仲景之方中,桂枝茯苓丸、八味丸、大黄牡丹皮汤,以上三方,虽有牡丹皮,而不以为
主药也。如此之类,皆从其全方之主治而用之,如征姑阙焉,以俟之后君子也。
品 考
牡丹皮 和、汉同。
主治发黄也。
考 证
茵陈五苓散证曰∶黄胆。
茵陈蒿汤证曰∶心胸不安、久久发黄。
以上二方茵陈蒿,一方六两,一方十分。
上观此二方,茵陈蒿治发黄也明矣。
互 考
或问曰∶发黄之证,治之之方,其不用茵陈蒿者,间亦有之,如何?答曰∶发黄、小便
不利、或渴无余证者,茵陈五苓散主之。发黄、大便不通者,茵陈蒿汤主之。若乃一身尽黄、
腹胀、大便必黑、时溏者,硝矾散主之。发黄、心中懊 ,柏子大黄豉汤。发黄、腹满、小
便不利,大黄硝石汤。发黄、头痛恶风自汗出,桂枝加黄 汤。发黄呕逆,小半夏汤主之。
发黄、胸胁苦满,小柴胡汤主之。发黄、腹中拘急,小建中汤主之。此皆随证而异方也;仲
景氏之于茵陈蒿,特用之于发黄,无他病者而已。
辨 误
世之医者,论黄胆为湿热,其以黄为土色也。无益于治,此不可从矣。
品 考
仲景之方中,芎归胶艾汤用艾,而非君药也。是以其所主治也,不可得而知矣。芎归胶
艾汤,主治漏下下血也,今从其成方而用之。
辨 误
《名医别录》曰∶艾可以灸百病。后人不审其证之可灸与否,一概行之,故罹其害也,
盖不鲜矣。医者见之,以为不候寒热之过也,不审可否,则固已失之矣。论寒热,亦未为得
也。灸者所以解结毒也,若夫毒着脊上,药之不知,下之不及,就其所着而灸之,其毒转而
走腹,而后药之为达也。临其可灸之证也,我不终问其寒热,而未有逢其害焉。有灸而发热,
是毒动也,世医以为灸误,非也。余于若证,灸而不止,其毒之散也,其热亦止,此即所谓
瞑眩而瘳者也。凡艾之为用也,灸之与煎,其施虽异,而以其一物也。偶尔言及焉,灸家言,
禁穴颇多,余家不言之,一从《灵枢》,以结毒为 也。大凡灸不止一日,乃至五日七日,
以多日为有效矣。一日暴之,十日寒之,我未见其能治者也。
品 考
艾 处处出焉。所卖者,杂它物可正焉。
在张仲景的方剂中,桂枝茯苓丸、八味丸、大黄牡丹皮汤,以上三方虽然都含有牡丹皮,但并不将其作为主药。像这样的情况,都是根据整个方剂的主治功效来使用的,如果征引缺失,就留给后来的君子去考证吧。
【品考】
牡丹皮:中国(和)与日本(汉)同名。
主治黄疸。
【考证】
茵陈五苓散的证候表现为:黄疸。
茵陈蒿汤的证候表现为:心胸不安稳,久久出现黄疸。
以上两个方剂中的茵陈蒿,一个用六两,一个用十分。
从上述两个方剂来看,茵陈蒿治疗黄疸是明确的。
【互考】
有人问:对于黄疸的证候,治疗时也有不使用茵陈蒿的方子,这是怎么回事?回答说:出现黄疸、小便不利、或者口渴而没有其他多余证候的,由茵陈五苓散主治。出现黄疸、大便不通畅的,由茵陈蒿汤主治。如果是全身发黄、腹部胀满、大便会发黑、时而稀溏的,由硝矾散主治。出现黄疸、心中烦闷懊恼的,由柏子大黄豉汤主治。出现黄疸、腹部胀满、小便不利的,由大黄硝石汤主治。出现黄疸、头痛、怕风、自汗出的,由桂枝加黄芪汤主治。出现黄疸且呕吐逆气的,由小半夏汤主治。出现黄疸、胸胁部苦于胀满的,由小柴胡汤主治。出现黄疸、腹中拘急疼痛的,由小建中汤主治。这些都是随证候不同而使用不同方剂;张仲景对于茵陈蒿,特别只用于黄疸,没有其他病症的使用情况罢了。
【辨误】
世间的医生,论述黄疸为湿热所致,因为黄色对应土的颜色。这对治疗没有益处,这种观点不可采纳。
【品考】
在张仲景的方剂中,芎归胶艾汤使用了艾草,但并非君药(主药)。因此它的主治功效无法得知。芎归胶艾汤主治漏下出血(非经期阴道持续出血或崩漏),如今是根据其成方的既定功效来使用的。
【辨误】
《名医别录》说:艾草可以灸治各种疾病。后人不审察证候是否适合艾灸,一概施行,所以遭受其害的情况,大概不少了。医生们看到这种情况,认为是没有辨别寒热证候的过错,如果不审察是否可行,本来就已经失当了。论述寒热,也未必是正确的。艾灸是用来解除结聚之毒的,如果毒素附着在脊背上,药物达不到,泻法也触及不到,就在毒素附着的地方施灸,使毒素转移并走向腹部,然后药物才能到达病所。面临适合艾灸的证候时,我不必完全询问寒热情况,也没有遇到遭受危害的。有艾灸后发热的,这是毒气发动的表现,世俗医生认为是艾灸的错误,其实不是这样。我对于这类证候,坚持艾灸不止一次,待毒气消散,发热也会停止,这就是所谓的“瞑眩”反应而痊愈。凡是艾草的运用,无论是艾灸还是煎服,虽然施用方法不同,但因为是同一种药材。偶尔提及此事,艾灸家说有很多禁忌穴位,我不谈论这些,完全遵从《灵枢》,以解除结聚之毒为根本原则。大凡艾灸不能只进行一天,甚至要持续到五天、七天,以多日为有效。如果一天暴晒(比喻短暂强烈刺激),十天寒冷(比喻后续缺乏维持),我没见过能治愈疾病的。
In the prescriptions of Zhang Zhongjing, Guizhi Fuling Wan (Cinnamon Twig and Poria Pill), Bawei Wan (Eight-Ingredient Pill), and Dahuang Mudanpi Tang (Rhubarb and Moutan Decoction), although all three formulas contain Mudanpi (Moutan Cortex), it is not used as the principal herb. In such cases, it is employed according to the overall therapeutic indication of the entire formula. If historical records are lacking, this matter is left for future scholars to investigate.
[Product Examination]
Mudanpi (Moutan Cortex): The name is identical in China (He) and Japan (Han).
Indications: Jaundice.
[Evidence Verification]
The syndrome indicated by Yinchen Wuling San (Artemisiae Scopariae and Poria Powder) presents with Huangdan (Jaundice).
The syndrome indicated by Yinchen Hao Tang (Artemisiae Scopariae Decoction) presents with Xiongxin Bu'an (Restlessness in the chest and heart) and Jiujiu Huangfan (Chronic development of jaundice).
In these two formulas containing Yinchenshao (Artemisiae Scopariae Herba), one uses six liang, and the other uses ten fen.
From observing these two formulas, it is clear that Yinchenshao treats Huangfan (Jaundice).
[Cross-Verification]
A question was asked: Regarding the syndrome of Huangfan (Jaundice), there are occasionally prescriptions that do not use Yinchenshao (Artemisiae Scopariae Herba); how should this be understood? The answer is: For cases presenting with Huangfan (Jaundice), Xiaobian Buli (Difficulty in urination), or Ke (Thirst) without other excess symptoms, Yinchen Wuling San (Artemisiae Scopariae and Poria Powder) is the primary treatment. For cases presenting with Huangfan (Jaundice) and Dachang Butong (Constipation), Yinchen Hao Tang (Artemisiae Scopariae Decoction) is the primary treatment. If the case involves Shenyijinhuang (Whole-body yellowing), Fuzhang (Abdominal distension), Dachang Bidai (Black stools), and Shitang (Occasional loose stools), Xiaofan San (Alum and Mirabilite Powder) is the primary treatment. For cases presenting with Huangfan (Jaundice) and Xinzhong Aonao (Mental restlessness and oppression), Baizi Dahuang Chi Tang (Perilla Seed, Rhubarb, and Fermented Soybean Decoction) is used. For cases presenting with Huangfan (Jaundice), Fuman (Abdominal fullness), and Xiaobian Buli (Difficulty in urination), Dahuang Xiaoshi Tang (Rhubarb and Gypsum Decoction) is the primary treatment. For cases presenting with Huangfan (Jaundice), Toutong (Headache), Efeng (Aversion to wind), and Zihan (Spontaneous sweating), Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus) is the primary treatment. For cases presenting with Huangfan (Jaundice) and Ouni (Vomiting and regurgitation), Xiaobanxia Tang (Minor Ginger and Pinellia Decoction) is the primary treatment. For cases presenting with Huangfan (Jaundice) and Xionxie Kuman (Bitterness and fullness in the chest and hypochondrium), Xiao Chaihu Tang (Minor Bupleurum Decoction) is the primary treatment. For cases presenting with Huangfan (Jaundice) and Fuzhong Jiuji (Cramping pain in the abdomen), Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment. These are all instances where different formulas are chosen according to the specific syndrome; Zhang Zhongjing specifically employed Yinchenshao (Artemisiae Scopariae Herba) only for Huangfan (Jaundice) and did not use it for other diseases.
[Correction of Errors]
Physicians of the world discuss Huangdan (Jaundice) as being caused by Shire (Damp-Heat), reasoning that yellow corresponds to the color of Earth (Spleen/Soil). This is of no benefit to treatment and such views should not be adopted.
[Product Examination]
In the prescriptions of Zhang Zhongjing, Xionggui Jiao'ai Tang (Ligusticum, Angelica, Gelatin, and Mugwort Decoction) employs Ai (Mugwort), but it is not the Jun Yao (Monarch Herb/Principal Ingredient). Therefore, its independent therapeutic indication cannot be determined. Xionggui Jiao'ai Tang (Ligusticum, Angelica, Gelatin, and Mugwort Decoction) primarily treats Louxia Xiexue (Metrorrhagia and bleeding). Currently, it is used according to the established indications of this complete formula.
[Correction of Errors]
The Mingyi Bielu (Separate Records of Famous Physicians) states: "Ai (Mugwort) can be used for moxibustion to treat various diseases." Later generations, without carefully examining whether the syndrome was suitable for moxibustion, applied it indiscriminately, thus suffering harm, which was quite frequent. Physicians observing this attributed it to the failure to distinguish between Hanre (Cold and Heat syndromes). However, failing to examine suitability is already an error. Discussing Cold and Heat is also not necessarily correct. Moxibustion is used to resolve Jiedu (Accumulated Toxins). If toxins adhere to the spine, where medicinal herbs cannot reach and purgatives cannot act, one applies moxibustion directly at the site of adherence. This causes the toxin to shift and move toward the abdomen, allowing subsequent medication to reach the disease site. When facing a syndrome suitable for moxibustion, I do not need to exhaustively inquire about Cold and Heat, nor have I encountered harm from doing so. Fever following moxibustation indicates the movement of toxins; worldly physicians consider this a mistake of moxibustion, which is incorrect. For such syndromes, I persist with moxibustion until the toxins dissipate and the fever subsides. This is what is referred to as Mingxuan (Critical Reaction) leading to recovery. Regarding the use of Ai (Mugwort), whether for moxibustion or decoction, although the methods differ, it is the same substance. Briefly mentioning this, practitioners of moxibustion claim there are many contraindicated acupoints; I do not discuss these, but follow the Ling Shu (Spiritual Pivot), focusing on resolving accumulated toxins. Generally, moxibustion should not last only one day; it may extend to five or seven days, with longer durations being more effective. Treating intensely for one day and then neglecting it for ten days (like exposing to sun for one day and cold for ten), I have never seen it cure diseases.
[Product Examination]
Ai (Mugwort): Grows everywhere. The Ai sold in markets is often mixed with other plants and requires correction.