下石疽在膝上生,坚硬如石牵筋疼,皮色如常难溃敛,证由血滞外寒凝。
【注】此证生于膝间,无论膝盖及左右,俱可以生。坚硬如石,牵筋疼痛,肿如鸡卵,
皮色不变,并无 热,难消难溃,既溃难敛,最属疲顽。由身虚,寒邪深袭,致令血瘀凝
结,而成肿溃。内外治法,俱与中石疽参考。但此证肿溃俱凉,若凉化为热,见诸善证者
始吉;仍见恶证者,难痊。
\r下石疽图\p04-34a197.bmp\r
缓疽血滞外寒凝,肿硬如馒膝上生,紫黯溃迟多 热,肿久渐腐烂皮疼。
【注】此证由外寒深袭,血瘀凝滞而成。生于两膝上,或生于膝两旁,肿硬如馒,木
痛日增,其色紫黯,积日不溃,证之情形,与下石疽相似,惟多 热,肿久则腐烂肌肉、皮
肤。初服当归拈痛汤,以宣通湿热,次按中石疽治法,内宜温补,外宜灸法。虚甚者,十
全大补汤相兼治之
\r缓疽图\p04-34a198.bmp\r
当归拈痛汤(见股部腿游风)
十全大补汤(见溃疡门)
委中毒在 纹生,屈伸木硬微肿红,胆热流入膀胱遏,速宜活血刺委中。
【注】此证生委中穴,穴在膝后 中央约纹,动脉陷中即是。约纹者,折纹也,又名
血郗,穴属膀胱经,俗名腿凹,经曰 中,由胆经积热,流入膀胱,壅遏不行而成。木硬
肿痛、微红、屈伸艰难。治宜速用活血散瘀汤,逐下恶血为效,缓则筋缩而成废疾!诸
书皆云∶兼刺委中穴出血自消,然刺穴必兼有腰痛不能转移者,方可刺之,即出血亦不
可过多,多则令人身扑,面见脱色。其余内外治法,俱按痈疽肿疡、溃疡门。亦有 痛,
色赤、溃速者,由湿热凝结所致,治法亦按肿疡、溃疡门。
\r委中毒图\p04-34a199.bmp\r
活血散瘀汤
当归尾 赤芍 桃仁(去皮、尖) 大黄(酒炒,各二钱) 川芎 苏木(各一钱五分) 丹皮 枳壳(麸
炒) 栝蒌仁(各一钱) 槟榔(六分)
水二盅,煎八分,空心服;渣再煎服。
【方歌】活血散瘀委中毒,皆因积热肿其处、归芍丹皮桃枳榔,栝蒌大黄芎苏木。
下石疽生于膝盖上方,肿块坚硬如石头,牵引筋脉疼痛,皮肤颜色正常但难以溃破和愈合,此证由血行滞涩、外感寒邪凝结所致。
【注】此证生于膝部之间,无论是膝盖正中间还是左右两侧,都可以发生。肿块坚硬如石,牵引筋脉疼痛,肿胀如同鸡蛋大小,皮肤颜色不变,没有热感,难以消散也难以溃破,即使溃破后也难以收敛愈合,属于顽固难治之症。这是由于身体虚弱,寒邪深入侵袭,导致血液瘀结凝聚,从而形成肿胀溃烂。内治和外治的方法,均可参考“中石疽”的论述。但是此证在肿胀和溃破阶段都表现为凉性,如果凉性转化为热性,并出现各种顺证(善证)则吉利;如果仍然出现逆证(恶证),则难以痊愈。
缓疽也是由血行滞涩、外感寒邪凝结所致,肿块坚硬如馒头,生于膝盖上方,颜色紫暗,溃破迟缓且多伴有热感,肿胀日久逐渐腐烂,皮肤疼痛。
【注】此证由外感寒邪深入侵袭,导致血液瘀滞凝结而成。生于双膝上方,或生于膝盖两旁,肿块坚硬如馒头,麻木疼痛日渐加重,颜色紫暗,经过多日也不溃破,病情情形与下石疽相似,只是多伴有热感,肿胀日久则肌肉、皮肤腐烂。初期服用当归拈痛汤,以宣通湿热,随后按照中石疽的治疗方法处理,内服宜温补,外用宜灸法。体质极虚者,配合十全大补汤治疗。
委中毒生于腘窝纹处,屈伸时感觉麻木僵硬,轻微肿胀发红,这是胆经热邪流入膀胱经受阻所致,应当迅速使用活血散瘀汤进行针刺治疗委中穴。
【注】此证生于委中穴,该穴位位于膝盖后方腘窝中央的横纹处,动脉凹陷之中即是。所谓约纹,即折叠的纹路,又名血郗,该穴位属于膀胱经,俗称腿凹。医经记载,此病由胆经积热,流入膀胱,壅塞阻滞不通而成为病。表现为麻木僵硬、肿痛、微红、屈伸困难。治疗应当迅速使用活血散瘀汤,驱逐下部的恶血以见效,若拖延则会导致筋脉收缩而形成废疾!各类医书都说:兼刺委中穴出血即可自行消除,然而只有当患者兼有腰痛且不能转动身体时,才可以针刺,即使出血也不可过多,过多会导致人跌倒,面色苍白脱色。其余内外治疗方法,均按照痈疽肿疡、溃疡门的规范处理。也有疼痛剧烈、颜色赤红、溃破迅速的,是由湿热凝结所致,治疗方法也按照肿疡、溃疡门处理。
活血散瘀汤
当归尾、赤芍、桃仁(去皮、尖)、大黄(酒炒,各二钱)、川芎、苏木(各一钱五分)、丹皮、枳壳(麸炒)、栝蒌仁(各一钱)、槟榔(六分)。
用水两盅,煎至八分,空腹服用;药渣再煎服用。
Xia Shiju (Lower Stone Abscess) arises above the knee, with a mass hard as stone causing tendon-pulling pain. The skin color remains normal, yet it is difficult to suppurate and heal. This condition results from blood stasis and external cold coagulation.
[Note] This condition occurs in the inter-knee region; whether at the patella or on either side, it can manifest. The mass is hard as stone, causing tendon-pulling pain, swelling like an egg. The skin color does not change, there is no heat sensation, it is difficult to dissipate and difficult to suppurate, and even after suppuration, it is difficult to granulate and close. It is most stubborn and persistent. It is caused by body deficiency and deep invasion of cold pathogens, leading to blood stasis and coagulation, resulting in swelling and ulceration. Internal and external treatment methods should refer to Zhong Shiju (Middle Stone Abscess). However, since this condition presents as cold during both swelling and suppuration phases, if the cold transforms into heat and favorable signs appear, it is auspicious; if unfavorable signs persist, recovery is difficult.
Huan Ju (Slow Abscess) also stems from blood stasis and external cold coagulation. The swelling is hard like a steamed bun, arising above the knee. The color is purple-dark, suppuration is delayed often accompanied by heat, and prolonged swelling leads to gradual rotting of the skin and flesh, causing pain.
[Note] This condition is formed by deep invasion of external cold and blood stasis. It arises above both knees or on the sides of the knees. The swelling is hard like a steamed bun, with numbness and pain increasing daily. The color is purple-dark, and it does not suppurate after many days. The clinical presentation is similar to Xia Shiju, except for the presence of heat. Prolonged swelling causes rotting of muscles and skin. Initially, Danggui Nian Tong Tang (Angelica Ligustichi Chuanxiong Decoction) is administered to diffuse damp-heat. Subsequently, treat according to the methods for Zhong Shiju: internally use warming tonification, externally apply moxibustion. For severe deficiency, combine with Shiquan Dabu Tang (Ten Complete Tonifying Decoction).
Wei Zhong Du (Poison at Weizhong) arises at the popliteal crease. Flexion and extension cause numbness, stiffness, slight swelling, and redness. This is due to Gallbladder heat flowing into the Bladder meridian and being obstructed. One should promptly use Huoxue Sanyu Tang (Blood-Invigorating and Stasis-Expelling Decoction) and puncture Weizhong.
[Note] This condition arises at the Weizhong acupoint, located in the depression of the arterial pulse at the center of the popliteal crease behind the knee. The "creased line" refers to the fold, also known as Xuexi (Blood Pool). The point belongs to the Bladder Meridian, commonly called the leg hollow. The classics state that this disease is caused by accumulated heat in the Gallbladder meridian flowing into the Bladder meridian, where it becomes congested and stagnant. Symptoms include numbness, hardness, swelling, pain, slight redness, and difficulty in flexion and extension. Treatment requires prompt use of Huoxue Sanyu Tang to expel evil blood from below for efficacy; delay will lead to tendon contraction and disability. All books state that puncturing Weizhong to bleed will cause spontaneous resolution. However, puncture is only indicated when accompanied by lower back pain and inability to turn the body. Even then, bleeding must not be excessive; excessive bleeding may cause fainting and pallor. Other internal and external treatments follow the protocols for Yong Ju (Carbuncle and Ulcer) swelling and ulcer sections. Cases with severe pain, bright red color, and rapid suppuration are caused by damp-heat coagulation and are treated according to the swelling and ulcer sections.
Huoxue Sanyu Tang (Blood-Invigorating and Stasis-Expelling Decoction)
Dangguiwei (Radix Angelicae Sinensis Cauda), Chishao (Radix Paeoniae Rubra), Taoren (Semen Persicae, peeled and de-husked), Dahuang (Radix et Rhizoma Rhei, wine-fried), each 2 qian; Chuanxiong (Rhizoma Chuanxiong), Sumu (Lignum Sappan), each 1.5 qian; Danpi (Cortex Moutan), Zhike (Fructus Aurantii Immaturus, bran-fried), Gualouren (Semen Benincasae, each 1 qian); Binglang (Areca Seed) 6 fen.
Boil in two sheng of water until reduced to eight fen. Take on an empty stomach; decoct the dregs again and take.
[Prescription Song] Huoxue Sanyu treats Wei Zhong Du, all due to accumulated heat swelling the area; Danggui, Chishao, Danpi, Taoren, Zhike, Binglang, Gualou, Dahuang, Chuanxiong, Sumu.