(洁古) 治脾经受湿,痢疾下血。
苍术(泔浸炒三两) 地榆(炒黑一两) 每一两煎。
苍术燥湿强脾,升阳而开郁,地榆清热凉血,酸收而断下,为治血痢肠风之平剂,初起
者勿用。加芍药阿胶卷柏,名芍药地榆汤,(河间)治泄痢脓血,乃到脱肛。(阿胶补血与液,
为
(洁古) 治下痢脓血稠粘,腹痛后重。(下痢皆属湿热,赤为伤血,白为伤气。脓血
稠粘,气血两伤也。腹痛后重,气血皆滞也。刘河间曰∶行血则脓血自愈,调气则后重自除
。)
芍药(一两) 归尾 黄芩 黄连 大黄(三钱) 木香 甘草(炙) 槟榔(二钱) 桂
(钱半) 每服五钱,痢不减加大黄。(此为实热者言也,然今之热者鲜矣。)
芍药酸寒,泻肝火,敛阴气,和营卫,故以为君。大黄归尾,破积而行血。木香槟榔,
通滞而行气。黄芩黄连,燥湿而清热。痢由湿热责于肠胃,不得宣通,故大便重急,小便赤
涩也。辛以散之,苦以燥之,寒以清之,甘以调之。加肉桂者,假其辛热以为反佐也。
除桂甘草,加枳壳,名导滞汤。(一作导气汤。)治前证兼渴者。(此方今人多用,偿遇
虚寒者而误用之,祸不旋踵矣。)
(东垣) 治痔疮痔漏,有脓血,大便燥结,痛不可忍。
桃仁(研) 归尾(酒洗) 秦艽 白术一两 枳实(麸炒) 皂角子(烧存性) 泽
泻(五钱) 地榆(三钱) 面糊丸。
秦艽归尾桃仁,润燥和血,(秦艽为风药中润剂。)皂角仁以除风燥,地榆以破血止血,
枳实苦寒,以泄胃实。泽泻咸泄,使气归于前阴,以清湿邪也。白术之苦甘,以泻火而益元
气,故曰甘寒泻火,乃假枳实之寒也大便秘涩,以大黄推荡之。其津液益不足,用当归和
血,加油润之剂,自然软利矣。
除地榆,加大黄红花,名秦艽当归汤,治痔漏大便燥结疼痛。用秦艽一味,加羌活防风
麻黄升麻柴胡 本细辛黄 炙草红花,名秦艽羌活汤,治痔漏成块下垂不任其痒。除皂角枳
实地榆,加防风升麻柴胡陈皮大黄黄柏红花炙草,名秦艽防风汤,治痔漏,大便时疼痛。(东
垣曰∶如无痛者,非痔漏也。)除白术枳实地榆,加苍术黄柏大黄槟榔防风,名秦艽苍术汤
,(以上俱东垣方)治同。
(李东垣)治疗脾经受湿邪侵袭,导致痢疾便血。
苍术(用米泔水浸泡后炒制,三两) 地榆(炒至焦黑,一两) 每服用一两药量煎煮。
苍术能燥湿健脾,升发阳气并开通郁结;地榆能清热凉血,味酸收敛以止泻痢,这是治疗血痢和肠风的平和方剂,但疾病初起时不宜使用。若加入芍药、阿胶、卷柏,则名为芍药地榆汤,(刘河间创制)用于治疗泄痢伴有脓血,甚至出现脱肛的情况。(阿胶能补血生津液,作为……)
(李东垣)治疗下痢脓血稠粘,腹痛且有里急后重感。(下痢多属于湿热证,便血红色为伤及血分,白色为伤及气分。脓血稠粘,说明气血两伤。腹痛和里急后重,说明气血运行皆受阻滞。刘河间说:调和血液则脓血自止,调理气机则里急后重自除。)
芍药(一两) 当归尾 黄芩 黄连 大黄(三钱) 木香 甘草(炙) 槟榔(二钱) 桂枝(一钱半) 每次服用五钱,若痢疾症状不减,加大黄用量。(这是针对实热证而言的,然而如今患热证的人很少了。)
芍药味酸性寒,能泻肝火,收敛阴气,调和营卫,因此作为君药。大黄和当归尾,能破除积滞并活血行血。木香和槟榔,能疏通滞气并行气。黄芩和黄连,能燥湿清热。痢疾由湿热引起,病位在肠胃,气机不得宣通,所以大便沉重急迫,小便赤涩。辛味药可以发散,苦味药可以燥湿,寒性药可以清热,甘味药可以调和。加入肉桂,是借用其辛热之性作为反佐药。
去掉桂枝和甘草,加入枳壳,名为导滞汤。(一作导气汤。)治疗上述症状兼有口渴者。(此方现在很多人使用,但如果遇到虚寒证患者而误用,灾祸立刻就会降临。)
(李杲/东垣)治疗痔疮痔漏,有脓血,大便干燥结硬,疼痛难以忍受。
桃仁(研碎) 当归尾(酒洗) 秦艽 白术一两 枳实(麸炒) 皂角子(烧至存性) 泽泻(五钱) 地榆(三钱) 用面糊制成丸药。
秦艽、当归尾、桃仁,能润燥和血。(秦艽是风药中的润剂。)皂角仁能祛除风燥,地榆能破血止血,枳实味苦性寒,能泻胃腑的实热。泽泻味咸能泄,使气机归于前阴,以清除湿邪。白术味苦甘,能泻火并补益元气,所以说“甘寒泻火”,其实是借助枳实的寒性。大便秘涩,用大黄推荡通便。津液更加不足,用当归和血,加上油润的药物,自然就能软利通畅了。
去掉地榆,加入大黄、红花,名为秦艽当归汤,治疗痔漏伴有大便干燥结硬疼痛。只用秦艽一味药,加入羌活、防风、麻黄、升麻、柴胡、藁本、细辛、黄芩、炙甘草、红花,名为秦艽羌活汤,治疗痔漏形成肿块下垂,瘙痒难忍。去掉皂角、枳实、地榆,加入防风、升麻、柴胡、陈皮、大黄、黄柏、红花、炙甘草,名为秦艽防风汤,治疗痔漏,大便时疼痛。(李东垣说:如果没有疼痛,就不是痔漏。)去掉白术、枳实、地榆,加入苍术、黄柏、大黄、槟榔、防风,名为秦艽苍术汤,(以上均为李东垣的方剂)治疗同样的病症。
(Jiegu) Treats dysentery with bloody stool caused by dampness invading the Spleen Meridian.
Cangzhu (Atractylodis Rhizoma, soaked in rice wash water and stir-fried, 3 liang) Diyü (Sanguisorbae Radix, stir-fried until charred black, 1 liang). Decoct 1 liang per dose.
Cangzhu dries dampness and strengthens the Spleen, raises Yang Qi and opens stagnation; Diyü clears heat and cools blood, its sour astringency stops diarrhea and bleeding. This is a balanced formula for treating bloody dysentery and intestinal wind, but it should not be used in the early stage of the disease. Adding Shaoyao (Paeoniae Radix), Ejiao (Asini Corii Colla), and Juanbai (Serpylli Herba) creates Shaoyao Diyü Tang (Peony and Sanguisorba Decoction), created by Hejian, to treat dysentery with pus and blood, even to the point of rectal prolapse. (Ejiao nourishes blood and generates fluids...)
(Jiegu) Treats dysentery with thick and sticky pus and blood, abdominal pain, and tenesmus. (Dysentery generally belongs to damp-heat syndrome; red color indicates injury to the Blood level, white color indicates injury to the Qi level. Thick and sticky pus and blood indicate injury to both Qi and Blood. Abdominal pain and tenesmus indicate stagnation of both Qi and Blood. Liu Hejian said: Harmonizing the blood will naturally stop the pus and blood; regulating the Qi will naturally relieve tenesmus.)
Shaoyao (1 liang) Guiwei (Angelicae Sinensis Radix Caulis), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma, 3 qian), Muxiang (Aucklandiae Radix), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Binglang (Arecae Semen, 2 qian), Guizhi (Cinnamomi Ramulus, 1.5 qian). Take 5 qian per dose. If dysentery does not subside, increase the dosage of Dahuang. (This refers to excess-heat patterns; however, heat patterns are rare nowadays.)
Shaoyao is sour and cold, clears Liver Fire, astringes Yin Qi, and harmonizes Ying and Wei, thus serving as the Sovereign herb. Dahuang and Guiwei break up accumulation and promote blood circulation. Muxiang and Binglang unblock stagnation and move Qi. Huangqin and Huanglian dry dampness and clear heat. Dysentery arises from damp-heat affecting the Intestines and Stomach, where Qi mechanism cannot circulate freely, resulting in heavy and urgent stools and dark, scanty urine. Pungent herbs disperse, bitter herbs dry, cold herbs clear, and sweet herbs harmonize. The addition of Rougui (Cinnamomi Cortex) borrows its pungent and hot nature as an adjuvant (counter-agent).
Removing Guizhi and Gancao, adding Zhike (Aurantii Fructus), names Daozhi Tang (Regulating Stagnation Decoction). (Also known as Daoqi Tang.) Treats the aforementioned symptoms accompanied by thirst. (Many people use this formula today; if mistakenly used for deficiency-cold patterns, disaster will follow immediately.)
(Dongyuan) Treats hemorrhoids and fistulas with pus and blood, dry and hard stools, and unbearable pain.
Taoren (Persicae Semen, crushed) Guiwei (Angelicae Sinensis Radix Caulis, wine-washed) Qinjiao (Gentianae Macrophyllae Radix) Baizhu (Atractylodis Macrocephalae Rhizoma, 1 liang) Zhishi (Aurantii Fructus Immaturus, bran-fried) Zaojiaoren (Gleditsiae Sinensis Spina, burned to retain character) Zexie (Alismatis Rhizoma, 5 qian) Diyü (Sanguisorbae Radix, 3 qian). Form pills with wheat paste.
Qinjiao, Guiwei, and Taoren moisten dryness and harmonize blood. (Qinjiao is a moistening agent among wind-dispelling herbs.) Zaojiaoren dispels wind-dryness; Diyü breaks blood stasis and stops bleeding; Zhishi is bitter and cold, purging Stomach excess. Zexie is salty and draining, directing Qi to the anterior yin to clear dampness. Baizhu is bitter and sweet, clearing fire and benefiting primordial Qi; thus it is said "sweet and cold clears fire," actually borrowing the cold nature of Zhishi. For dry and constipated bowels, Dahuang pushes out the stagnation. When body fluids are insufficient, Danggui harmonizes blood; adding oily/lubricating agents naturally softens and facilitates passage.
Removing Diyü, adding Dahuang and Honghua (Carthami Flos), names Qinjiao Danggui Tang (Gentian and Angelica Decoction), treating hemorrhoidal fistulas with dry, hard stools and pain. Using only Qinjiao, added with Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Mahuang (Ephedrae Herba), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Bencao (Ligustici Chuanxiong Rhizoma), Xixin (Asari Radix et Rhizoma), Huangqin (Scutellariae Radix), Zhigancao (Glycyrrhizae Radix et Rhizoma, honey-fried), and Honghua (Carthami Flos), names Qinjiao Qianghuo Tang (Gentian and Notopterygium Decoction), treating hemorrhoidal fistulas forming masses that prolapse and cause intolerable itching. Removing Zaojiaoren, Zhishi, and Diyü, adding Fangfeng (Saposhnikoviae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Chenpi (Citri Reticulatae Pericarpium), Dahuang (Rhei Radix et Rhizoma), Huangbo (Phellodendri Cortex), Honghua (Carthami Flos), and Zhigancao (Glycyrrhizae Radix et Rhizoma, honey-fried), names Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction), treating hemorrhoidal fistulas with pain during defecation. (Dongyuan said: If there is no pain, it is not a hemorrhoidal fistula.) Removing Baizhu, Zhishi, and Diyü, adding Cangzhu (Atractylodis Rhizoma), Huangbo (Phellodendri Cortex), Dahuang (Rhei Radix et Rhizoma), Binglang (Arecae Semen), and Fangfeng (Saposhnikoviae Radix), names Qinjiao Cangzhu Tang (Gentian and Atractylodes Rhizoma Decoction). (All above are formulas by Dongyuan), treating the same condition.