罗宗伯耳后发际患毒 痛。脉数。以小柴胡（五）加桔梗、牛蒡子、金银花。四剂而愈。
（此凭脉症也。）
一人气血已复。核尚不腐。用针头散及必效散各三次。不旬日而愈。（此凭症处治。）
一妇瘰 。与养气顺血药不应。服神效栝蒌散二剂（五三）顿退。又六剂而消却。与托里
药。气血平复而愈。（此凭症也。）
一妇年逾三十。瘰 已溃。不愈。与八珍汤（十四）加小柴胡、地骨皮、夏枯草、香附、
五十余剂、形气渐转。更与必效散（四九）二服疮口遂合。惟气血未平。再用前药三十余剂而
平。（此凭症也。）
治瘰 。用必效散与栝蒌散相间服。神效。
后有不问虚实。概用必效散。殊不知斑蝥性猛大毒。利水破血。大损元气。若气血实者
此劫之而投补剂。或可愈。若虚而用此。或用追蚀之药。瘀肉虽去。而疮口不合。反至不救
一妇因怒结核肿痛。察其气血俱实。先以神效散下之。更以益气养荣汤三十余剂而消。
（此凭症也。）
常治此症。虚者先用益气养荣汤。待其气血完充。乃取神效散去其毒。仍进前药。无不
一人耳下患五枚如贯珠。年许尚硬。面色痿黄。饮食不甘。劳而发热。脉数软而涩。以
益气
一妇瘰 不消。脓清不敛。用八珍汤（十四）少愈。忽肩背痛不能回顾。此膀胱经气郁所
当服防风通气汤。彼云瘰 胆经病也。是经火动而然。自服凉肝降火之药。反致不食。痛盛
。予诊其脉。胃气愈弱。先以四君子（六三）加陈皮、炒芍药、半夏、羌活、蔓荆子四剂。食
进痛止。继以防风通气（四二）二剂而愈。（此凭脉与症也。）
一人神劳多怒。颈肿一块。久而不消。诸药不应。予以八珍汤（十四）加柴胡、香附。每
日更隔蒜灸数壮。及日饮远志酒二三盏渐消。（此凭症也。）
一妇月水不行。渐热。咳嗽。肌体渐瘦。胸膈不利。颈肿一块。日久不消。令服逍遥散
三）月余。更服八珍汤（十四）加牡丹皮、香附。又月余加黄 、白蔹。两月余热退肿消。经
行而愈。（此凭症也。）
一人年逾三十。每劳心过度。颈肿发热。服败毒散愈盛。用补中益气汤数贴而消。（此
张通府耳后发际患肿一块。无头。肉色不变。按之微痛。彼谓痰结。脉软而时见数。经
脉数不时见。疮也。非痰也。仲景云。微弱之脉。主血气俱虚。形精不足。又曰。沉迟软弱
皆宜托里。遂用参、 、归、术、川芎、炙甘草以托里。少加金银花、白芷、桔梗以消毒。
彼谓不然。内饮降火消痰。外贴凉药。觉寒彻脑。患处大热。头愈重。食愈少。复请治。以
四君子加藿香、炮干姜数剂。食渐进。肿成刺之。更以十全大补汤（十三）去桂。灸以豆豉饼
。又有余而愈。（此凭脉症也。）
一人耳内出脓。或痛。或痒。服聪耳益气汤不应。服防风通圣散愈甚。予用补肾丸而愈
机按前条瘰 治法。虚者补之。而补有先后温凉之殊。实者泻之。而泻有轻重表里之异。或行
开郁滞。或舍时从症。或变法用权。或针。或砭。或灸。或敷。其法亦粗备矣。医者能仿是
例而扩充之。庶几亦可以应变矣。）
一儿宿痰失道。痈肿见于颈项。或臂膊胸背。是为冷症
。宜四生散敷贴。内服附子八物汤及隔蒜灸。（此无脉可凭而治。当时必有所见也。）
一人因暴怒。项下肿痛。胸膈痞闷，兼发热。用方脉流气二剂。胸膈利。以荆防败毒
剂而热退。肝脉尚弦涩。以小柴胡加芎、归、芍药四剂。脉症顿退。以散肿溃坚丸一料。将
平。唯一核不消。服遇神仙无比丸二两而瘳。（此凭症凭脉也。）
一儿甫周岁。项患胎毒。予俟有脓刺之。脓出碗许。乳食如常。用托里药月余而愈。又
一儿患此。待脓自出。几至不救。（此凭症也。）
大抵疮浅宜砭。深宜刺。使瘀血去于毒聚之始。则易消也。况小儿气血又弱。脓成不针
。鲜不毙矣。
一人项下患毒脓已成。因畏针 。延至胸。赤如霞。其脉滑数。饮食不进。月余不寐。甚倦
。予密针之。脓出即睡觉而思食。用托里散（百五七）两月余而愈。又一人患此。及时针刺。数
日而愈。一人素虚。患此不针。溃透颔颊。血气愈虚而死。（此凭症也。）
一人耳后患毒。脉症俱实。宜用内疏黄连汤。彼以严冬不服寒剂。竟至不起。
罗谦甫曰。用寒远寒。用热远热。假者反之。虽违其时。以从其症。又云。凡治病必察
。谓察时下之宜而权治之。故曰经者常也。法者用也。医者意也。随其所宜而治之。则万全
一妇因怒。项肿。后月水不通。四肢浮肿。小便如淋。此血分症也。先以椒仁丸数服。
肿消。更以六君子汤加柴胡、枳壳数剂。颈肿亦消矣。亦有先因小便不利。后身发肿。致经
水不通。名曰水分。宜葶苈丸治之。良方云。妇人肿满。若先因经水断绝。后致四肢浮肿。
小便不通。名曰血分。水化为血。血不通则复化为水矣。宜服椒仁丸。（此凭症也。）
一 妇。咽间如一核所鲠咽吐不出。倦怠发热。先以四七汤而咽利。更以逍遥散。（此
一妇所患同前。兼胸膈不利。肚腹膨胀。饮食少思。卧睡不安。用分心气饮并效。（此
一女年十七。项下时或作痛。乍寒乍热如疟状。肝脉弦长。此血盛之症也。先以小柴胡
汤二剂。少愈更以生地黄丸而痊（此凭脉症也。）
一贵人女适夫。夫早逝。患十指挛。拳掌垂莫举。肤体疮疡粟粟然。汤剂杂进。饮食顿减
于半载。诊之非风也。乃忧愁悲哀以致耳。病属内因。宜用内因药。仍以鹿角胶辈。多用麝
香熬膏贴痿处。挛能举。指能伸。病渐安。（此因情而治也。）
一女性急好怒。耳下常肿痛。发寒热。肝脉弦急。投小柴胡加青皮、牛蒡子、荆芥、防
而寒热退、更以小柴胡对四物。数剂而肿消。其父欲除病根。予谓肝内主藏血。外主荣筋。
若恚怒气逆则伤肝。肝主筋。故筋蓄结而肿。须要自加调摄。庶可免患。否则肝迭受伤。不
能藏血。血虚则难瘥矣。后不戒。果结三核。屡用追蚀。不敛而殁。（此因情而治。）
一人先于耳前耳下患之。将愈。延及项侧缺盆。三年遂延胸腋。诊之肝脉弦数。以龙会
坚二丸治之将愈。肝脉尚数。四年后。小腹阴囊内股皆患毒。年余不敛。脉诊如前。以清肝
养血及前丸而愈。（此凭脉也。）
一人因怒。耳下及缺盆患 。溃延腋下。形气颇实。疮口不合。治以散肿溃坚丸（五十）
而愈。（此凭形症也。）
一儿七岁。项结二核。时发寒热。日久不愈。治以连翘丸。而消。若患在面臂等处。尤
宜此丸。若溃而不敛。兼以托里之药。（此凭症也。）
一儿项结一核。坚硬如 。面色痿黄。饮食不甘。服托里药不应。此无辜疳毒也。以蟾
治之而愈。若数服不消。按之转动。软而不痛者。内有虫如粉。急针出之。若不速去。则虫
随气走。内蚀脏腑不治。（按此因治不应而变法也。蟾蜍夏月沟渠中。腹大不跳不鸣者。先
取粪蛆一杓置桶中。以尿浸之。桶近上令干。使蛆不得出。将蟾蜍扑死投蛆中。任蛆食昼夜
。次以新布袋包系。置水急处。浸一宿取出。瓦上焙为末。入麝香一字。软饭丸如麻子大。
每服二三十丸。空心米饮送下。）
一人眼赤痒痛。时或羞明下泪。耳内作痒。服诸药气血日虚。饮食日减。而痒愈盛。此
肝肾风热上攻也，以四生散酒调四服而愈。（此凭症也。）
一妇人久郁。患而不溃。既溃不敛。发热口干月水短少。饮食无味。日晡尤倦。益气养
二十余剂少健。予谓须服百剂。庶保无危。彼欲速效。反服斑蝥之剂。及数用追蚀毒药。去
而复结。以致不能收敛。出水不止。遂致不救。（此凭症也。）
一妇久不作脓。脉浮而涩。此气血俱虚。欲补之。使自溃。彼欲内消。专服斑蝥及散坚
之药。血气愈虚而死。（此凭症也。）
一人因劳而患怠惰。发热。脉洪大。按之无力。宜用补中益气汤。（十六）彼不信。辄服
攻伐之剂。吐泄不止亦死。（此凭脉因补误治致死。）
大抵此症原属虚损。若不审虚实而犯病禁经禁。鲜有不误。常治先以调经解郁。更以膈
之多自消。如不消。即以琥珀膏贴之。候有脓则针之。否则变生他症。设若兼痰兼阴虚等症
。只宜加兼症之剂。不可干扰余经。或气血已复而核不消却。服散坚之剂。至月许不应。气
血亦不觉损。方进必效散。或遇神仙无比丸。其毒一下。即止二药。更服益气养荣汤（百二
十一）数剂以调理。疮口不敛。豆豉饼、琥珀膏贴。气血俱虚。或不慎饮食起居七情者。俱
不治。然此症以气血为主。气血壮实。不用追蚀之剂。彼亦能自腐。但取去使易于收敛。若
气血虚。不先用补剂而数用追蚀之药。适足以败矣。若发寒热。眼内有赤脉贯瞳仁者。亦不
治。一脉者一年死。二脉者二年死。
一女年十九。颈肿一块。硬而色不变。肌肉日削。筋挛急痛。此七情所伤。气血所损之
症。当先滋养血气。不信。乃服风药。后不起。（此凭症也。）
一人耳后漫肿〔（注）∶“漫”下疑有脱文〕
一少妇耳下患肿。素勤苦。发热口干。月水过期且少。一妪以为经闭。用水蚝之类通之。以
致愈虚而毙。
一女年十七。患瘰 久不愈。月水尚未通。发热咳嗽。饮食少思。老媪欲用巴豆、肉桂
先通其经。予谓此症渐热经候不调者不治。但喜脉不涩。且不潮热。尚可治。须养气血。益
津液。其经自行。彼欲效。仍用巴、桂。此剽悍之剂。大助阳火。阴血得之则妄行。脾胃得
之则愈虚。果通而不止。饮食愈少。更加潮热。遂致不救。
一人远途劳倦。发热。脉大无力
然热退肿消。彼不听。服降火药及必
夫劳倦损气。气衰则火旺。火乘脾土。故倦怠而热。此元气伤也。丹溪曰。宜补形气。
调经脉。其疮自消。不可汗下。若不详脉症经络受病之异。而辄用峻利之剂。鲜不危矣。
一妇因怒不思食。发热倦怠。骨肉酸疼。体瘦面黄。经渐不通。颈间结核。以逍遥散
（二三）八珍汤（十四）治之少可。彼自误服水蛭等药。血气愈虚。遂致不救。（此凭症也。）
一人耳后寸余发一毒。名曰锐疽。 痛寒热。烦躁喜冷。此胆经蕴热而然。先用神仙
一剂。势减二三。时值仲冬。彼惑于用寒远寒之禁。自用十宣托里之药。势渐炽。耳内脓溃
。喉肿。开药不能下而殁。
一放出宫女。年逾三十。两胯作痛。不肿。色不变。大小道作痛
血渍入隧道为患。乃男女失合之症也。难治。后溃不敛。又患瘰 而
此妇为人之外家。夫为商。常在外。可见此妇久怀忧郁。及放出。又不能如愿。是以致生
此疾。其流注瘰 。乃七情气血皆已损伤。不可用攻伐之剂皎然矣。
罗宗伯耳后发际处患毒，疼痛。脉象数。用小柴胡汤（五）加桔梗、牛蒡子、金银花。服用四剂后痊愈。
（这是依据脉象和症状进行治疗的。）
有一人气血已经恢复，但肿块尚未溃烂。使用针头散及必效散各三次。不到十天便痊愈。（这是依据症状进行治疗的。）
一位妇女患瘰疬。给予养气顺血的药物无效。服用神效栝蒌散两剂（五三）后迅速消退。又服六剂后肿块消除。再给予托里药。待气血平复而痊愈。（这是依据症状治疗的。）
一位三十多岁的妇女，瘰疬已经溃破，久不愈合。给予八珍汤（十四）加小柴胡汤、地骨皮、夏枯草、香附。服用五十余剂后，形体和气色逐渐好转。再给必效散（四九）两服，疮口随即闭合。只是气血尚未平复，再用前面的药物三十余剂而平复。（这是依据症状治疗的。）
治疗瘰疬，用必效散与栝蒌散交替服用，效果神奇。
后来有人不问虚实，一概使用必效散。却不知道斑蝥药性猛烈且有大毒，能利水破血，大损元气。如果气血实证者，用此劫夺之邪然后投以补剂，或许可以痊愈。如果是虚证而用此药，或者使用追蚀类药物，虽然瘀肉去除，但疮口不合，反而导致无法救治。
一位妇女因愤怒出现结核肿痛。观察其气血俱实。先用神效散攻下。再服用益气养荣汤三十余剂而消散。
（这是依据症状治疗的。）
我常治疗这种病症，虚证者先用益气养荣汤。等到气血充盈完备，才取神效散去其毒。然后再进前药，没有不愈的。
一人耳下患五枚如贯珠状，一年多还坚硬。面色萎黄，饮食不甘，劳累后发热。脉象数软而涩。以益气……（原文此处似有脱漏，结合上下文推测为益气养血类方药，但依规则只提取明确实体，故翻译时保留语意连贯性，略去未明示的具体方名部分，或根据后文“益气”二字推断为补气相关，但鉴于原文断裂，仅译出可见部分：以益气……）
一位妇女瘰疬不消，脓液清稀不收敛。用八珍汤（十四）稍见好转。忽然肩背痛不能回顾。这是膀胱经气郁所致。应当服用防风通气汤。患者说瘰疬是胆经病。这是经火动而然。自行服用凉肝降火的药物，反而导致不进食，疼痛加剧。我诊察其脉象，胃气更弱。先用四君子汤（六三）加陈皮、炒芍药、半夏、羌活、蔓荆子四剂。食欲进，疼痛止。继以防风通气汤（四二）两剂而痊愈。（这是依据脉象和症状治疗的。）
一人精神劳倦多怒，颈肿一块，久而不消。各种药物无效。我用八珍汤（十四）加柴胡、香附。每天再隔蒜灸几壮，以及每日饮用远志酒二三盏，逐渐消散。（这是依据症状治疗的。）
一位妇女月经不行，逐渐发热，咳嗽，身体逐渐消瘦，胸膈不利，颈肿一块，日久不消。令其服用逍遥散（二十三）月余。再服用八珍汤（十四）加牡丹皮、香附。又月余加黄芪、白蔹。两个月后热退肿消，月经来潮而痊愈。（这是依据症状治疗的。）
一人年过三十，每次劳心过度，颈肿发热。服用败毒散后病情加重。用补中益气汤数帖而消散。（这是依据……[原文截断，通常为凭症]）
张通府耳后发际患肿一块，无头，肉色不变，按之微痛。他认为是痰结。脉象软而时而见数。经脉数不时出现，是疮疡。不是痰。仲景说，微弱之脉，主血气俱虚，形精不足。又说，沉迟软弱皆宜托里。遂用人参、黄芪、当归、白术、川芎、炙甘草以托里。少加金银花、白芷、桔梗以消毒。
他不以为然。内服降火消痰药，外贴凉药。觉得寒气彻脑，患处大热，头更重，食更少。再次请治。以四君子汤加藿香、炮干姜数剂。食欲渐增。肿成刺之。再以十全大补汤（十三）去桂枝，用豆豉饼灸。又有余邪而痊愈。（这是依据脉象和症状治疗的。）
一人耳内出脓。有时痛，有时痒。服用聪耳益气汤无效。服用防风通圣散后更严重。我用补肾丸而痊愈。
汪机按：前条瘰疬治法，虚者补之，而补有先后温凉之殊。实者泻之，而泻有轻重表里之异。或行开郁滞，或舍时从症，或变法用权，或针，或砭，或灸，或敷。其法也粗略具备了。医者能仿照这个例子而扩充它，差不多也可以应变了。
一幼儿宿痰失道，痈肿见于颈项，或臂膊胸背。这是冷症。宜用四生散敷贴。内服附子八物汤及隔蒜灸。（这是没有脉象可凭据而治疗。当时必定有所见解。）
一人因暴怒，项下肿痛，胸膈痞闷，兼发热。用方脉流气饮二剂。胸膈通畅。用荆防败毒散……（原文此处似有脱漏，接下文：）剂而热退。肝脉尚弦涩。以小柴胡汤加川芎、当归、芍药四剂。脉症顿退。以散肿溃坚丸一料，将平。唯一核不消。服用遇神仙无比丸二两而痊愈。（这是依据症状和脉象治疗的。）
一幼儿刚满周岁，项部患胎毒。我等待有脓后刺之。脓出碗许，乳食如常。用托里药月余而愈。又一幼儿患此，等待脓自出，几乎致死。（这是依据症状治疗的。）
大抵疮浅宜砭，深宜刺。使瘀血去于毒聚之始，则容易消散。何况小儿气血又弱。脓成不针刺，很少有不死的。
一人项下患毒脓已成。因为害怕针刺。拖延至胸部，赤如霞。其脉滑数。饮食不进，月余不睡觉，非常疲倦。我秘密针刺之。脓出即睡觉并思食。用托里散（百五七）两月余而愈。又一人患此，及时针刺，数日而愈。一人素体虚弱，患此不针刺，溃透颔颊，血气更虚而死。（这是依据症状治疗的。）
一人耳后患毒。脉症俱实。宜用内疏黄连汤。他以严冬不服寒剂。竟然至死。
罗谦甫说：用寒远寒，用热远热。假者反之。虽违其时，以从其症。又说：凡治病必察……（原文此处似有脱漏，接下文：）谓察时下之宜而权治之。所以说经者是常理，法是运用。医者是意念。随其所宜而治之，则万全。
一位妇女因愤怒，项肿。后来月经不通，四肢浮肿，小便如淋。这是血分症。先以椒仁丸数服。肿消。再以六君子汤加柴胡、枳壳数剂。颈肿也消除了。也有先因小便不利，后身发肿，致经水不通。名叫水分。宜葶苈丸治之。良方说：妇人肿满，若先因经水断绝，后致四肢浮肿，小便不通。名叫血分。水化为血，血不通则复化为水矣。宜服椒仁丸。（这是依据症状治疗的。）
一妇女，咽间如一核所鲠，咽吐不出。倦怠发热。先以四七汤而咽利。再以逍遥散。（这是……[原文截断]）
一位妇女所患同前。兼胸膈不利，肚腹膨胀，饮食少思，卧睡不安。用分心气饮并有效。（这是……[原文截断]）
一女年十七，项下时或作痛，乍寒乍热如疟状。肝脉弦长。这是血盛之症。先以小柴胡汤二剂，稍好。再以生地黄丸而痊愈（这是依据脉象和症状治疗的。）
一位贵人女子出嫁，丈夫早逝。患十指挛缩，拳掌下垂不能举起，肤体疮疡粟米状。汤剂杂进，饮食减半。半年后诊之，非风也。乃忧愁悲哀所致。病属内因。宜用内因药。仍以鹿角胶辈，多用麝香熬膏贴痿处。挛能举，指能伸，病渐安。（这是因情志而治疗的。）
一女性急好怒，耳下常肿痛，发寒热。肝脉弦急。投小柴胡汤加青皮、牛蒡子、荆芥、防风……（原文此处似有脱漏，接下文：）而寒热退。更以小柴胡汤对四物汤。数剂而肿消。其父欲除病根。我说肝内主藏血，外主荣筋。若恚怒气逆则伤肝。肝主筋，故筋蓄结而肿。须要自己加以调摄，庶可免患。否则肝迭受伤，不能藏血。血虚则难痊愈了。后来不加戒慎，果然结三核，屡用追蚀，不敛而死亡。（这是因情志而治疗的。）
一人先在耳前耳下患之。将愈，延及项侧缺盆。三年遂延胸腋。诊之肝脉弦数。以龙会坚二丸治之将愈。肝脉尚数。四年后，小腹阴囊内股皆患毒。年余不敛。脉诊如前。以清肝养血及前丸而愈。（这是依据脉象治疗的。）
一人因怒，耳下及缺盆患瘰疬。溃延腋下。形气颇实。疮口不合。治以散肿溃坚丸（五十）而愈。（这是依据形体症状治疗的。）
一幼儿七岁，项结二核，时发寒热，日久不愈。治以连翘丸，而消散。若患在面臂等处，尤宜此丸。若溃而不敛，兼以托里之药。（这是依据症状治疗的。）
一幼儿项结一核，坚硬如石。面色萎黄，饮食不甘。服托里药无效。这是无辜疳毒也。以蟾蜍治之而愈。若数服不消，按之转动，软而不痛者，内有虫如粉。急针出之。若不速去，则虫随气走，内蚀脏腑不治。（按：此因治不应而变法也。蟾蜍夏月沟渠中，腹大不跳不鸣者。先取粪蛆一杓置桶中，以尿浸之，桶近上令干，使蛆不得出。将蟾蜍扑死投蛆中，任蛆食昼夜。次以新布袋包系，置水急处，浸一宿取出，瓦上焙为末，入麝香一字，软饭丸如麻子大。每服二三十丸，空心米饮送下。）
一人眼赤痒痛，时或羞明下泪，耳内作痒。服诸药气血日虚，饮食日减，而痒愈盛。这是肝肾风热上攻也，以四生散酒调四服而愈。（这是依据症状治疗的。）
一妇人久郁，患而不溃。既溃不敛，发热口干，月水短少，饮食无味，日晡尤倦。益气养荣……（原文此处似有脱漏，接下文：）二十余剂少健。我说须服百剂，庶保无危。彼欲速效，反服斑蝥之剂。及数用追蚀毒药，去而复结，以致不能收敛，出水不止，遂致不救。（这是依据症状治疗的。）
一妇久不作脓，脉浮而涩。这是气血俱虚。欲补之，使自溃。彼欲内消。专服斑蝥及散坚之药。血气更虚而死。（这是依据症状治疗的。）
一人因劳而患怠惰，发热。脉洪大，按之无力。宜用补中益气汤。（十六）彼不信。辄服攻伐之剂。吐泄不止亦死。（这是依据脉象因误治致死。）
大抵此症原属虚损。若不审虚实而犯病禁经禁，鲜有不误。常治先以调经解郁。更以膈……（原文此处似有脱漏，接下文：）之多自消。如不消，即以琥珀膏贴之。候有脓则针之。否则变生他症。设若兼痰兼阴虚等症。只宜加兼症之剂，不可干扰余经。或气血已复而核不消却，服散坚之剂。至月许不应，气血亦不觉损，方进必效散。或遇神仙无比丸。其毒一下，即止二药。更服益气养荣汤（百二十一）数剂以调理。疮口不敛，豆豉饼、琥珀膏贴。气血俱虚，或不慎饮食起居七情者，俱不治。然此症以气血为主。气血壮实，不用追蚀之剂，彼亦能自腐。但取去使易于收敛。若气血虚，不先用补剂而数用追蚀之药，适足以败矣。若发寒热，眼内有赤脉贯瞳仁者，亦不治。一脉者一年死，二脉者二年死。
一女年十九，颈肿一块，硬而色不变，肌肉日削，筋挛急痛。这是七情所伤，气血所损之症。当先滋养血气。不信，乃服风药。后不起。（这是依据症状治疗的。）
一人耳后漫肿〔（注）∶“漫”下疑有脱文〕
一少妇耳下患肿。素勤苦，发热口干，月水过期且少。一老妪以为经闭。用水蛭之类通之。以致愈虚而毙。
一女年十七，患瘰疬久不愈，月水尚未通。发热咳嗽，饮食少思。老媪欲用巴豆、肉桂先通其经。我说此症渐热经候不调者不治。但喜脉不涩，且不潮热，尚可治。须养气血，益津液，其经自行。彼欲效，仍用巴、桂。此剽悍之剂，大助阳火，阴血得之则妄行，脾胃得之则愈虚。果通而不止，饮食愈少，更加潮热，遂致不救。
一人远途劳倦，发热，脉大无力……（原文此处似有脱漏，接下文：）然热退肿消。彼不听。服降火药及必效……（原文此处似有脱漏，接下文：）夫劳倦损气，气衰则火旺，火乘脾土，故倦怠而热。此元气伤也。丹溪曰：宜补形气，调经脉，其疮自消，不可汗下。若不详脉症经络受病之异，而辄用峻利之剂，鲜不危矣。
一妇因怒不思食，发热倦怠，骨肉酸疼，体瘦面黄，经渐不通，颈间结核。以逍遥散（二三）八珍汤（十四）治之少可。彼自误服水蛭等药，血气更虚，遂致不救。（这是依据症状治疗的。）
一人耳后寸余发一毒，名曰锐疽。剧痛寒热，烦躁喜冷。这是胆经蕴热而然。先用神仙……（原文此处似有脱漏，接下文：）一剂。势减二三。时值仲冬。彼惑于用寒远寒之禁。自用十宣托里之药。势渐炽。耳内脓溃，喉肿，开药不能下而殁。
一放出宫女，年逾三十，两胯作痛，不肿，色不变，大小道作痛……（原文此处似有脱漏，接下文：）血渍入隧道为患。乃男女失合之症也。难治。后溃不敛，又患瘰疬而……（原文此处似有脱漏，接下文：）此妇为人之外家。夫为商，常在外。可见此妇久怀忧郁。及放出，又不能如愿。是以致生此疾。其流注瘰疬，乃七情气血皆已损伤，不可用攻伐之剂皎然矣。
Luo Zongbo developed a toxic swelling at the hairline behind the ear, accompanied by pain. The pulse was rapid. He was treated with Xiaochaihu Tang (Minor Bupleurum Decoction) [5] plus Jiegeng (Platycodon Root), Niubangzi (Arctii Fructus), and Jinyinhua (Lonicerae Japonicae Flos). After four doses, he recovered.
(This treatment was based on the pulse and symptoms.)
A patient whose Qi and Blood had already recovered still had nodules that had not suppurated. Zhentousan (Needle-Head Powder) and Bixiao San (Highly Effective Powder) were each applied three times. Within ten days, he recovered. (This treatment was based on the symptoms.)
A woman suffered from scrofula. Treatment with herbs to nourish Qi and regulate Blood was ineffective. She took Shenxiao Gualou San (Miraculous Trichosanthes Powder) for two doses [53], after which the swelling rapidly subsided. After another six doses, the nodules disappeared. She was then given Tuoli herbs (supporting interior remedies). Once her Qi and Blood returned to balance, she recovered. (This treatment was based on the symptoms.)
A woman over thirty years old had scrofula that had ulcerated but failed to heal. Bazhen Tang (Eight-Treasure Decoction) [14] was prescribed with Xiaochaihu Tang, Digupi (Lycii Cortex), Xiakucao (Prunellae Spica), and Xiangfu (Cyperi Rhizoma). After more than fifty doses, her physical appearance and Qi gradually improved. Two doses of Bixiao San [49] were then administered, causing the wound to close. However, her Qi and Blood were not yet balanced, so she continued with the previous prescription for another thirty-plus doses until she recovered. (This treatment was based on the symptoms.)
To treat scrofula, Bixiao San and Gualou San can be taken alternately, yielding miraculous results.
Later, some practitioners indiscriminately used Bixiao San regardless of deficiency or excess. They did not realize that Banmao (Mylabris) is extremely potent and highly toxic; it promotes urination and breaks blood stasis, severely damaging Yuan Qi (Original Qi). If the patient has an Excess pattern, using this harsh remedy to attack the pathogen followed by tonics might lead to recovery. However, if the patient is Deficient and uses this, or employs corrosive/cauterizing agents, although necrotic tissue may be removed, the wound will fail to heal, potentially leading to death.
A woman developed tender nodules due to anger. Her Qi and Blood were observed to be in a state of Excess. Shenxiao San was first used to purge downward. Subsequently, Yiqi Yangrong Tang (Qi-Nourishing and Blood-Supplementing Decoction) was taken for over thirty doses, resolving the nodules.
(This treatment was based on the symptoms.)
In my frequent treatment of this condition, for Deficiency patterns, I first use Yiqi Yangrong Tang. Only after Qi and Blood are fully replenished do I employ Bixiao San to eliminate toxicity, followed again by the tonic. This approach is invariably successful.
A man had five nodules under his ear like beads on a string, remaining hard for over a year. His complexion was sallow, appetite poor, and he experienced fever upon exertion. The pulse was rapid, soft, and choppy. Treatment involved boosting Qi... [Text fragment].
A woman’s scrofula did not resolve, with thin pus failing to heal. Bazhen Tang [14] provided slight relief. Suddenly, she experienced shoulder and back pain preventing her from turning her head. This was due to Qi stagnation in the Bladder Meridian. Fangfeng Tongqi Tang should have been taken. The patient claimed scrofula is a Gallbladder Meridian disease caused by Fire stirring within. Self-medicating with Liver-cooling and Fire-descending herbs led to loss of appetite and intensified pain. Upon diagnosis, her Stomach Qi was further weakened. Sijunzi Tang [63] plus Chenpi (Tangerine Peel), Chao Shaoyao (Fried Peony Root), Banxia (Pinelliae Tuber), Qianghuo (Notopterygii Rhizoma et Radix), and Manjingzi (Viticis Semen) were given for four doses. Appetite returned, and pain ceased. Fangfeng Tongqi Tang [42] for two doses then cured her. (This treatment was based on the pulse and symptoms.)
A man suffered from mental fatigue and frequent anger, resulting in a neck lump that persisted despite various medications. I prescribed Bazhen Tang [14] plus Chaihu (Bupleuri Radix) and Xiangfu. Additionally, he underwent garlic-separated moxibustion several times daily and drank Yuanzhi Jiu (Polygalae Wine) two to three cups daily. The lump gradually resolved. (This treatment was based on the symptoms.)
A woman with amenorrhea developed gradual fever, cough, emaciation, chest oppression, and a persistent neck lump. She was instructed to take Xiaoyao San [23] for over a month. Then, Bazhen Tang [14] plus Mudanpi (Moutan Cortex), Xiangfu, Huangqi (Astragali Radix), and Bailian (Belamcandae Rhizoma) were added for another month. After two months, the fever subsided, the swelling disappeared, menstruation resumed, and she recovered. (This treatment was based on the symptoms.)
A man over thirty experienced neck swelling and fever whenever he overexerted his mind. Taking Baidu San (Defeat Toxin Powder) worsened the condition. Butong Yiqi Tang (Supplement Middle and Boost Qi Decoction) for several doses resolved it. (Based on...)
Zhang Tongfu developed a non-purplulent, flesh-colored, slightly painful lump behind the ear at the hairline. He believed it was Phlegm accumulation. The pulse was soft with intermittent rapidness. Intermittent rapid pulses indicate a sore/ulcer, not Phlegm. Zhang Zhongjing stated: "Weak pulses indicate deficiency of both Qi and Blood, and insufficiency of form and spirit." Also, "Sinking, slow, and weak pulses all warrant supporting the interior." Thus, Renshen (Ginseng Radix), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanxiong (Chuanxiong Rhizoma), and Zhi Gancao (Prepared Licorice Root) were used to support the interior, with small amounts of Jinyinhua, Baizhi (Angelicae Dahuricae Radix), and Jiegeng to dispel toxicity.
He disagreed, taking internal Fire-descending and Phlegm-resolving herbs and applying cold external plasters. He felt cold penetrating his brain, while the affected area became hot, his head heavier, and appetite lower. Upon re-evaluation, Sijunzi Tang plus Huoxiang (Pogostemonis Herba) and Pao Ganjiang (Prepared Ginger Rhizome) for several doses restored his appetite. Once the abscess formed, it was punctured. Shiquan Dabu Tang [13] minus Guizhi (Cinnamomi Ramulus) was taken, along with moxibustion using Douchi Bing (Fermented Soybean Cake). He recovered after clearing residual pathogens. (This treatment was based on the pulse and symptoms.)
A man suffered from ear discharge, pain, and itching. Conger Yiqi Tang was ineffective; Fengwang Tongsheng San aggravated the condition. Bushen Wan (Kidney-Nourishing Pill) cured him.
Wang Ji notes: Regarding scrofula treatment, Deficiency requires tonification, distinguishing between early/late and warm/cool methods. Excess requires purging, distinguishing between heavy/light and exterior/interior approaches. Methods include opening stagnation, adapting to seasons vs. symptoms, flexible application, needling, pricking, moxibustion, or topical applications. These methods are roughly comprehensive. Physicians who expand upon these examples can adapt to changes.
An infant with retained Phlegm deviating from its pathway developed abscesses on the neck, arms, chest, or back. This is a Cold pattern. Apply Sisheng San (Four Generations Powder) externally. Internally, take Fuzi Bawu Tang (Aconite Eight-Ingredient Decoction) and undergo garlic-separated moxibustion. (Treatment without pulse reference implies prior clinical insight.)
A man developed neck swelling, pain, chest oppression, and fever due to sudden anger. Fangmai Liuqi Yin (Meridian Qi-Flowing Decoction) for two doses relieved chest oppression. Jingfang Baidu San (Schizonepeta and Saposhnikovia Decoction to Defeat Toxin)... doses reduced fever. The Liver pulse remained wiry and choppy. Xiaochaihu Tang plus Xiong (Chuanxiong), Gui (Danggui), and Shaoyao (Peony Root) for four doses resolved the pulse and symptoms. Sanzhong Kuijian Wan (Disperse Swelling and Harden Resolving Pill) one dose brought near recovery. One nodule remained; Yushenxian Wubi Wan (Meet Divine Peerless Pill) two taels cured it. (This treatment was based on symptoms and pulse.)
An infant just one year old had congenital toxin on the neck. I waited for suppuration before puncturing. A bowl of pus drained; feeding remained normal. Interior-supporting herbs for over a month led to recovery. Another infant with the same condition waited for spontaneous drainage and nearly died. (This treatment was based on symptoms.)
Generally, superficial sores require pricking (bian); deep ones require needle insertion (ci). Removing blood stasis at the onset of toxin aggregation facilitates resolution. Infants have weak Qi and Blood; failing to needle when pus forms often leads to death.
A man had a neck abscess ready to drain but feared needling. The infection spread to the chest, appearing red as rosy clouds. Pulse was slippery and rapid. No food intake, insomnia for a month, extreme fatigue. I secretly needled it. Pus drained, sleep returned, and appetite increased. Tuoli San (Interior-Supporting Powder) [1057] for over two months cured him. Another patient with the same condition was needled promptly and recovered in days. A chronically deficient patient who refused needling ruptured through the jaw/cheek, becoming more depleted in Qi and Blood, and died. (This treatment was based on symptoms.)
A man with a toxic swelling behind the ear had Excess pulse and symptoms. Neishu Huanglian Tang (Internally Purging Coptis Decoction) was indicated. Refusing cold-natured herbs in winter, he died.
Luo Qianfu said: "Avoid cold in cold seasons, avoid heat in hot seasons. For false patterns, reverse this." Even if contrary to season, follow the symptoms. "Investigate treatments must observe..." [text fragment] "Observe seasonal appropriateness and adjust treatment accordingly." Thus, Classics represent constant principles, Methods represent application. Physicians use intuition to treat appropriately, ensuring safety.
A woman developed neck swelling after anger, followed by amenorrhea, limb edema, and dysuria-like symptoms. This is a Blood Pattern disorder. Jiaoren Wan (Pepper Seed Pill) for several doses reduced swelling. Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu and Zhiqiao (Immature Bitter Orange) for several doses resolved the neck swelling. Some cases start with urinary difficulty, leading to body swelling and amenorrhea, named Water Pattern. Tingli Wan (Descurainia Seed Pill) treats this. Liangfang states: In women with edema, if amenorrhea precedes limb swelling and urinary obstruction, it is called Blood Pattern. Water transforms into Blood; if Blood does not flow, it reverts to Water. Jiaoren Wan is suitable. (This treatment was based on symptoms.)
A woman felt a lump in the throat, unable to swallow or spit out. Fatigue and fever were present. Siqi Tang (Four Seven Decoction) cleared the throat sensation. Xiaoyao San followed. (This...)
A woman with similar complaints also had chest oppression, abdominal distension, poor appetite, and insomnia. Fenxin Qi Yin (Dividing Heart Qi Decoction) was effective. (This...)
A seventeen-year-old girl had intermittent neck pain and alternating chills and fever resembling malaria. The Liver pulse was long and wiry. This indicates abundant Blood. Xiaochaihu Tang for two doses brought slight improvement. Shengdi Huang Wan (Rehmannia Pill) completed the cure. (This treatment was based on pulse and symptoms.)
The daughter of a nobleman, widowed early, developed flexion contracture of ten fingers, inability to lift hands, and millet-grain-sized skin lesions. Various decoctions were tried, halting food intake. Over half a year, diagnosis revealed it was not Wind (stroke) but caused by sorrow and grief. It belongs to Internal Causes. Internal cause herbs were used. Deer Antler Glue (Lujiao Jiao) and musk paste applied to the atrophic areas allowed finger extension and lifting. The condition gradually stabilized. (This treatment was based on emotional factors.)
A quick-tempered, angry-prone woman had frequent ear-side swelling, pain, chills, and fever. The Liver pulse was wiry and urgent. Xiaochaihu Tang plus Qingpi (Citri Reticulatae Pericarpium Viride), Niubangzi, Jingjie (Schizonepetae Spica), and Fangfeng (Saposhnikoviae Radix) resolved chills and fever. Xiaochaihu Tang combined with Siwu Tang (Four Substance Decoction) for several doses reduced swelling. Her father wanted to remove the root cause. I explained: The Liver stores Blood internally and nourishes sinews externally. Anger causes Qi reversal, injuring the Liver. Since the Liver governs sinews, sinew knotting causes swelling. Self-regulation is essential to prevent recurrence. Otherwise, repeated Liver injury prevents Blood storage; Blood deficiency makes recovery difficult. Ignoring advice, she developed three nodules. Repeated cauterization failed to heal them, leading to death. (This treatment was based on emotional factors.)
A man initially had lesions in front of and below the ear. As they healed, they spread to the neck/clavicle area. Three years later, they extended to the chest/axilla. Liver pulse was wiry and rapid. Longhui Jian Er Wan (Dragon Meeting Strengthening Two Pills) nearly cured it. Liver pulse remained rapid. Four years later, toxic swellings appeared in the lower abdomen, scrotum, and inner thighs, failing to heal for over a year. Pulse remained similar. Qinggan Yangxue (Clear Liver and Nourish Blood) herbs plus the previous pills cured him. (This treatment was based on the pulse.)
A man developed scrofula below the ear and clavicle due to anger, spreading to the axilla. His constitution and Qi were robust, but the wound failed to heal. Sanzhong Kuijian Wan [50] cured him. (This treatment was based on physical symptoms.)
A seven-year-old child had two neck nodules with intermittent chills and fever, persisting for a long time. Lianqiao Wan (Forsythia Pill) resolved them. This pill is especially suitable for lesions on the face or arms. If ulcerated and unhealed, combine with interior-supporting herbs. (This treatment was based on symptoms.)
A child had a single hard neck nodule, sallow complexion, and poor appetite. Interior-supporting herbs failed. This was Wugu Gan Du (Gu-less Malnutrition Toxin). Chan Chu (Toad Venom/Skin) treatment cured it. If multiple doses fail to reduce it, and it moves upon pressure, is soft, and painless, there are worms inside like powder. Needle them out immediately. If not removed quickly, worms travel with Qi, eroding internal organs, leading to untreatable conditions. (Note: This is a modified method due to initial treatment failure. Toads in summer ditches with large bellies that do not jump or croak are selected. First, place a scoop of maggot larvae in a bucket, soak in urine, keep the top dry to trap maggots. Kill the toad and throw it into the bucket. Let maggots feed day and night. Wrap in a new cloth bag, hang in fast-flowing water overnight, remove, dry on tiles, grind to powder. Add a pinch of Shexiang (Moschus). Form pills the size of hemp seeds with soft rice. Take 20-30 pills on an empty stomach with rice water.)
A man had red, itchy, painful eyes, photophobia, tearing, and ear itching. Various medicines depleted Qi and Blood, reduced appetite, and worsened itching. This was Liver-Kidney Wind-Heat attacking upward. Sisheng San mixed with wine, taken four times, cured him. (This treatment was based on symptoms.)
A woman with chronic depression had lesions that neither ulcerated nor healed. Fever, dry mouth, scanty menstruation, tasteless food, and evening fatigue were present. Yiqi Yangrong... [text fragment] Twenty-plus doses brought slight strength. I advised taking one hundred doses to ensure safety. Desiring quick results, she took Banmao (Mylabris) formulas and repeatedly used corrosive toxins. The lesion refisted, failed to heal, oozed continuously, leading to death. (This treatment was based on symptoms.)
A woman failed to produce pus for a long time. Pulse was floating and choppy, indicating Qi and Blood deficiency. Tonification was intended to allow spontaneous rupture. Desiring internal resolution, she exclusively took Banmao and hardness-dispersing herbs. Depleted Qi and Blood led to death. (This treatment was based on symptoms.)
A man suffering from fatigue and fever had a large, forceful pulse that was empty upon pressure. Butong Yiqi Tang [16] was indicated. Disbelieving this, he took attacking/purging herbs, leading to continuous vomiting/diarrhea and death. (Death due to misdiagnosis based on pulse.)
Generally, this condition originates from Deficiency and Damage. Failing to distinguish Deficiency/Excess and violating dietary/meridian taboos rarely avoids error. Standard treatment begins with regulating menstruation and resolving stagnation. More often, it resolves spontaneously. If not, Hupo Gao (Amber Plaster) is applied. Once pus forms, needle it. Otherwise, other symptoms may arise. If complicated by Phlegm or Yin Deficiency, add corresponding herbs without disturbing other meridians. If Qi and Blood recover but nodules persist, try hardness-dispersing herbs. If no effect after a month and Qi/Blood remain intact, then use Bixiao San or Yushenxian Wubi Wan. Stop these toxic drugs once effective. Follow with Yiqi Yangrong Tang [111] for regulation. Unhealed wounds benefit from Douchi Bing or Hupo Gao. Patients with severe Qi/Blood deficiency or those neglecting diet/lifestyle/emotions are untreatable. This condition relies primarily on Qi and Blood. If robust, even without corrosives, lesions may self-digest. Removal aids healing. If deficient, failing to tonify first and using corrosives repeatedly is disastrous. Fever with red vessels crossing the pupil is also untreatable. One vessel indicates death in one year; two vessels in two years.
A nineteen-year-old girl had a hard, colorless neck lump, daily muscle wasting, and tendon cramping pain. This was damage from Seven Emotions and depletion of Qi and Blood. Nourishing Qi and Blood was advised. Disobeying, she took Wind-expelling herbs and did not recover. (This treatment was based on symptoms.)
A man had diffuse swelling behind the ear [Note: Text likely missing characters after "Man"].
A young wife, accustomed to hard work, had ear-side swelling, fever, dry mouth, and delayed/scanty menstruation. An old woman mistook this for amenorrhea and used leeches etc. to promote flow. Increased deficiency led to death.
A seventeen-year-old girl had persistent scrofula and amenorrhea. Fever, cough, and poor appetite were present. An old woman suggested using Badou (Croton Seed) and Rougui (Cinnamon Bark) to induce menstruation. I stated that gradual fever and irregular menstruation are untreatable. However, since the pulse was not choppy and there was no tidal fever, it was treatable. Nourishing Qi/Blood and benefiting fluids would restore menstruation naturally. Desiring efficacy, she used Badou and Rougui. These harsh herbs greatly assist Yang Fire. Yin Blood flows recklessly; Spleen/Stomach become more deficient. Menstruation flowed uncontrollably, appetite decreased, tidal fever worsened, leading to death.
A man traveling far suffered fatigue, fever, and a large but empty pulse... [text fragment] Although fever subsided and swelling decreased, he did not listen. He took Fire-descending herbs and Bixiao... [text fragment] Fatigue damages Qi; Qi decline allows Fire to flare. Fire attacks Spleen Earth, causing fatigue and fever. This is Yuan Qi injury. Danxi said: "Tonify form and Qi, regulate meridians, and sores will resolve spontaneously. Do not sweat or purge." Without detailing pulse/symptoms/meridian differences, using harsh purgatives rarely avoids danger.
A woman lost appetite due to anger, with fever, fatigue, bone/muscle ache, emaciation, sallow complexion, irregular menstruation, and neck nodules. Xiaoyao San [23] and Bazhen Tang [14] provided slight relief. Self-medicating with Shui Zhi (Hirudo) etc. depleted Qi and Blood, leading to death. (This treatment was based on symptoms.)
A man developed a toxic swelling named Rui Ju (Sharp Carbuncle) one cun behind the ear. Severe pain, chills, fever, irritability, and preference for cold. This was Gallbladder Meridian Heat accumulation. Shenxian... [text fragment] One dose reduced severity by 20-30%. In mid-winter, confused by the taboo "avoid cold in cold," he self-administered Shixuan Tuoli (Ten Promoting Interior Support) herbs. Severity intensified. Ear pus drained, throat swelled, medication could not be swallowed, leading to death.
A released palace maid over thirty had bilateral hip pain, no swelling, normal color, and pain in bowels/bladder... [text fragment] Blood stasis entering tunnels causes harm. This is a syndrome of sexual incompatibility. Difficult to treat. Later ulcerated and failed to heal, developing scrofula... [text fragment] This woman was a relative-in-law. Her husband was a merchant often away. She harbored long-term depression. Release did not fulfill her desires, causing this illness. Her flowing deposits and scrofula resulted from damage to Qi, Blood, and Seven Emotions. Using attacking/purging herbs was clearly inappropriate.