幽痈,生脐上七寸。初起如粟,渐增漫肿疼痛,形如鹅卵,甚则坚硬,牵痛胸肋。由过
食膏粱浓味,忧思气结,肠胃不通,火郁而成斯毒,自内发外者也。初服神授卫生汤,溃后
即用补托。
赫痈,生脐上三寸,属任脉经建里穴。由七情郁火凝结而成。初如粟粒,痒痛相兼,其
肿迅速,寒热往来,甚则呕哕,牵引脐痛。初肿微红,顶尖根束,渐透赤色者,以活命饮消
散之;成脓后,用托里消毒散;既溃,宜参 内托散。
冲疽,一名中发疽,生于脐上二寸,系任脉经下脘穴。由心火炽甚,流入肾经所致。肿
高色赤,脓稠者,易愈;若平塌黑色,膨胀恶心,脓水清稀,内肾疼痛,泻利无度,谵语直
视者,死;溃久不敛者,死。凡此皆属虚耳。法宜用大补之剂。如能受补,即不死也。
薛立斋曰∶乳房属足阳明胃经,乳头属足厥阴肝经。男子房劳恚怒,伤于肝肾;妇人思
虑忧郁,损于肝脾,皆能致疡。第乳之为疡有不同。有乳中结核,形如丸卵,不疼痛,不发
寒热,皮色不变,其核随喜怒为消长,此名乳癖。良由肝气不舒郁积而成,若以为痰气郁结
,非也。夫乳属阳明,乳中有核,何以不责阳明而责肝?以阳明胃土最畏肝木,肝气有所不
舒,胃见木之郁,惟恐来克,伏而不扬,气不敢舒,肝气不舒,而肿硬之形成,胃气不敢舒
,而畏惧之色现,不疼不赤,正见其畏惧也。治法不必治胃,但治肝而肿自消矣。逍遥散去
姜、薄,加栝蒌、半夏、人参主之(此方专解肝之滞,肝解而胃气不解自舒,盖以栝蒌、半
夏,专治胸中积痰,痰去肿尤易消也)。
有乳中结核,始不作痛,继遂隐隐疼痛,或身发寒热,渐渐成脓溃破者,此名乳痰。或
亦由肝经气滞而成,或由于胃经痰气郁蒸所致。用药疏肝之中,必加贝母、半夏、栝蒌等以
治痰,则未脓可消,至已溃必兼补气血,方易收口。
乳疡之不可治者,则有乳岩。夫乳岩之起也,由于忧郁思虑,积想在心,所愿不遂,肝
脾气逆,以致经络痞塞结聚成核,初如豆大,渐若棋子,不红不肿,不疼不痒,或半年一年
,或两载三载,渐长渐大,始生疼痛,痛则无解日,后肿如堆栗,或如覆碗,紫色气秽,渐
渐溃烂,深者如岩穴,凸者如泛莲,疼痛连心,出血则臭,并无脓水,其时五脏俱衰,遂成
四大不救。凡犯此者,百人百死。如能清心静养,无挂无碍,不必勉治,尚可苟延。当以加
味逍遥散、归脾汤,或益气养营汤主之。此证溃烂体虚,亦有疮口放血如注,实时毙命者,
与失营证同。
幽痈,生于肚脐上方七寸处。初起时像粟米大小,逐渐发展为弥漫性肿胀并伴有疼痛,形状如同鹅卵,严重时变得坚硬,并向胸胁部牵引疼痛。这是由于过食肥甘厚味,加上忧思导致气机郁结,肠胃不通畅,火热之邪郁积而形成的毒邪,是从体内发向体表的病症。初期服用神授卫生汤,溃破后随即使用补托法治疗。
赫痈,生于肚脐上方三寸处,属于任脉经的建里穴。由七情(喜、怒、忧、思、悲、恐、惊)郁结化火凝结而成。初起如粟米粒大小,瘙痒与疼痛并存,肿胀发展迅速,伴有寒热往来,严重时出现呕吐呃逆,牵引脐部疼痛。初肿时微红,顶端尖锐根部收敛,逐渐透出赤色者,用活命饮消散;成脓后,用托里消毒散;已经溃破后,宜用参内托散。
冲疽,又名中发疽,生于肚脐上方二寸处,系任脉经的下脘穴。由心火炽盛,流入肾经所致。如果肿块高突、颜色红赤,脓液稠厚,容易痊愈;如果肿块平塌、颜色黑紫,腹部膨胀恶心,脓水清稀,肾脏内部疼痛,腹泻无度,胡言乱语且目光直视者,预后不良致死;溃破后长久不愈合者,亦致死。凡此种种皆属于虚证。治法应当使用大补的方剂。如果能耐受补益药物,就不会死亡。
薛立斋说:乳房归属于足阳明胃经,乳头归属于足厥阴肝经。男子因房劳过度或愤怒,损伤肝肾;妇人因思虑忧郁,损伤肝脾,都能导致疡病。只是乳房发生的疡病有所不同。有一种是乳中结核,形状如丸卵,不疼痛,不发寒热,皮肤颜色不变,其结节随情绪喜怒而消长,这名叫乳癖。这确实是由于肝气不舒畅、郁积而成的,如果认为是痰气郁结,就不对了。乳房属阳明经,乳中有核,为什么不责之于阳明经而责之于肝经?因为阳明胃土最畏惧肝木,肝气有所不舒畅,胃见到肝木的郁滞,唯恐被克制,潜伏而不张扬,气不敢舒展,肝气不舒,从而形成肿硬,胃气不敢舒展,从而显现出畏惧的神色,不疼不红,正是表现其畏惧。治疗方法不必治胃,只要治疗肝,肿胀自然消退。逍遥散去生姜、薄荷,加栝蒌、半夏、人参为主药(此方专门解除肝气的郁滞,肝气解除了,胃气不舒畅的情况自然也会舒缓,大概是因为栝蒌、半夏专门治疗胸中的积痰,痰去除了,肿胀更容易消除)。
还有一种是乳中结核,开始不痛,随后隐隐作痛,或者身体出现寒热,渐渐成脓溃破的,这名叫乳痰。这也可能是由肝经气滞而成,或者是由于胃经痰气郁蒸所致。用药在疏肝的同时,必须加入贝母、半夏、栝蒌等以治疗痰湿,那么未成脓时可以消散,到了已经溃破必须兼补气血,才容易收口。
乳疡中不可治愈的,就是乳岩。乳岩的发生,是由于忧郁思虑,积想在心中,愿望不能实现,导致肝脾气机逆乱,致使经络痞塞结聚成核,初起如豆大,渐渐像棋子一样,不红不肿,不疼不痒,有的半年一年,有的两三年,渐渐长大,才开始产生疼痛,疼痛没有缓解的时候,后来肿胀如堆栗,或像倒扣的碗,紫色且气味秽浊,渐渐溃烂,深的像岩穴,凸的像泛起的莲花,疼痛牵连心脏,出血则有臭味,并没有脓水,此时五脏俱衰,遂成四大(指四肢及躯干功能衰竭)无法挽救的局面。凡是患此病的,百人百死。如果能清心静养,没有挂碍,不必勉强治疗,还可以苟延残喘。应当用加味逍遥散、归脾汤,或益气养营汤来主治。此证溃烂且体质虚弱,也有疮口出血如注,当场毙命的,与失营证相同。
You Yong (Deep Abscess) arises seven cun above the umbilicus. Initially, it resembles a millet grain, gradually increasing to a diffuse swelling with pain, shaped like a goose egg; in severe cases, it becomes hard and causes pulling pain to the chest and hypochondrium. This condition results from excessive consumption of rich and greasy foods, combined with worry and thought leading to Qi stagnation, intestinal and stomach obstruction, and the accumulation of fire-toxin, manifesting from the interior to the exterior. In the early stage, Shen Shou Wei Sheng Tang is administered; after ulceration, tonifying and expelling methods are used immediately.
He Yong (Bright Abscess) arises three cun above the umbilicus, belonging to the Jianli acupoint (Jianli, CV11) of the Ren Mai (Conception Vessel). It is formed by the condensation of fire due to the stagnation of the Seven Emotions. Initially, it is like a millet grain, accompanied by both itching and pain, with rapid swelling, alternating chills and fever, and in severe cases, vomiting and hiccups, with pulling pain at the umbilicus. If the initial swelling is slightly red, with a pointed apex and constricted base, gradually turning crimson, Huo Ming Yin (Life-Saving Decoction) is used to dissipate it; after suppuration, Tuo Li Xiao Du San (Interior-Tonifying and Toxin-Expelling Powder) is applied; once ulcerated, Shen Nei Tuo San (Ginseng Interior-Tonifying and Expelling Powder) is suitable.
Chong Ju (Thrusting Carbuncle), also known as Zhong Fa Ju (Central-Erupting Carbuncle), arises two cun above the umbilicus, corresponding to the Xiawan acupoint (Xiawan, CV10) of the Ren Mai. It is caused by excessive Heart Fire flowing into the Kidney Meridian. If the swelling is high, red, and the pus is thick, it is easy to heal; if the swelling is flat, black, accompanied by abdominal distension and nausea, thin pus, internal Kidney pain, uncontrolled diarrhea, delirium, and fixed gaze, death ensues; if it ulcerates and fails to heal for a long time, death also ensues. All these conditions belong to Deficiency. The method should employ major tonifying agents. If the patient can tolerate tonification, they will not die.
Xue Lizhai stated: The breast belongs to the Foot-Yangming Stomach Meridian, and the nipple belongs to the Foot-Jueyin Liver Meridian. In men, sexual excess or anger injures the Liver and Kidneys; in women, overthinking and depression damage the Liver and Spleen; both can lead to sores. However, sores in the breast vary. One type presents as nodules in the breast, shaped like pills or eggs, without pain, chills, or fever, with unchanged skin color; the nodules fluctuate in size with emotions of joy or anger. This is named Ru Pi (Breast Lump). This is indeed caused by the stagnation and accumulation of Liver Qi; regarding it as Phlegm-Qi stagnation is incorrect. Since the breast belongs to the Yangming, why are nodules in the breast attributed to the Liver rather than the Yangming? Because Yangming Earth most fears Jueyin Wood. When Liver Qi is stagnant, the Stomach, seeing the stagnation of Wood, fears being overcome, thus lying dormant and not rising, with Qi不敢 (daring not) to relax. As Liver Qi does not relax, hardness and swelling form; as Stomach Qi dares not relax, signs of fear appear. The absence of pain and redness precisely reflects this fear. The treatment need not address the Stomach; only by treating the Liver will the swelling subside naturally. Xiaoyao San (Free and Easy Wanderer Powder) with ginger and mint removed, plus Gua Lou (Trichosanthes Fruit), Ban Xia (Pinellia Tuber), and Ren Shen (Ginseng Root) is the main prescription (This formula specifically resolves Liver stagnation; once the Liver is resolved, the Stomach's lack of relaxation naturally soothes, largely because Gua Lou and Ban Xia specifically treat accumulated Phlegm in the chest; once Phlegm is gone, swelling is easier to eliminate).
Another type presents as nodules in the breast that initially do not hurt, but later cause dull pain, or systemic chills and fever, gradually forming pus and ulcerating. This is named Ru Tan (Breast Phlegm). It may also be caused by Qi stagnation in the Liver Meridian or by the steaming and stagnation of Phlegm-Qi in the Stomach Meridian. In medication that soothes the Liver, one must add Bei Mu (Fritillaria Bulb), Ban Xia, and Gua Lou to treat Phlegm; thus, before suppuration, it can be dissipated, and after ulceration, tonifying Qi and Blood is necessary for wound closure.
Among breast sores that are incurable is Ru Yan (Breast Rock/Cancer). Ru Yan arises from depression and overthinking, with desires unfulfilled, causing Liver and Spleen Qi to rebel, leading to meridian obstruction and nodule formation. Initially small as a bean, it gradually grows like a chess piece, without redness, swelling, pain, or itching. Over half a year to a year, or two to three years, it gradually enlarges, then begins to hurt, with pain having no relief. Later, the swelling resembles piled chestnuts or an inverted bowl, purple with foul odor, gradually ulcerating. Deep ulcers resemble rock caves, protruding ones resemble floating lotuses. Pain radiates to the heart, bleeding has a foul odor, and there is no pus. At this stage, the Five Zang Organs are all exhausted, leading to the failure of the Four Extremities, which is incurable. Those who contract this disease die hundred percent. If one can maintain a clear mind and quiet nourishment, without attachments or obstructions, and does not force treatment, life may be prolonged. Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder), Gui Pi Tang (Restore the Spleen Decoction), or Yi Qi Yang Ying Tang (Tonify Qi and Nourish Ying Decoction) should be used. In this condition, with ulceration and constitutional weakness, there are cases where blood spurts from the wound, leading to immediate death, similar to Shi Ying Syndrome (Loss of Camp/Incurable Cancer).