以牛膝汤入竹沥饮之，三日后尽药一斤半，淋止思食，七日后尽药四斤，脓自涌出而得睡，又兼旬而安。
一男子年六十余，性好酒肉，背疽见脓，呕逆发热，盖其得内托、十宣多矣。医以呕逆，于
嘉禾散中加丁
香以温胃行气，时七月大热，脉洪数有力，予因谓∶此脉症在溃疡尤为忌。然形气实，只与人参
膏和竹沥饮之，尽药十五斤，竹百余竿而安。予曰∶此病幸安也，不薄味，必再作。仍浓味自若，
夏月醉后，坐水池中，又年余左胁旁生一软块如饼。二年后，软块为疽。本人见脓血淋漓而脉
洪数有力，又呕逆食少，遂自以人参膏入竹沥饮之，又百余竿而安。令八十岁，强健如旧。此病
两以老年血气弱，专服人参、竹沥而愈，若与内托十宣散，恐未能若是之安全也。
脓溃之后，肿退肌宽，痛必渐减，而反痛者，此为虚也，宜补之。亦有秽气所触者，宜和解
之。亦有风寒逼者，宜温散之。补者，归、 之类。和解者，乳香、芍药之类。温散者，防风、
桂枝之类。
权小娘，疟后右腿股生疖，破后筋吊疼，脉虚而涩。询之，小便时疼处亦相应，宜与生血
导热。
川芎 归头 条芩 生地 赤芍 牛膝 黄柏 甘草（炙，二分） 青皮（炒） 槟榔（五分）
通草（三分） 桂皮（一钱）
上煎，食前热饮之。
五香汤即五香连翘汤，去射干、大黄、升麻、连翘，加参、犀角。若用于肿疡犹可，借其
飞走以攻散其毒，使不延蔓，若用于溃疡，虽多有参、 、廿草之缓补，而走泄太多，宁不犯
仲景已有得汗复汗、得下复下，重虚之戒，可不省乎。
《精要》云∶血气闻香则行，闻臭则逆。又言饮食调令香美，益其脾土，养其真气。夫甘
而淡者，可养脾土，若香美者，但能起火，经以热伤脾、热伤气为戒。今曰益脾养气，若施之于
肿疡者，似有畅达之益，溃疡后用香美，恐有发湿热损真阴之患矣。
《精要》云∶热盛脉数，与漏芦汤、单煮大黄等汤。不甚热，脉缓弱，只投五香连翘汤。
夫热盛脉数，若肿疡时脏腑秘而体实者，犹可与大黄。若溃疡后，脓血出多者，热盛脉数，去死
为近，其可下乎。缓弱之脉，古人皆以为邪毒已散，五香之飞走升散，其可用乎！
《精要》云∶初成脓，宜用烙，得脓利为效。亦服神仙追毒丸，此又不能无疑者也。夫追毒
丸下积取毒之药，
决无取脓之效。今用烙而得脓，若在里之气血壮实，则脓自出如推矣。何不以和气活血之药，
佐参 补剂，使脓自托出乎。
《精要》云∶疮作渴甚，急与神仙追毒丸。取下恶毒，与清膻汤、万金散、五香连翘汤、六味
车螯散、千金漏芦汤皆可选用。下利以后，渴尚未止，宜用生津补气药，则津液生，气血完，
渴自止矣。夫大渴而与利药，非明示脉证，何以知其当下？后又言下利后，渴又不止，却用补药，又
不明言脉证，恐是但有大渴，必与峻下，下后尚渴，方与补药。夫医者治未病，如此用药可乎？
况渴属上焦，当肿疡时，犹或可用。若溃疡时，渴恐因血气之虚，何以待下利后，方议其虚哉？
《精要》论疽疾咽喉口舌生疮，归罪于不得内托，以致热毒冲心，与琥珀犀角膏。夫于肿疡
时用之犹或近理。若于溃疡后用之，彼犀角、脑子之升散，宁不助病邪致虚，以速其死也耶？
后有犀角散，以大黄佐黄 ，用黄 则知其虚，用大黄又似疑其有实热。夫疮溃体虚，纵有旧热，
将自渐因脓血而消，何必以峻冷利动脏腑？若在秋冬，何异用刀剑耶？
《精要》论痈疽发寒热多汗，或先寒后热，或先热后寒，或连日作，或间日作，必先呕痰，
然后寒热。寒热解，大汗出，不可专以为有热。亦有气虚而得者，亦有因怒而得者，又有先感寒
邪，脾气不正，而有此证者。夫气虚者，当以补气药补之；因怒者，当以顺气药和之；脾气不正
者，当以调脾药养之。今用不换金正气散，悉是温散泻卫之药，而欲以一两人参，收拾十四两
之泻卫可乎？若用于肿疡时感寒邪者，犹或庶几。彼气虚者、因怒者、脾气不正者，此方能兼
治乎？又未知用于肿疡耶，溃疡耶？
〔涓〕穴有孔，慎风，仍慎再合。如再合者，为风湿邪气攻搏，而再生脓，宜如前以通和汤药，
根据次第用，不可急性，恐伤气害人之命也。
〔无〕疮疡未合，风入为破伤风，湿入为破伤湿，二者害人最急，食卒不知其因，甚难认治。
痈疽瘰 溃后，尤宜谨之。
〔《精》〕加味十全汤治痈疽愈后，补气血，进饮食。
黄 （蒸） 地黄（蒸） 当归 川芎 人参 茯苓 芍药（炒） 白术 陈皮（各一两）
粉草（炙） 桂心 五味（各五钱） 乌药（七钱）
上 咀，每服一两，用水一碗，生姜五片，枣二枚，同煎，分作二服，留渣晒干为末，服之。
丹溪云∶加味十全汤，须看年之老壮，资之强弱，证之缓急，时之寒热，加减用之。
〔丹〕加味十全汤治痈疽后，补气血，进饮食，实为切要。盖脓血出多，阴阳两虚，非此药
何以回生起死。惜其不分经络，不载时令，又在识者触类而长之。今之外科，于疮疡肿平痛宽，
遂以为安，漫不加省，往往于结痂后两三日或半年，虚证乃见。医者不察，病者不悟，无补接调
养之功，因而转成他病者，惜哉。予治一士夫，因脚弱求诊，两手俱浮洪稍鼓，饮食如常，惟言
问不答，肌上起白屑如麸片。时在冬月，予作极虚处治。询其弟，乃知半年前，曾于背臂腿三处，
自夏至秋冬节次生疽，率用五香连翘汤、十宣散与之，今结痂久矣。予属作参 白术当归膏，以
二陈汤化饮之，三日后尽药一斤，白屑没者大半，病者自喜呼吸有力，补药应效以渐，而病家反
怨药不速应，自作风病论治，炼青礞石二钱半，以青州白丸作料，煎饮子顿服之。予谏止不听，
因致不救，书以为警云。
运气痈自溃者，惟土不及岁有之。经曰∶土不及曰卑监，卑监之纪，其动疡涌分溃痈肿，
盖土不及则肉腐为痈肿，故木化启折乘之，而脓涌分溃其痈肿也。
〔东垣〕痈疽用药加减法如发背疔肿，脓溃前后，虚而头痛者，于托里药内加五味子。恍惚不
宁，加人参、茯神。虚而发热者，加地黄、栝蒌根。潮热者，加柴胡、地骨皮。渴不止者，加
知母、赤小豆。虚烦者，加枸杞、天门冬。自利者，加浓朴。脓多者，加当归、川芎。痛甚者，
加芍药、乳香。肌肉迟生者，加白蔹、官桂。有风邪者，加独活、防风。心惊悸者，加丹砂。
口目 动者，加羌活、细辛。呕逆者，加丁香、藿叶。痰多者，加半夏、陈皮。
〔《精》〕麦饭石膏在脓溃后围疮口。
麦饭石（火 ，醋淬十次，研数日） 鹿角（ 烟尽） 白蔹
上用麦饭石末二两，白蔹末二两，鹿角灰四两，要研极细，如不细反痛。用好米醋，入银
石器内煎，令鱼眼沸，却入三味药末，用竹篦子不住手搅，熬一二时稀稠得所，倾出候冷，以纸盖。
每用时，先以猪蹄汤洗去脓血，挹干，以鹅翎拂药，涂四围，凡赤处尽涂之，但留一小口，如
钱大，以出脓血。凡用疮药上，久则药干，勿令绷急，须常用醋拂湿其药。初便一日洗换药，十
日后两日一换。（肉冷恶寒者不宜用。）
猪蹄汤治一切肿破，消毒瓦斯，去恶肉。凡疮有口，便用此汤濯洗。
白芷 生甘草 羌活 露蜂房 黄芩 赤芍药 川归（等分）
上为粗末，看疽大小用药。如疽大， 猪蹄两只，只用白水三升煮软，将汁分为两次，澄去
面上油并下面渣，却将药末投其中，再煎十数沸，去渣，以故帛蘸药汤温洗薄揩，恶血恶肉随洗
而下。洗讫，仍避风，忌人口气吹之，又忌狐臭人、月经人。
痈疽有死肉不去者，用白丁香、霜梅，深则 之，浅则干掺于膏药上，甚妙。
〔海〕又方 膏药内入雄黄巴豆少许，不伤好肉，止去恶肉。不惟恶疮，凡痈毒有恶肉者俱可
去。
又方雄黄散以雄黄一钱另研，巴豆不去皮，研如泥，入乳香、没药少许，再研细。少上，恶
肉自去。
〔《保》〕 治恶疮有死肉者及追脓。
白丁香 轻粉 粉霜 雄黄 麝香（各一钱） 巴豆霜（三个）
上细末，新饭和作锭子，用之。
〔丹〕治疮疽攻肿， 肉突出。乌头五枚，苦酒三升，渍三日，洗之，日夜三四次。（《古今录验》）
诸痈疽有肉凸出数寸者，更于凸出疮门求之。
〔《精》〕神异膏治诸般恶毒疮疖，发背痈疽，其妙如神。
露蜂房（要用蜂儿多者为妙，细剪净一两） 全蛇蜕（以盐水洗净，焙干，半两）
玄参（半两，去芦） 绵黄 （三两） 黄丹（五两，研细后入） 真麻
油（一斤） 杏仁（去皮尖，切小片，一两） 男子乱发（洗净，烙干，如鸡子大）
上件药，先将麻油入银铫中，同乱发于风炉上慢慢文武火熬，候发焦熔尽，以杏仁投入。
候杏仁色变黑，好绵滤去渣。再将所熬清油入银铫内，然后入黄 、玄参二味，慢火熬一二时，
取出铫子，安一冷风炉上。候半时久，火力稍息，旋入露蜂房、蛇蜕二味，将柳枝急搅，移铫
于火上不住手搅，慢火熬至黄紫色，用绵滤过后，复入清油在铫内，乘冷投黄丹，急搅片时，又移
铫于火上，文武火慢慢熬，不住手用柳枝搅千余转，候药油变黑色，滴于水中凝结成珠子，则
是膏成就矣。若珠子稀，再熬少时，必候得所。然后用瓷器内封收待用，或恐偶然熬火太过，稍
硬难用，却入少蜡熬添麻油在内，瓷器盛封，盖于甑上蒸，乘热搅匀，收而用之。膏药熬成了，
须用所盛瓷器，置净水盆中出火毒一昼夜，歇三日方可用。熬此膏药极难，于火候须耐烦，
看火紧慢，火猛即药中火发，千万谨戒。（膏药方甚多，效无出于此。）
〔垣〕热疮寒膏药
当归身（水洗，焙干，一两） 杏仁（汤浸，去皮尖，一百个） 黄丹（研细，六两）
肥嫩柳枝（三两半，切如寸许，水洗干） 肥嫩桃枝（一两，切作如寸，洗净干） 麻油（一斤）
上件，先熬麻油热，下桃、柳枝熬令半焦，以绵裹当归、杏仁同煎，至柳枝黑焦为度，去
药渣，滤油澄净，抹去铫中渣滓令净，再上令沸，旋旋入黄丹，熬成滴水中不散为度。
寒疮热膏药
与寒膏药同，只将当归身改作当归梢，桃、柳枝分两倒过便是。
刘氏贴发背痈疽，脓尽四面皮粘，恐有脓毒攻起，宜用逼毒散方。
黄药子 白药子（各一两） 赤小豆（二两） 雄黄（一钱）
上为末，水调敷。
治发背痈疽，脓尽生肉平满，宜用紧疮口生肌青散子。
槿花叶（盛时收，阴干，取四两为末） 青赤小豆 白芨（各二两）
为末，临时用槿花末三钱匕，白芨、小豆末各一钱匕，相和新汲水调摊纸上贴四畔，中心
疮口不用贴。
〔垣〕敛疮口方木香槟榔散用之决无疼痛，以蜡油涂覆疮上，生肌敛肉，甚速，必无恶血，
疮口疾合，易取平复，惟膏粱热疮所宜用也。贫人害地之寒湿外来寒疮者，禁不可用。
木香 槟榔 黄连（各等分）
上为极细末，根据前调用，湿则干贴。
治寒疮敛疮口药。
当归身（一钱，洗净，晒干） 青皮（二分，去白） 木香（一分） 黄连（五分）
上四味，为极细末，蜡油调涂，取效甚速。
〔《保》〕疮口大者，乳香散。
寒水石（ ） 滑石（各一两） 乳香 没药（各半两） 脑子（少许）
上各研细和匀，少许掺疮口上。
〔《撮》〕桃红散敛疮口，定痛，辟风邪。
滑石（四两） 乳香 轻粉（各二钱） 小豆粉（一两） 寒水石（三两， ）
上为细末，干掺口上。一方改小豆粉为定粉。
〔《精》〕有人患背疽已溃，如碗面大，视五脏仅膈膜耳，自谓必死。用大鲫鱼一枚，去肠脏，
以羯羊粪入其中，烘焙焦黑极燥，为细末，干掺之，疮口遂收，至今无恙。此方累用有效，须
候脓少，欲生肌肉时用之。
〔《保》〕又方治疮口久不收。
小椒（去目，炒黑，一钱） 定粉 风化硝（二钱） 白矾（二钱半） 乳香 没药（各一钱）
上为末掺之。
〔《精》〕生肌散
寒水石（锉） 滑石 乌鱼骨 龙骨（各一两） 定粉 密陀僧 白矾灰 干胭脂（各半两）
上为细末，干掺用之。
平肌散治诸疮久不敛。
密陀僧（ ） 花蕊石（ ） 白龙骨（各一两） 乳香（另研） 轻粉（各一钱）
上为细末，和匀干掺。
〔丹〕《精要》论痈疽久而疮口不合，其肉白而脓血少，此为疮口冷滞，乃病气血枯竭，不潮于
疮，遂致如此。用北艾叶一把，入瓦器内浓煎汤，避风处乘热用艾汤浇洗疮口四围净肉，以绢帛
兜艾叶乘热浇沃，一日一次。洗了，须避风，仍烧松香以烟熏疮口，良久，用神异膏贴之，不可
与厌秽之人见。若不能禁忌，疮口难安，药亦无效。夫以血气枯燥，不知补接于内，惟务热洗
于外，不揣其本，而齐其末，而乃归罪于冷滞。大抵溃疡宜洗，若非行补接之药，以实其内，
Using Niuxi Tang (Caulis Achyranthis Bidentatae Decoction) combined with Zhuli (Bamboo Sap), the patient drank it. After three days, the cumulative dosage reached one jin and half a liang; the strangury stopped, and appetite returned. After seven days, the cumulative dosage reached four jin; pus naturally discharged, followed by restful sleep. Another twenty days later, the condition resolved.
A man in his sixties, fond of alcohol and meat, developed a carbuncle on his back with visible pus, accompanied by vomiting, regurgitation, and fever. This was likely due to excessive prior use of Neituo San (Internal Support Powder) and Shixuan San (Ten Acupoints Powder). The physician, noting the vomiting and regurgitation, added Dingxiang (Flos Caryophylli) to Jiahe San (Harmonizing Grain Powder) to warm the stomach and move qi. It was then July, the height of summer heat, and the pulse was surging, rapid, and forceful. I remarked: "This pulse and symptom pattern is particularly contraindicated in the ulcerative stage." However, since the patient's constitution was robust, I prescribed Renshen Gao (Ginseng Paste) mixed with Zhuli (Bamboo Sap). The cumulative dosage reached fifteen jin, consuming over a hundred bamboo stalks, before the condition stabilized. I said: "This case recovered by luck. Without a bland diet, relapse is certain." Yet he continued rich foods and, after drinking heavily in summer and sitting in a pool, a soft, cake-like mass appeared on his left hypochondrium over the next year. Two years later, this mass became a carbuncle. Seeing profuse pus and blood, with a surging, rapid, forceful pulse, and again suffering from vomiting, regurgitation, and poor intake, he self-administered Renshen Gao (Ginseng Paste) with Zhuli (Bamboo Sap), consuming another hundred bamboo stalks before stabilizing. Now eighty years old, he remains vigorous as before. This illness healed twice because, in old age with weak qi and blood, he specifically took Ginseng and Bamboo Sap. If Neituo San (Internal Support Powder) or Shixuan San (Ten Acupoints Powder) had been used, such a safe cure would likely not have occurred.
After pus discharge, swelling subsides and muscles relax; pain should gradually decrease. If pain persists or worsens, it indicates deficiency, requiring tonification. Cases touched by foul pathogens require harmonization. Cases forced by wind-cold require warming and dispersing. Tonifying herbs include Danggui (Radix Angelicae Sinensis) and Dihuang (Radix Rehmanniae Preparata). Harmonizing herbs include Ruxiang (Resina Draconis) and Shaoyao (Radix Paeoniae Rubra/Alba). Warming and dispersing herbs include Fangfeng (Radix Saposhnikoviae) and Guizhi (Ramulus Cinnamomi).
Xiao Niang Quan, after malaria, developed a boil on her right thigh. After rupture, tendons contracted causing pain; the pulse was deficient and choppy. Inquiry revealed pain corresponded during urination. Treatment should generate blood and guide heat downward.
Chuanxiong (Rhizoma Chuanxiong), Guitou (Radix Angelicae Sinensis Head), Tiaoqin (Radix Scutellariae), Shengdi (Radix Rehmanniae), Chishao (Radix Paeoniae Rubra), Niuxi (Radix Achyranthis Bidentatae), Huangbai (Cortex Phellodendri), Gancao (Radix Glycyrrhizae Preparated, 2 fen), Qingpi (Pericarpium Citri Reticulatae Stir-fried), Binglang (Semen Arecae, 5 fen), Tongcao (Medulla Tetrapanacis, 3 fen), Guipi (Cortex Cinnamomi, 1 qian).
Decoct and drink hot before meals.
Wuxiang Tang is essentially Wuxiang Lianqiao Tang (Five Fragrances Forsythia Decoction), removing Shegan (Rhizoma Belamcandae), Dahuang (Radix et Rhizoma Rhei), Shengma (Rhizoma Cimicifugae), and Lianqiao (Fructus Forsythiae), adding Renshen (Radix Ginseng) and Xijiao (Cornu Rhinocerotis). For tumors (swollen ulcers), this is acceptable, utilizing its penetrating nature to attack and disperse toxicity, preventing spread. For ulcers (open sores), although it contains gentle tonics like Renshen (Radix Ginseng) and Gancao (Radix Glycyrrhizae), the draining action is too excessive. Does this not violate Zhang Zhongjing’s warning against sweating after sweating or purging after purging, leading to double deficiency? One must reflect on this.
The *Jingyao* states: Qi and blood move when smelling fragrance but reverse when smelling foul odors. It also says that food made fragrant and delicious benefits Spleen Earth and nourishes True Qi. Sweet and bland substances nourish Spleen Earth, but fragrant/delicious substances only generate fire. The Classics warn against heat injuring Spleen and Qi. Applying this to tumors might offer some benefit through unblocking, but using fragrant/delicious substances for ulcers risks generating damp-heat and damaging True Yin.
The *Jingyao* states: For excess heat with a rapid pulse, use Loulu Tang (Euphorbia Decoction) or boiled Dahuang (Radix et Rhizoma Rhei) decoctions. For mild heat with a slow/weak pulse, use only Wuxiang Lianqiao Tang (Five Fragrances Forsythia Decoction).
For excess heat and rapid pulse, if during the tumor stage organs are constipated and the body is strong, Dahuang (Radix et Rhizoma Rhei) may be used. But after ulceration, with significant loss of pus and blood, excess heat and rapid pulse indicate proximity to death; how can purgatives be used? A slow/weak pulse traditionally indicates dispersed pathogenic toxins; how can the penetrating and ascending Wuxiang formula be used?
The *Jingyao* states: When pus first forms, cauterization is appropriate; effective when pus drains freely. Also, Shenxian Zhuidu Wan (Immortal Poison-Chasing Pill) can be taken. This is questionable. Zhuidu Wan (Poison-Chasing Pill) contains purgatives to remove accumulation and toxins, having no effect on promoting pus discharge. If cauterization yields pus, and internal Qi/Blood are strong, pus will naturally expel like being pushed out. Why not use herbs to harmonize Qi and Blood, assisted by Renshen (Radix Ginseng) and Baizhu (Rhizoma Atractylodis Macrocephalae) tonics, to naturally support pus expulsion?
The *Jingyao* states: For severe thirst from sores, urgently give Shenxian Zhuidu Wan (Immortal Poison-Chasing Pill) to purge evil toxins. Qingtan Tang (Clear Diaphragm Decoction), Wanjing San (Myriad Gold Powder), Wuxiang Lianqiao Tang (Five Fragrances Forsythia Decoction), Liuwei Che’ao San (Six-Shell Clam Powder), and Qianjin Loulu Tang (Thousand Years Euphorbia Decoction) are options. If thirst persists after purgation, use fluids-generating and Qi-tonifying herbs; then fluids generate, Qi/Blood complete, and thirst stops. Giving purgatives for severe thirst without clear pulse/symptom indication is unjustified. Later stating that post-purgation persistent thirst requires tonification, without specifying pulse/symptoms, suggests simply giving harsh purgatives for any severe thirst, and tonics only if thirst persists. Is this appropriate for preventive treatment? Thirst belongs to the Upper Jiao; perhaps usable in tumor stages, but in ulcer stages, thirst likely stems from Qi/Blood deficiency. Why wait until after purgation to address deficiency?
The *Jingyao* attributes throat/mouth/tongue ulcers from carbuncles to failure to use internal support, allowing heat-toxin to rush to the Heart, prescribing Hupo Xijiao Gao (Amber Rhinoceros Horn Paste). Acceptable for tumors, perhaps rational. But for ulcers, the ascending/dispersing nature of Xijiao (Cornu Rhinocerotis) and Naozi (Borneolum Syntheticum) might aid pathogenic factors, cause deficiency, and accelerate death.
Later, Xijiao San (Rhinoceros Horn Powder) uses Dahuang (Radix et Rhizoma Rhei) with Huangqin (Radix Scutellariae). Using Huangqin implies deficiency; using Dahuang implies suspicion of excess heat. With ulcerated sores and body weakness, even existing heat should gradually dissipate with pus/blood loss. Why use harsh cold purgatives to disturb the Zang-Fu? In autumn/winter, this is akin to using swords.
The *Jingyao* discusses chills/fever/sweating in carbuncles: alternating chills/fever, continuous or intermittent, preceded by vomiting phlegm. After resolution, heavy sweating occurs. Do not assume this is solely heat. It can stem from Qi deficiency, anger, or initial cold invasion causing Spleen dysfunction. Qi deficiency requires tonification; anger requires Qi-regulating harmony; Spleen dysfunction requires Spleen-nourishing regulation. Huabujin Zhengqi San (Unchanging Metal Upright Qi Powder) consists entirely of warming/dispersing and Wei-Qi-draining herbs. Can one or two qian of Renshen (Radix Ginseng) counteract fourteen liang of Wei-Qi-draining herbs? Perhaps suitable for tumors with cold invasion, but can it treat Qi deficiency, anger-induced cases, or Spleen dysfunction? And is it for tumors or ulcers?
[Juan] If an acupoint has a hole, beware of wind and prevent re-closure. Re-closure causes wind-damp pathogens to clash, regenerating pus. Use Tonghe Tang (Harmonizing Decoction) as before, sequentially. Do not act hastily, fearing Qi injury and death.
[Wu] Unclosed sores allow Wind entry (leading to Traumatic Tetanus) or Damp entry (Traumatic Dampness). These are most urgent, sudden, hard to diagnose/treat. Especially cautious after carbuncles, scrofula, or ulcers.
[Jing] Jiawei Shiquan Tang (Modified Perfect Ten Decoction) treats post-carbuncle recovery, tonifying Qi/Blood and promoting appetite.
Huangqi (Radix Astragali Steamed), Dihuang (Radix Rehmanniae Steamed), Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Renshen (Radix Ginseng), Fuling (Poria), Shaoyao (Radix Paeoniae Stir-fried), Baizhu (Rhizoma Atractylodis Macrocephalae), Chenpi (Pericarpium Citri Reticulatae) (each 1 liang), Gancao (Radix Glycyrrhizae Preparated), Guixin (Cortex Cinnamomi), Wuweizi (Fructus Schisandrae) (each 5 qian), Wuyao (Radix Linderae, 7 qian).
Cinchona, each dose 1 liang, with 1 bowl water, 5 slices ginger, 2 dates. Decoct, divide into two doses. Reserve dregs, dry, powder, and take.
Danxi said: Jiawei Shiquan Tang (Modified Perfect Ten Decoction) must be adjusted based on age, constitution strength, urgency, and seasonal temperature.
[Dan] Jiawei Shiquan Tang (Modified Perfect Ten Decoction) for post-carbuncle Qi/Blood tonification and appetite promotion is crucial. Profuse pus/blood causes Yin/Yang dual deficiency; few remedies restore life like this. Regrettably, it lacks meridian differentiation and seasonal notes, relying on the practitioner's adaptability. Modern surgeons consider healing once swelling/pain subside, neglecting follow-up. Deficiencies often appear days or months after scabbing. Doctors fail to observe, patients unaware, lacking tonification/adaptation, leading to other diseases. Pitiful. I treated a scholar with weak legs. Pulses were floating, surging, slightly distended; diet normal; mute; skin covered in bran-like white scales. Winter season; treated as extreme deficiency. His brother revealed he had carbuncles on back/arm/leg from summer to winter, treated with Wuxiang Lianqiao Tang (Five Fragrances Forsythia Decoction) and Shixuan San (Ten Acupoints Powder). Scabs formed long ago. I prescribed Renshen (Radix Ginseng), Baizhu (Rhizoma Atractylodis Macrocephalae), Danggui (Radix Angelicae Sinensis) paste, resolving phlegm with Erchen Tang (Two-Aged Decoction). After 3 days (1 jin total), scales largely disappeared; patient felt stronger breathing; gradual efficacy. Family complained of slow response, diagnosed stroke, administered Qingmengshi (Calcareous Schist) and Qingzhou Baiwan (Qingzhou White Pill) decoction. I advised against it; ignored; patient died. Recorded as a warning.
In Luck-based theory, spontaneous ulceration occurs only in years of insufficient Earth. Classics say: Insufficient Earth is called Beijian. In Beijian cycles, movements manifest as ulcers, swelling, splitting, and carbuncles. Insufficient Earth leads to flesh rotting into carbuncles; Wood exploits this, causing pus discharge and splitting.
[Dongyuan] Carbuncle/Pustule Medication Adjustments: For Back Carbuncle/Furuncle, pre/post-pus discharge:
Deficiency + headache: Add Wuweizi (Fructus Schisandrae) to Tuoli (Support Interior) herbs.
Restlessness/confusion: Add Renshen (Radix Ginseng), Fushen (Poria with Hostwood).
Deficiency + fever: Add Dihuang (Radix Rehmanniae), Gualougen (Radix Trichosanthis).
Tidal fever: Add Chaihu (Radix Bupleuri), Digupi (Cortex Lycii).
Persistent thirst: Add Zhimu (Rhizoma Anemarrhenae), Chixiaodou (Semen Phaseoli Angularis).
Deficient vexation: Add Gouqi (Fructus Lycii), Tiandong (Radix Asparagi).
Spontaneous diarrhea: Add Houpo (Cortex Magnoliae Officinalis).
Profuse pus: Add Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong).
Severe pain: Add Shaoyao (Radix Paeoniae), Ruxiang (Resina Draconis).
Slow muscle growth: Add Bailian (Radix Ampelopsis), Guigui (Cortex Cinnamomi Cassiae).
Wind pathogen: Add Duhuo (Radix Angelicae Pubescentis), Fangfeng (Radix Saposhnikoviae).
Palpitations/fear: Add Dansha (Cinnabar).
Mouth/eye twitching: Add Qianghuo (Rhizoma Notopterygii), Xixin (Herba Asari).
Vomiting/regurgitation: Add Dingxiang (Flos Caryophylli), Huoye (Herba Viticis Negundo).
Profuse phlegm: Add Banxia (Rhizoma Pinelliae), Chenpi (Pericarpium Citri Reticulatae).
[Jing] Maifanshi Gao (Maifan Stone Plaster) applied around ulcerated sores.
Maifanshi (Maifan Stone Calcined, quenched in vinegar 10 times, ground for days), Lujiao (Deer Antler Burnt to Ash), Bailian (Radix Ampelopsis).
Mix 2 liang Maifanshi powder, 2 liang Bailian powder, 4 liang Deer Antler ash. Grind extremely fine; coarse texture causes pain. Use good rice vinegar, boil in silver/copper vessel until "fish-eye" bubbles form. Add powders, stir constantly with bamboo spatula for 1-2 hours until proper consistency. Pour out, cool, cover with paper. Before use, wash sore with Zhuti Tang (Pig Trotter Decoction) to remove pus/blood, dry. Apply medicine with goose feather to surrounding red areas, leaving a coin-sized opening for drainage. Keep medicine moist with vinegar spray; do not let it tighten. Change dressing daily initially, every two days after day 10. (Contraindicated for cold flesh/chills.)
Zhuti Tang (Pig Trotter Decoction) treats all ruptured swellings, disinfects, removes necrotic tissue. Wash any open sore with this.
Baizhi (Radix Angelicae Dahuricae), Sheng Gancao (Raw Radix Glycyrrhizae), Qianghuo (Rhizoma Notopterygii), Lubifengfang (Nidus Vespae), Huangqin (Radix Scutellariae), Chishao (Radix Paeoniae Rubra), Chuan Gui (Radix Angelicae Sinensis) (equal parts).
Coarse powder. Dosage depends on carbuncle size. For large carbuncles, boil 2 pig trotters in 3 sheng water until soft. Strain liquid, remove oil and dregs. Add herb powder, boil 10+ times. Strain. Soak cloth in warm decoction, gently wipe. Necrotic blood/tissue washes away. Avoid wind, human breath, fox odor, and menstruating women after washing.
For necrotic tissue in carbuncles: use Baixiangding (Excrement of White Cat) and Shuangmei (Frost Plum). Deep lesions: mash; shallow: sprinkle dry onto plaster. Very effective.
[Hai] Alternative: Add small amounts of Xionghuang (Realgar) and Badou (Semen Crotonis) to plasters. Removes necrotic tissue without harming healthy flesh. Effective for all toxic sores with necrosis.
Another Formula: Xionghuang San (Realgar Powder). Grind 1 qian Xionghuang (Realgar) separately. Grind Badou (Semen Crotonis, unpeeled) into paste. Add small amounts of Ruxiang (Resina Draconis) and Moyao (Resina Myrrhae), grind fine. Apply sparingly; necrotic tissue falls off.
[Bao] Treats necrotic tissue in malignant sores and promotes pus.
Baixiangding (Excrement of White Cat), Qingfen (Calomel), Fen Shuang (Sublimated Arsenic Trioxide), Xionghuang (Realgar), Shexiang (Moschus) (each 1 qian), Badou Shuang (Paste of Semen Crotonis) (3 grains).
Grind fine, mix with new rice to form pills. Use.
[Dan] Treats carbuncle swelling with protruding necrotic tissue. Wutou (Radix Aconiti Lateralis Preparata) 5 pieces, Kujiu (Vinegar) 3 sheng. Soak 3 days. Wash 3-4 times daily. (*Gu Jin Lu Yan*).
For carbuncles with tissue protruding inches, seek treatment at the protruding site.
[Jing] Shenyi Gao (Divine Extraordinary Plaster) treats various malignant sores/carbuncles/back carbuncles. Miraculous.
Lubifengfang (Nidus Vespae, 1 liang, finely cut, preferably with many larvae), Quanshetui (Whole Snake Molt, 0.5 liang, washed in salt water, dried), Xuanshen (Radix Scrophulariae, 0.5 liang, remove root), Mian Huangqi (Radix Astragali, 3 liang), Huangdan (Lithargyrum, 5 liang, finely ground, added later), Zhen Mazhong (True Sesame Oil, 1 jin), Xingren (Semen Pruni Armeniacae, peeled/cored, sliced, 1 liang), Nanzi Luankua (Human Hair, washed, dried, egg-sized).
Heat Mazhong (Sesame Oil) in silver crucible with hair over wind stove. Slowly simmer (civil/war fire) until hair melts/burns. Add Xingren (Semen Pruni Armeniacae). When black, filter through cotton. Return clear oil to crucible. Add Huangqi (Radix Astragali) and Xuanshen (Radix Scrophulariae). Simmer slowly for 1-2 hours. Remove from heat, place on cool stove. Wait 30 mins for heat to subside. Add Lubifengfang (Nidus Vespae) and Shetui (Snake Molt). Stir rapidly with willow branch. Return to fire, stir constantly. Simmer slowly until yellow-purple. Filter. Return clear oil to crucible. While cold, add Huangdan (Lithargyrum). Stir rapidly. Return to fire. Simmer slowly with civil/war fire, stirring 1000+ turns with willow branch. When oil turns black, drip into water; if it forms beads, plaster is ready. If beads are soft, simmer more. Seal in porcelain. If too hard, add wax and sesame oil, steam over steamer, stir hot, seal. After preparation, place container in clean water for 24 hours to remove "fire toxin". Wait 3 days before use. Difficult process; patience with fire control essential. Too hot damages medicine. Many formulas exist, but none match this efficacy.
[Yuan] Hot Sore Cold Plaster.
Danggui Shen (Radix Angelicae Sinensis Root Body, washed/dried, 1 liang), Xingren (Semen Pruni Armeniacae, soaked/blanched/peeled, 100), Huangdan (Lithargyrum, ground, 6 liang), Fei Nen Liuzhi (Young Willow Branch, 3.5 liang, cut inch-long, washed/dried), Fei Nen Taozhi (Young Peach Branch, 1 liang, cut inch-long, washed/dried), Mazhong (Sesame Oil, 1 jin).
Heat Mazhong (Sesame Oil). Add Peach/Willow branches until half-charred. Wrap Danggui (Radix Angelicae Sinensis) and Xingren (Semen Pruni Armeniacae) in cotton, simmer until branches black/charred. Strain, clarify oil. Clean crucible. Boil oil. Gradually add Huangdan (Lithargyrum). Simmer until drops don't disperse in water.
Cold Sore Hot Plaster.
Same as above, but use Danggui Shao (Radix Angelicae Sinensis Root Tip) instead of Shen, and swap weights of Peach/Willow branches.
Liu’s Plaster for Back Carbuncle: When pus is gone and skin adheres, fearing residual toxin, use Bi Du San (Toxin-Pushing Powder).
Huang Yaozi (Tuber Dioscoreae Hypoglaucae), Bai Yaozi (Tuber Dioscorea Bulbifera) (each 1 liang), Chixiaodou (Semen Phaseoli Angularis, 2 liang), Xionghuang (Realgar, 1 qian).
Powder, mix with water, apply.
For Back Carbuncle after pus/muscle regeneration: Use Jin Chuangkou Shengji Qing Sanzi (Tightening Orifice Muscle-Green Powder).
Jinhua Ye (Hibiscus Leaf, harvested/dried, 4 liang powder), Qingchi Xiaodou (Green/Red Adzuki Beans), Baiji (Rhizoma Bletillae) (each 2 liang).
Powder. Mix 3 qian Hibiscus powder, 1 qian Baiji (Rhizoma Bletillae) & Bean powder with fresh water. Spread on paper, apply around wound, leaving center open.
[Yuan] Mu Xiang Bing Lang San (Costus Betel Nut Powder) for closing sores causes no pain. Cover with beeswax oil. Promotes rapid muscle growth/healing without bad blood. Quick closure, easy recovery. Suitable only for rich-diet heat sores. Contraindicated for poor people with cold-damp external cold sores.
Muxiang (Radix Aucklandoniae), Binglang (Semen Arecae), Huanglian (Rhizoma Coptidis) (equal parts).
Fine powder. Apply dry if wet.
Cold Sore Closing Medicine.
Danggui Shen (Radix Angelicae Sinensis Root Body, 1 qian, washed/dried), Qingpi (Pericarpium Citri Reticulatae, 2 fen, remove white pith), Muxiang (Radix Aucklandoniae, 1 fen), Huanglian (Rhizoma Coptidis, 5 fen).
Four herbs, fine powder. Mix with beeswax oil. Rapid effect.
[Bao] For large sores: Ruxiang San (Dragon’s Blood Powder).
Hanshui Shi (Aragonite Calcined), Huashi (Talcum) (each 1 liang), Ruxiang (Resina Draconis), Moyao (Resina Myrrhae) (each 0.5 liang), Naobo (Borneolum Syntheticum, small amount).
Grind fine, mix. Sprinkle sparingly on sore.
[Cuo] Taohong San (Peach Red Powder) closes sores, stops pain, repels wind.
Huashi (Talcum, 4 liang), Ruxiang (Resina Draconis), Qingfen (Calomel) (each 2 qian), Xiaodou Fen (Bean Powder, 1 liang), Hanshui Shi (Aragonite Calcined, 3 liang).
Fine powder. Dry sprinkle on opening. Alternative: Replace Bean Powder with Dingfen (Lead Carbonate).
[Jing] Case: Back carbuncle ulcerated, bowl-sized, exposing diaphragm near viscera. Patient deemed doomed. Used large carp, gutted, stuffed with ram dung, baked charred/dry, powdered. Dry sprinkle on sore. Wound closed; patient healthy since. Effective repeatedly. Use when pus is scant, ready for muscle growth.
[Bao] Alternative for chronic non-healing sores.
Xiao Jiao (Zanthoxylum Fruit, de-stemmed/black fried, 1 qian), Dingfen (Lead Carbonate), Fenghua Xiao (Effloresced Sodium Sulfate, 2 qian), Bai Fan (Alumen, 2.5 qian), Ruxiang (Resina Draconis), Moyao (Resina Myrrhae) (each 1 qian).
Powder, sprinkle.
[Jing] Shengji San (Muscle-Growing Powder).
Hanshui Shi (Aragonite Chopped), Huashi (Talcum), Wuyu Gu (Cuttlebone Bone), Longgu (Fossilized Mammal Bones) (each 1 liang), Dingfen (Lead Carbonate), Mituoseng (Litharge), Bai Fan Hui (Ash of Alumen), Ganyanzhi (Dry Carmine) (each 0.5 liang).
Fine powder. Dry sprinkle.
Pingji San (Level Muscle Powder) for chronic non-healing sores.
Mituoseng (Litharge Calcined), Huarui Shi (Flower Corundum Calcined), Bai Longgu (White Fossilized Mammal Bones) (each 1 liang), Ruxiang (Resina Draconis, ground separately), Qingfen (Calomel) (each 1 qian).
Fine powder, mix, dry sprinkle.
[Dan] *Jingyao* discusses chronic non-healing sores with white flesh/scant pus: "Cold stagnation" due to exhausted Qi/Blood failing to nourish the sore. Use Northern Mugwort leaves, decoct strongly in clay pot. Wash surrounding healthy skin with hot mugwort water in wind-free area. Wrap mugwort in silk, pour hot water over wound once daily. Avoid wind after washing. Smoke wound with Pine Resin smoke. Apply Shenyi Gao (Divine Extraordinary Plaster). Avoid foul-smelling people. If precautions failed, wound won’t heal, medicine ineffective. Dry Qi/Blood requires internal tonification, not just external hot washing. Addressing symptoms without treating root, blaming "cold stagnation," is flawed. Generally, ulcers benefit from washing, but without internal tonification/adaptation...