(东垣) 治吐血,外感寒邪,内虚蕴热。
麻黄(去外寒。) 黄 (实表益卫) 甘草(炙补脾) 白芍药(安太阴各一钱) 人
参(益元气而实表) 麦冬(保肺气各三分) 五味子(五粒安肺气) 当归(和血养血) 桂
枝(和营卫各五分) 热服。
纲目曰∶观此一方,足以为万世模范矣。盖取仲景麻黄汤,与补剂各半服之。但凡虚人
当服仲景方者,宜以此为则。(东垣治一贫士,病脾胃虚,与补药愈后。继居旷室,卧热炕,
咳而吐血,东垣谓此久虚弱,冬居旷室,衣服单薄,是重虚其阳,表有大寒,壅遇里热,火
邪不得舒仲,故血出于口。当补表之阳,泻里之虚热。因思仲景治伤寒,脉浮紧,当以麻黄
汤发汗,而不与之,遂成衄血,却与麻黄汤立愈。与此甚同,因作此汤,一服而愈。)
(东垣) 治伤于劳役,肌热面赤,烦渴引饮,脉大而虚。
黄 (炙一两) 当归(酒洗二钱) 空心服。
当归滋阴养血,黄 乃补气之药。何以五倍于当归,而云补血汤乎。盖有形之血,生于
无形之气。又有当归为引,则从之而生血矣。经曰∶阳生则阴长,此其义尔。
(本事) 治肠风脏毒下血。
槐花(炒) 侧柏叶(杵) 荆芥(炒黑) 枳壳(炒) 等分为末。每服三钱。米饮
下。
侧柏养阴燥湿,最清血分。槐花疏肝泻热,能凉大肠。荆芥散瘀搜风,(为风病血病要
药。)
加当归生地川芎,入乌梅生姜煎,名加减四物汤。(济生)治同。(补血凉血。)除柏叶
荆芥,加当归黄芩防风地榆,酒糊丸。名槐角丸,(局方)治同。(凉血。疏血。)除柏叶枳
壳,加青皮等分,亦名槐花散。(洁古)治血痢,腹不痛,不里急后重。除柏叶枳壳,加当
归川芎熟地白术青皮升麻,名当归和血散。(东垣)亦名槐花散,治肠 下血,湿毒下血。
经验方单用槐花荆芥炒黑为末,酒服,亦治下血。
(李东垣)治疗吐血,因外感寒邪,内里虚弱且蕴藏热邪。
麻黄(去除体表寒邪)、黄芪(固护肌表、增益卫气)、炙甘草(温补脾胃)、白芍药(安抚太阴经),各一钱;人参(补益元气并充实肌表)、麦冬(保护肺气),各三分;五味子(安定肺气,用五粒)、当归(调和血液、滋养血液)、桂枝(调和营卫之气),各五分。煎好后热服。
《本草纲目》说:看这一张方子,足以成为万世的典范了。大概是取用张仲景的麻黄汤与补益药剂各半合用服用。凡是身体虚弱的人应当服用张仲景方剂的,适宜以此为准则。(李东垣曾治疗一位贫寒读书人,其病因为脾胃虚弱,服用补药痊愈后。接着居住在空旷寒冷的屋子,睡在热炕上,咳嗽并吐血。李东垣认为此人长期虚弱,冬天住在空旷屋子,衣服单薄,这是使阳气再次受损,体表有大寒,壅滞导致体内热邪郁结,火邪不能舒展,所以血液从口中溢出。应当补益体表的阳气,清泻体内的虚热。于是想到张仲景治疗伤寒,脉象浮紧,本应以麻黄汤发汗,如果不给服用,遂导致鼻衄血,后来却给予麻黄汤立刻痊愈。此病例与此非常相似,因此制作此汤,服用一次即愈。)
(李东垣)治疗因过度劳累损伤,出现肌肉发热、面色红赤、烦躁口渴想喝水,脉象大而无力。
黄芪(炙制,一两)、当归(酒洗,二钱)。空腹服用。
当归能滋阴养血,黄芪是补气之药。为什么黄芪用量是当归的五倍,却称为补血汤呢?大概是因为有形的血液,生于无形的真气。又有当归作为引经药,则随之而生血。医经说:阳气生长则阴血长养,这就是其中的道理。
(《济生方》/本事方)治疗肠风脏毒引起的便血。
槐花(炒制)、侧柏叶(捣碎)、荆芥(炒黑)、枳壳(炒制),等分研为细末。每次服用三钱,用米汤送下。
侧柏叶能滋养阴液、燥湿,最善于清解血分之热。槐花能疏肝泻热,可凉大肠。荆芥能散瘀搜风,(是治疗风病和血病的要药。)
加入当归、生地、川芎,配合乌梅、生姜煎煮,名为加减四物汤。(《济生方》治疗相同病症,功效为补血凉血。)除去侧柏叶、荆芥,加入当归、黄芩、防风、地榆,用酒糊制成丸剂,名为槐角丸,(《局方》治疗相同病症,功效为凉血、疏通血脉。)除去侧柏叶、枳壳,加入青皮等分,也名为槐花散。(洁古先生)治疗血痢,腹部不痛,没有里急后重感。除去侧柏叶、枳壳,加入当归、川芎、熟地、白术、青皮、升麻,名为当归和血散。(李东垣)也名为槐花散,治疗肠风下血、湿毒下血。
经验方单用槐花、荆芥炒黑研为细末,用酒送服,也能治疗便血。
(Li Dongyuan) Treats hematemesis (vomiting blood), caused by external contraction of cold pathogenic factors and internal deficiency with accumulated heat.
Mahuang (Ephedrae Herba) [dispels exterior cold], Huangqi (Astragali Radix) [consolidates the exterior and benefits Wei Qi (defensive qi)], Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) [warms and tonifies Spleen], Baishao Yao (Paeoniae Radix Alba) [calms the Taiyin channel], each 1 qian; Renshen (Ginseng Radix) [benefits Yuan Qi (original qi) and consolidates the exterior], Maidong (Ophiopogonis Radix) [protects Lung Qi], each 3 fen; Wuweizi (Schisandrae Fructus) [calms Lung Qi, use 5 berries], Danggui (Angelicae Sinensis Radix) [harmonizes and nourishes blood], Guizhi (Cinnamomi Ramulus) [harmonizes Ying (nutritive) and Wei (defensive) qi], each 5 fen. Take hot.
Bencao Gangmu states: Observing this single prescription is sufficient to serve as a model for ten thousand generations. It essentially takes half of Zhang Zhongjing's Mahuang Tang and half of a tonic formula, administered together. For those who are deficient and should take formulas from Zhang Zhongjing, this serves as a standard. (Li Dongyuan treated a poor scholar whose condition was Spleen-Stomach deficiency. After recovery with tonic medicines, he subsequently lived in an empty room and slept on a heated kang. He coughed and vomited blood. Li Dongyuan reasoned that due to long-term weakness, living in an empty room in winter with thin clothing, his Yang Qi was doubly depleted. There was severe cold on the exterior, obstructing and trapping interior heat, causing Fire pathogenic factors to be unable to diffuse freely, thus blood emerged from the mouth. One should tonify the exterior Yang and purge the interior deficient heat. Recalling that Zhang Zhongjing treated Shanghan (Cold Damage) where the pulse was floating and tight, which should have been treated with Mahuang Tang to induce sweating; failure to do so led to epistaxis (nosebleed), yet administering Mahuang Tang cured it immediately. This case was very similar, so this decoction was formulated, curing him after one dose.)
(Li Dongyuan) Treats injury from overwork, presenting with muscle fever, red face, irritability, thirst with desire to drink, and a large but deficient pulse.
Huangqi (Astragali Radix) (prepared with honey, 1 liang), Danggui (Angelicae Sinensis Radix) (washed with wine, 2 qian). Take on an empty stomach.
Danggui nourishes Yin and blood, while Huangqi is a Qi-tonifying herb. Why is the dosage five times that of Danggui, yet it is called Bu Xue Tang (Blood-Nourishing Decoction)? Generally, tangible blood is generated from intangible Qi. Furthermore, with Danggui acting as a guiding herb, blood is generated accordingly. The Classics state: "When Yang grows, Yin flourishes." This is the principle at work here.
(Benshi Fang / Jisheng Fang) Treats lower bleeding due to Changfeng (Intestinal Wind) or Zangdu (Visceral Toxin).
Huaihua (Sophorae Flos) (stir-fried), Cebaiye (Platycladi Cacumen) (pounded), Jingjie (Schizonepetae Spica) (stir-fried until black), Zhike (Aurantii Fructus Immaturus) (stir-fried), ground into equal parts fine powder. Take 3 qian per dose, washed down with rice water.
Cebaiye nourishes Yin and dries dampness, most effectively clearing heat from the Blood level. Huaihua soothes the Liver and purges heat, cooling the Large Intestine. Jingjie disperses stasis and searches out wind (it is an essential herb for wind and blood diseases).
Add Danggui, Shengdi (Rehmanniae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Wumei (Mume Fructus), and Shengjiang (Zingiberis Rhizoma Recens), decocted together, named Jiajian Siwu Tang (Modified Four Substances Decoction). (Jisheng Fang treats the same condition; effects are tonifying blood and cooling blood.) Remove Cebaiye and Jingjie, add Danggui, Huangqin (Scutellariae Radix), Fangfeng (Saposhnikoviae Radix), and Diyü (Sanguisorbae Radix), formed into pills with wine paste, named Huaijiao Wan (Sophora Fruit Pill). (Ju Fang treats the same condition; effects are cooling blood and unblocking blood.) Remove Cebaiye and Zhike, add Qingpi (Aurantii Pericarpium Viride) in equal parts, also named Huaihua San (Sophora Powder). (Jieguzhengzong treats bloody dysentery without abdominal pain or tenesmus.) Remove Cebaiye and Zhike, add Danggui, Chuanxiong, Shudi (Prepared Rehmanniae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Qingpi, and Shengma (Cimicifugae Rhizoma), named Danggui Hexue San (Angelica Blood-Harmonizing Powder). (Li Dongyuan) also names it Huaihua San, treating Changfeng lower bleeding and damp-toxin lower bleeding.
Empirical formula: Use only Huaihua and Jingjie, stir-fried until black, ground into powder, taken with wine, also treats lower bleeding.