暖而苏醒后复有余热不清此伏火后作也以黄连解毒竹叶石膏汤调之而愈
(外证欲眠目不闭声哑)
狐惑之为病状如伤寒或因伤寒而变成斯病其状默默欲眠目牵不得闭卧起不安虫蚀于喉咽为惑蚀于阴肛为狐不欲食
恶闻食臭其面目乍赤乍黑乍白蚀于上部则声嗄甘草泻心汤主之(方见痞)蚀于下部则咽干苦参汤洗之蚀于肛者雄黄散熏
之用雄黄一味为末取二瓦合之烧向肛熏之
脉经云病患或从呼吸后蚀其咽喉或从下焦蚀其肛阴蚀上为惑蚀下为狐狐惑病者猪苓散主之(方未考)病者脉数无热
微烦默默但欲卧汗出初得之三四日目赤如鸠眼七八日目四 (一本 下有黄字)黑若能食者脓已成也赤豆当归散主之(方
见杂病下血门)
附
一妇人狐惑声嗄多眠目不闭恶闻食臭不省人事半月后又手足拘强脉数而微细先与竹沥姜汁一盏服之忽胸中有汗腹
鸣即目闭省人事遂用参术归陈入竹沥姜汁饮之五六点而愈
活 狐惑伤寒与湿 皆虫证初得状如伤寒或因伤寒变成此疾大抵伤寒腹内热食少肠胃空虚三虫行作求食蚀人五脏
及下部为 虫病其候齿无色舌上尽白甚者唇黑有疮四肢沉重忽忽喜眠虫蚀其肛烂见五脏则死当数看其上下唇上唇有疮
虫蚀其藏下唇有疮虫蚀其肛杀人甚急多因下利而得治 桃仁汤黄连犀角汤雄黄锐散主之
治 桃仁汤
生艾 桃仁(去皮尖炒双仁不用) 槐花子(碎各一两) 大枣(十五个去核)上水二盏煎至一盏半分三服
黄连犀角汤 治伤寒及诸病之后有 出下部者
黄连(半两) 犀角(一两) 乌梅(七个) 没药(二钱半)上水二大盏半煎至一盏半分三服
雄黄丸 治伤寒狐惑微烦默默欲卧毒瓦斯上攻咽干声嗄下蚀湿 或便脓血
雄黄(研) 当归(炒各七钱半) 芦荟(研) 麝香(研各二钱半) 槟榔(半两)上捣研为末煮面糊为丸如梧
桐子大每服十五丸至一十丸食前温粥饮下日三服
雄黄锐散 治下部 疮
雄黄 苦参 青葙子 黄连(各半两) 桃仁(去皮尖二钱半)上为散以生艾捣汁为丸如枣核大绵裹纳下部匾竹叶
汁更佳冬月无艾只用散裹纳亦得
发热退去、神志清醒后,如果仍有残余热邪未清,这是伏火再次发作,用黄连解毒汤和竹叶石膏汤调理即可痊愈。
(外部症状表现为想睡觉但眼睛闭不上,声音嘶哑)
狐惑病,其症状类似伤寒,有的因患伤寒而转变为这种病。其表现是神情沉默,想睡觉却睁着眼无法闭合,躺下或坐起都感到不安。虫体侵蚀咽喉称为“惑”,侵蚀阴部及肛门称为“狐”。患者不想进食,厌恶食物的气味。若虫蚀上部(咽喉),则声音嘶哑,主治方剂为甘草泻心汤(方剂见痞证篇)。若虫蚀下部,则咽干,用苦参汤清洗患处。若虫蚀肛门,用雄黄散熏蒸治疗。方法是将一味雄黄研成粉末,取两片瓦相对合住,点燃后对着肛门进行熏蒸。
《脉经》记载:病人有的从呼吸之气导致咽喉被侵蚀,有的从下焦导致肛阴被侵蚀。侵蚀上部称为惑,侵蚀下部称为狐。狐惑病患者,主治方剂为猪苓散(方剂未能考证)。患者脉象数,身体无发热,仅有轻微烦躁,神情沉默只想躺卧,出汗。初得病三四天,眼睛发红像斑鸠的眼睛;到了七八天,眼四角变黑(另一版本在“黑”字下有“黄”字)。如果能吃东西,说明脓已经形成,主治方剂为赤豆当归散(方剂见杂病下血门)。
附案:
一位女性患者,患狐惑病,声音嘶哑,嗜睡多眠,眼睛闭不上,厌恶食物气味,甚至不省人事。半个月后,又出现手足拘挛强直,脉象数而微细。先给予竹沥和姜汁一盏服用,忽然胸中有汗出,腹中鸣响,随即眼睛闭上,神志恢复清醒。随后用人参、白术、当归、陈皮加入竹沥姜汁饮中服用,五六次后痊愈。
按语:狐惑、伤寒与湿毒,都属于虫证。初起时症状类似伤寒,有的因患伤寒而转变为这种疾病。大抵而言,伤寒导致腹内热盛,饮食减少,肠胃空虚,三虫活动寻找食物,侵蚀人的五脏及下部,成为虫病。其征候是牙齿颜色发暗,舌上布满白苔,严重时嘴唇发黑且有疮疡,四肢沉重,恍惚喜睡。虫侵蚀肛门,腐烂至可见五脏则死亡。应当经常查看上下唇:上唇有疮,说明虫侵蚀内脏;下唇有疮,说明虫侵蚀肛门。这种情况杀人非常急迫,多因腹泻痢疾而得此病。主治方剂为桃仁汤、黄连犀角汤、雄黄锐散。
治疗方剂:桃仁汤
生艾叶、桃仁(去皮尖,炒,双仁者不用)、槐花子(捣碎,各一两)、大枣(十五个,去核)。以上药材用水二盏煎至一盏半,分三次服用。
黄连犀角汤:治疗伤寒及其他病症之后,虫毒出于下部的情况。
黄连(半两)、犀角(一两)、乌梅(七个)、没药(二钱半)。以上药材用水两大盏半煎至一盏半,分三次服用。
雄黄丸:治疗伤寒狐惑病,轻微烦躁,神情沉默想躺卧,毒气上攻导致咽干声哑,下部侵蚀潮湿,或者大便带脓血。
雄黄(研细)、当归(炒,各七钱半)、芦荟(研细)、麝香(研细,各二钱半)、槟榔(半两)。以上药材捣碎研末,用面糊煮制为丸,如梧桐子大小。每次服用十五丸至十丸,饭前用温粥送服,每日三次。
雄黄锐散:治疗下部虫疮。
雄黄、苦参、青葙子、黄连(各半两)、桃仁(去皮尖,二钱半)。以上药材研为散剂,用生艾叶捣汁制成丸,如枣核大小,用棉布包裹纳入下部,用竹叶汁调和更佳。冬季没有艾叶时,只用散剂包裹纳入也可。
After the fever subsides and consciousness returns, if residual heat remains unclear, this is due to latent fire flaring up again. It can be cured by regulating with Huanglian Jiedu Tang (Coptis Decoction for Poisoning) and Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction).
(External symptoms include drowsiness with inability to close eyes, and hoarseness.)
The Huo-Huo disease presents with symptoms resembling Taiyang disease (Sun-Tang Disease/Exterior Syndrome), sometimes developing from Taiyang disease. The presentation involves silence, a desire to sleep but an inability to keep the eyes closed, and restlessness whether lying down or sitting up. Parasites eroding the throat are called "Huo" (Huò), while those eroding the yin and anus are called "Hu" (Hú). The patient loses appetite and dislikes the smell of food. If erosion occurs in the upper part (throat), causing hoarseness, Gancao Xiexin Tang (Licorice Inward-Draining Decoction) is the primary formula (see Pi syndrome section). If erosion occurs in the lower part, causing dryness of the throat, Kushen Tang (Sophora Decoction) should be used for washing. If erosion occurs at the anus, Xionghuang San (Realgar Powder) is used for fumigation. The method involves grinding Realgar into powder, placing it between two tiles, igniting it, and fumigating the anus.
The Mai Jing (Pulse Classic) states: Patients may have their throats eroded via respiratory qi, or their anal yin eroded via the Lower Jiao (Lower Burner). Erosion of the upper part is called Huo; erosion of the lower part is called Hu. For Huo-Huo disease, Zhuling San (Polyporus Powder) is the primary formula (formula not verified). The patient has a rapid pulse, no fever, slight irritability, silence, a desire to lie down, and sweating. Within three to four days of onset, the eyes turn red like a turtledove's eyes; by seven to eight days, the corners of the eyes turn black (another version adds the character 'yellow' after 'black'). If the patient can eat, it indicates that pus has formed. Chidou Danggui San (Red Bean and Angelica Powder) is the primary formula (see Miscellaneous Diseases, Hematochezia section).
Appendix:
A female patient suffered from Huo-Huo disease with hoarseness, excessive sleepiness, inability to close her eyes, aversion to food smells, and loss of consciousness. Half a month later, she developed stiffness and spasms of the hands and feet, with a rapid yet fine and weak pulse. Initially, one cup of Zhuli Jiangzhi (Bamboo Sap and Ginger Juice) was administered. Suddenly, sweat appeared on the chest, abdominal borborygmi occurred, and her eyes closed as consciousness returned. Subsequently, Renshen Baizhu Danggui Chenpi Yin (Ginseng, Atractylodes, Angelica, and Tangerine Peel Drink) added to Bamboo Sap and Ginger Juice was given. After five or six doses, she recovered.
Commentary: Huo-Huo, Taiyang disease, and Dampness-Toxin all belong to parasite syndromes. In the early stage, symptoms resemble Taiyang disease, sometimes transforming from it. Generally, Taiyang disease causes internal heat, reduced food intake, and empty intestines and stomach, allowing the Three Worms to move and seek food, eroding the Five Zang Organs and the lower body, resulting in worm disease. Signs include dark teeth, white coating covering the tongue, and in severe cases, black lips with sores, heavy limbs, mental confusion, and a preference for sleep. Parasites eroding the anus lead to rotting visible organs, which is fatal. One must frequently examine the upper and lower lips: sores on the upper lip indicate parasites eroding the viscera; sores on the lower lip indicate parasites eroding the anus. This condition kills rapidly and often arises from diarrhea/dysentery. Primary formulas include Taoren Tang (Peach Kernel Decoction), Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction), and Xionghuang Rui San.
Treatment Formulas:
Taoren Tang (Peach Kernel Decoction):
Sheng Ai Ye (Artemisia argyi Herb), Taoren (Peach Seed Kernel, peeled, de-husked, fried, double-kernels avoided), Huaizuizi (Styphnolobium Seed, crushed, each 1 liang), Dazao (Jujube Fruit, 15 pieces, pitted). Decoct these in 2 jin of water until 1.5 jin remains, divide into three doses.
Huanglian Xijiao Tang (Coptis and Rhinoceros Horn Decoction): Treats cases where toxins emerge from the lower part after Taiyang disease or other illnesses.
Huanglian (Coptis Rhizome, 0.5 liang), Xijiao (Rhinoceros Horn, 1 liang), Wumei (Mume Fruit, 7 pieces), Moyao (Myrrh, 2.5 qian). Decoct these in 2.5 large jin of water until 1.5 jin remains, divide into three doses.
Xionghuang Wan (Realgar Pill): Treats Taiyang disease and Huo-Huo with slight irritability, silence, desire to lie down, toxic qi attacking upward causing dry throat and hoarseness, lower erosion with dampness, or pus/blood in stool.
Xionghuang (Realgar, ground), Danggui (Angelica Sinensis Root, fried, each 7.5 qian), Lushen (Aloe, ground), Shexiang (Musk, ground, each 2.5 qian), Binglang (Areca Seed, 0.5 liang). Pound and grind into powder, make pills with wheat paste size of tung tree seeds. Take 10-15 pills before meals with warm porridge drink, three times daily.
Xionghuang Rui San (Realgar Acute Powder): Treats lower body worm sores.
Xionghuang (Realgar), Kushen (Sophora Root), Qingxiangzi (Celosia Seed), Huanglian (Coptis Rhizome, each 0.5 liang), Taoren (Peach Seed Kernel, peeled, de-husked, 2.5 qian). Grind into powder. Mix with juice from fresh Artemisia argyi leaves to form pills the size of a jujube pit. Wrap in cotton and insert into the lower orifice. Bamboo leaf juice is better for mixing. In winter without mugwort, using the powder wrapped for insertion is also acceptable.