伍氏曰∶疮肿赤色，按之色不变者，此脓已成矣。按之随手赤色者，其亦有脓也。按之
白者，良久方赤，此游毒已息，可就赤白尽处灸断，赤肿自消。凡痈疽，以手按之，若牢
，未有脓也。若半软半 ，已有脓也。又按肿上，不热者为无脓。热甚者为有脓，宜急破之。
愚按∶疮疡毒瓦斯已结而不发者，法当补其血气，使脓速成而针之。其脓既溃，宜培养脾
胃以生肌敛口。大凡疮疡脓血既溃，当大补血气为先，虽有他症，当以末治。
附治验
二守施希禄，项患毒，脓已成，因畏针， 延至胸，色赤如霞，其脉滑数，饮食不进，
月余不寐，肢体甚倦。此气血虚，而不能溃也。余针之，肿出即睡，觉而思食，用托里药，
两月而愈。
州守胡延器，脓熟不溃，倦怠发热。余为针之，脓遂涌出，已而发热恶寒，大渴不止，
此虚之极也。服人参黄 汤二剂，热愈甚，又二剂始应。再以当归补血汤数剂渐痊。
一老人，腿患痈，脓自溃，忽发昏瞀，脉细微，此血虚极也。以大补之剂而苏。
一弱人，流注内溃，出败脓五六碗，是时口眼歪斜。以独参汤加附子二钱，二剂少愈，
更以十全大补之剂，月余而痊。大抵疮疡脓血既泄，当大补气血为先，虽有他症，当以末
治之。
治痈久不合，其肉白而脓少者，此气血俱虚，不能潮运，而疮口冷涩也。每日用艾叶一
把煎汤，避风热洗，及烧松香烟熏之，更以神异膏贴之，必须守禁调理，否则不效。
愚按∶前症，果因寒邪凝滞气血，不能荣卫，宜用斯法祛散寒邪，补接阳气，其功甚大。
若因血气虚弱，不能潮会疮口，必用补脾胃生气血为善。丹溪先生云∶诸经惟少阳、厥阴之
生痈疽，宜预防之，以其多气少血也。血少而肌肉难长，疮久未合，必成败症。苟反用驱利
毒药，以伐其阴分之血，祸不旋踵矣。
附治验
地官李孟卿，环跳穴患疽，内服外敷，皆败毒寒剂，因痛极刺之，脓瘀大泄，疮口开
张，其色紫黯，右关脉浮大。此胃气复伤，不能荣于患处也。余以豆豉饼、六君子加藿香、
砂仁、炮姜数剂，由是胃气醒而饮食渐进，患处暖而肌肉渐生，再以十全大补汤而愈。
大尹都承庆，患附骨疽，内痛如锥，外色不变，势不可消。喜其未用寒剂，只因痛伤胃
气，而不思饮食，用六君子汤治之，饮食少进。更以十全大补，二十余剂而脓成，针去。仍
以大补汤倍用参、 、归、术，加麦门、五味、远志、贝母，数服，脓渐止，而疮亦愈。按
二症，盖因湿热滞于肉理，真气不能运化。其始治宜实脾土，和气血，隔蒜灸，而疽自消矣。
治背疽糁药方
李氏云∶龙游有患背疽者，大溃，五脏仅隔膜耳，自谓必死，用鲫鱼去肠，实以羯羊粪，烘
焦为末，干糁之，疮口自收。此出洪氏方，屡用有效，故附于此，须候脓少欲生肌肉时用之。
附治验
黄汝耘，患发背，用生肌药益溃，大便泄泻，其脉微缓。余谓脾胃虚，先用二神丸以止
其泻，次用大补药以固其本，更用猪蹄汤洗患处，用黄 末以涂其外。喜其初起曾用艾灸，
毒不内攻，两月而愈。
许鸿胪，发背十余日，肿硬木闷，肉色不变，脉沉而实，此毒在内。先以黄连内 汤，
更以消毒托里药，其毒始发。奈欲速愈，急用生肌药，患处如负石，身如火 ，遂致不起。
Wu stated: When a carbuncle or swelling is red, and the color does not change upon pressure, this indicates that pus has already formed. If it turns red immediately upon pressure, pus is also present. If it turns white upon pressure and only becomes red after a long time, this signifies that the wandering toxin has subsided; moxibustion can be applied at the boundary where redness and pallor meet to cut off the disease progression, and the redness and swelling will naturally dissipate. For all carbuncles and sores, if palpation reveals hardness, no pus is present. If it is half soft and half hard, pus is present. Furthermore, if the swollen area is not hot to the touch, there is no pus; if it is very hot, pus is present, and urgent incision and drainage are indicated.
My commentary: When the toxic qi of a sore or ulcer has condensed but cannot erupt, the treatment method should involve tonifying blood and qi to hasten pus formation, followed by needle drainage. Once the pus has erupted, one should nurture the spleen and stomach to generate flesh and close the wound. Generally, after a sore or ulcer has erupted with pus and blood, the priority must be massive tonification of blood and qi; even if other symptoms exist, they should be treated as secondary.
Attached Treatment Cases
Shi Xilu, an official of the Second Rank, suffered from a toxic sore on the neck. Pus had already formed, but due to fear of needles, he delayed treatment until the toxicity spread to the chest. The area was red like rosy clouds, the pulse was slippery and rapid, he could not eat, had not slept for over a month, and his limbs were extremely fatigued. This was due to deficiency of blood and qi, preventing eruption. I needled him; the swelling subsided, and he fell asleep immediately. Upon waking, he desired food. He used interior-supporting medicines and recovered in two months.
Hu Yanqi, a prefectural governor, had ripe pus that did not erupt, accompanied by fatigue and fever. I needled him, and pus gushed out. Subsequently, he experienced fever and aversion to cold, with extreme unquenchable thirst. This indicated extreme deficiency. After taking two doses of Ginseng and Astragalus Decoction (Renshen Huangqi Tang), the heat intensified. After two more doses, it began to respond. He then took several doses of Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction) and gradually recovered.
An elderly man suffered from a carbuncle on his leg. The pus ruptured spontaneously, but he suddenly became comatose and confused, with a fine and minute pulse. This indicated extreme blood deficiency. He revived after receiving massive tonifying agents.
A frail person suffered from internal rupture of migrating abscesses (Liuzhu), expelling five or six bowls of foul pus. At that time, his mouth and eyes deviated. He took Dushen Tang (Single Ginseng Decoction) with two qian of Aconite Root (Fuzi). After two doses, he improved slightly. He then took Shiquan Dabu Tang (Complete Great Tonifying Decoction) and recovered in over a month. Generally, once pus and blood have drained from a sore or ulcer, massive tonification of blood and qi must be prioritized. Even if other symptoms exist, they should be treated secondarily.
Treatment for chronic non-healing sores with pale flesh and scanty pus: This indicates deficiency of both blood and qi, failing to circulate and nourish, resulting in a cold and stagnant sore opening. Daily, decoct a handful of Artemisia argyi Leaves (Aiye) in water, wash the area avoiding wind and heat, fumigate with burning pine smoke, and apply Shenyi Gao (Divine Miracle Plaster). Strict dietary and lifestyle prohibitions must be observed during recovery, otherwise efficacy will be lacking.
My commentary: In the aforementioned condition, if it is indeed caused by cold pathogen stagnating blood and qi, preventing proper nourishment and defense, this method effectively dispels cold and restores yang qi, yielding great results. However, if it is due to weak blood and qi failing to converge at the sore opening, tonifying the spleen and stomach to generate blood and qi is superior. Master Danxi stated: Among the meridians, only Shaoyang and Jueyin are prone to carbuncles and sores and require prevention, because they possess abundant qi and scarce blood. Scarce blood makes muscle growth difficult; if a sore remains open for a long time, it inevitably becomes a critical condition. If one instead uses purgative or toxic drugs to attack the blood of the yin aspect, disaster will follow swiftly.
Attached Treatment Cases
Li Mengqing, an official of the Earth Ministry, suffered from a gangrenous sore at the Huantiao Acupoint (GB30). Internal and external treatments consisted of detoxifying and cold-natured agents. Due to extreme pain, he lanced it, causing large amounts of pus and stasis to drain. The sore opened wide with a purple-dark color, and the right Guan pulse was floating and large. This indicated further injury to stomach qi, failing to nourish the affected area. I used Fermented Soybean Cake (Douchi Bing) and Liujunzi Tang (Six Gentlemen Decoction) added with Agastache Rhizome (Huoxiang), Amomum Fruit (Sharen), and Processed Ginger (Paojiang) for several doses. Consequently, stomach qi awakened, diet gradually increased, the affected area warmed, and flesh regenerated. He recovered after taking Shiquan Dabu Tang.
Du Chengqing, a district magistrate, suffered from deep bone gangrene (Fugu Ju). Internal pain felt like awl piercing, external color remained unchanged, and the condition could not resolve. Fortunately, he had not used cold-natured agents. The pain had injured stomach qi, leading to loss of appetite. I treated him with Liujunzi Tang, and his diet slightly improved. He then took Shiquan Dabu Tang for over twenty doses until pus formed, which was then drained. He continued with a modified Da Bu Tang (Great Tonifying Decoction) with doubled doses of Ginseng Root (Renshen), Astragalus Root (Huangqi), Angelica Sinensis Root (Danggui), and Atractylodes Macrocephala Rhizome (Baizhu), added with Ophiopogon Tuber (Maimendong), Schisandra Berry (Wuweizi), Polygala Root (Yuanzhi), and Fritillaria Bulb (Beimu). After several doses, pus secretion ceased, and the sore healed. Analyzing these two cases, the cause was likely damp-heat stagnating in the muscle tissue, preventing true qi transformation. Initial treatment should focus on strengthening spleen earth, harmonizing blood and qi, and using Garlic-Separated Moxibustion (Gesan Jiu), allowing the gangrene to dissipate naturally.
Formula for Sprinkling Powder on Back Carbuncles
The Li family stated: In Longyou, a patient with a back carbuncle had extensive ulceration, leaving only the diaphragm separating the viscera. Believing death was certain, he used a carp cleaned of entrails, stuffed with sheep dung, roasted until charred, ground into powder, and sprinkled dry onto the wound. The sore closed naturally. This formula comes from Hong Shi’s records and has been effective repeatedly, so it is attached here. It should only be used when pus is scant and flesh regeneration is desired.
Attached Treatment Cases
Huang Yuyun suffered from a back carbuncle. Use of flesh-generating medicines worsened the ulceration, accompanied by diarrhea and a faint, slow pulse. I diagnosed spleen and stomach deficiency. First, I used Ershen Wan (Two Spirits Pill) to stop diarrhea, then used massive tonifying agents to secure the root. Additionally, I washed the affected area with Pig Trotter Soup and applied Astragalus Root powder externally. Fortunately, moxibustion had been used initially, preventing internal invasion of toxicity. He recovered in two months.
Xu Honglu suffered from a back carbuncle for over ten days. The swelling was hard and numb, skin color unchanged, and the pulse was deep and excess. This indicated internal toxicity. Initially, I used Huanglian Neishu Tang (Coptis Internal-Draining Decoction), followed by detoxifying and interior-supporting medicines, which allowed the toxicity to surface. However, desiring a quick cure, he urgently used flesh-generating medicines. The affected area felt heavy as if bearing a stone, and his body felt like burning fire, ultimately leading to his death.