44.伤寒发颐耳下肿, 失于汗下此毒生, 高肿焮红痛为顺, 反此神昏
命必倾. 毒伏未发脉亦隐, 冷汗淋漓肢若冰, 烦渴不便指甲紫, 颇似
三阴了了轻.
【注】伤寒颐毒, 皆因汗下失宜, 毒热挟少阳相火上攻而成也. 若其
人阳气素盛, 则高肿焮红疼痛, 易于成脓, 故为顺也, 宜连翘败毒散
攻之. 或其人阳气素虚, 或服冷药过多, 遏郁毒热伏藏在里, 内攻神
昏,外毒漫肿, 肉色不变, 不疼木硬, 则命必危也. 毒伏未发之前,
往往似三阴亡阳之证, 脉隐不见, 冷汗淋漓, 肢冷若冰, 但身轻目睛
了了, 烦渴不大便, 指甲红紫为异, 此毒发始, 临治不可忽也.
45.古名狐惑近名疳, 狐蚀肛阴惑唇咽, 病后余毒斑疹后, 癖疾痢后
也同然, 面眦赤白黑不一, 目不能闭喜贪眠, 潮热声哑腐秽气, 能食
堪药治多全.
【注】狐惑, 牙疳、下疳等疮之古名也, 近时惟以疳呼之. 下疳即狐
也,蚀烂肛阴;牙疳即惑也, 蚀咽腐龈, 脱牙穿腮破唇. 毒因伤寒病
后,余毒与湿?? 之为害也. 或生斑疹之后, 或生癖疾下痢之后, 其
为患亦同也. 其证则面色目眦或赤或白或黑, 时时不一 , 喜睡目不
能闭, 潮热声哑, 腐烂之处, 秽气熏人. 若胃壮能食, 堪受攻病重药
,或病之势缓, 治多全也.
44. 伤寒病后出现发颐(耳下腮部肿胀),是因为误用或漏用汗法、下法,导致毒邪内生。如果局部高肿、红热、疼痛,属于顺证;反之则会出现神志昏迷,生命垂危。若毒邪潜伏未发,脉象也会隐伏不见,伴有冷汗淋漓、四肢冰冷如冰。若有烦躁口渴、大便不通、指甲呈紫色等症状,颇似三阴病中的“了了轻”(精神清爽但身体沉重无力)之证。
【注】伤寒引起的发颐毒,都是因为汗法和下法使用不当,导致毒热挟带少阳相火上攻所致。如果患者阳气素来旺盛,就会出现高肿、红热、疼痛,容易化脓,所以称为顺证,宜用连翘败毒散进行攻逐治疗。或者患者阳气素来虚弱,或服用寒凉药物过多,导致毒热被遏制郁结,伏藏在体内,内攻心神导致昏迷,外现毒邪漫肿,肌肉颜色不变,不痛且麻木坚硬,那么生命必然危险。在毒邪潜伏未发之前,往往类似三阴病亡阳的证候,脉象隐伏不见,冷汗淋漓,四肢冷如冰,只是身体轻盈、眼睛明亮有神、烦躁口渴、不大便、指甲红紫为异常表现,这是毒邪开始发作的迹象,临证治疗时不可忽视。
45. 古称狐惑,近世称为疳。狐蚀肛门和外阴,惑蚀嘴唇和咽喉。此病多见于伤寒病后余毒未尽,或在斑疹之后,或在癖疾、痢疾之后,情况相同。患者面色及眼眦颜色赤、白、黑不一,眼睛不能闭合,喜欢贪睡,潮热、声音嘶哑、患处腐烂且有秽臭气味。如果患者胃气壮实、能进食,能够承受攻伐的重药,或者病情发展缓慢,大多可以治愈。
【注】狐惑,是牙疳、下疳等疮疡的古称,近代只称之为疳。下疳即指狐,腐蚀肛门和外阴;牙疳即指惑,腐蚀咽喉、牙龈腐烂,牙齿脱落,脸颊穿孔,嘴唇破裂。毒邪源于伤寒病后,余毒与湿气结合为害。或者发生在斑疹之后,或者发生在癖疾、痢疾之后,其危害也是相同的。其症状表现为面色和眼眦时而赤、时而白、时而黑,时时变化不一,喜欢睡觉且眼睛不能闭合,潮热、声音嘶哑,腐烂之处有秽臭之气熏人。如果胃气强壮、能进食,能够承受攻治病邪的重药,或者病势缓和,治疗大多能痊愈。
44. Post-typhoid fever, swelling below the ear (Fayi) occurs due to improper or missed use of sweating and purgative methods, leading to the generation of toxic pathogens. If the area is highly swollen, red, hot, and painful, it is a favorable condition (Shun); conversely, it leads to coma and imminent death. If the toxin is latent and not yet manifesting, the pulse may also be imperceptible, accompanied by profuse cold sweat and limbs as cold as ice. Symptoms such as irritability, thirst, constipation, and purple fingernails closely resemble the "Liaoliao Qing" syndrome in the Three Yin diseases.
[Note] The Fayi toxin caused by typhoid fever arises from improper application of sweating and purgative therapies, causing toxic heat to ascend along with the Ministerial Fire of the Shaoyang channel. If the patient's Yang qi is inherently robust, high swelling, redness, heat, and pain occur, facilitating suppuration; thus, it is considered a favorable condition, treatable with Lianqiao Baidu San (Forsythia Decoction for Resolving Toxins). Alternatively, if the patient's Yang qi is inherently deficient, or if excessive cold medicines have been taken, the toxic heat may be suppressed and郁结 (stagnant), hiding within the interior. Internal attack on the mind causes coma, while external manifestation shows diffuse swelling with unchanged skin color, numbness, hardness, and absence of pain, posing a critical threat to life. Before the toxin manifests, symptoms often mimic the Yang exhaustion syndrome of the Three Yin diseases: an imperceptible pulse, profuse cold sweat, and icy cold limbs. However, the patient remains physically light, eyes clear and bright, with irritability, thirst, constipation, and reddish-purple nails as distinguishing features. This marks the onset of toxin eruption; clinical treatment must not neglect this stage.
45. Anciently known as Huhu (Fox and Delusion), currently referred to as Gan (Gum Disease). "Hu" erodes the anus and genitals, while "Huo" erodes the lips and pharynx. This disease often follows residual toxins after typhoid fever, or occurs after exanthematous diseases, or after chronic abdominal masses and dysentery, presenting similarly in these contexts. Patients exhibit varying colors (red, white, black) on the face and eye corners, inability to close the eyes, excessive sleepiness, tidal fever, hoarseness, ulceration with foul odor. If the stomach qi is strong and the patient can eat, tolerating heavy attacking medications, or if the disease progression is slow, recovery is likely.
[Note] Huhu is the ancient name for conditions such as dental gangrene (Yagan) and chancres (Xiagan), now commonly referred to simply as Gan. Xiagan corresponds to "Hu," eroding the anus and genitals; Yagan corresponds to "Huo," eroding the pharynx, rotting gums, causing tooth loss, cheek perforation, and lip rupture. The pathogenic toxin originates from residual pathogens after typhoid fever, combining with dampness to cause harm. It may also arise after exanthematous diseases or after chronic abdominal masses and dysentery, with similar pathological consequences. Clinical manifestations include fluctuating redness, whiteness, or blackness of the face and eye corners, somnolence with inability to close the eyes, tidal fever, hoarseness, and foul odor from ulcerated areas. If the stomach qi is robust and the patient can ingest food, tolerating potent anti-pathogenic drugs, or if the disease course is gradual, prognosis is generally good.