局方桃花丸治冷痢腹痛下如鱼脑白物
赤石脂( ) 干姜(炮各等分)
上为末蒸饼糊丸米饮下三四十丸日三服
按此出阳明例药方
丹溪曰桃花丸即要略桃花汤也仲景以治便脓血用赤石脂丸者干姜粳米同煮作汤一饮病安
便止
后药意谓病下焦血虚且寒非干姜之温石脂之涩且重不能止血粳米味甘引入肠胃不使重涩之体
少有凝滞药行易散余毒亦无局方不知深意改为丸药剂以面糊日与三服果能与仲景之意合否也
严氏当归丸治冷留肠胃下痢纯白腹痛
当归(酒洗) 芍药 附子(炮去皮脐) 白术 干姜(炮) 浓朴 阿胶(各一两) 乌梅肉
(二两) 蛤粉(炒各一两)
上为细末醋糊丸桐子大每服五十丸米饮送下局方诃藜勒散治肠胃虚弱泄利水谷渐成痢疾
青皮(去穣) 肉豆蔻(面裹煨) 肉桂(五钱) 附子(炮去皮脐一两) 诃子仁(各四两)
上为末每服三钱姜三片煎服
按局方以白痢为寒多用辛热燥毒之药若用之于下痢清谷肠虚感寒者或可矣若脓血稠粘属
火之证用之非杀而何但感寒之证吾恐什百而一二也
古方驻车丸治冷热下痢肠滑赤白
黄连(六两) 干姜 当归(各二两) 阿胶
上先以醋煮胶令消入前三药和匀众手丸桐子大米饮下
局方香连丸治冷热不调下痢赤白脓血相杂里急后重
黄连(去芦二十两用吴茱萸十两同炒令赤色去茱萸不用) 木香(四两八钱不见火)
上为细末醋糊丸桐子大每服二十丸空心米饮下
按此出太阴例药也
戊己丸治胃经受热泄痢不止
黄连 吴茱萸(去梗炒) 白芍(各五两)
上为细末面糊丸桐子大每服三十丸米饮下
按此出厥阴已寒例以上三方出证治冷热下痢盖冷热异气水火相反岂能同在肠胃为病耶论
中辨
之详矣但其制方亦有暗合妙理惜乎世人莫知其深意也三方皆以黄连苦寒之药为君正治湿热之
气佐以辛苦温药所以开郁行滞气血宣通病亦自已干姜木香茱萸三者各随经合宜而用要在学人
临机应变又不可拘执于此也
局方桃花丸治疗冷痢,症状为腹痛且大便排出如鱼脑般的白色物质。
赤石脂(未注明剂量) 干姜(炮制,与赤石脂等分)
将上述药材研为细末,用蒸饼制成的糊剂作为粘合剂制成丸药,每次服用三四十丸,以米汤送服,每日三次。
按语:此方出自阳明病证的用药范例。
丹溪说:桃花丸即《金匮要略》中的桃花汤。张仲景用它来治疗便脓血,其中赤石脂、干姜、粳米共同煮成汤剂,服用一次后病愈即止。
后来的医家认为,此病属下焦血虚且伴有寒邪,若非干姜的温性、赤石脂的涩性且药力厚重,不能达到止血的效果;粳米味甘,能引导药力进入肠胃,避免过于重浊涩滞的药物造成凝滞,使药力易于发散,余毒也能随之清除。但局方不知其深意,将其改为丸剂,用面糊制作,每日服用三次,这果真能与张仲景的本意相合吗?
严氏当归丸治疗寒气滞留肠胃导致的下痢,排出纯白色粘液,伴有腹痛。
当归(酒洗) 芍药 附子(炮制,去皮去脐) 白术 干姜(炮制) 浓朴 阿胶(各一两) 乌梅肉(二两) 蛤粉(炒,各一两)
将上述药材研为细末,用醋糊制成如梧桐子大小的丸药,每次服用五十丸,以米汤送服。
局方诃黎勒散治疗因肠胃虚弱导致的泄泻,水谷不分,逐渐演变为痢疾。
青皮(去瓤) 肉豆蔻(面粉包裹煨熟) 肉桂(五钱) 附子(炮制,去皮去脐,一两) 诃子仁(各四两)
将上述药材研为细末,每次服用三钱,加生姜三片煎汤服用。
按语:局方将白痢视为寒证,多使用辛热燥烈有毒的药物。如果用于下利清谷、肠虚感寒的情况或许可以;但如果用于脓血稠粘属于火证的痢疾,使用这些药物岂不是等于杀人吗?但我担心感受寒邪的病例,百中难有一二。
古方驻车丸治疗冷热交杂引起的下痢,肠道滑脱,大便赤白相间。
黄连(六两) 干姜 当归(各二两) 阿胶
先将阿胶用醋煮化,再加入前三味药混合均匀,众人合力搓丸,制成如梧桐子大小的丸药,每次服用适量,以米汤送服。
局方香连丸治疗冷热不调引起的下痢,赤白脓血混杂,伴有里急后重感。
黄连(去芦头,二十两用吴茱萸十两同炒至红色,去掉吴茱萸不用) 木香(四两八钱,不经过火炒)
将上述药材研为细末,用醋糊制成如梧桐子大小的丸药,每次服用二十丸,空腹时以米汤送服。
按语:此方出自太阴病证的用药范例。
戊己丸治疗胃经受热导致的泄痢不止。
黄连 吴茱萸(去梗炒) 白芍(各五两)
将上述药材研为细末,用面糊制成如梧桐子大小的丸药,每次服用三十丸,以米汤送服。
按语:此方出自厥阴病已兼寒的用药范例。以上三方是针对证候辨别冷热下痢而设。大概是因为冷与热是异气,水与火性质相反,岂能在肠胃中同时致病呢?《伤寒论》中对此辨析得很详细了。但是它们的组方也有暗合妙理之处,可惜世人不知道其中的深意。这三方都以黄连这种苦寒的药作为君药,正治湿热之气,辅以辛苦温性的药物,所以能开郁结、行滞气,使气血宣通,病自然痊愈。干姜、木香、吴茱萸三者各自随经辨证适宜而用,关键在于学习者在临证时要随机应变,不可拘泥执着于此。
Ju Fang Taohua Wan (Peach Kernel Pill from the Bureau of Imperial Medical Establishment) treats cold dysentery, characterized by abdominal pain and the passage of white discharge resembling fish brain.
Shizhishi (Red Halloysite) [dose unspecified] Ganjiang (Dried Ginger, processed), equal parts to Shizhishi.
Grind the above ingredients into fine powder, use paste made from steamed bread as a binder to form pills. Take 30-40 pills per dose with rice water, three times daily.
Note: This prescription originates from the treatment examples for Yangming disease patterns.
Danxi stated: Taohua Wan is the same as Taohua Tang (Peach Seed Decoction) in *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). Zhang Zhongjing used it to treat pus and blood in the stool. In that decoction, Shizhishi, Ganjiang, and Jingmi (Rice) were boiled together; after one dose, if the illness resolved, administration was stopped.
Later physicians reasoned that this condition involves deficiency of blood in the lower jiao accompanied by cold. Without the warming nature of Ganjiang and the astringent property of Shizhishi, with heavy dosage, hemostasis cannot be achieved. Jingmi has a sweet flavor and guides the medicine into the intestines and stomach, preventing the heavy and astringent substances from causing stagnation, allowing the medicinal action to disperse easily and residual toxins to be cleared. However, Ju Fang did not understand this profound meaning and changed it into a pill, using flour paste as a binder, taken three times daily. Does this truly align with Zhang Zhongjing's original intent?
Yan Shi Danggui Wan (Angelica Sinensis Pill by Master Yan) treats dysentery caused by cold pathogen lingering in the intestines and stomach, characterized by pure white discharge and abdominal pain.
Danggui (Angelicae Sinensis Radix, washed with wine) Shaoyao (Paeoniae Radix) Fuzi (Aconiti Lateralis Radix Praeparata, processed, peeled, umbilicus removed) Baizhu (Atractylodis Macrocephalae Rhizoma) Ganjiang (Dried Ginger, processed) Houpo (Magnoliae Officinalis Cortex) Ejiao (Colla Corii Asini) [each 1 liang] Wumei Rou (Fructus Mume Semen) [2 liang] Gafen (Trogoderma Powder, stir-fried) [each 1 liang].
Grind the above ingredients into fine powder, use vinegar paste to form pills the size of paulownia seeds. Take 50 pills per dose with rice water.
Ju Fang Helile San (Terminalia Chebula Powder from the Bureau of Imperial Medical Establishment) treats diarrhea due to weakness of the intestines and stomach, where undigested food and water are passed, gradually evolving into dysentery.
Qingpi (Citri Reticulatae Pericarpium Viride, pith removed) Roudoukou (Myristicae Semen, baked in flour) Rougui (Cinnamomi Cortex) [5 qian] Fuzi (Aconiti Lateralis Radix Praeparata, processed, peeled, umbilicus removed, 1 liang) Hezi Ren (Terminaliae Chebulae Fructus Semen) [each 4 liang].
Grind the above ingredients into powder. Take 3 qian per dose, decocted with 3 slices of fresh ginger.
Note: Ju Fang considers white dysentery as a cold pattern and mostly uses acrid, hot, drying, and toxic drugs. If applied to cases of passing undigested food due to intestinal emptiness and cold invasion, it might be acceptable. However, if applied to dysentery with thick, sticky pus and blood, which belongs to fire patterns, using such drugs would essentially amount to killing the patient. But I fear that cases truly caused by cold invasion are rare, perhaps one or two in hundreds.
Gu Fang Chuzhe Wan (Chuzhe Pill from Ancient Formulas) treats mixed cold-heat dysentery with intestinal slippage, characterized by alternating red and white stools.
Huanglian (Coptidis Rhizoma) [6 liang] Ganjiang (Dried Ginger) Danggui (Angelicae Sinensis Radix) [each 2 liang] Ejiao (Colla Corii Asini).
First, dissolve Ejiao by boiling in vinegar, then add the other three medicines, mix evenly, and roll into pills by multiple hands, forming pills the size of paulownia seeds. Take an appropriate amount with rice water.
Ju Fang Xianglian Wan (Costus and Coptis Pill from the Bureau of Imperial Medical Establishment) treats dysentery with mixed red and white pus and blood, accompanied by tenesmus, due to imbalance of cold and heat.
Huanglian (Coptidis Rhizoma, radix removed, 20 liang stir-fried with 10 liang of Wuzhuyu until red, remove Wuzhuyu and do not use) Muxiang (Aucklandiae Radix) [4 liang 8 qian, not roasted over fire].
Grind the above ingredients into fine powder, use vinegar paste to form pills the size of paulownia seeds. Take 20 pills per dose on an empty stomach with rice water.
Note: This prescription originates from the treatment examples for Taiyin disease patterns.
Wuji Wan (Wuji Pill) treats persistent diarrhea and dysentery caused by heat in the Stomach channel.
Huanglian (Coptidis Rhizoma) Wuzhuyu (Evodiae Fructus, stem removed, stir-fried) Baishao (Paeoniae Radix Alba) [each 5 liang].
Grind the above ingredients into powder, use flour paste to form pills the size of paulownia seeds. Take 30 pills per dose with rice water.
Note: This prescription originates from examples of Jueyin disease patterns already complicated by cold. The above three prescriptions are designed for distinguishing cold and heat patterns in dysentery. Generally, cold and heat are opposing qi, and water and fire have contrary natures; how can they coexist in the intestines and stomach to cause disease? This is analyzed in detail in the *Lun* (referring to *Shanghan Lun*). However, their formulation principles also contain subtle and ingenious logic, which is a pity that most people do not understand. All three prescriptions use Huanglian, a bitter-cold herb, as the sovereign drug to directly treat damp-heat qi, assisted by acrid, bitter, and warm herbs. Thus, they can resolve depression, move stagnation, and promote the circulation of qi and blood, leading to spontaneous recovery. Ganjiang, Muxiang, and Wuzhuyu are each used appropriately according to the affected channel. The key lies in practitioners adapting flexibly during clinical practice, rather than rigidly adhering to these specific formulas.