治三焦实热 一切有余火证, 大便秘结者.
黄芩 大黄各等分 黄连水煎服.
治上焦火旺, 头面大肿, 目赤肿痛, 心胸, 咽喉, 口舌
,耳, 鼻热盛, 及生疮毒者.
黄芩 黄连 甘草各等分, 水煎, 食后服.
【注】三黄汤用黄芩泻上焦火, 黄连泻中焦火, 大黄泻下焦火, 三焦
实火大便实者, 诚为允当. 若大便不实者, 黄连解毒汤证也. 以大黄
易黄柏者, 因其下焦热结未实也. 加栀子者, 使其热不从大便出而从
小便出也. 上, 中二焦实火, 用凉膈散. 若夫上焦实火, 则以此汤之
大黄易甘草, 名二黄汤, 使芩, 连之性, 缓缓而下, 留连膈上. 张洁
古以凉膈散减硝, 黄加桔梗, 亦此义也. 虽同一泻火之剂, 而其中上
下,缓急, 轻重之不同, 此皆加减转换法也, 不可不知.
治伤寒阳证, 表里大热而不得汗. 或已经汗, 下,
过经不解, 六脉洪数, 面赤鼻干, 舌燥大渴, 烦躁不眠, 谵语鼻衄,
发黄, 发疹, 发斑. 以上诸证, 凡表实无汗, 而未入里成实者, 均宜
主之.
石膏两半 黄芩 黄连 黄柏 麻黄以上各七钱 淡豆豉二合 栀子
三十个 每服一两, 加葱三根, 水煎, 热服. 气实者倍服.
【注】仲景于表里大热, 立两解之法: 如大青龙汤治表里大热, 表实
无汗, 故发汗, 汗出而两得解也; 白虎汤治表里大热, 因表有汗, 不
主麻, 桂, 因里未实, 不主硝黄, 惟以膏, 知, 甘草, 外解阳明之肌
热, 内清阳明之腑热, 表里清而两得解也. 若夫表实无汗, 热郁营
卫,里未成实, 热盛三焦, 表里大热之证. 若以大青龙汤两解之, 则
功不及于三焦; 若以白虎汤两解之, 则效不及于营卫. 故陶华制此汤
:以三黄泻三焦之火盛, 佐栀子屈曲下行, 使其在里诸热从下而出.
以麻黄开营卫之热郁. 佐豉葱直走皮毛, 使其在表之邪从外而散. 石
膏倍用重任之者, 以石膏外合麻, 豉, 取法乎青龙, 是知解诸表之热
,不能外乎青龙也. 内合三黄, 取法乎白虎, 是知解诸里之热, 不能
外乎白虎也. 且麻, 豉得石膏, 三黄, 大发表热, 而不动里热; 三黄
得石膏, 麻, 豉, 大清内热, 而不碍外邪. 是此方擅表里俱热之长,
亦得仲景之心法者也. 若表有微汗, 麻黄减半, 桂枝倍加, 以防外疏
;里有微溏, 则减去石膏, 倍加葛根, 以避中虚也.
治疗三焦实热,以及一切有余之火证,且伴有大便秘结的患者。
黄芩、大黄各等分,黄连水煎后服用。
治疗上焦火旺,导致头面部严重肿胀,眼睛红肿疼痛,心胸、咽喉、口舌、耳朵、鼻子火热旺盛,以及生疮毒的患者。
黄芩、黄连、甘草各等分,水煎,饭后服用。
【注】三黄汤中,用黄芩清泻上焦之火,黄连清泻中焦之火,大黄清泻下焦之火,对于三焦实火且大便干结的患者,确实非常恰当。如果大便不干燥坚硬者,属于黄连解毒汤的证候。将大黄替换为黄柏的原因,是因为下焦的热结尚未坚实。加入栀子,是为了使热邪不从大便排出,而从小便排出。对于上、中二焦的实火,使用凉膈散。如果是上焦实火,则将此方中的大黄替换为甘草,命名为二黄汤,使黄芩、黄连的药性缓缓下行,停留于膈上。张洁古(张元素)在凉膈散中减去芒硝、大黄,加入桔梗,也是同样的道理。虽然都是泻火的方剂,但其中针对上、中、下不同部位,以及缓急、轻重的差异,这些都是加减转换的方法,不可不知道。
治疗伤寒阳证,表里大热且无汗出。或者已经经过发汗、攻下治疗,病邪传经未解,六脉洪大而数,面色红赤,鼻干,舌燥大渴,烦躁不眠,说胡话(谵语),流鼻血(衄血),发黄,出疹子,发斑。以上各种证候,凡是表实无汗,且病邪未入里形成实证的,均适宜主用此方。
石膏一两半,黄芩、黄连、黄柏、麻黄各七钱,淡豆豉二合,栀子三十个。每服一两,加葱三根,水煎,热服。体质壮实者加倍服用。
【注】张仲景针对表里大热,确立了表里双解的方法:如大青龙汤治疗表里大热,因表实无汗,所以通过发汗,使汗出而表里两解;白虎汤治疗表里大热,因表有汗,故不使用麻黄、桂枝,因里未成实,故不使用芒硝、大黄,仅用石膏、知母、甘草,外解阳明肌表之热,内清阳明腑脏之热,表里清凉而两解。如果是表实无汗,热郁阻营卫,里未成实,热盛于三焦,表里大热的证候。如果用大青龙汤来表里双解,则功效达不到三焦;如果用白虎汤来表里双解,则功效达不到营卫。所以陶华制作此汤:用三黄(黄芩、黄连、黄柏)清泻三焦的火盛,佐以栀子屈曲下行,使在里的各种热邪从下而出。用麻黄开泄营卫的热郁。佐以豆豉、葱白直走皮毛,使在表的邪气从外而散。重用石膏作为重任药物,是因为石膏外合麻黄、豆豉,取法于大青龙汤,由此可知解除各种表热,不能超出大青龙汤的范围。内合三黄,取法于白虎汤,由此可知解除各种里热,不能超出白虎汤的范围。而且麻黄、豆豉得到石膏、三黄,能大发表热,而不扰动里热;三黄得到石膏、麻黄、豆豉,能大清内热,而不阻碍解表散邪。因此此方擅长治疗表里俱热,也深得张仲景的心法。如果表有微汗,麻黄减半,桂枝倍加,以防腠理过疏;如果里有轻微腹泻,则减去石膏,倍加葛根,以避免中气虚弱。
Treats Sanjiao (Triple Burner) excess heat and all types of surplus fire syndromes accompanied by constipation.
Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma) in equal parts, Huanglian (Coptidis Rhizoma) decocted in water for oral administration.
Treats hyperactive fire in the Upper Jiao (Upper Burner), resulting in severe swelling of the head and face, redness and painful swelling of the eyes, excessive heat in the chest, heart, throat, mouth, tongue, ears, and nose, as well as the formation of sores and toxins.
Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) in equal parts, decocted in water, taken after meals.
[Note] In Sanhuang Tang (Three-Yellow Decoction), Huangqin (Scutellariae Radix) clears fire from the Upper Jiao (Upper Burner), Huanglian (Coptidis Rhizoma) clears fire from the Middle Jiao (Middle Burner), and Dahuang (Rhei Radix et Rhizoma) clears fire from the Lower Jiao (Lower Burner). For patients with Sanjiao (Triple Burner) excess fire and solid stools, this is indeed appropriate. If the stools are not hard or dry, it belongs to the syndrome of Huanglian Jiedu Tang (Coptis Decoction for Detoxification). Replacing Dahuang (Rhei Radix et Rhizoma) with Huangbai (Phellodendri Cortex) is because the heat accumulation in the Lower Jiao (Lower Burner) has not yet become solid. Adding Zhizi (Gardeniae Fructus) allows the heat to exit via urination rather than defecation. For excess fire in the Upper and Middle Jiao (Upper and Middle Burners), Liangge San (Cooling the Diaphragm Powder) is used. If it is excess fire solely in the Upper Jiao (Upper Burner), replace Dahuang (Rhei Radix et Rhizoma) in this formula with Gancao (Glycyrrhizae Radix et Rhizoma), naming it Erhuang Tang (Two-Yellow Decoction). This allows the properties of Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) to descend slowly and linger above the diaphragm. Zhang Jiegu (Zhang Yuansu) reduced Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) in Liangge San (Cooling the Diaphragm Powder) and added Jiegeng (Platycodonis Radix), which follows the same principle. Although these are all formulas for purging fire, their differences regarding the upper, middle, and lower regions, as well as their speed and intensity, represent methods of modification and transformation that must be understood.
Treats Yang syndromes of Shanghan (Cold Damage), characterized by severe heat in both the exterior and interior without sweating. Or, after having undergone sweating or purgative treatments, the pathogen remains unresolved after passing through meridians, with surging and rapid pulses in all six positions, red face, dry nose, dry tongue with extreme thirst, irritability, insomnia, delirium, epistaxis, jaundice, rash, or macules. For all the above syndromes, provided there is exterior excess with no sweat and the pathogen has not entered the interior to form a solid condition, this formula is indicated.
Shigao (Gypsum Fibrosum) 1.5 liang, Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Mahuang (Ephedrae Herba) each 7 qian, Danshichi (Sojae Semen Praeparatum) 2 he, Zhizi (Gardeniae Fructus) 30 pieces. Each dose is 1 liang, add 3 stalks of Congbai (Allii Fistulosi Bulbus), decocted in water, taken hot. Patients with strong constitution should take double doses.
[Note] Zhang Zhongjing established methods for simultaneous resolution of exterior and interior for severe heat: For example, Daqinglong Tang (Major Blue Dragon Decoction) treats severe heat in both exterior and interior; since the exterior is excess with no sweat, it induces sweating, allowing both exterior and interior to resolve upon sweating; Baihu Tang (White Tiger Decoction) treats severe heat in both exterior and interior; since there is sweat at the exterior, it does not use Mahuang (Ephedrae Herba) or Guizhi (Cinnamomi Ramulus); since the interior is not solid, it does not use Mangxiao (Natrii Sulfas) or Dahuang (Rhei Radix et Rhizoma). It only uses Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) to externally clear heat from the muscles of the Yangming channel and internally clear heat from the fu organs of the Yangming channel, achieving resolution of both exterior and interior. However, for cases of exterior excess with no sweat, heat stagnating in Ying (Nutrient) and Wei (Defensive) levels, interior not yet solid, heat flourishing in the Sanjiao (Triple Burner), representing severe heat in both exterior and interior: if treated with Daqinglong Tang (Major Blue Dragon Decoction) for simultaneous resolution, its efficacy does not reach the Sanjiao (Triple Burner); if treated with Baihu Tang (White Tiger Decoction) for simultaneous resolution, its efficacy does not reach the Ying (Nutrient) and Wei (Defensive) levels. Therefore, Tao Hua formulated this decoction: using Sanhuang (the three yellows: Huangqin, Huanglian, Huangbai) to purge the flourishing fire of the Sanjiao (Triple Burner), assisted by Zhizi (Gardeniae Fructus) to descend curvingly, allowing internal heat to exit downward. Using Mahuang (Ephedrae Herba) to open the heat stagnation in Ying (Nutrient) and Wei (Defensive) levels. Assisted by Danshichi (Sojae Semen Praeparatum) and Congbai (Allii Fistulosi Bulbus) to act directly on the skin and hair, allowing external pathogens to dissipate outward. Shigao (Gypsum Fibrosum) is used in heavy dosage as a key ingredient because, combined externally with Mahuang (Ephedrae Herba) and Danshichi (Sojae Semen Praeparatum), it follows the pattern of Qinglong (Blue Dragon), indicating that resolving various exterior heats cannot go beyond the scope of Qinglong. Internally combining with Sanhuang (the three yellows), it follows the pattern of Baihu (White Tiger), indicating that resolving various interior heats cannot go beyond the scope of Baihu. Moreover, Mahuang (Ephedrae Herba) and Danshichi (Sojae Semen Praeparatum) obtain Shigao (Gypsum Fibrosum) and Sanhuang (the three yellows) to vigorously release exterior heat without disturbing interior heat; Sanhuang (the three yellows) obtains Shigao (Gypsum Fibrosum), Mahuang (Ephedrae Herba), and Danshichi (Sojae Semen Praeparatum) to vigorously clear internal heat without hindering the dispersal of external pathogens. Thus, this formula excels in treating heat in both exterior and interior and also captures the essence of Zhang Zhongjing’s methodology. If there is slight sweating at the exterior, reduce Mahuang (Ephedrae Herba) by half and double Guizhi (Cinnamomi Ramulus) to prevent excessive dispersion of the exterior; if there is slight loose stool in the interior, remove Shigao (Gypsum Fibrosum) and double Gegen (Puerariae Lobatae Radix) to avoid deficiency in the middle jiao.