January 10, 2014

Yáng Dàn Tāng (陽旦湯) Yáng Dawn Decoction from the Jīn Guì Fāng Gē Kuò

As I am approaching close to 18 months of ardently working on the translation of the second volume of Chén Xiū-Yuàn's Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), I thought it was due time to share a small tidbit of the material.  I am getting quite close to finishing the text and it should be out sometime in the next few months.  

Yáng Dàn Tāng
Yáng Dawn Decoction

治產後中風續續數十日不解, 頭微疼, 惡寒, 時時有熱, 心下悶, 乾嘔汗出 ,雖久陽旦症續在者, 可與之。  即桂枝湯增桂加附。  坊本謂加黃芩者, 未知《傷寒論》太陽篇中已明其方, 孫真人及各家俱誤。  桂枝湯見《傷寒論》
A treatment for post-partum wind strike that remains unresolved for several tens of days with, a mild headache, aversion to cold, frequent heat effusion, oppression below the heart, dry retching, and sweating. Even though (the condition) has persisted for a long time, yáng dàn tāng signs are still present, and can be given. (This formula) is guì zhī tāng with increased guì zhī and the addition of fù zǐ.
An old block-printed version of the text refers to this formula as (guì zhī tāng) with the addition of huáng qín, but it is unknown whether this is the same tài yáng formula as in the Shāng hán lùn. Master Sūn Sīmiǎo and various others believed it to be so (for which) they were mistaken. For guì zhī tāng see the Shāng Hán Lùn.

 Commentary by (Chén) Yuánxī 男元犀按:
頭痛發熱、 惡寒汗出, 太陽表症也。  心下悶者, 太陽水邪彌漫心下而作悶也。  陽旦湯即桂枝湯倍桂枝加附子。  雖産後數十日不解, 其邪仍在於太陽之經, 故仍用桂枝湯解太陽之表邪, 加桂以化膀胱之水氣, 加附子以溫固水臟, 使經臟氣化, 則內外之邪出矣。  《傷寒論》桂枝加附子, 治漏汗; 加桂, 治氣從少腹上衝心; 去芍, 治胸滿, 俱有明文可據。  孫真人以桂枝湯加黃芩爲陽旦湯, 其意以心下悶爲熱氣, 誤矣。  夫有熱氣, 則當心煩, 今日心下悶, 則非熱可知矣。  況微惡寒時時有熱, 乾嘔汗出, 爲太陽桂枝湯之的症。  蓋太陽底面便是少陰, 續續至數十日不解, 顯系少陰之君火微, 而水寒之氣盛, 寒氣上淩陽位, 是以爲心下悶之苦。  故取桂枝湯增桂以扶君主之陽, 加附子以鎮水陰之逆, 使心陽振, 水臟溫, 則上逆之陰邪, 不攻而自散矣。

Headaches, heat effusion, aversion to cold, and sweating are symptoms associated with a tài yáng exterior pattern. (With) oppression below the heart, tài yáng water evils pervade (the area) below the heart and cause oppression. Yáng dàn tāng is guì zhī tāng with double the guì zhī and the addition of fù zǐ. Although there is a lack of resolution ten days post partum, evils are still located in the tài yáng channel, and it is for this reason that guì zhī tāng is used to resolve exterior evils in the tài yáng. Guì zhī is increased in order to transform water qì in the bladder.  Fù zǐ is added to the formula to warm and secure the water viscus, enabling the transformation of qì in the channels and viscera, and ensuring the expulsion of evils in both the interior and exterior. In the Shāng Hán Lùn, guì zhī jiā fù zǐ tāng is used to treat leaking sweat; increasing guì zhī treats surging qì from the lesser abdomen into the heart, and removing sháo yào treats chest fullness. These (principles) are in accordance with the (original) writings. (According to) master Sūn (sīmiǎo), yáng dān tāng is guì zhī jiā huáng qín tāng, (as he felt that) oppression below the heart was due to hot qì; this is a mistake! Now if there were hot qì, then there would be heart vexation, (but) presently with the oppression below the heart, we know there is no heat!  Moreover, slight aversion to cold, and frequent heat (effusion), dry retching, and sweating, is a guì zhī tāng tài yáng presentation. In all (cases) of tài yáng, there is shào yīn at the bottom, and with continuous (wind strike) reaching ten days without resolution, there is a clear relation to the debilitation of shào yīn sovereign fire, with exuberance of cold water qì. Cold qì ascends and encroaches into the position of yáng, resulting in oppression below the heart. Therefore, guì zhī tāng with increased guì zhī, supports sovereign yáng, and with the addition of fù zǐ counterflow of water yīn is settled, heart yáng is vitalized, and the water viscus is warmed.  Then, ascending counterflow of yīn evils will not attack, and dissipate on their own!