【方歌】青腿牙疳何故生,只缘上下不交通,阳火炎炽阴寒闭,
凝结为毒此病成。青腿如云茄黑色,疲顽肿硬履难行,
牙疳龈肿出臭血,穿破腮唇腐黑凶。
【注】此证自古方书罕载其名,仅传雍正年间,北路随营医官
陶起麟颇得其详。略云军中凡病腿肿色青者,其上必发
牙疳;凡病牙疳腐血者,其下必发青腿,二者相因而至
。推其原,皆因上为阳火炎炽,下为阴寒闭郁,以至阴
阳上下不交,各自为寒为热,各为凝结而生此证也。相
近内地,间亦有之,边外虽亦有不甚多,惟内地人初居
边外,得此证者,竟十居八九。盖中国之人,本不耐边
外严寒,更不免坐卧湿地,故寒湿之痰生于下,至腿青
肿,其病形如云片,色似茄黑,肉体顽硬,所以步履艰
难也。又缘边外缺少五谷,多食牛、羊等肉,其热与湿
合,蒸瘀于胃,毒火上薰,致生牙疳,牙龈腐肿,出血
,若穿腮破唇,腐烂色黑,即为危候。边外相传,仅有
令服马乳之法。麟初到军营诊视,青腿牙疽之证,亦仅
知投以马乳;阅历既久,因悟马脑之力,较马乳为效倍
速,令患者服之,是夜即能发出大汗,而诸病减矣!盖
脑为诸阳之首,其性温暖,且能流通故耳。兼服活络流
气饮、加味二妙汤,宣其血气,通其经络,使毒不得凝
结。外用砭法,令恶血流出,以杀毒势;更以牛肉片贴
敷,以拔出积毒,不数日而愈。盖黑血出,则阴气外泄
,阳气即随阴气而下降,两相交济,上下自安也。由是
习为成法,其中活者颇多,因不收自私,着之于书,以
公于世,并将所着应验诸方,备详于后。
方剂:服马乳法
主治:治青腿牙疳。
组成:用青白马乳,早、午、晚随挤随服,甚效。如无青、白
马,杂色马亦可。
又方:服马脑法
主治:治青腿牙疳。
组成:用马脑子一个,用竹刀挑去筋膜,放在碗内,先将马脑
搅匀,再用滚黄酒冲服,或一斤或半斤俱可。倘一次不
能服尽,分作二次冲服亦可。
又方:活络流气饮
组成:苍术 木瓜
羌活 附子(生)
山查肉 独活
怀牛膝 麻黄(各二钱)
黄柏 乌药
干姜 槟榔
枳壳(麸炒,各一钱五分) 甘草(八分)
黑豆四十九粒,生姜三片,水四钟,煎一钟服,渣
再煎,水三钟,煎八分。
如牙疳盛,减去干姜、附子,加胡黄连二钱,龙胆
草二钱,如牙疳轻而腿疼重,加肉桂二钱。如寒热已退
,减去羌活、麻黄,加威灵仙二钱,五加皮二钱。
【方歌】活络流气去风强,青肿牙疳初服良,除湿清胃通经络,
加减临时莫执方。苍术木瓜羌附子,山查独膝柏麻黄,
乌药干姜槟枳草,引加黑豆与生姜。
又方:加味二妙汤
组成:黄柏(生) 苍术(米泔水浸,炒)
牛膝(各三钱) 槟榔
泽泻 木瓜
乌药(各二钱) 当归尾(一钱五分)
黑豆四十九粒,生姜三片,水三钟,煎一钟;再煎
渣,水二钟半,煎八分。
【方歌】加味二妙行步难,青腿牙疳龈肿宣,柏苍牛膝归榔泻,
木瓜乌药豆姜煎。
又方:砭刺出血法
方法:用三棱扁针,形如锥挺者,向腿之青黑处,勿论穴道,
量黑之大小,针一分深,或十针、二十针俱可,务令黑
血流出;外以牛肉割片,贴针眼并黑处。次日再看,如
黑处微退,仍针仍贴。如无牛肉,当顶刺破,用罐拔法
。
又方:搽牙牛黄青黛散
组成:牛黄 青黛(各五分)
硼砂(二钱) 朱砂
人中白(〔火段〕) 龙骨(〔火段〕,各一钱)
冰片(三分)
共研细末,先以甘草汤将口漱净,再上此药。
【方歌】牛黄青黛散硼砂,冰片朱砂中白加,龙骨共研为细末,
牙疳肿腐此药搽。
又方:一方用煮马肉汤烫洗。
一方用羊肝割片,贴黑处。
一方用芥菜子捣面,烧酒调敷黑肿处,。
不治:一、形气衰败,饮食不思者不治。
一、牙齿俱落,紫黑流血,腐溃秽臭者不治。
一、腿大肿腐烂,或细干枯者不治。
【方歌】青腿牙疳为何产生?只因为上下气机不交通。阳火炎上炽盛,阴寒闭郁于下,凝结成毒,此病由此形成。双腿呈现青色如同云片,颜色似茄子般黑紫,肢体疲乏、顽固肿胀且坚硬,行走困难。牙龈肿胀出血且有恶臭,若穿破腮帮和嘴唇,腐烂发黑,病情凶险。
【注】这种病症在古代医书中很少记载其名称,仅流传雍正年间,北路随营医官陶起麟对此症了解颇详。大致说:军中凡是腿部肿胀色青的,上部必定发生牙疳;凡是患牙疳流出腐血的,下部必定发生青腿,这两种症状相继出现。推究其根源,都是因为上部阳火炎炽,下部阴寒闭郁,导致阴阳上下不能交通,各自为寒为热,各自凝结而产生此证。内地邻近地区,偶尔也有发生,边外虽然也有但不太多,只有内地人初到边外居住,得此病的,竟然占十之八九。大概中国人本来不耐受边外的严寒,又难免坐卧湿地,所以寒湿之痰生于下肢,导致腿青肿,病形如云片,颜色像茄子黑,肌肉顽硬,所以步履艰难。又因边外缺少五谷杂粮,多食牛、羊等肉类,其热与湿结合,蒸瘀于胃,毒火上熏,导致生牙疳,牙龈腐肿,出血,如果穿腮破唇,腐烂色黑,就是危重征候。边外相传,仅有让患者服用马乳的方法。陶起麟初到军营诊视时,对于青腿牙疽之证,也只知道投以马乳;阅历既久,因而领悟马脑的力量,比马乳见效快一倍,让患者服用,当晚就能发出大汗,各种病症减轻!大概脑为诸阳之首,其性温暖,且能流通的缘故。兼服活络流气饮、加味二妙汤,宣通其血气,疏通其经络,使毒邪不得凝结。外用砭法,令恶血流出,以杀灭毒势;再用牛肉片贴敷,以拔出积毒,不数日而痊愈。大概黑血流出,则阴气外泄,阳气即随阴气而下降,两者相交济,上下自然安宁。从此习以为成法,其中治愈者颇多,因不藏私,著录于书,以公之于世,并将所著应验的各种方剂,详细列于后。
方剂:服马乳法
主治:治疗青腿牙疳。
组成:用青白马乳,早、午、晚随挤随服,效果很好。如果没有青、白马,杂色马也可以。
又方:服马脑法
主治:治疗青腿牙疳。
组成:用马脑子一个,用竹刀挑去筋膜,放在碗内,先将马脑搅匀,再用滚黄酒冲服,或一斤或半斤都可以。倘若一次不能服尽,分作二次冲服也可以。
又方:活络流气饮
组成:苍术 木瓜
羌活 附子(生)
山楂肉 独活
怀牛膝 麻黄(各二钱)
黄柏 乌药
干姜 槟榔
枳壳(麸炒,各一钱五分) 甘草(八分)
黑豆四十九粒,生姜三片,水四钟,煎取一钟服,药渣再煎,水三钟,煎取八分。
如果牙疳严重,减去干姜、附子,加胡黄连二钱,龙胆草二钱;如果牙疳轻而腿疼重,加肉桂二钱。如果寒热已退,减去羌活、麻黄,加威灵仙二钱,五加皮二钱。
【方歌】活络流气饮祛风强壮,青肿牙疳初服良好,除湿清胃通经络,加减临时不要固执方剂。苍术木瓜羌活附子,山楂独活牛膝黄柏麻黄,乌药干姜槟榔枳壳甘草,引药加黑豆与生姜。
又方:加味二妙汤
组成:黄柏(生) 苍术(米泔水浸,炒)
牛膝(各三钱) 槟榔
泽泻 木瓜
乌药(各二钱) 当归尾(一钱五分)
黑豆四十九粒,生姜三片,水三钟,煎取一钟;再煎药渣,水二钟半,煎取八分。
【方歌】加味二妙汤治行走困难,青腿牙疳牙龈肿胀宣通,黄柏苍术牛膝归尾槟榔泽泻,木瓜乌药豆姜煎煮。
又方:砭刺出血法
方法:用三棱扁针,形状像锥挺一样的,向腿的青黑处,不论穴位,根据黑色范围大小,针刺一分深,或十针、二十针都可以,务必令黑血流出;外用牛肉割成片,贴在针眼及黑处。次日再看,如果黑处稍微消退,仍然针刺并贴敷。如果没有牛肉,在顶部刺破,用罐拔法。
又方:搽牙牛黄青黛散
组成:牛黄 青黛(各五分)
硼砂(二钱) 朱砂
人中白(煅) 龙骨(煅,各一钱)
冰片(三分)
共研细末,先用甘草汤将口漱净,再上此药。
【方歌】牛黄青黛散配硼砂,冰片朱砂人中白加入,龙骨共研为细末,牙疳肿腐此药搽涂。
又方:一方用煮马肉汤烫洗。
一方用羊肝割成片,贴在黑处。
一方用芥菜子捣成面,烧酒调敷在黑肿处。
不治:一、形体气息衰败,饮食不思者不治。
一、牙齿全部脱落,紫黑流血,腐溃秽臭者不治。
一、腿部大肿腐烂,或细小干枯者不治。
[Prescription Verse] Why does Qing Tui Ya Gan (Green Leg and Gangrenous Gingivitis) arise? It is solely due to the lack of communication between the upper and lower parts. Yang fire blazes fiercely while Yin cold closes in, condensing into toxin, thus forming this disease. The legs appear green like clouds, dark purple-black like eggplants; the limbs are fatigued, stubbornly swollen and hard, making walking difficult. The gums swell and bleed with a foul odor; if it penetrates through the cheeks and lips, rotting and turning black, the condition is ominous.
[Note] This syndrome was rarely recorded by name in ancient medical texts. Only during the Yongzheng reign did Tao Qilin, an army physician attached to the northern route, understand its details well. He stated roughly: In the army, whenever there were cases of leg swelling with green coloration, gangrenous gingivitis would inevitably develop above; whenever there were cases of gangrenous gingivitis with bleeding of putrid blood, green leg swelling would inevitably develop below. These two conditions occur sequentially. Tracing the origin, it is all because Yang fire blazes in the upper part while Yin cold stagnates in the lower part, causing the Yin and Yang to fail to communicate between upper and lower. Each becomes cold or hot independently, condensing separately to generate this syndrome. In regions near the interior, it occasionally occurs; although it also exists outside the borders, it is not very common. However, among people from the interior who newly reside outside the borders, those contracting this syndrome account for eight or nine out of ten. Generally, Chinese people are inherently intolerant to the severe cold outside the borders, and they inevitably sit or lie on damp ground. Thus, phlegm generated by cold-dampness arises in the lower body, leading to green and swollen legs. The disease presentation resembles cloud patches, the color is black like eggplant, the flesh is stubbornly hard, hence walking is arduous. Furthermore, due to the scarcity of grains outside the borders, people consume much beef and mutton. The heat combines with dampness, steaming and stasis-forming in the Stomach. Toxic fire flares upward, causing gangrenous gingivitis, gum swelling and putrefaction, and bleeding. If it perforates the cheeks and lips, rotting and turning black, it is a critical sign. Outside the borders, it is traditionally believed that only the method of administering horse milk is effective. When Tao Qilin first arrived at the military camp to examine patients with Qing Tui Ya Ju (Green Leg and Gangrenous Ulcer), he only knew to administer horse milk. After gaining experience, he realized that the power of horse brain is twice as fast-acting as horse milk. He ordered patients to take it, and on that night, profuse sweating occurred, and various symptoms subsided! This is because the brain is the head of all Yang meridians; its nature is warm and it can circulate freely. Concurrently administering Huoluo Liuqi Yin (Activating Collaterals and Regulating Qi Decoction) and Jiawei Ermiao Tang (Modified Two Marvels Decoction) to promote blood and Qi circulation and unblock collaterals prevents toxin condensation. Externally, Bian Fa (scarification therapy) is used to allow evil blood to flow out, thereby killing the toxic pathogen; additionally, slices of beef are applied topically to draw out accumulated toxins, resulting in recovery within a few days. Generally, when black blood flows out, Yin Qi escapes outward, and Yang Qi descends following Yin Qi. The two interact and nourish each other, bringing peace to the upper and lower parts naturally. This became a standard practice, with many cured. Not keeping it secret, it was written down and made public, along with the verified prescriptions detailed below.
Prescription: Method of Drinking Horse Milk
Indication: Treats Qing Tui Ya Gan.
Composition: Use fresh milk from blue or white horses, taken immediately after milking morning, noon, and evening. It is very effective. If blue or white horses are unavailable, mixed-color horses may be used.
Another Prescription: Method of Consuming Horse Brain
Indication: Treats Qing Tui Ya Gan.
Composition: Use one horse brain. Remove the fascia with a bamboo knife, place it in a bowl, stir evenly, then mix with boiling yellow rice wine and drink. One jin or half a jin is acceptable. If it cannot be consumed at once, divide into two doses.
Another Prescription: Huoluo Liuqi Yin (Activating Collaterals and Regulating Qi Decoction)
Composition:
Cangzhu (Atractylodis Rhizoma) 2 qian
Mugua (Chaenomelis Fructus) 2 qian
Qianghuo (Notopterygii Rhizoma et Radix) 2 qian
Fuzi (Aconiti Lateralis Radix Praeparata - Raw) 2 qian
Shanzha Rou (Crataegi Fructus) 2 qian
Duhuo (Angelicae Pubescentis Radix) 2 qian
Huainiuxi (Cyathulae Radix) 2 qian
Mahuang (Ephedrae Herba) 2 qian
Huangbai (Phellodendri Cortex) 2 qian
Wuyao (Linderae Radix) 2 qian
Ganjiang (Zingiberis Rhizoma) 1.5 qian
Binglang (Arecae Semen) 1.5 qian
Zhike (Aurantii Fructus) 1.5 qian (bran-fried)
Gancao (Glycyrrhizae Radix et Rhizoma) 0.8 fen
Heidou (Sojae Semen Nigrum) 49 grains
Shengjiang (Zingiberis Rhizoma Recens) 3 slices
Water: 4 zhong, decoct to 1 zhong. Take orally. Dregs: add water 3 zhong, decoct to 0.8 zhong.
If gangrenous gingivitis is severe, remove Ganjiang and Fuzi, add Huhuanglian (Coptidis Rhizoma) 2 qian and Longdancao (Gentianae Radix) 2 qian. If gangrenous gingivitis is mild but leg pain is severe, add Rougui (Cinnamomi Cortex) 2 qian. If chills and fever have subsided, remove Qianghuo and Mahuang, add Weilingxian (Salviae Miltiorrhizae Radix et Rhizoma - *Note: Standard is Saposhnikoviae Radix*) 2 qian and Wujia Pi (Acanthopanacis Cortex) 2 qian.
[Prescription Verse] Huoluo Liuqi Yin dispels wind and strengthens; good for initial use in green swelling and gangrenous gingivitis; removes dampness, clears Stomach, unblocks collaterals; do not stick rigidly to the formula for modifications. Cangzhu, Mugua, Qianghuo, Fuzi; Shanzha, Duhuo, Niuxi, Huangbai, Mahuang; Wuyao, Ganjiang, Binglang, Zhike, Gancao; guide with Heidiou and Shengjiang.
Another Prescription: Jiawei Ermiao Tang (Modified Two Marvels Decoction)
Composition:
Huangbai (Phellodendri Cortex - Raw) 3 qian
Cangzhu (Atractylodis Rhizoma - soaked in rice wash water, fried) 3 qian
Niuxi (Cyathulae Radix) 3 qian
Binglang (Arecae Semen) 2 qian
Zexie (Alismatis Rhizoma) 2 qian
Mugua (Chaenomelis Fructus) 2 qian
Wuyao (Linderae Radix) 2 qian
Danggui Wei (Angelicae Sinensis Radix tail) 1.5 qian
Heidou (Sojae Semen Nigrum) 49 grains
Shengjiang (Zingiberis Rhizoma Recens) 3 slices
Water: 3 zhong, decoct to 1 zhong. Dregs: add water 2.5 zhong, decoct to 0.8 zhong.
[Prescription Verse] Jiawei Ermiao Tang treats difficulty in walking; clears swelling and gangrenous gingivitis of Qing Tui Ya Gan. Huangbai, Cangzhu, Niuxi, Danggui Wei, Binglang, Zexie; Mugua, Wuyao, Heidiou, Shengjiang decocted.
Another Prescription: Bian Ci Chu Xue Fa (Scarification and Bleeding Method)
Method: Use a triangular flat needle, shaped like a cone. On the green-black areas of the leg, regardless of acupoints, depending on the size of the black area, prick to a depth of 1 fen. Ten or twenty pricks are acceptable. Ensure black blood flows out. Externally, apply sliced beef to the puncture sites and black areas. Check the next day; if the black area recedes slightly, repeat pricking and applying. If beef is unavailable, prick the topmost point and use cupping.
Another Prescription: Chaya Niuhuang Qingdai San (Tooth-Anointing Powder of Calculus Bovis and Gentian Violet)
Composition:
Niuhuang (Calculus Bovis) 0.5 fen
Qingdai (Indigo Naturalis) 0.5 fen
Pengsha (Borax) 2 qian
Zhusha (Cinnabaris) [Amount unspecified, implied equal or small dose based on context, usually minimal]
Renzhongbai (Humanis Odoris Depositum - calcined) 1 qian
Longgu (Fossilia Ossis Mastodi - calcined) 1 qian
Bingpian (Borneolum Syntheticum) 0.3 fen
Grind into fine powder. First rinse the mouth thoroughly with Licorice decoction, then apply this powder.
[Prescription Verse] Niuhuang Qingdai San with Pengsha; add Bingpian, Zhusha, Renzhongbai; grind Longgu into fine powder; anoint this medicine for swollen and putrid gangrenous gingivitis.
Another Prescription: One method uses boiled horse meat broth for washing/scalding.
Another method uses sliced sheep liver applied to the black area.
Another method uses mustard seeds ground into powder, mixed with strong liquor, and applied to the black swollen area.
Incurable Cases:
1. Those with衰竭 of form and Qi, with no desire for food, are incurable.
2. Those whose teeth have all fallen out, with purple-black bleeding, putrefaction, and foul odor, are incurable.
3. Those with massive leg swelling and putrefaction, or thin and dry/withered legs, are incurable.