(一）颈痈张××，男，49岁。门诊号：312013。初诊日期：1963年12月25日。七天前颈部生一疙瘩肿痛，诊为颈部痈。注射青霉素未效，肿势逐渐扩大，自溃出脓。患者自觉身热口苦，烦躁，不思饮食，小便黄赤，大便燥结。脉洪数有力，舌质红、苔白厚。检查：颈后右上方肿起约6x4厘米，周围组织发红，明显肿胀及压痛，疮面有多数小脓点，中心有杏核样大小疮口，有少量脓性分泌物。白细胞计数22，800／立方毫米，中性粒细胞85％，淋巴细胞15％，尿糖(-）。辨证：毒热壅盛，气血阻隔。治法：清热解毒，消肿排脓。方药：金银藤30克蒲公英18克败酱草9克连翘12克地丁12克赤芍12克炒山甲9克炒皂刺9克黄芩9克丹皮9克白芷3克乳香6克没药6克菊花9克疮口处敷京红粉软膏，四周用化毒散软膏外贴。12月28日：服上方3剂后，肿势继续扩展至12x8厘米，脓出不畅，剧痛，夜不得寐，心烦易怒，症属毒热炽盛，脓毒已成而不得外泄，法宜排脓托毒，继服前方加栝萎30克，公英30克，并于局麻下在原疮口处行井式切开扩创深至2．5厘米，用红粉纱条引流，外敷化毒散软膏。12月29日：手术后疼痛大减，肿势渐缩小，脓液粘稠，引流尚通畅，换药时清除脓栓及腐肉。症见胃纳欠佳，口渴思饮，大便燥结，鼻衄，口唇起疱，舌苔白厚，舌质红，脉象弦数。脓毒已泄，热邪未解。继以清热解毒、托毒排脓之剂。内服12月28日方加减，换药同前。1月8日：疮面脓汁减少，肿消痛减，疮口肉芽新鲜，仍有口干思饮，胃纳欠佳，舌质红、苔微黄，脉沉缓。此为热邪伤阴之象。拟以养阴清热，佐以和胃。生地12克元参9克白芍9克金银花9克天花粉9克焦麦芽9克橘皮6克炒白术9克生甘草4．5克石斛9克1月14日：伤口愈合，自觉症状消失，1964年10月随访时未见异常。
(《赵炳南临床经验集》）
【评按】此案毒热壅盛，气血痹阻。初诊时治以清热解毒、消肿排脓法，方用仙方活命饮加减。后因肿势扩展，脓毒不得外泄，除内服汤方外，配合切开扩创，以红粉纱条引流，继续围敷化毒散软膏而敛。见效的关键是毒热得泄，使邪有出路，未以清热养阴和胃法收功。
(二）子痈
例一张某，男，30岁。1963年7月31臼初诊。四个月前每在阴雨之时则感两侧睾丸隐痛，步履时亦牵引作肩，甚至不能下蹲，曾诊为“睾丸炎”。现阴囊粗大下垂，副睾丸肿胀，行动时少腹引痛，腰酸不耐久立，头昏，小溲色黄，溺时不畅。脉弦，舌边尖红，苔糙腻而厚。一341～辨证：肝气失疏，湿热交阻。拾法：疏肝理气，清热利湿。方药：”赤白芍各6克粉丹皮9克橹豆衣9克橘叶核各9克生枣仁15克。赤苓12克白蒺藜9克(去刺）梗通草4．5克建泽泻9克桑寄主9克忍冬藤9克块滑石9克(包煎）3剂。二诊：(略）三诊：睾肿渐软，久立则阴囊滞胀下垂，余症同前，系湿热蕴阻，前方去橹豆衣、白蒺藜，加佩兰梗。四诊：睾肿渐消，阴囊上束溺清、畅利。前方加陈皮4．5克。后又以此方去橘叶核，加制苍术、淮山药、川黄柏，连服十二剂而愈。
例二毛某，男。副睾丸炎由湿热所酿成。黄柏5克粉丹皮9至冬葵子9克上牛膝12克泽泻9至，大小蓟各9克荔枝核12至生侧柏叶30克(煎汤代水）另：银花12克生山栀9克代茶。二诊：睾丸炎除局部疗法外，清谅解毒、通利二便。银花12克大小蓟各9克丹皮9克蚤休5克土牛膝9至桃仁12克夏枯草9克菊花9克、‘蒲公英9克，粉草落9克车前子叶各9克甘草梢5克生熟锦纹各6克元明粉12克(分两次冲入）三诊：睾丸炎虽未消尽，但已不如前之掀红肿大。一3犯～土茯苓24克凤尾草12至）生山栀9、克马鞭草12至黄柏5至银花15至蒲公英9克小蓟9克、蚤休5克山慈菇3克(切片）“四诊：”治睾丸炎不外通利二便，消炎尚属次要1郁李仁9克(打）小蓟庞克桃仁泥儿克苦参片5克黄柏3克甘草3克“～、
(《章次公医案》
【评按】子痈相当于急住睾丸炎或副睾炎。多由湿热下注肝络、气血凝滞而致。常法以龙胆泻肝丸泻肝清热利湿为主方。例一属肝气失疏、湿热交阻，由于肝火不盛，故洽以硫肝理气、清热利湿，是为常法中之变法。例二为副睾炎，中医辨证亦属湿热壅遏所致，治以通利二便为主，清热解毒散结为辅。通利二便的目的，为使湿热毒邪从二便利泄；但患者如无大使难，则不须用通便法。细玩章氏立方’主治明确、药用精纯而效专，在主观上有欲结合西医药理的思想。。、
(三）臀痈、、尹××，男，32岁。门诊号：拢0187。初诊日期、1968克2月13日。＝一、＝：1＝、＝臀部肿痛、发热已八天。‘现病史已臀部初起一小红疙瘩，轻微痒痛，逐渐加重，伴有发冷发热，注射青霉素数日不效。来院就诊时仍发热，口干，不思饮食）大便干，小便黄赤。因局部肿痛影响走路。检查：体温38．8℃，左侧臀部红肿范围约8X5厘米，灼热明显，有压痛拒按，触之稍软，但波动不明显。左侧下肢活动受限，左腹股沟淋巴结肿大，有压痛。化验检查：白细胞计数30，00／立方毫米。脉弦数，舌苔黄厚，舌质红。辨证：毒热壅滞，发为臀痈。治法：清热解毒，活血内托。方药：金银花15克公英15克连翘12克赤芍9克白芷9克青陈皮12克炒山甲9克炒皂刺9克外用铁箍散软膏围帖。2月15日：体温38．6℃，服药后，臀部红肿渐退，疼痛仍剧烈，尤以夜间为甚。局部波动明显，局麻下切开一小口，流出脓汁约100毫升，用红粉纱条填塞，继以解毒内托之剂。金银花15克公英30克连翘15至花粉12克地了15至当归9克败酱草15克黄芩12克青陈皮12克局部每日换红粉纱条一次。2月17日：局部周围红肿已消，疼痛已止，有时局部有痒感如虫行，疮面肉芽组织红润，有少许脓液外溢。体温恢复正常，白细胞计数13，600／立方毫米，脓汁细菌培养结果为大肠杆菌，拟以理气活血、清热解毒为法。当归12克青陈皮15克全栝蒌15克红花9克金银花15克公英15克连翘15克生甘草9克局部换药同前。上方加减3剂后，疮口日渐变浅，疮面清洁，六天后疮口愈合，痊愈出院。
(《赵炳南临床经验集》）
【评按】此案除局部痈肿外，有发冷发热及内热症候。治以清热解毒、活血内托法，后配合切开排脓，局部红粉纱布填塞，其后则以解毒内托、理气活血为主。初诊时曾用铁箍散软膏围贴，有束毒追脓之功，临床用以疗痈疮、治诸般肿毒。赵氏运用多种医疗手段，在治法的配合和治疗层次的掌握方面颇有法度。
(四）疔疮
例一王某某，男，62岁。门诊号：480388，初诊日期：1972年4月3日。右手肿胀疼痛两周。患者于两周前因玻璃刺入右手中指感染，局部出现红肿疼痛，手掌麻木，发烧38℃。经注射链霉素、卡那霉素，口服土霉素及中药，发热稍退，但手掌、手背肿胀逐渐明显，手指不能弯曲，肿势逐渐向上蔓延至手腕以上，疼痛难忍，右前臂麻木，恶心，食欲不振，自感手部骨痛，每日晚仍发烧至39℃以上。检查：右侧手掌及手背部肿胀明显，皮色微红，按之较硬且痛，稍有波动感，腋淋巴结可扪及、有触痛，白细胞计数14，200／立方毫米，上午体温37。9℃，晚上最高体温39℃以上。脉滑数，舌质红、苔黄腻。辨证：毒热壅滞，经络阻隔
(托盘疔）。治法：清热解毒，除湿通络。方药：金银花30克公英30克地丁30克黄芩15克赤芍9克归尾9克姜黄9克白芷9克佩兰9克鸡血藤30克霍香9克酒军9克4月26日：按上方加减治疗，手掌及手背肿胀基本消失，体温一直正常，中指仍肿胀，右上肢发麻仍未解，舌苔黄腻，脉沉，纳差，口苦，烧心，大使干、二三日一行，尿黄。进一步分析其病情，系因湿热与毒热交炽阻隔经络，缠绵日久。拟以活血通络、清热利湿为法。一3；5一归尾12克赤芍9克桃仁9克红花9克白芷9克公英12克泽泻9克霍香9克泽兰9克、姜黄9克按上方加减继服，5月19日复查时肿胀已消，嘱加强手部功能锻炼。
(《赵炳南临床经验集》）
例二钟××，男，18岁。下颔部生疮3天。3天前下颌部发一小疹，翌日即灼热而痛，日渐扩大，疼痛发硬，影响咀嚼，伴有恶寒发热，食欲减退。曾用西药未愈。局部5x4厘米硬肿浸润，有数个脓头已破；流脓不多。舌质红，薄黄苔，脉弦数。辨证：疔疮散毒。治法：清热解毒。方药：银花丹皮生地白芷紫花地丁栀子蒲公英连翘黄芩另服紫雪丹，每日三次，每次1。5克。外敷拨毒膏于疮顶，疮周厚围六合丹。两天后肿硬渐消，化脓溃破，继用清热解毒之剂内服，当脓排尽；乃用化腐生肌药方治之，共治二十天痊愈。附方：
(1）拔毒膏：蓖麻子肉93克上松香(研）、银朱(研）、轻粉(研）、樟脑(研）各15克，冰片(研）6克。制法略。(2）六合丹：大黄、黄柏各93克薄荷叶、乌梅肉各46克白芷18克亮煤炭55克面粉155克。制法略。
(吴介诚《疮疡经验录》）
例三汪××，男，38岁。右口角生疮5天，面部发肿加重3天入院。5天前右上口角生一小疮，用手抓破，次日面部肿痛，畏寒发热，近3天肿痛加剧，不能张口进食，四天来大便未解，小便黄短，曾外敷草药未效。体温39℃，白细胞11，200／立方毫米，血片脓培养均为“金葡”生长。胸透：右胸腔大量积液。诊为败血症，用中西医结合治疗，因呼吸困难而作气管切开。中医以清热解毒、凉血养阴为治则。方药：银花：连翘蒲公英紫花地丁赤芍野菊花生地丹皮鲜芦根石斛花粉乳香大黄甘草另服紫雪丹，每天6次，每次1。5克。疮面用拔毒膏外敷，四周用六合丹围敷。3天后体温降至37℃东右，血培养阴转，大便仍燥结，脉数有力，精神好转。上方去野菊花、鲜芦根、花粉、乳香，加败酱草、川贝母、栝萎壳，紫雪丹改为每天服4次，每次1．5克。住院第8天，体温正常，治以清热解毒豁痰法：方药：银花连翘黄芩黄连紫花地丁栝萎壳浙贝桔梗花粉甘草局部处理同前，情况更趋好转，停服紫雪丹。住院18天患部疮口干净，停外用药。住院20天拔除气管切开插管，35天痊愈出院。
(吴介诚《疮疡经验录》）
例四夏××，男，22岁。五天前右唇生一疖，挤压后高烧。诊断：唇痈、败血症，血培养证实。用大剂抗菌素、支持疗法、物理疗法，仍未效，转入昏迷，腋下体温40℃以上。中医会诊：面颊皆肿，壮热神昏，口噤不语，两手握固，目赤，上唇腐烂出血。辨证；疔毒走黄，毒陷心包。治法：清热解毒，芳香开窍。方药：紫花地丁60克带心连翘15克金银花30克生甘草10克川贝(去心）10克丹皮6克赤芍10克黑山栀10克钩藤(后下）10克用水煎，冲入菊叶汁一杯，并调下紫雪丹3克，犀黄0．6克鼻饲给药。外治：疮头掺黄升丹，贴黄连膏，掀肿处用金黄散外敷，两委中穴放血。二诊：昨进药，次日下午体温37℃，神志较清，能讲一句话，治法原意扩充，药用：安宫牛黄丸2粒(研）西黄1克(研）犀角粉1克分3次鼻饲，5小时一次。汤药：鲜生地30克丹皮10克赤芍10克银花30克地丁30克天竺黄10克川贝10克带子青蒿10克甘菊花10克草河车10克鲜竹叶307克黛灯芯3扎鲜菊叶汁一杯(冲）煎汤鼻饲，上唇腐烂用珠黄散和蜜调敷，其余外用药仍按原法。三诊：中西医治疗两天，体温、脉搏正常，神志清楚，壮热告退，目衄既止，唇内腐烂亦定，面目颈肿十去八九，口尚干渴，脉数未静，舌红苔黄，余邪未净，改用下方：银花藤30克紫花地丁30克连翘10克甘菊10克生甘草3克赤芍10克丹皮10克黑山栀10克黄芩10克鲜生地30克鲜野菊叶汁一怀上犀黄0．3克会诊后5日，血培养(-），第9日局部红肿基本消退，一般情况良好，能下床活动，以后单用西药调理一月左右出院、
(《许履和外科医案医话集》）
【评按】疔疮以其形小、根深、坚硬如钉状而命名。多由感染风邪火毒所致。《内经》并指出“膏梁之变”是疔疮的发病因素之一。根据其发于体表的不同部位，各目纷繁。疔疮发病急、变化快，初起如粟状，继则焮红发热，肿势渐增，疼痛剧烈，甚者疔毒走黄。治疗以清热解毒为大法。
（一）颈痈
张××，男，49岁。门诊号：312013。初诊日期：1963年12月25日。七天前颈部生出一个疙瘩，肿痛，诊断为颈部痈（发生于颈部的急性化脓性疾病）。注射青霉素无效，肿胀范围逐渐扩大，自行破溃出脓。患者自觉身体发热、口苦，烦躁不安，不想吃东西，小便黄赤，大便干燥结硬。脉象洪大数而有力，舌质红，苔白厚。检查：颈后右上方肿起约6x4厘米，周围组织发红，明显肿胀及压痛，疮面有多个小脓点，中心有杏核大小的疮口，有少量脓性分泌物。白细胞计数22,800/立方毫米，中性粒细胞85%，淋巴细胞15%，尿糖阴性。辨证：毒热壅盛，气血阻隔。治法：清热解毒，消肿排脓。方药：金银藤30克，蒲公英18克，败酱草9克，连翘12克，地丁12克，赤芍12克，炒山甲9克，炒皂刺9克，黄芩9克，丹皮9克，白芷3克，乳香6克，没药6克，菊花9克。疮口处敷京红粉软膏，四周用化毒散软膏外贴。12月28日：服用上方3剂后，肿胀范围继续扩展至12x8厘米，脓液排出不畅，剧痛，夜间无法入睡，心烦易怒，症状属于毒热炽盛，脓毒已成但不得外泄，治法宜排脓托毒，继服前方加栝萎30克，公英30克，并于局麻下在原疮口处行井式切开扩创，深达2.5厘米，用红粉纱条引流，外敷化毒散软膏。12月29日：手术后疼痛大减，肿胀范围逐渐缩小，脓液粘稠，引流尚通畅，换药时清除脓栓及腐肉。症见胃纳欠佳，口渴思饮，大便燥结，鼻衄（鼻出血），口唇起疱，舌苔白厚，舌质红，脉象弦数。脓毒已泄，热邪未解。继续以清热解毒、托毒排脓之剂。内服12月28日方加减，换药同前。1月8日：疮面脓汁减少，肿消痛减，疮口肉芽新鲜，仍有口干思饮，胃纳欠佳，舌质红、苔微黄，脉沉缓。此为热邪伤阴之象。拟以养阴清热，佐以和胃。生地12克，元参9克，白芍9克，金银花9克，天花粉9克，焦麦芽9克，橘皮6克，炒白术9克，生甘草4.5克，石斛9克。1月14日：伤口愈合，自觉症状消失，1964年10月随访时未见异常。
（《赵炳南临床经验集》）
【评按】此案毒热壅盛，气血痹阻。初诊时治以清热解毒、消肿排脓法，方用仙方活命饮加减。后因肿势扩展，脓毒不得外泄，除内服汤方外，配合切开扩创，以红粉纱条引流，继续围敷化毒散软膏而敛。见效的关键是毒热得泄，使邪有出路，未以清热养阴和胃法收功。
（二）子痈
例一 张某，男，30岁。1963年7月31日初诊。四个月前每逢阴雨之时则感觉两侧睾丸隐痛，行走时亦牵引作痛，甚至不能下蹲，曾诊断为“睾丸炎”。现阴囊粗大下垂，副睾丸肿胀，行动时少腹引痛，腰酸不耐久立，头昏，小便色黄，排尿不畅。脉弦，舌边尖红，苔糙腻而厚。辨证：肝气失疏，湿热交阻。治法：疏肝理气，清热利湿。方药：赤白芍各6克，粉丹皮9克，橹豆衣9克，橘叶核各9克，生枣仁15克，赤苓12克，白蒺藜9克（去刺），梗通草4.5克，建泽泻9克，桑寄生9克，忍冬藤9克，块滑石9克（包煎），3剂。二诊：（略）。三诊：睾肿渐软，久立则阴囊滞胀下垂，余症同前，系湿热蕴阻，前方去橹豆衣、白蒺藜，加佩兰梗。四诊：睾肿渐消，阴囊上束，溺清、畅利。前方加陈皮4.5克。后又以此方去橘叶核，加制苍术、淮山药、川黄柏，连服十二剂而愈。
例二 毛某，男。副睾丸炎由湿热所酿成。黄柏5克，粉丹皮9克，冬葵子9克，牛膝12克，泽泻9克，大小蓟各9克，荔枝核12克，生侧柏叶30克（煎汤代水）。另：银花12克，生山栀9克，代茶。二诊：睾丸炎除局部疗法外，清谅解毒、通利二便。银花12克，大小蓟各9克，丹皮9克，蚤休5克，土牛膝9克，桃仁12克，夏枯草9克，菊花9克，蒲公英9克，粉甘草9克，车前子叶各9克，甘草梢5克，生熟锦纹各6克，元明粉12克（分两次冲入）。三诊：睾丸炎虽未消尽，但已不如前之掀红肿大。土茯苓24克，凤尾草12克，生山栀9克，马鞭草12克，黄柏5克，银花15克，蒲公英9克，小蓟9克，蚤休5克，山慈菇3克（切片）。四诊：治睾丸炎不外通利二便，消炎尚属次要。郁李仁9克（打），小蓟10克，桃仁泥10克，苦参片5克，黄柏3克，甘草3克。
（《章次公医案》）
【评按】子痈相当于急性睾丸炎或副睾炎。多由湿热下注肝络、气血凝滞而致。常法以龙胆泻肝丸泻肝清热利湿为主方。例一属肝气失疏、湿热交阻，由于肝火不盛，故治以疏肝理气、清热利湿，是为常法中之变法。例二为副睾炎，中医辨证亦属湿热壅遏所致，治以通利二便为主，清热解毒散结为辅。通利二便的目的，为使湿热毒邪从二便利泄；但患者如无大便难，则不须用通便法。细玩章氏立方，主治明确、药用精纯而效专，在主观上有欲结合西医药理的思想。
（三）臀痈
尹××，男，32岁。门诊号：拢0187。初诊日期：1968年2月13日。臀部肿痛、发热已八天。现病史：臀部初起一小红疙瘩，轻微痒痛，逐渐加重，伴有发冷发热，注射青霉素数日不效。来院就诊时仍发热，口干，不思饮食，大便干，小便黄赤。因局部肿痛影响走路。检查：体温38.8℃，左侧臀部红肿范围约8X5厘米，灼热明显，有压痛拒按，触之稍软，但波动不明显。左侧下肢活动受限，左腹股沟淋巴结肿大，有压痛。化验检查：白细胞计数30,000/立方毫米。脉弦数，舌苔黄厚，舌质红。辨证：毒热壅滞，发为臀痈（发生于臀部的急性化脓性疾病）。治法：清热解毒，活血内托。方药：金银花15克，公英15克，连翘12克，赤芍9克，白芷9克，青陈皮12克，炒山甲9克，炒皂刺9克。外用铁箍散软膏围帖。2月15日：体温38.6℃，服药后，臀部红肿渐退，疼痛仍剧烈，尤以夜间为甚。局部波动明显，局麻下切开一小口，流出脓汁约100毫升，用红粉纱条填塞，继以解毒内托之剂。金银花15克，公英30克，连翘15克，花粉12克，地丁15克，当归9克，败酱草15克，黄芩12克，青陈皮12克。局部每日换红粉纱条一次。2月17日：局部周围红肿已消，疼痛已止，有时局部有痒感如虫行，疮面肉芽组织红润，有少许脓液外溢。体温恢复正常，白细胞计数13,600/立方毫米，脓汁细菌培养结果为大肠杆菌，拟以理气活血、清热解毒为法。当归12克，青陈皮15克，全栝蒌15克，红花9克，金银花15克，公英15克，连翘15克，生甘草9克。局部换药同前。上方加减3剂后，疮口日渐变浅，疮面清洁，六天后疮口愈合，痊愈出院。
（《赵炳南临床经验集》）
【评按】此案除局部痈肿外，有发冷发热及内热症候。治以清热解毒、活血内托法，后配合切开排脓，局部红粉纱布填塞，其后则以解毒内托、理气活血为主。初诊时曾用铁箍散软膏围贴，有束毒追脓之功，临床用以疗痈疮、治诸般肿毒。赵氏运用多种医疗手段，在治法的配合和治疗层次的掌握方面颇有法度。
（四）疔疮
例一 王某某，男，62岁。门诊号：480388，初诊日期：1972年4月3日。右手肿胀疼痛两周。患者于两周前因玻璃刺入右手中指感染，局部出现红肿疼痛，手掌麻木，发烧38℃。经注射链霉素、卡那霉素，口服土霉素及中药，发热稍退，但手掌、手背肿胀逐渐明显，手指不能弯曲，肿势逐渐向上蔓延至手腕以上，疼痛难忍，右前臂麻木，恶心，食欲不振，自感手部骨痛，每日晚仍发烧至39℃以上。检查：右侧手掌及手背部肿胀明显，皮色微红，按之较硬且痛，稍有波动感，腋淋巴结可扪及、有触痛，白细胞计数14,200/立方毫米，上午体温37.9℃，晚上最高体温39℃以上。脉滑数，舌质红、苔黄腻。辨证：毒热壅滞，经络阻隔（托盘疔，生于手掌中心的疔疮）。治法：清热解毒，除湿通络。方药：金银花30克，公英30克，地丁30克，黄芩15克，赤芍9克，归尾9克，姜黄9克，白芷9克，佩兰9克，鸡血藤30克，霍香9克，酒军9克。4月26日：按上方加减治疗，手掌及手背肿胀基本消失，体温一直正常，中指仍肿胀，右上肢发麻仍未解，舌苔黄腻，脉沉，纳差，口苦，烧心，大便干、二三日一行，尿黄。进一步分析其病情，系因湿热与毒热交炽阻隔经络，缠绵日久。拟以活血通络、清热利湿为法。归尾12克，赤芍9克，桃仁9克，红花9克，白芷9克，公英12克，泽泻9克，霍香9克，泽兰9克，姜黄9克。按上方加减继服，5月19日复查时肿胀已消，嘱加强手部功能锻炼。
（《赵炳南临床经验集》）
例二 钟××，男，18岁。下颌部生疮3天。3天前下颌部发一小疹，翌日即灼热而痛，日渐扩大，疼痛发硬，影响咀嚼，伴有恶寒发热，食欲减退。曾用西药未愈。局部5x4厘米硬肿浸润，有数个脓头已破；流脓不多。舌质红，薄黄苔，脉弦数。辨证：疔疮散毒。治法：清热解毒。方药：银花，丹皮，生地，白芷，紫花地丁，栀子，蒲公英，连翘，黄芩。另服紫雪丹，每日三次，每次1.5克。外敷拨毒膏于疮顶，疮周厚围六合丹。两天后肿硬渐消，化脓溃破，继用清热解毒之剂内服，当脓排尽；乃用化腐生肌药方治之，共治二十天痊愈。附方：
(1) 拔毒膏：蓖麻子肉93克，上松香（研）、银朱（研）、轻粉（研）、樟脑（研）各15克，冰片（研）6克。制法略。
(2) 六合丹：大黄、黄柏各93克，薄荷叶、乌梅肉各46克，白芷18克，亮煤炭55克，面粉155克。制法略。
（吴介诚《疮疡经验录》）
例三 汪××，男，38岁。右口角生疮5天，面部发肿加重3天入院。5天前右上口角生一小疮，用手抓破，次日面部肿痛，畏寒发热，近3天肿痛加剧，不能张口进食，四天来大便未解，小便黄短，曾外敷草药未效。体温39℃，白细胞11,200/立方毫米，血片脓培养均为“金葡”生长。胸透：右胸腔大量积液。诊为败血症，用中西医结合治疗，因呼吸困难而作气管切开。中医以清热解毒、凉血养阴为治则。方药：银花，连翘，蒲公英，紫花地丁，赤芍，野菊花生地，丹皮，鲜芦根，石斛，花粉，乳香，大黄，甘草。另服紫雪丹，每天6次，每次1.5克。疮面用拔毒膏外敷，四周用六合丹围敷。3天后体温降至37℃左右，血培养阴转，大便仍燥结，脉数有力，精神好转。上方去野菊花、鲜芦根、花粉、乳香，加败酱草、川贝母、栝萎壳，紫雪丹改为每天服4次，每次1.5克。住院第8天，体温正常，治以清热解毒豁痰法：方药：银花，连翘，黄芩，黄连，紫花地丁，栝萎壳，浙贝，桔梗，花粉，甘草。局部处理同前，情况更趋好转，停服紫雪丹。住院18天患部疮口干净，停外用药。住院20天拔除气管切开插管，35天痊愈出院。
（吴介诚《疮疡经验录》）
例四 夏××，男，22岁。五天前右唇生一疖，挤压后高烧。诊断：唇痈、败血症，血培养证实。用大剂抗菌素、支持疗法、物理疗法，仍未效，转入昏迷，腋下体温40℃以上。中医会诊：面颊皆肿，壮热神昏，口噤不语，两手握固，目赤，上唇腐烂出血。辨证：疔毒走黄（疔疮毒邪走散入血，内攻脏腑的危重证候），毒陷心包。治法：清热解毒，芳香开窍。方药：紫花地丁60克，带心连翘15克，金银花30克，生甘草10克，川贝（去心）10克，丹皮6克，赤芍10克，黑山栀10克，钩藤（后下）10克。用水煎，冲入菊叶汁一杯，并调下紫雪丹3克，犀黄0.6克，鼻饲给药。外治：疮头掺黄升丹，贴黄连膏，掀肿处用金黄散外敷，委中穴放血。二诊：昨进药，次日下午体温37℃，神志较清，能讲一句话，治法原意扩充，药用：安宫牛黄丸2粒（研），西黄1克（研），犀角粉1克，分3次鼻饲，5小时一次。汤药：鲜生地30克，丹皮10克，赤芍10克，银花30克，地丁30克，天竺黄10克，川贝10克，带子青蒿10克，甘菊花10克，草河车10克，鲜竹叶30克，黛灯芯3扎，鲜菊叶汁一杯（冲），煎汤鼻饲，上唇腐烂用珠黄散和蜜调敷，其余外用药仍按原法。三诊：中西医治疗两天，体温、脉搏正常，神志清楚，壮热告退，目衄既止，唇内腐烂亦定，面目颈肿十去八九，口尚干渴，脉数未静，舌红苔黄，余邪未净，改用下方：银花藤30克，紫花地丁30克，连翘10克，甘菊10克，生甘草3克，赤芍10克，丹皮10克，黑山栀10克，黄芩10克，鲜生地30克，鲜野菊叶汁一杯，犀黄0.3克。会诊后5日，血培养(-)，第9日局部红肿基本消退，一般情况良好，能下床活动，以后单用西药调理一月左右出院。
（《许履和外科医案医话集》）
【评按】疔疮以其形小、根深、坚硬如钉状而命名。多由感染风邪火毒所致。《内经》并指出“膏梁之变”是疔疮的发病因素之一。根据其发于体表的不同部位，各自纷繁。疔疮发病急、变化快，初起如粟状，继则焮红发热，肿势渐增，疼痛剧烈，甚者疔毒走黄。治疗以清热解毒为大法。
(I) Neck Carbuncle (Jing Yong)
Zhang XX, male, 49 years old. Outpatient No.: 312013. Date of first visit: December 25, 1963. Seven days prior, a lump appeared on the neck with swelling and pain, diagnosed as Neck Carbuncle (an acute suppurative disease occurring in the neck). Penicillin injection was ineffective; the swelling gradually expanded and spontaneously ruptured, discharging pus. The patient felt feverish, bitter taste in the mouth, irritability, anorexia, yellow-red urine, and dry, hard stools. The pulse was surging, rapid, and forceful; the tongue body was red with a thick white coating. Examination: A swelling approximately 6x4 cm rose on the upper right posterior neck, with surrounding tissue erythema, obvious swelling, and tenderness. The wound surface had multiple small pustules, with an apricot-kernel-sized central opening discharging a small amount of purulent secretion. White blood cell count was 22,800/mm³, neutrophils 85%, lymphocytes 15%, urine sugar negative. Syndrome differentiation: Accumulation and excess of toxic heat, obstruction of Qi and Blood. Treatment method: Clear heat and detoxify, reduce swelling and discharge pus. Prescription: *Jinyin Teng* (Lonicerae Japonicae Caulis) 30g, *Gongying* (Taraxaci Herba) 18g, *Baijiang Cao* (Patriniae Herba) 9g, *Lianqiao* (Forsythiae Fructus) 12g, *Diding* (Violariae Herba) 12g, *Chishao* (Paeoniae Radix Rubra) 12g, *Chao Shan Jia* (Cochliae Carapax Preparatus) 9g, *Chao Zao Ci* (Gleditsiae Spina Preparata) 9g, *Huangqin* (Scutellariae Radix) 9g, *Danpi* (Moutan Cortex) 9g, *Baizhi* (Angelicae Dahuricae Radix) 3g, *Ruxiang* (Olibanum) 6g, *Moyao* (Myrrha) 6g, *Juhua* (Chrysanthemi Flos) 9g. Apply Jing Hongfen Ointment to the wound; apply Huadu San Ointment around the periphery. December 28: After taking three doses of the above prescription, the swelling continued to expand to 12x8 cm, pus drainage was poor, severe pain occurred, insomnia at night, irritability. Symptoms indicated blazing toxic heat with formed pus unable to drain externally. The treatment method should be to drain pus and support the expulsion of toxins. Continue the previous prescription adding *Guawei* (Trichosanthis Fructus) 30g, *Gongying* 30g. Under local anesthesia, perform a cross-incision debridement at the original wound site, extending deep to 2.5 cm. Use Hongfen gauze for drainage and apply Huadu San Ointment externally. December 29: Post-surgery pain significantly decreased, swelling gradually reduced, pus was viscous, drainage was patent. During dressing change, pus plugs and necrotic tissue were cleared. Symptoms included poor appetite, thirst, dry stools, epistaxis, lip vesicles, thick white coating, red tongue body, wiry-rapid pulse. Pus and toxins have drained, but pathogenic heat remains unresolved. Continue with formulas that clear heat, detoxify, support expulsion, and drain pus. Internal medicine adjusted from the December 28 formula; dressing changes remained the same. January 8: Purulent exudate on the wound decreased, swelling and pain subsided, granulation tissue was fresh. Dry mouth with thirst and poor appetite persisted. Tongue body red, slightly yellow coating, deep-slow pulse. This indicates pathogenic heat injuring Yin. Plan to nourish Yin and clear heat, assisted by harmonizing the Stomach. *Shengdi* (Rehmanniae Radix) 12g, *Yuanshen* (Scrophulariae Radix) 9g, *Baishao* (Paeoniae Radix Alba) 9g, *Jinyinhua* (Lonicerae Japonicae Flos) 9g, *Tianhuafen* (Trichosanthis Radix) 9g, *Jiao Maiya* (Hordei Fructus Germinatus Carbonisatus) 9g, *Jupi* (Citri Reticulatae Pericarpium) 6g, *Chao Baizhu* (Atractylodis Macrocephalae Rhizoma Preparatus) 9g, *Sheng Gancao* (Glycyrrhizae Radix et Rhizoma) 4.5g, *Shihu* (Dendrobii Caulis) 9g. January 14: Wound healed, subjective symptoms disappeared. Follow-up in October 1964 showed no abnormalities.
(From *Clinical Experience Collection of Zhao Bingnan*)
[Commentary] In this case, toxic heat accumulated excessively, obstructing Qi and Blood. At the first visit, the treatment focused on clearing heat, detoxifying, reducing swelling, and draining pus, using a modified *Xianfang Huoming Yin*. Due to subsequent expansion of swelling and inability of pus/toxins to drain externally, in addition to internal decoctions, surgical incision and debridement were performed with Hongfen gauze drainage, followed by continuous application of Huadu San Ointment to promote healing. The key to efficacy was the release of toxic heat, providing an exit for pathogens, rather than concluding with methods to nourish Yin, clear heat, and harmonize the Stomach.
(II) Zi Yong (Testicular/Paratesticular Abscess)
Case 1: Zhang XX, male, 30 years old. First visit: July 31, 1963. For four months, dull pain in both testes occurred during rainy weather, radiating to the shoulders when walking, even preventing squatting. Previously diagnosed as "epididymitis." Currently, the scrotum is coarse, large, and pendulous; the epididymis is swollen. Walking causes pulling pain in the lower abdomen, back soreness intolerable to prolonged standing, dizziness, yellow urine, and difficult urination. Pulse is wiry; tongue edges and tip are red with rough, greasy, thick coating. Syndrome differentiation: Liver Qi stagnation and failure to disperse, intermingling of damp-heat. Treatment method: Soothe the Liver and regulate Qi, clear heat and promote diuresis to remove dampness. Prescription: *Chibai Shao* (Red and White Paeonia Roots) 6g each, *Fen Danpi* (Moutan Cortex) 9g, *Ludouyi* (Phaseoli Semen) 9g, *Jie Yehe* (Citri Reticulatae Folium et Fructus) 9g each, *Sheng Zaoren* (Ziziphi Spinosomi Semen) 15g, *Chiling* (Poria) 12g, *Bajili* (Tribuli Fructus) 9g (spines removed), *Gengtongcao* (Tetrapanacis Medulla) 4.5g, *Jian Zexie* (Alismatis Rhizoma) 9g, *Sangjisheng* (Taxilli Caulis) 9g, *Rendongteng* (Lonicerae Japonicae Caulis) 9g, *Kuai Huashi* (Talcum) 9g (wrapped for decoction). Three doses. Second visit: (Omitted). Third visit: Testicular swelling softened; prolonged standing caused scrotal heaviness and pendulousness; other symptoms remained. This indicated damp-heat accumulation. Remove *Ludouyi* and *Bajili* from the previous formula, add *Peilan Geng* (Eupatorii Herba). Fourth visit: Testicular swelling gradually subsided, scrotum retracted, urine clear and free-flowing. Add *Chenpi* (Citri Reticulatae Pericarpium) 4.5g to the previous formula. Later, remove *Jie Yehe*, add *Zhi Cangzhu* (Atractylodis Rhizoma Preparatum), *Huai Shanyao* (Dioscoreae Rhizoma), and *Chuan Huangbai* (Phellodendri Chinensis Cortex). Take continuously for twelve doses until cured.
(From *Selected Experiences of Old TCM Practitioners in Shanghai*, Case Records of Zhang Zanchen. Organized by Zheng Sixiong et al.)
Case 2: Mao XX, male. Epididymitis caused by damp-heat. *Huangbai* (Phellodendri Chinensis Cortex) 5g, *Fen Danpi* 9g, *Dongkuizi* (Malvae Semen) 9g, *Niuxi* (Achyranthis Bidentatae Radix) 12g, *Zexie* (Alismatis Rhizoma) 9g, *Da Xiao Ji* (Cirsii Herba et Cynosuri Herba) 9g each, *Lizhihe* (Litchi Semen) 12g, *Sheng Cebeiye* (Platycladi Cacumen) 30g (decocted to replace water). Additionally: *Yinhua* (Lonicerae Japonicae Flos) 12g, *Sheng Zhizi* (Gardeniae Fructus) 9g, taken as tea. Second visit: For epididymitis, besides local therapy, clear cool heat, detoxify, and unblock bowel and bladder. *Yinhua* 12g, *Da Xiao Ji* 9g each, *Danpi* 9g, *Zhouxiu* (Paris Polyphyllae Rhizoma) 5g, *Tu Niuxi* (Cyathulae Radix) 9g, *Taoren* (Persicae Semen) 12g, *Xiakucao* (Prunellae Spica) 9g, *Juhua* (Chrysanthemi Flos) 9g, *Gongying* (Taraxaci Herba) 9g, *Fen Gancao* (Glycyrrhizae Radix et Rhizoma Preparatum) 9g, *Cheqianziye* (Plantaginis Semen et Folium) 9g each, *Gancao Shao* (Glycyrrhizae Radix et Rhizoma Caudex) 5g, *Sheng Shu Jinwen* (Rhei Radix et Rhizoma) 6g each, *Yuanmingfen* (Natrii Sulfas) 12g (taken in two divided doses). Third visit: Epididymitis not fully resolved, but less inflamed, red, and swollen than before. *Tufuling* (Polyporus Umbellatus) 24g, *Fengweicao* (Pteridis Multifidae Herba) 12g, *Sheng Zhizi* 9g, *Mabiancao* (Verbenae Herba) 12g, *Huangbai* 5g, *Yinhua* 15g, *Gongying* 9g, *Xiaoji* 9g, *Zhouxiu* 5g, *Shancigu* (Smilacis Glabrae Rhizoma) 3g (sliced). Fourth visit: Treating epididymitis essentially involves unblocking bowel and bladder; anti-inflammation is secondary. *Yuliren* (Pruni Semen) 9g (crushed), *Xiaoji* 10g, *Taoren Ni* (Persicae Semen Paste) 10g, *Kushen Pian* (Sophorae Flavescentis Radix Tablets) 5g, *Huangbai* 3g, *Gancao* 3g.
(From *Medical Cases of Zhang Cigong*)
[Commentary] Zi Yong corresponds to acute epididymo-orchitis or epididymitis. It is mostly caused by damp-heat pouring downward into the Liver meridians, leading to Qi and Blood stasis. The standard method uses *Longdan Xiegan Wan* to purge Liver heat, clear heat, and promote diuresis to remove dampness. Case 1 belongs to Liver Qi stagnation and intermingled damp-heat; since Liver fire is not excessive, the treatment focuses on soothing Liver Qi and clearing heat/dampness, representing a variation within standard methods. Case 2 is epididymitis, also differentiated in TCM as caused by damp-heat congestion. Treatment prioritizes unblocking bowel and bladder, assisting with clearing heat, detoxifying, and dissipating nodules. The purpose of unblocking bowel and bladder is to allow damp-heat toxins to be excreted through them; however, if the patient does not have difficulty defecating, laxative methods are unnecessary. Careful study of Dr. Zhang's prescriptions shows clear indications, pure medicinal selection, and specific efficacy, subjectively reflecting an intention to integrate Western pharmacology.
(III) Buttock Carbuncle (Gun Yong)
Yin XX, male, 32 years old. Outpatient No.: Long 0187. Date of first visit: February 13, 1968. Swelling, pain, and fever in the buttocks for eight days. History: Initially, a small red bump appeared on the buttock with mild itching and pain, gradually worsening, accompanied by chills and fever. Penicillin injections for several days were ineffective. Upon arrival, fever persisted, dry mouth, anorexia, dry stool, yellow-red urine. Local swelling and pain affected walking. Examination: Temperature 38.8°C; left buttock redness and swelling range approx. 8x5 cm, obvious burning heat, tenderness with refusal to press, slightly soft upon touch but fluctuation not obvious. Left lower limb movement restricted; left inguinal lymph nodes enlarged with tenderness. Lab tests: White blood cell count 30,000/mm³. Pulse wiry-rapid, coating yellow-thick, tongue body red. Syndrome differentiation: Toxic heat congestion, manifesting as Buttock Carbuncle (acute suppurative disease of the buttock). Treatment method: Clear heat and detoxify, invigorate Blood and internally support expulsion. Prescription: *Jinyinhua* (Lonicerae Japonicae Flos) 15g, *Gongying* (Taraxaci Herba) 15g, *Lianqiao* (Forsythiae Fructus) 12g, *Chishao* (Paeoniae Radix Rubra) 9g, *Baizhi* (Angelicae Dahuricae Radix) 9g, *Qing Chen Pi* (Green and Tangerine Peel) 12g, *Chao Shan Jia* (Cochliae Carapax Preparatus) 9g, *Chao Zao Ci* (Gleditsiae Spina Preparata) 9g. Externally apply Tie Gu San Ointment around the area. February 15: Temperature 38.6°C. After medication, buttock redness/swelling gradually receded, pain remained severe, worse at night. Local fluctuation obvious. Under local anesthesia, a small incision was made, draining approx. 100 ml of pus. Pack with Hongfen gauze. Continue with detoxifying and internally supporting formula. *Jinyinhua* 15g, *Gongying* 30g, *Lianqiao* 15g, *Huafen* (Trichosanthis Radix) 12g, *Diding* (Violariae Herba) 15g, *Danggui* (Angelicae Sinensis Radix) 9g, *Baijiang Cao* (Patriniae Herba) 15g, *Huangqin* (Scutellariae Radix) 12g, *Qing Chen Pi* 12g. Change Hongfen gauze locally once daily. February 17: Surrounding redness/swelling resolved, pain stopped, occasional itching like insects crawling on the local area. Wound granulation tissue ruddy-red, slight pus overflow. Temperature normalized, WBC 13,600/mm³. Pus culture grew E. coli. Plan: Regulate Qi, invigorate Blood, clear heat, detoxify. *Danggui* 12g, *Qing Chen Pi* 15g, *Quan Guawa* (Trichosanthis Fructus) 15g, *Honghua* (Carthami Flos) 9g, *Jinyinhua* 15g, *Gongying* 15g, *Lianqiao* 15g, *Sheng Gancao* (Glycyrrhizae Radix et Rhizoma) 9g. Dressing changes same as before. After three doses of modified formula, wound depth decreased daily, wound surface cleaned. Wound healed after six days; discharged cured.
(From *Clinical Experience Collection of Zhao Bingnan*)
[Commentary] Besides local carbuncle, this case presented chills, fever, and internal heat symptoms. Treatment used clearing heat, detoxifying, invigorating Blood, and internally supporting expulsion, later combined with incision and drainage, packing with Hongfen gauze, followed by detoxification, internal support, regulating Qi, and invigorating Blood. Initially, Tie Gu San Ointment was applied around the lesion to bind toxins and draw out pus, clinically used for carbuncles and various swellings. Dr. Zhao employed multiple medical means, demonstrating methodology in coordinating treatments and mastering therapeutic levels.
(IV) Ding Chuang (Carbuncle/Furuncle)
Case 1: Wang XX, male, 62 years old. Outpatient No.: 480388. Date of first visit: April 3, 1972. Right hand swelling and pain for two weeks. Two weeks prior, glass splinter entered right middle finger causing infection, local redness, swelling, pain, palm numbness, fever 38°C. Injected streptomycin, kanamycin; oral oxytetracycline and TCM. Fever subsided slightly, but palm/dorsum swelling became obvious, fingers unable to bend, swelling spread upward past wrist, unbearable pain, right forearm numbness, nausea, anorexia, sensation of bone pain in hand, evening fever >39°C. Examination: Right palm/dorsum obviously swollen, skin slightly red, hard and painful on pressure, slight fluctuation. Axillary lymph nodes palpable with tenderness. WBC 14,200/mm³. Morning temp 37.9°C, evening max >39°C. Pulse slippery-rapid, tongue body red, coating yellow-greasy. Syndrome differentiation: Toxic heat congestion, meridian obstruction (Pan Tao Ding, a carbuncle on the palm center). Treatment method: Clear heat, detoxify, remove dampness, unblock collaterals. Prescription: *Jinyinhua* 30g, *Gongying* 30g, *Diding* 30g, *Huangqin* 15g, *Chishao* 9g, *Guiwei* (Tail of Angelica Root) 9g, *Jianghuang* (Curcumae Longae Rhizoma) 9g, *Baizhi* 9g, *Peilan* (Agastaches Herba) 9g, *Jixueteng* (Spatholobi Caulis) 30g, *Huoxiang* (Pogostemonis Herba) 9g, *Jiu Jun* (Rhei Radix et Rhizoma prepared with wine) 9g. April 26: Modified treatment resulted in basic resolution of palm/dorsum swelling, temperature normal. Middle finger still swollen, right upper limb numbness unresolved. Coating yellow-greasy, pulse deep, poor appetite, bitter taste, heartburn, dry stool (once every 2-3 days), yellow urine. Further analysis: Damp-heat and toxic heat blazing together, obstructing meridians, lingering for long. Plan: Invigorate Blood, unblock collaterals, clear heat, promote diuresis to remove dampness. *Guiwei* 12g, *Chishao* 9g, *Taoren* 9g, *Honghua* 9g, *Baizhi* 9g, *Gongying* 12g, *Zexie* 9g, *Huoxiang* 9g, *Zelan* (Lycopus Herba) 9g, *Jianghuang* 9g. Continue modified formula. May 19 follow-up: Swelling resolved. Advised to strengthen hand functional exercise.
(From *Clinical Experience Collection of Zhao Bingnan*)
Case 2: Zhong XX, male, 18 years old. Sore on mandible for 3 days. Small rash appeared on mandible 3 days ago, next day became burning/painful, gradually expanding, hardening, affecting chewing. Accompanied by aversion to cold, fever, reduced appetite. Western medicine ineffective. Local 5x4 cm indurated infiltration, several pus heads ruptured; little pus flow. Tongue body red, thin yellow coating, wiry-rapid pulse. Syndrome differentiation: Dispersing toxicity of Ding Chuang. Treatment method: Clear heat, detoxify. Prescription: *Yinhua* (Lonicerae Japonicae Flos), *Danpi* (Moutan Cortex), *Shengdi* (Rehmanniae Radix), *Baizhi* (Angelicae Dahuricae Radix), *Zihua Diding* (Violariae Herba), *Zhizi* (Gardeniae Fructus), *Gongying* (Taraxaci Herba), *Lianqiao* (Forsythiae Fructus), *Huangqin* (Scutellariae Radix). Additionally take *Zixue Dan* (Purple Snow Pill), three times daily, 1.5g each time. Apply Bodu Gao (Toxin-Drawing Ointment) on the head of the sore; surround with Liuhe Dan (Six-Harmony Powder). Two days later, induration/swelling gradually subsided, suppuration and rupture occurred. Continue internal heat-clearing, detoxifying agents. When pus exhausted, use rot-resolving, muscle-regenerating formula. Total 20 days to cure. Attached Formulas:
(1) Bodu Gao: *Bimazi Rou* (Castoris Semen Flesh) 93g, *Shang Songxiang* (Pini Resina), *Yinzhu* (Cinnabar), *Qingfen* (Calomelas), *Zhangnao* (Borneolum Syntheticum) each 15g (ground), *Bingpian* (Borneolum Syntheticum) 6g (ground). Preparation omitted.
(2) Liuhe Dan: *Dahuang* (Rhei Radix et Rhizoma), *Huangbai* (Phellodendri Chinensis Cortex) each 93g, *Bohe Ye* (Menthae Haplocalycis Folium), *Wumei Rou* (Mume Fructus Flesh) each 46g, *Baizhi* 18g, *Liang Meitan* (Charcoal) 55g, *Mianfen* (Farina Tritici) 155g. Preparation omitted.
(Wu Jiecheng *Experience Record of Sores and Ulcers*)
Case 3: Wang XX, male, 38 years old. Sore on right corner of mouth for 5 days, facial swelling worsened for 3 days upon admission. Small sore appeared on upper right corner of mouth 5 days ago, scratched by hand. Next day facial swelling/pain, chills/fever. Severe swelling/pain in last 3 days, unable to open mouth/eat. No stool for 4 days, short yellow urine. External herbal application ineffective. Temp 39°C, WBC 11,200/mm³, blood smear/pus culture positive for "Staph aureus". Chest X-ray: Large effusion in right thoracic cavity. Diagnosed as sepsis; treated with integrated Chinese-Western medicine. Tracheotomy performed due to dyspnea. TCM principle: Clear heat, detoxify, cool Blood, nourish Yin. Prescription: *Yinhua*, *Lianqiao*, *Gongying*, *Zihua Diding*, *Chishao*, *Yejuhua Shengdi* (Wild Chrysanthemum Flower and Rehmannia Root), *Danpi*, *Xian Lugen* (Fresh Reed Rhizome), *Shihu* (Dendrobii Caulis), *Huafen* (Trichosanthis Radix), *Ruxiang* (Olibanum), *Dahuang* (Rhei Radix et Rhizoma), *Gancao* (Glycyrrhizae Radix et Rhizoma). Additionally take *Zixue Dan*, six times daily, 1.5g each time. Apply Bodu Gao on wound; surround with Liuhe Dan. Three days later, temp dropped to ~37°C, blood culture negative, stool still dry, pulse rapid-forceful, spirit improved. Remove *Yejuhua*, *Xian Lugen*, *Huafen*, *Ruxiang*; add *Baijiang Cao*, *Chuan Beimu* (Fritillariae Thunbergii Bulbus), *Guawe Qiao* (Trichosanthis Fructus Pericarpium). Reduce *Zixue Dan* to four times daily, 1.5g each time. Day 8 hospitalization: Temp normal. Treatment: Clear heat, detoxify, resolve phlegm. Prescription: *Yinhua*, *Lianqiao*, *Huangqin*, *Huanglian* (Coptidis Rhizoma), *Zihua Diding*, *Guawe Qiao*, *Zhe Bei* (Fritillariae Thunbergii Bulbus), *Jiegeng* (Platycodonis Radix), *Huafen*, *Gancao*. Local care same. Condition improved further; stop *Zixue Dan*. Day 18: Wound clean, stop external meds. Day 20: Tracheotomy tube removed. Day 35: Discharged cured.
(Wu Jiecheng *Experience Record of Sores and Ulcers*)
Case 4: Xia XX, male, 22 years old. Furuncle on right lip 5 days ago, high fever after squeezing. Diagnosis: Lip Carbuncle, Sepsis (confirmed by blood culture). High-dose antibiotics, supportive therapy, physical therapy ineffective. Entered coma, axillary temp >40°C. TCM consultation: Cheeks swollen, high fever with confusion, jaw locked/unable to speak, hands clenched, eyes red, upper lip rotten/bleeding. Syndrome differentiation: Ding Du Zouhuang (Carbuncle toxin spreading into blood/internal attack on organs), toxin trapped in Heart Bao (Pericardium). Treatment method: Clear heat, detoxify, aromatic opening of orifices. Prescription: *Zihua Diding* 60g, *Dai Xin Lianqiao* (Forsythiae Fructus with heart) 15g, *Jinyinhua* 30g, *Sheng Gancao* 10g, *Chuanbei* (Fritillariae Thunbergii Bulbus, heart removed) 10g, *Danpi* 6g, *Chishao* 10g, *Hei Shanzhi* (Gardeniae Fructus Charred) 10g, *Gouteng* (Uncariae Ramulus cum Uncis) 10g (added late). Decoct in water, mix in one cup of Chuye Juice, and administer *Zixue Dan* 3g and *Xihuang* (Moschus) 0.6g via nasogastric tube. External treatment: Sprinkle Huangsheng Dan on sore head, apply Huanglian Gao, apply Jinhuang San on swollen area, bleed Weizhong points. Second visit: Medication taken yesterday; afternoon temp 37°C, consciousness clearer, able to speak one sentence. Expand original treatment intent. Medications: *Angong Niuhuang Wan* (An-Gong Niu-Huang Pills) 2 pills (ground), *Xihuang* 1g (ground), *Xijiao Fen* (Rhinocerotis Cornu Powder) 1g, divide into 3 nasogastric doses, every 5 hours. Decoction: *Xian Shengdi* (Fresh Rehmannia Root) 30g, *Danpi* 10g, *Chishao* 10g, *Yinhua* 30g, *Diding* 30g, *Tianzhuhuang* (Bambusae Concretio Silicea) 10g, *Chuanbei* 10g, *Dai Zi Qinghao* (Artemisiae Annuae Herba with seeds) 10g, *Gan Juhua* (Chrysanthemi Flos) 10g, *Caoheche* (Isatidis Radix) 10g, *Xian Zhuye* (Fresh Bamboo Leaf) 30g, *Dai Dengxin* (Junci Medulla Dyed Black) 3 bundles, *Xian Juye Zhi* (Fresh Chrysanthemum Leaf Juice) 1 cup (mixed), decoct for nasogastric administration. Apply Zhuhuang San mixed with honey to rotten upper lip; other external meds remain same. Third visit: After 2 days of integrated treatment, temp/pulse normal, consciousness clear, high fever receded, eye bleeding stopped, lip rot stabilized, facial/neck swelling reduced by 80-90%. Mouth still dry/thirsty, pulse rapid unsettled, tongue red/yellow coating, residual pathogens not cleared. Switch to below formula: *Yinhua Teng* (Lonicerae Japonicae Caulis) 30g, *Zihua Diding* 30g, *Lianqiao* 10g, *Gan Ju* (Chrysanthemi Flos) 10g, *Sheng Gancao* 3g, *Chishao* 10g, *Danpi* 10g, *Hei Shanzhi* 10g, *Huangqin* 10g, *Xian Shengdi* 30g, *Xian Ye Juye Zhi* (Fresh Wild Chrysanthemum Leaf Juice) 1 cup, *Xihuang* 0.3g. 5 days post-consultation: Blood culture negative. Day 9: Local redness/swelling basically resolved, general condition good, able to get out of bed. Later managed with Western medicine alone for about a month before discharge.
(From *Surgical Medical Cases and Conversations Collection of Xu Lühe*)
[Commentary] Ding Chuang is named for its small shape, deep root, and hardness like a nail. It is mostly caused by infection with Wind Evil and Fire Toxin. The *Neijing* also points out that "changes from rich/greasy food" is one of the pathogenic factors for Ding Chuang. Depending on the different locations on the body surface, they vary greatly. Ding Chuang has acute onset and rapid changes; initially like millet grains, then becomes red-hot, swelling increases, pain is severe, and severely, the toxin may spread (Zouhuang). Treatment primarily focuses on clearing heat and detoxifying.