陈远公曰∶有腿上忽肿一块,其色如常不疼,人以为痈疽也,谁知气虚之故乎!
夫痈成于肿,未有肿而不变为痈者,予谓气虚非痈,人谁识之。嗟乎!气所以行血
者也,气行则血行,总有邪气,断难成肿,彼邪气之盛,每成于气血之衰,其肿为痈,
每每作痛,色必变红赤也。今即不疼,色又不变,是有肿之名,无肿之实,全是气
虚血无以养,非邪盛而气不能鼓也。治法补气以扶正,不必化毒以祛邪,用补中益
气汤∶人参五钱,白术一两,生黄 一两,当归五钱,柴胡一钱,升麻五分,陈皮一
钱,生甘草二钱,半夏二钱,茯苓三钱。水煎服。十剂肿消,此方益气圣药,非消毒
之剂,何以用之消肿耶?盖真气夺则虚,邪气盛则实,真气既虚,邪气益盛,不用补
气,气何以行,肿何以化耶!此方补气即所以消肿也,况益以化痰去湿之品,故更
易收功耳。(《冰鉴》)
冯鲁瞻曰∶腿痈者,发于内侧,属肝脾二经,发于外侧,属胆胃二经。平陷坚
硬者为气虚,当用内补黄 汤;势 肿痛
者,当用内托柴胡汤,外用蒜灸。(《锦囊》)
申斗垣曰∶阴包毒,在大腿内,是足厥阴肝经风热之毒,宜黄 柴胡汤,此汤
治腿内近股痈疽,大有神功。(《启玄》)
窦汉卿曰∶肫疽在腿内侧,肿高而硬,俗言此疽坚硬无脓,殊不知内脓已成,一
时不能透出皮肤,须用内托方溃,脓急宜针。
冯鲁瞻曰∶腿前廉为阳明,白芷、升麻为引;后廉太阳,羌活、防风为引;外
廉少阳,柴胡为引;内廉厥阴,青皮、吴萸为引;内前廉太阴,苍术、白芷为引。治无遗法矣。
陈远公说:有人大腿上突然肿起一块,颜色正常且不疼痛,人们以为是痈疽,却不知这是气虚的缘故!
痈是由肿发展而成的,没有肿而不转化为痈的。我认为气虚导致的肿并非真正的痈,谁能识别这一点呢?唉!气是推动血液运行的,气行则血行,即使有邪气存在,也极难形成肿胀。那些邪气旺盛的情况,往往是因为气血衰弱才形成的;其肿胀发展为痈,通常会感到疼痛,颜色必定变为红赤。现在如果不疼痛,颜色也不改变,这就是只有肿的名称,却没有肿的实质,完全是因为气虚导致血液无法滋养组织,并非邪气盛而气不能推动所致。治疗方法应补气以扶助正气,不必用化解毒邪的方法来祛除邪气。使用补中益气汤:人参五钱,白术一两,生黄芪一两,当归五钱,柴胡一钱,升麻五分,陈皮一钱,生甘草二钱,半夏二钱,茯苓三钱。水煎服。服用十剂后肿胀消退。此方是益气的圣药,并非消毒之剂,为何能用来消肿呢?大概是因为真气亏损则表现为虚证,邪气亢盛则表现为实证,既然真气已虚,邪气就会更加猖獗,如果不补气,气如何运行,肿胀又如何消散呢!此方通过补气来达到消肿的目的,况且还加入了化痰祛湿的药物,所以更容易取得疗效。(出自《冰鉴》)
冯鲁瞻说:腿部的痈,发于内侧的,属于肝、脾两经;发于外侧的,属于胆、胃两经。如果患处平陷且坚硬,属于气虚,应当使用内补黄芪汤;如果势急且肿痛,应当使用内托柴胡汤,并外用蒜灸法。(出自《锦囊》)
申斗垣说:阴包毒,发生在大腿内侧,是足厥阴肝经的风热毒邪,适宜使用黄芪柴胡汤,此汤治疗腿部内侧靠近股部的痈疽,大有神效。(出自《启玄》)
窦汉卿说:肫疽发生在腿部内侧,肿胀高突且坚硬,俗话常说这种疽坚硬无脓,却不知道内部脓液已经形成,只是暂时不能透出皮肤,必须使用内托方使其溃破,脓液急迫时应当针刺排脓。
冯鲁瞻说:腿部前侧为阳明经,以白芷、升麻作为引经药;后侧为太阳经,以羌活、防风作为引经药;外侧为少阳经,以柴胡作为引经药;内侧为厥阴经,以青皮、吴茱萸作为引经药;内侧前侧为太阴经,以苍术、白芷作为引经药。这样治疗就没有遗漏的方法了。
Chen Yuangong stated: There are cases where a lump suddenly swells on the leg, with normal color and no pain. People assume it is an abscess or carbuncle (Yongju), but who would know that this is due to Qi deficiency?
Abscesses (Yong) develop from swelling; there is no case of swelling that does not transform into an abscess. I assert that swelling caused by Qi deficiency is not a true abscess, yet few can recognize this. Alas! Qi is what moves Blood. When Qi moves, Blood moves. Even if pathogenic factors are present, it is extremely difficult for them to form swelling. The prevalence of pathogenic factors often arises from the decline of Qi and Blood. When such swelling develops into an abscess, it typically becomes painful, and the color must turn red. Now, if there is no pain and the color does not change, this is merely the name of swelling without its reality. It is entirely due to Qi deficiency causing Blood to fail in nourishing the tissues, rather than pathogenic excess preventing Qi from mobilizing. The treatment method should be to tonify Qi to support the Righteous Qi (Zhengqi), without needing to resolve toxins to expel pathogens. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction): Renshen (Ginseng Radix) 5 qian, Baizhu (Atractylodis Rhizoma) 1 liang, Sheng Huangqi (Astragali Radix) 1 liang, Danggui (Angelicae Sinensis Radix) 5 qian, Chaihu (Bupleuri Radix) 1 qian, Shengma (Cimicifugae Rhizoma) 5 fen, Chenpi (Citri Reticulatae Pericarpium) 1 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 2 qian, Banxia (Pinelliae Tuber) 2 qian, Fuling (Poria) 3 qian. Decoct in water and take orally. After ten doses, the swelling subsides. This formula is a sacred medicine for augmenting Qi, not a detoxifying agent. Why use it to reduce swelling? Generally, when True Qi is depleted, deficiency manifests; when pathogenic Qi is excessive, excess manifests. Since True Qi is already deficient, pathogenic Qi becomes even more vigorous. Without tonifying Qi, how can Qi move, and how can the swelling dissipate? This formula reduces swelling by tonifying Qi. Moreover, since it includes herbs that resolve phlegm and remove dampness, it achieves results more easily. (From *Bingjian*)
Feng Luzhan stated: Leg abscesses occurring on the medial side belong to the Liver and Spleen meridians; those occurring on the lateral side belong to the Gallbladder and Stomach meridians. If the area is flat, depressed, and hard, it indicates Qi deficiency, and Neibu Huangqi Tang (Internal Tonification with Astragalus Decoction) should be used. If the condition is urgent with swelling and pain, Neituo Chaihu Tang (Internal Support with Bupleurum Decoction) should be used, along with external garlic moxibustion. (From *Jinnang*)
Shen Douyuan stated: Yinbao Du (Poison at Yinbao) occurs on the inner thigh and is caused by wind-heat toxin of the Foot Jueyin Liver Meridian. Huangqi Chaihu Tang (Astragalus and Bupleurum Decoction) is suitable. This decoction has miraculous efficacy in treating abscesses and carbuncles near the thigh on the inner leg. (From *Qixuan*)
Dou Hanqing stated: Zhun Ju (Carbuncle at Zhun) occurs on the medial side of the leg, presenting as high, swollen, and hard. Commonly, it is said that this carbuncle is hard and lacks pus, but little do they know that internal pus has already formed but cannot temporarily penetrate the skin. One must use an internal support formula to induce suppuration. If pus is urgent, needle drainage is required.
Feng Luzhan stated: The anterior margin of the leg belongs to the Yangming meridian, using Baizhu (Angelicae Dahuricae Radix) and Shengma (Cimicifugae Rhizoma) as guiding herbs; the posterior margin belongs to the Taiyang meridian, using Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) as guiding herbs; the lateral margin belongs to the Shaoyang meridian, using Chaihu (Bupleuri Radix) as a guiding herb; the medial margin belongs to the Jueyin meridian, using Qingpi (Citri Reticulatae Pericarpium Viride) and Wuyu (Evodiae Fructus) as guiding herbs; the anteromedial margin belongs to the Taiyin meridian, using Cangzhu (Atractylodis Rhizoma) and Baizhu (Angelicae Dahuricae Radix) as guiding herbs. In this way, no therapeutic method is omitted.