乌梅
揩擦牙龈,涎出即开。
木旺则克土,木燥则筋急,泄木缓筋,则土郁自开矣。
白术(陈壁土炒)二两 人参 干姜(炮) 甘草(炙)一两
每服四钱。自利腹痛者加木香,不痛利多者倍加白术,渴者倍白术,蜷卧沉重利不止加
附子,腹满去甘草,呕吐去白术加半夏、姜汁,脐下动气则去术加桂,悸加茯苓,阴黄加茵
陈,寒结胸加枳实。本方等分蜜丸,名理中丸。
寒有外感、有传经、有直中、有痼冷。外感之寒先病在表,后传入里,必发热而恶寒,
此伤寒之寒病也;直中之寒,手足厥冷,并不发热;痼冷在内,遇寒而发,暴猝厥逆,其势
尤重,此中寒门之寒病也。施治之法,伤寒一门,在表者宜辛散,传里者宜辛温。中寒一门,
则每用辛热回阳急救之法。此伤寒、中寒治法之分也。理中汤,治伤寒太阴病,腹痛、便溏
等症,亦通治中脘虚寒。惟云治结胸吐蛔,感寒霍乱,此两条则宜去人参、甘草,量加浓朴、
附子一枚(生用) 干姜一两 甘草(炙)二两
冷服。面赤加葱九茎,腹痛加芍药二两,咽痛加桔梗一两,利止,脉不出加人参二两,
呕吐生姜二两。
四逆汤为四肢厥逆而设。仲景立此方,以治伤寒之少阴症。若太阴之腹痛下利、完谷不
化,厥阴之恶寒不汗、四肢厥冷者亦宜之。盖阴惨之气深入于里,真阳几几欲绝,非此纯阳
之品,不足以破阴气而发阳光。又恐姜附之性过于燥烈,反伤上焦,故倍用甘草以缓之。立
方之法,尽美尽善。后人分传经为热厥,直中为寒厥,程郊倩讥之。然亦有未可尽非者。仲
景曰∶“伤寒一二日至四五日而厥者,必发热,应下之。”此明明说厥逆在前,发热在后,
及至发热则不复厥冷,乃伤寒失下之症,故荡涤邪滞,则发热自退,本非为厥而不热者言也。
程氏又云∶“下之者,下其热,非下其厥也,遇发热则可下,遇厥则万不可下。”此数语最
为明白了当,可见传经之邪亦自有当下者,但不可概谓之热厥耳。四逆者,必手冷过肘,足
冷过膝,脉沉细无力,腹痛下利等象咸备,方可用之,否则不可轻投。
乌梅
用乌梅擦拭牙龈,唾液流出后牙关紧闭的症状即可缓解。
肝木之气过旺会克制脾土,肝木燥热则导致筋脉拘急,通过疏泄肝木、舒缓筋脉,脾土的郁结自然得以解开。
白术(用陈壁土炒制)二两 人参 干姜(炮制) 甘草(炙制)一两
每次服用四钱。如果是自发性腹泻且伴有腹痛,加入木香;如果不痛但腹泻次数多,加倍使用白术;口渴者加倍使用白术;身体蜷缩卧倒、沉重无力且腹泻不止,加入附子;腹部胀满去掉甘草;呕吐去掉白术并加入半夏和姜汁;脐下悸动气逆则去掉白术加入桂枝;心悸加入茯苓;阴黄症加入茵陈;寒邪凝结成胸痹加枳实。本方各药等分制成蜜丸,名为理中丸。
寒邪有外感所致、有由表传里、有直中脏腑、有久积之冷。外感之寒起初病在体表,后来传入体内,必然出现发热且恶寒,这是伤寒类的寒病;直中之寒,手足冰冷,并不发热;久积之冷在内,遇寒冷诱发,突然发生厥逆,病情尤其严重,这是中寒门类的寒病。治疗原则,伤寒一类,病在表宜用辛散法,传入里宜用辛温法。中寒一类,则多用辛热回阳急救的方法。这是伤寒与中寒治法的区别。理中汤,治疗伤寒太阴病,如腹痛、大便溏稀等症状,也通用治疗中脘虚寒。如果说治疗结胸吐蛔虫、感寒霍乱,这两条应当去掉人参、甘草,酌情加入厚朴、
附子一枚(生用) 干姜一两 甘草(炙制)二两
冷服。面色发红加葱九根,腹痛加芍药二两,咽痛加桔梗一两,腹泻停止但脉搏摸不到加人参二两,呕吐加生姜二两。
四逆汤是为四肢厥逆而设立的。张仲景创立此方,用于治疗伤寒少阴证。如果是太阴病的腹痛下利、完谷不化,厥阴病的恶寒无汗、四肢厥冷,也适宜使用。因为阴寒之气深入体内,真阳几乎要断绝,不用这种纯阳的药物,不足以破除阴气而激发阳气。又担心干姜、附子的性质过于燥烈,反而损伤上焦,所以加倍使用甘草来缓和药性。立方的方法,尽善尽美。后人将传经病变分为热厥,直中病变分为寒厥,程郊倩对此进行了讥讽。然而也有并非完全错误的地方。张仲景说:“伤寒一二天到四五天出现厥冷的,必定会发热,应该用下法。”这明明是说厥逆在前,发热在后,等到发热时就不再厥冷,这是伤寒失于攻下的病症,所以荡涤邪气滞结,发热自然消退,本来就不是针对只厥冷不发热的情况说的。程氏又说:“用下法,是下其热,不是下其厥,遇到发热可以下,遇到厥冷万万不可下。”这几句话最为明白妥当,可见传经的邪气也有应当用下法的,只是不能一概称为热厥罢了。所谓四逆,必须手冷超过肘部,脚冷超过膝盖,脉象沉细无力,腹痛下利等症状都具备,才可以应用,否则不可轻易投药。
Wumei (Fructus Mume)
Rubbing the gums with Wumei causes saliva to flow, which immediately relieves trismus (lockjaw).
When Liver Wood Qi is excessive, it overacts on Spleen Earth. When Liver Wood is dry, tendons become tense. By draining Liver Wood and relaxing the tendons, the stagnation of Spleen Earth naturally resolves.
Baizhu (Atractylodis Macrocephalae Rhizoma) stir-fried with aged wall soil two liang; Renshen (Ginseng Radix et Rhizoma); Ganjiang (Zingiberis Rhizoma Recens) processed; Gancao (Glycyrrhizae Radix et Rhizoma) honey-fried one liang.
Take four qian per dose. If there is spontaneous diarrhea with abdominal pain, add Muxiang (Aucklandiae Radix). If there is no pain but frequent diarrhea, double the amount of Baizhu. If thirsty, double the amount of Baizhu. If the patient curls up, feels heavy, and has intractable diarrhea, add Fuzi (Aconiti Lateralis Radix Preparata). If there is abdominal fullness, remove Gancao. If vomiting occurs, remove Baizhu and add Banxia (Pinelliae Rhizoma) and ginger juice. If there is qi movement below the navel, remove Baizhu and add Guizhi (Cinnamomi Ramulus). If palpitations occur, add Fuling (Poria). For Yin jaundice, add Ychen (Artemisiae Scopariae Herba). For cold binding in the chest, add Zhishi (Aurantii Fructus Immaturus). The ingredients of this formula in equal parts made into honey pills are named Lizhong Wan (Regulate the Middle Pill).
Cold pathogens can be exogenous, transmitted from the exterior, direct invasion, or chronic cold accumulation. Exogenous cold initially affects the exterior and later transmits inward, necessarily presenting with fever and aversion to cold; this is a cold disease of the Shanghan (Cold Damage) category. Direct invasion cold presents with cold limbs without fever. Chronic cold accumulated internally, triggered by cold, causing sudden syncope and reversal, is particularly severe; this is a cold disease of the Zhonghan (Middle Cold) category. In terms of treatment: for Shanghan, if the pathogen is in the exterior, acrid-dispersing methods are suitable; if transmitted inward, acrid-warm methods are suitable. For Zhonghan, acrid-hot methods to restore Yang and provide emergency rescue are commonly used. This distinguishes the treatment methods for Shanghan and Zhonghan. Lizhong Tang (Regulate the Middle Decoction) treats Taiyin syndrome of Shanghan, such as abdominal pain and loose stools, and also generally treats deficiency-cold of the middle jiao. However, regarding the treatment of chest binding with vomiting of roundworms and cold-induced cholera-like diarrhea, Ren Shen and Gan Cao should be removed, and Houpo (Magnoliae Officinalis Cortex) added in appropriate amounts.
Fuzi (Aconiti Lateralis Radix Preparata) one piece (raw use); Ganjiang (Zingiberis Rhizoma Recens) one liang; Gancao (Glycyrrhizae Radix et Rhizoma) honey-fried two liang.
Take cold. If the face is red, add nine stalks of Congbai (Allii Fistulosi Bulbus). If abdominal pain, add Shaoyao (Paeoniae Radix Alba) two liang. If sore throat, add Jiegeng (Platycodonis Radix) one liang. If diarrhea stops but the pulse is imperceptible, add Renshen (Ginseng Radix et Rhizoma) two liang. If vomiting, add Shengjiang (Zingiberis Rhizoma Recens) two liang.
Sini Tang (Recover the Extremities Decoction) is established for limb reversal-cold. Zhang Zhongjing formulated this decoction to treat Shaoyin syndrome of Shanghan. It is also suitable for Taiyin syndrome with abdominal pain and diarrhea, undigested food in stool, and Jueyin syndrome with aversion to cold, absence of sweating, and cold limbs. This is because yin-cold qi has penetrated deeply into the interior, and true Yang is nearly exhausted. Only pure yang substances are sufficient to break through yin qi and stimulate the sun-yang. Furthermore, fearing that the properties of Ganjiang and Fuzi are too drying and fierce, potentially damaging the upper jiao, Gancao is doubled to moderate their effects. The method of formulation is perfect. Later generations distinguished transmitted-heat as heat-reversal and direct-invasion as cold-reversal; Cheng Jiaoqian criticized this view. However, there are aspects that are not entirely incorrect. Zhang Zhongjing stated: "In Shanghan, if reversal-cold occurs from the first to the fourth or fifth day, there must be fever, and purgation should be used." This clearly indicates that reversal-cold precedes fever. When fever appears, reversal-cold ceases; this is a condition resulting from failure to purge in Shanghan. Therefore, clearing pathogenic stagnation allows the fever to subside naturally. This was not originally stated for cases where there is only reversal-cold without fever. Cheng further stated: "Purgation targets the heat, not the reversal-cold. Purge when there is fever; never purge when there is only reversal-cold." These words are very clear and appropriate. This shows that pathogens transmitted through meridians also have indications for purgation, but they cannot be broadly categorized as heat-reversal. Sini Tang should only be used when all signs of Si Ni (reversal-cold) are present: hand cold extending past the elbows, foot cold extending past the knees, deep, fine, and forceless pulse, accompanied by abdominal pain and diarrhea. Otherwise, it should not be administered lightly.