郑左 肝疽生于左胁肋，漫肿而硬，按之疼痛，大
如手掌。此气阴两亏，肝郁挟痰湿凝结，营卫不从，有酿脓之象。宜消托兼施，消未成之毒，托已成之脓也。
如脓从外泄则吉，破膜则危。
生黄 （六钱） 生草节（八分） 川象贝（各二钱） 皂角针（一钱） 全当归（三钱） 苦桔梗（一钱）
炙僵蚕（三钱） 陈广皮（一钱） 生赤芍（三钱） 银州柴胡（一钱） 炙甲片（一钱）
外用十将丹、平安散、阳和膏。
二诊 前投益气消托之剂，肝疽肿硬疼痛，较前大减，可望消散。惟神疲肢倦，形肉削瘦，脉象濡软，气血
两亏，痰湿未能尽化。既见效机，仍守原意出入。
生黄 （六钱） 云茯苓（三钱） 川象贝（各二钱） 杜赤豆（一两） 全当归（三钱） 生草节（六分）
紫丹参（二钱） 生苡仁（四钱） 生赤芍（三钱） 陈广皮（一钱） 鲜荷叶（一角）
王右 肺疽已成，漫肿如盆，疼痛不已，胸闷气结，汗多肢冷，脉象濡细。初由风邪痰瘀，蕴结肺俞，继则酿
脓，肺炎叶举，清肃之令不得下行，颇虑正不支持，致虚脱之变！勉拟扶正托毒，清肺化痰，尽人力以冀天眷耳。
生黄 （四钱） 抱茯神（三钱） 京赤芍（二钱） 丝瓜络（二钱） 生草节（八分） 炙远志肉（一钱）
象贝母（三钱） 冬瓜子
（二钱） 苦桔梗（一钱） 全当归（二钱） 炙僵蚕（三钱） 栝蒌皮（二钱） 水炙桑皮（二钱）
Mr. Zheng developed Gan Ju (Liver Abscess) in the left hypochondrium, presenting as diffuse swelling that is hard to the touch and painful upon pressure, with the mass being as large as a palm. This condition arises from deficiency of both Qi and Yin, combined with Liver Qi stagnation involving phlegm-dampness condensation, leading to disharmony of Ying (Nutrient) and Wei (Defensive) Qi, showing signs of pus formation. The treatment should employ both resolution (Xiao) and support/expulsion (Tuo) methods simultaneously: resolving toxins that have not yet formed pus, and supporting/expelling pus that has already formed. If the pus drains externally, the prognosis is auspicious; if the abscess membrane ruptures internally, it is critical.
Prescription: Sheng Huangqi (Raw Radix Astragali, 6 qian), Sheng Caojie (Raw Glycyrrhizae Radix et Rhizoma joint section, 8 fen), Chuan Xiangbei (Fritillariae Bulbus, each 2 qian), Zaojiaozhen (Gleditsiae Sinensis Spina, 1 qian), Quan Danggui (Radix Angelicae Sinensis, 3 qian), Ku Jiegeng (Platycodonis Radix, 1 qian), Zhi Jiangcan (Bombyx Batryticatus, 3 qian), Chen Guangpi (Citri Reticulatae Pericarpium, 1 qian), Sheng Chishao (Paeoniae Radix Rubra, 3 qian), Yinzhou Chaihu (Bupleuri Radix, 1 qian), Zhi Jiapian (Testudinis Carapax et Plastrum processed, 1 qian).
External application: Shijiang Dan, Ping'an San, Yanghe Gao.
Second visit: The previous prescription for tonifying Qi and employing Xiao-Tuo methods reduced the swelling, hardness, and pain of the Gan Ju significantly compared to before, suggesting potential for complete resolution. However, the patient suffers from mental fatigue, limb weakness, emaciation, and a soggy-soft pulse, indicating dual deficiency of Qi and Blood, with phlegm-dampness not yet fully resolved. Since efficacy is observed, we adhere to the original principle with modifications.
Prescription: Sheng Huangqi (Raw Radix Astragali, 6 qian), Yun Fuling (Poria, 3 qian), Chuan Xiangbei (Fritillariae Bulbus, each 2 qian), Du Chidou (Vigna umbellata seeds, 1 liang), Quan Danggui (Radix Angelicae Sinensis, 3 qian), Sheng Caojie (Raw Glycyrrhizae Radix et Rhizoma joint section, 6 fen), Zi Danshen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Sheng Yiren (Coicis Semen, 4 qian), Sheng Chishao (Paeoniae Radix Rubra, 3 qian), Chen Guangpi (Citri Reticulatae Pericarpium, 1 qian), Xian Heye (Nelumbinis Folium, 1 jiao).
Mr. Wang presents with Fei Ju (Lung Abscess) which has already formed, manifesting as diffuse swelling like a basin, unceasing pain, chest tightness with qi obstruction, profuse sweating, cold limbs, and a soggy-thin pulse. Initially caused by wind-pathogen, phlegm, and blood stasis accumulating at the Lung Shu point, it subsequently fermented into pus. The lung's dispersing and descending functions are impaired (Fei Yan Ye Ju), preventing the clear and pure descent, raising concern that righteous Qi may fail to sustain itself, leading to collapse! I tentatively prescribe methods to support righteousness and expel toxins, clear the lungs and resolve phlegm, doing my utmost to hope for heavenly favor.
Prescription: Sheng Huangqi (Raw Radix Astragali, 4 qian), Bao Fushen (Poria with hostwood, 3 qian), Jing Chishao (Paeoniae Radix Rubra, 2 qian), Sigualuo (Luffae Fructus Rete, 2 qian), Sheng Caojie (Raw Glycyrrhizae Radix et Rhizoma joint section, 8 fen), Zhi Yuanzhi Rou (Polygalae Radix processed flesh, 1 qian), Xiang Beimu (Fritillariae Cirrhosae Bulbus, 3 qian), Dongguazi (Benincasae Semen, 2 qian), Ku Jiegeng (Platycodonis Radix, 1 qian), Quan Danggui (Radix Angelicae Sinensis, 2 qian), Zhi Jiangcan (Bombyx Batryticatus, 3 qian), Gualou Pi (Trichosanthis Pericarpium, 2 qian), Shui Zhi Sangpi (Mori Cortex water-processed, 2 qian).