史左 时毒五天,寒热头痛,风邪挟痰瘀凝结,营卫不从。急拟疏散消解。
荆芥穗(一钱) 青防风(一钱) 薄菏叶(八分) 炒牛蒡(二钱) 生草节(八分) 苦桔梗(一钱)
轻马勃(八分) 大贝母(三钱) 炙僵蚕(三钱) 生蒲黄(包,三钱) 山慈菇片(八分) 万灵丹(入
煎,一大粒)
高右 瘰 发于耳后,头痛,脉弦,少阳胆火上升,挟痰凝结。拟清解化痰法。
羚羊尖(八分) 京玄参(二钱) 薄荷叶(八分) 川贝母(三钱) 生牡蛎(六钱) 连翘壳(三钱)
淡海藻(一钱五分) 海蛤粉(四钱) 夏枯草(二钱) 外用消核锭,陈醋磨敷。
翟左 瘰 之生也,多由于胆汁之不足。丹溪云∶瘰 皆起于少阳胆经。少阳风火之府也,内寄相火,风
气通肝,与少阳相合,少阳属木,木最易郁,郁未有不化火者也。郁火与相火交煽,胆汁被其消烁,炼液成痰。
痰即有形之火,火即无形之痰,痰火相聚为患,成为瘰 ,发于耳后颈项之间。延今已有半载,屡屡失寐,时
时头痛,一派炎炎之象,非大剂清化,不足以平其势;非情怀宽畅,不足以清其源,二者并施,或可消患于无形,
此正本清源之治也。
羚羊尖(八分) 大生地(四钱) 银柴胡(一钱) 京玄参(四钱) 象贝母(四钱) 生牡蛎(四钱)
竹沥半夏(二钱) 海蛤粉(四钱) 淡海藻(二钱) 夏枯草(二钱) 紫菜(二钱) 陈海蜇皮(漂淡,二两)
大荸荠(洗打、两味煎汤代水,二两)
外用海浮散,九宝丹,九仙丹,太乙膏。
郑右 疡自颈窜至胸膺,胛窝破深溃大,内热脉数,经闭,谷食不香,势入损门。急拟养阴清热。
南沙参(三钱) 川石斛(四钱) 炙鳖甲(三钱) 青蒿梗(一钱五分) 地骨皮(三钱) 粉丹皮(二钱)
云茯苓(三钱) 川贝母(四钱) 功劳子(三钱) 甘蔗(一两)
外用桃花散、海浮散、太乙膏。
朱右 瘰 窜发,未溃者肿硬疼痛,已溃者脓水不多。经停半载,寒热食减,肝脾肾三者并亏,难治之症
也。肝藏血,脾统血,肾藏精,三经精血大亏,血脉干涩,
经水不通,经不通则气不行,气不行则瘰 成矣。当补益三阴,怡养性情。
吉林参须(一钱五分) 银柴胡(一钱) 大生地(四钱) 炙鳖甲(三钱) 地骨皮(三钱) 生牡蛎(六钱)
广橘红(一钱) 云茯苓(三钱) 生于术(一钱五分) 京玄参(二钱) 夏枯草(二钱) 川象贝(各四钱)
红枣(四枚)
二诊 寒热已退,纳谷略增,项间累累成串,彼没此起,此敛彼溃,三阴精血不足,损症之根萌也。还宜
填补三阴,怡养性情,庶溃易敛而肿易消矣。
吉林参须(一钱五分) 云茯苓(三钱) 生于术(一钱五分) 清炙草(八分) 广橘白(一钱) 仙半
夏(二钱) 浓杜仲(三钱) 川断肉(三钱) 大生地(四钱) 玄武版(四钱) 川象贝(各四钱)
生牡蛎(四钱) 红枣(四枚)
黄左 阴虚肝火上升,肺经痰热入络,颈间瘰 肿大,内热咳呛,涕中夹红。拟滋阴清肝,养肺化痰。
南沙参(三钱) 川石斛(四钱) 石决明(四钱) 粉丹皮(二钱) 光杏仁(三钱) 象贝母(三钱)
京玄参(三钱) 栝蒌皮(三钱) 鲜竹茹(二钱) 夏枯草(二钱) 海蛤粉(四钱) 枇杷叶(去毛、包,三钱)
外用消核锭,酒磨敷。
史左:时毒(季节性流行性毒邪致病)五天,出现恶寒发热、头痛症状,这是风邪挟带痰浊与瘀血凝结,导致营卫之气运行失常。紧急拟定疏散风邪、消解结聚的治法。
荆芥穗(一钱) 青防风(一钱) 薄荷叶(八分) 炒牛蒡子(二钱) 生甘草节(八分) 苦桔梗(一钱)
轻马勃(八分) 大贝母(三钱) 炙僵蚕(三钱) 生蒲黄(包煎,三钱) 山慈菇片(八分) 万灵丹(入药同煎,一大粒)
高右:瘰疬(颈部淋巴结结核或慢性淋巴结炎)发于耳后,伴有头痛,脉象弦,此为少阳胆经之火上升,挟带痰浊凝结。拟用清解胆火、化痰散结的方法。
羚羊角尖(八分) 京玄参(二钱) 薄荷叶(八分) 川贝母(三钱) 生牡蛎(六钱) 连翘壳(三钱)
淡海藻(一钱五分) 海蛤粉(四钱) 夏枯草(二钱) 外用消核锭,用陈醋磨碎敷贴。
翟左:瘰疬的产生,多由于胆汁不足所致。丹溪(朱震亨)说:“瘰疬皆起于少阳胆经。”少阳是风火之府,内寄相火,风气通应于肝,与少阳相合,少阳属木,木气最容易郁结,郁结没有不化火的。郁火与相火交相煽动,胆汁被其消烁,煎熬津液形成痰浊。
痰即是有形的火,火即是无形的痰,痰火相聚为患,形成瘰疬,发于耳后颈项之间。至今已有半年,屡屡失眠,时时头痛,呈现一派火热炽盛之象,非大剂量清热化痰之法,不足以平息其病势;非心情宽畅,不足以清除其病源,两者并施,或许可以消除隐患于无形,这是正本清源的治法。
羚羊角尖(八分) 大生地(四钱) 银柴胡(一钱) 京玄参(四钱) 象贝母(四钱) 生牡蛎(四钱)
竹沥半夏(二钱) 海蛤粉(四钱) 淡海藻(二钱) 夏枯草(二钱) 紫菜(二钱) 陈海蜇皮(漂洗去咸,二两)
大荸荠(洗净捣碎,这两味煎汤代替水煎药,二两)
外用海浮散,九宝丹,九仙丹,太乙膏。
郑右:疮疡从颈部窜至胸膺部,肩窝处破溃深且创面大,内有热感,脉数,月经闭止,食欲不佳,病情已深入虚损范畴。紧急拟定滋养阴液、清泄热邪的治法。
南沙参(三钱) 川石斛(四钱) 炙鳖甲(三钱) 青蒿梗(一钱五分) 地骨皮(三钱) 粉丹皮(二钱)
云茯苓(三钱) 川贝母(四钱) 功劳子(三钱) 甘蔗(一两)
外用桃花散、海浮散、太乙膏。
朱右:瘰疬窜发,未溃破的肿块坚硬疼痛,已溃破的脓水不多。月经停止半年,恶寒发热,饮食减少,肝、脾、肾三脏同时亏虚,属于难治之症。
肝藏血,脾统血,肾藏精,这三条经脉的精血大亏,血脉干涩,
经血不通,经血不通则气机不行,气机不行则瘰疬形成。应当补益三阴(肝、脾、肾),怡养性情。
吉林参须(一钱五分) 银柴胡(一钱) 大生地(四钱) 炙鳖甲(三钱) 地骨皮(三钱) 生牡蛎(六钱)
广橘红(一钱) 云茯苓(三钱) 生于术(一钱五分) 京玄参(二钱) 夏枯草(二钱) 川象贝(各四钱)
红枣(四枚)
二诊:恶寒发热已退,进食略有增加,颈部间结块累累成串,此起彼伏,此处收敛彼处溃破,这是三阴精血不足,虚损病症的根本萌芽。仍宜填补三阴,怡养性情,这样溃口容易愈合而肿结容易消散。
吉林参须(一钱五分) 云茯苓(三钱) 生于术(一钱五分) 清炙甘草(八分) 广橘白(一钱) 仙半夏(二钱) 浓杜仲(三钱) 川断肉(三钱) 大生地(四钱) 玄武版(四钱) 川象贝(各四钱)
生牡蛎(四钱) 红枣(四枚)
黄左:阴虚导致肝火上升,肺经痰热侵入络脉,颈部瘰疬肿大,内有热感,咳嗽气喘,鼻涕中夹带血丝。拟用滋阴清肝、润肺化痰的治法。
南沙参(三钱) 川石斛(四钱) 石决明(四钱) 粉丹皮(二钱) 光杏仁(三钱) 象贝母(三钱)
京玄参(三钱) 栝蒌皮(三钱) 鲜竹茹(二钱) 夏枯草(二钱) 海蛤粉(四钱) 枇杷叶(去毛、包煎,三钱)
外用消核锭,用酒磨碎敷贴。
Shi (Left): For five days, suffering from seasonal epidemic toxic pathogen (Shidu), presenting with aversion to cold, fever, and headache. This is wind pathogen carrying phlegm and blood stasis condensing, causing disharmony of Ying and Wei (Defensive and Nutritive Qi). Urgently prescribe dispersing wind and resolving condensation.
Schizonepeta Spike (1 qian) Blue Pheretima (1 qian) Mint Leaf (8 fen) Stir-fried Arctium Fruit (2 qian) Raw Licorice Node (8 fen) Bitter Platycodon Root (1 qian)
Light Polyporus (8 fen) Large Fritillaria Bulb (3 qian) Honey-fried Silkworm (3 qian) Raw Coptis Rhizome? No, Raw Polygonum Multiflorum Vine? No, Raw Polygonum Multiflorum Rootlet? No, Raw Polygonum Multiflorum Stem? No, Raw Polygonum Multiflorum Root? No, Raw Polygonum Multiflorum Root is He Shou Wu. Wait, Pu Huang is Pollen Typhae. Raw Pollen Typhae (wrapped, 3 qian) Smilax Glabra Rhizome Slice (8 fen) Wan Ling Dan (added to decoction, one large pill)
Gao (Right): Scrofula (Luoli, cervical lymphadenitis/tuberculosis) erupted behind the ear, accompanied by headache and a wiry pulse. This is Shaoyang Gallbladder fire rising, carrying phlegm to condense. Prescribe clearing heat, resolving toxicity, and transforming phlegm.
Antelope Horn Tip (8 fen) Jing Scrophularia Root (2 qian) Mint Leaf (8 fen) Sichuan Fritillaria Bulb (3 qian) Raw Oyster Shell (6 qian) Forsythia Husk (3 qian)
Light Sargassum (1.5 qian) Clam Shell Powder (4 qian) Prunella Vulgaris (2 qian) External use: Xiaohe Ding, ground with aged vinegar for application.
Zhai (Left): The generation of scrofula is mostly due to insufficiency of bile juice. Danxi (Zhu Zhenheng) said: "Scrofula all originates from the Shaoyang Gallbladder Meridian." Shaoyang is the residence of wind and fire, housing ministerial fire internally. Wind qi connects with the Liver, combining with Shaoyang. Shaoyang belongs to Wood; Wood is most prone to stagnation. Stagnation inevitably transforms into fire. Stagnant fire and ministerial fire fan each other, consuming bile juice, refining body fluids into phlegm.
Phlegm is tangible fire; fire is intangible phlegm. Phlegm and fire gather to cause harm, forming scrofula, erupting between the ears, back of the neck, and nape. It has been half a year now. Frequent insomnia, occasional headaches, presenting a picture of blazing heat. Only a large dose of clearing and transforming can quell its momentum; only a broad-minded mood can clear its source. Applying both may eliminate the隐患 (hidden danger) invisibly. This is the treatment of rectifying the root and clearing the source.
Antelope Horn Tip (8 fen) Large Rehmannia Root (4 qian) Silver Bupleurum (1 qian) Jing Scrophularia Root (4 qian) Xiang Fritillaria Bulb (4 qian) Raw Oyster Shell (4 qian)
Bamboo Juice Processed Pinellia Tuber (2 qian) Clam Shell Powder (4 qian) Light Sargassum (2 qian) Prunella Vulgaris (2 qian) Seaweed (2 qian) Aged Jellyfish Skin (washed to remove salt, 2 liang)
Large Water Chestnut (washed and crushed, these two decocted to replace water for brewing herbs, 2 liang)
External use: Haifu San, Jiubao Dan, Jiuxian Dan, Taiyi Gao.
Zheng (Right): The sore spread from the neck to the chest and sternum. The axillary pit broke open deeply with a large ulcer. Internal heat, rapid pulse, amenorrhea, poor appetite. The condition is entering the realm of consumption/deficiency damage. Urgently prescribe nourishing yin and clearing heat.
Southern Sandwort Root (3 qian) Sichuan Dendrobium Stem (4 qian) Honey-fried Turtle Shell (3 qian) Artemisia Annua Stem (1.5 qian) Cortex Lycii (3 qian) Powdered Moutan Bark (2 qian)
Cloud Poria (3 qian) Sichuan Fritillaria Bulb (4 qian) Liao Gong Zi (3 qian) Sugarcane (1 liang)
External use: Taohua San, Haifu San, Taiyi Gao.
Zhu (Right): Scrofula spreading and erupting. Unulcerated masses are swollen, hard, and painful; ulcerated ones have little pus. Menstruation stopped for half a year. Aversion to cold, fever, reduced food intake. Simultaneous deficiency of Liver, Spleen, and Kidney. A difficult-to-treat syndrome.
The Liver stores blood, the Spleen controls blood, the Kidney stores essence. Profound deficiency of essence and blood in these three meridians leads to dryness and astringency of the blood vessels.
Menstrual flow is blocked. When menstrual flow is blocked, Qi does not move. When Qi does not move, scrofula forms. One should tonify the Three Yin (Liver, Spleen, Kidney) and nurture the temperament.
Jilin Ginseng Radicula (1.5 qian) Silver Bupleurum (1 qian) Large Rehmannia Root (4 qian) Honey-fried Turtle Shell (3 qian) Cortex Lycii (3 qian) Raw Oyster Shell (6 qian)
Broad Orange Peel (1 qian) Cloud Poria (3 qian) Fresh Atractylodes Macrocephala Rhizome (1.5 qian) Jing Scrophularia Root (2 qian) Prunella Vulgaris (2 qian) Sichuan and Xiang Fritillaria Bulbs (4 qian each)
Red Dates (4 pieces)
Second Visit: Aversion to cold and fever have subsided. Food intake slightly increased. Neck lumps form chains, appearing here and disappearing there, healing here and ulcerating there. This indicates insufficiency of essence and blood of the Three Yin, the root germination of consumption syndromes. Still appropriate to fill the Three Yin and nurture the temperament, so that ulcers heal easily and swelling dissipates easily.
Jilin Ginseng Radicula (1.5 qian) Cloud Poria (3 qian) Fresh Atractylodes Macrocephala Rhizome (1.5 qian) Clear Honey-fried Licorice Root (8 fen) Broad Tangerine Albedo (1 qian) Immortal Pinellia Tuber (2 qian) Strong Eucommia Bark (3 qian) Sichuan Achyranthes Root (3 qian) Large Rehmannia Root (4 qian) Black Tortoise Plastron (4 qian) Sichuan and Xiang Fritillaria Bulbs (4 qian each)
Raw Oyster Shell (4 qian) Red Dates (4 pieces)
Huang (Left): Yin deficiency leading to rising Liver Fire. Phlegm-heat in the Lung Meridian enters the collaterals. Scrofula swelling in the neck. Internal heat, coughing and wheezing, blood streaks in sputum. Prescribe nourishing yin, clearing Liver, moistening Lung, and transforming phlegm.
Southern Sandwort Root (3 qian) Sichuan Dendrobium Stem (4 qian) Halloysitum (4 qian) Powdered Moutan Bark (2 qian) Light Apricot Seed (3 qian) Xiang Fritillaria Bulb (3 qian)
Jing Scrophularia Root (3 qian) Trichosanthes Peel (3 qian) Fresh Bamboo Shavings (2 qian) Prunella Vulgaris (2 qian) Clam Shell Powder (4 qian) Loquat Leaf (dehired, wrapped, 3 qian)
External use: Xiaohe Ding, ground with wine for application.