〔鬼遗〕 正脑上一处起为脑痈及脑疽、脑铄，并在大椎骨上入发际生。脑痈皮起易
得破穴，急破急出脓，不害。脑疽皮浓难得破穴，须急发内毒，使破穴方可。脑铄一处，
初起如横木掘，上起顶门，下止大椎，发肿如火烧，其色青黑如靴皮，大硬不见脓，即
损外皮如犬咬去肉之迹，难愈。《灵枢》云∶阳气大发，消脑溜项，名曰脑烁。其色不药，
脑项痛，如刺以针，烦心者，死不可治。
〔薛〕 脑属足太阳膀胱经，积热。或湿毒上涌，或阴虚火炽，或肾水亏损，阴精消
涸，初起肿赤痛甚，烦渴饮冷，脉洪数而有力，乃湿热上涌，当用黄连消毒散，并隔蒜
灸，以除湿热。漫肿微痛，渴不饮冷，脉洪数而无力，乃阴虚火炽，当用六味丸及补中
益气汤，以滋化源，若口舌干燥，小便频数，或淋沥作痛，乃肾水亏损，急用加减八味丸
及前汤，以固根本引火归经。若不成脓，不腐溃，阳气虚也，四君加归 。不生肌，不
收敛，脾气虚也，十全大补汤。若色黯不溃，或溃而不敛，乃阴精消涸，名曰脑烁，为不
治。若攻补得宜，亦有可愈。治者审焉。
元好问记曰∶予素饮酒，于九月中患脑之下项之上，出小疮，后数日，脑项麻木，肿
势外 ，疡医遂处五香连翘汤，至八日不下，而云不可速疗。十八日得脓出用药，或砭刺，
三月乃可平，四月如故。予记医经云∶凡疮不见脓，九死一生。果如医言，则当有束
手待毙之悔矣。乃请李明之诊，且谓∶膏粱之变，不当投五香，事已无及，当先用火攻
之策，然后用药，以大艾炷如桃核许者，攻之至百壮，乃痛觉。次为处方云∶是足太阳
膀胱之经，其病逆，当反治，脉中得弦紧，按之洪大而数又且有力，必当伏其所主，而先
其所因，其始则同，其终则异，可使破积，可使溃坚，可使气和。可使必已，必先岁气，无
伐天和。以时言之，可收不可汗，经与病俱禁下，法当结者散之，咸以软之，然受寒邪
而禁咸，诸苦寒为君为用，甘寒为佐，酒热为因用为使，以辛温和气血，大辛以解结为
臣，三辛三甘益元气而和血脉，渗淡以导酒湿，扶持秋令以益气泻火，以入本经之药和
血且为引用，既以通经为主用，君以黄芩、黄连、黄柏、生地黄、知母酒制之，本经羌活、
独活、蒿本、防风、防己、当归、连翘以解结，黄 、人参、甘草配诸苦寒者三之一，多
则滋营气补土也，生甘草泻肾火补下焦元气，人参、橘皮以补胃，苏木、当归尾去恶血，生
地黄补血，酒制防己除膀胱留热，泽泻助秋令去酒之湿热，凡此诸药，必得桔梗为舟楫
乃不下沉，投剂之后疽当不痛不拆，食进体健。予如言服之，投床大鼾日出乃寤，以手
扪疮肿减七八，至疮痂都敛十四日而已。世医用技岂无取效者，至于治效之外，乃能历
数体中不言之秘，平生所见唯明之一人而已。（方名黄连消毒饮，见本条。）一人，素不慎起居
饮食， 赤肿痛，尺脉洪数，以黄连消毒散一剂，湿热顿除，惟肿硬作痛，以仙方活命
饮二剂，肿痛悉退，但疮头不消，投十宣去桂，加金银花、 本、白术、茯苓、陈皮，以
托里排脓。彼欲全消，自制黄连解毒散二服，反肿硬不作脓，始悟。仍用十宣散加白术、茯
苓、陈皮、半夏，肿少退，仍去桂，又四剂而脓成，肿势亦退，继以八珍汤加黄 、五
味子、麦门冬，月余脓溃而愈。夫苦寒之药，虽治阴证，尤当分表里虚实，次第时宜，岂
可始末悉用之。然 肿赤痛，尺脉数，按之则濡，乃膀胱经湿热壅盛也，故用黄连消毒
散，以解毒除湿。顾肿硬作痛，乃气血凝滞不行而作也，遂用仙方活命饮，以散结消毒
破血也。其疮头不消，盖因热毒熏蒸，气血凝滞而然也，宜用甘温之剂，补益阳气，托
里以腐溃之。况此证原属督脉经，因虚火盛而出，若不审其因，专用苦寒之药，胃气已
伤，何以腐化收敛？几何不致于败耶！凡疮易消散、易腐溃、易收敛、皆气血壮盛故也。
一人脑疽，已十余日，面目肿闭，头 如斗，脉洪数，烦躁饮冷，此膀胱湿热所致，用
黄连消毒饮二剂，次饮槐花酒二碗顿退，以指按下，肿则复起，此脓已成，于颈、额、肩、
颊各刺一孔，脓并涌出，口目始开，更以托里药，加金银花、连翘三十余剂，而愈。
一人患脑疽，势剧脉实，用黄连消毒散不应，以金银藤二两，水二盅，煎一盅，入酒半碗
服之，势去三四，再服渐退，又加黄柏、知母、栝蒌、当归、甘草节，数剂而溃止，加
黄、川芎、白芷、桔梗，数剂而愈。 一妇年将七十，形实性急好酒。脑疽才五日，脉
紧急又涩，急用大黄，酒煨细切，酒拌炒为末，又酒拌入参炒。入姜煎调一钱服，过两
时再与。得卧而上半身汗，睡觉病已失，此亦内托之意。（按∶此治因性急，因好酒，兼因其脉
而制此方。脉紧急且涩，由其性急嗜酒，以伤其血而然，故用大黄以泄酒热，人参以养气血也。） 杜清
碧病脑疽，疗之不愈，丹溪往视之，曰∶何不服防风通圣散？曰∶已服数剂。丹溪曰∶合
以酒制之。清碧乃自悟，以为不及， 一妇脑左肿痛，左鼻出脓，年余不愈，时或掉眩，
如坐舟车。许叔微曰∶肝虚风邪袭之然也，以川芎一两，当归三钱，羌活、旋复花、细辛、
防风、蔓荆子、石膏、 本、荆芥穗、半夏曲、干地黄、甘草各半两，每服一两，一料
而愈。（按∶此条认作肝虚风邪袭之，而治以去风、清热、养血、祛痰之剂，因其掉眩，痛偏于左也。经曰∶
诸风掉眩，皆属肝木。又病偏左，乃肝胆所主。又曰∶风从上受之。又曰∶无痰不成眩晕。又曰∶肝藏血。
又曰∶风乃阳邪，故方以风、热、痰、血而主治者，理也。）一老患此，色赤肿痛，脉数有力，与
黄连消毒饮二剂少退，更与清心莲子饮四剂而消。 一妇人，冬间患此，肿痛热渴，余
用清热消毒药，溃之而愈。次年三月，其舌肿大，遍身发疔如葡萄，不计其数，手足尤
多，乃脾胃受毒也。先各刺出黑血，随服夺命丹七粒，出臭汗，疮热益甚，便秘二日，与
大黄、芩、连各三钱，升麻、白芷、山栀、薄荷、连翘各二钱，生甘草一钱，水煎三五沸
服之，大小便出臭血甚多，下体稍退，乃磨入犀角汁，再服，舌本及齿缝出臭血，诸毒
乃消，更以犀角地黄汤而愈。
以上治案，皆足太阳经积热，挟风、挟湿、挟虚者，其进退出入，可以用黄连消毒
散之活法也。
黄连消毒饮
黄连（五分） 黄芩（五分） 黄柏（酒洗，五分） 人参（五分） 知母（四分，酒炒，此以苦寒引用通经，
为君） 羌活（一钱） 独活（五分） 防风（五分） 本（五分） 连翘（一钱，此以大辛解本经之结，为臣）
黄（一钱） 甘草（炙，五分，此以甘温配诸苦寒者，三之一，多则滋荣气而补土） 当归身（一钱，酒洗）
生地黄（一钱，酒洗，此以辛温之味，和血补血） 陈皮（五分，不去白，补胃气） 甘草梢（五分，生，
此以甘寒泻肾火之邪，补下焦元气） 泽泻（七分，渗淡导酒湿，扶助秋令） 防己（五分，酒洗，除膀胱留
热） 当归梢（五分） 苏木（五分，去恶寒） 桔梗（一钱，使诸药不下沉，为舟楫之用） 凡所用之药用
酒洗，并入酒煎者，用酒热为因，为使。
上俱作一服。水三盏，煎减一半，去滓，入酒少许再煎，食后温服。投剂之后，不得
饮水，必再作脓，效迟。初患三日者，服之立效。凡疮皆阴中之阳，阳中之阴二证而已。
东垣治疽，阳药七分，阴药三分，名曰升阳益胃散，老人宜之，亦名复煎散。或加没药、
乳香各一钱。
上东垣论膏粱肉食之变，治宜苦寒，不宜芳香者，如解里条，撮要内消升麻汤，孙
真人单煮大黄汤，皆为富贵肉食之辈设也。
羌活当归汤 治脑疽。
黄芩 黄连（各酒炒） 当归身（酒浸） 炙甘草（各一两） 羌活 黄柏（酒浸） 连翘（各五钱） 泽
泻独活 本（各三钱） 防风 栀子仁（各五分）
上 咀。分作四服，水一小碗，先浸一时许，入酒一匙，煎至八分，去渣。大温服
食后，日二服，和渣计六服，三日服尽。去渣；清药调下后槟榔散。
槟榔散
槟榔为细末，将羌活当归汤调下。
陈录判母，年七十余，于冬至后脑出疽，形可瓯面大。众疡医诊视，俟疮熟以针出脓，
因笞侍外家，疮辄内陷凹一韭叶许，面色青黄不泽，四肢逆冷，汗出身清，时复呕吐，脉
极沉细而迟。盖缘衰老之年，严寒之时，病中苦楚，饮食淡薄，已涤肥浓之气，独存瘦
悴之形，加之暴怒，精神愈损，故有此寒变也，病与时同。与疡医议，速制五香汤一剂，
加丁香、附子各五钱，剂尽疡复大发，随证调治而愈。《内经》曰∶凡治病必察其下。谓
察时下之宜也。诸痛痒疮疡皆属心火，言其常也。如疮盛形羸，邪高痛下，始热终寒，此
反常也，固当察时下之宜而权治。故曰∶经者常也，法者用也，医者意也，随所宜而治
之，可收十全之功矣。（按∶此条年老冬寒，理直温补，兹用五香汤加丁、附，以辛散何也？盖因其怒
气郁结，阻碍阳气不得营运，致疽凹陷且脉极沉细而迟，其为气郁可知矣。故用五香以开结，丁、附以助
阳，则郁散阳复，疽乃大发，此亦因其性，因其脉而为治也。）锦衣叶夫人，患脑疽，口干舌燥，
内服清热，外敷寒凉，色黯不 ，胸中气噎，证属阳气虚寒。彼疑素有痰火，不受温补，薛
以参 各五钱，姜桂各二钱，一剂顿然肿溃，又用大补药而愈。
一人脓将成，微痛兼渴，尺脉大而无力，此阴虚火动之证。彼谓心经热毒，自服清凉
降火药愈炽，复求治，乃以四物汤加黄柏、知母、五味、麦门、黄 ，及加减八味丸，渴
止疮溃，更以托里药，兼前丸而愈。
一妇人，年逾八十，脑疽已溃，发背继生，头如粟许，脉大无力，此膀胱经湿热所
致。脉无力血气衰，进托里消毒药数服稍可，更加参 ，虽起而渴，此血气虚甚，以参
各一两，归 各五钱，麦门五味各一钱，数服渴止。不溃加肉桂十余剂，脓成针之，瘀
肉渐腐，徐徐取去而脓清不敛，投十全大补汤，加白蔹、贝母、远志，三十余剂脓稠而
愈。设不峻补，不去腐肉，以渴为火，投以凉药，宁免死哉！疮疽之证，虽属心火，当
分表里虚实，果元气充实，内有实火，寒剂或可责效。若寒凉过度，使胃寒脾弱，阳证
变阴，或结而不溃，或溃而不敛，阴阳乖戾，水火交争，死无日矣。 一人脑疽作渴，脉
虽洪，按之无力，予 咀加减八味丸与之，彼不信，自用滋阴等药，七恶并至而殁。《精
要》曰∶患疽虽云有热，皆因虚而得之，愈后作渴，或先渴后疽，非加减八味丸不能治。
一人脑患疽，发热口渴，医用苦寒药，脓水益多，发热益甚，面目赤色，唇舌燥烈，小
便淋痛，昼夜不寐，死在反掌，请薛治之。乃以加减八味丸料加参、 、归、术、麦冬、甘
草煎服之。熟睡半日，觉来诸证悉退，不数剂而疮愈。薛曰∶病虽愈，当固其本元。彼
不经意，且不守禁，次年患中风；后患背疽而殁。
一老人，脓清兼作渴，脉软而涩。予以为气血俱虚，用八珍汤加黄 、五味。彼不
信，乃服降火之剂，果反作呕少食。始信，服香砂六君子汤四剂，呕止食进，仍投前汤，月
余而愈。 一人未溃兼作渴，尺脉大而无力，以四物汤加黄柏、知母、黄 、麦门，四剂
而渴减，又与加减八味丸，渴止疮溃，更用托里药兼前丸而愈。 一人头项俱痛，虽大
溃肿痛益甚，兼作泻，烦躁不睡，饮食少思，其势可畏。诊其脉毒尚在，与仙方活命饮二
剂，肿痛退半，与二神丸及六君于汤加五味、麦门、酸枣仁四剂，诸证少退，食颇进，睡
少得，及与参苓白术散数服，饮食颇进，又与十全大补汤加金银花、白芷、桔梗，月余
瘥。
〔鬼遗〕 赤色疽，发头额及脑前，并手掌中，十日不穴者死。七日可刺，出赤血，七
日未有脓，不可治也。（不穴者，不作穴而东攻西击也。） 杼疽，发鬓须及两耳，不穴十五日死。
可刺其脓色黑如豆豉，或见血者死。
【《鬼遗草》】在正脑门（头顶正中）一处发生的，称为脑痈、脑疽或脑铄，均生于大椎骨上方进入发际处。脑痈皮薄，容易破溃出脓，迅速破溃排脓则无大碍。脑疽皮厚，难以破溃，必须急用内服药物发散体内毒邪，使疮口破溃方可。脑铄是一处病变，初起时像横木掘地一样，上至头顶，下到大椎，肿胀如火烧般疼痛，颜色青黑如靴皮，坚硬不见脓头，随即外皮破损如同被狗咬去肉一般，难以痊愈。《灵枢经》说：阳气大发，消烁脑髓流注于项部，名叫脑烁。其面色不改药力，脑项疼痛，如针刺一般，心烦意乱者，为死证，不可治。
【薛己】脑属足太阳膀胱经，多因积热所致。或是湿毒上涌，或是阴虚火旺，或是肾水亏损，阴精枯竭。初起时红肿疼痛剧烈，烦躁口渴喜冷饮，脉象洪数而有力，这是湿热上涌，应当使用黄连消毒散，并配合隔蒜灸，以除湿热。若漫肿微痛，口渴但不喜冷饮，脉象洪数而无力，这是阴虚火旺，应当使用六味丸及补中益气汤，以滋养化源。如果口舌干燥，小便频数，或淋漓作痛，这是肾水亏损，急用加减八味丸及前一方剂，以固根本，引火归元。如果不成脓，不腐溃，是阳气虚衰；不生肌，不收敛，是脾气虚弱，可用十全大补汤。如果颜色黯黑不溃，或溃后不敛，这是阴精枯竭，名叫脑烁，属于不治之症。如果攻补得当，也有可愈的可能。治疗者需审慎判断。
元好问记载说：我平时饮酒，九月间患脑下项上的小疮，几日后脑项麻木，肿势向外扩散，疡医于是开五香连翘汤，到第八天脓未下，却说不能速疗。第十八天才出脓，用药或砭刺，三个月才能平复，四个月恢复如初。我记得医经说：凡疮不见脓，九死一生。果真如此，那就该有束手待毙的悔恨了。于是请李东垣（李明之）诊治，他说：膏粱厚味的病变，不当投用五香类药物，事已至此，当先用火攻策略，然后用药。用大艾炷如桃核大小，灸至百壮，才感到疼痛。随后处方说：病在足太阳膀胱经，病气逆乱，当反治。脉中得弦紧，按之洪大而数且有力，必当伏其所主，先治其因，始同终异，可使破积，可使溃坚，可使气和，必能治愈。必先顺应岁气，勿伐天和。从时令看，可收不可汗，经与病俱禁下，法当结者散之，咸以软之。但受寒邪而禁咸，故以诸苦寒药为君为用，甘寒为佐，酒热为因用为使，以辛温和气血，大辛以解结为臣，三辛三甘益元气而和血脉，渗淡以导酒湿，扶持秋令以益气泻火，以入本经之药和血且为引用，既以通经为主用，君以黄芩、黄连、黄柏、生地黄、知母酒制之，本经羌活、独活、藁本、防风、防己、当归、连翘以解结，黄芪、人参、甘草配诸苦寒者三分之一，多则滋营气补土也，生甘草泻肾火补下焦元气，人参、橘皮以补胃，苏木、当归尾去恶血，生地黄补血，酒制防己除膀胱留热，泽泻助秋令去酒之湿热，凡此诸药，必得桔梗为舟楫乃不下沉，投剂之后疽当不痛不拆，食进体健。我照方服用，躺下即大睡，日出才醒，用手摸疮肿减七八，至疮痂都敛十四日而已。世医用技岂无取效者，至于治效之外，乃能历数体中不言之秘，平生所见唯明之一人而已。（方名黄连消毒饮，见本条。）
一人，平时不注意起居饮食，患处赤肿痛，尺脉洪数，以黄连消毒散一剂，湿热顿除，惟肿硬作痛，以仙方活命饮二剂，肿痛悉退，但疮头不消，投十宣去桂，加金银花、藁本、白术、茯苓、陈皮，以托里排脓。彼欲全消，自制黄连解毒散二服，反肿硬不作脓，始悟。仍用十宣散加白术、茯苓、陈皮、半夏，肿少退，仍去桂，又四剂而脓成，肿势亦退，继以八珍汤加黄芪、五味子、麦门冬，月余脓溃而愈。夫苦寒之药，虽治阴证，尤当分表里虚实，次第时宜，岂可始末悉用之。然赤肿赤痛，尺脉数，按之则濡，乃膀胱经湿热壅盛也，故用黄连消毒散，以解毒除湿。顾肿硬作痛，乃气血凝滞不行而作也，遂用仙方活命饮，以散结消毒破血也。其疮头不消，盖因热毒熏蒸，气血凝滞而然也，宜用甘温之剂，补益阳气，托里以腐溃之。况此证原属督脉经，因虚火盛而出，若不审其因，专用苦寒之药，胃气已伤，何以腐化收敛？几何不致于败耶！凡疮易消散、易腐溃、易收敛、皆气血壮盛故也。
一人脑疽，已十余日，面目肿闭，头大如斗，脉洪数，烦躁饮冷，此膀胱湿热所致，用黄连消毒饮二剂，次饮槐花酒二碗顿退，以指按下，肿则复起，此脓已成，于颈、额、肩、颊各刺一孔，脓并涌出，口目始开，更以托里药，加金银花、连翘三十余剂，而愈。
一人患脑疽，势剧脉实，用黄连消毒散不应，以金银藤二两，水二盅，煎一盅，入酒半碗服之，势去三四，再服渐退，又加黄柏、知母、栝蒌、当归、甘草节，数剂而溃止，加黄芪、川芎、白芷、桔梗，数剂而愈。
一妇年将七十，形实性急好酒。脑疽才五日，脉紧急又涩，急用大黄，酒煨细切，酒拌炒为末，又酒拌入参炒。入姜煎调一钱服，过两时再与。得卧而上半身汗，睡觉病已失，此亦内托之意。（按：此治因性急，因好酒，兼因其脉而制此方。脉紧急且涩，由其性急嗜酒，以伤其血而然，故用大黄以泄酒热，人参以养气血也。）
杜清碧病脑疽，疗之不愈，丹溪往视之，曰：何不服防风通圣散？曰：已服数剂。丹溪曰：合以酒制之。清碧乃自悟，以为不及。
一妇脑左肿痛，左鼻出脓，年余不愈，时或掉眩，如坐舟车。许叔微曰：肝虚风邪袭之然也，以川芎一两，当归三钱，羌活、旋复花、细辛、防风、蔓荆子、石膏、藁本、荆芥穗、半夏曲、干地黄、甘草各半两，每服一两，一料而愈。（按：此条认作肝虚风邪袭之，而治以去风、清热、养血、祛痰之剂，因其掉眩，痛偏于左也。经曰：诸风掉眩，皆属肝木。又病偏左，乃肝胆所主。又曰：风从上受之。又曰：无痰不成眩晕。又曰：肝藏血。又曰：风乃阳邪，故方以风、热、痰、血而主治者，理也。）
一老患此，色赤肿痛，脉数有力，与黄连消毒饮二剂少退，更与清心莲子饮四剂而消。
一妇人，冬间患此，肿痛热渴，余用清热消毒药，溃之而愈。次年三月，其舌肿大，遍身发疔如葡萄，不计其数，手足尤多，乃脾胃受毒也。先各刺出黑血，随服夺命丹七粒，出臭汗，疮热益甚，便秘二日，与大黄、芩、连各三钱，升麻、白芷、山栀、薄荷、连翘各二钱，生甘草一钱，水煎三五沸服之，大小便出臭血甚多，下体稍退，乃磨入犀角汁，再服，舌本及齿缝出臭血，诸毒乃消，更以犀角地黄汤而愈。
以上治案，皆足太阳经积热，挟风、挟湿、挟虚者，其进退出入，可以用黄连消毒散之活法也。
黄连消毒饮
黄连（五分） 黄芩（五分） 黄柏（酒洗，五分） 人参（五分） 知母（四分，酒炒，此以苦寒引用通经，为君） 羌活（一钱） 独活（五分） 防风（五分） 藁本（五分） 连翘（一钱，此以大辛解本经之结，为臣） 黄芪（一钱） 甘草（炙，五分，此以甘温配诸苦寒者，三之一，多则滋荣气而补土） 当归身（一钱，酒洗） 生地黄（一钱，酒洗，此以辛温之味，和血补血） 陈皮（五分，不去白，补胃气） 甘草梢（五分，生，此以甘寒泻肾火之邪，补下焦元气） 泽泻（七分，渗淡导酒湿，扶助秋令） 防己（五分，酒洗，除膀胱留热） 当归梢（五分） 苏木（五分，去恶寒） 桔梗（一钱，使诸药不下沉，为舟楫之用） 凡所用之药用酒洗，并入酒煎者，用酒热为因，为使。
上俱作一服。水三盏，煎减一半，去滓，入酒少许再煎，食后温服。投剂之后，不得饮水，必再作脓，效迟。初患三日者，服之立效。凡疮皆阴中之阳，阳中之阴二证而已。
东垣治疽，阳药七分，阴药三分，名曰升阳益胃散，老人宜之，亦名复煎散。或加没药、乳香各一钱。
上东垣论膏粱肉食之变，治宜苦寒，不宜芳香者，如解里条，撮要内消升麻汤，孙真人单煮大黄汤，皆为富贵肉食之辈设也。
羌活当归汤 治脑疽。
黄芩 黄连（各酒炒） 当归身（酒浸） 炙甘草（各一两） 羌活 黄柏（酒浸） 连翘（各五钱） 泽泻独活 藁本（各三钱） 防风 栀子仁（各五分）
上㕮咀。分作四服，水一小碗，先浸一时许，入酒一匙，煎至八分，去渣。大温服食后，日二服，和渣计六服，三日服尽。去渣；清药调下后槟榔散。
陈录判母，年七十余，于冬至后脑出疽，形可瓯面大。众疡医诊视，俟疮熟以针出脓，因笞侍外家，疮辄内陷凹一韭叶许，面色青黄不泽，四肢逆冷，汗出身清，时复呕吐，脉极沉细而迟。盖缘衰老之年，严寒之时，病中苦楚，饮食淡薄，已涤肥浓之气，独存瘦悴之形，加之暴怒，精神愈损，故有此寒变也，病与时同。与疡医议，速制五香汤一剂，加丁香、附子各五钱，剂尽疡复大发，随证调治而愈。《内经》曰：凡治病必察其下。谓察时下之宜也。诸痛痒疮疡皆属心火，言其常也。如疮盛形羸，邪高痛下，始热终寒，此反常也，固当察时下之宜而权治。故曰：经者常也，法者用也，医者意也，随所宜而治之，可收十全之功矣。（按：此条年老冬寒，理直温补，兹用五香汤加丁、附，以辛散何也？盖因其怒气郁结，阻碍阳气不得营运，致疽凹陷且脉极沉细而迟，其为气郁可知矣。故用五香以开结，丁、附以助阳，则郁散阳复，疽乃大发，此亦因其性，因其脉而为治也。）
锦衣叶夫人，患脑疽，口干舌燥，内服清热，外敷寒凉，色黯不溃，胸中气噎，证属阳气虚寒。彼疑素有痰火，不受温补，薛以参、芪各五钱，姜、桂各二钱，一剂顿然肿溃，又用大补药而愈。
一人脓将成，微痛兼渴，尺脉大而无力，此阴虚火动之证。彼谓心经热毒，自服清凉降火药愈炽，复求治，乃以四物汤加黄柏、知母、五味、麦门、黄芪，及加减八味丸，渴止疮溃，更以托里药，兼前丸而愈。
一妇人，年逾八十，脑疽已溃，发背继生，头如粟许，脉大无力，此膀胱经湿热所致。脉无力血气衰，进托里消毒药数服稍可，更加参、芪，虽起而渴，此血气虚甚，以参、芪各一两，归、芍各五钱，麦门、五味各一钱，数服渴止。不溃加肉桂十余剂，脓成针之，瘀肉渐腐，徐徐取去而脓清不敛，投十全大补汤，加白蔹、贝母、远志，三十余剂脓稠而愈。设不峻补，不去腐肉，以渴为火，投以凉药，宁免死哉！疮疽之证，虽属心火，当分表里虚实，果元气充实，内有实火，寒剂或可责效。若寒凉过度，使胃寒脾弱，阳证变阴，或结而不溃，或溃而不敛，阴阳乖戾，水火交争，死无日矣。
一人脑疽作渴，脉虽洪，按之无力，予㕮咀加减八味丸与之，彼不信，自用滋阴等药，七恶并至而殁。《精要》曰：患疽虽云有热，皆因虚而得之，愈后作渴，或先渴后疽，非加减八味丸不能治。
一人脑患疽，发热口渴，医用苦寒药，脓水益多，发热益甚，面目赤色，唇舌燥烈，小便淋痛，昼夜不寐，死在反掌，请薛治之。乃以加减八味丸料加参、芪、归、术、麦冬、甘草煎服之。熟睡半日，觉来诸证悉退，不数剂而疮愈。薛曰：病虽愈，当固其本元。彼不经意，且不守禁，次年患中风；后患背疽而殁。
一老人，脓清兼作渴，脉软而涩。予以为气血俱虚，用八珍汤加黄芪、五味。彼不信，乃服降火之剂，果反作呕少食。始信，服香砂六君子汤四剂，呕止食进，仍投前汤，月余而愈。
一人未溃兼作渴，尺脉大而无力，以四物汤加黄柏、知母、黄芪、麦门，四剂而渴减，又与加减八味丸，渴止疮溃，更用托里药兼前丸而愈。
一人头项俱痛，虽大溃肿痛益甚，兼作泻，烦躁不睡，饮食少思，其势可畏。诊其脉毒尚在，与仙方活命饮二剂，肿痛退半，与二神丸及六君于汤加五味、麦门、酸枣仁四剂，诸证少退，食颇进，睡少得，及与参苓白术散数服，饮食颇进，又与十全大补汤加金银花、白芷、桔梗，月余瘥。
【《鬼遗草》】赤色疽，发于头额及脑前，并手掌中，十日不破溃者死。七日可刺，出赤血，七日未有脓，不可治也。（不穴者，不作穴而东攻西击也。）杼疽，发于鬓须及两耳，不破溃十五日死。可刺其脓色黑如豆豉，或见血者死。
[Gui Yi Cao] A lesion arising at the center of the crown (Baihui area) is called Nao Yong (Brain Abscess), Nao Ju (Brain Carbuncle), or Nao Shuo, all occurring above the Dazhui point entering the hairline. Nao Yong has thin skin and ruptures easily; prompt rupture and pus drainage pose no danger. Nao Ju has thick skin and is difficult to rupture; internal toxins must be urgently dispersed via internal medication to allow rupture. Nao Shuo is a single lesion that initially feels like a transverse wooden beam dug into the ground, extending from the vertex to the Dazhui point. It swells with burning pain, appears dark blue-black like boot leather, is hard without visible pus, and the outer skin soon breaks away resembling dog-bite wounds; it is difficult to heal. The Ling Shu states: "Excessive expansion of Yang Qi consumes brain marrow and flows into the neck, named Nao Shuo." If the complexion does not change with treatment, accompanied by brain-neck pain as if pierced by needles and irritability, it is a fatal, untreatable condition.
[Xue Ji] The head belongs to the Foot-Taiyang Bladder Meridian, often caused by accumulated heat. Etiologies include surging damp-toxin, Yin deficiency with blazing fire, or depletion of Kidney Water and essence. Initially, there is severe red swelling and pain, irritability, thirst for cold drinks, and a flooding, rapid, and forceful pulse, indicating surging damp-heat; use Huanglian Xiaodu San (Coptis Decoction to Eliminate Toxins) combined with garlic-separated moxibustion to dispel damp-heat. If there is diffuse swelling with slight pain, thirst without preference for cold drinks, and a flooding, rapid but weak pulse, this indicates Yin deficiency with blazing fire; use Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source of transformation. If accompanied by dry mouth and tongue, frequent urination, or painful dribbling, this indicates Kidney Water depletion; urgently use Jiawei Bawei Wan (Modified Eight-Ingredient Pill) and the aforementioned decoction to secure the root and guide fire back to its source. If pus does not form and tissue does not putrefy, it is Yang Qi deficiency; if granulation tissue does not grow and the wound does not close, it is Spleen Qi deficiency; use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction). If the color is dark and non-ulcerating, or ulcerating but non-healing, this is essence depletion, named Nao Shuo, which is incurable. However, with appropriate tonification and purgation, recovery is possible. Practitioners must exercise caution.
Yuan Haowen recorded: I drank alcohol regularly. In the ninth month, a small sore appeared below the brain and above the neck. Days later, my brain and neck became numb, and the swelling spread outward. The surgeon prescribed Wuxiang Liaoqiao Tang (Five-Aroma Forsythia Decoction). By the eighth day, no pus had emerged, yet he claimed it could not be cured quickly. On the eighteenth day, pus finally emerged. With medication or bloodletting, it would take three months to flatten and four months to return to normal. I recall medical classics stating: "For any sore, if pus does not appear, nine out of ten die." True enough, I faced the regret of waiting helplessly for death. I then invited Li Dongguan (Li Mingzhi) to diagnose him. He said: "Diseases arising from rich foods and alcohol should not be treated with aromatic herbs. It is too late now; we must first employ fire therapy, followed by medication." Using large moxa cones the size of peach pits, he applied one hundred moxibustion sessions until pain was felt. Then he prescribed: "The disease is in the Foot-Taiyang Bladder Meridian, with rebellious Qi, requiring reverse treatment. The pulse is wiry and tight, flooding, rapid, and forceful upon pressure. We must subdue the dominant pathogen and address its cause. Though starting similarly, the outcome differs; we can break accumulations, soften hardness, harmonize Qi, and ensure cure. We must respect seasonal Qi and not damage Heavenly Harmony. From a seasonal perspective, sweating is contraindicated, and purgation is forbidden for both meridian and disease patterns. For knotting, we scatter; for hardness, we soften with salty flavors. However, since cold pathogens are involved, salty flavors are restricted. Therefore, bitter-cold herbs are used as Sovereign and Minister to clear heat, sweet-cold herbs as Assistant, and hot wine as Enabler due to the etiology. Pungent-warm herbs harmonize Qi and Blood; highly pungent herbs resolve knots as Ministers. Three pungent and three sweet herbs benefit Yuan Qi and harmonize blood vessels; acrid and bland herbs guide dampness from alcohol; supporting Autumn Qi to benefit Qi and drain fire; using meridian-specific herbs to harmonize blood as Guides. The primary action is unblocking the meridian. Sovereigns: Huangqin, Huanglian, Huangbai, Sheng Dihuang, Zhimu (wine-processed). Ministers: Qianghuo, Duhuo, Gaoben, Fangfeng, Fangji, Danggui, Liaoqiao (to resolve knots). Astragalus, Ren Shen, and Gancao are combined with bitter-cold herbs in a ratio of one-third; excessive amounts would nourish Ying Qi and tonify Earth. Raw Gancao drains Kidney Fire and benefits Lower Jiao Yuan Qi. Ren Shen and Chenpi tonify Stomach. Sumu and Danggui Wei remove bad blood. Sheng Dihuang nourishes Blood. Wine-processed Fangji removes residual heat in the Bladder. Zexie assists Autumn Qi to eliminate damp-heat from alcohol. All these herbs require Jiegeng as a boat and oar to prevent sinking. After administration, the carbuncle will cease pain and splitting, appetite will improve, and strength will return." I followed the prescription, slept deeply until sunrise, and found the swelling reduced by seven or eight tenths. Scabs formed and healed completely in fourteen days. While many surgeons achieve results, only Li Mingzhi could articulate the hidden secrets of the body. (Formula name: Huanglian Xiaodu Yin, see this section.)
One patient, who neglected diet and lifestyle, presented with red, swollen, painful lesions and a flooding, rapid Chi pulse. One dose of Huanglian Xiaodu San eliminated damp-heat instantly, leaving only hard swelling and pain. Two doses of Xianfang Huoming Yin (Immortal Life Elixir) resolved swelling and pain, but the sore head persisted. Tenxuan San (Ten-Auspicious Powder) without Rougui, plus Jinyinhua, Gaoben, Baizhu, Fuling, and Chenpi, were used to support the interior and drain pus. Desiring complete resolution, he self-administered two doses of his own Huanglian Jiedu San, resulting in increased hardness and failure to suppurate. He then realized his error. Tenxuan San with Baizhu, Fuling, Chenpi, and Banxia reduced swelling slightly. Removing Rougui again and adding four more doses led to suppuration and reduced swelling. Subsequently, Bazhen Tang (Eight-Treasure Decoction) with Huangqi, Wuweizi, and Maimendong was used, leading to suppuration and healing after over a month. Bitter-cold herbs, even for Yin syndromes, must distinguish exterior/interior and deficiency/excess, following sequence and timing; they cannot be used indiscriminately from start to finish. Red swelling and pain with a rapid Chi pulse, soft upon pressure, indicate abundant damp-heat in the Bladder Meridian; thus, Huanglian Xiaodu San detoxifies and drains dampness. Hard swelling and pain result from stagnation of Qi and Blood; thus, Xianfang Huoming Yin disperses knots, detoxifies, and invigorates blood. The persistent sore head is due to heat-toxin steaming and Qi/Blood stagnation; sweet-warm formulas should tonify Yang Qi and support the interior to promote putrefaction and drainage. This condition originally belongs to the Du Mai (Governing Vessel), arising from deficient fire. Without addressing the cause and using only bitter-cold herbs, Stomach Qi is damaged, hindering putrefaction and healing, leading to collapse. Sores that dissipate, suppurate, and heal easily do so because Qi and Blood are robust.
Another patient with Nao Ju for over ten days had swollen eyes and face, head enlarged like a bucket, flooding rapid pulse, irritability, and thirst for cold drinks, caused by Bladder damp-heat. Two doses of Huanglian Xiaodu Yin reduced symptoms. Drinking two bowls of Huaihua Jiu (Sophora Flower Wine) caused immediate reduction. Pressing the swelling caused it to rebound, indicating pus formation. Holes were punctured in the neck, forehead, shoulder, and cheek, releasing pus, opening the mouth and eyes. Interior-supporting herbs plus Jinyinhua and Liaoqiao for over thirty doses led to recovery.
Another patient with severe Nao Ju and a solid pulse did not respond to Huanglian Xiaodu San. Two taels of Jin Yin Teng (Honeysuckle Stem) were decocted in two cups of water to one cup, mixed with half a bowl of wine. Symptoms decreased by three or four parts after one dose, gradually subsiding with repeated doses. Huangbai, Zhimu, Gualou, Danggui, and Gancao Jie were added, leading to suppuration cessation after several doses. Huangqi, Chuanxiong, Baizhu, and Jiegeng were added, leading to recovery.
A woman nearing seventy, robust in constitution, impatient, and fond of alcohol, developed Nao Ju. Five days in, her pulse was urgent and choppy. Da Huang (Rhubarb) was wine-steamed, sliced finely, stir-fried with wine, powdered, then stir-fried with Ren Shen and wine. Ginger was added for decoction. One qian was taken, repeated after two hours. She slept, sweated on the upper body, and woke with the illness gone. This illustrates the principle of interior support. (Note: Treatment addressed impatience, alcohol habit, and pulse. Urgent/choppy pulse indicated blood injury from impatience/alcohol; Da Huang drained alcohol-heat, Ren Shen nourished Qi and Blood.)
Du Qingbi suffered from Nao Ju unresponsive to treatment. Danxi visited and asked why he didn't take Fangfeng Tongsheng San? He replied he had taken several doses. Danxi advised processing them with wine. Qingbi realized his mistake.
A woman had left-sided brain swelling and pain, purulent discharge from the left nostril for over a year, occasional dizziness and vertigo as if on a boat. Xu Shuwei stated: "Liver deficiency allows Wind Pathogens to invade." Prescription: Chuanxiong (1 liang), Danggui (3 qian), Qianghuo, Xuanfuhua, Xixin, Fangfeng, Manjingzi, Shigao, Gaoben, Jingjie Sui, Banxia Qu, Sheng Dihuang, Gancao (each 0.5 liang). Take 1 liang per dose. One course cured her. (Note: Diagnosed as Liver deficiency with Wind invasion. Treated with wind-dispelling, heat-clearing, blood-nourishing, phlegm-resolving herbs due to vertigo and left-sided pain. Classics state: All wind-induced tremors/vertigo belong to Liver Wood. Left-sided pathology relates to Liver/Gallbladder. Wind enters from above. No phlegm, no vertigo. Liver stores Blood. Wind is a Yang pathogen. Thus, treating wind, heat, phlegm, and blood is logical.)
An elderly patient with red, swollen, painful lesions and a rapid, forceful pulse improved slightly with two doses of Huanglian Xiaodu Yin, then cleared with four doses of Qingxin Lianzi Yin.
A woman contracted this in winter with swelling, pain, heat, and thirst. Heat-clearing and detoxifying herbs led to suppuration and healing. In March the following year, her tongue swelled, and she developed numerous carbuncles like grapes all over her body, especially hands and feet, indicating Stomach/Spleen toxicity. Black blood was pricked out, followed by seven pills of Mingdan (Life-Rescuing Pill), causing foul-smelling sweat and increased sore heat. Constipation for two days was treated with Da Huang, Huangqin, Huanglian (each 3 qian), Shengma, Baizhu, Shanzhi, Bohe, Liaoqiao (each 2 qian), and raw Gancao (1 qian). Decoction boiled briefly. Large amounts of foul blood were excreted, reducing lower body symptoms. Rhinoceros Horn juice was added and administered again, releasing foul blood from the tongue base and gum lines, eliminating toxins. Finally, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) completed the cure.
The above cases involve Foot-Taiyang Meridian accumulated heat complicated by Wind, Dampness, or Deficiency. Their progression and regression demonstrate the flexible application of Huanglian Xiaodu San.
Huanglian Xiaodu Yin
Huanglian (5 fen), Huangqin (5 fen), Huangbai (wine-washed, 5 fen), Ren Shen (5 fen), Zhimu (4 fen, wine-fried, used as Sovereign to guide bitter-cold herbs through meridians), Qianghuo (1 qian), Duhuo (5 fen), Fangfeng (5 fen), Gaoben (5 fen), Liaoqiao (1 qian, used as Minister to resolve meridian knots with pungent flavor), Huangqi (1 qian), Gancao (roasted, 5 fen, combined with bitter-cold herbs in one-third proportion; excess nourishes Ying Qi and tonifies Earth), Danggui Shen (1 qian, wine-washed), Sheng Dihuang (1 qian, wine-washed, used to harmonize and nourish blood with warm-pungent flavor), Chenpi (5 fen, peel retained to tonify Stomach Qi), Gancao Shao (5 fen, raw, used to drain Kidney Fire and benefit Lower Jiao Yuan Qi with sweet-cold flavor), Zexie (7 fen, acrid-bland to guide alcohol-dampness, support Autumn Qi), Fangji (5 fen, wine-washed, remove residual Bladder heat), Danggui Shao (5 fen), Sumu (5 fen, remove bad blood), Jiegeng (1 qian, prevents herbs from sinking, acts as boat/oar). Herbs washed in wine or decocted with wine use wine-heat as an enabler.
All ingredients constitute one dose. Decoct three cups of water until half remains, strain, add a little wine, re-decoct, and take warm after meals. Do not drink water after administration, or pus will reform and efficacy will be delayed. For early-stage onset (3 days), immediate effect is expected. All sores are either Yang within Yin or Yin within Yang.
Dong Yuan treated carbuncles with 70% Yang-tonifying and 30% Yin-nourishing herbs, named Shengyang Yiwu San (Raise Yang and Benefit Stomach Powder), suitable for the elderly, also called Fujian San. May be supplemented with Moyao and Ruxiang (1 qian each).
Dong Yuan's discussion on diseases from rich foods/meat advocates bitter-cold over aromatic herbs, such as Neixiao Shengma Tang (Internal-Dissolving Corydalis Decoction) and Sun Simiao's Da Huang Tang (Rhubarb Decoction), designed for the wealthy meat-eaters.
Qianghuo Danggui Tang treats Nao Ju.
Huangqin, Huanglian (both wine-fried), Danggui Shen (wine-soaked), Zhi Gancao (each 1 liang), Qianghuo, Huangbai (wine-soaked), Liaoqiao (each 5 qian), Zexie, Duhuo, Gaoben (each 3 qian), Fangfeng, Zhizi Ren (each 5 fen).
Crush into coarse powder. Divide into four doses. Soak in one small bowl of water for about an hour, add one spoon of wine, decoct to 80%, strain. Take very warm after meals, twice daily. Include dregs for six doses total, finished in three days. Strain; take the clear liquid with Binglang San (Areca Nut Powder).
Binglang San
Binglang (Areca Seed) powdered. Mix with Qianghuo Danggui Tang.
Chen Lu Pan's mother, over seventy, developed a carbuncle on the head after Winter Solstice, size of a bowl. Surgeons waited for ripeness to lance. Due to beating a servant, the sore sank inward slightly. Complexion was dull yellow-green, limbs cold, sweating with clear fluid, occasional vomiting, pulse extremely deep, fine, and slow. Due to old age, severe cold, suffering, bland diet washing away rich Qi, leaving emaciation, plus sudden anger damaging Spirit, this cold transformation occurred, matching the season/time. Discussed with surgeons, immediately prepared Wuxiang Tang (Five-Aroma Decoction) with Dingxiang and Fuzi (each 5 qian). After finishing the dose, the carbuncle flared up significantly, and subsequent symptom-based treatment led to recovery. Nei Jing states: "In treating disease, always observe the lower [symptoms/context]." Meaning observe seasonal appropriateness. "All pain, itching, sores, and ulcers belong to Heart Fire" refers to the norm. But when sores are severe while the body is emaciated, pathogen is high but pain is low, starting hot ending cold, this is abnormal; one must adjust treatment based on seasonal appropriateness. Thus: Classics are norms, methods are applications, medicine is intuition. Treating according to appropriateness yields perfect results. (Note: Elderly in winter cold suggests warming/tonifying. Why use pungent-dispersing Wuxiang Tang with Ding/Fu? Anger caused Qi stagnation blocking Yang circulation, leading to sunken carbuncle and deep/slow pulse. Thus, Wuxiang opens knots, Ding/Fu assist Yang. Stagnation disperses, Yang recovers, carbuncle flares. Treatment matched constitution and pulse.)
Jinyi Ye Fu Ren suffered from Nao Ju with dry mouth/tongue. Internal heat-clearing and external cooling applications resulted in dark, non-ulcerating lesions and chest oppression, indicating Yang deficiency/cold. Suspecting chronic Phlegm-Fire and rejecting warming/tonics, Xue prescribed Renshen and Huangqi (each 5 qian), Jiang and Guizhi (each 2 qian). One dose caused immediate swelling and suppuration. Major tonics completed the cure.
One patient, near suppuration, had mild pain and thirst, with a large but weak Chi pulse, indicating Yin deficiency with moving fire. Believing it was Heart Fire-Toxin, he self-medicated with cooling/fire-draining herbs, worsening symptoms. Seeking treatment, he received Siwu Tang with Huangbai, Zhimu, Wuweizi, Maimendong, and Huangqi, plus Jiawei Bawei Wan. Thirst stopped, sore ulcerated. Interior-supporting herbs and the pill completed the cure.
A woman over eighty had an ulcerated Nao Ju, followed by Fa Bei (Back Carbuncle) with millet-sized heads, large but weak pulse, caused by Bladder Meridian damp-heat. Weak pulse indicates Qi/Blood decline. Several doses of interior-supporting detoxifying herbs helped slightly. Adding Renshen and Huangqi helped, but thirst remained due to severe Qi/Blood deficiency. Renshen/Huangqi (each 1 liang), Danggui/Shao Yao (each 5 qian), Maimendong/Wuweizi (each 1 qian) stopped thirst after several doses. For non-suppuration, Rougui was added for over ten doses. Once pus formed, it was lanced. Necrotic tissue gradually rotted and was removed slowly. Clear pus failed to heal; Shiquan Dabu Tang with Bailian, Beimu, and Yuanzhi for over thirty doses thickened pus and cured it. Without vigorous tonification and debridement, mistaking thirst for fire and using cooling drugs would surely lead to death. Although sores/carbuncles belong to Heart Fire, one must distinguish exterior/interior and deficiency/excess. If Yuan Qi is solid and internal excess fire exists, cold drugs may work. Overuse of cold damages Stomach/Spleen, transforming Yang syndromes into Yin, causing non-ulceration or non-healing, Yin-Yang disharmony, and imminent death.
One patient with Nao Ju and thirst had a flooding pulse, weak on pressure. Prescribed crushed Jiawei Bawei Wan. He disbelieved, used self-prescribed Yin-nourishing drugs, developed Seven Adversities, and died. Jing Yao states: "Although carbuncles involve heat, they arise from deficiency. Post-recovery thirst, or thirst preceding carbuncle, can only be treated with Jiawei Bawei Wan."
One patient with brain carbuncle had fever, thirst, increased pus, worse fever, red face/lips/tongue, painful urination, insomnia day and night, facing imminent death. Xue treated with Jiawei Bawei Wan formula plus Renshen, Huangqi, Danggui, Baizhu, Maimendong, and Gancao. Deep sleep for half a day resolved all symptoms. Few doses cured the sore. Xue said: "Though cured, consolidate the root." He neglected advice and dietary restrictions, suffered stroke the next year, and died from back carbuncle later.
An elderly patient with clear pus and thirst had a soft, choppy pulse. Diagnosed as dual Qi/Blood deficiency. Prescribed Bazhen Tang with Huangqi and Wuweizi. He disbelieved, took fire-draining herbs, vomited, and lost appetite. Believing thereafter, he took Xiangsha Liujunzi Tang for four doses, stopping vomiting and improving appetite, then resumed previous decoction, curing after a month.
One patient, pre-suppuration with thirst, had a large, weak Chi pulse. Siwu Tang with Huangbai, Zhimu, Huangqi, and Maimendong reduced thirst in four doses. Jiawei Bawei Wan stopped thirst and induced suppuration. Interior-supporting herbs and the pill completed the cure.
One patient with head/neck pain, severe swelling/pain despite large ulceration, diarrhea, irritability, insomnia, and poor appetite, showed dangerous signs. Pulse indicated lingering toxin. Xianfang Huoming Yin for two doses reduced swelling/pain by half. Ershen Wan and Liujunzi Tang plus Wuweizi, Maimendong, Suanzaoren for four doses improved symptoms, appetite, and sleep. Canling Baizhu San improved appetite further. Shiquan Dabu Tang plus Jinyinhua, Baizhu, Jiegeng cured after a month.
[Gui Yi Cao] Red carbuncles appearing on the forehead, front of the brain, and palms are fatal if not ulcerated within ten days. They can be lanced on the seventh day to release red blood. If no pus forms by the seventh day, it is untreatable. (Non-ulcerating means attacking east and west without forming a proper outlet.) Zhu Ju (Spindle Carbuncle) appearing on temples, beard, and ears is fatal if not ulcerated within fifteen days. Pus can be lanced; if black like fermented soybeans or bloody, it is fatal.