【方歌】颊疡胃经积热生,初如红粟渐榴形,脓出肿消易敛愈,
脓稀难敛漏因成。
【注】此证生于耳下颊车骨间,由阳明胃经积热而生。始发如
粟,色红大如榴,初起宜犀角升麻汤清解之。若失治,
或过敷寒药,以致肌冷凝结,坚硬难消难溃者,宜升阳
散火汤宣发之。将溃,宜托里消毒散。脓熟针之,脓出
肿退,疮口易敛者则愈。或牙关紧急不开,或旁肿不消
,脓水清稀,因而成漏,复被寒侵疮孔,致生多骨,经
年缠绵难愈者,服桂附地黄丸,外用豆豉饼垫灸艾壮,
初用九壮,以知热痒为止,每日灸之,以朽骨脱出,脓
渐少而肌渐平为度。兼用红升丹,捻入疮口内,万应膏
盖贴,每日一易。患者当慎起居,戒腥、发等物,渐渐
收功。
方剂:犀角升麻汤
组成:犀角(二钱五分) 升麻(一钱七分)
黄芩(八分) 白附子(面里煨熟,八分)
生甘草(五分) 白芷(八分)
川芎(八分) 羌活(一钱二分)
防风(八分)
水三钟,煎一钟,食远热服。
【方歌】犀角升麻医颊疡,色红初起服之良,黄芩白附生甘草,
白芷川芎羌活防。
又方:升阳散火汤
组成:抚芎(六分) 蔓荆子
白芍(酒炒) 防风
羌活 独活
甘草(半生,半炙) 人参(各一钱)
柴胡 香附(各一钱五分)
葛根(一钱) 升麻(一钱)
僵姜(炒,一钱五分)
生姜一片,红枣肉一枚,水二钟,煎一钟,食远温
服。
【方歌】升阳散火过敷寒,牙叉拘急木痛坚,抚蔓芍防羌独草,
参柴香附葛升蚕。
又方:托里消毒散(见肿疡门)
豆豉饼(见炙法内)
红升丹、万应膏(俱见溃疡门)
【方歌】颊部痈疡由胃经积热而生,初起像红色的谷粒,逐渐变得像石榴形状,脓液排出、肿胀消退后容易愈合;若脓液稀薄则难以收敛,从而形成瘘管。
【注】此证发生在耳下颊车骨之间,由阳明胃经的积热引起。刚开始发作时如粟米大小,颜色红,后来大如石榴。初起适宜用犀角升麻汤来清热解表。如果延误治疗,或者过度使用寒凉药物敷贴,导致肌肉寒冷凝结,坚硬难消且难以溃破,适宜用升阳散火汤宣发郁火。即将溃破时,适宜用托里消毒散。脓液成熟后用针穿刺,脓液排出、肿胀减退,疮口容易收敛者即可痊愈。如果出现牙关紧闭无法张开,或旁边肿胀不消,脓水清稀,因而形成瘘管,又遭受寒气侵袭疮孔,导致生出多块死骨,经年缠绵难以痊愈者,服用桂附地黄丸,外用豆豉饼垫着施以艾炷灸,初次使用九壮,以感到温热瘙痒为度,每天灸治,直到朽骨脱落,脓液逐渐减少而肌肉逐渐平整为止。兼用红升丹,捻成条状纳入疮口内,外用万应膏覆盖贴敷,每天更换一次。患者应当谨慎起居,忌食腥味及发物等,渐渐收效。
方剂:犀角升麻汤
组成:犀角(二钱五分) 升麻(一钱七分)
黄芩(八分) 白附子(面粉包裹煨熟,八分)
生甘草(五分) 白芷(八分)
川芎(八分) 羌活(一钱二分)
防风(八分)
用水三钟,煎取一钟,饭后稍远时间热服。
【方歌】犀角升麻治疗颊部痈疡,初起色红服用效果良好,黄芩、白附子、生甘草,
白芷、川芎、羌活、防风。
又一方:升阳散火汤
组成:抚芎(六分) 蔓荆子
白芍(酒炒) 防风
羌活 独活
甘草(一半生用,一半炙用) 人参(各一钱)
柴胡 香附(各一钱五分)
葛根(一钱) 升麻(一钱)
僵蚕(炒,一钱五分)
生姜一片,红枣肉一枚,用水二钟,煎取一钟,饭后稍远时间温服。
【方歌】升阳散火针对过度敷用寒药,牙关拘急麻木疼痛坚硬,抚芎、蔓荆子、白芍、防风、羌活、独活、甘草,
人参、柴胡、香附、葛根、升麻、僵蚕。
又一方:托里消毒散(见肿疡门)
豆豉饼(见灸法内)
红升丹、万应膏(均见溃疡门)
[Formula Song] Cheek abscess arises from accumulated heat in the Stomach Meridian; initially resembling red millet grains, it gradually takes on the shape of a pomegranate. When pus is discharged and swelling subsides, healing occurs easily; however, if the pus is thin, it is difficult to close, leading to the formation of a fistula.
[Annotation] This condition occurs between the bone below the ear and the Jiache point (ST6), caused by accumulated heat in the Yangming Stomach Meridian. It begins like a millet grain, red in color, and later enlarges to the size of a pomegranate. In the initial stage, Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction) should be used to clear heat and resolve the exterior. If treatment is delayed or if cold medicines are over-applied topically, causing the flesh to become cold and condensed, hard, difficult to dissipate, and difficult to suppurate, Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction) should be used to vent the stagnant fire. As it is about to suppurate, Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) is appropriate. Once the pus has matured, it should be punctured with a needle; if the pus drains, the swelling recedes, and the wound closes easily, the patient will recover. If there is trismus (lockjaw) preventing mouth opening, or persistent swelling nearby, with thin purulent discharge leading to fistula formation, and further invasion by cold pathogens into the wound causing the extrusion of multiple sequestra (dead bone fragments), resulting in chronic, lingering non-healing ulcers lasting for years, Guifu Dihuang Wan (Cinnamon Twig and Aconite Rehmannia Pill) should be taken. Externally, apply moxibustion using a fermented soybean cake pad: start with nine moxa cones, continuing until a sensation of warmth and itching is felt, performing this daily until the dead bone is expelled, pus decreases, and tissue levels out. Additionally, Hongshengdan (Red Arsenic Ointment) should be rolled into strips and inserted into the wound, covered with Wanying Gao (All-Purpose Plaster), changing once daily. The patient must maintain careful daily routines and avoid fishy foods and "fa-wu" (stimulating/triggering foods). Gradual recovery will follow.
Formula: Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction)
Composition: Xi Jiao (Hornis Rhinocerotis, 2.5 qian), Sheng Ma (Cimicifugae Rhizoma, 1.7 qian), Huang Qin (Scutellariae Radix, 0.8 qian), Bai Fu Zi (Typhonii Rhizoma Praeparatum, baked in flour, 0.8 qian), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma, 0.5 qian), Bai Zhi (Angelicae Dahuricae Radix, 0.8 qian), Chuan Xiong (Chuanxiong Rhizoma, 0.8 qian), Qiang Huo (Notopterygii Rhizoma et Radix, 1.2 qian), Fang Feng (Saposhnikoviae Radix, 0.8 qian).
Preparation: Decoct with three zhong of water to obtain one zhong; take hot after meals.
[Formula Song] Xijiao Shengma treats cheek abscess, effective when redness appears initially; Huang Qin, Bai Fu Zi, and Sheng Gan Cao, along with Bai Zhi, Chuan Xiong, Qiang Huo, and Fang Feng.
Another Formula: Shengyang Sanhuo Tang (Ascending Yang and Dispersing Fire Decoction)
Composition: Fu Xiong (Chuanxiong Rhizoma, 0.6 qian), Man Jing Zi (Vitalbae Fructus), Bai Shao (Paeoniae Radix Alba, wine-fried), Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma, half raw, half honey-fried), Ren Shen (Ginseng Radix, each 1 qian), Chai Hu (Bupleuri Radix), Xiang Fu (Cyperi Rhizoma, each 1.5 qian), Ge Gen (Puerariae Lobatae Radix, 1 qian), Sheng Ma (Cimicifugae Rhizoma, 1 qian), Jiang Can (Bombyx Batryticatus, fried, 1.5 qian).
Preparation: Add one slice of Sheng Jiang (Zingiberis Rhizoma Recens) and one piece of Da Zao (Jujubae Fructus); decoct with two zhong of water to obtain one zhong; take warm after meals.
[Formula Song] Shengyang Sanhuo addresses excessive application of cold medicines, treating trismus, numbness, pain, and hardness; Fu Xiong, Man Jing Zi, Bai Shao, Fang Feng, Qiang Huo, Du Huo, and Gan Cao, along with Ren Shen, Chai Hu, Xiang Fu, Ge Gen, Sheng Ma, and Jiang Can.
Another Formula: Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) (See Swollen Ulcer Section)
Dou Chi Bing (Fermented Soybean Cake Pad) (See Moxibustion Methods)
Hongshengdan (Red Arsenic Ointment), Wanying Gao (All-Purpose Plaster) (Both See Ulcer Section)