证
夫瘰 者，颈腋之间而生结核也。或在耳后，连及颐颔，下至缺盆（在锁字骨陷中），皆为瘰 ，手
少阳三焦经主之；或在胸及胸之侧，皆为马刀疮，足少阳胆经主之。二经多气少血，其初生如豆
粒，或如梅李，累累相连，历历三五杖，久久不消，渐渐长大，按之
则动而微痛。不憎寒壮热，惟午后微有热，或夜间口干，饮食少思，四肢倦怠，是以坚而不能溃，溃而不
能合。有风毒者，得之于风；热毒者，得之于热；气毒者，得之于气，乃风热邪气蕴结而成，皆由气血不足，
往往变为劳者。经云∶此不系膏粱丹石之变，因虚劳气郁所致。宜补形气，调经脉，则未成者自消，已成者自
溃。若不详经络血气多少，脉证受病之异，卒用牵牛、斑蝥，及流气饮、十宣散等，则血气已损，而实实虚
虚之祸，如搐诸掌。
治
治当以益气养荣汤主之。
方
益气养荣汤〔批〕（按此方治瘰 半攻半补之剂） 治怀抱抑郁，瘰 流
注，或四肢患肿，肉色不变，或日晡发热，或溃而不敛。
黄 （蜜炙） 当归（酒洗） 人参 白术（炒，各一钱半） 川芎 白芍（酒洗
）生地黄 陈皮 香附 贝母（各一钱） 地骨皮 柴胡 桔梗（炒） 甘草（炙，各五分）
上锉一剂，水煎，食远服。如有痰，加橘红。刺痛，加青皮或木香。午后有热，或头微眩，加酒炒
黄柏。脓水清，倍参、 、归。女人有郁气，胸膈不利，倍香附、贝母。月经不调，加丹皮、当归、红花。
散肿溃坚汤
治马刀疮，结硬如石，或在耳下，至缺盆中，或至肩上，或于胁下，皆手足少阳经中。及瘰 遍于颏，
或至颊车，坚而不溃，在足阳明经所出。或二疮已破，乃流脓水，并治，及生瘿瘤，大如升，久不溃者。
升麻（六分） 葛根（二钱） 白芍药（二钱） 当归尾（五分） 连翘（三钱）
黄连（二钱） 桔梗（五钱） 黄芩梢（酒洗，一钱半） 黄柏（酒炒，五钱）
贝母（酒炒，五钱） 昆布（洗，五钱） 龙胆草（酒洗，四钱） 海藻（酒炒，五钱）
三棱（酒炒，三钱） 莪术（酒炒，三钱） 天花粉（酒浸，五钱） 甘草（炙，五分）
白芍（二钱） 归尾（五分）
上锉，每一两，用水二钟，先浸半日，煎至一钟，去渣，热服。于卧处伸足在高处，头微低，每噙一口，
作十次咽。至服毕，根据常安卧，取药在胸中停蓄也。另攒半料，作细末，炼蜜为丸，如
绿豆大。每服百丸，或一百五十丸，此药汤留一口送下。
内消散（任中嵩传）
治瘰 ，宜先用益气养荣汤数十服，后服此方。
朱砂（一钱） 血竭（一钱） 斑蝥（去翅足，三分，生用）
上为细末，每服一分，空心烧酒调服。未破者，三、五日立消；已破者，内服此药，外用金头蜈蚣一
条，研极细末，用麻油一小钟，浸二旦夕，搽患处，其疮即肿溃。过一、二日肿消，可贴膏药，疮
势大者二十日痊，小者十余日平复。
天花散（京师传）〔批〕（按此方治瘰 专攻之剂） 治瘰 溃烂疼痛。
天花粉（一钱半） 白芷（一钱） 乳香（二分） 没药（五分） 赤芍药（一钱七分）
贝母（七分） 归尾（一钱） 金银花（三钱） 穿山甲（炒黄色，一钱二分）
上锉一剂，好酒一钟半，煎服，忌鲜鱼鸡羊等毒物。
乌龙膏（周排山传） 治瘰 溃烂，久不愈者。
木鳖子（带壳烧存性，去壳） 侧柏叶（焙） 人中血（即发烧灰） 青龙背（即旧锅上垢腻）
纸钱灰 飞罗面（各一钱）
上为末，用好醋调成膏涂疮上，外用纸贴效。
代灸散 治瘰 溃烂，臭不可闻，久不能愈。
官粉（一钱） 雄黄（一钱） 银朱（一钱） 麝香（二分）
上为细末，用槐皮一片，将针密密刺孔，置疮上。
上糁药一撮，以炭火炙热，其药气自然透入疮中，痛热为止。甚者换三次，轻者二次痊愈。
紫云膏 治瘰 及一切顽疮溃烂久不愈，并杖疮、 疮、小儿头疮并效。
黄蜡（一两） 松香（五钱） 黄丹（三钱） 香油（四两）
上四味，共入铁锅内，用柳条去皮搅之，文武火熬至半炷香尽为度。摊油纸贴之，或搽涂患处。
地龙膏（李养斋传） 治瘰 未破者，贴之立消。
雄黄 地龙粪 小麦面
各等分，研末，醋调涂之。
丹青散 治瘰 已破者，搽上即愈。
银朱（一钱） 铜青（一钱） 松香（五分）
研末，有水，干敷之，如干，灯油调搽。
瘰 妙方（刘前冈传）
用荞麦面捻作圈，围住疮上，用黄酒糟压干撒在疮上，用麝香
入艾槌烂，铺糟上，火烧艾，过则再换，以疮内水干为度，后贴膏药。
官粉（一两半） 乳香（二钱） 没药（二钱半） 孩儿茶（二钱半） 蛤粉（五钱）
龙骨（二钱半） 蜂房（二个） 密陀僧（二钱半） 血竭（二钱） 蓖麻子（去壳，一百二十个）
上研为细末，用香油四两熬黑色，后将各药放在油内，熬数沸，用瓦盆盛水，将药锅坐在上，
出火毒，纸摊贴患处如神。忌食鸡、鹅、羊肉、鸭蛋、鲜鱼、辛辣炙爆等物。
老君丹（黄宾江传） 治瘰 并痰核结硬。
老君须（四分） 紫背天葵（三钱） 乳香（三钱） 没药 红曲 防风
红花（各三钱） 栀子（五分） 当归（八分） 川芎（四分） 草果仁（一钱） 血竭（五分）
孩儿茶（五分） 土茯苓（五分） 金银花（五分） 白芥子（五分）
上共捣粗末，先用独蒜一个，顺擂烂，入好酒一碗，滤去渣，
入药于内，重汤煮一时。食后，临卧服三剂，全消，妙不可言。
天葵子丸（黄宾江传） 治瘰 。
紫背天葵（一两半） 海藻（一两） 海带（一两） 昆布（一两） 贝母（各一两） 桔梗（
一两） 海螵蛸（五钱）
上为细末，酒糊为丸如梧桐子大。每七十丸。此方用桔梗开提
诸气。贝母以消毒化痰，海藻、昆布以软坚核，治瘰 之圣药也。
[Symptoms]
Luo Li (Scrofula, lymph node tuberculosis) refers to nodular masses growing between the neck and axilla. If located behind the ears, extending to the cheeks and mandible, and downward to Quepen (the depression above the clavicle), these are governed by the Hand-Shaoyang Sanjiao Meridian; if located on the chest or its sides, this is called Madao Chuang (Marine Knife Sores), governed by the Foot-Shaoyang Gallbladder Meridian. These two meridians are characterized by abundant Qi and scarce Blood. Initially, Luo Li appears like a bean or a plum/prune, linked in clusters, clearly visible. After a long time without resolving, it gradually enlarges. Palpation reveals mobility and slight pain. The patient experiences no aversion to cold or high fever, only slight heat in the afternoon, or dry mouth at night, poor appetite, and fatigue in the four limbs. Consequently, the mass remains hard and fails to suppurate; even if it suppurates, it fails to heal. If caused by Wind-Toxin, it results from contracting Wind pathogen; if by Heat-Toxin, from Heat pathogen; if by Qi-Toxin, from Qi stagnation. This arises from the accumulation of Wind-Heat pathogens due to deficiency of Qi and Blood, often evolving into Lao Bing (Consumption/Chronic Deficiency Syndrome). The Classics state: "This is not a change caused by rich food or cinnabar/stone pills, but due to Consumption and Qi Stagnation." Treatment should tonify the body's Qi and regulate the meridians, so that unformed nodules will naturally dissipate and formed ones will naturally suppurate. If one does not carefully distinguish the abundance or scarcity of Qi and Blood in the meridians and the differences in pulse and symptoms, and suddenly uses harsh purgatives like Qian Niu Zi (Pharbitis Seed) or Ban Mao (Mustard Beetle), or formulas like Liuqi Yin and Shixuan San, it will damage Qi and Blood, leading to the disaster of "reinforcing excess and depleting deficiency" (making excess conditions more excessive and deficiency conditions more deficient), a mistake as obvious as looking at one's palm.
[Treatment Principle]
Treatment should primarily use Yiqi Yangrong Tang (Qi-Tonifying and Blood-Nourishing Decoction).
[Formulas]
Yiqi Yangrong Tang [Commentary] (Note: This formula is a semi-purgative, semi-tonic agent for treating Luo Li.) It treats depression of mind, flowing Luo Li, swelling of the four limbs with unchanged skin color, evening tidal fever, or ulcers that fail to close.
Huangqi (Honey-fried) Danggui (Wine-rinsed) Renshen Baizhu (Stir-fried, each 1.5 qian) Chuanxiong Baishao (Wine-rinsed) Shengdihuang Chenpi Xiangfu Beimu (each 1 qian) Digupi Chaihu Jiegeng (Stir-fried) Gancao (Honey-fried, each 0.5 qian)
Decoct one dose in water and take it well after meals. If there is phlegm, add Juhong. If there is stabbing pain, add Qingpi or Muxiang. If there is afternoon fever or slight dizziness, add Jiuchao Huangbai (Wine-stir-fried Phellodendron Bark). If pus is clear/thin, double the dosage of Renshen, Huangqi, and Danggui. For women with Qi stagnation and chest oppression, double Xiangfu and Beimu. For irregular menstruation, add Danpi, Danggui, and Honghua.
Sanzhong Kuijian Tang
Treats Madao Chuang, where knots are hard as stone, located below the ear to Quepen, or to the shoulder, or under the ribs, all within the Foot and Hand Shaoyang meridians. Also treats Luo Li spreading over the chin or to Jiache point, hard and non-suppurating, in the Foot-Yangming meridian. Or when two sores have broken and discharged pus, it treats both, as well as Yingliu (Goiter) large as a sheng vessel that has not ulcerated for a long time.
Shengma (6 fen) Gegen (2 qian) Baishao Yao (2 qian) Dangguiwei (5 fen) Lianqiao (3 qian)
Huanglian (2 qian) Jiegeng (5 qian) Huangqinshao (Wine-rinsed, 1.5 qian) Huangbai (Wine-stir-fried, 5 qian)
Beimu (Wine-stir-fried, 5 qian) Kunbu (Washed, 5 qian) Longdancao (Wine-rinsed, 4 qian) Haizao (Wine-stir-fried, 5 qian)
Sanleng (Wine-stir-fried, 3 qian) Ezhu (Wine-stir-fried, 3 qian) Tianhuafen (Wine-soaked, 5 qian) Gancao (Honey-fried, 5 fen)
Baishao (2 qian) Guiwei (5 fen)
Decoct 1 liang of the mixture in 2 zhong of water. Soak for half a day, boil down to 1 zhong, strain, and take hot. While lying down, elevate the feet and lower the head slightly. Hold one mouthful of the decoction in the mouth and swallow in ten portions. After finishing, lie down normally to allow the medicine to accumulate in the chest. Prepare half the dosage as fine powder, mix with refined honey to make pills the size of mung beans. Take 100 or 150 pills per dose, washed down with a mouthful of the decoction.
Neixiaosan (Transmitted by Ren Zhongsong)
For treating Luo Li, first administer dozens of doses of Yiqi Yangrong Tang, then take this formula.
Zhusha (1 qian) Xuexie (1 qian) Banmao (Remove wings and feet, 3 fen, raw)
Grind into fine powder. Take 1 fen per dose, mixed with roasted wine on an empty stomach. For unbroken cases, they will dissipate immediately in 3-5 days; for broken cases, take internally and externally apply a gold-headed centipede ground to fine powder, soaked in sesame oil for two nights/days, applied to the lesion, causing swelling and suppuration. After 1-2 days when swelling subsides, apply plaster. Large sores heal in 20 days, small ones in over 10 days.
Tianhua San (Transmitted in the Capital) [Commentary] (Note: This formula is a purely purgative agent for Luo Li.) Treats ulcerated and painful Luo Li.
Tianhuafen (1.5 qian) Baizhi (1 qian) Ruxiang (2 fen) Moyao (5 fen) Chishaoyao (1.7 qian)
Beimu (7 fen) Guiwei (1 qian) Jinyinhua (3 qian) Chuanshanjia (Stir-fried yellow, 1.2 qian)
Decoct one dose in 1.5 zhong of good wine. Avoid toxic foods such as fresh fish, chicken, and mutton.
Wulong Gao (Transmitted by Zhou Paishan) Treats chronic, non-healing ulcerated Luo Li.
Mubiezi (Burn shell with residue, remove shell) Cebaiye (Baked) Renzhongxue (Ash from burning hair/nails) Qinglongbei (Grease from old pots)
Paper money ash Feiluo mian (Each 1 qian)
Grind into powder, mix with good vinegar to form a paste. Apply to the sore and cover with paper. Effective.
Daijiusan Treats foul-smelling, chronic, non-healing ulcerated Luo Li.
Guanfen (1 qian) Xionghuang (1 qian) Yinzhu (1 qian) Shexiang (2 fen)
Grind into fine powder. Place a piece of Huai pi (Sophora bark) pierced densely with needles over the sore. Sprinkle a pinch of medicine on top, heat with charcoal fire until medicinal vapor penetrates the sore. Stop when pain and heat are felt. Severe cases require three changes, mild cases two changes for cure.
Ziyun Gao Treats Luo Li and all stubborn ulcerated sores that do not heal for a long time, as well as beating wounds, yin sores, and infantile scalp sores.
Huangla (1 liang) Songxiang (5 qian) Huangdan (3 qian) Xiangyou (4 liang)
Combine the four ingredients in an iron pot. Stir with peeled willow branch. Boil with gentle to strong fire until half an incense stick burns out. Spread on oil paper for application or rub onto the affected area.
Dilong Gao (Transmitted by Li Yangzhou) Treats unbroken Luo Li; applying it causes immediate dissipation.
Xionghuang Dilong fecen Xiaomaimian
Equal parts. Grind into powder, mix with vinegar for application.
Dansheng San Treats broken Luo Li; applying it leads to immediate healing.
Yinzhu (1 qian) Tongqing (1 qian) Songxiang (5 fen)
Grind into powder. If wet, apply dry; if dry, mix with lamp oil for application.
Luoli Miaofang (Transmitted by Liu Qiangan)
Make a ring of buckwheat flour to surround the sore. Press dried yellow wine lees onto the sore. Mix Shexiang with pounded mugwort, spread over the lees. Burn the mugwort, replacing as needed, until fluid inside the sore dries up. Then apply plaster.
Guanfen (1.5 liang) Ruxiang (2 qian) Moyao (2.5 qian) Haiercha (2.5 qian) Hafen (5 qian)
Longgu (2.5 qian) Fengfang (2 pieces) Mituoseng (2.5 qian) Xuexie (2 qian) Bimazi (Shelled, 120 seeds)
Grind into fine powder. Boil 4 liang of sesame oil until black. Add medicines, boil a few times. Place the medicine pot over a tile basin filled with water to remove fire toxicity. Spread on paper and apply to the site. Divine effect. Avoid chicken, goose, mutton, duck eggs, fresh fish, and spicy/fried foods.
Laojun Dan (Transmitted by Huang Binjiang) Treats Luo Li and hard phlegm nodules.
Laojunxu (4 fen) Zibeitiankui (3 qian) Ruxiang (3 qian) Moyao Hongqu Fangfeng
Honghua (Each 3 qian) Zhizi (5 fen) Danggui (8 fen) Chuanxiong (4 fen) Caoguoren (1 qian) Xuexie (5 fen)
Haiercha (5 fen) Tufuling (5 fen) Jinyinhua (5 fen) Baijiezi (5 fen)
Pound into coarse powder. Take one clove of garlic, pound smooth, mix with one bowl of good wine, strain. Add herbs, steam-cook for one shichen (2 hours). Take three doses after meals before bed. Complete resolution, miraculous.
Tiankuizi Wan (Transmitted by Huang Binjiang) Treats Luo Li.
Zibeitiankui (1.5 liang) Haizao (1 liang) Haidai (1 liang) Kunbu (1 liang) Beimu (Each 1 liang) Jiegeng (1 liang) Haipiaoxiao (5 qian)
Grind into fine powder, bind with wine paste into pills the size of paulownia seeds. Take 70 pills per dose. This formula uses Jiegeng to lift Qi. Beimu clears heat and resolves phlegm. Haizao and Kunbu soften hardness. They are sacred herbs for treating Luo Li.