[按]陈案初起，用大力子、薄荷、僵蚕辛以散风；大青叶、板蓝根、玄参、射干等清热解毒。王案里热炽盛，大便难，用凉膈散清热泻下；尝见此类患者，咽红肿痛，汤水难咽，下之则痛去大半，此为上病下取，釜底抽薪之法。谢案咽红，上罩白腐，当与白喉鉴别：白喉之伪膜不易拭去，易出血；乳蛾则易于拭去，且不易出血。初诊用清热解毒、凉血利咽，身热遂降，于此亦可断定并非真性白喉。
1．成幼。热2日，脉滑数，苔垢腻，不更衣而腹痛。此外感兼肠胃病，当表里两解。
柴胡2．4克，枳壳9克，黄芩6克，槟榔9克，连翘9克，地枯萝9克，蚤休5克，生甘草1．5克。
白芍9克，小青皮9克，山楂炭9克，生枳实5克，大腹皮9克，地枯萝9克，生麦芽9克。
2．王幼。有形之积，蕴酿成热，其热多作于日晡，溲赤，睡中断齿，此非清之、下之不能速效。
枳实6克，连翘9克，望江南9克，草决明9克，胡黄连2．4克，槟榔9克，蚤休2．4克，黄芩6克，生大黄3克(后下)。
[按]儿科最多表里同病。成案柴、枳同用，深得推陈致新之妙。柴胡并能通大便，是先生独到的经验。王案热起日晡，为食滞阳明，一般消导药不能见效，故以大黄、槟榔、蚤休、黄芩等清之下之。
3．葛幼。其主要证候：青筋暴露一也；精神萎靡不振二也，便不整调，溲有米泔状三也；嗜食不为肌肉四也。此伤于食，脾不健，酿成疳积者是。
麸炒枳壳9克，莱菔子9克，蓬莪术5克，花槟榔9克，制黑丑6克，干蟾皮2．4克，焦山楂9克，焦六曲9克，皂角9克，(蚕砂12克同捣)。
[按]小儿疳积，是指脾胃运化不良所引起的慢性营养障碍。案中所列四点，为疳积常见主症。其治疗常法，以攻坚化积，强脾助运在先，以补益扶正固本为善后。方中莪术行气活血，消胀化积；皂角不仅善于祛痰，且对肠内致病菌有抑制作用。二者同用，是治疳积的妙品。
川雅连1．2克，枳实9克，天花粉15克，黄芩9克，全瓜蒌12克，肥知母12克，橘皮9克，竹茹5克。
青蒿9克，地骨皮9克，金银花12克，白薇9克，杏仁泥15克，黑山栀9克，淡竹茹6克，茅芦根各30克。
[按]呕吐频繁，胃阴耗伤，故用花粉、知母之凉润以养胃阴；因高热如蒸，故用芩、连苦寒泄热；不降其逆，呕吐不能止，故用枳、蒌、橘皮、竹茹降逆和胃止呕。二诊时呕吐虽止，热未能退，故侧重清热消炎。其中茅、芦根二味，既能甘凉养胃，又擅清气分之热，为寻常易得之佳药。
1．徐幼。少腹硬而时痛，此虫积也。小便不爽利而频，亦因于此。
海南片9克，江枳实9克，石榴皮6克，赤苓9克，川楝子9克，杭白芍9克，乌梅5克，葫芦瓢12克，谷麦芽各9克。
2．吴女。绕脐痛，迄今匝月，痛有轻重而无休止，痛则发厥，徒用镇痛剂无效，下之。
海南片9克，青皮6克，郁李仁12克，山楂肉9克，川楝子9克，生枳实6克，芦荟5克，黑丑6克，杭白芍9克，乌梅5克，石榴皮6克，陈红茶6克。
二诊：根据其痛之时日延长，又曾数次发厥，其痛上及胃脘，牵及腰背，在成人亦当疑及虫积。
海南片9克，制乌梅6克，小青皮6克，杏仁泥12克，制黑丑9克，石榴皮9克，川楝子9克，羌活6克，旋覆花9克(包)。
3．某弟。满腹胀大，青筋暴露，形质日渐消瘦，无结核、肝硬化等病史，是虫积也。病者绍兴籍，恐是地方性之姜片虫病。
黑白丑各5克，槟榔9克，大戟5克，芫花6克，甘遂3克，鹤虱9克，芦荟3克，大枣12枚。
[按]姜片虫病是布氏姜片虫寄生在人体小肠所致的一种肠寄生虫病，以慢性腹泻、消化功能紊乱、营养不良等为主要临床表现。感染以5～20岁儿童和青年为多，主要流行于渐江绍兴、萧山一带。患儿虽有腹膨、青筋暴露、消瘦等证象，但无结核、肝硬化等病史，同时，又是绍兴籍，则姜片虫病最为可疑，故径予大队杀虫攻逐之品。
升麻5克，板蓝根9克，荆芥6克，僵蚕9克，浙贝9克，带皮槟榔6克，地枯萝9克，焦六曲9克，焦山楂9克。
2．林幼。右腮肿胀，咀嚼作痛，时作寒热，大便难。此病最近有流行。
荆芥6克，板蓝根6克，夏枯草9克，僵蚕9克，银花9克，小蓟9克，蚤休6克，桃仁12克，半枝莲15克，生草节3克，防风通圣丸12克(分吞)。
3．陈幼。发热起于昨夜，喉蛾发作，耳下腺亦发炎，风热上乘之候。
大贝母9克，薄荷6克，射干6克，大力子9克，僵蚕9克，玄参9克，赤芍9克，大青叶9克，板蓝根9克，白茅根30克(打)。
4．赵女。痄腮双发，曾有表证；表证退，痄腮仍未消失，清之。板蓝根9克，净连翘9克，紫丹参9克，大青叶9克，芦荟2．4克，忍冬藤12克，紫花地丁12克，炙僵蚕9克。
[按1痄腮即流行性腮腺炎。祖国医学认为系由温毒外袭，壅阻于少阳经所致，治疗主以普济消毒饮。李案因食滞便溏而兼用消导；林案以病情较重，增加了清热解毒药，更用防风通圣丸发表、清热、泻下，使表里双解；陈案喉蛾与痄腮同时发病，故兼用玄参、射干等清咽喉药；赵案表解后痄腮未消，重用清热解毒之剂。是为同中之异。
###############外科(8个门类)###################瘰疬
1．孙女。平素喉间多痰，左颈有小核，但不咳。最近3日痰多，夜间有倏忽无定之热。
大贝母9克，玉桔梗3克，冬桑叶9克，粉前胡9克，夏枯草9克，海藻9克，炙僵蚕9克，冬瓜子9克，甘草2．4克。
[按]瘰疬一证，多以痰火论治。此案平素喉间有痰，近三日痰多，夜间有不定之热，为瘰疬兼有外感。方用桑叶、前胡、桔梗微宜其表；冬瓜子、大贝母消痰；夏枯草、海藻、僵蚕散结。海藻与甘草同用，取其相反相成，以攻凝结之坚痰。
2．胡幼。患马刀挟瘿，历时已久，面色苍然，两颧发赤。调治失当，损怯之根萌也。
冬虫夏草30克，焙紫河车1具，炙鳖甲30克，水獭肝30克，淮山药30克，鹿衔草30克，京玄参30克，川贝母180克，煅牡蛎60克，淡海藻30克，淡昆布30克，夏枯草30克。共研末，和蜜为丸，如梧子大，每早晚服15粒，淡盐汤下。
[按]马刀挟瘿之名，始见于《灵枢》，云"其痈坚而不溃者，为马刀挟瘿"。证属瘰疬之一种，实多为淋巴结结核之属。此病例面色苍白，两颧发赤，是阴虚火旺之象，殆为结核性消耗热。方用冬虫夏草、紫河车、水獭肝等补益强壮之品，大补精血；以消瘰丸合海藻、昆布、夏枯草化痰软坚散结；鳖甲、玄参滋阴降火。
左牡蛎15克，浙贝母15克，生黄芪15克，京玄参15克，昆布30克，上肉桂15克，海藻30克，小蓟15克，淮山药30克。为末，作丸如梧子大，早晚各服10粒。
煅牡蛎15克，生黄芪9克，淮山药9克，夏枯草6克，昆布6克，海藻6克，炙鳖甲9克，京玄参9克，白术6克。
[按]方以消瘰疬为主，因便溏是脾虚，《医学心悟》消瘰丸中的浙贝、玄参均对便溏不利，故用黄芪、山药益脾升清，复加少量安桂以温脾阳。二诊瘰疬行将消退，便溏亦止，则去桂，一面补脾益气，一面消瘰散结。
京玄参60克，煅牡蛎90克，白归身60克，象贝母60克，炙鳖甲90克，淡苁蓉30克，仙鹤草60克，淮牛膝60克，夏枯草60克，獭肝1具(焙)。共研细末，炼蜜为丸，如梧子大，每饭后各服6克。
[按]苁蓉、淮牛膝功能填补肾精；獭肝古人用治肺痨，有补益强壮作用；当归活血；仙鹤草此处取其强壮作用；鳖甲养阴软坚；夏枯草清热散结，配合消瘰丸以除瘰疬。
5．王男。半年前曾患马刀挟瘿，尚未消失，复又痰中带红。今伤风匝月不除，两脉细数，实有大患潜伏。病者以肩胛胸背痛为苦。有不少损症，初起即以此为前驱。
远志肉5克，杭白芍9克，秦艽5克，蒸百部9克，炙鳖甲24克，旋覆花9克(包)，牡蛎24克，延胡索9克，芋艿丸9克(分2次吞)。
[按]马力挟瘿历半年不愈，复又痰中带血，为结核征象无疑。按其脉细数，证属阴虚而兼见伤风。秦艽、鳖甲滋阴退热，为治劳症伤风的要药；白芍和营益阴，牡蛎咸寒润下，得鳖甲相伍，可治痰中带红；百部能抗菌，与远志同用，为有效的止咳祛痰剂；旋覆花、延胡索通络定痛。芋艿丸(即食用芋艿干去皮研粉，加适量姜汁泛丸而成)能消痰散结，为治疗瘰疬的简便方。
6．张男。颈腋胯部皆生大小之核，推之可移，措置得当，亦能弭大患于无形。
生黄芪15克，杜仲9克，苁蓉9克，玄参12克，党参12克，甘杞子9克，全当归9克，煅牡蛎30克，淮山药15克，炙鳖甲24克，天麦冬各9克，五味子9克，淮牛膝9克，菟丝子9克，象贝母9克，大熟地24克，虎骨胶24克，阿胶30克。
7．蔡幼。马刀挟瘿，起于痧后，损之前驱，潮热、盗汗，更能使病势进展。
全当归6克，地骨皮9克，仙鹤草9克，夏枯草6克，秦艽5克，醋炒柴胡2．4克，瘪桃干5克，昆布5克，海藻5克。
8．沈弟。此方专为瘰疬而设，肛门作痒，多为蛲虫为患，当另治之。
全当归9克，黄芪9克，炙鳖甲15克，海藻12克，昆布12克，夏枯草9克，麦芽9克，芋艿丸9克。另：芫花、甘遂各60克，煎汤洗肛门。
昆布90克，京玄参120克，夏枯草90克，海藻90克，贝母90克，冬虫夏草90克，獭肝1具，脱力草150克，功劳叶150克，左牡蛎120克。共研细末，水泛为丸，日服3次，每次3克。
10．戴男。此种失音，属金破不鸣，何况再见鼻衄；颈间结核累累，非细故也。
北沙参6克，麦冬9克，五味子5克，阿胶珠9克，蜜炙兜铃9克，蜜炙牛蒡9克，肥玉竹9克，生侧柏叶30克，冬瓜子15克，白茅根1扎，仙鹤草12克。
[按]失音为肺金受损，以致阴虚无津上承。鼻衄为阴虚火旺，迫血妄行。颈间结核累累，亦与上症相关。方用生脉散合补肺阿胶汤加味、补肺阴、止鼻衄，以顾整体。
1．宋童。此古籍所谓流注，殆为骨结核之类，重症也。生麻黄2．4克，白芥子6克，肉桂末1．2克(分2次吞)，熟地15克，鹿角霜12克，炮姜炭3克，淮牛膝9克，独活6克，桑寄生12克，当归9克，威灵仙9克，粉草3克，小金丹1粒(化服)。
二诊；古人所谓阴证者，皮色不变而痛在经络骨节间，与痛风终日不休者不同，阴证转动则痛，用药当大补气血。
全当归12克，熟地24克，巴戟天9克，炮附片6克，生黄芪9克，补骨脂9克，鹿角霜9克，羌独活各5克，桑寄生12克，潞党参9克，小金丹1粒(化服)。
[按]此属阴证，治宜温补。初诊用阳和汤加味，温阳通络，定痛解凝。二诊重用大补阴阳气血之剂，辅以小金丹、羌独活散结定痛。此类证候多迁延日久，体虚不足抗病，非强壮补益，难以奏效。
2．陈女。右膝膑肌肉隆起，按之痛，皮色不变，此证古人称为流注，骨结核之类也。面色憔悴，咳而咽痛，两脉细数，端倪露矣。
炙鳖甲24克(先煎)，生熟地各12克，杜仲9克，左牡蛎30克(先煎)，当归9克，淮牛膝9克，桑寄生12克，鹿角霜9克，小金丹1粒(化服)，健步虎潜丸60克(分10次吞服)。
[按]病人虚损之途，以培本为主。面色憔悴，咳而咽痛，两脉细数，为一派阴虚之象，故方中寓以育阴潜阳之意，且咸寒之鳖甲、牡蛎又有软坚散结之功。
3．朱女。右臀从高处下坠，其骨脱臼，日久未能愈合，伤处作痛，不利于行。深虑骨骼腐蚀，转成骨痨。内服剂无非营养强壮之药。
全当归9克，杜仲9克，川续断9克，补骨脂9克，鹿角霜12克，落得打9克，炙乳没各3克，小金丹1粒(化服)。另：龙骨18克、虎骨30克、乌贼骨18克，三味炙研细末，每次和入饮食中少许。或用：川草乌各12克、杜红花9克、毛姜12克，煎汤熏洗患处。
[按]此伤久不愈，骨骼受损之症。案药以强健筋骨为主。龙骨、虎骨、乌贼骨并用，意在健骨护膜，促进伤口之愈合；川草乌、红
花、毛姜并用，煎汤熏洗，有活血镇痛之效。
[Commentary] In Mr. Chen's case, at the onset, Bupleuri Radix (Chaihu), Menthae Haplocalycis Herba (Bohe), and Bombyx Batryticatus (Jiangcan) were used for their acrid properties to disperse wind; Isatidis Folium (Daqingye), Isatis Root (Banlangen), Scrophulariae Radix (Xuanshen), and Belamcandae Rhizoma (Shegan) were used to clear heat and detoxify. In Mr. Wang's case, interior heat was blazing with difficulty in defecation; Liangge San (Cooling the Diaphragm Decoction) was used to clear heat and purge accumulation. I have seen such patients with swollen, red, and painful throats where even liquids are difficult to swallow; purgation removes most of the pain. This is the method of "treating upper diseases by lowering lower ones," akin to "removing firewood from under the cauldron." In Mr. Xie's case, the throat was red with a white pseudomembrane covering it, which needed differentiation from Diphtheria (Baihou): the pseudomembrane of diphtheria is not easily wiped off and bleeds easily; whereas in Mian E (tonsillitis), it is easily wiped off and does not bleed easily. At the first visit, methods to clear heat, detoxify, cool blood, and benefit the throat were used, and body heat subsided quickly. From this, it can be determined that it was not true diphtheria.
Food Stagnation
1. Child Cheng. Fever for 2 days, slippery and rapid pulse, greasy tongue coating, abdominal pain without defecation. This is an exterior contraction complicated by gastrointestinal disease; both exterior and interior should be resolved simultaneously.
Bupleuri Radix (Chaihu) 2.4g, Aurantii Fructus (Zhiqiao) 9g, Scutellariae Radix (Huangqin) 6g, Arecae Semen (Binglang) 9g, Forsythiae Fructum (Lianqiao) 9g, Raphani Radix (Dikuluoluo) 9g, Paris Polyphylla (Zaichou) 5g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao) 1.5g.
Second visit: Heat greatly subsided, stool passed, but abdominal pain persists, and appetite is poor. Focus on digestion and guiding out stagnation.
Paeoniae Radix Alba (Baishao), Citri Reticulatae Pericarpium Viride (Xiao Qingpi) 9g, Crataegi Fructus Carbonisatus (Shanzha Tan) 9g, Aurantii Fructus Immaturus (Zhishi) 5g, Arecae Pericarpium (Dafupi) 9g, Raphani Radix (Dikuluoluo) 9g, Hordeum Vulgare Germinatum (Maiya) 9g.
2. Child Wang. Solid accumulation brewing into heat; this heat often manifests in the late afternoon (Wei hour). Urine is dark, teeth grinding occurs during sleep. This cannot be rapidly effective with mere clearing or purging alone.
Aurantii Fructus Immaturus (Zhishi) 6g, Forsythiae Fructum (Lianqiao) 9g, Cassiae Tora Seed (Wangjiangnan) 9g, Cassiae Seed (Juemingzi) 9g, Picrorhizae Rhizoma (Huhuanglian) 2.4g, Arecae Semen (Binglang) 9g, Paris Polyphylla (Zaichou) 2.4g, Scutellariae Radix (Huangqin) 6g, Raw Rhei Radix et Rhizoma (Dasheng Huang) 3g (added later).
[Commentary] Pediatric cases most commonly involve simultaneous exterior and interior pathology. In Child Cheng's case, the combination of Chaihu and Zhiquiao deeply embodies the wonder of pushing out the old and generating the new. Chaihu can also promote bowel movement, which is a unique experience of the author. In Child Wang's case, heat arising in the late afternoon indicates food stagnation in the Yangming channel; general digestive herbs are ineffective, so Dasheng Huang, Binglang, Zaichou, and Huangqin were used to clear heat and purge.
3. Child Ge. Main symptoms: visible cyanotic veins (1); listless spirit (2); irregular bowel movements and urine resembling rice wash water (3); craving food but failing to gain muscle mass (4). This is injury from food, spleen dysfunction, leading to infantile malnutrition accumulation (Ganji).
Bran-fried Aurantii Fructus (Zhike) 9g, Raphani Semen (Laifuzi) 9g, Curcumae Rhizoma (Ezhu) 5g, Arecae Semen (Binglang) 9g, Prepared Strychnos Seed (Heichou) 6g, Dry Bufo Skin (Ganchanpi) 2.4g, Charred Crataegi Fructus (Jiaoshanzha) 9g, Fermented Rice Cake (Liuzuqu) 9g, Gleditsiae Spina (Zaojiao) 9g, (Sand of Bombyx Batryticatus 12g pounded together).
[Commentary] Infantile Ganji refers to chronic malnutrition caused by poor spleen and stomach transportation. The four points listed are common main symptoms of Ganji. The usual treatment prioritizes breaking up hardness and resolving accumulation, strengthening the spleen and aiding transportation, followed by tonifying and supporting healthy qi as aftercare. Ezhu moves qi and invigorates blood, reducing distension and resolving accumulation; Zaojiao is good at resolving phlegm and inhibiting intestinal pathogens. Their combination is a superb remedy for Ganji.
4. Child Zhu. Acute gastritis, frequent vomiting, high fever like steaming.
Coptidis Rhizoma (Yalianlian) 1.2g, Aurantii Fructus Immaturus (Zhishi) 9g, Trichosanthis Radix (Tianhuafen) 15g, Scutellariae Radix (Huangqin) 9g, Trichosanthis Fructus (Gualou) 12g, Anemarrhenae Rhizoma (Zhimu) 12g, Citri Reticulatae Pericarpium (Chenpi) 9g, Bambusae Mesocarpus (Zhuru) 5g.
Second visit: Acute gastritis, vomiting stopped after taking the above prescription; heat remains, inflammation has not cleared.
Artemisiae Annuae Herba (Qinghao) 9g, Lycii Cortex (Digupi) 9g, Lonicerae Japonicae Flos (Jinyinhua) 12g, Angustifoliae Radix (Baiwei) 9g, Armeniacae Semen Amarum (Xingrenni) 15g, Gardeniae Fructus (Zhizi) 9g, Light Bamboo Sap (Dan Zhuru) 6g, Imperatae Rhizoma (Maogen) and Phragmitis Rhizoma (Lugen) 30g each.
[Commentary] Frequent vomiting consumes stomach yin, hence Tianhuafen and Zhimu's cooling and moistening nature is used to nourish stomach yin; due to high fever like steaming, the bitter-cold Huangqin and Lianlian are used to drain heat; if rebellious qi is not directed downward, vomiting cannot stop, hence Zhishi, Gualou, Chenpi, and Zhuru are used to direct rebellious qi downward, harmonize the stomach, and stop vomiting. At the second visit, although vomiting stopped, heat did not recede, so the focus shifted to clearing heat and reducing inflammation. Maogen and Lugen are sweet-cool, nourish the stomach, and excel at clearing heat from the Qi level; they are excellent and accessible herbs.
Parasitic Accumulation
1. Child Xu. Hardness and intermittent pain in the lower abdomen indicate parasitic accumulation. Difficult and frequent urination is also caused by this.
Areca Seed (Hainanpian) 9g, Jiangzhishi 9g, Pomegranate Peel (Shiliupi) 6g, Red Poria (Chiling) 9g, Toosendan Fruit (Chuanlianzi) 9g, White Peony Root (Baishao) 9g, Mume Fruit (Wumei) 5g, Gourd Scoop (Hulupiao) 12g, Barley Sprout and Millet Sprout 9g each.
2. Girl Wu. Periumbilical pain lasting a month, varying in intensity without cessation, accompanied by syncope during pain attacks. Analgesics were ineffective; purgation was employed.
Areca Seed (Hainanpian) 9g, Citri Reticulatae Pericarpium (Qingpi) 6g, Prunus Sesquipedalis Seed (Yuliren) 12g, Hawthorn Flesh (Shanzhourou) 9g, Toosendan Fruit (Chuanlianzi) 9g, Raw Aurantii Fructus Immaturus (Zhishi) 6g, Aloe (Luhui) 5g, Black Strychnos Seed (Heichou) 6g, White Peony Root (Baishao) 9g, Mume Fruit (Wumei) 5g, Pomegranate Peel (Shiliupi) 6g, Aged Black Tea (Chenhongcha) 6g.
Second visit: Given the prolonged duration of pain and multiple episodes of syncope, with pain radiating to the epigastrium and lower back, parasitic accumulation should be suspected even in adults.
Areca Seed (Hainanpian) 9g, Processed Mume Fruit (Wumei) 6g, Young Citrus Peel (Xiao Qingpi) 6g, Armeniacae Semen Amarum (Xingrenni) 12g, Processed Black Strychnos Seed (Heichou) 9g, Pomegranate Peel (Shiliupi) 9g, Toosendan Fruit (Chuanlianzi) 9g, Notopterygii Rhizoma et Radix (Qianghuo) 6g, Inulae Flos (Xuanfuhua) 9g (wrapped).
3. Younger Brother. Abdominal distension and enlargement, visible cyanotic veins, progressive emaciation, no history of tuberculosis or liver cirrhosis; this is parasitic accumulation. The patient is from Shaoxing, suggesting possible Fasciolopsiasis (Fasciola hepatica infection).
Black and White Strychnos Seeds 5g each, Arecae Semen (Binglang) 9g, Euphorbiae Pekinensis Radix (Daji) 5g, Genkwa Flos (Yuanhua) 6g, Kansui Radix (Gansui) 3g, Carpesii Fructus (Heshi) 9g, Aloe (Luhui) 3g, Jujubae Fructus (Dazao) 12 pieces.
[Commentary] Fasciolopsiasis is an intestinal parasitic disease caused by *Fasciola buski* residing in the human small intestine, mainly manifesting as chronic diarrhea, digestive dysfunction, and malnutrition. Infection is most common in children and youths aged 5–20, primarily prevalent in Shaoxing and Xiaoshan, Zhejiang. Although the child presents with abdominal distension, visible veins, and emaciation, the absence of tuberculosis or liver cirrhosis history, combined with the Shaoxing origin, makes Fasciolopsiasis highly suspect. Thus, a large dose of anthelmintic and purgative herbs was administered directly.
Mumps (Zhasai)
Child Li. Mumps with fever, complicated by indigestion, abdominal distension, and loose stools.
Cimicifugae Rhizoma (Shengma) 5g, Isatis Root (Banlangen) 9g, Schizonepetae Spica (Jingjie) 6g, Bombyx Batryticatus (Jiangcan) 9g, Fritillariae Thunbergii Bulbus (Zhebei) 9g, Arecae Pericarpium with Skin (Daipibinglang) 6g, Raphani Radix (Dikuluoluo) 9g, Fermented Rice Cake (Jiaoliuzu) 9g, Charred Hawthorn (Jiaoshanzha) 9g.
2. Child Lin. Right cheek swelling, pain upon chewing, alternating chills and fever, difficulty defecating. This disease is currently epidemic.
Schizonepetae Spica (Jingjie) 6g, Isatis Root (Banlangen) 6g, Prunellae Spica (Xiakucao) 9g, Bombyx Batryticatus (Jiangcan) 9g, Lonicerae Japonicae Flos (Yinhua) 9g, Cirsii Japonici Herba (Xiaoji) 9g, Paris Polyphylla (Zaichou) 6g, Persicae Semen (Taoren) 12g, Scutellariae Barbatae Herba (Banzenlian) 15g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Caojie) 3g, Fangfeng Tongsheng Wan 12g (swallowed separately).
3. Child Chen. Fever started last night, tonsillar inflammation (Hou'e) occurred, parotid glands also inflamed; signs of wind-heat attacking upwards.
Fritillariae Cirrhosae Bulbus (Dabeimu) 9g, Menthae Haplocalycis Herba (Bohe) 6g, Belamcandae Rhizoma (Shegan) 6g, Arctii Fructum (Dalizi) 9g, Bombyx Batryticatus (Jiangcan) 9g, Scrophulariae Radix (Xuanshen) 9g, Red Peony Root (Chishao) 9g, Isatidis Folium (Daqingye) 9g, Isatis Root (Banlangen) 9g, Imperatae Rhizoma (Baimaogen) 30g (crushed).
4. Woman Zhao. Bilateral mumps, preceded by exterior syndrome; after exterior syndrome resolved, mumps persisted; treated with clearing. Isatis Root (Banlangen) 9g, Clean Forsythiae Fructum (Lianqiao) 9g, Salviae Miltiorrhizae Radix (Danshen) 9g, Isatidis Folium (Daqingye) 9g, Aloe (Luhui) 2.4g, Lonicerae Japonicae Caulis (Rendongteng) 12g, Viola Yedoensis Herba (Zihuadiding) 12g, Processed Bombyx Batryticatus (Jiangcan) 9g.
[Commentary 1] Zhasai refers to epidemic parotitis. Traditional Chinese Medicine attributes it to warm-toxin invading externally and obstructing the Shaoyang channel. The primary treatment is Puji Xiaodu Yin. In Child Li's case, food stagnation with loose stools required concurrent digestive herbs; in Child Lin's case, the condition was severe, requiring added heat-clearing and detoxifying herbs, plus Fangfeng Tongsheng Wan to release the exterior, clear heat, and purge, achieving simultaneous resolution of exterior and interior; in Child Chen's case, tonsillitis and mumps occurred simultaneously, so Xuanshen and Shegan were added to clear the throat; in Woman Zhao's case, after the exterior resolved, mumps persisted, so heavy doses of heat-clearing and detoxifying agents were used. This illustrates differences within similarities.
###############Surgery (8 Categories)###################Scrofula (Luoli)
1. Granddaughter. Usually has much phlegm in the throat, small nodules on the left neck, but no cough. For the past 3 days, increased phlegm and intermittent night fevers.
Fritillariae Thunbergii Bulbus (Dabeimu) 9g, Platycodonis Radix (Jiegeng) 3g, Mori Folium (Sangye) 9g, Peucedani Radix (Qianhu) 9g, Prunellae Spica (Xiakucao) 9g, Sargassum (Haizao) 9g, Processed Bombyx Batryticatus (Jiangcan) 9g, Benincasae Semen (Dongguazi) 9g, Glycyrrhizae Radix et Rhizoma (Gancao) 2.4g.
[Commentary] Scrofula is usually treated as phlegm-fire. In this case, chronic phlegm in the throat, recent increase in phlegm, and intermittent night fevers indicate scrofula complicated by exterior contraction. Sangye, Qianhu, and Jiegeng slightly release the exterior; Dongguazi and Dabeimu resolve phlegm; Xiakucao, Haizao, and Jiangcan dissipate nodules. Haizao and Gancao are used together for their antagonistic synergy to attack hard, congealed phlegm.
2. Child Hu. Had Madao Jia Ying (scrofula with goiter) for a long time, pale complexion, red malar flush. Improper treatment has sown the roots of deficiency and weakness.
Cordyceps Sinensis (Dongchongxiacao) 30g, Roasted Placenta Human (Ziheche) 1 unit, Processed Testudinis Carapax et Plastrum (Biejia) 30g, Lutrae Liver (Shuitagan) 30g, Dioscoreae Hypoglaucae Rhizoma (Huaiyshen) 30g, Daphne Genkwa (Luxiancao) 30g, Jing Xuanshen 30g, Chuan Beimu 180g, Calcined Ostreae Concha (Mu li) 60g, Light Sargassum (Haizao) 30g, Light Eckloniae Thallus (Kunbu) 30g, Prunellae Spica (Xiakucao) 30g. Pulverized, mixed with honey into pills the size of wu zi, take 15 pills morning and evening with light salt water.
[Commentary] The term Madao Jia Ying first appears in *Ling Shu*, stating "hard abscesses that do not ulcerate are called Madao Jia Ying." It belongs to scrofula, mostly corresponding to lymph node tuberculosis. The patient's pale face and red malar flush indicate yin deficiency with hyperactive fire, likely tuberculous consumption fever. Cordyceps, Ziheche, and Shuitagan are strong tonics to greatly repleness essence and blood; Xiaoluo Wan combined with Haizao, Kunbu, and Xiakucao resolves phlegm, softens hardness, and dissipates nodules; Biejia and Xuanshen nourish yin and descend fire.
3. Child Yuan. Scrofula like beads, stabilized after medication, no longer growing, loose stools reduced.
Left Ostreae Concha (Muli) 15g, Zhe Beimu 15g, Raw Astragali Radix (Huangqi) 15g, Jing Xuanshen 15g, Eckloniae Thallus (Kunbu) 30g, Cinnamomi Cortex (Rougui) 15g, Sargassum (Haizao) 30g, Cirsii Japonici Herba (Xiaoji) 15g, Dioscoreae Hypoglaucae Rhizoma (Huaiyshen) 30g. Pulverized, made into pills the size of wu zi, take 10 pills morning and evening.
Second visit: Scrofula about to subside, loose stools stopped, very gratifying, still pay attention to nutrition.
Calcined Ostreae Concha (Muli) 15g, Raw Astragali Radix (Huangqi) 9g, Dioscoreae Hypoglaucae Rhizoma (Huaiyshen) 9g, Prunellae Spica (Xiakucao) 6g, Eckloniae Thallus (Kunbu) 6g, Sargassum (Haizao) 6g, Processed Testudinis Carapax et Plastrum (Biejia) 9g, Jing Xuanshen 9g, Atractylodis Macrocephalae Rhizoma (Baizhu) 6g.
[Commentary] The formula focuses on resolving scrofula. Since loose stools indicate spleen deficiency, and Zhebei and Xuanshen in Xiaoluo Wan (*Yixue Xinwu*) are unfavorable for loose stools, Huangqi and Huaiyshen were used to benefit the spleen and raise clear yang, plus a small amount of Rougui to warm spleen yang. At the second visit, scrofula is subsiding and loose stools have stopped, so Rougui is removed to tonify spleen qi while resolving scrofula and dissipating nodules.
4. Child Fang. After taking tonic agents, scrofula improved by 70-80%. The previous formula was strengthened and taken regularly as pills.
Jing Xuanshen 60g, Calcined Ostreae Concha (Muli) 90g, Angelicae Sinensis Radix (Baiguishen) 60g, Xiang Beimu 60g, Processed Testudinis Carapax et Plastrum (Biejia) 90g, Cistanche Deserticola (Rongrong) 30g, Agrimoniae Herba (Xianhecao) 60g, Achyranthes Bidentatae Radix (Huainiuxi) 60g, Prunellae Spica (Xiakucao) 60g, Otari Liver (Tagan) 1 unit (roasted). Pulverized finely, refined honey into pills the size of wu zi, take 6g after each meal.
[Commentary] Rongrong and Huainiuxi fill kidney essence; Tagan was used by ancients for pulmonary tuberculosis, having tonic effects; Danggui invigorates blood; Xianhecao is used here for its tonic effect; Biejia nourishes yin and softens hardness; Xiakucao clears heat and dissipates nodules. Combined with Xiaoluo Wan to eliminate scrofula.
5. Male Wang. Had Madao Jia Ying half a year ago, not yet resolved, now hemoptysis. Caught a cold for a month without relief, fine and rapid pulses, indicating a major hidden pathology. Patient suffers from scapular and chest/back pain. Many consumptive diseases start with these as prodromes.
Polygalae Radix (Yuanzhi) 5g, Hang Baishao 9g, Gentianae Macrophyllae Radix (Qinjiao) 5g, Steamed Stemona Radix (Baibu) 9g, Processed Testudinis Carapax et Plastrum (Biejia) 24g, Inulae Flos (Xuanfuhua) 9g (wrapped), Ostreae Concha (Muli) 24g, Corydalis Rhizoma (Yanhusuo) 9g, Colocasia Esculenta Pill (Yunai Wan) 9g (swallowed in 2 doses).
[Commentary] Madao Jia Ying persisting for half a year with hemoptysis is undoubtedly a sign of tuberculosis. Fine and rapid pulse indicates yin deficiency with wind-cold. Qinjiao and Biejia nourish yin and reduce fever, essential herbs for treating consumptive disease with wind-cold; Baishao harmonizes nutritive qi and benefits yin; Muli is salty and cold, directing downward; combined with Biejia, it treats hemoptysis; Baibu has antibacterial properties, combined with Yuanzhi, it is an effective antitussive and expectorant; Xuanfuhua and Yanhusuo unblock collaterals and relieve pain. Yunai Wan (made from dried taro powder mixed with ginger juice) resolves phlegm and dissipates nodules, a simple formula for scrofula.
6. Male Zhang. Nodules of various sizes in neck, axilla, and groin, movable upon pushing. Proper management can prevent major disasters invisibly.
Raw Astragali Radix (Huangqi) 15g, Eucommiae Cortex (Duzhong) 9g, Cistanche Deserticola (Rongrong) 9g, Scrophulariae Radix (Xuanshen) 12g, Codonopsis Radix (Dangshen) 12g, Lycii Fructus (Gouqi) 9g, Whole Angelicae Sinensis Radix (Danggui) 9g, Calcined Ostreae Concha (Muli) 30g, Dioscoreae Hypoglaucae Rhizoma (Huaiyshen) 15g, Processed Testudinis Carapax et Plastrum (Biejia) 24g, Ophiopogonis Radix and Asparagi Radix 9g each, Schisandrae Fructus (Wuweizi) 9g, Achyranthes Bidentatae Radix (Huainiuxi) 9g, Cuscutae Semen (Tusizi) 9g, Xiang Beimu 9g, Rehmanniae Radix Preparata (Shudi) 24g, Osteum Tigris Colla (Hugu Jiao) 24g, Asini Corii Colla (Ejiao) 30g.
[Commentary] This uses tonic agents, aiming at the root cause of scrofula treatment.
7. Child Cai. Madao Jia Ying, starting after chickenpox, a precursor to consumption, tidal fever, and night sweats, further advancing the disease.
Whole Angelicae Sinensis Radix (Danggui) 6g, Lycii Cortex (Digupi) 9g, Agrimoniae Herba (Xianhecao) 9g, Prunellae Spica (Xiakucao) 6g, Gentianae Macrophyllae Radix (Qinjiao) 5g, Vinegar-fried Bupleuri Radix (Chaihu) 2.4g, Dried Peach (Bitaogan) 5g, Eckloniae Thallus (Kunbu) 5g, Sargassum (Haizao) 5g.
8. Younger Shen. This formula is specifically for scrofula. Anal pruritus is mostly caused by pinworms, which should be treated separately.
Whole Angelicae Sinensis Radix (Danggui) 9g, Astragali Radix (Huangqi) 9g, Processed Testudinis Carapax et Plastrum (Biejia) 15g, Sargassum (Haizao) 12g, Eckloniae Thallus (Kunbu) 12g, Prunellae Spica (Xiakucao) 9g, Hordeum Vulgare Germinatum (Maiya) 9g, Colocasia Esculenta Pill (Yunai Wan) 9g. Additionally: Genkwa Flos (Yuanhua) and Kansui Radix (Gansui) 60g each, decocted for washing the anus.
9. Male Qian. Mucus in stool is unimportant; importantly, scrofula is not resolving.
Eckloniae Thallus (Kunbu) 90g, Jing Xuanshen 120g, Prunellae Spica (Xiakucao) 90g, Sargassum (Haizao) 90g, Fritillariae Bulbus (Beimu) 90g, Cordyceps Sinensis (Dongchongxiacao) 90g, Otari Liver (Tagan) 1 unit, Tuolicao 150g, Ligustrum Lucidum Folium (Gaolaoye) 150g, Left Ostreae Concha (Muli) 120g. Pulverized finely, water-pilled, take 3 times daily, 3g each time.
10. Male Dai. This aphonia belongs to "broken metal not sounding"; moreover, epistaxis recurs; cervical lymphadenopathy is serious.
Glehniae Radix (Beishashen) 6g, Ophiopogonis Radix (Maidong) 9g, Schisandrae Fructus (Wuweizi) 5g, Ejiao Pearl (Ejiaozhu) 9g, Honey-fried Campanulae Fructus (Dailing) 9g, Honey-fried Arctii Fructum (Niubangzi) 9g, Polygonati Odorati Rhizoma (Yuzhu) 9g, Raw Platycladi Cacumen (Ce Baiye) 30g, Benincasae Semen (Dongguazi) 15g, Imperatae Rhizoma (Baimaogen) 1 bunch, Agrimoniae Herba (Xianhecao) 12g.
[Commentary] Aphonia results from lung metal damage, leading to yin deficiency and lack of fluids ascending. Epistaxis is due to yin deficiency with hyperactive fire forcing blood to move recklessly. Cervical lymphadenopathy is related to the above symptoms. The formula uses Shengmai San combined with modified Bufei Ejiao Tang to tonify lung yin and stop epistaxis, attending to the whole body.
Flowing Abscess (Liuzhu)
1. Child Song. The "flowing abscess" mentioned in ancient texts is likely bone tuberculosis, a severe condition. Raw Ephedrae Herba (Mahuang) 2.4g, Sinapis Albae Semen (Baijiezi) 6g, Cinnamon Bark Powder (Rougui) 1.2g (swallowed in 2 doses), Prepared Rehmanniae Radix (Shudi) 15g, Cornus Officinalis Antler Frost (Lujiaoshuang) 12g, Fried Ginger Charcoal (Paojiangtan) 3g, Achyranthes Bidentatae Radix (Huainiuxi) 9g, Notopterygii Rhizoma et Radix (Duhuo) 6g, Taxilli (Sangjisheng) 12g, Angelicae Sinensis Radix (Danggui) 9g, Spirit Flower Vine (Weilingxian) 9g, Licorice (Fencao) 3g, Xiaojin Dan 1 pill (dissolved and taken).
Second visit: Ancient "yin syndromes" refer to unchanged skin color with pain in meridians and joints, different from gout that lasts all day. Yin syndrome pain worsens with movement; medication should greatly tonify qi and blood.
Whole Angelicae Sinensis Radix (Danggui) 12g, Prepared Rehmanniae Radix (Shudi) 24g, Morinda Officinalis Radix (Bajitian) 9g, Prepared Aconiti Lateralis Radix (Paofupian) 6g, Raw Astragali Radix (Huangqi) 9g, Psoraleae Fructus (Buguzhi) 9g, Cornus Officinalis Antler Frost (Lujiaoshuang) 9g, Notopterygii Rhizoma et Radix and Angelicae Dahuricae Radix (Qiangduhuo) 5g each, Taxilli (Sangjisheng) 12g, Codonopsis Radix (Dangshen) 9g, Xiaojin Dan 1 pill (dissolved and taken).
[Commentary] This is a yin syndrome, suitable for warming and tonifying. First visit used Yanghe Tang modified to warm yang, unblock collaterals, relieve pain, and dissolve coagulation. Second visit heavily used agents to tonify yin, yang, qi, and blood, assisted by Xiaojin Dan and Qiangduhuo to dissipate nodules and relieve pain. Such conditions often drag on; the body is too weak to resist disease, so strong tonification is necessary for efficacy.
2. Female Chen. Right knee patella muscle bulges, painful on pressure, skin color unchanged. Ancients called this "flowing abscess," likely bone tuberculosis. Haggard complexion, cough with sore throat, fine and rapid pulses, early signs revealed.
Processed Testudinis Carapax et Plastrum (Biejia) 24g (decocted first), Raw and Prepared Rehmanniae Radix 12g each, Eucommiae Cortex (Duzhong) 9g, Left Ostreae Concha (Muli) 30g (decocted first), Angelicae Sinensis Radix (Danggui) 9g, Achyranthes Bidentatae Radix (Huainiuxi) 9g, Taxilli (Sangjisheng) 12g, Cornus Officinalis Antler Frost (Lujiaoshuang) 9g, Xiaojin Dan 1 pill (dissolved and taken), Jianbu Huqian Wan 60g (swallowed in 10 doses).
[Commentary] For patients on the path of deficiency, rooting is primary. Haggard complexion, cough with sore throat, and fine/rapid pulses indicate yin deficiency. Thus, the formula contains ideas of nourishing yin and subduing yang; additionally, the salty-cold Biejia and Muli soften hardness and dissipate nodules.
3. Female Zhu. Fell from height onto right buttock, bone dislocation, not healing for a long time, pain at injury site, difficulty walking. Deeply worried about bone corrosion turning into bone tuberculosis. Internal medicine consists only of nutritional and tonic agents.
Whole Angelicae Sinensis Radix (Danggui) 9g, Eucommiae Cortex (Duzhong) 9g, Teasel Root (Xuduan) 9g, Psoraleae Fructus (Buguzhi) 9g, Cornus Officinalis Antler Frost (Lujiaoshuang) 12g, Luodeda 9g, Processed Frankincense and Myrrh 3g each, Xiaojin Dan 1 pill (dissolved and taken). Additionally: Dragon Bone (Longgu) 18g, Tiger Bone (Hugu) 30g, Cuttlefish Bone (Wuzhegu) 18g, roasted and pulverized, mix a little into food each time. Or: Aconitum Carmichaelii Root and Aconitum Kusnezoffii Root (Chuan Caowu) 12g each, Safflower (Honghua) 9g, Polyporus Umbellatus (Maojiang) 12g, decocted for fumigation and washing the affected area.
[Commentary] This is a long-standing injury with bone damage. The prescription focuses on strengthening bones and sinews. Longgu, Hugu, and Wuzhegu are used together to strengthen bones and protect membranes, promoting wound healing; Chuan Caowu, Honghua, and Maojiang decocted for fumigation/washing have blood-invigorating and analgesic effects.
Eczema