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 第十九章.治燥结方

Chapter 19. herbs for constipation

 

1.硝菔通结汤

1. Xiaofu Tongjie Tang

 

治大便燥结久不通,身体兼羸弱者。
This formula is used for long time constipation and the person is weak in body condition.

净朴硝(四两) 鲜莱菔(五斤)
Poxiao (mirabilite) 120 gram, fresh radish 1250 gram.

将莱菔切片,同朴硝和水煮之。初次煮,用莱菔片一斤,水五斤,煮至莱菔烂熟捞出。就其余汤,再入莱菔一斤。如此煮五次,约得浓汁一大碗,顿服之。若不能顿服者,先饮一半,停一点钟,再温饮一半,大便即通。若脉虚甚,不任通下者,加人参数钱,另炖同服。
Chop the radish into pieces, cook in water with poxiao. First, cook 250 gram radish in water 1250 ml, until the radish is well cooked. Pick out the radish, add more radish, 250 gram until it is well cooked again. Repeat cook as such until the final water is about 250 ml. Drink the herbal tea once for all. If the person feels hard to drink all the tea, let him drink half first. After one hour, drink the remaining half tea. The stool should be easy to come out. If the pulse is very weak, hard to allow such opening therapy, add herb Renshen several gram, which is cooked separately and mixed in the herbal tea for drink.

软坚通结,朴硝之所长也。然其味咸性寒,若遇燥结甚实者,少用之则无效,多用之则咸寒太过,损肺伤肾。其人或素有劳疾或下元虚寒者,尤非所宜也。惟与莱菔同煎数次,则朴硝之咸味,尽被莱菔提出,莱菔之汁浆,尽与朴硝融化。夫莱菔味甘,性微温,煨熟食之,善治劳嗽短气(方附水晶桃下),其性能补益可知。取其汁与朴硝同用,其甘温也,可化朴硝之咸寒,其补益也,可缓朴硝之攻破。若或脉虚不任通下,又借人参之大力者,以为之扶持保护。然后师有节制,虽猛悍亦可用也。
It is the good function of Poxiao to soft hard mass and to promote a block stuff moving (in the intestine). However, it is salty and cold in herbal nature. When the constipation is severe with hard and big stool block in the intestine, it is no big use if the amount used is not large. But, large amount use may damage Lung and Kidney, for too salty and Cold. It is not good so to use in person with long time disease, or has asthenic Cold in the Lower Jiao of the body. To cook with radish for several time could remove its salty and the juice of the radish can melt the Poxiao well. The radish is sweet and warm in herbal nature. After cook, it can treat exhausting cough and short of breath, suggesting its nourishing ability. When used together with the Poxiao, its sweet and warm could combat the salty and Cold of the Poxiao, and its nourishing ability can slow down the sharp break ability of the Poxiao. If the pulse is weak, the Renshen could protect.


一媪,年近七旬,伤寒初得,无汗,原是麻黄汤证。因误服桂枝汤,遂成白虎汤证。上焦烦热太甚,闻药气即呕吐。但饮所煎石膏清水,亦吐。俾用鲜梨片蘸生石膏细末,嚼咽之。约用石膏两半,阳明之大热遂消,而大便旬日未通,其下焦余热,仍无出路,欲用硝黄降之,闻药气仍然呕吐。且其人素患劳嗽,身体羸弱,过用咸寒,尤其所忌。为制此方,煎汁一大碗,仍然有朴硝余味,复用莱菔一个,切成细丝,同葱 油醋,和药汁调作羹。病患食之香美,并不知是药,大便得通而愈。
A lady, 70 years of old, just got the Shanhan disease. She had no sweat. Her condition was originally the Mahuang Tang condition, but she was given Guizhi Tang by mistake, so that the condition was changed worse into the Baihu Tang condition. She felt very annoying hot in Upper Jiao, and she would vomit the movement she smelled the herb smell. She usually worked very hard and her body was usually slim and thin. Considering this, too salty and Cold herbs were not used. Therefore, this formula was prescribed to her. The final herb tea still has a kind of the Poxiao odor. So, a radish was cut into thin pieces. It was mixed with Chinese onion, sesame oil, vinegar, as well as the herbal tea, into a soup. The patient smelled it very delicious, and did not know it was herbal tea/soup, so she ate it. The stool was then past very easily.

 

一媪,年七旬,劳嗽甚剧,饮食化痰涎,不化津液,致大便燥结,十余日不行,饮食渐不能进。亦拟投以此汤,为羸弱已甚,用人参三钱,另炖汁,和药服之。一剂便通,能进饮食。复俾煎生山药稠汁,调柿霜饼服之,劳嗽亦见愈。

A lady, 70 years of old, suffered from exhausting cough very much. The diet was developed into phlegm and saliva but not body liquid, so that the bowel movement was very difficult. She could have the bowel movement once every ten days. The diet became less and less. This formula was tried to her. For her very weak body condition, herb Renshen (ginsheng) 9 gram was cooked separately and drink with the herbal tea. After one dose, the stool was past smoothly and she could eat. Then, she was given Shanyao soup, mixed with Shishuangbing. Her long term cough was also solved.

 

2.赭遂攻结汤

2. Zheshui Gongjie Tang (Zhe here means herb Daizheshi; Shui means herb Ganshui; Gong means to solve and to combat; Jie means hard stool in the intestine).

 治宿食结于肠间,不能下行,大便多日不通。其证或因饮食过度,或因恣食生冷,或因寒火凝结,或因呕吐既久,胃气冲气,皆上逆不下降。

This formula is used to solve the stop, the block, the stick of not digested food in the intestine. The stool did not pass down, so the bowel movement stopped for many days. It could be due to over-eating; or to too much eat or drink cold food; or to the clot formation of Cold and Fire in the intestine; or to the long term vomit, the stomach Qi and the Chong qi rushed up instead of moving down.

生赭石(二两,轧细) 朴硝(五钱) 干姜(二钱) 甘遂(一钱半,轧细药汁送服)
Daizheshi 60 gram (grind), Poxiao 15 gram, Ganjiang (dried ginger) 6 gram, Ganshui 4.5 gram (grind and drink it with herbal tea from other ingredients).

热多者,去干姜。寒多者,酌加干姜数钱。呕多者,可先用赭石一两、干姜半钱煎服,以止其呕吐。呕吐止后,再按原方煎汤,送甘遂末服之。
 If the body has more Hot condition, remove Ganjiang. If the  body has more Cold condition, add Ganjiang several gram. If the person has more vomit, first drink the tea prepared from Daizheshi 30 gram and Ganjiang 4.5 gram to stop vomit. After stop of vomit, follow the original formula.    

朴硝虽能软坚,然遇大便燥结过甚,肠中毫无水气者,其软坚之力,将无所施。甘遂辛窜之性,最善行水,能引胃中之水直达燥结之处,而后朴硝因水气流通,乃得大施其软坚之力,燥结虽久,亦可变为溏粪,顺流而下也。特是甘遂力甚猛悍,以攻决为用,能下行亦能上达,若无以驾驭之,服后恒至吐泻交作。况此证多得之涌吐之余,或因气机不能下行,转而上逆,未得施其攻决之力,而即吐出者。故以赭石之镇逆,干姜之降逆,协力下行,以参赞甘遂成功也。且干姜性热,朴硝性寒,二药并用,善开寒火之凝滞。寒火之凝滞于肠间者开,宿物之停滞于肠间者亦易开也。愚用此方救人多矣,即食结中脘下脘,亦未有不随手奏效者。
 Though the herb Poxiao can make the stool soft to pass, if the stool is too dry, there is no enough water or humidity in the intestine, it would not work properly. The herb Ganshui is fast moving in herbal property. It can bring the water in the stomach right down to the dried intestine portion, to help the Poxiao to soft the stool. Even if the stool is too hard to soft it completely, its surface can become soft enough and flow down along with passing water in the intestine. The nature of the Ganshui is very sharp. It can move down but can also rush up, so to cause diarrhea and vomit, if there is no proper control on it. Especially, the long term constipation happened after large vomit, or due to the reverse rushing up of the stomach Qi and/or the Chong Qi, the use of the Ganshui is more to cause vomit. The herb Daizheshi and Ganjiang are used here to bring the function of the Ganshui mostly down to the intestine to push the stool movement. In addition, the nature of Ganjiang is Hot, and that of Poxiao is Cold. The combinational use of the two helps to solve the Cold-Fire clot in the intestine. When the Cold-Fire clot is solved, the stick stool is also solved. I have tried this formula for many patients, no matter the dead stool was blocked in the middle part of the abdomen, there were no case without success.

乙卯之岁,客居广平,忽有车载病患,造寓求诊者。其人年过五旬,呻吟不止,言自觉食物结于下脘,甚是痛楚,数次延医调治,一剂中大黄用至两半不下。且凡所服之药,觉行至所结之处,即上逆吐出,饮食亦然。此时上焦甚觉烦躁,大便不通者已旬日矣。诊其脉,虽微弱,至数不数,重按有根。知犹可任攻下,因谓之曰:此病易治,特所服药中,有猛悍之品,服药时,必吾亲自监视方妥。然亦无须久淹,能住此四点钟,结处即通下矣。遂用此汤去干姜,方中赭石改用三两,朴硝改用八钱。服后须臾,腹中作响,迟两点半钟,大便通下而愈。后月余,又患结证如前,仍用前方而愈。
One year, when I lived in Guangping city, suddenly there was a patient who was send by a vehicle to me for help. The patient was 50 years of old. He signed continuously and said he felt there was something blocked in the lower abdomen and caused pain very much. He had visited several doctors. There had been a formula in which the herb Daihuang had been 45 gram but the stool did not just move down. He also felt that, any herbal tea, when moved to the blocked portion, would reverse up and vomited out. This was same for diet.

 

附录:
Appendix:

山东德州卢××来函:
Letter from Dezhou city, Shangdong province:

族侄孙××,患肠结证,缠绵两月有余。更医数十人,服药百余剂,不但无效,转大增剧。伊芳亦以为无人能治,无药可医。气息奄奄,殓服已备。后接先生来信(曾为去信服衷中参西录中赭遂攻结汤),即携《衷中参西录》往视,幸伊芳心神未昏,将赭遂攻结汤方查出示之。伊芳素知医,卧观一小时,即猛起一手拍腑,言我病即愈,幸不当死。立急派人取药,服后片刻,腹中大响一阵,自觉其结已开,随即大泻两三盆,停约两句钟,又泻数次,其病竟愈。随即食山药粉稀粥两茶杯,继用补益濡润之药数剂以善其后。

Mrs. Song is my relative. He got constipation for two moths. He had visited more than ten doctors, drink hundreds of herbal tea, without any improvement but worse. The patient also thought that his condition had no way to help. He was very weak with breath and the family was preparing for his death. Later, I got your letter and brought your book  Zhongzhong Canxi Luto see him. Thanks that he did not loss consciousness yet. I showed him the book and the formula Zheshui Gongjie Tang. He knew medicine before. He read the book on the bed for one hour, and tapped his stomach suddenly and said his condition would be solved and no need to die. He asked family urgently to buy the herbs, cooked the herbs. After drink the herbal tea for a while, there was a series of large sound in his abdomen. He felt that the dead stool in the intestine was opened, and soon he had a large bowel movement of three big basins of stool. After several tens of minutes, he had additional several times of bowel movement and his condition was solved. Later, he drink two cups of Shanyao soup, together with some nourishing herbs for a maintenance.

 

3.通结用葱白熨法

3. Tongjie Yong Chongbai Yun Fa (Tongjie means to open, and to conduct, in Chinese; Yong means to apply, and to use; Chongbai means Chinese onion; Yun means to warm up).

治同前证。

This formula is used for the same constipation condition as above.

葱白(四斤,切作细丝) 干米醋(多备待用)
Big Chinese onion 1000 gram (chop into pieces), Vinegar some amount.

葱白丝和醋炒至极热,分作两包,乘热熨脐上。凉则互换,不可间断。其凉者,仍可加醋少许,再炒热。然炒葱时,醋之多少,须加斟酌。以炒成布包后,不至有汤为度。熨至六点钟,其结自开。
Fry the Chinese onion in the vinegar to very hot. Fold it into two bags, apply it on to the naval. Replace with a warm one after the previous one became cold. Keep the application without stop. For the cold and used one, add little more vinegar to fry again to hot and to use it again. The amount of the vinegar used during the fry should be adjusted as no vinegar flow out after folded into the bag. After continuous application of the onion bag for six hours, the dead stool would open and start to move by itself.

一孺子,年六岁。因食肉过多,不能消化,郁结肠中。大便不行者六七日,腹中胀满,按之硬如石,用一切通利药皆不效。为用此法熨之,至三点钟,其腹渐软。又熨三点钟,大便通下如羊矢,其胀遂消。
A child, 6 years of old, ate too much meat and could not digest it. The meat blocked in the intestine to cause constipation for six to seven days. He felt bloating in the abdomen, which was very hard as stone when touch to feel. None of the herbs tried worked. This method was used to him, after three hours, the abdomen began to be soft. After another three hours, the stool came out as sheep stool and the bloating disappeared.

一童子,年十五六。因薄受外感,腹中胀满,大便数日不通,然非阳明之实热燥结也。医者投以承气汤,大便仍不通,而腹转增胀。自觉为腹胀所迫,几不能息,且时觉心中怔忡。诊其脉,甚微细,按之即无。脉虚证实,几为束手。亦用葱白熨法,腹胀顿减。又熨三点钟,觉结开,行至下焦。继用猪胆汁导法,大便得通而愈。
A child, 15 to 16 years of old, got common cold, felt bloating in abdomen, and had constipation for several days. His condition was not Yangming sthenic block condition, but his doctor gave him Chenqi Tang, which did not work either, and the bloating became worse, so as hard to have breath. He also felt palpitation from time to time. His pulse was very weak and thin, which could be felt when pressed harder. The pulse was asthenic but the condition was sthenic, the treatment was difficult. However, when the Congbai Yun Fa was used, the bloating reduced very soon. After another three hours, he felt the stool block opened and moved to lower intestine. He was given Pig Gall bladder conduction therapy, the stool came out.

一人,年四十许,素畏寒凉。愚俾日服生硫黄,如黑豆粒大两块,大见功效,已年余矣。偶因暑日劳碌,心中有火,恣食瓜果,又饱餐肉食,不能消化,肠中结而不行,且又疼痛,时作呕吐。医者用大黄附子细辛汤降之,不效。又用京都薛氏保赤万应散,三剂并作一剂服之,腹疼减去,而仍不通行。后愚诊视,其脉近和平,微弦无力。盖此时不食数日,不大便十日矣。遂治以葱白熨法,觉腹中松畅,且时作开通之声。而仍然恶心,欲作呕吐。继用赭石二两,干姜钱半,俾煎服以止其恶心。仍助以葱白熨法,通其大便。外熨内攻,药逾五点钟,大便得通而愈。
A man, 40 years of old, felt and disliked cold usually. I let him to take the Liuhuang (brimstone), two pieces, each as soy bean size. It worked well. A year later, since he worked very hard occasionally in a summer, he had Fire in the body, and he also ate lots of melon, as well as large amount of meat, which he could not digest, so that the dead stool caused block in the intestine as constipation. He felt pain in abdomen and had vomit from time to time. Doctors had tried Dahuang Fuzi Xixin Tang to him, no use. Later, also tried was Jingdou Xueshi Baochi Wanying San, three doses were combined as one dose to use, the stomach pain was reduced, but the constipation remained. Later, when I saw him, his pulse was nearly calm, only mild string and weak, since he did not eat nor had bowel movement for ten days. I used this Congbai Yun Fa to him. He felt loss in the abdomen, with kind of opening sound, but still felt nausea and had wish to vomit from time to time. I prescribed her Daizheshi 60 gram, Ganjiang 4.5 gram to stop his nausea, but the Congbai Yun Fa was continued to solve the constipation. By this way, let the herbs work from both inside and outside. Up to five house of the Yun Fa, the stool came out and the constipation was solved.

按:《金匮》大黄附子细辛汤,诚为开结良方。愚尝用以治肠结腹疼者甚效。即薛氏保赤万应散,三剂作一剂服之,以治大人,亦为开结良方。愚用过屡次皆效。而以治此证,二方皆不效者,以其证兼呕吐,二方皆不能止其呕吐故也。病患自言,从前所服之药,皆觉下行未至病所,即上逆吐出。独此次服药,则沉重下达,直抵病结之处,所以能攻下也。
Comments: the Dahuang Fuzi Xixin Tang in the book
Jin Kuiis good formula to open the stool block. I tried it for stool block in the intestine and it worked well. Even the Jingdou Xueshi Baochi Wanying San, three doses used as one dose, also worked well. I also tried it. For this case, neither formula worked. The reason is that, the person had nausea, but the two formula do not work for nausea. The patient said, with previous herbs, he never felt the herbs moved down to the abdomen but all were vomited out. Only this time, when he drink the herbal tea, he could feel the herbs move down to the diseased location, so that it worked for his constipation.

一人,年四十三。房事后,恣食生冷,忽然少腹抽疼,肾囊紧缩。大便四日不通,上焦兼有烦躁之意。医者投以大黄附子细辛汤,两胁转觉疼胀。诊其脉,弦而沉,两尺之沉尤甚。先治以葱白熨法,腹中作响,大有开通之意。肾囊之紧缩见愈,而大便仍未通。又用赭石二两,附子五钱,当归、苏子各一两,煎汤,甫饮下,即觉药力下坠。俾复煎渣饮之,有顷,降下结粪若干,诸病皆愈。
A man was 43 year of old. After sex activity, he ate lots of cold and not cooked food. He felt sudden pain in the lower abdomen, with kidney contraction feeling. He had constipation for four days and felt annoying in the Upper Jiao part of the body. Doctors had tried Dahuang Fuzi Xixin Tang, he felt bloating pain on the side of abdomen. His pulse was string and deep, especially deep feeling on the Chi position. The Congbai Yun Fa was tried first to him. He had sound in the abdomen, with kind of opening sense. The kidney contraction feeling was also less, but constipation was the same. The herbal formula used then was: Daizheshi 60 gram, Fuzi 15 gram, Danggui 30 gram, Souzi 30 gram. After drink of the herbal tea, he felt the herbal power moved down. The herbal residue was re-cooked and the second tea was drink. Pretty soon he had dry stool moved down. The Condition was solved.  

按:此证用葱白熨之,虽未即通,而肠中之结已开。至所服之药,重用赭石者,因此证,原宜用热药以温下焦,而上焦之烦躁,与大便之燥结,又皆与热药不宜。惟重用赭石以佐之,使其热力下达,自无僭上之患。而其重坠之性,又兼有通结之功。上焦之浮热,因之归根,下焦之凝寒,因之尽化矣。
Comment: In this case, when the Congbai Yun Fa was used, the constipation remained but the block was already loss. The herbal tea later with large amount of Daizheshi is for the reason that the annoying in the Upper Jiao and the dry block of stool prevent the use of warm herbs to warm the Lower Jiao. Only with the use of Daizheshi, to make the Hot power down, so no worry that the herb may cause rush up side effect. Also for its heavy falling force, it can conduct the movement of stool in the intestine. When the floating Fire in the Upper Jiao are conducted down to the its root, the Lower Jiao, the cold in the Lower Jiao is melted too. 

 

附:

Appendix:

1)猪胆汁导法,乃《伤寒论》下燥结之法也。原用猪胆汁,和醋少许,以灌谷道中。今变通其法,用醋灌猪胆中,手捻令醋与胆汁融和,再用以通气长竹管,一端装猪胆中,用细绳扎住,一端纳谷道中。用手将猪胆汁,由竹管挤入谷道。若谷道离大便犹远,宜将竹管深探至燥粪之处。若结之甚者,又必连用两三个。若畏猪胆汁凉,或当冷时,可将猪胆置水中温之。若无鲜猪胆,可将干者,用醋泡开,再将醋灌猪胆中,以手捻至胆汁之凝结者皆融化,亦可用。若有灌肠注射器,则用之更便。
(1). The Pig Gall Bladder conduct therapy, is introduced in the book
Shan Han Lunto solve dry stool block. Originally, it uses big gall bladder, which is mixed with little vinegar . The mixture is conducted into the anus. Now, it is modified as: add vinegar into the big gall bladder. Hold the opening and mix it with vinegar by shacking. Insert a long bamboo tube, with one end into the bladder (tied with string) and another end into the anus. Press the bladder to allow the juice into the anus. If the stool is deep to the anus, insert longer the time. If the dead block is very hard, two or three bladders are needed. If fearing the cold the bladder juice, warm it in warm water. If there is no fresh pig gall bladder, use the dried one. Soft it by rinse it in vinegar, than add vinegar in it. Press the bladder with hands until the inside contents in the bladder become soft. If there is syringe, use it. It is more convenient.

2)古方治小便忽然不通者,有葱白炙法。用葱白一握,捆作一束,将两端切齐,中留二寸。以一端安脐上,一端用炭火炙之。待炙至脐中发热,小便自通。此盖借其温通之性,自脐透达,转入膀胱,以启小便之路也。然仅以火炙其一端,则热力之透达颇难。若以拙拟葱白熨法代之。则小便之因寒不通,或因气滞不通者,取效当更速也。
(2). There is an ancient formula to solve sudden stop of urine. It is also the Congbai Yun Fa. Use several stems of Chinese onion, tie into a bunch. Chop the two ends even. Put one end on to the naval, and burn the other end with moxibustion method. When the naval feels warm, the urine comes out. This method is to use its warm-opening property of the onion, through the naval to the urine bladder, so as to open the hole for urine. However, only burn its one end, the warm power is hard to conduct. If use my Congbai Yun Fa, it works very fast for the block of urine, if it is due to Cold block, or to the Qi stagnation.  

按:此熨法,不但可通二便,凡疝气初得,用此法熨之,无不愈者。然须多熨几次,即熨至疝气消后,仍宜再熨两三次。或更加以小茴香胡椒诸末,同炒亦佳(用胡椒末时,不宜过五钱,小茴香可多用)。

Comment: This Congbai Yun Fa can not only open the urine and the stool, but also to solve hernia if it is iin early stage. It always works, but it needs to be repeated several times. Even the hernia disappear, it has to be repeated two to three times more. Or, add Xiao Huixiang (cumin), Hujiao (pepper) powder to fry with the onion. (when the Hujiao is used, it should not exceed 15 gram. The Xiao Huixiang can be used more).