作。脓已成者。当分脓之浅深高漫。脓已溃者。当分痛之止与不止。若作痛而发热者。活命饮。
作脓而发热者。托里消毒散。脓出而发热者。八珍加黄 。午前发热者。阳气虚也。补中益气汤。
发热作渴。小便频数者。肾气虚弱也。加减八味丸。脓血多而热者。阳无所附也。十全大补汤。
日将晡而热者。气血虚也。八珍汤。若无寐而热者。内补黄 汤。烦躁者。血脱也。当归补血汤。自汗而热者。
胃气虚也。四君子汤。恶寒发热者。肺气虚也。补中益气汤。或四君子加黄 、当归。亦有五脏
相胜。夹食夹寒。六淫七情所致者。不能备述。临证详之。
大便不通 疮疡大便不通。初起则审所致之因。所见之证。而内联疏外表之法。已溃则分气
血虚实传变之证。而用托里滋补之法。不可泛用苦寒疏导之剂。恐复伤真气。则肿者不能消散成
脓。溃者不能生肌收敛。故丹溪云。肿疡内外皆壅。宜托里表散为主。溃疡内外皆虚。宜托里补
接为主。治者审之。
小便不通 疮疡小便不通。其因不一。当分经络虚实而药之。若溃而恶寒发热。气血虚也。
八珍汤。手足并冷。阳气虚寒也。四君子加炮姜、升麻。手足不冷。乃脾气虚弱也。四君子加升、
柴、半夏。寒热往来。气血虚也。十全大补汤。大便了而不了。脾气虚而下陷也。补中益气汤。
切不可轻用疏导之剂。复伤元气。致肿者不能复起发腐溃。溃者不能生肌收敛。须临证制宜而治。庶无误矣。
作渴不止 疮疡作渴。当分经络所属。及血气虚实而治。若 痛发热。便利调和者。邪在表
也。清热消毒汤。肿痛发热。大便秘涩者。邪在里也。凉膈散。 痛炽盛。邪在经络也。活命饮。
右关脉洪数有力。胃火消烁津液也。竹叶石膏汤。右关脉数无力。胃虚津液短少也。补中益气汤。
饮食失度。胃气内伤而亡津液者。参苓白术散。脓血出多而气血虚弱者。八珍汤加五味。禀肾不
足而津液短少者。加减八味丸。余当临证制宜。
自汗不止 疮疡溃后多汗。卫虚元气外泄。大非所宜。其禀质肥盛者。湿热外泄。犹无大患。
若形槁色枯。胸中多气。血液衰少者。乃火热亢极。为害弥甚。故治肥盛之人。溃疡多汗。则宜
托里消毒散加减。气虚形盛者。则宜六君子
为主。酒客则加麋衔、泽泻之属。形瘦之人。溃疡多汗。则宜保元汤加归、芍。或生料六味加枣
仁救其津液。庶免火气内燔。咽燥噎塞。烦扰喘咳之患。大抵溃疡多汗。一切苦寒伤胃。腻滑夺食。
辛热耗气之药。皆当切禁。
下痢不止 痈疽溃久。疮口不收。脓水清稀。而见泄利惊溏。皆为脾气衰弱之候。理中、补
中、四柱、六柱、二神、四神。并可选用。如下痢白沫。此脾气下陷。补中益气加姜、桂、吴萸、
木香之类。若见脓血下滞。须详血色之鲜晦。鲜者则宜连理汤之姜、连并进以和其中。晦者则宜
理中汤稍加桂、附以温其下。赤白兼下如玛瑙色者。亦宜上法。倘数服不应。又当补中益气加辛
温之品兼升举其阳。若下痢清血。则加茜根、乌 骨、乌梅、白芍。苟非夏秋湿热下注。则黄连、
浓朴、枳壳、槟榔、泽泻等药。皆为戈戟也。
敷寒凉药 疮疡敷药。当分阴阳虚实而用内治之法。不可概敷寒凉之药。若肿痛热渴。脉滑
数有力。其证纯阳。宜内服解毒之剂。外敷寒凉之药。则热毒自消。瘀滞自散。若似肿非肿。似
痛非痛。似赤非赤。似溃非溃。脉洪数无力者。证属半阴半阳。宜内服助胃托里。兼行解毒。外
敷寒凉药中兼辛热药一分。则营逆自从。血郁自散。若微肿微痛。色黯坚硬。肉色如故。久而不
溃。脉按之沉细。举指虚浮者。其证属阴。宜内服回阳之剂。外敷辛热之药。则阴毒自解。阳气
自复。凡阳气虚寒。不能消散腐溃。或溃而肿不消。口不敛者。必内服温补药。外用生附子掺疮
口。则歹肉自去。新肉方生。若阴寒之证而用寒凉之药。则腠理闭塞。气血凝滞。毒瓦斯益深。良
肉反死。疮口不敛。恶证蜂起。不可复救矣。盖治病必求其本。假如肿痛热渴。大便秘结者。邪
在内也。疏利之。肿 作痛。寒热头疼者。邪在表也。发散之。 肿痛甚者。邪在经络也。和解
之。漫肿微痛而不溃者。血气虚弱也。急补托之。色黯微痛而不溃。或溃而不敛者。阳气虚
寒也。温补之。如是则五脏自和。六腑自调。气血自生。疮毒自解矣。
用刀针法 疮疡用针。当审经络表里之虚实。部分肌肉之浓薄而施之。夫肿高而软者。发于血
脉也。肿硬而坚者。发于肌肉也。肉色不变者。发于骨也。疮未成者。解散以消其毒。已成者。
托里以速其脓。脓已成者。当验其生熟浅深而后针之。以指轻按便痛者。脓浅也。重按方痛者。
脓深也。按之不起者。脓未成也。按之即痛者。脓已成也。若脓初生而即针。则腐溃益深而不能
收敛。若疮深而针浅。则内溃不出。外血反伤。若疮浅而针深。则其脓虽出。良肉亦伤。盖疮之
证。气血已伤。肌肉已坏。当随决其毒。不可拘泥人神部分。其脓一出。诸证自退。若脓出反痛。
或烦躁呕逆者。皆胃气亏损。急宜托里调补。凡脓已成者。急刺去。以纸捻蘸油 疮内。以膏药
贴之。如疮反复未痊。多是浓味七情火动而然。当审所因而调治。亦有脓清不敛。乃胃气虚弱之
故。又当兼饮食调补之。若小儿患疮肿。药中加漏芦。令母服之。乳中药过。儿疮自愈。
陈毓仁曰。肿疡初起。顶高根活。色赤发热。 肿疼痛。日渐高肿者顺。已成 肿。皮薄光
亮。饮食如常。二便调匀。身温和者顺。已溃脓稠。色鲜不臭。腐肉自脱。 肿易消。身轻者顺。
溃后脓浓稠黄。新肉易生。疮口易敛。食饮渐进者顺。初起顶平根散。色黯漫肿。不热不疼。身
体倦怠者逆。已成肿坚色紫。不作脓。不腐溃。口干多烦躁者逆。已溃皮烂肉坚。不腐肿。仍不
消。痛仍不减。心烦者逆。溃后脓水清稀。腐肉虽脱。新肉不生。疮口如冻。色败臭秽者死。治
法。初起毋论阴阳表里。知痛不知痛。起发不起发。但未成脓者。俱宜灸之。既灸不知痛者。再
灸之。 赤发热疼痛。有时脉来浮数。无便秘者。宜药托之。身体拘急。脉紧恶寒。饮食就暖者。
邪在表也。宜汗之。肿硬痛深。口干便利。身热脉实者。邪在
里也。宜下之。 痛势甚。烦躁饮冷。舌干口燥者。火在上也。宜清之。肿痛坚硬。背如负石。
恶心干呕。邪毒在内。宜解拔之。肿痛日深。内脓不出。瘀肉窒塞疮口者。急开导之。软漫不作
脓。不腐溃。及溃后疮口散大。不生肌肉者。阳气虚也。壮脾助胃以温补之。身凉自汗。手足并
冷。六脉虚细。便泄阳脱者急温之。迟则不效。西航曰。凡痈肿须观禀质气血调治。惟霉疮结毒。
非专方不应。但验病患身上有块。不时掣痛者。即为霉毒无疑。当与三白丹疏涤之。元气虚寒者。
加味三白丹最妙。虚甚不胜三白丹者。五宝丹亦能疗之。肿处用精猪肉贴之。若更发热头疼。或
手足颤振。筋脉缩急者。此复感风寒。触发经中郁毒也。先与万灵丹三服汗之。次用调和血气之
剂。俟胃气稍复。然后用三白、五宝治之。有用三白丹后。余毒未尽者。此胃虚不能行其药力也。
仍与调和气血之剂。俟能饮食起居。更与五宝丹。无不愈者。此因银粉劫剂。致成结毒。非仍用
水银不能拔去病根也。用精猪肉贴者。猪为水兽。取其通达肾气。而无瘢痕之患。
〔诊〕身重脉缓为湿胜。身热脉大。心躁时热。乍来乍去。当逐热。诸痛眩晕动摇。脉弦。宜
祛风。气涩气滞。干燥亡津液。脉涩。须调气补血。寒胜则浮。食不得入。便溺多。恶寒脉紧细。
应于水中补火。凡痈疽初起。 肿赤硬。脉浮数者易涩。洪大急疾者难治。弦紧沉细者危。脓成
脉洪滑者易治。虚大涩滞者难治。弦小沉涩者不治。已溃脓水未尽。脉缓滑者易治。数盛弦硬者
难治。涩数不调。及虚大者危。脓尽后。脉小弱缓滑者易治。迟涩虚细者难治。反洪盛或弦急者
不治。溃久不敛。有歹肉干脓。脉缓滑流利者易治。弦细小弱者难治。反数盛急疾。或虚大涩者不治。
(Regarding carbuncles and sores) When the lesion erupts, if pus has already formed, one must distinguish whether the pus is shallow or deep, high or spreading. If the pus has ulcerated, one must determine whether the pain has ceased or persists. If accompanied by pain and fever, use Huoming Yin (Life-Saving Decoction). If fever occurs during the suppuration process, use Tuoli Xiaodu San (Supporting Interior and Eliminating Toxin Powder). If fever persists after pus discharge, use Bazhen Tang (Eight-Treasure Decoction) with added Huangqi (Astragali Radix). Fever occurring in the forenoon indicates deficiency of Yang Qi; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Fever with thirst and frequent urination indicates weakness of Kidney Qi; use Jiaban Bawei Wan (Modified Eight-Ingredient Pill with Rehmannia). Abundant pus and blood with heat indicates that Yang Qi has no anchor; use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction). Fever occurring towards dusk indicates deficiency of Qi and Blood; use Bazhen Tang (Eight-Treasure Decoction). Insomnia accompanied by fever indicates internal deficiency; use Neibu Huangqi Tang (Internal Tonification with Astragalus Decoction). Restlessness indicates loss of Blood; use Danggui Buxue Tang (Angelica Tonifying Blood Decoction). Spontaneous sweating with heat indicates deficiency of Stomach Qi; use Sijunzi Tang (Four Gentlemen Decoction). Aversion to cold with fever indicates deficiency of Lung Qi; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), or Sijunzi Tang with added Huangqi (Astragali Radix) and Danggui (Angelicae Sinensis Radix). There are also cases caused by mutual overcoming among the Five Zang organs, retention of food or cold, or pathogenic factors of the Six Excesses and Seven Emotions, which cannot be exhaustively listed; clinical examination is required.
Constipation: Constipation resulting from sores and ulcers, in the initial stage, requires examining the cause and symptoms to apply methods of internal purgation and external release. After ulceration, one must distinguish between deficiency and excess of Qi and Blood to apply methods of supporting the interior and tonification. One should not indiscriminately use bitter-cold purgatives, lest they further damage True Qi, preventing swelling from resolving into pus or ulcerations from generating flesh and closing. Thus, Danxi stated: "For early-stage sores where both interior and exterior are obstructed, the primary approach is supporting the interior and releasing the exterior; for ulcerated sores where both interior and exterior are deficient, the primary approach is supporting the interior and connecting [the deficiency]." Practitioners must exercise caution.
Urinary Retention: Urinary retention resulting from sores and ulcers has various causes and requires differentiation of meridians and deficiency/excess patterns. If aversion to cold and fever occur after ulceration, it indicates Qi and Blood deficiency; use Bazhen Tang (Eight-Treasure Decoction). Coldness of both hands and feet indicates deficiency and cold of Yang Qi; use Sijunzi Tang (Four Gentlemen Decoction) with added Paojiang (Prepared Ginger Rhizome) and Shengma (Cimicifugae Rhizoma). Absence of coldness in hands and feet indicates spleen Qi deficiency; use Sijunzi Tang with added Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), and Banxia (Pinelliae Rhizoma). Alternating chills and fever indicates Qi and Blood deficiency; use Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction). Sensation of incomplete defecation indicates sinking of Spleen Qi due to deficiency; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). One must not lightly use draining agents to avoid damaging Yuan Qi, which would prevent swelling from rising and suppurating or ulcerations from healing. Treatment must be adapted to clinical presentation.
Unceasing Thirst: Thirst in sores and ulcers requires differentiation according to meridian involvement and Qi/Blood deficiency or excess. If redness, swelling, and pain accompany fever, with normal bowel and bladder movements, the pathogen is in the Exterior; use Qingre Xiaodu Tang (Clear Heat and Eliminate Toxin Decoction). If redness, swelling, and fever accompany constipation and dryness, the pathogen is in the Interior; use Liangge San (Cool the Diaphragm Powder). Intense redness, swelling, and pain indicate the pathogen is in the meridians; use Huoming Yin (Life-Saving Decoction). A surging, rapid, and forceful pulse at the Right Guan position indicates Stomach Fire consuming body fluids; use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). A rapid but weak pulse at the Right Guan position indicates Stomach deficiency with short body fluids; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Irregular diet causing internal injury to Stomach Qi and loss of fluids requires Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder). Abundant pus and blood loss leading to Qi and Blood deficiency requires Bazhen Tang (Eight-Treasure Decoction) with added Wuweizi (Schisandrae Fructus). Congenital Kidney insufficiency leading to short body fluids requires Jiaban Bawei Wan (Modified Eight-Ingredient Pill with Rehmannia). Other cases require clinical adaptation.
Unceasing Spontaneous Sweating: Profuse sweating after ulceration indicates deficiency of Defensive Qi and leakage of Yuan Qi, which is highly inadvisable. In robust individuals, damp-heat escaping externally poses little danger. However, in emaciated individuals with dry complexion, chest fullness, and depleted blood, extreme hyperactivity of Fire causes severe harm. Therefore, for robust patients with profuse sweating from ulcers, modify Tuoli Xiaodu San (Supporting Interior and Eliminating Toxin Powder). For those with Qi deficiency and robust physique, use Liujunzi Tang (Six Gentlemen Decoction) as the main formula; for wine drinkers, add Mixian (Dipsaci Radix) and Zexie (Alismatis Rhizoma). For emaciated patients, use Baoyuan Tang (Preserve the Origin Decoction) with added Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix), or Shengliuwei Dihuang Wan (Raw Six-Ingredient Pill with Rehmannia) with added Suanzaoren (Ziziphi Spinosae Semen) to preserve fluids, avoiding internal burning of Fire, dry throat, dysphagia, restlessness, and cough. Generally, all bitter-cold drugs that damage the Stomach, greasy/slippery drugs that impair appetite, and pungent-hot drugs that consume Qi are strictly contraindicated in such cases.
Unceasing Dysentery: Chronic ulceration with non-healing wounds, thin pus, and diarrhea or loose stools indicates weakness of Spleen Qi. Lizhong Tang (Regulate the Middle Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Sizhu Jian (Four Pillar Decoction), Liuzhu Jian (Six Pillar Decoction), Eshen Wan (Two Spirits Pill), and Sishen Wan (Four Spirits Pill) may be selected. White mucus in stool indicates sinking of Spleen Qi; use Buzhong Yiqi Tang with added Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), Wuyu (Evodiae Fructus), and Muxiang (Aucklandiae Radix). Bloody-purulent stool requires distinguishing bright from dull color. Bright color suggests using Lianli Tang (Coptis and Licorice Decoction) with Ganjiang (Zingiberis Rhizoma) and Huanglian (Coptidis Rhizoma) to harmonize the Middle; dull color suggests Lizhong Tang (Regulate the Middle Decoction) with added Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Praeparata) to warm the Lower Jiao. Red-and-white mixed stool resembling agate color follows the above methods. If ineffective after several doses, use Buzhong Yiqi Tang with pungent-warm herbs to raise Yang. Clear blood in stool requires adding Qiancao (Rubiae Radix), Wugu (Black Bone, likely referring to a specific preparation or herb contextually linked to stopping bleeding), Wumei (Mume Fructus), and Baishao (Paeoniae Radix Alba). Unless caused by summer-autumn damp-heat pouring downward, Huanglian (Coptidis Rhizoma), Houpo (Magnoliae Officinalis Cortex), Zhike (Aurantii Fructus Immaturus), Binglang (Arecae Semen), and Zexie (Alismatis Rhizoma) are harmful like weapons.
Application of Cold/Cooling Medicines: Topical applications for sores must differentiate Yin/Yang and deficiency/excess, employing internal treatment methods rather than universally applying cold/cooling agents. If redness, swelling, pain, thirst, and a slippery-rapid-forceful pulse indicate pure Yang patterns, internal detoxifying agents and external cooling applications will resolve heat-toxin and disperse stasis. If symptoms are ambiguous (pseudo-swelling, pseudo-pain, etc.) with a surging-rapid-weak pulse indicating semi-Yin semi-Yang patterns, internal stomach-supporting and interior-supporting herbs with mild detoxification, combined with external cooling applications mixed with a small amount of pungent-warm herbs, will correct rebellious Ying Qi and disperse blood stasis. If slight swelling/pain, dark/hard texture, unchanged skin color, and delayed ulceration with a deep-thin floating pulse indicate Yin patterns, internal Yang-restoring agents and external pungent-warm applications will resolve Yin-toxin and restore Yang Qi. For Yang deficiency/cold failing to resolve or heal ulcers, internal warming-tonics plus topical raw Fuzi (Aconiti Lateralis Radix Praeparata) will remove necrotic tissue and generate new flesh. Applying cold/cooling agents to Yin-cold patterns closes pores, stagnates Qi/Blood, deepens toxin, kills healthy tissue, and leads to incurable malignant signs. Treating the root is essential: Internal pathogens (swelling, pain, heat, thirst, constipation) require purgation/drainage; External pathogens (swelling, pain, chills, fever, headache) require diaphoresis; Meridian pathogens (severe swelling/pain) require harmonization; Deficiency-induced swelling/pain requires urgent tonification/support; Dark/yellowish non-healing ulcers due to Yang deficiency require warming-tonification. This harmonizes Zang-Fu, generates Qi/Blood, and resolves toxin.
Use of Needles/Knives: Needle use requires assessing meridian interior/exterior deficiency-excess and muscle thickness. High/soft swelling originates in blood vessels; hard/firm swelling originates in muscles; unchanged skin color originates in bone. Unformed lesions require dispersal to eliminate toxin; formed lesions require interior support to accelerate suppuration. For formed pus, assess maturity, depth, and shallowness before needling. Pain on light pressure indicates shallow pus; pain on heavy pressure indicates deep pus; no depression indicates unformed pus; immediate pain indicates formed pus. Early needling deepens ulceration; shallow needling in deep wounds fails to drain and damages blood; deep needling in shallow wounds damages healthy tissue. Since sores injure Qi/Blood and muscle, toxins must be drained promptly without rigid adherence to anatomical "deity" locations. Once pus drains, symptoms subside. Post-drainage pain, restlessness, or vomiting indicates Stomach Qi deficiency requiring urgent interior support. Drain formed pus urgently, insert oil-soaked paper wicks, and apply plaster. Recurrence often stems from rich foods or emotional fire; treat the cause. Thin pus/non-healing indicates weak Stomach Qi requiring dietary support. For children, add Loulu (Lobeliae Chinensis Herba) to medicine for the mother to pass through milk.
Chen Yuren states: Favorable prognoses include high peaks with active bases, redness, heat, and progressive swelling in early stages; thin shiny skin, normal diet/bowel/bladder, and warmth in formed stages; thick fresh-smelling pus, shedding of necrotic tissue, and easy healing in ulcerated stages. Unfavorable prognoses include flat peaks with scattered bases, dark spreading swelling, absence of heat/pain, and fatigue in early stages; hard purple swelling, lack of suppuration, dry mouth, and irritability in formed stages; rotting skin, hard flesh, persistent pain, and心烦 (restlessness) in ulcerated stages. Death is indicated by thin pus, non-regenerating flesh, frozen-looking wounds, decayed color, and foul odor. Treatment: Moxibustion is suitable for all pre-suppurative stages regardless of pattern. If moxibustion fails to relieve pain, repeat. Redness/heat/pain with floating-rapid pulse and no constipation requires supportive medication. Exterior patterns (stiffness, tight pulse, aversion to cold) require sweating. Interior patterns (hard swelling, deep pain, dry mouth, real pulse) require purgation. Upper Fire (intense pain, thirst, dry tongue) requires clearing. Internal toxin (back stiffness, nausea) requires extraction. Obstructed pus requires drainage. Yang deficiency (soft swelling, non-healing) requires warming-tonification. Yang collapse (cold limbs, weak pulse, diarrhea) requires urgent warming.
Xi Hang states: Treat sores based on constitution and Qi/Blood. Plum blossom sore (syphilis) toxins require specific formulas. Palpable lumps with pulling pain confirm plum blossom toxin; treat with Sanbai Dan (Three Whites Powder). For Qi/Yang deficiency, use Jiaban Sanbai Dan. For severe deficiency unable to tolerate Sanbai Dan, use Wubao Dan (Five Treasures Powder). Apply lean pork to the swelling. If wind-cold triggers郁毒 (stagnant toxin) causing fever/headache/tremors, first induce sweat with Wanling Dan (Myriad Miracles Powder), then harmonize Qi/Blood, and finally use Sanbai/Wubao Dans after Stomach Qi recovers. Residual toxin after Sanbai Dan indicates weak Stomach Qi failing to transport medicine; resume harmonizing Qi/Blood, then use Wubao Dan upon recovery. These toxins stem from mercury-based purgatives; only mercury can extract the root. Lean pork is used because pigs are water animals, promoting Kidney Qi without scarring.
[Diagnosis] Heavy body with slow pulse indicates excessive Dampness. Hot body with large pulse, irritability, and intermittent heat require eliminating heat. Pain, vertigo, and tremors with wiry pulse require dispelling Wind. Qi stagnation with dryness/fluid loss and choppy pulse require regulating Qi and nourishing Blood. Excessive Cold causes floating pulse; inability to eat, frequent urination, and aversion to cold with tight-thin pulse require tonifying Fire within Water. For early sores: Floating-rapid pulse is easy to treat; choppy is difficult; surging-rapid-sudden is difficult; wiry-tight-deep-thin is critical. Suppurated stage: Surging-slippery pulse is easy to treat; deficient-large-choppy is difficult; wiry-small-deep-choppy is untreatable. Ulcerated stage with residual pus: Slow-slippery pulse is easy to treat; rapid-abundant-wiry-hard is difficult; choppy-rapid-disordered or deficient-large is critical. Post-pus: Small-weak-slow-slippery pulse is easy to treat; slow-choppy-deficient-thin is difficult; surging-abundant or wiry-rapid is untreatable. Chronic non-healing with necrotic tissue: Slow-slippery-fluent pulse is easy to treat; wiry-small-thin-weak is difficult; rapid-abundant-sudden or deficient-large-choppy is untreatable.