Second, the method of tapping into the scripture formula is the doorway for Ye Gui to adapt the application of the scripture formula
Since the introduction of the Treatise on Typhoid and Miscellaneous Diseases, there are many people who are interested in studying Zhongjing’s prescriptions, but why is Ye Gui the only one who can be flexible and adaptable? Analyzing Ye’s medical cases with Jing prescriptions, we find that Ye has found a new way to adapt the application of Jing prescriptions, which is the “method” implied by each Jing prescription. Li Enqing, Department of Traditional Chinese Medicine, The First Hospital of Jinan University
He followed the theory of the Nei Jing on the odor of drugs and the relationship between odor and internal organs and diseases, and carefully studied the structure of each prescription in terms of odor and taste of drugs, summarized the “method” implied in it, and then changed it according to the law. For example, he said, “Sheng Di’s theory of disease is based on the four qi. His theory of prescriptions, pushing the odor, reason must be bitter down pungent pass, the heat and gas gang knot can be opened.” (“clinical evidence guide medical case – malaria” Huang case) and as he pointed out in the “clinical evidence guide medical case – abdominal pain” Hua case: “cover anger is depressed fold liver with. But the gas spicy can be solved, on the medicine must be the first to push the smell.” Jiang Shiyu in the “clinical evidence guide medical case・Diarrhea” pressed in the summary: “Now look at Ye’s diagnosis, with the smell, wonderful in fresh, vertical and horizontal treatment, not away from the rules – the so-called read the ancient and not mud in the ancient, take the formula and not insist on the formula, the subtlety of the cut, people are difficult to be able to.” This example illustrates Ye’s thinking in studying the “method” of prescriptions as follows.
Example 1: Han Xia Diarrhea Heart Soup
There are three groups of medicines in Hanxia Diarrhea Heart Soup: the first group: bitter cold medicine to lower the drainage: Scutellaria baicalensis and Huanglian; the second group: pungent warmth to open the knot: Hanxia and Ganjiang; the third group: sweet warmth to tonify the stomach: Ginseng, Licorice and Dazao. The three groups of medicines are bitter, pungent and sweet. That is, the bitterness of scutellaria and lian, the pungency of summer and ginger, and the sweetness of ginseng, herbs and jujube, which Ye called “bitter, pungent, open-drainage and sweet method”. Knowing the structure of the law, the variation and tailoring will have an idea. Such as damp-heat is embedded in the middle jiao, fullness of the stomach does not eat, the stomach is not deficient, do not need Gan medicine, that is, the Gan medicine ginseng grass dates, with scutellaria bitter, ginger summer pungent combination, bitter and pungent drainage of damp-heat gang nodes. In order to strengthen the opening of the plankton, imitating the method of Hovenia Tang, adding Hovenia, which is slightly bitter and cold, can help Scutellaria to lower the drainage, and spicy to move the Qi, can help Jiang Xia to open the knots. The damp-heat is contained, the Yang is not deficient, so not both sweet dry ginger, replaced by purely pungent go away ginger, thus formulating a half summer diarrhea heart soup to ginseng dry ginger licorice jujube plus heliotrope ginger formula. Further, in order to strengthen the opening and propagation of lung qi, so that qi can be transformed into dampness and also transformed, almonds were added, and the formula of Half Summer Diarrhea Heart Soup with Ginseng, Dry Ginger, Glycyrrhiza and Dates plus Hovenia Almonds was formulated. With these variations, a total of 9 variations of the Han Xia Diarrhea Heart Soup formula were formulated. In terms of these two formulas, the emphasis is on the combination of bitter and pungent to open and drain damp-heat. Ye even believed that “damp-heat is not solved by bitter, pungent and cold”. The method is innovative from the formula. In addition, and according to the evidence or the addition of ginseng, adding to the sweet method; or the use of dry ginger, adding to the pungent and warm sweet method; or more bitter herbs, adding to the bitter method; or more pungent herbs, adding to the pungent method; or vice versa. All kinds of variations are based on the method in the formula.
Example 2: Wu Mei Wan
Wu Mei Wan is composed of four groups of medicines: one is sour medicine: Wu Mei, vinegar; the second is bitter-cold medicine: Huang Lian, Huang Bai; the third is pungent-heat medicine: Radix et Rhizoma Phellodendron, Ginger, Pepper, Hosanna, Cinnamomum; the fourth is sweet-warm medicine: Ginseng, Angelica. The four groups of medicines imply four methods, which Ye called “acid, bitter, pungent and sweet method”. Clearly the structure of the “method” contained in the formula, it can be freely applied to change. If summer heat hurts yin, into the Shao Yin thirst, the mind confused heart heat irritability, into the sympathetic Yin paralysis, then go to the pungent medicine pungent method. Because of the damage to the yin fluid, so the use of sweet medicine and to maitong, raw earth, gum of the sweet and salty cold instead of ginseng, the sweet and warm. In this way, the combination of acid, bitter and sweet, with the sourness of Ume plum, and the bitterness of Huang Lian, and the sweetness of Dong, Di and Gum, constitutes the “sour and sweet method to transform Yin, and the sour and bitter method to drain heat”, which formulated the world famous formula Lian Mei Tang.
Example 3: Broiled Licorice Soup
Roasted licorice soup contains four groups of medicine: pungent warmth to open the heart and yang (Gui, ginger, wine), sweet warmth to nourish the heart’s qi (ginseng, grass, dates), sweet cold to nourish the heart’s yin (earth, winter, hemp), and sweet salty to nourish the heart’s blood (gum). Among them, the amount of raw earth alone heavy to one catty, and then with maitong, hemp, half a liter each, gum two, so the two methods of sweet cold, sweet and salty dominate. Ye seized this feature, and according to the pathogenesis of warming disease, the heat evil penetrated into the lower jiao and damaged true yin. It is used to treat the evidence of true yin deficiency. Further, salty medicines such as oyster, turtle nail and tortoise shell were added to formulate the formula of “Two A Fuyu Tang” and “Three A Fuyu Tang” for nourishing yin with salty cold and submerging yang to calm wind.
Example 4: Gardenia black bean soup
Gardenia black bean soup only two flavors of medicine, its black bean pungent warm, gardenia bitter cold, the bitter and pungent method. Ye called it “lightly bitter and slightly pungent method”, or “slightly bitter and slightly pungent method”. It is believed that light bitter and slightly pungent, a rise and a fall, “slightly bitter to clear down, slightly pungent to promote through”, can open and promote the upper jiao paralysis and depression, can “relieve its stale rot and depression heat”, “promote its stale rot and depression”. According to the evidence, he either increased the pungent dispersing and declaring medicine, or increased the bitter descending medicine, and formulated such formulas as Mulberry and Apricot Soup, Qiaohe Tang, Sanxiang Tang, Shangjiao Paralysis Declination Soup, Almond and Gypsum Soup, and Lianjiao and Red Bean Drink.
From the above analysis, it can be seen that Ye’s way to adapt the application of sutra prescriptions is to analyze the organization of the taste of the drugs in the formula, divide the drugs in the formula into several groups according to their taste structure, determine the “method” contained in the formula according to the taste of each group of drugs, and make new formulas according to the “method” of the formula. According to the “method” in the formula, the combination of the “method” in the formula is used to make new methods and new prescriptions.
Ye’s method of elucidating the “method” contained in a formula by using the properties and flavors of the drugs in the sutra formula is more scientific, practical and flexible in revealing the characteristics of the formula and guiding the clinical application of the formula compared with the method of “ruler, subject and coordinator”. For example, in the case of Zhu’s “Clinical Guide to Medicine – Wood by Earth”, the medicine used is ginseng, poria, fried semen, raw white peony, wu mei, small Sichuan Lian, light ginger, and wide skin white. Ye explained that “this Turk’s Yin, Yangming medicine. Stomach and internal organs to pass as a tonic, so the main body with a large half summer soup, heat congestion on the top, so less adjuvant ginger, even to diarrhea of the heart, liver is just dirty, the reference into the white peony, plum to soften it. The use of ginger and even is equivalent to the combination of the pungent open and bitter drainage of the half summer diarrhea heart Tang method, with peony and plum is equivalent to the combination of the sour and sweet Yin to soften the liver Wu Mei Wan method. Mastering the application of the method in the formula, you can be flexible and infinite adaptations.
Wu (Wu Sui) has a good understanding of Ye’s method of studying and analyzing the method contained in the prescriptions, and after most of the prescriptions in “Wenzhi Zhuanzhi”, the “method” represented by the “formula” is indicated, such as “San Xiang Tang” as “slightly bitter, slightly pungent, slightly cold and aromatic method For example, Sanxiang Tang is “slightly bitter, slightly pungent, slightly cold and aromatic”, and Lianmei Tang is “sour, sweet, yin, sour, bitter and heat relief”.
This invention of Ye Gui is of epoch-making significance, which can enlighten people how to adapt and apply the ancient formulae, how to push forward and make new formulas to deal with the common epidemic and difficult to treat diseases in today’s clinic.
It should be noted that the concept of “method” implied in the formula is different from the concept of “method” of prescriptions such as downward, vomiting, elimination, and tonic methods, and it is even different from the concept of “identification” in the current theory of evidence-based treatment. “The concept of “method” is very different from the concept of “method” of prescription according to the evidence, and the concept of “method” of prescription according to the evidence. It should be clearly distinguished.
Third, the identification of the method of evidence is the key to Ye Gui to open the door to the application of the variation of the sutra formula
On the basis of clarifying the structure of the “method” contained in each prescription and changing new prescriptions according to the “method”, Ye Gui created a new method of identification and treatment, which is the method of “identification of method evidence”.
This is the method of “identification of method and evidence”. The so-called “identification of method and evidence” is to prescribe according to the corresponding evidence of each “method” in a certain formula. Examples are given below.
Zhongjing Jing prescriptions have relatively fixed formulae, and identification of formulae is the basic principle for accurate application of Jing prescriptions. However, it is difficult to apply sutra prescriptions by simply following the method of identifying the evidence of the formula, only by digging out the “method” contained in the formula and going deeper into the level of “identifying the evidence of the method” can we freely adapt the application of sutra prescriptions.
Example 1: Huang Lian Agaricus Tang method (bitter drainage and salty nourishment method)
The basic combination of Huang Lian and Ah Giao Tang is bitter-cold Scutellaria and Huang Lian with sweet and salty Ah Giao and Bai Shao, which means bitter-cold, sweet and salty method. Wu detailed that the method of this formula is “bitter, sweet and salty cold method”. This method can be referred to as “bitter drainage and salty nourishment method”, bitter can be diarrhea heat, salty can nourish the true yin. The evidence corresponding to the bitter-cold defecation of Scutellaria is the bitter-cold method, which can be seen as heart trouble, bitterness in the mouth, fever, red and red tongue, etc.; the evidence corresponding to the sweet and salty nourishment of Yin and Yang of Gumbo is the sweet and salty cold method, which can be seen as low fever, moving wind, spasm, etc. Knowing the structure of this formula, you can apply this formula according to the law evidence. For example, if the warming evil injures true yin, gum and peony, but the heat of the warming evil is still prevalent, the fever remains unresolved, and the bitter cold evidence of Scutellaria is heavy, we should use Scutellaria again, or add Huang Bai and Zhi Mu to strengthen the diarrhea. If fire-heat injures yin, the yin fluid is deeply damaged, the evidence of sweet and salty cold method is significant, and the fire-heat evidence corresponding to the bitter-cold method of Scutellaria baicalensis is mild, we should remove Scutellaria baicalensis and use only a small amount of Huang Lian to drain the fire, while the group of yin nourishing herbs should use Agaricus blazei, Chicken seed yellow, White peony, and add Sheng Di and Tian Dong to strengthen yin nourishment. If the warm disease heat into the lower jiao, liver and kidney true yin is greatly injured, liver wind sprouts, gum and peony sweet and salty cold method evidence is obvious, there is no fever, mouth bitter and other bitter cold method evidence, then remove the bitter method, purely with gum, white peony, chicken seed yellow, add raw earth, maitong, etc., salty cold and sweet cold nourish yin and yang, or then add turtle nail, turtle nail, etc., salty cold nourish yin, submerge yang and calm wind.
Example 2: Han Xia Diarrhea Heart Soup Method (bitter and pungent method of opening and draining)
As we analyzed earlier, the method implied by Han Xia Diarrhea Heart Tang is “bitter, pungent, open-drainage and sweetening method”, when this formula is used clinically, we must identify the legal evidence before applying this formula in a flexible manner. If dampness-heat is embedded in the middle jiao and develops into vomiting and inappetence, but there is no evidence corresponding to the sweet method (ginseng, herbs, dates), then go to the sweet method representative medicine ginseng, herbs and dates. If heat is heavier than dampness, and the evidence corresponding to the bitter method (scutellaria, lian) is obvious, with red tongue, yellow fur, bitter mouth and irritable heart, the bitter method should be used again, and scutellaria and lian should be used, or the amount should be increased; on the contrary, the amount of scutellaria and lian should be reduced, or scutellaria should be removed, and only one medicine, Huang Lian, should be used. If dampness is heavier than heat, and the evidence corresponding to the pungent method (ginger and summer) is obvious, with thick and greasy moss, red tongue, and abdominal abdominal froth, then we should use ginger and summer again, or add Hovenia, Chen Pi, Hou Pu, almond and other drugs that promote and warm and dry dampness. If the damp-heat flow, long treatment, stomach qi has been injured, there is a Gan method corresponding to the evidence, the pulse is soft, weak, you need to add Gan method, and add ginseng, poria and other drugs. Ye Gui has made a ginseng diarrhea of the heart soup to treat “damp heat in the upper jiao has not been cleared, the inner deficiency is trapped, the consciousness is like a cloud, the tongue is slippery and the pulse is slow. In this way, we can identify the legal evidence, so that we can adapt Han Xia Diarrhea Heart Soup and tailor this formula to fit.
Example 3: Gui Zhi Tang Method (Pungent and sweet to transform Yang, sour and sweet to transform Yin)
Gui Zhi Tang is composed of the pungent and sweet method of Gui Zhi, Gan Cao and Ginger, and the sour and sweet method of Paeonia lactiflora, Gan Cao and Dazao. The pungent sweet method corresponds to the evidence of weakness of Wei, Yang, or deficiency of cold in the spleen and stomach, while the sour sweet method corresponds to the evidence of weakness of Ying, Yin, or contracture of the stomach and intestines. For example, in the case of Shen Ersi of the “Clinical Guide to Medicine: Plumpness”, Ye’s treatment of the weak stomach and yang, “food reduction in plumpness”, suggested that “discussing Xin Gan to regulate yang can be effective”, and the formula used Gui Zhi Tang to remove peony and add Poria. The formula uses Gui Zhi Tang with peony and Fu Ling. Another example is the case of Gu Wuyi in the Clinical Guide to Medicine – Gastroparesis, Ye said: “Ying deficiency stomach pain, into the pungent and sweet”, the formula used Gui Zhi Tang to remove peony and add Angelica cocos ling. This two cases of pungent and sweet law evidence is obvious, the spleen and stomach deficiency cold, so remove the peony, the so-called “pungent and sweet should be added, acid and sweet should be reduced”. This is a typical case of using Gui Zhi Tang to identify legal evidence.
From this, it can be seen that the method of identifying legal evidence can make the idea of identifying evidence go deeper to the level of legal evidence corresponding to the method in the formula, which is a more specific, precise and terminal method of identifying evidence based on the identification of formula evidence.