丹毒多般。病原则一。总由心火。风毒搏击。主血者心。血为火逼。阴滞于阳。血热郁逆。内而
熏蒸。先蕴胸膈。外达皮肤。热而色赤。赤若丹涂。热若火炙。凡热有毒。毒则痛极。渐至坏烂。水
流肌裂。入肾入腹。斯至于厄。亦有在胎。胎毒久积。迨至生后。感热发泄。亦有乳母。七情内迫。
酒醴燔炮。恣情而食。毒从乳流。与儿相贼。亦有食多。脾弱难克。热蕴于中。肌表红色。亦有孕
时。母受惊吓。惊邪伤胎。递相传袭。形发于外。向夜啼泣。眼胞微肿。面带青黑。种种诸丹。不能
尽悉。治法大要。清火涤热。顷刻丹消。肌肤一抹。
史演山曰。胎毒发丹者。因胎毒内伏。或频浴热汤。或着烘衣。或乳母饮食。七情内热。助邪
为患。发于头面四肢。延及胸腹。色赤。游走不定。古人云。从四肢起入腹囊者。皆不治。当急令人
随患处遍吮。毒血各聚一处。砭出之。急服活命饮。惟百日内忌砭。以其肌肉难任也。若发散太
过。表虚热而赤不退者。用补中益气汤。加防风、白芷。寒凉过剂。胃气受伤。而热赤不退者。异功
散加升、柴。或兼发搐等症。用四君加升、归、钩藤。若复用攻毒。必致不起。头额间患者。当砭之。
巢元方曰。火丹候。往来如伤寒。赤着身而日渐大者是也。又云丹火候状。发赤。如火烧。须
臾浆起。是也。
圣惠方曰。凡小儿一切丹。皆由风毒在于腠理。热毒搏于血。蒸发于外。其皮上热而赤。如丹
涂状。故谓之丹。若又不歇。则肌肉坏烂。若毒瓦斯入腹。则杀人。合以一方同疗之。故号一切丹也。
用升麻散。赤丹者。由风毒之重。故使赤也。初发肿起。大如连钱。小者如麻豆。肉上生粟如鸡
冠。故亦谓之茱萸丹也。宜升麻膏。又云。有天火丹者。肉中有如丹赤色者。大者如手。剧者遍身
赤痒。故名天火丹也。又云。天火丹。从背起赤点。用桑白皮末羊脂调涂。千金治天火丹病。初从
髀间起。小儿未满百日。犯行路灶君。若热流阴头。赤肿血出。方用伏龙肝末鸡子清调涂。又有鬼
火丹者。发两臂。赤起如李子。戎盐散。有野火丹者。丹发赤斑。斑如梅子。满背腹。千金遍身皆赤
者。名野火丹。雄黄戎盐各五钱为未。鸡子白调。频涂。以瘥为度。有家火丹者。初发着两颊两膀
上。两腋下。古方治家火丹攻喉入腹。用硝石、凝水石。铜器内熬干。研服方寸匕。有殃火丹者。初
发两胁。及腋下腿上。用朴硝研末。每服五分。竹沥调下。更量儿大小加减。有神火丹者。丹发两
膀。不过一日。便赤黑。醋调栀子仁末涂。有荧火丹者。丹发如灼。在胁下。正赤。初从额起。或从
耳起。而多痛。赤小豆一合。硝石五钱。寒水石一分。为末。冷水调五分。日三服。量儿大小加减。
冷水调涂。亦可。有朱田火丹者。先发于背。遍身一日一夜而成疮。蓝靛涂之。或未成疮。鸡子清
调赤小豆末敷。已成疮。赤豆末掺之。有天灶火丹者。发两膀里。尻间正赤。流至阴头。赤肿血出
者是也。用赤豆、伏龙肝等分为末。鸡子白调涂。车前子末水调涂亦可。有废灶火丹者。从足趺
起。正赤者是也。赤小豆一两。牛角二两。烧灰共末。鸡子白调涂。有尿灶火丹者。丹发膝上。从两
股起。及脐间。走入阴头者是也。李树根半斤烧灰。取田中流水调涂。有赤流者。小儿身上。或一
片片赤色如胭脂。及渐引。此名丹毒。俗谓之流火。若因热而得者赤色。因风而得者白色。皆肿而
壮热也。先砭其恶血。内服升麻汤。毒未入腹者。可疗也。有蛇缠丹者。此丹匝腰则死。捣莴苣烂
涂。或研莴苣子涂之。有蜘蛛丹者。满身病。用白矾、皂荚烧灰、猪糟下泥和涂之。有赤白游肿者。
小儿肌肉虚。为风毒热气所乘。热毒搏于血气。则皮肤赤而肿起。其风随气行游不定。故名也。又
云。游肿之状。为青黄赤白。无复定色。游走于皮肤之间。肉上微光是也。犀角散。凡丹入腹。生麻
油涂之。服婴孺方。丹痛。捣竹茹汁及一升作一服。只一二服效。丹痒。捣韭菜汁入些盐与香油以
手摩热。于丹上揩之。立愈。
曾氏曰。赤火丹瘤。皆心火内热而发。赤如丹砂。心主血而火性热。血热相搏。阴滞于阳。即
发丹毒。心虚寒则痒。心实热则痛。自腹生出四肢者易治。自四肢生入腹者难疗。先用百解散表
之。次以当归散。加连翘、荆芥水煎。与宣热拔毒。其次赤葛散。或初用化丹汤亦好。有身上发
时。亦如前症。不甚燥痒。但见出浮遍体。神昏不悦。名阴湿毒症。婴孩生后。百日之内。半岁以
上。忽两眼胞红晕微起。面青黯色。向夜烦啼。或脸如胭脂。此伏热在内。亦有脸不红者。始因居
胎之时。母受重惊。惊邪伤胎。递相传袭。形发于外。初发时。散生满面。状如水豆。脚微红而不
壮。出没休息无定。次到颈项。亦如朱砂。名曰惊丹。用四圣散。先洗其目。次百解散加五和汤同
煎。与解惊热丹毒。当归散、牛蒡汤亦可。如惊丹发至胸乳间。微有痰喘作搐。急宜宣热拔毒。免
至内流。为害不浅。五和汤加升麻、生地、灯心、生姜。则自消除。仍用前数药调治。不生他症。
吴绶曰。小儿丹毒。乃热毒之气极。与血相搏而风乘之。故赤肿。及游走遍身者。又名赤游
风。入腹入肾。则杀人也。大抵丹毒。虽有多种。病源则一。有赤丹毒遍身痒者。或女子十五六而
脉未通者。多发丹疹。皆由血有风毒乘之。宜防己散。
丹毒的种类繁多，但致病原则是一致的。总归是由心火引起，风毒与正气相搏击。心主血脉，血液被火热逼迫，导致阴血阻滞于阳气之中，血热郁结而逆乱。在内则熏蒸脏腑，先蕴积于胸膈；在外则通达皮肤，因热而颜色发红，红得像丹砂涂抹一样，热得像火烤一样。凡是热邪带有毒性，毒盛则疼痛剧烈，逐渐发展到肌肉腐烂，水流从肌理裂缝中渗出，若毒气深入肾脏或腹部，就会危及生命。
也有在胎儿时期就存在的，胎毒长期积聚，等到出生后，感受热邪而发泄出来。也有是因为乳母情绪内迫（七情所伤），或者食用辛辣烧烤、饮酒等刺激性食物，毒气通过乳汁流传给孩子，与孩子体内的正气相贼害。也有因为孩子饮食过多，脾气虚弱难以运化，热邪蕴积在体内，表现在肌肤表面呈红色。也有在母亲怀孕时受到惊吓，惊邪损伤胎儿，依次相传袭染，表现于外，夜间啼哭，眼睑微肿，面色青黑。各种类型的丹毒，不能一一详尽列举。治疗的大要在于清泻心火、涤除热毒，顷刻间丹毒即可消退，肌肤恢复如初。
史演山说：胎毒发丹，是因为胎毒潜伏在内，或者频繁用热水洗澡，或者穿着烘烤过的衣服，或者乳母饮食不当、七情内热，助长邪气为患。发作于头面四肢，蔓延至胸腹，颜色赤红，游走不定。古人说，如果从四肢起病并传入腹部和阴囊的，都是不治之症。应当立即让人随着患处遍身吮吸，使毒血聚集在一处，然后用砭石刺破放出。急服活命饮。只有百天内的婴儿禁止使用砭法，因为他们的肌肉难以承受。如果发散太过，导致表虚热而赤色不退的，用补中益气汤，加防风、白芷。如果寒凉药物使用过度，损伤胃气，导致热赤不退的，用异功散加升麻、柴胡。如果兼有抽搐等症状，用四君子汤加升麻、当归、钩藤。如果再用攻毒之法，必定导致死亡。头额间发病的，应当用砭法。
巢元方说：火丹候，症状往来像伤寒，身体出现红斑且日渐扩大就是这种病。又说丹火候的症状，皮肤发红，像火烧一样，须臾之间起水泡，就是这种病。
《圣惠方》说：凡是小儿的一切丹毒，都是由风毒存在于腠理，热毒搏结于血液，蒸发于体表。皮肤上发热而发红，像丹砂涂抹的样子，所以叫作丹。如果不间断发作，则肌肉腐烂。如果毒瓦斯进入腹部，则会致死。因此合用一个方子共同治疗，所以称为“一切丹”。用升麻散。赤丹，是由于风毒较重，所以使皮肤发红。初发时肿起，大的如连钱草，小的如麻豆，肉上生粟粒状突起如鸡冠，所以也叫作茱萸丹。宜用升麻膏。又说，有天火丹，肌肉中有像丹砂红色的斑块，大的如手掌，严重的遍身赤痒，所以叫天火丹。又说，天火丹，从背部起赤点，用桑白皮末配羊脂调匀涂抹。《千金方》治天火丹病，初从大腿根部起，小儿未满百日，触犯行路灶君（迷信说法，指不洁之气），如果热流注到阴头，红肿出血，方用伏龙肝末配鸡蛋清调匀涂抹。又有鬼火丹，发作于两臂，赤起如李子大小，用戎盐散。有野火丹，丹发赤斑，斑如梅子大，布满背腹，《千金方》称遍身皆赤者，名为野火丹。雄黄、戎盐各五钱研为末，鸡蛋清调匀，频频涂抹，以痊愈为度。有家火丹，初发在两颊、两膀上、两腋下。古方治家火丹攻喉入腹，用硝石、凝水石，在铜器内熬干，研细服用一方寸匕。有殃火丹，初发在两胁及腋下腿上，用朴硝研末，每服五分，竹沥调下，再根据患儿大小加减剂量。有神火丹，丹发于两膀，不过一日，便变为赤黑色，醋调栀子仁末涂抹。有荧火丹，丹发如灼烧状，在胁下，正赤色，初从额头起，或从耳朵起，且多疼痛。赤小豆一合，硝石五钱，寒水石一分，研为末，冷水调服五分，每日三次，根据患儿大小加减。也可用冷水调涂。有朱田火丹，先发于背部，遍身一日一夜而成疮，用蓝靛涂抹。或未成疮，用鸡蛋清调赤小豆末敷；已成疮，用赤豆末掺撒。有天灶火丹，发于两膀里侧、尻间正赤，流至阴头，红肿出血的就是此病。用赤豆、伏龙肝等分为末，鸡蛋清调涂。车前子末水调涂也可以。有废灶火丹，从足背起，正赤色的就是此病。赤小豆一两，牛角二两，烧成灰共研为末，鸡蛋清调涂。有尿灶火丹，丹发于膝上，从两股起，及脐间，走入阴头的就是此病。李树根半斤烧成灰，取田中流水调涂。有赤流者，小儿身上，或一片片赤色如胭脂，以及逐渐蔓延，此名丹毒，俗谓之流火。若因热而得的呈赤色，因风而得的呈白色，都伴有肿胀和高热。先砭刺放出恶血，内服升麻汤。毒未入腹的，可以治疗。有蛇缠丹，此丹环绕腰部则死，捣碎莴苣烂涂，或研莴苣子涂之。有蜘蛛丹，满身患病，用白矾、皂荚烧灰、猪槽泥混合涂抹。有赤白游肿者，小儿肌肉虚弱，被风毒热气所乘，热毒搏结于血气，则皮肤赤而肿起。其风随气行游走不定，所以叫这个名字。又说，游肿的形状，呈现青黄赤白，没有固定的颜色，游走于皮肤之间，肉上微光闪烁就是这种病。犀角散。凡丹毒入腹，生麻油涂之，服婴孺方。丹痛，捣竹茹汁及一升作为一服，只一二服见效。丹痒，捣韭菜汁加入少许盐和香油，用手摩热，在丹毒上揩擦，立刻痊愈。
曾氏说：赤火丹瘤，都是心火内热而发，赤如丹砂。心主血而火性热，血热相搏，阴滞于阳，即发丹毒。心虚寒则痒，心实热则痛。从腹部生出四肢的容易治疗，从四肢生入腹部的难疗。先用百解散解表，次以当归散，加连翘、荆芥水煎，以宣热拔毒。其次是赤葛散，或者初用化丹汤也好。有身上发时，也像前面的病症，不甚燥痒，只见浮遍体，神昏不悦，名叫阴湿毒症。婴儿出生后，百日之内，半岁以上，忽然两眼胞红晕微起，面现青黯色，夜间烦躁啼哭，或者脸如胭脂，这是伏热在内。也有脸不红的，始因在胞胎之时，母亲受重惊，惊邪伤胎，依次相传袭，表现于外。初发时，散生满面，状如水豆，脚微红而不壮，出没休息无定。次到颈项，也如朱砂，名叫惊丹。用四圣散。先洗其目，次百解散加五和汤同煎，以解惊热丹毒。当归散、牛蒡汤也可以用。如果惊丹发至胸乳间，微有痰喘作搐，急宜宣热拔毒，以免内流，为害不浅。五和汤加升麻、生地、灯心、生姜，则自消除。仍用前数药调治，不生他症。
吴绶说：小儿丹毒，是热毒之气极盛，与血相搏而风邪乘之，所以赤肿，及游走遍身者，又名赤游风。入腹入肾，则杀人。大抵丹毒，虽有多种，病源则一。有赤丹毒遍身痒者，或者女子十五六岁而脉未通者，多发丹疹，皆由血有风毒乘之，宜用防己散。
Dan Du (Erysipelas) presents in various forms, yet its pathogenesis follows a single principle. It generally originates from Heart Fire (Heart Fire), where Wind-Toxicity (Wind-Toxin) clashes with the body's righteous Qi. The Heart governs the blood vessels; when blood is forced by fire, Yin stagnates within Yang, leading to heat and blood郁结 (stagnation) and rebellion. Internally, it steams and steeps, first accumulating in the chest and diaphragm; externally, it reaches the skin, becoming red due to heat, resembling cinnabar application, and hot as if roasted by fire. Whenever heat carries toxicity, severe toxicity causes extreme pain, gradually progressing to tissue necrosis, with fluid oozing from muscle fissures. If the toxin enters the Kidneys or abdomen, it becomes fatal.
Some cases exist from fetal life, where fetal toxin (Fetal Toxin) accumulates over time and erupts after birth upon exposure to heat. Others arise from the wet nurse's emotional distress (Seven Emotions), consumption of spicy, fried foods, or alcohol, allowing toxins to flow through breast milk and harm the infant. Some result from excessive feeding in children with weak Spleen Qi, causing heat accumulation internally and redness on the skin. Others stem from maternal fright during pregnancy, where fright-pathogen damages the fetus, transmitting sequentially and manifesting externally as night crying, slightly swollen eyelids, and a bluish-black complexion. Various types of Dan cannot be exhaustively listed. The general treatment principle is to clear fire and purge heat, causing the Dan to vanish instantly and the skin to recover.
Shi Yanshan stated: Fetal toxin-induced Dan occurs because fetal toxin lies dormant internally. It may be triggered by frequent bathing in hot water, wearing heated clothes, or the wet nurse's dietary indiscretion and internal heat from emotions, which aids the pathogen. It appears on the head, face, limbs, spreading to the chest and abdomen, presenting as red, wandering patches. Ancient texts state that cases starting from the limbs and entering the abdomen or scrotum are incurable. One should immediately suck the affected areas to gather toxic blood in one spot, then lance it with a bi stone (Bianshi). Administer Huoming Yin (Life-Saving Decoction) urgently. Lancing is contraindicated for infants under 100 days due to their delicate muscles. If excessive dispersal leads to deficiency-heat with persistent redness, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Fangfeng (Saposhnikovia Root) and Baizhi (Angelica Dahurica). If excessive cold-cooling herbs damage Stomach Qi causing persistent redness, use Yigong San (Yi Gong Powder) with Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root). If accompanied by convulsions, use Sijunzi Tang (Four Gentlemen Decoction) with Shengma, Danggui (Chinese Angelica Root), and Gouteng (Uncaria Ramulus cum Uncis). Further use of detoxifying agents will surely lead to death. For Dan on the forehead, lancing is appropriate.
Chao Yuanfang stated: In Huo Dan (Fire Dan) syndrome, symptoms fluctuate like Taiyang disease (Exterior Cold Syndrome), with red spots appearing on the body and expanding daily. He also described the appearance of Dan Hou (Dan Heat): skin turns red as if burned, forming blisters shortly thereafter.
*Shenghui Fang* (Holy惠民 Formulas) stated: All pediatric Dan results from wind-toxicity residing in the couli (interstices) and heat-toxicity clashing with blood, evaporating outward. The skin becomes hot and red, resembling cinnabar, hence the name Dan. If unceasing, muscles rot. If toxin enters the abdomen, it is fatal. Thus, a single formula treats all, called "Yiqie Dan" (All Dan). Use Shengma San (Cimicifuga Powder). Chi Dan (Red Dan) is caused by heavy wind-toxicity, resulting in redness. Initially swelling like linked coins or small beans, with millet-grain-like elevations on the flesh resembling rooster combs, it is also called Zhuyu Dan (Cornel Dan). Apply Shengma Gao (Cimicifuga Ointment). Tianhuo Dan (Heavenly Fire Dan) features red patches in the flesh, palm-sized or widespread with intense itching. Treat back-originating Tianhuo Dan with Sangbaipi (Mulberry Root Bark) powder mixed with sheep fat. *Qianjin Fang* treats Tianhuo Dan starting from the thigh; for infants under 100 days touching "road stove gods," if heat flows to the glans causing swelling and bleeding, apply Fulonggan (Dragon's House Soil) powder mixed with egg white. Guihuo Dan (Ghost Fire Dan) appears on arms, red like plums; treat with Rongyan San. Yehuo Dan (Wild Fire Dan) presents as plum-sized red spots covering the back and abdomen; widespread redness is also Yehuo Dan. Mix Xionghuang (Realgar) and Rongyan (Rock Salt) each 5 qian, apply with egg white frequently until healed. Jiahuo Dan (House Fire Dan) starts on cheeks, arms, and axillae; ancient formulas for throat/abdominal invasion use Xiaoshi (Niter) and Ningshuishi (Halloysite), dried in copper, powdered, and taken as a cubic inch dose. Yanghuo Dan starts on flanks/axillae/legs; take Puxiao (Mirabilite) powder 5 fen with bamboo juice, adjusted by age. Shenhuo Dan (Divine Fire Dan) appears on arms, turning dark red/black within a day; apply Zhi Zi (Gardenia Fruit) powder mixed with vinegar. Yinghuo Dan burns intensely on flanks, starting at forehead/ears with pain; mix Xiaodou (Adzuki Bean) 1 he, Xiaoshi 5 qian, Hanshuishi (Calcitum) 1 fen, take 5 fen with cold water three times daily, adjusted by age. Can also be applied topically. Zhutianhuo Dan starts on back, becoming sores in 24 hours; apply Landian (Indigo). If no sore, apply Adzuki bean powder with egg white; if sore, sprinkle bean powder. Tianzao Huo Dan starts on inner arms/buttocks, flowing to glans with swelling/bleeding; mix Adzuki bean and Fulonggan equally, apply with egg white. Cheqianzi (Plantago Seed) powder with water is also effective. Feizao Huo Dan starts on dorsum pedis, bright red; mix Xiaodou 1 liang, Niujiao (Ox Horn) 2 liang, calcined to ash, apply with egg white. Niazao Huo Dan starts above knees/thighs/navel, flowing to glans; apply Li shu gen (Li Tree Root) ash mixed with field stream water. Chil Liu (Red Flow) presents as rouge-colored patches spreading on the body, known as Liuhuo (Flowing Fire). Heat-induced is red; wind-induced is white; both swell with high fever. Lance evil blood first, then administer Shengma Tang (Cimicifuga Decoction). Curable if toxin hasn't entered abdomen. Shechan Dan (Snake-Wrapping Dan) wrapping the waist is fatal; apply crushed lettuce or seeds. Zhizhu Dan (Spider Dan) covers the body; apply BaiFan (Alum), Zaojiao (Tamarisk Pod) ash, and pig trough mud. Chi Bai Youzhong (Red-White Wandering Swelling) occurs in children with deficient flesh, where wind-heat attacks, clashing with blood/qi, causing red swelling. Wind moves with qi, wandering不定 (indefinitely). It shows blue/yellow/red/white colors without fixed hue, wandering under skin with slight sheen. Use Xijiao San (Rhinoceros Horn Powder). For Dan entering abdomen, apply raw sesame oil and administer Yingru Fang. For Dan pain, drink 1 sheng of Zhuru (Bamboo Shavings) juice, effective in 1-2 doses. For Dan itch, mix Leijiu (Leek Juice) with salt and sesame oil, warm by rubbing, and wipe on Dan for instant relief.
Zeng Shi stated: Chi Huo Dan Liu (Red Fire Dan Tumor) stems from internal Heart Fire heat, red as cinnabar. Heart governs blood; fire is hot. Blood-heat clash causes Yin stagnation in Yang, triggering Dan. Heart deficiency-cold causes itching; Heart excess-heat causes pain. Dan originating from abdomen to limbs is easy to treat; limbs to abdomen is difficult. First use Baijie San (Hundred Resolutions Powder) to release exterior, then Danggui San (Angelica Powder) with Qiaojiao (Forsythia) and Jingjie (Schizonepeta) decocted in water to vent heat and extract toxin. Alternatively, Chige San or Hudan Tang. If accompanied by floating rash, lethargy, and irritability, it is Yin-Damp Toxic Syndrome. Infants (under 100 days or over 6 months) with sudden red eyelid rims, dark-blue face, night crying, or rouge-like face have latent heat. If caused by maternal fright damaging fetus, it manifests externally. Initial presentation resembles water beans on face, slightly red feet, intermittent. Spreading to neck like cinnabar is called Jing Dan (Fright Dan). Use Sisheng San. Wash eyes first, then decoct Baijie San with Wuhe Tang to resolve fright-heat/Dan. Danggui San or Niubang Tang are alternatives. If Jing Dan spreads to chest/breasts with phlegm-wheeze/convulsions, urgently vent heat/toxin to prevent internal spread. Use Wuhe Tang with Shengma, Shengdi (Rehmannia), Dengxincao (Juncus Effusus), and Shengjiang (Fresh Ginger) to eliminate. Continue previous medicines to prevent complications.
Wu Shou stated: Pediatric Dan Du is extreme heat-toxicity clashing with blood, invaded by wind, causing red swelling and wandering rash, also called Chi You Feng (Red Wandering Wind). Entering abdomen/Kidneys is fatal. Although diverse, the source is one. Widespread red Dan with itching, or girls aged 15-16 with unopened menses developing Dan rashes, are due to wind-toxicity invading blood. Use Fangji San (Stephania Powder).