夫结核者，相火之所为，痰火之征兆也。凡人病此不知预治，鲜有不致危者，何也？盖
以肾水先亏，相火随炽，熏迫津液，凝聚于皮肤之下，肌肉之上，似 非 ，不红不肿，不
甚痛苦，久而乃溃，人多怠忽，其为证也。初或寒热似疟，形容渐悴，久则肌肉渐消，咳嗽
因而失血，潮汗遗滑等证，蜂集见焉。治之之法，亦必益水清金，滋阴抑阳，兼以开结理气
之品，务使水升火降，津液流通，核消块散，庶无后虑矣，倘因循失治，致于肌肉脱尽，形
体羸，块腐核烂，势若坏都，可复御乎？慎之慎之。
圣谓结核之由，与疮疡痈毒之类大异，倘误治之，为害非细，何则？经曰∶诸痛痒疡疮
，皆属心火，以其心火迫血而成，此实证也。治法，未溃者，则宜凉血解毒，或以苦寒驱
之药攻下。已溃者，则宜排脓内托，脓散毒解则愈。若夫结核，由治不然，盖始于真阴先竭
，相火燔蒸熏迫，津液拂结凝聚，日积月累乃成，故久而不溃，此虚证也。初无痰火诸证，
形体如故，而但见核者，惟在开结降火，消痰理气，核消结散则已，犹火迫卤而为
，得水浸润复解之义。若初犹豫怠缓，致诸核遍溃，形体消瘦，则潮汗遗血，自是蜂起矣。
此盖阴虚之极，相火益炎，所以孤阳愈急，而微阴亦自难遂，故气散血聚，以致诸核遍溃，
或无完肤者有之，当此之际，治必本而标之，乃曰圆神。法以清金益水为君，益阳养阴为佐
，开结降火为使，必使水升火降，津液流通，溃者敛而结者散，庶亢害承制，五脏气平，是
犹寒谷一枝，而嘘阳和之一例也。倘以苦寒峻攻，或以疮疡例治，是犹渴饮鸩，宁不促其毙
乎！大抵瘰 痰核马刀，皆少阳胆气应逆，相火燔炙，治必开结疏利，令胆气通畅，结自解
结核这种病症，是由相火（寄居于肝肾、具有生理功能的命门之火）妄动引起的，是痰火内蕴的征兆。凡是患有此病的人如果不预先治疗，很少有不导致危重情况的，为什么呢？大概是因为肾水（肾阴）先已亏损，相火随之炽盛，熏蒸逼迫津液，凝聚在皮肤之下、肌肉之上，形状像梅核或李核，不红不肿，没有剧烈的痛苦，时间久了才会溃烂，人们往往对此懈怠忽视，这就是它的证候表现。初期可能表现为寒热往来像疟疾一样，形体逐渐憔悴，久了则肌肉逐渐消瘦，咳嗽并伴有咯血，潮热盗汗、遗精滑泄等症状，纷纷出现。治疗的方法，也必须通过滋补肾水、清肃肺金（滋阴降火），滋养阴液以抑制阳亢，兼用开郁散结、调理气机的药物，务必使肾水上承、心火下降，津液流通，结节消散，这样才没有后患。如果拖延失治，导致肌肉脱尽，身体极度瘦弱，肿块腐烂、结核破溃，形势如同都城崩塌，还能挽救吗？千万谨慎啊。
古人说结核的成因，与疮疡痈毒等病症大不相同，如果误治，危害不小，为什么呢？《内经》说：“各种疼痛、瘙痒、溃疡、疮疹，都归属于心火”，因为这是心火逼迫血液运行失常而形成的，属于实证。治疗方法，未溃烂时，适宜凉血解毒，或者用苦寒攻下的药物驱除邪气；已经溃烂时，适宜排脓托毒，脓液排出、毒素解除就会痊愈。至于结核，病因治法却不同，它始于真阴（肾阴）先竭，相火猛烈熏蒸逼迫，津液拂逆凝结，日积月累才形成，所以久不溃烂，这属于虚证。初期并没有痰火的各种症状，形体如常，只是见到结节，只需开郁散结、降火消痰理气，结节消散就没事了，这就像卤水遇水浸润重新溶解的道理一样。如果初期犹豫迟缓，导致各个结节全部溃烂，身体消瘦，那么潮热盗汗、咯血等症状自然蜂拥而起。这大概是阴虚到了极点，相火更加炎上，所以孤阳躁急，微弱的阴液也难以维持，导致气散血聚，以致各个结节全部溃烂，甚至全身无完好皮肤的也有这种情况。当此之际，治疗必须固本治标，才叫圆通神妙。治法以清肃肺金、滋补肾水为主，温养阳气、滋补阴液为辅，开郁散结、降火为引导，务必使肾水上承、心火下降，津液流通，溃烂者收敛，结节者消散，这样才使得亢盛的邪气受到制约，五脏之气平和，这就像寒冷山谷中吹来的一缕暖气，带来阳和生机一样。如果用苦寒峻猛的药物攻伐，或者按照疮疡的方法来治疗，这就像口渴时喝下毒药，难道不是加速死亡吗！大抵瘰疬、痰核、马刀侠瘿等病，都是少阳胆经气机逆乱，相火猛烈灼烧，治疗必须开郁散结、疏利气机，使胆气通畅，结节自然解开。
Tubercles (Lump-like swellings) are caused by the hyperactivity of Ministerial Fire (Xianghuo, the physiological fire residing in the Kidney and Liver) and are a manifestation of Phlegm-Fire. Those who suffer from this condition but fail to treat it preemptively rarely avoid critical danger. Why? This is generally because the Kidney Water (Kidney Yin) is first depleted, allowing Ministerial Fire to blaze forth. This heat steams and forces the Body Fluids to condense beneath the skin and above the muscle layers. The lumps resemble plums or dates; they are neither red nor swollen, nor do they cause severe pain, yet they eventually ulcerate over time. People often neglect them, which characterizes the syndrome. Initially, there may be alternating chills and fever resembling malaria, with gradual emaciation. In later stages, muscles waste away, coughing occurs accompanied by hemoptysis, and symptoms such as tidal fever, night sweats, spermatorrhea, and seminal emission arise concurrently. The treatment method must involve tonifying Water (Kidney Yin) and clearing Metal (Lung), nourishing Yin to suppress Yang, combined with herbs that resolve stagnation and regulate Qi. It is essential to ensure that Water ascends and Fire descends, Body Fluids circulate freely, and the nodules dissipate, thereby preventing future complications. If treatment is delayed or neglected, leading to complete wasting of muscles and extreme debility, with rotting masses and ulcerated tubercles, the situation becomes like the collapse of a capital city; can it still be saved? One must be extremely cautious.
It is said that the etiology of tubercles differs significantly from sores, ulcers, and carbuncles. Misdiagnosis and mistreatment can cause serious harm. Why? The Classics state: "All pain, itching, ulcers, and sores belong to Heart Fire," as they are formed by Heart Fire forcing blood dysregulation; this is an Excess syndrome. For unulcerated cases, cooling Blood and resolving toxicity, or using bitter-cold purgatives to drive out pathogens, is appropriate. For ulcerated cases, draining pus and supporting the interior to expel toxins is indicated; recovery follows when pus drains and toxins resolve. However, the etiology and treatment of tubercles differ. They originate from the initial exhaustion of True Yin (Kidney Yin), where blazing Ministerial Fire steams and forces fluids to become obstructed and condensed. Accumulating day after day, they form slowly and thus do not ulcerate easily; this is a Deficiency syndrome. Initially, without typical Phlegm-Fire symptoms and with normal body shape, only nodules are present. Treatment should focus on resolving stagnation, descending Fire, eliminating Phlegm, and regulating Qi. Once the nodules dissolve, the condition resolves, analogous to brine dissolving upon contact with water. If hesitation and delay allow all nodules to ulcerate and the body to emaciate, then tidal fever, night sweats, and bleeding will inevitably arise. This indicates extreme Yin deficiency with intensified Ministerial Fire, causing solitary Yang to become frantic while weak Yin struggles to sustain itself. Consequently, Qi scatters and Blood congeals, leading to widespread ulceration of nodules, sometimes leaving no intact skin. At this stage, treatment must address the root while managing the branch to achieve mastery. The method prioritizes clearing Lung Metal and tonifying Kidney Water as the principal strategy, supporting Yang and nourishing Yin as adjuncts, and resolving stagnation while descending Fire as guides. The goal is to ensure Water ascends and Fire descends, Body Fluids circulate, ulcers heal, and nodules disperse. This brings the excessive pathogenic factors under control, harmonizing the Qi of the Five Zang organs, similar to a warm breeze in a cold valley restoring harmony. If bitter-cold, harsh purgatives are used, or if treated according to protocols for sores and ulcers, it is akin to drinking poison when thirsty, surely accelerating death! Generally, scrofula (Luoli), phlegm nodules, and "horse knife" lymphadenopathy (Madao) result from rebellious Qi in the Shaoyang Gallbladder channel and intense burning of Ministerial Fire. Treatment must resolve stagnation and promote free flow, ensuring Gallbladder Qi flows smoothly so that nodules naturally resolve.