丹溪云∶脓溃之后，肿退肌宽，痛必渐减而反痛者，此为虚也，宜补之。（托里消毒散，
去后三味，加参 、归地。）脉数虚而痛者，属虚火，宜滋阴。（托里散，加生地。）脉数实而痛者，
邪气实也，宜泄之。脉实便秘而痛者，邪在内也，宜下之。（清凉饮。）脉涩而痛者，气
血虚寒也，温补之。（定痛托里散。）亦有秽气所触者，宜和解之。（东垣黄 人参汤。丹溪云∶芍
药，乳香之类。）亦有风寒所逼者，宜温散之。（败毒散，丹云∶防风、桂枝之类。） 若有脓为脂膜
问隔不出，或作胀痛者，宜用针引之。或用利刀剪之。腐肉堵塞者，去之。
〔丹〕 权小娘，疟后，右腿股生疖。破后筋吊疼，脉虚而涩。询之小便时疼处亦相
应，宜与生血导热。
川芎 当归头 条芩 生地黄 赤芍药 牛膝 黄柏 甘草（炙，二分） 青皮（炒） 槟榔
（五分） 通草（三分） 桂皮（一钱）
上煎，食前热饮之。
人参内托散 治疮疡，溃脓而作痛者。
人参 黄 当归 川芎 浓朴 防风 桔梗 白芷 官桂 紫草 木香 甘草
上入糯米一撮，水煎服。
余见后兼证痛门，宜参看。
戴院使云∶未溃之际，憎寒壮热，狂言妄语，如见鬼神，脓去已多而大热不休者，似
为难治。盖毒之得脓，犹伤寒表证之得汗，汗已而反太热，则为坏伤寒矣。又云∶患痈毒
人，脓血已溃，所去过多，津液枯渴。多病于渴，纵有发热躁扰等证，不可以治，宜用
益荣生津之剂，若大热不止者，难疗。脉浮或弱而热，或恶寒者，阳气虚也，宜补气，（补
中益气汤。）脉涩而热者，血虚也，宜补血，（四物汤，人参养荣汤，圣愈汤。） 午前热，补气为
主，（四君子汤，黄 六一汤。） 午后热，补血为主，（四物汤，圣愈汤。） 脉浮数发热而痛者，邪
在表也，宜散之。脉沉数发热而痛者，邪在内也，宜下之。
〔薛〕 疮疡，发热烦躁，或出血过多，或溃脓大泄，或汗多亡阳，或下多亡阴，以
致阴血耗散，阳无所根据，浮散于肌表之间而非火也。若发热无寐，血虚也，用圣愈汤。兼
汗不止气虚也，急用独参汤。发热烦躁，肉 筋惕，气血虚也，用八珍汤。大渴面赤，脉
洪大而虚，阴虚发热也，用当归补血汤。肢体微热，烦躁面赤，脉沉而微，阴盛发躁也，
用四君加姜附。东垣云∶昼发热而夜安静，是阳气自旺于阳分也。昼安静而夜发热，是阳
气下陷于阴中也。如昼夜俱发热者，重阳无阴也。当峻补其阴，治者详之。
托里消毒散加减法∶头痛发热，邪在表也，本方加川芎、羌活。若外邪在表，而元
气实者，暂用人参败毒散。头痛恶寒，表虚也，去金银花 连翘二味，倍参 。发热饮
冷便秘，内热也，去参 、归术，加大黄。发热饮热便秘，内虚也，去二味，加参 、归
术。面目赤色，烦热作渴，脉大而虚，血脱发躁也，去连翘、金银花、白芷三味，倍黄
、当归。如不应，暂用当归补血汤。身热恶衣，欲投于水，脉沉微细，气脱发躁也，去
三味，加肉桂、附子。如不应，暂用附子理中汤。若妇人劳役恚怒，或适经行，发热谵
语，或夜间热甚，病在血分也，去三味，加生地黄、牡丹皮、柴胡。如不应，暂用加味
四物汤。
一男子，脓熟不溃，微痛少食，倦怠发热，予为针之，脓涌出，热益甚，乃虚故也，
急以人参黄 汤二剂，热愈甚，此药力尚未及也。又二剂果应，再以当归补血汤数剂而
痊。东垣云∶发热恶热，大渴不止，烦躁肌热，不欲近衣，脉洪大，按之无力，或目痛
鼻干者，非白虎汤证也，此血虚发躁，宜当归补血汤主之。
一儒者，患流注，发热作渴，头痛自汗，脉洪大，按之无力，此气血虚寒也，用十全
大补，加麦门、五味治之，其症益甚，仍用前药加附子一钱，四剂诸证悉退，却去附子，
加肉桂二十余剂，气血渐复。又因劳心发热恶寒，饮食减少，此脾胃复伤，元气下陷，用
补中益气加附子一钱，二剂热止食进，仍用大补元气而安。后因考试不利，怀抱不舒，更
兼劳役，饮食日少，形气日衰，吐痰作渴，头
痛恶寒，或热来复去，或不时而动，仍用补中益气数剂，诸症渐愈，元气渐复，乃去附
于，再加肉桂五分，百余剂而愈。一男子背疮不敛，小便赤涩， 肿发热，口干体倦，脉
洪数而无力，用参 、归术、熟地，芎 、陈皮、麦门、五味、炙草、肉桂，以补元气，引
火归经，脉症益甚，此药力未能及也，再剂顿退，却去肉桂，又数剂而愈。此症因前失
补元气故耳。操江，五都宪，背疮愈后大热，误为热火，用苦寒药一盅，寒热益甚，欲冷
水浴身，脉浮大，按之全无。余曰∶此阳气虚浮于肌表，无根之火也，急用六君子加附
子，一剂即愈。
外舅于见，素膏粱浓味，四十三岁，疽发于背，疡医投五香汤，躁热欲狂。予固沮
之，而后已溃，后平静一日，热复大作，五六日益甚，脉洪数无伦，医皆以为虚，宜补。
予私计，膏粱之变，重以五香之热，当治以苦寒，且大便不行数日矣。盖下之，以泄其
毒乎！乃研石膏末两许，知母二三钱，甘草一钱，黄栝蒌一枚和仁，捣碎，为一剂，命
僮炽炭注水而自煎之。医夏生，苦口力谏，以隆冬溃疡，无用白虎法。余故复加石膏两许，
而置大黄片五钱于袖中，汤既沸，则以袖笼药铫，若为移远火者，而潜下大黄于铫中，时
妻叔二三辈，皆环炉坐，注目而视不觉也。夏生语于声甫，饮是药必死，别去。声甫以告
余，哂之。药成持以饮外舅，少顷，大便下结粪及食物未化者，满行清中，热退身凉，乃
以四君子汤调之，月余而平。先是每旦诊脉，皆言不思食，食少而疮大，去死肉多，自虑
何以生肌敛口乎？予信之，初意其便溺阻隔而漫下之，亦不知为伤食发热也，夏生愧甚，
遂从去。
黄 散 治痈溃后，补虚去客热。
黄 石膏（各二两） 知母 麦门冬（去心）
白芍药 白茯苓 桂心 熟地黄 人参（去芦） 川升麻（各一两） 甘草（炙，微赤，半两）
上锉碎。每服四钱，水一中盏，煎六分，去滓。温服，日三四服。
当归补血汤 治疮疡溃后，气血俱虚，肌热躁热，目赤面红，烦渴引饮昼夜不息，脉
洪大而虚，重按全无，此脉虚血虚也，若误服白虎汤必死，宜此主之。
黄 （炙，一两） 当归（酒拌，三钱）
作一剂。水一盅半。煎六分服。
沉香散 治痈脓溃已绝，肌肉内虚，尚有余热。
沉香（锉） 柴胡（去苗） 黄 麦门冬（去心，各一两） 白术（七钱半） 熟地黄（二两）
黄芩 栝蒌根 甘草（生锉，各半两）
上锉。每服四钱，水一中盏，入竹叶二七片，小麦五十粒，煎至六分，去滓。不拘
时温服。
加味逍遥散 治肝脾血虚，内热发热，或遍身瘙痒寒热，或肢体作痛，头目昏重，或
怔忡颊赤，口燥咽干，或发热盗汗，食少不寐，或口舌生疮，耳内作痛，或胸乳腹胀，小
便欠利。
甘草（炙） 当归 芍药（酒炒） 茯苓 白术（炒） 柴胡（各一钱） 牡丹皮 山栀（炒，各七分）
上水煎服。
栀子黄芩汤 治发背、痈疽溃后，因饮食有伤，调摄不到，发热不住，用以退热。
漏芦 连翘 山栀仁 黄芩（去心） 防风 石韦（如无有，以桑白皮代） 生甘草 生犀角
（屑） 人参 苦参（各去芦） 茯苓（去皮，各二钱半） 生黄 （一两，去叉芦）
上为粗末。每服四大钱，水一盅，煎至六分，去滓温服。
朱丹溪说：脓液排出之后，肿胀消退、肌肉松弛，疼痛应当逐渐减轻；如果反而疼痛加剧，这是虚证，应当采用补益法。（使用托里消毒散，去掉方中后三味药，加入人参、当归、地黄。）脉象数而虚弱且伴有疼痛的，属于虚火，应当滋阴治疗。（使用托里散，加入生地黄。）脉象数而有力且伴有疼痛的，是邪气盛实，应当泄泻祛邪。脉象实且大便秘结并伴有疼痛的，是邪气在体内，应当攻下治疗。（使用清凉饮。）脉象涩且伴有疼痛的，是气血虚寒，应当温补治疗。（使用定痛托里散。）也有因秽浊之气侵袭导致的，应当和解治疗。（使用东垣的黄连人参汤。朱丹溪说：可用芍药、乳香之类药物。）也有因风寒逼迫导致的，应当温散治疗。（使用败毒散，朱丹溪说：可用防风、桂枝之类药物。）如果有脓液被脂膜阻隔无法排出，或者出现胀痛感的，应当用针引流。或者用锋利的刀剪切开。腐肉堵塞创口的，将其去除。
〔丹〕权小娘，患疟疾之后，右大腿股部生疖子。破溃后筋脉拘急疼痛，脉象虚而涩。询问得知小便时疼痛部位也会相应疼痛，应当给予养血并导热外出的方药。
川芎、当归头、条芩、生地黄、赤芍药、牛膝、黄柏、甘草（炙，二分）、青皮（炒）、槟榔（五分）、通草（三分）、桂皮（一钱）。
以上药材煎煮，饭前热服。
人参内托散：治疗疮疡，溃破流脓后出现疼痛的情况。
人参、黄芪、当归、川芎、厚朴、防风、桔梗、白芷、官桂、紫草、木香、甘草。
以上药材加入糯米一撮，加水煎服。
其余内容见后文兼证痛门，宜参考查看。
戴院使说：在疮疡未溃破之际，出现憎恶寒冷、高热、胡言乱语、妄见鬼神等症状；脓液已排出很多但高热仍不退的，似乎难以治疗。因为毒邪化脓，就像伤寒表证出汗一样，汗出之后反而过于发热，就是坏病伤寒了。又说：患痈毒的人，脓血已经溃破流失过多，津液枯竭口渴。大多病人会感到口渴，即使有发热、烦躁等证候，也不可以用常规清热法治，应当使用滋养营血、生津液的方剂，如果高热不止的，难治。脉象浮或弱且发热，或者怕冷的，是阳气虚，应当补气治疗。（使用补中益气汤。）脉象涩且发热的，是血虚，应当补血治疗。（使用四物汤、人参养荣汤、圣愈汤。）午前发热，以补气为主。（使用四君子汤、黄芪六一汤。）午后发热，以补血为主。（使用四物汤、圣愈汤。）脉象浮数、发热且疼痛的，是邪气在体表，应当发散治疗。脉象沉数、发热且疼痛的，是邪气在体内，应当攻下治疗。
〔薛〕疮疡患者，出现发热烦躁，或者出血过多，或者溃脓大量流失，或者汗多导致亡阳，或者泻下过多导致亡阴，致使阴血耗散，阳气无所依附，浮散于肌表之间，这并不是实火。如果发热且无法入睡，是血虚，使用圣愈汤。兼有汗出不止，是气虚，紧急使用独参汤。发热烦躁，肌肉跳动、筋脉抽搐，是气血虚，使用八珍汤。极度口渴、面色红赤、脉象洪大但按之无力，是阴虚发热，使用当归补血汤。肢体微热、烦躁面赤、脉象沉而微弱，是阴盛格阳导致的烦躁，使用四君子汤加干姜、附子。东垣说：白天发热而夜间安静，是阳气在阳分旺盛。白天安静而夜间发热，是阳气下陷于阴中。如果昼夜都发热，是重阳无阴。应当峻补其阴，医者需仔细辨别。
托里消毒散加减法：头痛发热，邪气在体表，本方加川芎、羌活。如果外邪在体表，而元气充实的，暂时使用人参败毒散。头痛怕冷，是表虚，去掉金银花、连翘两味药，加倍人参用量。发热想喝冷饮且便秘，是内热，去掉人参、当归、白术，加大黄。发热想喝热饮且便秘，是内虚，去掉这两味药，加入人参、当归、白术。面目红赤、烦热作渴、脉大而虚，是血脱发躁，去掉连翘、金银花、白芷三味药，加倍黄芪、当归用量。如果无效，暂时使用当归补血汤。身热怕热、想脱衣服、想跳进水里，脉象沉微细，是气脱发躁，去掉这三味药，加入肉桂、附子。如果无效，暂时使用附子理中汤。如果是妇女因劳累、愤怒，或者正值经期，出现发热谵语，或者夜间发热严重，病在血分，去掉这三味药，加入生地黄、牡丹皮、柴胡。如果无效，暂时使用加味四物汤。
一个男子，脓熟但未溃破，轻微疼痛、食欲少、倦怠发热，我为他针刺排脓，脓液涌出后，发热更加严重，这是因为虚证，急忙用人参黄芪汤服用两剂，发热更甚，这是药力尚未到达所致。又服两剂果然见效，再服用数剂当归补血汤而痊愈。东垣说：发热怕热，极度口渴不止，烦躁、肌肤发热，不想靠近衣物，脉象洪大，按之无力，或者眼睛痛、鼻子干的，不是白虎汤证，这是血虚导致的烦躁，应当用当归补血汤主治。
一位儒者，患流注病，发热作渴、头痛自汗，脉象洪大，按之无力，这是气血虚寒，使用十全大补汤，加入麦冬、五味子治疗，症状反而加重，仍然用前方加入一钱附子，四剂后诸症全退，随后去掉附子，加入肉桂二十余剂，气血逐渐恢复。后来又因劳心导致发热怕冷、饮食减少，这是脾胃再次受伤，元气下陷，使用补中益气汤加一钱附子，两剂后热止食进，仍然用大补元气的方法而安宁。后来因考试不利，心怀不舒，再加上劳累，饮食日渐减少，形体气息日渐衰弱，吐痰作渴、头痛怕冷，有时发热有时停止，有时不时发作，仍然用补中益气汤数剂，诸症渐愈，元气渐复，于是去掉附子，再加五分肉桂，百余剂而痊愈。一个男子背疮不愈合，小便赤涩，局部肿胀发热，口干体倦，脉象洪数而无力，用人参、当归、白术、熟地黄、川芎、陈皮、麦冬、五味子、炙甘草、肉桂，以补元气，引火归经，脉症反而加重，这是药力未能及时到达，再服两剂顿然减退，去掉肉桂，又服数剂而痊愈。此症是因为之前失于补益元气所致。操江五都宪，背疮痊愈后大热，误认为是热火，使用苦寒药一盅，寒热更加严重，想用冷水洗澡，脉象浮大，按之全无。我说：这是阳气虚浮于肌表，是无根之火，紧急使用六君子汤加附子，一剂即愈。
我的岳父于见，平素喜食肥甘厚味，四十三岁时，背部发疽，疡医投用五香汤，导致躁热欲狂。我坚决阻止，之后疮已溃破，后平静一天，热势再次大作，五六天日益严重，脉象洪数无比，医生都认为这是虚证，应当补益。我私下考虑，膏粱之变，加上五香药的温热，应当用苦寒药治疗，而且好几天大便不通了。大概应该攻下，以泄解毒邪吧！于是研磨石膏末约一两，知母二三钱，甘草一钱，黄栝蒌一枚连同仁捣碎，作为一剂，命仆人烧炭注水自己煎药。医生夏生，极力劝谏，认为隆冬季节溃疡，不能用白虎汤法。我故意再加石膏约一两，并将五钱大黄片藏在袖中，汤煮沸后，就用袖子罩住药锅，假装移远火源，暗中将大黄放入锅中，当时妻叔等几人，都围着炉子坐着，注视着我却没发觉。夏生对声甫说，喝这药必死，便离开了。声甫告诉我，我笑了笑。药成后拿给岳父喝，不久，大便排出结粪及未消化的食物，满行清稀中，热退身凉，然后用四君子汤调理，月余而平复。起初每天早晨诊脉，都说不思饮食，吃得少而疮口大，去死肉多，自己担心如何生肌敛口呢？我相信了他的话，起初以为是二便阻隔而随意攻下，也不知道是伤食发热，夏生非常惭愧，于是离去。
黄芪散：治疗痈疮溃破后，补虚去除客热。
黄芪、石膏（各二两）、知母、麦冬（去心）、白芍药、白茯苓、桂心、熟地黄、人参（去芦）、川升麻（各一两）、甘草（炙，微赤，半两）。
以上切碎。每服四钱，水一中盏，煎至六分，去渣。温服，每日三四次。
当归补血汤：治疗疮疡溃破后，气血俱虚，肌肤发热、烦躁发热，眼睛红赤面红，烦渴引饮昼夜不息，脉象洪大而虚，重按全无，这是脉虚血虚，如果误服白虎汤必死，应当用此方主治。
黄芪（炙，一两）、当归（酒拌，三钱）。
作一剂。水一盅半。煎至六分服。
沉香散：治疗痈脓溃破已绝，肌肉内虚，尚有余热。
沉香（锉）、柴胡（去苗）、黄芪、麦冬（去心，各一两）、白术（七钱半）、熟地黄（二两）、黄芩、栝蒌根、甘草（生锉，各半两）。
以上切碎。每服四钱，水一中盏，入竹叶十四片，小麦五十粒，煎至六分，去渣。不拘时候温服。
加味逍遥散：治疗肝脾血虚，内热发热，或者遍身瘙痒寒热，或者肢体疼痛，头目昏重，或者怔忡颊赤，口燥咽干，或者发热盗汗，食少不寐，或者口舌生疮，耳内作痛，或者胸乳腹胀，小便欠利。
甘草（炙）、当归、芍药（酒炒）、茯苓、白术（炒）、柴胡（各一钱）、牡丹皮、山栀（炒，各七分）。
以上水煎服。
栀子黄芩汤：治疗发背、痈疽溃破后，因饮食损伤，调摄不到，发热不止，用以退热。
漏芦、连翘、山栀仁、黄芩（去心）、防风、石韦（如无，以桑白皮代）、生甘草、生犀角（屑）、人参、苦参（各去芦）、茯苓（去皮，各二钱半）、生黄芪（一两，去叉芦）。
以上为粗末。每服四大钱，水一盅，煎至六分，去渣温服。
Zhu Danxi stated: After the pus has drained, when swelling subsides and muscles relax, pain should gradually decrease. If pain instead intensifies, this indicates a deficiency syndrome, which requires tonification. (Use Tuoli Xiaodu San [Toxin-Expelling and Toxin-Detoxifying Decoction], removing the last three herbs from the formula, and adding Ren Shen [Ginseng Radix et Rhizoma], Dang Gui [Angelicae Sinensis Radix], and Di Huang [Rehmanniae Radix].) If the pulse is rapid and deficient with accompanying pain, it belongs to deficient fire, requiring yin-nourishing treatment. (Use Tuoli San [Supporting Interior Decoction], adding Sheng Di Huang [Rehmanniae Radix Recens].) If the pulse is rapid and excess with accompanying pain, it indicates pathogenic excess, requiring purgation or draining. If the pulse is excess accompanied by constipation and pain, the pathogen is internal, requiring downward purgation. (Use Qingliang Yin [Cooling Drink].) If the pulse is choppy with pain, it indicates qi and blood deficiency with cold, requiring warming and tonification. (Use Ding Tong Tuoli San [Pain-Stabilizing Supporting Interior Decoction].) There are also cases caused by contact with foul pathogens, requiring harmonization. (Use Dongyuan's Huang Lian Ren Shen Tang [Coptis and Ginseng Decoction]. Zhu Danxi noted that herbs such as Bai Shao [White Peony Root] and Ru Xiang [Olibanum] may be used.) There are also cases forced by wind-cold, requiring warming and dispersal. (Use Baidu San [Resolving Toxicity Decoction]; Zhu noted that Fang Feng [Saposhnikoviae Radix] and Gui Zhi [Cinnamomi Ramulus] may be used.) If pus is trapped behind fatty membranes and cannot drain out, or if distending pain occurs, needle drainage should be employed. Alternatively, sharp knives or scissors may be used to incise. If putrid flesh blocks the wound, it must be removed.
[Danzi] Xiao Niang Quan, after suffering from malaria, developed a boil on her right thigh. After rupture, tendon-like pulling pain occurred, with a deficient and choppy pulse. Upon inquiry, pain in the affected area corresponded with urination. Treatment should focus on generating blood and conducting heat outward.
Chuan Xiong [Ligustici Chuanxiong Rhizoma], Dang Gui Tou [Dong Quai Head], Tiao Qin [Scutellariae Radix], Sheng Di Huang [Rehmanniae Radix Recens], Chi Shao Yao [Red Peony Root], Niu Xi [Achyranthis Bidentatae Radix], Huang Bo [Phellodendri Cortex], Gan Cao [Licorice Root] (roasted, 2 fen), Qing Pi [Citri Reticulatae Pericarpium Viride] (stir-fried), Bing Lang [Arecae Semen] (5 fen), Tong Cao [Tetrapanacis Medulla] (3 fen), Gui Pi [Cinnamomi Cortex] (1 qian).
Decoct these ingredients and drink hot before meals.
Renshen Neituo San [Ginseng Internal-Supporting Decoction]: Treats sores and ulcers where pain occurs after ulceration and pus discharge.
Ren Shen [Ginseng Radix et Rhizoma], Huang Qi [Astragali Radix], Dang Gui [Angelicae Sinensis Radix], Chuan Xiong [Ligustici Chuanxiong Rhizoma], Hou Po [Magnoliae Officinalis Cortex], Fang Feng [Saposhnikoviae Radix], Jie Geng [Platycodonis Radix], Bai Zhi [Angelicae Dahuricae Radix], Guan Gui [Cinnamomi Cortex], Zi Cao [Arnebiae Radix seu Lithospermi Radix], Mu Xiang [Aucklandiae Radix], Gan Cao [Licorice Root].
Add a pinch of glutinous rice, decoct in water, and take orally.
For other details, refer to the section on concurrent symptoms and pain later; please consult there.
Dai Yuan Shi stated: Before ulceration, if there is aversion to cold with high fever, delirious speech, and hallucinations of seeing ghosts or deities; or if much pus has been discharged but high fever persists, the condition seems difficult to treat. The emergence of pus from toxins is akin to sweating resolving exterior syndromes in Shanghan [Cold Damage]; if excessive heat remains after sweating, it becomes a complicated Shanghan disease. He further stated: In patients with carbuncles and toxins, after extensive discharge of pus and blood, body fluids become depleted and thirst ensues. Most patients experience thirst. Even if symptoms such as fever and restlessness exist, standard clearing methods should not be used; instead, formulas that nourish Ying [Nutritive Qi] and generate fluids should be employed. If high fever persists, it is difficult to cure. If the pulse is floating or weak with fever, or aversion to cold, it indicates Yang Qi deficiency, requiring Qi tonification. (Use Buzhong Yiqi Tang [Tonify the Middle and Augment the Qi Decoction].) If the pulse is choppy with fever, it indicates Blood deficiency, requiring Blood tonification. (Use Siwu Tang [Four Substances Decoction], Renshen Yangrong Tang [Ginseng Nourishing the Nutritive Decoction], or Shengyu Tang [Generating Life Restoring Decoction].) Fever in the morning is primarily treated by tonifying Qi. (Use Sijunzi Tang [Four Gentlemen Decoction] or Huangqi Liuyi Tang [Astragalus Six-to-One Decoction].) Fever in the afternoon is primarily treated by tonifying Blood. (Use Siwu Tang or Shengyu Tang.) If the pulse is floating and rapid with fever and pain, the pathogen is at the Exterior, requiring dispersal. If the pulse is deep and rapid with fever and pain, the pathogen is internal, requiring purgation.
[Xue] In sores and ulcers, fever and irritability may result from excessive bleeding, massive pus discharge, excessive sweating leading to loss of Yang, or excessive purging leading to loss of Yin. This causes consumption of Yin Blood, leaving Yang without attachment, causing it to float and scatter on the muscle surface; this is not Fire. If there is fever with insomnia, it is Blood deficiency; use Shengyu Tang. Accompanied by incessant sweating indicating Qi deficiency, urgently use Dushen Tang [Single Ginseng Decoction]. Fever and irritability with muscle twitching and tremors indicate Qi and Blood deficiency; use Bazhen Tang [Eight Treasures Decoction]. Extreme thirst, red face, and a large, empty pulse upon pressure indicate Yin deficiency with fever; use Danggui Buxue Tang [Angelica Tonifying Blood Decoction]. Mild limb fever, irritability, red face, and a deep, faint pulse indicate Yin excess causing false agitation; use Sijunzi Tang plus Gan Jiang [Zingiberis Rhizoma] and Fu Zi [Aconiti Lateralis Radix Praeparata]. Dongyuan stated: Fever during the day and quietness at night indicates Yang Qi flourishing in the Yang divisions. Quietness during the day and fever at night indicates Yang Qi sinking into the Yin. Fever both day and night indicates extreme Yang and lack of Yin. One must vigorously tonify Yin; practitioners should examine this carefully.
Tuoli Xiaodu San Modification Rules: Headache and fever indicate pathogen at the Exterior; add Chuan Xiong and Qiang Huo [Notopterygii Rhizoma et Radix] to the base formula. If external pathogens are at the Exterior but Yuan Qi [Primal Qi] is solid, temporarily use Renshen Baidu San [Ginseng Resolving Toxicity Decoction]. Headache and aversion to cold indicate Exterior deficiency; remove Jin Yin Hua [Lonicerae Japonicae Flos] and Lian Qiao [Forsythiae Fructus], and double the dosage of Ren Shen. Fever with desire for cold drinks and constipation indicates Internal Heat; remove Ren Shen, Dang Gui, and Bai Zhu [Atractylodis Macrocephalae Rhizoma], and add Da Huang [Rhei Radix et Rhizoma]. Fever with desire for hot drinks and constipation indicates Internal Deficiency; remove the aforementioned two herbs, and add Ren Shen, Dang Gui, and Bai Zhu. Red face and eyes, irritability, thirst, and a large, empty pulse indicate Blood deficiency with hair loss and agitation; remove Lian Qiao, Jin Yin Hua, and Bai Zhi, and double Huang Qi and Dang Gui. If ineffective, temporarily use Danggui Buxue Tang. Body heat, aversion to clothing, desire to immerse in water, and a deep, faint, thin pulse indicate Qi deficiency with hair loss and agitation; remove the three herbs mentioned above, and add Rou Gui [Cinnamomi Cortex] and Fu Zi. If ineffective, temporarily use Fuzi Lizhong Tang [Aconite Regulate the Middle Decoction]. In women, due to overwork or anger, or during menstruation, if fever and delirium occur, or severe fever at night, the pathology is in the Blood division; remove the three herbs, and add Sheng Di Huang, Mu Dan Pi [Moutan Cortex], and Chai Hu [Bupleuri Radix]. If ineffective, temporarily use Jiawei Siwu Tang [Modified Four Substances Decoction].
A man had ripe pus that did not ulcerate, with slight pain, poor appetite, fatigue, and fever. I punctured him with a needle, pus gushed out, and fever intensified further. This was due to deficiency. I urgently administered two doses of Renshen Huangqi Tang [Ginseng and Astragalus Decoction], yet fever worsened; this indicated the medicinal force had not yet taken effect. After another two doses, improvement was indeed seen. Subsequently, several doses of Danggui Buxue Tang were administered, leading to recovery. Dongyuan stated: Fever, aversion to heat, extreme unquenchable thirst, irritability, skin heat, aversion to clothing, large pulse that feels empty upon pressure, or eye pain and dry nose, are not indications for Baihu Tang [White Tiger Decoction]. This is agitation due to Blood deficiency; Danggui Buxue Tang should be the primary treatment.
A scholar suffered from Liu Zhu [Flowing Abscess], with fever, thirst, headache, and spontaneous sweating. The pulse was large but empty upon pressure, indicating Qi and Blood deficiency with Cold. He was treated with Shiquan Dabu Tang [Ten Complete Great Tonifying Decoction] plus Mai Men Dong [Asparagi Radix] and Wu Wei Zi [Schisandrae Chinensis Fructus], but symptoms worsened. The previous prescription was continued with one qian of Fu Zi added. After four doses, all symptoms receded. Fu Zi was then removed, and Rou Gui was added for over twenty doses, gradually restoring Qi and Blood. Later, due to mental exertion, he experienced fever and aversion to cold with reduced diet, indicating secondary damage to the Spleen and Stomach and sinking of Yuan Qi. Bu Zhong Yi Qi Tang plus one qian of Fu Zi was used; after two doses, fever ceased and appetite returned. He was then stabilized by tonifying Yuan Qi extensively. Later, due to examination failure and frustration, compounded by overwork, his diet decreased daily, and his physical energy declined. He experienced vomiting phlegm, thirst, headache, aversion to cold, intermittent fever, and irregular movements. Several doses of Bu Zhong Yi Qi Tang were used; symptoms gradually improved, and Yuan Qi recovered. Fu Zi was then removed, and five fen of Rou Gui was added. After over a hundred doses, he was cured. A man had a non-healing back sore, reddish and scanty urine, local swelling and fever, dry mouth, fatigue, and a large, rapid but powerless pulse. He was treated with Ren Shen, Dang Gui, Bai Zhu, Shu Di Huang [Prepared Rehmannia Root], Chuan Xiong, Chen Pi [Citri Reticulatae Pericarpium], Mai Men Dong, Wu Wei Zi, roasted Gan Cao, and Rou Gui to tonify Yuan Qi and guide Fire back to its source. Pulse and symptoms initially worsened, indicating the medicinal force had not yet reached efficacy. After two more doses, symptoms suddenly receded. Rou Gui was removed, and after several more doses, he healed. This case resulted from prior failure to tonify Yuan Qi. Cao Jiang Wu Du Xian, after healing a back sore, developed high fever. Mistakenly diagnosed as Excess Fire, he took a bowl of bitter-cold medicine, worsening chills and fever, desiring a cold bath. His pulse was floating and large but empty upon pressure. I said: This is deficient Yang floating on the muscle surface, a rootless Fire. Urgently use Liujunzi Tang [Six Gentlemen Decoction] plus Fu Zi; one dose led to recovery.
My father-in-law, Yu Jian, accustomed to rich and greasy foods, aged forty-three, developed a carbuncle on his back. The surgeon prescribed Wuxiang Tang [Five Fragrances Decoction], causing restlessness and heat resembling madness. I firmly opposed this, and the prescription was abandoned. After ulceration, he was calm for one day, then fever flared up again, worsening over five to six days. The pulse was extremely large and rapid. Physicians considered it deficiency and recommended tonification. I privately reasoned that changes from rich food, combined with the heat of Wuxiang, required bitter-cold treatment, especially since he had not had a bowel movement for several days. Perhaps purgation could drain the toxin? I ground approximately one liang of Shi Gao [Gypsum Fibrosum], two to three qian of Zhi Mu [Anemarrhenae Rhizoma], one qian of Gan Cao, and one whole Gua Lou [Trichosanthis Fructus] including the seed, crushed them, and prepared one dose. I ordered a servant to heat charcoal and water for self-decoction. Physician Xia Sheng strongly advised against it, arguing that in deep winter with ulceration, Baihu method should not be used. I deliberately added another liang of Shi Gao, and hid five qian of Da Huang slices in my sleeve. When the decoction boiled, I covered the pot with my sleeve, pretending to move it away from the fire, while secretly dropping the Da Huang into the pot. My wife's uncles and others sat around the stove watching intently, unaware. Xia Sheng told Sheng Fu, "Drinking this will surely kill him," and left. Sheng Fu informed me, and I smiled. After the medicine was ready, I gave it to my father-in-law. Soon, hard stool and undigested food passed in the stool, followed by clear diarrhea, fever subsided, and body cooled. Then, Sijunzi Tang was used to regulate digestion, and he recovered within a month. Previously, every morning pulse diagnosis suggested anorexia, low intake, large sore, and excessive dead tissue removal, leading him to worry about how flesh would regenerate and the wound close. I believed him. Initially, I thought urinary/fecal blockage required arbitrary purgation, unaware it was food stagnation causing fever. Xia Sheng was ashamed and left.
Huangqi San [Astragalus Powder]: Treats post-ulceration of carbuncles, tonifying deficiency and removing lingering heat.
Huang Qi [Astragali Radix], Shi Gao [Gypsum Fibrosum] (2 liang each), Zhi Mu [Anemarrhenae Rhizoma], Mai Men Dong [Asparagi Radix] (decored), Bai Shao Yao [Paeoniae Radix Alba], Bai Fu Ling [Poria], Gui Xin [Cinnamomi Cortex], Shu Di Huang [Rehmanniae Radix Praeparata], Ren Shen [Ginseng Radix et Rhizoma] (decored), Chuan Sheng Ma [Bupleuri Radix seu Cimicifugae Rhizoma] (1 liang each), Gan Cao [Licorice Root] (roasted, slightly red, half liang).
Cut into pieces. Take 4 qian per dose, decoct in one zhan of water until 60% remains, strain. Take warm, 3-4 times daily.
Danggui Buxue Tang [Angelica Tonifying Blood Decoction]: Treats Qi and Blood deficiency after ulceration of sores, with skin heat, agitation, red eyes and face, extreme thirst drinking day and night, large and empty pulse, completely empty upon heavy pressure. This indicates pulse and Blood deficiency. Misuse of Baihu Tang will cause death; this formula is indicated.
Huang Qi [Astragali Radix] (roasted, 1 liang), Dang Gui [Angelicae Sinensis Radix] (mixed with wine, 3 qian).
Make one dose. Decoct in 1.5 bowls of water until 60% remains, take orally.
Chenxiang San [Agarwood Powder]: Treats persistent residual heat after abscess drainage, with internal muscle deficiency.
Chen Xiang [Aquilariae Lignum Resinatum], Chai Hu [Bupleuri Radix] (decored), Huang Qi [Astragali Radix], Mai Men Dong [Asparagi Radix] (decored, 1 liang each), Bai Zhu [Atractylodis Macrocephalae Rhizoma] (7.5 qian), Shu Di Huang [Rehmanniae Radix Praeparata] (2 liang), Huang Qin [Scutellariae Radix], Gua Lou Gen [Trichosanthis Radix], Gan Cao [Licorice Root] (raw cut, half liang each).
Cut into pieces. Take 4 qian per dose, decoct in one zhan of water with 14 bamboo leaves and 50 wheat grains until 60% remains, strain. Take warm anytime.
Jiawei Xiaoyao San [Modified Free and Easy Wanderer Plus Powders]: Treats Liver and Spleen Blood deficiency with internal heat and fever, generalized itching with chills and fever, limb pain, heavy head and eyes, palpitations, red cheeks, dry mouth and throat, fever with night sweats, poor appetite and insomnia, mouth and tongue sores, ear pain, chest/breast/abdominal distension, and difficult urination.
Gan Cao [Licorice Root] (roasted), Dang Gui [Angelicae Sinensis Radix], Shao Yao [Paeoniae Radix] (wine-stir-fried), Fu Ling [Poria], Bai Zhu [Atractylodis Macrocephalae Rhizoma] (stir-fried), Chai Hu [Bupleuri Radix] (1 qian each), Mu Dan Pi [Moutan Cortex], Shan Zhi [Gardeniae Fructus] (stir-fried, 7 fen each).
Decoct in water and take orally.
Zhizi Huangqin Tang [Gardenia and Scutellaria Decoction]: Treats persistent fever after ulceration of Fa Bei [Back Carbuncle] or carbuncles, due to dietary injury and improper care, to reduce fever.
Lou Lu [Euphorbiae Humifusae Herba], Lian Qiao [Forsythiae Fructus], Shan Zhi Ren [Gardeniae Semen], Huang Qin [Scutellariae Radix] (decored), Fang Feng [Saposhnikoviae Radix], Shi Wei [Pyrrosiae Folium] (substitute Sang Bai Pi [Mori Cortex] if unavailable), Sheng Gan Cao [Raw Licorice Root], Sheng Xi Jiao [Rhinocerotis Cornu] (powdered), Ren Shen [Ginseng Radix et Rhizoma], Ku Shen [Sophorae Flavescentis Radix] (decored), Fu Ling [Poria] (decored, 2.5 qian each), Sheng Huang Qi [Raw Astragali Radix] (1 liang, decored).
Grind into coarse powder. Take 4 da qian per dose, decoct in one bowl of water until 60% remains, strain, take warm.