杂方
东垣清燥汤治湿热成痿以燥金受湿热之邪是绝寒水生化之源绝则肾亏痿厥之病大作腰以
下痿软瘫痪不能动
黄 (一钱半) 苍术(一钱) 白术 橘皮 泽泻(各半钱) 五味子(九个) 人参 白茯
苓
升麻(各三分) 麦门冬 当归身 生地黄 曲末 酒黄柏 猪苓(各二分) 柴胡 黄连 甘
草(炙各一分)
上咀每半两水煎空心热服
健步丸治膝中无力屈伸不得腰背腿脚沉重行步艰难
羌活 柴胡 炒滑石 甘草(炙) 栝蒌根(酒洗各半钱) 防风(三钱) 泽泻(三钱) 酒
苦参 川乌(各一钱) 肉桂(半钱) 酒防己(一两)
上为细末酒糊为丸桐子大七十丸空心煎愈风汤送下
三因加味四斤丸治肾脏肝虚热淫于内致筋骨痿弱不能胜持
苁蓉(酒浸) 牛膝(酒浸) 天麻 干木瓜 鹿茸(燎去毛切酥炙) 菟丝子(酒浸软另研
细) 熟地黄 五味子(酒浸各一分)
上为末蜜丸桐子大五十丸温酒米饮下食前
按此方云热淫于内而用温补何也然阴血衰弱血不养筋筋缓不能自胜持阳燥热淫于内故用
此养阳滋阴阴实则水升火降矣
内经曰风为百病之长又曰风胜则动又曰贼虚邪者阳受之又曰伤于风者上先受之
按风本阳邪故善动善变甚伤于阳者所以各从其类也
脉经云脉浮而大者风
伤寒论云太阳病脉浮而缓者名曰中风又云太阳中风阳浮而阴弱
论伤风与伤寒六经转变相同
陈无择云经曰春伤于风乃四时之序也或表中风在经络中循经流注以日传变与伤寒无异但
寒泣
血故无汗恶寒风散气故有汗恶风为不同仲景太阳经分伤寒伤风不同而后人纂集者不分门类但
以伤寒暑湿时气疫 凡太阳病皆谓之伤寒今别立伤风一门且根据先哲以太阳经为始分注六经学
者当自知
按此分伤风六经用药可谓发诸家之未备在足太阳膀胱经用桂枝汤足阳明胃经用杏子汤足
少阳
胆经用柴胡加桂汤足太阴脾经用桂枝芍药汤足少阴肾经用桂附汤足厥阴肝经用八物汤其方以
桂枝汤三味加以各经之药皆是辛温解散之剂然既云与伤寒传变相似此六方亦可以尽其变也学
者当求仲景之法以调治之可也今不载其方(详见本文)
谨按伤风一证仲景与伤寒同论其药虽有麻黄桂枝之分至于传变之后亦未尝悉分之也诸家
之论
皆与感冒四气并中风条内衮同出治惟陈无择别立伤风一方在四淫之首且根据伤寒以太阳为始分
注六经可谓详密但以风本外邪诸方例用解表发表而治然受病之源亦有不同者且风为天地浩荡
之气四时八风之变未尝无也然人亦未尝悉伤之也间有受伤者皆因不能法道清净腠理不密表上
阳虚之所致也内经曰清净则内腠闭拒虽有大风苛毒弗之能害是也又有内挟痰热其气拂郁风邪
易于外束者若表虚受风专用发表之药必致汗多亡阳之证若内挟痰热而受风者亦宜内外交治不
可专于解表也或曰此云表虚与成无己注伤寒中风表虚同与予曰不同也彼以太阳中风而于有汗
无汗分虚实实者加麻黄虚者加葛根俱解表也此云表虚者当固守卫气而散风者也
杂方
东垣清燥汤:治疗因湿热导致痿证。其病机为燥金(肺)受湿热邪气侵袭,断绝了寒水(肾)生化之源,源绝则肾亏,导致痿厥之病大作,表现为腰以下痿软瘫痪,不能活动。
药材:黄芩(一钱半)、苍术(一钱)、白术、橘皮、泽泻(各半钱)、五味子(九个)、人参、白茯苓、升麻(各三分)、麦门冬、当归身、生地黄、神曲末、酒制黄柏、猪苓(各二分)、柴胡、黄连、炙甘草(各一分)。
制法与服法:将上述药物切碎,每取半两,加水煎煮,空腹时热服。
药材:羌活、柴胡、炒滑石、炙甘草、栝蒌根(酒洗,各半钱)、防风(三钱)、泽泻(三钱)、酒制苦参、川乌(各一钱)、肉桂(半钱)、酒制防己(一两)。
制法与服法:将上述药物研为细末,用酒糊制作成梧桐子大小的丸剂,每次七十丸,空腹时用愈风汤送服。
三因加味四斤丸:治疗肾脏和肝脏虚损,内热炽盛,导致筋骨痿弱,无法支撑身体。
药材:肉苁蓉(酒浸)、牛膝(酒浸)、天麻、干木瓜、鹿茸(燎去毛,切片,用酥油炙烤)、菟丝子(酒浸软后另研细)、熟地黄、五味子(酒浸,各一分)。
制法与服法:将上述药物研为细末,用蜂蜜制作成梧桐子大小的丸剂,每次五十丸,饭前用温酒或米饮送服。
按语:此方论述中提到“热淫于内”,却使用温补之法,这是为什么呢?这是因为阴血衰弱,血液不能滋养筋脉,导致筋脉弛缓,不能自我支撑;同时阳气燥热炽盛于内,所以使用此方以养阳滋阴。阴实(阴液充足)则肾水上行,心火下降,阴阳调和。
《内经》说:“风是百病的先导。”又说:“风胜则引起动摇。”又说:“贼风虚邪等外邪,首先侵犯阳分。”又说:“伤于风邪者,上部先受邪。”
按语:风本属阳邪,所以善于变动,极易损伤阳气,因此各种病症都遵循同类相从的规律。
《脉经》说:“脉象浮而大的,是风邪所致。”
《伤寒论》说:“太阳病,脉浮而缓的,称为中风。”又说:“太阳中风,阳脉浮而阴脉弱。”
陈无择说:“《内经》记载‘春伤于风’,这是符合四时顺序的。或者表有中风,邪气在经络中循经流注,按日传变,与伤寒无异。但寒邪凝滞血液,所以无汗、恶寒;风邪耗散气机,所以有汗、恶风。这是两者的不同之处。张仲景在太阳经区分了伤寒和伤风,但后人编纂集录时不分门类,凡是太阳病都称为伤寒。现在单独设立伤风一门,并且依据先哲的观点,以太阳经为起始,分别标注六经,学者应当自行知晓。”
按语:这种将伤风分为六经用药的方法,可以说是弥补了各家学说的不足。在足太阳膀胱经用桂枝汤,足阳明胃经用杏子汤,足少阳胆经用柴胡加桂汤,足太阴脾经用桂枝芍药汤,足少阴肾经用桂附汤,足厥阴肝经用八物汤。这些方剂都是以桂枝汤为基础,加上各经的药物,都是辛温解散的药剂。既然说与伤寒传变相似,这六个方剂也可以涵盖其变化。学者应当探求张仲景的方法来调治即可。现在不载列具体方剂(详见本文其他部分)。
谨按:伤风这一证候,张仲景将其与伤寒一同论述,虽然药物有麻黄、桂枝的区别,但在传变之后,也未曾完全区分开来。诸家的论述,都与感冒、四气以及中风条目的内容混杂在一起,采用相同的治疗方法。只有陈无择单独设立伤风一方,列为四淫之首,并且依据伤寒理论,以太阳经为起始,分别标注六经,可谓详细周密。但是,风本是外邪,各方通常都用解表发表的方法治疗。然而,致病的原因也有不同。风是天地间浩荡之气,四季八风的变幻,未尝没有。然而人也不曾全都受伤。偶尔有受伤的人,都是因为不能效法清静之道,腠理不致密,体表阳气虚弱所致。《内经》说:“清静则内部腠理闭拒,即使有大风苛毒,也不能伤害人体。”又有体内夹杂痰热,气机拂郁,风邪易于从外部束缚的情况。如果表虚受风,专门使用发表的药物,必然会导致汗多亡阳的证候。如果体内夹杂痰热又受风邪,也应当内外兼治,不可专门专注于解表。有人问:“这里所说的表虚,与成无己注解伤寒中风时的表虚相同吗?”我说:不同。他所说的是太阳中风,根据有汗无汗来区分虚实,实证加麻黄,虚证加葛根,都是解表的方法。这里所说的表虚,应当固护卫气并疏散风邪。
Miscellaneous Prescriptions
Dongyuan Qingzao Tang (Clearing Dryness Decoction): Treats flaccidity syndrome caused by damp-heat. The pathogenesis involves the Metal element (Lung) being invaded by damp-heat pathogens, severing the source of generation for Water (Kidney). When the source is severed, Kidney deficiency occurs, leading to severe flaccidity and cold extremities, manifesting as flaccid paralysis below the waist and inability to move.
Herbs: Huangqin (Scutellariae Radix, 1.5 qian), Cangzhu (Atractylodis Rhizoma, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma), Jupi (Citri Reticulatae Pericarpium), Zexie (Alismatis Rhizoma, each 0.5 qian), Wuweizi (Schisandrae Fructus, 9 berries), Renshen (Ginseng Radix), Baifuling (Poria with Hostwood, Shengma (Cimicifugae Rhizoma, each 0.3 fen), Maimendong (Ophiopogonis Radix), Dangguishen (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix), Qumò (End of Shenqu), Jiu Huangbai (Phellodendri Cortex processed with wine), Zhuling (Polyporus, each 0.2 fen), Chaihu (Bupleuri Radix), Huanglian (Coptidis Rhizome), Zhigancao (Glycyrrhizae Radix et Rhizoma processed with honey, each 0.1 fen).
Preparation and Administration: Coarsely crush the above herbs. For each dose of half liang, decoct in water and take hot on an empty stomach.
Jianbu Wan (Leg-Strengthening Pill): Treats weakness in the knees, inability to flex and extend, heaviness in the lower back, back, legs, and feet, and difficulty walking.
Herbs: Qianghuo (Notopterygii Rhizoma et Radix), Chaihu (Bupleuri Radix), Chao Huashi (Talcum processed), Zhigancao (Glycyrrhizae Radix et Rhizoma processed with honey), Gualougen (Trichosanthis Radix washed with wine, each 0.5 qian), Fangfeng (Saposhnikoviae Radix, 3 qian), Zexie (Alismatis Rhizoma, 3 qian), Jiu Kushen (Sophorae Flavescentis Radix processed with wine), Chuanwu (Aconiti Radix Lateralis Preparata, each 1 qian), Rougui (Cinnamomi Cortex, 0.5 qian), Jiu Fangji (Stephaniae Tetrandrae Radix processed with wine, 1 liang).
Preparation and Administration: Grind the above herbs into a fine powder. Use wine paste to form pills the size of paulownia seeds. Take 70 pills on an empty stomach, delivered with Yufeng Tang (Wind-Resolving Decoction).
Sanyin Jiawei Sijin Wan (Three Causes Modified Four-Yang Pill): Treats Kidney and Liver deficiency with excessive internal heat, resulting in weak sinews and bones that cannot support the body.
Herbs: Congrong (Cynomorii Herba soaked in wine), Niuxi (Achyranthis Bidentatae Radix soaked in wine), Tianma (Gastrodiae Rhizoma), Gan Mugua (Chaenomelis Fructum dried), Lurong (Cervi Cornu Pantotrichum scalded to remove hair, sliced, and roasted with suet oil), Tusizi (Cuscutae Semen soaked in wine until soft, separately ground finely), Shudihuang (Rehmanniae Radix Preparata), Wuweizi (Schisandrae Fructus soaked in wine, each 1 fen).
Preparation and Administration: Grind the above herbs into powder. Use honey to form pills the size of paulownia seeds. Take 50 pills before meals, delivered with warm wine or rice drink.
Commentary: This prescription mentions "excessive heat within" yet employs warming tonification. Why? Because Yin blood is deficient and fails to nourish the sinews, causing them to relax and fail to support the body; simultaneously, Yang dryness and heat are excessive within. Therefore, this formula is used to nourish Yang and Yin. When Yin is sufficient, Kidney Water ascends and Heart Fire descends, achieving balance.
The *Neijing* states: "Wind is the chief of all diseases." It also says: "Excess wind causes movement/tremors." It further states: "Treacherous winds and false evils first affect the Yang aspect." And: "Those injured by wind, the upper part receives it first."
Commentary: Wind belongs to Yang pathogens; thus, it is prone to change and easily damages Yang. Therefore, various conditions follow the principle of similarity attracting similarity.
The *Maijing* states: "A pulse that is floating and large indicates wind."
The *Shanghan Lun* states: "In Taiyang disease, if the pulse is floating and slow, it is named Zhongfeng (Wind Strike)." It also says: "In Taiyang Zhongfeng, the Yang pulse is floating and the Yin pulse is weak."
The discussion notes that the transmission of Shangfeng (Wind Injury) and Shanghan (Cold Injury) through the Six Channels is identical.
Chen Wuyue states: "The *Neijing* records 'Spring injury from wind,' which aligns with the sequence of the four seasons. If there is wind strike at the exterior, the pathogen flows through the meridians and transmits day by day, similar to Shanghan. However, Cold congeals blood, resulting in no sweat and aversion to cold; Wind disperses Qi, resulting in sweat and aversion to wind. These are differences. Zhang Zhongjing distinguished between Shanghan and Shangfeng in the Taiyang channel, but later compilers did not categorize them separately, referring to all Taiyang diseases as Shanghan. Now, a separate category for Shangfeng is established, following the ancients' approach starting with the Taiyang channel and annotating the Six Channels. Scholars should understand this."
Commentary: This method of differentiating Shangfeng treatment according to the Six Channels can be said to supplement the inadequacies of previous schools. For the Foot-Taiyang Bladder Channel, Guizhi Tang (Cinnamon Twig Decoction) is used; for the Foot-Yangming Stomach Channel, Xingzi Tang (Apricot Seed Decoction); for the Foot-Shaoyang Gallbladder Channel, Chaihu Jia Guizhi Tang (Bupleurum Plus Cinnamon Twig Decoction); for the Foot-Taiyin Spleen Channel, Guizhi Shaoyao Tang (Cinnamon Twig Plus Peony Decoction); for the Foot-Shaoyin Kidney Channel, Guifu Tang (Cinnamon Plus Aconite Decoction); for the Foot-Jueyin Liver Channel, Bawu Tang (Eight Substances Decoction). These formulas are based on Guizhi Tang plus herbs specific to each channel, all being acrid-warm dispersing agents. Since it is stated that transmission is similar to Shanghan, these six formulas can cover its variations. Scholars should seek the methods of Zhang Zhongjing for regulation and treatment. The specific formulas are not recorded here (see detailed text elsewhere).
Careful Review: Regarding the syndrome of Shangfeng, Zhang Zhongjing discussed it together with Shanghan. Although the medicines differ (e.g., Mahuang vs. Guizhi), after transmission, they were not strictly differentiated. Discussions by various authors are mixed with those on common cold, four qi, and Zhongfeng, using similar treatments. Only Chen Wuyue established a separate prescription for Shangfeng, placing it first among the four excesses, and followed the Shanghan model starting from Taiyang to annotate the Six Channels, which is detailed and rigorous. However, since wind is an external pathogen, most prescriptions use exterior-releasing methods. Yet, the source of disease varies. Wind is the vast energy of heaven and earth, subject to changes of the eight winds across four seasons, yet humans do not always get injured. Those who are injured do so because they fail to maintain purity and stillness, leading to loose interstices (couli) and deficiency of superficial Yang. The *Neijing* states: "Purity and stillness close the internal interstices; even with great wind and severe toxins, harm cannot occur." There are also cases where internal phlegm-heat causes Qi stagnation, making the body susceptible to external wind binding. If exterior deficiency leads to wind invasion, using only exterior-releasing drugs will cause excessive sweating and loss of Yang. If internal phlegm-heat accompanies wind invasion, both interior and exterior must be treated; one cannot focus solely on releasing the exterior. Some ask: "Is the 'exterior deficiency' mentioned here the same as Cheng Wuji's commentary on Taiyang Zhongfeng exterior deficiency?" I say: No. He refers to Taiyang Zhongfeng, distinguishing deficiency and excess based on presence or absence of sweat, adding Mahuang for excess and Gegen for deficiency, both for releasing the exterior. Here, 'exterior deficiency' implies securing the Defensive Qi while dispersing wind.