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Xue Lizhai stated: The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: The Liver governs the sinews and stores blood; the Heart envelops blood and governs the vessels; the Spleen controls blood and governs the muscles; the Lung regulates the couli (skin texture and pores) and governs qi; the Kidney controls the bones and governs water. If anger stirs up Liver fire, causing yin-blood to dry up and sinews to spasm, swelling arises from the sinews, feeling like sinew upon palpation, and over time red threads may appear; this is called a Sinew Tumor (Jin Liu). If labor and fatigue stir up internal fire, causing yin-blood to boil and external pathogens to contend with it resulting in swelling, swelling arises from the muscles, with red threads appearing over time or the skin turning entirely red; this is called a Blood Tumor (Xue Liu). If depression and stagnation injure the Spleen, causing muscles to thin and atrophy, and external pathogens contend with it resulting in swelling, swelling arises from the muscles, feeling solid yet soft upon palpation; this is called a Flesh Tumor (Rou Liu). If labor and fatigue injure Lung qi, causing the couli to be loose, and external pathogens obstruct and cause swelling, swelling arises from the skin, feeling floating and soft upon palpation; this is called a Qi Tumor (Qi Liu). If labor and fatigue injure Kidney water, failing to nourish the bones and resulting in swelling, swelling arises from the bones, feeling hard upon palpation; this is called a Bone Tumor (Gu Liu). The term "Liu" (Tumor) implies retention. It forms due to qi stagnation and is caused by injury to the zang-fu organs and disharmony of qi and blood. One must seek its root affiliation and treat the root. Generally, for nodules belonging to the Liver and Gallbladder meridians, Ba Zhen Tang (Eight Treasures Decoction) added with Gardeniae Fructus (Shan Zhi) and Gentianae Radix (Dan Cao) should be used to nourish qi and blood and clear Liver fire; combined with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) to nourish Lung metal and generate Kidney water. If it belongs to Liver fire and blood dryness, one must generate and cool blood, using Si Wu Tang (Four Substances Decoction), Er Di (Rehmanniae Radix Preparata and Rehmanniae Radix), Moutan Cortex (Dan Pi), wine-fried black Gentianae Radix, and Gardeniae Fructus. If Middle Qi is deficient, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be taken concurrently. If treatment is incorrect, leading to Spleen and Stomach deficiency, weak Ying Qi that cannot moisten the affected area, or cold qi condensing at the sore mouth preventing Ying Qi from nourishing the area, resulting in chronic non-healing ulcers (Lou), all cases should be treated by regulating and tonifying Spleen Qi, so that when qi and blood become strong, muscles will naturally regenerate. If one does not exercise caution in diet and daily life, nor in the seven emotions and six exogenous pathogens, or uses cold-cooling corrosive medicines, spider silk wrapping, Daphne genkwa thread methods, etc., to treat the exterior, then one has erred.

Regarding the syndrome of tumors and excrescences, as previously discussed by Xue, the essentials have been covered. However, besides these five types of tumors, the Powder Tumor (Fen Liu) is the most common. This occurs because fluids and secretions in the couli occasionally stagnate, gathering without dispersing, gradually forming a tumor; it is also a type of acne comedo, differing only in depth. Those deep within the skin gradually grow into large tumors. I once heard from seniors say that once a tumor grows large, it is most feared that it will rupture. Unless it has formed pus, it absolutely must not be incised. Incision will involve other meridians, deplete blood and qi, making it extremely difficult to manage, with no chance of survival. Upon detailed examination of several cases recorded in Xue’s annotations, those who ruptured all reached untreatable states; this is indeed true and must be known. Here I record my own case: after age thirty, a small grain suddenly appeared under the skin at the bony junction below the buttock and anterior to the anus. Initially the size of a mung bean, I paid no attention. After half a year, it was the size of a soybean; after another year, the size of a soap bean, then like a chestnut. At this point, riding horses or sitting on chairs became obstructive, and pain gradually set in. However, I reasoned that this could not be dispersed by topical applications, nor reached by decoctions. If allowed to grow day by day, hanging between the waist and thighs like a measuring vessel, making movement inconvenient, would it not become completely useless? I was deeply worried and consulted knowledgeable people, who all said it should not be cut or needled, fearing significant disaster. I deliberated for months, daring not act rashly. Yet privately calculating, if not removed while small, it would become harder to handle later; what could be done? I had seen people injured by arrows in their buttocks or thighs not necessarily die immediately; the pros and cons here were no different. Thus, I resolved to remove it. One day, slightly drunk from wine, I used a willow-leaf needle to puncture it while intoxicated. What came out resembled white tofu skin; this was indeed a Powder Tumor. Immediately after puncture, it subsided, and I felt very pleased. Two days later, it swelled like a hot abscess. I applied Hui Tong Gao (Hui Tong Ointment) for three days; after pus drained, it healed, and I felt pleased again. Within two days, it swelled again, becoming hotter and larger. I felt great fear and regret, thinking tumors truly should not be punctured. However, having no choice, I applied Hui Tong Gao again. Three days later, it ulcerated massively, discharging a sac resembling a fish bladder. Then the wound closed and fully healed. Decades after healing, a small orifice remains there; it was indeed a dangerous condition. Had it not been for my decisiveness, I do not know what state it would have reached; if opened too late, it truly would have been unmanageable. Therefore, if disease is not treated early, the outcome is unknown; this can serve as a warning for practitioners. (New Annotation)

1. Acupuncture and Moxibustion Methods: Once, a person had a small tumor growing along the lower margin of the eyelid, initially the size of a rice grain, gradually enlarging to the size of a bean. The person was suspicious and fearful, seeking treatment from a surgeon. The surgeon used a cluster of three or four needles, flipped the eyelid inside out, and punctured the inner membrane, causing slight bleeding. After two or three such sessions, the tumor shrank daily until it completely disappeared. Another person had a tumor on the arm, gradually enlarging to the size of a longan fruit. That person applied small moxa cones (Zhuang) directly on the tumor seven times, and it gradually subsided and stopped growing; this is also a good method. Alternatively, garlic-separated moxibustion can also be used. 2. For tumors arising in inconvenient locations, these two methods should be chosen appropriately. Generally, sinew and vessel disorders are suitable for moxibustion, while blood disorders are suitable for acupuncture. Some use topical applications of radish seeds, Arisaema Rhizome (Nan Xing), or Mirabilite (Piao Xiao) to temporarily reduce the tumor. To eradicate the root, the aforementioned methods are superior.

3. Spider Silk Wrapping Method: This can treat tumors that are not yet very large; this method is excellent. I once saw a person with a walnut-sized tumor on the abdomen. A practitioner took spider silk, twisted it into a thick thread, and wrapped it tightly around the base of the tumor. Over several days, the thread tightened, and the tumor base gradually thinned. After repeated tightening, it fell off naturally within ten days; truly a miraculous method. It shows that while other threads loosen over time, spider silk tightens. The subtlety of physical principles warrants such investigation. However, wrapping treatment should be done early; if the tumor is already large, it is likely unsuitable.

Xue’s Annotation states: A man had a swelling on the lateral side of his left leg near the buttock, with red threads present for three years. His diet and daily life were normal. When touched, it burst and oozed pus and blood, accompanied by fever and aversion to cold. This is a syndrome of the Gallbladder Meridian, hence occurring on the lateral leg. Palpation of the pulse revealed a surging and rapid Left Chi (Kidney) pulse, and a wiry and surging Left Guan (Liver) pulse. This indicates Kidney Water failing to generate Liver Wood. He was cured using Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan.

A man suffered from a tumor in the lower abdomen, with dripping pus and fluid. This is a syndrome of the Foot Three Yin Meridians. He was treated with Bu Zhong Yi Qi Tang added with Ophiopogon Tuber (Mai Dong) and Schisandra Fruit (Wu Wei Zi) to cultivate Spleen Earth, Liu Wei Di Huang Wan to generate Kidney Water, and Lu Hui Wan (Aloe Pill) to clear Liver Fire and astringe.

An old scholar suffered from a tumor on his glabella for three years. Its shape resembled a purple peach drooping to cover the eye, feeling like a water sac upon palpation. This is a Liver-Spleen syndrome, caused by internal ulceration of pus and blood stasis. Blood and pus were punctured and drained, and the eye immediately opened. He was cured using stir-baked black Gentianae Radix, Gardeniae Fructus, Ligusticum Chuanxiong Rhizome (Chuan Xiong), Angelica Sinensis Radix (Dang Gui), Paeonia Lactiflora Radix (Bai Shao), Bupleurum Radix (Chai Hu), Atractylodes Macrocephala Rhizome (Bai Zhu), and Poria (Fu Ling).