立斋治容台张美之。善怒。患瘰 。时孟春。或以为肝经有余之证。用克伐之剂。不愈
薛以为肝血不足。用六味地黄、补中益气。以滋化源。至季冬而愈。此证果属肝火风热。
亦因肝血不足。若主伐肝。则脾土先伤。木反克土。此证或延于胁腋。或患于胸乳。皆肝胆
三焦之经也。亦当以前法治之。
一儒者缺盆间结一核。薛谓此肝火。血燥筋挛。法当滋肾水。生肝血。彼反服行气化痰
外敷南星、商陆之类。渐如覆碗。仍用前药以滋化源。间与芦荟丸以清肝火。年余。元气
复而肿消。
一男子颈间结核大溃。年余不愈。又一男子。鬓间一核。初如豆粒。二年渐大如桃。又
一
妇人。左眉及发际。结核年余矣。皆与清肝火。养肝血。益元气而并愈。此证亦有大如升斗
者。治以前药。无不取效。
一妇人项结核。寒热头痛。胁乳胀痛。内热口苦。小便频数。证属肝火血虚。用四物加
柴胡、山栀、胆草而愈。又用加味逍遥散而安。
一妇瘰 后。遍身作痒。脉大。按之虚。以十全大补加香附治之而愈。大凡溃后。午前
痒作气虚。午后痒作血虚。若作风证治之。必死。
江应宿治休宁吴氏子。年十七。患瘰 三年矣。疡医用烂药刀砭破取。疮口甫平。即复
肿。累累如贯珠。遍体疮疥。两胁肿核如桃。江诊之。微弦而数。即语之曰。肝肾虚热。则
生矣。当从本。治内消。以柴胡、当归、连翘、黄芩、黄连、牛蒡、三棱、桔梗、花粉、
红花十余剂。再与黄连、海藻、昆布、干葛、石膏、山栀、龙胆、连翘、花粉为丸。以清其
上。更令空心服六味地黄丸。以滋化源。未尽一料。 消疮愈。不复作矣。
杨乘六治下昂俞文遇患瘰 。左右大小十余枚。坚硬如石。颈项肿大。不能转侧。兼吐
血咳嗽梦遗泄精等证。服药半年。皆滋阴泻火。固精伐肝之剂。遂致痰咳不绝。梦泄不止。
竟成弱证。邀杨视之。见其性情慷慨。有豪爽气。且操心精细。多思虑。刚果躁直。知其致
病之原。由于肝胆用事。恼怒居多。以致肝胆先病。而延及心脾者也。其痰咳不绝者。肝气
虚逆。痰随气上也。梦泄不止者。肝经气血亏损。疏泄失职也。瘰 肿大。坚硬不能消散者
肝经气血虚滞。郁结不舒也。诊其脉。弦劲中兼见躁动。而左手关尺独紧细如刀。口舌青
色。嫩而胖且滑。乃以养营汤倍肉桂主之。服至月余。内外各证。俱有痊意。遂以前方作丸
佐归脾养心两方。随证消息。守服三月。诸证悉除。而左右瘰 俱消。
Xue Lizhai treated Zhang Meizhi, a court official (Rongtai), who had a irritable temper and suffered from scrofula (tuberculous lymphadenitis of the neck). At that time, it was early spring (Mengchun). Some physicians considered it a syndrome of excess in the Liver channel and prescribed purgative or attacking agents, but the condition did not improve.
Xue Lizhai believed it was due to insufficiency of Liver blood. He used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source of transformation and transportation (the Spleen and Stomach). By late winter (Jidong), the patient recovered. Although this case might indeed involve Liver fire and wind-heat, it is fundamentally caused by insufficient Liver blood. If one primarily uses methods to attack the Liver, the Earth (Spleen) will be injured first, leading to Wood (Liver) overacting on Earth (Spleen). This condition may spread to the hypochondrium and axilla, or occur in the chest and breasts, all of which are pathways of the Liver-Gallbladder and Sanjiao channels. Such cases should also be treated with the aforementioned methods.
A scholar had a nodule formed in the supraclavicular fossa. Xue stated this was due to Liver fire causing dryness of blood and contraction of sinews. The treatment principle should be to nourish Kidney water and generate Liver blood. However, the patient instead took qi-moving and phlegm-resolving herbs, along with external applications of Arisaema Rhizome (Tian Nanxing) and Mercurialis Herb (Shanglu). Gradually, the swelling became as large as an inverted bowl. Subsequently, the previous formulas were used again to nourish the source of transformation, interspersed with Lulu Wan (Aloe Pill) to clear Liver fire. After more than a year, the primordial qi recovered, and the swelling subsided.
One man had a large, ulcerated tubercle in the neck that failed to heal for over a year. Another man had a nodule behind his ear; initially bean-sized, it gradually enlarged to the size of a peach over two years. A woman had tubercles above her left eyebrow and hairline for over a year. All these cases were cured simultaneously by clearing Liver fire, nourishing Liver blood, and benefiting primordial qi. Even cases where the nodules were as large as a sheng or dou measure were effectively treated with the aforementioned formulas.
A woman presented with cervical tubercles accompanied by alternating chills and fever, headache, distending pain in the hypochondrium and breasts, internal heat, bitter taste in the mouth, and frequent urination. The syndrome was identified as Liver fire with blood deficiency. She was treated with Siwu Tang (Four-Substance Decoction) added with Bupleurum Root (Chaihu), Gardenia Fruit (Shanzhi), and Gentiana Root (Dancao), resulting in recovery. She was then stabilized using Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).
After the rupture of scrofula, a woman experienced generalized pruritus. Her pulse was large but empty upon deep pressure. She was cured using Shiquan Dabu Tang (Ten-Increment Great Tonifying Decoction) added with Cyperus Rhizome (Xiangfu). Generally, after ulceration, pruritus occurring in the forenoon indicates Qi deficiency, while pruritus in the afternoon indicates Blood deficiency. If treated as a Wind syndrome, death would likely ensue.
Jiang Yingsu treated the son of the Wu family from Xiuning, aged seventeen, who had suffered from scrofula for three years. A surgeon had used caustic medicines or knife-lancets to drain the abscesses. As soon as the wounds healed, they swelled up again, appearing like strings of beads, with widespread skin sores and nodules in both hypochondria as large as peaches. Jiang diagnosed the pulse as slightly wiry and rapid. He told the patient: "Deficient heat in the Liver and Kidneys gives rise to this condition." Treatment should address the root cause to resolve the nodules internally. He prescribed ten doses of a decoction containing Bupleurum Root (Chaihu), Angelica Sinensis Radix (Danggui), Forsythia Fruit (Lianqiao), Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Burdock Fruit (Niubangzi), Sparganium Tuber (Sanleng), Platycodon Root (Jiegeng), Ophiopogon Tuber (Huafen), and Safflower Seed (Honghua). He then prepared pills with Coptis Rhizome (Huanglian), Sargassum Thallus (Haizao), Kelp (Kunbu), Kudzu Root (Gegen), Gypsum Fibrosum (Shigao), Gardenia Fruit (Shanzhi), Gentiana Root (Longdan), Forsythia Fruit (Lianqiao), and Ophiopogon Tuber (Huafen) to clear heat from the upper jiao. Additionally, he instructed him to take Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) on an empty stomach to nourish the source of transformation. Before finishing one supply of medicine, the scrofula resolved, the sores healed, and there was no recurrence.
Yang Chengliu treated Yu Wen'yu from Xiayang, who suffered from scrofula. There were more than ten nodules of varying sizes on both sides, hard as stones, with significant swelling of the neck and difficulty turning the head. He also exhibited symptoms of hematemesis, cough, nocturnal emission, and spermatorrhea. For half a year, he had taken medications for nourishing Yin, purging fire, securing essence, and suppressing the Liver. Consequently, he developed persistent phlegm-cough, continuous nocturnal emissions, and ultimately fell into a state of severe debility. Yang was invited to consult. Observing his generous temperament and bold demeanor, yet noting his meticulous nature, excessive worry, and impulsive, straightforward character, Yang deduced the etiology: the disease originated from dysfunction of the Liver and Gallbladder due to frequent anger, subsequently affecting the Heart and Spleen. The persistent phlegm-cough was attributed to deficient Liver Qi rebelling upward, carrying phlegm with it. The continuous nocturnal emissions resulted from deficiency and loss of Liver blood and Qi, impairing the function of dispersion and excretion. The large, hard, indissoluble scrofula nodules were due to deficiency and stagnation of Liver blood and Qi, with constrained depression. His pulse was wiry and forceful with restlessness, particularly tight and thin like a blade in the Guan and Chi positions on the left hand. His tongue was bluish-green, tender, swollen, and slippery. Yang prescribed Yangying Tang (Nourishing Camp Decoction) with doubled Cassia Twig (Rougui) as the main formula. After more than a month of intake, all internal and external symptoms showed signs of resolution. He then converted the formula into pills, supplemented with Guipi Tang (Restore the Spleen Decoction) and Yangxin Tang (Nourish the Heart Decoction), adjusting according to symptoms. After adhering to this regimen for three months, all symptoms disappeared, and the bilateral scrofula nodules completely resolved.