Volume Two. Middle Jiao Chapter [卷二. 中焦篇] Line 11 on wen bing tiao bain (溫病條辨)

 

[11] 陽明溫病, 無上焦證, 數日不大便, 當下之, 若其人陰素虛, 不可行承氣者, 增液湯主之. 服增液湯已. 周十二時觀之, 若大便不下者, 合調胃承氣湯微和之.

In cases of Yangming warm disease without upper jiao symptoms, and with no bowel movements for several days, it is appropriate to use purgative therapy. However, if the patient has usually yin deficiency and cannot use Cheng Qi Tang, treatment with Zeng Ye Tang (Humor-Increasing Decoction) may be used instead. After taking Zeng Ye Tang, observe the patient for 24 hours. If bowel movements still do not occur, it is advisable to combine Zeng Ye Tang with Tiao Wei Cheng Qi Tang (Stomach-Regulating Qi-Coordinating Decoction) for a harmonizing effect.

此方所以代吳又可承氣養榮湯法也. 妙在寓瀉于補, 以補藥之體, 作瀉藥之用, 既可攻實, 又可防虛. 餘治體虛之溫病, 與前醫誤傷津液, 不大便, 半虛半實之證, 專以此法救之, 無不應手而效.

This formula is used as a substitute for Wu Youke's Cheng Qi Yang Rong Tang (Qi-Coordinating Construction-Nourishing Decoction). Its brilliance lies in incorporating draining methods into the tonifying method by using tonifying herbs to play the role of purging herbs. It can both attack and dispel replete evils and prevent depletion of Yin. In my clinical experience, I have specialized in treating warm disease patients with weak constitutions or those who have suffered from fluid damage due to improper treatment and present with constipation, mixed deficiency and excess symptoms, using only this formula, and I have never failed to achieve immediate results.

Zeng Ye Tang (Humor-Increasing Decoction) 增液湯方

(鹹寒苦甘法) (method of salty, cold, bitter, and sweet flavors)

元參 (一兩) 麥冬 (連心, 八錢) 細生地 (八錢)

Yuan Shen (scrophularia) (one liang) Mai Men Dong (Ophiopogon) (8 qian) Xi Sheng Di (thin dried rehmannia) (8 qian)

水八盃, 煮取三盃, 口乾則與飮, 令盡, 不便, 再作服.

Prepare eight cups of water to cook the medicine. Boil it until three cups of liquid remain. After experiencing dry mouth or thirst, you may drink the medicine. If after taking one dose, you do not have a bowel movement, you may take it again.

〔方論〕溫病之不大便, 不出熱結液干二者之外. 其偏于陽邪熾甚, 熱結之實證, 則從承氣法矣; 其偏于陰虧液涸之半虛半實證, 則不可混施承氣, 故以此法代之. 獨取元參爲君者, 元參味苦鹹微寒. 壯水制火, 通二便, 啓腎水上潮于天, 其能治液干, 固不待言, 本經稱其主治腹中寒熱積聚, 其并能解熱結可知. 麥冬主治心腹結氣, 傷中傷飽, 胃絡脈絶, 羸瘦短氣, 亦系能補能潤能通之品, 故以爲之佐. 生地亦主寒熱積聚, 逐血痹, 用細者. 取其補而不腻, 兼能走絡也. 三者合用, 作增水行舟之计, 故湯名增液, 但非重用不爲功.

[Prescription Discussion] Constipation in warm diseases can be categorized into two types: ‘heat bind’ (熱結) and ‘dryness of body fluids’ (液乾). For cases with symptoms of excessive heat bind and internal blockage caused by an exuberant Yang evil, it is appropriate to use Cheng Qi Tang as the primary treatment. However, for cases with a half-deficient and half-excessive pattern due to deficiency of body fluids, Cheng Qi Tang is not recommended and should be replaced by another method of treatment. This formula specifically uses Yuan Shen (Scrophularia) as the sovereign herb because Yuan Shen has a bitter and salty taste, a slightly cold property, and can strengthen water to restrain fire (壯水制火), promote bowel movements, and bring kidney water upward to the upper jiao. Therefore, it can effectively treat dryness of body fluids without the need for further explanation. The ‘Shen Nong's Classic of Materia Medica’ states that Yuan Shen is used to treat the accumulation of cold and heat in the abdomen, and thus can also relieve heat bind. Mai Men Dong (ophiopogon) is mainly used to treat abdominal bind Qi, middle damage, damage due to eating too much, obstruction of the stomach meridian, marked emaciation and shortness of breath. It is also a medicine that can nourish essence and invigorate qi, moisturize body fluids, and promote smooth breathing by regulating the movement of qi, which is why it is used as an assistant herb. Sheng Di Huang (dried/fresh rehmannia) can also treat cold and heat accumulations, and disperse blood impediment. Using Xi Sheng Di (thin dried rehmannia) is for its nourishing effect without being too greasy and entering into the network vessels. The three herbs are combined to increase water and move ‘the boat’ (i.e., promote urination), hence the name of the formula, Zeng Ye Tang. However, if not used in sufficient quantities, the desired effects cannot be achieved.

本論于陽明下證, 峙立三法∶熱結液干之大實證, 則用大承氣; 偏于熱結而液不干者, 旁流是也, 則用調胃承氣; 偏于液干多而熱結少者, 則用增液, 所以回護其虛, 務存津液之心法也.

This book clearly presents three treatment methods for the syndrome that requires an aggressive precipitating approach in the treatment of Yangming disease.': when 'heat bind (熱結) ' and ' dryness of body fluids' appear together in 'great repletion syndrome',’the treatment of Da Cheng Qi’ should be used. For the pattern that is more inclined to ‘heat bind (熱結)’ while 'dryness of body fluids 'are not severe, that is,’heat clumping with circumfluence,’ it should be treated according to ‘the treatment of Tiao Wei Cheng Qi.’ For the pattern that is more inclined to ‘'dryness of body fluids (液乾)’ while ‘heat bind (熱結)’ is relatively mild,’the treatment of Zeng Ye’ should be used. The method aims to protect Yin from damage and to preserve fluids.

按吳又可純恃承氣以爲攻病之具, 用之得當則效, 用之不當, 其弊有三∶一則邪在心包, 陽明兩處, 不先開心包, 徒攻陽明, 下後仍然昏惑譫語, 亦將如之何哉？吾知其必不救矣. 二則體虧液涸之人, 下後作戰汗, 或随戰汗而脫, 或不蒸汗徒戰而脫. 三者下後雖能戰汗, 以陰氣大傷, 轉成上嗽下泄, 夜熱早凉之怯證, 補陽不可, 救陰不可, 有延至數月而死者, 有延至歲餘而死者, 其死均也. 在又可當日, 溫疫盛行之際, 非尋常溫病可比, 又可創溫病治法, 自有矯枉過正不暇詳審之處, 斷不可概施于今日也. 本論分别可與不可與, 可補不可補之處, 以俟明眼裁定, 而又爲此按語于後, 奉商天下之欲救是證者. 至若張氏, 喻氏, 有以甘溫辛熱立法者, 濕溫有可用之處, 然須兼以苦泄淡渗, 盖治外邪, 宜通不宜守也, 若風溫, 溫熱, 溫疫, 溫毒, 斷不可從.

Wu Youke relied solely on Cheng Qi Decoction as the primary tool to attack evils, which can be effective if used properly. However, if used improperly, there are three potential drawbacks. Firstly, if evils exist in both the pericardium and the Yangming channel, attacking the Yangming without first opening the pericardium may result in continued confusion and delirium after the purgation. In such cases, it is extremely difficult to treat the patient. Secondly, in the case of individuals with weak constitution and depleted fluids, shiver sweating may occur after purging methods. They may experience either syncope accompanied by shiver sweating, tremble without sweating, or even shock without sweating. Thirdly, even if shiver sweating occurs after the purging method, if Yin Qi suffers severe damage, the condition may turn into timidity pattern (怯證), leading to symptoms including coughing in the upper and diarrhea in the lower, with night heat and early morning chills. In this scenario, neither tonifying Yang nor rescuing Yin will cure the patient, prolonging the patient's suffering for several months or up to over a year before they perish. Ultimately, death is inevitable.

During the time when Wu Youke was living, there was a widespread outbreak of Warm Epidemic, which is significantly different from common warm diseases. As he was the first to create a treatment method for Warm Diseases, he naturally corrected errors while making new ones, and there are also some gaps that were not fully examined at the time. Therefore, it cannot be used as it is today. This book separates cases in which it can be used, cannot be used, can be supplemented, and cannot be supplemented, while waiting for the judgment of wise readers. For this purpose, the character ‘按 annotations’ is placed at the back. It is intended to share the opinions of all people in the world who want to treat these illnesses. Zhang Jingyue and Yu Jiayan, for instance, have created treatment methods predominantly using sweet-warm and acrid-heat. However, even in cases like damp-heat disease, where treatment may be possible, but it is necessary to use medicines which drain with bitter and percolate with bland. Usually, treatment of External evil needs to be freed and unblocked, rather than preserved and nourished. Nonetheless, this approach is not applicable for wind warmth, warm heat, warm epidemic, and warm toxin.