属性;骨槽风火三焦胃,耳前腮颊隐隐疼,腐溃筋骨仍硬痛,
牙关拘急夹邪风。
【注】此证一名牙叉发,一名穿腮发。乃手少阳三焦、足阳明
胃二经风火也。起于耳前,连及腮颊,筋骨隐痛,日久
腐溃,腮之里外筋骨,仍然漫肿硬痛,牙关拘急,皆由
邪风深袭筋骨故也。此证属在筋骨阴分,故初起肿硬难
消,溃后疮口难合,多致不救。初起热不盛者,内宜服
清阳散火汤,外以清胃散擦牙,真君妙散贴敷腮。如初
起发表之后,人壮火盛者,用皂刺、大黄、甘草节、白
芷、僵蚕下之,后减大黄,加生石膏以清之。然亦不可
过用寒凉之药,恐其凝结也。有硬肿日久失治,不能尽
消者,脓势将成,宜用中和汤托之。已溃按痈疽溃疡门
治法。亦有过服寒凉,以致肌肉坚凝腐臭,非理中汤佐
以附子不能回阳,非僵蚕不能搜风。如法治之,诸证俱
减,惟牙关拘急不开,宜用生姜片垫灸颊车穴二七壮(
其穴在耳垂下五分陷中处),每日灸之,兼用针刺口内
牙尽处出血,其牙关即开。若寒热不退,形焦体削,痰
盛不食,或口内腐烂,甚则穿腮落齿者,俱为逆证。当
腐烂之初,治法即同牙疳,亦不过稍尽人事耳。
方剂:清胃散
组成:姜黄 白芷
细辛 川芎
各等分,共研细末。先以盐汤漱口,擦牙痛处。
【方歌】清胃散擦牙肿疼,姜黄白芷细辛芎,同研先以盐汤漱,
后擦此药有奇功。
又方:中和汤
组成:白芷 桔梗
人参 黄耆(各一钱)
藿香(五分) 肉桂(五分)
甘草 白术(土炒)
川芎 当归
白芍(酒炒,各一钱) 麦门冬(去心,五分)
水二钟,姜三片,枣二枚,煎八分,加酒一杯食远
服。
【方歌】中和汤法骨槽风,日久不消欲溃脓,芷桔参煮藿桂草,
术芎归芍麦门冬。
又方:理中汤(见溃疡门)
真君妙贴散(见肿疡门)
升阳散火汤(方面颊疡)
【属性】骨槽风与手少阳三焦经、足阳明胃经的风火邪气有关,疼痛部位在耳前及腮颊部,表现为隐隐作痛;若病情发展导致筋骨腐烂溃破,则依然感到坚硬疼痛,且伴有牙关拘急(嘴巴张不开),这是夹带邪风侵袭所致。
【注】此病又名“牙叉发”或“穿腮发”。这是由于手少阳三焦经和足阳明胃经感受了风火邪气所致。病势起始于耳前,蔓延至腮部和脸颊,筋骨出现隐痛;日久之后发生腐烂溃破,腮部的内外筋骨仍然弥漫性肿胀、坚硬且疼痛,牙关拘急,这都是因为邪风深入侵袭筋骨的缘故。此病病变部位在筋骨阴分,所以初期肿胀坚硬难以消散,溃破后疮口难以愈合,多数会导致死亡。如果初起时热象不严重,内服宜用清阳散火汤,外用清胃散擦拭牙齿,并用真君妙散贴敷腮部。如果在初起经过发汗解表治疗后,患者壮热火势旺盛的,可用皂刺、大黄、甘草节、白芷、僵蚕等药物攻下泄热,随后减少大黄用量,加入生石膏以清热。然而也不可过度使用寒凉药物,恐怕导致气血凝结。如果有硬肿日久失治,不能全部消散的,脓液即将形成,宜用中和汤托毒排脓。已经溃破的,按照痈疽溃疡门的治法处理。也有因为过服寒凉药物,导致肌肉坚硬凝固、腐烂发臭的,非用理中汤配合附子不能回阳救逆,非用僵蚕不能搜剔风邪。按此法治疗,各种症状都会减轻,唯独牙关拘急无法张开,宜用生姜片垫着灸颊车穴十四壮(该穴位在耳垂下方五分处的凹陷中),每天施灸,同时用针刺口腔内牙齿尽头处出血,牙关即可张开。如果寒热不退,形体消瘦枯槁,痰多不能进食,或者口腔内部腐烂,甚至穿透腮部脱落牙齿的,都属于逆证(预后不良)。当刚开始腐烂时,治疗方法同牙疳,也不过是尽力挽救罢了。
方剂:清胃散
组成:姜黄、白芷、细辛、川芎,各等分,共同研成细末。先用盐水漱口,然后用药粉擦拭疼痛的牙齿部位。
【方歌】清胃散用于擦牙治疗肿痛,由姜黄、白芷、细辛、川芎组成,一同研磨,先用盐水漱口,再擦拭此药有奇效。
又一方:中和汤
组成:白芷、桔梗、人参、黄芪(各一钱)、藿香(五分)、肉桂(五分)、甘草、白术(土炒)、川芎、当归、白芍(酒炒,各一钱)、麦门冬(去心,五分)。
用水两钟,生姜三片,大枣二枚,煎至八分,加入酒一杯,饭后服用。
【方歌】中和汤用于治疗骨槽风,病程日久不消欲化脓,由白芷、桔梗、人参、煮水加藿香、肉桂、甘草、白术、川芎、当归、白芍、麦门冬组成。
[Attributes] Gucao Feng (Bone Trough Wind) is associated with wind-fire pathogenic factors of the Hand-Shaoyang Sanjiao Meridian and Foot-Yangming Stomach Meridian. Pain manifests as a dull ache in the area anterior to the ear, extending to the parotid and cheek regions. If the condition progresses to involve rotting and ulceration of the bones and sinews, hardness and pain persist. Jaw stiffness (trismus) occurs due to the invasion of pathogenic wind.
[Note] This syndrome is also known as "Yacha Fa" (Tooth Fork Abscess) or "Chuansai Fa" (Cheek-Penetrating Abscess). It arises from wind-fire pathogens affecting the Hand-Shaoyang Sanjiao and Foot-Yangming Stomach meridians. The onset begins anterior to the ear, spreading to the parotid and cheek areas, causing dull pain in the bones and sinews. Over time, rotting and ulceration occur; the bones and sinews inside and outside the cheek remain diffusely swollen, hard, and painful, accompanied by trismus. These symptoms result from deep invasion of pathogenic wind into the bones and sinews. Since the lesion resides in the Yin aspect of the bones and sinews, initial swelling and hardness are difficult to dissipate, and post-ulceration wounds fail to heal, often leading to death. If heat signs are mild at the onset, internal treatment should employ Qingyang Sanhuo Tang (Clear Yang Disperse Fire Decoction), external application of Qingwei San (Clear Stomach Powder) for tooth brushing, and Zhenjun Miaosan (True Lord's Miraculous Powder) applied to the cheek. If, after initial diaphoresis (sweating to release the exterior), the patient exhibits intense heat and fire, use Cishi (Gallus Spinae), Dahuang (Rhei Radix et Rhizoma), Gancaojie (Cannabis Semen), Baizhi (Angelicae Dahuricae Radix), and Jiangcan (Bombyx Batryticatus) to purge downward. Subsequently, reduce the dosage of Dahuang and add Sheng Shigao (Gypsum Fibrosum) to clear heat. However, excessive use of cold-natured herbs should be avoided to prevent coagulation. In cases of long-standing induration that fails to resolve completely, indicating impending suppuration, Zhonghe Tang (Harmonizing Decoction) should be used to support the expulsion of pus. For already ulcerated lesions, follow the treatment protocols for Ulcers under the Carbuncle and Ulcer section. Some patients, due to overuse of cold-natured medicines, develop hardened, necrotic, and foul-smelling flesh; such cases require Lizhong Tang (Regulate the Middle Decoction) combined with Fuzi (Aconiti Lateralis Radix Praeparata) to restore Yang, and Jiangcan (Bombyx Batryticatus) to dispel wind. With this treatment, most symptoms subside, but if trismus persists, apply moxibustion to Jiache (ST6) using slices of Shengjiang (Zingiberis Rhizoma Recens) as a medium, 14 moxa cones daily (the acupoint is located 0.5 cun below the earlobe in the depression). Simultaneously, prick the gingiva at the posterior end of the teeth to bleed, which will relieve trismus. If chills and fever persist, the body becomes emaciated, phlegm is profuse preventing eating, or oral cavity ulceration occurs, potentially penetrating the cheek and causing tooth loss, these are considered adverse prognoses (Ni Zheng). At the initial stage of ulceration, the treatment is similar to Yagan (Dental Gangrene), representing merely an attempt to save life.
Formula: Qingwei San (Clear Stomach Powder)
Composition: Jianghuang (Curcumae Longae Rhizoma), Baizhi (Angelicae Dahuricae Radix), Xixin (Asari Radix et Rhizoma), Chuanxiong (Chuanxiong Rhizoma), in equal proportions, ground into fine powder. First rinse the mouth with salt water, then apply the powder to the painful teeth.
[Prescription Verse] Qingwei San treats tooth swelling and pain when rubbed on teeth; composed of Jianghuang, Baizhi, Xixin, and Chuanxiong. Grind together, rinse with salt water first, then rub with this medicine for miraculous efficacy.
Another Formula: Zhonghe Tang (Harmonizing Decoction)
Composition: Baizhi (Angelicae Dahuricae Radix), Jiegeng (Platycodonis Radix), Renshen (Ginseng Radix), Huangqi (Astragali Radix) (each 1 qian), Huoxiang (Agastaches Herba) (0.5 qian), Rougui (Cinnamomi Cortex) (0.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) (soil-fried), Chuanxiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba) (wine-fried, each 1 qian), Maimendong (Ophiopogonis Radix) (heart removed, 0.5 qian).
Decoct with 2 zhong of water, 3 slices of Shengjiang (Zingiberis Rhizoma Recens), and 2 dates (Jujubae Fructus) until reduced to 0.8 zhong. Add 1 cup of wine and take after meals.
[Prescription Verse] Zhonghe Tang treats Gucao Feng; for long-standing non-resolving conditions about to suppurate. Ingredients include Baizhi, Jiegeng, Renshen, boiled with Huoxiang, Rougui, Gancao, Baizhu, Chuanxiong, Danggui, Baishao, and Maimendong.
Another Formula: Lizhong Tang (Regulate the Middle Decoction) (See Ulcer Section)
Zhenjun Miaotie San (True Lord's Miraculous Adhesive Powder) (See Swollen Ulcer Section)
Shengyang Sanhuo Tang (Raise Yang Disperse Fire Decoction) (See Facial Ulcer Section)