2.积聚牢坚不软动, 胃弱溏泻不堪攻, 奔豚发作状欲死, 气上冲喉
神怖惊.
【注】积聚牢固不动, 坚硬不软, 则病深矣. 胃弱食少, 大便溏泻,
不堪攻矣. 五积之中, 奔豚最为难治, 若更发作, 正气虚不能支, 其
状欲死, 从少腹起, 气上冲喉, 神色惊怖, 皆恶候也.
3.积聚胃强攻可用, 攻虚兼补正邪安, 气食积癖宜化滞, 温白桃仁
控涎丹.
【注】积聚宜攻, 然胃强能食, 始可用攻. 若攻虚人, 须兼补药, 或
一攻三补, 或五补一攻, 攻邪而不伤正, 养正而不助邪, 则邪正相安
也. 凡攻气食积癖, 宜用秘方化滞丸, 方在内伤门. 攻积聚, 症瘕,
宜用温白丸, 即万病紫菀丸, 方倍川乌. 攻血积, 血瘕, 宜用桃仁煎
,即桃仁, 大黄各一两, 虻虫炒五钱, 朴硝一两, 共为末, 先以醇醋
一斤, 用砂器慢火煎至多半钟, 下末药搅良久, 为小丸, 前一日不吃
晚饭, 五更初, 温酒送一钱, 取下恶物如豆汁鸡肝. 未下次日再服,
见鲜血止药. 如无虻虫, 以?? 虫代之, 然不如虻虫为愈也. 攻痰积,
宜用控涎丹, 方在痰饮门.
1.经云任脉结七疝, 子和七疝主于肝, 肝经过腹环阴器, 任脉循腹
里之原. 疝证少腹引阴痛, 冲上冲心二便难, 厥吐瘕症狐出入, 溃脓
癃秘木?? 顽.
【注】经曰: 任脉为病, 男子内结七疝, 女子带下瘕聚. 瘕聚者, 即
女子之疝也. 七疝主任者, 原以任脉起中极, 循腹里也. 七疝主肝者
,盖以肝经过腹里, 环阴器也. 是以诸疝病, 无不由是二经, 故主之
也. 疝病之证, 少腹痛引阴丸, 气上冲心, 不得二便者, 为冲疝也.
少腹痛引阴丸, 肝之逆气冲胃作吐者, 为厥疝也. 少腹之气不伸, 左
右症块作痛者, 为瘕疝也. 卧则入腹, 立则出腹入囊, 似狐之昼则出
穴而溺, 夜则入穴而不溺者, 为狐疝也. 少腹痛引阴丸, 横骨两端约
文中状如黄瓜, 内有脓血者, 为?? 疝也. 少腹痛引阴丸, 小便不通
者,为癃疝也. 少腹不痛, 阴囊肿大顽硬者, 为?? 疝心.
2. 积聚病证表现为肿块牢固坚硬、推之不动,若患者胃气虚弱、大便溏薄泄泻,则不可使用攻下法。奔豚病发作时,患者感觉痛苦欲死,有气从少腹上冲至咽喉,神情惊恐害怕。
【注】积聚病证如果牢固不动、坚硬不软,说明病邪深入。如果胃气虚弱、进食量少、大便溏泻,就不堪承受攻伐治疗。在五积之中,奔豚病最为难治,如果再次发作,正气虚弱无法支撑,其症状表现为痛苦欲死,气从少腹向上冲至咽喉,神色惊恐害怕,这些都是凶险的征候。
3. 如果积聚病患者胃气强盛、能进食,可以使用攻下法;攻伐虚人时需兼用补益药,以使邪去正安。对于气滞、食积、癖块,适宜使用化滞丸来消导积滞;对于积聚,可使用温白丸或桃仁煎;对于痰积,宜用控涎丹。
【注】积聚病适宜用攻法,但必须是在患者胃气强盛、能够进食的情况下,才可以采用攻法。如果攻伐身体虚弱的人,必须同时配合补益药物,或者采取“一攻三补”、“五补一攻”的策略,做到攻邪而不伤正气,扶正而不助长邪气,这样邪气与正气就能相安无事。凡是攻治气积、食积、癖块,适宜使用秘方化滞丸,该方记载在内伤门中。攻治积聚、症瘕(腹内结块),适宜使用温白丸,即万病紫菀丸,此方中川乌用量加倍。攻治血积、血瘕,适宜使用桃仁煎,即由桃仁一两、大黄一两、炒虻虫五钱、朴硝一两组成,共研为末。先用纯醋一斤,在砂器中用慢火煎至大半钟量,加入药末搅拌良久,制成小丸。前一天晚上不吃晚饭,次日五更初,用温酒送服一钱,排出如豆汁、鸡肝样的恶物。未排净者,次日再服,见到鲜血排出即停药。如果没有虻虫,可以用蛭虫替代,但不如虻虫效果好。攻治痰积,适宜使用控涎丹,该方记载在痰饮门中。
1. 经书云:任脉病变可导致七疝,张子和认为七疝主要责之于肝。肝经经过腹部并环绕阴器,任脉循行于腹部深处。疝病的症状包括少腹牵引阴部疼痛,气上冲心,大小便困难,厥逆呕吐,症瘕积聚,狐疝出入无常,溃烂流脓,小便淋漓不通,以及阴囊肿大顽硬等。
【注】经书说:任脉发生病变,男子体内结聚成七疝,女子带下及症瘕积聚。症瘕积聚,就是女子的疝病。之所以说七疝由任脉主管,是因为任脉起于中极穴,循行于腹部深处。之所以说七疝主属于肝,是因为肝经经过腹部深处,环绕阴器。因此各种疝病,无不是由这两条经脉引起,所以由它们主管。疝病的证候中,少腹痛牵引阴丸,气上冲心,大小便不通的,称为冲疝。少腹痛牵引阴丸,肝之逆气上冲胃部导致呕吐的,称为厥疝。少腹之气不得舒展,左右两侧出现结块作痛的,称为瘕疝。躺下时肿块进入腹腔,站立时肿块出腹入囊,像狐狸白天出洞排尿、晚上入洞不排尿一样,称为狐疝。少腹痛牵引阴丸,横骨两端约文中状如黄瓜,内有脓血的,称为㿗(cuī)疝。少腹痛牵引阴丸,小便不通的,称为癃(lóng)疝。少腹不痛,阴囊肿大顽硬的,称为㿗(cuī)疝心。
2. Accumulation and mass disorders present with firm, hard masses that do not move upon palpation. If the patient has weak stomach qi and loose stools or diarrhea, purgative methods should not be used. In the onset of Ben Tun (Rushing Pig) disease, the patient suffers to the point of feeling like dying, with Qi rushing up from the lower abdomen to the throat, accompanied by a frightened and terrified spirit.
[Note] When accumulation and mass disorders are firm and immobile, hard and unyielding, it indicates that the pathogen is deep-seated. If the stomach qi is weak, food intake is scanty, and there are loose stools or diarrhea, the body cannot withstand purgative treatment. Among the Five Accumulations, Ben Tun (Rushing Pig) is the most difficult to treat. If it recurs, the healthy Qi is too deficient to sustain itself. The symptoms include suffering to the point of feeling like dying, Qi rushing up from the lower abdomen to the throat, and a frightened, terrified expression; these are all ominous signs.
3. If the patient with accumulation and mass disorders has strong stomach qi and can eat, purgative methods may be used. When treating deficiency patients with purgatives, tonifying herbs must be combined to achieve harmony between the elimination of pathogens and the preservation of healthy Qi. For Qi stagnation, food retention, and癖块 (masses), Huazhi Wan (Eliminate Stagnation Pill) should be used to resolve stagnation. For accumulations, Wenbai Wan (Warm White Pill) or Taoren Jian (Peach Kernel Decoction) may be used. For Phlegm accumulation, Kongxian Dan (Control Fluids Pill) is appropriate.
[Note] Accumulation and mass disorders are suitable for purgative treatment, but only when the patient's stomach qi is strong and they can eat. If purging a debilitated person, tonifying medicines must be combined, employing strategies such as "one purge followed by three tonifications" or "five tonifications followed by one purge," ensuring that pathogens are eliminated without damaging healthy Qi, and healthy Qi is nourished without aiding pathogens, thus achieving balance between pathogen and healthy Qi. For treating Qi accumulation, food retention, and masses, the secret formula Huazhi Wan (Eliminate Stagnation Pill) is suitable, recorded in the Internal Injury section. For treating accumulations and Zheng Jia (symptomatic masses), Wenbai Wan (Warm White Pill), also known as Wanbing Ziwan Wan (Ten Thousand Disease Astera Pill) with doubled Chuanwu (Aconiti Radix Preparata), is suitable. For treating Blood accumulation and Xue Jia (blood masses), Taoren Jian (Peach Kernel Decoction) is suitable, composed of Tao Ren (Persicae Semen, 1 liang), Da Huang (Rhei Radix et Rhizoma, 1 liang), Meng Chong (Blattidae, stir-fried, 5 qian), and Po Xiao (Natrii Sulfas, 1 liang), ground into powder. First, boil 1 jin of pure vinegar slowly in a clay pot until reduced to slightly more than half a zhong. Add the powder and stir for a long time, then form small pills. Do not eat dinner the night before. At dawn (Wu Geng), take 1 qian with warm wine to expel foul matter resembling bean juice or chicken liver. If not fully expelled, take again the next day; stop medication when fresh blood appears. If Meng Chong (Blattidae) is unavailable, Shui Zhi (Hirudo, leech) may be substituted, though Meng Chong is superior. For treating Phlegm accumulation, Kongxian Dan (Control Fluids Pill) is suitable, recorded in the Phlegm-Fluids section.
1. The Classics state: Disorders of the Ren Mai (Conception Vessel) can lead to Seven Hernias (Qi Shan). Zhang Hezi attributes the Seven Hernias primarily to the Liver. The Liver Meridian passes through the abdomen and circles the genitalia, while the Ren Mai circulates within the abdominal interior. Symptoms of Shan diseases include pain in the lower abdomen radiating to the genitals, Qi rushing up to the heart, difficulty in urination and defecation, Jue (cold extremities) and vomiting, Zheng Jia (masses), Hu Shan (Fox Hernia) with intermittent protrusion, ulceration with pus discharge, Long Bi (difficulty in urination), and hard, swollen scrotum.
[Note] The Classics say: Disorders of the Ren Mai result in Seven Hernias in men and Dai Xia (leukorrhea) and Zheng Ju (accumulations) in women. Zheng Ju refers to hernias in women. The reason Seven Hernias are governed by the Ren Mai is that the Ren Mai originates at Zhongji (CV3) and circulates within the abdomen. The reason Seven Hernias are governed by the Liver is that the Liver Meridian passes through the abdominal interior and circles the genitalia. Therefore, all Shan diseases arise from these two meridians and are thus governed by them. Regarding the syndromes of Shan diseases: Lower abdominal pain radiating to the testicles, Qi rushing up to the heart, and inability to pass urine or stool constitute Chong Shan (Surging Hernia). Lower abdominal pain radiating to the testicles, with rebellious Liver Qi rushing to the Stomach causing vomiting, constitutes Jue Shan (Rebellious Hernia). Qi stagnation in the lower abdomen causing painful masses on either side constitutes Xia Shan (Mass Hernia). A mass that enters the abdomen when lying down and protrudes into the scrotum when standing, resembling a fox that urinates out of its hole during the day and stays in at night, constitutes Hu Shan (Fox Hernia). Lower abdominal pain radiating to the testicles, with a cucumber-shaped swelling at both ends of the Henggu bone containing pus and blood, constitutes Cui Shan (Cui Hernia). Lower abdominal pain radiating to the testicles with urinary obstruction constitutes Long Shan (Long Hernia). Absence of lower abdominal pain but with a large, hard, swollen scrotum constitutes Cixin (Cixin condition).