曾氏曰∶痈疽脓熟，涂以替针丸，疮口自开。古人云，痈疽能杀人，若针药得其宜则
生，失其宜则死，可不慎哉。
愚按∶疮疡之症，若毒瓦斯已结，肿赤炽盛，中央肉死黯黑者，内用托里健脾之剂，外用
乌金膏涂之，则黯处渐低，赤处渐起，至六七日间，赤黯之界，自有裂纹如刀划状，其黯渐
溃。若用铍针利剪，徐去犹好，须使不知疼痛、不见鲜血为善。若脓未流利，宜用针于纹中
引之。若脓水已出，肿痛仍作，乃内筋间隔，亦用针引之。若元气虚弱，误服克伐之剂，患
处不痛，或肉死不溃者，急温补脾胃，亦有复生矣。后须纯补脾胃，庶能收敛？若妄用针刀
去肉出血，使阳随阴散，是速其危也。若脓溃而烦痛未痊，脉洪滑粗散者，真气虚而邪气实
也，为难治。脉微涩迟缓者，邪气虚而真气将复也，为易治。
李氏云∶痈疽有误搽毒药，或针刀开割，疮口不合，不可用涩敛之药。宜用猪蹄汤、北
艾汤间洗，敷贴神异膏，及服内补十宣散、内托黄 丸。
愚按∶经云∶脾主肌肉。脾健则肉自生。然其势炽甚，宜用前药以消其毒，毒将尽宜用
四君汤以养脾（详见附录用药关键）。
内托黄 丸 治针砭所伤，恶寒发热，脓水不止，肌肉不生，疮口不敛。
黄 八两 当归（洗焙三两） 肉桂（去外皮） 木香 沉香 乳香（另研各一两） 绿豆末（四两）
上为末，用姜汁、豆末糊丸，熟水下。
愚按∶前症若肌肉伤，而疮口不敛，用六君子汤，以补脾胃。若气虚恶寒，而疮口不
敛，用补中益气汤，以补脾肺。若血虚发热，而疮口不敛，用四物参术，以滋肝脾。若脓多
而疮口不敛，用八珍汤，或十全大补汤，以养血气。经云∶脾主肌肉。如前药未应，但用四
君、归、 以补脾胃。更不应，乃属命门火衰，急用八味丸以壮火生土。若脉数发渴者难
治，以真气虚而邪气实也。
Zeng said: When the pus of a carbuncle or ulcer is ripe, applying Tiphen Wan (Needle-Replacing Pill) will cause the wound to open naturally. The ancients said that carbuncles and ulcers can be fatal; if needles and medicines are used appropriately, life is preserved, but if misused, death ensues. Can one not be cautious?
My commentary: In cases of sores and ulcers, if the pathogenic toxins have consolidated, with intense redness and swelling, and the central flesh is necrotic and dark black, internal administration of formulas that support the interior and strengthen the spleen, combined with external application of Wujin Gao (Gold Ointment), will cause the dark areas to gradually flatten and the red areas to gradually rise. By the sixth or seventh day, cracks resembling knife cuts will naturally appear at the boundary between the red and dark areas, and the necrotic tissue will gradually slough off. It is preferable to slowly remove the necrotic tissue using a Pi Zhen (Lancet Needle) and sharp scissors, provided that the patient feels no pain and no fresh blood is seen. If the pus is not yet flowing freely, it is appropriate to use a needle to guide drainage through the cracks. If pus has drained but swelling and pain persist, this indicates obstruction by internal fascia; again, needle guidance should be used. If the primordial qi is deficient and offensive/depleting medicines were mistakenly taken, resulting in a painless lesion or necrotic flesh that does not ulcerate, urgent warming and tonification of the spleen and stomach is required, and recovery is possible. Subsequently, pure tonification of the spleen and stomach is necessary to facilitate healing. If one recklessly uses needles and knives to remove flesh causing bleeding, dispersing yang following yin, this accelerates danger. If after ulceration, vexation and pain persist, and the pulse is surging, slippery, coarse, and scattered, this indicates deficiency of true qi and excess of pathogenic factors, making it difficult to treat. If the pulse is faint, choppy, slow, and delayed, this indicates deficiency of pathogenic factors and the impending recovery of true qi, making it easy to treat.
Li said: In carbuncles and ulcers, if poisonous drugs were mistakenly applied, or if needles and knives were used for incision, and the wound fails to close, astringent and收敛 (astringent/healing) medicines should not be used. It is advisable to wash alternately with Pig Trotter Decoction and Northern Mugwort Decoction, apply Shenyi Gao (Miraculous Efficacy Ointment), and administer Neibu Shixuan San (Internal-Nourishing Ten-Accumulation Powder) and Naituo Huangqi Wan (Interior-Supporting Astragalus Pill).
My commentary: The Classics state: The Spleen governs the muscles. When the Spleen is healthy, muscles regenerate naturally. However, when the pathological condition is intense, the aforementioned medicines should be used to eliminate toxins. When the toxins are nearly exhausted, Sijunzi Tang (Four Gentlemen Decoction) should be used to nourish the Spleen (see Appendix on Key Medication Principles).
Naituo Huangqi Wan (Interior-Supporting Astragalus Pill) treats injuries caused by acupuncture and cupping/scarification, characterized by aversion to cold and fever, continuous discharge of pus, failure of muscle regeneration, and non-healing wounds.
Huangqi (Astragali Radix) 8 liang
Danggui (Angelicae Sinensis Radix) 3 liang (washed and dried)
Rougui (Cinnamomi Cortex) (outer bark removed)
Muxiang (Aucklandiae Radix)
Chenxiang (Aquilariae Lignum Resinatum)
Ruxiang (Boswelliae Resina) (separately ground) 1 liang each
Lvdou Mo (Vigna Radiata Semen Pulvis) 4 liang
Grind all into powder. Make pills using ginger juice and a paste made from mung bean flour. Swallow with well-cooked water.
My commentary: For the aforementioned conditions, if muscles are injured and the wound fails to heal, use Liujunzi Tang (Six Gentlemen Decoction) to tonify the spleen and stomach. If qi deficiency causes aversion to cold and the wound fails to heal, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify the spleen and lungs. If blood deficiency causes fever and the wound fails to heal, use Siwu Tang (Four Substances Decoction) plus Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) to nourish the liver and spleen. If there is excessive pus and the wound fails to heal, use Bazhen Tang (Eight Treasures Decoction) or Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) to nourish blood and qi. The Classics state: The Spleen governs the muscles. If the aforementioned medicines are ineffective, simply use Sijunzi Tang, Danggui (Angelicae Sinensis Radix), and Shudi (Rehmanniae Radix Preparata) to tonify the spleen and stomach. If still ineffective, it belongs to decline of Mingmen Fire (Gate of Life Fire); urgently use Bawei Wan (Eight-Ingredient Pill) to strengthen fire to generate earth. If the pulse is rapid and accompanied by thirst, it is difficult to treat, as true qi is deficient and pathogenic factors are excess.