风注一症,古书未载,头额间忽然肿起,软似绵,大如馒头,木不知痛,按之似有痒状,
此风入腠理,卫气滞而不行。有肿及头半者,宜以万灵丹汗之,内服疏风流气饮,外以洪宝
丹敷之,五七日即消散而愈。予见有肿而日久不消者,医者疑其脓,遂用刀针窜空半头,未
能收功。凡遇此者,禁用刀针,极宜慎之。
疏肝流气饮
青防风(一钱) 川抚芎(八分) 陈皮(一钱) 炒僵蚕(钱半) 甘草(五分) 赤芍(一钱)
荆芥穗(一钱) 全当归(钱半) 白芷(八分) 菊花(钱半) 乌药(八分) 葱白头(三个)
恙因折伤,起见瘀血凝滞,脚跟疽外溃两月,肿胀不消,防成多骨,宜养血化毒。
当归 赤芍 川萆 川贝母 苡米 陈皮 泽泻 忍冬藤 生首乌 怀牛膝 甘草 桑枝 红枣
复诊
当归 生首乌 牛膝 云茯苓 苡米 川萆 大贝 忍冬藤 赤芍 粉甘草 广皮 甜冬术 桑枝 红枣
足跟疽溃久,窜及内踝,又将破溃,夜分发热,汗出即解,虚中夹邪,先为和解。
生首乌 炙鳖甲 当归 川贝母 威灵仙 云茯苓 制半夏 广皮 青蒿 柴胡 炙甘草 生姜 枣
湿热下注,小便后白浊点滴,法以厘清。
川萆 (三钱) 黄柏(淡水炒,八分) 炒知母(钱半) 赤苓(三钱) 远志(八分) 泽泻(盐水炒,
二钱) 茅术(八分) 石菖蒲(五分)
别服威喜丸(白浊最妙,每服三钱)
久患小便淋滴近带,白浊绵绵,气化失职,湿热下坠。拟开太阳法。
桂枝(三分) 白术(八分) 猪苓(二钱) 赤苓(二钱) 泽泻(二钱)
淋浊不止,阴头碎痒不时,肾虚湿热不化,满身筋骨微痛。
大生地(四钱) 茯苓(三热) 怀山药(二钱) 泽泻(钱半) 丹皮(钱半) 益智仁(八分)
五味子(炒,四分) 麦冬(五钱) 萸肉(钱半) 莲子(五粒)
湿热下注,小便混浊如膏,遇劳即发,五淋中之劳淋是也。
黄柏(八分) 知母(钱半) 赤白苓(各二钱) 海金沙(三钱) 泽泻(二钱) 石菖蒲(五分)
田字草(即河边头四瓣如田字,或仿佛如乌菱丘)
脊曳酸痛,时时遗泄,督脉交亏也。
沙苑子(二钱) 茯苓(三钱) 金樱子(钱半) 远志(八分) 黄柏(三钱) 归身(二钱) 牡蛎
(钱半) 山药(三钱) 萸肉(钱半)
梦泄频频,心肾不交故也。宜清心寡欲为安。
制半夏(钱半) 米仁(三钱) 枣仁(二钱) 豆衣(三钱) 茯苓(三钱) 橘白(三钱) 金樱子
(三钱) 左牡蛎(四钱) 远志(炒,一钱) 莲子(七粒)
阳物作痛而胀,总是膀胱湿未清。
川萆 (三钱) 黑栀(二钱) 甘草梢(四分) 瞿麦(钱半) 木通(八分) 泽泻(钱半) 车前子
(三钱) 牛膝梢(钱半) 赤白苓(各二钱) 淡竹叶(一钱)
小溲痛,或有瘀腐,渐化湿火。
冬葵子(二钱) 秋石(四分) 扁蓄(钱半) 甘草梢(四分) 牛膝梢(钱半) 川黄柏(一钱)
龙胆草(六分) 赤白苓(各二钱) 寒水石(钱半) 淡竹叶(一钱) 大淡菜(二只)
火郁于膀胱,下为癃闭。
细生地(四钱) 竹叶(一钱) 甘草梢(四分) 车前子(三钱) 牛膝梢(二钱) 赤芍(钱半)
麝香(冲,二厘)
湿热溺血。
川萆 (三钱) 车前子(三钱) 茯苓(二钱) 小蓟炭(二钱) 麦冬(钱半) 莲肉(七粒)
甘草梢(四分)
按∶疏肝流气饮以下各案,皆属补遗。
风注这一病症,古代医书中没有记载。其表现为头额部位突然肿起,质地柔软像棉花一样,大小如同馒头,皮肤麻木不知疼痛,按压时感觉似有痒意。这是由于风邪侵入腠理(皮肤与肌肉之间的间隙),导致卫气(运行于体表、具有防御功能的气)停滞而不能正常运行。有的患者肿胀波及半个头部,适宜使用万灵丹通过发汗的方法治疗,内服疏肝流气饮,外用洪宝丹敷贴,五到七天后即可消散痊愈。我曾见到肿胀日久不消退的病例,医生怀疑是化脓,于是用刀针刺破半边头部,结果未能治愈。凡是遇到这种情况,严禁使用刀针,务必谨慎对待。
疏肝流气饮
青防风(一钱) 川抚芎(八分) 陈皮(一钱) 炒僵蚕(一钱半) 甘草(五分) 赤芍(一钱)
荆芥穗(一钱) 全当归(一钱半) 白芷(八分) 菊花(一钱半) 乌药(八分) 葱白头(三个)
病因是跌打损伤,导致瘀血凝滞。脚跟疽外部溃烂两个月,肿胀未消,担心形成多骨痨(指疮疡久溃不愈,死骨排出不尽的慢性骨髓炎),应当采用养血解毒的方法。
当归 赤芍 川萆薢 川贝母 苡米 陈皮 泽泻 忍冬藤 生首乌 怀牛膝 甘草 桑枝 红枣
复诊
当归 生首乌 牛膝 云茯苓 苡米 川萆薢 大贝母 忍冬藤 赤芍 粉甘草 广皮 甜冬术 桑枝 红枣
足跟疽溃烂时间长久,病灶窜及内踝,即将再次破溃,夜间发热,出汗后热退,属于虚证中夹杂邪气,先采用和解法治疗。
生首乌 炙鳖甲 当归 川贝母 威灵仙 云茯苓 制半夏 广皮 青蒿 柴胡 炙甘草 生姜 枣
湿热下注,小便结束后出现白色浑浊点滴状分泌物,治法以分清利湿为主。
川萆薢(三钱) 黄柏(淡水炒,八分) 炒知母(一钱半) 赤茯苓(三钱) 远志(八分) 泽泻(盐水炒,二钱) 茅术(八分) 石菖蒲(五分)
另外服用威喜丸(对白浊症效果极佳,每次服用三钱)
长期患有小便淋漓不尽且伴有带下,白浊绵绵不断,这是气化功能失职,湿热下坠所致。拟用通利太阳膀胱经的方法。
桂枝(三分) 白术(八分) 猪苓(二钱) 赤茯苓(二钱) 泽泻(二钱)
淋证和浊证不止,阴头发碎痒不时发作,这是肾虚兼夹湿热无法化解,导致全身筋骨轻微疼痛。
大生地(四钱) 茯苓(三钱) 怀山药(二钱) 泽泻(一钱半) 丹皮(一钱半) 益智仁(八分)
五味子(炒,四分) 麦冬(五钱) 山茱萸(一钱半) 莲子(五粒)
湿热下注,小便混浊如膏脂,遇劳累即发作,这是五淋中的劳淋。
黄柏(八分) 知母(一钱半) 赤茯苓和白茯苓(各二钱) 海金沙(三钱) 泽泻(二钱) 石菖蒲(五分)
田字草(即河边生长、叶片呈四瓣如田字形,或形状类似乌菱角的植物)
脊柱牵引样酸痛,时时遗精泄精,这是督脉精气亏损所致。
沙苑子(二钱) 茯苓(三钱) 金樱子(一钱半) 远志(八分) 黄柏(三钱) 归身(二钱) 牡蛎(一钱半) 山药(三钱) 山茱萸(一钱半)
梦遗频繁,这是心肾不交的缘故。宜清心寡欲以求安宁。
制半夏(一钱半) 米仁(三钱) 枣仁(二钱) 豆衣(三钱) 茯苓(三钱) 橘白(三钱) 金樱子(三钱) 左牡蛎(四钱) 远志(炒,一钱) 莲子(七粒)
阳物疼痛且胀满,总是因为膀胱湿气未清。
川萆薢(三钱) 黑栀子(二钱) 甘草梢(四分) 瞿麦(一钱半) 木通(八分) 泽泻(一钱半) 车前子(三钱) 牛膝梢(一钱半) 赤茯苓和白茯苓(各二钱) 淡竹叶(一钱)
小便疼痛,可能有瘀腐之物,逐渐化为湿火。
冬葵子(二钱) 秋石(四分) 扁蓄(一钱半) 甘草梢(四分) 牛膝梢(一钱半) 川黄柏(一钱)
龙胆草(六分) 赤茯苓和白茯苓(各二钱) 寒水石(一钱半) 淡竹叶(一钱) 大淡菜(两只)
火邪郁结于膀胱,向下导致小便不通(癃闭)。
细生地(四钱) 竹叶(一钱) 甘草梢(四分) 车前子(三钱) 牛膝梢(二钱) 赤芍(一钱半)
麝香(冲服,二厘)
湿热导致的溺血。
川萆薢(三钱) 车前子(三钱) 茯苓(二钱) 小蓟炭(二钱) 麦冬(一钱半) 莲肉(七粒)
甘草梢(四分)
按语:疏肝流气饮以下的各个医案,都属于补遗内容。
Feng Zhu (Wind Injection, a condition characterized by sudden soft swelling on the head/forehead) is not recorded in ancient texts. Its manifestation involves sudden swelling on the forehead or head, soft like cotton, size resembling a steamed bun, with numbness and lack of pain sensation; pressure yields a sensation akin to itching. This occurs because Wind pathogen invades the Cou Li (interstitial spaces between skin and muscle), causing Wei Qi (Defensive Qi) to stagnate and fail to circulate normally. In cases where swelling extends to half the head, it is appropriate to use Wan Ling Dan (Myriad Spirits Pill) to induce sweating, internally administer Shu Gan Liu Qi Yin (Liver-Soothing Qi-Circulating Decoction), and externally apply Hong Bao Dan (Red Treasure Pill). The swelling should dissipate and heal within five to seven days. I have observed cases where swelling persisted for a long time without subsiding; physicians suspected suppuration (pus formation) and used knives or needles to incise half the head, failing to achieve a cure. For such cases, the use of knives and needles is strictly prohibited; utmost caution is required.
Shu Gan Liu Qi Yin (Liver-Soothing Qi-Circulating Decoction)
Qing Fang Feng (Saposhnikoviae Radix, 1 qian) Chuan Fu Xiong (Ligusticum Chuanxiong Rhizoma, 8 fen) Chen Pi (Citri Reticulatae Pericarpium, 1 qian) Chao Jiang Can (Bombyx Batryticatus, 1.5 qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, 5 fen) Chi Shao (Paeoniae Radix Rubra, 1 qian)
Jing Jie Sui (Schizonepetae Spica, 1 qian) Quan Dang Gui (Angelicae Sinensis Radix, 1.5 qian) Bai Zhi (Angelicae Dahuricae Radix, 8 fen) Ju Hua (Chrysanthemi Flos, 1.5 qian) Wu Yao (Linderae Radix, 8 fen) Cong Bai Tou (Allii Fistulosi Bulbus, 3 pieces)
The etiology is traumatic injury, resulting in blood stasis coagulation. The heel abscess has been externally ulcerated for two months, with persistent swelling, raising concern for Du Gu Lao (chronic osteomyelitis with sequestrum). The treatment should focus on nourishing blood and resolving toxicity.
Dang Gui (Angelicae Sinensis Radix) Chi Shao (Paeoniae Radix Rubra) Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) Yi Mi (Coicis Semen) Chen Pi (Citri Reticulatae Pericarpium) Ze Xie (Alismatis Rhizoma) Ren Dong Teng (Lonicerae Japonicae Caulis) Sheng Shou Wu (Polygoni Multiflori Preparated Radix) Huai Niu Xi (Achyranthis Bidentatae Radix) Gan Cao (Glycyrrhizae Radix et Rhizoma) Sang Zhi (Mori Ramulus) Hong Zao (Ziziphi Jujubae Fructus)
Second Visit
Dang Gui (Angelicae Sinensis Radix) Sheng Shou Wu (Polygoni Multiflori Preparated Radix) Niu Xi (Achyranthis Bidentatae Radix) Yun Fu Ling (Poria, 3 qian) Yi Mi (Coicis Semen) Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma) Da Bei Mu (Fritillariae Thunbergii Bulbus) Ren Dong Teng (Lonicerae Japonicae Caulis) Chi Shao (Paeoniae Radix Rubra) Fen Gan Cao (Glycyrrhizae Radix et Rhizoma, processed) Guang Pi (Citri Reticulatae Pericarpium) Tian Zhu Shu (Atractylodis Macrocephalae Rhizoma, sweetened) Sang Zhi (Mori Ramulus) Hong Zao (Ziziphi Jujubae Fructus)
The heel abscess has been ulcerated for a long time, spreading to the medial malleolus, about to break open again. There is fever at night, which resolves with sweating. This indicates deficiency mixed with pathogenic factors; initially, a harmonizing method should be employed.
Sheng Shou Wu (Polygoni Multiflori Preparated Radix) Zhi Bie Jia (Testudinis Carapax et Plastrum, honey-fried) Dang Gui (Angelicae Sinensis Radix) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) Wei Ling Xian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Context suggests Saposhnikoviae or similar dispelling wind-damp herb, but standard Wei Ling Xian is Salvia/Clematis mix, here likely Clematidis Radix et Rhizoma*) Yun Fu Ling (Poria) Zhi Ban Xia (Pinelliae Rhizoma, processed) Guang Pi (Citri Reticulatae Pericarpium) Qing Hao (Artemisiae Annuae Herba) Chai Hu (Bupleuri Radix) Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) Sheng Jiang (Zingiberis Rhizoma Recens) Zao (Ziziphi Jujubae Fructus)
Damp-Heat pouring downward causes white turbid droplets after urination. The method is to clear and separate.
Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian) Huang Bo (Phellodendri Cortex, stir-fried in fresh water, 8 fen) Chao Zhi Mu (Anemarrhenae Rhizoma, stir-fried, 1.5 qian) Chi Ling (Poria with Red Coir, 3 qian) Yuan Zhi (Polygalae Radix, 8 fen) Ze Xie (Alismatis Rhizoma, salt-water fried, 2 qian) Mao Zhu (Atractylodis Rhizoma, 8 fen) Shi Chang Pu (Acori Tatarinowii Rhizoma, 5 fen)
Additionally take Wei Xi Wan (Wei Xi Pill, excellent for turbidity, 3 qian per dose).
Long-standing dribbling urine with leukorrhea, continuous white turbidity, indicates failure of Qi transformation and sinking of Damp-Heat. The proposed method is to open the Tai Yang (Bladder) channel.
Gui Zhi (Cinnamomi Ramulus, 3 fen) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 8 fen) Zhu Ling (Polyporus, 2 qian) Chi Ling (Poria with Red Coir, 2 qian) Ze Xie (Alismatis Rhizoma, 2 qian)
Continuous stranguria and turbidity, intermittent cramping itch at the glans penis, indicate Kidney Deficiency with unresolved Damp-Heat, causing mild pain in muscles and bones throughout the body.
Da Sheng Di (Rehmanniae Radix Preparata, 4 qian) Fu Ling (Poria, 3 qian) Huai Shan Yao (Dioscoreae Rhizoma, 2 qian) Ze Xie (Alismatis Rhizoma, 1.5 qian) Dan Pi (Moutan Cortex, 1.5 qian) Yi Zhi Ren (Alpiniae Oxyphyllae Fructus, 8 fen)
Wu Wei Zi (Schisandrae Chinensis Fructus, stir-fried, 4 fen) Mai Dong (Ophiopogonis Radix, 5 qian) Yu Rou (Corni Fructus, 1.5 qian) Lian Zi (Nelumbinis Semen, 5 grains)
Damp-Heat pouring downward causes cloudy urine like paste, triggered by fatigue; this is Lao Lin (Fatigue Stranguria) among the Five Types of Stranguria.
Huang Bo (Phellodendri Cortex, 8 fen) Zhi Mu (Anemarrhenae Rhizoma, 1.5 qian) Chi Bai Ling (Poria with Red Coir and White Poria, 2 qian each) Hai Jin Sha (Lygodii Spora, 3 qian) Ze Xie (Alismatis Rhizoma, 2 qian) Shi Chang Pu (Acori Tatarinowii Rhizoma, 5 fen)
Tian Zi Cao (Plantainweed, named for its four-petaled leaf shape resembling a field, or similar to Trapa natans/Water Chestnut).
Spinal dragging soreness and pain, frequent seminal emission, indicate deficiency of the Du Mai (Governing Vessel).
Sha Yuan Zi (Astragali Complanati Semen, 2 qian) Fu Ling (Poria, 3 qian) Jin Ying Zi (Cherokee Rose Fruit, 1.5 qian) Yuan Zhi (Polygalae Radix, 8 fen) Huang Bo (Phellodendri Cortex, 3 qian) Gui Shen (Angelicae Sinensis Radix, 2 qian) Mu Li (Ostreae Concha, 1.5 qian) Shan Yao (Dioscoreae Rhizoma, 3 qian) Yu Rou (Corni Fructus, 1.5 qian)
Frequent nocturnal emissions are due to Heart-Kidney Non-Interaction. Peace can be achieved by clearing the Heart and reducing desires.
Zhi Ban Xia (Pinelliae Rhizoma, processed, 1.5 qian) Mi Ren (Coicis Semen, 3 qian) Zao Ren (Ziziphi Spinosae Semen, 2 qian) Dou Yi (Sojae Semen Praeparatum, 3 qian) Fu Ling (Poria, 3 qian) Ju Bai (Citri Reticulatae Pericarpium Album, 3 qian) Jin Ying Zi (Cherokee Rose Fruit, 3 qian) Zuo Mu Li (Ostreae Concha, left side, 4 qian) Yuan Zhi (Polygalae Radix, stir-fried, 1 qian) Lian Zi (Nelumbinis Semen, 7 grains)
Pain and distension of the penis always stem from uncleared Bladder Dampness.
Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian) Hei Zhi (Gardeniae Fructus, charred, 2 qian) Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip, 4 fen) Qu Mai (Dianthi Herba, 1.5 qian) Mu Tong (Akebiae Caulis, 8 fen) Ze Xie (Alismatis Rhizoma, 1.5 qian) Che Qian Zi (Plantaginis Semen, 3 qian) Niu Xi Shao (Achyranthis Bidentatae Radix tip, 1.5 qian) Chi Bai Ling (Poria with Red Coir and White Poria, 2 qian each) Dan Zhu Ye (Lophatheri Herba, 1 qian)
Painful urination, possibly with necrotic debris, gradually transforms into Damp-Fire.
Dong Kui Zi (Malvae Seed, 2 qian) Qiu Shi (Mineral Urine Salt, 4 fen) Bian Xu (Polygoni Avicularis Herba, 1.5 qian) Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip, 4 fen) Niu Xi Shao (Achyranthis Bidentatae Radix tip, 1.5 qian) Chuan Huang Bo (Phellodendri Cortex, 1 qian)
Long Dan Cao (Gentianae Radix, 6 fen) Chi Bai Ling (Poria with Red Coir and White Poria, 2 qian each) Han Shui Shi (Halloysitum Rubrum, 1.5 qian) Dan Zhu Ye (Lophatheri Herba, 1 qian) Da Dan Cai (Mussel, 2 pieces)
Fire郁 (Stagnation) in the Bladder leads to lower obstruction (Long Bi, difficulty in urination).
Xi Sheng Di (Rehmanniae Radix Preparata, thin slices, 4 qian) Zhu Ye (Bambusae Folium, 1 qian) Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip, 4 fen) Che Qian Zi (Plantaginis Semen, 3 qian) Niu Xi Shao (Achyranthis Bidentatae Radix tip, 2 qian) Chi Shao (Paeoniae Radix Rubra, 1.5 qian)
She Xiang (Moschus, taken with liquid, 2 li)
Damp-Heat causing hematuria.
Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian) Che Qian Zi (Plantaginis Semen, 3 qian) Fu Ling (Poria, 2 qian) Xiao Ji Tan (Cirsii Japonici Herba, charred, 2 qian) Mai Dong (Ophiopogonis Radix, 1.5 qian) Lian Rou (Nelumbinis Semen Plumula, 7 grains)
Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip, 4 fen)
Note: The following cases starting from Shu Gan Liu Qi Yin all belong to supplementary records.