薛立斋治一妇人，胁患痈，未成脓，恶寒脉紧，以十宣散加柴胡，二剂表症悉退。更以托里散数
剂，脓清而愈。
一男子近胁患疽，肿而不溃，投大补之剂，溃而已愈。后患弱症而殁。
薛立斋治一上舍，年逾四十，因怒，胁内作痛不止，数日后外结一块，三寸许，漫肿，色不赤，
按之微痛此怒气伤肝，致血伤气郁为患。以小柴胡汤对四物，倍用芎、归、黄芩、贝母、肉桂治之。
彼谓丹溪云∶肿疡内外皆痈，宜托里表散为主。又云∶凡疮未破，毒攻脏腑，一毫热药，断不可用。
况此症为气血凝滞，乃服流气饮愈虚，始信而复求治。视之虚症并臻，诊之胃气更虚。彼欲服薛前药。
曰∶急者先治。遂以四君子汤加酒芍、炮姜，四剂少得。更加当归，又四剂，胃气渐醒。乃去姜，又
加黄 、芎、归、肉桂，数剂疮色少赤，并微作痛。又二十余剂，脓成针之。却与十全大补汤，喜其
谨疾，又两月余而瘳。夫气血凝滞，多因荣卫之气弱，
不能运散，岂可复用流气饮，以益其虚。况各经气血多寡不同，心包络、膀胱、小肠、肝经，多血少
气，三焦、胆、肾、心、脾、肺，少血多气。前症正属胆经少血之脏，人年四十以上，阴血日衰，且
肝症俱属不足，肿疡内外皆壅，宜托里表散为主。乃补气血药而加以行散之剂，非专攻之谓也。若肿
痛甚，烦躁脉大，辛热之剂，不但肿疡不可用，虽溃疡亦不可用也。凡患者须分经络气血，地步远
近，年岁老幼，禀气虚实及七情所感，时令所宜而治之。常见以流气、十宣二散概治结肿之症，以致
取败者多矣。（此案与旧案东侍御一则正同，而此之发明，最为紧要，而旧案节之，故重录于此。）
马元仪治沈氏妇，左胁患肿疡，长五寸许。治已两月，发表托里，剂多功少。诊其两脉弦数兼涩，
肿处低陷作痛，寒热，经行不止，口燥艰食。此症颇危，必得之劳郁且怒，邪热结聚厥阴之位，荣卫
不行，周身火邪，独彻上下，表敛俱所不宜。用生首乌一两，滋其内燥；柴胡一钱，疏其气血；枳壳、
桔梗各一钱，舒通肺气，以制肝木；杏仁、苏子各二钱，调气化痰，以清上焦；丹皮一钱，清其血；
半夏曲一钱，和其中。两剂寒热减而经止，患处 肿，溃稠脓，饮食少进。疡医以溃后当行大补，投
、术之属，后致疮口内陷，食少。曰∶痈疽已溃，当补，此其常耳。今两脉迟涩，迟则气滞，涩则
血滞，郁而得补，其郁弥甚。始犹肝木自伤，既乃转戕脾胃，以不循常度，分肉不温，经隧不行，而
欲疮之敛也，其可得乎？夫荣不通，须以血药和之，当归、桃仁、红花、延胡索是也。白术、枳壳，
一补一泻，所以推陈气以致新气，干姜暖胃而和血，楂肉消滞而和中。服二剂，复大溃出稠脓碗许，
食进神旺而安。（名言至理，须细参之。）
朱丹溪诊李兄，年四十余，而面稍白，神气劳甚，忽胁下生一痈，肿如桃。一人教用补剂，众笑
阻之，于是流气饮、十宣散杂而进之。旬余召视之，曰∶非惟不与补药，抑且多得解利，血气俱惫，
不可为矣。已而果然。
立斋曰∶一男子因怒，左胁肿一块，不作痛，脉涩而浮，此肝经邪火炽甚，而真气不足为患，宜
培养气血为主。乃用草药数帖，遂致不救。
一男子因劳发热，胁下肿痛，脉虽大而按之无力，此气血虚，腠理不密，邪气袭于肉里而然也。
河间云∶若人饮食疏，精神衰，气血弱，肌肉消导，荣卫之气短促而涩滞，故寒搏腠理而痈肿也，当
补之以接虚怯之气。遂以补中益气汤加羌活，四剂少可。去羌活，又十余剂而愈。又一男子，年二十，
遍身微痛，腰间作肿痛甚，以前药加茯苓、半夏并愈。
一朝士腹胁间病疽经岁，或以地骨皮煎汤淋洗，出血一二升，家人惧，欲止之。病者曰∶疽似快。
更淋之，有五升许，血渐淡乃止，以细穣贴之，次日结痂而愈。（同上。）
张子和治襄陵马国卿，左乳二肋间期门穴中，发痛硬而不溃，痛不可忍。疡医皆曰乳痈，或曰红
丝漏，或曰 心疮，使服内托数百日，又服五香连翘汤数月，皆无验。张曰∶此马刀也，足少阳胆经
之病。出《灵枢》十二经以示之，其状如马刀，故曰马刀，坚而不溃。乃邀之于食肆中，使食浸汤饼，
稍觉缓。次日先以沧盐上涌，又以凉剂涤去热势，约十数行，肿已散矣。
朱葛黄家外家，左胁病马刀，憎寒发痛，已四五日矣。张曰∶此足少阳胆经病也，少血多气，坚而
不溃，不可急攻，当以苦剂涌之。以五香连翘汤托之，既而痛止，然疮根未散。有一道人过见之，曰∶
我有妙药，可溃而为脓，不如此，何时而愈？既 毒药，痛不可忍，外寒，内呕血不止，大便黑色，
饮食不下，号呼闷乱，几于死。再求治，张曰∶胁间皮薄肉浅，岂可轻用毒药？复令洗去，以凉剂下
之，痛立止，肿亦消。
薛立斋治疗一位妇人，胁部患痈肿，脓液尚未形成，表现为恶寒、脉象紧，使用十宣散加入柴胡，服用两剂后表证全部消退。随后改用托里散服用数剂，脓液排出且伤口清洁，病情痊愈。
另一位男子在靠近胁部处患疽，肿胀但未溃破，投以大补的药剂，疮口溃破后随即痊愈。后来因患虚损性疾病去世。
薛立斋治疗一位上舍（官职名），年龄超过四十岁，因为发怒，胁内疼痛不止，几天后外部结成一个约三寸大小的肿块，漫肿无头，颜色不红，按压时有轻微疼痛。这是怒气伤肝，导致血伤气郁而引发的疾病。用小柴胡汤合四物汤，加倍使用川芎、当归、黄芩、贝母、肉桂来治疗。患者认为朱丹溪说过：“肿疡无论内外都是痈，应以托里透表和发散为主。”又说：“凡是疮疡未破，毒邪攻冲脏腑，一点热药都绝对不可用。”况且此症是气血凝滞，却服用流气饮使正气更虚，这才相信薛立斋并重新求治。观察发现虚证并至，诊察发现胃气更加虚弱。患者想服用薛立斋之前的药物。薛立斋说：“急症先治。”于是使用四君子汤加入酒白芍、炮姜，服用四剂后症状稍减。再加当归，又服四剂，胃气逐渐恢复。然后去掉姜，再加入黄芪、川芎、当归、肉桂，服用数剂后疮色微红，并开始轻微疼痛。又服用二十多剂，脓液形成后用针穿刺排脓。接着给予十全大补汤，庆幸他谨慎调养，又过了两个多月才痊愈。气血凝滞，多是因为营卫之气虚弱，不能运化消散，怎么可以再复用流气饮来增加其虚损呢？况且各经络的气血多少不同，心包络、膀胱、小肠、肝经是多血少气，三焦、胆、肾、心、脾、肺是少血多气。前症正属于胆经这种少血的脏腑，人年过四十，阴血日渐衰退，且肝病都属于不足之症，肿疡内外皆壅塞，应以托里透表和发散为主。这里是用补气血的药加上行气散结的药剂，并不是专事攻伐的意思。如果肿痛剧烈，烦躁不安，脉象洪大，辛热之剂不但肿疡不可用，即使是溃疡也不可用。凡患者必须分辨经络气血、病位远近、年龄老幼、禀赋虚实以及七情所感、时令适宜等因素来治疗。常见有人用流气散、十宣散一概治疗结肿之症，以致失败者很多。（此案与旧案中东侍御一则完全相同，而本案的阐发最为紧要，旧案有所省略，所以重新记录在此。）
马元仪治疗沈氏妇，左胁患肿疡，长约五寸左右。治疗已两个月，发表和托里的方法用了不少，但功效很少。诊察其两手脉象弦数兼涩，患处低陷作痛，伴有寒热往来，月经淋漓不止，口干燥渴，进食困难。此症颇为危重，必定是由于劳累、抑郁且愤怒，邪热结聚在厥阴经的位置，营卫运行不畅，周身火邪独盛，上下彻通，此时发表和收敛都不适宜。使用生首乌一两，滋养内部干燥；柴胡一钱，疏理气血；枳壳、桔梗各一钱，舒展通畅肺气，以制约肝木；杏仁、苏子各二钱，调理气机化痰，以清利上焦；丹皮一钱，清泄血分热毒；半夏曲一钱，调和中焦。服用两剂后寒热减轻且月经停止，患处肿胀消退，溃破流出稠脓，饮食略有进益。外科医生认为溃后应当进行大补，投用黄芪、白术之类的药物，后来导致疮口内陷，食量减少。马元仪说：“痈疽已经溃破，应当补益，这是常理。如今两手脉象迟涩，迟则气滞，涩则血滞，郁结状态下再补益，郁结会更加严重。起初还是肝木自伤，继而转而去伤害脾胃，因为不遵循常规法则，肌肉不得温煦，经脉隧道不通畅，想要疮口愈合，怎么可能呢？既然营血不通，需要用血分药来调和它，如当归、桃仁、红花、延胡索等。白术、枳壳，一补一泻，用来推陈出新，干姜暖胃而和血，山楂肉消滞而和中。服用两剂后，再次大量溃破流出约一碗稠脓，饮食增进，精神旺盛而安定。（名言至理，须仔细参悟。）”
朱丹溪诊治李兄，年龄四十多岁，面色稍白，神气劳损严重，忽然胁下生一痈，肿胀如桃子大小。一人教唆使用补剂，众人嘲笑并阻止，于是流气饮、十宣散混杂服用。十多天后召请朱丹溪来看，说：“不仅不给补药，而且多得了解利（泻下）过度，血气都已疲惫，无法救治了。”不久果然如此。
薛立斋说：一名男子因为发怒，左胁肿起一块，不疼痛，脉象涩而浮，这是肝经邪火炽盛，而真气不足的病患，应该以培养气血为主。却使用草药数帖，最终导致无法挽救。
另一名男子因为劳累发热，胁下肿痛，脉象虽然大但按之无力，这是气血虚弱，腠理不紧密，邪气侵袭于肌肉之间所致。刘河间说：“如果人饮食粗疏，精神衰败，气血虚弱，肌肉消瘦，营卫之气短促而涩滞，所以寒气搏结于腠理而引发痈肿，应当补益以接续虚怯之气。”于是使用补中益气汤加入羌活，服用四剂后稍有好转。去掉羌活，又服用十余剂而痊愈。又有一名男子，二十岁，遍身轻微疼痛，腰部肿痛剧烈，用前面的药方加入茯苓、半夏一并治愈。
一位朝士腹胁间患疽一年，有人用地骨皮煎汤淋洗，出血一二升，家人害怕，想停止。病人说：“疽似乎好转了。”继续淋洗，共有五升左右，血液逐渐变淡才停止，用细软的棉絮贴敷，第二天结痂而愈。（同上。）
张子和治疗襄陵马国卿，左乳第二肋骨间期门穴中，发生疼痛坚硬且不溃破，疼痛难以忍受。外科医生都说这是乳痈，有的说是红丝漏，有的说是心疮，让服用内托散数百日，又服用五香连翘汤数月，都没有效果。张子和说：“这是马刀瘘，属于足少阳胆经的疾病。”出示《灵枢》十二经图给他看，其形状像马刀，所以叫马刀，坚硬而不溃破。于是邀请他在饭馆吃饭，让他吃浸在汤里的饼，稍微觉得舒缓。第二天先用沧盐催吐，再用凉剂涤除热势，大约腹泻十多次，肿胀已经消散。
朱葛黄家的外亲，左胁患马刀，憎寒发热疼痛，已经四五天了。张子和说：“这是足少阳胆经的病，少血多气，坚硬而不溃破，不可急于攻伐，应当用苦味药剂催吐。”用五香连翘汤托毒，之后疼痛停止，但是疮根未散。有一位道人经过看见，说：“我有妙药，可以使疮溃破化为脓液，不这样做，什么时候能痊愈？”于是使用毒药，疼痛难以忍受，外部寒冷，内部呕血不止，大便黑色，饮食不下，号呼闷乱，几乎死亡。再次求治，张子和说：“胁间皮肤薄肌肉浅，怎么能轻易使用毒药？”命令再次清洗去除，用凉剂泻下，疼痛立即停止，肿胀也消退。
Xue Lizhai treated a woman who had an abscess in the hypochondrium. The pus had not yet formed, and she presented with aversion to cold and a tight pulse. He prescribed Shixuan San (Ten Acupoints Powder) added with Chaihu (Bupleuri Radix). After two doses, the exterior symptoms completely subsided. Subsequently, he administered Tuoli San (Support the Interior Powder) for several doses, after which the pus was clear and the patient recovered.
A man developed a carbuncle near his hypochondrium. The area was swollen but did not ulcerate. He was given strong tonifying formulas, after which it ulcerated and healed. However, he later died from a deficiency syndrome.
Xue Lizhai treated a Shangshe (an official title) over forty years old. Due to anger, he suffered continuous pain inside the hypochondrium. Several days later, a lump about three cun in size appeared externally, diffuse swelling without a head, non-red in color, and slightly painful upon pressure. This was caused by anger injuring the Liver, leading to blood injury and Qi stagnation. Xue prescribed Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Siwu Tang (Four Substances Decoction), doubling the dosage of Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), Huangqin (Scutellariae Radix), Beimu (Fritillariae Thunbergii Bulbus), and Rougui (Cinnamomi Cortex). The patient argued that Danxi (Zhu Zhenheng) stated: "For sores and ulcers, whether internal or external, the primary treatment should be supporting the interior and releasing the exterior." He also cited Zhu's saying: "When a sore has not broken and toxin attacks the zang-fu organs, absolutely no hot medicines should be used." Furthermore, since this condition was due to Qi and blood stagnation, taking Liuqi Yin (Flowing Qi Drink) only increased his deficiency. Only then did he believe Xue and seek treatment again. Observation revealed multiple deficiency syndromes, and pulse diagnosis showed even weaker Stomach Qi. The patient wished to take Xue's previous prescription. Xue said, "Treat the acute condition first." Thus, he prescribed Sijunzi Tang (Four Gentlemen Decoction) added with Jiushao (Paeoniae Radix Alba processed with wine) and Paojiang (Zingiberis Rhizoma Preparatum). After four doses, there was slight improvement. Dangui (Angelicae Sinensis Radix) was added, and after another four doses, Stomach Qi gradually recovered. Then, ginger was removed, and Huangqi (Astragali Membranacei Radix), Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Rougui (Cinnamomi Cortex) were added. After several doses, the lesion became slightly red and mildly painful. After more than twenty doses, pus formed, and it was lanced. Then, Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction) was given. Fortunately, the patient was careful with his health, and he recovered after another two months. Qi and blood stagnation is often due to weak Ying and Wei (Nutritive and Defensive) Qi, which cannot circulate and disperse. How could one reuse Liuqi Yin to exacerbate the deficiency? Moreover, the amount of Qi and blood varies among meridians. The Pericardium, Bladder, Small Intestine, and Liver meridians have abundant blood and little Qi; the Sanjiao, Gallbladder, Kidney, Heart, Spleen, and Lung meridians have little blood and abundant Qi. The previous case belonged to the Gallbladder meridian, which is an organ with little blood. People over forty experience daily decline in Yin blood, and Liver diseases are generally deficiencies. For sores and ulcers with internal and external blockage, the primary treatment should be supporting the interior and releasing the exterior. Here, tonifying Qi and blood herbs were combined with moving and dispersing agents, which is not a method of exclusive attack. If swelling and pain are severe, accompanied by irritability and a large pulse, acrid-hot medicines are contraindicated not only for sores but also for ulcers. Patients must be treated based on differentiation of meridians and Qi/blood, distance of the lesion, age, constitutional strength or weakness, emotional influences, and seasonal appropriateness. It is common to see practitioners using Liuqi San and Shixuan San indiscriminately for nodular swellings, leading to many failures. (This case is identical to the previous case of Dong Shiyu, but the elaboration here is crucial, whereas the previous case was abbreviated, so it is re-recorded here.)
Ma Yuanyi treated Lady Shen, who had a sore on the left hypochondrium, about five cun long. Treatment had lasted two months, with various exterior-releasing and interior-supporting formulas yielding little effect. Her pulses were wiry, rapid, and choppy on both sides. The lesion was depressed and painful, accompanied by alternating chills and fever, continuous menstruation, dry mouth, and difficulty eating. This condition was critical, likely caused by fatigue, depression, and anger, leading to pathogenic heat accumulating in the Jueyin position. Ying and Wei circulation was blocked, and fire pathogens pervaded the upper and lower body. Neither exterior release nor consolidation was suitable. He used Sheng Shouwu (Polygoni Multiflori Radix Preparata) 1 liang to nourish internal dryness; Chaihu (Bupleuri Radix) 1 qian to soothe Qi and blood; Zhike (Aurantii Fructus) and Jiegeng (Platycodonis Radix) 1 qian each to smooth Lung Qi and control Liver Wood; Xingren (Armeniacae Semen Amarum) and Suzi (Perillae Fructus) 2 qian each to regulate Qi and resolve phlegm, clearing the Upper Jiao; Danpi (Moutan Cortex) 1 qian to clear blood heat; Banxiaqu (Pinelliae Fermentatum) 1 qian to harmonize the Middle Jiao. After two doses, chills and fever decreased, menstruation stopped, the swelling subsided, thick pus drained, and appetite slightly improved. The surgeon believed that post-ulceration required strong tonification and administered Huangqi (Astragali Membranacei Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). Later, the wound cavity collapsed, and appetite decreased. Ma said, "It is customary to tonify after a carbuncle ulcerates. However, the current pulses are slow and choppy. Slow indicates Qi stagnation; choppy indicates Blood stagnation. Tonifying amidst stagnation worsens the stagnation. Initially, it harmed the Liver Wood, and subsequently damaged the Spleen and Stomach. Because the normal course was not followed, flesh was not warmed, and meridians did not flow, how could the wound heal? Since Ying blood does not flow, it must be harmonized with blood-invigorating herbs such as Danggui (Angelicae Sinensis Radix), Taoren (Persicae Semen), Honghua (Carthami Flos), and Yanshusuo (Corydalis Rhizoma). Baizhu and Zhike represent tonification and purgation, used to eliminate stale Qi and generate new Qi. Ganjiang (Zingiberis Rhizoma) warms the Stomach and harmonizes blood; Shanrrou (Crataegi Fructus) resolves stagnation and harmonizes the middle. After two doses, there was massive drainage of about a bowl of thick pus, appetite increased, spirit revived, and the patient stabilized. (These are profound truths that require careful contemplation.)"
Zhu Danxi diagnosed Brother Li, over forty years old, with a slightly pale complexion and severely depleted spirit. Suddenly, an abscess appeared under the hypochondrium, swollen like a peach. Someone advised using tonics, but others laughed and opposed it. Instead, Liuqi Yin (Flowing Qi Drink) and Shixuan San (Ten Acupoints Powder) were mixed and administered. Ten days later, Zhu visited and said, "Not only were tonics withheld, but excessive purgatives were given. Both Qi and blood are exhausted; recovery is impossible." This proved true.
Xue Lizhai stated: A man developed a lump in the left hypochondrium due to anger, which was painless. The pulse was choppy and floating. This was caused by blazing evil fire in the Liver meridian and insufficient True Qi. The treatment should focus on cultivating Qi and blood. However, herbal remedies were used for several prescriptions, leading to an untreatable condition.
Another man developed fever due to labor, with swelling and pain in the hypochondrium. The pulse was large but empty upon pressure. This indicated Qi and blood deficiency, loose interstices, and pathogenic invasion into the muscle layer. He Jingjian (Liu Wansu) said: "If a person eats poorly, has declining spirit, weak Qi and blood, and emaciated muscles, the Ying and Wei Qi become short and stagnant. Cold condenses at the interstices causing swelling and abscesses. One should tonify to support the deficient and fearful Qi." Thus, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) was used. After four doses, there was slight improvement. Qianghuo was removed, and after more than ten doses, the patient recovered. Another man, twenty years old, suffered mild pain all over the body and severe swelling and pain in the waist. The previous formula added with Fuling (Poria) and Banxia (Pinelliae Rhizoma) cured him.
A scholar suffered from a carbuncle in the abdomen and hypochondrium for a year. Someone suggested washing with a decoction of Digupi (Lycii Cortex), resulting in the discharge of one to two sheng of blood. The family was frightened and wanted to stop. The patient said, "The carbuncle seems better." He continued washing, discharging about five sheng until the blood lightened. Fine cotton was applied, and the next day, a scab formed, and he healed. (Same source.)
Zhang Zihe treated Ma Guoqing from Xiangling. Pain and hardness developed in the Qimen acupoint between the left breast and second rib, unulcerated and unbearable. Surgeons diagnosed it as mammary abscess, red thread fistula, or heart sore. They prescribed Neituo (Internal Support) for hundreds of days and Wuxiang Liaoqiao Tang (Five Fragrant Forsythia Decoction) for months, with no effect. Zhang said, "This is Machdao (Horse Knife Fistula), a disease of the Foot Shaoyang Gallbladder Meridian." He showed him the Twelve Meridians from Ling Shu. Its shape resembles a horse knife, hence the name. It is hard and does not ulcerate. He invited him to a restaurant, having him eat soup noodles, which provided slight relief. The next day, he induced vomiting with Cangyan (Halite) and cleared the heat with cooling purgatives, resulting in about ten defecations, after which the swelling dissipated.
An outsider of the Zhu Ge Huang family suffered from Machdao in the left hypochondrium, with aversion to cold, fever, and pain for four or five days. Zhang said, "This is a disease of the Foot Shaoyang Gallbladder Meridian, characterized by little blood and abundant Qi. It is hard and does not ulcerate. Do not attack urgently. Use bitter emetics." He used Wuxiang Liaoqiao Tang (Five Fragrant Forsythia Decoction) to support the interior. Pain ceased, but the root remained. A Daoist passerby saw it and said, "I have a miraculous medicine to induce suppuration. Without this, when will it heal?" Strong drugs were used, causing unbearable pain, external cold, continuous hematemesis, black stool, inability to eat, screaming and confusion, nearly fatal. Seeking treatment again, Zhang said, "The skin and flesh in the hypochondrium are thin. How can strong drugs be used lightly?" He ordered them washed off and administered cooling purgatives. Pain stopped immediately, and swelling subsided.