金匮当归生姜羊肉汤治寒疝腹中痛及胁痛里急
当归(三两) 生姜(五两) 羊肉(一斤)
上三味以水八升煮取三升温服七合日三若寒多加生姜呕者加陈皮二两白术一两
蜘蛛散治阴狐疝气偏有大小时时上下
蜘蛛(十四枚熬焦) 桂枝(半两)
上二味为散取八分七饮和服日再服蜜丸亦可
三因失笑散治小肠气痛
五灵脂 蒲黄(等分)
上为末每二钱先用醋一合熬成膏水一盏煎
本事方立效散
川芎 川楝子 青皮 舶上茴香 牵牛(炒) 桃仁(各一两)
上为末每二钱无灰酒一盏煎食前温服
三因葱白散治一切冷疝疼痛
川芎 当归 枳壳(炒) 浓朴(炒) 官桂 青皮 干姜 茴香(炒) 茯苓 川楝子 麦
(炒) 神曲(炒) 三棱(炮) 莪术(煨) 熟地黄 白芍 木香 人参(各一两)
上 咀每三钱葱白二寸盐少许水煎空心服
东垣丁香楝实丸治男子七疝痛不可忍妇人瘕聚带下皆任脉所主阴经也乃肾肝受病故治同
法
当归 附子(炮) 茴香(炒) 川楝(各一两)
上锉细用好酒三升同煮尽为度焙干作细末每药末一两入
丁香 木香(各半钱) 玄胡索(五钱) 全蝎(十三个)
上为末入在前药末内拌匀酒糊丸梧子大每三十丸加至百丸空心温酒送下
按以上方与前理血之剂并厥阴例药也然诸经论疝主于风盖指厥阴风木之气尔故疝病则多
痛痛
亦木气之实即风象也但古今方多主寒主气论治然行者不察气寒浅深之异以分治则不能不无差
误也观东垣之法庶几近理大抵亦不可视为常例盖肾恶燥恐久则反增其势矣
熨法 严氏云盐半斤炒极热以故帛包熨痛处一法用葱白泥一握置脐中上用熨斗熨之或上
置艾灼之妙
《金匮要略》中的当归生姜羊肉汤,用于治疗寒疝引起的腹部疼痛以及胁肋部疼痛、内部拘急不适。
配方:当归(三两)、生姜(五两)、羊肉(一斤)。
以上三味药,用水八升,煎煮至剩余三升,每次温服七合,每日服用三次。如果寒气较重,可增加生姜用量;如果出现呕吐症状,则增加陈皮二两、白术一两。
蜘蛛散,用于治疗阴狐疝气(表现为睾丸偏大偏小,时上时下)。
配方:蜘蛛(十四枚,炒至焦黑)、桂枝(半两)。
以上两味药研为散剂,每次取八分七厘,用温水调和服用,每日服用两次。也可以制成蜜丸服用。
《三因极一病证方论》中的失笑散,用于治疗小肠气痛。
配方:五灵脂、蒲黄(等量)。
以上药物研为细末,每次取二钱,先用醋一合熬成膏状,再加入水一盏煎煮。
《本事方》中的立效散。
配方:川芎、川楝子、青皮、舶上茴香、牵牛子(炒制)、桃仁(各一两)。
以上药物研为细末,每次取二钱,用无灰酒一盏煎煮,饭前温服。
《三因极一病证方论》中的葱白散,用于治疗各种冷疝疼痛。
配方:川芎、当归、枳壳(炒制)、厚朴(炒制)、官桂、青皮、干姜、茴香(炒制)、茯苓、川楝子、麦芽(炒制)、神曲(炒制)、三棱(炮制)、莪术(煨制)、熟地黄、白芍、木香、人参(各一两)。
以上药物切碎,每次取三钱,加葱白二寸、少许盐,用水煎煮,空腹服用。
李东垣的丁香楝实丸,用于治疗男子七种疝气疼痛剧烈难忍,以及妇人癥瘕积聚、带下病。这些病症均由任脉所主,属于阴经病变,是肾和肝受邪所致,因此治疗方法相同。
配方:当归、附子(炮制)、茴香(炒制)、川楝子(各一两)。
以上药物切碎,用好酒三升同煮,直至酒尽为止,然后焙干,研为细末。每取药末一两,加入丁香、木香(各半钱)、玄胡索(五钱)、全蝎(十三个)。
以上药物研为细末,混入前面的药末中拌匀,用酒糊制作成梧桐子大小的丸剂。每次服用三十丸,可逐渐增加至一百丸,空腹时用温酒送服。
按语:以上方剂与前文理血之剂及厥阴经例药类似。然而,各经论述疝气多主于风,这大概是指厥阴风木之气。所以疝病往往多痛,疼痛也是木气实证的表现,即风的征象。但古今方书大多主张从寒、从气论治,而医者若不仔细辨别气与寒的深浅差异来分别治疗,就不能不出现差错。观察李东垣的方法,大致比较合乎道理,但大体上也不可将此视为固定不变的常规例子,因为肾恶燥,恐怕久用燥药反而会增加病情。
熨法:严氏说,取盐半斤炒至极热,用旧布包裹熨烫疼痛部位。另一种方法是用葱白泥一握置于脐中,上面用熨斗熨烫,或者在上面放置艾草进行艾灸,效果奇妙。
The Danggui Shengyang Rousoup (Cinnamon Twig and Lamb Decoction) from *Jingui Yaolue* treats cold hernia (*Han Shan*) with abdominal pain, as well as hypochondriac pain and internal tension.
Formula: Danggui Radix (3 liang), Shengjiang Rhizoma Zingiberis Recens (5 liang), Yangrou Meat of Ovis aries (1 jin).
Take the above three ingredients, add 8 sheng of water, and decoct until 3 sheng remain. Take 7 ge warm each time, three times daily. If cold is severe, increase the dosage of Shengjiang; if vomiting occurs, add Chenpi Pericarpium Citri Reticulatae (2 liang) and Baizhu Rhizoma Atractylodis Macrocephalae (1 liang).
Zhizhu San (Spider Powder) treats Yin Hu Hernia (*Yin Hu Shan Qi*), characterized by testicular swelling alternating in size and position.
Formula: Zhizhu Araneus (14 pieces, roasted until charred), Guizhi Ramulus Cinnamomi (0.5 liang).
Grind the above two ingredients into powder. Take 8 fen 7 li per dose, mixed with warm water for oral administration, twice daily. Honey pills are also acceptable.
Shixiao San (Pain-Dispersing Powder) from *Sanyin Jiyi Bingzheng Fanglun* treats Xiao Chang Qi pain (pain associated with the Small Intestine Qi disorder).
Formula: Wulingzhi Faeces Trogopterori, Puhuang Pollinis Typhae (equal parts).
Grind into fine powder. Take 2 qian per dose. First, boil 1 ge of vinegar into a paste, then add 1 zhan of water and decoct.
Lixiao San (Instant-Efficacy Powder) from *Bencao Fang*.
Formula: Chuanxiong Rhizoma Ligustici Chuanxiong, Chuanlianzi Fructus Toosendan, Qingpi Pericarpium Citri Reticulatae Viride, Bo Shang Huixiang Fructus Foeniculi, Qianniu Semen Pharbitidis (roasted), Taoren Semen Persicae (each 1 liang).
Grind into fine powder. Take 2 qian per dose, decocted in 1 zhan of non-cloudy wine, taken warm before meals.
Congbai San (Scallion White Powder) from *Sanyin Jiyi Bingzheng Fanglun* treats all types of cold hernia pain.
Formula: Chuanxiong Rhizoma Ligustici Chuanxiong, Danggui Radix Angelicae Sinensis, Zhike Fructus Aurantii Immaturus (roasted), Houpo Cortex Magnoliae Officinalis (roasted), Guanni Rou Cortex Cinnamomi, Qingpi Pericarpium Citri Reticulatae Viride, Ganjiang Rhizoma Zingiberis, Huixiang Fructus Foeniculi (roasted), Fulings Sclerotium Poria, Chuanlianzi Fructus Toosendan, Maimai Semen Hordei (roasted), Shenqu Mass Medicamentum Fermentatum (roasted), Sanleng Rhizoma Sparganii, Ezhu Rhizoma Curcumae, Shudihuang Radix Rehmanniae Preparata, Baishao Radix Paeoniae Alba, Muxiang Radix Aucklandiae, Renshen Radix Ginseng (each 1 liang).
Cut the herbs. Take 3 qian per dose, add 2 cun of Congbai Scallion Bulb and a little salt, decoct in water, and take on an empty stomach.
Dingxiang Lianshi Wan (Clove and Melon Pill) by Li Dongyuan treats unbearable pain from seven types of hernia in men, and zhij mass accumulation and leukorrhea in women. These conditions are governed by the Ren Mai (Conception Vessel), belong to the Yin meridians, and result from pathology in the Kidney and Liver; thus, the treatment method is the same.
Formula: Danggui Radix Angelicae Sinensis, Fuzi Radix Aconiti Lateralis Preparata (processed), Huixiang Fructus Foeniculi (roasted), Chuanlian Fructus Toosendan (each 1 liang).
Cut finely, and boil together in 3 sheng of good wine until the wine is completely consumed. Dry and grind into fine powder. For every 1 liang of this powder, add Dingxiang Flos Caryophylli (0.5 qian), Muxiang Radix Aucklandiae (0.5 qian), Yuanhusuo Rhizoma Corydalis (5 qian), Quanxie Scorpio (13 pieces).
Grind into fine powder and mix thoroughly with the previous powder. Use wine paste to make pills the size of wutong seeds. Take 30 pills initially, increasing up to 100 pills, taken on an empty stomach with warm wine.
Commentary: The above formulas, along with the blood-regulating agents and Jueyin meridian examples mentioned previously, share similarities. However, discussions on hernia across various meridians often attribute it to Wind, referring specifically to the Wind-Wood qi of the Jueyin. Therefore, hernia diseases often present with pain, which is a manifestation of excess Wood qi, i.e., the image of Wind. Yet, ancient and modern prescriptions mostly focus on Cold and Qi stagnation in their treatment. If practitioners do not carefully distinguish the depth of Qi vs. Cold to apply differentiated treatments, errors are inevitable. Observing Li Dongyuan’s method, it seems reasonably close to the truth. Generally, however, it should not be regarded as a fixed routine example, because the Kidney dislikes dryness, and prolonged use might inadvertently exacerbate the condition.
External Application Method (Wen Fa): Yan Shi states, take 0.5 jin of salt, stir-fry until extremely hot, wrap in old cloth, and apply to the painful area. Another method involves placing a handful of Congbai mud (scallion white paste) in the umbilicus, then applying heat with a moxibustion iron or placing moxa above it for excellent results.