(宜与囊肿参看)
总括 疝有七症君须记,狐 寒水筋血气;总之寒气结而成,丹溪独断湿热致。
脉法 寸口脉弦而紧,弦则卫气不行,卫气不行则恶寒;紧则不欲饮食,弦紧相搏,则为寒疝。
《内经》曰∶肾脉太急沉,肝脉太急沉,皆为疝。又曰∶三阳结为瘕,三阴结为疝。(批∶怒则气上,喜则气缓,
悲则气消,恐则气下,寒则气收,热则气泄,劳则气耗,思则气结。)
《难经》曰∶任脉之为病,其内苦结,男子为七疝。夫谓七疝者,寒、水、筋、血、气、狐、 是也。自《素问》
而下,俱称寒气结聚之所为,故令脐腹绞痛也。而丹溪独断为湿热焉,或者热郁于中,寒束于外者有矣,宜五苓散加茴
香、橘核、金铃子、槟榔、木通之类,斯愈矣。又或肝经湿热而拗肿痛者,服龙胆泻肝汤。
〔附方〕
五苓散 见惊风症内。
龙胆泻肝汤 胆草 泽泻 车前子 木通 生地 当归 栀子 黄芩 甘草
治疝神方 用胡麻根捣汁,入无灰酒调下,以渣涂疝四围,效。(朱仁甫传)
总括 滞颐之症口流涎,脾家有热涌而然;亦有胃寒而作者,虫痛涎流湿热兼。
《内经》曰∶足太阴之经通于口。盖脾之液为涎,小儿口流涎出而积于颐间者,因脾家受病,不能收摄耳。凡作渴
饮冷者属实热,宜泻胃火;作渴饮汤者属虚热,宜补中气。若脾经实热而廉泉不能约制者,用牛黄清心丸。(自批∶药
铺中不可用,以其药味不纯也。不如用万氏牛黄清心丸较稳。)脾经虚热而廉泉不能统摄者,用六君子加木香。胃经实
热而虫动津涎流出者,用泻黄散;虚热用五味异功散。大便闭结,用四顺清凉饮。食积内热,用大安丸。
〔附方〕
六君子汤 见疟疾症内。
泻黄散 见热症内。
五味异功散 人参 白术 茯苓 陈皮 甘草
四顺清凉饮(即四顺饮) 见伤寒症内。
大安丸 即保和丸加白术 神曲 山楂 半夏 茯苓 陈皮 连翘 卜子
(宜与囊肿参看)
总括:疝病有七种证型,你必须牢记:狐疝、寒疝、水疝、筋疝、血疝、气疝;总之是由寒气凝结而成,但朱丹溪独自断定是由湿热所致。
脉法:寸口脉象弦而紧,弦脉则导致卫气运行不畅,卫气运行不畅就会恶寒;紧脉则导致不想饮食,弦脉与紧脉相互搏结,就形成寒疝。
《内经》说:肾脉过于急沉,肝脉过于急沉,都表现为疝病。又说:三阳经邪气结聚形成瘕积,三阴经邪气结聚形成疝病。(批注:愤怒则气机上逆,喜悦则气机舒缓,悲伤则气机消减,恐惧则气机下陷,寒冷则气机收敛,炎热则气机泄越,劳累则气机耗散,思虑则气机郁结。)
《难经》说:任脉发生病变,内部感觉痛苦结滞,男子表现为七疝。所谓七疝,就是寒、水、筋、血、气、狐、[肉]疝。自从《素问》以下,都称为寒气结聚所导致的,因此引起脐腹绞痛。而朱丹溪独自断定是湿热,或许是有热邪郁结于内、寒邪束缚于外的情况,适宜使用五苓散加小茴香、橘核、金铃子、槟榔、木通之类的药物,这样就能痊愈。又或者是肝经湿热导致肿胀疼痛的,服用龙胆泻肝汤。
〔附方〕
五苓散 见惊风症章节内。
龙胆泻肝汤 龙胆草 泽泻 车前子 木通 生地 当归 栀子 黄芩 甘草
治疝神方 用胡麻根捣取汁液,加入无灰酒调服,并将药渣涂抹在疝气周围,有效。(朱仁甫传授)
总括:滞颐的症状是口流涎水,这是因为脾家有热涌出所致;也有因胃寒引起的,还有因虫痛导致涎水流出的,以及兼夹湿热的情况。
《内经》说:足太阴脾经通达于口。大概脾的体液为涎,小儿口中流出涎水积聚在下巴颏间,是因为脾脏受病,不能收摄津液罢了。凡是口渴想喝冷水的属于实热证,适宜清泻胃火;口渴想喝热水的属于虚热证,适宜补益中气。如果是脾经实热导致廉泉穴不能约束控制的,使用牛黄清心丸。(自批:药店中的成药不可用,因为其药味不纯正。不如使用万氏牛黄清心丸比较稳妥。)脾经虚热导致廉泉穴不能统摄的,使用六君子汤加木香。胃经实热导致虫动津涎流出的,使用泻黄散;虚热证使用五味异功散。大便闭结的,使用四顺清凉饮。食积内热的,使用大安丸。
〔附方〕
六君子汤 见疟疾症章节内。
泻黄散 见热症章节内。
五味异功散 人参 白术 茯苓 陈皮 甘草
四顺清凉饮(即四顺饮) 见伤寒症章节内。
大安丸 即保和丸加白术 神曲 山楂 半夏 茯苓 陈皮 连翘 莱菔子
(Refer to Cyst for comparison)
General Overview: There are seven types of Shan (Hernia), which you must remember: Hu Hernia, Han Hernia, Shui Hernia, Jin Hernia, Xue Hernia, Qi Hernia; in essence, they are formed by the congealing of Cold Qi, but Zhu Danxi independently concluded that they are caused by Damp-Heat.
Pulse Diagnosis: The pulse at Cun Kou is wiry and tight. A wiry pulse indicates that Wei Qi (Defensive Qi) does not circulate freely; when Wei Qi does not circulate freely, there is aversion to cold. A tight pulse indicates a lack of appetite. When wiry and tight pulses interact, it results in Cold Shan (Hernia).
The *Neijing* states: If the Kidney pulse is excessively rapid and deep, or if the Liver pulse is excessively rapid and deep, both manifest as Shan (Hernia). It also states: The binding of the Three Yang meridians forms Jia masses, while the binding of the Three Yin meridians forms Shan (Hernia). [Commentary: Anger causes Qi to rise upward; joy causes Qi to relax; grief causes Qi to dissipate; fear causes Qi to sink downward; cold causes Qi to contract; heat causes Qi to leak out; exertion causes Qi to be consumed; overthinking causes Qi to knot.]
The *Nanjing* states: When the Ren Mai (Conception Vessel) is diseased, there is internal painful binding, and in men, this manifests as Seven Shan (Hernias). The so-called Seven Shan (Hernias) are Han (Cold), Shui (Water), Jin (Sinew), Xue (Blood), Qi (Qi), Hu (Fox), and [Rou] (Flesh) hernias. Since the *Suwen*, it has been universally attributed to the accumulation and congealing of Cold Qi, thus causing colicky pain in the umbilical and abdominal regions. However, Zhu Danxi independently concluded it was due to Damp-Heat. Perhaps there are cases where Heat is constrained internally while Cold binds externally; in such cases, it is appropriate to use Wuling San (Five-Ingredient Powder with Poria) added with Huixiang (Fennel Fruit), Juhe (Tangerine Seed), Jinlingzi (Szechwan Chinaberry Fruit), Binglang (Areca Seed), Mutong (Akebia Stem), and similar herbs, which will lead to recovery. Alternatively, if it is Damp-Heat in the Liver Meridian causing swelling and pain, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) should be taken.
[Attached Formulas]
Wuling San (Five-Ingredient Powder with Poria) See within the Convulsive Disease chapter.
Longdan Xiegan Tang (Gentian Liver-Draining Decoction) Gentian Root, Alisma Rhizome, Plantago Seed, Akebia Stem, Rehmannia Root, Angelica Sinensis Root, Gardenia Fruit, Scutellaria Root, Licorice Root.
Divine Formula for Treating Hernia Use juice extracted from flaxseed root, mixed with unadulterated wine for oral administration, and apply the dregs around the periphery of the hernia. Effective. (Transmitted by Zhu Renfu)
General Overview: The symptom of Zhiyi (Drooling) is drooling from the mouth, caused by Heat surging from the Spleen; it can also be caused by Stomach Cold, by worm-induced pain leading to salivation, or by concurrent Damp-Heat.
The *Neijing* states: The Foot-Taiyin Spleen Meridian connects to the mouth. Essentially, the fluid of the Spleen is saliva. When children drool and accumulate saliva between the chin and lower lip, it is because the Spleen is diseased and cannot control the fluids. Those who are thirsty and desire cold drinks belong to Excess-Heat patterns, suitable for draining Stomach Fire. Those who are thirsty and desire hot drinks belong to Deficiency-Heat patterns, suitable for tonifying Middle Qi. If it is Excess-Heat in the Spleen Meridian causing the Lianquan acupoint to fail in its restraining function, Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill) should be used. [Self-commentary: Do not use commercial pills from pharmacies, as their ingredients are impure. It is more stable to use Wan's Niuhuang Qingxin Pill.] If it is Deficiency-Heat in the Spleen Meridian causing the Lianquan acupoint to fail in its governing function, Liujunzi Tang (Six-Gentlemen Decoction) added with Muxiang (Costus Root) should be used. If it is Excess-Heat in the Stomach Meridian causing worms to move and saliva to flow, Xiehuang San (Drain Yellow Powder) should be used; for Deficiency-Heat, Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) should be used. For constipation, Sishun Qingliang Yin (Four-Obedience Cooling Drink) should be used. For food stagnation with internal heat, Da'an Wan (Great Peace Pill) should be used.
[Attached Formulas]
Liujunzi Tang (Six-Gentlemen Decoction) See within the Malaria chapter.
Xiehuang San (Drain Yellow Powder) See within the Heat Disease chapter.
Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder) Ginseng, Atractylodes Macrocephala Rhizome, Poria, Tangerine Peel, Licorice Root.
Sishun Qingliang Yin (Four-Obedience Cooling Drink) (Also known as Sishun Yin) See within the Cold Damage chapter.
Da'an Wan (Great Peace Pill) Is Bahe Wan (Harmony-Preserving Pill) plus Atractylodes Macrocephala Rhizome, Medicated Leaven, Hawthorn Fruit, Pinellia Tuber, Poria, Tangerine Peel, Forsythia Fruit, Radish Seed.