鳞坐两臀痘若鳞，急急治之莫逡巡，平扁灰滞通圣效，板硬紫黯归宗神。
[注]
鳞坐者，两臀之痘聚集如鳞也，因毒火太甚，攒聚于至阴之地，
若不急治，变如反掌，
如平扁灰滞者，松肌通圣散主之，
板硬紫黯者，归宗汤主之。
(松肌通圣散)方见蒙头证治
(归宗汤)方见发热证治。
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囊球痘密在肾囊，毒聚于斯最难当，即用散结汤调治，毒宣热解始安康。
[注]
肾囊者，乃肾之外候关要处也，若痘出稠密，乃毒聚于斯也，
宜用散结汤主之疏解通畅，庶可愈矣。
(散结汤) 荆芥 羌活 牛蒡子炒 升麻 川芎 丹皮 紫花地丁 赤芍
木通 紫草 青皮 山查 引加芦□十株 水煎服。
(方歌)
散结汤中药堪夸，荆芥羌蒡共升麻，川芎丹皮地丁芍，木通紫草青山查。
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两膝之痘独稠密，因地命名为抱膝，须防行浆难下达，速用松肌通圣治。
[注]
抱膝者，遍身痘出稀疏，独两膝攒簇如饼，此毒气凝聚于膝，
至行浆时恐难下达于足胫也，宜用松肌通圣散加牛膝透之，功效甚速。
(松肌通圣散)方见蒙头证治。
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足踝以下痘无形，毒热锢蔽势多凶，速宜驱毒扶脾气，快□越婢汤有功。
[注]
足踝以下属于脾经，若过身有痘而此地独无者，名曰无根，是毒滞于脾也，
但足为至阴之地，非创建中州发越脾气，不能下达，故用快□越婢汤以发之。
(快□越婢汤) 黄耆蜜制 桂枝 防风 白芍药炒 甘草生 引用生姜红枣水煎服。
(方歌)
快□越婢药最灵，黄耆桂枝及防风，白芍甘草姜枣引，煎服之后痘自生。
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【背景信息】
书名：《医宗金鉴》 作者：吴谦 朝代：清 章节：鳞坐 / ... / 无根（共4节） 类别：医论
【原文翻译】
臀部痘疹若如鳞片般密集，必须紧急治疗，不可迟疑拖延。若痘形平扁、颜色灰暗滞涩者，使用通圣散（Tongsheng San）疗效显著；若痘形板硬、颜色紫黑黯淡者，使用归宗汤（Guizong Tang）为对症良方。
[注释]
所谓“鳞坐”，是指两臀部的痘疹聚集在一起，如同鱼鳞一般。这是因为毒火过于炽盛，汇聚于人体最阴寒的部位（臀部）。如果不及时救治，病情变化将易如反掌（极快）。
如果是痘形平扁、色泽灰暗滞涩的，以松肌通圣散（Songji Tongsheng San）为主治方剂；
如果是痘形板硬、色泽紫黑的，以归宗汤（Guizong Tang）为主治方剂。
(松肌通圣散) 方剂见“蒙头证”治疗章节。
(归宗汤) 方剂见“发热证”治疗章节。
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肾囊部位痘疹密集，毒邪聚集于此最为难治。应立即使用散结汤（Sanjie Tang）进行调理治疗，只有当毒邪宣散、热邪解除后，患者才能恢复安康。
[注释]
肾囊（阴囊），是肾脏外在表现的关键部位。如果此处痘疹出得稠密，说明毒邪聚集在此处。
适宜使用散结汤（Sanjie Tang）来主治，通过疏解使气机通畅，这样才可以痊愈。
(散结汤) 组成：荆芥 (Jingjie)、羌活 (Qianghuo)、炒牛蒡子 (Chao Niubangzi)、升麻 (Shengma)、川芎 (Chuanxiong)、丹皮 (Danpi)、紫花地丁 (Zihuadiding)、赤芍 (Chishao)、木通 (Mutong)、紫草 (Zicao)、青皮 (Qingpi)、山楂 (Shanzha)。引药加芦根十株，水煎服。
(方歌)
散结汤中药效值得夸，荆芥、羌活、牛蒡子与升麻同用，川芎、丹皮、地丁、芍药配合，木通、紫草、青皮与山楂相佐。
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双膝部位的痘疹特别稠密，因为发生部位而得名“抱膝”。必须防止在行浆期痘液难以下达至足部，应迅速使用松肌通圣散（Songji Tongsheng San）进行治疗。
[注释]
所谓“抱膝”，是指全身痘疹稀疏，唯独双膝处聚集簇拥，形状像饼一样。这是毒气凝聚在膝盖所致。
到了行浆期时，恐怕痘液难以向下通达至小腿和足部。适宜使用松肌通圣散（Songji Tongsheng San）加入牛膝（Niuxi）以透达病邪，功效非常迅速。
(松肌通圣散) 方剂见“蒙头证”治疗章节。
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足踝以下的部位没有痘疹，这是毒热固结闭阻的表现，形势大多凶险。应当迅速驱除毒邪并扶持脾气，快□越婢汤（Kuai... Yebing Tang）会有功效。
[注释]
足踝以下属于脾经所主。如果身体其他部位有痘疹，而唯独这个部位没有，称为“无根”。这是毒邪停滞在脾脏所致。
但足部是人体至阴之地，如果不是建立中焦脾胃之气并开发发散脾气，痘疹就不能下达。因此使用快□越婢汤（Kuai... Yebing Tang）来发散毒邪。
(快□越婢汤) 组成：蜜制黄耆 (Huangqi)、桂枝 (Guizhi)、防风 (Fangfeng)、炒白芍药 (Baishaoyao)、生甘草 (Gancao)。引用生姜、红枣，水煎服。
(方歌)
快□越婢药效最灵验，黄耆、桂枝及防风同用，白芍、甘草配以姜枣为引，煎服之后痘疹自然生出。
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Background Information
Book: *Yizong Jinjian* (Golden Mirror of Medical Tradition)
Author: Wu Qian
Dynasty: Qing
Chapter: Linzuo / ... / Wugen (Total 4 Sections)
Category: Medical Discourse
[Translation]
If the variola lesions on both buttocks are dense like scales, urgent treatment is required without hesitation. If the lesions are flat and gray with a stagnant appearance, *Tongsheng San* (Universal Holy Powder) is effective; if the lesions are hard and purple-black, *Guizong Tang* (Guizong Decoction) is the appropriate prescription.
[Annotation]
"Linzuo" refers to the clustering of variola lesions on both buttocks, resembling fish scales. This occurs because the pathogenic fire toxin is excessively severe and gathers in the most Yin region of the body (the buttocks). If not treated promptly, the condition will change rapidly.
For cases where the lesions are flat and gray with a stagnant appearance, *Songji Tongsheng San* (Muscle-Loosening Universal Holy Powder) should be used as the primary treatment.
For cases where the lesions are hard and purple-black, *Guizong Tang* (Guizong Decoction) should be used as the primary treatment.
(The formula for *Songji Tongsheng San* can be found in the section on treating "Mengtou Syndrome".)
(The formula for *Guizong Tang* can be found in the section on treating "Febrile Syndrome".)
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When variola lesions are dense in the scrotum, the toxin gathering there is extremely difficult to manage. One should immediately use *Sanjie Tang* (Scattering Knots Decoction) for regulation and treatment. Only when the toxin is dispersed and the heat resolved can health be restored.
[Annotation]
The scrotum is a critical external indicator of the Kidney system. If the lesions here are dense, it indicates that the toxin has gathered at this site.
It is suitable to use *Sanjie Tang* (Scattering Knots Decoction) as the main treatment to disperse and unblock the Qi mechanism, which will lead to recovery.
(*Sanjie Tang* Composition): Jingjie (*Schizonepetae Herba*), Qianghuo (*Notopterygii Rhizoma et Radix*), Chao Niubangzi (*Arctii Fructus*, fried), Shengma (*Cimicifugae Rhizoma*), Chuanxiong (*Ligustici Chuanxiong Rhizoma*), Danpi (*Moutan Cortex*), Zihuadiding (*Violais Herba*), Chishao (*Paeoniae Radix Rubra*), Mutong (*Akebiae Caulis*), Zicao (*Arnebiae Radix seu Lithospermi Radix*), Qingpi (*Citri Reticulatae Pericarpium Viride*, green tangerine peel), Shanzha (*Crataegi Fructus*). Add ten stalks of Lugen (*Phragmitis Rhizoma*) as an guiding herb. Decoct in water and take orally.
(Verse Formula)
The efficacy of herbs in Sanjie Tang is praiseworthy;
Jingjie, Qianghuo, Niubangzi, and Shengma work together.
Chuanxiong, Danpi, Diziding, and Shaoyao combine;
Mutong, Zicao, Qingpi, and Shanzha assist.
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Variola lesions on both knees are particularly dense; due to their location, this condition is named "Baoxi" (Embracing Knees). One must prevent the failure of pus formation to reach the lower extremities during the pus-forming stage. Quickly use *Songji Tongsheng San* (Muscle-Loosening Universal Holy Powder) for treatment.
[Annotation]
"Baoxi" refers to a condition where variola lesions are sparse over the whole body but cluster densely around both knees, resembling a cake. This is caused by the condensation of toxic Qi in the knees.
During the pus-forming stage, there is a fear that the pus fluid may fail to descend to the shins and feet. It is suitable to use *Songji Tongsheng San* (Muscle-Loosening Universal Holy Powder) added with Niuxi (*Achyranthis Bidentatae Radix*) to penetrate and guide the pathology downward, yielding very rapid results.
(The formula for *Songji Tongsheng San* can be found in the section on treating "Mengtou Syndrome".)
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The absence of variola lesions below the ankles indicates that toxic heat is firmly bound and obstructed, a situation that is often ominous. One should quickly dispel the toxin and support Spleen Qi; *Kuai... Yebing Tang* (Fast... Yebing Decoction) will be effective.
[Annotation]
The area below the ankles is governed by the Spleen Meridian. If lesions appear on the rest of the body but are absent specifically in this area, it is called "Wugen" (Rootless). This signifies that the toxin is stagnating in the Spleen.
However, the feet are the most Yin region of the body. Unless the Middle Jiao (Spleen/Stomach) is established and the Spleen Qi is developed and dispersed, the lesions cannot descend. Therefore, *Kuai... Yebing Tang* (Fast... Yebing Decoction) is used to disperse the condition.
(*Kuai... Yebing Tang* Composition): Huangqi (*Astragali Radix*, honey-processed), Guizhi (*Cinnamomi Ramulus*), Fangfeng (*Saposhnikoviae Radix*), Baishaoyao (*Paeoniae Radix Alba*, fried), Gancao (*Glycyrrhizae Radix et Rhizoma*, raw). Use Shengjiang (*Zingiberis Rhizoma Recens*) and Hongzao (*Jujubae Fructus*) as guiding herbs. Decoct in water and take orally.
(Verse Formula)
The efficacy of Kuai... Yebing Tang is most spiritual;
Huangqi, Guizhi, and Fangfeng are combined.
Baishaoyao and Gancao, guided by Ginger and Jujube;
After decoction and ingestion, the lesions naturally emerge.
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