治思虑伤脾, 或健忘怔忡, 惊悸盗汗, 寤而不寐, 或心
脾作痛, 嗜卧少食, 及妇女月经不调.
人参 龙眼肉 黄耆 甘草 白术 茯苓 木香 当归 酸枣仁 远
志,姜三片, 水煎服.
【集注】罗谦甫曰: 方中龙眼, 枣仁, 当归, 所以补心也; 耆, 参,
术,苓, 草, 所以补脾也. 薛己加入远志, 又以肾药之通乎心者补之
,是两经兼肾合治矣. 而特名归脾何也? 夫心藏神, 其用为思; 脾藏
智,其出为意, 见神智思意火土合德者也. 心以经营之久而伤, 脾以
意虑之郁而伤, 则母病必传之子, 子又能令母虚, 所必然也. 其病则
健忘怔忡, 怵惕不安之征见于心也; 饮食倦怠不能运输, 手足无力,
耳目昏眊之证见于脾也. 故脾阳苟不运, 心肾必不交, 彼黄婆者, 若
不为之媒合, 则已不能摄肾气归心, 而心阴何所赖以养, 此取坎填离
者,所以必归之脾也, 其药一滋心阴, 一养脾阳, 取乎健者, 以壮子
益母. 然恐脾郁之久, 思意不通, 故稍取木香之辛且散者, 以畅气醒
脾,使能速通脾气, 以上行心阴, 脾之所归, 正在斯耳. 张璐曰: 补
中益气与归脾同出保元, 并加归, 术, 而有升举胃气滋, 补脾阴之不
同.此方滋养心脾, 鼓动少火, 妙佐以木香少许, 调顺诸气, 畅和心
脾.世医不谙此理, 反以木香性燥不用, 服之多致痞闷减食者, 以其
补药多滞, 不能输化故耳.
主治思虑过度损伤脾脏,或者出现健忘、心悸怔忡、惊悸盗汗、醒后难以入睡,或者心脾部位疼痛、嗜睡且食欲减退,以及妇女月经周期不调。
方药组成:人参、龙眼肉、黄芪、甘草、白术、茯苓、木香、当归、酸枣仁、远志,加生姜三片,用水煎煮后服用。
【集注】罗谦甫说:方中的龙眼肉、酸枣仁、当归,是用来补益心脏的;黄芪、人参、白术、茯苓、甘草,是用来补益脾脏的。薛己在方中加入远志,又选用能通于心经的补肾药物来补益,这是心、脾、肾三经兼治的方法。但为什么特别命名为“归脾”呢?心藏神,其功能表现为思虑;脾藏智,其外现为意念,可见神、智、思、意是火(心)与土(脾)相合德性的体现。心因长期操劳而受伤,脾因思虑郁结而受伤,那么母病(心病)必然传及子脏(脾),子脏又能使母脏虚弱,这是必然的道理。其病症表现为:健忘、心悸、恐惧不安等征象显现于心脏;饮食倦怠、运化无力、手足无力、耳目昏花等证候显现于脾脏。所以,如果脾阳不能运化,心肾必然无法相交。那个充当媒人的“黄婆”(指脾土),如果不为它们做媒介结合,就不能摄纳肾气回归于心,那么心阴依靠什么来滋养呢?这就是取坎填离(调整阴阳水火关系)的方法,所以必须归于脾脏。这些药物,一方面滋伤心阴,一方面养健脾阳,选取具有强健作用的药物,以壮子脏(脾)来益母脏(心)。然而,担心脾脏郁结日久,导致思虑意念不通畅,所以稍微使用木香的辛散之性,来疏通气机、唤醒脾的功能,使其能迅速通畅脾气,向上输送心阴,脾脏的作用归宿,正是在于此。张璐说:补中益气汤与归脾汤都出自保元汤的基础,并加入了当归、白术,但在升举胃气和滋补脾阴方面有所不同。此方能滋养心脾,鼓动少火(生理之火),巧妙地佐以少量木香,调理顺达各种气机,舒畅调和心脾。世间的医生不熟悉这个道理,反而因为木香性燥而不用它,服药后多导致痞闷、食欲减少,这是因为补益药物大多容易滞涩,不能输布转化的缘故。
Indicated for spleen injury due to excessive overthinking, or symptoms such as forgetfulness, palpitations (Xin Ji Zheng Chong), startle palpitations with night sweats, waking up unable to sleep, pain in the heart and spleen regions, lethargy with poor appetite, and irregular menstruation in women.
Prescription: Ren Shen (Ginseng Radix), Long Yan Rou (Longan Aril), Huang Qi (Astragali Radix), Gan Cao (Licorice Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Mu Xiang (Aucklandiae Radix), Dang Gui (Angelicae Sinensis Radix), Suan Zao Ren (Ziziphi Spinosae Semen), Yuan Zhi (Polygalae Radix); add three slices of Sheng Jiang (Zingiberis Rhizoma Recens), decoct in water and take orally.
[Collected Annotations] Luo Qianfu stated: In this formula, Long Yan Rou, Suan Zao Ren, and Dang Gui are used to tonify the Heart; Huang Qi, Ren Shen, Bai Zhu, Fu Ling, and Gan Cao are used to tonify the Spleen. Xue Ji added Yuan Zhi and incorporated kidney herbs that communicate with the Heart, thereby treating the Heart, Spleen, and Kidney meridians simultaneously. Why is it specifically named "Gui Pi Tang" (Spleen-Restoring Decoction)? The Heart stores the Spirit (Shen), and its function manifests as thought; the Spleen stores wisdom (Zhi), and its expression manifests as intention. Thus, Shen, Zhi, Si (thought), and Yi (intention) represent the harmonious virtue of Fire (Heart) and Earth (Spleen). The Heart is injured by prolonged management and labor, and the Spleen is injured by depression from deliberation and thinking. Consequently, disease in the Mother organ (Heart) must transmit to the Child organ (Spleen), and the Child can also cause deficiency in the Mother; this is inevitable. The pathological manifestations include signs of forgetfulness, palpitations, and fear/anxiety appearing in the Heart; and symptoms of dietary fatigue, inability to transport and transform, weakness in the limbs, and dimness of hearing and vision appearing in the Spleen. Therefore, if Spleen Yang fails to transform, the Heart and Kidney will inevitably fail to interact. The "Yellow Matriarch" (Huang Po, referring to the Spleen/Earth acting as a mediator), if not facilitating this union, cannot grasp Kidney Qi and return it to the Heart, leaving Heart Yin without nourishment. This is why the method of "drawing Kan to fill Li" (adjusting Water and Fire/Yin and Yang) must rely on the Spleen. These herbs one tonify Heart Yin, and one nourish Spleen Yang, selecting strengthening agents to fortify the Child (Spleen) to benefit the Mother (Heart). However, fearing that long-standing Spleen depression leads to blocked thoughts and intentions, a small amount of Mu Xiang's pungent and dispersing nature is taken to unblock Qi and awaken the Spleen, enabling it to rapidly circulate Spleen Qi upward to convey Heart Yin. The true return of the Spleen lies precisely here. Zhang Lu stated: Bu Zhong Yi Qi Tang and Gui Pi Tang both originate from Bao Yuan Tang, adding Dang Gui and Bai Zhu, but differ in their ability to raise Stomach Qi and nourish Spleen Yin. This formula nourishes the Heart and Spleen, stirs the "Lesser Fire" (Shao Huo, physiological fire), and cleverly uses a small amount of Mu Xiang to regulate and smooth all Qi mechanisms, freely harmonizing the Heart and Spleen. Physicians of the world do not understand this principle; instead, they avoid using Mu Xiang due to its dry nature, resulting in patients experiencing fullness and reduced appetite after taking the medicine. This is because tonic herbs tend to cause stagnation and cannot be transported and transformed effectively.