一人年十九，腰间肿一块，无头不痛色不变，三月不溃，饮食少思，肌肉日瘦。此气搏腠理，
荣卫不行，郁而为肿，名曰湿毒流注。《元戎》曰∶若人饮食疏精神衰，气血弱，肌肉消瘦，
荣卫之气短促而滞，故寒搏腠理闭郁为痈者，当补，以接虚怯之气。以十全大补汤加香附、
陈皮，三十剂，始针出白脓二碗许，仍用药，倍加参、 ，仍灸以豆豉饼，渐愈。彼惑于连效，
内服败毒，外贴凉药，反至食少脓清，患处色紫，复求治。喜得气冷衰，仍以前药加远志、
贝母、白敛，百剂而愈。此或久而不愈，或脓水清稀，当服内塞散及附子饼，然
后可愈。
一人年四十，患腰疼，服流气饮、寄生汤不应，以热手熨之少可，其脉沉弦，肾虚所致，
服补肾丸，愈。
一人年二十，遍身微痛，腰间作肿痛甚，以补中益气汤加羌活，四剂少可。又去羌活，
十余剂而愈。
一人臀痈，肿硬作痛，尺脉浮紧，按之无力。以内托羌活汤，一剂痛止，再以金银花散，四剂脓溃而愈。
一人臀痈，肿硬痛甚，隔蒜灸之，更服仙方活命饮，二剂痛止肿消。以托里消毒散加黄柏、
苍术、羌活，疮溃而愈。
一人臀痈，不作脓，饮食少思，先以六君子汤加芎、归、黄 ，饮食渐进；更以托里散，
脓溃而愈。
一人腿痈内溃，针之，脓出五碗许，恶寒畏食，脉诊如丝。此阳气微也。以四君子加炮
附子，畏寒少止，又四剂而安。以六君子加桂，数剂，饮食颇进，乃以十全大补，及灸附子饼，
两月愈。
一妇腿疽，久而不愈，疮口紫陷，脓水清稀，予谓为虚，彼不信，乃服攻毒之剂，虚证蜂
起，复求治。灸以附子饼，服十全大补汤，百贴而愈。
一人腿根近环跳穴痛彻骨，外皮如故，脉数带滑。此附骨疽，脓将成。用托里药六剂，
肿起作痛，脉滑数，脓已成，针之，脓出碗许，再加补剂，月余痊。
一人腿兼筋挛骨痛，脉弦紧，以大防风汤六剂，筋挛少愈，又二剂而肿消，但内一处
尚作痛，脉不弦紧。此寒邪已去，乃所滞瘀浊之物欲作脓，故痛不止。用托里药数剂，肿起脉
滑，乃脓已成，针之，用十全大补汤，月余而安。
一人右腿赤肿 痛，脉沉数，用当归拈痛汤，四肢反痛，乃湿热壅遏，又沉下部，药
力难达，非药不对证。遂砭患处，去毒血，仍用前药，一剂顿减，又四剂而消。
一人先腿痛，后又四肢皆痛，游走不定，至夜益甚，服除湿败毒之剂不应，脉滑
而数，湿痰浊血为患。以二陈汤加苍术、羌活、桃仁、红花、牛膝、草乌治之而愈。凡湿痰
湿热，或死血流注关节，非辛温之剂开发腠理，流通隧道，使气行血和，安能得愈？
一人腿痛，每痛则痰盛，或作嘈杂，脉滑而数。以二陈汤加升麻、二术、泽泻、
羌活、南星，治之而安。
一人素有香港脚，胁下作痛发热，头晕呕吐，腿痹不仁，服消毒护心等药不应。左关脉
紧，右关脉弦。此亦香港脚也。以半夏左经汤治之愈。
一人脚软肿痛，发热饮冷，大小便秘，右关脉数，乃足阳明经湿热下注也。以大黄左
经汤治之愈。
一人两腿肿痛，脉滑而缓，此湿所致。先以五苓散加苍术、黄柏，二剂少愈。再以二
陈、二术、槟榔、紫苏、羌活、独活、牛膝、黄柏而瘥。
一人肢节肿痛，脉细而数。此湿热之证。以荆防败毒散加麻黄，二剂痛减半，以槟榔败
毒散，四剂肿消，更以四物汤加二术、牛膝、木瓜，数剂而愈。
一妇两腿痛，脉涩而数。此血虚兼湿热。先以苍术、黄柏、知母、龙胆草、茯苓、防风、
防己、羌活数剂，肿痛渐愈。又以四物加二术、黄柏、牛膝、木瓜，月余而愈。
一妇患腿不能伸屈，遇风寒痛益甚，诸药不应，甚苦。先以活络丹一丸顿退，又服而瘳。
次年复痛，仍服一丸，亦退大半，更以独活寄生汤，四剂愈。
一妇腿痛兼足胫挛痛，服发散药愈甚，脉弦紧，此肾肝虚弱，风湿内侵也。治以独活
寄生汤，痛止，更以神应养真丹，而不挛矣。
一人腿痈脓成，针之出脓二碗许，以托里药一剂，大发热，更用圣愈汤二剂而止。
翌日恶寒不食，脉细如丝，以人参一两、熟附三片，姜枣煎服而愈，但少食不寐，更以内补黄
汤而平。
一人腿痛，发热恶寒，以补中益气汤治之。彼以为缓，自服芩、连等药，热愈甚。
治以人参养荣汤，二十
剂而溃，更以参、 、归、术、炙甘草、肉桂，月余敛。夫火之为病，当分虚实，芩、连苦寒，
能泄心肺有余之火。若先弱，或饮食劳倦而发者，此为不足，当治以甘温之剂，未尝有实热而
畏寒，虚热而喜寒者，此其验也。
一人年二十，腿膝肿痛，不能屈伸，服托里散不应，以人参败毒散加槟榔、木瓜、柴胡、
紫苏、苍术、黄柏而愈。
一人五十岁，两腿痛胀，或生 ，小便频而少，声如瓮出，服五皮散不应。诊右关沉缓，
此脾虚湿气流注而然也，非其疮。经曰∶诸湿肿满，皆属脾土。按之不起，皆属于湿。以五
苓散加木香，倍二术，亦不应。予意至阴之地，关节之间，湿气滞凝，且水性下流，脾气既虚，
安能运散？非辛温之药开通胰理，行经活血，邪气安能发散？遂以五积散二剂，病减半，更
以六君子加木香、升麻、柴胡、薏苡仁，两月而愈。设使前药不应，更投峻剂，虚虚之祸岂能
免乎！
一僧股内患肿一块，不痛不溃，以托里二十余剂，脓成，刺之作痛。凡肿而溃，溃而反
痛，此血气虚甚也，宜峻补之。彼云气无补法。予曰∶正气不足，不可不补，补之则气化而痛
自除。遂以参、 、归、术、熟地治之，两月而愈。
一人年逾四十，夏患附骨痈。予以火针刺去瘀血，更服托里药而愈。至秋忽不饮食，痰气
壅盛，劳即口舌生疮，服寒药腹痛，彼疑为疮。脾胃脉轻取似大，按之无力。此真气不足，
虚火炎上也，治以八味丸。彼不信，自服二陈、四物，几殆。复请治，仍以前丸而愈。
一老人年七十，三月间因寒湿地气得附骨疽，于左腿足少阳分微侵足阳明，阔六七寸，
长一尺，坚硬漫肿，肉色不变，皮泽深，但行步作痛，以指接至骨大痛。用内托黄 汤一服
立止，再服愈。
内托黄 汤
黄 当归（各三钱） 柴胡 鼠粘子 连翘（各一钱） 黄柏 肉桂 甘草（各五分） 升麻（七分）
上咀，水一盏，酒一盏，共煎一盏，空心温服。少时以早 压之，不令大热上攻，犯上中
二焦也。
一人环跳穴息附骨疽。彼谓小疮，服败毒药，外以寒药敷贴，因痛极针之，脓瘀血大泄，
方知为痈。其脉右关浮大，此胃气已伤，故疮口开张，肉紫下陷，扪之不热，彼谓疮内更觉
微冷，自谓必成漏矣。灸以豆豉饼，服六君子汤加藿香、砂仁、炮姜数剂，胃气渐醒，饮食渐
进，患处渐暖，肌肉渐生，再以十全大补汤而愈。
一人腿痛筋挛，遍身酸软。方士与痰药及托里药，期三日可愈，并不应。予谓∶非疮
毒也，大筋经短，小筋弛长，此湿热为患。以人参败毒散加苍术、黄柏、槟榔、木瓜，少愈；
更以清燥汤二十帖，愈。
A nineteen-year-old man had a swelling on his waist, without a head, painless, with unchanged skin color, which did not suppurate for three months. His appetite was poor, and his muscles wasted daily. This is Qi clashing in the Couli (interstices of skin and muscle), causing Ying and Wei (Nutritive and Defensive) Qi to fail to circulate, leading to stagnation and swelling, named "Damp-Toxin Flowing Accumulation" (Shidu Liuzhu). The *Yuanrong* states: If a person has sparse diet, depleted spirit, weak Qi and Blood, emaciated muscles, and short, stagnant Ying and Wei Qi, thus cold pathogens clash in the Couli, closing and stagnating to form an abscess, one should use tonification to replenish deficient and frail Qi. Using Shiquan Dabu Tang (Complete Ten Tonifying Decoction) added with Xiangfu (Cyperus Rhizome) and Chenpi (Tangerine Peel), taken for thirty doses, white pus of about two bowls was finally drained by needle. Medication continued with doubled Ren Shen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome), accompanied by moxibustion using Douchi Bing (Fermented Soybean Cake), leading to gradual recovery. Confused by the continuous efficacy, he took internal detoxifying drugs and applied cooling external plasters, which instead reduced his appetite, made the pus clear and thin, turned the affected area purple, and led him to seek treatment again. Fortunately, the Yang Qi was cold and declining; the previous prescription was used again, adding Yuanzhi (Polygala Root), Beimu (Fritillaria Bulb), and Bailian (Lily Bulb), taken for one hundred doses until cured. In cases where sores do not heal for a long time or the pus is clear and thin, Neisai San (Internal Blocking Powder) and moxibustion with Fuzi Bing (Aconite Cake) should be administered before healing can occur.
A forty-year-old man suffered from lower back pain. Liuyin Yin (Flowing Qi Drink) and Jisheng Tang (Viscum Decoction) were ineffective. Warm hand massage provided slight relief. The pulse was deep and wiry, indicating Kidney Deficiency. Taking Bushen Wan (Kidney Tonifying Pill) led to recovery.
A twenty-year-old man experienced mild pain all over his body, with severe swelling and pain in the waist. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Qianghuo (Notopterygium Rhizome) provided slight relief after four doses. After removing Qianghuo, taking it for another ten-plus doses led to recovery.
A patient with a buttock carbuncle presented with hard, painful swelling. The Chi (cun-guan-chi at wrist) pulse was floating and tight, but powerless upon pressure. One dose of Naituo Qianghuo Tang (Interior-Supporting Notopterygium Decoction) stopped the pain. Subsequently, Jinyinhua San (Honeysuckle Powder) was taken for four doses, leading to suppuration and recovery.
Another patient with a buttock carbuncle had severe hard swelling and pain. Garlic-separated moxibustion was applied, along with Xianfang Huoming Yin (Immortal Life-Saving Drink). Pain ceased and swelling subsided after two doses. Tuoli Xiaodu San (Interior-Supporting and Toxin-Expelling Powder) added with Huangbai (Phellodendron Bark), Cangzhu (Atractylodes Lancea Rhizome), and Qianghuo cured the ulcerated sore.
A patient with a buttock carbuncle failed to suppurate and had poor appetite. Liujunzi Tang (Six Gentlemen Decoction) added with Xiong (Ligusticum Rhizome), Danggui (Angelica Sinensis Root), and Huangqi (Astragalus Root) gradually improved appetite. Tuoli San (Interior-Supporting Powder) then facilitated suppuration and recovery.
A patient with an internal rupture of a leg abscess had approximately five bowls of pus drained by needle. He exhibited aversion to cold and food refusal, with a thread-like pulse. This indicated minute Yang Qi. Sijunzi Tang (Four Gentlemen Decoction) added with Paofuzi (Prepared Aconite Child) slightly alleviated the aversion to cold. Four more doses brought stability. Liujunzi Tang added with Rougui (Cinnamon Bark) taken for several doses significantly improved appetite. Finally, Shiquan Dabu Tang and moxibustion with Fuzi Bing were used, resulting in recovery after two months.
A woman with a chronic leg carbuncle had a purple, depressed wound with clear, thin pus. I diagnosed it as Deficiency, but she disbelieved and took attacking-toxin agents, causing deficiency syndromes to arise. She sought treatment again. Moxibustion with Fuzi Bing and Shiquan Dabu Tang taken for one hundred patches led to recovery.
A patient had bone-piercing pain near the Huantiao (GB30) acupoint at the root of the leg, with normal skin appearance. The pulse was rapid and slippery. This was Gujue (Bone Abscess), with pus forming. Six doses of interior-supporting medicine caused swelling and pain; the pulse became slippery and rapid, indicating pus formation. Needle drainage yielded about one bowl of pus. Additional tonic medication led to recovery in over a month.
A patient suffered from leg pain, tendon spasms, and bone pain with a wiry-tight pulse. Dafangfeng Tang (Great Wind-Expelling Decoction) taken for six doses slightly improved spasms. Two more doses reduced swelling. However, pain persisted in one internal area, though the pulse was no longer wiry-tight. The cold pathogen had left; the remaining pain was due to stagnant turbid matter attempting to suppurate. Several doses of interior-supporting medicine caused swelling and a slippery pulse, confirming pus formation. Needle drainage followed by Shiquan Dabu Tang led to recovery in over a month.
A patient with red, swollen, painful right leg had a deep-rapid pulse. Danggui Niangong Tong Tang (Angelica Relieving Pain Decoction) was used, but limb pain worsened. This was due to damp-heat obstruction sinking to the lower part, making medicinal power difficult to reach; it was not a mismatch of formula and syndrome. Phlebotomy (Bian) was performed on the affected area to release toxic blood. The previous formula was resumed, showing immediate reduction in one dose and resolution in four doses.
A patient initially had leg pain, then widespread wandering limb pain worsening at night. Dampness-expelling and toxin-clearing agents were ineffective. The pulse was slippery and rapid, indicating damp-phlegm and turbid blood pathology. Erchen Tang (Two-Aged Decoction) added with Cangzhu, Qianghuo, Taoren (Peach Kernel), Honghua (Safflower), Niuxi (Achyranthes Root), and Caowu (Aconitum Carmichaelii Lateral Root) cured the condition. For damp-phlegm, damp-heat, or dead blood flowing into joints, only acrid-warm agents can open the Couli, unblock meridians, promote Qi circulation and Blood harmony, ensuring recovery.
A patient with leg pain experienced increased phlegm or gastric discomfort during pain episodes. The pulse was slippery and rapid. Erchen Tang added with Shengma (Cimicifuga Rhizome), Ershu (Cangzhu and Baizhu), Zexie (Alisma Rhizome), Qianghuo, and Nanting (Pinellia Tuber) brought stability.
A patient with a history of Hongxiangjiao (Jamaican Foot/Popliteal Abscess) had hypochondriac pain, fever, dizziness, vomiting, and leg numbness. Xiaodu Huxin agents were ineffective. The Left Guan pulse was tight, and Right Guan was wiry. This was also Hongxiangjiao. Banxia Zuojing Tang (Pinellia Left Meridian Decoction) cured it.
A patient with soft, swollen, painful feet, fever, preference for cold drinks, and constipation had a rapid Right Guan pulse. This was damp-heat pouring down the Foot-Yangming Meridian. Dahuang Zuojing Tang (Rhubarb Left Meridian Decoction) cured it.
A patient with swollen, painful legs had a slippery-slow pulse, indicating dampness. Wuling San (Five-Ingredient Powder with Poria) added with Cangzhu and Huangbai provided slight relief in two doses. Erchen Tang, Ershu, Binglang (Areca Seed), Zisu (Perilla Leaf), Qianghuo, Duhuo (Angelica Pubescens Root), Niuxi, and Huangbai cured the condition.
A patient with joint swelling and pain had a fine-rapid pulse, indicating damp-heat. Jingfang Baidu San (Aster and Saposhnikovia Expelling Toxin Powder) added with Mahuang (Ephedra Stem) halved the pain in two doses. Binglang Baidu San reduced swelling in four doses. Siwu Tang (Four Substance Decoction) added with Ershu, Niuxi, and Mugua (Chaenomelis Fructus) cured it in several doses.
A woman with swollen, painful legs had a choppy-rapid pulse, indicating Blood Deficiency combined with damp-heat. Cangzhu, Huangbai, Zhimu (Anemarrhena Rhizome), Longdancao (Gentiana Root), Fuling (Poria), Fangfeng (Saposhnikovia Root), Fangji (Stephania Root), and Qianghuo taken for several doses gradually relieved swelling and pain. Siwu Tang added with Ershu, Huangbai, Niuxi, and Mugua cured it in over a month.
A woman unable to flex or extend her legs suffered worse pain with wind-cold exposure. Various medicines failed. Huoluo Dan (Meridian-Unblocking Pill) taken once provided immediate relief, and subsequent doses cured her. When pain recurred the next year, one pill reduced it by half. Duhuo Jisheng Tang (Angelica Pubescens and Viscum Decoction) taken for four doses cured it.
A woman with leg pain and calf spasms worsened with dispersing medicines. The pulse was wiry-tight, indicating Liver-Kidney Deficiency with internal invasion of wind-damp. Duhuo Jisheng Tang stopped the pain. Shenyang Zhenzhen Dan (Spirit-Nourishing True-Preserving Pill) resolved the spasms.
A patient with a suppurated leg abscess had two bowls of pus drained. One dose of interior-supporting medicine caused high fever. Shengyu Tang (Holy Salvation Decoction) taken for two doses stopped the fever. The next day, aversion to cold and anorexia appeared with a thread-like pulse. Ren Shen (Ginseng Root) 1 liang and Shufu (Prepared Aconite) 3 slices decocted with Ginger and Jujube cured him. Due to poor intake and insomnia, Neibu Huangqi Tang (Internal-Nourishing Astragalus Decoction) stabilized him.
A patient with leg pain, fever, and aversion to cold was treated with Buzhong Yiqi Tang. Finding it slow, he self-medicated with Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome), worsening the heat. Renshen Yangrong Tang (Ginseng Nourishing Harmony Decoction) was used. It suppurated after twenty doses. Ren Shen, Baizhu, Danggui, Zhigancao (Licorice Root), and Rougui healed it in over a month. Fire diseases must be differentiated as excess or deficiency. Huangqin and Huanglian are bitter-cold, clearing excess fire in Heart and Lung. If weakness exists or onset follows dietary/labor strain, it is deficiency, requiring sweet-warm agents. There is no case of excess heat with aversion to cold, or deficiency heat preferring cold; this validates the principle.
A twenty-year-old with swollen, painful knees unable to flex/extend recovered from Ren Shen Baidu San (Ginseng Expelling Toxin Powder) added with Binglang, Mugua, Chaihu (Bupleurum Root), Zisu, Cangzhu, and Huangbai after Tuoli San failed.
A fifty-year-old with swollen, painful legs, occasional sores, frequent scant urination, and resonant voice had an ineffective Wupi San (Five-Bark Powder). Right Guan pulse was deep-slow, indicating Spleen Deficiency with damp-flowing accumulation, not a sore. Classics state: All dampness, swelling, and fullness belong to Spleen Earth. Pressing indents indicate dampness. Wuling San added with Muxiang (Aucklandia Root) and doubled Ershu was ineffective. Considering the location (Yin region) and joint stagnation, plus water flowing downward and weak Spleen transport, acrid-warm agents were needed to open interstices and move blood. Wuji San (Five Accumulations Powder) halved the illness in two doses. Liujunzi Tang added with Muxiang, Shengma, Chaihu, and Yiyiren (Coix Seed) cured it in two months. Had harsher agents been used if the first failed, the disaster of "deficientizing the deficient" would have been unavoidable!
A monk had a painless, non-suppurating thigh swelling. Over twenty doses of interior-supporting medicine formed pus, causing pain upon puncture. Swelling that becomes painful after suppuration indicates extreme Qi and Blood deficiency, requiring strong tonification. He claimed Qi cannot be tonified. I replied: Insufficient Zheng Qi (Upright Qi) must be tonified; tonification promotes Qi transformation, eliminating pain. Ren Shen, Baizhu, Danggui, and Shudi (Rehmannia Root) cured it in two months.
A man over forty developed a Gujue (Bone Abscess) in summer. Fire-needle therapy removed stasis, followed by interior-supporting medicine, leading to recovery. In autumn, he lost appetite, had phlegm-Qi congestion, mouth ulcers upon exertion, and abdominal pain from cold herbs. Suspecting sore toxicity, his Spleen-Stomach pulse was superficially large but powerless deeply. This was Zhen Qi (True Qi) deficiency with deflected deficiency fire. Bawei Wan (Eight-Ingredient Pill) was prescribed. Disbelieving, he took Erchen Tang and Siwu Tang, nearly dying. Upon re-consultation, the same pill cured him.
A seventy-year-old elder contracted Gujue in March due to cold-damp Qi, affecting the left leg's Shaoyang meridian slightly invading Yangming. The area was 6-7 cun wide, 1 chi long, hard, diffusely swollen, with unchanged flesh color but dark skin. Walking caused pain, and pressing to the bone caused severe pain. Neituo Huangqi Tang (Interior-Supporting Astragalus Decoction) stopped pain immediately after one dose and cured it upon repetition.
Neituo Huangqi Tang
Huangqi (Astragalus Root), Danggui (Angelica Sinensis Root) [3 qian each]; Chaihu (Bupleurum Root), Shi Niu Zi (Arctium Fruit), Lianqiao (Forsythia Fruit) [1 qian each]; Huangbai (Phellodendron Bark), Rougui (Cinnamon Bark), Gancao (Licorice Root) [0.5 qian each]; Shengma (Cimicifuga Rhizome) [0.7 qian].
Chop ingredients. Decoct with one cup water and one cup wine to yield one cup. Take warm on an empty stomach. Shortly after, eat morning rice to prevent excessive heat from ascending and damaging the Upper and Middle Jiao.
A patient with Gujue at Huantiao (GB30) considered it a minor sore, took detoxifying agents, and applied cold plasters. Severe pain led to needle drainage, releasing large amounts of pus and stasis, revealing the abscess. Right Guan pulse was floating-large, indicating damaged Stomach Qi. The wound opened, flesh was purple and depressed, cool to touch. The patient felt internal cold, fearing a fistula. Moxibustion with Douchi Bing and Liujunzi Tang added with Huoxiang (Patchouli Herb), Sharen (Amomum Fruit), and Paojiang (Prepared Ginger) revived Stomach Qi, improved appetite, warmed the site, and regenerated flesh. Shiquan Dabu Tang completed the cure.
A patient with leg pain, tendon spasms, and body soreness was given phlegm-resolving and interior-supporting medicines by a practitioner expecting recovery in three days, with no effect. I stated: This is not sore toxicity. Large tendons shorten, small tendons lengthen; this is damp-heat pathology. Ren Shen Baidu San added with Cangzhu, Huangbai, Binglang, and Mugua provided slight relief. Qingzao Tang (Clear-Dryness Decoction) taken for twenty doses cured it.