凡痈疽服药,宜照顾脾胃为主,不得已而用清凉;但期中病,切勿过剂。大法初起时,
设有挟风寒者,宜先用芎芷香苏散一剂以散之。散后而肿未消,随用银花甘草以和解之。若
肿势 痛,大便闭结,内热极盛者,则用卫生汤加大黄以疏利之。若病势虽盛而元气渐虚
者,则清药中须兼托补之剂,透脓散主之。若脓水已溃,必须托补元气为主,参 内托散主之
。如或元气虚寒,则补托药中须用辛热以佐之。脾虚者,理中汤、参苓白术散。气虚下陷者
,补中益气汤。胃经受寒,饮食停滞者,藿香正气散。气血两虚者,十全大补汤加附子、鹿
茸辈。间亦有虚而挟热者,即于前方中去附子、姜、桂,加麦冬、银花、丹皮等药以收功。
是又不可不知也。大抵有阳毒,有阴毒,有半阴半阳,宜细辨之。阳毒者,疮势红肿,疮顶
尖耸,根脚不散,饮食如常,口渴便结,五心烦热,脉洪数。阴毒者,疮势灰白,平塌顽麻
,少痛,根脚走散,食少便溏,手足厥冷,口鼻气冷,脉沉迟。半阴半阳者,疮肿虽红,不
甚尖耸,饮食差减,大便不结,寒热往来,微渴喜热,脉虚软。此三者必须细辨,俾用药寒
温得宜,方为合法。治阳者,清凉解毒。治阴者,温中回阳。半阴半阳之治,清不伤胃,温
不助邪,如斯而已矣。
凡治疗痈疽(体表化脓性感染)服药,应当以顾护脾胃功能为主;不得已才使用清凉药物;但必须中病即止,切勿用药过量。
基本法则:在疾病初起阶段,如果兼夹风寒邪气,宜先用芎芷香苏散一剂来疏散表邪。发散之后,如果肿胀仍未消退,随即使用金银花、甘草来调和解毒。如果肿胀疼痛剧烈,大便闭结不通,体内热势极盛,则使用卫生汤加大黄来通腑泄热、疏通利导。如果病势虽然旺盛,但元气逐渐虚弱,则在清热药中必须兼用托补正气的方剂,以透脓散为主治。如果脓液已经溃破,必须以托补元气为主,以参内托散为主治。假如元气虚寒,则在补托药中须用辛热药物作为辅助。脾虚者,用理中汤、参苓白术散。气虚下陷者,用补中益气汤。胃经受寒,饮食停滞者,用藿香正气散。气血两虚者,用十全大补汤加附子、鹿茸等药。间或也有体虚而兼夹热邪的,就在前方中去掉附子、干姜、肉桂,加入麦冬、金银花、牡丹皮等药来收功。这一点也是不可不知道的。
大抵毒邪有阳毒、阴毒、半阴半阳之分,应当仔细辨别。阳毒的表现是:疮势红肿,疮顶高耸尖锐,根基不散漫,饮食如常,口渴,大便干结,五心烦热,脉象洪数。阴毒的表现是:疮色灰白,平塌不起,顽固麻木,疼痛轻微,根基走散漫延,食少便溏,手足厥冷,口鼻气息寒冷,脉象沉迟。半阴半阳的表现是:疮肿虽红,但不甚高耸,饮食稍减,大便不干结,寒热往来,微渴且喜热饮,脉象虚软。这三种情况必须仔细辨别,使得用药寒温适宜,这才是合法的治疗。治疗阳毒,用清凉解毒法;治疗阴毒,用温中回阳法;治疗半阴半阳,清热不伤胃气,温补不助长邪气,如此而已。
In the administration of medicines for treating carbuncles and sores (superficial suppurative infections), care should primarily be taken to protect the Spleen and Stomach; cooling herbs should only be used when necessary. However, once the disease is addressed, dosage must not be excessive.
The general principle is: In the early stage of the disease, if there is an accompanying Wind-Cold pathogen, one should first administer a dose of Xiongzhi Xiangsu San (Sichuan Lovage, Chrysanthemum, and Perilla Leaf Powder) to disperse the exterior. After dispersion, if the swelling has not subsided, Honeysuckle (Jinyinhua, Lonicerae Japonicae Flos) and Licorice (Gancao, Glycyrrhizae Radix et Rhizoma) should be used to harmonize and resolve toxicity. If the swelling and pain are severe, accompanied by constipation and extreme internal heat, Weisheng Tang (Health Preservation Decoction) with added Rhubarb (Dahuang, Rhei Radix et Rhizoma) should be used to unblock the bowels and promote drainage. If the pathological condition is vigorous but the Yuan Qi (Original Qi) is gradually weakening, tonic-boosting agents must be combined with clearing herbs; Tou Nong San (Pus-Penetrating Powder) is the primary formula. Once the pus has drained, the treatment must focus on tonifying and boosting the Yuan Qi, using Shen Nei Tuo San (Ginseng Internal-Supporting Powder) as the main formula. If the Yuan Qi is deficient and cold, acrid-hot herbs should be added as assistants to the tonic-boosting prescription. For Spleen deficiency, Lizhong Tang (Regulate the Middle Decoction) or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is indicated. For Qi deficiency with sinking, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used. For Cold invading the Stomach channel with food stagnation, Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) is prescribed. For dual deficiency of Qi and Blood, Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction) with added Aconite (Fuzi, Aconiti Lateralis Radix Praeparata) and Deer Antler (Lurong, Cervi Cornu Degelatinatum) is employed. Occasionally, there may be deficiency accompanied by Heat; in such cases, remove Aconite, Ginger (Shengjiang, Zingiberis Rhizoma Recens), and Cinnamon (Rougui, Cinnamomi Cortex) from the previous formulas, and add Ophiopogon (Maidong, Ophiopogonis Radix), Honeysuckle, and Moutan Bark (Danpi, Moutan Cortex) to complete the treatment. This point must not be overlooked.
Generally speaking, toxins can be classified into Yang Toxin, Yin Toxin, and Half-Yin Half-Yang Toxin, which require careful differentiation. Yang Toxin manifests as redness and swelling of the sore, a high and pointed apex, a localized base, normal appetite, thirst, constipation, heat sensation in the palms, soles, and chest (Five Hearts Hot), and a surging and rapid pulse. Yin Toxin manifests as grayish-white color of the sore, flat and collapsed appearance, stubborn numbness, mild pain, spreading base, poor appetite, loose stools, cold extremities, cold breath from mouth and nose, and a deep and slow pulse. Half-Yin Half-Yang Toxin manifests as redness of the swelling but without significant height, slightly reduced appetite, non-constipated stool, alternating chills and fever, slight thirst preferring hot drinks, and a weak and soft pulse. These three types must be carefully differentiated to ensure that the use of cold and warm herbs is appropriate, which constitutes the correct method. The treatment for Yang involves clearing heat and resolving toxicity; the treatment for Yin involves warming the middle and restoring Yang. The treatment for Half-Yin Half-Yang involves clearing heat without damaging the Stomach and warming without assisting the pathogen; this is all there is to it.