周左 骨槽风肿硬不痛,牙关拘紧,缠绵二月余,此阴症也。位在少阳,少阳少血多气之脏,脉络空虚,
风寒乘隙而入,痰瘀凝结,徒恃清凉无益也。法当温化,阳和汤主之。
净麻黄(五分) 肉桂心(四分) 大熟地(二味同捣,四钱) 炮姜炭(五分) 生草节(八分) 白芥
子(砂研,一钱) 鹿角霜(三钱) 小金丹(陈酒化服,一粒)
外用生姜切片,上按艾绒灸之,再覆以阳和膏。
朱右 骨槽风破溃经年,脓积成骨,流水清稀,气血两亏,不能载毒外出,缠绵之症也。法与补托。
潞党参(三钱) 生黄 (四钱) 全当归(二钱) 京赤芍(二钱) 云茯苓(三钱) 炮姜炭(五分)
陈广皮(一钱) 川贝母(三钱) 炙僵蚕(三钱) 香白芷(六分)
金右 骨槽风穿腮落齿,脓水臭秽,症属棘手。
西洋参(二钱) 北沙参(三钱) 川石斛(四钱) 赤白芍(各一钱五分) 金银花(三钱) 粉丹皮(二钱)
川贝母(三钱) 天花粉(三钱) 旱莲草(二钱) 黛蛤散(包,六钱)
施左 颐肿坚硬,寒热交作,牙关开合不利,骨槽风之渐也。宜与疏散。
荆芥穗(一钱五分) 青防风(一钱) 薄荷叶(八分) 炒牛蒡(二钱) 生草节(八分) 苦桔梗(一钱)
大贝母(三钱) 炙僵蚕(三钱) 晚蚕砂(包,三钱) 山慈菇片(八分) 万灵丹(入煎,一粒)
外用消核锭,陈醋磨敷。
二诊 寒热已退,肿硬渐消,此系风痰交阻络道所致。再与疏散。
荆芥穗(一钱五分) 青防风(一钱) 薄荷叶(八分) 炒牛蒡(二钱) 生草节(八分) 苦桔梗(一钱)
大贝母(三钱) 炙僵蚕(三钱) 小青皮(一钱) 光杏仁(三钱) 万灵丹(入煎,一粒)
洪左 颊车漫肿 红,且有寒热,肝胃之火升腾,风热之邪外乘。宜以清疏。
荆芥穗(一钱五分) 青防风(一钱) 薄荷叶(八分) 炒牛蒡(二钱) 生石膏(打,四钱)
生草节(八分) 苦桔梗(一钱) 京赤芍(二钱) 大贝母(三钱) 炙僵蚕(三钱) 金银花(三钱) 茅芦根(去
心、节,各一两)
邹左 骨槽痈内外穿溃,腐烂已久,气阴两伤,少阴伏热上升,喉痹燥痛,蒂丁下坠,妨于咽饮,咳嗽痰浓
夹红,舌质红绛,脉象濡小而数,加之手足浮肿,动则气喘,胸膺骨胀,肺络损伤,子盗母气,脾土薄弱。肺喜清
润,脾喜香燥,治肺碍脾,治脾碍肺,棘手重症。勉拟培土生金,养肺化痰,未识能得应手否?
南沙参(三钱) 生甘草(六分) 栝蒌皮(二钱) 猪肤(刮去油、毛,三钱) 淮山药(三钱)
苦桔梗(一钱) 生苡仁(四钱) 冬瓜子皮(各三钱) 连皮苓(四钱) 川象贝(各二钱) 藏青果(一钱)
外用金不换吹喉搽腐。
周先生,左侧。骨槽风表现为肿胀坚硬但不疼痛,牙关拘紧不舒,病程缠绵已两个多月,这属于阴证。病位在于少阳经,少阳经是血少气多的脏腑经络,脉络空虚,风寒之邪乘虚而入,导致痰浊与瘀血凝结,单纯依靠清凉药物是没有益处的。治疗法则应当温阳化散,主方选用阳和汤。
净麻黄(五分) 肉桂心(四分) 大熟地(这两味药一起捣碎,四钱) 炮姜炭(五分) 生草节(八分) 白芥子(砂研细,一钱) 鹿角霜(三钱) 小金丹(用陈年黄酒化开服用,一粒)
外用生姜切片,上面放置艾绒进行艾灸,然后再敷上阳和膏。
朱先生,右侧。骨槽风破溃已经一年多了,脓液积聚形成死骨,流出的液体清稀,气血两亏,无法托毒外出,这是缠绵难愈的病症。治疗法则采用补益气血、托毒外出的方法。
潞党参(三钱) 生黄芪(四钱) 全当归(二钱) 京赤芍(二钱) 云茯苓(三钱) 炮姜炭(五分) 陈广皮(一钱) 川贝母(三钱) 炙僵蚕(三钱) 香白芷(六分)
金先生,右侧。骨槽风穿腮导致牙齿脱落,脓水气味臭秽,病情属于棘手难治。
西洋参(二钱) 北沙参(三钱) 川石斛(四钱) 赤芍和白芍(各一钱五分) 金银花(三钱) 粉丹皮(二钱) 川贝母(三钱) 天花粉(三钱) 旱莲草(二钱) 黛蛤散(包煎,六钱)
施先生,左侧。下颌部肿胀坚硬,寒热交替发作,牙关开合不利,这是骨槽风的初期征兆。适宜采用疏散风邪的方法。
荆芥穗(一钱五分) 青防风(一钱) 薄荷叶(八分) 炒牛蒡子(二钱) 生草节(八分) 苦桔梗(一钱) 大贝母(三钱) 炙僵蚕(三钱) 晚蚕砂(包煎,三钱) 山慈菇片(八分) 万灵丹(入煎剂,一粒)
外用消核锭,用陈醋磨碎后敷贴。
二诊:寒热症状已经消退,肿胀坚硬逐渐减轻,这是由于风痰交阻于络道所致。再次给予疏散风痰的治疗。
荆芥穗(一钱五分) 青防风(一钱) 薄荷叶(八分) 炒牛蒡子(二钱) 生草节(八分) 苦桔梗(一钱) 大贝母(三钱) 炙僵蚕(三钱) 小青皮(一钱) 光杏仁(三钱) 万灵丹(入煎剂,一粒)
洪先生,左侧。颊车穴周围漫肿发红,且有寒热症状,这是肝胃之火升腾,风热之邪外袭所致。适宜采用清热疏风的方法。
荆芥穗(一钱五分) 青防风(一钱) 薄荷叶(八分) 炒牛蒡子(二钱) 生石膏(打碎,四钱)
生草节(八分) 苦桔梗(一钱) 京赤芍(二钱) 大贝母(三钱) 炙僵蚕(三钱) 金银花(三钱) 茅根和芦根(去心、节,各一两)
邹先生,左侧。骨槽痈内外穿溃,腐烂时间已久,气阴两伤,少阴伏热上升,导致喉痹干燥疼痛,会厌下坠,妨碍吞咽饮水,咳嗽痰浓且夹有血丝,舌质红绛,脉象濡小而数,加之手足浮肿,动则气喘,胸膺部骨骼胀闷,肺络损伤,子盗母气(肺病及脾),脾土薄弱。肺喜清润,脾喜香燥,治疗肺病会妨碍脾,治疗脾病会妨碍肺,这是棘手重症。勉强拟定培土生金、养肺化痰的治法,不知能否见效?
南沙参(三钱) 生甘草(六分) 栝蒌皮(二钱) 猪肤(刮去油、毛,三钱) 淮山药(三钱)
苦桔梗(一钱) 生薏苡仁(四钱) 冬瓜子皮(各三钱) 连皮茯苓(四钱) 川象贝母(各二钱) 藏青果(一钱)
外用金不换吹喉药搽拭腐肉。
Mr. Zhou, left side. The bone trough wind (Gu Cao Feng, a type of chronic osteomyelitis of the jaw) presents with swelling and induration without pain, and trismus (stiffness of the jaw). The condition has lingered for over two months; this is classified as a Yin syndrome (Yin Zheng). The location involves the Shaoyang (Lesser Yang) channel, which is characterized by scant blood and abundant Qi. Due to the emptiness of the collaterals, Wind-Cold pathogens have entered through the gaps, causing phlegm and blood stasis to congeal. Relying solely on cooling herbs is of no benefit. The treatment principle should be to warm and transform, primarily using Yang He Tang (Cordyceps Decoction).
Purified Ephedrae Herba (Mahuang, 5 fen), Cinnamon Twig Heart (Rougui Xin, 4 fen), Prepared Rehmanniae Radix (Dushudi, 4 qian, these two crushed together), Prepared Zingiberis Rhizoma Carbonis (Paojiangtan, 5 fen), Raw Glycyrrhizae Radix et Rhizoma Node (Shengcaojie, 8 fen), Semen Sinapis Albae (Baijizi, ground with sand, 1 qian), Cornu Cervi Degelatinatum Frost (Lujiaoshuang, 3 qian), Xiao Jin Dan (Little Golden Pill, dissolved in aged yellow wine for administration, 1 pill).
Externally: Slice fresh ginger, place moxa wool on top and moxibustion; then cover with Yang He Gao (Yang He Plaster).
Mr. Zhu, right side. The bone trough wind has been ulcerated for over a year, pus accumulation has formed sequestrum (dead bone), and the discharge is clear and thin. Both Qi and Blood are deficient, unable to carry toxins outwards; this is a lingering condition. The treatment method is tonification and expulsion (Bu Tuo).
Codonopsis Radix (Ludangshen, 3 qian), Astragali Radix (Shenghuang, 4 qian), Angelicae Sinensis Radix Quan (Quandanggui, 2 qian), Paeoniae Radix Rubra (Jingchishao, 2 qian), Poria (Yunfuling, 3 qian), Prepared Zingiberis Rhizoma Carbonis (Paojiangtan, 5 fen), Aged Tangerine Peel (Chenguangpi, 1 qian), Fritillariae Thunbergii Bulbus (Chuanbeimu, 3 qian), Bombyx Batryticatus (Zhijiangcan, 3 qian), Angelicae Dahuricae Radix (Xiangbaizhi, 6 fen).
Mr. Jin, right side. The bone trough wind has perforated the cheek leading to tooth loss, and the pus water is foul-smelling; the condition is considered difficult to treat.
American Ginseng (Xiyangshen, 2 qian), Glehniae Radix (Beishashen, 3 qian), Dendrobii Caulis (Chuanshihu, 4 qian), Paeoniae Radix Rubra et Paeoniae Radix Alba (Chibaishao, 1.5 qian each), Lonicerae Japonicae Flos (Jinyinhua, 3 qian), Moutan Cortex (Fendanpi, 2 qian), Fritillariae Thunbergii Bulbus (Chuanbeimu, 3 qian), Trichosanthis Radix (Tianhuafen, 3 qian), Ecliptae Herba (Hanliancao, 2 qian), Dai Ge San (Indigo Naturalis and Clam Shell Powder, wrapped for decoction, 6 qian).
Mr. Shi, left side. Swelling and induration of the chin/jaw area, alternating chills and fever, difficulty in opening and closing the jaw; this is the onset of bone trough wind. It is suitable to use dispersing methods.
Schizonepeta Spike (Jingjiesui, 1.5 qian), Saposhnikoviae Radix (Qingfangfeng, 1 qian), Menthae Haplocalycis Herba (Boheye, 8 fen), Fried Arctii Fructus (Chaoniubang, 2 qian), Raw Glycyrrhizae Radix et Rhizoma Node (Shengcaojie, 8 fen), Platycodonis Radix (Kujiegeng, 1 qian), Fritillariae Cirrhosae Bulbus (Dabeimu, 3 qian), Bombyx Batryticatus (Zhijiangcan, 3 qian), Bombyx Batryticatus Excrement (Wancansha, wrapped for decoction, 3 qian), Smilacis Glabrae Rhizoma Pian (Shancigu pian, 8 fen), Wan Ling Dan (Ten Thousand Spirit Pill, added to decoction, 1 pill).
Externally: Xiao He Ding (Nodule Dissolving Stick), ground with aged vinegar for application.
Second visit: Chills and fever have subsided, swelling and induration are gradually diminishing. This is caused by Wind-Phlegm obstructing the collaterals. Again, administer dispersing treatment.
Schizonepeta Spike (Jingjiesui, 1.5 qian), Saposhnikoviae Radix (Qingfangfeng, 1 qian), Menthae Haplocalycis Herba (Boheye, 8 fen), Fried Arctii Fructus (Chaoniubang, 2 qian), Raw Glycyrrhizae Radix et Rhizoma Node (Shengcaojie, 8 fen), Platycodonis Radix (Kujiegeng, 1 qian), Fritillariae Cirrhosae Bulbus (Dabeimu, 3 qian), Bombyx Batryticatus (Zhijiangcan, 3 qian), Green Citri Reticulatae Pericarpium (Xiaoqingpi, 1 qian), Prunus Armeniaca Seed (Guangxingren, 3 qian), Wan Ling Dan (Ten Thousand Spirit Pill, added to decoction, 1 pill).
Mr. Hong, left side. Diffuse swelling and redness around the Jiache acupoint, accompanied by chills and fever. This is due to the rising fire of the Liver and Stomach, with Wind-Heat pathogens attacking externally. Clearing and dispersing is appropriate.
Schizonepeta Spike (Jingjiesui, 1.5 qian), Saposhnikoviae Radix (Qingfangfeng, 1 qian), Menthae Haplocalycis Herba (Boheye, 8 fen), Fried Arctii Fructus (Chaoniubang, 2 qian), Raw Gypsum Fibrosum (Shengshigao, crushed, 4 qian).
Raw Glycyrrhizae Radix et Rhizoma Node (Shengcaojie, 8 fen), Platycodonis Radix (Kujiegeng, 1 qian), Paeoniae Radix Rubra (Jingchishao, 2 qian), Fritillariae Cirrhosae Bulbus (Dabeimu, 3 qian), Bombyx Batryticatus (Zhijiangcan, 3 qian), Lonicerae Japonicae Flos (Jinyinhua, 3 qian), Imperatae Rhizoma and Phragmitis Rhizoma (Maolugen, heart and nodes removed, 1 liang each).
Mr. Zou, left side. Bone trough abscess has perforated internally and externally, with long-standing putrefaction. Qi and Yin are both injured. Hidden Heat in the Shaoyin (Lesser Yin) rises, causing throat obstruction (Hou Bi) with dryness and pain, prolapse of the uvula/epiglottis area, hindering swallowing and drinking, cough with thick sputum containing blood, red crimson tongue coating, and a soggy, small, rapid pulse. Additionally, there is edema of hands and feet, panting upon movement, distension of the chest and rib bones, damage to Lung collaterals. The child steals from the mother (Lung disease affecting Spleen), resulting in weak Spleen Earth. The Lung prefers clarity and moistening, while the Spleen prefers aromatic dryness. Treating the Lung hinders the Spleen, and treating the Spleen hinders the Lung; this is a difficult and severe case. Tentatively prescribing strengthening the Earth to generate Metal (Spleen to Lung), nourishing the Lung and transforming phlegm, we shall see if it proves effective.
Glehniae Radix (Nanshashen, 3 qian), Raw Glycyrrhizae Radix et Rhizoma (Shenggancao, 6 fen), Trichosanthis Pericarpium (Gualoupi, 2 qian), Porcine Skin (Zhufu, scraped of oil and hair, 3 qian), Dioscoreae Hypoglaucae Rhizoma (Huai shanyao, 3 qian).
Platycodonis Radix (Kujiegeng, 1 qian), Coicis Semen (Shengyiren, 4 qian), Benincasae Semen Exocarpium and Exocarpium (Dongguazipi, 3 qian each), Poria with Husk (Lianpiling, 4 qian), Fritillariae Thunbergii Bulbus and Fritillariae Cirrhosae Bulbus (Chuanxiangbei, 2 qian each), Myrobalanus Chebulae Fructus (Zangqingguo, 1 qian).
Externally: Jin Bu Huan (Golden Unchanging) powder blown into the throat and applied to remove necrotic tissue.