附子 川乌(各炮半两) 全蝎(净) 僵蚕(一分) 乳香(三钱研) 草乌头(水
煮烂去皮
尖半两) 雄黄 没药(一钱研) 上为末。蜜丸梧桐子大。薄荷汤下二十丸。若发急者只
作
末。每一钱茶酒任下。
内解散
川乌(炮一两) 甘草(半生半炙) 麻黄(一两) 沉香 苍术 防风 萆 (一分)
杜仲
(半两炙) 上为末。每服二钱。姜三片。枣一个。水一盏。煎至六分。去滓温服。上二方
须
溃破脓透。内虚之后可服。
一方 向友正、元仲之子也。淳熙八年。为江陵支使。摄江陵令。痈发于胸臆间。极痛。
疗半岁弗愈。常浴罢痛甚。委顿而卧。似梦而非梦。见一丈夫微揖而坐。传药方与之曰。用
没药、栝蒌、乳香。酒煎服之。且言桃源许轸知县。亦有此方。但不用栝蒌。其效故不速。
友正敬谢。即如所诫。不终剂而愈。后诣玉泉祷雨。瞻寿亭关王。盖所感梦者。因绘像于家
焉。
疮疡治验 戊申岁。以饮酒太过。脉候沉数。九月十七日至真定。脑之下项之上。出小
疮。不痛不痒。谓是白疮。漫不加省。是夜宿睡善甫家。二日后觉微痛。见国医李公明之不
之问。凡三见之。终不以为言。又二日。脑项麻木。肿势外散。热毒 发。且闻此府刘帅者。
近以脑疽物故。便疑之。三日间痛大作。夜不复得寐。二十二日请镇之疡医。遂处五香连翘。
明日再往。又请同门一医。共视之云。此疽也。然而不可速疗。十八日得脓。俟脓出用药或
砭刺。三月乃可平。四月如故。予记医经凡疮见脓九死一生。果如二子言。则当有束手待毙
之悔矣。乃诣姨兄韩参谋彦俊家。请明之诊视。明之见疮。谈笑如平时。且谓予言疮固恶。
子当恃我无忧恐耳。膏粱之变。不当投五香。五香已无及。且疽已八日。当先用火攻之策。
然后用药。午后以大艾炷如枣核许者。攻之至百壮。乃觉痛。次为处方云。是足太阳膀胱之
经。其病逆。当反治。脉中得弦紧。按之洪大而数。又且有力。必当伏其所主。而先其所因。
其始则同。其终则异。可使破积。可使溃坚。可使气和。可使必已。必先岁气。无伐天和。
以时言之。可收不可汗。经与病禁下。法当结者散之。咸以 之。然受寒邪而禁咸。诸苦寒
为君为用。甘寒为佐。酒热为引。用为使。以辛温和血。大辛以解结为臣。三辛三甘。益元
气而和血脉。淡渗以导酒湿。扶持秋令。以益气泻火。以入本经之药和血。且为引用。既以
通经。以为主用。君以黄芩、黄连、黄柏、生地黄、知母。酒制之。本经羌活、独活、防风、
本、防己、当归、连翘。以解结。黄 、人参、甘草。配诸苦寒者三之一。多则滋营气补
土也。生甘草泻肾之火。补下焦元气。人参、橘皮以补胃。苏木、当归尾去恶血。生地黄、
当归身补血。酒制汉防己。以除膀胱留热。泽泻助秋。去酒之湿热。凡此诸药。必得桔梗为
舟楫。乃不下沉。投剂之后。疽当不痛不拆。精气大旺。饮啖进。形体健。予如言服之。药
后投床大鼾。日出乃寤。以手扪疮。肿减七八。予疑疮透候。遽邀明之视之。明之惊喜曰。
疮平矣。屈指记曰。不五七日作痂子。可出门矣。如是三日。忽有宵寐之变。予惧其为死候。
甚忧之。而无可告语之者。适明之入门。戏谓予曰。子服药后有三验。而不以相告何也。乃
历数云。子二三日来健啖否乎。曰然。又问、子脚膝旧弱。今行步有力否乎。曰然。又问、
子昨宵梦有宵寐之变。何不自言。予为之一笑。终不以此变告之也。二十九日。疮痛全失去。
灸瘢脓出。寻作痂。初镇人见刘帅病疽之苦。言及者皆为悲惨。闻予复病此疮。亲旧相念者。
皆举手加额。以早安为祷。十月十七日。明之邀往其家。乘马过市。人见之有为之失喜者。
盖始于投剂。至疮痂敛。都十四日而已。予住在聊城。见明之治梁县杨飞卿胁痈。及郭文之
父脑疽。杨叔能背疽。不十数日皆平复。然皆不若治予疮之神也。医无不难。疗背脑疮尤难。
世医用技。岂无取效者。至于治效之外。乃能历数体中不言之秘。平生所见。惟明之一人而
已。乙未秋。予自济南回。伤冷太过。气绝欲死。明之投剂。应手而愈。起予之死。并此为
二矣。他日劝刘斯立传钱乙。当补述之。明年秋七月二十有五日。河东元好问记。
黄连消毒散
黄连(一钱) 黄芩(五分) 黄柏(五分) 生地黄(四分) 知母(四分) 羌活
(一钱) 独
活(四分) 防风(四分) 本(四分) 当归尾(四分) 桔梗(五分) 黄 (二分)
人参(三
分) 甘草(三分) 连翘(四分) 苏木(二分) 防己(五分) 泽泻(二分) 橘皮
(二分) 上
件锉如麻豆大。都作一服。水二盏。煎至一盏半。去滓温服。食后。一方加山栀子二分。五
味子二分。麦门冬二分。枳壳二分。猪苓二分。名消毒溃坚汤。治人发痈肿、瘰 、乳 。
随病患虚实。药剂轻重。用之无不作效。
附子、川乌(各炮制半两)、全蝎(去净杂质)、僵蚕(一分)、乳香(三钱,研细)、草乌头(用水煮烂,去皮尖,半两)、雄黄、没药(一钱,研细)。以上药物制成粉末。用蜂蜜制成如梧桐子大小的丸剂。用薄荷汤送服二十丸。如果病情发作急骤,只制成散剂。每次服用一钱,用茶或酒任意送下。
内解散方
川乌(炮制一两)、甘草(一半生用,一半炙用)、麻黄(一两)、沉香、苍术、防风、萆薢(一分)、杜仲(炙半两)。以上药物制成粉末。每次服用二钱。加生姜三片、大枣一个、水一盏,煎至六分,去渣温服。上述两个方剂,必须在疮疡溃破流脓之后,且体内正气虚弱时方可服用。
一方
向友正是元仲的儿子。淳熙八年,他担任江陵支使,代理江陵县令。他的胸臆之间长了痈疽,疼痛剧烈。治疗半年没有痊愈。常常在洗澡后疼痛加剧,疲惫地躺卧,似睡非睡,梦见一位男子微微作揖坐下,传给他药方说:“使用没药、栝蒌、乳香,用酒煎服。”并且说桃源县的许轸知县也有这个方子,只是不用栝蒌,所以疗效不够迅速。友正恭敬地致谢,立即按照嘱咐执行,还没服完一剂药就痊愈了。后来他去玉泉祈雨,瞻拜寿亭侯关王庙,原来梦中感应的人就是关王,于是在家绘制了关王的像。
疮疡治验
戊申年,因为饮酒过多,脉象沉而数。九月十七日到达真定。脑后与颈部之间长出一个小小的疮,不痛不痒,以为是白疕(银屑病),漫不经心不加注意。当晚住在善甫家。两天后感觉轻微疼痛,去拜访国医李公明之询问。总共见了三次,他始终没有说什么。又过了两天,脑项麻木,肿胀向外扩散,热毒发作。而且听说本府刘帅最近因患脑疽去世,便怀疑自己也是此病。三天间疼痛大作,夜里无法入睡。二十二日请镇上的外科医生诊治,于是开了五香连翘汤。第二天再去,又请同门的一位医生一起诊视,都说这是疽病。然而不能快速治愈。十八日排出了脓,等待脓液流出后用药或者砭刺,三个月才能平复,四个月才能恢复如初。我记得医经上说凡是疮疡见到脓液是九死一生,果然像这两位医生所说,那我应当有束手待毙的悔恨了吧。于是前往姨兄韩参谋彦俊家,请明之诊视。明之看到疮疡,谈笑如常,并且对我说:“疮固然恶劣,你应当依靠我,不要忧虑恐惧。”膏粱厚味引起的病变,不应当投用五香散。五香散已经来不及用了,况且疽病已经八天,应当先用火攻的策略,然后再用药。午后用大艾炷如枣核大小,灸治达到一百壮,才感觉到疼痛。接着为他处方说:这是足太阳膀胱经的病,病势逆乱,应当反治。脉象中得弦紧,按之洪大而数,而且有力。必须伏其所主,而先治其病因。开始症状相同,最终结果不同。可以破除积滞,可以溃散坚结,可以使气血调和,可以使疾病必愈。必须先顺应岁气,不要破坏天和之气。从时令来说,可收不可发汗。经脉与病症禁忌泻下,法度上应当结者散之,咸味以软之。然而受寒邪则禁咸,诸苦寒药作为君药和臣药,甘寒药作为佐药,酒热作为引经药,用为使药。用辛温药调和血液,大辛药以解结作为臣药。三辛三甘,益元气而和血脉,淡渗药以导酒湿,扶持秋令,益气泻火,用入本经的药物和血,并且作为引用。既然以通经为主用,君药用黄芩、黄连、黄柏、生地黄、知母,用酒炮制。本经羌活、独活、防风、藁本、防己、当归、连翘,以解结。黄芪、人参、甘草,配合诸苦寒药的三分之一,多了则会滋腻营气补土。生甘草泻肾之火,补下焦元气,人参、橘皮以补胃,苏木、当归尾去恶血,生地黄、当归身补血,酒制汉防己,以除膀胱留热,泽泻助秋气,去酒之湿热。所有这些药物,必须得到桔梗作为舟楫,才不会下沉。服药之后,疽疮应当不痛不破,精气大旺,饮食增进,形体健壮。我按照他的话服用。服药后躺床大睡,日出才醒。用手摸疮,肿胀减少七八成。我怀疑疮透发的时机,急忙邀请明之来看。明之惊喜地说:“疮平了。”屈指计算说:“不到五七天结成痂皮,就可以出门了。”像这样过了三天,忽然有夜间睡眠中的变故,我害怕那是死亡的征兆,非常担忧,却无可告诉的人。恰好明之进门,开玩笑对我说:“你服药后有三验,为什么不告诉我呢?”于是历数道:“你这两三天来健食吗?”我说:“是的。”又问:“你脚膝旧弱,现在行走有力吗?”我说:“是的。”又问:“你昨晚梦到夜间睡眠的变故,为什么不自己说?”我为之一笑,终究没有把这个变故告诉他。二十九日,疮痛完全消失,灸痕处脓出,随即结成痂。起初镇上人见刘帅患疽的痛苦,谈论起来都感到悲惨,听说我又患这种疮,亲戚朋友挂念的,都举手加额,祈祷平安。十月十七日,明之邀请我去他家,骑马经过集市,人们看见我有的为之失喜。大概从投药开始,到疮痂收敛,总共十四天而已。我住在聊城,见明之治疗梁县杨飞卿的胁痈,以及郭文之父的脑疽,杨叔能的背疽,都不到十几天都平复了。然而都不如治疗我的疮神奇。医术没有不难的,治疗背脑部的疮尤其难。世医用技术,难道没有取效的吗?至于在治疗有效之外,还能历数身体中不言的秘密,平生所见,只有明之一个人罢了。乙未年秋天,我从济南回来,受寒太过,气绝欲死,明之投药,应手而愈,起死回生,这与此事并列为两件。改日劝刘斯立传记钱乙,应当补述此事。明年秋七月二十五日,河东元好问记。
黄连消毒散
黄连(一钱)、黄芩(五分)、黄柏(五分)、生地黄(四分)、知母(四分)、羌活(一钱)、独活(四分)、防风(四分)、藁本(四分)、当归尾(四分)、桔梗(五分)、黄芪(二分)、人参(三分)、甘草(三分)、连翘(四分)、苏木(二分)、防己(五分)、泽泻(二分)、橘皮(二分)。以上药材锉如麻豆大,全部作为一服。水二盏,煎至一盏半,去渣温服,饭后服用。一方加山栀子二分、五味子二分、麦门冬二分、枳壳二分、猪苓二分,名为消毒溃坚汤,治疗人发痈肿、瘰疬、乳痈。随病患虚实,药剂轻重,用之无不奏效。
Fuzi (Aconiti Lateralis Radix Praeparata), Chuanwu (Aconiti Kusnezoffii Radix) (each processed, ban liang), Quanxie (Scorpio, cleaned), Jiangcan (Bombyx Batryticatus, 1 fen), Ruxiang (Olibanum, 3 qian, ground), Caowutou (Aconiti Kusnezoffii Radix, boiled in water until soft, skin and tip removed, ban liang), Xionghuang (Realgar), Moyao (Myrrha, 1 qian, ground). The above are made into powder. Honey pills the size of Sophora japonica seeds. Take 20 pills with Bohe Tang (Mint Decoction). If the onset is urgent, take only as powder. Take 1 qian each time, with tea or wine as desired.
Neijiesan Powder
Chuanwu (Aconiti Kusnezoffii Radix, processed, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, half raw, half roasted), Mahuang (Ephedrae Herba, 1 liang), Chenxiang (Aquilariae Lignum Resinatum), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), Bixie (Dioscoreae Hypoglaucae Rhizoma, 1 fen), Duzhong (Eucommiae Cortex, roasted, ban liang). The above are made into powder. Take 2 qian each time. Add 3 slices of Shengjiang (Zingiberis Rhizoma Recens), 1 Zao (Jujubae Fructus), 1 zhen of water. Decoct to 6 fen, remove dregs, take warm. The above two formulas must be used after the ulcer has ruptured and pus has emerged, and only when the interior deficiency has occurred.
Another Case
Xiang Youzheng was the son of Yuan Zhong. In the eighth year of Chunxi, he served as the Assistant Administrator of Jiangling and acted as the Magistrate of Jiangling. An abscess developed between his chest and epigastrium, causing extreme pain. It did not heal for half a year. Often after bathing, the pain would intensify, leaving him exhausted and lying down, in a state between sleep and wakefulness. He dreamed of a man who bowed slightly and sat down, transmitting a prescription to him saying: "Use Moyao (Myrrha), Gualou (Trichosanthis Fructus), and Ruxiang (Olibanum). Decoct with wine and take." He also said that Xu Zhen, the Magistrate of Taoyuan, had this same prescription but did not use Gualou, so its effect was not as rapid. Youzheng respectfully thanked him and immediately followed the advice. He recovered before finishing one dose. Later, he went to Yuquan to pray for rain and visited the Temple of Guan Yu at Shouting Pavilion. The person who appeared in his dream was indeed Guan Yu, so he painted his portrait at home.
Clinical Experience in Treating Sores and Ulcers
In the Wushen year, due to excessive drinking, the pulse was deep and rapid. On September 17th, I arrived in Zhending. A small sore appeared below the brain and above the neck. It was neither painful nor itchy. I thought it was Baibang (Psoriasis) and paid no attention to it. That night, I stayed at Shanfu's house. Two days later, I felt slight pain. I visited the National Physician Li Gong Mingzhi three times, but he never mentioned anything. Two days later, my head and neck felt numb, the swelling spread outward, and heat-toxin erupted. Moreover, I heard that Commander Liu of this prefecture had recently died from a carbuncle on the back of the head, so I suspected I had the same disease. Within three days, the pain became severe, and I could not sleep at night. On the 22nd, I invited a surgeon from Zhen to treat me. He prescribed Wuxiang Liaoqiao Decoction. The next day, I went again and invited a fellow physician to examine me together. Both said it was a ju (deep-seated abscess). However, it could not be cured quickly. Pus was discharged on the 18th. Wait for the pus to come out, then apply medicine or use bianci (stone needle therapy). It would take three months to heal and four months to return to normal. I remembered that medical classics state that seeing pus in sores means nine deaths and one life. Indeed, if what these two doctors said was true, I would have regretted waiting helplessly for death. So I went to the home of my maternal cousin, Staff Officer Han Yanjun, and asked Mingzhi to diagnose me. Mingzhi saw the sore, talked and laughed as usual, and told me: "Although the sore is severe, you should rely on me and have no fear." For diseases caused by rich and greasy food, Wuxiang San should not be used. It is too late for Wuxiang San now. Moreover, since the ju has lasted eight days, fire therapy should be used first, followed by medicine. In the afternoon, large moxa cones the size of a jujube pit were applied, totaling 100 moxibustions, until pain was felt. Then he prescribed: This is a disease of the Foot-Taiyang Bladder Meridian. The pathology is rebellious, so reverse treatment is required. The pulse is wiry and tight; pressing it reveals a surging, large, and rapid quality, and it is forceful. One must subdue the dominant pathogen and address the cause first. The beginning may seem similar, but the end will differ. One can break accumulations, soften hardness, harmonize qi and blood, and ensure recovery. One must first consider the seasonal qi and not damage the harmony of heaven and humanity. From the perspective of the season, sweating is contraindicated. The meridian and disease prohibit purgation. The method dictates that stagnation should be dispersed, and salty flavors should soften hardness. However, cold evil prohibits salty flavors. Bitter-cold herbs serve as Sovereign and Minister drugs, sweet-cold herbs as Assistant drugs, hot wine as Guide drugs, and specific herbs as Envoy drugs. Acrid-warm herbs harmonize blood; highly acrid herbs resolve knots as Ministers. Three acrid and three sweet herbs benefit primordial qi and harmonize blood vessels. Bland-draining herbs guide dampness from wine, supporting the autumn energy, benefiting qi, draining fire, using herbs entering the primary meridian to harmonize blood, and serving as guides. Having established unblocking the meridian as the main function, the Sovereign herbs are Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Shengdihuang (Rehmanniae Radix), and Zhimu (Anemarrhenae Rhizoma), all prepared with wine. Ben-meridian herbs Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), Fangfeng (Saposhnikoviae Radix), Gaoben (Ligustici Rhizoma et Radix), Fangji (Stephaniae Tetrandrae Radix), Danggui (Angelicae Sinensis Radix), and Liaoqiao (Forsythiae Fructus) resolve knots. Huangqi (Astragali Radix), Renshen (Ginseng Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) are combined with one-third of the bitter-cold herbs; too much would cloy the Ying qi and tonify Earth. Raw Gancao drains Kidney fire and benefits Lower Jiao primordial qi. Renshen and Ju pi (Citri Reticulatae Pericarpium) tonify the Stomach. Sumu (Sappan Lignum) and Dangguiwei (Angelicae Sinensis Radix) eliminate bad blood. Shengdihuang (Rehmanniae Radix) and Dangguishen (Angelicae Sinensis Radix) nourish blood. Wine-prepared Hanfangji (Stephaniae Tetrandrae Radix) removes retained heat in the Bladder. Zexie (Alismatis Rhizoma) assists autumn energy and removes damp-heat from wine. All these herbs must have Jiegeng (Platycodonis Radix) as a boat and oar to prevent sinking. After taking the medicine, the ju should become painless and not burst, Jing qi will flourish greatly, appetite will increase, and the body will become robust. I took the medicine as instructed. After taking it, I fell into a deep sleep in bed and woke up at sunrise. Touching the sore, the swelling had reduced by seven or eight parts. Suspecting the timing of the sore opening, I urgently invited Mingzhi to see it. Mingzhi was surprised and delighted, saying: "The sore has flattened." Counting on his fingers, he said: "In five to seven days, scabs will form, and you can go out." Three days passed like this. Suddenly, there was a disturbance during nocturnal sleep. I feared it was a sign of death and was very worried, but had no one to tell. Just then, Mingzhi entered the door and jokingly said to me: "You have three signs of efficacy after taking the medicine, why didn't you tell me?" He then listed them: "Have you been eating well these past two or three days?" I said yes. He asked again: "Your legs and knees were previously weak; do you walk with strength now?" I said yes. He asked again: "You had a nocturnal disturbance last night; why didn't you say so yourself?" I smiled, but ultimately did not tell him about the disturbance. On the 29th, the sore pain completely disappeared. Pus came out from the moxa scars, and scabs soon formed. Initially, people in Zhen saw the suffering of Commander Liu's carbuncle, and those who spoke of it felt tragic. Hearing that I had contracted this sore again, relatives and old friends who missed me raised their hands to their foreheads, praying for peace. On October 17th, Mingzhi invited me to his home. Riding a horse through the market, people saw me and some were overjoyed. From the administration of the medicine to the healing of the scab, it took only fourteen days. I lived in Liaocheng and saw Mingzhi treating Yang Feiqing's flank abscess in Liang County, Guo Wen's father's carbuncle on the back of the head, and Yang Shuneng's back carbuncle. None of them took more than ten or twenty days to recover. However, none were as miraculous as the treatment of my sore. Medicine is not difficult; treating sores on the back and head is especially difficult. Do worldly physicians not achieve results with their skills? Beyond achieving therapeutic effects, being able to enumerate the secrets of the body that are not spoken of—throughout my life, I have seen only Mingzhi. In the autumn of Yiwei year, returning from Jinan, I suffered from excessive cold, my qi seemed to cease and I was near death. Mingzhi administered medicine, and I recovered instantly. He brought me back from death; this and the previous case make two. Another day, I advised Liu Sili to write a biography of Qian Yi; it should be supplemented then. On July 25th of the following autumn, recorded by Yuan Haowen of Hedong.
Huanglian Xiaodu San (Coptis Detoxification Powder)
Huanglian (Coptidis Rhizoma, 1 qian), Huangqin (Scutellariae Radix, 5 fen), Huangbai (Phellodendri Cortex, 5 fen), Shengdihuang (Rehmanniae Radix, 4 fen), Zhimu (Anemarrhenae Rhizoma, 4 fen), Qianghuo (Notopterygii Rhizoma et Radix, 1 qian), Duhuo (Angelicae Pubescentis Radix, 4 fen), Fangfeng (Saposhnikoviae Radix, 4 fen), Gaoben (Ligustici Rhizoma et Radix, 4 fen), Dangguiwei (Angelicae Sinensis Radix, 4 fen), Jiegeng (Platycodonis Radix, 5 fen), Huangqi (Astragali Radix, 2 fen), Renshen (Ginseng Radix, 3 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 3 fen), Liaoqiao (Forsythiae Fructus, 4 fen), Sumu (Sappan Lignum, 2 fen), Fangji (Stephaniae Tetrandrae Radix, 5 fen), Zexie (Alismatis Rhizoma, 2 fen), Ju pi (Citri Reticulatae Pericarpium, 2 fen). The above ingredients are cut like hemp beans. Make into one dose. Add 2 zhen of water, decoct to 1.5 zhen, remove dregs, take warm after meals. Another formula adds Shanzhizi (Gardeniae Fructus, 2 fen), Wuweizi (Schisandrae Fructus, 2 fen), Maimendong (Ophiopogonis Radix, 2 fen), Zhike (Aurantii Fructus, 2 fen), Zhuling (Polyporus, 2 fen), named Xiaodu Kuijian Tang (Detoxification and Hardness-Resolving Decoction). It treats carbuncles, swellings, scrofula, and breast abscesses. Depending on the patient's deficiency or excess, and the weight of the prescription, it is invariably effective.