妇人瘰 ，或因胎产血崩，亏损肾肝；或因忧思郁怒，伤损肝脾；或因恚怒风热，肝胆血燥
；或因水涸血虚，筋挛则累累然如贯珠，故多生于耳前后、项侧、胸胁间，若寒热肿痛，乃
肝经气动而为病。用柴胡栀子散以清肝火为主，而佐以逍遥散以养肝血。若寒热既止，而核
不消，乃肝经之血亦病，用加味四物汤以养肝血为主，而佐以柴胡栀子散以清肝火。若初生
如豆粒，附着于筋，肉色不变，内热口干，精神倦怠，久不消溃，乃肝脾亏损，用逍遥散、
归脾汤、六味丸健脾土，培肝木，切不可轻用散坚追毒之剂。《外台秘要》云∶肝肾虚热，
则生 矣。《病机》云∶瘰 不系膏粱丹毒，因虚劳气郁所致。补形气，调经脉，其疮当自
消散。误下之，先犯病禁经禁。若久溃脉浮大，邪火盛也；而色 白，金克木也，皆不治。
若赤脉贯瞳子有几条，则几年死。
治验
一妇人久而不愈，或以为木旺之症，用散肿溃坚汤伐之，肿硬益甚，余以为肝经气血亏损，
当滋化源，用六味地黄丸、补中益气汤，至春而愈。此症若肝经风火暴病，元气无亏，宜用
前汤。若风不旺而自病，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，但壮脾土，则木自不能克矣。若行伐肝，则脾胃先
伤，而木反来克土矣。
一妇人患之，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。余以为思虑亏损脾血，用归脾汤作丸，午前以六君
子送下，午后以逍遥散送下，两月余得寐，半载后经行如期，年余而疮愈。
一 妇溃后，发热烦躁作渴，脉大而虚，以当归补血汤，六剂而寒热退，又以圣愈汤，数剂
而痊愈。更以八珍加贝母、远志，三十余剂而敛。
一妇人项结核，寒热头痛，胁乳胀痛，内热口苦，小便频数，症属肝火血虚，用四物加柴胡
、山栀、胆草而愈，又用加味逍遥散而安。
一妇人瘰 后，遍身作痒，脉大按而虚，以十全大补加香附治之而愈。大凡溃后，午前痒作
气虚，午后痒作血虚。若作风症治之，必死。
一妇人项核肿痛，察其气血俱实，先以必效散一服下之，更以益气养荣汤补之，三十余剂而
消。常治此症，若必欲出脓，但虚弱者，先用前汤，待其气血稍充，乃用必效散，去其毒，
仍用补药无不效。未成脓者，灸肘尖调经解郁及隔蒜灸，多自消，有脓即针之。若气血复而
核不消，却服散坚之剂，月许不应，气血不损，须用必效散，其毒一下，即多服益气养荣汤
，如不应，亦灸肘尖。如疮口不敛者，更用豆豉饼、琥珀膏。若气血俱虚，或不慎饮食七情
者，不治。然此症以气血为主，气血壮实，不用追蚀之剂，亦能自腐。但取去使易于收敛耳
，血虚而用追蚀，不惟徒治，适足以败矣。
妇人患瘰疬，有的因为怀孕生产或产后血崩，导致肾肝亏损；有的因为忧思郁怒，损伤肝脾；有的因为愤怒兼感风热，导致肝胆血燥；有的因为肾水枯竭、血液亏虚，筋脉拘挛，结节累累如同串珠，所以多发生在耳前后、颈侧、胸胁之间。如果出现寒热肿痛，这是肝经气机逆乱而引发的疾病。治疗以柴胡栀子散为主清泻肝火，辅以逍遥散滋养肝血。如果寒热症状停止后，肿块仍未消散，说明肝经之血也已受损，治疗以加味四物汤为主滋养肝血，辅以柴胡栀子散清泻肝火。如果初起时如豆粒大小，附着在筋上，皮肤颜色不变，伴有内热口干、精神疲倦，且久不溃破，这是肝脾亏损所致，应使用逍遥散、归脾汤、六味地黄丸来健脾土、培补肝木，切不可轻易使用散坚追毒的药物。《外台秘要》说：肝肾虚热，就会生发瘰疬。《病机》说：瘰疬并非由于膏粱厚味或丹毒引起，而是因虚劳和气郁所致。通过补益形体元气、调理经脉，疮疡自然会自行消散。如果误用攻下法，首先违反了病症禁忌和经络治疗原则。如果久溃之后脉象浮大，是邪火旺盛的表现；如果面色㿠白，是金克木的征象，都属于难治之症。如果眼底赤脉贯穿瞳孔有几条，则预示几年后死亡。
医案举例：
有一位妇人患病日久不愈，有人认为是肝木旺盛之症，使用散肿溃坚汤攻伐，结果肿胀坚硬更加严重。我认为这是肝经气血亏损，应当滋生化之源，于是使用六味地黄丸、补中益气汤，到春季痊愈。此症如果是肝经风火暴发的实证，元气没有亏损，适宜使用前文提到的攻伐方剂。如果是风邪不旺而自发病变，适宜用泻青丸；如果是虚证，用地黄丸。如果是肾水不能生养肝木，也使用地黄丸。如果是肺金来克制肝木，应当补益脾土以生肾水。大凡风木类的疾病，只要壮实脾土，那么肝木自然就不能克制脾土了。如果强行伐肝，则脾胃先受伤，反而会导致肝木来克制脾土。
另一位妇人患此病，担心无法治愈，导致失眠少睡，一年多后疮口破溃，脓水淋漓，月经或五十天或两个多月才来一次。她误服通经丸，辗转反侧无法入睡，午前恶寒，午后发热。我认为这是思虑过度亏损脾血，于是将归脾汤制成丸药，午前用六君子汤送服，午后用逍遥散送服，两个多月后得以安睡，半年后月经如期而至，一年多后疮疡愈合。
还有一位妇人疮口溃烂后，出现发热烦躁、口渴，脉象大而虚，使用当归补血汤，服用六剂后寒热退去，又使用圣愈汤，数剂后痊愈。随后使用八珍汤加入贝母、远志，三十余剂后疮口收敛。
一位妇人颈部淋巴结结核，伴有寒热头痛、胁肋乳房胀痛、内热口苦、小便频数，症状属于肝火血虚，使用四物汤加入柴胡、山栀、龙胆草而痊愈，后又使用加味逍遥散调理而安定。
一位妇人患瘰疬溃破后，全身瘙痒，脉象大但按之空虚，使用十全大补汤加入香附治疗而痊愈。大凡溃破之后，午前瘙痒发作属气虚，午后瘙痒发作属血虚。如果当作风症治疗，必然致死。
一位妇人颈部核结肿痛，观察其气血俱实，先用必效散一服攻下，再用益气养荣汤补益，三十余剂后消散。我常治此类病症，如果一定要排脓，对于虚弱者，先用前文提到的补益汤剂，待其气血稍充盛，再使用必效散去除毒邪，然后仍用补药，无不奏效。未成脓者，可灸肘尖穴、调经解郁及隔蒜灸，多能自行消散，已有脓液即针刺排出。如果气血恢复后肿块仍未消散，却服用散坚药物，一个月左右无效，此时气血未损，须用必效散，毒邪一旦排出，随即多服益气养荣汤，如果仍无效，也可灸肘尖穴。如果疮口不收敛，更可使用豆豉饼、琥珀膏。如果气血俱虚，或不慎饮食七情者，属于不治之症。然而此症以气血为主，气血壮实，即使不使用追蚀药物，也能自行腐溃排脓。只是取去腐肉使其易于收敛罢了，若血虚而使用追蚀药物，不仅徒劳无功，反而足以败坏病情。
In women, scrofula (Luo Li, 瘰疬) may arise from blood loss due to pregnancy, childbirth, or postpartum hemorrhage, leading to a deficiency of the Liver and Kidney; or from worry, overthinking, depression, and anger, damaging the Liver and Spleen; or from indignation combined with wind-heat, causing dryness of the Liver and Gallbladder blood; or from depletion of Kidney water and blood deficiency, resulting in tendon spasms where nodules accumulate like beads. Thus, it often occurs around the ears, sides of the neck, and between the chest and hypochondrium. If accompanied by chills, fever, swelling, and pain, it is a disease caused by disordered Qi movement in the Liver channel. Treatment primarily uses Chaihu Zhizi San (Bupleurum and Gardenia Powder) to clear Liver fire, assisted by Xiaoyao San (Free and Easy Wanderer Powder) to nourish Liver blood. If chills and fever cease but the nodules do not dissipate, it indicates that the blood of the Liver channel is also diseased; treatment primarily uses Jiawei Siwu Tang (Modified Four Substances Decoction) to nourish Liver blood, assisted by Chaihu Zhizi San to clear Liver fire. If initially bean-sized, attached to tendons, with unchanged skin color, internal heat, dry mouth, mental fatigue, and failure to ulcerate for a long time, it is due to Liver and Spleen deficiency. Use Xiaoyao San, Guipi Tang (Restore the Spleen Decoction), and Liuwei Wan (Six-Ingredient Pill with Rehmannia) to strengthen Earth (Spleen) and cultivate Wood (Liver). One must absolutely avoid using harsh agents to dissipate hardness and chase toxins. *Waitai Miyao* states: "Deficient heat in the Liver and Kidney generates scrofula." *Bingji* states: "Scrofula is not caused by rich food or carbuncles/toxins, but by consumptive disease and Qi stagnation." By tonifying form and Qi, and regulating meridians, the sores will naturally dissipate. Misusing purgatives violates disease and meridian contraindications. If a chronic ulcer presents with a floating and large pulse, it indicates excessive pathogenic fire; if the complexion is pale white, it indicates Metal overcoming Wood, both being difficult to treat. If red vessels penetrate the pupil, death will occur within the corresponding number of years.
Case Record 1:
A woman suffered from the condition for a long time without recovery. Some believed it was an excess of Wood (Liver), and used Sanzhong Kuijian Tang (Disperse Swelling and Harden Dissolution Decoction) to attack it, resulting in increased swelling and hardness. I considered it a deficiency of Qi and Blood in the Liver channel and should nourish the source of transformation. I used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and she recovered in spring. If this condition were acute Wind-Fire in the Liver channel with intact Yuan Qi, the aforementioned attacking decoction would be appropriate. If Wind is not excessive but the disease arises spontaneously, Xieqing Wan (Drain Green Pill) is suitable; for deficiency, Dihuang Wan is used. If Water fails to generate Wood, Dihuang Wan is also used. If Metal comes to overcome Wood, one should tonify Spleen Earth to generate Kidney Water. Generally, for Wind-Wood diseases, strengthening Spleen Earth ensures Wood cannot overcome it. Forcibly attacking the Liver first injures the Spleen and Stomach, causing Wood to overcome Earth instead.
Case Record 2:
Another woman suffered from this, fearing it was incurable, leading to insomnia. After more than a year, the sore broke, oozing pus continuously. Her menstruation occurred every fifty days or two months. She mistakenly took Tongjing Wan (Unblock Menses Pill), resulting in restless insomnia, chills before noon, and fever after noon. I considered this a deficiency of Spleen Blood due to overthinking. I prepared Guipi Tang as pills, administered with Liujunzi San (Six Gentlemen Powder) before noon, and Xiaoyao San after noon. After more than two months, she could sleep peacefully. After half a year, her menstruation returned to its regular schedule, and after more than a year, the sore healed.
Case Record 3:
A woman, after ulceration, experienced fever, restlessness, and thirst, with a large and empty pulse. She was treated with Danggui Buxue Tang (Angelica Tonifies the Qi and Nourishes Blood Decoction); after six doses, chills and fever subsided. Then Shengyu Tang (Holy to Save Life Decoction) was given for several doses until recovery. Subsequently, Bazhen Tang (Eight Treasures Decoction) added with Beimu (Fritillaria Bulb) and Yuanzhi (Polygala Root) was taken for more than thirty doses until the wound closed.
Case Record 4:
A woman had cervical lymph node tuberculosis with chills, fever, headache, distending pain in the hypochondrium and breasts, internal heat, bitter taste in the mouth, and frequent urination. The syndrome belonged to Liver Fire and Blood Deficiency. She was cured using Siwu Tang added with Chaihu (Bupleurum Root), Shanzhi (Gardenia Fruit), and Dancao (Gentian Root), and then stabilized with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).
Case Record 5:
After a woman’s scrofula ulcerated, her whole body itched. Her pulse was large but empty upon pressure. She was treated with Shiquan Dabu Tang (Perfect Great Tonification Decoction) added with Xiangfu (Cyperus Rhizome) and recovered. Generally, after ulceration, itching occurring before noon indicates Qi deficiency, while itching after noon indicates Blood deficiency. Treating it as a Wind syndrome will certainly lead to death.
Case Record 6:
A woman had painful swelling of cervical nodules. Observing that both Qi and Blood were excess, I first administered Yixiao San (Sure Effect Powder) to purge, followed by Yiqi Yangrong Tang (Augment Qi and Nourish Ying Decoction) for tonification. After more than thirty doses, it dissipated. In treating this condition, if suppuration is desired, for weak patients, use the aforementioned tonifying decoction first. Wait until Qi and Blood are slightly replenished, then use Yixiao San to remove toxins, followed by tonic medicines, which are invariably effective. For un-suppurated cases, moxa on Zhoushan (Elbow Tip) acupoint, regulating meridians and resolving stagnation, and garlic-partitioned moxibustion often cause spontaneous resolution. If pus is present, puncture it. If Qi and Blood recover but nodules remain, and dispersing-hardness agents fail after a month without damaging Qi and Blood, use Yixiao San. Once toxins are expelled, administer copious amounts of Yiqi Yangrong Tang. If ineffective, moxa on Zhoushan can be used. If the wound does not close, use Douchi Bing (Fermented Soybean Cake) and Hupo Gao (Amber Plaster). If both Qi and Blood are deficient, or if dietary and emotional precautions are neglected, it is untreatable. However, this condition depends primarily on Qi and Blood. If Qi and Blood are strong, even without cauterizing agents, necrosis and discharge can occur naturally. The goal is merely to facilitate easy closure. Using cauterizing agents when Blood is deficient is not only futile but detrimental.