疮疡敷药，当分阴阳虚实，而用内治之法，不可概敷寒凉之药。若肿痛热渴，脉滑数而有力者，其症为纯阳，宜服
济阴汤，外敷抑阳散，则热毒自消，瘀滞自散。若似肿非肿，似痛非痛，似赤非赤，似溃非溃，脉洪数而无力者，其症
属半阴半阳，宜内服冲和散，外敷阴阳散，则荣逆自从，血郁自散。若微肿微痛，色黯坚硬，肉色如故，久而不溃，脉
按之沉细，举指虚浮者，其症属纯阴，宜内服回阳汤，外敷抑阴散，则寒气自解，阳气自复。凡阳气虚寒，不能消散腐
溃，或溃而肿不消，口不敛者，必内外温补，庶可保全。若阴寒之症，而用寒凉之药，则腠理迷塞，气血凝滞，毒瓦斯益
深，良肉反死，疮口不敛，恶症蜂起，不可复救矣。盖胃气得寒则不能营运；瘀血得寒则不能消散；死肉得寒则不能腐
溃；新肉得寒则不能化生。治者不可不察也。
一小儿面疮，敷寒凉之药，患处坚实，头面俱肿，此脾胃受寒，血气凝滞，而不能行耳，先用冲和汤、阴阳散，患
处和软；次用托里消毒散，坚硬顿消；又用托里散，疮溃而愈。
一小儿腹痈，敷寒凉之药，腹胀吃逆，手足并冷，此脾胃复伤而虚寒也，用回阳汤、抑阴散，诸症渐退；用托里散
而溃，八珍汤而愈。
一小儿溃疡，敷寒凉之药，肌肉不生，脓水不止，余谓脾气亏损而然，用异功散加升麻、白芷渐愈，又用托里散而
痊。
一小儿臂痈，敷服皆寒凉之药，更加肿硬，余谓当助脾胃以解凝寒，乃用益气汤加茯苓、半夏、薄、桂及如圣饼熨
之而愈。大凡疮疡久而不愈，不问已溃未溃，皆因阳气虚不能营运耳，用如圣饼或葱熨法为善。
一小儿两足胫内外赤肿， 连膝上，因痘愈之后，或谓痘毒，欲用寒剂；或谓丹毒，欲砭出血。余曰∶非也，此足
三阳经热毒壅肿耳，况痘愈之后，元气未复，设若砭剂出血，则患处愈伤；敷贴凉药，则荣气愈滞；服败毒之药，则元
气愈虚，瘀血愈凝。不信，竟用前法，果两胫溃而色黯，疮口不敛，大便去后如痢，欲用治痢之药。余曰∶此因误用前
法，元气复伤而下陷也，非痢非毒。遂用补中益气汤之类而愈。
一小儿大腿漫肿不赤，服败毒之药，手足并冷，吐泻不食。余曰∶元气虚而半阴半阳之症也。用阴阳散、冲和汤，
肿起色赤，此变纯阳之吉症也，仍用前药，佐以活命饮而消。
一小儿臂痈，面色痿黄，饮食少思，脉洪数，按之软弱，余谓真气虚而邪气凝滞也，用白芷升麻汤，以清胃经热毒，
用五味异功散，以补胃经元气。不信，反用寒凉之剂，外敷内服，肿硬至手，肉色如故，腹中作痛，脉浮大，按之沉细，
此脾胃之气复伤，而变虚寒之症也，当祛散寒邪，温补脾气。仍不信，又与败毒，吃逆不食，手足并冷，此寒气逼阳于
外，无根之火泛行耳，果死。手足俱青，患处皆黑。
一小儿足胫肿硬一块，年余而溃，时出清脓，其肿益坚，肉色青黯，发热烦躁，余谓真气虚而邪气实，当先调脾胃，
或以为热毒凝滞，敷寒凉之药，肿硬至膝，肉溃腹胀，吐泻而死。
托里冲和汤 治疮疡，属半阴半阳，似溃非溃，似肿非肿，因元气虚弱，失于补托所致。（自制）
人参（二钱） 黄 （三钱） 白术（炒） 陈皮 当归（各一钱） 甘草（炒，五分）
上水煎，徐徐服，手足冷者加姜、桂；其热已退而未消溃，用仙方活命饮。可内消者，再用托里消毒散。可作脓者，
再用托里散。
阴阳散（即冲和膏） 治疮疡，元气虚弱，似肿非肿，似痛不痛，似热不热，属半阴半阳之症。用此以和阴阳，
内服冲和汤或托里散，以助元气。
紫荆皮（炒，五两） 独活（炒，三两） 赤芍药（炒） 白芷 石菖蒲（各二两）
上为末，用葱酒调服。
托里回阳汤 治疮疡属纯阴，不肿痛，不 赤，不腐溃，或腹痛泄泻，呕吐逆冷，阳气既陷，急用之多有生者。
（自制）
干姜 附子（重一两四钱者） 当归 陈皮 白术 黄 人参 甘草（炒。各二钱） 柴胡 升麻（各三分）
上水煎，徐徐服之，如不应，倍加姜、附，外敷抑阴散（一方名回阳上龙膏。）
抑阴散 治疮疡，元气虚寒，不能消散，或腹痛泄泻，呕吐不食，手足或冷或不溃敛，筋挛骨痛，属纯阴之症。
以此助阳行阴，内服回阳汤，以回阳气。
草乌（炒，二两） 南星 白芷（各一两） 肉桂（五钱） 赤芍药（炒，一两）
上各为末，葱汤调涂，热酒亦可。
解毒济阴汤 治疮疽 肿作痛，属纯阴者，用以此解毒。其热未退，用仙方活命饮。（自制）
连翘 山栀（炒） 黄芩（炒） 黄连（炒。各一钱） 赤芍药（一钱五分） 金银花（三钱） 甘草（一两）
上每服二三钱，水煎，大便秘结者，量加炒大黄，外敷抑阳散。
抑阳散（即洪宝丹） 治疮疡属纯阳者。
天花粉（三两） 姜黄 白芷 赤芍药（各一两）
上为末，茶汤搽调患处。
五味异功散（方见败毒之药）
仙方活命饮
托里消毒散
托里散（三方见热毒疮疡）
补中益气汤（方见肌肉不生）
八珍汤（方见发热不止）
如圣饼
葱熨法（二方见流注）
For the external application of medicines for sores and ulcers, one must distinguish between Yin and Yang syndromes, as well as Deficiency and Excess syndromes, and employ internal treatment methods. One should not indiscriminately apply cold-natured (Han) and cool-natured (Liang) medicines. If there is swelling, pain, heat, and thirst, with a slippery and rapid pulse that is forceful, this indicates a Pure Yang syndrome. It is appropriate to administer Ji Yin Tang (Nourish Yin Decoction) internally and apply Yi Yang San (Suppress Yang Powder) externally, so that heat toxins will naturally dissipate and blood stasis will resolve. If the area appears swollen but not truly swollen, painful but not truly painful, red but not truly red, or ulcerated but not truly ulcerated, with a surging and rapid pulse that is weak, this belongs to a Half-Yin Half-Yang syndrome. It is appropriate to take Chong He San (Harmonizing Powder) internally and apply Yin Yang San (Yin-Yang Powder) externally, so that rebellious Ying Qi (Nutritive Qi) will return to normal and blood郁 (stagnation) will disperse. If there is slight swelling and pain, dark and hard discoloration, muscle color remaining unchanged, and failure to ulcerate after a long time, with a deep and fine pulse upon heavy pressure and a floating and empty pulse upon light pressure, this belongs to a Pure Yin syndrome. It is appropriate to take Hui Yang Tang (Restore Yang Decoction) internally and apply Yi Yin San (Suppress Yin Powder) externally, so that cold pathogenic factors will resolve and Yang Qi will recover. Whenever Yang Qi is deficient and cold, failing to dissipate necrotic tissue or promote ulceration, or when ulceration occurs but swelling persists and the wound fails to close, internal and external warm-tonifying methods must be used to preserve life. If a Cold-Yin syndrome is treated with cold-cooling medicines, the cou li (pores and interstices) will become blocked, Qi and Blood will stagnate, toxic pathogens will penetrate deeper, healthy flesh will die, the wound will fail to heal, and malignant symptoms will arise in swarms, making it irretrievable. This is because Stomach Qi cannot circulate when injured by cold; blood stasis cannot dissipate when exposed to cold; dead flesh cannot slough off when exposed to cold; new flesh cannot generate when exposed to cold. Practitioners must examine these factors carefully.
A child had facial sores and was applied cold-cooling medicines, resulting in firmness at the affected site and swelling of the head and face. This was due to Cold injuring the Spleen and Stomach, causing Qi and Blood stagnation and failure to flow. Initially, Chong He Tang (Harmonizing Decoction) and Yin Yang San were used, softening the affected site. Subsequently, Tuo Li Xiao Du San (Support Interior and Eliminate Toxin Powder) was used, eliminating the hardness instantly. Finally, Tuo Li San (Support Interior Powder) was used, leading to ulceration and healing.
A child had an abdominal carbuncle and was applied cold-cooling medicines, resulting in abdominal distension, hiccups, and cold hands and feet. This indicated further injury to the Spleen and Stomach leading to Deficient-Cold. Hui Yang Tang and Yi Yin San were used, gradually alleviating all symptoms. Tuo Li San was used to promote ulceration, and Ba Zhen Tang (Eight Treasures Decoction) led to recovery.
A child had an ulcerative lesion and was applied cold-cooling medicines, resulting in failure of muscle regeneration and continuous discharge of purulent fluid. I attributed this to Spleen Qi deficiency. Yi Gong San (Benefit Work Powder) plus Sheng Ma (Cimicifugae Rhizoma) and Bai Zhi (Angelicae Dahuricae Radix) were used for gradual improvement, followed by Tuo Li San for complete recovery.
A child had an arm carbuncle and received both internal and external cold-cooling medicines, resulting in increased swelling and hardness. I reasoned that the Spleen and Stomach needed support to resolve stagnant Cold. Therefore, Yi Qi Tang (Tonify Qi Decoction) plus Fu Ling (Poria), Ban Xia (Pinelliae Rhizoma), Bo He (Menthae Haplocalycis Herba), and Gui Zhi (Cinnamomi Ramulus) were administered, along with external warming moxibustion using Ru Sheng Bing (Ru Sheng Cake), leading to recovery. Generally, for chronic sores and ulcers that fail to heal, whether ulcerated or not, the cause is often Deficient Yang failing to circulate. Using Ru Sheng Bing or Cong Yun Method (Scallion Warming Method) is advisable.
A child had erythematous swelling on the inner and outer aspects of both lower legs, extending up to the knees, following the resolution of smallpox. Some suggested it was Smallpox Toxin and recommended cold-purgative agents; others suggested it was Erysipelas and recommended bloodletting via cupping/scarification. I stated: Incorrect. This is Heat-Toxin congestion and swelling in the Foot Three Yang Meridians. Moreover, after smallpox resolution, Yuan Qi (Original Qi) has not yet recovered. If bloodletting is performed, the affected site will be further injured; applying cooling medicines will further stagnate Ying Qi; administering detoxifying/purgative medicines will further deplete Yuan Qi and coagulate blood stasis. Disregarding my advice, they proceeded with the previous methods. Indeed, both lower legs ulcerated with dark discoloration, wounds failed to close, and stool resembled dysentery. They wished to use anti-dysentery medicines. I stated: This is due to the prior erroneous treatment re-injuring Yuan Qi, causing it to sink. It is neither dysentery nor toxin. Consequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and similar formulas were used for recovery.
A child had diffuse swelling on the thigh without redness. After taking detoxifying/purgative medicines, hands and feet became cold, accompanied by vomiting, diarrhea, and anorexia. I diagnosed this as a Half-Yin Half-Yang syndrome due to Yuan Qi deficiency. Yin Yang San and Chong He Tang were used. The swelling rose and turned red, indicating a transformation into a Pure Yang syndrome, which is auspicious. The previous medicines were continued, assisted by Xian Fang Huo Ming Yin (Immortal Formula for Saving Lives Decoction), leading to resolution.
A child had an arm carbuncle with sallow complexion, reduced appetite, and a surging, rapid pulse that felt weak upon heavy pressure. I diagnosed this as True Qi deficiency with pathogen stagnation. Bai Zhi Sheng Ma Tang (Angelica and Cimicifuga Decoction) was used to clear Heat-Toxin from the Stomach Meridian, and Wu Wei Yi Gong San (Five-Ingredient Yi Gong Powder) was used to tonify Yuan Qi of the Stomach Meridian. Disregarding this, cold-cooling agents were used internally and externally. Swelling became hard to the touch, muscle color remained unchanged, abdominal pain occurred, and the pulse became floating and large but deep and fine upon pressure. This indicated re-injury to Spleen and Stomach Qi, transforming into a Deficient-Cold syndrome. Cold pathogens should have been dispersed and Spleen Qi warmed. Ignoring this, detoxifying medicines were given again, resulting in hiccups, anorexia, and cold extremities. This indicated Cold forcing Yang outward, with rootless Fire flaring. The child indeed died, with cyanosis of hands and feet and blackening of the affected site.
A child had a hard swelling on the lower leg that ulcerated after more than a year, discharging thin pus. The swelling became harder, muscle color dark blue, accompanied by fever and irritability. I diagnosed this as True Qi deficiency with Excess Pathogen, advising first to regulate the Spleen and Stomach. Others believed it was Heat-Toxin stagnation and applied cold-cooling medicines. The swelling extended to the knee, muscles ulcerated, abdomen distended, and the child died from vomiting and diarrhea.
Tuo Li Chong He Tang (Support Interior and Harmonize Decoction) treats sores and ulcers belonging to Half-Yin Half-Yang syndromes, appearing ulcerated but not truly so, swollen but not truly so, caused by Yuan Qi deficiency and lack of supportive tonification. (Self-made formula)
Ren Shen (Ginseng Radix et Rhizoma, 2 qian) Huang Qi (Astragali Radix, 3 qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried) Chen Pi (Citri Reticulatae Pericarpium) Dang Gui (Angelicae Sinensis Radix) [each 1 qian] Gan Cao (Licorice Radix et Rhizoma, stir-fried, 0.5 qian)
Decoct in water and take slowly. Add Sheng Jiang (Zingiberis Rhizoma Recens) and Gui Zhi if hands and feet are cold. If heat has subsided but swelling/ulceration persists, use Xian Fang Huo Ming Yin. For cases resolvable internally, use Tuo Li Xiao Du San. For cases forming pus, use Tuo Li San.
Yin Yang San (i.e., Chong He Gao/Paste) treats sores and ulcers where Yuan Qi is deficient, presenting as swollen but not truly swollen, painful but not truly painful, hot but not truly hot, belonging to Half-Yin Half-Yang syndromes. Use this to harmonize Yin and Yang. Internally administer Chong He Tang or Tuo Li San to assist Yuan Qi.
Zi Jing Pi (Bauhiniae Purpureae Cortex, stir-fried, 5 liang) Du Huo (Angelicae Pubescentis Radix, stir-fried, 3 liang) Chi Shao Yao (Paeoniae Radix Rubra, stir-fried) Bai Zhi (Angelicae Dahuricae Radix) Shi Chang Pu (Acori Tatarinowii Rhizoma) [each 2 liang]
Grind into powder, mix with Cong Jiu (Scallion Wine) for oral administration.
Tuo Li Hui Yang Tang (Support Interior and Restore Yang Decoction) treats sores and ulcers belonging to Pure Yin syndromes, characterized by no swelling/pain, no redness, no ulceration/necrosis, or abdominal pain/diarrhea, vomiting, cold limbs, and sunken Yang Qi. Urgent use often results in survival. (Self-made formula)
Gan Jiang (Zingiberis Rhizoma) Fu Zi (Aconiti Lateralis Radix Praeparata, weighing approx. 1.4 qian) Dang Gui (Angelicae Sinensis Radix) Chen Pi (Citri Reticulatae Pericarpium) Bai Zhu (Atractylodis Macrocephalae Rhizoma) Huang Qi (Astragali Radix) Ren Shen (Ginseng Radix et Rhizoma) Gan Cao (Licorice Radix et Rhizoma, stir-fried) [each 2 qian] Chai Hu (Bupleuri Radix) Sheng Ma (Cimicifugae Rhizoma) [each 0.3 qian]
Decoct in water and take slowly. If ineffective, double the dosage of Sheng Jiang and Fu Zi. Apply Yi Yin San externally (another name: Hui Yang Shang Long Gao).
Yi Yin San (Suppress Yin Powder) treats sores and ulcers where Yuan Qi is Deficient-Cold, unable to dissipate, or accompanied by abdominal pain/diarrhea, vomiting/anorexia, cold/non-ulcerating/closing limbs, tendon spasms, and bone pain, belonging to Pure Yin syndromes. Use this to assist Yang and move Yin. Internally administer Hui Yang Tang to restore Yang Qi.
Cao Wu (Aconiti Kusnezoffii Radix, stir-fried, 2 liang) Nan Xing (Arisaematis Rhizoma) Bai Zhi (Angelicae Dahuricae Radix) [each 1 liang] Rou Gui (Cinnamomi Cortex, 0.5 liang) Chi Shao Yao (Paeoniae Radix Rubra, stir-fried, 1 liang)
Grind each into powder separately. Mix with Cong Tang (Scallion Decoction) for topical application; Re Jiu (Hot Wine) is also acceptable.
Jie Du Ji Yin Tang (Detoxify and Nourish Yin Decoction) treats carbuncles and ulcers with swelling and pain belonging to Pure Yang syndromes, using this to detoxify. If heat has not subsided, use Xian Fang Huo Ming Yin. (Self-made formula)
Lian Qiao (Forsythiae Fructus) Shan Zhi (Gardeniae Fructus, stir-fried) Huang Qin (Scutellariae Radix, stir-fried) Huang Lian (Coptidis Rhizoma, stir-fried) [each 1 qian] Chi Shao Yao (Paeoniae Radix Rubra, 1.5 qian) Jin Yin Hua (Lonicerae Japonicae Flos, 3 qian) Gan Cao (Licorice Radix et Rhizoma, 1 liang)
Take 2-3 qian per dose, decoct in water. If constipation exists, add Chao Da Huang (Rhei Radix et Rhizoma, stir-fried) according to need. Apply Yi Yang San externally.
Yi Yang San (Suppress Yang Powder, i.e., Hong Bao Dan) treats sores and ulcers belonging to Pure Yang syndromes.
Tian Hua Fen (Trichosanthis Radix, 3 liang) Jiang Huang (Curcumae Longae Rhizoma) Bai Zhi (Angelicae Dahuricae Radix) Chi Shao Yao (Paeoniae Radix Rubra) [each 1 liang]
Grind into powder. Mix with Cha Tang (Tea Decoction) for topical application to the affected site.
Wu Wei Yi Gong San (See formula under Detoxifying Medicines)
Xian Fang Huo Ming Yin
Tuo Li Xiao Du San
Tuo Li San (These three formulas see Heat-Toxin Sores and Ulcers)
Bu Zhong Yi Qi Tang (See formula under Failure of Muscle Regeneration)
Ba Zhen Tang (See formula under Persistent Fever)
Ru Sheng Bing
Cong Yun Method (These two formulas see Liu Zhu/Abscess)