秦子曰∶腋痛者,在两胁之上,奶旁外侧,痛连缺盆,肺经症也。若在腋之下,原是胁
痛,而非腋痛。方书以右腋为肺,左腋为肝,愚无左右之分,若见气粗喘咳者,即痛连左腋
,亦名肺病。即见肝家形症,只作金邪乘木,治肺不治肝。以腋下为肺之部分,不比胁肋,
主乎肝胆,此余宗钱仲阳肺脏治病之独诀。
【外感腋痛之症】恶寒发热,喘急嗽痰,腋下作痛,痛引缺盆,此风寒伤肺症也。若
口渴面赤,吐痰干涸,小便短赤,此燥热伤肺症也。
【外感腋痛之因】风寒壅于肺经,腋为肺脉所注之俞,故腋为之痛。燥热刑金,肺气
焦满,攻注腋下,亦令人痛。是以风寒暑湿燥,皆有腋痛之候也。
【外感腋痛之脉】右寸浮紧,风寒伤肺。或见浮洪,风热之诊。或见躁疾,燥火刑金。
【外感腋痛之治】伤寒者,麻黄杏子汤。风邪伤肺,加味泻白散。燥火伤肺金之气者
,知石泻白散。燥火伤肺金之血者,青金泻白散。
麻黄杏子汤
麻黄 杏子 米仁 桑白皮 桔梗 甘草
加味泻白散
桑白皮 地骨皮 桔梗 杏仁 防风 黄芩 栝蒌仁 知母 薄
荷枳壳 橘红 甘草
清肺饮
山栀 黄芩 薄荷 甘草 桔梗 连翘
加竹叶七片,同煎。口渴,加石膏;大便秘,加大黄。
知石泻白散 家秘治火邪伤肺之气。
桑白皮 地骨皮 甘草 知母 石膏
胃火上冲,加葛根;肝火旺,加柴胡、黄芩。
青金泻白散 家秘治火邪伤肺之血。
桑白皮 地骨皮 甘草 黄芩 山栀
肝火刑金,加白芍药;胃火旺,加干葛、石膏。
秦子说:腋痛,发生在两胁之上、乳房外侧,疼痛牵连缺盆穴,这是肺经的病证。如果疼痛在腋下下方,原本属于胁痛,而不是腋痛。医书中有将右腋归属于肺、左腋归属于肝的说法,但我认为没有左右之分。如果见到气粗、喘咳的症状,即使疼痛牵连左腋,也命名为肺病。即使见到肝脏的形症表现,也只当作金邪(肺病)乘克木(肝病),治疗肺而不治疗肝。因为腋下是肺所主的部位,不同于胁肋部主要主管肝胆,这是我遵循钱仲阳关于肺脏治病的独特诀窍。
【外感腋痛的病症】恶寒发热,气喘急促并咳嗽有痰,腋下疼痛,疼痛牵引至缺盆穴,这是风寒伤肺的病证。如果口渴、面色红赤,吐出的痰液干枯少津,小便短少且颜色深黄,这是燥热伤肺的病证。
【外感腋痛的病因】风寒邪气壅滞于肺经,腋下是肺经经脉气血灌注的俞穴所在,所以腋下会疼痛。燥热之邪刑克肺金(金属性对应肺),导致肺气焦灼胀满,攻注于腋下,也会使人疼痛。因此,风、寒、暑、湿、燥等邪气,都有导致腋痛的表现。
【外感腋痛的脉象】右寸脉浮紧,是风寒伤肺的征象。或者出现浮洪脉,是风热的诊断依据。或者出现躁动疾数脉,是燥火刑克的征象。
【外感腋痛的治疗】伤寒者,使用麻黄杏子汤。风邪伤肺,使用加味泻白散。燥火损伤肺金之气者,使用知石泻白散。燥火损伤肺金之血者,使用青金泻白散。
加味泻白散
桑白皮 地骨皮 桔梗 杏仁 防风 黄芩 瓜蒌仁 知母 薄荷 枳壳 橘红 甘草
清肺饮
山栀 黄芩 薄荷 甘草 桔梗
加竹叶七片,一同煎煮。口渴,加石膏;大便秘结,加大黄。
知石泻白散 家传秘法,治疗火邪损伤肺之气。
桑白皮 地骨皮 甘草 知母 石膏
胃火上冲,加葛根;肝火旺盛,加柴胡、黄芩。
青金泻白散 家传秘法,治疗火邪损伤肺之血。
桑白皮 地骨皮 甘草 黄芩 山栀
肝火刑克肺金,加白芍药;胃火旺盛,加干葛、石膏。
Qin Zi said: Axillary pain occurs above the two hypochondria and on the lateral side of the breast, with pain radiating to the Quepen (LI15) acupoint; this is a syndrome of the Lung Meridian. If the pain is located below the axilla, it originally belongs to hypochondriac pain rather than axillary pain. Medical texts state that the right axilla corresponds to the Lung and the left axilla to the Liver, but I hold that there is no distinction between left and right. If one observes symptoms such as rough breathing, wheezing, and coughing, even if the pain radiates to the left axilla, it is still named as a Lung disease. Even if manifestations of the Liver are present, it should only be treated as Metal Evil (Lung pathology) overcoming Wood (Liver pathology), treating the Lung without treating the Liver. This is because the area under the armpit is the domain governed by the Lung, unlike the hypochondrium and ribs which are primarily governed by the Liver and Gallbladder. This is my adherence to the unique prescription for treating Lung diseases from Qian Zhongyang.
[Symptoms of Exogenous Axillary Pain] Aversion to cold and fever, rapid panting with cough and sputum, pain in the axilla radiating to the Quepen (LI15) acupoint; this is a syndrome of Wind-Cold injuring the Lung. If there is thirst, flushed face, dry and scanty sputum, and short, dark yellow urine, this is a syndrome of Dry-Heat injuring the Lung.
[Etiology of Exogenous Axillary Pain] Wind-Cold stagnates in the Lung Meridian. The axilla is the location where the meridians of the Lung pour their Qi into the Shu points; therefore, the axilla becomes painful. Dry-Heat punishes Metal (Lung), causing the Lung Qi to become scorched and distended, attacking and pouring into the axilla, also causing pain. Thus, Wind, Cold, Summerheat, Dampness, and Dryness all have manifestations of axillary pain.
[Pulse Signs of Exogenous Axillary Pain] The Right Cun pulse is Floating and Tight, indicating Wind-Cold injuring the Lung. Alternatively, a Floating and Surging pulse may be seen, which is the diagnostic sign for Wind-Heat. Alternatively, a Restless and Rapid pulse may be seen, indicating Dry-Fire punishing Metal.
[Treatment of Exogenous Axillary Pain] For Cold Damage (Shanghan), use Mahuang Xingzi Tang (Ephedra and Apricot Seed Decoction). For Wind Evil injuring the Lung, use Jiawei Xiebai San (Modified Draining White Powder). For Dry-Fire damaging the Qi of Lung Metal, use Zhishi Xiebai San (Gypsum and Anemarrhena Draining White Powder). For Dry-Fire damaging the Blood of Lung Metal, use Qingjin Xiebai San (Blue-Gold Draining White Powder).
Mahuang Xingzi Tang (Ephedra and Apricot Seed Decoction)
Ephedrae Herba (Mahuang, 麻黄)
Armeniacae Semen Amarum (Xingren, 杏仁)
Coicis Semen (Yiyiren, 米仁)
Mori Cortex (Sangbaipi, 桑白皮)
Platycodonis Radix (Jiegeng, 桔梗)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Jiawei Xiebai San (Modified Draining White Powder)
Mori Cortex (Sangbaipi, 桑白皮)
Borricis Cortex (Dugupi, 地骨皮)
Platycodonis Radix (Jiegeng, 桔梗)
Armeniacae Semen Amarum (Xingren, 杏仁)
Saposhnikoviae Radix (Fangfeng, 防风)
Scutellariae Radix (Huangqin, 黄芩)
Trichosanthis Fructus (Gualouren, 栝蒌仁)
Anemarrhenae Rhizoma (Zhimu, 知母)
Menthae Haplocalycis Herba (Bohe, 薄荷)
Aurantii Fructus Immaturus (Zhike, 枳壳)
Citri Reticulatae Pericarpium (Chenhpi, 橘红)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Qingfei Yin (Lung-Clearing Decoction)
Gardeniae Fructus (Zhizi, 山栀)
Scutellariae Radix (Huangqin, 黄芩)
Menthae Haplocalycis Herba (Bohe, 薄荷)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Platycodonis Radix (Jiegeng, 桔梗)
Add seven leaves of Bamboo Leaves (Zhuyeqian, 竹叶), decoct together. For thirst, add Gypsum (Shigao, 石膏); for constipation, add Rheum Palmatum (Dahuang, 大黄).
Zhishi Xiebai San (Gypsum and Anemarrhena Draining White Powder)
Family secret method for treating Fire Evil damaging Lung Qi.
Mori Cortex (Sangbaipi, 桑白皮)
Borricis Cortex (Dugupi, 地骨皮)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Anemarrhenae Rhizoma (Zhimu, 知母)
Gypsum (Shigao, 石膏)
For Stomach Fire rushing upward, add Puerariae Radix (Gegen, 葛根); for hyperactive Liver Fire, add Bupleuri Radix (Chaihu, 柴胡) and Scutellariae Radix (Huangqin, 黄芩).
Qingjin Xiebai San (Blue-Gold Draining White Powder)
Family secret method for treating Fire Evil damaging Lung Blood.
Mori Cortex (Sangbaipi, 桑白皮)
Borricis Cortex (Dugupi, 地骨皮)
Glycyrrhizae Radix et Rhizoma (Gancao, 甘草)
Scutellariae Radix (Huangqin, 黄芩)
Gardeniae Fructus (Zhizi, 山栀)
For Liver Fire punishing Metal, add Paeoniae Radix Alba (Baishao, 白芍药); for hyperactive Stomach Fire, add Puerariae Radix (Gegen, 干葛) and Gypsum (Shigao, 石膏).