（肿疡 溃疡 作痛不止 作呕不止 出血不止 肌肉不生 发热不止 大便不通 小便不通
作渴不止 自汗不止 下痢不止 敷寒凉药 用刀针法）
痈疽一科。自有专擅其术者。以是手辑医通。独略此门。然有兼患内证。疡医不能措指者。
因取灵素金匮明之新甫等数条。列之本门。诸凡治例。未遑遍述。庶免瘠环同类之诮云。
灵枢云。夫血脉营卫。周流不休。上应星宿。下应经数。寒邪客于经络之中则血泣。血泣则
不通。不通则卫气归之。不得复反。故痈肿。寒气化为热。热胜则肉腐。肉腐则为脓。脓不泻则
烂筋。筋烂则伤骨。骨伤则髓消。不当骨空。不得泄泻。血枯空虚。则筋骨肌肉不相荣。经脉败
漏。熏于五脏。脏伤则死矣。痈发于嗌中。名曰猛疽。猛疽不治化为脓。脓不泻。塞咽半日死。
其化为脓者。泻则合豕膏冷食。三日而已。发于颈。名曰天疽。其痈大以赤黑。不急治则热气下
入渊液。前伤任脉。内熏肝肺。十余日而死矣。阳气大发。消脑留项。名曰脑烁。其色不乐。项
痛。如刺以针。烦心者死。发于肩及 。名曰疵疽。其状赤黑。急治之。此令人汗出至足。不害
五脏。痈发四五日逞 之。发于腋下赤坚者。名曰米疽。治之以砭石。欲细而长。疏砭之。涂以
豕膏。六日已。勿裹之。其痈坚而不溃者。为马刀挟瘿。急治之。发于胸。名曰井疽。其状如大
豆。三四日起。不早治。下入腹。不治。七日死。发于膺。名曰肝疽。色青。其状如谷实、栝蒌。
常苦寒热。急治之。去其
寒热。半岁死。死后出脓。发于胁。名曰败疵。败疵者女子之病也。灸之。其状大痈脓。治之。
其中乃有生肉。大如赤小豆。锉 、翘草根各一升。（零 连翘根各一升也。）以水一斗六升。
煮之竭。为取三升。则强浓衣。坐于釜上。令汗出至足已。发于股胫。名曰股胫疽。其状不甚
变。而痈脓搏骨。不急治。三十日死。发于尻。名曰锐疽。其状赤坚大。急治之。不治。三十日
死。发于股阴。名曰赤疽。不急治。六十日死。在两股内。不治。十日当死。发于膝。名曰疵痈。
其状大痈。色不变。寒热。如坚石。勿石。石之者死。须其柔乃石之者生。诸痈疽之发于节而相
应者。不可治也。发于阳者百日死。发于阴者三十日死。发于胫。名曰兔啮。其状赤至骨。急治
之。不治害人也。发于内踝。名曰走缓。其状痈也。色不变。数石其输。而止其寒热不死。发于
足上下。名曰四淫。其状大痈。不急治。百日死。发于足傍者。名曰疠痈。其状不大。初如小指。
发急治之。去其黑者。不消辄益。不治。百日死。发于足指。名脱痈。（一名脱疽。）其状赤黑。
死不治。不赤黑不死。不衰。急斩之。不则死矣。
营气稽留于经脉之中。则血泣而不行。不行则
卫气从之而不通。壅遏而不得行。故热。大热不止。热胜则肉腐。肉腐则为脓。然不能陷。骨髓
不为焦枯。五脏不为伤。故命曰痈。热气深甚。下陷肌肤。筋骨枯。内连五脏。血气竭。当其痈下
筋骨良肉皆无余。故命曰疽。疽者。上之皮夭以坚。上如牛领之皮。痈者。其皮上薄以泽。此其
候也。病有形而不痛者。阳之类也。无形而痛者。阴之类也。无形而痛者。其阳完而阴伤之也。
急治其阴。无攻其阳。有形而不痛者。其阴完而阳伤之也。急治其阳。无攻其阴。阴阳俱动。乍
有形。乍无形。加以心烦。命曰阴胜其阳。此为不表不里。其形不久。身有五部。伏兔一。腓二。
腓者 也。背三。五脏之俞四。项五。此五部有痈疽者死。喜怒不测。饮食不节。阴气不足。阳
气有余。营气不行。乃发为痈。阴阳不相通。两热相持。乃化为脓。其白眼青。黑眼小。是一逆
也。内药而呕。是二逆也。
腹痛渴甚。是三逆也。肩项中不便。是四逆也。音嘶色脱。是五逆也。除此五者为顺矣。
素问云。膏粱之变。足生大疔。受如持虚。汗出见湿。乃生痤痱。营气不从。逆于肉理。乃
生痈肿。气伤痛。形伤肿。先痛而后肿者。气伤形也。先肿而后痛者。形伤气也。
金匮云。诸浮数脉。应当发热。而反洒淅恶寒。若有痛处。当发其痈。师曰。诸痈肿。欲知
有脓无脓。以手掩肿上。热者为有脓。不热者为无脓。
发热而脉见浮数。证脉相应也。脉见浮数而反洒淅恶寒。是火郁不得发越。若有痛处而饮食
如常。必发痈肿之候。肿热未甚。尤可消散。肿热已剧。痈脓已成。后世用湿纸贴肿上。候其痈
肿之头。亦不出乎此意。
浸淫疮。从口流向四肢者可治。从四肢流来入口者不可治。浸淫疮。黄连粉主之。（方缺）
病机机要云。瘰 者结核是也。或在耳后。或在耳前。或在耳下连及颐颔。或在颈下连缺盆。
皆谓瘰 。或在胸之侧。或在两胁。皆谓之马刀。手足少阳主之。此本膏粱丹毒火热之变。因虚
劳气郁所致。止宜补形气。调经脉。其疮当自消。盖不待汗之下之而已也。其不详脉证经络受病
之异者。下之先犯病禁经禁。故致失手。且有兼痰兼气兼血兼阴虚等证者。病本不同。治当求责。
疮疡者火之属。须分内外以治其本。内之外者。其脉沉实。发热烦躁。外无 赤。痛深于内。其
邪气深矣。故疏通脏腑以绝其源。外之内者。其脉数。 肿在外。形证外显。恐气极而犯内。故
先托里也。内外之中者。外无 恶之气。内亦脏腑宣通。知其在经。当和营卫也。用此三法之后。
虽未愈。必无变证。亦可使邪气峻减而易愈。
外科精要云。热发于皮肤之间。浮肿根小。至大不过二三寸者为疖。六腑积热。腾出于肌肉
之间。其发暴盛肿。皮肉光软。根脚广大为痈。五脏风毒积热。攻 肉骨。风毒猛暴。初生一如
蓓蕾。形自焦枯。触之应者乃疽也。夫五善七恶者。动息自宁。饮食知味。一善也。便利调匀。
二善也。脓稠肿消不臭。三善也。神采精明。语声清爽。四善也。体气平和。五善也。烦躁时嗽。
腹痛渴甚。或泄利无度。小便如淋。一恶也。脓血大泄。肿 尤甚。脓色败臭。痛不可近者。二
恶也。喘粗短气。恍惚嗜卧。三恶也。目视不正。黑睛紧小。白睛青赤。瞳子上视者。四恶也。
肩背不便。四肢沉重。五恶也。饮食不下。服药而呕。食不知味。六恶也。声嘶色败。唇鼻青。
面目四肢浮肿。七恶也。五善见三则瘥。七恶见四则危。然则病有源同七恶者。乃皮紧急而知善
也。病有源同五善者。乃皮缓虚而知恶也。是岂凡医所知哉。
凡人初见发背。欲结未结。赤热肿痛。先以湿纸覆其上。立视候之。其纸先干处。即是结痈
头也。取大蒜切成片。如三钱浓薄。安于头上。用大艾炷灸之。三壮即换一蒜片。痛者灸至不痛。
不痛者灸至痛时方佳。最要早觉早灸为上。一日二日。十灸十活。三日四日。六七活。五六日。
三四活。过七日则不可灸矣。若有十数头作一处生者。即用大蒜研成膏。作薄饼铺头上。聚艾于
蒜饼上烧之。亦能活也。若背上初发赤肿一片。中间有一片黄粟米头子。便用独蒜切去两头。取
中间切三钱浓。正安疮上。着艾灸十四壮。多至四十九壮。此谓痈疽初发。宜灸之也。然诸疮患
久成漏者。常有脓水不绝。其脓不臭。内无反肉。尤宜用附子浸透。切作大片。浓三二分。于疮
着艾灸之。仍服内托之药。隔二三日再灸之。不五七次。自然肌肉长满矣。至有脓水恶物。渐渍
根深者。郭氏用白面、硫黄、大蒜三物一处捣烂。看疮大小捻作饼子。浓约三分。安疮上。用艾
灸二十一壮。一灸一易。灸后四五日。方用挺子 入疮内。歹肉尽去。好肉长平。然
后贴收敛之药。内服应病之剂。调理即瘥矣。盖不止宜灸于疮之始发也。惟发于头脑者。皆不可
灸。头为诸阳之会。灸之反助其火毒耳。
肿疡 薛立斋曰。肿疡者。以疳疡未溃而言也。经云。形伤痛。气伤肿。又云。营气不从。
逆于肉理乃生痈肿。皆因膏粱浓味。七情阴火。或炙爆甘美积毒。气血不和所致。当分其经络所
属。五脏相胜。与元禀亏损。预为审用攻补调和之剂。速令散溃。尤当审其势之肿漫。色之赤白。
与痛有微甚。毒有表里。若肿高 痛。便利调和。邪在表也。宜表散之。肿硬痛深。大便秘涩。
邪在内也。宜下之。外无拘急。内则便利调和者。邪在经络也。宜调营卫。肿 大痛。或麻木不痛。
邪气凝滞也。外用隔蒜灸。内服活命饮。或归 饮尤效。无问何部分。但赤肿者必消。若烦躁饮
冷。赤痛发热。二便不通者。火热内炽也。用四味清凉饮。或活命饮加大黄尤善。若微肿微痛或
不痛。阳气虚弱也。参 内托散。微黯微赤或不赤。或恶寒而不作脓。或脓熟而不溃者。阳气虚
寒也。并用千金托里散。如此则未成者自能消。已成者自能溃。尤当别其属阴属阳。或半阴半阳
而治之。若泥于肿疡禁用辛热之说。不分受证之因。兼证之经。概行败毒。泛扰诸经。诛伐无过。
以致不能起发。或不能溃腐收敛。变证莫能枚举。痈疽论云。肿疡内外皆壅。宜以托里表散为主。
但见肿痛。参之脉证虚弱。便与兼补。气血无亏。可保终吉。若肿疡之际。治失其法。必致溃疡
之变证。此推内经之微旨。而生平之征验者。尤当触类而长。愚奚庸赘。
溃疡 溃疡者。以疮疡脓溃而言也。脓溃而肿消痛止者为顺。若脓溃肿痛。或发寒热者。气
血虚也。十全大补汤。脓溃欲呕少食。脾胃虚弱也。六君子加炮姜。手足并冷者。脾气虚寒也。
六君子加姜、桂。不应。急加附子。脓溃而仍痛。
或二便秘涩者。热毒未解也。清热消毒汤。热退而渴不退。津液不足也。八珍加黄 、麦冬、山
茱萸。热止而小便频数。肾虚也。加减八味丸料。若热不止。或肿痛反甚。虚热内作也。保元汤
加清心凉血之剂。或热退而肌肉不生者。气血俱虚也。十全大补汤。疮色夭白。或陷下不敛。寒
气所袭也。五味异功散。佐以豆豉饼。脓血过多。烦躁不安。乃亡阳也。急用独参汤尤当。审其
肿之软硬。饮食冷热。与脓之稠稀多少。肉之赤色青黯。及疮口之收敛迟速。而投托里消毒调补
之剂。庶无变证。痈疽论云。溃疡内外皆虚。宜以托里补接为主。盖溃疡之变证。由于肿疡之际。
治失其宜。亏损元气所致。治者可不慎欤。
作痛不止 疮疡作痛。当审邪之所在。证之所因。如寒热而痛。邪在表也。人参败毒散。便
秘而痛。邪在里也。清热消毒汤加白蜜。肿 而痛。血凝滞也。活命饮。作脓而痛者。托里消毒
散。排脓胀而痛者针之。脓溃而痛者补之。气虚而痛。四君子加归、 。血虚而痛。四物汤加参、
。大抵形伤痛。气伤肿。不知此数者。徒以乳香、没药为止痛之方。则非所以为法矣。仍审五
脏相胜相兼之证而治之。后仿此。
作呕不止 丹溪云。肿疡时呕。当作毒瓦斯攻心治之。溃疡时呕。当作阴虚补之。此论其常耳。
如肿赤 痛而呕者。热毒甚也。活命饮。作脓而呕者。血气虚也。六君子加归、 。便秘而呕者。
热在脏也。清热消毒汤去生地、金银花加槟榔、木香。寒药服多而呕者。胃气伤也。六君子加桔
梗、柴胡。有肝气乘脾而呕者。有胃虚停痰而呕者。有郁结伤脾而呕者。皆由脾胃虚弱。毒瓦斯蓄
聚。治宜调补中气。则正气复而邪气去矣。
出血不止 疮口出血。有因五脏相胜。阴阳不调。而血不止者。有因六淫七情之气不平。而
血妄行者。若因肝火
内动。四物加山栀、丹皮。肝经血虚。六味丸。心虚不能统血。四物加参、术、丹皮。酸枣仁。
脾虚不能统血。四君子加山栀、丹皮。脾虚郁滞。归脾汤。脾肺气虚。补中益气汤。气血俱虚。
十全大补汤。肾气不足而肝火内动。六味丸、栀子清肝散加五味。大凡失血过多而见烦热发渴等
证。勿论其脉。不问其证。急用独参汤以补其气。经云。血生于气。苟非参、 、归、术甘温之
药。决不能愈。若发热脉大者多不治。
肌肉不生 肌肉乃脾胃所生。收敛皆气血所主。二者相济以成者也。若肌肉不生而色赤。血
热也。四物加山栀、丹皮。晡热内热。血虚也。四君子加归、地、丹皮。脓水清稀。气血虚也。
十全大补汤。食少体倦。脾气虚也。补中益气汤。烦热作渴。起居如常者。胃热也。竹叶黄 汤。
烦热作渴。小便频数者。肾虚也。六味丸。肉腐而不溃者。乌金膏。若肉溃而不敛者。六君子汤。
外用珍珠散敷之。臭秽脉洪大而作渴。乃真气虚而邪气实也。此为难治。大凡疮疡久而不愈者。
皆元气不足。或因邪气凝滞于患处。苟能调补脾胃。则元气自足。元气既足。则邪气自消。死肉
自溃。新肉自生。而疮自敛矣。若不保其本。而概敷生肌之剂。是反助其邪。后更溃烂耳。
发热不止 疮疡发热。初患乃毒瓦斯所 。已成乃内 作脓。已溃乃血气亏损。不可概行败毒。
以伤元气。盖未成者。当分邪之在表在里。将成者。当分邪之可攻可补。已成者。当分脓之作与未
[Swollen Ulcer, Ulcer, Unceasing Pain, Unceasing Vomiting, Unceasing Bleeding, Non-formation of Muscle, Unceasing Fever, Constipation, Urinary Retention, Unceasing Thirst, Spontaneous Sweating, Unceasing Dysentery, Application of Cold-Cooling Medicines, Use of Knife and Needle Therapy]
The specialty of carbuncles and sores (Yong Ju) naturally has practitioners who specialize in this art. Therefore, when compiling *Yi Tong* (Medical Compendium), I deliberately omitted this section. However, for cases where internal diseases are concurrent and surgeons cannot handle them, I selected several passages from *Ling Shu* (Spiritual Pivot), *Su Wen* (Basic Questions), *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), and works by Li Zhongzi (courtesy name Xinfu) of the Ming Dynasty, listing them in this section. As for all treatment principles, there was no time to describe them comprehensively, hoping to avoid criticism from peers for superficial knowledge.
*Ling Shu* states: Blood vessels, Ying Qi (Nutritive Qi), and Wei Qi (Defensive Qi) flow continuously without rest, corresponding to the stars above and the numbers of meridians below. When cold pathogenic factors lodge in the meridians, blood becomes stagnant. Stagnant blood leads to obstruction. Obstruction causes Wei Qi to gather there and prevents it from returning to normal circulation. Thus, swelling and abscesses form. Cold qi transforms into heat; excessive heat causes flesh to rot. Rotten flesh turns into pus. If pus is not drained, tendons will decay. Decayed tendons damage bones. Damaged bones lead to depletion of marrow. If drainage does not occur through bone cavities, blood becomes dry and empty, causing tendons, bones, muscles, and flesh to lose mutual nourishment. Meridians become defective and leaky, with heat steaming into the five Zang organs. Damage to the Zang organs results in death.
An abscess occurring in the middle of the pharynx is called Meng Ju (Fierce Abscess). If untreated, Meng Ju turns into pus. If pus is not drained and blocks the throat, death occurs within half a day. For those who have formed pus, draining it and consuming pig fat ointment (Shi Gao) while eating cold food allows recovery in three days. An abscess on the neck is called Tian Ju (Heavenly Abscess). The swelling is large with red-black coloration. If not treated urgently, heat qi flows downward into the Yuanli acupoint, damaging the Ren Mai (Conception Vessel) forward and steaming into the Liver and Lung internally, leading to death after more than ten days. Excessive expansion of Yang qi depletes brain marrow and stagnates in the nape, called Nao Shuo (Brain Melting). The patient appears unhappy, has nape pain like needle pricks, and experiences irritability; such cases result in death. An abscess on the shoulder and [missing character] is called Ci Ju (Flawed Abscess). Its appearance is red and black, requiring urgent treatment. This condition causes sweating down to the feet but does not harm the five Zang organs. An abscess appearing on the chest after four or five days with [missing character] presentation. An abscess in the axilla that is red and hard is called Mi Ju (Rice Abscess). It is treated with Bian Shi (stone needles), which should be fine and long, pricking sparsely, and coated with pig fat ointment. Recovery occurs in six days; do not bandage it. Abscesses that are hard but do not ulcerate are referred to as Ma Dao Jia Ying (Horse Dagger with Goiter); they require urgent treatment. An abscess on the chest is called Jing Ju (Well Abscess). It resembles a soybean, appearing within three to four days. If not treated early, the pathogen descends into the abdomen; if untreated, death occurs in seven days. An abscess on the anterior chest is called Gan Ju (Liver Abscess). It is blue in color, resembling grain kernels or Trichosanthes fruit. The patient suffers from alternating chills and fever; urgent treatment is needed to remove chills and fever, otherwise death occurs in half a year, with pus discharge after death. An abscess on the hypochondrium is called Bai Ci (Decayed Flaw). Bai Ci is a disease specific to women. Moxibustion is used for treatment. The condition presents as a large abscess with pus; during treatment, raw flesh resembling red adzuki beans may appear inside. Crushed Lian Qiao Gen (Root of Forsythia) and Ling Lian Qiao Gen (Root of Zero-Ling Forsythia), one sheng each, are boiled in one dou and six sheng of water until reduced. Three sheng of liquid are obtained. The patient then wears thick clothing and sits over the pot to steam, inducing sweat down to the feet until cured. An abscess on the thigh and calf is called Gu Ting Ju (Thigh-Calf Abscess). The appearance changes little, but pus presses against the bone. Without urgent treatment, death occurs in thirty days. An abscess on the sacrum is called Rui Ju (Sharp Abscess). It is red, hard, and large; urgent treatment is required, otherwise death occurs in thirty days. An abscess on the inner thigh is called Chi Ju (Red Abscess); without urgent treatment, death occurs in sixty days. If located between the inner thighs and untreated, death occurs in ten days. An abscess on the knee is called Ci Yong (Flawed Swelling). It presents as a large abscess with unchanged color, accompanied by chills and fever, feeling hard like stone. Stone needling is contraindicated; pricking leads to death. One must wait for softness before pricking to ensure survival. Any abscesses arising at joints that correspond to each other are incurable. Those arising in Yang meridians die in one hundred days; those in Yin meridians die in thirty days. An abscess on the lower leg is called Tu Nie (Rabbit Bite). It is red extending to the bone; urgent treatment is necessary, otherwise it harms the person. An abscess on the medial malleolus is called Zou Huan (Running Slowness). It presents as an abscess with unchanged color. Repeated needling of its Shu points stops chills and fever without causing death. An abscess on the upper and lower foot is called Si Yin (Four Pollutions). It presents as a large abscess; without urgent treatment, death occurs in one hundred days. An abscess on the side of the foot is called Li Yong (Leper Swelling). It is not large, initially resembling a small finger. Urgent treatment is required; remove blackened areas. If it does not resolve and instead enlarges, death occurs in one hundred days if untreated. An abscess on the toe is called Tuo Yong (Falling Abscess), also known as Tuo Ju (Falling Carbuncle). It is red and black; if red and black, it is incurable and fatal. If not red and black, it is not fatal. If it does not subside, urgent amputation is required; otherwise, death ensues.
When Ying Qi stagnates in the meridians, blood becomes stagnant and ceases to flow. Flow cessation causes Wei Qi to follow but become obstructed and unable to move, resulting in heat. Persistent high heat causes flesh to rot, turning into pus. However, it does not sink deeply; the bone marrow is not scorched, and the five Zang organs are not damaged. This is termed Yong (Carbuncle). When heat qi is deep and severe, sinking into the skin and muscle, drying out tendons and bones, and connecting internally to the five Zang organs, exhausting blood and Qi, leaving no healthy flesh beneath the abscess, it is termed Ju (Deep Abscess). The characteristic of Ju is that the skin above is pale and hard, resembling the skin of an ox's neck. The characteristic of Yong is that the skin above is thin and glossy. These are their signs. A disease with form but no pain belongs to the Yang category. A disease without form but with pain belongs to the Yin category. Pain without form indicates intact Yang but injured Yin; urgently treat the Yin, do not attack the Yang. Form without pain indicates intact Yin but injured Yang; urgently treat the Yang, do not attack the Yin. When both Yin and Yang move, alternately showing form and formlessness, compounded by heart irritability, it is called Yin overcoming Yang. This is neither exterior nor interior, and life expectancy is short. There are five parts of the body: Futu (ST32) is one; the calf (Fei) is two; the calf is also called Shuchang; the back is three; the Shu points of the five Zang organs are four; the neck is five. Death occurs if carbuncles and sores arise in these five parts. Unpredictable anger and joy, irregular diet, deficiency of Yin Qi, excess of Yang Qi, and stagnation of Ying Qi lead to carbuncles. Lack of communication between Yin and Yang, with two heats holding each other, leads to pus formation. If the whites of the eyes are green and the pupils small, this is the first reversal (Ni). Vomiting after taking medicine is the second reversal. Abdominal pain with extreme thirst is the third reversal. Inconvenience in the shoulders and nape is the fourth reversal. Hoarse voice and loss of complexion is the fifth reversal. Excluding these five reversals constitutes favorable conditions (Shun).
*Su Wen* states: Changes from rich and sweet foods can generate large Ding (malignant boils), receiving pathogens as easily as holding an empty vessel. Sweating followed by exposure to dampness generates Cuo Fei (acne and prickly heat). Stagnation of Ying Qi reversing into the muscle texture generates swelling and abscesses. Qi injury causes pain; form injury causes swelling. Pain preceding swelling indicates Qi injuring form; swelling preceding pain indicates form injuring Qi.
*Jin Gui Yao Lue* states: Various floating and rapid pulses should accompany fever, yet the patient instead feels chilly and aversed to cold. If there is a painful area, a carbuncle is likely to develop. The Master said: To determine whether pus exists in various swellings, place the hand over the swelling. Heat indicates pus; lack of heat indicates no pus.
Fever with floating and rapid pulses corresponds to the syndrome. Floating and rapid pulses with chills indicate trapped fire unable to vent. Painful areas with normal appetite indicate impending carbuncle development. If swelling and heat are mild, resolution is possible; if severe, pus has formed. Later generations used wet paper applied to the swelling to locate the head of the abscess, following this same principle.
Jin Yin Chuang (Erosive Sores) flowing from the mouth to the limbs is treatable; flowing from the limbs to the mouth is untreatable. Jin Yin Chuang is primarily treated with Huang Lian Fen (Coptis Powder). (Formula missing).
*Bing Ji Jing Yao* states: Luo Li (scrofula) refers to nodular masses. They may occur behind the ear, in front of the ear, below the ear connecting to the jaw, or below the neck connecting to the collarbone; all are called Luo Li. Those on the sides of the chest or in the hypochondrium are called Ma Dao (Horse Dagger). These are governed by the Hand-Shaoyang and Foot-Shaoyang meridians. This originates from transformations of rich foods, Dan Du (poisonous heat), and fire, caused by consumptive fatigue and Qi stagnation. Treatment should focus on tonifying form and Qi, regulating meridians, allowing the sore to dissipate naturally without relying on sweating or purging methods. Those who fail to examine differences in pulse, syndrome, and meridian involvement often violate contraindications for disease and meridians when using purgatives, leading to errors. Cases involving phlegm, Qi, blood, or Yin deficiency have different root causes and require targeted treatment. Sores belong to the Fire category; one must distinguish internal and external origins to treat the root. Internal origin manifesting externally: pulse is deep and solid, with fever and irritability, no external redness, deep pain indicating deep pathogen; thus, unblock the Zang-Fu to cut off the source. External origin invading internally: pulse is rapid, swelling is external, symptoms are apparent externally; fearing Qi exhaustion affecting the interior, first support the interior. Middle ground: no external evil qi, internal Zang-Fu are open and smooth, knowing the pathogen is in the meridians, harmonize Ying and Wei Qi. After applying these three methods, even if not fully cured, complications are avoided, and pathogens are significantly reduced, facilitating recovery.
*Wai Ke Jing Yao* states: Heat emerging between the skin, with edema and a small root, not exceeding two or three cun in size, is a Jie (furuncle). Accumulated heat in the Six Fu organs surging into the muscle texture, presenting with sudden, severe swelling, smooth and soft skin, and a broad base is a Yong (carbuncle). Wind-toxin and accumulated heat in the Five Zang organs attacking flesh and bone, with fierce wind-toxin, initially appearing like a bud with scorched and dried appearance, tender to touch, is a Ju (deep abscess). Regarding the Five Favors and Seven Evils: Calm breathing and knowing the taste of food is the First Favor; regular bowel movements and urination is the Second Favor; thick pus, reduced swelling, and no odor is the Third Favor; bright spirit and clear voice is the Fourth Favor; balanced body Qi is the Fifth Favor. Irritability with coughing, abdominal pain with extreme thirst, or unlimited diarrhea and dysuria resembling strangury is the First Evil; massive discharge of pus and blood, increased swelling,败坏 (decayed) foul-smelling pus, and unbearable pain is the Second Evil; coarse panting, shortness of breath, confusion, and drowsiness is the Third Evil; abnormal eye gaze, tight small pupils, green-red whites of eyes, and upward-deviating pupils is the Fourth Evil; inconvenience in shoulders and back, heavy limbs is the Fifth Evil; inability to eat, vomiting after medication, and loss of taste is the Sixth Evil; hoarse voice, ruined complexion, blue lips and nose, and edema of face, eyes, and limbs is the Seventh Evil. Seeing three of the Five Favors indicates recovery; seeing four of the Seven Evils indicates danger. However, if the source matches the Seven Evils but the skin is tight, it reveals favor; if the source matches the Five Favors but the skin is loose and deficient, it reveals evil. Is this known to ordinary physicians?
When a patient first develops a back carbuncle, before it forms, with redness, heat, swelling, and pain, cover it with wet paper and observe immediately. The place where the paper dries first is the head of the forming abscess. Slice garlic to a thickness of about three qian, place it on the head, and apply large moxa cones. Change the garlic slice after three moxibustions. If painful, moxa until pain ceases; if painless, moxa until pain arises, which is ideal. Early detection and moxibustion are crucial. On days one or two, ten applications save ten lives; days three or four, six or seven save; days five or six, three or four save. After seven days, moxibustion is ineffective. If multiple heads arise together, grind garlic into paste, make a thin cake, place on the head, and burn moxa on the garlic cake; this can also save lives. If the back shows a patch of red swelling with a yellow millet-grain-like center, use a single clove of garlic, cut off both ends, take the middle slice three qian thick, place directly on the sore, and apply fourteen moxibustions, up to forty-nine. This is indicated for initial carbuncles and sores. However, for chronic sores becoming fistulas with continuous non-foul pus and no internal necrotic tissue, soaked Aconite slices (three to two fen thick) should be placed on the sore for moxibustion, combined with internal supportive medicines, repeated every two to three days. Within five to seven sessions, muscle growth will naturally occur. For sores with foul pus and deep roots, Guo Shi used white flour, sulfur, and garlic pounded together, shaped into cakes about three fen thick based on sore size, placed on the sore, and moxated twenty-one times, changing each time. Four to five days later, insert suppositories into the sore to remove necrotic tissue until healthy flesh is level, then apply astringent powders and internal appropriate formulas for recovery. Moxibustion is not only for initial stages. However, sores on the head and brain must never be moxated, as the head is the meeting point of all Yang meridians, and moxibustion would exacerbate fire toxins.
[Swollen Ulcer] Xue Lizhai stated: Swollen ulcer refers to sores before ulceration. Classics state: Form injury causes pain, Qi injury causes swelling. Also: Stagnation of Ying Qi reversing into muscle texture generates carbuncles. These are caused by rich foods, emotional Yin-fire, or accumulation of toxins from roasted/sweet foods, leading to disharmony of Qi and blood. One must differentiate meridian involvement, Zang organ interactions, and constitutional deficiency to prescribe attacking, tonifying, or harmonizing formulas to rapidly disperse or ulcerate. Assess swelling extent, redness/whiteness, pain severity, and depth of toxin. High swelling with pain and regular bowel/bladder function indicates exterior pathogen; use dispersing methods. Hard swelling with deep pain and constipation indicates interior pathogen; use purging methods. No external tension with regular internal function indicates pathogen in meridians; harmonize Ying and Wei Qi. Large red swelling or numbness/painlessness indicates Qi-blood stagnation; use external garlic-separated moxibustion and internal Huo Ming Yin (Alive Life Decoction) or Gui Qi Yin (Angelica and Astragalus Decoction). Regardless of location, red swelling resolves. Irritability, desire for cold drinks, red painful fever, and urinary/fecal retention indicate intense internal fire; use Si Wei Qing Liang Yin (Four-Ingredient Cooling Decoction) or Huo Ming Yin with Da Huang (Rhubarb). Mild swelling/pain or painlessness indicates Yang deficiency; use Shen Qi Nei Tuo San (Ginseng and Astragalus Interior-Supporting Powder). Darkish/red or non-red, aversion to cold without pus formation, or ripe pus without ulceration indicates Yang deficiency-cold; use Qian Jin Tuo Li San (Thousand Gold Interior-Supporting Powder). Thus, unformed abscesses resolve spontaneously, and formed ones ulcerate spontaneously. Differentiate Yin/Yang or Half-Yin/Half-Yang. Adhering strictly to prohibitions against acrid-hot medicines for swollen ulcers, ignoring etiology and meridian involvement, and indiscriminately using detoxifying herbs disrupts meridians and attacks non-pathogenic areas, preventing elevation, ulceration, or healing, leading to countless complications. *Yong Ju Lun* states: Swollen ulcers involve internal and external blockage; prioritize interior-supporting and dispersing methods. If swelling/pain accompanies weak pulse/syndrome, combine tonification. If Qi and blood are not depleted, auspicious outcomes are assured. Improper treatment of swollen ulcers inevitably leads to complications in ulcerated stages. This extends the subtle meaning of the Inner Canon and personal experience; one should extend this logic. What need for further elaboration?
[Ulcer] Ulcer refers to sores after pus discharge. Resolution of swelling and pain after pus discharge is favorable. Swelling/pain or fever/chills after discharge indicates Qi-blood deficiency; use Shi Quan Da Bu Tang (Ten Great Tonifying Decoction). Vomiting and poor appetite after discharge indicates Spleen-Stomach weakness; use Liu Jun Zi Tang (Six Gentlemen Decoction) with Pao Jiang (Roasted Ginger). Cold hands and feet indicate Spleen-Qi deficiency-cold; use Liu Jun Zi Tang with Jiang (Ginger) and Gui (Cinnamon). If ineffective, urgently add Fu Zi (Aconite). Persistent pain or constipation/urinary difficulty after discharge indicates unresolved heat toxin; use Qing Re Xiao Du Tang (Clear Heat and Detoxify Decoction). Thirst persisting after fever subsides indicates fluid deficiency; use Ba Zhen Tang (Eight Treasure Decoction) with Huang Qi (Astragalus), Mai Dong (Ophiopogon), and Shan Zhu Yu (Cornus). Frequent urination after heat cessation indicates Kidney deficiency; use Jia Jian Ba Wei Wan (Modified Eight Flavor Pill). Persistent heat or worsening swelling/pain indicates internal deficiency-heat; use Bao Yuan Tang (Protect Origin Decoction) with Heart-cooling and blood-chilling agents. Failure of muscle growth after heat cessation indicates joint Qi-blood deficiency; use Shi Quan Da Bu Tang. Pale/dead-looking or depressed/non-healing sores indicate cold invasion; use Wu Wei Yi Gong San (Five-Flavor Extraordinary Power Powder) assisted by Dou Chi Bing (Fermented Soybean Cake). Excessive pus/blood with irritability indicates Yang collapse; urgently use Du Shen Tang (Single Ginseng Decoction). Assess hardness of swelling, dietary preferences, pus consistency/volume, flesh color (red/dark), and healing speed to prescribe interior-supporting, detoxifying, and tonifying formulas to avoid complications. *Yong Ju Lun* states: Ulcers involve internal and external deficiency; prioritize interior-supporting and connecting methods. Complications of ulcers stem from improper treatment of swollen ulcers, depleting Yuan Qi. Can practitioners afford to be careless?
[Unceasing Pain] Assess the location of pathogen and cause of syndrome for persistent sore pain. Chills/fever with pain indicates exterior pathogen; use Ren Shen Bai Du San (Ginseng Detoxifying Powder). Constipation with pain indicates interior pathogen; use Qing Re Xiao Du Tang with Bai Mi (White Honey). Red swelling with pain indicates blood stagnation; use Huo Ming Yin. Pain during pus formation indicates need for interior support; use Tuo Li Xiao Du San. Pain from pus pressure requires needle drainage. Pain after ulceration requires tonification. Qi-deficiency pain uses Si Jun Zi Tang plus Dang Gui (Angelica) and Huang Qi (Astragalus). Blood-deficiency pain uses Si Wu Tang (Four Substance Decoction) plus Shen (Ginseng) and Qi (Astragalus). Generally, form injury causes pain, Qi injury causes swelling. Ignoring these and merely using Ru Xiang (Frankincense) and Mo Yao (Myrrh) for pain is incorrect. Still, assess Zang organ interactions and treat accordingly. Follow this pattern for others.
[Unceasing Vomiting] Danxi stated: Vomiting during swollen ulcer stage treats toxic vapors attacking the Heart. Vomiting during ulcer stage treats Yin deficiency. This addresses common cases. Red/swollen/painful vomiting indicates severe heat toxin; use Huo Ming Yin. Vomiting during pus formation indicates Qi-blood deficiency; use Liu Jun Zi Tang plus Dang Gui and Huang Qi. Constipation with vomiting indicates heat in Zang organs; use Qing Re Xiao Du Tang removing Di Gu Pi/Jin Yin Hua, adding Bing Lang (Areca Nut) and Mu Xiang (Aucklandia). Vomiting from excessive cold medicines indicates Stomach Qi injury; use Liu Jun Zi Tang plus Jie Geng (Platycodon) and Chai Hu (Bupleurum). Vomiting due to Liver Qi invading Spleen, Stomach deficiency with retained phlegm, or depression injuring Spleen all stem from Spleen-Stomach weakness and toxic accumulation; treat by regulating and tonifying Middle Qi to restore Zheng Qi and expel pathogens.
[Unceasing Bleeding] Bleeding from sore openings may result from Zang organ interactions, Yin-Yang disharmony, or imbalance of Six Exteriors/Seven Emotions causing reckless blood movement. Liver fire moving internally: Si Wu Tang plus Shan Zhi (Gardenia) and Dan Pi (Moutan). Liver channel blood deficiency: Liu Wei Di Huang Wan. Heart deficiency failing to control blood: Si Wu Tang plus Shen, Zhu, Dan Pi, and Suan Zao Ren. Spleen deficiency failing to control blood: Si Jun Zi Tang plus Shan Zhi and Dan Pi. Spleen deficiency with stagnation: Gui Pi Tang. Spleen-Lung Qi deficiency: Bu Zhong Yi Qi Tang. Joint Qi-blood deficiency: Shi Quan Da Bu Tang. Kidney Qi insufficiency with internal Liver fire: Liu Wei Di Huang Wan plus Zhi Zi Qing Gan San and Wu Wei Zi (Schisandra). For massive blood loss with irritability/fever/thirst, regardless of pulse/syndrome, urgently use Du Shen Tang to tonify Qi. Classics state: Blood is born from Qi. Without acrid-sweet-warm herbs like Shen, Qi, Gui, and Zhu, recovery is impossible. Fever with large pulse is mostly untreatable.
[Non-formation of Muscle] Muscle is generated by Spleen-Stomach; healing is governed by Qi-blood; both complement each other. Muscle non-formation with redness indicates blood heat; use Si Wu Tang plus Shan Zhi and Dan Pi. Afternoon/internal heat indicates blood deficiency; use Si Jun Zi Tang plus Dang Gui, Di Huang, and Dan Pi. Thin/clear pus indicates Qi-blood deficiency; use Shi Quan Da Bu Tang. Poor appetite and fatigue indicate Spleen-Qi deficiency; use Bu Zhong Yi Qi Tang. Irritability/thirst with normal activity indicates Stomach heat; use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). Irritability/thirst with frequent urination indicates Kidney deficiency; use Liu Wei Wan. Rotting flesh without ulceration: use Wu Jin Gao (Black Gold Ointment). Ulcerated flesh without healing: use Liu Jun Zi Tang externally with Zhen Zhu San (Pearl Powder). Foul odor, rapid pulse, and thirst indicate true Qi deficiency and pathogen excess; this is difficult to treat. Chronic non-healing sores stem from insufficient Yuan Qi or pathogen stagnation. Regulating and tonifying Spleen-Stomach restores Yuan Qi, eliminating pathogens, sloughing dead flesh, generating new flesh, and healing sores. Failing to protect the root and indiscriminately applying muscle-generating agents aids pathogens and worsens ulceration.
[Unceasing Fever] Fever in sores: initial stage due to trapped toxic vapors; formed stage due to internal rotting/pus formation; ulcerated stage due to Qi-blood depletion. Do not indiscriminately use detoxifying herbs to injure Yuan Qi. Unformed stage: differentiate exterior/interior pathogen. Forming stage: differentiate attack/tonification suitability. Formed stage: differentiate pus presence/absence...