内消 消者、减也。于初起红肿结聚之际。施行气、活血、解毒消肿之剂。必分之以虚实。如脉症俱实者。
汗利之。脉症俱虚者。滋补之。次分部位。佐以引经消毒之药。使气血各得其常。则可内消也。再如热渴
便闭。邪在里也。则疏导之。寒热 痛。邪在表也。则发散之。无表里症。邪在经也。则和解之。
内托 托者、起也。已成之时。不能突起。亦难溃脓。或坚肿不赤。或不痛大痛。或得脓根散。
或脓少脓清。或疮口不合者。皆气血虚也。主以大补。佐以活血祛毒之品。或加以芳香。行其郁滞。或加以温热。御其
风寒。如托里消毒散。随时加减之。候脓出肿消腐净。用参、 、归、术、大补之。甚加附子。使气血滋茂。则新
肉易生。是为内托也。又云。治痈以寒。是为内消。治疽以热。是为内托。内消内托。乃正治从治之义也。
肿溃诸症。须辨虚实。随行补泻。若或稍差。关系甚大。假如肿起坚硬脓稠者。疮疽之实也。肿下软慢脓
稀者。疮疽之虚也。泻利肠鸣。食少呕吐。手足并冷。脉弱皮寒。小便自利。或小便时难。大便滑利。声音
不出。精神不爽者。悉脏腑之虚也。大便硬。小便涩。饮食如故。肠满胀闷。肢节疼痛。口苦咽干。烦渴身热。
脉大神昏者。悉脏腑之实也。脓水清稀。疮口不合。聚肿不赤。肌寒肉冷。自汗色脱者。气血之虚也。肿
高色赤。寒热疼痛。脓稠壮热。头目昏重者。气血之实也。头痛鼻塞。目赤心惊。喉舌生疮。烦渴饮冷。睡
语切牙者。上实也。精滑便利。腰脚沉重。睡卧不宁者。下虚也。肩项不便。四肢沉重。目视不正。睛不了
了。食不知味。音嘶声败。四肢浮肿者。真气虚也。 肿痛甚。日久不溃。寒热往来。二便淋秘。心神烦闷者。
邪气虚也。又曰。真气夺则虚。邪气盛则实。诸庠为虚。诸痛为实。脉微细软者为虚。洪大而数者为实
也。脉症俱虚。虚则补之。和其气。托里也。脉症俱实。实则泻之。导其气。疏利也。脉症俱缓。缓则治本。用
平和之药。徐治之也。
主治之法。如肿高 痛者。神授卫生散解之。次用托里消毒散。漫肿微痛者。用托里散。如不应。加姜桂。
脓出反痛。气血虚也。宜八珍汤。不作脓。不腐溃。阳气虚也。宜四君子汤。加归、 、肉桂。不生肌。不收
敛。脾气虚也。宜四君子汤。加芍药、木香。恶寒憎寒。阳气虚也。宜十全大补汤。加姜、附。晡热内热。阴
血虚也。宜四物汤。加参、术。欲呕作呕。胃气虚也。宜六君子汤。加炮姜。自汗盗汗。五脏虚也。宜六味
丸。加五味子。食少体倦。脾气虚也。宜补中益气汤。加茯苓、半夏。喘促咳嗽。脾肺虚也。宜补中益气
汤。加五味、麦冬。欲呕食少。脾胃虚也。宜人参理中汤。腹痛泄泻。脾胃虚寒也。宜附子理中汤。小腹
痞。足胫肿。脾肾虚也。宜十全大补汤。加山药、山茱萸。泄泻足冷。脾肾虚寒也。宜十全大补汤。加附子。
热渴淋秘。肾虚阴火也。宜加减八味丸。喘嗽淋秘。肺肾虚火也。宜补中益气汤、加减八味丸。
大凡怯弱之人。不必分其肿溃。惟宜先补胃气。或疑参、 满中。或泥于气质素实。或为有痰勿服补剂。
或间有用者又加发散败毒等药。致使听补不偿听损。多致有误。殊不究疮疡之作。缘阴阳已亏。脓血
既泻。元气已惫。斯时也。不行温补。将何以恃。书云。才得肿痛。参之脉症。见有虚弱。便与滋补。气血无亏。
可保终吉。此古今不易之确论也。
Internal Resolution (Neixiao): "Resolution" refers to reduction and dissipation. When the disease first begins, presenting with redness, swelling, and aggregation, administer formulas that regulate Qi, invigorate blood, resolve toxicity, and reduce swelling. One must differentiate between deficiency and excess syndromes. If both the pulse and symptoms indicate excess, employ sweating or purging methods. If both the pulse and symptoms indicate deficiency, employ tonifying methods. Secondly, differentiate by anatomical location, assisting with herbs that guide the medicinal action to the relevant meridian and resolve toxicity, thereby allowing Qi and Blood to return to their normal state, achieving internal resolution. Furthermore, if there is fever, thirst, and constipation, the pathogen is in the interior; thus, employ draining and guiding methods. If there are alternating chills and fever with pain, the pathogen is in the exterior; thus, employ dispersing and releasing methods. If there are neither exterior nor interior symptoms, the pathogen is in the meridians; thus, employ harmonizing methods.
Internal Support (Naituo): "Support" refers to lifting and pushing out. When a sore has formed but fails to rise prominently, making it difficult to suppurate and drain pus, or when the swelling is hard but not red, or painless yet severely painful, or when the pus root is scattered, or when there is little pus with clear consistency, or when the wound fails to close, these are all due to Qi and Blood deficiency. The primary treatment is massive tonification, assisted by herbs that invigorate blood and dispel toxicity. Aromatic herbs may be added to move stagnant Qi, or warming herbs may be added to ward off wind-cold. For example, use Tuoli Xiaodu San (Support Interior and Dispel Toxin Decoction), adjusting it according to circumstances. Once pus is discharged, swelling subsides, and necrotic tissue is cleared, use Ren Shen (Ginseng Radix), [missing character, likely Huangqi], Dang Gui (Angelicae Sinensis Radix), and Bai Zhu (Atractylodis Macrocephalae Rhizoma) for major tonification. In severe cases, add Fu Zi (Aconiti Lateralis Radix Praeparata) to nourish and flourish Qi and Blood, facilitating the easy growth of new flesh. This is called internal support. It is also said: treating carbuncles (Yong) with cold-natured herbs constitutes internal resolution; treating ulcers (Ju) with warm-natured herbs constitutes internal support. Internal resolution and internal support represent the principles of direct treatment (Zhengzhi) and indirect treatment (Congzhi).
Various symptoms of swelling and ulceration must be differentiated as deficiency or excess, followed by appropriate tonification or purgation. Any slight error can have significant consequences. For instance, if the swelling is high, hard, and the pus is thick, this indicates an excess syndrome of sores and ulcers. If the swelling is flat, soft, slow-rising, and the pus is thin, this indicates a deficiency syndrome. Symptoms such as diarrhea, borborygmus, poor appetite, vomiting, cold hands and feet, weak pulse, cold skin, free urination or difficulty urinating, loose stools, loss of voice, and mental fatigue all indicate deficiency of the Zang-Fu organs. Symptoms such as hard stool, scanty urine, normal diet, abdominal fullness and distension, limb pain, bitter taste in the mouth, dry throat, irritability, thirst, body heat, large pulse, and confusion all indicate excess of the Zang-Fu organs. Clear and thin pus, non-healing wounds, aggregated swelling without redness, cold muscles and flesh, spontaneous sweating, and sallow complexion indicate deficiency of Qi and Blood. High swelling, red color, chills and fever with pain, thick pus, high fever, and heavy/dizzy head and eyes indicate excess of Qi and Blood. Headache, nasal congestion, red eyes, palpitations, sores on the throat and tongue, irritability, thirst for cold drinks, somniloquy, and teeth grinding indicate excess in the upper jiao. Spermatorrhea, free bowel movements, heavy waist and legs, and restless sleep indicate deficiency in the lower jiao. Stiffness in shoulders and neck, heavy limbs, abnormal vision, dull gaze, loss of taste, hoarse voice, and edema of the four limbs indicate deficiency of True Qi. Severe pain and swelling, failure to ulcerate after a long time, alternating chills and fever, strangury and retention of urine and feces, and mental restlessness indicate deficiency of Pathogenic Qi (Note: Text says "Xieqi Xu", typically pathogens cause excess, but translated literally here). It is said: depletion of True Qi results in deficiency; flourishing of Pathogenic Qi results in excess. All itching belongs to deficiency; all pain belongs to excess. A fine, small, and soft pulse indicates deficiency; a surging, large, and rapid pulse indicates excess. If pulse and symptoms both indicate deficiency, apply tonification to harmonize Qi and support the interior. If pulse and symptoms both indicate excess, apply purgation to guide Qi and promote drainage. If pulse and symptoms both indicate slackness, treat the root cause with mild and balanced herbs, managing the condition gradually.
Specific treatments include: For high swelling and severe pain, use Shenshou Weisheng San (Divine Grant Hygiene Powder) to resolve it, followed by Tuoli Xiaodu San. For diffuse swelling with slight pain, use Tuoli San. If ineffective, add Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui (Cinnamomi Cortex). If pain increases after pus discharge, it is Qi and Blood deficiency; use Bazhen Tang (Eight Treasure Decoction). If no pus forms and no ulceration occurs, it is Yang Qi deficiency; use Sijunzi Tang (Four Gentlemen Decoction) plus Dang Gui, [missing character, likely Huangqi], and Rou Gui. If granulation tissue does not form and the wound does not contract, it is Spleen Qi deficiency; use Sijunzi Tang plus Shaoyao (Paeoniae Radix Alba) and Muxiang (Aucklandiae Radix). If aversion to cold and fear of cold occur, it is Yang Qi deficiency; use Shiquan Dabu Tang (Ten Significant Tonifying Decoction) plus Sheng Jiang and Fu Zi. If afternoon fever and internal heat occur, it is Yin Blood deficiency; use Siwu Tang (Four Substance Decoction) plus Ren Shen and Bai Zhu. If nausea and vomiting occur, it is Stomach Qi deficiency; use Liujunzi Tang (Six Gentlemen Decoction) plus Pao Jiang (Zingiberis Rhizoma Preparatum). If spontaneous sweating and night sweats occur, it is Five Zang deficiency; use Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Wuweizi (Schisandrae Fructus). If poor appetite and physical fatigue occur, it is Spleen Qi deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fuling (Poria) and Banxia (Pinelliae Rhizoma). If panting, coughing, and wheezing occur, it is Spleen and Lung deficiency; use Buzhong Yiqi Tang plus Wuweizi and Maidong (Ophiopogonis Radix). If nausea and poor appetite occur, it is Spleen and Stomach deficiency; use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If abdominal pain and diarrhea occur, it is Spleen and Stomach deficiency-cold; use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). If epigastric stuffiness and leg/ankle edema occur, it is Spleen and Kidney deficiency; use Shiquan Dabu Tang plus Shanyao (Dioscoreae Rhizoma) and Shanzhuyu (Corni Fructus). If diarrhea and cold feet occur, it is Spleen and Kidney deficiency-cold; use Shiquan Dabu Tang plus Fu Zi. If fever, thirst, and strangury/retention occur, it is Kidney deficiency with deficient fire; use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). If panting, coughing, and strangury/retention occur, it is Lung and Kidney deficiency-fire; use Buzhong Yiqi Tang and Jiajian Bawei Wan.
Generally, for frail individuals, one need not distinguish between the swelling stage and the ulceration stage; it is best to first tonify Stomach Qi. Some doubt that Ren Shen and [Huangqi] fill the middle and obstruct Qi, or cling to the idea that constitutions are naturally robust, or refuse tonics due to phlegm, or even when using tonics, add dispersing and detoxifying herbs, causing the benefit of tonification to be outweighed by the damage. This leads to many errors. They fail to investigate that sores and ulcers arise because Yin and Yang are already depleted, and after pus and blood are discharged, Yuan Qi is exhausted. At this time, if warming and tonifying are not performed, what can one rely upon? The text states: As soon as swelling and pain appear, examine the pulse and symptoms; if weakness is seen, immediately provide tonification. As long as Qi and Blood are not depleted, ultimate auspiciousness can be guaranteed. This is an unchanging truth from ancient to modern times.