《鬼遗》云∶左右牙叉骨接处发痈疽,肿处胀攻骨及牙关,张口不得。因诸风热上攻,
或多食烧炙之物所为,或因患牙痈,即从牙缝中破出脓血,切忌外风水触犯。按∶此系
阳明经郁热,治宜清胃散、甘露饮、防风通圣、凉膈之属,量虚实表里用之。若服寒凉
过多,火不归源者,服理中之属,佐以姜附始安。
或问∶地角下生疽何如?曰∶是名颏痈,属阳明胃经积热所致。用白芷升麻汤、活命
饮,加升麻、桔梗,更服紫金丹汗之。壮实者,一粒金丹下之。
或问∶耳叶生疽何如?曰∶是名耳发疽,属手少阳、三焦经风热所致。六七日渐肿,如
胡桃或如蜂房之状,或赤或紫热如火,痛彻心是也。十日刺出黄白脓者生,刺之无脓,时
出鲜血,饮食不下,神昏狂躁者死。小儿耳窍旁生者,相传指月而生,恐未必然,大抵
风湿热毒成疳,故名月蚀疳疮。
水银膏 治月蚀疮多在两耳上及窍傍,随月虚盈。
水银(二钱半) 胡粉(研) 松脂 黄连(去须,为末,各半两) 猪脂(四两)
上先熬猪脂令沸,下松脂诸末及水银,搅令匀,瓷盒盛,先以盐汤洗净疮,涂敷,日
三五度。
胡粉散 治月蚀疮。
胡粉(炒微黄) 白矾( ) 虢丹( ) 黄连(净) 轻粉(各二钱) 胭脂(一钱) 麝香
(少许)
上为末。先以温浆水入盐,洗拭后掺药,如疮干,麻油调敷。
《鬼遗集》记载:在左右下颌骨连接处发生的痈疽,肿胀部位会胀痛并波及骨骼及牙关,导致无法张口。这是由于各种风热之邪上攻,或者过多食用烧烤炙烤食物所致;也有可能是因为患过牙痈,脓血从牙缝中破溃流出。此时切忌让外感的风水(风寒湿邪)触犯患处。按语认为:此病属于阳明经郁积的热邪,治疗适宜使用清胃散、甘露饮、防风通圣散、凉膈散这类方剂,根据患者体质的虚实和病位的表里来酌情选用。如果服用寒凉药物过多,导致火邪不能归元(虚阳浮越或真寒假热),则应服用理中汤这类温中散寒的方剂,并佐以干姜、附子才能安定病情。
有人问:下巴角落下发生疽疮怎么样?回答说:这名叫颏痈,属于阳明胃经积热所导致。使用白芷升麻汤、仙方活命饮,加入升麻、桔梗,再服用紫金丹使其发汗。身体壮实的人,用一粒金丹泻下通便。
有人问:耳叶上发生疽疮怎么样?回答说:这名叫耳发疽,属于手少阳三焦经受风热侵袭所致。六七天后逐渐肿胀,形状像胡桃或者像蜂房一样,颜色或红或紫,灼热如火,疼痛直达心脏,就是这种病症。十天内刺破排出黄白色脓液的可以存活;如果刺破后没有脓液,时常流出鲜血,饮食无法咽下,神志昏迷狂躁不安的则会死亡。小儿耳窍旁边生长的,相传是随着月亮盈亏而生长,恐怕未必如此,大体上是风湿热毒形成疳疾,所以名叫月蚀疳疮。
水银膏:治疗月蚀疮,多发生在两耳上方及耳窍旁边,随月亮盈亏变化。
配方:水银(二钱半)、胡粉(研细)、松脂、黄连(去须,研为末,各半两)、猪脂(四两)。
制法与用法:先将猪脂熬开,放入松脂、各种药末及水银,搅拌均匀,盛放在瓷盒中。先用盐水汤洗净疮口,涂抹药膏,每天三到五次。
胡粉散:治疗月蚀疮。
配方:胡粉(炒至微黄)、白矾、虢丹、黄连(净选)、轻粉(各二钱)、胭脂(一钱)、麝香(少许)。
制法与用法:将上述药物研为细末。先用温水浆水加盐,清洗擦拭疮口后撒布药粉;如果疮口干燥,用麻油调和后敷贴。
According to the *Guiyi Ji* (Treatise on Ghosts' Remains): An abscess or carbuncle occurring at the junction of the left and right mandibular bones causes swelling that distends and attacks the bone and jaw joint, resulting in an inability to open the mouth. This is caused by the upward attack of various wind-heat pathogens, or by excessive consumption of roasted and grilled foods; it may also occur when a dental abscess ruptures, discharging pus and blood from between the teeth. In such cases, one must strictly avoid exposure to external wind-water (wind-cold-dampness) pathogens. Commentary: This condition belongs to stagnant heat in the Yangming Meridian. Treatment should employ formulas such as Qingwei San (Clear Stomach Powder), Ganlu Yin (Sweet Dew Decoction), Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder), or Liangge San (Cooling Diaphragm Powder), selected according to the patient's deficiency/excess patterns and the superficial/deep location of the disease. If too many cold-cooling medicines are taken, causing fire to fail to return to its source (deficient fire floating outward), formulas like Lizhong Tang (Regulate the Middle Decoction) should be administered, assisted by Shengjiang (Dried Ginger) and Fuzi (Prepared Aconite Root), to stabilize the condition.
Question: What about a carbuncle arising below the corner of the chin? Answer: This is named Ke Yong (Chin Carbuncle), caused by accumulated heat in the Yangming Stomach Meridian. Use Baizhi Shengma Tang (Angelica Dahurica and Cimicifuga Decoction) or Xiaoyao Huoming Yin (Free and Easy Wanderer Life-Saving Decoction), added with Shengma (Cimicifuga Rhizome) and Jiegeng (Platycodon Root), and further administer Zijin Dan (Purple Gold Pill) to induce sweating. For robust individuals, Yili Jin Dan (One-Pill Golden Pill) can be used to purge downward.
Question: What about a carbuncle arising on the earlobe? Answer: This is named Er Fa Ju (Ear Carbuncle), caused by wind-heat affecting the Hand-Shaoyang Sanjiao Meridian. After six or seven days, it gradually swells, resembling a walnut or a honeycomb, appearing red or purple, burning hot like fire, with pain penetrating to the heart. If yellow-white pus is discharged after puncturing within ten days, the patient will survive; if no pus is discharged upon puncturing, fresh blood flows intermittently, food cannot be swallowed, and the patient suffers from delirium and mania, death ensues. When this arises beside the ear canal in children, it is traditionally said to grow with the phases of the moon, but this is likely not accurate. Generally, it is formed by wind-dampness and heat-toxin becoming a gan disorder (chronic wasting disease), hence named Yueshi Gan Chuang (Moon-Eclipse Gan Sore).
Shuiyin Gao (Mercury Ointment): Treats Yueshi Chuang (Moon-Eclipse Sore), which mostly occurs above both ears and beside the ear canal, varying with the waxing and waning of the moon.
Ingredients: Yínqī (Mercury Bichloride, 2.5 qian), Hufen (Lead Carbonate, ground), Songzhi (Pine Rosin), Huanglian (Coptis Rhizome, de-stamened, powdered, each 0.5 liang), Zhuzhi (Pig Fat, 4 liang).
Preparation and Application: First boil the pig fat until bubbling, then add pine rosin, all powders, and mercury, stirring until uniform. Store in a porcelain box. First wash the sore with salt water, then apply the ointment, three to five times daily.
Hufen San (Lead Carbonate Powder): Treats Yueshi Chuang (Moon-Eclipse Sore).
Ingredients: Hufen (Lead Carbonate, stir-fried until slightly yellow), Bai Fan (Alum), Guo Dan (Red Lead Oxide), Huanglian (Coptis Rhizome, cleaned), Qingfen (Calomel, each 2 qian), Yanzhi (Vermilion/Carmine, 1 qian), Shexiang (Musk, a small amount).
Preparation and Application: Grind all ingredients into powder. First wash and wipe the area with warm grain water mixed with salt, then sprinkle the powder. If the sore is dry, mix with Sesame Oil (Mayou) for application.