大全云∶ 者,在腹内近脐左右,各有一条筋脉急痛,大者如臂,次者如指,因气而成,
如弦之状,名曰 也。癖者,为僻侧在两肋之间,有时而痛,故曰癖也。二者皆阴阳不和,经
络痞隔,饮食停滞,不得宣流,邪冷之气,搏结不散,得冷则发作疼痛。夫 癖 瘕血气
块硬,发作则痛,甚则欲死,究而言之,皆血之所为。仆尝治一妇人,血气刺痛,极不可忍,甚
而死一二日方省,医巫并治,数年不愈,仆以葱白散、乌鸡丸遂安。又尝治一妇人,血气作
楚,如一小盘样,走注刺痛,要一人扶定,方少止,亦用此二药而愈。寻常小小血气,用此二
药,亦有奇效,故录于后。
大全云∶妇人疝瘕,由饮食不节,寒温不调,气血劳伤,脏腑虚弱,风冷入腹,与血相结
所生。疝者,痛也,瘕者,假也,结聚浮假百痛,推移乃动也。妇人之病,有异于丈夫者,或因
产后血虚受寒,或因经水往来,取冷过度,非独因饮食失节,多挟于血气所成也。其脉弦急
者生,虚弱小者死。尺脉涩而浮牢,为血实气虚,其发腹痛,逆气上行,此为胞中有恶血,
(巢氏止言胞门伤,而此直指胞中恶血,亦本病源来)久则结成血瘕也。
薛氏曰∶子和云遗溺闭癃,阴痿浮痹,精滑白淫,皆男子之疝也。若血涸,月事不行,行
后小腹有块,或时动移,前阴突出,后阴痔核,皆女子之疝也。但女子不谓之疝,而谓之瘕。
(女子亦有疝,男子亦有瘕)
一妇人小腹痞胀,小便时下白带,小水淋沥,此肝经湿热下注,用龙胆泻肝汤而愈。
一妇人小腹胀痛,小水不利,或胸乳作痛。或胁肋作胀,或气逆心吻,余以为肝火而
血伤脾,用四物、柴胡、青皮、玄胡索、木香而愈。
一妇人小腹痞闷,小便不利,内热体倦,懒食,用八珍汤加柴胡、山栀、龙胆草治之而安。
《大全》记载:奔豚病,是在腹部靠近肚脐的左右两侧,各有一条筋脉拘急疼痛,大的像手臂那么粗,小的像手指那么细,因气机郁结而成,形状像琴弦一样,称为奔豚。癖积,是指偏侧位于两肋之间,时有疼痛发作,所以称为癖。这两种病症都是因为阴阳失调,经络阻滞,饮食停滞,不能正常宣通流布,寒邪冷气搏结不散,遇到寒冷就会发作疼痛。所谓奔、癖、瘕,都是血气凝结成块变硬,发作时疼痛,严重时甚至让人痛不欲生,究其根本原因,都是由血分病变引起的。我曾经治疗一位妇人,血气刺痛,极度难以忍受,痛得昏死过去一两天才苏醒,医生和巫师一起治疗,几年都不见好转,我用葱白散、乌鸡丸治疗后便痊愈了。又曾经治疗一位妇人,血气作痛,感觉像有一小盘东西在体内游走窜动并刺痛,需要一个人扶住固定住,才能稍微缓解,也是用了这两种药而治愈。寻常轻微的血气病,用这两种药,也有奇效,所以记录在后面。
《大全》记载:妇女的疝瘕病,是由于饮食不节制,寒温不调,气血劳损受伤,脏腑虚弱,风冷侵入腹部,与血液相互搏结所产生。疝,意思是疼痛;瘕,意思是假象(聚散无常),结聚浮泛不定引起各种疼痛,推动它才会移动。妇女的疾病,与男子不同,有的因为产后血虚受寒,有的因为月经往来期间贪凉过度,不仅仅是因为饮食失节,大多夹杂血气病变而形成。脉象弦急的预后良好,脉象虚弱细小的预后不良。尺脉涩而浮且牢,表示血实气虚,发作时腹痛,逆气上行,这是胞宫中有恶血停留,(巢元方只说胞门受伤,而这里直接指出胞中有恶血,也是依据《诸病源候论》的本意),时间久了就结成血瘕。
薛己说:张子和说,遗尿、小便闭塞不通、阳痿、浮肿麻痹、精液滑泄、白带过多,都是男子的疝病。如果阴血枯竭,月经不行,行经后小腹有肿块,或者时常移动,前阴突出,后阴长痔核,这些都是女子的疝病。但是女子不称之为疝,而称之为瘕。(其实女子也有疝,男子也有瘕)
有一位妇人小腹痞闷胀满,小便时下白带,小便淋漓不尽,这是肝经湿热下注所致,用龙胆泻肝汤治疗而痊愈。
有一位妇人小腹胀痛,小便不利,有时胸乳疼痛,有时胁肋胀满,有时气逆冲心,我认为这是肝火旺盛损伤了脾血,用四物汤加柴胡、青皮、玄胡索、木香治疗而痊愈。
*Daquan* records: Ben Tun (Rushing Pig Disease) involves cramping pain in the tendons on either side of the abdomen near the umbilicus. The larger masses are as thick as an arm, and the smaller ones as thick as a finger. It forms due to Qi stagnation and resembles a taut string; it is named Ben Tun. Pi Ji (Favoring Accumulation) refers to masses located obliquely between the two hypochondria, causing intermittent pain, hence the name Pi Ji. Both conditions arise from disharmony of Yin and Yang, obstruction of collaterals, retention of food, and failure of normal circulation. Cold pathogenic Qi binds and does not disperse; upon exposure to cold, pain erupts. Generally speaking, Ben, Pi, and Jia involve hardening of blood-Qi masses. Upon attack, they cause pain, and in severe cases, may lead to near-death agony. Ultimately, all these are manifestations of Blood pathology. I once treated a woman suffering from stabbing pain due to Blood-Qi stagnation, which was unbearable, causing her to faint for one or two days before regaining consciousness. Despite treatment by both physicians and shamans over several years without success, she recovered after I administered Congbai San (Scallion Juice Powder) and Wuji Wan (Black Chicken Pill). I also treated another woman whose Blood-Qi pain felt like a small plate moving within her body with stabbing sensations; she required someone to hold her still for slight relief. She too was cured using these two remedies. For ordinary mild Blood-Qi disorders, these two medicines also yield miraculous effects, so I record them hereafter.
*Daquan* records: Women's Shan Jia (Hernia and Masses) arises from irregular diet, imbalance of cold and heat, exhaustion and injury of Qi and Blood, weakness of the Zang-Fu organs, invasion of wind-cold into the abdomen, and binding with Blood. "Shan" denotes pain; "Jia" denotes falsity (transience); the masses gather and float unpredictably causing various pains, moving only when pushed. Women's diseases differ from men's; some result from cold invasion following postpartum Blood deficiency, others from excessive exposure to cold during menstruation. It is not solely due to dietary irregularities but mostly involves complications with Blood-Qi pathology. A wiry and urgent pulse indicates a favorable prognosis, while a weak and thready pulse indicates an unfavorable one. A Chi (Cun Cun) pulse that is choppy, floating, and firm indicates Excess of Blood and Deficiency of Qi. Attacks involve abdominal pain and rebellious Qi rising upward; this signifies foul blood retained in the Bao Zhong (Uterus). (Chao Yuanfang only mentioned injury to the Bao Men [Uterine Gate], whereas this text directly points to foul blood in the Bao Zhong, consistent with the *Bing Yuan*). Over time, this condenses into a Xue Jia (Blood Mass).
Xue Ji states: Zhang Zihe said that enuresis, urinary retention, impotence, edema and numbness, seminal emission, and leukorrhea are all Shan (Hernia) in men. If Yin Blood is depleted, menstruation ceases; after menstruation, a mass appears in the lower abdomen, sometimes shifting; protrusion of the anterior orifice and hemorrhoidal nodules at the posterior orifice are all Shan in women. However, women's conditions are not called Shan but Jia. (Note: Women can indeed have Shan, and men can have Jia.)
A woman presented with distension and fullness in the lower abdomen, intermittent leukorrhea in urine, and dribbling urination. This was Damp-Heat pouring downward from the Liver Channel, treated successfully with Longdan Xiegan Tang (Gentian Liver-Draining Decoction).
Another woman presented with distending pain in the lower abdomen, difficult urination, occasional chest and breast pain, hypochondriac distension, and rebellious Qi rushing to the heart. I diagnosed this as Liver Fire injuring Spleen Blood, treating her successfully with Siwu Tang (Four Substances Decoction) augmented with Chai Hu (Bupleuri Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Yan Hu Suo (Corydalis Rhizoma), and Mu Xiang (Aucklandiae Radix).
A third woman presented with stuffiness and oppression in the lower abdomen, difficulty urinating, internal heat, fatigue, and poor appetite. She was stabilized using Bazhen Tang (Eight Treasures Decoction) augmented with Chai Hu, Shan Zhi (Gardeniae Fructus), and Long Dan Cao (Gentianae Radix).