一人年逾五十。腋下患毒。疮口不合。右关脉数而渴。此胃火也。用竹叶黄 汤（二九）而
止。再用补气药而愈。尝治午后发渴或发热。用地骨皮散效。
一人性急。味浓。常服躁热之药。左胁一点痛。轻诊弦重芤。知其痛处有脓。与四物加
、香附、生姜煎十余帖。痛处微肿如指大。针之。少时屈身脓出。与四物调理而安。（此因
脉而处治。）
一夫人左胁内作痛。牵引胸前。此肝气不和。尚未成疮。用小柴胡（五）加青皮、枳壳四
剂少可。加芎、归治之而愈。
一人连年病疟。后生子。三月病热。右胁下阳明少阳之分生一疖甫平。左胁下相对又一
脓血淋漓几死。医以四物汤败毒散数倍人参。以香附为佐。犀角为使。大料饮乳母两月而愈
逾三月忽腹胀。生赤疹如霞片。取剪刀草汁调原蚕砂敷随消。又半月移胀入囊为肿。黄莹裂
开。两丸显露水出。以紫苏叶盛麸炭末托之。旬余而合。此胎毒症也。
一妇因忿郁。腋下结一核二十余年。因怒加肿痛。完谷不化。饮食少思。此肠胃虚也。
君子（二）加砂仁、肉桂、干姜、肉豆蔻。泄虽止而脓清。疮口不合。用十全大补汤（十三）月
余而愈。（此凭症也。）
机按。前项二条胁疮。一因其性多躁急。故用四物汤阴柔之剂以安静之。一因其肝气不
平。故用小柴胡疏理之剂以和解之。此又因其性情为治。不特专于攻毒也。
张通北人年逾四十。夏月腋下患毒。溃后不敛。脓出清稀。皮寒脉弱。肠鸣切痛。大便
食下即呕。此寒变而内陷也。宜大辛温之剂。遂以托里温中汤一二帖。诸症悉退。更以六君
子（二）加炮干姜、肉桂数剂。再以十全大补汤而愈。（此凭症也。）
一人胁肿一块。日久不溃。按之微痛。脉微而涩。此形症俱虚也。经曰。形气不足。病
足。当补不当泻。宜用人参养荣汤。彼不信。乃服流气饮。虚症悉至。方服前汤月余少愈。
但肿尚硬。以艾叶炒热熨患处。至十余日脓成。以火针刺之。更灸豆豉饼。（四三）又服十全
大补汤（十三）百帖而愈。（此凭脉症也。）
盖流气饮通行十二经。诸经皆为所损。况胆经之血本少。又从而损之。宁不伤生。东垣
凡一经受病。止当求责其一经。不可干扰余经。苟泛投克伐之剂。则诸经被戕宁无危乎。
一人年三十。素饥寒。患右肋肿如覆瓢。转侧作水声。脉数。经曰。阴虚阳气凑袭。寒
热。热甚则肉腐为脓。即此症也。及按其肿处即起。是脓成。遂浓煎黄 六一汤。令先饮二
钟。然后针之。脓出数碗。虚症并至。遂用大补三月余而愈。（此凭脉症也。）
大抵脓血大泄。血气俱虚。当峻补之。虽有他病。皆宜缓治。盖元气一复。诸病自退。
老弱之人。不问肿溃。尤当补也。
一人因劳发热。胁下肿痛脉虽大。按之无力。此气血虚。腠理不密。邪气袭于肉理而然
当补之。以接虚怯之气。以补中益气汤加羌活四剂少可。去羌活又百余剂而愈。（此凭脉也
一人面白神劳。胁下生一红肿如桃。教用补剂不信。乃用流气饮十宣散。血气俱惫而死
一人年逾二十。腋下患毒。十余日肿硬不溃。脉弱时呕。予谓肿硬不溃阳气虚。呕吐少
气弱。宜六君子汤加砂仁、藿香。彼谓肿疡时呕。毒瓦斯攻心。溃疡时呕。阴虚宜补。予曰。
此丹溪大概言也。若肿赤痛甚。烦躁脉实而呕为有余。当作毒瓦斯攻心而下之。以疮属心火故
也。肿硬不溃。脉弱时呕为不足。当补之。亦有痛伤胃气。或感寒邪秽气而呕者。虽肿疡尤
当助胃壮气。盖肿疡毒瓦斯内侵作呕。十有一二。溃疡湿气内伤作呕。十有八九。彼不信。饮
攻伐药愈甚。复请诊。脉微弱而发热。予谓热而脉静。及脱血脉实。汗后脉躁。皆难治。果
殁。（此凭脉症也。）
有一位年过五十的人，腋下患毒疮，疮口久不愈合。右关脉数且口渴，这是胃火所致。服用竹叶石膏汤（二九）后症状停止。再服用补气药而痊愈。我曾治疗午后发渴或发热者，用地骨皮散有效。
另一位性格急躁的人，口味浓重，常服用燥热性质的药物。左胁下有一点疼痛，轻取脉弦，重按脉芤，知道疼痛处有脓。给予四物汤加木香、香附、生姜煎煮十余帖。疼痛处微肿如手指大，用针穿刺。片刻后屈身，脓液流出。再用四物汤调理而安定。（这是根据脉象进行治疗的。）
一位夫人左胁内部作痛，牵引至胸前。这是肝气不和，尚未形成疮疡。用小柴胡汤（五）加青皮、枳壳，服四剂后稍有好转。再加川芎、当归治疗而痊愈。
一个人连年患疟疾，后来生子。产后三个月出现发热，右胁下阳明经与少阳经交界处生一疖子刚平复，左胁下相对位置又生一处，脓血淋漓，几乎致死。医生用四物汤和败毒散，加入数倍人参，以香附为佐使，犀角为使药。大量煎煮让乳母服用两个月而痊愈。过了三个月忽然腹胀，生出红色皮疹如霞片。取剪刀草汁调原蚕砂外敷，随即消退。又半个月，胀气移入阴囊变为肿胀，皮肤黄莹裂开，两丸显露出水。用紫苏叶盛放麸炭末托敷患处。十几天后愈合。这是胎毒症。
一位妇女因愤怒抑郁，腋下结成一核二十多年。因发怒加重肿痛，完谷不化，饮食减少思虑。这是肠胃虚弱。服用六君子汤（二）加砂仁、肉桂、干姜、肉豆蔻。泄泻虽止但脓液清稀，疮口不合。用十全大补汤（十三）月余而痊愈。（这是根据症状进行治疗的。）
汪机按语：前两条胁部疮疡，一条因其人性情多躁急，故用四物汤这种阴柔之剂以使其安静；一条因其肝气不平，故用小柴胡汤这种疏理之剂以和解之。这又是根据其性情来治疗，不仅专门攻毒。
张通是北方人，年过四十。夏季腋下患毒疮，溃破后不收敛，脓出清稀，皮肤寒冷，脉弱，肠鸣切痛，大便食物下咽即呕吐。这是寒邪变证而内陷。宜用大辛温之剂。于是用托里温中汤一二帖，诸症悉退。再用六君子汤（二）加炮干姜、肉桂数剂。最后用十全大补汤而痊愈。（这是根据症状进行治疗的。）
一个人胁部肿起一块，日久不溃烂，按压微痛，脉微而涩。这是形症俱虚。《内经》说：形气不足，病气有余，当补不当泻。宜用人参养荣汤。他不相信，反而服用流气饮，导致虚症全部出现。才服用前面的人参养荣汤月余稍有好转。但肿块仍然坚硬，用艾叶炒热熨烫患处。到十多天脓成，用火针刺之。再灸豆豉饼。（四三）又服十全大补汤（十三）一百帖而痊愈。（这是根据脉象和症状进行治疗的。）
大概流气饮通行十二经，各经都被它损伤。何况胆经的血本少，又从而损伤它，岂能不伤生命？李东垣认为凡一经受病，只应当求责于这一经，不可干扰其余各经。如果泛投克伐之剂，那么各经被残害，难道没有危险吗？
一个人年三十岁，素来饥寒交迫，患右肋肿胀如倒扣的瓢，转侧时发出水声，脉数。《内经》说：阴虚阳气凑袭，寒热。热甚则肉腐为脓。就是此症。等到按压肿胀处即起，说明脓已成。于是浓煎黄芪六一汤，令先喝两钟。然后针刺。脓出数碗，虚症并至。于是用大补之法三月余而痊愈。（这是根据脉象和症状进行治疗的。）
大抵脓血大泄，血气俱虚，应当峻补。即使有其他病，都宜缓治。因为元气一旦恢复，诸病自然消退。老弱之人，不问是否肿胀溃破，尤其应当补益。
一个人因劳累发热，胁下肿痛，脉虽大，按之无力。这是气血虚，腠理不密，邪气袭于肌肉纹理所致。应当补益。以接引虚怯之气。用补中益气汤加羌活，服四剂稍有好转。去羌活后又服百余剂而痊愈。（这是根据脉象进行治疗的。）
一个人面白神疲，胁下生一红肿如桃。教他用补剂他不信，反而用流气饮和十宣散，导致血气俱惫而死。
一个人年过二十，腋下患毒，十余日肿硬不溃，脉弱时而呕吐。我认为肿硬不溃是阳气虚，呕吐少气弱，宜用六君子汤加砂仁、藿香。他认为肿疡时呕吐是毒瓦斯攻心，溃疡时呕吐是阴虚宜补。我说：这是朱丹溪的大概说法。如果肿赤痛甚，烦躁脉实而呕为有余，当作毒瓦斯攻心而下之。因为疮属心火故也。肿硬不溃，脉弱时呕为不足，应当补益。也有因痛伤胃气，或感寒邪秽气而呕者。即使是肿疡，尤其应当助胃壮气。大概肿疡毒瓦斯内侵作呕，十有一二；溃疡湿气内伤作呕，十有八九。他不相信，饮用攻伐药病情更重，再次请诊。脉微弱而发热。我说：热而脉静，及脱血脉实，汗后脉躁，皆难治。果然死亡。（这是根据脉象和症状进行治疗的。）
A person over fifty years old suffered from a toxic sore in the axilla, with the wound failing to heal. The pulse at the right Guan position was rapid accompanied by thirst, indicating Stomach Fire (Wei Huo). After taking Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), symptoms ceased. Subsequently, Qi-tonifying herbs were administered, leading to recovery. I once treated patients with afternoon thirst or fever using Digupi San (Lycium Bark Powder) with good effect.
Another individual had an irritable temperament, consumed rich flavors, and frequently took drying-hot medications. He experienced localized pain in the left hypochondrium. Light palpation revealed a wiry pulse (Xian Mai), while heavy pressure revealed a hollow pulse (Kou Mai), indicating pus formation at the painful site. Siwu Tang (Four Substances Decoction) was prescribed with added Muxiang (Aucklandiae Radix), Xiangfu (Cyperus Rhizome), and Shengjiang (Fresh Ginger), decocted for more than ten doses. The painful area swelled slightly to the size of a finger. It was punctured with a needle. Upon bending the body, pus drained out. The patient was then regulated with Siwu Tang and stabilized. (Treatment based on pulse diagnosis.)
A lady suffered from internal pain in the left hypochondrium radiating to the chest. This indicated Disharmony of Liver Qi (Gan Qi Bu He), without yet forming an abscess. Xiao Chaihu Tang (Minor Bupleurum Decoction) was prescribed with Qingpi (Green Tangerine Peel) and Zhike (Aurantium Fructus). After four doses, there was slight improvement. Xiong (Chuanxiong Rhizome) and Danggui (Angelicae Sinensis Radix) were added, leading to recovery.
A man suffered from malaria for years. After childbirth, he developed fever three months later. A boil appeared at the junction of the Yangming and Shaoyang meridians under the right hypochondrium, which just healed. However, a corresponding lesion appeared under the left hypochondrium, draining pus and blood profusely, nearly causing death. The physician used Siwu Tang combined with Baidu San (Toxin-Resolving Powder), adding several times the amount of Renshen (Ginseng Radix), with Xiangfu as assistant and Xijiao (Rhinoceros Horn - *Note: Substitute with water buffalo horn in modern practice*) as guide. Large quantities were decocted and given to the wet nurse for two months, resulting in recovery. Three months later, abdominal distension suddenly occurred, accompanied by red rashes like rosy clouds. Juice of Jian Dao Cao (Scissors Grass) mixed with Yuancansha (Silkworm Excrement) was applied topically, resolving immediately. Half a month later, the distension moved into the scrotum, causing swelling. The skin became yellowish and cracked, exposing both testicles with fluid discharge. Bran charcoal powder held in Perillae Folium (Zisuye) was used to support the area. Healing occurred after ten days. This is known as Fetal Toxin Disease (Taidu Zheng).
A woman, due to anger and depression, had a nodule in her axilla for over twenty years. Anger exacerbated the swelling and pain, leading to undigested food in stool and poor appetite. This indicated Spleen and Stomach Deficiency (Chang Wei Xu). Liujunzi Tang (Six Gentlemen Decoction) was prescribed with Sharen (Amomi Fructus), Rougui (Cinnamon Bark), Ganjiang (Dried Ginger), and Roudoukou (Myristica Seed). Although diarrhea stopped, the pus remained thin and the wound failed to close. Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was administered for over a month, leading to recovery. (Treatment based on symptoms.)
Wang Ji’s Commentary: Regarding the previous two cases of hypochondriac sores: one was treated with Siwu Tang, a yin-nourishing and softening formula, because the patient’s nature was irritable; the other was treated with Xiao Chaihu Tang, a soothing and harmonizing formula, because of Liver Qi stagnation. Treatment was tailored to the patient’s constitution, not merely attacking toxins.
Zhang Tong, a northerner over forty, suffered from a toxic sore in the axilla during summer. After ulceration, it failed to heal, discharging thin pus. Skin was cold, pulse weak, intestines rumbling with sharp pain, and vomiting occurred immediately after eating. This indicated Cold Transformation with Internal Collapse. Strong acrid-warm formulas were appropriate. Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) was given for one or two doses, resolving all symptoms. Then, Liujunzi Tang with Pao Ganjiang (Prepared Dried Ginger) and Rougui was administered for several doses. Finally, Shiquan Dabu Tang led to recovery. (Treatment based on symptoms.)
A man had a hard swelling in the hypochondrium that did not ulcerate for a long time, with mild pain upon pressure and a faint, choppy pulse. This indicated Deficiency of both Form and Symptoms. The Classic states: When form and qi are insufficient but disease excess remains, tonification is indicated over purgation. Ren Shen Yang Rong Tang (Ginseng Nourishing Young Decoction) was recommended. He refused, taking Liuqi Yin (Flowing Qi Drink) instead, causing all deficiency symptoms to manifest. Only after taking Ren Shen Yang Rong Tang for over a month did he improve slightly. The swelling remained hard. Hot mugwort leaves were used to moxa/warm the area. After ten days, pus formed. It was punctured with a fire needle. Douchi Bing (Fermented Soybean Cake) moxibustion was applied. Shiquan Dabu Tang was taken for one hundred doses, leading to recovery. (Treatment based on pulse and symptoms.)
Generally, Liuqi Yin circulates through the twelve meridians, damaging them all. Since Gallbladder Blood is naturally scant, further damage is harmful. Li Dongyuan stated that when one meridian is diseased, one should seek the cause within that meridian, not disturb others. Indiscriminate use of draining agents can endanger life.
A thirty-year-old man, chronically hungry and cold, suffered from right rib swelling resembling an inverted bowl, producing splashing sounds upon turning. The pulse was rapid. The Classic states: Yin deficiency allows Yang Qi to invade, causing alternating cold and heat. Intense heat causes flesh to rot into pus. This matches the case. Pressing the swelling caused it to rise, indicating pus formation. Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) was heavily decocted. Two cups were drunk first, then punctured. Several bowls of pus drained. Deficiency symptoms followed. Major tonification was maintained for over three months, leading to recovery. (Treatment based on pulse and symptoms.)
Generally, massive loss of pus and blood leads to Qi and Blood deficiency, requiring strong tonification. Other conditions should be treated slowly. Once Yuan Qi (Primal Qi) recovers, other ailments retreat. Elderly and weak individuals require tonification regardless of swelling or ulceration.
A man suffered from fatigue-induced fever, with swollen and painful hypochondrium. The pulse was large but empty upon pressure, indicating Qi and Blood deficiency with loose interstices allowing pathogenic invasion. Tonification was needed to support deficient Qi. Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) plus Qianghuo (Notopterygii Rhizoma) was given for four doses, showing slight improvement. Qianghuo was removed, and over one hundred doses were taken, leading to recovery. (Treatment based on pulse.)
A man with a pale face and mental fatigue developed a peach-sized red swelling under the hypochondrium. He refused tonics, taking Liuqi Yin and Shixuan San (Ten-Auspicious Powder) instead, leading to exhaustion of Qi and Blood and death.
A man over twenty suffered from an axillary toxin. After ten days, it was swollen and hard without ulceration. Pulse was weak with occasional vomiting. I diagnosed Yang Qi deficiency causing hardness and vomiting due to weak Qi. Liujunzi Tang with Sharen and Huoxiang (Pogostemonis Herba) was suggested. He believed vomiting in the swelling stage indicates Toxin attacking the Heart, while in the ulcer stage it indicates Yin deficiency requiring tonification. I replied: This is Zhu Danxi’s general view. If red, swollen, painful, with irritability, full pulse, and vomiting, it is Excess/Toxin attacking the Heart, requiring purgation because sores relate to Heart Fire. If hard, non-ulcerated, with weak pulse and vomiting, it is Deficiency, requiring tonification. Vomiting can also result from pain damaging Stomach Qi or cold/dirty pathogens. Even in the swelling stage, supporting Stomach Qi is crucial. Toxin-induced vomiting accounts for 10-20%; dampness-induced vomiting in ulcers accounts for 80-90%. He refused, taking draining herbs, worsening his condition. Upon re-examination, pulse was faint with fever. I stated: Fever with quiet pulse, collapse with full pulse, or agitation after sweating are difficult to treat. He indeed died. (Treatment based on pulse and symptoms.)