治阳明病, 脉浮发热, 渴欲饮水; 少阴病下痢六, 七
日,咳而呕渴, 心烦不得眠者.
猪苓 ( 去皮 ) 茯苓 阿胶 滑石 泽泻各一两, 右五味, 以水四
升,先煮四味, 取二升, 去滓; 纳下阿胶, 烊消, 温服七合, 日三服
.
【集注】赵羽皇曰: 仲景制猪苓一汤, 以行阳明, 少阴二经水热. 然
其旨全在益阴, 不专利水. 盖伤寒表虚最忌亡阳, 而里热又患亡阴.
亡阴者, 亡肾中之阴与胃家之津液也. 故阴虚之人, 不但大便不可轻
动,即小水亦忌下通. 盖阴虚过于渗利, 则津液反致耗竭. 方中阿胶
质膏养阴而滋燥, 滑石性滑去热而利水, 佐以二苓之渗泻, 既疏浊热
而不留其瘀壅, 亦润真阴而不苦其枯燥, 是利水而不伤阴之善剂也.
故太阳利水用五苓者, 以太阳职司寒水, 故加桂以温之, 是暖肾以行
水也. 阳明, 少阴之用猪苓, 以二经两关津液, 特用阿胶, 滑石以润
之,是滋养无形以行有形也. 利水虽同, 寒温迥别, 惟明者知之.
治脉浮小便不利, 热微消渴者. 发汗已,
脉浮数烦渴者. 中风发热, 六, 七日不解, 而烦, 有表里证, 渴欲饮
水,水入则吐者.
茯苓十八铢 猪苓十八铢 白术十八铢 泽泻一两 桂半两, 右五味
为散, 以白饮和服方寸匕, 日三服, 多服暖水, 汗出愈.
【注】是方也, 及太阳邪热入腑, 水气不化, 膀胱表里药也. 治水逆
,水入则吐; 一治消渴, 水入则消. 夫膀胱者, 津液之腑, 气化则能
出矣. 邪热入之, 若水盛则水壅不化而水蓄于上, 膀胱之气化不行,
致不便不利也. 若热盛则水为热耗, 而水消于上, 膀胱之津液告竭,
致小便不利也. 水入吐者, 是水盛于热也; 水入消者, 是热盛于水也
.二证皆小便不利, 故均得而主之. 然小便利者不可用, 恐重伤津液
也. 由此可知五苓散非治水热之专剂, 乃治水热小便不利之主方也.
君泽泻之咸寒, 咸走水腑, 寒胜热邪. 佐二苓之淡渗, 通调水道, 下
输膀胱, 并泻水热也. 用白术之燥湿, 健脾助土, 为之堤防以制水也
.用桂之辛温, 宣通阳气, 蒸化三焦以行水也. 泽泻得二苓下降, 利
水之功倍, 小便利而水不蓄矣. 白术须桂上升, 通阳之效捷, 气腾津
化渴自止也. 若发热表不解, 以桂易桂枝, 服后多服暖水, 令汗出愈
.是此方不止治停水小便不利之里, 而犹解停水发热之表也. 加人参
名春泽汤, 其意专在助气化以生津. 加茵陈名茵陈五苓散, 治湿热发
黄,表里不实, 小便不利者, 无不克也.
治疗阳明病,脉象浮、发热、口渴想喝水;以及少阴病下痢六七天,出现咳嗽、呕吐、口渴、心烦、无法入睡的症状。
猪苓(去皮)、茯苓、阿胶、滑石、泽泻各一两,以上五味药,用水四升,先煮前四味药,取二升药液,去渣;加入阿胶,使其烊化溶解,每次温服七合,每日三次服用。
【集注】赵羽皇说:张仲景制定猪苓汤这一方剂,是为了疏通阳明经和少阴经的水热之邪。然而其主旨全在于益养阴液,并不专门用于利水。大概伤寒表虚证最忌讳阳气亡失,而里热证又担忧阴液亡失。所谓亡阴,是指肾中的阴液与胃中的津液耗竭。所以阴虚的人,不但大便不可轻易攻下,就连小便也不宜用通利之法。因为阴虚之人如果过度使用渗湿利水药,反而会导致津液耗竭。方中阿胶质地膏润,能养阴滋润干燥;滑石性滑,能清热利水;配合茯苓、猪苓的渗湿泄浊作用,既能疏泄浊热而不留瘀滞壅塞,又能滋润真阴而不致枯燥痛苦,这是利水而不伤阴的良方。所以太阳病利水用五苓散,是因为太阳经主管寒水,所以加桂枝以温阳,这是通过温暖肾阳来行水。阳明病和少阴病用猪苓汤,是因为这两经都关乎津液,特意使用阿胶、滑石来滋润,这是通过滋养无形的阴液来推动有形的尿液排出。虽然都是利水,但一寒一温截然不同,只有明理者才能知晓。
治疗脉浮、小便不利、热微、消渴的症状。发汗后,脉浮数、心烦口渴的。中风发热,六七天未解,且心烦,有表里证,口渴想喝水,水喝进去就吐出来的。
茯苓十八铢、猪苓十八铢、白术十八铢、泽泻一两、桂枝半两,以上五味药研为散剂,用米汤调和,每次服用一方寸匕,每日三次,服药后多喝暖水,出汗即可痊愈。
【注】这个方剂,是针对太阳邪热入腑,水气不化,是治疗膀胱表里的药物。治疗水逆证,即水喝进去就吐出来;另一种治疗消渴证,即水喝进去就被消耗掉。膀胱是津液之腑,气化功能正常才能排出尿液。邪热侵入其中,如果水盛,则水壅滞不化而蓄水于上,膀胱的气化功能不行,导致小便不通利。如果热盛,则水被热邪耗伤,而水在上部被消耗,膀胱的津液枯竭,导致小便不利。喝水就吐,是水盛于热;喝水就消,是热盛于水。这两种证候都有小便不利,所以都用此方主治。然而小便利的人不可使用,恐怕会重伤津液。由此可知五苓散不是治疗水热互结的专用方,而是治疗水热导致小便不利的主方。以泽泻的咸寒为君药,咸味走水腑,寒性能胜热邪。佐以茯苓、猪苓的淡渗之性,通调水道,向下输注膀胱,并泻除水热。用白术的燥湿作用,健脾助土,作为堤防以制约水势。用桂枝的辛温,宣通阳气,蒸化三焦以行水。泽泻得到茯苓、猪苓的帮助下降,利水的功效加倍,小便利而水不蓄积。白术需要桂枝帮助上升,通阳的效果迅速,气机腾跃,津液化生,口渴自然停止。如果发热表证不解,可以用桂枝代替桂心(注:原文“以桂易桂枝”在历代版本中有争议,此处依原文直译,通常理解为调整桂的使用或指代桂枝),服药后多喝暖水,令其出汗痊愈。因此此方不仅治疗停水导致的小便不利的里证,还能解除停水导致的发热的表证。加入人参名为春泽汤,其用意专在辅助气化以生津液。加入茵陈名为茵陈五苓散,治疗湿热发黄,表里不实,小便不利者,没有不能治愈的。
Treat Yangming disease presenting with a floating pulse, fever, and thirst for water; as well as Shaoyin disease involving diarrhea for six or seven days, accompanied by cough, vomiting, thirst, irritability, and inability to sleep.
Zhu Ling (Polyporus), Fu Ling (Poria), E Jiao (Donkey-hide Gelatin), Hua Shi (Talcum), Ze Xie (Alisma) each one liang. The above five herbs are decocted in four sheng of water. First, boil the first four herbs until two sheng remain, then strain. Add E Jiao and melt it. Take seven he of the warm decoction three times a day.
[Collected Notes] Zhao Yuhuang stated: Zhang Zhongjing formulated Zhu Ling Tang to regulate water-heat in the Yangming and Shaoyin meridians. However, its main purport lies in nourishing Yin, not merely in promoting diuresis. Generally, in Taiyang disease with exterior deficiency, the loss of Yang is most feared, whereas in interior heat conditions, the loss of Yin is a concern. Loss of Yin refers to the depletion of Kidney Yin and Stomach fluids. Therefore, in patients with Yin deficiency, not only should the bowels not be lightly purged, but also the urine should not be forced out through strong diuretics. For if Yin-deficient patients undergo excessive diuresis, their body fluids will instead be exhausted. In this formula, E Jiao has a gelatinous quality that nourishes Yin and moistens dryness; Hua Shi is slippery in nature, clearing heat and promoting urination; assisted by the draining actions of Fu Ling and Zhu Ling, it disperses turbid heat without retaining stagnation, and moistens true Yin without causing bitterness or dryness. Thus, it is an excellent remedy that promotes urination without damaging Yin. Hence, Wu Ling San is used for diuresis in Taiyang disease because Taiyang governs cold-water, so Gui Zhi (Cinnamon Twig) is added to warm it, thereby warming the Kidney to move water. In contrast, Zhu Ling Tang is used for Yangming and Shaoyin diseases because these two meridians are closely related to body fluids; specifically, E Jiao and Hua Shi are used to moisten them. This represents nourishing the formless (Yin) to move the formed (urine). Although both promote urination, their thermal natures are vastly different; only those with clear understanding can discern this.
Treat cases with a floating pulse, difficulty in urination, slight heat, and polydipsia. After sweating, if the pulse becomes floating and rapid with irritability and severe thirst. Or wind-stroke with fever persisting for six or seven days without resolution, accompanied by irritability, presenting both exterior and interior signs, thirst for water, and vomiting immediately after drinking.
Fu Ling (Poria) 18 zhu, Zhu Ling (Polyporus) 18 zhu, Bai Zhu (Atractylodes Macrocephala Rhizome) 18 zhu, Ze Xie (Alisma) one liang, Gui (Cinnamon Bark/Twig) half liang. The above five herbs are powdered. Mix with rice water and take one fang cun bi per dose, three times a day. Drink plenty of warm water after administration; recovery occurs when sweat appears.
[Note] This formula addresses Taiyang pathogenic heat entering the fu-organs, where water qi fails to transform. It treats disorders of the Bladder's exterior and interior. It treats Shui Ni (Water Reversal), where water is vomited upon ingestion; and it treats Xiao Ke (Wasting-Thirst), where water is consumed rapidly. The Bladder is the fu-organ of body fluids; it excretes urine only when Qi transformation functions normally. When pathogenic heat enters, if water accumulation predominates, water stagnates and fails to transform, accumulating above, while Bladder Qi transformation fails, leading to urinary retention or difficulty. If heat predominates, water is consumed by heat, depleting Bladder fluids, also leading to difficult urination. Vomiting after drinking indicates water excess over heat; consuming water quickly indicates heat excess over water. Both conditions feature difficult urination, hence this formula is indicated for both. However, it must not be used if urination is already normal, lest it severely damage body fluids. From this, we know that Wu Ling San is not exclusively for water-heat intermingling, but is the primary formula for water-heat causing difficult urination. Ze Xie (Alisma) is the Sovereign herb, salty and cold; saltiness directs action to the water fu-organs, and coldness overcomes pathogenic heat. Poria (Fu Ling) and Polyporus (Zhu Ling) act as Ministers, providing mild permeability to regulate water pathways and direct flow downward to the Bladder, draining water-heat together. Bai Zhu (Atractylodes Macrocephala Rhizome) dries dampness, strengthens the Spleen, and aids Earth element, acting as a dam to control water. Gui (Cinnamon) is acrid and warm, disseminating Yang Qi and steaming/transforming the Triple Burner to move water. With the descending assistance of Fu Ling and Zhu Ling, Ze Xie’s diuretic effect is doubled, allowing free urination and preventing water accumulation. With the ascending assistance of Gui, Bai Zhu’s efficacy in unblocking Yang is swift; as Qi rises and fluids transform, thirst ceases. If fever and exterior signs persist, use Gui Zhi (Cinnamon Twig); drink ample warm water afterward to induce sweating for cure. Thus, this formula not only treats interior water retention causing difficult urination but also resolves exterior heat caused by water retention. Adding Ren Shen (Ginseng) creates Chun Ze Tang, whose intent is specifically to assist Qi transformation to generate fluids. Adding Yin Chen (Artemisia Capillaris) creates Yin Chen Wu Ling San, which treats damp-heat jaundice with deficient exterior and interior and difficult urination, proving effective in all such cases.