立斋曰∶鬓疽属肝胆二经怒火,或风热血虚所致。若 痛或发热者,宜祛风清热。 痛
发寒热,或拘急者,发散表邪。作脓 痛,托里消毒。脓已成作痛者,针之。不作脓或脓
成而不溃者,俱宜托里。不敛或脓清者,宜峻补之。
又《治法》曰∶若发热作渴者,用柴胡清肝散。肿 痛甚者,仙方活命饮。若大势已
退
,余毒未散,用参苓归术为主,佐以川芎、白芷、金银花以速其脓。脓成仍用参苓之类,托
而溃之。若欲其生肌收敛,肾虚者六味丸,血虚者四物汤加参 ,或血燥者四物汤,或水不
能生木者六味地黄丸,气虚者用补中益气汤,皆当滋其化源为善。
立斋曰∶ 腮,属足阳明胃经,或外因风热所乘,或内因积热所致。若肿痛寒热者,白
芷胃风汤。内热肿痛者,升麻黄连汤。外肿作痛,内热口干者,犀角升麻汤。
内伤寒凉不能消溃者,补中益气汤。发热作渴,大便
秘结,清凉饮。表里俱解而仍肿痛者,欲作脓也,托里散。若饮食少思,胃气虚弱者,六君
子汤。肢体倦怠,阳气虚弱也,补中益气汤。脓毒既溃,肿痛不减,热毒未解也,托里消毒
散。脓出而反痛,气血虚也,参 内托散。发热晡热,阴血虚也,八珍汤。恶寒发热,气血
俱虚也,十全大补汤。若 肿痛连耳下者,属手足少阳经,当清肝火。若连颐及耳后者,属
足少阴经虚火,当补肾水。此证而有不治者,多泥风热,用克伐之剂耳。
薛立斋说:鬓疽属于肝胆二经的怒火,或者是风热侵袭、血虚所致。如果疼痛或伴有发热,适宜祛风清热。如果疼痛并出现寒热往来,或者身体拘急不舒,应当发散表邪。如果化脓且疼痛,宜用托里消毒法。如果脓已形成且疼痛,应当针刺排脓。如果不化脓,或者脓成后不能溃破,都适宜使用托里法。如果疮口不收敛,或者脓液清稀,适宜峻补。
另外《治法》中说:如果有发热口渴的症状,使用柴胡清肝散。如果肿胀疼痛严重,使用仙方活命饮。如果大势已退,但余毒未散,以参苓归术为主药,佐以川芎、白芷、金银花来加速脓液的生成。脓成后仍用参苓之类药物,托毒外出使其溃破。如果想要生肌收敛,肾虚者用六味丸,血虚者用四物汤加人参,或者血燥者用四物汤,或者水不能生木(肾水不足不能滋养肝木)者用六味地黄丸,气虚者用补中益气汤,这些都应当滋养生化之源为妙。
薛立斋又说:发颐(腮部肿痛),属于足阳明胃经,或者是外感风热所乘,或者是内积热所致。如果肿痛伴有寒热,用白芷胃风汤。如果内热导致肿痛,用升麻黄连汤。如果外部肿胀疼痛,内部有热且口干,用犀角升麻汤。如果因内伤寒凉之邪导致不能消散溃破,用补中益气汤。如果发热口渴,大便秘结,用清凉饮。如果表里症状都已解除但仍然肿痛,说明将要化脓,用托里散。如果饮食减少、思食减退,是胃气虚弱,用六君子汤。如果肢体倦怠,是阳气虚弱,用补中益气汤。如果脓毒已经溃破,但肿痛不减,是热毒未解,用托里消毒散。如果脓出后反而疼痛,是气血虚弱,用人参内托散。如果发热,特别是午后潮热,是阴血虚弱,用八珍汤。如果恶寒发热,是气血俱虚,用十全大补汤。如果肿痛连及耳下,属于手足少阳经,应当清肝火。如果连及面颊及耳后,属于足少阴经虚火,应当补肾水。这种病症中有不治而死的,大多是因为拘泥于风热,使用了克伐(攻伐正气)的药物罢了。
Li Zhai said: Beard carbuncle (Biju) belongs to the fire of the Liver and Gallbladder meridians, or is caused by wind-heat invasion and blood deficiency. If there is pain or fever, it is appropriate to dispel wind and clear heat. If there is pain accompanied by alternating chills and fever, or stiffness and spasm, the exterior pathogen should be dispersed. If pus forms with pain, interior support and detoxification should be employed. If pus has formed and causes pain, it should be punctured. If pus does not form, or if pus has formed but fails to ulcerate, interior support is appropriate in both cases. If the wound fails to close or the pus is thin, vigorous tonification is indicated.
Furthermore, "Treatment Methods" states: If there is fever and thirst, Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) should be used. If swelling and pain are severe, Xianfang Huoming Yin (Immortal Recipe for Life-Preserving Decoction) should be used. If the major symptoms have subsided but residual toxins remain, Shenling Guizhu Tang (Ginseng, Poria, Atractylodes, and Angelica Decoction) should be the main formula, assisted by Chuanxiong Rhizome (Chuanxiong), Angelicae Dahuricae Radix (Baizhi), and Lonicerae Japonicae Flos (Jinyinhua) to accelerate pus formation. Once pus has formed, formulas containing Ginseng and Poria should still be used to support the interior and promote ulceration. To promote tissue regeneration and wound closure, Liuwei Wan (Six-Ingredient Pill) is used for Kidney deficiency; Siwu Tang (Four-Substance Decoction) added with Ginseng is used for Blood deficiency; Siwu Tang alone is used for dryness of Blood; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used when Water fails to generate Wood (Kidney Yin failing to nourish Liver); and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is used for Qi deficiency. In all cases, it is best to nourish the source of transformation and generation.
Li Zhai also stated: Parotitis (Fayi, swelling of the cheeks/jaw) belongs to the Foot-Yangming Stomach Meridian, and may be caused by external wind-heat invasion or internal accumulation of heat. If there is swelling, pain, and chills/fever, Baizhi Weifeng Tang (Angelica Dahurica Wind-Dispelling Decoction) should be used. If internal heat causes swelling and pain, Shengma Lianhua Tang (Coptis and Goldthread Decoction with Cimicifuga) should be used. If there is external swelling and pain with internal heat and dry mouth, Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction) should be used. If cold and cool pathogens internally prevent resolution and ulceration, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used. If there is fever, thirst, and constipation, Qingliang Yin (Cooling and Refreshing Drink) should be used. If exterior and interior symptoms are resolved but swelling and pain persist, indicating impending pus formation, Tuoli San (Interior-Supporting Powder) should be used. If appetite is poor and desire to eat is diminished due to weak Stomach Qi, Liujunzi Tang (Six-Gentlemen Decoction) should be used. If limbs are fatigued due to weak Yang Qi, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used. If pus has ulcerated but swelling and pain persist, indicating unresolved heat-toxin, Tuoli Xiaodu San (Interior-Supporting and Detoxifying Powder) should be used. If pain persists after pus discharge, indicating Qi and Blood deficiency, Renshen Neituo San (Ginseng Interior-Supporting Powder) should be used. If there is fever, particularly afternoon tidal fever, indicating Yin-Blood deficiency, Bazhen Tang (Eight-Treasure Decoction) should be used. If there are aversion to cold and fever, indicating deficiency of both Qi and Blood, Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) should be used. If swelling and pain extend below the ear, it belongs to the Hand and Foot-Shaoyang meridians, and Liver Fire should be cleared. If it extends to the jaw and behind the ear, it belongs to deficient fire of the Foot-Shaoyin Kidney Meridian, and Kidney Water should be nourished. Cases of this condition that prove untreatable often result from rigid adherence to the concept of wind-heat, leading to the use of harsh purgative or attacking agents.