或恶寒而不溃,用补中益气汤。发热而不溃,用八珍汤。若因克伐而不溃者,用六
君子汤加当归。其外皮黑,坚硬不溃者,内火蒸炙也,内服八珍汤,外涂当归膏。其死
肉不能溃,或新肉不能生而致死者,皆失于
不预补脾胃也。 有一患者,瘀血已去,饮食少思,死肉不溃,又用托里之药,脓稍溃
而清,此血气虚也,非大补不可。彼不从,薛强用大补之剂,饮食进而死肉溃,但少寐,以
归脾汤加山栀二剂而寐,因劳心,烦躁作渴,脉浮洪大,以当归补血汤二剂而安。 有一
患者,受刑太重,外皮伤破,瘀血如注,内肉縻烂黯肿,上胤胸背,下至足指,昏愦不
食,随以黑羊皮热贴患处,灌以童便酒、薄粥,更以清肝、活血、调气、健脾之剂,神
思稍苏,始言遍身强痛。又用大剂养血补气之药,肿消食进。时仲冬,瘀血凝结,不能
溃脓,又用大补之剂,壮其阳气,其脓方熟,遂砭去,洞见其骨,涂以当归膏,及服前药
百余剂,肌肉渐生。 少宗伯刘五清, 伤一块,微痛少食,用六君子汤倍加当归、黄
,其痛渐止,月余,瘀血内涸而不溃,公以为痊。予曰∶此阳气虚极,须用调补。不
从,至来春,头晕痰涎壅塞,服清气化痰,病势愈盛,脉洪大而微细,欲以参、 、归、术、
附子之类补之。不信,至秋初,因怒昏愦而厥。
如果患者出现恶寒且疮口不溃烂,使用补中益气汤。如果发热且疮口不溃烂,使用八珍汤。如果是因过度攻伐(如误用泻下、清热等峻猛药物)导致不溃烂的,使用六君子汤加入当归。如果外皮发黑、坚硬且不溃烂,这是内火炽盛熏灼所致,内服八珍汤,外用当归膏涂抹。那些死肉不能溃烂排出,或者新肉不能生长而导致死亡的病例,都是因为未能预先补益脾胃造成的。
有一位患者,瘀血已经去除,饮食减少且食欲不振,死肉不溃烂,又使用了托毒排脓的药物,但流出的脓液稀薄清稀,这是气血虚弱的表现,必须大补气血才能治愈。患者没有听从建议,薛己强行使用大补气血的药剂,随后患者饮食增加,死肉开始溃烂,只是睡眠较少,于是用归脾汤加入山栀,服用两剂后睡眠改善。因为劳心过度,出现烦躁和口渴,脉象浮洪大,再用当归补血汤服用两剂而病情安定。
有一位患者,遭受刑罚过重,外皮破损,瘀血如注般流出,内部肌肉糜烂、颜色暗黑且肿胀,伤势蔓延至胸背,向下延伸至脚趾,神志昏迷、无法进食,随即用热的黑羊皮贴在患处,灌服童便酒和稀薄的米粥,再配合清肝、活血、调气、健脾的药剂,神志稍微清醒,才诉说全身僵硬疼痛。接着使用大剂量的养血补气药物,肿胀消退,食欲恢复。当时正值仲冬,瘀血凝结,不能化脓,又使用大补药剂以壮阳气,脓液方才成熟,于是用砭石刺破排脓,洞见骨骼,涂抹当归膏,并继续服用之前的药物一百多剂,肌肉逐渐生长。
少宗伯刘五清,身体受伤一块,轻微疼痛且食量减少,使用六君子汤加倍加入当归、黄芪,疼痛逐渐停止,一个月后,瘀血在体内枯竭但未溃烂,刘公以为痊愈了。我说:这是阳气极度虚弱,必须使用调理补益的方法。他不听从,到了来年春天,出现头晕、痰涎壅塞的症状,服用清气化痰药,病势更加严重,脉象洪大却兼见微细,想要用人参、白术、当归、附子之类的药物进行补益。他不相信,到了秋初,因为愤怒导致神志昏迷、四肢厥冷。
If the patient presents with aversion to cold and the ulcer fails to discharge, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If there is fever and the ulcer fails to discharge, use Bazhen Tang (Eight-Treasure Decoction). If the failure to discharge is due to excessive purgation or harsh treatment, use Liujunzi Tang (Six-Gentleman Decoction) with Danggui added. If the external skin is black, hard, and fails to discharge, this indicates internal fire steaming and scorching; internally administer Bazhen Tang (Eight-Treasure Decoction), and externally apply Danggui Gao (Angelica Sinensis Ointment). Cases where dead flesh cannot discharge or new flesh cannot grow, leading to death, are all due to a failure to preemptively tonify the Spleen and Stomach.
One patient had already cleared the blood stasis but suffered from poor appetite and lack of desire for food, with dead flesh not discharging. After using drugs to support the interior and expel toxins, the pus discharged was thin and clear, indicating deficiency of Blood and Qi, which requires substantial tonification. The patient did not comply, but Xue Ji forcibly administered strong tonifying agents. Subsequently, the patient’s appetite improved, and the dead flesh began to discharge. However, the patient suffered from slight insomnia, so Guipi Tang (Restore the Spleen Decoction) with Zhizi added was prescribed for two doses, after which sleep normalized. Due to mental exertion, irritability and thirst arose, with a floating, forceful, and large pulse; Danggui Buxue Tang (Danggui Tonifies the Blood Decoction) was then administered for two doses, bringing stability.
Another patient suffered severe corporal punishment, resulting in broken external skin and profuse bleeding like a stream. The internal flesh was rotten, dark, and swollen, extending from the chest and back down to the toes. The patient was comatose and unable to eat. Immediately, hot black sheepskin was applied to the affected area, and the patient was given urine from a young boy mixed with wine and thin porridge. This was followed by formulas to clear the Liver, invigorate Blood, regulate Qi, and strengthen the Spleen. Mental clarity slightly returned, and the patient reported generalized stiffness and pain. Large doses of Blood-nourishing and Qi-tonifying medicines were then used, reducing swelling and improving appetite. It was mid-winter, and the blood stasis had coagulated, preventing pus formation. Strong tonifying agents were again used to strengthen Yang Qi, allowing the pus to mature. It was then lanced with a bi stone (stone lancet), exposing the bone. Danggui Gao (Angelica Sinensis Ointment) was applied, and over one hundred doses of the previous medicines were taken, gradually regenerating muscle tissue.
Liu Wuqing, Vice Minister of Rites, sustained an injury on one part of his body, experiencing mild pain and reduced appetite. Liujunzi Tang (Six-Gentleman Decoction) with doubled amounts of Danggui and Huangqi was prescribed, and the pain gradually ceased. Over a month later, the internal blood stasis dried up without discharging, and Mr. Liu believed he had recovered. I stated: "This is extreme deficiency of Yang Qi, requiring regulation and tonification." He did not comply. By the following spring, he experienced dizziness and phlegm-saliva obstruction. After taking Qingqi Huatan Wan (Clear Qi and Resolve Phlegm Pills), the condition worsened. His pulse was forceful and large yet subtly fine. I proposed using Ginseng, Atractylodes, Angelica, and Aconite for tonification, but he refused. By early autumn, anger induced coma and cold extremities.