大凡疮疾有五善七恶之证。不可不察也。烦躁时嗽。腹痛渴甚。或泄利无度。或小便如淋。一
恶也。脓血大泄。肿 尤甚。脓血败臭。痛不可近。二恶也。喘粗短气。恍惚嗜卧。三恶也。目视
不正。黑睛紧小。白睛反青。瞳子上看。四恶也。肩项不便。四肢沉重。五恶也。不能下食。服药
则呕。食不知味。六恶也。声嘶色败。口鼻青赤。面目四肢浮肿。七恶也。动息自宁。饮食知味。
一善也。便利调匀。二善也。脓溃肿消。色鲜不臭。三善也。神彩精明。语言清爽。四善也。体气
和平。五善也。若五善见三则瘥。七恶见四则危。然则病有源同七恶。皮紧急者如善。病有源同五
善。皮缓虚者如恶。夫如是者岂凡医之所知哉。若五善病至。则妙无以加也。如七恶并臻。则恶之
剧矣。
丁巳岁。予从军回。住冬于曹州界。以事至州。有赵同知谓予曰。家舅牛经历。病头面赤肿。
耳前后尤甚。疼
痛不可忍。发热恶寒。牙关紧急。涕唾稠粘。饮食难下。不得安卧。一疡医于肿上砭刺四五百余针
。肿赤不减。其痛益甚。不知所由然。愿请君一见。予遂往诊。视其脉浮紧。按之洪缓。此证乃寒
覆皮毛。郁遏经络。热不得升。聚而赤肿。经云。天寒则地冻水冰。人气在身中。皮肤致密。腠理
闭。汗不出。血气强。内坚涩。当是之时。善行水者不能注冰。善穿地者不能凿冻。善用针者亦不
得取四厥。必待天温冰释冻解。而后水可行。地可穿。人脉亦犹是也。又云。冬月闭藏。用药多而
少针石也。宜以苦温之剂。温经散寒则已。所谓寒致腠理。以苦发之。以辛散之。宜以托里温经汤
。麻黄苦温。发之者也。故以为君。防风辛温。散之者也。升麻苦辛。葛根甘平。解肌出汗。专治
阳明经中之邪。故以为臣。血留而不行者则痛。以香白芷、当归身辛温以和血散滞。湿热则肿。苍
术苦甘温。体轻浮。力雄壮。能泄肤腠间湿热。人参、甘草甘温。白芍药酸微寒、调中益气。使托
其里。故以为佐。根据方饵之。以薄衣覆其首。以浓被覆其身。卧于暖处。使经血温。腠理开。寒乃
散。阳气伸。大汗出。后肿减八九分。再服去麻黄、防风。加连翘、黍粘子。肿痛悉去。经言汗之
则疮已。信哉斯言。或人以仲景言。疮家虽身肿痛。不可发汗。其理何也。予曰。此说乃营气不从
。逆于肉理而患疮肿。作身疼痛。非外感寒邪而作疼痛。故戒之以不可发汗。若汗之则成 也。又
问仲景言鼻衄者不可发汗。复言脉浮紧者。当以麻黄汤发之。衄血自止。所说不同。其故何也。愿
闻其说。予曰。此议论血正与疮家概同。且夫人身血之与汗。异名而同类。夺汗者无血。夺血者无
汗。今衄血妄行。为热所逼。更发其汗。反助邪热。重竭津液。必变凶证。故不可汗。若脉浮则为
在表。脉紧则为寒。寒邪郁遏。阳不得伸。热伏荣中。迫血妄行。上出于鼻。
则当麻黄汤散其寒邪。使阳气得舒。其衄自止。又何疑焉。或者叹曰。知其要者。一言而终。不知
其要。流弊无穷。洁古之学。可谓知其要者矣。
【托里温经汤】治寒覆毛皮。郁遏经络。不得伸越。热伏荣中。聚而为赤肿。痛不可忍。
恶寒发热。或相引肢体疼痛。
人参（去芦） 苍术（各一钱） 白芍药 甘草（炙。各一钱半）
白芷 当归身 麻黄（去根节。各二钱） 防风（去芦）
葛根（各三钱） 新升麻（四钱）
上 咀。每服一两重。水三盏。先煎麻黄令沸。去沫。再下余药同煎。至一盏。去渣。大温服
讫。卧于暖处。以绵衣覆之。得汗而散。
Generally, sores and ulcers present with five favorable (Shan) and seven unfavorable (E) syndromes. These must be carefully examined.
Irritability accompanied by occasional coughing, abdominal pain with extreme thirst, or uncontrolled diarrhea, or dysuria resembling strangury—this is the first unfavorable sign.
Profuse discharge of pus and blood, worsening swelling, foul-smelling putrid pus and blood, and severe pain that cannot be tolerated to touch—this is the second unfavorable sign.
Rapid and short breathing, mental confusion, and excessive drowsiness—this is the third unfavorable sign.
Abnormal gaze, tight and small black pupils, greenish hue in the whites of the eyes, and upward deviation of the pupils—this is the fourth unfavorable sign.
Stiffness and inconvenience in the shoulders and neck, and heaviness in the four limbs—this is the fifth unfavorable sign.
Inability to eat, vomiting after taking medicine, and loss of taste—this is the sixth unfavorable sign.
Hoarseness, deteriorated complexion, bluish-red color around the mouth and nose, and edema of the face, eyes, and four limbs—this is the seventh unfavorable sign.
Calm breathing and awareness of taste—this is the first favorable sign.
Regular bowel movements and urination—this is the second favorable sign.
After pus discharges, swelling subsides, the color is fresh, and there is no foul odor—this is the third favorable sign.
Bright spirit and clear speech—this is the fourth favorable sign.
Harmonious body qi—this is the fifth favorable sign.
If three of the five favorable signs are present, the disease will heal. If four of the seven unfavorable signs appear, the condition is critical. However, diseases with the same origin may present as seven unfavorable signs, yet if the skin is tense, it resembles a favorable sign; diseases with the same origin may present as five favorable signs, yet if the skin is loose and deficient, it resembles an unfavorable sign. Such cases, can they be known by ordinary physicians? If the five favorable signs manifest, nothing could be better. If all seven unfavorable signs converge, the evil pathogen is at its most severe.
In the Ding Si year, I returned from military service and stayed in winter within the jurisdiction of Caozhou. Due to some matters, I went to the prefecture. A Zhao Tongzhi said to me: "My uncle, Niu Jingli, suffers from red and swollen head and face, especially severe around the ears. The pain is unbearable, accompanied by fever and aversion to cold, trismus (lockjaw), thick and sticky sputum and nasal discharge, difficulty swallowing food, and inability to lie down peacefully. A surgeon applied cupping-needle therapy (Bianci) with over four or five hundred punctures on the swelling, but the redness and swelling did not decrease, and the pain increased. We do not know the cause. We wish for you to examine him." I then went to diagnose. His pulse was floating and tight, but deep pressing revealed it to be surging and slow. This syndrome is caused by cold covering the hair and skin, obstructing the meridians, preventing heat from ascending, causing it to gather and result in redness and swelling. The Classics state: "When heaven is cold, the earth freezes and water turns to ice. In the human body, the skin becomes dense, the cou-li (pores) close, sweat does not emerge, blood and qi become strong, and the interior becomes firm and stagnant. At this time, even those skilled in managing water cannot make ice flow, and those skilled in digging cannot pierce frozen ground. Even those skilled in acupuncture cannot treat tetanus (Si Jue). One must wait for warm weather, melting ice, and thawing ground before water can flow and earth can be dug. Human meridians are similar." It also states: "In winter, when storage prevails, medicines are used more frequently than needles and stones." It is appropriate to use bitter-warm agents to warm the meridians and dispel cold. As stated, cold causes the closure of cou-li; it should be dispersed with bitter agents and scattered with pungent agents. Toli Wenjing Tang (Support Interior and Warm Meridian Decoction) is suitable. Mahuang (Ephedrae Herba) is bitter and warm, serving as a dispersing agent, thus acting as the Sovereign herb. Fangfeng (Saposhnikoviae Radix) is pungent and warm, serving as a scattering agent. Shengma (Cimicifugae Rhizoma) is bitter and pungent, Gegen (Puerariae Lobatae Radix) is sweet and neutral; they resolve the muscle layer and induce sweating, specifically treating pathogens in the Yangming meridian, thus acting as Ministers. Stagnant blood causes pain; Xiang Baizhi (Angelicae Dahuricae Radix) and Danggui Shen (Angelicae Sinensis Radix - root body) are pungent and warm to harmonize blood and dissipate stagnation. Damp-heat causes swelling; Cangzhu (Atractylodis Rhizoma) is bitter, sweet, and warm, light in texture, and powerful in action, capable of draining damp-heat from the cou-li. Renshen (Ginseng Radix) and Gancao (Glycyrrhizae Radix et Rhizoma) are sweet and warm; Shaoyao (Paeoniae Radix Alba) is sour and slightly cold; they regulate the middle and boost qi, supporting the interior, thus acting as Assistants. Following this prescription, cover the head with thin clothing and the body with thick blankets, lie in a warm place to warm the meridians and blood, open the cou-li, scatter the cold, extend the yang qi, and induce profuse sweating. Afterward, the swelling and pain reduced by eight or nine parts. For the next dose, remove Mahuang and Fangfeng, add Lianqiao (Forsythiae Fructus) and Niu Bang Zi (Arctii Fructus), and the swelling and pain completely disappeared. The Classics say, "Inducing sweating cures sores," truly these words are credible. Someone asked: "Zhang Zhongjing stated that although patients with sores have body pain and swelling, they should not be induced to sweat. What is the rationale?" I replied: "This statement refers to Ying Qi (Nutritive Qi) failing to follow its course, reversing in the muscle tissue causing sores and swelling, resulting in body pain, not pain caused by external cold pathogens. Therefore, it warns against sweating. If sweating is induced, it leads to complications." He further asked: "Zhang Zhongjing stated that those with epistaxis should not be induced to sweat, yet also stated that those with a floating and tight pulse should be treated with Mahuang Tang to induce sweating, after which the epistaxis stops naturally. The statements differ; what is the reason?" I replied: "The discussion on blood conditions is similar to that of sore patients. Blood and sweat in the human body have different names but are of the same category. Depriving sweat results in lack of blood; depriving blood results in lack of sweat. Now, spontaneous epistaxis is forced by heat. Inducing sweat again would further assist the pathogenic heat and deplete fluids, inevitably leading to ominous signs. Hence, sweating is contraindicated. If the pulse is floating, the pathogen is in the exterior; if tight, it indicates cold. Cold pathogens obstruct, preventing Yang Qi from extending. Heat hides in the Ying level, forcing blood to move recklessly and exit through the nose. In this case, Mahuang Tang should be used to scatter the cold pathogen, allowing Yang Qi to relax, and the epistaxis will stop naturally. Is there any doubt?" The person sighed and said: "Those who understand the essentials need only one word to conclude; those who do not understand face endless complications. Jiegu's (Zhang Yuansu's) learning can be said to understand the essentials."
[Toli Wenjing Tang] Treats cold covering the hair and skin, obstructing the meridians, preventing extension and transcendence, heat hiding in the Ying level, gathering to form redness and swelling, unbearable pain, aversion to cold and fever, or pain radiating to the limbs.
Renshen (Ginseng Radix) (remove rhizome) 1 qian
Cangzhu (Atractylodis Rhizoma) 1 qian
Shaoyao (Paeoniae Radix Alba)
Gancao (Glycyrrhizae Radix et Rhizoma) (roasted) 1.5 qian
Baizhi (Angelicae Dahuricae Radix)
Danggui Shen (Angelicae Sinensis Radix - root body)
Mahuang (Ephedrae Herba) (remove roots and joints) 2 qian
Fangfeng (Saposhnikoviae Radix) (remove rhizome)
Gegen (Puerariae Lobatae Radix) 3 qian
Xin Shengma (Cimicifugae Rhizoma) 4 qian
Cut the herbs into pieces. Take 1 liang per dose. Add 3 cups of water. First decoct Mahuang until boiling, skim off the foam. Then add the remaining herbs and decoct together until 1 cup remains. Strain. Drink warm. Lie in a warm place and cover with cotton clothes. Obtain sweating to resolve the condition.