杨司天,骨已入臼,患处仍痛,服药不应,肝脉洪大而急。薛曰∶此肝火盛而作痛
也,用小柴胡汤加山栀、黄连,二剂痛止,用四物,山栀、黄柏、知母调理而康。 有一
患者,瘀血内胀, 痛发热,口干作渴,饮食不甘,四肢倦怠。薛曰∶此肝火炽盛,脾
土受制,故患前证,喜其禀实年壮,第用降火、清肝、活血之剂而愈。
青肿不消,用补中益气汤以补气。肿黯不消,用加味消遥散以散血。若 肿胀痛,瘀
血作脓也,以八珍汤加白芷托之。若脓溃而反痛,气血虚也,以十全大补汤补之。若骨
HT接而复脱,肝肾虚也,用地黄丸。肿不消,青不退,气血虚也,内用八珍汤,外用葱熨
法,则瘀血自散,肿痛自消。若行血破血,则脾胃愈虚,运气愈滞。若敷贴凉药,则瘀血
益凝,内腐益深,致难收拾。 一妇人,闪臂腕肿大,已三月。手臂日细,肌瘦恶寒,食
少短气,脉息微细,属形病俱虚也,遂投补中益气加肉桂,引诸药以行至臂,再加贝母、
香附以解久病之郁,间服和血定痛丸,以葱熨之,肿消二三。因怒患处仍胀,胸膈两胁
微痛,以前汤更加木香、山栀、半夏、桔梗服之,少可。复因惊不寐,少食、盗汗,以
归脾汤加五味、麦门二十余剂而安,肿消三四,手臂渐肥。但经水过期而少。此心脾之
血,尚未充足而然也,乃用八珍加五味、麦门、丹皮、远志、香附、贝母、桔梗,四十
余剂诸症悉愈。后因怒发热谵语,经水如涌,此怒动肝火,以小柴胡汤加生地黄二钱,一
剂遂止;以四物加柴胡调理而康。 州守陈克明子,闪右臂腕肿痛,肉色不变,久服流
气等药,加寒热少食,舌干作渴。薛曰∶伤损等症,肿不消色不变,此运气虚而不能愈,
当助脾胃,壮气血为主,遂从薛法治之。不二月形气渐充,肿热渐消,半载诸症悉退,体
臂如常。 一小儿,闪腿腕壅肿,形气怯弱。薛欲治以补气血为主,佐以行散之剂,不信。
乃内服流气饮,外敷寒凉药,加寒热体倦。薛曰∶恶寒发热,脉息洪大,气血虚极也,治
之无功,后内溃,沥尽气血而亡。 李考功子,十四岁,脚腕闪伤,肿而色夭,日出清
脓少许,肝脉微涩,此肝经受伤,气血虚而不能溃,难治之证也,急止克伐之剂,不信。
乃杂用流气等药,后果出烂筋而死。
Yang Sitian's hip joint (bone returned to the acetabulum) had already been reduced, but the affected area still hurt, and medication was ineffective. The liver pulse was surging (Hong) and rapid (Ji). Xue Ji said: This is pain caused by excessive Liver Fire. He prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Gardenia Fruit (Shanzhi) and Coptis Rhizome (Huanglian). After two doses, the pain ceased. He then used Si Wu Tang (Four Substances Decoction) combined with Shanzhi, Phellodendron Bark (Huangbai), and Anemarrhena Rhizome (Zhimu) for regulation, leading to recovery.
A patient suffered from internal distension due to blood stasis, accompanied by pain, fever, dry mouth and thirst, loss of appetite, and fatigue in the four limbs. Xue Ji said: This is caused by blazing Liver Fire suppressing Spleen Earth. Fortunately, the patient had a robust constitution and was young. Treatment with herbs that descend fire, clear the Liver, and invigorate blood resulted in a cure.
If green swelling does not dissipate, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify Qi. If swelling remains dark and does not dissipate, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) to dissipate blood stasis. If there is swelling and pain, it indicates that blood stasis is turning into pus; treat with Ba Zhen Tang (Eight Treasures Decoction) plus Angelica Dahurica Root (Baizhi) to expel toxicity. If pain persists after the pus breaks, it indicates deficiency of Qi and Blood; treat with Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction). If the bone reconnects but dislocates again, it indicates deficiency of the Liver and Kidney; treat with Di Huang Wan (Rehmannia Pill). If swelling does not subside and the green color does not fade, it is due to Qi and Blood deficiency. Internally administer Ba Zhen Tang, and externally apply the Scallion Moxibustion Method (Cong Yun Fa); thus, blood stasis will naturally dissipate, and swelling and pain will vanish. If blood-invigorating or blood-breaking agents are used, the Spleen and Stomach will become more deficient, and the movement of Vital Qi (Yunqi) will become more stagnant. If cooling herbs are applied topically, blood stasis will coagulate further, internal rot will deepen, making the condition difficult to manage.
A woman suffered from swelling of the arm and wrist due to a sprain for three months. Her arm grew thinner daily, muscles wasted, she felt aversion to cold, ate little, had shortness of breath, and her pulse was faint and fine. This indicated deficiency in both form and disease. She was administered Bu Zhong Yi Qi Tang with added Cinnamon Twig (Rougui) to guide the herbs to the arm. Beimu (Fritillaria Bulb) and Cyperus Rhizome (Xiangfu) were added to resolve the stagnation of long-standing illness. Intermittently, Hexue Dingtong Wan (Blood-Invigorating and Pain-Relieving Pill) was taken, and Scallion Moxibustion was applied externally. The swelling subsided by two or three parts. Due to anger, the affected area swelled again, with mild pain in the chest, diaphragm, and hypochondrium. The previous decoction was modified with Mugwort Root (Muxiang), Shanzhi, Pinellia Tuber (Banxia), and Platycodon Root (Jiegeng), resulting in slight improvement. Later, due to fright causing insomnia, poor appetite, and night sweats, Guipi Tang (Restore the Spleen Decoction) with added Schisandra Berry (Wuweizi) and Ophiopogon Tuber (Maimendong) was given for over twenty doses, bringing stability. Swelling subsided by three or four parts, and the arm gradually became plump. However, menstruation was delayed and scanty. This was due to insufficient Heart and Spleen Blood. Therefore, Ba Zhen Tang was modified with Wuweizi, Maimendong, Moutan Cortex (Danpi), Polygala Root (Yuanzhi), Xiangfu, Beimu, and Jiegeng. After over forty doses, all symptoms resolved. Later, due to anger, she developed fever and delirium, and menstruation flowed heavily like a surge. This was Liver Fire stirred by anger. Xiao Chai Hu Tang with 2 qian of Rehmannia Root (Shengdihuang) stopped it in one dose. Si Wu Tang with Chaihu was used for regulation, leading to recovery.
The son of Prefect Chen Keming suffered from painful swelling of the right wrist due to a sprain, with no change in skin color. Long-term use of Liqi-type medicines aggravated alternating chills and fever, anorexia, dry tongue, and thirst. Xue Ji said: In injuries, if swelling does not subside and color does not change, it is because the body's Vital Qi is deficient and cannot heal. The treatment should focus on strengthening the Spleen and Stomach and boosting Qi and Blood. Following this method, within two months, his physique and Qi strengthened, and swelling and heat gradually subsided. After half a year, all symptoms disappeared, and his body and arm returned to normal.
A child suffered from severe swelling of the leg and ankle due to a sprain, with weak physique and Qi. Xue Ji intended to treat him primarily by tonifying Qi and Blood, assisted by herbs that move and dissipate. The family did not believe this. Instead, they administered Liqi Yin internally and applied cooling herbs externally, which aggravated chills, fever, and fatigue. Xue Ji said: Aversion to cold and fever with a surging pulse indicate extreme deficiency of Qi and Blood. Treatment failed. The wound later ulcerated internally, draining all Qi and Blood, leading to death.
The son of Ministry Official Li was fourteen years old. His ankle was sprained, swollen, with a dull complexion. A small amount of thin pus exuded at sunrise. The Liver pulse was faint and choppy. This indicated injury to the Liver Meridian, with Qi and Blood deficiency preventing the rupture and drainage of pus. It was a difficult-to-treat condition. Urgent cessation of attacking/depleting agents was advised, but the family did not comply. They indiscriminately used Liqi-type medicines. Consequently, rotten sinews were discharged, and he died.