【方歌】石疽生于颈项旁，坚硬如石色照常，肝郁凝结于经络，
溃后法根据瘰历疮。
【注】此疽生于颈项两旁，形如桃李，皮色如常，坚硬如石，
〔兴〕痛不热，由肝经郁结，以致气血凝滞经络而成。
此证初小渐大，难消难溃，即溃难敛，疲顽之证也。初
起气实者，宜服舒肝溃坚汤；气虚者，宜服香贝养荣汤
，外用葱白、蜂蜜捣泥敷贴。日久不消者，以阳燧锭每
日灸之，以或消、或软、或将溃为度。既溃法同瘰历。
方剂：香贝养荣汤
组成：白术（土炒，二钱） 人参
茯苓 陈皮
熟地黄 川芎
当归 贝母（去心）
香附（酒炒） 白芍（酒炒，各一钱）
桔梗 甘草（各五钱）
姜三片，枣二枚，水二钟，煎八分，食远服。
胸膈痞闷，加枳壳、木香。饮食不甘，加厚朴、苍
术，寒热往来，加柴胡、地骨皮。脓溃作疡，倍人参、
当归、白术，加黄耆。脓多或清，倍当归、川芎。胁下
痛或痞，加青皮、木香。肌肉生迟，加白蔹、肉桂。痰
多，加半夏、橘红。口干，加麦冬、五味子。发热，加
柴胡；黄芩。渴不止，加知母、小豆。溃后反痛，加熟
附子、沈香。脓不止，倍人参、当归，加黄耆。虚烦不
眠，倍人参、熟地，加远志、枣仁。
【方歌】香贝养荣用四君，四物贝桔香附陈，气血两虚宜多服，
筋瘰石疽效如神。
又方：阳燧锭（见首卷烙法）
舒肝溃坚汤失荣证（见瘰历门）
[Prescription Verse] Shiju (Stone Scrofula) arises on the side of the neck and nape, hard as stone with normal skin color; Liver Qi stagnation condenses in the meridians, after ulceration follow the method for Luoli (Scrofula).
Shiju (Stone Scrofula) develops on the sides of the neck. The mass is hard as stone, yet the skin color remains normal. This condition results from Liver Qi stagnation causing condensation of Qi and Blood within the meridians. After ulceration, the treatment principles should follow those used for Luoli (Scrofula).
[Annotation] This ju (carbuncle/ulcer) arises on both sides of the neck, shaped like peaches or plums, with normal skin color, hard as stone. [Xing] It is painful but not hot, caused by stagnation in the Liver Meridian, leading to stagnation of Qi and Blood in the meridians.
This type of ulcer occurs on both sides of the neck. Its shape resembles a peach or plum, the skin color is unchanged, and it feels hard as stone. [Xing] It presents with pain but no heat sensation. It is caused by stagnation in the Liver Meridian, resulting in the stagnation of Qi and Blood within the meridians.
This syndrome starts small and gradually enlarges; it is difficult to resolve and difficult to ulcerate. Even if it ulcerates, it is difficult to heal. It is a stubborn and refractory condition.
The lesion begins small and gradually increases in size. It is resistant to resolution and difficult to suppurate. Even upon suppuration, healing is difficult. It constitutes a stubborn and intractable disease.
In the early stage, if the patient has excess Qi (robust constitution), Shugan Kuijian Tang (Liver-Soothing and Hardness-Resolving Decoction) is appropriate; if the patient has deficient Qi (weak constitution), Xiangbei Yangrong Tang (Fragrant Fritillaria Nourishing Nutrient Decoction) is appropriate. Externally, apply a paste made from scallion white and honey.
For patients presenting with excess Qi at the onset, Shugan Kuijian Tang is indicated. For patients with deficient Qi, Xiangbei Yangrong Tang is indicated. Externally, a paste prepared from Allii Fistulosi Bulbus (scallion white) and Honey should be applied.
If it does not resolve after a long time, moxa cautery using Yangsui Ding (Yangfire Moxibustion Plug) should be performed daily until the mass resolves, softens, or is about to ulcerate.
If the mass persists without resolving over a long period, daily moxibustion using Yangsui Ding should be administered until the mass disappears, becomes soft, or approaches ulceration.
Once ulcerated, the method is the same as for Luoli.
After ulceration, the treatment follows the same protocol as for Luoli (Scrofula).
Formula: Xiangbei Yangrong Tang
Composition: Baizhu (Earth-fried, 2 qian), Renshen, Fuling, Chenpi, Shudihuang, Chuanxiong, Danggui, Beimu (heart removed), Xiangfu (Wine-fried), Baishao (Wine-fried, each 1 qian), Jiegeng, Gancao (each 5 qian). Add three slices of Shengjiang (Ginger) and two dates (Zao). Boil in two zhong (bowls) of water until eight-tenths remain. Take well after meals.
Formula Name: Xiangbei Yangrong Tang (Fragrant Fritillaria Nourishing Nutrient Decoction)
Ingredients: Atractylodis Macrocephalae Rhizoma (Baizhu, stir-fried with soil, 2 qian), Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), Citri Reticulatae Pericarpium (Chenpi), Rehmanniae Radix Praeparata (Shudihuang), Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Fritillariae Thunbergii Bulbus (Beimu, remove heart), Cyperi Rhizoma (Xiangfu, wine-fried), Paeoniae Radix Alba (Baishao, wine-fried, each 1 qian), Platycodonis Radix (Jiegeng), Glycyrrhizae Radix et Rhizoma (Gancao, each 5 qian). Decoct with three slices of Zingiberis Rhizoma Recens (Shengjiang) and two Fructus Jujubae (Zao) in two bowls of water until reduced to 80%. Administer well after meals.
Add Zhike and Muxiang for chest and diaphragm fullness and oppression.
For sensations of fullness and oppression in the chest and diaphragm, add Aurantii Fructus Immaturus (Zhike) and Aquilariae Lignum Resinatum (Muxiang).
Add Houpo and Cangzhu for poor appetite; add Chaihu and Digupi for alternating chills and fever.
For poor appetite, add Magnoliae Officinalis Cortex (Houpo) and Atractylodis Rhizoma (Cangzhu). For alternating chills and fever, add Bupleuri Radix (Chaihu) and Lycii Cortex (Digupi).
When pus ulcerates into a sore, double the dosage of Renshen, Danggui, and Baizhu, and add Huangqi.
When the pus discharges forming an ulcer, double the dosages of Ginseng Radix et Rhizoma (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizoma (Baizhu), and add Astragali Radix (Huangqi).
If there is excessive or thin pus, double the dosage of Danggui and Chuanxiong.
If the discharge is abundant or thin, double the dosages of Angelicae Sinensis Radix (Danggui) and Chuanxiong Rhizoma (Chuanxiong).
Add Qingpi and Muxiang for pain or fullness under the ribs.
For pain or fullness in the hypochondriac region, add Citri Reticulatae Pericarpium Viride (Qingpi) and Aquilariae Lignum Resinatum (Muxiang).
Add Bailian and Rougui for delayed muscle regeneration.
For slow granulation tissue formation, add Ampelopsis Radix (Bailian) and Cinnamomi Cortex (Rougui).
Add Banxia and Juhong for excessive phlegm.
For excessive phlegm, add Pinelliae Tuber (Banxia) and Citri Reticulatae Pericarpium (Juhong).
Add Maidong and Wuweizi for dry mouth.
For dry mouth, add Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi).
Add Chaihu and Huangqin for fever.
For fever, add Bupleuri Radix (Chaihu) and Scutellariae Radix (Huangqin).
Add Zhimu and Xiaodou for unquenchable thirst.
For persistent thirst, add Anemarrhenae Rhizoma (Zhimu) and Phaseoli Semen (Xiaodou, typically referring to Vigna angularis or Phaseolus calcaratus).
Add Shufuzi and Chenxiang for pain after ulceration.
For pain occurring after ulceration, add Aconiti Lateralis Radix Praeparata (Shufuzi) and Aquilariae Lignum Resinatum (Chenxiang).
If pus continues to drain, double Renshen and Danggui, and add Huangqi.
If drainage persists, double the dosages of Ginseng Radix et Rhizoma (Renshen) and Angelicae Sinensis Radix (Danggui), and add Astragali Radix (Huangqi).
Double Renshen and Shudi, and add Yuanzhi and Zaoren for deficiency irritability and insomnia.
For restlessness due to deficiency and insomnia, double the dosages of Ginseng Radix et Rhizoma (Renshen) and Rehmanniae Radix Praeparata (Shudi), and add Polygalae Radix (Yuanzhi) and Ziziphi Spinosae Semen (Zaoren).
[Verse] Xiangbei Yangrong uses Sijunzi, combined with Siwu, Beimu, Jiegeng, Xiangfu, and Chenpi; suitable for dual deficiency of Qi and Blood, effective as magic for Jinluo and Shiju.
[Verse] Xiangbei Yangrong Tang incorporates the Sijunzi Tang (Four Gentlemen Decoction) and Siwu Tang (Four Substances Decoction), along with Beimu, Jiegeng, Xiangfu, and Chenpi. It is suitable for conditions of dual deficiency of Qi and Blood and is efficacious for Jinluo (Tendon Scrofula) and Shiju (Stone Scrofula).
Another Formula: Yangsui Ding (See First Volume, Moxibustion/Lau Fa)
Alternative Formula: Yangsui Ding (Refer to the First Volume regarding Lau Fa/Moxibustion techniques).
Shugan Kuijian Tang and Shirong Syndrome (See Luoli Section)
Shugan Kuijian Tang and Shirong Syndrome (Refer to the Luoli Section).