按百合狐惑阴阳毒四症。其病脉证治。并详于金匮要略三卷内。百合症。仲景论
之最详。治法亦备。贞尝留心于此。而遇斯症甚罕。故不敢述。狐惑。虫病也。状似
伤寒。或伤寒后变症。蚀于喉为惑。蚀于阴为狐。面目乍白乍赤乍黑。默默欲眠。恶
闻食气。蚀其喉则声嗄。甘草泻心汤。蚀其肛则咽干。苦参汤洗之。或雄黄熏之。又
狐惑。即近时之疳症也。牙疳即惑。下疳即狐。说详金鉴。
邵评∶金匮注曰。看其上唇内有疮如粟。唾血。心内懊 痛。此虫在上。食其五脏。
下唇内生疮者。其人不寤。此虫食下部是也。
阴阳毒。考诸金匮。阳毒。面赤斑斑如锦纹。咽喉痛。唾脓血。五日可治。七日不可治。升麻鳖甲
汤主之。阴毒。面目青。身痛如被杖。咽喉痛。五日可治。七日不可治。升麻鳖甲汤去雄黄蜀椒主之。
邵评∶毒者。邪蕴不解也。阴阳非指脏腑气血。以面赤。喉痛。吐脓血。其邪着而在
表者。谓之阳。言此邪适中人之阳。而非极热之谓也。面目青。身疼咽痛。不吐脓
血。其邪隐而在表之里者。谓之阴。言此邪适中人之阴。而非极寒之谓也。故俱
用辛温升散以发其邪。甘润咸以安其阴。阴毒去雄黄蜀椒二物者。恐阴不可
劫。而阴气反受损也。五日邪气尚浅。发之犹易。故可治。七日邪气已深。发之则难。故不可治。
按仲景所称阴阳毒。乃感其异气。入阳经为阳毒。入阴经为阴毒。故于阳毒。用蜀
椒雄黄之温且猛者。以驱阳经之邪。而于阴毒。反去蜀椒雄黄。止用鳖甲、当归、升
麻、甘草等。入阴以散邪。不取其温烈也。若后人所述阴毒阳毒。乃是极热极寒之
证。自应以极热极寒方药为治。不得执定仲景之方。
邵评∶二症俱咽喉痛。以此症邪从口鼻而下入咽喉。故痛。甚至有心腹绞痛。大满大胀。通
身脉络。青紫暴出。手足指甲。色如靛叶。口噤牙闭。心中烦闷而乱。死在旦夕。不必问其阴阳。但刺尺
泽、委中二穴。及手中十指。脉络暴出之处出血。如症轻者。用刮痧法。随服紫金锭。或吐或下或汗出而愈。
按：百合病、狐惑病、阳毒、阴毒这四种病症，其脉象、症状和治疗方法，在《金匮要略》第三卷中已有详细记载。百合病，张仲景的论述最为详尽，治疗方法也完备。我（吴坤安）曾经留心研究此病，但遇到这种病例非常罕见，所以不敢妄加叙述。
狐惑病，是由虫邪引起的疾病。症状类似伤寒，或者是伤寒后的变证。虫邪侵蚀咽喉称为“惑”，侵蚀前后二阴称为“狐”。患者面色时而发白、时而发红、时而发黑，神情沉默想睡觉，厌恶闻到食物的气味。如果虫邪侵蚀咽喉，声音就会嘶哑，可用甘草泻心汤治疗；如果虫邪侵蚀肛门，则会出现咽干，可用苦参汤清洗患处，或者用雄黄烟熏。另外，狐惑病就是近代的疳症。牙疳相当于惑，下疳相当于狐，详细说明见《医宗金鉴》。
邵评注：《金匮要略》注解说：看其上唇内侧有像粟米大小的疮疡，吐出血，心中烦闷疼痛，这是虫邪在上部，啃食五脏的表现；下唇内侧生疮的，患者无法入睡，这是虫邪在下部啃食的缘故。
阴阳毒：考证《金匮要略》，阳毒的症状是面部红赤，斑纹如锦缎花纹，咽喉疼痛，吐出脓血。发病五天内可治，七天后不可治。主方用升麻鳖甲汤。阴毒的症状是面目青暗，身体疼痛如同被棍棒打过一样，咽喉疼痛。发病五天内可治，七天后不可治。主方用升麻鳖甲汤去掉雄黄和蜀椒。
邵评注：所谓“毒”，是指邪气蕴结不解。这里的“阴阳”不是指脏腑气血的阴阳，而是根据症状判断：面红、喉痛、吐脓血，说明邪气附着且在体表，称为“阳”，意思是此邪气侵犯的是人体的阳分，而非指极热的证候。面目青暗、身疼咽痛、不吐脓血，说明邪气隐蔽且在表之里，称为“阴”，意思是此邪气侵犯的是人体的阴分，而非指极寒的证候。因此，两种病症都使用辛温升散的药物来发散邪气，使用甘润咸味的药物来安定阴液。阴毒方剂中去掉雄黄和蜀椒两味药，是担心阴证不可强行攻劫，反而损伤阴气。发病五天时邪气尚浅，发散它比较容易，所以可治；发病七天时邪气已深，发散它比较困难，所以不可治。
按：张仲景所称的阴阳毒，是感受了异气（特殊的致病邪气），进入阳经成为阳毒，进入阴经成为阴毒。所以对于阳毒，使用蜀椒、雄黄这样温热且猛烈的药物，以驱除阳经的邪气；而对于阴毒，反而去掉蜀椒、雄黄，只使用鳖甲、当归、升麻、甘草等药物，入阴经以疏散邪气，不取其温热猛烈之性。如果是后人所述的阴毒阳毒，那是极热或极寒的证候，自然应该用极热或极寒的方药来治疗，不能拘泥于张仲景的方子。
邵评注：这两种病症都有咽喉痛，因为邪气从口鼻向下侵入咽喉，所以疼痛。严重的甚至有心腹绞痛，腹部极度胀满，全身脉络青紫暴起，手足指甲颜色像靛蓝叶子一样，口噤牙关紧闭，心中烦闷混乱，死亡就在旦夕之间。这时不必问它是阴毒还是阳毒，只需针刺尺泽穴、委中穴以及手中十指脉络暴起之处放血。如果症状较轻，可以用刮痧法，同时服用紫金锭，通过呕吐、腹泻或出汗而痊愈。
According to: The pulse, symptoms, and treatment of *Baihe* disease (Lily Disease), *Huo Huo* disease (Gnawing Disease), Yang Poison, and Yin Poison are detailed in Volume 3 of the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet). Regarding *Baihe* disease, Zhang Zhongjing's discussion is the most comprehensive, and the treatment methods are complete. I (Wu Kun'an) have paid attention to this condition, but encountering such cases has been very rare; therefore, I dare not elaborate on it.
*Huo Huo* disease is caused by parasitic pathogens. Its presentation resembles *Shanghan* (Cold Damage) or may be a sequela of *Shanghan*. Erosion of the throat is termed "Huo" (Confusion/Parasite), while erosion of the genitalia or anus is termed "Hu" (Fox/Parasite). The patient's complexion may appear pale, red, or black intermittently; they remain silent and desire sleep, and dislike the smell of food. If the parasite erodes the throat, hoarseness occurs, treated with *Gancao Xiexin Tang* (Licorice Decoction for Draining the Epigastrium). If the parasite erodes the anus, dryness of the throat occurs, treated by washing with *Kushen Tang* (Sophora Root Decoction) or fumigating with *Xionghuang* (Realgar). Furthermore, *Huo Huo* disease corresponds to modern *Gan* syndrome (Pediatric Malnutrition Syndrome). Dental *Gan* corresponds to "Huo," and genital *Gan* corresponds to "Hu." Detailed explanations can be found in the *Yi Zong Jin Jian* (Golden Mirror of Medicine).
Commentary by Shao: The commentary on the *Jin Gui Yao Lue* states: If there are sores like millet grains inside the upper lip, accompanied by hemoptysis and internal restlessness/pain, this indicates parasites located superiorly, consuming the five zang organs. If sores develop inside the lower lip, the patient cannot sleep, indicating parasites located inferiorly.
Regarding Yang Poison and Yin Poison: Consulting the *Jin Gui Yao Lue*, Yang Poison presents with facial erythema and mottled rash resembling brocade patterns, sore throat, and expectoration of pus and blood. It is treatable within five days but untreatable after seven days. The primary formula is *Shengma Biejia Tang* (Cimicifuga and Turtle Shell Decoction). Yin Poison presents with cyanotic complexion and face, body pain as if beaten with a club, and sore throat. It is treatable within five days but untreatable after seven days. The primary formula is *Shengma Biejia Tang* minus *Xionghuang* (Realgar) and *Shujiao* (Sichuan Pepper).
Commentary by Shao: "Poison" refers to pathogenic factors that are accumulated and unresolved. Here, "Yin" and "Yang" do not refer to the yin/yang of zang-fu organs or qi-blood. Rather, based on symptoms: facial erythema, sore throat, and expectoration of pus/blood indicate pathogenic factors adhering to and manifesting on the exterior, termed "Yang." This means the pathogen affects the yang aspect of the human body, not necessarily implying an extreme heat syndrome. Cyanotic complexion, body pain, sore throat, and absence of pus/blood expectoration indicate pathogenic factors hidden and located interior to the exterior, termed "Yin." This means the pathogen affects the yin aspect of the human body, not necessarily implying an extreme cold syndrome. Therefore, both conditions utilize acrid-warm and ascending-dispersing herbs to vent the pathogen, and sweet-moistening and salty herbs to anchor the yin. In the Yin Poison formula, *Xionghuang* and *Shujiao* are removed because one fears that attacking a yin condition too aggressively might damage yin qi. When the disease duration is five days, the pathogenic factor is still shallow, making dispersion easier; thus, it is treatable. When seven days have passed, the pathogenic factor is deep, making dispersion difficult; thus, it is considered untreatable.
Note: The Yang Poison and Yin Poison mentioned by Zhang Zhongjing result from contracting abnormal qi (peculiar pathogenic factors). Entering the yang meridians constitutes Yang Poison, while entering the yin meridians constitutes Yin Poison. Hence, for Yang Poison, warm and potent herbs like *Shujiao* and *Xionghuang* are used to drive out pathogens from the yang meridians. For Yin Poison, these are removed, and only herbs like *Biejia* (Turtle Shell), *Danggui* (Angelica Sinensis), *Shengma* (Cimicifuga), and *Gancao* (Licorice) are used to enter the yin and disperse pathogens, avoiding their warm and acrid nature. If later authors describe Yin and Yang Poisons as extreme cold or extreme heat syndromes, they should indeed be treated with formulas corresponding to extreme cold or extreme heat, and one must not rigidly adhere to Zhang Zhongjing's formulas.
Commentary by Shao: Both syndromes involve sore throat because the pathogen enters downward from the mouth and nose into the throat. Severe cases may present with severe heart and abdominal cramping, extreme abdominal distension, sudden emergence of cyanotic veins throughout the body, fingernails and toenails turning dark blue like indigo leaves, trismus (lockjaw), and mental restlessness/confusion, leading to death within a day or night. In such critical stages, one need not distinguish between Yin and Yang Poison. One should merely puncture the *Zuchi* (Chize, LU5) and *Weizhong* (BL40) acupoints, as well as the sites where collaterals protrude on the ten fingers of the hands, to bleed. For milder cases, scraping therapy (*Gua Sha*) may be used, accompanied by oral administration of *Zijin Ding* (Purple Gold Pellet), leading to recovery through vomiting, purging, or sweating.