总括 诸风夹热隐皮肤,凝结难为陡顿除;项颊肿须护喉舌,内疏风热外宜涂。
《内经》曰∶荣气不从,逆于肉内,乃生痈肿。夫小儿风毒者,因惊风之后风从气行,血从气使,毒瓦斯蓄于皮肤,
流结而为肿毒,遂结顽核赤色,多成腮颊之间,或耳根骨节之处,重则成痈疖,谓之遁毒风。宜以当归散倍加枳壳、大
黄,或皂角刺、薄荷之类。如结在腮颊者,治用乌豉膏含化,以护咽喉,外则敷以拂毒散。若因跌仆损伤皮肤,风邪侵
袭患处面发肿者,谓之破血伤风,可投疏风散、活血散之类。
夫瘰 之症,《内经》谓之结核,究其所因,丹溪所谓五味之浓,郁气之积,曰风、曰热,与血相搏而结成者,其
始生于耳后、颏下至项者,此出足阳明胃经来也,此曰瘰 ;生于缺盆胸侧,或在两胁者,此出手足少阳经来也,此曰
马刀,俱当从其所因究治。其小儿幼弱不堪针灸,但以服饵涂贴之剂,施之可也,然须服引经之药,以除根本,可获全
功耳。此症服药,须当卧在床褥,每日作十次咽,服毕安卧。盖取药力在膈上故也。若发于喉下,如带横缠者,乃缠喉
风也,宜服化毒汤及乌豉膏含化以护咽喉外,但根据遁毒风治法。如服药后散止不定,或上头顶,或游面目,而反复来喉
下,如赤紫微浮,中有白突者,阳症变阴,亢则必害,谓之赤游风毒,亦难治矣。
〔附方〕
当归散 见诸泻症内。
乌豉膏 绵川乌(水浸透去皮脐,五钱炮制) 玄明粉(二钱) 淡豉(三钱) 水浸润,饭上蒸透杵烂为膏。
拂毒散 半夏 贝母 大黄 朴硝 五倍 上为末醋调敷
疏风散 荆芥 防风 甘草 葱汤调服。
活血散 当归 川芎 生地 红花 赤芍 苏木
升麻调经汤(治阳明经) 升麻 干葛 胆草 黄芩 黄柏 归尾 桔梗 连翘 白芍 知母 黄连 白术
三棱 甘草(秤一半为丸,一半作蚊蛆秤五钱) 煎汤送下前丸。
连翘散 柴胡 连翘 归尾 白芍 生黄芩 白术 天花粉 胆草 炙甘草 三棱 苍术 黄连 煎汤服法
如前。
化毒汤 桔梗 薄荷 荆芥 甘草 牙硝 朴硝 硼砂 雄黄 山豆根 朱砂 为细末,每用一匙或五分,干
点舌下,或温汤浓调,少与含吞亦可。
总括:各种风邪夹带热毒潜伏于皮肤,凝结后难以迅速清除;若出现项部和脸颊肿胀,必须保护喉舌部位,内部宜疏泄风热,外部适宜涂抹药物。
《黄帝内经》说:营气运行不畅,逆乱于肌肉之内,就会生成痈肿。所谓小儿风毒,是因为在惊风发作之后,风邪随着气机运行,血液也随气机推动,毒瓦斯蓄积在皮肤,流动凝结而成肿毒,于是结成坚硬的核块,颜色发红,多发生在腮颊之间,或者耳根、骨节之处,严重的会形成痈疖,称为遁毒风。适宜使用当归散并加倍加入枳壳、大黄,或者皂角刺、薄荷之类的药物。如果结块在腮颊部位,治疗时使用乌豉膏含服化开,以保护咽喉,外部则敷上拂毒散。如果是因跌打损伤导致皮肤破损,风邪侵袭患处而引发肿胀的,称为破血伤风,可以投用疏风散、活血散之类的方剂。
关于瘰疬这一病症,《黄帝内经》称之为结核,探究其成因,正如丹溪先生所说,是由于五味过于浓厚,加上郁结之气的积聚,风、热与血液相互搏结而形成的。起初生于耳后、下巴至颈项部位的,这是出自足阳明胃经,称为瘰疬;生于缺盆(锁骨上窝)胸侧,或在两胁部的,这是出自手足少阳经,称为马刀,都应当根据病因进行彻底治疗。由于小儿体弱不堪忍受针灸,只可以使用内服和外敷贴的药物,施治即可,但必须服用引经药,以除根本病因,才能取得完全疗效。此症服药时,应当卧床,每天分十次咽下,服完后安静躺卧。这是因为取药力停留在膈上的缘故。如果发于喉下,像带子一样横缠的,就是缠喉风,适宜服用化毒汤及乌豉膏含服化开以保护咽喉,除此之外,均按照遁毒风的治疗方法处理。如果服药后肿块消散但仍不稳定,或者向上蔓延至头顶,或者游走于面目之间,反复来到喉下,呈现赤紫色且微微浮肿,中间有白色突起的,属于阳证变为阴证,亢盛之气必然造成伤害,称为赤游风毒,也难以治疗了。
〔附方〕
当归散 见诸泻症章节内。
乌豉膏 绵川乌(用水浸透去皮和脐,五钱,炮制) 玄明粉(二钱) 淡豆豉(三钱) 用水浸润,放在饭上蒸透后捣烂成膏。
拂毒散 半夏 贝母 大黄 朴硝 五倍子 以上研为细末,用醋调匀外敷。
疏风散 荆芥 防风 甘草 用葱汤调服。
活血散 当归 川芎 生地 红花 赤芍 苏木 用升麻调经汤送服。
升麻调经汤(治疗阳明经) 升麻 干葛 胆草 黄芩 黄柏 归尾 桔梗 连翘 白芍 知母 黄连 白术 三棱 甘草(称量一半做成丸药,一半作为煎汤用的分量,重五钱) 煎汤送服前面的丸药。
连翘散 柴胡 连翘 归尾 白芍 生黄芩 白术 天花粉 胆草 炙甘草 三棱 苍术 黄连 煎汤服用方法如前所述。
化毒汤 桔梗 薄荷 荆芥 甘草 牙硝 朴硝 硼砂 雄黄 山豆根 朱砂 研为细末,每次用一匙或五分,干点舌下,或者用温水浓调,少量含吞也可以。
General Summary: Various wind pathogens accompanied by heat toxins lurk in the skin; once condensed, they are difficult to remove abruptly. If swelling occurs in the neck and cheeks, the throat and tongue must be protected; internally, wind-heat should be purged, and externally, topical applications are suitable.
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When Ying Qi (Nutritive Qi) fails to circulate properly and rebels within the flesh, carbuncles and swellings arise. The so-called "Wind Toxin" in children arises after convulsions due to wind disorders; wind follows the movement of Qi, and blood is driven by Qi. Toxic vapors accumulate in the skin, flow and condense to form toxic swellings, resulting in hard nodules with red coloration. These often occur between the cheeks or at the roots of the ears and joints. In severe cases, they become carbuncles and furuncles, known as Dun Du Feng (Escaping Wind Poison). It is appropriate to use Dang Gui San (Angelica Decoction) with doubled Zhi Qiao (Aurantium Fructus) and Da Huang (Rhubarb Radix), or such herbs as Zao Jiao Ci (Gleditsia Spine) and Bo He (Mint Leaf). If the nodule is located in the cheeks, treat it using Wu Chi Gao (Black Bean and Aconite Ointment) held in the mouth to dissolve, thereby protecting the throat; externally, apply Fu Du San (Toxin-Dispelling Powder). If swelling arises from broken skin due to falls or injuries, where wind pathogens invade the affected area, it is called Po Xue Shang Feng (Broken Blood Injured Wind); one may administer Shu Feng San (Wind-Dispersing Powder) or Huo Xue San (Blood-Invigorating Powder).
Regarding the condition of Luo Li (Scrofula), the *Neijing* refers to it as He Jie (Knots). Investigating its etiology, as Danxi stated, it results from the accumulation of rich flavors and stagnant Qi, where wind and heat contend with blood to form knots. Those initially appearing behind the ears, under the chin, and down to the neck originate from the Foot-Yangming Stomach Meridian and are called Luo Li; those appearing in the Que Pen (Clavicular Fossa) on the chest side or in the hypochondrium originate from the Hand and Foot-Shaoyang Meridians and are called Ma Dao (Horse Knife). All should be treated according to their underlying causes. Since young children are too weak for acupuncture and moxibustion, only internal medicines and external plasters should be used. However, Jing Yin Yao (Meridian-Guiding Herbs) must be taken to eradicate the root cause to achieve complete success. When taking medicine for this condition, the patient should lie in bed and swallow the medicine ten times a day, then rest quietly afterward. This is because the medicinal power is intended to remain above the diaphragm. If it appears below the throat, wrapping around like a band, it is Chan Hou Feng (Throat-Wrapping Wind); one should take Hua Du Tang (Toxin-Dissolving Decoction) and hold Wu Chi Gao in the mouth to protect the throat. Otherwise, follow the treatment method for Dun Du Feng. If, after taking medicine, the swelling does not stabilize, spreads upward to the top of the head, wanders across the face and eyes, or repeatedly returns to below the throat, presenting as reddish-purple, slightly swollen, with white protrusions in the center, it indicates Yang syndrome transforming into Yin syndrome. Hyperactivity will inevitably cause harm; this is called Chi You Feng Du (Red Wandering Wind-Toxin), which is also difficult to treat.
[Attached Formulas]
Dang Gui San (Angelica Decoction) See section on various purgative syndromes.
Wu Chi Gao (Black Bean and Aconite Ointment) Mian Chuan Wu (Cuscutae Semen processed with water until soft, peeled, umbilicus removed, 5 qian), Xuan Ming Fen (Mirabilite, 2 qian), Dan Chi (Light Fermented Soybean, 3 qian). Moisten with water, steam thoroughly over rice, pound into an ointment.
Fu Du San (Toxin-Dispelling Powder) Ban Xia (Pinellia Rhizome), Bei Mu (Fritillaria Bulb), Da Huang (Rhubarb Radix), Pu Xiao (Thenardite), Wu Bei Zi (Chinese Gall). Grind all into powder, mix with vinegar for external application.
Shu Feng San (Wind-Dispersing Powder) Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Gan Cao (Licorice Root). Mix with scallion decoction for administration.
Huo Xue San (Blood-Invigorating Powder) Dang Gui (Angelica Sinensis), Chuan Xiong (Ligusticum Rhizome), Sheng Di Huang (Rehmannia Root), Hong Hua (Carthamus Flower), Chi Shao (Red Peony Root), Su Mu (Sappan Wood). Take with Sheng Ma Tiao Jing Tang.
Sheng Ma Tiao Jing Tang (Bupleurum and Ligusticum Regulating Meridian Decoction - Treats Yangming Meridian) Sheng Ma (Cimicifuga Rhizome), Gan Ge (Pueraria Root), Dan Cao (Gentian Root), Huang Qin (Scutellaria Root), Huang Bai (Phellodendron Bark), Gui Wei (Angelica Tail), Jie Geng (Platycodon Root), Lian Qiao (Forsythia Fruit), Bai Shao (White Peony Root), Zhi Mu (Anemarrhena Rhizome), Huang Lian (Coptis Rhizome), Bai Zhu (Atractylodes Rhizome), San Leng (Sparganium Rhizome), Gan Cao (Licorice Root). Weigh half to make pills, half for decoction (5 qian). Decoct and take with the aforementioned pills.
Lian Qiao San (Forsythia Powder) Chai Hu (Bupleurum Root), Lian Qiao (Forsythia Fruit), Gui Wei (Angelica Tail), Bai Shao (White Peony Root), Sheng Huang Qin (Raw Scutellaria Root), Bai Zhu (Atractylodes Rhizome), Tian Hua Fen (Trichosanthes Root), Dan Cao (Gentian Root), Zhi Gan Cao (Honey-fried Licorice Root), San Leng (Sparganium Rhizome), Cang Zhu (Atractylodes Lancea Rhizome), Huang Lian (Coptis Rhizome). Decoct and take as described previously.
Hua Du Tang (Toxin-Dissolving Decoction) Jie Geng (Platycodon Root), Bo He (Mint Leaf), Jing Jie (Schizonepeta Spike), Gan Cao (Licorice Root), Ya Xiao (Saltpeter), Pu Xiao (Thenardite), Peng Sha (Borax), Xiong Huang (Realgar), Shan Dou Gen (Sophora Tonkinensis Root), Zhu Sha (Cinnabar). Grind into fine powder. Use one spoon or 5 fen per dose, dry-dusted under the tongue, or mixed thickly with warm water and swallowed slowly.