宋左 中发背腐溃，得脓不多，大似覆碗，肉坚肿，疮顶深陷，临晚寒热不壮，纳谷减少，舌苔薄腻，脉象虚
弦。背脊属督脉所主，脊旁为太阳之经，督阳已衰，太阳主寒水之化，痰湿蕴结，营血凝塞，此阴疽也，势勿轻
视。急拟助督阳以托毒，和营卫而化湿，冀其疮顶高起，
脓毒外泄，始能入于坦途。
生黄 （五钱） 朱茯神（三钱） 陈广皮（一钱） 鹿角胶（一钱五分） 紫丹参（三钱） 仙半夏（二
钱） 大贝母（三钱） 生草节（五分） 全当归（三钱） 红枣（四枚） 生熟谷芽（各三钱）
洗方
全当归（二钱） 生草节（六分） 独活（二钱） 大川芎（二钱） 石菖蒲（二钱） 鲜猪脚爪（劈碎，一枚）
煎汤洗之。
外用九黄丹，海浮散，阳和膏。
二诊 中发背腐溃，得脓不多，大如覆碗，疮顶不起，四围肿硬色紫，纳后减少，舌苔薄腻，脉象濡滑。少
阴阴阳本亏，痰湿蕴结太阳之络，营卫凝塞，肉腐为脓。前投助阳托毒和营化湿之剂，尚觉合度，仍守原意出入。
生黄 （六钱） 朱茯神（三钱） 陈广皮（一钱） 春砂壳（八分） 生草节（四分） 紫丹参（三钱）
炙远志肉（一钱） 全当归（三钱） 生熟谷芽（各三钱） 鹿角胶（三钱） 仙半夏（三钱） 大贝母（三钱）
红枣（四枚）
三诊 中发背腐溃，腐肉渐脱，脓渐多，四围肿硬略减，舌苔薄腻，脉象虚弦而滑。少阴阴阳本亏，痰湿
凝结太阳之络，营卫循序失常，仍拟助阳益气，化湿托
毒，冀其正气充足，则脓自易外泄。
生黄 （六钱） 朱茯神（三钱） 全当归（三钱） 生草节（四分） 紫丹参（二钱） 陈广皮（一钱）
春砂壳（八分） 炙远志肉（一钱） 炒赤芍（一钱五分） 仙半夏（二钱） 红枣（四枚） 鹿角霜（二钱）
大贝母（三钱） 生熟谷芽（各三钱）
外用九黄丹，呼脓丹，海浮散，阳和膏。
四诊 中发背腐肉渐脱，脓亦多，根脚肿硬亦收，苔薄腻，脉虚滑。少阴阴阳两亏，痰湿稽留太阳之络，
营卫循序失常。饮食喜甜，中虚故也。再拟助阳益气，化湿托毒，佐入和胃之品。
生黄 （六钱） 云茯苓（三钱） 全当归（三钱） 光杏仁（三钱）
紫丹参（二钱） 炙远志肉（一钱） 陈广皮（一钱） 红枣（五枚） 生草节（四分） 仙半夏（三钱）
春砂壳（八分） 鹿角霜（二钱） 川象贝（各二钱） 生熟谷芽（各三钱）
五诊 中发背腐肉渐脱，得脓亦多，根脚肿硬亦松，惟胃纳不旺，脉象左虚弦右濡滑。少阴阴阳两亏，
蕴毒痰湿，稽留太阳之络，脾胃运化失其常度。再拟益气托毒和胃化湿。
生黄 （四钱） 全当归（二钱） 仙半夏（三钱） 鹿角霜（四钱） 红枣（五枚） 紫丹参（二钱）
云茯苓（三钱） 陈广皮（一钱） 炙款冬（一钱五分） 生姜（一片） 生草节（四分） 炙远志肉
一钱） 春砂仁（一钱） 生熟谷芽（各三钱）
六诊 中发背腐肉已去其半，得脓亦多，根脚肿硬亦松，胃纳不旺，脉象左虚弦右濡滑。少阴阴阳两亏，
蕴毒痰湿留恋，一时未易清沏。再拟益气托毒，和胃化痰。
生黄 （四钱） 生草节（四分） 仙半夏（一钱五分） 紫丹参（二钱） 抱茯神（三钱） 陈广皮（一
钱） 全当归（二钱） 鹿角霜（三钱） 生熟谷芽（各三钱） 杜赤豆（五钱） 红枣（五枚）
洗药方
全当归（三钱） 生草节（三钱） 石菖蒲（一钱五分） 猪脚爪（劈碎，一枚） 紫丹参（三钱） 生赤
芍（三钱） 蜂房窠（二钱）
煎汤洗之。
外用，红肉∶上补天丹、海浮散。腐肉∶上桃花散、九黄丹。外贴阳和膏。
七诊 中发背腐肉已去其半，得脓亦多，四围根脚渐平，纳谷不旺，临晚足跗浮肿，牙龈虚浮，脉象左濡弦
右濡滑。气血两亏，脾胃不健，余毒蕴湿未楚，再拟益气托毒，崇土化湿。
生黄 （四钱） 抱茯神（三钱） 全当归（二钱） 紫丹参（二钱） 陈广皮（一钱） 冬瓜皮（三钱）
生白术（一钱五分） 生草节（四分） 焦谷芽（三钱） 红枣（五枚）
外用海浮散、九黄丹、补天丹、九仙丹，阳和膏。
八诊 中发背腐肉十去七八，四围根脚，亦觉渐收，牙龈虚浮，临晚足跗微肿，脉象左虚弦不柔，右濡
滑。气血两亏，浮火易升，脾弱清气下陷，余毒留恋。再拟益气托毒，崇土化湿。
生黄 （四钱） 抱茯神（三钱） 淮山药（三钱） 冬瓜皮（三钱） 紫丹参（三钱） 全当归（三钱）
生白芍（一钱） 红枣（五枚） 生草节（四分） 陈皮（一钱） 生熟谷芽（各三钱）
外用海浮散、桃花散、九黄丹、补天丹，阳和膏。
九诊 中发背腐肉已去七八，根脚亦平，脓水亦少，惟纳谷不香，牙龈虚肿，面部虚浮，脉左虚弦右濡
滑。气血两亏，津少上承，脾胃不健，运化失常。再拟益气托毒，理脾和胃。
生黄 （四钱） 云茯苓（三钱） 大贝母（三钱） 冬瓜子（三钱） 紫丹参（二钱） 陈广皮（一钱）
佩兰梗（一钱五分） 红枣（四枚） 全当归（二钱） 生草节（四分） 生熟谷芽（各三钱）
外用桃花散、九黄丹、补天丹，阳和膏。
十诊 中发背腐肉已除，新肉已生，纳谷衰少，口舌糜点，牙龈肿痛，妨于咽纳，便溏似痢，苔腻布，脉象
左虚弦右濡滑。此乃气阴两亏，无根之火，易于上升，脾胃不运，湿浊留恋，人以胃气为本。再拟和胃运脾，
宣化湿浊。
炒淮药（三钱） 炒扁豆衣（三钱） 佩兰梗（一钱五分） 藏青果（一钱） 云茯苓（三钱） 新会皮
（一钱五分） 谷麦芽（各三钱） 干荷叶（一角） 野蔷薇花露（二两） 香稻叶露（二两，二味后入）
龙脑薄荷一支，剪碎泡汤，洗口舌糜腐处，再用珠黄散搽之。
十一诊 中发背腐肉已去七八，新肉已生，便溏似痢亦止，惟口舌糜点碎痛，牙龈虚浮，妨于咽饮，纳谷减
少，苔薄腻，左脉弦象略缓，右部濡滑。此气阴两亏，虚火挟湿浊上浮，脾胃运化无权。人以胃气为本，再拟和
胃清宣。
炒淮药（三钱） 川象贝（各二钱） 通草（八分） 佩兰梗（一钱五分） 云茯苓（三钱） 陈广皮（一钱）
炒谷麦芽（各三钱） 香稻叶露（三两） 蔷薇花露（三两，二味后入）
十二诊 中发背腐肉虽去七八，新肉生长迟迟。皆由正气亏虚，不能生长肌肉，口舌糜腐碎痛，牙龈腐
烂，妨于咽饮，谷食衰少，苔粉腻，虚火挟湿浊上浮，脾胃生气无权，还虑正虚不支，致生变迁。再拟和胃清化。
真芦荟（八分） 甘中黄（五分） 赤茯苓（三钱） 京玄参（一钱五分） 胡黄连（五分） 活贯众（三钱）
川象贝（各二钱） 通
草（八分） 生熟谷芽（各三钱） 蔷薇花露（三两） 香稻叶露（三两，二味后入）
宋先生，背部正中发背疮已溃烂，但脓液排出不多，疮面形状大似倒扣的碗，肌肉坚硬肿胀，疮顶深陷。傍晚时分出现寒热往来，热度不高，食欲减退，舌苔薄而腻，脉象虚弦。背部脊柱属督脉所主，脊旁为足太阳膀胱经循行部位。督脉阳气已衰，太阳经主司寒水之气化，导致痰湿蕴结，营血凝滞不通，这是阴疽之证，病情不可轻视。急拟采用扶助督脉阳气以托毒外出，调和营卫以化解湿邪的方法，期望疮顶能够高起，脓毒得以外泄，方能转入坦途（好转）。
处方：生黄芪五钱，朱茯神三钱，陈广皮一钱，鹿角胶一钱五分，紫丹参三钱，仙半夏二钱，大贝母三钱，生甘草节五分，全当归三钱，红枣四枚，生谷芽与熟谷芽各三钱。
外洗方：全当归二钱，生甘草节六分，独活二钱，大川芎二钱，石菖蒲二钱，鲜猪脚爪一枚（劈碎），煎汤清洗患处。
外用药物：九黄丹，海浮散，阳和膏。
二诊：背部正中发背疮已溃烂，脓液不多，疮面大如倒扣的碗，疮顶未起，四周肿硬且颜色紫暗，进食后食欲更减，舌苔薄腻，脉象濡滑。少阴肾中阴阳本已亏虚，痰湿蕴结于太阳经络，营卫凝滞，肌肉腐败化为脓液。前次投用助阳托毒、调和营卫、化湿的药物，尚觉合适，仍守原意进行加减。
处方：生黄芪六钱，朱茯神三钱，陈广皮一钱，春砂壳八分，生甘草节四分，紫丹参三钱，炙远志肉一钱，全当归三钱，生谷芽与熟谷芽各三钱，鹿角胶三钱，仙半夏三钱，大贝母三钱，红枣四枚。
三诊：背部正中发背疮已溃烂，腐肉逐渐脱落，脓液渐多，四周肿硬略见减轻，舌苔薄腻，脉象虚弦而滑。少阴肾中阴阳本已亏虚，痰湿凝结于太阳经络，营卫运行循序失常，仍拟采用助阳益气、化湿托毒的方法，期望正气充足，则脓液自然容易外泄。
处方：生黄芪六钱，朱茯神三钱，全当归三钱，生甘草节四分，紫丹参二钱，陈广皮一钱，春砂壳八分，炙远志肉一钱，炒赤芍一钱五分，仙半夏二钱，红枣四枚，鹿角霜二钱，大贝母三钱，生谷芽与熟谷芽各三钱。
外用药物：九黄丹，呼脓丹，海浮散，阳和膏。
四诊：背部正中发背腐肉逐渐脱落，脓液亦多，疮根肿硬亦见收敛，舌苔薄腻，脉象虚滑。少阴阴阳两虚，痰湿滞留于太阳经络，营卫运行循序失常。患者喜食甜食，乃中气虚弱所致。再拟助阳益气、化湿托毒，佐入和胃之品。
处方：生黄芪六钱，云茯苓三钱，全当归三钱，光杏仁三钱，紫丹参二钱，炙远志肉一钱，陈广皮一钱，红枣五枚，生甘草节四分，仙半夏三钱，春砂壳八分，鹿角霜二钱，川象贝母各二钱，生谷芽与熟谷芽各三钱。
五诊：背部正中发背腐肉逐渐脱落，脓液亦多，疮根肿硬亦见松软，惟胃纳不佳，脉象左侧虚弦，右侧濡滑。少阴阴阳两虚，蕴毒痰湿滞留于太阳经络，脾胃运化失去常度。再拟益气托毒、和胃化湿。
处方：生黄芪四钱，全当归二钱，仙半夏三钱，鹿角霜四钱，红枣五枚，紫丹参二钱，云茯苓三钱，陈广皮一钱，炙款冬花一钱五分，生姜一片，生甘草节四分，炙远志肉一钱，春砂仁一钱，生谷芽与熟谷芽各三钱。
六诊：背部正中发背腐肉已去其半，脓液亦多，疮根肿硬亦见松软，胃纳不佳，脉象左侧虚弦，右侧濡滑。少阴阴阳两虚，蕴毒痰湿留恋，一时难以清除干净。再拟益气托毒，和胃化痰。
处方：生黄芪四钱，生甘草节四分，仙半夏一钱五分，紫丹参二钱，抱茯神三钱，陈广皮一钱，全当归二钱，鹿角霜三钱，生谷芽与熟谷芽各三钱，杜赤豆五钱，红枣五枚。
外洗药方：全当归三钱，生甘草节三钱，石菖蒲一钱五分，猪脚爪一枚（劈碎），紫丹参三钱，生赤芍三钱，蜂房窠二钱，煎汤清洗。
外用药物：红肉处用上补天丹、海浮散；腐肉处用上桃花散、九黄丹。外贴阳和膏。
七诊：背部正中发背腐肉已去其半，脓液亦多，四周疮根逐渐平复，食欲不旺，傍晚时足背浮肿，牙龈虚浮，脉象左侧濡弦，右侧濡滑。气血两虚，脾胃不健，余毒蕴湿未清，再拟益气托毒，崇土化湿。
处方：生黄芪四钱，抱茯神三钱，全当归二钱，紫丹参二钱，陈广皮一钱，冬瓜皮三钱，生白术一钱五分，生甘草节四分，焦谷芽三钱，红枣五枚。
外用药物：海浮散、九黄丹、补天丹、九仙丹，阳和膏。
八诊：背部正中发背腐肉十去七八，四周疮根亦觉逐渐收敛，牙龈虚浮，傍晚时足背微肿，脉象左侧虚弦不柔和，右侧濡滑。气血两虚，浮火易升，脾弱清气下陷，余毒留恋。再拟益气托毒，崇土化湿。
处方：生黄芪四钱，抱茯神三钱，淮山药三钱，冬瓜皮三钱，紫丹参三钱，全当归三钱，生白芍一钱，红枣五枚，生甘草节四分，陈皮一钱，生谷芽与熟谷芽各三钱。
外用药物：海浮散、桃花散、九黄丹、补天丹，阳和膏。
九诊：背部正中发背腐肉已去七八，疮根亦平，脓水亦少，惟食欲不佳，牙龈虚肿，面部虚浮，脉象左侧虚弦，右侧濡滑。气血两虚，津液不足无法上承，脾胃不健，运化失常。再拟益气托毒，理脾和胃。
处方：生黄芪四钱，云茯苓三钱，大贝母三钱，冬瓜子三钱，紫丹参二钱，陈广皮一钱，佩兰梗一钱五分，红枣四枚，全当归二钱，生甘草节四分，生谷芽与熟谷芽各三钱。
外用药物：桃花散、九黄丹、补天丹，阳和膏。
十诊：背部正中发背腐肉已除，新肉已生，食欲衰退减少，口舌生糜点，牙龈肿痛，妨碍吞咽，大便溏薄似痢疾，舌苔腻布，脉象左侧虚弦，右侧濡滑。此乃气阴两虚，无根之火易于上升，脾胃不运，湿浊留恋。人以胃气为本，再拟和胃运脾，宣化湿浊。
处方：炒淮山药三钱，炒扁豆衣三钱，佩兰梗一钱五分，藏青果一钱，云茯苓三钱，新会皮一钱五分，谷麦芽各三钱，干荷叶一角，野蔷薇花露二两，香稻叶露二两（后入）。龙脑薄荷一支，剪碎泡汤，清洗口舌糜腐处，再用珠黄散搽涂。
十一诊：背部正中发背腐肉已去七八，新肉已生，便溏似痢亦止，惟口舌糜点碎痛，牙龈虚浮，妨碍吞咽饮水，食欲减少，舌苔薄腻，左脉弦象略缓，右部濡滑。此乃气阴两虚，虚火挟湿浊上浮，脾胃运化无权。人以胃气为本，再拟和胃清宣。
处方：炒淮山药三钱，川象贝母各二钱，通草八分，佩兰梗一钱五分，云茯苓三钱，陈广皮一钱，炒谷麦芽各三钱，香稻叶露三两，蔷薇花露三两（后入）。
十二诊：背部正中发背腐肉虽去七八，新肉生长迟缓。皆因正气亏虚，不能生长肌肉，口舌糜腐碎痛，牙龈腐烂，妨碍吞咽饮水，饮食衰少，舌苔粉腻，虚火挟湿浊上浮，脾胃生气无权，还担心正气虚弱不能支撑，导致病情变迁。再拟和胃清化。
处方：真芦荟八分，甘中黄五分，赤茯苓三钱，京玄参一钱五分，胡黄连五分，活贯众三钱，川象贝母各二钱，通草八分，生谷芽与熟谷芽各三钱，蔷薇花露三两，香稻叶露三两（后入）。
Mr. Song, the "Fa Bei" (back carbuncle) located at the center of the back has ulcerated, but pus discharge is scanty. The lesion resembles an inverted bowl, with hard and swollen flesh and a depressed wound apex. In the evening, there are alternating chills and fever without high heat, reduced appetite, a thin and greasy tongue coating, and a deficiency-wiry pulse. The spinal column is governed by the Du Meridian (Governing Vessel), while the sides of the spine are traversed by the Taiyang (Greater Yang) Bladder Meridian. The Yang Qi of the Du Meridian is declining; as the Taiyang Meridian governs the transformation of Cold Water, phlegm-dampness accumulates, and Ying (Nutritive) and Wei (Defensive) blood stagnate. This constitutes a Yin Abscess (Yin Ju, a type of chronic abscess characterized by cold, deficiency, and slow healing), which must not be taken lightly. Urgently, we propose to assist the Du Meridian's Yang Qi to expel toxins, harmonize Ying and Wei to resolve dampness, hoping that the wound apex will rise and pus/toxins will drain externally, leading to a favorable outcome.
Prescription: Sheng Huang Qi (Astragali Radix, 5 qian), Zhu Fu Shen (Poria with Hostwood, 3 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Lu Jiao Jiao (Deer Antler Glue, 1.5 qian), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 3 qian), Xian Ban Xia (Pinelliae Tuber, 2 qian), Da Bei Mu (Fritillariae Thunbergii Bulbus, 3 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.5 qian), Quan Dang Gui (Angelicae Sinensis Radix, 3 qian), Hong Zao (Jujubae Fructus, 4 pieces), Sheng Gu Ya (Sprouted Hordeum Vulgare Seed) and Shu Gu Ya (Prepared Sprouted Hordeum Vulgare Seed, 3 qian each).
External Wash Prescription: Quan Dang Gui (Angelicae Sinensis Radix, 2 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.6 fen), Du Huo (Angelicae Pubescentis Radix, 2 qian), Da Chuan Xiong (Ligustici Chuanxiong Rhizoma, 2 qian), Shi Chang Pu (Acori Tatarinowii Rhizoma, 2 qian), Xian Zhu Jiao Zhua (Fresh Pig Trotter Claws, crushed, 1 piece). Decoct in water for washing.
External Application: Jiu Huang Dan (Nine-Yellow Powder), Hai Fu San (Sea-Floating Powder), Yang He Gao (Yang-He Plaster).
Second Visit: The central back carbuncle has ulcerated with scanty pus, resembling an inverted bowl. The wound apex remains depressed, surrounded by hard, purple swelling. Appetite decreases further after meals. Tongue coating is thin and greasy; pulse is soggy and slippery. The Shaoyin (Lesser Yin) Kidney's Yin and Yang are inherently deficient. Phlegm-dampness accumulates in the Taiyang collaterals, causing stagnation of Ying and Wei, leading to tissue corruption and pus formation. The previous prescription assisting Yang, expelling toxins, harmonizing Ying/Wei, and resolving dampness was appropriate. We maintain the original strategy with modifications.
Prescription: Sheng Huang Qi (Astragali Radix, 6 qian), Zhu Fu Shen (Poria with Hostwood, 3 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Chun Sha Ke (Amomi Fructus Shell, 0.8 fen), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 3 qian), Zhi Yuan Zhi Rou (Polygalae Radix, honey-fried, 1 qian), Quan Dang Gui (Angelicae Sinensis Radix, 3 qian), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each), Lu Jiao Jiao (Deer Antler Glue, 3 qian), Xian Ban Xia (Pinelliae Tuber, 3 qian), Da Bei Mu (Fritillariae Thunbergii Bulbus, 3 qian), Hong Zao (Jujubae Fructus, 4 pieces).
Third Visit: The central back carbuncle has ulcerated; necrotic tissue is gradually shedding, pus is increasing, and surrounding hardness/swelling is slightly reduced. Tongue coating is thin and greasy; pulse is deficiency-wiry and slippery. The Shaoyin Kidney's Yin and Yang are inherently deficient. Phlegm-dampness condenses in the Taiyang collaterals, disrupting the rhythmic flow of Ying and Wei. We continue to assist Yang, tonify Qi, resolve dampness, and expel toxins, hoping that sufficient Zheng Qi (Upright Qi) will facilitate pus drainage.
Prescription: Sheng Huang Qi (Astragali Radix, 6 qian), Zhu Fu Shen (Poria with Hostwood, 3 qian), Quan Dang Gui (Angelicae Sinensis Radix, 3 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Chun Sha Ke (Amomi Fructus Shell, 0.8 fen), Zhi Yuan Zhi Rou (Polygalae Radix, honey-fried, 1 qian), Chao Chi Shao (Paeoniae Radix Rubra, stir-baked, 1.5 qian), Xian Ban Xia (Pinelliae Tuber, 2 qian), Hong Zao (Jujubae Fructus, 4 pieces), Lu Jiao Shuang (Deer Antler Frost, 2 qian), Da Bei Mu (Fritillariae Thunbergii Bulbus, 3 qian), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each).
External Application: Jiu Huang Dan (Nine-Yellow Powder), Hu Nong Dan (Pus-Calling Powder), Hai Fu San (Sea-Floating Powder), Yang He Gao (Yang-He Plaster).
Fourth Visit: Necrotic tissue is shedding, pus is abundant, and the base swelling/hardness is receding. Tongue coating is thin and greasy; pulse is deficiency-slippery. Shaoyin Yin and Yang are both deficient. Phlegm-dampness lingers in the Taiyang collaterals, disrupting Ying/Wei rhythm. Preference for sweet foods indicates Middle Jiao (Spleen/Stomach) deficiency. We again assist Yang, tonify Qi, resolve dampness, and expel toxins, adding herbs to harmonize the Stomach.
Prescription: Sheng Huang Qi (Astragali Radix, 6 qian), Yun Fu Ling (Poria, 3 qian), Quan Dang Gui (Angelicae Sinensis Radix, 3 qian), Guang Xing Ren (Armeniacae Semen Amarum, 3 qian), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Zhi Yuan Zhi Rou (Polygalae Radix, honey-fried, 1 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Hong Zao (Jujubae Fructus, 5 pieces), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Xian Ban Xia (Pinelliae Tuber, 3 qian), Chun Sha Ke (Amomi Fructus Shell, 0.8 fen), Lu Jiao Shuang (Deer Antler Frost, 2 qian), Chuan Xiang Bei Mu (Fritillariae Cirrhosae Bulbus and Fritillariae Thunbergii Bulbus, 2 qian each), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each).
Fifth Visit: Necrotic tissue is shedding, pus is abundant, and the base is softening. However, gastric appetite is poor. Pulse: left deficiency-wiry, right soggy-slippery. Shaoyin Yin and Yang are deficient. Retained toxin-phlegm-dampness lingers in Taiyang collaterals; Spleen/Stomach transportation is impaired. We continue to tonify Qi, expel toxins, harmonize the Stomach, and resolve dampness.
Prescription: Sheng Huang Qi (Astragali Radix, 4 qian), Quan Dang Gui (Angelicae Sinensis Radix, 2 qian), Xian Ban Xia (Pinelliae Tuber, 3 qian), Lu Jiao Shuang (Deer Antler Frost, 4 qian), Hong Zao (Jujubae Fructus, 5 pieces), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Yun Fu Ling (Poria, 3 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Zhi Kuan Dong Hua (Adenophorae Radix or Sonchus Flower? Note: Kuan Dong Hua is Saussureae Inflorescence, 1.5 qian), Sheng Jiang (Zingiberis Rhizoma Recens, 1 slice), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Zhi Yuan Zhi Rou (Polygalae Radix, honey-fried, 1 qian), Chun Sha Ren (Amomi Fructus, 1 qian), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each).
Sixth Visit: Half of the necrotic tissue is gone, pus is abundant, base is softening. Gastric appetite is poor. Pulse: left deficiency-wiry, right soggy-slippery. Shaoyin Yin and Yang are deficient. Retained toxin-phlegm-dampness lingers, difficult to clear quickly. We continue to tonify Qi, expel toxins, harmonize the Stomach, and transform phlegm.
Prescription: Sheng Huang Qi (Astragali Radix, 4 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Xian Ban Xia (Pinelliae Tuber, 1.5 qian), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Bao Fu Shen (Poria with Hostwood, 3 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Quan Dang Gui (Angelicae Sinensis Radix, 2 qian), Lu Jiao Shuang (Deer Antler Frost, 3 qian), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each), Du Chi Dou (Vigna Angularis Seed, 5 qian), Hong Zao (Jujubae Fructus, 5 pieces).
External Wash Prescription: Quan Dang Gui (Angelicae Sinensis Radix, 3 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 3 qian), Shi Chang Pu (Acori Tatarinowii Rhizoma, 1.5 qian), Zhu Jiao Zhua (Pig Trotter Claws, crushed, 1 piece), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 3 qian), Sheng Chi Shao (Paeoniae Radix Rubra, 3 qian), Feng Fang Ke (Vespa Nest, 2 qian). Decoct in water for washing.
External Application: For red flesh: Shang Bu Tian Dan (Sky-Mending Powder), Hai Fu San (Sea-Floating Powder). For necrotic tissue: Shang Tao Hua San (Peach-Blossom Powder), Jiu Huang Dan (Nine-Yellow Powder). External plaster: Yang He Gao (Yang-He Plaster).
Seventh Visit: Half of the necrotic tissue is gone, pus is abundant, surrounding base is flattening. Appetite is poor. Evening edema of the dorsum of feet, floating gums. Pulse: left soggy-wiry, right soggy-slippery. Qi and Blood are both deficient. Spleen/Stomach is weak. Residual toxin-dampness is not cleared. We continue to tonify Qi, expel toxins, strengthen Earth (Spleen), and resolve dampness.
Prescription: Sheng Huang Qi (Astragali Radix, 4 qian), Bao Fu Shen (Poria with Hostwood, 3 qian), Quan Dang Gui (Angelicae Sinensis Radix, 2 qian), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Dong Gua Pi (Benincasae Exocarpium, 3 qian), Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Jiao Gu Ya (Charred Sprouted Hordeum Vulgare Seed, 3 qian), Hong Zao (Jujubae Fructus, 5 pieces).
External Application: Hai Fu San (Sea-Floating Powder), Jiu Huang Dan (Nine-Yellow Powder), Bu Tian Dan (Sky-Mending Powder), Jiu Xian Dan (Nine-Immortal Powder), Yang He Gao (Yang-He Plaster).
Eighth Visit: 70-80% of necrotic tissue is gone, surrounding base is receding. Floating gums, slight evening foot edema. Pulse: left deficiency-wiry and unyielding, right soggy-slippery. Qi and Blood are deficient. Floating Fire rises easily. Spleen weakness causes Clear Yang to sink. Residual toxins linger. We continue to tonify Qi, expel toxins, strengthen Earth, and resolve dampness.
Prescription: Sheng Huang Qi (Astragali Radix, 4 qian), Bao Fu Shen (Poria with Hostwood, 3 qian), Huai Shan Yao (Dioscoreae Oppositae Rhizoma, 3 qian), Dong Gua Pi (Benincasae Exocarpium, 3 qian), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 3 qian), Quan Dang Gui (Angelicae Sinensis Radix, 3 qian), Sheng Bai Shao (Paeoniae Radix Alba, 1 qian), Hong Zao (Jujubae Fructus, 5 pieces), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Chen Pi (Tangerine Peel, 1 qian), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each).
External Application: Hai Fu San (Sea-Floating Powder), Tao Hua San (Peach-Blossom Powder), Jiu Huang Dan (Nine-Yellow Powder), Bu Tian Dan (Sky-Mending Powder), Yang He Gao (Yang-He Plaster).
Ninth Visit: 70-80% of necrotic tissue is gone, base is flat, pus is scanty. Poor appetite, floating gums, facial puffiness. Pulse: left deficiency-wiry, right soggy-slippery. Qi and Blood are deficient. Fluids fail to ascend. Spleen/Stomach is weak, transportation impaired. We continue to tonify Qi, expel toxins, regulate Spleen, and harmonize Stomach.
Prescription: Sheng Huang Qi (Astragali Radix, 4 qian), Yun Fu Ling (Poria, 3 qian), Da Bei Mu (Fritillariae Thunbergii Bulbus, 3 qian), Dong Gua Zi (Benincasae Semen, 3 qian), Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Pei Lan Geng (Eupatorii Herba Stem, 1.5 qian), Hong Zao (Jujubae Fructus, 4 pieces), Quan Dang Gui (Angelicae Sinensis Radix, 2 qian), Sheng Cao Jie (Glycyrrhizae Radix et Rhizoma nodes, 0.4 fen), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each).
External Application: Tao Hua San (Peach-Blossom Powder), Jiu Huang Dan (Nine-Yellow Powder), Bu Tian Dan (Sky-Mending Powder), Yang He Gao (Yang-He Plaster).
Tenth Visit: Necrotic tissue is removed, new flesh is growing. Appetite is low. Mouth/tongue ulcers, swollen/painful gums, difficulty swallowing. Loose stools resembling dysentery. Greasy tongue coating. Pulse: left deficiency-wiry, right soggy-slippery. This is Qi and Yin deficiency. Rootless Fire rises easily. Spleen/Stomach fails to transport. Damp-turbidity lingers. The Stomach Qi is the foundation of life. We harmonize the Stomach, move the Spleen, and ventilate/resolve damp-turbidity.
Prescription: Chao Huai Yao (Stir-fried Dioscoreae Oppositae Rhizoma, 3 qian), Chao Bian Dou Yi (Stir-fried Phaseoli Cordati Testa, 3 qian), Pei Lan Geng (Eupatorii Herba Stem, 1.5 qian), Zang Qing Guo (Terminalia Chebula Retz. Fruit? Note: Qing Guo usually refers to Terminalia chebula, 1 qian), Yun Fu Ling (Poria, 3 qian), Xin Hui Pi (Xinhui Tangerine Peel, 1.5 qian), Gu Mai Ya (Hordeum Vulgare Sprout and Hordeum Vulgare Germinated Grain, 3 qian each), Gan He Ye (Dried Nelumbinis Folium, one corner), Ye Qiang Wei Hua Lu (Wild Rose Flower Distillate, 2 liang), Xiang Dao Ye Lu (Fragrant Rice Leaf Distillate, 2 liang, added later). Long Nao Bo He (Borneol and Mentha Haplocalyx), crushed and soaked in water to wash mouth/tongue ulcers, then apply Zhu Huang San (Pearl and Realgar Powder).
Eleventh Visit: 70-80% of necrotic tissue is gone, new flesh is growing. Dysenteric loose stools have stopped. Mouth/tongue ulcers are painful, gums are floating, difficulty swallowing/drinking. Appetite is low. Thin-greasy coating. Left pulse wiry but slightly relaxed, right soggy-slippery. This is Qi and Yin deficiency. Deficient Fire carries damp-turbidity upward. Spleen/Stomach transportation lacks power. Stomach Qi is the foundation. We harmonize the Stomach and clear/ventilate.
Prescription: Chao Huai Yao (Stir-fried Dioscoreae Oppositae Rhizoma, 3 qian), Chuan Xiang Bei Mu (Fritillariae Cirrhosae Bulbus and Fritillariae Thunbergii Bulbus, 2 qian each), Tong Cao (Tetrapanacis Medulla, 0.8 fen), Pei Lan Geng (Eupatorii Herba Stem, 1.5 qian), Yun Fu Ling (Poria, 3 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Chao Gu Mai Ya (Stir-fried Sprouted Hordeum Seeds, 3 qian each), Xiang Dao Ye Lu (Fragrant Rice Leaf Distillate, 3 liang), Qiang Wei Hua Lu (Rose Flower Distillate, 3 liang, added later).
Twelfth Visit: 70-80% of necrotic tissue is gone, but new flesh growth is slow due to deficiency of Zheng Qi failing to generate muscle. Mouth/tongue ulcers are painful, gums are rotting, difficulty swallowing/drinking. Food intake is low. Powdery-greasy coating. Deficient Fire carries damp-turbidity upward. Spleen/Stomach generating Qi lacks power. We fear Zheng Qi may collapse, leading to complications. We harmonize the Stomach and clear/transform.
Prescription: Zhen Lu Hui (True Aloe, 0.8 fen), Gan Zhong Huang (Melis Succus Depuratum, 0.5 fen), Chi Fu Ling (Red Poria, 3 qian), Jing Xuan Shen (Scrophulariae Radix, 1.5 qian), Hu Huang Lian (Coptidis Chinensis Rhizoma? Note: Hu Huang Lian is often Coptis or related, 0.5 fen), Huo Guan Zhong (Cyrtomii Rhizoma, 3 qian), Chuan Xiang Bei Mu (Fritillariae Cirrhosae Bulbus and Fritillariae Thunbergii Bulbus, 2 qian each), Tong Cao (Tetrapanacis Medulla, 0.8 fen), Sheng Gu Ya and Shu Gu Ya (Sprouted Hordeum Vulgare Seeds, 3 qian each), Qiang Wei Hua Lu (Rose Flower Distillate, 3 liang), Xiang Dao Ye Lu (Fragrant Rice Leaf Distillate, 3 liang, added later).