白头翁 甘草 阿胶各二两 秦皮 黄连 蘖皮各三两
右六味,以水七升,煮取二升半,内胶,令消尽,分温三服。
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妇人之病,因虚、积冷、结气,为诸经水断绝,至有历年,血寒积结胞门。寒伤经络
,凝坚在上,呕吐涎唾,久成肺痈,形体损分。在中盘结,绕脐寒疝,或两□疼痛,
与藏相连,或结热中,痛在关元,脉数无疮,肌若鱼鳞,时着男子,非止女身。在下
来多,经候不匀,令阴掣痛,少腹恶寒,或引腰脊,下根气街,气冲急痛,膝胫疼烦
,奄忽眩冒,状如厥癫,或有忧惨,悲伤多嗔,此皆带下,非有鬼神。久则羸瘦,脉
虚多寒,三十六病,千变万端,审脉阴阳,虚实紧弦,行其针药,治危得安,其虽同
病,脉各异源,子当辨记,勿谓不然。
【按】
此条为妇人杂病提纲,当冠篇首,以揭病情。在下来多之「来」字,当是「未」字。
本条皆经水断绝之脉,若系来多,则与上文不合,与下文经候不匀亦不合。又本条内
有「此皆带下」一句,当在「非有鬼神」之下,文义相属,是传写之□。
【注】
此条为妇人诸病纲领,其病之所以异于男子者,以其有月经也。其月经致病之根源,
则多因虚损,积冷、结气也。三者一有所感,皆能使经水断绝。至有历年寒积胞门,
以致血凝气结而不行者。先哲云:女子以经调为无病,若经不调,则变病百出矣。以
下皆言三者阻经之变病,其变病之不同,各因其人之脏腑、经络、寒热、虚实之异也
。如寒外伤经络,其人上焦素寒,则凝坚在上,故上焦胸肺受病也。形寒伤肺,则气
滞阻饮,故呕吐涎唾也。若其人上焦素热,寒同其化,久则成热,热伤其肺,故成肺
痈,而形体损瘦也。若其人中焦素寒,则在中盘结,故绕脐疝痛也,或两□疼痛,是
中焦之部,连及肝脏故也。或其人中焦素热,则不病寒疝,而病结热于中矣。中热故
不能为寒疝,而绕脐之痛,仍在关元也。其人脉数当生疮,若无疮,则热必灼阴,皮
肤失润,故肌粗若鱼鳞也。然此呕吐涎唾,寒疝疼痛,肌若鱼鳞等病,亦时着男子,
非止女子病也。在下未多,谓经候不匀,而血不多下也。邪侵胞中,乃下焦之部,故
病阴中掣痛,少腹恶寒也。或痛引腰脊,下根气街急痛,腰膝疼烦,皆胞中冲任为病
所必然也。或痛极奄忽眩冒,状如厥癫,亦痛甚之常状也。若其人或有忧惨悲伤多嗔
之遇,而见此眩冒厥巅之证,实非有鬼神也。凡此胞中冲任血病,皆能病带,故谚曰
:十女九带也。然带下病久,津液必伤,形必羸瘦,诊其脉虚,审其多寒。岂止病此
三十六病,而千变万端矣。虽千变万端,然必审脉阴阳虚实紧弦,与病参究,行其针
药,治危得安也。其有病虽同而脉不同者,则当详加审辨,故曰:子当辨记,勿谓不
然也。
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妇人咽中如有炙脔,半夏厚朴汤主之。
【注】
咽中如有炙脔,谓咽中有痰涎,如同炙肉,咯之不出,咽之不下者,即今之梅核气病
也。此病得于七情郁气,凝涎而生。故用半夏、厚朴、生姜,辛以散结,苦以降逆,
茯苓佐半夏,以利饮行涎,紫苏芳香,以宣通郁气,俾气舒涎去,病自愈矣。此证男
子亦有,不独妇人也。
【集注】
尤怡曰:凝痰结气,阻塞咽嗌之间,『千金』所谓咽中帖帖如有炙肉,吞之不下,吐
之不出者是也。
白头翁、甘草、阿胶各二两,秦皮、黄连、黄檗(即黄柏)各三两。
以上六味药,用水七升,煎煮至取汁二升半,加入阿胶,使其完全溶化,分三次温服。
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妇女的疾病,多因虚损、积冷、气结所致,导致各种月经断绝,甚至历时多年,血寒积结于胞门(子宫口)。寒气损伤经络,若凝滞坚固于上部,则呕吐涎唾,日久形成肺痈(肺部化脓性病变),形体消瘦受损;若盘结于中部,则出现绕脐的寒疝(腹中拘急疼痛),或两侧胁肋疼痛,病势与脏腑相连;或者郁热结于中焦,疼痛位于关元穴处,脉象数而体表无疮疡,皮肤粗糙如鱼鳞,这些病症有时也发生在男子身上,并非仅限于女子。若表现为下部出血过多,月经周期不规律,导致阴部牵引作痛,小腹畏寒,或者疼痛牵连腰脊,向下延伸至气街(腹股沟动脉搏动处),气冲穴处急痛,膝胫部疼痛烦扰,突然头晕目眩,状如厥证或癫证,或者伴有忧愁凄惨、悲伤易怒的情绪,这些都是带下病(泛指妇科经、带、胎、产疾病),并非鬼神作祟。病程长久则身体羸瘦,脉象虚弱且多寒象,三十六种妇人杂病,变化万千,必须审察脉象的阴阳、虚实、紧弦,施行针药治疗,可使危重转为平安。虽然病症相同,但脉象来源各异,你应当辨别记录,不要认为我说得不对。
【按语】
此条为妇人杂病的提纲,应当置于篇首,以揭示病情要点。文中“在下**来**多”的“来”字,应当是“未”字。本条所述皆为经水断绝的脉象,若是“来多”(出血多),则与上文不合,也与下文“经候不匀”不符。另外,本条内有“此皆带下”一句,应当放在“非有鬼神”之下,文义才相属连贯,这是传抄过程中的脱漏或错乱。
【注解】
此条为妇人诸病的纲领,其病因之所以异于男子,是因为女子有月经。月经致病的根源,多因虚损、积冷、结气所致。这三者一旦受感,都能使经水断绝。甚至历经多年,寒邪积结于胞门,导致血凝气结而不行。先哲说:女子以月经调和为无病,若月经不调,则变病百出。以下皆言这三种因素阻碍经血的变病,其变病不同,各因人而异,取决于脏腑、经络、寒热、虚实的差异。例如,寒邪外伤经络,若其人上焦素寒,则凝滞坚固于上部,故上焦胸肺受病。形寒伤肺,则气滞阻饮,故呕吐涎唾。若其人上焦素热,寒邪随其热化,日久成热,热伤其肺,故成肺痈,而形体消瘦。若其中焦素寒,则在中部盘结,故绕脐疝痛,或两侧胁肋疼痛,这是中焦部位连及肝脏的缘故。若其中焦素热,则不患寒疝,而患结热于中。中热故不能为寒疝,但绕脐之痛仍在关元穴处。其人脉数当生疮,若无疮,则热必灼伤阴液,皮肤失润,故肌肤粗糙如鱼鳞。然而,呕吐涎唾、寒疝疼痛、肌若鱼鳞等病,有时也发生于男子,并非仅是女子病。在下“未”多,指经候不匀,且血量不多。邪气侵袭胞中,乃下焦部位,故病见阴中牵引作痛,少腹畏寒。或疼痛引及腰脊,向下根源于气街急痛,腰膝疼痛烦扰,这都是胞中冲任二脉为病所必然的结果。或痛极突然头晕目眩,状如厥癫,也是痛甚的常见表现。若其人或有忧愁凄惨、悲伤易怒的情况,而出现此眩晕厥巅之证,实非有鬼神作祟。凡此胞中冲任血病,皆能引发带下病,故谚语说:十女九带。然而带下病久,津液必伤,形体必羸瘦,诊其脉虚,审其多寒。岂止是这三十六种病,而是千变万端。虽千变万端,但必须审察脉象的阴阳虚实紧弦,与病症参究,施行针药,治危得安。虽有病同而脉不同者,则当详细审辨,所以说:你应当辨别记录,不要认为我说得不对。
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妇人咽中如有炙脔(感觉咽喉中有烤肉块),用半夏厚朴汤主治。
【注解】
咽中如有炙脔,谓咽喉中有痰涎,如同烤肉块,咯之不出,咽之不下,即今之梅核气病。此病得于七情郁气,凝涎而生。故用半夏、厚朴、生姜,辛以散结,苦以降逆,茯苓佐半夏,以利饮行涎,紫苏芳香,以宣通郁气,使气舒涎去,病自愈矣。此证男子亦有,不独妇人也。
【集注】
尤怡曰:凝痰结气,阻塞咽嗌之间,《千金》所谓咽中帖帖如有炙肉,吞之不下,吐之不出者是也。
Baitouweng (Folium Mahoniae), Gancao (Radix Glycyrrhizae), and Ejiao (Colla Corii Asini) each 2 liang; Qinpi (Cortex Fraxini) and Huanglian (Rhizoma Coptidis) and Bopi (Cortex Phellodendri, i.e., Huangbai) each 3 liang.
The above six herbs are decocted in 7 sheng of water, reduced to 2.5 sheng. Add Ejiao and stir until completely dissolved. Divide into three doses and take warm.
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Women's diseases often arise from deficiency, accumulated cold, and qi stagnation, leading to the cessation of menstruation, sometimes persisting for years. Blood-cold accumulates at the Baomen (uterine opening). Cold damages the meridians; if it condenses and solidifies in the upper part, it causes vomiting of saliva and froth, which over time may develop into Fei Yong (lung abscess), resulting in emaciation and physical deterioration. If it knots in the middle part, it manifests as Han Shan (cold hernia with periumbilical pain) or pain in both flanks, connecting with the zang-fu organs. Alternatively, heat may knot in the middle jiao, causing pain at the Guanyuan point, with a rapid pulse but no external sores, and skin rough like fish scales. These conditions may also occur in men, not exclusively in women. If there is excessive bleeding from the lower part, irregular menstruation, pulling pain in the yin region, aversion to cold in the lower abdomen, or pain radiating to the waist and spine, extending down to the Qi Jie (inguinal region) with urgent pain at the Qichong point, and painful restlessness in the knees and shins, sudden dizziness and vertigo resembling Jue syndrome (syncope/cold extremities) or Dian syndrome (mania/epilepsy), or accompanied by sorrow, grief, and irritability, these are all Dai Xia disorders (gynecological leukorrhea and related diseases), not caused by ghosts or spirits. Prolonged illness leads to emaciation, a deficient pulse indicating much cold. The thirty-six gynecological miscellaneous diseases have myriad variations. One must examine the pulse for yin/yang, deficiency/excess, tightness, and wiriness, and apply acupuncture and herbal medicine to transform critical conditions into safety. Although the diseases may be similar, their pulse origins differ; you should distinguish and record them, do not say otherwise.
[Commentary]
This paragraph serves as the outline for gynecological miscellaneous diseases and should be placed at the beginning of the chapter to reveal the general condition. The character "Lai" (coming) in "Zai Xia Lai Duo" should be "Wei" (not yet). This section describes pulses associated with the cessation of menstruation; if it were "excessive bleeding," it would contradict the preceding text and the subsequent mention of "irregular menstruation." Furthermore, the phrase "Ci Jie Dai Xia" (these are all Dai Xia disorders) should follow "Fei You Gui Shen" (not caused by ghosts or spirits) for logical coherence, indicating a transcription error.
[Annotation]
This paragraph is the guideline for various women's diseases. The reason these diseases differ from those in men is due to menstruation. The root cause of menstrual-related diseases is often deficiency, accumulated cold, and qi stagnation. Any of these three factors can cause the cessation of menstruation. Over years, cold accumulates in the Baomen, causing blood coagulation and qi stagnation, preventing flow. Ancients said: Women are healthy when menstruation is regular; if irregular, myriad diseases arise. The following discusses the pathological changes caused by these three factors obstructing menstruation. The variations depend on individual differences in zang-fu, meridians, cold/heat, and deficiency/excess. For instance, if external cold damages the meridians and the person has inherent upper jiao cold, condensation occurs in the upper part, affecting the chest and lungs. Cold damaging the lungs causes qi stagnation and fluid retention, leading to vomiting of saliva. If the person has inherent upper jiao heat, cold transforms into heat, damaging the lungs and causing lung abscess and emaciation. If the person has inherent middle jiao cold, it knots in the middle, causing periumbilical hernia pain or flank pain, involving the liver. If the person has inherent middle jiao heat, they suffer from internal heat knotting rather than cold hernia. Heat in the middle prevents cold hernia, but periumbilical pain remains at Guanyuan. A rapid pulse usually indicates sores; without sores, heat scorches yin fluids, causing dry, rough skin like fish scales. However, symptoms like vomiting saliva, cold hernia pain, and fish-scale skin can also occur in men, not just women. "Zai Xia Wei Duo" refers to irregular menstruation with scanty flow. Pathogens invading the Baozhong (uterus), located in the lower jiao, cause pulling pain in the yin and cold in the lower abdomen. Pain radiating to the waist/spine and urgent pain at the Qi Jie, along with knee/shin discomfort, are inevitable consequences of Chong and Ren meridian pathology in the uterus. Extreme pain may cause sudden dizziness resembling Jue or Dian syndromes, which is common with severe pain. If such symptoms occur alongside emotional distress like sorrow or irritability, it is not due to spirits. All blood disorders of the Baozhong and Chong/Ren meridians can lead to Dai Xia disorders, hence the saying: "Nine out of ten women have Dai Xia." Long-standing Dai Xia consumes body fluids, leading to emaciation and a deficient, cold-predominant pulse. It involves not just the thirty-six diseases but myriad variations. Despite these variations, one must examine the pulse for yin/yang, deficiency/excess, tightness, and wiriness, correlating with symptoms, and apply acupuncture and herbs to ensure safety. Even with similar diseases, differing pulses require careful differentiation; thus, "you should distinguish and record, do not say otherwise."
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When a woman feels as if there is a roasted meat slice stuck in her throat, Banxia Houpo Tang is indicated.
[Annotation]
"Yan Zhong Ru You Zhi Luan" means feeling phlegm and saliva in the throat like a piece of roasted meat, difficult to expectorate or swallow, known today as Mei He Qi (plum-pit qi). This disease arises from emotional stagnation condensing into phlegm. Therefore, Banxia, Houpo, and Shengjiang are used for their acridity to dissipate nodules and bitterness to direct rebellious qi downward. Fuling assists Banxia to promote fluid metabolism and resolve phlegm. Zisu, with its aromatic property, circulates stagnant qi. When qi flows freely and phlegm resolves, the disease heals. This condition can also occur in men, not exclusively in women.
[Collected Notes]
You Yi stated: Condensed phlegm and knotted qi block the throat. This corresponds to what the *Qianjin Fang* describes as feeling a lump in the throat like roasted meat, impossible to swallow or spit out.