凡浑身走注疼痛,皆为气滞血凝,有痰勿作痰治,只行气行血,而痛自除。用人参、甘
草补其气,川芎、归身行其血。无汗加麻黄;有汗加肉桂;痛加乌药、香附、木香;胀加羌活;
胸膈不宽加苏梗;大便秘多加芎、归;脾胃虚弱加脾胃药。加减虽有不同,无能外乎气血,
气血周流,痛从何来?
如两手脉浮大,气血皆虚,血凝气滞,浑身肿痛者,十全大补汤加羌活、防风,通经活
络;倘自汗胀痛,阳气不营于表,表极虚者,补中益气汤加附子;如六脉有力,浑身胀痛,气血
凝滞者,定痛散加减,或四制香附散。
定痛散
紫苏 青皮 乌药 浓朴 藿香 苍术 白芷 赤芍(各八分) 肉桂 吴茱萸 小茴(
葱、姜煎,热服。
痛在腰,加山药、破故纸、牛膝、芍药各五分;痛在胃脘,加山楂,香附、槟榔、五灵
脂
香附散
香附(盐酒便醋四分制之) 乌药
共细末,酒下四五分。
验案
一女患虚证五年,右手臂痛二月有余,胁痛、腹痛、腰痛、遍身疼痛,俱牵心痛欲死,
气血壅滞,四物汤合和中丸不愈。此肾不纳气也,用山萸、泽泻各五分,丹皮、肉桂、茯苓
各七分,山药、人参、附子各一钱,熟地二钱,沉香汁三匙。三帖效,二十帖全愈。
一女年三十,尝有气痛,走注遍身,后生产之后一日,腹痛不食,遍身俱痛,诸药不效
,恶寒发热,诊脉洪大有力。方用沉香、木香、良姜、甘草、延胡、乌药、没药为末,酒服
三日愈。
一人周身疼痛,面色淡黄。盖人身四肢十二节,三百六十空窍,全赖阳气流行,阴血濡
润,然后运动无滞;阳气一亏,则阴血成痹,或涩,或空,或滞,诸痛生矣。则痛处虽多,
而其根则一。一者,脾胃有伤也。脾胃者,气血之原也。只在理脾起胃,而使气血流行。如
保元加葛根、山药,或稍用羌活、苏梗以通行之可也。身痛,古人责之肝气实,然肝之实由
肺之虚;肺之虚,由脾之亏也。可用温肺汤以补脾肺。
凡是全身游走性疼痛,都是由于气机阻滞、血液凝涩所致。即使有痰湿存在,也不按痰湿治疗,只需调理气机和血液,疼痛自然消除。使用人参、甘草来补益正气,川芎、当归身来活血行血。无汗者加麻黄;有汗者加肉桂;疼痛剧烈者加乌药、香附、木香;伴有胀满者加羌活;胸膈部感觉不宽畅者加紫苏梗;大便秘结多者增加川芎、当归的用量;脾胃虚弱者加入调理脾胃的药物。虽然加减变化有所不同,但离不开调理气血这一原则,只要气血运行通畅,疼痛从何而来呢?
如果两手脉象浮大,说明气血都虚弱,导致血凝气滞,全身肿痛,用十全大补汤加入羌活、防风,以疏通经络、活化络脉;如果是自汗且胀痛,这是阳气不能温煦体表,表证极度虚弱的情况,用补中益气汤加入附子;如果六脉有力,全身胀痛,属于气血凝滞的情况,用定痛散加减,或者四制香附散。
定痛散
紫苏、青皮、乌药、厚朴、藿香、苍术、白芷、赤芍(各八分),肉桂、吴茱萸、小茴香(用葱、姜煎煮,热服)。
疼痛在腰部,加山药、补骨脂、牛膝、芍药各五分;疼痛在胃脘部,加山楂、香附、槟榔、五灵脂。
香附散
香附(用盐、酒、便、醋四种方法炮制)
乌药
共研为细末,用酒送服四五分。
验案
有一个女子患虚证五年,右手臂疼痛两个多月,伴有胁痛、腹痛、腰痛、全身疼痛,所有疼痛都牵连到心脏,让人痛苦欲死。诊断为气血壅滞,服用四物汤合和中丸没有痊愈。这是因为肾不纳气,使用山茱萸、泽泻各五分,丹皮、肉桂、茯苓各七分,山药、人参、附子各一钱,熟地黄二钱,沉香汁三匙。服用三帖见效,二十帖后完全痊愈。
另一个三十岁的女子,曾经患有气痛,疼痛走窜全身。产后一天,出现腹痛、食欲不振、全身疼痛,各种药物无效,伴有恶寒发热,诊察脉搏洪大有力。处方使用沉香、木香、良姜、甘草、延胡索、乌药、没药,研为细末,用酒送服,三天痊愈。
一个人周身疼痛,面色淡黄。人体的四肢十二个关节,三百六十个孔窍,全赖阳气的流行和阴血的濡润,然后才能运动无阻碍;一旦阳气亏损,阴血就会成为痹阻,或涩滞,或空虚,或停滞,各种疼痛就产生了。所以疼痛部位虽然多,但其根源只有一个。这个根源就是脾胃受损。脾胃是气血生成的源头。只需调理脾脏、振奋胃气,使气血流通即可。如保元汤加入葛根、山药,或者稍加羌活、紫苏梗来通行气血也可以。对于身痛,古人归责于肝气实,然而肝之实是由于肺之虚;肺之虚,是由于脾之亏虚。可以使用温肺汤来补益脾肺。
Whenever there is wandering pain throughout the whole body, it is due to Qi stagnation and Blood coagulation. Even if Phlegm exists, do not treat it as Phlegm; simply regulate Qi and Blood, and the pain will naturally disappear. Use Renshen (Ginseng Radix) and Gancao (Licorice Root) to tonify Qi, and Chuanxiong (Szechwan Lovage Rhizome) and Danggui Shen (Angelica Sinensis Root Tip) to promote Blood circulation. If there is no sweating, add Mahuang (Ephedra Herb); if there is sweating, add Rougui (Cinnamon Bark); for severe pain, add Wuyao (Lindera Fruit), Xiangfu (Cyperus Rhizome), and Muxiang (Aucklandia Root); for distension, add Qianghuo (Notopterygium Rhizome); for a feeling of tightness in the chest and diaphragm, add Sugen (Perilla Stem); for frequent constipation, increase the dosage of Chuanxiong and Danggui; for Spleen and Stomach deficiency, add herbs that regulate the Spleen and Stomach. Although the modifications vary, they cannot go beyond regulating Qi and Blood. When Qi and Blood flow freely, where would the pain come from?
If the pulses in both hands are floating and large, indicating that both Qi and Blood are deficient, leading to Blood coagulation and Qi stagnation with swelling and pain throughout the body, use Shiquan Dabu Tang (Decoction for Tenfold Tonification) added with Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root) to unblock the channels and activate the collaterals. If there is spontaneous sweating accompanied by distending pain, this indicates that Yang Qi fails to nourish the exterior, representing extreme exterior deficiency; use Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) added with Fuzi (Prepared Aconite Lateral Root). If the six pulses are forceful, with full-body distending pain due to Qi and Blood stagnation, use Dingtong San (Powder for Definitive Pain Relief) with modifications, or Sizhi Xiangfu San (Four-Processed Cyperus Powder).
Dingtong San
Zisu (Perilla Leaf), Qingpi (Green Tangerine Peel), Wuyao (Lindera Fruit), Houpo (Magnolia Bark), Huoxiang (Patchouli Herb), Cangzhu (Atractylodes Rhizome), Baizhi (Angelica Dahurica Root), Chishao (Red Peony Root) (each 8 fen), Rougui (Cinnamon Bark), Wuzhuyu (Evodia Fruit), Xiaohui (Fennel Fruit). Decoct with Congbai (Scallion White) and Shengjiang (Fresh Ginger), and take hot.
For pain in the waist, add Shanyao (Dioscorea Rhizome), Puguzhi (Psoralea Fruit), Niuxi (Achyranthes Root), and Shaoyao (Peony Root) each 5 fen; for pain in the epigastrium, add Shanzha (Hawthorn Fruit), Xiangfu (Cyperus Rhizome), Binglang (Areca Seed), and Wulingzhi (Trogopterus Dung).
Xiangfu San
Xiangfu (Cyperus Rhizome processed with salt, wine, urine, and vinegar in four ways)
Wuyao (Lindera Fruit)
Grind into fine powder, take 4-5 fen with wine.
Case Record
A woman suffered from deficiency syndrome for five years, with right arm pain lasting over two months, accompanied by hypochondriac pain, abdominal pain, lower back pain, and generalized body pain, all radiating to the heart causing unbearable suffering. The diagnosis was Qi and Blood congestion. Siwu Tang (Four Substances Decoction) combined with Hezhong Wan (Harmonizing the Middle Pill) failed to cure her. This was due to Kidney failing to grasp Qi. Use Shanzhuyu (Cornus Fruit), Zexie (Alisma Rhizome) each 5 fen, Danpi (Moutan Bark), Rougui (Cinnamon Bark), Fuling (Poria) each 7 fen, Shanyao (Dioscorea Rhizome), Renshen (Ginseng Radix), Fuzi (Prepared Aconite Lateral Root) each 1 qian, Shudi (Prepared Rehmannia Root) 2 qian, and Chenchen juice (Citrus Aurantium Juice) 3 spoons. Effective after three doses, fully recovered after twenty doses.
Another thirty-year-old woman had a history of Qi pain with wandering sensations throughout the body. One day after childbirth, she experienced abdominal pain, anorexia, and generalized body pain. Various medicines were ineffective. She presented with aversion to cold and fever. Her pulse was surging and forceful. The prescription used Chenxiang (Aquilaria Wood), Muxiang (Aucklandia Root), Liangjiang (Galangal Rhizome), Gancao (Licorice Root), Yanhusuo (Corydalis Rhizome), Wuyao (Lindera Fruit), Moyao (Myrrh), ground into powder, taken with wine. Cured in three days.
A man suffered from generalized body pain with a pale yellow complexion. The human body's four limbs, twelve joints, and three hundred and sixty apertures rely entirely on the free flow of Yang Qi and the moistening of Yin Blood to move without obstruction. Once Yang Qi is deficient, Yin Blood becomes bi-syndrome, either stagnant, empty, or obstructed, giving rise to various pains. Thus, although the painful areas are many, their root is singular. This root is injury to the Spleen and Stomach. The Spleen and Stomach are the source of Qi and Blood. Simply regulate the Spleen and invigorate the Stomach to allow Qi and Blood to circulate. For example, Baoyuan Tang (Decoction for Protecting the Primal Qi) added with Gegen (Kudzu Root) and Shanyao (Dioscorea Rhizome), or slightly adding Qianghuo (Notopterygium Rhizome) and Sugen (Perilla Stem) to facilitate circulation is acceptable. Regarding body pain, ancient texts attribute it to Liver Qi excess; however, Liver excess stems from Lung deficiency; Lung deficiency stems from Spleen deficiency. Wenfei Tang (Decoction for Warming the Lung) can be used to tonify the Spleen and Lung.