外科，盖指疮疡门言也。上古无外科专名，实 于季世，后人遂分内外为二科。
兹外科乃宋陈良甫先生所着。虽以疡科名其书，而其治法，固多合内外之道。如作渴、
泄泻、灸法等论，诚有以发《内经》之微旨。殆不无宜于昔，而不宜于今者，非先生之术，有
未精要也。良由今人所禀，远不逮昔，虽使先生至今存，亦不得不因时而损益之矣。余于时
自忌浅鄙，漫仿元本之所既备而未悉者，断以愚意而折衷之，仍其旧名，厘为四卷。其补录
一卷，则出余管见。同志勿咎其僭，而进其所未至焉。
嘉靖丁未春月吉日奉政大夫太医院使致仕吴郡薛己谨序
经云∶诸痛痒疮疡，皆属心火。前辈又谓痈疽多生于丹石房劳之人。凡人年四十以上，
患发背等疮，宜安心早治。此症如虎入室，御而不善，必至伤人。宜先用内托散，次用五香
连翘汤，更以骑竹马法，或隔蒜灸，并明灸足三里，以发泄其毒。盖邪之所凑，其气必虚，
留而不去，其病乃实。故痈疽未溃，脏腑蓄毒，一毫热药，断不可用。痈疽已溃，脏腑既亏，
一毫冷药，亦不可用，犹宜忌用敷贴之药闭其毫孔。若热渴便秘，脉沉实洪数，宜用大黄等
药以泄其毒；后国老膏、万金散、黄矾丸、远志酒之类，选而用之。
愚按∶前症若热毒蕴于内，大便秘结，元气无亏者，宜用大黄等药泄其热毒。若阴虚阳
凑，精虚气节，脾胃虚弱者，宜用甘温之剂培其本源。若疮不 肿，不作脓者，虽未溃，仍
须温补。若疮已溃，而肿不退，痛不止者，仍宜清凉之剂治之。若病急而元气实者，先治其
标；病缓而元气虚者，先治其本；或病急而元气更虚者，必先治本而兼以治标。大抵肿高
痛，脓水稠粘者，元气未损也，治之则易。漫肿微痛，脓水清稀者，元气虚弱也，治之则难。
不肿不痛，或漫肿、肿黯不溃者，发于阴也，元气虚甚，理所不治。若肿高 痛者，先用仙
方活命饮，后用托里消毒散。漫肿微痛者，宜托里散，如不应，加姜、桂。若脓出而反痛，
气血虚也，八珍散。不作脓，不腐溃，阳气虚也，四君加归、 、肉桂。不生肌，不收
敛，脾气虚也，十全大补加姜、桂。晡热内热，阴血虚也，四物加参、术。欲呕作呕，胃气
虚也，六君加炮姜。自汗盗汗，五脏虚也，六味丸加五味子。食少体倦，脾气虚也，补中益
气加茯苓、半夏。喘促咳嗽，脾肺虚也，前汤加麦门、五味。欲呕少食，脾胃虚也，人参理
中汤。腹痛泄泻，脾胃虚寒也，附子理中汤。小腹痞，足胫肿，脾肾虚弱也，十全大补加山
茱、山药、肉桂。泄泻足冷，脾肾虚寒也，前药加桂、附。热渴淋闭，肾虚阴火也，加减八
味丸。喘嗽淋闭，肺肾虚火也，补中益气汤、加减八味丸。凡此变证，皆因元气亏损，失于
预补所致。故丹溪先生云∶但见肿痛，参之脉症，虚弱便与滋补，气血无亏，可保终吉。旨
哉斯言！盖古今虚实不同，因时施治，不无少异。是集治论义悉类此。
附治验
上林陈静涵，面患疔，脉洪数有力，属邪气蕴结。余用清热消毒散二剂未应。或用黄 、
肉桂等药二剂，反益其势，致耳目唇口俱肿闭，头面如斗，由邪气外实也。前脉按之无力，
由元气内虚也。连进托里消毒之药，及数砭患处，出黑血碗许，已而脓与腐肉并溃而出。复
用托里之药，疮势渐愈。七日后，复因调护失宜，以致烦渴不食，两尺脉如丝欲绝，急用八
味丸料煎服，其脉顿复，手足自温。使非砭以泄其外，托里散以补其内，八味丸以回其阳，
则治之失宜，必致不救。慎之慎之！
宪副陈鲁山，居官勤苦，劳伤元气，背患疽，漫肿，中央色黯，四畔微赤微痛，脉浮
大，按之微细，左寸短而右寸若无。十余日，肿未全起。此病气元气虚寒，朝用参、 、姜、
桂、归、术、陈皮、半夏、炙草，温补其阳，夕用加减八味丸滋其肝肾，各四剂而腐溃。但
脓水清稀，盗汗自汗，内热晡热，脉浮而数，改用八珍汤。复发热，而夜阳举，此肾虚而火
动，仍用加减八味丸料煎服而安。又因怒动肝火，疮出鲜血二盏许，左关弦数，右关弦弱。
此肝木侮脾，以致肝不能藏血，脾不能统血，用十全大补兼前药各二剂而血止。再用前药，
调理而痊。
一武职患脑疽，内溃热渴，头面肿胀如斗，胸背色 如涂丹，烦热便秘，此表里俱实，
若非苦寒之剂，内 外泄不救。遂针周项出脓，及用清凉饮一剂，内大黄用五钱，再用消毒
散而愈。
节推王器之，背患疽，疮头如黍， 痛背重，脉沉而实，此毒在内。服黄连内 汤二剂
少退，更与仙方活命饮而愈。
举人刘华甫， 肿作痛，脉浮而数，此毒蓄于经络。用内托复煎散二剂而 肿减，用仙
方活命饮四剂而肿痛止，更用托里药而痊。
一儒者患背疽，肿 痛甚，此热毒蕴结而炽盛。用隔蒜灸而痛止，服仙方活命饮而肿
消，更与托里药而溃愈。
一男子，背患疽，腐肉虽溃而新肉不生，此毒瓦斯解而脾胃之气虚也。用六君子加芎、归、
五味、黄 渐愈，用十全大补汤全愈。
一男子，背患疽，肉腐脓清，肌肉不生，此邪去而气血俱虚也。用十全大补汤，月余而敛。
一男子，背患疽，肿痛，赤晕尺余，背如负石。其势当峻攻，其脉又不宜。遂砭赤处，
出紫血碗许，肿痛顿退。更用神功散及仙方活命饮二剂，疮口及砭处出血水而消。
儒者周在鲁，怀抱久郁，背脊患疽，肝脉弦洪，脾脉浮大，按之微细。以补中益气加桔
梗、贝母，少用银花、白芷，二剂，肝脉顿退，脾脉顿复。乃以活命饮二剂，脓溃肿消，肝
脉仍弦。此毒虽去，而胃气复伤。仍用前汤加半夏、茯苓而愈。用银花、白芷，非为治疮，
乃解患者之疑耳。
Surgery, in general, refers to the department of sores and ulcers. In ancient times, there was no specific name for "surgery"; it was only in later eras that medicine was divided into internal and external departments.
This book, *Waike Jingyao* (Essentials of Surgery), was authored by Mr. Chen Liangfu of the Song Dynasty. Although named after the department of sores and ulcers, its treatment methods largely conform to the principles of integrating internal and external treatments. For instance, discussions on thirst, diarrhea, and moxibustion truly elucidate the profound implications of the *Huangdi Neijing* (Yellow Emperor's Inner Canon). Some content may have been suitable for the past but less so for the present; this is not because Mr. Chen's techniques were not refined and essential, but rather because the innate constitution of people today is far inferior to that of ancients. Even if Mr. Chen were alive today, he would inevitably have to make adjustments according to the times. I, with my humble and shallow understanding, have casually imitated the parts already prepared in the original text but not fully detailed, making compromises based on my own insights, retaining the old title, and organizing it into four volumes. The supplementary volume comes from my limited perspective. I hope like-minded scholars will not blame me for overstepping but instead point out any shortcomings.
On an auspicious day in the spring of the Dingwei year of the Jiajing era (1547), Xue Ji, a Gentleman of Worth and Retired Director of the Imperial Medical Bureau from Wu Commandery, respectfully wrote the preface.
The classic states: "All pain, itching, sores, and ulcers belong to Heart Fire." Predecessors also stated that carbuncles and malignant sores often arise in individuals who consume cinnabar/mercury pills (Dan Shi) and engage in excessive sexual activity. Anyone over forty years old suffering from back carbuncles or similar sores should remain calm and treat it early. This condition is like a tiger entering a room; if not handled properly, it will surely cause harm. One should first use *Neituo San* (Internal Support Powder), followed by *Wuxiang Lianqiao Tang* (Five-Aromatic Forsythia Decoction), combined with the "Riding a Bamboo Horse" method, garlic-partitioned moxibustion, and explicit moxibustion on Zusanli (ST36) to vent the toxicity. Generally, where pathogenic factors gather, Qi must be deficient; if they linger and do not depart, the disease becomes excess. Therefore, before a carbuncle or malignant sore ulcerates, when viscera accumulate toxins, absolutely no hot-natured herbs should be used. After ulceration, when viscera are depleted, absolutely no cold-natured herbs should be used, and topical applications that close pores should also be avoided. If there is heat-thirst and constipation with a deep, solid, flooding, and rapid pulse, herbs such as Dahuang (Rhubarb Rhizome) should be used to drain the toxin; subsequently, options include Guolao Gao (Old Man Paste), Wanjing San (Ten-Thousand Gold Powder), Huangfan Wan (Yellow Alum Pill), and Yuanzhi Jiu (Polygala Wine).
My commentary: If the aforementioned symptoms involve heat-toxin accumulating internally with constipation and intact Yuan Qi, Dahuang (Rhubarb Rhizome) and similar herbs should be used to drain heat-toxin. If there is Yin deficiency with Yang encroachment, essence and Qi depletion, and Spleen-Stomach weakness, sweet-warm formulas should be used to cultivate the root. If the sore does not swell or suppurate, even if un-ulcerated, warming and tonifying are still required. If the sore has ulcerated but swelling and pain persist, cooling agents should still be used. If the disease is acute with solid Yuan Qi, treat the branch first; if chronic with deficient Yuan Qi, treat the root first; or if acute with severe Yuan Qi deficiency, prioritize treating the root while addressing the branch. Generally, high swelling with pain and thick, sticky pus indicates undamaged Yuan Qi, making treatment easier. Diffuse swelling with slight pain and clear, thin pus indicates weak Yuan Qi, making treatment difficult. No swelling or pain, or diffuse dark non-ulcerating lesions, indicate Yin-type onset with extreme Yuan Qi deficiency, which is theoretically incurable. For high swelling with pain, first use Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction), then Tuoli Xiaodu San (Support Interior and Detoxify Powder). For diffuse swelling with slight pain, use Tuoli San (Support Interior Powder); if ineffective, add Shengjiang (Fresh Ginger Rhizome) and Rougui (Cinnamon Bark). If pain persists after pus discharge, it indicates Qi and Blood deficiency; use Bazhen San (Eight-Treasure Powder). Failure to form pus or slough indicates Yang deficiency; use Sijunzi Tang (Four Gentlemen Decoction) plus Danggui (Angelica Sinensis Root), Huangqi (Astragalus Membranaceus Root), and Rougui (Cinnamon Bark). Failure to generate flesh or contract indicates Spleen Qi deficiency; use Shiquan Dabu Tang (Great Tonifying Decoction of Ten Ingredients) plus Shengjiang (Fresh Ginger Rhizome) and Rougui (Cinnamon Bark). Afternoon fever and internal heat indicate Yin-Blood deficiency; use Siwu Tang (Four Substances Decoction) plus Renshen (Ginseng Radix) and Baizhu (Atractylodes Macrocephala Rhizome). Nausea or vomiting indicates Stomach Qi deficiency; use Liujunzi Tang (Six Gentlemen Decoction) plus Paojiang (Prepared Ginger Rhizome). Spontaneous and night sweats indicate Five Viscera deficiency; use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Wuweizi (Schisandra Fruit). Poor appetite and fatigue indicate Spleen Qi deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Fuling (Poria) and Banxia (Pinellia Tuber). Panting and coughing indicate Spleen-Lung deficiency; add Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) to the previous formula. Nausea and poor appetite indicate Spleen-Stomach deficiency; use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). Abdominal pain and diarrhea indicate Spleen-Stomach deficiency-cold; use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). Lower abdominal fullness and lower leg edema indicate Spleen-Kidney weakness; use Shiquan Dabu Tang (Great Tonifying Decoction of Ten Ingredients) plus Shanzhuyu (Cornus Fruit), Shanyao (Dioscorea Rhizome), and Rougui (Cinnamon Bark). Diarrhea with cold feet indicate Spleen-Kidney deficiency-cold; add Rougui (Cinnamon Bark) and Fuzi (Aconite Lateral Root) to the previous formula. Heat-thirst and dysuria indicate Kidney deficiency with deflected fire; use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). Panting, coughing, and dysuria indicate Lung-Kidney deficiency-fire; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Jiajian Bawei Wan (Modified Eight-Ingredient Pill). All these variations result from Yuan Qi depletion and failure to tonify preemptively. Thus, Mr. Danxi said: "Whenever swelling and pain are seen, consult the pulse and symptoms; if deficient, immediately provide tonification. If Qi and Blood are not depleted, ultimate auspiciousness can be ensured." How profound these words are! Since the patterns of deficiency and excess differ between ancient and modern times, treatment adapted to the era may vary slightly. The theories in this collection generally follow this principle.
Attached Treatment Cases
Chen Jinghan from Shanglin suffered from a carbuncle on his face. His pulse was flooding, rapid, and forceful, indicating pathogenic accumulation. I administered Qingre Xiaodu San (Clear Heat and Detoxify Powder) for two doses without effect. Someone else prescribed Huangqi (Astragalus Membranaceus Root) and Rougui (Cinnamon Bark) for two doses, which exacerbated the condition, causing swelling and closure of the eyes, ears, lips, and mouth, with the head and face swelling like a bucket. This was due to exterior pathogenic excess. However, the pulse was weak upon deep pressure, indicating interior Yuan Qi deficiency. Continuous administration of Tuoli Xiaodu (Support Interior and Detoxify) medicines, along with multiple phlebotomies at the lesion site, expelled about one bowl of black blood. Subsequently, pus and necrotic tissue discharged together. Continued use of interior-supporting medicines gradually healed the sore. Seven days later, due to improper care, he developed irritability, thirst, and anorexia. Both Chi pulses became thread-like and nearly imperceptible. Urgently, Bawei Wan (Eight-Ingredient Pill) decoction was administered, restoring the pulse instantly and warming the limbs. Had we not used phlebotomy to vent the exterior, Tuoli San to tonify the interior, and Bawei Wan to restore Yang, improper treatment would have led to death. Caution is paramount!
Chancellor Chen Lushan, burdened by official duties and labor, injured his Yuan Qi. He developed a carbuncle on his back: diffuse swelling, dark center, slightly red and painful periphery, floating-large pulse, fine upon pressure, short Left Cun, and almost absent Right Cun. After ten days, swelling had not fully risen. This indicated deficiency-cold of both pathogenic and Yuan Qi. Mornings: Renshen (Ginseng Radix), Huangqi (Astragalus Membranaceus Root), Shengjiang (Fresh Ginger Rhizome), Rougui (Cinnamon Bark), Danggui (Angelica Sinensis Root), Baizhu (Atractylodes Macrocephala Rhizome), Chenpi (Tangerine Peel), Banxia (Pinellia Tuber), Zhigancao (Prepared Licorice Root) to warm and tonify Yang. Evenings: Jiajian Bawei Wan (Modified Eight-Ingredient Pill) to nourish Liver and Kidney. Four doses each resulted in sloughing. However, pus was clear and thin, with night sweats, spontaneous sweating, internal heat, and afternoon fever. Pulse was floating and rapid. Switched to Bazhen Tang (Eight-Treasure Decoction). Fever recurred with nocturnal erection, indicating Kidney deficiency with fire agitation. Resumed Jiajian Bawei Wan (Modified Eight-Ingredient Pill) decoction, leading to stability. Anger stirred Liver Fire, causing bleeding of about two cups from the sore. Left Guan pulse was wiry-rapid, Right Guan wiry-weak. This indicated Liver Wood insulting Spleen Earth, causing Liver inability to store Blood and Spleen inability to control Blood. Used Shiquan Dabu Tang (Great Tonifying Decoction of Ten Ingredients) combined with previous medicine for two doses to stop bleeding. Continued调理 (regulation) with previous medicines for recovery.
A military officer suffered from a brain carbuncle with internal ulceration, heat-thirst, head/face swelling like a bucket, chest/back redness like applied cinnabar, irritability, and constipation. This indicated exterior-interior excess. Without bitter-cold agents to drain internally and externally, rescue was impossible. Acupuncture around the neck drained pus. One dose of Qingliang Yin (Cooling Drink) containing 5 qian of Dahuang (Rhubarb Rhizome) was given, followed by Xiaodu San (Detoxify Powder) for cure.
Jietui Wang Qizhi suffered from a back carbuncle. The sore head was like a millet seed, with back pain and heaviness. Pulse was deep and solid, indicating internal toxin. Two doses of Huanglian Neituo Tang (Coptis Internal Support Decoction) reduced symptoms slightly. Cured with Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction).
Juren Liu Huaifu suffered from localized swelling and pain. Pulse was floating and rapid, indicating toxin accumulated in collaterals. Two doses of Neituo Fujian San (Internal Support Re-decocting Powder) reduced swelling. Four doses of Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction) stopped pain and swelling. Continued with interior-supporting medicines for recovery.
A scholar suffered from a back carbuncle with severe swelling and pain, indicating intense heat-toxin accumulation. Pain stopped after garlic-partitioned moxibustion. Swelling subsided after Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction). Ulcerated and healed with interior-supporting medicines.
A man suffered from a back carbuncle. Necrotic tissue discharged but new flesh did not grow, indicating toxin resolved but Spleen-Stomach Qi deficient. Gradually improved with Liujunzi Tang (Six Gentlemen Decoction) plus Chuanxiong (Ligusticum Rhizome), Danggui (Angelica Sinensis Root), Wuweizi (Schisandra Fruit), and Huangqi (Astragalus Membranaceus Root). Fully recovered with Shiquan Dabu Tang (Great Tonifying Decoction of Ten Ingredients).
A man suffered from a back carbuncle. Flesh rotted with clear pus, no muscle growth, indicating pathogen gone but Qi and Blood both deficient. Recovered after one month using Shiquan Dabu Tang (Great Tonifying Decoction of Ten Ingredients).
A man suffered from a back carbuncle with swelling, pain, a red halo extending over a chi, and back heaviness like carrying a stone. The condition warranted aggressive attack, but the pulse contraindicated it. Phlebotomy at the red area expelled about one bowl of purple blood, instantly reducing swelling and pain. Two doses of Shengong San (Divine Merit Powder) and Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction) caused bloody water discharge from the sore and phlebotomy sites, leading to resolution.
Scholar Zhou Zailu, harboring long-term depression, developed a spine carbuncle. Liver pulse was wiry-flooding, Spleen pulse floating-large, fine upon pressure. Prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Jiegeng (Platycodon Root) and Beimu (Fritillaria Bulb), with small amounts of Yinhua (Honeysuckle Flower) and Baizhi (Angelica Dahurica Root). After two doses, Liver pulse retreated, Spleen pulse recovered. Then two doses of Huoming Yin (Saving Lives Decoction) caused pus discharge and swelling reduction, but Liver pulse remained wiry. This indicated toxin removed but Stomach Qi re-injured. Continued with previous formula plus Banxia (Pinellia Tuber) and Fuling (Poria) for cure. Yinhua (Honeysuckle Flower) and Baizhi (Angelica Dahurica Root) were used not to treat the sore, but to alleviate the patient's anxiety.