一百一十一、败毒牛黄丹,疮子出定,大便不通,疮中脓汁不干。
真牛黄 大黄(末,和两) 粉霜 珍珠(末,各一两)
上件同研匀,炼蜜和丸,如黍米大,每服十粒,煎人参汤下,量儿大小加减。
一百一十二、大黄丸。治疮痂起而能食,以此药下之。钱氏虽云∶此未可以能食为有热
而便下,须有他证相表里方可下。且疮痂起而能食,食而腹满,腹满而不大便,不大便而喘
急,喘急昏甚而谵语者,方可下。下之药,但能去热毒,不为疮痘之害。若疮痂起而能食一
证便下之,下之则不稳。盖热气未深故也。如伤寒发厥,须在六七日已后,益气深方能发厥
,厥而下之,表里皆解,伤寒则汗解,蕴热则疮疹出矣。
大黄(一两,酒浸洗,蒸熟) 黑牵牛(半生半熟,各一钱) 川芎(半两) 甘草(炙,
一钱)
上为细末,糯米糊为丸,如麻子大,每服量大小加减,蜜汤吞下,以溏利为度。
一百一十三、川黄散。治麸疮及斑疮,大便不通。
大黄(锉,微炒) 川芎(各一两) 甘草(炙) 黄芩 枳谷(炒,各半两)
上为粗末,每服一钱,水一小盏,紫草少许,同煎至半小盏,去滓温服,不拘时候。疮
痘则大便不通,不为害者则不下,其为害可下者,证大便不通,欲大便而不得通,不得通而
腹胀满,心胃闷,喘急面赤,睡中谵语,有诸证即可下。又看热气浅深,药有多少轻重也。
又有诸热证,大便如常,此又不可下,热在表故也,当与小柴胡汤、五苓散治之。
一百一十四、大承气汤。治昏甚谵语妄言,大便不通,腹胀手心腋下有汗,目睛黄赤喘
急者,当用之。
浓朴(八两) 大黄(四两) 枳实(一两,麸炒)
上为粗末,每服五钱,水半盏,煎至二分,入芒硝一字,去滓温服,不拘时候。
111. 败毒牛黄丹:适用于痘疹已出定,但大便不通,疮口脓汁不干结的情况。
配方:真牛黄、大黄(研末,用量为二两)、粉霜、珍珠(研末,各一两)。
制法与用法:将上述药材共同研磨均匀,用炼蜜调和制成丸药,大小如黍米。每次服用十粒,用人参汤煎送服,根据患儿年龄大小增减剂量。
112. 大黄丸:治疗痘痂形成且患儿能进食的情况,以此药攻下。钱乙虽然说过:不能仅凭能进食就判断有热而立即使用泻下药,必须有其他表里相应的症状才可以攻下。况且痘痂形成且能进食,如果伴有饮食后腹部胀满,腹部胀满且大便不通,大便不通且呼吸急促,呼吸急促导致神志昏沉甚至胡言乱语的情况下,才可以攻下。攻下的药物只能去除热毒,不会伤害疮痘。如果在痘痂形成且能进食这一证候时就立即攻下,会导致病情不稳。这是因为热气尚未深重。如同伤寒引起的四肢厥冷,必须在发病六七天以后,正气充足深入时才会出现厥冷,在厥冷且伴有可下之证时攻下,表里之邪皆可解除;若是伤寒则通过发汗解表,若是蕴热则通过发出疮疹来解。
配方:大黄(一两,酒浸洗,蒸熟)、黑牵牛(半生半熟,各一钱)、川芎(半两)、甘草(炙,一钱)。
制法与用法:将上述药材研成细末,用糯米糊制成丸药,大小如麻子。每次服用量根据患儿年龄大小增减,用蜜汤吞服,以大便稀溏通畅为度。
113. 川黄散:治疗麸疮及斑疮,大便不通。
配方:大黄(锉碎,微炒)、川芎(各一两)、甘草(炙)、黄芩、枳壳(炒,各半两)。注:原文“枳谷”疑为“枳壳”或“枳实”,此处依方义及常见配伍推测为枳壳/实类理气药,保留原名“枳谷”或按通假理解,但在实体提取中需注意。根据上下文“枳谷”极大概率为“枳壳”之误或异写,此处翻译保留原文词汇“枳谷”。
制法与用法:将上述药材研成粗末。每次取一钱,加水一小盏,加入少许紫草,共同煎煮至剩余半小盏,去渣温服,不限时间。如果是疮痘导致的大便不通,若不属于有害情况则不攻下;属于有害情况且可攻下的,表现为大便不通,想排便却无法排出,无法排出导致腹部胀满,心胃闷塞,呼吸急促,面色红赤,睡眠中胡言乱语,具备这些症状即可攻下。另外还要观察热气的深浅,决定药物的多少和轻重。又有各种热证,大便正常,这种情况不可攻下,因为热在体表,应当用小柴胡汤、五苓散治疗。
114. 大承气汤:治疗神志极度昏沉、胡言乱语、妄自言语,大便不通,腹部胀满,手心腋下有汗,眼睛发黄发红,呼吸急促的情况,应当使用此方。
配方:厚朴(八两)、大黄(四两)、枳实(一两,麸炒)。
制法与用法:将上述药材研成粗末。每次取五钱,加水半盏,煎煮至剩余二分之一的药液,加入芒硝“一字”(约一钱匕),去渣温服,不限时间。
111. Baodu Niuhuang Dan (Toxin-Resolving Cow-bezoar Pill): Indicated for cases where pustules/rash have settled, but defecation is obstructed and pus from sores remains un-dried.
Ingredients: Real Niu Huang (Calculus Bovis), Da Huang (Rhei Radix et Rhizoma, powdered, 2 liang), Fen Shuang (Arsenicum Album), Zhen Zhu (Margarita, powdered, 1 liang each).
Preparation and Administration: Grind the above ingredients uniformly. Mix with refined honey to form pills the size of millet seeds. Take 10 pills per dose, administered with a decoction of Ren Shen (Ginseng Radix et Rhizoma). Adjust dosage according to the child's age and size.
112. Da Huang Wan (Rhubarb Pill): Treats conditions where scabs have formed and the patient can eat; this formula is used for purgation. Qian Yi (Qian Yizhi) stated that one should not assume heat exists solely based on the ability to eat and immediately administer purgatives; there must be other internal and external corresponding symptoms to justify purgation. Specifically, if scabs have formed and the patient can eat, but experiences abdominal fullness after eating, which leads to constipation, then tachypnea, followed by severe lethargy and delirium, only then is purgation indicated. Purgative medicines can remove heat toxins without harming the rash/pustules. If purgation is applied merely because scabs have formed and the patient can eat, it will lead to instability, as the heat pathogen has not yet penetrated deeply. Similar to cold damage causing limb coldness (Jue), purgation should only be considered after six or seven days when the qi is sufficiently deep; purging in such cases resolves both exterior and interior pathogens. Cold damage is resolved through sweating, while accumulated heat is resolved through the eruption of rashes.
Ingredients: Da Huang (Rhei Radix et Rhizoma, 1 liang, soaked in wine, washed, steamed until cooked), Hei Qian Niu (Semen Phytolaccae, half raw and half processed, 1 qian each), Chuan Xiong (Ligusticum Chuanxiong Rhizome, 0.5 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, processed with honey, 1 qian).
Preparation and Administration: Grind into fine powder. Form pills using rice paste, sized like hemp seeds. Administer an appropriate amount based on age/size, swallowed with honey water. Stop when loose stools are achieved.
113. Chuan Huang San (Chuanhuang Powder): Treats Ma Chuang (smallpox-like rash) and Ban Chuang (macular rash) accompanied by constipation.
Ingredients: Da Huang (Rhei Radix et Rhizoma, cut, lightly stir-fried), Chuan Xiong (Ligusticum Chuanxiong Rhizome, 1 liang each), Gan Cao (Glycyrrhizae Radix et Rhizoma, processed with honey), Huang Qin (Scutellariae Radix), Zhi Gu (Zhi Ke/Zhi Shi - likely Bitter Orange/Aurantium Fructus or Immature Bitter Orange, stir-fried, 0.5 liang each). Note: "Zhi Gu" is interpreted here as Zhi Ke/Shi based on context.
Preparation and Administration: Grind into coarse powder. Take 1 qian per dose, add one small cup of water and a little Zi Cao (Arnebiae Radix seu Cortex), decoct together until half a small cup remains. Strain and take warm, at any time. If constipation is caused by rash/pustules and is not harmful, do not purge. If it is harmful and purgation is indicated, symptoms include constipation, inability to pass stool despite the urge, abdominal distension, chest and epigastric oppression, tachypnea, flushed face, and delirium during sleep. Presence of these symptoms justifies purgation. Furthermore, assess the depth of heat to determine the dosage and potency. For various heat syndromes with normal bowel movements, purgation is contraindicated as the heat is in the exterior; instead, treat with Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Wu Ling San (Five-Ingredient Powder with Poria).
114. Da Cheng Qi Tang (Major Order the Qi Decoction): Indicated for severe lethargy, delirious speech, wild talking, constipation, abdominal distension, sweating on palms and axillae, yellow-red eyes, and tachypnea.
Ingredients: Hou Po (Magnoliae Officinalis Cortex, 8 liang), Da Huang (Rhei Radix et Rhizoma, 4 liang), Zhi Shi (Aurantii Fructus Immaturus, 1 liang, stir-fried with bran).
Preparation and Administration: Grind into coarse powder. Take 5 qian per dose, add half a cup of water, decoct until reduced to two parts (approx. half volume). Add Mang Xiao (Natrii Sulfas, one zi/approx. 1 qian bi). Strain and take warm, at any time.