头疮(头部多发性毛囊炎)
邢某某，男，49岁
初诊
头部多处痔肿，核起作痛，此起彼伏。前医用仙方败毒饮，五味消毒饮等清热解毒之剂无效。诊脉沉细无力，面色晦暗，神疲乏力，腰酸腿软，舌淡胖苔白润，边有齿痕。夫脑为髓海，肾气通于脑。头疮频发，虽多阳症，然此症清之不效，所谓“寒之不寒，是无水也，壮水之主，以制阳光”，水之主，肾也，当用填补下元方法，以引火归元。
大熟地20克，山萸肉15克，怀山药15克，杜仲10克，补骨脂10克，川续断10克，荆芥6克，防风6克，白芷6克，生地榆10克，茜草10克，七付
二诊
药后疼痛渐减，头疮肿势已轻，脉仍沉细，舌白苔掴)药中病机，继用前法。
熟地黄15克，山萸肉10克，生山药15克，杜仲10克，川续断10克，补骨脂10克，荆芥6克，防风6克，白芷6克，生地榆10克，丹参10克，茜草10克，茅芦根各10克，七付
三诊
头疮已归于平复，自觉精神体力均有增强，填补下元已奏其效。再以前法进退，并宜加强锻炼，以增强体质。
熟地黄15克，山萸肉10克，怀山药15克，杜仲10克，川续断10克，补骨脂10克，生地榆10克，炒槐花10克，丹参10克，茜草10克，焦三仙各10克，水红花子10克，七付
药后头疮痊愈，诸症皆平。遂停药观察。半年后因劳作，头疮复作，仍以前法治之而愈。
[按]：头部疮瘴，掀肿作痛，似属阳证。然清热解毒常法治之不效。及察其体质素弱，脉象沉细无力，舌胖苔润，则知其病本为虚，此亦“至虚有盛候”之一种，下元亏虚，龙火上爝，灼肉为腐，发为疮瘴，故数数劳作即发，是其特征也。治用大剂填补下元方法，下元足则火自归附，是渭引火归元。以此法治疮瘴而获佳效，宜深究之，大有开悟之功。
赘疣(面部扁平疣)
梁某某，女，29岁
初诊
面部遍起赘疣如粟如大小数十个，前额及两颊为多，始发于两月前，渐次增多。面色萎黄晦暗，神疲乏力，抑郁寡欢，两脉弦细，按之无力，舌淡苔白且润，前医用疏风清热化湿方法，服之无效。此气血不足，不能上荣于面，则邪气乘虚结聚，治当益气养血，扶正达邪。
黄芪15克，桂枝6克，白芍10克，炙甘草6克，当归10
克，生姜10克，大枣5枚。七付
二诊
脉仍弦细，舌白苔润，心情抑郁不舒，阳和之气不得上达，浊邪因而上聚为疣，继用升和方法。
黄芪15克，桂枝6克，赤白芍各10克，防风6克，荆芥6
克，炙甘草6克，当归10克，生苡米30克，生姜10克，大枣5
枚，七付
三诊
面色渐润，赘疣略见稀疏。气血有冲和之象。脉象仍属弦细，郁滞尚未全开。继用前法加减。
生黄芪15克，桂枝6克，赤自芍各10克，当归10克，川芎10克，防风6克，白芷6克，荆芥6克，丹参10克，生苡仁30克，生姜10克，大枣5枚，七付
四诊
面部赘疣显著减少，红润之色渐显于面，言语之间可见欢愉。然脉仍弦细，足见郁结日久，气血失和，此非徒赖药物所可治，必自我解脱，达观乐业，并辅以运动锻炼，乃为治本之法。
前法进退。
生黄芪15克，桂枝6克，赤白芍各10克，当归10克，丹参10克，川芎10克，白芷6克，防风6克，香附10克，生苡仁30克，生姜10克，大枣5枚，焦三仙各10克，七付
上药续服两周，面部赘疣完全脱落，面色有荣润之象。嘱其宽怀自解，多事运动，以为善后之望。
[按]：面部扁平疣突然发生，多系病毒感染。然必与机体功能状态有关。本案患者体质柔弱，忧郁寡欢，木郁土中，阳气不能上升，故面色晦暗萎黄。经云“清阳出上窍”。若中阳不足，不能上达于面，则浊阴必乘虚凑之。此赘疣之所以生于颜面也。初诊用黄芪桂枝五物汤辛甘温之剂鼓舞中阳，以滋元气之本。次诊加入风药升阳上达，并重用生苡仁化湿浊。前后教诊，皆以黄芪桂枝五物汤加减。《难经》所谓“损其肝者缓其中。”本案患者起于抑郁伤肝，土受术乘，中气伤损日久，故变疏肝为扶中之法，而后逐渐加入活血调气疏郁之药，解其郁而升其阳，则湿浊自化而疣去。然要在患者能宽怀自解，达观乐业，否则此病虽愈，他病复起，恐其不免矣。
腹部漏疮
马某，男，82岁
初诊
患者半年前因肝内占位性病变在某医院作肝脏肿物切除术。术后切口感染，至今不能愈合。查见右胁下斜行切口略开约6cm，深及腹腔内，每日由切口内滋流水液甚多。疮面色暗塌陷。诊脉大而濡软，舌胖质淡且润。年老气血不足，生长乏力。拟用甘温益气养血，气足新肌易生也。
黄芪60克，当归10克，赤芍10克，川芎10克，白芷6克，防风6克，荆芥6克，茅芦根各10克，焦三仙各10克，七付
二诊
伤口流水减少。自觉气力有增。脉仍濡软且大，舌白苔润。
仍用养气养血方法。
黄芪80克，当归15克，赤白芍各10克，川芎10克，熟地黄15克，白芷6克，防风6克，荆芥6克，焦三仙各10克，水红花子10克，七付
三诊：
上方续服两局，伤口流水已止，疮面显著缩小，有愈合之势。胃纳甚佳，二便如常，脉象濡软，舌红苔白而润。气血生长颅速，仍用前法进退。
四诊
黄芪100克，当归15克，赤白芍各10克，川芎10克，熟地黄15克，炮姜3克，花粉10克。白芷6克，防风6克，荆芥6克，焦三仙各10克，水红花子10克，七付
五诊
创口已完全愈合，皮色如常，按之不痛，纳食甚香，夜寐安稳，二便正常。脉仍濡软，舌红苔白，老年气血已衰，久病元气受损，仍宜调补为要。
黄芪30克，当归10克，白芍10克，川芎10克，熟地黄10克，焦三仙各10克，水红花子10克，荆芥6克，防风6克，白芷6克，七付
上方续服两周后停药观察，腹部创口平复如常，遂停药观察。
[按]：手术之后切口久不愈合，当详察其原因，不可单纯以外症治之。若因感染所致者，西医抗感染治疗应当有效。本案初因感染，但经用抗菌素治疗，效果欠佳，则当另求原因。若因伤口内存有异物，则必须取净异物，否则不但不易愈合，而且一旦愈合，后必复发，化脓溃破也。若因患者元气不足，生长无力，虽频频换药，亦不能愈合。本案即属此例，因患者年事已高，又经手术创伤，元气大亏，气血不足，鼓动无力。故切口久不收敛，滋流黄水，是水谷不化精微，反为水湿矣。其脉濡软而大，大则为虚，舌白且润，是阳气不足。故治疗重用黄芪补气，使气足则能生血，阳旺则能生阴。初诊即用60克，渐次速增至100克，李中梓尝谓；“气血俱要，而补气在补血之先；阴阳并需，而养阳在滋阴之上。”本案之治疗用药正合此法。虽用黄芪，再合以四物汤补血，荆、防、白芷疏风胜湿，运化脾阳，焦三仙等疏调三焦以助消化。此等组方，看似非治外症之方，却有治外症之效。故患者服之月余即获治愈。
头疮（头部多发性毛囊炎）
邢某某，男，49岁
初诊
头部多处出现疖肿，结节隆起且疼痛，此起彼伏。前医使用仙方败毒饮、五味消毒饮等清热解毒的方剂治疗无效。诊察脉象沉细无力，面色晦暗无光泽，精神疲倦乏力，腰膝酸软，舌质淡胖，苔白润，舌边有齿痕。脑为髓海，肾气通于脑。头疮频繁发作，虽然多属阳证，但此症用清热法无效，正如古籍所言“寒之不寒，是无水也”，即应当“壮水之主，以制阳光”。“水之主”指的是肾，因此应当采用填补下元的方法，以引火归元。
大熟地20克，山萸肉15克，怀山药15克，杜仲10克，补骨脂10克，川续断10克，荆芥6克，防风6克，白芷6克，生地榆10克，茜草10克，七付
二诊
服药后疼痛逐渐减轻，头疮肿胀之势已缓解，脉象仍沉细，舌苔白润。药证相符，继续沿用前法。
熟地黄15克，山萸肉10克，生山药15克，杜仲10克，川续断10克，补骨脂10克，荆芥6克，防风6克，白芷6克，生地榆10克，丹参10克，茜草10克，茅根与芦根各10克，七付
三诊
头疮已平复，自觉精神和体力均有增强，填补下元的方法已见效。继续以前法加减，并宜加强锻炼，以增强体质。
熟地黄15克，山萸肉10克，怀山药15克，杜仲10克，川续断10克，补骨脂10克，生地榆10克，炒槐花10克，丹参10克，茜草10克，焦三仙各10克，水红花子10克，七付
服药后头疮痊愈，所有症状皆平。于是停药观察。半年后因劳作，头疮复发，仍用前法治愈。
[按]：头部疮疡，红肿疼痛，看似属于阳证。然而常规清热解毒法治疗无效。及至察其体质素来虚弱，脉象沉细无力，舌体胖大苔润，则知其病本为虚证，这也是“至虚有盛候”的一种表现。下元亏虚，龙雷之火上炎，灼烧肌肉化为腐败之物，发为疮疡，所以多次劳作后即发作，这是其特征。治疗使用大剂量填补下元的方法，下元充足则火自归附，这就是所谓的引火归元。以此法治愈疮疡而获得良好疗效，值得深入探究，大有启发之功。
赘疣（面部扁平疣）
梁某某，女，29岁
初诊
面部遍起赘疣，如粟米大小数十个，前额及两颊较多，始于两个月前，逐渐增多。面色萎黄晦暗，精神疲倦乏力，情绪抑郁不欢，双侧脉弦细，按之无力，舌淡苔白且润。前医使用疏风清热化湿的方法，服用后无效。此为气血不足，不能上荣于面部，导致邪气乘虚结聚，治疗当益气养血，扶正祛邪。
黄芪15克，桂枝6克，白芍10克，炙甘草6克，当归10克，生姜10克，大枣5枚。七付
二诊
脉仍弦细，舌苔白润，心情抑郁不舒，阳气不得上达，浊邪因而上聚形成疣赘，继续用升阳和营的方法。
黄芪15克，桂枝6克，赤芍与白芍各10克，防风6克，荆芥6克，炙甘草6克，当归10克，生薏苡仁30克，生姜10克，大枣5枚，七付
三诊
面色渐显润泽，赘疣略见稀疏。气血呈现冲和之象。脉象仍属弦细，郁滞尚未完全开通。继续用前法加减。
生黄芪15克，桂枝6克，赤芍与白芍各10克，当归10克，川芎10克，防风6克，白芷6克，荆芥6克，丹参10克，生薏苡仁30克，生姜10克，大枣5枚，七付
四诊
面部赘疣显著减少，红润之色渐显于面，言语间可见欢愉。然而脉仍弦细，足见郁结日久，气血失和，这并非单纯依靠药物可以治愈，必须自我解脱，达观乐业，并辅以运动锻炼，才是治本之法。
前法加减。
生黄芪15克，桂枝6克，赤芍与白芍各10克，当归10克，丹参10克，川芎10克，白芷6克，防风6克，香附10克，生薏苡仁30克，生姜10克，大枣5枚，焦三仙各10克，七付
上述药物连续服用两周，面部赘疣完全脱落，面色呈现荣润之象。嘱咐其宽心自我解脱，多做运动，作为善后的希望。
[按]：面部扁平疣突然发生，多系病毒感染。但必然与机体功能状态有关。本案患者体质柔弱，忧郁寡欢，肝木郁结于脾土之中，阳气不能上升，故面色晦暗萎黄。《内经》云“清阳出上窍”。若中阳不足，不能上达于面部，则浊阴必乘虚侵袭。这就是赘疣生于颜面的原因。初诊使用黄芪桂枝五物汤这一辛甘温的方剂，鼓舞中阳，以滋元气之本。次诊加入风药以升阳上达，并重用生薏苡仁化湿浊。前后数诊，皆以黄芪桂枝五物汤加减。《难经》所谓“损其肝者缓其中。”本案患者起于抑郁伤肝，脾土受肝木乘侮，中气受损日久，故将疏肝法改为扶中法，而后逐渐加入活血调气疏郁的药物，解其郁而升其阳，则湿浊自化而疣去。关键在于患者能宽心自我解脱，达观乐业，否则此病虽愈，他病复起，恐怕难免。
腹部漏疮
马某，男，82岁
初诊
患者半年前因肝内占位性病变在某医院行肝脏肿物切除术。术后切口感染，至今不能愈合。检查见右胁下斜行切口裂开约6厘米，深及腹腔内，每日由切口内流出液体甚多。疮面色暗塌陷。诊脉大而濡软，舌体胖大质淡且润。年老气血不足，生长修复乏力。拟用甘温益气养血之法，气足则新肌易生。
黄芪60克，当归10克，赤芍10克，川芎10克，白芷6克，防风6克，荆芥6克，茅根与芦根各10克，焦三仙各10克，七付
二诊
伤口流水减少。自觉气力有所增加。脉仍濡软且大，舌苔白润。
仍用养气养血方法。
黄芪80克，当归15克，赤芍与白芍各10克，川芎10克，熟地黄15克，白芷6克，防风6克，荆芥6克，焦三仙各10克，水红花子10克，七付
三诊：
上方连续服用两周，伤口流水已止，疮面显著缩小，有愈合之势。胃纳很好，二便正常，脉象濡软，舌红苔白而润。气血生长迅速，仍用前法加减。
四诊
黄芪100克，当归15克，赤芍与白芍各10克，川芎10克，熟地黄15克，炮姜3克，天花粉10克，白芷6克，防风6克，荆芥6克，焦三仙各10克，水红花子10克，七付
五诊
创口已完全愈合，皮色如常，按压不痛，食欲甚佳，夜寐安稳，二便正常。脉仍濡软，舌红苔白。老年气血已衰，久病元气受损，仍宜调补为要。
黄芪30克，当归10克，白芍10克，川芎10克，熟地黄10克，焦三仙各10克，水红花子10克，荆芥6克，防风6克，白芷6克，七付
上方连续服用两周后停药观察，腹部创口平复如常，遂停药观察。
[按]：手术之后切口久不愈合，应当详细查明原因，不可单纯以外症治疗。若因感染所致，西医抗感染治疗应当有效。本案初因感染，但经用抗菌素治疗，效果欠佳，则应当另求原因。若因伤口内存有异物，则必须取净异物，否则不仅不易愈合，而且一旦愈合，日后必复发，化脓溃破。若因患者元气不足，生长无力，虽频频换药，亦不能愈合。本案即属此类，因患者年事已高，又经手术创伤，元气大亏，气血不足，鼓动无力。故切口久不收敛，滋流黄水，这是水谷不能化为精微，反变为水湿所致。其脉濡软而大，大则为虚，舌白且润，是阳气不足。故治疗重用黄芪补气，使气足则能生血，阳旺则能生阴。初诊即用60克，逐渐递增至100克，李中梓曾谓：“气血俱要，而补气在补血之先；阴阳并需，而养阳在滋阴之上。”本案的治疗用药正合此法。虽用黄芪，再合以四物汤补血，荆芥、防风、白芷疏风胜湿，运化脾阳，焦三仙等疏调三焦以助消化。此类组方，看似非治外症之方，却有治外症之效。故患者服之月余即获治愈。
Head Sores (Multiple Folliculitis of the Head)
Patient Xing XX, Male, 49 years old.
First Visit
Multiple boils appeared on the head, with nodular elevations and pain, occurring one after another. Previous physicians used Fangzheng Baidu Yin (Decoction for Resolving Toxins with Antidote Formula) and Wuwei Xiaodu Yin (Five-Ingredient Decoction for Eliminating Toxins), which are heat-clearing and detoxifying formulas, but to no avail. The pulse was deep, fine, and weak; the complexion was dull and lusterless; there was mental fatigue and physical weakness; soreness and weakness in the lower back and legs; the tongue was pale and fat with a white, moist coating, and teeth marks on the edges. The brain is the sea of marrow, and Kidney Qi connects to the brain. Frequent occurrence of head sores, although often belonging to Yang syndromes, did not respond to heat-clearing methods here. As stated in ancient texts, "If cooling does not cool, it is due to lack of Water"; thus, one should "strengthen the master of Water to control the excessive Yang." The "master of Water" refers to the Kidney. Therefore, the method of tonifying the Lower Yuan (Lower Burner/Essence) should be used to guide fire back to its source (Yin Huo Gui Yuan).
Prepared Rehmannia Root (Shu Di Huang) 20g, Cornus Fruit (Shan Yu Rou) 15g, Chinese Yam (Huai Shan Yao) 15g, Eucommia Bark (Du Zhong) 10g, Psoralea Fruit (Bu Gu Zhi) 10g, Oldenlandia Root (Chuan Xu Duan) 10g, Schizonepeta (Jing Jie) 6g, Saposhnikovia Root (Fang Feng) 6g, Angelica Dahurica (Bai Zhi) 6g, Raw Sanguisorba Root (Sheng Di Yu) 10g, Rubia Root (Qian Cao) 10g. Seven doses.
Second Visit
After taking the medicine, pain gradually decreased, and the swelling of the head sores subsided. The pulse remained deep and fine; the tongue coating was white and moist. The prescription matched the pathogenesis; continue with the previous method.
Prepared Rehmannia Root (Shu Di Huang) 15g, Cornus Fruit (Shan Yu Rou) 10g, Raw Chinese Yam (Sheng Shan Yao) 15g, Eucommia Bark (Du Zhong) 10g, Oldenlandia Root (Chuan Xu Duan) 10g, Psoralea Fruit (Bu Gu Zhi) 10g, Schizonepeta (Jing Jie) 6g, Saposhnikovia Root (Fang Feng) 6g, Angelica Dahurica (Bai Zhi) 6g, Raw Sanguisorba Root (Sheng Di Yu) 10g, Salvia Root (Dan Shen) 10g, Rubia Root (Qian Cao) 10g, Reed Rhizome (Mao Gen) and Imperata Rhizome (Lu Gen) 10g each. Seven doses.
Third Visit
The head sores had flattened and healed. The patient felt an improvement in spirit and physical strength. The method of tonifying the Lower Yuan had taken effect. Continue adjusting the previous method, and strengthen exercise to enhance constitution.
Prepared Rehmannia Root (Shu Di Huang) 15g, Cornus Fruit (Shan Yu Rou) 10g, Chinese Yam (Huai Shan Yao) 15g, Eucommia Bark (Du Zhong) 10g, Oldenlandia Root (Chuan Xu Duan) 10g, Psoralea Fruit (Bu Gu Zhi) 10g, Raw Sanguisorba Root (Sheng Di Yu) 10g, Stir-fried Sophora Flower (Chao Huai Hua) 10g, Salvia Root (Dan Shen) 10g, Rubia Root (Qian Cao) 10g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Seed (Shui Hong Hua Zi) 10g. Seven doses.
After medication, the head sores were cured, and all symptoms resolved. Medication was stopped for observation. Six months later, due to labor, the head sores recurred. They were cured again using the previous method.
[Commentary]: Head sores with redness, swelling, and pain seem to belong to Yang syndromes. However, conventional heat-clearing and detoxifying methods failed. Upon examining the patient's constitution as inherently weak, with a deep, fine, and weak pulse, and a fat tongue with moist coating, it was known that the root of the disease was deficiency. This is a manifestation of "extreme deficiency presenting with excess-like symptoms." Deficiency of the Lower Yuan causes Dragon Fire (Ministerial Fire) to flare upward, burning flesh into腐 material, resulting in sores. Hence, they recur after frequent labor, which is their characteristic. Treatment used large doses to tonify the Lower Yuan. When the Lower Yuan is sufficient, fire returns to its source, known as guiding fire back to its source (Yin Huo Gui Yuan). Using this method to cure sores yielded excellent results, worthy of deep study and offering great enlightenment.
Skin Tags (Facial Flat Warts)
Patient Liang XX, Female, 29 years old.
First Visit
Numerous skin tags, like millet seeds, appeared all over the face, mostly on the forehead and cheeks. They started two months ago and gradually increased. The complexion was sallow and dull; there was mental fatigue and physical weakness; depression and unhappiness; the bilateral pulses were string-taut and fine, weak upon pressure; the tongue was pale with a white, moist coating. Previous physicians used wind-dispersing, heat-clearing, and damp-resolving methods without effect. This is due to insufficiency of Qi and Blood, failing to nourish the face, allowing pathogenic factors to gather due to deficiency. Treatment should tonify Qi and nourish Blood, supporting the Righteous Qi to expel pathogens.
Astragalus Root (Huang Qi) 15g, Cinnamon Twig (Gui Zhi) 6g, White Peony Root (Bai Shao) 10g, Honey-fried Licorice Root (Zhi Gan Cao) 6g, Angelica Sinensis (Dang Gui) 10g, Fresh Ginger (Sheng Jiang) 10g, Jujube (Da Zao) 5 pieces. Seven doses.
Second Visit
The pulse remained string-taut and fine; the tongue coating was white and moist. Mood was depressed and uncomfortable. Yang Qi could not ascend, causing turbid pathogens to gather upward forming warts. Continue with the method of raising Yang and harmonizing.
Astragalus Root (Huang Qi) 15g, Cinnamon Twig (Gui Zhi) 6g, Red Peony Root (Chi Shao) and White Peony Root (Bai Shao) 10g each, Saposhnikovia Root (Fang Feng) 6g, Schizonepeta (Jing Jie) 6g, Honey-fried Licorice Root (Zhi Gan Cao) 6g, Angelica Sinensis (Dang Gui) 10g, Raw Coix Seed (Sheng Yi Mi) 30g, Fresh Ginger (Sheng Jiang) 10g, Jujube (Da Zao) 5 pieces. Seven doses.
Third Visit
Complexion gradually became moist; skin tags became slightly sparse. Qi and Blood showed signs of harmony. The pulse remained string-taut and fine; stagnation had not fully opened. Continue adjusting the previous method.
Raw Astragalus Root (Sheng Huang Qi) 15g, Cinnamon Twig (Gui Zhi) 6g, Red Peony Root (Chi Shao) and White Peony Root (Bai Shao) 10g each, Angelica Sinensis (Dang Gui) 10g, Lovage Rhizome (Chuan Xiong) 10g, Saposhnikovia Root (Fang Feng) 6g, Angelica Dahurica (Bai Zhi) 6g, Schizonepeta (Jing Jie) 6g, Salvia Root (Dan Shen) 10g, Raw Coix Seed (Sheng Yi Ren) 30g, Fresh Ginger (Sheng Jiang) 10g, Jujube (Da Zao) 5 pieces. Seven doses.
Fourth Visit
Facial skin tags significantly reduced; rosy color gradually appeared on the face; joy was visible in speech. However, the pulse remained string-taut and fine, indicating long-standing stagnation and disharmony of Qi and Blood. This cannot be treated solely by drugs; self-release, optimism, and engagement in work/hobbies are necessary, along with exercise, to treat the root.
Adjust the previous method.
Raw Astragalus Root (Sheng Huang Qi) 15g, Cinnamon Twig (Gui Zhi) 6g, Red Peony Root (Chi Shao) and White Peony Root (Bai Shao) 10g each, Angelica Sinensis (Dang Gui) 10g, Salvia Root (Dan Shen) 10g, Lovage Rhizome (Chuan Xiong) 10g, Angelica Dahurica (Bai Zhi) 6g, Saposhnikovia Root (Fang Feng) 6g, Cyperus Rhizome (Xiang Fu) 10g, Raw Coix Seed (Sheng Yi Ren) 30g, Fresh Ginger (Sheng Jiang) 10g, Jujube (Da Zao) 5 pieces, Scorch Three Immortals (Jiao San Xian) 10g each. Seven doses.
After continuing the above medicine for two weeks, facial skin tags completely fell off, and the complexion showed a healthy glow. Advised to relax and release oneself mentally, engage in more exercise, as a hope for recovery.
[Commentary]: Sudden onset of facial flat warts is often due to viral infection but must relate to the body's functional state. This patient has a weak constitution, depression, and liver Qi stagnation affecting spleen Earth, preventing Yang Qi from ascending, hence the dull, sallow complexion. The Classic states, "Clear Yang exits through the upper orifices." If Middle Yang is insufficient and cannot reach the face, turbid Yin will invade due to deficiency. This is why warts grow on the face. The first visit used Huangqi Guizhi Wuwu Tang, a pungent-sweet-warm formula to stimulate Middle Yang and nourish the root of Yuan Qi. The second visit added wind-dispersing herbs to raise Yang upward and heavily used Raw Coix Seed to resolve damp turbidity. All visits adjusted Huangqi Guizhi Wuwu Tang. The Nan Jing says, "To damage the Liver, soothe the center." This patient's condition originated from depression injuring the Liver, with Spleen Earth being overcome by Wood, damaging Middle Qi for a long time. Thus, the method changed from soothing the Liver to supporting the Center, gradually adding blood-invigorating, Qi-regulating, and stagnation-resolving herbs. Resolving stagnation and raising Yang allows damp turbidity to transform and warts to disappear. The key lies in the patient's ability to relax and be optimistic; otherwise, even if cured, other diseases may arise.
Abdominal Fistula
Patient Ma XX, Male, 82 years old.
First Visit
Six months ago, the patient underwent hepatic mass resection at a hospital for an intrahepatic space-occupying lesion. Post-operative incision infection has not healed. Examination revealed a diagonal incision under the right hypochondrium split open about 6cm, extending deep into the abdominal cavity, discharging large amounts of fluid daily. The wound surface was dark and sunken. The pulse was large and soggy/soft; the tongue was fat, pale, and moist. Elderly patients have insufficient Qi and Blood, lacking strength for regeneration. Prescribe sweet-warm methods to tonify Qi and nourish Blood; when Qi is sufficient, new tissue grows easily.
Astragalus Root (Huang Qi) 60g, Angelica Sinensis (Dang Gui) 10g, Red Peony Root (Chi Shao) 10g, Lovage Rhizome (Chuan Xiong) 10g, Angelica Dahurica (Bai Zhi) 6g, Saposhnikovia Root (Fang Feng) 6g, Schizonepeta (Jing Jie) 6g, Reed Rhizome (Mao Gen) and Imperata Rhizome (Lu Gen) 10g each, Scorch Three Immortals (Jiao San Xian) 10g each. Seven doses.
Second Visit
Wound discharge decreased. Subjective feeling of increased energy. Pulse remained soggy/soft and large; tongue coating white and moist.
Continue with methods to nourish Qi and Blood.
Astragalus Root (Huang Qi) 80g, Angelica Sinensis (Dang Gui) 15g, Red Peony Root (Chi Shao) and White Peony Root (Bai Shao) 10g each, Lovage Rhizome (Chuan Xiong) 10g, Prepared Rehmannia Root (Shu Di Huang) 15g, Angelica Dahurica (Bai Zhi) 6g, Saposhnikovia Root (Fang Feng) 6g, Schizonepeta (Jing Jie) 6g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Seed (Shui Hong Hua Zi) 10g. Seven doses.
Third Visit:
After continuing the above prescription for two weeks, wound discharge stopped, the wound surface significantly shrank, showing signs of healing. Appetite was excellent, urination and defecation normal. Pulse was soggy/soft; tongue red with white, moist coating. Qi and Blood generation was rapid. Continue adjusting the previous method.
Fourth Visit
Astragalus Root (Huang Qi) 100g, Angelica Sinensis (Dang Gui) 15g, Red Peony Root (Chi Shao) and White Peony Root (Bai Shao) 10g each, Lovage Rhizome (Chuan Xiong) 10g, Prepared Rehmannia Root (Shu Di Huang) 15g, Roasted Ginger (Pao Jiang) 3g, Trichosanthes Root (Hua Fen) 10g, Angelica Dahurica (Bai Zhi) 6g, Saposhnikovia Root (Fang Feng) 6g, Schizonepeta (Jing Jie) 6g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Seed (Shui Hong Hua Zi) 10g. Seven doses.
Fifth Visit
The wound was completely healed, skin color normal, non-tender upon pressure. Appetite excellent, sleep stable, urination and defecation normal. Pulse remained soggy/soft; tongue red with white coating. In the elderly, Qi and Blood are declining, and Yuan Qi is damaged by chronic illness. Regulation and tonification remain essential.
Astragalus Root (Huang Qi) 30g, Angelica Sinensis (Dang Gui) 10g, White Peony Root (Bai Shao) 10g, Lovage Rhizome (Chuan Xiong) 10g, Prepared Rehmannia Root (Shu Di Huang) 10g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Seed (Shui Hong Hua Zi) 10g, Schizonepeta (Jing Jie) 6g, Saposhnikovia Root (Fang Feng) 6g, Angelica Dahurica (Bai Zhi) 6g. Seven doses.
After continuing the above prescription for two weeks, medication was stopped for observation. The abdominal wound healed flat and normal.
[Commentary]: Incisions that fail to heal long-term after surgery require detailed investigation of causes; they should not be treated merely as external lesions. If caused by infection, Western anti-infection treatment should be effective. This case initially involved infection, but antibiotic treatment yielded poor results, necessitating other causes. If foreign bodies remain in the wound, they must be removed completely; otherwise, healing is difficult, and recurrence with suppuration is inevitable after initial healing. If caused by insufficient Yuan Qi and lack of regenerative strength, frequent dressing changes will not help. This case belongs to this category. The patient is elderly and suffered surgical trauma, leading to severe depletion of Yuan Qi and insufficiency of Qi and Blood, lacking driving force. Thus, the incision fails to close, discharging yellow fluid, because food and water fail to transform into essence, instead becoming dampness. The pulse is soggy/soft and large, where large indicates deficiency; the white, moist tongue indicates insufficient Yang Qi. Therefore, treatment heavily used Astragalus to tonify Qi; when Qi is sufficient, it generates Blood; when Yang is vigorous, it generates Yin. Started with 60g in the first visit, gradually increasing to 100g. Li Zhongzi once said: "Both Qi and Blood are important, but tonifying Qi precedes tonifying Blood; both Yin and Yang are needed, but nourishing Yang precedes nourishing Yin." The medication in this case aligns with this principle. Although Astragalus was used, combined with Siwu Tang to nourish Blood, Jingjie, Fangfeng, and Baizhi to disperse wind and overcome dampness, transforming Spleen Yang, and Jiao San Xian to regulate the Triple Burner and aid digestion. Such prescriptions, seemingly not for external lesions, effectively treat them. Thus, the patient was cured within a month.