予患腹痛多年,由午餐饭冷强食而起,痛处在脐之上,痛时腹冷,掌按热熨稍瘥。虽盛
暑亦
必以帛护其腹,饮食渐减,喜暖畏凉,他物食尚相安,惟饭蒸煮未透,或稍冷食则必痛,素
嗜瓜果,得疾后不敢尝。向患痔红,食姜蒜烧酒即发,故忌之。此疾作时,食入阻滞,饮烧
酒一二杯,反觉通畅,不但姜蒜不忌,即食椒末辣酱,均与痔红无碍。经云∶痛者寒气多也
。证属寒凝气滞无疑。予素畏药,痛发无何,香砂姜萸陈半谷芽神曲之类,服一两剂即罢去
,往岁发疏尚轻,惟餐饭不能如常,年来发频且重,不拘何物,餐后必痛。须食下行,其痛
方止。于是餐后不敢坐卧,乃学古人养生,食后行百步,常宜手摩腹之法,并遵释教过午戒
食
,然亦无益于病,遂视食为畏途,无如疾经重载,消恐耗元,补防助壅,踌躇无策。友人谓
予年近古稀,命阳衰弱,寒从内生,是以喜暖畏凉。釜底无火,物终不熟,是以谷食难化,
须用八味丸补火生土。所论固是,予意终未坦然。思痛若在鬲,虑其妨食成噎,今幸在腹,
当不害命。药饵乱投,恐反有伤,恪守不药得中医之诫。己丑季夏,旌邑孙村汪宅延诊,下
塌塾中,时二鼓既寝,急欲大便。灯灭暗中摸索,跌仆莫能挣扎,大孔 遗出如泻水状,
呼仆持火至,扶起视地皆污,色如漆,汗淋气坠,即忙就枕。汪宅献楠志仁二公闻之驰至,
殊为着惊,予曰无妨,此因久痛蓄瘀,刻瘀下脱,未免伤气耳。饮党参、桂圆汤,少顷气稍
续,汗亦敛,次早登厕,犹有余瘀。予恐其瘀复脱,遄归到家更衣,瘀已无矣。自此腹不再
痛,餐饭如常。细求其故,究由瘀凝肠胃,阻其传导之机,以故食入则痛。夫血犹水也,血
之
结而为瘀,亦如水之结而为冰。所以痛处常冷,按熨饮醇热气至,故觉稍快。至于瘀蓄年久
,胶固已深,一旦倾囊自出,理殊不解,得无长夏炎蒸,奔驰烦劳,动则阳化,如雪消而春
水来耶。从斯悟入,书称久痛在络,络主血,不独肢体之痛为在络,即胸腹之痛,痞积之痛
,皆为在络,皆宜治血,无徒从事于气。又如噎隔一证,方书虽有胃脘枯槁,及阳气结于上
,阴液衰于下等语,然由瘀血阻塞胃口者恒多。进而思之,予疾将十年,固未能自知瘀蓄于
先,然不药稳持,尚不失为中驷。不然补泻杂投,不殒于病,而殒于药矣。予见败坏之证自
萎者十之二三,药伤者十之七八。药本生人,而反杀人,可不惧哉。自今以往,伏愿医家证
未审明,勿轻用药,病家疾如可待,勿急求医,如此或亦可为卫生之一助耳。
安波曰∶初痛在经,久痛入络二语,叶氏实发前人数千年之未发,启后学于意万载之
无窍
。然不独胃病噎膈之症,浑融使然也,凡病久根深蒂固,综须治血为主,此即古人窍必及肾
之意也夫。
我患有腹痛多年,起因是午餐时强行进食冷饭。疼痛部位在肚脐上方,发作时腹部发冷,用手掌按压或用热物熨烫后症状稍有好转。即使在盛夏,我也必须用布帛护住腹部,饮食逐渐减少,喜欢温暖而畏惧寒冷,其他食物尚能安然食用,唯独米饭蒸煮不透或稍冷的食物吃下就必然疼痛。我平时嗜好瓜果,患病后不敢尝试。过去患有痔疮出血,食用姜、蒜、烧酒就会诱发,因此忌口这些。此病发作时,食物进入体内会有阻滞感,喝一两杯烧酒反而觉得通畅,不仅不忌讳姜蒜,即使食用椒末辣酱,对痔疮出血也无妨碍。《内经》说:“疼痛多由寒气引起。”证候属于寒凝气滞无疑。我向来畏惧服药,疼痛刚发作不久,服用香砂、干姜、吴茱萸、陈皮、半夏、谷芽、神曲等药物,服一两剂后就停止。往年发病稀疏且轻微,只是吃饭不能像往常一样;近年来发病频繁且严重,无论吃什么,餐后必然疼痛。必须等到食物下行排出,疼痛才会停止。于是餐后不敢坐卧,便学习古人的养生之道,饭后行走百步,经常按摩腹部的方法,并遵循佛教过午不食的规定,然而这对病情并无益处,于是把进食视为畏途。无奈疾病经过长期积累,担心消导药耗伤元气,补益药又恐怕助长壅滞,犹豫之间无计可施。朋友对我说,你年近七十,命门之火衰弱,寒气从内生发,所以喜欢温暖而畏惧寒冷。就像锅底没有火,食物终究煮不熟,所以谷物难以消化,应当使用八味丸(金匮肾气丸)来补火生土。这种说法固然有道理,但我心里始终不能坦然。我想如果疼痛在膈肌处,担心阻碍进食形成噎膈,现在幸好疼痛在腹部,应当不危及生命。胡乱用药,恐怕反而造成伤害,严格遵守“不轻易用药”这一符合中医精神的告诫。己丑年夏季,我在旌德县孙村汪宅受邀诊病,住在低矮的塾舍中,当时二更天已经睡下,突然急于大便。灯灭了,在黑暗中摸索,跌倒无法挣扎,肛门流出液体状如泻水,叫仆人拿火把来,扶起查看地上全是污物,颜色如漆,大汗淋漓气息下坠,急忙躺回枕上。汪宅的楠志仁二位先生听说后赶来,非常吃惊,我说不要紧,这是因为久痛蓄积瘀血,此刻瘀血下脱,未免损伤正气罢了。饮用党参、桂圆汤,片刻后气息稍续,汗也收敛了。第二天早上上厕所,还有残留的瘀血。我担心瘀血再次下脱,匆忙回家更衣,瘀血已经没有了。从此腹部不再疼痛,吃饭恢复正常。仔细推究其中的缘故,究其原因是瘀血凝结在肠胃,阻碍了传导的功能,所以食物进入就疼痛。血液就像水一样,血液凝结成瘀,也如同水凝结成冰。所以疼痛的地方常常发冷,按压、熨烫、饮用温热醇酒使热气到达,所以觉得稍微痛快。至于瘀血蓄积多年,胶结牢固已深,一旦倾囊而出,道理确实令人费解,难道不是由于长夏炎热蒸腾,奔波烦劳,动则阳气化生,如同雪消而春水到来吗?由此悟入,医书称久痛在络脉,络脉主血,不只是肢体的疼痛是在络脉,就是胸腹的疼痛,痞块积聚的疼痛,都是在络脉,都应当治疗血分,不要只从事于理气。又如噎膈这一病症,方书中虽然有胃脘枯槁,以及阳气结于上、阴液衰于下等说法,然而由瘀血阻塞胃口导致的很多。进而思考,我的病将近十年,固然未能自知先有瘀血蓄积,但如果不乱吃药稳稳地持守,尚不失为中等水平的医疗策略。不然的话,补泻杂投,不会死于疾病,而会死于药物。我看到败坏之证自然萎缩自愈的十之二三,被药物伤害的十之七八。药物本是救人的,却反而杀人,怎能不害怕呢?从今以后,希望医生在证候未审明之前,不要轻易用药;病人如果疾病可以等待,不要急着求医,这样或许也可以作为养生保健的一个帮助。
安波说:初痛在经,久痛入络这两句话,叶天士确实发掘了前人数千年未曾阐发的理论,开启了后世学者万年未有窍门的智慧。然而不仅仅胃病和噎膈的症状是这样,凡是病久根深蒂固的,综合来看都必须以治血为主,这就是古人所谓“窍必及肾”的意思啊。
I suffered from abdominal pain for many years, caused by forcibly eating cold rice at lunch. The pain was located above the umbilicus; during attacks, the abdomen felt cold, and symptoms improved slightly with palm pressure or hot compresses. Even in midsummer, I had to protect my abdomen with cloth, my diet gradually decreased, I preferred warmth and feared cold, other foods were generally tolerated, but only when rice was thoroughly steamed or food was not slightly cold could I eat without inevitable pain. I used to enjoy melons and fruits, but dared not try them after falling ill. Previously, I suffered from hemorrhoidal bleeding, which would flare up upon consuming ginger, garlic, or distilled liquor, so I avoided these. When this ailment flared, food intake felt obstructed; drinking one or two cups of distilled liquor反而 (instead) made me feel unblocked. Not only did I no longer avoid ginger and garlic, but even consuming pepper powder or spicy sauce had no adverse effect on the hemorrhoids. The *Classic* states: "Pain is mostly due to cold qi." The syndrome undoubtedly belongs to cold coagulation and qi stagnation. I have always feared medication. When pain first started, I took herbs such as *Amomi Fructus Rotundus* (Xiangsha), *Zingiberis Rhizoma* (Jiang), *Evodiae Fructus* (Ruyu), *Citri Reticulatae Pericarpium* (Chenpi), *Pinelliae Tuber* (Banxia), *Oryzae Fructus Germinatus* (Guya), and *Meditae Fructus* (Shenqu) for one or two doses and then stopped. In previous years, attacks were sparse and mild, merely affecting normal eating habits; in recent years, they became frequent and severe, causing pain after every meal regardless of what was eaten. Pain ceased only after food moved downward. Thus, I dared not sit or lie down after meals. I learned from ancients' health preservation methods: walking a hundred steps after meals, frequently massaging the abdomen, and following the Buddhist precept of abstaining from food after noon. However, this brought no benefit to the illness. Consequently, I viewed eating as a fearful path. Helpless against the chronic accumulation of disease, I feared that resolving drugs would deplete Yuan Qi (Primordial Qi), while tonics might aid stagnation. Pondering without a solution, a friend said, "You are near seventy, your Mingmen Fire (Gate of Life Fire) is weak, cold generates internally, hence you prefer warmth and fear cold. Just as a pot lacks fire underneath and food cannot cook, grains are hard to digest. You should use *Bawei Wan* (Eight-Ingredient Pill with Rehmannia) to tonify fire and generate earth." Although his argument was sound, my mind remained unsettled. I thought if the pain were in the diaphragm, it might hinder eating and lead to dysphagia (Yige); fortunately, it is now in the abdomen and likely not life-threatening. Random medication might cause harm; strictly adhering to the admonition of "not using medicine lightly" aligns with true medical wisdom. In the summer of Jichou year, I was invited to diagnose patients at the Wang residence in Sun Village, Jingde County. Living in a low schoolhouse, at the second watch (9–11 PM), I suddenly needed to defecate. The lamp went out; groping in the dark, I fell and could not struggle. Fluid like diarrhea flowed from the anus. I called a servant for a torch, got up, and saw the ground stained black as lacquer. Sweating profusely with sinking Qi, I hurriedly lay back on the pillow. Mr. Nan and Mr. Zhi Ren from the Wang residence rushed over upon hearing this, greatly alarmed. I said, "No matter. This is because long-standing pain has accumulated blood stasis; now the stasis is discharging downwards, inevitably injuring Qi." I drank a decoction of *Codonopsis Radix* (Dangshen) and *Longan Arillus* (Guiyuan). Shortly after, my Qi recovered slightly, and sweating stopped. The next morning, upon using the toilet, residual stasis remained. Fearing further discharge, I hurried home to change clothes; the stasis had disappeared. From then on, abdominal pain never returned, and eating normalized. Investigating the cause, it turned out that stasis coagulated in the intestines and stomach, obstructing the mechanism of conduction and transmission, thus causing pain upon food intake. Blood is like water; when blood condenses into stasis, it is like water freezing into ice. Hence, the painful area is often cold. Pressure, heat application, and drinking warm alcohol bring heat, providing relief. As for stasis accumulating for years, becoming deeply entrenched, its sudden discharge is puzzling. Could it be that the intense heat of midsummer, combined with travel and fatigue, activated Yang transformation, like snow melting bringing spring water? From this realization, I understood: texts state that long-standing pain resides in the collaterals (Luo Mai), and collaterals govern blood. It is not only limb pain that resides in the collaterals; chest and abdominal pain, as well as pain from masses and accumulations, also reside in the collaterals and should be treated by addressing blood, not merely regulating Qi. Similarly, regarding dysphagia (Yige), although texts mention dryness of the stomach opening, Yang qi knotting above, and Yin fluid deficiency below, cases caused by blood stasis blocking the stomach opening are common. Further thinking, my illness lasted nearly ten years; although I could not know beforehand of the accumulated stasis, refraining from medication and maintaining stability was still a competent strategy. Otherwise, mixing tonics and purgatives would not kill me via disease, but via medicine. I see that among deteriorated syndromes, 20–30% resolve naturally, while 70–80% are harmed by drugs. Drugs are meant to save lives but can kill; how can one not fear this? From now on, I hope physicians will not prescribe lightly before clearly diagnosing, and patients whose conditions can wait should not rush to seek doctors. This may serve as an aid to health preservation.
An Bo said: The phrases "initial pain is in the meridians, long-standing pain enters the collaterals" were truly expounded by Ye Tianshi, uncovering theories unexplored by predecessors for millennia and enlightening later learners who had been clueless for ages. However, this principle applies not only to stomach diseases and dysphagia but universally: for any chronic, deeply rooted disease, treatment must primarily focus on blood. This is the meaning behind the ancient saying that "orifices must involve the Kidney."