治伤寒, 寒实结胸无热证者, 及胸膈寒实痰水内结等证.
桔梗三分 贝母三分 巴豆 ( 去皮, 熬黑, 研如泥 ) 一分, 右杵二
味为末, 纳巴豆于臼中杵之, 以白饮合服. 强人一钱, 羸者减之. 病
在膈上必吐, 在膈下必痢. 不痢进热粥一杯, 痢过不止, 进冷粥一杯
.
【注】是方治寒实痰水结胸, 极峻之药也. 君以巴豆极辛极烈, 攻寒
逐水, 斩关夺门, 所到之处无不破也. 佐以贝母开胸之结. 使以桔梗
为之舟楫, 载巴豆搜逐胸邪. 膈上者必吐, 膈下者必痢, 使其邪悉尽
无余矣. 然惟知任毒以攻邪, 不量强羸, 鲜能善其后也, 故羸者减之
.不利进热粥, 利过进冷粥, 盖巴豆性热, 得热则行, 得冷则止. 不
用水而用粥者, 藉谷气以保胃也.
治伤寒表解, 心下痞, 按之不软, 其脉关上浮者.
大黄二两 黄连一两, 右二味, 以麻沸汤二升渍之, 须臾绞去滓, 分
温再服.
【注】痞硬虚邪而用大黄, 黄连, 能不起后人之疑耶? 仲景使人疑处
,正是妙处. 盖因后人未尝细玩, 不得其法, 皆煎而服之, 大悖其旨
矣.观乎用气薄之麻沸汤渍大黄, 黄连, 须臾去滓, 仅得其无形之气
,不重其有形之味, 是取其气味俱薄, 不大泻下. 虽曰攻痞, 而攻之
之妙义无穷也.
治疗伤寒病中,寒邪与实邪结聚于胸膈且无发热症状的证候,以及胸膈部位因寒邪、实邪、痰饮和水湿内停互结等证候。
桔梗三分 贝母三分 巴豆(去皮,炒至黑色,研成泥状)一分,将前二味药捣碎研为细末,把巴豆放入臼中捣烂,用米汤送服。体质强壮者服用一钱,体质虚弱者减量。病位在膈膜以上者必然引起呕吐,病位在膈膜以下者必然引起腹泻。如果服药后不腹泻,可喝一碗热粥以助药力;如果腹泻不止,可喝一碗冷粥以止泻。
【注解】此方用于治疗寒邪、实邪、痰饮与水气结聚于胸膈的“寒实结胸”证,属于药性极为峻猛的方剂。方中以巴豆为君药,其性极辛极烈,能攻逐寒邪、驱逐水饮,如斩关夺门般猛烈,所到之处无不攻破。以贝母为佐药,以开解胸膈的郁结。以桔梗为使药,如同舟楫一般,载着巴豆搜剔并驱逐胸膈间的邪气。病在膈上者通过呕吐排出邪气,病在膈下者通过腹泻排出邪气,从而使邪气彻底清除无余。然而,如果只知道任用毒性药物来攻伐邪气,而不衡量患者体质的强弱,很少能妥善处理好后续事宜,所以体质虚弱者需减少剂量。如果不腹泻则服用热粥,如果腹泻过度则服用冷粥,这是因为巴豆性热,遇热则药效发挥,遇冷则药效停止。不用水而用米汤送服,是借助谷气来保护胃气。
治疗伤寒表证已解,但心下部痞塞胀满,按压时感觉坚硬而不柔软,脉象在关部呈现浮象的证候。
大黄二两 黄连一两,将这两味药,用滚开的沸水二升浸泡片刻,随即滤去药渣,分两次温服。
【注解】对于痞硬之证,若属虚邪却使用大黄、黄连,难道不会引起后人的疑惑吗?张仲景在让人产生疑惑的地方,正是其精妙之处。大概是因为后人未曾仔细研读玩味,未能掌握其用法,都将其煎煮后服用,这完全违背了原方的旨意。观察其使用气味清淡的麻沸汤(滚开水)浸泡大黄、黄连,片刻后便滤去药渣,仅取其无形的气味,而不取其有形的厚重滋味,这是为了获取气味俱薄的特性,从而避免剧烈的泻下作用。虽然说是攻除痞结,但其攻邪的奥妙含义无穷无尽。
Treats conditions of Shāng Hán (Cold Damage) where cold and excess pathogens are knotted in the chest and diaphragm without heat signs, as well as conditions such as internal knotting of cold, excess, phlegm, and fluid retention in the chest and diaphragm.
Jiegeng (Platycodon Root) 3 fen, Beimu (Fritillaria Bulb) 3 fen, Badou (Croton Seed) [peeled, stir-fried until black, ground into a paste] 1 fen. Pound the first two herbs into powder, place the Badou in a mortar and pound it, then take with rice water. For robust individuals, take 1 qian; for frail individuals, reduce the dose. If the pathogen is above the diaphragm, vomiting will inevitably occur; if below the diaphragm, diarrhea will inevitably occur. If there is no diarrhea, drink one cup of hot porridge to promote bowel movement; if diarrhea persists excessively, drink one cup of cold porridge to stop it.
[Annotation] This formula treats "Cold-Excess Chest Knotting" (Hánshí Jiéxiōng), caused by the knotting of cold, excess, phlegm, and water in the chest. It contains extremely potent drugs. Badou serves as the Sovereign herb; its nature is extremely pungent and fierce, attacking cold and expelling water, breaking through barriers like an army storming gates, destroying all obstacles in its path. Beimu acts as the Minister herb to open knots in the chest. Jiegeng acts as the Guide herb, serving as a vessel to carry Badou to search out and expel pathogens from the chest. Pathogens above the diaphragm are expelled via vomiting; those below are expelled via diarrhea, ensuring all pathogens are completely eliminated. However, if one only relies on toxic herbs to attack pathogens without assessing the patient's strength or frailty, few can manage the aftermath well; hence, the dose is reduced for frail patients. Hot porridge is taken if there is no diarrhea, and cold porridge if diarrhea is excessive. This is because Badou is hot in nature: its action is promoted by heat and stopped by cold. Rice water is used instead of plain water to leverage the grain qi to protect the Stomach qi.
Treats Shāng Hán where the exterior syndrome has resolved, but there is epigastric fullness and obstruction (Pì), which feels hard upon pressure and is not soft, accompanied by a floating pulse at the Guan position.
Dahuang (Rhubarb Root and Rhizome) 2 liang, Huanglian (Coptis Rhizome) 1 liang. Pour 2 sheng of boiling water (Mafei Tang) over these two herbs, steep for a short while, strain off the dregs, and divide into two doses to be taken warm.
[Annotation] Using Dahuang and Huanglian for Pì hardness caused by deficient pathogens might indeed raise doubts among later practitioners? The very places where Zhang Zhongjing creates doubt are precisely where his brilliance lies. This is likely because later generations failed to study carefully and did not grasp the method, often decocting and taking them, which fundamentally contradicts the original intent. By using Mafei Tang (boiling water), which has a light aroma, to soak Dahuang and Huanglian, and straining them after a short time, only the formless Qi (aroma/energy) is extracted, not the heavy material flavor. This aims to utilize their light aroma and flavor to avoid severe purgation. Although it is said to attack Pì, the profound meaning of this method is infinite.