夫五发者,谓痈疽生于脑、背、眉、髯、鬓是也。大概论之,分为三等。一者疽也,二
也,三者疖也。夫疽初生,如黍米大,痒痛有异,误触破之,即 展四畔,赤肿沉闷,牵引
胁肋疼痛;数日之后,渐觉肌肤壮热,恶寒烦渴,肿晕侵展, 浆汁出,积日不溃,抑之则
流血者,谓之发背疽也。其发于脑者,为脑疽也;其发于鬓、眉、髯者,以类呼也。又有初
生,其状无头,肿阔三、四寸,始觉注闷疼痛,因循数日,皮光微软者,甚则亦令人发热恶
寒,头痛烦渴者,谓之发背痈也。又有初生一头,色浮赤而无根肿,见于皮肤之间,大小一
二寸者疖也。三者之候,惟疽最重。此疾初生,皆由滋味与浓衣。衣服浓暖,则表易招寒;
滋味过多,则五脏生热。脏腑积热,则血脉不流,而毒瓦斯凝滞,邪气伏留,热搏于血,血聚
则肉溃成疮,浅则为疖,实则为痈,深则为疽矣。亦有因服金石发动而患此疾者,亦有平生
服金石药而亦患此疾者,盖由上祖曾服饵者,其毒瓦斯流传子孙。此病初生认是疽,则宜速疗
之;若气实之人,急服五香连翘汤、漏芦汤。若年几未五十,少壮实者,可服五利大黄汤、
化毒丸,取通利脏腑一、二行,疮头上用追毒散之类,贴温热膏剂,更 肿汤,溃毒汤淋
之。如此调治,以待脓成,以前不可以诸药救疗,以安患人之心,慎勿恼触。着至脓成败溃
,宜服五香汤及内托里散、茯苓汤、当归托里散之类;渴不止者,服竹叶黄 汤、乳香散,
勿为大热服大黄、朴硝苦寒之药。若因服利药而利不止者死矣。若疮中恶肉未退,脓水不快
者,即用追蚀之药,或铤子 之,上用鹿角散,以醋熬为糊贴之。恶肉退去,好肉渐生,即
用搜脓散、翠霞散之类 之。若疮中毒瓦斯未尽,慎勿早敛,忌早上生肌之药;纵得平复,必
再发。其间调理次第,临时制宜,将护忌慎之法耳!
所谓“五发”,是指痈疽发生在脑、背、眉、胡须和鬓角部位。大致来说,分为三等:一是疽,二是痈,三是疖。
疽初起时,像黍米大小,瘙痒与疼痛表现各异。如果误触破溃,疮口就会向四周扩散,出现红肿沉闷,并牵引胁肋部疼痛;几天之后,逐渐感觉肌肤壮热,恶寒且心烦口渴,肿胀范围扩大,流出浆液,多日不溃烂,按压则出血的,称为发背疽(背部发生的疽)。发生在脑部的,称为脑疽;发生在鬓角、眉毛、胡须部位的,依其发生部位类比命名。
又有初起时,形状没有头目,肿胀宽阔三四寸,起初只觉得沉重闷痛,拖延数日后,皮肤光亮而柔软的,严重时也会让人发热恶寒、头痛心烦口渴的,称为发背痈(背部发生的痈)。
又有初起只有一个头,颜色浮红赤色而没有根基肿胀,出现在皮肤之间的,大小一二寸的,称为疖。这三种病症中,只有疽最为严重。
这种病初起,都是由饮食厚味和穿着过暖引起的。衣服穿得浓密温暖,体表就容易招致寒气;饮食滋味过于浓厚,五脏就会产生内热。脏腑积热,导致血脉运行不畅,毒邪凝滞,邪气潜伏停留,热邪搏结于血分,血液淤聚则肌肉腐烂形成疮疡,浅表的为疖,坚实的为痈,深部的为疽。
也有因为服用金石类药物引发此病的,也有平生服用金石药而患此病的,大概是因为祖先曾服用过这类药物,其毒性流传给了子孙。
此病初起若确认为疽,应当迅速治疗。如果是体质壮实的人,急服五香连翘汤、漏芦汤。如果年龄不到五十岁,身体少壮结实者,可服用五利大黄汤、化毒丸,使脏腑通畅排泄一两次,在疮头上使用追毒散之类,贴敷温热膏剂,再用消肿汤、溃毒汤淋洗患处。这样调治,等待脓液成熟。在此之前不可用各种药物强行救治,以安定患者心情,切勿恼怒触碰。等到脓液成熟败坏溃破后,宜服用五香汤及内托里散、茯苓汤、当归托里散之类;如果口渴不止,服用竹叶石膏汤、乳香散,不要给大热之证服用大黄、朴硝等苦寒药物。如果因为服用泻下药而导致腹泻不止的,就会死亡。
如果疮中的腐肉未退,脓水排出不畅的,立即使用追蚀药物,或用药线引流,上面用鹿角散,用醋熬成糊状贴敷。腐肉退去,好肉渐生,即使用搜脓散、翠霞散之类处理。如果疮中毒邪未尽,切勿过早收敛伤口,忌早上生肌的药物;即使暂时平复,必定会复发。其中的调理次序,需根据当时情况制宜,主要是护理和禁忌的方法罢了!
The term "Wu Fa" (Five Eruptions) refers to carbuncles and sores occurring on the brain, back, eyebrows, beard, and temples. Generally speaking, they are divided into three grades: first, Ju (deep-seated suppurative infection); second, Yong (superficial abscess); third, Jie (furuncle).
When a Ju first appears, it is as small as a millet seed, with varying sensations of itching and pain. If accidentally touched and broken, the lesion spreads to the surrounding areas, presenting with redness, swelling, heaviness, and dullness, radiating pain to the hypochondrium; after several days, one gradually feels intense heat in the skin and muscles, aversion to cold, restlessness, and thirst, with the swelling expanding, exuding serous fluid, failing to ulcerate for many days, and bleeding upon pressure; this is called "Fa Bei Ju" (Back Carbuncle). Those occurring on the brain are called "Nao Ju" (Brain Carbuncle); those occurring on the temples, eyebrows, and beard are named by analogy to their location.
There is another type that initially presents without a distinct head, with swelling spanning three or four cun, initially feeling heavy and painful; after lingering for several days, the skin becomes smooth and soft; if severe, it also causes fever, aversion to cold, headache, restlessness, and thirst; this is called "Fa Bei Yong" (Back Abscess).
There is yet another type that initially presents with a single head, floating red color without deep-rooted swelling, appearing between the skin layers, sized one or two cun; this is called "Jie" (Furuncle). Among these three conditions, only the Ju is the most severe.
The onset of this disease is generally caused by rich dietary flavors and wearing thick, warm clothing. Wearing dense and warm clothes makes the exterior susceptible to cold pathogens; consuming too many rich flavors generates internal heat in the five zang organs. Accumulated heat in the zang and fu organs impedes blood circulation, causing toxic factors to stagnate and evil qi to linger. Heat combats the blood, leading to blood stasis, which causes muscle decay and forms sores: superficial ones become Jie, solid ones become Yong, and deep ones become Ju.
Some suffer from this disease due to the activation triggered by ingesting mineral drugs (Jin Shi), while others have suffered from it throughout life due to taking such drugs. This is likely because ancestors once ingested these substances, and their toxicity has been transmitted to descendants.
If the disease is identified as a Ju at its onset, prompt treatment is required. For individuals with strong constitution, urgently administer Wu Xiang Liao Qiao Tang (Five-Spice Forsythia Decoction) or Lou Lu Tang (Rhaponticum Decoction). For those under fifty years old with robust constitutions, Wu Li Da Huang Tang (Five-Benefits Rhubarb Decoction) or Hua Du Wan (Toxin-Resolving Pill) may be taken to promote bowel movement and clear the zang-fu one or two times. Apply Zhui Du San (Toxin-Pursuing Powder) to the sore head, paste with warm ointments, and wash with Xiao Zhong Tang (Swelling-Reduction Decoction) and Kui Du Tang (Ulceration-Decomposing Decoction). Treat thusly until pus matures. Before this stage, do not use various medicines to forcibly treat it, in order to calm the patient's mind; strictly avoid irritation. Once the pus matures, breaks down, and ulcerates, take Wu Xiang Tang (Five-Spice Decoction), Nei Tuo Li San (Interior-Supporting Powder), Fu Ling Tang (Poria Decoction), or Dang Gui Tuo Li San (Angelica Interior-Supporting Powder). If thirst persists, take Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) or Ru Xiang San (Frankincense Powder); do not administer bitter-cold drugs like Da Huang (Rhubarb) and Po Xiao (Mirabilite) for excessive heat. If diarrhea continues indefinitely due to purgatives, death ensues.
If foul flesh remains in the sore and pus drainage is poor, immediately apply cauterizing/erosive medicines or use setons for drainage, and apply Lu Jiao San (Deer Horn Powder) pasted with vinegar above the area. After foul flesh is removed and healthy flesh begins to grow, apply Sou Nong San (Pus-Searching Powder) or Cui Xia San (Emerald Cloud Powder). If toxic factors within the sore are not fully cleared, do not close the wound prematurely; avoid applying flesh-generating medicines early; even if it temporarily heals, it will inevitably recur. The sequence of regulation must be adapted to the specific situation, focusing on nursing care and precautions.