夫鸬 瘟者,因一时风温偶袭少阳,络脉失和。生于耳下,或发于左,或发于右,或左
右齐发。初起形如鸡卵,色白濡肿,状若有脓,按不引指,但酸不痛,微寒微热;重者或憎
寒壮热,口干舌腻。初时则宜疏解,热甚即用清泄,或挟肝阳上逆,即用熄风和阳。此证永
不成脓,过一候自能消散。
耳根痈,初起根盘坚肿,其色亦白,止发一边,从无双发,憎寒发热,斯时疏解散邪,
得汗则消。如过七日,身热不退,即欲成脓,治用羚羊角散。如寒热无汗,即用小柴胡汤加
制蚕、角刺攻透之;俟开刀出脓,肿消热退而安。其时用药,须扶胃和营,不可乱投补托,
盖风温偶阻,是正旺邪实,若投参 归术,必致气血壅滞,脾胃呆钝,脓反不清,以致延绵
日期,不即收口。大凡风温偶感者,此为阳实证,正旺邪实,俟脓泄邪退,营卫自和而愈。
若用参 扶正固托,则反受其累矣,此不可不知也,同学人宜类推之。如时邪瘟证后余邪未
彻,耳项发颐,亦有成脓者,治法与此同。
发颐,乃伤寒汗下不彻,余热之毒未除,邪结在腮颌之上,两耳前后硬肿疼痛。初起身
热口渴,当用连翘败毒散清热解毒,或普济消毒饮亦可;如正虚邪实,津亏液枯,大便秘结
。神识昏蒙,脉来弦硬者,则以犀角地黄汤加西黄、胆星、竹沥主之。又有湿温时邪,或伏
邪瘅疟,或温痧疫毒,虽得汗而余邪未彻,走入少阳,发于颐者,身体仍然寒热,舌苔白腻
,或大便坚结,或协热下泄,当以泻心合温胆,或葛根芩连汤治之。如寒热不止,患上红肿
光亮而 者,势均力敌必成脓,穿溃后不可骤投补托,止宜扶胃和营;外以升膏盖贴。如脓不外泄
,用升药线提之。
豌豆疮者,亦因伤寒汗下后余毒未尽,故于瘥后而发。只以黄连、甘草、归尾、红花、
防风、苦参、荆芥、连翘、羌活、白芷之类煎服。外用芒硝、赤小豆、青黛为末,以鸡子
清和猪胆汗调和,敷疮上最效。勿动其靥,待其脱落无痕。
鸬瘟(俗称土婆风),是由于一时之间风温之邪偶然侵袭少阳经,导致经络气血失和所致。病变部位生在耳下,可能发于左侧,也可能发于右侧,或者左右同时发作。初期形状像鸡蛋,颜色白而肿胀柔软,看起来好像有脓,但按压时不凹陷留指印,感觉只有酸楚而没有疼痛,伴有轻微的恶寒和发热;病情重的可能出现严重的恶寒和高热,口干且舌苔腻。初起阶段适宜用疏风解表的方法,如果热势很盛就立即用清热泄火的方法,如果兼有肝阳上逆的情况,就用平熄肝风和调和营卫的方法。这种证候永远不会化脓,经过一个周期(约七天)自然能够消散。
耳根痈,初起时根基盘结坚硬肿胀,颜色也是白的,只发于一侧,绝不会双侧同时发作,伴有恶寒发热,此时应用疏风解散邪气的方法,出汗后就能消退。如果过了七天,身体发热不退,就要准备化脓了,治疗使用羚羊角散。如果寒热交替且无汗,就使用小柴胡汤加入制僵蚕、皂角刺来攻透毒邪;等到切开排脓,肿消热退后就安稳了。这个时候用药,必须扶助胃气、调和营血,不可乱用补益托毒的药物,因为这是风温偶然阻滞,属于正气旺盛而邪气实盛的阶段,如果使用人参、当归、白术等补药,必然导致气血壅滞,脾胃功能呆钝,脓液反而不能清澈,以致病程拖延,伤口不能迅速愈合。大凡因偶然感受风温者,这属于阳实证,正气旺而邪气实,等到脓液排出、邪气退去,营卫自然调和而痊愈。如果使用人参扶正固托,反而会受其害,这一点是不可不知道的,学习中医的人应该由此类推。如果是时行疫病之后余邪未清,在耳项发颐部位,也有化脓的,治疗方法与此相同。
发颐,是因为伤寒病经过发汗或攻下治疗后不彻底,余热毒邪未能清除,邪气结聚在腮颌之上,两耳前后出现硬肿疼痛。初起时身体发热口渴,应当使用连翘败毒散清热解毒,或者普济消毒饮也可以;如果正气虚弱而邪气实盛,津液亏损枯涸,大便秘结,神志昏蒙,脉象弦硬,则以犀角地黄汤加入牛黄、胆南星、竹沥为主进行治疗。又有湿温时邪,或者伏气温疟,或者温痧疫毒,虽然已经出汗但余邪未清,邪气走入少阳经,发于颐部,身体仍然寒热往来,舌苔白腻,或者大便干结,或者伴随热势腹泻,应当使用泻心汤合温胆汤,或者葛根芩连汤治疗。如果寒热不止,患处红肿光亮且表面溃破,邪正势力相当必然化脓,穿溃后不可突然投用补益托毒药物,只宜扶助胃气、调和营血;外用升膏覆盖贴敷。如果脓液不外泄,用升药线提脓祛腐。
豌豆疮(天花),也是因为伤寒发汗攻下后余毒未尽,所以在病愈后发作。只用黄连、甘草、当归尾、红花、防风、苦参、荆芥、连翘、羌活、白芷这类药材煎服。外用芒硝、赤小豆、青黛研成粉末,用鸡蛋清和猪胆汁调和,敷在疮面上效果最好。不要触动疮痂,等待其自然脱落不留痕迹。
Luwen (Colloquially known as "Tupo Feng"), is caused by wind-warmth pathogen occasionally attacking the Shaoyang channel at one time, leading to disharmony of the collaterals. It occurs below the ear, either on the left side, on the right side, or simultaneously on both sides. In the early stage, it resembles a chicken egg, with white color and soft swelling, appearing as if there is pus, but pressing does not leave an indentation, feeling only soreness without pain, accompanied by slight aversion to cold and fever; in severe cases, there may be severe aversion to cold and high fever, dry mouth, and greasy tongue coating. At the initial stage, dispersing and resolving methods are suitable; if heat is severe, clearing and purging methods should be used immediately; if accompanied by rebellious Liver Yang, extinguishing wind and harmonizing methods should be employed. This condition will never form pus and can naturally dissipate after one period (approximately seven days).
Ergen Yong (Abscess at the Root of the Ear), in the early stage, has a firm and swollen base, with white color, occurring only on one side and never bilaterally, accompanied by aversion to cold and fever. At this time, dispersing and releasing methods should be used to scatter pathogens; sweating leads to resolution. If after seven days, body heat persists, pus formation is imminent, and Lingyangjiao San (Antelope Horn Decoction) is used for treatment. If there is alternating chills and fever without sweat, Xiaochaihu Tang (Minor Bupleurum Decoction) added with processed Jiangcan (Bombyx Batryticatus) and Jiaoci (Gleditsiae Spina) is used to attack and penetrate the toxin; once incised to drain pus, swelling subsides, heat recedes, and the patient stabilizes. Medication at this time must support Stomach Qi and harmonize Ying and Wei (Nutritive and Defensive Qi); blind use of tonifying and pushing-out methods is prohibited. This is because wind-warmth obstruction represents a state where Zheng Qi (Upright Qi) is strong and Xie Qi (Pathogenic Qi) is excess. Using Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) will inevitably cause Qi and Blood stagnation, dulling Spleen and Stomach function, resulting in unclear pus, prolonged course, and delayed wound healing. Generally, accidental contraction of wind-warmth constitutes a Yang Excess pattern, with strong Zheng Qi and excess Xie Qi. Once pus drains and pathogens retreat, Ying and Wei naturally harmonize, leading to recovery. Using Ren Shen to tonify and support upright Qi will instead cause harm; this point must be understood, and students should infer similar principles from this. If residual pathogens remain uneliminated after an epidemic disease, abscesses may also form in the area of Ergen Fayi; the treatment method is the same as described above.
Fayi (Mumps-like Swelling), results from incomplete sweating or purgation in Shanghan (Cold Damage) diseases, leaving residual heat toxins unremoved, with pathogens knotting above the cheeks and jaw, causing hard swelling and pain before and behind both ears. Early symptoms include fever and thirst; Linqiao Baidu San (Forsythia Detoxification Powder) should be used to clear heat and detoxify, or Puji Xiaodu Yin (Universal Benefit Toxin-Resolving Decoction) is also acceptable. If Zheng Qi is deficient while Xie Qi is excess, with depletion of fluids and dryness, constipation, confused consciousness, and wiry and stiff pulse, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) added with Xi Huang (Bezoar), Danning (Arisaematis Cum Bile) and Zhuli (Bambusa Textilis Sap) is the primary treatment. Additionally, damp-warmth pathogens, latent warm malaria, or warm toxic plague, even after sweating, if residual pathogens remain and enter the Shaoyang channel, manifesting as Fayi, present with persistent chills and fever, white greasy tongue coating, either hard stools or diarrhea with heat. Xixin Tang (Gastrodia and Uncaria Decoction combined with Warming Gallbladder Decoction) or Gegen Qinlian Tang (Kudzu and Coptis Decoction) should be used. If chills and fever persist, and the affected area shows red, swollen, bright skin with ulceration, the balance between pathogen and resistance indicates pus formation. After rupture, sudden use of tonifying and pushing-out methods is contraindicated; supporting Stomach Qi and harmonizing Ying and Wei is appropriate, with Sheng Gao (Rising Paste) applied externally. If pus does not drain externally, Sheng Yao Line (Arsenic-containing Extract Thread) is used to promote drainage.
Wandou Chuang (Smallpox), also occurs due to incomplete elimination of residual toxins after sweating or purgation in Shanghan, manifesting after recovery. Treatment involves decocting and administering herbs such as Huanglian (Coptidis Rhizoma), Gancao (Licorice Root), Guiwei (Angelicae Sinensis Radix Tail), Honghua (Carthami Flos), Fangfeng (Saposhnikoviae Radix), Kushen (Sophorae Flavescentis Radix), Jingjie (Schizonepetae Herba), Linqiao (Forsythiae Fructus), Qianghuo (Notopterygii Rhizoma et Radix), and Baizhi (Angelicae Dahuricae Radix). Externally, Mangxiao (Natrii Sulfas), Chixiaodou (Adzuki Bean), and Qingdai (Indigo Naturalis) are powdered, mixed with Jizi Qing (Egg White) and Zhudanhan (Porcine Bile), and applied to the sores for best effect. Do not disturb the scabs; wait for them to fall off naturally without leaving scars.