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Xue Lizhai treated a male patient suffering from scrofula (tuberculosis of cervical lymph nodes), presenting with local swelling, pain, fever, and constipation. He prescribed Shegan Lianqiao San (Belamcanda and Forsythia Powder), which was taken for six doses; the fever subsided by more than half. Subsequently, Xianfang Huoming Yin (Immortal Recipe for Activating Life Decoction) was administered for four doses, resulting in the resolution of the mass.

Another male patient presented with this condition, characterized by hard swelling without suppuration, and a wiry and rapid pulse. Xiao Chaihu Tang (Minor Bupleurum Decoction) was combined with Shenxiao Gualou San (Miraculous Efficacy Trichosanthes Powder), each taken for several doses, along with garlic-separated moxibustion applied several times. The condition resolved after more than a month.

A female patient had persistent neck swelling. Shenxiao Gualou San was given, and after six doses, there was slight improvement. Then, Xiao Chaihu Tang was modified with Qingpi (Green Tangerine Peel), Zhike (Bitter Orange), and Beimu (Fritillaria Bulb). After several doses, the swelling reduced significantly. Finally, Siwu Tang (Four Substance Decoction) was combined with Xiao Chaihu Tang, and after several doses, the condition stabilized.

A male patient developed nodules under the neck due to anger, accompanied by swelling, pain, fullness, and fever. Liuyang Liuqi Yin (Regulating Qi and Blood Decoction) was taken for two doses, relieving chest and diaphragm stagnation. Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Overcome Toxins) was then administered for two doses, resolving the fever. The liver pulse remained wiry and choppy. Xiao Chaihu Tang was modified with Xiong (Ligusticum Rhizome), Danggui (Angelica Sinensis), and Baishao (White Peony Root). After four doses, the pulse and symptoms improved markedly. Sanzhong Kuijian Wan (Powder to Disperse Swelling and Harden Nodules) was taken for one preparation, bringing the condition near resolution. Only one nodule remained, so Yuxian Wubi Wan (Matchless Pill Encountering Immortals) was administered for two taels, leading to recovery.

Xue Lizhai treated a female patient with long-standing depression who developed scrofula that neither ulcerated nor healed after ulceration. Symptoms included fever, dry mouth, scanty menstruation, loss of appetite, and extreme fatigue in the afternoon. Qiyi Yangrong Tang (Qi-Nourishing and Blood-Enriching Decoction) was prescribed for over twenty doses, yielding slight improvement. Xue advised that one hundred doses were necessary to ensure safety. Desiring quick results, the patient instead took Mayscan preparations and repeatedly used cauterizing toxic medicines. This caused the wound to re-close rather than heal, leading to continuous discharge and eventual death. This condition resulted from deficiency labor and qi stagnation; treatment should have focused on tonifying form and qi and regulating meridians. Unformed nodules would resolve spontaneously, and formed ones would ulcerate spontaneously. Using harsh agents would further deplete qi and blood, often transforming into consumption diseases. Hardness without ulceration or failure to heal after ulceration clearly indicated qi and blood deficiency. Moreover, the blood of the Shaoyang and Jueyin channels is inherently insufficient, a fact that must not be overlooked.

A male patient had scrofula that ulcerated but failed to heal for a long time, accompanied by mental fatigue and a deficient pulse. A method to support the interior was proposed, but the patient considered it too slow and instead took Sanzhong Kuijian Tang. More than half a month later, fever appeared, and food intake decreased further. Upon seeking treatment again, Qiyi Yangrong Tang was administered for three months. Fortunately, he adhered strictly to the regimen, leading to efficacy. Qi Shi stated: For tubercles without pus and unclear external signs, supporting the interior is appropriate. If pus has not formed, it promotes early formation; if already ulcerated, it promotes early granulation. For qi and blood deficiency, tonify via supporting the interior; for yin-yang disharmony, regulate via supporting the interior. Generally, this method prevents adverse changes in sores.

A male patient had chronic non-healing scrofula with thin pus, sallow complexion, emaciation, and morning diarrhea. Ershen Wan (Two Spirits Pill) was given, stopping diarrhea after several doses. Liujunzi Tang (Six Gentlemen Decoction) modified with Xiong and Danggui was then administered. Within a month, physical strength gradually recovered. Moxibustion with fermented soybean cakes and application of tonic plasters led to recovery after more than three months.

A female patient had scrofula that ulcerated but the nodule did not necrose. Qiyi Yangrong Tang was given for over thirty doses, followed by topical application of Zhentousan (Needle Head Powder) to induce necrosis. Another thirty doses of the previous decoction led to healing.

A male patient with un-ulcerated scrofula presented with fatigue and fever. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) provided slight relief. Qiyi Yangrong Tang was then administered; the lesion ulcerated after a month and healed after another month.

A female patient with accumulated heat in the Liver channel suffered from painful scrofula and a deep, rapid pulse. Shegan Lianqiao Tang was given for four doses, showing slight improvement. Sanzhong Kuijian Wan was then used, resolving the condition after a month.

Zhu Danxi stated: Scrofula invariably originates in the Foot-Shaoyang Gallbladder channel. Without observing taboos, it spreads to the Foot-Yangming Stomach channel. Rich diet and prolonged emotional stagnation generate toxins, wind, and heat, all stemming from these two channels. The progression varies between excess and deficiency, with deficiency being concerning. This channel governs decision-making, contains ministerial fire, and 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 seventeen-year-old maiden experienced intermittent neck pain and alternating chills and fever resembling malaria, with a long and wiry liver pulse, indicating abundant blood. Xiao Chaihu Tang was given for two doses, providing slight relief. Dihuang Wan (Rehmannia Pill) was then used for complete recovery. *Funren Liangfang* states: Diseases of widows have rarely been discussed since antiquity, except briefly in *Canggong Zhuan* and Chu Cheng's writings. "Widow" refers to a woman without a husband, such as nuns or widows. Being purely yin without yang, desiring men but unable to attain them leads to melancholy and disease. The *I Ching* says: Heaven and earth interact, and all things are transformed harmoniously; male and female essence joins, and all things are born. Can isolated yang and isolated yin exist? Women confined to inner quarters whose desires arise but remain unfulfilled experience yin-yang conflict, causing alternating chills and fever similar to malaria, which eventually becomes consumption. Other symptoms include amenorrhea, leukorrhea, phlegm reversal, headache, chest oppression, palpitations, dark complexion, and emaciation, all characteristic of widows' diseases. Pulse diagnosis reveals the liver pulse wiry and extending beyond the cunkou to the fish-mouth area. The root cause is abundant blood. The classics state: When a man's essence is abundant, he desires intercourse; when a woman's blood is abundant, she conceives. Observing their essence and blood, half the understanding is gained. (Note: This pulse may also result from yin deficiency with fire hyperactivity and should not always be attributed to abundant blood.)

A male patient had five pearl-like nodules below the ear, hard for over a year, with sallow complexion, poor appetite, fatigue-induced fever, and a soft, choppy, rapid pulse. Qiyi Yangrong Tang was administered for over sixty doses, restoring primal qi and reducing the lesions. One remaining nodule was resolved with two doses of Bixiao San.

A male patient developed lethargy and fever due to overwork, with a large pulse that was empty upon pressure. Buzhong Yiqi Tang was recommended, but he refused and took attacking agents, leading to vomiting, diarrhea, anorexia, and death. This condition is essentially deficiency. Failing to distinguish excess from deficiency and violating dietary or meridian taboos almost guarantees error. Standard treatment involves regulating menstruation and resolving stagnation, followed by garlic-separated moxibustion, which often resolves the condition. If unresolved, Hupo Gao (Amber Plaster) is applied; once pus forms, it is lanced. Otherwise, it may spread. If complicated by phlegm or yin deficiency, treat those specific patterns without interfering with other channels. If qi and blood are restored but nodules persist, avoid hard-resolving agents initially. If no response after a month and qi/blood remain stable, Bixiao San or Yuxian Wubi Wan may be tried. Stop these toxic agents immediately after use and follow with Qiyi Yangrong Tang for regulation. For non-healing wounds, apply fermented soybean cake moxibustion and Hupo Gao. Cases with severe qi-blood deficiency or negligence in diet, lifestyle, and emotions are incurable. This disease centers on qi and blood; if robust, sores will necrose and heal without caustics, provided necrotic tissue is removed. If deficient, failing to tonify first and using caustics leads to deterioration. (Note: A large, empty pulse indicates yin deficiency. Attacking agents are wrong, and Buzhong Yiqi Tang may also be inappropriate. The rest of the commentary represents insightful observation.)

A male patient with inherent weakness had scrofula that ulcerated but did not necrose, indicating qi and blood deficiency. Tuoli Yangrong Tang was used to restore qi and blood. The nodule remained and was mechanically removed with a hairpin. Continued medication led to recovery after a month.

A male patient with restored qi and blood still had non-necrotic nodules. Zhentousan and Bixiao San were applied topically three times each, leading to recovery within ten days.

A male patient with scrofula had excessive phlegm, chest oppression, and a wiry spleen/stomach pulse, indicating spleen earth deficiency with liver wood invasion. Treatment should focus on strengthening spleen earth and subduing liver wood. He initially treated phlegm with bitter-cold expectorants without success, then added qi-breaking herbs, worsening the condition. Liujunzi Tang modified with Xiong and Danggui was given, improving appetite. Buzhong Yiqi Tang with doubled Baizhu was used for a month, strengthening middle qi. Qiyi Yangrong Tang was then administered for two months, resolving swelling and restoring qi and blood. A wiry left guan pulse indicates wood excess overcoming spleen earth (robber pathogen). Using bitter-cold agents in deficiency worsens deficiency. Phlegm etiology varies, requiring different treatments. Excessive draining herbs weaken spleen qi, generating more phlegm. For middle qi deficiency, Ginseng and Atractylodes should be primary, supplemented by phlegm-resolving herbs.

A female patient with anger-induced neck swelling, amenorrhea, limb edema, and dysuria suffered from blood-pattern disorder. Jiaoren Wan was given for several doses, inducing menstruation and reducing swelling. Liujunzi Tang modified with Chaihu and Zhike resolved the neck swelling. Conversely, if edema precedes amenorrhea due to urinary difficulty, it is called water pattern, treated with Tingli Wan. *Funren Liangfang* states: If menstruation stops first, followed by edema and urinary obstruction, it is blood pattern; water transforms into blood, and blocked blood turns back to water, treated with Jiaoren Wan. If urinary difficulty precedes edema and amenorrhea, it is water pattern, treated with Tingli Wan.

A nineteen-year-old maiden had a hard, colorless neck lump, wasting muscles, and painful tendon spasms, caused by emotional injury and qi-blood damage. Nourishing qi and blood was advised, but she took wind-dispersing herbs instead, leading to death. Lu Dijing cited the classics: Mental worry damages flesh, sorrow damages limbs, grief damages tendons, joy damages skin, and rage damages waist/spine. Official He’s daughter, widowed young, suffered from clenched fingers, inability to lift arms, and widespread ulcers. After half a year of mixed treatments, Xue diagnosed it as emotional sorrow, not wind. Treating internal causes with Deer Antler Glue and muscat plaster allowed finger extension and gradual recovery.

A female patient with limb fatigue resembling flaccidity recovered with qi-blood nourishing and spleen-strengthening herbs.

A hot-tempered maiden had recurrent ear swelling, pain, chills, and fever, with a wiry-tight liver pulse. Xiao Chaihu Tang modified with Qingpi, Niupang, Jingjie, and Fangfeng resolved chills and fever. Xiao Chaihu Tang combined with Siwu Tang reduced swelling. Her father sought permanent cure. Xue explained: The Liver stores blood and nourishes tendons externally. Anger injures the Liver, causing tendon accumulation and swelling. Self-regulation is essential; otherwise, repeated Liver injury leads to blood deficiency and difficult-to-cure conditions. Ignoring advice, she developed three nodules and died after repeated caustic treatments.

A young wife had ear swelling, fatigue, fever, dry mouth, and scanty, delayed menstruation. An old woman mistook this for amenorrhea and used Leeches to promote flow, causing death from excessive depletion. Menstruation is governed by the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart channels. These exterior-interior paired channels produce milk above and menstruation below. With strong spleen/stomach qi and no external/internal pathogens, Chong and Ren qi flourish, ensuring timely menstruation. Sallow complexion, emaciation, fever, dry mouth, and scanty/delayed menses indicate yin-blood deficiency, not excess heat. Nourishing qi and blood gently restores regular cycles.

A released palace maid over thirty suffered hip pain without swelling or color change, painful urination/defecation resembling strangury, worse during toilet visits. This was blood stasis penetrating tunnels due to sexual deprivation, a difficult case. She later died from non-healing ulcers and scrofula. Her husband, a merchant, was often away. Long-term frustration and unfulfilled desires caused this. The prevalence of flowing deposits and scrofula shows severe qi-blood damage from emotions, making attacking agents contraindicated. The *Jingxue Pian* states: Premature sexual activity damages the body, leading to future obscure diseases. Impotence with sexual desire causes internal decay and strangury. Depleting exhausted essence causes pain in urination/defecation. Women with established Tian Gui who lack male contact for over ten years develop irregular menstruation. Those desiring contact within ten years also become irregular. Irregularity causes old blood retention and new blood misdirection, potentially entering bones or causing swelling. Frequent intercourse drains essence and causes deficiency; multiple births deplete blood and cause death. Observing essence and blood clarifies much.

A seventeen-year-old maiden had chronic scrofula, amenorrhea, fever, cough, and poor appetite. An old woman suggested Ban Dou and Rou Gui to induce menstruation, claiming tidal fever and irregular menses were untreatable. Xue noted her pulse was not choppy and she lacked true tidal fever, suggesting treatment with qi-blood nourishment and fluid enrichment would naturally restore menstruation. Seduced by promises of quick results, she used the harsh herbs. Xue criticized this: Such agents strongly assist yang fire, causing wild bleeding and spleen/stomach deficiency. Induced menstruation continued excessively, worsening anorexia and fever, leading to death. The classics state: At seven, kidney qi flourishes; at fourteen, Tian Gui arrives, Ren vessel opens, Taichong vessel flourishes, and menstruation begins. Delayed menstruation implies pathology. Humans rely on qi and blood as roots; illness always injures yin-blood first. Women are particularly susceptible to emotional injuries. Kou Zongshi stated: Repeated thoughts and worries cause consumption. Men lose spirit/color first; women lose menstruation first. Worry injures the Heart, causing blood reversal and exhaustion, leading to scattered spirit and closed menstruation. Fire disease fails to nourish its offspring (Earth), causing anoremia. Spleen deficiency weakens Metal, causing cough. Water qi exhaustion dries limbs. Wood qi insufficiency causes irritability, brittle hair, and flaccid sinews. Once the Five Viscera are affected, death is inevitable, though not immediate. This is the hardest type of consumption. Disease originating in the viscera has no fixed end, and medicine cannot reach it. Only if the patient changes their mindset and uses supportive medicine can survival occur. Other cases should be treated according to pulse and symptoms.

A male patient had scrofula near the ear that nearly healed, but spread to the neck and clavicle the next year, and to the chest and axilla after three years. Liver pulse was wiry and rapid. Longhui Wan and Sanjian Wan were used. Near recovery, the liver pulse remained rapid. Four years later, abscesses appeared in the lower abdomen, scrotum, and inner thighs, failing to heal for over a year. Pulse remained similar. Qinggan Yangxue Tang and the previous pills cured him.

Xue Lizhai reported: A wealthy merchant had a large scarred area on his neck from scrofula, caused by anger, lasting two years despite various treatments. A Daoist gave a powder; one dose reduced it slightly, two doses significantly, and four doses cleared it. Seeking the formula, he learned it was Bixiao San. Another old woman treated it by applying a medium-grade pill inside the sore and covering it with plaster, causing the root to necrose. Reapplication and Shengji San accelerated healing. A Daoist treated it by steaming seven eggs, each containing one May chan, and having patients eat one daily on an empty stomach. Many sought this. Texts on scrofula and materia medica suggest these methods work only for those with sufficient qi and blood; they are likely ineffective for the deficient.

Xue Lizhai treated a scrofula patient with sallow face, fatigue, acid regurgitation, and belching, indicating middle qi deficiency. Buzhong Yiqi Tang plus Fuling and Banxia was proposed. She refused, taking heat-clearing and qi-draining herbs instead, leading to chest oppression, sore swelling, continuous belching, loose stools, and cold limbs. Xue diagnosed middle qi deficiency and cold. Liujunzi Tang plus Jiang and Rong, with small amounts of Shengma and Chaihu, gradually improved the condition, followed by Buzhong Tang for full recovery.

A female patient with scrofula and belching was treated with heat-clearing and stomach-cooling herbs, leading to poor appetite, acid regurgitation, and chest oppression. Qi-moving and digestion-promoting herbs caused shortness of breath and reduced intake. Heat-clearing and phlegm-resolving herbs led to dry stool, internal heat, and emaciation. Xue diagnosed: Acid regurgitation/belching indicates spleen/stomach qi deficiency; chest oppression/phlegm wheezing indicates spleen/lung qi deficiency; dry stool/internal heat/emaciation indicates spleen/lung blood deficiency. Buzhong Yiqi Tang plus roasted Wu Zhu Yu was given for several doses, supported by Liuwei Wan, resolving symptoms. Guipi Tang and Xiaoyao San were then alternated for recovery.

A male patient with hard, non-suppurating scrofula unresponsive to hard-resolving and toxin-expelling drugs was treated with moxibustion at Jianjian and Zhoujian acupoints and Qiyi Yangrong Tang, recovering in a month.

A female patient with chronic ulcerated scrofula, fever, and scanty/delayed menstruation was treated with Xiaoyao San combined with the previous decoction. After two months, qi and blood were restored, and the sore healed, except for one opening. Zhentousan and moxibustion at the previous points cured it. Chronic cases (2-3 years) usually require three sessions of moxibustion and interior-supporting herbs.

Mrs. Tian, over thirty, had unhealed ulcerated scrofula. Bazhen Tang plus Chaihu, Digupi, Xiakucao, Xiangfu, and Beimu was given for fifty doses, improving constitution. Two doses of Bixiao San closed the wound. Remaining qi-blood imbalance was treated with thirty doses of the previous prescription for full recovery. Later, Mr. Tian used this formula indiscriminately for others, unaware that the toxic May chan in the powder damages primal qi if overused. It may work for excess patterns followed by tonification, but using purgatives or caustics on deficiency removes necrotic tissue but prevents healing, making it difficult.

A scholar with post-scrofula emaciation and irregular fever had deficiency of qi and blood in the Three Yin foot channels. Bazhen Tang plus Maidong and Wuweizi for twenty doses, followed by Buzhong Yiqi Tang plus Maidong, Wuweizi, and Liuwei Wan, led to recovery.

Confucian Zhang Zirong, prone to anger, had chronic scrofula with bloody discharge and a wiry-large left guan pulse that vanished under pressure, indicating Liver fire disturbing blood and qi-blood deficiency. Buzhong Yiqi Tang tonified spleen/lung, and Liuwei Wan nourished kidney, leading to recovery.

Lu Ziwen had hard swelling below both ears. Liver-subduing and hard-softening agents worsened the condition. Left guan pulse was wiry-tight; left chi was large-rapid, indicating Kidney water deficiency and tendon spasm. Generating Lung metal to nourish Kidney water would allow Liver blood to relax tendons. He ignored this, continued previous meds, and died.

Yang Chengliu treated Yu with scrofula: over ten hard, stone-like nodules on both sides, swollen head/neck, inability to turn, hemoptysis, cough, and nocturnal emission for half a year. Previous treatments included yin-nourishing, fire-descending, essence-stabilizing, and Liver-subduing agents. Pulse was wiry-firm with agitation; left guan/chip were tight and fine as blades; tongue was blue-green, tender, fat, and slippery. This indicated Liver/Gallbladder dominance, with initial Liver/Gallbladder disease spreading to Heart/Spleen. Continuous phlegm/cough resulted from deficient Liver qi reversing upward, carrying phlegm. Nocturnal emissions resulted from Liver blood...