绍奇谈医(转自民间中医网)2

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 绍奇谈医(简略版)

何绍奇 转自民间中医网

(Part II)

 

9.  栀子豉汤

9. Zhizi Chi Tang

10.  奔豚气病

10. Ben-Tun-Qi

11.  酒客与桂枝汤

11. Alcoholism and Guizhi Tang

12. 附子为百病之长

12. Fuzi is one the most important herbs for many diseases

13.   附子何辜

13. What’s wrong with Fuzi?

14.  麻黄浅识

14. Preliminary discussion for herb Mahuang

15.  谈大黄──兼与沈自尹院士商榷

15. Talk about herb Dahuang (Chinese Rhubarb) – discussion with Academician Zi-yin Shen

 

 

 

  1. 栀子豉汤

9. Zhizi Chi Tang

 

发汗吐下后,虚烦不得眠,若剧者,必反复颠倒,心中懊_,栀子豉汤主之。

“After a sweat therapy, a vomiting therapy, or a colon cleansing therapy, the person feels annoying  and hard to fall into sleep, and if the condition is so severe that the person turns over and over on the bed, and feels annoyin in the heart, use Zhizi Chi Tang as the main herbal formula for the treatment”.

发汗,若下之,而烦热,胸中窒者,栀子豉汤主之。

“After a sweat therapy, and the colon cleansing therapy is followed, the person feels annoying hot and choke and bloating feeling in the chest, use Zhizi Chi Tang as the main herbal formula for the treatment”.

伤寒五六日,大下之后,身热不去,心中结痛者,未欲解也,栀子豉汤主之。

“Five to six days after getting the Shang Han disease, a colon cleansing therapy has been used and the person has had strong bowel movement, but the body fever remains, and the person feels blocking-like pain in the chest, it means the disease is not to be solved. In this case, use Zhizi Chi Tang as the main herbal formula for the treatment”.

这三条原文都明确指出:栀子豉汤证是因为误治而造成的。证之临床,也有不因误治,而在热病病程中自然形成的,常见于在表不解而初入于里之时。

These three paragraphs clearly tell that: the Zhizi Chi Tang is used to solve a condition that happens due to mis-treatment. In clinic, however, the clinic indication condition may not all happen after an improper treatment, but happens during a natural development of a Hotness disease. Commonly, it happens when the body surface condition has not been solved and the disease just starts to penetrate in deeper phases (such as in the Shaoyang phase).

虚烦,一字,点明非是热邪入里与有形之痰、水、宿食互结,故此亦非虚弱之虚,而是空虚无物之虚。有人说虚烦虽无实邪,但却是火热之郁,这句话有语病,甚么叫邪气盛则实,火热是实邪,不过火热为无形之邪而已。

The “annoying feeling” here does not mean that a concrete Fire comes deeper in the body to entangle with the formed Phlegm, water, or non-digested food. The “annoying” does not either means a weakness condition, but a hollow, a “empty” annoying. …….

栀子豉汤的主证是 (虚烦、烦热)、失眠 (不得眠)胸闷 (胸中窒)心中结痛;烦甚则反复颠倒,心中懊_。其么叫反复颠倒?《医宗金鉴》说 烦,心烦也,躁,身躁也。身之反复颠倒,则谓之躁无宁时,三阴死证也。心之反复颠倒,则谓之懊_,三阳热证也。懊者,即心中欲吐不吐,烦扰不宁之象也

The main symptom to indicate the use of the Zhizi Chi Tang is the hollow annoying, poor sleep, choking feeling in the chest, blocking pain in the heart, and in severe case, it could be a repeated turning over on the bed with an Ao-nao feeling. What means the “repeated turning over”? In the book <<Yi Zong Jin Jian>> , it says: “ the annoying, is the heart feels annoying; the restless, is the body physically in restless. Once the body is in restless, and the body turns over and over again, it is an indicator to die in three Yin phases in the Shang Han disease. Annoying in heart is the indicating to the hotness in the three Yang phases in the Shang Han disease. Another symptom that indicating the use of the Zhizi Chi Tang is the “Ao-nao”. There is no exact word in English to describe the feeling of the “Ao-nao”. It is a feeling to vomit but no vomit out, and a feeling of hard to sit for a while and hard to stand up for a while, or hard to lie down for a while.”

这里有三点值得商榷:烦与躁不尽相同,栀子豉汤证只说,未说,所以不应该混入。把反复颠倒强分为心之反复颠倒身之反复颠倒亦有悖于原意;懊_云何?说是烦扰不宁是对的,但哪里有欲吐不吐的意思。柯韵伯说:反复颠倒四字,切肖不得眠之状,为虚烦二字传神。实际上反复颠倒就是说翻来覆去睡不看,卧起不安。心中懊_就是说郁闷心烦不可名状;我曾问过几个河南人,都说是这个意思,并且说现在河南口语中也有心中懊_(读)得慌

Here it should be discussed clearly for the annoying and the restless. They are not exacely the same meaning. For the Zhizi Chi Tang, it is only stated the annoying, but not the restless. Therefore, the restless is not the indicator to use this formula. It would be against the original meaning in the Master’s book if the turning over is separated into the turning over feeling in the heart, or a body turning over. Also, the Ao-nao means annoying feeling without clear reason, and without a minute calm down. It does not mean “a feeling to vomit but no vomit”. The “turning over” is the well description of the poor sleep. The person turns over on the bed again and again (not the body or part of the body automatic jumping – not the body restless). The Ao-nao means the no reason annoying feeling without a movement calm. I have asked some people who come from the Henan province of China (the Master Zhongjing Zhang lived in this province at his time). They confirmed this meaning of the word “Ao-nao”. They also said that, in current folk language of people in the Henan provine, people there still say this word with this meaning.

胸中窒:胸闷,胸有窒塞之感。

Choking feeling in chest: the bloating feeling in the chest. The chest feels choken and pressed.

心中结痛:或谓绞痛,或谓支结疼痛,或谓火邪郁结而作疼痛,或谓如物支撑作痛,俱觉不妥。实则胸中窒,较之烦热重一些,心中结痛,较之胸中窒又重一些,既然是无形热邪,上扰心胸,只有热,而无痰水相合,即无所谓。这里的,是的意思,热邪壅滞不散,气机不利,故胸中窒,气机因热邪而窒塞不通。最严重的后果,就是心胸疼痛了,也都是热邪无从发越、聚结不散的缘故,故结痛,是言其原因,是言其后果。由于烦热不得眠、胸中窒、心中结痛都是由邪引起的,所以用栀子豉汤祛热,热去则胸无留邪,胸中气机流通,则诸证自已。

Compressed pain in the heart: it can be a “twisting feeling pain”, or a “compressed feeling pain”, or “the Fire Xie Qi choked to cause the pain”, or “a pain that feels as something stretching in the chest”.  Actually, the choking feeling in the heart is a feeling severe than the “annoying hotness”. The “choking pain” is more severe than the “Choking feeling in the chest”. The Xie Qi here is a no form Hotness Xie Qi, which rushes up to disturb the heart. There is only hotness, but no combination with phlegm or water, e.g. there is no a concrete “mass or knob”.  The “choking” here means “accumulation”. Due to the Hotness Xie Qi stagnated in the chest without dispersed off, the Qi circulation is blocked and stagnated, so there is a bloating and choking feeling in the chest. Once the Qi circulation is severely affected, it would be the pain in the chest and heart. All of these phenomenon is due to the failure of disperse of the Hotness Xie Qi in the chest. So, the “choking” means the cause and the “pain” means the result. Because the annoying hot and hard to fall into sleep, the choking feeling in the chest, and compressed pain feeling in the heart, all are caused by a Xie Qi, the use of Zhizi Chi Tang is to dispel the Hotness. ONCe the Hotness is dispelled off the chest, the Qi circulation in the chest became smooth, all the bloating and annoying feeling would be subsided.  

过去很多注家包括教材都说栀子豉汤证是热扰胸膈,与一般的心火、肺火、肝火等不同。不知烦热,不得眠,甚则反复颠倒,心中懊_,胸闷窒痛,无一不是心肺之病,即使是热在胸膈,火性炎上,也必定会扰乱主神明的心,主气化的肺,影响心肺的功能,而出现上述症状。

Many of the previous scholars, including the text book, said that the indication to the use of the Zhizi Chi Tang is the disturb of the chest and the diagram by the Hotness. The Hotness is different from the Heart Fire, the Lung Fire or the Liver Fire. They forgot that, the annoying hot feeling, the poor sleep, the repeat turning over, the Ao-nao feeling, the choking and pain in the chest and heart, all are the disease in the heart and the lung. Even if the hotness in the chest, due to the nature of the Fire and Hotness as of being rising up, it would disturb the heart, which in nature dominates the calm of the spirit, and the lung, which dominates the Qi dispersion to the whole body, so as to affect their functions and to cause the above symptoms.

临床用栀子豉汤,最多、最巧的,当推清代叶天士。王旭高说此方治温邪之的方,他指出叶氏温热论温邪上受,首先犯肺未出主方,只说挟风则加入薄荷、牛蒡之属,挟湿加入芦根滑石之流,没说加入何方之内,实际上当是此方。读《临证指南医案》,风温门叶案(风温入肺,肺气不通,热渐内郁心中懊_,脘中痞满,犹是气不舒展),郭案(风温入肺,气不肯降,形寒内热胸痞,皆郁之象);温热门某案(温邪入肺),陈案(热病后不饥不食不寐);温门李案(时今湿热之气,触自口鼻,由募原以达中道,遂至清肃不行,不饥不食)都用栀子豉汤加味。至于杂病中的气火上郁,用栀豉开通壅过,心痛肝阳直犯胃络;肠便不通,不能纳食,乃气为结;黄疸,一身面目发黄,不饥溺赤;喘胀,气壅不通,便不通爽,弱短浑浊,嗽血,痰多纳减脘闷,也都用栀子豉汤加味。大旨无非解其陈腐郁热,宣其陈腐郁结而已。今人之临床运用,尚不能出叶氏范围。

In clinic, it is Dr. Tianshi Ye in Qing dynasty of China, who used the Zhizi Chi Tang most common and in most smart ways. Dr. Xugao Wang said that, this formula “is the formula to treat Wen Xie”. Dr. Wang pointed out that Dr. Ye said “The Wen Xie attacks the upper part of the body. It first attacks the lung” but he did not give out the herbal formula to treat it, as he only said “if the Xie Qi is with the Wind, add herb Bohe and Niubangzi; if it is with Wetness, add herbs such as Lugeng and Huashi”, he did not mention to which formula these herbs should be added in. In fact, it is this formula.  In the book <<Lin Zheng Zhi Nan Yi An>>, in the Wind-Hotness disease chapter, the case report for patient Ye (The Wind-Hotness penetrated into the lung, the lung Qi stagnated, the Hotness gradually developed into a choking condition, the patient felt Ao-nao, bloating in the stomach region as the Qi was not freely dispersing), for patient Guo (the Wind-Hotness in the lung, the lung Qi did not descend, the body showed as cold but inside as hot in the chest, all of these indicated as Hotness stagnation), in the Hotness-Fire disease chapter, the case report for a patient (the Hotness Xie Qi penetrated into the lung), the patient Chen (after fever, the patient felt no appetite, no desire to sleep, neither to eat); in the Hotness disease chapter, the patient Li (Seasonal Wetness-Hotness Qi attacks the body. …… The patient felt no desire to eat, no appetite), all used the Zhizi Chi Tang with more or less modification. Also in various imtypical diseases, the Zhizi Chi Tang was used to “open the choking, conduct the blocking”. It was used in heart pain (the Liver Yang attacked the Stomach meridian), in intestine pain syndrome (The bowel movement wss difficult, hard to eat, both of which are due to Qi stagnation into block), jaundice (whole body, including the eyes and face, was yellow. The person had no appetite, no hungry feeling and the urine was red in color), asthma (The Qi was stagnated. The bowel movement was not smoothly. The urine was little and the cloudy. There was cough with blood and with heavy phlegm. The person felt bloating in the stomach and ate less). In all of these cases, the Zhizi Chi Tang was used with more or less modification. The main aim is just about to dispel old-stagnation and a choking Fire. When the doctors in current time use this formula, they still follow the main idea by Dr. Ye.  

栀子豉汤是阳明清泄之方,而绝非涌吐之剂,柯韵伯认为栀子并非吐药,唯豉之腐气能令人吐,并以瓜蒂散取用豉汁合服为证。王旭高于此提出批评,他说瓜蒂本是吐药,用豉汁调服,是因为豆豉有调中下气的作用,恐过吐伤其中气,非瓜蒂必得豉而吐也。

The Zhizi Chi Tang is a dispelling formula to clear the Fire in the Yangming phaseof a disease.It is not at all a vomit-stimulating formula. Dr. Yunbo Ke believed that the herb Zhizi is not a vomit-stimulating herb. Only the Dandouzhi could cause nausea. He took the formula Guodi San, which need the drink of Dandouchi juice, as example to approve his argument. Dr. Xugao Wang argued again his comment. Dr. Wang said that, the herb Guadi is originally a vomit-stimulating herb. To drink the Dandouzhi the same time is to take the ability of the Dandouchi to adjust, and to balance the middle and lower Qi in the body, for prevention of the hurt of the Qi by possible over-vomit from the Guidi, not means that the Guodi will cause vomit only when used together with the Dandouchi. .

豆豉究竟有甚么作用?过去都认为它有发汗解表作用,如谓豆豉发汗,读仲景原文就说不过去,既指出发汗、吐下后,岂有再发汗之理?姜春华先生曾经指出,豆豉并无发汗作用,也没有催吐作用,先生总结其用有四:1.除烦;2.调理肠胃;3.有轻微解热作用;4.作治寒性哮喘的砒制剂紫金丹的赋形剂。(上海成药名寒哮丸)

What anyway the function of the Dandouchi? Previously, it is believed that it functions to stimulate sweat and to release the body surface symptom. If it in deed has function to stimulate sweat, it would be against the original text of Master Zhongjing Zhang in his book <<Shan Han Lun>>. If Master pointed out that the Zhizi Chi Tang is used after sweat-therapy, vomit-therapy, or colon-cleansing therapy”, how could the sweat-therapy would be used again? Dr. Chunhua Jiang said: Dandouchi does not have sweat-stimulating function at all, neither vomit-stimulating function. He summarized four functions of Dandouchi: (1), to clear off annoying feeling; (2), to balance and adjust the function of digestive system; (3), to slight reduce fever; (4), to be used as excipient of herb Zijin Dan, which works to solve Cold type asthma (the name of the herbal product in Shanghai is Han Xiao Wan).

乡前辈李孔定先生则认为豆豉为滋阴之品,功能滋肾宁心,开胃消食,其滋阴之力不及地黄麦冬,但无地麦之呆滞碍胃,因此用于内热尚盛,阴未大虚者,与栀子合用,颇为合拍。外热尚盛,微见阴虚,与葱白合用,亦甚相宜。豆豉加盐即为食品,李时珍曾说它香美绝胜也。今天对其成分的研究证实了:豆豉富含蛋白质,并分解出多种氨基酸,此外还含钙、铁、磷及多种维生素,有帮助消化,增加食欲,消除疲劳,增强脑力,减慢老化,提高肝脏解毒能力的作用。所以在初起恶风发热无汗,配葱白之发汗(葱豉汤);太阳初传阳明,虚烦不眠心中懊_,胸闷,配栀子之清热(栀子豉汤);温毒热入营血,发斑,配生地黄(黑膏),皆取其平和之性,香美之味,既有滋养营阴,又调气和中之长。

Dr. Konding Li, our senior doctor, believed that, Douchi is a Yin-nourishing herb. It works to nourish the Kidney, to calm Heart, to improve digestion, and to improve appetite. Though its Yin-nourishing capacity is not as strong as herb Dihuang or Maidong, it has no side effect of affecting digestive function. For this, when it is used in a condition, in which the inner Hotness is still overwhelming, but the Yin has not been exhausted too much yet. In this case, the use of the Dandouchi and Zhizi matches the clinic need very well. If the external Hotness is overwhelming and the Yin is only slightly exhausted, use it with Chunbai (the white part of Chinese onion) works well. After addition with salt, the Dandouchi is a regular food. Master Shizhen Li said it is excellent food in taste. Medical research on its contents indicated that it is rich in protein, as well as some amount of calcium, iron, potassium, and various vatamines, and that it helps digestion, increases appetite, reduces fatigue, improves mental ability, retards speed to get old, and increases the liver ability to detoxify. Therefore, it is used in the early stage of a common cold when the person just start to have wind-dislike feeling, fever but no sweat, in which it is used with Chinese onion white (as in the formula Chun Chi Tang). When the disease passes just from the Taiyang phse into the Shaoyang phase, and the person feels no-reason annoying, Ao-nao feeling in the heart, choking feeling in chest, the Douchi is used together with Zhizi (in the Zhizi Chi Tang). In a Hotness disease, when the Hotness toxic and Fire penetrates into the Ying Blood phase, the body showes bleeding spo on skin, the Douchi is used together with Shengdi (black paste form). In all of above formulas, the Douchi is used for its calm and gentle property and delicious taste, so to nourish Yin and to balance the Qi and harmonize the middle digestive part of the body.      

 

 

  1. 奔豚气病

10. Ben-Tun-Qi

 

仲景所论的奔豚气病,是一种发作性的疾病,以患者自觉气从少腹上冲至心胸为特点,其状如猪之奔突,发作时恐惧莫名,甚至有濒死的感觉,但移时冲气渐平,即和常人无多差异。

The Ben-Tun-Qi that is described by Master Zhongjing Zhang in his book <<Shan Han Lun>> is a paroxysmal disease. It is characterized by a feeling of gas that is rising and rushing up to the heart or chest. It feels as a small pig running and bumping. Opon the attack, the person feels no-reason fear, even feels as close to die. Soon after,  the bumping feeling subsided, and the person looks and feels as normal.

此病在西医学中很难找到与之近似的疾病,而临床时有所见,我曾留心查阅过近三十年的有关资料,粗计亦有数十例之多。

It is hard to find a similar disease or symptom in the medical report or textbook in the western medicine. But it can be seen from time to time in clinic. I have paid attention to the medical literatures for the past thirty years. There are tens of such reports.

仲景认为奔豚气的病因是起于惊恐。《诸病源候论》在惊恐之下,又添忧思二字,说明多种情志变化皆可引起脏气不平,发为奔豚。

Master Zhongjing Zhang believed that the Ben-Tun-Qi is caused by scare or fear. In the book <<Zhu Bing Yuan Hou Lun>>, under the words “scare”, it listed also the word “worry”. It means that various emotional disorders could cause the organ Qi in disorder, so to develop into the Ben-Tun-Qi condition.

奔豚汤以气从少腹上冲至胸为主证,腹痛往来寒热为兼证,(非必具症状)。方用李根白皮、黄芩、葛根,凉肝清热;半夏、生姜,降逆平冲;芍药、甘草合当归、川芎,缓急止痛。其病位在肝,病性属热,病机为肝郁化火,气逆上冲(气有余即是火)。于证,当有舌红(边尖),苔薄黄,脉弦滑数,口苦、咽干、心烦、腹痛或往来寒热。

The herbal formula Ben-Tun-Qi Tang takes the “a gas pushing and bumping feeling from lower belly up to the chest” as the main indication to use it. The “belly pain” and the “come and goes of fever and chilly feeling” are the accompanying indications (e.g. they are not the obligatory indications). The formula contains herb Ligenbaipi, Huangqin, Gegen to cold down liver fire; the Banxia, fresh ginger to reverse the up-bumping feeling down; the Shaoyao and Gancao, together with the Danggui and Chuanxiong, to calm down the pain and to release the spasm. The location of the disease is in the liver. The nature of the disease is Fire and hotness. The reason for the disease is that the Liver Qi is stagnated so that the stagnated Qi develops into Fire. The Qi bumps up (The overwhelming Qi would develop into Fire). In the clinic, the tongue tip should be red in color, the tongue cover should be thin and yellow. The pulse is string and slippery. The person feels bitter in mouth, dry in throat, annoying feeling in heart, pain in belly or fever-chilly feeling that comes and goes.

[笔者治验]

Successful cases by the writer:

刘宪章,男,37岁,山西省襄垣县电业局。病起于惊恐,已二年,呈发作性,发作时气从下腹上冲至胸、咽,惊慌莫名,伴腹痛、冷汗,严重时甚至昏仆,不省人事(但无口吐白沫、四肢抽搐及遗尿),约20分钟~30分钟可自愈,但觉浑身乏力。在当地曾做各种相关检查,未明确西医诊断,中医诊断为奔豚气,曾用过桂枝加桂汤等方,久治无效。其人清瘦黝黑,平素性情急躁,痰多,常失眠。舌红、苔黄腻,脉弦滑数,病属中医所称奔豚气无疑,桂枝加桂方非不佳,无如其不对证何!拟以降火、平冲、坠痰为治,用黄芩15g,黄连6g,桑白皮30g,葛根20g,丹参15g,赤、白芍各10g,当归6g,川芎6g,茯苓15g,姜半夏10g,生姜3片,服12剂。另用礞石滚痰丸9g11次。药后3日内竟无动静,至第4剂,大便始通,日45次,混有鲜血及痰涎状物;再服,血止。尽剂。此系我1987年在西苑医院门诊接诊者,至今已十余年矣,未再发作。饮食增进,睡眠亦安,易方调理。随访多年,一切安好。

Mr. Xianzhang Liu, male, 37 years of old….  His disease started from scare. It has been for two years and it is paroxysmal. When the disease broke, he felt air or gas rushed from the lower belly up to the chest and throat. He felt no-reason scared, which was accompanied by belly pain, cold sweat. In severe break, he could fall into coma without consciousness (but no white bubble saliva from mouth, no spasm in arms or legs, or urine leakage). The break could stop by itself after 20 to 30 minutes but he would feel fatique afterwards. He had been under various detect or test in local hospital but the western medicine diagnosis remain unclear. The Chinese medicine diagnosis was the Ben-Tun-Qi. He was given Guizhi plus Guizzhi Tang for a long time, but stil no improvement. He looked black and slim. He was usually an acute temple, had more phlegm and usually suffered from poor sleep. His tongue was red in color, the tongue cover was yellow and greasy. His pulse was string, slippery and frequent. No doubt his condition belongs to the Ben-Tun-Qi in Chinese medicine, but the formula Guizhi plus Gui Tang did not work. Clearly the herbal formula did not match the disease condition! The therapeutical principle should be to clear Fire, to calm down the reverse and to press down the phlegm. The herbs given to him were: Huangqin 15 g, Huanglian 6 g, Sanbaipi 30 g, Gegen 20 g, Danshen 15 g, Chishao 10 g, Baishao 15 g, Dangui 6 g, Chuanxiong 6 g, Fuling 15 g, Ginger-cooked Banxia 10 g, fresh ginger three pieces. He was given this formula for 12 doses (12 days amount). In addition, he was given Menshi Gongtan Wan 9 g, once pill one day. After three days of the herbal therapy, his condition did not change at all. Upon the fouth day, he started to have bowel movement, which was 4 to 5 times a day and which was mixed with fresh blood and phlegm-like material. The herbal therapy was continued and the bleeding stoped. After the 12 doses of treatments, the break stopped. His appetite was improved, so did his sleep. The herbal formula was changed for a meintanence. This was the case in year 1987 when I worked in the clininc of Xiyuan hospital. It is so far tens years. There was no any disease break.

李根白皮,即李子树根白皮,废用已久,药肆无售,只好代之以桑白皮。桑白皮功擅清肺平喘,利尿消肿,清金以平木,用于肝气肝火痰热,于理可通。

The Ligen Bai Pi is the white bark of plum tree. It is no in use for a long time and no sale in herbal shop, so it is replaced with the white bark of mulberry. Mulberry works to clear the lung and to calm down asthma, to improve urination and to reduce edema. To clar the Metal is to calm down the Liver. It is logical and reasonable when it is used in the Liver overwhelming with Fire and Phlegm.

桂枝加桂汤仲景原书认为发汗后,烧针令其汗,针处被寒,核起而赤者,必发奔豚,注家亦多以外寒从针孔而入为释(尤怡),独《医宗金鉴》认识到乃其人素寒阴盛也。征诸实际,也不必一定是由误汗、烧针引起的。奔豚有寒热二证,热证已如上述,寒证即桂枝加桂汤证也。

The Guizhi plus Gui Tang, in the original text of the book <<Shang Han Lun>> by Master Zhongjing Zhang, is used “after sweat therapy, buring the acupuncture needle to create more sweat, and the acupuncture hole is invaded by Cold Xie Qi, the holes become rising and red in color. In person would have the Ben-Tun-Qi”. Most of doctors explained that “the external Cold invaded into the needle holes” (such as by Dr. Yi You). Only I the book <<Yi Zhong Jin Jian>., it said that it is “the person’s body is a Cold constitution and a Yin overqhelming constitution”. In practice and in reality, it should not always be caused by the mis-use of the sweat therapy or by the use of burning needles. There are two types of Ben-Tun-Qi condition: the Hot type has been introduced above. The Cold type is the condition for the use of Guizhi plus Gui Tang.

关于此方是加桂枝还是加肉桂的问题,历来有不同看法。岳美中老师认为是加桂枝,一则根据《伤寒论》气从少腹上冲心与桂枝加桂汤,更加桂二两也,果加肉桂,应云当加,不可云更加;二则《伤寒论》有其气上冲者,可与桂枝汤,是桂枝原治气上冲证,若加重剂量,自可治气上冲之奔豚了。柯韵伯更赞扬此方说:更加桂者,益火之阳而阴自平也。桂枝更加桂,治阴邪上攻,只在一味中加分两,不于本方内求他味,不即不离之妙如此。

 It is a long time question whether the Gui that is added is the Guizhi[1] or Rougui[2]. Doctor Meizhong Yue believed that it should be the Guizhi. One of the reasons is that in the book <<Shang Han Lun>>, “When the Qi rushes up from the lower belly to the heart, use the Guizhi plus Gui Tang, with more addition of Guizhi 30 grams”. If it is the Rougui, it should be written as “added with Rougui 30 grams”. The second reason is that, in the same book, it said “If there is Qi rushing up, Guizhi Tang can be used”, indicating that, it is the Guizhi, that works to calm down the reversely up-rushing Qi. With high amout of the Guizhi, it would work to solve the Ben-Tun-Qi with the Qi up-rushing. Dr. Yunbo Ke admired this formula that “to add more Guizhi, to nourish the Yang Fire so to calm down the Yin. Use the Guizhi plus Gui to solve the Yin Xie up-rushing. Only change the dose of a single herb, not to add more other herbs into the formula. So smart way to set up the formula!”  

尤怡及近人曹颖甫、余无言等主张:加桂应是加肉桂或桂心,因为肉桂味厚下行,能散少腹之积寒。曹、余等皆有医案证明。

Dr. Yi You, Dr. Yinpu Cao, and  Dr. Wuyan Yu, etc. believed that, the “plus Gui” should be to add Rougui or the inner part of the Guizhi. Because the Rougui is heavy and strong in smell and taste, so its herbal nature is descending, as to disperse the old Cold in the lower belly. Both Dr. Cao and Dr. Yu had their cases to prove their statement.  

实际上,仲景全书无用肉桂者,如建中汤、五苓散、肾气丸之当用肉桂者亦用桂枝,这是因为汉代桂枝、肉桂混用不分的缘故。后世本草著作认为肉桂、桂心均为温里寒药,气味俱厚于桂枝,因此加用肉桂或桂心,用于奔豚气病更为合宜。如张璐的《本经逢源》中谈到:肉桂辛热下行,入足太阴、少阴,益火消阴,大补阳气,下焦火不足者宜之,其性下行,导火之源,所谓肾苦急,急食辛以润之,元素言补下焦不足,沉寒痼冷之病,下部疼痛,非此不能止。桂心独取中心甘润之味,专温营分之里药,故治九种心痛,腹内冷痛。《本草汇言》更明确指出肉桂可治奔豚寒疝而攻冲欲死

In fact, in the book by Master Zhongjing Zhang, there is no use of Rougui in his formula, such as in the formula Jianzhong Tang, Wuling San and Shen Qi Wan, in which, whenever the Rougui is to be used, it is the Guizhi. This is because in the Han dynasty, the Guizhi and the Rougui are not separated clear in herbal medicine. In later herbological books, it believes that the inner Gui and Rougui both belong to inside-warming herbs. Their smell and taste both are stronger than the Guizhi. It would therefore be more suitable to use these two than use Guizhi, in the treatment of Ben-Tun-Qi. For example, in the book <<Ben Jing Feng Yuan>> by Dr. Lu Zhang, it stated: “The Rougui is spicy and hot, moves downwards, into foot Taiyin, Shaoyin meridian, to nourish the Fire and to disperse Yin condition, to strongly nourish the Yang Qi, good to be used when the lower Jiao Fire is in deficiency. Its nature is descending, guide Fire down into its source. As it is stated (in another book) ‘The Kidney does not like spasm. When it is in such condition, eat spicy food to wet it as soon as possible’. Dr. Yuansu Liu said it works to nourish the weakness in the lower Jiao of the body. It cannot be omitted to solve old Cold condition, or the pain in lower belly. The inner Gui picks solely the inner sweet and wet part of the Gui tree, it works mostly in the Ying portion of the body, so it works to stop various pain, including the cold pain in the belly.” In the book <<Ben Cao Hui Yan>>, it further more clearly states that the Rougui works to “solve Ben-Tun-Qi, Cold hernia condition, in which the person feels rushing are inside body and with feeling to die”.

 

[笔者治验]

Successful cases by the author:

徐庭良,男,64岁,军人,20011013日。平素体健,忽于今年春末某日,感觉小腿地一下,一股气上冲至腹部,胸部、咽喉,周身冷汗,难受之极,惊恐莫名,但一分钟即过。此后,或一天有12次发作,或多至10多次,睡在床上也发,也有十天半月安然无恙者。去空军总院住院检查一个月,无何发现,未予确诊。此奔豚气病也。察其脉沉而弦,舌质淡,边有齿痕。拟以调营卫,降冲逆为治,用桂枝加桂汤加味:桂枝18g,赤、白芍各10g,炙甘草6g,大枣七个,生姜20g,肉桂10g,生龙骨30g,牡蛎30g7剂。服毕,多次随访,未再发作。

Patient Tingliang Xu, male, 64 years of old, an armyman. The first visit date: Oct. 13, 2001. He is usually healthy. Suddenly in one day at the end of spring this year, he suddenly felt a gas up-rushed from his calf to the belly, chest and throat. He felt cold sweat in whole body. He felt very painful and very scared without reason. But it lasted for only one minute. From that time on, he could suffer from similar break with one to two times a day, or evern more than ten times more. It came even when he lied down on the bed.  There could also have no such break for ten days or half month. He visited the military hospital and was admitted in the ward for one month for diagnosis. No any clear diagnosis at all. In Chinese medicine, it is the Ben-Tun-Qi disease. On assessment, it was found that his pulse was deep and string. The tongue was less red than normal, and with index on the side of the tongue. The principle for the herbal therapy was to adjust the Ying and Wei, to reversely turn down the up-rushing. The herbal formula used was Guizhi plus Gui Tang: Guizhi 18 g, Chishao 10 g, Baishao 10g, Zhi Gancao 6 g, 7 Chinese dates, fresh ginger 20g, Rougui 10 g, Longgu 30 g, Muli 30g. He was given seven doses. After finish of the herbal therapy, and followed up for many times, there was no more break out of the Ben-Tun-Qi.

上述桂枝加桂汤证实用药历代者作中也有些足资参考的资料,医者可从中得到启发。如《肘后方》用吴茱萸、生姜、半夏、桂心、人参、炙甘草;《千金要方》用桂枝甘草汤;《外合秘要》引《广济方》用半夏,吴茱萸;《太平圣惠方》用甘李根皮、吴茱萸、生姜;《经方实验录》用吴茱萸汤合理中汤、桂枝加桂更加半夏;《爰庐医案》用附子、茯苓、白芍、川芎、半夏、橘核、李根白皮;《张伯臾医案》用真武汤合苓桂术甘汤,二陈汤加菖蒲、远志、白金丸,桂枝加桂更加紫石英、茯苓等。

From literatures in the history, there are sufficient data support the use of Guizhi plus Gui Tang in the treatment of Ben-Tun- Qi condition. Medical doctors can get idea from them. For example, in the book <<Zhou Hou Fang >>, it used Wuzhuyu, fresh ginger, Banxia, inner Gui, Renshen, and Zhigancao; in the book <<Qian Jin Yao Fang>>, it used Guizhi Gancao Tang; in the book <<Wai Tai Mi Yao>>, which cited the herbal formula in book <<Guang Ji Fang>>, used Banxia and Wuzhuyu; in <<Yuan Lu Yi An>>, used Fuzi, Fuling, Baishao, Chuanxiong, Banxia, Juhe, Ligenbaipi; in book <<Zhang Bo Yu Yi An>>, used Zhen Wu Tang plus Ling Gui Zhu Gan Tang, Er Chen Tang plus Shichangpu, Yuanzhi, Bai Jin Wan; Guizhi plus Gui plus Zishiying and Fuling, etc. 

至于苓桂甘枣汤,其证非奔豚气病,仲景已指明只是欲作奔豚而已。脐下悸多系水饮为患,临床时有所见,桂、苓通阳而降逆,甘、枣培土以制水,苓桂术甘汤之类方也。用甘澜水煎药,意在不助水邪,这是古人的经验,也属于东方哲人之思。不能说什么水不就是H2O,干嘛还要这么麻烦,用勺子把它搅来搅去干什么?

For the formula Ling Gui Gan Zao Tang, the condition indicates its use is not the Ben-Tun-Tang. Master Zhongjing Zhang pointed out that the indication is “about to start the Ben-Tun-Qi”. “palpitation feeling” under the naval mostly is due to accumulation of excess water. In clinic, it can be seen from time to time. The Guizhi and Fuling work to conduct the Yang Qi circulation and to down-turn the reversed Qi; the Gancao and Chinese date work to nourish the Soil, so as to suppress the Water. It is the similar formula to Ling Gui Zhu Gan Tang. To cook the herbs with Ganlan water does not aim to help the Water Xie. This is the clinic experience of old Chinese, belonging to the wisdom of Asian sage. It should not say that, the water is but the H2O, why it should be so compex to use a big spoon to up stirring water again and again (to create the Ganlan water)?

 

 

11.  酒客与桂枝汤

11. Alcoholism and Guizhi Tang

 

《伤寒.太阳上篇》云:若酒客病,不可与桂枝汤,得之则呕,以酒客不喜甘故也。凡服桂枝汤吐者,其后必吐脓血也。

In the first chapter for Taiyang phase of Shang Han disease in the book <<Shang Han Lun>>, it says: if the person is an alcoholist, the Guizhi Tang should not be used. Otherwise, there would be nausea, since the body of the alcoholist does not tolerate the sweet. Once there is vomit after drink of Guizhi Tang, later it would be vomit with pus and blood.

注家多认为平素好酒之人,湿热在中,如患桂枝汤证,汗出恶风发热,但因为桂枝汤甘温,服后因甘碍湿、温助热则呕。酒客确喜食辛辣焦香,而不喜甜腻。至于凡服桂枝汤吐者,其后必吐脓血,则不仅因为湿热,而且还包括阳热内盛之人,所谓桂枝下咽,阳盛则毙。如恽铁樵说 当阳盛得桂枝,胃不能受而呕,则其后当见血,但他指出可疑处在字,当是讹字。舒驰远说:服桂枝汤而吐者,我见过,然其后果必吐脓血乎?”“从未之见也!姜春华先生认为:古人偶有所见,则笔之于书,桂枝本非吐药,即或服后偶有吐之者,亦未必吐脓血。

Usually, doctors or scholars believed that for the alcoholist, there is Wetness and Hotness in the body. If the person suffers from a condition that indicates the use of Guizhi Tang, and the person has sweat, dislikes wind (or air-conditioning environment), and has fever. Because the Guizhi Tang is sweet and warm, after drink, its sweet makes the Wetness stick longer time in the body, and the warm makes the Hotness stronger, so both cause nausea. In deed, alcoholist tends to like spicy, and fried food, but dislike sweet or greasy food. For the statement “once the person has vomit after drink the Guizhi Tang, the person would have vomit of pus and blood”, not only because the Wetness and Hotness, but also because the person is originally a body constitution of Yang Hotness and overwhelming inside. It is as so said “for those with Yang overwhelming, drink the Guizhi Tang may cause quick death”. Dr. Tiejiao Yun said: “When the Yang is excess in the body and the person drink Guizhi Tang, the stomach could not tolerate the herbal tea so as to cause nausea. Later, the person would have blood in vomit”. However, he pointed out that, the suspection is the word “pus”, which should be a mis-writing. Dr. Chiyuan Shu said: I saw someone, who have vomit after drink the Guizhi Tang, but “later they would have vomit of pus and blood”? I never saw! Dr. Chunhua Jiang said: “For doctors in old time, they would write down or make record of whatever they observed even a occasional event. The Guizhi Tang is not a vomit-stimulating formula. Even if someone has vomit after drink of it, the person may not necessarily have vomit of pus and blood”.

在我的阅历中,用桂枝汤吐血者时或可见,如雷某之儿子,平素不慎饮食,喜饮酒,胃痛,十多年前适逢前辈蒲辅周先生百年诞辰,名医云集梓潼,遂请为其诊治,其中一位诊为胃溃疡病,虽舌红苔黄脉数,医仍用黄蓍建中汤数帖,不意一服便呕,随即吐血盈碗,送县医院急诊,诊断为溃疡病出血。黄蓍建中为桂枝汤之变方,较之桂枝汤,以有黄蓍、饴糖,就更为甜腻,湿热内蕴者则颇不相宜。此辨证既误,又未了解患者病史及生活喜好,只照某病某方套路,误用甘温,而至吐血之变。

In my experience, it can be seen from time to time that someone have vomit after drink of Guizhi Tang. For example, the son of Mr. Lei normally did not care his diet. He drunk alcohol, and felt pain in stomach. Ten years ago, it was the time to celibrate the centrury birth of famours doctor Pufu Zhou. There were a lot of famous doctors there, who were invited to have a look at the son. One of the doctors diagnosed he having gastric ulcer. Though the tongue was red, the tongue cover was yellow, and the pluse was frequent, he still was given Huangqi Jianzhong Tang several doses. Unexpected, the son had vomit after drink the herbal tea only once. Later, he vomit blood several bowls and had to be sent to hospital for emergency treatment. He was diagnosed as ulcer bleeding. The Huangqi Jianzhong Tang is developed from the Guizhi Tang. It contains herb Huangqi and malt sugar, so it is more sweet than the Guizhi Tang. It is not suitable for person with Wetness and Hotness inside of the body. In this case, the diagnosis is wrong, and the doctor did not either understand the client’s history of disease nor life habit, but followed the fixed mind that “individual disease can be treated by a given formula”. The warm herbal formula was given, which caused such vomit of blood.

 

12. 附子为百病之长

12. Fuzi is one the most important herbs for many diseases

 

(一)

儿时上学住校,周末步行30多里回家。时值盛夏,见路边有不知其名的庄稼,长势甚好,叶如艾,呈剑齿状,质厚,墨绿色,泛油光。询之,才知为中药附子。后来,每到附子采挖之时,经济拮据的邻里人家便将一袋袋的附子拎回家,浸洗削皮切片,以获得一点加工费。不过活得快点干,因为新鲜附子易烂,只有浸在卤碱水中始不烂。那些天,全县所有的汽车都要赶去盐都自贡拉卤碱。

When I was young, I lived in school after school. In the weekend, I walked 30 miles home. One time, it was in hot summer, I saw a “crop” growing on the side of the road. It grew very well. Its leaves looked as Chinese mugwort, as index on edge. The leaves were thick, black-green in color, with oily bright. Upon ask, I knew it is the herb Fuzi. Later, whenever it was the time to excavate Fuzi, my neighbours, who were poor families, would brough one big bag and one big bag of Fuzi home. The Fuzi was washed, peeled, and chopped into slides, to earn some process fee. But they had to work fast, for the fresh Fuzi is easy to rotten. If it was not rinsed into alkali halide solution, it would be rotten. At that time, the trucks of the whole county were hurry up to Salt city, Zigong, to buy and to transport the alkali halides back.

我作医生后,曾数至大乘寺附近的附子厂考察,亲见了附子加工的全过程。江油为附子之乡,至今街上还设店卖附子,11kg,色如冰糖,谓是上品,用以馈赠亲友。我小时侯身体弱,尿床,每到冬至,几乎家家户户都用附子狗肉,这时,父亲就带我去他朋友家喝狗肉附子汤。在我印象里,附子和土豆的味道差不多,久煮之后,嚼著面面的,大概14-5片,约1两左右。一次,我在上海拜访姜春华先生,他问我:你们四川人拿附子当菜吃,是真的吗?我说我就吃过,姜老为之咋舌。

After I became a doctor, I have been visited the Fuzi process factory near Great Chen Temple. I saw by myself the whole course the process for Fuzi. Jianyou city is the hometown of Fuzi. Even today, there are shops in the street to sell Fuzi. It is packed 1 kg per bag. It looks as crystal sugar. It is said it is the best gift to send to friends or relatives. When I was young, my body was very weak with bedwetting. Once in the solsctice, almost every family would cook dog meat with the Fuzi. At this time, my father would bring me to his friend’s home to drink the soup. In my memory, the taste of Fuzi is similar to potato. After a long time cook in water, it chews as mild powder. Each bowl contained about 4 – 5 slides, about 30 grams. Once, I visited Dr. Chunhua Jiang in Shanghai, he asked me: you Sichuan people eat Fuzi as vegetables, is that true? I said yes, I ate it too. Dr. Jiang looked very surprised.  

 

(二)

善用附子者莫过于四川医生。明代泸州人韩飞霞在《医通》中说:附子回阳,霸功赫奕,但尚不以善用附子著称。清同治年间,邛崃郑钦安在成都开创了火神派,观其治病,恒以阴阳为纲,阴证则无论吐血、便血、尿血、喉蛾、失眠、牙痛、口臭、便秘,概投以附子、干姜之类,效如桴鼓。光绪时复有罗定昌者,其治热病发热谵语,舌生芒刺,烦躁不便,而脉尺寸俱无,即用承气加附子。说非用附子治病,而是借其热直达少阴耳。传此派之学者,百余年来不乏其人:吴佩衡南下昆明,云南遂有吴附子之名,他尤以善用附子治麻疹逆证而风靡一时。祝味菊东去上海,当时沪上几无不知祝附子者,他治热病,虽高热神昏,唇焦舌蔽,亦用附子,说热病不死于发热,而死于心衰。章次公先生于此十分心折,说他治病心狠手辣。名医徐小圃的两个儿子俱死于热病,小儿子又病热,几至不救,祝以附子起之。今沪上徐氏儿科仍以用附子见长,即祝公昔年所教也。祝味菊誉附子为百病之长,其用附子有每剂34两的。华阳刘民叔悬壶于上海,高僧惠宗病胃癌,吐血不止,刘力阻西医输血,以大剂干姜附子佐甘草、灶心黄土、花蕊石、云南白药、阿胶,三帖而血全止。近贤重庆龚志贤、成都戴云波诸先生,治风寒湿,附子都用60g以上,其中戴氏所拟乌附麻辛姜桂草汤为治名方。有一年,四川医生带著计算机证软件到北京义诊,处方用附子30g,川乌30g。竟无人敢服用,中医界攻讥者亦复不少,不几天即门可罗雀,铩羽而归。

One is better than doctors in the Sichuan province, China, in the use of herb Fuzi. In Ming dynasty China, Mr. Feixia Han, who lived in the Lu Zhou City, said in his book <<Yi Tong>> that: “Fuzi is used to restore Yang Qi. Its merit is very great”. He was not good at the use of Fuzi, as commended by others. In the Tongzhi years of Qing dynasty, China, Dr. Qin-An Zheng, who was Qiong-Lai city, went to Chen-Dou city in Sichuan province and started the Fire-dominating style of Chinese medicine. In his clinic, he always separated the disease condition into the Yin or Yang, the two main principles. For Yin condition, no matter it was vomit blood, bowel bleeding, urine bleeding, throat swelling, poor sleeping, toothache, bad odor in mouth, constipation, he always used Fuzi or dried ginger, as such herbs. The healing effects were excellent. In the Guang-Xu times of the Qing dynasty, China, Dr. Ding-Chang Luo, when he treated fever disease with delirious speech, thorn in the tongue, annoying and restless, constipation, in which no pulse could be felt on the Chun and Chi positions, he used Chen-qi Tang plus Fuzi. He said that the aim to use Fuzi is not to treat the disease, but to let the hot of the Fuzi to bring the other herbs into the Shaoyin phase.  For the past hundreds of years, there are more than hundred of doctors following this medical style. Dr. Pei-Hen Wu, went south to Kun-Ming city of the Yun-Nan province, so there came a “Wu Fuzi” in the Yun-Nan province. He was famous in the use of Fuzi to treat severe condition of measles. Dr. Wei-Ju Zhu, went to Shanghai, at that time no one in Shanghai did not know the “Zhu Fuzi”. When he treated disease with fever, he also used Fuzi, though the patient was with high fever, loss of consciousness, very dry in mouth lips, and shrink in tongue. He said that the disease with fever would not die from the fever but from heart failure. Dr. Ci-Gong Zhang admired him very much. He said Dr. Zhu was very “cruel heart and malicious means” in the treatment. Another famous doctor, whose name is Xiao-Pu Xu, had two sons died from a disease with fever. Again, his youngest son got sick again with fever, nearly to die without ways to treat. It was the Dr. Zhu, who used Fuzi again and solved the disease. Nowadays, Dr. Xu, in his pediatrics clinic, is good at the use of Fuzi. It is learnt from Dr. Zhu. Dr. Zhu admired the herb Fuzi is the “master of various diseases”. When he used the Fuzi, he could use it up to 90 grams to 120 grams. Dr. Ming-Shu Liu from Hua-Yang city, had clinic also in Shanghai. There was a time that great Buddhist monk Hui-Zhong suffered from stomach cancer with continuous vomit of blood. Dr. Liu strongly insisted to have blood infusion by western medicine, and used large dose of dried ginger and Fuzi, together with Gancao, Soil from inside oven, Huarui stone, Yun-nan White herbs, A Jiao. After three doses, the bleeding stopped. In later times, Dr. Zhi-xian Gong from Chong-Qing city, China, and Dr. Yun-Po Dai, when they treated pain in muscle and joints of Wind, Cold and Wetness, they used Fuzi more than 60 grams. The herbal formula settled by Dr. Dai, the formula Wu Fu Ma Xin Gui Cao Tang, is a very famous one. One year, doctors from Si-Chuan province came to Beijjing with computer software for free consultation. On their prescription, the Fuzi was 30 g, Chuan Wu is 30 g. No one dared to use it for the treatment. There were also lots of criticize for their way of herbal therapy. After only several days, there was very little client visiting, and they had to go back Si-Chuan.

 

(三)

附子大辛大热,通行十二经,其性刚雄,温五脏之阳。 心功能不全多见于肺原性心脏病、风湿性心脏病、冠心病等疾病,大率以心阳虚衰为本,血瘀水停为标,证见心悸怔忡,汗出肢冷,喘促,神疲乏力,面色恍白,紫绀,胸闷腹胀,下肢水肿,严重者甚至出现胸、腹水,全身浮肿,小便不利,脉沉细或结代,舌淡苔白者,常用参附汤、真武汤、桂枝茯苓丸、防己黄_汤四方合方,收效甚速。我曾在某部队医院会诊一风心病、充血性心力衰竭患者,一剂即效,再剂即可下床活动。韩飞霞说人参回元气于无何有之乡,王道也;黑附子回阳,霸功赫奕,合用于心衰,则相得益彰。心衰之重者,则非伍用干姜不可,或干姜、生姜同用,附子无姜不热,附子配干姜、甘草则仲景之四逆汤也,用于心衰之吐利不止,有回阳返本,起死回生之功;阳衰而阴竭者,合生脉饮阴阳两补。章次公先生治疗心衰尝用《冯氏锦囊》的全真一气汤,即参、附合麦冬、五味子、熟地、白术、怀牛膝。

Fuzi is very spicy and very Hot in herbal nature. It moves in all the 12 meridians. Its nature is as male strong, being able to warm the Yang Qi in all the organs. The cardiac insufficiency can be seen in pulmonary heart disease, rheumatic heart disease, coronary heart disease, etc. Mostly its nature is the heart Yang Qi insufficiency with blood stagnation and excess water accumulation, both of which cause symptoms. In clinic, patient with cardiac insufficiency has palpitation, sweat, cold hands and feet, short of breath, fatigue, pale face, purple color in nails or lips, compressing or bloating feeling in chest and belly, swelling in legs. In severe case, there could be excess water in the chest and belly or in whole body, difficulty in urination, deep and thin pulse or irregular pulse, pale tongue and white tongue cover. The herbal formulae used usually are Shen Fu Tang, Zhen Wu Tang, Guizhi Fuling Wan, Fangji Huangqi Tang, or their combinations. It works very fast. I have had a consultation in one military hospital for a patient with rheumatic heart disease with congestic heart failure. One dose of the herbal therapy worked for the main symptoms. After second dose, the patient could go down bed to walk. Dr. Fei-xia Han said: Renshen (ginseng) works to bring Yuan Qi into the body from “Somewhere”. It is the most powerful way of treatment by prestige nature. The black Fuzi works to restore the Yang Qi with its strong force nature. When used together in the treatment of heart failure, they help each other and cooperate each other. If the heart failure is severe, the dried ginger, or both the dried ginger and fresh ginger, must be used too. Without ginger, the Fuzi has no hot nature. When the Fuzi is accompanied by dried ginger and Gancao, it becomes the Si Ni Tang, the herbal formula of Master Zhongjing Zhang. When it is used in heart failure with vomit and diarrhea, it works to bring the Yang Qi back to the kidney so to save life. When the Yang Qi is deficiency with Yin exhaust, it would be used together with formula Shen Mai Yin, so to nourish and supply both the Yin and Yang the same time. Dr. Ci-Gong Zhang used Quan Zhen Yi Qi Tang from book <<Feng Shi Jin Nang>> for the treatment of heart failure. It contains Renshen (e.g. ginseng), Fuzi, Maidong, Wuweizi, Shoudi, white Zhu, Huai Niuxi.  

附子温肾阳,李时珍说附子是补下焦命门阳虚之药;《本草正义》说附子达下元而温痼冷,举凡肾阳不足,证见畏寒肢冷、尿频、口渴、不食,下利滑脱不禁,腰痛,阳痿、痛经诸证,皆可用附子。命火式微,火不暖土,常用右归丸;脾肾两虚可用附子配炒山药、人参、白术;虚寒痛经,常用小温经汤(附子、当归);消渴晚期阴损及阳,阴阳两虚时,渴极而凉润生津不效者,可用附子、肉桂。唐代王焘《外台秘要》以釜盖之干润作喻:譬如釜中有水,以火暖之,其釜盖若以板盖之,则暖气上腾,故板能润也,若无火力,水气则不上,此板终不可润也。至于肾阳衰惫,不能化气行水之水肿,则非真武汤不可为功。

The Fuzi works to warm up Kidney Yang. Dr. Shi-zhen Li said Fuzi “works to nourish the Yang deficiency in the Lower Jiao partion, and Ming Men region of the body”. In the book <<Ben Cao Zhen Yi>>, it stated that the Fuzi “goes to the Lower Yuan region and to warm up the old Cold there”.  The Fuzi can be used whenever there is Kidney Yang deficiency, and when the patient likes warm but hates cold, has frequent urination, thirsty, no appetite, slippery diarrhea, lower back pain, impotency, pain in menstruation, etc. When the Fire in the Ming Men (e.g. in the life gate region) is very weak, the Fire is not sufficient to warm the Soil, commonly use You Gui Wan (e.g. Right Returning Pills). In the Spleen- and Kidney-deficiency, the Fuzi can be used together with fried Shanyao, Renshen (ginseng), Baizhu. In painful menstruation due to weakness and Cold, commonly use Small Wen Jin Tang (Fuzi and Danggui). In the later stage of Xiaoke condition, when the Yin is exhausted so affects the Yang, the thirsty is very severe and the regular cool-wetness therapy does not work, use Fuzi and Rougui. In the book <<Wai Tai Mi Yao>>, Dr. Tao Wang (Tang dynasty) used the cover of a water-containing pot as example for the explanation: “As there is water in a pot. Warm it with fire and cover it with a pot cover, the warmed stream rises up, so the cover becomes wet. If there is no fire to warm, the water vapour does not rise, so the cover would not be wet.” As for the edema (swelling) in Kidney Yang deficiency, due to insufficient Fire that fails to push the Qi in circulation to transport the water, it would not be solved without the use of Zhen Wu Tang.    

《珍珠囊》说附子温暖脾胃,脾阳伤而下利不止,腹中冷痛,手足不温,脉沉迟者,理中汤加附子,即附子理中汤。我年轻时在农村作医生,经常遇到前来求救的因剧烈吐泻而亡阳的孩子,急用大剂附子配人参、干姜、干草、龙骨、牡蛎回阳固脱救逆,多能挽回。有一左姓老人,寒邪直中三阴,吐泻不已,神昏烦躁,扬手掷足,郑声喃喃,人或疑为阳证议用清下,我力阻之,盖六脉极沉微故也,用制附子24g,红人参10g,干姜15g,炙甘草6g,白术10g,龙骨、牡蛎各30g,一服而泻全止,酣然入睡,次日易方调理而安。《伤寒蕴要》说附子有通阴回阳之力,起死回生之功,信然。

In the book <<Zhen Zhu Nang>>, it states that the Fuzi warms up the Spleen and Kidney. When the Spleen Yang is hurt, there would be continuous diarrhea, cold pain in belly, cold hands and feet, and deep-slow pulse. In this case, use Li Zhong Tang plus Fuzi, e.g. Fuzi Li Zhong Tang. When I was young and worked in countryside as countryside doctor, I usually met children who were urgently sent to me. The children were with Yang exhaustion due to severe vomit and diarrhea. I used urgently large amount of Fuzi, together with Renshen, dried ginger, Gancao, Longgui and Muli to restore the Yang, to fix the slippery condition, and to retard the cold (shock condition). In most cases, it worked. There was a old man wih family name of Zuo. He had a condition, in which Cold Xie penetrated directly into the three Yin phases. He suffered from continuous vomit and diarrhea, loss of consciousness and restless, jumping hands and feet, random and no meaning speech. Some people considered it was a Yang condition and suggested to use colon-cleansing therapy. I strongly disagreed, because all the pulses were very deep and weak. I used Zhi Fuzi 24 g, Red Renshen 10g, Dried ginger 15 g, Zhi Gancao 6 g, Baizhu 10 g, Longgu 30 g, Muli 30 g. After one dose, the diarrhea stopped completely and he falled into sleep. Next day, the herbal formula was changed for a maintanence. In the book <<Shang Han Wen Yao>>, it said that Fuzi “has ability to bring back the Yang Qi and to save life”. I believe it.   

附子亦温肺阳、肝阳。肺阳虚则咳喘、咯痰清稀,背冷、形寒;肝阳虚则疲惫乏力,巅顶疼痛,胁肋少腹隐痛阴冷。前者可用附子合干姜、炙草,后者可用附子合肉桂、黄芪。

Fuzi also warms up the Lung Yang and Liver Yang. In the Lung Yang deficiency, the person will have asthma, cough with water-like phlegm, cold on back and chilly. In Liver Yang deficiency, the person feels chronic fatique, pain on the top of the head, mild pain in the upper side of the belly, and cold in the sexual organ area (perineum and groin regions).  For the former, it can be used the Fuzi plus dried ginger and Zhi Gancao. For the later, it can be used the Fuzi plus Rougui and Huangqi.

 

(四)

附子治,古方多用之,仲景桂枝附子汤治风湿相抟,一身尽痛,不能自转侧;桂枝芍药知母汤治历节疼痛,脚肿如脱,皆其范例。《汤液本草》说附子无所不至,味辛大热,为阳中之阳,故行而不止。痹证的病机是,附子走而不守,温经散寒,除湿通闭,实为痹证不可或缺之药,,痛甚附子合川乌、草乌、细辛,可增强散寒止痛之功,附子合桂枝则温经通脉的作用益佳。不仅风寒湿痹可用附子,即使风热湿痹舌红脉数者,也可在祛风、清热、燥湿利湿的基础上酌用小剂量附子以通闭解结。我治类风湿性关节炎、风湿性关节炎、肩关节周围炎、坐骨神经痛、腰椎间盘脱出、强直性脊柱炎等,就恒以大剂量附子、川乌同用。《千金方》独活寄生汤亦治痹名方,用以治疗风寒湿久羁之肩、腰、膝、腿痛,陈无择《三因方》说:如加附子,则其效益佳。

In the treatment of Bi syndrome (e.g. arthritis due to Wind, Cold, and Wetness in the joint or muscles), Fuzi is used commonly by doctors in old time. Master Zhongjing Zhang used Guizhi Fuzi Tang for the treatment of condition, in which the Wind and Wetness entangle together to cause pain in whole body, so that it is hard to turn over body; used Guizhi Shaoyao Zhimu Tang for the treatment of Li Jie Pain (severe pain in smaller joints) with heavy swelling in ankles. These are just some of the examples. In the book <<Tang Yi Jin Fa>>, it says that “Fuzi goes anywhere in the body. It is spicy and strong hot. It is the Yang herbs among the Yang, so it continuously goes without stop”.  The root cause for the Bi syndrome is “choking, block, stop, or close”. Fuzi is a very necessary herb to be used in the treatment of Bi syndrome, for its ability of continueing going but not staying, of warming the meridians and dispelling Cold, and of dispelling Wetness and conducting the block. If the pain is very severe, Fuzi will be used together with Chuan Wutou, Caowu, Xixing, to increase the ability to dispel Cold and the reduce pain. When the Fuzi is used together with Guizhi, the couple work much better to warm up meridian and to conduct the block. Not only in the Bi syndrome of Wind-Cold-Wetness type, is used the Fuzi, but also that of Wind-Hotness-Wetness type with red tongue and frequent pulse. In the later, small amount of Fuzi can be used with the major therapy of wind-dispelling, fire-clearing, and Wetness-dispersing, so to conduct the block and to solve the lumps. When I treat the rheumatoid arthritis, rheumatic arthritis, stiff shoulder syndrome, sciatic pain, lumber disc protrution, etc, I routinely use large amount of Fuzi together with Chuanwu. The herbal formula Duhuo Jisheng Tang in the book <<Qian Jin Fang>> is also a famours formula for the treatment of Bi syndrome. It is used for chronic Bi syndrome of Wind-Cold-Wetness style in the shoulder, lower back, knee, legs. Dr. Wuze Chen said in his book <<San Yin fang>> : if with the Fuzi added, it would work much better.  

 

(五)

或曰:川人喜用附子,是盆地多雨湿,地势使然。此不知附子,亦不知川人之言,仲景就是善用、倡用、多用附子的第一人。仲景用附子与干姜、甘草相配(四逆汤)而为回阳救逆第一方;与茯苓、白术、白芍、生姜相配(真武汤)治水肿;与人参、白术、茯苓、白芍相配(附子汤)温补元阳;与麻黄、细辛相配(麻黄附子细辛汤)温经发表;与白术等(桂枝附子去桂加白术汤)相配治风湿骨节烦疼(术附合用为除湿之圣药);与半夏、粳米、大枣、生姜配伍(附子粳米汤)温脾止泻;与大黄、细辛相配(大黄附子汤)温下寒积;与大黄、黄芩、黄连相配(附子泻心汤)扶阳消痞;与生地、阿胶、黄土、白术、甘草、黄芩相配(黄土汤)温脾止血;与薏苡仁、败酱草相配(薏苡附子败酱散)治肠痈;与乌梅、黄连、黄柏、川椒等相配(乌梅丸)治蛔厥及久利;与地黄、山茱萸、山药、丹皮、茯苓、泽泻、桂枝相配(肾气丸)而为补肾祖方。可以说他已经把附子之用发挥到极致了,而仲景并非川人。

It is said that the reason for the doctors in the Sichuan province liking to use the Fuzi is because the Sichuan is a basin-like geographic environment with rich rain and wetness. The people who said so actually do not how the people who live in the Sichun say. Dr. Zhongjing Zhang is the first one who is very good at using the Fuzi, strongly recommends to use the Fuzi, and uses Fuzi very common. But he is not from Sichuan province. He used Fuzi with dired ginger and Gancao (e.g. the Si Ni Tang), which is the first and the most important herbal formula to save the Yang Qi in the body. He used Fuling, Baizhu, Baizhao and fresh ginger (e.g. the Zhen Wu Tang) to treat edema; used  with Renshen, Baizhu, Fuling and Baishao (e.g. the Fuzi Tang) to warm up Yuan Yang; used with Mahuang and Xixing (e.g. the Mahuang Fuzi Xixing Tang) to warm meridian and to release body surface; with Baizhu and other herbs (e.g. Guizhi Fuzi without Guizhi but with Baizhu Tang) to treat joint pain due to Wind and Wetness (the couple of Fuzi and Baizhu is excellent pare herbs to dispel Wetness); with Banxia, Genmi, Chinese date and fresh ginger (e.g. Fuzi Genmi Tang) to warm up Spleen and to stop diarrhea; with Dahuang and Xixin (e.g. the Dahuang Fuzi Tang) to warm the lower part of the body and to dispel old Cold in the lower part of the body; with Dahuang, Huangqin and Huanglian (e.g. the Fuzi Xiexin Tang) to support the Yang and to melt away bloating; with Shengdi, Ajiao, yellow soil, Baizhu, Gancao, Huangqin (e.g. Yellow Soil Tang) to warm Spleen and to stop bleeding; with Yiyiren and Baijiangcao (e.g. Yiyi Fuzi Baijiang San) to treat intestine carbuncle; with Wumei, Huanglian, Huangbo, and Chuan Jiao (e.g. Wumei Wan) to treat reversing developing cold in hands and feet due to roundworm and chronic diarehea; with Dihuang, Shanzhuyu, Shanyao, Danpi, Fuling, Zexie and Guizhi (e.g. Shen Qi Wan), which is the mother formula to nourish the Kidney system. It can be said that, Master Zhongjing Zhang used Fuzi to a great extreme level.

仲景之后,附子的临床应用更加广泛,如:《古今录验》以附子与麻黄、桂枝、丹参、人参、防风、杏仁、防己、黄芩、生地、甘草相配(小续命汤)治风寒历节痛不可忍,腰痛背痛不可转侧,昼静夜剧。《千金方》以附子配细辛、防风、干姜、山茱萸、茯苓(三五七散)治大寒中于风腑,头痛项筋紧急。《近效方》以附子配白术、甘草、大枣、生姜(术附汤)治风虚头重眩晕。《肘后方》以附子配天雄、川乌(三建汤)治元阳素虚,寒邪外入,厥后脉沉。《太平圣惠方》以附子配独活、牛膝、桂心、川芎、赤芍、当归、桃仁(独活散)治冷滞风气攻刺,肢体疼痛。

After the time of Master Zhongjing Zhang, the use of Fuzi was much popular. For example, in book <<Gu Jin Lu Yan>>, the Fuzi is used with Mahuang, Guizhi, Danshen, Renshen, Fangfeng, Xingren, Fangji, Huangqin, Shengdi, and Gancao (e.g. the Small Xu Ming Tang) to treat painful joint due to Wind and Cold, lower back pain and back pain that prevent free turning of the body, and which was less in the daytime but worse at night. In book <<Qian Jin Fang>>, Fuzi is used with Xixin, Fangfeng, dried ginger, Shanzhuyu, and Fuling (e.g. the Three Five and Seven San) to treat big Cold in the Wing organ (the liver), in which the person feels very much head ache and tightness in the neck. In book <<Jin Xiao Fang>>, the Fuzi is used with Baizhu, Gancao, Chinese date and fresh ginger (e.g. the Zhu Fu Tang), to treat heavy feeling in head and dizziness due to Wind and weakness condition. In book <<Zhou Hou Fang>>, the Fuzi is used with Tianxiong, Chuanwu (the Three Jian Tang) to treat Yuan Yang weakness with external Cold invasion into the body, in which condition the person feels reversing cold in hands and feet and has deep pulse. In book <<Tai Ping Sheng Hui Fang>>, Fuzi is used with Duhuo, Niuxi, Guixing, Chuanxiong, Chishao, Danggui and Taoren (e.g. the Duhuo Tang) to treat pain in the arms and legs due to Cold stagnation in the muscle.

《三因方》以附子配干姜、甘草、人参、芍药、茯苓、桂心、白术(附子八物汤)治历节四肢疼痛,如槌锻不可忍。《局方》以附子配草乌、全蝎、天麻、苍术、胡桃肉(善肾散)治肾气虚损,腰脚骨节疼痛,膝胫不能屈伸;配鹿茸、肉苁蓉、人参、熟地、肉桂、石斛、五味子、黄_、茯苓、白芍、白术、半夏、甘草(鹿茸大补汤)治孕妇诸虚不足;配人参、干姜、甘草、肉桂、吴茱萸、麦芽、神曲、枳实、桔梗、细辛(大温脾丸)治脾胃虚寒,饮食不化,食少伤多。《赤水玄珠》以生附子、生半夏、生姜相配(三生饮)治痰眩。《张氏医通》以附子配白果、橘红、生姜、甘草(冷香饮子)治夏月中寒,腹痛吐泻。《医学心悟》以附子配干姜、白术、甘草、茵陈(茵陈术附汤)治阴黄。

In book <<San Yin Fang>>, Fuzi is used with dried ginger, Gancao, Renshen, Shaoyao, Fuling, Guixing, and Baizhu (e.g. the Fuzi Ba Wu Tang), to treat multiple joint pain, in which the pain is very severe as beat by hammer. In book <<Ju Fang>>, Fuzi is used with Caowu, Quan Xie, Tianma, Cangzhu, and Hutaorou (e.g. Shan Shen San) to treat kidness deficiency, in which the person has pian in lowaer back, feet, and joints, the knee could not bend. The Fuzi is also used with Lurong, Roucongrong, Renshen, Shoudi, Rougui, Shihu, Wuweizi, Huangqi, Fuling, Baishao, Baizhu, Banxia, and Gancao (the Lu Rong Da Bu Tang) to treat various weakness conditions in pregnant women. It is used with Renshen, dried ginger, Gancao, Rougui, Wuzhuyu, Maiya, Shenqu, Zhishi, Jiegen, and Xixin (e.g. the Da Wen Pi Wan) to treat weakness and cold condition in Spleen and Stomach, in which the person feels poor digestion, eat less. In book <<Chi Shui Xuan Zhu>>, Fuzi is used with Banxia and fresh ginger (e.g. the Three Sheng Yin) to treat phlegm caused dizziness. In book <<Zhang Shi Yi Tong>>, Fuzi is uses with Baiguo, Juhong, fresh ginger, and Gancao (the Len Xiang Yin Zi) to treat Cold-attack in summer season, in which the person feels belly pain, and has vomit and diarrhea. In book <<Yi Xue Xin Wu>>, Fuzi is used with dried ginger, Baizhu, Gancao and Yinchen (Yin Chen Zhu Fu Tang) to treat Yin Jaundice.

以上名方,不过随手写来,已是挂一漏万,然从唐宋一直到明清,从官修方书到个人著作,从中可见附子之用广矣哉!近贤祝味菊更用附子配枣仁,治心动过速及期前收缩(早搏);配知母,治热病口渴欲饮而心阳不振;配磁石,治神经衰弱之失眠。姜春华先生认为许多慢性疑难杂病,特别是许多慢性炎症用常法清热解毒不效,原因即在于久病体虚而湿热火毒病邪不解,他从仲景乌梅丸、薏苡附子败酱散诸方得到启发,打破常规,温清并用,补泻兼施,体病同治,如他治白塞氏病,用附子配党参、黄_、甘草、淫羊藿、黄连、黄芩、丹皮、蒲公英、半枝莲而效,即其范例。

The famous formulae above are just some of the examples in the literatures that can be cited very easy from the books. In fact, from Tang dynasty and Song dynasty to the Ming dynasty and Qing dynasty, from the government-organized editions to private auther books, there are lots of formulae that involve the use of the Fuzi. Dr. Wei-ju Zhu in recent times used Fuzi with Chinese date kernel to treat over beat of heart and also premature entricular contractions. He also used the Fuzi with Zhimu to treat thirsty with desire to drink in fever disease and with Heart Yang weakness; with Cishi to treat poor sleep due to neurosism. Dr. Chun-hua Jiang believed that for many chronic diseases, especially many chronic inflammative diseases, when they are not well solved with regular Fire-clearing and toxic-dispelling, the reason for it would be the accumulation of the Wetness-hotness and Fire toxic in the weak body. He got idea from the Wumei Wan and Yiyi Fuzi Baijiang San in the book <<Shang Han Lun>>, created the use of Fire-clearing and Warming therapy at the same time, and dispelling and nourishing the same time. For example when he treated the Behcet’s disease, he used Fuzi with Dangshen, Huangqi, Gancao, Yinyanghuo, Huanglian, Huangqin, Danpi, Pugongying, and Banzhilian.

我用附子也薄有体会。除前已述及者外,肾著,用甘姜苓术汤加附子,其效更捷;肩关节周围炎,我常用黄_、当归、白术、淫羊藿、威灵仙、希莶草、桂枝、姜黄、海桐皮,然必重用附子,否则不效;虚人易感,用玉屏风散加附子、姜、枣;急性肾炎初起,畏寒、无汗、水肿,用麻黄附子细辛汤;慢性肾炎水肿,用真武汤、实脾饮,皆以附子为主药;久泻不止、五更泻、老人大小便失禁,用理中合四神再加肉桂、附子温补命火;口腔溃疡用凉药不效者,多为阴盛阳浮,可用姜附剂破阴回阳,必阴霾去而火始安其位;慢性咽炎,用附子一片蜜炙,切成小块含咽;痛经寒症居十之七八,则用附子合当归。

I have also my own experience in the use of Fuzi. Beside the herbal formulae above, in the Shen Zhe syndrome, I use Gan Jiang Ling Zhu Tang plus Fuzi, which works much faster. For freezing should syndrome, I usually use Huangqi, Danggui, Baizhu, Yinyanghuo, Weilingxian, Xiqiancao, Guizhi, Jianghuang and Haitongpi. However, the Fuzi must be used in large amount, otherwise it would not work. Weak person is easy to catch cold. I use Yu Ping Feng San plus Fuzi, ginger, and Chinese dates. For the early stage of acute nephritis, when the person feels cold-disliking, no sweat, and edema, I use Mahuang Fuzi Xixing Tang, for chronic nephritis, I use Zhen Wu Tang and Shi Pi Yin, both of which use Fuzi as the main ingredient. For chronic diarrhea, early morning diarrhea, incontinence of urine and stool in elderly, I use Li Zhong Tang plus Si Shen Wan with Rougui and Fuzi to warm and nourish the Life Gate. For mouth ulcer, when it is hard be solved with cold herbs, it most possiblly belongs to the Yin excess but Yang floating condition. It can be solved by the use of Fuzi- and ginger-containing herbal formulae to break the Yin and to restore the Yang. Yin Qi would be dispelled away and the Fire would go back to its origin. For chronic pharyngitis, take one piece of Fuzi, processes it with honey, cut into a small slide and chew it in mouth. For painful menstruation, seven or eight out of ten cases are due to Cold condition in the meridian. Use Fuzi and Danggui together to solve it.

综合古今用附子的经验和我的粗浅体会,附子一物,可上可下,可攻可补,可寒可热,可行可止,可内可外,随其配伍之异而变化无穷,用之得当,疗效卓著,在群药中具有不可替代的作用,说它是百药之长,是并不过分的。

 Combined the experience in the use of Fuzi by other doctors in history and my own, it can be said that, Fuzi can travel in the body everywhere, up and down, inside and outside, can dispel and can nourish, can create hot and cold, can move and stop. The healing effect varies very much with the use of other herbs the same time. If it is used in a proper way, the healing effect is excellent, with a role that can not be replaced by other herbs. It is not overstated that it is the most important herb among the Chinese herbs.

(六)

附子的用量,向来争议很大。仲景方用附子一枚,炮,破八片,则每帖约60g,附子质量,一大片即6-8g,曰,则为生附子,其力更大。所以当用附子时,不必畏忌,初用10-15g,如无问题,完全可以续增至30g以上。

It is in a great argument about how much the Fuzi should be used in a formula. When Maste Zhongjing Zhang used the Fuzi, the one Fuzi is to be processed, choped into 8 slides. It would be about 60 grams in each dose (one day amount). Each slide weights about 6 – 8 grams, e.g. the processed Fuzi. If it is not processed, its healing power is much great. When use the Fuzi, no need to worry side effect, if the initial dose is 10-15 grams. If there is no side effect, it can be increased more than 30 grams. 

我治痹证,阳虚畏寒,用量均在30g以上,屡遭药房拒配,不得不郑重签字,但也有签字后仍不配的时候。我曾治张某类风湿性关节炎,每剂用附子30g,药房拒配,医生也不愿抄方,好在他在海淀药房有个亲戚,这才取了,共服百余剂而愈,前后用附子十几斤。又治孙某的寒湿痹,每付用附子30g,不应,增至60g,他为省事,两付药一起煮,则其用量实为120g矣。我不是说剂量愈大愈好,但对大证、重证,如仅用数克,则无异于隔靴搔痒,不能解决问题。

When I treated the Bi syndrome with Yang deficiency and cold-dislike feeling, the Fuzi is usually more than 30grams. My prescription is again and again returned by herbal shop. I had to seriously sign on the prescription with my signature. But it still happened that the herbal shop refused my prescription. I treated Mr. Zhang with rheumatoid arthritis before. The Fuzi in each dose is 30 g. The herbal shop refused to sell the herbs and the doctor did not want to write a copy of my prescription (for their own record). It was lucky that Mr. Zhang had a relatives in one of the herbal shop in another community of the city, where he got the whole herbs. I continued about hundred of doses for his treatment. Totally it consumed about tens of pounds of Fuzi. In another case for patient Song with Cold-Wetness Bi syndrome, I used Fuzi 30 grams in each dose. The illness had no response to the herbal therapy. I increased the Fuzi to 60 g. For time saving and for convenience, he had the two doses cooked in the same pot the same time. The actual abount of Fuzi was 120grams. I do not mean that the more the amount of Fuzi, the better the healing effect. However, for severe cases, and for life-threantening cases, if the Fuzi used is only several grams, it would be as to scratch off the itch from out of the boots. It does not work at all.

附子须先煎,小剂量(9g左右)先煎半小时,中等剂量(15g左右)先煎1小时,大剂量(30g以上)先煎2小时,头煎如此,二煎小火煮40分钟即可。煎附子时加生姜一块(约30g,拍破)、蜂蜜1两更好,可以减低附子的毒性。

Fuzi must be boiled in water before addition of any other herbs. For small dose (about 9 g), pre-cook it for half hour; for middle dose (15 g about), pre-cook for one hour; and for large amount (mor than 30 g), pre-cook it for two hours. This is for the first cook of the herbs. For the second cook, cook the whole herbs with mild fire fore about 40 min. It would be better to add fresh one ginger (about 30 g, press it to broken), and honey 30 ml, the same time when cooking the Fuzi.

用附子不会蓄积中毒,沈阳有位强直性脊柱炎患者,至今服药400剂以上,每方皆重用附子至30g,共用附子数十斤矣,从初诊起到现在一直坚持上班工作,已基本痊愈。

The use of Fuzi would not cause accumulated toxic reaction. There was a patient in the Shen-yang city, China, with ankylosing spondylitis. The patient took the Fuzi-containing herbal therapy for more than 400 doses. It contained Fuzi more than 30 grams in each dose. Totally it has consumed tens pounds of Fuzi. From the beginning of the treatment up to now, the patient continued work and has got cured.

古有乌头反半夏、栝楼、贝母、白芨、白蔹之说,为十八反的一组药,但没有说半夏、栝楼等反附子。川乌系附子的母头,但这是两味药,如说附子也反半夏、栝楼等,便是株连了。何况乌头半夏同用,在医圣张仲景已开先河。

In history, it has a saying that functionally, Fuzi is toxic-enhancing against the herb Wutou (Wutou and Fuzi are from the root of the same plant. The Wutou is the main stem of the root, while the Fuzi is the branch root of it), Gualu, Beimu, Baiji and Baijian. They are one of the toxic-enhancing couples among the herbal family. But it did not say that Fuzi is also against the Banxia and Guolu, etc. The Chuan Wutou is the mother part of the Fuzi, but in Chinese herbal therapy, they are two different herbs. If we say that the Fuzi is against the Banxia and Gualu, since its mother Wutou is against these herbs, it is “wrong involving” the Fuzi and Wutou. In addition, and in fact, Maste Zhongjing Zhang had already used the Wutou and Banxia in his herbal formulae (see bellow).

半夏、附子同用的机会很多,如果要我证明,我可以举出古今100个以上的医案医方来作证。有一次我处方里半夏、附子同用,某药店的药工一看处方,大为不屑,说这是哪儿的江湖医生开的方?连常识都不懂。我听了,不生气,只是苦笑。当代名医姜春华、朱良春、颜德馨诸先生都曾郑重地撰文驳斥过半夏反附子之说,读者诸君有兴趣的不妨找来看看。

There are many chances, in which the Fuzi and Banxia are used together in the same herbal formulae. If you want me give you example, I can list more than 100 formulae that have been listed in the case reports and in the books in history. One time, I have had the Fuzi and Banxia in the same formula. A herbal shop staff looked at my formula slightingly and said that, which low level doctor prescribed a formula as such? He knew nothing about Chinese herbal therapy! I heard it but I did not get angry but smiled wryly. Famous doctors in current times, such as Dr. Chun-hua Jiang, Liang-chun Zhu, and De-xing Yan, all have seriously wrote articles to argue against the saying that the Fuzi is toxic-enhancing with the Banxia and Gualu. If the readers are interested, you can find these articles to have a read.  

 

 

13.   附子何辜

13. What’s wrong with Fuzi?

 

有病消渴 (非糖尿病,尿崩症待排除)者来诊,思量再三,为拟清上、安中、温下方,分别以天花粉、山药、附子三味药为主药,这张处方的底子,便是张仲景《金匮要略?消渴小便不利淋病脉证并治》篇的栝楼瞿麦丸(栝楼根、茯苓、山药、附子、瞿麦)。患者到了药店,立遭拒配。药师说:附子和天花粉是反药!我听了哭笑不得,过去只遇到过附子和半夏同用遭拒配的事,当时我就指出过,传统的十八反半蒌贝蔹芨攻乌中乌是乌头,乌头与附子虽然关系密切但是却是两味药,性味主治亦不相同。如麻黄与麻黄根一样,一个辛温发汗,一个凉涩止汗,能说它们是同一味药,只是部位不同吗?

One day I have a patient who suffered from Xiao Ke disease (The patient felt very thirsty, but it was not due to diabetes. It was unknown if it was insipidus). After consideration again and again, I prescribed a herbal formula to clear the upper part, to calm the middle and to warm up the lower part of the body. The formula contained Tianhuafeng, Shanyao and Fuzi as the three main ingredients. The basic structure of this formula is just the herbal formula Guolu Jumai Wan that is introduced in the chapter of the diagnosis and treatment of thirsty, difficulty in urination, and infection in urinary system in the book <<Jin Kui Yao Luo>>by Master Zhongjing Zhang. This formula contains Gualu root (e.g. Tianhuafeng), Fuling, Shanyao, Fuzi and Jumai. The patient went to the herbal shop. The staff there refused to sell herbs to him. The staff said: “The Fuzi and Tianhuafeng conflict each other!” When I heard this, I felt at a loss whether to cry or to laugh. I had had experience my prescription was refused because it contained Fuzi and Banxia. At that time, I had had pointed out that, in the traditional “18 toxic-enhancing pairs of herbs”, the Wutou was said to be conflict with Banxia, and so on, but not Fuzi with Banxia. Though there is close relationship between the Wutou and Fuzi, but they are totally different herbs for their names and for their herbal natures. For example, herb Mahuang and the its root, one is spicy-warm to stimulate sweat, and another is cold-astringent to stop sweat. Can we say that they are the same herb but from different part of the same plant?

1997年,我曾写过一篇题为《为十八反平反》的文章,对十八反提出质疑,后来此文载在《朱良春用药经验集》(湖南科技出版社,1998)一书中,看来有很多读者未能看到它,我因此将其附于本文之末,一并与同道探讨。

In 1977, I wrote an article titled <<Redress for the 18 toxic-enhancing herbal pairs>>. I proposed the doubt for the toxic-enhancing relationships between 18 pairs of herbs. It has been published in the book <<The clinic experience of Dr. Liang-chun Zhu>> (Hu-nan publisher, 1998). It appeared that many readers did not read it, so I cited it here to share my opinion with my colleagues.

附:《为十八反平反》

Appendix: <<Redress for the 18 toxic-enhancing herbal pairs>>

药有相反,其说始见于《神农本草经.例》(原书早佚,现行本为后世从历代本草书中所辑出者)。五代时韩保升《蜀本草》指出:相反者十八种,当为十八反说的蓝本。迨至金代,张元素《珍珠囊补遗药性赋》将十八反以及十九畏编成歌诀广为流传,相沿至今。千百年来,父以传子,师以授徒,药房见有反药,则拒绝配药。若干有反药的良方被束之高阁。至于医生因用反药而负屈含冤者,古往今来,更不知凡几!尤有甚焉,十八反之外,还有株连:笔者一次处方中半夏与附子同用,患者去市内药店配药,药工一看,面露鄙夷地说:医生连半夏反附子都不知道么?这应该是常识。附子乃附生于川乌者,半夏反附子,便是因母而牵连到子了,这不是株连扩大化是什么?

That there is toxic-enhancing relationship between herbs is seen first in the book <<Shen Non Ben Cao Jing – Preface>> (The original book is not available. The current edition is cited from various other herbal therapy books by later doctors). Dr. Bao-shen Han, the Five-dynasty time in China, pointed out in his book <<Shu Ben Cao>>: “There are 18 toxic-enhancing herbal pairs”. This might be the original source of the “18 toxic-enhancing theory”. Upon the Jin dynasty, Dr. Yuan-su Zhang, in his book <<Zhen Zhu Nang Bu Yi, Yao Xing Fu>>, edited the “18 toxic-enhancing pairs of herbs” and “19 effect-reducing pairs of herbs” into mnemonics to spread popularly, which are still used in current times. For thousands of years, the mnemonics passed from father to son, from master to student. In herb shops, once the staff sees a formula that contains such “toxic-enhancing herbal pair”, the staff would refuse to sell the herbs. Therefore, some very good herbal formulae are no longer be used since they contain such “toxic-enhancing herbal pair”. In addition, there are quite a few cases in history, in which doctors were put in jail for their medical accidents, in which patients were hurt and the herbal formula used contained the “toxic-enhancing herbal pairs”. Much worse is that, beside the “18 toxic-enhancing herbal pairs”, there is “implicating case”: one day, I had Banxia and Fuzi in the same formula. The patient brought it to a herbal shop to purchase the herbs. The staff in the shop looked and said distainfully: How the doctor does not know the Banxia conflicts against the Fuzi? It is a common sense!” The Fuzi grows attaching to the Wutou. To say that the Banxia conflicts against the Fuzi because it does so against Wutou is as the fault of mother passing down to the son (e.g. the son is involved and blaimed because his mother’s fault). How can you say that this is not a “wrong involvement”?

 

对此,我们先不妨看一看前人的论述。

For this discussion, let us have a review how the doctors in history said.

处方中用反药者,首推汉代医圣张仲景,《金匮要略?痰饮篇》之甘遂半夏汤(甘遂、半夏、芍药、甘草、蜜),甘遂和甘草同用;同书《腹满寒疝宿食病篇》之赤丸(茯苓、细辛、乌头、半夏),乌头与半夏同用。

It is the Master Zhongjing Zhang, Han dynasty, China, who first used the toxic-enhancing herbal pair in his formula. In the Phlegm and Wanter chapter of book <<Jin Kui Yao Luo>>, in the formula Gansui Banxia Tang (ingredients: Gansui, Banxia, Shaoyao, Gancao, Fengmi), the Gansui and Gancao are used in the same formula. In the Chapter of Belly bloating, hernia, stored old food, in the same book, the formula Chi Wan contains Fuling, Xixing, Wutou and Banxia. Here, the Wutou and Banxia are used in the same formula.

唐代有药王之称的孙思邈。在其两部《千金方》中用反药的处方乃多达数十方,如《千金要方》卷七之风缓汤,乌头与半夏同用;大八风散,乌头与白蔹同用;卷十茯苓丸,大戟与甘草同用;卷十八大五饮丸既有人参、苦参与藜芦同用,又有甘遂、大戟、芫花与甘草同用,皆其例也。

Dr. Si-miao Sun in the Tang dynasty, China, is called “Herb King”. In his book <<Qian Jin Fang>>, there are more than ten formulae that contain the toxic-enhancing herbal pairs. For example in the Chapter seven, in the book <<Qian Jin Yao Fang>>, the Feng Huan Tang contains both Wutou and Banxia. The formula Big Wind Powder contains Wutou and Baiji. In Chapter 10, the Fuling Pill contains Daji and Gancao. In Chapter 18, the formula Big Five Yin Pill contains Renshen (ginseng), Kushen and Lilu; Gansui, Daji, Yuanhua and Gancao. All are examples.

宋代官方颁布推行的《局方》,其润体丸、乌犀丸二方皆川乌与半夏同用。陈无择《三因方》卷十四大豆汤,甘草与甘遂同用。许叔微《本事方》星附散、趁痛丸二方皆半夏与川乌同用。

In the Song dynasty, China, the government published book <<Ju Fang>>, in which in the Rongti Pill and Wuxi Pill, the Chuan Wutou and Banxia are used in the same time. Dr. Wu-ze Chen in his book <<San Yin Fang>>, in the chapter 14, introduced formula Dadou Tang that contains Gancao and Gansui. In the book <<Ben Shi Fang>>, Dr. Shu-wei Xu used Xing Fu Powder and Chen Tong Pill, both contain Banxia and Chuan Wutou.

金代李东垣散肿溃坚汤海藻与甘草同用。

In the Jin dynasty, China, Dr. Dong-yuan Li used Haizao and Gancao in his San Zhong Kui Jian Tang.

元代朱丹溪《脉因证治》莲心散芫花与甘草同用。

In Yuan dynasty, Dr. Dan-xi Zhu used Yuanhua and Gancao in his formula Lianxing Powder, which is introduced in his book <<Mai Yin Zheng Zhi>>.

明代吴昆《医方考》卷一通顶散,人参、细辛与藜芦同用。陈实功《外科正宗》海藻玉壶汤海藻与甘草同用(此方后来载入吴谦等编《医宗金鉴》中)

In Ming dynasty, in volume I of book <<Yi Fang Kao>>, Renshen (ginseng) and Xixin are used with Lilu in the same formula Tong Ding Powder. Dr. Shi-gong Chen, in the book <<Wai Ke Zheng Zong>>, used Haizao Yu Hu Tang, in which the Haizao and Gancao are used together. This formula has been included in the book <<Yi Zong Jin Jian>> (edited by Dr. Qian Wu).

清代余听鸿《外证医案汇编》辑录名家方案,其中瘰历门亦有用海藻甘草者。

In Qing dynasty, Dr. Ting-hong Yu edited book <<Wai Zheng Yi An Hui Bian>>, in which he included formulae and case reports of many famous doctors, and in which in the chapter of Lei Li Men, the Haizao and Gancao were used the same time.

以上例子,不过信手拈来,汉、唐、宋、金、元、明、清皆有了,可见所谓反药也者,古人立方,每每有之(余听鸿语)

The examples above are simply cited by random choose. They are cited from literatures from the Han, Tang, Song, Jin, Yuan, Ming and Qing dynasties. Apparently, the so called “toxic-enhancing herbal pairs” were used by doctors in history again and again.

那么,前人于此持什么态度呢?一种意见是:既有成说,不如不用为好。如陶宏景说:凡于旧方用药,亦有相恶相反者,如仙方甘草丸,有防己、细辛;俗方玉石散,用栝楼、干姜之类,服之乃不为害,或有将制者也,譬如寇贾辅汉,程周佐吴,大体既正,不得以私情为害。虽尔,不如不用尤良。(原书佚,转引自《本草纲目》)

It would be interested to know how the doctors in old times thought about such “toxic-enhancing herbal pairs”? One opinion is: it is better not to use them, since there are such comments (for the toxic-enhancing relationship between herbs). For example, Dr. Hong-jing Tao said: “In the formulae used in old times, there were toxic-enhancing herbal pairs, such as in the Xian Fang Gancao Tang, in which the Fangji and Xixin were used together; in Yu Shi Powder, in which the Gualu and dried ginger were used together. They were used without side effects. It might be due to some herbal preparation processes that prevented or eliminated the side effects. Once the overall healing effect of the herbal formula is fine, the effect of a given herb might not cause clear side effect. Though it can be predicted and explained as such, it might be better not to use these toxic-enhancing pairs.” (This book is not available. The texts were cited form book <<Ben Cao Gang Mu>>).

另一种意见是:贤者用得,昧者用不得。如虞抟说:其为性相反者,各怀酷毒,如两军相敌,决不与之同队也。虽然,外有大毒之疾,必用大毒之药以攻之,又不可以常理论也。如古方感应丸用巴豆、牵牛同剂,以为攻坚积药,四物汤加人参、五灵脂辈,以治血块。丹溪治尸瘵二十四味莲心散,以甘草、芫花同剂,而谓好处在此。是盖贤者真知灼见方可用之,昧者固不可妄试以杀人也。夫用药如用兵,善用者置之死地而后成,若韩信行背水阵也;不善者徒取灭亡之祸耳,可不慎哉。

Another opinion is: A doctor who is wisdom in herbal therapy can use such toxic-enhancing herbal pairs, other wise not. For example, Dr. Zhuan Yu said: “The herbs in the toxic-enhancing pairs contain toxic or poison nature. Such as the army and its enemy meets on the war field, it is impossible that they would stand in the same team. Although a severe external toxic disease needs high toxic herbs to solve it, it should not be treated as such for every case as a rule. For example, the old herbal formula Ganying Pill uses Badou and Qianniuzi the same time, as said to dissolve hard mass and the Si Wu Tang uses Renshen and Wulingzhi to solve blood clot accumulation. There is a herbal formula called “24 ingredient Lian Xing Powder” to treat tuberculosis, in which Gancao and Yuanhua are used together. It is said good to solve tuberculosis with such pair present in the same formula. For doctors with wisdom in herbal therapy, they can use the herbs in a smart way and effective way. However, a ordinary herbalist who is not good the understanding of the herb nature should not try with less precausion.  

再一种是李时珍的意见,他说:古方多有用相恶相反者。盖相须相使用同者,帝道也;相畏相杀同用者,王道也。(注:这里的相畏,是依《本经名例》:有毒者宜制,可用相畏相杀者与后世十九畏完全不同);相恶相反同用者,霸道也。有经有权,在用者识悟耳。他还指出:胡冶居土治痰僻,以十枣汤加甘草、大黄,乃是痰在上,欲令通泄以拔去病根也。东垣李杲治颈下结核,海藻溃坚汤,加海藻;丹溪朱震亨治劳瘵莲心饮,用芫花,二方皆有甘草,皆本胡居士之意也。故陶弘景言古方亦有相恶相反,并乃不为害。非妙达精微者,不能知此理。他的意思是说,用者能够妙达精微,有所识悟,还是可以用的,不过需要特别慎重而已。以上这三种意见,应该是有一定的代表性的。

Another opinion is that of Famous doctor, Dr. Shi-zhen Li. He said: “There are herbal formulae in old times, which used the toxic-enhancing herbal pairs in the same formula. If the herbal formula contains herbs that helps each other or that have similar healing effects, it belongs to popular use. If an herbal formula caontain herbs that may reduce the effect each other partially or completely, the use of such herbal formula needs quite kind of wisdom. If an herbal formula contains herbs that have toxic-enhancing or opposite effect, the use of the formula needs very much brave. Whether to use such herbal formulae depends on the knowledge and experience of the users.” He also pointed out that when treat phlegm-formed lump/mass, Lay Buddhist Ye Hu used Ten Chinese Date Tang with addition of Gancao and Dahuang. It is for the reason that the phlegm is in above the diaphragm, the herb Dahuang is used to deplete the phlegm from the stool. In the treatment of tuberculosis on the neck, Dr. Dong-yuan Li used HaizaoKui Jian Tang with addition of Haizao in it. In the treatment of tuberculosis, Dr. Dan-xi Zhu used Lao Ji Lian Xing Yin, in which the herb Yuanhua was used. In both the herbal formulae, there were herb Gancao, which followed the idea of Lay Buddhist Hu. For this, Dr. Hong-jing Tao stated that “In the old herbal formulae, there were herbs which were toxic-enhancing each other in herbal effect but they did not cause side effects. Only those who really understand the nature of the herbs could understand how to organize them in the same formula.” What he means is that, such toxic-enhancing herbs can be used, but need causion, if the user really understands the fine nature of the herbs. The three opinions above should be with some representative. 

对于十八反的问题,朱良春老先生曾多次向吾侪道及:

For the 18 toxic-enhancing herbal pairs, Dr. Liang-chun Zhu mentioned to us many times about his own opinion:

- 我从来都是有斯症用斯药,当用则用,不受十八反十九畏之类成说的约束。临床六十年来,海藻与甘草同用治颈淋巴结核、单纯性及地方性甲状腺肿大、肿瘤;人参(党参)与五灵脂同用治慢性萎缩性胃炎、胃及十二指肠溃疡;海藻、甘遂与甘草同用治疗胸水、渗出性胸膜炎,皆效果甚佳而未见任何毒副作用。

I always use the herbs if the clinic condition is indicating the use of them, independent of the theory of “18  toxic-enhancing relationships of herbs” or “19 healing effect-reducing herb pairs”. For my past 60 years of clinic, I used Haizao and Gancao for the treatment of neck lymphatic tuberculosis, simple goiter, iodine deficiency disorders, thyroid tumor; used Renshen (or Dangshen) with Wulingzhi for the treatment of chronic atrophic gastrititis, gastric ulcer, duodenal ulcer; used Haizai, Gansui with Gancao for the treatment of pleural effusion, exudative pleurisy. The healing effects are excellent and no any side effects or toxic effects were noticed.

- 十八反之说,本身就有很多可商之处。如人参、苦参、丹参、沙参等反藜芦,四种药虽皆以为名,而众所周知,其功能性味主治各异,岂有一沾上之名,便皆反藜芦之理?又,海藻与昆布性味主治皆相同,常常二者同用,为何甘草只反海藻不反昆布?

The theory of the “18 toxic-enhancing herbal pairs” per se is with many questions. For example that the herb Renshen, Kushen, Danshen, and Sharen is conflicting with Lilu, the four herbs, though with name of “shen”, are quite different for their healing effects, herbal tastes and oders. How could be that, once there is name of “shen”, they would be conflicting with herb Lilu? Again, the Haizao and Kunbu are sharing the same nature of herbs, and the same healing effects, and they are used commonly in the same formula, how the Gancao is only conflicting against the Haizao but no Kunbu? 

- 十八反为何相反? 即其相反的道理是什么?古今皆没有一个说法。只能说是古人的实践经验,很可能是古人在实践中把偶然当作了必然。要说实践经验,那么,前述从汉代张仲景,唐代孙思邈,宋代陈无择、许叔微,金元李东垣、朱丹溪,明代陈实功,清代余听鸿等记载的又是不是实践经验?

Why the herbs in the 18 toxic-enhancing pairs are conflicting? That is, what is the reason for them to be conflicting? It is not clearly stated from history. It might be only a practice experience of doctors in old time. Most possibly, it is the doctors in old time, who made the occasional phenomenon as a necessity. If it is a practice summary, how can we say the documents from those of doctors in old times are not from practice, such as Dr. Zhongjing Zhang (Han dynasty), Dr. Si-miao Sun (Tang dynasty), Dr. Wu-ze Chen (Song dynasty), Dr. Shu-wei Xu (Song Dynasty), Dr. Dong-yuan Li (Jin Dynastry), Dr. Dan-xi Zhu (Jin Dynasty), Dr. Shi-gong Chen (Ming Dynasty)?  

- 十八反的三组药中,芫花、大戟、甘遂、乌头(川草乌)、藜芦皆有毒的剧药,即芫花、大戟、甘遂不与甘草配伍,藜芦不与诸参、辛、芍等配伍,乌头不与半、楼、贝、蔹、芨配伍,这三组药,都会因用量太大,或煎煮不当,或服药量太大,或患者体弱不支,而出现中毒,甚至可致死亡。因此,古人十八反之说,很可能是在这样的情况下做出来的错误判断。

There are three pairs among the “18 toxic-enhancing pairs”, Yuanhua, Daji, Gansui, and Wutou (Chuanwu and Caowu) all are poisoning herbs, e.g. the Yuanhua, Daji and Gansui are not to used together with Gancao, and Lilu is not used with several Shen (Dangshen, Shashen, Danshen, Renshen, etc.), Xixin, or Shaoyao; the Wutou is not used with Banxia, Guolu, Beimu, Beijian or Beiji. For these three groups, it is possible to cause toxic reaction to person, or even cause death, if the dose is too big; if the cooking (preparation) of the herbs is not with a proper way; if the dose for each drink is too much, or if the person is too weak in body condition. For this reason, it might be a wrong summary that is made in such conditions for the “18 toxic-enhancing pairs” by doctors in old time.

- 如果拘于十八反之说,一方面,许多古人包括张仲景的名方都得不到运用 (当然也有人用),势必使许多古人的好经验被废弃不用;另一方面,中药配伍中很可能存在真正相反的药,即绝对不能配合使用,误用后会有中毒、死亡危险的中药,十八反反而会使人们对这些可能存在的真正相反的药物的进一步的认识和探索带来负面影响。

If we believe such “18 toxic-enhancing pairs” theory, in one way, many good herbal formulae from doctors in old times, including those by Master Zhongjing Zhang, could not be used (of course someone may use it anyway, such as high level doctors.), which would make many excellent formulae of doctors in old times not been used (or past from generations to generations up to now); on the other side, there might be some real conflicting herbs, e.g. they should absolutely not be used in the same formula, other wise their use would cause toxic reaction, or even cause death. The presence of the “18 toxic enhancing herbal pairs” may anyway mislead doctors only stick to remember these 18 pairs, not to make further more research for more possible toxic-enhancing  pairs.

- 朱良春老先生老最后指出:十八反之说不能成立,十九畏更属无谓。对于古人的东西,应予批评地吸收,不是凡是古人说的就一定对.古人有大量好经验,但限于时代条件,也有不少不可取的,如《神农本草经》说丹砂(朱砂)可久服,李时珍《本草纲目》说马钱子(番木鳖)无毒等皆是。现在应该是为十八反平反的时候了! 不知医界贤达以为然否?

Dr. Liangchun Zhu finally pointed out: The “18 toxic-enhancing herbal pairs” theory does not make sense, the “19 warning pair’ theory is even more nonsense. For the reports from doctors in old times, they should be learnt with caution. It does not mean that everything from the doctors in old times should be correct or be right. Some very good experience from the doctors in old times is very good at that time, but some of them may not be so in current time, for the change of time, or environment factors, etc.  For example the ingredient Dansha (Zhusha) said in the book <<Shen Non Ben Cao Jing>> can be intake orally for long time. The Maqianzi is said in the book <<Ben Cao Gang Mu>> by Dr. Shi-zhen Li as “no toxic”. There are more such examples. Now, it is the time to clear the mistakes caused by the “18 toxic-enhancing pairs” theory. Tell me please, my dear famous doctors, do you agree? 

 

14.  麻黄浅识

14. Preliminary discussion for herb Mahuang

 

麻黄为麻黄科植物草麻黄、木贼麻黄或���麻黄的草质茎。性味:辛苦,温。归经:肺经、膀胱经。功用:发汗、平喘、利水。

Mahuang …..is spicy and bitter in herbal taste and nature. It goes in the Lung and Urine Bladder meridians in the body.  It works to stimulate sweat, to calm down asthma and to improve urination.

 

1. 外感第一药

1. Mahuang is the number one herb used in common cold.

陶弘景说麻黄是伤寒解肌第一药,后世本草著作,亦称麻黄是发表第一药治感第一要药。名之为第一药者,则其他药不可替代之谓也。犹记20世纪80年代一个冬天,我在山东沂水探亲,有几天气温在零下十多度,农村居住条件又差,室内室外一样冷,来找我看感冒的乡亲很多,患者恒多畏寒,发热无汗,头痛,身痛,舌淡,苔薄白,脉浮紧数,投以麻黄汤,多能应手而效。但有李姓老人,七十多岁,亦感冒风寒,因有高血压病史,所以用不用麻黄,颇费踌躇。后来决定要审慎一点,用麻黄汤,去麻黄,权以荆芥、防风、羌活、苏叶四味代之。喝了二次,不得汗,仍发热,恶寒,头痛如裂,干呕。次日凌晨,病情仍无变化,乃书麻黄汤一服:麻黄10g,桂枝12g,杏仁10g,甘草4g,加生姜5片。服后温覆避风,片时即得畅汗,霍然而起。

Dr. Hong-jin Tao said that Mahuang is the number one herb among others in the treatment of common cold (to release body surface phase). The herbal pharmacological books in the later times also said that Mahuang is the “Number one herb to release body surface phase”, and the “number one herb for the treatment of common cold”. That it is called the “number one herb” means it is so important as it can not be replaced by other herbs. I remembered that, during a winter in year 1980s, when I visited my relatives in Shang-dong province, there were several days during which the weather was bellow ten celcius degree. The living conditions for the residences there was poor, so the room temperature was the same as outside. Many village residences came to see me for their common cold. Most of them felt cold and chilly, had fever but without sweat, headache, and whole body pain. The tongue was less red than normal and the pulse felt floating, tight and frequent. When the herbal formula Mahuang Tang was used, it worked for most of them. However, there was an old man, more than 70 years of old, whose family name is Li. He suffered from common cold too, but for his high blood pressure, I felt hesitated to use herb Mahuang. Later, I decided to use the Mahuang Tang, but with caution, to delete the Mahuang, but use Jingjie, Fangfeng, Qianghuo and Suye to replace. After two times of drinking the herbal tea, he had no sweat. He still had fever, chilly, severe headache as to split, and nausea without vomit. Early morning next day, the illness condition was not any improvement yet. So, I used original Mahuang Tang: Mahuang 10 g, Guizhi 12 g, Xingren 10 g, Gancao 4 g, fresh ginger 5 slides. After drinking of the herbal tea, he was kept warm and to avoid wind. Soon after that, he got sweat and all symptoms subsided.   

1975年农忙季节,我所在的医疗队曾广信医生4岁的女儿高烧,用西药解热药、中药银翘散,打针、输液,高热不退或退而复炽,已经3天,想送县城,又逢连日倾盆大雨,焦急万分之际,乃转求当地夏耀光老中医,夏老说无汗而热,乃伤寒表实证,即投以麻黄汤,一服即汗出热退。其时我因事返城,回到医疗队后,毕业于江西医学院的曾医生向我道及此事,感慨地说:没想到中医治急症疗效也这么好!如今,这位小姑娘已经是绵阳市人民医院的医生了。

In a busy farm season in 1975, I was in a medical team. Dr. Guang-xin Zen was one of our team members. His daughter was 4 years of old and suffered from fever. She had been given western medicine to reduce fever, and Chinese herbal therapy of Yinqiao San. After use of in vein infusion and muscle injection of medicine, her fever continued or after reduced but soon rised up again. The condition has lasted for three days. It has been considered to send her to the county, the higher level hospital, but it was raining heavily for several days. Upon the emernent condition, the local TCM doctor, Dr. Yao-guang Xia, had been visited. Dr. Xia said that, the patient had no sweat but fever, which was the body surface overwhelming condition of the Shanghan disease. So the patient was given herbal formula Mahuang Tang. After one dose, the girl had sweat and the fever went away. At that time, I was absence for I was in the county for something. After I returned to the medical team, Dr. Zen, who was graduated from Jiangxi Medical University, told me this story. He said with great emotion: “I have never thought that the Traditional Chinese medicine could also work excellent for emergent condition!”  Now, the small girl has grown up and is the doctor of the People’s Hospital of Mian-yang city.

这件事正好与近代名医恽铁樵的一段往事相映成趣:恽的第二、三两个儿子都因伤寒热病而死,当时他还在上海商务印书馆作编辑,痛定思痛,乃苦攻《伤寒论》者有年。这时,他的四儿子又病伤寒,发热无汗而喘,遍请诸医家,疏方不过栀子、豆豉、豆卷、桑叶、菊花、薄荷、连翘、杏仁、象贝之类,服药后,热不退,喘益甚。恽先生着急了。终夜不寝,绕室踌躇,一直到天亮,才拿定主意:此非《伤寒论》太阳病,头痛,发热,身疼,腰痛,骨节疼痛,恶风,无汗而喘者,麻黄汤主之之病而何?乃援笔书:麻黄七分,桂枝七分,杏仁三钱,炙草五分。持方与夫人云:吾二儿、三儿皆死于是,今四儿病,医家又谢不敏,与其坐而待毙,曷若含药而亡。夫人默然。乃配药煎服,药后,喘较平,肌肤有润意,乃更进之,竟得汗出喘平而愈。以上为何公度文,姜佐景节录于《经方实验录》中者。

It is interesting that this case is similar to the story happened with Dr. Tie-jiao Yun, who is a very famous TCM doctor in current times. Dr. Yun had his second and third son died from fever of Shanghan disease. At that time, he worked as a editor in Commercial Press, Shanghai city. Due to the heavy pain of loss of suns, he studied very hard the book <<Shang Han Lun>> for years. One day later, his fourth sun got the Shanghan disease again. The sun got fever, no sweat, but with asthma. Various TCM doctors had been consulted for the treatment. The herbal formula contained such as Zhizi, Douchi, Doujuan, Sangye, Juhua, Bohe, Lianqiao, Xingren, Beimu, etc. After tried these formula, the fever did not go down at all but the asthma became worse. Mr. Yun felt anxious and worried a lot again. He “could not get into sleep and walked in the room round and roud with hesitation”. Upon the early morning, he made the decision: “Why not this condition is the Taiyang phase of the Shanghan disease, as described in the book <<Shang Han Lun>>: in the Taiyang phase, if the patient has headache, fever, pain in whole body, pain in the lower back and joints, dislike wind, no-sweat asthma, use Mahuang Tang as the main herbal formula.” Therefore he decided to make a priscription by himself: Mahuang 0.21 g, Guizhi 0.21 g, Xingren 21 g, Zhi Gancao 0.15 g. He showed the formula to his wife and said: “Our second and third sun both died from such disease. Now our fourth sun got the same illness, but the doctors tried and refused to continue for the treatment. If we have to wait for him to die, why not let him try the herbal therapy again with hope the formula might work?” His wife agreed with silent nodding her head. So, the herbs were purchased and cooked. After the sun drunken the herbal tea, his asthma became less and there was kind of wet on the skin. So continued the herbal therapy. The sun got sweat and his asthma stopped. The text above was written by Dr. Gong-du He, which was cited in the <<Jing Fang Shi Yan Lu>> by Dr. Zuo-jing Jiang.  

麻黄用于风寒表证,并不受一日太阳,二日阳明,三日少阳之说的约束,曹颖甫先生曾治一人,患感证无力延医,延至一月之久。曹氏诊之,麻黄汤证仍在,乃用麻黄汤一剂而愈。我在廿多年前读研究生时,病房有一人始为麻黄汤证,因循而未用,二十多天发热不退。乃请赵锡武先生会诊。赵老见其发热恶寒,一日二三度发,无汗,不呕,清便自可,面红,身痒,投以桂麻各半汤,亦一剂而愈。

When the herb Mahuang is used in the Wind-cold body overwhelming condition, it is not restricted to be used only on the first day, as it was said (in the <<Shang Han Lun>> that, on the first day, the disease is in the Taiyang phase; on the second day, it is in the Shaoyang phase; and on the third day, it is in the Shaoyang phase. There was a case by Dr. Yin-pu Cao. The patient got common cold but was not affordable to go to a doctor. The disease was delayed for one month. Dr. Cao saw the patient, and found that the body condition was still the indication for the Mahuang Tang. So, the Mahuang Tang was prescribed and disease subsided by the use of only one dose. About 20 years ago when I was student for my bachelor degree, there was a patient in the ward of hospital. His condition indicated the Mahuang Tang, but it was not used due to the habit of doctor. The fever lasted for more than 20 days. Later, Dr. Xi-wu Zhao was asked for consultation. Dr. Zhao noticed that the patient had fever and chilly, which came two to three times a day, no sweat, no nausea, and no disorder in the urination or bowel movement, red face and itch in the body. He prescribed herbal formula Mahuang Guizhi half-half Tang. One dose solved the problem.

前不久见到一位老前辈对他的学生的谈话,说麻黄不可以用于外感热病,屡用屡败。反复思之,竟同梦呓,不知其依据何在。

Not far ago, I heard one old TCM doctor told his students: “Mahuang can not be used in fever disease due to external common cold. Other wise it would fail again and again.” I kept thinking for a long time, felt it was as a dream chatting, and did not know what reason it is for that comment.

外感风寒当用麻黄,温病初起可不可以用麻黄呢?这在清代温热学家是视为禁例的。但风温初起,往往挟风寒,证见发热而渴,恶风寒,无汗,头痛身痛,虽初起就可能有里热,但同时有风寒束表的表证。吴鞠通也承认有这种情况,他的解释是春初余寒未消,但他惑于喻嘉言微发于不发之议,而捏造了一段仲景原文,用桂枝汤,颇遭物议,今日视之,也确实欠妥。而银翘散方,虽然用了荆芥,但对风寒外束之表证,就嫌发散之力不足,王孟英主张用葱豉汤,何廉臣、孙纯一就认为不妨加麻黄数分,使病在表者仍从表而解。至于春温、冬温,初起既见表卫为风寒所束而又见里热,俗称寒包火者,麻杏石甘汤就更是的当之方了。

For external Wind-cold attack, the Mahuang can be used. Then, can the Mahuang be used in Hotness attack (e.g. during the Wen disease)? It is inhibited in the Qing dynasty, China, by the TCM doctors who favored the disease treatment by use of cooling herbs (Mahuang belongs to warm herb). However, in the early stage of the hotness disease, it is usually combined with the attack of Wind and Cold too. The person feels dislike of wind and cold, no sweat, but pain in the head and in whole body. Though the patient may have inside fire in the beginning phase, he has also the sign of body surface layer choking by the Wind-cold. Dr. Ju-tong Wu also admitted the presence of such clinic condition. His explanation is “in the early spring, the cold remains not disappear yet.” However, he was misled by the statement of Dr. Jia-yang Yu that “to release the body surface slightly (with releasing therapy) when the body condition does not allow strang release (therapy).” He fabricated a part of text that was claimed the original text of <<Shang Han Lun>>, and recommended the use of Guizhi Tang, which was criticized by other doctors. If we review what he did, what he did in deed is improper. The herbal formula Yinqiao San, though it uses also herb Jingjie, when used in the Wind-cold fettering (of body surface) condition, is not sufficient enough to dispel the Wind and the Cold. For such disease phase, Dr. Meng-ying Wang recommended the use of  Cong Chi Tang.  Dr. Lian-chen He and Dr. Chun-yi Sun recommended to add little amount of Mahuang to release the body surface synddrom from the skin. For the spring Hotness and winter Hotness disease, the patient has both the syndrome due to the Wind-cold enclosing and that of inside fire, which is commonly called “Fire enclosed with Cold”, the herbal formula Ma Xing Shi Gan Tang is the most suitable one to choose.

因此,说麻黄是外感第一药应该是没有疑义的。

Therefore, there should be no question to say that “Mahuang is the first choice in the treatment of external common cold”.

2.  咳喘圣药

2. Excellent herb for cough and asthma

风寒咳嗽,但治风寒,病去则咳嗽可愈,并非棘手之证。而临床却很常见咳嗽迁延,时久不愈,其中固然有很多原因,据我粗浅的体会,多是医生一见是急性支气管炎,便套用西医消炎的概念,见用凉,见咳止咳,其实川贝、枇杷叶、桑白皮都是凉药,不利于风寒咳嗽的,更不消说清热解毒泻火药了,不当用凉药而屡用之,则往往冰伏其邪,而致咳嗽不止。轻者用止嗽散可效,重则只非搬动麻黄不可。

For cough due to Wind-cold attack, the cough would go away by treat the Wind and Cold. It should not be a big challenge. However, in clinic, it is common to see a cough that lasts for a long time. Though there are various reasons for the chronic cough, I have a feelling that in most cases, it was due to the mistake by doctor. Once the doctor saw it was as “acute bronchitis”, the doctor tended to eagerly use Cold herb if there was evidence of “inflammation” and use cough-stopping herbs if there was cough, based on the “inflammation reduction” concept of western medicine. In fact, the herb Chuan Beimu, Pibaye and Sanbeipi, all belong to Cold herbs. They are not suit to be used with the cough due to Wind-cold attack, not to speak of the use of other herbs that belong to stronger cold (to clear Fire and to dispel toxic). If the cold herbs are used when it is not proper to use, it would cause ice-folding phenomenon, so as to make the cough last for long time. In such case, for mild cough, the herbal formula Zhi Su San could work. In severe case, the herbal Mahuang Tang has to be used.

这样的咳嗽,怎样辨证?我的经验,五个字:无热便是寒。无热,指舌不红,口不渴(即口干也喜热饮),脉不数,痰清稀。这样便可以用麻黄剂温而散之,常用方为三拗汤,麻黄一般用35 g,杏仁10 g,甘草 3g,三拗汤原方麻黄不去根节,杏仁不去皮尖,甘草不炙,可以不拘。方虽三味,麻黄宣肺散寒,杏仁降气肃肺,甘草既缓麻黄之发散,又缓咳嗽。痰多清稀加法半夏、橘红、茯苓,即合了燥湿化痰的二陈汤。

For such chronic cough, how to make TCM diagnosis? My experience is: “if there is no fire (hotness), the cough would belong to cold.” No fire means that the tongue is not in strong red color, there is no thirsty (e.g. if there is dry mouth, the person likes to drink warm water), the pulse is not frequent, and the phlegm is clear as water like. If the clinic condition is as such, the cough can be treated with formula Mahuang-containing formulae to warm it and to dispel the Wind and Cold. The commonly used formula is San Ao Tang, in which, the Mahuang is usually  3- 5 g, Xingren 10 g, and Gancao 3 g. In the original formula, the Mahuang is not asked to remove its joint and root, the Xingren is not required to remove its tips and skin, and the Gancao is not asked to process. Whether following such requirement or not does not matter too much. Though there are only three ingredients, the herb Mahuang works to release the lung and to dispel Cold away; the Xingren works to descend Qi and to clean the lung; and the Gancao works to buffer the over-disperse effect of Mahuang and to calm down cough. If the phlegm is heavy in amount, clear as water, add herb Fa Banxia, Juhong, Fuling, making the whole formula similar as Er Chen Tang, which works to dry the wetness and to clear the phlegm.  

此证亦可用苏陈九宝汤(麻黄、桂枝、杏仁、甘草、苏叶、桑白皮、生姜、薄荷、大腹皮、陈皮),此方虽有麻黄汤的四味药,但麻桂用量都仅用 3g 而已,宣肺散寒,取轻可去实之义,如无意外,一般一至二服药即可获效。

Such Wind-cold cough can also be treated by herbal formula Su Chen Jiu Bao Tang (Mahuang, Guizhi, Xingren, Gancao, Suye, Sanbeipi, fresh ginger, Bohe, Dafupi, and Chenpi). Though this formula contains four ingredients as Mahuang Tang, the amount of Mahuang and Guizhi is only 3 grams, taking the idea that light amount can solve overwhelming condition. It works to loose the lung and to dispel the Cold. Generally speaking, it takes only one to two doses to solve the cough.

若内有伏饮,而年高体弱阳气素虚,不任发越者,浙江宁波范文虎拟定一方,即变通小青龙汤(小青龙汤照用,除半夏用10g外,麻黄、桂枝、干姜、细辛、白芍、甘草、五味子都仅用3g),我多年使用,效佳而无弊。曾治董某,咳嗽三月不止,咯痰清稀,背寒,舌淡苔白滑,脉沉弦。用此方三剂,即因事入狱,一年后获释,来向我致谢,说多亏了那三服药,不然要咳死在牢中了。

If there is inside hidden water, or if the patient is old and weak in body condition, whose body does not allow strong releasing therapy, there is one formula from Dr. Wen-hu Fang, Ningpo city, Zhejiang province, e.g. the modified Xiao Qinglong Tang (the ingredients of the Xiao Qinglong Tang were kept, but the amount of Mahuang, Guizhi, dried ginger, Xixing, Baishao, Gancao and Wuweizi was only 3 g, except the amount of Banxia was 10 g). I have used this formula for many years. It worked very well without side effect. I have dad a patient with name of Dong. He had cough for three months without stop. His phlegm was clear as water. He felt cold on the back. His tongue was less red in color and the tongue cover was white and slipper. I used this formula to him for three days. He was brought into jail for something. After one year, he was released and came to say thanks to me. He said, it was due to that herbal therapy to stop the cough, other wise he might die in the jail.

用小青龙汤不必拘定在外受寒邪,即无恶寒发热表证者,只要是痰饮内伏,咯痰清稀,背部冷感,舌淡,脉弦即可使用。盖此际用麻桂,目的不在发表而在温肺散寒。阳虚可加附子;小便不利加茯苓、车前仁;气虚可加党参、黄芪;喘促加杏仁、苏子、葶苈子、心烦口干有郁热加石膏、芦根,稍凉服。

When use the Xiao Qinglong Tang, it is not restricted to have external Cold attack to the body. Even if there is no chilly, no fever, no body surface syndrome, it can be used if there is latent phlegm in the body, in which the person feels cold on that back, spits water-like clear phlegm, has less-red tongue and has string pulse. The aim of this time to use the Mahuang and Guizhi is not to release the body surface but to warm lung and to dispel Cold. If there is sign of Yang deficiency, add herb Fuzi; of difficulty in urination, add Fuling and Cheqianzi; of Qi deficiency, add Dangshen and Huangqi; of asthma, add Xingren, Suzi and Qinglizi; of annoying feeling in heart and dry mouth, such choking fire, add Shigao, Lugen. The herbal tea should also be drunk when it is little bit cold.   

病久肺气虚寒者,证见咳而气喘,畏寒自汗,脉弱无力,乏力,食少,便溏,在原则上麻黄便不可轻投,否则更虚其虚。温肺汤(人参或党参、茯苓、白术、半夏、橘红、甘草、肉桂、炮干姜、黄芪、桔梗)可以酌用,方用六君子汤加味。

If the patient has Lung Qi deficiency after a long time sick, has cough with asthma, dislikes cold, has self sweat, fatique, poor appetite, loose stool, and weak pulse, the herb Mahuang would have to be used in principle with great caution. Other wise, the Qi deficiency would be worse. In this case, the herbal formula Wen Fei Tang[3] (Renshen or Dangshen, Fuling, Baizhu, Banxia, Juhong, Gancao, Rougui, Pao dried ginger, Huangqi, Jiegen), which is modified from formula Liu Jun Zi Tang[4] with some herb addition.

吴楚说:近来医家凡遇此证,必用麦冬、贝母,以重寒其肺,桑皮、白前、苏子以重泻其气,甚至黄芩、花粉雪上加霜,而病无瘳时矣。然久病咳嗽也有用麻黄者。患者肺气虚寒,而又感受风寒之邪而咳喘加重,即可以用麻黄。5060年代何时希先生在西苑工作时,对慢性咳喘曾拟过一张方子叫清金膏,即是取小青龙汤、百合固金汤、金匮肾气丸合方。

Dr. Chu Wu said: “Recently, TCM doctors, once they saw such patients, sticked to use herb Maidong, Beimu, which make the Cold worse; or to use Sangbeipi, and Suzi, which deplete the Qi away much. They even use Huangqin and Tianhuafeng, to make things much worse and the cough lasts without hope to subside. However, there is also condition, in which the Mahuang is used in a chronic cough. If the patient has Lung Qi deficiency and weakness, but also suffers from external Wind and Cold attack, as as the cough became worse, the Mahuang can also be used. In 1950s and 1960s, when Dr. Shi-xi He worked in Xi Yuan, he prescribed a formula to treat chronic cough, which was named Qing Jin Gao. The formula is the combination of formula Xiao Qinglong Tang, Baihe Gu Jin Tang and Jin Kui Shen Qi Wan.

或谓这样的处方,不是嫌太杂乱了么?不知病情复杂,用药也不得不复杂,虚不得不补,实也不得不泻,那么又何妨补泻同用甚至补泻寒热同用呢?我过去在农村工作时,也曾经这样用药,姜春华老师见了居然大加赞赏,他在给我的信中说:人体脏腑有此脏寒而彼脏热者,有此脏虚而彼脏实者,何妨此脏温之,他脏寒之,此脏补之,他脏泻之,寒热补泻同用,各不相妨。慢性支气管炎常用这样的方法,以其病情远不止一端也。同时也不能株守发作时治标,平时治本的框框,两步可以并作一步,标本兼治,不过在具体病人身上,有不同的侧重而已。

It might be argued that, a formula as such would be too complex and mass? The person asked this question does not realize that, because the disease condition is complex, the formula has to be also complex. The weakness condition has to be nourished or supplied, and the overwhelming condition has to be also depleted. So, why worry to nourish and to deplete the same time, even to use the warming therapy and cooling therapy the same time with the nourishment and the depletion? Previously when I worked in countryside, I did so. Dr. Chun-hua Jiang saw my way and admired greatly. He said in his letter to me: in the body, there is an organ that is warm and another is cold; an organ that is weak and another might be overwhelming. Therefore, why not to warm up this organ and to cool that organ, and to nourish this organ and to deplete another organ? To warm, to cool, too nourish and to deplete, all work by its way without affecting each other. For the treatment of chronic bronchitis, this way is used quite often, for the disease is not only on one side. At the same time, we do not need to stick to the common idea to solve symptoms when the disease is in acute phase and to treat the root reason when it is in silent phase. What we can also do is to walk the two steps into one, to treat the symptom and the reason of the disease the same time. Only thing we need to do is to decide to nourish more or to deplete more for a given patient.

关于麻黄用于咳喘的剂量,需因时、因地、因人、因证而异,我在汤剂中一般用69g,儿童酌减。但就是这样的剂量,也常常被药师把处方打回来,或者要医生签字。这种情况,在成都、上海尤甚,以至乡前辈蒲辅周先生在成都行医时,不得把麻黄研成粉,赠给病人,说是老家带来的药引子。犹记60年代中期,农村患慢性支气管炎的病人很多,又无力就医,我采用当时杂志上报道的麻味甘散,即麻黄、五味子、甘草各30g,研末,分30包,一日三次吞服,价既廉,效果也不错,用了上百例。调回城里工作后,县医院有位西医叶医生正当盛年,为哮喘所苦,百药不效,连民间单方尿泡鸡蛋都吃过几十个了,也不效。我据她的病情,开了小剂量的小青龙汤,另用麻味甘散。药取回去后,她的母亲误将小青龙打粉,麻味甘散煮成汤药。我闻讯后即赶忙去看望,因为麻黄用量是30g!而叶医生喘息顿平,唯有些心跳,不想睡觉,有些出汗而已。此所谓歪打正著,可见在病情需要之时,麻黄也可以用较大剂量的,唯须注意观察,老人、小儿、虚弱人尤应慎重,不可贸然便投以大剂量。

For the amount of Mahuang used in the treatment of asthma, it depends on the time of the treatment, the geographic zone where the patient lives, the given person, and the exact syndrome (symptom) the patient has. I usually use 6-9 g, with less dose in children. However, even for such amount, the staff in herbal shops often refused to sell the herbs, or they needed doctor to sign on the formula. Such situation happened more often in Chendu and Shanghai. When senior doctor, Dr. Pu-fu Zhou, practiced in Chendu city, he had to grind the Mahuang into powder to give patient as gift, saying that it is the “herb directing powder”. I remembered that in the middle of 1960s, there were a lot of patients in countryside who suffered from chronic bronchitis and who had no money for the treatment. I learnt from a medical journal a formula named “Ma Wei Gan San”, eg. the Mahuang, Wuweizi and Gancao, 30g each to grind into powder. The powder was separated into 30 pouches. The patients were asked to take it one pouch each time and three times a day. It was cheaper while the healing effect was pretty good. This way was used for hundreds of patients. After I moved back to the hospital in city, there was a young western medicine doctor, whose name is Ye, who suffered from asthma. He had tried various medicine or herbs without any improvement. He even tried to take folk therapy, which asks the person to eat chicken eggs that had been rinsed urine. According to her condition, I prescribed her Xiao Qinglong Tang, with additional use of the Ma Wei Gan San. After she brought the herbs home, her mother made a mistake to grind the Xiao Qinglong Tang into powder while cooked the Ma Wei Gan San into soup to drink. I heard this and hurried up to her home to check, since the amount of Mahuang by this way is 30 g! However, Dr. Ye’s asthma subsided, though she felt slight heart beat, no desire to have sleep and little sweat. This is so called “to beat what not aimed to beat”. Apparently, if the disease condition needs, the Mahuang can also be used in large amount, though it is needed to monitor the clinic reaction, especially for children, elderly and weak patients, to whom the large dose of Mahuang should not be given without caution.

 

3 宣通肺气

3. Dredge Lung Qi

风寒外束,肺失宣散,痰热内蕴,积而化火,俗称寒包火,以此而发热,咳嗽,失音,哮喘,喉痛者,在冬春季颇为多见,麻杏石甘汤是有效之方。麻黄汤、麻杏石甘汤虽都用麻黄,但取义不同,配伍不同,作用也不同。前者是用以散寒解表,后者用以宣肺平喘。麻黄辛温,得桂枝之辛甘温增强了发汗的作用,得石膏则只有宣肺的作用了,所以即使有汗出也要用它。

When Wind and Cold fold the lung, the lung loses its dispersing function, so that phlegm Hotness accumulated inside of the body to develop into Fire. This is commonly called “Fire folded by Cold”. Due to this, the person has fever, cough, loss of voice, asthma, sour throat. This condition is common in winter and spring. The herbal formula Ma Xing Shi Gan Tang is a effective formula. The formula Mahuang Tang and the Ma Xing Shi Gan Tang both use Mahuang, but the function of the Mahuang is different. Once a herb is used with different other herb(s), its function could be different too. In the former formula, the Mahuang is used to disperse Cold and to release the body surface. In the later, it is to dredge lung and to calm asthma. Mahuang is spicy and warm in herbal nature. When it is used with Guizhi, helped by the Guizhi, the formula is more effective to stimulate sweat. When used with Shigao, the whole formula can only work to dredge lung. In this case, even if the patient has sweat, the Mahuang still needs to be used.

麻黄之辛温与石膏之甘寒相合,则温性大减,当然石膏得麻黄,甘寒之性味也要打点折扣,正因为如此,前人从其总合之效力说,麻杏石甘汤乃是一首辛凉方。我的体会,用此方的要点是掌握好麻黄、石膏的比例,就一般情况而论,石膏应是麻黄的510倍。

When the Mahuang, its spicy and warm, is used with Shigao, its sweet and cold, the warm capacity of the Mahuang is dramatically reduced. Of course, when the Shigao is used with Mahuang, its sweet and cold nature is also reduced. For this, TCM doctors in old time emphasize the comprehensive effect of a formula and said that the Ma Xing Shi Gan Tang is a spicy cold formula. My experience is that, the key point to be able to well use this formula is to control the ratio between the Mahuang and Shigao. Generally speaking, the amount of Shigao should be 5 to 10 times of that of Mahuang.

治廖某失音,证属客寒包火,金实不鸣,我用麻黄4g,杏仁10g,石膏30g,生甘草3g,加花粉、玄参润燥,蝉衣、僵蚕、牛蒡子、射干振闭,一剂而愈。寒包火证,外则恶寒,内则口干,渴思凉饮,舌红,脉滑数。如无口干舌燥,舌红,脉数,则不唯花粉、玄参不可早投,即石膏也可去之,三拗汤加射干、蝉衣即可。

I have a patient, whose name is Liao. He had loss of voice. His condition belonged to the Fire folded by Cold. TCM states that, if the Lung is in overwhelming condition, there would be no voice of speak. I used Mahuang 4 g, Xingren 10 g, Shigao 30 g, Gancao 3 g, with addition of Tianhuanfeng and Xuanshen to wet the dryness, the Chanyi, Jiangcan, Niubangzi and Shegan to open the block (on the throat). One day treatment solved the problem. In the Fire folded by cold, the person feels chilly out side of the body, but dry mouth, thirsty with desire to drink cold water, has stronger red color in the tongue, and has slippery and frequent pulse. If there is no dry mouth, dry throat, the tongue is not in strong red, and the pulse is not frequent, not only the Tianhuafeng and Xuanshen should not be given urgently, the Shigao can also be omitted. In this case, the formula San Ao Tang with addition of Shegan and Chanyi can be used.

我用麻杏石甘汤治疗单纯性鼻炎、鼻窦炎,患者经常鼻塞,声重,喷嚏,流脓性鼻涕,前额痛,头昏,鼻腔黏膜鲜红、暗红者,常在方中加黄芩、银花、茜草、连翘、鱼腥草、桔梗、辛夷、白芷、苍耳子等,有较好疗效,比单用辛夷散、苍耳散效果好。因为苍耳散、辛夷散虽然都有开鼻窍、散风寒的作用,但药性偏温,所以对肺热之证以麻黄、石膏相配,再加入黄芩、鱼腥草,清肺泻热作用更好,一般1020剂可愈。至于麻杏石甘汤治疗小儿肺炎、麻疹并发肺炎、百日咳,用之对证,疗效奇佳,皆取其宣肺清热之长,这里就不赘述了。

I use the Ma Xing Shi Gan Tang for the treatment of simple rhinitis, sinusitis, in which the patient commonly has stiff nose, heavy noise in nose, snizz, running pus nose, headache in front of head, and cloudy head. If the nose mucus is fresh red or dark red, I add Huangqin, Yinhua, Qiancao, Lianqiao, Yuxingcao, Jiegen, Xingyi, Baizhi and Canerzi, etc, to the formula. It works pretty well. It works better than single Xingyi San or Canerzi San. The formula Xingyi San or Cangerzi San both have function to open the nose and to dispel cold, but their herbal nature is relatively warmer. Therefore, for a lung hotness condition, use the Mahuang and Shigao together, with addition of Huangqin, Yuxingcao, the function to clear lung and to deplete Fire is stronger. Generally it needs about 10 to 20 days of such herbal therapy to cure. As for the Ma Xing Shi Gan Tang to be used in the treatment of children neumonia, neumonia following measles, or whooping cough, if it is used in a patient with a matched condition, the healing effect is surpisingly excellent. It is to take the advantage of dredging lung and clearing Fire. No need to explain it more here.  

 

4  消肾炎水肿

4. Reduce swelling in nephritis

我对急性肾小球肾炎初起,以水肿为主要表现者,恒用麻黄。但分寒热二证:发热,咽痛,舌红或身有疮疖,脉滑数者,用越婢汤(麻黄、石膏、甘草、大枣、生姜),去甘草、姜、枣,加白花蛇舌草、野菊花、蝉退、白茅根、益母草、连翘、银花;畏寒,舌淡,脉弦迟者,用麻黄附子细辛汤加白术、防风、丹参、益母草、茯苓皮、生姜皮、大腹皮,消肿甚捷,蛋白尿,红、白细胞转阴也很快。

I always use Mahuang in the early stage of an acute nephritis, in which the swelling is the more dominated clinic phenomenon. It is needed to make sure if the condition belongs to Hotness (Fire) or Cold. If the person has fever, sour throat, the tongue is stonger red in color, or there is furuncles in the body, or the puls is slippery and frequent, use Yu Bi Tang (Mahuang, Shigao, Gancao, Dazao, fresh ginger), with removal of Gancao, Dazao, and ginger, but with addition of Baihuashe She Cao, wild Juhua, Chantui, Baimaogen, Yimucao, Lianqiao, Yinhua. If the person is with chilly or dislikes cold, the tongue is less red in color, and the pulse is string and less frequent, use Mahuan Fuzi Xixing Tang with addition of Baizhu, Fangfeng, Danshen, Yimucao, Fulingpi, fresh ginger skin, Dafupi. It reduces swelling very fast. The urine protein, red blood cells and white blood cells, all subside very fast.

我有一位老友,是位西医,因工作紧张、劳累、受寒,而病恶寒发热,适我回乡探亲,便为之诊治,热退。又发现眼皮肿,原有的双眼皮不见了,查尿,始知为急性肾小球肾炎。我即用越婢去姜、枣、甘草,加白花蛇舌草、蝉退、野菊花等,二剂其肿即消,尿检亦速恢复正常,连化验师都感到哪有这么快就消失之理。

I have a old friend. He is a western medicine doctor. For hardy work, very tired, attacked by cold, he started to have chilly and fever. It was the time when I went back to my hometown to visit my family. I so treated him. His fever subsided, but his eyelids were found swelling. The original two layers of lids disappeared. After check the urine, it was known that he got acute nephritis. I soon used Yu Bi Tang, with removal of ginger, Dazao and Gancao, but with addition of Baihuasheshecao, Chantui and wild Juhua. After two days of herbal therapy, the swelling disappeared. The lab test for urine was also normal. It made the lab technician wondered how fast the disorder disappeared so fast.

时下世俗差不多都认为中医治病慢,急性病要靠西医,我说要看什么病了,像这样的病,中医药刚好是独擅胜场。最近治一30岁女性,眼睑水肿,恶风,小便不利,外院诊断为急性肾炎,察其舌淡,苔白腻,脉浮,遂拟温肾行水之法,用麻黄附子细辛汤合五苓散7剂,服至第四剂其肿即消。

Currently, it is commonly believed that the healing effect of Traditional Chinese medicine (TCM) is slow. An acute disease should go to western medicine for the treatment. To me, it depends on the disease it is. For an acute disease as such acute nephritis, the TCM therapy is uniquely excellent. Recently I had a case, who was a female of 30 years of old. She had eyelid swelling, dislikes wind, and difficulty in urination. In another hospital, she was diagnosed as acute nephritis. Her tongue was less red than normal, the tongue cover was greasy and her pulse was floating.  She was given the herbal therapy to warm kidney and to conduct water, which was Mahuang Fuzi Xixing Tang plus Wu Ling San for seven days. Upon the fourth day, the swelling subsided completely.

由疮毒引起的急性肾炎水肿,用麻黄连翘赤小豆汤合五皮饮、仙方活命饮或五味消毒饮加减,收效也很迅捷。如邸某,男,40余,青龙桥派出所。1980年春因疮疖化脓感染而出现水肿,经某医院用青霉素注射二周未效,我用麻黄、连翘、野菊花、丹皮、银花、蒲公英、白茅根、桑白皮、益母草、当归、赤芍,二剂即消肿。

For the acute nephritis due to skin furuncle or carbuncle, it also works to use Mahuang Lianqiao Chixiaodou Tang plus Wu Pi Yin; Xian Fang Huo Ming Yin or Wu Wei Xiao Du Yin with some modification. For example, there was a case, whose name is Qiu, a male, 40 years of old. In 1980, he got swelling due to pus infection from skin furuncle. He was treated in a hospital with penicillin for two weeks without improvement. I used Mahuang, Lianqiao, wild Juhua, Danpi, Yinhua, Pugongyin, Baimaogen, Sanbaipi, Yimucao, Dangui, Chishao. After two days of the herbal therapy, the swelling disappeared.

麻黄既能开鬼门以发汗,又能洁净府以利小便,故向来为实证水肿初起之要药,我也历用不爽。由于用药时间不是很长,且有是证用是药,因此对急性肾炎有高血压者,麻黄也不必避忌。

Mahuang can open the sweat hole to stimulate sweat, and can clear the urinary bladder to improve urination, so it is always the key herb in the treatment of swelling in a overwhelming condition. I used it very often and the healing effect is excellent too. Since the Mahuang is not used for a long time, and also since the TCM principle that a herb should be used if there is indication to use it, Mahuang can be used in patient with acute nephritis and with high blood pressure.

 

5 痹证要药

5. It is the key herb in the treatment of Bi syndrome

麻黄为痹证要药,仲景乌头汤、桂枝芍药知母汤、麻黄加术汤等治痹名方都用麻黄。我治风寒湿痹,多以麻黄附子细辛汤为主方,张璐说麻黄得附子则发中有补,诚是。即湿热痹、久痹、顽痹,也有用麻黄之时,取其开达腠理,温阳散寒,通畅经络。

Mahuang is the key herb in the treatment of Bi syndrome.[5] The famous herbal formulae from Master Zhongjing Zhang, such as Wutou Tang, Guizhi Shaoyao Zhimu Tang, Mahuang plus Zhu Tang, all use the Mahuang. When I treat the Bi syndrome due to Wind, Cold and Wetness, I often use the Mahuang Fuzi Xixing Tang as the main frame. Dr. Lu Zhang said that when the Mahuang is used together with Fuzi, the formula works as “to nourish and at the same time to disperse”. I agree. Even if the Bi syndrome belongs to the Wetness-Fire, to a chronic condition, or a obstinate condition, there is also a chance to use the Mahuang. It is to take its advantage to dredge the meridian, the legments, to warm the Yang Qi and to dispel the Cold.

《内经》说风寒湿三气杂至,合而成痹。风寒湿相合,性质偏寒,盖风为寒风,寒、湿皆为阴邪也。曾治中央党校司机张某风寒湿痹(类风湿性关节炎),仿成都戴云波先生法,川乌、附子、麻黄、细辛、桂枝、干姜、甘草合为一方,服百余剂而终获痊愈。又治张某,女,中学教师,下半身恶寒甚,虽盛夏也见不得一点风,屡用附子、姜、桂辈得小效,然腿寒终不除。于是改用麻黄附子细辛汤温而散之,仅三剂,即有豁然通畅之感。去麻黄,再用温阳益肾之剂数十剂而愈,其温散通阳之功,于兹可见。

In the book <<Nei Jing>>, it states that, the combination of the Wind, the Cold and the Wetness causes the Bi syndrome. The mixture of the Wind, the Cold and the Wetness is with more Cold nature, since the Wind is the cold Wind, and the Cold and the Wetness both belong to the Yin Xie Qi. I had a patient, whose name is Zhang, and who is the driver for the Central Party school. He suffered from the Wind-Cold-Wetness Bi syndrome (rheumatoid arthritis). Learnt from Dr. Yun-po Dai, Chendu city, I used Chuan Wutou, Fuzi, Mahuang, Xixing, Guizhi, dried ginger and Gancao in the same formula. He was asked to continue the herbal therapy for hundred of days. His condition was finally cured. In another case, Mrs. Zhang, who is a teacher in middle school. She felt very cold in the lower half part of the body. Though it was peak summer, she would not be able to tolerate little wind blowing. Continueous use of Fuzi-, ginger- and Guizhi-containing herbal formulae, the improvement was very little and the cold feeling in the legs remained. So, she was given the Mahuang Fuzi Xixing Tang to warm and to disperse for three days. She felt sudden opening feeling. After removal of Mahuang, the Yang-warming, and kidney-nourishing herbs were continues for ten days more. Her condition was also cured. The function of the Mahuang to dredge the Yang Qi can be seen in the examples.  

 

6  祛风止痒

6. To dispel Wind and to stop itch

麻黄常用于荨麻疹等皮肤过敏性疾患。传统认识是风邪客于皮肤腠理之间,不得出汗,因而郁遏不出。小发其汗,则邪去痒止。我治荨麻疹常用麻黄连翘赤小豆汤加蝉衣、赤芍、丹皮、防风、荆芥,对服抗过敏西药无效者,投以本方,往往一剂即愈。但兼里热实证者须合清热通腑药,刘河间防风通圣散即用麻黄配防风、荆芥、薄荷祛风于表,大黄、芒硝、栀子、石膏、滑石、连翘、黄芩清泻于里,佐以赤芍、当归、川芎活血,白术燥湿。临床用药,可师其意,不必泥于其方。有些慢性荨麻疹也可用防风通圣丸成药,一日三次,每次6g,研碎冲服。

The herb Mahuang is usually used to treat urticaria and other skin allergic disorders. Traditionally it is believed that such disease is due to the Wind Xie accumulated and sticked in between the skin and the body fibro membrance, the body fails to have sweat to dispel the Wind away from the skin. So, to stimulate small sweat would be able to remove the Wind Xie and to stop the itch. To treat the urticaria, I usually use the Mahuang Lianqiao Chixiaodou Tang with addition of Chanyi, Chishao, Danpi, Fangfeng, and Jingjie. For those of patients without effectice reaction to the anti-allergic drugs of western medicine, one day of herbal therapy with this formula usually solve the problem. However, if the body is with inner Fire condition, this formula should be used together with other formula to clear the inner Fire and to dredge the intestine-colon. The formula Fangfeng Tong Shen San of Dr. He-jian Liu is to use the Mahuang, Fangfeng, Jingjie, and Bohe to dispel Wind in the body surface, the Dahuang, Mangxiao, Zhizi, Shigao, Huashi, Lianqiao and Huangqin to clear the inner Fire, helped by Chishao, Danggui, and Chuanxiong to activate blood circulation, and Baizhu to dry the Wetness. In the clinic, we can formula the main idea of him, not necessary to follow exactly the ingredients. Some patients with chronic urticaria can also use the Fangfeng Tong Shen San but its pill form, three times a day, 6 g each time (swallow the pills after break it).

 

7用于遗尿

7. To treat night enuresis (bed-wetting)

用麻黄杏仁石膏甘草汤治疗遗尿,最先见于四川成都中医药大学彭宪章先生1978年的报导。他观察6例长期遗尿的患者,都有咳喘咯痰的症状,用麻杏石甘汤后,咳喘平,遗尿亦愈,从而推论其药效机理是肺气壅滞,治节无权。我学习彭先生的经验,对肺有痰热者之遗尿,用之确然有效;而无肺热征象者,用麻黄30g、甘草30g、蜂房6g,共研细末,和匀,一日三次,每次4g,亦效。

The first report to use the Ma Xing Shi Gan Tang for the treatment of bed-wetting is Dr. Zhang-xian Peng, the doctor in the Cheng-dou TCM university, Sichuan provine, China, in 1978. He observed 6 cases with long term of bed-wetting. All the patients had cough and spitting phlegm. After the use of Ma Xing Shi Gan Tang, the asthma calmed down, and the bed-wetting stopped too. He therefore inferred that the reason for the bed-wetting is the sluggish of the Lung Qi, so the Lung fails to control the water excresion. I leant from Dr. Peng. For patient with bed-wetting and with phlegm and Fire, this formula in deed works. For those of patients without lung Fire-Hotness signs, use Mahuang 30 g, Gancao 30 g, Fengfang 6 g. Grind them into powder. Mix them well. Drink it 4 g each time, three times a day. It also works.   

 

8 温振心阳

8. Warm up and activate Heart Yang Qi

麻黄有振奋心阳的作用。李东垣《兰室秘藏》治客寒犯胃,心胃大痛不可忍,有麻黄豆蔻丸,以麻黄配伍行气药厚朴、荜澄茄、木香、青陈皮、草豆蔻;活血药红花、苏木、当归等,且麻黄、豆蔻二味在方中用量独大,以之为君,以之名方。不过东垣说的心胃痛,究竟是心痛还是胃痛?古人于此每每含混不清,从东垣独重脾胃的学术思想看,恐怕是指胃痛,而从其用药之温阳行气、化瘀合方,用于心痛之属寒凝气滞血瘀,也颇适宜。尤其是方中的麻黄,一般是并不用于胃痛的。

Mahuang has a function to boost Heart Yang. Dr. Dong-yuan Li said in his book <<Lan Shi Mi Cang>> that (Mahuang) treats severe pain in the stomach and heart that is due to external Cold attack to the stomach. He introduced Mahuang Doukou Wan, in which the Mahuang is used together with Houpu, Bichenqie, Muxiang, Qingpi and Chenpi, and Caodoukou, as well as herbs that work to stimulate blood circulation, such as Honghua, Sumu, and Danggui, etc. The amounts of Mahuang and Doukou in the formula are the biggest, working as King, so use them as the name of the formula. However, the Stomach pain said by Dr. Dong-yuan Li means the stomach or the heart? It is usually confused when doctors in old time discussed this. Because Dr. Li usually argue for the treatment of disease from the point view of Stomach and Spleen, he might mean the stomach pian. However, this formula uses herbs that work to warm Heart Yang, to conduct the Qi movement, and to dissolve blood stagnation, it is also suitable for the pain in heart that is due to Cold frozen, Q sluggish and Blood stagnation. It should be pointed out that, the Mahuang in this formula is normally not used in the treatment of pain in the stomach.  

姜春华老师说古籍中,《外台秘要》引范汪方,有通命丸,即以麻黄为君药,治疗心胸满闷,而且邹润安《本经疏证》也说过麻黄通心阳,散烦闷。而证之今日临床,麻黄与附子、细辛、干姜、肉桂、丹参、红人参等配伍,对于病态窦房结综合症之属,心阳虚者,确有较好的作用,能迅速地增加心率,改善心脏功能。

Dr. Chun-hua Jiang said that, in the old medical book <<Wai Tai Mi Yao>>, there is a formula called “Tong Ming Wan” which is the formula of Dr. Wang Fan, which uses Mahuang as the king herb, to treat “fullness and bloating feeling in the heart and chest”. In the book <<Ben Jing Shu Zheng>>, Dr. Rong-an Zou said that Mahuang works to “conduct the Heart Yang, and to disperse annoying”. Check the clinic practice, the use of Mahuang together with Fuzi, Xixing, dried ginger, Rougui, Danshen, and Hong Renshen, works pretty good for the sick sinus syndrome that belongs to Heart Yang deficiency. It can increase the heart beat and improve heart function quickly.

曾治研究生梅智胜之亲戚王某,女,54岁,患病窦有年,心率每分钟仅38次,面色苍白,心慌,头晕,乏力,短气,四肢欠温。属阳气虚衰,拟温通心阳,药予麻黄、制附子、细辛、炙甘草、桂枝、红人参、当归、黄6剂药后,心率即至62/分,头晕、乏力、肢凉等症状减轻,汤方更加玉竹、白芍、枸杞子、枣仁、桂元肉、远志、龙骨、牡蛎,兼养心阴。调理二月余,病情稳定,可去户外散步或短距离内买东西。当然,麻黄用于心阳虚心气虚,其作用不过是振奋阳气,治心阳虚之本,必须与大剂参、附、桂、姜同用,始克有济,这是应予强调的。

I had a client, who is the relative of one of my student. The client was a female, 54 years of old. She had the sick sinus syndrome for some years. Her heart beat was only 38 times per minute. She was pale in face. She felt dizzy, palpitation, short of breath, chronic fatigue, cold and hands and feet. Her condition was considered to be Yang Qi deficiency. It was figured out to warmly conduct the Heart Yang. The herbs gaven were Mahuang, Zhu Fuzi, Xixing, Zhi Gancao, Guizhi, Hong Renshen, Danggui, Huangqi. After 6 days, the heart beat increased to 62 times per minute. The dizzy, fatigue and cold hands and feet were less. To the formula, added Yuzhu, Baishao, Gouqizi, Zaoren, Guiyuanrou, Yuanzhi, Longgu, and Muli, to nourish the Heart Yin too. After two months’ treatment, she could walk outside or go shopping in a closer market. Of course, when used for the treatment of Heart Yang deficiency and Heart Qi deficiency, its function is simply to boost the Yang Qi. To solve the basic cause of such problem, it is still needed to use large amount of Renshen (Dangshen), Fuzi, Guizhi (or Rougui), and ginger. By this way, the symptoms and the cause of the disease can be solved for a long term. This has to be emphasized.  

 

9  破症坚积聚

9. Break the mass or the accumulated stuff in the body

麻黄破症坚积聚的记载,出自《神农本草经》。徐灵胎说这是因为麻黄能深入积痰凝血中,凡药力不到之处,此能无微不到也。古人论药,多系推理,可贵者在证之于临床实践。《本经》的记载,徐灵胎的诠释,最有力的证据就是清代王洪绪《外科证治全生集》的名方阳和汤,用麻黄与熟地、鹿角胶、肉桂、白芥子、干姜炭、甘草相配伍,治疗阴疽、痰核、流注结块,患处漫肿无头,皮色不变,舌淡苔白,脉沉细者。

That Mahuang can work to break mass is introduced in book <<Shen Nun Ben Cao Jing>>. Dr. Ling-tai Xu said this is because Mahuang can penetrate deep into the accumulated phlegm and stagnated blood clot. If other herbs fail to penetrate, Mahuang can. When doctors in old time discuss the herbs, they mostly inferred the function of the herbs. The most important thing is to check them in clinic. What can most strongly support the record in the book <<Ben Jing>> and the statement of Dr. Ling-tai Xu, is the Yang He Tang, which is introduced in the  book <<Wai Ke Zheng Zhi Quan Sheng Ji>> by Dr. Hong-xu Wang (Qing dynasty). This formula uses Mahuang, Shoudi, Lujiaojiao, Rougui, Baijiezi, Ganjiangtan, and Gancao. It is used to treat dorsal Furuncle, tuberculosis in lympha nodes, mass under skin, all of which show as a bloating or mass without clear edge, without skin color change. The patient’s tongue is less red in color and the pulse is deep and thin.

王氏说阴疽是气血两虚,毒痰凝结而致,治之之法,用大剂熟地、鹿胶峻补气血,但非麻黄不能开其腠理,非肉桂、炮姜不能解其寒凝。此三味虽酷暑不可缺也,只有腠理一开,寒凝一解,气血乃行,毒亦随之而消。马培之也说此方治阴证,无出其右,用之得当,应手而愈。

Dr. Wang said that the dorsal furuncle is a condition of Qi and Blood both deficiency, and poison and phlegm both coagulation. The principle of the treatment should be to use large amount of Shoudi and Lujiaojiao to urgently supply the Qi and Blood. However, if there is no Mahuang to dredge the muscle and tendon, and if there is no Rougui and processed ginger to solve the coagulated Cold, they would not work properly. These three herbs can not be omitted even if the formula is to be used in peak summer. Only when the muscle and tendon is dredged, and the Cold is dispersed, the Qi and blood can then start to move properly, and the poison stuff can be depleted off right away. Mr. Pei-zhi Ma said too: “To treat dorsal furuncle, this formula is the number one to choose. If used in a proper way, it works very well.”   

多年以来,我用阳和汤治疗中老年乳腺增生屡屡得效。如患者何某,男,50岁,绵阳市委党校干部。19825月发现左侧乳头内陷,乳头下有一核桃大小的肿块,能推动,无疼痛感。当地医院拟诊为乳腺癌,即赴成都四川医学院进一步检查,门诊、病理科均认为是乳腺癌,遂入院手术。术中活检,结果为良性,乃改诊断为男性乳腺增生病,认为可能与患者过去患前列腺炎,长时间服用雌激素有关。返绵阳后,8月中旬,不意右侧乳头下又发现一核桃大小的肿块,西医建议服中药治疗,在当地用疏肝理气,活血化瘀,软坚散结中药二十余剂无效,乃来信求助于我。我寄去的处方用药,也和上述治疗差不多,又二十来付,了无寸效。再来信相商,反复筹思,患者年届五旬,久用疏肝无效,应考虑冲任亏虚。遂用阳和汤加丹参、淫羊藿、法半夏、青陈皮、当归,鹿胶改用老鹿角,取其活血攻坚。服至15剂,肿块开始缩小,坚持服26剂,即完全消散。患者今年已70岁,每年都有电话给我,至今未见复发。

For many years, I used the Yang He Tang for the treatment of hyperplasia of mammary glands in middle age and in elderly. It worked quite often. For example, there was a patient, whose name is He, male, 50 years of old, a officer. In May 1982, he noticed that his left nipple shrank and there was a mass of a size of about a walnut under the nipple, which was movable by pushing and which felt no pain. The local hospital diagnosed it as breast cancer. He then went to the Sichuan Medical college (Chengdu city) for further check. The clinic and the pathology department both believed it was breast cancer. He was arranged to live into the ward and to have a surgical operation. Biopsy during the surgical operation showed that the mass was a benign mass in nature, so that the diagnosis was corrected into “Male benign breast hyperplasia”. It was suspected be due to the use of estrogen product used previously to him to treat his proslatitis. When he return home and in August the same year, he unconsciously found another mass bellow his right nipple, a size of also a walnut. The western medicine doctor suggested him to see a TCM doctor. The herbs used by local TCM doctor were to dredge liver, dredge Qi, to activate blood and to disperse blood stagnation, and to soften the hard mass and to disperse the mass/knot. After 20 doses (20 days), there was no any improvement. He wrote a letter to me for help. The herbs I prescribed to him was pretty similar to the above herbs used by local TCM doctors. After about 20 doses, there was no any improvement either. He wrote me letter again for further consultation. I though over and over that the patient was over 50 years of old. A long time intake of herbs that supported to dredge liver and Qi did not work. It should be considered that his Chong meridian and Ren meridian both were in deficiency. For this consideration, I used Yang He Tang to him, with addition of herb Danshen, Yinyanghuo, Fa Banxia, Qingpi and Chenpi, Danggui, and Old Lujiao (to take the advantage of the old Lujiao able to activate blood circulation and to attack the hard mass). After the intake of the herbs for more than 15 doses (15 days), the mass started to become smaller. He insisted the herbal therapy for total 26 doses, the mass subsided completely. Now, the patient was 70 years of old. He called me every year for consultation. No recurrence at all so far.

最近在三芝堂治疗王某,女,63岁,北京某中学教师,于今年2月底洗澡时发现大腿内外有8个、上肢3个圆形疙瘩,大约1.21.2cm,有2个局部紫瘀,其他皮色不变。乃去协和医院作活体切片检查,诊断为非何杰金氏恶性淋巴瘤(切片号30211943021196),诊其脉弦滑,眼眶周围黯黑,拟诊为痰核,用温阳活血化痰通络法。用阳和汤(麻黄每剂用3g)加姜半夏、炮南星、山甲珠、僵蚕、橘络、紫背天葵、丹参、桃仁、红花等,513日开始,服药12剂,已有一个结节消失,因在非典期间,未来复诊,自取原方,服至38剂,结节由10个减至2个,其间新起一个,起而又退。至本文成文之前数日,来复诊,仅下肢余一个矣。

Recently, I treated a lady in San Zhi Tang clinic, whose name was Wang, 63 Years of old, and a teacher in a middle school in Beijing. In the end of February this year, she found some round knots on the body, 8 in the both sides of her thighs, and 3 in the arms, about 1.2 cm x 1.2 cm in size. Two of the mass were with purple color on the skin over them, but most of others were without skin color change. Biopsy did in the Xie He Hospital (Beijing) diagnosed them as Non-Hodgkin's malignant lymphoma (the biopsy sample number of 3021194 and 3021196). Her pulse was string and slippery. The color around her eyes was dark black. Her condition was considered to be “phlegm mass” in the TCM. It was decided to use herbal therapy to activate blood circulation, to dissolve phlegm, and to dredge meridian. The herbal formula used was the Yang He Tang (the Mahuang in the formula was 3 g in each dose), using Mahuang, ginger-processed Banxia, Processed Manxing, Shanjiazhu, Jiangcan, Juluo, Zibei Tiankui, Danshen, Taoren, and Honghua, etc. From May 13, after 12 doses of the herbal therapy, one mass disappeared. Because at that time, it was the period in which the SARS spread in China, she did not continue for consultation. She continued the herbal therapy for 38 days, the number of the mass reduced from 10 to 2. During that time, there was one new mass, but it shrank again and disappeared. Several days before this article was finished, she came for consultation, there was only one mass in the leg.

现代外科名家北京赵炳南先生亦赏用阳和汤,其经验方外用消化膏有温阳散寒,活血消肿之功,方即用炮姜、红花、白芥子、南星、生半夏、黑附子、肉桂、大戟等与麻黄配伍;治疗腋窝淋巴结核、胸壁结核、胸前疽、腋疽等疾病的回阳软坚汤,即阳和汤的加减方(去鹿角胶、甘草,加白僵蚕、橘红、三棱、莪术、全丝瓜)。从古今经验结合《本经》的记载,似不能用一般的散寒、开腠理、开泄卫气之类说法来解释麻黄在方中的作用,而是要肯定麻黄的破症坚积聚作用,徐灵胎之说还嫌说服力不足。如何能有这样的作用?我看不难作释,那就是以其迅捷之性,温通阳气,气通瘀散,则其病可去。

Dr. Bing-nan Zhao, who is a very famous doctor in surgery in Beijing, also strongly recommends the use of Yang He Tang. He uses experienced herbal formula “Xiao Hua Gao” to warm the Yang Qi and to disperse Cold, to activate the blood circulation and to solve the mass/knot in the body. The formula uses Processed ginger, Honghua, Baijiezi, Nanxing, fresh Banxia, Black Fuzi, Rougui and Daji, etc. together with Mahuang. He also uses Huiyang Ruanjian Tang for the treatment of armpit lymphatic tuberculosis, chest tuberculosis, carbuncle in chest or in arm pit. This formula is modified from the Yang He Tang (remove the Lujiaojiao and Gancao, but add Baijiangcan, Juhong, Sanleng, Ezhu and whole Gualu). From the experience of doctors in the history and the record in the book <<Ben Jing>>, the function of Mahuang seems hardly explained by its function to disperse Cold, to dredge the skin-fascia, or to open and to deplete the Wei Qi. It has to confirm its function to “break the mass and knot”. The explanation by Dr. Ling-tai Xu seems not convincing. I don’t think it hard to explain. The function of Mahuang in these formulae, due to its fast movement nature, is to warm Yang Qi. When the Qi is moving, the blood stagnation disappears, so the disease (the mass) subsides.  

以上,我分别从几个不同的方面谈了个人对麻黄的认识。为什么要谈这些,主要是我不满于当今大学中药学教材麻黄发汗、平喘、利尿三大功用之说,我觉得教材这样的编写方法,在某个意义上说,不是写中医教材,而是印证麻黄含麻黄油,麻黄碱,伪麻黄碱等化学成分的作用。照此下去,在堂而皇之的科学的大旗下(谁敢跟科学较劲儿呢),不仅要丢掉前人许多宝贵的经验,而且危及中医药的前途,希望引起同道的重视。而我所谈,并不全面,也很肤浅,企盼同道指正。

From discussion above, I, from various aspects, introduced my own understanding of Mahuang. Why I spend so long and so thorough to discuss it? The reason is that I feel not satisfied for the introduction of Mahuang in the text book used now in the Medical universities, in which the Mahuang is said to only stimulate sweat, to ease asthma, and to improve urination. I think that such a way to edit a text book in Chinese medicine, from some point of view, is not to edit a text book for Chinese medicine, but to confirm the function of the ingredients of Mahuang, such as Mahuang oil, ephedrine, and iso-ephedrine, etc. If such a way continues, under the influence of so called science (who dares to conflict against science nowadays?), there would be a great risk not only to lose a lot of valuable clinic experience of doctors in old time, but also the future of the Chinese medicine. I hope my colleagues in the Chinese medicine understand this. What I said here of course is not complete or thorough. I hope that my colleages could correct my mistake, if any.

此外,我还想再谈谈与麻黄有关的一些问题。麻黄辛、苦、温,但非大热。李时珍引僧继洪言,说有麻黄之地,冬不积雪,恐怕不是事实,或者是把偶然看成了必然。我去年在山西曾问过当地药农,药农大笑,说哪有那回事。或许就是由于以讹传讹的缘故,才使人们畏麻黄如虎吧?

In addition, I want to talk more things related to the Mahuang. Mahuang in deed is spicy, bitter and warm, but not strong hot. Dr. Shi-zheng Li cited the statement of Ji-hong Shen that wherever there is Mahuang growth, there would have no snow in winter there. This might not be true, or he took the occasional observation as a common phenomenon. Last year, I have been in the Shanxi province and asked a local farmer a question about this. He laughed and said there is no such thing at all. Probably, it is a circulation of a erroneous report, which makes people fears the Mahuang as fears a tiger?

其实单味麻黄,用一般剂量(成人69g)入汤剂,在体质壮实者,并没有很强的发汗作用。蒲辅周先生深知麻黄的利与弊,从前他在四川农村县镇行医时,遇时行感冒,发热无汗者,常用走马通圣散,即麻黄研粉,二份,甘草研粉,一份,合匀,每服35g,得汗则停服,可收汗出热解之效。走马,言其效之迅捷也。查《景岳全书》亦载此方,唯多雄黄一味耳。但走马通圣散并非峻汗之方,蒲老曾向我指出:就是麻黄汤。因为麻黄与桂枝相配,发汗之力大大增强,但亦非一般书上说的峻汗之方,唯大青龙汤才是峻汗之方,虽然也是麻桂同用,但桂枝量二两未动,麻黄用量却由原方的三两倍量为六两了。记得余无言先生《余氏父子经验方》说:服桂枝汤不可汗出如水流漓,麻黄汤用后必须大汗淋漓始解,但麻黄汤发汗之力并不如此强大。

In fact, when the Mahuang is used as an ordinary dose (such as 6-9 g in an adult) and to a person of strong body constitution, there is no strong function to stimulate sweat. Dr. Pu-fu Zhou understands the advantage and disadvantage of Mahuang very much. Previously when he had clinic in a small town in Sichuan province and whenever there was a seasonly common cold, he used herbal formula Zou Ma Tong Shen San, in which, the Mahuang powder (two parts) was mixed with Gancao powder (one part). The patients were asked to take orcally 3-5 g each time. It was stopped to continue after the patient got sweat. It worked to reduce fever after having sweat. The words “Zou Ma” means that the herbs works very fast. By check, it is found that this formula is also recorded in the book <<Jing Yue Quan Shu>> but with one more ingredient: Xionghuang. However, the Zou Ma Tong Shen San is neither a strong formula to stimulate sweat. Dr. Pu told me that it is the Mahuang Tang actually. When the Mahuang is used together with herb Guizhi, the function to stimulate sweat in largely enhanced, but it is not as said in some book that it is a strong sweat-stimulating formula. Only the formula Da Qinglong Tang is the strong formula to stimulate sweat, in which though the amount of Guizhi is the same (30 g) but the amount of Mahuang is increased from 45 g to 90 g. I remembered that Dr. Wu-yan Yu said in his book <<Yu Shi Fu Zi Jingyan Fang>> that when use Guizhi Tang, it should be controlled not to cause heavy sweat, while in the use of Mahuang Tang, the disease would be dissolved only after a heavy sweat. However, the ability of Mahuang Tang to stimulate sweat is not so powerful.

当然,我国幅员广大,南北东西,温差甚大。在东北、西北、西南,如遇伤寒表实证,用麻黄23g,等于不用,而在江南、岭南,确实往往23g即可得汗。不唯此也,不同的人用麻黄后反应也不同。秉赋强,体质壮,药与证又相当者,用之固佳,而体弱之人,即使当用者也要斟酌。我看以前丁甘仁医案,麻黄23g,桂枝23g,石膏9g,也叫仿大青龙法表里两解,不禁窃笑。后来读《程门雪医案》,才知素禀孱弱者,不要说麻黄,就是用桑叶也会造成汗出不止,说明在不同的医疗对象面前用药,还是应当持小心谨慎的态度。

Of course, our country is so big and broad. The difference in temperature between south and north is so big. In the zone of Northeast, Westeast, and Westsouth, once there is a Shanghan body surface overwhelming condition, to use Mahuang as 2 or 3 g is as not use it yet. Not only this, the reaction of different person to the Mahuang is also different. For person who is stronge in body constitution and if herbal formula matches the body condition, the Mahuang-containing formula of course works well. For person who is weak in body condition, the Mahuang should be used very carefully even if the disease condition really indicates the use of it. Previously when I read the case report from Dr.Gan-ren Ding, who used Mahuang 2-3 g, Guizhi 2-3 g, and Shigao 9 g, which he called “mimicking Da Qinglong Fang (to solve the body surface and inside illness the same time). I could not refrain from laugh. Later, after I read book <<Cheng Men Xue Yi An>>, I knew that, for person with very weak body constitution, not to speak of Mahuang, even the herb Sangye could cause running sweat. It clearly indicates that, to face different patients, it needs very careful attitude to choose herbs.  

此外,麻黄毕竟有泻无补,毕竟温燥发散,所以一般说应中病即止,不宜长服久服。外感时病用麻黄,得汗即须停用;哮喘、证等内伤病用麻黄,须较长时期使用者,一般不宜大量,而宜得效后减量,同时还须注意调整配伍。刘渡舟老师曾治一人哮喘,用小青龙汤甚效,患者亦以此方为依赖,连续用十余剂,不意竟鼻衄如注,不得不送医院急救。刘老因此认为用小青龙汤喘减者,可用苓桂剂调理为妥。张锡纯《衷中参西录》亦提出过:北地严寒干燥,各令却最多伏热伏燥,故用小青龙汤,不管有没有里热烦燥,都可以加石膏;用小青龙汤得效后,病未全愈,或愈而复者,又可用从龙汤(龙骨、牡蛎、白芍、清半夏、苏子、牛蒡子)。同样道理,在外感病用麻黄汤时,张锡纯主张,凡阴分不足,内有蕴热者,宜加知母,是为麻黄加知母汤;气虚者则可酌加益气药。这些都是宝贵的经验之谈,足资临证用药参考。

 Further more, Mahuang functions mostly to deplete, not to nourish at all. It is warm, dry and bears function to disperse, so it should be stopped to use when the disease has been improved, and it should not be used for long time. When used in the treatment of external common cold, it should be stopped when the patient gets sweat. If it is used in patients with asthma and Bi syndrome (such as arthritis), which need long time use of Mahuang, the amount of Mahuang should not be large. Also, once the herbs start to work, the amount of Mahuang should be reduced. At the same time, it is needed to pay attention to change and modify the remaining ingredients in the formula. Dr. Du-zhou Liu had a patient with asthma. He used Xiao Qinglong Tang and it worked very well. The patient had also addictive to the formula. He used ten doses of the Xiao Qinglong Tang continuously. However, it came out that the patient got heavy nose bleeding. The condition was so severe that he had to be send into the emergency department in hospital. For this, Dr. Liu believed that for those of patients with successful treatment with Xiao Qinglong Tang, the herbal formula should be changed to Fuling- and Guizhi-containing herbal formula. Dr. Xi-chun Zhang also stated in his book <<Yixue Zhong Zhong Can Xi Lu>> that in the north part of the China, it is very cold and dry, and the body is easy to have hidden hotness and hidden dryness inside, so that the Xiao Qinglong Tang is used very often. No matter there is inside Hotness or annoying, the herb Shigao can be added in the formula. For those of patients whose asthma had been well improved, but the illness had not been completely solved, or it breaks out again after a complete improvement, use Cong Long Tang for the treatment (Longgu, Muli, Baishao, Qing Banxia, Suzi and Niubangzi). For the same reason, when used to treat external common cold with Mahuang Tang, Dr. Xi-chun Zhang supposed that, if the patient is poor in the Yin part of the body, and is with inner hotness, the herb Zhimu should be added. This is the Mahuang puls Zhimu Tang. If the patient is with Qi deficiency, add proper amount of Qi-nourishing herbs. All of these are valuable experience, sufficient to be a reference in clinic use of herbal therapy.

 

 

15.  谈大黄──兼与沈自尹院士商榷

15. Talk about herb Dahuang (Chinese Rhubarb) – discussion with Academician Zi-yin Shen

 

1. 关于大黄的别名

1. About the folk name of herb Dahuang

沈自尹院士在《北京晚报》20021226日发表了宫廷大黄研究的继承与创新一文,首先提到大黄古代亦称黄良,言其疗效良好,性质良好也;又称将军,言其能戡定祸乱,是救民于水火的将帅,并将大黄、人参、附子、生地喻为佛教中的四大金刚

Academician Zi-yin Shen published an article in newspaper <<Bei Jing Wan Bao>> on Dec. 26, 2002. The title of the article is “the carry forward and the development of the study on herb Dahuang”. He first of all mentioned that “The herb Dahuang was called Huangliang in old time, meaning that its healing effect is very good, and its nature is very good too; it was also called General (as in military), meaning that it is able to calm down disaster, and to save folk from fire and flood. The Dahuang was listed together with the herb Reshen (ginseng), Fuzi and Shengdi as the Four Devarajas in Buddhism.”

大黄的确有许多别名,其中也确以黄良将军最为人知。为什么别名黄良?张锡纯说:《神农本草经》谓其能推陈致新,因有黄良之名。(《医学衷中参西录.大黄解》),一语破的。如果还可以补充一点,那就是因为大黄虽有推陈致新,祛邪扶正之力,但不若巴豆、甘遂之类峻烈。如果说黄良就是疗效良好,则人参、干姜、附子、石膏用之对证,哪一味中药不疗效良好?何得为大黄一药所独专?

In deed, the herb Dahuang has various alias, among which the name “Huang Liang”[6] and “the General” is most popularly known. Why it is called “Huang Liang”? Dr. Xi-chun Zhang said: “in book <<Shen Nong Ben Cao Jing>>, it states that the Dahuang could “deplete the old and to create the new”, so that it is called Huang Liang.” (See book <<Yi Xue Zhong Zhong Can Xi Lu – explanation on Dahuang>>) It speaks the point. If we can talk more about the Dahuang, we can say that the Dahuang, though has such function, is not as violent as the herb Badou and Gansui. If it can be said that, the alias Huang Liang means “the healing effect is excellent”, which of the following herbs, such as Rensheng, Ganjiang, Fuzi and Shigao, not work “excellent”, when they are used in a matched disease condition and used in a proper way? Why this name is only given to the Dahuang?

大黄有将军之名,则以其迅速见走,直达下焦,深入血分,无坚不摧,荡涤积垢,有犁庭扫穴之功(《本草正义》);主通利结毒也,故能治胸腹满、腹痛及便闭、小便不利,旁治发黄瘀血、脓肿(《药征》);气味重浊,直降下行,走而不守,有斩关夺门之力,故号为将军(《药品代义》),推陈致新,去陈垢而安五脏,谓如戡定祸乱以致太平无异,所以有将军之名(《汤液本草》),无非是言其药性及作用,推陈致新,攻坚破结,俾邪去而正安而已,怎么竟被扯上救民于水火来?至于说古人将大黄、人参、附子、生地喻为佛教中的四大金刚,不免有望文生义之嫌,不知出于何人何书?我读书不多,只知道明代张介宾曾称大黄、人参���附子、熟地为药中四维,以大黄、附子为药中良将,言其攻邪之力;人参、熟地为药中良相,誉其扶正之功(《景岳全书.本草正》)。良将良相何时竟和佛教中的四大金刚扯上关系的?请沈院士有以教我。

The reason for the Dahuang has the alias of “General” is because it “moves very fast, straigt to the lower part of the body, deep into the blood portion. It breaks any kind of mass and clears every kind of dirty.” (<<Ben Cao Zheng Yi>>). “It works mostly to dredge and conduct the knob toxic mass, so being able to treat the bloating and fullness in the chest and stomach, the pain in belly, the block and stop in bowel movement, the difficulty in urination, and also treat jaundice, stagnated blood and abscessus” (<<Yao Zheng>>). “Dahuang is with heavy and strong smell. It goes straight downwards, moves without stay, and is able to break the block. So it is called General.” (<<Yao Ping Dai Yi>>). “It depletes old and creates new. It removes dirty so to calm the organs, such as to create peace by combating down the disaster, so that it is called the General.” (<<Tang Ye Ben Cao>>). All of the statements talk about its herbal nature and its function. How it is implicated to the “save the folk from fire and flood”? So far as to say that Dahuang, Renshen, Fuzi and Shengdi as the Four Devarajias in Buddhism, it bears some kind of strained effort. Where such saying comes? I did not read a lot of books. I only know that Mr. Jie-Bing Zhang in Ming dynasty mentioned that, the Dahuang, Renshen, Fuzi and Shoudi are the four meridians in the herbs. It said that Dahuang and Fuzi is good General, meaning that they have power to deplete the Xie Qi; the Renshen and Shoudi are the good Prime Minister, praising that they have ability to support body defense Qi. (<<Jing Yue Quan Shu – Ben Cao Zheng>>). How the good General and the good Pirme Minister are involved with the Four Devarajias in Buddhism? I wish Academician Sheng could teach me. 

 

2.大黄是补药还是泻药

2. Is Dahuang a nourishing herb or an depleting herb

这本来不算个问题,不懂医的老百姓也能答出来,但是,大谬不然,例如前些年,有位中国在英国剑桥大学的访问学者,当李约瑟夫人问他大黄的作用是补还是泻时,他的回答居然是:有一点补。这个小故事后来还收在他写的一本书里。沈自尹院士则写道:宋代名医张之河也是应用大黄的能手,他提出养生当论全补,治病当论药攻,通下才可以补虚的观点,并明确指出阴虚则补之以大黄硝石’”。宋代没有名医叫什么张之河的,倒是金代有位名医叫张子和,他确实提出过养生当论食补,治病当用药攻的观点,也确实说过阴虚则补之以大黄硝石。但是,张子和的本意是因为世俗喜补而畏攻,但病是由邪气强加于人而起,所以先论攻其邪,邪去则元气自复,如果邪盛之时畏攻用补,那就等于资寇助粮;只有攻邪,才是有效保护元气的方法。所以这种不补之补,才是真补。也就是说,张子和之论,是为了补偏救弊。不过他的话失于偏激,阴虚则补之以大黄硝石是因为热邪劫烁津液,用硝黄撤去其热,阴即受到最有效的保护,但这并不是说大黄芒硝真有补阴的作用。我们评介古人学术观点,要有分析,要有批判,而不是不负责任地照抄出来,否则还叫什么研究?只能是误导。

This should not be a question actually. Even a ordinary folk who do not know Chinese medicine knows the answer. However, it is not so. For example in previous years, there was a Chinese, who is a visiting scholar in Cambridge, England, in deed answered: “there is little nourishing function”, when Mrs. Joseph Needham asked him the Dahuang’s function is to nourish or to deplete. This small story later has been cited in one of his books. Academician Shen wrote however: “The famous doctor in Ming dynasty, Dr. Zhi-he Zhang, is also good at the use of Dahuang. He recommended “To maintain health needs to nourish completely; to treat a disease needs to use herbs. To nourish the weakness condition needs the conduction downwards. He clearly pointed out to use Dahuang and Xiaoshi to nourish the Yin deficiency.”

In the Song dynasty, there was no a famours doctor named Zhi-he Zhang, but in the Jin dynasty, there was a famours doctor with name of Zi-he Zhang. Dr. Zi-he Zhang in deed mentioned that “to maintain health needs nourishment by diet, and to treat a disease needs herbal therapy.” He also in deed said “to nourish the Yin deficiency needs the use of Dahuang and Xiaoshi.”  However, the real meaning of Dr. Zi-he Zhang is to emphasize that a disease is caused by a Xie Qi invasion, so that it is needed to deplete the Xie Qi. Once the Xie Qi is depleted, the body health condition would be then restored. This is because people in that time like to use the nourishing therapy but dislike the depleting therapy for a treatment. When the Xie Qi is overwhelming in the body, the nourishing therapy is used but not the depleting therapy, it almost means to help the Xie Qi with more nutrition. Only by the use of depleting therapy, could help and protect body defense Qi. In another words, the statement of Dr. Zi-he Zhang is to correct the mistakes in the selection of therapy at that time. Of course his argument is extreme stated. “To use Dahuang and Xiaoshi to nourish the Yin deficiency” is because a Fire Xie Qi burns the body liquid portion. Now use the Dahuang and Xiaoshi to cool down the Fire, so as to save the body liquid portion (e.g. the Yin). This does not mean that the Dahuang and Xiaoshi have a function to nourish the Yin. When we evaluate the opinion of people in old time, we should check and analysize their real meaning, not just copy what they said. Other wise, why do we need a “research” work now? Simply “copy” the words of people in old time would cause a misleading.

 

3.大黄治疫

3. Use of Dahuang in the treatment of epidemic disease

有关的记载早出于《伤寒论》,《素问遗篇.刺法论》说五疫之至,皆相染易,无问大小,病状相似。和他差不多同时的曹植在其名篇《说疫气》里说建安二十二年,疫气流行,家家有强尸之痛,户户有号泣之哀,或沿门而殪,或覆族而丧,联系到仲景原序中说的余宗族素多,向余二百,建安纪年以来,未及十稔(不到十年),其死亡者三分有二,伤寒十居其七,可知《伤寒论》的主要内容是疫病即急性热性传染病的证治。

The record for the description of a epidemic disease is in book <<Shang Han Lun>. … It is therefore known that the main context of the book <<Shang Han Lun>> is about the diagnosis and treatment of an epidemic disease.

《伤寒论》阳明篇的白虎承气二方,就是疫病(当然也包括感染性疾病、杂病)的有效处方,白虎汤是清法代表方,承气汤是下法的代表方,疫病到了阳明阶段,得清下二法而解者,柳宝诒说十之六七,实际上恐怕还不止此数。也就是说,疫病治法是包含在《伤寒论》中的。但后世明确提出疫病的概念,还是一种进步,是对仲景之学的继承和发扬。

In the chapter of Yangming phase in book <<Shang Han Lun>>, there is a formula called Bai Hu Tang[7] which is a effective formula in the treatment of epidemic disease (as well for the treatment of infectious disease and various other disease). Bai Hu Tang is a representative formula to clear Fire in the body. The Chen Qi Tang is the representative formula to stimulate bowel cleansing. Once an epidemic disease develops into the Yangming phase, it is needed to use the Fire clearing and bowel cleansing therapy. Mr. Bao-yi Liu said that “six out of ten, or seven out of ten kinds of disease need such treatment”. In fact, there might be more cases that needs such therapy. In another words, the treatment principle of an epidemic disease is included in the book <<Shang Han Lun>>. Doctors in later time point out the concept of “epidemic disease”, which is a further development of the book, and which is the carrying on and development of the opinion of Dr. Zhongjing Zhang.

 

现在再回到大黄的话题上来:

Now we come back to the discussion of Dahuang:  

用大黄治疫,始见于《元史.耶律楚材传》。其时元军南下,军旅中出现疫病,耶律楚材让大家服大黄得愈。是什么样的疫病?《元史》说是土疫,五行中脾胃属土,可知是消化系统染病。其后若干年,在《丹溪心法》中,有人间治疫有仙方,一两僵蚕二大黄的记载,丹溪不以外感病见长,这张方子,是否与《元史》上述记载有关,就不得而知了。

To use Dahuang in the treatment of an epidemic disease is first seen in book <<Yuan Shi-Ye Lu Chu Cai Zhuan>>. At that time, the Yuan army moved down south. It broke out an epidemic disease in the army. General Ye Lu Chu Cai asked soldiers to drink Dahuang extract and they got recovery. In the <<Yuan Shi[8]>> it said the epidemic disease was “Soil epidemic disease”. In the Five element theory, the Spleen and Stomach belong to the Soil. So it can be implied that the epidemic disease at that time is a disease in digestive system. Some years later, in the book <<Dan Xi Xing Fa>>, there is record “There is very good formula to treat epidemic disease, which uses Jiangcan (30g) and Dahuang (60 g)”. Since Dr. Dan-xi is not so good at the treatment of external invading disease, it is not know whether this formula in his book may or may not be associated to the record in the <<Yuan Shi>> above.

明代吴又可在《温疫论》中提出,大黄之用,本为逐邪,邪热是疾病的本质,结粪只是邪热内结的现象,所以不能等到结粪形成才用下法,贵乎早用大黄,频用大黄。当然他也分表里,但温疫热变甚快,初起一二日,服达原饮一服,早晨还苔如积粉,中午苔就可能变成黄色,这是邪毒传胃,这时就要在方中加大黄了;午后舌黑生刺,鼻如烟煤,便当急投大承气汤。这样的认识,别开生面,是宝贵的实践经验的总结。我在农村、工地工作时,多用此法。

Dr. You-ke Wu (Ming dynasty, China) mentioned in his book <<Wen Yi Lun[9]>> that the original use of Dahuang is to deplete Xie Qi. The Xie fever (hotness) is the nature of the disease (of this kind). The knot-forming of stool in colon is the phenomenon of the Xie Qi and the fever tangled inside the body. Therefore, it should not wait to use the depleting therapy until the formation of the tangled stool. It is important to use the Dahuang in early stage and use it frequently. Of course, Dr. Wu also separated the disease into the body surface phase and the inner phase. However, epidemic disease develops very fast. In the first one or two days, drink Da Yuan Yin for one dose, in the morning, the tongue cover is white as a layer of white powder on it, at noon, it might become yellow in color. This is the Xie Qi passing into the stomach. At this time, it is needed to add Dahuang to the formula. In the afternoon, the tongue becomes black in color, which looks as there is thorn on the tongue, and the nose looks as black as coal. At this time, the Da Cheng Qi Tang should be given urgently. Such recognition is very interesting. It is very valuable summary of clinic practice. When I worked in countryside and in construction site, I used this way often.

石某,男,40余岁,在春耕会议期间患流行性感冒,发作性憎寒发热,身痛如被杖,无汗,舌红,舌苔白腻,脉滑数,曾自服中成药及汤剂荆防败毒散未得汗。病属风寒挟湿,邪伏募原,予达原饮(厚朴、草果、槟榔、知母、黄芩、赤芍、甘草)一剂,当晚服药1次,次日晨突发寒战,舌苔由白腻转为焦干,厚如积粉,此热盛劫津之象,加入大黄15g,葛根、柴胡各15g,羌活12g,一服即腹中雷鸣,再服即得畅便2次,汗出如渖,臭秽难闻,寒热身痛皆愈,表解里和而安。

Mr. Shi, male, 40 years of old. He suffered from flu during a meeting. He felt chilly and fever, which came and went. He felt pain whole of the body as beat by rod. He had no sweat. The tongue was dark red in color. The tongue cover was white and greasy. The pulse was slippery and frequent. He tried by himself several Chinese herbal product (such as pills or tablet), as well as herb extract Jing Fang Bai Du San, but no sweat stimulated. His disease belonged to the attack by Wind and Cold, together with Wetness, in which the Xie Qi hidden in the Muyuan layer of the body. He was given Da Yuan Yin (With herb Houpu, Caoguo, Binglang, Zhimu, Huangqin, Chishao, and Gancao) one dose. At that night, he drank one time. Next morning, he dad a suddon chilly. His tongue cover changed from white and greasy into charred and dry, which was thick as a layer of powder on it. This is the sign that the Fire burned and dried the liquid portion of the body. To the formula above, added were Dahuang 15 g, Gegen 15 g, Chaihu 15 g, Qianghuo 12 g. One time drink of this herbal tea stimulated his belly sound laudly as thunder. After second drink, he had two times of easy bowel movements with heavy sweat, which was with very bad odor. The chilly and fever went away and he got recovery completely.  

但是,需要指出,吴又可治疫,并非如沈先生所说有邪必逐,除寇务尽,更不是只知道一味用大黄猛攻,而是视具体情况而定,表里虚实还是要分的,不能攻者即不攻。如他说初起邪不在里,下之徒伤胃气愈后大便数日不行,别无它证,此是三阴不足,此致大肠虚燥,此不可攻。强调逐邪,然亦必因证而施,这才是符合科学道理的

However, it should be pointed out that, Dr. You-ke Wu treats epidemic disease, not “to deplete the Xie Qi completely{, as mentioned as Dr. Shen (above), nor to use the Dahuang continuously to deplete the Xie Qi, but to make clinic decision according to the body condition of the patients. Wheter the Xie Qi is in the body surface condition and/or inner condition need to be considered. Whenever the body condition does not allow depletion, the depleting therapy would not be used. As he said: “if the Xie Qi is not in the inner body, the use of depleting therapy would only hurt the Stomach Qi”. “If the person has diarrhea after the recovery from the fever and constipation, but no signs for any other body trouble, it indicates the three Yin all in deficiency, which causes the large intestine in weakness and dryness. In this case, the depleting therapy should not be used.” He emphasizes the depletion of Xie Qi, but also takes care of body condition. This is in deed along with the “scientific spirit”.

近至近代,江西肖俊逸(人称肖大黄)善用大黄治疗肠伤寒,上海聂云台的表里和解丹、葛苦三黄丹亦都以大黄为主药。肖氏治肠伤寒,主以攻下,应下即下,以大黄、黄芩、黄连为主,且一直服至热退为度,若热虽退而黄苔未化,亦须继续服用以防再燃20世纪50年代陕西米伯让治疗钩端螺旋体病,对钩体温黄(黄疸型)热重于湿,高热持续,黄疸不退之重证,主张用清瘟败毒饮重加茵陈、大黄,获得显著疗效。南京周仲瑛、江西万兰清等治疗流行性出血热病中最为棘手的少尿期,以大黄配合芒硝、枳实、生地、麦冬、白茅根、猪苓、桃仁、牛膝,一般23天即可进入多尿期甚至跃过多尿期进入恢复期。这些也都是大黄用于疫病所取得的新成绩。

Now in recent times, Dr. Jun-yi Xiao in Jiangxi province (people call him Xiao Dahuang) is good at use of Dahuang for the treatment of jejunotyphoid. Dr. Yun-tai Nie in Shanghai is good at the use of Biao Li He Jie Dan and Ge Ku San Huang Dan, both of which use Dahuang as main ingredient. In the treatment of jejunotyphoid, Dr. Xiao focused the depleting therapy (colon-cleansing therapy) if the body condition indicate the colon cleansing therapy, in which the Dahuang, Huangqin and Huanglina are the main ingredients. The herb extract were asked to take until the fever subsided completely. If the fever is over, but the tongue cover is still with yellow color. The herbal tea is still needed to drink, so as to prevent the “recurrence” of the disease. In the 1950s, Dr. Bo-rang Mi in Shannxi province treated leptospirosis. He recommended to use Qing Wen Bai Du Yin, with large amount use of Yinchen and Dahuang in it, for the treatment of the disease, in which the Hotness is overwhelming over the Wetness, the patients had fever and continuous jaundice. It worked very well. Dr. Zhong-ying Zhou in Nanning, and Dr. Lan-qing in Jiangxi province, both treated the “low urination phase” of epidemic hemorrhagic fever. They used Dahuang, together with Mangxiao, Zhishi, Shengdi, Maidong, Baimaogen, Zhuling, Taoren, and Niuxi. Generally speaking, it needed only 2- 3 days to make the patient from the “low urination phase” into the “more urination phase” and further into the recovery phase. These are also the new achievement in the treatment of epidemic disease by use of Dahuang.

 

4.大黄用于急性感染性疾病;

4. The use of Dahuang in the acute infectious disease

大黄可用于多种急性感染病疾病,如肺炎、胆囊炎、胆石症、急性胰腺炎、急性阑尾炎、败血症、尿路感染以及细菌性痢疾等,用得恰当,效如桴鼓,兹就肺炎言之.

Dahuang can be used for the treatment of infectious disease, such as pneumonia, cholecystitis, gall bladder stone, acute pancreatitis, septicemia, infection in urinary tract, as well as bacillary dysentery, etc. If used in a proper way, it works very fast and very well. Here we discuss its use in the treatment of pneumonia.

今人治肺炎,主张早用大黄,如江苏省中医院用麻杏石甘汤加生大黄、大青叶、金银花、紫草、蒲公英等,北京西苑医院用清肺液(大黄、黄芩、赤芍),友谊医院用肺炎泻热方(大黄、玄明粉、甘草、玄参),据大宗病例报告,效果很好,尤其对病毒性肺炎及耐药菌株产生的细菌性肺炎,往往可以有抗菌素起不到的治疗效果。以上这些经验都是具有突破性的。

TCM doctors in now a days recommend the early use of Dahuang in the treatment of pneumonia. For example, TCM doctors in the Chinese medical hospital (Jiangsu province) used Ma Xing Shi Gan Tang plus Dahuang, Daqingye, Jingyinhua, Zicao, and Pugongying, etc. Doctors in Beijing Xiyuan hospital used Qing Fei Ye (Dahuang, Huangqin, and Chishao). Doctors in Youyi hospital in Beijing used Fei Yan Xie Re Tang (Dahuang, Xuanming powder, Gancao, and Xuanshen). Review of its use in large samples suggested very good healing results. Especially for virus pneumonia and the bacterial pneumonia with drug-resistance, the Dahuang-containing herbal therapy often worked surprisingly well that can not be obtained by the use of anti-biotics. These experience are revolutionary break out in the Chinese medicine. 

我学习这些经验之后,有些肤浅的领悟。肺炎一般多归属于中医学风温范围,初起病在肺卫,卫之后,方言气,营之后,方言血,其中一部分可以依照这样的证治规律而获效,但更多的患者,初起卫分证多不明显或极短暂,一开始就出现喘、憋、高热、口渴、烦躁不安等里热证,这显然不是在卫汗之可也能解决问题的,这是温热伏邪又挟痰热的表现,因此不同于一般的风温肺热,一开始就要用苦寒直折,佐以清热化痰,甚至通腑泻热,这时及时合理地使用大黄,就是合符辨证论治原则的,是有是证,用是药的,而不是把大黄视作抗生素,在抗生素疗效不佳时寻找到的一味替代药。这些认识是否有当?盼同道指正之。

I learnt these experience and also had some my own brief understanding. Pneumonia is commonly related to the “Wing Hotness” disease in Chinse medicine. Initially it locates in the lung and Wei layer of the body. “After the Wei phase, it is the Qi phase. After the Ying phase, it would be the blood phase.” Some patients can be cured according to such rule of the treatment. However, for more cases, the initial Wei phase is not clear or is very short to show. The patients had asthma, choking in breath, high fever, thirsty, annoying, such inner hotness syndrome, very soon when they felt sick. Apparently, such condition cannot be solved with the sweat therapy for the initial Wei phase. It is the clinic phenomenon of the hidden Hotness Xie Qi together with phlegm-hotness. Therefore it is different from the ordinary Wind-hotness Lung Fire. For such condition, it is needed to use the bitter-cold herbs straightly in the beginning phase of the disease, to clear the Fire and to dissolve the phlegm, even to conduct the intestine to deplete the Fire from colon. At this time, proper use of Dahuang is in accordance with the principle of TCM in diagnosis and treatment (treatment bases on the clinic condition). It means to “use the herb if there is indication to use it.” It does not mean to use the Dahuang as a biotics or to use it as a replacement to the biotic when the biotics does not work. Am I right to think this way? I hope my colleague in TCM could make correction if I am wrong.

兹录我的一例重症肺炎治验:

Here is my experience in the treatment of a case of severe pneumonia:

林卫仪,女,8岁,住荷兰埃因霍温大学医院,因肺炎病危进入监护室。各种管子插了一大堆,病不见轻,其家长征得荷兰医生同意试用中药。顷诊:高热,神昏,抽搐,痰声如曳锯,隔著玻璃窗也能听见,颜面潮红,额有微汗,舌红,苔黄腻,脉滑数,此痰热壅肺之重证,拟通腑清热豁痰定惊。药用生大黄10g,黄连6g,黄芩6g,焦栀子6g,全栝楼10g,猴枣粉0.3g(二次冲),钩藤10g,川贝3g,石膏30g(先煎),羚羊角丝10g,前胡3g,石菖蒲3g,桔梗3g,鱼腥草10g11服,分3次鼻饲。服1剂后得畅泻34次,再剂加芦根30g,鱼腥草加倍,热退喘平,抽搐亦止,患儿第3天即进入普通病房。

The patient name is Wei-yi Lin, a 8 years of old girl. She was admitted into the Eindhoven university hospital. For high risk pneumonia, she was then sent into the ICU. She got various catheters in her body but no any improvement yet. Her family members got consent from doctors to try Chinese medicine. Upon the consulting and assessment, the girl had high fever, loss of consciousness, spasm, strong phlegm noice as sawing, which could be heard on the other side of the window. Her face was wet red with slight sweat on the front head. The tongue was extremely red with yellow and greasy tongue cover. The pulse was slippery and frequent. This is a severe case of Phlegm-Hotness stocking in the lung. It is considered to use herbal therapy to clear Fire, to disperse phlegm and calm down spasm. The herbs used were Dahuang 10 g, Huanglian 6 g, Huangqin 6 g, Jiao Zhizi 6 g, whole Gualu 10 g, Houzao powder 0.3 g (drink as powder twice), Gouteng 10g, Chuan Beimu 3 g, Shigao 30 g (cook first), silk Lingyang horn 10 g, Qianhu 3 g, Shichangpu 3 g, Jiegen 3 g, Yuxingcao 10 g. The herbal extract was intaken through nose catheter three times a day. After one time of the intake, the girl had bowel movement three to four times. In the second dose, added were Lugen 30 g, and doubled the amount of Yuxingcao. After that, the fever subsided, the asthma stopped and the spasm stopped too. On the third day, the girl was sent back to ordinary ward.    

 

5.止血圣药

5. Dahuang is very good herb to stop bleeding

大黄止血,早见于仲景《金匮要略》泻心汤证,此方实即大黄黄连黄芩泻心汤,治疗热邪内炽,迫血妄行之吐血衄血,方中主药即是大黄,不仅可用于吐衄,咯血、便血、尿血、妇女崩漏,只要是实热出血,大黄皆有殊功,且大黄止血而不留瘀,故唐容川《血证论》称之为圣药

To use Dahuang to stop bleeding is first seen in the formula Xie Xing Tang in the book <<Jin Kui Yao Luo>> of Dr. Zhongjing Zhang. This formula is the Dahuang Huanglian Huangqin Xie Xing Tang, which is used to treat Fire Xie accumulation inside the body, which forces the blood to bleed from nose and by vomit. The main ingredient in the formula is the Dahuang actually. It is used in the bleeding from nose, stomach, cough, urine, colon, and vagina. Actually, once the bleeding is due to an overwhelming Fire, Dahuang would work very well. In addition, to stop bleeding by Dahuang would not leave stagnation, so that Dr. Rong-chuan Tang said in his book <<Xue Zheng Lun>> that Dahuang is a “sacred herb”.

我多年来用大黄治疗支气管扩张或肺结核大咯血、鼻出血、胃溃疡吐血、便血、痔血,也都收到较为理想的效果。

For many years, I have been using Dahuang in the treatment of bronchiectasis, or cough blood due to tuberculosis, or nose bleeding, vomit blood due to gastric ulcer, bleeding in stool or urine. It works pretty well to stop the bleeding.

患者陈林,男,18岁。因肺结核进展期、肺出血,住某医院。每天早、中、晚都要咯血1次,每次约50100ml,已5天,总失血量约1800ml,曾用维生素K、维生素C、仙鹤草注射液、云南白药、脑垂体后叶素及养阴清热止血中药,血未能止。我诊其脉,弦数有力,舌红苔薄黄而干,面赤,口鼻气热,干咳,胁痛,大便色黑而硬。证属木火刑金,用大黄黄连黄芩泻心汤加味,1剂血止。

Patient Lin Chen, male, 18 years of old. For the developing phase of tuberculosis and lung bleeding, he was admitted into a hospital. Every morning, noon and night, he coughed blood once. The blood was about 50-100 ml. Such condition had lasted for 5 days. Total blood volume lost was about 1800 ml. He had been given Vc, Vk and herb Xianhecao injection, herbal powder Yunnan Baiyao, posterior pituitrin hormone, as well as herbal formula that was to clear Fire and to stop bleeding. The bleeding still continued. I felt his pulse. It was string, frequent and strong. The tongue was extraordinarily red, the tongue cover was thin, yellow and dry. His face was red in color, and air from nose and mouth was hot. He coughed without phlegm. He had pain on the side of body (between the chest and belly). The stool was black and hard. His condition was considered as the Wood and Fire attacks the Metal. He was given Dahuang Huanglian Huangqin Tang with some addition. After only one day of the herbal therapy, the bleeding stopped.

由这个病例可以看出:大黄止血,用之对证,其效立见,然必先议证,后议药,不是什么样的出血都可以一概地用大黄。例如阳气大虚即阳虚者阴必走(杨仁斋语)的出血、脾失统摄的出血,均非大黄的适应证,误用之则祸不旋踵。

It can be seen from the above case that, when use the Dahuang for stop bleeding, if it is used matching the clinic condition, it works very fast. However, it is needed to check the clinic condition before start the use of any herbs. It does not mean that the Dahuang can be used in any kind of bleeding. For example, for bleeding due to  heavy deficiency of Yang Qi, e.g. “when the Yang is in deficiency, the Yin must go away” (statement by Dr. Ren-zai Yang), or bleeding due to Spleen deficiency, it is not proper to use Dahuang for the treatment. If it is mis-used in such conditions, there would be a lot of more troubles coming out.

6. 大黄是气分药还是血分药

6. Dahuang goes to the Qi portion or to the Blood portion of the body

判断一味药是气分药还是血分药的标准,除了一般的形、色、气、味外,主要还在于药的功效,而药的功效又主要来自医者的经验。李时珍提出并强调大黄是一味入血分的降火要药,凡病在五经血分者宜用之(李说的五经即足太阴、手足阳明、手足厥阴)。他还说若在气分用之,是谓诛伐无过矣。沈先生对李说是持肯定态度的。细思之,大黄入血分固然有理,如仲景名方大黄虫丸、下瘀血汤都可以作为依据,但三承气汤、大陷胸汤及丸、厚朴三物汤、大黄甘草汤及后世名方如礞石滚痰丸,主治皆在气分。考诸文献,《神农本草经》既谓大黄下瘀血,血闭寒热,破症瘕积聚,又谓大黄主留饮宿食,荡涤肠胃,推陈致新,通利水谷,调中化湿,安和五脏,明明白白地表明大黄既入血分,又入气分,李时珍所言未必恰当。为什么在气分用之诛伐无过?无非强调大黄是血分药,故在气分者不可用也。如果真如他所说,那么大、小、调胃三承气汤将置于何地?攻下热邪与燥屎又怎么会是诛伐无过?胃火上冲,食已则吐,仲景用大黄甘草汤,你说是治气还是治血?滚痰丸用大黄黄芩泻火,礞石坠痰,沉香行气,与血分竟完全无涉,也是诛伐无过吗?

To tell whether a herb belongs to a Qi portion or a Blood portion herb, it is needed to check its shape, color, odor, smell. Mostly it depends on its function, which however comes from clinic experience of TCM doctors. Dr. Shi-zhen Li proposed and emphasized that Dahuang is a herb that goes into Blood portion and works to reduce Fire. He said “the Dahuang needs to be used whenever the disease is located in the Blood portion of the five meridians”. He also said: “if it is used to the Qi portion, it would cause trouble.” Academician Shen confirmed and supported the Dr. Li. By thanking over, it seems reasonable that Dahuang works in the Blood portion of the body. For example, the formula Dahuang Zhechong Wan, Xia Yu Xue Tang, those are the formula of Dr. Zhongjing Zhang, all support this idea. However, the three Cheng Qi Tang, Da Xian Xiong Tang (and its pill form), Houpu San Wu Tang, Dahuang Gancao Tang, as well as the Men Shi Gong Tang Wan, developed in later times, all work in the Qi portion of the body. Referenced from literatures, in book <<Shen Nong Ben Cao Jing>>, it states that Dahuang works to “deplete stagnated blood downwards, solve hotness and chilly due to blocked circulation, and break mass (tumor or fibrosis) in the body.” It also states that Dahuang works to “treat accumulated old phlegm and food, to clear stomach and intestine, to deplete the old and to create the new, to conduct water and food downwards movement, to calm digestive system and to dissolve wetness, and to harmonize all the organs.” It has clearly indicated that Dahuang works in both the blood and the Qi portion of the body. Therefore, what Dr. Shi-zheng Li said may not be necessarily correct. Why to say that if the Dahuang is used in the Qi portion of the body, it would cause trouble? It is simply to emphasize that Dahuang is a Blood-portion working herb, so it should not be used in the Qi portion. If he Shi-zheng Liis correct, where we could contribute the Dahuang in the three Cheng Qi Tang, to the Blood portion or to the Qi portion? …

读古人书,不要作古人的奴隶,孟子说尽信书则不如无书,也就是这个道理.

When read the books of people in old times, we should not become the slave of the books. Mr. Men Zi said “it is better do not read any book if you truth all books”. It means this. 

 

7.叶天士治温病不轻用大黄.

7. Dr. Tian-shi Ye do not use Dahuang without care in the treatment of Wen disease (epidemic disease)

叶天士是清代温热学派的领袖,惜生平无著述,《外感温热篇》、《三时伏气外感篇》皆其门人记录而传世者,反映了叶氏的温热学理论和经验。

Dr. Tian-shi Ye is the leader doctor of the Wen disease[10] style in Qing dynasty. It is pity that he did not leave any book to later generations. The book <<Wai Gan Wen Re Pian>> and << San Shi Fu Qi Wai Gan Pian>>, both are the records by his student and followers about his theory and practical experience.

叶天士治温病不仅用大黄非常谨慎,就是其他苦寒药,也反复告诫,不可轻投。他虽然指出三焦不从外解,必致里结,里结于何,在阳明胃与肠也,亦须用下法,但温病与伤寒不同,特别是吾吴湿邪害人极广多湿邪内搏,故下之不宜猛而宜轻。邪已入里,表证必无,或存十之一、二,当下者亦要验之于舌,或黄甚,或如沉香色,或如灰黄色,或老黄舌,或中有断纹,皆当下之,如小承气汤,用槟榔、青皮、枳实、元明粉、生首乌等,说,而不言主之,所用的药中也不提小承气汤的主药大黄,都可以看出他在用不用大黄上的态度,而其之所以反复论舌,也在表明哪些情况可用,哪些情况不可用。

In the treatment of Wen disease, Dr. Ye is very careful to use Dahuang. Even for some other Cold herbs, he reminded again and again to use them very carefully. He in deed also said that “if the disease in the three Jiao portion would not be released through body surface layer, they would entangle inside the body. Where inside the body? It is the Yangming phase. In this case, the colon-cleansing therapy should be used. However, the Wen disease is different from the Shang Han disease. Especially due to the fact that in the Wu area, disease is more caused by a Wetness Xie Qi, patients are usually with Wetness inside the body. Therefore, the colon-cleansing therapy should be used carefully. The therapy should work mildly, not violently. “Once the disease-causing Xie Qi is inside the body, the Xie Qi is no longer in the body surface phase, or, there would be one or two out of ten of the Xie Qi in the body surface.” At this movement, before the use of colon-cleansing therapy, the tongue should be checked, see if the tongue is very yellow in color, or as a color of eaglewood, or gray-yellow, or old yellow, or there is crack on the tongue. If the tongue is seen as such, the colon-cleansing therapy should be used, such as the Small Cheng Qi Tang, considering the herbs such as Binglang, Qingpi, Zhishi, Yuanming powder, Heshouwu, etc. Say “consider to use”, not “should use”, or “must use”, or “mostly use”, as well as not mention the Dahuang, which is the main ingredient in the original formula of Small Cheng Qi Tang, suggests his attitude in the use of Dahuang. The he reminded the check of the tongue is to demonstrate when to use the Dahuang, and when it should not be used.

我们再看他的《临证指南医案》,温、暑、湿温、燥、疫诸门所有医案,竟无一例用大黄者。沈自尹先生说:清代名医叶天士,在我国医学史上第一次提出了应用大黄的重要体征之一是最要紧者莫过于验舌若黄苔或如沉香色或灰黄色或中有断纹者均可用大黄,他认为湿热病者不论表邪罢与不罢,但兼是证,即可用大黄泻之’”。叶天士没有说过这样的话,不知沈先生是在叶天士的哪本书上看到的?

Now let’s see see the book <<Ling Zheng Zhi Nan Yi An>> about his way in clinic. In the case reports in the Wen, Shu, Wetness-Hotness, Dryness, and Yi chapter, there is in deed no any case which habe been used with Dahuang for the treatment. Mr. Zi-yin Shen said: “Dr. Tian-shi Ye is the first one in the Chinese medicine history to point out one of the important indications to use Dahuang is “most importantly check the tongue of the patient.” If the tongue conver is yellow or the cover is as eaglewood, or it is gray-yellow, or there is crack on the tongue, the Dahuang can be used.” He believed ‘no matter there is body surface symptoms or not in a Hotness-Wetness disease, once there is indications to use the Dahuang, Dahuang can be used to do a colon-cleansing therapy.” Dr. Tian-shi Ye did not say so. I do not know from which book Academician Shen see it?

正是因为叶氏治疗温病用药轻淡,即当用大黄等苦寒药时也不用,所以遭致姜春华先生尖锐的批评,他说:我们看清代许多名医医案,治疗温病(包括湿温)险证百出,令人惊心动魄,其效果之所以不佳,正是受此老之教,清淡如儿戏。据说,沈院士曾经和姜老共事过,不知他听到过这些话没有?要是知道,那就不会把上述均可用大黄即可用大黄下之这些话加在叶天士头上了。

Just because Dr. Ye uses light dose of herbs (and less violet functioning herbs) and he did not use Dahuang even if there is clinic indication to use, Dr. Chun-hua Jiang criticized him and said : “when we see the case reports from many famous doctors in the Qing dynasty for the treatment of the Wen disease (including Wetness Wen disease), the healing courses were very risky with very dangerous situations during the treatment. The reason for the poor healing results is just because the statement from Dr. Ye, who used herbal so light in dose, and less powder enough for the treatment, so that it almost as child playing.” It is heard that Academician Shen had worked together with Dr. Jiang. I do not know if he heard these from Dr. Jiang or not? If he knew, he would have not contributed the “all can use Dahuang” and “can use Dahuang for a colon cleansing therapy” to the head of Dr. Ye.  

 

8.大黄的用法用量

8. The amount of Dahuang to use

大黄的用法有很多讲究:单味开水浸泡或只煎一、二分钟,则力锐,与其他药同煎则力钝。脑出血昏迷病人,水入则吐,腹胀,不大便,舌红,苔黄而干,即用前法,分作2杯,先服1杯(约100ml),腑气若通,另一杯即不用,不通,再服第2杯,无不在二、三小时内排出稀溏便,久煎则无此作用。此类病人,虽属邪实,毕竟正虚,用大黄要谨慎,正所谓偷营窃寨,可一而不可再。肺胃实热,咯血吐血,用大黄粉吞服效果优于汤剂。大黄用酒炒则利于行。头面之病,亦多用酒炒,《用药法象》说大黄之性沉降,酒炒则可上升,如鸟巢高巅,射而去之。大黄用醋炒,缓消瘀血,且服后无腹痛之弊。小剂量(2g以下)醋制大黄装胶囊中吞服,有通便、健胃降脂、轻身减肥作用,气虚人、老人、妇女可配以一定比例的生晒参或红参须。1992年我在马来西亚工作时,曾拟此方,许多华侨朋友服后反映不错。

There are many things that need to be care in the use of Dahuang: it can be simply rinsed in boiled water for one to two minutes. The healing effect of the water is powerful. If it is cooked with other herbs the same time, the healing power is less. For patient with bleeding in brain and with loss of consciousness, who had vomit with drink of little water, bloating in belly, no bowel movement, extra-ordinarily red tongue, yellow and dry tongue cover, rinse the Dahuang in boiled water for one to two minutes. The water is separated into two parts. Drink the first cup (about 100 ml). If the intestine is conducted, the another cup does not need to finish. If not (e.g. no gas or stool out of the colon), finish the second cup. No patient had no bowel movement with loss stool within 2 to 3 hours. If the Dahuang is cooked in water for a long time, there is no such effect. The condition of such patient belongs to Xie overwhelming, but any way the body basic condition still belongs to a weakness as a background. The use of Dahuang should be careful, as it is said: “to attack enemy by hidden action can be done once but not again and again”. For the treatment of spit blood and vomit blood, due to Fire in the lung or stomach, drink the Dahuang powder (without cook in water) works better than its water extract form. After fry of Dahuang with liquor, the Dahuang would have more mobile ability. For disease in the face, the liquor-fried Dahuang is used more. In the book <<Yong Yao Fa Xiang>>, it states “For the nature of the Dahuang, for its going down or up in the body, the liquur frying increases its ability to go up, as the bird nest on the high peak position, which needs shot to removal.” After fried with vinegar, the Dahuang works to dissolve stagnated blood in a slower manner, and there is no side effect to cause stomach spasm. Small dose of such vinegar-processed Dahuang (less than 2 g), filled in capsules, works to move bowel, nourish the stomach, reduce blood lipids, and to reduce body weight. For patients with Qi deficiency, of for elderly or for women, it can be used together with some amount of Hongshen (red ginseng). In 1992, when I worked in Malaysia, I used this formula. Many Chinese-origin friends felt good after use it.

至于大黄炒炭用,实无深意,古方十灰散用之,大黄炭的作用无非收敛止血。而吐血、衄血、咯血之由气火上冲莫制者,用大黄炭则无效,必得生大黄苦寒沉降以直折之;阳明里结痞满燥实,也不用大黄炭,必得生大黄配枳实、厚朴、芒硝,通利荡涤;至于症瘕积聚、恶血瘀滞、黄疸、癫狂、疮痈、跌打损伤,亦皆宜生用,或酒制、醋制,炒炭则气味俱失,欲用它拨乱反正,岂能有效?曾治一人大咯血,用生大黄得效,改用制大黄后,其火又炽,血不得止,不得不再用生大黄。

For the process of Dahuang into a char, there is no big meaning. In the old herbal formula Shi Hui San, the function of charred Dahuang is to stop bleeding by restraining effect. If the bleeding from nose, stomach and lung is due to up-rushing of Qi and Fire, the charred Dahuang does not work. In the later case, it needs the fresh (not processed) Dahuang to reverse the Qi and Fire, by its bitter and Cold nature. If it is a Yangming phase with inner block, dryness, entangle, such overwhelming condition, the charred Dahuang is normally not used. In this case, the Dahuang is used without any process, and it is used together with Zhishi, Houpo, Mangxiao, to clear the intestine-colon. For the treatment of mass/tumor, stagnated blood or blood clots, jaundice, madness, carbuncle, bruise, or external hurt, the Dahuang had better to be used without process either. After process with liquor, or vinegar, or charred, the odor/smell and the taste of the Dahuang is lost, how could it be continued to use to solve severe disease conditions? I had a case with heavy spit of blood. The condition was solved with the use of non-processed Dahuang. Later, after changed to processed Dahuang, the Fire came back again and the patient had continuous bleeding, so that the non-processed Dahuang had to be used again.

大黄用量,因人而异,因证而异,有的人用1520g可能毫无动静,有的用35g即大泻。如本市农科院刘仁玉老太太,患急性阑尾炎,我用大黄牡丹皮汤加减,大黄用10g,即腹泻不止;另一例张姓阑尾炎老人,用30g却腹满如故。血证用散剂,13次,每次3g为宜;一般感染性疾病,每剂汤药常用量为615g,急腹症、疫证用量可达1530g,甚至更多一些。一般说,用大黄都要中病即止,即《内经》所谓大毒治病,十去其六衰其大半而止,如急腹症大便秘结者,可重用大黄、芒硝,而得效后大便溏泄者,就要减少大黄之量,泄得厉害的,则停用大黄。胆囊炎、胆石症患者当用大黄,一般也多采取打打停停的战术,片面地强调除恶务尽,其实很不科学,不顾正气,一味蛮干,肯定会出问题的。

The amount of Dahuang needed to be used depends on each patient and on the phase of the disease as well. For some, the amount of 15-20 g may have no any effect. For others, even 3-5 g may cause heavy diarrhea. For example, for Mrs. Yu-ren Liu, who was from Agriculture research institute of this city, suffered from acute appendicitis.  I used Dahuang Mudanpi Tang with some modification. The Dahuang used was only 10 g, but she got continuous diarrhea. In another case, Mr. Zhang, a old man, suffered also from appendicitis, 30 g of Dahuang did not change the belly bloating at all. When used in the disease in Blood portion, Dahuang is used as powder form, which is better to be three times a day, 3 g each time. For ordinary infectious disease, the common dose of Dahuang in a water extract form is 6-15 g. For acute abdominal diseases, it can be 15-30 g or more. Generally speaking, Dahuang should be stopped to use once the disease is under control, as stated in the book <<Nei Jing>> “when use violent herb to solve disease, it should be stopped to use after the disease condition has been improved 60%”, and “it should be stopped after the disease has been improved mostly.” For stop of bowel movement in acute abdominal disease, large amount of Dahuang and Mangxiao can be used. The Dahuang should be reduced in amount after the patient starts to have loss bowel movement or even diarrhea. If the diarrhea is severe, Dahuang should be stopped. For cholecystitis and cholelithiasis, if the Dahuang is needed to use, it generally used as try and stop, try and see. To emphasize to “solve the disease as completely as possible” is actually not reasonable. To attack the Xie Qi without the situation of body defense system would definitely create problem.

 



[1] Guizhi: the branches of Gui tree, e.g. the Chinese Cassia tree.  

[2] Rougui: the bark part of Chinese Cassia tree.

[3] Wen Fei Tang: Wen means to warm; Fei means lung.

[4] Liu Jun Zi Tang: Liu means number 6; Jun Zi means gentleman.

[5] Bi syndrome: it includes various clinic conditions with pain, stiffness, numb in the joints and muscle, including various arthritis.

[6] Huang Liang: Huang means yellow color; Liang means very good.

[7] Bai Hu Tang: Bai means white color; Hu means tiger; Tang means herbal extract. So Bai Hu Tang means White Tiger Tang.

[8] <<Yuan Shi>>: Historical record of Yuan dynasty in China.

[9] <<Wen Yi Lun>>: Wen means Fever; Yi means epidemic disease; Lun means discussion or talk about. So Wen Yi Lun means talk about epidemic disease with fever.

[10] Wen disease: a group of epidemic disease that causes fever.