大渴发热，或泄泻淋闭者，邪火内淫，一恶也。凡疮肿发热潮烦，或失血过多，或溃脓大泄，或汗多亡阳，
或下多亡阴，以致阴血耗散，阳无所附，浮于肌表而非火也。若发热不寝，虚热也，圣愈汤；兼汗不止，气虚
也，单人参汤；发热烦躁，肉 筋惕，气血俱虚也，八物汤；大渴面赤，脉洪大而虚，阴虚发热也，古归 汤；
微热烦躁，面赤脉沉而微，阴盛发躁也，四君子汤加姜、附。凡渴不可专泥于火。若 痛发热，便利调和者，
竹叶石膏汤；肿痛发热，大便秘涩者，四顺清凉饮； 痛炽盛者，活命饮；脓水多者，圣愈汤；胃伤内亡津液
者，钱氏白术散∶肾水干涸者，八味丸。有先作渴，小便频数，而后患疽者；或愈后作渴，或舌黄干硬，小便
频数，而后患疽者，尤其恶也，宜预服八味丸、补中益气汤，以滋化源，可免是患。盖痈疽未有不因肾虚而作，
切忌知母、黄柏损阳则阴气无由而生。泄泻因寒凉伤脾者，六君子汤加砂仁，或托里建中汤、托里温中汤；脾
虚下陷者，补中益气汤吞二神丸；命门火衰者，八味丸料煎吞四神丸；肾虚不固者，古姜附汤加吴萸、五味子；
大孔痛者，附子理中汤、四逆汤。凡痈疽呕泻，肾脉虚者，死。便秘因热毒入脏，呕 心逆，发热肿硬秘结，
固宜通之。又有伏热，阳气怫郁，面赤便秘者，为邪火在经，宜汗以发之，溃后气虚血涸便秘者，十全大补
汤，或因入房伤肾便秘者，加姜。附以回阳气，则大便自润。凡便秘能食，而肚腹不胀者，切不可下。若腹痞
胀而秘者，猪胆法∶用猪胆一枚，剪去头，入盐、醋少许，以鹅管插入胆中，灌谷道内，须臾自通。小便淋沥，
频数短少，或茎中涩痛，皆肾虚恶证，详四卷淋类。
溃后肿痛臭难当；
脓血既泄，肿痛尤甚，脓色臭败者，胃虚火盛，二恶也，人参黄 汤，或十全大补汤加麦门冬、五味子。
黑睛紧小白青赤，
目视不正，黑睛紧小，白睛青赤，瞳人上视者，肝肾阴虚而目系急，三恶也，肾气丸料，或八物汤，
俱加炒山栀、麦门冬、五味子。
喘急恍惚喜卧床；
喘粗短气，恍惚嗜卧者，脾肺虚火，四恶也，六君子汤加姜、枣，或补中益气汤加麦门冬、五味子。心火
克肺金，人参平肺散；阴火伤肺，肾气丸料加五味子煎服。
虚恶肩背四肢重，
肩背不硬，四肢沉重者，脾肾亏损，五恶也，补中益气汤、十全大补汤，俱加山药、山茱萸、五味子。
食少呕药伤寒凉；
不能下食，服药而呕，食不知味者，胃气虚弱，六恶也，六君子汤加木香、砂仁；甚，加附子。挟痰者，
托里清中汤；挟火者，托里益黄汤。抑论疮肿时作呕，热毒攻心；溃时作呕，阴虚；溃后作呕，脾虚。如热盛
痛，活命饮、护心散；作脓 痛，托里消毒散；脓熟胀痛，托里散，或针以泄之。 痛便秘者，内疏黄连汤。
寒凉伤胃者，六君子汤加干姜、木香。木乘土位加芍药、柴胡；胃脘停痰，加桔梗；脾虚自病，或水侮土，加益
智仁、砂仁；郁结伤脾，加川芎、山栀、苍术、香附；湿气侵胃，倍白术。白术，生肌敛口妙剂。又有登厕触
秽作呕者，仍宜补胃。
声嘶唇鼻变青色，面目四肢肿且黄；
脾肺俱虚，七恶也，补中益气汤加姜、枣，或六君子汤加炮姜，甚，加附子，或十全大补汤加炮姜。
阳虚寒战腹疼甚，自汗呃逆雷鸣肠；
阳虚皆因误服寒凉，或溃后劳役，或吐泻之后，或误入房、梦遗，或外邪所乘。初则虚火假证，仍发热头
痛；良久寒战切牙、腹痛雷鸣、泄泻呃逆、自汗盗汗，阳虚寒气所乘之证，八恶也。急用托里温中汤，后用
六君子汤加附子，或加姜、桂；甚者，用大剂参、 、归、术，倍加姜、附，以手足温为度。
虚极发躁欲坐井，蓦然变痉身反张；
溃后发热恶寒，作渴怔忡，睡卧不宁，阳衰阴盛，发躁，脉洪大，按之微细或无，此阳虚极。蓦然牙关紧
急、腰背反张，变为痉 病，或无汗恶寒，或有汗不恶寒，九恶也。俱宜八味丸料加参、 、归、术，大剂煎服。
阴虚晡热夜不寐，消渴便污血难藏；
原禀瘦怯，或房欲竭精，或疮出脓多，或误汗下，以致日晡潮热、口干作渴、夜寐不着、疮出紫血，四物汤、
托里益气汤、肾气丸主之。便污黑者，不治；便血瘀滞者，犀角地黄汤饮之。疮疡时，或愈后，口鼻吐衄、牙宣
龈露，皆因疮疡出血，为火动而错经妄行，当求经审其因而治之。肝热则血妄行，四物汤加山栀、牡丹皮、黄
芩、白术；肝虚则不能藏血，肾气丸；心火不能生血，四物汤加炒黄连、牡丹皮、苓、术；脾虚热不能统血，
四君子汤加炒山栀、牡丹皮；脾经郁结者，归脾汤加五味子；脾肺气虚者，补中益气汤加五味子；气血俱虚者，
十全大补汤；阴火动者，肾气丸加五味子。大凡失血过多，而见烦热发渴等证，勿论其脉，急用单人参汤补之。
经云∶血生于气。苟非甘温参、 、归、术之类，以生心肝之血，决不能愈。若发热脉大者，死。
五善见三容易治，七恶见四真恶疮。
正传以善为顺，恶为逆。疮疡仍忌倒陷，又增为九逆，殊为有理。
又有一般无名肿，
非痈、非疽、非疮、非癣，状如恶疮，或瘥或剧，名曰无名肿毒。随其见证，在表在里在经用药，外以槐枝
煎汤洗净，后以赤小豆、吴萸、白胶香、黄连、黄柏、贝母、硫黄、糯米、黄丹、轻粉为末，麻油调搽。一切
恶疮，人所不识者皆同。
疖癌瘭痼也同方。
阔一寸至二寸为疖；一寸至五寸为痈；五寸至一尺为癌；一尺至二尺为竟体疽。未溃色紫黑坚硬，已溃深陷
如岩为癌。四畔生如牛唇黑硬，为瘭。无头，面色淡红为痼。四轮肿起为痈；沉溃为疽；发出于外者，为外疽；
隐伏肠胃者，为内疽。疖比痈、疽更轻，癌、瘭、痼多难治。癌多生乳、胁、臀、胯，全宜大补气血脾胃，及蜡
矾丸护膜生肌，冀其万一。瘭、痼见后周身部。
Extreme thirst, fever, or diarrhea with stranguria and urinary retention indicate pathogenic fire rampant internally; this is the first ominous sign. Whenever a carbuncle or swelling presents with fever, afternoon tidal fever, and irritability, or excessive blood loss, or profuse pus discharge leading to severe diarrhea, or excessive sweating leading to Yang collapse, or excessive purgation leading to Yin collapse, resulting in the consumption of Yin and Blood such that Yang has no root and floats on the body surface, this is not true fire. If fever prevents sleep, it is deficiency heat; treat with Shengyu Decoction (Sage and Rehmannia Decoction). If accompanied by incessant sweating, it is Qi deficiency; treat with Single Ginseng Decoction. If fever and irritability are accompanied by muscle twitching and tendon tremors, it is dual deficiency of Qi and Blood; treat with Bawu Tang (Eight-Ingredient Decoction). If there is extreme thirst, red face, and a surging yet empty pulse, it is Yin deficiency fever; treat with Gu Gui Pi Tang (Ancient Spleen-Nourishing Decoction). If there is mild fever and irritability, red face, and a deep, faint pulse, it is irritability caused by Yin excess repelling Yang; treat with Six Gentlemen Decoction plus Ginger and Aconite. Thirst should not be exclusively attributed to fire. If pain with fever occurs but bowel movements and urination are harmonious, use Bamboo Leaf and Scutellaria Decoction. If swelling and pain with fever occur with dry constipation, use Four-Harmonizing Cooling Decoction. If pain is intense, use Life-Saving Decoction. If there is much pus, use Shengyu Decoction. If stomach injury leads to internal fluid loss, use Qian's Atractylodes Macrocephala Powder. If kidney water is dried up, use Eight-Ingredient Pill. Some patients experience thirst and frequent urination before developing a carbuncle/ulcer; or after recovery, they develop thirst, yellow dry tongue, and frequent urination before developing a carbuncle/ulcer; these are particularly ominous. Preemptively administer Eight-Ingredient Pill and Tonify Middle and Boost Qi Decoction to nourish the source of transformation, avoiding this disaster. Generally, carbuncles and ulcers arise from Kidney deficiency; avoid Zhi Mu (Anemarrhenae Rhizoma) and Huang Bo (Phellodendri Cortex) which damage Yang, otherwise Yin cannot generate. Diarrhea due to cold-cooling herbs damaging the Spleen: treat with Six Gentlemen Decoction plus Amomum, or Interior-Protecting Middle-Building Decoction, or Interior-Protecting Warming-Middle Decoction. Spleen deficiency with Qi sinking: treat with Tonify Middle and Boost Qi Decoction taken with Er Shen Pill. Mingmen Fire decline: treat with Eight-Ingredient Pill decoction taken with Si Shen Pill. Kidney deficiency failing to secure: treat with Ancient Ginger-Aconite Decoction plus Evodia and Schisandra. Anal pain: treat with Aconite and Poria Decoction or Four-Reversal Decoction. For any carbuncle/ulcer with vomiting and diarrhea, if the Kidney pulse is weak, the prognosis is fatal. Constipation due to heat-toxin entering the Zang organs, with nausea, retching, fever, swelling, hardness, and constipation, should indeed be purged. However, latent heat with constrained Yang, red face, and constipation indicates pathogenic fire in the meridians; treat with diaphoresis. After ulceration, Qi deficiency and blood exhaustion causing constipation: treat with Ten-Ingredient Great-Boosting Decoction. Constipation due to sexual indiscretion damaging the Kidneys: add Ginger and Aconite to restore Yang, and stool will naturally moisten. If constipation exists but the patient can eat and the abdomen is not distended, absolutely do not purge. If abdominal fullness, distension, and constipation exist, use Pig Gallbladder Method: take one pig gallbladder, cut off the head, add a little salt and vinegar, insert a goose quill into the gallbladder, and irrigate the anus; passage will occur shortly. Dribbling urine, frequent short urination, or painful urination are all ominous signs of Kidney deficiency; see Vol 4 under Stranguria.
After ulceration, swelling, pain, and unbearable foul odor:
After pus and blood have drained, if swelling and pain worsen and the pus is foul and敗败 (decayed), this indicates Stomach deficiency and flourishing fire; this is the second ominous sign. Treat with Ginseng and Astragalus Decoction, or Ten-Ingredient Great-Boosting Decoction plus Ophiopogon and Schisandra.
Black pupil tight and small, white sclera blue-red:
Misaligned vision, tight/small black pupil, blue-red sclera, and upward-gazing pupil indicate Liver-Kidney Yin deficiency causing tension in the eye system; this is the third ominous sign. Treat with Kidney Qi Pill formula, or Bawu Tang (Eight-Ingredient Decoction), both added with stir-fried Gardenia, Ophiopogon, and Schisandra.
Panting, urgency, trance-like state, preferring to lie down:
Rapid breathing, shortness of breath, trance-like state, and somnolence indicate Spleen-Lung deficiency fire; this is the fourth ominous sign. Treat with Six Gentlemen Decoction plus Ginger and Jujube, or Tonify Middle and Boost Qi Decoction plus Ophiopogon and Schisandra. If Heart fire overacts on Lung metal, use Ginseng Lung-Pacifying Powder. If Yin fire damages the Lung, use Kidney Qi Pill formula plus Schisandra.
Extreme deficiency causing heaviness in shoulders, back, and limbs:
Non-stiff shoulders/back and heavy limbs indicate Spleen-Kidney depletion; this is the fifth ominous sign. Treat with Tonify Middle and Boost Qi Decoction or Ten-Ingredient Great-Boosting Decoction, both added with Yam, Cornus, and Schisandra.
Poor appetite, vomiting medicine, cold damage, or cold-cooling injury:
Inability to eat, vomiting upon taking medicine, and loss of taste indicate Stomach Qi weakness; this is the sixth ominous sign. Treat with Six Gentlemen Decoction plus Aucklandia and Amomum; if severe, add Aconite. With phlegm accumulation: use Interior-Protecting Middle-Clearing Decoction. With fire accumulation: use Interior-Protecting Yellow-Nourishing Decoction. In summary, vomiting during the carbuncle stage indicates heat-toxin attacking the Heart; vomiting during ulceration indicates Yin deficiency; vomiting after ulceration indicates Spleen deficiency. If heat is excessive with pain, use Life-Saving Decoction or Heart-Protecting Powder. During suppuration with pain, use Interior-Protecting Detoxification-Decaying Decoction. When pus is ripe with distending pain, use Interior-Protecting Powder or puncture to drain. Pain with constipation: use Internal-Draining Coptis Decoction. Cold-cooling damaging the Stomach: use Six Gentlemen Decoction plus Dried Ginger and Aucklandia. Liver Wood invading Earth: add Peony and Bupleurum. Phlegm retention in epigastrium: add Platycodon. Spleen deficiency self-disease or Water insulting Earth: add Alpinia Oxyphylla and Amomum. Emotional constraint damaging Spleen: add Ligusticum, Gardenia, Atractylodes Lancea, and Cyperus. Dampness invading Stomach: double the dose of Atractylodes Macrocephala. Atractylodes Macrocephala is an excellent agent for generating flesh and closing sores. Vomiting triggered by contact with filth while defecating still requires Stomach tonification.
Hoarse voice, cyanotic lips and nose, facial and limb edema with jaundice:
Dual deficiency of Spleen and Lung constitutes the seventh ominous sign. Treat with Tonify Middle and Boost Qi Decoction plus Ginger and Jujube, or Six Gentlemen Decoction plus Roasted Ginger; if severe, add Aconite, or Ten-Ingredient Great-Boosting Decoction plus Roasted Ginger.
Yang deficiency with chills, severe abdominal pain, spontaneous sweating, hiccups, and borborygmus:
Yang deficiency results from misusing cold-cooling herbs, labor after ulceration, post-vomit/diarrhea states, sexual misconduct/emission, or external pathogens. Initially, false deficiency-fire signs appear with fever and headache; later, severe chills, teeth grinding, abdominal pain, borborygmus, diarrhea, hiccups, and sweating occur. This is Yang deficiency with cold-pathogen invasion; this is the eighth ominous sign. Urgently use Interior-Protecting Warming-Middle Decoction, followed by Six Gentlemen Decoction plus Aconite, or plus Ginger and Cinnamon. If severe, use large doses of Ginseng, Astragalus, Angelica, and Atractylodes Macrocephala, doubling Ginger and Aconite, until hands and feet warm.
Extreme deficiency with irritability (desire to sit in well), sudden spasms with opisthotonos:
Post-ulcer fever and aversion to cold, thirst, palpitations, restlessness, Yin excess with Yang decline, irritability, surging pulse but faint/empty on pressure indicate extreme Yang deficiency. Sudden lockjaw, opisthotonos, becoming a Spasm disease, or anhidrosis with aversion to cold, or diaphoresis without aversion to cold, constitute the ninth ominous sign. Treat with Eight-Ingredient Pill formula plus Ginseng, Astragalus, Angelica, and Atractylodes Macrocephala, decocted in large doses.
Yin deficiency with afternoon fever, insomnia at night, wasting-thirst, and bloody stools difficult to contain:
Constitutional emaciation, sexual exhaustion, excessive pus drainage, or misused diaphoresis/purgation lead to afternoon tidal fever, dry mouth/thirst, insomnia, and purple blood from sores. Treat with Four-Substance Decoction, Interior-Protecting Qi-Boosting Decoction, or Kidney Qi Pill. Black feces: untreatable. Bloody stools with stasis: use Rhinoceros Horn and Rehmannia Decoction. Epistaxis or gingival bleeding during or after sores indicates fire disturbing blood vessels; investigate the cause. Liver heat causing wild blood flow: Four-Substance Decoction plus Gardenia, Moutan, Scutellaria, and Atractylodes Macrocephala. Liver deficiency failing to store blood: Kidney Qi Pill. Heart fire failing to generate blood: Four-Substance Decoction plus stir-fried Coptis, Moutan, Poria, and Atractylodes Macrocephala. Spleen deficiency-heat failing to control blood: Six Gentlemen Decoction plus stir-fried Gardenia and Moutan. Spleen meridian constraint: Gui Pi Tang (Restore the Spleen Decoction) plus Schisandra. Spleen-Lung Qi deficiency: Tonify Middle and Boost Qi Decoction plus Schisandra. Dual Qi-Blood deficiency: Ten-Ingredient Great-Boosting Decoction. Yin fire movement: Kidney Qi Pill plus Schisandra. Generally, for excessive blood loss with irritability/fever/thirst, regardless of pulse, urgently use Single Ginseng Decoction. The Classics state: Blood is born from Qi. Without sweet-warm agents like Ginseng, Astragalus, Angelica, and Atractylodes Macrocephala to generate Heart-Liver blood, recovery is impossible. Fever with large pulse: fatal.
Five Good Signs with three present: easy to treat. Seven Bad Signs with four present: truly bad sore.
Orthodox transmission considers Good as favorable and Bad as unfavorable. Sores must avoid inversion/collapse; adding Nine Reversions is reasonable.
Another type of nameless swelling:
Not a carbuncle, ulcer, sore, or tinea, resembling a malignant sore, fluctuating in severity, named Nameless Swelling-Toxin. Medication depends on manifestation in exterior, interior, or meridians. Externally, wash with Sophora Root decoction. Then apply powder made from Adzuki Bean, Evodia, Dammar, Coptis, Phellodendron, Fritillaria, Sulfur, Glutinous Rice, Red Lead, and Calomel, mixed with Sesame Oil. All unrecognized malignant sores are treated similarly.
Jie (Furuncle), Ai (Cancerous Ulcer), Biao (Carbuncle-like), Gu (Stubborn Ulcer) share formulas.
1-2 cun wide is Jie; 1-5 cun is Yong (Carbuncle); 5 cun-1 chi is Ai; 1-2 chi is Jingti Ju (Generalized Ulcer). Unulcerated, purple-black and hard; ulcerated, deep and rock-like is Ai. Edges like ox-lip, black and hard is Biao. Headless, pale red face is Gu. Four-sided swelling is Yong; deep ulceration is Ju; external emergence is External Ju; internal hidden in intestines/stomach is Internal Ju. Jie is lighter than Yong/Ju; Ai/Biao/Gu are difficult to treat. Ai often occurs on breasts, flanks, buttocks, hips; always tonify Qi-Blood and Spleen-Stomach, use Wax-Alum Pill to protect membranes and generate flesh, hoping for survival. Biao and Gu are described in the Whole Body section.