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If the pulse is deep and rapid, it indicates excess pathogenic qi; purgation should be employed. If swelling and pain are accompanied by aversion to cold and fever, or muscle stiffness, the pathogen is in the exterior; dispersing methods should be used.

For cases caused by anger, tonifying Qi is the primary approach. For hard, non-ulcerating swellings, tonifying both Qi and Blood is primary. For those caused by depression, resolving stagnation and regulating Qi and Blood is indicated. For ulcers that fail to heal after rupture, this belongs to deficiency of both Qi and Blood; major tonification is required. For cases caused by consumptive disease (Xu Lao), tonification is applied. For nodules that fail to heal due to the presence of lumps, putrefaction followed by tonification is used. If the pulse is excess and healing does not occur, or if the lump does not resolve, purgation is indicated.

A male patient suffered from this condition with swelling, pain, aversion to cold, fever, and constipation. After taking Shegan Lianqiao San (Belamcanda and Forsythia Powder) for six doses, the fever subsided significantly. Subsequently, Xianfang Huoming Yin (Immortal Life-Rescuing Decoction) was administered for four doses, resulting in the resolution of the swelling.

A female patient presented with swelling and pain below the ear, accompanied by aversion to cold and fever. Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins) was given for four doses, completely resolving the exterior symptoms. Sanzhong Kuijian Tang (Decoction to Reduce Swelling and Harden Nodules) was then administered for several doses, reducing the swelling by more than half. Finally, Shenxiao Gualou San (Miraculous Trichosanthes Powder) was given for four doses, leading to recovery.

A male patient with Wind-Heat in the Liver Channel presented with swelling, pain, and fever below the ear, and a floating, rapid pulse. Bohe Dan (Mint Pills) was used to treat him, resulting in resolution.

A male patient experienced swelling below the ear and occasional hypochondriac pain upon anger. Xiaochaihu Tang (Minor Bupleurum Decoction) was prescribed with added Qingpi (Green Tangerine Peel), Muxiang (Costus Root), Honghua (Safflower), and Taoren (Peach Kernel). Recovery occurred after four doses.

A male patient had a hard, non-suppurating mass with a wiry and rapid pulse. Xiaochaihu Tang (Minor Bupleurum Decoction) combined with Shenxiao Gualou San (Miraculous Trichosanthes Powder) was administered for several doses each. Garlic-partitioned moxibustion was also performed several times. Resolution occurred after more than a month.

A female patient had a persistent neck swelling. Shenxiao Gualou San (Miraculous Trichosanthes Powder) was given for six doses, showing slight improvement. Then, Xiaochaihu Tang (Minor Bupleurum Decoction) with added Qingpi (Green Tangerine Peel), Zhike (Aurantii Fructus), and Beimu (Fritillaria Bulb) was administered for several doses, reducing the swelling by more than half. Finally, Siwu Tang (Four Substance Decoction) combined with Xiaochaihu Tang (Minor Bupleurum Decoction) was given for several doses, leading to recovery.

A male patient suffered from swelling, pain, and nodules in the neck after sudden anger, accompanied by chest oppression and fever. Fangmai Liuqi Yin (Flowing Qi Decoction for Pulse Diagnosis) was administered for two doses, relieving chest obstruction. Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins) was then given, bringing the condition near resolution. However, one nodule remained. Yuxian Wubi Wan (Peerless Pill of Encountering Immortals) was taken in a dosage of two liang, resulting in cure.

A female patient with long-term depression presented with a lesion that did not ulcerate initially, and failed to heal after ulceration. Symptoms included fever, dry mouth, scanty menstruation, loss of appetite, and extreme fatigue in the afternoon. [The text mentions "Yiqi Yangdu Yao" which likely refers to a tonifying formula, possibly a typo for Yiqi Yangrong Tang, but translated literally as Tonifying Qi and Nourishing Poison Drugs]. The condition recurred despite treatment, failing to heal, with continuous discharge of fluid, ultimately leading to death. This condition is attributed to consumptive disease and Qi stagnation. It requires tonifying the body's Qi and regulating the meridians. Unformed lesions will resolve spontaneously; formed ones will ulcerate spontaneously. Using harsh agents would further deplete Qi and Blood, often transforming into tuberculosis (Zhai Syndrome). Hardness without ulceration, or failure to close after ulceration, clearly indicates Qi and Blood deficiency. Moreover, the blood in these two channels is originally insufficient, a fact that must not be overlooked.

A male patient had a non-healing wound with mental fatigue and a deficient pulse. I intended to use Tuoli (Supporting Interior) methods, but he considered it too slow and took Sanzhong Kuijian Tang (Decoction to Reduce Swelling and Harden Nodules). After more than half a month, there was initial improvement. Internal resolution is suitable initially. If the condition persists, Qi and Blood gradually decline, muscles become cold, pus becomes thin, toxins do not exit, wounds do not close, swelling is not red, nodules lack pus, and external signs are unclear; Tuoli methods are appropriate in all such cases. For unformed pus, it promotes early formation; for ulcerated wounds, it prevents deterioration.

A male patient had a non-healing wound with thin pus, sallow complexion, emaciation, and morning diarrhea.ershensan Wan (Two Spirits Pill) was administered for several doses, stopping the diarrhea. Liu Junzi Tang (Six Gentlemen Decoction) with Chuanxiong (Szechuan Lovage Rhizome) and Danggui (Angelica Sinensis) was then given. Muscle mass recovered over a month. Fermented soybean cake moxibustion was applied, and tonic plasters were used. Recovery occurred after more than three months.

A female patient had non-putrefying nodules after ulceration. Yiqi Yangrong Tang (Tonifying Qi and Nourishing Blood Decoction) was administered for over thirty doses. Zhentou San (Needle Head Powder) was applied externally to promote putrefaction. Another thirty doses of the decoction led to healing.

A male patient with non-ulcerated lesions presented with fatigue and fever. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) was used, providing slight relief. Yiqi Yangrong Tang (Tonifying Qi and Nourishing Blood Decoction) was then administered. Ulceration occurred after a month, and full recovery followed a month later.

A female patient with accumulated Heat in the Liver Channel presented with painful lesions and a deep, rapid pulse. Shegan Lianqiao Tang (Belamcanda and Forsythia Decoction) was given for four doses, showing slight improvement. Sanzhong Kuijian Wan (Pills to Reduce Swelling and Harden Nodules) was then used. After a month, the toxin resolved.

Regarding etiology, Wind and Heat are the two main factors, evolving through transformation. One must distinguish between Excess and Deficiency. Excess is easy to treat; Deficiency is concerning. This channel governs decision-making and contains Ministerial Fire; it has abundant Qi but scarce Blood. In women, if menstruation is irregular and alternating chills and fever arise, progressing to tidal fever over time, only by abstaining from sexual desire and eating bland food can even a divine physician cure it.

A male patient had a hard, non-resolving facial swelling that did not suppurate. Sanjian Baidu Yao (Hardness-Scattering and Toxin-Expelling Medicine) was ineffective. Moxibustion at Zhoushi (Elbow Tip) and Jianjian (Shoulder Tip) acupoints was performed, along with internal medication [text missing, likely a tonic]. Menstruation was delayed and scanty. Xiaoyao San (Free and Easy Wanderer Powder) combined with the previous decoction was used. After two months, Qi and Blood recovered, and the sore healed, except for one opening. Zhentou San (Needle Head Powder) was applied, and the previous acupoints were moxibusted again, leading to complete recovery. For chronic cases lasting two to three years, three sessions of moxibustion combined with interior-supporting medicines usually result in cure. A female patient with angry-induced nodular swelling had Excess Qi and Blood. Shenshao San (Miraculous Scattering Powder) was used first for purgation, followed by Yiqi Yangrong Tang (Tonifying Qi and Nourishing Blood Decoction) for over thirty doses, resulting in resolution. Generally, for deficiency cases, Yiqi Yangrong Tang is used first until Qi and Blood are slightly replenished, then Shenshao San is used to remove toxins, followed by resumption of the tonic. This approach is invariably effective.

A female patient felt a sensation of a lump in the throat, unable to swallow or spit out, accompanied by fatigue and fever. Siqi Tang (Four Words Decoction) was used first, relieving throat obstruction. Xiaoyao San (Free and Easy Wanderer Powder) was then administered [text incomplete]. Another female patient with similar symptoms, plus chest oppression, abdominal distension, poor appetite, and restlessness, was cured using Fenxin Qi Yin (Dividing Heart Qi Decoction).

A seventeen-year-old unmarried girl had intermittent neck pain, alternating chills and fever resembling malaria, and a long, wiry Liver pulse. This indicates abundant Blood. Xiaochaihu Tang (Minor Bupleurum Decoction) was used first [text incomplete].

Cang Gong passed knowledge to Chu Cheng, briefly discussing widows. Mencius defined a widow as a woman without a husband. Nuns or widows, possessing only Yin without Yang, desiring men but unable to obtain them, develop illness due to depression. The *I Ching* states: Heaven and Earth interact, and all things mature; men and women unite, and all things are born. Can isolated Yin or Yang exist? Women confined to their chambers, whose desires arise but are unfulfilled, experience conflict between Yin and Yang, causing alternating chills and fever resembling malaria, which over time becomes consumption (Lao). Other conditions include amenorrhea, leukorrhea, phlegm-induced headache, diaphragmatic Qi stagnation, and emaciation, all diseases of widows. Diagnosis reveals a wiry Liver pulse extending from Cun Kou above the fish-mouth area. These conditions stem from abundant Blood. The Classics state: When men's Essence is abundant, they desire intercourse; when women's Blood is abundant, they conceive. Observing their Essence and Blood, one understands half the matter.

A male patient had five pearl-like nodules below the ear, remaining hard for a year. His complexion was sallow, appetite poor, and he had labor-induced fever with a soft, choppy, rapid pulse. Yiqi Yangrong Tang (Tonifying Qi and Nourishing Blood Decoction) was administered for over sixty doses. Vital Qi recovered, and most lesions resolved. One nodule remained. Bixiao San (Highly Effective Powder) was taken twice, resulting in resolution.

A female patient had no pus formation for a long time, with a floating and choppy pulse. I diagnosed Qi and Blood deficiency and recommended tonification to allow spontaneous ulceration. She desired internal resolution and exclusively took Banmao (Mylabris) and hardness-scattering medicines. Her Qi and Blood became increasingly depleted, leading to death.

A male patient suffering from fatigue and fever due to overwork had a large, forceful pulse that was weak upon pressure. I advised Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). He did not believe me and took attacking medicines [text incomplete].

Treatment begins with regulating menstruation and resolving depression, followed by garlic-partitioned moxibustion, which often resolves spontaneously. If it does not resolve, Hupo Gao (Amber Plaster) is applied. Once pus forms, it should be punctured; otherwise, complications may arise elsewhere. If complicated by Phlegm or Yin Deficiency, add corresponding formulas without interfering with other channels. If Qi and Blood have recovered but nodules persist, hardness-scattering medicines may be tried. If there is no response after a month and Qi and Blood remain intact, Bixiao San (Highly Effective Powder) or Yuxian Wubi Wan (Peerless Pill of Encountering Immortals) can be used. Once the toxin is expelled, stop these drugs and take Yiqi Yangrong Tang (Tonifying Qi and Nourishing Blood Decoction) for several doses to regulate. For non-healing wounds, fermented soybean cake moxibustion and Hupo Gao (Amber Plaster) are indicated. Cases with severe Qi and Blood deficiency, or those who neglect diet, lifestyle, and emotional regulation, are untreatable. However, this disease depends primarily on Qi and Blood. If strong, lesions will self-putrefy and heal easily once removed. If deficient, using corrosive medicines without prior tonification is futile and harmful. If accompanied by fever and red veins penetrating the pupil, it is untreatable. One vein indicates death within one year; two veins indicate death within two years [text incomplete].

A frail male patient had non-putrefying nodules after ulceration, indicating Qi and Blood deficiency. Tuoli Yangrong Tang (Interior-Supporting and Blood-Nourishing Decoction) was used. As Qi and Blood recovered, the nodule remained. It was mechanically removed with a hairpin, and the previous medicine was continued. Recovery occurred after a month.

A male patient with recovered Qi and Blood still had non-putrefying nodules. Zhentou San (Needle Head Powder) and Bixiao San (Highly Effective Powder) were used three times each. Healing occurred within ten days.

A male patient with profuse Phlegm, chest oppression, and a wiry Spleen/Stomach pulse indicated Spleen Earth deficiency with Liver Wood invasion. Strengthening Spleen Earth and subduing Liver Wood was the primary strategy. [Text incomplete] poor appetite. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) with doubled Baizhu (Atractylodes Macrocephala Rhizome) improved middle Qi over a month. Yiyangrong Tang (Nourishing Qi and Blood Decoction) reduced swelling and restored Qi and Blood over two months. A wiry Right Guan pulse indicates Wood excess overcoming Spleen Earth (Thief Evil). Using bitter-cold medicines in deficiency worsens the deficiency. Phlegm has various causes and treatments. Overusing draining medicines damages Spleen Qi, making Phlegm easier to generate. For middle Qi deficiency, Ginseng and Atractylodes should be primary, assisted by Phlegm-resolving herbs.

A female patient had neck swelling after anger, followed by amenorrhea, limb edema, and dysuria resembling strangury. This is a Blood Division syndrome. Jiaoren Wan (Pepper Seed Pill) was taken for several doses, restoring menstruation [text incomplete]. Amenorrhea is called Water Division, treated with Tingli Wan (Descurainia Seed Pill). *Furen Liangfang* states: If menstruation stops first, followed by limb edema and urinary obstruction, it is Blood Division. Water transforms into Blood; if Blood does not flow, it reverts to Water. Jiaoren Wan is indicated. If urinary difficulty occurs first, followed by edema and amenorrhea, it is Water Division. Tingli Wan is indicated.

A nineteen-year-old unmarried girl had a hard, colorless neck swelling, daily muscle wasting, and tendon spasms/pain. This is a syndrome damaged by Seven Emotions and depleted Qi and Blood [text incomplete]. Sadness damages limbs; grief damages sinews causing spasms; excessive joy dries skin; rage damages Will, making bending and stretching difficult. Vice Minister Ke’s daughter married early, her husband died young. She developed curled fingers, drooping palms, and skin eruptions. Medicines were mixed, appetite dropped, and the condition lasted half a year. Upon diagnosis, it was not Wind, but caused by sorrow and grief. Belonging to Internal Causes, internal cause medicines were used. Deer Antler Glue and Musk paste were applied to the affected areas. Spasms resolved, fingers extended, and the condition improved.

A female patient with limb fatigue resembling flaccidity syndrome was cured with medicines nourishing Blood, tonifying Qi, and strengthening the Spleen and Stomach.

An impatient, anger-prone unmarried girl had frequent swelling, pain, and fever below the ear with a wiry, urgent Liver pulse. Xiaochaihu Tang (Minor Bupleurum Decoction) with Qingpi (Green Tangerine Peel), Niubangzi (Arctium Fruit), and Jingjie (Schizonepeta) was administered [text incomplete].

I stated: The Liver stores Blood internally and nourishes sinews externally. Anger causes Qi reversal, damaging the Liver. Since the Liver governs sinews, sinew accumulation causes swelling. The patient must regulate themselves to avoid recurrence. Otherwise, Liver Qi reversal damages Blood storage. Blood deficiency leads to difficult-to-cure syndromes. Later, she did not heed advice, developed three nodules, and died after repeated use of corrosive medicines without healing.

A young wife had swelling below the ear, worked hard, had fever, dry mouth, and delayed, scanty menstruation. An old woman mistook it for amenorrhea and used Leeches [text incomplete]. Milk above and menstruation below are residual Qi of the meridians. Without external Six Evils or internal Seven Emotions, strong Spleen/Stomach Qi ensures healthy Chong and Ren [text incomplete].

A released palace maid over thirty years old had hip pain without swelling or color change, painful urination resembling strangury, worse during defecation. This is stagnant Blood [text incomplete]. Being a merchant's wife, she was often outside, while this woman harbored long-term inner depression and could not fulfill desires outside, causing this disease. Seeing flowing abscesses and scrofula, it is clear that Seven Emotions and Qi/Blood were damaged, and attacking medicines are contraindicated. *Jingxue Pian* states: If a boy engages in sex before his Essence is complete, his body will have deficiencies, leading to difficult diseases later. If a man with impotence seeks sexual gratification, Essence fails to exit and rots internally, causing涩 (obstruction) and strangury. If Essence is exhausted and further drained, urination/defecation pain increases, driving more urges, worsening pain. For women, after Tian Gui arrives, ten years without male union causes irregularity; less than ten years, desiring union also causes irregularity. Irregularity means old Blood does not exit, new Blood flows wrongly, soaking into bones or becoming swelling. Even with union, difficulties may persist. Excessive sex drains men; frequent childbirth kills women. Observing Essence and Blood, one understands half the matter.

A seventeen-year-old unmarried girl had prolonged scrofula, unstarted menstruation, fever, cough, and poor appetite. An old woman wanted to use Radix Crotonis (Badou) and Cinnamon Bark (Rougui) [text incomplete]. Nourish Qi and Blood, benefit fluids, and menstruation will start naturally. Confused by promises of quick effects, she still used them. I said: "This is not the correct treatment. These are harsh agents, greatly assisting Yang Fire. Yin Blood will flow recklessly, and Spleen/Stomach will become more deficient." Menstruation started but did not stop, appetite decreased further, tidal fever increased, leading to death. The Classics state: At seven, Kidney Qi is strong, teeth change, hair grows. At fourteen, Tian Gui arrives, Ren Mai is open, Tai Chong Mai is abundant, menstruation comes on time. Delayed menstruation is abnormal and has a cause. Human life is based on Qi and Blood. Illness always injures Qi and Blood first. Women often suffer from Seven Emotions. Kou Zongshi said: Human life is based on Qi and Blood. Illness always injures Qi and Blood first. Maidens and boys with excessive thoughts often suffer consumption. Men lose spirit/color first; women have amenorrhea first. Why? Worry and thought damage the Heart. Heart damage causes Blood reversal and exhaustion. Exhausted Blood loses spirit/color and causes amenorrhea. Fire is diseased, cannot nourish its child (Earth), so appetite is lost. Spleen deficiency weakens Metal, causing cough. Cough exhausts Water, drying limbs. Wood is insufficient, causing anger. Hair turns gray, sinews/bones become flaccid. After transmission through five organs, death ensues. This type is hardest to treat among consumption. Disease originates in the five organs, has no fixed end, and medicine cannot reach it. If the patient changes their mindset and uses medicine to support, one in nine might survive. This example applies to other formulas; treat according to pulse and syndrome. Zhang Shi said: Maiden menstruation [text incomplete]. Cold causes coagulation. *Yangsheng Biyong Fang* discusses this in detail; the theory is sound and must be known. If menstruation is scanty and gradually stops, with limb pain, emaciation, tidal fever, and a faint, rapid pulse, it is Yin Deficiency and Blood weakness, with Yang invading. Small water cannot extinguish strong Fire; Fire forces Water dry, losing fluids. Nourish Blood and benefit Yin. Do not use toxic medicines to induce flow. Baizi Ren Wan (Biota Seed Pill) or Zelan Wan (Eclipta Pill) are indicated.

A male patient had lesions in front of and below the ear. As they healed, the next year spread to the side of the neck and collarbone. Three years later, it spread to the chest and axilla, not healing. The Liver pulse was wiry and rapid [text incomplete]. Diagnosed as before, cleared Liver and nourished Blood with the previous pill, resulting in cure.

A female patient had fever, irritability, and thirst after ulceration, with a large, weak pulse. This is due to Blood deficiency. Danggui Buxue Tang (Angelica Tonifying Blood Decoction) was given for six doses, rapidly reducing symptoms. Then Sheng [text incomplete], irritability, muscle heat, aversion to clothing, large pulse weak on pressure, or eye pain/dry nose, is not Baihu Tang syndrome. This is Blood deficiency causing irritability; Danggui Buxue Tang (Angelica Tonifying Blood Decoction) is primary. There is also Heat constrained by Fire. If unable to eat with fever, sweating, and shortness of breath, it is deficiency. Use sweet-cold medicines to drain Heat and tonify Qi. If able to eat with fever, dry mouth/tongue, and difficult stool, use pungent-bitter great-cold medicines to purge downward, draining Fire and benefiting Water.

Attached Formulas
Shegan Lianqiao San (Belamcanda and Forsythia Powder): Treats alternating chills/fever and scrofula.
Shegan, Lianqiao, Xuanshen, Chishaoyao, Muxiang, Shengma, Qianhu, Shanzhiren, Danggui, Gancao (Honey-fried, 0.7 fen each); Dahuang (Stir-fried, 2 qian). One dose, boil in 2 zhong water to 0.8 zhong. Take after meals.
Jingfang Baidu San (See Ulcer Fever Chapter).
Xianfang Huoming Yin (See Back Carbuncle Chapter).
Xiaochaihu Tang (Minor Bupleurum Decoction): Treats scrofula, breast abscess, groin abscess, chancre, and all sores in Liver/Gallbladder channels with fever/tidal fever or poor appetite.
Banxia (Ginger-processed, 1 qian), Chaihu (2 qian), Huangqin (Stir-fried, 2 qian), Renshen (1 qian), Gancao (Honey-fried, 0.5 fen). One dose, boil in 2 zhong water with 3 ginger slices to 0.8 zhong. Take far from meals.
Bohe Dan (Mint Pills): Treats Wind-Heat scrofula. Long-term use expels toxin via urine. Non-suppurating lesions resolve spontaneously.
Bohe, Zaorao (De-seeded), Lianqiao, Sanleng (Roasted), Heshouwu (Soaked in rice water), Manjingzi (Each purified, 1 liang). [Text incomplete] Twice daily. Continue even after cure.
Yiqi Yangrong Tang (Tonifying Qi and Nourishing Blood Decoction): Treats depression, labor-induced Qi/Blood injury, or swelling in limbs/neck (soft/hard, red/non-red, painful/non-painful), afternoon fever, or non-healing ulcers.
Renshen, Fuling, Chenpi, Beimu, Xiangfu, Danggui (Wine-mixed), Chuanxiong, Huangqi (Salt-water stir-fried), Shudihuang (Wine-mixed), Shaoyao [Text incomplete]. Boil to 0.8 zhong. Take far from meals. Add Zhike/Xiangfu (1 qian each) for chest oppression; reduce Renshen/Shudihuang by 0.2 fen. Add Houpo/Cangzhu temporarily for poor appetite. Add Chaidu/Digupi for alternating chills/fever. Add Renshen/Huangqi/Danggui/Baizhu for thirst after ulceration. Add Danggui/Chuanxiong for excessive/thin pus. Add Qingpi/Muxiang for hypochondriac pain/oppression. Add Bailian/Guigui for slow flesh growth. Add Juhong/Banxia for Phlegm. Add Wuweizi/Mendong for dry mouth. Add Chaihu/Huangqin for fever. Add Zhimu/Xiaodoudou (Wine-stir-fried) for inextinguishable thirst. Double Renshen/Huangqi/Danggui for non-stop pus.
Douchi Bing (Fermented Soybean Cake - See Arm Abscess Chapter).
Ershen Wan (Two Spirits Pill - See Vomiting Chapter).
Gesan Jiu Fa (Garlic-Partitioned Moxibustion - See Back Carbuncle Chapter).
Zhentou San (Needle Head Powder): Treats stubborn sores with residual necrotic tissue, non-resolving nodules, and non-healing wounds. Promotes putrefaction.
Chishizhi (5 qian), Ruxiang, Baixingding (2 qian each), Pi (Raw), Huangdan (1 qian each), Qingfen, Muxiang (0.5 fen each), Wugong [Text incomplete]. Grind to powder. Apply to sores. For chronic non-healing sores with sinus tracts, use this to promote putrefaction, combined with interior-supporting medicines.
Rushen San (Miraculous Powder): Treats ulcerated scrofula with retained necrotic tissue and non-healing wounds.
Songxiangmo (1 liang), Baifan (3 qian). Grind to powder. Mix with sesame oil for application, or apply dry.
Shenxiao Gualou San (See Breast Abscess Chapter).
Liu Junzi Tang (See Vomiting Chapter).