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《卷之四十九》[View] [Edit] [History]

1 痼冷門附論
2 夫痼冷者,痼為年久長固者也,冷為寒極至甚者也。《三因方》云:人以髒腑稟賦不同,亦有將理失宜,遂致偏冷偏熱,故方中有痼冷積熱之說。痼冷者,中寒也,多因真氣既微,胃氣不實,複啖生冷冰雪之屬,致腸胃虛寒。陰既停凝,陽不能正,大便洞洩,小便頻數,鼻多清涕,嘔吐涎沫,水穀不化,腸胃絞痛,肚腹如冰冷。灑灑淅淅,皆陽虛陰盛之所為也,張長沙有陰毒之証,雖不為痼冷,即冷寒所傷,令人為手足冷,腰背強,臍腹築痛,咽喉不利,嘔吐不利,身如被杖,脈細欲絕。此由腎氣虛寒,外傷風冷,或因冷物傷脾。蓋脾為太陰,內外皆陰,則陽氣不守,遂成陰毒。四肢逆冷,額上手背冷,而汗出不止,或眼痛不堪任,唇口手足爪甲俱青黑,氣上衝心,而脈沉細伏匿者。或多煩渴者,精神如失,故曰陰勝則身寒汗出,身必鼓慄而寒,寒則厥,宜溫藥以複其陽氣,或於氣海關元灸之。《醫律》云:冷者陰之至盛,陽之至衰,陰過曰寒。經曰:寒者熱之,服以熱劑,乃治冷之正法。
3 內則飲以至燥至剛之藥,外則灼以數百艾炷,逐其陰而助其陽,斯又治冷夾攻之道也。大抵人身貴乎陰陽升降,平和無偏,則無疾矣。若有偏勝,是即有沉寒痼冷之証,乃真陽耗散,脾胃虛弱,失於調理,以致胃寒,食啖冷物粘膩難化生硬之類,經年累月,久積而成痼冷,漸被其傷,脾腎因而漬積,髒腑以成痼疾矣,但有寒冷等邪觸犯,速然而作,以臻手足厥逆,畏冷增寒,飲食不化,或嘔吐涎沫,或大便洞洩,米穀不消,或小便頻數,或肚腹絞痛,或逢寒咳嗽,或 疝大作,是其証也。《內經》曰:寒淫所勝,平以辛熱。又《內經·舉痛篇》云:經脈流行不止,環周不休,寒氣入經而稽遲,泣而不行,客於脈外則血少,客於脈中則氣不通,故卒然而痛。岐伯曰:寒氣客於脈外則脈寒,脈寒則縮蜷,縮蜷則脈絀急,絀急則外引小絡,故卒然而痛。得炅則痛立止。因重中於寒,則痛久矣。寒氣客於經脈之中,與炅氣相搏則脈滿,滿則痛而不可按也。寒氣稽留,炅氣從上,則脈充大而血氣聚,故痛甚不可按也。寒氣客於腸胃之間,膜原之下,血不得散,小絡急引故痛。按之則血氣散,故按之痛止。寒氣客於俠脊之脈則深,按之不能及,故按之無益也。寒氣客於衝脈,衝脈起於關元,隨腹直上,寒氣客則脈不通,脈不通則氣因之,故喘動應手矣。寒氣客於背俞之脈,則血脈泣,脈泣則血虛,血虛則痛,其俞注於心,故相引而痛。按之則熱氣至,熱氣至則痛止矣。寒氣客於厥陰之脈,厥陰之脈者,絡陰器,系於肝,寒氣客於脈中,則血泣脈急,故脅肋與少腹相引痛矣。厥氣客於陰股,寒氣上及少腹,血泣在下相引,故腹痛引陰股。寒氣客於小腸膜原之間,絡血之中,血泣不得注于大經,血氣稽留不得行,故宿昔而成積矣。寒氣客於五髒,厥逆上洩,陰氣竭,陽氣未入,故卒然痛死不知人,氣複反則生矣,寒氣客於腸胃,厥逆上出,故痛而嘔也。寒氣客於小腸,小腸不得成聚,故後洩腹痛矣,然寒則腠理閉,則氣道不行,故氣收斂,冷積於中,遂為痼冷之疾也。《直指方》云:人之處世飲食為上,湯藥次之,惟其口腹不充,嗜欲無節,所以髒中停聚而為之沉痼也,故有沉寒痼冷之名耶。男子遺精,女子帶下,骨寒腦冷,氣乏血衰,嘔吐惡心,久洩暴下,皆其証耳。療治之法,在乎溫補,不可用剛劑。惟於滋血養氣之中,或佐以姜桂則可,古人所謂精不足者,補之以味,若執剛燥之劑,亟欲陽氣頓回,猶恐腎水易涸,心火獨盛,亢則害,承乃制也。《內經》曰:陰氣有餘,多汗身寒。《陰陽應象》云:陰盛則身寒汗出,身常清數,慄而寒,寒而厥。《調經篇》云:陰盛生內寒。岐伯曰:厥氣上逆,寒氣積於胸中而不可瀉,瀉則溫氣去,寒獨留,故為寒中。東垣解云:此脾胃不足,勞役形體,中焦不能營運,病傳為寒中,宜補陽以附子理中湯為末,用蔥白煎羊肉湯,取清汁,調進數服而愈。前人立論至詳,凡為醫者深探其意,根據經用藥,則無夭閼之禍也。
URN: ctp:ws77742

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