鹳口疽生尻尾尖，经属督脉湿痰源，肿如鱼肫溃鹳嘴，少壮易愈老难痊。
【注】此证一名锐疽，生于尻尾骨尖处。初肿形如鱼肫，色赤坚痛，溃破口若鹳嘴，属
督脉经，由湿痰流结所致。朝寒暮热，夜重日轻，溃出稀脓为不足；或流稠脓鲜血为有
余。少壮可愈，老弱难敛，易于成漏。初起宜滋阴除湿汤以和之；已成不得内消者，用
和气养荣汤以托之；气血虚弱，溃而敛迟者，滋肾保元汤以补之。若失治久而不敛者，宜
服先天大造丸；兼服琥珀蜡矾丸，久久收敛。外治法按痈疽肿疡、溃疡门。
\r鹳口疽图\p04-34a174.bmp\r
滋阴除湿汤
当归 熟地 川芎 白芍（酒炒，各一钱）
陈皮 柴胡 知母 贝母（去心，研） 黄芩（各八分） 泽泻 地骨皮 甘草（生，各五分）
水二盅，姜三片，煎八分，食前服。
【方歌】滋阴除湿鹳口疽，退热消痰初起宜，四物陈柴知母草，泽泻黄芩地骨皮。
和气养荣汤
人参 白术（土炒） 白茯苓 丹皮 陈皮 熟地 当归 黄 （各一钱） 沉香 甘草（炙，各五分）
水二盅，煎八分，食前服。
【方歌】和气养荣托锐疽，将脓煎服溃更宜，四君丹皮陈熟地，当归沉香共黄 。
滋肾保元汤
人参 白术（土炒） 白茯苓 当归身 熟地 黄 山萸肉 丹皮 杜仲（各一钱） 肉
桂附子（制） 甘草（炙，各五分）
水二盅，姜三片、红枣肉二枚、建莲子
七个去心，煎八分，食前服。
【方歌】滋肾保元溃后虚，敛迟脓清水淋漓，十全大补除芎芍，山萸附子杜丹皮。
先天大造丸
人参 白术（土炒） 当归身 白茯苓 菟丝子 枸杞 黄精 牛膝（各二两） 补骨脂（炒）
骨碎补（去毛，微炒） 巴戟肉 远志（去心，各一两）
广木香 青盐（各五钱） 丁香（以上共研末，三钱） 熟地（酒煮，捣膏，四两） 仙茅（浸
去赤汁，蒸熟，去皮，捣膏） 何首乌（去皮，黑豆同煮，去豆，捣膏） 胶枣肉（捣膏，各二两）
肉苁蓉（去鳞并内膜，酒浸捣膏） 紫河车（白酒煮烂捣膏，一具，以上六膏共入前药末内）
上为细末，捣膏共合一处，再加炼过白蜂蜜为丸，如梧桐子大。每服七十丸，空心温酒送下。
【方歌】先天大造补气血，专治痈疽溃后虚，脓水清稀难收敛。参术归苓地首乌，补
骨青盐骨碎补，枸杞黄精远菟丝，巴戟仙茅丁木枣，河车牛膝苁蓉俱。
琥珀蜡矾丸（见肿疡门）
鹳口疽生于尾椎骨尖端，归属于督脉，病因为湿痰蕴结。肿胀形状如同鱼肚（鱼肫），溃破后创口形似鹳鸟之嘴，年少体壮者容易痊愈，年老体弱者难以治愈。
【注】此证又名锐疽，生长在尾椎骨尖处。初起时肿胀形状像鱼肚，颜色红赤、坚硬且疼痛，溃破后开口如同鹳嘴，属于督脉经，由湿痰流注凝结所致。早晨怕冷傍晚发热，夜间症状重白天轻，若溃破流出稀薄脓液为正气不足；若流出稠厚脓液和鲜血为邪气有余。年少体壮者可愈，年老体弱则难愈合，容易形成瘘管。初起宜用滋阴除湿汤调和；已成脓且不能内消者，用和气养荣汤托毒外出；气血虚弱，溃破后收敛迟缓者，用滋肾保元汤补益。若失治日久不愈合者，宜服用先天大造丸；兼服琥珀蜡矾丸，长期服用以促使疮口收敛。外治法参照痈疽肿疡、溃疡章节的方法。
滋阴除湿汤
当归、熟地黄、川芎、白芍（酒炒，各一钱）、陈皮、柴胡、知母、贝母（去心，研碎）、黄芩（各八分）、泽泻、地骨皮、甘草（生用，各五分）。
用水两盅，生姜三片，煎至八分，饭前服用。
【方歌】滋阴除湿治鹳口疽，退热消痰在初起适宜，四物汤加陈皮、柴胡、知母、甘草，再加泽泻、黄芩、地骨皮。
和气养荣汤
人参、白术（土炒）、白茯苓、牡丹皮、陈皮、熟地黄、当归、黄芪（各一钱）、沉香、甘草（炙用，各五分）。
用水两盅，煎至八分，饭前服用。
【方歌】和气养荣汤托出锐疽，将成脓或已溃时煎服更适宜，四君子汤加丹皮、陈皮、熟地，当归与沉香共配黄芪。
滋肾保元汤
人参、白术（土炒）、白茯苓、当归身、熟地黄、黄芪、山茱萸肉、牡丹皮、杜仲（各一钱）、肉桂、附子（制）、甘草（炙用，各五分）。
用水两盅，生姜三片、红枣肉二枚、建莲子七个（去心），煎至八分，饭前服用。
【方歌】滋肾保元汤治疗溃后虚证，收敛迟缓脓水清稀淋漓，十全大补汤去掉川芎、白芍，加上山茱萸、附子、杜仲、牡丹皮。
先天大造丸
人参、白术（土炒）、当归身、白茯苓、菟丝子、枸杞子、黄精、牛膝（各二两）、补骨脂（炒）、骨碎补（去毛，微炒）、巴戟天肉、远志（去心，各一两）、广木香、青盐（各五钱）、丁香（以上共研为细末，三钱）、熟地黄（酒煮，捣成膏，四两）、仙茅（浸去红色汁液，蒸熟，去皮，捣成膏）、何首乌（去皮，与黑豆同煮，去豆，捣成膏）、胶枣肉（捣成膏，各二两）、肉苁蓉（去鳞并内膜，酒浸捣成膏）、紫河车（白酒煮烂捣成膏，一具，以上六味药膏共同加入前面的药末中）。
以上药物制成细末，将药膏混合一处，再加入炼过的白蜂蜜制成丸药，大小如梧桐子。每次服用七十丸，空腹时用温酒送下。
【方歌】先天大造丸补益气血，专门治疗痈疽溃后虚证，脓水清稀难以收敛。人参、白术、当归、茯苓、熟地、何首乌，补骨脂、青盐、骨碎补，枸杞、黄精、远志、菟丝子，巴戟天、仙茅、丁香、木香、胶枣，紫河车、牛膝、肉苁蓉皆在其中。
Guankou Ju (Swan's Mouth Carbuncle) arises at the tip of the coccyx, belonging to the Du Meridian (Governing Vessel), with its etiology rooted in Damp-Phlegm accumulation. The swelling resembles a fish gizzard; upon ulceration, the opening looks like a swan's beak. It is easily cured in the young and vigorous but difficult to heal in the elderly and weak.
[Note] This condition is also known as Rui Ju (Sharp Carbuncle), occurring at the tip of the coccyx. Initially, the swelling resembles a fish gizzard, appearing red, hard, and painful. Upon ulceration, the opening resembles a swan's beak. It belongs to the Du Meridian (Governing Vessel) and is caused by the flow and accumulation of Damp-Phlegm. There is morning chills and evening fever, with symptoms worsening at night and improving during the day. If thin pus is discharged after ulceration, it indicates Deficiency; if thick pus and fresh blood are discharged, it indicates Excess. The young and strong can recover, while the old and weak have difficulty healing and are prone to forming fistulas. At the initial stage, Ziyin Chushi Tang (Nourish Yin and Dispel Dampness Decoction) should be used to harmonize; if the abscess has formed and cannot resolve internally, Heqi Yangrong Tang (Harmonize Qi and Nourish Blood Decoction) should be used to expel toxins; for those with Qi and Blood deficiency who heal slowly after ulceration, Zishen Baoyuan Tang (Nourish Kidney and Preserve Origin Decoction) should be used to tonify. If neglected and failing to heal over time, Xiantian Dazao Wan (Pre-heaven Great Creation Pill) should be taken; combined with Hupo Lafan Wan (Amber Beeswax Alum Pill), long-term use will promote healing. External treatment follows the methods for Tumors/Abscesses (Yong Ju) in the Swelling/Ulcer chapters.
Ziyin Chushi Tang (Nourish Yin and Dispel Dampness Decoction)
Danggui (Angelicae Sinensis Radix), Shudi (Rehmanniae Radix Praeparata), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba, stir-fried with wine, each 1 qian), Chenpi (Citri Reticulatae Pericarpium), Chaihu (Bupleuri Radix), Zhimu (Anemarrhenae Rhizoma), Beimu (Fritillariae Thunbergii Bulbus, heart removed, ground), Huangqin (Scutellariae Radix, each 8 fen), Zexie (Alismatis Rhizoma), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma, raw, each 5 fen).
Add two cups of water and three slices of Shengjiang (Zingiberis Rhizoma Recens). Decoct until eight-tenths remain. Take before meals.
[Formula Song] Ziyin Chushi treats Guankou Ju, suitable for reducing heat and resolving phlegm in the early stage; Siwu Tang combined with Chenpi, Chaihu, Zhimu, and Gancao, plus Zexie, Huangqin, and Digupi.
Heqi Yangrong Tang (Harmonize Qi and Nourish Blood Decoction)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Baifuling (Poria, white part), Danpi (Moutan Cortex), Chenpi (Citri Reticulatae Pericarpium), Shudi (Rehmanniae Radix Praeparata), Danggui (Angelicae Sinensis Radix), Huangqi (Astragali Radix, each 1 qian), Chenxiang (Aquilariae Lignum Resinatum), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 5 fen).
Add two cups of water. Decoct until eight-tenths remain. Take before meals.
[Formula Song] Heqi Yangrong expels Rui Ju, suitable for decocting and taking when pus is about to form or has already ulcerated; Sijunzi Tang combined with Danpi, Chenpi, and Shudi, along with Danggui, Chenxiang, and Huangqi.
Zishen Baoyuan Tang (Nourish Kidney and Preserve Origin Decoction)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Baifuling (Poria, white part), Dangguishen (Angelicae Sinensis Radix, root body), Shudi (Rehmanniae Radix Praeparata), Huangqi (Astragali Radix), Shanyurou (Corni Fructus), Danpi (Moutan Cortex), Duzhong (Eucommiae Cortex, each 1 qian), Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 5 fen).
Add two cups of water, three slices of Shengjiang (Zingiberis Rhizoma Recens), two pieces of Hongzao (Jujubae Fructus pulp), and seven Jianlianzi (Nelumbinis Semen, hearts removed). Decoct until eight-tenths remain. Take before meals.
[Formula Song] Zishen Baoyuan treats post-ulceration deficiency, where healing is slow and pus/water is clear and dripping; Shiquan Dabu Tang minus Chuanxiong and Baishao, plus Shanyurou, Fuzi, Duzhong, and Danpi.
Xiantian Dazao Wan (Pre-heaven Great Creation Pill)
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil), Dangguishen (Angelicae Sinensis Radix, root body), Baifuling (Poria, white part), Tusizi (Cuscutae Semen), Gouqi (Lycii Fructus), Huangjing (Polygonati Rhizoma), Niuxi (Achyranthis Bidentatae Radix, each 2 liang), Buguzhi (Psoraleae Fructus, stir-fried), Gusui (Drynariae Rhizoma, hairs removed, lightly stir-fried), Bajirou (Morindae Officinalis Radix, meat part), Yuanzhi (Polygalae Radix, hearts removed, each 1 liang), Guangmuxiang (Aucklandiae Radix), Qingyan (Natrii Chloridum, each 5 qian), Dingxiang (Caryophylli Flos, above three ground together into powder, 3 qian), Shudi (Rehmanniae Radix Praeparata, boiled in wine, pounded into paste, 4 liang), Xianmao (Curculiginis Rhizoma, soaked to remove red juice, steamed, peeled, pounded into paste), Heshouwu (Polygoni Multiflori Radix, peeled, boiled with black soybeans, beans removed, pounded into paste), Jiazaorou (Jujubae Fructus pulp, pounded into paste, each 2 liang), Rongrongrou (Cistanches Herba, scales and inner membrane removed, soaked in wine, pounded into paste), Ziheche (Placenta Humana, boiled in white wine until soft, pounded into paste, one placenta, above six pastes combined with the previous powders).
Grind all into fine powder. Mix with the pastes. Add refined white honey to form pills the size of wutong seeds. Take 70 pills per dose, swallowed with warm wine on an empty stomach.
[Formula Song] Xiantian Dazao tonifies Qi and Blood, specifically treating post-ulceration deficiency from Tumors/Abscesses where pus/water is clear and thin and difficult to heal. Renshen, Baizhu, Danggui, Fuling, Shudi, Heshouwu, Buguzhi, Qingyan, Gusui, Gouqi, Huangjing, Yuanzhi, Tusizi, Bajiji, Xianmao, Dingxiang, Muxiang, Jiazaorou, Ziheche, Niuxi, and Rongrongrou are all included.
Hupo Lafan Wan (Amber Beeswax Alum Pill) (See Swelling Chapter)