大小肠痈因湿热,气滞瘀血注肠中,初服大黄行瘀滞,脓成薏苡牡丹平。
【注】此二证俱由湿热气滞凝结而成。或努力瘀血,或产后败瘀蓄积,流注于大肠、小
肠之中。初起发热,恶风,自汗,身皮甲错,关元、天枢二穴隐痛微肿,按之腹内急痛,大
肠痈多大便坠肿,小肠痈多小水涩滞,脉俱迟紧,此时痈脓未成,宜大黄汤下之;瘀血
利尽,若小水闭涩,仍宜大黄汤加琥珀末,木通利之自效。若痈成日久不溃,身皮甲错,内
无积聚,腹急腹痛,身无热而脉数者,系肠内阴冷,不能为脓,宜薏苡附子散主之;若
脉见洪数,肚脐高突,腹痛胀满不食,动转侧身则有水声,便淋刺痛者,痈脓已成,宜
薏苡汤主之;腹濡而痛,少腹急胀,时时下脓者,毒未解也,宜丹皮汤治之;如脓从脐
出,腹胀不除,饮食减少,面白神劳,此属气血俱虚,宜八珍汤加牡丹皮、肉桂、黄 、
五味子,敛而补之。患者转身动作,宜徐缓而勿惊,慎之。如耽延日久,因循失治,以
致毒攻五内,腹痛牵阴,肠胃受伤,或致阴器紫黑、腐烂,色败无脓,每流污水,衾帏
多臭,烦躁不止,身热嗌干,俱属逆证。
关元穴又名小肠募,在脐下三寸。天枢穴又名大肠募,在脐旁开二寸。
\r五脏六腑诸募穴图(一)\p04-34a137.bmp\r
大黄汤
大黄(锉、炒) 牡丹皮 硝石(研) 芥子 桃仁(炒,先以汤浸去皮、尖,双仁勿用)
上各等分,共锉碎,每用五钱,水二盅,煎至一盅,去渣,空心温服。以利下脓血为
度,未利再服。
【方歌】大黄汤善治肠痈,少腹坚痛脓未成,牡丹皮与大黄炒,芥子桃仁硝石灵。
薏苡附子散
附子(炮,二分) 败酱(五分) 薏苡仁(炒,一钱)
上为末,每服方寸匕,以水二合煎,顿服,小水当下。《三因》云∶薏苡、附子同前,
败酱用一两一分,每四钱水盏半,煎七分,去渣,空心服。
【方歌】薏苡附子散甲错,肠痈腹胀痛脉数,附子败酱薏苡仁,为末水煎空心服。
薏苡汤
薏苡仁 栝蒌仁(各三钱) 牡丹皮 桃仁(泥,各二钱)
水二盅,煎至一盅,不拘时服。
【方歌】薏苡汤治腹水声,肠痈便淋刺痛疼,牡丹皮共栝蒌子,还有桃仁薏苡仁。
丹皮汤
丹皮 栝蒌仁(各一钱) 桃仁(泥) 朴硝(各二钱) 大黄(五钱)
水二盅,煎一盅,去渣入硝,再煎数滚,不拘时服。
【方歌】丹皮汤疗肠痈证,腹濡而痛时下脓,硝黄丹蒌桃仁共,水煎服之有奇功。
八珍汤(见溃疡门)
大小肠痈由湿热引起,气机阻滞、瘀血流入肠道所致。初期服用大黄汤以行瘀滞;脓液形成后,用薏苡牡丹方(薏苡附子散或薏苡汤)来平复病情。
【注】这两种证候都是由湿热气机阻滞凝结而成。或因用力过度导致瘀血,或因产后败血蓄积,流注于大肠和小肠之中。初起时出现发热、恶风、自汗、皮肤粗糙如鳞甲状,关元穴和天枢穴处隐痛微肿,按压时腹部内部急痛。大肠痈多表现为大便坠胀感,小肠痈多表现为小便涩滞不畅,脉象均为迟紧。此时痈脓尚未形成,适宜用大黄汤攻下;若瘀血排尽后,小便仍闭涩不通,仍宜在大黄汤中加入琥珀末、木通以利水,自有疗效。如果痈脓形成日久不溃破,身体皮肤粗糙如鳞甲状,体内无积聚物,腹部拘急疼痛,身体无发热但脉数,这是肠内阴寒凝滞,不能化生脓液,适宜用薏苡附子散主治;如果脉象洪数,肚脐高突,腹痛胀满不能进食,转动侧身时有水声,小便淋沥刺痛,说明痈脓已成,适宜用薏苡汤主治;腹部柔软而痛,少腹拘急胀满,时常排出脓液,说明毒邪未解,适宜用丹皮汤治疗;如果脓液从脐部流出,腹胀不除,饮食减少,面色苍白神疲乏力,这属于气血俱虚,适宜用八珍汤加牡丹皮、肉桂、黄芪、五味子,以收敛并补益气血。患者转身动作,宜缓慢而不要惊扰,务必谨慎。如果拖延日久,因循守旧延误治疗,致使毒邪攻入五脏六腑,腹痛牵引至阴部,肠胃受伤,或者导致阴器紫黑、腐烂,色泽败坏无脓,经常流出污水,被褥多有臭味,烦躁不止,身体发热咽喉干燥,都属于逆证(难治之证)。
关元穴又名小肠募穴,位于脐下三寸。天枢穴又名大肠募穴,位于脐旁开二寸。
大黄汤
大黄(锉碎、炒) 牡丹皮 硝石(研细) 芥子 桃仁(炒,先以热水浸泡去皮、尖,双仁勿用)
以上各等分,共锉碎,每次用五钱,加水两盅,煎至一盅,去渣,空腹温服。以利下脓血为度,未利再服。
【方歌】大黄汤善治肠痈,少腹坚痛脓未成,牡丹皮与大黄炒,芥子桃仁硝石灵。
薏苡附子散
附子(炮制,二分) 败酱草(五分) 薏苡仁(炒,一钱)
以上研为末,每次服用方寸匕,加水两合煎煮,一次性服下,小便当下利。《三因极一病证方论》记载:薏苡仁、附子用量同上,败酱草用一两一分,每次四钱,加水一盏半,煎至七分,去渣,空腹服用。
【方歌】薏苡附子散甲错,肠痈腹胀痛脉数,附子败酱薏苡仁,为末水煎空心服。
薏苡汤
薏苡仁 栝蒌仁(各三钱) 牡丹皮 桃仁(捣泥,各二钱)
加水两盅,煎至一盅,不拘时间服用。
【方歌】薏苡汤治腹水声,肠痈便淋刺痛疼,牡丹皮共栝蒌子,还有桃仁薏苡仁。
丹皮汤
丹皮 栝蒌仁(各一钱) 桃仁(捣泥) 朴硝(各二钱) 大黄(五钱)
加水两盅,煎至一盅,去渣加入硝石,再煎数次沸腾,不拘时间服用。
【方歌】丹皮汤疗肠痈证,腹濡而痛时下脓,硝黄丹蒌桃仁共,水煎服之有奇功。
八珍汤(见溃疡门)
Intestinal and Large Intestine Abscesses are caused by Damp-Heat, with Qi stagnation and Blood stasis pouring into the intestines. In the initial stage, Da Huang Tang (Rhubarb Decoction) is taken to move blood stasis; once pus has formed, Yi Yi Mu Dan Fang (Coix and Moutan Formula, referring to Yi Yi Fu Zi San or Yi Yi Tang) is used to calm the condition.
[Note] These two conditions are both formed by the coagulation of Damp-Heat and Qi stagnation. It may be due to effort-induced blood stasis, or postpartum retained blood accumulating and flowing into the Large Intestine and Small Intestine. Initially, there is fever, aversion to wind, spontaneous sweating, and skin rough like scales. There is dull pain and slight swelling at Guan Yuan (CV4, Conception Vessel 4) and Tian Shu (ST25, Stomach 25) acupoints; pressing causes acute abdominal pain. Large Intestine abscesses often present with a sensation of heaviness in defecation, while Small Intestine abscesses often present with difficult and obstructed urination. The pulse is consistently slow and tight. At this time, the abscess pus has not yet formed, and it is appropriate to purge using Da Huang Tang (Rhubarb Decoction); if after the blood stasis is cleared, urination remains obstructed, it is still appropriate to add Su Po (Amber) powder and Mu Tong (Akebia Decoction) to Da Huang Tang to promote diuresis, which will be effective. If the abscess has formed for a long time without ulcerating, the body skin is rough like scales, there is no accumulation inside, the abdomen is tense and painful, the body has no fever but the pulse is rapid, this indicates cold-Yin in the intestines that cannot transform into pus, and Yi Yi Fu Zi San (Coix and Aconite Powder) is indicated; if the pulse is surging and rapid, the umbilicus protrudes, there is abdominal pain, distension, fullness, and inability to eat, and there is a sound of water when turning or changing position, along with dribbling and stabbing pain during urination, the abscess pus has formed, and Yi Yi Tang (Coix Decoction) is indicated; if the abdomen is soft and painful, the lower abdomen is tense and distended, and pus is discharged frequently, the pathogenic toxin has not been resolved, and Dan Pi Tang (Moutan Decoction) is indicated; if pus flows from the umbilicus, abdominal distension persists, food intake decreases, the complexion is pale, and spirit is fatigued, this belongs to deficiency of both Qi and Blood, and Ba Zhen Tang (Eight Treasure Decoction) added with Mu Dan Pi (Moutan Cortex), Rou Gui (Cinnamon Bark), Huang Qi (Astragalus Root), and Wu Wei Zi (Schisandra Fruit) is indicated to astringe and tonify. When patients turn their bodies or move, they should do so slowly and without startling, exercising caution. If delayed for a long time, neglecting treatment leads to the toxin attacking the Five Zang and Six Fu organs, abdominal pain radiating to the Yin region, damaging the stomach and intestines, potentially causing the external genitalia to turn purple-black and rot, with a deteriorated complexion, lack of pus, frequent discharge of turbid water, foul odor on bedding, incessant irritability, fever, and dry throat, all of which are adverse signs (difficult-to-treat conditions).
Guan Yuan (CV4, Conception Vessel 4) is also known as the Front-Mu point of the Small Intestine, located three cun below the umbilicus. Tian Shu (ST25, Stomach 25) is also known as the Front-Mu point of the Large Intestine, located two cun lateral to the umbilicus.
Da Huang Tang (Rhubarb Decoction)
Da Huang (Rhei Radix et Rhizoma, crushed and stir-fried) Mu Dan Pi (Moutan Cortex) Xiao Shi (Natrii Sulfas, ground) Jie Zi (Sinapis Semen) Tao Ren (Persicae Semen, stir-fried, soaked in water first to remove skin and tips, double-kernel seeds should not be used)
All in equal proportions, finely crushed. Use five qian each time, add two zhong of water, decoct to one zhong, remove dregs, and take warm on an empty stomach. Continue until pus and blood are purged; if not purged, take again.
[Formula Song] Da Huang Tang excellently treats intestinal abscess, hard pain in the lower abdomen before pus forms; stir-fried Moutan Cortex and Rhubarb, mustard seed, peach kernel, and niter are efficacious.
Yi Yi Fu Zi San (Coix and Aconite Powder)
Fu Zi (Prepared Aconiti Lateralis Radix, two fen) Bai Jiang Cao (Patriniae Herba, five fen) Yi Yi Ren (Coicis Semen, stir-fried, one qian)
Grind into powder. Take one fang cun bi each time, decoct with two he of water, and take in one dose. Urination should follow. *San Yin Fang* states: Coix Seed and Aconite are as above; Patriniae Herba uses one liang and one fen. Take four qian with one and a half cups of water, decoct to seven parts, remove dregs, and take on an empty stomach.
[Formula Song] Yi Yi Fu Zi San for scaly skin, intestinal abscess with abdominal distension, pain, and rapid pulse; Aconite, Patriniae Herba, and Coix Seed, ground and decocted in water, taken on an empty stomach.
Yi Yi Tang (Coix Decoction)
Yi Yi Ren (Coicis Semen) Gua Lou Ren (Trichosanthis Semen, three qian each) Mu Dan Pi (Moutan Cortex) Tao Ren (Persicae Semen, pounded into paste, two qian each)
Add two zhong of water, decoct to one zhong, take at any time.
[Formula Song] Yi Yi Tang treats abdominal water sounds, intestinal abscess with dribbling urine and stabbing pain; Moutan Cortex together with Trichosanthis Seed, along with Peach Kernel and Coix Seed.
Dan Pi Tang (Moutan Decoction)
Dan Pi (Moutan Cortex) Gua Lou Ren (Trichosanthis Semen, one qian each) Tao Ren (Persicae Semen, pounded into paste) Pu Xiao (Natrii Sulfas, two qian each) Da Huang (Rhei Radix et Rhizoma, five qian)
Add two zhong of water, decoct to one zhong, remove dregs, add Niter, boil a few more times, and take at any time.
[Formula Song] Dan Pi Tang treats intestinal abscess syndrome, soft abdomen with pain and frequent pus discharge; Niter, Rhubarb, Moutan, Trichosanthis, and Peach Kernel together, decocted in water for miraculous efficacy.
Ba Zhen Tang (Eight Treasure Decoction) (See Ulcer Section)