解胆结。白莲花藕润心经气分之燥。牛乳润心经血分之燥。防己泻血分中湿热。杜仲、泽泻
可用。葶苈得大戟,则逐水之功愈大。赤石脂入心大肠,性涩可以止脱,气脱者为虚寒,则
涩从温可知。丁香温胃。干姜和中。牛膝利小便行血,同补肾药,去湿热,理下焦之痿弱。
晚蚕沙去上焦风湿热。制香附治走气痛。吴茱萸性下,若脐腹作胀,知气已下陷,多用之,
气愈陷,故行气者用一分,脐腹作痛,邪气已滞,少用之,恐邪气难开,故破气者用三五分
。大茴、小茴俱辛温,小茴走少阴与气海,大茴厥阴肝经。
四物汤,加黄柏、知母,去血积血块血鳖。加肉桂,行血,气得上升,而诸积从小便出
八珍汤,人参与当归相并,川芎与甘草相并,白芍与白术相并,茯苓与生地相并。用川
芎,不得用生地、熟地,用人参,不得用茯苓,以上下相制,不能专用其力也。
纳气法,有用和而令气纳者,甘草用一钱五分以和中,益智用一钱以温肾,此和而纳之
也。
肉桂、磁石、人参,此温而纳之也。有用凉而令气纳者,黄连五钱,生姜一两,同捣烂服之
。肺之脾胃虚,气不归肾,生地一两,生姜七钱同捣烂服之,或生脉散,加磁石、牡蛎,此
麻黄,脉紧数,畏寒无汗者当用。桂枝,脉迟缓,畏风有汗者当用。
白芍,大便泄,酒炒黄色。若后重紧急,则生用。
燥渴大泻,干姜必用。咽喉痛禁之。
神曲生用消食,炒用消积,打糊消痰。麦芽和平,治腹中气鸣,滞血膨胀。
山楂破滞,虚人少用。
黄柏,两尺脉洪大,真有力者当用。
附子,尺脉迟弱,大便溏者可用。若尺脉洪大,便闭者忌之。
大便坚实,脉沉有力,的是热证。宜用皮硝,助以大黄,大黄可用五钱,皮硝用七钱。
巴豆用一粒,大戟酒泡为末,只用三四厘,斑蝥用一枚,丁香用三分,细辛用三分,此
五味,根据数用之,再多伤人。(以上钱登谷本有之,而草庐本不载,今附录于后。)
人参钱五分,黄 三钱,可配柴胡一钱。(此条从胡念庵家所钞周慎斋家藏医案内出,
以见柴胡之不可多用也,草庐本不载。今附录于后。)
疏通胆经的郁结。白莲花藕能滋润心经气分的燥热。牛乳能滋润心经血分的燥热。防己能泻除血分中的湿热。杜仲、泽泻可以使用。葶苈子配合大戟,则逐水的作用更加显著。赤石脂入心和大肠经,性质涩滞可以固脱止泄,如果是气虚寒导致的脱证,那么涩法应当配合温法来使用。丁香温暖胃腑。干姜调和脾胃。牛膝通利小便并活血,与补肾药同用,可去除湿热,调理下焦的痿弱无力。晚蚕沙去除上焦的风湿热邪。制香附治疗气机走窜引起的疼痛。吴茱萸药性下行,如果脐腹部胀满,说明气机已经下陷,若多用吴茘萸,气机会更加下陷,所以行气药只用一分;如果脐腹部疼痛,说明邪气已经阻滞,应少用吴茱萸,因为恐邪气难以散开,所以破气药只用三五分。大茴香和小茴香都属辛温之性,小茴香走少阴经和气海穴,大茴香走厥阴肝经。
四物汤,加入黄柏、知母,可以去除血积、血块和血鳖(瘀血积聚)。加入肉桂,可以推动血液运行,使气机上升,从而使各种积滞从小便排出。八珍汤中,人参和当归相配,川芎和甘草相配,白芍和白术相配,茯苓和生地黄相配。如果使用川芎,就不宜使用生地黄、熟地黄;如果使用人参,就不宜使用茯苓,这是利用上下相互制约的原理,不能单独依赖某一种药物的力量。
纳气法中,有用平和之法令气归纳的,用甘草一钱五分以调和脾胃,用益智仁一钱以温补肾阳,这是通过平和之法来纳气。肉桂、磁石、人参,这是通过温补之法来纳气。有用清凉之法令气归纳的,用黄连五钱,生姜一两,共同捣烂后服用。肺脾两虚,气不归肾,用生地黄一两,生姜七钱共同捣烂后服用,或者使用生脉散,加入磁石、牡蛎。
麻黄,适用于脉象紧数、畏寒无汗的患者。桂枝,适用于脉象迟缓、畏风有汗的患者。
白芍,大便泄泻者,用酒炒至黄色。如果出现里急后重且紧急的情况,则生用。
神曲生用可消食,炒用可消积,打糊状可消痰。麦芽药性平和,治疗腹中肠鸣,以及因气滞血瘀导致的腹胀。山楂破除滞气,体虚之人应少用。
附子,尺脉迟弱、大便溏薄者可以使用。如果尺脉洪大、大便闭结者忌用。
大便坚硬,脉象沉而有力,确属热证。适宜使用芒硝,辅以大黄,大黄可用五钱,芒硝用七钱。
巴豆用一粒,大戟用酒浸泡后研为粉末,只用三四厘,斑蝥用一枚,丁香用三分,细辛用三分,这五味药根据数量使用,再多则会伤害人体。(以上条目在钱登谷版本中存在,但草庐本未收录,现附录在后面。)
人参五分,黄芩三钱,可搭配柴胡一钱。(此条抄录自胡念庵家所藏的周慎斋家医案,用以说明柴胡不可多用的道理,草庐本未收录。现附录在后面。)
Resolve gallbladder nodules. White lotus root moistens the dryness of the Qi level in the Heart channel. Cow's milk moistens the dryness of the Blood level in the Heart channel. Fangji (Stephaniae Tetrandrae Radix) drains damp-heat from the Blood level. Duzhong (Eucommiae Cortex) and Zexie (Alismatis Rhizoma) can be used. Tinglizi (Lepidii Semen) combined with Daji (Euphorbiae Pekinensis Radix) greatly enhances the water-draining efficacy. Chishizhi (Halloysit Rubrum) enters the Heart and Large Intestine channels; its astringent nature can stop collapse. For Qi collapse due to deficiency-cold, the astringent method implies the use of warming methods. Dingxiang (Caryophylli Flos) warms the Stomach. Ganjiang (Zingiberis Rhizoma) harmonizes the Middle Jiao. Niuxi (Achyranthis Bidentatae Radix) promotes urination and invigorates blood; when combined with Kidney-tonifying herbs, it removes damp-heat and treats flaccidity and weakness in the Lower Jiao. Wancansha (Bombyx Batryticatus) removes wind-damp-heat from the Upper Jiao. Zhixiangfu (Cyperi Rhizoma processed) treats pain caused by wandering Qi. Wuzhuyu (Evodiae Fructus) has a descending nature. If there is distension in the umbilical and abdominal regions, indicating that Qi has sunk, using too much Wuzhuyu will cause further sinking of Qi; therefore, Qi-moving herbs are used in small doses (1 fen). If there is pain in the umbilical and abdominal regions, indicating stagnation of pathogenic factors, Wuzhuyu should be used sparingly to avoid difficulty in dispersing the pathogen; thus, Qi-breaking herbs are used in doses of 3-5 fen. Da Huixiang (Anisi Stellati Fructus) and Xiao Huixiang (Foeniculi Fructus) are both acrid and warm. Xiao Huixiang travels to the Shaoyin channel and Qihai (CV6), while Da Huixiang travels to the Jueyin Liver channel.
Siwu Tang (Four Substances Decoction) added with Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) resolves blood stasis, blood masses, and blood accumulations. Added with Rougui (Cinnamomi Cortex), it moves blood, causes Qi to ascend, and allows various accumulations to exit via urination. In Bazhen Tang (Eight Treasures Decoction), Renshen (Ginseng Radix) pairs with Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma) pairs with Gancao (Glycyrrhizae Radix et Rhizoma), Baishao (Paeoniae Radix Alba) pairs with Baizhu (Atractylodis Macrocephalae Rhizoma), and Fuling (Poria) pairs with Shengdihuang (Rehmanniae Radix). When using Chuanxiong, one must not use Shengdihuang or Shudihuang (Prepared Rehmanniae Radix); when using Renshen, one must not use Fuling. This reflects mutual restraint between upper and lower aspects, preventing exclusive reliance on the power of any single herb.
The method of grasping Qi includes using mild/harmonizing methods to grasp Qi: using 1.5 qian of Gancao (Licorice Root) to harmonize the Middle Jiao, and 1 qian of Yizhiren (Alpinia Oxyphylla Fruit) to warm the Kidney; this is grasping Qi through harmonization. Rougui (Cinnamon Bark), Cishi (Magnetitum), and Renshen (Ginseng Root) represent grasping Qi through warming. There are also cooling methods to grasp Qi: using 5 qian of Huanglian (Coptidis Rhizoma) and 1 liang of Shengjiang (Zingiberis Rhizoma Fresh), pounded together for administration. For deficiency of Lung and Spleen where Qi does not return to the Kidney, use 1 liang of Shengdihuang (Rehmanniae Radix) and 7 qian of Shengjiang (Fresh Ginger), pounded together for administration, or use Shengmai San (Generate the Pulse Powder) added with Cishi (Magnetite) and Muli (Ostrea Concha).
Mahuang (Ephedrae Herba) is indicated for patients with tight and rapid pulse, aversion to cold, and absence of sweating. Guizhi (Cinnamomi Ramulus) is indicated for patients with slow and moderate pulse, aversion to wind, and presence of sweating.
Baishao (White Peony Root): For loose stools, use wine-fried until yellow. If there is tenesmus and urgency, use raw.
For dryness-thirst accompanied by severe diarrhea, Ganjiang (Dried Ginger) is essential. It is contraindicated in sore throat.
Shenqu (Medicated Leaven) used raw digests food; stir-fried it resolves accumulation; made into paste it resolves phlegm. Maiya (Hordei Fructus Germinatus) is mild and harmonious, treating borborygmus in the abdomen and distension due to stagnant blood. Shanzha (Crataegi Fructus) breaks stagnation; those with deficiency should use it sparingly.
Huangbai (Phellodendri Cortex) is indicated only when the Chi (Kidney) pulse is full, large, and truly forceful.
Fuzi (Aconiti Lateralis Radix Praeparata) can be used when the Chi pulse is slow and weak, and stools are loose. It is contraindicated if the Chi pulse is full and large with constipation.
If stools are hard and the pulse is deep and forceful, it is definitely a heat syndrome. Poxiao (Natrii Sulfas) should be used, assisted by Dahuang (Rhei Radix et Rhizoma). Dahuang can be used in 5 qian, and Poxiao in 7 qian.
Badou (Crotonis Fructus) 1 grain, Daji (Euphorbiae Pekinensis Radix) soaked in wine and powdered, used in 3-4 li; Banmao (Mylabris) 1 insect; Dingxiang (Caryophylli Flos) 3 fen; Xixin (Asari Radix et Rhizoma) 3 fen. These five herbs must be used strictly according to these quantities; exceeding them harms the body. (The above items exist in Qian Denggu's edition but are not recorded in the Caolu edition; they are appended here.)
Renshen (Ginseng Root) 0.5 qian, Huangqin (Scutellariae Radix) 3 qian, can be paired with Chaihu (Bupleuri Radix) 1 qian. (This item was copied from the Zhou Shenzhai family medical records held by Hu Nian'an's family, illustrating that Chaihu should not be overused; it is not recorded in the Caolu edition. Appended here.)