【纲】仲景金匮曰。阳毒之为病。面赤斑斑如锦纹。咽喉痛。唾脓血。五日可治。七日不可治。
升麻鳖甲汤主之。
【目】朱肱曰。伤寒病。若阳气独盛。阴气暴绝。必发躁。狂走妄言。面赤咽痛。身斑斑若锦
纹。或下利赤黄。脉洪数。或滑促者。此名阳毒也。宜用酸苦之药。令阴气复而大汗解矣。葶苈苦
酒汤、阳毒升麻汤、大黄散、栀子仁汤、黑奴丸。可选用之。若阳毒倍常。躁盛大渴者。黑奴丸主之。
李 曰。伤寒三阳病深。必变为阳毒。或有失于汗下。或本阳症。误用热药。使热毒陷深。发
为狂乱。面赤眼红。身发斑黄。或下利黄赤。六脉洪大。名曰阳毒发斑。宜黑奴丸、三黄石膏汤、
消斑青黛饮。
楼英曰。伤寒先观两目。或赤或黄赤。为阳毒。脉洪大有力。燥渴者。轻则三黄石膏汤、三黄
巨胜汤。重则用大承气汤下之。外用水渍法。
吴绶曰。凡咽痛。有阴阳二毒。阳毒咽喉肿痛。乃热极也。阴毒咽喉不利。乃冷极也。阳毒脉
浮数而大。咽痛吐脓血。活
人用黑奴丸。又阳气独胜。狂躁咽痛。脉洪实滑。活人用葶苈苦酒汤。
徐彬曰。内经云。人伤于寒。皆为热病。然邪在阳经。久而炽盛。则为毒矣。故有阳毒之病。
其病乃热淫营卫。抟结于卫。上干咽喉。总是阳热。故炽于上焦。而肝脾之阴不交。面者。阳明之
气所注。故火热盛而面赤斑斑如锦纹也。咽喉虽有阴阳之分。大火所冲。玉石无分。故咽喉俱痛也。
阳经热盛。心火并之。心主血。则化而为脓。病在上焦。故唾也。阳毒病甚。虽非伤寒传经之比。
非人身经脉递运。五日经气未遍。故可治。七日则阴阳经气。已周而再行。故不可治。药用升麻鳖
甲汤。此热抟气血。不可直折。故以升麻合生甘草。升散热毒为主。而以雄黄解毒为臣。鳖甲、当
归以理其肝阴为佐。以蜀椒导其热气为使。非阳毒反起于阴经而用鳖甲也。盖治病之法。病在阳必
兼和其阴。亦即所谓病现于阳以阴法救之也。然非补也。
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[General Principle] Zhang Zhongjing stated in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): Yang Poison (Yang Du) is characterized by a red face with mottled rashes resembling brocade patterns, sore throat, and expectoration of pus and blood. If treated within five days, it is curable; if treatment is delayed until the seventh day, it becomes incurable.
The primary formula is Shengma Biejia Tang (Rhizoma Cimicifugae and Carapax Trionycis Decoction).
[Commentary] Zhu Gong said: In the course of Shanghan (Cold Damage), if Yang Qi alone becomes hyperactive while Yin Qi suddenly fails, restlessness, wild running, and delirious speech will inevitably occur. The patient presents with a red face, sore throat, body rashes resembling brocade patterns, or bloody-yellow diarrhea. The pulse may be flooding and rapid, or slippery and hurried. This condition is named Yang Poison. It is appropriate to use sour and bitter herbs to restore Yin Qi, allowing the disease to resolve through profuse sweating. Formulas such as Tingli Kujiu Tang (Descurainiae Semen and Vinegar Decoction), Yangdu Shengma Tang (Yang Poison Rhizoma Cimicifugae Decoction), Dahuang San (Rhubarb Powder), Zhizi Ren Tang (Gardeniae Seed Decoction), and Heinu Wan (Black Slave Pill) can be selected. If Yang Poison is exceptionally severe, accompanied by intense restlessness and extreme thirst, Heinu Wan (Black Slave Pill) should be used as the primary treatment.
Li said: When Shanghan (Cold Damage) penetrates deeply into the Three Yang channels, it must transform into Yang Poison. This may result from improper sweating or purging treatments, or from misapplying hot-natured herbs to an original Yang syndrome, causing heat toxin to sink deep and induce mania. Symptoms include a red face, red eyes, yellowish rashes on the body, or yellow-red diarrhea, with a flooding pulse in all six positions. This is called Yang Poison with Rash. Suitable formulas include Heinu Wan (Black Slave Pill), Sanhuang Shigao Tang (Three Yellow and Gypsum Decoction), and Xiaoban Qingdai Yin (Eliminate Rashes and Indigo Naturalis Drink).
Lou Ying said: In diagnosing Shanghan (Cold Damage), one must first observe the eyes. Redness or yellow-red discoloration indicates Yang Poison. With a flooding, forceful pulse and dryness-thirst, mild cases are treated with Sanhuang Shigao Tang (Three Yellow and Gypsum Decoction) or Sanhuang Jusheng Tang (Three Yellow and Sesame Decoction); severe cases require Dachengqi Tang (Major Order the Qi Decoction) for purging. Externally, the water immersion method can be applied.
Wu Shou said: Sore throats are categorized into Yin Poison and Yang Poison. Yang Poison presents with swollen and painful throat due to extreme heat; Yin Poison presents with throat obstruction due to extreme cold. Yang Poison features a floating, rapid, and large pulse, sore throat, and expectoration of pus and blood; the *Ren Jian Shu* recommends Heinu Wan (Black Slave Pill). Furthermore, if Yang Qi dominates exclusively, causing mania, restlessness, and sore throat with a flooding, solid, and slippery pulse, the *Ren Jian Shu* recommends Tingli Kujiu Tang (Descurainiae Semen and Vinegar Decoction).
Xu Bin said: The *Neijing* states that injury by cold always results in heat diseases. However, when pathogenic factors remain in the Yang channels for a long time, they become blazing and transform into toxins, giving rise to Yang Poison. The pathology involves heat overflowing in Ying (Nutritive) and Wei (Defensive) levels, knotting in the Wei level, and affecting the throat upwards. It is fundamentally Yang-heat, blazing in the Upper Jiao, preventing the intersection of Liver and Spleen Yin. The face is where Yangming Qi flows; thus, when fire-heat is excessive, the face turns red with mottled rashes like brocade. Although the throat has Yin-Yang distinctions, when great fire rushes forth, it affects both indiscriminately, hence the sore throat. Yang channel heat excess combines with Heart Fire. Since the Heart governs Blood, the blood transforms into pus due to heat. As the disease is in the Upper Jiao, it manifests as expectorating pus. Yang Poison is severe; although it does not follow the sequential transmission of Shanghan (Cold Damage), if treated within five days when Jing Qi has not yet circulated fully, it is treatable. By the seventh day, Yin-Yang Jing Qi has completed a cycle and begun again, implying exhaustion, making it incurable. The prescribed herb is Shengma Biejia Tang (Rhizoma Cimicifugae and Carapax Trionycis Decoction). Because heat knots in Qi and Blood, it cannot be directly suppressed. Therefore, Shengma (Rhizoma Cimicifugae) combined with raw Gancao (Radix Glycyrrhizae) serves as the chief herb to ascend and disperse heat-toxin; Xionghuang (Realgar) acts as the deputy herb to detoxify; Biejia (Carapax Trionycis) and Danggui (Radix Angelicae Sinensis) assist by regulating Liver Yin; Shujiao (Fructus Zanthoxyli) guides heat downward as the envoy herb. This is not because Yang Poison originates from Yin channels requiring Biejia. Generally, the principle of treatment dictates that when disease is in the Yang, one must harmonize the Yin, which is referred to as "treating Yang manifestations with Yin methods." However, this is not a tonification method.
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