或问∶喉之两旁生疽何如？曰∶此名夹疽，属手少阴心经、足太阴脾经、足厥阴肝
火热毒上攻而然。宜琥珀犀角膏、犀角散、黄连消毒饮、活命饮、加玄参、桔梗、黄连。溃
内者难治，虚火上升，痰壅饮食不进者死。
《灵枢》云∶痈发于嗌中，名曰猛疽。猛疽不治，化为脓，脓不泻塞咽，半日死。其
化为脓者泻，则合豕膏冷食，三日而已。或问∶当结喉生痈何如？曰∶是名喉痈，又
名猛疽。以其势毒猛烈可畏也，属任脉、及手太阳、手少阴经，积热忧愤所致。急宜清
热攻毒，用琥珀犀角膏、及黄连消毒饮、紫金丹、乌金散选用，壮实者，一粒金丹下之。
若过时不治，溃穿咽嗌者死。
（结核连续者，为瘰 。形长如蛤者，为马刀。一云，瘰 者，结核是也。或在耳后耳前，或在耳下连
及颐颔，或在颈下连缺盆，皆谓之瘰 。或在胸及胸之侧，或在两胁，皆谓之马刀。手足少阳主之。）
《集验》云∶夫瘰 疮者，有风毒、热毒、气毒之异；瘰 、结核，寒热之殊。其证皆
由忿怒、气逆、忧思过甚，风热邪气内搏于肝经。盖怒伤肝，肝主筋，故令筋缩结蓄而
肿也。其候多生于颈项、胸腋之间，结聚成核，初如豆粒，后若梅李，累累相连，大小
无定。初觉憎寒壮热，咽项强痛，肿结不消者，盒饭服散肿溃坚汤，或五香连翘、漏芦
汤之类散之。或用牡蛎大黄汤，疏利三两行，疮上可用十香膏之类贴之，及诸淋洗、敷贴
等药治之，庶得消散。若不散，可用内消丸之类消之，或隔蒜灸之。仍断欲、息气、薄
滋味调理之。不然，恐日久变生寒热咳嗽而成劳瘵之疾，不可治矣。又有马刀疮，亦生
于项腋之间，有类瘰 。但初起其状如马刀，赤色如火烧烙极痛，此疮甚猛，宜急治之，不
然多成危殆也，临证辨之。
丹溪云∶夫瘰 初发，必起于少阳经，不守禁戒，必延及阳明经。大抵食味之浓，郁
气之积，曰毒，曰风，曰热，皆此二端，招引变换，须分虚实。彼实者固易治，自非痛
断浓味与发气之物，虽易亦难，殊为可虑，以其属胆经，主决断，有相火而且气多血少。妇
人见此，若月经行不作寒热可生，稍久转为潮热，其证危矣。自非断欲，绝虑，食淡，虽
神圣不可治也。
戴复庵云∶瘰 之病，皆血气壅结，根在脏腑，多结于颈项之间，累累大小，无定
发作，寒热，脓血，溃烂，或此没而彼起，宜于隔宿，用米饮调下桂府滑石二钱盅，动时
进黑白散，必有物如葡萄肉，从小便出至数枚，其肿核则愈。仍常服四七汤加木香，或
苏子降气汤，其匝颈者，俗名蟠蛇 难治。
薛新甫云∶瘰 之病，属三焦肝胆二经，怒火，风热，血燥，或肝肾二经精血亏损，虚
火内动，或恚怒，气逆，忧思过甚，风热邪气内搏于肝。盖怒伤肝，肝主筋，肝受病，则
筋累累然如贯珠也。其候多生于耳前后、项腋间，结聚成核。初觉憎寒恶热，咽项强痛。
若寒热 痛者，此肝火风热而气病也，用小柴胡汤以清肝火，并服加味四物汤以养肝血。
若寒热既止而核不消散者，此肝经火燥而血病也，用加味逍遥散以清肝火，六味地黄丸
以生肾水。若肿高而稍软，面色痿黄，皮肤壮热，脓已成也，可用针以决之，及服托里
之剂。若经久不愈，或愈而复发，脓水淋漓，肌体羸瘦者，必纯补之剂，庶可收敛，否则
变成九 。《内经》曰∶陷脉为 ，留连肉腠。即此病也。外用豆豉饼、琥珀膏以驱散寒邪，
补接阳气，内服补中益气汤、六味丸以滋肾水、培肝木、健脾土，亦有可愈者。大抵肝
胆部分结核，不问大小，其脉左关弦紧，左尺洪数者，乃肾水不能生肝木，以致肝火燥
而筋挛，须用前药以滋化源，是治其本也。《外台秘要》云∶肝肾虚热，则生 。《病
机》云∶瘰 不系膏粱丹毒火热之变，因虚劳气郁所致，止宜补形气，调经脉，其疮自
消散。盖不待汗之、下之而已也。其不详脉证经络受病之异者，下之则犯经禁、病禁，虚
虚之祸，如指诸掌。若脉洪大，元气虚败，为不治。若面 白，为金克木，亦不治。若眼
内赤脉贯瞳人，见几条则几年死。使不从本而治，妄用伐肝之剂则误矣。盖伐肝则脾土
先伤，脾伤则损五脏之源矣，可不慎哉。按∶《脉经》云∶人年五六十，其脉浮大者，痹侠
背行，苦肠鸣、马刀、侠瘿者，皆为劳得之。可见瘰 之证，多起于虚也。薛氏之论，可
为典要。故详着之。
〔治疗次第〕
初觉憎寒壮热，咽项强痛，肿结不消者，以羌活连翘汤，又宜长服消 丸。却以棱针
刺破出血，以拔毒汤热淋洗，一日洗五七次，针五七次，放蟾酥末少许于针处上，以琥珀
膏贴之，更以内消膏贴之，久久自然而消也。如不散者，用铁筒拔毒膏点破，次以下品锭
子取去恶肉，可作溃疡治之，用十宣散之类托里。若毒攻心呕吐者，用粉乳托里散发出
毒，此要兼针灸法同施。若已溃不愈者，宜益气养荣汤，八物汤加柴胡、地骨皮、夏枯
草、香附子、贝母多服取效。凡用锭子药线，必用托里之剂服之。 赤肿痛，脉沉数者，
邪气实也，宜泄之，以化毒消肿和里散，加减。肿痛憎寒发热，或拘急，脉浮数者，邪
在表也，宜散表，以荆防败毒散加减。因怒结核，或肿痛，或发热者，宜疏肝行气，以
小柴胡汤加青皮、青木香、红花、桃仁。肿硬不溃者，宜补气血，以益气养荣汤。
抑郁所致者，解郁结，调气血，以益气养荣汤。溃后不敛者，属气血俱虚，宜大补，以
益气养荣汤，次用十全大补汤加香附子、贝母、远志。 虚劳所致者，宜补之，先以补
中益气汤，次以益气养荣汤加减。 因有核，溃而不敛者，腐而补之，以针头散腐之；以
益气养荣汤补之。 脉实而不敛，或不消者下之，以羌活连翘汤。 肿痛发寒热，大便
秘，以羌活连翘汤，次以神仙活命饮。 耳下结核肿痛，发寒热，宜荆防败毒散，表证
悉退，以散肿溃坚汤。 溃后核不腐，以益气养荣汤，更敷针头散腐之。 肿硬久不消，
亦不作脓，服散坚败毒药不应。宜灸肘尖、肩尖、服益气养荣汤而消。 气血壮实之人，脉
沉实而大者，亦不觉损，方可进必效散、遇仙无比丸下其毒。若其毒一下，即止二药，更
服益气养荣汤调理。 疮口不敛，宜用豆豉饼灸之。以琥珀膏、十香膏贴之。 溃后发
热，烦躁作渴，脉大无力，此血虚也，宜以当归补血汤，次以圣愈汤，再八物汤加贝母、
远志。 每劳心过度，颈肿发热，服败毒药愈甚，以补中益气汤数剂而消。
〔治验〕
阁老，杨石斋子，年十七，发热作渴，日晡颊赤，左关尺脉大而浮，此肝肾阴虚，用
补阴八珍汤五十余剂，又加参 二十余剂而溃。但脓水清稀，肌肉不生，乃以参、 、归、
术为主，佐以芍药、熟地、麦门、五味，脓水稠而肌肉生。更服必效散一剂， 毒去而
疮口敛。 容台张美之，善怒，孟春患此。或用伐肝之剂不愈，余以为肝血不足，用六味
地黄丸、补中益气汤，以滋化源，至季冬而愈。 一儒者，愈后体瘦，发热昼夜无定，此
足三阴气血俱虚，用八珍加麦门、五味二十余剂，又用补中益气加麦门、五味，及六味
丸而愈。 儒者张子容，素善怒，患此久而不愈。疮出鲜血，左关弦洪，重按如无，此
肝火动而血妄行，证属气血俱虚，用补中益气汤，以补脾肺，用六味丸以滋肾肝而愈。
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
益气养荣汤六十余剂，元气已复，患处已消，一核尚存，以必效散二服而平。 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，以龙荟、散坚二丸
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。 一人因怒，耳下及缺盆患 ，溃延腋下，形气颇实，疮口不合，治
以散肿溃坚丸而愈。 一人因劳而患，怠惰发热，脉洪大按之无力，宜用补中益气汤。彼
不信，辄服攻伐之剂，吐泻不止而死。 大抵此证原属虚损，若不审虚实而犯病禁、经
禁，鲜有不误。常治先以调经解郁，更以隔蒜灸之多自消。如不消即以琥珀膏贴之，候
有脓则针之，否则发生他证，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
余不应，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。然此证以气血为主，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
贯瞳人者亦不治。一脉者一年死，二脉者二年死。 一人患之，痰盛胸膈痞闷，脾胃脉
弦，此脾土虚，肝木乘之也，当实脾土，伐肝木为主。彼以治痰为先，乃服苦寒化痰药，
不应。又加破气药，病愈甚，始用六君子汤加芎归数剂，饮食少思，以补中益气汤倍加
白术月余，中气少健，又以益气养荣汤四月，肿消而血气亦复矣。夫右关脉弦，弦属木，乃
木盛而克脾土为贼邪也，虚而用苦寒之剂，是虚虚也。况痰之为病，其因不一，主治之法
不同，凡治痰，利药过多则脾气愈虚，虚则痰愈易生，如中气不足，必用参术之类为主，
佐以痰药。 一人久而不敛，神思困倦，脉虚，予欲投以托里，彼以为迂。乃服散肿溃
坚汤半月余，果发热，饮食愈少，复求治。投益气养荣汤三月，喜其谨守，得以收救。齐
氏曰∶结核瘰 初觉宜内消之。如经久不除，气血渐衰，肌寒肉冷，或脓汗清稀，毒瓦斯不
出，疮口不合，聚肿不赤，结核无脓，外证不明者，并宜托里。脓未成者，使脓早成；脓
已溃者，使新肉早生。血气虚者，托里补之，阴阳不和，托里调之。大抵托里之法，使疮
无变坏之证，所以宜用也。
一妇患瘰 ，延至胸腋，脓水淋漓，日久五心烦热，肢体疼痛，头目昏重，心忪颊
赤，口干咽燥，发热盗汗，食少嗜卧，月水不调，脐腹作痛，予谓血虚而然，非 故也。
服逍遥散月余少可，更服八珍汤加牡丹皮、香附子，又月余而经通，再加黄 、白蔹两月
余而愈。 一妇久患瘰 不消，自汗恶寒，此血气俱虚，服十全大补汤，月余而溃。然坚
核难取，疮口不敛，灸以豆豉饼，仍与前药加香附、乌药，两月而愈。 一妇 溃后，发
热，烦躁作渴，脉大无力，此血虚也，以当归补血汤六剂顿退，又以圣愈汤数剂少健，加
以八珍汤加贝母、远志，三十余剂而敛。一妇溃后，核不腐，以益气养荣汤三十余剂，
更敷针头散腐之，再与前汤三十余剂而敛。一妇久溃发热，月经过期且少，用逍遥散兼
前汤两月余，气血复而疮亦愈，但一口不收，敷针头散，更灸前穴而痊。 一妇肝经积热，
患而作痛，脉沉数，以射干连翘汤四剂少愈，更用散肿溃坚丸月余而消。 一妇瘰 ，与
养气顺血药不应，服神效栝蒌散二剂顿退，又六剂而消。却与托里药，气血平复而愈。
一妇年逾三十，瘰 已溃不愈，与八珍汤加柴胡、地骨皮、夏枯草、香附、贝母，五十
余剂，形气渐转，更与必效散二服，疮口遂合。惟血气未平，再用前药三十余剂而平。
一妇瘰 不消，脓清不敛，用八珍汤少愈，忽肩背痛不能回顾，此膀胱经气郁所致，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；
继以防风通气二剂而愈。 一女年十七，患瘰 久不愈，月水尚未通，发热咳嗽，饮食
少思，老妪欲用巴豆、肉桂之类，先通其经。予谓∶此证潮热经候不调者，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。 一妇人，瘰 久不愈，或以木旺之证，用散肿溃坚汤伐之，肿硬益甚，
薛以为肝经气血亏损，当滋化源，用六味地黄丸、补中益气汤，至春而愈。此证若肝经
风火暴病，元气无亏，宜用前汤。若风木旺而自病，宜用泻青丸，虚者用地黄丸。若水
不能生木，亦用此丸。若金来克木，宜补脾
土，生肾水。大凡风木之病，壮脾土则木自不能克矣。若行伐肝，则脾胃先伤，而木反
克土矣。 一妇患之，恐不起，致少寐年余， 破脓水淋漓，经水或五十日、或两月余一
至，误服通经丸，展转无寐，午前恶寒，午后发热。薛以为思虑亏损脾血，用归脾汤作
丸，午前以六君送下，午后以逍遥送下，两月余得寐，半载后经行如期，年余疮愈。
问：喉部两侧发生疽疮是怎么回事？答：这称为夹疽，属于手少阴心经、足太阴脾经、足厥阴肝经的火热毒邪上攻所致。适宜使用琥珀犀角膏、犀角散、黄连消毒饮、活命饮（加玄参、桔梗、黄连）。若溃烂深入体内者难治，若是虚火上升、痰涎壅盛导致饮食不进者则预后不良，多致死亡。
《灵枢》说：痈发生在咽喉中间，名叫猛疽。猛疽若不治疗，化脓后脓液不排出堵塞咽喉，半天内就会死亡。如果已经化脓，应排脓，然后配合食用猪脂膏并冷服，三天即可痊愈。问：在结喉部位发生痈疮是怎么回事？答：这叫喉痈，也叫猛疽。因为其病势毒烈可怕，属于任脉及手太阳、手少阴经，由积热和忧愤引起。急需清热攻毒，选用琥珀犀角膏、黄连消毒饮、紫金丹、乌金散等；体质壮实者，可用一粒金丹泻下。如果延误时机不治疗，溃烂穿透咽喉者会死亡。
（结核连续不断的，称为瘰疬。形状长如蛤蜊的，称为马刀。另一种说法，瘰疬就是结核。有的在耳后耳前，有的在耳下连及面颊下颌，有的在颈下连及锁骨上窝，都叫作瘰疬。有的在胸部及胸侧，有的在两胁，都叫作马刀。这些病症由手足少阳经主治。）
《集验方》说：瘰疬疮，有风毒、热毒、气毒的不同；瘰疬和结核，有寒证和热证的差异。其症状都是由愤怒、气逆、过度忧思，导致风热邪气内搏于肝经引起的。因为怒伤肝，肝主筋，所以导致筋脉收缩结聚而肿胀。其表现多生于颈部、胸腋之间，结聚成核，初起像豆粒，后来像梅子李子，累累相连，大小不定。初起时感觉怕冷高热，咽项强痛，肿结不消的，应当服用散肿溃坚汤，或五香连翘汤、漏芦汤之类来消散。或者用牡蛎大黄汤，疏利三焦，疮上可用十香膏之类贴敷，以及诸淋洗、敷贴等药物治疗，庶几可以消散。如果不消散，可用内消丸之类来消除，或隔蒜灸之。同时节制房事、平息怒气、清淡饮食来调理。否则，恐怕日久变生寒热咳嗽而成劳瘵之疾，就无法治愈了。又有马刀疮，也生于项腋之间，类似瘰疬。但初起时形状像马刀，赤色如火烧烙般极痛，此疮非常猛烈，宜急治，否则多成危殆之症，临证需仔细辨别。
朱丹溪说：瘰疬初发，必起于少阳经，若不遵守禁忌，必延及阳明经。大抵由于饮食厚味、郁积之气，称为毒、风、热，皆由这两端招引变换，必须分虚实。实证固然容易治，如果不是彻底断绝浓味与动气之物，虽然易治也难，非常值得忧虑，因为它属胆经，主决断，有相火而且气多血少。妇女见此病，若月经行而不出现寒热可生，稍久转为潮热，病情就危险了。若不是断欲、绝虑、食淡，即使是神医也难以治愈。
戴复庵说：瘰疬之病，都是血气壅结，根在脏腑，多结于颈项之间，累累大小不定，发作时有寒热、脓血、溃烂，或此处消失彼处又起，宜于隔夜，用米饮调服桂府滑石二钱，发作时进服黑白散，必有物如葡萄肉样，从小便排出数枚，其肿核则愈。仍常服四七汤加木香，或苏子降气汤，环绕颈部的，俗名蟠蛇疬，难治。
薛新甫说：瘰疬之病，属三焦、肝胆二经，因怒火、风热、血燥，或肝肾二经精血亏损，虚火内动，或恚怒、气逆、忧思过甚，风热邪气内搏于肝。因为怒伤肝，肝主筋，肝受病，则筋脉累累然如贯珠。其表现多生于耳前后、项腋间，结聚成核。初起时感觉憎寒恶热，咽项强痛。若寒热疼痛的，这是肝火风热而气病，用小柴胡汤以清肝火，并服加味四物汤以养肝血。若寒热既止而核不消散的，这是肝经火燥而血病，用加味逍遥散以清肝火，六味地黄丸以生肾水。若肿高而稍软，面色萎黄，皮肤壮热，脓已成的，可用针穿刺，并服托里之剂。若经久不愈，或愈而复发，脓水淋漓，肌体消瘦的，必用纯补之剂，庶可收敛，否则变成九漏。《内经》说：陷脉为漏，留连肉腠。就是这个病。外用豆豉饼、琥珀膏以驱散寒邪，补接阳气，内服补中益气汤、六味丸以滋肾水、培肝木、健脾土，也有可愈的。大抵肝胆部分结核，不问大小，其脉左关弦紧，左尺洪数的，是肾水不能生肝木，以致肝火燥而筋挛，须用前药以滋化源，这是治本。《外台秘要》说：肝肾虚热，则生漏。《病机》说：瘰疬不系膏粱丹毒火热之变，因虚劳气郁所致，只宜补形气，调经脉，其疮自消散。大概不需要发汗、泻下。那些不详察脉证经络受病差异的，误用泻下则犯经禁、病禁，造成虚虚之祸，如同指掌般明显。若脉洪大，元气虚败，为不治。若面色㿠白，为金克木，也不治。若眼内赤脉贯瞳人，见几条则几年死。如果不从本而治，妄用伐肝之剂则误矣。因为伐肝则脾土先伤，脾伤则损五脏之源，可不谨慎吗？按：《脉经》说：人年五六十，其脉浮大的，痹侠背行，苦肠鸣、马刀、侠瘿者，皆为劳得之。可见瘰疬之证，多起于虚。薛氏之论，可为典要。故详细记载。
〔治疗次第〕
初起感觉憎寒壮热，咽项强痛，肿结不消的，用羌活连翘汤，又宜长期服用消核丸。然后用棱针刺破出血，以拔毒汤热淋洗，一日洗五七次，针五七次，放少许蟾酥末于针处上，以琥珀膏贴之，更以内消膏贴之，久久自然消除。如不散者，用铁筒拔毒膏点破，次以下品锭子取去恶肉，可按溃疡治疗，用十宣散之类托里。若毒攻心呕吐的，用粉乳托里散发出毒，这需要兼针灸法同施。若已溃不愈的，宜益气养荣汤，八物汤加柴胡、地骨皮、夏枯草、香附子、贝母多服取效。凡用锭子药线，必用托里之剂服之。红肿热痛，脉沉数的，邪气实也，宜泄之，以化毒消肿和里散加减。肿痛憎寒发热，或拘急，脉浮数的，邪在表也，宜散表，以荆防败毒散加减。因怒结核，或肿痛，或发热者，宜疏肝行气，以小柴胡汤加青皮、青木香、红花、桃仁。肿硬不溃者，宜补气血，以益气养荣汤。抑郁所致者，解郁结，调气血，以益气养荣汤。溃后不敛者，属气血俱虚，宜大补，以益气养荣汤，次用十全大补汤加香附子、贝母、远志。虚劳所致者，宜补之，先以补中益气汤，次以益气养荣汤加减。因有核，溃而不敛者，腐而补之，以针头散腐之；以益气养荣汤补之。脉实而不敛，或不消者下之，以羌活连翘汤。肿痛发寒热，大便秘，以羌活连翘汤，次以神仙活命饮。耳下结核肿痛，发寒热，宜荆防败毒散，表证悉退，以散肿溃坚汤。溃后核不腐，以益气养荣汤，更敷针头散腐之。肿硬久不消，亦不作脓，服散坚败毒药不应。宜灸肘尖、肩尖、服益气养荣汤而消。气血壮实之人，脉沉实而大者，亦不觉损，方可进必效散、遇仙无比丸下其毒。若其毒一下，即止二药，更服益气养荣汤调理。疮口不敛，宜用豆豉饼灸之。以琥珀膏、十香膏贴之。溃后发热，烦躁作渴，脉大无力，此血虚也，宜以当归补血汤，次以圣愈汤，再八物汤加贝母、远志。每劳心过度，颈肿发热，服败毒药愈甚，以补中益气汤数剂而消。
〔治验〕
阁老杨石斋之子，年十七，发热作渴，日晡颊赤，左关尺脉大而浮，此为肝肾阴虚，用补阴八珍汤五十余剂，又加人参、黄芪二十余剂而溃。但脓水清稀，肌肉不生，乃以人参、黄芪、当归、白术为主，佐以芍药、熟地、麦门冬、五味子，脓水稠而肌肉生。更服必效散一剂，毒去而疮口敛。
容台张美之，善怒，孟春患此。或用伐肝之剂不愈，余以为肝血不足，用六味地黄丸、补中益气汤，以滋化源，至季冬而愈。
一儒者，愈后体瘦，发热昼夜无定，此足三阴气血俱虚，用八珍加麦门冬、五味子二十余剂，又用补中益气加麦门冬、五味子，及六味丸而愈。
儒者张子容，素善怒，患此久而不愈。疮出鲜血，左关弦洪，重按如无，此肝火动而血妄行，证属气血俱虚，用补中益气汤，以补脾肺，用六味丸以滋肾肝而愈。
一人耳下患五枚如贯珠，年许尚硬，面色萎黄，饮食不甘，劳而发热，脉数软而涩，以益气养荣汤六十余剂，元气已复，患处已消，一核尚存，以必效散二服而平。
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，以龙荟丸、散坚二丸治之将愈，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。
一人因怒，耳下及缺盆患瘰疬，溃延腋下，形气颇实，疮口不合，治以散肿溃坚丸而愈。
一人因劳而患，怠惰发热，脉洪大按之无力，宜用补中益气汤。彼不信，辄服攻伐之剂，吐泻不止而死。
大抵此证原属虚损，若不审虚实而犯病禁、经禁，鲜有不误。常治先以调经解郁，更以隔蒜灸之多自消。如不消即以琥珀膏贴之，候有脓则针之，否则发生他证，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，至月余不应，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。然此证以气血为主，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，眼内有赤脉贯瞳人者亦不治。一脉者一年死，二脉者二年死。
一人患之，痰盛胸膈痞闷，脾胃脉弦，此脾土虚，肝木乘之也，当实脾土，伐肝木为主。彼以治痰为先，乃服苦寒化痰药，不应。又加破气药，病愈甚，始用六君子汤加芎归数剂，饮食少思，以补中益气汤倍加白术月余，中气少健，又以益气养荣汤四月，肿消而血气亦复矣。夫右关脉弦，弦属木，乃木盛而克脾土为贼邪也，虚而用苦寒之剂，是虚虚也。况痰之为病，其因不一，主治之法不同，凡治痰，利药过多则脾气愈虚，虚则痰愈易生，如中气不足，必用参术之类为主，佐以痰药。
一人久而不敛，神思困倦，脉虚，予欲投以托里，彼以为迂。乃服散肿溃坚汤半月余，果发热，饮食愈少，复求治。投益气养荣汤三月，喜其谨守，得以收救。齐氏曰：结核瘰疬初觉宜内消之。如经久不除，气血渐衰，肌寒肉冷，或脓汗清稀，毒瓦斯不出，疮口不合，聚肿不赤，结核无脓，外证不明者，并宜托里。脓未成者，使脓早成；脓已溃者，使新肉早生。血气虚者，托里补之，阴阳不和，托里调之。大抵托里之法，使疮无变坏之证，所以宜用也。
一妇患瘰疬，延至胸腋，脓水淋漓，日久五心烦热，肢体疼痛，头目昏重，心忪颊赤，口干咽燥，发热盗汗，食少嗜卧，月水不调，脐腹作痛，予谓血虚而然，非瘰疬故也。服逍遥散月余少可，更服八珍汤加牡丹皮、香附子，又月余而经通，再加黄芪、白蔹两月余而愈。
一妇久患瘰疬不消，自汗恶寒，此血气俱虚，服十全大补汤，月余而溃。然坚核难取，疮口不敛，灸以豆豉饼，仍与前药加香附、乌药，两月而愈。
一妇瘰疬溃后，发热，烦躁作渴，脉大无力，此血虚也，以当归补血汤六剂顿退，又以圣愈汤数剂少健，加以八珍汤加贝母、远志，三十余剂而敛。
一妇溃后，核不腐，以益气养荣汤三十余剂，更敷针头散腐之，再与前汤三十余剂而敛。
一妇久溃发热，月经过期且少，用逍遥散兼前汤两月余，气血复而疮亦愈，但一口不收，敷针头散，更灸前穴而痊。
一妇肝经积热，患而作痛，脉沉数，以射干连翘汤四剂少愈，更用散肿溃坚丸月余而消。
一妇瘰疬，与养气顺血药不应，服神效栝蒌散二剂顿退，又六剂而消。却与托里药，气血平复而愈。
一妇年逾三十，瘰疬已溃不愈，与八珍汤加柴胡、地骨皮、夏枯草、香附、贝母，五十余剂，形气渐转，更与必效散二服，疮口遂合。惟血气未平，再用前药三十余剂而平。
一妇瘰疬不消，脓清不敛，用八珍汤少愈，忽肩背痛不能回顾，此膀胱经气郁所致，当服防风通气汤。彼云瘰疬胆经病也，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；继以防风通气二剂而愈。
一女年十七，患瘰疬久不愈，月水尚未通，发热咳嗽，饮食少思，老妪欲用巴豆、肉桂之类，先通其经。予谓：此证潮热经候不调者，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。
一妇人，瘰疬久不愈，或以木旺之证，用散肿溃坚汤伐之，肿硬益甚，薛以为肝经气血亏损，当滋化源，用六味地黄丸、补中益气汤，至春而愈。此证若肝经风火暴病，元气无亏，宜用前汤。若风木旺而自病，宜用泻青丸，虚者用地黄丸。若水不能生木，亦用此丸。若金来克木，宜补脾土，生肾水。大凡风木之病，壮脾土则木自不能克矣。若行伐肝，则脾胃先伤，而木反克土矣。
一妇患之，恐不起，致少寐年余，瘰疬破脓水淋漓，经水或五十日、或两月余一至，误服通经丸，展转无寐，午前恶寒，午后发热。薛以为思虑亏损脾血，用归脾汤作丸，午前以六君送下，午后以逍遥送下，两月余得寐，半载后经行如期，年余疮愈。
Q: What is the condition of carbuncles occurring on both sides of the throat? A: This is called "Jia Ju" (Clasping Carbuncle), caused by the upward attack of fire-heat and toxic pathogens from the Hand-Shaoyin Heart Meridian, Foot-Taiyin Spleen Meridian, and Foot-Jueyin Liver Meridian. It is appropriate to use Hupo Xijiao Gao (Amber and Rhinoceros Horn Ointment), Xijiao San (Rhinoceros Horn Powder), Huanglian Xiaodu Yin (Coptis Decoction for Eliminating Toxins), Huoming Yin (Decoction for Living Life), or add Xuanshen (Scrophulariae Radix), Jiegeng (Platycodonis Radix), and Huanglian (Coptidis Rhizoma) to the formula. If it ulcerates internally, it is difficult to treat; if deficiency-fire rises and phlegm obstructs causing inability to eat or drink, death ensues.
The *Ling Shu* states: An abscess occurring in the middle of the pharynx is called "Meng Ju" (Fierce Carbuncle). If Meng Ju is not treated, it turns into pus. If the pus is not drained and blocks the pharynx, death occurs within half a day. If it has turned into pus, drain it, then have the patient consume Shi Gao (Pig Fat) while cold; recovery occurs in three days. Q: What is the condition of an abscess occurring at the Jiehou (Adam's Apple)? A: This is called Hou Yong (Throat Abscess), also known as Meng Ju. Because its pathogenic force is fierce and terrifying, it belongs to the Ren Mai (Conception Vessel) and the Hand-Taiyang and Hand-Shaoyin meridians, caused by accumulated heat and resentment/anger. Urgent treatment requires clearing heat and attacking toxins, using Hupo Xijiao Gao, Huanglian Xiaodu Yin, Zijin Dan (Purple Gold Pill), or Wujin San (Black Gold Powder) as selected; for robust individuals, Yili Jin Dan (One Pill Golden Pill) can be used to purge downwards. If treatment is delayed and it ulcerates through the pharynx, death ensues.
(Continuous tubercles are called Luoli (Scrofula). Those shaped long like clams are called Madao (Hatchet-shaped Scrofula). Another view states that Luoli refers to tubercles. They may occur behind or in front of the ears, below the ears connecting to the jaw/chin, or below the neck connecting to the supraclavicular fossa, all referred to as Luoli. They may occur in the chest and lateral chest, or in the hypochondrium, all referred to as Madao. These conditions are governed by the Hand-Shaoyang and Foot-Shaoyang meridians.)
The *Ji Yan Fang* states: Luoli sores differ in having wind-toxin, heat-toxin, or qi-toxin; Luoli and tubercles differ in cold and heat syndromes. The symptoms are all caused by anger, rebellious qi, and excessive worry/thought, leading to wind-heat pathogens clashing internally with the Liver Meridian. Anger injures the Liver; the Liver governs sinews, thus causing sinew contraction, accumulation, and swelling. The manifestations mostly occur between the neck and axilla, forming nodules. Initially like bean grains, later like plums or apricots, connected in clusters, with indeterminate size. At the onset, feeling aversion to cold and high fever, stiffness and pain in the throat and neck, with non-resolving swelling and nodules, one should take Sanzhong Kuijian Tang (Decoction for Dispersing Swelling and Hardening) or similar formulas like Wuxiang Lianqiao Tang (Five-Spice Forsythia Decoction) or Loulu Tang (Rhubarb and Euphorbia Decoction) to disperse them. Alternatively, use Muli Dahuang Tang (Oyster Shell and Rhubarb Decoction) to unblock and promote movement three times; apply Shixiang Gao (Ten-Fragrance Ointment) to the sore, along with various washing and poultice treatments, hoping for resolution. If it does not resolve, use Neixiao Wan (Internal Resolution Pill) to eliminate it, or apply Ai Jiu (Moxibustion with Garlic Partition). Also, abstain from sexual desire, calm the mind, and maintain a bland diet for conditioning. Otherwise, fear that over time it will transform into cold/heat coughs and become Lao Zhai (Consumption disease), which is incurable. There is also Madao Chuang (Hatchet Sores), also occurring between the neck and axilla, resembling Luoli. But initially, the shape resembles a hatchet, red like fire burning, extremely painful. This sore is very fierce and requires urgent treatment; otherwise, it often becomes critical. Differentiate carefully in clinical practice.
Danxi stated: Luoli initially originates in the Shaoyang Meridian. If prohibitions are not observed, it inevitably extends to the Yangming Meridian. Generally, rich flavors and accumulated stagnant qi constitute toxin, wind, and heat, all induced by these two factors, requiring differentiation of excess and deficiency. Excess patterns are indeed easier to treat, but unless one strictly avoids rich foods and qi-aggravating substances, even easy cases are difficult, which is worrying because it belongs to the Gallbladder Meridian, governing decision-making, possessing Ministerial Fire, and having abundant Qi but scarce Blood. In women, if menstruation flows without chills/fever, there is hope; if it slowly transforms into tidal fever, the condition is critical. Unless one abstains from desire, eliminates worries, and eats blandly, even divine healers cannot cure it.
Dai Fu'an stated: Luoli disease involves stagnation and knotting of Qi and Blood, rooted in the Zang-Fu organs, mostly knotting between the neck and shoulders, varying in size, with episodes of chills/fever, pus/blood, and ulceration, where one subsides and another arises. It is suitable to take Guifu Huashi (Guifu Talcum) 2 qian mixed with rice water overnight. During attacks, administer Heibai San (Black and White Powder). There will be grape-meat-like matter discharged via urine several times, and the swollen nodes will heal. Continue taking Sizhi Tang (Four-Seven Decoction) with Muxiang (Aucklandiae Radix) or Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). Those encircling the neck, commonly called Panshe Li (Coiling Snake Scrofula), are difficult to treat.
Xue Xinpu stated: Luoli disease belongs to the Sanjiao (Triple Burner) and Liver/Gallbladder meridians, caused by angry fire, wind-heat, blood dryness, or essence/blood deficiency in the Liver/Kidney meridians with internal moving deficiency-fire, or anger/rebellious qi/excessive worry causing wind-heat pathogens to clash with the Liver. Anger injures the Liver; the Liver governs sinews. When the Liver is diseased, sinews become knotted like beads. Manifestations mostly occur around the ears, back of the neck, and axilla, forming nodules. Initial symptoms include aversion to cold/hatred of heat, stiffness/pain in throat/neck. If accompanied by chills/fever and pain, this is Liver fire/wind-heat affecting Qi; use Xiao Chaihu Tang (Minor Bupleurum Decoction) to clear Liver fire, and Jiawei Siwu Tang (Modified Four Substances Decoction) to nourish Liver blood. If chills/fever cease but nodules do not dissipate, this is Liver meridian fire-dryness affecting Blood; use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) to clear Liver fire, and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to generate Kidney Water. If swollen, high, slightly soft, with sallow complexion and hot skin, indicating pus formation, puncture with a needle and administer Tuoli agents (Interior-Supporting Agents). If chronic/non-healing or recurring with dripping pus and emaciation, pure tonifying agents are required for convergence; otherwise, it becomes Ji Lou (Nine Leaks). The *Nei Jing* states: Depressed vessels lead to leaks, lingering in flesh and interstices. This is that disease. Externally apply Douchi Bing (Fermented Soybean Cake) and Hupo Gao (Amber Ointment) to dispel cold pathogens and supplement Yang Qi; internally take Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Liuwei Wan to nourish Kidney Water, cultivate Liver Wood, and strengthen Spleen Earth; some recover. Generally, for tubercles in the Liver/Gallbladder region, regardless of size, if the left Guan pulse is wiry/tight and left Chi pulse is surging/rapid, it indicates Kidney Water failing to generate Liver Wood, causing Liver fire dryness and sinew contraction. Use previous medicines to nourish the source; this treats the root. The *Waitai Mi Yao* states: Liver/Kidney deficiency-heat generates leaks. The *Bingji* states: Luoli is not a transformation of rich food/toxic herbs/fire-heat, but caused by deficiency-consumption and Qi stagnation. Only tonify form/Qi and regulate meridians; the sore will self-dissipate. No need for sweating or purging. Those who fail to detail pulse/symptoms/meridian differences and use purgatives violate meridian/disease prohibitions, causing "deficiency of deficiency" disasters clearly. If pulse is surging/large with exhausted Yuan Qi, it is incurable. If face is pale white, Metal overcoming Wood, it is incurable. If red vessels in eyes penetrate the pupil, the number of lines indicates years until death. Treating without addressing the root and blindly using Liver-punishing agents is erroneous. Punishing the Liver first injures Spleen Earth; injuring Spleen damages the source of Five Zang organs. Be cautious! Note: The *Mai Jing* states: For people aged 50-60, if pulse is floating/large, with bi-syndrome along the back, intestinal borborygmus, Madao, and Xiaying, all are obtained from consumption. Thus, Luoli syndromes mostly originate from deficiency. Xue’s discussion serves as a standard. Therefore, recorded in detail.
[Treatment Sequence]
At onset, with aversion to cold/high fever, throat/neck stiffness/pain, and non-resolving swelling/nodules, use Qianghuo Lianqiao Tang (Notopterygium and Forsythia Decoction), and preferably long-term use of Xiaohe Wan (Nodule-Resolving Pill). Then prick with a triangular needle to bleed, wash hot with Badu Tang (Toxin-Drawing Decoction) 5-7 times daily, needle 5-7 times, place a little Chansu (Toad Venom) powder on the needle site, apply Hupo Gao, and further apply Neixiao Gao; gradually it will naturally dissolve. If it does not dissolve, use Tietong Badu Gao (Iron Tube Toxin-Draw Ointment) to puncture, then use Pin-level Dingzi (Ingot-shaped Medicines) to remove foul tissue, treating as an ulcer with Shixuan San (Ten-Auspicious Powder) for support. If toxin attacks the heart causing vomiting, use Fenru (Powdered Milk) to support interior and draw out toxin; this requires combining acupuncture/moxibustion. If ulcerated and non-healing, use Yiqi Yangrong Tang (Qi-Boosting and Nourishing Blood Decoction), or Babao Tang (Eight Treasure Decoction) plus Chaihu (Bupleuri Radix), Digupi (Lycii Cortex), Xiakucao (Prunellae Spica), Xiangfuzi (Cyperi Rhizoma), and Beimu (Fritillariae Bulbus) taken frequently for effect. Whenever using Dingzi/thread medicines, always accompany with interior-supporting agents. Red/swollen/hot/painful with deep/rapid pulse indicates excess pathogen; purge it with Huadu Xiaozhong Heli San (Toxin-Transforming Swelling-Reduction Harmonizing Interior Powder) modified. Painful/swollen with aversion to cold/fever or spasms, floating/rapid pulse indicates pathogen in exterior; release exterior with Jingfang Baidu San (Aristolochia and Saposhnikovia Decoction to Overcome Poison) modified. Tubercles due to anger, or painful/swollen/febrile, require soothing Liver and moving Qi with Xiao Chaihu Tang plus Qingpi (Citri Reticulatae Pericarpium Viride), Qingmuxiang (Aucklandiae Radix Viridis), Honghua (Carthami Flos), and Taoren (Persicae Semen). Hard/swollen non-ulcerated requires tonifying Qi/Blood with Yiqi Yangrong Tang. Caused by depression requires resolving stagnation and regulating Qi/Blood with Yiqi Yangrong Tang. Post-ulceration non-convergence indicates Qi/Blood dual deficiency; strongly tonify with Yiqi Yangrong Tang, followed by Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) plus Xiangfuzi, Beimu, Yuanzhi. Caused by deficiency-consumption requires tonification: first Buzhong Yiqi Tang, then modified Yiqi Yangrong Tang. Due to nodules, ulcerated but non-converging: rot and tonify; use Zhentou San (Needle-Head Powder) to rot, then Yiqi Yangrong Tang to tonify. Solid pulse with non-convergence/non-resolution: purge with Qianghuo Lianqiao Tang. Painful/swollen with chills/fever and constipation: Qianghuo Lianqiao Tang, followed Shenxian Huoming Yin (Divine Immortal Life-Living Decoction). Submandibular tubercles painful/swollen with chills/fever: Jingfang Baidu San; after exterior signs resolve, Sanzhong Kuijian Tang. Post-ulceration node not rotting: Yiqi Yangrong Tang, apply Zhentou San to rot. Hard/swollen long-time non-resolution, no pus formation, unresponsive to Jianhard/Damp-clearing drugs: moxa Zhoujian (Elbow Tip) and Jianjian (Shoulder Tip), take Yiqi Yangrong Tang to resolve. Robust Qi/Blood with deep/solid/large pulse, no sensation of damage: only then administer Bixiao San (Must-Effect Powder) or Yuxian Wubi Wan (Immortal Peerless Pill) to purge toxin. Once toxin is purged, stop these two drugs, resume Yiqi Yangrong Tang for regulation. Non-converging sore: moxa Douchi Bing (Fermented Soybean Cake). Apply Hupo Gao, Shixiang Gao. Post-ulceration fever, irritability/thirst, large/weak pulse indicates Blood deficiency: Danggui Buxue Tang, then Shengyu Tang, then Babao Tang plus Beimu, Yuanzhi. Excessive mental labor, neck swelling/fever, worsening with detoxifying drugs: Buzhong Yiqi Tang for several doses resolves it.
[Case Records]
Son of Grand Secretary Yang Shizhai, age 17, fever/thirst, malar flush at dusk, left Guan/Chi pulses large/floating. This is Liver/Kidney Yin deficiency. Used Buyin Bazhen Tang (Yin-Nourishing Eight Treasures Decoction) for 50+ doses, then added Renshen (Ginseng) and Huangqi (Astragali Radix) for 20+ doses until ulceration. Pus was thin/clear, muscle not growing. Main ingredients: Renshen, Huangqi, Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma); assisted by Shaoyao (Paeoniae Radix), Shudi (Rehmanniae Radix Preparata), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus). Pus became thick, muscle grew. One dose of Bixiao San removed toxin and closed sore.
Zhang Meizhi of Rongtai, prone to anger, contracted this in early spring. Used Liver-punishing agents without success. I considered Liver Blood insufficient, used Liuwei Dihuang Wan and Buzhong Yiqi Tang to nourish the source; recovered by late winter.
A scholar, emaciated after recovery, irregular day/night fever. Deficiency of Qi/Blood in Foot-Sanyin meridians. Used Bazhen Tang plus Maidong, Wuweizi for 20+ doses, then Buzhong Yiqi Tang plus Maidong, Wuweizi, and Liuwei Wan; recovered.
Scholar Zhang Zirong, prone to anger, chronic non-healing. Bleeding from sore, left Guan wiry/surging, empty on heavy pressure. Liver fire moving causing reckless blood flow; syndrome of Qi/Blood dual deficiency. Used Buzhong Yiqi Tang to tonify Spleen/Lung, Liuwei Wan to nourish Kidney/Liver; recovered.
One person, five bead-like nodules under ear, hard after a year, sallow complexion, poor appetite, fatigue/fever, rapid/soft/choppy pulse. Yiqi Yangrong Tang for 60+ doses restored Yuan Qi, resolved local area, one node remained. Two doses of Bixiao San flattened it.
One person, recovering from pre/subauricular infection, extended to lateral neck/supraclavicular fossa for 3 years, then to chest/axilla. Liver pulse wiry/rapid. Treated with Longhui Wan and Sanjian Er Wan; nearly healed, liver pulse still rapid. Four years later, toxicity in lower abdomen/scrotum/inner thigh, non-healing for over a year, pulse same. Clear Liver/Nourish Blood, plus previous pills; recovered.
One person, due to anger, subauricular/supraclavicular Luoli, ulcerated extending to axilla, substantial form/Qi, non-closing sore. Treated with Sanzhong Kuijian Wan; recovered.
One person, due to labor, lethargy/fever, surging/large pulse empty on pressure. Should use Buzhong Yiqi Tang. Did not believe, took attacking/purging agents, died from continuous vomiting/diarrhea.
Generally, this syndrome originates from deficiency. Not examining excess/deficiency and violating prohibitions leads to error. Standard treatment: first regulate meridians/resolve depression, moxa garlic partition for spontaneous resolution. If unresolved, apply Hupo Gao; wait for pus, then needle. Otherwise, other syndromes arise. If complicated by phlegm/Yin deficiency, add corresponding agents, do not disturb other meridians. If Qi/Blood restored but nodules persist, yet Jianhard agents fail for a month without damaging Qi/Blood, then administer Bixiao San or Yuxian Shenxian Wubi Wan. Once toxin purged, stop, resume Yiqi Yangrong Tang. Non-converging sore: moxa Douchi Bing, apply Hupo Gao. Dual Qi/Blood deficiency or negligence in diet/lifestyle/emotions: incurable. However, this syndrome relies on Qi/Blood. If robust, self-putrefaction occurs without caustic agents; just remove to facilitate convergence. If deficient, using caustics before tonification leads to failure. Chills/fever with red vessels penetrating pupil: incurable. One vessel line: death in one year; two lines: death in two years.
One person, profuse phlegm, chest oppression, Spleen/Stomach pulse wiry. Spleen Earth deficiency, Liver Wood encroaching. Should strengthen Spleen, punish Liver. Patient prioritized phlegm treatment, took bitter-cold phlegm-resolving drugs without effect. Added Qi-breaking drugs, worsened. Finally used Liujunzi Tang plus Xiong/gui (Chuanxiong, Angelica) for several doses, poor appetite. Buzhong Yiqi Tang with doubled Baizhu for over a month, middle Qi slightly strengthened. Yiqi Yangrong Tang for four months, swelling resolved, Qi/Blood restored. Right Guan wiry (Wood), Wood excess overcoming Spleen Earth (Tevil Evil). Using bitter-cold on deficiency causes "deficiency of deficiency". Phlegm etiology varies; treatment differs. Too many diuretics weaken Spleen Qi, making phlegm generation easier. For Middle Qi deficiency, use Renshen/Baizhu as main, assist with phlegm drugs.
One person, chronic non-convergence, mental fatigue, weak pulse. Intended to use Tuoli agent, patient thought it slow. Took Sanzhong Kuijian Tang for 15+ days, developed fever, decreased appetite, sought treatment again. Yiqi Yangrong Tang for three months; adhered strictly, saved. Qi Shi stated: Early Luoli/tubercles should be internally resolved. If chronic, Qi/Blood decline, cold muscles/flesh, thin pus/sweat, toxin not exiting, non-closing sore, non-red swelling, non-suppurating tubercles, unclear exterior signs: all require Tuoli (Interior Support). Before pus forms, hasten formation; after ulceration, hasten new flesh growth. Qi/Blood deficiency: support/tonify interior. Yin/Yang disharmony: regulate interior. Generally, Tuoli method prevents deterioration, hence appropriate.
One woman, Luoli extending to chest/axilla, dripping pus, chronic five-center heat, limb pain, heavy head/eyes, palpitations, malar flush, dry mouth/throat, fever/night sweats, poor appetite/lethargy, irregular menstruation, umbilical/abdominal pain. I said Blood deficiency, not Luoli cause. Xiaoyao San for one month improved slightly. Babao Tang plus Mudanpi (Moutan Cortex), Xiangfuzi for another month, menstruation resumed. Add Huangqi, Bailian (Belamcandae Rhizoma) for two more months; recovered.
One woman, chronic non-resolving Luoli, spontaneous sweating/aversion to cold. Dual Qi/Blood deficiency. Shiquan Dabu Tang for one month until ulceration. Hard node difficult to remove, non-converging sore. Moxa Douchi Bing, continue previous meds plus Xiangfu, Wuyao; recovered in two months.
One woman, post-Luoli ulceration fever, irritability/thirst, large/weak pulse. Blood deficiency. Danggui Buxue Tang for six doses rapidly reduced fever. Shengyu Tang for several doses improved slightly. Babao Tang plus Beimu, Yuanzhi for 30+ doses closed sore.
One woman, post-ulceration node not rotting. Yiqi Yangrong Tang for 30+ doses, apply Zhentou San to rot, then previous decoction for 30+ doses to close.
One woman, chronic ulceration fever, delayed/scanty menstruation. Xiaoyao San combined with previous decoction for two months, Qi/Blood restored, sore healed, but one opening remained. Apply Zhentou San, moxa previous acupoints; recovered.
One woman, Liver Meridian accumulated heat, painful Luoli, deep/rapid pulse. Shegan Lianqiao Tang (Belamcanda and Forsythia Decoction) for four doses slightly improved. Sanzhong Kuijian Wan for one month resolved.
One woman, Luoli, unresponsive to Qi-nourishing/Blood-smoothing meds. Shenxiao Gualou San (Miraculous Trichosanthes Powder) for two doses rapidly reduced, six doses resolved. Then Tuoli agents, Qi/Blood balanced, recovered.
One woman, over 30, ulcerated non-healing Luoli. Babao Tang plus Chaihu, Digupi, Xiakucao, Xiangfu, Beimu for 50+ doses, form/Qi gradually turned. Bixiao San two doses closed sore. Qi/Blood not yet balanced, previous meds 30+ doses balanced.
One woman, non-resolving Luoli, thin pus/non-converging. Babao Tang slightly improved. Suddenly shoulder/back pain unable to turn head. Bladder Meridian Qi stagnation. Should take Fangfeng Tongqi Tang (Saposhnikovia Ventilation Decoction). Patient claimed Luoli is Gallbladder disease, meridian fire moving, took cooling Liver/descending fire drugs, resulting in anorexia/severe pain. Pulse showed weaker Stomach Qi. First Sijunzi Tang plus Chenpi (Citri Reticulatae Pericarpium), Chao Shaoyao (Fried Peony Root), Banxia (Pinelliae Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Manjingzi (Vernoniae Fructus) for four doses, appetite returned, pain stopped. Fangfeng Tongqi Tang for two doses recovered.
Female, 17, chronic non-healing Luoli, menstruation not started, fever/cough, poor appetite. Old woman wanted Baydou (Croton Seed), Rougui (Cinnamon Bark) to open menstruation. I said: Tidal fever with irregular menstruation is incurable. But glad pulse is not choppy, no tidal fever, still treatable. Must nourish Qi/Blood, benefit fluids, menstruation will self-start. Patient desired quick effect, still used Baydou/Rougui. These harsh agents greatly aid Yang fire; Yin blood flows recklessly; Spleen/Stomach becomes more deficient. Indeed, menstruation opened but did not stop, appetite decreased, tidal fever increased, leading to untreatable state.
One woman, chronic non-healing Luoli. Others treated as Wood-excess with Sanzhong Kuijian punishing, swelling/hardness worsened. Xue considered Liver Meridian Qi/Blood deficiency, should nourish source. Liuwei Dihuang Wan, Buzhong Yiqi Tang; recovered in spring. If acute Wind-Fire in Liver Meridian with intact Yuan Qi, use previous decoction. If Wind-Wood excess self-disease, use Xieqing Wan (Drain Green Pill); deficiency use Dihuang Wan. If Water fails to generate Wood, use this pill. If Metal overcomes Wood, tonify Spleen Earth, generate Kidney Water. Generally, for Wind-Wood diseases, strengthening Spleen Earth prevents Wood from overcoming. Punishing Liver first injures Spleen/Stomach, and Wood counter-overcomes Earth.
One woman, feared death, insomnia for over a year, Luoli broken with dripping pus, menstruation every 50 days or two months, mistakenly took Tongjing Wan (Menstruation-Opening Pill),辗转无寐 (tossed/restless), chills morning, fever afternoon. Xue considered worry/injury to Spleen Blood. Guipi Wan (Restore the Spleen Pill) taken in morning with Liujunzi, evening with Xiaoyao. Two months sleep restored. Half-year menstruation regular. Year-plus sore healed.