腮属足阳明胃经，其生痈者，多因儿食甘甜浓味，脾胃积热所致。亦有乳母郁怒，儿受其患者。若因热积于内，二
便不通者，用凉膈散。风邪相搏，二便如常者，用漏芦汤。胃经风热，或兼咽喉肿痛，用升麻防风汤。若禀赋阴虚火动，
颏间或两耳内生疮，或出脓不止者，宜用地黄丸。若因乳母肝火乘脾，用加味逍遥散。脾经郁热，用加味归脾汤。膏粱
积热，用东垣清胃散。脾胃风热，用清咽利膈汤。仍参口疮治之。
一小儿腮肿，肉色不变，大便不实，属胃经虚热，用五味异功散加升麻、柴胡而愈。又乳母饮酒兼怒，两腮赤肿，
憎寒发热，用加味清胃散二剂、加味逍遥散一剂治其母，儿亦饮数滴而愈。
一小儿嗜炙 ，腮肿发热，作渴饮冷，用加味清胃散而消。后仍不戒浓味，腮肿赤痛， 连舌本。先用泻黄散而退，
次用加味清胃散而消。
一小儿腮患疮，作渴饮汤，饮食少思，服败毒散益甚，余谓此胃经虚热，先用七味白术散；次用五味异功散而渴止。
后因母怒，两腮赤肿，作渴发热，用加味逍遥散治其母，儿患亦愈。
一小儿十六岁，腮患此，三年不愈，色黯下陷，此胃经症也，宜滋化源，以生肾水，外散寒邪，以接阳气。不信，
妄用杂方，元气益虚，七恶蜂起，始信余言，后用前药果验。
一小儿颊肿，敷寒凉之药，色白肿硬，久而不愈，此胃气虚而寒邪凝滞也，用葱熨法，以散寒邪，异功散以助元气
遂愈，若用攻毒之剂则误矣。
一小儿酷嗜甘味，药饵惟甘者乃服，后患腮肿，余知其胃症也。经曰∶酸能胜甘。当用酸味之药，遂以乌梅肉作丸，
甘草末为衣，服至二两许，始恶甘味，腮肿渐消。
一小儿腮肿痛，外敷铁箍散，内服寒凉药，日久坚硬，其色不变。夫药之寒凉者，外敷则气色凝滞，内服则脾胃有
伤，故气血有亏，而肉不溃色不赤也。用四君加柴胡、升麻、白芷、当归，外散寒邪，内补脾气，更用葱熨法，不数日
脓溃而愈。
一小儿腮颏常 肿，服清热败毒之药，更口渴足热，面色微黑，余谓肾肝症，用六味地黄丸与子服；母服加味逍遥
散而愈。后因别服伐肝之药，前症复作，寒热面青，小便频数，此肝火血燥耳，用柴胡栀子散以清肝；六味地黄丸以滋
肾，遂痊。
一小儿腮颏肿痛，后耳内出脓，久而不愈，视其母两脸青黄，属郁怒所致，朝用加味归脾汤，夕用加味逍遥散，母
子皆愈。
一小儿腮间发热，手足并热，用清胃、泻黄二散而愈。后颏间肿痛， 连耳内，余谓此肾经所属之地。不信，杂用
降火之药，耳出脓水，或痒或痛，稍加用心，即发热倦怠，两腿乏力，用补中益气汤，及六味地黄丸稍愈。毕姻后，朝
寒暮热，形气倦怠，足心发热，气喘唾痰，仍用前二药，佐以六君子汤而愈。后不守禁，恶寒发热，头晕唾痰。余谓肾
虚不能摄水而为痰，清气不能上升而头晕，阳气不能护守肌肤而寒热。遂用补中益气汤各加蔓荆子、附子各一钱，不应，
乃用人参一两、附子二钱，二剂而应，乃用十全大补汤百余剂而痊。
一小儿先颏间肿痛，用败毒之药，耳中流脓，项间结核，两目或连札，或赤痛，小便或作痒，或赤涩，皆肝胆二经
风热，用四味肥儿丸悉愈。
一小儿腮颏肿痛，服败毒药后，耳出秽水，余谓肝肾之症，先用九味芦荟丸而痊。毕姻后，面黄发热，用黄柏、知
母等药。更胸膈痞满，食少痰壅，乃利气化痰，加噫气下气，用六君子，补中益气二汤加干姜、木香，寻愈。
一小儿腮肿，搽锻石末，久而不散，余用四君子加升麻、白芷，及葱熨之法渐消；又用仙方活命，一剂而瘥。夫石
灰乃辛热燥血之药，小儿气血虚者搽之，反致难治。慎之！
一小儿腮间肿痛，用铁箍散、败毒散之类，出脓久不愈，面色黧，足心热，口舌干。余谓∶此禀肾水不足之虚症，
当补肺金，滋肾水为主。不信，仍服前剂，脾土益虚，绝生气而殁。
升麻防风汤 治胃经实热，咽痛口燥腮痈等症。
升麻 防风 黄柏（炒） 茯苓 芍药（炒） 陈皮（各五分） 连翘 当归（各七分）
上每服二钱，水煎，仍量大小用之。
清咽利膈汤 治心脾蕴热，或咽喉腮舌肿痛。
玄参 升麻 桔梗（炒） 甘草（炒） 茯苓 防风 黄芩（炒） 黄连（炒） 牛蒡子（炒杵） 芍药（炒。各
等分）
上每服一二钱，水煎。
东垣清胃散（方见腹痈）
异功散（方见用败毒之药）
地黄丸（方见作渴不止）
神效葱熨法（方见流注）
仙方活命饮（方见疮疡热毒）
The cheek region belongs to the Foot-Yangming Stomach Meridian. Abscesses (swellings) occurring here are mostly caused by children consuming sweet and rich foods, leading to heat accumulation in the Spleen and Stomach. It may also result from the wet nurse's emotional depression and anger, which affects the child. If heat accumulates internally causing obstruction of urination and defecation, Liangge San (Cooling the Diaphragm Powder) is used. If wind pathogens struggle with heat, but urination and defecation remain normal, Loulu Tang (Radix Euphorbiae Humifusae Decoction) is used. For Wind-Heat of the Stomach Meridian, or when accompanied by sore throat and swelling, Shengma Fangfeng Tang (Cimicifugae Rhizoma and Saposhnikoviae Radix Decoction) is used. If innate constitution is Yin-deficient with hyperactive fire, sores appear on the chin or inside both ears, or pus flows incessantly, Dihuang Wan (Rehmannia Pill) is appropriate. If caused by Liver Fire invading the Spleen due to the wet nurse's condition, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is used. For Depression-Heat of the Spleen Meridian, Jiawei Guipi Tang (Modified Restore the Spleen Powder) is used. For heat accumulation from rich and fatty foods, Dongyuan Qingwei San (Dongyuan's Stomach-Clearing Powder) is used. For Wind-Heat of the Spleen and Stomach, Qingyan Lige Tang (Throat-Clearing and Diaphragm-Purging Decoction) is used. Treatment should also refer to that for mouth ulcers.
A child presented with swollen cheeks, unchanged skin color, and loose stools, indicating Deficient-Heat of the Stomach Meridian. Wuyi Yigong San (Five-Agent Extra-Efficacy Powder) added with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) resulted in recovery. In another case, a wet nurse drank alcohol and became angry, causing the child's cheeks to become red and swollen, with aversion to cold and fever. The mother was treated with two doses of Jiawei Qingwei San (Modified Stomach-Clearing Powder) and one dose of Jiawei Xiaoyao San; the child also ingested a few drops of the medicine and recovered.
Another child, addicted to roasted foods, developed swollen and febrile cheeks with thirst for cold drinks. Jiawei Qingwei San reduced the swelling. However, after continuing to consume rich flavors, the cheeks became red, painful, and the pain extended to the root of the tongue. Xiehuang San (Draining Yellow Powder) was first used to subside the symptoms, followed by Jiawei Qingwei San to eliminate the swelling.
A child with cheek sores experienced thirst for hot water, poor appetite, and worsened after taking Baidu San (Defeat Toxin Powder). I diagnosed this as Deficient-Heat of the Stomach Meridian. Qiwu Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) was administered first; subsequently, Wuyi Yigong San stopped the thirst. Later, due to maternal anger, the child's cheeks became red and swollen with thirst and fever. Jiawei Xiaoyao San was given to the mother, and the child recovered as well.
A sixteen-year-old child suffered from cheek lesions for three years without healing; the area was dark and sunken, indicating a Stomach Meridian issue. The treatment principle was to nourish the source to generate Kidney Water and disperse external Cold Evil to connect Yang Qi. The patient did not believe this, used miscellaneous prescriptions blindly, further depleting Yuan Qi and presenting seven ominous signs. Only then did he trust my advice. Using the previous medicines proved effective.
A child with swollen cheeks applied cold-natured herbs externally, resulting in pale, hard swelling that persisted. This indicated Deficient Qi of the Stomach with stagnation of Cold Evil. The Congyun Method (Onion Fumigation Method) was used to disperse Cold, and Yigong San aided Yuan Qi, leading to recovery. Using detoxifying agents would have been a mistake.
A child who craved sweets only accepted sweet-tasting medicines later developed cheek swelling. Knowing this was a Stomach issue, I recalled the classic saying: "Sour overcomes Sweet." Therefore, sour herbs were used. Smoked plum flesh was made into pills coated with licorice powder. After taking approximately two liang, the child began to dislike sweetness, and the cheek swelling gradually subsided.
A child with painful cheek swelling applied Tiegu San (Iron Hoop Powder) externally and took cold-natured herbs internally. Over time, the area became hard with unchanged color. Cold-natured herbs cause qi and blood stagnation when applied externally and damage the Spleen and Stomach when taken internally, leading to qi and blood deficiency, preventing suppuration and redness. Sijunzi Tang (Four Gentlemen Decoction) added with Chaihu, Shengma, Baizhi, and Danggui was used to disperse external Cold and tonify Spleen Qi internally. Combined with the Congyun Method, suppuration occurred and healing followed within a few days.
A child with frequent swelling of the cheeks and chin developed increased thirst and hot soles after taking heat-clearing and toxin-defeating herbs, with a slightly black complexion. This was diagnosed as a Kidney and Liver issue. Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was given to the child, and Jiawei Xiaoyao San to the mother, resulting in recovery. Later, due to other liver-damaging herbs, symptoms recurred with alternating chills and fever, blue-green face, and frequent urination, indicating Liver Fire and Blood Dryness. Chaihu Zhizi San (Bupleurum and Gardenia Powder) cleared the Liver, and Liuwei Dihuang Wan nourished the Kidney, leading to cure.
A child with cheek and chin swelling later had pus draining from the ear without healing. The mother's face appeared blue-yellow, indicating emotional depression. Jiawei Guipi Tang was administered in the morning and Jiawei Xiaoyao San in the evening; both mother and child recovered.
A child with febrile cheeks and hot hands and feet recovered using Qingwei San and Xiehuang San. Later, chin swelling extended to the ear. I identified this as belonging to the Kidney Meridian. Disbelieving this, the patient used miscellaneous fire-reducing herbs, causing purulent discharge from the ear, sometimes itchy, sometimes painful. Mental exertion triggered fever, fatigue, and weak legs. Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) and Liuwei Dihuang Wan provided slight improvement. After marriage, morning chills and evening fever, physical fatigue, hot soles, wheezing, and phlegm sputum occurred. The previous two medicines were used again, assisted by Liujunzi Tang (Six Gentlemen Decoction), leading to recovery. Violating dietary restrictions led to aversion to cold, fever, dizziness, and phlegm sputum. I diagnosed Kidney Deficiency failing to control water production causing phlegm, clear Qi failing to ascend causing dizziness, and Yang Qi failing to protect the skin causing chills and fever. Buzhong Yiqi Tang with Manjingzi (Vitex Fruit) and Fuzi (Aconite Root) each at one qian was ineffective. Then, Ren Shen (Ginseng Root) at one liang and Fuzi at two qian were used; response occurred after two doses. Finally, Shiquan Dabu Tang (Complete Great Tonifying Decoction) was taken for over a hundred doses for full recovery.
A child initially had chin swelling. After taking toxin-defeating herbs, pus flowed from the ear, lymph nodes appeared on the neck, eyes twitched or became red and painful, and urination was itchy or dark and difficult. These were all Wind-Heat of the Liver and Gallbladder meridians. Siwei Feier Wan (Four-Agent Child-Nourishing Pill) cured all symptoms.
A child with cheek and chin swelling had foul-smelling fluid draining from the ears after taking toxin-defeating herbs. This was diagnosed as a Liver-Kidney issue. Jiuwei Lujian Wan (Nine-Ingredient Aloe Pill) was used first for recovery. After marriage, yellow face and fever appeared, treated with Huangbai (Phellodendron Bark) and Zimu (Anemarrhenae Rhizoma). This led to chest oppression, poor appetite, and phlegm congestion. Qi-regulating and phlegm-resolving methods, plus anti-belching and qi-descending herbs, were used. Liujunzi Tang and Buzhong Yiqi Tang added with Ganjiang (Dried Ginger) and Muxiang (Aucklandiae Radix) led to quick recovery.
A child with cheek swelling applied Duanshi Mo (Calcined Lime Powder) without resolution. I used Sijunzi Tang added with Shengma and Baizhi, along with the Congyun Method, to gradually reduce the swelling; then Xianfang Huoming Yin (Immortal Life-Decreeing Decoction) cured it in one dose. Lime is a pungent, hot, blood-drying herb. Applying it to children with deficient qi and blood makes treatment difficult. Caution is advised!
A child with painful cheek swelling used Tiegu San and Baidu San, resulting in prolonged suppuration, dark complexion, hot soles, and dry mouth/tongue. I diagnosed this as a deficiency pattern of insufficient innate Kidney Water, requiring tonification of Lung Metal and nourishment of Kidney Water as the main approach. Disbelieving this, the patient continued previous medications, further damaging Spleen Earth, cutting off vital energy, and resulting in death.
Shengma Fangfeng Tang treats Excess-Heat of the Stomach Meridian, including sore throat, dry mouth, and cheek abscesses.
Ingredients: Shengma (Cimicifugae Rhizoma), Fangfeng (Saposhnikoviae Radix), Huangbai (Phellodendri Cortex, stir-fried), Fuling (Poria), Shaoyao (Paeoniae Radix, stir-fried), Chenpi (Citri Reticulatae Pericarpium, each 5 fen); Lianqiao (Forsythiae Fructum), Danggui (Angelicae Sinensis Radix, each 7 fen).
Dosage: Take 2 qian per dose, decoct in water, adjusting according to age.
Qingyan Lige Tang treats Heat accumulation in Heart and Spleen, or swelling/pain of throat, cheeks, and tongue.
Ingredients: Xuanshen (Scrophulariae Radix), Shengma, Jiegeng (Platycodonis Radix, stir-fried), Gancao (Licorice Root, stir-fried), Fuling, Fangfeng, Huangqin (Scutellariae Radix, stir-fried), Huanglian (Coptidis Rhizoma, stir-fried), Niubangzi (Arctii Fructum, stir-fried and pounded), Shaoyao (Paeoniae Radix, stir-fried, equal parts).
Dosage: Take 1-2 qian per dose, decoct in water.
Dongyuan Qingwei San (See Abdominal Abscess formula)
Yigong San (See Formula for Using Toxin-Defeating Herbs)
Dihuang Wan (See Formula for Unremitting Thirst)
Shenxiao Congyun Method (See Flowing Obstruction formula)
Xianfang Huoming Yin (See Sores and Ulcers Heat-Toxin formula)