陈右 阴虚痰热结于脉络,项左痰核破溃,近及结喉, 骨肿痛,四肢酸楚,阴血亏耗,营卫不能流通。拟
养阴清络法。
羚羊尖(八分) 小生地(四钱) 炙鳖甲(三钱) 全当归(二钱) 粉丹皮(二钱) 京玄参(二钱)
京赤芍(二钱) 天花粉(三钱) 川黄柏(一钱) 丝瓜络(二钱) 大贝母(三钱) 竹二青(二钱)
外用海浮散、太乙膏。
黄右 少阳相火,挟痰上升,颈左痰核,肿突坚硬,劳则作痛,并起水泡,防其破溃。拟养阴清肝。
羚羊尖(八分) 粉丹皮(二钱) 京赤芍(二钱) 全当归(二钱) 京玄参(二钱) 大贝母(三钱)
炙僵蚕(三钱) 夏枯草(二钱) 广橘红(八分) 海蛤粉(四钱) 淡海藻(二钱) 连翘壳(三钱)
海蜇皮(漂淡,二两) 大荸荠(洗打、两味煎汤代水,二两)
费右 盘颈痰毒半月,势将成脓。
熟牛蒡(二钱) 大贝母(三钱) 炙僵蚕(三钱) 粉丹皮(二钱) 京赤芍(二钱) 酒炒黄芩(二钱)
陈广皮(一钱) 粉甘草
六分) 夏枯草(二钱) 竹二青(二钱) 小金丹(陈酒化服,一粒)
外用金箍散,金黄散,葱汁,白蜜调,炖温敷。
鲍左 锁喉痰毒,漫肿疼痛,根盘 红,风温痰热,蕴结上焦。拟辛凉清解。
荆芥穗(一钱) 青防风(一钱) 薄荷叶(八分) 炒牛蒡(二钱) 生草节(八分) 苦桔梗(一钱)
轻马勃(八分) 大贝母(三钱) 炙僵蚕(三钱) 金银花(三钱) 连翘壳(三钱) 海蛤粉(四钱) 六
神丸(吞服,十粒)
二诊 清解后,证象较松,药既合病,仍宗原法进步。
薄荷叶(八分) 生草节(八分) 大贝母(三钱) 熟牛蒡(二钱) 苦桔梗(一钱) 炙僵蚕(二钱)
青防风(一钱) 轻马勃(八分) 京赤芍(二钱) 金银花(三钱) 海蛤粉(三钱) 山慈菇片(八分)
六神丸(吞服,十粒)
周左 痰毒漫肿作痛,酿脓之兆。宜与和托,以冀一溃,症自安矣。
薄菏叶(八分) 熟牛蒡(二钱) 京赤芍(二钱) 生草节(六分) 苦桔梗(一钱) 轻马勃(八分)
大贝母(三钱) 炙僵蚕(三钱) 山慈菇片(八分) 炙甲片(一钱五分) 皂角针(一钱五分) 丝瓜络(二钱)
陈姓患者,右侧。阴虚体质,痰热之邪结聚于脉络之中,左侧颈部出现痰核并已破溃,病灶蔓延至结喉部位,伴有骨骼肿痛,四肢酸楚不适。因阴血亏耗,导致营气与卫气运行不畅。治疗拟采用养阴清络之法。
处方:羚羊角尖(八分)、小生地(四钱)、炙鳖甲(三钱)、全当归(二钱)、粉丹皮(二钱)、京玄参(二钱)、京赤芍(二钱)、天花粉(三钱)、川黄柏(一钱)、丝瓜络(二钱)、大贝母(三钱)、竹二青(二钱)。
外用海浮散、太乙膏敷贴。
黄姓患者,右侧。少阳相火旺盛,挟带痰浊上升,左侧颈部痰核肿胀突起且质地坚硬,劳累后疼痛加剧,并起水泡,需防止其破溃。治疗拟采用养阴清肝之法。
处方:羚羊角尖(八分)、粉丹皮(二钱)、京赤芍(二钱)、全当归(二钱)、京玄参(二钱)、大贝母(三钱)、炙僵蚕(三钱)、夏枯草(二钱)、广橘红(八分)、海蛤粉(四钱)、淡海藻(二钱)、连翘壳(三钱)、海蜇皮(漂洗去咸味,二两)、大荸荠(洗净捣碎,这两味药煎汤代替水煎药,二两)。
费姓患者,右侧。颈部盘绕状痰毒已半月,病情即将化脓。
处方:熟牛蒡子(二钱)、大贝母(三钱)、炙僵蚕(三钱)、粉丹皮(二钱)、京赤芍(二钱)、酒炒黄芩(二钱)、陈广皮(一钱)、粉甘草(六分)、夏枯草(二钱)、竹二青(二钱)、小金丹(用陈年黄酒化开服用,一粒)。
外用金箍散、金黄散,用葱汁和白蜜调匀,炖温后敷贴患处。
鲍姓患者,左侧。锁喉痰毒,漫肿疼痛,根部周围发红,属风温痰热蕴结于上焦。治疗拟采用辛凉清解之法。
处方:荆芥穗(一钱)、青防风(一钱)、薄荷叶(八分)、炒牛蒡子(二钱)、生草节(八分)、苦桔梗(一钱)、轻马勃(八分)、大贝母(三钱)、炙僵蚕(三钱)、金银花(三钱)、连翘壳(三钱)、海蛤粉(四钱)、六神丸(吞服,十粒)。
第二次就诊:经过清解治疗后,症状表现较为舒缓,药物既然契合病情,仍遵循原法继续治疗以推进疗效。
处方:薄荷叶(八分)、生草节(八分)、大贝母(三钱)、熟牛蒡子(二钱)、苦桔梗(一钱)、炙僵蚕(二钱)、青防风(一钱)、轻马勃(八分)、京赤芍(二钱)、金银花(三钱)、海蛤粉(三钱)、山慈菇片(八分)、六神丸(吞服,十粒)。
周姓患者,左侧。痰毒漫肿作痛,有酿脓的征兆。适宜采用和托之法,期望通过溃破排脓,病症自然安宁。
处方:薄荷叶(八分)、熟牛蒡子(二钱)、京赤芍(二钱)、生草节(六分)、苦桔梗(一钱)、轻马勃(八分)、大贝母(三钱)、炙僵蚕(三钱)、山慈菇片(八分)、炙甲片(一钱五分)、皂角针(一钱五分)、丝瓜络(二钱)。
Patient Chen, Right side. Yin deficiency with phlegm-heat binding in the collaterals; a phlegma nodule (Phlegma Nodule) on the left neck has ulcerated, extending to the larynx (Larynx), accompanied by bone swelling and pain, and soreness/heaviness in the four limbs. Due to the depletion of yin-blood, Ying (Nutritive Qi) and Wei (Defensive Qi) fail to circulate smoothly. The proposed treatment is to nourish yin and clear the collaterals.
Prescription: Antelope Horn Tip (Lingyang Jiao, 8 fen), Little Rehmannia Root (Xiao Shengdi, 4 qian), Prepared Turtle Shell (Zhi Biejia, 3 qian), Whole Angelica Sinensis (Quan Danggui, 2 qian), Powdered Moutan Cortex (Fen Danpi, 2 qian), Jing Scrophularia Root (Jing Xuanshen, 2 qian), Jing Red Peony Root (Jing Chishao, 2 qian), Trichosanthes Root (Tianhuafen, 3 qian), Sichuan Phellodendron Bark (Chuan Huangbai, 1 qian), Luffa Vine Network (Sigualuo, 2 qian), Large Fritillaria Bulb (Da Beimu, 3 qian), Bamboo Sap (Zhu Erqing, 2 qian).
External application: Haifu San (Sea Floating Powder), Taiyi Gao (Taiyi Plaster).
Patient Huang, Right side. Shaoyang Ministerial Fire, carrying phlegm upward; a phlegma nodule on the left neck is swollen, protruding, and hard. Pain worsens with exertion, and blisters have appeared; prevention of ulceration is advised. The proposed treatment is to nourish yin and clear the liver.
Prescription: Antelope Horn Tip (Lingyang Jiao, 8 fen), Powdered Moutan Cortex (Fen Danpi, 2 qian), Jing Red Peony Root (Jing Chishao, 2 qian), Whole Angelica Sinensis (Quan Danggui, 2 qian), Jing Scrophularia Root (Jing Xuanshen, 2 qian), Large Fritillaria Bulb (Da Beimu, 3 qian), Prepared Silkworm (Zhi Jiangcan, 3 qian), Prunella Spike (Xiakucao, 2 qian), Broad Tangerina Peel (Guang Juhong, 8 fen), Clam Shell Powder (Haige Fen, 4 qian), Light Seaweed (Dan Zaocai, 2 qian), Forsythia Fruit Shell (Lianqiao Qiao, 3 qian), Jellyfish Skin (Hai Zhe Pi, rinsed to remove salt, 2 liang), Large Water Chestnut (Da Biqi, washed and crushed, these two ingredients decocted as water substitute, 2 liang).
Patient Fei, Right side. Neck coiling phlegma-toxin for half a month, condition approaching suppuration (formation of pus).
Prescription: Prepared Arnebia/Buddleja Seed (Shu Niubang, 2 qian), Large Fritillaria Bulb (Da Beimu, 3 qian), Prepared Silkworm (Zhi Jiangcan, 3 qian), Powdered Moutan Cortex (Fen Danpi, 2 qian), Jing Red Peony Root (Jing Chishao, 2 qian), Wine-fried Scutellaria Root (Jiu Chao Huangqin, 2 qian), Aged Tangerina Peel (Chen Guangpi, 1 qian), Powdered Licorice Root (Fen Gancao, 6 fen), Prunella Spike (Xiakucao, 2 qian), Bamboo Sap (Zhu Erqing, 2 qian), Xiao Jin Dan (Little Golden Pill, dissolved in aged yellow wine and taken orally, 1 pill).
External application: Jin Gu San (Golden Hoop Powder), Jin Huang San (Golden Yellow Powder), mixed with green onion juice and white honey, warmed in a steamer, and applied externally.
Patient Bao, Left side. Lock-throat phlegma-toxin, diffuse swelling and pain, redness at the root base. Wind-warmth phlegm-heat accumulating in the Upper Jiao (Upper Burner). The proposed treatment is acrid-cool clearing and resolving.
Prescription: Schizonepeta Spike (Jingjie Sui), Green Saposhnikovia Root (Qing Fangfeng, 1 qian), Mint Leaf (Bohe Ye, 8 fen), Fried Arnebia/Buddleja Seed (Chao Niubang, 2 qian), Raw Licorice Node (Sheng Caojie, 8 fen), Bitter Platycodon Root (Ku Jiegeng, 1 qian), Light Polyporus Mushroom (Qing Mabo, 8 fen), Large Fritillaria Bulb (Da Beimu, 3 qian), Prepared Silkworm (Zhi Jiangcan, 3 qian), Honeysuckle Flower (Jinyinhua, 3 qian), Forsythia Fruit Shell (Lianqiao Qiao, 3 qian), Clam Shell Powder (Haige Fen, 4 qian), Liu Shen Wan (Six Gods Pill, swallowed, 10 pills).
Second Visit: After clearing and resolving, the symptoms appear looser/more relaxed. Since the medication matches the disease pattern, continue with the original method to advance the treatment.
Prescription: Mint Leaf (Bohe Ye, 8 fen), Raw Licorice Node (Sheng Caojie, 8 fen), Large Fritillaria Bulb (Da Beimu, 3 qian), Prepared Arnebia/Buddleja Seed (Shu Niubang, 2 qian), Bitter Platycodon Root (Ku Jiegeng, 1 qian), Prepared Silkworm (Zhi Jiangcan, 2 qian), Green Saposhnikovia Root (Qing Fangfeng, 1 qian), Light Polyporus Mushroom (Qing Mabo, 8 fen), Jing Red Peony Root (Jing Chishao, 2 qian), Honeysuckle Flower (Jinyinhua, 3 qian), Clam Shell Powder (Haige Fen, 3 qian), Smilax Glabra Rhizome Slice (Shancigu Pian, 8 fen), Liu Shen Wan (Six Gods Pill, swallowed, 10 pills).
Patient Zhou, Left side. Phlegma-toxin with diffuse swelling and pain, signs of impending suppuration. It is appropriate to use harmonizing and supporting methods (He Tuo), hoping that upon rupture/drainage, the condition will settle naturally.
Prescription: Mint Leaf (Bohe Ye, 8 fen), Prepared Arnebia/Buddleja Seed (Shu Niubang, 2 qian), Jing Red Peony Root (Jing Chishao, 2 qian), Raw Licorice Node (Sheng Caojie, 6 fen), Bitter Platycodon Root (Ku Jiegeng, 1 qian), Light Polyporus Mushroom (Qing Mabo, 8 fen), Large Fritillaria Bulb (Da Beimu, 3 qian), Prepared Silkworm (Zhi Jiangcan, 3 qian), Smilax Glabra Rhizome Slice (Shancigu Pian, 8 fen), Prepared Tortoise/Turtle Shell Plate (Zhi Jiapian, 1.5 qian), Gleditsia Sinensis Thorn (Zaojiaozhen, 1.5 qian), Luffa Vine Network (Sigualuo, 2 qian).