丘太守镇山翁令侄,淮阴人也。丁年患两手筋挛,指掉不能屈伸,臂肉瘦削,体瘠面白
,寝
食大减。市中诸友调治不验,乃任京口诸名家疗之半年,肉更消,色更瘁。闻予在吴比部衙
中,敦予为治。诊其脉,六部俱弦,重按稍快。诊竟,扣其受病之源,太守公曰∶自上年冬
底,偶发寒热,筋骨疼痛,迨于仲春,寒热虽退,而筋骨之疼不减。服药无虚日,甚之日三
四进,肉渐消去,指掉不随,似有加于往昔。医之来者,一曰风,二曰风,三四五六皆曰风
,即十数辈,又莫不皆曰风者。竭技尽方,卒无一应,奄奄床第,绝不知为何病。予对公曰
∶
此筋痿症也,乃少年不谨欲而受风湿,邪气乘虚而入。医者不察天时,不分六经,概而汗之
。仲景治风湿之法,但使微汗津津,则风湿尽去,若汗大出,则风去而湿存,由是血气俱虚
。经云,阳气者,精则养神,柔则养筋。虚则筋无所养,渐成痿弱,乃不足之疾。故陈无择
、朱丹溪、刘宗浓皆谓诸痿切不可作风治,误则成痼疾,公闻言愕然曰∶服风药几二百剂矣
,顾今已痼,奈之何?予对曰∶令侄青年,犹可图也。公曰∶用何法?予曰∶法当大补气血。
经云∶气主煦之,血主濡之。气血旺则筋柔而软,由是乃可以束骨而利机关也。抑何掉之有
哉!病者闻言大喜曰∶聆先生详病之源,治法之略,虽未服药,已觉沉 去体矣!即请剂。予
以五加皮、薏苡仁、红花、人参、鹿角胶、龟板、虎骨、当归、丹参、地黄、骨碎补、苍耳
子之类。服两月,肌肉渐生,饮食大进,两手指掉亦平复。
丘太守镇山翁的侄子,是淮阴人。他在二十岁左右时患上双手筋脉拘挛,手指颤抖无法屈伸,手臂肌肉消瘦萎缩,身体瘦弱面色苍白,睡眠和饮食大幅减少。市井间的各位医生调理治疗无效,于是任由京口地区的几位名医诊治了半年,结果肌肉更加消减,气色更加憔悴。听说我在吴比部衙门中,便恳请我为他治疗。我诊察他的脉象,六部脉都呈现弦象,重按时稍显缓和。诊脉结束后,询问他发病的根源,丘太守说:“从去年冬天底端,偶然出现寒热交替、筋骨疼痛的症状,到了仲春时节,寒热虽然退了,但筋骨疼痛并未减轻。每天服药没有间断,严重时一天进药三四次,肌肉逐渐消减,手指颤抖不受控制,似乎比过去更严重了。来的医生,一位说是风邪,两位说是风邪,三、四、五、六位也都说是风邪,即使是十几位医生,又无不都说这是风邪。他们竭尽技艺和方药,最终毫无效果,病人奄奄一息躺在床榻上,完全不知道是什么病。”我对太守说:“这是筋痿症,是由于少年时期房事不节制而感受风湿,邪气乘虚而入。医生们没有考察天时气候,也没有区分六经辨证,一概使用发汗法治疗。张仲景治疗风湿的方法,只是让病人微微出汗,这样风湿就能全部去除;如果大汗淋漓,则风邪虽去而湿邪留存,从而导致气血俱虚。《内经》说:‘阳气,精微部分能滋养精神,柔和部分能滋养筋脉。’气血虚弱则筋脉得不到滋养,逐渐形成痿弱,这是虚损类的疾病。所以陈无择、朱丹溪、刘宗浓都认为各种痿证切不可当作风证来治疗,误治则会变成顽固性疾病。太守听后惊讶地说:“服用了近二百剂祛风药,如今已经成了痼疾,该怎么办呢?”我回答说:“令侄正值青年,还可以救治。”太守问:“用什么方法?”我说:“治疗方法应当大补气血。《内经》说:‘气主要起温煦作用,血主要起濡润作用。’气血旺盛则筋脉柔韧柔软,从而能够约束骨骼并利于关节运动,哪里还会有手指颤抖的情况呢!”病人听后非常高兴地说:“聆听先生详细分析病因和治疗原则,虽然还没吃药,已经觉得沉重的病痛离体了!”随即请求开方。我使用了五加皮、薏苡仁、红花、人参、鹿角胶、龟板、虎骨、当归、丹参、地黄、骨碎补、苍耳子等药物。服用两个月后,肌肉逐渐生长,饮食大增,双手手指的颤抖也平复恢复正常。
The nephew of Governor Qiu, courtesy name Zhanshan Weng, was from Huaiyin. In his twenties, he suffered from tendon spasms in both hands, with fingers trembling and unable to flex or extend; the muscles of his arms wasted away, his body emaciated, complexion pale, and his sleep and appetite significantly decreased. Various physicians in the market treated him without success, so he left himself to be treated by several renowned experts in Jingkou for half a year, yet his muscles diminished further and his complexion grew more haggard. Hearing that I was residing in the office of the Wu Ministry Official, they earnestly requested my treatment. Upon palpating his pulse, all six positions (Cun, Guan, Chi on both wrists) were wiry (Xian Mai), becoming slightly relaxed upon heavy pressure. After finishing the pulse diagnosis, I inquired about the origin of the disease. The Governor stated: "At the end of last winter, I suddenly experienced alternating chills and fever accompanied by bone and tendon pain. By mid-spring, although the chills and fever subsided, the bone and tendon pain did not diminish. Medication was taken daily without fail, sometimes three or four times a day when severe. Gradually, the flesh wasted away, and the finger tremors became uncontrollable, appearing worse than before. Every physician who came diagnosed it as 'wind'—one said wind, two said wind, and the third through sixth also said wind. Even among a dozen practitioners, all unanimously attributed it to wind. They exhausted their skills and prescriptions, yet achieved no effect. He lies dying in bed, completely unaware of what disease this is." I replied to the Governor: "This is Tendon Atrophy (Jin Wei Zheng). It results from immoderate sexual activity in youth leading to susceptibility to Wind-Dampness, allowing pathogenic factors to enter due to deficiency. The physicians failed to consider the seasonal climate and distinguish between the Six Channels (Liu Jing), instead uniformly applying diaphoretic (sweating) methods. Zhang Zhongjing's method for treating Wind-Dampness involves inducing only slight perspiration, thereby eliminating both Wind and Dampness. If profuse sweating occurs, the Wind is expelled but Dampness remains, leading to exhaustion of both Qi and Blood. The Classic states: 'Yang Qi, in its refined aspect, nourishes the Spirit; in its soft aspect, it nourishes the Tendons.' When deficient, the Tendons lack nourishment, gradually developing into atrophy and weakness; this is a deficiency disorder. Therefore, Chen Wuzhe, Zhu Danxi, and Liu Zongnong all asserted that various forms of Atrophy must never be treated as Wind disorders; misdiagnosis leads to chronic, intractable diseases." The Governor, hearing this, exclaimed in astonishment: "He has taken nearly two hundred doses of Wind-dispelling medicines. Now that it has become a chronic condition, what can be done?" I replied: "Your nephew is still young; there is hope for recovery." The Governor asked: "What method should be used?" I said: "The treatment principle should be to greatly tonify Qi and Blood. The Classic states: 'Qi primarily provides warmth; Blood primarily provides moistening.' When Qi and Blood are abundant, the Tendons become supple and soft, thereby able to bind the bones and facilitate joint movement. How could there be trembling then!" The patient, hearing this, was overjoyed: "Listening to your detailed explanation of the disease's origin and treatment principles, although I have not yet taken medicine, I already feel the burden of illness lifting from my body!" He immediately requested a prescription. I prescribed herbs such as Acanthopanacis Cortex (Wujia Pi), Coicis Semen (Yiyiren), Carthami Flos (Honghua), Ginseng Radix et Rhizoma (Renshen), Cornu Cervi Pantotrichum (Lujiao Jiao), Testudinis et Plastrum (Guiban), Ossis Tigris (Hugu), Angelicae Sinensis Radix (Danggui), Salviae Miltiorrhizae Radix (Danshen), Rehmanniae Radix (Dihuang), Drynariae Rhizoma (Gusuibu), and Xanthii Fructus (Cangerzi). After taking the decoction for two months, the muscles gradually regenerated, dietary intake increased significantly, and the trembling of both hands subsided and returned to normal.