酒 防风汤 蜈蚣散 大芎黄汤 羌活汤 白术防风汤 玉真散外 敷药
养血当归地黄汤
立斋曰∶大凡痈疽溃后，筋糜肉烂，脓血大泄，阳随阴散，或筋脉拘急，恶寒惕搦
，甚者舌强口噤，项背反张，痰涎壅盛，便闭汗出，不时发热，此气血俱虚。而变见若此，
虽与破伤风相类，而主治之法，但当大补血气。若果有风证，亦须以大补气血为主，而兼以治
风之药。设若不审是非，而妄药之，则误矣。
司徒边华泉，肩患痈而发热，目直或 ，殊类中风，日晡热甚，脉益数，此足三阴
气血亏损，虚火妄动也。用参、 、归、术、炙甘草，加酒炒黑黄柏、五味、麦冬、肉桂，四
剂而愈，又数剂而敛。
一儒者，患腿痈，深蓄于内，肉色不变，久不穿溃，针出脓瘀五碗许，恶证骈臻，全
类中风，此脾胃虚而变证也。用六君子汤加当归、炮姜，及圣愈汤，各四剂而安。又劳心不
寐，用归脾汤而愈。（薛按）
斑疹一证，虽已有正门详载，然彼以小儿麻 为言。其有非麻 ，而无论大人小儿，忽患
斑疹小疮者，此虽与彼相类，而实有小异也。是亦不可不辨而治之，盖多由风热外感之证耳
治此之法，脉浮而身热有表证者，惟散风邪为主。脉浮而数者，祛风兼清热。脉沉滑而无
表证者，清火为主。脉浮沉俱滑数，而表里兼见者，宜表里双解之。然惟小儿多有此证，须
察其表里虚实，酌而治之可也。总之小儿脆弱，宜安里之药多，攻发之药少；秘则微泄之，
结则微导之，但令邪气不壅而散之易，则证轻而儿自安矣。大抵身温暖者顺，身凉者逆。
王海藏曰∶前人云，首尾俱不可下者，何也。曰∶首不可下者，为斑未见于表，下则邪
气不得伸越，此脉证有表而无里，故禁首不可下也。尾不可下者，为斑毒已显于外，内无根
蒂，大便不秘，本无一切里证，下之则斑气陷逆，故禁尾不可下也。
洁古曰∶斑疹之病，其为证各异。发 肿于外者，属少阳三焦相火也，谓之斑。小红靥
行皮肤之中不出者，属少阴君火也，谓之疹。凡见斑证，若自吐泻者多吉，慎勿乱治，谓邪
气上下俱出也。若斑疹并出者，其邪必甚，小儿难胜，是以多生别证也。然首尾皆不可下。
立斋曰∶凡小儿丹毒，遍身俱赤，不从砭治，以致毒瓦斯入腹，则不救。盖此证，乃恶毒
热血，蕴蓄于命门，遇相火而合起也。如霞片者，须砭去恶血为善。如肿起赤色，游走不定
者，宜先以生麻油涂患处砭之，以泄其毒。凡从四肢起入腹者，不治。虽云丹有数种，治有
数法，无如砭之为善。常见患重者，不用砭法，俱不救。
一妇人，患斑作痒，脉浮。以消风散，四剂而愈。
一妇人，患斑作痒，脉浮数。以人参败毒散，二剂少愈，更以消风散，四剂而安。
一男子患斑，色赤紫 痛，发热喜冷，脉沉实。以防风通圣散，一剂顿退，又以防风
败毒散加芩、连，四剂而愈。
一老人患疹，色微赤，作痒发热。以人参败毒散，二剂少愈，以补中益气汤加黄芩、山栀而愈。
一小儿患疹，发热作痛，烦渴，欲以清凉饮下之。诊其脉不实，举指不数，此邪在经
络也，不可下，遂以解毒防风汤，二剂而愈。此证小儿多患之，须详审在表在里，及邪之微甚而治之。
一儿作痒发热，以犀角散一剂作吐泻，此邪气上下俱出也，毒必自解。少倾吐泻俱止
，其疹果消。吐泻后，脉见七至，此小儿和平之脉也，邪已尽矣。不须治，果愈。（俱薛按）
一男子患丹毒， 痛便秘，脉数而实，服防风通圣散不应，令砭患处，去恶血，仍用前药而愈。
一小儿，腿患丹，如霞，游走不定，先以麻油涂患处，砭出恶血，毒即渐散。更以神
功托里散，一剂而安。
一小儿患丹毒，外势虽轻，内则大便不利，此患在脏也，服大连翘饮，敷神功散而瘥。
一小儿遍身皆赤，砭之，投解毒药而愈。尝治小儿丹毒便秘，或烦躁者，服五福化毒
丹亦效。（俱薛按）
一、白虎丹方治，在外科方二九二。
酒剂、防风汤、蜈蚣散、大芎黄汤、羌活汤、白术防风汤、玉真散，以及外敷药物和养血当归地黄汤。
薛立斋说：大凡痈疽溃破之后，筋肉腐烂，脓血大量流失，阳气随着阴液耗散，出现筋脉拘挛紧急，怕冷且身体颤抖抽搐；严重的出现舌头僵硬、牙关紧闭、头项背部向后反折（角弓反张），痰涎壅盛，大便闭塞、出汗，不时发热，这是气血都虚弱的表现。虽然变化出这些症状，与破伤风相似，但主治的方法，应当以大补气血为主。如果确实有风邪证候，也必须以大补气血为主，兼用治风的药物。如果不审察是非，而胡乱用药，那就错了。
司徒边华泉，肩膀患痈疽并伴有发热，眼睛直视或斜视，非常像中风，下午申时发热加重，脉搏更加快速，这是足三阴经的气血亏损，虚火妄动所致。使用人参、[缺失字]、当归、白术、炙甘草，加上酒炒黑黄柏、五味子、麦冬、肉桂，服用四剂后痊愈，又服几剂后伤口收敛。
一位读书人，腿部患痈疽，毒气深聚在内部，皮肤颜色不变，长久不溃破，针刺放出约五碗的脓血瘀血，各种恶证接踵而至，完全像中风，这是脾胃虚弱导致的变证。使用六君子汤加当归、炮姜，以及圣愈汤，各服四剂后病情安定。后来又因劳心导致失眠，使用归脾汤而痊愈。（薛立斋按语）
斑疹这一类病症，虽然已有正门详细记载，但那是针对小儿麻疹而言的。那些不是麻疹，无论大人小孩，突然患上斑疹小疮的，这虽然与麻疹相似，但实际上有细微差别。这也是不可不辨别而治疗的，大多是由风热外感引起的。
治疗这类病症的方法：脉象浮而身体发热且有表证的，以疏散风邪为主。脉象浮而数的，祛风兼清热。脉象沉滑且没有表证的，以清火为主。脉象浮沉都滑数，且表里症状同时出现的，适宜表里双解。然而只有小儿多有此证，必须观察其表里虚实，斟酌治疗即可。总之小儿体质脆弱，宜多用安里的药，少用攻发的药；便秘则轻微通便，结滞则轻微导滞，只要让邪气不壅滞而容易消散，那么病情轻而孩子自然平安了。大抵身体温暖的为顺证，身体发凉的为逆证。
王海藏说：前人讲，发病初期和末期都不可用下法，为什么呢？回答说：初期不可下，是因为斑疹尚未显现于体表，如果用下法，邪气就不能向外透发，这是脉证有表而无里，所以禁止初期用下法。末期不可下，是因为斑毒已经明显显露于外部，内部没有根蒂，大便不秘结，本来就没有一切里实证，如果用下法，会导致斑气下陷逆乱，所以禁止末期用下法。
洁古说：斑疹的病，其证候各不相同。发肿于体表的，属于少阳三焦相火，称为斑。小红点行走在皮肤之中而不出来的，属于少阴君火，称为疹。凡是见到斑证，如果出现自发性呕吐腹泻的，大多吉利，千万不要乱治，这是因为邪气从上下两路排出。如果斑疹同时出现，邪气一定很盛，小儿难以承受，因此容易产生其他变证。然而初期和末期都不可用下法。
薛立斋说：凡是小儿丹毒，遍身发红，如果不采用砭石放血治疗，导致毒瓦斯进入腹部，就无法救治。这个病证，是恶毒热血蕴蓄在命门，遇到相火而发作。如霞片状的，必须用砭石去除恶血才好。如红肿起色赤红，游走不定的，宜先用生麻油涂抹患处进行砭刺，以泄其毒。凡是四肢起病并向腹部发展的，无法救治。虽然说丹毒有多种，治疗方法也有多种，不如砭法好。常见患重症的，不用砭法，都无法救治。
一位妇人，患斑疹作痒，脉象浮数。使用人参败毒散，二剂后稍见好转，再用消风散，四剂后安定。
一位男子患斑疹，颜色赤紫且疼痛，发热喜冷饮，脉象沉实。使用防风通圣散，一剂后症状顿退，又用防风败毒散加黄芩、黄连，四剂后痊愈。
一位老人患疹，颜色微赤，作痒发热。使用人参败毒散，二剂后稍见好转，再用补中益气汤加黄芩、山栀而痊愈。
一个小儿患疹，发热作痛，烦躁口渴，想用清凉饮来泻下。诊察其脉象不实，轻取不数，这是邪气在经络，不可用下法，遂用解毒防风汤，二剂后痊愈。这种证候小儿多患，必须详细审察是在表还是在里，以及邪气的轻重而治疗。
一个幼儿作痒发热，服用犀角散一剂后出现呕吐腹泻，这是邪气从上下两路排出，毒气必然自行解除。不久呕吐腹泻停止，其疹果消退。吐泻后，脉象见七至，这是小儿平和的脉象，邪气已尽。不需要再治疗，果然痊愈。（以上均为薛立斋按语）
一个男子患丹毒，肿痛便秘，脉象数而实，服用防风通圣散无效，令其砭刺患处，去除恶血，仍用前药而痊愈。
一个小儿，腿部患丹毒，如霞片状，游走不定，先用麻油涂抹患处，砭出恶血，毒气即逐渐消散。再用神功托里散，一剂后安定。
一个小儿患丹毒，外部形势虽轻，内部却大便不利，这是病在脏腑，服用大连翘饮，外敷神功散而病愈。
一个小儿遍身皆红，砭刺后，投予解毒药而痊愈。曾治疗小儿丹毒便秘，或烦躁者，服用五福化毒丹也有效。（以上均为薛立斋按语）
一、白虎丹方的治疗，参见外科方第二九二页。
Wine preparations, Fangfeng Tang (Saposhnikovia Decoction), Wugong San (Centipede Powder), Da Xionghuang Tang (Major Rhubarb and Ligusticum Decoction), Qianghuo Tang (Notopterygium Decoction), Baizhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction), Yuzhen San (True Jade Powder), external application medicines, and Yangxue Danggui Dihuang Tang (Blood-Nourishing Decoction of Angelica Sinensis and Rehmannia).
Xue Lizhai stated: Generally, after the ulceration of carbuncles and sores, muscles and flesh rot, pus and blood are largely discharged, and Yang Qi scatters with Yin fluids. This may result in tendon and vessel spasms, aversion to cold, and tremors or convulsions. In severe cases, it presents with a stiff tongue, locked jaw, opisthotonos (backward arching of the head and back), excessive phlegm and saliva, constipation, sweating, and intermittent fever. These indicate deficiency of both Qi and Blood. Although these manifestations resemble wind-stroke (Pochang Feng, Tetanus-like syndrome), the primary treatment method should be greatly tonifying Qi and Blood. If there is indeed a wind pathogen, the main approach must still be tonifying Qi and Blood, supplemented by herbs that treat wind. If one fails to examine the nature of the disease and prescribes recklessly, it will lead to error.
Si Tu Bian Huaquan suffered from a shoulder carbuncle with fever, staring eyes or strabismus, resembling wind-stroke. His fever intensified at Shen hour (3-5 PM), and his pulse became more rapid. This was due to Qi and Blood deficiency in the three Yin meridians of the foot, causing deficient fire to move recklessly. He was treated with Ren Shen (Ginseng Radix et Rhizoma), [missing character], Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Zhi Gan Cao (Prepared Licorice Root), added with Jiu Chao Hei Huang Bo (Phellodendri Cortex fried with wine and charred), Wu Wei Zi (Schisandrae Fructus), Mai Dong (Ophiopogonis Tuber), and Rou Gui (Cinnamomi Cortex). After four doses, he recovered; after several more doses, the wound healed.
A scholar suffered from a leg carbuncle, with deep accumulation internally and unchanged skin color, failing to ulcerate for a long time. Needling released about five bowls of pus and blood stasis. Various malignant symptoms appeared simultaneously, completely resembling wind-stroke. This was a transformation due to Spleen and Stomach deficiency. He was treated with Liujunzi Tang (Six Gentlemen Decoction) added with Dang Gui (Angelicae Sinensis Radix) and Pao Jiang (Prepared Ginger Rhizome), as well as Shengyu Tang (Sage Preservation Decoction). Each prescription was taken for four doses, leading to stability. Later, due to mental exertion causing insomnia, Guipi Tang (Restore the Spleen Decoction) cured him. (Note by Xue Lizhai)
The condition of macules and papules (Ban Zhen), although detailed in the main section, refers specifically to infantile measles. For those who do not have measles, whether adults or children, suddenly suffering from macules and papules or small sores, this resembles the former but has subtle differences. It must be differentiated and treated, as it mostly arises from external contraction of Wind-Heat.
The treatment method for this condition: If the pulse is floating and the body is hot with exterior signs, the focus is on dispersing Wind pathogens. If the pulse is floating and rapid, dispel Wind and clear Heat simultaneously. If the pulse is deep and slippery without exterior signs, clearing Fire is the priority. If both superficial and deep pulses are slippery and rapid, with both exterior and interior signs present, a simultaneous release of exterior and interior is appropriate. However, this condition is mostly seen in children. One must observe the exterior/interior and deficiency/excess patterns and prescribe accordingly. In general, children are fragile; thus, medications that stabilize the interior should be used more frequently than those that attack and disperse. If constipated, mildly purge; if bound, gently guide out stagnation. As long as the pathogen does not obstruct and dissipates easily, the condition will be mild and the child safe. Generally, a warm body indicates a favorable prognosis, while a cool body indicates an unfavorable one.
Wang Haicang said: Predecessors stated that purgatives should not be used at the beginning or end of the disease. Why? The answer is: At the beginning, purgatives are forbidden because the macules have not yet emerged on the surface. Using purgatives prevents the pathogen from extending outward. Since the pulse and symptoms show exterior presence without interior excess, purgatives are prohibited at the start. At the end, purgatives are forbidden because the macule toxin is already manifest externally, lacking internal roots, and the stool is not constipated, meaning there are no interior excess syndromes. Using purgatives would cause the macule Qi to sink and rebel, hence they are prohibited at the end.
Jiegu said: The manifestations of macules and papules vary. Swelling appearing on the exterior belongs to the Ministerial Fire of the Shaoyang Triple Burner and is called Ban (Macules). Small red spots moving within the skin without emerging belong to the Sovereign Fire of Shaoyin and are called Zhen (Papules). Whenever Ban syndrome appears, spontaneous vomiting and diarrhea are generally auspicious; do not treat recklessly, as this indicates the pathogen exiting through both upper and lower pathways. If Ban and Zhen appear together, the pathogen is likely severe, which children may not withstand, often leading to other complications. However, purgatives are prohibited at both the beginning and end.
Xue Lizhai said: Regarding infantile Dan Du (Erysipelas), if the entire body turns red and one does not use Bian therapy (scarification/bloodletting), allowing the toxic vapor to enter the abdomen, the patient cannot be saved. This condition involves evil toxic hot blood accumulating in the Mingmen (Gate of Life), combining with Ministerial Fire to erupt. For lesions like rosy patches, scarification to remove bad blood is best. For swollen, bright red lesions that wander unpredictably, apply raw Sesame Oil to the affected area first, then scarify to drain the toxicity. Lesions starting from the limbs and moving inward are incurable. Although there are several types of Dan and several treatments, none are as effective as scarification. Commonly, severe cases treated without scarification fail to recover.
A woman suffered from macules with itching and a floating pulse. She was treated with Xiaofeng San (Wind-Dispersing Powder) for four doses and recovered.
Another woman suffered from macules with itching and a floating-rapid pulse. She was treated with Renshen Baidu San (Ginseng Detoxification Powder) for two doses, showing slight improvement, followed by Xiaofeng San for four doses, leading to stability.
A man suffered from macules, which were crimson-purple and painful, accompanied by fever and a preference for cold drinks. His pulse was deep and solid. He was treated with Fangfeng Tongsheng San (Saposhnikovia Unblocking and Generating Powder) for one dose, resulting in immediate relief, followed by Fangfeng Baidu San (Saposhnikovia Detoxification Powder) added with Huang Qin (Scutellariae Radix) and Lian Lian (Coptidis Rhizoma) for four doses, leading to recovery.
An elderly man suffered from papules, which were slightly red, itchy, and accompanied by fever. He was treated with Renshen Baidu San for two doses, showing slight improvement, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Huang Qin (Scutellariae Radix) and Shan Zhi (Gardeniae Fructus), leading to recovery.
A child suffered from papules with fever, pain, irritability, and thirst, desiring to take Qingliang Yin (Cooling Drink) to purge. Examination revealed a pulse that was not solid and not rapid upon light pressure, indicating the pathogen was in the collaterals. Purging was contraindicated. He was treated with Jiedu Fangfeng Tang (Detoxifying Saposhnikovia Decoction) for two doses and recovered. This condition is common in children; one must carefully examine whether the pathogen is in the exterior or interior and its severity before treating.
A toddler had itching and fever. After one dose of Xijiao San (Rhinoceros Horn Powder), he experienced vomiting and diarrhea, indicating the pathogen exiting via upper and lower pathways; the toxin naturally resolved. Shortly after, vomiting and diarrhea stopped, and the papules disappeared. Following the emesis and purgation, the pulse showed seven beats per breath cycle, which is a harmonious pulse for children, indicating the pathogen was exhausted. No further treatment was needed, and he recovered. (All noted by Xue Lizhai)
A man suffered from Dan Du (Erysipelas) with swelling, pain, constipation, and a rapid-solid pulse. Fangfeng Tongsheng San was ineffective. Scarification of the affected area was performed to remove bad blood, and the previous medication was continued, leading to recovery.
A child had Dan on the leg, resembling rosy patches, wandering unpredictably. Raw sesame oil was applied to the site, followed by scarification to remove bad blood, gradually dissipating the toxicity. Then, Shengong Tuoli San (Divine Efficacy Supporting Interior Powder) was administered for one dose, leading to stability.
A child suffered from Dan Du. Although the external presentation was mild, internally there was difficulty defecating, indicating the disease involved the Zang organs. Dalianqiao Yin (Large Forsythia Decoction) was taken, and Shengong San (Divine Efficacy Powder) was applied externally, leading to cure.
A child had redness all over the body. After scarification and administration of detoxifying medicines, he recovered. I once treated children with Dan Du presenting with constipation or irritability; administering Wufu Huadu Dan (Five Blessings Toxin-Dissolving Pill) was also effective. (All noted by Xue Lizhai)
1. The treatment for Baihu Dan (White Tiger Dan) can be found in Surgical Formulas, page 292.