予患腹痛多年,由午餐饭冷强食而起,痛处在脐之上,痛时腹冷,掌按热熨稍瘥。虽盛
暑亦
必以帛护其腹,饮食渐减,喜暖畏凉,他物食尚相安,惟饭蒸煮未透,或稍冷食则必痛,素
嗜瓜果,得疾后不敢尝。向患痔红,食姜蒜烧酒即发,故忌之。此疾作时,食入阻滞,饮烧
酒一二杯,反觉通畅,不但姜蒜不忌,即食椒末辣酱,均与痔红无碍。经云∶痛者寒气多也
。证属寒凝气滞无疑。予素畏药,痛发无何,香砂姜萸陈半谷芽神曲之类,服一两剂即罢去
,往岁发疏尚轻,惟餐饭不能如常,年来发频且重,不拘何物,餐后必痛。须食下行,其痛
方止。于是餐后不敢坐卧,乃学古人养生,食后行百步,常宜手摩腹之法,并遵释教过午戒
食
,然亦无益于病,遂视食为畏途,无如疾经重载,消恐耗元,补防助壅,踌躇无策。友人谓
予年近古稀,命阳衰弱,寒从内生,是以喜暖畏凉。釜底无火,物终不熟,是以谷食难化,
须用八味丸补火生土。所论固是,予意终未坦然。思痛若在鬲,虑其妨食成噎,今幸在腹,
当不害命。药饵乱投,恐反有伤,恪守不药得中医之诫。己丑季夏,旌邑孙村汪宅延诊,下
塌塾中,时二鼓既寝,急欲大便。灯灭暗中摸索,跌仆莫能挣扎,大孔 遗出如泻水状,
呼仆持火至,扶起视地皆污,色如漆,汗淋气坠,即忙就枕。汪宅献楠志仁二公闻之驰至,
殊为着惊,予曰无妨,此因久痛蓄瘀,刻瘀下脱,未免伤气耳。饮党参、桂圆汤,少顷气稍
续,汗亦敛,次早登厕,犹有余瘀。予恐其瘀复脱,遄归到家更衣,瘀已无矣。自此腹不再
痛,餐饭如常。细求其故,究由瘀凝肠胃,阻其传导之机,以故食入则痛。夫血犹水也,血
之
结而为瘀,亦如水之结而为冰。所以痛处常冷,按熨饮醇热气至,故觉稍快。至于瘀蓄年久
,胶固已深,一旦倾囊自出,理殊不解,得无长夏炎蒸,奔驰烦劳,动则阳化,如雪消而春
水来耶。从斯悟入,书称久痛在络,络主血,不独肢体之痛为在络,即胸腹之痛,痞积之痛
,皆为在络,皆宜治血,无徒从事于气。又如噎隔一证,方书虽有胃脘枯槁,及阳气结于上
,阴液衰于下等语,然由瘀血阻塞胃口者恒多。进而思之,予疾将十年,固未能自知瘀蓄于
先,然不药稳持,尚不失为中驷。不然补泻杂投,不殒于病,而殒于药矣。予见败坏之证自
萎者十之二三,药伤者十之七八。药本生人,而反杀人,可不惧哉。自今以往,伏愿医家证
未审明,勿轻用药,病家疾如可待,勿急求医,如此或亦可为卫生之一助耳。
安波曰∶初痛在经,久痛入络二语,叶氏实发前人数千年之未发,启后学于意万载之
无窍
。然不独胃病噎膈之症,浑融使然也,凡病久根深蒂固,综须治血为主,此即古人窍必及肾
之意也夫。
I suffered from abdominal pain for many years, caused by forcibly eating cold rice at lunch. The pain was located above the umbilicus; during attacks, the abdomen felt cold, and symptoms improved slightly with palm pressure or hot compresses. Even in midsummer, I had to protect my abdomen with cloth, my diet gradually decreased, I preferred warmth and feared cold, other foods were generally tolerated, but only when rice was thoroughly steamed or food was not slightly cold could I eat without inevitable pain. I used to enjoy melons and fruits, but dared not try them after falling ill. Previously, I suffered from hemorrhoidal bleeding, which would flare up upon consuming ginger, garlic, or distilled liquor, so I avoided these. When this ailment flared, food intake felt obstructed; drinking one or two cups of distilled liquor反而 (instead) made me feel unblocked. Not only did I no longer avoid ginger and garlic, but even consuming pepper powder or spicy sauce had no adverse effect on the hemorrhoids. The *Classic* states: "Pain is mostly due to cold qi." The syndrome undoubtedly belongs to cold coagulation and qi stagnation. I have always feared medication. When pain first started, I took herbs such as *Amomi Fructus Rotundus* (Xiangsha), *Zingiberis Rhizoma* (Jiang), *Evodiae Fructus* (Ruyu), *Citri Reticulatae Pericarpium* (Chenpi), *Pinelliae Tuber* (Banxia), *Oryzae Fructus Germinatus* (Guya), and *Meditae Fructus* (Shenqu) for one or two doses and then stopped. In previous years, attacks were sparse and mild, merely affecting normal eating habits; in recent years, they became frequent and severe, causing pain after every meal regardless of what was eaten. Pain ceased only after food moved downward. Thus, I dared not sit or lie down after meals. I learned from ancients' health preservation methods: walking a hundred steps after meals, frequently massaging the abdomen, and following the Buddhist precept of abstaining from food after noon. However, this brought no benefit to the illness. Consequently, I viewed eating as a fearful path. Helpless against the chronic accumulation of disease, I feared that resolving drugs would deplete Yuan Qi (Primordial Qi), while tonics might aid stagnation. Pondering without a solution, a friend said, "You are near seventy, your Mingmen Fire (Gate of Life Fire) is weak, cold generates internally, hence you prefer warmth and fear cold. Just as a pot lacks fire underneath and food cannot cook, grains are hard to digest. You should use *Bawei Wan* (Eight-Ingredient Pill with Rehmannia) to tonify fire and generate earth." Although his argument was sound, my mind remained unsettled. I thought if the pain were in the diaphragm, it might hinder eating and lead to dysphagia (Yige); fortunately, it is now in the abdomen and likely not life-threatening. Random medication might cause harm; strictly adhering to the admonition of "not using medicine lightly" aligns with true medical wisdom. In the summer of Jichou year, I was invited to diagnose patients at the Wang residence in Sun Village, Jingde County. Living in a low schoolhouse, at the second watch (9–11 PM), I suddenly needed to defecate. The lamp went out; groping in the dark, I fell and could not struggle. Fluid like diarrhea flowed from the anus. I called a servant for a torch, got up, and saw the ground stained black as lacquer. Sweating profusely with sinking Qi, I hurriedly lay back on the pillow. Mr. Nan and Mr. Zhi Ren from the Wang residence rushed over upon hearing this, greatly alarmed. I said, "No matter. This is because long-standing pain has accumulated blood stasis; now the stasis is discharging downwards, inevitably injuring Qi." I drank a decoction of *Codonopsis Radix* (Dangshen) and *Longan Arillus* (Guiyuan). Shortly after, my Qi recovered slightly, and sweating stopped. The next morning, upon using the toilet, residual stasis remained. Fearing further discharge, I hurried home to change clothes; the stasis had disappeared. From then on, abdominal pain never returned, and eating normalized. Investigating the cause, it turned out that stasis coagulated in the intestines and stomach, obstructing the mechanism of conduction and transmission, thus causing pain upon food intake. Blood is like water; when blood condenses into stasis, it is like water freezing into ice. Hence, the painful area is often cold. Pressure, heat application, and drinking warm alcohol bring heat, providing relief. As for stasis accumulating for years, becoming deeply entrenched, its sudden discharge is puzzling. Could it be that the intense heat of midsummer, combined with travel and fatigue, activated Yang transformation, like snow melting bringing spring water? From this realization, I understood: texts state that long-standing pain resides in the collaterals (Luo Mai), and collaterals govern blood. It is not only limb pain that resides in the collaterals; chest and abdominal pain, as well as pain from masses and accumulations, also reside in the collaterals and should be treated by addressing blood, not merely regulating Qi. Similarly, regarding dysphagia (Yige), although texts mention dryness of the stomach opening, Yang qi knotting above, and Yin fluid deficiency below, cases caused by blood stasis blocking the stomach opening are common. Further thinking, my illness lasted nearly ten years; although I could not know beforehand of the accumulated stasis, refraining from medication and maintaining stability was still a competent strategy. Otherwise, mixing tonics and purgatives would not kill me via disease, but via medicine. I see that among deteriorated syndromes, 20–30% resolve naturally, while 70–80% are harmed by drugs. Drugs are meant to save lives but can kill; how can one not fear this? From now on, I hope physicians will not prescribe lightly before clearly diagnosing, and patients whose conditions can wait should not rush to seek doctors. This may serve as an aid to health preservation.
An Bo said: The phrases "initial pain is in the meridians, long-standing pain enters the collaterals" were truly expounded by Ye Tianshi, uncovering theories unexplored by predecessors for millennia and enlightening later learners who had been clueless for ages. However, this principle applies not only to stomach diseases and dysphagia but universally: for any chronic, deeply rooted disease, treatment must primarily focus on blood. This is the meaning behind the ancient saying that "orifices must involve the Kidney."