丹溪曰虚者补而养之局方何例用辛香燥热之剂以火济火不无实实虚虚之祸若曰菟丝子丸
之治
肾虚金钗石斛丸之治气不足茴香丸之治脏虚冷玉霜丸之治气虚养正丹之治诸虚朴附丸之治脾
虚弱按气丹之治真元虚四神丹之治五脏虚苁蓉大补丸之治元脏虚钟乳白泽丸之治诸虚三健汤
之治气不足甚者内聚丹剂悉曰补脾胃补肾补五脏补真气而方各条下曰口苦面黄曰气促喘急口
淡曰舌涩曰噫酸曰舌干曰溺数曰水道涩痛曰唇口干燥等证悉是明具热论如何类聚燥热而谓可
以健脾温胃而滋肾补气乎又骨碎补丸治肝肾风虚乳香宣经丸治体虚换腿丸治足三阴经虚或因
感
风而虚或因虚而感寒既曰体虚肝肾虚足三阴经虚病非轻小理宜补养而自然铜半夏威灵仙荆芥
地龙川楝乌药防风牵牛灵脂草乌羌活石南天麻南星槟榔等疏通燥疾之药俱补剂之大半果何以
补虚乎地仙丹既曰补肾而滋补之药与 燥走窜之药相半用之肾恶燥而谓可以补肾乎借曰足少
阴经非附子辈不能自达八味丸仲景肾经药也八两地黄以一两附子佐之观此则是非可得而定矣
金匮桂枝加龙骨牡蛎汤治诸脉芤动微紧男子失精女人梦交
桂枝 白芍 生姜(各三钱) 甘草(一钱) 大枣(一枚) 龙骨 牡蛎(各三钱)
上 咀水煎食前服
小建中汤治虚劳里急悸衄腹中痛失精四肢酸疼手足烦热咽干口燥
桂枝 甘草(炙各三钱) 大枣(二枚) 白芍 生姜(二钱) 阿胶(炒一合)
上 咀水煎
黄 建中汤治虚劳里急诸不足
前方加黄 (二钱)
炙甘草汤治虚劳不足汗出而闷脉结悸行动如常不出百日危急者十一日死
甘草(二钱炙) 桂枝 生姜(各一钱半) 麦门冬(一合) 麻子仁(一合) 人参 阿胶(
各一钱) 大枣(二枚) 生地黄(三钱)
上 咀水煎入酒些小日作三四料服
局方人参养荣汤
方见热门
按以上诸方并太阳例药也
十味人参散
人参黄 散
东垣补中益气汤
方并见热门
益胃升阳汤血脱益气古圣人之法也先补胃气以助生发之气故曰阳生阴长诸甘药为之先务
举世皆以为补气殊不知甘能生血此阳生阴长之理故先理胃气人之身内谷为宝
前方加炒曲(一钱半) 生黄芩(泻盛暑之伏庚金肺逆每服少许秋凉去之)
上 咀水煎
按以上诸方并少阳例药也东垣云表虚用桂枝黄 里虚用人参芍药以上方有兼用者治表里
俱虚
也然观其法有辛温甘温甘寒主治之别苦寒酸苦之佐升降奇耦之意皆异者盖虚中有兼寒兼热或
气虚血虚阴阳气血俱不足或阴虚阳虚虚脱与夫
胃气下陷精神不足等因不同故也用者当细分之补气之剂
严氏 附汤治气虚阳弱虚汗不止肢体倦怠
黄 (蜜炙) 附子(炮等分)
上咀每四钱加生姜煎
参附汤治真阳不足上气喘急自汗盗汗气短头晕
人参(半两) 附子(炮去皮脐一两)
上咀分作三服加生姜煎
按此二方少阴例药也
四君子汤治肺损皮聚而毛落宜此益气
人参 白术 茯苓 甘草(炙)
上 咀水煎服
济生茯神汤治脉虚极或咳则心痛喉仲介或肿
茯神 人参 远志 通草 麦门冬 黄 桔梗 甘草(等分)
上 咀每半两入姜煎
瑞竹堂补气汤治气虚脉浮而软怔忡无力自汗
黄 (三两蜜水拌炒) 人参 甘草(炙各半两) 麦门冬(去心) 桔梗(炒各一两)
上 咀每四钱水煎入姜三片三因方名润神散
按此三方手太阴少阴药也
丹溪说:虚证应当用补益的方法来调养,而《局方》为何惯例使用辛香燥热的药物?这如同用火去救火,难免造成“实者更实、虚者更虚”的祸患。如果说菟丝子丸治疗肾虚,金钗石斛丸治疗气不足,茴香丸治疗脏腑虚冷,玉霜丸治疗气虚,养正丹治疗各种虚损,朴附丸治疗脾虚弱,按气丹治疗真元虚,四神丹治疗五脏虚,苁蓉大补丸治疗元脏虚,钟乳白泽丸治疗各种虚损,三健汤治疗气虚严重……这些内服丸剂都称为补脾胃、补肾、补五脏、补真气。但是查看各方条文下的症状描述:口苦面黄、气促喘急、口淡、舌涩、嗳气泛酸、舌干、小便频数、水道涩痛、唇口干燥等证候,全都明确具备热象。如何能将它们归类为燥热之药,并声称可以健脾温胃、滋肾补气呢?
另外,骨碎补丸治疗肝肾风虚,乳香宣经丸治疗体虚,换腿丸治疗足三阴经虚。既然说是体虚、肝肾虚、足三阴经虚,病情并非轻小,理应通过补养来治疗。然而方中却使用了自然铜、半夏、威灵仙、荆芥、地龙、川楝子、乌药、防风、牵牛子、五灵脂、草乌、羌活、石南藤、天麻、南星、槟榔等大量疏通经络、燥湿祛疾的药物,这些占据了补剂的大部分。这究竟凭什么来补虚呢?
地仙丹既然说是补肾,但方中滋补药物与燥烈走窜的药物各占一半。使用这种方剂,肾脏厌恶燥性,怎么能说是补肾呢?假如说足少阴经非用附子这类药物不能直达病所,八味丸是张仲景治疗肾经疾病的方剂,其中重用八两地黄,仅用一两附子作为佐使。由此可见,是非曲直是可以确定的。
《金匮要略》中的桂枝加龙骨牡蛎汤,治疗各种脉象见芤、动、微、紧,男子失精,女子梦交。
处方:桂枝、白芍、生姜(各三钱),甘草(一钱),大枣(一枚),龙骨、牡蛎(各三钱)。
制法:切碎,水煎,饭前服用。
小建中汤,治疗虚劳引起的腹中拘急疼痛、心悸、鼻衄、失精、四肢酸痛、手足烦热、咽干口燥。
处方:桂枝、炙甘草(各三钱),大枣(二枚),白芍、生姜(二钱),阿胶(炒一合)。
制法:切碎,水煎。
黄芪建中汤,治疗虚劳腹中拘急及诸般不足。
前方加入黄芪(二钱)。
炙甘草汤,治疗虚劳不足,汗出而胸闷,脉结代,心动悸,行动如常不出百日即危急者,或十一日死。
处方:炙甘草(二钱),桂枝、生姜(各一钱半),麦门冬(一合),麻子仁(一合),人参、阿胶(各一钱),大枣(二枚),生地黄(三钱)。
制法:切碎,水煎,加入少量酒,每日分三四次服用。
《局方》人参养荣汤
方剂见热门章节。
按:以上各方均属于太阳经例药。
益胃升阳汤:血脱益气是古圣人的治法。先补胃气以助生发之气,所以叫“阳生阴长”。各种甘味药物是首要任务。举世的人都认为这是补气,殊不知甘味能生血,这是“阳生阴长”的道理,所以先调理胃气。人身以内谷为宝。
前方加入炒神曲(一钱半)、生黄芩(泻盛暑时潜伏的金气肺逆,每服少许,秋凉时去掉)。
制法:切碎,水煎。
按:以上各方均属于少阳经例药。李东垣说:表虚用桂枝汤加黄芪,里虚用人参芍药汤。以上方剂有兼用的情况,用于治疗表里俱虚。然而观察其治法,有辛温、甘温、甘寒主治的区别,以及苦寒、酸苦作为佐使,升降奇偶的变化之意,都是不同的。这是因为虚证中兼夹寒热,或者气虚血虚、阴阳气血俱不足,或者阴虚阳虚、虚脱,以及胃气下陷、精神不足等原因不同,所以使用者应当仔细分辨。
补气之剂:
严氏附子汤,治疗气虚阳弱,虚汗不止,肢体倦怠。
处方:黄芪(蜜炙)、附子(炮制,等分)。
制法:切碎,每次四钱,加生姜煎服。
参附汤,治疗真阳不足,上气喘急,自汗盗汗,气短头晕。
处方:人参(半两),附子(炮制,去皮脐,一两)。
制法:切碎,分作三次服用,加生姜煎服。
按:此二方属于少阴经例药。
四君子汤,治疗肺损导致皮毛枯槁脱落,宜用此方益气。
处方:人参、白术、茯苓、炙甘草。
制法:切碎,水煎服。
济生茯神汤,治疗脉极虚,或者咳嗽则心痛,喉咙中介介然不适或肿胀。
处方:茯神、人参、远志、通草、麦门冬、黄芪、桔梗、甘草(等分)。
制法:切碎,每次半两,入姜煎服。
瑞竹堂补气汤,治疗气虚脉浮而软,怔忡无力,自汗。
处方:黄芪(三两,蜜水拌炒)、人参、炙甘草(各半两)、麦门冬(去心)、炒桔梗(各一两)。
制法:切碎,每次四钱,水煎,入姜三片。三因方名为润神散。
按:此三方属于手太阴、手少阴经药。
Danxi stated: For deficiency syndromes, tonification and nourishment should be employed. Why does the *Ju Fang* (Formulas of the Imperial Medical Bureau) routinely use acrid, aromatic, dry, and hot agents? This is akin to using fire to extinguish fire, inevitably leading to the disaster of "making the excess more excessive and the deficiency more deficient." If one argues that Tusi Zi Wan (Cuscuta Seed Pill) treats Kidney deficiency, Jinchai Shihu Wan (Dendrobium Nobile Pill) treats Qi insufficiency, Huixiang Wan (Fennel Pill) treats coldness in the Zang organs, Yushuang Wan (Jade Frost Pill) treats Qi deficiency, Yangzheng Dan (Nourishing Righteousness Elixir) treats various deficiencies, Pufu Wan (Magnolia Bark and Aconite Pill) treats Spleen weakness, Anqi Dan (Regulating Qi Elixir) treats depletion of True Yuan, Sishen Dan (Four Miracles Elixir) treats Five Viscera deficiency, Congrong Dabu Wan (Cistanche Great Tonification Pill) treats Yuan Zang (Primordial Organ) deficiency, Zhongru Baize Wan (Tricalcium Carbonate and White Luster Pill) treats various deficiencies, Sanjian Tang (Three Strengths Decoction) treats severe Qi deficiency... All these internal pills are termed as tonifying the Spleen and Stomach, tonifying the Kidney, tonifying the Five Viscera, and tonifying True Qi. However, examining the symptom descriptions under each formula: bitter taste in the mouth with sallow complexion, shortness of breath and panting, bland taste in the mouth, rough tongue, belching with acid reflux, dry tongue, frequent urination, painful and difficult urination, dry lips and mouth—these signs clearly indicate Heat patterns. How can they be classified as dry-hot agents and claimed to strengthen the Spleen, warm the Stomach, nourish the Kidney, and benefit Qi?
Furthermore, Gusuibu Wan (Drynaria Pill) treats Wind-Deficiency of the Liver and Kidney; Ruxiang Xuanjing Wan (Frankincine Meridian-Unblocking Pill) treats Body Deficiency; Huantui Wan (Leg-Changing Pill) treats Deficiency of the Foot Shaoyin, Jueyin, and Taiyin meridians. Since it is stated as Body Deficiency, Liver-Kidney Deficiency, and Foot Three Yin Meridian Deficiency, the condition is not minor, and tonification and nourishment should naturally be indicated. Yet, the formulas contain a majority of herbs for unblocking collaterals and drying dampness/diseases, such as Ziran Tong (Natural Copper), Banxia (Pinellia Rhizome), Weilingxian (Clematis Root), Jingjie (Schizonepeta Spike), Dilong (Earthworm), Chuanlianzi (Melia Fruit), Wuyao (Lindera Root), Fangfeng (Saposhnikovia Root), Qianniu (Pharbitis Seed), Wulingzhi (Trogopterus Dung), Caowu (Aconitum Carmichaelii Root), Qianghuo (Notopterygium Rhizome), Shinan (Rhododendron Dauricum Stem), Tianma (Gastrodia Rhizome), Nanxing (Arisaema Rhizome), and Binglang (Areca Seed). On what basis do these constitute the majority of a tonifying agent and claim to treat deficiency?
Dixian Dan (Immortal Earth Elixir) claims to tonify the Kidney, yet half the ingredients are moistening tonics and half are drying, acrid, and penetrating agents. Using this, given that the Kidney dislikes dryness, how can it be said to tonify the Kidney? Even if one argues that the Foot Shaoyin Meridian cannot reach its target without agents like Fuzi (Prepared Aconite Root), Bawei Wan (Eight-Ingredient Pill) is Zhang Zhongjing’s formula for Kidney meridian diseases. It uses eight liang of Dihuang (Rehmannia Root) assisted by only one liang of Fuzi. From this, right and wrong can be determined.
The Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) in the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) treats various pulse presentations of Kong (Hollow), Dong (Fluctuating), Wei (Fine), and Jin (Tight), seminal emission in men, and nocturnal emissions/sexual dreams in women.
Formula: Guizhi (Cinnamon Twig), Baishao (White Peony Root), Shengjiang (Fresh Ginger) (each 3 qian), Gancao (Licorice Root) (1 qian), Dazao (Jujube) (1 piece), Longgu (Dragon Bone), Muli (Oyster Shell) (each 3 qian).
Preparation: Coarsely crush, decoct in water, take before meals.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction) treats Xu Lao (Consumptive Disease) with Li Ji (abdominal urgency/tightness), Ji (palpitations), Nu (epistaxis), Fuzhong Tong (abdominal pain), Shijing (seminal emission), Sizhi Suanteng (soreness and pain in four limbs), Shouzhu Fanre (heat in hands and feet), Yangan Kouzao (dry throat and mouth).
Formula: Guizhi (Cinnamon Twig), Zhigancao (Honey-fried Licorice Root) (each 3 qian), Dazao (Jujube) (2 pieces), Baishao (White Peony Root), Shengjiang (Fresh Ginger) (2 qian), Ejiao (Donkey-hide Gelatin) (1 he, stir-fried).
Preparation: Coarsely crush, decoct in water.
Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction) treats Xu Lao with Li Ji and various insufficiencies.
Add Huangqi (Astragalus Root) (2 qian) to the previous formula.
Zhigancao Tang (Honey-fried Licorice Decoction) treats Xu Lao insufficiency, sweating with chest oppression, Jie Dai (knotted or intermittent pulse), Xin Ji (palpitations). If the patient moves normally, death may occur within 100 days; otherwise, within 11 days.
Formula: Zhigancao (Honey-fried Licorice Root) (2 qian), Guizhi (Cinnamon Twig), Shengjiang (Fresh Ginger) (each 1.5 qian), Maimendong (Ophiopogon Tuber) (1 he), Maziren (Hemp Seed) (1 he), Ren Shen (Ginseng Root), Ejiao (Donkey-hide Gelatin) (each 1 qian), Dazao (Jujube) (2 pieces), Shengdihuang (Raw Rehmannia Root) (3 qian).
Preparation: Coarsely crush, decoct in water with a small amount of wine, divide into three or four doses per day.
Ju Fang Renshen Yangrong Tang (Imperial Bureau Ginseng Nourishing Blood Decoction)
See Hot Category section.
Note: The above formulas all belong to the Taiyang pattern examples.
Shiwei Renshen San (Ten-Ingredient Ginseng Powder)
Huangqi Renshen San (Astragalus and Ginseng Powder)
Dongyuan Butong Yiqi Tang (Dongyuan Tonify the Middle and Benefit Qi Decoction)
See Hot Category section.
Yiwei Shengyang Tang (Benefit Stomach and Raise Yang Decoction): "Tonifying Qi in cases of Blood loss" is the method of the ancient sages. First tonify Stomach Qi to assist the generating Qi; hence it is called "Yang generates Yin." Sweet herbs are the primary task. The world generally considers this to tonify Qi, but little do they know that sweet flavors generate Blood; this is the principle of "Yang generates Yin." Therefore, first regulate Stomach Qi. Internal grain is the treasure of the human body.
Add Chaoqu (Stir-fried Divine Leaven) (1.5 qian) and Sheng Huangqin (Raw Scutellaria Root) (to drain latent Metal/Lung rebellion from summer heat, take a small amount per dose, remove when autumn cools) to the previous formula.
Preparation: Coarsely crush, decoct in water.
Note: The above formulas all belong to the Shaoyang pattern examples. Dongyuan stated: For Exterior Deficiency, use Guizhi Tang with Huangqi; for Interior Deficiency, use Renshen Shaoyao Tang. The above formulas have combined uses for treating both Exterior and Interior Deficiency. However, observing their methods, there are distinctions in main treatments of Acrid-Warm, Sweet-Warm, and Sweet-Cold, and in auxiliaries of Bitter-Cold and Sour-Bitter, with meanings of ascending-descending and odd-even combinations. These differ because Deficiency may involve concurrent Cold or Heat, or Qi and Blood deficiency, or simultaneous Yin and Yang deficiency, or Yin/Yang collapse, or sinking of Stomach Qi and insufficiency of Spirit. Thus, users must distinguish carefully.
Qi Bu Zhi Ji (Agents for Tonifying Qi):
Yan Shi Fuzi Tang (Master Yan's Aconite Decoction) treats Qi deficiency and Yang weakness with continuous spontaneous sweating and limb fatigue.
Formula: Huangqi (Astragalus Root, honey-fried), Fuzi (Prepared Aconite Root) (equal parts).
Preparation: Coarsely crush, add ginger, decoct for 4 qian per dose.
Renshen Fuzi Tang (Ginseng and Aconite Decoction) treats insufficiency of True Yang with rapid breathing, spontaneous and night sweats, shortness of breath, and dizziness.
Formula: Renshen (Ginseng Root) (0.5 liang), Fuzi (Prepared Aconite Root, peeled and umbilicus removed) (1 liang).
Preparation: Coarsely crush, divide into three doses, add ginger, decoct.
Note: These two formulas belong to the Shaoyin pattern examples.
Sijunzi Tang (Four Gentlemen Decoction) treats Lung damage causing skin aggregation and hair fall; this formula is suitable to benefit Qi.
Formula: Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Zhigancao (Honey-fried Licorice Root).
Preparation: Coarsely crush, decoct in water, take orally.
Jisheng Fushen Tang (Jisheng Spore-bearing Poria Decoction) treats extremely deficient pulses, or heart pain upon coughing, sensation of obstruction in the throat, or swelling.
Formula: Fushen (Poria with Hostwood), Renshen (Ginseng Root), Yuanzhi (Polygala Root), Tongcao (Tetrapanax Pith), Maimendong (Ophiopogon Tuber), Huangqi (Astragalus Root), Jiegeng (Platycodon Root), Gancao (Licorice Root) (equal parts).
Preparation: Coarsely crush, add ginger, decoct for 0.5 liang per dose.
Ruizhutang Bqi Tang (Ruizhu Hall Tonify Qi Decoction) treats Qi deficiency with floating and soft pulses, palpitations, weakness, and spontaneous sweating.
Formula: Huangqi (Astragalus Root, 3 liang, stir-fried with honey water), Renshen (Ginseng Root), Zhigancao (Honey-fried Licorice Root) (each 0.5 liang), Maimendong (Ophiopogon Tuber, core removed), Jiegeng (Platycodon Root, stir-fried) (each 1 liang).
Preparation: Coarsely crush, decoct in water for 4 qian per dose, add three slices of ginger. In the *San Yin Fang*, this is named Runshen San (Moisten Spirit Powder).
Note: These three formulas belong to the Hand Taiyin and Hand Shaoyin meridian medicines.