吴左 外痔 痛已止，脱肛未收。气虚不能收摄，
阴虚湿热下注，大肠不清，传导变化乏力，苔薄腻，脉濡滑。姑拟补中益气，育阴清化。
米炒南沙参（二钱） 蜜炙升麻（五分） 清炙黄 （二钱） 炒扁豆衣（三钱） 朱茯神（三钱） 水炙
桑叶（三钱） 净槐米（包，三钱） 生白术（二钱） 土炒当归（三钱） 杜赤豆（一两） 灶心黄土（一两，荷叶
包，煎汤代水）
潘左 外痔 痛，脱肛便血，气阴两虚，大肠湿热留恋，今拟调益气阴，清化湿热。
细生地（四钱） 粉丹皮（一钱五分） 京赤芍（二钱） 净槐米（包，三钱） 抱茯神（三钱） 地榆炭（三
钱） 脏连丸（包，一钱） 橘白络（各一钱） 生苡仁（三钱） 全当归（二钱） 杜赤豆（一两） 干柿饼（三钱）
外用黄连膏。
高右 伤筋起见，变为缩脚阴痰，顶虽溃，未尝得脓，根脚肿硬疼痛，痛引少腹，小溲不利，腑行燥结，身
热晚甚，口有甜味，舌苔薄腻，脉象濡滑。蕴湿缩瘀，凝结厥阴之络，营卫不从，症属缠绵。姑拟益气托毒，化
湿通络。
生黄 （三钱） 茯苓皮（三钱） 炙甲片（一钱） 清水豆卷
（四钱） 当归尾（三钱） 福泽泻（一钱五分） 泽兰叶（一钱五分） 光杏仁（三钱） 桃仁泥（一钱五分）
赤芍药（二钱） 通草（八分） 象贝母（三钱） 苏木（一钱五分） 陈广皮（一钱）
外用九黄丹、阳和膏，并用金箍散、冲和膏，敷其四周。
二诊 伤筋起见，变为缩脚阴痰，肿硬疼痛，连及少腹，咳嗽则痛更甚，小溲不利，身热晚甚，舌苔薄腻。
蕴湿凝结厥阴之络，营卫不从，缠绵之症。再拟和营去瘀，化湿通络。
清水豆卷（四钱） 藏红花（八分） 福泽泻（一钱五分） 通草（八分） 当归尾（三钱） 桃仁泥（一钱
五分） 黑白丑（各八分） 泽兰叶（一钱五分） 生赤芍（三钱） 连皮苓（四钱） 炙甲片（八分）
大贝母（三钱） 苏木（一钱五分） 醒消丸（吞服，一钱）
三诊 缩脚阴痰，肿硬疼痛，上及少腹，下及腿侧，皮色不变，右足曲而不伸，寒热晚甚，舌苔薄腻，脉弦小
而迟。寒湿痰瘀，凝结厥阴之络，营卫不从，缠绵之症也。今拟阳和汤加减，温化消解，冀望转阴为阳，始能
出险入夷。
净麻黄（三分） 大熟地（四钱，二味同捣） 肉桂心（五分） 生草节（一钱） 炮姜炭（五分）
银柴胡（一钱） 白芥子（炒
研，三钱） 鹿角胶（陈酒化冲服，二钱） 醒消丸（吞服，一钱）
吴左：外痔疼痛已经停止，但脱肛仍未收回。这是气虚导致固摄无力，阴虚兼有湿热下注，大肠功能不清爽，传导变化乏力。舌苔薄腻，脉象濡滑。暂拟补中益气、滋养阴液并清化湿热的治法。
米炒南沙参（二钱） 蜜炙升麻（五分） 清炙黄芪（二钱） 炒扁豆衣（三钱） 朱茯神（三钱） 水炙桑叶（三钱） 净槐米（包煎，三钱） 生白术（二钱） 土炒当归（三钱） 杜赤豆（一两） 灶心黄土（一两，用荷叶包裹，煎汤代替水煎药）
潘左：外痔疼痛，伴有脱肛和便血。证属气阴两虚，大肠湿热留恋不去。现拟定调理益气养阴、清化湿热的治法。
细生地（四钱） 粉丹皮（一钱五分） 京赤芍（二钱） 净槐米（包煎，三钱） 抱茯神（三钱） 地榆炭（三钱） 脏连丸（包煎，一钱） 橘白络（各一钱） 生苡仁（三钱） 全当归（二钱） 杜赤豆（一两） 干柿饼（三钱）
外用黄连膏。
高右：因伤筋而起病，演变为缩脚阴痰（一种发生于大腿内侧或腹股沟部的慢性化脓性疾病，此处指代严重的阴疽流注）。疮顶虽然溃破，但未出脓，根部肿胀坚硬且疼痛，痛感牵引至少腹部，小便不利，大便燥结，身体发热且傍晚加重，口中有甜味，舌苔薄腻，脉象濡滑。此为湿浊蕴结、瘀血凝滞，凝结于厥阴肝经之络脉，营卫不和，病症属于缠绵难愈。暂拟益气托毒、化湿通络的治法。
生黄芪（三钱） 茯苓皮（三钱） 炙穿山甲片（一钱） 清水豆卷（四钱） 当归尾（三钱） 福泽泻（一钱五分） 泽兰叶（一钱五分） 光杏仁（三钱） 桃仁泥（一钱五分） 赤芍药（二钱） 通草（八分） 象贝母（三钱） 苏木（一钱五分） 陈广皮（一钱）
外用九黄丹、阳和膏，并用金箍散、冲和膏敷贴于患处四周。
二诊：因伤筋而起病，演变为缩脚阴痰，局部肿胀坚硬疼痛，牵连至少腹部，咳嗽时疼痛加剧，小便不利，身体发热且傍晚加重，舌苔薄腻。此为湿浊凝结于厥阴肝经之络脉，营卫不和，属于缠绵难愈的病症。再拟调和营血、祛除瘀血、化湿通络的治法。
清水豆卷（四钱） 藏红花（八分） 福泽泻（一钱五分） 通草（八分） 当归尾（三钱） 桃仁泥（一钱五分） 黑白丑（牵牛子黑与白者，各八分） 泽兰叶（一钱五分） 生赤芍（三钱） 连皮苓（四钱） 炙穿山甲片（八分） 大贝母（三钱） 苏木（一钱五分） 醒消丸（吞服，一钱）
三诊：缩脚阴痰，肿胀坚硬疼痛，向上波及少腹部，向下波及腿侧，皮肤颜色无改变，右足弯曲而不能伸直，寒热往来且傍晚加重，舌苔薄腻，脉象弦小且迟。此为寒湿痰瘀，凝结于厥阴肝经之络脉，营卫不和，属于缠绵难愈的病症。现拟定以阳和汤加减，采用温化消解之法，期望能转阴证为阳证，从而脱离危险，走向平安。
净麻黄（三分） 大熟地黄（四钱，与鹿角胶两味同捣碎） 肉桂心（五分） 生甘草节（一钱） 炮姜炭（五分） 银柴胡（一钱） 白芥子（炒后研末，三钱） 鹿角胶（用陈年黄酒烊化冲服，二钱） 醒消丸（吞服，一钱）
Wu, Left: External hemorrhoids. The pain has ceased, but the rectal prolapse has not yet retracted. This is due to Qi deficiency failing to maintain control, and Yin deficiency with damp-heat pouring downward, causing the Large Intestine to be unclean and its conduction and transformation functions to be weak. The tongue coating is thin and greasy, and the pulse is soggy and slippery. Tentatively prescribe Bu Zhong Yi Qi (Tonify the Middle and Augment the Qi) to nourish Yin and clear/dissipate dampness.
Mi-chao Nan Sha Shen (Fried with Rice, Adenophorae Radix, 2 qian) Mi-zhi Sheng Ma (Honey-fried, Cimicifugae Rhizoma, 0.5 qian) Qing-zhi Huang Qi (Clear-fried, Astragali Radix, 2 qian) Chao Bian Dou Yi (Stir-fried, Dolichoris Semen Tegmen, 3 qian) Zhu Fu Shen (Cinnabar-coated, Poria with Hostwood, 3 qian) Shui-zhi Sang Ye (Water-fried, Mori Folium, 3 qian) Jing Huai Mi (Cleaned Sophorae Flos, wrapped for decoction, 3 qian) Sheng Bai Zhu (Raw Atractylodis Macrocephalae Rhizoma, 2 qian) Tu-chao Dang Gui (Earth-stir-fried, Angelicae Sinensis Radix, 3 qian) Du Chi Dou (Vigna umbellata Seed, 1 liang) Zao Xin Huang Tu (Heart of the Stove Earth, 1 liang, wrapped in Nelumbinis Folium, decocted as water substitute).
Pan, Left: External hemorrhoids with pain, rectal prolapse, and hematochezia. The pattern is Qi and Yin dual deficiency, with lingering damp-heat in the Large Intestine. Now prescribe Tiao Li Qi Yin (Regulate Qi and Nourish Yin) and Qing Hua Shi Re (Clear and Dissipate Damp-Heat).
Xi Sheng Di (Fine Rehmanniae Radix, 4 qian) Fen Dan Pi (Powdered Moutan Cortex, 1.5 qian) Jing Chi Shao (Peking Paeoniae Radix Rubra, 2 qian) Jing Huai Mi (Cleaned Sophorae Flos, wrapped for decoction, 3 qian) Bao Fu Shen (Embracing Poria, 3 qian) Di Yu Tan (Sanguisorbae Radix Charred, 3 qian) Zang Lian Wan (Zang Lian Pill, wrapped for decoction, 1 qian) Ju Bai Luo (Tangerine White Rind and Veins, each 1 qian) Sheng Yi Ren (Raw Coicis Semen, 3 qian) Quan Dang Gui (Whole Angelicae Sinensis Radix, 2 qian) Du Chi Dou (Vigna umbellata Seed, 1 liang) Gan Shi Bing (Dried Persimmon Cake, 3 qian).
Externally apply Huang Lian Gao (Coptis Ointment).
Gao, Right: Arising from tendon injury, it transformed into Suo Jiao Yin Tan (A chronic suppurative disease manifesting as induration and swelling in the groin/thigh, often associated with cold-phlegm and blood stasis). Although the apex has ulcerated, no pus has been discharged. The root is swollen, hard, painful, and the pain radiates to the lower abdomen. Urination is difficult, bowel movements are dry and constipated, body heat is worse in the evening, there is a sweet taste in the mouth, the tongue coating is thin and greasy, and the pulse is soggy and slippery. This is dampness accumulating and blood stasis condensing, knotting in the collaterals of the Jueyin Liver channel, with disharmony of Ying and Wei. The condition is lingering and stubborn. Tentatively prescribe Yi Qi Tuo Du (Boost Qi to Expel Toxin) and Hua Shi Tong Luo (Transform Dampness and Unblock Collaterals).
Sheng Huang Qi (Raw Astragali Radix, 3 qian) Fu Ling Pi (Poria Peel, 3 qian) Zhi Jia Pian (Honey-fried Pangolin Scale, 1 qian) Qing Shui Dou Juan (Clear Water Bean Sprout Decoction, 4 qian) Dang Gui Wei (Tail of Angelicae Sinensis Radix, 3 qian) Fu Ze Xie (Fujian Alismatis Rhizoma, 1.5 qian) Ze Lan Ye (Lycopus Japonicus Herba, 1.5 qian) Guang Xing Ren (Smooth Apricot Kernel, 3 qian) Tao Ren Ni (Peach Kernel Paste, 1.5 qian) Chi Shao Yao (Red Paeoniae Radix, 2 qian) Tong Cao (Tetrapanacis Medulla, 0.8 fen) Xiang Bei Mu (Elephant-shaped Fritillariae Thunbergii Bulbus, 3 qian) Su Mu (Sappan Wood, 1.5 qian) Chen Guang Pi (Aged Tangerine Peel, 1 qian).
Externally apply Jiu Huang Dan (Nine-Yellow Powder), Yang He Gao (Yang-Soften Ointment), Jin Gu San (Golden Hoop Powder), and Chong He Gao (Harmonizing Ointment), applied around the periphery of the lesion.
Second Visit: Arising from tendon injury, it transformed into Suo Jiao Yin Tan. Swelling, hardness, and pain extend to the lower abdomen; coughing exacerbates the pain. Urination is difficult, body heat is worse in the evening, and the tongue coating is thin and greasy. Dampness condenses in the collaterals of the Jueyin Liver channel, with disharmony of Ying and Wei. This is a lingering condition. Again prescribe He Ying Qu Yu (Harmonize Ying and Remove Stasis), Hua Shi Tong Luo (Transform Dampness and Unblock Collaterals).
Qing Shui Dou Juan (Clear Water Bean Sprout Decoction, 4 qian) Zang Hong Hua (Saffron, 0.8 fen) Fu Ze Xie (Fujian Alismatis Rhizoma, 1.5 qian) Tong Cao (Tetrapanacis Medulla, 0.8 fen) Dang Gui Wei (Tail of Angelicae Sinensis Radix, 3 qian) Tao Ren Ni (Peach Kernel Paste, 1.5 qian) Hei Bai Chou (Black and White Phaselolus Radiatus Seeds, each 0.8 fen) Ze Lan Ye (Lycopus Japonicus Herba, 1.5 qian) Sheng Chi Shao (Raw Red Paeoniae Radix, 3 qian) Lian Pi Ling (Poria with Peel, 4 qian) Zhi Jia Pian (Honey-fried Pangolin Scale, 0.8 fen) Da Bei Mu (Large Fritillariae Thunbergii Bulbus, 3 qian) Su Mu (Sappan Wood, 1.5 qian) Xing Xiao Wan (Xing Xiao Pill, taken orally, 1 qian).
Third Visit: Suo Jiao Yin Tan. Swelling, hardness, and pain extend upward to the lower abdomen and downward to the lateral leg. The skin color remains unchanged. The right foot is flexed and cannot extend. Chills and fever are worse in the evening. The tongue coating is thin and greasy, and the pulse is wiry, small, and slow. This is Cold-Dampness, Phlegm, and Blood Stasis knotting in the collaterals of the Jueyin Liver channel, with disharmony of Ying and Wei. It is a lingering condition. Now prescribe Yang He Tang (Warm-Soften Decoction) with modifications, employing Wen Hua Xiao Jie (Warm Transformation and Resolution) to hope for turning Yin into Yang, thereby escaping danger and reaching safety.
Jing Ma Huang (Cleaned Ephedrae Herba, 0.3 fen) Da Shu Di (Great Prepared Rehmanniae Radix, 4 qian, crushed together with Lu Jiao Jiao) Rou Gui Xin (Cinnamon Twig Heart, 0.5 fen) Sheng Cao Jie (Raw Glycyrrhizae Radix et Rhizoma Joint, 1 qian) Pao Jiang Tan (Roasted Ginger Charcoal, 0.5 fen) Yin Chai Hu (Stellariae Radix, 1 qian) Bai Jie Zi (White Mustard Seed, stir-fried and ground, 3 qian) Lu Jiao Jiao (Deer Antler Glue, melted with aged yellow wine and taken orally, 2 qian) Xing Xiao Wan (Xing Xiao Pill, taken orally, 1 qian).