热毒瘰 ，乃手足少阳、足厥阴二经风热之症，或肝疳食积所致。其症发于项腋，或耳前后，或如贯珠，当分表里
虚实。若 赤肿者，肝经热毒也，用人参败毒散。作痛寒热者，肝火内作也，用加味小柴胡汤。不痛而小便黄，肝血虚
也，用六味地黄丸。隐于肉里而色不变者，肝疳内作也，用九味芦荟丸。脓成而不溃，或溃而不敛者，脾气虚弱也，用
益气养荣汤。凡此肿 疼痛，寒热作渴者，属病气有余，形气不足，治宜清肝火，生肝血。肿硬不溃，溃而不敛者，属
病气形气俱虚，治宜补肾水，实脾土。若因乳母恚怒，肝火遗患者，又当随所因而治之。
一小儿脓水淋漓，其核未消，发热憎寒，此肝经气血虚而有热也，用补阴八珍汤为主，间以清肝益荣汤而愈。后复
核结，小便赤涩，晡热作渴，用参术柴苓汤为主，佐以六味地黄丸料加柴胡、山栀，及四味肥儿丸而敛。
一小儿十五岁患此，发热作渴，日晡颊赤，脉数无力，属阴虚而有热，用补阴八珍汤五十剂，加参、 又二十剂而
溃。但脓水清稀，肌肉不生，此脾气虚弱也，以参、 、归、术为主，佐以芍药、熟地、麦门、五味，气血乃复，遂进
必效散一服，毒下而痊。
一小儿十三岁，久不愈，寒热兼作，饮食少思，此肝火炽而脾胃虚也，用益脾清肝散；佐以九味芦荟丸而愈。至十
六岁，阴茎忽痿，服温补之药，茎窍出臭津，旧痕肿痛，余用清肝火之药而愈。
一小儿十五岁患此，恪用攻痰，前症益甚，虚症悉至，仍议前法。余曰∶小便频数，肝经阴虚也；两目连札，肝经
风热也；作呕懒食，胃气虚弱也；泄泻后重，脾气虚陷也。遂用补中益气汤、六味地黄丸渐愈，又用九味芦荟丸而消。
一小儿项间及四肢结核，久溃不敛，形体骨立，大便不调，小便频数，此肝脾疳症，用九味芦荟丸、补中益气汤而
愈。
一小儿十四岁患此，脓水清稀，肌体骨立，晡热盗汗，口干咳痰，此肾水不能生肝木也，用六味地黄丸、补中益气
汤。三月余，元气渐复，佐以四味肥儿丸而愈。毕姻后，唾痰体倦，发热作渴，此脾肺虚，不能生肾水，水泛而为痰，
用地黄丸、补中益气汤而痊。
一小儿患此，服克治之药，致寒热腹膨，此肝脾疳症，先用五味异功散加柴胡、升麻，佐以九味芦荟丸，渐退，又
用四味肥儿丸、五味异功散而消。
一小儿患此，服化痰散坚之药，面色赤白，少阳三焦部分见青筋，又目札出泪，此肝胆风热所致，脾土虚而肝木所
侮也，先用补中益气汤、柴胡清肝散加芜荑，核渐消，佐以五味异功散加芜荑而愈。
一小儿九岁患此，面色常青，肿硬不溃，肉色不变，乃伐肝化痰。余曰∶常调补肝脾。不信。果虚症蜂起。复请
治，仍欲伐肝。余曰∶面带青色，肝虚而本色见也；面色变白，肺虚而本色见也；痰涎上涌，脾虚而不能摄也；两目连
札，肝血虚而生风也。经云∶胃为五脏之本。当先救胃气。遂用五味异功散加升麻、柴胡，元气稍复。乃朝用补中益气
汤，夕用五味异功散，佐以九味芦荟丸，面色始黄，而核渐消；又以四味肥儿丸，间服地黄丸而愈。
一小儿五岁患此，小便白色，此肝脾疳症，用九味芦荟丸、四味肥儿丸而消。因食橙橘，二便俱白，拗间结核，亦
用前丸而愈。后目连札，颈间耳后结核，用柴胡清肝散、芦荟丸而愈。
张阁老侄孙患此，久服化痰削坚之剂，夜热吐痰，时季夏，脉大，按之而涩。余曰∶夏月肝症，而见肺脉，至金旺
之时，其病必进矣。至八月疾甚，果不治。
一女子十四岁，耳下患此，服化痰泄气药，前症益甚，诸症 臻。余曰∶此肝胆经虚火之症也，前药乃泛扰诸经，
无脏不伤者。不悟，仍服之，更四肢发搐，目闭口噤。余曰∶此肺经虚，肝木动，而脾土复伤也，当补脾土，滋肺金，
养肾水。亦不信，后果殁。
一小儿四岁，患此，泛服软坚伐肝之剂，益甚。余曰∶此禀肝经之虚羸，兼乳母郁怒所致，当调补乳母肝脾，滋子
之肾水。不悟，仍用前药，以致不起。
四味肥儿丸 治食积脾疳，面耳口舌生疮，目障云翳，牙齿腐烂等症。（方见贴骨痈）
柴芍参苓饮 治肝火血热，遍身搔痒，或起赤晕，或筋挛结核。
柴胡 芍药 人参 白术 茯苓 陈皮 当归（各五分） 牡丹皮 山栀（炒） 甘草（炒。各三分）
上姜枣水煎服。
神功散 治疮疡初起，肿 者用之可消，加血竭更好。丹毒未砭者，亦可用之。
黄柏（炒） 草乌（生用）
上各另为末等分，用漱口水调敷，常漱口水润之。
清肝益荣汤 治肝胆经风热血燥，筋挛结核，或作瘊子。
柴胡 山栀（炒，各五分） 龙胆草（酒拌炒黑，五分） 当归 川芎 芍药（各一钱） 熟地黄（自制）
白术（炒） 木瓜（不犯铁器） 茯苓 薏苡仁（各五分） 甘草（三分）
上水煎服。
加味小柴胡汤 山栀牡丹皮。治肝胆经风热，耳前后肿痛，或结核 痛，或寒热晡热，口苦耳聋等症。
（前方去山栀、丹皮，即小柴胡汤。）
柴胡（二钱） 黄芩（炒，二钱） 人参 半夏（各七分） 甘草（炙，五分） 山栀 牡丹皮（各一钱）
上姜水煎，徐徐服。
九味芦荟丸 治肝脾疳热，患瘰 结硬，或三焦目生云翳，耳内生疮，或肢体消瘦，热渴少食，或肚腹
不调，牙龈蚀，颊腐烂，下部生疮等症。（方见喉痹）
必效散 治瘰 ，元气无亏者，宜用此方。若元气怯弱者，宜先补而后服之， 毒已下，便与滋补，庶
无他患。若孕妇及虚劳气郁所致者，尤不可服。世以此方为良剂，故并注之。
南硼砂（二钱五分） 轻粉（一钱） 麝香（五分） 巴豆（五粒，去皮心膜） 白槟榔（一个） 斑蝥
（四十个去头足翅，用糯米炒）
上为末，取鸡子二个，去黄用清，调药入壳内，以湿纸数重糊口甑，蒸熟取出，曝干研末，每服五分，用
炒生姜酒五更调服，如毒出，小便涩痛，用益元散一服，其毒出而不痛。
益气养荣汤（方见鹤膝风）
栀子清肝散（方见胁痈）
补阴八珍汤（即八珍汤加黄柏、知母）
益脾清肝散（方见黄水疮）
Thermal-toxin scrofula (Res, thermal-toxin type) is a syndrome caused by wind-heat invading the Foot-Shaoyang and Hand-Shaoyang meridians, as well as the Foot-Jueyin Liver meridian, or it may result from Liver Gan (Liver deficiency with heat leading to malnutrition syndrome) and food stagnation. The lesions manifest in the neck, axillae, or around the ears, sometimes arranged like beads. One must differentiate between exterior and interior locations, as well as excess and deficiency patterns. If the area is red and swollen, it indicates thermal-toxin in the Liver meridian; treat with Renshen Baidu San (Ginseng Detoxification Powder). If accompanied by pain, aversion to cold, and fever, it indicates internal stirring of Liver fire; treat with Jiawei Xiaochaihu Tang (Modified Minor Decoherence Decoction). If there is no pain but yellow urine, it indicates Liver blood deficiency; treat with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If the lump is hidden deep within the flesh with unchanged skin color, it indicates internal activity of Liver Gan; treat with Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill). If pus forms but does not ulcerate, or if it ulcerates but fails to heal, it indicates Spleen Qi deficiency; treat with Yiqi Yangrong Tang (Tonify Qi and Nourish Blood Decoction). In cases of swelling, pain, aversion to cold, fever, and thirst, the pathogenic Qi is in excess while the Formative Qi is deficient; treatment should clear Liver fire and nourish Liver blood. If the mass is hard, does not ulcerate, or ulcerates without healing, both pathogenic Qi and Formative Qi are deficient; treatment should tonify Kidney Water and strengthen Spleen Earth. If caused by the wet nurse's anger transmitting Liver fire to the infant, treatment must address the specific cause.
A child presented with dripping pus, unresolving lymph nodes, fever, and aversion to cold. This indicated deficiency of Qi and Blood in the Liver meridian with internal heat. Treatment primarily used Buyin Bazhen Tang (Nourish Yin Eight-Treasure Decoction), interspersed with Qinggan Yirong Tang (Clear Liver and Nourish Blood Decoction), resulting in recovery. Later, lymph nodes re-aggregated with red, scanty urination, afternoon fever, and thirst. Treatment primarily used Shenzu Chailing Tang (Ginseng, Atractylodes, Bupleurum, and Poria Decoction), assisted by Liuwei Dihuang Wan ingredients added with Chaihu (Bupleuri Radix) and Zhizi (Gardeniae Fructus), along with Siwei Feier Wan (Four-Ingredient Stomach-Strengthening Pill), leading to healing.
A fifteen-year-old child suffered from this disease with fever, thirst, flushed cheeks in the afternoon, and a rapid, forceless pulse. This indicated Yin deficiency with internal heat. After taking fifty doses of Buyin Bazhen Tang (Nourish Yin Eight-Treasure Decoction) and another twenty doses with added Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma), the lesion ulcerated. However, the pus was thin and clear, and muscle did not regenerate, indicating Spleen Qi deficiency. Treatment focused on Renshen (Ginseng), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), assisted by Shaoyao (Paeoniae Radix), Shudihuang (Rehmanniae Radix Praeparata), Maimendong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). Once Qi and Blood were restored, one dose of Bixiao San (Extremely Effective Powder) was administered to expel the toxin, resulting in recovery.
A thirteen-year-old child had a chronic condition with alternating chills and fever, and poor appetite. This indicated excessive Liver fire and weak Spleen/Stomach. Treatment used Yipi Qinggan San (Spleen-Strengthening and Liver-Clearing Powder), assisted by Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill), leading to recovery. At sixteen, sudden penile flaccidity occurred. After taking warming and tonifying medicines, foul fluid exuded from the urethra, and old scars became swollen and painful. I treated with herbs that clear Liver fire, resulting in recovery.
A fifteen-year-old child took strong phlegm-resolving drugs strictly, worsening previous symptoms and bringing forth all deficiency signs. I recommended the previous method. I stated: Frequent urination indicates Liver Yin deficiency; frequent blinking of eyes indicates wind-heat in the Liver meridian; vomiting and anorexia indicate weak Stomach Qi; diarrhea with tenesmus indicates sinking of Spleen Qi. Thus, Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) were used for gradual improvement, followed by Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill) to eliminate the nodules.
A child had tubercles in the neck and limbs, chronically ulcerating without healing, emaciated to the point of being skeletal, with irregular bowel movements and frequent urination. This was Liver-Spleen Gan syndrome. Treatment with Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill) and Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) led to recovery.
A fourteen-year-old child presented with thin, clear pus, skeletal emaciation, afternoon fever, night sweats, dry mouth, and coughing with sputum. This indicated Kidney Water failing to nourish Liver Wood. Treatment used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction). After more than three months, Yuanqi (Primal Qi) gradually recovered, assisted by Siwei Feier Wan (Four-Ingredient Stomach-Strengthening Pill), leading to recovery. After marriage, he experienced spitting of phlegm, fatigue, fever, and thirst. This indicated Spleen-Lung deficiency failing to generate Kidney Water, causing water flooding to form phlegm. Treatment with Dihuang Wan (Rehmannia Pill) and Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) resulted in cure.
A child took harsh attacking medicines, leading to chills, fever, and abdominal distension. This was Liver-Spleen Gan syndrome. Initially, Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma) was used, assisted by Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill), leading to gradual subsidence. Subsequently, Siwei Feier Wan (Four-Ingredient Stomach-Strengthening Pill) and Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) eliminated the condition.
A child took phlegm-resolving and hardness-dispersing medicines, resulting in mottled red and white complexion, visible blue veins in the Shaoyang Sanjiao region, eye blinking, and tearing. This was caused by wind-heat in the Liver and Gallbladder, with weak Spleen Earth being overacted upon by Liver Wood. Initially, Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) with Wuyi (Meliae Cortex) were used, leading to gradual nodule reduction. Assisted by Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) with Wuyi (Meliae Cortex), recovery ensued.
A nine-year-old child presented with a constant greenish complexion, hard swelling without ulceration, and unchanged skin color, due to excessive liver-subduing and phlegm-resolving. I advised regular tonification of Liver and Spleen. He did not believe me. Indeed, deficiency signs arose rapidly. Upon re-consultation, he still desired liver-subduing treatment. I stated: Green complexion indicates Liver deficiency revealing its true color; white complexion indicates Lung deficiency revealing its true color; surging saliva indicates Spleen deficiency failing to control; frequent eye blinking indicates Liver blood deficiency generating wind. The Classics state: The Stomach is the root of the Five Zang organs. One must first rescue Stomach Qi. Thus, Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) was used, slightly restoring Yuanqi (Primal Qi). Then, Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) was taken in the morning, and Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) in the evening, assisted by Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill). The complexion turned yellow, and nodules gradually reduced. Finally, Siwei Feier Wan (Four-Ingredient Stomach-Strengthening Pill) and intermittent Dihuang Wan (Rehmannia Pill) led to recovery.
A five-year-old child presented with white urine, indicating Liver-Spleen Gan syndrome. Treatment with Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill) and Siwei Feier Wan (Four-Ingredient Stomach-Strengthening Pill) eliminated the condition. Due to eating oranges and tangerines, both stool and urine turned white, and axillary tubercles also healed with the aforementioned pills. Later, frequent eye blinking and cervical/retroauricular tubercles were treated with Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) and Lvhui Wan (Aloe Pill), resulting in recovery.
The nephew of Grand Secretary Zhang suffered from this disease, long taking phlegm-resolving and hardness-reducing agents. He had night fever and spitting of phlegm. It was mid-summer, and his pulse was large but choppy upon pressure. I stated: Summer Liver disease presenting with a Lung pulse indicates that when Metal energy peaks, the disease will progress. By August, the disease worsened, and indeed, it was incurable.
A fourteen-year-old girl developed this below the ear. Taking phlegm-resolving and Qi-draining medicines worsened previous symptoms and brought forth various signs. I stated: This is a deficiency-fire syndrome of the Liver and Gallbladder meridians. The previous medicines disturbed all meridians, injuring every Zang organ. She did not realize this, continued taking them, and subsequently developed limb convulsions, closed eyes, and locked jaws. I stated: This is Lung deficiency, Liver Wood agitation, and further injury to Spleen Earth. One must tonify Spleen Earth, nourish Lung Metal, and nourish Kidney Water. She did not believe, and eventually died.
A four-year-old child suffered from this, widely taking softening-hardness and liver-subduing agents, worsening the condition. I stated: This is congenital Liver meridian weakness and deficiency, compounded by the wet nurse's depression and anger. One should regulate and tonify the wet nurse's Liver and Spleen, and nourish the child's Kidney Water. She did not realize this, continued using the previous medicines, and the child died.
Siwei Feier Wan (Four-Ingredient Stomach-Strengthening Pill) treats food stagnation Spleen Gan, sores on face/ears/mouth/tongue, visual obstruction with nebula, and dental caries. (Formula see Tiegu Yong section)
Chaishao Shenling Yin (Bupleurum, Peony, Ginseng, and Poria Drink) treats Liver fire and blood heat, generalized pruritus, red halos, or tendon spasms with tubercles.
Ingredients: Chaihu (Bupleuri Radix), Shaoyao (Paeoniae Radix), Renshen (Ginseng), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix) (each 0.5 fen); Mudanpi (Moutan Cortex), Zhizi (Gardeniae Fructus, stir-fried), Gancao (Licorice Root, stir-fried) (each 0.3 fen).
Preparation: Decoct with fresh ginger and dates.
Shengong San (Divine Merit Powder) treats early-stage sores and swellings; can reduce swelling. Adding Xuejie (Dragon's Blood) is better. Also usable for erysipelas before scarification.
Ingredients: Huangbai (Phellodendri Cortex, stir-fried), Caowu (Aconiti Radix, raw).
Preparation: Grind each into fine powder separately, mix equal parts. Apply mixed with mouthwash, keeping the area moist with mouthwash frequently.
Qinggan Yirong Tang (Clear Liver and Nourish Blood Decoction) treats wind-heat and blood dryness in Liver/Gallbladder meridians, tendon spasms, tubercles, or warts.
Ingredients: Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus, stir-fried) (each 0.5 fen); Longdancao (Gentianae Radix, wine-stir-fried until black, 0.5 fen); Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix) (each 1 qian); Shudihuang (Rehmanniae Radix Praeparata, homemade); Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried); Mugua (Chaenomelis Fructus, avoid iron); Fuling (Poria), Yiyiren (Coicis Semen) (each 0.5 fen); Gancao (Licorice Root) (0.3 fen).
Preparation: Decoct with water.
Jiawei Xiaochaihu Tang (Modified Minor Decoction of Bupleurum): Zhizi (Gardeniae Fructus), Mudanpi (Moutan Cortex). Treats wind-heat in Liver/Gallbladder meridians, swelling/pain around ears, painful tubercles, chills/fever, afternoon fever, bitter taste, deafness. (Removing Zhizi and Mudanpi from the above formula yields Xiaochaihu Tang.)
Ingredients: Chaihu (Bupleuri Radix) (2 qian); Huangqin (Scutellariae Radix, stir-fried, 2 qian); Renshen (Ginseng), Banxia (Pinelliae Rhizoma) (each 0.7 fen); Gancao (Licorice Root, honey-fried, 0.5 fen); Zhizi (Gardeniae Fructus), Mudanpi (Moutan Cortex) (each 1 qian).
Preparation: Decoct with ginger water, take slowly.
Jiuwei Lvhui Wan (Nine-Ingredient Aloe Pill) treats Liver-Spleen Gan heat, hard scrofula tubercles, nebula in Sanjiao/eyes, otitis interna, emaciation, thirst with poor appetite, abdominal irregularity, gingival erosion, cheek rot, and lower body sores. (Formula see Hou Bi section)
Bixiao San (Extremely Effective Powder) treats scrofula in patients with intact Yuanqi (Primal Qi). For those with weak Yuanqi, tonify first, then administer. After toxin expulsion, provide nourishment to prevent complications. Contraindicated in pregnancy and deficiency-wasting with Qi stagnation.
Ingredients: Nan Pengsha (South Borax) (2.5 qian); Qingfen (Calomelas) (1 qian); Shexiang (Moschus) (0.5 fen); Badou (Crotonis Fructus, 5 seeds, peeled, heart and membrane removed); Baibinglang (Arecae Betel Nut) (1 piece); Banmao (Mylabris, 40 pieces, heads, feet, wings removed, stir-fried with glutinous rice).
Preparation: Grind into powder. Take two eggs, separate whites from yolks. Mix medicine into egg whites inside the shell. Seal with multiple layers of wet paper. Steam in a steamer until cooked. Remove, dry, and grind into powder. Take 0.5 fen per dose, mixed with stir-fried ginger wine at dawn (fifth watch). If toxin exits causing dysuria/pain, take Yiyuan San (Beneficial Origin Powder) to relieve pain upon toxin exit.
Yiqi Yangrong Tang (Tonify Qi and Nourish Blood Decoction) (See Hexikfeng section)
Zhizi Qinggan San (Gardenia Liver-Clearing Powder) (See Xieyong section)
Buyin Bazhen Tang (Nourish Yin Eight-Treasure Decoction) (Eight-Treasure Decoction plus Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma))
Yipi Qinggan San (Spleen-Strengthening and Liver-Clearing Powder) (See Huangshichuang section)