肤胀者,寒气客于皮肤之间, 然不坚,腹大,身尽肿,皮浓。按其腹, 而不起,腹色不变,此其候也。
肤胀因阳虚寒气客于皮肤,内无水邪,但是虚肿,故 然不坚,其皮浓。按其腹, 而不起,以气虚不
鼓也,腹色不变,则与水胀之皮薄色亮,按之随手而起者不同矣。 音杳,坎陷之义。
鼓胀者,腹胀,身皆大,大与肤胀等也。色苍黄,腹筋起,此其候也。
此由内伤肝脾,故色青黄并现,腹胀而有筋绽。与水胀、肤胀因各不同,其证亦异。如后条旦食不能暮食,
用鸡矢醴者相类。
肠覃者,寒气客于肠外,与卫气相搏,气不得营,因有所系,癖而内着,恶气乃起,息肉乃生。其始生
也,大如鸡卵,稍以益大,至其成,如怀子之状,久者离岁,按之则坚,推之则移,月事以时下,此其候也。
肠覃始由寒气客于肠外,是在躯壳之内,正卫气出入之区,寒邪与气相搏,因而结成癖积,恶气乃起,息肉
乃生。岁久大如怀子,按之坚而推之移,其结在气分,故血脉流通,月事仍应时
而下,盖与卫气所结,卫行脉外故也。
石瘕生于胞中,寒气客于子门,子门闭塞,气不得通,恶血当泻不泻, 以留止,日以益大,状如怀子,
月事不以时下。皆生于女子,可导而下。
石瘕由寒气客于子门,假血成形,结如石坚,故名石瘕,而在胞脉之中,故状如怀子,俗所谓鬼胎也。
此以恶血当泻不泻,瘀结而月事不通,与上之肠覃有气血之分,而皆生于女子,当通利导之而下也。帝所问尚有
石水一证,岐伯无答,义详前卷诸风证中。
肤胀,是由于寒气停留在皮肤之间,腹部叩击呈鼓音但不坚硬,腹部膨大,全身浮肿,皮肤增厚。按压腹部时,凹陷不能立即恢复,腹部肤色没有变化,这是肤胀的征候。
肤胀是因为阳气虚弱,寒气客居于皮肤,体内没有水湿邪气,只是虚性肿胀,所以叩击呈鼓音且不坚硬,皮肤增厚。按压腹部,凹陷不起,是因为气虚不能推动所致;腹部肤色不变,这就与水胀(水肿)不同,水胀的皮肤薄而光亮,按压后凹陷随手即起。杳(yǎo),意为深远、陷下。
鼓胀,表现为腹部胀满,身体也都肿大,肿大的程度与肤胀相当。面色苍黄,腹壁青筋暴露,这是鼓胀的征候。
这是由于内伤肝脾,所以青色和黄色同时显现,腹部胀满且有筋脉绽露。这与水胀、肤胀的成因各不相同,其症状也有差异。例如后面提到的“早晨吃饭晚上就不能吃”,使用鸡矢醴治疗的病症是类似的。
肠覃,是寒气客居在肠外,与卫气相互搏结,气机不能正常运行,因而有所附着,癖积内生,恶气由此产生,息肉随之生成。刚开始形成时,大小如鸡蛋,逐渐增大,直到成熟时,状似怀孕,病程长的可达一年以上,按压时感觉坚硬,推之可以移动,月经仍能按时来潮,这是肠覃的征候。
肠覃起初由寒气客居在肠外,位于躯壳之内,正是卫气出入的区域,寒邪与气相搏结,从而结成癖积,恶气产生,息肉生成。日久变大如怀孕状,按压坚硬而推之可移,因为结聚在气分,所以血脉流通,月经仍能按时下行,这是因为是与卫气相结,而卫气行于脉外的缘故。
石瘕生于胞宫之中,寒气客居于子门,子门闭塞,气机不能通畅,恶血应当排出却未能排出,因而留滞停止,日渐增大,形状像怀孕,月经不能按时来潮。石瘕都发生于女子,可以用导引通下的方法治疗。
石瘕是由寒气客居于子门,假借血液成形,结块坚硬如石,所以称为石瘕,病位在胞脉之中,所以形状像怀孕,俗称鬼胎。这是因为恶血应当排出却未排出,瘀血结聚导致月经不通,与上面的肠覃有气分和血分的区别,但都发生于女子,应当通过通利导下的方法来治疗。黄帝所问还有石水这一证候,岐伯没有回答,义理详见前卷诸风证中。
Fu Zhang (Skin Distension) occurs when Cold Evil lodges between the skin and flesh. Percussion yields a drum-like sound, yet the abdomen is not firm; the abdomen is distended, the whole body is swollen, and the skin is thick. Pressing the abdomen leaves an indentation that does not rise immediately, and the abdominal color remains unchanged; this is the manifestation of Fu Zhang.
Fu Zhang arises from Yang Deficiency with Cold Evil lodging in the skin. There is no Water Evil internally, only Qi deficiency causing swelling; thus, percussion sounds like a drum and it is not firm, with thickened skin. Pressing the abdomen causes an indentation that does not rebound because Qi is deficient and cannot push upwards. The abdominal color remaining unchanged distinguishes it from Shui Zhang (Water Distension), where the skin is thin and lustrous, and indentations rebound immediately upon release. "Yao" (杳) implies depth or depression.
Gu Zhang (Drum Distension) presents with abdominal distension and generalized bodily enlargement, comparable in degree to Fu Zhang. The complexion is pale yellow, and abdominal collateral vessels are prominent; this is the manifestation of Gu Zhang.
This condition results from internal injury to the Liver and Spleen, causing cyanosis and jaundice to appear simultaneously, along with abdominal distension and protruding veins. Its etiology differs from Shui Zhang and Fu Zhang, and its symptoms are distinct. It is similar to the case mentioned later regarding inability to eat at night after eating in the morning, treated with Ji Shi Li (Chicken Dropping Fermented Liquid).
Chang Qun (Intestinal Polyp/Tumor) occurs when Cold Evil lodges outside the intestines, struggling with Wei Qi (Defensive Qi). Qi fails to circulate properly, becomes anchored, and forms fixed masses. Evil Qi arises, and polyps grow. Initially, the mass is the size of a chicken egg, gradually enlarging until it resembles pregnancy. In chronic cases lasting over a year, the mass feels firm upon pressure but can be moved by pushing. Menstruation still arrives on time; this is the manifestation of Chang Qun.
Chang Qun begins with Cold Evil lodging outside the intestines, within the shell of the body, which is the region of Wei Qi circulation. Cold Evil struggles with Qi, forming fixed accumulations, generating Evil Qi, and producing polyps. Over years, it grows large like pregnancy; it is firm on pressure but movable. Since the accumulation is in the Qi level, blood vessels remain patent, allowing menstruation to proceed on schedule. This is because it binds with Wei Qi, which circulates outside the vessels.
Shi Jia (Stone Mass) originates in the Bao Zhong (Uterus/Womb). Cold Evil lodges at the Zi Men (Os Uteri/Cervical Orifice), causing closure. Qi fails to flow freely, and Evil Blood (stagnant blood) should be discharged but is retained, stopping and accumulating daily. It enlarges progressively, resembling pregnancy, and menstruation does not occur on time. Shi Jia occurs exclusively in women and can be treated by guiding and purging downward.
Shi Jia results from Cold Evil lodging at the Zi Men, taking shape from blood, forming a stone-hard mass, hence the name. Located in the Bao Mai (Uterine Collaterals), it resembles pregnancy, commonly known as Ghost Fetus. Because Evil Blood is retained rather than discharged, stasis blocks menstruation. Unlike Chang Qun above, which involves the Qi level, Shi Jia involves the Blood level. Both occur in women and require treatment via promoting free flow and guiding downward. The Yellow Emperor also asked about Shi Shui (Stone Water), but Qibo did not answer; the principle is detailed in the previous volume under Various Wind Syndromes.