胁肋者，足厥阴少阳之经，相火之司也，乃木之主。肝胆之气不平，则风火内搏，荣逆血郁，热聚为脓，而痈肿之
所由生也。亦有禀赋母气肝胆之热，恚怒之火而致。然初患 肿作痛者，宜用柴胡栀子散。未消者，用仙方活命饮。其
热既杀而肿不消者，则必成脓也，乃用托里消毒散。其脓既成，以代针膏决之，仍用托里散，自愈。若脓出，而痛止肿
消，则不必用药也。
一小儿四岁，胁间漫肿一块甚痛，色如故，服流气败毒等药，加寒热作呕，食少作泻，此禀肝脾气滞之症，元气复
伤而甚耳，乃择乳母气血壮盛者，与加味归脾汤、加味逍遥散服之，儿饮其乳半载而消。
一小儿左胁生疮，寒热作呕，右关脉弦数，此肝症传于脾也，先用柴胡清肝散，次用五味异功散，又用托里散，疮
敛而愈。其时同患是症，专用败毒者，俱致不起。
一小儿左胁下生疮，漫肿色赤，此肝胆经形伤气也，先用托里散、消毒散、加味小柴胡汤间服，肿渐减；又用托里
消毒散、加味小柴胡汤，疮溃而愈。
一小儿四岁，患胁痈，色赤肿痛，肝脉弦而迟。此肝胆经血虚有热，先用加味逍遥散数剂，大势已消，中间成脓，
又用托里消毒散加柴胡、山栀，脓溃而敛。
一小儿肩患痈，痛甚肿至背，乃膀胱经部分，血瘀滞也，先用仙方活命饮，毒解痛止。又用加味小柴胡汤加连翘、
山栀、金银花，其势渐退，乃用加味逍遥散加金银花、黄 ，漫肿悉消，但中间不退，此欲作脓也，用托里消毒散，脓
成而溃；又用托里散、地黄丸，补气血，滋肾水而痊。
一小儿患之，久不愈，左关脉弦数，右尺脉按之而弱。此禀肾虚而然也，用地黄丸为主，佐以八珍汤、托里散而愈。
一小儿未期，胁间赤肿。此禀肝火所致，用加味逍遥散
数剂，与母服，子日服数匙，漫肿悉退，佐以托里消毒散加山栀、柴胡，疮溃而愈。后因母恚怒劳役，子胁复肿赤，用
加味逍遥散、加味归脾汤，母子服之并愈。
一小儿胁痈，服伐脾之药，脓清不敛，呵欠呀咬，饮食少思，仍用伐脾。余曰∶此脾虚之症也，胃为五脏之主，当
补脾胃，则肝不侮而肌肉自生矣。不信，乃伐肝木，遂致不救。
加味归脾汤 治小儿因乳母忧思郁怒，胸胁作痛；或肝脾经分患疮疡之症；或寒热惊悸无寐；或便血盗汗，疮
口不敛等症。
人参 黄 （炒） 茯神（去木。各二两） 甘草（炒） 白术（炒，一两） 木香（五分） 远志（去心） 酸
枣仁 龙眼肉 当归 牡丹皮 山栀（炒。各一钱）
上水煎，乳母服，儿亦服之。
小柴胡汤 治肝胆经分一切疮疡，发热潮热；或饮食少思，加山栀、牡丹皮，名加味小柴胡汤。
柴胡（一钱五分） 人参（五分） 黄芩（七分） 半夏（五分） 甘草（炒，三分）
上作二三服，姜枣水煎。
柴胡清肝散 治肝经风热，或乳母怒火，患一切疮疡。
柴胡 黄芩（炒） 人参 川芎（各一钱） 山栀（炒，一钱五分） 连翘 甘草（各五分） 桔梗（炒八分）
上水煎，母子服之。
栀子清肝散（一名栀子柴胡散） 治三焦及足少阳经风热生疮，或发热，耳内生疮作痒，或出水疼痛。
柴胡 栀子（炒） 牡丹皮 茯苓 川芎 芍药（炒） 当归 牛蒡子（炒。各七分） 甘草（二分）
上水煎，母子并服。
龙胆泻肝汤 治肝胆经有热，小腹胁间患疮疡；或玉茎便毒，悬痈、囊痈肿痛；或溃烂作痛，小便涩滞，或睾
丸悬挂。（方见下疳阴痿）
加味逍遥散 治小儿肝脾血虚内热，胁腹作痛，头目昏黑，怔忡颊赤，口燥咽干；或发热盗汗，食少不寐；或
口舌生疮，胸乳膨胀，小便不利；或女子患前症，经候不调，发热咳嗽，寒热往来等症。（方见发热不止）
六味地黄丸 治肝经血虚发热，或风客淫气瘰 结核；或四肢发搐，眼目抽动，痰涎上涌；或伤损出血，发热
抽搐等症。（方见作渴不止）
仙方活命饮
托里消毒散
托里散（三方见热毒疮疡）
八珍汤（方见发热不止）
The hypochondriac region is the pathway of the Foot Jueyin Liver Meridian and the Foot Shaoyang Gallbladder Meridian, governed by Ministerial Fire (Mingmen fire residing in the liver and gallbladder), and belongs to the Wood element. If the Qi of the liver and gallbladder is not harmonious, wind and internal fire will contend internally, causing counterflow and stagnation of Ying blood (nutritive blood), leading to heat accumulation and pus formation, which gives rise to carbuncles and swellings. There are also cases caused by congenital inheritance of maternal liver-gallbladder heat or anger-induced internal fire.
In the initial stage, when swelling and pain occur, Chaihu Zhizi San (Bupleurum and Gardenia Powder) is appropriate. If the symptoms have not subsided, Xianfang Huoming Yin (Immortal Recipe for Saving Lives Decoction) should be used. When the heat has been subdued but the swelling remains, it indicates that pus has necessarily formed; at this point, Tuoli Xiaodu San (Support the Interior and Eliminate Toxin Powder) should be used. Once the pus is mature, it should be lanced with Daizhen Gao (Needle-Replacement Paste), followed by continued use of Tuoli San (Support the Interior Powder), leading to spontaneous recovery. If the pus drains, pain ceases, and the swelling subsides, no further medication is necessary.
A four-year-old child presented with a diffuse, very painful swelling in the hypochondriac region, with normal skin color. After taking drugs such as Liufei Baidu (Flowing Qi and Resolving Toxin) preparations, the condition worsened with alternating chills and fever, vomiting, poor appetite, and diarrhea. This was a syndrome of liver-spleen Qi stagnation due to congenital endowment, with further damage to Yuan Qi (Original Qi). A wet nurse with robust Qi and blood was selected to take Jiawei Guipi Tang (Modified Gui Pi Decoction) and Jiawei Xiaoyao San (Modified Xiao Yao Powder); the infant suckled her milk for half a year, resulting in the resolution of the swelling.
Another child developed a sore on the left hypochondrium with alternating chills and fever and vomiting. The pulse at the right Guan position was wiry and rapid, indicating liver disease transmitting to the spleen. Initially, Chaihu Qinggan San (Bupleurum Clearing the Liver Powder) was used, followed by Wuwei Yigong San (Five-Ingredient Decoction for Benefiting the Center), and then Tuoli San (Support the Interior Powder). The sore healed upon contraction. At that time, others suffering from the same condition who exclusively used toxin-resolving treatments all died.
A third child developed a sore under the left hypochondrium, presenting as a diffuse red swelling. This indicated injury to the form and Qi of the liver and gallbladder meridians. Tuoli San (Support the Interior Powder), Xiaodu San (Eliminate Toxin Powder), and Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction) were administered alternately, gradually reducing the swelling. Subsequently, Tuoli Xiaodu San (Support the Interior and Eliminate Toxin Powder) and Jiawei Xiao Chaihu Tang were used, leading to suppuration and healing.
A four-year-old child suffered from a hypochondriac carbuncle with redness, swelling, and pain. The liver pulse was wiry and slow. This indicated blood deficiency with internal heat in the liver and gallbladder meridians. Several doses of Jiawei Xiaoyao San (Modified Xiao Yao Powder) were administered first, resolving the major symptoms. Pus formed in the center, so Tuoli Xiaodu San (Support the Interior and Eliminate Toxin Powder) with added Chaihu (Bupleuri Radix) and Shanzhi (Gardeniae Fructus) was used, leading to suppuration and healing.
A child developed a carbuncle on the shoulder, with severe pain and swelling extending to the back. This area belongs to the Bladder Meridian and indicated blood stasis. Xianfang Huoming Yin (Immortal Recipe for Saving Lives Decoction) was used first to resolve toxicity and stop pain. Then, Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction) with added Lianqiao (Forsythiae Fructus), Shanzhi (Gardeniae Fructus), and Jinyinhua (Lonicerae Japonicae Flos) was used to gradually reduce the pathogenic factor. Next, Jiawei Xiaoyao San (Modified Xiao Yao Powder) with added Jinyinhua (Lonicerae Japonicae Flos) and Huangbo (Phellodendri Cortex) was used, resolving the diffuse swelling. However, the central part remained unresolved, indicating impending suppuration. Tuoli Xiaodu San (Support the Interior and Eliminate Toxin Powder) was used, leading to suppuration and rupture. Finally, Tuoli San (Support the Interior Powder) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) were used to tonify Qi and blood and nourish Kidney Water, resulting in recovery.
A child suffered from the condition for a long time without healing. The left Guan pulse was wiry and rapid, and the right Chi pulse was weak upon pressure. This was due to congenital Kidney deficiency. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was used as the principal formula, assisted by Bazhen Tang (Eight-Treasure Decoction) and Tuoli San (Support the Interior Powder), leading to recovery.
An infant under one year old presented with redness and swelling in the hypochondriac region. This was caused by congenital Liver Fire. Jiawei Xiaoyao San (Modified Xiao Yao Powder) was administered for several doses to the mother, and the infant took a few spoonfuls daily. The diffuse swelling completely receded. It was assisted by Tuoli Xiaodu San (Support the Interior and Eliminate Toxin Powder) with added Shanzhi (Gardeniae Fructus) and Chaihu (Bupleuri Radix), leading to suppuration and healing. Later, due to the mother's anger and overwork, the infant's hypochondrium became red and swollen again. Jiawei Xiaoyao San (Modified Xiao Yao Powder) and Jiawei Guipi Tang (Modified Gui Pi Decoction) were administered to both mother and infant, resulting in mutual recovery.
A child with a hypochondriac carbuncle took drugs that damaged the Spleen. The pus was clear, the sore did not heal, and the child exhibited yawning and teeth-grinding with poor appetite. The practitioner continued to administer drugs damaging the Spleen. I stated: "This is a Spleen deficiency syndrome. The Stomach is the master of the five Zang organs; tonifying the Spleen and Stomach will prevent Liver Wood from insulting Earth, allowing muscles to regenerate naturally." He did not believe me and instead attacked Liver Wood, leading to an untreatable condition.
Jiawei Guipi Tang (Modified Gui Pi Decoction): Treats pediatric conditions caused by the wet nurse's worry, thought, depression, and anger, leading to chest and hypochondriac pain; or sores in the liver-spleen meridians; or alternating chills/fever, palpitations, and insomnia; or hematochezia, night sweats, and non-healing sores.
Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix, stir-fried), Fushen (Poria with Hostwood, removed wood, 2 liang each), Gan Cao (Licorice Root, stir-fried), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 1 liang), Mu Xiang (Aucklandiae Radix, 5 fen), Yuan Zhi (Polygalae Radix, removed heart), Suan Zao Ren (Ziziphi Spinosae Semen), Long Yan Rou (Longan Aril), Dang Gui (Angelicae Sinensis Radix), Mu Dan Pi (Moutan Cortex), Shanzhi (Gardeniae Fructus, stir-fried, 1 qian each).
Decoct in water. The wet nurse takes it, and the infant also takes it.
Xiao Chaihu Tang (Minor Bupleurum Decoction): Treats all sores in the liver and gallbladder meridians, with fever or tidal fever; or poor appetite. Adding Shanzhi (Gardeniae Fructus) and Mu Dan Pi (Moutan Cortex) creates Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction).
Chai Hu (Bupleuri Radix, 1.5 qian), Ren Shen (Ginseng Radix et Rhizoma, 0.5 qian), Huang Qin (Scutellariae Radix, 0.7 qian), Ban Xia (Pinelliae Tuber, 0.5 qian), Gan Cao (Licorice Root, stir-fried, 0.3 qian).
Divide into two or three doses. Decoct with fresh ginger and jujube.
Chaihu Qinggan San (Bupleurum Clearing the Liver Powder): Treats Wind-Heat in the Liver Meridian, or maternal anger-fire causing all types of sores.
Chai Hu (Bupleuri Radix), Huang Qin (Scutellariae Radix, stir-fried), Ren Shen (Ginseng Radix et Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 1 qian each), Shanzhi (Gardeniae Fructus, stir-fried, 1.5 qian), Lian Qiao (Forsythiae Fructus), Gan Cao (Licorice Root, 0.5 qian each), Jie Geng (Platycodonis Radix, stir-fried, 0.8 qian).
Decoct in water. Mother and infant take it together.
Zhizi Qinggan San (Gardenia Clearing the Liver Powder, also known as Zhizi Chaihu San): Treats Wind-Heat in the Sanjiao and Foot Shaoyang Gallbladder Meridian causing sores, or fever, sores inside the ear with itching, or oozing and pain.
Chai Hu (Bupleuri Radix), Zhizi (Gardeniae Fructus, stir-fried), Mu Dan Pi (Moutan Cortex), Fu Ling (Poria, 0.7 qian each), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Shao Yao (Paeoniae Radix, stir-fried), Dang Gui (Angelicae Sinensis Radix), Niu Bang Zi (Arctii Fructus, stir-fried, 0.7 qian each), Gan Cao (Licorice Root, 0.2 qian).
Decoct in water. Mother and infant take it together.
Longdan Xiegan Tang (Gentian Decoction to Drain the Liver): Treats Heat in the Liver and Gallbladder meridians causing sores in the lower abdomen and hypochondrium; or sores on the penis and perineum, suspension abscesses, scrotal abscesses with swelling and pain; or ulceration with pain, difficult urination, or hanging testicles. (Formula see section on Chancre and Impotence).
Jiawei Xiaoyao San (Modified Xiao Yao Powder): Treats pediatric Liver-Spleen Blood deficiency with internal heat, causing hypochondriac and abdominal pain, dizziness, dark vision, palpitations, red cheeks, dry mouth and throat; or fever, night sweats, poor appetite, and insomnia; or mouth and tongue sores, chest and breast distension, and difficult urination; or in females, irregular menstruation, fever, cough, and alternating chills and fever. (Formula see section on Unremitting Fever).
Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia): Treats Liver Meridian Blood deficiency with fever, or Wind invading and generating Phlegm-Nodules; or limb convulsions, eye twitching, surging phlegm-saliva; or trauma with bleeding, fever, and convulsions. (Formula see section on Unremitting Thirst).
Xianfang Huoming Yin (Immortal Recipe for Saving Lives Decoction)
Tuoli Xiaodu San (Support the Interior and Eliminate Toxin Powder)
Tuoli San (Support the Interior Powder) (See section on Toxic Heat Sores for these three formulas)
Bazhen Tang (Eight-Treasure Decoction) (See section on Unremitting Fever for formula)