(即伤寒论桂枝人参汤。)
人参 干姜 白术 桂枝 甘草
歌曰 理中加桂人参汤。(尤云。速复其不振之阳。)阳复阴邪自散藏。休讶补攻分两道。
道消(小人道消。)道长(君子道长。)细推详。
元犀按。此别胸痹证虚实之治。实者邪气抟结。蔽塞心胸。故不用补虚之品。而专以开
泄之
使
审
治胸痹。胸中气塞短气者。此汤主之。橘皮枳实生姜汤亦主之。
茯苓(三两。) 杏仁(五十个。) 甘草(一两。)
上三味。以水一斗。煮取五升。温服一升。日三服。不瘥。更服。
歌曰 痹而短气孰堪医。甘一苓三淡泄之。更有杏仁五十粒。水行(则)气(自)顺不
求奇。
橘皮(一斤。) 枳实(三两。) 生姜(半斤。)
上三味。以水五升。煮取二升。分温再服。
歌曰 痹而气塞又何施。枳实辛香三两宜。橘用一斤姜减半。气开(则)结(自)散勿
迟疑。受业林礼丰按。胸痹胸中气塞者。由外邪搏动内饮。充塞于至高之分。闭其气路。非
辛温不
枳实
水邪
水行
而酌
治胸痹缓急者。此散主之。
薏苡仁(十五两。) 大附子(十枚。炮。)
上二味。杵为散。服方寸匕。日三服。
歌曰 痹来缓急属阳微。(经云。阳气者精则养神。柔则养筋。)附子十枚切莫违。更有
薏仁
元犀按。薏苡禀阳明金气。金能制风。肝为风脏而主筋。取治筋之缓急。人之所知也。
合附
汤。与此相表里。
(此方即《伤寒论》中的桂枝人参汤。)
人参、干姜、白术、桂枝、甘草。
歌诀说:理中汤加入桂枝和人参。(尤在泾认为:能迅速恢复那不振的阳气。)阳气恢复,阴寒邪气自然消散于脏腑之中。不要惊讶于补益与攻散分为两条路径。
小人之道消退,君子之道增长,需细细推究详察。
元犀按语:此处区分胸痹证虚实不同的治法。实证是邪气聚结,遮蔽堵塞心胸部位。所以不使用补虚的药物,而专门用开泄的方法治疗胸痹。若出现胸中气塞、呼吸短促的症状,此汤主治。橘皮枳实生姜汤也主治此证。
茯苓(三两)、杏仁(五十个)、甘草(一两)。
以上三味药,用水一斗,煮取五升,温服一升,每日三次服用。若病未愈,继续服用。
歌诀说:胸痹且伴短气,如何医治?用甘草一两、茯苓三两以淡味渗泄之。再加上五十粒杏仁,水液运行则气机自然顺畅,不必追求奇特之法。
橘皮(一斤)、枳实(三两)、生姜(半斤)。
以上三味药,用水五升,煮取二升,分两次温服。
歌诀说:胸痹且伴气塞,又该如何施治?宜用辛香之味的枳实三两。橘皮用一斤,生姜减半用量,气机开通则郁结自然消散,切勿迟疑。受业弟子林礼丰按语:胸痹且胸中气塞,是由于外邪搏动体内停饮,充塞于人体最高之处,闭塞了气机通路。非辛温药物不能……(原文此处有缺漏或错简,结合上下文推测意为“非辛温不能化饮散结”)。
治疗胸痹表现为时缓时急症状的,此散剂主治。
薏苡仁(十五两)、大附子(十枚,炮制过)。
以上两味药,捣碎成散剂。每次服用一方寸匕,每日三次服用。
歌诀说:胸痹发作时缓时急,属于阳气微弱。(《内经》云:阳气精微则养神,柔和则养筋。)附子十枚切莫违背不用。更有薏苡仁……(原文此处有缺漏)。
元犀按语:薏苡仁禀受阳明金气,金能克制风邪。肝为风脏而主司筋脉,选取它来治疗筋脉的时缓时急,这是人们所知道的。配合附子……(原文此处有缺漏,推测为“同用”)……汤剂,与此方表里相应。
(This formula is the Guizhi Renshen Tang [Cinnamon Twig and Ginseng Decoction] from *Shanghan Lun* [Treatise on Cold Damage].)
Renshen (Ginseng Radix et Rhizoma), Ganjiang (Dried Ginger Rhizome), Baizhu (Atractylodis Macrocephalae Rhizoma), Guizhi (Cinnamon Twig), Gancao (Licorice Root).
The verse states: Lizhong Jia Guiren Renshen Tang (Lizhong Decoction added with Cinnamon Twig and Ginseng). (You Zaijing comments: It rapidly restores the failing Yang Qi.) When Yang Qi is restored, Yin pathogenic factors naturally dissipate within the zang-fu organs. Do not be surprised that tonification and purging are treated as two distinct approaches.
When the Way of the Petty Man declines and the Way of the Gentleman grows, one must examine it carefully and thoroughly.
Yuansi’s commentary: This section distinguishes the treatment for deficiency and excess patterns of Xiongbi [Chest Bi Syndrome / Chest Pain Syndrome]. In excess patterns, pathogenic factors knot together, obstructing and blocking the chest and heart region. Therefore, tonifying deficiency substances are not used; instead, methods to open and drain are employed exclusively. For treating Xiongbi manifesting as a sensation of Qi obstruction in the chest and shortness of breath, this decoction is indicated. JuPi Zhishi Shengjiang Tang [Citrus Peel, Immature Bitter Orange, and Fresh Ginger Decoction] is also indicated.
Fuling (Poria, 3 liang), Xingren (Apricot Seed, 50 units), Gancao (Licorice Root, 1 liang).
Take the above three herbs, add ten dou of water, boil to obtain five sheng, take one sheng warm, three times daily. If not cured, continue taking it.
The verse states: How can one treat Bi syndrome accompanied by shortness of breath? Use one liang of Gancao and three liang of Fuling to drain via bland flavor. Furthermore, fifty grains of Xingren ensure that when Water moves, Qi flows smoothly without seeking extraordinary remedies.
Jupi (Citrus Peel, 1 jin), Zhishi (Immature Bitter Orange Fruit, 3 liang), Shengjiang (Fresh Ginger Rhizome, 0.5 jin).
Take the above three herbs, add five sheng of water, boil to obtain two sheng, divide into two warm doses.
The verse states: What should be done for Bi syndrome accompanied by Qi obstruction? Three liang of pungent-aromatic Zhishi is suitable. Use one jin of Jupi and half the amount of Shengjiang; when Qi opens, stagnation naturally disperses, do not hesitate. Student Lin Lifeng’s commentary: In Xiongbi with Qi obstruction in the chest, it is caused by external pathogens agitating internal fluid retention, filling the highest part of the body and closing off the Qi pathways. Non-pungent-warm herbs cannot... [text missing/fragmented].
For treating Xiongbi manifesting as intermittent spasms or relief (huanji), this powder is indicated.
Yiyiren (Coix Seed, 15 liang), Dafuzi (Prepared Aconite Root, 10 pieces, processed/pao).
Crush the above two herbs into a powder. Take one fangcun bi (a measure equivalent to a square inch spoonful) per dose, three times daily.
The verse states: When Bi syndrome presents with intermittent spasms, it belongs to deficient Yang. (The Classic states: Yang Qi nourishes the spirit when refined and soft, and nourishes the sinews when gentle.) Do not neglect the ten pieces of Fuzi. Furthermore, Yiren... [text missing/fragmented].
Yuansi’s commentary: Yiyiren inherits the Metal Qi of the Yangming channel; Metal can control Wind. The Liver is the organ of Wind and governs the sinews; using it to treat the spasmodic tension of sinews is common knowledge. Combined with Fuzi... [text missing/fragmented], this formula stands in a exterior-interior relationship with the aforementioned decoction.