甘遂 芫花 大戟(各一两,俱醋炒) 大黄(二两) 黑牵牛(头末四两) 青皮 陈皮 木香
槟榔(各半两) 轻粉(一钱) 取蛊,加芜荑(半两)
为末,水丸。空心服。
河间根据仲景十枣汤例制出此方,主疗一切水湿为病。戴人云∶十枣泄诸水之上药,所
谓温药下者是已。如中满腹胀,喘嗽淋闭,水气蛊肿,留饮癖积,气血壅滞,不得宣通,风
热燥郁,肢体麻痹,走注疼痛,久新疟痢等,患妇人经病带下,皆令按法治之,病去如扫,
故贾同知称为神仙之奇药也。缘此方河间所定,初服五丸,日三服,加至快利后,却常
服以病去为度。设病愈后,平人能常服保养,宣通气血,消运饮食。若病痞闷极甚者便多
服,反烦满不开,转加痛闷,宜初服二丸,每服加二丸,加至快利为度,以意消息。小儿
丸如麻子大,随强弱增损,三四岁者三五丸,根据前法加减。至戴人变为神芎丸,神秘不传。
然每令病患夜卧先服百余粒,继以 川等药投之,五更当下,种种病出,投下少末,再
服和膈药,须以利为度,有五日一下者,三日一下者,病轻者可一二度止,重者五六度
方愈,是擒纵卷舒之妙,临证制宜,非言可谕。观其药虽峻急,认病的确,自非老手谙
练,有大负荷者,焉敢见诸行事。予每亲制用之,若合符节,然又随人强弱,当根据河间
渐次进服,强实之人,根据戴人治法行之,神效。
大圣浚川散
大黄(煨) 牵牛(取头末) 郁李仁(各一两) 木香(三钱) 芒硝(三钱) 甘遂(半钱)
评曰∶此下诸积之圣药也。诸湿为土,火热能生湿土,故夏热则万物湿润,秋凉则湿
复燥干,湿病本不自生,因于火热怫郁,水液不能宣通,停滞而生水湿也。凡病湿者,多
自热生,而热气多为兼病。《内经》云∶明知标本,正行无间者是也。夫湿在上者,目黄
而面浮;在下者,股膝肿厥;在中者,肢满痞膈痿逆;在阳不去者,久则化气;在阴不
去者,久则成形。世俗不详《内经》所言留者攻之,但执补燥之剂,怫郁转加,而病愈
甚也。法当求病之所在而为施治,泻实补虚,除邪养正,以平为期而已。又尝考戴人治法,
假如肝木乘脾土,此土不胜木也,不胜之气,寻救于子,已土能生庚金,庚为大肠,味辛
者为金,故大加生姜,使伐肝木,然不开脾土,无由行也,遂以舟车丸先通闭塞之路,是
先泻其所不胜,后以姜汁调 川散大下之,是泻其所胜也。戴人每言,导水丸必用禹功散
继之,舟车丸必以 川散随后。如寒疝气发动,腰脚胯急痛者,亦当下之,以泻其寒水。
世俗喑于治体,一概卤莽,有当下而非其药,终致委顿而已。岂知巴豆可以下寒,甘遂、芫
花可以下湿,大黄芒硝可以下燥,如是分经下药,兼食疗之,非守一方,求其备也。故
戴人曰∶养生与攻 ,本自不同,今人以补剂疗病,宜乎不效,是难言也。
甘遂、芫花、大戟(各一两,均用醋炒制)、大黄(二两)、黑牵牛(取头末四两)、青皮、陈皮、木香、槟榔(各半两)、轻粉(一钱)。若需取蛊毒,加芜荑(半两)。
以上药材研为细末,用水泛丸。空腹服用。
河间先生根据仲景《伤寒论》中十枣汤的体例制定此方,主治一切因水湿引起的疾病。戴人曾说:十枣汤是排泄体内诸种水邪的上等药物,这就是所谓“用温性药来攻下”的方法。如出现心腹痞满腹胀、气喘咳嗽、淋证闭结、水气蛊胀浮肿、留饮癖积、气血壅滞不通、风热燥郁、肢体麻痹、游走性疼痛、新旧疟疾痢疾等症,以及妇女经病带下等,均可按照本法治疗,病去如扫,因此贾同知称之为神仙般的奇药。此方由河间先生确定,初服五丸,每日三次,逐渐增加剂量至大便通畅有力后,再常服以病愈为止。若病愈后,健康人常服可保养身体,宣通气血,助运饮食。若患痞闷极重者便多服,反而会导致烦闷不开,加重痛闷,适宜初服二丸,每次增加二丸,增至大便通畅有力为止,需根据具体情况灵活掌握。小儿丸药如麻子大小,根据体质强弱增减,三四岁者服三五丸,根据前述方法加减。后来戴人将其演变为神芎丸,秘而不传。然而他常让病患夜间先服百余粒,继以川芎等药投之,五更时分必然腹泻,各种病邪随之排出,待泻下少许后,再服用调和膈气的药物,必须以大便通畅为度。有的五日一次,有的三日一次,病轻者可一两次即止,病重者需五六次方能痊愈,这是擒纵卷舒的奥妙,临证制宜,非言语所能完全表达。看这药虽然峻猛急迫,但只要认病确切,如果不是老练经验丰富的医生,有担当能力的人,怎敢付诸实施?我每次亲自制作使用,效果如同符节相合,但又根据人的体质强弱,应当根据河间先生的方法逐渐进服,强壮结实之人,则根据戴人的治法施行,神效。
大圣浚川散
大黄(煨制)、牵牛(取头末)、郁李仁(各一两)、木香(三钱)、芒硝(三钱)、甘遂(半钱)
评论说:这是消除各种积聚的圣药。各种湿气属于土,火热能生湿土,所以夏天炎热则万物湿润,秋天凉爽则湿气复归干燥。湿病本身并非自然产生,而是由于火热怫郁,导致水液不能宣通,停滞而生水湿。凡是患湿病的,多从热而生,而热气多为兼夹之病。《内经》说:明知道标本,正行无间者是也。湿在上的,目黄而面浮;在下的,股膝肿厥;在中的,肢满痞膈痿逆;在阳不去者,久则化气;在阴不去者,久则成形。世俗人不详察《内经》所言“留者攻之”,只执着于补燥之剂,导致怫郁加重,病情更甚。法当求病之所在而为施治,泻实补虚,除邪养正,以平为期而已。又曾考戴人治法,假如肝木乘脾土,此土不胜木也,不胜之气,寻救于子,已土能生庚金,庚为大肠,味辛者为金,故大加生姜,使伐肝木,然不开脾土,无由行也,遂以舟车丸先通闭塞之路,是先泻其所不胜,后以姜汁调 川散大下之,是泻其所胜也。戴人每言,导水丸必用禹功散继之,舟车丸必以 川散随后。如寒疝气发动,腰脚胯急痛者,亦当下之,以泻其寒水。世俗喑于治体,一概卤莽,有当下而非其药,终致委顿而已。岂知巴豆可以下寒,甘遂、芫花可以下湿,大黄芒硝可以下燥,如是分经下药,兼食疗之,非守一方,求其备也。故戴人曰∶养生与攻 ,本自不同,今人以补剂疗病,宜乎不效,是难言也。
Gansui, Yuanhua, Daji (each 1 liang, all stir-fried with vinegar), Dahuang (2 liang), Hei Qianniu (head powder 4 liang), Qingpi, Chenpi, Muxiang, Binglang (each 0.5 liang), Qingfen (1 qian). To extract gu poison, add Wuyi (0.5 liang).
Grind the above herbs into fine powder, make pills with water. Take on an empty stomach.
Hejian formulated this prescription based on the example of Shizao Tang from Zhongjing's *Shanghan Lun*, primarily treating all diseases caused by water and dampness. Dairen said: Shizao Tang is the superior medicine for draining various waters in the body; this is what is meant by "using warm medicines to purge." For conditions such as abdominal fullness and distension, wheezing and coughing, stranguria and retention, ascites and edema, retained fluid and mass accumulation, qi and blood stagnation with obstruction, wind-heat dryness and depression, limb numbness, migratory pain, chronic or acute malaria and dysentery, as well as women's menstrual disorders and leukorrhea, one may treat according to this method, removing the disease as if sweeping it away. Therefore, Jia Tongzhi called it a miraculous drug like a deity. This prescription was established by Hejian; initially take five pills, three times a day, increasing the dose until there is rapid and effective bowel movement, then continue taking it regularly until the disease is cured. If after recovery, healthy people take it regularly, it can nourish the body, promote the circulation of qi and blood, and aid digestion. If suffering from extreme stuffiness and oppression, taking more may cause irritability and fullness without relief, worsening pain and discomfort. It is advisable to start with two pills, increasing by two pills per dose until rapid bowel movement occurs, adjusting according to circumstances. For children, make pills the size of hemp seeds, increasing or decreasing according to strength; those aged three or four years take three to five pills, adjusting according to the aforementioned methods. Later, Dairen transformed it into Shenxiong Wan, keeping it secret. However, he often instructed patients to take over a hundred pills before sleep, followed by Chuanxiong and other medicines, expecting defecation at dawn (wugeng time), with various pathogens expelled. After slight purging, administer medicines to harmonize the diaphragm, ensuring efficacy through bowel movement. Some have one bowel movement every five days, some every three days; mild cases may stop after one or two times, while severe cases require five or six times to heal. This is the subtlety of controlling and releasing, adapting to clinical situations, which cannot be fully explained by words. Although these medicines are harsh and urgent, if the diagnosis is accurate, only experienced physicians with great responsibility would dare to use them. I have personally prepared and used them, finding the effect consistent with expectations, but adjusted according to individual constitution. One should gradually increase the dose following Hejian's method; for robust individuals, follow Dairen's treatment method, yielding miraculous effects.
Dasheng Xunchuan San
Dahuang (roasted), Qianniu (head powder), Yuliren (each 1 liang), Muxiang (3 qian), Mangxiao (3 qian), Gansui (0.5 qian)
Commentary: This is the supreme medicine for eliminating various accumulations. All dampness belongs to Earth; fire and heat can generate damp Earth. Thus, in summer heat, all things are moist; in autumn coolness, dampness returns to dryness. Dampness does not arise spontaneously but results from fire-heat stagnation, preventing the free flow of fluids, leading to stagnation and the generation of water-dampness. Diseases involving dampness mostly originate from heat, and heat often accompanies other pathologies. The *Neijing* states: Knowing the root and branch, acting without interruption is correct. When dampness is above, there is yellow eyes and facial edema; when below, swelling and coldness of thighs and knees; when in the middle, limb fullness, epigastric blockage, flaccidity, and reversal; when remaining in Yang channels, it transforms into qi pathology over time; when remaining in Yin channels, it forms structural changes. Laypeople ignore the *Neijing*'s instruction "attack what remains," sticking instead to tonifying and drying agents, causing increased stagnation and worsened disease. Treatment should target the location of the disease, purging excess and tonifying deficiency, expelling evil and nurturing righteousness, aiming for balance. Furthermore, examining Dairen's treatment methods: for example, if Liver Wood overacts on Spleen Earth, this Earth cannot overcome Wood. The overcoming energy seeks rescue from its offspring; Ji Earth generates Geng Metal, where Geng corresponds to the Large Intestine, and pungent flavors belong to Metal. Therefore, adding large amounts of Shengjiang helps subdue Liver Wood. However, without opening Spleen Earth, it cannot function. Thus, using Zhouche Wan first to clear blocked pathways purges the unconquered element first, followed by mixing Jiangzhi with Chuan San for massive purging, which attacks the conquering element. Dairen always stated that Daoshui Wan must be followed by Yugong San, and Zhouche Wan must be followed by Chuan San. For cold hernia attacks causing acute pain in waist, legs, and hips, purging is also indicated to drain cold water. Laypeople ignorant of treatment principles act rashly, using inappropriate purgatives, ultimately leading to exhaustion. How could they know that Badou can purge cold, Gansui and Yuanhua can purge dampness, and Dahuang and Mangxiao can purge dryness? Such differentiation by channel for medication, combined with dietary therapy, avoids relying on a single formula seeking completeness. Thus, Dairen said: Nourishing life and attacking pathogens are fundamentally different. Today, people use tonics to treat diseases, which naturally fails; this is difficult to explain.