治中脘留伏痰饮。臂痛难举。手足不得转移。
指迷最切茯苓丸。风化芒硝分外看。枳半合成四味药。停痰伏饮胜灵丹。(半夏制二两。
茯
)柯韵伯曰。痰饮之本。皆水也。水入于胃。游溢精气。上输于脾。此自阳入阴也。脾气散
精。上归于肺。此地气上升也。通调水道。下输膀胱。是天气下降也。水精四布。五经并行。
是水入于经。而血乃成也。若阴阳不和。清浊相干。胃气乱于中。脾气难于升。肺气滞于降
。而痰饮随作矣。痰与饮同源。而有阴阳之别。阳盛阴虚。则水气凝而为痰。阴盛阳虚。则
水气溢而为饮。除痰者。降气清火是治其标。补阴利水是治其本也。涤饮者。降气燥湿是治
其标。温肾利水是治其本也。此方欲兼两者而合治之。半夏燥湿。茯苓渗湿。风硝软坚。枳
壳利气。别于二陈之甘缓。远于礞石之峻悍。殆攻中之平剂欤。
○涩可固脱
火炎汗出六黄汤。(醒而汗出曰自汗。寐而汗出曰盗汗。)二地芩连柏与当。(生地黄熟
地黄黄柏黄芩黄连当归各等分。黄 加倍。)倍用黄 偏走表。苦坚妙用敛浮阳。
陈修园曰。阴虚火扰之汗。得当归熟地生地之滋阴。又得黄芩黄连之泻火。治汗之本也。
然此方之妙。则在于苦寒。寒则胜热。而苦复能坚之。又恐过于苦寒。伤其中气。中者。阴
之守也。阴愈虚则火愈动。火愈动则汗愈出。尤妙在大苦大寒坠中倍加黄 。俾黄 领苦寒
之性。尽达于表。以坚汗孔。不使留中而为害。此旨甚微。注家向多误解。特表而出之。
治疗中脘部停留潜伏的痰饮。手臂疼痛难以举起,手足不能随意转动。
指迷茯苓丸最为对症。风化芒硝需单独看待。半夏、枳壳、茯苓、甘草合成四味药。对于停积的痰饮,其疗效胜过灵丹妙药。(制半夏二两,茯苓一两半,枳壳七分,风化朴硝五分。)
柯韵伯说:痰饮的根本,都是水液代谢失常。水进入胃中,游溢精气,向上输送到脾,这是从阳入阴的过程。脾气散布精微物质,向上归聚于肺,这是地气上升的过程。通调水道,向下输送到膀胱,这是天气下降的过程。水精四布,五行经脉并行,这是水进入经脉而化生为血的过程。如果阴阳不和,清浊之气相互干扰,胃气在中焦紊乱,脾气难以升清,肺气滞于肃降,那么痰饮就会随之产生。痰与饮同源,但有阴阳的区别。阳气盛而阴气虚,则水气凝结而成痰;阴气盛而阳气虚,则水气溢出而成饮。祛除痰邪,降气清火是治标,补阴利水是治本。涤除饮邪,降气燥湿是治标,温肾利水是治本。这个方子想要兼收两者之效而综合治疗。半夏燥湿,茯苓渗湿,风化芒硝软坚散结,枳壳理气。不同于二陈汤的甘缓,远离礞石滚痰丸的峻猛悍烈,这大概是攻邪中的平和剂型吧。
○ 涩可固脱
火炎汗出用当归六黄汤。(清醒时出汗称为自汗,睡眠时出汗称为盗汗。)生地黄、熟地黄、黄芩、黄连、黄柏与当归。(生地黄、熟地黄、黄柏、黄芩、黄连、当归各等分,黄芪加倍。)加倍使用黄芪偏向走表,苦寒坚阴的妙用在于收敛浮越之阳气。
陈修园说:阴虚火扰导致的汗出,得到当归、熟地黄、生地黄的滋阴作用,又得到黄芩、黄连的泻火作用,这是治汗的根本。然而这个方子的妙处,在于苦寒。寒能胜热,而苦又能坚阴。又担心过于苦寒,损伤中焦之气。中气是阴气的守御者。阴越虚则火越动,火越动则汗越多。尤其巧妙的是在大苦大寒的药中加倍加入黄芪。使黄芪带领苦寒药性,全部到达体表,以坚固汗孔,不让药性留滞在中焦而产生危害。这个旨意非常微妙,注家向来多有误解,特此表明并指出。
Treats phlegm-fluid retention (Tan Yin) lingering in the epigastrium. The arm is painful and difficult to lift; the hands and feet cannot move freely.
Zhi Mi Fu Ling Wan (Poria Pill for Guiding Confusion) is most appropriate. Feng Hua Mang Xiao (Desiccated Mirabilite) should be viewed separately. Ban Xia (Pinelliae Rhizoma), Zhi Ke (Aurantii Fructus), Fu Ling (Poria), and Gan Cao (Glycyrrhizae Radix et Rhizoma) combine into four ingredients. For retained phlegm and fluid, its efficacy surpasses miraculous elixirs. (Processed Ban Xia 2 liang, Fu Ling 1.5 liang, Zhi Ke 0.7 qian, Desiccated Mirabilite 0.5 qian.)
Ke Yunbo stated: The root of phlegm and fluid lies in water metabolism. Water enters the Stomach, overflows with essence and qi, and is transported upward to the Spleen; this is a process from Yang entering Yin. The Spleen disperses essence, which returns upward to the Lung; this is Earth Qi ascending. It regulates water passages, transporting downward to the Bladder; this is Heaven Qi descending. Water essence distributes in all directions, traversing the Five Meridians; this is water entering the meridians to transform into blood. If Yin and Yang are disharmonious, clear and turbid energies interfere with each other, Stomach Qi becomes chaotic in the middle, Spleen Qi fails to ascend clearly, and Lung Qi stagnates in its descent; thus, phlegm and fluid arise. Phlegm and fluid share the same origin but differ in Yin and Yang nature. When Yang is excess and Yin is deficiency, water energy condenses to form phlegm; when Yin is excess and Yang is deficiency, water energy overflows to form fluid. To eliminate phlegm, descending Qi and clearing Fire treats the branch (symptom), while tonifying Yin and promoting urination treats the root (cause). To scour fluid, descending Qi and drying Dampness treats the branch, while warming the Kidney and promoting urination treats the root. This formula seeks to combine both approaches for comprehensive treatment. Ban Xia dries Dampness, Fu Ling leaches out Dampness, Desiccated Mirabilite softens hardness, and Zhi Ke promotes Qi movement. It differs from Er Chen Tang's sweet and緩 (gentle/slow) nature, and stays far from the harsh and fierce action of Meng Shi Tan Wan (Nostoc Pill). It is likely a moderate agent among purgatives.
○ Astringents can consolidate leakage
For sweating due to blazing fire, use Dang Gui Liu Huang Tang. (Sweating while awake is called spontaneous sweating; sweating while asleep is called night sweating.) Di Huang (Rehmanniae Radix), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Huang Bai (Phellodendri Cortex), and Dang Gui (Angelicae Sinensis Radix). (Raw Rehmannia Root, Prepared Rehmannia Root, Phellodendron Bark, Scutellaria Root, Coptis Rhizome, Angelica Sinensis Root in equal parts; Astragalus Root doubled.) Doubling the use of Huang Qi (Astragali Radix) favors moving outward to the exterior. The subtle application of bitter and cold properties lies in consolidating floating Yang.
Chen Xiuyuan said: Sweating caused by Yin deficiency and Fire disturbance benefits from the Yin-nourishing effects of Dang Gui, Shu Di Huang (Prepared Rehmanniae Radix), and Sheng Di Huang (Raw Rehmanniae Radix), as well as the Fire-clearing effects of Huang Qin and Huang Lian; this addresses the root of sweating. However, the subtlety of this formula lies in its bitter-cold nature. Cold overcomes heat, and bitterness can strengthen/consolidate. One might fear that excessive bitter-coldness damages Middle Jiao Qi. The Middle is the guardian of Yin. The more deficient the Yin, the more active the Fire; the more active the Fire, the more profuse the sweating. The particular brilliance lies in adding double the amount of Huang Qi amidst the great bitter and cold herbs. This allows Huang Qi to lead the bitter-cold properties entirely to the exterior, to solidify the sweat pores, preventing the medicinal nature from lingering in the interior and causing harm. This principle is very subtle; commentators have often misunderstood it. I hereby highlight and clarify it.