腿痈之症，所主之经不同，而所治之法亦异。发于内侧者，属肝脾二经；发于外侧者，属胆胃二经；漫肿坚硬者，
元气虚弱也，用内补黄 汤。肿势高 者，元气未虚也，用内托柴胡黄 汤，外并用隔蒜熨法。若瘀血凝结而不消，或
不作脓者，用活命饮。血气虚弱而不能溃，及不生肌肉者，用托里散。此其梗概云尔。
一小儿内 肿痛，恶寒发热，此属肝胆经分，乃用神效解毒散加柴胡、白芷二剂，漫肿顿消，惟中央一块尚肿，又
二剂而成脓，以托里消毒散，溃脓而愈。
一小儿腿内侧前 患毒，溃后肿硬，色黯脓清不敛，面色青黄，此脾虚肝旺，兼寒邪袭于患处也，当壮元气为主，
先用异功散加柴胡、升麻及葱熨法，脾气渐复，患处渐愈，佐以八珍汤、豆豉饼而愈。
一小儿腿内 赤，大肿发热，此血热内郁，而欲为脓耳，当先杀其大势，用隔蒜灸法，灼艾试蒜热移患处二十余炷，
痛始减，再三十余炷，肿渐消；又用仙方活命饮，疮头出水而愈。
一小儿腿内侧患此，脓内溃，恶心倦怠，面色萎黄，右
关脉弦大，按之微细，此脾胃虚弱，肝木所乘也，先用六君、升麻、柴胡，四剂元气渐复，乃佐以托里散而愈。
一小儿腿外侧痛肿，肉色如故。用托里消毒散，二剂而肿始赤，又四剂而肿赤亦退，又六剂溃而脓出清稀，食少体
倦；用异功散加芎、归，仍用托里散，补其元气而愈。
一小儿漫肿坚硬，肉色不变，此阳气虚而不能成脓也，用托里散、如圣饼，肿起色赤；用托里消毒散，而脓成针之；
用八珍汤加肉桂渐愈。因伤食吐泻，患处夭白，饮食少思，先用六君、干姜，次用八珍汤及葱熨法而愈。
一小儿患此，久不愈，脓水清稀，面色痿黄，腹大青筋，此脾气虚而肝所侮也，朝用补中益气汤，夕用五味异功散，
元气稍复，乃佐以四味肥儿丸，及葱熨之法，两月余而愈。
一小儿腿外 肿一块，服消毒之药，其肿益甚，肢体羸瘦，饮食少思，更加作痛。余曰∶先肿而后痛者，形伤气也，
先痛而后肿者，气伤形也，当补接阳气。不信，仍投疏泄之药，后果殁。《机要》云∶荣卫之气充满，抑遏不能行，故闭
塞气血，腐而为痈者，当泄之，以夺盛热之气。若人饮食疏，精神衰，气血弱，肌肉消薄，故荣卫之气短促而涩滞，故
寒搏腠理，闭郁而为痈者，当补之以接虚怯之气。信矣！
四味肥儿丸 治肝脾不和，患疮疡久不愈，或兼疳症，腹胀作泻；或食积脾疳，发热瘦怯，遍身生疮。
黄连（炒） 芜荑 神曲 麦芽（炒。各等分）
上为末，水糊丸，桐子大。每服一二十丸，空心白滚汤送下。
附子饼 治溃疡，气虚不能收敛，或风邪所袭，气血不能运于疮口，以致不能收敛者。用炮附子去皮脐，研末，
以唾津和为饼，置疮口上，将艾壮于饼上灸之，每日灸数壮，
但令微热，勿至热痛，如饼炙干，用唾津再和灸之，以疮口活润为度。
六君子汤 治疮疡，因脾气虚弱，不能生肌，以致疮口不敛。若脾气既充，而疮口不能生肌肉者，此寒邪所袭
也，更用豆豉饼或附子饼熨之。
仙方活命饮
托里消毒散（二方见热毒疮疡）
葱熨法
如圣饼（二方见流注）
内托羌活汤（方见臀痈）
五味异功散（方见用败毒之药）
附子饼（方见腹痈）
十全大补汤（方见便痈）
补中益气汤（方见肌肉不生）
八珍汤（即四君、四物）
豆豉饼（方见腋痈）
Leg carbuncle (leg abscess) involves different meridians, and thus the treatment methods vary. Those occurring on the medial side of the leg belong to the Liver Meridian and Spleen Meridian; those on the lateral side belong to the Gallbladder Meridian and Stomach Meridian. If the swelling is diffuse and hard, it indicates deficiency of Yuan Qi (Original Qi), and Neibu Huangqi Tang (Internal Supplementing Astragalus Decoction) should be used. If the swelling is high and protruding, it indicates that Yuan Qi is not yet deficient; Neituo Chaihu Huangqi Tang (Internal Supporting Bupleurum and Astragalus Decoction) should be used, along with external application of the Garlic-Separation Moxibustion Method. If blood stasis condenses and does not dissipate, or if pus fails to form, Xianfang Huoming Yin (Immortal Life Elixir) should be used. If Qi and Blood are too weak to ulcerate, or if new flesh fails to grow, Tuoli San (Supporting Interior Powder) should be used. These are the general principles.
A child presented with pain and swelling in the medial thigh, accompanied by aversion to cold and fever. This was diagnosed as a disorder of the Liver and Gallbladder meridians. Shenxiao Jiedu San (Miraculous Effect Detoxifying Powder) was prescribed with added Chaihu (Bupleuri Radix) and Baizhi (Angelicae Dahuricae Radix). After two doses, the diffuse swelling subsided instantly, leaving only a central area swollen. After another two doses, pus formed. Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) was then administered, leading to ulceration, discharge of pus, and recovery.
A child suffered from a toxic sore on the anterior-medial aspect of the leg. After ulceration, the area remained swollen and hard, with dark discoloration, thin pus, and failure to heal. The complexion was greenish-yellow. This indicated Spleen deficiency with Liver hyperactivity, compounded by Cold pathogen invading the affected site. The primary strategy was to strengthen Yuan Qi. Yigong San (Extraordinary Skill Powder) was first used with added Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), along with the Scallion-Mashing Method. As Spleen Qi gradually recovered, the lesion improved. It was assisted by Bazhen Tang (Eight Treasures Decoction) and Douchi Bing (Fermented Soybean Cake), resulting in cure.
A child presented with redness and severe swelling with heat in the medial thigh. This indicated internal stagnation of Heat in the Blood, impending suppuration. The initial step was to suppress the major pathogenic force using the Garlic-Separation Moxibustion Method. More than twenty moxa cones were applied through garlic slices onto the affected area until pain decreased. Another thirty-plus cones were applied, causing gradual reduction in swelling. Xianfang Huoming Yin (Immortal Life Elixir) was then used, and the patient recovered after fluid discharged from the sore head.
A child suffered from this condition on the medial thigh. Following internal ulceration of pus, symptoms included nausea, fatigue, and sallow complexion. The pulse at the right Guan position was wiry and large but fine upon deep pressure. This indicated Spleen and Stomach weakness with suppression by Liver Wood. Liujunzi Tang (Six Gentlemen Decoction) with added Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) was administered for four doses, gradually restoring Yuan Qi. Tuoli San (Supporting Interior Powder) was then added, leading to recovery.
A child presented with painful swelling on the lateral thigh, with normal skin color. Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) was used. After two doses, the swelling turned red; after four more doses, the redness subsided. After six additional doses, the lesion ulcerated, discharging thin pus, accompanied by poor appetite and fatigue. Yigong San (Extraordinary Skill Powder) with added Xiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix) was used, along with continued Tuoli San (Supporting Interior Powder) to tonify Yuan Qi, resulting in cure.
A child presented with diffuse, hard swelling without change in skin color. This indicated Yang Qi deficiency failing to generate pus. Tuoli San (Supporting Interior Powder) and Rusheng Bing (Like-Sage Cake) were used, causing the swelling to rise and turn red. Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) was then used; once pus matured, it was lanced. Bazhen Tang (Eight Treasures Decoction) with added Rougui (Cinnamomi Cortex) was used for gradual improvement. Due to food stagnation causing vomiting and diarrhea, the lesion became pale white, and appetite decreased. Liujunzi Tang (Six Gentlemen Decoction) with Ganjiang (Zingiberis Rhizoma) was used first, followed by Bazhen Tang (Eight Treasures Decoction) and the Scallion-Mashing Method, leading to cure.
A child suffered from this condition for a long time without healing. Pus was thin, complexion was sallow, and the abdomen was distended with visible veins. This indicated Spleen Qi deficiency with bullying by Liver Qi. Buchong Yiqi Tang (Supplementing the Middle and Boosting Qi Decoction) was administered in the morning, and Wuwei Yigong San (Five-Ingredient Extraordinary Skill Powder) in the evening. As Yuan Qi slightly recovered, Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pills) and the Scallion-Mashing Method were added. Recovery occurred after more than two months.
A child had a localized swelling on the lateral thigh. After taking detoxifying herbs, the swelling worsened, limbs became emaciated, appetite decreased, and pain intensified. I stated: Swelling preceding pain indicates injury to Form damaging Qi; pain preceding swelling indicates injury to Qi damaging Form. One should tonify and connect Yang Qi. The patient did not believe this and continued taking dispersing/draining herbs, resulting in death. *Jiyao* states: When Ying and Wei Qi are abundant but suppressed and unable to circulate, causing blockage of Qi and Blood, rotting into carbuncle, one should use draining methods to reduce excessive Heat. However, if diet is coarse, spirit is depleted, Qi and Blood are weak, and muscles are thin, causing Ying and Wei Qi to be short and stagnant, allowing Cold to knot in the pores and cause carbuncle through closure and depression, one should use tonifying methods to support deficient and timid Qi. This is indeed true!
Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pills) treats disharmony between Liver and Spleen, chronic non-healing sores, or accompanying infantile malnutrition (Gan syndrome), abdominal distension with diarrhea; or food stagnation Spleen Gan syndrome, fever with emaciation, and sores all over the body.
Huanglian (Stir-fried) Wuyi Shenqu Maiya (Stir-fried). Equal parts.
Grind into powder, bind with water paste into pills the size of paulownia seeds. Take 10–20 pills per dose, swallowed with warm boiled water on an empty stomach.
Fuzi Bing (Aconite Cake) treats ulcers where Qi deficiency prevents contraction, or Wind pathogen invasion prevents Qi and Blood from reaching the sore, leading to failure to heal. Use processed Fuzi (Aconiti Lateralis Radix Praeparata) with skin and navel removed, ground into powder. Mix with saliva to form a cake. Place on the sore. Apply moxa cones on top of the cake. Moxa several cones daily, ensuring only mild warmth, avoiding pain. If the cake dries, re-mix with saliva and continue moxibustion. Stop when the sore becomes moist and vibrant.
Liujunzi Tang (Six Gentlemen Decoction) treats sores due to Spleen Qi deficiency failing to generate flesh, resulting in non-healing ulcers. If Spleen Qi is sufficient but the sore still fails to generate flesh, it indicates Cold pathogen invasion. In such cases, apply Douchi Bing (Fermented Soybean Cake) or Fuzi Bing (Aconite Cake) for warming therapy.
Xianfang Huoming Yin (Immortal Life Elixir)
Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) (See "Heat-Toxic Carbuncles and Ulcers" for these two formulas)
Scallion-Mashing Method
Rusheng Bing (Like-Sage Cake) (See "Flowing Abscesses" for this formula)
Neituo Qianghuo Tang (Internal Supporting Notopterygium Decoction) (See "Buttock Carbuncle" for this formula)
Wuwei Yigong San (Five-Ingredient Extraordinary Skill Powder) (See "Use of Defeating Toxin Herbs" for this formula)
Fuzi Bing (Aconite Cake) (See "Abdominal Carbuncle" for this formula)
Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) (See "Genital Carbuncle" for this formula)
Buchong Yiqi Tang (Supplementing the Middle and Boosting Qi Decoction) (See "Failure of Muscle Growth" for this formula)
Bazhen Tang (Eight Treasures Decoction) (Combination of Liujunzi Tang [Six Gentlemen Decoction] and Sigui Tang [Four Substances Decoction])
Douchi Bing (Fermented Soybean Cake) (See "Axillary Carbuncle" for this formula)