（附结核，凡结核当与瘰 参看）
《内经》云∶肝统筋而藏血，心里血而主脉，脾主肉而统血，肺主气而司腠理，肾统骨
而主
味地黄丸、四物、山栀、木瓜之类。若劳役火动，阴血沸腾，外邪所搏而为肿者，其自肌
肉肿起，久而有赤缕，或皮俱赤，名曰血瘤，用四物、茯苓、远志之类。若郁结伤脾，肌肉
消薄，外邪所搏而为肿者，其自肌肉肿起，按之实软，名曰肉瘤，用归脾、益气二汤。若劳
伤肺气，腠理不密，外邪所搏而壅肿者，其自皮肤肿起，按之浮软，名曰气瘤，用补中益气
之类。若劳伤肾水，不能荣骨而为肿者，其自骨肿起，按之坚硬，名曰骨瘤，用地黄丸，及
补
。大凡属肝胆二经结核，八珍加山栀、胆草，以养气血清肝火
；六味丸以养肺金生肾水。若属肝火血燥，须生血凉血，用四物、生地、丹皮、酒炒黑胆草
、山栀。中气虚者，补中益气兼服。若治失其法，脾胃亏损，营气虚弱，不能濡于患处；或
寒气凝于疮口，荣气不能滋养于患处；以致久不生肌，而成漏者，悉调补脾胃，则气血壮而
肌肉自生矣。若不慎起居及七情六淫，或用寒凉蚀药、蛛丝缠、芫花线等法，以治其外，则
治验
长州庠王天爵，辛丑春，左腿近环跳患之，状如大桃，按之濡软，恪服除湿流气化痰之
剂，
于胆经部分，乃肺金侮肝木，元气亏损，而其脓已内溃矣。遂用十全大补汤数剂，出青白稀
脓甚多，顿加寒热，烦渴头痛，殊类伤寒状。余谓∶此因脓泄而血气益虚耳。仍用前汤，其
势益甚，脉洪数大，按之如无，乃加附子一钱，其势愈甚，而脉复如前，此虚甚而药未能及
也。更加附子二钱，三剂诸症顿退。乃朝用补中益气汤，夕用十全大补汤，各三十余剂，出
腐骨五块，疮口将完。后因不慎起居，患处复溃，诸症更发，咽间如焚，口舌无皮，用十全
大补加附子一钱服之，诸症痊。二日不服，内病悉至，患处复溃。二年后又患，服前药不应
，诊其尺脉，微细如丝，此属命门火衰，用七味丸为主，佐以十全大补汤稍愈。至乙巳仍患
一男子左腿外侧近臀肿一块，上有赤缕三年矣，饮食起居如常，触破涌出血脓，发热恶
寒，此
、六味地黄丸而痊。
一男子小腹患之，脓水淋漓，此足三阴之症，用补中益气加麦门、五味，以培脾土；用
六味地黄丸，以生肾水。更用芦荟丸，以清肝火而敛。
一老儒眉间患之，二年，其状如紫桃，下坠盖目，按之如水囊，此肝脾之症，脓瘀内溃
而然
举人江节夫，两耳下两臂两肋结核，恪服祛痰降火软坚之剂，益甚。余曰∶此胆经血虚
火燥也。盖胆经行人之侧，前药必致亏损。至明年七月复请视，各核皆溃，脉浮大而涩。时金旺
于秋，木受金克，必不治，果卒。
嘉善周上舍，两耳下项间筋挛，壅肿坚硬，咳嗽气喘，内热盗汗。所服皆化痰散坚行气
之剂，势益甚。余诊之，左关弦涩，左尺洪数，此怒气伤肝，房劳损肾。须滋肾水，生肝血，慎
调摄，至水旺之际，庶可愈矣。彼欲速效。乃外敷商陆、锻石等药，内服海藻、莪术之类。
至秋金旺之际，元气愈虚，其肿愈甚而殁。
镇江孙上舍，缺盆间肿如覆瓯，坚硬色赤，内热晡热，自汗盗汗。就治于余曰∶贱疾皆
以散
此怒气伤肝，血涸而筋挛也。因其急于仕进，余辞不能治，彼亦不信，后果殁。此症若补脾
肺，滋肝肾，则木得水而敷华，筋得血而滋润，多有得生者。
《黄帝内经》记载：肝主管筋脉并贮藏血液，心统摄血脉并主宰脉管，脾主管肌肉并统摄血液，肺主管气机并司理腠理（皮肤纹理及汗孔），肾主管骨骼。
若因劳役过度导致相火妄动，阴血沸腾，外邪搏结而形成的肿胀，其肿起于肌肉之间，日久可见红色血丝，或皮肤全部发红，称为血瘤，治疗使用四物汤、茯苓、远志等药物。若因情志郁结损伤脾胃，导致肌肉消损变薄，外邪搏结而形成的肿胀，其肿起于肌肉之中，按压时感觉实中带软，称为肉瘤，治疗使用归脾汤、益气汤两方。若因劳损伤及肺气，导致腠理不固密，外邪搏结而壅滞肿胀，其肿起于皮肤表面，按压时浮软，称为气瘤，治疗使用补中益气汤之类。若因劳损伤及肾水，不能滋养骨骼而形成的肿胀，其肿起于骨骼部位，按压坚硬，称为骨瘤，治疗使用地黄丸，以及补肾类药物。（原文此处有缺漏，依上下文推断为补肾填精之剂）。
大凡属于肝胆二经的结核肿块，使用八珍汤加入山栀、龙胆草，以滋养气血并清泻肝火；使用六味地黄丸以滋养肺金并滋生肾水。若属于肝火旺盛、血液枯燥，必须生血凉血，使用四物汤、生地、丹皮、酒炒黑制的龙胆草、山栀。中气虚弱者，兼服补中益气汤。如果治疗失当，导致脾胃亏损，营气虚弱，不能濡养患处；或者寒气凝结于疮口，营气不能滋养患处；以致长久不生肌愈合，形成瘘管，都应调理补益脾胃，那么气血壮盛后肌肉自然生长。如果不谨慎起居作息及调摄七情六淫，或者使用寒凉腐蚀药物、蛛丝缠绕、芫花线结扎等方法来治疗外部症状，则治疗效果不佳。
长州县庠生王天爵，在辛丑年春季，左腿靠近环跳穴处患病，形状像大桃子，按压柔软，他严格服用除湿、流气、化痰的药物，病情反而加重。诊察发现病位在胆经部分，这是肺金反侮肝木，元气亏损，而且脓液已经在内部溃破。于是使用十全大补汤数剂，排出大量青白色稀脓，顿时出现寒热交替、烦躁口渴、头痛等症状，非常类似伤寒的样子。我说：这是因为脓液流出导致气血更加虚弱的缘故。仍然使用前面的汤药，病情反而更加严重，脉搏洪大数急，但重按却感觉空虚无力，于是加入一钱附子，病情更加严重，脉搏又恢复如前，这是因为虚损太甚，药力未能到达病所。再加附子二钱，服用三剂后各种症状立刻消退。于是早晨服用补中益气汤，晚上服用十全大补汤，各服用三十多剂，排出腐骨五块，疮口即将愈合。后来因为不谨慎起居，患处再次溃烂，各种症状复发，咽喉间如火烧，口舌无皮，使用十全大补汤加一钱附子服用，各种症状痊愈。两天不服药，内伤病症全部发作，患处再次溃烂。两年后又患病，服用之前的药物无效，诊察其尺脉，微细如丝，这属于命门火衰，以七味丸为主药，佐以十全大补汤，稍微好转。到了乙巳年仍然患病。
一男子左腿外侧靠近臀部肿起一块，上面有红色血丝三年了，饮食起居如常，触碰破裂后涌出血脓，伴有发热恶寒，这属于……（原文此处有缺漏，依上下文推断为血瘤或相关症候），使用四物汤、六味地黄丸而痊愈。
一男子小腹患病，脓水淋漓不断，这是足三阴经的病症，使用补中益气汤加麦门冬、五味子，以培补脾土；使用六味地黄丸，以滋生肾水。更使用芦荟丸，以清泻肝火并收敛疮口。
一位老儒生在眉间患病，历时两年，形状像紫桃，下垂遮盖眼睛，按压像水囊，这是肝脾的病症，因脓瘀在内溃破所致。
举人江节夫，双耳下、双臂、两肋出现结核，严格服用祛痰降火、软坚散结的药物，病情反而加重。我说：这是胆经血虚火燥。因为胆经行走在人体侧面，前面的药物必然导致亏损。到第二年七月再次请我诊治，各个结核都已溃破，脉搏浮大而涩。当时秋季金气旺盛，木受金克，必定无法治愈，果然去世。
嘉善县周上舍，双耳下颈部筋脉拘挛，壅肿坚硬，咳嗽气喘，内热盗汗。所服用的都是化痰散坚、行气的药物，病情反而加重。我诊察他的脉象，左关脉弦涩，左尺脉洪数，这是怒气伤肝，房劳损肾。必须滋补肾水，生养肝血，谨慎调摄，等到水气旺盛的季节，或许可以痊愈。但他想要快速见效，于是外用商陆、锻石等药物，内服海藻、莪术之类。到了秋季金气旺盛的时候，元气更加虚弱，肿胀更加严重而死亡。
镇江孙上舍，锁骨窝（缺盆）间肿胀像倒扣的碗，坚硬色红，内热午后发热，自汗盗汗。找我治疗说：我的贱疾都是因为……（原文此处有缺漏，依上下文推断为误用消散药物所致）。这是怒气伤肝，血液枯竭而导致筋脉拘挛。因为他急于仕途进取，我推辞说不能治疗，他也不相信，后果然死亡。此症如果补益脾肺，滋补肾肝，那么树木得到水分就能开花结果，筋脉得到血液滋润，大多能够存活。
(Note: Scrofula and tubercles, when encountering such conditions, should be cross-referenced with scrofula.)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The Liver governs the sinews and stores blood; the Heart controls the blood vessels and presides over the pulse; the Spleen governs the muscles and controls the blood; the Lung governs Qi and regulates the couli (skin texture and pores); the Kidney governs the bones.
If swelling arises from excessive labor causing ministerial fire to flare up, boiling yin blood, and external pathogens combing with it, the swelling originates in the muscles. After a long time, red threads may appear, or the skin may become entirely red. This is called a Blood Tumor. Treatment uses Siwu Tang (Four Substance Decoction), Poria (Fuling), and Polygala (Yuanzhi). If swelling arises from emotional stagnation injuring the Spleen, causing muscle wasting and thinning, and external pathogens combing with it, the swelling originates within the muscles and feels solid yet soft upon palpation. This is called a Flesh Tumor. Treatment uses Guipi Tang (Restore the Spleen Decoction) and Yiqi Tang (Boost Qi Decoction). If swelling arises from labor injuring Lung Qi, causing insecure couli, and external pathogens combing and obstructing, the swelling originates on the skin surface and feels floating and soft upon palpation. This is called an Air Tumor. Treatment uses Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If swelling arises from labor injuring Kidney Water, failing to nourish the bones, the swelling originates from the bone area and feels hard upon palpation. This is called a Bone Tumor. Treatment uses Dihuang Wan (Rehmannia Pill) and Kidney-tonifying herbs.
Generally, for tubercles belonging to the Liver and Gallbladder meridians, Bazhen Tang (Eight Treasure Decoction) is used with Gardenia (Shanzhi) and Gentian (Dancao) to nourish Qi and blood and clear Liver fire; Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used to nourish Lung Metal and generate Kidney Water. For cases of Liver fire and dry blood, blood generation and cooling are required, using Siwu Tang, Shengdi Huang (Rehmannia Root), Mudan Pi (Tree Peony Bark), wine-fried black Gentian (Dancao), and Gardenia (Shanzhi). For deficiency of Middle Qi, Bu Zhong Yi Qi Tang is taken concurrently. If treatment is incorrect, leading to Spleen and Stomach damage and weak Ying Qi unable to moisten the affected area; or if cold qi condenses at the sore opening, preventing Ying Qi from nourishing the area; resulting in prolonged failure to regenerate tissue and forming a fistula, all cases should be treated by regulating and tonifying the Spleen and Stomach. When Qi and blood become robust, muscle will naturally grow. If one does not carefully manage daily life and emotions, or uses cold/clearing corrosive medicines, spider web wrapping, or Genkwa thread ligation methods to treat externally, the therapeutic effect will be poor.
Wang Tianjue, a student from Changzhou, suffered illness near the Huantiao point on his left leg in the spring of the Xinchui year. The lesion resembled a large peach and was soft upon palpation. He strictly took dampness-draining, Qi-moving, and phlegm-resolving agents, but the condition worsened. Examination revealed the disease location in the Gallbladder meridian part, indicating Lung Metal insulting Liver Wood and depletion of Yuan Qi, with pus already internally ulcerated. Subsequently, Shiquan Dabu Tang (Perfect Golden Great Tonifying Decoction) was administered for several doses. A large amount of green-white thin pus was discharged, suddenly accompanied by alternating chills and fever, irritability, thirst, and headache, resembling Taiyang disease (Exterior Syndrome). I stated: This is due to further depletion of Qi and blood following pus discharge. The previous decoction was continued, but the condition worsened. The pulse was surging, rapid, and large, but empty upon deep pressure. Therefore, 1 qian of Aconite (Fuzi) was added. The condition worsened further, and the pulse returned to its previous state, indicating severe deficiency where the medicinal force could not reach the pathology. An additional 2 qian of Aconite was added. After three doses, all symptoms subsided abruptly. Then, Bu Zhong Yi Qi Tang was taken in the morning and Shiquan Dabu Tang in the evening, each for over thirty doses. Five pieces of necrotic bone were discharged, and the wound was nearly healed. Later, due to careless lifestyle, the affected area ulcerated again, and various symptoms recurred. The throat felt like burning, and the mouth and tongue lost their mucosal lining. Shiquan Dabu Tang plus 1 qian of Aconite was taken, curing the symptoms. After two days without medication, internal diseases returned, and the affected area ulcerated again. Two years later, the illness recurred. Previous medications were ineffective. Palpation of the Chi (Cunamens) pulse revealed it was minute and thread-like, indicating decline of Mingmen Fire. Qimai Wan (Seven-Ingredient Pill) was used as the main formula, assisted by Shiquan Dabu Tang, resulting in slight improvement. The illness persisted into the Yisi year.
A man had a swelling on the outer side of his left leg near the buttocks, with red threads visible for three years. His diet and daily life were normal. Upon rupture, blood and pus gushed out, accompanied by fever and aversion to cold. This belongs to [Blood Tumor context], cured by Siwu Tang and Liuwei Dihuang Wan.
A man suffered from a small abdominal lesion with dripping pus and water. This is a syndrome of the Three Yin Meridians of the Foot. Buzhong Yiqi Tang plus Ophiopogon (Maimen) and Schisandra (Wuweizi) was used to cultivate Spleen Earth; Liuwei Dihuang Wan was used to generate Kidney Water. Additionally, Luohui Wan (Aloe Pill) was used to clear Liver fire and astringe the wound.
An old scholar suffered from a lesion between his eyebrows for two years. It resembled a purple peach, hanging down to cover the eyes, and felt like a water sac upon palpation. This is a Liver-Spleen syndrome caused by internal ulceration of pus and stasis.
Jiang Jiefu, a Jinshi degree holder, had tubercles under both ears, on both arms, and in both ribs. He strictly took phlegm-resolving, fire-descending, and softening-hardness agents, but the condition worsened. I said: This is blood deficiency and fire dryness in the Gallbladder meridian. Since the Gallbladder meridian runs along the sides of the body, the previous medicines must have caused damage. In July of the following year, he requested another examination. All tubercles had ulcerated, and the pulse was floating, large, and choppy. In autumn, Metal Qi is prosperous, and Wood is controlled by Metal. It was deemed incurable, and indeed, he died.
Zhou Shangshe from Jiashan suffered from tendon spasms, obstructed swelling, hardness, cough, asthma, internal heat, and night sweats between the lower ears and neck. He had taken phlegm-resolving, hardness-dispersing, and Qi-moving agents, worsening the condition. My diagnosis showed a wiry and choppy Left Guan pulse and a surging and rapid Left Chi pulse. This indicates anger injuring the Liver and sexual excess damaging the Kidneys. One must nourish Kidney Water and generate Liver Blood, with careful regulation. Recovery might be possible during the season of abundant Water. Desiring quick results, he applied external medicines like Phytolacca (Shanglu) and Calcined Stone, and took internal herbs like Seaweed (Haizao) and Curcuma (Ezhu). By autumn, when Metal Qi was prosperous, Yuan Qi became more deficient, the swelling worsened, and he died.
Sun Shangshe from Zhenjiang had swelling in the supraclavicular fossa (Quepen) resembling an inverted bowl, hard and red, with internal heat, afternoon fever, spontaneous sweating, and night sweats. He sought my treatment, stating his ailment was caused by [misuse of dispersing drugs]. This is anger injuring the Liver, leading to blood exhaustion and tendon spasm. Because he was eager for official advancement, I declined to treat him, saying it was incurable. He did not believe me, and indeed died later. If this syndrome were treated by tonifying Spleen and Lung, and nourishing Liver and Kidney, so that Wood receives water to flourish and tendons receive blood to be moistened, many could survive.