薛立斋治一男子，胸患痈，肿高 痛，脉浮而紧，以内托散煎服二剂，表症悉减。以托里消毒散，
四剂而消。
一男子素弱，胸患痈，饮食少而倦，以六君子汤加芎、归、黄 。脓成针之，更以托里药而愈。
薛立斋治一男子，胸患痈， 痛烦躁，发热作渴，脉数而实，时季冬，此热毒内蓄也。须舍时从
症，欲治以内疏黄连汤。彼以时当隆寒，乃杂用败毒药，愈炽。仍求治，投前药二剂，后去二次，诸
症悉退。以金银花散加连翘、山栀，四剂出水而消。大抵症有主末，治有权宜，治其主，则末自退，
用其权，则不拘于时，泥于守常，必致病势危甚。况惯用攻剂，动损各经。故丹溪云∶凡疮发于一经，
只当求责本经，不可干扰余经。罗谦甫曰∶守常者，众人之见；知变者，智者之事。知常而不知变，
细事因而取败者多矣。
一男子胸患毒， 痛怕冷，脉洪数，以黄连解毒汤，二剂顿退。更以金银花散，六剂而消。
一少妇胸膺间溃一窍，脓血与口中所咳相应而出，以参、 、当归，加退热排脓等药而愈。（余
按∶此因肺痿所致。原注。）
张都宪夫人，性刚多怒，胸前作痛，肉色不变，脉数恶寒。经云∶洪数之脉，应发热而反恶寒，
疮疽之谓也。今脉洪数，则脓已成。但体丰浓，故色不变，似乎无脓。以痛极始肯用针，入数寸，脓
出数碗，遂以清热消毒药治之而愈。设泥其色而不用针，无可救之理矣。
（ 按∶肝脉挟胃贯膈，又曰，是所生病者为胸满，故胸之痈疽，本由于肝也。）
杨百户胸患毒，肿高 赤，发热，脉数，大小便涩，饮食如常。齐氏曰∶肿起色赤，寒热疼痛，
皮肤壮热，头目昏重，气血之实也。又云∶大便硬，小便涩，饮食如故，肠满膨胀，胸膈痞闷，肢节
疼痛，身热脉大，精神昏塞，脏腑之实也。遂以黄连内疏汤二剂，诸症渐退。更以荆防败毒散加芩、
连、山栀，四剂少愈。再以四
物加芩、连、白芷、桔梗、甘草、银花，数剂而愈。
一男子胸肿一块，半载不消，令明灸百壮方溃。与大补药不敛，复灸以附子饼而愈。
张路玉治谈仲安，体肥善饮，夏患壮热呕逆，胸膈左畔隐痛，手不可拊，便溺涩数，舌上滑胎，
食后痛呕稠痰，渐见血水，脉来涩涩不调，与凉膈散加石斛、连翘，下稠腻极多。先是医作肺痈治，
不效。张曰∶肺痈必咳嗽，吐腥秽痰，此但呕不嗽，洵为胃病无疑。下后四五日，复呕如前。再以小
剂投之，三十而势甫平。后以保元、苓、橘，平调二十日而痊。先时有李姓者患此，专以清热豁痰解
毒为务，直至膈畔溃腐，脓水淋漓，缠绵匝月而毙。良因见机不早，悔无及矣。
（ 按∶此症最难别白，即《内经》所谓内有裹大脓血之症也。吾乡一名医自患此，同道诊之，
不知为痈也。杂进参、附、丁、桂之剂，久之吐出臭脓乃省，已无及矣。）
薛立斋治疗一名男子，胸部患痈肿，肿胀高突且疼痛，脉象浮而紧。服用内托散煎剂两剂后，表证全部减轻。随后改用托里消毒散，服用四剂后痈肿消散。
另一名男子体质素来虚弱，胸部患痈，饮食减少且感到疲倦。使用六君子汤加川芎、当归、黄芪治疗。脓液形成后用针穿刺排脓，再服用托里药物而痊愈。
薛立斋治疗一名男子，胸部患痈，疼痛烦躁，发热口渴，脉象数而实。当时正值隆冬，这是热毒内蓄所致。应当舍去时令因素而从症状论治，打算用内疏黄连汤治疗。患者因当时正值严寒，反而杂用败毒药物，导致病情更加炽盛。再次求治时，投予前药（内疏黄连汤）两剂，后来去掉大黄、芒硝等泻下药两次，各种症状全部消退。再用金银花散加连翘、山栀，服用四剂后出水而消散。大抵病症有主次之分，治疗有权宜之计，抓住主要矛盾，次要问题自然消退；运用权变之法，就不拘泥于时令，死守常规，必然导致病势危重。况且惯用攻伐之剂，容易损伤各条经络。所以朱丹溪说：凡是疮疡发于一经，只应当追究本经的原因，不可干扰其他经络。罗谦甫说：墨守成规是普通人的见解；懂得变通是智者的行为。知常道却不知变通，因小事而失败的人太多了。
另一名男子胸部患毒，疼痛怕冷，脉象洪数。使用黄连解毒汤，两剂后症状迅速消退。再用金银花散，六剂后消散。
一名少妇胸膺间溃破一个孔窍，流出的脓血与口中咳出的相应而出。用人参、白术、当归，加入退热排脓等药物治疗而痊愈。（我按语：此症是由肺痿引起的。原注。）
张都宪的夫人，性格刚烈易怒，胸前作痛，皮肤颜色不变，脉象数且恶寒。《内经》说：洪数之脉，应当发热却反而恶寒，这是疮疽的表现。现在脉象洪数，说明脓已经形成。只是因为她身体肥胖丰满，所以颜色看不出变化，似乎没有脓。直到疼痛极度剧烈时才肯用针穿刺，刺入数寸，流出脓液数碗，随后用清热消毒药物治疗而痊愈。如果拘泥于肤色不用针，就没有可救的道理了。
（我按语：肝脉挟胃贯穿膈部，又说，该经所生的疾病包括胸满，所以胸部的痈疽，本来是由于肝引起的。）
杨百户胸部患毒，肿胀高突且发红，发热，脉象数，大小便涩滞，饮食如常。齐氏说：肿胀突起、颜色红赤、寒热疼痛、皮肤壮热、头目昏重，这是气血实证。又说：大便硬结、小便涩滞、饮食正常、肠满膨胀、胸膈痞闷、肢节疼痛、身热脉大、精神昏塞，这是脏腑实证。于是用黄连内疏汤两剂，各种症状逐渐消退。再用荆防败毒散加黄芩、黄连、山栀，四剂后稍有好转。接着用四物汤加黄芩、黄连、白芷、桔梗、甘草、银花，服用数剂后痊愈。
一名男子胸部肿块一块，半年不消，命令艾灸一百壮后才溃破。服用大补药后伤口不收敛，又用附子饼灸而痊愈。
张路玉治疗谈仲安，体型肥胖且喜欢饮酒，夏季患高热呕吐逆气，胸膺左侧隐痛，手不能触碰，大小便涩滞频数，舌苔滑腻，食后呕吐稠痰，渐渐出现血水，脉象涩滞不调。给予凉膈散加石斛、连翘，排出大量稠腻之物。起初医生将其作为肺痈治疗，无效。张路玉说：肺痈必定咳嗽，吐出腥臭秽浊的痰，此人只是呕吐而不咳嗽，确认为胃病无疑。泻下后四五日，再次呕吐如前。再用小剂量药物投服，三十日后病势才平息。后来用保元汤、茯苓、陈皮平调二十日而痊愈。先前有个姓李的人患此病，专门以清热豁痰解毒为务，直到膈畔溃烂腐败，脓水淋漓，缠绵一个月而死。确实是因为见机不早，后悔也来不及了。
（我按语：此症最难辨别清楚，就是《内经》所说的体内包裹着大脓血的病症。我们家乡一名医生自己患了此病，同行诊治，不知道是痈。杂进人参、附子、丁香、肉桂等温补药剂，很久之后吐出臭脓才明白，已经来不及救治了。）
Xue Lizhai treated a male patient who suffered from a carbuncle in the chest. The swelling was high and painful, with a floating and tight pulse (Pulse Floating and Tight). After taking two doses of Neituo San (Internal Support Powder) decoction, the exterior symptoms (Exterior Syndrome) completely subsided. Subsequently, using Tuoli Xiaodu San (Support Interior and Eliminate Toxin Powder), four doses resulted in the resolution of the carbuncle.
Another male patient, whose constitution was inherently weak, developed a chest carbuncle. He had reduced appetite and fatigue. He was treated with Liujunzi Tang (Six Gentlemen Decoction) added with Chuanxiong Rhizoma (Chuanxiong), Danggui Radix (Danggui), and Huangqi Radix Astragali Membranacei (Huangqi). Once pus formed, it was lanced with a needle, and he recovered after further treatment with interior-supporting medicines.
Xue Lizhai treated another male patient with a chest carbuncle characterized by painful irritability, fever, thirst, and a rapid and solid pulse (Pulse Rapid and Solid). It was late winter, indicating internal accumulation of heat-toxin. One should set aside seasonal constraints and treat based on symptoms, intending to use Neishu Huanglian Tang (Internal Draining Coptis Decoction). However, due to the severe cold, the patient had indiscriminately used cooling-toxin drugs, exacerbating the condition. Upon seeking treatment again, the aforementioned prescription was administered for two doses; later, the purgative components were removed twice, and all symptoms subsided. Then, Jinyinhua San (Lonicera Powder) added with Lianqiao Fructus Forsythiae (Lianqiao) and Gardeniae Fructus (Shanzhi) was given for four doses, leading to resolution through drainage. Generally, diseases have primary and secondary aspects; treating the primary aspect causes the secondary aspects to recede. Applying flexible strategies means not being bound by seasons or rigid conventions; sticking to routine will inevitably lead to critical conditions. Moreover, habitual use of attacking agents damages the meridians. Thus, Zhu Danxi stated: When sores arise in one meridian, one should seek the cause within that meridian and not interfere with others. Luo Qianfu said: Adhering to convention is the view of the masses; knowing how to vary is the act of the wise. Knowing the constant but not knowing how to vary leads many to failure over minor matters.
Another male patient suffered from chest toxicity with pain, aversion to cold, and a surging and rapid pulse (Pulse Surging and Rapid). Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) was administered for two doses, causing immediate relief. Subsequently, Jinyinhua San was given for six doses until resolution.
A young woman had an ulcerated opening between her chest and diaphragm, discharging pus and blood corresponding to what she coughed up. She was treated with Renshen Radix Ginseng (Renshen), Baizhu Rhizoma Atractylodis Macrocephalae (Baizhu), Danggui Radix (Danggui), plus antipyretic and pus-draining herbs, resulting in recovery. (My note: This condition was caused by Fei Wei [Flaccidity Disease of the Lung]. Original annotation.)
Madam Zhang, wife of Commissioner Zhang, had a stern and irritable temperament. She experienced pain in the front of her chest, unchanged skin color, a rapid pulse, and aversion to cold. The Classic states: A surging and rapid pulse usually corresponds to fever; if there is aversion to cold instead, it indicates Chuang Ju (sores and ulcers). Since the pulse is surging and rapid, pus has already formed. However, because she was obese, the color did not change, suggesting no pus. Only when the pain became extreme did she consent to needling; several inches were inserted, draining bowls of pus. She was then cured with heat-clearing and detoxifying medicines. If one had stuck to the appearance of the skin and avoided needling, there would have been no hope for rescue.
(My note: The Liver Meridian passes through the stomach and pierces the diaphragm. It is also said that diseases generated by this meridian include chest fullness. Therefore, chest carbuncles and ulcers originate from the Liver.)
Military Officer Yang suffered from chest toxicity with high, red swelling, fever, a rapid pulse, and difficult urination and defecation, while his diet remained normal. Qi Shi stated: Swelling rising with red color, chills and fever, pain, hot skin, and heavy/dizzy head and eyes indicate excess of Qi and Blood. He also said: Hard stool, difficult urination, normal diet, abdominal distension, chest oppression, limb/joint pain, body heat, large pulse, and mental confusion indicate excess in the Zang-Fu organs. Thus, Huanglian Neishu Tang was given for two doses, gradually reducing symptoms. Then, Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Defeat Pathogens) added with Huangqin Radix Scutellariae (Huangqin), Huanglian Rhizoma Coptidis (Huanglian), and Shanzhi was given for four doses, showing slight improvement. Finally, Siwu Tang (Four Substance Decoction) added with Huangqin, Huanglian, Baizhis Radix Angelicae Dahuricae (Baizhi), Jiegeng Radix Platycodonis (Jiegeng), Gancao Radix Glycyrrhizae (Gancao), and Yinhua Flos Lonicerae Japonicae (Yinhua) was given for several doses until recovery.
A male patient had a chest lump that did not resolve for half a year. He was instructed to undergo moxibustion for one hundred burns before it could suppurate. Large tonifying medicines failed to close the wound, but he recovered after moxibustion with Fuzi Bing (Aconite Cake).
Zhang Luyu treated Tan Zhongan, who was obese and fond of drinking. In summer, he suffered from severe fever, vomiting, and retching, with dull pain on the left side of the chest/diaphragm, intolerable to touch, difficult and frequent urination/defecation, slippery tongue coating, vomiting thick phlegm after eating, and eventually bloody fluid. The pulse was choppy and irregular. Liangge San (Cool the Epigastrium Powder) added with Shihu Dendrobii Caulis (Shihu) and Lianqiao was prescribed, expelling much thick greasy material. Initially, other doctors treated him as Fei Yong (Lung Carbuncle) without effect. Zhang said: Lung Carbuncle must involve coughing and expectoration of foul-smelling sputum. This patient only vomited and did not cough, undoubtedly indicating Stomach disease. Four or five days after purgation, vomiting recurred. A small dose was administered again, and the condition stabilized after thirty doses. Later, Baoyuan Tang (Preserve the Origin Decoction), Fuling Sclerotium Poriae (Fuling), and Chenpi Pericarpium Citri Reticulatae (Chenpi) were used to harmonize for twenty days until cure. Previously, a Mr. Li suffered from this condition, focusing solely on clearing heat, resolving phlegm, and detoxifying. Eventually, the diaphragmatic area ulcerated and腐rotted, with dripping pus, lingering for a month before death. Indeed, failing to recognize the opportunity early led to irreparable regret.
(My note: This condition is hardest to distinguish clearly, corresponding to the Nei Jing's description of "internal wrapping of large amounts of pus and blood." A famous doctor in my hometown suffered from this himself. Colleagues diagnosed him but did not recognize it as a carbuncle. They indiscriminately administered Renshen, Fuzi Radix Aconiti Lateralis Preparata (Fuzi), Dingxiang Flos Syzygii Aromatici (Ding), and Rougu Cortex Cinnamomi (Rougui). Only after spitting out foul-smelling pus long afterward did he realize the truth, but it was too late.)