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(Axillary rib area refers to the region under the armpit overlying the ribs; "Li" refers to the ribs. The part covered by bone is called "Xie," while the part without bone coverage is called "Li.")

The *Ling Shu* states: Carbuncles developing in the axillary rib area are named "Bai Ci." This is a disease prevalent in women and can be treated with moxibustion. Its presentation involves large abscesses with pus, containing fleshy growths resembling red adzuki beans. The treatment involves chopping Ling Cao (Radix Glehniae) root, taking one sheng of each. Boil in 16 sheng of water until reduced, extract three sheng of the decoction, and have the patient drink it forcefully. Then, dress warmly and sit over a pot to steam, inducing sweating down to the feet. ("Ci" is pronounced similarly to "Ci." In the *Jia Yi Jing*, after "red adzuki bean," it reads "treat by chopping Ling Cao and Chi Song Gen [Cortex Pinus], one sheng each.")

The *Gui Yi Miao Fang* states: Carbuncles occurring along the spine and swelling into the two ribs and both shoulders and elbows will result in death within twenty days if not punctured. Puncture may be performed on the ninth day. If the lesion shows alternating red and white colors with abundant pus, it is treatable; if there is no red or white coloration, it is untreatable. It further states: Carbuncles arising in both ribs are named "Fa Lei." Initially, swelling is severe; if not punctured for ten-plus days, aggressive intervention causes swelling like a cup or bowl, rising high like a mound, with back pain radiating inward causing intestinal cramping. Puncturing the left affected side elicits pain on the right; puncturing the right affects the left. This location often harbors internal toxins, and aggressive treatment leading to internal invasion has caused many deaths. For such conditions, urgently puncture with a needle to drain pus and blood to prevent internal damage.

A question was raised: How about carbuncles on the ribs? The answer is: This is named "Lei Ju" (Rib Carbuncle), belonging to the Hand Jueyin Pericardium Meridian and Foot Jueyin Liver Meridian. It arises from the combination of fire-heat toxin and angry qi. Treat with Huo Ming Yin (Life-Saving Decoction) added with Chai Hu (Radix Bupleuri), or select Zi Jin Dan (Purple Gold Pill) and Wu Jin San (Black Gold Powder). For robust individuals, use Ba Zhen San (Eight Array Powder) or Yi Li Jin Dan (One Pill Golden Elixir) to purge. This condition requires rapid treatment; otherwise, ulceration will fail to heal, leading to critical danger.

One patient suffered from this, initially presenting as a walnut-sized nodule with slight pain and swelling. After a month, it grew to the size of a cup. Physicians mistakenly treated it as phlegm, liver accumulation, or a mass, achieving no effect. Months later, it enlarged to the size of a basin, hard as stone, with minimal pain, slight redness, and diffuse swelling. Following a fit of rage, the patient experienced chest and abdominal distension, difficult urination, a slow and thready pulse. Administration of Hua Qi Wan (Qi-Transforming Pills) and Liu Yi San (Six-to-One Powder) facilitated urination and relieved chest tightness. Subsequently, Wu Jin San and Duo Ming Dan (Life-Restoring Pill) were given, interspersed with Ba Zhen San. After a month, the swelling gradually subsided.

Another patient, over fifty years old, had an infection in the axilla with non-healing wounds. The pulse at the Right Guan position was rapid, accompanied by thirst, indicating Stomach Fire. Treatment with Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) stopped the heat, followed by Qi-tonifying herbs for recovery. Postprandial thirst or fever was effectively treated with Gu Pi San (Danhui Bark Powder).

A patient with an irritable temperament and preference for rich flavors, who frequently consumed drying and heating herbs, experienced localized pain in the left hypochondrium. Light palpation revealed a wiry pulse, while heavy pressure revealed a hollow pulse, indicating pus formation at the painful site. Four Mo Decoction (Si Wu Tang) added with Jie Geng (Radix Platycodonis), Xiang Fu (Rhizoma Cyperi), and Sheng Jiang (Rhizoma Zingiberis Recens) was decocted and taken for over ten doses. The painful area swelled slightly to the size of a finger. Upon needling, pus drained upon flexion. Recovery was achieved with Si Wu Tang for regulation.

A lady experienced internal pain in the left hypochondrium radiating to the chest, indicating Disharmony of Liver Qi, before abscess formation. Xiao Chai Hu Tang (Minor Bupleurum Decoction) added with Qing Pi (Exocarpium Citri Reticulatae Viride) and Zhi Ke (Fructus Aurantii) was administered for four doses, showing improvement. Adding Xiong Gui (Radix Chuanxiong and Radix Angelicae Sinensis) led to full recovery.

A patient suffering from malaria for years developed fever three months postpartum. A boil appeared in the Yangming-Shaoyang junction of the right hypochondrium. As it healed, a corresponding boil appeared in the left hypochondrium, draining pus and blood profusely, nearly causing death. The physician prescribed Si Wu Tang and Bai Du San (Anti-Toxin Powder) with multiple times the dose of Ren Shen (Radix Ginseng), using Xiang Fu as assistant and Xi Jiao (Cornu Rhinocerotis) as guide. Large amounts were brewed and given to the wet nurse. Recovery occurred after two months. Three months later, abdominal distension arose with red rashes like clouds. Juice from Jian Dao Cao (Hedyotis diffusa) mixed with Can Sha (Semen Bombyx Batryticatus) was applied topically, resolving immediately. Half a month later, distension moved to the scrotum, causing swelling. The yellow sac ruptured, exposing the testes with fluid discharge. Bran charcoal powder held in Perilla leaves was used for support. Healing occurred after ten days. This was identified as Fetal Toxin Syndrome.

A woman, due to anger and depression, had a nodule in her axilla for over twenty years. Anger exacerbated pain and swelling. She presented with undigested food in stool and poor appetite, indicating Spleen-Stomach Deficiency Cold. Liu Jun Zi Tang (Six Gentlemen Decoction) added with Sha Ren (Fructus Amomi Rotundus), Rou Gui (Cortex Cinnamomi), Gan Jiang (Rhizoma Zingiberis Preparatum), and Dou Kou (Semen Myristicae) stopped diarrhea but resulted in thin pus and non-healing wounds. Shi Quan Da Bu Tang (Great Tonifying Decoction) cured her after a month. (Wang Ji notes: Regarding the previous two cases of hypochondriac sores, one was treated with Si Wu Tang's yin-nourishing nature to calm irritability; the other with Xiao Chai Hu Tang's soothing nature to harmonize Liver Qi. Treatment was tailored to temperament, not solely focused on detoxification.)

Zhang Tong, a northerner over forty, developed an axillary infection in summer. After ulceration, it failed to heal, discharging thin pus. Skin was cold, pulse weak, with borborygmus, cutting pain, loose stools, and vomiting after eating. This indicated Cold transformation with internal sinking. Strong acrid-warm formulas were indicated. Tuo Li Wen Zhong Tang (Support Interior and Warm Middle Decoction) resolved symptoms in two doses. Liu Jun Zi Tang added with Pao Gan Jiang and Rou Gui for several doses, followed by Shi Quan Da Bu Tang, led to recovery.

A patient had a hypochondriac swelling that did not ulcerate after a long time, with slight pain on pressure and a faint, choppy pulse, indicating deficiency of both form and syndrome. The Classics state: When form and qi are insufficient, and pathogenic qi is insufficient, tonify rather than drain. Ren Shen Yang Rong Tang (Ginseng Nourishing Courage Decoction) was indicated. Distrusting this, he took Liu Qi Yin (Flowing Qi Decoction), exacerbating deficiency symptoms. Only then did he take the previous formula, improving slightly after a month, though hardness remained. Hot mugwort compresses promoted pus formation after ten days. Needling with fire needles and moxibustion with Fermented Soybean Cake, followed by hundred doses of Shi Quan Da Bu Tang, cured him. Liu Qi Yin circulates through all twelve meridians, damaging them all. Since Gallbladder Meridian blood is naturally scant, further damage is life-threatening. Dong Yuan stated: Disease in one meridian should be addressed in that meridian alone; interfering with others by indiscriminately using attacking agents damages all meridians, posing grave danger.

A thirty-year-old patient, chronically hungry and cold, developed a right hypochondriac swelling like an inverted gourd, making water sounds upon turning, with a rapid pulse. The Classics state: Yin deficiency allows Yang qi to converge; cold transforms into heat; excessive heat rots flesh into pus. This matches the case. Pressing the swelling caused it to rise, indicating pus formation. Concentrated Huang Qi Liu Yi Tang (Astragalus Six-to-One Decoction) was drunk first, then needled. Several bowls of pus drained. Deficiency symptoms emerged, requiring strong tonification. Recovery took over three months. Generally, massive loss of pus and blood leads to Qi and Blood deficiency, requiring vigorous tonification. Other ailments should be treated slowly. Once Yuan Qi recovers, other diseases retreat. Especially for the elderly and weak, tonification is crucial regardless of swelling or ulceration.

A patient developed fever due to overwork, with hypochondriac swelling and pain. The pulse was large but empty on pressure, indicating Qi and Blood deficiency with loose interstices allowing pathogenic invasion into muscle layers. Tonification was needed to support deficient Qi. Bu Zhong Yi Qi Tang (Pump Up the Middle and Benefit Qi Decoction) added with Qiang Huo (Radix Notopterygii) improved symptoms in four doses. Removing Qiang Huo and continuing for over a hundred doses led to recovery.

A pale-faced, fatigued patient had a peach-like red swollen nodule in the hypochondrium. Advised tonics, he refused, taking Liu Qi Yin and Shi Xuan San (Ten Acupoints Powder) instead. Depletion of Qi and Blood led to death.

A patient over twenty had an axillary infection for ten days, with hard swelling, no ulceration, weak pulse, and occasional vomiting. I stated: Hard swelling without ulceration indicates Yang Qi deficiency; vomiting and poor intake indicate weak Stomach Qi. Liu Jun Zi Tang added with Sha Ren and Huo Xiang was indicated. He argued: Vomiting during the swelling stage implies toxin attacking the Heart; vomiting during the ulcer stage implies Yin deficiency requiring tonification. I replied: This is Dan Xi’s generalization. If red, swollen, painful, with restlessness, solid pulse, and vomiting, it is excess (toxin attacking Heart), requiring purgation due to Heart Fire association. If hard, non-ulcerated, with weak pulse and vomiting, it is deficiency, requiring tonification. Vomiting can also result from pain injuring Stomach Qi or cold/dirty pathogens invading. Even in the swelling stage, supporting Stomach Qi is vital. Toxin-induced vomiting occurs in 10-20% of swelling cases; dampness-induced vomiting occurs in 80-90% of ulcer cases. He refused, taking attacking herbs, worsening his condition. Upon re-examination, pulse was faint with fever. I stated: Fever with quiet pulse, pulse becoming solid after collapse, or restless pulse after sweating are difficult to treat. The patient indeed died.