立斋曰∶疣,属肝胆经,风热血燥,或怒动肝火,或肝客淫气所致。盖肝热水涸,肾气
不荣,故精亡而筋挛也。宜以地黄丸,滋肾水以生肝血为善。若用蛛丝缠、螳螂蚀、着艾灸
,必致多误。大抵此证与血燥结核相同,故外用腐蚀等法,内服燥血消毒,则精血益虚,肝
筋受伤,疮口翻突开张,卒成败证。
府庠朱宏仁,年二十,右手背近中指患五疣,中一大者如黄豆,余皆如聚黍,拔之
如丝,长三四寸许,此血燥筋缩也。用清肝益荣汤,五十余剂而愈。
府庠沈妪文,幼啮指甲,及长不能自禁。余曰,此肝火血燥也。又颈侧常生小疣子,屡
散屡发。又臂生一块如绿豆大,若触碎,则如断束缕,扯之则长,纵之则缩,后两鬓发白点,
求治。余曰∶子素肝病,此部亦属肝胆经也。夫爪为筋之余,胆行人身之侧,正与啮爪生庥
等证相应。须滋补肾水,以生肝胆,则诸病自愈矣。乃与六味地黄丸服之二年,白点自退,
疣亦不生。
一男子,小腹中一块,不时攻痛,或用行气化痰等药不应。尤以为血鳖,服行气逐血之
剂后,手背结一庥子,渐长寸许,形如鳖状,肢节间如豆大者甚多。彼疑鳖生子,今发于
外,亦用行血。虚证悉至,左尺洪数,关脉洪数而弦。余以为肾水不能生肝木,以致肝火血
燥而筋挛,用六味地黄丸,生肾水滋肝血,三月余,诸证悉愈。
一妇人,左手背,并次指,患五六枚,如熟椹,内热晡热,月经素不及期。余曰∶此因
肝脾血虚而有热也,当调补二经,使阴血生而诸证自愈。不信,乃用艾灸手,即肿胀发热,
手指皆挛,两胁项及胸乳间皆患疣,经行无期。余用加味逍遥散少加炒黑黄连,数剂渐愈。
乃去黄连,更佐以归脾汤,各患渐愈。又百余剂,经行如期,再用地黄丸三料而痊。(俱薛按)
薛立斋说:疣,归属于肝胆经,多由风热与血燥引起,或因愤怒引发肝火,或肝经受邪气侵袭所致。因为肝热导致肾水枯竭,肾气不能滋养,所以出现精亏而筋脉拘挛的症状。适宜使用地黄丸,通过滋补肾水来生养肝血,这样效果最好。如果使用蛛丝缠绕、螳螂咬蚀、艾灸等外治法,必然会导致许多误治。大抵这种病症与血燥引起的结核相似,因此如果外用腐蚀类药物,内服燥血解毒的药物,会使精血更加虚弱,损伤肝筋,导致疮口翻突张开,最终变成难以治愈的败证。
府庠(府学学生)朱宏仁,二十岁,右手背靠近中指处生了五个疣,其中较大的一个像黄豆大小,其余的都像聚集的黍米一样小,拔除时像拉丝一样,长约三四寸左右,这是血燥筋缩的表现。使用清肝益荣汤,服用五十多剂后痊愈。
府庠沈老太太,小时候有咬指甲的习惯,长大后无法自我控制。我说,这是肝火和血燥的表现。她又颈侧经常长小疣子,多次消散后又复发。手臂上长了一块像绿豆大小的肿块,如果触碰破碎,就像断开的丝线束,拉扯则变长,松开则收缩,后来两鬓出现白发点,前来求治。我说:你素来患有肝病,这个部位也属于肝胆经。爪甲是筋的余气,胆经行走在人体侧面,正好与咬指甲、生疣等症状相应。必须滋补肾水,以生养肝胆,那么各种疾病自然会痊愈。于是给予六味地黄丸服用两年,白发点自然消退,疣也不再生长。
一名男子,小腹中有一块肿块,不时攻冲作痛,使用行气化痰等药物无效。他自认为是“血鳖”(一种瘀血结块),服用行气逐血的药剂后,手背上结了一个疣子,逐渐长到一寸多长,形状像鳖,肢体关节间有很多像豆子大小的结节。他怀疑是鳖生子发作于体外,也使用活血药物。结果虚证全部出现,左尺脉洪数,关脉洪数且弦。我认为这是肾水不能生养肝木,导致肝火旺盛、血燥筋挛,使用六味地黄丸,生肾水滋肝血,三个多月后,各种症状全部痊愈。
一名妇人,左手背及无名指处,患有五六个疣,像成熟的桑葚,伴有内热和傍晚发热,月经素来提前。我说:这是因为肝脾血虚而有热,应当调理补益这两条经脉,使阴血生成,各种症状自然痊愈。她不相信,反而用艾灸手部,立即出现肿胀发热,手指全部拘挛,两胁、颈部及胸乳间都长了疣,月经来潮没有定期。我使用加味逍遥散,少加炒黑的黄连,几剂后逐渐好转。然后去掉黄连,再配合归脾汤,各个患处逐渐痊愈。又服用一百多剂,月经来潮如期而至,再服用三料地黄丸后痊愈。(均为薛己按语)
Xue Lizhai stated: Warts (cutaneous growths) belong to the Liver and Gallbladder meridians. They are caused by wind-heat combined with blood dryness, or by anger stirring up Liver fire, or by pathogenic qi invading the Liver channel. Since Liver heat depletes Kidney water and Kidney qi fails to nourish, it results in essence depletion and tendon contraction. It is advisable to use Dihuang Wan (Rehmannia Pill) to nourish Kidney water to generate Liver blood, which yields the best results. If one employs external treatments such as wrapping with spider silk, erosion with mantis saliva, or moxibustion, it will inevitably lead to numerous therapeutic errors. Generally speaking, this condition is similar to tubercles caused by blood dryness. Therefore, if corrosive agents are used externally and blood-drying detoxifying herbs are taken internally, essence and blood will be further depleted, Liver tendons will be damaged, wound edges will evert and open, ultimately resulting in intractable complications.
Zhu Hongren, a student at the Prefectural Academy, aged twenty, developed five warts on the dorsum of his right hand near the middle finger. The largest was the size of a soybean, while the others were clustered like millet grains. When pulled, they extended like threads, measuring about three to four cun in length. This indicated blood dryness and tendon contraction. He was treated with Qinggan Yirong Tang (Liver-Clearing and Nourishing Decoction) for over fifty doses and recovered.
Madam Shen Wen, a student's mother at the Prefectural Academy, had a habit of biting her fingernails since childhood, which she could not control as she grew older. I said this was due to Liver fire and blood dryness. She also frequently developed small warts on the side of her neck, which would disperse but recur repeatedly. A lump the size of a mung bean appeared on her arm; if crushed upon touch, it resembled broken bundles of thread, elongating when pulled and shrinking when released. Later, white spots appeared in her temples, prompting her to seek treatment. I said: You have a history of Liver disease, and this area also belongs to the Liver and Gallbladder meridians. Nails are the surplus of tendons, and the Gallbladder meridian runs along the sides of the body, corresponding precisely to symptoms like nail-biting and wart formation. One must nourish Kidney water to generate Liver and Gallbladder qi, whereupon all diseases will heal spontaneously. I prescribed Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) for two years. The white spots receded naturally, and no new warts formed.
A man presented with a mass in his lower abdomen that caused intermittent attacking pain. Treatments involving Qi-moving and phlegm-resolving herbs were ineffective. He believed himself to suffer from "Blood鳖" (a type of blood stasis nodule) and took formulas for moving Qi and expelling blood. Subsequently, a wart formed on the dorsum of his hand, growing to over an inch, shaped like a turtle. Many bean-sized nodules appeared between his joints. Suspecting that a "turtle offspring" had manifested externally, he attempted blood-invigorating treatments. Consequently, deficiency syndromes fully emerged. His left Chi pulse was flooding and rapid, and the Guan pulse was flooding, rapid, and wiry. I diagnosed this as Kidney water failing to nourish Liver wood, leading to Liver fire, blood dryness, and tendon contraction. I administered Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to generate Kidney water and nourish Liver blood. After more than three months, all symptoms resolved.
A woman presented with five or six warts on the dorsum of her left hand and ring finger, resembling ripe mulberries. She suffered from internal heat and afternoon fever, and her menstruation consistently occurred early. I stated this was due to Liver and Spleen blood deficiency with heat. Treatment should regulate and tonify these two meridians so that Yin blood generates and symptoms resolve. Disbelieving this, she underwent moxibustion on her hand, which immediately caused swelling and fever, with all fingers becoming contracted. Warts subsequently appeared on both hypochondriac regions, the neck, chest, and breasts, and her menstruation became irregular. I prescribed Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with a small amount of stir-fried and charred Huanglian (Coptis Rhizome). After several doses, she gradually improved. I then removed Huanglian and added Guipi Tang (Restore the Spleen Decoction). Each lesion gradually healed. After over a hundred doses, her menstruation returned to its regular cycle. Finally, she took three doses of Dihuang Wan (Rehmannia Pill) and made a full recovery. (All cases annotated by Xue Ji)