方剂：琼酥散
主治：此散治一切肿毒等疮，服之开针不痛。
组成：蟾酥（一钱） 半夏（六分）
闹羊花（六分） 胡椒（一钱八分）
川椒（一钱八分） 荜拨（一钱）
川乌（一钱八分）
上七味，共为细末，每服半分，黄酒调服。如欲大
开，加白酒药一丸。
【方歌】琼酥散是麻人药，开针不痛用蟾酥，荜拨闹羊生半夏，
胡椒川椒与川乌。
又方：整骨麻药
主治：此药开取箭头，服之不痛。
组成：麻黄 胡茄子
姜黄 川乌
草乌 闹羊花（各等份）
上六味共为末，每服五分，茶、酒任下，欲解，用
甘草煎汤，服之即苏。
【方歌】整骨麻药取箭头，不伤筋骨可无忧，麻黄姜黄胡茄子，
川草乌与闹羊投。
又方：外敷麻药
主治：此药敷于毒上，麻木任割不痛。
组成：川乌尖（五钱） 草乌尖（五钱）
蟾酥（四钱） 胡椒（一两）
生南星（五钱） 生半夏（五钱）
上为末，用烧酒调敷。一方加荜拨五钱，一方加细
辛一两。
【方歌】外敷麻药调烧酒，刀割不痛效最神，川草乌蟾椒星夏，
一加荜拨一加辛。
属性：腐者，坏肉也。诸书云：腐不去则新肉不生，盖以腐能
浸浮好肉也，当速去之。如遇气实之人，则用刀割之取
效；若遇气虚之人，则惟恃药力以化之。盖去腐之药，
乃疡科之要药也。
方剂：白降丹
主治：此丹治痈疽发背，一切疔毒，用少许。疮大者用五、六
厘，疮小者用一、二厘，水调敷疮头上。初起者立刻起
疱消散，成脓者即溃，腐者即脱、消肿，诚夺命之灵丹
也。
组成：朱砂 雄黄（各二钱）
水银（一两） 硼砂（五钱）
火硝 食盐
白矾 皂矾（各一两五钱）
先将朱、雄、硼三味研细，入盐、矾、硝、皂、水
银共研匀，以水银不见星为度。用阳城罐一个，放微炭
火上，徐徐起药入罐化尽，微火逼令干取起。如火大太
干则汞走，如不干则药倒下无用，其难处在此。再用一
阳城罐合上，用棉纸截半寸宽，将罐子泥、草鞋痰、光
粉三样研细，以盐滴卤汁调极湿，一层泥一层纸，糊合
口四、五重，及糊有药罐上二、三重。地下挖一小潭，
用饭碗盛水放潭底。将无药罐于于碗内，以瓦挨潭口四
边齐地，恐炭灰落碗内也。有药罐上以生炭火盖之，不
可有空处。约三柱香，去火冷定开看，约有一两外药矣
。炼时罐上如有缘烟起，急用笔蘸罐子盐泥固之。
又方：红升丹
主治：此丹治一切疮疡溃后，拔毒去腐，生肌长肉，疮口坚硬
肉黯紫黑，用丹少许，鸡翎扫上立刻红活。疡医若无红
、白二丹，决难立刻取效。
组成：朱砂（五钱） 雄黄（五钱）
水银（一两） 火硝（四两）
白矾（一两） 皂矾（六钱）
先将二矾、火硝研碎，入大同杓内，加火酒一小杯
炖化，一干即起研细。另将汞、朱、雄研细，至不见星
为度，再入硝矾末研匀。将阳城罐用纸筋泥搪一指厚，
阴干，常轻轻扑之，不使生裂纹，搪泥罐子泥亦可用。
如有裂纹，以罐子泥补之，极干再晒。无裂纹方可入前
药在内，罐口以铁油盏盖定，加铁梁盏，上下用铁〔金
攀〕铁丝扎紧，用棉纸拈条蘸蜜，周围塞罐口缝间，外
用熟石膏细末，醋调封固。盏上加炭火二块，使盏热罐
口封固易干也。用大钉三根钉地下，将罐子放钉上，罐
底下置坚大炭火一块，外砌百眼炉，升三炷香。第一炷
香用底火，如火大则汞先飞上；二炷香用大半罐火，以
笔蘸水擦盏；第三炷香火平罐口，用扇扇之，频频擦盏
，勿令干，干则汞先飞上。三香完，去火冷定开看，方
气足，盏上约有六、七钱，刮下研极细，磁罐盛用。再
预以盐卤汁调罐子稀泥，用笔蘸泥水扫罐口周围，勿令
泄气。盖恐有绿烟起汞走也，绿烟一起即无用矣。
【方歌】白降丹为夺命丹，拔脓化腐立时安，朱雄汞与硼砂入，
还有硝盐白阜矾，若去硼盐红升是，长肉生肌自不难。
又方：元珠膏
主治：此膏治肿疡将溃，涂之脓从毛孔吸出。已开针者，用捻
蘸送孔内，呼脓腐不净，涂之立化。
组成：木鳖子肉（十四个） 蟹蝥（八十一个）
柳枝（四十九寸） 驴甲片（三钱）
草乌（一钱） 麻油（二两）
上药浸七日，文火炸枝，去渣，入巴豆仁三个，煎
至黑，倾于钵内，研如泥，加麝香一分，搅匀入罐内收
用。
【方歌】呼脓化腐用元珠，木鳖蟹螯共柳枝，驴甲草乌油肉浸，
炸枝巴豆麝香施。
【背景信息】
书名：医宗金鉴 作者：吴谦 朝代：清 章节：麻药类方 / 去腐类方 类别：医论
【待处理原文】
方剂：琼酥散（Qiongsu San, Pearl and Toad Venom Powder）
主治：此散剂治疗各种肿毒等疮疡，服用后针刺时不感到疼痛。
组成：蟾酥（一钱） 半夏（六分）
闹羊花（六分） 胡椒（一钱八分）
川椒（一钱八分） 荜拨（一钱）
川乌（一钱八分）
以上七味药，共同研磨成细末，每次服用半分，用黄酒调服。如果想要扩大创口，加上一丸白酒药。
【方歌】琼酥散是麻醉人的药物，针刺不痛使用蟾酥，荜拨、闹羊花和生半夏，
加上胡椒、川椒与川乌。
又方：整骨麻药（Zhenggu Mayao, Bone-setting Anesthetic）
主治：此药用于取出箭头，服用后不感到疼痛。
组成：麻黄 胡茄子
姜黄 川乌
草乌 闹羊花（各等份）
以上六味药共同研成粉末，每次服用五分，茶或酒送服均可。想要解毒，用甘草煎汤，服用后即苏醒。
【方歌】整骨麻药用于取箭头，不伤筋骨可无忧虑，麻黄、姜黄和胡茄子，
川乌、草乌与闹羊花投放。
又方：外敷麻药（Waifu Mayao, Topical Anesthetic）
主治：此药敷在毒疮上，麻木后任其切割也不感到疼痛。
组成：川乌尖（五钱） 草乌尖（五钱）
蟾酥（四钱） 胡椒（一两）
生南星（五钱） 生半夏（五钱）
以上药物研成粉末，用烧酒调匀后外敷。另一配方加入荜拨五钱，另一配方加入细辛一两。
【方歌】外敷麻药用烧酒调匀，刀割不痛效果最神奇，川乌、草乌、蟾酥、花椒、南星、半夏，
一加荜拨，一加细辛。
属性：腐肉，是指坏死的肌肉组织。各类医书说：腐肉不去则新肉不生，因为腐肉能侵蚀浸泡好肉，应当迅速去除它。如果遇到体质壮实的人，就用刀割除以见效；如果遇到体质虚弱的人，则只依靠药力来化解它。大概去除腐肉的药物，是外科的重要药物。
方剂：白降丹（Baijiang Dan, White Reduction Cinnabar）
主治：此丹药治疗痈疽发背，各种疔毒，使用少量。疮口大的用五、六厘，疮口小的用一、二厘，用水调匀敷在疮头上。初起者立刻起泡消散，成脓者立即溃破，腐肉立即脱落、消肿，确实是救命的灵丹。
组成：朱砂 雄黄（各二钱）
水银（一两） 硼砂（五钱）
火硝 食盐
白矾 皂矾（各一两五钱）
先将朱砂、雄黄、硼砂三味药研细，放入盐、矾、硝、皂、水银共同研磨均匀，直到看不见水银颗粒为止。用一个阳城罐，放在微炭火上，慢慢将药放入罐中化尽，用微火逼令干燥取出。如果火太大太干则汞会挥发流失，如果不干则药液倒下无用，难点就在这里。再用一个阳城罐盖在上面，用棉纸截半寸宽，将罐子泥、草鞋痰、光粉三样东西研细，用盐水滴卤汁调得极湿，一层泥一层纸，糊合口四、五重，以及糊在有药的罐上二、三重。在地上挖一个小潭，用饭碗盛水放潭底。将无药的罐子放在碗内，用瓦片挨着潭口四边齐地，防止炭灰落入碗中。有药的罐子上面盖上生炭火，不可有空处。大约三柱香的时间，去掉火冷却定形后打开看，大约有一两多的药了。炼制时罐上如果有烟缘升起，急忙用笔蘸罐子盐泥固定它。
又方：红升丹（Hongsheng Dan, Red Ascending Cinnabar）
主治：此丹药治疗各种疮疡溃烂后，拔毒去腐，生肌长肉，疮口坚硬肉色黯紫黑，用少许丹药，用鸡毛掸扫在上面立刻红润鲜活。外科医生如果没有红、白两种丹药，很难立刻见效。
组成：朱砂（五钱） 雄黄（五钱）
水银（一两） 火硝（四两）
白矾（一两） 皂矾（六钱）
先将两种矾、火硝研碎，放入大同杓内，加火酒一小杯炖化，一干就取出研细。另外将汞、朱砂、雄黄研细，直到看不见颗粒为止，再放入硝矾末研磨均匀。将阳城罐用纸筋泥搪一指厚，阴干，经常轻轻拍打，不让产生裂纹，搪泥罐子泥也可以用。如果有裂纹，用罐子泥修补，极干后再晒。没有裂纹才可以放入前面的药在内，罐口用铁油盏盖定，加铁梁盏，上下用铁攀铁丝扎紧，用棉纸捻条蘸蜜，周围塞入罐口缝间，外用熟石膏细末，醋调封固。盏上加炭火两块，使盏热罐口封固容易干燥。用大钉三根钉地下，将罐子放在钉上，罐底下放置坚大炭火一块，外面砌百眼炉，升三炷香。第一炷香用底火，如果火大则汞先飞上；二炷香用大半罐火，用笔蘸水擦拭盏；第三炷香火平罐口，用扇子扇它，频频擦拭盏，不让干燥，干燥则汞先飞上。三炷香完毕，去掉火冷却定形后打开看，药气才足，盏上约有六、七钱，刮下来研极细，磁罐盛装使用。再预先用盐卤汁调罐子稀泥，用笔蘸泥水扫罐口周围，不让漏气。盖恐有绿烟升起汞流失，绿烟一起就没用了。
【方歌】白降丹为夺命丹，拔脓化腐立时平安，朱砂、雄黄、汞与水银、硼砂入，
还有硝盐白矾，若去掉硼盐就是红升丹，长肉生肌自然不难。
又方：元珠膏（Yuanzhu Gao, Pearl Ointment）
主治：此膏治疗肿疡将要溃破，涂抹后脓液从毛孔吸出。已经切开针孔的，用棉捻蘸药送入孔内，呼出脓腐不净，涂抹后立即化解。
组成：木鳖子肉（十四个） 蟹蝥（八十一个）
柳枝（四十九寸） 驴甲片（三钱）
草乌（一钱） 麻油（二两）
以上药物浸泡七天，文火炸柳枝，去渣，放入巴豆仁三个，煎至黑色，倒在钵内，研磨如泥，加入麝香一分，搅匀放入罐内收存使用。
【方歌】呼脓化腐使用元珠膏，木鳖子、蟹螯共柳枝，驴甲、草乌、油肉浸泡，
炸枝、巴豆、麝香施用。
[Background Information]
Book: Yizong Jinjian (Golden Mirror of Medicine)
Author: Wu Qian
Dynasty: Qing
Chapter: Formulas for Anesthesia / Formulas for Removing Necrotic Tissue
Category: Medical Discourse
[Original Text Processing]
Formula: Qiongsu San (Pearl and Toad Venom Powder)
Indications: This powder treats various swellings, toxic sores, and other ulcers; it renders the patient insensible to pain during needle insertion.
Composition: Chan Su (Toad Venom, *Chansui*) - 1 qian; Ban Xia (Pinellia Rhizome, *Pinelliae Rhizoma Praeparatum*) - 6 fen; Yang Tao Hua (Datura Flower, *Daturae Flos*) - 6 fen; Hu Jiao (Pepper, *Piperis Fructus*) - 1.8 qian; Chuan Jiao (Sichuan Pepper, *Zanthoxyli Pericarpium*) - 1.8 qian; Bi Bo (Long Pepper, *Piperis Longi Fructus*) - 1 qian; Chuan Wu (Aconitum Carmichaelii Root, *Aconiti Radix Lateralis Preparata*) - 1.8 qian.
Preparation: The above seven herbs are ground into a fine powder. Each dose is 0.5 fen, taken with yellow wine mixed in. If a larger incision is desired, add one pill of Baijiu Yao (White Wine Yeast).
[Prescription Verse] Qiongsu San is an anesthetic agent, using Toad Venom to prevent pain during needling,
Bi Bo, Yang Tao Hua, and raw Ban Xia,
along with Hu Jiao, Chuan Jiao, and Chuan Wu.
Another Formula: Zhenggu Mayao (Bone-setting Anesthetic)
Indications: This medicine is used to extract arrowheads without causing pain after ingestion.
Composition: Ma Huang (Ephedra Herb, *Ephedrae Herba*), Hu Qie Zi (Solanum Melongena Fruit, *Solanis Melonganae Fructus*), Jiang Huang (Turmeric Rhizome, *Curcumae Longae Rhizoma*), Chuan Wu (Aconitum Carmichaelii Root, *Aconiti Radix Lateralis Preparata*), Cao Wu (Aconitum Kusnezoffii Root, *Aconiti Radix*), Yang Tao Hua (Datura Flower, *Daturae Flos*). All in equal parts.
Preparation: The above six herbs are ground into powder. Each dose is 5 fen, taken with tea or wine as desired. To detoxify, decoct Gan Cao (Licorice Root, *Glycyrrhizae Radix et Rhizoma*) in water and ingest it to restore consciousness.
[Prescription Verse] Zhenggu Mayao is used to extract arrowheads, ensuring no harm to bones or sinews,
Ma Huang, Jiang Huang, and Hu Qie Zi,
with Chuan Wu, Cao Wu, and Yang Tao Hua combined.
Another Formula: Waifu Mayao (Topical Anesthetic)
Indications: Applied topically on toxic sores, it induces numbness allowing cutting without pain.
Composition: Chuan Wu Jian (Tip of Aconitum Carmichaelii Root, *Aconiti Radix Lateralis Preparata*) - 5 qian; Cao Wu Jian (Tip of Aconitum Kusnezoffii Root, *Aconiti Radix*) - 5 qian; Chan Su (Toad Venom, *Chansui*) - 4 qian; Hu Jiao (Pepper, *Piperis Fructus*) - 1 liang; Sheng Nan Xing (Raw Arisaema Rhizome, *Arisaematis Rhizoma*) - 5 qian; Sheng Ban Xia (Raw Pinellia Rhizome, *Pinelliae Rhizoma*) - 5 qian.
Preparation: Grind the above herbs into powder and mix with Sha Jiu (Burning Wine, *Liquor*) for topical application. One variant adds Bi Bo (Long Pepper, *Piperis Longi Fructus*) 5 qian; another variant adds Xi Xin (Asarum Root, *Asari Radix et Rhizoma*) 1 liang.
[Prescription Verse] Waifu Mayao is mixed with burning wine, cutting causes no pain and efficacy is miraculous,
Chuan Wu, Cao Wu, Chan Su, Hu Jiao, Nan Xing, and Ban Xia,
one adds Bi Bo, one adds Xi Xin.
Discourse: "Fu" (Necrotic Tissue) refers to dead flesh. Various medical texts state: if necrotic tissue is not removed, new flesh cannot grow, because necrotic tissue can erode and soak healthy flesh; therefore, it should be removed promptly. For patients with robust Qi (Vital Energy), surgical excision with a knife is effective; for patients with deficient Qi, reliance is placed solely on the dissolving power of medicines. Generally, drugs that remove necrotic tissue are essential in dermatology and surgery.
Formula: Baijiang Dan (White Reduction Cinnabar)
Indications: This cinnabar treats carbuncles, back infections, and all types of Ding (hard, deep-seated boils). Use a small amount. For large sores, use 5-6 li; for small sores, use 1-2 li. Mix with water and apply to the head of the sore. In early stages, it immediately causes blistering and resolution; when pus has formed, it promotes immediate ulceration; necrotic tissue detaches, swelling subsides. It is indeed a life-saving miracle drug.
Composition: Zhu Sha (Cinnabar, *Cinnabaris*), Xiong Huang (Realgar, *Realgar); each 2 qian.
Shui Yin (Mercury, *Hydrargyrum*), Peng Sha (Borax, *Borax*); 1 liang and 5 qian respectively.
Huo Xiao (Saltpeter, *Natrii Nitras*), Yan Shi (Salt, *Natrii Chloridum*).
Bai Fan (Alum, *Alumen*), Zao Fan (Green Vitriol, *Vitriolum Ferrosum); each 1.5 liang.
Preparation: First, grind Zhu Sha, Xiong Huang, and Peng Sha finely. Add Yan Shi, Bai Fan, Huo Xiao, Zao Fan, and Shui Yin, grinding together until the mercury particles are no longer visible. Place a Yangcheng jar on mild charcoal fire, slowly adding the medicine to melt completely. Use mild fire to drive off moisture and retrieve. If the fire is too strong and dry, mercury will volatilize; if not dry enough, the medicine will collapse and become useless; this is the difficulty. Cover with another Yangcheng jar. Cut cotton paper into half-inch strips. Grind Jar Mud, Caoxie Tan (Mold from straw sandals), and Guang Fen (Light Powder) finely. Mix with salt brine to a very wet consistency. Apply alternating layers of mud and paper, four to five layers at the seal, and two to three layers on the jar containing medicine. Dig a small pit in the ground, place a rice bowl filled with water at the bottom. Place the empty jar inside the bowl. Seal the rim of the pit with tiles flush with the ground to prevent charcoal ash from falling into the bowl. Cover the medicine jar with live charcoal fire, ensuring no gaps. After approximately three incense sticks' time, extinguish the fire and let it cool before opening. Approximately one tael of medicine should remain. If smoke rises from the jar edges during smelting, immediately seal with a brush dipped in salt mud.
Another Formula: Hongsheng Dan (Red Ascending Cinnabar)
Indications: This cinnabar treats post-ulceration of all sores and ulcers, extracting toxins, removing necrotic tissue, and promoting muscle regeneration. For hard sores with dark purple/black flesh, apply a small amount of cinnabar with a chicken feather; the area will immediately become red and vibrant. Without these red and white cinnabars, surgeons find it difficult to achieve immediate results.
Composition: Zhu Sha (Cinnabar, *Cinnabaris*) - 5 qian; Xiong Huang (Realgar, *Realgar*) - 5 qian.
Shui Yin (Mercury, *Hydrargyrum*) - 1 liang; Huo Xiao (Saltpeter, *Natrii Nitras*) - 4 liang.
Bai Fan (Alum, *Alumen*) - 1 liang; Zao Fan (Green Vitriol, *Vitriolum Ferrosum*) - 6 qian.
Preparation: First, crush the two alums and Huo Xiao. Place in a Datong ladle, add a small cup of Huo Jiu (Fire Wine/Alcohol), and stew until dissolved. Retrieve when dry and grind finely. Separately, grind Shui Yin, Zhu Sha, and Xiong Huang finely until no particles are visible. Then mix with the nitrate-alum powder. Coat a Yangcheng jar with paper-mud paste to a thickness of one finger, dry in shade, and gently pat to prevent cracks. Jar mud can also be used. Repair any cracks with jar mud, dry thoroughly, and sun-dry. Only when crack-free should the previous medicines be added. Seal the jar mouth with an iron oil lamp cover, add an iron beam lamp, and tighten top and bottom with iron wire. Stuff jar seams with cotton wicks dipped in honey. Seal externally with cooked gypsum powder mixed with vinegar. Place two pieces of charcoal fire on the lamp to heat the lamp mouth and dry the seal. Drive three large nails into the ground, place the jar on the nails, and put a large piece of solid charcoal under the jar. Build a Baiyan Furnace around it. Smelt for three incense sticks. First stick: use bottom fire; if too hot, mercury flies up first. Second stick: use fire filling half the jar; wipe the lamp with a water-dipped brush. Third stick: fire level with jar mouth; fan it, wiping the lamp frequently to prevent drying, which would cause premature mercury volatilization. After three sticks, extinguish fire, cool, and open. The medicinal qi is now sufficient. Scrape 6-7 qian from the lamp, grind extremely finely, and store in a porcelain jar. Prepare salt-brine mud beforehand, brush around the jar mouth with a brush to prevent gas leakage, lest green smoke appear indicating mercury loss, rendering it useless.
[Prescription Verse] Baijiang Dan is a life-snatching cinnabar, draining pus and resolving necrosis instantly,
Zhu Sha, Xiong Huang, Mercury, and Borax enter,
along with Saltpeter, Salt, and Alum; remove Borax and Salt to make Hongsheng Dan,
promoting muscle growth and regeneration becomes easy.
Another Formula: Yuanzhu Gao (Pearl Ointment)
Indications: This ointment treats abscesses about to rupture; applying it draws pus out through pores. For already incised wounds, dip a cotton swab in the ointment and insert it into the hole to expel pus and necrotic residue; application causes immediate dissolution.
Composition: Mu Bie Zi Rou (Seed of Momordica Cochinchinensis, *Momordicae Semen*) - 14 seeds; Xie Mao (Spider Crab, *Portunus trituberculatus*) - 81 crabs.
Liu Zhi (Willow Branch, *Salicis Ramulus*) - 49 cun; Lv Jia Pian (Donkey Hide Slice, *Corii Asini Preparata*) - 3 qian.
Cao Wu (Aconitum Kusnezoffii Root, *Aconiti Radix*) - 1 qian; Ma You (Sesame Oil, *Sesami Oleum*) - 2 liang.
Preparation: Soak the above herbs for seven days. Fry the willow branches over gentle heat, remove dregs, add three Ba Dou Ren (Seminal Crotonis, *Crotonis Fructus*), fry until black, pour into a mortar, grind into a paste. Add She Xiang (Musk, *Moschi Fermentum*) 1 fen, mix well, and store in a jar.
[Prescription Verse] Expelling pus and resolving necrosis uses Yuanzhu Gao,
Mu Bie Zi, Xie Mao, and Willow Branch together,
Donkey hide, Cao Wu, oil, and meat soaked,
Fried branches, Ba Dou, and Musk applied.