治心神昏乱, 惊悸怔忡, 寤寐不安.
朱砂 ( 另研 ) 黄连各半两 当归二钱 生地黄三钱 甘草二钱,
右为细末, 酒泡蒸饼丸如麻子大, 朱砂为衣. 每服三十丸, 卧时津液
下.
【集注】叶仲坚曰: 经云: 神气舍心, 精神毕具. 又曰: 心者生之本
,神之舍也. 且心为君主之官, 主不明, 则精气乱; 神太劳, 则魂魄
散,所以寤寐不安, 淫邪发梦. 轻则惊悸怔忡, 重则痴妄癫狂也. 朱
砂具光明之体, 色赤通心, 重能镇怯, 寒能胜热, 甘以生津, 抑阴火
之浮游, 以养上焦之元气, 为安神之第一品. 心若热, 配黄连之苦寒
,泻心热也, 更佐甘草之甘以泻之. 心主血, 用当归之甘温, 归心血
也,更佐地黄之寒以补之. 心血足则肝得所藏, 而魂自安, 心热解则
肺得其职, 而魄自宁也.
医宗金鉴 二十七卷
洪大, 心烦不安, 四肢困倦, 懒于言语, 无气以动, 动则气高而喘.
黄耆 人参 云术 炙甘草 陈皮 当归 升麻 柴胡, 右八味, 加
生姜三片, 大枣二枚, 水煎, 温服.
【集注】柯琴曰: 仲景有建中, 理中二法. 风木内干中气, 用甘草,
饴,枣, 培土以御木; 姜, 桂, 芍药, 平木而驱风, 故名曰建中. 寒
水内凝于中气, 用参, 术, 甘草, 补土以制水, 佐干姜而生土以御寒
,故名曰理中. 至若劳倦形衰, 气少阴虚而生内热者, 表证颇同外感
,惟李杲知其为劳倦伤脾, 谷气不胜阳气, 下陷阴中而发热, 制补中
益气之法. 谓风寒外伤其形, 为有余; 脾胃内伤其气, 为不足. 遵『
内经』劳者温之, 损者益之之义, 大忌苦寒之药, 选用甘温之品升其
阳,以达阳春升生之令. 凡脾胃一虚, 肺气先绝, 故用黄耆护皮毛而
闭腠理, 不令自汗. 元气不足, 懒言气喘, 人参以补之. 炙甘草之甘
,以泻心火而除烦, 补脾胃而生气. 此三味, 除烦热之圣药也. 佐白
术以健脾, 当归以和血. 气乱于胸, 清浊相干, 用陈皮以理之, 且以
散诸甘药之滞. 胃中清气下陷, 用升麻, 柴胡气之轻而味之薄者, 引
胃气以上腾, 复其本位, 便能升浮, 以行生长之令矣. 补中之剂, 得
发表之品而中自安; 益气之剂, 赖清气之品而气益培, 此用药有相须
之妙. 是方也, 用以补脾, 使地道卑而上行, 亦可以补心, 肺, 损其
肺者, 益其气, 损其心者, 调其营卫也. 亦可以补肝木, 郁则达之也
.惟不宜于肾, 阴虚于下者不宜升, 阳虚于下者更不宜升也. 凡李杲
治脾胃方, 俱是益气. 去当归, 白术, 加苍木, 木香便是调中, 加麦
冬,五味辈, 便是清暑. 此正是医不执方, 亦是医必有方. 赵献可曰
:后天脾土, 非得先天之气不行, 此气因劳而下陷于太阴, 清气不升
,浊气不降, 故用升, 柴以佐参, 耆, 是方所以补益后天中之先天也
.凡脾胃不足, 喜甘而恶苦, 喜补而恶攻, 喜温而恶寒, 喜通而恶滞
,喜升而恶降, 喜燥而恶湿, 此方得之矣. 陆丽京曰: 此为清汤下陷
者言之, 非为下虚而清汤不升者言之也. 倘人之两尺虚微者, 或者肾
中水竭, 或者命门火衰, 若再一升提, 则如大木将摇而拨其本也.
治疗心神昏乱、惊悸怔忡（心中跳动不安）、睡眠不安。
朱砂（单独研磨）半两，黄连半两，当归二钱，生地黄三钱，甘草二钱，
以上药物研成细末，用酒浸泡蒸饼制成如麻子大小的丸药，以朱砂粉末为衣。每次服用三十丸，临睡前用津液送服。
【集注】叶仲坚说：医经记载：“神气安居于心，精神完备。”又说：“心是生命的根本，也是神的居所。”况且心作为君主之官，若君主不明，则精气混乱；神过度劳累，则魂魄离散，所以导致睡眠不安，多梦。轻者表现为惊悸怔忡，重者则出现痴呆妄言或癫狂。朱砂具有光明的质地，色赤入通于心，质重能镇怯，性寒能清热，味甘能生津，抑制阴火的浮游，滋养上焦的元气，是安神的上品。如果心热，配伍黄连的苦寒之性，以泻心热，再佐以甘草的甘味来辅助泻火。心主血，使用当归的甘温之性，以归补心血，再佐以地黄的寒性以滋补。心血充足则肝有所藏，魂自然安宁；心热解除则肺得其职能，魄自然宁静。
《医宗金鉴》第二十七卷
治疗脉象洪大、心烦不安、四肢困倦、懒于言语、无气以动、活动后气逆而喘。
黄芪、人参、白术、炙甘草、陈皮、当归、升麻、柴胡，以上八味药，加生姜三片，大枣二枚，水煎，温服。
【集注】柯琴说：张仲景有建中汤和理中汤两种治法。风木之气内犯中气，使用甘草、饴糖、大枣，培补脾土以抵御肝木；使用生姜、肉桂、芍药，平抑肝木而驱散风邪，所以名为建中。寒水之气内凝于中气，使用人参、白术、甘草，补益脾土以制约肾水，佐以干姜以生脾土抵御寒冷，所以名为理中。至于因劳倦导致形体衰败，气少阴虚而生内热的情况，表证颇似外感病，只有李杲知道这是劳倦损伤脾胃，谷气不能胜阳气，下陷于阴分而发热，于是制定了补中益气的方法。他认为风寒外伤其形，属于有余（实证）；脾胃内伤其气，属于不足（虚证）。遵循《内经》“劳者温之，损者益之”的原则，大忌苦寒药物，选用甘温的药物提升阳气，以顺应春天阳气升发生长的规律。凡是脾胃虚弱，肺气先绝，所以使用黄芪保护皮毛而闭合腠理，防止自汗。元气不足，懒言气喘，用人参来补益。炙甘草的甘味，用来泻心火而除烦，补脾胃而生发气机。这三味药，是除烦热的圣药。佐以白术健脾，当归和血。气乱于胸，清浊相干，使用陈皮来调理，并且可以疏散各种甘味药物的壅滞。胃中清气下陷，使用升麻、柴胡气味轻薄者，引导胃气上升，恢复其本位，便能升浮，以执行生长的命令。补中的药剂，得到发表的药物而中气自安；益气的药剂，赖清气药物而气更培固，这是用药有相互助益的妙处。这个方子，用来补脾，使地道卑下而上行，也可以补心肺，损伤肺的，益其气；损伤心的，调其营卫。也可以补肝木，郁结则疏达它。唯独不适合用于肾，阴虚于下的不宜升提，阳虚于下的更不宜升提。凡是李杲治疗脾胃的方子，都是益气。去掉当归、白术，加入苍术、木香就是调中；加入麦冬、五味子等，就是清暑。这正是医生不固执于固定方剂，也是医生必须有方剂。赵献可说：后天脾土，没有先天之气就不能运行，此气因劳而下陷于太阴，清气不升，浊气不降，所以用升麻、柴胡辅助人参、黄芪，这个方子所以能补益后天中的先天。凡是脾胃不足，喜欢甘味而厌恶苦味，喜欢补益而厌恶攻伐，喜欢温补而厌恶寒凉，喜欢通畅而厌恶停滞，喜欢升提而厌恶下降，喜欢干燥而厌恶湿润，这个方子符合这些特点。陆丽京说：这是针对清气下陷而言的，不是针对下虚而清气不升的情况说的。如果人的两尺脉虚微的，或者是肾中水竭，或者是命门火衰，如果再一升提，就像大树将要动摇而去摇动它的根基一样。
Treats mental confusion, palpitations (palpitation), and insomnia.
Cinnabar (separately ground) 15 g, Rhizoma Coptidis (Huanglian, 黄连) 15 g, Radix Angelicae Sinensis (Danggui, 当归) 6 g, Radix Rehmanniae Preparata (Shengdihuang, 生地黄) 9 g, Radix Glycyrrhizae Preparata (Zhigancao, 炙甘草) 6 g.
The above herbs are ground into fine powder, soaked in wine, steamed with steamed bread dough, and formed into pills the size of hemp seeds, coated with Cinnabar powder. Take thirty pills each time, swallowed with saliva before sleep.
[Collected Annotations] Ye Zhongjian stated: The classics say, "Spirit resides in the heart, and spirit and vitality are complete." It also says, "The Heart is the root of life and the residence of the Spirit." Moreover, as the Monarch official, if the Monarch is unclear, essence and qi become chaotic; if the Spirit is overworked, the Hun and Po scatter, leading to insomnia and vivid dreams. Mild cases manifest as palpitations, while severe cases result in dementia, delirium, or mania. Cinnabar possesses a luminous nature, its red color corresponds to the Heart, its heaviness calms fright, its coldness clears heat, and its sweetness generates fluids. It suppresses the floating of Yin fire and nourishes the Yuan Qi of the Upper Jiao, making it the premier herb for calming the Spirit. If the Heart is hot, it is paired with the bitter-cold Rhizoma Coptidis to drain Heart heat, assisted by the sweet nature of Licorice Root to further drain fire. The Heart governs Blood; thus, the sweet-warm Radix Angelicae Sinensis is used to replenish Heart blood, assisted by the cold nature of Rehmannia Root to tonify. When Heart blood is sufficient, the Liver has what to store, and the Hun naturally settles; when Heart heat is resolved, the Lung fulfills its function, and the Po naturally rests.
*Yi Zong Jin Jian*, Volume 27
Treats a洪大 (Hongda, surging) pulse, vexation and restlessness, fatigue in the four limbs, reluctance to speak, lack of energy to move, and panting with rising Qi upon exertion.
Radix Astragali (Huangqi, 黄芪), Radix Ginseng (Renshen, 人参), Rhizoma Atractylodis Macrocephalae (Baizhu, 白术), Radix Glycyrrhizae Preparata (Zhigancao, 炙甘草), Pericarpium Citri Reticulatae (Chenpi, 陈皮), Radix Angelicae Sinensis (Danggui, 当归), Rhizoma Cimicifugae (Shengma, 升麻), Radix Bupleuri (Chaihu, 柴胡). These eight herbs, added with three slices of Fresh Ginger (Shengjiang, 生姜) and two Jujubes (Dazao, 大枣), are decocted in water and taken warm.
[Collected Annotations] Ke Qin stated: Zhang Zhongjing had two methods: Jianzhong (Establish the Middle) and Lizhong (Regulate the Middle). When Wind-Wood internally invades the Middle Qi, Licorice, Maltose, and Jujube are used to cultivate Earth to control Wood; Ginger, Cinnamon Twig, and Paeonia Root are used to calm Wood and expel Wind, hence named Jianzhong. When Cold-Water internally coagulates in the Middle Qi, Ginseng, Atractylodes, and Licorice are used to tonify Earth to control Water, assisted by Dried Ginger to generate Earth and resist Cold, hence named Lizhong. Regarding cases where fatigue and overwork lead to physical decline, Qi deficiency, Yin deficiency, and internal heat generation, the exterior symptoms resemble external contraction diseases. Only Li Gao recognized this as Spleen damage due to fatigue and overwork, where Grain Qi cannot overcome Yang Qi, sinking into the Yin level and causing fever. Thus, he formulated the method of Tonifying the Middle and Augmenting Qi. He posited that external Wind-Cold damages the form, constituting an Excess condition; internal Spleen-Stomach damage to Qi constitutes a Deficiency condition. Following the principle from the *Neijing*: "For exhaustion, use warmth; for loss, use tonification," one must strictly avoid bitter-cold drugs and select sweet-warm substances to raise Yang Qi, thereby achieving the command of spring's ascending and generating force. Whenever Spleen and Stomach are weak, Lung Qi is first severed; therefore, Astragalus Root is used to protect the skin and hair and close the interstices to prevent spontaneous sweating. For insufficient Yuan Qi, reluctance to speak, and panting, Ginseng is used to tonify. The sweetness of Prepared Licorice drains Heart fire and relieves vexation, while tonifying the Spleen and Stomach to generate Qi. These three herbs are the sacred remedies for relieving vexation and heat. Atractylodes Macrocephala assists in strengthening the Spleen, and Angelica Sinensis harmonizes the Blood. When Qi is chaotic in the chest and clear and turbid Qi interfere with each other, Tangerine Peel is used to regulate it and disperse the stagnation caused by various sweet herbs. When Clear Qi of the Stomach sinks, Cimicifuga and Bupleurum, being light in odor and thin in flavor, are used to guide Stomach Qi upward, restoring it to its original position, allowing it to ascend and float, thus executing the command of growth. Tonifying the Middle agents, when combined with exterior-releasing agents, ensure the Middle remains secure; Qi-augmenting agents, relying on Clear Qi agents, further cultivate Qi. This demonstrates the wonderful synergy in medication. This formula, when used to tonify the Spleen, makes the Earth path low yet ascending; it can also tonify the Heart and Lungs. For Lung damage, augment Qi; for Heart damage, regulate Ying and Wei. It can also tonify Liver Wood; when stagnant, unblock it. However, it is unsuitable for the Kidney; those with Yin deficiency below should not have Qi raised, and those with Yang deficiency below especially should not. All formulas by Li Gao for treating Spleen and Stomach focus on augmenting Qi. Removing Angelica and Atractylodes, adding Atractylodes Lancea and Costus Root creates Tiao Zhong (Regulate the Middle); adding Ophiopogon and Schisandra creates Qing Shu (Clear Summerheat). This exemplifies that doctors do not adhere rigidly to fixed formulas, yet doctors must have formulas. Zhao Xianke said: Postnatal Spleen Earth cannot function without Prenatal Qi. This Qi, due to fatigue, sinks into the Taiyin channel; Clear Qi does not ascend, and Turbid Qi does not descend. Therefore, Cimicifuga and Bupleurum assist Ginseng and Astragalus; this formula thus tonifies the Prenatal within the Postnatal. Whenever Spleen and Stomach are deficient, they prefer Sweet and dislike Bitter, prefer Tonification and dislike Purging, prefer Warmth and dislike Cold, prefer Unblocking and dislike Stagnation, prefer Ascending and dislike Descending, prefer Dryness and dislike Dampness. This formula embodies these characteristics. Lu Lijing stated: This addresses the sinking of Clear Qi, not the case where Lower Deficiency causes Clear Qi to fail to ascend. If a person's Chi pulses at both wrists are faint and minute, whether due to exhaustion of Kidney Water or decline of Mingmen Fire, raising them further would be like shaking the roots of a large tree about to fall.