(有三因∶一因阳明胃热,一因少阴肾虚,一因厥阴风壅。非此三者,牙不出血也。)
戴氏曰∶风壅牙宣,消风散搽之。肾虚者,为下虚上盛,宜盐汤下安肾丸。用黑锡丹,
仍用姜盐炒附米黑色为末,揩擦,其妙不可言也。
阳明热详见齿门。
消风散(治厥阴风胜,牙宣出血,方见伤寒门。) 安肾丸(治肾虚齿动有血,方见水饮门。)
黑锡丹(方见痼冷门。)
吕沧州治一人偶搔 中疮出血,汨汨如涌泉,竟日不止,困甚。二尺脉如蛛丝,他部皆无。
予曰∶夫脉气,血之先也。今血妄行,故荣气暴衰,二尺尚可按。当益荣以泻阴火。
以四神汤加防风、荆芥连进,脉渐出。更服十全大补汤遂愈。
稠浊者为痰,清稀者为饮,一为火燥,一为寒湿。今医不分,混同出治,所以鲜能取效。
经曰∶诸痉强直,积饮,痞膈中满,霍乱吐下,体重 肿,肉如泥,按之不起,皆属
于湿。(此是太阴湿土,乃脾胃之气为病也。)
张子和论痰有五∶曰风痰,曰湿痰,曰食痰、火痰、酒痰是也。风痰多带涎沫,因形寒饮
冷,或因感风而发,或因风热拂郁而致,则痰清白。湿痰因停饮不散而成。热痰为火盛制金,
饮食辛辣,重 浓褥所致。酒痰因浩饮所得。食痰因浓味炙爆过多。
《玉机微义》云∶痰之为病,诚多也。何则?人之血气流行,无一息之间断,才有壅滞,津
液凝积,郁而成热,痰遂生焉。因证而观痰,则火之变出也,未有痰病而不因火而成者也。间有
寒痰为病者,亦千百中之一二
也。(甫谓寒痰之说非也。饮则有寒有热不同,痰则一因于热而已。加之寒字,不得所以。痰脉
多滑大,明知停冷成痰,亦遂郁而为热。药惟以橘皮、半夏、神曲之辛以散之行之,亦不敢
用热药也。陈无择云∶饮脉多沉弦微细,始可以言寒,治以理中、二陈之属是也,性理所谓有
温泉而无寒火,不其然欤?)
(引起牙宣出血的原因有三种:一是因阳明胃热,二是因少阴肾虚,三是因厥阴风邪壅盛。如果不是这三种情况,就不会出现牙齿缝隙出血的症状。)
戴氏说:如果是风邪壅盛导致的牙龈出血,可用消风散外搽。若是肾虚所致,属于下虚上盛的证候,宜用盐汤送服安肾丸。使用黑锡丹时,仍需用姜和盐炒附子至黑色,研成粉末,用来擦拭患处,其疗效妙不可言。
阳明胃热导致的症状详见“齿”门。
消风散(治疗厥阴风邪偏胜引起的牙龈出血,方剂见《伤寒》门。)
安肾丸(治疗肾虚引起的牙齿松动出血,方剂见《水饮》门。)
黑锡丹(方剂见《痼冷》门。)
吕沧州治疗一个人,偶然抓挠皮肤导致疮口出血,血流如涌泉般汩汩不止,整天不停,病人非常困乏虚弱。此时两尺脉象细弱如蛛丝,其他部位的脉象都摸不到。
我说:脉气是血的先导。现在血液妄行,导致营气突然衰败,但两尺脉尚且可以按到。应当补益营气以泻除阴火。
给予四神汤加入防风、荆芥,连续服用后,脉象逐渐显现出来。再服用十全大补汤,病便痊愈了。
质地稠浊的是痰,质地清稀的是饮,前者多由火燥引起,后者多由寒湿引起。现在的医生不加以区分,混同进行治疗,所以很少能取得疗效。
《内经》说:各种痉挛强直、积饮、痞膈胸中胀满、霍乱吐泻、身体沉重浮肿、肌肉松软如泥、按压后凹陷不起,都属于湿证的范畴。(这是太阴湿土之气为病,即脾胃之气失调引起的疾病。)
张子和论述痰有五种:分别是风痰、湿痰、食痰、火痰、酒痰。风痰多带有涎沫,是因为形体受寒、饮用冷水,或者感受风邪而发作,或者因风热拂郁而导致,则痰液清白。湿痰是因为停饮不散而形成。热痰是因为火势旺盛克制肺金,加上饮食辛辣、厚味暖褥所致。酒痰是因为大量饮酒所得。食痰是因为过多食用浓味烧烤炙爆食物所致。
《玉机微义》说:痰作为致病因素,确实很多。为什么呢?人的气血流行,没有一息之间断的时候,一旦出现壅滞,津液就会凝积,郁结而成热,痰就产生了。从病症来观察痰,它是火的变证,没有不是因火而产生的痰病。偶尔也有寒痰致病的,也是千中一二。(徐春甫认为说寒痰是不对的。饮则有寒有热的不同,痰则是完全因为热而已。加上“寒”字,不符合道理。痰的脉象多滑大,明明知道是停冷成痰,但也随即郁结化为热。用药只用橘皮、半夏、神曲等辛温药物来发散运行它,也不敢用热药。陈无择说:饮的脉象多沉弦微细,才可以说是寒,治疗用理中汤、二陈汤之类。性理所谓只有温泉而没有寒火,难道不是这样吗?)
(There are three causes: one is Yangming Stomach Heat, one is Shaoyin Kidney Deficiency, and one is Jueyin Wind Obstruction. If it is not one of these three, there will be bleeding from the gums.)
Dai said: For gum bleeding caused by Wind Obstruction, apply Xiaofeng San (Wind-Dispersing Powder). For those with Kidney Deficiency, which presents as Lower Deficiency and Upper Excess, Anshen Wan (Kidney-Anchoring Pill) should be taken with salt water. When using Heixi Dan (Black Tin Pill), still use Aconiti Lateralis Radix Praeparata (Prepared Lateral Root of Aconite) stir-fried with ginger and salt until black, ground into powder, and applied to rub the affected area; its efficacy is indescribable.
Yangming Heat symptoms are detailed in the "Teeth" section.
Xiaofeng San (Treats Jueyin Wind Excess causing gum bleeding, formula seen in the *Shanghan* section.)
Anshen Wan (Treats Kidney Deficiency causing loose teeth and bleeding, formula seen in the *Yin-Yang/Water* section.)
Heixi Dan (Formula seen in the *Chronic Cold* section.)
Lu Cangzhou treated a person who accidentally scratched their skin, causing a wound to bleed profusely like a gushing spring, continuing all day without stopping, leaving the patient extremely exhausted. The pulse at both Chi positions was fine as a spider's thread, while pulses in other positions were imperceptible.
I said: Pulse Qi is the precursor of Blood. Now that Blood is flowing recklessly, Ying Qi has suddenly declined, yet the Chi pulses can still be palpated. One should tonify Ying Qi to drain Yin Fire.
Four Shen Tang (Four Spirit Decoction) was administered with Fangfeng (Saposhnikovia Root) and Jingjie (Schizonepeta Spike), given continuously, after which the pulse gradually emerged. Subsequently, Shiquan Dabu Tang (Ten Significant Tonifying Decoction) was taken, leading to recovery.
Thick and turbid substances are Tan (Phlegm), clear and thin substances are Yin (Fluid Retention); the former is associated with Fire Dryness, the latter with Cold-Dampness. Current physicians do not distinguish between them and treat them indiscriminately, which is why few achieve effective results.
The Classics state: Various spasms and rigidity, accumulation of Yin fluids, chest/abdominal fullness and obstruction, Huoluan (Colic with vomiting and diarrhea), heavy body and edema, flesh soft like mud that does not rise when pressed, all belong to Dampness. (This refers to Taoyin Damp Earth pathology, i.e., disease arising from Spleen-Stomach Qi dysfunction.)
Zhang Zihe discussed five types of Tan (Phlegm): namely Feng-Tan (Wind-Phlegm), Shi-Tan (Damp-Phlegm), Shi-Tan (Food-Phlegm), Huo-Tan (Fire-Phlegm), and Jiu-Tan (Wine-Phlegm). Feng-Tan often carries frothy saliva, caused by cold exposure or drinking cold liquids, or triggered by Wind invasion, or resulting from Wind-Heat stagnation, resulting in clear-white phlegm. Shi-Tan forms due to retained fluids failing to dissipate. Huo-Tan arises from excessive Fire suppressing Metal (Lung), combined with spicy diet and heavy bedding. Jiu-Tan results from excessive drinking. Shi-Tan (Food-Phlegm) results from overconsumption of rich flavors and roasted/fried foods.
*Yuji Wei Yi* states: As a pathogenic factor, Tan (Phlegm) indeed manifests in many ways. Why? Human Qi and Blood flow without interruption for even an instant; once stagnation occurs, Jin-Ye (Body Fluids) condense and accumulate, becoming stagnant and generating Heat, thus Tan (Phlegm) is produced. Observing Tan (Phlegm) through syndromes reveals it as a transformation of Fire; there is no Tan (Phlegm) disease that does not arise from Fire. Occasionally, Han-Tan (Cold-Phlegm) causes disease, but this is only one or two cases in a thousand. (Xu Chunfu argues that the concept of Cold-Phlegm is incorrect. While Yin (Fluids) can be Cold or Hot, Tan (Phlegm) arises solely from Heat. Adding "Cold" contradicts the principle. Tan (Phlegm) pulses are mostly slippery and large; even if one knows it formed from cold retention, it subsequently stagnates and transforms into Heat. Medications used are only pungent herbs like Chenpi (Citrus Rind), Banxia (Pinellia Tuber), and Shenqu (Massa Medicata Fermentata) to disperse and move it; hot medicines are never used. Chen Wuyue stated: Yin (Fluid) pulses are mostly deep, wiry, and fine, indicating Cold, treated with Lizhong Tang (Regulate the Middle Decoction) and Erchen Tang (Two-Aged Decoction). Philosophically, there is warm spring water but no cold fire, is this not so?)