes in Cold Damage).
Siwu Tang (See section on Deficiency Consumption).
Mi Jian Dao Method (See section on Cold Damage).
Bazhen Tang (See section on Deficiency Consumption).
Sanhuang Zhiyu Wan (See section on Abdominal Pain).
Lizhong Tang (See section on Cold Damage - Cold Invasion Chapter).
Wuling San (See section on Taiyang Fu Organ Disease).
Shaoyao Gancao Tang (See section on Abdominal Pain).
Buzhong Yiqi Tang (See section on Stroke-like Syndromes).