良方升麻和气饮治疮肿疖疥痒痛
甘草 陈皮(各一两半) 芍药(七钱半) 大黄(半两煨) 干葛 苍术 桔梗 升麻(各
一两) 当归 半夏 茯苓 白芷(各二钱) 干姜 枳壳(各半钱三因方有浓朴半钱)
上 咀每服一两水煎
按此手足太阴阳明经药也五积散加减法世俗多用之故收入盖欲燥脾胃胜湿和气为治疮之
剂然临证而不通变恐未合宜也
当归饮子治疮疥风癣湿毒燥痒疮
当归 白芍 川芎 生地黄 白蒺藜 防风 荆芥(各一两) 何首乌 黄 甘草(各
半两)
上 咀每服一两水煎或为末每服一二钱亦得
按此疏风热之剂手足三阴药也血虚者不可缺此圣济总录金针散治发背诸疮肿
皂角针春取一半新采一半黑者
上一味不拘多少晒干为末食后酒调二三钱服
按丹溪曰此药治痈疽已破未破皆用直 领到溃处意谓当入群队中用也
局方托里十补散
黄 人参 当归(各二钱) 浓朴 桔梗 川芎 防风 桂心 甘草 白芷(各一钱)
上 咀水煎
谨按卫生宝鉴曰诸痛痒疮疡皆属心火言其常也如疮盛形羸邪高痛下始热终寒此反常也固
当察时下之宜而
权治故曰经者常也法者用也医者意也随其宜而
治之可收十全之功矣故此方用之于痈疽初发或已发或内托然疮证脉缓涩或身倦恶
寒热少脉弦或紧细者宜用之散风寒助阳之剂也表里气血之药若施之于积热 毒更不分经络时
宜不能不无误也丹溪曰精要谓排脓内补十宣散治未成者速散已成者速溃诚哉是言也若用之于
些小痈疽与冬月时令尽用内托之功若于冬月肿疡用之亦可转重就轻移深于浅若溃疡于夏月用
之其桂朴之温散佐以防风白芷吾恐虽有参 难为倚仗比见世人用此者不分痈疽冬夏无经络无
前后如盲人骑瞎马半夜临深池危哉
十六味流气饮治无名恶肿痈疽等证
川芎 当归 芍药 防风 人参 木香 黄 官桂 桔梗 白芷 槟榔 浓朴 乌药
甘草 紫苏 枳壳
上 咀水煎
按此表里气血药也复以疏风助阳之剂世俗多用之故收入非脉之洪缓沉迟紧细者不宜用此
每见
外科诸家载此往往不分经络脉证不具时宜但云化毒消肿有云不退者加以补气血之药盖又使人
不能无疑也用者当触类而长之可矣
郭氏神效乌金散治痈疽疔肿时毒附骨疽诸恶疮等证若疮黑陷如石坚四肢冷脉细或时昏冒
谵语循衣烦渴危笃者服此汗之疮起
苍耳头(五月五日午时效) 小草乌头 火麻头(火日收采) 木贼(去节) 虾蟆头 桦皮
节(酥炙) 麻黄(去根节)
上晒干各等分同入瓷器内盐泥固济炭火内从早 至申分如黑煤色为度碾为末每服二钱病
重者三钱用热酒调下未汗再一服如汗干却服解毒疏
利之药如修合此药必选天睛好日于静室中勿令
鸡犬猫畜及阴人见也又名首功玄黑散
夺命丹治诸般肿毒疔疽恶疮
蟾酥 轻粉(各半钱) 朱砂(三钱) 白矾(枯) 寒水石 铜绿(各一钱) 蜗牛(二十一
个别研) 乳香 没药 麝香(一钱)
上件为细末将蜗牛别研一处丸如丸不就用好酒糊和丸如绿豆大每服一丸生葱三五茎嚼极
烂吐于手心包药在内热酒和葱送下如重车行五七里汗出为效重者再服一二丸
蟾酥丸治疗黄一切恶疮
川乌 莲花叶 朱砂(各一钱半) 乳香 没药(各二钱) 轻粉 蟾酥(各一钱) 麝香(
半钱)
上为细末糊丸菀豆大每服一丸病重者二丸根据前法服取汗
按以上三方郭氏称为首药皆主乎发散散出太阳例后二方出少阴例然皆劫剂也智者当较轻
重阴阳之分取择用之
东垣托里荣卫汤治证见前疮宜发汗论
黄 红花 桂枝(各五钱) 苍术(三钱) 柴胡 连翘(各二钱) 羌活 防风 当归身
炙甘草 黄芩(各一钱半) 人参(一钱)
上 咀每服一两水酒各半煎
按此足三阳太阴经药出桂枝例表里气血之剂也
良方升麻和气饮,用于治疗疮疡肿胀、疖子、疥癣及瘙痒疼痛。
药材组成:甘草、陈皮(各一两半);芍药(七钱半);大黄(半两,煨制);干葛、苍术、桔梗、升麻(各一两);当归、半夏、茯苓、白芷(各二钱);干姜、枳壳(各半钱,《三因方》中另有浓朴半钱)。
以上药物切碎,每次服用一两,加水煎煮。
按语:此方属于手足太阴、阳明经的药物。五积散的加减法在世俗中多用,因此将其收入本书,旨在通过燥湿健脾、调和气血来治疗疮疡。然而,如果在临床实践中不能灵活变通,恐怕难以适宜。
当归饮子,用于治疗疮疥、风癣、湿毒引起的干燥瘙痒性疮疡。
药材组成:当归、白芍、川芎、生地黄、白蒺藜、防风、荆芥(各一两);何首乌、黄耆、甘草(各半两)。
以上药物切碎,每次服用一两,加水煎煮;或者制成散剂,每次服用一二钱也可以。
按语:此方是疏解风热的药剂,属于手足三阴经的药物,血虚者不可缺少的方剂。
《圣济总录》金针散,用于治疗发背及其他各种疮肿。
药材组成:皂角针(春季采集一半新采的,一半黑色的)。
以上一味药,不拘数量,晒干后研为细末,饭后用酒调服二三钱。
按语:朱丹溪说:此药治疗痈疽,无论已破或未破,都使用它,意在引导药力直达溃烂之处,意思是应当将其加入其他药物队伍中一同使用。
局方托里十补散
药材组成:黄耆、人参、当归(各二钱);浓朴、桔梗、川芎、防风、桂心、甘草、白芷(各一钱)。
以上药物切碎,加水煎煮。
谨按:《卫生宝鉴》说:“诸痛痒疮疡皆属心火”,这是指一般情况而言。如果疮疡盛大而形体消瘦,邪气高位而疼痛低位,开始发热最终转寒,这是反常的情况。因此必须观察当下的适宜时机而权宜治疗,所以说“经”是常规,“法”是运用,“医”在于意会,根据适宜情况治疗,可以收到十全的效果。所以此方用于痈疽初发,或已经发作,或用于内托疗法。但是,如果疮证脉象缓涩,或身体疲倦、恶寒、热少、脉弦或紧细者,适宜使用此方,它是散风寒、助阳气的药剂,也是调理表里气血的药物。如果施用于积热毒盛的情况,且不分辨经络和时令适宜与否,就不能不产生错误。丹溪说:《精要》认为排脓内补十宣散,对于未形成的疮疡能迅速消散,对于已形成的能迅速溃破,这确实是至理名言。如果使用于轻微的痈疽,或在冬季时令全部使用内托之功,若在冬季对肿疡使用此方,也可以使病情由重转轻、由深变浅;若对溃疡在夏季使用,其中桂枝、浓朴的温散作用,辅以防风、白芷,我担心即使有人参、黄耆也难以倚仗。近来见到世人使用此方,不分痈疽类型、冬夏季节、经络归属、前后病程,如同盲人骑瞎马,半夜面临深渊,危险啊!
十六味流气饮,用于治疗无名恶肿、痈疽等证候。
药材组成:川芎、当归、芍药、防风、人参、木香、黄耆、官桂、桔梗、白芷、槟榔、浓朴、乌药、甘草、紫苏、枳壳。
以上药物切碎,加水煎煮。
按语:此方属于调理表里气血的药物,又加上疏风助阳的药剂,世俗多用,因此收入本书。如果不是脉象洪缓、沉迟、紧细者,不宜使用此方。常见外科各家记载此方,往往不分辨经络、脉证不全、不顾及时令适宜,只说能化毒消肿,有的说无效则加上补气血的药物,这又使人不能不怀疑。使用者应当触类旁通即可。
郭氏神效乌金散,用于治疗痈疽、疔肿、时毒、附骨疽等各种恶疮等证候。如果疮色黑陷如石坚硬,四肢冰冷,脉细或时常昏冒、谵语、循衣摸床、烦躁口渴,病情危笃者,服用此方使其出汗,疮疡即可起效。
药材组成:苍耳头(五月五日午时采收)、小草乌头、火麻头(火日采收)、木贼(去节)、虾蟆头、桦皮节(酥炙)、麻黄(去根节)。
以上药物晒干,各等分,同入瓷器内,用盐泥密封固定,在炭火中从早晨烧到申时,直到变成黑煤色为止,碾为细末。每次服用二钱,病重者三钱,用热酒调下。若未出汗,再服一次。如果汗出后,却服用解毒疏利之药。如配制此药,必选晴天好日子,在静室中进行,不要让鸡犬猫畜及阴人看见。又名首功玄黑散。
夺命丹,用于治疗各种肿毒、疔疽、恶疮。
药材组成:蟾酥、轻粉(各半钱);朱砂(三钱);白矾(枯矾)、寒水石、铜绿(各一钱);蜗牛(二十一个,单独研磨);乳香、没药、麝香(一钱)。
以上药材研为细末,将蜗牛单独研磨一处,用好酒糊和丸,如绿豆大小。每次服用一丸,取生葱三五茎嚼极烂吐在手心,将药包在内,用热酒和着葱送下。如果病情重,车行五七里路出汗为有效,重者再服一二丸。
蟾酥丸,治疗黄水疮一切恶疮。
药材组成:川乌、莲花叶、朱砂(各一钱半);乳香、没药(各二钱);轻粉、蟾酥(各一钱);麝香(半钱)。
以上研为细末,用糊丸如菀豆大。每次服用一丸,病重者二丸,根据前法服用,取汗。
按语:以上三方,郭氏称为首药,都主要在于发散,发散出自太阳经例;后两方出自少阴经例。然而这些都是劫剂(猛烈的药剂),明智的人应当权衡轻重阴阳之分,选择使用。
东垣托里荣卫汤,治疗证候见前文“疮宜发汗论”。
药材组成:黄耆、红花、桂枝(各五钱);苍术(三钱);柴胡、连翘(各二钱);羌活、防风、当归身、炙甘草、黄芩(各一钱半);人参(一钱)。
以上药物切碎,每次服用一两,用水和酒各半煎煮。
按语:此方属于足三阳、太阴经的药物,出自桂枝汤例,是调理表里气血的药剂。
Liangfang Shengma Heqi Yin (Sheng Ma Harmonizing Qi Decoction from Excellent Prescriptions) is used to treat sores, swellings, boils, scabies, itching, and pain.
Ingredients: Gancao (Licorice Root), Chenpi (Aged Tangerine Peel) (each 1 liang 5 qian); Shaoyao (Peony Root) (7 qian 5 fen); Dahuang (Rhubarb Root) (0.5 liang, stir-baked); Gange (Kudzu Root), Cangzhu (Atractylodis Rhizoma), Jiegeng (Platycodon Root), Shengma (Cimicifugae Rhizoma) (each 1 liang); Danggui (Angelicae Sinensis Radix), Banxia (Pinelliae Tuber), Fuling (Poria), Baizhi (Angelicae Dahuricae Radix) (each 2 qian); Ganjiang (Zingiberis Rhizoma), Zhike (Aurantii Fructus Immaturus) (each 0.5 qian; San Yin Fang adds Nongpo (Magnoliae Officinalis Cortex) 0.5 qian).
The above herbs are cut into small pieces. Each dose of 1 liang is decocted in water.
Commentary: These herbs belong to the Foot and Hand Taiyin and Yangming meridians. The modification method of Wuji San (Five Accumulations Powder) is commonly used in secular practice, hence it is included here. The intention is to dry dampness, strengthen the spleen and stomach, overcome dampness, and harmonize qi as a treatment for sores. However, if clinical application lacks flexibility, it may not be appropriate.
Danggui Yinzi (Angelica Decoction) is used to treat sores, scabies, wind-xuan (wind-induced skin lesions), wet-toxin causing dry itching sores.
Ingredients: Danggui (Angelicae Sinensis Radix), Baishao (White Peony Root), Chuanxiong (Chuanxiong Rhizome), Shengdihuang (Rehmanniae Radix), Baijili (Tribuli Fructus), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica) (each 1 liang); Heshouwu (Polygoni Multiflori Radix), Huangqi (Astragali Radix), Gancao (Licorice Root) (each 0.5 liang).
The above herbs are cut into small pieces. Each dose of 1 liang is decocted in water; or processed into powder, each dose of 1-2 qian is also acceptable.
Commentary: This is a formula for dispersing wind-heat, belonging to the Foot and Hand Three Yin meridians. It is indispensable for those with blood deficiency.
Jinzhen San (Golden Needle Powder) from Shengji Zonglu (General Records of Holy Relief) is used to treat back carbuncles and various other sores and swellings.
Ingredients: Zaogaozhen (Gleditsiae Sinensis Spina) (half newly harvested in spring, half black ones).
One ingredient only, quantity unrestricted. Dry and grind into fine powder. Take 2-3 qian mixed with wine after meals.
Commentary: Zhu Danxi said: This medicine treats yongju (abscesses and ulcers), whether broken or unbroken. Its purpose is to lead the effect directly to the ulcerated area, implying it should be used in combination with other herbs.
Ju Fang Tuoli Shibu San (Ten-Nourishing Interior-Supporting Powder from the Bureau Formulas)
Ingredients: Huangqi (Astragali Radix), Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix) (each 2 qian); Nongpo (Magnoliae Officinalis Cortex), Jiegeng (Platycodon Root), Chuanxiong (Chuanxiong Rhizome), Fangfeng (Saposhnikoviae Radix), Guixin (Cinnamomi Ramulus), Gancao (Licorice Root), Baizhi (Angelicae Dahuricae Radix) (each 1 qian).
The above herbs are cut into small pieces and decocted in water.
Careful Commentary: Weisheng Baojian (Treasures for Maintaining Health) states: "All pain, itching, sores, and ulcers belong to Heart Fire," which refers to the general rule. If the sore is severe but the constitution is emaciated, the pathogen is high while pain is low, starting with heat and ending with cold, this is an abnormal situation. Therefore, one must observe the current timing and apply flexible treatment. Thus, it is said that "Jing" (Classic) is the constant, "Fa" (Method) is the application, and "Yi" (Physician) relies on intuition. Treating according to appropriateness can achieve perfect results. Hence, this formula is used for the initial onset of yongju, or when already developed, or for internal support therapy. However, if the pulse is slow and choppy, or the body is fatigued, aversion to cold, little heat, or the pulse is wiry, tight, or thin, this formula is suitable. It is a formula to disperse wind-cold and assist yang, regulating the exterior, interior, qi, and blood. If applied to cases of accumulated heat and toxin without distinguishing meridians and seasonal appropriateness, errors are inevitable. Danxi stated: Jingyao suggests that Paimo Neibu Shixuan San (Ten-Ventilation Internal-Supporting Pus-Draining Powder) rapidly dissipates unformed sores and rapidly drains formed ones. This is indeed true. If used for minor yongju or entirely for internal support in winter, applying it to swelling ulcers in winter can turn heavy conditions lighter and deep conditions superficial. However, using it for ulcerated sores in summer, the warming and dispersing nature of Guizhi (Cinnamon Twig) and Nongpo (Magnolia Bark), assisted by Fangfeng (Saposhnikovia Root) and Baizhi (Angelica Dahurica Root), I fear that even with Renshen (Ginseng) and Huangqi (Astragalus), reliance may be difficult. Recently, I have seen people use this formula without distinguishing between yongju types, seasons (winter/summer), meridians, or stages (early/late), like a blind man riding a blind horse facing a deep pool at midnight—how dangerous!
Shiliuwei Liuqi Yin (Sixteen-Ingredient Flowing-Qi Decoction) is used to treat nameless malignant swellings, yongju, and other conditions.
Ingredients: Chuanxiong (Chuanxiong Rhizome), Danggui (Angelicae Sinensis Radix), Shaoyao (Peony Root), Fangfeng (Saposhnikoviae Radix), Renshen (Ginseng Radix), Muxiang (Aucklandiae Radix), Huangqi (Astragali Radix), Guanzi Gui (Cassia Twig), Jiegeng (Platycodon Root), Baizhi (Angelicae Dahuricae Radix), Binglang (Areca Seed), Nongpo (Magnoliae Officinalis Cortex), Wuyao (Litseae Fructus), Gancao (Licorice Root), Zisu (Perilla Leaf), Zhike (Aurantii Fructus Immaturus).
The above herbs are cut into small pieces and decocted in water.
Commentary: This formula regulates the exterior, interior, qi, and blood, combined with wind-dispersing and yang-assisting agents. It is widely used in secular practice, hence included. It is not suitable for pulses that are surging-slow, deep-slow, tight, or thin. Often, surgical specialists record this formula without distinguishing meridians, lacking complete pulse and symptom analysis, and ignoring seasonal appropriateness, merely claiming it resolves toxins and reduces swelling. If ineffective, they add qi- and blood-nourishing herbs, causing further doubt. Users should extend their understanding analogously.
Guoshi Shenxiao Wujin San (Guo's Divine Efficacy Black Gold Powder) is used to treat yongju, dingzhong (carbuncles), shidu (seasonal toxins), fugujü (bone-attached abscesses), and various malignant sores. If the sore is black and sunken, hard as stone, limbs are cold, pulse is thin, or there is occasional dizziness, delirium, picking at clothes, irritability, thirst, and critical condition, taking this formula induces sweating, and the sore rises.
Ingredients: Cang'er Tou (Xanthii Fructus head) (harvested at noon on the fifth day of the fifth lunar month), Xiao Caowutou (Aconitum Carmichaelii Lateral Root Preparatio minor), Huomato (Hemp seed head) (harvested on fire days), Muze (Equiseti Herba) (remove joints), Xiamato (Toad head), Hua Pi Jie (Betula Platyphylla bark nodes) (roasted with butter), Mahuang (Ephedrae Herba) (remove roots and joints).
Dry all ingredients equally, place together in a porcelain jar, seal with salt mud, and roast over charcoal fire from morning until Shen hour (3-5 PM), until turning black like coal. Grind into powder. Take 2 qian per dose, 3 qian for severe cases, mixed with hot wine. If no sweat occurs, take another dose. After sweating, administer detoxifying and draining medicines. When preparing this medicine, choose clear sunny days, work in a quiet room, and do not allow chickens, dogs, cats, or women during menstruation/pregnancy to see it. Also known as Shougong Xuanhei San (First Merit Black Mystery Powder).
Duoming Dan (Life-Seizing Pill) is used to treat various swellings, toxins, dingju, and malignant sores.
Ingredients: Chansu (Bufonis Venenum), Qingfen (Calomel) (each 0.5 qian); Zhusha (Cinnabar) (3 qian); Baifan (Alumen Exsiccatum - calcined alum), Hanshuishi (Hydrocerussite), Tonglü (Chalcitis) (each 1 qian); Woniu (Helix Aspersa) (21 snails, ground separately); Ruxiang (Olibanum), Moyao (Myrrha), Shexiang (Moschus) (1 qian).
Grind all ingredients into fine powder. Grind the snails separately. Mix with good wine paste to form pills the size of mung beans. Take one pill per dose. Chew 3-5 stalks of raw green onion thoroughly, spit into the palm, wrap the pill inside, and swallow with hot wine mixed with onion. For severe cases, walking for five to seven li inducing sweat indicates efficacy. Severe cases may take 1-2 more pills.
Chansu Wan (Toad Venom Pill) treats huangshui chuang (weeping sores) and all malignant sores.
Ingredients: Chuanwu (Aconiti Radix Preparata), Lianhua Ye (Nelumbinis Nuciferae Folium), Zhusha (Cinnabar) (each 1.5 qian); Ruxiang (Olibanum), Moyao (Myrrha) (each 2 qian); Qingfen (Calomel), Chansu (Bufonis Venenum) (each 1 qian); Shexiang (Moschus) (0.5 qian).
Grind into fine powder, mix with paste to form pills the size of shepherd's purse seeds. Take one pill per dose, two for severe cases. Administer according to the previous method to induce sweat.
Commentary: The above three formulas, referred to by Guo as "Shou Yao" (Primary Medicines), primarily focus on dispersion, following the Taiyang meridian pattern. The latter two follow the Shaoyin meridian pattern. However, these are all "Jie Ji" (drastic/capturing agents). Wise practitioners should weigh the severity and yin-yang distinctions before choosing.
Dongyuan Tuoli Rongwei Tang (Dongyuan's Interior-Supporting Ying-Wei Decoction) treats conditions described in the preceding section "Sores Suitable for Sweating."
Ingredients: Huangqi (Astragali Radix), Honghua (Carthami Flos), Guizhi (Cinnamomi Ramulus) (each 5 qian); Cangzhu (Atractylodis Rhizoma) (3 qian); Chaihu (Bupleuri Radix), Lianqiao (Forsythiae Fructus) (each 2 qian); Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Danggui Shen (Danggui Root Tip), Zhigancao (Prepared Licorice Root), Huangqin (Scutellariae Radix) (each 1.5 qian); Renshen (Ginseng Radix) (1 qian).
The above herbs are cut into small pieces. Each dose of 1 liang is decocted in half water and half wine.
Commentary: These herbs belong to the Foot Three Yang and Taiyin meridians, derived from the Guizhi Tang pattern. It is a formula regulating the exterior, interior, qi, and blood.