脑发五种 头疮 风屑 白秃 软疖 大头肿 鬓疽 耳疮（附浸淫疮） 月蚀疮 内疳疮 腮 瘰
痰核 瘿瘤
脑后颈后顶心发，六腑阳毒好上蒸；
六腑阳毒聚顶，惟太阳膀胱主之。久积痰火湿热，上蒸于脑，古谓发脑、发鬓、发眉、发颐、发背，谓之五
发，至险。凡眼不见疮，皆恶。有生于两边发际穴者，如有核，宜取核以去病根。有生于脑心者，四边肿赤连
耳项，不急治，脓水从头中而出，血逆痰起不治。有生于颈后者，疮头向上，疮尾向下，形如蜂窠，乃反证也。
肿者，急宜托里散加升麻、赤芍、桔梗，防毒攻心。如痰发，或流入两肩者，不治。有生脑后对口者，名曰
天疽。其状大而色紫黑，不急治，热入渊腋，前伤任脉，内熏肝肺，十余日而死。有生耳后一寸三分至命之处，
名曰发颐，又日锐毒。凡头上痈疽，宜服降火化痰、消肿托里之药，不可针灸，惟初起隔蒜灸之则可，但艾炷
宜小而少。势成者，外敷南星膏，或阴阳散，敛口古香榔散。若热上蒸，连颐而穿口，必主穿喉而死。
肿纳冷真热证，
肿作痛，烦渴好饮冷水，宜解毒汤加天花粉，以除痰火湿热，或黄连消毒散、当归羌活汤、清热消毒饮、
活命饮，选用。
口干饮热肾虚情。
肿痛口干作渴，好饮热汤，为肾阳虚火炽，宜托里消毒散、托里益气汤、肾气丸、八味丸。漫肿微痛、少
食者，补中益气汤；痰多者，托里清中汤。若色黯，不溃不敛，为阴精消涸，名脑烁，不治。
头疮风屑秃软疖，总是湿热证稍轻。
头疮，宜内服酒归饮，外用雄黄、水银各等分为末，以腊月猪脂（半生半熟）和匀，洗净敷之；湿烂者，
用燕窠土、黄柏为末，干糁；痂高者，用黄蜡、沥清同熬，敷之。头上风屑、白屑极痒，宜内服单苦参丸；
下虚者，薄荷茶。外用藜芦煎汤，避风洗头，候稍干，分开头发，仍以藜芦末糁头皮上，绢帕紧缚两日夜，头风
亦效。秃疮，初起白团斑剥如癣，上有白皮，久则成痂，遂至满头生疮，中有脓孔细虫入里，不痛微痒，经久
不瘥，宜内用通圣散酒拌，除大黄另用酒炒，共为末，再用酒拌令干。每一钱，水煎服。外用红炭淬长流水，
洗去疮痂，再用淡豆豉一合，炒令烟起色焦，屋尘一团，饭饮调剂，炭火 令灰烬，等分为末，入轻粉少许，
麻油调搽。如有热，加黄连、寒水石；有水，加枯矾；有虫，加川椒、麝香少许；肿浓，加消皮烟洞烟胶、香
炉盖上香胶。如久不愈，有虫者，摩风膏加黄柏、黄丹、烟胶各一两。一方用盐乌鱼头烧灰，麻油调搽。软疖，
用抱鸡卵壳，烧存性，入轻粉、黄连减半为末，清油调敷。外肾生疮亦效。愈而再作者，用野蜂房二个，烧存
性，为末，以巴豆二十粒去壳，煎清油二三沸，去豆，以清油调敷，或枯矾亦好。多年不愈者，用猪颈上毛、
猫颈上毛各一握，烧存性，鼠屎一粒，为末，清油调敷，或加轻粉尤妙。如暑月生疖，用木槿花捣烂敷之，
最妙。
大头肿痛（又名雷头风）时行毒，
湿在高巅之上，故头面痛肿疙瘩，甚则咽嗌堵塞，害人最速。冬温后，多病此证，似伤寒寒热身痛。
治分表里三阳属；
连两目、鼻、面肿者，阳明也；发耳前后，并头角者，少阳也；脑后项下肿起者，太阳也。脉浮表证多
者，清震汤，或败毒散加荆、防；脉沉里证见者，宜羌活、黄芩，俱酒炒，大黄酒蒸为主。阳明加干葛、升麻、
芍药、石膏；少阳加栝蒌仁、牛蒡子；太阳加荆芥、防风，水煎，时时呷之。取大便，邪气去则止。甚者，
加芒硝，或防风通圣散加牛蒡子、玄参，俱用酒炒，微微下之。咽喉肿痛者，用僵蚕一两，大黄二两，蜜丸如
弹，井水化服。凶荒劳役，宜普济消毒饮，以安里。虚者，加参、归；便秘加大黄，或人中黄丸亦妙。服后
俱仰卧，使药气上行，故非便秘热盛，忌用降下之药。
表里证罢肿不消，瓷锋去血通关搐。
表里俱解，肿不消者，砭去血，外用通关散倍羊踯躅及藜芦少许，搐鼻嚏以泄其毒。久不愈，欲作脓者，
内服托里消毒散；体倦食少恶寒者，补中益气汤加桔梗。溃后肿赤不消，脓清色白者，六君子汤加桔梗、芎、归。
元气素弱、脉微者，用参、术、芎、归、陈皮、柴胡、升麻、甘草各等分，以升举阳气；用牛蒡子、玄参、
连翘、桔梗减半，以解热毒。肿赤便属纯阳，脉微便属纯阴，慎之。
鬓疽肝胆之怒火，或因风热药同裹；
怒火、风热，俱宜柴胡清肝汤。肿痛甚者，活命饮。
肾虚血燥日晡潮，
肾水不能生木，以致肝胆火盛血燥，鬓及头目肿痛者，四物汤加玄参、柴胡、桔梗、甘草。风热，连头面、咽、
牙痛者，犀角升麻汤；血虚者，四物汤加参、 。
汗多喘渴脾劳过。
因劳役，肿痛、寒热、喘渴、自汗者，补中益气汤去升、柴，加五味子、麦门冬、炮姜。
耳疮三焦肝风热，
耳疮发热 痛，属三焦、厥阴风热者，柴胡清肝汤、栀子清肝汤；中气素虚者，补中益气汤加酒炒山栀、
黄芩、牛蒡子。寒热作痛，属肝风热者，小柴胡汤加山栀、川芎。
痒痛出脓兼养血；
内热痒痛出脓，寒热溺数，牵引胸胁胀痛，属肝火血虚者，八味逍遥散。
出水贪冷属肾虚，火动切忌风药劫。
耳内痒痛出水，喜冷银簪探入，属肾经虚火挟怒，忌用风药燥筋，宜肾气丸。耳边浸淫疮，出黄水者，
用羊须、荆芥、枣肉等分烧灰，入腻粉为末，麻油调搽。月蚀疮，生耳、鼻、面间及下部诸窍，随月盛衰。
用胡粉炒黄、枯矾、黄丹、黄连、轻粉各二钱，胭脂烧灰一钱，麝少许，为末，先用盐水洗净，糁之，或麻油
调搽。
内疳（疮）生于口上 ，治以钩刀并铁烙；敷以雄粉支其牙，最是虚劳元气薄。
初发如莲花，根蒂小而下垂乃大。治法以钩刀决其根，烧铁烙以止其血；次以雄黄、轻粉、粉霜、白芷、
白蔹为末，敷之∶以槐枝作枕，支其牙颊间，毋使口合。一两时许，疮瘢定合，口自梗。次日出脓，以生肌散
敷之。上 多骨疽，见后。
腮（髭发同）风热犯其胃，表分寒热里不利；
外因风热肿痛，在表寒热者，升麻胃风汤；在里二便不利者，四顺清凉饮。如表里俱解，肿痛又不消，欲
作脓也，托里消毒散，治同大头肿。
积热肿痛颇难当，
膏粱浓味，胃经积热，腮肿作痛，或发寒热者，用升麻、黄连、连翘、牛蒡子、白芷等分，水煎服。连耳
上太阳部分肿，属风热，加羌活、防风；连耳下少阳部分肿，属怒火，加柴胡、山栀、牡丹皮；连耳后少阴部
分肿，属相火，加知母、黄柏。头面齿牙俱肿，内热口干者，犀角升麻汤；齿牙唇口俱肿，出血者，清胃散加
石膏。
内寒不溃宜补剂。
内伤生冷、凉药，不能消溃，食少体倦者，补中益气汤；内伤气血俱虚者，八物汤加麦门冬、五味子。伤
七情有寒热者，八味逍遥散；伤色欲，连颐及耳后肿者，肾气丸、八味丸、十全大补汤。不可误用风药克伐之
剂。
瘰 马刀属少阳，风热痰气结核囊；
生颈前项侧，结核如大豆、如银杏，曰瘰 ；生胸胁腋下，坚硬如石，形如马刀虫，曰马刀，多气少血之
病，总皆手足少阳相火所主。盖耳前后与缺盆、肩上、胛下，属足少阳部分；延及颏、项、颊车与颈，属足阳
明部分；延及胸中、中府、云门肺经部分者死。风 尖而小；热 肿赤色，又名血 ；痰 推展滑软；气
圆而动。又有鼠残 ，大小不一。
实者化痰通经脉，清肝养血是上方。
无痰不成核。诸瘰初起，实者皆以化痰为主，通用二陈汤加防风、桔梗、黄芩、竹沥。胸紧者，以此探
吐尤妙。通经脉，必用斑蝥。疏渗小便以泻心火，古方必效散、立应散是也。但此二药甚峻，服后宜量体调治∶
体实风热盛者，继以宣热丹服之；体虚者，托里益气汤，或八物汤合二陈汤，多服，疮口自敛。又有虚甚者，
宜先服健脾药，而后服二散；轻者，只用斑鸡丸。便坚胃盛者，白蚕丸，或追脓化毒散、软硬皂子丸。少阳分
者，柴胡通经汤；阳明分者，升麻调经汤；少阳、阳明二经，二汤合服调之。误下则犯经禁、病禁。清肝者，
胆与肝合病，则筋累累如贯珠，寒热 痛，乃肝气动而为病也，当清肝火为主，佐以养血。若寒热止而疮不愈
者，乃肝血燥而为病也，当养血为主，佐以清肝，清肝益荣汤、栀子清肝汤、柴胡清肝汤，选用。
虚久滋润肺脾肾，
疮如豆粒附筋，肉色不变，内热口干，精神倦忌，久不消溃，及肝脉弦紧，肾脉洪数，乃肾水不能生木，
以致肝血火动筋挛，忌用风药燥肝。经久烂破，脓血大泄者，脾肾愈亏，火炎于肺，皆宜肾气丸、补中胜毒饼为
主，兼服逍
遥散加桔梗、麦门冬、玄参以清肺火。多怒有肝火者，清肝解郁汤；有寒热者，单夏枯草散。肝火旺盛，或近
骨处生虫作痒者，芦荟丸。通用猫头丸、海藻散坚丸。外治∶银右散、蚕茧散、猫蝠散。虚弱者，单夏枯草膏
内服，外贴加麻油。
成 泻水补且防；
，即漏也。经年成漏者，与痔漏之漏相同。但在颈则曰瘰漏，在痔则曰痔漏，治法则一。初起者，宜温散
风冷，及行肾经湿热邪水；久则大补气血，兼用熏洗平肌塞窍之药。古方白蛇散，治瘰 成漏，以其有牵牛能
利肾经恶水，免至淋漓穿穴。但利后当量体调治，痛节酒色财气。凡漏，治详漏条。
女人经闭有潮死，
经调及经闭无潮者，可治；经闭有潮，或咳者，死。古方用玉烛散治瘰 ，和血通经，服之自消。日进一
服，七八日见效。便不闭者，柴胡通经汤、升麻调经汤。久闭者，加味逍遥散、清肝益荣汤，或用二陈汤合四
物汤加牡蛎、柴胡、黄芩、玄参、神曲为末，以桑椹膏捣丸，绿豆大。每五十丸，温酒下。或肾气丸尤妙。
男子潮咳是真伤。
瘰 ，伤证之标也。故痨瘵类有曰腹中有块、颈上有核，最为难治。况成溃漏，而不清金降火、滋肾健脾，
病患又不清心淡口，则潮汗咳泻，恶证蜂起，其可生乎？但视其目内赤脉，贯瞳人有几条，则知其几年死。
面色 白，金克木；脉洪大，为元气虚败，俱为不治。故曰∶实者可治，虚者可虑。
痰核在颈全不痛，
颈项生核，不红不痛，不作脓，推之则动，乃痰聚不散也。不可误用瘰 药治，宜二陈汤加大黄、连翘、
柴胡、桔梗。体薄者，二陈汤加桔梗、黄芩、玄参，麦门冬及防风少许，入竹沥，多服自消。如耳后与项间各有
一块者，含化丹。
在臂或痛亦不红。
臂核或作微痛者，以内无脓，散外虽肿不红，或生背膊皆然，宜陈皮、半夏、茯苓、防风、酒芩各一钱，
连翘二钱，皂角刺一钱半，川芎、苍术各五分，甘草三分，水煎服。
遍身结块多痰注，湿痰下体却宜通。
凡遍身有块，多是痰注，但在上体多兼风热，在下体多兼湿热，宜加味小胃丹、竹沥达痰丸，量体虚实服之。
通用海带丸。
瘿瘤有五应五脏，
旧分五瘿六瘤，惟薛立斋止言五瘤。盖瘿、瘤本共一种，皆痰气结成，惟形有大小，及生颈项、遍身之殊
耳。立斋云∶肝统筋，怒动肝火，血燥筋挛，曰筋瘤；心主血，劳役火动，阴火沸腾，外邪所搏而为肿，曰血
瘤；脾主肉，郁结伤脾，肌肉消薄，外邪搏而为肿，曰肉瘤；肺主气，劳动元气，腠理不密，外邪搏而为肿，
曰气瘤；肾主骨，劳伤肾水，不能荣骨而为肿，曰骨瘤。瘤之名有五者，此也。仁斋云∶筋脉呈露曰筋瘿，赤
脉交络曰血瘿，皮色不变曰肉瘿，随忧愁消长曰气瘿，坚硬不可移曰石瘿。瘿之名有五者，此也。瘿、瘤俱内
应五脏，药治相同。
瘤赤遍身瘿颈项；
瘿、瘤所以两名者，以瘿形似樱桃，一边纵大亦似之，槌槌而垂，皮宽不急。原因忧恚所生，故又曰瘿
气，今之所谓影囊者，是也。瘤初起如梅、李，皮嫩而光，渐如石榴、瓜瓠之状。原因七情劳欲，复被外邪，
生痰聚瘀，随气流住，故又曰瘤。瘤总皆气血凝滞结成。惟忧恚耗伤心肺，故瘿多着颈项及肩；劳欲邪气乘经
之虚而作，故瘤随处有之。
虽无痛痒有虚实，散坚行气不可妄。
瘿瘤或软或硬，无痛无痒，体实者，海藻散坚丸、海带丸；痰火盛者，舐掌散、神效开结散。此皆化痰
行气破坚之剂，久虚者不可妄服。虚者∶筋瘤，肾气丸，或八物汤加山栀、木瓜、炒黑龙胆草，肝火盛者，间
以芦荟丸暂服；血瘤，四物汤加茯苓、远志；肉瘤，归脾汤、补
中益气汤；气瘤，补中益气汤；骨瘤，肾气丸、补中益气汤。通用∶初起者，十六味流气饮、单蜘蛛方；稍久
者，蜡矾丸，常服自然缩小消磨。外敷南星膏。切不可轻用针刀决破，破则脓血崩溃，渗漏无已，必至杀人。
但有一种脂瘤红粉色，全是痰结，用利刀破去脂粉则愈。或有如茄垂下，根甚小者，用药点其蒂，俟茄落，即
用生肌敛口药敷之，防其出血。
Five Types of Brain Carbuncles: Head sores, wind dandruff, white alopecia, soft boils, big head swelling, temple carbuncle, ear sores (including impetigo), moon erosion sores, internal chancre sores, mumps, scrofula, phlegm nodules, and goiter.
Carbuncles occurring at the back of the brain, neck, and vertex are often caused by Yang pathogens of the six fu organs steaming upwards; these Yang pathogens gathering at the vertex are primarily governed by the Foot-Taiyang Bladder Meridian. If phlegm-fire and damp-heat accumulate over a long period and steam upwards to the brain, ancient texts refer to this as Fa Nao (Brain Carbuncle), Fa Bin (Temple Carbuncle), Fa Mei (Eyebrow Carbuncle), Fa Yi (Cheek Carbuncle), and Bei Fa (Back Carbuncle), collectively known as the "Five Carbuncles," which are extremely dangerous. Any ulcer not visible to the eye is generally considered ominous. Some occur at the hairline on both sides, presenting as hard nodules; removing the nodule can eliminate the root cause. Others arise at the center of the brain, with swelling and redness extending to the ears and neck; if not treated urgently, pus and fluid will discharge from the head, leading to blood reversal and phlegm rush, resulting in death. Those arising at the back of the neck have the sore head pointing up and the tail down, resembling a honeycomb, which is a contrary sign. In cases of swelling, Tuoli San (Support-the-Interior Powder) should be taken urgently with added Shengma (Cimicifugae Rhizoma), Chishao (Paeoniae Radix Rubra), and Jiegeng (Platycodonis Radix) to prevent toxic pathogens from attacking the heart. If it is a phlegm-type eruption or spreads to both shoulders, it is incurable. Those arising opposite the spine at the back of the head are called Tian Ju (Heaven Carbuncle). The lesion is large and purple-black; without urgent treatment, heat toxins enter the Yuanye acupoint, damage the Ren Mai (Conception Vessel) anteriorly, and internally smoke the Liver and Lungs, causing death within ten days. Those arising one inch and three fen behind the ear at the life-threatening point are called Fa Yi (Cheek Carbuncle), also known as Rui Du (Sharp Toxin). For all carbuncles and sores on the head, medications that clear fire, resolve phlegm, reduce swelling, and support the interior should be used. Acupuncture and moxibustion should generally be avoided; only garlic-partitioned moxibustion is permissible in the early stages, using small and few moxa cones. Once suppuration has formed, apply Nanxing Gao (Arisaema Paste) or Yinyang San (Yin-Yang Powder); for wound closure, use Gu Xianglang San (Ancient Incense Areca Seed Powder). If heat toxins steam upwards, involving the cheeks and penetrating the mouth, throat perforation and death are inevitable.
True Heat Syndrome with Swelling and Cold Sensation:
Swelling with pain, irritability, thirst, and preference for cold water indicates phlegm-fire and damp-heat. Use Jiedu Tang (Detoxification Decoction) with added Huafen (Trichosanthis Radix) to clear phlegm-fire and damp-heat, or select Huanglian Xiaodu San (Coptis Detoxification Powder), Danggui Qianghuo Tang (Angelica and Notopterygium Decoction), Qingre Xiaodu Yin (Heat-Clearing Detoxification Drink), or Xianfang Huoming Yin (Immortal Life Elixir).
Dry Mouth and Thirst for Hot Drinks Indicating Kidney Deficiency:
Swelling, pain, dry mouth, thirst, and preference for hot drinks indicate Kidney Yang deficiency with blazing fire. Use Tuoli Xiaodu San (Support-the-Interior Detoxification Powder), Tuoli Yiqi Tang (Support-the-Interior Qi-Boosting Decoction), Shenqi Wan (Kidney Qi Pill), or Bawei Wan (Eight-Ingredient Pill). For diffuse swelling with slight pain and poor appetite, use Buzhong Yiqi Tang (Center-Boosting Qi-Supplementing Decoction); for excessive phlegm, use Tuoli Qingzhong Tang (Support-the-Interior Middle-Clearing Decoction). If the color is dark, and the sore neither suppurates nor heals, it indicates exhaustion of Yin essence, named Naoshuo (Brain Melting), which is incurable.
Head Sores, Wind Dandruff, Alopecia, and Soft Boils are Mild Damp-Heat Syndromes:
For head sores, take Jiugui Yin (Wine-Infused Angelica Drink) internally. Externally, mix equal parts Xionghuang (Realgar) and Shuiyin (Mercury) into powder, blend with lard from a pig slaughtered in the twelfth lunar month (half raw, half cooked), clean the area, and apply. For weeping lesions, use Yanke Tu (Swallow Nest Soil) and Huangbai (Phellodendri Cortex) powder applied dry. For thick crusts, boil Huangla (Beeswax) and Liqing (Bitumen) and apply. For itchy wind dandruff and white flakes on the head, take Danshen Can Wan (Single Sophora Pill) internally; for lower deficiency, drink Mint Tea. Externally, wash the head with Licorice decoction while avoiding wind. When slightly dry, part the hair and sprinkle Licorice powder on the scalp, binding tightly with silk cloth for two days; this is also effective for head wind. For alopecia, initial white patches resemble tinea with white scales; later, crusts form, spreading over the head with pus holes and fine insects entering internally, causing slight itching but no pain. It persists for a long time. Internally, use Tongsheng San (Universal Salvation Powder) mixed with wine (remove Dahuang/Rhubarb, stir-fry separately with wine, grind together, mix with wine until dry). Take 1 qian (approx. 3-5g) boiled in water. Externally, wash off crusts with long-flowing water quenched with red charcoal. Stir-fry 1 he (approx. 60g) of Danshichi (Fermented Soybean) until smoking and charred, add a clump of house dust, mix with rice drink, and calcine to ash. Grind to powder, add a little Qingfen (Calomel), and apply with sesame oil. Add Huanglian (Coptidis Rhizoma) and Hanshuishi (Calcitum) for heat; Kuban (Alum) for fluid; Chuanjiao (Sichuan Pepper) and Shexiang (Musk) for insects; Xiaopi Yandong Yanjiao (Smoke Resin from Pipe Hole) and Xianglu Gai Shangjiao (Incense Resin from Burner Lid) for swelling and pus. For chronic cases with insects, use Mofeng Gao (Wind-Rubbing Ointment) with Huangbai, Huangdan (Lithargyrum), and Yanjiao (Smoke Resin), each 1 liang (approx. 30g). Alternatively, burn salted cuttlefish head to ash and apply with sesame oil. For soft boils, burn chicken eggshell until carbonized, mix with reduced amounts of Qingfen and Huanglian, and apply with clear oil. This is also effective for external genital sores. For recurrent healing, burn two wild bee hives until carbonized, powder them, fry 20 shelled bitter beans in clear oil for two or three boils, remove beans, and apply the oil. Alum is also good. For years-long non-healing cases, burn one handful each of pig neck hair and cat neck hair with one rat dropping, powder them, and apply with clear oil; adding Qingfen is excellent. For boils in summer, mashed hibiscus flower paste is best.
Big Head Swelling (Also Known as Thunder Head Wind) due to Epidemic Toxins:
Dampness at the highest peak causes headache, facial swelling, and nodules, potentially blocking the throat and pharynx, killing quickly. After winter warmth, this syndrome is common, resembling Taiyang disease with chills, fever, and body pain.
Treatment Differentiates by Exterior/Interior and Three Yang Meridians:
Swelling involving eyes, nose, and face belongs to Yangming; swelling around ears and temples belongs to Shaoyang; swelling at the back of the neck and occiput belongs to Taiyang. For floating pulse with exterior signs, use Qingzhen Tang (Clear Earthquake Decoction) or Baidu San (Defeat Toxicity Powder) with Jingjie (Schizonepetae Herba) and Fangfeng (Saposhnikoviae Radix). For sinking pulse with interior signs, use Qianghuo (Notopterygii Rhizoma) and Huangqin (Scutellariae Radix), all wine-fried, with Dahuang (Rhei Radix et Rhizoma) steamed in wine as the main ingredient. Add Ge Gen (Puerariae Lobatae Radix), Shengma (Cimicifugae Rhizoma), Shaoyao (Paeoniae Radix Alba), and Shigao (Gypsum Fibrosum) for Yangming; add Gualou Ren (Trichosanthis Semen) and Niubangzi (Arctii Fructus) for Shaoyang; add Jingjie and Fangfeng for Taiyang. Decoct in water and sip frequently. Indicate bowel movement to expel pathogens; stop when achieved. For severe cases, add Mangxiao (Natrii Sulfas) or Fengwang Tongsheng San (Wind-Blocking Universal Salvation Powder) with Niubangzi and Xuanshen (Scrophulariae Radix), all wine-fried, to mildly purge. For swollen/painful throat, use Jiangcan (Bombyx Batryticatus) 1 liang and Dahuang 2 liang, honey-pilled like a bullet, dissolved in well water. During famine and labor, use Puji Xiaodu Yin (Universal Relief Detoxification Drink) to stabilize the interior. For deficiency, add Renshen (Ginseng Radix) and Danggui (Angelicae Sinensis Radix); for constipation, add Dahuang, or Renzhonghuang Wan (Human Waste Yellow Pill) is excellent. Lie supine after taking medicine to allow medicinal qi to ascend; thus, purgatives are contraindicated unless there is constipation and excess heat.
When Exterior/Interior Signs Cease but Swelling Persists, Use Lancet to Bleed and Clear Orifice Obstruction:
If exterior and interior are resolved but swelling remains, use bianfa (lancet therapy) to bleed. Externally, use Tongguan San (Open the Pass Powder) doubled with Yangzhizhu (Daphne Genkwa) and a little Licorice, insufflated into the nose to induce sneezing and vent toxicity. For chronic cases wanting to suppurate, take Tuoli Xiaodu San. For fatigue, poor appetite, and aversion to cold, use Buzhong Yiqi Tang with Jiegeng. After rupture, if swelling/redness persists with clear white pus, use Liujunzi Tang (Six Gentlemen Decoction) with Jiegeng, Xiong (Ligustici Chuanxiong Rhizoma), and Danggui. For those with weak constitution and faint pulse, use equal parts Renshen, Baizhu (Atractylodis Macrocephalae Rhizoma), Xiong, Danggui, Chenpi (Citri Reticulatae Pericarpium), Chaihu (Bupleuri Radix), Shengma, and Gancao (Glycyrrhizae Radix) to raise Yang Qi; use half doses of Niubangzi, Xuanshen, Lianqiao (Forsythiae Fructus), and Jiegeng to clear heat toxins. Red swelling with hard stool indicates pure Yang; faint pulse indicates pure Yin; be cautious.
Temple Carbuncle due to Liver/Gallbladder Fire or Wind-Heat:
Both fire anger and wind-heat respond to Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction). For severe swelling/pain, use Xianfang Huoming Yin.
Kidney Deficiency, Blood Dryness, and Afternoon Fever:
If Kidney Water fails to nourish Wood, causing Liver/Gallbladder fire excess and blood dryness with temple/head/eye swelling, use Siwu Tang (Four Substances Decoction) with Xuanshen, Chaihu, Jiegeng, and Gancao. For wind-heat involving head/face/throat/teeth, use Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction); for blood deficiency, Siwu Tang with Renshen and Huangqi (Astragali Radix).
Excessive Sweating, Wheezing, Thirst, and Spleen Fatigue:
Due to overwork, with swelling, chills/fever, wheezing/thirst, and spontaneous sweating, use Buzhong Yiqi Tang removing Shengma and Chaihu, adding Wuweizi (Schisandrae Fructus), Maidong (Ophiopogonis Radix), and Paojiang (Prepared Ginger).
Ear Sores due to Sanjiao/Liver Wind-Heat:
Ear sores with fever/pain belonging to Sanjiao/Jueyin wind-heat respond to Chaihu Qinggan Tang or Zhizi Qinggan Tang (Gardenia Liver-Clearing Decoction); for middle Qi deficiency, use Buzhong Yiqi Tang with wine-fried Zhizi (Gardeniae Fructus), Huangqin, and Niubangzi. For chills/pain due to Liver wind-heat, use Xiao Chaihu Tang (Minor Bupleurum Decoction) with Zhizi and Chuanxiong.
Itching/Pain with Pus Discharge Requires Blood Nourishment:
Internal heat causing itching/pain with pus, chills/fever, frequent urination, and chest/hypochondriac distension/pain due to Liver fire and blood deficiency responds to Bawei Xiaoyao San (Eight-Ingredient Free Wanderer Powder).
Water Discharge, Preference for Cold, and Kidney Deficiency; Avoid Wind Medicines Aggravating Fire:
Ear itching/pain with water discharge, preferring cold silver needles inserted, indicates Kidney meridian deficiency fire with anger. Avoid wind medicines that dry tendons; use Shenqi Wan. For impetigo around the ear with yellow discharge, burn equal parts sheep whiskers, Jingjie, and jujube flesh to ash, add Nifen (Calomel), powder, and apply with sesame oil. Moon erosion sores appear between ears/nose/face and lower orifices, waxing/waning with the moon. Use Hufen (Lead Carbonate) fried yellow, Kuban, Huangdan, Huanglian, Qingfen (Light Calomel) each 2 qian, Zhiyan (Rouge) burnt to ash 1 qian, and a little Shexiang. Clean with salt water, sprinkle powder, or apply with sesame oil.
Internal Chancre Sores Above the Mouth: Treated with Hook Knife and Iron Brand; Supported by Powder to Hold Teeth; Indicates Severe Deficiency:
Initially resembling a lotus flower, with a small root hanging down then enlarging. Treat by cutting the root with a hook knife, branding with iron to stop bleeding. Apply powder of Xionghuang, Qingfen, Fenshuang (Sublimated Arsenic), Baizhi (Angelicae Dahuricae Radix), and Bailian (Houttuyniae Rhizoma). Use locust branch pillow to support teeth/jaw, preventing mouth closure. After an hour, scar forms, mouth stiffens. Next day, pus discharges; apply Shengji San (Generate Flesh Powder). Upper palate osteomyelitis, see below.
Mumps Due to Wind-Heat Invading Stomach: Exterior Chills/Fever, Interior Urinary/Bowel Difficulty:
External wind-heat causing swelling/pain with exterior chills/fever responds to Shengma Weifeng Tang (Cimicifuga Stomach-Wind Decoction); interior urinary/bowel difficulty responds to Sishun Qingliang Yin (Smooth Cooling Drink). If exterior/interior resolved but swelling persists indicating suppuration, use Tuoli Xiaodu San, same treatment as Big Head Swelling.
Accumulated Heat Swelling/Pain is Hard to Bear:
Rich food/greasy diet causing Stomach meridian accumulated heat, cheek swelling/pain, or chills/fever, uses equal parts Shengma, Huanglian, Lianqiao, Niubangzi, and Baizhi, decocted in water. Swelling connecting to upper ear/Solar portion due to wind-heat adds Qianghuo and Fangfeng; swelling connecting to lower ear/Shao portion due to fire anger adds Chaihu, Zhizi, and Mudanpi (Moutan Cortex); swelling connecting to posterior ear/Yin portion due to ministerial fire adds Zhimu (Anemarrhenae Rhizoma) and Huangbai. Head/face/teeth swelling with internal heat/dry mouth uses Xijiao Shengma Tang; teeth/lips/mouth swelling with bleeding uses Qingwei San (Clear Stomach Powder) with Shigao.
Internal Cold Preventing Suppuration Requires Tonification:
Internal injury from cold/raw food or cooling medicines preventing resolution, with poor appetite/fatigue, uses Buzhong Yiqi Tang; internal injury with Qi/Blood deficiency uses Bawu Tang (Eight Matters Decoction) with Maidong and Wuweizi. Seven emotions causing chills/fever uses Bawei Xiaoyao San; sexual excess causing cheek/post-ear swelling uses Shenqi Wan, Bawei Wan, or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction). Do not mistakenly use wind medicines that attack healthy Qi.
Scrofula and Horse-Knife Belong to Shaoyang: Wind-Heat, Phlegm, Qi Knots:
Knots like soybeans/ginkgo nuts on front/side of neck are Scrofula (Luo Li); hard stones like horse-knife worms in chest/flax/armpits are Horse-Knife (Ma Dao). These are Qi-abundant/Blood-deficient diseases, governed by Ministerial Fire of Hand/Foot Shaoyang. Behind/front ears, Quepen, shoulder tops, under shoulder blades belong to Foot Shaoyang; chin, neck, Jiache, neck belong to Foot Yangming; extending to chest, Zhongfu, Yunmen Lung meridian areas indicates death. Wind knots are sharp/small; Heat knots are red/swollen (also Blood knots); Phlegm knots are smooth/soft/mobile; Qi knots are round/mobile. Rat-residual knots vary in size.
Excess Type: Resolve Phlegm, Unblock Meridians; Clear Liver, Nourish Blood is Superior Formula:
No phlegm, no knot. Initial Scrofula/Ma Dao excess types focus on resolving phlegm, generally using Erchen Tang (Two Aged Ingredients Decoction) with Fangfeng, Jiegeng, Huangqin, and Zhuli (Bamboo Juice). For tight chest, inducing vomiting with this is excellent. To unblock meridians, must use Banmao (Mylabris). Promote urination to drain Heart fire; ancient formulas Bixiao San (Must-Effect Powder) and Liying San (Immediate-Response Powder) do this. These are harsh; adjust based on constitution post-ingestion. For excess wind-heat, follow with Xuanre Dan (Heat-Releasing Pill); for deficiency, Tuoli Yiqi Tang or Bawu Tang combined with Erchen Tang, taken long-term allows natural closure. For severe deficiency, first tonify Spleen, then take the two powders; for mild cases, only Banji Wan (Spotted Chicken Pill). For hard stools/stomach excess, Baican Wan (White Silkworm Pill), Zhuinong Huadu San (Purge Pus Transform Toxin Powder), or Ruan Ying Zaozi Wan (Soft/Hard Soap Pill). Shaoyang type: Chaihu Tongjing Tang (Bupleurum Meridian-Unblocking Decoction); Yangming type: Shengma Tiaojing Tang (Cimicifuga Meridian-Regulating Decoction); Both: combine both decoctions. Incorrect purging violates meridian/disease prohibitions. Clearing Liver: Gallbladder/Liver combined disease causes tendon knots like beads, chills/fever/pain due to Liver Qi disturbance; clear Liver fire primarily, assist with blood nourishment. If chills/fever cease but sore persists, it is Liver blood dryness; nourish blood primarily, assist with clearing Liver. Select Qinggan Yirong Tang (Clear Liver Enrich Glory Decoction), Zhizi Qinggan Tang, or Chaihu Qinggan Tang.
Chronic Deficiency Moisturizes Lung/Spleen/Kidney:
Knots like beans attached to tendons, unchanged skin color, internal heat/dry mouth, fatigue, persistent non-resolution, wiry Liver pulse, surging rapid Kidney pulse indicate Kidney Water failing to nourish Wood, causing Liver blood/fire moving and tendon contraction. Avoid wind medicines drying Liver. Chronic rupture with heavy pus/blood loss further depletes Spleen/Kidney, fire flares to Lungs; use Shenqi Wan and Buzhong Shengdu Bing (Center-Boosting Toxin-Overcoming Cake) primarily, combined with Xiaoyao San plus Jiegeng, Maidong, Xuanshen to clear Lung fire. Anger/Liver fire: Qinggan Jieyu Tang (Clear Liver Resolve Depression Decoction); Chills/fever: Dan Xiakucao San (Single Prunella Powder). Excessive Liver fire/insect itch near bone: Lushui Wan (Aloe Pill). General: Maotou Wan (Cat Head Pill), Haizao Sanjian Wan (Seaweed Solidify Scatter Pill). External: Yinyou San, Canjian San, Maofu San. For weakness, Dan Xiakucao Gao (Single Prunella Paste) internally, externally paste with sesame oil.
Formation of Fistula: Drain Water, Tonify, and Prevent:
Fistula (Lou) is similar to hemorrhoidal fistulas after years. Neck fistula is Luo Li Lou; hemorrhoidal is Zhi Lou; treatment principles are same. Early stage: warm-disperse wind-cold, move damp-heat evil water of Kidney meridian; late stage: greatly tonify Qi/Blood, use fumigation/washing to level muscle/close orifice. Ancient Baisha San (White Snake Powder) treats Luo Li fistula because Qian Niu (Morning Glory Seed) drains Kidney evil water, preventing dripping/perforation. After draining, adjust constitution, abstain from alcohol/sex/wealth/anger. See Fistula section for details.
Women's Amenorrhea with Tide Indicates Death:
Regular menstruation or amenorrhea without tide is treatable; amenorrhea with tide or cough indicates death. Ancient formula Yuzhu San (Jade Candle Powder) treats Scrofula, harmonizes blood/unblocks menstruation, self-resolves. One dose daily, effective in 7-8 days. If bowels not closed, Chaihu Tongjing Tang or Shengma Tiaojing Tang. Long-term amenorrhea: Jiawei Xiaoyao San, Qinggan Yirong Tang, or Erchen Tang combined with Siwu Tang plus Muli (Ostrea Concha), Chaihu, Huangqin, Xuanshen, Shenqu (Medicated Leaven) powder, pilled with Mulberry Paste, mung bean size. 50 pills with warm wine. Shenqi Wan is excellent.
Men's Tidal Cough Indicates True Injury:
Scrofula is a manifestation of consumption syndromes. Abdominal masses/neck nodes are hardest to treat. If ulcerated/fistulated, without clearing Metal/descending fire/nourishing Kidney/tonifying Spleen, and patient not calming mind/lightening diet, tidal sweat/cough/diarrhea and evil signs arise; survival is unlikely. Count red vessels piercing pupil to predict years to death. Pale face (Metal overcomes Wood); surging large pulse (Qi/Blood collapse) are incurable. Thus: Excess is treatable, Deficiency is concerning.
Phlegm Nodules in Neck are Completely Painless:
Neck nodules, non-red/non-painful, non-suppurating, mobile upon pushing, are phlegm accumulation. Do not mistakenly use Scrofula medicines; use Erchen Tang plus Dahuang, Lianqiao, Chaihu, Jiegeng. For thin constitutions, Erchen Tang plus Jiegeng, Huangqin, Xuanshen, Maidong, and little Fangfeng, add Zhuli, taken long-term resolves. For blocks behind ear and neck, use Hanhua Dan (Resolve and Transform Pill).
Arm Nodules May Pain but Not Red:
Arm nodules with slight pain, no internal pus, external swelling without redness, or back/shoulder occurrence, use Chenpi, Banxia (Pinelliae Rhizoma), Fuling (Poria), Fangfeng, Jiu Qin (Wine-Fried Scutellaria) each 1 qian, Lianqiao 2 qian, Zaocigu (Gleditsiae Spina) 1.5 qian, Chuanxiong, Cangzhu (Atractylodis Rhizoma) each 0.5 qian, Gancao 0.3 qian, decoct in water.
Whole Body Knots Mostly Phlegm Accumulation; Damp-Phlegm Lower Body Needs Unblocking:
Whole body knots are mostly phlegm accumulation. Upper body combines wind-heat; lower body combines damp-heat. Use Jiawei Xiaowei Dan (Addicted Minor Stomach Pill) or Zhuli Datang Wan (Bamboo Juice Phlegm-Reaching Pill), adjust for constitution. General: Haitai Wan (Kelp Pill).
Goiter/Nodules Correspond to Five Zang Organs:
Old texts divide into five Goiters/Six Nodules; Xue Lizhai mentions only five Nodules. Goiter/Nodule are essentially one type, formed by phlegm/Qi knots, differing only in size/location. Lizhai says: Liver governs sinews, anger moves Liver fire, blood dryness/tendon contraction is Jin Liu (Sinew Nodule); Heart governs blood, labor moves fire, Yin fire boiling/external pathogen swelling is Xue Liu (Blood Nodule); Spleen governs flesh, depression injures Spleen, muscle thinning/external pathogen swelling is Rou Liu (Flesh Nodule); Lung governs Qi, labor damages Yuan Qi, loose pores/external pathogen swelling is Qi Liu (Qi Nodule); Kidney governs bones, labor injures Kidney Water, inability to nourish bones/swelling is Gu Liu (Bone Nodule). These are the five Nodules. Renzhai says: Visible sinews/vessels is Jin Ying (Sinew Goiter); red vessel network is Xue Ying (Blood Goiter); unchanged skin color is Rou Ying (Flesh Goiter); fluctuates with sorrow is Qi Ying (Qi Goiter); hard/immobile is Shi Ying (Stone Goiter). These are the five Goiters. Goiter/Nodule internally correspond to Five Zang, treatments are same.
Red Nodules Whole Body, Goiter Neck/Shoulder:
Reason for two names: Goiter resembles cherry, elongated, hanging loosely, wide skin. Caused by worry/resentment, also called Ying Qi (Shadow Bag), now called cyst. Nodule starts like plum/prune, tender/shiny skin, grows like pomegranate/gourd. Caused by seven emotions/labor/desire, compounded by external pathogen, generating phlegm/stasis, stopping with Qi flow, also called Liu. All are Qi/Blood stagnation knots. Worry/resentment damages Heart/Lung, so Goiter attaches to neck/shoulder; Labor/desire/pathogen exploits meridian deficiency, so Nodule occurs anywhere.
Painless/Itchless with Excess/Deficiency; Do Not Recklessly Scatter Hardness Move Qi:
Goiter/Nodule soft/hard, painless/itchless. Excess constitution: Haizao Sanjian Wan, Haitai Wan; Phlegm-fire excess: Shizhang San (Lick Palm Powder), Shenxiao Kaijie San (Divine Effective Unbind Scatter Powder). These scatter hardness/move Qi/resolve phlegm; chronic deficiency must not take recklessly. Deficiency types: Jin Liu, Shenqi Wan or Bawu Tang plus Zhizi, Mugua (Chaenomelis Fructus), Heilongdan Cao (Blackened Gentiana Root); Liver fire excess, occasionally Lushui Wan temporarily; Xue Liu, Siwu Tang plus Fuling, Yuanzhi (Polygalae Radix); Rou Liu, Guipi Tang (Restore Spleen Decoction), Buzhong Yiqi Tang; Qi Liu, Buzhong Yiqi Tang; Gu Liu, Shenqi Wan, Buzhong Yiqi Tang. General: Early stage, Shiliuwei Liuqi Yin (Sixteen-Ingredient Flowing Qi Drink), Dan Zhizhu Fang (Single Spider Formula); Later stage, Lafan Wan (Beeswax Alum Pill), long-term use shrinks/absorbs. External Nanxing Gao. Never lightly use needle/knife to break; rupture causes pus/blood collapse, endless leakage, certain death. However, Lip Liu (Fat Nodule) pink/red, purely phlegm knot, incise with sharp knife to remove fat powder for cure. Or eggplant-like hanging with small root, apply medicine to stalk, wait for fall, apply flesh-generating/healing medicine to prevent bleeding.