烂喉痧一症,古书不载,起于近时,而并易传染。治之者,每谓太阴阳明二经风热之毒。而至烂之由,亦不可不详
察也,譬之于物,以盛火逼之,只见干燥,而不知湿热郁蒸,所以致烂耳。此症凡风热者,治宜清透;湿热者,治宜清
渗;痰火凝结者,治宜消降。盖邪达则痧透,痧透则烂自止矣;若过用寒凉,势必内陷,其害可胜言哉!夫症有可治,
有不可治。口中作臭者,谓之回阳。其色或淡黄,或深黄者,此系痰火所致,皆可治之症。他如烂至小舌者,鼻塞者,
合眼 者,并有元气日虚,毒瓦斯深伏,色白如粉皮样者,皆不可治之症也。总之、因天地不正之气,感而受之,故体
有虚实之不同,即症有重轻之各异耳。其余喉症、痧症,古人言之详矣,概不复赘。
夫丹痧一症,方书未有详言,余究心是症之所来,不外乎风寒温热时厉之气而已。故解表清热,各有所宜,治之得
当,愈不移时,治失其宜,祸生反掌,无非宜散、宜清之两途也。其症初起,凛凛恶寒,身热不甚,并有壮热而仍兼憎
寒者,斯时虽咽痛烦渴,先须解表透达为宜;即或宜兼清散,总以散字为重,所谓“火郁发之”也。苟漫用寒凉,则外
益闭而内火益焰,咽痛愈剧,溃腐日甚矣。不明是理者,反云如此凉药,尚且火势勃然,不察未散之误,犹谓寒之未尽,
于是愈凉愈遏,以致内陷而毙者有之。或有云是症专宜表散者,余谓所见亦偏。前所云寒热之时,散为先务,俾汗畅而
丹痧透发;已无恶寒等症,至此则外闭之风寒已解,内蕴之邪火方张,寒凉泄热,是所宜投,热一尽而病自愈矣。若仍
执辛散之方,则火得风而愈炽,肿势反增,腐亦滋蔓,必至滴水下咽,痛如刀割。间有议用清凉者,乃以郁遏诽之,炎
热燎原,杀人最暴,此偏于散而谤匪清者之为害也。彼言散之宜,此言散之祸,彼言寒之祸,此言寒之宜,要惟于先后
次第之间,随机权变,斯各中其 耳。再此症愈后,每有四肢酸痛,难以屈伸之状,盖由火烁阴伤,络失所养,宜进滋
阴,非同痹症,此又管窥之所及,敢以质之高明。
烂喉痧这一病症,古代医书中没有记载,是近代才出现的,而且容易传染。治疗的人,常常认为是太阴经和阳明经的风热毒邪所致。至于导致咽喉腐烂的原因,也不可不详加考察。这就好比对待物体,如果用烈火去逼迫它,只会看到干燥,却不知道是因为湿热郁结蒸腾,所以才导致腐烂。这种病症,凡是属于风热的,治疗应当用清透法;属于湿热的,治疗应当用清渗法;属于痰火凝结的,治疗应当用消降法。因为邪气外达则痧疹透出,痧疹透出则腐烂自然停止;如果过度使用寒凉药物,势必导致邪气内陷,其危害怎能说得完呢!
病症有可以治疗的,有不可以治疗的。口中发臭的,称为“回阳”(此处指病情危重或特定证型,原文语境似指一种难治或特殊表现,注:古文中“回阳”多指阳气回复,但在此处结合上下文“不可治”,可能指代某种特定的危重征象或误称,依原文直译)。其颜色如果是淡黄色或深黄色的,这是由痰火引起的,都是可治的病症。其他如腐烂延伸到小舌(悬雍垂)的,鼻塞的,眼睛闭合的,以及元气日益虚弱、毒邪深伏、色泽白得像粉皮一样的,都是不可治的病症。总之,这是因为感受了天地间不正之气而患病,所以人体体质有虚实的不同,因此病症也有轻重之别罢了。其余的喉症、痧症,古人已经论述得很详细了,这里就不再赘述。
至于丹痧这一病症,方书也没有详细论述。我深入研究此症的由来,不外乎是风寒、温热及时行厉气(具有强烈传染性的致病因素)而已。所以解表和清热,各有适宜的时机,治疗得当,不久即可痊愈;治疗失宜,灾祸转瞬即生,无非是适宜发散和适宜清热这两条途径。此症初起时,感到阵阵恶寒,身体发热不严重,也有高热但仍然兼有怕冷的,这时候虽然咽喉疼痛、烦躁口渴,首先必须解表透达为宜;即使需要兼顾清散,总以“散”字为重,这就是所谓的“火郁发之”(火热郁结于内,需用发散的方法治疗)。如果随意使用寒凉药物,那么体表更加闭塞,体内的火气更加旺盛,咽喉疼痛更加剧烈,溃烂腐坏一天比一天严重。不明白这个道理的人,反而说如此寒凉的药,火势依然猛烈,不考察未能发散的错误,还认为寒凉不够,于是越用寒凉越遏制邪气,导致邪气内陷而死亡的例子都有。
有人说此症专门适宜表散,我认为这种看法也偏颇。前面所说的在寒热交替之时,发散是当务之急,使汗液畅达而丹痧透发;等到已经没有恶寒等症状时,此时体表的闭塞之风寒已解,体内蕴藏的邪火正盛,使用寒凉药物泄热,是适宜的投药方法,热邪一尽疾病自然痊愈。如果仍然坚持使用辛温发散的药物,那么火借风势更加炽烈,肿胀反而增加,腐坏也更加蔓延,必然导致水都咽不下去,疼痛像刀割一样。偶尔有人建议用清凉药,却被指责为郁遏邪气,其实炎热如火燎原,杀人最猛,这是偏重于发散而诽谤不用清凉药的害处。那些人说发散适宜,这里说发散的祸患;那些人说寒凉的祸患,这里说寒凉的适宜,关键在于先后次序之间,随机应变,才能各中肯綮(切合要害)。另外,此症痊愈后,常有四肢酸痛,难以屈伸的情况,这是由于火热灼伤阴液,经络失去滋养,适宜进补滋阴,不同于痹症,这又是我的管见所及,敢于向高明之士请教。
Lanhou Sha (Rotting Throat with Sand-like Rash) is a condition not recorded in ancient texts, emerging in recent times, and prone to contagion. Practitioners often attribute it to wind-heat toxic pathogens affecting the Taiyin (太阴) and Yangming (阳明) meridians. However, the mechanism leading to ulceration requires detailed examination. Consider an analogy: if an object is subjected to intense fire, it appears dry; yet, one fails to realize that it is actually damp-heat stagnation and steaming that cause the rotting. For this condition, if caused by wind-heat, treatment should employ clearing and venting methods; if caused by damp-heat, clearing and draining methods are appropriate; if caused by phlegm-fire congealation, reducing and descending methods are indicated. When pathogens are expelled, the rash emerges, and once the rash emerges, the ulceration naturally ceases. Conversely, excessive use of cold-cooling herbs will inevitably drive pathogens inward, with consequences too dire to enumerate.
Some cases are treatable, while others are not. A foul odor in the mouth is termed "Huiyang" (Return of Yang). If the color of the lesion is pale yellow or deep yellow, it is caused by phlegm-fire and is treatable. Other signs indicating untreatability include ulceration extending to the uvula (Xiaoshe), nasal congestion, closed eyes, progressive depletion of Yuan Qi (Original Qi), deep-seated toxic factors, and a white appearance resembling rice paper. In summary, this disease results from contracting abnormal qi of heaven and earth. Consequently, individuals differ in their deficiency or excess constitution, leading to variations in the severity of symptoms. Other throat and sand-rash conditions have been detailed by ancients, so no further elaboration is needed here.
Regarding Dansha (Cinnabar Rash), medical formularies lack detailed descriptions. Upon investigating its origin, I find it stems solely from wind-cold, warm-heat, or epidemic pestilential qi. Thus, releasing the exterior and clearing heat each have their appropriate indications. Proper treatment leads to recovery quickly; improper treatment brings disaster instantly. The approach essentially falls into two categories: dispersing or clearing. In the initial stage, patients experience chills, mild fever, or high fever accompanied by aversion to cold. Although they suffer from sore throat, irritability, and thirst, the priority must be to release the exterior and vent pathogens. Even if clearing and dispersing are combined, the emphasis remains on "dispersing," adhering to the principle of "Fa Zhi" (Venting) for "Fire Yu" (Stagnant Fire). Indiscriminate use of cold-cooling herbs causes further exterior closure and intensifies internal fire, worsening the sore throat and accelerating ulceration. Those ignorant of this principle may argue that despite cold herbs, the fire remains fierce, failing to recognize the error of non-dispersion, and mistakenly believing more cooling is needed. This leads to further suppression, pathogen invasion, and death.
Some claim this condition strictly requires dispersing; I consider this view biased. As stated earlier, during the phase of alternating chills and fever, dispersing is urgent to promote sweating and rash emergence. Once chills cease, the exterior wind-cold is resolved, but internal pathogenic fire flares up. At this stage, using cold-cooling herbs to drain heat is appropriate; once heat clears, the disease resolves. Persisting with acrid-warm dispersing formulas allows fire to thrive with wind, increasing swelling and spreading ulceration, potentially causing dysphagia and excruciating pain like knife cuts. Occasionally, suggestions to use cooling herbs are criticized as suppressing pathogens. However, blazing heat kills swiftly; the harm lies in bias towards dispersing and vilifying clearing. One side praises dispersing and condemns cold; the other condemns dispersing and praises cold. The key lies in adapting to the sequence and timing, exercising flexibility to hit the mark accurately. Furthermore, post-recovery often involves limb soreness and stiffness due to Yin injury from fire scorching and meridian malnourishment. Treatment should nourish Yin, differing from Bi Syndrome (Obstruction Syndrome). This is my limited insight, offered for discussion with experts.