导之剂，变脾虚发肿之证而殁。 一妇两 肿痛，内热作渴，饮食不甘，肢体倦怠，阴
中作梗，小便赤涩，为肝脾阴虚湿热，用加味归脾汤而愈。后因怒复作，小腹肿胀，小
便不利，用小柴胡加山栀、芎、归，以清理肝火，胀痛顿止。又以加味逍遥散，调补肝
火而痊。 一妇人，两 肿痛，寒热内热，小便赤涩，胸胁不利，此肝火动而脾气伤，用
补中益气汤加茯苓数剂，少愈；又与加味归脾汤，诸证悉退。再用加味逍遥散而全愈。
一妇小腹痞闷，小便不利，内热体倦懒食，此气血虚而兼肝火，用八珍汤加柴、栀、胆草，
治之而安。 一妇阴中如梗，两 肿痛，寒热不食，小便频数，小腹重坠。余以为肝脾
郁结所致。先以补中益气汤加山栀、茯苓、车前子、青皮，以清肝火升脾气，更以加味归
脾汤，二十余剂调理脾郁而愈。
〔杂方〕
退毒散 治便毒肿结。
穿山甲（蘸醋炙焦，五钱） 木猪腰子（醋微炙，三钱）
为末。每服二钱，食前老酒调下。次以醋煮肥皂，研膏敷之妙。（木猪腰子，即木猪苓）
立消散 消便毒痈肿如神。
全蝎（炒） 核桃（去壳、肉，只用隔膜，炒）
等分为末。空心酒调下三钱；下午再服，三日全愈。
又方 白僵蚕、槐花为末。酒调服。一方，加酒大黄。
〔外治〕
敷药方 治便毒肿痛。
雄黄 乳香（各二两） 黄柏（一两）
上为细末。用新汲水调敷肿处，自消。
〔丹〕 又方 用甘草节、白芷、黄连各等分，如破者，龙骨、白枯矾、赤石脂，并
用铁围散。痈疽肿毒亦治，用之效。
乳香 没药（各半两） 大黄 黄连 黄柏 南星 半夏 防风 羌活 皂角刺 木鳖
子栝蒌 甘草节 草乌尖 阿胶
上为细末。醋调成膏，入石器内，火熬黑色。鹅羽蘸敷之。
The patient died due to the misapplication of purgative agents (Dao Zhi Ji), which transformed a syndrome of Spleen deficiency with edema into a fatal condition.
A female patient presented with bilateral inguinal swelling and pain, internal heat, thirst, lack of appetite, limb fatigue, a sensation of obstruction in the vagina, and red, scanty, and painful urination. This was diagnosed as Liver and Spleen Yin deficiency with damp-heat. She was cured using Jia Wei Gui Pi Tang (Modified Guipi Decoction). Later, the condition recurred after an episode of anger, presenting with lower abdominal swelling and difficult urination. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was administered with added Gardenia (Shan Zhi), Ligusticum chuanxiong (Xiong), and Angelica sinensis (Gui) to clear and drain Liver fire, resulting in immediate cessation of distension and pain. Subsequently, Jia Wei Xiao Yao San (Modified Xiaoyao Powder) was used to regulate and tonify the Liver, leading to full recovery.
Another female patient suffered from bilateral inguinal swelling and pain, alternating chills and fever, internal heat, red and painful urination, and chest and hypochondriac stagnation. This indicated Liver fire agitation injuring Spleen Qi. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Poria (Fu Ling) was prescribed for several doses, yielding slight improvement. Then, Jia Wei Gui Pi Tang (Modified Guipi Decoction) was given, causing all symptoms to subside. Finally, Jia Wei Xiao Yao San (Modified Xiaoyao Powder) was used for complete recovery.
A third female patient experienced epigastric fullness and stuffiness, difficult urination, internal heat, body fatigue, and anorexia. This was attributed to Qi and Blood deficiency combined with Liver fire. Ba Zhen Tang (Eight Treasure Decoction) with added Bupleurum (Chai), Gardenia (Zhi), and Gentiana scabra (Dan Cao) was administered, stabilizing the condition.
A fourth female patient presented with a sensation of obstruction in the vagina, bilateral inguinal swelling and pain, alternating chills and fever, inability to eat, frequent urination, and a heavy, bearing-down sensation in the lower abdomen. I attributed this to Liver and Spleen Qi stagnation. Initially, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with added Gardenia (Zhi), Poria (Fu Ling), Plantago seed (Che Qian Zi), and Tangerine peel (Qing Pi) was used to clear Liver fire and raise Spleen Qi. This was followed by Jia Wei Gui Pi Tang (Modified Guipi Decoction), taken for over twenty doses to regulate Spleen stagnation, resulting in a cure.
[Miscellaneous Formulas]
Tui Du San (Remove Toxin Powder): Treats inguinal abscesses with swelling and induration.
Squama Manis (Chuan Shan Jia, five qian, scorched with vinegar), Polyporus umbellatus (Mu Zhu Ye Zi/Mu Zhu Ling, three qian, lightly scorched with vinegar).
Grind into powder. Take two qian before meals, mixed with aged wine. Afterwards, boil soapberries in vinegar, grind into a paste, and apply externally for excellent results. (Note: Mu Zhu Ye Zi refers to Mu Zhu Ling).
Li Xiao San (Immediate Resolution Powder): Eliminates inguinal abscesses and swellings with miraculous effect.
Scorpio (Quan Xie, stir-fried), Walnut (He Tao, shell and kernel removed, only the septum used, stir-fried).
Grind equal parts into powder. Take three qian on an empty stomach with wine; take again in the afternoon. Complete recovery occurs within three days.
Another prescription: White silkworm (Bai Jiang Can) and Sophora flower (Huai Hua) ground into powder. Take with wine. Another variation adds Rhubarb (Da Huang) processed with wine.
[External Treatment]
Fu Yao Fang (Application Formula): Treats inguinal abscesses with swelling and pain.
Realgar (Xiong Huang), Frankincense (Ru Xiang) (two liang each), Phellodendron bark (Huang Bo) (one liang).
Grind all into fine powder. Mix with fresh well water and apply to the swollen area; the swelling will resolve spontaneously.
[Dandan] Another prescription: Equal parts of Licorice nodes (Gan Cao Jie), Angelica dahurica (Bai Zhi), and Coptis rhizome (Huang Lian). If the lesion is ulcerated, add Dragon bone (Long Gu), calcined alum (Bai Ku Fan), and Red kaolin (Chi Shi Zhi), and combine with Tie Wei San. This is also effective for carbuncles, sores, and toxic swellings.
Tie Wei San (Iron Enclosure Powder) Composition:
Frankincense (Ru Xiang), Myrrh (Mo Yao) (half liang each), Rhubarb (Da Huang), Coptis rhizome (Huang Lian), Phellodendron bark (Huang Bo), Arisaema (Nan Xing), Pinellia ternata (Ban Xia), Saposhnikovia root (Fang Feng), Notopterygium root (Qiang Huo), Gleditsia sinensis thorn (Zao Jiao Ci), Momordica charantia seed (Mu Bei Zi), Trichosanthes fruit (Gua Lou), Licorice nodes (Gan Cao Jie), Aconite lateral root tip (Cao Wu Jian), Donkey-hide gelatin (E Jiao).
Grind all into fine powder. Mix with vinegar to form a paste, place in a stone vessel, and simmer over fire until black. Apply with a goose feather.