王肯堂曰∶颐发生于颧骨之下,腮颔之上,耳前一寸三分,古云不治,属足阳
明胃经热毒上攻。若治不得法,延及咽嗌溃烂,穿口不食者死。(《准绳》)
又曰∶《素问》云∶肾热者颐先赤。故颐属足少阴肾经也。而今医师以耳后一寸
三分发锐毒者,名曰发颐,则是少阳分野,而薛氏亦以为属足少阴经,当补肾水者,何
也?盖肾为相火之宅,宅完且固,而火得归息焉,则治肾正所以治少阳也。此证伤
寒汗出不彻者,多患之。亦有杂证客热,久而不散,而发于颐者,宜以药速消散之。失
治成脓,则费手矣。倘误服克伐之药,而不滋补其气血者,即穿口破唇而死。
申斗垣曰∶颐发,乃足阳明胃经多气少血,在唇旁腮上颊车穴、(穴在耳下曲颊端陷
中。)大迎穴。(穴在曲颔前一寸三分陷中动脉。)上下左右相同,双发最凶。如肿痛不可忍者,八
日可刺。脓汁出,四畔软者生;如反硬,牙关紧,不能食,似蜂窠涓流黄水,十无一
生。女子患此,主四五日死。(《启玄》)
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窦汉卿曰∶发颐乃伤寒发汗未透而成。在头耳一寸三分、在心窝两胁、在身者可
治;在身后,相连咽喉,恐毒瓦斯内攻,难进饮食药饵,鼻流清脓,两耳闭塞者,即死不治。
陈实功曰∶发颐又名汗毒。此症原因,风寒用药发表未尽,日久传化为热,不散,
以致项之前后结肿疼痛。初起身热口渴,当用柴葛汤清热解毒;如患上红肿热痛者,如
意金黄散敷之。(《正宗》)
又曰∶如身凉不渴者,宜牛蒡甘桔汤。
冯鲁瞻曰∶头痛肿大如斗,是天行时疫,大头病也。夫身半以上,天之气也;身
半以下,地之气也。邪热客于心肺之间,阳明少阳之火复炽,且感天地四时瘟疫之气,
所以上焦壅热不散,干犯清道,湿热上乘
巅顶而为肿,木挟火邪而为痛,甚至溃裂脓血,复染他人,所以谓之疫疠。轻者名
为发颐,肿在两耳前后,有以承气下之,泻胃中之实热,是诛伐太过矣。治法不宜药
速,速则过其病,所谓上热未除,中寒复生,必伤人命。宜用缓药,徐徐少与;再
视肿势在于何方,随经治之。阳明为邪,首大肿;少阳之邪,出与耳前后也。大概普
济消毒饮主之。
王肯堂说:发颐病发生在颧骨下方、腮帮与下巴之间的区域,距离耳前一寸三分处,古人认为此病难以治愈,归属于足阳明胃经的热毒向上攻冲所致。如果治疗不得法,病情会蔓延至咽喉导致溃烂,甚至穿破口腔无法进食者,将会死亡。(出自《医学准绳六要》)
又说:《素问》中提到:“肾有热邪时,颐部首先发红。”因此,发颐也属于足少阴肾经的病变。然而现在的医生将耳后一寸三分处发生的锐毒称为发颐,这实际上属于少阳经的分野范围;而薛己(薛氏)也认为它属于足少阴经,主张通过补肾水来治疗,这是为什么呢?因为肾是相火寄居之所,只要肾宅稳固,相火就能归位潜藏,所以治疗肾脏正是为了治疗少阳经。这种病症在伤寒病患者汗出而不彻底的情况下,容易患上。也有因杂病中的客热久留不散,而在颐部发作的情况,应当用药迅速消散。若延误治疗形成脓液,则处理起来就棘手了。倘若误服攻伐克制的药物,而不滋补气血,就会导致口腔穿破、嘴唇破裂而死。
申斗垣说:发颐病,是由于足阳明胃经多气少血,病变位于唇旁腮上颊车穴(穴位在下颌角前方凹陷处)、大迎穴(穴位在下巴前一寸三分处的动脉凹陷中),上下左右对称发生,双侧同时发病最为凶险。如果肿痛剧烈难以忍受,可在第八天进行刺破排脓。若脓液流出,四周变软者预后良好;如果反而变硬,牙关紧闭,不能进食,且渗出物像蜂巢一样点滴流出黄水,十人中难救活一个。女性患此病,主死期在四五日内。(出自《外科启玄》)
窦汉卿说:发颐是由于伤寒发汗不透彻而形成的。病变如果在头耳一寸三分处、心窝两胁部位、身体其他部位,尚可治疗;如果病变在身后,并连及咽喉,恐怕毒气内攻,难以进食服药,出现鼻流清脓、双耳闭塞症状的,就会死亡,无法救治。
陈实功说:发颐又名“汗毒”。此症的原因在于,风寒之邪用药发表未尽,日久传化为热邪,郁结不散,导致颈部前后结肿疼痛。初起时身体发热、口渴,应当使用柴葛汤清热解毒;如果出现患处红肿热痛的症状,可用如意金黄散外敷。(出自《外科正宗》)
冯鲁瞻说:头痛肿大如斗,这是天行时疫,即大头瘟病。人体上半身属天之阳气,下半身属地之阴气。邪热客居于心肺之间,阳明、少阳之火再次炽盛,加之感受天地四时的瘟疫之气,所以上焦壅滞的热邪不散,干犯清窍,湿热上乘至头顶而导致肿胀,肝木挟带火邪而导致疼痛,甚至溃裂流脓出血,又能传染给他人,所以称之为疫疠。轻症称为发颐,肿胀位于两耳前后。有人用承气汤类方剂攻下,以泻胃中实热,这是诛伐太过。治疗方法不宜用药过猛过快,药力过猛会超过病情的需要,所谓上部的热邪未除,中部的寒邪又生,必然伤害人命。适宜使用缓和的药物,慢慢少量服用;再观察肿胀趋势位于哪一经络,随经论治。如果是阳明经受邪,头部首先肿大;如果是少阳经受邪,肿胀出现在耳的前后。大概以普济消毒饮为主方治疗。
Wang Kentang stated: "Fa Yi" (Parotid Abscess) occurs below the zygomatic bone, above the cheek and mandible, at a distance of one cun and three fen in front of the ear. Ancient texts considered this condition untreatable, attributing it to heat-toxin from the Foot-Yangming Stomach Meridian attacking upward. If treated improperly, the condition may spread to the pharynx causing ulceration; if it perforates the mouth preventing eating, death ensues. (From *Yixue Zhunsheng*)
Furthermore, he stated: The *Suwen* (Basic Questions) mentions: "When the Kidney has heat, the area of the Yi turns red first." Thus, Fa Yi is also associated with the Foot-Shaoyin Kidney Meridian. However, contemporary physicians name the acute toxicity occurring one cun and three fen behind the ear as Fa Yi, which actually falls within the Shaoyang distribution. Yet Xue Ji (Xue Shi) also considers it belonging to the Foot-Shaoyin Meridian and advocates tonifying Kidney Water. Why? Because the Kidney is the residence of Ministerial Fire. If the residence is intact and solid, the fire returns to its origin; therefore, treating the Kidney is precisely how one treats the Shaoyang. This condition is commonly seen in patients with Taiyang Cold Damage who have sweated but not thoroughly. It can also arise from lingering external heat in miscellaneous diseases that fails to dissipate over time. Medication should be used to rapidly dissipate it. If treatment is delayed and pus forms, management becomes difficult. If astringent or purgative drugs are mistakenly taken without nourishing Qi and Blood, it will lead to perforation of the mouth and rupture of the lips, resulting in death.
Shen Douyuan stated: Fa Yi arises because the Foot-Yangming Stomach Meridian is abundant in Qi but deficient in Blood. It affects the Jiache Acupoint (located in the depression anterior to the angle of the mandible) and the Daying Acupoint (located in the depression of the pulsating artery one cun and three fen anterior to the chin). The presentation is symmetrical above, below, left, and right. Bilateral occurrence is the most severe. If swelling and pain are unbearable, puncture may be performed on the eighth day. If pus drains and the surrounding tissue softens, survival is likely; if it remains hard, the jaw is locked, eating is impossible, and yellow fluid drips like a honeycomb, fewer than one in ten survives. For women suffering from this, death is expected within four to five days. (From *Waike Qixuan*)
Dou Hanqing stated: Fa Yi results from incomplete sweating during the treatment of Taiyang Cold Damage. If located at the head/ear region, heart pit, hypochondrium, or body, it is treatable. If located posteriorly, connecting to the throat, with fear of toxic qi attacking inward, difficulty in taking food or medicine, nasal discharge of clear pus, and bilateral ear blockage, it is fatal and untreatable.
Chen Shigong stated: Fa Yi is also known as "Sweat Toxin." The etiology lies in insufficient release of Wind-Cold via diaphoretic herbs, which transforms into heat over time and stagnates, causing swelling and pain in the neck. Initially presenting with fever and thirst, Chai Ge Tang (Bupleurum and Pueraria Decoction) should be used to clear heat and resolve toxicity. If the affected area presents with redness, swelling, heat, and pain, Ruyi Jinhuang San (Ruyi Golden Yellow Powder) should be applied externally. (From *Waike Zhengzong*)
He further stated: If the body is cool and there is no thirst, Niubang Ganjie Tang (Arctium and Licorice & Platycodon Decoction) is appropriate.
Feng Luzhan stated: Headache with massive swelling resembling a beanbag indicates an epidemic disease known as Da Tou Bing (Big Head Plague). The upper half of the body corresponds to Heavenly Qi; the lower half to Earthly Qi. Pathogenic heat lodges between the Heart and Lungs, while Yangming and Shaoyang fires flare up again. Combined with the influence of seasonal epidemic Qi, heat stagnates in the Upper Jiao, invades the clear orifices, and damp-heat ascends to the vertex causing swelling. Wood (Liver) carrying fire-pathogen causes pain. In severe cases, ulceration and bleeding of pus occur, and it can infect others, hence termed Yi Li (Epidemic Pestilence). Mild cases are called Fa Yi, with swelling around both ears. Some use Chengqi formulas to purge excess heat from the Stomach, which is excessive punishment. Treatment should not rely on harsh or rapid medications; rapid action may exceed the pathology's needs, leading to the scenario where 'upper heat is not cleared, yet middle cold arises,' inevitably harming life. Gentle medications should be used slowly and in small doses. Observe which meridian the swelling follows and treat accordingly. Yangming pathogenic involvement causes initial head swelling; Shaoyang pathogenic involvement manifests around the ears. Generally, Puji Xiaodu Yin (Universal Benefit Detoxification Decoction) is the primary formula.