少冢宰徐检老,以万历丁酉三月初旬,往贺长兴臧老夫人眉寿而发寒热,臀近肛硬处生
一毒
,红肿而痛,坐卧为艰,因归荆溪访治外科,即以 针点开,插药线于内,涂以烂药,使脓
血急溃,又于疮口上以生肌药敷之使易收口,可受谢而去,未半月,其傍之硬处,又红肿痛
,
寒热交作,几于成脓。以前医有功,遂复延之,至则又以向者之法治之,受谢而去。递医递
患,递针而递插药,计其患者凡八遍,计其医之更者,如张。如鲁,如冯,凡八人,有陈外
科者,则总其中而受谢独多,其时则丁酉三月至戊戌八月,几年半矣。于时,予赴吴少溪翁
召,因知翁在褥,亟往谒于卧榻间,翁见予至,悲喜交集,备陈其历病之由,针刀之苦,伏
枕岁月之深,辄为痛心,予闻之亦为鼻酸。谛观其色则青惨,诊其脉皆濡弱,把其手足,则
冷如冰,问其饮食,减平日之六,究其所服之药,则槐角、黄柏、生地、凉血解毒之类。予
骇然而语翁曰∶此痔痈非痔漏也,痔漏当用挂线,以五灰膏点之可愈。今肿硬无定处,离肛
门且远,况其初原无硬块,硬块由插药凝滞中来。谚云∶剜肉做疮者非耶?假令非翁禀气浓
,胃气壮,安能六十以外之年,而当此剥削哉!初只可大补气血,即有毒,只宜托出一脓而
愈,未成者,使活动消散,不复生毒,此王道之治,不胜于针刀万万?诸君之治,如避影者
,不知息阴而急趋以求避,则影益速,而气促敝矣,自迨之道也。翁初不逆予者,以非外科
,至听予之论,幡然有悟,又见《玄珠》集有外科二卷,益信予之善外科,而听予治,予即
以十全大补汤进之,四帖,而饮食加,手足暖,大便艰涩百方润而不能行者,今亦通利,而
肛门如不知也。诸外科犹晓晓议补非是,予极言排之,翁惟予为听,予以何首乌四两,人参
、
枸杞子、黄 、当归、熟地各二两,槐角、秦艽各一两,蜜丸服之。不终剂,其肿处少出脓
而全瘳,旁亦不生硬块,益信向之硬块为插药之毒所致也。翁喜为谑曰∶予病非孙君,诸外
科视我疾为金穴,其取宁有已耶。呵呵!
少冢宰徐检老,在万历丁酉年(1577年)三月初旬,前往祝贺长兴臧老夫人高寿时,突然发作寒热症状,臀部靠近肛门坚硬处生出一个毒疮,红肿且疼痛,坐卧都非常困难。于是回到荆溪寻求外科医生的治疗,医生用针挑破患处,插入药线,涂抹腐蚀性药物,使脓血迅速溃烂排出,又在疮口上敷上生肌药以促进愈合,徐公付了诊金后离开。不到半个月,旁边原本硬的地方又出现红肿疼痛,寒热交替发作,几乎要化脓了。因为之前的医生似乎有些成效,便再次请他诊治。医生到了之后,依然用原来的方法治疗,收钱后离去。病情和医生不断更替,每次都用针挑并插药,统计下来患者共经历了八次这样的治疗,更换的医生有张、鲁、冯等共八人,其中有一位姓陈的外科医生,总体来看他收取的诊金最多。时间从丁酉年三月持续到戊戌年八月,长达一年半之久。
当时,我应吴少溪先生之邀前往苏州,得知吴先生卧床不起,急忙去卧榻间拜见。吴先生见到我到来,悲喜交加,详细陈述了他患病以来的经过、遭受针刀之苦以及长期伏枕呻吟的痛苦,令人痛心,我也为之鼻酸。仔细观察他的面色,呈现青惨之色;诊察他的脉象,均为濡弱脉;触摸他的手足,冷如冰霜。询问他的饮食情况,比平时减少了六分。探究他所服用的药物,多是槐角、黄柏、生地等凉血解毒类的药材。
我惊骇地对吴先生说:“这痔痈并非痔漏。痔漏应当使用挂线疗法,用五灰膏点涂即可治愈。现在肿胀坚硬且位置不固定,距离肛门很远,况且起初并没有硬块,现在的硬块是由于插入腐蚀性药物导致气血凝滞形成的。俗话说:‘剜肉做疮’说的不就是这种情况吗?假如不是您禀赋之气浓厚,胃气壮实,怎么能承受得住六十多岁高龄还要遭受这种剥削呢!起初只应该大补气血,即使有毒邪,也只宜用托法引出脓液而痊愈,未成脓的,使其活动消散,不再产生毒邪,这是王道般的温和治法,难道不比针刀好上万倍吗?各位医生的治疗,就像躲避影子的人一样,不知道在阴凉处停下来以消除影子,反而急着奔跑想避开影子,结果影子跑得更快,人的气息也急促疲惫了,这是自取灭亡之道。”
吴先生起初并不顺从我,因为我不是外科医生。但听完我的论述后,幡然醒悟,又看到我编著的《玄珠》集中有两卷关于外科的内容,更加相信我在外科方面的专长,于是听从我的治疗。我随即给他服用十全大补汤,吃了四帖后,饮食增加,手足变暖,之前无论用多少润肠通便的方法都无法通畅的大便,现在也通利了,而且感觉不到肛门的痛苦。那些外科医生还在喋喋不休地议论说补益是错误的,我极力驳斥他们,吴先生只听从我。我给他开具由何首乌四两,人参、枸杞子、黄芪、当归、熟地黄各二两,槐角、秦艽各一两组成的方剂,炼蜜为丸服用。还没吃完一剂药,肿胀处稍微流出一些脓液就完全痊愈了,旁边也没有再生硬块,更加证实了之前的硬块是由插入腐蚀性药物导致的毒邪所致。吴先生高兴地说:“如果不是孙君,各位外科医生把我的病当作金矿穴,他们的索取哪里会有尽头呢?”呵呵!
Xu Jianlao, Vice Minister of Works, in the early days of the third month of the Dingyou year (1577) of the Wanli era, went to congratulate the longevity of Madam Zang of Changxing. He developed chills and fever, and a toxic carbuncle (a severe skin infection) appeared on the hard area near the anus in his buttocks. It was red, swollen, and painful, making sitting and lying down difficult. Therefore, he returned to Jingxi to seek treatment from a surgeon. The surgeon punctured the lesion with a needle, inserted a medicinal thread into it, applied caustic medicine to induce rapid suppuration and drainage of pus and blood, and then applied flesh-regenerating medicine to the wound to facilitate healing. After receiving payment, Mr. Xu left. Within half a month, the adjacent hard area became red, swollen, and painful again, with alternating chills and fever, nearly forming an abscess. Because the previous doctor seemed to have achieved some effect, he was invited back. Upon arrival, the doctor used the same method as before, took payment, and left. The condition and doctors changed repeatedly; each time involving needle puncture and insertion of medicinal threads. In total, the patient underwent this treatment eight times, and there were eight different doctors involved, including Zhang, Lu, and Feng. Among them, a surgeon surnamed Chen received the most payments overall. This period lasted from March of the Dingyou year to August of the Wuxu year, spanning one and a half years.
At that time, I was summoned by Mr. Wu Shaoxi to Suzhou. Learning that Mr. Wu was bedridden, I hurriedly visited him at his bedside. Seeing me arrive, Mr. Wu was filled with both sorrow and joy. He detailed the history of his illness, the suffering caused by needles and knives, and the deep pain of lying prostrate for so long, which moved me to tears. Observing his complexion closely, it appeared blueish and gloomy. Palpating his pulse, it was soggy and weak. Touching his hands and feet, they were cold as ice. Asking about his diet, he reported eating only four-tenths of his usual amount. Investigating the medicines he had taken, they consisted mainly of Huaijiao (Fructus Acanthopanacis Senticosi), Huangbai (Cortex Phellodendri), and Shengdi (Radix Rehmanniae Preparata), which are herbs for cooling blood and detoxifying.
I was shocked and said to Mr. Wu: "This perianal carbuncle is not a fistula ani (anal fissure/fistula). Fistula ani should be treated with seton therapy, and applying Wuhui Gao (Five Ashes Ointment) can cure it. Now, the swelling and hardness are indefinite in location and far from the anus. Moreover, initially, there was no hard mass; the current hardness resulted from the stagnation caused by inserting caustic medicines. As the proverb says: 'Digging out flesh to create a sore,' does this not describe the situation? If your constitution were not robust and your Stomach Qi (digestive energy) not strong, how could you endure such exploitation at over sixty years old? Initially, one should only greatly tonify Qi and Blood. Even if there is pathogenic toxin, one should only use the method of expelling toxins by drawing out pus to achieve healing. For unformed pus, one should promote its dispersion and resolution, preventing further toxicity. This is the 'King's Way' of gentle treatment, which is vastly superior to needles and knives! Your treatments are like people trying to avoid their shadows: not realizing that stopping in the shade eliminates the shadow, but instead running frantically to escape it, causing the shadow to move faster and exhausting one's breath. This is self-destruction."
Mr. Wu initially did not accept my advice because I was not a surgeon. However, after listening to my analysis, he suddenly realized the truth. Seeing that my book *Xuanzhu Ji* contained two volumes on surgery, he further believed in my surgical expertise and accepted my treatment. I immediately prescribed Shiquan Dabu Tang (Complete Golden Pill to Tonify Great Deficiency Decoction). After four doses, his appetite increased, his hands and feet warmed up, and his previously stubborn constipation, which resisted all moistening and purgative methods, became smooth and easy, with no sensation of anal discomfort. The other surgeons continued to argue that tonification was incorrect. I strongly refuted them. Mr. Wu listened only to me. I prescribed a pill formula containing Hesouwu (Polygoni Multiflori Radix Praeparata, 4 liang), Renshen (Ginseng Radix et Rhizoma, 2 liang), Gouqizi (Lycii Fructus, 2 liang), Huangqi (Astragali Radix, 2 liang), Danggui (Angelicae Sinensis Radix, 2 liang), Shudi (Rehmanniae Radix Preparata, 2 liang), Huaijiao (Fructus Acanthopanacis Senticosi, 1 liang), and Qinjiu (Gastrodiae Rhizoma, 1 liang), made into honey pills. Before finishing one dose, the swelling slightly discharged pus and completely healed, without any new hard masses forming nearby. This further confirmed that the previous hardness was caused by the toxicity of the inserted caustic medicines. Mr. Wu joked happily: "If not for Dr. Sun, the other surgeons would view my illness as a gold mine, and their demands would never end!" Haha!