丹溪越鞠丸治血郁
桃仁 香附子 红花 抚芎 青黛(等分)
上为末糊丸每四五十丸食前服
按此一门东垣先生内外伤辨法也议论方制精备故不取他书但其间不系内伤法皆节而不
录内论暑证者附入暑门
古人以脉上辨内外伤于人迎气口人迎脉大于气口为外伤气口脉大于人迎为内伤此辨固是
但其
说有所未尽耳外感风寒皆有余之证是从前客邪来也其病必见于左手左手主表乃行阳二十五度
内伤饮食及饮食不节劳役所伤皆不足之病也必见于右手右手主里乃行阴二十五度故外感寒邪
则独左手人迎脉浮紧按之洪大紧者急甚于弦是足太阳寒水之脉按之洪大而有力中见手少阴
心火之脉丁与壬合内显洪大乃伤寒脉也若外感风邪则人迎脉缓而大或大于气口一倍或两倍三
倍内伤饮食则右寸气口脉大于人迎一倍伤之重者过在少阴则两倍太阴则三倍此内伤饮食之脉
若
饮食不节劳役过甚则心脉变见于气口是心火刑肺其肝木挟心火之势亦来薄肺经云侮所不胜寡
于畏者是也故气口脉急大而数时一代而涩也涩者肺之本脉大者元气不相接脾胃不及之脉洪大
而数者心脉刑肺也急者肝木挟心火而反克肺金也若不甚劳役惟右关脾脉大而数谓独大于五脉
数中显缓时一代也如饮食不节寒暑失所则先右关胃脉损弱甚则隐而不见惟内显脾脉之大数微
缓时一代也宿食不消则独右关脉沉而滑经云脉滑者有宿食也
丹溪越鞠丸治疗血郁。
桃仁、香附子、红花、抚芎(川芎)、青黛(各等分)。
以上药物研为细末,用糊剂制成丸药,每次服用四五十丸,饭前服用。
按语:这一部分属于东垣先生《内外伤辨惑论》中的内容,其议论和方制精妙完备,因此不选取其他书籍的内容。但其中不属于内伤治法的内容,都节选而不全部收录。关于暑证的论述,附录在暑门中。
古人通过脉象来辨别内伤和外感病,依据是人迎脉和气口脉的比较。人迎脉大于气口脉,属于外感病;气口脉大于人迎脉,属于内伤病。这种辨别方法固然正确,但其说法有所未尽之处。外感风寒都属于有余的实证,是由外来邪气侵袭所致,其病证必然表现在左手,因为左手主表,行阳二十五度。内伤由饮食及饮食不节制、劳役过度所伤,都属于不足的虚证,其病证必然表现在右手,因为右手主里,行阴二十五度。所以,外感寒邪时,独见左手人迎脉浮紧,按之洪大紧,急促甚至超过弦脉的程度,这是足太阳寒水经的脉象;按之洪大而有力,中间显现出手少阴心火经的脉象,丁与壬相合,内部显现出洪大的脉象,这就是伤寒的脉象。如果外感风邪,则人迎脉缓而大,或者比气口脉大一倍、两倍或三倍。内伤饮食,则右寸气口脉大于人迎脉一倍;伤势重的,涉及少阴经则大二倍,涉及太阴经则大三倍,这是内伤饮食的脉象。如果是饮食不节制、劳役过度,则心脉的变化出现在气口,这是心火刑克肺金,肝木挟带心火的势力也来侵迫肺经,《内经》说“侮所不胜,寡于畏者”,就是这个道理。所以气口脉急大而数,时而出现代脉且涩。涩是肺的本脉,大是元气不相接续、脾胃功能不及的脉象,洪大而数是心脉刑克肺金的脉象,急是肝木挟带心火而反克肺金的脉象。如果不甚劳役,仅见右关脾脉大而数,谓其单独大于其他五脉,数中显缓,时而出现代脉。如饮食不节制、寒暑失调,则先见右关胃脉损弱,严重时隐伏不见,只内部显现出脾脉的大、数、微缓,时而出现代脉。宿食不消化,则独见右关脉沉而滑,《内经》说“脉滑者有宿食”。
Danxi Yueju Wan (Yueju Pill from Danxi) treats Blood Stagnation (Blood Yu).
Tao Ren (Persicae Semen), Xiang Fu Zi (Cyperi Rhizoma), Hong Hua (Carthami Flos), Fu Xiong (Ligustici Chuanxiong Rhizoma), Qing Dai (Atriplae Folium) (in equal proportions).
The above ingredients are ground into powder, mixed with paste to form pills. Take 40-50 pills before meals.
Note: This section belongs to Mr. Dongyuan's "Differentiation of Internal and External Injuries". Its discussions and prescriptions are exquisite and complete, therefore other books are not selected. However, content not related to internal injury treatment is excerpted but not fully recorded. The discussion on Summerheat Syndrome is appended to the Summerheat Section.
Ancients distinguished between internal injuries and external infections by pulse, comparing the Renying (Human Welcome) pulse and the Qikou (Qi Mouth) pulse. If the Renying pulse is larger than the Qikou pulse, it is an external infection; if the Qikou pulse is larger than the Renying pulse, it is an internal injury. This differentiation is indeed correct, but its explanation is not exhaustive. External contraction of Wind-Cold all belong to excess syndromes, caused by pathogenic factors invading from outside. The disease manifestations must appear in the left hand, because the left hand governs the exterior and circulates Yang for twenty-five degrees. Internal injuries caused by diet, irregular eating habits, and overexertion all belong to deficiency syndromes. The disease manifestations must appear in the right hand, because the right hand governs the interior and circulates Yin for twenty-five degrees. Therefore, when contracting Cold Evil externally, only the left-hand Renying pulse appears floating and tight. Pressing it reveals a surging, large, and tight quality, urgent even exceeding the string-like quality. This is the pulse of the Foot-Taiyang Bladder channel (Water). Pressing it reveals a surging and forceful quality, internally manifesting the pulse of the Hand-Shaoyin Heart channel (Fire). Ding and Ren combine, internally manifesting a surging quality; this is the pulse of Cold Damage (Shanghan). If contracting Wind Evil externally, then the Renying pulse is slow and large, or one, two, or three times larger than the Qikou pulse. For internal injury due to diet, the right Cun position of the Qikou pulse is larger than the Renying pulse by one time. If the injury is severe, involving the Shaoyin channel, it is two times larger; involving the Taiyin channel, it is three times larger. This is the pulse of internal injury due to diet. If due to irregular diet or excessive exertion, the Heart pulse changes appear at the Qikou. This is Heart Fire punishing Lung Metal. Liver Wood, carrying the momentum of Heart Fire, also attacks the Lung Meridian. As stated in the classics: "Insulting what it cannot overcome, lacking fear," refers to this principle. Thus, the Qikou pulse is urgent, large, and rapid, occasionally showing a intermittent pulse (Dai Mai) and choppy quality (Se). Se (choppy) is the root pulse of the Lung. Large indicates Yuan Qi (Original Qi) failing to connect, and Spleen-Stomach insufficiency. Surging, large, and rapid indicates Heart Fire punishing Lung. Urgent indicates Liver Wood carrying Heart Fire counter-attacking Lung Metal. If exertion is not severe, only the right Guan position Spleen pulse appears large and rapid, specifically larger than the other five pulses. Within the rapid quality, it shows slowness, occasionally showing an intermittent pulse. If due to irregular diet or improper adaptation to cold and heat, first the right Guan Stomach pulse becomes damaged and weak; in severe cases, it hides and disappears, only internally manifesting the Spleen pulse as large, rapid, slightly slow, occasionally showing an intermittent pulse. Undigested food retention manifests solely as a deep and slippery pulse at the right Guan position. The classics state: "A slippery pulse indicates retained food."