养血当归地黄散治病日久气血渐虚邪气入胃养血为度
当归 地黄 芍药 川芎 本 防风 白芷(各一两) 细辛
上 咀水煎服
按此厥阴四物例药也
杂方
如圣散
方见中风门
一方本药内加两头尖二两
内经云人有所堕坠恶血留内腹中胀满不得前后先饮利药此上伤厥阴之脉下伤少阴之络刺
足内踝下然骨之前出血刺足肘上动脉不已刺三毛各一 见血立已左刺右右刺左
灵枢云有所堕坠恶血留于内若有所大怒气上而不下积于胁下则伤肝又中风及有所击打若
醉入
房汗出当风则伤脾又头痛不可取于 者有所击堕恶血恶血在于内若内伤痛不已可侧刺不可远
取之也
按发明经云夫从高坠下恶血留于内不分十二经络圣人俱作风中肝经留于胁下以中风疗之
血者
皆肝之所主恶血必归于肝不问何经之伤必留于胁下盖肝主血故也痛甚则必有自汗但人汗出皆
为风证诸痛皆属于肝木况败血凝涩从其所属入于肝也从高堕下逆其所行之血气非肝而何以破
血行经药治之
内经云肝脉搏坚而长色不青当病堕若搏因血在胁下令人呕逆
金匮云寸口脉浮微而涩然当亡血若汗出设不汗出者当身有疮被刀斧所伤亡血故也
脉经云金疮出血太多其脉虚细者生数实大者死
金疮出血脉沉小者生浮大者死
砍疮出血一二石脉来大者二十日死
砍刺出血不止者其脉止脉来大者七日死滑细者生
从高颠仆内有血腹胀满其脉坚强者生小弱者死按破伤有瘀血在内脉坚强实则生虚小弱者
死若亡血过多脉虚细小者生浮大数实者死皆为脉病不相应故也
养血当归地黄散用于治疗病程日久、气血逐渐虚弱且邪气侵入胃腑的情况,治疗以养血为准则。
药材包括:当归、地黄、芍药、川芎、藁本、防风、白芷(各一两)、细辛。
将上述药材切碎,加水煎煮后服用。
按语:此方是厥阴病四物汤的变通用药示例。
杂方
如圣散
该方见载于中风门章节。
另一方剂是在上述药物基础上加入两头尖二两。
《黄帝内经》记载:人若遭受跌坠损伤,恶血滞留体内,导致腹部胀满,大小便不通利,应先服用通利药物。这是上伤厥阴经脉,下伤少阴络脉所致。针刺足内踝下方然骨穴之前出血;若刺足外踝上方动脉处无效,则刺足大趾丛毛处(即大敦穴),每处一针,见血立愈。左病右刺,右病左刺。
《灵枢经》记载:若有跌坠损伤,恶血滞留体内,或者因大怒导致气机上逆而不能下行,积聚在胁下,则会损伤肝脏。此外,若感受风邪或受到击打,或者醉酒后行房事出汗并当风受邪,则会损伤脾脏。还有头痛不可取穴于某处者,是因为有击打或跌坠导致的恶血,若内部伤痛不止,可侧向浅刺,不可远取穴位。
按语:《针灸聚英》等医籍阐发经文指出:从高处坠落,恶血滞留体内,不分十二经络,圣人皆将其归为风中肝经,恶血留于胁下,用治疗中风的方法来处理。血由肝所主,恶血必然归于肝,不问哪条经络受伤,必留于胁下,这是因为肝主血的原因。疼痛剧烈时必然伴有自汗,但人的汗出多为风证,各种疼痛多归属于肝木。况且败血凝涩,顺从其所属关系进入肝脏。从高处分坠落,逆乱了气血运行的常规,若非肝经受损何以如此?需用破血行经的药物来治疗。
《黄帝内经》记载:肝脉搏动坚实而长,面色不青,应当诊断为跌坠伤所致;若脉象搏动有力,因血液积存在胁下,令人呕吐逆气。
《金匮要略》记载:寸口脉浮、微而涩,本当是失血或汗出过多之象;如果不出汗,则是身体有疮疡,被刀斧所伤,导致失血的原故。
《脉经》记载:金创(刀剑创伤)出血过多,脉象虚细的预后良好,脉象实大的预后不良。
金创出血,脉象沉小的预后良好,脉象浮大的预后不良。
砍伤出血一二石(古代容量单位,此处指血量极大),脉象来的盛大者,二十日死。
砍刺出血不止,脉象停止,脉来盛大者,七日死;脉象滑细者预后良好。
从高处颠仆,内有瘀血,腹部胀满,脉象坚强者预后良好,脉象小弱者预后不良。按破伤有瘀血在内,脉象坚强实则预后良好,脉象虚小弱者预后不良。若亡血过多,脉象虚细小者预后良好,脉象浮大数实者预后不良,这都是因为脉象与病情不相适应的缘故。
Yangxue Danggui Dihuang San (Nourish Blood Decoction of Angelica and Rehmannia) is indicated for conditions where the disease has persisted for a long time, leading to gradual deficiency of Qi and Blood, with pathogenic factors invading the Stomach. The treatment principle is to nourish the Blood.
The ingredients are: Danggui (Radix Angelicae Sinensis), Dihuang (Radix Rehmanniae Preparata), Shaoyao (Radix Paeoniae Alba), Chuanxiong (Rhizoma Chuanxiong), Bencao (Radix Ligustici Wallichii), Fangfeng (Radix Saposhnikoviae), Baizhi (Radix Angelicae Dahuricae) (each 1 liang), and Xixin (Herba Asari).
Crush the above herbs, decoct in water, and take orally.
Note: This formula follows the pattern of Siwu Tang (Four Substances Decoction) used for Jueyin disease (disease of the Liver and Pericardium meridians).
Miscellaneous Formulas
Rusheng San (Like-Sage Powder)
See the Stroke section for this formula.
Another prescription adds Liangtoujian (Rhizoma Gastrodiae or similar herb depending on local tradition, often Rhizoma Gastrodiae Elata) 2 liang to the above herbs.
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: If a person suffers a fall, evil blood remains inside, causing abdominal distension and inability to urinate or defecate. One should first administer purgative or diuretic medicines. This injury affects the Jueyin meridian above and the Shaoyin collateral below. Needle the area anterior to Ran Gu (BL64) below the medial malleolus until bleeding occurs. If needling the arterial pulse above the lateral malleolus is ineffective, needle the hair tuft at the big toe (Dadun, LR1), one prick per side. Bleeding will stop the condition immediately. Treat the left side by needling the right, and the right side by needling the left.
The *Ling Shu* (Spiritual Pivot) states: If there is a fall and evil blood remains inside, or if there is great anger causing Qi to rise and not descend, accumulating under the hypochondrium, the Liver is injured. Also, wind-stroke or blows/bruises, or sexual intercourse after intoxication with sweating exposed to wind, will injure the Spleen. Regarding headache that cannot be treated by needling certain points, it is due to blows or falls causing evil blood; if internal pain persists, shallow lateral needling is appropriate, not distant point selection.
Note: Commentaries on the classics explain that falling from a height causes evil blood to remain inside. Regardless of the twelve meridians, sages attribute this to Wind affecting the Liver meridian, with evil blood lodging under the hypochondrium, treating it as wind-stroke. Blood is governed by the Liver; thus, evil blood inevitably returns to the Liver. No matter which meridian is injured, the blood lodges under the hypochondrium because the Liver governs Blood. Severe pain implies spontaneous sweating, but sweating is generally a sign of Wind. All pains belong to Wood (Liver). Moreover, congealed blood enters the Liver following its affinity. Falling from a height disrupts the normal flow of Qi and Blood; since it is not merely a Liver issue, how else can it be treated? It requires herbs that break stasis and promote circulation in the meridians.
The *Huangdi Neijing* states: A Liver pulse that is firm and long, without green discoloration of the face, indicates an injury from a fall. If the pulse is forceful, it indicates blood lodged under the hypochondrium, causing vomiting and regurgitation.
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: If the Cun Kou (radial artery) pulse is floating, fine, and choppy, it usually indicates loss of Blood or excessive sweating. If there is no sweating, it indicates body sores caused by knives or axes, resulting in blood loss.
The *Mai Jing* (Pulse Classic) states: In traumatic injuries (Jinchuang) with excessive bleeding, a deficient and fine pulse indicates survival, while a full and large pulse indicates death.
In traumatic injuries with bleeding, a deep and small pulse indicates survival, while a floating and large pulse indicates death.
In chopping wounds with bleeding of one or two shi (a large volume), if the pulse comes strongly/large, death occurs in twenty days.
If chopping or stabbing wounds bleed incessantly and the pulse stops, a large pulse indicates death in seven days; a slippery and fine pulse indicates survival.
After falling from a height, with internal blood stasis and abdominal distension, a firm and strong pulse indicates survival, while a small and weak pulse indicates death. Note: For broken wind injuries with internal blood stasis, a firm and strong pulse indicates survival, while a deficient and small pulse indicates death. If there is excessive blood loss, a deficient and fine pulse indicates survival, while a floating, rapid, full, and strong pulse indicates death. These are cases where the pulse does not correspond to the pathology.