见消渴门
东垣曰金匮真言论云北方黑色入通于肾开窍于二阴藏精于肾又云肾主大便大便难取足少
阴夫
肾主五液津液润则大便如常若饥饱劳逸损伤胃气及食辛热味浓之物而助火邪伏于血中耗散真
阴津液亏少故大便结燥然结燥之病不一有热燥有风燥有阳结有阴结又有年老气虚津液不足
而结者治法云肾恶燥急食辛以润之结者散之如少阴不得大便以辛润之太阴不得大便以苦泻之
阳结者散之阴结者热之仲景云小便利大便硬不可攻下以脾约丸润之食伤太阴腹满食不化腹响
然不能大便者以苦药泻之大抵津液耗少而燥者以辛润之有物而结者当下之若不究其源一概用
巴豆牵牛之类下之损其津液燥结愈甚有复下复结极则以至引导于下而不能通者遂成不救之证
可不慎哉
按此只是论结燥言里证也河间所论则兼表里而言之矣犹宜以燥热胜阴相火论诸篇兼看
机要大秦艽汤治血弱阴虚不能养筋筋燥而手足不能运动指爪干燥属风热甚者
方见中风门
按此散风热养血之剂太阳例药也
麻仁丸
郁李仁 麻子仁(各一两另研) 大黄(二两半以一半炒) 山药 防风 枳壳(炒各七钱
半) 槟榔(半两) 羌活 木香(各五钱半)
上为细末炼蜜丸梧子大每三二丸温水下
按此手足阳明足太阳经药表里之剂气分药也
东垣润肠丸治脾胃中伏火大便秘涩或干燥秘塞不通全不思食乃风结秘血结秘皆令秘塞也
以润燥和血疏风自然通矣
麻子仁 桃仁(各一两去皮尖另研) 羌活 当归尾 大黄(煨各半两) 皂角仁 秦艽(
各五钱)
上除另研外为细末五上火炼蜜丸如桐子大每三五十丸食前白汤下又有润燥丸一方于本方
加郁李仁防风是也
按此足太阴手足阳明表里药也
(此段内容参见“消渴”门类)
李东垣说:《金匮真言论》记载:“北方对应黑色,内通于肾,开窍于前后二阴,精气藏于肾。”又说:“肾主管大便,治疗大便困难应取足少阴肾经。”
肾主管五种津液,津液滋润则大便正常。如果因饥饱失常、劳逸过度损伤了胃气,以及食用辛辣、气味浓烈且性热的食物而助长火邪,火邪潜伏在血中,耗散真阴,导致津液亏少,所以大便秘结干燥。然而,便秘的病因不止一种,有热燥、风燥、阳结、阴结,还有年老体弱、气虚津液不足而导致的便秘。治疗方法如《内经》所说:“肾恶燥,急食辛以润之;结者散之。”例如,少阴病导致的大便不通,用辛味药来润下;太阴病导致的大便不通,用苦味药来泻下;阳结者用发散法,阴结者用温法治之。张仲景说:“小便利、大便硬者,不可攻下,应用脾约丸润下。”如果是饮食损伤太阴脾经,出现腹部胀满、食物不消化、肠鸣音明显但不能大便的情况,应用苦味药泻下。大抵而言,因津液耗少而干燥的,用辛味药润之;因有形实邪结聚的,应当攻下。如果不探究其根源,一概使用巴豆、牵牛子等峻下药,会损伤津液,使燥结更加严重。如果有反复攻下后再次结滞,极端情况下甚至导致引导药物下行却无法通便,最终成为不治之证,能不谨慎吗?
按语:以上只是论述便秘这一里证。刘河间所论述的则兼及表里两方面,因此还宜结合《燥热胜阴相火论》等篇章一起阅读。
机要大秦艽汤:治疗血虚阴虚不能濡养筋脉,导致筋脉干燥,手足不能运动,指爪干燥,属于风热重症。
方剂见“中风”门类。
按语:这是疏散风热、养血的药物,属于太阳经例方。
麻仁丸
配方:郁李仁、麻子仁(各一两,另研)、大黄(二两半,其中一半炒制)、山药、防风、枳壳(炒,各七钱半)、槟榔(半两)、羌活、木香(各五钱半)。
制法与用法:将上述药物除另研者外,研为细末,用炼蜜制成梧桐子大小的丸剂。每次服用三二十丸,温水送服。
按语:这是作用于手足阳明经和足太阳经的药物,属于表里双解的气分药。
李东垣润肠丸:治疗脾胃中有伏火,导致大便秘涩或干燥秘塞不通,完全不想进食。这无论是风结秘还是血结秘,都会导致便秘。通过润燥、和血、疏风,自然就能通畅。
配方:麻子仁、桃仁(各一两,去皮尖,另研)、羌活、当归尾、大黄(煨,各半两)、皂角仁、秦艽(各五钱)。
制法与用法:除另研者外,将其他药物研为细末,加入五钱上火炼蜜,制成如桐子大小的丸剂。每次服用三五十丸,饭前用白开水送服。另有润燥丸一方,即在本方基础上加郁李仁、防风即可。
按语:这是作用于足太阴经和手足阳明经的药物,属于表里同治的药方。
(See the section on "Xiaoke" [Wasting and Thirsting Syndrome].)
Li Dongyuan stated: The *Jinkui Zhenyan Lun* (Treatise on the True Sayings of the Golden Cabinet) records: "The North corresponds to black, internally connecting to the Kidney, opening into the two yin orifices [anterior and posterior], and storing essence in the Kidney." It also states: "The Kidney governs defecation; for difficult defecation, one should seek treatment from the Foot-Shaoyin [Kidney] channel."
The Kidney governs the five body fluids. When body fluids are moistening, defecation is normal. If the Stomach Qi is damaged by irregular eating and drinking, overwork, or rest, and if one consumes pungent, hot, and strongly flavored foods that assist Fire pathogenic factors, these Fire pathogens lurk within the blood, consuming True Yin. This leads to a deficiency of body fluids, resulting in dry and constipated stool. However, the pathology of constipation is not uniform; there are Heat-Dryness, Wind-Dryness, Yang-Constipation, and Yin-Constipation. Additionally, there are cases caused by advanced age, Qi deficiency, and insufficient body fluids. The treatment methods are as stated in the classics: "The Kidney dislikes dryness; urgently consume pungent substances to moisten it; for consolidation, scatter it." For example, for Shaoyin disease causing inability to pass stool, use pungent substances to moisten; for Taiyin disease causing inability to pass stool, use bitter substances to purge; for Yang-Constipation, use dispersing methods; for Yin-Constipation, use warming methods. Zhang Zhongjing said: "When urination is frequent and stool is hard, do not use purgatives; instead, use Pi Yue Wan [Spleen-Restriction Pill] to moisten." If dietary injury affects the Taiyin Spleen, leading to abdominal fullness, indigestion, borborygmus, and inability to pass stool, use bitter substances to purge. Generally speaking, for dryness due to consumption of body fluids, use pungent substances to moisten; for constipation due to tangible accumulation, one should purge. If one fails to investigate the root cause and indiscriminately uses harsh purgatives such as Crotonis Fructus [Badou] and Lapsanae Fructus [Qianniu], it will damage body fluids, making the dryness and constipation worse. In extreme cases, repeated purging may lead to a state where even guided downward-draining agents cannot promote bowel movement, resulting in an incurable condition. Can one not be cautious?
Note: The above merely discusses constipation as an interior syndrome. Liu Hejian’s discussions encompass both exterior and interior aspects; therefore, it is advisable to read them in conjunction with chapters such as "Dryness-Heat Overcoming Yin and Ministerial Fire."
Ji Da Da Qin Jiao Tang [Major Decoction of Smilax Glabra]: Treats conditions where Blood deficiency and Yin deficiency fail to nourish the sinews, causing sinew dryness, immobility of the hands and feet, and dry nails, belonging to severe Wind-Heat patterns.
For the formula, see the "Zhongfeng" [Wind-Stroke] section.
Note: This is a formula for dispersing Wind-Heat and nourishing Blood, categorized under the Taiyang pattern examples.
Maren Wan [Hemp Seed Pill]
Ingredients: Pruni Semen [Yuliren] and Cannabis Fructus [Maziren] (each 1 liang, ground separately); Rheum Radix et Rhizoma [Dahuang] (2.5 liang, half stir-fried); Dioscoreae Rhizoma [Shanyao]; Saposhnikoviae Radix [Fangfeng]; Aurantii Fructus [Zhiqiao] (stir-fried, each 7 qian 5 fen); Arecae Semen [Binglang] (0.5 liang); Notopterygii Rhizoma et Radix [Qianghuo]; Costi Radix [Muxiang] (each 5 qian 5 fen).
Preparation and Administration: Grind all ingredients except those specified for separate grinding into fine powder. Mix with refined honey to form pills the size of mulberry seeds. Take 30–20 pills per dose with warm water.
Note: This formula acts on the Hand-Yangming, Foot-Yangming, and Foot-Taiyang channels; it is a formula addressing both exterior and interior, targeting the Qi level.
Li Dongyuan Run Chang Wan [Moistening Intestine Pill]: Treats latent Fire in the Spleen and Stomach causing constipation, dryness, or complete obstruction, accompanied by total loss of appetite. Whether due to Wind-Constipation or Blood-Constipation, these conditions lead to obstruction. By moistening dryness, harmonizing Blood, and dispersing Wind, patency will naturally be restored.
Ingredients: Cannabis Fructus [Maziren] and Persicae Semen [Taoren] (each 1 liang, skin and tips removed, ground separately); Notopterygii Rhizoma et Radix [Qianghuo]; Angelicae Sinensis Radix [Dangguiwei]; Rheum Radix et Rhizoma [Dahuang] (stir-baked, each 0.5 liang); Gleditsiae Sinensis Spina [Zaoren]; Gentianae Macrophyllae Radix [Qinjiao] (each 5 qian).
Preparation and Administration: Except for those specified for separate grinding, grind the remaining ingredients into fine powder. Add 5 qian of refined honey heated until boiling, and form pills the size of paulownia seeds. Take 30–50 pills per dose before meals with plain boiled water. There is another formula called Run Zao Wan [Moistening Dryness Pill], which consists of adding Pruni Semen [Yuliren] and Saposhnikoviae Radix [Fangfeng] to this base formula.
Note: This formula acts on the Foot-Taiyin and Hand/Yangming channels; it is a formula treating both exterior and interior simultaneously.