【方歌】佛顶疽属督上星,阴阳不调毒热成,不论虚实皆险证,
溃烂黑陷必然凶。
【注】此证一名顶门疽。生于头顶硵门之前,属督脉经上星穴
。由藏府阴阳不调,热毒上壅而成。色紫,坚硬肿痛,
脉洪大而数者为实;脉微细而数者为虚,皆属险证。若
溃烂黑陷,六脉散大,神昏谵语,二便闭结者为逆。首
尾内外治法,俱按百会疽。
【方歌】额疽生额火毒成,左右膀胱正督经,顶陷焦紫无脓重,
高耸根收红肿轻。
【注】此证生前额正中者,属督脉经。或生左右额角者,属膀
胱经。总由火毒而成。初起疮顶塌陷,干焦色紫,不生
大脓者,其势重而属险也;若红肿高耸,疮根收束者,
其势轻而属顺也。初服荆防败毒散汗之,次服仙方活命
饮消之。将溃气虚者,宜服托里透脓汤;气实者,宜服
透脓散,外敷冲和膏。已溃宜服托里排汤,外贴琥珀膏
。其余内外治法,俱按痈疽溃疡门。
方剂:荆防败毒散(见项部脑疽)
仙方活命饮(见肿疡门)
托里透脓汤(见前侵脑疽)
透脓散、冲和膏(俱见肿疡门)
托里排脓汤(见项部鱼尾毒)
琥珀膏(见发际疮内)
【方歌】勇疽眦后太阳穴,胆经怒火伏鼠形,七日不溃毒攻眼,
黄脓为吉黑血凶。
注解:此证一名勇疽,又名脑发疽。属足少阳胆经怒火而成,
生于目小眦之后五分。生在太阳穴者,无论左右皆可以
生。初起如粟,渐肿疼痛,形如伏鼠,面目浮肿,七日
信脓不溃,火毒攻睛,腐烂损目。若十一日针出黄脓,
毒从胆解为顺易治;若出紫黑色者,系气虚不能化毒为
逆难治。初服仙方活命饮清解之,毒甚宜服内疏黄连汤
,外敷二味拔毒散。其将溃已溃,内外治法,俱按痈疽
肿疡、溃疡门。溃后避风忌水。
方剂:仙方活命饮、内疏黄连汤、二味拔毒散(俱见肿疡门)
【方歌】佛顶疽病位在督脉经的上星穴,因阴阳失调、毒热蕴结而成。无论实证还是虚证,均属危险病症;若出现溃烂且疮面黑陷,则必然凶险。
【注】此证又名顶门疽。生于头顶囟门之前,归属于督脉经的上星穴。由脏腑阴阳不调,热毒上壅所致。若患处色紫、坚硬肿痛,脉象洪大而数,属于实证;若脉象微细而数,属于虚证,二者皆属危险病症。若出现溃烂黑陷,六脉散大无根,神志昏迷胡言乱语,大小便闭塞不通,属于逆证。其初起至痊愈的内治与外治方法,均参照“百会疽”篇处理。
【方歌】额疽生于额头,由火毒蕴结而成。病变涉及足太阳膀胱经、足少阳胆经及督脉。若疮顶凹陷、焦紫无脓者病情重;若疮顶高耸、根脚收束、红肿者病情轻。
【注】此证生于额头正中的,归属于督脉经。若生于左右额角的,归属于膀胱经。总由火毒所致。初起时疮顶塌陷,干燥焦紫,不生大量脓液者,其势重而属险证;若红肿高耸,疮根收束者,其势轻而属顺证。初起宜服用荆防败毒散发汗解表,随后服用仙方活命饮消散肿毒。即将溃破时,气虚者宜服用托里透脓汤;气实者宜服用透脓散,外用冲和膏敷贴。已溃破后宜服用托里排脓汤,外用琥珀膏贴敷。其余内外治法,均参照痈疽溃疡门处理。
方剂:荆防败毒散(见项部脑疽)
仙方活命饮(见肿疡门)
托里透脓汤(见前侵脑疽)
透脓散、冲和膏(俱见肿疡门)
托里排脓汤(见项部鱼尾毒)
琥珀膏(见发际疮内)
【方歌】勇疽生于目外眦后的太阳穴部位,属足少阳胆经怒火蕴结所致,形态如伏鼠。若七日不溃破,毒邪攻眼,流出黄脓为吉兆,流出黑血为凶兆。
注解:此证又名勇疽,或称脑发疽。属足少阳胆经怒火蕴结而成,生于目小眦后方五分处。生于太阳穴者,无论左右皆可发生。初起如粟米大小,逐渐肿胀疼痛,形状如伏鼠,面目浮肿。若七日后仍不化脓溃破,火毒攻入眼睛,导致腐烂损目。若十一日针刺后流出黄脓,说明毒邪从胆经化解,属于顺证,易于治疗;若流出紫黑色血液,系气虚不能化解毒邪,属于逆证,难以治疗。初起宜服用仙方活命饮清热解表,毒邪严重者宜服用内疏黄连汤,外用二味拔毒散敷贴。其将溃破及已溃破的内外治法,均参照痈疽肿疡门、溃疡门处理。溃破后需避风忌水。
方剂:仙方活命饮、内疏黄连汤、二味拔毒散(俱见肿疡门)
[Verse] The Foding Ju (Foding Carbuncle) is located at the Shangxing acupoint of the Du Meridian. It arises from disharmony of Yin and Yang with accumulation of toxic heat. Whether it presents as excess or deficiency, it is a dangerous condition; if ulceration occurs with black depression, it is inevitably ominous.
[Note] This condition is also known as Dingmen Ju (Vertex Carbuncle). It arises anterior to the fontanelle on the vertex, belonging to the Shangxing acupoint of the Du Meridian. It results from disharmony of Yin and Yang in the Zang-Fu organs, causing hot toxicity to ascend and obstruct. If the lesion is purple, hard, swollen, painful, and the pulse is surging and rapid, it indicates an Excess pattern; if the pulse is faint, thin, and rapid, it indicates a Deficiency pattern. Both are considered dangerous conditions. If ulceration occurs with black depression, the six pulses are scattered and enlarged, there is coma and delirious speech, and both urine and stool are constipated, it indicates a Reverse pattern. The internal and external treatment methods from onset to resolution should follow those for Baihui Ju (Baihui Carbuncle).
[Verse] E Ju (Forehead Carbuncle) arises on the forehead due to fire-toxicity accumulation. It involves the Bladder Meridian, Gallbladder Meridian, and Du Meridian. A depressed, scorched-purple top with no pus indicates severe disease; a high, raised top with contracted roots and redness/swelling indicates mild disease.
[Note] When this condition arises in the center of the forehead, it belongs to the Du Meridian. When it arises at the left or right frontal angles, it belongs to the Bladder Meridian. It is generally caused by fire-toxicity. In the initial stage, if the sore top is depressed, dry, scorched-purple, and does not produce abundant pus, the condition is severe and dangerous; if it is red, swollen, high, and the root is contracted, the condition is mild and favorable. Initially, administer Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction to Overcome Toxicity) to induce sweating; subsequently administer Xianfang Huoming Yin (Immortal Life-Protecting Decoction) to dissipate the swelling. As it approaches suppuration, if Qi is deficient, administer Tuoli Tou Nong Tang (Supporting Interior and Penetrating Pus Decoction); if Qi is sufficient, transmit Tounong San (Pus-Penetrating Powder), and apply Chonghe Gao (Harmonizing Plaster) externally. After ulceration, administer Tuoli Paimai Tang (Supporting Interior and Expelling Pus Decoction) and apply Hupo Gao (Amber Plaster) externally. For other internal and external treatments, refer to the Chapter on Ulcers of Carbuncles and Sores.
Formulas: Jingfang Baidu San (see Neck Back Carbuncle); Xianfang Huoming Yin (see Swollen Sore Chapter); Tuoli Tou Nong Tang (see preceding Brain-Infiltrating Carbuncle); Tounong San, Chonghe Gao (both see Swollen Sore Chapter); Tuoli Paimai Tang (see Fish-Tail Toxin of the Neck); Hupo Gao (see Inner Hairline Sore).
[Verse] Yong Ju (Yong Carbuncle) arises behind the outer canthus at the Taiyang acupoint, caused by fire-toxicity stagnation in the Gallbladder Meridian, resembling a crouching rat. If it does not suppurate within seven days, the toxin attacks the eye; yellow pus is auspicious, black blood is ominous.
Annotation: This condition is also known as Yong Ju or Naofa Ju (Brain-Hair Carbuncle). It is caused by fire-toxicity stagnation in the Foot-Shaoyang Gallbladder Meridian, arising five fen posterior to the outer canthus. It may occur at the Taiyang acupoint on either side. Initially, it resembles a millet grain, gradually becoming swollen and painful, shaped like a crouching rat, with facial edema. If after seven days it has not yet suppurred, fire-toxicity attacks the eyes, causing rotting and damage. If after eleven days puncture yields yellow pus, the toxin resolves via the Gallbladder channel, indicating a Favorable pattern that is easy to treat; if purple-black blood appears, it indicates Qi deficiency failing to transform the toxin, constituting a Reverse pattern that is difficult to treat. Initially, administer Xianfang Huoming Yin (Immortal Life-Protecting Decoction) to clear and resolve; if toxicity is severe, administer Neishu Huanglian Tang (Internal-Draining Coptis Decoction), and apply Erwei Baidu San (Two-Ingredient Detoxifying Powder) externally. For the pre-ulcerative and post-ulcerative stages, internal and external treatments follow the Chapters on Swollen Sores and Ulcers of Carbuncles. After ulceration, avoid wind and water.
Formulas: Xianfang Huoming Yin (Immortal Life-Protecting Decoction), Neishu Huanglian Tang (Internal-Draining Coptis Decoction), Erwei Baidu San (Two-Ingredient Detoxifying Powder) (all see Swollen Sore Chapter).