三建汤所用附子天雄川乌而莫晓其命名之义比见一老医云川乌建上头目虚风者主之附子
建中脾胃虚寒者主之天雄建下腰肾虚惫者主之故名之曰三建汤是也(癸心杂志)
凡人胃气为湿热所伤必泻其土实而元气乃得上下同流此承气之所由名也
或曰吐血衄血之症乃心气不足所致仲景治法不用补心汤而反用泻心汤何也余曰若心气独
不
足则不止吐衄也此乃邪热因不足而客之则虚火妄动故有吐衄之症得大黄之寒以苦泄其热以苦
补其心则火亦有制而无妄动之害一举而两得之矣岂莫学所能知哉
古人汤散命名必有取义如催生方名为达(音脱)生散何也羊初生曰达羊子易生无留难也故
取其易生而无产难之义诗经生民篇云诞弥厥月先生如达是也
戴原礼辩伤寒论中所谓传经一日太阳二日阳明三日少阳岂有第二日病在里而第三日又在
半表
半里者何也以五行生克论之阳主生则水生木太阳膀胱阳水合传之少阳胆木兼太阳在表少阳表
里之间阳明在里自外渐入于内次第正当阳明居少阳之次此说实前人之所未发陶节庵伤寒琐
言未之及何耶
近世患阴症伤寒往往疑似参瘥初便不敢用附子直待阴极阳竭而用之则为迟矣大抵治法有
是病
而投是药岂可狐疑而误治也哉且夹阴伤寒先因欲事伏阴于内却又着寒内外皆阴阴气独盛则阳
气以衰故脉沉而足冷也必须急用人参健脉以益元气为主佐以附子温肾经散寒邪以退阴而回阳
也若舍此二味不用将何以救之哉近见一人病阴症伤寒先因感寒湿既而发热不食数日后不省人
事语多错乱神思昏迷面青齿露人谓其必死张致和诊之两手脉沉细先以小柴胡汤与之急以四君
子汤加炮附子数片煎成药置盆中以水制其热性少时令温与服其脉渐回神思亦爽更用他药调理
而愈
三建汤所用到的附子、天雄、川乌,人们并不知晓其命名的含义。后来见到一位老医生说:川乌主治头部和眼目的虚风,起到“建上”的作用;附子主治脾胃的虚寒,起到“建中”的作用;天雄主治腰肾的虚惫,起到“建下”的作用。所以称之为三建汤。(出自《癸辛杂志》)
大凡人的胃气被湿热所伤,必须泻去脾土的实邪,元气才能上下通畅流动,这就是承气汤名称的由来。
有人问:吐血、鼻衄(鼻出血)的症状,是由于心气不足导致的吗?张仲景的治疗法则不用补心汤,反而用泻心汤,这是为什么呢?我回答说:如果仅仅是心气单独不足,那么症状就不止于吐血和鼻衄了。这是因为邪热趁着正气不足而侵入体内,导致虚火妄动,所以出现吐血、鼻衄的症状。得到大黄的寒性,以苦味泄去热邪;以苦味补益心气,那么火势就有节制,而不会产生妄动的危害。这是一举两得的方法,这难道是那些没有学问的人所能知道的吗?
古人给汤剂、散剂命名必定有取义之处。例如催生方名为达生散,为什么呢?因为羊初生叫做“达”,羊羔容易出生,没有滞留困难。所以取其容易出生而没有产难的含义。《诗经·大雅·生民》篇中说:“诞弥厥月,先生如达。”
戴原礼辨析《伤寒论》中所谓的传经:第一天太阳病,第二天阳明病,第三天少阳病。难道会有第二天病在里,而第三天又回到半表半里的情况吗?从五行生克的理论来看,阳主生发,水生木。太阳膀胱属阳水,传变给少阳胆属木。少阳兼有太阳在表的特征,处于半表半里之间;阳明在里。病邪自外逐渐向内传入,次序正当如此,阳明居于少阳之后。这种说法确实是前人未曾发表过的见解,陶节庵的《伤寒琐言》为何没有提及呢?
近代患阴证伤寒的病人,往往症状疑似,刚发病时不敢使用附子,一直等到阴气极盛、阳气竭绝时才使用,这就太迟了。大抵治疗法则是有这样的病就投用相应的药,怎么可以犹豫不决而误治呢?况且夹阴伤寒,起初是因为房事导致阴气潜伏于内,然后又感受寒邪,内外皆阴,阴气独盛则阳气衰微,所以脉象沉细而脚冷。此时必须急用人参来健脉以补益元气为主,佐以附子温补肾经、散除寒邪,以退阴气而回阳气。如果舍弃这两味药不用,将用什么来救治呢?最近见到一个人患阴证伤寒,起初因感受寒湿,继而发热、不进食,几天后神志不清,言语错乱,精神昏迷,面色青黑,牙齿外露。别人都说他必死无疑。张致和诊察他的两手脉象沉细,先用小柴胡汤给他服用,接着用四君子汤加入几片炮附子煎成药汁,放在盆中以水冷却其热性,稍微凉一点后让他温服。他的脉象逐渐恢复,精神也清爽了,再用其他药物调理而痊愈。
The Fuzi (Aconiti Lateralis Radix Praeparata), Tianxiong (Aconiti Kusnezoffii Radix), and Chuanwu (Aconiti Karakolicis Radix) used in Sanjian Tang (Three Establishments Decoction) are not understood by people regarding the meaning of their naming. Later, an old physician was seen saying: Chuanwu treats deficiency-wind of the head and eyes, establishing the "Upper"; Fuzi treats deficiency-cold of the spleen and stomach, establishing the "Middle"; Tianxiong treats deficiency-exhaustion of the waist and kidneys, establishing the "Lower." Hence it is named Sanjian Tang (Three Establishments Decoction). (From *Guixin Zazhi*)
Generally, when a person's Stomach Qi (Stomach Vital Energy) is injured by damp-heat, one must purge the excess of the Spleen Earth so that Yuan Qi (Original Vital Energy) can flow up and down smoothly. This is the reason for the name Chengqi Tang (Inheriting Qi Decoction).
Someone asked: Are symptoms such as hematemesis (vomiting blood) and epistaxis (nosebleed) caused by insufficiency of Heart Qi? Why does Zhang Zhongjing's treatment method not use Xinbu Tang (Heart-Nourishing Decoction) but instead uses Xiexin Tang (Draining Heart Decoction)? I replied: If only Heart Qi were insufficient, the symptoms would not be limited to hematemesis and epistaxis. This occurs because pathogenic heat invades due to insufficiency, causing deficient fire to move recklessly, thus resulting in hematemesis and epistaxis. Obtaining the cold nature of Dahuang (Rhei Radix et Rhizoma), one uses bitterness to drain the heat; using bitterness to tonify the Heart, the fire will then be controlled without the harm of reckless movement. This achieves two benefits with one action. How could this be known by those lacking learning?
The naming of ancient decoctions and powders always had specific meanings. For example, the formula for inducing labor is named Dasheng San (Reaching Life Powder). Why? Because a newborn lamb is called "Da" (reaching). Lambs are born easily without obstruction. Thus, it takes the meaning of easy birth without difficulty. The *Shijing* (Classic of Poetry), chapter "Shengmin," states: "When the month was full, the firstborn came forth like a lamb."
Dai Yuanli analyzed the so-called transmission of meridians in *Shanghan Lun* (Treatise on Cold Damage): Day 1 Taiyang (Greater Yang), Day 2 Yangming (Bright Yang), Day 3 Shaoyang (Lesser Yang). Could it be that on the second day the disease is in the interior, and on the third day it returns to half-exterior and half-interior? Discussing from the perspective of Five Elements generation and restriction: Yang governs growth; Water generates Wood. Taiyang Bladder belongs to Yang Water, transmitting to Shaoyang Gallbladder which belongs to Wood. Shaoyang combines with Taiyang at the exterior and lies between the exterior and interior; Yangming is in the interior. Pathogens enter gradually from the outside to the inside, in proper sequence, with Yangming following Shaoyang. This theory was indeed unpublished by predecessors. Why did Tao Jian'an's *Shanghan Suoyan* (Trivial Words on Cold Damage) not mention it?
In recent times, patients suffering from Yin-pattern cold damage often present with ambiguous symptoms. At the initial stage, practitioners dare not use Fuzi (Aconiti Lateralis Radix Praeparata). They wait until Yin is extreme and Yang is exhausted before using it, which is too late. Generally, the treatment principle is to administer the appropriate medicine for the disease. How can one hesitate and cause mis-treatment? Furthermore, Jia Yin Shanghan (Cold Damage with Concomitant Yin Deficiency) initially arises from sexual activity causing Yin to hide within, followed by exposure to cold. Both interior and exterior are Yin; Yin Qi alone becomes excessive while Yang Qi declines. Therefore, the pulse is deep and the feet are cold. One must urgently use Renshen (Ginseng Radix) to strengthen the vessels and tonify Yuan Qi as the main approach, assisted by Fuzi to warm the Kidney Meridian and disperse cold pathogens, thereby retreating Yin and restoring Yang. If these two herbs are discarded, what else can be used to save the patient? Recently, I saw a person suffering from Yin-pattern cold damage. Initially, he contracted cold-dampness, then developed fever and loss of appetite. After several days, he became unconscious, spoke confusedly, suffered mental coma, had a cyan face, and exposed teeth. Others said he would surely die. Zhang Zhihe examined his bilateral pulses, finding them deep and fine. He first administered Xiaochaihu Tang (Minor Bupleurum Decoction). Then, he prepared Sijunzi Tang (Four Gentlemen Decoction) with several slices of Pao Fuzi (Prepared Aconite), boiled the medicine, placed it in a basin, and cooled it with water to mitigate its hot nature. He instructed the patient to take it warm. The patient's pulse gradually returned, and his mental state cleared. He was cured after further regulation with other medicines.