鳖甲丸
夜明砂（净，微炒） 鳖甲（醋煮令黄，去肋） 枳壳 黄连（各二两） 雄全蝎（一个）
诃子（生一枚，熟一枚）
共为末。入麝香少许，蜜为丸如绿豆大，每服五丸，食后用米饭送下。
陈实功曰∶瘿瘤非阴阳正气结肿，乃五脏瘀血，浊气痰滞而成也。瘿者，阳也。
色红而高突，或蒂小而下垂。瘤者，阴也。
色白而漫肿，亦无痒痛，人所不觉。（《正宗》）
又曰∶筋骨呈露曰筋瘿，属肝。赤脉交结曰血瘿，属心。皮色不变曰肉瘿，属
脾。忧喜消长曰气瘿，属肺。坚硬不移曰石瘿，属肾。治宜消散。自然缩小，切不
可轻用刀针掘破，出血不止，多致危亡；久则脓血崩溃，渗漏不已，终致伤人。（《正宗》）
\r瘿瘤\p04-a41a96.bmp\r
又曰∶筋瘤坚而色紫，累累青筋盘曲，甚则结若蚯蚓。此乃肝统筋，怒动肝火，血
燥筋挛而成也。治当清肝解郁，养血舒筋为主。清肝芦荟丸主之。
又曰∶血瘤，微紫微红，软硬间杂，皮肤隐隐，缠若丝缕色红，擦破血流，禁之
不住，此乃心主血，暴急太甚，火旺逼血沸腾，复被外邪所搏而成也。治当养血凉
血，抑火滋阴，安敛心神，调和血脉为主。芩连二母丸主之。
又曰∶肉瘤软如绵，硬似馒，皮色不变，不紧不宽，终年只似覆肝，此乃脾主
肌肉，郁结伤脾，肌肉消薄，土气不行，逆
于肉里而为肿也。治当理脾宽中，疏通戊土，开郁行痰，调理饮食为主。加味归脾汤主之。
又曰∶气瘤，软而带坚，皮色如故，或消或长，无热无寒，此乃肺主气，劳伤元
气，腠理不密，外寒传而为肿也。治当清肺气，调经脉，理劳伤，和荣卫为主。通气散坚丸主之。
又曰∶骨瘤形色紫黑，坚硬如石，疙瘩高起，推之不移，昂昂坚贴于骨，此乃
肾主骨，恣欲伤肾，肾火郁遏，骨无荣养而为肿也。治当滋补肾气，养血行瘀，散
肿破坚利窍为主。调元肾气丸主之。
又曰∶粉瘤，红粉色，多生耳项前后，亦有生于下体者，全是痰气凝结而成。宜
用披针破去脂粉，以三品一条枪插入，数次化尽内膜自愈。
又曰∶黑砂瘤多生臀腿，肿突大小不一，以手捏起，内有黑色是也。亦用披针
刺内，出黑砂有声，软硬不一。
又曰∶发瘤多生耳后发下寸许，软小高突，按之不痛，针之粉发齐出。
又曰∶蛔虫瘤生于胁下。
又曰∶蛆瘤生于肩膊。
又曰∶虱瘤破之虱出，但诸瘤形状之异，皆由五脏湿热邪火，浊气瘀血，各感
而成，非正病耳。
又曰∶小儿胎瘤，初生头上、胸乳间，肿起大者如馒，小似梅李，此乃胎中瘀血
凝滞而成。须候小儿盈月以后，方可用针刺破，内如赤豆汁则安，内服五福化毒丹即愈。
又曰∶治瘿之法，初起元气实者，海藻玉壶汤、六军丸，久而元气虚者，琥珀
黑龙丹、十全流气饮。选而治之。
薛立斋曰∶瘿瘤诸证，只宜服药消磨，切不可轻用刀针掘破，血出不止，多致立
危。医家病家，均当慎之，万勿孟浪。
冯鲁瞻曰∶瘿则着于肩项，瘤则随气凝结，戒食浓味，忌妄破掘，五瘿皆不可
妄掘破，惟胎瘿破而去其脂粉则愈。（《锦囊》）
李东垣辨瘤法∶若发肿都软而不痛者，血瘤也。发肿日渐增长而大，不热，时时
牵痛者，气瘤也。气结微肿，久而不消，后亦成脓，此是寒热所为也。留积经久，极
阴生阳，寒化为热，以此溃必多成 。宜早服内塞散以排之，诸癃瘤疣赘等至年衰，
皆自内溃，理于壮年，可无后忧。（《十书》）
《百效全书》曰∶夫瘿瘤皆因气血凝滞，结而成之。瘿则喜怒所生，多着于肩项，皮
宽不急，垂垂而重者是也。瘤则随留所住，初如梅李之状，皮嫩而光，渐如杯卵者是
也。瘿虽有五，瘤则类多，不痛不痒，切不可抉破，恐脓血崩溃，渗漏无已，必致
杀人；惟肉瘤更不可攻疗。如脂瘤、气瘤体气充实者，如海藻散坚丸，东垣散肿溃
坚汤多服，亦可消散。如虚弱者，又宜斟酌，不可纯用化痰行气破坚之药。
《灵枢》曰，虚邪之入于身也深，寒与热相搏，久留而内着，寒胜其热，则骨疼
肉枯，热胜其寒，则烂肉腐肌为脓，内伤骨，内伤骨为骨蚀。有所疾前筋，（疾前二字，
衍文也。筋当作结。）筋结不得伸，邪气居其间而不及，发为筋瘤。有所结，气归之，卫气
留之，不得反，津液久留，合为肠瘤，久者数岁乃成，以手按之柔。已有所结，气
居为昔瘤，以手按之坚。有所结，日以易甚，连以聚归之，津液留之，邪气中之，凝
结深中骨，气固于骨，骨与气并，日以益大，则为骨疽。有所结，中于肉，宗气居
之，邪留而不去，有热则化而为脓，无热则为肉疽。凡此数气者，其发无常处，而
有常名也。（《刺节真邪篇》∶此皆虚邪中人为病，费去而久留着，故积岁累月而成疽瘤也。）
《三因》云∶瘿多着肩项，瘤则随气凝结。
岐天师曰∶瘿瘤不同，瘿者连肉而生，根大而身亦大；瘤者根小而身亦大也。即
瘤之中，又各有不同，有粉瘤，有肉瘤，有筋瘤，有物瘤。筋瘤不可治，亦不必治，终
身十载，不过大如核桃。粉瘤则三年之后，彼自然而破，出粉如线香末，出尽自愈，亦
不必治也。肉瘤最易治，用水银、硼砂各一钱，血竭、儿茶各三钱，黄柏五钱，冰
片、麝香各三分，共为细末，将此药擦于瘤之根处，随擦随落，根小者，无不落也。
物瘤则根大，最难治，不时而动，无故而鸣，或如虫鸣，或如鸟啼，必须用刀破其
中孔，则物自难居，必然突围而出，后用生肌神药，则瘤化为水，平复如故矣。（《秘录》）
又曰∶物瘤乃不敬神鬼，触犯岁君而得。病不可测，非理可谈，故《内经》不
言，然世未尝无此病也。
又曰∶瘿固不同，形亦各异，然皆湿热之病也。由小而大，由大而破，由破而
死矣。初起之时，即宜用小刀割破，略出白水，以生肌散敷之立愈。倘若失治，渐
渐大来，用药一点，点其陷处，半日作疼，出水，其色白者易愈，如黄者、红者皆难愈。
张仲景曰∶人有手臂生疮，变成大块，更有肚上生疮，结成顽块，终年不去者，或
如拳头大者，必须用刀割去，人必晕绝，不可学也。止用小刀略破其皮一分后，以化
毒丹敷之，即化为水，此方神奇，不可轻视。如足上生瘤如斗大者，不必破碎治之，
止用针轻轻刺一小针眼，以化毒丹敷之，必流水不止，急用煎方治之，方用人参、黄
各三两，生甘草、薏苡仁各五两，白芥子三钱，水煎服。二剂即消尽其水，而人
绝无惫色，此内外双治之法。然此方之妙，乃补其本源之气，又利水而不走其气，刺
其孔而出水，未免大损元气，今补其气，又何惧水之尽出哉？此方之所以奇也，妙也。
岐天师曰∶人有喉患大肿，又非瘿瘤，忽痛忽不痛，外现五色之纹，中按之半空
半实，此乃痰病结成，似瘤非瘤，似瘿非瘿也。宜消痰汤主之。此方乃消上焦之痰
圣药也。又有海藻、昆布以去瘿瘤之外象，
消其五色之奇纹，妙在消痰而仍不损气，则胃气健而痰易化也。一剂知，二剂消大半，
三剂则全消，四剂永不再发。此方兼可治瘿证神效。（《秘录》）
鳖甲丸
夜明砂（洗净，微炒） 鳖甲（用醋煮至黄色，去除硬肋） 枳壳 黄连（以上各二两） 全蝎雄虫（一个）
诃子（生用一枚，熟用一枚）
共同研磨成粉末。加入少量麝香，用蜂蜜制成如绿豆大小的药丸，每次服用五丸，饭后用米汤送服。
陈实功说：瘿瘤并非由阴阳正气结聚而成的肿物，而是五脏的瘀血、浊气和痰湿停滞所形成的。瘿，属于阳证。
颜色红且高突，有的蒂小而下垂。瘤，属于阴证。
颜色白且漫肿，也没有瘙痒疼痛，人们往往察觉不到。（《外科正宗》）
又说：筋骨显露称为筋瘿，归属于肝。赤色脉络交错称为血瘿，归属于心。皮肤颜色不变称为肉瘿，归属于脾。随情绪喜怒而消长称为气瘿，归属于肺。坚硬不移称为石瘿，归属于肾。治疗应当以消散为主。自然会缩小，切不可轻易用刀针挖掘破溃，否则出血不止，多导致危亡；时间久了则脓血崩溃，渗漏不停，最终致人死亡。（《外科正宗》）
[图片：瘿瘤]
又说：筋瘤坚硬且颜色紫暗，累累青筋盘曲，严重时结节像蚯蚓一样。这是肝主筋，愤怒触动肝火，血燥筋挛所形成的。治疗应当以清肝解郁、养血舒筋为主。用清肝芦荟丸主治。
又说：血瘤，颜色微紫微红，软硬相间，皮肤隐隐可见，缠绕如丝缕般红色，擦破后血流不止，难以控制。这是心主血，暴急太甚，火旺逼迫血液沸腾，再加上被外邪搏结所形成的。治疗应当以养血凉血、抑火滋阴、安敛心神、调和血脉为主。用芩连二母丸主治。
又说：肉瘤软得像棉花，硬得像馒头，皮色不变，不紧也不宽，整年看起来像覆盖在肝脏上。这是脾主肌肉，郁结损伤脾气，肌肉消薄，土气运行不畅，逆阻于肌肉之中而形成肿胀。治疗应当以理脾宽中、疏通胃气、开郁行痰、调理饮食为主。用加味归脾汤主治。
又说：气瘤，软中带硬，皮色如常，有时消退有时增大，无发热恶寒症状。这是肺主气，劳伤元气，腠理不紧密，外寒传入而形成肿胀。治疗应当以清肺气、调经脉、理劳伤、和营卫为主。用通气散坚丸主治。
又说：骨瘤形色紫黑，坚硬如石头，疙瘩高起，推之不动，高高地紧贴于骨骼之上。这是肾主骨，纵欲伤肾，肾火郁遏，骨骼缺乏荣养而形成肿胀。治疗应当以滋补肾气、养血行瘀、散肿破坚利窍为主。用调元肾气丸主治。
又说：粉瘤，呈红粉色，多生于耳项前后，也有生于下体的，完全是由痰气凝结而成。宜用披针挑破去除脂粉，插入三品一条枪，数次后将内膜化尽即可自愈。
又说：黑砂瘤多生于臀部和大腿，肿突大小不一，用手捏起，里面有黑色物质。也用披针刺入内部，排出黑砂时有声响，质地软硬不一。
又说：发瘤多生于耳后头发下一寸左右处，软小高突，按压不痛，针刺后粉状头发全部排出。
又说：蛔虫瘤生于胁下。
又说：蛆瘤生于肩膊。
又说：虱瘤破开后有虱子出来。但各种瘤形状各异，都是由五脏湿热邪火、浊气瘀血，各自感受而形成的，不是正病。
又说：小儿胎瘤，初生时在头上、胸乳之间，肿起大的像馒头，小的像梅李。这是胎中瘀血凝滞所形成的。必须等到婴儿满月以后，方可用针刺破，如果流出像赤豆汁一样的液体则平安，内服五福化毒丹即可痊愈。
又说：治疗瘿的方法，初起时元气实的，用海藻玉壶汤、六军丸；日久元气虚的，用琥珀黑龙丹、十全流气饮。选择其中一种进行治疗。
薛立斋说：瘿瘤诸证，只宜服药消磨，切不可轻易用刀针挖掘破溃，血出不止，多导致立即危险。医生和病人，都应当谨慎，千万不要鲁莽。
冯鲁瞻说：瘿附着于肩项，瘤随气凝结，忌食浓味，忌妄自破掘，五种瘿都不可妄自破掘，只有胎瘿破去其脂粉即可痊愈。（《医宗金鉴·锦囊秘录》）
李东垣辨别瘤的方法：如果发肿全都软而不痛的，是血瘤。发肿日渐增长变大，不热，时时牵拉作痛的，是气瘤。气结微肿，久而不消，后来也化成脓，这是寒热所为。留积经久，极阴生阳，寒化为热，以此溃烂必然多成漏管。宜早服内塞散以排脓，各种癃瘤疣赘等到了年老体衰，都会从内部溃烂，如果在壮年时期处理，可以没有后患。（《十书》）
《百效全书》说：瘿瘤都是因为气血凝滞，结聚而成。瘿多因喜怒而生，多附着于肩项，皮宽不急，垂垂沉重的是它。瘤则随气停留之处而生，初起像梅李的形状，皮嫩而光，渐渐像杯卵的是它。瘿虽然有五种，瘤则类别很多，不痛不痒，切不可抉破，恐怕脓血崩溃，渗漏不已，必致杀人；只有肉瘤更不可攻疗。如果是脂瘤、气瘤体质充实者，如海藻散坚丸，李东垣的散肿溃坚汤多服，也可以消散。如果是虚弱者，又应当斟酌，不可纯用化痰行气破坚的药物。
《灵枢》说，虚邪侵入身体很深，寒与热相互搏结，久留而内着，寒胜其热，则骨痛肉枯，热胜其寒，则烂肉腐肌为脓，内伤骨，内伤骨成为骨蚀。如果有疾前筋（“疾前”二字是衍文，“筋”当作“结”），筋结不得伸展，邪气居于其间而不能及，发为筋瘤。有所结聚，气归向之，卫气停留其中，不能返回，津液久留，合为肠瘤，久了数年才形成，用手按之柔软。已经有所结聚，气居成为昔瘤，用手按之坚硬。有所结聚，日益加重，连聚归之，津液停留，邪气侵入，凝结深入骨中，气固于骨，骨与气并，日益增大，则为骨疽。有所结聚，中于肉，宗气居之，邪气停留不去，有热则化为脓，无热则为肉疽。凡这些气，它们的发作没有固定地方，但有固定的名称。（《刺节真邪篇》：这些都是虚邪中人造成的疾病，邪气离去而久留，所以积累岁月而成疽瘤。）
《三因方》说：瘿多附着于肩项，瘤则随气凝结。
岐天师说：瘿和瘤不同，瘿连着肉而生，根大而身也大；瘤则是根小而身也大。即在瘤之中，又各有不同，有粉瘤，有肉瘤，有筋瘤，有物瘤。筋瘤不可治，也不必治，终身十年，不过大如核桃。粉瘤则三年之后，自然破裂，流出像线香末一样的粉，出尽即自愈，也不必治。肉瘤最容易治，用水银、硼砂各一钱，血竭、儿茶各三钱，黄柏五钱，冰片、麝香各三分，共同研为细末，将此药擦于瘤的根部，随擦随落，根小的，无不脱落。物瘤则根大，最难治，不时而动，无故鸣叫，或像虫鸣，或像鸟啼，必须用刀破其中的孔，则物体自然难以居住，必然突围而出，后用生肌神药，则瘤化为水，平复如初。（《秘录》）
又说：物瘤是因为不敬神鬼，触犯岁君而得的。病情不可测度，非道理可谈论，所以《内经》不说，然而世间未尝没有此病。
又说：瘿固然不同，形状也各异，但都是湿热之病。由小变大，由大变破，由破而死。初起之时，就应用小刀割破，略出白水，敷上生肌散立即痊愈。倘若失治，渐渐变大，用药点一点，点其凹陷处，半天作疼，出水，颜色白的易愈，如黄的、红的都难愈。
张仲景说：有人手臂生疮，变成大块，更有肚子上生疮，结成顽块，终年不去的，或者像拳头大的，必须用刀割去，人必晕绝，不可模仿学习。只用小刀略破其皮一分后，敷上化毒丹，即化为水，此方神奇，不可轻视。如果足上生瘤如斗大者，不必破碎治疗，只用针轻轻刺一小针眼，敷上化毒丹，必定流水不止，急用煎方治疗，方用人参、黄芪各三两，生甘草、薏苡仁各五两，白芥子三钱，水煎服。两剂即消尽其水，而人绝无疲惫之色，这是内外双治的方法。然而此方的妙处，在于补其本源之气，又利水而不耗气，刺其孔而出水，未免大损元气，现在补其气，又何惧水之尽出呢？这就是此方之所以奇、之所以妙的原因。
岐天师说：有人喉部患大肿，又不是瘿瘤，忽痛忽不痛，外现五色之纹，中按之半空半实，这是痰病结成的，似瘤非瘤，似瘿非瘿。宜用消痰汤主治。此方是消除上焦痰的圣药。又有海藻、昆布以去除瘿瘤的外象，消除五色的奇异纹路，妙在消痰而仍不损气，则胃气健而痰易化。一剂见效，二剂消大半，三剂则全消，四剂永不再发。此方兼可治瘿证神效。（《秘录》）
Biejia Wan (Turtle Shell Pill)
Yeming Sha (Candor, 夜明砂) (cleaned, lightly stir-fried), Biejia (Testudinis Carapax et Plastrum, 鳖甲) (boiled in vinegar until yellow, remove hard ribs), Zhike (Aurantii Fructus, 枳壳), Huanglian (Coptidis Rhizoma, 黄连) (each two liang), Xiong Quanxie (Scorpio, 全蝎) (one male scorpion), Hezi (Terminaliae Chebulae Fructus, 诃子) (one raw, one cooked).
Grind all into powder. Add a small amount of Shexiang (Moschus, 麝香), and form pills with honey the size of mung beans. Take five pills per dose, administered after meals with rice water.
Chen Shigong stated: Yingliu (Goiter and Tumor) are not swellings formed by the knotting of yin and yang qi, but are caused by blood stasis, turbid qi, and phlegm stagnation in the five zang organs. Ying (Goiter) is yang.
Its color is red and it protrudes high; some have a small pedicle and hang down. Liu (Tumor) is yin.
Its color is white and it presents as diffuse swelling, without itching or pain, often unnoticed by people. (Zhengzong)
He further stated: Jinying (Sinew Goiter) is characterized by exposed sinews and bones, associated with the Liver. Xueying (Blood Goiter) features intersecting red vessels, associated with the Heart. Rouying (Flesh Goiter) shows unchanged skin color, associated with the Spleen. Qiying (Qi Goiter) fluctuates with emotions of joy and anger, associated with the Lung. Shiying (Stone Goiter) is hard and immobile, associated with the Kidney. Treatment should aim at dissipation. It will naturally shrink. One must never lightly use knives or needles to pierce it; otherwise, uncontrolled bleeding may lead to critical danger. Over time, pus and blood may collapse and leak continuously, ultimately causing death. (Zhengzong)
[Image: Yingliu]
He further stated: Jinliu (Sinew Tumor) is hard and purple, with coiled blue veins appearing in clusters; severely, it knots like earthworms. This is caused by the Liver governing sinews; anger stirring Liver fire, leading to dry blood and spasming sinews. Treatment should focus on clearing the Liver, resolving depression, nourishing blood, and relaxing sinews. Qinggan Lulu Wan (Liver-Clearing Aloe Pill) is indicated.
He further stated: Xueliu (Blood Tumor) is slightly purple or red, with mixed hardness and softness; the skin shows faint red threads. If scratched, blood flows uncontrollably. This is caused by the Heart governing blood; sudden excess leads to vigorous fire forcing blood to boil, compounded by external pathogens. Treatment should focus on nourishing and cooling blood, suppressing fire, nourishing yin, calming the spirit, and harmonizing the blood vessels. Qinlian Ermu Wan (Scutellaria and Anemarrhena Pill) is indicated.
He further stated: Roulou (Flesh Lump) is soft as cotton, hard as steamed bun, with unchanged skin color, neither tight nor loose, resembling a covered liver throughout the year. This is caused by the Spleen governing muscles; depression injuring the Spleen, leading to thinning muscles and stagnant Earth qi reversing into the flesh causing swelling. Treatment should focus on regulating the Spleen, widening the middle, unblocking Stomach qi, resolving depression, moving phlegm, and adjusting diet. Jiawei Guipi Tang (Modified Restore the Spleen Decoction) is indicated.
He further stated: Qilou (Qi Lump) is soft yet firm, with normal skin color, fluctuating in size without fever or chills. This is caused by the Lung governing qi; labor injury depleting primordial qi, loose interstices allowing external cold to transmit and cause swelling. Treatment should focus on clearing Lung qi, regulating meridians, treating labor injury, and harmonizing Ying and Wei. Tongqi Sanjian Wan (Qi-Unblocking Hardness-Dissipating Pill) is indicated.
He further stated: Guli (Bone Tumor) is purple-black, hard as stone, with raised nodules that do not move, firmly attached to the bone. This is caused by the Kidney governing bones; excessive desire injuring the Kidney, depressing Kidney fire, and failing to nourish bones, causing swelling. Treatment should focus on nourishing and tonifying Kidney qi, nourishing blood, moving stasis, dissipating swelling, breaking hardness, and opening orifices. Diaoyuan Shenqi Wan (Origin-Regulating Kidney Qi Pill) is indicated.
He further stated: Fenliu (Powder Tumor) is pink-red, mostly occurring behind the ears and neck, sometimes on the lower body, entirely formed by phlegm and qi knotting. It is suitable to use a lancet to break it, remove the powder, insert Sanpin Yitiaoqiang (Three-Grade Single-Spear), and repeat until the inner membrane is dissolved for self-healing.
He further stated: Heishaliu (Black Sand Tumor) mostly occurs on buttocks and legs, with varying sizes of protrusion. Pinching reveals black material inside. Use a lancet to puncture internally; black sand exits with sound, varying in hardness.
He further stated: Faliu (Hair Tumor) mostly occurs about one cun below the hair behind the ear, soft, small, and protruding, non-painful upon pressure. Needling causes powdery hair to exit completely.
He further stated: Hui Chong Liu (Roundworm Tumor) occurs under the hypochondrium.
He further stated: Qu Liu (Maggot Tumor) occurs on the shoulders and arms.
He further stated: Shi Liu (Louse Tumor) releases lice when broken. However, the varied shapes of tumors are all caused by damp-heat, evil fire, turbid qi, and blood stasis in the five zang organs, each sensing different factors; they are not standard diseases.
He further stated: Xia'er Tai Liu (Infant Congenital Tumor) appears at birth on the head or between chest and breasts. Large ones resemble buns, small ones resemble plums. This is formed by stagnant blood in the womb. Wait until the infant is one month old, then prick with a needle. If red bean juice-like fluid exits, it is safe; internal administration of Wufu Huadu Dan (Five Blessings Detoxifying Pill) leads to cure.
He further stated: For treating Ying, if primordial qi is strong at onset, use Haizao Yuhu Tang (Seaweed Jade Pot Decoction) or Liu Jun Wan (Six-Army Pill); if primordial qi is deficient after a long time, use Hupo Heilong Dan (Amber Black Dragon Pill) or Shiquan Liuqi Yin (Perfect Ten Qi-Flowing Decoction). Select and treat accordingly.
Xue Lizhai stated: For various syndromes of Ying and Liu, only medication for gradual dissolution is suitable. Never lightly use knives or needles to pierce them; uncontrolled bleeding often leads to immediate danger. Both doctors and patients must be cautious and never act rashly.
Feng Luzhan stated: Ying attaches to the shoulder and neck; Liu forms with qi knotting. Avoid rich flavors, forbid reckless piercing. The five types of Ying must not be recklessly pierced; only Taiying (Congenital Ying) heals after piercing and removing its powder. (Jinnang)
Li Dongyuan's method for distinguishing Liu: If swelling is uniformly soft and painless, it is Xueliu (Blood Tumor). If swelling grows daily, is not hot, but causes pulling pain, it is Qilou (Qi Tumor). If qi knotting causes slight swelling that persists and eventually suppurates, it is caused by cold and heat. Long-standing accumulation generates yang from extreme yin, transforming cold into heat; thus, ulceration likely leads to fistulas. Early administration of Neisai San (Internal-Sealing Powder) to drain pus is advisable. Various ulcers, warts, and excrescences in old age will ulcerate internally; treating them in youth prevents future worries. (Shi Shu)
Baixiao Quanshu states: Ying and Liu are both formed by qi and blood stagnation knotting together. Ying arises from joy and anger, mostly attaching to the shoulder and neck, with loose, heavy, hanging skin. Liu forms where qi stays; initially like a plum, with tender, shiny skin, gradually becoming cup-shaped. Although Ying has five types, Liu has many categories. They are painless and itchless; do not rupture them, lest pus and blood collapse and leak endlessly, causing death. Rouliu (Flesh Tumor) especially should not be aggressively treated. For Zhi Liu (Fat Tumor) and Qilou (Qi Tumor) in robust individuals, Haizao Sanjian Wan (Seaweed Hardness-Dissipating Pill) or Li Dongyuan's Sanzhong Kuijian Tang (Swelling-Reducing Hardness-Ulcerating Decoction) taken in large amounts can also dissipate them. For weak individuals, caution is needed; do not solely use drugs that resolve phlegm, move qi, or break hardness.
Ling Shu states: When xu xie (deficient evils) enter deeply, cold and heat contend. Long retention leads to internal fixation. If cold overcomes heat, bone pain and muscle wasting occur; if heat overcomes cold, rotting flesh and corrupting muscle form pus, damaging bones internally, leading to bone erosion. If there is prior tendon pathology ("prior" is a textual error, "tendon" should be "knot"), tendon knots cannot extend, and evil qi occupies the space, causing Jinliu (Sinew Tumor). If there is knotting, qi gathers there, Wei qi stays and cannot return, fluids remain long-term, forming Changliu (Intestinal Tumor), taking years to form, soft upon palpation. If knotting exists, qi resides forming Xiliu (Ancient Tumor), hard upon palpation. If knotting worsens daily, gathering fluids and evil qi, condensing deep into bone, qi solidifies in bone, bone and qi combine, enlarging daily, forming Guju (Bone Abscess). If knotting occurs in flesh, Zong qi resides there; evil stays, heat transforms to pus, no heat forms Rouju (Flesh Abscess). These airs arise without fixed locations but have fixed names. (Ci Jie Zhen Xie Pian: These are diseases caused by deficient evils entering humans, lingering after the pathogen leaves, accumulating over years to form abscesses and tumors.)
San Yin Fang states: Ying mostly attaches to the shoulder and neck; Liu forms with qi knotting.
Qi Tian Shi stated: Ying and Liu differ. Ying grows connected to flesh, with a large root and large body; Liu has a small root but large body. Among Liu, there are differences: Fenliu (Powder Tumor), Rouliu (Flesh Tumor), Jinliu (Sinew Tumor), and Wuliu (Object Tumor). Jinliu is untreatable and need not be treated; over ten years, it may only grow walnut-sized. Fenliu naturally ruptures after three years, expelling powder like incense ash; once expelled, it heals spontaneously, requiring no treatment. Rouliu is easiest to treat: mix Shuiyin (Mercurius, 水银) and Pengsha (Borax, 硼砂) one qian each, Xuexie (Draconis Sanguis, 血竭) and Ercha (Camelliae Semen, 儿茶) three qian each, Huangbai (Phellodendri Cortex, 黄柏) five qian, Bingpian (Borneolum Syntheticum, 冰片) and Shexiang (Moschus, 麝香) three fen each. Grind to fine powder and apply to the tumor base; it falls off upon application. Small-rooted tumors always fall off. Wuliu (Object Tumor) has a large root and is hardest to treat; it moves occasionally and makes sounds without cause, like insects or birds. One must cut a hole in it so the object cannot stay and escapes. Then apply miraculous flesh-regenerating medicine to dissolve the tumor into water, restoring normal appearance. (Milu)
He further stated: Wuliu results from disrespecting gods and ancestors, offending the Year Lord. The disease is unpredictable and beyond rational discussion, hence not mentioned in Nei Jing, yet such cases exist in the world.
He further stated: Ying varies in shape but is always a damp-heat disease. It grows from small to large, breaks from large, and leads to death from breaking. At onset, cut with a small knife to release clear white fluid, apply Shengji San (Flesh-Generating Powder) for immediate cure. If neglected, it grows larger. Apply medication to the depressed area; pain and fluid discharge occur in half a day. White fluid indicates easy cure; yellow or red indicates difficult cure.
Zhang Zhongjing stated: Some have arm sores turning into large masses, or abdominal sores forming hard lumps persisting all year, or拳头-sized masses. These must be cut out with a knife, but this causes fainting and should not be imitated. Instead, use a small knife to break the skin slightly, then apply Huadu Dan (Toxin-Dissolving Pill) to dissolve it into water. This formula is miraculous and should not be underestimated. For foot tumors the size of a dou, do not break them; gently prick with a needle, apply Huadu Dan, and fluid will flow incessantly. Immediately administer a decoction: Ren Shen (Ginseng Radix, 人参) and Huang Qi (Astragali Radix, 黄芪) three liang each, Sheng Gan Cao (Raw Glycyrrhizae Radix, 生甘草) and Yi Yi Ren (Coicis Semen, 薏苡仁) five liang each, Bai Jie Zi (Sinapis Semen, 白芥子) three qian. Decoct and drink. Two doses eliminate the fluid, leaving the patient without fatigue. This is an internal-external dual treatment. Its brilliance lies in tonifying primordial qi while promoting diuresis without depleting qi. Pricking releases fluid, which damages qi, but tonifying qi counters this fear. This is why the formula is miraculous.
Qi Tian Shi stated: Some have severe throat swelling, not Ying or Liu, with intermittent pain, five-colored patterns externally, and semi-empty/hard sensation internally. This is phlegm knotting, resembling Liu but not Liu, resembling Ying but not Ying. Xiaotan Tang (Phlegm-Resolving Decoction) is indicated. This is a sacred formula for resolving upper jiao phlegm. With Haizao (Sargassum Herba, 海藻) and Kunbu (Eckloniae Thallus, 昆布) to remove the external appearance of Ying/Liu and eliminate five-colored patterns, its妙 (wonder) lies in resolving phlegm without damaging qi, strengthening Stomach qi to facilitate phlegm resolution. One dose brings improvement, two reduce most symptoms, three eliminate completely, four prevent recurrence. This formula is also miraculous for treating Ying syndromes. (Milu)