润肌膏
当归身(一两五钱) 粉甘草(一两) 白芷(八钱) 血竭(六钱) 紫草茸(五钱) 白蜡(切片,二两)
真麻油八两,先将当归身、白芷、甘草熬深黄色,滤去渣,再入血竭熬化,又
滤净,再入紫草、白蜡片略沸十数滚,即起火,滤去紫草渣,其色即鲜明可爱,若
熬过则紫黑矣。
验方 胡椒四钱,烧酒四两,共入磁碗内重汤炖煮,以软绵蘸酒温 患处,即愈。
陈实功曰∶手足破裂,乃干枯之象,气血不能荣养故也。此因热体骤被风寒所逼,
凝滞血脉,以致皮肤渐枯渐槁,乃生破裂,日袭于风,风热相乘,故多作痛。以玉肌
散、润肌膏润之。内服当归饮子。(《正宗》)
王肯堂曰∶手发背初生如水刺,无头脑,顽然满手背肿,满后聚毒成疮,深入
至骨是也。(《准绳》)
《鬼遗方》曰∶俗名蜘蛛背。
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李氏曰∶手背肿毒,乃三阳经风热郁滞而发。(《十书》)
申斗垣曰∶手发背即手背毒,乃心肝两经风热相乘,气血壅聚而成。初起憎寒
恶热,昏闷疼痛,呕逆,先宜发表解毒。(《启玄》)
胡公弼曰∶大抵此证,多由恼怒七情,皆能动火。各经之火不同,当分别治之。(《青囊》)
又曰∶如溃后出血,发热谵语,宜清心流气饮;不应,乃热入血室,宜加减小
柴胡汤,血止而热亦解矣。
汪省之曰∶手发背,发于手背中渚、液门二穴,乃手少阳三焦经,多气少血。初
起寒热,或作呕,或作痒痛。(《理例》)
朱丹溪曰∶手发背,由风火与湿凝滞而成。初起形如芒刺,渐觉疼痛高肿。红
活热溃速为脓者顺;若漫肿坚硬,无红无热,溃迟为疽。其证情势大小,但溃深露筋骨者难全。
王杏庵曰∶病虾生于手背,属手三阳经积热毒盛而成。情势如虾,高埂赤肿疼
痛。初宜黄连消毒饮,外用食盐酒糟香油同炒令香,淬以滚汤,淋洗患处即消。
润肌膏
当归身(一两五钱)、粉甘草(一两)、白芷(八钱)、血竭(六钱)、紫草茸(五钱)、白蜡(切片,二两)。
取真麻油八两,先将当归身、白芷、甘草熬至深黄色,滤去药渣,再放入血竭熬化,再次过滤干净,然后放入紫草和白蜡片,稍微煮沸十余次,立即离火,滤去紫草药渣,药膏颜色即鲜明可爱,如果熬制过度则变为紫黑色。
验方
胡椒四钱,烧酒四两,共同放入瓷碗内,隔水炖煮,用软绵蘸取药酒温敷患处,即可痊愈。
陈实功说:手足皮肤破裂,是干枯的表现,因为气血不能濡养肌肤所致。这是因为体质偏热之人突然遭受风寒侵袭,导致血脉凝滞,致使皮肤逐渐干枯萎缩,从而产生破裂,每日受风邪侵袭,风与热相互搏结,所以多伴有疼痛。使用玉肌散、润肌膏外涂滋润。内服当归饮子。(《外科正宗》)
王肯堂说:手发背初起时像被水刺扎一样,没有明显的脓头,顽固地布满整个手背肿胀,随后聚集成毒形成疮疡,深入至骨骼。(《外科准绳》)
《鬼遗方》说:俗称蜘蛛背。
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李氏说:手背肿毒,是由于三阳经的风热郁滞而引发的。(《医宗必读·十书》)
申斗垣说:手发背即手背部的毒疮,是由于心、肝两经的风热相互搏结,气血壅聚而成。初起时憎寒发热,昏闷疼痛,呕吐逆气,初期宜采用发表解毒的方法治疗。(《启玄集》)
胡公弼说:大抵此证,多由恼怒等七情刺激,皆能引动内火。各经之火性质不同,应当分别进行治疗。(《青囊秘传》)
又说:如果溃破后出血,出现发热、谵语症状,宜服用清心流气饮;若无效,则是热入血室,宜服用加减小柴胡汤,血止住而热邪也随之解除。
汪省之说:手发背,发于手背中渚穴、液门穴两个穴位处,属于手少阳三焦经,该经多气少血。初起时有寒热症状,或作呕,或作痒痛。(《理例》)
朱丹溪说:手发背,由风、火与湿邪凝滞而成。初起形状像芒刺,逐渐感到疼痛且高肿。若红肿活络、发热、溃破迅速出脓者为顺证;若漫肿坚硬,无红无热,溃破迟缓则为疽证。其病情轻重,只要溃破后深露筋骨者难以完全治愈。
王杏庵说:病虾生于手背,属于手三阳经积热毒盛而成。病情形态如虾,高埂赤肿疼痛。初期宜服用黄连消毒饮,外用食盐、酒糟、香油同炒至香,用滚开水冲泡淬取汁液,淋洗患处即可消除。
Rouji Ointment (Nourishing Muscle Ointment)
Danggui Shen (Radix Angelicae Sinensis, specific part), 1 liang 5 qian; Fen Gancao (Radix Glycyrrhizae Preparata), 1 liang; Baizhi (Radix Angelicae Dahuricae), 8 qian; Xuexie (Sanguis Draconis), 6 qian; Zicao Rong (Flos Lappitidis), 5 qian; Bala (Cera Alba), sliced, 2 liang.
Take 8 liang of genuine Sesame Oil (Oleum Sesami). First, decoct Danggui Shen, Baizhi, and Gancao until they turn deep yellow, then filter out the dregs. Next, add Xuexie and decoct until dissolved, filter again until clean. Then add Zicao and sliced Bala, boil slightly for more than ten cycles, immediately remove from fire, and filter out the Zicao dregs. The color will be bright and attractive; if over-decocted, it will turn purple-black.
Empirical Prescription
Hu Jiao (Fructus Piperis Nigris), 4 qian; Shaojiu (Baijiu/Chinese Liquor), 4 liang. Place them together in a porcelain bowl and stew over water. Dip soft cotton into the wine and apply warmly to the affected area; it will heal immediately.
Chen Shigong stated: Cracking of the hands and feet is a sign of dryness, caused by the inability of Qi and Blood to nourish the tissues. This occurs when a person with a hot constitution is suddenly exposed to wind-cold, causing blood vessels to stagnate, leading to gradual drying and withering of the skin, resulting in cracking. Daily exposure to wind, combined with wind-heat, causes pain. Apply Yujisan (Jade Skin Powder) and Roujigao (Nourishing Muscle Ointment) externally to moisten. Internally administer Danggui Yinzi (Angelica Decoction). (*Waike Zhengzong* / *Standard Practice of Surgery*)
Cracked Hands
Grind Dafengzi Rou (Endocarpium Seminis Crotonis Tiglii) into a paste and apply topically.
Wang Kentang stated: Hand Fabei (Back of Hand Carbuncle) initially feels like a water sting, without a distinct head, presenting as stubborn swelling covering the entire back of the hand. Later, toxins gather to form sores that penetrate deeply to the bone. (*Waike Zhunsheng* / *Precise Standards of Surgery*)
*Guiyi Fang* states: Commonly known as Spider Back.
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Li Shi stated: Swelling and toxicity on the back of the hand are caused by the stagnation of wind-heat in the three Yang meridians. (*Yi Zong Bi Du / Ten Books*)
Shen Douyuan stated: Hand Fabei is a toxic sore on the back of the hand, formed by the interaction of wind-heat in the Heart and Liver meridians, causing Qi and Blood to accumulate. Initially, there is aversion to cold and fever, mental confusion, pain, vomiting, and regurgitation. Early treatment should focus on releasing the exterior and resolving toxicity. (*Qixuan Ji* / *Collection of Qixuan*)
Hu Gongbi stated: Generally, this condition arises mostly from emotional disturbances such as anger, which can stir up internal fire. The fire in different meridians varies, so treatment must be differentiated accordingly. (*Qingnang Michuan* / *Secret Transmission of Qingnang*)
He also stated: If bleeding occurs after ulceration, accompanied by fever and delirium, Qingxin Liuqi Yin (Clear Heart and Regulate Qi Decoction) should be used. If ineffective, it indicates heat entering the Blood Chamber, and Jiajian Xiaochaihu Tang (Modified Minor Bupleurum Decoction) should be used. Once bleeding stops, the heat will resolve.
Wang Shengzhi stated: Hand Fabei originates at the Zhongzhu (TE3) and Yemen (TE2) acupoints on the back of the hand, belonging to the Hand-Shaoyang Sanjiao Meridian, which is characterized by abundant Qi and scarce Blood. Initially, there may be chills and fever, vomiting, or itching and pain. (*Lili* / *Principles*)
Zhu Danxi stated: Hand Fabei is formed by the stagnation of wind, fire, and dampness. Initially, it resembles thorns, gradually becoming painful and swollen. If red, vibrant, hot, and rapidly suppurating, it is a favorable progression (Shun); if diffusely swollen and hard, without redness or heat, and slow to ulcerate, it is a Ju (deep abscess). Regarding severity, cases where ulceration exposes tendons and bones are difficult to cure completely.
Wang Xing'an stated: Bingxia (Disease resembling a shrimp) on the back of the hand is caused by accumulated heat and severe toxicity in the three Hand-Yang meridians. The presentation resembles a shrimp, with high ridges, redness, swelling, and pain. Initially, Huanglian Xiaodu Yin (Coptis Detoxification Decoction) should be administered internally. Externally, mix edible salt, distiller's grains, and sesame oil, stir-fry until fragrant, steep in boiling water, and rinse the affected area to eliminate the condition.