痛或发热者。祛风清热。
痛发寒热或拘急者。发散表邪。
作脓 痛者。托里消毒。
脓已成作痛者。针之。
不敛或脓清者。宜峻补。
不作脓或脓成不溃者。并用托里。
一人患此。 痛作肿。发热。以小柴胡汤加连翘、金银花、桔梗。四剂而消。（此因症
一人因怒后鬓际肿痛。发热。以小柴胡汤加连翘、金银花、天花粉、四剂根畔俱消。惟
疮头作痛。以仙方活命饮二剂。痛止脓熟。针之。更以托里消毒药而愈。（此因情也。）
一老肿痛发热。脓清作渴。脉软而涩。此气血俱虚也。欲补之。彼见作渴发热。乃服降
剂。果作呕。少食。复求治。投六君子汤四剂。呕止食进。仍用补药。月余而愈。（此因症
与脉也。）夫患者脏腑气血上下虚实。（详见溃疡作痛第十三条。）况阴症似阳。阳症似阴。（
治论见外科心法）岂可以发热作渴而遂用寒凉之剂。常治患者正气虚。邪气实。以托里为主
。消毒佐之。正气实。邪气虚。以攻毒为主。托里佐之。正气虚。邪气实。而专用攻毒则先
损胃气。宜先服仙方活命饮。托里消毒散。或用灸法。俟邪气退。正气复。更酌量治之。
大抵正气夺则虚。邪气盛则实。盖邪正不并立。一胜则一负。其虚不待损而自虚矣。若
脑疽疔毒。及患在四肢。必用灸法。拔引郁毒以行瘀滞。尤不可专于攻毒。诊其脉而辨之。
庶不有误。
一官肩患毒。发热恶寒。大渴烦躁。症似有余。脉虽大而无力。却属不足。用当归补血
汤治之。（此凭脉也。）
一人脓熟不溃。胀痛。针之而止。更以托里消毒散而愈。凡脓熟不溃。血气虚也。若不
托里。必致难瘥。
一人作脓 痛。发呕。少食。以仙方活命饮一剂而止。以六君子加当归、桔
梗、皂角刺溃而愈。（此凭症也。）
一人脓清不敛。以托里散加五味麦门而愈。（此凭症也。）
一人嗜酒与煎爆。年五十余。夏初左丝竹空穴忽努出一角。长短大小如鸡距而稍坚。予
此少阳所过。气多血少。未易治也。须断肉味。先解其食毒。针灸以开泄其壅滞。彼不听。
以大黄、朴硝、脑子等冷药盒之。一夕豁开如酱蚶。径三寸。二日后蚶中溅血高数寸而死。
因冷外逼。气郁不得发。宜其发之暴也如此。（此凭症也。）
一人肿痛寒热拘急。脉浮数。以荆防败毒散二剂。表症悉退。更以托里消毒散溃之而安
一人 肿痛甚。发寒热。服十宣散愈炽。诊之脉数而实。此表里俱有邪也。以荆防败毒
散加芩、连、大黄二剂少愈。更以荆防败毒散四剂而消。
俞黄门年逾三十。冬患鬓毒。肿 烦躁。便秘脉实。此胆经风热壅上也。马氏曰。疮疡
不利者。大黄汤下之。一剂便通疮退。更以荆防败毒散（七）二剂。十宣散去桂加天花粉、金
银花数剂而愈。（此凭症脉也。）
一人头面 肿作痛。时仲冬。脉弦紧。以托里温经汤汗之而消。
赵宜人年逾七十。鬓疽已溃。 肿痛甚。喜冷。脉实便秘。东垣云。烦躁饮冷。身热脉
精神昏闷者。脏腑实也。以清凉饮（二六）肿痛悉退。更以托里药三十余剂而平。（此凭脉症
机按。前疽虽出少阳血少之分。然症与脉皆属于实。故年壮者用泻剂之重。老年者用泻
剂之轻。若拘以年老。或守其经禁。而投补剂。实实之祸杂免矣。
If pain or fever occurs, employ the method of dispelling wind and clearing heat.
If pain is accompanied by alternating chills and fever or muscle stiffness/spasms, employ the method of dispersing exterior pathogens.
If suppuration is occurring with pain, employ the method of supporting the interior and detoxifying (Tuoli Xiaodu).
If pus has formed causing pain, perform acupuncture to drain it.
If the sore does not heal or the pus is thin/clear, strong tonification is appropriate.
If suppuration fails to occur or if pus forms but does not ulcerate, use the method of supporting the interior (Tuoli) in both cases.
A patient suffered from this condition with painful swelling and fever; Xiao Chai Hu Tang (Minor Bupleurum Decoction) was modified with Jinqiao (Forsythiae Fructus), Yinyinhua (Lonicerae Japonicae Flos), and Jiegeng (Platycodonis Radix). After four doses, the swelling subsided. (This case was determined by symptoms.)
Another patient developed painful swelling at the temple after anger, accompanied by fever. Xiao Chai Hu Tang (Minor Bupleurum Decoction) was modified with Jinqiao (Forsythiae Fructus), Yinyinhua (Lonicerae Japonicae Flos), and Tianhuafen (Trichosanthis Radix). After four doses, the root area completely resolved, leaving only pain at the head of the sore. Xianfang Huoming Yin (Immortal Life Elixir) was administered for two doses, stopping the pain and ripening the pus. Acupuncture was then used to drain it, followed by a formula to support the interior and detoxify, leading to recovery. (This case was determined by emotional factors.)
An elderly patient presented with painful swelling, fever, clear pus, thirst, and a soft, choppy pulse. This indicated deficiency of both Qi and Blood. The intention was to tonify, but seeing his thirst and fever, he took cooling/draining herbs himself, resulting in vomiting and poor appetite. Upon seeking further treatment, Liu Junzi Tang (Six Gentlemen Decoction) was prescribed for four doses, stopping the vomiting and improving appetite. Tonics were continued, and he recovered after more than a month. (This case was determined by symptoms and pulse.)
Generally, patients have varying degrees of deficiency and excess in their Zang-Fu organs and Qi/Blood. (See Article 13 on Pain in Ulcers.) Furthermore, Yin syndromes may resemble Yang, and Yang syndromes may resemble Yin. (Treatment theories are found in *Waike Xinfa*). How can one simply use cold/cooling herbs just because of fever and thirst? Typically, when treating patients with deficient Zheng Qi (Upright Qi) and excess Xie Qi (Pathogenic Qi), the primary approach is supporting the interior (Tuoli), assisted by detoxification. When Zheng Qi is sufficient and Xie Qi is weak, the primary approach is attacking toxicity, assisted by supporting the interior. If Zheng Qi is deficient and Xie Qi is excessive, using only attacking methods will first damage Stomach Qi. It is advisable to first administer Xianfang Huoming Yin (Immortal Life Elixir) or Tuoli Xiaodu San (Support Interior and Detoxify Powder), or use moxibustion. Wait until the pathogen recedes and Zheng Qi recovers, then adjust the treatment accordingly.
In general, loss of Zheng Qi leads to deficiency, while abundance of Xie Qi leads to excess. Pathogenic and Upright Qi cannot coexist; when one wins, the other loses. Deficiency manifests naturally without needing to be caused by damaging treatments. For conditions like Nao Ju (Brain Carbuncle) or Ding Du (Malignant Furuncle), or lesions on the limbs, moxibustion must be used to draw out stagnant toxins and promote blood circulation. One must not rely solely on attacking methods. Diagnose by pulse to distinguish correctly, so as to avoid errors.
An official suffered from a toxic lesion on the shoulder with fever, aversion to cold, severe thirst, and irritability. The symptoms appeared excessive (Excess syndrome), but the pulse was large yet forceless, indicating insufficiency (Deficiency syndrome). Danggui Buxue Tang (Dong Quai and Astragalus Decoction) was used for treatment. (This case was determined by pulse.)
A patient had ripe pus that did not ulcerate, causing distending pain. After acupuncture stopped the pain, Tuoli Xiaodu San (Support Interior and Detoxify Powder) was used for recovery. Whenever pus is ripe but does not ulcerate, it is due to deficiency of Blood and Qi. Without supporting the interior, healing will inevitably be difficult.
A patient experienced pain during suppuration, vomiting, and poor appetite. Xianfang Huoming Yin (Immortal Life Elixir) was given for one dose to stop the vomiting. Then, Liu Junzi Tang (Six Gentlemen Decoction) modified with Danggui (Angelicae Sinensis Radix), Jiegeng (Platycodonis Radix), and Zaogao Ci (Gleditsiae Spina) was used to induce ulceration and achieve recovery. (This case was determined by symptoms.)
A patient had clear, non-healing pus. Tuoli San (Support Interior Powder) modified with Wuweizi (Schisandrae Fructus) and Maimendong (Ophiopogonis Radix) led to recovery. (This case was determined by symptoms.)
A patient who loved alcohol and fried foods, aged over fifty, suddenly developed a hard, horn-like protrusion at the Sizhukong (SJ23) acupoint on the left side in early summer. It was about the size of a chicken spur. I considered this to be in the pathway of the Shaoyang channel, where Qi is abundant but Blood is scarce, making it difficult to treat. He needed to abstain from meat, resolve food toxicity first, and use acupuncture/moxibustion to open blockages. He did not listen. Instead, he applied cold herbs such as Dahuang (Rhei Radix et Rhizoma), Puxiao (Natrii Sulfas), and Naozi (Borneolum Syntheticum) in a box. Overnight, it burst open like a sauce clam, three inches in diameter. Two days later, blood sprayed several inches high from the wound, and he died. This was due to external cold forcing inward, causing Qi stagnation and inability to vent, leading to such a violent outbreak. (This case was determined by symptoms.)
A patient had severe painful swelling, chills, fever, and stiffness, with a floating and rapid pulse. Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Rescue from Toxicity) was given for two doses, resolving all exterior symptoms. Tuoli Xiaodu San (Support Interior and Detoxify Powder) was then used to induce ulceration, leading to stability.
A patient had severe painful swelling and chills/fever. After taking Shixuan San (Ten Perfection Powder), the condition worsened. The pulse was rapid and solid, indicating pathogens in both the exterior and interior. Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Rescue from Toxicity) modified with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Dahuang (Rhei Radix et Rhizoma) was given for two doses, showing slight improvement. Four more doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Rescue from Toxicity) led to resolution.
Yu Huangmen, over thirty years old, suffered from a temporal carbuncle in winter with swelling, irritability, constipation, and a solid pulse. This was Wind-Heat obstructing the Gallbladder channel ascending upwards. Master Ma stated that for unbeneficial sores, Dahuang Tang (Rhubarb Decoction) should be used to purge. After one dose, bowels moved and the sore subsided. Jingfang Baidu San (Schizonepeta and Saposhnikovia Powder to Rescue from Toxicity) was given for two doses, followed by Shixuan San (Ten Perfection Powder) with Guizhi (Cinnamomi Ramulus) removed and Tianhuafen (Trichosanthis Radix), Yinyinhua (Lonicerae Japonicae Flos) added for several doses, leading to recovery. (This case was determined by symptoms and pulse.)
A patient had facial swelling and pain in mid-winter, with a wiry and tight pulse. Tuoli Wenjing Tang (Support Interior and Warm Meridian Decoction) was used to induce sweating, resolving the swelling.
Zhao Yiren, over seventy years old, had an ulcerated temporal carbuncle with severe painful swelling, preference for cold drinks, solid pulse, and constipation. Li Dongyuan said: Irritability, desire for cold drinks, body heat, solid pulse, and mental confusion indicate internal organ excess heat. Qingliang Yin (Cooling Drink) was used, and all swelling and pain subsided. More than thirty doses of interior-supporting medicines were taken to stabilize the condition. (This case was determined by pulse and symptoms.)
Editor's Note: Although the previous carbuncle occurred in the area of the Shaoyang channel where Blood is scant, the symptoms and pulse both indicated Excess. Therefore, for the younger patient, heavy purgatives were used; for the elderly patient, lighter purgatives were used. If one rigidly adheres to age or follows taboos by administering tonics, the disaster of "treating excess with excess" (Shi Shi) would likely not be avoided.