论
《内经》曰∶诸痛痒疮疡，皆属心火。又曰膏粱之变，足生大疔。荣气不从，逆于肉理，乃生痈肿。东垣谓荣气即
胃气也，盖胃气调和，则荣卫之气，皆顺流而无逆于肉理耳。若夫饮食失节，肥甘过伤，以致湿热蕴积于肠胃之间，烧
烁腑脏，煎熬真阴，此经之所谓阴之五宫，伤在五味，味伤发热，久而增气。故湿热之气，聚于下集，阴火炽盛，蓄于
八脉，八脉沸腾，逆于经隧，气凝血滞，故其滋养精微之气，不能如常荣于肉理，是以结聚而成痈肿矣，经曰热胜则肉
腐是也。法当视其所发之地，各从其经而处治焉。夫发于身之表者，其名一十有七∶曰脑发（督脉，足太阳经），曰背发
（中属督脉，余皆足太阳经），曰鬓发（手足少阳经），曰眉发（手足太阳经，手足少阳经），曰 发（手足阳明经），曰
腮颔发（手阳明经），曰髭发（手足阳明经），曰腋发（手太阳经），曰穿裆发（督衔任三脉），曰腿发（表足三阳，裹足
三阴），曰肝痈（足厥阴经），曰喉痈（任脉，阳明经），曰脐痈（任脉，阳明），曰乳痈（内阳明经，外少阳经，乳头足
厥阴经），曰臀痈（足太阳经），曰跨马痈（足厥阴经），曰囊痈（足厥阴经）。发于腔子之内者，其名有四∶曰内疽，曰
肺痈（手太阴经），曰肠痈（手太阳经，手阳明经），曰胃脘痈（足阳明经）。夫十二经有气血多少之不同，痈疽浅深之有
异。是故为治之法，或疏散，或消毒，或针焙，或内托，或外消，或泻利，或补益。是故肿疡为实，宜泻利；溃疡为虚，
宜补益；浮露而浅者为痈，宜外消；藏伏而深者为疽，宜内托，此千古不易之定议也。虽然其证有善而易治者为顺，恶
而难消者为逆。其为眼白睛黑，目紧小者，一逆也；不能饮食，纳药而呕，食不知味，二逆也；伤痛渴甚，三逆也；膊
项转动不便，四肢沉重，四逆也；声嘶色脱，唇口青黑，面目四肢浮肿，五逆也；烦躁时咳，腹痛甚，泄利无度，小便
如淋，六逆也。脓血大泄， 肿尤甚，脓水臭败莫近，七逆也；喘促气短，恍惚嗜卧，八逆也；未溃先黑陷，面青唇黑
便污，九逆也。又如噫气痞塞，喘咳，身冷自汗，目瞪耳聋，恍惚惊悸，语言错乱，皆是恶证。若夫动息自宁，饮食知
味，一顺也；便利调匀，二顺也；神彩精明，语声清朗，三顺也；脓溃肿消，色鲜不臭，四顺也；体气和平，五顺也。
凡五顺见三则吉，九逆见六则危矣。先哲垂训，班班可考，学人其可不详察乎。
脉法
《脉经》曰∶脉数身无热，内有痈也。一云∶腹无积聚，身无热，脉数，此为肠中有脓，薏苡附子败酱汤主之。
诸浮数脉，应当发热，而反洒淅恶寒，苦有痛处，当发痈肿。脉微而迟，反发热，弱而数，反振寒，当发痈肿。
脉浮而数，身体无热，形嘿嘿，胸中微躁，不知痛之所在，此人当发痈肿。
脉滑而数，数则为热，滑则为实，滑则主荣，数则主卫，荣卫相逢，则结为痈，热之所过，则为脓也。
羽林妇病，医者脉之，知妇人肠中有脓，为下之即愈。盖寸口脉滑而数，滑则为实，数则为热，滑则为荣，数则为
卫，卫数下降，荣滑上升，荣卫相干，血为浊败，小腹痞坚，小便或涩，或时汗出，或复恶寒，脓为已成。设脉迟紧，
聚为瘀血，下之即愈。
肠痈之为病，其身体甲错，腹皮急，按之软如肿状。
夫肠痈者，小腹肿，按之则痛，小便数如淋，时时发热，自汗出，复恶寒。其脉迟紧者，脓未成，可下之，当有血；
脉洪数者，脓已成，不可下也。大黄牡丹汤主之。
方法
丹溪曰∶痈疽因阴阳相滞而生。盖气阳也，血阴也，血行脉内，气行脉外，相并周流。寒与湿搏之，则凝泣而行迟，
为不及；热与火搏之，则沸腾而行速，为太过。气得邪而郁，津液稠粘，为痰为饮，积久渗入脉中，血为之浊，此阴滞
于阳也。血得邪而郁，隧道阻隔，或溢或结，积久渗出脉外，气为之乱，此阳滞于阴也。百病皆由于此，又不止于痈疽
而已。
痈疽因积毒在脏腑，当先助胃壮气，使根本坚固，而以行经活血药为佐，参以经络时令，使毒瓦斯外发，施治之早，
可以内消，此内托之意也。
或问内托之法，予曰∶河间治肿 于外，根盘不深，形证在表，其脉多浮，病在皮肉，非气盛则必侵于内，急须内
托，宜腹煎散，除湿散郁，使胃气和平。如或未已，再煎半料饮之。如大便闭及烦热，少服黄连汤。如微利及烦热已退，
却与复煎散。如此使荣卫俱行，邪气不能内伤也。
《外科精要》谓排脓内补十宣散，治未成者速散，已成者速溃，诚哉是言也。若用之于小疮疖与冬月，亦可转重就
轻，移深居浅。若溃疡与夏月用之，其桂朴之温散，佐以防风、白芷，吾恐虽有参 ，难为倚仗。比见世人用此，不分
轻重时令，经络前后，正若盲人骑瞎马，半夜临深池，危哉！
诸经惟少阳厥阴二经生痈疽宜预防之，以其多气少血也。血少而肌肉难长，疮久未合，必成死证。苟不知此，遽用
驱逐利药，以伐其阴分之血，祸不旋踵。
肿疡内外皆壅，宜以托里表散为主。如欲用大黄者，宜戒猛浪之非。
溃疡内外皆虚，宜以补接为主。如欲用香散者，宜戒虚虚之失。
《外科精要》一书，惟务纪录旧方，应酬轻小证候耳。
痈疽始发，即以艾多灸之，可使轻浅，骑竹马灸法最妙。盖艾火畅达，拔引郁毒，此从治之意。惟头为诸阳所聚，
艾炷宜小而少。若身上，必痛灸至不痛，不痛灸至痛。亦有因灸而死者，盖虚甚，孤阴将绝，其脉必浮数而大且不鼓，
精神必短而昏，无以抵当火气，宜其危也。
按河间灸刺法曰∶凡疮疡须分经络部分，血气多少， 穴远近。从背出者，当从太阳经五穴选用，至阴、通谷、束
骨、昆仑、委中是也。从鬓出者，当从少阳经五穴选用，窍阴、夹溪、临泣、阳辅、阳陵泉是也。从髭出者，当从阳明
经五穴选用，厉兑、内庭、陷谷、冲阳、解溪是也。从脑出者，则以绝骨一穴治之。（各穴点法，俱见《铜人针灸经》，
兹不再具。）
蜞针之法，可施于轻小证候，吮出恶血。若积毒在脏腑者，徒竭其血于外，无益也。
外施贴药，亦发表之意。《精要》谓贴冷药有神效，夫气得热则散，得冷败敛，何谓神效？经曰发表不远热，是也。
（贴冷药，惟轻小疖毒可也。）
外科用针烙得脓后，服神仙追毒丸。此药能下积取毒，无取脓之功。若血气壮实，则脓自出，当以和气活血药，佐
参补剂服之。
肿疡用手按之，热则有脓，不热则无脓。
脓出而反痛者，此为虚也，宜补之。亦有秽气所触而作痛者，宜和解之。风冷所逼者，宜温养之。
疽发深不痛者，胃气大虚，必死肉多而不知痛也。
肿疡时呕者，当作毒瓦斯上攻治之。溃后，当作阴虚补之。若年老溃后发呕不食，又宜参 白术膏峻补，随证加佐使
药。河间谓疮疡呕者，湿气侵于胃也，宜倍白术。
痈疽发渴，乃血气两虚，用参、 以补气，当归、地黄以养血，或忍冬丸、黄 六一汤皆效。
加味十全大补汤，治痈疽溃后，补气血，进饮食，实为切要。凡脓血出多，阴阳两虚，此药有回生起死之功，但不
分经络，不载时令，医者触类而长之可也。或见肿平痛宽，遂以为安，漫不知省，无补接调养之功，愈后虚证复见，因
而转为他病而危剧者多矣。
蒲公英，化热毒，消恶肿，散结核，有奇功。田间路侧皆有之，三四月开黄花，似菊花，味甘。《衍义补遗》云∶四
时常花，花罢飞絮，节叶间折之有白汁出者是。能解食毒，散滞气，可入阳明太阴二经。同忍冬藤煎，以少酒佐而服之，
捣烂 之亦妙。
白蜡属金，禀收敛坚凝之气，外科之要药也。生肌止血，定痛接骨，续筋补虚，常与合欢皮同入长肉膏药用之有神
效。但未试其可服否，若合欢皮常服之验矣。
蓖麻子性善收，能追脓取毒，亦要药也。
痈疽已破未破，用皂角刺，能钻引至痛处。
取剩骨法∶取久疽久痔漏中朽骨（俗名剩骨），用乌骨鸡胫骨，以信砒实之，盐泥固济，火 通红，地上出火毒，用
骨研细，饭丸如粟米大，以皮纸拈送入窍内，外以拔毒膏药封之，其骨自出。
（以上丹溪方法凡二十三条）
恶疮发背脑疽等证方法∶
升阳益胃汤（东垣） 治一切恶疮、发背、脑疽等证。
羌活（一钱五分） 独活（五分） 防风（五分） 本（一钱五分） 知母（一钱）
生地黄（一钱） 黄芩（三钱） 黄连（五分） 黄柏（五分） 当归（三钱） 防风梢（五分）
连翘（二钱） 人参（五分） 黄 （一钱五分） 生甘草（一钱） 陈皮（五分） 当归
梢（五分） 苏木（五分） 炙甘草（一钱五分） 酒防己（五分） 泽泻（七分） 桔梗（一钱）
上细切，分作二服，每服用水二大盏，浸半日，煎至一盏，滴酒数十点，去渣临卧温服。忌饮水，再作脓，效迟。
初患二、三日者服之立消，作脓者立溃，随病上下食前后服。一人患脑疽，第八日肿硬如拳，即日晚服此药一剂，次日
便平复，肿势消，更不疼痛，又服半剂，七日全愈如常。明之言∶凡疮皆阴中之阳、阳中之阴二证而已。我治此疮，阳
药七分，阴药三分，名曰升阳益胃散；胜十宣也，老人宜之，亦名复煎散，或加乳香没药各一钱尤妙。
当归羌活汤 治脑疽证。
黄芩（酒炒） 黄连（酒炒，各二钱） 黄柏（酒炒，一钱） 泽泻（五分） 连翘（一钱） 当归身（二钱） 防
风羌活（各一钱） 甘草（炙，一钱） 山栀子（一钱） 独活（七分） 本（七分）
上细切，作一服，水二盏，先浸一时许，入酒一匙，煎至八分，去渣食后稍热服，日进二服，三日尽六服，俱将药
清汁调下后项槟榔散。
槟榔散（东垣） 大敛疮口。
槟榔 木香（各三钱）
上为细末，用前汤调下或敛疮口用之，决无疼痛，以蜡油调涂疮口，生肌敛肉甚速，别无恶肉，疮口易合平复，膏
粱热疮所宜用也。贫人寒地及寒湿外来之寒疮，禁不可多用。
背疽方法∶
托里散（千金）治背疽并诸恶疮，如三日以里未针灸及利大便者，则可消矣。
羌活（一钱五分） 防风（酒洗，五分） 防风梢（五分） 本（一钱五分） 当归身（三钱） 当归梢（五
分） 连翘（三钱） 黄芩（酒洗，三钱） 黄 （一钱五分生用） 人参（一钱五分） 炙甘草（一钱五分） 生甘
草（五分） 陈皮（五分） 苏木 五味子 酒黄柏 酒防己（各五分） 桔梗 栀子 生地黄（酒洗，各一钱） 酒
大黄（三钱） 酒黄连（一钱） 木猪苓（一钱五分） 麦门冬（二钱）
上细切，分作二服，每服用水三大盏，浸
半日，煎至一盏，稍热服，后一服如前，并渣再煎服，忌冷水。此方如觉病，即便忙服，无不效者。若疮势已发三四日，
或成脓，则不消也。崔经历二次发背疽，皆得此方而愈。
丹溪治背疽方，用大黄、防风、羌活、甘草节、生地黄、当归身、贝母、白芷、赤芍药、皂角刺、黄芩作大剂煎服，
气虚加人参、黄 ，疮溃后亦宜加之。
附骨疽方法∶
丹溪曰∶附骨疽者，皆因久得浓味，及劳役与酒后涉水得，此阳滞于阴之证也。又曰∶环跳穴痛不止，防生附骨疽，
以苍术为君，佐以黄柏之辛，行以青皮，冬加桂枝，夏加条芩，体虚者加杜仲、牛膝，以生甘草为使，作大料煎，入姜
汁，食前饮之。痛甚者，恐前药十数帖发不动，少加麻黄。一二帖又不动者，恐疽将成，急掘地坑，以火 坑通红，沃
以小便，令患者赤体坐于坑中，以席或绵衣围抱下体，使热气熏蒸，腠理开，气血通畅而愈。
羌活防己汤（东垣） 治附骨疽初发于太阳、厥阴、太阴分者。
羌活 川芎 苍术 防己 木香 连翘 射干 甘草 白芍药 木通 当归尾 苏木（各七分）
上细切，水酒各一大盏，煎至七分，食前服，美膳压之。
托里黄 汤（东垣） 治附骨疽初发于足少阳、阳明分者。
柴胡（一钱二分） 连翘（八分） 肉桂（八分） 鼠粘子（八分） 黄 （八分） 当归尾（一钱五分） 黄柏
（四分） 升麻（四分） 甘草（炙，四分） 白芷（一钱）
上细切，作一服，酒一盏，水一盏半，煎至一大盏，空心服，美膳压之。
内托黄 酒煎汤（东垣） 治疮生腿外侧，或因寒湿，得附骨疽于足少阳经分，微侵足阳明经，坚硬漫肿，行
步作痛，或不能行。
柴胡（六钱五分） 连翘（八分） 肉桂（八分） 大力子（炒） 黄 （各四钱一作四分） 当归尾（八钱） 黄
柏（五分） 升麻（七分） 甘草（炙，五分） 白芷（二钱）
上细切，水酒各一盏，煎至一盏，食前温服。
黄连消毒饮（东垣） 治附骨疽。
黄连（一钱） 黄芩 黄柏（各五分） 生地黄（四分） 知母（四分） 羌活（一钱） 独活（四分） 防风（四
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: All pain, itching, and sores belong to Heart Fire. It also says: Changes from rich and sweet foods are sufficient to produce large Ding (severe carbuncles). When Ying Qi (Nutritive Qi) does not flow smoothly and rebels within the muscle tissue, abscesses and swellings arise. Li Dongyuan stated that Ying Qi is Stomach Qi; generally, when Stomach Qi is harmonious, Ying and Wei (Defensive) Qi flow smoothly without rebellion in the muscle tissue. If dietary habits are irregular, and excessive consumption of fatty and sweet foods leads to damp-heat accumulating between the intestines and stomach, scorching the Zang-Fu organs and boiling away True Yin, this is what the classics refer to as injury to the Five Palaces (Zang Organs) by the Five Flavors. Injury by flavors causes fever, and over time increases pathogenic qi. Thus, damp-heat gathers at the lower part, Yin Fire blazes, accumulates in the Eight Extraordinary Vessels, causing them to boil, rebelling in the meridians and collaterals. Qi stagnates and blood congeals, so the nourishing subtle qi cannot normally nourish the muscle tissue as usual, leading to accumulation and formation of abscesses. The classics say, "When heat prevails, flesh rots," which is exactly this situation. The treatment method should observe the site of onset and treat according to the respective meridian.
Those manifesting on the surface of the body have seventeen names: Nao Fa (Brain Carbuncle, belonging to the Du Mai and Foot-Taiyang Bladder Meridian); Bei Fa (Back Carbuncle, centrally belonging to Du Mai, others to Foot-Taiyang Bladder Meridian); Bin Fa (Temple Carbuncle, Hand and Foot-Shaoyang Gallbladder Meridians); Mei Fa (Eyebrow Carbuncle, Hand and Foot-Taiyang Bladder Meridians, Hand and Foot-Shaoyang Gallbladder Meridians); He Fa (Chin Carbuncle, Hand and Foot-Yangming Stomach Meridians); Sai Han Fa (Cheek and Jaw Carbuncle, Hand-Yangming Large Intestine Meridian); Zi Fa (Moustache Carbuncle, Hand and Foot-Yangming Stomach Meridians); Ye Fa (Axillary Carbuncle, Hand-Taiyang Small Intestine Meridian); Chuan Dang Fa (Perineal Carbuncle, Du, Ren, and Chong Mai); Tui Fa (Leg Carbuncle, superficially Foot-Sanyang, internally Foot-Sanyin); Gan Yong (Liver Abscess, Foot-Jueyin Liver Meridian); Hou Yong (Throat Abscess, Ren Mai and Yangming Stomach Meridian); Qi Yong (Umbilical Abscess, Ren Mai and Yangming Stomach Meridian); Ru Yong (Breast Abscess, internally Yangming Stomach, externally Shaoyang Gallbladder, nipple belongs to Foot-Jueyin Liver Meridian); Tun Yong (Buttock Abscess, Foot-Taiyang Bladder Meridian); Kua Ma Yong (Straddle Horse Abscess, Foot-Jueyin Liver Meridian); Nang Yong (Scrotal Abscess, Foot-Jueyin Liver Meridian).
Those manifesting inside the thoracic cavity have four names: Nei Ju (Internal Carbuncle); Fei Yong (Lung Abscess, Hand-Taiyin Lung Meridian); Chang Yong (Intestinal Abscess, Hand-Taiyang Small Intestine Meridian, Hand-Yangming Large Intestine Meridian); Wei Wan Yong (Gastric Epigastric Abscess, Foot-Yangming Stomach Meridian). The twelve meridians differ in the quantity of Qi and Blood, and the depth of carbuncles and ulcers varies. Therefore, treatment methods include dispersing, detoxifying, needle-cauterizing, internal support (Nei Tuo), external resolution, purging/draining, or tonifying. Thus, swelling before ulceration (Zhong Yang) is excess, suitable for purging; ulcerated sores (Kui Yang) are deficiency, suitable for tonifying; those floating and superficial are called Yong (superficial abscesses), suitable for external resolution; those hidden and deep are called Ju (deep carbuncles), suitable for internal support. This is an unchangeable principle since antiquity. Nevertheless, conditions can be favorable and easy to treat (Shun/Smooth) or malignant and difficult to resolve (Ni/Rebellious). Among these: white of the eye turning black, eyes tightly closed and small is the first Rebellious sign; inability to eat, vomiting upon taking medicine, food tasting flavorless is the second; severe pain and extreme thirst is the third; stiffness in arms and neck, heaviness in limbs is the fourth; hoarse voice, sallow complexion, blue-black lips and mouth, edema of face and limbs is the fifth; irritability with frequent coughing, severe abdominal pain, unlimited diarrhea, urine resembling strangury is the sixth; massive discharge of pus and blood, worsening swelling, foul-smelling pus that cannot be approached is the seventh; panting, shortness of breath, mental confusion and drowsiness is the eighth; pre-ulceration blackening and sinking, blue face, black lips, dirty stool is the ninth. Additionally, belching and chest fullness, panting and coughing, cold body with spontaneous sweating, staring eyes and deafness, mental confusion and palpitations, disordered speech are all malignant signs. Conversely: calm breathing and appetite is the first Smooth sign; regular bowel movements and urination is the second; bright spirit and clear voice is the third; pus discharged, swelling reduced, fresh color without odor is the fourth; balanced constitution and Qi is the fifth. Seeing three of the five Smooth signs indicates auspiciousness; seeing six of the nine Rebellious signs indicates danger. The teachings of the sages are clearly recorded; students must examine them carefully.
Pulse Diagnosis
The *Mai Jing* (Pulse Classic) states: A rapid pulse without fever indicates internal abscess. Another version says: No abdominal mass, no fever, but a rapid pulse indicates pus in the intestines, treated with Yiyi Fuzi Baijiang Tang (Coix Seed and Aconite Decoction with Betel Leaf).
Various floating and rapid pulses usually indicate fever; if instead there is chills and aversion to wind, with painful areas, an abscess will develop. A faint and slow pulse with fever, or a weak and rapid pulse with chills, indicates an impending abscess.
A floating and rapid pulse without fever, silent demeanor, slight restlessness in the chest, and unknown pain location indicates an impending abscess.
A slippery and rapid pulse: rapid indicates heat, slippery indicates excess. Slippery governs Ying Qi, rapid governs Wei Qi. When Ying and Wei meet, they knot to form an abscess; where heat passes, it becomes pus.
A woman of the Yulin Guard was ill; the physician diagnosed pus in her intestines via pulse diagnosis. Purging cured her. Because the Cun Kou (Radial Artery) pulse was slippery and rapid: slippery indicates excess, rapid indicates heat, slippery indicates Ying, rapid indicates Wei. Wei Qi's rapid nature descends, Ying Qi's slipperiness ascends; Ying and Wei interfere with each other, blood becomes turbid and spoiled, lower abdomen is distended and hard, urination may be obstructed, sometimes sweating occurs, sometimes chills follow, indicating pus has formed. If the pulse is slow and tight, stasis forms; purging cures it.
Intestinal Abscess presents with rough, scaly skin, tense abdominal wall, soft upon pressure like swelling.
In Intestinal Abscess, the lower abdomen swells, painful upon pressure, frequent urination resembling strangury, intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not formed; purging is indicated, expecting blood discharge. If the pulse is surging and rapid, pus has formed; purging is contraindicated. Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) is used.
Methods
Zhu Danxi said: Carbuncles and ulcers arise from the stagnation of Yin and Yang. Qi is Yang, Blood is Yin. Blood flows within vessels, Qi flows outside vessels, circulating together. Cold and damp combats cause stagnation and slow movement (insufficiency); Heat and Fire combats cause boiling and fast movement (excess). Qi constrained by pathogens becomes stagnant, fluids become thick and sticky, forming phlegm and fluid retention, which penetrate into vessels over time, making blood turbid; this is Yin stagnating in Yang. Blood constrained by pathogens blocks the channels, overflowing or knotting, seeping out of vessels over time, disrupting Qi; this is Yang stagnating in Yin. All diseases stem from this, not just carbuncles and ulcers.
Carbuncles and ulcers result from accumulated toxins in the Zang-Fu. One must first strengthen Stomach Qi and root Qi to solidify the foundation, assisting with herbs that move meridians and invigorate blood, considering meridians and seasons to allow toxins to emit outward. Early treatment allows internal resolution; this is the meaning of Internal Support (Nei Tuo).
Regarding the method of Internal Support: Liu Hejian treated swellings on the exterior with shallow roots and superficial manifestations, often with floating pulses, affecting skin and flesh. If Qi is not strong, it will invade internally; urgent Internal Support is needed. Fu Jian San (Abdominal Decoction Powder) dispels dampness and dissipates stagnation, harmonizing Stomach Qi. If unresolved, take half a dose again. For constipation and irritability, take small doses of Huang Lian Tang (Coptis Decoction). For mild diarrhea and resolved irritability, return to Fu Jian San. This ensures Ying and Wei circulate, preventing pathogenic invasion.
*Waike Jingyao* (Essentials of Surgery) states that Pai Nong Nei Bu Shi Xuan San (Draining Pus and Tonifying Ten Acupoints Decoction) rapidly disperses unformed lesions and rapidly ulcerates formed ones. This is true. Used for minor boils in winter, it can turn heavy to light and deep to shallow. However, used for ulcers in summer, the warming dispersion of Guizhi (Cinnamon Twig) and Houpo (Magnolia Bark), assisted by Fangfeng (Saposhnikovia) and Baizhi (Angelica Dahurica), I fear that even with Renshen (Ginseng) and Huangqi (Astragalus), reliance is difficult. I see people using this formula regardless of severity, season, or meridian, like a blind man riding a blind horse near a deep pool at midnight—dangerous!
Among the meridians, only Shaoyang and Jueyin are prone to carbuncles and ulcers and require prevention because they have much Qi and little Blood. Little Blood makes muscle growth difficult; prolonged non-healing leads to death. Ignoring this and hastily using purgative drugs to attack Yin-Blood brings immediate disaster.
For swelling with internal and external obstruction, prioritize supporting interior and releasing exterior. If using Dahuang (Rhubarb), avoid reckless use.
For ulcers with internal and external deficiency, prioritize tonifying and connecting. If using aromatic dispersants, avoid exacerbating deficiency (*Xu Xu*).
*Waike Jingyao* merely records old formulas for minor conditions.
At the onset of carbuncles and ulcers, moxibustion with Ai (Mugwort) can lighten the condition; Qizhuma Moxibustion is excellent. Moxa fire penetrates deeply, drawing out stagnant toxins, following the principle of treating contrary symptoms. Only the head, gathering all Yang, requires small and few moxa cones. On the body, moxa until pain stops, or stop pain until it hurts. Some die from moxibustion due to extreme deficiency and impending Yin extinction; pulse is floating, rapid, large, and empty; spirit is short and confused, unable to withstand fire heat, hence dangerous.
According to Liu Hejian’s moxibustion and acupuncture method: Divide sores by meridian, Qi/Blood quantity, and acupoint distance. Those from the back select from Taiyang five points: Zhiyin, Tonggu, Shugu, Kunlun, Weizhong. From temples, select from Shaoyang five points: Xiaolin, Jiaxi, Linqid, Yangfu, Yanglingquan. From moustache area, select from Yangming five points: Lidui, Neiting, Xangu, Chongyang, Jiexi. From brain, use Jiegu (Guanggu) point alone. (Acupoint locations are in *Tongren Jiuxue Jing*, not detailed here.)
Leech therapy applies to minor conditions to suck out evil blood. For toxins in Zang-Fu, depleting blood externally is useless.
External plasters also release the exterior. *Jingyao* claims cold plasters are miraculous. But Qi disperses with heat and contracts with cold; how is this miraculous? Classics say releasing exterior does not avoid heat. (Cold plasters are only for minor boils.)
After surgical incision and drainage of carbuncles, take Shenxian Zhuidu Wan (Divine Pill for Pursuing Toxins). This drug expels accumulated toxins but does not drain pus. If Qi and Blood are strong, pus drains naturally; use harmonizing and blood-invigorating herbs with Ginseng and Astragalus tonics.
Pressing swelling: heat indicates pus; no heat indicates no pus.
Pain after pus discharge indicates deficiency; tonify. Pain caused by foul odors requires harmonization. Pain from wind-cold requires warming and nourishing.
Deep ulcers without pain indicate severe Stomach Qi deficiency and inevitable necrosis with insensitivity.
Vomiting during swelling stage treats toxic vapors attacking upward. Post-ulceration vomiting treats Yin deficiency. Elderly post-ulceration vomiting and anorexia require strong tonification with Renshen and Baizhu Paste, adding adjuvant herbs per syndrome. Liu Hejian attributes ulcer vomiting to dampness invading Stomach; double Baizhu dosage.
Thirst in carbuncles/ulcers indicates dual Qi and Blood deficiency. Use Renshen and Huangqi to tonify Qi, Danggui and Dihuang to nourish Blood. Rendong Wan or Huangqi Liuyi Tang are effective.
Jiawei Shiquan Dabu Tang tonifies Qi and Blood, promotes appetite after ulceration, crucial for cases with massive pus/blood loss and dual Yin-Yang deficiency, capable of reviving the dying. However, it lacks meridian specificity and seasonal guidance; physicians must adapt it. Patients often mistake reduced swelling/pain for cure, neglecting recovery care, leading to relapse and critical complications.
Pugongying (Dandelion) resolves heat-toxin, eliminates malignant swelling, dissipates nodules with remarkable efficacy. Found in fields/roadsides, blooms yellow flowers in March-April like chrysanthemum, sweet taste. *Yanyi Buyi* notes ever-blooming, flying seeds, white sap when broken. Resolves food toxin, moves stagnant Qi, enters Yangming and Taiyin meridians. Decoct with Rendong Teng (Honeysuckle Vine), take with wine, or apply mashed externally.
Baila (Beeswax) belongs to Metal, possessing converging and solidifying properties, a key surgical herb. Generates flesh, stops bleeding, calms pain, sets bones, reconnects tendons, tonifies deficiency. Often combined with Hehuanpi (Albizia Bark) in flesh-generating pastes for miraculous effects. Oral use untested; Hehuanpi oral use is verified.
Bimazi (Castor Bean) has astringent properties, draws out pus and toxins, also essential.
For broken or unbroken carbuncles, Zaocis (Stinging Thorn) drills to the painful site.
Method for removing remaining bone: Take rotten bone from chronic ulcers/fistulas (commonly called remaining bone). Fill Wuguji Jinggu (Black Chicken Tibia) with Xin Pi (Realgar and Arsenic mixture), seal with salt mud, fire until red-hot, remove fire toxicity on ground, grind fine, make rice pills sized like millet grains. Insert via paper wick into the orifice, cover with detoxifying plaster. Bone will exit naturally.
(Above are twenty-three methods from Danxi.)
Methods for Malignant Sores, Back Carbuncles, Brain Carbuncles, etc.:
Shengyang Yiwang Tang (Li Dongyuan) treats all malignant sores, back carbuncles, brain carbuncles.
Qianghuo (1.5 qian), Duhuo (0.5 qian), Fangfeng (0.5 qian), Gaoben (1.5 qian), Zhimu (1 qian), Sheng Dihuang (1 qian), Huangqin (3 qian), Huanglian (0.5 qian), Huangbai (0.5 qian), Danggui (3 qian), Fangfeng Shao (0.5 qian), Lianqiao (2 qian), Renshen (0.5 qian), Huangqi (1.5 qian), Sheng Gancao (1 qian), Chenpi (0.5 qian), Danggui Shao (0.5 qian), Sumu (0.5 qian), Zhi Gancao (1.5 qian), Jiu Fangji (0.5 qian), Zexie (0.7 qian), Jiegeng (1 qian).
Finely cut, divide into two doses. Each dose soaked in two large bowls of water for half a day, decocted to one bowl. Add dozens of drops of wine, strain, take warm before bed. Avoid drinking water to prevent recurrent suppuration and delayed effect. For early stages (2-3 days), it clears immediately; for suppuration, it induces drainage immediately. Take according to disease location and meal timing. Case: Brain carbuncle, swollen/hard as fist on day 8. Took one dose evening, flattened next day, swelling subsided, pain ceased. Half dose more, fully recovered in seven days. Mingyan states: All sores are either Yang-within-Yin or Yin-within-Yang. My treatment uses 70% Yang herbs, 30% Yin herbs, named Shengyang Yiwang San; superior to Shixuan San, suitable for elderly, also called Fu Jian San. Adding Rushen (Frankincense) and Moyao (Myrrh) 1 qian each is excellent.
Danggui Qianghuo Tang treats brain carbuncles.
Huangqin (wine-fried), Huanglian (wine-fried, 2 qian each), Huangbai (wine-fried, 1 qian), Zexie (0.5 qian), Lianqiao (1 qian), Danggui Shen (2 qian), Fangfeng & Qianghuo (1 qian each), Zhi Gancao (1 qian), Shanzhizi (1 qian), Duhuo (0.7 qian), Gaoben (0.7 qian).
Finely cut, one dose. Two bowls water, soak one hour, add one spoon wine, decoct to 0.8 bowl. Strain, take warm after meals, twice daily. Finish six doses in three days, mixing clear juice with Binglang San below.
Binglang San (Li Dongyuan) greatly closes wound openings.
Binglang, Muxiang (3 qian each).
Grind to fine powder. Mix with previous decoction or close wounds. Painless. Apply wax oil to wound for rapid flesh generation and closure, preventing bad flesh, facilitating healing. Suitable for rich-food heat sores. Contraindicated for poor people in cold regions or cold-damp external sores.
Back Carbuncle Methods:
Tuoli San (Qianjin Fang) treats back carbuncles and malignant sores. If treated within three days with moxibustion/acupuncture and purgatives, it can resolve.
Qianghuo (1.5 qian), Fangfeng (wine-washed, 0.5 qian), Fangfeng Shao (0.5 qian), Gaoben (1.5 qian), Danggui Shen (3 qian), Danggui Shao (0.5 qian), Lianqiao (3 qian), Huangqin (wine-washed, 3 qian), Huangqi (raw, 1.5 qian), Renshen (1.5 qian), Zhi Gancao (1.5 qian), Sheng Gancao (0.5 qian), Chenpi (0.5 qian), Sumu, Wuweizi, Jiu Huangbai, Jiu Fangji (0.5 qian each), Jiegeng, Zhizi, Sheng Dihuang (wine-washed, 1 qian each), Jiu Dahuang (3 qian), Jiu Huanglian (1 qian), Mumuling (1.5 qian), Maidong (2 qian).
Finely cut, divide into two doses. Each dose soaked in three large bowls of water for half a day, decocted to one bowl. Take warm. Second dose same, including dregs, re-decoct. Avoid cold water. Take immediately upon feeling ill for best results. If developed 3-4 days or suppurated, it will not resolve. Case: Cui experienced two back carbuncles, both cured by this formula.
Danxi’s Back Carbuncle Formula: Dahuang, Fangfeng, Qianghuo, Gancao Jie, Sheng Dihuang, Danggui Shen, Beimu, Baizhi, Chi Shaoyao, Zaocis, Huangqin. Decoct in large dose. Add Renshen and Huangqi for Qi deficiency; continue after ulceration.
Osteomyelitis (Fugu Ju) Methods:
Danxi says: Osteomyelitis results from long-term rich diet, labor, or wading in water after drinking. This is Yang stagnating in Yin. Also: Persistent pain at Huantiao point warns of osteomyelitis. Use Cangzhu as sovereign, assist with Huangbai’s pungency, move with Qingpi. Winter add Guizhi, summer add Tiao Qin. Deficient bodies add Duzhong, Niuxi. Use Sheng Gancao as envoy. Decoct large dose with Jiangzhi (Ginger Juice), take before meals. For severe pain, if ten doses fail to mobilize, add small amount of Mahuang. If still ineffective after 1-2 doses, abscess may form. Dig a pit, heat with fire, pour urine, sit naked in pit, wrap lower body with mat/cotton clothes. Steam opens pores, unblocks Qi/Blood, curing the condition.
Qianghuo Fangji Tang (Li Dongyuan) treats early Osteomyelitis in Taiyang, Jueyin, Taiyin divisions.
Qianghuo, Chuanxiong, Cangzhu, Fangji, Muxiang, Lianqiao, Shegan, Gancao, Baishao, Mutong, Danggui Wei, Sumu (0.7 qian each).
Finely cut. One large bowl water, one large bowl wine, decoct to 0.7 bowl. Take before meals, follow with good food.
Tuoli Huangqi Tang (Li Dongyuan) treats early Osteomyelitis in Foot-Shaoyang, Yangming divisions.
Chaihu (1.2 qian), Lianqiao (0.8 qian), Rougui (0.8 qian), Niuzibang (0.8 qian), Huangqi (0.8 qian), Danggui Wei (1.5 qian), Huangbai (0.4 qian), Shengma (0.4 qian), Zhi Gancao (0.4 qian), Baizhi (1 qian).
Finely cut. One dose. One bowl wine, 1.5 bowls water, decoct to one bowl. Take fasting, follow with good food.
Neituo Huangqi Wine-Decoction (Li Dongyuan) treats sores on outer leg, or Osteomyelitis in Foot-Shaoyang due to cold-damp, slightly invading Foot-Yangming. Hard, diffuse swelling, painful walking or immobility.
Chaihu (6.5 qian), Lianqiao (0.8 qian), Rougui (0.8 qian), Dalizi (fried), Huangqi (4 qian each, note: text says 4 qian or 4 fen), Danggui Wei (8 qian), Huangbai (0.5 qian), Shengma (0.7 qian), Zhi Gancao (0.5 qian), Baizhi (2 qian).
Finely cut. One bowl water, one bowl wine, decoct to one bowl. Take warm before meals.
Huanglian Xiaodu Yin (Li Dongyuan) treats Osteomyelitis.
Huanglian (1 qian), Huangqin, Huangbai (0.5 qian each), Sheng Dihuang (0.4 qian), Zhimu (0.4 qian), Qianghuo (1 qian), Duhuo (0.4 qian), Fangfeng (4