三阳少阳为枢,平日上升清道,为枢机转旋,升清降浊,三焦分理,皆是物也。病后清
阳微弱,勉强劳力,伤在气分,枢机无力,转旋失司矣。
顾(葑门) 失血既止,入冬不但血来,呛嗽火升,外寒内热。夫冬为蛰藏汇神之令,少
壮不
自保惜收藏,反致泄越,乃肾肝藏阴内怯,阳气闪炼自铄,草木填阴,临时堵塞其隙,精血
无以宁养。务潜以绝欲,百日不发为是,屡发必凶。(真水所以养真火,冬为万物归根,阳
气内伏藏阴因不谨亏损,真火独旺,真水愈涸,至木旺春升,温热病所由炽也。)
熟地(炒炭) 茯神 萸肉 五味 湖莲 芡实 女贞 川斛
不特火气内伏,煎熬精血,至来春水不养木,少阳相火炽甚也。阴虚者火必升,呛嗽吐
血,当时有必致者耳。
于(金坛,二十六岁) 风热伤卫外之阳,再发散升药动阳,血自阳络而出,医用大黄逐
瘀使下
,下则阴伤,不饥痞闷,痰粘不渴。急急醒脾扶胃,再以清寒治嗽。决无愈期(盖卫应乎胃
,卫外阳伤,当亟醒脾胃之阳,但治血溢之所以然,绝不于血分内瞻顾。盖治其本则标自愈
,非如今人之见血治血也。)
人参 白芍 生益智 茯苓 炙草 广皮
服十剂后,接服异功散(血从胃来,非关肺肾,故异治也。)
胃为多气多血之海,而脾实统之,是以少年从色欲致伤而失血者,久则尚须亟固脾胃,
使精生于谷,以渐补肾肝。况因风热伤阳,再以发散升泄,阳不固而致血上溢者乎?治病安
可通套耶!
张(二十九岁) 劳伤阳气(直起喝破,惟老手能之不可以为老生常谈,)当壮盛年岁,自
能保养安逸,气旺可愈。
三阳经中,少阳经作为枢机,平时负责将清气向上输送至清窍,通过枢机的旋转运动,实现升清降浊的功能,并调理三焦的分理运作,这些都是正常的生理现象。病后如果清阳之气微弱,勉强从事体力劳动,就会损伤气分,导致枢机功能无力,旋转调控失常。
顾姓患者(葑门人),失血症状虽然已经停止,但进入冬季后不仅再次出血,还出现呛咳、虚火上炎,表现为外有寒邪、内有郁热。冬季是蛰伏闭藏、神气汇聚的时令,青壮年如果不注意自我保养和收藏精气,反而导致精气泄越,这是肾阴和肝阴内在虚弱,阳气闪炼自耗的结果。此时若用草木类滋阴药物填补阴液,只是在临时堵塞其亏虚之隙,精血无法得到宁静的滋养。务必通过潜阳固摄来断绝房事欲望,若能百日不发作才算正确,如果屡次复发必然凶险。(真水能够涵养真火,冬季是万物归根的时节,阳气内伏并藏于阴中。因为不慎亏损,导致真火独旺,真水更加枯竭,到了春季木气旺盛、阳气升发时,温热病就会因此炽盛。)
处方:熟地黄(炒炭)、茯神、山茱萸、五味子、湖莲、芡实、女贞子、川石斛。
不仅仅是火气内伏,煎熬精血,到了来年春天,水不能滋养肝木,导致少阳相火炽盛。阴虚的人火势必然上炎,出现呛咳吐血,当时这种情况是必然会导致的后果。
于姓患者(金坛人,二十六岁),风热之邪损伤了卫外的阳气,如果再使用发散升提的药物扰动阳气,血液就会从阳络溢出而出。医生使用大黄逐瘀使之下行,下行则进一步损伤阴液,导致没有食欲、胸脘痞闷、痰粘但不口渴。急需醒脾扶胃,然后再用清寒药物治疗咳嗽。决不会有痊愈的日期(因为卫气与胃气相应,卫外阳气受损,应当紧急唤醒脾胃的阳气,只治疗血溢的根本原因,绝不局限于在血分内部顾惜。治疗根本则标症自然痊愈,不像现在有些人见血就治血。)
服用十剂后,接着服用异功散(血液来自胃部,与肺肾无关,所以治疗方法不同。)
胃是多气多血的海洋,而脾脏统摄它,所以年轻人因色欲过度导致损伤而失血的,时间久了还必须紧急巩固脾胃,使精气由水谷化生,从而逐渐补肾肝。更何况是因为风热损伤阳气,再使用发散升泄的方法,阳气不固而导致血液上溢的情况呢?治病怎么可以千篇一律呢!
张姓患者(二十九岁),劳倦损伤了阳气(直接点破关键,只有老练的医生能做到,不能视为老生常谈)。应当在壮盛的年纪,自己能够保养安逸,气旺自然能痊愈。
In the three Yang meridians, Shaoyang (Lesser Yang) serves as the pivot. Under normal conditions, it ascends clear qi to the orifices; through the rotation of this pivot mechanism, it facilitates the ascending of clear and descending of turbid substances, and regulates the distribution of the Sanjiao (Triple Burner). These are all physiological phenomena. After an illness, if the clear yang qi is weak and one forces physical labor, the qi aspect is injured, causing the pivot mechanism to lack strength and lose its regulatory function.
Patient Gu (from Fengmen), although bleeding has stopped, not only experiences recurrent bleeding in winter but also suffers from choking cough, rising fire, exterior cold, and interior heat. Winter is the season for hibernation, storage, and the gathering of spirit. If a young person fails to preserve and store essence during this time, instead allowing leakage and dispersion, it indicates that the kidney yin and liver yin are internally deficient. The yang qi flickers and self-consumes. Using herbal medicines to tonify yin merely temporarily blocks the gaps of deficiency, preventing jing (essence) and blood from being nourished and calmed. One must employ subduing methods and abstain from sexual desires; remaining symptom-free for one hundred days is considered correct, whereas frequent relapses will surely be fatal. (True water nourishes true fire. Winter is when all things return to their roots. When yang qi is internally stored within yin due to negligence and injury, true fire flares alone, causing true water to dry up further. By spring, when wood qi is vigorous and yang ascends, warm-heat diseases become rampant.)
Prescription: Shu Di Huang (Prepared Rehmannia Root, charred), Fu Shen (Poria with Hostwood), Yu Rou (Cornus Fruit), Wu Wei Zi (Schisandra Berry), Hu Lian (Lotus Seed from Huzhou), Qian Shi (Euryale Seed), Nv Zhen Zi (Ligustrum Lucidum Fruit), Chuan Huo Zhu (Dendrobium Officinale Stem).
It is not only that fire qi is latent inside, simmering jing and blood, but also that by the following spring, water fails to nourish wood, leading to excessive blazing of Shaoyang Ministerial Fire. In cases of yin deficiency, fire inevitably rises, causing choking cough and hemoptysis; such outcomes were inevitable at that time.
Patient Yu (from Jintan, 26 years old), wind-heat pathogen injured the defensive yang qi. The use of dispersing and ascending herbs further disturbed the yang, causing blood to exit via the yang collaterals. The physician used Da Huang (Rhubarb Rhizome) to purge stasis downward. Downward purging further injured the yin, resulting in loss of appetite, epigastric fullness, sticky phlegm, and absence of thirst. Urgent spleen-awakening and stomach-supporting measures are needed, followed by clearing-cold treatment for the cough. There is no hope for recovery. (Defensive qi corresponds to Stomach qi. When defensive yang is injured, the yang of the Spleen and Stomach must be urgently awakened. One should treat the root cause of hemorrhage, without focusing solely on the blood aspect. Treating the root causes the branch symptoms to resolve spontaneously, unlike contemporary practitioners who treat blood merely because there is bleeding.)
Prescription: Ren Shen (Ginseng Root), Bai Shao (White Peony Root), Sheng Yi Zhi Ren (Raw Alpinia Oxyphylla Fruit), Fu Ling (Poria), Zhi Gan Cao (Honey-fried Licorice Root), Guang Chen Pi (Aged Tangerine Peel).
After taking ten doses, continue with Yi Gong San (Four Gentlemen Decoction plus Atractylodes Macrocephala Rhizome). (The blood originated from the Stomach, unrelated to the Lung or Kidney; hence, the treatment differs.)
The Stomach is the sea of abundant qi and blood, governed by the Spleen. Therefore, young people who suffer hemorrhage due to sexual excess must urgently consolidate the Spleen and Stomach over time, allowing essence to be generated from grain, thereby gradually tonifying the Liver and Kidney. How much more so in cases where wind-heat injures yang, and dispersing/ascending methods are used again, causing yang insecurity and upward hemorrhage? How can medical treatment be uniform and formulaic!
Patient Zhang (29 years old), labor fatigue injured the yang qi. (This directly points out the key issue, achievable only by experienced physicians, and should not be dismissed as cliché.) At a prime age, one should naturally maintain rest and preservation; with robust qi, recovery will occur.