东垣谓∶参、术补脾,非以防风、白芷行之,则补药之力不能到。慎斋谓∶调理脾胃,
须加羌活
,以散肝结。此皆发表散气之品也,是能运补药之力于周身,又能开通三焦与经络之滞气也
。此外尚有川芎、乌药、香附、降香、白檀香、郁金,皆可选用,以皆芳香,有通气之功也
。防风、秦艽,尤为散中之润。若味辛者,不可混用,味辛则燥,能耗津液矣。
滑伯仁谓∶每加行血药于补剂中,其效倍捷。行血之药,如红花、桃仁、茜草、归须、
茺蔚
子、三棱、莪术之属皆是也。叶天士亦谓热病用凉药,须佐以活血之品,始不致有冰伏之虞
。盖凡大寒、大热病后,脉络之中必有推荡不尽之瘀血,若不驱除,新生之血不能流通,元
气终不能复,甚有传为劳损者。又有久病气虚,痰涎结于肠胃,此宜加涤痰之品,如蒌皮、
焦楂、蒲黄、刺蒺藜、 牡蛎、海蛤粉、海浮石、青黛、 石膏,皆可随寒热而施之。行血
之药,以水蛭为上,虻虫、 虫、蛴螬次之。坏痰之药,以硼砂为上,礞石、皂荚次之,今
人已不敢用矣。痰本血液,非津水之类也,世以茯苓、泽泻利之;血属有形,瘀积膜络曲折
之处,非潜搜默剔不济也,世以大黄、芒硝下之,大谬。着有《痰饮分治说》、《仲景抵当
汤丸解》,具在集中,可以互览。
李东垣曾说:人参、白术用于补脾,如果不配合防风、白芷来行气推动,那么补药的功效就无法到达全身。杨慎斋曾说:调理脾胃时,必须加入羌活,以疏散肝气的郁结。这些都是发表散气的药物,它们能够带动补药的力量运行于周身,同时疏通三焦和经络中停滞的气机。此外还有川芎、乌药、香附、降香、白檀香、郁金等,都可以选用,因为它们都具有芳香之气,有通利气机的作用。防风、秦艽,更是发散药中性质较为滋润的。如果是味道辛烈的药物,不可混合使用,因为味辛则燥,会耗伤津液。
滑伯仁曾说:在补益剂中加入活血药物,疗效会加倍迅速。具有活血作用的药物,如红花、桃仁、茜草、当归须、茺蔚子、三棱、莪术等都属于此类。叶天士也说:治疗热病使用凉药时,必须佐以活血的药物,才能避免产生“冰伏”(寒凉凝滞,邪气深伏不出)的隐患。大概凡是患过大寒或大热病之后,脉络之中必然有未能完全清除的瘀血,如果不将其驱除,新生成的血液就不能流通,元气最终也无法恢复,甚至可能演变为虚劳损证。又有久病导致气虚,痰涎凝结在肠胃之间,这种情况适宜加入涤痰的药物,如瓜蒌皮、焦山楂、蒲黄、刺蒺藜、牡蛎、海蛤粉、海浮石、青黛、石膏等,都可以根据病证的寒热属性来施用。
在活血药物中,水蛭为上品,虻虫、土鳖虫、蛴螬次之。在破痰药物中,硼砂为上品,礞石、皂荚次之,如今的人已经不敢使用了。痰本质上是血液变成的,不属于津液水湿之类;世人用茯苓、泽泻来利水祛湿是错误的。血液属于有形之物,瘀血积聚在膜原络脉曲折之处,不用潜藏搜剔的方法无法奏效;世人用大黄、芒硝来攻下,这是极大的谬误。我曾著有《痰饮分治说》、《仲景抵当汤丸解》,都收录在我的文集中,可以互相参考阅读。
Li Dongyuan stated: When using Renshen (Ginseng Radix) and Baizhu (Atractylodis Rhizoma) to tonify the Spleen, if Fengfang (Saposhnikoviae Radix) and Baizhi (Angelicae Dahuricae Radix) are not added to promote circulation, the efficacy of the tonifying herbs cannot reach the whole body. Shen Zhai stated: When regulating the Spleen and Stomach, Qianghuo (Notopterygii Rhizoma et Radix) must be added to dissipate Liver Qi stagnation. These are all herbs that release the exterior and disperse Qi; they can mobilize the power of tonifying herbs throughout the body and open up stagnant Qi in the Sanjiao (Triple Burner) and meridians. Additionally, Chuanxiong (Ligustici Chuanxiong Rhizoma), Wuyao (Linderae Radix), Xiangfu (Cyperi Rhizoma), Jiangxiang (Dalbergiae Odoriferae Lignum), Baitanxiang (Santalum Album Lignum), and Yujin (Curcumae Longae Radix) can all be selected because they possess aromatic properties and have the function of promoting Qi movement. Fengfang (Saposhnikoviae Radix) and Qinjiao (Gentianae Macrophyllae Radix) are particularly moistening among dispersing herbs. If herbs with pungent flavors are mixed indiscriminately, their dryness will consume Body Fluids.
Hua Borun stated: Adding blood-invigorating herbs to tonifying formulas doubles the speed of efficacy. Blood-invigorating herbs include Honghua (Carthami Flos), Taoren (Persicae Semen), Qiancao (Rubiae Cordifoliae Radix), Guixu (Angelicae Sinensis Radix), Chongweizi (Leonuri Fructus), Sanleng (Sparganii Rhizoma), and Ezhu (Curcumae Rhizoma). Ye Tianshi also stated: When treating heat diseases with cooling herbs, one must assist them with blood-invigorating agents to avoid the risk of "Ice-Fu" (cold coagulation causing pathogens to become deeply entrenched). Generally, after severe cold or heat diseases, there must be residual blood stasis in the collaterals that has not been fully swept away. If this is not expelled, newly generated blood cannot circulate freely, and Yuan Qi (Primal Qi) ultimately cannot recover; it may even progress into consumptive disease (Lao Sun). Furthermore, in chronic illnesses leading to Qi deficiency, phlegm-saliva may knot in the intestines and stomach; in such cases, phlegm-resolving herbs should be added, such as Loupi (Benincasae Exocarpium), Jiaozha (Crataegi Fructus Preparata), Puhuang (Typhae Pollen), Cijili (Tribuli Fructus), Muli (Concha Ostreae), Haigefen (Concha Arcae), Haifushi (Lithotrichum), Qingdai (Indigo Naturalis), and Shigao (Gypsum Fibrosum), which can be applied according to the cold or heat nature of the condition.
Among blood-invigorating herbs, Shui zhi (Hirudo) is superior, followed by Meng chong (Tabanus), E chong (Eupolyphaga), and Qiluo (Blaberus). Among phlegm-breaking herbs, Pengsha (Borax) is superior, followed by Mengshi (Calamine) and Zaojiao (Gleditsiae Sinensis Fructus); however, modern practitioners dare not use these. Phlegm is essentially transformed blood, not a type of fluid or water; yet the world uses Fuling (Poria) and Zexie (Alismatis Rhizoma) to drain it via diuresis. Blood is tangible matter; when blood stasis accumulates in the tortuous places of membranes and collaterals, only subtle searching and meticulous elimination can resolve it; yet the world uses Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) to purge it downward, which is a great error. I have written "Shu Tan Yin Fen Zhi Shuo" (Theory on Separate Treatment of Phlegm and Fluid Retention) and "Zhongjing Didang Tang Wan Jie" (Explanation of Zhang Zhongjing's Didang Decoction and Pills), both included in my collected works, for mutual reference.