斑疹既退,咳嗽声低,热炽舌赤少苔,此痧热逗
留,肺胃阴伤。宜用沙参、花粉、甜杏、地骨皮、川
贝、生甘草、桑白皮、绿豆壳、枇杷叶等味,清肺养
胃也。
肺胃为斑疹往来之路,兹病退热炽,咳声不扬,舌赤少
苔,是余热逗留,消烁肺胃。故用沙参,杏仁、川贝、桑
皮、地骨皮、枇杷叶,一派清肺润津,合绿豆壳,生甘草,
粳米养胃解毒,毌使热留肺底,酿成痨痑,最宜慎之。
斑疹之后,颈颔核肿,牙关不宣,寒热脉数,此
痧毒壅结。宜用蓝根、马勃、元参,连翘,银花、桔
梗、僵蚕、土贝母、甘草、夏枯草等味,软坚化毒
也。
斑疹虽退,热结上焦,其肿核在颔下者属阳明,在耳下
者属少阳,在颈项者属太阳,总由三阳热壅,风毒上攻,以
致牙关不宣,而成时毒。故用苦辛泄降清解上焦,又须按经
施治,以图速解,则不致延成渍破之累矣。
斑疹未现,颈颔热肿,延及头面,皮肿色赤,此
大头温也。宜用东垣普济消毒饮,苦辛化解也。
凡大头温初发,必先恶寒,烦热头痛,口渴,颈面赤
肿,延及满头。然须分经辨症。其肿在耳下及面颊者属少
阳,肿在面膛及鼻额者属阳明,肿在头顶及颈项者属太阳,
亦有满头俱肿者为三阳合病,古称大头温,亲戚不相访问,
恐其传染。东垣制普济消毒饮,最为的当,其用芩、连苦寒
降火,升、柴辛凉升阳,犹恐芩、连之苦寒直入肠胃,俱用
酒炒,借以上行,且合升降之机,而成不易之法;更兼薄
荷、大力祛风,连翘,元参清热,蓝根、马勃解毒,桔梗、
甘草载之上行,僵蚕引之入络。观此方大有巧手,非深于仲
经之心法者,不能臻此妙圯。
斑疹消退后,出现咳嗽、声音低微,体内热势炽盛,舌质红赤且少苔,这是痧热残留,导致肺胃阴液受损。适宜使用沙参、天花粉、甜杏仁、地骨皮、川贝母、生甘草、桑白皮、绿豆壳、枇杷叶等药物,以清润肺脏并滋养胃阴。
肺胃是斑疹邪气出入的通道,如今病邪虽退但热势仍炽,咳嗽声音不响亮,舌红少苔,说明余热逗留,正在消耗肺胃津液。因此使用沙参、杏仁、川贝母、桑白皮、地骨皮、枇杷叶,这一组药物主要起到清润肺燥、滋润津液的作用;配合绿豆壳、生甘草、粳米来养胃解毒,务必防止热邪留滞于肺部深处,酿成虚劳痨瘵之证,这一点最需谨慎对待。
在斑疹之后,出现颈部和下颌淋巴结肿大,牙关紧闭不能张开,伴有寒热往来、脉搏快速,这是痧毒壅滞结聚所致。适宜使用板蓝根、马勃、玄参、连翘、金银花、桔梗、僵蚕、土贝母、甘草、夏枯草等药物,以软坚散结、化解毒素。
斑疹虽然消退,但热邪结聚在上焦,肿块位于下颌的属于阳明经,位于耳下的属于少阳经,位于颈项部的属于太阳经,总归是三阳经热邪壅盛,风毒向上攻冲,从而导致牙关紧闭,形成时行疫毒(大头瘟类病症)。因此使用苦辛泄降、清解上焦的方法,并且必须按照经络辨证施治,以求迅速解除病邪,这样就不会延误病情导致溃烂破损的后果。
在斑疹尚未显现时,颈部和下颌发热肿胀,蔓延至头面部,皮肤肿胀且颜色发红,这是大头温病。适宜使用李东垣创制的普济消毒饮,采用苦辛之法化解病邪。
凡是初发的大头温病,必定先出现恶寒、烦热头痛、口渴、颈部和面部红肿,并蔓延至整个头部。然而必须分经辨证。如果肿胀位于耳下及面颊部,属于少阳经;肿胀位于面膛及鼻额部,属于阳明经;肿胀位于头顶及颈项部,属于太阳经;也有整个头部都肿胀的,称为三阳合病,古代称之为大头温,患者亲戚不敢互相探访,担心其具有传染性。李东垣制定的普济消毒饮最为恰当,方中用黄芩、黄连苦寒以降火,升麻、柴胡辛凉以升阳,又恐怕黄芩、黄连的苦寒之性直入肠胃,所以都用酒炒制,借药力上行,同时结合升降的气机原理,成为不易更改的定法;再加上薄荷、牛蒡子祛风,连翘、玄参清热,板蓝根、马勃解毒,桔梗、甘草载药上行,僵蚕引药入络。观察这个方子大有巧思,如果不是深谙张仲景经典心法的医者,不能达到这种精妙的境界。
After the macules and papules (Ban Zhen) have subsided, there is coughing with a low voice, intense heat in the body, a red tongue with little coating. This indicates that the Sha-heat (Sha-re) lingers, damaging the Yin fluids of the Lung and Stomach. It is appropriate to use Glehniae Radix (Shashen), Trichosanthis Radix (Huafen), sweet Prunus armeniaca seed (Tianxing), Lycii Cortex (Digupi), Fritillariae Cirrhosae Bulbus (Chuanbei), raw Glycyrrhizae Radix et Rhizoma (Shenggancao), Morus Albae Cortex (Sangbaipi), mung bean shell (Lvdouke), and Loquat leaf (Pipaye) to clear the Lung and nourish the Stomach.
The Lung and Stomach are the pathways through which Ban Zhen pathogens enter and exit. Now that the pathogen has retreated but heat remains intense, with hoarse coughing, a red tongue with little coating, it shows that residual heat lingers, consuming the fluids of the Lung and Stomach. Therefore, Glehniae Radix (Shashen), Apricot Seed (Xingren), Fritillariae Cirrhosae Bulbus (Chuanbei), Morus Albae Cortex (Sangpi), Lycii Cortex (Digupi), and Loquat leaf (Pipaye) are used; this combination primarily clears the Lung and moistens dryness while generating fluids. Combined with mung bean shell (Lvdouke), raw Glycyrrhizae Radix et Rhizoma (Shenggancao), and Rice (Jingmi) to nourish the Stomach and detoxify, one must ensure that heat does not remain deep in the Lung, brewing into consumptive tuberculosis (Lao Lao). This requires utmost caution.
After the macules and papules, swelling of lymph nodes in the neck and submandibular region occurs, with trismus (lockjaw), alternating chills and fever, and a rapid pulse. This is due to Sha-toxin stagnation and knotting. It is appropriate to use Isatidis Radix (Langen), Euphrasiae Herba (Mabo), Scrophulariae Radix (Yuanshen), Forsythiae Fructus (Lianqiao), Lonicerae Japonicae Flos (Yinhua), Platycodonis Radix (Jiegeng), Bombyx Batryticatus (Jiangcan), Fritillariae Thunbergii Bulbus (Tubeimu), Glycyrrhizae Radix et Rhizoma (Gancao), and Prunellae Spica (Xiakucao) to soften hardness and resolve toxins.
Although the macules and papules have subsided, heat knots in the Upper Jiao. Swelling under the jaw belongs to the Yangming channel, swelling below the ear belongs to the Shaoyang channel, and swelling on the neck and nape belongs to the Taiyang channel. Generally, this results from heat stagnation in the three Yang channels, with wind-toxin attacking upward, causing trismus and forming epidemic toxic diseases (Shi Du). Therefore, bitter and pungent methods are used to drain downward and clear the Upper Jiao. Treatment must be administered according to the meridians to achieve rapid resolution, preventing the complication of ulceration and rupture.
Before the macules and papules appear, there is hot swelling in the neck and submandibular region extending to the head and face, with swollen skin and red color. This is Da Tou Wen (Big Head Plague). It is appropriate to use Dongyuan's Puji Xiaodu Yin (Universal Benefit Decoction for Eliminating Toxins), employing bitter and pungent methods to resolve the pathogen.
Whenever Da Tou Wen first appears, it must initially present with aversion to cold, vexing heat, headache, thirst, red and swollen neck and face extending to the entire head. However, differentiation by channel and syndrome is necessary. Swelling below the ears and on the cheeks belongs to the Shaoyang channel; swelling on the face and nose/forehead belongs to the Yangming channel; swelling on the vertex and neck/nape belongs to the Taiyang channel. There are also cases where the entire head swells, known as San Yang He Bing (Combined Disease of the Three Yang Channels), anciently called Da Tou Wen. Relatives avoid visiting each other for fear of contagion. Dongyuan’s formulation of Puji Xiaodu Yin is most appropriate. It uses Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian) for bitter-cold fire-draining, and Cimicifugae Rhizoma (Shengma) and Bupleuri Radix (Chaihu) for pungent-cool yang-raising. Fearing that the bitter-cold nature of Huangqin and Huanglian might go directly into the intestines and stomach, they are all stir-fried with wine to facilitate upward movement, combining ascending and descending mechanisms to form an unchangeable method. Additionally, Menthae Haplocalycis Herba (Bohe) and Arctii Fructus (Niubangzi) dispel wind, Forsythiae Fructus (Lianqiao) and Scrophulariae Radix (Yuanshen) clear heat, Isatidis Radix (Langen) and Euphrasiae Herba (Mabo) detoxify, Platycodonis Radix (Jiegeng) and Glycyrrhizae Radix et Rhizoma (Gancao) carry the herbs upward, and Bombyx Batryticatus (Jiangcan) guides them into the collaterals. Observing this prescription reveals great skill; only those deeply versed in the heart-method of Zhang Zhongjing’s classics can reach such subtlety.