桔梗 贝母(各三分) 巴豆(一钱,炒黑)
伤寒寒实结胸,无热证者,此方主之。
此证或由表解里热之时过食冷物,故令寒实结胸,然必无热证者为是。桔梗、贝母之苦
,用之以下气;巴豆之辛,用之以去实。又曰∶病在膈上则吐,病在膈下则利,此桔、贝主
上,巴豆主下之意。服后不行者,益以温汤;行之过多者,止以凉粥。
大黄(酒浸,半斤) 葶苈(炒) 杏仁(去皮尖) 芒硝(各半升) 甘遂(一钱) 白
蜜(二
顿服之,一宿乃下。不下者,更服之。
伤寒结胸项强,如柔痉状,此方下之则和。
结胸项强者,胸满硬痛,能仰而不能俯也。有汗项强为柔痉。此虽有汗,其项强乃胸中
满实而不能俯,非是中风痉急,故曰如柔痉。不用汤液而用丸剂,何也?汤主荡涤,前用大
陷胸汤者,以其从心下至少腹皆硬痛,三焦皆实,故用汤以荡之。此惟上焦满实,用汤液恐
伤中、下二焦之阴,故用丸剂以攻之。大黄、芒硝之苦寒,所以下热;葶苈、杏仁之苦甘,
所以泄满;甘遂取其直达;白蜜取其润利。
水蛭(三十枚,炒褐色) 虻虫(去翅足,炒,三十枚) 桃仁(三十枚,去皮尖) 大
黄(
伤寒不结胸,发狂,少腹硬满,小便自利,脉沉结者,以太阳随经,瘀热在里,而有瘀
血也,此方主之。
宜结胸而不结胸,故曰不结胸;瘀热内实,故令发狂,发狂则重于桃仁承气如狂矣。少
腹硬满者,下焦实也;小便利者,血病而气不病也;病深入里,故脉沉;内有积瘀,故脉结。
脉行肌下谓之沉,迟时一止谓之结。自经而言,则曰太阳;自腑而言,则曰膀胱。阳邪由经
而入,结于膀胱,故曰随经。瘀热在里,热结而燥,是瘀血也。经曰∶苦走血,咸胜血。虻
虫、水蛭之咸苦,所以除蓄血;滑能利肠,苦能泻热,桃仁、大黄之苦滑,所以利血热
伤寒病中属于寒实结胸证,且没有热象表现的,此方为主治方。
这种病症有的因为在表证已解、里热清除之时,过食生冷食物,导致寒邪与实邪结聚于胸膈,形成寒实结胸,但必须是没有热象表现才适用此方。桔梗、贝母的苦味,用来降气;巴豆的辛味,用来祛除实邪。又说:病位在膈膜以上则引起呕吐,病位在膈膜以下则引起腹泻,这是桔梗、贝母主要作用于上部,巴豆主要作用于下部的意思。服药后如果药力未行,可喝些温开水以助药力;如果药力运行过多,可吃些凉粥以停止药力。
大黄(用酒浸泡,半斤)、葶苈子(炒制)、杏仁(去皮和尖)、芒硝(各半升)、甘遂(一钱)、白蜜(二合)。将上述药物制成丸剂,如弹子大小,每次服用一丸,用煎煮的白蜜水送服。白天服用,夜间大便通下。如果未通下,再服用一次。
伤寒病出现结胸且项部僵硬,类似柔痉的症状,此方攻下后病情即可调和。
所谓结胸项强,是指胸部胀满硬痛,头能后仰但不能前俯。有汗出且项强的是柔痉。此处虽然有汗出,但其项强是因为胸中满实导致不能前俯,并非中风引起的筋脉拘急痉挛,所以说“像柔痉”。不用汤剂而用丸剂,为什么呢?汤剂主要起荡涤作用,之前使用大陷胸汤,是因为病变从心下直到小腹都硬痛,三焦皆实,所以用汤剂来荡涤。此处只有上焦满实,如果用汤剂恐怕会损伤中、下二焦的阴液,所以用丸剂来攻逐邪气。大黄、芒硝的苦寒之性,用来清泄热邪;葶苈子、杏仁的苦甘之性,用来泻除胀满;甘遂取其药力直达病所的特性;白蜜取其滋润滑利的特性。
水蛭(三十枚,炒至褐色)、虻虫(去掉翅膀和足,炒制,三十枚)、桃仁(三十枚,去皮和尖)、大黄(三两,酒洗)。将上述四味药捣碎过筛,混合均匀,加入白蜜和蜂蜜炼制的丸剂,制成如梧桐子大小的丸剂。每次服用五到七丸,每日三次。
伤寒病没有出现结胸症状,却出现发狂,少腹部硬满,小便自利,脉象沉结的,这是因为太阳经邪气随经入腑,瘀热结聚在体内,形成了瘀血,此方为主治方。
按理应当出现结胸却没有出现,所以说不结胸;瘀热内结实证,所以导致发狂,发狂比桃仁承气汤证的如狂症状更重。少腹硬满,说明下焦实证;小便通利,说明是血分有病而气分无病;病邪深入体内,所以脉象沉;内有积滞瘀血,所以脉象结。脉行于肌肉之下称为沉,脉搏跳动缓慢时偶尔有一次停顿称为结。从经络而言,称为太阳;从脏腑而言,称为膀胱。阳邪由经络传入,结聚在膀胱,所以叫作随经。瘀热在体内,热结而燥,这就是瘀血。医经说:苦味入血分,咸味能胜血。虻虫、水蛭的咸苦之性,用来消除蓄积的瘀血;滑性能通利肠道,苦性能泻热,桃仁、大黄的苦滑之性,用来通利血分之热。
Radix Platycodi (Jiegeng), Rhizoma Anemarrhenae (Beimu) (each 3 fen); Semen Crotonis Tiglii (Badou) (1 qian, stir-fried until black).
For Taiyang disease presenting as Cold-Excess Chest Binding (Han Shi Jie Xiong) without heat signs, this formula is indicated.
This condition may arise when, after the exterior syndrome has resolved and interior heat cleared, excessive consumption of cold foods leads to the binding of cold and excess in the chest. However, it must be a case without heat signs. The bitter nature of Radix Platycodi (Jiegeng) and Rhizoma Anemarrhenae (Beimu) is used to descend Qi; the pungent nature of Semen Crotonis Tiglii (Badou) is used to remove excess. It is also said: if the pathogen is above the diaphragm, vomiting occurs; if below the diaphragm, diarrhea occurs. This illustrates that Radix Platycodi (Jiegeng) and Rhizoma Anemarrhenae (Beimu) act on the upper part, while Semen Crotonis Tiglii (Badou) acts on the lower part. If the purgative effect does not occur after ingestion, drink warm water to promote it; if the effect is too strong, stop it by eating cool congee.
Radix et Rhizoma Rhei (Dahuang) (soaked in wine, 0.5 jin), Semen Lepidii seu Descurainiae (Tinglizi) (stir-fried), Semen Pruni Armeniacae (Xingren) (skin and kernels removed), Natrii Sulfas (Mangxiao) (each 0.5 sheng), Radix Kansui (Gansui) (1 qian), Mel Album (Baimi) (2 he). Process into pills the size of a bullet. Take one pill at a time, administered with honey water decoction. Ingest during the day, expect defecation overnight. If defecation does not occur, administer another dose.
In Taiyang disease, if Chest Binding (Jie Xiong) presents with stiffness of the neck, resembling Soft Spasm (Rou Jing), this formula, by purging, will harmonize the condition.
Chest Binding with neck stiffness refers to chest fullness, hardness, and pain, where the head can extend backward but cannot flex forward. Soft Spasm (Rou Jing) is characterized by sweating and neck stiffness. Although there is sweating here, the neck stiffness is due to fullness and excess in the chest preventing flexion, not due to wind-stroke causing spasm. Hence, it is described as "resembling Soft Spasm." Why use pills instead of decoctions? Decoctions primarily serve to sweep and cleanse. The previous Da Xian Xiong Tang was used because the hardness and pain extended from the epigastrium to the lower abdomen, involving all three Jiaos with excess, thus requiring a decoction for sweeping. Here, only the Upper Jiao is full and excess; using a decoction might damage the Yin of the Middle and Lower Jiaos. Therefore, pills are used to attack the pathogen gently. The bitter-cold nature of Radix et Rhizoma Rhei (Dahuang) and Natrii Sulfas (Mangxiao) clears heat; the bitter-sweet nature of Semen Lepidii seu Descurainiae (Tinglizi) and Semen Pruni Armeniacae (Xingren) drains fullness; Radix Kansui (Gansui) is chosen for its ability to reach the site directly; Mel Album (Baimi) is chosen for its moistening and lubricating properties.
Hirudo (Shuizhi) (30 pieces, stir-fried until brown), Ophryotrocha (Mengchong) (wings and feet removed, stir-fried, 30 pieces), Semen Persicae (Taoren) (30 pieces, skin and kernels removed), Radix et Rhizoma Rhei (Dahuang) (3 liang, washed with wine). Crush and sieve the four herbs, mix uniformly, and combine with refined honey to form pills the size of wutong seeds. Take 5–7 pills per dose, three times daily.
In Taiyang disease, if Chest Binding (Jie Xiong) does not occur, but mania (Fa Kuang) appears, accompanied by hardness and fullness of the lower abdomen, free urination, and a deep, knotted pulse, this indicates that Yang pathogenic factors have followed the meridians into the interior, resulting in blood stasis due to heat binding within. This formula is indicated.
It should have presented as Chest Binding but did not, hence "not Chest Binding"; internal excess of blood-heat causes mania, which is more severe than the delirious state seen in Tao Ren Cheng Qi Tang. Hardness and fullness of the lower abdomen indicate Lower Jiao excess; free urination indicates pathology in the Blood aspect rather than Qi; the pathogen has entered deeply into the interior, hence the deep pulse; accumulation of blood stasis internally results in a knotted pulse. A pulse felt beneath the muscle is called Deep (Chen); a pulse that occasionally pauses is called Knotted (Jie). From the perspective of meridians, it is Taiyang; from the perspective of zang-fu, it is the Bladder. Yang pathogens enter via the meridians and bind in the Bladder, hence termed "following the meridians." Blood-heat in the interior, bound and dry, constitutes blood stasis. The Classics state: Bitter enters the Blood, Saline overcomes Blood. The saline-bitter nature of Hirudo (Shuizhi) and Ophryotrocha (Mengchong) eliminates accumulated blood stasis; Slippery substances facilitate intestinal movement, and Bitter substances purge heat. The bitter-slippery nature of Semen Persicae (Taoren) and Radix et Rhizoma Rhei (Dahuang) facilitates the clearance of heat in the blood.