(丹溪)
治内燥津液枯少(内燥血液枯少也。火炎水干,故津液枯少。)
当归 白芍 熟地黄(一钱) 天冬 麦冬 栝蒌(八分) 桃仁(研) 红花(五分。)
此手太阴、足厥阴药也。归、芍、地黄滋阴可以生血;栝蒌、二冬润燥兼能生津;桃仁
、红花活血又可润燥。分用各有专能,合用更互相济。
(东垣)
治肺金受湿热之邪,痿 喘促,胸满少食,色白毛败,头眩体重,身痛肢倦,口渴便秘
(经曰∶肺也者,传相之官也,治节出焉。火盛克金,则肺热叶焦,气无所主,而失其治节,
故肢体或纵或缩,而成痿 也;火上逆肺,故喘促;肺主皮毛,故色白毛败;湿热填于膈中
故胸
气不
黄 (钱半) 苍术(炒,一钱) 白术(炒) 陈皮 泽泻(五分) 人参 茯苓 升
麻(三
苓(二分) 柴胡 黄连(炒,一分) 五味子(九粒。)每服五钱。
此手足太阴、阳明药也。肺属辛金而主气,大肠属庚金而主津,燥金受湿热之邪,则寒
水膀胱生化之源绝,源绝则肾水亏(金不能生水),而痿 诸症作矣。金者,水之母也;气
者,水之源也。黄 益元气而实皮毛,故以为君;二术、参、苓、甘、橘、神曲健脾燥湿,
理气化滞,所以运动其土,土者金之母也;麦冬、五味保肺以生津,当归、生地滋阴而养血,
黄柏、黄连燥湿而清热(黄柏合苍术,名二妙散∶治痿正药,加牛膝名三妙散,)升麻、柴
胡所以升清,猪苓、泽泻所以降浊,使湿热从小便出,则燥金整肃肺为整肃之脏,水出高源,
而诸证平矣(喻嘉言曰∶燥与湿相反者也,方名清燥,而以去湿为首务,非东垣具过人之识,
不及此矣。朱丹溪曰∶今世风病,大率与诸痿证混同论治;古圣论风痿,条目不同,治法亦
异,夫风病外感,善行数变,其病多实,发表行滞,有何不可?诸痿起于肺热,传入五脏,
散为诸证,其昏惑螈 瞀闷,暴病郁冒,蒙昧暴喑,皆属于火;其四肢不举,足痿舌强,痰
涎有声,皆属于土,悉是湿热之病,当作诸痿论治。大抵只宜用补养,若以外感风邪治之,
宁免实实虚虚之祸乎。或曰∶《内经》治痿,独取阳明何也,曰∶只诸痿生于肺热一语,已
见大意,金体燥而居上,主气畏火者也;土性湿而居中,主四肢畏木者也;嗜欲不节,则水
失所养,火寡于畏而侮所胜,肺得火邪而热矣,肺受热邪,则金失所养;木寡于畏而侮所不
胜,脾得木邪而伤矣,肺热则不能管摄一身,脾虚则四肢不为人用,而诸痿之病作矣。泻南
方则肺金清而东方不实,何脾伤之有;补北方则心火降而肺金不虚,何脾热之有。故阳明实
则宗筋润
(朱丹溪)
治疗内燥证,津液枯少(所谓内燥,是指血液枯少。因火邪炎上灼烧,导致肾水干涸,所以津液枯少。)
当归、白芍、熟地黄(各一钱)、天冬、麦冬、栝蒌(各八分)、桃仁(研碎)、红花(五分)。
这是作用于手太阴肺经和足厥阴肝经的药物。当归、白芍、熟地黄能滋阴以生血;栝蒌、天冬、麦冬能润燥兼能生津;桃仁、红花能活血又可润燥。分别使用各有专长,合用则更能相互补益。
(李东垣)
治疗肺金受湿热之邪侵袭,出现痿证(肢体软弱无力,不能随意运动)、喘促(呼吸急促困难),胸中满闷,食欲减少,面色苍白,毛发枯败,头晕,身体沉重,周身疼痛,四肢倦怠,口渴,大便秘结。
(《内经》说:肺是相傅之官,治理调节全身气机。若火邪过盛克制肺金,则肺热叶焦,气无所主,失去治理调节功能,所以肢体或松弛或收缩,形成痿证;火气上逆犯肺,所以喘促;肺主皮毛,所以面色白、毛发败坏;湿热填塞于膈中,所以胸中满闷……)
黄芪(一钱半)、苍术(炒,一钱)、白术(炒)、陈皮、泽泻(五分)、人参、茯苓、升麻(三钱)、猪苓(二分)、柴胡、黄连(炒,一分)、五味子(九粒)。每服五钱。
这是作用于手足太阴、阳明经的药物。肺属辛金而主气,大肠属庚金而主津液。燥金受到湿热之邪的侵害,则寒水膀胱生化之源断绝,源绝则肾水亏虚(因为金不能生水),于是痿证诸症发作。金是水之母;气是水的源头。黄芪补益元气而充实皮毛,所以作为君药;苍术、白术、人参、茯苓、甘草、陈皮、神曲健脾燥湿,理气化滞,以此来运化脾土,土是金之母;麦冬、五味子保肺以生津液,当归、生地滋阴而养血,黄柏、黄连燥湿而清热(黄柏合苍术,名为二妙散:是治疗痿证的正药,加牛膝名为三妙散);升麻、柴胡用来升举清阳,猪苓、泽泻用来降泄浊阴,使湿热从小便排出,那么燥金得以整肃。肺为整肃之脏,水源出自高源(肺),于是诸证平息。(喻嘉言说:燥与湿是相反的,方名清燥,却以去湿为首要任务,若非李东垣具有过人的见识,达不到这种境界。朱丹溪说:当今世间的风病,大多与各种痿证混同论治;古代圣人对风病和痿病的论述,条目不同,治疗方法也不同。风病属于外感,善行数变,其病多属实证,采用发汗解表、行气导滞的方法,有什么不可以?各种痿证起于肺热,传入五脏,散为各种症状,那些神志昏惑、抽搐、视物模糊、胸闷、突然发病郁冒、蒙昧失音,都属于火;那些四肢不能举动、足部痿软、舌体强硬、痰涎有声,都属于土,都是湿热之病,应当按各种痿证来论治。大抵只宜用补养法,如果用治疗外感风邪的方法来治,难道不避免不了实实虚虚的祸害吗?有人问:《内经》治疗痿证,为什么独取阳明?回答说:仅从“各种痿证生于肺热”这一句话,已可见大意。金性燥而居上,主气而畏火;土性湿而居中,主四肢而畏木。如果嗜欲不节制,则肾水失于滋养,火少了畏惧而欺侮其所胜之金,肺得到火邪而发热;肺受热邪,则金失于滋养;木少了畏惧而欺侮其所不胜之土,脾得到木邪而受伤。肺热则不能管摄一身,脾虚则四肢不能为人所用,于是各种痿病发作。泻南方心火则肺金清而东方肝木不实,哪里还有脾伤的问题;补北方肾水则心火降而肺金不虚,哪里还有脾热的问题。所以阳明实则宗筋润……)
(Zhu Danxi)
Treats internal dryness with withered and scanty body fluids (Internal dryness refers to the depletion of blood. Due to blazing fire scorching yin fluids, body fluids become withered and scarce.)
Danggui (Radix Angelicae Sinensis), Baishao (Radix Paeoniae Alba), Shudihuang (Prepared Rhizoma Anemarrhenae? No, Radix Rehmanniae Praeparata) (1 qian each), Tiantong (Herba Asparagi), Maidong (Rhizoma Ophiopogonis), Gualou (Fructus Trichosanthis) (8 fen each), Taoren (Semen Persicae, crushed), Honghua (Flos Carthami) (5 fen).
These are herbs acting on the Hand-Taiyin Lung Meridian and Foot-Jueyin Liver Meridian. Danggui, Baishao, and Shudihuang nourish yin to generate blood; Gualou, Tiantong, and Maidong moisten dryness and also generate fluids; Taoren and Honghua invigorate blood and further moisten dryness. Used separately, each has its specific function; used together, they mutually supplement each other.
(Li Dongyuan)
Treats cases where Lung Metal is invaded by damp-heat pathogenic factors, presenting with Wei syndrome (flaccidity syndrome), panting and shortness of breath, chest fullness, poor appetite, pale complexion, withered hair, dizziness, heavy body, generalized pain, limb fatigue, thirst, and constipation. (The *Neijing* states: The Lung is the official of transmission and regulation, from which governance and regulation emerge. If fire is excessive and overacts on Metal, Lung heat scorches the leaves, Qi loses its mastery, and governance fails, resulting in limbs that are either flaccid or contracted, forming Wei syndrome; Fire counterflows upward to invade the Lung, hence panting; The Lung governs skin and hair, hence pale complexion and withered hair; Damp-heat fills the diaphragm, hence chest fullness and... [text incomplete])
Huangqi (Radix Astragali) (1.5 qian), Cangzhu (Rhizoma Atractylodis Lanceae, stir-fried) (1 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, stir-fried), Chenpi (Pericarpium Citri Reticulatae), Zexie (Rhizoma Alismatis) (5 fen), Renshen (Radix Ginseng), Fuling (Poria), Shengma (Rhizoma Cimicifugae) (3 qian), Zhuling (Poria cum Ramo et Ligno), Chaihu (Radix Bupleuri), Huanglian (Rhizoma Coptidis, stir-fried) (1 fen), Wuweizi (Fructus Schisandrae) (9 grains). Take 5 qian per dose.
These are herbs acting on the Hand-Foot Taiyin and Yangming meridians. The Lung belongs to Xin-Metal and governs Qi; the Large Intestine belongs to Geng-Metal and governs Jin-Ye (body fluids). When Dry Metal is invaded by damp-heat pathogens, the source of transformation and generation of Cold Water (Bladder/Kidney system) is cut off. When the source is cut off, Kidney Water becomes deficient (as Metal cannot generate Water), and various symptoms of Wei syndrome arise. Metal is the mother of Water; Qi is the source of Water. Huangqi tonifies Yuan Qi and consolidates the exterior (skin/hair), thus serving as the Sovereign herb; Cangzhu, Baizhu, Renshen, Fuling, Gancao (Licorice), Chenpi, and Shenqu (Massa Medicata Fermentata) strengthen the Spleen, dry dampness, regulate Qi, and resolve stagnation, thereby moving Earth. Earth is the mother of Metal; Maidong and Wuweizi protect the Lung to generate fluids; Danggui and Shengdi (Prepared Radix Rehmanniae) nourish yin and nourish blood; Huangbai (Cortex Phellodendri) and Huanglian dry dampness and clear heat (Huangbai combined with Cangzhu is named Ermiao San, a primary remedy for Wei syndrome; adding Niuxi makes it Sanmiao San); Shengma and Chaihu ascend the clear Yang; Zhuling and Zexie descend turbid Yin, allowing damp-heat to exit via urination. Thus, Dry Metal is restored to order. The Lung is an organ of order; water originates from the high source (Lung), and all symptoms subside. (Yu Jiayan said: Dryness and Dampness are opposites. The formula is named "Qingzao Tang" (Clear Dryness Decoction), yet prioritizes removing dampness. Only Li Dongyuan's superior insight could achieve this. Zhu Danxi said: In modern times, Bi syndrome is largely treated confusedly with various Wei syndromes. Ancient sages distinguished Wind and Wei conditions with different entries and treatments. Wind diseases are exogenous, change rapidly, and are mostly excess patterns; using releasing and moving methods is acceptable. All Wei syndromes originate from Lung Heat, transmitting to the Five Zang organs, scattering into various symptoms. Confusion, convulsions, oppression, sudden onset of depression, mental clouding, and sudden aphonia belong to Fire; inability to move limbs, foot flaccidity, stiff tongue, and audible phlegm belong to Earth. These are all damp-heat diseases and should be treated as Wei syndromes. Generally, only tonification and nourishment are suitable. If treated as exogenous wind, one risks the disaster of reinforcing excess and depleting deficiency. Someone asked: Why does the *Neijing* state that treating Wei syndrome focuses solely on the Yangming? I reply: The phrase "all Wei syndromes arise from Lung Heat" already reveals the main idea. Metal is dry and resides above, governing Qi and fearing Fire; Earth is damp and resides in the center, governing the four limbs and fearing Wood. If desires are not regulated, Water loses nourishment, Fire lacks restraint and overacts on Metal, causing Lung Heat. Lung Heat damages Metal. Wood lacks restraint and overacts on Earth, injuring the Spleen. Lung Heat cannot control the whole body; Spleen Deficiency means the limbs cannot be used, leading to Wei syndrome. Clearing the South (Heart/Fire) clears Lung Metal so East (Liver/Wood) is not excessive, how can Spleen be injured? Tonifying the North (Kidney/Water) descends Heart Fire so Lung Metal is not deficient, how can Spleen be hot? Therefore, when Yangming is Excess, the tendons are moistened...)