经曰。肺内主气。外司。皮毛。若肺气虚则腠理不密。皮毛不泽。肺受伤则皮毛错纵。
肺痈。肺痿。肠痈。必致皮毛如此。以其气不能荣养而然也。亦有服表药。见邪不解。又复
发表。殊不知邪不解者。非邪不能解。多因腠理不密而邪复入也。专用发表则腠理愈虚。邪
愈易入。反为败症矣。宜胗其脉。邪在表者。止当和解而实腠理。乘虚复入者。亦当和解。
兼实腠理。故用托里益气之药。若小便赤涩为肺热所传。小便短少为肺气虚盖肺为母。肾为
子。母虚不能生子故也。亦有小便频数者。亦为肺虚不能约制耳。大抵劳伤血气。则腠理不
密。风邪乘肺。虚风热相抟。郁滞结不散。以致喘嗽。若误汗下过度。则津液重亡。遂成肺
痈、肺痿之症矣。
桷按以上一十五条。原系后病案中互发挥者。虽非外科。以其议论有切于杂症。不敢脱
略。故采附诸论之后。俾学人以便观览。
（时毒发于面鼻耳项者是）
里实而不利者。下之。
表实而不解者。散之。
表里俱实而不解者。解表攻里。
表里俱解而不消者。和之。
肿甚 痛者。砭去恶血。更用消毒之剂。
不作脓或不溃者。托之。
饥年普患者。不宜用峻利。当审而治之。
时毒者。为四时邪毒之气感之于人也。其候发于面、鼻、耳、项、咽喉。赤肿无头。或
有根。令人增寒。发热。头痛。或肢体痛。恍惚不宁。咽喉闭塞。人不识者将为伤寒。便服
解药。一二日肿气益增。方悟。始求疮医。原夫此疾古无方论。世俗通为丹瘤。病家恶言时
。切恐传染。考之经曰。人身忽经变赤。状如涂丹。谓之丹毒。此风热恶毒所为。与时毒特
不同耳。盖时毒初状如伤寒。五七日间乃能杀人。治者宜精辨之。先论其脉、滑、数、浮、
洪、沉、紧、弦、涩、皆其候。盖浮数者邪在表也。沉涩者邪气深也。气实之人急服化毒丹
以攻之。热实不利。大黄汤下之。有表证者。解毒升麻汤以发之。年高气软者。五香连翘
主之。又于鼻内搐。通气散。取十余嚏作效。若搐药不嚏者。不可治。如嚏出脓者。治之必愈
。左右之人。每日用嚏药搐之。必不传染。其病患亦每日用嚏药三五次以泄热毒。此治时毒
之良法也。经三四日不解者。不可大下。犹宜和解之。犀角连翘散之类。至七八日大小便通
利。头面肿起高赤者。可服托里散。黄 散。宜针镰出血。泄其毒瓦斯。十日外不治自愈也。
此病若五日以前。精神昏乱。咽喉闭塞。语声不出。头面不肿。食不知味者必死。治之无功
矣。然而此疾有阴有阳。有可汗。有可下。粗工但云热毒。就用寒药。殊不知病有微甚。治
有逆从。不可不审也。
一人头面肿痛。服硝黄败毒之剂愈甚。诊之脉浮数。邪在表尚未解。用荆防败毒散二剂
。势退大半。更以葛根牛蒡子汤。四剂而痊。（此凭脉发表。）
经云。身半以上肿。天之气也。身半以下肿。地之气也。乃邪客心肺之间。上攻头目而
。此感四时不正之气也。与膏粱积热之症不同。硝黄之剂。非大便秘实不可用。若不审其因
。及辨其虚实表里。概用攻之。必致有误。常见饥馑之际。刍荛之人多患之。乃是胃气有损
。邪气从之。不可不察。予常治邪在表者。用葛根牛蒡子汤。人参败毒散。或普济消毒饮子
。邪在里者。五利大黄汤。栀子仁汤。表里俱不解者。防风通圣散。表里俱解而肿不退者。
犀角升麻汤。肿甚者砭患处。出恶血以泄其毒。十日外自愈。若嚏出脓血即愈。欲其作脓者
。用托里消毒散。欲其收敛者。用托里散。此法最为稳当。五七日咽喉不闭。言语不出。头
面不肿。食不知味者。不治。
一人患此。肿痛发热。作渴。脉实便闭。以五利大黄汤下之。诸症悉退。以葛根牛蒡
子汤四剂而痊。（此凭脉攻里。）
一人表里俱解。肿痛尚不退。以葛根升麻汤二剂而消。（此凭症也。）
一人肿痛发寒热。脉浮数。以荆防败毒散二剂。少愈。再人参败毒散二剂。势减半。又
二剂而瘥。（此凭脉发表。）
一人耳面赤肿作痛。咽干发热。脉浮数。先以荆防败毒散二剂。势退大半。又以葛根牛
蒡子汤四剂而痊。（凭脉发表）
一妇表邪已解。肿尚不消。诊之脉滑而数。乃瘀血作脓也。以托里消毒散溃之而愈。（
此凭脉也。）
一人 肿胀痛。作渴烦热。便秘脉数。按之尤实。用防风通圣散一剂。诸症顿退。以荆
防败毒散加玄参牛蒡黄芩。二剂而瘥。（此凭症凭脉。发表攻里。）
一老冬月头面耳项俱肿。痛甚。便秘脉实。此表里俱实也。饮防风通圣散不应。遂砭患
出黑血。仍投前药。即应。又以荆防败毒散而瘳。盖前药不应者。毒血凝聚上部经络。药力
难达故也。恶血既去。其药自效。或拘用寒远寒。及年高畏用硝黄。而用托里与夫寻常消毒
之剂。或不砭泄其毒。专假药力。鲜不危矣、（此舍时从症。）
一人表里俱解。惟肿不消。以托里消毒散四剂。脓成。针之而愈。（此凭症而治。）
一妇肿痛。用硝黄之剂攻之。稍缓。翌日复痛。诊。之外邪已退。此瘀血欲作脓也。用
托里消毒散溃之而愈。（此凭脉与症也。）
一人表散药愈炽。发热便秘。诊脉沉实。此邪在里也。以大黄汤下之。里症悉退。以葛
根牛蒡子汤。浮肿亦消。惟赤肿尚存。更以托里药溃之而愈。（此凭脉与症也。）
一人冬月病头面赤肿。耳前后尤甚。痛不可忍。发热恶寒。牙关紧急。涕唾稠粘。饮食
。不得安卧。医砭肿上四五十针。肿赤不减。痛益甚。予诊其脉浮紧。按之洪缓。知为寒覆
皮毛。郁遏经络。热不得升。聚而赤肿。且夫天冷寒凛之时。腠理闭。汗不出。血气强。肉
坚涩。善用针者不得取四厥。必待天温。又云。冬月闭脏。用药多。少针石也。宜以苦温之
剂。温经散寒。所谓寒致腠理。以苦发之。以辛散之。
方名托里温经汤
麻黄（苦温发之为君去根节二钱） 防风（辛温散之去芦二分） 升麻（苦辛四钱） 葛根（
解肌出汗专治阳明经邪故以为臣） 白芷归身（血流不行则痛白芷归身辛温以和血散滞各二钱
）苍术（湿热则肿苍术甘温体轻浮力雄壮能泄肤腠间温热一钱） 人参（去芦一钱） 甘草（甘
温） 白芍药（酸微寒调中益气使托其里为佐各钱半）
上锉。每服一两。水二盏。先煎麻黄令沸。去沫。再下余药。同煎至一盏。去渣。大温
。以薄衣覆首。浓被覆身。卧暖处。使经血温。腠理开。寒乃散。阳气升。大汗出。肿减七
八分。再服去麻黄、防风。加连翘、鼠粘子。肿痛悉愈。经言汗之则。疮已。信哉。
或曰。仲景言疮家虽身痛不可汗。何也。予曰。此言营气不从。逆于肉理。乃主痈肿而
痛。非外感寒邪作痛。故戒不可汗。汗之则成 。又问。仲景言鼻衄者不可汗。复言脉浮紧
者以麻黄汤发之。衄血自止。何也。予曰。血与汗异名同类。夺汗者无血。夺血者无汗。今
血妄行。为热所逼。更发其汗。反助邪热。重竭津液。必变凶症。故不可汗。若脉浮为在表
。紧则为寒。寒邪郁遏。阳不得伸。热伏荣中。迫血妄行。上出于鼻。故用麻黄汤散其寒邪
。阳气得舒。其衄自止。洁古之学。可谓知其要矣。
泰和二年四月。民多疫疠。初觉增寒体重。次传头目。肿盛目不能开。上喘。咽喉不利
。舌干口燥。俗云大头天行。亲戚不通。染之多殆。
一人病此五六日。医以承气加蓝根下之。稍缓。翌日其病如故。下之又缓。终莫能愈。
困笃。予曰。身半以上。天之气也。身半以下。地之气也。此邪热客于心肺之间。上攻头目
肿盛。以承气泻胃中之实热。是诛罚无过。不知适其至所为。故遂用
黄连 黄芩（味苦寒各半两泄心肺间热为君） 橘红（苦平） 玄参（苦寒） 生甘草（甘寒
）人参（三钱泄火补气为臣） 连翘 鼠粘子 薄荷叶（苦辛平） 板蓝根（苦寒） 马勃（各一
钱） 白僵蚕（炒七分） 升麻 柴胡（苦平各二钱行少阳阳明二经气不得伸） 桔梗（辛温为舟
楫不使下行）
共为细末。半用汤调。时时服之。半用蜜丸噙化。服尽良愈。
凡他处有病此者。书方贴之。名曰
普济消毒饮。或加川芎、归身。 咀如麻豆。每服五钱。水二钟。煎至一钟。去滓。食
后稍热时时服。如大便硬。加大黄（酒煨一钱或二钱）以利之。肿势甚。宜砭刺之。
按时行疫疾。虽由热毒所染。有气实人下之可愈。气虚者概下之。鲜不危矣。故东垣制
此方救斯人。其惠博哉。
一人年逾三十。肩患毒。服人参败毒散一剂。更服十宣散去参、桂。加金银花、天花粉
而溃。因怒动肝火。风热上壅。头面赤肿。 痛。饮冷。以荆防败毒散。加芩、连、薄荷。
二剂不应。急砭患处。出黑血盏许。仍以一剂。势退大半。再服人参败毒散四剂而愈。
夫病有表里、上下之殊。治有缓急攻补之异。若不砭刺。气血结为肉理。药不能及。肿
日盛。使峻利之药。则上热未除。中寒已作。必伤命矣。
升麻牛蒡子散 治时毒疮发头面胸膈。脉浮洪在表者。
升麻 牛蒡 甘草 桔梗 葛根 玄参 麻黄 连翘（各一钱） 锉。作一服。姜三片。
水二盏煎。一黄门腮赤肿痛。此胃经风热上攻。以犀角升麻汤（三八）二剂而平。
又一大理患此。用前汤为人所惑。谓汤内白附子性温故也。另用荆防败毒散愈盛。后用
此汤尚去白附子。不应。再用全方。三剂而愈。
本草云。白附子。味甘辛。气温。无毒。主面上百病。及一切风疮。乃风热之主药。经
曰。有是病。用是药。苟不用主病之药。安得而愈。
一人腮颊肿 至于牙龈。右关脉数。此胃经风热上攻也。治以犀角升麻汤（三八）而消。
《黄帝内经》说：肺在体内主司气，在体外主管皮毛。如果肺气虚弱，则腠理（皮肤纹理及汗孔）不致密，皮毛失去光泽；肺受到损伤，则皮毛出现纵横交错、枯槁不顺的现象。
肺痈（肺部化脓性病变）、肺痿（肺叶枯萎萎缩之病）、肠痈（肠道化脓性病变），必然会导致皮毛出现上述状况。这是因为气不能滋养荣润的缘故。也有服用解表药后，见邪气未解，又再次使用发汗解表法的情况。殊不知邪气不解，并非邪气不能被解除，多是因为腠理不致密，导致邪气再次侵入。专门使用发汗解表的方法，会使腠理更加虚损，邪气更容易进入，反而变成败坏难治的病症。应当诊察患者的脉象：邪气在表的，只应当采用和解的方法并充实腠理；因腠理空虚而邪气复入的，也应当采用和解的方法，兼以充实腠理。因此使用托里益气的药物。如果小便颜色红赤且排尿涩痛，这是由肺热传变所致；小便短少，是因为肺气虚弱。盖因肺为母脏，肾为子脏，母脏虚弱不能滋生子脏的缘故。也有小便频数的情况，这也是因为肺虚不能制约水道所致。大抵劳倦损伤气血，则腠理不致密，风邪乘袭于肺，虚风与热邪相互搏结，郁滞凝聚不散，从而导致气喘咳嗽。如果误用发汗或攻下法过度，则津液严重耗亡，遂形成肺痈、肺痿的病症。
桷按：以上十五条论述，原本是在后面的医案中互相阐发的。虽然不属于外科范畴，但因其议论切中杂病的要害，不敢遗漏，所以采集附在诸论之后，使学习的人便于观览。
（时毒发作于面部、鼻部、耳部、颈项部的情况是）
里实而大便不通的，用泻下法。
表实而邪气不解的，用发散法。
表里俱实而邪气不解的，解表攻里并用。
表里邪气已解而肿胀不消的，用调和法。
肿胀严重且疼痛的，用砭石刺破排出恶血，再使用消毒的药物。
不化脓或不溃破的，用托里透脓法。
饥荒年间普遍流行的，不宜使用峻猛利下的药物，应当审慎辨证治疗。
所谓“时毒”，是四时不正的邪毒之气感于人所致。其症状表现为发作于面、鼻、耳、项、咽喉部位，红肿无头，或有根脚，使人怕冷，发热，头痛，或肢体疼痛，神志恍惚不安，咽喉闭塞。不认识这种病的人，会以为是伤寒，就服用解表药。一两天后，肿势更加加重，这才醒悟，开始求治于疮疡医生。原来这种疾病古代没有方论记载，世俗通称为丹瘤。病人厌恶谈论“时毒”二字，担心被传染。考证经典说：人身突然发生红色变化，状如涂抹丹砂，称为丹毒。这是由风热恶毒引起的，与时毒完全不同。大概时毒初起状如伤寒，五到七天内能致人死亡。治疗者应当精细辨别。先论述其脉象：滑、数、浮、洪、沉、紧、弦、涩，都是其征候。其中浮数脉表示邪气在表，沉涩脉表示邪气深入。体质壮实之人，急服化毒丹以攻逐邪气；若热盛且大便不通，用大黄汤泻下；有表证的，用解毒升麻汤发散；年老体弱之人，用五香连翘汤主治。又在鼻内搐药，使用通气散，取十余次喷嚏作为见效的标志。如果用药搐鼻却不打喷嚏的，不可治愈。如果嚏出脓液的，治疗必愈。左右陪同的人，每天用嚏药搐鼻，必定不会传染。病患也每天用嚏药三到五次以泄热毒。这是治疗时毒的好方法。经过三四天邪气不解的，不可猛烈攻下，仍宜和解，如犀角连翘散之类。到了七八天，大小便通畅，头面肿起高赤的，可服用托里散、黄芪散。适宜用针镰放血，泄其毒瓦斯。十日外不治也会自愈。此病如果在五日以前，精神昏乱，咽喉闭塞，声音不出，头面不肿，饮食不知味道，必定死亡，治疗无效了。然而此疾有阴证阳证之分，有可汗法，有可下法。粗劣的医生只说是热毒，就用寒凉药物。殊不知病情有轻重，治疗有逆从，不可不审慎。
有一人头面肿痛，服用硝石、大黄等败毒的药物后病情加重。诊察其脉象浮数，邪气在表尚未解除。用荆防败毒散两剂，势头退去大半。再用葛根牛蒡子汤，四剂痊愈。（这是凭脉象判断邪在表而用发表法。）
经书说：身体上半部肿胀，是天之气（风邪）所致；身体下半部肿胀，是地之气（湿邪）所致。这是邪气客居在心肺之间，上攻头目所致。这是感受四时不正之气造成的。与膏粱厚味积热之症不同。硝石、大黄这类药物，不是大便秘结实证不可使用。如果不审察病因，以及辨别虚实表里，一概使用攻下法，必定导致失误。常见饥荒之际，底层百姓多患此病。乃是胃气受损，邪气随之入侵，不可不考察。我常治疗邪在表的，用葛根牛蒡子汤、人参败毒散，或普济消毒饮子。邪在里的，用五利大黄汤、栀子仁汤。表里俱不解的，用防风通圣散。表里俱解而肿不退的，用犀角升麻汤。肿胀严重的，砭刺患处，放出恶血以泄其毒。十日外自愈。如果嚏出脓血即愈。想要它化脓的，用托里消毒散。想要它收敛的，用托里散。此法最为稳妥。五到七天咽喉不闭，言语不出，头面不肿，饮食不知味道，属不治之症。
有一人患此病，肿痛发热，口渴，脉实大便闭结。用五利大黄汤泻下，各种症状全部消退。再用葛根牛蒡子汤四剂痊愈。（这是凭脉象判断邪在里而用攻里法。）
有一人表里邪气已解，肿痛尚不退。用葛根升麻汤两剂而消肿。（这是凭症状治疗。）
有一人肿痛伴有寒热，脉浮数。用荆防败毒散两剂，稍好转。再用人参败毒散两剂，势头减半。又两剂而痊愈。（这是凭脉象判断邪在表而用发表法。）
有一人耳面部赤肿作痛，咽干发热，脉浮数。先用荆防败毒散两剂，势头退去大半。再用葛根牛蒡子汤四剂痊愈。（凭脉象判断邪在表而用发表法。）
一位妇女表邪已解，肿胀尚不消除。诊察其脉滑而数，这是瘀血化脓的表现。用托里消毒散使其溃破而愈。（这是凭脉象判断。）
有一人腮部肿胀疼痛，口渴烦热，便秘脉数，按压尤其坚实。用防风通圣散一剂，各种症状顿时消退。再用荆防败毒散加玄参、牛蒡子、黄芩，两剂而痊愈。（这是凭症状和脉象，发表攻里并用。）
一位老人在冬天头面耳项全部肿胀，疼痛剧烈，便秘脉实。这是表里俱实。饮用防风通圣散无效，于是砭刺患处流出黑血，仍然投予前药，立即见效。再用荆防败毒散而痊愈。之前药无效的原因，是毒血凝聚在上部经络，药力难以到达。恶血既去，药物自然生效。或者拘泥于“用寒远寒”（冬季慎用寒药）的说法，以及年高畏惧使用硝石、大黄，而只用托里和寻常消毒的药物，或者不砭刺泄毒，专借药力，很少有不危险的。（这是舍弃时令禁忌而从症状治疗。）
有一人表里邪气已解，只有肿胀不消。用托里消毒散四剂，脓成，针刺后痊愈。（这是凭症状治疗。）
一位妇女肿痛，用硝石、大黄攻下，稍缓解，第二天又痛。诊察发现外邪已退，这是瘀血欲化脓。用托里消毒散溃破而愈。（这是凭脉象和症状治疗。）
有一人服用表散药后火势更旺，发热便秘。诊脉沉实，这是邪气在里。用大黄汤泻下，里证全部消退。用葛根牛蒡子汤，浮肿也消退。只有赤肿尚存，再用托里药溃破而愈。（这是凭脉象和症状治疗。）
有一人在冬天患病，头面赤肿，耳前后尤其严重，疼痛难忍，发热恶寒，牙关紧急，鼻涕唾液稠粘，饮食困难，不得安卧。医生在肿处砭刺四五十针，肿赤不减，疼痛更甚。我诊察其脉浮紧，按之洪缓，知道这是寒邪覆盖皮毛，郁遏经络，热气不能上升，聚而成赤肿。况且天气寒冷凛冽之时，腠理闭合，汗不出，血气强盛，肌肉坚涩。善于用针的人不得取四肢厥冷时的穴位，必须等待天气温暖。又说：冬月闭藏脏腑，用药多，少用针石。适宜用苦温的药物，温经散寒。所谓寒邪导致腠理闭塞，用苦味药发散，用辛味药疏散。
方名：托里温经汤
麻黄（苦温，发汗为君药，去根节二钱） 防风（辛温，疏散为臣药，去芦二分） 升麻（苦辛四钱） 葛根（解肌出汗，专治阳明经邪，故以为臣药） 白芷、归身（血流不行则痛，白芷、归身辛温以和血散滞，各二钱） 苍术（湿热则肿，苍术甘温，体轻浮，力雄壮，能泄肤腠间温热，一钱） 人参（去芦一钱） 甘草（甘温） 白芍药（酸微寒，调中益气，使托其里为佐药，各钱半）
以上锉碎。每服一两，水二盏，先煎麻黄令沸，去掉沫，再下其余药物，同煎至一盏，去渣。大温服。用薄衣覆盖头部，厚被覆盖身体，睡在暖和的地方，使经血温暖，腠理开泄，寒气乃散，阳气升发，大汗出，肿减七八分。再服时去掉麻黄、防风，加连翘、鼠粘子（牛蒡子），肿痛悉愈。经书说：发汗则疮已，确实如此。
有人问：张仲景说疮家即使身体疼痛也不可用汗法，为什么呢？我说：这是说营气不从，逆于肉理，乃是主痈肿而痛，不是外感寒邪作痛。所以告诫不可发汗。发汗则会变成坏证。又问：张仲景说鼻衄（流鼻血）的人不可发汗，又说脉浮紧的用麻黄汤发汗，衄血自止，为什么呢？我说：血与汗异名同类。夺汗者无血，夺血者无汗。现在血妄行，是被热所逼，如果再发其汗，反而助长邪热，重竭津液，必定变成凶险病症。所以不可发汗。如果脉浮表示在表，紧则表示寒。寒邪郁遏，阳气不得伸展，热伏于营中，迫血妄行，上出于鼻。所以用麻黄汤散其寒邪，阳气得舒，其衄自止。洁古（张元素）的学问，可以说抓住了要领。
泰和二年四月，百姓多患疫疠。起初觉得怕冷体重，接着传到头目，肿胀严重眼睛不能睁开，向上喘息，咽喉不利，舌干口燥。俗称为大头天行，亲戚不通往来，感染的人大多危险。
有一人患此病五到六天，医生用承气汤加蓝根泻下，稍缓解。第二天病如故，又泻下又缓解，最终不能痊愈。困顿危笃。我说：身体上半部，是天之气；身体下半部，是地之气。这是邪热客居在心肺之间，上攻头目导致肿胀严重。用承气汤泻胃中之实热，是诛罚无罪（病位不在胃肠）。不知道适其至所为（药力直达病所）。所以我用
黄连、黄芩（味苦寒，各半两，泄心肺间热为君药） 橘红（苦平） 玄参（苦寒） 生甘草（甘寒） 人参（三钱，泄火补气为臣药） 连翘、鼠粘子、薄荷叶（苦辛平） 板蓝根（苦寒） 马勃（各一钱） 白僵蚕（炒七分） 升麻、柴胡（苦平，各二钱，行少阳、阳明二经气不得伸） 桔梗（辛温，为舟楫之药，不使下行）
共为细末。一半用汤调，时时服之。一半用蜜丸噙化。服完良愈。
凡他处有病此者，书写方子贴之，名为
普济消毒饮。或加川芎、归身。咀如麻豆。每服五钱，水二钟，煎至一钟，去滓。食后稍热时时服。如果大便硬，加大黄（酒煨一钱或二钱）以利之。肿势甚，宜砭刺之。
按时行疫疾，虽由热毒所染，有气实之人下之可愈。气虚者概下之，鲜有不危险的。所以东垣（李杲）制此方救斯人，其恩惠广博啊。
有一人年过三十，肩部患毒，服人参败毒散一剂，更服十宣散去参、桂，加金银花、天花粉而溃破。因怒动肝火，风热上壅，头面赤肿，疼痛，饮冷。用荆防败毒散，加芩、连、薄荷，两剂不应。急砭患处，出黑血约一盏许。仍以一剂，势头退去大半。再服人参败毒散四剂而愈。
夫病有表里、上下之殊，治有缓急攻补之异。如果不砭刺，气血结为肉理，药不能及，肿日盛。使用峻利之药，则上热未除，中寒已作，必伤性命。
升麻牛蒡子散 治疗时毒疮发于头面胸膈，脉浮洪在表者。
升麻、牛蒡、甘草、桔梗、葛根、玄参、麻黄、连翘（各一钱） 锉。作一服。姜三片，水二盏煎。
一黄门（宦官）腮赤肿痛，这是胃经风热上攻。用犀角升麻汤（三八）两剂而平。
又一大理（官员）患此，用前汤被人迷惑，认为汤内白附子性温的缘故。另用荆防败毒散，病势更盛。后用此汤尚去白附子，无效。再用全方，三剂而愈。
本草说：白附子，味甘辛，气温，无毒。主面上百病，及一切风疮，乃风热之主药。经书说：有是病，用是药。如果不使用主病之药，怎么能痊愈。
The *Yellow Emperor's Inner Classic* states: The Lung governs Qi internally and controls the skin and hair externally. If Lung Qi is deficient, the couli (skin texture and pores) will not be dense, and the skin and hair will lose luster; if the Lung is injured, the skin and hair will appear disordered and withered.
Lung abscess (pulmonary suppurative lesion), Lung flaccidity (atrophy of lung lobes), and intestinal abscess will inevitably lead to such conditions in the skin and hair. This is because Qi cannot nourish and moisten them. There are also cases where, after taking exterior-releasing medicines, the pathogenic factor remains unresolved, and exfoliation methods are used again. Little do they know that the failure to resolve the pathogen is not due to the inability to expel it, but often because the couli are not dense, allowing the pathogen to re-enter. Exclusively using exfoliation methods will further weaken the couli, making it easier for pathogens to enter, resulting in a deteriorating condition. One should examine the pulse: if the pathogen is at the exterior, one should only employ harmonizing methods and strengthen the couli; if the pathogen re-enters due to vacuity of the couli, one should also use harmonizing methods while strengthening the couli. Therefore, medicines that support the interior and tonify Qi are used. If urine is red and dysuric, this is transmitted from Lung heat; if urine is scanty, it is due to Lung Qi deficiency. Since the Lung is the Mother organ and the Kidney is the Child organ, maternal deficiency fails to generate the child. There are also cases of frequent urination, which is also due to Lung deficiency failing to control water passages. Generally, labor injury to Blood and Qi leads to loose couli; Wind pathogen attacks the Lung; Deficient Wind and Heat struggle together, stagnating and condensing without dispersing, leading to asthma and cough. If mistaken sweating or purging is excessive, Body Fluids are severely depleted, forming Lung abscess or Lung flaccidity.
Jue notes: The above fifteen discussions originally served to elaborate on each other in subsequent medical cases. Although not strictly surgical, their arguments are pertinent to miscellaneous diseases, so I dare not omit them. Thus, they are collected and attached after the various discussions for students' convenience.
(When Shidu [Seasonal Toxin] occurs on the face, nose, ears, and neck:)
If Interior Excess exists with constipation, purge it.
If Exterior Excess exists with unresolved pathogen, disperse it.
If both Exterior and Interior are Excess and unresolved, release the exterior and attack the interior simultaneously.
If both Exterior and Interior pathogens are resolved but swelling persists, harmonize it.
If swelling is severe and painful, use bian stone to puncture and remove evil blood, then apply detoxifying agents.
If no pus forms or it does not ulcerate, use interior-supporting methods to promote suppuration.
If prevalent during famine years, harsh purgatives should not be used; treatment must be cautious and differentiated.
"Shidu" refers to toxic qi of the four seasons infecting humans. Symptoms include onset on the face, nose, ears, neck, and throat, with redness and swelling without heads, sometimes with roots, causing chills, fever, headache, limb pain, restlessness, and throat obstruction. Those unfamiliar with this disease may mistake it for Cold Damage and take exterior-releasing medicines. After one or two days, swelling increases, and they seek a surgeon. Originally, ancient texts had no formulas for this disease; laypeople generally call it Dan Liu (Dan Tumor). Patients dislike the term "Shidu" due to fear of contagion. Examining classics: sudden redness on the body resembling cinnabar is called Dan Du (Red Poison), caused by Wind-Heat toxicity, distinct from Shidu. Shidu initially resembles Cold Damage but can be fatal within five to seven days. Practitioners must differentiate carefully. Pulse signs include Slippery, Rapid, Floating, Surging, Deep, Tight, Wiry, and Choppy. Floating-Rapid indicates pathogen at the exterior; Deep-Choppy indicates deep pathogen. For robust individuals, Huadu Dan should be taken urgently to attack the pathogen; if Heat Excess with constipation, Dahuang Tang (Rhubarb Decoction) should be used to purge; if Exterior signs exist, Jiedu Shengma Tang (Detoxification and Cimicifuga Decoction) should be used to release; for elderly and weak individuals, Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction) is primary. Nasal insufflation with Tongqi San (Unblocking Qi Powder) is effective if more than ten sneezes occur. If no sneezing occurs, it is incurable. If pus is sneezed out, cure is certain. Companions should use nasal insufflation daily to prevent contagion. Patients should use it three to five times daily to vent Heat-Toxin. This is an excellent method for treating Shidu. If unresolved after three to four days, do not purge heavily; instead, harmonize, e.g., Xijiao Lianqiao San (Rhino Horn and Forsythia Powder). By seven to eight days, if urination and defecation are smooth and head/face swelling is high and red, Tuoli San (Interior-Supporting Powder) and Huangqi San (Astragalus Powder) can be taken. Needle-lancing to bleed and vent toxic gas is appropriate. It may heal spontaneously after ten days. If before the fifth day, there is mental confusion, throat obstruction, voice loss, no head/face swelling, and loss of taste, death is inevitable, and treatment is futile. However, this disease has Yin and Yang aspects, and allows for sweating or purging. Incompetent doctors merely label it Heat-Toxin and use cold medicines. They fail to realize that disease severity varies and treatment requires adherence or counteraction; caution is essential.
One patient had head and face swelling and pain, worsening after taking Xiaoshi and Dahuang (Mirabilite and Rhubarb) detoxifying agents. Pulse was Floating-Rapid, indicating unresolved Exterior pathogen. Two doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Detoxification Powder) reduced symptoms by half. Four doses of Gegen Niuziqi Tang (Pueraria and Arctium Decoction) cured him. (Treatment based on pulse indicating Exterior pathogen.)
The Classics state: Swelling in the upper half of the body is due to Heavenly Qi (Wind); swelling in the lower half is due to Earthly Qi (Dampness). This is pathogen lodging between Heart and Lung, attacking head and eyes, caused by improper seasonal qi. It differs from accumulation-heat from rich food. Xiaoshi and Dahuang should not be used unless there is solid constipation. Without examining etiology and differentiating Empty/Full and Exterior/Interior, indiscriminate purging causes error. Often seen among poor people during famines, it stems from damaged Stomach Qi allowing pathogen invasion. I often treat Exterior pathogen with Gegen Niuziqi Tang, Renshen Baidu San (Ginseng Detoxification Powder), or Puji Xiaodu Yinzi (Universal Benefit Detoxification Drink). For Interior pathogen, Wuli Dahuang Tang (Five-Advantage Rhubarb Decoction) or Zhizi Ren Tang (Gardenia Seed Decoction). For unresolved Exterior and Interior, Fangfeng Tongsheng San (Saposhnikovia Unobstructed Defense Powder). For resolved Exterior/Interior but persistent swelling, Xijiao Shengma Tang (Rhino Horn and Cimicifuga Decoction). For severe swelling, bian stone puncture to vent evil blood. Healing occurs after ten days. If pus/blood is sneezed out, healing occurs. To promote suppuration, use Tuoli Xiaodu San (Interior-Supporting Detoxification Powder). To promote convergence, use Tuoli San. This method is most stable. If after five to seven days, throat is not closed, speech is absent, head/face is not swollen, and taste is lost, it is incurable.
One patient had swelling, pain, fever, thirst, solid pulse, and constipation. Purged with Wuli Dahuang Tang; all symptoms subsided. Cured with four doses of Gegen Niuziqi Tang. (Treatment based on pulse indicating Interior pathogen.)
One patient had resolved Exterior/Interior but persistent swelling. Reduced with two doses of Gesheng Ma Tang (Pueraria and Cimicifuga Decoction). (Treatment based on symptoms.)
One patient had swelling, pain, chills, fever, and Floating-Rapid pulse. Two doses of Jingfang Baidu San improved slightly. Two doses of Renshen Baidu San halved the intensity. Two more doses cured him. (Treatment based on pulse indicating Exterior pathogen.)
One patient had red/swollen/painful ears/face, dry throat, fever, and Floating-Rapid pulse. Two doses of Jingfang Baidu San reduced intensity by half. Four doses of Gegen Niuziqi Tang cured him. (Treatment based on pulse indicating Exterior pathogen.)
A woman had resolved Exterior pathogen but persistent swelling. Pulse was Slippery-Rapid, indicating Blood stasis turning to pus. Cured with Tuoli Xiaodu San to ulcerate. (Treatment based on pulse.)
One patient had cheek swelling/pain, thirst, irritability, constipation, Rapid pulse, and tenderness on pressure. One dose of Fangfeng Tongsheng San rapidly subsided symptoms. Two doses of Jingfang Baidu San plus Xuanshen, Niuziqi, Huangqin cured him. (Treatment based on symptoms and pulse, releasing Exterior and attacking Interior.)
An elderly man had winter-onset head/face/ear/neck swelling, severe pain, constipation, and Solid pulse. This is Exterior/Interior Excess. Fangfeng Tongsheng Tang was ineffective. Bian stone puncture released black blood; previous medicine then worked. Jingfang Baidu San cured him. Previous ineffectiveness was due to toxic blood coagulating in upper meridians, blocking drug action. Once evil blood was removed, drugs became effective. Adhering to "avoid cold in cold season" or fearing laxatives in the elderly, relying solely on interior-supporting/detoxifying drugs without puncturing, rarely avoids danger. (Treatment prioritizing symptoms over seasonal taboos.)
One patient had resolved Exterior/Interior but persistent swelling. Four doses of Tuoli Xiaodu San formed pus; needle drainage cured him. (Treatment based on symptoms.)
A woman had swelling/pain, treated with Xiaoshi/Dahuang, temporarily relieved, then returned. Pulse showed resolved Exterior pathogen, indicating Blood stasis turning to pus. Cured with Tuoli Xiaodu San. (Treatment based on pulse and symptoms.)
One patient worsened with exterior-releasing drugs, having fever and constipation. Pulse was Deep-Solid, indicating Interior pathogen. Purged with Dahuang Tang; Interior symptoms subsided. Gegen Niuziqi Tang reduced edema. Only red swelling remained; treated with interior-supporting drugs to ulcerate and cure. (Treatment based on pulse and symptoms.)
One patient had winter-onset head/face red swelling, worse around ears, unbearable pain, fever/chills, trismus, thick sputum, difficulty eating/sleeping. Doctor punctured forty to fifty times with bian stone, but swelling/redness persisted and pain increased. My pulse diagnosis was Floating-Tight, surging-slow upon pressure. This indicated Cold covering skin/hair, obstructing meridians, preventing Heat ascent, condensing into red swelling. In cold weather, couli close, sweat stops, Blood/Qi strengthens, muscles become firm/rigid. Skillful acupuncturists avoid extremities in winter cold, waiting for warmth. Winter is when Zang organs close; use more medicine, less acupuncture. Bitter-Warm medicines should warm meridians and scatter Cold. As stated, Cold closes couli; scatter with Bitter, disperse with Pungent.
Formula Name: Tuoli Wenjing Tang (Interior-Supporting Meridian-Warming Decoction)
Mahuang (Ephedrae Herba, Bitter-Warm, Sovereign for sweating, remove root nodes, 2 qian)
Fangfeng (Saposhnikoviae Radix, Pungent-Warm, Assistant for dispersion, remove rhizome, 2 fen)
Shengma (Cimicifugae Rhizoma, Bitter-Pungent, 4 qian)
Gegen (Puerariae Lobatae Radix, Releases muscle layer and induces sweat, treats Yangming channel pathogen, Assistant, dosage implied)
Baizhi (Angelicae Dahuricae Radix) & Danggui (Angelicae Sinensis Radix) - Blood stasis causes pain; these are Pungent-Warm to harmonize Blood and dissipate stasis, 2 qian each)
Cangzhu (Atractylodis Rhizoma, Damp-Heat causes swelling; Sweet-Warm, light/floating, strong power to vent Heat-Heat in couli, 1 qian)
Renshen (Ginseng Radix, remove rhizome, 1 qian)
Gancao (Glycyrrhizae Radix, Sweet-Warm)
Baishao (Paeoniae Radix Alba, Sour-Slightly Cold, regulates Middle, boosts Qi, supports Interior, Deputy, 1.5 qian each)
Crush ingredients. Take 1 liang per dose, 2 zhan water. Boil Mahuang first, skim foam, add remaining herbs, boil to 1 zhan, strain. Drink warm. Cover head with thin cloth, body with thick quilt, sleep in warm place. Warm Blood/Qi, open couli, scatter Cold, raise Yang, induce heavy sweat. Swelling reduces by 70-80%. Next dose, remove Mahuang/Fangfeng, add Lianqiao and Niuziqi. Pain/swelling fully healed. Classics say: Sweating cures sores. True indeed.
Question: Zhang Zhongjing says "Chuangjia [sores patients] even with body pain should not be sweated." Why?
Answer: This refers to Ying Qi not following its course, reversing in muscle tissue, causing pain from carbuncles/swellings, not external Cold-Damage pain. Hence, sweating is forbidden. Sweating leads to deterioration.
Question: Zhang Zhongjing says "Nosebleed patients should not be sweated," yet also says "Floating-Tight pulse uses Mahuang Tang to sweat, and nosebleed stops." Why?
Answer: Blood and Sweat are different names for the same substance. Depriving sweat leaves no blood; depriving blood leaves no sweat. Now, blood flows recklessly due to Heat forcing it. Sweating again aids Evil Heat and depletes fluids, causing凶症 (ominous symptoms). Hence, forbidden. If pulse is Floating (Exterior) and Tight (Cold), Cold obstructs Yang, Heat hides in Ying, forcing blood up the nose. Mahuang Tang scatters Cold, frees Yang, and nosebleed stops. Jiegu's learning grasped the essence.
In the second year of Taihe (April), many suffered epidemic pestilence. Initially chills and heaviness, then spreading to head/eyes, severe swelling closing eyes, upward panting, throat obstruction, dry tongue/mouth. Commonly called "Big Head Epidemic." Relatives avoided contact; infection was often fatal.
One patient suffered for 5-6 days. Doctor used Chengqi Tang + Lan Gen (Isatis Root) to purge. Slight relief. Next day, same illness. Purged again, slight relief. Never cured. Critical condition. I said: Upper body is Heavenly Qi; lower body is Earthly Qi. This is Evil Heat lodging between Heart/Lung, attacking head/eyes causing severe swelling. Using Chengqi Tang to purge Stomach excess heat punishes the innocent. It misses the target. So I used:
Huanglian (Coptidis Rhizoma) & Huangqin (Scutellariae Radix) - Bitter-Cold, 0.5 liang each, vents Heart/Lung Heat as Sovereign)
Juhong (Citri Reticulatae Pericarpium, Bitter-Ping)
Xuanshen (Scrophulariae Radix, Bitter-Cold)
Sheng Gancao (Raw Glycyrrhizae Radix, Sweet-Cold)
Renshen (Ginseng Radix, 3 qian, vents Fire, boosts Qi as Assistant)
Lianqiao (Forsythiae Fructus), Niuziqi (Arctii Fructus), Bohe Ye (Menthae Haplocalycis Folium) - Bitter-Pungent-Ping)
Banlangen (Isatidis Radix, Bitter-Cold)
Mabo (Fly Agaric Mushroom, dosage implied)
Bai Jiangcan (Bombyx Batryticatus, stir-fried, 7 fen)
Shengma (Cimicifugae Rhizoma) & Chaihu (Bupleuri Radix) - Bitter-Ping, 2 qian each, moves Shaoyang/Yangming Qi obstruction)
Jiegeng (Platycodonis Radix, Pungent-Warm, acts as boat/oar to prevent downward movement)
Grind to fine powder. Half mixed with water, taken frequently. Half made into honey pills for sucking. Cure achieved.
For other locations, write formula and paste. Named Puji Xiaodu Yin (Universal Benefit Detoxification Drink). Add Chuanxiong and Danggui if needed. Crush like hemp seeds. Take 5 qian per dose, 2 zhong water, boil to 1 zhong, strain. Take warm after meals. If stool hard, add Dahuang (wine-baked 1-2 qian) to unblock. If swelling severe, use bian stone puncture.
Seasonal epidemics, though caused by Heat-Toxin, can be purged in Qi-Excess persons. Purging Qi-Deficient persons rarely avoids danger. Hence, Dongyuan (Li Gao) created this formula to save people. His benevolence is vast.
One patient, over thirty, had shoulder toxin. Took one dose of Renshen Baidu San, then Shixuan San removing Renshen/Guizhi, adding Jinyinhua and Tianhuafen, leading to suppuration. Anger stirred Liver Fire, Wind-Heat congested upward, causing head/face red swelling and pain, craving cold drinks. Used Jingfang Baidu San + Huangqin/Huanglian/Bohe. Two doses ineffective. Urgently punctured site, released about one cup of black blood. One more dose reduced intensity by half. Four doses of Renshen Baidu San cured him.
Diseases differ in Exterior/Interior and Upper/Lower; treatments differ in Slow/Fast, Attack/Support. Without puncturing, Blood/Qi knots in tissue, drugs cannot reach, swelling grows. Harsh purgatives leave Upper Heat while creating Middle Cold, endangering life.
Shengma Niuziqi San (Cimicifuga and Arctium Powder) treats Shidu sores on head/face/chest/diaphragm with Floating-Surging pulse at Exterior.
Shengma, Niuzi, Gancao, Jiegeng, Gegen, Xuanshen, Mahuang, Lianqiao (1 qian each). Crush. One dose. 3 slices ginger, 2 zhan water, boil.
A eunuch had red/swollen/painful cheeks due to Stomach Channel Wind-Heat attacking upward. Cured with Xijiao Shengma Tang (Rhino Horn and Cimicifuga Decoction) in two doses.
Another official had this disease. Used previous decoction but was misled, claiming Baifuzi (Typhonii Rhizoma) is too warm. Used Jingfang Baidu San, worsening condition. Later used previous decoction but removed Baifuzi, ineffective. Used full formula, cured in three doses.
Bencao states: Baifuzi is Sweet-Pungent, Warm, non-toxic. Treats hundred diseases on face and all wind-sores. It is the chief medicine for Wind-Heat. Classics say: Have the disease, use the medicine. Without chief medicine, how can one heal?
One patient had cheek/jaw swelling extending to gums, Right Guan pulse Rapid. This is Stomach Channel Wind-Heat attacking upward. Cured with Xijiao Shengma Tang.