痈疽已溃，脓出者也。
〔仲〕诸痈疽欲知有脓无脓，以手掩肿上，热者为有脓，不热为无脓。
〔《精》〕凡痈疽，按之牢 ，未有脓也。按之半软半 ，已有脓也，宜急破之。（ ，未
详何切。半软，谓中央脓熟处。半 谓四旁无脓肿肉也。）
凡疮肿，以手指从疮旁按至四畔上赤黑者，按之色不变，脓已结成。又按之随手赤色，此
亦有脓。按之白，良久方赤，游毒已息，可就赤白色尽处灸断，疮肉平实，久而方消。夫痈则
皮薄肿高，疽则皮浓肿坚，初发并宜灼艾，惟痈脓成则宜针，疽脓成则宜烙。切宜熟视详审，
候其溃熟脓透于外，其势盈盈欲出，只用替针丸自疮头咬开，不半日许，其脓自出，切不用针刀
也。（丹溪云∶《精要》论戒用针刀，业外科者，当拳拳服膺。）
替针丸治痈疽已溃未破，或破后脓出不快者。
白丁香（一字） 砂（一字以上） 没药（一字） 乳香（一字）
锻石饼药纳种糯米十四粒，其法用锻石五升，炉灰三升，以水五升，淋取清汁，入大锅
内熬浓汁，至三五升，用瓦器盛贮，临用时以小青盏盛取半盏浓汁，却用皮纸贴盏中浓汁面上安
定，然后取糯米十四粒，种在皮纸面上，一宿即是。
上为细末，糯米饭丸，如麦粒大。每用一粒。未破用津贴疮头薄处即破，脓滞不快，则用一粒
纳疮口内，使脓不滞，好肉易生。
〔无〕替针丸
雄雀粪（二十粒） 砂 陈仓米 没药（各一字）
上研匀，以米饭丸，如粟大。每用一粒贴疮口眼中，即溃脓出。
〔梅〕治诸痈不消，已成脓，惧针不得破，令速决。取雄雀粪涂头上，干即易之，雀粪中竖者
为雄。
〔《本》〕 治痈疽已有疮眼，未出脓，痛不可忍，用此药 即脓出。巴豆一个，去皮膜，不
去心油，盐豉十四个，口中含去皮令软，同研烂，真麝少许，如难丸，入少稀糊，捏作饼子，如
鼠粪大。大小临时看疮口 之，只以纸捻子送入药，须臾必痛，忍之，良久脓遂出。
〔丹〕出一切疮口。出蛾茧壳，烧存性，无灰酒调下，每服一枚。服下一个时辰，便有疮口一
个。若服两枚，出疮口两枚。
〔《精》〕 痈成脓，宜针，其铁用马衔铁为之，形如韭叶，两面皆利，可以横直裂开五六分
许，取其毒血。如觉病轻，须先灸而后裂。
按痈如椒眼数十粒，或如蜂窠莲房，而脓出痛不除，宜用针者，以针横直裂之，则毒血挟脓
出而愈。如无椒眼之类，只消直入取脓，不必裂之也。又法当椒眼上，各各灸之亦佳，不必裂也。
铍针者，末如剑锋，以取大脓。（全文见针灸门。）
〔《素》〕 夫痈气之息者，宜以针开除去之。（病能篇 王注云∶息， 也，死肉也。今世
用刀割去死肉者是也。）治腐肿者刺腐上，视痈小大深浅刺。刺大者多血，小者深之，必端内针
为故正。（长刺节论“大者多血，小者深之”八字，衍文也。大小深浅刺七字，取脓之法，尽
矣备矣。）
〔《精》〕疽成脓宜烙。可用银篦大二分，长六寸，火上烧令赤，急手熨烙毒上，得脓为效。
〔涓〕凡痈觉在虚处，及眼不见处，皆是恶症。如发高肿紫赤，皮薄光泽，觉里有脓毒，
诸药贴 不破者，宜用熟铜针于油火上燎透，先用墨笔点定，却当头以针浅刺入。随针出脓者，顺
也。有不随针脓出，当用白纸作 ， 入针孔，引出脓毒，当时肿退，可及三分。如肿不退，是
一逆也。肿不退，疼不除，但脓出，二逆也。脓疼不退，患人不觉疮轻，三逆也。虽用针破出脓，
亦无所济，须急用引脓托里汤药，以助其势力可也。更有
痈生实处，不问深浅，如有脓即用针烙无害。稍迟缓，即恐伤筋骨内疼。凡近筋脉骨节处，不
得乱行针烙，反致他病也。患疽初生赤硬，或在处处毒瓦斯浅，或在实处毒瓦斯深，切须仔细辨认，
仍问患人疼痛觉浅觉深。其患处疮头不拘多少，其间须有一个最大者，即是大脓窍。当用熟铁大
针头如钗脚者，于麻油灯上烧令热透，以大头处按定，插入一寸或至二寸，脓当下，恐未有脓毒出，
却用白纸作 子， 入，直候次日取出，其脓即随 下矣。脓色黄白即好，若赤黑色，防复有鲜血
出，即患人寒战不禁。其有虚处，不得乱行针烙。凡患发背，觉似有脓成，便用大熟铁烙，当
正头上烙之。其烙并用麻油灯上烧令通红，烙入可二寸许。初入肉即须横插入，不得正入，恐烙
透膜也。如已有破处，皮烂溃熟，更不得用针烙。如是横长，赤引开阔，当须两头下火针，令脓毒随
针引出。肥人脓汁多，瘦人脓汁少。如肥人却少，瘦人却多，多是肉败坏成脓，少是肉不腐烂，变气
实也，犹宜审详，不可造次，便行针烙。亦看患者气脉匀和，荣卫气不节滞，血脉不致凝涩，即
行针烙无畏，切须仔细。患者气虚脉气大者，亦不可乱行针烙。针烙之法，不可容易，先看皮纹紧
慢浓薄，紫赤色大光泽者，即可用针烙，如皮肉未变，不可用针，针亦无济。大抵用针，只欲引脓，
如针刺无脓，是气伏也，不可用针烙。
〔丹〕或问烙法如何？曰∶脓或汪洋欲出，奈何皮浓肉深难穴者，既前无内托之药先致力于内，后
又不用烙以开窍脉，脓何由出？脓本肉腐所成，皆挟毒热之气。若久留肉腠间则毒瓦斯浸淫，好肉
亦化为脓腐，此所以烙法有功于溃疡也。彼根浅而皮薄者，何必假此以卖弄假法，恐吓而胁取利
也。
〔《灵》〕帝曰∶愿闻身形应九野，奈何？岐伯曰∶请言身形之应九野，左足应立春，其日戊寅
己丑；左胁应春分，其日乙卯；左手应立夏，其日戊辰己巳；膺喉首头应夏至，其日丙午；右手应
立秋，其日戊申己未；右胁应秋分，其日辛酉；右足应立冬，其日戊戌己亥；腰尻下窍应冬至，
其日壬子。六腑膈下五脏应中州，其大禁太乙所在之日及诸戊己。凡此九者，善候八正，所在之
处，所主左右上下，身体有痈肿者，欲治之，无以其所直之日溃治之，是谓天忌日也。
\r身形应九野图\ps91a7.bmp\r
〔涓〕十岁，二十二岁，三十三岁，七十三岁，以上四人，百神在上部，不可患痈疽发背，
见血者死。申子辰年，血忌，余年不妨。男女同。
二十五岁，三十一岁，六十八岁，七十四岁，以上四人，百神在额，不可患疮肿，见血者死。
十八岁，二十四岁，三十五岁，四十五岁，五十六岁，六十七岁，七十二岁，八十九岁，
以上八人，百神在两肩隅，不宜患痈疽疮肿，见血者死。
十二岁，二十七岁，三十六岁，五十九岁，六十六岁，九十七岁，以上六人，百神在中部，
不可患痈疽发背，见血者死。巳西丑年，血忌，余年不妨。男女同。
三十二岁，四十二岁，五十五岁，六十一岁，以上四人，百神在肩背，不可患痈疽，见血者死。
十九岁，二十六岁，四十九岁，五十六岁，五十七岁，六十二岁，八十岁，九十一岁，
以上八人，百神在肝肺俞，不宜患痈肿，见血者死。
十一岁，二十三岁，二十四岁，五十八岁，九十六岁，以上五人，百神在胁肋，不可患痈疽，
见血者死。
十四岁，二十九岁，三十九岁，四十六岁，五十二岁，六十岁，六十九岁，七十六岁，八十
一岁，八十八岁，九十五岁，以上十一人，百神在下部，不可患疮漏疾，见血者死。下部尤忌见
劳瘵人，不宜下部出脓，难瘥。
十一岁，十五岁，二十七岁，六十三岁，七十五岁，以上五人百神在尻尾间，不可患痈疽，
见血者死。
十三岁，二十八岁，五十二岁，七十二岁，九十三岁，以上五人，百神在足下，不可患痈疽，
见血者死。
二十一岁，三十八岁，四十一岁，五十岁，以上四人，百神在遍身，不可患疮肿，见血者不
治。
凡发背及痈疽，皆在背上，不问大小，有疼无疼，或热或不热，或冷或不冷，但从小至大，
肿起至一尺以上者，其赤肿 热者，即用紧急收赤肿药围定，不令引开，中心即用抽脓聚毒散贴
之，急令散毒外透，内服排脓缩毒内托汤药。候脓成，相次破穴，看疮大小深浅，内发其脓汁。
脓水大泄，急须托里内补。虽破穴脓汁不多，再须排脓拔毒，透后慎不令再肿，须疼止肿消，患
人自觉轻便，即是顺疾也。最宜节慎饮食。其热毒方盛，
或发大渴，多饮冷水及冷浆之类，此是毒瓦斯攻心，令口干烦渴，但以心气药内补脏腑即止矣。
（内补谓参、 之属，排脓谓皂角刺之属。）
〔丹〕《精要》云∶凡疽疾，勿食羊、鸡、牛、鹅、鱼、面、煎爆、炙炒、法酒等味，犯之必
发热，只有栀子黄芩汤，用之取效。夫栀、芩、苦参、犀角辅佐人参，固可解食毒之热，若寒
月与虚人，宁无加减乎？《内经》谓膏粱之变，足生大疔，此原痈疽之因也。禁戒浓味，盖以浓
味能引起宿火之热，此诚富贵豢养口腹者所宜谨守，若素贫者，大不然矣。予治章兄，背疽径尺，
家贫，待死而已。视疮穴黑深似有近内之意，急作参 归术膏。饮三日，略以艾芎汤洗，气息奄
奄，不可支持。幸其身不发热，而可进饮食，每日作馄饨大碗与之。尽药膏五斤，馄饨多肉者三
十碗，疮口渐合，以其因肉与馄饨助气之有益也。
〔罗〕凡治病必察其下予从军，戊午年冬于武城县，有贾仓使父，年逾六旬，冬至后数日，疽
发于背，五七日肿势约七寸许，不任其痛，疡医曰∶视之脓成可开矣。公惧不从。越三日，医曰∶
不开，恐变证生矣。遂以燔针开之，脓泄痛减，以开迟之故。迨二日，变证果生，觉重如负石，
热如 火，痛楚倍常，六脉沉数按之有力，此膏粱积热之变也。邪气酷热，故宜寒药治之，时月
严凝，复有用寒远寒之惑。乃思《内经》曰∶有假者反之，虽违其时，以从其证可也。与疡医议，
急作清凉饮子加黄连一两五钱与之，利下两行，痛减七分。翌日，复用前药，其证悉除，月余平
复。陈录判母，年七十余岁，忽冬至后脑出疽，形如瓯面大，命疡医诊视，俟疮熟以针出脓。因
怒笞侍外家，疮即内陷凹一韭叶许，面色青黄不泽，四肢逆冷，汗出身清，时复呕吐，脉极沉细而
迟。盖缘衰老之年，严寒之时，病中苦楚，饮食淡薄，已涤肥脓之气，独存憔悴之形，加之暴怒，
精神愈损，故有此寒变也。病与时同，与疡医议，遂制五香汤一剂，加丁香、附子各五钱，剂尽，
疮复大发，随证调治而愈。《内经》曰∶凡治病，必察其下，谓察时下之宜也。诸痛痒疡疮，
皆属心火，言其常也。如疮盛形羸，邪高痛下，始热终寒，此反常也，固当察时下之宜而权治。
故曰∶经者常也，法者用也，医者意也，随所宜而治之，可收十全之功矣。
至元壬午五月二十八日，王伯禄年五十有七，右臂膊肿盛，上至肩，下至手指，色变，皮
肤凉，六脉沉细而微，脉证俱寒。予举疡医孙彦和视之。曰∶此附骨痈，开发已迟。以燔针启之，
脓清稀解，次日肘下再开之，加呃逆不绝。彦和以丁香柿蒂散，两服稍缓。次日，呃逆尤甚，自
利，脐腹冷痛，腹满，饮食减少，时发昏愦。于左乳下黑尽处灸二七壮，又处托里温中汤，用干
姜、附子、木香、沉香、茴香、羌活等分， 咀，一两半，欲与服。或者曰∶诸痛痒疮疡，皆
属心火，又当盛暑之时，干姜、附子可乎？予应之曰∶理所当然，不得不然。《内经》曰∶脉
细皮寒，泻利前后，饮食不进，此谓五虚。况呃逆者，胃中虚寒极也。诸痛痒疮疡，皆属心火，
是言其定理也。此证内外相反，须当舍时从证，非大方辛热之剂急治之，则不能愈矣。遂投之，
诸症悉去，饮食倍进，疮势温，脓色正。彦和又与五香散数服，月余平复。噫！守常者，众人
之见。知变者，智者之事。知常而不知变，因而取败者亦多矣，况医乎哉！守常知变，岂可同日
而语。
托里温中汤治疮疡为寒变而内陷者，脓出清解，皮肤凉，心下痞满，肠鸣切痛，大便微溏，
食则呕逆，气短促，呃逆不绝，不得安卧，时发昏愦。
羌活 干姜（炮。各三钱） 黑附子（四钱，炮，去皮脐） 益智仁（一钱） 茴香 甘草（炙）
丁香 沉香（各一钱） 木香（一钱半） 陈皮（一钱）
按经曰∶寒淫于内，治以辛热，佐以苦温。附子、干姜，大辛热温中，外发阳气，自里之表，
以为君；羌活味苦辛温透关节；炙甘草甘温补脾胃，行经络，通血脉。胃寒则呕吐呃逆，不下食，
益智仁、沉香、丁香大辛热，以散寒邪为佐。疮气内攻，气聚而为满，木香、茴香、陈皮苦辛温，
治痞散满为使也。
上 咀，都作一服，水三盏，生姜五片，煎至一盏，去渣，温服无时。忌一切冷物。
〔丹〕一老人年七十，患背疽径尺余，已杂与五香、十宣数十帖，脓血腥秽，呕逆不食者旬余。病患自去
吃内托散，隔中不安，且素有淋病三十年，今所苦者淋之痛，与呕吐不得睡而已。急以参、 、归、术煮膏，
When carbuncles and sores have ulcerated, pus is discharged.
Zhang Zhongjing stated: To determine whether pus is present in various carbuncles and sores, press the swollen area with your hand. If it feels hot, pus is present; if not hot, pus is absent.
The *Jingyao* (Essentials) states: For all carbuncles and sores, if the area feels firm and hard upon pressure, pus has not yet formed. If it feels half-soft and half-hard, pus has formed, and it should be punctured immediately. ("Half-hard" refers to the peripheral tissue without abscessed muscle. "Half-soft" refers to the central area where pus has matured.)
For all swellings, press from the side of the sore towards the four edges. If the skin turns red or black and the color does not change upon pressing, the pus has consolidated. If the area turns red immediately upon pressing, this also indicates the presence of pus. If it remains white and only turns red after a long time, the wandering pathogenic toxin has subsided. Moxibustion can be applied at the boundary between the red and white areas to block the disease progression. The sore flesh will become flat and solid, and gradually resolve over time. Generally, carbuncles are characterized by thin skin and high swelling, while sores are characterized by thick skin and hard swelling. Both are suitable for moxibustion at the initial stage. However, once pus forms in carbuncles, needle puncture is appropriate; once pus forms in sores, cauterization is appropriate. Careful observation is essential. Wait until the ulceration matures and pus penetrates outward, appearing full and ready to burst. Use the *Tizhen Wan* (Needle-Replacing Pill) to bite open the head of the sore. Within half a day, pus will discharge naturally. Do not use needles or scalpels. (Zhu Danxi said: The *Jingyao* warns against using needles and scalpels. Those practicing surgery should sincerely adhere to this advice.)
*Tizhen Wan* treats carbuncles and sores that have ulcerated but not fully opened, or where pus discharge is slow after opening.
*Baidingxiang* (Stole Sparrow Dropping), *Shadan* (Cinnabar), *Moyao* (Myrrh), *Ruxiang* (Olibanum).
To prepare the *Duan Shi Bing Yao Na Zhong Nuomi* (Hammered Iron Scale Cake Medicine for Planting Glutinous Rice): Use five sheng of hammered iron scale powder and three sheng of furnace ash. Pour five sheng of water to leach out the clear juice. Boil the clear juice in a large pot until reduced to three or five sheng. Store in a ceramic vessel. When needed, take half a cup of the concentrated juice in a small green cup. Place a piece of leather paper on the surface of the juice to fix it. Then place fourteen grains of glutinous rice on the paper. Leave overnight.
Grind the above herbs into fine powder. Form pills with glutinous rice paste, sized like wheat grains. Use one pill per application. For unopened sores, apply to the thinnest part of the sore head to induce rupture. For stagnant or slow pus discharge, insert one pill into the sore mouth to facilitate drainage and promote healthy tissue growth.
Wu Ze's *Tizhen Wan*:
*Xiongquefen* (Male Sparrow Droppings), *Shadan*, *Chencangmi* (Aged Warehouse Rice), *Moyao*. Grind evenly. Form pills with rice paste, sized like millet seeds. Apply one pill to the center of the sore mouth to induce pus discharge.
Mei's Formula: Treats various carbuncles that do not dissipate and have formed pus, where the patient fears needle puncture. It promotes rapid rupture. Apply male sparrow droppings (identified by vertical orientation) to the sore head. Replace when dry.
The *Bencao* (Materia Medica) formula: Treats carbuncles and sores with an open sore eye but no pus discharge, causing unbearable pain. This medicine induces immediate pus discharge. One *Badou* (Croton Seed), peeled but retaining the heart oil. Fourteen *Yanchi* (Salted Soybeans), softened by chewing. Grind together with a small amount of *Zhen Shexiang* (Real Musk). If difficult to form pills, add a little thin paste. Shape into cakes the size of mouse droppings. Insert into the sore using a paper twist according to the sore's size. Pain will occur shortly; endure it. Pus will discharge after a while.
Danxi's Formula: Induces discharge from all sore openings. Burn *Ejianqiao* (Silkworm Cocoon Shell) to retain its properties. Take with unfermented wine, one shell per dose. After one hour, one sore opening will discharge. Two shells yield two openings.
The *Jingyao* states: Carbuncles with formed pus should be treated with needles. The iron tool should be made from horse bit iron, shaped like a leek leaf, sharp on both sides, capable of splitting horizontally or vertically by about five to six fen to drain toxic blood. If the condition is mild, moxibustion should precede splitting.
Note: If a carbuncle resembles dozens of pepper eyes or a honeycomb/lotus pod, and pus discharges without relieving pain, needle splitting is appropriate. Splitting allows toxic blood and pus to exit, leading to recovery. If there are no pepper-eye-like lesions, simply insert the needle straight to drain pus without splitting. Alternatively, applying moxibustion to each pepper eye is also effective without splitting.
*Pizhen* (Saber Needle): The tip is sword-shaped, used to drain large amounts of pus. (See the Acupuncture section for the full text.)
The *Suwen* states: For stagnation of Qi in carbuncles, it is appropriate to use needles to open and remove the stagnation. (Wang Bing's commentary on the *Bingneng Pian* states: "Xi" refers to rotting flesh or dead tissue, which is now removed by scalpel.) To treat rotting swellings, puncture the rotting area. Observe the size and depth of the carbuncle to determine needle insertion. For larger ones, allow more blood to flow; for smaller ones, insert deeper. Ensure the needle is inserted straight and correctly. (The phrase "larger ones bleed more, smaller ones go deeper" in the *Changci Jie Lun* is considered a textual error. The seven characters "size, depth, and oblique insertion" fully describe the method of draining pus.)
The *Jingyao* states: Sores with formed pus are suitable for cauterization. Use a silver comb two fen wide and six cun long. Heat it red-hot in fire and quickly press it onto the toxic area. Discharge of pus indicates efficacy.
Juan states: Carbuncles occurring in deficient areas or hidden places are malignant. If they present as high, purple-red swelling with thin, glossy skin, and internal pus/toxin is suspected but not broken by topical medicines, use a heated copper needle. Mark the spot with ink, then lightly puncture. If pus follows the needle, it is a favorable sign. If pus does not follow, insert a paper twist into the needle hole to draw out the toxin. Swelling should reduce by up to three fen. If swelling persists, it is the first adverse reaction. If swelling persists and pain remains despite pus discharge, it is the second adverse reaction. If pain persists and the patient feels no relief, it is the third adverse reaction. Even if pus is drained, it may be ineffective. Urgently administer *Yinnuo Tuoli* (Pus-Draining and Interior-Supporting) decoctions to boost vitality.
Carbuncles in solid areas, regardless of depth, can be safely punctured and cauterized if pus is present. Delay may damage muscles and bones, causing internal pain. Avoid random puncture/cauterization near tendons, vessels, and joints to prevent other diseases.
Initial sores are red and hard. Toxic qi may be shallow in some areas and deep in solid areas. Carefully distinguish and ask the patient about pain depth. Among multiple sore heads, identify the largest one as the main pus aperture. Use a large熟 iron needle (shaped like a hairpin tip), heat it thoroughly in sesame oil lamp, press the broad end, and insert one to two cun. Pus should discharge. If not, insert a paper twist and leave until the next day. Yellow-white pus is good; red-black pus suggests fresh bleeding and chills. Avoid random puncture/cauterization in deficient areas.
For back carbuncles (*Fabei*), if pus seems formed, use a large熟 iron cauterizer on the center. Heat red-hot in sesame oil lamp. Insert about two cun. Initially insert horizontally to avoid piercing membranes. If already ruptured and rotten, do not puncture/cauterize. If horizontal and spreading, apply fire needles at both ends to draw out toxin. Fat people produce more pus; thin people less. If fat people produce little or thin people produce much, it indicates tissue decay vs. qi excess. Examine carefully before puncturing/cauterizing. Ensure the patient's pulse is harmonious and Ying-Wei Qi flows freely. If Qi is deficient and pulse is large, avoid random puncture/cauterization. Puncture/cauterization requires caution. Check skin texture and color. Purple-red and glossy skin indicates suitability. Unchanged skin/tissue is unsuitable. The purpose of puncture is to drain pus. If no pus drains, Qi is stagnant; do not puncture.
Danxi asked: How is cauterization performed? Answer: If pus is abundant but the skin is thick and muscles deep, making acupuncture difficult, and internal support medicines have been used but the pathway is not opened by cauterization, how can pus exit? Pus is formed from rotting flesh and carries toxic heat. If retained in the interstices, it infiltrates and rots healthy flesh. Thus, cauterization benefits ulcerations. For shallow-rooted, thin-skinned cases, this method is unnecessary and potentially exploitative.
The *Lingshu* records: The Emperor asked: I wish to hear how the body corresponds to the Nine Regions. Qibo answered: The left foot corresponds to Lichun (Start of Spring), days Wuyin/Jichou. The left hypochondrium corresponds to Chunfen (Spring Equinox), day Yimao. The left hand corresponds to Lixia (Start of Summer), days Wuchen/Jisi. The chest, throat, head, and neck correspond to Xiazhi (Summer Solstice), day Bingwu. The right hand corresponds to Liqiu (Start of Autumn), days Wushen/Jiwei. The right hypochondrium corresponds to Qiufen (Autumn Equinox), day Xinyou. The right foot corresponds to Lidong (Start of Winter), days Wuxu/Jihai. The lower waist, buttocks, and orifices correspond to Dongzhi (Winter Solstice), day Renzi. The Six Fu organs below the diaphragm and the Five Zang organs correspond to the Central Region. The major taboos are the days when Taiyi resides and all Wuji days. For these nine regions, observe the Eight Regularities. If treating a carbuncle/swelling in the corresponding body region, do not perform incision/draining on the specific day associated with that region. This is called a Heavenly Taboo Day.
Juan states: Ages 10, 22, 33, 73: Hundred Spirits are in the upper region. Do not suffer from carbuncles/sores/back carbuncles. Hemorrhage leads to death. Years of Shen/Zi/Chen are Blood Taboo years; other years are safe. Applies to both sexes.
Ages 25, 31, 68, 74: Hundred Spirits are on the forehead. Do not suffer from swellings. Hemorrhage leads to death.
Ages 18, 24, 35, 45, 56, 67, 72, 89: Hundred Spirits are at the shoulder corners. Do not suffer from carbuncles/sores. Hemorrhage leads to death.
Ages 12, 27, 36, 59, 66, 97: Hundred Spirits are in the middle region. Do not suffer from carbuncles/back carbuncles. Hemorrhage leads to death. Years of Si/You/Chou are Blood Taboo years; other years are safe. Applies to both sexes.
Ages 32, 42, 55, 61: Hundred Spirits are on the shoulders and back. Do not suffer from carbuncles. Hemorrhage leads to death.
Ages 19, 26, 49, 56, 57, 62, 80, 91: Hundred Spirits are at the Liver and Lung Shu points. Do not suffer from swellings. Hemorrhage leads to death.
Ages 11, 23, 24, 58, 96: Hundred Spirits are in the costal region. Do not suffer from carbuncles. Hemorrhage leads to death.
Ages 14, 29, 39, 46, 52, 60, 69, 76, 81, 88, 95: Hundred Spirits are in the lower region. Do not suffer from fistula/sore diseases. Hemorrhage leads to death. The lower region particularly avoids contact with tuberculosis patients. Pus discharge in the lower region is difficult to heal.
Ages 11, 15, 27, 63, 75: Hundred Spirits are between the sacrum and tailbone. Do not suffer from carbuncles. Hemorrhage leads to death.
Ages 13, 28, 52, 72, 93: Hundred Spirits are under the feet. Do not suffer from carbuncles. Hemorrhage leads to death.
Ages 21, 38, 41, 50: Hundred Spirits are throughout the body. Do not suffer from swellings. Hemorrhage is untreatable.
For back carbuncles and sores on the back, regardless of size, pain, temperature, or coldness, if swelling expands from small to large, reaching over one chi, and is red, swollen, and hot, immediately apply astringent/topical medicines to contain the redness and swelling, preventing spread. Apply *Chounong Judu San* (Pus-Draining and Toxin-Gathering Powder) to the center to rapidly dissipate toxins outward. Internally administer *Painong Suodu Neituo Tang* (Pus-Draining, Toxin-Contraction, and Interior-Supporting Decoction). Once pus forms, sequentially open the sites. Based on sore size and depth, encourage internal pus discharge. Upon massive pus discharge, urgently support the interior. Even if pus discharge is scant after opening, continue draining and extracting toxins. Prevent re-swelling. Recovery is indicated by cessation of pain, reduction of swelling, and patient feeling light. Dietary restraint is crucial.
If heat-toxin is strong, causing extreme thirst, drinking cold water/gruel indicates toxin attacking the Heart, causing dry mouth and irritability. Treat with Heart-Qi tonifying medicines to internally nourish the Zang organs. (Internal nourishment refers to Ginseng/Astragalus; pus-draining refers to Gleditsia Spine.)
Danxi commented: The *Jingyao* states: For sores, avoid mutton, chicken, beef, goose, fish, flour, fried foods, roasted foods, and medicinal wines. Violating these causes fever. Only *Zhizi Huangqin Tang* (Gardenia and Scutellaria Decoction) is effective. Gardenia, Scutellaria, Sophora, Rhinoceros Horn, assisted by Ginseng, can resolve food-toxin heat. However, in cold months or for deficient persons, modifications are necessary. The *Neijing* states that rich food changes cause large boils, identifying the origin of carbuncles/sores. Avoiding rich flavors prevents reigniting latent fire. This applies to the wealthy who indulge their appetites. It does not apply to the poor.
I treated Brother Zhang with a one-chi back carbuncle. He was poor and resigned to death. The sore was black and deep, suggesting internal invasion. I urgently prepared a paste of Ginseng, Astragalus, Angelica, and Atractylodes. After three days, washed with Mugwort and Ligusticum decoction, he was weak and barely surviving. Fortunately, he had no fever and could eat. I gave him large bowls of wonton soup daily. After consuming five jin of paste and thirty bowls of meat-heavy wontons, the sore closed. The meat and wontons aided Qi.
Luo Qianfu stated: Treating diseases requires observing the timing. In winter of the Wuwu year, in Wucheng County, the father of Official Jia suffered from a back carbuncle several days after Winter Solstice. At five to seven days, swelling was about seven cun. Pain was unbearable. The surgeon said pus was ready to open. The patient refused due to fear. Three days later, the doctor warned of complications. Fire needles were used. Pus drained, pain decreased, but due to delay. On the second day, complications arose: heaviness like carrying a stone, heat like fire, severe pain. Pulse was deep, rapid, and forceful. This was a transformation from rich-food accumulated heat. Pathogenic heat required cold medicines. Despite the freezing season and the principle of avoiding cold in cold weather, recalling the *Neijing*: "In cases of false presentation, reverse the treatment." Although contrary to season, follow the syndrome. With the surgeon, I prescribed *Qingliang Yinzi* (Cooling Drink) plus one liang five qian of Scutellaria. Two bowel movements occurred, pain reduced by 70%. Next day, repeated dose, symptoms resolved. Recovered in a month.
Mother of Registrar Chen, over seventy, developed a brain carbuncle after Winter Solstice, size of a bowl bottom. Surgeon waited for maturation. Angered by punishment of servants, the sore sank inward (one leek-width depression). Complexion was sallow/dull. Limbs were cold. Sweating with clear fluid. Vomiting. Pulse was extremely deep, fine, and slow. Due to old age, severe cold, illness suffering, bland diet, depletion of rich-food Qi, emaciation, and sudden anger damaging Spirit, this cold transformation occurred. Disease matched the season. With the surgeon, I formulated *Wuxiang Tang* (Five Fragrances Decoction) plus five qian each of Clove and Aconite. After one dose, the sore flared again. Treated according to syndrome, she recovered. The *Neijing* says: "Observe the appropriateness of the time." All pain, itching, sores, and ulcers belong to Heart Fire, stating the norm. But if sore is severe while body is emaciated, pathogen is high while pain is low, starting hot ending cold, this is abnormal. One must observe seasonal appropriateness and adjust treatment. Thus: Classics state norms; Methods state applications; Physicians use judgment. Treating according to appropriateness achieves perfect results.
On May 28, Renwu year of Zhiyuan, Wang Bolu, aged 57, had severe right arm swelling extending to shoulder and fingers. Skin color changed, temperature cooled. Pulse was deep, fine, and faint. Pulse and syndrome indicated Cold. I recommended Surgeon Sun Yanhe. He diagnosed *Fugu Yong* (Bone-Adherent Carbuncle), delayed treatment. Fire needles opened it. Pus was clear and thin. Next day, opened below elbow. Hiccups ensued. Yanhe gave *Dingxi Disan* (Clove and Persimmon Calyx Powder). Slightly relieved after two doses. Next day, hiccups worsened. Diarrhea, cold pain in navel/abdomen, fullness, reduced appetite, occasional confusion. I moxa-ed seven times at the dark spot below the left breast. Prescribed *Tuoli Wenzhong Tang* (Interior-Supporting and Middle-Warming Decoction): Dried Ginger, Aconite, Aucklandia, Agarwood, Fennel, Notopterygium equal parts. Crushed, 1.5 liang. Someone objected: "All sores belong to Heart Fire, and it is midsummer. Can Dried Ginger and Aconite be used?" I replied: "Reason dictates it is necessary. The *Neijing* states: Fine pulse, cold skin, diarrhea/vomiting, inability to eat—this is 'Five Deficiencies'. Hiccups indicate extreme Stomach Cold. 'All sores belong to Heart Fire' is the general principle. This case shows internal/external contradiction. Abandon season, follow syndrome. Only large-dose acrid-warm medicines can cure it." Administered. Symptoms vanished. Appetite doubled. Sore became warm, pus color normal. Yanhe gave *Wuxiang San* (Five Fragrances Powder). Recovered in a month. Alas! Adhering to convention is the view of the masses. Knowing variation is the task of the wise. Many fail by knowing convention but not variation, especially physicians. Convention and variation cannot be compared.
*Tuoli Wenzhong Tang* treats carbuncles/sore sinking internally due to cold transformation. Symptoms: Clear/thin pus, cool skin, epigastric fullness, loud borborygmi/cutting pain, slight loose stools, vomiting after eating, shortness of breath, incessant hiccups, inability to lie down, occasional confusion.
Notopterygium Root, Dried Ginger (processed, 3 qian each), Black Aconite Root (processed, peeled, 4 qian), Alpinia Oxyphylla Fruit (1 qian), Fennel, Roasted Licorice Root, Clove, Agarwood (1 qian each), Aucklandia Root (1.5 qian), Tangerina Peel (1 qian).
According to the classics: For Cold invading internally, treat with Acrid-Warm, assist with Bitter-Warm. Aconite and Dried Ginger are Great Acrid-Warm, warming the middle, emitting Yang Qi from interior to exterior, serving as Sovereign herbs. Notopterygium is Bitter-Acrid-Warm, penetrating joints. Roasted Licorice is Sweet-Warm, tonifying Spleen/Stomach, moving meridians/blood vessels. Stomach Cold causes vomiting/hiccups/anorexia; Alpinia, Agarwood, and Clove are Great Acrid-Warm, dispersing Cold as Minister herbs. Sore Qi attacking internally causes Qi accumulation/fullness; Aucklandia, Fennel, and Tangerina Peel are Bitter-Acrid-Warm, treating fullness as Envoy herbs.
Crush all. One dose. Add three cups of water and five slices of Fresh Ginger. Decoct to one cup. Strain. Warm drink at any time. Avoid all cold substances.
Danxi stated: An elderly man, aged 70, suffered from a one-chi back carbuncle. He had taken dozens of doses of *Wuxiang* and *Shixuan* formulas. Pus was bloody/foul. Vomiting and anorexia persisted for ten days. He self-medicated with *Neituo San*, causing epigastric discomfort. He had a 30-year history of strangury. Current suffering was strangury pain and vomiting preventing sleep. I urgently boiled a paste of Ginseng, Astragalus, Angelica, and Atractylodes.