答曰。不当服而服之。是为犯本小便强利。津液重亡。侵阳之极则侵阴而成血证也。轻
则桃仁承气汤。重则(抵当汤)故(五苓散)调和阴阳者也。乃太阳阳明之间。故
为调和之剂。
若热在中焦。未入太阳之本。小便自利而清。是津液已行。若与五苓散利之。是重涸肾
水也
。不惟重涸肾水。酒毒之热亦不能去。故上下不通。而溺涩则为发黄也。若入血室。则为蓄
血也。
火土入水
假令太阳证。伤寒自外入。标本有二说。以主言之。膀胱为本。经络为标。以邪言之。
先得
者为本。后得者为标。此标先受之即是本也后入于膀胱。本却为标也。此乃客邪之标本也。
治当从客之标本。
小肠火为本。
膀胱水为本。
寒毒之气从标入本邪与手经相合。而下至膀胱(五苓散)主之。桂枝阳中之阳。茯苓阳中
之阴。相引而下。入于本道出邪气。
手经 自上之下 足经 丙火 壬水 小肠 自下之上 膀胱
火邪之气。从下之上。以内为本。水中有火。火为客气当再责其本。两肾相通。又在下
责在下焦。下焦如渎。相火明也。生地黄黄柏主之。邪从本受。下焦火邪遗于小肠。是热在
下焦。填塞不便自内而之外也。
生地黄 黄柏 黄连 为阴中之阳
治酒病宜发汗。若利小便。炎焰不肯下行。故曰火郁则发之。辛温散之。是从其火体也
。是
之最为之近。是湿热俱去。治以辛温。发其火也。佐以苦寒。除其湿也。
回答说:不应当服用却服用了,这就违背了病机根本。导致小便通利过度,津液严重耗伤。阳气被侵犯到极点就会波及阴分,从而形成血证。病情轻的,用桃仁承气汤;病情重的,用抵当汤。所以五苓散是调和阴阳的方剂,它处于太阳病和阳明病的中间阶段,因此属于调和之剂。
如果热邪在中焦,尚未传入太阳经的根本(膀胱),小便自然通利且颜色清亮,这说明津液运行正常。如果此时给予五苓散来利尿,就是使肾水再次枯竭。这不仅会加重肾水的枯竭,酒毒产生的热邪也无法去除。于是上下气机不通,小便涩滞,进而导致发黄。如果热邪进入血室,就会形成蓄血证。
假设是太阳病,伤寒从外部侵入。关于标本有两种说法。从正气主导的角度来说,膀胱为本,经络为标。从邪气的角度来说,先感受的为本,后感受的为标。这里体表先受邪即为本,随后邪气内传于膀胱,膀胱反而成了标。这是客邪的标本关系。治疗应当遵循客邪的标本规律。
小肠以火为本。
膀胱以水为本。
寒毒之气从标(经络)传入本(脏腑),邪气与手经相合,下行至膀胱,由五苓散主治。桂枝是阳中之阳,茯苓是阳中之阴,二者相互引导下行,进入本道排出邪气。
手经(小肠)自上而下,足经(膀胱)自下而上;丙火对应小肠,壬水对应膀胱。
火邪之气,从下向上,以内脏为本。水中含有火,火作为客气,应当再追究它的根本。两肾相通,又在下部涉及下焦。下焦如同沟渠,相火明亮。这种情况用生地黄、黄柏主治。邪气从根本受病,下焦的火邪遗留于小肠,这是热在下焦,填塞不通,病势由内向外发展。
桂枝、白术、泽泻、猪苓,属于阳中之阴。
生地黄、黄柏、黄连,属于阴中之阳。
治疗酒病适宜发汗。如果采用利小便的方法,炎上的火势不肯下行,所以说“火郁则发之”。用辛温药物发散,这是顺应火的特性。这种方法最为接近病机,能使湿热同时去除。治疗用辛温药发散火邪,佐以苦寒药清除湿邪。
Answer: Taking the medicine when it is not indicated constitutes violating the root of the disease. This leads to excessive urination and severe depletion of body fluids (Jin-Ye). When Yang is invaded to the extreme, it invades Yin, resulting in blood disorders (Xue Zheng). For mild cases, Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) is used; for severe cases, Di Dang Tang (Wait-Until-It-Goes Decoction) is used. Therefore, Wu Ling San (Five-Ingredient Powder with Poria) is a formula that harmonizes Yin and Yang. It lies between Taiyang disease (Disease of the Taiyang Channel) and Yangming disease (Disease of the Yangming Channel), thus serving as a harmonizing agent.
If heat is located in the Middle Jiao (Middle Burner) and has not yet entered the root of the Taiyang channel (the Bladder), urination will be free and clear, indicating that body fluids are circulating normally. If Wu Ling San is administered at this time to promote diuresis, it causes further depletion of Kidney water (Shen Shui). Not only does this deplete Kidney water further, but the heat from alcohol toxicity also cannot be eliminated. Consequently, the upper and lower pathways become obstructed, urinary difficulty occurs, leading to jaundice (Huang). If the pathogen enters the Blood Chamber (Xue Shi), it results in Blood Accumulation (Xu Xue).
Assuming it is a Taiyang condition, where cold damage (Shang Han) enters from the exterior, there are two theories regarding Root (Ben) and Branch (Biao). From the perspective of the host's righteous Qi, the Bladder is the Root, and the channels and collaterals are the Branch. From the perspective of the pathogen, what is acquired first is the Root, and what is acquired later is the Branch. Here, the exterior is affected first, constituting the Root; subsequently, the pathogen enters the Bladder, making the Bladder the Branch. This refers to the Root and Branch of an exogenous pathogen. Treatment should follow the Root and Branch of the exogenous pathogen.
The Small Intestine has Fire as its Root.
The Bladder has Water as its Root.
Cold-toxic qi enters from the Branch to the Root. The pathogen combines with the Hand Channels and descends to the Bladder, which is primarily treated by Wu Ling San. Gui Zhi (Cinnamon Twig) is Yang within Yang, and Fu Ling (Poria) is Yin within Yang. They guide each other downward, entering the Root pathway to expel the pathogenic qi.
Hand Channels descend from above to below; Foot Channels ascend from below to above. Bing Fire corresponds to the Small Intestine; Ren Water corresponds to the Bladder.
Fire-pathogenic qi ascends from below to above, with the interior as the Root. There is fire within water. Since fire acts as a guest pathogen, one must again investigate its Root. The two Kidneys are connected, and the issue pertains to the Lower Jiao (Lower Burner). The Lower Jiao is like a drainage ditch, where Ministerial Fire (Xiang Huo) is bright. This condition is treated with Sheng Di Huang (Rehmanniae Radix Preparata) and Huang Bo (Phellodendri Cortex). The pathogen originates from the Root; fire pathogenic qi from the Lower Jiao lingers in the Small Intestine, meaning heat is in the Lower Jiao, causing obstruction and difficulty, with the pathology moving from the interior to the exterior.
Gui Zhi (Cinnamon Twig), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ze Xie (Alismatis Rhizoma), and Fu Ling (Poria) belong to Yin within Yang.
Sheng Di Huang (Rehmanniae Radix Preparata), Huang Bo (Phellodendri Cortex), and Huang Lian (Coptidis Rhizoma) belong to Yang within Yin.
For treating alcohol-related diseases, inducing sweating is appropriate. If diuresis is used, the flaming fire will not descend. Hence, it is said that "when fire is constrained, it should be dispersed." Using acrid-warm herbs to disperse aligns with the nature of fire. This approach is closest to the pathology, allowing both dampness and heat to be eliminated. Treatment employs acrid-warm herbs to disperse fire, assisted by bitter-cold herbs to remove dampness.