或曰∶“前书放痧有十,今放痧者,奚不止于此?”余曰∶“遍身青筋,古有载矣。谓放痧有十者,不过就痧毒先达
脏腑者明之尔,至腿弯痧筋,尤人易晓,余详之为初学人便,推而广之,宁有暨乎”。
或曰∶“前子伤寒辨痧详矣,若犯痧似伤风何如”?余曰∶“肺主皮毛,心主血,肝主筋,伤风犯痧三部见者居多。”
且风,阳也。风伤卫,仕表,故脉浮。伤风有汗,表虚也,故脉缓,有犯此症,脉不浮缓,反见沉紧或洪大,痧胀一验
也。若伤风带寒,鼻塞畏冷,脉当浮而微紧,脉反沉伏或芤长,痧胀二验也。若伤风热,鼻塞声重,喉痛,脉当浮而微
数,脉反沉紧或芤或伏,痧胀三验也。若伤风有痰,气急发喘,脉当浮滑,反微涩沉伏,痧胀四验也。以此推之,足矣。
治验∶
一骆叔源,伤风发热,咳嗽痰喘已半月矣。左脉沉伏,右脉涩而微数,此慢痧为患也。左腿弯放二针,紫黑血流至
足。又刮痧,不愈。付宝花散加明矾末稍冷汤饮之,用荆芥汤减川芎加苏子、红花、蒲黄,土贝母、乌药,微冷冻饮料之而
愈。
一高充谟,伤风鼻塞,肩背拘急,头顶、疼痛,有以足太阳膀胱经药治之。头顶益痛,叫喊不已,甚至肩背沉重,
时觉昏迷。延余治之,左寸微伏,右关芤大。先服圆红散,稍醒刺腿弯六针,不愈。用宝花散清茶微冷冻饮料之,肩背稍转,
头痛少安。询所服者,腹中觉冷,即用防风散痧汤减枳壳加羌活,川芎,紫苏、乌药温饮,寒散而安。
一凌公远内室,伤风喉哑,胸腹饱闷,两关俱芤。余曰∶“芤者,瘀血,未有上下俱瘀,其痧乎”。其家人刮之,紫
痧甚多,饱闷即解。付独活红花汤加射干、前胡、薄荷、石斛、连翘、玄参三剂,微冷冻饮料之,伤风喉哑俱痊。
有人问:“前书中记载放痧有十种,如今放痧的方法,为何不止这十种?”我回答说:“遍身青筋显露,古书早有记载。所谓放痧有十种,不过是针对痧毒先到达脏腑的情况加以说明罢了。至于腿弯处的痧筋,更是人们容易知晓的,我详细列出是为了方便初学者学习,由此推广开来,难道会有穷尽吗?”
有人问:“之前您辨别伤寒与痧症非常详尽,如果患上类似伤风的痧症该怎么办呢?”我回答说:“肺主管皮毛,心主管血液,肝主管筋脉,伤风兼夹痧邪在三部(上、中、下或表、里、半表半里)出现的病例居多。”况且风属于阳邪。风邪损伤卫气,停留在体表,所以脉象浮。伤风通常有汗出,这是表虚的表现,所以脉象缓。如果有患者出现此类症状,但脉象不浮不缓,反而出现沉紧或洪大,这是判断为痧胀的第一个依据。如果是伤风兼夹寒邪,鼻塞怕冷,脉象应当浮而微紧,如果脉象反而沉伏或芤长,这是判断为痧胀的第二个依据。如果是伤风兼夹热邪,鼻塞声音重浊,咽喉疼痛,脉象应当浮而微数,如果脉象反而沉紧或芤或伏,这是判断为痧胀的第三个依据。如果是伤风兼夹痰饮,气急发喘,脉象应当浮滑,如果脉象反而微涩沉伏,这是判断为痧胀的第四个依据。以此类推,就足够了。
治疗验案:
一位叫骆叔源的患者,因伤风发热,咳嗽痰喘已经半个月了。左脉沉伏,右脉涩而微数,这是慢痧致病所致。在其左腿弯处放血两针,流出紫黑色血液直至足部。又进行了刮痧,但未痊愈。给予宝花散加明矾末,用稍冷的汤剂送服;再用荆芥汤减去川芎,加入苏子、红花、蒲黄、土贝母、乌药,微冷冻后饮用,病愈。
一位叫高充谟的患者,伤风鼻塞,肩背拘急僵硬,头顶及身体其他部位疼痛。有人用足太阳膀胱经的药物进行治疗,导致头顶疼痛加剧,叫喊不停,甚至感到肩背沉重,时常觉得昏迷。请我诊治,发现左寸脉微伏,右关脉芤大。先服用圆红散,稍后清醒,再刺腿弯六针,仍未痊愈。用宝花散配清茶,微冷冻后饮用,肩背稍感舒缓,头痛略安。询问所服药物后的感觉,患者自觉腹中寒冷,于是改用防风散痧汤减去枳壳,加入羌活、川芎、紫苏、乌药,温饮以驱散寒气,病情安定。
凌公远的内室眷属,伤风导致喉咙嘶哑,胸腹胀闷,左右关脉均呈芤象。我说:“芤脉主瘀血,没有上下都瘀滞却非痧症的。”其家人为其刮痧,放出大量紫痧,胀闷随即解除。给予独活红花汤加入射干、前胡、薄荷、石斛、连翘、玄参,共三剂,微冷冻后饮用,伤风喉哑全部痊愈。
A questioner asked: "The previous book listed ten types of Sha-bleeding (Sha-bleeding, a therapeutic technique involving puncturing superficial veins to release pathogenic heat/toxins). Why are there now more than ten methods?" I replied: "The manifestation of greenish-blue veins throughout the body has been recorded in ancient texts. The statement that there are ten types of Sha-bleeding merely clarifies cases where Sha-toxin first reaches the Zang-Fu organs. As for the Sha-veins in the popliteal fossa (back of the knee), these are easily understood by people. I detailed them for the convenience of beginners; extending this method further, can it possibly have an end?"
Another asked: "You previously distinguished between Shanghan (Cold Damage) and Sha-disease in detail. What if one contracts Sha-disease resembling Wind-Cold (Shangfeng)?" I replied: "The Lung governs the skin and hair, the Heart governs blood, and the Liver governs sinews. Cases where Wind-Cold combines with Sha-pathogen appearing in the three regions (Upper, Middle, Lower or Exterior, Interior, Half-Exterior/Half-Interior) are common." Furthermore, Wind is a Yang pathogen. When Wind damages the Wei-Qi (Defensive Qi) and remains at the exterior, the pulse is Floating (Fu). Wind-Cold typically presents with sweating, indicating Exterior Deficiency, so the pulse is Slow (Huan). If a patient presents with such symptoms but the pulse is neither Floating nor Slow, but instead Sinking-Tight (Chen Jin) or Surging-Hong (Hong Da), this is the first verification for Sha-Zhang (Sha Distension). If Wind-Cold is combined with Cold, causing nasal congestion and aversion to cold, the pulse should be Floating and slightly Tight; if the pulse is instead Sinking-Hidden (Chen Fu) or Hollow-Kou (Kou Chang), this is the second verification for Sha-Zhang. If Wind-Cold is combined with Heat, causing nasal congestion, heavy voice, and sore throat, the pulse should be Floating and slightly Rapid (Shu); if the pulse is instead Sinking-Tight, Hollow, or Hidden, this is the third verification for Sha-Zhang. If Wind-Cold is combined with Phlegm, causing rapid breathing and wheezing, the pulse should be Floating-Slippery (Hua); if the pulse is instead Slightly-Choppy (Se) and Sinking-Hidden, this is the fourth verification for Sha-Zhang. By extrapolating from this, it is sufficient.
Clinical Records:
1. Mr. Luo Shuyuan suffered from fever due to Wind-Cold, with cough, phlegm, and wheezing for half a month. His left pulse was Sinking-Hidden, and his right pulse was Choppy and slightly Rapid. This was caused by chronic Sha-disease. Two needles were used to bleed the Sha-veins in the left popliteal fossa, releasing dark purple-black blood down to the foot. Scraping (Gua Sha) was also performed, but he did not recover. He was prescribed Baohua San (Treasure Flower Powder) with added alum powder, taken with a slightly cool decoction. Subsequently, Jingjie Tang (Schizonepeta Decoction) was modified by removing Chuanxiong and adding Zi Su Zi (Perilla Seed), Hong Hua (Safflower), Pu Huang (Pollen Typhae), Tu Bei Mu (Fritillaria Thunbergii Bulb), and Wu Yao (Lindera Root). It was consumed after being cooled slightly, and he recovered.
2. Mr. Gao Chongmo had Wind-Cold with nasal congestion, stiffness and tension in the shoulders and back, and pain in the head and other areas. Someone treated him with herbs targeting the Foot-Taiyang Bladder Meridian, which exacerbated the headache, causing incessant shouting, heaviness in the shoulders and back, and frequent sensations of coma. I examined him and found his Left Cun (Inch) pulse slightly Hidden, and his Right Guan (Bar) pulse Hollow-Large. First, he took Yuanhong San (Round Red Powder), which made him slightly lucid. Then, six needles were inserted into the popliteal Sha-veins, but he did not improve. He was given Baohua San mixed with clear tea, consumed after being cooled slightly. His shoulder and back discomfort eased somewhat, and his headache subsided slightly. Upon asking about his reaction to the medication, he felt coldness in his abdomen. Therefore, Fangfeng San Sha Tang (Saposhnikovia Detoxifying Sha Decoction) was modified by removing Zhi Qiao and adding Qiang Huo (Notopterygium Rhizome), Chuanxiong, Zi Su Ye (Perilla Leaf), and Wu Yao. Taken warm to disperse the cold, he stabilized.
3. The wife of Lord Ling Gongyuan contracted Wind-Cold resulting in hoarseness and fullness/stuffiness in the chest and abdomen. Both her Left and Right Guan pulses were Hollow (Kou). I said: "The Hollow pulse indicates Blood Stasis. There is no condition without Sha when both upper and lower aspects are stagnant." Her family members performed scraping on her, releasing a large amount of dark purple Sha, and the fullness immediately resolved. She was prescribed Duhuo Honghua Tang (Angelica Pubescens and Safflower Decoction) with added Yexia (Belamcanda Rhizome), Qian Hu (Peucedani Radix), Bo He (Mentha Haplocalyx), Shi Hu (Dendrobium Stem), Lian Qiao (Forsythia Fruit), and Xuan Shen (Scrophulariae Radix) for three doses. Consumed after being cooled slightly, her Wind-Cold and hoarseness completely healed.