论一首 方三十三首
论曰∶诸痈,状多种不同,无问久近,皆五香连翘汤主之。先刺去热,小豆薄之,其间
数数针去血,若已失疗溃烂者,犹常服五香漏芦等汤下之,当下大针入五分者则速愈。凡痈
高而光者不大热,其肉正平无尖而紫色者不须治,但以竹叶黄 汤申其气耳。其肉正平为无
脓也,痈卒痛,用八物黄 薄,大痈七日,小痈五日。其有坚疆者,诊宁生破发背及发乳,
若热手不可得近者,内先服王不留行散,外摩发背膏。若背生破无苦在乳者,宜令极熟,熟
之候,手按之随手即起者便熟,须针之,针法要得着脓,以意消息之,胸背不可过一寸,酌
量。不得脓以食肉膏散着兑头内痈口中,如人身热气歇服木占斯散。五日后痈欲瘥者,服排
脓内塞散。凡破痈之后,病患便绵 欲死。内寒外热肿自有似痈而非者,当以手按肿上无所
连,即是风毒耳,勿针,可服升麻汤。外摩膏破痈口,当令上留三分近下一分,针唯令极热,
极热便不痛,破痈后败坏不瘥者,作猪蹄汤洗之,日再。夏汤二日可用,冬六七日,汤半剂
亦可用,胸中痛短气者,当入暗中以手中指按左眼视若见光者,胸中有结痈,若不见光者,
疽内发,针伤脉,血不出住实不泻,当成痈也。凡脉来细而沉,时直者,身有痈疽,脉来
大渐小者,阴结苦肌肉痹,痈疖寻寸口,如此来大而渐小也。
漏芦汤方∶
漏芦 白蔹 黄芩 枳实(炙) 芍药 升麻 麻黄 甘草(炙,各二两) 大黄(三
两)
上九味, 咀,以水一斗煮取三升,分三服,无药处,单服大黄下之,一方白薇二两。
连翘五香汤方∶
连翘 青木香 薰陆香 麝香 沉香 射干 独活 桑寄生 通草 升麻(各二两) 丁
香(一两) 大黄(三两,别浸)
上一十一味, 咀,以水九升,煮取减半,纳竹沥二升,煮取三升,分三服。未瘥,中
间常服,佳。
王不留行散 主痈疽及诸杂肿已溃,皆服之方∶
王不留行子(一升) 五色龙骨(二两) 野葛皮(半分) 栝蒌(六合) 当归(二
两) 干姜
上七味,捣筛为散。食讫,温酒服方寸匕,日三。以四肢习习为度,不知,渐稍加之。
此浩仲堪方,隋济暗梨所名为神散。痈肿即消,极安稳(《千金》云∶治痈肿不能溃,困苦
无聊赖)
论一首 方三十三首
论述说:各种痈(体表化脓性感染),症状表现多种多样,无论病程长短,都以五香连翘汤为主治方。先用针刺排出热毒,再用赤小豆捣烂外敷,期间多次针刺放血。如果已经延误治疗导致溃烂的,仍然常服用五香漏芦等汤剂以通下泄热,若大便通畅则病速愈。凡是痈肿高突且表面光亮的,热度不会特别大;其肉质平正无突起且呈紫色的,不需要特殊治疗,只需服用竹叶黄耆汤来补益肺气即可。肉质平正是因为没有脓液。痈突然疼痛时,用八物黄耆散外敷,大的痈敷七天,小的痈敷五天。如果有坚硬强硬的,诊断是否会发生破背疽或发乳疽,如果患处发热烫手不可触碰的,内服王不留行散,外用发背膏摩涂。如果背部生破口而没有痛苦在乳房部位的,宜令疮口极熟,成熟的标志是手按下去随即弹起,这时需要针刺,针刺的要领是要刺中脓腔,根据情况斟酌处理,胸背部针刺深度不可超过一寸,需酌情衡量。如果没有脓液,将食肉膏散涂抹在疮口内,如人体热气消退则服用木占斯散。五日后痈肿欲痊愈时,服用排脓内塞散。凡是破溃后的痈,病患往往感到绵软无力几乎要死。体内寒而体外热肿胀,有的看似痈其实不是,应当用手按压肿胀处,感觉没有牵连感,这就是风毒所致,不要针刺,可以服用升麻汤。外用膏药摩涂破溃的痈口,应当让疮口上部留出三分,下部留一分,针刺时要使针极热,极热的针就不会痛。破溃后败坏不愈合的,用猪蹄汤清洗,每天两次。夏季使用汤剂两天即可,冬季六七天,半剂汤也可使用。胸中疼痛气短的,应当进入暗室,用手中指按住左眼观察,如果见到光亮,说明胸中有结痈;如果不见光亮,说明是疽从内部发出,针刺伤及血脉,血液不出而停滞充实不能泻出,将会形成痈。凡是脉象细而沉,有时直挺的,身体有痈疽;脉象由大逐渐变小的,是阴结导致肌肉痹痛,痈疖在寸口脉诊察,脉象如此由大渐小。
漏芦汤方:
漏芦、白蔹、黄芩、枳实(炙)、芍药、升麻、麻黄、甘草(炙,各二两)、大黄(三两)
以上九味药,切碎,用水一斗煮取三升,分三次服用。没有药的地方,单服大黄通下即可,另一方案用白薇二两。
连翘五香汤方:
连翘、青木香、薰陆香、麝香、沉香、射干、独活、桑寄生、通草、升麻(各二两)、丁香(一两)、大黄(三两,另浸泡)
以上十一味药,切碎,用水九升,煮取减半,加入竹沥二升,再煮取三升,分三次服用。未痊愈,中间常服用,效果佳。
王不留行散 主治痈疽及诸杂肿已溃烂,皆服用此方:
王不留行子(一升)、五色龙骨(二两)、野葛皮(半分)、栝蒌(六合)、当归(二两)、干姜
以上七味药,捣碎过筛为散剂。饭后,温酒送服一方寸匕,每日三次。以四肢微微麻木为度,若无感觉,逐渐稍加剂量。这是浩仲堪的方子,隋朝济暗梨命名为神散。痈肿即消,非常安稳(《千金》云:治疗痈肿不能溃烂,困苦无聊赖)。
One Treatise, Thirty-Three Prescriptions
The treatise states: Various types of carbuncle (superficial suppurative infection) present with diverse symptoms. Regardless of whether the condition is recent or chronic, they should all be primarily treated with Wuxiang Liaoqiao Tang (Five Fragrances and Forsythia Decoction). Initially, puncture with a needle to drain heat, apply a thin paste of Adzuki Bean (Vigna angularis), and repeatedly prick to release blood during the interval. If treatment was delayed leading to ulceration, one should still frequently take decoctions such as Wuxiang Loulu Tang (Five Fragrances and Rhapontic Decoction) to purge downward; if large amounts of stool are passed after inserting a large needle five fen deep, recovery will be rapid. For carbuncles that are high and shiny, the heat is not severe. For those with flat flesh, no protrusion, and purple color, no specific treatment is needed; simply administer Zhuye Huangqi Tang (Bamboo Leaf and Astragalus Decoction) to benefit Lung Qi. Flat flesh indicates the absence of pus. When a carbuncle suddenly becomes painful, apply Bayi Huangqi San (Eight-Ingredient Astragalus Powder) externally; for large carbuncles, apply for seven days, and for small ones, five days. If the swelling is hard and firm, diagnose whether it will develop into Back Carbuncle (Daji) or Breast Carbuncle (Faru). If the area is hot to the touch and unbearable, internally take Wangbuliuxing San (Vaccaria Seed Powder) and externally massage with Fabei Gao (Back-Carbuncle Ointment). If there is an open sore on the back but no pain in the breast, allow the sore to mature thoroughly. The sign of maturity is that pressing with the hand causes immediate rebound; at this point, puncture is required. The key to puncturing is to reach the pus cavity, adjusting according to circumstances. Puncture depth on the chest and back must not exceed one cun, to be judged appropriately. If there is no pus, apply Shirou Gao San (Flesh-Eating Ointment Powder) into the wound opening. If body heat subsides, take Muzhansi San (Caulis Sarcostemmas Powder). Five days later, when the carbuncle is about to heal, take Painong Neisai San (Pus-Draining and Internal-Sealing Powder). After any carbuncle ruptures, the patient often feels weak and near death. Cold inside and heat outside with swelling may resemble a carbuncle but is not one; press the swollen area with the hand. If there is no connection or tension, it is Wind-Toxin. Do not puncture; instead, take Shengma Tang (Cimicifuga Decoction). Apply ointment externally to the ruptured carbuncle opening. Leave the upper third and lower one-third of the opening intact. The needle must be extremely hot; extreme heat prevents pain. For ruptured carbuncles that fail to heal due to decay, wash with Zhu Ti Tang (Pig Trotter Decoction) twice daily. In summer, use the decoction for two days; in winter, six to seven days, half a dose is also acceptable. For chest pain and shortness of breath, enter a dark room, press the left eye with the middle finger, and observe. If light is seen, there is a clustered carbuncle in the chest; if no light is seen, it is a deep-seated jiu (gangrenous sore) originating internally. Puncture injuring the vessels without blood flow causing stagnation and fullness will result in carbuncle formation. Generally, if the pulse is fine and deep, sometimes straight, there is a carbuncle or jiu on the body. If the pulse starts large and gradually becomes small, it indicates Yin knotting causing muscle bi-syndrome. Examine the Cun Kou (Radial Pulse); the pulse changes from large to small in this manner.
Loulu Tang Prescription:
Rhapontic Radix (Loulou), White Peony Root (Bailian), Scutellaria Root (Huangqin), Immature Bitter Orange (Zhishi, roasted), Red Peony Root (Shaoyao), Cimicifuga Rhizome (Shengma), Ephedra Stem (Mahuang), Licorice Root (Gancao, roasted, each 2 liang), Rhubarb (Dahuang, 3 liang).
These nine ingredients are coarsely crushed. Boil in ten dou of water to obtain three sheng. Divide into three doses. In areas without these herbs, taking Rhubarb alone to purge downward is effective. Another variation uses Cistanche Vine (Baiwei) 2 liang.
Liaoqiao Wuxiang Tang Prescription:
Forsythia Fruit (Liaoqiao), Aucklandia Root (Qingmuxiang), Frankincense (Xunluxiang), Musk (Shexiang), Agarwood (Chenxiang), Belamcanda Rhizome (Shegan), Angelica Pubescens Root (Duhuo), Taxillus Branches (Sangjisheng), Ligusticum Stem (Tongcao), Cimicifuga Rhizome (Shengma, each 2 liang), Clove Bud (Dingxiang, 1 liang), Rhubarb (Dahuang, 3 liang, soaked separately).
These eleven ingredients are coarsely crushed. Boil in nine sheng of water until reduced by half. Add two sheng of Bamboo Juice (Zhuli) and boil until three sheng remain. Divide into three doses. If not cured, continue taking it intermittently for best results.
Wangbuliuxing San: Mainly treats carbuncles, jiu, and various miscellaneous swellings that have already ulcerated. All should take this prescription:
Vaccaria Seed (Wangbuliuxingzi, 1 sheng), Five-Color Dragon Bone (Wuse Longgu), Kadsura Bark (Yegepi), Trichosanthes Fruit (Gualou, 6 he), Angelica Sinensis Root (Danggui, 2 liang), Dried Ginger (Ganjiang).
These seven ingredients are pounded and sifted into a powder. After meals, take one fangcun bi (square-inch measure) with warm wine, three times a day. Stop when the limbs feel slightly numb. If no sensation is felt, gradually increase the dosage slightly. This is a prescription by Hao Zhongan, named "Shen San" (Divine Powder) by Ji Anli of the Sui Dynasty. It eliminates swellings quickly and provides great stability (Qianjin Jiyao states: Treats swellings that cannot ulcerate, alleviating distress and helplessness).