薛立斋治一妇人，胁患痈，未成脓，恶寒脉紧，以十宣散加柴胡，二剂表症悉退。更以托里散数
剂，脓清而愈。
一男子近胁患疽，肿而不溃，投大补之剂，溃而已愈。后患弱症而殁。
薛立斋治一上舍，年逾四十，因怒，胁内作痛不止，数日后外结一块，三寸许，漫肿，色不赤，
按之微痛此怒气伤肝，致血伤气郁为患。以小柴胡汤对四物，倍用芎、归、黄芩、贝母、肉桂治之。
彼谓丹溪云∶肿疡内外皆痈，宜托里表散为主。又云∶凡疮未破，毒攻脏腑，一毫热药，断不可用。
况此症为气血凝滞，乃服流气饮愈虚，始信而复求治。视之虚症并臻，诊之胃气更虚。彼欲服薛前药。
曰∶急者先治。遂以四君子汤加酒芍、炮姜，四剂少得。更加当归，又四剂，胃气渐醒。乃去姜，又
加黄 、芎、归、肉桂，数剂疮色少赤，并微作痛。又二十余剂，脓成针之。却与十全大补汤，喜其
谨疾，又两月余而瘳。夫气血凝滞，多因荣卫之气弱，
不能运散，岂可复用流气饮，以益其虚。况各经气血多寡不同，心包络、膀胱、小肠、肝经，多血少
气，三焦、胆、肾、心、脾、肺，少血多气。前症正属胆经少血之脏，人年四十以上，阴血日衰，且
肝症俱属不足，肿疡内外皆壅，宜托里表散为主。乃补气血药而加以行散之剂，非专攻之谓也。若肿
痛甚，烦躁脉大，辛热之剂，不但肿疡不可用，虽溃疡亦不可用也。凡患者须分经络气血，地步远
近，年岁老幼，禀气虚实及七情所感，时令所宜而治之。常见以流气、十宣二散概治结肿之症，以致
取败者多矣。（此案与旧案东侍御一则正同，而此之发明，最为紧要，而旧案节之，故重录于此。）
马元仪治沈氏妇，左胁患肿疡，长五寸许。治已两月，发表托里，剂多功少。诊其两脉弦数兼涩，
肿处低陷作痛，寒热，经行不止，口燥艰食。此症颇危，必得之劳郁且怒，邪热结聚厥阴之位，荣卫
不行，周身火邪，独彻上下，表敛俱所不宜。用生首乌一两，滋其内燥；柴胡一钱，疏其气血；枳壳、
桔梗各一钱，舒通肺气，以制肝木；杏仁、苏子各二钱，调气化痰，以清上焦；丹皮一钱，清其血；
半夏曲一钱，和其中。两剂寒热减而经止，患处 肿，溃稠脓，饮食少进。疡医以溃后当行大补，投
、术之属，后致疮口内陷，食少。曰∶痈疽已溃，当补，此其常耳。今两脉迟涩，迟则气滞，涩则
血滞，郁而得补，其郁弥甚。始犹肝木自伤，既乃转戕脾胃，以不循常度，分肉不温，经隧不行，而
欲疮之敛也，其可得乎？夫荣不通，须以血药和之，当归、桃仁、红花、延胡索是也。白术、枳壳，
一补一泻，所以推陈气以致新气，干姜暖胃而和血，楂肉消滞而和中。服二剂，复大溃出稠脓碗许，
食进神旺而安。（名言至理，须细参之。）
朱丹溪诊李兄，年四十余，而面稍白，神气劳甚，忽胁下生一痈，肿如桃。一人教用补剂，众笑
阻之，于是流气饮、十宣散杂而进之。旬余召视之，曰∶非惟不与补药，抑且多得解利，血气俱惫，
不可为矣。已而果然。
立斋曰∶一男子因怒，左胁肿一块，不作痛，脉涩而浮，此肝经邪火炽甚，而真气不足为患，宜
培养气血为主。乃用草药数帖，遂致不救。
一男子因劳发热，胁下肿痛，脉虽大而按之无力，此气血虚，腠理不密，邪气袭于肉里而然也。
河间云∶若人饮食疏，精神衰，气血弱，肌肉消导，荣卫之气短促而涩滞，故寒搏腠理而痈肿也，当
补之以接虚怯之气。遂以补中益气汤加羌活，四剂少可。去羌活，又十余剂而愈。又一男子，年二十，
遍身微痛，腰间作肿痛甚，以前药加茯苓、半夏并愈。
一朝士腹胁间病疽经岁，或以地骨皮煎汤淋洗，出血一二升，家人惧，欲止之。病者曰∶疽似快。
更淋之，有五升许，血渐淡乃止，以细穣贴之，次日结痂而愈。（同上。）
张子和治襄陵马国卿，左乳二肋间期门穴中，发痛硬而不溃，痛不可忍。疡医皆曰乳痈，或曰红
丝漏，或曰 心疮，使服内托数百日，又服五香连翘汤数月，皆无验。张曰∶此马刀也，足少阳胆经
之病。出《灵枢》十二经以示之，其状如马刀，故曰马刀，坚而不溃。乃邀之于食肆中，使食浸汤饼，
稍觉缓。次日先以沧盐上涌，又以凉剂涤去热势，约十数行，肿已散矣。
朱葛黄家外家，左胁病马刀，憎寒发痛，已四五日矣。张曰∶此足少阳胆经病也，少血多气，坚而
不溃，不可急攻，当以苦剂涌之。以五香连翘汤托之，既而痛止，然疮根未散。有一道人过见之，曰∶
我有妙药，可溃而为脓，不如此，何时而愈？既 毒药，痛不可忍，外寒，内呕血不止，大便黑色，
饮食不下，号呼闷乱，几于死。再求治，张曰∶胁间皮薄肉浅，岂可轻用毒药？复令洗去，以凉剂下
之，痛立止，肿亦消。
Xue Lizhai treated a woman who had an abscess in the hypochondrium. The pus had not yet formed, and she presented with aversion to cold and a tight pulse. He prescribed Shixuan San (Ten Acupoints Powder) added with Chaihu (Bupleuri Radix). After two doses, the exterior symptoms completely subsided. Subsequently, he administered Tuoli San (Support the Interior Powder) for several doses, after which the pus was clear and the patient recovered.
A man developed a carbuncle near his hypochondrium. The area was swollen but did not ulcerate. He was given strong tonifying formulas, after which it ulcerated and healed. However, he later died from a deficiency syndrome.
Xue Lizhai treated a Shangshe (an official title) over forty years old. Due to anger, he suffered continuous pain inside the hypochondrium. Several days later, a lump about three cun in size appeared externally, diffuse swelling without a head, non-red in color, and slightly painful upon pressure. This was caused by anger injuring the Liver, leading to blood injury and Qi stagnation. Xue prescribed Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Siwu Tang (Four Substances Decoction), doubling the dosage of Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), Huangqin (Scutellariae Radix), Beimu (Fritillariae Thunbergii Bulbus), and Rougui (Cinnamomi Cortex). The patient argued that Danxi (Zhu Zhenheng) stated: "For sores and ulcers, whether internal or external, the primary treatment should be supporting the interior and releasing the exterior." He also cited Zhu's saying: "When a sore has not broken and toxin attacks the zang-fu organs, absolutely no hot medicines should be used." Furthermore, since this condition was due to Qi and blood stagnation, taking Liuqi Yin (Flowing Qi Drink) only increased his deficiency. Only then did he believe Xue and seek treatment again. Observation revealed multiple deficiency syndromes, and pulse diagnosis showed even weaker Stomach Qi. The patient wished to take Xue's previous prescription. Xue said, "Treat the acute condition first." Thus, he prescribed Sijunzi Tang (Four Gentlemen Decoction) added with Jiushao (Paeoniae Radix Alba processed with wine) and Paojiang (Zingiberis Rhizoma Preparatum). After four doses, there was slight improvement. Dangui (Angelicae Sinensis Radix) was added, and after another four doses, Stomach Qi gradually recovered. Then, ginger was removed, and Huangqi (Astragali Membranacei Radix), Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Rougui (Cinnamomi Cortex) were added. After several doses, the lesion became slightly red and mildly painful. After more than twenty doses, pus formed, and it was lanced. Then, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was given. Fortunately, the patient was careful with his health, and he recovered after another two months. Qi and blood stagnation is often due to weak Ying and Wei (Nutritive and Defensive) Qi, which cannot circulate and disperse. How could one reuse Liuqi Yin to exacerbate the deficiency? Moreover, the amount of Qi and blood varies among meridians. The Pericardium, Bladder, Small Intestine, and Liver meridians have abundant blood and little Qi; the Sanjiao, Gallbladder, Kidney, Heart, Spleen, and Lung meridians have little blood and abundant Qi. The previous case belonged to the Gallbladder meridian, which is an organ with little blood. People over forty experience daily decline in Yin blood, and Liver diseases are generally deficiencies. For sores and ulcers with internal and external blockage, the primary treatment should be supporting the interior and releasing the exterior. Here, tonifying Qi and blood herbs were combined with moving and dispersing agents, which is not a method of exclusive attack. If swelling and pain are severe, accompanied by irritability and a large pulse, acrid-hot medicines are contraindicated not only for sores but also for ulcers. Patients must be treated based on differentiation of meridians and Qi/blood, distance of the lesion, age, constitutional strength or weakness, emotional influences, and seasonal appropriateness. It is common to see practitioners using Liuqi San and Shixuan San indiscriminately for nodular swellings, leading to many failures. (This case is identical to the previous case of Dong Shiyu, but the elaboration here is crucial, whereas the previous case was abbreviated, so it is re-recorded here.)
Ma Yuanyi treated Lady Shen, who had a sore on the left hypochondrium, about five cun long. Treatment had lasted two months, with various exterior-releasing and interior-supporting formulas yielding little effect. Her pulses were wiry, rapid, and choppy on both sides. The lesion was depressed and painful, accompanied by alternating chills and fever, continuous menstruation, dry mouth, and difficulty eating. This condition was critical, likely caused by fatigue, depression, and anger, leading to pathogenic heat accumulating in the Jueyin position. Ying and Wei circulation was blocked, and fire pathogens pervaded the upper and lower body. Neither exterior release nor consolidation was suitable. He used Sheng Shouwu (Polygoni Multiflori Radix Preparata) 1 liang to nourish internal dryness; Chaihu (Bupleuri Radix) 1 qian to soothe Qi and blood; Zhike (Aurantii Fructus) and Jiegeng (Platycodonis Radix) 1 qian each to smooth Lung Qi and control Liver Wood; Xingren (Armeniacae Semen Amarum) and Suzi (Perillae Fructus) 2 qian each to regulate Qi and resolve phlegm, clearing the Upper Jiao; Danpi (Moutan Cortex) 1 qian to clear blood heat; Banxiaqu (Pinelliae Fermentatum) 1 qian to harmonize the Middle Jiao. After two doses, chills and fever decreased, menstruation stopped, the swelling subsided, thick pus drained, and appetite slightly improved. The surgeon believed that post-ulceration required strong tonification and administered Huangqi (Astragali Membranacei Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). Later, the wound cavity collapsed, and appetite decreased. Ma said, "It is customary to tonify after a carbuncle ulcerates. However, the current pulses are slow and choppy. Slow indicates Qi stagnation; choppy indicates Blood stagnation. Tonifying amidst stagnation worsens the stagnation. Initially, it harmed the Liver Wood, and subsequently damaged the Spleen and Stomach. Because the normal course was not followed, flesh was not warmed, and meridians did not flow, how could the wound heal? Since Ying blood does not flow, it must be harmonized with blood-invigorating herbs such as Danggui (Angelicae Sinensis Radix), Taoren (Persicae Semen), Honghua (Carthami Flos), and Yanshusuo (Corydalis Rhizoma). Baizhu and Zhike represent tonification and purgation, used to eliminate stale Qi and generate new Qi. Ganjiang (Zingiberis Rhizoma) warms the Stomach and harmonizes blood; Shanrrou (Crataegi Fructus) resolves stagnation and harmonizes the middle. After two doses, there was massive drainage of about a bowl of thick pus, appetite increased, spirit revived, and the patient stabilized. (These are profound truths that require careful contemplation.)"
Zhu Danxi diagnosed Brother Li, over forty years old, with a slightly pale complexion and severely depleted spirit. Suddenly, an abscess appeared under the hypochondrium, swollen like a peach. Someone advised using tonics, but others laughed and opposed it. Instead, Liuqi Yin (Flowing Qi Drink) and Shixuan San (Ten Acupoints Powder) were mixed and administered. Ten days later, Zhu visited and said, "Not only were tonics withheld, but excessive purgatives were given. Both Qi and blood are exhausted; recovery is impossible." This proved true.
Xue Lizhai stated: A man developed a lump in the left hypochondrium due to anger, which was painless. The pulse was choppy and floating. This was caused by blazing evil fire in the Liver meridian and insufficient True Qi. The treatment should focus on cultivating Qi and blood. However, herbal remedies were used for several prescriptions, leading to an untreatable condition.
Another man developed fever due to labor, with swelling and pain in the hypochondrium. The pulse was large but empty upon pressure. This indicated Qi and blood deficiency, loose interstices, and pathogenic invasion into the muscle layer. He Jingjian (Liu Wansu) said: "If a person eats poorly, has declining spirit, weak Qi and blood, and emaciated muscles, the Ying and Wei Qi become short and stagnant. Cold condenses at the interstices causing swelling and abscesses. One should tonify to support the deficient and fearful Qi." Thus, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) was used. After four doses, there was slight improvement. Qianghuo was removed, and after more than ten doses, the patient recovered. Another man, twenty years old, suffered mild pain all over the body and severe swelling and pain in the waist. The previous formula added with Fuling (Poria) and Banxia (Pinelliae Rhizoma) cured him.
A scholar suffered from a carbuncle in the abdomen and hypochondrium for a year. Someone suggested washing with a decoction of Digupi (Lycii Cortex), resulting in the discharge of one to two sheng of blood. The family was frightened and wanted to stop. The patient said, "The carbuncle seems better." He continued washing, discharging about five sheng until the blood lightened. Fine cotton was applied, and the next day, a scab formed, and he healed. (Same source.)
Zhang Zihe treated Ma Guoqing from Xiangling. Pain and hardness developed in the Qimen acupoint between the left breast and second rib, unulcerated and unbearable. Surgeons diagnosed it as mammary abscess, red thread fistula, or heart sore. They prescribed Neituo (Internal Support) for hundreds of days and Wuxiang Liaoqiao Tang (Five Fragrant Forsythia Decoction) for months, with no effect. Zhang said, "This is Machdao (Horse Knife Fistula), a disease of the Foot Shaoyang Gallbladder Meridian." He showed him the Twelve Meridians from Ling Shu. Its shape resembles a horse knife, hence the name. It is hard and does not ulcerate. He invited him to a restaurant, having him eat soup noodles, which provided slight relief. The next day, he induced vomiting with Cangyan (Halite) and cleared the heat with cooling purgatives, resulting in about ten defecations, after which the swelling dissipated.
An outsider of the Zhu Ge Huang family suffered from Machdao in the left hypochondrium, with aversion to cold, fever, and pain for four or five days. Zhang said, "This is a disease of the Foot Shaoyang Gallbladder Meridian, characterized by little blood and abundant Qi. It is hard and does not ulcerate. Do not attack urgently. Use bitter emetics." He used Wuxiang Liaoqiao Tang (Five Fragrant Forsythia Decoction) to support the interior. Pain ceased, but the root remained. A Daoist passerby saw it and said, "I have a miraculous medicine to induce suppuration. Without this, when will it heal?" Strong drugs were used, causing unbearable pain, external cold, continuous hematemesis, black stool, inability to eat, screaming and confusion, nearly fatal. Seeking treatment again, Zhang said, "The skin and flesh in the hypochondrium are thin. How can strong drugs be used lightly?" He ordered them washed off and administered cooling purgatives. Pain stopped immediately, and swelling subsided.