黄柏(二分) 干姜(三分) 天麻 苍术 白茯苓 黄 泽泻 人参(以上各五分) 白术 炒
曲(以上各一钱) 半夏(汤洗七次) 大麦 面 橘皮(以上各一钱五分)
上件 咀。每服半两,水二盏,煎至一盏,去渣,带热服,食前。此头痛苦甚,
谓之足太阴痰厥头痛,非半夏不能疗。眼黑头旋,风虚内作,非天麻不能除;其苗为定风草
,独不为风所动也。黄 甘温,泻火补元气;人参甘温,泻火补中益气;二术俱苦甘温,
除湿补中益气;泽、苓利小便导湿;橘皮苦温,益气调中升阳;曲消食,荡胃中滞气;大麦
面宽中助胃气;干姜辛热,以涤中寒;黄柏苦大寒,酒洗以主冬天少火在泉发躁也。
麦门冬(二分) 当归身 人参(以上各三分) 炙甘草 白芍药 黄 (以上各一钱) 五味子(五
上件 咀。分作二服,每服用水二盏,煎至一盏,去渣,稍热服。既愈。继而冬
居旷室,卧热炕,而吐血数次。予谓此人久虚弱,附脐有形,而有大热在内,上气不足,阳气
外虚,当补表之阳气,泻里之虚热。
冬居旷室,衣服复单薄,是重虚其阳。表有大寒,壅遏里热,火邪不得舒伸,故血出于
口。因思仲景太阳伤寒一证,当以麻黄汤发汗,而不与之,遂成衄血,却与之立愈,与此
甚同,因与麻黄人参芍药汤。
黄柏(二分) 干姜(三分) 天麻 苍术 白茯苓 黄芪 泽泻 人参(以上各五分) 白术 炒曲(以上各一钱) 半夏(用汤清洗七次) 大麦面 橘皮(以上各一钱五分)
将上述药材切碎。每次服用半两,加水二盏,煎煮至一盏,滤去药渣,趁热服用,饭前服用。这种头痛非常剧烈,称为足太阴痰厥头痛(因足太阴脾经痰湿阻滞导致的厥逆性头痛),非半夏不能治疗。眼睛发黑、头晕目眩,是风虚在内作祟,非天麻不能消除;天麻的苗被称为定风草,唯独它不被风所动摇。黄芪味甘性温,能泻火并补益元气;人参味甘性温,能泻火并补中益气;苍术和白术都味苦甘性温,能祛除湿邪并补中益气;泽泻和白茯苓能通利小便以引导湿气排出;橘皮味苦性温,能益气、调理中焦并升举阳气;神曲能消食化积,清除胃中的停滞之气;大麦面能宽中理气、助养胃气;干姜味辛性热,能涤除中焦寒邪;黄柏味苦性大寒,经酒洗后用于主治冬季少火在泉(指相火潜伏于下焦)引发的烦躁。
麦门冬(二分) 当归身 人参(以上各三分) 炙甘草 白芍药 黄芪(以上各一钱) 五味子(五枚)
将上述药材切碎。分作两次服用,每次用水二盏,煎煮至一盏,滤去药渣,稍温热后服用。病愈之后。接着冬天居住在空旷寒冷的房间,睡在热的炕上,导致吐血数次。我认为此人长期虚弱,肚脐周围有有形之邪积聚,且体内有大热,上气不足,阳气在外虚弱,应当补益体表的阳气,清泻体内的虚热。
冬天居住在空旷寒冷的房间,衣服穿得单薄又厚重(此处原文“复单薄”疑为衍文或特定语境,结合下文“重虚其阳”,意指衣着不当导致阳气更虚,或指外寒束表),这是使阳气更加虚弱。体表有大寒,壅遏体内的热气,火邪不得舒展伸张,所以血液从口中溢出。因此想到张仲景《伤寒论》中太阳伤寒证,应当用麻黄汤发汗,如果不给发汗药,就会造成衄血(鼻出血),如果给予麻黄汤则立即痊愈,这与本例情况非常相似,因此给予麻黄人参芍药汤。
Phellodendri Cortex (Huangbai, 黄柏) [2 fen], Zingiberis Rhizoma (Ganjiang, 干姜) [3 fen], Gastrodiae Rhizoma (Tianma, 天麻), Atractylodis Macrocephalae Rhizoma (Cangzhu, 苍术), Poria (Fuling, 白茯苓), Astragali Radix (Huangqi, 黄芪), Alismatis Rhizoma (Zexie, 泽泻), Ginseng Radix et Rhizoma (Renshen, 人参) (all above at 5 fen each), Atractylodis Rhizoma (Baizhu, 白术), Fermented Wheat Mass (Qu, 神曲) (both above at 1 qian each), Pinelliae Rhizoma (Banxia, 半夏) (washed seven times with boiling water), Hordeum Vulgare Fructus (Damai, 大麦), Pericarpium Citri Reticulatae (Chenpi, 橘皮) (all above at 1.5 qian each).
The above ingredients are coarsely crushed. Take 0.5 liang per dose, add two zhan of water, decoct until one zhan remains, remove the dregs, and take warm before meals. This severe headache is called Foot-Taiyin Phlegm-Jue Headache (a type of headache caused by phlegm-dampness obstructing the Foot-Taiyin Spleen meridian leading to Jue syndrome); only Banxia can treat it. Blackout vision and vertigo are caused by internal wind-deficiency; only Tianma can eliminate it. Its sprout is called "Wind-Calming Grass," uniquely unaffected by wind. Huangqi is sweet and warm, clearing fire and supplementing primal Qi; Renshen is sweet and warm, clearing fire and supplementing Middle-Jiao Qi; Cangzhu and Baizhu are bitter, sweet, and warm, dispelling dampness and supplementing Middle-Jiao Qi; Zexie and Fuling promote urination to guide out dampness; Chenpi is bitter and warm, benefiting Qi, regulating the Middle, and raising Yang; Qu digests food and clears stagnant Qi in the stomach; Damai broadens the Middle and assists Stomach Qi; Ganjiang is acrid and hot, cleansing Cold from the Middle; Huangbai is bitter and very cold, washed with wine to address restlessness caused by Minister Fire lurking in the Lower Jiao during winter.
Ophiopogonis Radix (Maidong, 麦门冬) [2 fen], Angelicae Sinensis Radix (Danggui, 当归身), Ginseng Radix et Rhizoma (Renshen, 人参) (all above at 3 fen each), Glycyrrhizae Radix et Rhizoma (Zhigancao, 炙甘草), Paeoniae Radix Alba (Baishao, 白芍药), Astragali Radix (Huangqi, 黄芪) (all above at 1 qian each), Schisandrae Fructus (Wuweizi, 五味子) [5 pieces].
The above ingredients are coarsely crushed. Divide into two doses. For each dose, use two zhan of water, decoct until one zhan remains, remove the dregs, and take slightly warm. The illness was cured. Subsequently, living in a spacious, cold room in winter and sleeping on a heated kang led to several episodes of hematemesis. I reasoned that this person has long been weak, with palpable accumulation around the umbilicus and significant internal heat, insufficient Upper Qi, and deficient exterior Yang. It is necessary to tonify the exterior Yang and purge the interior deficiency-heat.
Living in a spacious, cold room in winter while wearing thin clothing (or inappropriate layering) further depletes Yang. Exterior severe Cold obstructs Interior Heat, preventing the Fire pathogen from extending freely, thus causing blood to issue from the mouth. Recalling Zhang Zhongjing's treatment of Taiyang Cold Damage, where Mahuang Tang should be used to induce sweating; failure to do so leads to epistaxis, whereas administering it cures immediately. This case is very similar. Therefore, Mahuang Renshen Shaoyao Tang was administered.