立斋曰∶《内经》云∶肝主筋而藏血，心裹血而主脉，脾统血而主肉，肺司腠理而主
气，肾统骨而主水。若怒动肝火，血涸而筋挛者，自筋肿起，按之如筋，久而或有赤缕，名
曰筋瘤。若劳役火动，阴血沸腾，外邪所搏而为肿者，自肌肉肿起，久而有赤缕，或皮俱赤
者，名曰血瘤。若郁结伤脾，肌肉消薄，外邪所搏而为肿者，自肌肉肿起，按之实软，名曰
肉瘤。若劳伤肺气，腠理不密，外邪所搏，而壅肿者，自皮肤肿起，按之浮软，名曰气瘤。
若劳伤肾水，不能荣骨，而为肿者，自骨肿起，按之坚硬，名曰骨瘤。夫瘤者，留也。随气
凝滞，皆因脏腑受伤，气血乖违，当求其属，而治其本。大凡属肝胆二经结核，宜八珍加
山栀、胆草，以养气血、清肝火；六味丸以养肺金、生肾水。若属肝火血燥，须生血凉血，
用四物、二地、丹皮、酒炒黑胆草、山栀。若中气虚者，补中益气汤兼服之。若治失其法，
脾胃亏损，营气虚弱，不能濡于患处，或寒气凝于疮口，营气不能滋养于患处，以致久不生
肌而成漏者，悉宜调补脾气，则气血壮而肌肉自生矣。若不慎饮食起居，及七情六淫，或用寒
凉蚀药，蛛丝缠，芫花线等法，以治其外，则误矣。
按瘤赘一证，如前薛论，已尽其略。然此五瘤之外，又惟粉瘤为最多，盖此以腠理津沫
，偶有所滞，聚而不散，则渐以成瘤，是亦粉刺之属，但有浅深耳。深者在皮里则渐成大瘤
也。余尝闻之，先辈曰，瘤赘既大，最畏其破。非成脓者，必不可开。开则牵连诸经，漏竭
血气，最难收拾，无一可活。及详考薛按所载数人，凡其破溃者，皆至不治，诚信然也，不
可不知。兹纪予于三旬之外，忽于臀下肛门前骨际皮里生一小粒，初如绿豆许，不以为意，
及半年而如黄豆矣，又一年而如皂子，复如栗矣。此时乘马坐椅皆有所碍，而渐至痛矣。然料此
非敷药可散，又非煎药可及，使其日渐长大，则如升如斗悬挂腰股间，行动不便，岂不竟成
废物乎。抱忧殊甚，谋之识者，皆言不可割刺，恐为祸不少。予熟筹数月，莫敢妄动。然窃
计，此时乘小不取，则日后愈大愈难矣，将奈之何。尝见人臀股间受箭伤者，未必即死，此
之利害不过如是，遂决意去之。一日饮酒微醺，乘醉以柳叶针刺之，所出者皆如豆腐白皮之
属，盖即粉瘤也。刺后顿消，予甚快然。又两日后，则肿如热痈，予以会通膏贴三日，脓溃
而愈，予又快然。不两日又肿起，更热更大，予则大惧大悔，谓瘤赘诚不可刺也。然而无奈
，复以会通膏贴之，又三日而大溃，则溃出一囊如鱼胞者，然后收口全愈。今愈后数十年，
此间仍有一小窍，诚险证也。向非予之勇决，则此后不知作何状，使开之再迟则真有不可收
拾矣。是以病不早治，则不知所终，此亦可为治病者之鉴。（新按）
一、刺灸法∶向一人于眼皮下弦，生一小瘤，初如米粒，渐大如豆。其人疑畏，求治于外科
，彼用攒针三四枚，翻转眼皮，刺其内膜，少少出血，如此二三次，其瘤日缩，竟得尽消。
又一人于手臂上生一瘤，渐大如龙眼，其人用小艾于瘤上灸七壮，竟尔渐消不长，亦善法也。
或用隔蒜灸之，亦无不可。一、凡于不便处有生此物者，
当以此二法酌宜用之。大都筋脉宜灸，血病宜刺，或有以萝卜子、南
星、朴硝之类敷而治者，亦可暂消。若欲拔根，无如前法。
一、蛛丝缠法∶可治瘤赘，未甚大者，其法最妙。予尝见一人于腹上生一瘤，其大如胡桃，
一治者取珠丝捻成粗线，缠扎其根。数日其丝渐紧，瘤根渐细，屡易屡细，不十日意尔脱落，
诚奇法也。可见诸线日松，惟蛛丝日紧，物理之妙，有当格致者如此。然亦缠治宜早，若形
势既大，恐不宜也。
薛氏按曰∶一男子左腿外侧近臀肿一块，上有赤缕三年矣。饮食起居如常，触破涌出脓
血，发热恶寒，此胆经受证，故发于腿外侧。诊其脉，左尺洪数，左关弦洪，此肾水不能生
肝木，用补中益气汤、六味地黄丸而愈痊。
一男子小腹患之，脓水淋漓，此足三阴之证，用补中益气汤加麦冬、五味，以培脾土，
用六味地黄丸，以生肾水，更用芦荟丸，以清肝火而敛。
一老儒，眉间患之三年，其状如紫桃下坠盖目，按之如水囊，此肝脾之证，脓瘀内溃而
然耳。遂刺出血脓，目即开。以炒黑胆草、山栀、芎、归、芍药、柴胡、白术、茯苓等药而愈。
薛立斋说：《黄帝内经》记载：肝主管筋脉并贮藏血液，心包裹血液并主管血脉，脾统摄血液并主管肌肉，肺司理腠理（皮肤纹理及汗孔）并主管气，肾统管骨骼并主管水液。如果因愤怒引动肝火，导致阴血枯竭而筋脉拘挛，从筋脉处肿起，按压时感觉像筋一样，时间久了可能出现红色血丝，这种称为筋瘤。如果因过度劳累引动内火，阴血沸腾，外邪侵袭搏结而形成肿胀，从肌肉处肿起，时间久了出现红色血丝，或者皮肤全部变红，这种称为血瘤。如果因忧郁结滞损伤脾气，导致肌肉消减变薄，外邪侵袭搏结而形成肿胀，从肌肉处肿起，按压时感觉实中带软，这种称为肉瘤。如果因劳累损伤肺气，导致腠理不紧密，外邪侵袭壅滞而形成肿胀，从皮肤处肿起，按压时感觉浮软，这种称为气瘤。如果因劳累损伤肾水，不能滋养骨骼而形成肿胀，从骨骼处肿起，按压时感觉坚硬，这种称为骨瘤。所谓“瘤”，就是停留的意思。随着气机凝滞而成，都是因为脏腑受伤，气血逆乱失调，应当探究其所属脏腑根源，从而治本。大凡属于肝胆二经的结节肿块，适宜用八珍汤加入山栀、龙胆草，以滋养气血、清泻肝火；配合六味地黄丸以滋养肺金、滋生肾水。如果属于肝火炽盛、血液枯燥，必须生血凉血，使用四物汤、二地（生地、熟地）、丹皮、酒炒黑龙胆草、山栀。如果中气虚弱者，兼服补中益气汤。如果治疗失当，导致脾胃亏损，营气虚弱，不能濡养患处，或者寒气凝结在疮口，营气不能滋养患处，以致长久不生肌肉而成漏症，都应当调理补益脾气，那么气血壮盛而肌肉自然生长。如果不谨慎饮食起居，以及七情六淫（情志和外界致病因素），或者使用寒凉腐蚀药物，蛛丝缠绕，芫花线等法来治疗外部症状，那就错了。
关于瘤赘这一病症，如前文薛氏论述，已大致讲完。然而在这五种瘤之外，又以粉瘤最为多见，这是因为腠理间的津液沫汁，偶然有所停滞，聚积而不消散，就逐渐形成肿瘤，这也是粉刺的一类，只是深浅不同罢了。深在皮里的就逐渐长成大的肿瘤。我曾听前辈说过，瘤赘一旦长大，最害怕它破溃。如果不是已经化脓的，绝对不能切开。切开会牵连各条经脉，耗竭气血，最难收拾，没有能存活的。等到详细考察薛氏按语中所载的几个人，凡是破溃的，都到了无法医治的地步，确实如此，不可不知道。这里记录我自己在三十岁之后，忽然在臀部下方、肛门前的骨际皮里长出一小粒，起初像绿豆大小，没在意，半年后像黄豆大小，又一年后像皂角子大小，又像栗子大小。这时骑马坐椅都有阻碍，并且逐渐疼痛。然而料想这不是敷药可以消散的，也不是煎药可以达到的，让它日渐长大，就像升斗一样悬挂在腰股之间，行动不便，岂不是完全成为废物吗？心中非常忧虑，咨询有见识的人，都说不可切割针刺，恐怕带来不少祸患。我仔细筹划数月，不敢轻举妄动。然而私下盘算，此时趁着小不切除，日后越大越难处理，该怎么办呢？曾见有人在臀股间受箭伤，未必立即死亡，这里的利害不过如此，于是决意去除它。一天喝酒微醉，乘着酒劲用柳叶针刺破它，排出的东西都像豆腐白皮一类，这大概就是粉瘤。刺后顿时消退，我非常高兴。两天后，又肿胀得像热痈，我用会通膏贴敷三天，脓液溃破而痊愈，我又很高兴。不到两天又肿起，更热更大，我非常恐惧后悔，认为瘤赘确实不可刺破。然而无可奈何，再次用会通膏贴敷，又三天后大溃，溃出一个像鱼胞一样的囊袋，然后收口完全痊愈。现在痊愈后几十年，此处仍有一个小窍，真是险证啊。如果不是我的勇决，则以后不知会变成什么样子，如果开刀再迟就真的难以收拾了。所以疾病不早治，就不知道结局，这也可为治病者作为借鉴。（新按）
一、刺灸法：曾经有一人眼皮下缘长一个小瘤，起初像米粒，逐渐大如豆子。那人怀疑畏惧，求治于外科医生，医生用攒针三四枚，翻转眼皮，刺其内膜，少量出血，这样二三次，其瘤日渐缩小，最终完全消除。又有一人在手臂上长一个瘤，逐渐大如龙眼，那人用小艾绒在瘤上灸七壮，竟然渐渐消退不再生长，也是好方法。或者用隔蒜灸，也没有不可以。一、凡是在不方便之处长此物的，应当根据这两种方法酌情使用。大体上筋脉病变适宜灸，血病适宜刺，或者有用人萝卜子、南星、朴硝之类敷贴治疗的，也可以暂时消退。若想拔除病根，不如前述方法。
一、蛛丝缠法：可治疗瘤赘，尚未很大的，这种方法最妙。我曾见一人在腹部生一个瘤，大如胡桃，一位医者取蛛丝捻成粗线，缠绕扎紧其根部。几天后丝线逐渐收紧，瘤根逐渐变细，多次更换更加变细，不到十天竟然脱落，真是奇妙的疗法。可见各种线日久变松，只有蛛丝日久变紧，物理之妙，有应当推究至此的。然而缠绕治疗宜早，如果形势已经很大，恐怕不宜采用。
薛氏按语说：一男子左腿外侧近臀部肿一块，上面有红色血丝三年了。饮食起居如常，触破后涌出脓血，发热恶寒，这是胆经受邪所致，故发于腿外侧。诊其脉，左尺脉洪数，左关脉弦洪，这是肾水不能生肝木，用补中益气汤、六味地黄丸而痊愈。
一男子小腹患病，脓水淋漓，这是足三阴经的证候，用补中益气汤加麦冬、五味子，以培补脾土，用六味地黄丸，以滋生肾水，再用芦荟丸，以清泻肝火而收敛。
一老儒生，眉间患病三年，形状像紫桃下垂遮盖眼睛，按压像水囊，这是肝脾的证候，脓瘀在内溃烂所致。于是刺出血脓，眼睛即睁开。用炒黑龙胆草、山栀、川芎、当归、芍药、柴胡、白术、茯苓等药而痊愈。
Xue Lizhai stated: The *Huangdi Neijing* (Yellow Emperor's Inner Canon) records: The Liver governs the sinews and stores blood; the Heart envelops blood and governs the vessels; the Spleen controls blood and governs the muscles; the Lung regulates the couli (skin texture and pores) and governs qi; the Kidney controls the bones and governs water. If anger stirs up Liver fire, causing yin-blood to dry up and sinews to spasm, swelling arises from the sinews, feeling like sinew upon palpation, and over time red threads may appear; this is called a Sinew Tumor (Jin Liu). If labor and fatigue stir up internal fire, causing yin-blood to boil and external pathogens to contend with it resulting in swelling, swelling arises from the muscles, with red threads appearing over time or the skin turning entirely red; this is called a Blood Tumor (Xue Liu). If depression and stagnation injure the Spleen, causing muscles to thin and atrophy, and external pathogens contend with it resulting in swelling, swelling arises from the muscles, feeling solid yet soft upon palpation; this is called a Flesh Tumor (Rou Liu). If labor and fatigue injure Lung qi, causing the couli to be loose, and external pathogens obstruct and cause swelling, swelling arises from the skin, feeling floating and soft upon palpation; this is called a Qi Tumor (Qi Liu). If labor and fatigue injure Kidney water, failing to nourish the bones and resulting in swelling, swelling arises from the bones, feeling hard upon palpation; this is called a Bone Tumor (Gu Liu). The term "Liu" (Tumor) implies retention. It forms due to qi stagnation and is caused by injury to the zang-fu organs and disharmony of qi and blood. One must seek its root affiliation and treat the root. Generally, for nodules belonging to the Liver and Gallbladder meridians, Ba Zhen Tang (Eight Treasures Decoction) added with Gardeniae Fructus (Shan Zhi) and Gentianae Radix (Dan Cao) should be used to nourish qi and blood and clear Liver fire; combined with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) to nourish Lung metal and generate Kidney water. If it belongs to Liver fire and blood dryness, one must generate and cool blood, using Si Wu Tang (Four Substances Decoction), Er Di (Rehmanniae Radix Preparata and Rehmanniae Radix), Moutan Cortex (Dan Pi), wine-fried black Gentianae Radix, and Gardeniae Fructus. If Middle Qi is deficient, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be taken concurrently. If treatment is incorrect, leading to Spleen and Stomach deficiency, weak Ying Qi that cannot moisten the affected area, or cold qi condensing at the sore mouth preventing Ying Qi from nourishing the area, resulting in chronic non-healing ulcers (Lou), all cases should be treated by regulating and tonifying Spleen Qi, so that when qi and blood become strong, muscles will naturally regenerate. If one does not exercise caution in diet and daily life, nor in the seven emotions and six exogenous pathogens, or uses cold-cooling corrosive medicines, spider silk wrapping, Daphne genkwa thread methods, etc., to treat the exterior, then one has erred.
Regarding the syndrome of tumors and excrescences, as previously discussed by Xue, the essentials have been covered. However, besides these five types of tumors, the Powder Tumor (Fen Liu) is the most common. This occurs because fluids and secretions in the couli occasionally stagnate, gathering without dispersing, gradually forming a tumor; it is also a type of acne comedo, differing only in depth. Those deep within the skin gradually grow into large tumors. I once heard from seniors say that once a tumor grows large, it is most feared that it will rupture. Unless it has formed pus, it absolutely must not be incised. Incision will involve other meridians, deplete blood and qi, making it extremely difficult to manage, with no chance of survival. Upon detailed examination of several cases recorded in Xue’s annotations, those who ruptured all reached untreatable states; this is indeed true and must be known. Here I record my own case: after age thirty, a small grain suddenly appeared under the skin at the bony junction below the buttock and anterior to the anus. Initially the size of a mung bean, I paid no attention. After half a year, it was the size of a soybean; after another year, the size of a soap bean, then like a chestnut. At this point, riding horses or sitting on chairs became obstructive, and pain gradually set in. However, I reasoned that this could not be dispersed by topical applications, nor reached by decoctions. If allowed to grow day by day, hanging between the waist and thighs like a measuring vessel, making movement inconvenient, would it not become completely useless? I was deeply worried and consulted knowledgeable people, who all said it should not be cut or needled, fearing significant disaster. I deliberated for months, daring not act rashly. Yet privately calculating, if not removed while small, it would become harder to handle later; what could be done? I had seen people injured by arrows in their buttocks or thighs not necessarily die immediately; the pros and cons here were no different. Thus, I resolved to remove it. One day, slightly drunk from wine, I used a willow-leaf needle to puncture it while intoxicated. What came out resembled white tofu skin; this was indeed a Powder Tumor. Immediately after puncture, it subsided, and I felt very pleased. Two days later, it swelled like a hot abscess. I applied Hui Tong Gao (Hui Tong Ointment) for three days; after pus drained, it healed, and I felt pleased again. Within two days, it swelled again, becoming hotter and larger. I felt great fear and regret, thinking tumors truly should not be punctured. However, having no choice, I applied Hui Tong Gao again. Three days later, it ulcerated massively, discharging a sac resembling a fish bladder. Then the wound closed and fully healed. Decades after healing, a small orifice remains there; it was indeed a dangerous condition. Had it not been for my decisiveness, I do not know what state it would have reached; if opened too late, it truly would have been unmanageable. Therefore, if disease is not treated early, the outcome is unknown; this can serve as a warning for practitioners. (New Annotation)
1. Acupuncture and Moxibustion Methods: Once, a person had a small tumor growing along the lower margin of the eyelid, initially the size of a rice grain, gradually enlarging to the size of a bean. The person was suspicious and fearful, seeking treatment from a surgeon. The surgeon used a cluster of three or four needles, flipped the eyelid inside out, and punctured the inner membrane, causing slight bleeding. After two or three such sessions, the tumor shrank daily until it completely disappeared. Another person had a tumor on the arm, gradually enlarging to the size of a longan fruit. That person applied small moxa cones (Zhuang) directly on the tumor seven times, and it gradually subsided and stopped growing; this is also a good method. Alternatively, garlic-separated moxibustion can also be used. 2. For tumors arising in inconvenient locations, these two methods should be chosen appropriately. Generally, sinew and vessel disorders are suitable for moxibustion, while blood disorders are suitable for acupuncture. Some use topical applications of radish seeds, Arisaema Rhizome (Nan Xing), or Mirabilite (Piao Xiao) to temporarily reduce the tumor. To eradicate the root, the aforementioned methods are superior.
3. Spider Silk Wrapping Method: This can treat tumors that are not yet very large; this method is excellent. I once saw a person with a walnut-sized tumor on the abdomen. A practitioner took spider silk, twisted it into a thick thread, and wrapped it tightly around the base of the tumor. Over several days, the thread tightened, and the tumor base gradually thinned. After repeated tightening, it fell off naturally within ten days; truly a miraculous method. It shows that while other threads loosen over time, spider silk tightens. The subtlety of physical principles warrants such investigation. However, wrapping treatment should be done early; if the tumor is already large, it is likely unsuitable.
Xue’s Annotation states: A man had a swelling on the lateral side of his left leg near the buttock, with red threads present for three years. His diet and daily life were normal. When touched, it burst and oozed pus and blood, accompanied by fever and aversion to cold. This is a syndrome of the Gallbladder Meridian, hence occurring on the lateral leg. Palpation of the pulse revealed a surging and rapid Left Chi (Kidney) pulse, and a wiry and surging Left Guan (Liver) pulse. This indicates Kidney Water failing to generate Liver Wood. He was cured using Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan.
A man suffered from a tumor in the lower abdomen, with dripping pus and fluid. This is a syndrome of the Foot Three Yin Meridians. He was treated with Bu Zhong Yi Qi Tang added with Ophiopogon Tuber (Mai Dong) and Schisandra Fruit (Wu Wei Zi) to cultivate Spleen Earth, Liu Wei Di Huang Wan to generate Kidney Water, and Lu Hui Wan (Aloe Pill) to clear Liver Fire and astringe.
An old scholar suffered from a tumor on his glabella for three years. Its shape resembled a purple peach drooping to cover the eye, feeling like a water sac upon palpation. This is a Liver-Spleen syndrome, caused by internal ulceration of pus and blood stasis. Blood and pus were punctured and drained, and the eye immediately opened. He was cured using stir-baked black Gentianae Radix, Gardeniae Fructus, Ligusticum Chuanxiong Rhizome (Chuan Xiong), Angelica Sinensis Radix (Dang Gui), Paeonia Lactiflora Radix (Bai Shao), Bupleurum Radix (Chai Hu), Atractylodes Macrocephala Rhizome (Bai Zhu), and Poria (Fu Ling).