瘰 生于耳前后项腋间，与结核相似，初起小块，渐大如桃核，皮色不变，连缀不一，有单窠 ，难治。
宜小犀角丸。遍绕
颈项，为蛇蟠 ，消毒化坚汤。外起一 ，中裹十数核块，为莲子 ，宜内消丸，琥珀散。初止单窠，后乃叠
出，为重台 ∶形似燕窝，为燕窝 。皆不治。初生项后，流注四肢，为流注 。夏枯草散。症由肝胆三焦风
热血燥，及肝肾阴虚生热，忧思恚怒气结而成。《外台秘要》云∶肝肾虚热则生 。《病机》云∶瘰 不系膏
粱丹热之变，因虚劳气郁所致。宜补形气，调经脉，自愈。不得妄汗妄下，致虚虚之祸。初起寒热拘急肿痛，
邪在表也，宜荆防败毒散。用蒜饼安 核上，艾灸六七壮，可消软。外用敷瘰方，内服立效散。若患顶软脓成，
针之，外贴琥珀膏，内服托里散。若结核 肿，肝经风热也，栀子清肝汤加龙胆草。发热抽痛，肝经血燥也，
加味逍遥散。脉弦尺数，肝肾阴亏也，地黄丸加白芍、五味。 核坚而不移者，连翘散坚汤，海藻溃坚汤。
怒伤肝火筋挛者，柴胡清肝汤。郁伤心脾掣痛者，归脾汤， 、术、草生用。气血俱虚，脓汁清稀者，八
珍汤加生 。经久不愈，体羸自汗出，保元汤加熟地、白芍、五味。妇女项 ，流注遍体，孔窍相穿，脓水淋
漓者，化气调经汤。溃久疮口不敛者，先服益气养营汤，次服十全大补汤加香附、贝母、远志肉。气血
已复， 核不去者，用必效散。丹溪云∶治 用必效散与栝蒌散间服，神效。疮口敛后，再服益气养营汤。男
子患此，忌潮热咳嗽，加味地黄丸。妇人患此，忌潮热经闭，但以加味逍遥散加泽兰、牛膝解郁调经。立斋谓∶
坚而不溃，溃而不敛，皆由于气血不足，不加调补，变为瘵症。朝用补中益气汤，夕用六味地黄丸。若发寒
热，眼内有赤脉贯瞳人者，死不治。结核经年，不红不痛，坚而难移，久而渐肿疼者，为痰核，多生耳项肘
腋等处，宜消核丸。专由肝胆经气郁痰结，毒根深固，不易消溃，未溃前忌贴凉膏。外宜山药膏。忌服凉剂。
内宜养营汤。全生内消法，用阳和犀黄丸。王维德着《外科症治全生集》。若坚久难消，咸以软之，海带
丸。寒凝气滞，温以散之，夏枯草、白芥子、浓朴、半夏、橘红、生香附。风痰郁结成核，搜而逐之，消风
化痰丸。气火烁筋为痛，清以泄之，钩藤、山栀、生地、丹皮、贝母、连翘。血结入络为肿，咸辛通理之，旋
复花汤加当归尾、延胡。肿痛溃脓不痊，和之。内托
白蔹散。生耳项，加钩藤、川芎、连翘、夏枯草。生肘臂，加姜黄、桑条、桂枝。生两腋，加柴胡、青皮、
白芥子。生遍体，多是痰注，竹沥达痰丸。溃久不愈，照瘰 治法。
更有瘿瘤初生，如梅李状，皮嫩而光，渐如杯卵。瘿生肩项，瘤随处皆有，其症属五脏，其原由肝火。
瘿有五∶筋瘿者，筋脉呈露，宜玉壶散、破结散。血瘿者，赤脉交络，宜化瘿丹合四物汤。肉瘿者，皮色不变，
宜人参化瘿丹。气瘿者，随忧思消长，宜白头翁丸、消瘿散、归脾丸。石瘿者，坚硬不移，宜破结散。瘤有五∶
筋瘤者，自筋肿起，按之如筋，或有赤缕。此怒动肝火，血涸而筋挛也，六味丸，或四物汤，加山栀、木瓜。
血瘤者，自肌肉肿起，久而现赤缕，或皮色赤，此劳役动火，血沸而邪搏也，四物汤加茯苓、远志。肉瘤者，
自肌肉肿起，按之实软。此郁结伤脾，肌肉伤而邪搏也，归脾汤、补中益气汤。气瘤者，自皮肤肿起，按之浮
软，此劳伤肺气，腠疏而邪搏也，补中益气汤。骨瘤者，自骨肿起，按之坚硬，此房劳肾伤，阴虚不荣骨也，
六味丸。外有脓瘤，宜海藻丸。石瘤，神效开结散∶一井散。脂瘤，用针挑去脂粉自愈。凡瘿瘤皆忌决破，
令脓血崩溃，多致夭枉。宜敷桃花散，止血药。惟脂粉瘤红色，全是痰结，可决去脂粉。又有形似垂茄，
根甚小者，用五灰膏点其蒂。俟茄落，以生猪脂贴自愈。又有手背生瘤，如鸡距，如羊角，向明照之如桃胶，
名胶瘤，以排针刺破，按出脓立平。生于面名粉瘤，海藻浸酒饮。有翻花瘤，用马齿苋烧灰，研猪脂调服。
立斋云∶瘤者留也，随气留滞，皆因脏腑受伤，气血乖违。当求其属而治其本，勿用蛛丝缠芫花腺等治。又
有毒坚如石，形长似蛤，疮名马刀，亦属肝胆三焦经部分，浸及太阳阳明，流注胸胁腋下，不论未溃已溃，
用鲜夏枯草熬膏服，并敷患处。初起气血未损，用立应散一钱，浓煎木通汤下。毒从小便出如粉片血块是也，
倘小便涩，用益元散，煎灯芯汤调下。宣毒后，接服薄荷丹。疏散风热。若肿犹不消，海藻溃坚汤、消肿汤。
气血已亏，补中胜毒饼。溃久不愈，根据前瘰 法治。
Luo Li (Scrofula) occurs around the ears, posterior neck, and axillae, resembling Tuberculosis (Jie He). Initially presenting as small lumps, they gradually enlarge to the size of a peach pit. The skin color remains unchanged, and the distribution varies; solitary locules are difficult to treat.
Xiao Xi Jiao Wan (Small Rhinoceros Horn Pill) is indicated. When lumps encircle the neck, it is called She Pan Luo Li (Snake-Coiling Scrofula), treated with Xiao Du Hua Jian Tang (Detoxification and Hardness-Resolving Decoction). If an external protrusion contains numerous internal nodules, it is called Lian Zi Luo Li (Lotus Seed Scrofula), treated with Nei Xiao Wan (Internal Resolution Pill) or Hu Po San (Amber Powder). If starting as a single locule and later appearing in layers, it is called Chong Tai Luo Li (Double-Terrace Scrofula); if resembling a swallow's nest, it is called Yan Wo Luo Li (Swallow's Nest Scrofula). Both are considered incurable.
If occurring initially at the back of the neck and spreading to the limbs, it is called Liu Zhu Luo Li (Flowing-Note Scrofula), treated with Xia Ku Cao San (Prunella Powder). This condition arises from Wind-Heat and Blood Dryness in the Liver, Gallbladder, and San Jiao (Triple Burner), combined with Yin Deficiency generating Heat in the Liver and Kidneys, exacerbated by worry, anger, and Qi stagnation. *Waitai Mi Yao* states: "Liver and Kidney deficiency-heat generates Luo Li." *Bing Ji* states: "Luo Li is not caused by rich food or Dantian heat toxicity, but by consumption and Qi stagnation." Treatment should tonify the body's Qi and regulate meridians for spontaneous recovery. Do not use reckless sweating or purging methods, which cause the harm of "deficiency making deficiency worse."
In the early stage, with chills, fever, stiffness, and swelling/pain, the pathogen is in the Exterior; Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxicity) is indicated. Apply garlic cake on the nodule and moxibustion for 6-7 cones to reduce softening. Externally apply Fu Luo Fang (Scrofula Compress Formula), internally take Li Xiao San (Instant Efficacy Powder). If the lesion softens indicating pus formation, puncture it, externally apply Hu Po Gao (Amber Plaster), and internally take Tuo Li San (Support the Interior Powder). If tubercles are red and swollen, it indicates Liver Meridian Wind-Heat; Zhi Zi Qing Gan Tang (Gardenia Clearing Liver Decoction) with Long Dan Cao (Gentian Root) is used. With fever and twitching pain, it indicates Liver Meridian Blood Dryness; Jia Wei Xiao Yao San (Modified Free Wanderer Powder) is used. With a wiry pulse and rapid chi position, it indicates Liver-Kidney Yin Deficiency; Di Huang Wan (Rehmannia Pill) with Bai Shao (White Peony Root) and Wu Wei Zi (Schisandra Berry) is used. For hard, immobile nodules, Lian Qiao San Jian Tang (Forsythia Hardness-Resolving Decoction) and Hai Zao Kui Jian Tang (Sargassum Hardness-Resolving Decoction) are used.
For anger injuring Liver Fire causing tendon spasms, Chai Hu Qing Gan Tang (Bupleurum Clearing Liver Decoction) is used. For depression injuring Heart-Spleen causing pulling pain, Gui Pi Tang (Restore the Spleen Decoction) is used, with Ren Shen (Ginseng), Bai Zhu (Atractylodes), and Gan Cao (Licorice) raw. For dual Qi and Blood deficiency with thin pus, Ba Zhen Tang (Eight Treasures Decoction) with Sheng Huang Qi (Raw Astragalus) is used. For chronic non-healing cases with emaciation and spontaneous sweating, Bao Yuan Tang (Protect the Origin Decoction) with Shu Di Huang (Prepared Rehmannia), Bai Shao, and Wu Wei Zi is used. For women with neck lesions spreading throughout the body with perforating orifices and dripping pus, Hua Qi Tiao Jing Tang (Transform Qi Regulate Menses Decoction) is used. For ulcers that fail to close after a long time, first take Yi Qi Yang Ying Tang (Tonify Qi Nourish Nutrient Decoction), then Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) with Xiang Fu (Cyperus), Bei Mu (Fritillaria), and Yuan Zhi Rou (Polygala Flesh). Once Qi and Blood are restored but nodules remain, Bi Xiao San (Must-Efficacy Powder) is used. Danxi stated: Alternating Bi Xiao San and Gua Lou San (Trichosanthes Powder) yields miraculous results. After wound closure, resume Yi Qi Yang Ying Tang. For men with this condition accompanied by tidal fever and cough, Jia Wei Di Huang Wan (Modified Rehmannia Pill) is contraindicated/used cautiously. For women with tidal fever and amenorrhea, Jia Wei Xiao Yao San with Ze Lan (Lygodium Spore) and Niu Xi (Achyranthes Root) is used to resolve depression and regulate menses. Lizhai stated: Hardness without ulceration or ulceration without healing stems from Qi and Blood insufficiency; without tonification, it transforms into Zhai Syndrome (Consumption Disease). Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) in the evening. If chills, fever, and red vessels piercing the pupil occur, it is a fatal, untreatable condition.
Tubercles persisting for years, non-red, non-painful, hard and immobile, becoming swollen and painful over time, are called Tan He (Phlegm Nodules), often occurring around ears, neck, elbows, and axillae. Xiao He Wan (Nodule-Resolving Pill) is indicated. These result specifically from Liver-Gallbladder Qi stagnation and Phlegm binding, with deep-rooted toxicity resistant to resolution. Before ulceration, cool plasters are forbidden. Externally use Shan Yao Gao (Dioscorea Plaster). Cool agents are forbidden internally; Yang Ying Tang (Nourish Nutrient Decoction) is preferred. The Quansheng School's internal resolution method uses Yang He Tang (Yang Harmony Decoction) combined with Xi Huang Wan (Calves' Musk Pill). Wang Weide authored *Waike Zhengzhi Quansheng Ji*. For hard, long-standing nodules difficult to resolve, salty substances soften them, e.g., Hai Dai Wan (Kelp Pill). For Cold coagulation and Qi stagnation, warm agents disperse them, e.g., Xia Ku Cao, Bai Jie Zi, Hou Po, Ban Xia, Ju Hong, Sheng Xiang Fu. For Wind-Phlegm郁结 forming nodules, search and expel them using Xiao Feng Hua Tan Wan (Eliminate Wind Transform Phlegm Pill). For Qi-Fire scorching tendons causing pain, clear and drain using Gou Teng, Shan Zhi, Sheng Di, Dan Pi, Bei Mu, Lian Qiao. For Blood binding entering collaterals causing swelling, use salty-sweet regulation, e.g., Xuan Fu Hua Tang (Inula Flower Decoction) with Dang Gui Wei (Angelica Tail) and Yan Hu (Corydalis). For persistent swelling, pain, and pus, harmonize using Tuo Li Bai Lian San (Support Interior White Bletilla Powder). Add Gou Teng, Chuan Xiong, Lian Qiao, Xia Ku Cao for ear/neck locations; add Jiang Huang, Sang Tiao, Gui Zhi for elbow/arm locations; add Chai Hu, Qing Pi, Bai Jie Zi for axillary locations; for whole-body occurrence, likely Phlegm Note, use Zhu Li Da Tan Wan (Bamboo Juice Expelling Phlegm Pill). For chronic ulcers, follow Luo Li treatment protocols.
Regarding Ying Liu (Goiter and Tumors): Initial growth resembles plum or apricot, with tender, shiny skin, gradually enlarging like a cup or egg. Ying occurs on shoulders/neck; Liu can occur anywhere. Symptoms belong to the Five Zang organs, originating from Liver Fire.
Ying has five types: Jin Ying (Sinew Goiter) shows exposed sinews, treated with Yu Hu San (Jade Pot Powder) or Po Jie San (Break Knots Powder). Xue Ying (Blood Goiter) shows intersecting red veins, treated with Hua Ying Dan (Resolve Goiter Pellet) combined with Si Wu Tang (Four Substances Decoction). Rou Ying (Flesh Goiter) has unchanged skin color, treated with Ren Shen Hua Ying Dan (Ginseng Resolve Goiter Pellet). Qi Ying fluctuates with worry/thought, treated with Bai Tou Weng Wan (Patrinia Pill), Xiao Ying San (Reduce Goiter Powder), or Gui Pi Wan (Restore Spleen Pill). Shi Ying (Stone Goiter) is hard and immobile, treated with Po Jie San.
Liu has five types: Jin Liu (Sinew Tumor) swells from sinews, feels like sinews upon pressure, may have red threads. Caused by anger moving Liver Fire, blood depletion, and sinew spasm; treated with Liu Wei Wan or Si Wu Tang plus Shan Zhi, Mu Gua. Xue Liu (Blood Tumor) swells from muscle, develops red threads or red skin over time. Caused by labor stirring fire, boiling blood, and evil binding; treated with Si Wu Tang plus Fu Ling, Yuan Zhi. Rou Liu (Flesh Tumor) swells from muscle, feels solid yet soft. Caused by depression injuring Spleen, muscle damage, and evil binding; treated with Gui Pi Tang or Bu Zhong Yi Qi Tang. Qi Liu (Qi Tumor) swells from skin, feels floating and soft. Caused by labor injuring Lung Qi, loose pores, and evil binding; treated with Bu Zhong Yi Qi Tang. Gu Liu (Bone Tumor) swells from bone, feels hard. Caused by sexual excess injuring Kidney, Yin deficiency failing to nourish bone; treated with Liu Wei Wan. Additionally, Nong Liu (Pus Tumor) is treated with Hai Zao Wan. Shi Liu (Stone Tumor) uses Shen Xiao Kai Jie San or Yi Jing San. Zhi Liu (Fat Tumor) heals spontaneously after needle extraction of fat powder. All Ying and Liu are forbidden from being lanced, lest pus and blood collapse leading to premature death. Apply Tao Hua San (Peach Blossom Powder, a hemostatic agent). Only Zhi Fen Liu (Fat-Powder Tumor) is red due to pure Phlegm binding and can be lanced to remove fat powder. Another type resembles hanging eggplant with a small root; apply Wu Hui Gao (Five Ashes Plaster) to the stalk. After falling off, apply fresh pork fat for self-healing. Tumors on the back of the hand resembling chicken spurs or sheep horns, looking like peach gum in light, are named Jiao Liu (Glue Tumor); puncture with multiple needles, squeeze out pus for immediate relief. Those on the face are Fen Liu (Powder Tumor), treated with seaweed-infused wine. Fan Hua Liu (Flower-Overturning Tumor) is treated with purslane ash mixed with pork fat.
Lizhai stated: Liu means retention; it stays where Qi stagnates, caused by organ injury and Qi-Blood discord. Seek the root cause and treat fundamentally; do not use harsh treatments like spider silk wrapped around Yuan Hua gland.
There is also Ma Dao (Horse Dagger), a sore hard as stone, shaped like a clam, belonging to Liver, Gallbladder, and San Jiao meridians, invading Taiyang and Yangming, flowing to chest, hypochondrium, and axillae. Regardless of ulceration status, use fresh Xia Ku Cao paste orally and topically. In early stages with intact Qi-Blood, use Li Ying San (Immediate Response Powder) one qian, taken with strong decoction of Mu Tong (Akebia). Toxin exits via urine as powder-like blood clots. If urination is obstructed, use Yi Yuan San adjusted with Deng Xin Cao (Juncus Decoction). After toxin release, follow with Bo He Dan (Mint Pellets) to disperse Wind-Heat. If swelling persists, use Hai Zao Kui Jian Tang or Xiao Zhong Tang. If Qi-Blood is depleted, use Bu Zhong Sheng Du Bing (Tonify Middle Overcome Toxicity Cake). For chronic non-healing ulcers, follow previous Luo Li methods.