例一名“托盘疔”，即“掌心毒”之“未老白头，木痛而痒者”(见清·邹五峰《外科真诠》）。赵氏用五味消毒饮之银花、公英、地丁，配合黄芩、赤芍、酒军以清热解毒；苦参、六一散、桑枝、鸡血藤以除湿通络。后参入活血、透脓、化湿等品，心思灵巧，方具新意。例二为下颔部疔疮，其治亦重在清热解毒，配合紫雪者，防毒热内陷心包，“拔毒膏”为吴氏自订经验方，适应于一切痈疔、火毒、恶疮初期脓未成或脓液不易排出者，功能托毒排脓；六合丹为吴氏师传秘方，治痈、疖、疔毒以及一切疮疡阳证，功能清解、敛毒。例三、例四属疔毒走黄、败血症，症势凶险，按其疔毒所生部位，二例均名锁口疔。例三除疔毒走黄、败血症外，并有大量胸腔积液，呼吸困难，故采取中西医结合救治，疏方为五味消毒饮加减方，配合紫雪丹及局部外用药大致与例二同，而在主辅药的配合应用方面，则根据具体症情的不同，各有特色。例四高热昏迷，毒陷心包。治以清热解毒、清心开窍为大法，配合外敷、针刺，发挥综合疗能，其效益彰。按例四之治，解毒尤重于清热，许氏于疔毒内陷心包，吸取温热病中“温邪逆传心包”治法，治疗方药中用紫雪、安宫牛黄丸，此为“异病同治”，是祖国医学学术经验的一个重要组成部分。又：疔毒走黄之治，清·赵濂《医门补要》主张用五味消毒饮加没药、牡蛎粉、牛子、皂角刺、僵蚕、草河车诸味，一qAq一另加绿豆(约30克）包煎为引。我们过去在临床上亦曾试用(一天服两剂，每隔4小时服一次），对于早期患者确有良效，特别是对一些青、链霉素过敏或无效的病例，不妨试服。
(五）夭疽唐左：夭疽肿硬，位在左耳之后，症由情志抑郁，郁而生火，郁火挟血瘀踩结，营卫不从，颇虑毒不外泄，致育内陷之变，急与提托，冀其速腐，得脓为佳。银柴胡3克全当归6克京赤芍6克川象贝各6克生草节2。4克陈广皮3克炙远志3克炙僵蚕9克炙甲片4．5克皂角针1．5克琥珀蜡矾丸一粒开水化服。二诊：前投提托透脓之剂，疮顶红肿高活，有溃脓之象，是属佳兆；惟恙从七情中来，务须恬淡虚无。生黄芪9至全当归6克京赤芍6克紫丹参6克生草节2．4克银柴胡2．4克生香附3克皂角针4．5克川象贝各9克炙僵蚕9克笋尖9克琥珀蜡矾丸一粒开水化服。三诊：疽顶隆起，内脓渐化。旋理调护，可保无虑矣。全当归6克京赤芍6克、银柴胡2。4克生草节2．4克川象贝各9克炙僵蚕9克陈广皮3克半夏曲6克制首乌9克香白芷1．8克1(《丁甘仁医案》）
【评按】夭疸的病名见于《灵枢经·痈疽》。此案属郁火挟血瘀凝结，丁氏虑其内陷，故疏方以托毒败脓为主。二诊加用琥珀蜡矾丸(《外科正宗》方）者，以其有护心、散血、解毒之功。三诊重在调理）清余毒而兼顾气血，方颇可取。
(六）背疽
例一俞左，背心发，漫肿不红，顶平散涣，脓腐不化，身热，脉数，数为毒盛遏而不泄之征，当以攻透泄毒。黄芪9克、皂角针6克赤芍9克僵蚕9克丹皮6克首乌9克银花9克当归9克连翘9克山甲6克另：黎峒丸一丸
(吞）。外用：大乙膏掺雄麝散。二诊：高年生发背疽，疮顶不显，周围色紫、根盘平塌，坚硬不化，痛虽作而不甚剧，纳少口燥；脾土困败，脓毒不泄，防其毒陷内闭，再以托补，冀能转机。党参6克黄芪9克皂角针6克茯苓9克谷芽9克甘草节3克陈皮6克山甲9克银花9克赤芍9克另：用三年老母鸡浓煨。食鸡汁(日服一只）。三诊：背疽腐脓渐化，根脚亦定，疮口溃烂，毒邪已得外泄，惟高年正气已伤，气血本衰，须要着意调摄，不在药饵中也。外用：五五丹药线引流，外敷太乙膏。四诊：背疽已半月有余，脓水渐少，疮口略收功，但正气已亏，年高易虚难复，尚宜小心。党参9克黄芪9克全当归9克茯苓9克谷麦芽各9克银花9克生地12克赤芍9克炙甘草3克新会皮6克外用：太乙膏掺八宝丹。
(章志方治验，章琴韵等整理：无锡章氏外科经验简介，《上海中医药杂志》9t11，1964）
例二何左，背疽五天，疽头孔多，疽根微赤，痛不归中，肿象平塌，色暗根散，洒浙恶寒，头晕便溏，脉象虚细，拟以十全大补汤加减。潞党参10克生熟黄芪各6克冬白术10克制附子3克云茯苓10至大熟地10克全当归10克大白芍6克生甘草5克小川芎3克红枣4枚生姜2片上肉桂(冲）1．5克二诊：背疽十天，连进托里温补之剂，喜得顶高根活，四围收束，便溏已止，饮食如常，渐入佳境，脉象虚细，拟参苓白术散加减。潞党参10克云茯苓10至大砂仁3克全当归10至淮山药10克粉丹皮6克仙半夏5克大枣4枚三诊：迭投十全大补合参苓白术散，背疽腐去新生，渐入佳境，便溏虽止，泛恶未除。脉象虚细，仍与前法出入。潞党参10克焦白术10克云茯苓12克粉丹皮6克，山萸肉6克淮山药10克仙半夏6至新会皮5克春砂壳3克全当归10克大白芍6克生姜2片红枣4枚四诊：背疽日臻佳象，新肌溢然，疮口渐平，惟觉脘腹作胀，此乃脾失健运所致，再与参苓白术散加减。潞党参10克焦白术10克云茯苓10克生苡仁10克扁豆衣10克青陈皮各5克山萸肉10克淮山药10克春砂仁5克炒丹皮6克香附10克苦桔梗5克霍苏梗各5克
(陈树人整理：许半龙外科医案，《江苏中医杂志》2：42，1981）
【评按】背疽为发背之阴证，多见于高年患者，须防毒气内陷而成险候。
例一重点反映了章氏治疗背疽的经验，他认为如疮顶不显，周围散漫，脓液又难以透泄者，除内服益气和营托毒之剂，外用五五丹去腐拔毒外，并以食疗为辅，常用老母鸡文火煨煎，饮其原汁，日服一只，连服二三天，使内陷之毒外发，疮疽易脓易腐，有助于扶元挽危。此案初诊另服黎峒丸(《外科全生集》方），外用太乙膏掺雄麝散以加强方药之消肿解毒定痛作用；后以太乙膏掺八宝丹者，因其脓水渐少，八宝丹有生肌收口之效。
例二症脉为一派阴证逆象，疽头孔多，故又有“莲蓬发”之称，投以温补托里之剂，方用十全大补汤加减，不仅补益气血，其中参芪鼓舞正气，合桂、附温和托毒。连服五剂，背疽转入顶高根活，四围收缩之佳境，这种用温、补、托以调动并加强患者自身的抗病能力，使阴证转阳的洽法，是祖国医学治疗阴疽的一大特色。
(七）骨结核
例一宗，童。此古籍所谓流注，殆为骨结核之类，重症也。生麻黄2．4克白芥子6克肉桂末1．2克(分二次吞）熟地15克鹿角霜12克炮姜炭3克淮牛膝9克独活6克桑寄生12克当归9克威灵仙9克粉草3克小金丹一粒(化服）二诊：古人所谓阴证者，皮色不变而痛在经络骨节间，与痛风终日不休者不同：阴证转动则痛，用药当大补气血。全当归12克熟地24克巴戟天9克炮附片6克生黄芪9克补骨脂9克鹿角霜9克羌独活各5克桑寄生12克潞党参9克小金丹一粒(化服）
(《章次公医案》）
例二袁某某，男，41岁，工人。门诊号：259966。1973年1月29日初诊：患者自1972年8月起，感到腰背酸痛，两下肢萎软无力。当时检白细胞多次，均在1，200～4，500／立方毫米之间，分类淋巴球较正常值为高。以往有肺结核和副睾结核史。12月8日于某院诊治，摄片见有9、1O胸椎间隙狭窄，并见骨质破坏，有冷脓肿可见。确诊为“胸椎结核”。经用西药抗痨治疗，病情未能控制而日趋加重。后转来本院服用中药。检查：慢性病容，形态消瘦，精神萎顿，面色皓白，畏寒，下肢瘫痪，行动不能自主。第9～10胸椎棘突有明显压痛，右侧胸部有边界不清块物可扪及，站立则较明显可见，不红不热。苔薄黄腻：脉濡细。脉搏68次／分，血沉73毫米／小时。辨证：肾亏致骨骼空虚，风寒乘虚而入，痰浊凝聚。洽法：拟温经散寒化痰，益肾壮骨。方药：阳和汤加减。净麻黄6克大熟地12克鹿角粉3克
(分吞）生狗脊15克补骨脂12克白芥子9克姜半夏9克川桂枝9克白芍6克生甘草4．5克护理：卧(木板）床休息。加强食物营养，多晒太阳。二诊：诸症同前，兼见盗汗，口干、发热(38～38。5℃）。舌红少苔，脉细数(110次／分）。阴虚火旺，有渐成痨之势。拟养真阴、清虚热、益肾壮骨，宜大补阴丸合清骨散加减。左秦艽9克炙鳖甲15克(先煎）虎杖15克百部12克生狗脊15克炒川断12克补骨脂15克白芥子9克丹参9克黄芩9克淮牛膝12克熟地12克三诊：前方加减服用四个多月，胃纳渐增，精神好转，体力逐步恢复。但摄片提示冷脓疡较前为增大。苔薄舌淡，脉细数。气血两亏，人参养荣汤加减以调补气血，益肾壮骨。党参12克焦白术9克当归9克生白芍6克淮牛膝12克炒川断12克补骨脂12克白芥子9克陈皮4．5克百部9克黄芩9克鸡血藤15克四诊：前方加减服6个多月，局部冷脓肿渐吸收。苔薄润。脉率72次／分。检血沉为9毫米／小时。已能参加全天轻工作。1974年6月4日摄片，提示局部病变与以往诸片比较已趋好转。当归片每次5片，每日3次；虎挣片每次1片，每日2次，均饭后服用，以巩固疔效。
(《顾伯华外科经验选》）
【评按】骨结核的病证，大致属于祖国医学外科中的流痰、流注(流注多阳证，流痰多阴证，二者又以流痰属结核者更多）、附骨痰、附骨疽等病的范畴，以阴寒虚证，气血衰惫，湿痰凝滞成串为基本病理。清·柳宝治认为：“阴虚挟痰之证，用药最难恰好”(见《柳选四家医案·痰火门》）。当分别根据主症。兼症审因论治。
例一章氏诊断为流注，初诊用阳和汤加味以温阳通络、定痛解凝。二诊重用大补阴阳气血之剂，辅以小金丹。羌活散以散结定痛，虚实兼顾，颇合病机。
例二为胸腰椎结核，证属肾亏骨虚，风寒乘袭，痰浊凝聚，洽以温经散寒化痰，益肾壮骨法，方以阳和汤加减治疗；阴虚者宜养真阴、清虚热，溃后宜用人参养荣汤以调补气血，其中益肾壮骨是贯彻始终的治法。中医治疗骨结核，其成功的要点应使冷脓肿逐渐吸收，这样方能兔除手术，并能体现中医治疗此病的某些优越性。
(八）瘿瘤吴××，男，49岁。右侧甲状腺肿一月余。经放射性同位素检查，印象为右叶凉结节，医院建议手术治疗。来诊时症见右侧甲状腺部有一乒乓球大肿块，质较硬，可随吞咽动作上下移动。此痰气互结而主瘿瘤，治拟化痰理气。海藻10克昆布10克海浮石10克木香2克醋炒三棱、莪术各3克陈皮3克川军2克生草2克大枣2枚上药服10剂后，肿瘤缩小如绿豆大，梢有触痛，即再以原方续服3剂，瘿肿完全消失。
(《许履和外科医案医话集》
【评按】此案痰气互结，当属肉瘿，治以化痰理气为大法。方用四海舒郁丸
(《疡医大全》方）加减，所加三棱、莪木、海浮石等，加强了原方化痰行气、软坚消肿的作用。陈实功谓，“瘿瘤……乃五脏瘀血、浊气、痰凝而成”。案中用少量川军配合三棱、莪术以散瘀，方内甘草、海藻虽“相反”但前贤认为二者合用，使消瘿作用尤为突出，古代治瘿方旱有先例，医者不必疑虑。
中医瑰宝苑 近现代名医验案类编san
（九）瘰疬
例一王左，瘰疬溃后，滋水淋漓而无稠厚之脓，脉象弦细，宜育阴化毒。大生地12克川贝母6克炙鳖甲12克夏枯草10克粉丹皮6克大白芍10克煅牡蛎12克太子参10克全当归10克制首乌12克云茯苓12克炙芪皮10克二诊：迭进育阴化毒之剂，瘰疬滋水已减，脉象弦细，仍拟前法加减。大生地12克制首乌12克炙鳖甲12克当归6克白芍6克粉丹皮6克川贝母10克陈广皮5克仙半夏5克煅石决12克钩藤12克夏枯草12克三诊：瘰疬滋水未尽，腰部又觉胀痛，脉象弦细，拟再育阴化毒，参以疏理气机。制首乌12克太子参10克大白芍10克炙芪皮10克当归须6克旋复花（包）5克真新绛4克川贝母6克青陈皮各5克制乳没各6克炙鳖甲12克煅石决15克
（陈树人整理：许半龙外科医案，《江苏中医杂志》2：42，1981）
例二徐××，25岁。过去有肺结核病史，经过治疗已稳定。1962年3月发现左侧颈项之间有核，经西医检查，诊断为颈淋巴结核，曾注射链霉素，口服异菸肼、P.A.S及深度X线照射，未见消散。同年五月上旬，进行穿刺诊断后引起感染，结核溃破，有豆滓样之脓腔，兼流黄水，旋在疮口上方又起一核，质坚。治疗至9月上旬，两核一溃一坚，既不消散，又不收口，于9月7日转至中医门诊治疗。患者面色黄而不泽，精神不振。自诉神疲乏力，自汗畏寒，头痛且晕，夜寐多梦，胸闷肋痛，咽干梗塞。患处上部之核坚硬，皮色如常：下部之核则已溃，溃面结二小痂，色呈紫黑，按之有黄色稠液溢出，去其痂则有少量滓样之脓性物，咽部两侧掀赤有小瘰。处治经过：
Background Information
Book Title: Compilation of Verified Cases by Famous Modern Doctors
Chapter: Main Text (42/53)
Category: Medical Discussion
Case 1 was diagnosed as "Tray Ding" (a type of carbuncle on the palm), which refers to "palm toxin" described in Qing Dynasty Zou Wufeng's *Waike Zhenquan* ("Surgical Truths") as "white head appearing prematurely, with numb pain and itching." Zhao used Silver Flower (Jinyinhua), Dandelion (Gongying), and Purple Flower Groundsel (Zihua Didang) from Wuwei Xiaodu Yin (Five-Ingredient Decoction for Eliminating Toxins), combined with Scutellaria (Huangqin), Red Peony Root (Chishao), and Wine-processed Rhubarb (Jiu Jun) to clear heat and detoxify; Sophora Flavescens (Kushen), Liuyi San (Six-to-One Powder), Mulberry Twig (Sangzhi), and Spatholobus Stem (Jixueteng) to remove dampness and unblock collaterals. Later, herbs for invigorating blood, penetrating pus, and resolving dampness were added. The构思 (conceptualization) was ingenious, and the prescription had a fresh approach. Case 2 was a ding (carbuncle/furuncle) on the mandible. Its treatment also focused on clearing heat and detoxifying, combined with Zixue (Purple Snow) to prevent toxic heat from sinking into the Pericardium. "Badu Gao" (Toxin-Pulling Plaster) is an empirical formula self-prescribed by Wu, applicable to the early stages of all sores, ding, fire toxins, and malignant ulcers where pus has not yet formed or is difficult to drain, functioning to support the expulsion of toxins and pus. "Liuhe Dan" (Six-Harmony Pill) is a secret family recipe passed down by Wu's master, treating sores, boils, ding toxins, and all yang-type ulcerations, functioning to clear resolve and astringe toxins. Cases 3 and 4 belong to "Ding Du Zouhuang" (spreading of ding toxin leading to sepsis) and septicemia, with perilous conditions. Based on the location of the ding toxin, both cases were named "Suokou Ding" (Lock-Mouth Ding). Case 3, besides spreading toxin and septicemia, had massive pleural effusion and dyspnea, so integrated Chinese and Western medicine rescue measures were adopted. The prescription was a modified Wuwei Xiaodu Yin, combined with Zixue Dan and local external medications roughly similar to Case 2, but in the combination of main and auxiliary drugs, it had its own characteristics based on specific symptoms. Case 4 presented with high fever and coma, with toxin sinking into the Pericardium. The treatment followed the major principle of clearing heat and detoxifying, clearing the heart and opening the orifices, combined with external application and acupuncture to exert comprehensive therapeutic effects, achieving significant results. Regarding the treatment of Case 4, detoxification was prioritized over clearing heat. Xu, when dealing with toxin sinking into the Pericardium due to ding, drew upon the treatment method for "warm pathogen counter-flowing to the Pericardium" in warm diseases. The prescription used Zixue and Angong Niuhuang Wan. This is "treating different diseases with the same method," an important component of the academic experience of Traditional Chinese Medicine (TCM). Additionally: For treating spreading toxin from ding, Zhao Lian's *Yimen Buyao* (Supplement to the Gate of Medicine) in the Qing Dynasty advocated using Wuwei Xiaodu Yin plus Myrrh (Moyao), Oyster Shell Powder (Muli Fen), Burdock Fruit (Niuzi), Gleditsia Sinensis Thorn (Zaogiao Ci), Bombyx Batryticatus (Jiangcan), and Anemone Radicle (Caoheche), along with Mung Bean (about 30g) decocted in a bag as a guide drug. We have previously tried this clinically (two doses per day, taken every 4 hours), and it has indeed been effective for early-stage patients, especially for cases allergic to or unresponsive to penicillin and streptomycin, so it is worth trying.
(V) Yao Ju (Early-stage Carbuncle) Patient Tang (Left): Yao Ju presents with swelling and hardness behind the left ear. The condition arises from emotional depression, leading to stagnation generating fire. Stagnant fire carries blood stasis to condense, causing Ying and Wei qi to fail to harmonize. There is concern that the toxin will not be excreted externally, leading to internal sinking. Urgently apply lifting and supporting methods, hoping for rapid putrefaction and pus formation, which is auspicious. Bupleurum Root (Yin Chaihu) 3g, Whole Angelica Sinensis (Quandanggui) 6g, Beijing Red Peony Root (Jing Chishao) 6g, Sichuan Fritillaria Bulb (Chuan Xiangbei) 6g each, Raw Licorice Knots (Sheng Caojie) 2.4g, Aged Tangerine Peel (Chen Guangpi) 3g, Processed Polygala Root (Zhi Yuanzhi) 3g, Processed Bombyx Batryticatus (Zhi Jiangcan) 9g, Processed Turtle Shell (Zhi Jiapian) 4.5g, Gleditsia Sinensis Thorn (Zaogiao Zhen) 1.5g, one pill of Hupo Lafan Wan (Amber and Wax Pill) dissolved in boiling water. Second visit: Previous administration of lifting and promoting pus-draining agents resulted in redness, swelling, and elevation at the sore apex, indicating impending rupture, which is a good omen; however, since the illness stems from seven emotions, one must maintain tranquility and emptiness. Raw Astragalus Root (Sheng Huangqi) 9g, Whole Angelica Sinensis (Quandanggui) 6g, Beijing Red Peony Root (Jing Chishao) 6g, Red Sage Root (Zi Danshen) 6g, Raw Licorice Knots (Sheng Caojie) 2.4g, Raw Cyperus Rhizome (Sheng Xiangfu) 3g, Gleditsia Sinensis Thorn (Zaogiao Zhen) 4.5g, Sichuan Fritillaria Bulb (Chuan Xiangbei) 9g each, Processed Bombyx Batryticatus (Zhi Jiangcan) 9g, Bamboo Shoot Tip (Sunjian) 9g, one pill of Hupo Lafan Wan dissolved in boiling water. Third visit: The abscess apex has risen, and internal pus is gradually dissolving. With subsequent care and regulation, there is no cause for worry. Whole Angelica Sinensis (Quandanggui) 6g, Beijing Red Peony Root (Jing Chishao) 6g, Bupleurum Root (Yin Chaihu) 2.4g, Raw Licorice Knots (Sheng Caojie) 2.4g, Sichuan Fritillaria Bulb (Chuan Xiangbei) 9g each, Processed Bombyx Batryticatus (Zhi Jiangcan) 9g, Aged Tangerine Peel (Chen Guangpi) 3g, Pinellia Paste (Banxia Qu) 6g, Prepared Polygonum Multiflorum (Zhi Shouwu) 9g, White Angelica Root (Xiang Baizhi) 1.8g. (*Ding Ganren's Medical Cases*)
[Commentary] The name Yao Ju appears in *Ling Shu Jing: Yong Ju*. This case belongs to stagnant fire carrying blood stasis to condense. Ding was concerned about internal sinking, so he prescribed mainly to support expulsion and defeat pus. In the second visit, Hupo Lafan Wan (from *Waike Zhengzong*) was added because of its functions to protect the heart, dissipate blood stasis, and detoxify. The third visit focused on regulation, clearing residual toxins while attending to Qi and Blood; the prescription is quite commendable.
(VI) Back Abscess (Bei Ju)
Case 1 Yu (Left): Back abscess appeared on the back, diffuse swelling without redness, flat and scattered apex, pus and necrotic tissue not transforming, body heat, rapid pulse. Rapid pulse indicates abundant toxin suppressed and not excreted; attack and penetrate to vent the toxin. Astragalus Root (Huangqi) 9g, Gleditsia Sinensis Thorn (Zaogiao Zhen) 6g, Red Peony Root (Chishao) 9g, Bombyx Batryticatus (Jiangcan) 9g, Moutan Cortex (Danpi) 6g, Polygonum Multiflorum (Shouwu) 9g, Silver Flower (Yinhua) 9g, Angelica Sinensis (Danggui) 9g, Forsythia Fruit (Lianqiao) 9g, Pangolin Scale (Shanjia) 6g. Additionally: Lidong Wan one pill (swallowed). External: Dayi Gao mixed with Xiong She San. Second visit: Gao Niansheng developed back abscess. The sore apex is indistinct, surrounding area purple, root base flat and collapsed, hard and untransformed. Pain occurs but is not severe; poor appetite and dry mouth; Spleen Earth is exhausted, pus and toxin not excreted. Prevent toxin sinking and internal closure; again use supporting and tonifying methods, hoping for a turning point. Codonopsis (Dangshen) 6g, Astragalus Root (Huangqi) 9g, Gleditsia Sinensis Thorn (Zaogiao Zhen) 6g, Poria (Fuling) 9g, Sprouted Grain (Guyá) 9g, Licorice Knots (Gancao Jie) 3g, Tangerine Peel (Chenpi) 6g, Pangolin Scale (Shanjia) 9g, Silver Flower (Yinhua) 9g, Red Peony Root (Chishao) 9g. Additionally: Simmer a three-year-old hen strongly, consume the chicken broth (one hen per day). Third visit: Back abscess pus and necrotic tissue gradually transforming, root base stabilizing, sore ulcerated, toxin evil having been excreted externally. However, the elderly patient's healthy Qi is damaged, and Qi and Blood are originally deficient. Careful regulation is needed, relying less on medication. External: Wuwu Dan medicinal thread for drainage, external application of Taiyi Gao. Fourth visit: Back abscess has lasted over half a month, pus fluid gradually decreasing, sore slightly closing, but healthy Qi is depleted. Elderly people are easily deficient and hard to recover; caution is still advisable. Codonopsis (Dangshen) 9g, Astragalus Root (Huangqi) 9g, Whole Angelica Sinensis (Quandanggui) 9g, Poria (Fuling) 9g, Sprouted Barley and Millet (Guy Maiya) 9g each, Silver Flower (Yinhua) 9g, Rehmannia Root (Shengdi) 12g, Red Peony Root (Chishao) 9g, Processed Licorice (Zhigancao) 3g, Xinhui Peel (Xinhui Pi) 6g. External: Taiyi Gao mixed with Babao Dan.
(Zhang Zhifang's Treatment Experience, organized by Zhang Qinyun et al.: Brief Introduction to Wuxi Zhang Family Surgery Experience, *Shanghai Journal of Traditional Chinese Medicine*, 1964, No. 11)
Case 2 He (Left): Back abscess for five days, many holes at the abscess head, root slightly red, pain not localized, swelling flat, color dark and root scattered, chills, dizziness, loose stools, deficiency-thin pulse. Prescribe modified Shiquan Dabu Tang (Ten Significant Tonifying Decoction). Codonopsis (Ludangshen) 10g, Raw and Prepared Astragalus Root (Sheng Shu Huangqi) 6g each, Winter Atractylodes Rhizome (Dong Baizhu) 10g, Prepared Aconite Root (Zhi Fuzi) 3g, Cloud Poria (Yun Fuling) 10g, Large Prepared Rehmannia Root (Da Shudi) 10g, Whole Angelica Sinensis (Quandanggui) 10g, Large White Peony Root (Da Baishao) 6g, Raw Licorice (Sheng Gancao) 5g, Small Ligusticum Rhizome (Xiao Chuanxiong) 3g, Red Dates (Hongzao) 4 pieces, Ginger Slice (Shengjiang) 2 slices, Cinnamon Bark (Shang Rougui) 1.5g (added just before serving). Second visit: Back abscess for ten days, continuous administration of interior-supporting and warming-tonifying agents. Fortunately, the apex is high and root active, four sides contracting, loose stools stopped, diet normal, gradually entering a good state, deficiency-thin pulse. Prescribe modified Shenling Baizhu San (Codonopsis, Poria and Atractylodes Macrocephala Powder). Codonopsis (Ludangshen) 10g, Cloud Poria (Yun Fuling) 10g, Large Amomum Fruit (Da Sharen) 3g, Whole Angelica Sinensis (Quandanggui) 10g, Huai Yam (Huai Shanyao) 10g, Powdered Moutan Cortex (Fen Danpi) 6g, Fairy Pinellia (Xian Banxia) 5g, Big Dates (Dazao) 4 pieces. Third visit: Successive administration of Shiquan Dabu combined with Shenling Baizhu San. Back abscess necrotic tissue removed, new tissue growing, gradually improving. Loose stools stopped, but nausea remains. Deficiency-thin pulse, still modifying previous methods. Codonopsis (Ludangshen) 10g, Charred Atractylodes Rhizome (Jiao Baizhu) 10g, Cloud Poria (Yun Fuling) 12g, Powdered Moutan Cortex (Fen Danpi) 6g, Cornus Fruit (Shanyurou) 6g, Huai Yam (Huai Shanyao) 10g, Fairy Pinellia (Xian Banxia) 6g, Xinhui Peel (Xinhui Pi) 5g, Spring Cardamom Shell (Chun Shaqiao) 3g, Whole Angelica Sinensis (Quandanggui) 10g, Large White Peony Root (Da Baishao) 6g, Ginger Slice (Shengjiang) 2 pieces, Red Dates (Hongzao) 4 pieces. Fourth visit: Back abscess daily approaching good signs, new muscle overflowing, sore surface flattening, only feeling abdominal distension, caused by Spleen failing to transport and transform. Again prescribe modified Shenling Baizhu San. Codonopsis (Ludangshen) 10g, Charred Atractylodes Rhizome (Jiao Baizhu) 10g, Cloud Poria (Yun Fuling) 10g, Raw Coix Seed (Sheng Yiren) 10g, Broad Bean Coat (Biandou Yi) 10g, Green and Aged Tangerine Peel (Qing Chenpi) 5g each, Cornus Fruit (Shanyurou) 10g, Huai Yam (Huai Shanyao) 10g, Spring Cardamom (Chun Sharen) 5g, Stir-fried Moutan Cortex (Chao Danpi) 6g, Cyperus Rhizome (Xiangfu) 10g, Bitter Platycodon Root (Ku Jiegeng) 5g, Perilla Stem (Huosugeng) 5g each.
(Chen Shuren organized: Xu Banlong Surgical Medical Cases, *Jiangsu Journal of Traditional Chinese Medicine* 2:42, 1981)
[Commentary] Back abscess is a Yin syndrome of the back, mostly seen in elderly patients. One must guard against toxic gas sinking internally to become a critical condition.
Case 1 highlights Zhang's experience in treating back abscess. He believes that if the sore apex is indistinct, surroundings diffuse, and pus difficult to vent, besides internal administration of Qi-nourishing and Ying-supporting toxin-expelling agents and external use of Wuwu Dan to remove rot and extract toxin, dietary therapy should be auxiliary. Commonly, an old hen is simmered gently, drinking its original juice, one per day, for two or three consecutive days, to cause internally sunk toxin to emerge externally, making sores prone to pus and rot, helping to support the origin and rescue danger. In the first visit of this case, Lidong Wan (from *Waike Quanshengji*) was taken additionally, and Taiyi Gao mixed with Xiong She San applied externally to strengthen the prescription's effect on reducing swelling, detoxifying, and relieving pain; later, Taiyi Gao mixed with Babao Dan was used because pus fluid was gradually decreasing, and Babao Dan has the effect of generating flesh and closing wounds.
Case 2's symptoms and pulse show a set of Yin syndrome adverse signs. Many holes at the abscess head give it the name "Lotus Pod Emission." Administration of warming, tonifying, and interior-supporting agents, using modified Shiquan Dabu Tang, not only tonifies Qi and Blood, but Ginseng and Astragalus stimulate healthy Qi, combined with Cinnamon and Aconite to gently support toxin expulsion. After taking five doses, the back abscess transitions to a good state of high apex, active root, and contracting sides. This treatment method, using warming, tonifying, and supporting to mobilize and enhance the patient's own resistance, transforming Yin syndrome to Yang, is a major characteristic of TCM in treating Yin abscesses.
(VII) Bone Tuberculosis
Case 1 Zong, Child. This is what ancient texts call Liuzhu (Flowing Note), likely a type of bone tuberculosis, a severe disease. Raw Ephedra Herb (Sheng Mahuang) 2.4g, White Mustard Seed (Baijiezì) 6g, Cinnamon Bark Powder (Rougui Mo) 1.2g (taken in two doses), Prepared Rehmannia Root (Shudi) 15g, Deer Antler Glue (Lu Jiaoshuang) 12g, Roasted Ginger Charcoal (Pao Jiangtan) 3g, Huai Achyranthes Root (Huai Niuxi) 9g, Notopterygium Rhizome (Duhuo) 6g, Taxillus Branch (Sangjisheng) 12g, Angelica Sinensis (Danggui) 9g, Spirit Clipping Vine (Weilingxian) 9g, Powdered Licorice (Fencao) 3g, one pill of Xiaojin Dan (dissolved). Second visit: What ancients called Yin syndrome is unchanged skin color with pain in meridians and joints, different from gout that does not cease all day; Yin syndrome hurts when moving, medication should greatly tonify Qi and Blood. Whole Angelica Sinensis (Quandanggui) 12g, Prepared Rehmannia Root (Shudi) 24g, Morinda Root (Bajitian) 9g, Prepared Aconite Slice (Pao Fupian) 6g, Raw Astragalus Root (Sheng Huangqi) 9g, Psoralea Fruit (Buguzhi) 9g, Deer Antler Glue (Lu Jiaoshuang) 9g, Notopterygium and Saposhnikovia Root (Qiang Duhuo) 5g each, Taxillus Branch (Sangjisheng) 12g, Codonopsis (Ludangshen) 9g, one pill of Xiaojin Dan (dissolved).
(*Zhang Cigong's Medical Cases*)
Case 2 Yuan XX, Male, 41 years old, Worker. Outpatient No.: 259966. First visit Jan 29, 1973: Patient felt lower back and hip soreness/aching, and weakness/flaccidity in both lower limbs since August 1972. At that time, white blood cell counts multiple times were between 1,200–4,500/mm³, lymphocyte classification higher than normal values. Past history of pulmonary tuberculosis and epididymal tuberculosis. On Dec 8, treated at a certain hospital, X-ray showed narrowing of T9-T10 intervertebral spaces, bone destruction visible, cold abscess visible. Diagnosed as "Thoracic Vertebral Tuberculosis." Condition could not be controlled by Western anti-tuberculosis drugs and worsened day by day. Later transferred to our hospital for Chinese herbal medicine. Examination: Chronic illness appearance, emaciated form, depressed spirit, pale complexion, aversion to cold, lower limb paralysis, inability to move independently. Obvious tenderness at spinous processes of T9-T10 thoracic vertebrae. Indistinct mass palpable on right chest, more obvious when standing, not red or hot. Thin yellow greasy coating; soggy-thin pulse. Pulse rate 68 bpm, ESR 73 mm/h. Syndrome Differentiation: Kidney deficiency leads to empty bones, Wind-Cold takes advantage of deficiency to enter, turbid phlegm condenses. Treatment Method: Plan to warm meridians, scatter cold, resolve phlegm, benefit kidney, strengthen bones. Prescription: Modified Yanghe Tang. Clean Ephedra Herb (Jing Mahuang) 6g, Large Prepared Rehmannia Root (Da Shudi) 12g, Deer Antler Powder (Lu Jiaofen) 3g (taken separately), Raw Dogwood Root (Sheng Gouji) 15g, Psoralea Fruit (Buguzhi) 12g, White Mustard Seed (Baijiezì) 9g, Ginger Pinellia (Jiang Banxia) 9g, Sichuan Cinnamon Twig (Chuan Guizhi) 9g, White Peony Root (Baishao) 6g, Raw Licorice (Sheng Gancao) 4.5g. Nursing: Rest on (wooden board) bed. Strengthen food nutrition, get more sun exposure. Second visit: Symptoms same as before, additionally night sweats, dry mouth, fever (38–38.5°C). Red tongue with little coating, fine-rapid pulse (110 bpm). Yin deficiency with Fire hyperactivity, tendency towards consumption disease. Plan to nourish True Yin, clear deficient heat, benefit kidney, strengthen bones. Suitable for modified Dabu Yin Wan combined with Qinggu San. Left Gastrodia Rhizome (Zuo Qinjiao) 9g, Processed Softshell Turtle Shell (Zhi Biejia) 15g (decoct first), Giant Knotweed Rhizome (Huzhang) 15g, Stemona Root (Baibu) 12g, Raw Dogwood Root (Sheng Gouji) 15g, Stir-fried Drynaria Rhizome (Chao Chuanduan) 12g, Psoralea Fruit (Buguzhi) 15g, White Mustard Seed (Baijiezì) 9g, Salvia Root (Danshen) 9g, Scutellaria Root (Huangqin) 9g, Huai Achyranthes Root (Huai Niuxi) 12g, Prepared Rehmannia Root (Shudi) 12g. Third visit: Taking modified previous prescription for over four months, stomach appetite gradually increased, spirit improved, physical strength gradually recovered. But X-ray suggests cold abscess enlarged compared to before. Thin coating, pale tongue, fine-rapid pulse. Qi and Blood both deficient. Modified Renshen Yangrong Tang to regulate and tonify Qi and Blood, benefit kidney, strengthen bones. Codonopsis (Dangshen) 12g, Charred Atractylodes Rhizome (Jiao Baizhu) 9g, Angelica Sinensis (Danggui) 9g, Raw White Peony Root (Sheng Baishao) 6g, Huai Achyranthes Root (Huai Niuxi) 12g, Stir-fried Drynaria Rhizome (Chao Chuanduan) 12g, Psoralea Fruit (Buguzhi) 12g, White Mustard Seed (Baijiezì) 9g, Tangerine Peel (Chenpi) 4.5g, Stemona Root (Baibu) 9g, Scutellaria Root (Huangqin) 9g, Spatholobus Stem (Jixueteng) 15g. Fourth visit: Taking modified previous prescription for over 6 months, local cold abscess gradually absorbed. Thin moist coating. Pulse rate 72 bpm. Checked ESR 9 mm/h. Able to participate in light work all day. X-ray on June 4, 1974, suggests local lesions trending better compared to previous films. Danggui Tablets 5 pills each time, 3 times daily; Huzhang Tablets 1 pill each time, 2 times daily, taken after meals to consolidate curative effect.
(*Gu Bohua's Selected Surgical Experiences*)
[Commentary] Bone tuberculosis pathology roughly belongs to the categories of Liutan (Flowing Phlegm), Liuzhu (Flowing Note - Liuzhu mostly Yang syndrome, Liutan mostly Yin syndrome, and among these, Liutan belonging to tuberculosis is more common), Fugu Tan (Attached Bone Phlegm), Fugu Ju (Attached Bone Abscess) in TCM surgery. The basic pathology is Yin-Cold deficiency syndrome, exhaustion of Qi and Blood, and stagnation of damp-phlegm forming chains. Qing Dynasty Liu Baozhi believed: "In cases of Yin deficiency carrying phlegm, it is hardest to use medication appropriately" (see *Liu Xuan Si Jia Yi An: Tan Huo Men*). One should analyze causes and treat according to main and accompanying symptoms respectively.
Case 1 Zhang diagnosed as Liuzhu. First visit used modified Yanghe Tang to warm Yang, unblock collaterals, relieve pain, and resolve凝 (stagnation). Second visit heavily used agents to greatly tonify Yin-Yang Qi and Blood, assisted by Xiaojin Dan and Qianghuo San to dissipate nodules and relieve pain, attending to both deficiency and excess, fitting the pathology well.
Case 2 is thoracolumbar vertebral tuberculosis, syndrome belonging to Kidney deficiency and bone emptiness, Wind-Cold attacking, turbid phlegm condensing. Treatment uses warming meridians, scattering cold, resolving phlegm, benefiting kidney, strengthening bones method, prescribing modified Yanghe Tang; for Yin deficiency, suitable to nourish True Yin, clear deficient heat; after ulceration, suitable to use Renshen Yangrong Tang to regulate and tonify Qi and Blood. Among these, benefiting kidney and strengthening bones is the treatment method贯穿 (running through) throughout. The key to success in TCM treatment of bone tuberculosis should be gradual absorption of cold abscesses, thereby avoiding surgery and reflecting certain advantages of TCM in treating this disease.
(VIII) Goiter (Ying Liu) Wu XX, Male, 49 years old. Right thyroid swelling for over a month. Radioisotope examination impression: Right lobe cold nodule. Hospital suggested surgical treatment. At consultation, symptoms showed a ping-pong ball-sized mass in the right thyroid region, relatively hard texture, movable up and down with swallowing. This is Phlegm-Qi mutual knotting leading to Ying Liu. Treatment plans to resolve phlegm and regulate Qi. Sargassum (Haizao) 10g, Kelp (Kunbu) 10g, Pumice Stone (Haifushi) 10g, Aucklandia Root (Muxiang) 2g, Vine-processed Tripterygium Wilfordii Root (Sanleng) and Curcuma Longa Rhizome (Ezhu) 3g each, Tangerine Peel (Chenpi) 3g, Rhubarb (Chuanjun) 2g, Raw Licorice (Shengcao) 2g, Red Dates (Dazao) 2 pieces. After taking the above medicine for 10 doses, tumor shrank to size of mung bean, slight tenderness. Immediately continue taking original prescription for 3 doses, goiter completely disappeared.
(*Xu Lühe's Surgical Medical Cases and Conversations Collection*)
[Commentary] This case of Phlegm-Qi mutual knotting belongs to Rou Ying (Flesh Goiter). Treatment uses resolving phlegm and regulating Qi as the major method. Prescription uses modified Sihai Shuyu Wan (from *Yangyi Daquan*), adding Sanleng, Ezhu, Haifushi etc., strengthening the original prescription's effects of resolving phlegm, moving Qi, softening hardness, and reducing swelling. Chen Shigong said, "Ying Liu... is formed by blood stasis, turbid Qi, and phlegm coagulation in the Five Zang organs." In the case, small amount of Chuanjun combined with Sanleng and Ezhu to dissipate stasis. Although Gancao and Haizao are "contrary" in the prescription, former sages believe their combination makes the effect of eliminating goiter particularly prominent. Ancient prescriptions for goiter have precedents; physicians need not hesitate.
Chinese Medical Treasures: Compilation of Verified Cases by Famous Modern Doctors
(IX) Scrofula (Luoli)
Case 1 Wang (Left): After scrofula ulcerates, serous fluid drips continuously without thick pus, pulse string-thin. Suitable to nourish Yin and resolve toxin. Large Rehmannia Root (Da Shengdi) 12g, Fritillaria Cirrhosa Bulb (Chuan Beimu) 6g, Processed Softshell Turtle Shell (Zhi Biejia) 12g, Prunella Vulgaris Spike (Xiakucao) 10g, Powdered Moutan Cortex (Fen Danpi) 6g, Large White Peony Root (Da Baishao) 10g, Calcined Oyster Shell (Duan Muli) 12g, Pseudostellaria Root (Taizishen) 10g, Whole Angelica Sinensis (Quandanggui) 10g, Prepared Polygonum Multiflorum (Zhi Shouwu) 12g, Cloud Poria (Yun Fuling) 12g, Processed Astragalus Skin (Zhi Qipi) 10g. Second visit: Successive administration of Yin-nourishing and toxin-resolving agents, scrofula serous fluid reduced, pulse string-thin. Still plan previous method modification. Large Rehmannia Root (Da Shengdi) 12g, Prepared Polygonum Multiflorum (Zhi Shouwu) 12g, Processed Softshell Turtle Shell (Zhi Biejia) 12g, Angelica Sinensis (Danggui) 6g, White Peony Root (Baishao) 6g, Powdered Moutan Cortex (Fen Danpi) 6g, Fritillaria Cirrhosa Bulb (Chuan Beimu) 10g, Aged Tangerine Peel (Chen Guangpi) 5g, Fairy Pinellia (Xian Banxia) 5g, Calcined Hematite (Duan Shijue) 12g, Uncaria Ramulus with Hook (Gouteng) 12g, Prunella Vulgaris Spike (Xiakucao) 12g. Third visit: Scrofula serous fluid not fully exhausted, waist feels distending pain, pulse string-thin. Plan again to nourish Yin and resolve toxin, refer to regulating Qi mechanism. Prepared Polygonum Multiflorum (Zhi Shouwu) 12g, Pseudostellaria Root (Taizishen) 10g, Large White Peony Root (Da Baishao) 10g, Processed Astragalus Skin (Zhi Qipi) 10g, Angelica Sinensis Root Hair (Danggui Xu) 6g, Inula Flower (Xuanfuhua) 5g (wrapped), Real New Crimson (Zhen Xinjiang) 4g, Fritillaria Cirrhosa Bulb (Chuan Beimu) 6g, Green and Aged Tangerine Peel (Qing Chenpi) 5g each, Processed Frankincense and Myrrh (Zhi Rumu) 6g each, Processed Softshell Turtle Shell (Zhi Biejia) 12g, Calcined Hematite (Duan Shijue) 15g.
(Chen Shuren organized: Xu Banlong Surgical Medical Cases, *Jiangsu Journal of Traditional Chinese Medicine* 2:42, 1981)
Case 2 Xu XX, 25 years old. Past history of pulmonary tuberculosis, stabilized after treatment. March 1962 found nodes between left neck and shoulder. Western medical examination diagnosed cervical lymph node tuberculosis. Injected Streptomycin, oral Isoniazid, PAS, and deep X-ray irradiation, no resolution seen. Early May same year, puncture diagnosis caused infection, tuberculosis ulcerated, bean-dregs-like pus cavity, flowing yellow water. Soon another node rose above the sore, hard texture. Treatment until early September, two nodes one ulcerated one hard, neither dissolving nor closing. Transferred to TCM clinic for treatment on Sept 7. Patient's face yellow without luster, spirit listless. Complains of mental fatigue and weakness, spontaneous sweating, aversion to cold, headache and dizziness, dream-disturbed sleep, chest tightness and rib pain, dry throat and obstruction. Upper node at lesion site hard, skin color normal; lower node already ulcerated, ulcer surface formed two small scabs, color purple-black, pressing yields yellow thick liquid, removing scab yields small amount of dreg-like purulent matter, both sides of throat red with small scrofula nodes. Treatment process: