(仲景 一名三物浓朴汤。) 治伤寒阳明证,谵语便硬,潮热而喘,及杂病上焦痞
满不通。
大黄(四两) 浓朴(二两姜炒) 枳实(三枚麸炒) 水四升。煮一升二合,去渣,
分温二服。
邪在上焦则满,在中焦则胀,胃实则潮热。(犹潮水之来,其来有时。阳明燥金,旺于
申酉
故
下焦真阴也。(阳明证,有正阳阳明,有太阳阳明,有少阳阳明。自阳明经传入胃腑,不恶
寒,腹满便硬者,宜大承气下之。若汗多发热,微恶寒者,为外未解,其热不潮,未可
与承气。若腹大满不通者,可与小承气,微和胃气,勿令大泄下。谓阳明有在经者,未全入
腑,尤宜审慎。阳明少自病,多由太阳传入。成无己曰∶自太阳少阳传入者,众所共知。自
三阴传入者,鲜或能识。三阴有急下之证多矣,岂非仲景之微旨与。经曰∶伤寒脉浮缓,手
足温者,系在太阴,当发黄,若小便利者,不能发黄。至七八日,大便硬者,阳明病也。程
郊倩曰∶此证谓之太阴阳明,阳明为病,本之胃实,不特三阳受邪,能转属阳明,三阴亦能
转属阳明。推之少阴三大承气,厥阴一小承气,何非转属阳明之病哉。)
金匮用治支饮胸满,更名浓朴大黄汤。(徐忠可曰∶言支饮,则必稍偏矣。然不引痛胁
下,
此即
对照
焦通利
坚实之
(张仲景创制,又名三物浓朴汤。)用于治疗伤寒阳明证,表现为谵语、大便干硬、潮热且气喘,以及杂病中上焦痞塞满闷不通的症状。
大黄(四两) 浓朴(二两,姜汁炒) 枳实(三枚,麸皮炒) 用水四升。煎煮至一升二合,滤去药渣,分两次温服。
邪气在上焦则导致胀满,在中焦则导致腹胀,胃中有实热则出现潮热。(所谓潮热,如同潮水涨落,定时而来。阳明经属燥金,在申时、酉时旺盛。)下焦的真阴……(阳明证分为正阳阳明、太阳阳明、少阳阳明三种类型。若病邪从阳明经传入胃腑,表现为不恶寒、腹部胀满、大便干硬者,适宜用大承气汤攻下。如果汗出多、发热、轻微怕冷,说明表证未解,此时热度不呈潮热状,不可使用承气汤。如果腹部显著胀满不通者,可以使用小承气汤,轻微调和胃气,不要令其剧烈泻下。这说明阳明病有在经的,尚未完全入腑,尤其需要审慎对待。阳明病多由太阳病传入而成。成无己说:从太阳、少阳传入的,大家共知;从三阴传入的,很少人能识别。三阴病也有许多需要急下的证候,这难道不是张仲景的深意吗?《内经》说:伤寒脉象浮缓,手足温暖,病系于太阴,应当发黄,如果小便通利,则不会发黄。到了七八天,大便变硬的,就是阳明病。程郊倩说:此证称为太阴阳明。阳明发病,根本在于胃实,不仅三阳经受邪能转属阳明,三阴经也能转属阳明。推而言之,少阴病的三大承气证,厥阴病的小承气证,哪不是转属阳明的病呢?)
《金匮要略》用它治疗支饮导致的胸满,更名为浓朴大黄汤。(徐忠可说:提到支饮,病势必然偏侧。然而如果不牵引胁下疼痛……此处即……对照……上焦通利……坚实之……)
(Zhang Zhongjing created this formula, also known as Sanwu Nongpo Decoction.) It is used to treat Yangming syndrome in cold damage, manifesting as delirium, hard stool, tidal fever, and panting, as well as upper jiao (upper burner) stuffiness and fullness due to miscellaneous diseases.
Da Huang (Rhei Radix et Rhizoma, 4 liang) Nong Po (Magnoliae Officinalis Cortex, 2 liang, stir-fried with ginger juice) Zhi Shi (Aurantii Fructus Immaturus, 3 pieces, stir-fried with bran). Add four sheng of water. Boil until reduced to one sheng and two he, remove the dregs, and divide into two warm doses.
Pathogenic factors in the upper jiao cause fullness; in the middle jiao, they cause distension; excess heat in the stomach leads to tidal fever. (Tidal fever is like the tide, arriving at regular intervals. The Yangming channel belongs to Dry Metal, which is prosperous during the Shen and You hours.) The true yin of the lower jiao... (Yangming syndrome includes Zhengyang Yangming, Taiyang Yangming, and Shaoyang Yangming. If pathogenic factors transmit from the Yangming channel to the stomach fu-organ, presenting with aversion to cold absent, abdominal fullness, and hard stool, Da Chengqi Tang should be used for purgation. If there is profuse sweating, fever, and slight aversion to cold, the exterior pattern is not yet resolved; since the fever is not tidal, Chengqi formulas are contraindicated. If there is significant abdominal fullness and obstruction, Xiao Chengqi Tang may be used to mildly harmonize the stomach qi, avoiding severe purgation. This indicates that Yangming disease can reside in the channels without fully entering the fu-organs, requiring particular caution. Yangming disease often transmits from Taiyang. Cheng Wuji stated: Transmission from Taiyang and Shaoyang is commonly known; transmission from the Three Yin channels is rarely recognized. There are many cases in the Three Yin channels requiring urgent purgation; is this not Zhang Zhongjing's profound intent? The Classic says: In cold damage, if the pulse is floating and slow, and hands and feet are warm, the disease is related to Taiyin, and jaundice should develop. If urination is free, jaundice will not develop. After seven or eight days, if the stool becomes hard, it is a Yangming disease. Cheng Jiaoqian said: This condition is called Taiyin-Yangming. Yangming disease originates from stomach excess. Not only do the Three Yang channels transmitting pathogens convert to Yangming, but the Three Yin channels can also convert to Yangming. By extension, the three major Chengqi patterns in Shaoyin and the minor Chengqi pattern in Jueyin, are they not all diseases converting to Yangming?)
Jingui Yaolue uses this to treat chest fullness caused by Zhi Yin (fluid retention), renaming it Nong Po Da Huang Decoction. (Xu Zhongke said: Mentioning Zhi Yin implies the pathology is somewhat lateral. However, if it does not radiate pain to the hypochondrium... here corresponds... upper jiao unobstructed... solid...)