幽痈,生脐上七寸。初起如粟,渐增漫肿疼痛,形如鹅卵,甚则坚硬,牵痛胸肋。由过
食膏粱浓味,忧思气结,肠胃不通,火郁而成斯毒,自内发外者也。初服神授卫生汤,溃后
即用补托。
赫痈,生脐上三寸,属任脉经建里穴。由七情郁火凝结而成。初如粟粒,痒痛相兼,其
肿迅速,寒热往来,甚则呕哕,牵引脐痛。初肿微红,顶尖根束,渐透赤色者,以活命饮消
散之;成脓后,用托里消毒散;既溃,宜参 内托散。
冲疽,一名中发疽,生于脐上二寸,系任脉经下脘穴。由心火炽甚,流入肾经所致。肿
高色赤,脓稠者,易愈;若平塌黑色,膨胀恶心,脓水清稀,内肾疼痛,泻利无度,谵语直
视者,死;溃久不敛者,死。凡此皆属虚耳。法宜用大补之剂。如能受补,即不死也。
薛立斋曰∶乳房属足阳明胃经,乳头属足厥阴肝经。男子房劳恚怒,伤于肝肾;妇人思
虑忧郁,损于肝脾,皆能致疡。第乳之为疡有不同。有乳中结核,形如丸卵,不疼痛,不发
寒热,皮色不变,其核随喜怒为消长,此名乳癖。良由肝气不舒郁积而成,若以为痰气郁结
,非也。夫乳属阳明,乳中有核,何以不责阳明而责肝?以阳明胃土最畏肝木,肝气有所不
舒,胃见木之郁,惟恐来克,伏而不扬,气不敢舒,肝气不舒,而肿硬之形成,胃气不敢舒
,而畏惧之色现,不疼不赤,正见其畏惧也。治法不必治胃,但治肝而肿自消矣。逍遥散去
姜、薄,加栝蒌、半夏、人参主之(此方专解肝之滞,肝解而胃气不解自舒,盖以栝蒌、半
夏,专治胸中积痰,痰去肿尤易消也)。
有乳中结核,始不作痛,继遂隐隐疼痛,或身发寒热,渐渐成脓溃破者,此名乳痰。或
亦由肝经气滞而成,或由于胃经痰气郁蒸所致。用药疏肝之中,必加贝母、半夏、栝蒌等以
治痰,则未脓可消,至已溃必兼补气血,方易收口。
乳疡之不可治者,则有乳岩。夫乳岩之起也,由于忧郁思虑,积想在心,所愿不遂,肝
脾气逆,以致经络痞塞结聚成核,初如豆大,渐若棋子,不红不肿,不疼不痒,或半年一年
,或两载三载,渐长渐大,始生疼痛,痛则无解日,后肿如堆栗,或如覆碗,紫色气秽,渐
渐溃烂,深者如岩穴,凸者如泛莲,疼痛连心,出血则臭,并无脓水,其时五脏俱衰,遂成
四大不救。凡犯此者,百人百死。如能清心静养,无挂无碍,不必勉治,尚可苟延。当以加
味逍遥散、归脾汤,或益气养营汤主之。此证溃烂体虚,亦有疮口放血如注,实时毙命者,
与失营证同。
You Yong (Deep Abscess) arises seven cun above the umbilicus. Initially, it resembles a millet grain, gradually increasing to a diffuse swelling with pain, shaped like a goose egg; in severe cases, it becomes hard and causes pulling pain to the chest and hypochondrium. This condition results from excessive consumption of rich and greasy foods, combined with worry and thought leading to Qi stagnation, intestinal and stomach obstruction, and the accumulation of fire-toxin, manifesting from the interior to the exterior. In the early stage, Shen Shou Wei Sheng Tang is administered; after ulceration, tonifying and expelling methods are used immediately.
He Yong (Bright Abscess) arises three cun above the umbilicus, belonging to the Jianli acupoint (Jianli, CV11) of the Ren Mai (Conception Vessel). It is formed by the condensation of fire due to the stagnation of the Seven Emotions. Initially, it is like a millet grain, accompanied by both itching and pain, with rapid swelling, alternating chills and fever, and in severe cases, vomiting and hiccups, with pulling pain at the umbilicus. If the initial swelling is slightly red, with a pointed apex and constricted base, gradually turning crimson, Huo Ming Yin (Life-Saving Decoction) is used to dissipate it; after suppuration, Tuo Li Xiao Du San (Interior-Tonifying and Toxin-Expelling Powder) is applied; once ulcerated, Shen Nei Tuo San (Ginseng Interior-Tonifying and Expelling Powder) is suitable.
Chong Ju (Thrusting Carbuncle), also known as Zhong Fa Ju (Central-Erupting Carbuncle), arises two cun above the umbilicus, corresponding to the Xiawan acupoint (Xiawan, CV10) of the Ren Mai. It is caused by excessive Heart Fire flowing into the Kidney Meridian. If the swelling is high, red, and the pus is thick, it is easy to heal; if the swelling is flat, black, accompanied by abdominal distension and nausea, thin pus, internal Kidney pain, uncontrolled diarrhea, delirium, and fixed gaze, death ensues; if it ulcerates and fails to heal for a long time, death also ensues. All these conditions belong to Deficiency. The method should employ major tonifying agents. If the patient can tolerate tonification, they will not die.
Xue Lizhai stated: The breast belongs to the Foot-Yangming Stomach Meridian, and the nipple belongs to the Foot-Jueyin Liver Meridian. In men, sexual excess or anger injures the Liver and Kidneys; in women, overthinking and depression damage the Liver and Spleen; both can lead to sores. However, sores in the breast vary. One type presents as nodules in the breast, shaped like pills or eggs, without pain, chills, or fever, with unchanged skin color; the nodules fluctuate in size with emotions of joy or anger. This is named Ru Pi (Breast Lump). This is indeed caused by the stagnation and accumulation of Liver Qi; regarding it as Phlegm-Qi stagnation is incorrect. Since the breast belongs to the Yangming, why are nodules in the breast attributed to the Liver rather than the Yangming? Because Yangming Earth most fears Jueyin Wood. When Liver Qi is stagnant, the Stomach, seeing the stagnation of Wood, fears being overcome, thus lying dormant and not rising, with Qi不敢 (daring not) to relax. As Liver Qi does not relax, hardness and swelling form; as Stomach Qi dares not relax, signs of fear appear. The absence of pain and redness precisely reflects this fear. The treatment need not address the Stomach; only by treating the Liver will the swelling subside naturally. Xiaoyao San (Free and Easy Wanderer Powder) with ginger and mint removed, plus Gua Lou (Trichosanthes Fruit), Ban Xia (Pinellia Tuber), and Ren Shen (Ginseng Root) is the main prescription (This formula specifically resolves Liver stagnation; once the Liver is resolved, the Stomach's lack of relaxation naturally soothes, largely because Gua Lou and Ban Xia specifically treat accumulated Phlegm in the chest; once Phlegm is gone, swelling is easier to eliminate).
Another type presents as nodules in the breast that initially do not hurt, but later cause dull pain, or systemic chills and fever, gradually forming pus and ulcerating. This is named Ru Tan (Breast Phlegm). It may also be caused by Qi stagnation in the Liver Meridian or by the steaming and stagnation of Phlegm-Qi in the Stomach Meridian. In medication that soothes the Liver, one must add Bei Mu (Fritillaria Bulb), Ban Xia, and Gua Lou to treat Phlegm; thus, before suppuration, it can be dissipated, and after ulceration, tonifying Qi and Blood is necessary for wound closure.
Among breast sores that are incurable is Ru Yan (Breast Rock/Cancer). Ru Yan arises from depression and overthinking, with desires unfulfilled, causing Liver and Spleen Qi to rebel, leading to meridian obstruction and nodule formation. Initially small as a bean, it gradually grows like a chess piece, without redness, swelling, pain, or itching. Over half a year to a year, or two to three years, it gradually enlarges, then begins to hurt, with pain having no relief. Later, the swelling resembles piled chestnuts or an inverted bowl, purple with foul odor, gradually ulcerating. Deep ulcers resemble rock caves, protruding ones resemble floating lotuses. Pain radiates to the heart, bleeding has a foul odor, and there is no pus. At this stage, the Five Zang Organs are all exhausted, leading to the failure of the Four Extremities, which is incurable. Those who contract this disease die hundred percent. If one can maintain a clear mind and quiet nourishment, without attachments or obstructions, and does not force treatment, life may be prolonged. Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder), Gui Pi Tang (Restore the Spleen Decoction), or Yi Qi Yang Ying Tang (Tonify Qi and Nourish Ying Decoction) should be used. In this condition, with ulceration and constitutional weakness, there are cases where blood spurts from the wound, leading to immediate death, similar to Shi Ying Syndrome (Loss of Camp/Incurable Cancer).