余自幼爱治岐黄术。谓医虽小道。有裨于人己。读书人所宜旁及。顾不登门不索谢。据六经之法而治之。
求方者日益众。嗣以有妨举业。乃力辞而置之矣。惟治疠则尤汲汲不遑。常恐其不我遇。夫疠疾也。得之
者。父子离散。夫妻暌违。戚友避之。行道叱之。非若他疾只伤一人。疠实传染常多。或伤邻友。或伤一家。至
于无与为婚而绝嗣者不少。张子云。疲癃生理残障。皆吾兄弟之颠连而无告者也。不其然乎。顾治是疾。古今
既少专书。方亦寥寥。而庸辈偶得一二方。私为秘本。挟此以索重资。及叩以病源药性。茫然不知其故。精
医之士。又或畏其秽污而不经心。或目为正报而托于缘定。使抱是病者。有病无药。致自缢投水死者。往
往有之。余甚悯焉。究心多年。治不下数百余人。爰着此编。举其纲。张其目。条分缕晰。三易寒暑。颇费苦心。
阅是编者。岂惟可以治疠。亦于分经治病之道。可得其概矣。有心者广而行之。亦吾辈随地利人之一端
也欤。
嘉庆元年孟夏月初九日晓亭主人书
素问脉要精微论曰。脉风。成为疠风。又风论曰。风寒客于脉而不去。名曰疠风。疠风者。营卫热 。其气不
清。故使鼻柱坏而色败。皮肤疡溃。
长刺篇论曰。大风骨节重。须眉堕。名曰大风。
灵枢曰。疠风者。数刺其肿上。已刺。以锐针针其处。按出其恶气。肿尽乃止。常食方食。毋食他食。
千金翼耆婆治恶病曰。疾风有四百四种。总而言之。不出五种。即是五风所摄云。何名五风。一曰黄风。二
曰青风。三曰白风。四曰赤风。五曰黑风。其风合五脏。故曰五风。五风生五种虫。黄风生黄虫。青风生青虫。
白风生白虫。赤风生赤虫。黑风生黑虫。此五种虫。食人五脏。若食人脾。语变声散。食人肝。眉睫堕落。食人
心。遍身生疮。食人肺。鼻柱崩倒。鼻中生息肉。食人肾。耳鸣啾啾。或如车行雷鼓之声。食人皮。皮肤顽痹。食
人筋。肢节坠落。五风合五脏。虫生至多。入于骨髓。来去无碍。坏于人身。名曰疾风。疾风者。即疠病之根本
也。病之初起。或如针椎所刺。名曰刺风。如虫走。名曰游风。遍身掣动。名曰 风。不觉痛痒。名曰顽风。肉起
如桃李小枣核。从头面起者。名曰顺风。从两脚起者。名曰逆风。如连钱团圆。赤白青黑斑驳。名曰KT 风。或
遍体生疮。或如疥癣。或如鱼鳞。或如榆荚。或如钱孔。或痒或痛。黄汁流出。肢节坏烂。悉为脓血。或不痒不
疼。或起或灭。青黄赤白黑。变易不定。病起之由。皆因冷热交通。流入五脏。通彻骨髓。用力过度。饮食相违。
房室不节。虚动劳极。汗流遍体。因此积热。风热彻五脏。饮食杂秽。虫生至多。食人五脏骨髓皮肉筋节。久
久坏败。名曰疠风。
丹溪云。疠疾须分在上在下。在上者以醉仙散。取臭恶血于齿缝中出。在下者以通天再造散。取恶物蛔
虫于谷道中出。所出虽有上下道路之异。然皆不外于阳明一经而已。看其证之上先见。上身多者。病在
上也。下先见。在下体多者。病在下也。上下同得者。病在上下也。何则。阳明主胃与大肠。无物不受。多气多
血。邪风之伤人也。气受之。上身多。血受之。下体多。气血俱受。上下皆多。自非医者神手。病者铁心。罕有效
者。夫气为阳为卫。血为阴为营。身半以上。阳先受之。身半以下。阴先受之。是故再造散治病在阴分。用皂
角刺逐风毒于营血中。肝藏血。恶血留注不能运动。故虫生焉。必用此以治其脏气杀虫为主。以大黄引
入肠胃。利出瘀恶虫物。醉仙散治病在阳分。用牛蒡子驱风毒恶疮于遍身。胡麻逐风补肺。润皮肤。蒺藜
去恶血。身体风痒。通鼻气。防风治诸风。栝蒌根治瘀血。消热肿。枸杞消风热。解毒疮。蔓荆子逐贼风。苦参
解热毒。然必藉轻粉为使。逐出胃腑恶毒臭秽之物。杀所生之虫。循经上行。至牙齿软薄之分。而出其臭
毒之涎水。服药后。若损齿。则以黄连末揩之。或先佐入剂中。以解轻粉之毒。轻粉在醉仙散中。有夺旗斩
将之功。遂成此方之妙用。非他方所可并及者。
薛新甫曰。疠疡所患。非止一脏。然其气血。无有不伤。而其证亦无有不杂。况积久而发现于外。须分经络
之上下。审气血之虚实。不可概施攻毒之药。当先助胃壮气。使根本坚固。而后治其疮可也。
疠疡当知有变有类之不同。而治法有汗下砭刺灸补之不一。盖类证当审轻重。变证当详真伪。而治法
又当量其人之虚实。究其病之源委。而施治焉。夫虚者正气虚也。实者邪气实也。
疠疡针砭之张子和。以一汗抵千金。盖以针血不如发汗之周遍也。发汗针血。二者一律。若恶血凝滞在
肌表经络者。宜刺宜汗。取委中出血则效。若恶毒蕴结于脏。非荡涤其内。则不能疗。若毒在外者。非刺遍
身患处。及两臂腿腕手足指缝。其毒必不能散。若表里俱受其毒者。非外针内泄。其毒决不能出透。若上
身患多。宜用醉仙散。使内蓄恶血于齿缝中出。又刺十指甲并臂腕。以去肌表毒血。下体患多。宜用再造
散。令恶血蛔虫于谷道出。仍针足指缝并腿腕。隔一二日再刺之。以血赤为度。如有寒热头痛等证。又当
因证而施治焉。
我自幼喜爱钻研中医医术。认为医学虽然只是小道，但能有益于他人和自己，这是读书人应当涉猎的领域。不过，我不登门行医也不索取报酬，而是依据六经辨证的方法进行治疗。
求取药方的人日益增多，后来因为妨碍了科举学业，我便极力推辞并搁置了此事。唯独治疗麻风病（疠疾）时，我尤为急切，常常担心自己不能遇到这样的患者。那麻风病啊，得了它的人，会导致父子离散、夫妻分离，亲戚朋友都躲避它，路人也会呵斥它。不像其他疾病只伤害一个人，麻风病确实具有传染性且往往波及多人，有时伤害邻居朋友，有时伤害一家人，甚至导致无法婚配、断绝后代的情况不少见。张子说：“那些瘫痪、癃闭、生理残疾的人，都是我们处境困顿、无处诉说的兄弟。”难道不是这样吗？然而治疗这种疾病的古今书籍很少专门论述，方剂也寥寥无几。而庸医偶然得到一两个方子，就私自作为秘本，凭借这个索要重金。等到询问他们病因和药性时，却茫然不知其所以然。精通医术的人士，又或许畏惧其污秽而不加留意，或者将其视为因果报应而托词说是命中注定，使得患有此病的人有病无药可治，导致自缢或投水自杀的情况，往往发生。我很怜悯这种情况。于是潜心研究多年，治疗的病人不下数百人，因此编写了这本书，列出大纲，展开细目，条理清晰，历经三个寒暑，颇费苦心。阅读这本书的人，岂止可以治疗麻风病，也可以从中大致了解分经治病的方法。有心之人广泛推广施行，也是我们顺应地利、利益人群的一个方面吧。
《素问·脉要精微论》说：脉象受风邪影响，就会形成疠风（麻风）。又在《风论》中说：风寒邪气侵入经脉而不去除，名叫疠风。疠风患者，营卫之气发热，气息不清，所以导致鼻梁塌陷、面色败坏，皮肤溃疡溃烂。
《灵枢·长刺节论》说：大风病表现为骨节沉重，胡须眉毛脱落，名叫大风。
《灵枢》说：治疗疠风，多次针刺肿胀部位。刺完后，用锐针针刺患处，按压排出恶气，直到肿胀消退才停止。平时吃正常的食物，不要吃其他食物。
《千金翼方》引用耆婆治疗恶病的话说：风病有四百多种，总而言之，不出五种，即由五风所统摄。什么是五风？一是黄风，二是青风，三是白风，四是赤风，五是黑风。这五种风对应五脏，所以叫五风。五风产生五种虫：黄风生黄虫，青风生青虫，白风生白虫，赤风生赤虫，黑风生黑虫。这五种虫子会侵蚀人的五脏。如果侵蚀脾脏，说话声音改变且散乱；如果侵蚀肝脏，眉毛睫毛脱落；如果侵蚀心脏，全身生疮；如果侵蚀肺脏，鼻梁崩塌倒塌，鼻中长出息肉；如果侵蚀肾脏，耳朵鸣响，像车行雷鼓的声音；如果侵蚀皮肤，皮肤麻木不仁；如果侵蚀筋脉，肢体关节坠落。五风结合五脏，虫子滋生最多，进入骨髓，来去无阻，破坏人体，名叫疾风。疾风，就是麻风病的根本。疾病初起时，有的像被针锥刺入，名叫刺风；有的像虫子爬行，名叫游风；全身抽搐跳动，名叫掣风；不觉痛痒，名叫顽风；肌肉隆起像桃李小枣核，从头面部开始的，名叫顺风；从两脚开始的，名叫逆风；像连钱团圆状，红白青黑斑驳，名叫KT风（注：原文为异体字或通假，此处保留原意或指某种特定形态），或者遍体生疮，或者像疥癣，或者像鱼鳞，或者像榆荚，或者像钱孔，或者痒或者痛，流出黄色汁液，肢体关节腐烂，全部化为脓血；或者不痒不疼，或者时起时灭，颜色青黄赤白黑，变化不定。发病的原因，都是因为冷热之气交通，流入五脏，通达骨髓，用力过度，饮食违和，房事不节制，虚劳极度疲劳，汗流遍体。因此积热，风热通达五脏，饮食杂乱污秽，虫子滋生最多，侵蚀人的五脏、骨髓、皮肉、筋节，久而久之败坏，名叫疠风。
朱丹溪说：麻风病必须分为在上部和下部。在上部的用醉仙散，使臭恶的血从齿缝中排出；在下部的用通天再造散，使恶物和蛔虫从肛门排出。排出的途径虽然有上下道路的不同，但都不外乎阳明经而已。看症状先出现在哪里，上身多的，病在上部；先出现在下部，下体多的，病在下部。上下都有的，病在上下。为什么呢？阳明经主管胃与大肠，没有东西不接受，多气多血。邪风伤人，气受邪则上身多，血受邪则下体多，气血都受邪，上下都多，如果不是医生手法高明，病人意志坚定，很少有见效的。气属阳属卫，血属阴属营。身体半以上，阳先受邪；身体半以下，阴先受邪。所以再造散治疗病在阴分的，用皂角刺驱逐风毒于营血之中。肝藏血，恶血留注不能运动，所以虫子产生。必须用这个方法来治疗，以调理脏气、杀虫为主，用大黄引导进入肠胃，利出瘀恶虫物。醉仙散治疗病在阳分的，用牛蒡子驱除风毒恶疮于遍身，胡麻驱逐风邪补肺，滋润皮肤，蒺藜去除恶血，治疗身体风痒，通鼻气，防风治疗各种风邪，栝楼根治疗瘀血，消除热肿，枸杞消除风热，解毒疮，蔓荆子驱逐贼风，苦参解热毒。但是必须借助轻粉作为引经药，驱逐出胃腑恶毒臭秽之物，杀死所生的虫子，顺着经络上行，到达牙齿软薄的地方，排出臭毒的涎水。服药后，如果损伤牙齿，就用黄连末擦拭。或者先在药方中加入，以解除轻粉的毒性。轻粉在醉仙散中，有夺旗斩将的功效，从而成就此方的妙用，不是其他方剂所能比及的。
薛己（新甫）说：麻风溃疡所患，不止一个脏腑，但其气血，没有不受伤的，而且症状也没有不混杂的。何况积累久了表现在外部，必须分辨经络的上下，审察气血的虚实，不能一概施用攻毒的药物。应当先助胃壮气，使根本坚固，然后治疗其疮疡才可以。
麻风溃疡应当知道有变证和类证的不同，而治疗方法有发汗、泻下、砭石、针刺、艾灸、补益等不一。大概类证应当审察轻重，变证应当详辨真伪，而治疗方法又应当衡量病人的虚实，探究病的源委，然后施治。所谓虚，是正气虚；所谓实，是邪气实。
张子和擅长用针灸砭石治疗麻风溃疡，认为一次发汗抵得上千金的价值，因为针刺放血不如发汗那样周遍。发汗和针刺放血，两者道理一致。如果恶血凝滞在肌表经络，适宜针刺或发汗，取委中穴出血则有效。如果恶毒蕴结在脏腑，不荡涤其内部，就不能治愈。如果毒邪在外部，不针刺遍身患处，以及双臂、腿腕、手足指缝，其毒邪一定不能消散。如果表里都受到毒邪，不外用针刺内用泄法，其毒邪决不能透出。如果上身患病多，适宜用醉仙散，使内蓄的恶血从齿缝中排出，又针刺十指甲以及臂腕，以去除肌表的毒血。下身患病多，适宜用再造散，令恶血蛔虫从肛门排出，仍然针刺足指缝以及腿腕，隔一两天再刺，以血色变红为度。如果有寒热头痛等症状，又应当根据症状施治。
I have loved studying the art of medicine since childhood. I believe that although medicine is a minor skill, it benefits both others and oneself, and thus should be studied by scholars. However, I do not visit patients' homes to practice nor do I demand payment; instead, I treat according to the methods of the Six Channels (Six Meridians).
As more and more people sought prescriptions, later on, fearing it would interfere with my preparation for the imperial examinations, I firmly declined and set it aside. Yet, when treating Leprosy (Leprosy disease), I was particularly eager and hurried, often fearing that I might not encounter such cases. Leprosy causes fathers and sons to be separated, husbands and wives to live apart; relatives and friends avoid those afflicted, and passersby scold them. Unlike other diseases that harm only one person, leprosy is indeed contagious and often affects many. It may harm neighbors and friends, or an entire family, leading to situations where marriage is impossible and lineage ends. Zhang Zi said, "Those who are paralyzed, suffering from strangury, or physically disabled are our brothers in distress without anyone to appeal to." Is this not true? However, ancient and modern texts rarely have dedicated books on treating this disease, and prescriptions are scarce. Quack doctors occasionally obtain one or two prescriptions, keep them as secret manuscripts, and use them to extort heavy fees. When asked about the disease etiology and drug properties, they are clueless. Skilled physicians, on the other hand, may shun the filth and neglect it, or attribute it to karmic retribution and fate, leaving sufferers with no medicine, leading to suicides by hanging or drowning, which happens frequently. I deeply pity this situation. After years of devoted study, having treated hundreds of patients, I compiled this book, outlining its principles and details, clarifying each point meticulously. It took three winters and summers and considerable effort. Readers of this book will not only learn to treat leprosy but also gain a general understanding of treating diseases according to channel differentiation. If those with sincere intentions widely promote and apply these methods, it will be one way we benefit people according to local conditions.
Written by the Master Xiaoting on the 9th day of the first month of early summer, in the first year of the Jiaqing reign.
The *Suwen: Treatise on the Essence and Subtleties of Pulse Diagnosis* states: "When the pulse is affected by wind, it becomes Li Feng (Leprosy)." In the *Treatise on Wind*, it says: "When wind-cold pathogens lodge in the vessels and do not depart, it is called Li Feng." Patients with Li Feng have heat in their Ying (Nutrient) and Wei (Defensive) levels, and their qi is impure, causing the nasal bridge to collapse, complexion to deteriorate, and skin to ulcerate.
The *Changci Chapter* states: "Severe wind disease presents with heavy joints and loss of eyebrows and beard, named Da Feng (Great Wind)."
The *Lingshu* states: "To treat Li Feng, puncture the swollen areas multiple times. After puncturing, use a sharp needle at the site, press to expel evil qi, and stop when the swelling subsides. Eat regular food, avoid other foods."
The *Qianjin Yifang* cites Qipo's treatment of severe diseases: "Wind diseases number four hundred types, but generally fall into five categories, governed by the Five Winds. What are the Five Winds? First, Yellow Wind; second, Green Wind; third, White Wind; fourth, Red Wind; fifth, Black Wind. These winds correspond to the Zang organs, hence the name Five Winds. The Five Winds generate five types of worms: Yellow Wind generates yellow worms, Green Wind generates green worms, White Wind generates white worms, Red Wind generates red worms, Black Wind generates black worms. These five worms consume the Zang organs. If they consume the Spleen, speech becomes altered and voice scattered; if they consume the Liver, eyebrows and eyelashes fall out; if they consume the Heart, sores appear all over the body; if they consume the Lungs, the nasal bridge collapses and polyps grow in the nose; if they consume the Kidneys, tinnitus occurs like the sound of thunder drums or moving carts; if they consume the Skin, the skin becomes numb and insensible; if they consume the Tendons, limbs and joints drop off. The Five Winds combine with the Zang organs, worms multiply excessively, enter the bone marrow, move freely, and damage the human body, named Ji Feng (Rapid Wind). Ji Feng is the root cause of Leprosy. At the onset of the disease, some feel like being pricked by needles, named Ci Feng (Pricking Wind); some feel like insects crawling, named You Feng (Wandering Wind); whole-body twitching, named Che Feng (Twitching Wind); no sensation of pain or itch, named Wan Feng (Stupid/Insensible Wind); flesh raised like small peach or jujube pits, starting from the head and face, named Shun Feng (Smooth Wind); starting from both feet, named Ni Feng (Reverse Wind); resembling linked coins or round shapes, with mottled red, white, green, black patterns, named KT Feng; or sores all over the body, resembling eczema or psoriasis, fish scales, elm seeds, or coin holes; itching or painful, flowing with yellow fluid, limbs and joints rotting into pus and blood; or neither itchy nor painful, appearing and disappearing, colors changing unpredictably among green, yellow, red, white, and black. The cause of onset is due to the interaction of cold and heat entering the Zang organs, penetrating the bone marrow, excessive physical exertion, improper diet, irregular sexual activity, deficiency and extreme fatigue, profuse sweating throughout the body. This leads to accumulated heat, allowing wind-heat to penetrate the Zang organs. Impure and mixed diet causes worms to multiply, consuming the Zang organs, bone marrow, skin, flesh, tendons, and joints. Over time, destruction occurs, named Li Feng."
Zhu Danxi stated: "Leprosy must be differentiated into upper and lower parts. For those in the upper part, use Zuixian San (Immortal Drunken Powder) to extract foul blood from between the teeth. For those in the lower part, use Tongtian Zaizai San (Sky-Penetrating Rebirth Powder) to expel foul matter and roundworms from the anus. Although the exit paths differ, both relate to the Yangming Channel. Observe where symptoms appear first: if mostly on the upper body, the disease is above; if mostly on the lower body, the disease is below; if both, the disease is in both. Why? The Yangming Channel governs the Stomach and Large Intestine, accepting everything, and is rich in Qi and Blood. When evil wind attacks, Qi involvement manifests more in the upper body, Blood involvement more in the lower body. If both Qi and Blood are involved, affecting both upper and lower, unless the physician is skilled and the patient resolute, few will succeed. Qi is Yang and Wei, Blood is Yin and Ying. Above the mid-body, Yang is affected first; below the mid-body, Yin is affected first. Thus, Zaizai San treats diseases in the Yin aspect, using Gelsemium spinosum thorns (Zaojiao Ci) to drive out wind toxins from the Ying-Blood. The Liver stores Blood; stagnant foul blood cannot move, generating worms. Treatment must focus on regulating Zang Qi and killing worms, using Rhubarb (Dahuang) to guide toxins into the intestines and bowels for expulsion. Zuixian San treats diseases in the Yang aspect, using Arctium fruit (Niubangzi) to drive wind toxins and sores from the body, Sesame (Huma) to dispel wind and tonify the Lungs, moistening the skin, Tribulus (Jili) to remove foul blood, relieve wind-itch, and open nasal passages, Saposhnikovia (Fangfeng) to treat various winds, Trichosanthes root (Gualougen) to resolve blood stasis and reduce heat-swelling, Goji berry (Gouqi) to clear wind-heat and detoxify sores, Vitex (Manjingzi) to drive away thief-wind, and Sophora root (Kushen) to clear heat-toxins. Crucially, Calomel (Qingfen) is used as a guiding agent to expel foul and toxic substances from the stomach, kill generated worms, travel up the channels to the soft gums, and discharge foul saliva. If teeth are damaged after taking the medicine, wipe them with Coptis powder (Huanglian), or add it initially to the formula to neutralize Calomel's toxicity. Calomel in Zuixian San has the power of capturing flags and slaying generals, creating the unique efficacy of this prescription, unmatched by others."
Xue Xinpu stated: "Leprosy ulcers affect not just one Zang organ, but Qi and Blood are invariably injured, and symptoms are invariably mixed. Since manifestations appear externally after accumulation, one must differentiate the upper and lower channels and examine the deficiency and excess of Qi and Blood. One should not indiscriminately use toxic-resolving drugs. Instead, one should first strengthen the Stomach and boost Qi to solidify the root, then treat the ulcers."
One must understand that Leprosy ulcers have different variations and similar presentations, requiring diverse treatments such as diaphoresis, purgation, scarification, acupuncture, moxibustion, and tonification. Similar presentations require assessing severity; variable presentations require distinguishing truth from falsehood. Treatment must weigh the patient's deficiency or excess and investigate the disease's origin before applying therapy. Deficiency refers to weak Zheng Qi (Upright Qi); Excess refers to strong Xie Qi (Evil Qi).
Zhang Hezi, skilled in acupuncture and scarification for Leprosy ulcers, claimed that one session of diaphoresis is worth a thousand gold pieces, because bleeding via acupuncture is less comprehensive than inducing sweat. Diaphoresis and bloodletting share the same principle. If foul blood stagnates in the muscles and channels, acupuncture or diaphoresis is suitable; bleeding from Weizhong (BL40) is effective. If toxic heat accumulates in the Zang organs, internal purgation is necessary for cure. If toxins are external, one must puncture all affected areas, including arms, legs, wrists, hands, feet, and finger webs, to disperse the toxin. If both exterior and interior are affected, external needling and internal purging are required to fully expel the toxin. If lesions are predominantly on the upper body, use Zuixian San to expel internal foul blood through the gums, and prick the fingernails and wrists to remove surface toxic blood. If lesions are predominantly on the lower body, use Zaizai San to expel foul blood and worms via the anus, and prick the toe webs and leg wrists. Repeat every one or two days until the blood turns bright red. If symptoms like chills, fever, or headache occur, treat according to the specific presentation.