张路玉治一仆人之妇。经闭三月。少腹痛贯彻心。而阴吹不已。与失笑散一服。瘀血大
下。遂不复作。
又治一贵妇。小产后寒热腹痛。亦病阴吹。与山查炭熬焦黑糖为丸。用伏龙肝煮水澄清
煎独参汤送三钱。一服结粪大下。再进。瘀血续行而愈。始悟猪膏发煎。实为逐瘀而设也
〔附〕一妇人阴肿坚硬。用枳实八两碎。炒令热。故帛裹熨。冷则易之。
东垣治一女子脱肛。用糯米一勺。浓煎饮。去米。候温。洗肛温柔。却先以砖一片火烧
通红。用醋沃之。以青布铺砖上。坐肛于青布上。如热则加布令浓。其肛自吸入而愈。
〔附〕一人大肠头出寸余。干即自脱落。随又出。名截肠病。用芝麻油。器盛坐之。饮
大麻子汁数升。愈。
薛立斋治余时正。素有痔。每劳役。脱肛肿痛出水。此中气下陷。用补中益气加茯苓、
芍药。十余剂而愈。
震治一人脱肛肿痛出水。尺脉洪数。用樗根白皮、川柏、诃子肉、没石子、鳖头灰而愈
其人好酒形实。乃湿热下注。非气虚下陷也。
一妇产后痔作。疮有头如赤豆大。或下鲜血。或紫血。大便疼。与黑神散。又多食肉太
饱。湿热在大肠所为。以郁李仁去皮、麻仁、槐角各七分。枳壳、皂角仁各五钱。苍术、归
尾、生地各三钱。大黄炒一钱六分。煎服。
震按此方。与酒煮黄连丸、及脏连丸。皆治痔痛下血之正法也。余如干柿烧灰。饮下。
四时取其方。柏叶烧灰调服。亦佳。而道场慧禅师所云。平直量骨脊与脐平处椎上灸七壮。
或年深。更于椎骨两旁各一寸灸如上数。无不除根者。此法犹可试。若骆谷驿吏用柳枝煎浓
汤洗痔。随以艾炷灸痔上三五壮。因大泻鲜血秽物。极痛楚而痔随泯迹。此则不敢轻试者矣
予一徐姓友。先患内痔。复生外痔。外则肿痛出脓血。内又胀痛异常。每登圊后。内痔坠出
欲捺之进内。碍于外痔。欲俟其自收。则相抵痛极。以致行坐不得。昼夜侧卧而已。内服
芩、连、槐花等药。外抹熊胆及冰片、田螺水等法。总不应。痛甚汗多困乏。稍进人参。则
痛益加。无计可施。诊之右关尺沉大有力。因忆丹方有用荞麦面以猪胆汁收丸者。令其制服
计服猪胆二十枚。而内外之痔亦皆泯迹。
陆上舍。冬患痔作痛。右寸浮大。左寸口洪数。立斋曰。冬见夏脉。当壮水之主以镇阳
光。彼以为迂。别服芩、连之剂。薛谓其侄曰。令舅氏肾水不能生肝木。殁于春。验矣。今
令叔肾水不能制心火。当殁于夏。至甲辰六月。薛复视之。痰涎上涌。日夜不寐。脉洪大而
数。按之无力。左尺绝无。足膝肩膊逆冷。薛曰。事急矣。彼云。但求少延数日。以待嗣子
一见。始用参、 、归、术、炮姜之类。及六味丸料加肉桂。至本月而殁。五行之理信然。
张路玉治疗一位仆人的妻子。月经闭止三个月，少腹疼痛放射至心胸，且伴有阴吹（阴道排气）不止的症状。给予失笑散服用一剂后，瘀血大量排出，症状随即不再发作。
又治疗一位贵妇。小产后出现寒热往来、腹痛，同时也患有阴吹。用山楂炭熬制成焦黑色，配合黑糖制成丸药；另用伏龙肝煮水澄清，煎煮独参汤，送服三钱药丸。服用一剂后，干结的大便大量排出；再服用一次，瘀血继续下行而痊愈。至此才领悟到猪膏发煎，原本就是为祛除瘀血而设立的。
【附记】有一位妇人外阴肿胀坚硬。用枳实八两捣碎，炒热后用旧布包裹熨烫患处，变冷则更换。
李东垣治疗一位女子脱肛。用糯米一勺，浓煎成汁饮用，去米渣。待药液温热时，用来温柔地清洗肛门。随后先取一块砖头烧得通红，浇上醋，用青布铺在砖头上，让患者将脱出的肛门坐在青布上。如果感觉太热就增加布的层数使其变厚。这样肛门自然回纳而痊愈。
【附记】有一人大肠头脱出寸余，干燥后即自行脱落，脱落后随即又脱出，这种病称为截肠病。用芝麻油盛在容器中，让患者坐于其中，并饮用大麻子汁数升，得以痊愈。
薛立斋治疗余时正。素来患有痔疮，每次劳累后，出现脱肛、肿痛、渗出水液。这是中气下陷所致。使用补中益气汤加入茯苓、芍药，服用十余剂后痊愈。
俞震治疗一人脱肛、肿痛、渗出水液。尺脉洪大数急。使用樗根白皮、川柏、诃子肉、没石子、鳖甲头灰等药物治疗而愈。此人喜好饮酒，体质壮实，属于湿热下注，并非气虚下陷。
一位产妇产后痔疮发作。疮口有头如赤豆大小，有时流出鲜血，有时流出紫血，大便时疼痛。给予黑神散治疗。又因多吃肉类导致过饱，湿热蕴结在大肠。处方：郁李仁去皮、麻仁、槐角各七分，枳壳、皂角仁各五钱，苍术、当归尾、生地各三钱，大黄炒制一钱六分，煎服。
俞震按语：此方与酒煮黄连丸、脏连丸，都是治疗痔疮疼痛下血的正规方法。其他如干柿烧成灰，用水冲服，四季均可采用；或取柏叶烧成灰调服，效果也很好。至于道场慧禅师所说，在平直测量骨脊与肚脐平齐处的椎骨上灸七壮，或者年代久远者，再在椎骨两旁各一寸处如上法施灸，没有不能除根的。这种方法还可以尝试。至于骆谷驿吏用柳枝煎浓汤洗痔疮，随即用艾炷在痔疮上灸三五壮，结果导致大量泻出鲜血秽物，极度痛苦，但痔疮随之消失。这种方法我不敢轻易尝试。
我有一位姓徐的朋友，先患内痔，后又生外痔。外部肿痛流脓血，内部胀痛异常。每次排便后，内痔脱出想要推回去，却受外痔阻碍；想等它自行收回，则相互抵压疼痛剧烈，以致无法行走坐下，只能昼夜侧卧。内服黄芩、黄连、槐花等药物，外涂熊胆及冰片、田螺水等方法，均无效。疼痛剧烈，出汗多，身体困乏。稍进用人参，则疼痛更加加剧，无计可施。诊察其右关、尺脉沉大而有力。于是想起民间偏方有用荞麦面以猪胆汁调和做丸的方法。令其服用，共服猪胆二十枚，内外痔疮皆消除痕迹。
陆上舍，冬季患痔疮发作疼痛。右寸脉浮大，左寸脉洪数。薛立斋说：“冬季出现夏季的脉象，应当壮水之主以镇阳光。”他认为这话迂腐，另外服用了黄芩、黄连的药剂。薛立斋对他的侄子说：“你舅舅肾水不能生肝木，将在春季去世。”果然应验。如今你叔叔肾水不能制心火，应当在夏季去世。到了甲辰年六月，薛立斋再次诊治他，痰涎上涌，日夜不寐，脉洪大数急，重按无力，左尺脉绝无，足膝肩膊逆冷。薛立斋说：“情况危急了。”他说：“只求稍微延长几天，以便见到继子一面。”才开始使用人参、白术、当归、炮姜之类，以及六味丸料加肉桂。到了当月去世。五行的道理确实可信。
Zhang Luyu treated the wife of a servant. Her menstruation had been closed for three months, with lower abdominal pain radiating to the heart and chest, accompanied by persistent Yin Chui (vaginal flatulence). After one dose of Shixiao San (Pain-Relieving Powder), a large amount of blood stasis was discharged, and the symptom ceased.
He also treated a noblewoman who, after a miscarriage, suffered from alternating chills and fever, abdominal pain, and Yin Chui (vaginal flatulence). Hawthorn charcoal was charred black and made into pills with brown sugar. Longgu Fulonggan (Dragon Bone and Dragon Liver Earth) was boiled in water, clarified, and used to decoct Dushen Tang (Single Ginseng Decoction) to deliver three qian of the pills. One dose resulted in the passage of large amounts of dry feces; upon further administration, blood stasis continued to discharge, leading to recovery. It was then realized that Zhigao Fa Jian (Pig Fat and Hair Decoction) was indeed established for expelling blood stasis.
[Appendix] A woman suffered from hard swelling of the external genitalia. Eight liang of Zhishi (Immature Bitter Orange) were crushed, stir-fried until hot, wrapped in old cloth, and applied as a hot compress to the affected area. The compress was replaced when it cooled.
Li Dongyuan treated a young woman with rectal prolapse. One spoonful of Nuomi (Glutinous Rice) was decocted strongly in water, strained, and drunk while warm. The anus was gently washed with the liquid. Then, a brick was heated red-hot, splashed with vinegar, and covered with a green cloth. The patient sat on the cloth with the prolapsed rectum exposed. If it felt too hot, more layers of cloth were added to thicken it. The rectum naturally retracted and healed.
[Appendix] A man suffered from a portion of the large intestine protruding over one cun. When dry, it would fall off spontaneously, only to protrude again immediately. This condition is called Jiechang Bing (Intestinal Truncation Disease). He sat in a vessel containing Sesame Oil (Zhima You) and drank several sheng of Dama Ren Juice (Cannabis Seed Juice), resulting in recovery.
Xue Lizhai treated Yu Shizheng, who had a history of hemorrhoids. Every time he exerted himself physically, he experienced rectal prolapse, swelling, pain, and oozing fluid. This was due to Sinking of Middle Qi (Spleen Qi Deficiency with sinking sensation). Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was modified with Fuling (Poria) and Shaoyao (Peony Root). After more than ten doses, he recovered.
Yu Zhen treated a man with rectal prolapse, swelling, pain, and oozing fluid. The Chi pulse (Kidney pulse) was surging and rapid. Chugen Baipi (Phellodendri Cortex), Chuanbai (Phellodendri Chinensis Cortex), Hezi Rou (Chebulae Fructus Retortae Pericarpium), Meishizi (Myrobalan Nut), and Bie Tou Hui (Ash of Turtle Head) were used, leading to recovery. The patient enjoyed alcohol and had a robust constitution, indicating Damp-Heat Pouring Downward, rather than Qi Deficiency with Sinking.
A postpartum woman developed hemorrhoids. The lesions had heads the size of a red bean, sometimes discharging fresh blood, sometimes purple blood, with pain during defecation. Heishen San (Black Divine Powder) was administered. Additionally, excessive meat consumption led to Damp-Heat accumulating in the Large Intestine. The prescription included: Yuliren (Pericarpium Pruni Armeniaci Semen Amarum, peeled), Mahuang Ren (Cannabis Seed), Huaijiao (Gleditsiae Sinensis Fructus) each 7 fen; Zhike (Aurantii Fructus Immaturus), Zaojiao Ren (Gleditsiae Sinensis Spina) each 5 qian; Cangzhu (Atractylodis Rhizoma), Guiwei (Angelicae Sinensis Radix Tail), Shengdi (Rehmanniae Radix) each 3 qian; Dahuang (Rhei Radix et Rhizoma), stir-fried, 1.6 qian. Decoct and take orally.
Yu Zhen commented: This formula, along with Jiuzhu Huanglian Wan (Wine-Boiled Coptis Pill) and Zanglian Wan (Viscera-Connected Pill), are standard methods for treating hemorrhoid pain and bleeding. Other remedies include burning dried persimmons to ash and taking them with water, which can be used in all seasons; or burning Baiye (Bamboo Leaf) to ash and taking it mixed. These are also good. Chan Hui of Daochang stated that moxibustion of seven moxa cones on the vertebra level with the umbilicus, or on both sides of the vertebral column one cun away for chronic cases, invariably cures the root cause. This method is worth trying. However, the case of the Luogu Post Station clerk, who washed hemorrhoids with strong willow branch decoction and then applied three to five moxa cones directly on the hemorrhoids, resulting in massive discharge of bloody foul matter, extreme pain, but eventual disappearance of hemorrhoids, is a method I dare not lightly attempt.
A friend of mine, surnamed Xu, first suffered from internal hemorrhoids, followed by external ones. The external ones swelled, pained, and discharged pus and blood; the internal ones caused severe distending pain. After defecation, the internal hemorrhoids would prolapse and needed to be pushed back, but were obstructed by the external ones. Waiting for them to retract caused extreme pain due to friction, making walking and sitting impossible, forcing him to lie on his side day and night. Internally, he took Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huaihua (Flos Sophorae), etc. Externally, he applied Xiongdan (Ursi Fel), Bingpian (Borneolum Syntheticum), and Tianshui (Concha Meretrix) water, all without effect. Severe pain, profuse sweating, and exhaustion ensued. Taking even a small amount of Renshen (Ginseng Radix et Rhizoma) exacerbated the pain. Diagnosis revealed deep, large, and forceful pulses at the Right Guan (Spleen/Stomach) and Chi (Kidney) positions. Recalling a folk remedy using Qiaomai Mian (Buckwheat Flour) bound with Zhu Dan (Porcine Bile) into pills, he was instructed to take this regimen. After consuming bile from twenty pigs, both internal and external hemorrhoids disappeared.
Lu Shangshe suffered painful hemorrhoids in winter. The Right Cun pulse was floating and large; the Left Cun pulse was surging and rapid. Xue Lizhai said, "Winter presenting with Summer pulses indicates the need to strengthen the Water element to suppress Yang Fire." The patient considered this pedantic and took Huangqin and Huanglian formulas instead. Xue told his nephew, "Your uncle's Kidney Water fails to nourish Liver Wood; he will die in Spring." This proved accurate. Now, your uncle's Kidney Water fails to control Heart Fire; he will die in Summer. In the sixth month of Jiachen year, Xue examined him again. Phlegm-saliva surged upward, insomnia persisted day and night, the pulse was surging, large, and rapid but empty upon pressure, the Left Chi pulse was absent, and the feet, knees, shoulders, and arms were cold. Xue said, "The situation is critical." The patient requested only a few more days to see his heir. Treatment began with Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Paojiang (Zingiberis Rhizoma Preparatum), and Liuwei Wan material plus Rougui (Cinnamomi Cortex). He died that month. The principles of the Five Elements are indeed trustworthy.