薏苡仁十分 附子二分 败酱(一名苦菜)五分
右三味,杵为末,取方寸匕,以水二升,煎减半,顿服,小盒饭下。
【集注】
徐彬曰:薏苡寒能除热,兼下气胜湿,利肠胃,破毒肿;败酱善排脓破血利,结热毒
气,故以为臣;附子导热行结,故为反佐。
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肠痈者,少腹肿痞,按之即痛,如淋,小便自调,时时发热,自汗出,复恶寒。其脉
迟紧者,脓未成,可下之,当有血;脉洪数者,脓已成,不可下也,大黄牡丹汤主之
。
【注】
此承上条,详发其证,以明其治也。肠痈者,其证则少腹肿硬,按之即痛,可知痈在
内也;溺时如淋,尿色自调,可知肿碍之也。时时发热,汗出恶寒,似有表病,而实
非表病也。其脉迟紧,则阴盛血未化,其脓未成,可下之,大盒饭有血也。若其脉洪
数,则阳盛血已腐,其脓已成,不可下也。下之以大黄牡丹汤,消瘀泻热也。
大黄四两 牡丹一两 桃仁五十个 芒硝三合 瓜子半升
右五味,以水六升,煮取一升,去滓,内芒硝再煎沸,顿服之。有脓当下,如无脓当
下血。
【集解】
李□曰:大黄、芒硝泄热,桃仁行瘀,丹皮逐血痹,去血分中伏火,瓜子主溃脓血。
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问曰:寸口脉微而涩,法当亡血,若汗出,设不汗者云何?答曰:若身有疮,被刀斧
所伤,亡血故也。
【注】
脉微气夺也,脉涩血夺也,故曰:法当亡血汗出也。设无亡血汗出等病,则必身有疮
被刀斧所伤,亡血故也。
【集注】
李□曰:汗出亡阳,则脉微;亡血伤阴,则脉涩。微与涩皆阴脉也,设不汗而疮疡全
疮,虽不亡阳而亡血,故亦见微涩之脉也,总是荣卫虚衰之故。
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病金疮,王不留行散主之。
【注】
此承上条以明其治也。金疮,谓刀斧所伤之疮也。亡血过多,经络血虚,风寒易得干
之,故用王不留行散,一以止血出,一以防外邪也。小疮粉之,即外敷也。
Shiyi Ren (Coicis Semen) 10 fen, Fuzi (Aconiti Lateralis Radix Praeparata) 2 fen, Baijiang Cao (Patriniae Herba, also known as Kucail) 5 fen.
The above three herbs are crushed and ground into powder. Take one fangcunbi (a square-inch measure) of the powder, add two sheng (approx. 400ml) of water, and decoct until the volume is reduced by half. Take the decoction in one dose. The patient's urination should become smooth and unobstructed after ingestion.
[Collected Annotations]
Xu Bin stated: Shiyi Ren (Coicis Semen), being cold in nature, can eliminate heat, descend qi, overcome dampness, benefit the intestines and stomach, and break down toxic swellings; Baijiang Cao (Patriniae Herba) excels at draining pus, breaking blood stasis, and resolving stagnant heat-toxic qi, thus serving as the minister herb; Fuzi (Aconiti Lateralis Radix Praeparata) guides heat to resolve stagnation, thus serving as an antagonistic adjuvant (fan zuo).
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Changyong (Intestinal Abscess) presents with swelling and distension in the lower abdomen, pain upon palpation, a sensation similar to strangury but with normal urination, intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, it indicates that pus has not yet formed; purgation may be applied, and blood may appear in the stool. If the pulse is surging and rapid, it indicates that pus has already formed; purgation is contraindicated. Dahuang Mudan Tang (Rhubarb and Moutan Decoction) should be administered.
[Annotation]
This passage follows the previous one, detailing the symptoms to clarify the treatment. In Changyong (Intestinal Abscess), the symptom of swelling and hardness in the lower abdomen with pain upon palpation indicates the abscess is internal; the sensation of strangury during urination with normal urine color indicates obstruction due to swelling. Intermittent fever, sweating, and aversion to cold resemble exterior syndrome but are not actually exterior syndrome. A slow and tight pulse indicates yin excess and blood that has not yet transformed into pus; purgation may be applied, and blood should appear in the stool. If the pulse is surging and rapid, it indicates yang excess and corrupted blood, meaning pus has formed; purgation is contraindicated. Purgation using Dahuang Mudan Tang (Rhubarb and Moutan Decoction) eliminates blood stasis and drains heat.
Dahuang (Rhei Radix et Rhizoma) 4 liang, Mudan Pi (Moutan Cortex) 1 liang, Taoren (Persicae Semen) 50 pieces, Mangxiao (Natrii Sulfas) 3 he, Guazi (Cucurbitae Semina) 0.5 sheng.
The above five herbs are decocted in six sheng (approx. 1200ml) of water until one sheng remains. Strain the dregs, add Mangxiao (Natrii Sulfas), boil again until boiling, and take in one dose. If pus is present, it will be discharged via stool; if no pus is present, blood stasis will be discharged.
[Collected Exegesis]
Li [Name Redacted] stated: Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) drain heat; Taoren (Persicae Semen) promotes blood circulation; Danpi (Moutan Cortex) dispels blood bi and removes latent fire in the blood level; Guazi (Cucurbitae Semina) primarily facilitates the discharge of pus and blood.
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Question: Cun Kou (Inch Position) pulse is faint and choppy. By law, this should indicate loss of blood or excessive sweating. If there is no sweating, what is the explanation? Answer: If the body has sores or wounds caused by knives or axes, resulting in blood loss, this occurs.
[Annotation]
A faint pulse indicates qi depletion; a choppy pulse indicates blood depletion. Thus, by law, it should indicate loss of blood or sweating. Assuming there are no diseases such as blood loss or sweating, it must be that the body has sores or wounds caused by knives or axes, leading to blood loss.
[Collected Annotations]
Li [Name Redacted] stated: Sweating leads to loss of yang, resulting in a faint pulse; loss of blood damages yin, resulting in a choppy pulse. Both faint and choppy pulses are yin pulses. Assuming no sweating but full manifestation of sores, although yang is not lost, blood is lost, hence the faint and choppy pulse appears. This is always due to the deficiency and decline of Ying (Nutritive Qi) and Wei (Defensive Qi).
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Jinchuang (Metal Wounds) is treated with Wangbuliuxing San (Vaccaria Seed Powder).
[Annotation]
This passage follows the previous one to clarify the treatment. Jinchuang refers to wounds caused by knives or axes. Excessive blood loss leads to blood deficiency in the meridians, making the body susceptible to wind-cold invasion. Therefore, Wangbuliuxing San (Vaccaria Seed Powder) is used to stop bleeding and prevent external pathogens. For minor wounds, the powder is applied externally.