腿游风在绕腿生,赤肿如云 热疼,荣卫风热相搏滞,宜砭出血双解清。
【注】此证两腿里外忽生赤肿,形如堆云, 热疼痛,由荣卫风热相搏,结滞而成。凡
遇此证,先施砭石,放出恶血,随服双解通圣散,次以当归拈痛汤清解治之;外贴牛肉
片,以拔风毒甚效。
\r腿游风图\p04-34a192.bmp\r
当归拈痛汤
当归 羌活 茵陈蒿 苍术(米泔水浸,炒)
防风(各一钱) 苦参 白术(土炒) 升麻(各七分)
葛根 泽泻 人参 知母 黄芩 猪苓 甘草(各五分) 黄柏(三分)
水二盅,煎八分,食前服。
【方歌】当归拈痛腿游风,羌活人参二术升,茵陈葛草芩知柏,苦参风泻共猪苓。
双解通圣散(见唇部唇风)
青腿牙疳何故生,只缘上下不交通,阳火炎炽阴寒闭,凝结为毒此病成。青腿如云
茄黑色,疲顽肿硬履难行,牙疳龈肿出臭血,穿破腮唇腐黑凶。
【注】此证自古方书罕载其名,仅传雍正年间,北路随营医官陶起麟颇得其详。略云∶
军中凡病腿肿色青者,其上必发牙疳;凡病牙疳腐血者,其下必发青腿,二者相因而至。
推其原,皆因上为阳火炎炽,下为阴寒闭郁,以至阴阳上下不交,各自为寒为热,各为凝
结而生此证也。相近内地,间亦有之,边外虽亦有不甚多,惟内地人,初居边外,得此
证者竟十居八九,盖中国之人,本不耐边外严寒,更不免坐卧湿地,故寒湿之痰生于
下,致腿青肿,其病形如云片,色似茄黑,肉体顽硬,所以步履艰难也。又缘边外缺少五
谷,多食牛、羊等肉,其热与湿合,蒸瘀于胃,毒火上熏,致生牙疳,牙龈腐肿出血,若
穿腮破唇,腐烂色黑,即为危候。边外相传,仅有令服马乳之法。麟初到军营,诊视青腿
牙疳之证,亦仅知投以马乳;阅历既久,因悟马脑之力,较马乳为效倍速,令患者服之,
是夜即能发出大汗,而诸病减矣!盖脑为诸阳之首,其性温暖,且能流通故耳。兼服活
络流气饮、加味二妙汤,宣其血气,通其经络,使毒不得凝结。外用砭法,令恶血流出,
以杀毒势;更以牛肉片贴敷,以拔出积毒,不数日而愈。盖黑血出,则阴气外泄,阳气即
随阴气而下降,两相交济,上下自安也。由是习为成法,其中活者颇多,因不敢自私,着
之于书,以公于世,并将所着应验诸方,备详于后。
\r青腿牙疳图\p04-34a193.bmp\r
服马乳法 治青腿牙疳。
用青、白马乳,早、午、晚随挤随服,甚效。如无青、白马,杂色马亦可。
服马脑法 治青腿牙疳。
用马脑子一个,用竹刀挑去筋膜,放在碗内,先将马脑搅匀,再用滚黄酒冲服,或
一斤或半斤俱可。倘一次不能服尽,分作二次冲服亦可。
活络流气饮(一名和中既济汤)
苍术 木瓜 羌活 附子(生) 山楂肉 独活 怀牛膝 麻黄(各二钱) 黄柏 乌药
干姜 槟榔 枳壳(麸炒,各一钱五分) 甘草(八分)
黑豆四十九粒,生姜三片,水四盅,煎一盅服,渣再煎,水三盅,煎八分。
如牙疳盛,减去干姜、附子,加胡黄连二钱,龙胆草二钱。如牙疳轻而腿疼重,加
肉桂二钱。如寒热已退,减去羌活、麻黄,加威灵仙二钱,五加皮二钱。
【方歌】活络流气去风强,青腿牙疳初服良,除湿清胃通经络,加减临时莫执方。苍
术木瓜羌附子,山楂独膝柏麻黄,乌药干姜榔枳草,引加黑豆与生姜。
加味二妙汤
黄柏(生) 苍术(米泔浸,炒) 牛膝(各三钱) 槟榔 泽泻 木瓜 乌药(各二钱)
当归尾(一钱五分)
黑豆四十九粒,生姜三片,水三盅,煎一盅;再煎渣,水二盅半,煎八分。
【方歌】加味二妙行步难,青腿牙疳龈肿宣,柏苍牛膝归榔泻,木瓜乌药豆姜煎。
砭刺出血法
此法用三棱扁针,形如锥挺者,向腿之青黑处,勿论穴道,量黑之大小,针一分深,
或十针、二十针俱可,务令黑血流出;外以牛肉割片,贴针眼并黑处。次日再看,如黑
处微退,仍针仍贴。如无牛肉,当顶刺破,用罐拔法。
搽牙牛黄青黛散
牛黄 青黛(各五分) 硼砂(二钱) 朱砂 人中白( ) 龙骨( 各一钱) 冰片(三分)
共研细末,先以甘草汤将口漱净,再上此药。
【方歌】牛黄青黛散硼砂,冰片朱砂中白加,龙骨共研为细末,牙疳肿腐此药搽。
一方用煮马肉汤烫洗。
一方用羊肝割片,贴黑处。
一方用芥菜子捣面,烧酒调,敷黑肿处。
腿游风生在腿部周围,表现为皮肤赤红肿胀,状如云朵,伴有发热和疼痛。这是由于营卫之气与风热邪气相互搏结、阻滞所致,适宜采用砭石放血疗法,并内服双解清中汤(即双解通圣散)进行治疗。
【注】此证候表现为双腿内外突然发生赤色肿胀,形状如同堆积的云朵,伴有发热和疼痛,是由营卫之气与风热邪气相互搏结,凝结阻滞而形成的。凡是遇到这种证候,先施用砭石,放出恶血,随后服用双解通圣散,接着用当归拈痛汤进行清热解表治疗;外用贴敷牛肉片,以拔出风毒,效果显著。
当归拈痛汤
当归 羌活 茵陈蒿 苍术(用米泔水浸泡后炒制)
防风(各一钱) 苦参 白术(土炒) 升麻(各七分)
葛根 泽泻 人参 知母 黄芩 猪苓 甘草(各五分) 黄柏(三分)
加水两盅,煎至八分,饭前服用。
【方歌】当归拈痛治腿游风,羌活人参二术升,茵陈葛草芩知柏,苦参风泻共猪苓。
双解通圣散(参见唇部唇风章节)
青腿牙疳为何产生?只因为上下阴阳之气不能交通。阳火炽盛炎上,阴寒闭郁于下,凝结成毒,此病由此形成。青腿颜色像云片一样,呈茄子般的黑色,肢体疲乏顽固,肿胀坚硬,行走困难。牙疳则牙龈肿胀,流出臭秽血液,若穿破腮帮和嘴唇,腐烂发黑,病情凶险。
【注】此证候在古代医书中很少记载其名称,仅流传雍正年间,北路随营医官陶起麟对此症了解颇详。大致说:军中凡是患腿部肿胀颜色发青的人,其上必并发牙疳;凡是患牙疳流出腐臭血液的人,其下必并发青腿,这两种病症相继而至。推究其根源,都是因为上部为阳火炽盛,下部为阴寒闭郁,导致阴阳上下之气不能相交,各自形成寒热,分别凝结而产生此证。靠近内地地区,偶尔也有发生,边外虽然也有但不太多,只有内地人初到边外居住,得此证的竟占十之八九,大概是因为中国人本来就不耐受边外的严寒,又难免坐卧在潮湿之地,所以寒湿之痰生于下肢,导致腿部青肿,病形如云片,颜色似茄子黑,肌肉肉体顽硬,所以步履艰难。又因为边外缺少五谷杂粮,多食用牛、羊等肉类,其热性与湿气结合,蒸瘀于胃,毒火上熏,导致产生牙疳,牙龈腐烂肿胀出血,如果穿腮破唇,腐烂色黑,就是危重征候。边外相传,仅有让患者服用马乳的方法。陶起麟初到军营时,诊治青腿牙疳之证,也只知道投予马乳;阅历既久,因而领悟到马脑的力量,比马乳见效快一倍,让患者服用,当天晚上就能发出大汗,各种病症减轻!大概因为脑为诸阳之首,其性温暖,且能流通的缘故。同时服用活络流气饮、加味二妙汤,宣通气血,疏通经络,使毒邪不得凝结。外用砭刺法,令恶血流出,以杀灭毒势;再用牛肉片贴敷,以拔出积毒,不几天就能痊愈。大概因为黑血流出,则阴气外泄,阳气随即随着阴气而下降,两者相交济,上下自然安宁。因此习以为常成为定法,其中治愈者很多,因不敢私藏,著录于书,公之于世,并将所著应验的各种方剂,详细列在后面。
服马乳法 治疗青腿牙疳。
使用青色或白色的马乳,早、午、晚随时挤取随时服用,效果很好。如果没有青、白马,杂色马也可以。
服马脑法 治疗青腿牙疳。
用一个马脑子,用竹刀挑去筋膜,放在碗内,先将马脑搅匀,再用滚烫的黄酒冲服,或者一斤或者半斤都可以。如果一次不能服完,分作两次冲服也可以。
活络流气饮(又名和中既济汤)
苍术 木瓜 羌活 附子(生用) 山楂肉 独活 怀牛膝 麻黄(各二钱) 黄柏 乌药
干姜 槟榔 枳壳(麸炒,各一钱五分) 甘草(八分)
黑豆四十九粒,生姜三片,加水四盅,煎至一盅服用,药渣再煎,加水三盅,煎至八分。
如果牙疳严重,减去干姜、附子,加胡黄连二钱,龙胆草二钱。如果牙疳轻而腿疼重,加肉桂二钱。如果寒热已退,减去羌活、麻黄,加威灵仙二钱,五加皮二钱。
【方歌】活络流气去风强,青腿牙疳初服良,除湿清胃通经络,加减临时莫执方。苍术木瓜羌附子,山楂独膝柏麻黄,乌药干姜榔枳草,引加黑豆与生姜。
加味二妙汤
黄柏(生用) 苍术(米泔浸,炒) 牛膝(各三钱) 槟榔 泽泻 木瓜 乌药(各二钱)
当归尾(一钱五分)
黑豆四十九粒,生姜三片,加水三盅,煎至一盅;再煎药渣,加水二盅半,煎至八分。
【方歌】加味二妙行步难,青腿牙疳龈肿宣,柏苍牛膝归榔泻,木瓜乌药豆姜煎。
砭刺出血法
此法使用三棱扁针,形状像锥挺一样的,对着腿部青黑色的地方,不论穴位,根据黑色区域的大小,针刺一分深,或者十针、二十针都可以,务必令黑血流出;外用割下的牛肉片,贴在针眼及黑色处。第二天再看,如果黑色处稍微消退,仍然针刺并贴敷。如果没有牛肉,应当在顶部刺破,用罐拔法。
搽牙牛黄青黛散
牛黄 青黛(各五分) 硼砂(二钱) 朱砂 人中白( ) 龙骨( 各一钱) 冰片(三分)
共同研成细末,先用甘草汤将口漱净,再涂上此药。
【方歌】牛黄青黛散硼砂,冰片朱砂中白加,龙骨共研为细末,牙疳肿腐此药搽。
一方用煮马肉汤烫洗。
一方用羊肝割片,贴在黑色处。
一方用芥菜子捣碎成面,用烧酒调匀,敷在黑色肿胀处。
Leg You Feng (Wandering Wind of the Leg) occurs around the legs, presenting with erythema and swelling resembling clouds, accompanied by heat and pain. This is caused by the interplay and stagnation of Ying-Wei (Nutritive and Defensive Qi) with Wind-Heat pathogenic factors. It is appropriate to use Bian stone (Bian Shi, 砭石) bloodletting therapy and internally administer Shuangjie Tongsheng San (Double-Decoction Holy Unifier Powder).
[Note] This syndrome manifests as sudden erythema and swelling on both the inner and outer aspects of the legs, shaped like piled clouds, accompanied by heat and pain. It is formed by the interplay and stagnation of Ying-Wei Qi with Wind-Heat pathogens. Whenever this syndrome is encountered, first apply Bian stone therapy to release evil blood, then administer Shuangjie Tongsheng San, followed by Danggui Niantong Tang (Angelica Sinensis Decoction for Relieving Pain) to clear and resolve the condition externally. Applying beef slices topically to draw out wind-toxin is also highly effective.
Danggui Niantong Tang (Angelica Sinensis Decoction for Relieving Pain)
Danggui (Radix Angelicae Sinensis), Qianghuo (Rhizoma et Radix Notopterygii), Yinchenhao (Herba Artemisiae Scopariae), Cangzhu (Rhizoma Atractylodis Chinensis, soaked in rice wash water and stir-fried)
Fangfeng (Radix Saposhnikoviae) [each 1 qian], Kushen (Cortex Sophorae Flavescentis), Baizhu (Rhizoma Atractylodis Macrocephalae, stir-fried with soil), Shengma (Rhizoma Cimicifugae) [each 0.7 qian]
Gegen (Puerariae Lobatae Radix), Zexie (Rhizoma Alismatis), Renshen (Radix Ginseng), Zhimu (Cortex Anemarrhenae), Huangqin (Radix Scutellariae), Zhuling (Polyporus) [each 0.5 qian], Huangbai (Cortex Phellodendri) (0.3 qian)
Add two cups of water, decoct until eight-tenths remain, take before meals.
[Formula Song] Danggui Niantong treats Leg You Feng, Qianghuo, Renshen, Er Zhu (Cangzhu and Baizhu), and Shengma; Yichen, Gegen, Gancao, Huangqin, Zhimu, and Huangbai; Kushen, Fangfeng, Zexie, and Zhuling together.
Shuangjie Tongsheng San (See Lip Chufeng section)
Why does Qing Tui Ya Gan (Blue Legs and Gangrenous Gums) arise? It is solely due to the lack of communication between the upper and lower parts. Yang fire blazes upward while Yin cold closes off below, condensing into toxin, thus forming this disease. The blue legs appear cloud-like, dark purple-black like an eggplant; the limbs are weary and stubborn, swollen and hard, making walking difficult. The gangrenous gums present with swollen gingiva oozing foul-smelling blood; if it perforates the cheeks and lips and turns black and rotting, the prognosis is ominous.
[Note] This syndrome is rarely recorded in ancient medical texts by name. Only during the Yongzheng reign was detailed knowledge transmitted from Tao Qilin, a military physician accompanying the troops in the northern region. He stated roughly: In the army, anyone suffering from leg swelling with a blue color must simultaneously develop gangrenous gums; anyone suffering from gangrenous gums with foul bloody discharge must simultaneously develop blue legs. These two conditions arise sequentially. Tracing their origin, it is because the upper part suffers from blazing Yang fire, while the lower part suffers from closed-off Yin cold, leading to a failure of Yin and Yang to communicate between upper and lower. Each forms its own cold or heat, condensing separately to produce this syndrome. Near inland areas, it occasionally occurs; outside the borders, although not very common, among people from inland who newly reside outside the border, nine out of ten suffer from this. This is likely because Chinese people are inherently intolerant to the severe cold outside the border, and furthermore, they inevitably sit or lie on damp ground. Thus, phlegm generated by cold-dampness arises in the lower body, causing blue and swollen legs. The shape resembles cloud patches, the color is dark purple-black like an eggplant, the flesh is tough and hard, hence walking is arduous. Additionally, due to the scarcity of grains outside the border, people consume much beef and mutton. The heat combines with dampness, steaming and stasis-forming in the Stomach. Toxin-fire harasses upward, causing gangrenous gums, with rotten, swollen, and bleeding gingiva. If it perforates the cheeks and lips and rots black, it is a critical sign. Outside the border, it is traditionally believed that only administering horse milk is effective. When Tao Qilin first arrived at the military camp, diagnosing Qing Tui Ya Gan, he only knew to prescribe horse milk; after extensive experience, he realized that the power of horse brain is twice as fast-acting as horse milk. He ordered patients to take it, and that night they could sweat profusely, reducing all symptoms! This is because the brain is the head of all Yang meridians, its nature is warm, and it can circulate freely. Concurrently administering Huoluo Liuqi Yin (Collateral-Unblocking Qi-Circulating Decoction) and Jiawei Ermiao Tang (Modified Two Marvels Decoction) to promote blood and Qi circulation and unblock meridians prevents toxin condensation. Externally, Bian puncture is used to let evil blood flow out, killing the toxic pathogen; beef slices are applied to draw out accumulated toxin. Within a few days, recovery occurs. Generally, when black blood flows out, Yin Qi escapes outward, and Yang Qi descends following Yin Qi. The two interact and balance each other, ensuring peace in the upper and lower parts. Thus, it became a standard method, with many cured. Not daring to keep it private, it was recorded in books and made public. The verified formulas are detailed below.
Horse Milk Method: Treats Qing Tui Ya Gan.
Use green or white horse milk. Squeeze and drink immediately morning, noon, and evening. Very effective. If green or white horses are unavailable, mixed-color horses are also acceptable.
Horse Brain Method: Treats Qing Tui Ya Gan.
Take one horse brain. Use a bamboo knife to remove fascia and membranes, place it in a bowl. Stir the horse brain evenly first, then mix with boiling yellow wine and ingest. One jin or half a jin is acceptable. If it cannot be consumed at once, divide into two doses for ingestion.
Huoluo Liuqi Yin (Also known as Hezhong Jiji Tang / Harmonizing Middle and Completing Mutual Decoction)
Cangzhu (Rhizoma Atractylodis Chinensis), Mugua (Fructus Chaenomelis), Qianghuo (Rhizoma et Radix Notopterygii), Fuzi (Radix Aconiti Lateralis Preparata, raw), Shanzha Rou (Sarcocarpus Crataegi), Duhuo (Radix Angelicae Pubescentis), Huainiuxi (Radix Achyranthis Bidentatae), Mahuang (Herba Ephedrae) [each 2 qian], Huangbai (Cortex Phellodendri), Wuyao (Radix Linderae), Ganjiang (Rhizoma Zingiberis Recens), Binglang (Semen Arecae), Zhike (Fructus Aurantii Immaturum, stir-fried with bran) [each 1.5 qian], Gancao (Radix Glycyrrhizae) (0.8 qian)
49 Black Beans, 3 slices of Fresh Ginger. Add four cups of water, decoct until one cup remains, take the liquid. Re-decoct the dregs with three cups of water until eight-tenths remain.
If gangrenous gums are severe, reduce/remove Ganjiang and Fuzi, add Huhuanglian (Rhizoma Coptidis) 2 qian, Longdancao (Herba Gentianae) 2 qian. If gangrenous gums are mild but leg pain is severe, add Rougui (Cortex Cinnamomi) 2 qian. If chills and fever have subsided, reduce/remove Qianghuo and Mahuang, add Weilingxian (Herba Siegesbeckiae) 2 qian, Wujia Pi (Cortex Acanthopanacis Senticosi) 2 qian.
[Formula Song] Huoluo Liuqi dispels wind strongly, good for initial treatment of Qing Tui Ya Gan; removes dampness, clears Stomach, unblocks meridians, do not rigidly adhere to the formula for modifications. Cangzhu, Mugua, Qianghuo, Fuzi; Shanzha, Duhuo, Niuxi, Huangbai, Mahuang; Wuyao, Ganjiang, Binglang, Zhike, Gancao; guided by Black Beans and Fresh Ginger.
Jiawei Ermiao Tang (Modified Two Marvels Decoction)
Huangbai (Cortex Phellodendri, raw), Cangzhu (Rhizoma Atractylodis Chinensis, soaked in rice wash water and stir-fried), Niuxi (Radix Achyranthis Bidentatae) [each 3 qian], Binglang (Semen Arecae), Zexie (Rhizoma Alismatis), Mugua (Fructus Chaenomelis), Wuyao (Radix Linderae) [each 2 qian], Danggui Wei (Radix Angelicae Sinensis caudex) (1.5 qian)
49 Black Beans, 3 slices of Fresh Ginger. Add three cups of water, decoct until one cup remains; re-decoct dregs with two and a half cups of water until eight-tenths remain.
[Formula Song] Modified Two Marvels helps when walking is difficult, clears swelling of gums in Qing Tui Ya Gan; Huangbai, Cangzhu, Niuxi, Danggui, Binglang, Zexie; Mugua, Wuyao, Beans, Ginger decocted.
Bian Puncture Bloodletting Method
This method uses a triangular flat needle, shaped like a cone. Aim at the blue-black areas of the leg, regardless of acupoints. Based on the size of the black area, prick one fen deep. Ten or twenty pricks are acceptable. Ensure black blood flows out. Externally, slice beef and apply it to the puncture sites and black areas. Check the next day; if the black area has slightly receded, continue pricking and applying. If beef is unavailable, prick the topmost point and use cupping therapy.
Niu Huang Qing Dai San (Ox Gallstone and Indigo Naturalis Powder for Gargling/Smearing)
Niu Huang (Calculus Bovis), Qing Dai (Indigo Naturalis) [each 0.5 qian], Pengsha (Borax) (2 qian), Zhusha (Cinnabaris), Renzhong Bai (Urinae Humanis Depuratum), Longgu (Os Mastodi et SCapulae Bovis) [each 1 qian], Bingpian (Borneolum Syntheticum) (0.3 qian)
Grind all into fine powder. First rinse the mouth thoroughly with Licorice Decoction, then apply this medicine.
[Formula Song] Niu Huang, Qing Dai, Pengsha; add Bingpian, Zhusha, Renzhong Bai. Grind Longgu together into fine powder; smear this medicine on swollen and rotten gangrenous gums.
One prescription uses boiled horse meat broth for washing.
One prescription uses sliced sheep liver applied to the black area.
One prescription uses crushed mustard seeds mixed with flour, blended with strong liquor, and applied to the black swollen area.