多骨疽由肾虚源，疮久肿溃复受寒，落草患此胎元结，名为骨胀治一般。
【注】此证一名剩骨，一名朽骨，无论老少，皆有生者，多在腮 牙床、眼胞颏下
手足、腿膊等处，有因肾虚之人，生疮久溃，肿硬不退，口不收敛，外被寒邪袭入，与脓
毒凝结，借人之气血化成多骨者；又有初生落草，身肉之中，按之有如脆骨，由胎元受
之精血交错而致，迨其人长大后，必于脆骨所生之处，突然发肿生疽，及溃破后，多骨
脱出，其口方收。有多骨出之不休者，名曰
骨胀，难愈。以上二因，治法皆同，俱宜隔附子饼艾灸，以宣寒凝，令骨速脱。盖骨属
肾，遇寒则凝，故从热治也。若朽骨内含，或出臭脓，或出涎泡，宜撒黄灵药，陀僧膏
盖贴，令朽骨出尽，其口始易敛也，肾虚微寒者，服六味地黄丸；虚而寒甚者，桂附地
黄丸常服可愈。由胎元结成者，禀赋身虚，不可强取多骨，候自破则取之。
\r多骨疽图\p04-34a233.bmp\r
附子饼灸法（贝首卷灸法）
黄灵药 陀僧膏（俱见溃疡门）
六味地黄丸（见面部雀斑）
桂附地黄丸（见面部颊疡）
结核即同果核形，皮里膜外结凝成，或由风火气郁致，或因怒火湿痰生。
【注】此证生于皮里膜外，结如果核，坚而不痛，由风火气郁，结聚而生，初发令人
寒热往来，有表证者，荆防败毒散解之；表既解，即服连翘消毒饮，若湿痰气郁凝结者，
宜行气化痰，以五香流气饮、《千金》指迷丸辛凉之药治之，其核自消；若误投苦寒之
剂，必至溃破，或服之而反甚者，其势将溃，不可强消，以耗其气，宜用透脓散。溃而不
愈者，属气虚，宜用补中益气汤平补之。外治按痈疽肿疡、溃疡门。
\r结核图\p04-34a234.bmp\r
《千金》指迷丸
半夏（制，四两） 白茯苓 枳壳（麸炒，各三两） 风化硝（三钱）
共研为末，河水煮糊为丸，如梧桐子大，每服二钱，白滚水送下。
【方歌】《千金》指迷丸半夏，茯苓枳壳硝同砑，河水煮糊作成丸，消坚去核结痰化。
荆防败毒散（见项部脑疽）
连翘消毒饮（见背部酒毒发）
五香流气饮（见胫部黄鳅痈）
透脓散（见肿疡门）
补中益气汤（见溃疡门）
多骨疽源于肾气亏虚，疮疡日久溃烂后再次感受寒邪所致；婴儿出生时患此病，是因胎元中精气凝结而成，称为“骨胀”，其治疗方法与上述情况相同。
【注】此证又名剩骨、朽骨，无论老少都可能发生，多见于腮部、牙床、眼睑、下巴、手足、手臂及腿部等处。有的因肾气虚弱之人，生疮日久溃烂，肿胀坚硬不退，伤口不收敛，外部寒邪侵入，与脓毒凝结，借助人体气血化生为多余骨骼；也有刚出生时，身体肌肉之中，触摸有类似脆骨的感觉，这是由于胎元受精血交错影响所致，等到此人长大后，必然在脆骨所在之处突然肿胀生疽，破溃后多余骨骼脱出，伤口才能愈合。有多余骨骼不断排出的，称为骨胀，难以治愈。以上两种病因，治疗方法相同，都适宜用隔附子饼艾灸，以宣散寒凝，促使骨骼尽快脱落。因为骨属于肾，遇寒则凝滞，所以从热性方法治疗。如果朽骨内含，或流出臭脓，或流出涎泡，宜撒布黄灵药，用陀僧膏覆盖贴敷，令朽骨排尽，伤口才容易收敛。肾气虚兼微寒者，服用六味地黄丸；虚而寒甚者，常服桂附地黄丸可愈。由胎元结成者，禀赋身体虚弱，不可强行取出多余骨骼，等待其自然破溃后再取出。
结核形状如同果核，生于皮里膜外，结聚凝成，或由风火气郁导致，或因怒火湿痰生成。
【注】此证生于皮里膜外，结块如果核，坚硬但不疼痛，由风火气郁结聚而生，初发时令人寒热往来，有表证的，用荆防败毒散解表；表证既解，即服用连翘消毒饮，若湿痰气郁凝结者，宜行气化痰，用五香流气饮、《千金》指迷丸等辛凉药物治疗，其核自消；若误投苦寒之剂，必致溃破，或服用后反而加重，其势将溃，不可强行消散，以免耗伤正气，宜用透脓散。溃破后不愈者，属气虚，宜用补中益气汤平补。外治按痈疽肿疡、溃疡门处理。
《千金》指迷丸
半夏（制，四两） 白茯苓 枳壳（麸炒，各三两） 风化硝（三钱）
共研为末，河水煮糊为丸，如梧桐子大，每服二钱，白滚水送下。
Mutilated Bone Abscess (Duogu Ju) originates from Kidney deficiency. After a sore has been ulcerated for a long time, it is re-exposed to cold pathogens. Infants suffering from this condition at birth have it due to the conglomeration of essence and blood in the fetal origin. It is named "Bone Distension" (Gu Zhang), and its treatment is generally the same as that described above.
[Note] This condition is also known as Remaining Bone (Sheng Gu) or Rotten Bone (Xiu Gu). It can occur in people of any age, mostly appearing on the cheeks, gums, eyelids, chin, hands, feet, arms, and legs. In some cases, individuals with Kidney deficiency suffer from sores that ulcerate for a long time; the swelling remains hard without subsiding, and the wound fails to close. External cold pathogens invade and condense with pus and toxins, utilizing the body's Qi and Blood to transform into extra bones. In other cases, newborns feel brittle bone-like structures upon palpation within their flesh, caused by the intermingling of essence and blood during fetal development. When these individuals grow up, sudden swelling and abscess formation will inevitably occur at the site of the brittle bone. After rupture, the extra bones are expelled, and only then does the wound heal. If extra bones continue to be discharged indefinitely, it is called Bone Distension (Gu Zhang), which is difficult to cure. For both causes mentioned above, the treatment method is identical: moxibustion with Aconite Cake (Fuzi Bing) is suitable to disperse cold stagnation and facilitate the rapid expulsion of the bones. Since bones belong to the Kidney and coagulate when exposed to cold, heat-based treatments are employed. If rotten bone is retained internally, or if foul-smelling pus or salivary blisters are discharged, apply Huang Ling Yao (Yellow Spirit Medicine) and cover with Tuoseng Gao (Lead Monoxide Ointment) to ensure complete expulsion of the rotten bone, after which the wound will easily contract. For those with slight Kidney deficiency and cold, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) should be taken; for severe deficiency with cold, Guifu Dihuang Wan (Cinnamon Twig and Aconite Rehmannia Pill) taken regularly can lead to recovery. For cases formed by fetal origin conglomeration, where constitution is weak, forcibly removing the extra bones is contraindicated; one should wait for natural rupture before removal.
Tubercles (Jiehe) resemble fruit pits, forming through condensation between the skin and fascia. They may result from Wind-Fire and Qi stagnation, or from Liver Fire and Damp-Phlegm accumulation.
[Note] This condition arises between the skin and fascia, forming nodules like fruit pits that are hard but painless. It is generated by the aggregation of Wind-Fire and Qi stagnation. Initially, it causes alternating chills and fever with exterior syndrome signs; Jingfang Baidu San (Aucklandia and Saposhnikovia Decoction) is used to resolve the exterior. Once the exterior is resolved, Liaoqiao Xiaodu Yin (Forsythia Detoxification Decoction) is administered. If caused by Damp-Phlegm and Qi stagnation condensation, methods to move Qi and transform Phlegm should be used, treating with Wuxiang Liqi Yin (Five-Aroma Qi-Flowing Decoction) or Qianjin Zhimi Wan (Thousand Gold Pill to Guide the Lost) from the *Qianjin Fang*, which are acrid-cool formulas, causing the nodules to dissipate spontaneously. If bitter-cold agents are mistakenly prescribed, ulceration will inevitably occur, or symptoms may worsen; if the momentum indicates impending ulceration, forced resolution is contraindicated as it depletes Qi; instead, Tou Nong San (Pus-Penetrating Powder) should be used. If ulceration fails to heal, it indicates Qi deficiency, and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used for mild tonification. External treatment follows the protocols for Sores, Ulcers, Swelling, and Open Wounds sections.
Qianjin Zhimi Wan (Thousand Gold Pill to Guide the Lost)
Prepared Pinellia Rhizome (Banxia, 4 liang), White Poria (Baifuling), Fried Aurantium Fruit (Zhike, bran-fried, each 3 liang), Weathered Nitre (Fenghua Xiao, 3 qian).
Grind all into powder, make pills using rice paste boiled in river water, sized like paulownia seeds. Take 2 qian per dose, washed down with plain boiling water.
[Prescription Verse] Qianjin Zhimi Wan contains Banxia, Fuling, Zhike, and Xiao ground together; boiled in river water to form pills, they dissolve hardness, remove nodules, and transform phlegm.