Before humans invented antibiotics, surgical infectious diseases such as carbuncle were extremely dangerous diseases and seriously affected people's health. Some historical celebrities died of carbuncle. Such as Fan Zeng in the late Qin Dynasty, in the Tang Dynasty, Meng Haoran in the Song Dynasty, Zong Ze in the Ming Dynasty, and Xu Da in the Ming Dynasty. Southern Song doctor Chen Ziming sighed, therefore, "All carbuncles and ulcers are the coolest diseases than other diseases, and the sages recommend it as a miscellaneous disease." Although there were special ulcer doctors in at the latest in weeks, and related medical works have appeared later, the treatment effect is not ideal. In order to improve the cure rate of carbuncles, "to make it a point when you are sick," Chen Ziming, the author of "Essence of Surgery", wrote a group of words and independent skills, and compiled the book "Essence of Surgery".
"Surgery Essence" focuses on the diagnosis, differentiation, moxibustion and medication of carbuncles, which are divided into three volumes: upper, middle and lower, with a total of 60 articles and 55 discussions. Volume 22, the content includes an introduction to carbuncles, moxibustion, cause and syndrome differentiation and medication rules. Volume 16 of the second volume involves the diagnosis and protection of carbuncles. The diagnosis includes the inside and outside, inside and outside, yin and yang, shallow and deep, slow and urgent, good and evil, smooth and negative, etc., and the content is detailed; the regulation includes being cautious in daily life, diet, and avoiding the seven emotions, and speaking in a pertinent manner, which is practical and practical. Volume 17 of the second volume discusses the use of external application of maifan gypsum and Shenyi paste to treat carbuncles, the treatment and aftermath of common complications of carbuncles, and Prime Minister Hong used acupuncture method, etc. At the end of the volume, there are mixed recipes for carbuncle experience, albums and appendixes.
"Essence of Surgery" is a monograph named after surgery earlier (some scholars believe it is the earliest), and it has set a precedent for the diagnosis and treatment of surgical diseases. It requires the diagnosis and treatment of surgical diseases to start from a holistic concept and advocate internal and external treatment. Not only does the number of internal prescriptions have increased, but surgical medical technology has also made great progress, which has had an important impact on the development of later surgical science. "Essence of Surgery" has the following characteristics.
comprehensively discusses the causes and pathogenesis of carbuncles
1. Comprehensively understand the source of carbuncles. Carbuncles are mostly born in people with cream, so Chen Ziming believes that food accumulation is the source of carbuncles. Too much fatty, sweet and thick flavor, the internal organs are fumigated by heat and toxins, the flesh and blood turn into pus, and carbuncles are "mostly obtained by food accumulation of poison", which is similar to diabetes and carbuncle ulcers. Chen Ziming set up a new chapter, pointing out the other five sources of carbuncles: one is the movement of heaven; two is thinness, stagnation of qi; three is anger; four is , kidney qi deficiency, ; five is drinking cold wine, eating roasted vegetarian food, and taking pills.
2. Poor congestion of essence and energy is an important part of the occurrence of carbuncles. If the seven emotions are excessive and the qi, blood and meridians are congested, it is an internal cause; if the six lusts invade outside, the qi, blood and blood are injured, cold turns into heat, and meat rots into pus, it is an external cause; if the elixir is taken, it is an internal cause; if the elixir is taken, the elixir is a internal cause; if the elixir is taken, the elixir is a internal cause; if the elixir is taken, the elixir is a internal cause.
3. The internal organs do not flow and cause carbuncles. The internal organs stored in the "toxicity" can be judged based on the location of the attack. Those that are emitted from the mouth and tongue are poisonous to the heart, those that are emitted from the skin and fur are poisonous to the lungs, those that are emitted from the muscles are poisonous to the spleen, those that are emitted from the bone marrow are poisonous to the kidneys, those that are emitted from the lower part are poisonous to the yin, those that are emitted from the upper part are poisonous to the yang, those that are emitted from the outside are poisonous to the six internal organs, those that are emitted from the outside are poisonous to the five internal organs.
4. An important link in grasping the mechanism of carbuncles. First, pay attention to the spleen and stomach. The spleen is the official of the granary and the stomach is the sea of water and grain, which can promote diet and generate qi and blood. Excessive consumption of fat, sweet, hot medicine, etc. leads to carbuncles, which are related to the adverse transportation and transformation of the spleen and stomach. The spleen and stomach are the root of the positive energy. If the strong one is, the evil will decline. Therefore, carbuncles and ulcers should be treated to regulate the spleen and stomach. The second is to pay attention to the heart pulse. The key to the occurrence of carbuncle is that the heart meridian is blocked, and the qi of heat and toxin has no way to vent. If the heart meridian is circulating and the poison gas is vented, it will not attack internally. This is the method of riding bamboo horse riding and horse moxibustion for treating the upper Tongxin meridian. Third, the root of carbuncles is cold. " Huangdi Neijing·Suwen " records: "The yang energy is coming together, and cold turns into heat. When the heat is strong, the flesh rots into pus." Chen Ziming believes that the origin of carbuncles lies in cold, so he pays great attention to the role of moxibustion in the treatment of carbuncles.
comprehensive summary of carbuncles and ulcers diagnose deficiency and excess
1. Diagnosis is carried out based on the deficiency and excess of meridians. "Surgery Essence" details the key points of syndrome differentiation of carbuncle deficiency and excess from the aspects of swelling, pain, pulse patterns, etc.Those with high swelling and pain are full of evil qi; those with overflowing and slightly painful swelling are true qi deficiency; those without pus, not rotting and ulceration are weak, which is weak yang qi; once the pus comes out, it is painful and painful, it is weak qi and blood; swelling and painful, irritable, and the pulse is strong and rapid, which is the five solids; the pulse is thin and cold, which is diarrhea and intestinal rumbling, which is the five deficiency.
2. A comprehensive summary of the syndrome differentiation methods such as exterior and interior syndrome, pulse syndrome, yin and yang syndrome and manual syndrome differentiation of pus are summarized. Chen Ziming believed that the toxicity of the six internal organs is caused by yang and the toxicity of the five internal organs is stored in yin and the ulcer is caused by yin and the characteristics of the pulse, and pointed out that the ulcer is easy to treat on the surface, while the ulcer is difficult to treat in the internal. "Surgery Essence" distinguishes the presence or absence of pus based on three aspects: skin color, hardness, heat and no heat of the carbuncle, and is used to distinguish pus from surgery. If the sore is swollen and red, the color of pressing remains unchanged, this is the pus. If it is pressed with your hands, it will be hard and there will be no pus. If it is half soft and hard, there will be pus. If it is pressed on the swelling, there will be no pus. If it is not hot, there will be pus. If it is very hot, there will be pus. Determine whether to treat the carbuncle or not, and this method has been used in later generations.
Discrimination and treatment according to specific circumstances
1. Stage treatment, focusing on efficacy. Chen Ziming believed that carbuncles and ulcers were like tigers entering the room, and if they were not good at control, they would definitely hurt people. Therefore, the treatment should start with internal and external attacks and suppress the poisonous gas and prevent it from spreading. Then, "find the name, whether it is a carbuncle or a ulcer, whether it is a deficiency or a solid, whether it is cold or hot, whether it is severe or light, and the symptomatic medication is used without order." Only in this way can good therapeutic effects be achieved. This idea of focusing on efficacy and comprehensive consideration is consistent with the concept of "specimen is urgent" in traditional Chinese medicine. According to the clinical characteristics of carbuncles, Chen Ziming divided them into pus, pus has become, and ulcerated pus, and applied the treatment principles of eliminating swelling, supporting the poison, and replenishing the positive energy. For treatment, it is advisable to use Neitu Powder first, then use Wuxiang Lianqiao Decoction, riding bamboo horse moxibustion or garlic moxibustion, and explicitly moxibustion Zusanli acupoint to vent the poison. Chen Ziming believed that the carbuncle had not ulcerated and the internal organs were poisoned, and a slight hot medicine was not available; the carbuncle had ulcerated and the internal organs were not ulcerated, and the cold medicine was not available. It is advisable to use a medicine to close the holes of the skin. If it is heat and toxins, and the pulse is deep, solid and rapid, it is advisable to use rhubarb , etc. to relieve the poison. Then use Guolao Paste, Wanjin San, Huang'an Pills, Yuanzhi wine and other treatments.
2. Check the symptoms in detail and treat them accordingly. Chen Ziming provided symptomatic treatment for several key symptoms of carbuncle. If the carbuncle has a fever and thirst, it means that the poison is strong. Use Shenxian Zhui Du Pill (Yu Shu Dan) to drive away the viciousness. If the sores are cold and astringent, the inside is white and the pus is small, which means that the qi and blood are weak and cannot be tidbited, and the sores are cold and astringent. Use a handful of mugwort leaves every day, decoct the soup to avoid wind and heat, wash it, burn rosin and smoke it, or use the magic paste externally; if the sores are tight and small and hard, this is the wind and poison, combined with the scorpion powder externally; if the carbuncle has been calm, or when it is not settled, the mouth and tongue are dry and yellow like the inner gizzard of chicken, the kidney water is exhausted, and the heart fire is on the . Use Add-to-spot Bawei Pills and Mulberry Branch Decoction Schisandra Chinensis Decoction to nourish it.
3. Treat both internal and externally, and pay attention to fragrant medicine. Chen Ziming believed that carbuncles are mostly caused by the poison of the heart fire. Moxibustion can circulate the heart fire and the poisonous gas leaks out. Therefore, he attached great importance to the treatment of carbuncles and ulcers. He believed that when carbuncles and ulcers first, they should burn mugwort. There is a saying that "the method of curing ulcers is better than using medicine." "Essence of Surgery" introduces in detail the moxibustion method of riding bamboo horses, garlic-separating moxibustion method, etc. The moxibustion method of riding bamboo horses is gentle and has a wide range of applications. It can be used to treat most aches and ulcers . The method of moxibustion of garlic is to take a large single-headed garlic slices, place it on the top of the gangrene, and use moxibustion to separate the garlic. Garlic is warm in nature and spicy in taste, and is mainly used to disperse carbuncles. The heat of moxibustion can help the medicinal power, so it is suitable for those with red, swelling, purple, and black poisons. The principle of moxibustion is to open the heart meridians, so that the heat can penetrate the heart meridians, and the blood vessels can flow, so that the upper and lower parts can be opened; the second is to release poison gas. If the heart meridians are open, then the poison gas will be released and will not be attacked internally. The moxibustion points include the Jizhuma point, the Refu point, the top of the carbuncle, etc. During moxibustion therapy, if the pain is not painful, the pain can only be stopped. The taboos of moxibustion are in the brain. While moxibustion, pay attention to the use of fragrant medicine. Fragrance medicine can promote the circulation of qi and blood, promote the dissipation or healing of sores, regulate the fragrance and make the fragrance beautiful, benefit the spleen and earth, and maintain true qi.
4. Pay attention to the treatment of carbuncle complications. Chen Ziming believes that there are three complications of carbuncles: one is the symptoms of real heat, irritability, dry mouth, dry throat, and secret difficulties of the body; the second is diarrhea; and the third is vomiting.If there is one of them, you can take 号本号, rhubarb and other medicines to relieve heat and remove poison. If two of them are bad symptoms, they should not be blamed on the medicine; if there is any suspected case, take Tuosan in Nei, then use Wuxiang Lianqiao Decoction and Chenmu Decoction. After 5 to 7 days, the Guolao Paste is used as the need to defeat the enemy. If there are three of them, it should be clear whether it is heat sinking on the heart or qi deficiency . If you vomit due to heat, you can take Neiduan; if you vomit due to weakness, you should take Jiahe San in the morning; if you have both cold and heat, you can do not change to Jinzheng Qi San.
Scientifically judge the prognosis of carbuncles
Chen Ziming listed the "five good and seven evils" based on the clinical manifestations of carbuncles. "Five Goods" refer to diet as normal; full heat and astringent urination and defecation; internal and external diseases; clear muscle likes and dislikes; and medication as expected. Seeing the "Five Goods" in three ways, it means that the positive energy in the body is still strong, the stomach qi is not weak, and the prognosis is good. "Seven Evils" refer to thirst and panting, the corners of the eyes are facing the nose, and the urination and defecation are slippery; the qi is continuous and the pulse is moist, which is opposite to the disease; the eyes are incomplete, the eyes are clear and inwardly sunken; the flesh is not ulcerated and the flesh is dark and sunken; the muscles and bones are rotten; phlegm and vomiting. The "seven evils" are seen in four, which means that the vital energy is weak, the poison gas is infiltrated, and the prognosis is poor. Chen Ziming not only attaches importance to overall diagnosis, but also emphasizes the identification of local symptoms, such as analyzing the size, skin color, hardness, heat and no heat, and symptomatic treatment. This method has been used in surgical clinical practice to this day.
After the publication of "Essence of Surgery", its academic views were praised by later generations and promoted the development of traditional Chinese medicine surgery. Zhu Zhenheng wrote "Essence of Surgery", Xiong Zongli "Essence of Surgery", Xue Ji uses scientific knowledge beyond his knowledge, comprehensively annotated the "Essence of Surgery", detailed explanations, and attached a case. To this day, "Essence of Surgery" is still a must-read book in traditional Chinese medicine surgery, which is enough to set an example for future generations and inspire future generations.
