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(Note: Scrofula and tubercles, when encountering such conditions, should be cross-referenced with scrofula.)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The Liver governs the sinews and stores blood; the Heart controls the blood vessels and presides over the pulse; the Spleen governs the muscles and controls the blood; the Lung governs Qi and regulates the couli (skin texture and pores); the Kidney governs the bones.

If swelling arises from excessive labor causing ministerial fire to flare up, boiling yin blood, and external pathogens combing with it, the swelling originates in the muscles. After a long time, red threads may appear, or the skin may become entirely red. This is called a Blood Tumor. Treatment uses Siwu Tang (Four Substance Decoction), Poria (Fuling), and Polygala (Yuanzhi). If swelling arises from emotional stagnation injuring the Spleen, causing muscle wasting and thinning, and external pathogens combing with it, the swelling originates within the muscles and feels solid yet soft upon palpation. This is called a Flesh Tumor. Treatment uses Guipi Tang (Restore the Spleen Decoction) and Yiqi Tang (Boost Qi Decoction). If swelling arises from labor injuring Lung Qi, causing insecure couli, and external pathogens combing and obstructing, the swelling originates on the skin surface and feels floating and soft upon palpation. This is called an Air Tumor. Treatment uses Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If swelling arises from labor injuring Kidney Water, failing to nourish the bones, the swelling originates from the bone area and feels hard upon palpation. This is called a Bone Tumor. Treatment uses Dihuang Wan (Rehmannia Pill) and Kidney-tonifying herbs.

Generally, for tubercles belonging to the Liver and Gallbladder meridians, Bazhen Tang (Eight Treasure Decoction) is used with Gardenia (Shanzhi) and Gentian (Dancao) to nourish Qi and blood and clear Liver fire; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used to nourish Lung Metal and generate Kidney Water. For cases of Liver fire and dry blood, blood generation and cooling are required, using Siwu Tang, Shengdi Huang (Rehmannia Root), Mudan Pi (Tree Peony Bark), wine-fried black Gentian (Dancao), and Gardenia (Shanzhi). For deficiency of Middle Qi, Bu Zhong Yi Qi Tang is taken concurrently. If treatment is incorrect, leading to Spleen and Stomach damage and weak Ying Qi unable to moisten the affected area; or if cold qi condenses at the sore opening, preventing Ying Qi from nourishing the area; resulting in prolonged failure to regenerate tissue and forming a fistula, all cases should be treated by regulating and tonifying the Spleen and Stomach. When Qi and blood become robust, muscle will naturally grow. If one does not carefully manage daily life and emotions, or uses cold/clearing corrosive medicines, spider web wrapping, or Genkwa thread ligation methods to treat externally, the therapeutic effect will be poor.

Wang Tianjue, a student from Changzhou, suffered illness near the Huantiao point on his left leg in the spring of the Xinchui year. The lesion resembled a large peach and was soft upon palpation. He strictly took dampness-draining, Qi-moving, and phlegm-resolving agents, but the condition worsened. Examination revealed the disease location in the Gallbladder meridian part, indicating Lung Metal insulting Liver Wood and depletion of Yuan Qi, with pus already internally ulcerated. Subsequently, Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) was administered for several doses. A large amount of green-white thin pus was discharged, suddenly accompanied by alternating chills and fever, irritability, thirst, and headache, resembling Taiyang disease (Exterior Syndrome). I stated: This is due to further depletion of Qi and blood following pus discharge. The previous decoction was continued, but the condition worsened. The pulse was surging, rapid, and large, but empty upon deep pressure. Therefore, 1 qian of Aconite (Fuzi) was added. The condition worsened further, and the pulse returned to its previous state, indicating severe deficiency where the medicinal force could not reach the pathology. An additional 2 qian of Aconite was added. After three doses, all symptoms subsided abruptly. Then, Bu Zhong Yi Qi Tang was taken in the morning and Shiquan Dabu Tang in the evening, each for over thirty doses. Five pieces of necrotic bone were discharged, and the wound was nearly healed. Later, due to careless lifestyle, the affected area ulcerated again, and various symptoms recurred. The throat felt like burning, and the mouth and tongue lost their mucosal lining. Shiquan Dabu Tang plus 1 qian of Aconite was taken, curing the symptoms. After two days without medication, internal diseases returned, and the affected area ulcerated again. Two years later, the illness recurred. Previous medications were ineffective. Palpation of the Chi (Cunamens) pulse revealed it was minute and thread-like, indicating decline of Mingmen Fire. Qimai Wan (Seven-Ingredient Pill) was used as the main formula, assisted by Shiquan Dabu Tang, resulting in slight improvement. The illness persisted into the Yisi year.

A man had a swelling on the outer side of his left leg near the buttocks, with red threads visible for three years. His diet and daily life were normal. Upon rupture, blood and pus gushed out, accompanied by fever and aversion to cold. This belongs to [Blood Tumor context], cured by Siwu Tang and Liuwei Dihuang Wan.

A man suffered from a small abdominal lesion with dripping pus and water. This is a syndrome of the Three Yin Meridians of the Foot. Buzhong Yiqi Tang plus Ophiopogon (Maimen) and Schisandra (Wuweizi) was used to cultivate Spleen Earth; Liuwei Dihuang Wan was used to generate Kidney Water. Additionally, Luohui Wan (Aloe Pill) was used to clear Liver fire and astringe the wound.

An old scholar suffered from a lesion between his eyebrows for two years. It resembled a purple peach, hanging down to cover the eyes, and felt like a water sac upon palpation. This is a Liver-Spleen syndrome caused by internal ulceration of pus and stasis.

Jiang Jiefu, a Jinshi degree holder, had tubercles under both ears, on both arms, and in both ribs. He strictly took phlegm-resolving, fire-descending, and softening-hardness agents, but the condition worsened. I said: This is blood deficiency and fire dryness in the Gallbladder meridian. Since the Gallbladder meridian runs along the sides of the body, the previous medicines must have caused damage. In July of the following year, he requested another examination. All tubercles had ulcerated, and the pulse was floating, large, and choppy. In autumn, Metal Qi is prosperous, and Wood is controlled by Metal. It was deemed incurable, and indeed, he died.

Zhou Shangshe from Jiashan suffered from tendon spasms, obstructed swelling, hardness, cough, asthma, internal heat, and night sweats between the lower ears and neck. He had taken phlegm-resolving, hardness-dispersing, and Qi-moving agents, worsening the condition. My diagnosis showed a wiry and choppy Left Guan pulse and a surging and rapid Left Chi pulse. This indicates anger injuring the Liver and sexual excess damaging the Kidneys. One must nourish Kidney Water and generate Liver Blood, with careful regulation. Recovery might be possible during the season of abundant Water. Desiring quick results, he applied external medicines like Phytolacca (Shanglu) and Calcined Stone, and took internal herbs like Seaweed (Haizao) and Curcuma (Ezhu). By autumn, when Metal Qi was prosperous, Yuan Qi became more deficient, the swelling worsened, and he died.

Sun Shangshe from Zhenjiang had swelling in the supraclavicular fossa (Quepen) resembling an inverted bowl, hard and red, with internal heat, afternoon fever, spontaneous sweating, and night sweats. He sought my treatment, stating his ailment was caused by [misuse of dispersing drugs]. This is anger injuring the Liver, leading to blood exhaustion and tendon spasm. Because he was eager for official advancement, I declined to treat him, saying it was incurable. He did not believe me, and indeed died later. If this syndrome were treated by tonifying Spleen and Lung, and nourishing Liver and Kidney, so that Wood receives water to flourish and tendons receive blood to be moistened, many could survive.