醉后饮水过多,脾气不化,则流入下焦,或房劳汗出入水,肾气不治,则渗入脬囊,
此水疝
之源也。子和以导水、禹功,治蔡参军疝痛,泻水三十余行,肿痛立消,盖必决去其水而疝
乃愈。若杂进姜、附,水湿为燥热所壅,则三焦闭塞,水道不行,而肿痛益甚矣。
禹功散
黑丑(头末,四两) 茴香(炒,一两)
上为末,以生姜自然汁,调一二钱,临卧服。
宣胞丸 治外肾肿痛。
黑牵牛(半生半热,取头末,一两) 川木通(炒,一两) 青木香(一两,用盐蝥七枚同
炒香)
上为细末,酒糊为丸,如梧子大。每服三十丸,温酒下。
水湿同气也。然水汪洋而湿淹濡,故水可逐而湿宜渗,水成形而湿化气,故水无阳而湿
有热。子和水疝、 疝所由分也。学人辨诸。
《元戎》加味五苓散
术 茯苓 猪苓 泽泻 肉桂 川楝子
上为末。
治疝降心火之说,子和语焉而未详。戴氏有心火下降,则肾水不患不温之语,然与子和
之治
不同。子和所谓降心者,治在筋疝,茎肿痛,溃脓血。戴氏所谓降心者,治在木肾顽痹,结
硬如石。大抵子和主清降,使心火下泄,如加味通心散之类。戴氏主咸降,使心火下济,如
海藻溃坚丸之类,然而治法悬殊矣。
加味通心散 治膀胱实热,小肠气痛。
瞿麦穗 木通(去皮节) 栀子仁 黄芩 连翘 甘草 枳壳(去瓤,) 川楝(去核,各
等分)
上锉散,每服五钱,水一盏半,灯心二十茎,车前草五茎,同煎,空心温服。
海藻溃坚丸 治木肾如斗,结硬如石。
海藻 昆布 川楝实 吴茱萸(汤泡,各一两) 木香 青皮 小茴香 荔枝核(炒) 延
胡索(炒) 肉桂(各五钱) 海带 橘核(炒) 桃仁(麸炒,去皮炒,各一两) 木通(七钱)
酒糊丸梧子大,每服六十丸,温酒盐汤主下。
醉酒后饮水过多,导致脾气无法运化水湿,水液便流入下焦;或者因房事劳累后出汗时进入水中,致使肾气失于固摄,水液便渗入膀胱。这就是水疝(以阴囊肿大、积水为主要特征的疝病)的成因。张子和用导水丸和禹功散治疗蔡参军的疝痛,通过泻下排出三十多次水样便,肿痛立刻消除,这一定是因为决去了积水,疝病才能痊愈。如果混杂使用干姜、附子等温热药,水湿会被燥热所壅滞,导致三焦闭塞,水道不通,从而使肿痛更加严重。
禹功散
黑丑(取头末四两) 茴香(炒制一两)
以上药物研为细末,用生姜自然汁调服一二钱,临睡前服用。
宣胞丸 治疗外生殖器肿痛。
黑牵牛(半生半熟,取头末一两) 川木通(炒制一两) 青木香(一两,与七枚盐炒虻虫同炒至香)
以上药物研为细末,用酒糊制成梧桐子大小的丸剂。每次服用三十丸,用温酒送服。
水和湿虽然同气,但水势汪洋而湿气浸渍濡润,所以水邪可以用逐水法攻逐,而湿邪适宜用渗利法祛除;水是有形之邪而湿是无形之气,所以水邪无阳热之性而湿邪常伴有热象。这是张子和区分水疝与其他类型疝病的依据。学习中医的人应当仔细辨别。
《元戎》加味五苓散
白术 茯苓 猪苓 泽泻 肉桂 川楝子
以上药物研为细末。
关于治疗疝病要降心火的说法,张子和讲得不够详细。戴氏有“心火下降,则肾水不患不温”的说法,但这与张子和的治疗方法不同。张子和所说的“降心”,是针对筋疝(表现为阴茎肿痛、溃烂流脓血),治法在清降心火;戴氏所说的“降心”,是针对木肾(睾丸坚硬如石、麻木不仁),治法在咸寒软坚。大体上,张子和主张清降,使心火下行泄出,如加味通心散之类;戴氏主张咸降,使心火下济肾水,如海藻溃坚丸之类,然而这两种治疗方法差异很大。
加味通心散 治疗膀胱实热,小肠气痛。
瞿麦穗 木通(去皮节) 栀子仁 黄芩 连翘 甘草 枳壳(去瓤) 川楝(去核,各等分)
以上药物切碎成散剂,每次服用五钱,加水一盏半,灯心草二十茎,车前草五茎,共同煎煮,空腹温服。
海藻溃坚丸 治疗木肾肿大如斗,结硬如石。
海藻 昆布 川楝实 吴茱萸(汤泡,各一两) 木香 青皮 小茴香 荔枝核(炒制) 延胡索(炒制) 肉桂(各五钱) 海带 橘核(炒制) 桃仁(麸炒,去皮炒,各一两) 木通(七钱)
用酒糊制成梧桐子大小的丸剂,每次服用六十丸,用温酒盐汤送服。
After excessive drinking and subsequent overconsumption of water, the Spleen Qi fails to transform fluids, causing water to flow into the Lower Jiao (Lower Burner). Alternatively, after sexual exertion with sweating followed by entering water, the Kidney Qi loses its controlling function, allowing water to infiltrate the bladder. This is the origin of Shui Han (Water Hernia, a type of hernia characterized by scrotal swelling and fluid accumulation). He Zihe used Dao Shui Wan (Water-Draining Pill) and Yu Gong San (Yu Gong Powder) to treat the hernia pain of Censor Cai. After purging more than thirty times with watery stools, the swelling and pain disappeared immediately. This demonstrates that only by draining the accumulated water can the hernia be cured. If one indiscriminately adds warming herbs like Gan Jiang (Dried Ginger) and Fu Zi (Prepared Aconite), the water-dampness will be obstructed by dry-heat, leading to blockage of the Three Jiao (Triple Burner) and failure of the water pathways, thereby exacerbating the swelling and pain.
Yu Gong San (Yu Gong Powder)
Hei Qian Niu (Black Morning Glory Seed, head powder, 4 liang) Huixiang (Fennel Fruit, stir-fried, 1 liang)
Grind the above ingredients into fine powder. Mix with fresh ginger juice and take 1–2 qian before bedtime.
Xuan Bao Wan (Xuan Bao Pill)
Treats swelling and pain of the external genitalia.
Hei Qian Niu (Black Morning Glory Seed, half raw half roasted, head powder, 1 liang) Chuan Mu Tong (Akebia Stem, stir-fried, 1 liang) Qing Mu Xiang (Vladimiria Root, 1 liang, stir-fried with 7 salt-treated Blatta Orientalis until fragrant)
Grind the above ingredients into fine powder. Make pills with wine paste, sized like wu-tzu (wisteria seeds). Take 30 pills each time, washed down with warm wine.
Water and dampness share the same qi. However, water is vast and overflowing while dampness is soaking and moistening; therefore, water pathogenic factors should be expelled by purgation, whereas dampness should be drained by diuresis. Water takes form while dampness transforms into qi; thus, water lacks yang-heat nature, whereas dampness often involves heat. This is how He Zihe distinguishes between Shui Han (Water Hernia) and other types of hernias. Students must distinguish among them carefully.
Jia Wei Wu Ling San (Modified Five-Atractylodes Powder) from *Yuan Rong*
Bai Zhu (Atractylodes Macrocephala Rhizome) Fu Ling (Poria) Zhu Ling (Polyporus) Ze Xie (Alisma Rhizome) Rou Gui (Cinnamon Bark) Chuan Lian Zi (Sichuan Chinaberry Fruit)
Grind the above ingredients into powder.
Regarding the theory of treating hernias by descending Heart Fire, He Zihe mentioned it but did not elaborate. Dai Shi stated, "If Heart Fire descends, there is no worry that Kidney Water will not be warmed." However, this differs from He Zihe's treatment approach. He Zihe's concept of "descending Heart" applies to Jin Han (Sinew Hernia), characterized by swelling and pain of the penis, ulceration, and pus/blood discharge. Dai Shi's concept of "descending Heart" applies to Mu Shen (Wood Testicle), characterized by hardness like stone and numbness. Generally, He Zihe emphasizes clearing and descending, allowing Heart Fire to drain downward, as seen in formulas like Jia Wei Tong Xin San (Modified Heart-Unblocking Powder). Dai Shi emphasizes saline descent, allowing Heart Fire to descend and nourish, as seen in formulas like Hai Zao Kui Jian Wan (Kelp Hardness-Resolving Pill). Thus, the therapeutic methods are vastly different.
Jia Wei Tong Xin San (Modified Heart-Unblocking Powder)
Treats Excess-Heat in the Bladder and Qi Pain in the Small Intestine.
Qu Mai Sui (Dianthus Flower Spike) Mu Tong (Akebia Stem, remove skin and nodes) Zhi Zi Ren (Gardenia Seed) Huang Qin (Scutellaria Root) Lian Qiao (Forsythia Fruit) Gan Cao (Licorice Root) Zhi Ke (Bitter Orange Pericarp, remove pith) Chuan Lian (Sichuan Chinaberry Fruit, remove core, all in equal proportions)
Cut the above ingredients into pieces for decoction. Take 5 qian per dose, add 1.5 sheng of water, 20 stems of Deng Xin Cao (Juncus Medulla), and 5 stems of Che Qian Cao (Plantago Leaf), decoct together, and take warm on an empty stomach.
Hai Zao Kui Jian Wan (Kelp Hardness-Resolving Pill)
Treats Mu Shen (Wood Testicle) swollen like a beanbag, hard as stone.
Hai Zao (Sargassum Thallus) Kun Bu (Laminaria Thallus) Chuan Lian Shi (Sichuan Chinaberry Fruit) Wu Zhu Yu (Evodia Fruit, soaked in hot water, each 1 liang) Mu Xiang (Costus Root) Qing Pi (Citrus Reticulata Green Peel) Xiao Hui Xiang (Fennel Fruit) Li Zhi He (Lychee Seed, stir-fried) Yan Hu Suo (Corydalis Rhizome, stir-fried) Rou Gui (Cinnamon Bark, each 5 qian) Hai Dai (Kelp) Ju He (Citrus Aurantium Seed, stir-fried) Tao Ren (Apricot Seed, bran-roasted, peeled, stir-fried, each 1 liang) Mu Tong (Akebia Stem, 7 qian)
Make pills with wine paste, sized like wu-tzu (wisteria seeds). Take 60 pills per dose, washed down with warm wine and salted water.