一男子三十,胃脘作痛久矣。黄瘦食少,而胸中常常如食饱。与加味枳术丸,服之不效。
日渐大痛叫号,声闻四邻,欲自尽。与桃仁承气汤作剂与之,连二服,大下瘀血四五腕许,困
倦不能言者三日,教以稀粥少食,渐渐调理病全安。
松野匡掌科夫人年三十余岁,病胃脘连胸胁痛,日轻夜甚,两寸关脉弦滑且有力。其始请医,
咸以积滞凝寒,用发散及攻下剂皆不效。继用铁刷散、四磨饮等方,并莫应,及用汤水皆吐而不
纳,经月不食痛益甚。予谓其证为痰郁明矣。但痛久弱甚,不敢行吐法奈何?偶一医谓五灵脂、
没药素用有效,众皆哂之。此药前用之多矣,予谓再用之亦无妨,何哂之有?彼用酒调,病者
到口便吐,随吐绿痰两碗许,痛即止,遂纳饮食。此盖痰在膈上,攻下之不去,必得吐法而后愈。
经曰∶有故无殒,此之谓欤?
黄帝间曰∶予闻善言天者,必有验于人;善言古者,必有合于今;善言人者,必有正于己。
如此则道不惑而要数极,所谓明明者。今余问于夫子,令言而可知,视而可见,扪而可得,令
验于己如发蒙解惑,可得而闻乎?岐伯再拜稽首对曰∶何道之问也?帝曰∶愿闻人之五脏卒痛,
何气使然?岐伯对曰∶经脉流行不止,环周不休,寒气入经而稽迟,泣而不行,客于脉外
则血少,客于脉中则气不通,效卒然而痛。帝曰∶其痛或卒然而止者,或痛甚不休者,或痛甚
不可按者,或按之而痛止者,或按之无益者,或喘动应手者,或心与背相引而痛者,或胁肋与少
腹相引而痛者,或腹痛引阴股者,或痛宿昔而成积者,或卒然痛死不知人少间复生者,或
痛而呕者,或腹痛而后泻者,或痛而闭不通者。凡此诸痛,各不同形,别之奈何?岐伯曰∶寒气
客于脉外则脉寒,脉寒则缩蜷,缩蜷则脉绌急,绌急则引小络,故卒然而痛,得炅则痛止。因重
中于寒,则痛久矣。寒气客于经脉之中,与炅气相薄则脉满,脉满则痛而不可按也。寒气稽留,
炅气在上,则脉充大而血气乱,故痛甚不可按也。寒气客于肠胃之间,膜原之下,血不得散,
小络急引故痛,按之则气血散,故按之痛止。寒
气客于侠脊之脉,则深按之不能及,故按之无益也。寒气客于冲脉,则脉不通,脉不通则
气因之,故喘动应手矣。寒气客于背俞之脉。(云云,见背痛门。)寒气客于厥阴之脉,厥阴
之脉者,络阴器系于肝。寒气客于脉中,则血泣脉急,故胁肋与少腹相引痛矣。厥气客于阴股,
寒气上及小腹,血泣在下相引,故腹痛引阴股。寒气客于小肠膜原之间,络血之中,血泣不得
注于大经,血气稽留不得行,故宿昔而成积矣。寒气客于五脏,厥气上泄,阴气竭,阳气未入,
故卒然痛死不知人,气复反则生矣。寒气客于肠胃,厥逆上出,故痛而呕也。寒气客于小
肠,小肠不得成聚,故后泄腹痛矣。热气留于小肠,肠中痛,瘅热焦渴,则坚干不得出,故痛
而闭不通矣。
一位三十岁的男子,胃脘部疼痛已经很久了。他面色萎黄消瘦,食欲减退,但胸中常常感觉像吃饱了一样胀满。医生给他服用加味枳术丸(在枳术丸基础上加减的方剂),服药后没有见效。
病情逐渐加重,疼痛剧烈并大声呼号,声音传到邻居那里,他甚至想要自杀。医生给予桃仁承气汤(具有泻热逐瘀功效的方剂)作为一剂药给他服用,连续服了两剂后,排出大量瘀血约四五碗左右。患者因此感到困倦乏力、不能说话,持续了三天。医生教导他少量进食稀粥,慢慢调养,最终病愈完全康复。
松野匡掌科(官职名)的夫人,年龄三十多岁,患病表现为胃脘部连带胸胁疼痛,白天轻晚上重,两手寸部和关部的脉象弦滑且有力。起初请医生诊治,大家都认为是积滞凝寒所致,使用发散表和攻下的药物都没有效果。后来改用铁刷散、四磨饮等方剂,也都无效,甚至喝汤水都会呕吐无法接纳,经过一个月不进食,疼痛更加严重。我认为这个病症显然是痰郁阻滞。但是疼痛日久导致身体极度虚弱,不敢使用吐法,该怎么办呢?偶然有一位医生说五灵脂、没药平时使用很有效,众人都嘲笑他。这些药之前用得很多了,我说再用一次也无妨,有什么好笑的?那位医生用酒调服,病人刚入口就吐出来,随即吐出绿色痰液约两碗左右,疼痛立即停止,于是能够进食。这大概是痰浊停留在膈上,攻下法不能去除,必须通过吐法才能痊愈。《内经》说:有实邪存在就不会造成伤害,说的就是这种情况吧?
黄帝问道:我听说善于谈论天道的人,一定能在人体上得到验证;善于谈论古代道理的人,一定符合现在的实际情况;善于谈论人体生理病理的人,一定能端正自己的认知。这样道就不会迷惑,要领和规律就能穷尽,这就是所谓的明智之人。现在我向夫子请教,希望听到那些言语可以知晓、观察可以看见、触摸可以获得的知识,让我在自己身上验证如同揭开蒙蔽、解除困惑一样,可以听一听吗?岐伯拜了两拜,叩头回答说:您问的是哪方面的道理呢?黄帝说:我希望了解人的五脏突然疼痛,是什么气导致的?岐伯回答说:经脉之气流行不止,循环周身不停息,寒气侵入经脉导致运行迟缓,血液凝涩而不流动,寒气客居在脉外则血液减少,客居在脉中则气机不通畅,所以突然发生疼痛。
黄帝说:这种疼痛有时突然停止,有时疼痛剧烈不止,有时疼痛剧烈不可按压,有时按压后疼痛停止,有时按压后毫无益处,有时脉搏跳动应手可感,有时心口与背部相互牵引而痛,有时胁肋与小腹相互牵引而痛,有时腹痛牵引至大腿内侧,有时疼痛日久形成积聚,有时突然剧痛昏死不知人事,片刻后又苏醒,有时疼痛伴有呕吐,有时腹痛随后腹泻,有时疼痛伴有大便闭塞不通。所有这些疼痛,形态各不相同,如何辨别它们呢?岐伯说:寒气客居在脉外,则经脉寒冷,经脉寒冷则收缩卷曲,收缩卷曲则经脉拘急,经脉拘急则牵引细小的络脉,所以突然发生疼痛,遇到温热则疼痛停止。如果再次遭受寒邪侵袭,则疼痛持久。寒气客居在经脉之中,与热气相搏结则脉管充盈,脉管充盈则疼痛剧烈不可按压。寒气稽留不去,热气在上,则脉管充大,气血紊乱,所以疼痛剧烈不可按压。寒气客居在肠胃之间,膜原之下,血液不能散布,小络脉紧急牵引故疼痛,按压后气血分散,所以按压后疼痛停止。寒气客居在夹脊两侧的经脉,深按也达不到病所,所以按压后毫无益处。寒气客居在冲脉,则脉道不通,脉道不通则气随之逆乱,所以脉搏跳动应手可感。寒气客居在背俞之脉。(此处省略,见背痛章节。)寒气客居在厥阴之脉,厥阴之脉联络生殖器并系属于肝。寒气客居在脉中,则血液凝涩,经脉拘急,所以胁肋与小腹相互牵引而痛。厥气客居在大腿内侧,寒气上行及于小腹,血液凝涩在下部相互牵引,所以腹痛牵引至大腿内侧。寒气客居在小肠膜原之间,络脉血液之中,血液凝涩不能注入大经脉,气血稽留不能运行,所以日久形成积聚。寒气客居在五脏,厥逆之气上泄,阴气竭绝,阳气未能入内,所以突然剧痛昏死不知人事,若气机恢复则能生还。寒气客居在肠胃,厥逆之气向上溢出,所以疼痛伴有呕吐。寒气客居在小肠,小肠不能正常聚化食物,所以出现腹泻和腹痛。热气停留于小肠,肠中疼痛,湿热焦渴,导致大便坚硬干燥无法排出,所以疼痛伴有大便闭塞不通。
A thirty-year-old man had suffered from epigastric pain for a long time. He was sallow and emaciated with poor appetite, yet his chest often felt as if he were full after eating. He was prescribed Jiawei Zhizhu Wan (Modified Bitter Orange and Atractodes Pill), but it proved ineffective.
The condition gradually worsened; the pain became severe, causing him to cry out loudly, audible to neighbors, leading him to attempt suicide. The physician administered Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) as a single dose, which was taken twice consecutively. This resulted in the evacuation of approximately four or five bowls of blood stasis. For three days, he remained fatigued, weak, and unable to speak. He was instructed to consume small amounts of thin rice gruel and recuperate gradually, eventually recovering completely.
The wife of Songye Kuang, an official holding the rank of Zhangke, aged over thirty, suffered from pain radiating from the epigastrium to the chest and hypochondrium, which was milder during the day and worse at night. Her Cun (Cun position) and Guan (Guan position) pulses on both wrists were wiry, slippery, and forceful. Initially, physicians diagnosed stagnation and congealed cold, prescribing dispersing and purgative agents without effect. Subsequently, formulas such as Tieshua San (Iron Brush Powder) and Simo Yin (Four-Mortar Drink) were used, also without success. Even drinking water induced vomiting and rejection. After a month of not eating, the pain intensified further. I determined that the syndrome was clearly phlegm obstruction. However, given the prolonged pain and extreme weakness, I dared not employ the emetic method. What could be done? Accidentally, a physician suggested that Wulingzhi (Trogopterus Dung) and Moyao (Myrrh) were effective when used previously, but everyone mocked him. These herbs had been used extensively before. I said there was no harm in using them again; why mock him? That physician prepared them with wine. Upon ingestion, the patient vomited immediately, expelling approximately two bowls of green phlegm. The pain ceased instantly, and she was able to eat. This indicated that the phlegm was lodged above the diaphragm; purgatives could not remove it, so only the emetic method could cure it. As the Classic says: "When there is an excess pathogen, there will be no injury," this is precisely what is meant.
The Yellow Emperor asked: "I have heard that those who speak well of Heaven must have verification in humanity; those who speak well of antiquity must align with the present; those who speak well of humanity must rectify themselves. In this way, the Dao is not confused, and its essential principles are exhausted, which is called being enlightened. Now I ask you, Master, hoping to hear knowledge that can be known through words, seen through observation, and obtained through palpation, allowing me to verify it upon myself as if removing blindness or resolving confusion. May I hear it?" Qibo bowed twice and kowtowed, replying: "What aspect of the Dao do you inquire about?" The Emperor said: "I wish to understand sudden pain in the five Zang organs of humans; what Qi causes this?" Qibo replied: "The flow of meridians never ceases, circulating endlessly around the body. When Cold Qi enters the meridians, its flow becomes sluggish, and blood coagulates and fails to move. If Cold lodges outside the vessels, blood volume decreases; if it lodges inside the vessels, Qi circulation is obstructed, resulting in sudden pain."
The Emperor said: "This pain sometimes stops suddenly, sometimes persists severely without relief, sometimes is too painful to press, sometimes relieves upon pressing, sometimes pressing yields no benefit, sometimes pulsates under the hand, sometimes heart pain radiates to the back, sometimes hypochondriac pain radiates to the lower abdomen, sometimes abdominal pain radiates to the inner thighs, sometimes pain lingers and forms masses, sometimes sudden severe pain causes unconsciousness with recovery after a short while, sometimes pain accompanies vomiting, sometimes abdominal pain is followed by diarrhea, sometimes pain accompanies constipation. All these pains differ in form; how should they be distinguished?" Qibo said: "When Cold lodges outside the vessels, the vessels become cold, contract, and cramp. Cramping pulls on small collaterals, causing sudden pain; warmth alleviates the pain. If repeatedly attacked by Cold, the pain becomes chronic. When Cold lodges within the vessels and clashes with Warmth, the vessels become full, causing severe pain that cannot be pressed. If Cold remains stagnant and Warmth rises, the vessels swell, and Qi and Blood become chaotic, making the pain severe and intolerable to pressure. When Cold lodges between the stomach and intestines, below the membrane source, blood cannot disperse, and small collaterals tense, causing pain; pressing disperses Qi and Blood, relieving pain. When Cold lodges in the vessels flanking the spine, deep pressure cannot reach it, so pressing yields no benefit. When Cold lodges in the Chong Mai (Penetrating Vessel), the vessel becomes obstructed, Qi follows the obstruction, and pulsation is felt under the hand. When Cold lodges in the Back-Shu vessels... [omitted, see Back Pain section]. When Cold lodges in the Jueyin Meridian, which connects to the genitalia and ties to the Liver, Cold in the vessels causes blood coagulation and vessel tension, leading to radiating pain between the hypochondrium and lower abdomen. When Jue Qi lodges in the inner thighs, and Cold ascends to the lower abdomen, blood coagulation below causes mutual traction, resulting in abdominal pain radiating to the inner thighs. When Cold lodges in the membrane source and collateral blood of the Small Intestine, blood coagulates and cannot enter the major meridians; Qi and Blood stagnate, forming masses over time. When Cold lodges in the Five Zang organs, Jue Qi leaks upward, Yin Qi exhausts, and Yang Qi fails to enter, causing sudden severe pain and unconsciousness; life returns if Qi recovers. When Cold lodges in the stomach and intestines, Jue Ni (Rebellious Qi) flows upward, causing pain with vomiting. When Cold lodges in the Small Intestine, it fails to gather and transform properly, causing diarrhea and abdominal pain. When Heat Qi stays in the Small Intestine, intestinal pain occurs; intense heat causes dryness and thirst, leading to hard, dry stool that cannot pass, causing pain with constipation."