（附谓两拗小腹两边拘中患之）
便痈因肝火肝疳，或禀肝经热毒。若初起肿硬作痛者，先用龙胆泻肝汤一二剂，肿痛不减，用仙方活命饮二剂。五
七日不减肿尚硬，亦用前二药各一剂，如不消或更痛，欲成脓也，用活命饮一剂，却用托里消毒散加柴胡、山栀一二剂。
若脓已成而不溃者，血气虚也，用托里消毒一二剂。脓已溃而痛不止者，毒瓦斯不解也，用活命饮一剂。若脓已出而反痛
者，气益虚也，用内补黄 汤。脓已溃而发热烦躁者，气虚血脱也，用当归补血汤。脓已溃而恶寒发热者，血气俱虚也，
用十全大补汤。脓已溃而恶寒者，元气虚也，用补中益气汤。脓已溃而不生肌者，脾气虚也，用六君子汤。若禀赋怯弱，
或因饮食劳倦而为患者，但用补中益气汤加射干，自消。设使不分经络，不别虚实，概行攻伐，亏损气血，则轻者难治，
重者必变瘵症，甚至不起。
一小儿肿痛色赤，寒热似疟，小便不通，此肝经湿热，用龙胆泻肝汤一剂，小便清利，寒热顿除，又用加味逍遥散
加龙胆草二剂，肿痛悉退而愈。
一小儿患此，肿硬作痛，小便涩滞，先用龙胆泻肝汤，小便顿利，又用活命饮一剂而消。后腹肿赤作痛，此欲作脓
也，先用活命饮二剂，杀其大势，却用托里消毒散加柴胡、山栀三剂，以指按之，肿随指复起，此脓已成也，用托里散
一剂，翌日针之，肿出肿消，再用托里散而愈。
一小儿患此，服大黄等药，泻而肠鸣，腹肿硬痛少食，
此脾胃复伤而变症也，用五味异功散加升麻、柴胡、木香，饮食渐进，乃去木香，加黄 、当归，数剂而脓成；又用托
里散加皂角刺而脓溃，乃去皂角刺，倍用参、 而愈。
一小儿疮势已成，用消毒之药，其肿散漫，自汗发热，恶寒少食，此气血虚甚也，用大补汤四剂，针之脓出肿消，
却用托里散、八珍汤，间服而愈。
一小儿脓成不溃，误用大黄之类以下脓，泄泻不止，肿硬色白，腹痛欲呕，手足并冷，此脾气虚而复伤也，用异功
散加升麻、姜、桂四剂，乃去姜、桂加归、 二十余剂，脓溃而愈。
一小儿溃后切牙呵欠，寻衣捻物，此肝经气血虚也，先用八珍汤加钩藤钩、五味子，诸症顿愈，又用托里散及八珍
汤而痊。
一小儿溃后惊悸发搐，呵欠切牙。此心肝二经气血俱虚也，先用补心汤、安神丸，虚症寻愈；再用八珍汤、托里散，
肌肉渐生；却用地黄丸而疮口敛。
一小儿患此久不愈，头重胸满，饮食少思，此禀脾胃虚弱也，先用补中益气汤加蔓荆子，诸症寻愈，次用八珍汤佐
以五味异功散，月余疮口渐敛，仍用十全大补汤而痊。
一小儿十五岁，禀赋虚弱，因劳役过度患此，寒热如疟，用补中益气汤将愈。惑于人言，误服大黄之药，吐泻大作，
手足厥冷，寒热尤甚。余用六君子加姜、桂，诸症稍愈，但赤肿不消，此欲作脓也，又数剂后，朝用益气汤，夕用大补
汤，五十余剂而痊。
一小儿溃后肿硬，肌肉不生，疮口不敛，余欲滋其化源以生肝血。不从，仍伐肝清热，以致元气日虚，恶症蜂起而
殁。夫肺者肾之母，脾者肺之母，今既不滋肺肾以生肝木，
又伤脾土以绝肺肾之化源，其不死者鲜矣！
一小儿十四岁，每饮食劳倦，则恶寒发热，两拗患肿，余用益气汤而愈。彼惑于人言，乃服大黄之类，发搐口噤，
手足并冷，良久少苏。余用大料益气汤数剂而安，又用二十余剂而愈。
一小儿两拗痛肿，小便澄白，肢体消瘦，发热眼札，此禀肝火之症，用龙胆泻肝汤为主，四味肥儿丸为佐，又各数
服将愈，及用地黄丸而痊。
一小儿两拗肿痛，小便不利，或赤白浊，此系肝火炽而脾气伤也，朝用补中益气汤，夕用地黄丸各数剂而愈。后因
过劳，盗汗发热，两拗仍肿。用前药，佐以地黄丸而愈。
一小儿每劳则两拗肿痛，小便白浊，夜间发热。此禀肝火脾虚而元气下陷也，用补中益气汤、清心莲子饮。后患下
疳，用四味肥儿丸，加逍遥散而愈。
一小儿两拗肿痛，小便赤涩，或兼澄白。此肝脾疳症，先用九味芦荟丸数服，诸症渐退；次用四味肥儿丸二十余服
而愈。
一女子两拗肿痛，小腹作痒，小便赤涩，发热晡热，月经不调，先用加味小柴胡汤四剂肿渐消，次用加味逍遥散诸
症渐愈，佐以四味肥儿丸而愈。
一小儿十四岁，每饮食劳倦，随患寒热，两拗肿痛，服大黄之类，发搐口噤，手足并冷，良久少苏。余用大剂补中
益气汤数剂而安，又二十余剂而肿痛愈。
一小儿患此，肿硬色白，形气俱虚，余谓常补脾胃则肿硬自消，不信，乃以铜器压之，及敷山药，内服伐肝之药，
遂致不起。夫铜金也，山药属金，金能制木，肝经有余之症当用之。今不足之症，宜滋肾水而反克之，不起宜矣！治者
不可不察。
一小儿患此，肿硬作痛，自汗盗汗，体倦少食，此禀虚弱也，非补元气不能化腐成脓；非补脾胃不能生肌敛口。彼
嫌迂缓，另用万金散，毒从大便出，而内消一服，咽下连泻数次皆饮食，再服泻下鲜血，遍身皆青。余曰∶此阴阳二络
俱伤也，辞不治。经云∶阳络伤则血外溢，阴络伤则血内溢。信然。
一小儿十四岁，功课过度，梦遗恶寒，拗间肿痛，余用大剂益气汤而愈，彼误用攻毒之剂，患便痈，肿硬作痛，肉
色不变，余用益气汤及大补汤而愈。毕姻后复患此，服穿山甲、大黄之类，元气益虚，肿硬如石，外敷大黄、朴硝，虚
症蜂起，余用葱熨法、豆豉饼及前二剂，虽愈，终以不谨，变瘵症而殁。
清心莲子饮 治心肾虚热，患便痈，发热口干，小便白浊，夜则安，昼则发。
黄芩（炒） 麦门冬 地骨皮 车前子（炒） 甘草（各三钱半） 石莲肉 茯苓 黄 （炒） 柴胡 人参（各
二钱）
上每服五钱，水煎。
秘旨安神丸 治禀心脾气血虚弱，发热不安，疮不生肌，睡中则惊悸。
人参 半夏（汤泡） 酸枣仁 茯神（各一钱） 当归（酒洗） 橘红 赤芍药 五味子（五粒，杵） 甘草（炙，
三分）
上为末，姜汁糊丸芡实大。每服一丸，姜汤下。
补中益气汤 治禀元气虚弱，因劳而拗中作痛，或患便痈，寒热口干作渴，宜此汤加射干主之。如寒热已退，
而肿不消，此欲作脓也，宜用十全大补汤。（方见肌肉不生）
十全大补汤 治禀元气虚弱，因劳患便痈，或拗中作痛，服补中益气汤，寒热退而肿不消散，此血气虚而不能
成脓也，宜服此汤。已成而不能溃，或已溃而不能生肌，寒热不止，自汗盗汗，脓清不敛者，但服此药，则元气自复，
诸症自愈。
白茯苓 人参 当归 白术（炒） 黄 （炒） 川芎 肉桂（去皮） 白芍药（炒） 熟地黄（自制） 甘草（炒。
各等分）
上每服三五钱，姜枣水煎服。
内补黄 汤（方见发热不止）
龙胆泻肝汤（方见下疳疮）
九味芦荟丸（方见喉痹）
四味肥儿丸（方见贴骨痈）
补心汤（方见胎毒疮疡）
六味地黄丸（方见作渴不止）
加味小柴胡汤（方见热毒瘰 ）
(Note: Bian Yong refers to a disease occurring in the hypochondriac region and the sides of the lower abdomen where tension is felt.)
Bian Yong (Perineal Abscess) is caused by Liver Fire, Liver Jian (Liver-related parasitic or wasting condition), or innate heat-toxin accumulated in the Liver Meridian. If initially presenting with swelling, hardness, and pain, administer Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) for one to two doses. If swelling and pain persist, use Xianfang Huoming Yin (Immortal Life-Rescuing Elixir) for two doses. If after five to seven days the swelling remains and is still hard, continue using the aforementioned two medicines, one dose each. If the swelling does not subside or pain increases, indicating suppuration is impending, first use Xianfang Huoming Yin for one dose, then switch to Tuoli Xiaodu San (Supporting the Interior and Detoxifying Powder) added with Chaihu (Bupleuri Radix) and Shanzhi (Gardeniae Fructus) for one to two doses. If pus has formed but has not ulcerated, it is due to deficiency of Blood and Qi; use Tuoli Xiaodu San for one to two doses. If the abscess has ulcerated but pain persists, the pathogenic toxin has not been resolved; use Xianfang Huoming Yin for one dose. If pain worsens after pus discharge, Qi is further deficient; use Neibu Huangqi Tang (Internal Supplemental Astragalus Decoction). If fever and irritability occur after ulceration, it indicates Qi deficiency and Blood collapse; use Danggui Buxue Tang (Angelica Sinensis Decoction to Tonify Blood). If chills and fever occur after ulceration, both Qi and Blood are deficient; use Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction). If only chills occur after ulceration, Yuan Qi (Primal Qi) is deficient; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If granulation tissue fails to grow after ulceration, Spleen Qi is deficient; use Liujunzi Tang (Six Gentlemen Decoction). For those with innate frailty or illness caused by dietary irregularity and overexertion, simply using Buzhong Yiqi Tang added with Shegan (Belamcandae Rhizoma) will lead to spontaneous resolution. If one fails to differentiate meridians and does not distinguish between excess and deficiency, indiscriminately using attacking methods will damage Qi and Blood. Mild cases will be difficult to treat, severe cases will transform into Zhai Syndrome (Consumptive Disease/Tuberculosis), and may even result in death.
A child presented with red, swollen, painful lesions, alternating chills and fever resembling malaria, and urinary obstruction. This was damp-heat in the Liver Meridian. One dose of Longdan Xiegan Tang cleared the urine and instantly resolved the chills and fever. Subsequently, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Longdancao (Gentianae Radix) for two doses completely resolved the swelling and pain, leading to recovery.
Another child had swollen, hard, painful lesions and dysuria. Longdan Xiegan Tang was used first, immediately relieving urination. Then, Xianfang Huoming Yin for one dose dissipated the swelling. Later, abdominal swelling turned red and painful, indicating impending suppuration. Two doses of Xianfang Huoming Yin were used to curb the major pathogenic factor, followed by Tuoli Xiaodu San added with Chaihu and Shanzhi for three doses. Pressing the swelling with a finger caused it to rebound immediately, confirming pus formation. One dose of Tuoli San was administered, and the next day, acupuncture was performed to drain the pus. The swelling subsided, and further administration of Tuoli San led to recovery.
A third child took Da Huang (Rhei Radix et Rhizoma) and other purgatives, resulting in diarrhea, borborygmus, abdominal swelling, hardness, pain, and poor appetite. This indicated secondary injury to the Spleen and Stomach causing transformation into complicated symptoms. Wuyi Yigong San (Five Agents Extraordinary Effort Powder) added with Shengma (Cimicifugae Rhizoma), Chaihu, and Muxiang (Aucklandiae Radix) gradually restored diet. Muxiang was then removed, and Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix) were added. After several doses, pus formed. Tuoli San added with Zhaojiaoci (Gleditsiae Spina) was used to induce ulceration. Zhaojiaoci was removed, and Renshen (Ginseng Radix) and Huangqi were doubled, leading to recovery.
A fourth child had an established abscess but was treated with detoxifying herbs, causing the swelling to spread diffusely, spontaneous sweating, fever, chills, and poor appetite. This indicated extreme deficiency of Qi and Blood. Dabu Tang (Great Tonifying Decoction) for four doses was used. After puncturing to drain pus and reduce swelling, Tuoli San and Bazhen Tang (Eight Treasures Decoction) were alternately administered until recovery.
A fifth child had formed pus that did not ulcerate. Misusing Da Huang to purge the pus caused incessant diarrhea, white-hard swelling, abdominal pain with nausea, and cold extremities. This indicated Spleen Qi deficiency with secondary injury. Yigong San added with Shengma, Jiang (Zingiberis Rhizoma Recens), and Guirou (Cinnamomi Cortex) for four doses was used. Jiang and Guirou were then removed, and Danggui and Huangqi were added. After more than twenty doses, the pus ulcerated, and recovery ensued.
A sixth child, after ulceration, exhibited teeth grinding, yawning, and picking at empty air. This indicated deficiency of Qi and Blood in the Liver Meridian. Bazhen Tang added with Goutenggou (Uncariae Ramulus cum Uncis) and Wuweizi (Schisandrae Fructus) instantly resolved all symptoms. Tuoli San and Bazhen Tang were subsequently used for complete recovery.
A seventh child, after ulceration, suffered from palpitations, convulsions, yawning, and teeth grinding. This indicated joint deficiency of Qi and Blood in the Heart and Liver Meridians. Buxin Tang (Tonify the Heart Decoction) and Anshen Wan (Calming the Spirit Pill) were used first to resolve deficiency symptoms. Bazhen Tang and Tuoli San were then used to promote gradual muscle growth. Finally, Dihuang Wan (Rehmannia Pill) was used to close the wound.
An eighth child had a chronic, non-healing lesion with heavy head, chest fullness, and lack of desire for food. This indicated innate Spleen and Stomach weakness. Buzhong Yiqi Tang added with Manjingzi (Vittariae Spora) resolved symptoms quickly. Next, Bazhen Tang assisted by Wuyi Yigong San was used. After more than a month, the wound gradually closed. Continued use of Shiquan Dabu Tang led to recovery.
A fifteen-year-old child with innate weakness developed this condition due to excessive labor, presenting with alternating chills and fever like malaria. Buzhong Yiqi Tang was nearly curative. However, misled by others, the child mistakenly took Da Huang, causing severe vomiting and diarrhea, cold extremities, and intensified chills and fever. I used Liujunzi Tang added with Jiang and Guirou, which slightly improved symptoms. The red swelling remained, indicating impending suppuration. After several more doses, Yi Qi Tang (Tonify Qi Decoction, i.e., Buzhong Yiqi Tang) was taken in the morning and Dabu Tang in the evening. Recovery occurred after fifty-plus doses.
A ninth child, after ulceration, had hard swelling without muscle regeneration and unhealed wounds. I proposed nourishing the source of transformation to generate Liver Blood. The patient refused, continuing to attack the Liver and clear heat, causing daily depletion of Yuan Qi and emergence of malignant symptoms, leading to death. The Lung is the mother of the Kidney; the Spleen is the mother of the Lung. Since neither the Lung and Kidney were nourished to generate Liver Wood, nor was the Spleen Earth spared to preserve the transformation source of the Lung and Kidney, survival was unlikely!
A tenth child, aged fourteen, experienced chills and fever upon dietary indiscretion or fatigue, with swelling in the hypochondrium. Yi Qi Tang cured him. Misled by others, he took Da Huang, resulting in convulsions, trismus, and cold extremities, recovering slowly. Large-dose Yi Qi Tang stabilized him, and another twenty-plus doses completed the cure.
An eleventh child had painful swelling in both hypochondria, clear white urine, emaciation, fever, and dry/stinging eyes. This was an innate Liver Fire syndrome. Longdan Xiegan Tang was the main formula, assisted by Siwei Fei'er Wan (Four-Agent Child-Nourishing Pill). After several doses, nearing recovery, Dihuang Wan was used for final cure.
A twelfth child had painful swelling in both hypochondria, dysuria, or turbid red/white urine. This was excessive Liver Fire injuring Spleen Qi. Buzhong Yiqi Tang was taken in the morning, and Dihuang Wan in the evening, each for several doses, leading to recovery. Later, overwork caused night sweats, fever, and persistent hypochondriac swelling. The previous medicines assisted by Dihuang Wan cured him.
A thirteenth child experienced hypochondriac swelling and pain upon exertion, white turbid urine, and nighttime fever. This was innate Liver Fire, Spleen deficiency, and sinking of Yuan Qi. Buzhong Yiqi Tang and Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) were used. Later, developing Xiagan (Genital Chancre), Siwei Fei'er Wan added to Xiaoyao San cured him.
A fourteenth child had painful swelling in both hypochondria, reddish-dysuric or clear-white urine. This was Liver-Spleen Jian syndrome. Jiwei Luhui Wan (Nine-Ingredient Aloe Pill) for several doses gradually reduced symptoms. Siwei Fei'er Wan for twenty-plus doses completed the cure.
A female patient had painful swelling in both hypochondria, itching in the lower abdomen, reddish-dysuric urine, fever with afternoon tidal fever, and irregular menstruation. Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction) for four doses gradually reduced swelling. Jiawei Xiaoyao San resolved other symptoms, assisted by Siwei Fei'er Wan for final cure.
A fifteenth child, aged fourteen, developed chills and fever, and hypochondriac swelling upon dietary/labor issues. Taking Da Huang caused convulsions, trismus, and cold extremities, recovering slowly. Large-dose Buzhong Yiqi Tang stabilized him, and another twenty-plus doses cured the swelling and pain.
A sixteenth child had white-hard swelling and dual deficiency of Form and Qi. I advised tonifying the Spleen and Stomach to naturally dissipate swelling. Disbelieving, the patient used copper vessels to press the area, applied Dioscorea (Shanyao) externally, and took Liver-attacking herbs internally, leading to death. Copper belongs to Metal; Dioscorea also belongs to Metal. Metal controls Wood, suitable for Liver Meridian Excess syndromes. Here, however, it was a Deficiency syndrome requiring nourishment of Kidney Water, yet Metal was used to counteract it. Death was inevitable! Physicians must examine this carefully.
A seventeenth child had hard-swelling pain, spontaneous and night sweats, fatigue, and poor appetite. This was innate weakness. Without tonifying Yuan Qi, rotting could not transform into pus; without tonifying Spleen and Stomach, muscle could not grow and wounds close. Disliking the slow pace, the patient used Wanjinsan (Ten Thousand Gold Powder). Toxins exited via stool. After one internal dose, multiple diarrheas occurred with undigested food. A second dose caused bloody diarrhea and generalized cyanosis. I stated: "Both Yang and Yin collaterals are injured," and declined treatment. The Classic says: "Injury to Yang collaterals causes external bleeding; injury to Yin collaterals causes internal bleeding." Indeed.
An eighteenth child, aged fourteen, had nocturnal emission, chills, and hypochondriac swelling due to excessive study. Large-dose Yi Qi Tang cured him. Mistakenly using toxic-attacking agents, he developed Bian Yong with hard-swelling pain and unchanged skin color. Yi Qi Tang and Dabu Tang cured him. After marriage, recurrence occurred. Taking Shanjiashan (Manis Squama) and Da Huang further depleted Yuan Qi, making swelling hard as stone. External application of Da Huang and Puxiao (Natrii Sulfas) caused myriad deficiency symptoms. Using Congyi Method (Scallion Moxibustion), Douchi Bing (Fermented Soybean Cake), and the aforementioned two decoctions, he recovered, but ultimately died of Zhai Syndrome due to imprudence.
Qingxin Lianzi Yin: Treats Heart-Kidney deficiency heat, Bian Yong with fever, dry mouth, white turbid urine, quiet at night, active during day.
Huangqin (Stir-fried) 5.625g, Maidong 5.625g, Digupi 5.625g, Cheqianzi (Stir-fried) 5.625g, Gancao (Licorice Root) 5.625g, Shilianrou 3.75g, Fuling 3.75g, Huangqi (Stir-fried) 3.75g, Chaihu 3.75g, Renshen 3.75g.
Take 15g per dose, decoct in water.
Mizhi Anshen Wan: Treats innate Heart-Spleen Qi-Blood deficiency, fever and restlessness, ulcers failing to granulate, palpitations during sleep.
Renshen 3g, Banxia (Soaked in boiling water) 3g, Suanzaoren 3g, Fushen 3g, Danggui (Washed in wine) 3g, Juhong 3g, Chi Shaoyao 3g, Wuweizi (5 berries, crushed) 3g, Gancao (Roasted) 0.9g.
Grind into powder, make pills with Ginger Juice paste, size of Euryale seed. Take one pill per dose, swallow with Ginger Tea.
Buzhong Yiqi Tang: Treats innate Yuan Qi deficiency, pain in the hypochondrium due to labor, or Bian Yong, with chills, fever, dry mouth, and thirst. Use this decoction added with Shegan. If chills and fever subside but swelling remains, indicating impending suppuration, use Shiquan Dabu Tang. (Formula see entry "Muscle Not Growing")
Shiquan Dabu Tang: Treats innate Yuan Qi deficiency, Bian Yong due to labor, or hypochondriac pain. After taking Buzhong Yiqi Tang, if chills and fever subside but swelling persists, it is Blood-Qi deficiency unable to form pus. Take this decoction. If pus forms but cannot ulcerate, or has ulcerated but cannot granulate, with persistent chills/fever, spontaneous/night sweats, and thin non-converging pus, taking this medicine will restore Yuan Qi and heal all symptoms.
Baifuling, Renshen, Danggui, Baizhu (Stir-fried), Huangqi (Stir-fried), Chuanxiong, Rougui (Bark removed), Baishaoyao (Stir-fried), Shudihuang (Homemade), Gancao (Stir-fried). Equal parts.
Take 9-15g per dose, decoct with Ginger and Jujube in water.
Neibu Huangqi Tang (Formula see entry "Persistent Fever")
Longdan Xiegan Tang (Formula see entry "Xiagan Chancre")
Jiwei Luhui Wan (Formula see entry "Sore Throat")
Siwei Fei'er Wan (Formula see entry "Deep Bone Abscess")
Buxin Tang (Formula see entry "Fetal Toxin Sores")
Liuwei Dihuang Wan (Formula see entry "Unstoppable Thirst")
Jiawei Xiao Chaihu Tang (Formula see entry "Heat-Toxin Scrofula")