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(1) Internal medicine treatment: A total of nine consultations were conducted.
First consultation on September 7th: The scrofula ulcer on the left side of the neck has been ruptured for several months, frequently leaking thin yellow serous fluid. The base of the lesion is diffuse, extending to the root of the ear. Usually, sleep is restless with frequent dreaming. Headache feels like a cone piercing, especially severe in the forehead and both sides. The pulse is fine and weak; the tongue coating is thin and rough. There is occasional dryness in the throat. This belongs to Liver Qi stagnation complicated by phlegm-fire condensation. The condition is lingering and requires careful and quiet regulation to expect efficacy. Raw Bai Shao (Paeoniae Radix Alba) 6g, Zhen Zhu Mu (Margarita) 30g (decocted first), Sheng Mu Li (Ostreae Concha) 24g (decocted first), Xia Ku Cao (Prunellae Spica) 9g, Bai Jie Geng (Platycodonis Radix) 3g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Gua Lou Pi (Trichosanthis Pericarpium) 9g, Da Mai Dong (Ophiopogonis Radix) 9g, Sheng Suan Zao Ren (Ziziphi Spinosomi Semen) and Shu Suan Zao Ren each 9g, Water-processed Yuan Zhi (Polygalae Radix) 3g, Dan Kun Bu (Laminariae Thallus) 9g, Dan Hai Zao (Sargassii Thallus) 9g, Xi Huang Xing Xiao Wan (Calculus Bovis and Borneolum Syntheticum Pill) 3g (swallowed in two doses).

Second consultation on September 14th: After taking five doses, symptoms remained as before. Sleep was not deep, and abdominal distension occurred after eating. Therefore, Gua Lou Pi, Mai Dong, and Yuan Zhi were removed from the original formula, Ye Jiao Teng (Caulis Polygoni Multiflori) 9g, Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma fried with bran) 6g, and Fu Chao Zhi Ke (Aurantii Fructus fried with bran) 4.5g were added. Take another five doses.

Third consultation on September 21st: Pus and toxins at the wound site are not yet cleared, but the surrounding area is clean. The hardness remains. There is a pulling pain sensation at the root of the ear and in the neck. Dizziness and blurred vision occur. Liver Yang rises and fails to submerge. Sleep is good, stomach distension has decreased. Pulse is fine and weak, coating is thin and light, roughness and greasiness have transformed. Use methods to calm the Liver, reduce swelling, and soften hardness. Raw Bai Shao 4.5g, Zhen Zhu Mu 30g (decocted first), Hang Ju Hua (Chrysanthemi Flos) 9g, Xia Ku Cao 9g, Bai Jie Geng 3g, Sheng Gan Cao 2.4g, Xiang Bei Mu (Fritillariae Cirrhosae Bulbus) 9g, Ye Jiao Teng 9g, Sheng Yi Yi Ren (Coicis Semen) and Shu Yi Yi Ren each 9g, Jiao Bai Zhu 9g, Dan Kun Bu 9g, Dan Hai Zao 9g, Xi Huang Xing Xiao Wan 3g (swallowed in two doses).

Fourth to Sixth consultations from September 28th to October 12th: Symptoms continued to improve. White putrid tissue at the wound site has gone, granulation tissue has proliferated, and the nodules above have gradually receded. However, the chest and epigastrium still feel full and stuffy, with much flatulence. Ye Jiao Teng, Sheng/Shu Yi Yi Ren, and Jiao Bai Zhu were successively removed from the upper formula. Fu Chao Zhi Ke 6g, Chun Sha Hua (Amomi Fructus) 2.4g, Chao Wu Yao (Linderae Radix) 4.5g, and Cai Yun Qu (Medicated Leaven) 9g were added.

Seventh consultation on October 19th: The wound is clean, pus and serum are cleared, and healing is imminent. However, there is dizziness and distension as if bound, constitution is deficient, and Liver Yang fails to submerge. Again use methods to harmonize the Ying level, calm the Liver, regulate Qi, and promote transformation. Raw Bai Shao 4.5g, Zi Dan Shen (Salviae Miltiorrhizae Radix) 4.5g, Xia Ku Cao 9g, Gan Ju Hua (Chrysanthemi Flos) 4.5g, Xiang Bei 9g, Jie Geng 3g, Sheng Gan Cao 2.4g, Kun Bu 9g, Hai Zao 9g, Chun Sha Hua 4.5g, Chao Wu Yao 4.5g, Cai Yun Qu 9g, Xi Huang Xing Xiao Wan 3g (swallowed in two doses).

Eighth to Ninth consultations from October 26th to November 2nd: The ulcerated opening has healed, but residual lumps in the upper part remain. There is still a sensation of Qi distension in the stomach. Continue with the previous formula for five doses. Additionally, provide Xi Huang Xing Xiao Wan 9g, taken over six days, and Xiang Sha Liu Jun Zi Wan (Atractylodes Macrocephala and Tuckahoe Pill with Aucklandia and Amomum) 60g, taken 9g daily, divided into two doses morning and evening.

Review on December 7th: The root of the neck wound is smooth, and all residual lumps have disappeared.

2. External treatment: Conducted in three steps. Step 1: Remove the crust, pass a probe between the two holes, cut open with scissors to expose the wound, wipe clean, then apply Wu Xing Dan (Five Elements Powder) (Appendix Formula 1) and cover with Qing Ling You Gao (Qing Ling Ointment) (Appendix Formula 2). Step 2: When pus secretion decreases but skin edges protrude, trim evenly with scissors, still apply Wu Xing Dan, and change dressing to He He You Gao (He He Ointment) (Appendix Formula 3). Step 3: When the wound surface is clean and pus/serum are cleared, change to Tao Hua Wu Bao Dan (Peach Blossom Five Treasures Powder) (Appendix Formula 4), continue applying He He You Gao until healing is complete.

Appendix Formulas:
① Wu Xing Dan: Fei Han Shui Shi (Calcitum Preparatum) 9g, Teng Huang (Gambiris Resina) 4.5g, Dong Dan (Minii Cerussa Preparata) 15g, Er Cha (Catechu) 4.5g, Niao Jin Shi Gao (Urine-soaked Calcined Gypsum) 15g, Hong Sheng Dan (Rubrum Minii Preparatum) 6g, Bing Pian (Borneolum Syntheticum) 2.4g. Grind into fine powder, sprinkle on the wound.
② Qing Ling You Gao: Niao Jin Shi Gao (Calcined, water-flying) 60g, Hai Piao Xiao (Sepiae Endoconcha) 18g, Zhen Qing Dai (Indigo Naturalis) 9g, Bing Pian 2.4g. Grind into fine powder, mix every 12g powder into 120g Vaseline, apply on gauze, and dress the wound.
③ He He You Gao: Niao Jin Shi Gao (Calcined) 30g, Fei Dong Dan 30g, Bing Pian 1.5g. Grind into fine powder, mix every 12g into 120g Vaseline, apply on gauze, and dress the wound.
④ Tao Hua Wu Bao Dan: Shui Fei Dong Dan 24g, Niao Jin Duan Shi Gao 30g, Hai Piao Xiao 9g, Shui Fei Chen Nian Jiu Hui (Water-flying Aged Hair Ash) 15g, Bing Pian 1.5g. Grind into fine powder, sprinkle on the wound (All are Zhang family hereditary experience formulas).

(Zhang Zanchen's treatment case, organized by Chen Zhicai et al.: One case of cured long-term non-healing scrofula ulcer, *Journal of Traditional Chinese Medicine* 4:17, 1964)

[Commentary] Scrofula corresponds to cervical lymph node tuberculosis. As early as the *Nei Jing*, it was known that the pathogenesis of scrofula is closely related to internal organ tuberculosis (see *Ling Shu Jing · Han Re*). Traditional Chinese Medicine believes it mostly arises from Qi stagnation and Phlegm condensation.

Case 1 belongs to late-stage scrofula, presenting with deficiency of Qi and Blood, Yin deficiency after ulceration, and dripping pus. Thus, the treatment uses nourishing Yin and resolving toxins, combined with tonifying Qi and Blood. For mild cases of scrofula, internally taking Xiao Luo Wan (Formula from *Yi Xue Xin Wu*) or Nei Xiao Luo Li Wan (Formula from *Yang Yi Da Quan*) is also effective.

Case 2 is long-term non-healing scrofula. Combined with systemic symptoms, it is treated based on Liver stagnation with Phlegm-Fire. Adding Xi Huang Xing Xiao Wan (Formula from *Wai Ke Quan Sheng Ji*) is also a commonly used formula for treating scrofula. The differentiation in this case is accurate, and the prescription is natural and appropriate. The external treatment formula used is a Zhang family hereditary empirical formula. Combined with internal medication, the curative effect is remarkable.

(X) Ma Swelling (Mumps) and Fa Yi (Parotitis)

Case 1 Li X, Male, 5 years old. In February 1964, he suffered from mumps for four or five days, with fever and aversion to cold. Both cheeks were red, swollen, and painful below the ears. Previously, crushed leaves of Chou Ling Dan were applied externally, and Liu Shen Wan was taken orally, but the effect was not obvious. Instead, he felt cold pain and discomfort in the abdomen after taking Liu Shen Wan. Symptoms showed unrelieved chills and fever, persistent swelling and pain in both cheeks, abdominal pain, loss of appetite, and mental fatigue. Pulse is wiry and fine; tongue coating is thin white, slightly yellow and greasy at the root. Differentiation: Wind-Cold attacking externally, pathogens obstructing Taiyang and Shaoyang meridians, meridian Qi blocked, collaterals unobstructed. Treatment: Release Taiyang and Shaoyang, combined with unblocking collaterals and reducing swelling. Prescribe Gui Zhi Tang and Xiao Chai Hu Tang combined with modifications. Prescription: Chai Hu 6g, Huang Qin 6g, Ming Dang Shen 9g, Gui Zhi 9g, Hang Shao 6g, Fa Xia 6g, Sheng Jiang 3 slices, Da Zao 3 pieces, Ban Lan Gen 9g, Gan Cao 6g. After one dose, fever subsided, aversion to cold lessened, cheek swelling and pain reduced by more than half, abdominal pain stopped, appetite returned, pulse became fine and slow, yellow-greasy coating at tongue root disappeared. Continue with the above formula removing Huang Qin, adding Jia Zhu (Phalli Vitellinati) 6g, Bai Jiang Cao (Patriniae Herba) 6g. Take continuously for 2 doses to recover. (*Wu Peiheng Medical Cases*)

Case 2 Female Gao, 4 years old. First consultation date: March 8, 1957. Fever, slight aversion to cold, dry mouth and thirst. Left parotid and mandibular region high swelling and burning pain, difficulty in urination and defecation. This is Wind-Heat congestion and stagnation, simultaneous disease of Yangming and Shaoyang. Swelling has lasted two days, tendency to suppurate. Should be relieved to prevent becoming Fa Yi. Long Dan Cao 6g, Bai Shao 6g, Shan Zhi Pi 6g, Jiu Qin 6g, Hua Fen 6g, Yin Hua 6g, Lian Qiao 6g, Jiu Jun 6g, Sheng Di 9g, Ku Ding Cha 6g, Xia Ku Cao 6g, Sheng Gan Cao 1.5g.

Second consultation: After taking two doses of the previous prescription, exterior and interior symptoms resolved, swelling subsided, redness retreated, pain greatly reduced, no other complications expected. Use the previous prescription with reduced ingredients to dissipate residual toxins. Sheng Di 9g, Long Dan Cao 6g, Shan Zhi Pi 6g, Huang Qin 6g, Shu Jun 6g, Lian Qiao 6g, Hua Fen 6g, Ze Xie 6g, Yin Hua 6g, Gan Cao 1.5g.

(Organized by Shang Guyu et al.: Wang Pucheng Medical Cases, *Journal of Traditional Chinese Medicine* 6:405, 1958)

[Commentary] Ma Swelling belongs to the category of Warm Toxins, called epidemic parotitis in Western medicine. Fa Yi often results from incomplete sweating during febrile diseases or untransmitted rashes, leading to residual toxin congestion. It usually presents as a kernel-like swelling on one side of the cheek, extending to the front and back of the ear, eventually suppurating with sore throat. Commonly seen in Western medicine as mandibular osteomyelitis or alveolar abscess. Case 1 is a Ma Swelling case. According to routine treatment methods, Pu Ji Xiao Du Yin with modifications is generally used. However, this case involves Wind-Cold attacking externally, pathogens obstructing Taiyang and Shaoyang, meridian Qi blocked, collaterals unobstructed. Thus, Zhongjing's Xiao Chai Hu Tang combined with Gui Zhi Tang was modified and used. Based on its therapeutic effect and connecting with former sages' views that *Shang Lun* formulas can serve as legislation for hundred diseases, this is quite insightful.

Case 2 Fa Yi, differentiated as Wind-Heat congestion and stagnation, simultaneous disease of Yangming and Shaoyang. Mr. Wang's prescription extracts main drugs from Long Dan Xie Gan Tang and Yin Qiao San. The prescription also contains Jiu Jun, Xia Ku Cao, Ku Ding Cha, etc., making the meaning of clearing heat, detoxifying, and reducing swelling particularly prominent. It can be praised as a specialized formula with great efficacy.

(11) Dysphagia (Ye Ge)

Liu XX, Female, 23 years old. First consultation date: January 17, 1970. Regurgitation after eating for three months. The patient felt dysphagia three months ago, regurgitating after eating, progressively worsening. For over a month, she felt stuffiness and burning pain behind the sternum, subsequently unable to eat slightly hard foods like steamed buns or rice. Eating caused blockage and difficulty swallowing, even vomiting, able to take only liquid food. On January 4, 1970, she was treated at a certain hospital in the city. An X-ray revealed a walnut-sized mass outside the middle segment of the esophagus. Preliminary diagnosis was "tuberculosis." Anti-tuberculosis drug treatment was ineffective. Later diagnosed as "benign extra-esophageal mass," suggesting thoracotomy exploration and surgical treatment. The patient did not agree and came to our hospital for treatment. Mental status was as before, physical strength was good, bowel movements and menstruation were normal. Examination: X-ray showed a circular mass about 4x5 cm in size in the left anterior oblique position of the middle esophagus. Surface smooth, esophagus showed a 2x5 cm semi-circular indentation, barium passage appeared linear, upper esophagus slightly dilated. Pulse wiry and slippery. Tongue coating thin white, tongue body pale. Differentiation: Qi stagnation and Blood stasis, Phlegm-Qi condensation lodging in the Upper Jiao, gathering to form a痞 (mass) (Western diagnosis: Benign extra-esophageal mass). Treatment: Move Qi and invigorate Blood, resolve Phlegm and dissipate masses. Prescription: Dai Zhe Shi, Sheng Wa Leng, Dou Dou Zi, Ze Lan each 30g, Ban Lan Gen 15g, Dang Gui, Gua Lou each 12g, Xuan Fu Hua, Xing Ren, Ju Hong, Xiang Fu, Fo Shou, Chi Shao, Bai Shao, Shan Ci Gu, Jiao Bai Zhu each 9g.

Follow-up on January 21, 1970: After taking 3 doses of the above medicine, self-perceived symptoms slightly alleviated but not significantly, still feeling burning pain behind the sternum. Following the previous formula, add Ou Jie, Nan Hong Hua, Sheng Mu Li each 15g, Yuan Hu 9g, Dang Gui, Chi/Bai Shao, Ze Lan changed to 15g, Gua Lou changed to 30g. Reduce Shan Ci Gu, Fo Shou. After taking 12 doses of the above formula, food regurgitation significantly reduced, able to eat steamed buns, noodles, etc., sternum pain also lightened. Review on February 2, 1970, X-ray showed: Esophagus widened to 0.8-1 cm, extra-esophageal mass smaller, slight burning pain in throat. Still modify according to the previous formula. Continue taking medicine for over three months. By May 6, 1970, the patient felt all symptoms had disappeared completely, able to eat steamed buns, rice, and even thicker/harder foods like pan-fried cakes, everything else normal. Occasionally felt slightly fatigued and irritable. Specifically prescribed a formula for long-term use to consolidate efficacy. Prescription: Gua Lou, Di Ding each 30g, Dai Zhe Shi, Dang Shen, Chi/Bai Shao, Dan Shen each 15g, Ge Gen 12g, Xuan Fu Hua, Xing Ren, Ju Hong, Jiu Dan Cao, Xiang Fu, Wu Wei Zi, Dang Gui, Sheng Cao each 9g. Follow-up showed the patient continued taking the above formula, previous symptoms did not recur, spirit and physical strength were like normal people. Re-examination on March 11, 1971, X-ray clearly showed: Extra-esophageal mass blurred and unclear, esophagus basically restored to normal width (about 1.2 cm). (Guan Youbo: Two medical cases of cardiac spasm and benign extra-esophageal mass, *New Medical Science Journal* 9:31, 1975)

[Commentary] Dysphagia (Ye Ge) mostly belongs to esophageal malignant tumors. This case's Western diagnosis was benign extra-esophageal mass, TCM differentiation belonged to Qi stagnation and Blood stasis, Phlegm-Qi condensation. Treatment used moving Qi and invigorating Blood, resolving Phlegm and dissipating masses. Its treatment differs from ancient books' treatments for Ye Ge. Analyzing the whole case, the treatment method does not depart from eliminating stasis, moving Qi, and resolving Phlegm, with酌情 addition of supporting healthy substances in the later stage. The formula matches the syndrome, the case is clear, and the medicine is appropriate.

(12) Breast Abscess (Ru Yong)

Case 1 Zhang XX, Female, 24 years old. First consultation date: April 18, 1972. Twenty-something days postpartum, suddenly experienced aversion to cold and fever, right breast distending pain. Hospital examination diagnosed "acute mastitis." Injected Penicillin and Streptomycin, no improvement seen. On the third day after onset, visited Beijing Hospital of Traditional Chinese Medicine. Still felt aversion to cold and fever, nausea, poor appetite, dry mouth and thirst, restlessness, dry stool, yellow urine. Pulse wiry and rapid, tongue body red, coating yellow and greasy. Examination: Temperature 38.6°C, face flushed, breathing rapid, 11x9 cm mass in the upper inner quadrant of the right breast, skin color slightly red, tenderness and refusal to press, no fluctuation sense, right axillary lymph nodes enlarged and tender. Lab test: White blood cell count 22,600/cubic mm, neutrophils 84%. Differentiation: Toxic heat congesting and blocking milk collaterals, developing into Ru Yong (Western diagnosis: Acute Mastitis). Treatment: Clear heat and detoxify, regulate Qi and invigorate Blood, unblock milk and dissipate nodules. Prescription: Yin Hua 24g, Lian Qiao 15g, Gong Ying 24g, Chi Shao 9g, Chen Pi 9g, Zhu Ru 9g, Zhi Ke 9g, Lou Lu 9g, Tong Cao 6g, Chuan Jun 6g, Bo He 9g, Huang Lian 6g. Affected breast warm wet compress, breast massage, Furong Gao applied externally to red/swollen areas.

April 21 (Follow-up): After taking 3 doses, fever subsided, temperature 36.9°C, right breast mass shrunk to 4x2 cm, nausea stopped, appetite increased, thirst improved, stool smooth (1-2 times/day), urine slightly yellow. Recheck WBC count 9,300/cubic mm, neutrophils 70%. Tongue coating thin yellow, pulse wiry and slippery. Remove Zhi Ke, Chuan Jun, Bo He, Huang Lian from the above formula. Add Gui Wei 9g, Zhu Ling 9g, Hua Fen 12g, Yuan Shen 15g. External treatment: Same as before.

April 24 (Third consultation): Temperature 36.7°C, right breast mass disappeared, right axillary lymph nodes disappeared, no other discomfort, tongue coating thin yellow, pulse wiry and slippery. Continue with the current formula for 3 doses to consolidate efficacy. (*Fang Zhidong Surgical Experience*)

Case 2 Female Huang. Postpartum imbalance, complicated by Ru Yong. Self-ulcerated once, fainted for a whole day. Subsequently gradually revived, but every day at 2 PM and 2 AM, must have tidal fever and faint for several hours. Treatment had little effect. Red patches like erysipelas appeared around the chest and breasts, gradually spreading to limbs and back, lips scorched, tongue withered, pulse deep. Differentiation: Ru Yong self-ulcerated, pathogenic heat entering Ying level. Treatment: Clear Ying level and detoxify, invigorate Blood and penetrate collaterals to extinguish wind. Prescription: Xian Sheng Di 30g, Bai Mao Gen 9g, Pu Gong Ying 9g, Qing Hao Lu, Yin Hua Lu each 30g, Xi Jiao Jian 3g (ground into juice), Mo Yao 4.5g, Dan Pi 9g. Take 1 dose, slightly comfortable; 3 doses, slight sweat, heat reduced, spirit clear. Reduce Sheng Di by four-tenths, heat flared again; increase dosage, heat reduced again. Three days without defecation, add Huo Ma Ren, Yu Li Ren to the formula, combined with enema suppositories, passed 5-6 pieces of dry feces, subsequently passed much turbid matter, heat greatly subsided, spirit clear, appetite excellent. Remove Sheng Di, Dan Pi from the previous formula, add Dang Gui, Shao Yao for blood tonification. Heat finally did not fully retreat, slight dizziness occurred. Then remove Dang Gui's bitter-warm nature, still add Sheng Di's cool-moist nature, heat cleared, redness completely disappeared, abscess wound flattened. (*Ran Xuefeng Medical Cases*)

[Commentary] Ru Yong is a common and frequent disease, the name first appearing in *Zhou Hou Bei Ji Fang*. Motherland's medicine has always believed it is caused by Liver Heat and Stomach Heat congestion, while injury to the local area during infant suckling causing infection is indeed an important pathogenic factor. Clinically, the main treatment methods are reducing swelling and detoxifying, soothing Liver and clearing Stomach, unblocking milk and dissipating nodules.

Case 1 differentiated as toxic heat congesting and blocking milk collaterals, treated with clearing heat, detoxifying, regulating Qi, and invigorating Blood methods. Added Lou Lu, Tong Cao, Zhi Ke to the formula to unblock milk and dissipate nodules. Applied Furong Gao (Formula from *Yang Yi Da Quan*) externally, functioning to reduce swelling, bind toxins, and gather roots.

Case 2 is Ru Yong self-ulcerated, righteous Qi deficient and pathogen excess, new pathogen and old pathogen combined. Symptoms show tidal fever and fainting, differentiated as pathogenic heat entering Ying level. Mr. Ran advocates clearing Ying level and detoxifying, invigorating Blood and penetrating collaterals to extinguish wind as the major method, among which clearing Ying is primary, hoping to prevent pathogenic fire from blazing and causing spasms and fainting. The formula uses Xi Jiao Di Huang Tang with modifications, which is the method of saving from burning by pouring water. Former sages had the saying that postpartum should be warm rather than cool, but this case involves Yin deficiency and blazing heat, thus requiring cool-moist treatment. As for subsequent conditioning and tonification, that is another discussion.

(13) Breast Nodule (Ru Pi)

Jin Mou, Male, 32 years old. "Breast nodule has persisted for one year, lump in the left breast gradually enlarged to the size of a walnut, frequently painful, hard to touch and immobile. Diagnosed as breast tumor by a certain Western hospital, surgery suggested. Combining with dark complexion, soft wiry slippery pulse, thin yellow coating. Differentiation: Emotional depression, Liver Qi carrying Phlegm, Qi stagnation and Blood coagulation, meridian obstruction, condensing in the breast forming Ru Pi. Treatment: First suitable to soothe Liver and relieve depression, eliminate stasis and dissipate nodules. Prescription: Chai Hu 6g, Quan Dang Gui 9g, Zhi Xiang Fu 9g, Ju Ye/Pi each 6g, Qiang/Du Huo each 9g, Gou Ju Li 15g, Pu Gong Ying 20g, Lou Lu 9g, Zhi Ban Xia 9g, Gua Lou Ren 9g, Sheng Zi Wan 5g. Additionally: Xiao Jin Dan 10 pills, take 1 pill nightly; Xiao Yao Wan 90g, take 9g every morning. External treatment: Make a raw steamed bun using fermented flour, add a small amount of Pi Xiao, apply to the breast, change once every night. Taking the above medicine continuously for one month, breast hard mass softened and shrank. Taking another 20 doses and pills, the mass completely disappeared, not recurring for twenty years to date. (*Huang Yifeng Medical Cases and Talks Collection*)