(陈无择)
治缠喉风痹,咽喉肿痛,咽物有碍;或风涎壅滞,口舌生疮,大人酒症,小儿奶癣,及
骨屑哽塞。
元参 黄连 荆芥 贯众 山豆根 茯苓 甘草 砂仁 滑石(五钱) 硼砂 寒水石
(三钱。)为
玄参最能生
此足阳明、少阴药也。元参、黄连、寒水石清火,贯众、山豆根解毒,滑石、茯苓利水
,砂仁、硼砂软坚(并能消骨鲠),荆芥散结,甘草和中,故能统治诸证也(朱丹溪曰∶咽
痛必用荆芥,虚火上炎必用玄参。又有阴气大虚,虚火游行无制,客于咽喉,遂成咽痛,脉
必浮大,重
(《直指》)
治下痢赤白,脓血相杂,里急后重(湿热之积,干于血分则赤,干于气分则白,赤白兼
下者,气血俱病也。后重里急者,气滞不通也。按∶里急后重,有因火热者,有因气滞者,
有因积
黄连(二十两,)吴茱萸(十两同炒) 木香(四两八钱,不见火。)醋糊丸。米饮下。
一方等分,蜜丸。一方加甘草八两,黄连用蜜水拌,蒸晒九次,入木香为丸。
此手足阳明药也。痢为饮食不节,寒暑所伤,湿热蒸郁而成。黄连苦燥湿,寒胜热,直
折心脾之火,故以为君;用吴茱同炒者,取其能利大肠壅气(痢乃脾病传于大肠),且以杀
大寒之性也。里急由于气滞,木香辛行气,温和脾,能通利三焦,泄肺以平肝,使木邪不克
脾土,气行而滞亦去也。一寒一热,一阴一阳,有相济之妙,经所谓热因寒用也(痢疾初起
忌用,为黄连浓胃涩肠也。《原病式》曰∶或言下痢白为寒者,误也,寒则不能消谷,何由
反化为脓也。燥郁为白,属肺金也。泄痢皆兼于湿,湿热甚于肠胃之内,致气液不得宣通,
使烦渴不止也;下痢赤白,俗言寒热相兼,其说尤误,寒热异气,岂能俱甚于肠胃,而同为
痢乎,各随五脏之部而见其色,其本则一出于热,但分浅深而已。或曰∶何故服辛热之药亦
有愈者,曰∶为能开发郁结,使气液宣通,流湿润燥,气和而已;莫若用辛苦寒之药,微加
辛热佐之,如钱氏香连丸之类是也。昂按∶刘说固是,然病亦有寒热合邪者)。
本方加石莲肉,治噤口痢。本方倍大黄,治热痢积滞。本方加吴茱萸、肉豆蔻,名乌梅
汤丸、本方加诃子、龙骨,名黄连丸(《宣明》)∶并治痢疾断下(石莲清心火,开胃口;大
黄泻胃热,荡积滞;吴茱利壅气;肉蔻、诃子、乌梅、龙骨,皆涩大肠)。
(陈无择)
治疗缠喉风痹,咽喉红肿疼痛,吞咽食物有阻碍感;或者风痰壅滞,口舌生疮,成人酒毒积聚,小儿奶癣,以及鱼骨刺卡住喉咙。
玄参、黄连、荆芥、贯众、山豆根、茯苓、甘草、砂仁、滑石(各五钱)、硼砂、寒水石(各三钱)。研为细末。
玄参最能滋阴降火。
这是足阳明胃经和足少阴肾经的药物。玄参、黄连、寒水石清热泻火,贯众、山豆根解毒,滑石、茯苓利水渗湿,砂仁、硼砂软化坚积(并能消除骨鲠),荆芥散结消肿,甘草调和脾胃,所以能统治上述各种病症。(朱丹溪说:咽痛必须用荆芥,虚火上炎必须用玄参。又有阴气大虚,虚火游行不受制约,客居于咽喉,于是形成咽痛,脉象必定浮大,重按无力……)
(《直指方》)
治疗下痢赤白,脓血混杂,里急后重(湿热之邪积聚,侵犯血分则便下赤色,侵犯气分则便下白色,赤白兼下的,是气血都患病了。里急后重的,是气机阻滞不通所致。按语:里急后重,有的因火热引起,有的因气滞引起,有的因积滞引起……)
黄连(二十两),吴茱萸(十两同炒),木香(四两八钱,不经过火炒)。用醋糊制成丸剂。米汤送服。
另一配方各药等分,用蜂蜜制丸。另一配方加甘草八两,黄连用蜜水拌润,蒸晒九次,加入木香制成丸剂。
这是手足阳明经的药物。痢疾是由于饮食不节制,受寒暑侵袭,湿热蒸腾郁结而成。黄连苦燥能祛湿,寒性能胜热,直接折抑心脾之火,所以作为君药;用吴茱萸同炒的原因,是取其能疏通大肠壅滞之气(痢疾是脾病传变到大肠),并且可以抑制黄连大寒的性质。里急是因为气滞,木香辛散能行气,温和脾胃,能通利三焦,泄肺金以平肝木,使木邪不克制脾土,气行则滞去。一寒一热,一阴一阳,有相互济助的妙处,即经书所说的“热因寒用”(痢疾初起忌用此法,因为黄连浓浊会涩肠止泻。《原病式》说:有人说下痢白色属寒证,这是错误的,寒证则不能消化谷物,怎么能反化为脓呢?燥郁导致白色,属于肺金。泄痢都兼夹湿邪,湿热在肠胃内甚盛,导致气液不得宣通,使人烦渴不止;下痢赤白,俗话说是寒热兼夹,这种说法尤其错误,寒热是两种不同的气,怎么能同时在肠胃内极盛而共同导致痢疾呢?颜色随五脏所属部位而显现,其根本都出于热,只是深浅不同而已。有人问:为什么服用辛热药物也有痊愈的?回答说:因为能开发郁结,使气液宣通,流湿润燥,气机调和罢了;不如使用辛苦寒的药物,微微加入辛热药作为佐使,如钱乙的香连丸之类就是如此。汪昂按语:刘完素的说法固然正确,然而疾病也有寒热合邪的情况)。
本方加石莲肉,治疗噤口痢。本方倍加大黄,治疗热痢积滞。本方加吴茱萸、肉豆蔻,名为乌梅汤丸;本方加诃子、龙骨,名为黄连丸(出自《宣明论方》):均治疗痢疾断下(石莲清心火,开胃气;大黄泻胃热,荡涤积滞;吴茱萸利壅滞之气;肉豆蔻、诃子、乌梅、龙骨,都能涩肠止泻)。
(Chen Wuyue)
Treats *Chanhoufeng* (Entangling Throat Wind), characterized by swelling and pain in the throat and pharynx, with difficulty swallowing; or wind-phlegm obstruction, sores on the mouth and tongue, alcohol toxicity in adults, infantile eczema (*Nai Xuan*), and fish bone impaction.
Xuan Shen (Scrophulariae Radix), Huang Lian (Coptidis Rhizoma), Jing Jie (Schizonepetae Herba), Guan Zhong (Cyathullae Rhizoma), Shan Dou Gen (Sophorae Tonkinensis Radix et Cortex), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sha Ren (Amomi Fructus), Hua Shi (Talcum) (each 5 qian), Peng Sha (Borax), Han Shui Shi (Aqua Calcit) (each 3 qian). Grind into fine powder.
Xuan Shen is most effective at nourishing yin and descending fire.
This formula acts on the Foot-Yangming Stomach channel and Foot-Shaoyin Kidney channel. Xuan Shen, Huang Lian, and Han Shui Shi clear heat and purge fire; Guan Zhong and Shan Dou Gen detoxify; Hua Shi and Fu Ling promote urination to leach out dampness; Sha Ren and Peng Sha soften hardness (and can also resolve bone impaction); Jing Jie disperses nodules; Gan Cao harmonizes the middle jiao. Thus, it can comprehensively treat these various conditions. (Zhu Danxi said: For sore throat, Jing Jie must be used; for deficiency fire flaming upward, Xuan Shen must be used. There are cases where yin qi is severely deficient, causing deficiency fire to wander uncontrollably and lodge in the throat, resulting in sore throat. The pulse will be floating and large, but empty upon heavy pressure...)
(*Zhizhi Fang*)
Treats dysentery with red and white discharge, where pus and blood are mixed, accompanied by tenesmus (Strain and urgency). (Damp-heat accumulation invading the blood level results in red discharge; invading the qi level results in white discharge; mixed red and white indicates both qi and blood are affected. Tenesmus is caused by stagnation of qi flow. Note: Tenesmus may be due to fire-heat, qi stagnation, or food retention...)
Huang Lian (Coptidis Rhizoma) (20 liang), Wu Zhu Yu (Evodiae Fructus) (10 liang, stir-fried together), Mu Xiang (Aucklandiae Radix) (4 liang 8 qian, not roasted). Make pills using vinegar paste. Take with rice water.
Another prescription uses equal parts of herbs, made into honeyed pills. Another prescription adds 8 liang of Gan Cao; Huang Lian is moistened with honey-water, steamed and sun-dried nine times, then mixed with Mu Xiang to make pills.
This formula acts on the Hand-Yangming Large Intestine and Foot-Yangming Stomach channels. Dysentery arises from irregular diet and injury by cold or summerheat, leading to steaming and郁 (stagnation) of damp-heat. Huang Lian is bitter and drying to remove dampness, and cold to overcome heat, directly subduing the fire of the Heart and Spleen, hence serving as the Sovereign herb. Wu Zhu Yu is stir-fried with it to utilize its ability to unblock stagnant qi in the Large Intestine (dysentery is a transmission of Spleen disease to the Large Intestine), and to mitigate the excessive cold nature of Huang Lian. Tenesmus is due to qi stagnation; Mu Xiang is acrid and moving to circulate qi, warms and harmonizes the Spleen, unblocks the Triple Burner, drains Lung metal to pacify Liver wood, preventing Wood from overacting on Earth, so that when qi moves, stagnation resolves. One is cold, one is hot; one is yin, one is yang; they have the subtle benefit of mutual assistance, as described in the classics as "treating heat with cold" (Note: Contraindicated in early-stage dysentery because Huang Lian's cloying nature may bind the intestines. *Yuan Bing Shi* states: Some say white dysentery is due to cold; this is wrong. Cold cannot digest grain, how could it transform into pus? Dryness and stagnation causing whiteness belong to Lung Metal. Diarrhea and dysentery always involve dampness. When damp-heat is severe within the intestines and stomach, qi and fluids fail to circulate freely, causing incessant thirst and irritability. The popular notion that red-and-white dysentery implies mixed cold and heat is particularly erroneous. Cold and heat are different pathogens; how can they both become severe in the intestines simultaneously to cause dysentery? Colors appear according to the zones of the Five Zang organs, but the root origin is always heat, differing only in depth. Someone asks: Why do some cases recover after taking acrid-hot medicines? Answer: Because they can open up stagnation, allowing qi and fluids to circulate, moistening dryness, and harmonizing qi. It is better to use acrid-bitter-cold medicines, slightly adding acrid-hot herbs as assistants, such as Qian Yi's Xianglian Wan. Wang Ang notes: Liu Wansu's theory is indeed correct, yet diseases can also present with combined cold and heat pathogens).
Adding Shi Lian Rou (Nelumbinis Semen) to this formula treats Jin Kou Li (Closed-mouth dysentery). Doubling the dosage of Da Huang (Rhei Radix et Rhizoma) treats heat-dysentery with retention. Adding Wu Zhu Yu and Rou Dou Kou (Myristicae Semen) creates Wumei Tang Wan. Adding He Zi (Terminalia Chebulae Fructus) and Long Gu (Fossilia Ossis Mastodi et Ossis Femoris) creates Huanglian Wan (*Xuan Ming Lun Fang*): Both treat persistent dysentery. (Shi Lian clears Heart fire and opens the stomach appetite; Da Huang purges Stomach heat and sweeps away retention; Wu Zhu Yu promotes the flow of stagnant qi; Rou Dou Kou, He Zi, Wumei, and Long Gu all astringe the Large Intestine).