小腹痈,生于小腹皮里膜外。或因膏粱浓味,或因七情火郁,以致脾虚气滞而成,小儿
乃惊积亏损所致。初起漫肿坚硬,肉色不变。数日后,有热渐红者,属阳,易治;无热不红
者,属阴,难治。此证不问初起未溃已溃,俱宜助胃壮气,而以行经活血之药佐之,如四君
子汤加川芎、当归、白芷、枳壳之类。如误用克伐攻利凉药,败证必出。若其纯阴无阳者,
宜十全大补加参、 、姜、附以温发之。又有肿高 赤作痛者,此属湿火,先用仙方活命饮
,或化毒除湿汤;成脓后脉洪数者,用托里消毒散。
缓疽,生于少腹之旁,乃脾经气滞寒积而成。坚硬,不红不热,痛引腰腿,有数月不溃
者。若寒热间作,饮食减少,渐致羸瘦,此属败证。治宜补养气血、温通经络,理中汤合四
物汤主之。
肾俞发者,即腰疽,生于两腰内肾陷肉之间,或生两腰中间,最为险候。盖肾为性命根
本,藏精藏气藏神;又乃受命先天,育女育男育寿。此必房劳过度,气竭精伤,欲火销阴,
外阳煽动,以致真阴从此而耗,既耗之后,其脏必虚,所以诸火诸邪,乘虚而入。其证初起
令人口干,寒热大作,百节俱痛。如本脏稍有真阴制火,疮形自可高肿红活为脓。治以人参
养营汤加山萸肉、北五味、知母、黄柏,及加减八味丸,以救其源。若疮形紫黑干枯,坚硬
不作脓者,为真阴内败,再无可生之理,死在十五日前后。
鹳口疽,发于尾闾穴之高骨尖上,亦名尾闾发,《灵枢》名锐疽。此由三阴亏损,督脉
之经浊气湿痰流结而成。初起形似鱼肫,久则突如鹳嘴,朝寒暮热,日轻夜重,溃后稀脓出
而无禁,又或鲜血出而不停。凡发此者,壮年犹可,老者可危。初宜滋阴除湿汤和之;已成
未溃者,和气养营汤托之;溃而不敛者,滋肾保元汤补之;久而成漏者,琥珀蜡矾丸、先天
大造丸,兼服甚妙。
小腹痈,生长在小腹皮肤与筋膜之间的空隙中。有的因为饮食过于肥甘厚味所致,有的因为七情内伤导致火气郁结,从而引起脾气虚弱、气机阻滞而形成;小儿则是因为受惊和积滞亏损所导致。初起时肿胀弥漫且坚硬,皮肤颜色没有改变。几天后,如果局部发热并逐渐变红,属于阳证,容易治疗;如果不发热也不发红,属于阴证,难以治疗。此病证无论处于初起、未溃破还是已溃破阶段,都适宜使用扶助胃气、强壮正气的药物,并配合行气活血的药物辅助治疗,例如在四君子汤中加入川芎、当归、白芷、枳壳等药物。如果误用攻伐、泻下或寒凉的药物,必然会导致病情恶化出现败象。如果是纯阴无阳的证候,适宜使用十全大补汤加入人参、肉桂、干姜、附子来温阳发散。又有肿势高突、色赤作痛的情况,这属于湿火,先用仙方活命饮,或者化毒除湿汤;脓成之后脉象洪数的,使用托里消毒散。
缓疽,生长在少腹旁边,是由脾经气机阻滞、寒邪积聚而成的。肿块坚硬,不红不热,疼痛牵引腰部和腿部,有的数月都不溃破。如果出现寒热交替发作,饮食减少,逐渐导致身体消瘦,这属于败证。治疗应当补养气血、温通经络,以理中汤合四物汤为主方。
肾俞发,就是腰疽,生长在两腰内部肾脏凹陷处的肌肉之间,或者生在两腰中间,是最为危险的证候。因为肾是性命根本,藏精、藏气、藏神;又是受命于先天的脏腑,主宰生育男女和寿命长短。这必定是由于房劳过度,导致气竭精伤,欲火消耗真阴,外阳煽动,从而导致真阴从此耗损。既然后真阴耗损,肾脏必然虚弱,所以各种火邪和各种病邪,乘虚而入。其症状初起时让人口干,寒热大作,全身关节都疼痛。如果本脏稍微有一点真阴来制约火邪,疮形自然可以高肿、红活并化为脓液。治疗用人参养营汤加入山萸肉、北五味子、知母、黄柏,以及加减八味丸,以挽救其本源。如果疮形紫黑干枯,坚硬且不化脓,这是真阴在内败坏,再也没有可生的道理,大约在十五日前后死亡。
鹳口疽,发于尾闾穴的高骨尖上,也叫做尾闾发,《灵枢》中称为锐疽。这是由于三阴(肝、脾、肾)亏损,督脉中的浊气和湿痰流注凝结而成。初起形状像鱼肚,久了则突起像鹳鸟的嘴巴,早晨怕冷晚上发热,白天轻晚上重,溃破后流出稀薄的脓液且无法止住,或者又流出鲜血且不停止。凡是发生此病的,壮年人还可以救治,老年人就很危险了。初起适宜用滋阴除湿汤调和;已经成形但未溃破的,用和气养营汤托毒外出;溃破后不能收敛的,用滋肾保元汤补益;日久形成瘘管的,琥珀蜡矾丸、先天大造丸,兼服效果很好。
Xiao Fu Yong (Abscess of the Lower Abdomen) arises in the space between the skin and fascia of the lower abdomen. It may be caused by a diet rich in rich, greasy, and sweet foods, or by emotional disturbances leading to the stagnation of fire, resulting in Spleen Qi deficiency and Qi stagnation; in children, it is caused by fright and accumulation leading to depletion. Initially, there is diffuse swelling that is hard, with unchanged skin color. After several days, if heat gradually appears and redness develops, it belongs to the Yang pattern and is easy to treat; if there is no heat and no redness, it belongs to the Yin pattern and is difficult to treat. For this condition, regardless of whether it is in the initial stage, un-ulcerated, or ulcerated, it is appropriate to use herbs that tonify Stomach Qi and strengthen healthy Qi, assisted by herbs that promote circulation through the meridians and invigorate blood, such as Sizijunzi Tang (Four Gentlemen Decoction) added with Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), Baizhis Fructus (Baizhi), and Zhike Pericarpium Citri Reticulatae (Zhike). If harsh purgatives, draining agents, or cooling medicines are mistakenly used, a collapse syndrome will inevitably occur. In cases of pure Yin without Yang, Shiquan Dabu Tang (Ten Significant Tonifying Decoction) added with Renshen Radix Ginseng (Renshen), Rouguici Cortex Cinnamomi Cassiae (Rougui), Ganjiangis Rhizoma (Ganjiang), and Fuzii Radix Preparata (Fuzi) should be used to warm and disperse. If the swelling is high, red, and painful, this belongs to Damp-Fire; Xianfang Huoming Yin (Immortal Formula for Saving Lives Infusion) or Huadu Chushi Tang (Toxin-Transforming and Dampness-Removing Decoction) should be used first; after suppuration occurs and the pulse is surging and rapid, Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) is used.
Huan Ju (Slow Carbuncle) arises on the side of the lower abdomen, formed by Qi stagnation and cold accumulation in the Spleen Meridian. The mass is hard, not red, not hot, with pain radiating to the waist and legs, sometimes failing to ulcerate for months. If alternating chills and fever occur, food intake decreases, and emaciation gradually ensues, this belongs to a collapse syndrome. Treatment should focus on tonifying Qi and Blood and warming and unblocking the meridians, primarily using Lizhong Tang (Regulate the Middle Decoction) combined with Siwu Tang (Four Substances Decoction).
Shensu Fa (Eruption at Shensu Point), also known as Yao Ju (Lumbar Carbuncle), arises between the muscles in the depression of the kidneys on both sides of the waist, or in the middle of both waists, representing a most critical condition. The Kidney is the root of life and nature, storing Essence, Qi, and Spirit; it is the organ receiving destiny from the Pre-heaven, governing reproduction of males and females, and longevity. This condition must result from excessive sexual activity, leading to exhaustion of Qi and injury of Essence, where desire-fire consumes True Yin, and external Yang flares up, causing True Yin to be depleted. Once depleted, the Zang organ becomes deficient, allowing various fires and pathogens to enter due to deficiency. Symptoms initially include dry mouth, severe alternating chills and fever, and pain in all joints. If the Zang organ retains some True Yin to control fire, the lesion will naturally become high, swollen, red, and active, forming pus. Treatment uses Renshen Yangying Tang (Ginseng Nourishing Ying Decoction) added with Shanzhuyu Fructus Corni Officinalis (Shanzhuyu), Beiwuzizi Fructus Schisandrae Chinensis (Bei Wuzi), Zhimu Rhizoma Anemarrhenae (Zhimu), and Huangbai Cortex Phellodendri (Huangbai), along with Jiaban Bawei Wan (Modified Eight-Ingredient Pill), to rescue the source. If the lesion is purple-black, dry, hard, and does not form pus, this indicates internal failure of True Yin, with no possibility of survival, and death will occur around fifteen days later.
Guankou Ju (Stork-Mouth Carbuncle) erupts on the sharp bone tip of the Weilu point, also called Weilü Fa (Eruption at Weilu), named Ruiju (Sharp Carbuncle) in Ling Shu. This is caused by deficiency of the Three Yin (Liver, Spleen, Kidney), with turbid Qi and damp-phlegm from the Du Mai (Governor Vessel) flowing and condensing. Initially, the shape resembles a fish stomach; over time, it protrudes like a stork's beak, with morning chills and evening fever, lighter during the day and heavier at night. After ulceration, thin pus flows out uncontrollably, or fresh blood flows continuously. Those who develop this in their prime years can still be saved, but it is dangerous for the elderly. Initially, Ziyin Chushi Tang (Yin-Nourishing and Dampness-Removing Decoction) should be used to harmonize; if formed but not yet ulcerated, Heqi Yangying Tang (Harmonizing Qi and Nourishing Ying Decoction) should be used to support expulsion; if ulcerated but not healing, Zishen Baoyuan Tang (Kidney-Nourishing and Yuan-Qi-Supporting Decoction) should be used to tonify; if it persists and forms a fistula, Hupo Lafan Wan (Amber and Wax-Alum Pill) and Xiandian Dazao Wan (Pre-heaven Great Creation Pill) taken together are very effective.