立斋曰∶疮疡溃后无寐,发热烦躁,血虚也,圣愈汤。自汗不止无寐,气虚也,四君子
加黄 、五味子。发热烦躁,肉 筋惕,气血虚也,八珍汤。大渴面赤,脉洪大而浮,阴
虚发热也,当归补血汤。肢体微热,烦躁面赤,脉沉微,阴盛发躁也,四君加姜附。
立斋曰∶疮疡出血,因五脏之气亏损,虚火动而错经妄行也。当求其经,审其因而治之
。若肝热而血妄行者,宜四物加炒山栀、芩、术、丹皮。肝虚而不能藏血者,六味地黄丸。
心虚而不能主血者,四物加炒黄连、丹皮、苓、术。脾虚热而不能统血者,四君子加炒栀子
、丹皮。若脾经郁结,用归脾汤加五味子。脾肺气虚,用补中益气汤加五味子。气血俱虚,
用十全大补汤。阴火动者,用六味丸加五味子。大凡失血过多,见烦躁发渴等证。勿论其脉
,急用独参汤,以补气。经云∶血生于气。苟非参 归术,甘温等剂,以生心肝之血,决不
能愈。若发热脉大者,不治。凡患血证,皆当以犀角地黄汤为主。
李氏云∶病疽之人,当戒酒面、炙爆腌腊、生冷油腻、鸡鹅鱼腥之类。若起居七情,
尤为深戒。必令卧室洁净馨香,使气血流畅。仍忌僧道孝子,产妇经妇,及鸡犬猫畜。之类若背疽
难于隐几,宜用绿豆十斗做一袋,隐伏其上,以解毒凉心也。又曰∶大凡脏腑已利,疮毒已溃
,气血既虚,最当调护,若发热而服凉药,无不致祸。
立斋曰∶绿豆性寒,主丹毒烦热、风疹或金石所发。实热烦渴,饮食如常,证属纯阳者
,极宜用之,否则不可轻用也。又曰∶疮疡食肉,乃自弃也。疮疡之毒,发于营气,今反助
之,与自弃何异。虽用药施治,亦不能愈。
东垣云∶胃为五脏之根本。胃气一伤,诸证皆虚,七恶蜂起,可不慎哉。
愚按∶疮疡当忌荤腥,然以愚见言之,则惟热火证及疔毒阳痈,则毫不可犯,宜切慎之。至
若营卫大虚,而毒不能化,肉不能长,凡宜温宜补等证,岂亦不宜滋补乎。故古人号黄 为
羊肉,则既宜黄 ,未有不宜羊肉者。惟猪肉、牛肉、醇酒及伤脾助湿等物,则不可不忌。
薛立斋说:疮疡溃破后出现失眠,伴有发热、烦躁,这是血虚所致,用圣愈汤治疗。自汗不止且失眠,这是气虚所致,用四君子汤加黄芪、五味子治疗。发热、烦躁,肌肉跳动、筋脉抽搐,这是气血两虚所致,用八珍汤治疗。极度口渴、面色发红,脉搏洪大且浮,这是阴虚发热,用当归补血汤治疗。肢体轻微发热,烦躁、面色发红,脉搏沉微,这是阴盛格阳导致的躁动,用四君子汤加干姜、附子治疗。
薛立斋说:疮疡出血,是因为五脏之气亏损,虚火妄动导致血液不循常道而溢出。应当审察所属经络,辨析病因进行治疗。如果是肝热导致血液妄行,适宜用四物汤加炒山栀、黄芩、白术、丹皮。肝虚不能藏血的,用六味地黄丸。心虚不能主血的,用四物汤加炒黄连、丹皮、茯苓、白术。脾虚有热不能统摄血液的,用四君子汤加炒栀子、丹皮。如果是脾经郁结,用归脾汤加五味子。脾肺气虚的,用补中益气汤加五味子。气血都虚的,用十全大补汤。阴火妄动的,用六味丸加五味子。凡是失血过多,出现烦躁、发渴等症状,不论脉象如何,应立即使用独参汤来补气。医经说:血由气所生。如果不是用人参、当归、白术等甘温的药物来化生心肝之血,决不能痊愈。如果发热且脉搏大的,属于不治之症。凡是患有血证的,都应当以犀角地黄汤为主方。
李氏说:患疽病的人,应当戒除酒类、面食、烤炸腌制腊肉、生冷油腻以及鸡鹅鱼腥等食物。对于起居和七情(喜、怒、忧、思、悲、恐、惊)的调摄,更要特别谨慎。必须让卧室洁净芳香,使气血运行流畅。还要忌讳僧人、道士、孝子、产妇、月经期妇女,以及鸡犬猫畜等靠近。如果背疽严重到难以倚靠几案休息,适宜用十斗绿豆做成一个袋子,躺在上面,以此来解毒凉心。又说:凡是脏腑功能已经通畅,疮毒已经溃破,气血已经虚弱的时候,最应当注意调养护理。如果此时发热却服用寒凉药物,没有不招致祸害的。
薛立斋说:绿豆性寒,主治丹毒引起的烦热、风疹或金石类药物引发的热证。如果是实热烦渴,饮食如常,证候属于纯阳性质的,极适宜使用;否则不可以轻易使用。又说:疮疡患者吃肉,是自寻死路。疮疡的毒邪发于营气,现在反而通过吃肉来助长它,这与自寻死路有什么区别呢?即使用药治疗,也不能痊愈。
李东垣说:胃是五脏的根本。胃气一旦受损,各种证候都会变得虚弱,七恶证蜂拥而起,能不谨慎吗?
我按语:疮疡确实应当忌食荤腥,但依我个人的看法,只有火热证及疔毒、阳痈,是绝对不可触犯这些禁忌的,应该格外谨慎。至于那些营卫气血大虚,导致毒邪不能化解,肌肉不能生长的情况,凡是适宜温补的证候,难道也不宜滋补吗?所以古人称羊肉为“黄耆”,既然适宜用黄耆,就没有不适宜吃羊肉的道理。只有猪肉、牛肉、浓酒以及伤脾助湿的食物,才是不可以不忌的。
Li Zhai said: Insomnia following the ulceration of sores and carbuncles, accompanied by fever and irritability, is due to Blood deficiency; Shengyu Tang (Saint's Vitality Decoction) should be used. Insomnia with incessant spontaneous sweating is due to Qi deficiency; Sijunzi Tang (Four Gentlemen Decoction) added with Huangqi (Astragali Radix) and Wuweizi (Schisandrae Fructus) should be used. Fever, irritability, muscle twitching, and tendon tremors are due to both Qi and Blood deficiency; Bazhen Tang (Eight Treasures Decoction) should be used. Extreme thirst, flushed face, and a洪大 (surging) and floating pulse indicate Yin deficiency with false heat; Danggui Buxue Tang (Angelica Tonifying Blood Decoction) should be used. Slight limb fever, irritability, flushed face, and a deep, minute pulse indicate agitation caused by Yin excess repelling Yang; Sijunzi Tang (Four Gentlemen Decoction) added with Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) should be used.
Li Zhai said: Bleeding from sores and carbuncles results from the depletion of Qi in the Five Viscera, causing deficient fire to stir and blood to flow recklessly outside its vessels. One must identify the affected meridian, examine the cause, and treat accordingly. If liver heat causes reckless bleeding, Siwu Tang (Four Substances Decoction) added with fried Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Danpi (Moutan Cortex) is suitable. For liver deficiency failing to store blood, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is indicated. For heart deficiency failing to govern blood, Siwu Tang (Four Substances Decoction) added with fried Huanglian (Coptidis Rhizoma), Danpi (Moutan Cortex), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizoma) is appropriate. For spleen deficiency with heat failing to control blood, Sijunzi Tang (Four Gentlemen Decoction) added with fried Zhizi (Gardeniae Fructus) and Danpi (Moutan Cortex) is used. If there is stagnation in the spleen meridian, Guipi Tang (Restore the Spleen Decoction) added with Wuweizi (Schisandrae Fructus) is prescribed. For Qi deficiency of the spleen and lungs, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) added with Wuweizi (Schisandrae Fructus) is used. For deficiency of both Qi and Blood, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) is indicated. For stirring of Yin fire, Liuwei Wan (Six-Ingredient Pill) added with Wuweizi (Schisandrae Fructus) is used. Generally, when excessive blood loss presents with symptoms such as irritability and thirst, regardless of the pulse, Dushen Tang (Single Ginseng Decoction) should be urgently administered to tonify Qi. The Classics state: "Blood is generated by Qi." Without using sweet and warm agents such as Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) to generate the blood of the Heart and Liver, recovery is impossible. If fever is accompanied by a large pulse, it is incurable. In all cases of blood disorders, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should serve as the primary formula.
Mr. Li said: Patients suffering from deep abscesses (Ju) must abstain from alcohol, wheat products, roasted/fried foods, cured meats, cold/raw items, greasy foods, and fish/poultry considered "fishy" or stimulating. Particular caution is required regarding daily routine and emotional regulation (Seven Emotions). The bedroom must be kept clean and fragrant to ensure smooth circulation of Qi and Blood. One must also avoid contact with monks, Taoist priests, mourners, postpartum women, menstruating women, and animals such as chickens, dogs, and cats. If a back abscess is so severe that one cannot lean on a cushion, it is advisable to make a bag from ten dou of mung beans, lie upon it, and thereby detoxify and cool the Heart. Furthermore, once the internal organs are functioning smoothly, the sore has ulcerated, and Qi and Blood are depleted, careful nursing is paramount. Administering cooling herbs during fever in this stage invariably leads to disaster.
Li Zhai said: Mung beans are cold in nature and treat erysipelas-related irritability, wind-rashes, or heat conditions induced by minerals/metals. They are highly suitable for pure Yang patterns characterized by excess heat, irritability, and thirst with normal appetite; otherwise, they should not be used lightly. He also stated: Eating meat during the course of sores and carbuncles is akin to abandoning oneself. The toxicity of sores arises from Ying (Nutritive) Qi; consuming meat further assists this pathogen. How is this different from self-destruction? Even with medicinal treatment, cure will not be achieved.
Li Dongyuan said: The Stomach is the root of the Five Viscera. Once Stomach Qi is damaged, all syndromes become deficient, and the Seven Evil signs arise like bees swarming. Can one not be cautious?
My commentary: While sores and carbuncles generally require avoiding pungent and strong-flavored foods, in my opinion, only Heat-Fire syndromes, Ding toxins (furuncles/carbuncles), and Yang abscesses absolutely prohibit these dietary indiscretions and require strict caution. However, in cases where Ying and Wei (Defensive) Qi and Blood are severely deficient, preventing toxin resolution and tissue regeneration, are tonifying and warming treatments not indicated? Thus, since ancient texts refer to mutton as "Huangqi," if Huangqi (Astragali Radix) is suitable, mutton should also be suitable. Only pork, beef, strong wine, and other dampness-producing or spleen-damaging foods must strictly be avoided.