(仲景)
治伤寒胸中有热而欲呕,胃中有寒而腹痛(成氏曰∶湿家下后舌上有苔者,是丹田有热,
胸中
阴不
降阴
黄连(炒) 干姜(炒) 桂枝 甘草(三两) 人参(二两) 半夏(半升) 大枣
(十二枚)
此足阳明药也。黄连苦寒泄热以降阳,姜桂辛温除寒以升阴,人参助正祛邪,半夏和胃
止呕,甘草、大枣调中止痛,上中二焦寒热交战,以此和解之(喻嘉言曰∶湿家下之,舌上
有苔者
则从
连汤
问下
邪,
焦属
(仲景)
治太阳少阳合病自下利者(合病者,谓有太阳之证,身热头痛脊强,又有少阳之证,耳
聋胁痛,呕而口苦,寒热往来也。自利者,不因攻下而泄泻也。自利固多可温,然肠胃有积
结,与下焦客热,又非温剂所能止,或分利之,或攻泄之可也。成氏曰∶太阴阳明合病下利
为在表,与葛根汤以汗之;少阳阳明合病下利为阳邪入里,与承气汤以下之;此太阳少阳合
病下利
黄芩(三两) 芍药 甘草(二两) 大枣(十二枚)
此足太阳、少阳药也。成氏曰∶虚而不实者,苦以坚之,酸以收之,黄芩、芍药之苦酸
以坚敛肠胃之气;弱而不足者,甘以补之,甘草、大枣之甘以补肠胃之弱(昂按∶二经合病
何以不用二经之药?盖合病而兼下利,是阳邪入里,则所重者在里,故用黄芩以彻其热,而
以甘、芍、大枣和其太阴,使里气和则外证自解,和解之法,非一端也,仲景之书,一字不
苟,此证单言下利,故此方亦单治下利,《机要》用之治热痢腹痛,更名黄芩芍药汤;洁古
因之加木香、槟榔、大黄、黄连、归尾、官桂,更名芍药汤,治下痢;仲景此方遂为万世治
痢之祖
本方加半夏(半升),生姜(三两),名黄芩加半夏生姜汤(仲景)∶治前证兼(呕者呕,
胃气逆也,加半夏、生姜以散逆气。《千金》曰∶生姜,呕家圣药,是散其逆气也。《金匮》
曰∶呕家用半夏以去其水,水去则呕止,是下其痰饮也);亦治胆腑发咳,呕苦水如胆汁(胃
气逆则呕苦,胆液溢则口苦)。本方除大枣,名黄芩芍药汤∶治火升鼻衄及热痢。《外台》黄
芩汤∶黄芩、人参、干姜(三两),桂枝(一两),半夏(半斤),大枣(十二枚)∶治干呕下
痢。
(张仲景)
治疗伤寒病,胸中有热邪导致想呕吐,胃中有寒邪导致腹痛。
黄连(炒制)、干姜(炒制)、桂枝、甘草(各三两)、人参(二两)、半夏(半升)、大枣(十二枚)。
这是足阳明胃经的药物。黄连味苦性寒,能泄热使阳气下降;干姜、桂枝味辛性温,能除寒使阴气上升;人参扶助正气以祛除邪气;半夏调和胃气并止呕;甘草、大枣调理中焦并止痛。上焦和中焦寒热交争,用此方来和解(喻嘉言说:湿病患者误用下法后,舌上有苔的,是丹田有热,胸中……连汤……问下……邪,……焦属……[注:此处原文残缺严重,仅翻译可辨识部分])。
(张仲景)
治疗太阳经与少阳经合病,出现自发性腹泻的情况。(所谓合病,是指既有太阳经的症状,如身热、头痛、项背强直,又有少阳经的症状,如耳聋、胁痛、呕吐、口苦、寒热往来等。自利,是指没有经过攻下治疗而出现的泄泻。自利大多可以用温法,但如果肠胃有积滞结聚,或者下焦有客热,就不是温剂所能止住的,可以采用分利小便或攻下泄热的方法。成无己说:太阴和阳明合病导致的下利属于表证,用葛根汤发汗;少阳和阳明合病导致的下利是阳邪入里,用承气汤攻下;这里是太阳和少阳合病导致的下利……)
这是足太阳膀胱经和足少阳胆经的药物。成无己说:脏腑功能虚弱而不充实的,用苦味药使其坚固,用酸味药使其收敛,黄芩、芍药的苦酸之性能坚固收敛肠胃之气;脏腑功能衰弱而不足的,用甘味药来补益,甘草、大枣的甘味能补益肠胃的虚弱。(汪昂按语:两经合病为什么不用这两经的药物?因为合病兼见下利,说明阳邪已经入里,此时重点在于治里,所以用黄芩来清除内热,并用甘草、芍药、大枣调和太阴脾土,使里气调和则外证自然解除。和解的方法不止一种,张仲景的著作,一字不苟,这个病症只提到下利,所以这个方子也专门治疗下利。《医学启源》用它治疗热痢腹痛,改名为黄芩芍药汤;李东垣在此基础上加入木香、槟榔、大黄、黄连、当归尾、官桂,改名为芍药汤,治疗痢疾;张仲景的这个方子遂成为后世治疗痢疾的祖方。)
本方加入半夏(半升)、生姜(三两),名为黄芩加半夏生姜汤(张仲景):治疗上述症状兼有呕吐的情况(呕吐是因为胃气上逆,加入半夏、生姜以散降逆气。《千金方》说:生姜是治疗呕吐的名家圣药,这是为了散其逆气。《金匮要略》说:呕吐患者使用半夏是为了去除水饮,水饮去则呕吐停止,这是为了下行痰饮);也治疗胆腑引发的咳嗽,呕吐出像胆汁一样的苦水(胃气上逆则呕吐苦水,胆液溢出则口苦)。
(Zhang Zhongjing)
Treats Shanghan (Cold Damage) where there is heat in the chest causing nausea, and cold in the stomach causing abdominal pain.
Huanglian (Coptidis Rhizoma, stir-fried), Ganjiang (Zingiberis Rhizoma, stir-fried), Guizhi (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma, each 3 liang), Renshen (Ginseng Radix, 2 liang), Banxia (Pinelliae Rhizoma, 0.5 sheng), Dazao (Jujubae Fructus, 12 pieces).
This formula acts on the Foot-Yangming Stomach Meridian. Huanglian is bitter and cold, clearing heat to descend Yang; Ganjiang and Guizhi are acrid and warm, dispelling cold to ascend Yin; Renshen supports the healthy Qi to expel pathogenic factors; Banxia harmonizes the Stomach and stops vomiting; Gancao and Dazao regulate the Middle Jiao and relieve pain. When cold and heat contend in the Upper and Middle Jiaos, this formula is used to harmonize them (Yu Jiayan stated: In patients with dampness who were incorrectly treated with purgatives, if there is a coating on the tongue... Lian Tang... ask about purging... evil... Jiao belongs... [Note: The original text here is severely fragmented]).
(Zhang Zhongjing)
Treats combined disease of the Taiyang and Shaoyang meridians presenting with spontaneous diarrhea. (Combined disease refers to having symptoms of both Taiyang, such as fever, headache, and stiffness of the neck and back, and Shaoyang, such as deafness, hypochondriac pain, vomiting, bitter taste, and alternating chills and fever. Spontaneous diarrhea refers to diarrhea occurring without prior use of purgative therapy. While spontaneous diarrhea is often suitable for warming methods, if there are accumulations in the intestines and stomach, or exogenous heat in the Lower Jiao, warming agents alone cannot stop it; one may employ methods to separate clear from turbid or purge and drain. Cheng Wuji stated: Diarrhea due to combined disease of Taiyin and Yangming belongs to the exterior, treated with Gegen Tang to induce sweating; diarrhea due to combined disease of Shaoyang and Yangming involves yang pathogens entering the interior, treated with Chengqi Tang to purge; this case involves diarrhea due to combined disease of Taiyang and Shaoyang...)
Huangqin (Scutellariae Radix, 3 liang), Shaoyao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma, each 2 liang), Dazao (Jujubae Fructus, 12 pieces).
This formula acts on the Foot-Taiyang Bladder Meridian and Foot-Shaoyang Gallbladder Meridian. Cheng Wuji stated: For deficiency without fullness, bitter substances solidify, and sour substances astringe; the bitterness and sourness of Huangqin and Shaoyao solidify and astringe the Qi of the intestines and stomach; for weakness and insufficiency, sweet substances tonify; the sweetness of Gancao and Dazao tonifies the weakness of the intestines and stomach. (Wang Ang's note: Why not use herbs of both meridians for their combined disease? Because combined disease accompanied by diarrhea indicates yang pathogens have entered the interior; thus, priority is given to treating the interior. Therefore, Huangqin is used to clear the heat, while Gancao, Shaoyao, and Dazao harmonize the Taiyin Spleen. When the interior Qi is harmonized, the exterior symptoms resolve naturally. Harmonization methods are not limited to one approach. Zhang Zhongjing’s writings are precise; since this syndrome mentions only diarrhea, this formula treats only diarrhea. *Yixue Qiyuan* uses it for heat-dysentery with abdominal pain, renaming it Huangqin Shaoyao Tang; Li Dongyuan added Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Dahuang (Rhei Radix et Rhizoma), Huanglian (Coptidis Rhizoma), Guishao (Rosae Chinensis Fructus), and Guigui (Cinnamomi Cortex), renaming it Shaoyao Tang to treat dysentery; Zhang Zhongjing’s formula thus became the ancestral prescription for treating dysentery for all generations.)
Adding Banxia (Pinelliae Rhizoma, 0.5 sheng) and Shengjiang (Zingiberis Rhizoma Recens, 3 liang) to this base formula creates Huangqin Jia Banxia Shengjiang Tang (Zhang Zhongjing): Treats the aforementioned conditions accompanied by vomiting (vomiting is due to rebellious Stomach Qi; Banxia and Shengjiang are added to disperse rebellious Qi. *Qianjin Fang* states: Shengjiang is the sacred medicine for vomiting, dispersing rebellious Qi. *Jinkui Yaolue* states: Banxia is used for vomiting to remove fluid retention; once fluids are removed, vomiting stops, thereby descending phlegm-fluids); it also treats cough induced by the Gallbladder Fu-organ, characterized by vomiting bitter fluid like bile (rebellious Stomach Qi causes vomiting of bitter fluid; overflow of Gallbladder juice causes bitter taste).
Removing Dazao from this base formula creates Huangqin Shaoyao Tang: Treats epistaxis caused by rising fire and heat-dysentery.
*Waitai Miyao*’s Huangqin Tang: Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Ganjiang (Zingiberis Rhizoma, each 3 liang), Guizhi (Cinnamomi Ramulus, 1 liang), Banxia (Pinelliae Rhizoma, 0.5 jin), Dazao (Jujubae Fructus, 12 pieces): Treats dry heaving and diarrhea.