【方歌】流注原有证数般,湿痰瘀风汗后寒,发无定处连肿漫,
溃近骨节治难痊,此证本由脾胃弱,留结肌肉骨筋间。
【注】此证名虽无殊,其原各异。盖人之血气,每日周身流行
,自无停息,或因湿痰,或因瘀血,或因风湿,或因伤
寒汗后余毒,或因欲后受寒,积留于肌肉之中,致令气
血不行,故名流注。
诸家书云:流者流行,注者住也,发无定处,随在可生
。初发漫肿无头,皮色不变,凝结日久,微热渐痛,透
红一点,方是脓熟,即宜用针开破。若湿痰化成者,脓
色粘白;瘀血化成者,脓色金黄;粘水风湿化成者,脓
色稀白如豆汁;汗后余邪化成者,脓色或黄、或黑,稀
脓秽臭;以上四证,发在肉厚处可愈,发在骨节及骨空
处难痊。淫欲受寒化成者,脓色稀白而腥,其水中有猪
脂水油之状,此为败浆脓也。诸书虽有治法,终成败证
。初起湿痰所中者,火香流气饮导之;产后瘀血所中者
,通经导滞汤通活之;跌扑伤损瘀血所中者,宜散瘀葛
根汤逐之;风湿所中者,万灵丹、五积散加附子温散之
;汗后余邪发肿者,人参败毒散散之;房欲后外寒侵袭
者,初宜服五积散加附子,次服附子八物汤温之;又有
室女、孀妇,郁怒伤肝,思虑伤脾而成者,宜服归脾汤
加香附青皮散之。此皆流注初起将成之法,一服至三、
四服皆可。外俱用乌龙膏或冲和膏敷贴,皮肉不热者,
雷火神针针之,轻者即消,重者其势必溃;将溃时俱宜
服托里透脓汤;已溃俱服人参养荣汤;久溃脓水清稀,
饮食减少,不能生肌收敛者,俱宜服调中大成汤;久溃
脓水清稀,精神怯少,渐成漏证者,俱宜服先天大造丸
。溃后其余治法,俱按痈疽溃疡门参考。
方剂:通经导滞汤
组成:当归 熟地
赤芍 川芎
枳壳(麸炒) 紫苏
香附 陈皮
丹皮 红花
牛膝(各一钱) 独活
甘草(节,各五分)
水二钟,煎八分,入酒一杯,食前服。
【方歌】通经导滞产后疾,败血流瘀肿痛积,四物枳苏香附陈,
丹皮独草红花膝。
又方:散瘀葛根汤
组成:葛根 川芎
半夏(制) 桔梗
防风 羌活
升麻(各八分) 细辛
甘草(生) 香附
红花 苏叶
白芷(各六分)
水二钟,葱三根,姜三片,煎八分,不拘时服。
【方歌】散瘀葛根瘀血凝,皆因跌扑流注成,芎半桔风羌细草,
香附红花苏芷升。
又方:附子八物汤
组成:附子(制) 人参
白术(土炒) 当归
白茯苓 熟地
川芎 白芍(酒炒,各一钱)
木香 肉桂
甘草(炙,各五分)
水二钟,姜三片,红枣肉一枚,煎八分,食远服。
【方歌】附子八物医流注,房欲伤阴外寒入,木香肉桂八珍汤,
姜枣水煎食远服。
又方:调中大成汤
组成:人参(二钱) 白术(土炒)
白茯苓 黄耆
山药(炒) 丹皮
当归身 白芍(酒炒)
陈皮(各一钱) 肉桂
附子(制,各八分) 远志(去心)
藿香 缩砂仁
甘草(炙,各五分)
水二钟,煨姜三片,红枣肉二枚,煎八分,食远服
。
【方歌】调中大成四君耆,山药丹皮归芍宜,远藿缩砂陈桂附,
能医流注溃脓稀。
又方:木香流气饮(见疔疮门)
万灵丹、乌龙膏、冲和膏(俱见肿疡门)
五积散(见内痈部肾痈)
人参败毒散(即荆防败毒散减去荆防。见项部脑疽)
归脾汤(见乳部乳中结核)
雷火神针(见股部附骨疽)
托里透脓汤(见头部侵脑疽)
人参养荣汤(见溃疡门)
先天大造丸(见臀部鹳口疽)
【方歌】流注病原本有多种证型,包括湿痰、瘀血、风湿以及伤寒发汗后遗留的寒邪。其特点是发病部位不固定,肿胀蔓延连片,溃破后若靠近骨节则难以治愈。此证的根源在于脾胃虚弱,导致病邪滞留结聚在肌肉与筋骨之间。
【注】此病名称虽无差异,但其病因各不相同。人的气血每天在全身循环流动,没有片刻停息。如果因为湿痰、瘀血、风湿,或者因伤寒发汗后余毒未清,又或因房事后受寒,这些邪气积聚停留在肌肉之中,致使气血运行不畅,因此称为“流注”。
各家医书说:“流”指流行,“注”指停留,发病部位不固定,随处都可能发生。初起时表现为漫肿无头,皮肤颜色不变;凝结日久后,出现微热并逐渐疼痛,直到透出一点红色,才表示脓液已成熟,此时应立即用针切开排脓。如果是湿痰化成的脓,颜色粘腻发白;瘀血化成的脓,颜色金黄;由水湿、风湿化成的脓,颜色稀薄发白如豆汁;由汗后余邪化成的脓,颜色或黄或黑,脓液稀薄且气味秽臭。以上四种证型,发生在肉厚处可以痊愈,发生在骨节及骨空处则难治。因淫欲过度受寒化成的脓,颜色稀白且有腥味,水中漂浮着类似猪脂油状物,这被称为败浆脓。虽然各书有治疗方法,但最终多转为坏证(难治之证)。
初起由湿痰引起的,用火香流气饮疏导;产后由瘀血引起的,用通经导滞汤疏通活血;跌打损伤致瘀血引起的,宜用散瘀葛根汤逐瘀;由风湿引起的,用万灵丹、五积散加附子温散;发汗后余邪致肿的,用人参败毒散发散;房事后感外寒侵袭的,初起宜服五积散加附子,随后服附子八物汤温补;又有少女、寡妇,因郁怒伤肝、思虑伤脾而形成的,宜服归脾汤加香附、青皮疏解。这些都是流注初起将成时的治法,服用一至四剂即可。外用均敷贴乌龙膏或冲和膏,若皮肉不热者,用雷火神针艾灸,轻症即消,重症必然溃破;将溃时均宜服托里透脓汤;已溃破均服人参养荣汤;久溃后脓水清稀,饮食减少,不能生肌收敛的,均宜服调中大成汤;久溃后脓水清稀,精神怯弱,渐成漏证的,均宜服先天大造丸。溃后的其他治法,均参照痈疽溃疡门的内容。
方剂:通经导滞汤
组成:当归、熟地黄、赤芍药、川芎、枳壳(麸炒)、紫苏、香附、陈皮、牡丹皮、红花、牛膝(各一钱)、独活、甘草(节,各五分)。
用法:水两钟,煎至八分,加入酒一杯,饭前服用。
【方歌】通经导滞治产后疾,败血流瘀致肿痛积聚,方含四物、枳壳、紫苏、香附、陈皮,再加丹皮、独活、甘草、红花、牛膝。
又方:散瘀葛根汤
组成:葛根、川芎、半夏(制)、桔梗、防风、羌活、升麻(各八分)、细辛、甘草(生)、香附、红花、苏叶、白芷(各六分)。
用法:水两钟,葱三根,姜三片,煎至八分,不拘时候服用。
【方歌】散瘀葛根汤治瘀血凝,皆因跌打损伤致流注成,方含川芎、半夏、桔梗、防风、羌活、细辛、甘草,再加香附、红花、苏叶、白芷、升麻。
又方:附子八物汤
组成:附子(制)、人参、白术(土炒)、当归、白茯苓、熟地黄、川芎、白芍(酒炒,各一钱)、木香、肉桂、甘草(炙,各五分)。
用法:水两钟,姜三片,红枣肉一枚,煎至八分,饭后服用。
【方歌】附子八物汤医治流注,房劳伤阴复感外寒入,方为木香、肉桂合八珍汤,加姜枣水煎饭后服。
又方:调中大成汤
组成:人参(二钱)、白术(土炒)、白茯苓、黄芪、山药(炒)、牡丹皮、当归身、白芍(酒炒)、陈皮(各一钱)、肉桂、附子(制,各八分)、远志(去心)、藿香、缩砂仁、甘草(炙,各五分)。
用法:水两钟,煨姜三片,红枣肉二枚,煎至八分,饭后服用。
【方歌】调中大成汤含四君子加黄芪,山药、丹皮、当归、芍药适宜,远志、藿香、缩砂、陈皮、肉桂、附子,能医治流注溃后脓液清稀。
又方:木香流气饮(见疔疮门)
万灵丹、乌龙膏、冲和膏(均见肿疡门)
五积散(见内痈部肾痈)
人参败毒散(即荆防败毒散减去荆芥、防风。见项部脑疽)
归脾汤(见乳部乳中结核)
雷火神针(见股部附骨疽)
托里透脓汤(见头部侵脑疽)
人参养荣汤(见溃疡门)
先天大造丸(见臀部鹳口疽)
[Verse] Liu Zhu (Flowing Abscess) originally presents in several patterns, including damp-phlegm, blood stasis, wind-dampness, and residual cold after sweating from Taiyang disease. Its characteristics are an indeterminate location of onset with spreading swelling; if it ulcerates near bone joints, it is difficult to cure. This condition stems from Spleen-Stomach deficiency, causing pathogens to accumulate and knot between muscles, bones, and tendons.
[Annotation] Although the name of this condition is uniform, its origins vary. Human Qi and Blood circulate throughout the body daily without pause. If due to damp-phlegm, blood stasis, wind-dampness, or residual toxins after sweating from Cold Damage, or due to cold invasion after sexual intercourse, these pathogens accumulate in the muscles, obstructing the flow of Qi and Blood, hence named "Liu Zhu" (Flowing Abscess).
Various medical texts state: "Liu" means flowing, "Zhu" means stopping. The onset has no fixed location and can occur anywhere. Initially, it presents as a diffuse swelling without a head, with unchanged skin color. After long-term accumulation, slight heat and gradual pain appear. Only when a red spot emerges does it indicate that pus is ripe, at which point it should be incised with a needle immediately. If formed from damp-phlegm, the pus is sticky and white; if from blood stasis, the pus is golden yellow; if from water-dampness and wind-dampness, the pus is thin and white like bean juice; if from residual pathogens after sweating, the pus is either yellow or black, thin, and foul-smelling. Among these four types, those occurring in thick flesh areas can heal, while those at bone joints or hollows are difficult to cure. Pus formed from cold invasion after excessive sexual desire is thin, white, and fishy, containing oil-like substances resembling lard; this is called "Bai Jiang Nong" (Decayed Pus). Although various books offer treatments, they often result in refractory cases.
For initial damp-phlegm obstruction, use Huo Xiang Liu Qi Yin (Aromatic Qi-Regulating Decoction) to guide it out; for postpartum blood stasis, use Tong Jing Dao Zhi Tang (Unblocking Meridians and Guiding Stasis Decoction) to promote circulation; for trauma-induced blood stasis, use San Yu Ge Gen Tang (Dispersing Stasis and Kudzu Root Decoction) to expel it; for wind-dampness, use Wan Ling Dan (Ten Thousand Spirits Pill) and Wu Ji San (Five Accumulations Powder) with Fu Zi (Prepared Aconite Root) to warm and disperse; for swelling from residual pathogens after sweating, use Ren Shen Bai Du San (Ginseng Detoxification Powder) to scatter it; for external cold invasion after intercourse, initially take Wu Ji San with Fu Zi, followed by Fu Zi Ba Wu Tang (Aconite Eight-Ingredient Decoction) to warm; for young unmarried women or widows suffering from Liver injury due to anger and Spleen injury due overthinking, use Gui Pi Tang (Restore the Spleen Decoction) with Xiang Fu (Cyperus Rhizome) and Qing Pi (Tangerine Peel) to dissipate stagnation. These are methods for the initial stage of Liu Zhu. One to four doses are sufficient. Externally, apply Wu Long Gao (Black Dragon Ointment) or Chong He Gao (Harmonizing Ointment). If the skin and flesh are not hot, use Lei Huo Shen Zhen (Thunder-Fire Divine Needle/Moxibustion); mild cases resolve, severe cases will inevitably ulcerate. When about to ulcerate, take Tuo Li Tou Nong Tang (Supporting Interior and Penetrating Pus Decoction); after ulceration, take Ren Shen Yang Rong Tang (Ginseng Nourishing Nutritive Decoction); for chronic ulcers with thin pus, reduced appetite, and failure to regenerate tissue, take Diao Zhong Da Cheng Tang (Regulating Middle and Great Success Decoction); for chronic ulcers with thin pus, weak spirit, and progression to fistula, take Xian Tian Da Zao Wan (Heavenly Creation Pill). Other post-ulceration treatments refer to the Ulcerative Sores section.
Formula: Tong Jing Dao Zhi Tang (Unblocking Meridians and Guiding Stasis Decoction)
Composition: Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Chi Shao Yao (Paeoniae Radix Rubra), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Zhi Ke (Aurantii Fructus Immaturus, stir-fried with bran), Zi Su (Perillae Folium), Xiang Fu (Cyper Rotundus Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Mu Dan Pi (Moutan Cortex), Hong Hua (Carthami Flos), Niu Xi (Achyranthis Bidentatae Radix) [each 1 qian], Du Huo (Angelicae Pubescentis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, nodes) [each 5 fen].
Usage: Water 2 zhong, decoct to 8 fen, add 1 cup of wine, take before meals.
[Verse] Tong Jing Dao Zhi Tang treats postpartum diseases,敗血 (decayed blood) and stasis causing swelling and accumulation; it contains Si Wu Tang (Four Substances Decoction), Zhi Ke, Zi Su, Xiang Fu, Chen Pi, plus Mu Dan Pi, Du Huo, Gan Cao, Hong Hua, and Niu Xi.
Another Formula: San Yu Ge Gen Tang (Dispersing Stasis and Kudzu Root Decoction)
Composition: Ge Gen (Puerariae Lobatae Radix), Chuan Xiong, Ban Xia (Pinelliae Rhizoma Praeparatum), Jie Geng (Platycodonis Radix), Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Sheng Ma (Cimicifugae Rhizoma) [each 8 fen], Xi Xin (Asari Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma, raw), Xiang Fu, Hong Hua, Su Ye (Perillae Folium), Bai Zhi (Angelicae Dahuricae Radix) [each 6 fen].
Usage: Water 2 zhong, 3 stalks of green onion, 3 slices of ginger, decoct to 8 fen, take at any time.
[Verse] San Yu Ge Gen Tang treats blood stasis coagulation caused by trauma leading to Liu Zhu; it contains Chuan Xiong, Ban Xia, Jie Geng, Fang Feng, Qiang Huo, Xi Xin, Gan Cao, plus Xiang Fu, Hong Hua, Su Ye, Bai Zhi, and Sheng Ma.
Another Formula: Fu Zi Ba Wu Tang (Aconite Eight-Ingredient Decoction)
Composition: Fu Zi (Aconiti Lateralis Radix Praeparata), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried with earth), Dang Gui, Bai Fu Ling (Poria), Shu Di Huang, Chuan Xiong, Bai Shao (Paeoniae Radix Alba, stir-fried with wine) [each 1 qian], Mu Xiang (Aucklandiae Radix), Rou Gui (Cinnamomi Cortex), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) [each 5 fen].
Usage: Water 2 zhong, 3 slices of ginger, 1 piece of jujube flesh, decoct to 8 fen, take well after meals.
[Verse] Fu Zi Ba Wu Tang treats Liu Zhu where sexual exhaustion injures Yin and external cold enters; it consists of Mu Xiang, Rou Gui, and Ba Zhen Tang (Eight-Treasure Decoction), decocted with ginger and jujube, taken after meals.
Another Formula: Diao Zhong Da Cheng Tang (Regulating Middle and Great Success Decoction)
Composition: Ren Shen (2 qian), Bai Zhu (stir-fried with earth), Bai Fu Ling, Huang Qi (Astragali Radix), Shan Yao (Dioscoreae Rhizoma, stir-fried), Mu Dan Pi, Dang Gui Shen (Angelicae Sinensis Radix, root tip), Bai Shao (stir-fried with wine), Chen Pi [each 1 qian], Rou Gui, Fu Zi (prepared) [each 8 fen], Yuan Zhi (Polygalae Radix, heart removed), Huo Xiang (Agastaches Herba), Suo Sha Ren (Amomi Fructus), Gan Cao (honey-fried) [each 5 fen].
Usage: Water 2 zhong, 3 slices of baked ginger, 2 pieces of jujube flesh, decoct to 8 fen, take well after meals.
[Verse] Diao Zhong Da Cheng Tang contains Si Jun Zi Tang (Four Gentlemen Decoction) plus Huang Qi; Shan Yao, Mu Dan Pi, Dang Gui, and Bai Shao are suitable; Yuan Zhi, Huo Xiang, Suo Sha Ren, Chen Pi, Rou Gui, and Fu Zi can treat Liu Zhu with thin pus after ulceration.
Another Formula: Mu Xiang Liu Qi Yin (see Ding Chuang Section)
Wan Ling Dan, Wu Long Gao, Chong He Gao (all see Zhong Yang Section)
Wu Ji San (see Internal Carbuncles, Kidney Carbuncle)
Ren Shen Bai Du San (i.e., Jing Fang Bai Du San minus Jing Jie and Fang Feng. see Neck Area Brain Carbuncle)
Gui Pi Tang (see Breast Area Intramammary Nodule)
Lei Huo Shen Zhen (see Thigh Area Deep-Bone Carbuncle)
Tuo Li Tou Nong Tang (see Head Area Brain-Penetrating Carbuncle)
Ren Shen Yang Rong Tang (see Ulcer Section)
Xian Tian Da Zao Wan (see Buttock Area Stork-Mouth Carbuncle)