(附∶大黄扫毒汤)
疮疡以疔毒为最紧要,因其毒发于脏腑,非仅在于经络。其脉多见沉紧。紧者毒也,紧在沉部,其毒
在内可知也。至其重者,发于鸠尾穴处,名为半日疔,言半日之间即有关于人性命也。若系此种疔毒,当于
未发现之前,其人或心中怔忡,或鸠尾处隐隐作疼,或其处若发炎热,似有漫肿形迹,其脉象见沉紧者,即宜
预防鸠尾穴处生疔,而投以大剂解毒清血之品。其大便实者,用大黄杂于解毒药中下之,其疔即可暗消于
无形。此等疔毒,若待其发出始为疗治,恒有不及治者矣。
至若他处生疔,原不必如此预防,而用他药治之不效者,亦宜重用大黄降下其毒。忆愚少时,见同里
患疔者二人,一起于脑后,二日死;一起于手三里穴,三日死。彼时愚已为人疏方治病,而声名未孚于乡里,
病家以为年少无阅历,不相延也。后愚堂侄女于口角生疔,疼痛异常,心中忙乱。投以清热解毒药不效,脉
象沉紧,大便三日未行。恍悟寒温之证,若脉象沉洪者,可用药下之,以其热在里也。今脉象沉紧,夫紧
为有毒(非若伤寒之紧脉为寒也),紧而且沉,其毒在里可知。律以寒温脉之沉洪者可下其热,则疔
毒脉之沉紧者当亦可下其毒也,况其大便三日未行乎。遂为疏方∶大黄、天花粉各一两,皂刺四钱,穿山甲、
乳香、没药(皆不去油)各三钱,薄荷叶一钱,全蜈蚣三大条。煎服一剂,大便通下,疼减心安。遂去大黄,
又服一剂,全愈。方用大黄通其大便,不必其大便多日未行,凡脉象沉紧,其大便不滑泻者,皆可用。若身
体弱者,大黄可以斟酌少用。愚用此方救人多矣,因用之屡建奇效,遂名之为大黄扫毒汤。
友人朱钵文传一治疔方,大黄、甘草各一两,生牡蛎六钱,栝蒌仁四十粒捣碎,疔在上者川芎三钱作引,
在两臂者桂枝尖三钱作引,在下者怀牛膝三钱作引。煎服立愈。身壮实者,大黄可斟酌多用。此亦重
用大黄,是以奏效甚捷也(“答陈××疑《内经》十二经有名无质”一节中有刺疔法,宜参观)。
(附方:大黄扫毒汤)
疮疡之中,以疔毒最为紧要,因为它的毒邪发于脏腑,不仅仅局限于经络。其脉象多见沉紧。紧脉代表毒邪,脉位深沉且紧,说明毒邪在体内。到了严重的情况,疔毒发于鸠尾穴处,称为“半日疔”,意思是半天之内就可能危及性命。如果是这种疔毒,在症状尚未完全显现之前,患者可能心中惊悸怔忡,或者鸠尾穴处隐隐作痛,或者该部位感觉发热,似乎有漫肿的迹象,脉象表现为沉紧的,就应当预防鸠尾穴处生疔,并投以大剂量的解毒清血药物。如果患者大便干结,将大黄混入解毒药中服用以通下,疔毒即可在无形中暗中消散。这类疔毒,如果等到它发作出来才开始治疗,常常会有来不及救治的情况。
至于身体其他部位生的疔,原本不必如此预先防范,但如果用其他药物治疗无效,也应当重用大黄来降泄毒邪。回忆我年轻时,看见同乡有两人患疔,一个生于脑后,两天后死亡;另一个生于手三里穴,三天后死亡。那时我已经为人开方治病,但名声还未在乡里确立,病人家属认为我年轻缺乏阅历,没有聘请我。后来我的堂侄女嘴角生了疔,疼痛异常,心中慌乱。投以清热解毒药物无效,脉象沉紧,大便三天未行。我突然领悟到,寒温病证中,如果脉象沉洪,可以用下药攻下,因为热邪在里。现在脉象沉紧,紧脉是有毒的表现(不同于伤寒中紧脉主寒),脉既紧又沉,可知毒邪在里。根据寒温病脉象沉洪者可下其热的规律,那么疔毒脉象沉紧者,也应该可以下其毒,何况患者大便三天未行呢。于是我为她开方:大黄、天花粉各一两,皂角刺四钱,穿山甲、乳香、没药(均不去油)各三钱,薄荷叶一钱,全蜈蚣三条。煎服一剂后,大便通畅,疼痛减轻,心神安宁。随后去掉大黄,又服一剂,完全痊愈。方中使用大黄是为了通导大便,并不一定非要等到大便多日未行才用,凡是脉象沉紧,且大便不滑泻的患者,都可以使用。如果身体虚弱的人,大黄可以酌情少用。我用这个方子救了很多人的命,因为屡次使用都取得奇效,所以命名为“大黄扫毒汤”。
友人朱钵文传授了一个治疔方:大黄、甘草各一两,生牡蛎六钱,瓜蒌仁四十粒捣碎,疔毒在上部的加川芎三钱作为引经药,在两臂的加桂枝尖三钱作为引经药,在下部的加怀牛膝三钱作为引经药。煎服后立即痊愈。身体强壮的人,大黄可以酌情多用。这也是重用大黄,因此奏效非常迅速。(“回答陈××质疑《内经》十二经有名无质”一节中有刺疔的方法,宜参考阅读)。
(Attached Formula: Dahuang Saodu Decoction)
Among sores and ulcers, Ding poison (carbuncle toxin) is the most critical because its toxicity originates in the Zang-Fu organs (internal organs), not merely in the meridians. The pulse is often deep and tight. A tight pulse indicates toxicity; if it is deep and tight, the toxicity is known to be internal. In severe cases, the Ding poison erupts at the Jiwei acupoint, called "Half-Day Ding," meaning it can endanger life within half a day. If it is this type of Ding poison, before symptoms fully manifest, the patient may experience palpitations or anxiety, or feel a dull pain at the Jiwei acupoint, or feel heat in that area with signs of diffuse swelling, and the pulse appears deep and tight. In such cases, one should prevent Ding poison from forming at the Jiwei acupoint and administer a large dose of detoxifying and blood-clearing herbs. If the patient has constipation, adding Dahuang (Rhubarb Root) to the detoxifying herbs to promote bowel movement can cause the Ding poison to dissipate invisibly. For this kind of Ding poison, if treatment is delayed until it erupts, it is often too late to save the patient.
As for Ding poisons arising elsewhere on the body, such preemptive measures are not originally necessary. However, if other treatments fail, heavy doses of Dahuang should still be used to descend and purge the toxicity. I recall when I was young, I saw two fellow townspeople suffer from Ding poison: one erupted at the back of the head and died in two days; the other erupted at the Shousanli acupoint and died in three days. At that time, I was already prescribing medicine for others, but my reputation had not yet gained trust in the village. The patients' families thought I was young and inexperienced, so they did not hire me. Later, my cousin's daughter developed Ding poison at the corner of her mouth with extreme pain and mental agitation. Prescriptions of heat-clearing and detoxifying herbs were ineffective. Her pulse was deep and tight, and she had not had a bowel movement for three days. I suddenly realized that in Cold-Warm diseases, if the pulse is deep and surging, purgatives can be used because the heat is internal. Now, her pulse is deep and tight. A tight pulse indicates toxicity (unlike the tight pulse in Cold Damage which indicates cold). Since the pulse is both tight and deep, the toxicity must be internal. According to the principle that Deep-Surging pulses in Cold-Warm diseases allow for purging heat, Deep-Tight pulses in Ding poison should also allow for purging toxicity, especially since she has not had a bowel movement for three days. Therefore, I prescribed: Dahuang (Rhubarb Root) and Tianhuafen (Trichosanthes Root) each 30g, Zaocis Spina (Spina Gleditsiae Sinensis) 12g, Chuan Shan Jia (Pangolin Scales), Ruxiang (Frankincense), and Moyao (Myrrh) (all retaining their oil) each 9g, Bohe Ye (Mint Leaf) 3g, and Quan Wugong (Whole Centipede) 3 large pieces. After one dose decocted and taken, her bowels moved, pain decreased, and her mind calmed. Subsequently, Dahuang was removed, and after another dose, she recovered completely. This formula uses Dahuang to unblock the bowels; it is not necessary to wait for several days of constipation. Whenever the pulse is deep and tight and there is no loose stool, it can be used. For those with weak constitutions, Dahuang should be used cautiously in smaller doses. I have saved many lives with this formula due to its frequent miraculous efficacy, hence naming it "Dahuang Saodu Decoction."
My friend Zhu Bowen transmitted a formula for treating Ding poison: Dahuang (Rhubarb Root) and Gancao (Licorice Root) each 30g, Sheng Muli (Raw Oyster Shell) 18g, Gualou Ren (Trichosanthes Seed) 40 grains crushed. If the Ding poison is located above, use Chuanxiong (Szechwan Lovage Rhizome) 9g as a guiding herb; if in both arms, use Guizhi Jian (Cinnamon Twig Tip) 9g as a guiding herb; if below, use Huai Niuxi (Achyranthes Root) 9g as a guiding herb. Decoct and take, and recovery is immediate. For robust individuals, Dahuang can be used in larger doses according to judgment. This also relies on heavy use of Dahuang, which is why the effect is very rapid. (See the section "Answering Chen XX's Doubts about the Twelve Meridians Having Names but No Substance" for a method of puncturing Ding poison, which should be consulted).