黄 (蜜炙) 当归(洗,去芦,薄切,焙干,秤,各一两半) 白芍药(三两) 桂
(一两
一分去粗皮不见火) 甘草(一两,炙)
上粗末,每服五钱,生姜三片,枣一个,水一盏半,同煎至八分,去滓,取七厘清汁,
日三服,夜二服,尺脉尚迟,再作一剂。
昔有乡人丘生者病伤寒。予为诊视,发热头疼烦渴,脉虽浮数而无力,尺以下迟而弱。
予曰∶虽属麻黄证,而尺迟弱。仲景云∶尺中迟者,荣气不足,血气微少,未可发汗。予于
建中
但只
得汗矣
时日,
官,武
之曰∶
二年乎
文伯曰
效乎。
之戒。
蜜四两,铜器中文武火煎之稍凝如饴状,搅之勿令焦,候可丸。即取出捻作梃,如指许
长二寸,当热时急作,令头锐,纳谷道中,以手急抱定。欲大便时乃去之,未利再作。
有一士人家病者二人,皆旬日矣。
一则身热发汗,大便不通,小便如经,神昏多睡,诊其脉长大而虚。予用承气汤下之而愈。
一则阳明自汗,大便不通,小便利,津液少口干燥,其脉亦大而虚。予作蜜兑三易之,下燥
屎,得溏利而解。其家问曰∶皆阳明大便不通,何治之异?予曰∶二症虽相似,然自汗小便
利者,不可荡涤五脏,为无津液也,然则伤寒大证相似。余证稍有不同,要在变通仔细斟酌
,不可不谨。
黄耆(用蜂蜜炙烤)一两半,当归(洗净,去除芦头,切成薄片,焙干后称量)一两半,白芍药三两,桂枝(一两一分,去掉粗皮,不要经过火炒)一两一分,甘草(一两,炙过)一两。
以上药材捣成粗末,每次服用五钱,加入生姜三片、大枣一个,用水一盏半,共同煎煮至八分满,滤去药渣,取七分之一的清汁,白天服用三次,夜间服用两次。如果尺部脉搏仍然迟缓,再制作一剂。
从前有一个同乡人丘生得了伤寒病。我为他诊脉,见他发热、头痛、心烦口渴,脉象虽然浮数但无力,尺部以下的脉搏迟缓而弱。我说:“虽然属于麻黄汤证,但尺部脉迟弱。张仲景说:‘尺部脉迟的,是营气不足,气血微弱,不可以发汗。’”我在建中汤的基础上只加了当归,不久就出汗了。
蜜四两,在铜器中用文火和武火交替煎煮,稍微凝固像饴糖状时,搅拌它不要让它焦糊,等到可以做成丸药时,就取出来搓成条状,像手指那样长二寸,趁热赶紧做成,让一头尖锐,塞入肛门中,用手紧紧抱住固定。想要大便时才取出,如果没有通便效果再制作一个。
有一户士人家里有两个病人,都病了十几天了。
其中一个身体发热,已经发过汗,大便不通,小便正常,神志昏迷多睡,诊察他的脉象长大而虚。我用承气汤攻下他,痊愈了。
另一个阳明经自汗,大便不通,小便通利,津液少口干燥,他的脉象也是大而虚。我给他用了蜜兑法,换了三次,排出了燥屎,得到溏便而解除了病症。这家人问我说:“都是阳明病大便不通,为什么治疗方法不同?”我说:“这两个症状虽然相似,但是自汗且小便通利的,不可以荡涤五脏,因为体内没有津液了。然而伤寒的大证候相似,其余症状稍有不同,关键在于灵活变通仔细斟酌,不可不谨慎。”
Huangqi (Honey-fried Astragali Radix) 1.5 liang, Danggui (Washed, de-lumened, thinly sliced, dried by baking, weighed) 1.5 liang, Baishao (White Peony Root) 3 liang, Guizhi (Cinnamon Twig) 1.1 liang (remove the rough bark, do not roast over fire), Gancao (Licorice Root) 1 liang (roasted).
Crush the above herbs into coarse powder. For each dose, take 5 qian, add 3 slices of Shengjiang (Fresh Ginger), 1 Zao (Jujube), and 1.5 zhang of water. Decoct together until reduced to 0.8 zhang. Strain the dregs, and take 1/7 of the clear liquid. Take three times during the day and twice at night. If the Chi pulse (pulse felt at the wrist position corresponding to the kidney/lower jiao) remains slow, prepare another dose.
In the past, a fellow villager named Qiu Sheng suffered from Shanghan (Cold Damage disease). I examined his pulse; he had fever, headache, irritability, and thirst. Although his pulse was floating and rapid, it was forceless. The Chi portion below was slow and weak. I said, "Although this belongs to the Mahuang Tang (Ephedra Decoction) pattern, the Chi pulse is slow and weak. Zhang Zhongjing stated: 'If the Chi pulse is slow, Ying Qi (Nutritive Qi) is insufficient, and Qi and Blood are slightly deficient; sweating therapy should not be used.' Therefore, I modified Jianzhong Tang (Middle-Buildering Decoction) by only adding Danggui (Angelica Sinensis). Shortly after, he sweated."
Take 4 liang of Femi (Bee Honey). Simmer in a copper vessel alternating between Wenhuo (Mild Fire) and Wuhuo (Strong Fire) until it slightly coagulates like maltose syrup. Stir constantly to prevent burning. When it can be molded, remove it and roll it into sticks, about two cun long and as thick as a finger. While hot, shape them quickly so that one end is sharp. Insert into the anal canal and hold firmly with hands. Remove when defecation is desired. If no evacuation occurs, prepare another one.
There were two patients in a scholar's household who had been ill for ten days.
One patient had body heat, had already undergone sweating therapy, had constipation, normal urination, coma, and excessive sleepiness. His pulse was large and empty. I treated him with Chengqi Tang (Purgative Decoction) to purge the bowels, and he recovered.
The other patient had Yangming syndrome with spontaneous sweating, constipation, free urination, scanty body fluids, dry mouth, and a pulse that was also large and empty. I treated him with Midui Method (Honey Suppository), changing it three times. He passed dry feces and achieved relief through loose stools. The family asked, "Both have Yangming constipation; why are the treatments different?" I replied, "Although these two conditions appear similar, those with spontaneous sweating and free urination cannot undergo harsh purgation to scour the five zang organs, because there are no body fluids left. Thus, although the major patterns of Shanghan are similar, slight differences in other symptoms require flexible adaptation and careful deliberation. One must not be careless."