严氏曰痹证因体虚腠理空疏受之而成逢寒则急蓬热则纵随所受邪气而生证也诊其脉大而
涩为痹脉来急亦为痹脉涩而紧者亦为痹又有风血痹阴邪入于血经故也
谨按人感三气为痹者正因形虚血虚尔但有在肌皮血脉浅深之异故入脏者死虽陈氏具经论
颇详而其方未能以尽其变学人自宜充扩也
三因附子汤治风寒湿痹骨节疼痛皮肤不仁肌肉重着四肢缓纵
附子(生) 白芍 桂心 甘草 白茯苓 人参(各三分) 白术(一两)
上 咀每服四钱水煎服
按此太阳例药温中解表之剂
三因黄 五物汤治人骨弱肌重因疲劳汗出卧不时动摇加以微风遂作血痹脉当阴阳俱微尺
中少紧身体如风痹状
黄 芍药 桂心(等分)
上 咀每服四五钱入姜枣煎
严氏蠲痹汤治身体烦疼项背拘急或痛或重举动艰难手足冷痹腰腿沉重筋脉无力
当归 芍药 黄 片子姜黄 羌活(各一两半) 甘草(炙半两)
上 咀每服四五钱入姜枣煎
黄 酒治风湿痹身体顽麻皮肤瘙痒筋脉挛急言语謇涩手足不遂时觉不仁
黄 防风 桂 天麻 萆 石斛 虎骨(炙) 白芍 当归 云母粉 白术 茵芋叶
木香 仙灵脾 甘草 川续断
上锉如麻豆大以生绢袋盛好酒一斗浸之春五夏三秋七冬十日每服一盏温服之不拘时
防风汤治血痹皮肤不仁
防风(二两) 川独活 川当归 赤茯苓 秦艽 赤芍 黄芩(各一两) 桂心 杏仁 甘
草(炙各半两)
上 咀每四五钱入姜煎
独活寄生汤治肝肾虚弱感风湿致痹两胫缓纵痹弱不仁
方见香港脚门
谨按以上方多太阳例药也大抵痹证有兼风兼湿寒热独胜腑脏所受不同用者自宜扩充然此
证因
虚而感既着体不去须制对证药日夜饮之虽留连不愈能守病禁不令入脏庶可扶持也如钱仲阳取
茯苓其大逾斗者以法啖之阅月乃尽由此虽偏废而气骨坚悍如无疾者寿八十二而终惜乎其方无
传
严氏说:痹证是因为身体虚弱、腠理(皮肤纹理及汗孔)疏松,邪气乘虚而入而形成的。遇到寒气则筋脉拘急,遇到热气则筋脉弛纵,随着所感受的邪气不同而产生相应的证候。诊察其脉象,脉大而涩是痹证的脉象;脉来急促也是痹证;脉涩而紧的也是痹证,这又有风血痹、阴邪侵入血脉经络的缘故。
谨按:人感受风、寒、湿三气而成痹证,正是因为形体虚弱、血液亏虚所致。只是病邪在肌表、皮肤、血脉中的深浅有所不同,所以病邪入脏者预后不良(多死)。虽然陈氏对经论阐述颇为详细,但其方剂未能穷尽变化之理,学习的人自然应当加以扩充发挥。
三因附子汤:治疗风寒湿痹引起的骨节疼痛、皮肤麻木不仁、肌肉沉重着滞、四肢弛缓无力。
处方:附子(生用)、白芍、桂心、甘草、白茯苓、人参(各三分),白术(一两)。
制法与用法:将药物捣碎成粗末,每次服用四钱,加水煎服。
按语:此方属于太阳经例药,是温中解表的方剂。
三因黄芪五物汤:治疗人体骨弱肌重,因疲劳出汗后睡觉时身体不时动摇,又加上微风侵袭,从而形成血痹。脉象应当表现为阴阳俱微,尺部脉稍紧,身体感觉像风痹一样。
处方:黄芪、芍药、桂心(等分)。
制法与用法:将药物捣碎成粗末,每次服用四五钱,加入生姜、大枣煎服。
严氏蠲痹汤:治疗身体烦痛、项背拘急,或痛或重,举动艰难,手足冷痹,腰腿沉重,筋脉无力。
处方:当归、芍药、黄芪、片子姜黄、羌活(各一两半),甘草(炙半两)。
制法与用法:将药物捣碎成粗末,每次服用四五钱,加入生姜、大枣煎服。
黄芪酒:治疗风湿痹证引起的身体顽麻、皮肤瘙痒、筋脉挛急、言语謇涩、手足不遂、时常感觉麻木不仁。
处方:黄芪、防风、桂枝、天麻、萆薢、石斛、虎骨(炙)、白芍、当归、云母粉、白术、茵芋叶、木香、仙灵脾、甘草、川续断。
制法与用法:将药物锉如麻豆大小,用生绢袋盛装,浸入好酒一斗中。春季浸泡五日,夏季三日,秋季七日,冬季十日。每次服用一盏,温服,不拘时间。
防风汤:治疗血痹引起的皮肤麻木不仁。
处方:防风(二两)、川独活、川当归、赤茯苓、秦艽、赤芍、黄芩(各一两),桂心、杏仁、甘草(炙,各半两)。
制法与用法:将药物捣碎成粗末,每次服用四五钱,加入生姜煎服。
独活寄生汤:治疗肝肾虚弱,感受风湿导致痹证,两小腿弛缓无力,痹弱麻木不仁。
出处:见“香港脚”门(章节)。
谨按:以上方剂大多属于太阳经例药。大抵痹证有兼夹风邪、兼夹湿邪、寒热偏胜的不同,脏腑受邪各异,使用者自然应当根据情况扩充运用。然而此证因虚而感邪,既已附着于体表不去,必须制作对症的药物日夜饮用。即使病情迁延不愈,只要遵守病禁,不让病邪深入脏腑,或许可以扶持生命。例如钱仲阳取直径超过一斗的大茯苓,依法让患者食用,一个月才吃完。由此虽然半身偏废,但气骨坚悍如同无病之人,享年八十二岁去世。可惜他的方子没有流传下来。
Yan stated: Bi syndrome (Bi Syndrome) arises from physical deficiency and loose interstices (loose skin texture and pores), allowing pathogenic factors to enter. Upon exposure to cold, the sinews become tense; upon exposure to heat, they become flaccid. The specific manifestations depend on the nature of the pathogenic factor received. Palpation reveals that a large and choppy pulse indicates Bi syndrome; a rapid pulse also indicates Bi syndrome; a choppy and tight pulse is likewise indicative of Bi syndrome, which may involve Wind-Bi or Blood-Bi, where Yin pathogens invade the blood vessels and meridians.
Note: Humans develop Bi syndrome by contracting the three pathogenic factors (Wind, Cold, Dampness) precisely because of physical and blood deficiency. The difference lies only in the depth of invasion into the muscle, skin, or blood vessels. Therefore, if the pathogen enters the Zang organs, the prognosis is poor (often fatal). Although Chen’s commentary on the classics is quite detailed, his formulas do not exhaust all variations. Practitioners should naturally expand upon these principles.
San Yin Fuzi Decoction (Aconite Decoction for Three Causes): Treats Bi syndrome caused by Wind-Cold-Dampness, characterized by joint pain, cutaneous anesthesia, heavy and adherent muscles, and flaccidity/weakness of the four limbs.
Ingredients: Raw Aconite Root (Fuzi), White Peony Root (Baishao), Cinnamon Heart (Guixin), Licorice Root (Gancao), Poria (Baifuling), Ginseng Radix et Rhizoma (Renshen) (each 3 fen); Atractylodes Macrocephala Rhizome (Baizhu) (1 liang).
Preparation and Administration: Coarsely crush the herbs. Take 4 qian per dose, decoct with water, and drink.
Commentary: This formula belongs to the Taiyang category and is a warming interior and releasing the exterior formula.
San Yin Huangqi Wuwu Decoction (Huangqi Five-Ingredient Decoction for Three Causes): Treats individuals with weak bones and heavy muscles who, after sweating due to fatigue and moving during sleep, are exposed to slight wind, resulting in Blood-Bi. The pulse should be faint in both yin and yang positions, slightly tight at the cun position of the chi pulse. The body feels as if affected by Wind-Bi.
Ingredients: Astragalus Root (Huangqi), Peony Root (Shaoyao), Cinnamon Heart (Guixin) (equal parts).
Preparation and Administration: Coarsely crush the herbs. Take 4–5 qian per dose, decoct with ginger and jujube, and drink.
Yan Shi Juanbi Decoction (Yan’s Bi-Dispelling Decoction): Treats vexing body pain, stiffness or pain/heaviness in the neck and back, difficulty in movement, cold numbness in hands and feet, heaviness in waist and legs, and weakness of sinews and vessels.
Ingredients: Angelica Sinensis Radix (Danggui), Peony Root (Shaoyao), Astragalus Root (Huangqi), Turmeric Tuber (Pianzi Jianghuang), Notopterygium Rhizome et Radix (Qianghuo) (each 1.5 liang); Roasted Licorice Root (Zhi Gancao) (0.5 liang).
Preparation and Administration: Coarsely crush the herbs. Take 4–5 qian per dose, decoct with ginger and jujube, and drink.
Huangqi Wine (Huangqi Infusion in Wine): Treats Wind-Damp Bi syndrome manifesting as stubborn numbness, pruritus, sinew contracture, dysarthria, hemiplegia or inability to move extremities, and frequent sensations of anesthesia.
Ingredients: Astragalus Root (Huangqi), Saposhnikovia Root (Fangfeng), Cinnamon Twig (Guizhi), Gastrodia Rhizome (Tianma), Dioscorea Hypoglauca Rhizome (Bixie), Dendrobium Stem (Shihu), Tiger Bone (processed) (Hugu), White Peony Root (Baishao), Angelica Sinensis Radix (Danggui), Cloud Mother Powder (Yunmu Fen), Atractylodes Macrocephala Rhizome (Baizhu), Ilex Leaf (Yinyu Ye), Costus Root (Muxiang), Epimedium Herba (Xianlingpi), Licorice Root (Gancao), Teasel Root (Chuanxuduan).
Preparation and Administration: Cut the herbs into pieces the size of hemp seeds. Place in a raw silk bag and steep in 1 dou of good wine. Steep for 5 days in spring, 3 days in summer, 7 days in autumn, and 10 days in winter. Take one zhan per dose, warm and drink, without restriction on time.
Fangfeng Decoction (Saposhnikovia Decoction): Treats Blood-Bi causing cutaneous anesthesia.
Ingredients: Saposhnikovia Root (Fangfeng) (2 liang), Pubescent Angelica Root (Chuan Du Huo), Angelica Sinensis Radix (Chuan Dang Gui), Red Poria (Chi Fu Ling), Gentiana Macrophylla Root (Qinjiao), Red Peony Root (Chi Shao), Scutellaria Root (Huangqin) (each 1 liang); Cinnamon Heart (Guixin), Apricot Seed (Xingren), Roasted Licorice Root (Zhi Gancao) (each 0.5 liang).
Preparation and Administration: Coarsely crush the herbs. Take 4–5 qian per dose, decoct with ginger, and drink.
Duhuo Jisheng Decoction (Notopterygium and Sangjisheng Decoction): Treats Bi syndrome caused by Liver and Kidney deficiency combined with Wind-Damp invasion, manifesting as flaccidity and weakness in the lower calves, and numbness/anesthesia.
Source: See the section on Hongxiangjiao (Charley Horse/Podagra).
Note: The above formulas mostly belong to the Taiyang category. Generally, Bi syndrome may involve concurrent Wind, concurrent Dampness, or an excess of Cold or Heat, affecting different Zang and Fu organs. Users should appropriately expand their application based on the condition. However, since this syndrome arises from deficiency leading to pathogenic attachment that does not easily disperse, it is necessary to prepare targeted medicines for daily consumption. Even if recovery is slow, adhering to dietary and lifestyle restrictions to prevent the pathogen from entering the Zang organs can help sustain life. For example, Qian Zhongyang had a patient consume a large Poria sclerotium (larger than a bushel) according to specific methods, finishing it over a month. Although the patient suffered from hemiplegia, their Qi and bone structure remained robust, akin to a healthy person, and they lived to the age of eighty-two. It is a pity that his formula was not transmitted.