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(Attached: Goiter)

Zhou Hanqing treated an old gentleman named Yang from Shanyin, who had a wart-like growth on his neck, the size of a melon. After falling down drunk onto the steps, the growth ulcerated and bled uncontrollably. Ulceration of warts is invariably fatal. Zhou Hanqing applied medicinal powder to the wound, and the bleeding stopped immediately. (From *History of Ming*)

Xue Lizhai treated Wang Tianjue, a student at the Changzhou county school. In the spring of the Xinchou year, he developed a tumor near the Huantiao acupoint on his left leg, shaped like a large peach and soft to the touch. He strictly took decoctions for dampness removal, qi circulation, and phlegm resolution, but developed aversion to cold, fever, poor appetite, fatigue, and deficiency in both form and vital energy. His pulse was surging yet empty upon pressure, indicating Qi Tumor (a type of tumor associated with the Lung organ). Since the Liver belongs to Wood and the Lung to Metal, but the lesion occurred in the Gallbladder meridian region, this represented Metal insulting Wood, compounded by depletion of Yuan Qi (Original Vital Energy), with pus already forming internally. He prescribed Shiquan Dabu Tang (Ten-Agent Tonifying Decoction). After several doses, copious clear white thin pus was discharged. Suddenly, chills and fever intensified, accompanied by irritability, thirst, and headache, resembling Cold Damage (Shanghan). This was due to further depletion of Qi and Blood following pus discharge; thus, the previous formula was continued. The condition worsened, and the pulse became surging, rapid, and large but vanished upon deep pressure. An additional one qian of Fuzi (Prepared Aconite Root) was added. The condition deteriorated further, and the pulse returned to its previous state, indicating severe deficiency where the medication could not reach. Another two qian of Fuzi were added. After three doses, all symptoms subsided. Thereafter, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was taken in the morning, and Shiquan Dabu Tang in the evening, each for over thirty doses. Five pieces of necrotic bone were expelled, and the wound nearly healed. Later, due to improper daily care, the site re-ulcerated, and symptoms recurred: burning sensation in the throat, loss of skin on the mouth and tongue. Shiquan Dabu Tang with one qian of Fuzi was administered, resolving the symptoms. However, after two days without medication, internal disorders returned, and the site re-ulcerated. Two years later, the illness recurred, and previous medications failed. The Chi pulse (Kidney pulse) was faint and thread-like, indicating Declining Fire of the Gate of Vitality (Mingmen). Bayi Wan (Eight-Ingredient Pill) was used as the main formula, assisted by Shiquan Dabu Tang, resulting in slight improvement. By the Yisi year, he died from deficiency-cold syndrome.

A man had a swelling on the lateral aspect of his left thigh near the buttock, with red blood vessels on the surface, lasting three years. His diet and daily activities were normal. Upon rupture, blood and pus gushed out, accompanied by fever and aversion to cold. This resulted from pathogenic factors affecting the Gallbladder meridian, hence appearing on the lateral leg. The left Chi pulse was surging and rapid, and the left Guan pulse was wiry and surging, indicating that Kidney Water fails to nourish Liver Wood. Treatment with Buzhong Yiqi Tang and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) led to recovery.

An elderly woman developed a tumor in her right axilla, growing to about one chi long, resembling a long gourd, which eventually ulcerated. A Daoist practitioner applied powder made from fresh long-handled gourds calcined to preservation of nature, ground into powder. The exudate dried up, and the tumor resolved.

Method for Ligating Tumors: Wash Yuanhua (Genkwa Flower) while wet, avoiding iron utensils. Crush in wooden or stone vessels to extract juice. Soak a thread in the juice for half a day or overnight. Use this thread to ligate the base of the tumor. It will fall off after one night. If not, replace the thread; it should fall off within two attempts. Apply powder of Longgu (Fossilized Bones) and Hezi (Chebula Fruit) to the wound to promote healing. This method has been effective for mammary tumors. *Su Shen Liang Fang* mentions using spider silk, but it is laborious and less convenient than this method. If no root is present, soaking thread in concentrated Yuanhua infusion suffices. Ms. Zhao used this method to remove a waist tumor in half a day without pain. (From *Bai Bai Fang*)

(Note: Yuanhua's efficacy in causing immediate tumor detachment reveals its potent nature. Sun Wentan used three fen of insect-derived medicines to treat a woman, achieving immediate results. Such potent agents should not be used lightly unless there is substantial accumulation.)

Sun Simiao treated goiter of one to two years' duration using half a jin of Huangyaizi (Yellow Drug tuber) from Wanzhou, selecting only dense, solid specimens. If lighter or from other regions, use one jin. Soak in ten dou of unadulterated wine, seal the vessel, and heat with bran for the time it takes to cook a meal. Cool, then let the patient drink daily without letting the effect cease. After three to five days, if encircling the neck shows reduction, stop drinking to prevent excessive neck thinning. Heat carefully until wine vapor escapes and moisture appears, then stop heating; do not wait overnight. This method is highly effective; avoid toxic foods.

Huang Lvsu stated: At age thirty, I developed a small tumor on my buttock, with a root as thin as a thread and a head the size of a bean. Ten years later, it grew to the size of a lychee, hindering horse riding. Knowing the risks of surgical removal, I dared not treat it. I sighed, "If I live to sixty or seventy, this will be bowl-sized and hinder walking and sitting. What then?" Then I reasoned, "Even if it hinders movement at seventy, what harm is there?" So I accepted it. At forty-seven, I accidentally scratched the tumor skin, causing continuous fluid leakage. Fearing fistula formation, I consulted Pan Huifeng. He said, "Removing the tumor is easy; sealing the leak is hard. Remove the tumor, and the leak seals itself." Reluctantly, I agreed. Pan applied medicine to the tumor, causing severe pain and blackening of the flesh, followed by oozing blood. I feared and regretted, seeking only hemostatics. Overnight, the blackened flesh hardened like stone and shed after several days, leaving a bean-sized root with continued leakage. Pan said, "Without removing the root, the leak cannot be sealed." He reapplied the medicine three times. Internally, Tuoli San (Support the Interior Powder) with five qian of Huangqi (Astragalus Root) per dose was given. After ten days, the hardened flesh shed, the root flattened, and Tuoli San continued externally with muscle-regenerating agents. Abstaining from sexual activity and labor allowed gradual healing. My diligence in taking medicine and Pan's skill combined for success.

Zihe Zheng (Zhang Yuansu) was in Xihua, mocked by many for inducing vomiting and purging. One day, Wei Shouzhi and Zheng entered a restaurant and saw a man with a tumor above the eye, grayish like a plum, hanging over the eyeball, obscuring vision. Zheng told Wei, "I will remove this tumor before our food cooks." Wei doubted him. Zheng asked the patient, who said others dared not cut it. Zheng replied, "I do not use a knife; I have another technique." The patient agreed. Zheng led him to a small room, instructed him to lie prone, tied the nipple, pierced it causing heavy bleeding, rubbed the eye, and pierced the tumor, discharging material resembling sparrow droppings. The tumor flattened instantly. Wei was astonished. Zheng said, "Can human skills be fully understood?"

An unmarried eighteen-year-old girl had tumors on both dorsal hands, resembling chicken spurs and horned testicles, limiting wrist movement. They looked like peach gum when held to light. Her husband's family wanted to discard her. Zheng identified them as Jiao Liu (Glue Tumors) on the hands, distinct from Fen Liu (Powder Tumors) on the face. He punctured them in a cross pattern, expressing three spoonfuls of yellow glue. The tumors flattened instantly and did not recur. Only those well-versed in such methods dare use this technique.

A woman in her forties had a tri-lobed goiter. Zheng induced vomiting three times, sweating three times, and purging three times. The goiter reduced by half. Subsequent administration of goiter-resolving herbs caused significant reduction. Diseases located superiorly are often suitable for emesis, following specific principles.

Zhang Jingyue, in his thirties, developed a small lump under the skin between the anus and buttocks, initially mung-bean sized. Ignored initially, it grew to soybean size in six months, jujube pit size in a year, and chestnut size thereafter, hindering riding and sitting, with increasing pain. He suspected external application could resolve it, believing decoctions would not reach it. He worried about future enlargement and immobility. Advisers warned against cutting. Reflecting that early removal is easier, he decided to proceed. Drunk, he pricked it with a willow-leaf needle, extruding material resembling tofu skin. It was a Fen Liu (Powder Cyst). It collapsed immediately post-pricking. Two days later, it swelled like a hot abscess. Applied Huitong Gao (Huitong Plaster) for three days; pus drained, and it healed. Two days later, it swelled again, hotter and larger. Regretting the prick, he reapplied plaster. Three days later, it ulcerated massively, expelling a fish-bladder-like sac. Healing ensued. Delayed treatment would have been difficult. (Li's Note: Xu Lingtai stated, "External treatment is best for tangible形体 abnormalities." This is insightful. A villager had a拳-sized neck tumor for ten years that suddenly disappeared after applying a plaster containing Banxia, Beimu, Fenhua, Chenpi, Jiezi, Danggui, Chuanxiong, Honghua, Jiangxiang, Guizhi, Shan Jia, Qianghuo, Fangfeng, Mahuang, Dahuang, etc., aimed at resolving phlegm, invigorating blood, and unblocking meridians. Effectiveness depends on correct diagnosis, not novelty. Zhang's belief that tumors cannot be resolved by plasters was mistaken.)

A man had a small tumor below the eyelid margin, starting rice-grain sized, growing to bean-sized. A surgeon used multiple needles to evert the eyelid and pierce the inner membrane, causing slight bleeding. After two or three sessions, the tumor shrank and disappeared.

A man had a tumor on his arm, growing to longan size. He moxa-burned it with seven cones of small mugwort, leading to gradual resolution. Alternatively, garlic-separated moxibustion is also acceptable.

A man had a walnut-sized tumor on his abdomen. The practitioner tied its base with thick spider-silk thread. As the thread tightened over days, the tumor base narrowed. After changing threads repeatedly over ten days, it detached. This demonstrates the unique property of spider silk tightening over time. Early intervention is crucial; advanced cases may not be suitable. (From Jiao Shi's *Bicheng*, previously recorded briefly.)

Shen Kouwen bit his nails in childhood, unable to stop as an adult, indicating Liver Fire and Blood Dryness. He also frequently developed small warts on the neck side and a绿豆-sized lump on the arm that elongated when pulled and contracted when released, resembling broken threads. Later, white spots appeared on his temples. Diagnosis: Chronic Liver disease affects the Gallbladder/Liver meridian region. Nails are extensions of sinews, running along the body's sides, correlating with nail-biting and warts. Treatment required nourishing Kidney Water to generate Liver Wood. Liuwei Dihuang Wan was administered. White spots faded, and tumors ceased after one year.

A man had intermittent abdominal pain from a mass. Qi-moving and phlegm-resolving drugs failed. Suspecting Blood Bi, he took blood-invigorating formulas. Later, a wart appeared on the hand, growing to an inch, turtle-shaped, with many bean-sized lesions on the limbs. Suspecting external manifestation of internal parasites, he used blood-invigorating drugs, leading to deficiency signs. Left Chi pulse was surging/rapid; Guan pulse was surging/rapid/wiry. Diagnosis: Kidney Water failing to nourish Liver Wood, causing Liver Fire, Blood Dryness, and tendon spasms. Liuwei Wan nourished Water to generate Liver Wood. Recovery in three months.

A tenant of the Tao family suffered from goiter. While transporting grain with a servant over a long distance, exhaustion aggravated the goiter, nearly stopping his breath. The foolish servant quickly sharpened a bamboo stick and pierced the goiter. Air escaped, the neck restored, and he resumed carrying loads without discomfort. (From *Shuo Yi*. Note: This illustrates extreme folly.)

My brother Qifeng had fist-sized tumors. A monk provided a recipe: Pierce the top of the tumor slightly, opening the oily skin without bleeding. Grind a small amount of Tonglv (Malachite Green), apply to the opened area, and cover with plaster. Pus and powder discharged after several days, curing the condition. (From *Xu Jinling Suoshi*)

Qian Guobin treated a seventeen-year-old niece of a local official in Shenshi, Shanxi. She had developed a tumor on her left hand since age eight, growing to bell-sized. Identified as a Fen Liu (Powder Cyst), treatable. Prescribed a plaster made from Sibadou (Croton Seed), Bimazi Rou (Castor Bean Paste), Daxingren (Almond), Sesame Oil, and Xuedan (Cinnabar). Applied daily. Skin thickened, reddened in ten days, ruptured in fifteen days, draining a bowl of pus. Tumor resolved, wound closed.

In summer of Xinyou year, an epidemic swept salt fields in Guangling, causing damp-heat syndromes. Symptoms resembled Cold Damage but included headache, fever without aversion to cold, body ache, red tongue, lethargy, anorexia, craving cold drinks, jaundice, constipation, and red urine. Dispersing and cooling agents failed. Qian observed the condition worsening despite treatment. Dozens of walnut-sized tumors with thin skin appeared on the chest and back. Puncturing them released thousands of lice. Scratching caused chills; people avoided them. Administering the extracted lice content cured subsequent cases.

Qi Jing (Qi Neck) refers to a sagging mass on the neck resembling a long tumor. Common in Shandong, caused by wind-water, sleeping on hot kang, and excessive spicy food. Pathogenesis involves the Foot Jueyin Liver meridian circling the throat and connecting to the Liver, governed by the Foot Yangming Stomach meridian. Arising from Liver-Stomach disharmony, these tumors hang down, unsightly though not fatal. No ancient treatments existed. Qian learned a secret formula: Qingpi (Green Tangerine Peel) 6 qian to soothe Liver; Jiegeng (Platycodon Root) 6 qian to guide; Mutouteng (Wood Mallow) 1 liang, calcined, to dissipate stagnation in Liver/Stomach meridians. Ground to powder, taken with wine, one qian. Small cases resolve in 3-4 months; large ones in 7-8 months or a year. Slow but effective. Qian successfully treated Wang Yuanzhi and Zhao Hulian. Sharing this good prescription for public benefit.

Huang Yuanliang, a scholar from Huixi, aged fifty, developed a Qi Tumor on his neck. Pulse waves were vigorous, Ying and Wei sufficient, spirit and Yuan Qi robust, except for stagnation in the Liver sector causing Qi condensation. Qian advised: "You have no serious illness. The Qi Tumor is merely unsightly, not harmful. Texts state: Fen Liu, Tan Liu, Gu Liu, Shi Liu, Tui Liu, Shi Liu, Fa Ju Liu are treatable. Qi Liu, Jin Liu, Rou Liu, Jian Liu, Ying Liu, Xue Liu, Lei Liu, Ru Liu, Zhou Bi Liu are untreatable. Treating them breaks membranes, leaks Qi, and is fatal. Abandon this idea. Do not trust quacks and risk your life." Huang thanked him and left.