足跟疽生脚挛根,状如兔咬紫红 ,阳跃积热溃难敛,初宜隔蒜艾灸勤。
【注】此证生足跟,俗名脚挛根,由脏腑积热,汗出涉水,远行伤筋而成。初肿红紫
疼痛,溃破脓水淋沥,状如兔咬。经云∶兔啮状如赤豆,至骨急治,迟则害人。盖谓毒
之深恶也。属足太阳膀胱经,穴名申脉,即阳跷脉发源之所,又系肾经所过之路,疮口
久溃不合,阳跷脉气不能冲发,肾气由此漏泄,以致患者益虚,初起宜隔蒜片灸之,服
仙方活命饮加肉桂、牛膝;溃后宜补中益气汤、人参养荣汤、桂附地黄丸随证滋补治之。
余按痈疽溃疡门。海藏云∶兔啮久不收敛,用盐汤洗之,白术研末撒之,两日一易,谨戒
一切劳碌即效。
\r足跟疽图\p04-34a221.bmp\r
隔蒜灸法(见首卷灸法)
仙方活命饮(见肿疡门)
补中益气汤 人参养荣汤(俱见溃疡门)
桂附地黄丸(见面部颊疡)
厉痈势小足旁生,四淫在足上下凝,三阴亏损为疽重,三阳湿热发痈轻。
【注】《灵枢》云∶发于足上下,名曰四淫,其状大痈,急治之,百日死;发于足旁,
名曰厉痈,其状不大,急治之,去其黑者,不消辄益,不治,百日死。此二证俱由足三阴
经亏损,为疽者重;若兼足三阳经湿热下注,而成痈者轻。若红肿疼痛,溃破有脓,腐脱
无黑气浸漫,属湿热偏盛,顺证易治;若微红微肿,溃出脓水,属阴气凝结,不能化脓,
险证难治;若黑暗漫肿,痛不溃脓,烦热作渴,小水淋漓,为阴败恶证,属逆。四淫无
边沿,厉痈类敦疽,初俱宜仙方活命饮,外宜隔蒜灸,以宣壅毒。将溃宜服人参养荣汤,
兼六味地黄丸以滋补之,若色黯不痛,即用桑柴烘法,以行壅滞助阳气,更宜十全大补
汤兼桂附地黄丸,壮脾滋水治之,或可成功。若妄用苦寒克伐之药,多致不救,外治法同
敦疽。
\r厉痈图\p04-34a222.bmp\r
\r四淫图\p04-34a223.bmp\r
仙方活命饮(见肿疡门)
隔蒜灸法(见首卷灸法)
人参养荣汤 十全大补汤(俱见溃疡门)
六味地黄丸(见面部雀斑)
桑柴烘法(见首卷)
桂附地黄丸(见面部颊疡)
足跟疽生于脚后跟,俗称“脚挛根”,形状像兔子咬伤一样呈紫红色。这是由于阳跷脉积热导致溃烂后难以愈合,初期适宜频繁进行隔蒜艾灸治疗。
【注释】此证发生在足跟,俗名“脚挛根”,是由脏腑积热、出汗后涉水、长途行走损伤筋脉所致。初起时肿胀、发红发紫、疼痛,溃破后脓水淋漓,形状像兔子咬伤。医经记载:“兔啮疮状如赤豆,若伤及骨骼需紧急治疗,延误则危害生命。”这是指毒邪深重恶劣。本病属于足太阳膀胱经,穴位名为申脉,即阳跷脉的发源之处,同时也是肾经经过的路径。如果疮口长期溃烂不愈合,阳跷脉的气血不能冲发,肾气由此漏泄,导致患者更加虚弱。初起时宜采用隔蒜片灸法,服用仙方活命饮并加入肉桂、牛膝;溃烂后宜服用补中益气汤、人参养荣汤、桂附地黄丸,根据症状进行滋补治疗。
我按:在痈疽溃疡门类中,海藏(张元素)说:“兔啮疮久不收敛,用盐汤清洗,将白术研成粉末撒在患处,每两天更换一次,严格戒除一切劳累即可见效。”
足跟疽图
隔蒜灸法(见首卷灸法章节)
仙方活命饮(见肿疡门章节)
桂附地黄丸(见面部颊疡章节)
厉痈势小,生于足旁;四淫生于足部上下部位。三阴经亏损导致的疽病情重;三阳经湿热引发的痈病情轻。
【注释】《灵枢》记载:发生在足部上下方的,名叫四淫,其状为大痈,需紧急治疗,否则百日死亡;发生在足旁的,名叫厉痈,其状不大,需紧急治疗,去除黑色坏死组织,若不消退反而加重,不治疗则百日死亡。这两种证候都由于足三阴经亏损所致,属于疽的病情较重;如果兼有足三阳经湿热下注,而成痈的病情较轻。如果红肿疼痛,溃破后有脓,腐肉脱落且无黑色气体浸漫,属于湿热偏盛,为顺证,容易治疗;如果微红微肿,溃出脓水,属于阴气凝结,不能化脓,为险证,难治;如果黑暗漫肿,疼痛但不溃脓,伴有烦热口渴、小便淋漓不尽,为阴败恶证,属于逆证。四淫没有边缘界限,厉痈类似敦疽,初起时都适宜服用仙方活命饮,外用隔蒜灸,以宣通壅滞之毒。将要溃破时宜服用人参养荣汤,兼服六味地黄丸以滋补身体。如果颜色暗哑且不痛,即用桑柴烘法,以行散壅滞、助长阳气,更宜服用十全大补汤兼桂附地黄丸,通过壮脾滋水来治疗,或许可以成功。如果妄用苦寒克伐的药物,多导致无法救治,外治法同敦疽。
厉痈图
四淫图
仙方活命饮(见肿疡门章节)
隔蒜灸法(见首卷灸法章节)
六味地黄丸(见面部雀斑章节)
桑柴烘法(见首卷)
桂附地黄丸(见面部颊疡章节)
Heel abscess (Zu Gen Ju) arises at the heel, commonly known as "Jiao Luan Gen" (foot spasm root), presenting with a purple-red appearance resembling a rabbit bite. This condition is caused by accumulated heat in the Yang Qiao Mai (Yang Heel Vessel), leading to ulceration that is difficult to heal; early treatment should involve frequent moxibustion with garlic slices (Ge Suan Jiu).
[Note] This lesion occurs on the heel, colloquially called "Jiao Luan Gen." It results from accumulated heat in the Zang-Fu organs, exposure to water while sweating, and injury to the tendons from long-distance walking. Initially, there is swelling, redness, purplish discoloration, and pain. Upon ulceration, pus drains continuously, and the shape resembles a rabbit bite. The Classics state: "The 'rabbit bite' sore resembles a red bean; if it reaches the bone, urgent treatment is required, otherwise it will harm the patient." This refers to the depth and malignancy of the toxin. The disease belongs to the Foot-Taiyang Bladder Meridian, specifically the Shenmai (BL62) acupoint, which is the source of the Yang Qiao Mai (Yang Heel Vessel) and also a pathway for the Kidney Meridian. If the wound remains unhealed for a long time, the Qi of the Yang Qiao Mai cannot surge forth, causing Kidney Qi to leak, thereby exacerbating the patient's deficiency. In the early stage, moxibustion with garlic slices is indicated, along with the administration of Xian Fang Huo Ming Yin (Immortal Life Elixir Decoction) supplemented with Rou Gui (Cinnamon Bark) and Niu Xi (Achyranthes Root). After ulceration, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Ren Shen Yang Rong Tang (Ginseng Nourishing the Nutritive Decoction), and Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) should be prescribed according to symptoms to nourish and tonify.
Commentary: In the section on Carbuncles and Ulcers, Haizang (Zhang Yuansu) stated: "For 'rabbit bite' sores that do not heal over time, wash with salt water, apply powdered Bai Zhu (Atractylodes Macrocephala Rhizome) to the area, change every two days, and strictly avoid all exertion for effectiveness."
Image of Heel Abscess
Moxibustion with Garlic Slices (see Moxibustion Methods in Volume 1)
Xian Fang Huo Ming Yin (Immortal Life Elixir Decoction) (see Swollen Ulcer Section)
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); Ren Shen Yang Rong Tang (Ginseng Nourishing the Nutritive Decoction) (both see Ulcerated Ulcer Section)
Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) (see Facial Cheek Ulcer Section)
Li Yong (Fierce Carbuncle) is small in size and arises beside the foot; Si Yin (Four Extremities) condenses above and below the foot. Gangrene (Ju) resulting from the deficiency of the Three Yin meridians is severe; Carbuncle (Yong) arising from damp-heat in the Three Yang meridians is mild.
[Note] The *Ling Shu* states: "Arising above and below the foot, it is named Si Yin (Four Extremities); its presentation is a large carbuncle, requiring urgent treatment, or death within one hundred days. Arising beside the foot, it is named Li Yong (Fierce Carbuncle); its presentation is not large, requiring urgent treatment to remove black necrotic tissue. If it does not subside but worsens, and is untreated, death occurs within one hundred days." Both conditions result from the deficiency of the Foot-Sanyin meridians; those classified as Gangrene are severe. If accompanied by damp-heat pouring downward from the Foot-Sanyang meridians, forming a Carbuncle, the condition is milder. If there is redness, swelling, pain, and pus upon ulceration, with sloughing off of dead tissue and no spreading black gas, it indicates predominant damp-heat, representing a favorable syndrome that is easy to treat. If there is slight redness and swelling, with pus drainage indicating congealed Yin Qi unable to transform into pus, it represents a dangerous syndrome that is difficult to treat. If there is dark, diffuse swelling, pain without suppuration, accompanied by irritability, fever, thirst, and dribbling urination, it is a malignant syndrome of Yin collapse, representing an unfavorable syndrome. Si Yin has no distinct borders, and Li Yong resembles Dun Ju (Dun Gangrene). In the early stage, both are suitable for Xian Fang Huo Ming Yin (Immortal Life Elixir Decoction) internally and garlic slice moxibustion externally to disseminate stagnant toxins. As ulceration approaches, Ren Shen Yang Rong Tang (Ginseng Nourishing the Nutritive Decoction) should be taken, combined with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) for nourishment. If the color is dark and painless, the Sang Chai Hong Fa (Mulberry Wood Roasting Method) should be used to move stagnation and assist Yang Qi. Additionally, Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) combined with Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) should be used to strengthen the Spleen and nourish Water, which may lead to success. The reckless use of bitter-cold draining herbs often leads to untreatable conditions. External treatments are the same as for Dun Ju.
Image of Li Yong
Image of Si Yin
Xian Fang Huo Ming Yin (Immortal Life Elixir Decoction) (see Swollen Ulcer Section)
Moxibustion with Garlic Slices (see Moxibustion Methods in Volume 1)
Ren Shen Yang Rong Tang (Ginseng Nourishing the Nutritive Decoction); Shi Quan Da Bu Tang (Complete Great Tonifying Decoction) (both see Ulcerated Ulcer Section)
Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) (see Facial Freckle Section)
Sang Chai Hong Fa (Mulberry Wood Roasting Method) (see Volume 1)
Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) (see Facial Cheek Ulcer Section)