精要谓一日至三日进十数服。防毒瓦斯攻脏腑。名护心散。切详绿豆解丹毒。又言治石毒
甘入阳明。性寒能补为君。以乳香去恶毒。入少阴。性温善窜为佐。甘草性缓。解五金八石
及百药毒为使。想此方专为服丹石发疽者。设不因丹石而发疽。恐非必用之剂。
丹溪曰。痈疽因积毒在脏腑。非一朝一夕。治当先助气壮胃。使本根坚固。而以行经活
佐。参以经络时令。使毒外发。施治之。早。可以内消。此乃内托之本意。(又云)内托散性
冷。治呕有降火之理。若夫老年者病深。诸症备者。体虚者。绿豆虽补。将有不胜重任之患
一妇年七十。形实性急。好酒。冬病脑疽。与麻黄桂枝汤而愈。此亦内托。岂必皆冷药
精要曰。初成脓宜烙。得脓利为效。亦服追毒丸。
丹溪曰。追毒丸下积取毒之药。决无取脓之效。今用烙而得脓。若在里而血气实。则脓
。如托不出。何不以和气活血药。佐以参 补剂。使脓托出也。其方用五倍子。消毒杀虫解
风为君。山慈菇、千金子、大戟、皆驱逐走泄为臣。佐以麝香升散。用之以治痈疽。实非所
宜。果见脏腑有积毒。或异虫缠滞深固而体气不虚者。亦是快药、但戒勿轻用耳。
谓痈疽皆绿气滞血凝。或因怒气所致。用香附子去毛。以生姜汁淹一夕。研干为末。白
汤调服二钱。无时。
丹溪曰。本方谓疽后常服。半年尤效。此皆施于体实气郁之人也。
一人浓味气郁。形实性重。年近六十。背疽。医与他药皆不行。惟饮香附米甚快。始终只
此一味而安此千百而一二。
《精要》中说,从发病第一天到第三天,每天服用十几剂。目的是防止毒瓦斯攻入脏腑。这个方子名叫护心散。仔细推究,绿豆能解丹毒。又说治疗石毒。
甘味药入阳明经。性寒且具有补益作用,作为君药。用乳香去除恶毒,入少阴经。性温善于走窜,作为佐药。甘草性缓,能解五金、八石以及百药的毒性,作为使药。猜想此方专门针对因服用丹石导致发疽的患者。如果不是因为丹石而引发的疽,恐怕不是必用的方剂。
朱丹溪说:痈疽是因为积毒在脏腑中,不是一朝一夕形成的,治疗应当先助气壮胃,使根本坚固,再配合行经活血的药物,参酌经络和时令,使毒邪向外发散。施治越早,可以使痈疽在内部消散。这才是内托法的本意。(又说)内托散药性寒冷,治疗呕吐有降火的道理。如果是老年人,病情深重,各种症状都具备,身体虚弱的,虽然绿豆有补益作用,但可能会有不胜任重任的隐患。
有一位七十岁的妇人,形体结实,性格急躁,喜好饮酒,冬天患脑疽,给予麻黄桂枝汤而痊愈。这也是内托法,难道一定都用冷药吗?
《精要》说:初起成脓时适宜用火烙,出脓通畅即为有效,同时也服用追毒丸。
朱丹溪说:追毒丸是下积取毒的药物,绝对没有排脓的效果。现在用火烙而出脓。如果病邪在里且血气充实,那么脓液自然形成。如果托不出来,为什么不用调和气血的药物,配合人参等补剂,使脓液托出呢?那个方子用五倍子消毒杀虫解毒风为君药。山慈菇、千金子、大戟,都是驱逐走泄的药物为臣药。佐以麝香升散,用来治疗痈疽,实在是不适宜的。果然见到脏腑有积毒,或者异虫缠滞深固而体质不虚的人,这也算是峻猛的药,只是告诫不要轻率使用罢了。
(书中)说痈疽都是因为绿气(疑为“郁”字之误或特定术语,此处依原文直译,通常指气机郁滞)滞涩、血凝,或者因为怒气所致。用香附子去毛,用生姜汁浸泡一夜,研成干末,白开水调服二钱,不限时间。
朱丹溪说:原方说疽后常服,半年尤其有效。这都是适用于形体结实、气机郁滞的人。
一个人饮食肥厚、气机郁滞,形体结实、性格沉稳,年近六十,患背疽,医生给他其他药都不见效,只有喝香附米非常舒服。始终只用了这一味药就安定了。这种情况千百人中才有一两个。
The *Jingyao* (Essentials) states that from the first to the third day of onset, more than ten doses should be administered daily. This is to prevent toxic vapors from attacking the Zang-Fu organs. It is named Huxin San (Protect the Heart Powder). Upon careful examination, Mung Bean (Vigna radiata) resolves Dan toxicity (toxicity from mineral pills). It also mentions treating Shi Du (stone toxicity).
Sweet-flavored herbs enter the Yangming channel. With a cold nature and tonifying properties, they serve as the Sovereign herb. Frankincense (Boswellia carterii) is used to remove malignant toxins; it enters the Shaoyin channel. With a warm nature and a propensity for dispersal, it serves as the Assistant herb. Licorice Root (Glycyrrhizae Radix et Rhizoma) has a mild nature and can resolve the toxicity of the five metals, eight stones, and hundred drugs; it serves as the Envoy herb. One might speculate that this formula is specifically designed for patients who develop carbuncles due to taking cinnabar and stone minerals. If the carbuncle does not arise from such minerals, it is likely not an indispensable prescription.
Zhu Danxi said: Carbuncles and sores arise from accumulated toxins within the Zang-Fu organs; this accumulation does not happen overnight or in a single day. Treatment should first assist Qi and strengthen the Stomach to solidify the root, then employ herbs that move the channels and invigorate blood. By considering the meridians and seasonal timing, the toxin can be directed outward. Early intervention can lead to internal resolution. This is the original intent of the Internal Support method. (It is also stated that) Neituo San has a cold nature; its use in treating vomiting relies on the principle of descending fire. However, for elderly patients with deep-seated disease, presenting all symptoms, and with deficient constitutions, although Mung Bean has tonifying properties, there is a risk that it may be too heavy for their constitution to bear.
A seventy-year-old woman, with a robust physique and irritable temperament, who enjoyed alcohol, developed a brain carbuncle in winter. She was cured using Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction). This also constitutes an Internal Support method; must one always use cold-natured medicines?
The *Jingyao* states: When pus initially forms, cauterization is appropriate; effective results are achieved when pus drains freely. The Zhuidu Wan (Pursue Toxin Pill) should also be taken.
Zhu Danxi said: Zhuidu Wan consists of herbs that purge accumulation and extract toxins; it absolutely lacks the effect of expelling pus. Now, pus is obtained through cauterization. If the pathogen is interior and the Blood and Qi are substantial, pus will naturally form. If it cannot be supported outwards, why not use herbs that harmonize Qi and invigorate Blood, assisted by tonics containing Ginseng (Panax ginseng), to support the expulsion of pus? That formula uses Chinese Gall (Rheae Rhizoma) as the Sovereign herb to detoxify, kill parasites, and resolve wind. Smilax Glabra Rhizome (Smilacis Glabrae Rhizoma), Croton Seed (Crotonis Fructus), and Spurge Root (Euphorbiae Pekinensis Radix) are all purgative and draining herbs serving as the Minister herbs. Musk (Moschus) is added as an Assistant herb for its ascending and dispersing properties. Using this to treat carbuncles and sores is truly inappropriate. Only if there is confirmed accumulation of toxins in the Zang-Fu organs, or deep-seated entanglement by strange worms without constitutional deficiency, might this be considered a potent medicine. Nevertheless, caution against casual use is advised.
(The text) states that carbuncles and sores are all caused by Qi stagnation and Blood coagulation, or induced by anger. Use Cyperi Rhizoma (Cyperi Rhizoma) with hairs removed, soaked overnight in Ginger Juice (Zingiberis Recens Juice), ground into a dry powder, and taken with plain water, two qian per dose, at any time.
Zhu Danxi said: The original formula states that regular consumption after the sore heals is particularly effective over half a year. This applies only to individuals with robust constitutions and Qi stagnation.
An individual who consumed rich foods and suffered from Qi stagnation, with a robust physique and steady temperament, nearly sixty years old, developed a back carbuncle. Other medications prescribed by physicians were ineffective. Only drinking Cyperi Rhizoma provided significant relief. Ultimately, he was cured using solely this single herb. Such cases occur in only one or two out of a thousand.