《治法纲》曰∶夫肝为将军之官,其性善怒,故经谓肝性最急,以甘缓之,如用细生甘草之属。大怒则火
起于肝,实火用黄连、栀子泻之,虚火看阴阳而施治。《内经》曰∶怒则气逆,甚则呕血及飧泄。呕血者,用
四物加丹皮、甘草兼香附。飧泄者,以四君子加青皮、柴胡、神曲、香附以清之。
有乘于肺者,则咳嗽,或喘急衄血;乘于心者,则病心跳怔忡。精神恍惚,夜卧不安,或烦躁口渴,或吐
血;乘于脾者,则善食易饥,食入反胀;乘于肾,则病骨蒸烦热,或夜梦泄,咳嗽,而似阴虚火动。若本经自
病,则两胁与小腹
疼痛而吐,或吐血,或如寒热似疟,是皆怒气所伤,而致气血乘乱,母子相乘为患。则当平肝调气为主,
各加引经之药。
有肝胆之火动,而热火沸腾,留滞于颈项之间而成瘰 者。
有因怒而致小腹与两足肿胀者,此肝气郁滞于下故也。
有怒而致小便欲去时,则两手十指甲痛不可忍,盖爪甲乃筋之余,筋乃肝之余,况肝主疏泄,而失其
令故也。
有郁怒所伤,而患头疼之疾,凡遇怒气则头便痛,此则先因浊血与滞气留积于头故也。
有暴怒而卒中者,名曰中怒。《内经》曰阳气者,大怒则形气绝而血菀于上,使人薄厥是矣。
有因大怒,复患腰背强痛难以伸屈者。《内经》曰志伤于盛怒,则腰脊难以俯仰是矣。
有怒火郁于肝经,用诸开郁降火之药而不愈,反用发散之药,微取其汗而愈者,此亦火郁则发之
义也。
有怒气挟食,郁于胃口,患吐呕不食,胸膈胀闷,痰涎壅盛。治分虚实,实则可吐者吐之,此因
而越之之法;虚则元气不足故也。
有怒气挟血,郁于胃口而然,用破血行气之剂开之。
凡怒气伤肝,肝木之气凌犯脾土,致使胃中元气衰甚不食,虽肝之病气有余,只宜益元救土,不宜疏
正气。可于补养药中多加白芍,少佐青皮治之。
又有遇怒便欲泄泻,此先因怒气挟食伤胃故也。禀壮者,用调胃承气汤下之,去其旧积,其病自瘳;
禀弱者,只以消导等剂主之。
有患手足冷,心下痛,痛则汗泄,呕吐不欲食。或食入复出,此肝木之气乘于脾胃之间,使太阴、阳
明之气上逆而
不出,名曰食痹,治以白术、青皮、人参、香附、神曲、砂仁、沉香之类。
妇人产后及小产后,或行经时,因怒气所伤,凡遇行经之时,则小腹胀痛,及经水不调,此为怒伤
血海,用当归、川芎、乌药、香附、木香、青皮、玄胡索、蒲黄、五灵脂作汤。看有血逆者,再加破血之
剂。
夫肝者,风之舍也,大怒则伤肝,因怒而内动厥阴,与少阳风热,患头疼发热,或嗽咳气逆,或为耳
鸣烦躁,或为寒热似疟,并以四物汤加香附、柴胡、防风、黄芩、栀子、黄柏之类。
又有郁怒伤肝,患目珠胀痛,四物汤加柴胡、青皮、黄连、甘草、香附主之。
若真脏脉见,其人不病而自死。有真肝脏病者亦死。
《治法纲》中说:肝被称为将军之官,其本性容易发怒,所以医经说肝的特性最为急躁,治疗应用甘味药来缓和它,比如使用生甘草这类药物。大怒会导致肝火升起,实火用黄连、栀子来清泻,虚火则根据阴阳虚实的情况施治。《内经》说:愤怒会导致气机逆乱,严重时会出现呕血和完谷不化的泄泻。对于呕血的,用四物汤加入丹皮、甘草并配合香附治疗。对于完谷不化泄泻的,用四君子汤加入青皮、柴胡、神曲、香附来清利。
如果肝气乘袭肺脏,就会出现咳嗽,或者气喘急促、鼻出血;如果肝气乘袭心脏,就会导致心悸怔忡、精神恍惚、夜间睡眠不安,或者烦躁口渴、吐血;如果肝气乘袭脾脏,就会表现为食欲旺盛但容易饥饿,进食后反而腹胀;如果肝气乘袭肾脏,就会导致骨蒸潮热烦闷,或者梦中遗精、咳嗽,症状类似阴虚火旺。如果是肝脏本经自病,就会出现两胁和小腹疼痛并呕吐,或者吐血,或者像寒热交替似疟疾的症状,这些都是因为怒气损伤,导致气血紊乱,母子相乘为患。治疗应当以平肝调气为主,各加引经药物。
如果有肝胆之火妄动,火热沸腾,留滞于颈项之间形成瘰疬(颈部淋巴结结核)。
有因发怒导致小腹和双足肿胀的,这是因为肝气郁滞在下部所致。
有因发怒导致小便欲解时,双手十指甲疼痛难忍,因为爪甲是筋之余,筋是肝之余,况且肝主疏泄,失去其正常功能所致。
有因忧郁愤怒所伤,患上头痛的疾病,凡是遇到怒气发作头部就痛,这是因为先有瘀血与滞气积聚在头部所致。
有因暴怒而猝然昏倒的,名叫“中怒”。《内经》说:阳气之人,大怒会导致形体之气断绝,血液郁积于上部,使人发生薄厥(因怒致气血上冲而昏厥),说的就是这种情况。
有因大怒,又患上腰背强痛难以伸展弯曲的。《内经》说:意志被盛怒所伤,就会导致腰脊难以俯仰,说的就是这种情况。
有怒火郁结在肝经,使用各种开郁降火的药物无效,反而使用发散药物,微微取汗而痊愈的,这也是“火郁则发之”的道理。
有怒气挟带食积,郁结在胃口,出现呕吐不食、胸膈胀闷、痰涎壅盛。治疗要分虚实,实证可以用吐法,这是“因而越之”的方法;虚证则是元气不足所致。
有怒气挟带瘀血,郁结在胃口而导致的,用破血行气的方剂来开通。
凡是怒气伤肝,肝木之气凌犯脾土,致使胃中元气衰败而不思饮食,虽然肝的病气有余,只宜益元救土,不宜疏泄正气。可以在补养药中多加白芍,少佐青皮来治疗。
又有遇到发怒就想泄泻的,这先是因为怒气挟带食物损伤了胃的缘故。体质强壮者,用调胃承气汤攻下,去除旧积,病自然痊愈;体质虚弱者,只用消导等方剂主治。
有患手足冰冷,心下疼痛,痛则出汗,呕吐不想吃东西。或者食物吃进去又吐出来,这是肝木之气乘袭脾胃之间,使太阴、阳明之气上逆而不能下行,名叫“食痹”,治疗用白术、青皮、人参、香附、神曲、砂仁、沉香之类的药物。
妇女产后及小产之后,或行经期间,因怒气所伤,每逢行经之时,就小腹胀痛,以及月经不调,这是怒气伤了血海,用当归、川芎、乌药、香附、木香、青皮、玄胡索、蒲黄、五灵脂煎汤服用。看是否有血逆的情况,再加破血药剂。
肝是风邪寄居的地方,大怒会伤肝,因怒导致内动厥阴,兼夹少阳风热,出现头痛发热,或者咳嗽气逆,或者耳鸣烦躁,或者寒热似疟,都用四物汤加入香附、柴胡、防风、黄芩、栀子、黄柏之类的药物。
The *Zhi Fa Gang* states: The Liver is referred to as the "General Officer"; its nature is prone to anger. Therefore, the classics state that the Liver's temperament is most urgent, and it should be softened with sweet flavors, such as using raw Gancao (Glycyrrhizae Radix et Rhizoma). Great anger causes Fire to rise from the Liver. Excess Fire is purged with Huanglian (Coptidis Rhizoma) and Zhizi (Gardeniae Fructus), while Deficient Fire is treated according to Yin and Yang patterns. The *Neijing* says: Anger causes Qi to rebel; in severe cases, it leads to hematemesis (vomiting blood) and undigested food diarrhea (Sun Xie). For hematemesis, Siwu Tang (Four Substances Decoction) is used with Danpi (Moutan Cortex), Gancao, and Xiangfu (Cyperi Rhizoma). For undigested food diarrhea, Sijunzi Tang (Four Gentlemen Decoction) is used with Qingpi (Aurantii Fructus Immaturus Pericarpium), Chaihu (Bupleuri Radix), Shenqu (Massa Medicata Fermentata), and Xiangfu to clear the condition.
If Liver Qi overacts on the Lung, coughing occurs, or rapid breathing and epistaxis (nosebleed); if Liver Qi overacts on the Heart, palpitations and frightful palpitations (Zheng Tong) occur, accompanied by mental distraction, restless sleep at night, irritability, thirst, or hematemesis; if Liver Qi overacts on the Spleen, there is excessive appetite with easy hunger, but abdominal distension after eating; if Liver Qi overacts on the Kidney, bone-steaming fever and vexation occur, or nocturnal emission, coughing, resembling Yin deficiency with Fire hyperactivity. If the Liver channel itself is diseased, there is pain in the hypochondrium and lower abdomen with vomiting, or hematemesis, or alternating chills and fever resembling malaria. All these are caused by anger injuring the body, leading to chaotic Qi and Blood, where mother and child organs attack each other causing harm. Treatment should focus on calming the Liver and regulating Qi, adding guiding herbs for each channel.
If Liver and Gallbladder Fire moves recklessly, boiling heat stagnates between the neck and throat, forming Luoli (scrofula/cervical lymphadenitis).
Anger can cause swelling of the lower abdomen and both legs due to Liver Qi stagnation in the lower part.
Anger can cause unbearable pain in the fingernails when urination is attempted, because nails are the surplus of sinews, and sinews are the surplus of the Liver. Moreover, the Liver governs free flow and drainage; losing this command causes the issue.
Injury from pent-up anger can cause headaches; whenever anger arises, the head hurts. This is because turbid blood and stagnant Qi have accumulated in the head.
Sudden collapse due to violent anger is called "Zhong Nu" (Stroke of Anger). The *Neijing* states: In individuals with Yang Qi, great anger causes form and Qi to sever, and blood to pool above, causing Bo Jue (syncope due to Qi and Blood rushing upward).
Great anger can also cause stiffness and pain in the waist and back, making flexion and extension difficult. The *Neijing* states: When will is injured by excessive anger, the waist and spine become difficult to bend and extend.
If Fire anger is constrained in the Liver channel and does not respond to various herbs for resolving constraint and descending Fire, but heals with dispersing herbs that induce slight sweating, this follows the principle of "dispersing constrained Fire."
Anger combined with food stagnation, constrained in the stomach area, causes vomiting, anorexia, chest and diaphragm fullness, and profuse phlegm-saliva. Treatment distinguishes excess and deficiency. In excess cases, emesis may be induced ("causing it to ascend"); in deficiency cases, it is due to insufficiency of Yuan Qi (Original Qi).
Anger combined with blood stasis, constrained in the stomach area, is treated with formulas that break stasis and move Qi.
Whenever anger injures the Liver, Liver Wood Qi invades Spleen Earth, causing severe decline of Stomach Yuan Qi and anorexia. Although Liver pathogenic Qi is in excess, one should tonify Yuan Qi and save Earth, rather than disperse healthy Qi. Add more Baishao (Paeoniae Radix Alba) to tonic formulas, with a small amount of Qingpi.
Some experience diarrhea upon becoming angry, initially due to anger combining with food to injure the Stomach. Those with strong constitutions are treated with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge old accumulations, curing the disease spontaneously; those with weak constitutions are treated primarily with digestion-promoting formulas.
Patients may present with cold hands and feet, epigastric pain, sweating during pain, vomiting, and anorexia. Or food is vomited immediately after ingestion. This is Liver Wood Qi overacting on the Spleen and Stomach, causing Taiyin and Yangming Qi to rebel upward without descending, named Shib Bi (Food Obstruction). Treatment uses Baizhu (Atractylodis Macrocephalae Rhizoma), Qingpi, Renshen (Ginseng Radix), Xiangfu, Shenqu, Sharen (Amomi Fructus), and Chenxiang (Aquilariae Lignum Resinatum).
After childbirth or minor abortion, or during menstruation, injury from anger causes lower abdominal distending pain and irregular menstruation upon the onset of menses. This is anger injuring the Sea of Blood. Treat with Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Wuyao (Tsaoko Fructus), Xiangfu, Muxiang (Aucklandiae Radix), Qingpi, Yanhusuo (Corydalis Rhizoma), Puhuang (Pollinis Typhae), and Wulingzhi (Trogopterori Faeces) as a decoction. If blood rebellion is present, add blood-breaking agents.
The Liver is the residence of Wind. Great anger injures the Liver, internally moving Jueyin and combining with Shaoyang Wind-Heat, causing headache and fever, or coughing with rebellious Qi, tinnitus, and irritability, or alternating chills and fever resembling malaria. Treat all with Siwu Tang plus Xiangfu, Chaihu, Fangfeng (Saposhnikoviae Radix), Huangqin (Scutellariae Radix), Zhizi, and Huangbai (Phellodendri Cortex).
Pent-up anger injuring the Liver, causing distending pain in the eyeballs, is treated with Siwu Tang plus Chaihu, Qingpi, Huanglian, Gancao, and Xiangfu.
If Zhen Zang Mai (True Organ Pulse) appears, the person dies even without apparent illness. True Liver organ diseases also result in death.