骤然臌胀胃苓汤,虚证当知圣术前方,病起吐酸连理(丸)妙,桂甘麻附细辛(汤)良。
蛊胀由来少的方,山风卦内得津梁。艮安止息能(胃能二字,出《医贯》)均废(胃其有能,
一于止,则其能废隳矣,)巽则顺从气弗扬(此证须振肝木之气,以冲开胃土,方得治法。庸医
尚云∶法取平肝,可发一叹。)参透生机原主动(其止也,当矫之以奋发,)须知大气本乎刚(其巽
也,当矫之以刚果,先甲三日在辛,谓自新也,后甲三日在丁,谓叮嗌也,此《周易》治蛊
之道也。今医用肾气丸,一派静柔之品,杂以些少之桂附,不死何待。)仲师心下如盘训,宜
苦宜辛二法详(气无形也,宜散之以辛,水有形,宜泄之以苦也。此证不出方,恐泄天地之秘
,亦恐人轻其道。
疝气者,睾丸肿大而痛也。大抵属于任脉与肝经之病,而他经亦有之。七疝之名,亦不
必拘。后贤于此证加一“气”字,可知治此症以调气为主,统以五苓散作汤,加小茴、木香
、木通、金铃子主之。如痛甚者,须防其溃烂,加金银花为君,再加乳香、没药为佐。如麻
木不痛者,恐其为 疝,难治。数年后如升如斗,宜加桃仁 、附子、荜茇、沙参、蒺藜
蜜丸,盐汤送下。此证多属寒气凝滞,故列于寒证。
(经义)《骨空论》曰∶“任脉为病,男子内结七疝,女子带下瘕聚。督脉生病,从少腹上
冲心而痛,不得前后为冲疝。”《长刺节论》曰∶“病在少腹,腹痛不得大小便,病名曰疝
,得之寒。”《经脉篇》曰∶“足厥阴肝病,丈夫 疝,妇人少腹肿。肝所生病,为飧
泄狐
疝。”《阴阳别论》曰∶“三阳为病发寒热,其传为 疝。”《邪气脏腑病形篇》曰∶“
小
肠病者,小腹痛,腰脊控睾而痛,时窘之后。”《大奇论》曰∶“肾脉大急沉,肝脉大急沉
,皆为疝。”
对于突然发生的臌胀病,应使用胃苓汤;若是虚证,则应当知晓圣术前方(方剂名)的妙用。若病症起因于呕吐酸水,连理丸(方剂名)疗效奇妙;桂枝甘草麻黄附子细辛汤(方剂名)亦为良方。
蛊胀病的由来,治疗方药较少,需从《周易》山风蛊卦中寻求治疗的桥梁与指引。“艮”代表停止与静止,如果胃气只知停止而不知运化,那么它的功能就会废弛毁坏;“巽”代表顺从,此处指病情需要振奋肝木之气,以冲开胃土之壅滞,这才是正确的治法。庸医尚且声称采用平抑肝木的方法,实在令人叹息。参透生机的关键在于主动奋发,必须知道大气本乎刚健。其“止”的状态,应当用奋发来纠正;其“巽”的状态,应当用刚果断决来纠正。正如《周易》所言,“先甲三日在辛”,意为自新;“后甲三日在丁”,意为叮咛告诫,这是《周易》治疗蛊道的道理。如今医生使用肾气丸,这是一派静柔的药物,仅夹杂少许桂枝、附子,患者不死还等什么?张仲景关于“心下如盘”的教诲,详细阐述了宜苦宜辛两种治法。气是无形的,适宜用辛味药物发散;水是有形的,适宜用苦味药物泄降。此证未列出具体方剂,是担心泄露天地之秘密,也担心人们轻视此道。
疝气,是指睾丸肿大且疼痛的疾病。大体上属于任脉和肝经的病变,其他经络也可能涉及。七疝的名称,也不必拘泥固定。后世贤者在“疝”字上加一“气”字,可知治疗此症应以调气为主。统用五苓散煎汤,加入小茴香、木香、木通、金铃子作为主药。如果疼痛剧烈,须防止溃烂,加入金银花为君药,再加乳香、没药作为佐药。如果出现麻木而不痛的情况,恐怕其为阴疝,难以治疗。数年后若肿物如升如斗般大,宜加桃仁、附子、荜茇、沙参、蒺藜制成蜜丸,用盐汤送服。此证多属于寒气凝滞,因此列于寒证之中。
(经文义理)《素问·骨空论》说:“任脉发病,男子体内结聚成七疝,女子带下及瘕聚。督脉生病,气从少腹上冲心脏而疼痛,大小便不通,称为冲疝。”《素问·长刺节论》说:“病位在少腹,腹痛且不能大小便,病名叫做疝,这是由于受寒所致。”《素问·经脉篇》说:“足厥阴肝经发生病变,男子患疝气,女子少腹部肿胀。肝所生的疾病,包括飧泄和狐疝。”《素问·阴阳别论》说:“三阳经发病,出现寒热症状,传变后成为疝。”《素问·邪气脏腑病形篇》说:“小肠有病,小腹疼痛,腰脊牵引睾丸疼痛,时常窘迫想解大便。”《素问·大奇论》说:“肾脉大而急沉,肝脉大而急沉,都表现为疝病。”
For sudden onset of distension (Gu Zhang), Weiling Tang (Stomach Calming Decoction) should be used; for deficiency syndromes, one must know the efficacy of Shengzhu Qianfang (Holy Atractylodes Anterior Formula). If the disease originates from vomiting acid, Lianli Wan (Continuous Reason Pill) is miraculous; Guigan Mahuang Fuzi Xixin Tang (Cinnamon Twig, Licorice, Ephedra, Aconite, and Asarum Decoction) is also an excellent prescription.
The etiology of Gu distension has few specific formulas; one must seek guidance in the Mountain-Wind Gu hexagram of the *I Ching* (Book of Changes). "Gen" signifies stillness; if stomach Qi only stops and fails to transform, its function will become derelict. "Xun" signifies compliance; this condition requires stirring up Liver Wood Qi to break through the stagnation of Stomach Earth, which constitutes the correct treatment method. Quack doctors still claim that calming the Liver is the approach, which is lamentable. Understanding the mechanism of life requires proactive mobilization; one must realize that Great Qi is fundamentally vigorous. The state of "stopping" should be corrected by exertion; the state of "Xun" should be corrected by resoluteness. As stated in the *I Ching*, "Three days before Jia is Xin," meaning self-renewal; "Three days after Jia is Ding," meaning admonition. This is the way of treating Gu according to the *I Ching*. Today, physicians use Shenqi Wan (Kidney Qi Pill), a formula consisting entirely of quiet and soft substances, mixed with only a small amount of Cinnamon Twig and Aconite. How can the patient avoid death? Master Zhongjing's instruction regarding "a plate under the heart" details two methods: bitter and acrid. Qi is formless and should be dispersed with acrid flavors; Water has form and should be drained with bitter flavors. No specific formula is listed here to avoid revealing heavenly secrets or causing people to slight this path.
Hernia (Shan Qi) refers to swelling and pain of the testicles. Generally, it belongs to diseases of the Ren Mai (Conception Vessel) and Liver Meridian, though other meridians may also be involved. The names of the Seven Hernias need not be rigidly adhered to. Later scholars added the character "Qi" to "Shan," indicating that regulating Qi is the primary treatment. Use Wuling San (Five-Ingredient Powder with Poria) as a decoction base, adding Xiao Hui Xiang (Fennel), Mu Xiang (Costus Root), Mu Tong (Akebia Stem), and Jin Ling Zi (Sichuan Chinaberry Fruit) as main herbs. If pain is severe, prevent ulceration by adding Jin Yin Hua (Honeysuckle Flower) as the sovereign herb, plus Ru Xiang (Olibanum) and Mo Yao (Myrrh) as assistants. If numbness occurs without pain, it may be a Yin hernia, which is difficult to treat. Years later, if the swelling rises like a measure or a bowl, add Tao Ren (Peach Seed), Fu Zi (Prepared Aconite Root), Bi Bo (Long Pepper), Sha Shen (Glehnia Root), and Ji Li (Tribulus Fruit) to make honey pills, taken with salt water. This condition mostly belongs to cold qi stagnation, so it is classified under Cold Syndromes.
(Scriptural Meaning) *Su Wen: Gu Kong Lun* states: "Disease of the Ren Mai causes seven hernias in men and leukorrhea with masses in women. Disease of the Du Mai causes Qi to rush from the lower abdomen to the heart with pain, accompanied by inability to pass urine or stool, called Chong Hernia." *Su Wen: Chang Ci Jie Lun* states: "Disease located in the lower abdomen, abdominal pain with inability to pass urine or stool, is named Shan, caused by cold." *Su Wen: Jing Mai Pian* states: "Liver disease of the Foot-Jueyin meridian causes hernia in men and swelling of the lower abdomen in women. Diseases generated by the Liver include unsolidified stool diarrhea and Hu Hernia." *Su Wen: Yin Yang Bie Lun* states: "Disease of the Three Yang meridians presents with chills and fever, which transmits into hernia." *Su Wen: Xie Qi Zang Fu Bing Xing Pian* states: "Small Intestine disease causes lower abdominal pain, lumbar and spinal pain radiating to the testicles, and frequent urgency to defecate." *Su Wen: Da Qi Lun* states: "If the Kidney pulse is large, rapid, and deep, and the Liver pulse is large, rapid, and deep, both indicate hernia."