仲景先生治伤寒,有汗、吐、下三法。东垣先生治疮疡,有疏通、托里、和荣卫三法。
用之得宜,厥疾瘳矣。假如疮疡肿硬木闷,烦热,便秘,脉沉而实,其邪在内,当先疏其内以下
之。 肿作痛,便利调和,脉浮而洪,其邪在表,当先托其里以汗之。元戎云∶荣卫充满,
抑遏而为痈者,当泄之,以夺盛热之气。荣卫虚弱壅滞而为痈者,当补之,以接虚怯之气。
又东垣先生云∶疮疡虽面赤伏热,不得攻里,里虚则下利。仲景先生云∶疮家虽身体疼痛,
不可发汗,汗之则发痉。苟不详审,妄为汗下,以致血气亏损,毒反延陷,少壮者难以溃敛
,老弱者多致不救。
治验
给事钱南郭,患腹痈已成,余用托里之药,渐起发,彼惑于众论,用行气破血,以图内
消。形体甚倦,饮食益少,患处顿陷,色黯坚硬,按之不痛,余用大补之剂,色赤肿起,脓熟针
之;再用托里,肿硬渐消而愈。
一男子腹内作痛,腹外微肿,或用药汗之,外无形色,脉数无力,此元气亏损,毒不能
外起。遂与参、 、归、术之类,数剂渐发于外;又数剂脓成,而欲针之;惑于人言,用大黄、
白芷、穿山甲之类,引脓从便出,以致水泻不止,患处平陷,自汗盗汗,发热作渴不食,仍
用前药加半夏、陈皮、姜、桂四剂,形气渐复;又数剂,针去其脓;仍用补剂,喜年幼未婚
张仲景先生治疗伤寒病,采用汗法、吐法、下法三种治法。李东垣先生治疗疮疡病,采用疏通(通里攻下以祛除内邪)、托里(补益气血以托毒外出)、调和营卫(调和气血运行)三种治法。
如果运用得当,疾病就能痊愈。假如疮疡局部肿胀坚硬、麻木闷痛,伴有烦热、便秘,脉象沉而有力,这是病邪在体内,应当先疏通内部以使用下法。如果疮疡红肿疼痛,二便调和,脉象浮而洪大,这是病邪在体表,应当先补益内部以使用汗法。元戎说:营气和卫气充盈,被郁遏阻滞而形成痈肿的,应当泄其邪热,以削弱亢盛的火热之气;营气和卫气虚弱且壅滞而形成痈肿的,应当补益正气,以接续虚弱的元气。
另外,李东垣先生说:疮疡患者虽然面部发红、内有伏热,但不可攻伐里实,因为里气虚弱会导致腹泻。张仲景先生说:患有疮疡的人虽然身体疼痛,但不可发汗,发汗会导致痉病(肌肉痉挛)。如果不详细审察病情,妄用汗法或下法,导致气血亏损,毒邪反而内陷蔓延,年轻力壮者难以溃破愈合,年老体弱者多会导致死亡。
【治疗案例】
给事钱南郭,患腹部痈肿已成,我用托里补益的药物,疮势逐渐起发。他听信众人的议论,使用行气破血的药物,企图使疮毒内消。结果形体非常疲倦,饮食日益减少,患处突然凹陷,颜色暗红坚硬,按压不痛。我改用大补气血的药剂,患处颜色转红并肿胀起发,脓液成熟后针刺排脓;再用托里药物,肿胀坚硬逐渐消退而痊愈。
一名男子腹内作痛,腹外轻微肿胀。有人用药发汗,但外表没有明显的红肿形色,脉数而无力,这是元气亏损,毒邪不能向外透发。于是给予人参、[此处原文缺字,推测为黄芪等补气药]、当归、白术之类的药物,服用数剂后疮毒逐渐发于体表;又服数剂,脓液形成,准备针刺排脓。但他听信他人言论,使用大黄、白芷、穿山甲之类的药物,企图引导脓液从大便排出,导致水泻不止,患处平陷,出现自汗、盗汗、发热、口渴、食欲不振等症状。我仍然使用前面的药物,加入半夏、陈皮、生姜、肉桂,连服四剂,形体和元气逐渐恢复;又服数剂,针刺排出脓液;继续使用补益药剂,庆幸他年幼未婚(肾气未泄,易于恢复)。
Mr. Zhang Zhongjing treated cold damage diseases (Shanghan) using three methods: sweating (diaphoresis), vomiting (emesis), and purging (catharsis). Mr. Li Dongyuan treated sores and ulcers using three methods: unblocking and draining (clearing internal stagnation), supporting the interior (tonifying Qi and Blood to expel toxins outward), and harmonizing Ying and Wei (regulating defensive and nutritive Qi).
If applied appropriately, the serious illness will be cured. For instance, if a sore or ulcer presents with swelling, hardness, numbness, and stifling sensation, accompanied by irritability, heat, constipation, and a deep, forceful pulse, the pathogenic factor is internal; one should first unblock the interior and apply purging. If the area becomes red, swollen, and painful, with normal bowel and bladder functions, and a floating, surging pulse, the pathogenic factor is at the exterior; one should first support the interior and apply sweating. Yuan Rong stated: When Ying and Wei Qi are abundant but obstructed, leading to an abscess, it should be drained to reduce excessive heat; when Ying and Wei Qi are weak and stagnant, leading to an abscess, it should be tonified to restore deficient Qi.
Furthermore, Mr. Li Dongyuan stated: Although a patient with a sore or ulcer may have a red face and latent heat, one must not attack the interior, as deficiency of the interior will lead to diarrhea. Mr. Zhang Zhongjing stated: A patient with a sore or ulcer who experiences body pain must not undergo sweating therapy, as sweating will induce spasms (Jing disease). If the condition is not carefully examined and sweating or purging is used recklessly, it will deplete Qi and Blood, causing the toxin to sink inward and spread. Young and strong individuals may fail to suppurate and heal, while the old and weak often die from it.
**Treatment Cases**
Qian Nanguo, a Censor, suffered from an abdominal abscess that had already formed. I used formulas to support the interior, and the lesion gradually rose and developed. Confused by public opinion, he used Qi-moving and blood-breaking herbs, hoping for internal resolution. His physical condition became severely fatigued, food intake decreased further, and the affected area suddenly sank, becoming dark, hard, and painless upon pressure. I then used a major tonifying formula. The color turned red, and swelling appeared. Once the pus matured, I punctured it with a needle. Subsequently, I used formulas to support the interior; the swelling and hardness gradually subsided, and he recovered.
A man suffered from abdominal pain and slight external swelling. Someone attempted to treat him with sweating herbs, but there were no obvious external signs of redness or swelling, and the pulse was rapid yet powerless. This indicated a loss of Yuan Qi (Original Qi), preventing the toxin from rising outward. Therefore, I prescribed herbs such as Renshen (Ginseng Radix et Rhizoma), [missing character in text, likely Huangqi], Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma). After several doses, the condition gradually manifested externally. After several more doses, pus formed, and he desired needle drainage. However, influenced by others' words, he used herbs like Dahuang (Rhei Radix et Rhizoma), Baizhi (Angelicae Dahuricae Radix), and Chuanshanjia (Manis Squama) to guide the pus out through the bowels. This resulted in incessant watery diarrhea, a flat and sunken lesion, spontaneous sweating, night sweats, fever, thirst, and loss of appetite. I continued using the previous prescription, adding Banxia (Pinelliae Tuber), Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), and Rougui (Cinnamomi Cortex). After four doses, his physical form and Qi gradually recovered. After several more doses, the pus was drained via needle. He continued using tonifying formulas; fortunately, he was young and unmarried.