治热伤元气, 气短倦怠, 口渴出汗.
人参 麦门冬 五味子水煎服.
【注】经云: 大气积于胸中, 则肺主之. 夫暑热伤肺, 肺伤则气亦伤
矣.故气短, 倦怠而喘咳也. 肺主皮毛, 肺伤则失其卫护, 故汗出也
.热伤元气, 气伤则不能生津, 故口渴也. 是方君人参以补气, 即所
以补肺. 臣麦冬以清气, 即所以清肺. 佐五味以敛气, 即所以敛肺.
吴琨云: 一补, 一清, 一敛, 养气之道备矣. 名曰生脉, 以脉得气则
充,失气则弱. 李杲谓: 月服生脉饮, 加黄耆, 甘草, 名生脉保元汤
,令人气力涌出; 更加当归白芍, 名人参饮子, 治气虚喘咳, 吐血衄
血,亦虚火可补之例也.
治男妇气虚之总方也. 婴儿惊怯, 痘家虚者, 最宜.
黄耆三钱 人参二钱 甘草一钱 肉桂春夏二三分 秋冬六七分
,右四味, 水煎服.
【集注】柯琴曰: 昔东垣以此三味能泻火, 补金, 培土, 为除烦热之
圣药, 镇小儿之惊, 效如桴骨. 魏桂岩得之, 以治痘家阳虚顶陷, 血
虚浆清, 皮薄发痒, 难灌难敛者, 始终用之. 以为血脱须补气, 阳生
则阴长, 有起死回生之功, 故名之为保元也. 又稍佐肉桂, 分四时之
气而增损之, 谓桂能治血以推动其毒, 扶阳益气以充达周身. 血内泣
,引之出表, 则气从内托; 血外散, 引之归根, 则气从外护. 参, 耆
非桂引导, 不能独树其功. 桂不得甘草和平气血, 亦不能绪其条理 ,
要非寡闻浅见者能窥其万一也. 四君中不用白术, 避其燥; 不用茯苓
,恐其渗也. 用桂而不用四物者, 以芎之辛散, 归之湿润, 芍之酸寒
,地黄之泥滞故耳. 如宜升则加升柴, 宜燥加苓术, 宜润加当归, 宜
利气加陈皮, 宜收加芍. 宜散加芎. 又表实去耆, 里实去参, 中满忌
甘,内热除桂, 斯又当理会矣.
【按】元气者, 太虚之气也, 人得之则藏乎肾, 为先天之气, 即所谓
生气之原, 肾间动气者是也. 生化于脾, 为后天之气, 即所谓水谷入
胃,其精气行于脉中之营养, 其悍气行于脉外之卫气者是也. 若夫合
先后而言, 即大气之积于胸中, 司呼吸, 通内外, 周流一身, 顷刻无
间之宗气者是也. 总之, 诸气随所在而得名, 实一元气也. 保元者,
保守此元气之谓. 是方用黄耆保在外一切之气, 甘草保在中一切之气
,人参保上, 中, 下, 内, 外一切之气, 诸气治而元气足矣. 然此汤
补后天水谷之气则有余, 生先天命门之气则不足, 加肉桂以鼓肾间动
气,斯为备耳.
治疗热邪损伤元气,出现气短、疲倦乏力、口渴、出汗的症状。
用人参、麦门冬(麦冬)、五味子,水煎后服用。
【注释】《内经》说:大气积聚在胸中,由肺所主管。暑热之邪损伤肺脏,肺受伤则肺气也随之受损。所以会出现气短、疲倦乏力以及气喘咳嗽。肺主司皮毛,肺受伤则失去对体表的卫护功能,所以会出汗。热邪损伤元气,气受损则不能化生津液,所以出现口渴。这个方剂以人参为君药来补益元气,这也就是补益肺气;以麦冬为臣药来清泄热气,这也就是清泄肺热;以五味子为佐药来收敛耗散之气,这也就是收敛肺气。吴琨说:一补、一清、一敛,养气的道理就完备了。命名为“生脉”,是因为脉搏得到气的充养则充盈有力,失去气的充养则微弱无力。李杲说:每月服用生脉饮,加入黄芪、甘草,称为“生脉保元汤”,能让人体力充沛涌出;再加入当归、白芍,称为“人参饮子”,用于治疗气虚引起的气喘咳嗽、吐血、鼻衄,这也是虚火可以通过补益来治疗的范例。
这是治疗男女气虚的通用方剂。对于婴儿受惊胆怯、痘疮患者体质虚弱者,最为适宜。
用黄芪三钱、人参二钱、甘草一钱、肉桂春夏季节二三分、秋冬季节六七分,以上四味药,水煎后服用。
【集注】柯琴说:过去李东垣认为这三味药(指四君子汤中的参、术、草,此处语境略有混淆,但原文如此)能泻火、补金(肺)、培土(脾),是清除烦热的圣药,能镇定小儿惊悸,效果如同槌击鼓面般迅速。魏桂岩运用此法,治疗痘疮患者阳气虚弱导致痘顶凹陷、血虚导致浆液清稀、皮薄发痒、难以灌浆和收口的情形,始终使用此方。他认为血脱必须补气,阳气生发则阴血增长,有起死回生的功效,所以命名为“保元”。又稍微佐以肉桂,根据四季气候的不同而增减用量,认为肉桂能治理血液以推动毒邪外出,扶持阳气以益气并通达周身。如果血液内滞,引导其透出体表,则气从内部托举;如果血液外散,引导其归根,则气从外部护卫。人参、黄芪如果没有肉桂的引导,就不能单独建立功效。肉桂如果没有甘草来调和气血,也不能理顺条理,这绝不是见闻浅陋的人所能窥探到万一的。四君子汤中不用白术,是为了避开其燥性;不用茯苓,是担心其渗利作用。使用肉桂而不用四物汤,是因为川芎辛散、当归湿润、白芍酸寒、地黄滋腻的缘故。如需要升提则加升麻、柴胡,需要燥湿则加茯苓、白术,需要滋润则加当归,需要理气则加陈皮,需要收敛则加白芍,需要发散则加川芎。又如表实证去掉黄芪,里实证去掉人参,中焦胀满忌用甘味药,内有实热去除肉桂,这些又应当仔细领会。
【按语】元气,就是太虚之气,人获得它则藏于肾中,作为先天之气,也就是所谓的“生气之源”,即肾间动气。后天之气生化于脾,也就是所谓饮食入胃后,其精气运行于脉中以提供营养的部分,以及其悍气运行于脉外作为卫气的部分。如果将先天与后天合而言之,就是积聚在胸中、主管呼吸、沟通内外、周流全身、片刻不间断的宗气。总之,各种气随着所在部位不同而得名,实际上都是同一种元气。“保元”,意思就是保守这种元气。这个方剂用黄芪保护外在的一切气,甘草保护中焦的一切气,人参保护上、中、下、内、外一切气,诸气调理得当则元气充足了。然而此汤补充后天水谷之气则有余,生成先天命门之气则不足,加入肉桂以鼓动肾间动气,这才算完备。
Treats conditions where heat pathogen damages the primordial Qi (Yuan Qi, 原气), presenting with shortness of breath, fatigue and lassitude, thirst, and sweating.
Ren Shen (Ginseng Radix), Mai Men Dong (Ophiopogonis Tuber), Wu Wei Zi (Schisandrae Fructus) are decocted in water and taken orally.
[Annotation] The *Classic of Difficult Issues* states: "The Great Qi accumulates in the chest, and it is governed by the Lung." Heat and summer-heat pathogens injure the Lung; when the Lung is injured, its Qi is also damaged. Therefore, there is shortness of breath, fatigue and lassitude, and wheezing with cough. The Lung governs the skin and hair; when the Lung is injured, it loses its protective function over the exterior, resulting in sweating. Heat damages the primordial Qi; when Qi is damaged, it cannot generate body fluids, leading to thirst. In this formula, Ren Shen serves as the Sovereign herb to tonify Qi, which effectively tonifies Lung Qi. Mai Men Dong serves as the Minister herb to clear heat, which effectively clears Lung heat. Wu Wei Zi serves as the Assistant herb to astringe dissipating Qi, which effectively astringes Lung Qi. Wu Kun stated: "One tonifies, one clears, one astringes; the method of nourishing Qi is complete." It is named "Sheng Mai Yin" (Pulse-Generating Decoction) because the pulse becomes full and robust when supported by Qi, and weak when Qi is lost. Li Gao said: "Taking Sheng Mai Yin monthly, added with Huang Qi (Astragali Radix) and Gan Cao (Licorice Radix), is called 'Sheng Mai Bao Yuan Tang' (Pulse-Generating and Primordial-Preserving Decoction), which causes physical strength to surge forth; adding Dang Gui (Angelicae Sinensis Radix) and Bai Shao (Paeoniae Radix Alba) makes it 'Ren Shen Yin Zi' (Ginseng Drink), used to treat asthma and cough due to Qi deficiency, hematemesis, and epistaxis. This is also an example where deficient fire can be treated by tonification."
This is a general formula for treating Qi deficiency in both men and women. It is most suitable for infants suffering from fright and timidity, and for patients with smallpox who have a deficient constitution.
Huang Qi three qian, Ren Shen two qian, Gan Cao one qian, Rou Gui (Cinnamon Bark) two or three fen in spring and summer, six or seven fen in autumn and winter. The above four herbs are decocted in water and taken orally.
[Collected Annotations] Ke Qin stated: "In the past, Li Dongyuan believed that these three herbs [referring to Ginseng, Atractylodes, and Licorice in the context of Si Jun Zi Tang, though here applied differently] could purge fire, tonify Metal (Lung), and cultivate Earth (Spleen). They are holy medicines for eliminating vexation and heat, capable of calming infantile fright, with efficacy as immediate as striking a drum." Wei Guiyan utilized this approach to treat smallpox cases characterized by Yang deficiency leading to sunken pustule tops, Blood deficiency leading to thin pus, thin skin with itching, and difficulty in filling and healing. He consistently used this formula throughout the course of treatment. He believed that when Blood is depleted, Qi must be tonified; when Yang generates, Yin grows. It possesses the power to revive the dying, hence the name 'Bao Yuan' (Preserving Primordial Qi). Slightly assisted by Rou Gui, the dosage is adjusted according to the seasonal Qi. It is said that Cinnamon can regulate Blood to push out toxins, support Yang, and benefit Qi to reach the whole body. If Blood stagnates internally, guiding it to the exterior allows Qi to support from within; if Blood scatters externally, guiding it back to its root allows Qi to protect from without. Ren Shen and Huang Qi cannot achieve their effects independently without the guidance of Rou Gui. Rou Gui cannot organize its properties without Gan Cao to harmonize Qi and Blood. This is certainly not something that those with shallow knowledge can glimpse even a fraction of. In Si Jun Zi Tang (Four Gentlemen Decoction), Bai Zhu is omitted to avoid dryness; Fu Ling is omitted to prevent excessive draining. Rou Gui is used instead of Si Wu Tang (Four Substance Decoction) because Chuan Xiong is acrid and dispersing, Dang Gui is moistening, Bai Shao is sour and cold, and Di Huang is cloying and stagnant. If lifting is needed, add Sheng Ma and Chai Hu; if drying is needed, add Fu Ling and Bai Zhu; if moistening is needed, add Dang Gui; if moving Qi is needed, add Chen Pi; if astringing is needed, add Bai Shao; if dispersing is needed, add Chuan Xiong. Furthermore, if the Exterior is excess, remove Huang Qi; if the Interior is excess, remove Ren Shen; if there is fullness in the Middle Jiao, avoid sweet herbs; if there is internal heat, remove Rou Gui. These points require careful understanding.
[Commentary] Primordial Qi (Yuan Qi) is the Qi of the Great Void. Humans receive it, and it resides in the Kidney, serving as Pre-heaven Qi. It is what is referred to as the "Source of Life," specifically the Moving Qi between the Kidneys. Post-heaven Qi is generated by the Spleen. It refers to the essence derived from food and drink entering the Stomach: its Nutritive Qi (Ying Qi) circulates within the vessels to provide nourishment, and its Defensive Qi (Wei Qi) circulates outside the vessels. When combining Pre-heaven and Post-heaven, it refers to the Zong Qi (Gathering Qi) that accumulates in the chest, governs respiration, connects the interior and exterior, circulates throughout the body without interruption. In summary, various types of Qi are named according to their location, but they are essentially one Primordial Qi. "Bao Yuan" means preserving this Primordial Qi. This formula uses Huang Qi to preserve all Qi on the exterior, Gan Cao to preserve all Qi in the Middle Jiao, and Ren Shen to preserve all Qi in the Upper, Middle, Lower, Interior, and Exterior. When all Qi is regulated, Primordial Qi becomes sufficient. However, while this decoction is abundant in supplementing Post-heaven Qi from food and drink, it is insufficient in generating Pre-heaven Qi from the Gate of Vitality (Ming Men). Adding Rou Gui to stimulate the Moving Qi between the Kidneys makes it complete.