一近来人之气禀体质与曩昔迥乎相殊，即牙疳一症，有明属实火，而根据古法用消疳饮及芩连羚羊角之类，每
多不效。若不知权变，定致误事，然亦须证之以脉，如两脉迟滞，无数大之象则寒凉便不宜投，惟玉女煎甚妙。
一喉瘤与双蛾相似，蛾形圆生于咽门之
左右，而喉瘤形稍长如肉豆蔻样，生于关内之两傍，其色淡而有红丝相裹，初起疼痛不发热者，多由肺肾阴虚，
热郁于肺，因多语损气，或怒中高喊，或诵读太急，或多饮烧醇及恣食炙 之味，或七情抑郁，或酒后当风喊叫，
患因各别，而证偏属虚，切不可妄施表散，更勿用刀伤破。治法初发热者，可微疏解之，继用益气清金汤除黄芩、
山栀、竹叶加生地；若质虚无热者，照前方减法加大熟地三钱。其因忧郁而致者，或用归脾加山栀、丹皮或用六
味加麦冬、贝母吹药，则用消瘤碧玉散或青雪丹。是症最难除根，微感六气便发，发不易平，却无碍于事，近来
质虚者，每患是焉。或有年久肿硬难消，惟以真番 和碧玉散每日频点肿处可消其半。倘治之不善，恐延烂难敛
也。方载《医宗金鉴》第六十六卷外科心法口舌部。
一青腿牙疳症，患者甚少，惟边瘴之。地有之治法亦载于《金鉴》第七十卷外科心法。
一舌底两傍肿如豆大，色黄，初软，渐次转硬，或一边长如条形，微痛，且有妨饮食言语，论证非舌痈、舌
疳、舌瘤，亦非痰包诸候第，是症知治者更少，每执心火，率主清降，或投寒凉，用泻心导赤以及牛黄、犀角、
紫雪丹之类，愈遏而肿愈甚，倍难转动，淹缠日久，因清凉之剂频多，徒使血气亏，损脾胃颓败，而终不获验，
尤忌用刀。若谓血实宜决之，希图侥幸必反成延烂，连及舌本，诚难疗救矣。此皆由不识本源，罔察虚实，拘泥
于心火为患之误也。经云∶厥阴脉络于舌本，手足少阴之脉，皆系于舌，舌病殊不尽属于心，于此经文可见，亟
宜详审，于平时以免临症之茫然无措也。按∶是症责在肝肾，或由七情抑郁，或嗜炙 之味，或由过饮醇酒，虽
似火之有余，实因水之不足故也。有初起舌底暴肿，而外边结喉之旁亦肿如痰核，渐次转硬亦痛，或肿大如覆杯，
而色不红，开首未服寒凉者，犹易治。若经妄投而肿处反成坚硬，便难疗矣。然治法只须重用六味地黄汤，大剂
煎服，初起不过五六剂即除，何难之有哉？
一、近来人的气禀体质与过去截然不同，即使是牙疳这一病症，有的明明属于实火证，但依据古法使用消疳饮以及黄芩、黄连、羚羊角等药物，往往多不奏效。如果不懂得灵活变通，必定会导致误事。然而，也必须通过脉象来验证病情，如两手脉象迟滞，没有洪大之象，那么寒凉药物就不宜投用，此时唯有玉女煎（Yunü Decoction）非常巧妙。
一、喉瘤与双蛾（扁桃体肿大）相似，双蛾形状圆润，生于咽门左右；而喉瘤形状稍长，像肉豆蔻样，生于关内两侧，颜色淡白而有红丝包裹。初起时疼痛但不发热，多由肺肾阴虚，热邪郁结于肺，因多说话损伤元气，或发怒中高喊，或诵读过于急促，或多饮烈性酒及恣意食用炙烤之味，或七情抑郁，或酒后当风喊叫所致。患病原因各不相同，但证候偏属虚证，切不可妄施解表发散之法，更勿用刀切割伤破。治疗方面，初起伴有发热者，可轻微疏解，继后使用益气清金汤（Yiqi Qingjin Decoction），去掉黄芩、山栀、竹叶，加入生地黄；若体质虚弱而无热者，照前方减去上述药物，加大熟地黄三钱。因忧郁而导致者，可用归脾汤（Guipi Decoction）加山栀、丹皮，或用六味地黄丸（Liuwei Dihuang Wan）加麦冬、贝母吹药，外用消瘤碧玉散（Xiaoliu Biyu San）或青雪丹（Qingxue Dan）。此症最难除根，稍微感受六淫之气便会发作，发作后不易平息，但却无碍于生命。近来体质虚弱的人，常常患此病。若有多年久治不愈、肿硬难消的，唯有用真番泻叶（Zhen Fanxieye，此处指代某种泻下通便药材，原文可能为“番泻”或特定地方用药，依语境保留原名或译为Senna Leaf）配合碧玉散每日频繁点涂肿处，可消除一半。倘若治疗不善，恐怕会蔓延溃烂难以收敛。方剂记载于《医宗金鉴》第六十六卷外科心法口舌部。
一、青腿牙疳症，患者很少见，只有边远瘴疠之地才有。治疗方法也记载于《金鉴》第七十卷外科心法。
一、舌底两侧肿胀如豆子大小，颜色黄，初起柔软，逐渐转硬，或者一边长如条形，微痛，且妨碍饮食和言语。辨证分析，这不是舌痈、舌疳、舌瘤，也不是痰包等证候。知晓此症治法的人更少，往往固执地认为是心火，率主清热降火，或投用寒凉药物，使用泻心导赤散（Xiexin Daochi San）以及牛黄、犀角、紫雪丹（Zixue Dan）之类，结果越遏制肿痛越严重，倍加难以转动，拖延日久，因清凉之剂频多，徒然使血气亏损，脾胃颓败，最终不获疗效，尤其忌讳用刀。如果说血实应当决泄，希图侥幸成功，必定反而造成延烂，连及舌本，确实难以疗救。这都是由于不识本源，不明察虚实，拘泥于心火为患的错误观念所致。《内经》云：厥阴肝经脉络于舌本，手足少阴心肾之脉，皆系于舌，舌病并不完全归属于心，从这段经文可见，亟需详细审察，于平时以免临症时茫然无措。按语：此症责在肝肾，或由七情抑郁，或嗜食炙烤之味，或由过饮醇酒，虽然看似火有余，实则因水不足所致。有初起舌底暴肿，而外边结喉旁亦肿如痰核，逐渐转硬亦痛，或肿大如倒扣的杯子，而颜色不红，开头未服寒凉药者，尚易治疗。若经妄投寒凉药而肿处反成坚硬，便难治疗了。然而治法只需重用六味地黄汤（Liuwei Dihuang Decoction），大剂量煎服，初起不过五六剂即可痊愈，有何困难呢？
1. The innate constitution and physical endowment of people nowadays are vastly different from those in the past. Even for a condition such as *Ya Gan* (Gum Disease), which may clearly present as Excess Fire, using ancient methods with formulas like *Xiao Gan Yin* (Eliminate Gum Decoction) and herbs such as Huang Qin (Scutellariae Radix), Lian Zi (Corylinae Semen), and Ling Yang Jiao (Saiga Antelope Horn) often proves ineffective. If one fails to exercise flexibility and adapt to changes, errors are inevitable. However, the diagnosis must be verified by pulse taking. If both radial pulses are slow and sluggish without any surging or large characteristics, cold-natured drugs should not be administered; in such cases, *Yu Nu Jian* (Jade Woman Decoction) is particularly effective.
2. A *Hou Liu* (Throat Tumor) resembles *Shuang E* (Double Tonsillar Swelling). *Shuang E* is round in shape and located on the left and right sides of the pharyngeal gate, whereas *Hou Liu* is slightly elongated, resembling a nutmeg, and arises on both sides inside the throat gate. Its color is pale with red filaments wrapping around it. In the early stage, there is pain but no fever. This is mostly caused by Yin deficiency of the Lung and Kidney, with heat stagnating in the Lung. It can result from excessive talking damaging Qi, shouting in anger, reading too hastily, consuming strong alcohol excessively, indulging in roasted or fried foods, emotional depression, or shouting after drinking while exposed to wind. Although the causes vary, the syndrome tends to be deficient in nature. One must absolutely avoid reckless use of exterior-releasing and dispersing methods, and never cut or break it with a knife. For treatment, if fever is present at the onset, mild release and resolution can be employed. Subsequently, *Yi Qi Qing Jin Tang* (Qi-Nourishing and Lung-Clearing Decoction) should be used, removing Huang Qin (Scutellariae Radix), Shan Zhi (Gardeniae Fructus), and Zhu Ye (Bambusae Folium), and adding Sheng Di Huang (Rehmanniae Radix). If the constitution is deficient without heat, follow the previous formula modification but add 3 qian of Shu Di Huang (Prepared Rehmanniae Radix). For cases caused by depression, *Gui Pi Tang* (Restore the Spleen Decoction) added with Shan Zhi (Gardeniae Fructus) and Dan Pi (Moutan Cortex), or *Liu Wei Di Huang Wan* (Six-Ingredient Pill with Rehmannia) added with Mai Dong (Ophiopogonis Radix) and Bei Mu (Fritillariae Bulbus), can be used for internal administration, along with blowing powders such as *Xiao Liu Bi Yu San* (Tumor-Eliminating Jade Powder) or *Qing Xue Dan* (Clear Blood Pellet) externally. This condition is difficult to eradicate completely; slight exposure to the Six Evils (pathogenic factors) can trigger an attack, which is hard to calm down but generally not life-threatening. Recently, individuals with deficient constitutions often suffer from this. For long-standing cases where swelling is hard and difficult to resolve, applying *Zhen Fan Xie* (Senna Leaf) mixed with *Bi Yu San* frequently to the swollen area daily can reduce the swelling by half. If treated improperly, it may spread into ulceration that is hard to heal. The formula is recorded in Volume 66 of "Wai Ke Xin Fa" (External Medicine Core Methods) in *Yi Zong Jin Jian* (Golden Mirror of Medicine).
3. *Qing Tui Ya Gan* (Blue Leg Gum Disease) is rare among patients and is found only in border regions with miasma. Its treatment methods are also recorded in Volume 70 of "Wai Ke Xin Fa" in *Jin Jian*.
4. Swelling on both sides of the base of the tongue, about the size of a bean, yellow in color, initially soft but gradually becoming hard, or extending linearly on one side with slight pain, interfering with eating and speaking. Upon differentiation, this is not *She Yong* (Tongue Abscess), *She Gan* (Tongue Ulcer), *She Liu* (Tongue Tumor), nor *Tan Bao* (Phlegm Sac). Few practitioners know how to treat this. They often stubbornly attribute it to Heart Fire, prescribing cooling and descending methods, or administering cold-natured drugs such as *Xie Xin Dao Chi San* (Drain Heart and Guide Out Redness Powder), Niu Huang (Calculus Bovis), Xi Jiao (Rhinocerotis Cornu), and *Zi Xue Dan* (Purple Snow Pellet). This further suppresses the condition, causing increased swelling and difficulty in movement. Prolonged illness results from frequent use of cooling agents, which merely deplete Qi and Blood and damage the Spleen and Stomach, ultimately failing to produce results. The use of knives is especially contraindicated. If one assumes that excess blood requires puncturing to drain, hoping for a lucky outcome, it will likely lead to spreading ulceration involving the root of the tongue, making it extremely difficult to save. These errors stem from ignorance of the root cause, failure to distinguish between deficiency and excess, and rigid adherence to the notion that Heart Fire is the sole culprit. The Classics state: "The Jueyin Liver Meridian connects to the root of the tongue, and the Shaoyin Heart and Kidney meridians are all connected to the tongue." Tongue diseases do not exclusively belong to the Heart, as evident from this text. Careful examination is urgently needed to avoid confusion during clinical practice. Note: This condition is related to the Liver and Kidney. It may be caused by emotional depression, preference for roasted/fried foods, or excessive alcohol consumption. Although it appears as Excess Fire, it is actually due to Insufficiency of Water (Kidney Yin). In some cases, sudden swelling at the base of the tongue occurs, accompanied by swelling beside the larynx resembling phlegm nodules, which gradually become hard and painful, or swell like an inverted cup without redness. If cold-natured drugs were not taken initially, it is still easy to treat. However, if wrongly treated with cold drugs and the swelling becomes hard, it becomes difficult to cure. Nevertheless, the treatment only requires heavy doses of *Liu Wei Di Huang Tang* (Six-Ingredient Rehmannia Decoction) prepared in large quantities and taken orally. In the early stage, recovery can be achieved in just five or six doses. How difficult is that?