仲景治大病瘥后,劳复者,枳实栀子豉汤主之。广剂加葱白、粟米、雄鼠粪。范汪加桂
枝、
大黄、麻黄;又方去栀、豉,加甘草、桂心、大黄、芒硝。《千金》加石膏、鼠粪。崔氏单
加鼠粪一味。《古今录验》加麻黄、大黄;一加鼠粪、大黄;一去栀、豉,加鼠粪;一加鼠
粪、麻黄;一去栀子,加甘草、大黄、芒硝。许仁则又加葱白、生姜、干葛、麦冬、生地。
或主表,或主里,或兼主表里,或兼养,或兼滋,或表里与滋养兼施,凡十余变,而栀豉之
法尽矣。
热淫于内,治以咸寒,《内经》之旨也。仲景疗伤寒,加芒硝于苦寒药中。文仲又加芒
硝于甘
寒药中,其方以生麦冬一升,生地黄一升,知母二两,生姜二两半,芒硝二两半,水煮,分
五服,取利为度。由是,而咸寒之用乃广矣。
院河南治天行热,解毒多用苦酒、猪胆、生艾汁、苦参、青葙、葶苈之属。《外台》单
用苦
参一两,酒煮,并服,取吐如烊胶便愈。张文仲疗伤寒、温病等,三日以上,胸中满,用苦
酒半升,猪胆一枚,和服,取吐。盖即《内经》酸苦涌泄之义。然今人之用此者罕矣。
五疰鬼气之病,或助正气以辟之,如苏合香丸之属是也;或假鬼气以引之,如死人枕、
天灵
盖之属是也。徐嗣伯、刘大用恒用此法,而嗣伯云∶鬼气伏而不起,故令人沉滞,得死人
枕,促之魂气飞越,不得攸附体,故尸疰可瘥。刘氏治妇人因人入庙,为邪鬼所凭,致精采
荡越,与死人枕煎汤饮之,大泻数行而愈。则是死人之枕引鬼气,或从上越,或从下出,随
其攸利,与草木气味升降浮沉,各具一体性者不同。今人亦罕有闻用之者矣。
《千金》疗尸疰方∶发灰、杏仁,熬令紫色,等分,捣如泥,以猪膏和酒服,如桐子三
丸,
日三,神良。愚谓此治血枯经络涩闭成劳者之良方也,亦即百劳 虫之意,而气味和调,可
以无弊,或以桃仁易杏仁,亦得。
张仲景治疗大病初愈后因劳累而复发(劳复)的情况,主张使用枳实栀子豉汤。该方剂通常加入葱白、粟米和雄鼠粪。范汪的方剂中则加入桂枝、大黄、麻黄;另有方剂去掉栀子、豆豉,加入甘草、桂心、大黄、芒硝。《千金方》中加入石膏、鼠粪。崔氏仅单加鼠粪一味。《古今录验》中加入麻黄、大黄;有的加入鼠粪、大黄;有的去掉栀子、豆豉,加入鼠粪;有的加入鼠粪、麻黄;有的去掉栀子,加入甘草、大黄、芒硝。许仁则又加入葱白、生姜、干葛、麦冬、生地。这些变方有的主治表证,有的主治里证,有的兼治表里,有的兼以补养,有的兼以滋润,有的表里双解与滋养并用,共有十余种变化,至此栀子豉汤的变法已穷尽。
“热邪蕴结于内,用咸寒之品治疗”,这是《内经》的宗旨。张仲景在治疗伤寒时,在苦寒药中加入芒硝。文仲又在甘寒药中加入芒硝,其方剂由生麦冬一升、生地黄一升、知母二两、生姜二两半、芒硝二两半组成,用水煎煮,分五次服用,以大便通利为度。由此,咸寒药物的应用范围便广泛了。
院河南治疗天行热病(流行性热病),解毒多使用醋、猪胆、生艾汁、苦参、青葙子、葶苈子等药物。《外台秘要》中单用苦参一两,用酒煎煮后一次性服下,令患者呕吐出如溶胶状的物质即可痊愈。张文仲治疗伤寒、温病等发病三日以上,出现胸中胀满症状时,使用醋半升、猪胆一枚,混合服用,令患者呕吐。这大概符合《内经》中“酸苦涌泄”的理论。然而如今很少有人使用这种方法了。
关于五疰鬼气这类疾病,有的通过扶助正气来驱除邪气,如苏合香丸之类的方剂;有的借助鬼气将其引出体外,如死人枕、天灵盖之类的物品。徐嗣伯、刘大用经常使用这种方法,而徐嗣伯说:鬼气潜伏而不发,所以使人精神沉滞,得到死人的枕头,能促使魂气飞越,使其无处依附躯体,因此尸疰可以痊愈。刘氏治疗一位妇人因进入庙宇,被邪鬼附身,导致精气神荡然无存,便给病人喝死人枕煎成的汤,病人多次腹泻后痊愈。这说明死人的枕头能引导鬼气,或从上窍排出,或从下窍排出,顺应其有利的途径,这与草木气味具有升降浮沉的固定属性是不同的。如今也很少有人听说使用这种方法了。
《千金方》治疗尸疰的方剂:将头发烧成灰、杏仁炒至紫色,两者等分,捣烂如泥,用猪脂调和,酒送服,制成如梧桐子大小的丸药,每日三次,效果神奇。我认为这是治疗血枯、经络涩闭形成虚劳症的良好方剂,也蕴含了百劳虫的治疗意图,且药性和调,没有弊端。也可以用桃仁代替杏仁,同样有效。
Zhang Zhongjing treated cases of recurrence due to overexertion (Lao Fu) after a major illness had subsided, prescribing Zhishi Zhizi Chitang (Immature Bitter Orange and Gardenia Fermented Soybean Decoction). The standard formula adds Congbai (Scallion White), Sumi (Millet), and Xiong Shufen (Male Rat Feces). Fan Wang’s formula added Guizhi (Cinnamon Twig), Dahuang (Rhubarb), and Mahuang (Ephedra); another variant removed Zhizi (Gardenia Fruit) and Chishao (Fermented Soybean), adding Gancao (Licorice Root), Guixin (Cinnamon Bark), Dahuang (Rhubarb), and Mangxiao (Mirabilite). *Qianjin Fang* (Prescriptions Worth a Thousand Gold) added Shigao (Gypsum Fibrosum) and Shufen (Rat Feces). Cui Shi used only Shufen (Rat Feces) as a single herb. *Gujin Luyan* added Mahuang (Ephedra) and Dahuang (Rhubarb); some variants added Shufen (Rat Feces) and Dahuang (Rhubarb); others removed Zhizi (Gardenia Fruit) and Chishao (Fermented Soybean), adding Shufen (Rat Feces); some added Shufen (Rat Feces) and Mahuang (Ephedra); yet others removed Zhizi (Gardenia Fruit), adding Gancao (Licorice Root), Dahuang (Rhubarb), and Mangxiao (Mirabilite). Xu Renze further added Congbai (Scallion White), Shengjiang (Fresh Ginger), Gange (Kudzu Root), Maidong (Ophiopogon Tuber), and Shengdi (Rehmannia Root). Some formulas targeted the exterior syndrome, some the interior syndrome, some both, some combined with nourishment, some with moistening, and some employed simultaneous exterior-interior resolution and nourishment. There were more than ten variations, exhausting the methods derived from Zhizi Chitang (Gardenia and Fermented Soybean Decoction).
"The treatment for heat rampant within is salty and cold," this is the principle of *Neijing* (The Yellow Emperor's Inner Canon). Zhang Zhongjing, when treating Shanghan (Cold Damage), added Mangxiao (Mirabilite) to bitter-cold herbs. Wenzhong further added Mangxiao (Mirabilite) to sweet-cold herbs. His formula consisted of Sheng Maidong (Fresh Ophiopogon Tuber, 1 sheng), Sheng Dihuang (Fresh Rehmannia Root, 1 sheng), Zhimu (Anemarrhena Rhizome, 2 liang), Shengjiang (Fresh Ginger, 2.5 liang), and Mangxiao (Mirabilite, 2.5 liang), boiled in water and divided into five doses, taken until bowel movement was achieved. Thus, the application of salty-cold substances became extensive.
Yuan Henan treated Tianxing Re (Epidemic Heat) by using Du Jie (Detoxification) agents such as Ku Jiu (Vinegar), Zhu Dan (Pig Gallbladder), Sheng Ai Zhi (Fresh Mugwort Juice), Kushen (Sophora Root), Qingxiangzi (Celosia Seed), and Tingli (Descurainia Seed). *Waitai Miyao* (Essential Prescriptions of the Imperial Library) used Kushen (Sophora Root, 1 liang) alone, boiled in wine and taken all at once, inducing vomiting of a substance resembling melted glue, which resulted in cure. Zhang Wenzhong treated Shanghan (Cold Damage) and Wenbing (Warm Diseases) that had persisted for three days or more, presenting with chest fullness, using Ban Sheng Ku Jiu (Half a sheng of vinegar) and one Zhu Dan (Pig Gallbladder), mixed and taken to induce vomiting. This likely aligns with the *Neijing* principle of "sour and bitter inducing vomiting and purging." However, few people use this method nowadays.
Regarding illnesses of Wuzhu Guiqi (Five Sticking Ghost Qi), some treatments support Zhengqi (Upright Qi) to repel the pathogen, such as Suhe Xiang Wan (Styrax Pill); others borrow the Guiqi (Ghost Qi) to draw it out, using items like Siren Zhen (Dead Man's Pillow) or Tianlinggai (Skull Cap). Xu Sibai and Liu Dayong frequently employed these methods. Sibai stated: "Ghost qi lies dormant and does not rise, causing lethargy; obtaining a dead man's pillow causes the Hun Qi (Soul Qi) to fly away, leaving no place to attach to the body, thus Shizhu (Corpse Sticking) can be cured." Liu treated a woman who, upon entering a temple, was possessed by evil ghosts, causing her Jingcai (Essence and Spirit) to dissipate. He gave her decoction made from a dead man's pillow to drink; she suffered several episodes of diarrhea and recovered. This shows that the dead man's pillow guides the ghost qi, expelling it either upwards or downwards, according to what is beneficial, which differs from the inherent ascending, descending, floating, and sinking properties of herbal flavors and aromas. Nowadays, few have heard of using such methods.
*Qianjin Fang* (Prescriptions Worth a Thousand Gold) provides a formula for Shizhu (Corpse Sticking): Hair ash and Xingren (Apricot Kernel) are roasted until purple, equal parts, pounded into a paste, mixed with Zhugao (Pork Fat), and taken with wine. Formed into pills the size of tung tree seeds, taken three times daily, it is highly effective. I consider this an excellent formula for treating blood deficiency leading to meridian obstruction and consumptive disease. It also embodies the intent of Bailao Chong (Hundred Consumptions Worm), with harmonious properties and no adverse effects. Taoren (Peach Kernel) may be substituted for Xingren (Apricot Kernel) with equal efficacy.