鬓疽三焦胆二经,证由欲怒火凝成,此经气多而血少,溃腐惟宜少见脓。
\r鬓疽图\p04-34a29.bmp\r
【注】此证发于鬓角,属手少阳三焦、足少阳胆二经,由于相火妄动,外受风热,更
因性情急怒,欲念火生,凝结而成。此二经俱属气多血少,最难腐溃,更兼鬓角肌肉,浇
薄不宜针灸,候其自溃。溃后不宜多见脓,脓多者过耗血液难敛。初起宜服柴胡清肝汤解
之,脓成者宜托里消毒散托之,外敷二味拔毒散。已溃内外治法,俱按痈疽溃疡门。
柴胡清肝汤
柴胡 生地(各一钱五分) 当归(二钱) 赤芍(一钱五分) 川芎(一钱) 连翘(去心,二钱) 牛蒡子
(炒、研,一钱五分) 黄芩(一钱) 生栀子(研) 天花粉 甘草节 防风(各一钱)
水二盅,煎八分,食远服。
【方歌】柴胡清肝治怒证,宣血疏通解毒良,四物生用柴翘蒡,黄芩栀粉草节防。
托里消毒散 二味拔毒散(俱见肿疡门)
夭疽居左锐毒右,经属胆腑生耳后,谋虑太过郁火成,此处肉薄当急救。
\r夭疽锐毒图\p04-34a30.bmp\r
【注】此二证左为夭疽,右为锐毒,俱生耳后一寸三分高骨之后。夭者,不尽天年谓
之夭;锐者,如锋刃之锐利,言毒甚也。得此二证,愈者甚少。初起俱如黍粒,渐肿如
瓜,坚硬平塌,紫暗不泽,较诸疮疼痛倍增。名虽各异,而左右耳后,俱属足少阳胆经,由
谋虑不决,郁火凝结而成。此处皮肉浇薄,气多血少,终属险证,急当治之。迟则热气下
入渊液,前伤任脉,内熏肝肺,恶证悉添,必致不救。若红肿速溃者顺,坚硬黑陷者逆。如
果投方应证,亦只十全四五也。初宜服柴胡清肝汤消解之,脓将成宜服托里消毒散,虚
者十全大补汤托补之,外俱敷乌龙膏,其余内外治法,俱按痈疽肿溃疡门(渊液,胆经穴名)。
柴胡清肝汤(见前鬓疽)
托里消毒散 乌龙膏(俱见肿疡门)
十全大补汤(见溃疡门)
Bristle abscess (Binju) occurs in the Hand-Shaoyang Sanjiao Meridian and Foot-Shaoyang Gallbladder Meridian. The syndrome is formed by the condensation of desire-fire and anger qi. These two meridians are characterized by abundant qi and scarce blood; therefore, after ulceration, the discharge of pus should not be excessive.
[Annotation] This syndrome manifests at the sideburns, belonging to the Hand-Shaoyang Sanjiao Meridian and the Foot-Shaoyang Gallbladder Meridian. The etiology involves hyperactive ministerial fire, external invasion of wind-heat, combined with an irritable temperament and anger, where desires generate internal fire, leading to condensation of qi and blood. Both meridians belong to the category of abundant qi and scarce blood, making it difficult for tissue to necrose and suppurate. Furthermore, the muscles at the sideburns are thin, making acupuncture and moxibustion unsuitable; one should wait for natural rupture. After rupture, excessive pus is undesirable, as it indicates excessive consumption of blood and fluids, hindering wound healing. In the initial stage, Chaihu Qinggan Tang (Caulis Bupleuri Liver-Clearing Decoction) is indicated to resolve the pathogen. When pus has formed, Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) is used to support the healthy qi and expel toxins. Externally, Ermiao Baidu San (Two-Ingredient Antidote Powder) is applied. For treatment methods after ulceration, refer to the section on Carbuncles and Ulcers.
Chaihu Qinggan Tang (Caulis Bupleuri Liver-Clearing Decoction)
Ingredients: Caulis Bupleuri (Chaihu), Rhizoma Anemarrhenae (Zhimu - *Note: Text says Shengdi, correcting to standard text if implied, but strictly following input: Radix Rehmanniae Preparata/Shengdihuang*), Radix Angelicae Sinensis (Danggui), Radix Paeoniae Rubra (Chishao), Rhizoma Chuanxiong (Chuanxiong), Fructus Forsythiae (Lianqiao), Semen Arctii (Niubangzi), Radix Scutellariae (Huangqin), Fructus Gardeniae Jasminoidis (Zhizi), Radix Trichosanthis (Tianhuafen), Radix Glycyrrhizae (Gancao), Radix Saposhnikoviae (Fangfeng).
*Correction based on strict input text:* Caulis Bupleuri (Chaihu), Radix Rehmanniae Recens (Shengdi), Radix Angelicae Sinensis (Danggui), Radix Paeoniae Rubra (Chishao), Rhizoma Chuanxiong (Chuanxiong), Fructus Forsythiae (Lianqiao), Semen Arctii (Niubangzi), Radix Scutellariae (Huangqin), Fructus Gardeniae Jasminoidis (Zhizi), Radix Trichosanthis (Tianhuafen), Radix Glycyrrhizae (Gancao), Radix Saposhnikoviae (Fangfeng).
Dosage: Chaihu, Shengdi (each 1.5 qian); Danggui (2 qian); Chishao (1.5 qian); Chuanxiong (1 qian); Lianqiao (decentered, 2 qian); Niubangzi (stir-fried and crushed, 1.5 qian); Huangqin (1 qian); Zhizi (raw, crushed); Tianhuafen; Gancao Jie (Gancao nodes); Fangfeng (each 1 qian).
Preparation: Decoct in two cups of water until reduced to eight-tenths. Take after meals.
[Prescription Verse] Chaihu Qinggan Tang treats syndromes caused by anger, promoting blood circulation, unblocking collaterals, and detoxifying effectively. It uses Siwu Tang ingredients raw, combined with Chaihu, Lianqiao, and Niubangzi, along with Huangqin, Zhizi, Tianhuafen, Gancao Jie, and Fangfeng.
Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) and Ermiao Baidu San (Two-Ingredient Antidote Powder) are both described in the chapter on Swollen Sores (Zhongyang).
Tianju (Premature Death Abscess) appears on the left, and Ruidu (Sharp Toxicity) appears on the right. These conditions belong to the Gallbladder Fu-organ and manifest behind the ear. They are caused by excessive deliberation leading to stagnant fire. Since the flesh here is thin, urgent treatment is required.
[Annotation] These two syndromes are named Tianju on the left and Ruidu on the right, both occurring behind the high bone one inch and three fen behind the ear. "Tian" refers to dying prematurely without fulfilling one's natural lifespan; "Rui" means sharp or keen, indicating severe toxicity. Few patients recover from these conditions. Initially, they appear like millet grains, gradually swelling to the size of a melon, becoming hard, flat, purple-dark, and lusterless. The pain is significantly more intense than other sores. Although named differently, both locations behind the left and right ears belong to the Foot-Shaoyang Gallbladder Meridian. They result from indecisive deliberation and condensation of stagnant fire. The skin and flesh here are thin, with abundant qi and scarce blood, ultimately constituting a dangerous syndrome requiring immediate treatment. Delay allows heat qi to descend into the Yuanli point (GB12), damage the Ren Mai (Conception Vessel) anteriorly, and internally熏 (smolder/burn) the Liver and Lungs, causing all malignant symptoms to appear, inevitably leading to death. Rapid redness, swelling, and suppuration indicate a favorable prognosis (Shun); hardness and black depression indicate an unfavorable prognosis (Ni). Even with correct prescription matching, only four or five out of ten cases may be cured. Initially, Chaihu Qinggan Tang is taken to dissipate the pathogen. As pus forms, Tuoli Xiaodu San is taken. For deficient patients, Shiquan Dabu Tang (Ten-Ingredient Great Tonifying Decoction) is used to support and tonify. Externally, Wulong Gao (Black Dragon Ointment) is applied. Other internal and external treatments follow the chapter on Carbuncles, Swollen Sores, and Ulcers. (Yuanli is an acupoint of the Gallbladder Meridian).
Chaihu Qinggan Tang (See above under Binju)
Tuoli Xiaodu San and Wulong Gao are both described in the chapter on Swollen Sores (Zhongyang).
Shiquan Dabu Tang is described in the chapter on Ulcers (Kuailang).