此阴火之郁于上焦气分。而残暴其血中之清阳者。气分属阳而受毒。故曰阳毒。与俗称阳火亢热之毒不
涉。阳气受阴火之毒。不能载血流行。面为诸阳之合。故独赤。斑斑如锦纹。气病而不与血相入之象也。咽喉。
为清气上出之道。气从阴火之化。故痛。气伤则脓。气伤而血亦与之俱伤者。故吐脓亦吐血也。五日可治。五
日以内尚可治。七日不可治。谓七日以外则不可治矣。见急宜治之。迟则必死。警惕之词也。盖此及下文二
条。系邪火销铄真水之症。五日以内。为五行之生数。生而未成。则邪火尚易扑灭。故可治。七为火之成数。燎
原之势。便不可向迩矣。况七日以外乎。故不可治也。所谓五日可治。而主升麻鳖甲汤者。妙哉仲景。诚聪明
睿智。高视九天九地之下。而秋毫不遗者也。夫此症。原为阴邪之火。郁于上焦气分。而残暴其血中之清阳。
故用鳖甲为主。以鳖为水族疥虫。得金水之正。后天之水能制火。先天之丙伏于庚。合先后天而两治。阴邪
之火。焉有不服者哉。且鳖性属阴。而其甲属天象。是为阴中之阳。与补血之当归相合。则峻补残暴之阴。而
尤能行血中之气矣。雄黄、蜀椒。俱属味辛气重之品。味辛则能制伏阴火。气重。则又能专引鳖甲、当归。而入
于气分矣。且雄黄之气重于散。而不使阴火之毒。内郁于气机。蜀椒之气重于敛。而不使阴火之毒。上炎于
喉咽。然后以甘缓守中之甘草。兜托诸药之性。高理于上焦。以轻浮疏泄之升麻。薄引阴火之邪。分散于玄
窍。顿服者。取其力并也。老小再服。非老人小儿另行作服。盖一升分作再服之义。旧注谬甚。
阴毒之为病。面目青。身痛如被杖。咽喉痛。五日可治。七日不可治。升麻鳖甲汤。去雄黄蜀椒主之。
此阴火之郁于上焦营分。而残暴其血中之清阳者。营血属阴而受毒。故曰阴毒。与伤寒阴邪中脏之毒。不
涉。营血受阴火之毒。色不上华。故面青。又肝藏血。而开窍于目。营血伤于阴热。而肝气外应。故目亦青也。营
行脉中。营血热而脉络之气不舒。故身痛如被杖也。膻中为阳腑而多热。其别络。则内通心主之血。而外络
咽喉。阴火逼营阴。而膻中更热。故上逆于咽喉而刺痛也。五日以内可治。七日以外不可治。以阴火之毒。如
阴险阴毒之人。其阴狠忍酷。不问中气中血。俱不得因循养祸以待毙也。即主本汤而独去雄黄蜀椒者。以
阴火热邪。其中伤血分而耗血。与中伤气分而耗血颇同。故只消去其气分之使药。而已足矣。旧注牵扯疫
热阴寒。以释阴阳二毒。略无是处。
This is the depression of Yin Fire in the Qi aspect of the Upper Jiao, which cruelly damages the clear Yang within the Blood. The Qi aspect belongs to Yang and receives toxic pathogens, hence it is called Yang Toxic (Yang Du). This is unrelated to the common notion of toxicity caused by hyperactive Yang fire. When Yang Qi is poisoned by Yin Fire, it cannot carry the Blood in smooth circulation. Since the face is the convergence point of all Yang meridians, only the face becomes red, presenting with mottled spots like brocade patterns. This indicates a Qi pathology without mixing into the Blood. The throat is the pathway for clear Qi to ascend; when Qi transforms under Yin Fire, pain occurs. Damage to Qi leads to pus formation; since both Qi and Blood are injured together, purulent sputum is expectorated along with hematemesis. If treated within five days, recovery is possible; if beyond seven days, treatment is futile. This implies that after seven days, it becomes incurable. Upon seeing urgent symptoms, immediate treatment is required; delay will inevitably lead to death. These are words of warning. Generally, this clause and the following two clauses refer to conditions where pathogenic fire consumes True Water. Within five days corresponds to the "generative number" in Five Elements theory; life is generated but not yet fully formed, so pathogenic fire is still easy to extinguish, thus treatable. Seven is the "completed number" of Fire; once the fire spreads like a prairie blaze, it becomes uncontrollable, let alone after seven days. Hence, it is untreatable. The fact that Zhang Zhongjing prescribed Shengma Biejia Tang (Cimicifugae Rhizoma and Turtle Shell Decoction) for treatability within five days shows his profound wisdom. He was truly intelligent and insightful, observing everything from the highest heavens to the deepest earth, missing nothing minute. This condition originates from Yin pathogenic fire depressing in the Qi aspect of the Upper Jiao and damaging the clear Yang in the Blood. Therefore, Bie Jia (Turtle Shell) is used as the principal herb. As an aquatic creature with a shell, Bie Jia embodies the correct energies of Metal and Water. Postnatal Water can control Fire, while Prenatal Bing Fire lies hidden under Geng Metal, allowing treatment through both prenatal and postnatal mechanisms. How could Yin pathogenic fire not submit? Moreover, the nature of the turtle is Yin, but its shell corresponds to Heaven, making it "Yin containing Yang." Combined with Dang Gui (Angelicae Sinensis Radix), which nourishes Blood, it vigorously tonifies the damaged Yin and promotes the movement of Qi within the Blood. Xiong Huang (Realgar) and Shu Jiao (Sichuan Pepper) are substances with pungent flavors and heavy qi. Pungency subdues Yin Fire, while heavy qi guides Bie Jia and Dang Gui specifically into the Qi aspect. Furthermore, the qi of Xiong Huang is heavy and dispersing, preventing Yin Fire toxicity from stagnating internally in the Qi mechanism; the qi of Shu Jiao is heavy and astringent, preventing Yin Fire toxicity from flaring upward into the throat. Finally, Gan Cao (Licorice Root), with its sweet,緩 (soothing) and central-stabilizing properties, anchors the actions of the other herbs, keeping them high in the Upper Jiao. Sheng Ma (Cimicifugae Rhizoma), being light and floating with dispersing and draining properties, gently guides the Yin Fire pathogen to disperse through the Xuan Qiao (pores/sweat glands). Taking the dose at once concentrates the medicinal force. Administering it again to the elderly and young does not mean preparing a separate decoction for them, but rather dividing one sheng (a unit of volume) into two doses. Old annotations are severely erroneous.
The disease of Yin Toxic presents with bluish-green complexion, body pain as if beaten with a club, and sore throat. It is treatable within five days and untreatable beyond seven days. The primary prescription is Shengma Biejia Tang (Cimicifugae Rhizoma and Turtle Shell Decoction), removing Xiong Huang (Realgar) and Shu Jiao (Sichuan Pepper).
This is the depression of Yin Fire in the Ying (Nutrient) aspect of the Upper Jiao, which cruelly damages the clear Yang within the Blood. The Ying-Blood aspect belongs to Yin and receives toxic pathogens, hence it is called Yin Toxic. This is unrelated to the toxicity of Yin pathogens invading the Zang organs in Shang Han (Cold Damage) diseases. When Ying-Blood is poisoned by Yin Fire, its luster fails, resulting in a bluish complexion. Additionally, the Liver stores Blood and opens into the eyes; when Ying-Blood is injured by Yin-Heat, the Liver Qi manifests externally, causing the eyes to also appear blue/green. Ying Qi circulates within the vessels; when Ying-Blood is hot and the Qi in the collaterals is constrained, body pain resembling blows from a club occurs. Dan Zhong (Conception Vessel area/Chest center) is a Yang Fu organ prone to heat, with collateral networks connecting internally to the Heart Master's Blood and externally to the throat. Yin Fire forces the Ying-Yin, causing further heat in Dan Zhong, which then rebels upward into the throat, causing stabbing pain. Treatable within five days, untreatable beyond seven days. The toxicity of Yin Fire is like that of a treacherous and venomous person: ruthless and cruel. Regardless of whether it injures Middle Qi or Middle Blood, one must not indulge in negligence, nurture disaster, and wait for death. Although the main formula is used, Xiong Huang and Shu Jiao are removed because Yin-Heat pathogenic fire injuring the Blood aspect and consuming Blood is similar to injuring the Qi aspect and consuming Blood. Thus, removing only the guiding herbs for the Qi aspect is sufficient. Old annotations attempting to explain Yin and Yang Toxic by referencing epidemic heat and Yin-cold are completely unfounded.