1.脚气风寒湿热病, 往来寒热状伤寒, 腿脚痛肿热为火, 不肿不热
是寒干.
【注】脚气内有湿热, 外感风寒, 相合为病, 故往来寒热, 状类伤寒
.两脚腿痛肿热如火者, 是火盛也. 不肿不热而痛者, 是寒盛也, 名
曰干脚气.
2.脚气脉急少腹顽, 不三五日入心间, 呕吐喘满目额黑, 恍忽?? 妄
命难全.
【注】脚气脉急, 少腹顽木, 不知痛痒, 不过三, 五日内, 其邪必入
心间, 若入心间, 呕吐喘满, 是为脚气冲心之证. 目额皆黑, 恍惚??
妄,则是水来克火之征, 故曰命难全也.
攒风散 羌活导滞汤 胜湿饼子 五积散 独活寄生汤
3.脚气表解攒风散, 麻桂杏草萆乌良, 里解导滞羌独活, 防己当归
枳大黄, 湿盛重肿胜湿饼, 二丑荞面遂成方, 寒湿五积加附子, 寒虚
独活寄生汤.
【注】初病脚气, 表实无汗, 用攒风散汗之, 即麻黄, 桂枝, 杏仁,
甘草, 萆薢, 炮川乌也. 里实热盛, 二便不利, 用羌活导滞汤下之,
即羌活, 独活, 防己, 当归, 枳实, 大黄也. 湿盛重肿, 用胜湿饼子
,即黑丑, 白丑头末, 甘遂末, 各五钱, 荞麦面一两五钱, 水和作饼
,三钱, 煮熟, 空心茶清服逐之. 寒湿者, 用五积散加附子治之, 方
在伤寒门. 寒虚者, 用独活寄生汤补之, 方在痹门.
当归拈痛汤
4.当归拈痛虚湿热, 茵陈四苓与羌防, 人参当归升苓草, 苦参知母
葛根苍.
【注】湿热脚气而形气虚者, 宜用当归拈痛汤, 即茵陈, 白术, 茯苓
,猪苓, 泽泻, 羌活, 防已, 人参, 当归, 升麻, 黄芩, 甘草, 苦参
,知母, 葛根, 苍术也.
加味苍柏散
5.加味苍柏实湿热, 二活二术生地黄, 知柏芍归牛膝草, 木通防己
木瓜榔.
【注】湿热脚气而形质实者, 宜用加味苍柏散, 即羌活, 独活, 苍术
,白术, 生地黄, 知母, 黄柏, 赤芍, 当归, 牛膝, 甘草, 木通, 防
己,木瓜, 槟榔也.
大防风汤
6.两膝肿大而疼痛, 髀胫枯细鹤膝风, 大防风附羌牛杜, 十全大补
减茯苓.
【注】两膝肿大疼痛, 膝上至髀, 膝下胫足枯细, 但存皮骨, 两膝状
若鹤膝, 故名鹤膝风也. 宜大防风汤, 即防风, 附子, 羌活, 牛膝,
杜仲, 人参, 白术, 炙草, 当归, 川芎, 白芍, 熟地, 炙耆, 肉桂也
.此病若得之于痢疾病后者, 名曰痢风, 亦用此方.
医宗金鉴 四十卷
1. 脚气病由风寒湿热邪气引起,其症状表现为寒热往来,类似伤寒;若腿脚疼痛、肿胀且发热,属于火毒炽盛;若不肿不热,则是寒邪干犯。
【注】脚气病内部蕴有湿热,外部感受风寒,内外合邪而发病,因此出现寒热往来的症状,状似伤寒。如果两腿和脚部疼痛、肿胀且发热如火,这是火邪亢盛的表现。如果不肿不热但疼痛,这是寒邪亢盛的表现,称为“干脚气”。
2. 脚气病患者脉象紧急,小腹部麻木僵硬,若不及时治疗,三至五日内邪气必入心包,出现呕吐、气喘、面目及额头发黑、神志恍惚、谵语妄动等症状,此时性命难保。
【注】脚气病见脉象紧急,小腹部麻木不知痛痒,不超过三到五天,邪气必然侵入心间。若邪气入心,出现呕吐、气喘胸满,这是“脚气冲心”的证候。若眼睛和额头都变黑,神志恍惚、胡言乱语,这是水气克制心火的征象,所以说性命难全。
攒风散 羌活导滞汤 胜湿饼子 五积散 独活寄生汤
3. 脚气病表证已解或需解表者用攒风散,方含麻黄、桂枝、杏仁、甘草、萆薢、川乌;里实证需通下者用羌活导滞汤,方含羌活、独活、防己、当归、枳实、大黄;湿气盛重者用胜湿饼子;寒湿证用五积散加附子;虚寒证用独活寄生汤。
【注】初患脚气,若表实无汗,应用攒风散发汗,该方由麻黄、桂枝、杏仁、甘草、萆薢、炮制过的川乌组成。若里实热盛,二便不通,应用羌活导滞汤攻下,该方由羌活、独活、防己、当归、枳实、大黄组成。若湿气盛导致严重浮肿,应用胜湿饼子,该方由黑丑(牵牛子)、白丑(牵牛子)头末各五钱,甘遂末五钱,荞麦面一两五钱组成,用水调和做成饼剂,每次三钱,煮熟后空腹用茶清送服以逐水湿。若是寒湿证,用五积散加附子治疗,方剂在《伤寒门》中记载。若是虚寒证,用独活寄生汤补益,方剂在《痹门》中记载。
当归拈痛汤
4. 当归拈痛汤适用于湿热脚气且体质虚弱者,方含茵陈、四苓散(白术、茯苓、猪苓、泽泻)、羌活、防风、人参、当归、升麻、黄芩、甘草、苦参、知母、葛根、苍术。
【注】湿热脚气且形体正气虚弱者,适宜使用当归拈痛汤,该方由茵陈、白术、茯苓、猪苓、泽泻、羌活、防己、人参、当归、升麻、黄芩、甘草、苦参、知母、葛根、苍术组成。
加味苍柏散
5. 加味苍柏散适用于湿热脚气且体质壮实者,方含羌活、独活、苍术、白术、生地黄、知母、黄柏、赤芍、当归、牛膝、甘草、木通、防己、木瓜、槟榔。
【注】湿热脚气且形体质实者,适宜使用加味苍柏散,该方由羌活、独活、苍术、白术、生地黄、知母、黄柏、赤芍、当归、牛膝、甘草、木通、防己、木瓜、槟榔组成。
大防风汤
6. 双膝肿大疼痛,大腿和小腿枯细,仅存皮骨,膝盖形状像鹤膝,称为鹤膝风,宜用大防风汤,方含防风、附子、羌活、牛膝、杜仲、人参、白术、炙甘草、当归、川芎、白芍、熟地黄、炙黄芪、肉桂。此病若继发于痢疾之后,称为痢风,也使用此方。
医宗金鉴 第四十卷
1. Jiaoqi (Foot Qi) disease is caused by wind, cold, dampness, and heat pathogens. Its symptoms manifest as alternating chills and fever, resembling Shanghan (Cold Damage). If the legs and feet are painful, swollen, and hot, it indicates excessive Fire toxin; if there is no swelling or heat, it indicates invasion by Cold pathogen.
[Note] Jiaoqi disease involves internal accumulation of damp-heat and external contraction of wind-cold. The combination of these factors causes the disease, resulting in alternating chills and fever, similar to Shanghan. If both legs and feet are painful, swollen, and feel hot like fire, this signifies an excess of Fire pathogen. If there is pain without swelling or heat, this signifies an excess of Cold pathogen, a condition named "Dry Jiaoqi" (Gan Jiaoqi).
Zanfeng San (Gathering Wind Powder), Qianghuo Daoshi Tang (Notopterygium Decoction for Guiding Stagnation), Shengshi Bingzi (Dampness-Overcoming Cake), Wuji San (Five Accumulations Powder), Duhuo Jisheng Tang (Angelica Pubescens Decoction for Nourishing the Living).
2. In Jiaoqi disease, the pulse is rapid/tight, and the lower abdomen feels numb and rigid. Within three to five days, the pathogen will invade the Heart region. Symptoms such as vomiting, wheezing, chest fullness, blackening of the eyes and forehead, mental confusion, and delirious speech indicate that life is difficult to save.
[Note] When Jiaoqi presents with a rapid/tight pulse and numbness/rigidity in the lower abdomen where pain and itch are not felt, within three to five days, the pathogen must enter the Heart region. Once it enters the Heart, symptoms of vomiting, wheezing, and chest fullness appear, constituting the syndrome of "Jiaoqi Rushing to the Heart" (Jiaoqi Chongxin). Blackening of the eyes and forehead, along with mental confusion and delirium, are signs of Water overcoming Fire (Kidney Water overacting on Heart Fire); thus, it is said that life is difficult to preserve.
3. For Jiaoqi with exterior syndrome requiring release, use Zanfeng San, containing Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Xingren (Armeniacae Semen Amarum), Gancao (Glycyrrhizae Radix et Rhizoma), Bibai (Dioscoreae Hypoglaucae Rhizoma), and Pao Chuanwu (Prepared Aconiti Radix). For interior excess requiring purgation, use Qianghuo Daoshi Tang, containing Qianghuo (Notopterygii Radix), Duhuo (Angelicae Pubescentis Radix), Fangji (Stephaniae Tetrandrae Radix), Danggui (Angelicae Sinensis Radix), Zhishi (Aurantii Fructus Immaturus), and Dahuang (Rhei Radix et Rhizoma). For severe dampness with heavy edema, use Shengshi Bingzi. For cold-dampness, use Wuji San with added Fuzi (Aconiti Lateralis Radix Praeparata). For deficiency-cold, use Duhuo Jisheng Tang.
[Note] In early-stage Jiaoqi, if there is exterior excess with no sweating, use Zanfeng San to induce sweating. This formula consists of Mahuang, Guizhi, Xingren, Gancao, Bibai, and Pao Chuanwu. If there is interior excess with intense heat and difficulty in urination and defecation, use Qianghuo Daoshi Tang to purge. This formula consists of Qianghuo, Duhuo, Fangji, Danggui, Zhishi, and Dahuang. If dampness is excessive causing severe edema, use Shengshi Bingzi. This cake is made from Heiqiu (Black Seeds of Semen Convolvuli), Baiqiu (White Seeds of Semen Convolvuli) head powder, each 5 qian, Gansui (Kansui Radix) powder 5 qian, and Buckwheat flour 1 liang 5 qian. Mix with water to form cakes, take 3 qian per dose, cook thoroughly, and administer on an empty stomach with tea liquor to drain dampness. For cold-dampness, treat with Wuji San plus Fuzi; the formula is recorded in the Shanghan section. For deficiency-cold, tonify with Duhuo Jisheng Tang; the formula is recorded in the Bi (Obstruction) section.
Danggui Niangong Tang (Angelica Sinensis Decoction for Relieving Pain).
4. Danggui Niangong Tang is suitable for damp-heat Jiaoqi in patients with deficient constitution. It contains Yinchen (Artemisiae Scopariae Herba), Siling San (Four Porias Powder: Baizhu, Fuling, Zhuling, Zexie), Qianghuo, Fangfeng, Renshen, Danggui, Shengma, Huangqin, Gancao, Kushen, Zhimu, Gegen, and Cangzhu.
[Note] For damp-heat Jiaoqi accompanied by deficiency of form and qi, Danggui Niangong Tang is appropriate. This formula consists of Yinchen, Baizhu, Fuling, Zhuling, Zexie, Qianghuo, Fangji, Renshen, Danggui, Shengma, Huangqin, Gancao, Kushen, Zhimu, Gegen, and Cangzhu.
Jiawei Cangbai San (Modified Cangbai Powder).
5. Jiawei Cangbai San is suitable for damp-heat Jiaoqi in patients with robust constitution. It contains Qianghuo, Duhuo, Cangzhu, Baizhu, Shengdihuang, Zhimu, Huangbai, Chishao, Danggui, Niuxi, Gancao, Mutong, Fangji, Mugua, and Binglang.
[Note] For damp-heat Jiaoqi accompanied by robust physical constitution, Jiawei Cangbai San is appropriate. This formula consists of Qianghuo, Duhuo, Cangzhu, Baizhu, Shengdihuang, Zhimu, Huangbai, Chishao, Danggui, Niuxi, Gancao, Mutong, Fangji, Mugua, and Binglang.
Da Fangfeng Tang (Great Saposhnikovia Decoction).
6. Swelling and pain in both knees, with withered and thin thighs and calves, leaving only skin and bone around the knees resembling a crane's knee, is named "Crane Knee Wind" (He Xi Feng). It should be treated with Da Fangfeng Tang, containing Fangfeng, Fuzi, Qianghuo, Niuxi, Duzhong, Renshen, Baizhu, Zhi Gancao, Danggui, Chuanxiong, Baishao, Shudihuang, Zhi Huangqi, and Rougui. If this disease occurs after dysentery, it is called "Dysentery Wind" (Li Feng), and this same formula is used.
Yizong Jinjian, Volume 40