大黄(蒸)十分 黄芩二两 甘草三两 桃仁一升 杏仁一升 芍药四两 干漆一两
□虫一升 水蛭百枚 □虫半升 蛴螬一升 干地黄十两
右十二味,末之,炼蜜为丸,小豆大,酒饮服五丸,日三服。
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虚劳诸不足,风气百疾,薯蓣圆方主之。
【注】
虚劳诸不足者,谓五劳诸虚百损也。上条以热伤干血为言,此条以风气百疾立论。热
伤其上之血分,则病肺痈;热伤其下之血分,则病干血。风中其外之气分,则病肺痿
;风中其内之气分,则病百疾。主之以薯蓣丸,散诸风邪,补诸不足,滋诸枯槁,调
诸荣卫,故其药温润共剂,补散同方也。
【集注】
徐彬曰:虚荣不足证,多有兼风者,正不可着急治风气,故仲景以四君四物,养其气
血;麦冬、阿胶、干姜、大枣,补其肺胃;而以桔梗、杏仁、开提肺气;桂枝行阳,
防风运脾,神麴开郁,黄卷宣肾,柴胡升少阳之气,白□化入荣之风。虽有风气未尝
专治之,谓正气运而风气自去也。然以薯蓣名丸者,取其不寒不热,不燥不滑,脾肾
兼宜,故多用以为君,则诸药相助以为理耳。
薯蓣三十分 当归 桂枝 神# 干地黄 豆黄卷各十分 甘草二十八分 人参七分
芎藭芍药 白术 麦门冬 杏仁各六分 柴胡 桔梗 茯苓各五分 阿胶七分 干
姜三分 白蔹二分 防风六分 大枣(为膏)百枚
右二十一味,末之,炼蜜和丸,如弹子大,空腹酒服一丸,一百丸为剂。
大黄(蒸制)十分,黄芩二两,甘草三两,桃仁一升,杏仁一升,芍药四两,干漆一两,虻虫一升,水蛭一百枚,䗪虫半升,蛴螬一升,干地黄十两。
以上十二味药,研成细末,用炼过的蜂蜜制成丸剂,大小如梧桐子,用酒送服五丸,每日服用三次。
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虚劳病各种气血阴阳不足,以及因风邪引起的多种疾病,用薯蓣丸方主治。
【注】
所谓“虚劳诸不足”,是指五劳(久视伤血、久卧伤气、久坐伤肉、久立伤骨、久行伤筋)所致的各种虚损和百种损伤。上一条论述的是热邪损伤导致干血(瘀血日久不化),这一条则是从风邪引起多种疾病立论。热邪损伤上部的血分,则病发为肺痈(肺部化脓性感染);热邪损伤下部的血分,则病发为干血。风邪侵袭外部的卫气分,则病发为肺痿(肺叶枯萎不用);风邪侵袭内部的营气分,则病发为各种杂病。使用薯蓣丸来主治,是为了疏散各种风邪,补益各种不足,滋润各种枯槁,调和各种营卫,所以该方的药物温润并施,补益与发散同处一方。
【集注】
徐彬说:虚荣不足的证候,多兼有风邪,此时正不可急于治疗风邪,所以张仲景使用四君子汤和四物汤的组方思路,来滋养患者的气血;使用麦冬、阿胶、干姜、大枣,来补益肺胃;并使用桔梗、杏仁,来开提肺气;桂枝运行阳气,防风运脾,神曲开通郁结,黄卷宣通肾气,柴胡提升少阳之气,白蒺藜(原文缺字,据方义推测为白蒺藜或类似祛风药,此处依文意译为白某以祛入营之风)。虽然存在风邪却并未专门针对风邪治疗,认为只要正气运行通畅,风邪自然就会去除。然而之所以以薯蓣命名此丸,是取其性质不寒不热、不燥不滑,适宜脾肾双补,所以大量使用它作为君药,其他药物辅助配合以调理身体。
薯蓣三十分,当归、桂枝、神曲、干地黄、豆黄卷各十分,甘草二十八分,人参七分,川芎、芍药、白术、麦门冬、杏仁各六分,柴胡、桔梗、茯苓各五分,阿胶七分,干姜三分,白蔹二分,防风六分,大枣(熬成膏状)一百枚。
以上二十一味药,研成细末,用炼蜜调和制成丸剂,大小如弹丸,空腹时用酒送服一丸,一百丸为一个疗程剂量。
Da Huang (Rhizoma Rhei Preparata, steamed) 10 fen, Huang Qin (Cortex Scutellariae) 2 liang, Gan Cao (Radix Glycyrrhizae) 3 liang, Tao Ren (Semen Persicae) 1 sheng, Xing Ren (Semen Armeniacae Amarum) 1 sheng, Shao Yao (Radix Paeoniae Alba) 4 liang, Gan Qi (Resina Ferulae Siccata) 1 liang, Meng Chong (Asio/Otis/Bombyx etc., here likely Asio or similar insect, traditionally Meng Chong), 1 sheng, Shui Zhi (Hirudo) 100 pieces, E Chong (Trogopterus Dung/Excrement of Trogopterus, here likely refers to a specific insect like E Chong/Scorpion or similar, traditionally E Chong), 0.5 sheng, Si Lao (Larva Of Melolontha) 1 sheng, Gan Di Huang (Radix Rehmanniae Preparata) 10 liang.
The above twelve ingredients are powdered, mixed with refined honey to form pills, sized like wu-tou seeds (Viburnum odoratissimum fruits). Take five pills with wine, three times daily.
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For deficiency consumptive diseases characterized by various insufficiencies of qi, blood, yin, and yang, as well as various ailments caused by wind pathogens, the Shen Yu Wan formula is indicated.
[Annotation]
"Various insufficiencies of deficiency consumptive disease" refers to the various deficiencies and damages caused by the Five Labors (prolonged viewing damages blood, prolonged lying down damages qi, prolonged sitting damages flesh, prolonged standing damages bones, prolonged walking damages sinews). The previous clause discussed heat injuring dry blood (stagnant blood that has persisted for a long time without resolving); this clause establishes its argument based on wind pathogens causing various ailments. Heat injuring the blood aspect in the upper body leads to Lung Abscess (Fei Yong); heat injuring the blood aspect in the lower body leads to Dry Blood. Wind invading the exterior wei-qi aspect leads to Lung Withering (Fei Wei); wind invading the interior ying-qi aspect leads to various miscellaneous diseases. Shen Yu Wan is used to treat these conditions to disperse various wind pathogens, tonify various insufficiencies, moisten various withered states, and harmonize various ying and wei aspects. Therefore, the herbs in this formula are warm and moistening combined, and tonifying and dispersing actions are present in the same prescription.
[Collected Annotations]
Xu Bin stated: Cases of deficiency and insufficiency often accompany wind pathogens. At such times, one must not rush to treat the wind directly. Therefore, Zhang Zhongjing employed the principles of Si Jun Zi Tang (Four Gentlemen Decoction) and Si Wu Tang (Four Substances Decoction) to nourish qi and blood; used Mai Dong (Radix Ophiopogonis), E Jiao (Corium Corii Asini), Gan Jiang (Rhizoma Zingiberis Preparata), and Da Zao (Fructus Jujubae) to tonify the lungs and stomach; used Jie Geng (Radix Platycodonis) and Xing Ren (Semen Armeniacae Amarum) to elevate lung qi; Gui Zhi (Ramulus Cinnamomi) to circulate yang; Fang Feng (Radix Saposhnikoviae) to move spleen function; Shen Qu (Massa Medicata Fermentata) to open stagnation; Huang Juan (Soybean Sprouts/Mung Bean Sprouts prepared) to disseminate kidney qi; Chai Hu (Radix Bupleuri) to ascend shaoyang qi; and Bai Ji Li (Spina Gleditsiae) to expel wind entering the ying level. Although wind pathogens are present, they are not specifically targeted for treatment, under the belief that once righteous qi circulates freely, wind pathogens will naturally dissipate. However, the reason the pill is named after Shen Yu (Dioscorea) is because it is neither cold nor hot, neither drying nor slippery, and suitable for both spleen and kidney. Thus, it is used in large quantities as the sovereign herb, while other herbs assist in regulating the body.
Shen Yu (Rhizoma Dioscoreae) 30 fen, Dang Gui (Radix Angelicae Sinensis), Gui Zhi (Ramulus Cinnamomi), Shen Qu (Massa Medicata Fermentata), Gan Di Huang (Radix Rehmanniae Preparata), Dou Huang Juan (Semen Sojae Praeparatum) each 10 fen, Gan Cao (Radix Glycyrrhizae) 28 fen, Ren Shen (Radix Ginseng) 7 fen, Xiong Qiong (Radix Chuanxiong), Shao Yao (Radix Paeoniae Alba), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Mai Men Dong (Radix Ophiopogonis), Xing Ren (Semen Armeniacae Amarum) each 6 fen, Chai Hu (Radix Bupleuri), Jie Geng (Radix Platycodonis), Fu Ling (Sclerotium Poriae) each 5 fen, E Jiao (Corium Corii Asini) 7 fen, Gan Jiang (Rhizoma Zingiberis Preparata) 3 fen, Bai Lian (Radix Ampelopsis Japonicae) 2 fen, Fang Feng (Radix Saposhnikoviae) 6 fen, Da Zao (Fructus Jujubae, made into paste) 100 pieces.
The above twenty-one ingredients are powdered, mixed with refined honey to form pills, sized like bullet seeds. Take one pill with wine on an empty stomach; one hundred pills constitute one course of treatment.