东垣曰。疮疡食肉。乃自弃也。疮疡乃营气而作。今反补之。自弃何异。虽用药治。不
精要曰。羊、鸡、牛、鹅、鱼、面、煎爆、炒、炙、酒等味。犯之必发热。用栀子黄苓
丹溪曰。栀苓、苦参、犀角。佐辅人参。固可解食毒之热。若寒月与虚人。宁无加减乎
经谓膏粱之变。足生大丁。此言疮疽之因也。禁戒浓味。恐其引起宿火之热。此诚富贵豢养
口腹者所当谨。若素贫者大不然矣。
予治一人。背痈径尺。穴深而黑。家贫得此。急作参 归术膏。多肉馄饨与之而安。多
肉馄饨补气之有益者也。
精要曰。凡血气闻香则行。闻臭则逆。饮食调令香美。益脾土。养真气。疮疡或为秽气
所触。可用香药熏之。
丹溪曰。甘而淡者可养脾土。若香美者但能起火。故经以热伤脾、热伤气为戒。今曰益
脾养气。施之肿疡。似有畅达之益。溃疡后用香美。恐有发湿热、损真阴之患。
夫痈、疽、疮、疖。皆由气血壅滞而生。当推虚、实、表、里而早治之。可以内消。此
里之意也。若毒瓦斯已结者。勿泥此内消之法。当辨脓之有无浅深。急酌量刺之。缓则穿通脏
腑。腐烂筋骨。可不慎哉。若脉紧而数。为脓未成。紧去但数。为脓已成。以手按上。热者
有脓。不热无脓。按之牢硬未有脓。按之半软半硬已有脓。大软方是脓成。若大按之痛者脓
深。按之不甚痛者脓未成。按之即复痛者为有脓。不复痛者无脓。薄皮剥起。起者脓浅。
皮色不变。不高阜者脓深。浅者宜砭。深者宜针。手足指梢及乳上。宜脓大软方开。麻豆后
肢疖有痈。稍觉有脓。便用决破。迟则成挛曲之疾。
Li Dongyuan stated: For patients with sores and ulcers, consuming meat is an act of self-neglect. Sores and ulcers arise from the stagnation of Ying-Qi (Nutritive Qi). To tonify them now with rich meats is no different from self-neglect. Even with medicinal treatment, without dietary precision, essential results cannot be achieved.
The *Waike Jingyao* (Essentials of Surgery) states: Consuming mutton, chicken, beef, goose, fish, wheat noodles, fried foods, roasted meats, and alcohol will inevitably cause fever if these taboos are violated.
Zhu Danxi stated: Using Gardenia (Gardeniae Fructus), Scutellaria (Scutellariae Radix), Sophora (Sophorae Flavescentis Radix), and Rhinoceros Horn (Rhinocerotis Cornu) assisted by Ginseng (Ren Shen) can indeed resolve the heat caused by dietary toxicity. However, in cold months or for patients with deficiency constitutions, should adjustments not be made accordingly?
The Classics state: "Changes from rich and greasy food are sufficient to produce large carbuncles." This refers to the etiology of sores and ulcers. Prohibiting strong-flavored and rich foods is to prevent the triggering of latent internal fire-heat. This is indeed a caution for those of wealth who indulge their appetites. For those who have always been poor, however, the situation is entirely different.
I treated one patient with a back carbuncle measuring one chi in diameter, with a deep cavity and black discoloration. Being poor, upon contracting this illness, I urgently prescribed a paste made of Ginseng (Ren Shen), Angelica Sinensis (Danggui), and Atractylodes Macrocephala (Baizhu), and provided him with wonton dumplings containing abundant meat, resulting in stabilization of the condition. Consuming ample meat in wontons is beneficial for tonifying Qi.
The *Waike Jingyao* (Essentials of Surgery) states: Blood and Qi flow smoothly when exposed to fragrant aromas but become reversed and obstructed by foul odors. Regulating diet to be aromatic and delicious benefits the Spleen Earth and nourishes True Qi. If sores and ulcers are touched by turbid qi, they can be fumigated with aromatic herbs.
Zhu Danxi stated: Foods that are sweet and bland can nourish Spleen Earth. However, those that are overly aromatic may only ignite fire-heat. Therefore, the Classics warn against "Heat injuring the Spleen" and "Heat injuring Qi." Now, it is said that aromatic and delicious foods benefit the Spleen and nourish Qi; applying this during the early stage of swelling (Zhongyang) seems to have the benefit of promoting free flow. However, using aromatic and delicious foods after ulceration (Kuyang) may pose the risk of inducing damp-heat and damaging True Yin.
Carbuncles (Yong), deep abscesses (Ju), sores (Chuang), and boils (Jie) all arise from the stagnation of Qi and Blood. One must deduce the patterns of Deficiency, Excess, Exterior, and Interior and treat them early to allow for internal resolution (Neixiao). This is the meaning of internal resolution. If the pathogenic factors have already condensed, do not rigidly adhere to this method of internal resolution. Instead, differentiate the presence and depth of pus, and urgently decide on incision and drainage. Delaying allows the toxin to penetrate viscera and rot bones and sinews. Can one be too cautious? If the pulse is tight and rapid, pus has not yet formed; if the tightness disappears and only rapidness remains, pus has formed. Pressing the area: if hot, there is pus; if not hot, there is no pus. If hard and firm upon pressure, there is no pus; if half-soft and half-hard, pus has formed; if very soft, the pus is mature. If pain occurs only upon deep pressure, the pus is deep; if pain upon pressure is not severe, pus has not formed. If pain occurs immediately upon pressing, there is pus; if there is no pain even after pressing, there is no pus. If the skin is thin and elevated, the pus is shallow; if the skin color does not change and there is no elevation, the pus is deep. Shallow pus should be treated with Bian stone (Bianshi) pricking; deep pus requires needle puncture. On the tips of fingers and toes and on the breasts, incision and drainage should only be performed when the pus is large and soft. For boils on the posterior limbs that develop into carbuncles, if one senses the formation of pus, immediate rupture and drainage should be used. Delay will result in contracture deformities of the limbs.