大腿痈之证,发于内侧者,属肝脾二经;发于外侧者,属胆胃二经。或由于湿热不化,
留滞经络,阻其气血而成;或由于风寒湿外邪侵袭,壅遏不行而结。须辨其色之赤白,审其
证之阴阳,然后施治。势 肿痛者,属湿热,宜清利解毒;平陷坚硬,色不变者,为阴邪凝
结,宜疏散温发;脓溃后,均宜补托。
阴包毒,生于大腿内阴包穴,是足厥阴肝经风热之毒,兼挟湿浊而成。肿高而硬,又名
肫疽。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,急即针
之。宜服荆防败毒散,或黄 柴胡汤,此汤治腿内近股痈疽,大有神效。
鹤膝风者,以膝肿而 腿枯细,如鹤膝之形而名之也。此证有二∶有发之暴者为水
鹤膝,有发之缓者为旱鹤膝。凡人骤感风寒暑湿,膝中即觉疼痛。三、五日后,腿足不得屈
伸,寒热间作,膝之内外皆肿,色微红, 热光亮,股形渐觉细小,此实邪也,为轻证。若
通其经络、祛其湿热、散其风寒,无难平复而愈。若发之缓者,由足三阴经亏损,风寒湿之
邪乘虚而入,血脉阻滞,不得流行,注膝成病。下股之血脉,有去而无返,是以愈瘦愈冷而
筋愈缩;上腿之血脉,有积而无散,是以愈肿愈热而肌愈削。此证与附骨疽俱系肾虚所致。
盖肾主骨,而臀以下俱属肾,真气衰弱,邪气得以深袭,经久不消,极阴生阳,寒化为热,
而后溃也。若误用寒凉,必成废疾,或挛曲偏枯,或痿弱不起,或坚硬如石为石疽,或日久
始溃、皮肉俱腐为缓疽。必当以桂附治之,以下部道远,非此不能下达,又非此不能入肾经
而宣行也。又小儿鹤膝风,如色红 肿,朝轻暮重,寒热交作者,先以羚羊角散加黄柏、苍
术,或独活寄生汤,先去其湿火,然后温补。若肿硬色白不作脓者,因禀受肾虚,血气不充而
成,宜以六味丸加鹿茸,或虎潜丸补其精血;仍须调补脾胃,以助生化之源。
人面疮者,即鹤膝风破烂所成,以膝有盖骨似额,下两旁有眼,中有高骨似鼻,穿溃腐
坏,宛如人面之形,故名。非真有生出疮形如人之面。前人谓与之肉且能食,有是理乎?要
之,此证冷毒入于骨髓,但有白浆流出,元气消乏,肌肉已死,不能化脓生新,虽有仙术,
亦不能为之收功矣。
大腿痈这一病症,发生在内侧的,归属于肝经和脾经;发生在外侧的,归属于胆经和胃经。有的因为湿热不能化解,滞留于经络,阻碍气血运行而形成;有的因为风寒湿等外邪侵袭,壅滞不通而结聚。必须辨别疮色是红还是白,审察证候属于阴证还是阳证,然后进行治疗。肿胀疼痛明显的,属于湿热,适宜用清热利湿、解毒的方法;平坦下陷且坚硬、颜色不变的,为阴邪凝结,适宜用疏散温通发汗的方法;脓液溃破后,都适宜用补益托毒的方法。
阴包毒,生于大腿内侧的阴包穴,这是足厥阴肝经的风热之毒,兼夹湿浊而成。肿胀高耸且坚硬,又名肫疽。俗话常说这种疽坚硬没有脓,却不知道内部脓液已经形成,只是暂时不能透出皮肤,必须使用内托方药促使脓液溃破,紧急情况下可以用针刺排脓。适宜服用荆防败毒散,或者黄芩柴胡汤,这个汤剂治疗腿部内侧靠近股部的痈疽,有极大的神效。
鹤膝风,是因为膝盖肿胀而小腿枯细,形状像鹤的膝盖而得名。这个病症有两种:发作急骤的是水鹤膝,发作缓慢的是旱鹤膝。凡人突然感受风寒暑湿,膝盖立即感到疼痛。三到五天后,腿脚不能屈伸,寒热交替发作,膝盖内外都肿胀,颜色微红,发热光亮,大腿形状逐渐觉得细小,这是实邪所致,属于轻证。如果疏通经络、祛除湿热、散发风寒,不难平复痊愈。如果发作缓慢的,是由于足三阴经亏损,风寒湿邪乘虚而入,血脉阻滞,不能正常运行,注积于膝盖而成病。大腿下部的血脉,只有流出而没有回流,所以越瘦越冷而筋脉越收缩;小腿上部的血脉,只有积聚而不能消散,所以越肿越热而肌肉越消瘦。这个病症与附骨疽都属于肾虚所致。大概肾主骨,臀部以下都属于肾,真气衰弱,邪气得以深入侵袭,经久不消,极阴产生阳气,寒转化为热,然后才溃破。如果误用寒凉药物,必然导致残疾,或者拘挛弯曲偏瘫,或者痿弱不能站立,或者坚硬如石头成为石疽,或者日久才开始溃破、皮肉全部腐烂成为缓疽。必须用桂枝、附子来治疗,因为下部道路遥远,不用这些药不能下达病所,也不用这些药不能进入肾经而宣行药力。另外小儿鹤膝风,如果颜色红肿,早晨轻晚上重,寒热交作的,先用羚羊角散加黄柏、苍术,或者独活寄生汤,先祛除湿火,然后进行温补。如果肿胀坚硬颜色白且不化脓的,因为禀受肾虚,血气不充而成,适宜用六味丸加鹿茸,或者虎潜丸来补益精血;仍然需要调补脾胃,以助生化之源。
人面疮,就是鹤膝风溃烂破损后形成的,因为膝盖有盖骨类似额头,下面两旁有眼孔类似眼睛,中间有高骨类似鼻子,穿溃腐坏,宛如人面的形状,所以得名。并不是真的生出像人面一样的疮形。前人说给它肉吃它能吃,有这样的道理吗?总之,这个病症是冷毒进入骨髓,只有白色浆液流出,元气消耗疲乏,肌肉已经死亡,不能化脓生新,即使有仙术,也不能为此取得疗效了。
The manifestation of thigh carbuncle (Thigh Carbuncle) occurring on the medial side belongs to the Liver Meridian and Spleen Meridian; that occurring on the lateral side belongs to the Gallbladder Meridian and Stomach Meridian. It may arise from damp-heat failing to transform, stagnating in the meridians, and obstructing the flow of Qi and Blood; or it may result from external pathogens such as wind-cold-damp invading, causing congestion and failure to circulate, leading to knotting. One must distinguish whether the color is red or white, and examine whether the syndrome is Yin or Yang, before administering treatment. Cases with prominent swelling and pain belong to damp-heat and are suitable for clearing heat, promoting diuresis, and resolving toxicity; cases that are flat, depressed, hard, and unchanged in color indicate condensation of Yin pathogens and are suitable for dispersing and warming to induce resolution; after pus has ulcerated, supplementation and expulsion methods should be applied to both.
Yinbao Toxicity arises at the Yinbao acupoint on the medial aspect of the thigh. It is caused by wind-heat toxicity of the Foot-Jueyin Liver Meridian, complicated by turbid dampness. The area swells high and becomes hard, also known as Zhun Ju (Abdominal Carbuncle). Folklore often claims this carbuncle is hard without pus, not realizing that internal pus has already formed but cannot temporarily penetrate the skin. Internal support formulas should be used to promote pus rupture; in urgent cases, needle drainage is required. Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction for Overcoming Toxins) is suitable, or Huangqin Chaihu Tang (Scutellaria and Bupleurum Decoction). This decoction is highly effective for treating carbuncles and sores near the thigh on the inner leg.
Crane’s Knee Wind (Crane’s Knee Deformity) gets its name because the knee is swollen while the lower leg is emaciated and thin, resembling the knee of a crane. This condition has two types: those that develop abruptly are called Water Crane’s Knee, and those that develop slowly are called Dry Crane’s Knee. When a person suddenly contracts wind, cold, summer-heat, or dampness, pain is immediately felt in the knee. After three to five days, the legs and feet cannot flex or extend, alternating chills and fever occur, and both the inside and outside of the knee swell with a slight redness, shining heat, and the thigh gradually appears thinner. This is due to excess pathogens and is considered a mild case. If the meridians are unblocked, damp-heat is dispelled, and wind-cold is scattered, recovery is easily achieved. In cases developing slowly, it is due to deficiency of the Three Yin Meridians of the Foot, allowing wind-cold-damp pathogens to enter through the deficiency. Blood vessels become obstructed and fail to circulate normally, accumulating in the knee to cause disease. In the upper thigh, blood vessels have outflow but no return, leading to increasing emaciation, coldness, and tendon contraction; in the lower leg, blood vessels have accumulation but no dispersion, leading to increasing swelling, heat, and muscle wasting. This condition, along with Gu Ben Ju (Bone-Adhering Carbuncle), is caused by Kidney deficiency. The Kidney governs the bones, and the area below the buttocks belongs to the Kidney. When true Qi is weak, pathogens can invade deeply. If unresolved over time, extreme Yin generates Yang, transforming cold into heat, leading to eventual ulceration. Misuse of cold-natured drugs will inevitably lead to disability, such as contracture and hemiplegia, flaccidity and inability to rise, hardness like stone becoming Shi Ju (Stone Carbuncle), or late ulceration with rotting of skin and flesh becoming Huan Ju (Slow Carbuncle). Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) must be used. Because the lower body pathways are distant, these herbs are necessary to reach the site and enter the Kidney Meridian to distribute their effects. Additionally, for pediatric Crane’s Knee Wind, if there is redness and swelling, worsening in the evening compared to morning, with alternating chills and fever, Lingyang Jiao San (Antelope Horn Powder) added with Huangbai (Phellodendron Bark) and Cangzhu (Atractylodes Rhizome), or Duhuo Jisheng Tang (Angelica Pubescens and Poria Decoction), should be used first to clear damp-fire, followed by warming tonification. If the swelling is hard, white in color, and does not form pus, it is due to congenital Kidney deficiency and insufficient Qi and Blood. Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Lurong (Deer Antler Velvet) or Huqian Wan (Tiger Crouching Pill) should be used to tonify essence and blood; furthermore, the Spleen and Stomach must be regulated and tonified to aid the source of production and transformation.
Renmian Chuang (Human-Face Sore) is formed from the ulceration and breakdown of Crane’s Knee Wind. The patella resembles a forehead, the openings on either side resemble eyes, and the central bony prominence resembles a nose. Ulceration and decay make it look remarkably like a human face, hence the name. It is not truly a sore shaped like a human face. Did predecessors claim that feeding it meat causes it to eat? Is there any truth to this? In summary, this condition involves cold toxin entering the bone marrow. Only white serous fluid flows out, vital energy is depleted, muscles are necrotic, and new tissue cannot regenerate. Even with immortal techniques, no therapeutic success can be achieved.