治肾阴不足, 筋骨痿软, 不能步履.
龟板 黄柏各四两 知母 熟地各二两 牛膝三两五钱 芍药一两五
钱 锁阳一两 虎骨一两 当归一两 陈皮七钱五分, 右为末, 煮羯
羊肉, 捣为丸, 桐子大, 淡盐汤下.
【集注】王又原曰: 肾为作强之官, 有精血以为之强也. 若肾虚精枯
,而血必随之, 精血交败, 湿热风毒遂乘而袭焉. 此不能步履, 腰酸
筋缩之证作矣. 且肾兼水火, 火胜烁阴, 湿热相搏, 筋骨不用宜也.
方用黄柏清阴中之火, 燥骨间之湿, 且苦能坚肾, 为治痿要药, 故以
为君. 虎骨去风毒, 健筋骨为臣. 因高源之水不下, 母虚而子亦虚,
肝脏之血不归, 子病而母愈病, 故用知母清肺原, 归芍养肝血, 使归
于肾. 龟禀天地之阴独厚, 茹而不吐, 使之坐镇北方. 更以熟地, 牛
膝,锁阳, 羊肉群队补水之品, 使精血交补. 若陈皮者, 疏血行气.
兹又有气化血行之妙, 其为筋骨壮盛, 有力如虎也必矣. 『道经』云
:虎向水中生, 以斯为潜之义焉夫! 是以名之曰: 虎潜丸. 叶仲坚曰
:痿原虽分五脏, 然其本在肾, 其标在肺, 『内经』云: 五脏因肺热
叶焦, 发为痿躄. 又曰: 阳气内伐, 水不胜火, 则骨痿髓虚, 故足不
任身. 骨痿者生于大热也, 若视为虚寒而投以桂, 附, 多致不救. 是
方以虎名者, 虎于兽中禀金气之至刚, 风生一啸, 特为肺金取象焉.
其潜之云者, 金从水养, 母隐子胎, 故生金者必丽水, 意在纳气归肾
也. 龟应北方之象, 禀阴最厚, 首常向腹, 善通任脉, 能大补真阴,
证深得夫潜之意者. 黄柏味厚, 为阴中之阴, 专补肾膀之阴不足, 能
使足膝中气力涌出, 故痿当家必用二者为君, 一以固本, 一以治标,
恐奇之不去, 则偶之也. 熟地填少阴之精, 用以佐龟板, 知母清太阴
之气; 用以佐黄柏, 牛膝入肝舒筋. 归, 芍佐之, 肝血有归; 陈皮疏
之,气血以流, 骨正筋柔矣. 又虑热则生风, 逗留关节, 用虎骨所以
驱之; 纯阴无阳不能发生, 佐锁阳以温之. 羊肉为丸, 补之以味. 淡
盐汤下, 急于入肾. 斯皆潜之为义.
龟板、黄柏各四两;知母、熟地黄各二两;牛膝三两五钱;白芍一两五钱;锁阳一两;虎骨一两;当归一两;陈皮七钱五分。以上药物研为细末,用煮熟的羯羊肉捣烂混合制成丸药,大小如梧桐子,服用时用淡盐水送服。
【集注】王又原说:肾是作强之官(指肾脏功能强健,主司技巧与体力),依靠精血来维持其强健。如果肾虚导致精液枯竭,血液也必然随之亏损,精血同时衰败,湿热风毒便会趁机侵袭人体。于是出现了不能行走、腰部酸痛、筋脉拘挛的症状。而且肾兼有水和火两种属性,若火气过盛灼伤阴液,湿热相互搏结,筋骨失去濡养而无法正常运动,这是理所当然的。方中选用黄柏清泻阴分中的虚火,燥除骨骼间的湿气,且苦味能坚阴补肾,是治疗痿证的重要药物,所以作为君药。虎骨能祛除风毒,强健筋骨,作为臣药。因为肺金(高源之水)之气不下行,母脏(肺)虚弱则子脏(肾)亦虚,肝脏之血不能归藏,子病累及母脏使其更虚,所以使用知母清肃肺气,当归和白芍滋养肝血,使气血归于肾。龟板禀受天地深厚的阴气,吞食而不吐出,象征其镇守北方(肾位)。再加上熟地黄、牛膝、锁阳、羊肉这一群补水填精的药物,使精血得到双重滋补。至于陈皮,则是疏通血脉、运行气机。这里又有气化生血、血行助气的妙处,这样筋骨必定强壮兴盛,有力如虎。《道经》说:“虎向水中生”,以此作为“潜”的含义,因此将此方命名为“虎潜丸”。叶仲坚说:痿证的根源虽然涉及五脏,但其根本在肾,其标象在肺。《内经》说:五脏因肺热叶焦,发为痿躄(肢体萎软无力)。又说:阳气内伐,水不胜火,则骨痿髓虚,所以双脚无法支撑身体。骨痿是由大热引起的,如果将其视为虚寒而投以桂枝、附子等温热药,大多会导致病情恶化甚至死亡。此方以“虎”命名,是因为虎在兽类中禀受金气中最刚强的特性,虎啸生风,特别取象于肺金。所谓“潜”,是指金从水养,母隐子胎,所以生金者必赖丽水(肾水),意在纳气归肾。龟对应北方的意象,禀受阴气最厚,头常缩入腹中,善于通达任脉,能大补真阴,此证深得“潜”的意义。黄柏气味厚重,属于阴中之阴,专门补肾与膀胱的阴液不足,能使足膝中的气力涌出,所以治疗痿证必须将二者作为君药,一个固本,一个治标,恐怕单用奇数配伍无效,则改用偶数配伍。熟地黄填补少阴肾精,用来辅助龟板;知母清肃太阴肺气,用来辅助黄柏;牛膝入肝经舒展筋脉;当归、白芍辅助它,使肝血有所归依;陈皮疏理它,使气血流通,骨骼端正,筋脉柔和。又担心热极生风,留滞于关节,所以使用虎骨来驱散风邪;纯阴无阳则不能生机发动,所以佐以锁阳来温煦。用羊肉制作丸药,是以味道来补益形体。用淡盐水送服,是为了急于引导药力入肾。这些都是“潜”的含义所在。
Treats insufficiency of Kidney Yin, resulting in flaccidity and weakness of the sinews and bones, and inability to walk.
Gui Ban (Testudinis Carapax et Plastrum), Huang Bo (Phellodendri Cortex) each 4 liang; Zhi Mu (Anemarrhenae Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata) each 2 liang; Niu Xi (Achyranthis Bidentatae Radix) 3 liang 5 qian; Bai Shao (Paeoniae Radix Alba) 1 liang 5 qian; Suo Yang (Cynomorii Herba) 1 liang; Hu Gu (Pantheris Os) 1 liang; Dang Gui (Angelicae Sinensis Radix) 1 liang; Chen Pi (Citri Reticulatae Pericarpium) 7 qian 5 fen. The above herbs are ground into fine powder. Cooked male castrated sheep meat is used to mash and mix with the powder to form pills, sized like wu tong seeds. Take with light salt water.
[Collected Annotations] Wang Youyuan states: The Kidney is the official of strength and vigor (Zuo Qiang), relying on Jing (Essence) and Blood to maintain its robustness. If Kidney deficiency leads to the exhaustion of Jing, Blood will inevitably follow, causing a simultaneous decline of both Jing and Blood. Damp-heat and wind-toxins then take the opportunity to invade. Consequently, symptoms such as inability to walk, soreness and weakness of the lower back, and contraction of the sinews arise. Furthermore, the Kidney encompasses both Water and Fire. If Fire becomes excessive and scorches Yin, and damp-heat intertwines, it is natural for the sinews and bones to lose their function due to lack of nourishment. In this formula, Huang Bo is selected to clear deficient fire within the Yin aspect and dry dampness between the bones. Since bitter flavor can firm the Kidney, it serves as a crucial herb for treating Wei syndrome (Flaccidity Syndrome) and is thus designated as the Sovereign (Jun) herb. Hu Gu removes wind-toxin and strengthens the sinews and bones, serving as the Minister (Chen) herb. Because the water from the high source (Lung Metal) does not descend, when the Mother organ (Lung) is deficient, the Child organ (Kidney) also becomes deficient. When Liver blood fails to return and store, the child's disease exacerbates the mother's condition. Therefore, Zhi Mu is used to clear Lung Yuan (source Qi), while Dang Gui and Bai Shao nourish Liver blood, guiding them back to the Kidney. Gui Ban possesses profound Yin energy from heaven and earth, swallowing without regurgitating, symbolizing its role in stabilizing the North (the seat of the Kidney). Additionally, Shu Di Huang, Niu Xi, Suo Yang, and mutton constitute a group of substances that tonify water and essence, allowing for dual supplementation of Jing and Blood. As for Chen Pi, it regulates blood flow and moves Qi. Here lies the subtle interaction where Qi transformation generates Blood and Blood movement aids Qi. Thus, the sinews and bones will surely become strong and vigorous, powerful like a tiger. The "Daoist Scriptures" state: "The tiger is born from water," which embodies the meaning of "Qian" (Submerge/Hide). Hence, the name "Hu Qian Wan" (Tiger Submerging Pill) is given. Ye Zhongjian states: Although Wei syndrome originates from the five Zang organs, its root lies in the Kidney, and its manifestation lies in the Lung. The "Nei Jing" (Inner Canon) states: When the lungs suffer heat causing the leaves to wither, Wei Bi (flaccid paralysis) ensues. It also says: When Yang qi invades internally and Water cannot overcome Fire, bone flaccidity and marrow emptiness occur, rendering the feet unable to support the body. Bone flaccidity arises from intense heat. If mistaken for deficiency-cold and treated with Gui Zhi (Cinnamomi Ramulus) or Fu Zi (Aconiti Lateralis Radix Praeparata), it often leads to untreatable conditions. This formula uses "Tiger" in its name because the tiger, among beasts, embodies the most rigid Metal Qi. Its roar generates wind, specifically symbolizing Lung Metal. The term "Qian" implies that Metal is nourished by Water, the mother hides within the fetus; thus, the generator of Metal must rely on Liushui (clear water/Kidney Water), intending to guide Qi back to the Kidney. The turtle corresponds to the image of the North, possessing the thickest Yin energy. Its head often tucks into its abdomen, facilitating the Ren Mai (Conception Vessel), and greatly tonifies True Yin. This pathology deeply embodies the meaning of "Qian." Huang Bo has a heavy taste and belongs to Yin within Yin, specifically tonifying the insufficient Yin of the Kidney and Bladder, enabling strength to surge in the feet and knees. Therefore, these two herbs must be used as Sovereigns for treating flaccidity: one to secure the root, the other to treat the branch. Fearing that odd-numbered prescriptions may fail, even-numbered combinations are employed. Shu Di Huang fills the Essence of Shaoyin (Kidney), assisting Gui Ban; Zhi Mu clears the Qi of Taiyin (Lung), assisting Huang Bo; Niu Xi enters the Liver to relax sinews; Dang Gui and Bai Shao assist in ensuring Liver blood has a place to reside; Chen Pi regulates to ensure the free flow of Qi and Blood, making bones upright and sinews flexible. Furthermore, fearing that extreme heat generates wind which lingers in the joints, Hu Gu is used to disperse it. Pure Yin without Yang cannot generate vitality, so Suo Yang is added to warm. Mutton is used to make pills, tonifying through flavor. Light salt water is used for administration to urgently direct the medicine into the Kidney. All these illustrate the meaning of "Qian."