〔薛〕腋痈属足少阳手少阴手厥阴三经,小儿患之,多禀赋肝火所致。初起先用
活命饮。次用柴胡栀子散。五七日间作脓 肿作痛者,亦用活命饮杀其大势,虽溃
亦轻而易敛。若脓已成,用托里消毒散。已出用托里散。如有变证,当随证治之。
〔薛〕胁肋者,足厥阴、少阳之经,相火之司也,乃木之主,肝胆之气不平,则
风火内搏,荣逆血郁,热聚为脓,而痈肿之所由生也。亦有禀赋母气肝胆之热,恚
怒之火而致。然初患 肿作痛者,宜用柴胡栀子散。未消者,用仙方活命饮。其热
既杀而肿不消者,则必成脓也,乃用托里消毒散。其脓既成,以代针膏决之,仍用
托里散自愈。若脓出而痛止肿消,则不必用药也。
加味归脾汤 治小儿因乳母忧思郁怒,胸胁作痛,或肝脾经分患疮疡之证,或
寒热惊悸无寐,或便血盗汗,疮口不敛等证。
人参 黄 (炒) 茯神(去木) 甘草(炒) 白术(炒。各一钱) 木香(五分)
远志(去心) 酸枣仁 龙眼肉 当归 牡丹皮 山栀(炒。各一钱)
上,水煎,乳母服,儿亦服之。
小柴胡汤 治肝胆经分一切疮疡发热潮热,或饮食少思。加山栀、牡丹皮,名加味
小柴胡汤。(方见发热)
柴胡清肝散 治肝经风热,或乳母怒火患一切疮疡。(见肝热)
栀子清肝散(一名栀子柴胡散) 治三焦及足少阳经风热生疮,或发热耳内生疮作痒,
或出水疼痛。(见肾热)
【薛己】腋痈归属于足少阳胆经、手少阴心经和手厥阴心包经。小儿患此病,多因先天禀赋中肝火旺盛所致。初起时,先用仙方活命饮治疗。随后使用柴胡栀子散。在发病五到七天内,若出现化脓、肿胀和疼痛的情况,也使用仙方活命饮以遏制病势的大势发展,即使溃破,病情也较轻且容易愈合。如果脓液已经形成,则使用托里消毒散。脓液已排出后,使用托里散。如果出现变证(病情变化),应当根据具体症状进行治疗。
【薛己】胁肋部位,是足厥阴肝经和足少阳胆经所过之处,由相火所主管,属于木行的主导,与肝胆之气相关。若肝胆之气不调和,则风火在内相互搏结,导致营血运行逆乱、血液郁滞,热邪聚集而化为脓液,从而产生痈肿。也有因先天禀赋继承了母体肝胆的热气,或因愤怒等情绪之火而导致的。然而,初患时若出现肿胀疼痛,适宜使用柴胡栀子散。若肿块未消退,使用仙方活命饮。当热势已减但肿块仍未消退时,则必然成脓,此时使用托里消毒散。脓液既已形成,用代针膏刺破排脓,随后仍用托里散即可自愈。如果脓液排出后疼痛停止、肿块消退,则不必再用药。
加味归脾汤:治疗小儿因乳母忧思郁怒,导致胸胁疼痛,或肝脾经分发生疮疡病症,或寒热交替、惊悸失眠,或便血、盗汗,疮口不愈合等症状。
人参、黄芪(炒)、茯神(去除木质部分)、甘草(炒)、白术(炒,各一钱)、木香(五分)、远志(去除心)、酸枣仁、龙眼肉、当归、牡丹皮、山栀(炒,各一钱)。
以上药材,加水煎煮,乳母服用,婴儿也同时服用。
小柴胡汤:治疗肝胆经分一切疮疡引起的发热、潮热,或饮食减少、食欲不振。加入山栀、牡丹皮,名为加味小柴胡汤。(方剂见“发热”章节)
柴胡清肝散:治疗肝经风热,或乳母怒火引发的一切疮疡。(见“肝热”章节)
栀子清肝散(又名栀子柴胡散):治疗三焦及足少阳胆经风热生疮,或发热、耳内生疮作痒,或流出水液并伴有疼痛。(见“肾热”章节)
[Xue] Axillary carbuncle (Axillary abscess) belongs to the Foot-Shaoyang Gallbladder Channel, Hand-Shaoyin Heart Channel, and Hand-Jueyin Pericardium Channel. In children, it is mostly caused by innate liver fire (Liver Fire). At the initial stage, Xianfang Huoming Yin (Immortal Life Powder) should be used first. Subsequently, Chaihu Zhizi San (Bupleurum and Gardenia Powder) is administered. Between the fifth and seventh days, if suppuration, swelling, and pain occur, Xianfang Huoming Yin (Immortal Life Powder) is also used to suppress the major pathogenic force; even if ulceration occurs, the condition remains mild and heals easily. If pus has already formed, Tuoli Xiaodu San (Supporting the Interior and Detoxifying Powder) is used. After the pus has drained, Tuoli San (Supporting the Interior Powder) is applied. If complicated symptoms arise, treatment should be adjusted according to the specific manifestations.
[Xue] The hypochondriac region is governed by the Foot-Jueyin Liver Channel and Foot-Shaoyang Gallbladder Channel, under the jurisdiction of Ministerial Fire (Xiang Huo), and is the master of Wood, relating to the Qi of the Liver and Gallbladder. When the Qi of the Liver and Gallbladder is imbalanced, Wind and Fire contend internally, causing counterflow of Ying (Nutritive) blood and blood stasis; heat accumulates and transforms into pus, giving rise to carbuncles and swellings. This may also result from inheriting maternal Liver-Gallbladder heat or from anger-induced fire. However, at the onset with swelling and pain, Chaihu Zhizi San (Bupleurum and Gardenia Powder) is appropriate. If the swelling does not subside, Xianfang Huoming Yin (Immortal Life Powder) is used. Once the heat is suppressed but the swelling persists, suppuration is inevitable, and Tuoli Xiaodu San (Supporting the Interior and Detoxifying Powder) is then employed. Once pus has formed, Daizhen Gao (Needle-Replacement Paste) is used to lancedrain it, followed by Tuoli San (Supporting the Interior Powder) for spontaneous healing. If pain ceases and swelling subsides after pus drainage, no further medication is necessary.
Jiawei Guipi Tang (Modified Return-to-the-Spleen Decoction): Treats infants suffering from chest and hypochondriac pain due to the wet nurse's worry, thought, depression, and anger; or sores and ulcers in the Liver and Spleen channels; or alternating chills and fever, palpitations, insomnia; or hematochezia, night sweats, and non-healing wound margins.
Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix, stir-fried), Fushen (Poria with Hostwood, woody part removed), Gan Cao (Licorice Radix, stir-fried), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried, each 1 qian), Mu Xiang (Aucklandiae Radix, 0.5 qian), Yuan Zhi (Polygalae Radix, heart removed), Suan Zao Ren (Ziziphi Spinosae Semen), Long Yan Rou (Longan Aril), Dang Gui (Angelicae Sinensis Radix), Mu Dan Pi (Moutan Cortex), Zhi Zi (Gardeniae Fructus, stir-fried, each 1 qian).
Decoct these ingredients in water. The wet nurse takes the decoction, and the infant also consumes it.
Xiao Chaihu Tang (Minor Bupleurum Decoction): Treats all sores and ulcers in the Liver and Gallbladder channels accompanied by fever or tidal fever, or poor appetite. Adding Zhi Zi (Gardeniae Fructus) and Mu Dan Pi (Moutan Cortex) creates Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction). (Formula see "Fever" section)
Chaihu Qinggan San (Bupleurum Liver-Clearing Powder): Treats Wind-Heat in the Liver channel, or sores and ulcers caused by the wet nurse's anger-fire. (See "Liver Heat" section)
Zhizi Qinggan San (Gardenia Liver-Clearing Powder, also known as Zhizi Chaihu San): Treats sores caused by Wind-Heat in the Sanjiao and Foot-Shaoyang Gallbladder channels, or fever with sores inside the ear causing itching, or oozing fluid with pain. (See "Kidney Heat" section)