疮疡在外者引而拔之。在内者疏而下之。灼艾之功甚大。若毒瓦斯郁结。气血凝聚。轻者
药散。重者药无全功。东垣云。若不针烙。则毒瓦斯无从而散。脓瘀无从而泄。过时不烙。反
攻于内。故治毒者必用隔蒜灸。舍是而用苦寒之剂。其壮实内有火者或可。彼怯弱气寒。未
有不败者也。又有毒瓦斯沉伏。或年高气弱。若服克伐之剂。气血愈虚。脓因不溃。必假火力
以成功。
一人足患疔已十一日。气短。灸五十余壮。更以托里药而愈。黄君腿痈。脓清脉弱。一
结一块。溃不收敛。各灸以豆豉饼。更饮托里药而愈。一人胸肿一块。半载不消。明灸百壮
方溃。与大补药不敛。复灸以附子饼而愈。一人发背 痛如灼。隔蒜灸三十余壮。肿痛悉退
。更服托里消毒而愈。一人发背疮。头甚多。肿硬。色紫。不甚痛。不腐溃。以艾铺患处灸
之。更服大补药。数日死肉脱去而愈。一人发背已四五日。疮头虽小。根畔颇大。隔蒜灸三
十余壮。其根内消。惟疮头作脓而愈。精要。曰。灸法有回生之功。信矣。大凡蒸灸。若未
溃则拔引郁毒。已溃则补接阳气。祛散寒邪疮口自合。其功甚大。尝治四肢疮疡气血不足者
。只以前法灸之皆愈。疔毒甚者。痛则灸至不痛。不痛则灸至痛。亦无不愈。若中虚者。不
服败毒药。则疮毒未除。中气先伤。未有不败者也。李氏云。治疽之法。着艾胜于用药。缘
热毒中隔。外内不通。不发泄则不解散。又有处贫居僻。一时无药。用灸尤便。大概蒜用大者。取其散
毒有力。用着艾炷多者。取其火力透也。如法灸之。疮发脓溃。继以神异膏贴之。不日而安
。一则疮不开大。二则内肉不溃。三则疮口易合。见效甚神。
辨精要曰。始发时用针灸。十死八九。丹溪曰。火以畅达。拔引郁毒。此从治之意。因
死者。盖虚甚孤阴将绝。脉必浮数而大且鼓。精神必短而昏。无以抵当火气故也。岂可泛言
始发不可灸以误人。精要又谓头上有毒不得灸。恐火拔起热毒而加病。丹溪曰。头为诸阳所
聚。艾炷宜小而少。小者如椒粒。少者三五壮而已。若猛浪如灸腹背。炷大数多。斯为误矣
。按东垣灸元好问脑疽。以大艾炷如两核许。灸百壮。始觉痛而安。由是推之。则头上发毒
。灸之痛则炷宜小。数宜少。不痛者。炷大数多亦无妨也。
经曰。陷者灸之。如外微觉木硬不痛者。是邪气深陷也。急灸之。浅者不可灸。又曰。
浅者有数头肿痛。亦灸之无妨。
For sores and ulcers located on the exterior, employ the method of drawing and pulling them out; for those located in the interior, employ the method of dispersing and purging them downward. The efficacy of moxibustion is profound. If toxic pathogens are constrained and stagnant, and qi and blood coagulate, mild cases can be resolved with herbs alone; severe cases cannot achieve complete cure with herbs alone. Li Dongyuan stated: "If acupuncture and cauterization (needle and fire) are not employed, there is no pathway for toxic pathogens to dissipate, and no outlet for pus and stasis to drain. If cauterization is delayed, the pathogenic factors will counter-attack inward." Therefore, when treating toxic sores, garlic-separated moxibustion must be used. Abandoning this method in favor of bitter-cold formulas may be acceptable for individuals with robust constitutions and internal heat, but for those who are frail, deficient, and cold in constitution, it invariably leads to deterioration. Furthermore, if toxic pathogens are deeply latent, or if the patient is elderly and weak, administering harsh purgative or attacking herbs will further deplete qi and blood, preventing the formation and rupture of pus; one must rely on the thermal power of moxibustion to achieve success.
One case involved a patient with a carbuncle on the foot for eleven days, presenting with shortness of breath. After receiving over fifty moxa cones, followed by administration of *Tuoli* (Supporting the Interior) medicine, he recovered. Another case involved Mr. Huang, who suffered from a thigh abscess with thin pus and a weak pulse, presenting as a single hardened lump that failed to heal after rupture. He was treated with fermented soybean cake-separated moxibustion and administered *Tuoli* medicine, resulting in recovery. A third case involved a swelling on the chest that persisted for half a year without resolution. After direct moxibustion of one hundred cones, the lesion ruptured. Although large tonifying herbs were given, the wound failed to close; subsequent treatment with ginger-attached moxibustion led to healing. A fourth case involved a back carbuncle with burning pain. Thirty-plus garlic-separated moxa cones were applied, causing the swelling and pain to subside completely, followed by administration of *Tuoli* detoxification medicine, leading to recovery. A fifth case involved a back carbuncle with numerous heads, hard swelling, purple discoloration, minimal pain, and lack of suppuration. Moxa was spread directly on the affected area for moxibustion, followed by large tonifying herbs; dead tissue sloughed off within several days, and the patient recovered. A sixth case involved a back carbuncle present for four to five days, with small heads but a wide base. Garlic-separated moxibustion of thirty-plus cones caused the base to resolve internally, leaving only the head to suppurate, leading to recovery. *Jingyao* states: "Moxibustion possesses the power to restore life," which is indeed true. Generally, steaming moxibustion, if applied before rupture, draws out constrained toxins; if applied after rupture, it supplements yang qi and dispels cold pathogens, allowing the wound to heal naturally. Its efficacy is significant. I once treated patients with sores and ulcers on the limbs due to qi and blood deficiency, using only the aforementioned moxibustion methods, all of whom recovered. For severe carbuncles, if painful, moxibustion should continue until pain ceases; if painless, until sensation returns. There are no failures in such cases. However, for those with middle-jiao deficiency, failing to administer detoxifying herbs means the toxin remains while the middle qi is damaged first, inevitably leading to deterioration. Li Shi stated: "In treating carbuncles, moxibustion surpasses herbal medicine." This is because heat toxins are blocked internally, preventing communication between the interior and exterior; without venting via moxibustion, they cannot disperse. Additionally, for those living in poverty or remote areas lacking immediate access to medicine, moxibustion is particularly convenient. Large garlic cloves should be used for their strong toxin-dispersing capability; numerous moxa cones should be used to ensure deep penetration of thermal energy. Following this method, the sore suppurates and ruptures, followed by application of *Shenyi Gao* (Miraculous Ointment), leading to rapid peace and stability. This ensures three benefits: the wound does not open excessively, internal flesh is not overly destroyed, and the wound closes easily. The results are remarkably effective.
*Bian Jingyao* states: "Using acupuncture and moxibustion at the onset of disease results in eight or nine deaths out of ten." Zhu Danxi stated: "Fire promotes free flow and draws out constrained toxins, embodying the principle of 'treating according to the nature of the disease' (Cong Zhi)." Those who died after moxibustion did so because their deficiency was extreme, with isolated yin nearing extinction. Their pulses were floating, rapid, large, and forceful; their spirit was diminished and confused, unable to withstand the fire energy. How can one broadly state that moxibustion is contraindicated at the onset, thereby misleading people? *Jingyao* also claims that toxic lesions on the head must not be moxibusted, fearing that fire will draw up heat toxins and worsen the condition. Zhu Danxi stated: "The head is the gathering point of all yang meridians. Moxa cones should be small and few in number—small like peppercorns, and few, only three to five cones. Acting recklessly as one would on the abdomen or back, using large cones and high numbers, constitutes an error." According to Li Dongyuan’s treatment of Yuan Haowen’s brain carbuncle, large moxa cones the size of two nuts were used, applying one hundred cones. Pain was felt initially, then relief ensued. From this, we deduce that for toxic lesions on the head, if painful, use small cones and few applications; if painless, large cones and many applications are permissible.
The *Classic* states: "For sinking conditions, use moxibustion." If the exterior feels slightly numb, hard, and painless, it indicates deep invasion of pathogenic factors; urgent moxibustion is required. Superficial conditions should not be moxibusted. It also states: "Superficial conditions with multiple swollen and painful heads can also be moxibusted without harm."