Month: February 2020

From the Yīfāng Jíjiě 《医方集解》 1689 CE by Wang Ang 王昂.

 

少陽陽明解表攻裏，仲景
It is for shàoyáng and yángmíng resolving the exterior and attacking the interior, by Zhòngjǐng

治傷寒發熱，汗出不解，陽邪入裏，熱結在裏（1）。心下痞鞕，嘔而下利，或往來寒熱，煩渴譫語，腹滿便秘，表證未除，裏證又急，脈洪或沉實弦數者（2）。
It treats cold damage with heat effusion, unresolved after sweating, yáng evil entering the interior, and heat binding internally (1). Hard glomus below the heart, retching and diarrhoea, or possibly alternating chills and fever/heat, vexation and thirst with delirious speech, abdominal fullness and constipation, and exterior pattern that is has not yet resolved, and an interior pattern with urgency, the pulse is surging or possibly deep, replete, wiry, and rapid (2).

1. 裏非三陰之裏，乃胃腑也。此為少陽陽明，三陰亦有轉入陽明者，如太陰有桂枝加大黃湯，少陰有三大承氣，厥陰一小承氣，皆兼陽明證也。
   The interior is not the interior of the three yīn, it is the stomach fǔ-bowel. This is shàoyáng and yángmíng [disease], the three yīn can also transfer to enter the yángmíng, for example in tàiyīn there is Guìzhī Jiā Dàhuáng Tāng [pattern], and shàoyīn has three Dà Chéng Qì [patterns], and juéyīn also has Xiǎo Chéng Qì [pattern], these are all concurrent yángmíng patterns.
2. 表證未除者，發熱，頭痛，脅痛，寒熱仍在也。裏證又急者，痞鞕，燥渴，譫狂，便秘也。脈沉實為在裏，弦數者邪在少陽也。洪者邪在陽明也。其嘔而下利者，何亦用之，張兼善曰：裏虛者便雖難而勿攻，裏實者雖吐利而可下，心煩喜嘔，裏熱已甚，結於胃中，故下之則愈。
   For an exterior pattern that has not yet resolved, there is heat effusion, headache, rib-side pain, and chills and fevers; these are still present. For an interior pattern with urgency, there is hard glomus, dryness and thirst, delirious mania, and constipation. When the pulse is deep and replete, it indicates the interior; when the pulse is wiry and rapid, the evil is located in shàoyáng; when it is surging, the evil is located in yángmíng.

For those with retching and diarrhoea, why can [this formula] also be utilised?

Zhāng Jiānshàn[1] said, “When the interior is deficient, although the stool may be difficult [to pass], [one] should not attack. When the interior is excess although there is retching and diarrhoea, [one] can precipitate. With heart vexation and frequent retching, the interior heat has already become severe and become bound in the stomach; therefore, precipitate it and there will be recovery.”

柴胡 八兩  半夏 半升  黃芩、芍藥 三兩  生薑 五兩  大棗 十二枚擘  枳實 四枚  大黃 二兩酒浸

Cháihú 8 liǎng , Bànxià ½ shēng, Huángqín and Sháoyào 3 liǎng each,  Shēngjiāng 5 liǎng, Dàzǎo 12 pieces (split) Zhǐshí 4 pieces, Dàhuáng 2 liǎng (alcohol steeped/soaked)

一方無大黃，下註云：若不加大黃，恐不為大柴胡湯也。崔氏去柴胡加前胡，名大前胡湯，胡洽云：亦出仲景方，治同。

One instance of this formula does not have dàhuáng. An annotation below it says: “if dàhuáng is not added, then I fear it cannot be Dà Cháihú Tāng. Master Cuī removed cháihú and added qiánhú, and names it Dà Qiánhú Tāng. Hú Qià says that this was also a Zhòng Jǐng formula, and treated identical [patterns].”

 

[1] Unfortunately, I am unable to locate who this person is.

 

Next week will include further commentary on this formula.

 

With special thanks to Allen Tsaur for editing.

Dǎohuàn Sàn (Rearrangement Powder) 倒換散

From the section on Urinary Stoppage in the Yī Fāng Kǎo (Analysing Medical Formulas) by Wu Kun, 1584 CE. 《醫方考·小便不通門第三十八》

大黃（一兩） 荊芥（二兩）
dà huáng (1 liǎng) Jīngjiè (2 liǎng)

每服末二錢。
Every dose take 2 qián [of the powder].

 

內熱小便不通者，此方主之。
For those with internal heat and urinary stoppage,[1] this formula governs it.

內熱而小便不通者，鬱其少火，而氣不化也。 《內經》曰∶膀胱者，州都之官，津液藏焉，氣化則能出矣。然化氣之道，莫妙於升降。天地以升而降化萬物，奈何而昧於人乎？
For those with internal heat that leads to urinary stoppage, this is depression of the lesser fire, and then qì cannot transform. The Nèijīng says the bladder, it is the official of provinces and cities, the jīnyè-fluids are stored within it;  with qì transformation, it (jinyè-fluids) can emanate. And for the dào (principle/natural law) of this qì transformation, there is nothing more marvelous than the [movements] of ascending and descending. Heavens and earth, by ascending and descending, are able to transform the ten-thousand things. How can people be ignorant of this?

 

故用荊芥之輕清者以升其陽。用大黃之重濁者以降其陰。清陽既出上竅，則濁陰自歸下竅，而小便隨泄矣。方名倒換者，小便不通，倍用荊芥。大便不通，倍用大黃。顛倒而用，故曰倒換。
Thus, by utilising the light and clear [nature] of jīngjiè, it can raise the yáng. By utilising the heavy and turbid [nature] of dàhuáng, it can descend the yīn. Once the yáng exits via the upper orifices, the turbid yīn will naturally return to the lower orifices, and then urination will be discharged subsequently.

For the name of the formula name, Dǎohuàn (Rearranging), when urination is stopped, double the dosage of jīngjiè; when there is constipation, double the dosage of the dàhuáng; [the dosage] can be reverted in use,, therefore it is called Rearrangement [Powder].

Thanks to Allen Tsaur and Will Ceurvels for their help, and Mark Gearing for picking up an error in the dosages.

[1] According to the Practical Dictionary “this is either dribbling urination or complete blockage in severe cases.”

[2] From Suwen Chapter 5.