1-10 lines in lower burner part (wen bing tiao bian)
1. wind
warmth, warm heat,
warm epidemic, warm toxin, winter warmth
(1) in the disease of wind warmth, warm heat, warm epidemic, warm toxin, and winter warmth, generally evil
remains in yang
brightness for long time, whether precipitation is used or not, there is generalized heat, red complextion, dry
mouth and tongue, if it is severe, teeth becom black and lips get chapped. If
the pulse is sunken and replete, precipitation can be used, if the pulse is
vacuity and large and palms and soles are heater than the back of hands and
feet, treat this with Jia Jian Fu Mai Tang (加减复脈汤, Modified Restore the Pulse
Decoction).
If warm evil stays in middle burner for long time, yang earth of yang brightness will restrain Gui (癸) water of lesser yin. Even though yin is damaged by precipitation
or yin gets exhausted by another reason, if replete pattern exists, right qi does not collapse, and the pulse is sunken,
replete, and powerful, then one can precipitated this one time. This method
means ‘saving fluids urgently’ on Shang
Han Lun (傷寒論). But if there
is absence of dry and bind stool in the interior and evil heat is scant and vacuous heat is copious, then the
pulse will be vacuity, palms and soles govern the interior, therefore palms and soles
will be heater than the back of hands and feets which govern the exterior. In this condition, draining of heat downward will exhaust the fluids and quicken one’s death. Therefore
the fluids should be recovered with Fu Mai Tang (复the pulse汤), if yin gets to recover, yang gets to stay, so
one does not reach death. In this formula Ren Shen, Gui Zhi, Sheng Jiang, and
Da Zao, which supplement yang,
are subtracted and Bai Shao (白芍), which contract yin qi of
three yin, is added, therefore this is named as Jia Jian Fu Mai Tang (加减复the pulse汤, Modified Restore the Pulse Decoction). In the
time of Zhang Zhong Jing (張仲景), this treats bound and intermittent due to cold damage, so Ren
Shen, Gui Zhi, Sheng Jiang, and Da Zao, which supplement yang qi in the pulse,
are used, but now, due to warm disease, yang evil is exuberant and yin is exhausted,
therefore those herbs cannot be used.
(2) Exterior-effusing method
is used to warm
disease erroneously, so the fluids are greatly damaged, there is palpitation, stiff tongue,
and loss of consciousness, this should be treated with Fu Mai Tang (复the pulse湯) to restore the fluids.
If the fluids on the tongue returns, one gets to recover. If sweat issues
spontaneously and heart and sprit lose sovereignty, Jiu Ni Tang (救逆汤, Conterflow-Stemming Decoction) governs this.
Exterior-effusing
method is used to warm disease erroneously, this stirs yang qi, therefore heart
qi is damaged and palpitation occurs, and damaged heart humor
brings about stiff tongue, therefore the
fluid should be recovered with If the damage is too severe so there is a sign
of separation between yin and yang, Fu Mai Tang (复the pulse湯) can take charge of this, wihout Jiu Ni Tang (救逆汤), this cannot be treated.
(3) Deafness of warm disease belongs to lesser yin pattern, if Chai Hu Tang
(柴胡汤) is given, death will occur, after six or seve days from on set of
disease, one should recover the essence with Fu Mai Tang (复the pulse湯).
In warm disease, the pattern of three yang channels do
not appear but yang brightness bowel pattern and three yin organ pattern appear.
Generally organ is to store, organ stores
essence. Warm disease is
best at damaging essence, the three yin organs are very important. Replete heat
binding in yang brightness damages spleen yin and normal transportation fails
to. The spleen is right next to the stomach, the fatigue of husband influences
to wife. In this case, there is a method of saving the fluids
with precipitating urgently. If earth is replete, water becomes vacuity and gradually influences to
lesser yin, deafness and inability to lie down belong to this pattern. If water is
replete, wood becomes strong, gradually influences to reverting yin, closed eyes, tetanic
reversal, etc belong to this pattern. The evil of warm disease extends from the
upper part to the lower part, and from yang part to yin part, learners should
know this.
按 in Ling Shu
(靈樞) and Su Wen
(素問), deafness in warm disease is death sign, maybe one will not die of deafness
in lesser yang pattern in cold damage. Nei Jing says that kidney opens at the
ears, and one with essence deserting cannot hear. Generally in case of deafness
in warm disease, at early stage, yang fire closes the upper part, at that
timem, if yin essence is unable to ascend and clear orifice does not free, and as time goes on,
yang gets exuberant and yin gets exhausted.
At that time, if Xiao Chai Hu Tang (小柴胡汤)
directly raise the qi of lesser
yang, this will bring about lower exhaustion upper reversal (下竭上厥). Nowadays, why do doctors tend to treat only with Shang Han Liu Shu (傷寒六书) of 陶氏 and not to study Ling Shu
(靈樞), Su Wen
(素問) Nan Jjing (难经)?
(4), Warm disease is again added to internal damage due to fatigue, even though
six or seven days has passed, if the disease has been still, treatment as Fu
Mai Tang (复the pulse湯) is appropriate.
This ling is the treatment of Liang Gan (double
contraction , the overlap
of internal damage and external contraction). Sweet can boost qi,
generally sweet flaovor supplements
vacuity, therefore the
method of restoring pulse is appropriate. After taking two or three Tie (帖), if generalized heat is not
severe but fatigue is severe, then add Ren Shen (人参).
(5) In warm
disease, sweat
is promoted, but sweating is not obtained, precipitation is applied but heat does not retreat, after six or seven days,
if the pulse is still large and strong, raise the dose of Fu Mai Tang (复脈湯).
Sweat is promoted, but sweating is not
obtained, precipitation is applied but heat does not retreat, from this, one
can know that promotion of sweating and precipitation are not appropriate. The
large and strong pulse indicates that evil is not weat at all by drugs and right qi also have a capacity to contend with
evil qi. Therefore increased dosage of Fu Mai Tang (复脈湯) can support right qi to contend with evil qi,
then right qi defeats evil qi and then recover occurs.
(6) in warm disease, after formula for bearing
upward and effusing are used erroneously, if the pulse gets to be bound and intermittent and in severe case the pulse arrives only two times during one
time of inhale and exhale, increase the dose of Fu Mai Tang (复the
pulse湯). Even though there is other
signs, treat them later.
This line is about treating disease by preserving
right qi. This theory is related with that when interior pattern is urgent, one
must first treat the interior in Zhang Zhong Jing (張仲景).
(7) After promotion of sweating or precipitation, if
there is dry mouth and throat, a desire to sleep due to fatigue spirit, and dry
coating on with red tongue, then give Fu Mai Tang (复脈湯).
In the parat of middle burner [中焦篇], after precipitation Yi Wei Tang (益胃汤) recovers the fluid in the
stomach,; this is because evil qi has not
yet enter lower burner deep. In this line, dry
mouth and throat are because the humor of lesser yin does not provide upward. a desire to
sleep due to fatigue spirit is same sign as in the image of desire only to
sleep of cold damge lesser yin pattern. Therefore Fu Mai Tang (复脈湯) is used.
(8). If heat
evil enters deep, or is in lesser yin, or in reverting yin, Fu Mai Tang (复脈湯) should be used.
This
mentions that Fu Mai Tang (复the pulse湯) is main formula for the disease
that evil heat damages yin humor greatly. Generally lesser yin stores essence, the essence
of reverting yin always gets to engender after the essence of lesser yin sufficient.
Both lesser yin and reverting yin channels can be treated with Fu Mai Tang (复脈湯), this is related with the homogeny of the liver
and kidney (乙癸同源).
Jia Jian Fu Mai Tang (加减复脈汤, Modified Restore the
Pulse Decoction).
the method that preserving
the fluids with sweet and moisture.
Zi Gan Cao（six qian）Gan Di Huang (干地黄, six qian, reviewing Di Huang, Di Huang is of three
sorts∶ Sheng Di (生地) is fresh Di
Huang (地黃) undried, this can be decocted or used as
juice. The nature is sweet and cool, this acts in upper and middle burner and retreats heat and preserve the fluids.; Gan Di Huang (干地黄) is dried Sheng Di (生地) under sun, in the process of
drying under sun, the nature of cold and cool is removed, Ben Cao Jing (本草經) states this is sweet and bland.；Shu Di (熟地) is processed with wine and Sha Ren (砂仁), this
is completely made after the Nine method, which is a process of steaming and
drying for nine cycles, in the process the qi of Ding Huo (丁火) is adde to Bing Fire (丙火), therefore the nature
is sweet and warm. Nowadays doctors know Gan Di Huang (干地黄) is Sheng Di (生地), north people (北人) do not know there is Sheng
Di (生地) in the world, this is as like that one says
that deer is horse. One must distinguish them when using them.) Sheng Bai
Shao (生白芍, six qian）Mai Men
Dong (麦winter, five
qian）E Jiao (阿胶, three qian）麻仁（Ma Ren, three qian）
Decoct them until eight cups of water
becomes three cups. Take them three times. If the disease is severe, add Gan
Cao up to one liang, Di huang (地黃), Bai Shao (白芍, each eight qian), Mai Men Dong (麦winter, seven qian), take this three times in day and one time at
night.
Jiu Ni Tang (救逆汤, Conterflow-Stemming Decoction)
In Jia Jian Fu Mai Tang (加减复脈汤),
subtract Ma Ren (麻仁), add Long Gu (龙骨, four qian), Mu Li (牡蛎, eight qian)
Decocting method is same with Jia
Jian Fu Mai Tang. if the pulse is vacuity and large and is about to dissipated,
add Ren Shen (人参, two qian).
(9). After precipitation is
very severe, though diarrhea occurs three or four times a day, if the pulse is
still rapid, Fu Mai Tang (复脈湯) cannot be given. This should be treated with Yi Jia Jian (一甲煎). One or two
days after taking, if there is absence of diarrhea, Yi Jia Fu Mai Tang (一甲复脈汤) can be used.
It is natural there is absence of
defacation after precipitation, but now, there is frequent defecation of
diarrhea, this is because the person is used to be vacuity in true yang or precipitation
is not used properly, there
is worry of yin collapse. At this condition if Fu Mai Tang (复the pulse湯), which is slippery and moisture, is used, on
the contrary to intention, this will
drain yin. Therefore one falavor of Mu Li (牡蛎) is used. if formula is composed of one flavor,
the force gets more stronger. This can preserve yin, astringe the intestines and
check diarrhea, and also clear the residual heat in the interior. One can take
three effects from one herb.
Yi Jia Jian (一甲煎 )
（saly and cold with astringent method.）
Mu Li (牡蛎, two
liang)
Decoct this until eight cups of water becomes
three cups. Take them three times warm.
Yi
Jia Fu Mai Tang (一甲复脈汤)
In Jia Jian Fu Mai Tang,
subtract Ma Ren (麻仁), add Mu Li (牡蛎, one liang)
(10). In case of lower burner
warm disease, if even there is loose stool, immediately
give Yi Jia Fu Mai Tang (一甲复脈汤).
In case warm disease enters lower burner deep and damage yin
greatly, one should urgently save yin. but in the middle of formula which saves
yin, there is lots of things which make stool slippery or loose. Therefore as
soon as checking the loose stool, do not waite utill defecation occurs three or
four times, immediately one should recover yin and prevent defection from
becoming slippery or loose with the method of Yi Jia Fu Mai Fa (一甲复脈法).
[卷三·下焦篇] 风温、温热、温疫、温毒、冬温
一、风温、温热、温疫、温毒、冬温，邪在阳明久羁，或已下，或未下，身热面赤，口干舌燥，甚则齿黑唇裂，脉沉实者，仍可下之；脉虚大，手足心热甚于手足背者，加减复脉汤主之。
温邪久羁中焦，阳明阳土，未有不克少阴癸水者，或已下而阴伤，或未下而阴竭。若实证居多，正气未至溃败，脉来沉实有力，尚可假手于一下，即《伤寒论》中急下以存津液之谓。若中无结粪，邪热少而虚热多，其人脉必虚，手足心主里，其热必甚于手足背之主表也。若再下其热，是竭其津而速之死也。故以复脉汤复其津液，阴复则阳留，庶可不至于死也。去参、桂、姜、枣之补阳，加白芍收三阴之阴，故云加减复脉汤。在仲景当日，治伤于寒者之结代，自有取于参、桂、姜、枣，复脉中之阳；今治伤于温者之阳亢阴竭，不得再补其阳也。用古法而不拘用古方，医者之化裁也。
二、温病误表，津液被劫，心中震震，舌强神昏，宜复脉法复其津液，舌上津回则生；汗自出，中无所主者，救逆汤主之。
误表动阳，心气伤则心震，心液伤则舌蹇，故宜复脉其津液也。若伤之太甚，阴阳有脱离之象，复脉亦不胜任，则非救逆不可。
三、温病耳聋，病系少阴，与柴胡汤者必死，六、七日以后，宜复脉辈复其精。
温病无三阳经证，却有阳明腑证（中焦篇已申明腑证之由矣）三阴脏证。盖脏者藏也，藏精者也。温病最善伤精，三阴实当其冲。如阳明结则脾阴伤而不行，脾胃脏腑切近相连，夫累及妻，理固然也，有急下以存津液一法。土实则水虚，浸假而累及少阴矣，耳聋不卧等证是也。水虚则木强，浸假而累及厥阴矣，目闭痉厥等证是也。此由上及下，由阳入阴之道路，学人不可不知。按温病耳聋，《灵》《素》称其必死，岂少阳耳聋，竞至于死耶？经谓肾开窍于耳，脱精者耳聋，盖初则阳火上闭，阴精不得上承，清窍不通，继则阳亢阴竭，若再以小柴胡汤直升少阳，其势必至下竭上厥，不死何待！何时医悉以陶氏六书，统治四时一切疾病，而不究心于《灵》《素》《难经》也哉！瑭于温病六、七日以外，壮火少减，阴火内炽耳聋者，悉以复阴得效，曰宜复脉辈者，不过立法如此，临时对证，加减尽善，是所望于当其任者。
四、劳倦内伤，复感温病，六、七日以外不解者，宜复脉法。
此两感治法也。甘能益气，凡甘皆补，故宜复脉。服二、三帖后，身不热而倦甚，仍加人参。
五、温病已汗而不得汗，已下而热不退，六、七日以外，脉尚躁盛者，重与复脉汤。
已与发汗而不得汗，已与通里而热不除，其为汗下不当可知。脉尚躁盛，邪固不为药衰，正气亦尚能与邪气分争，故须重与复脉，扶正以敌邪，正胜则生矣。
六、温病误用升散，脉结代，甚则脉两至者，重与复脉，虽有他证，后治之。
此留人治病法也。即仲景里急，急当救里之义。
七、汗下后，口燥咽干，神倦欲眠，舌赤苔老，与复脉汤。
在中焦下后与益胃汤，复胃中津液，以邪气未曾深入下焦。若口燥咽干，乃少阴之液无以上供，神昏欲眠，有少阴但欲寐之象，故与复脉。
八、热邪深入，或在少阴，或在厥阴，均宜复脉。
此言复脉为热邪劫阴之总司也。盖少阴藏精，厥阴必待少阴精足而后能生，二经均可主以复脉者，乙癸同源也。
加减复脉汤方
（甘润存津法）炙甘草（六钱）干地黄（六钱）按地黄三种用法∶生地者，鲜地黄未晒干者也，可入药煮用，可取汁用，其性甘凉，上中焦用以退热存津；干地黄者，乃生地晒干，已为丙火炼过，去其寒凉之性，本草称其甘平；熟地制以酒与砂仁，九蒸九晒而成，是又以丙火、丁火合炼之也，故其性甘温。奈何今人悉以干地黄为生地，北人并不知世有生地，佥谓干地黄为生地，而曰寒凉，指鹿为马，不可不辨。
生白芍（六钱）麦冬（不去心，五钱）阿胶（三钱）麻仁（三钱，按柯韵伯谓∶旧传麻仁者误，当系枣仁。彼从心悸动三字中看出传写之误，不为无见，今治温热，有取于麻仁甘益气，润去燥，故仍从麻仁）水八杯，煮取八分三杯，分三次服。剧者加甘草至一两，地黄、白芍八钱，麦冬七钱，日三夜一服。
救逆汤方
（镇摄法）即于加减复脉汤内去麻仁，加生龙骨四钱，生牡蛎八钱，煎如复脉法。脉虚大欲散者，加人参二钱。
九、下后大便溏甚，周十二时三、四行，脉仍数者，未可与复脉汤，一甲煎主之；服一二日，大便不溏者，可与一甲复脉汤。
下后法当数日不大便，今反溏而频数，非其人真阳素虚，即下之不得其道，有亡阴之虑。若以复脉滑润，是以存阴之品，反为泻阴之用。故以牡蛎一味，单用则力大，即能存阴，又涩大便，且清在里之余热，一物而三用之。
一甲煎
（咸寒兼涩法）生牡蛎（二两，碾细）水八杯，煮取三杯，分温三服。
一甲复脉汤方
即于加减复脉汤内，去麻仁，加牡蛎一两。
十、下焦温病，但大便溏者，即与一甲复脉汤。
温病深入下焦劫阴、必以救阴为急务。然救阴之药多滑润，但见大便溏，不必待日三、四行，即以一甲复脉法，复阴之中，预防泄阴之弊。