伤损之证肿痛者,乃瘀血凝结作痛也。若胀而重坠,色或青黑,甚则发热作渴汗出者,
乃经络壅滞,阴血受伤也。宜先刺去恶血以通壅塞,后用四物汤以调之。
四物汤(方见伤损出血)
伤损之证血虚作痛者,其证则发热作渴,烦闷头晕,日晡益甚,此阴虚内热之证。宜八珍汤加丹皮、麦冬、
五味子、肉桂、骨碎补治之。
八珍汤(方见瘀血泛注)
伤损呕吐黑血者,始因打仆伤损,败血流入胃脘,色黑如豆汁,从呕吐而出也。形气实者,用百合散;形气
虚者,加味芎 汤。
百合散
川芎 赤芍药 当归 百合 生地 侧柏叶 荆芥 犀角 丹皮 黄芩 黄连 栀子 郁金 大黄(各一钱)
水煎,加童便和服。
加味芎 汤
芎 当归 白术 百合(水浸一日) 荆芥(各一钱)
水一盅半,酒半盅,煎八分,不拘时服。
伤损之发热者,若因出血过多,脉洪大而虚,重按之全无者,此血虚发热也,用当归补血汤;脉若沉微,按
之软弱者,此阴盛发热也,宜用四君子汤加炮姜、附子;若发热烦躁,肉 筋惕者,此亡血也,宜用圣愈汤;如发
热汗出不止者,此血脱也,宜用独参汤。血脱之证,其脉实者难治,细小者易治。
当归补血汤
黄 (炙,一两) 当归(三钱)
水煎服。
圣愈汤
人参 川芎 当归 熟地黄 生地 黄 (炙,各等分)
水煎服。
四君子汤 独参汤(俱见伤损出血)
凡因外力损伤导致的肿痛症状,是由于瘀血凝结阻滞经络而引发的疼痛。如果患处肿胀且伴有沉重下坠感,皮肤颜色呈现青色或黑色,严重时出现发热、口渴、出汗等症状,这是经络气血壅滞不通,阴血受损的表现。治疗上应先通过针刺放出恶血以疏通壅塞,然后再使用四物汤进行调理。
若损伤后表现为血虚引起的疼痛,其症状包括发热、口渴、心烦胸闷、头晕目眩,且在下午申时(日晡)症状加重,这属于阴虚内热的证候。治疗宜选用八珍汤,并加入牡丹皮、麦冬、五味子、肉桂、骨碎补进行调理。
若损伤后呕吐出黑色血液,起初是因为跌打扑损导致败血流入胃脘部位,血液颜色黑得像豆汁一样,随呕吐排出体外。对于体质壮实者,使用百合散;对于体质虚弱者,使用加味芎劳汤。
百合散的组成:川芎、赤芍药、当归、百合、生地黄、侧柏叶、荆芥、犀角、牡丹皮、黄芩、黄连、栀子、郁金、大黄(每味各一钱)。用水煎煮,加入童子尿混合服用。
加味芎劳汤的组成:川芎、当归、白术、百合(用水浸泡一天)、荆芥(每味各一钱)。用水一盅半、酒半盅,煎至剩余八分,不拘泥于固定时间服用。
若损伤后出现发热,若因失血过多导致脉象洪大但按之空虚无力,重按时完全感觉不到脉搏,这是血虚发热,应使用当归补血汤;若脉象沉细微弱,按之软弱无力,这是阴寒盛极导致的发热,宜用四君子汤加入炮姜、附子;若发热伴烦躁不安,肌肉跳动、筋脉抽搐,这是亡血(严重失血)的表现,宜用圣愈汤;若发热且汗出不止,这是血脱(气随血脱)的表现,宜用独参汤。对于血脱证,若脉象坚实有力则难治,脉象细小微弱则易治。
当归补血汤的组成:黄芪(炙,一两)、当归(三钱)。用水煎服。
In cases of injury characterized by swelling and pain, the pain is caused by the coagulation and stagnation of blood stasis. If there is distension with a heavy, bearing-down sensation, discoloration appearing blue or black, and in severe cases, fever, thirst, and sweating, this indicates obstruction and stagnation of the meridians and damage to Yin blood. Treatment should first involve pricking to release evil blood (stagnant blood) to unblock the obstruction, followed by regulation using Siwu Tang (Four Substances Decoction).
If pain following an injury is due to Blood deficiency, symptoms include fever, thirst, irritability, chest oppression, dizziness, and worsening in the late afternoon (Shi hour, 3-5 PM). This constitutes a syndrome of Yin deficiency with internal heat. Treatment is appropriate with Bazhen Tang (Eight Treasures Decoction) added with Mudanpi (Moutan Cortex), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Rougui (Cinnamomi Cortex), and Gusuibu (Drynariae Rhizoma).
If vomiting of black blood occurs after injury, it initially results from trauma causing damaged blood to flow into the stomach cavity. The blood appears black like bean juice and is expelled through vomiting. For patients with robust constitution and Qi, Baihe San (Lily Powder) is used; for those with deficient constitution and Qi, Jiawei Xiong Gui Tang (Modified Chuanxiong and Angelica Decoction) is indicated.
Baihe San Composition: Chuanxiong (Ligusticum Chuanxiong Rhizome), Chi Shaoyao (Paeoniae Radix Rubra), Danggui (Angelicae Sinensis Radix), Baihe (Lilii Bulbus), Shengdihuang (Rehmanniae Radix), Cebaiye (Platycladi Cacumen), Jingjie (Schizonepetae Herba), Xijiao (Rhinocerotis Cornu - *Note: Substitute with legal alternatives in modern practice*), Mudanpi (Moutan Cortex), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), Yujin (Curcumae Radix), Dahuang (Rhei Radix et Rhizoma) (each 1 qian/3g). Decoct in water, mix with Tongbian (urine of a healthy young boy) and take orally.
Jiawei Xiong Gui Tang Composition: Chuanxiong (Ligusticum Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baihe (Lilii Bulbus, soaked in water for one day), Jingjie (Schizonepetae Herba) (each 1 qian/3g). Decoct with 1.5 cups of water and 0.5 cup of wine until 0.8 cup remains. Take at any time.
Regarding fever following injury: If caused by excessive blood loss, resulting in a pulse that is surging yet empty upon light pressure and completely imperceptible upon deep pressure, this is Fever due to Blood Deficiency, treated with Danggui Buxue Tang (Angelica Tonifying the Blood Decoction). If the pulse is deep, minute, and weak upon pressure, this is Fever due to Excess Yin (Cold), treated with Sijunzi Tang (Four Gentlemen Decoction) added with Paojiang (Prepared Ginger) and Fuzi (Aconiti Lateralis Radix Praeparata). If fever is accompanied by restlessness, muscle twitching, and fasciculations, this indicates Loss of Blood (severe hemorrhage), treated with Shengyu Tang (Savior the Life Decoction). If fever is accompanied by incessant sweating, this indicates Blood Collapse (Qi collapsing with Blood), treated with Dushen Tang (Single Ginseng Decoction). In cases of Blood Collapse, if the pulse is solid/excess, prognosis is difficult; if the pulse is fine/small, prognosis is favorable.
Danggui Buxue Tang Composition: Huangqi (Astragali Radix, roasted/honey-fried, 1 liang/30g), Danggui (Angelicae Sinensis Radix, 3 qian/9g). Decoct in water and take orally.
Shengyu Tang Composition: Renshen (Ginseng Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Shudihuang (Rehmanniae Radix Preparata), Shengdihuang (Rehmanniae Radix), Huangqi (Astragali Radix, roasted/honey-fried) (equal parts). Decoct in water and take orally.
Sijunzi Tang (Four Gentlemen Decoction) and Dushen Tang (Single Ginseng Decoction) (See "Hemorrhage from Injury" section for formulas).