经曰∶汗之则疮已。（高肿者毒在表，故汗之则疮已。若误下之，则诛戕无过，反伤元气。）
李东垣曰∶夫痈疽之病，治疗多方，总而论之，各有所宜，补泻淋HT ，及敷扫贴 ，针镰炙烙，用之不同。
盖知其道也，与治必效；昧于理者，利害不无；尝见以寒疗热，以热疗寒，古今之通论也。又有检方疗病，妄
制加减，以意裁之，自以为可。殊不知病有逆从，治有缓急，法有正权，方有奇偶，用有轻重。夫医者，意也，
得其意，然后能变通也，达其变通者，悟其道而省其理也，则左右逢其源矣。愚虽不才，略陈万一∶尝见以寒
治热，而寒弥甚，治热以寒，而热弥炽者，何也？盖不知五脏有阴阳之性，其可因其类而取之也。假如心实生
热者，当益其肾，肾水滋，热将自除；肾水虚，生寒当补心，心火既降，寒当自除；此所谓寒之而热者取之阴，
热之而寒者取之阳也。又寒因热用，热因寒用，要通其理类而已。又闻微者逆之，甚者从之，何谓也？盖治寒
以热，必凉而行之，治热以寒，必温而行之，此亦欲其调和也。其间有正有权者，何也？盖病有微有甚，微者
逆治，理之正也，甚者从治，理之权也。然为疮科，于补泻、汗下、标本、逆从、正权之理，乌可阙而不知也！
大凡治疗疮疽之要法曰∶初觉热毒，发热郁结而作疮疽，一二日宜荡涤邪气，疏通脏腑，令内消也。古今汤法
谓切锉、 咀如麻豆大，以猛火急煎，无令过熟，欲其速利也；次用丸散宣导血脉，渐次消磨，令缓散也；助
以淋 ，调和荣卫，行经络也；更当膏润温养，兼磨敷四畔贴 之药，顺其阴阳也。追蚀托里，汗下调补，临
时制宜，深浅缓急，自有等差，如男女贵贱，亦当别论。晋尚书褚澄曰∶寡妇尼僧异于妻外家，虽无房室之劳，
而有忧思之苦，此深达其情者也。又仲景云∶物性刚柔，餐居亦异，治之不同也。所以黄帝与四方之间，岐伯
举四治之能，况病之新旧，形志乐苦，岂可执方无权，以求其愈疾哉！亦有疮疽肿痛，初生
一二日，便觉脉沉细烦闷，脏腑弱而皮寒，邪毒猛暴，恍惚不宁，外证深沉者，亦宜即当用托里温热之剂，以
从治之。（《十书》）
又曰∶夫疮疽丹肿，结核瘰 ，初觉有之，即用内消之法。经久不除，气血渐衰，肌寒肉冷，脓汁清稀，
毒不出，疮口不合，或聚肿不赤，结核无脓，外证不明者，并宜托里。脓未成者，使脓早成；脓已溃者，使新
肉早生；气血虚者，托里补之；阴阳不和，托里调之；大抵托里之治，使疮无变坏之证。凡为疮医，不可一日
无托里之药，然而寒热温凉，烦渴利呕，临证宜审其缓急耳。
又曰∶夫痈疽脓溃，肿毒侵里，证候危恶者，须辨虚实。况夫虚者难补，实者易泻，补泻之法，不可轻用。
若或少差，利害甚大，然而虚实证端，不可不辨，有疮之虚实，有脏腑、气血、上下、真邪，各有虚实，故不
同也。分而言之，则肿起坚硬脓稠者，疮疽之实也；肿下软慢脓稀者，疮疽之虚也。泻痢肠鸣，饮食不入，呕
吐无时，手足并冷，脉弱皮寒，小便自利，或小便时难，大便滑利，声音不出，精神不爽者，悉脏腑之虚也；
大便硬，小便涩，饮食如故，肠满膨胀，胸膈痞闷，肢节疼痛，口苦嗌干，烦躁多渴，身热脉大，精神昏塞者，
悉脏腑之实也。凡诸疮疽脓水清稀，疮口不合，聚肿不赤，肌寒肉冷，自汗色脱者，气血之虚也；肿起色赤，
寒热疼痛，皮肤壮热，脓水稠粘，头目昏重者，气血之实也。头痛鼻塞，目赤心惊，咽喉不利，口舌生疮，烦
躁饮冷，睡语切牙者，上实也；精滑不固，大便自利，腰脚沉重，睡卧而不宁者，下虚也。肩项不便，四肢沉
重，目视不正，睛不了了，食不知味，音嘶色败，四肢浮肿者，真气之虚也；肿 尤甚，痛不可近，积日不溃，
寒热往来，大便秘涩，小便如淋，心神烦闷，恍惚不宁者，邪气之实也。
又曰∶真气夺则虚，邪气胜则实。
又曰∶诸痛为实，痒为虚也。
又曰∶诊其脉洪大而数者实也，微细而软者虚也。虚则补之，和其气托里也；实则泻之，疏利而自导其气。
《内经》谓∶血实则决之，气虚则掣引之。
又曰∶治疮疡，治表不云发汗，而曰托里；治里不云攻下，而曰疏通；治经络不云疏通，而曰和荣卫；盖
欲保全元气为主，而不专于攻疮也。今之医者，以速愈为高，汗下峻攻，温毒漫治，毒或速散，不知元气伤而
天年夭矣。可不慎哉！
又曰∶古人用药因病制宜，治不执方，随病增损，疗积聚补益，可用丸药，以从旧不改方增损。盖疮疡危
要之际，证候多种，安有执方之论？固可临时加减，以从其法，只如发背、脑疽、恶疔、肿脓溃前后虚而头痛
者，于托里药内加五味子；恍惚不宁，加人参、茯苓；虚而发热者，加地黄、栝蒌；往来寒热者；潮热者，加
地骨、柴胡；渴不止，加知母、赤小豆；大便不通者，加木通、灯草；虚烦者，加枸杞子、天门冬；自利者，
加浓朴；四肢厥逆者，加附子、生姜；呕逆者，加藿香、丁香；多痰者，加半夏、陈皮；脓多者，加当归、川
芎；甚痛者，加芍药、乳香；肌肉迟生者，加白蔹、官桂；有风邪者，加独活、防风；心惊怯者，加丹砂；口
目动者，加羌活、细辛。愚虽不才，自幼及老，凡治疮疽，常根据此法，加减用药，取效如神，后之学人，宜
细详焉。
又曰∶九窍不利，皆不可下。疮疡郁冒，俗呼昏迷，是不可下，汗之则愈。
又曰∶痈疽之发，其受之有内外之别，治之有寒温之异。受之外者，法当托里，以温剂反用寒药，则是皮毛
始受之邪，引入骨髓；受之内者，法当疏利，以寒剂反用温剂托里，则是骨髓之病，上彻皮毛，表里通溃，共为
一疮，助邪为毒，苦楚百倍，轻则危殆，重则死矣。予闻洁古云∶疮疡之生也，表里不同，或攻或发，少有差舛，
变证随能杀人，甚于伤寒也。针灸施治，各随其宜，所用之药，又当明入五脏君臣，是其法也。
又曰∶大抵痈肿之证，不可专泥于火为患。况禀有虚实及老弱不同，岂可概用寒凉之药！设若毒始聚，势
不盛者，庶可消散，尤当推其病因，别其虚实，若概用凉药，必致误事；如脓将成，邪盛气实者，用消毒之剂
先杀其毒，虽作脓不为大苦，溃亦不甚，若就用托里，必益其势；如脓将成不成，及不溃者，方用托里。脓成
势盛者针之，脓一出诸证悉退。
又曰∶疮热奋然高起，结硬而痛，色赫赤微带黯色，其邪在血脉之上，皮肤之间，急发其汗，则毒随汗散
矣。大法宜荆防败毒散，冬月万灵丹，脉虚者四妙汤，内托复煎汤。
张仲景云∶疮家虽身疼痛，不可发汗，汗之则痉。（发汗，为大汗出。非谓托里之药，轻轻表散也。）
薛立斋云∶夫疮疡之作，皆膏粱浓味，醇酒炙 ，房劳过度，七情郁火，阴虚阳凑，精虚气节，命门火衰，
不能生土，荣卫虚弱，外邪所袭，气血受伤而为患。当审其经络受证，标本缓急以治之。若病急而元气实者，
先治其标；病缓而元虚者，先治其本；或病急而元气又虚者，必先于治本而兼以治标。大要肿高 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，或漫肿黯黑不溃
者，元气虚甚，治之尤难者也。主治之法，若肿高 痛者，先用仙方活命饮解之，后用托里消毒散，漫肿微痛
者，用托里散，如不应，加姜桂，若脓出而反痛，气血虚也，八珍汤；不作脓，不腐溃，阳气虚也，四君加当
肉桂；不生肌，不收敛，脾气虚也，四君加芍药、木香；恶寒憎热，阳气虚也，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，六味丸料加五味子；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
汤加麦冬、五味；欲呕少食，脾胃虚也，人参理中汤；脾痛泄泻，脾胃虚寒也，附子理中汤；小腹痞，足胫肿，
脾肾虚也，十全大补汤加山药、山萸、肉桂；泄泻足冷，脾肾虚寒也，前药加桂附；热渴淋秘，肾虚阴火也，
加减八味丸；咳嗽淋秘，肺肾虚火也，补中益气汤、加减八味丸。大凡怯弱之人，不必分其肿疡，惟当先补胃
气，或疑参 满中，间有用者，又加发散败毒，所补不偿所损。又有泥于气质素实，或有痰不服补剂者，多致
有误。殊不知疮疡之作，缘阴阳亏损。其脓既泄，气血愈虚，岂有不宜补者哉。故丹溪云∶但见肿痛，参之脉
证虚弱，便与滋补，气血无亏，可保终吉。
又曰∶大抵脓血大泄，当大补气血为先，虽有他证，以末治之，疮口虽合，尤当补益。
又曰∶按张仲景先生治伤寒，有汗、吐、下三法，东垣先生治疮疡，有疏通、托里、和荣卫三法，用之得
宜，厥疾瘳矣。假如疮疡肿硬木闷，烦热便秘，脉沉而实，其邪在内，当先疏其内以下之； 肿作痛，便利调
和，脉浮而洪，其邪在表，当先托其里以汗之。元戎云∶荣卫充满，抑遏而为痈者，当泄之，以夺盛热之气；
荣卫虚弱，壅滞而为痈者，当补之，以接虚怯之气。又东垣先生云∶疮疡虽面赤伏热，不得攻里，里虚则下利。
仲景先生云∶疮家虽身体疼痛，不可发汗，汗之则发痉，苟不详审，妄为汗下，以致血气亏损，反延陷少壮者，
难以溃敛，老弱者多致不救。
朱丹溪曰∶痈疽因积毒在脏腑，非一朝一夕，今发于外，宜以标本为治，当先助气壮胃，使根本坚固，而
以行经活血为佐，参以经络时令，使毒瓦斯外发，此正仲景解表用麻黄、桂枝之意，施治之早，可以内消，此乃
内托之本意也。
又曰∶山栀、黄芩、苦参、犀角佐辅人参，固可解食毒之热，若寒月与虚人，宁无加减乎？《内经》谓∶
膏粱之变，足生大疔，此言疮疽之因也。禁戒浓味，恐其引出宿火之热，此诚富贵豢养口腹者所当谨，若素贫
者，大不然也。予治一人背痈径尺，穴深而黑，家贫得此，急作参 归术膏，多肉馄饨与之而安，多肉馄饨补
气之有益者也。
朱丹溪曰∶排脓内补十宣散，若用之于些小痈疽与冬月，尽可助内托之功。若于冬月肿疡用之，亦可转重
就轻，移深为浅，若溃疡与夏月用之，其桂朴之温散，佐以防风、白芷，吾恐虽有参 ，难为倚仗。比见世人
用此方者不分痈疽冬夏，无经络、无先后，如盲人骑瞎马，半夜临深池，危哉！
又曰∶内补十宣散，泻卫燥血药太多，止可用于轻小证候，虚之甚者，恐难倚仗。
又曰∶《精要》云∶大黄治痈疽之要药，以其宣热拔毒。又云∶疮始作，皆须以大黄等汤，极转利之。且
排日不废，继又自言，患痈疽者，每有泄泻，皆是恶候，此是不能无疑者也。藉曰∶前用大黄，恐因病体实而
大便秘结，有积热沉痼之积者发也，止可破结导滞，推令转动而已，岂可谓极转利之，而且排日不废乎！若下
利之后，又与利药，恐非防微杜渐之意。疮之始作，即《周礼》肿疡之时也，肿在肌肉，若非大满大实大坚之
证，自当行仲景发表之法，借五香汤为例，散之于外，何必遽以峻下之药，以夺其里自取其祸乎！
又曰∶内托散，（即护心丹。）此散绿豆解丹毒，又治石毒，味甘入阳明胃，性寒能补为君；乳香去恶肿，
入少阴，性温善窜为佐；甘草性缓解五金八石及百药毒为使。此方专为服丹石而发疽者设，若不因丹石而发疽
者，恐非必用之剂。
又曰∶独胜散（即香附去毛净，以姜汁浸一宿，焙研。）治气郁血滞，而诸疮愈后常服半年尤
妙，此皆施于体实气郁之人。每思香附，经不言有补，惟不老汤一方，乃言于老人有益，用片子姜黄、香附、
甘草三味，而以不老为名，且引铁翁先生与刘君为证，夫岂无其故哉。盖于行气中有补之之理耳。天之所以为
天者，健而有常也，因其不息，所以生生无穷。正如茺蔚子活血行气，有补阴之妙，故名益母；胎前产后所恃
者气血耳，胎前无滞，产后无虚，以其行中有补也。夏枯草治瘰 亦然。
《精要》云∶大凡痈疽不可舍五香汤，此又不能无言者也，开卷便于第一论中详言之。吾不知良甫之时，
有许多大腑坚秘，病气郁塞，若是之顽浓，可以骤散而大下者！若果有之，亦当开陈时之先后，证之可否，庶
乎后人不敢孟浪杀人也。或曰∶痈疽用大黄走泄以去毒，自孙真人行《千金方》已言之矣，良甫祖述其说，何
吾子病之深也？曰∶大黄除诸实热而性峻急，孙以盛行奇术于公卿间，时在晚宋，民不知兵，交游于富贵之家，
肉食之辈，固皆捷效，今良甫不分贫富苦乐劳逸，一概用之，宁无孟浪之患乎！况有房劳而虚者，忧怒而虚者，
极意贪求而虚者，强力动劳而虚者，大醉过饱而虚者，皆因气弱而涩，血少而浊。生疽固是难治之病者，大腑
秘而稍安谷食，肯守戒律，甘心澹味者，犹为可治，但费补工夫耳。苟因旬日半月，大便秘实，不知其气不降
The classics state: "Sweating will cure the sores." (When swelling is high, the pathogenic toxin is at the exterior level; therefore, sweating will cure the sores. If purgation is mistakenly used, it will harm the innocent healthy qi and damage the primordial qi.)
Li Dongyuan said: "Regarding diseases of carbuncles and ulcers, there are many treatment methods. Generally speaking, each has its appropriate application, including tonification, purgation, washing, sweeping, and applying pastes, as well as acupuncture, lancets, moxibustion, and cauterization, all applied differently."
Generally, understanding the principle ensures effective treatment; failing to understand the rationale leads to potential harm. I have seen cases where cold herbs were used to treat heat, and hot herbs to treat cold, which is a common theory in ancient and modern times. Some people consult prescriptions to treat diseases, arbitrarily adding or subtracting ingredients based on their own judgment, believing it to be correct. However, they do not realize that diseases have contrary and compliant manifestations, treatments have urgent and gradual approaches, methods include orthodox and flexible strategies, prescriptions have single and paired formulas, and medication dosages vary from light to heavy. The art of medicine lies in intuitive comprehension ("Yi"); only by grasping this essence can one adapt flexibly. Those who master flexibility comprehend the Dao and simplify the principles, thereby finding abundant resources. Although I am untalented, I briefly offer my insights: I have observed that using cold herbs to treat heat sometimes intensifies the heat, and treating heat with cold makes it more blazing. Why? Because one fails to recognize the yin-yang nature of the five zang organs and does not select herbs according to their affinity. For instance, if heart excess generates heat, one should tonify kidney water; once kidney water is nourished, the heat will subside spontaneously. If kidney water deficiency generates cold, one should tonify heart fire; once heart fire descends, the cold will resolve spontaneously. This is what is meant by 'when cold treatment fails to resolve heat, seek the yin; when heat treatment fails to resolve cold, seek the yang.' Also, 'using cold for heat and heat for cold' requires understanding the underlying logic. Furthermore, "treat mild conditions oppositely and severe conditions similarly" – what does this mean? Treating cold with heat must be guided by cool herbs; treating heat with cold must be guided by warm herbs, aiming for harmony. There are orthodox and flexible approaches: mild conditions are treated oppositely (orthodox), while severe conditions are treated similarly (flexible). In the field of surgery, how can one neglect the principles of tonification/purgation, sweating/purgation, root/branch, contrary/compliance, and orthodox/flexible!
The essential method for treating carbuncles and ulcers is: upon initial detection of heat toxin causing fever and stagnation leading to sores, within one or two days, one should purge pathogenic qi and unblock the zang-fu organs to achieve internal resolution. Ancient and modern decoction methods involve chopping herbs into hemp seed size, boiling rapidly over strong fire without overcooking to ensure quick efficacy; subsequently, using pills and powders to guide blood vessels and gradually dissipate the swelling; assisting with washes to harmonize Ying and Wei qi and circulate through meridians; and finally, using ointments for moistening and warming nourishment, along with external applications around the periphery to align with yin-yang. Pursuing erosion and interior support, sweating and purgation, warming and tonification, should be adapted to circumstances, with distinctions in depth and urgency, considering factors like gender and social status. Chu Cheng, Minister of Jin, stated that widows and nuns differ from married women and their natal families; although free from sexual exhaustion, they suffer from worry and thought, showing deep insight into human nature. Zhang Zhongjing also noted that substances have rigid and soft natures, and dietary habits vary, requiring different treatments. Thus, Qibo enumerated four therapeutic capabilities between Huangdi and the four directions. How can one stick rigidly to a single formula without flexibility when dealing with old and new diseases, physical and mental states? In cases of carbuncle swelling and pain, appearing within one or two days, if the pulse is deep and fine with vexation, organs are weak, skin is cold, toxins are fierce, spirit is unsettled, and external signs are profound, one should immediately use interior-supporting and warming agents to comply with the disease's nature (from *Ten Books*).
It is also said: For carbuncles, ulcers, erysipelas, swellings, tubercles, and scrofula, if detected early, use internal resolution methods immediately. If persistent, qi and blood decline, muscles become cold, pus is thin, toxins do not exit, and wounds fail to heal, or if swelling is gathered but not red, tubercles lack pus, and external signs are unclear, interior support is indicated. For unformed pus, promote early formation; for ruptured pus, promote early granulation; for qi-blood deficiency, tonify via interior support; for yin-yang disharmony, regulate via interior support. Generally, interior support prevents worsening complications. Surgeons must always have interior-supporting medicines, adjusting for cold, heat, warmth, coolness, vexation, thirst, diarrhea, and vomiting based on clinical urgency.
Furthermore: When carbuncle pus ruptures and toxins invade internally with critical symptoms, distinguish deficiency and excess. Deficiency is hard to tonify, excess is easy to purge; these methods must not be used lightly. A slight error brings great harm. One must distinguish the nature of deficiency/excess in sores, zang-fu, qi-blood, upper/lower, and true/pathogenic aspects. Specifically: Hard swelling with thick pus indicates excess; soft, slow swelling with thin pus indicates deficiency. Diarrhea, borborygmus, anorexia, frequent vomiting, cold limbs, weak pulse, cold skin, spontaneous urination or difficulty urinating, loose stools, hoarseness, and poor spirit indicate zang-fu deficiency. Hard stool, difficult urination, normal appetite, abdominal distension, chest oppression, limb pain, bitter taste, dry throat, vexation, thirst, fever, large pulse, and mental confusion indicate zang-fu excess. Clear, thin pus, non-healing wounds, non-red gathered swelling, cold muscles, spontaneous sweating, and pale complexion indicate qi-blood deficiency. Red swelling, chills/fever, pain, hot skin, thick sticky pus, and heavy head/eyes indicate qi-blood excess. Headache, nasal congestion, red eyes, palpitations, throat obstruction, mouth/tongue sores, vexation, craving cold drinks, sleep-talking, and teeth-grinding indicate upper excess. Sperm leakage, loose stools, heavy waist/legs, and restless sleep indicate lower deficiency. Stiff shoulders/neck, heavy limbs, abnormal vision, dull eyes, loss of taste, hoarse voice, sallow complexion, and limb edema indicate primordial qi deficiency. Severe swelling, unbearable pain, prolonged non-ulceration, alternating chills/fever, constipation, dysuria, mental vexation, and restlessness indicate pathogenic excess.
It is said: Primordial qi depletion results in deficiency; pathogenic excess results in excess.
It is said: Pain indicates excess; itching indicates deficiency.
It is said: A surging, rapid pulse indicates excess; a minute, fine, and soft pulse indicates deficiency. Tonify deficiency to harmonize qi and support the interior; purge excess to unblock and guide qi. The *Neijing* states: "If blood is excess, lanced it; if qi is deficient, draw it forth."
It is said: Treating sores externally is called "supporting the interior" rather than "sweating"; treating internally is called "unblocking" rather than "purgation"; treating meridians is called "harmonizing Ying and Wei" rather than "unblocking." The goal is primarily to preserve primordial qi, not just attack the sore. Modern doctors prioritize rapid cure, using harsh sweating and purgation, negligently treating toxic heat. Toxins may disperse quickly, but primordial qi is damaged, shortening life. Must one not be cautious!
It is said: Ancients prescribed medicines according to the disease, not sticking to fixed formulas, adjusting as needed. For accumulations and tonification, pills are used, following old formulas without major changes. However, in critical stages of sores with diverse symptoms, how can one stick to a single formula? Adjustments are necessary. For example, for back carbuncles, brain ulcers, malignant疔 (ding), or pre/post-ulceration headaches due to deficiency, add Schisandra (Wuweizi) to interior-supporting formulas; for restlessness, add Ginseng (Renshen) and Poria (Fuling); for deficiency fever, add Rehmannia (Dihuang) and Trichosanthes (Gualou); for alternating chills/fever, add Groundcherry Root (Digupi) and Bupleurum (Chaihu); for unquenchable thirst, add Anemarrhena (Zhimu) and Adzuki Bean (Chixiaodou); for constipation, add Akebia (Mutong) and Juncus (Dengcao); for deficiency vexation, add Goji (Gouqizi) and Asparagus (Tianmendong); for diarrhea, add Magnolia Bark (Houpo); for cold limbs, add Aconite (Fuzi) and Ginger (Shengjiang); for vomiting, add Agastache (Huoxiang) and Clove (Dingxiang); for phlegm, add Pinellia (Banxia) and Tangerine Peel (Chenpi); for excessive pus, add Angelica Sinensis (Danggui) and Ligusticum (Chuanxiong); for severe pain, add Peony (Shaoyao) and Frankincense (Ruxiang); for slow granulation, add Ampelopsis (Bailian) and Cinnamon Twig (Guangui); for wind pathogens, add Angelica Pubescens (Duhuo) and Saposhnikovia (Fangfeng); for fright, add Cinnabar (Dansha); for twitching eyes/mouth, add Notopterygium (Qianghuo) and Ashitaba/Xixin (Xixin). Though untalented, I have used these adjustments successfully since youth. Future practitioners should study them carefully.
It is also said: Obstruction of the nine orifices contraindicates purgation. Coma/dizziness from sores (Yu Mao) contraindicates purgation; sweating cures it.
It is said: Carbuncles originate from internal or external causes, requiring warm or cold treatments respectively. External origin requires interior support; using cold herbs draws exterior pathogens into the marrow. Internal origin requires unblocking; using warm herbs pushes marrow pathogens to the skin, causing systemic ulceration and aiding toxins, leading to severe suffering or death. Jiegu said: Errors in treating sores can kill faster than Shanghan. Acupuncture and herbs must follow organ-specific protocols.
It is said: Do not assume all swellings are fire-toxins. Constitution varies (deficiency/excess, old/young); cold herbs should not be used universally. If toxins are newly gathered and weak, dispersal is possible, but etiology and constitution must be assessed. Universal cold herbs cause errors. If pus is forming with strong pathogens, use detoxifying agents first to reduce severity; immediate interior support may worsen it. Use interior support only when pus is forming but not yet ready or not ulcerating. If pus is mature and abundant, lance it; symptoms resolve upon drainage.
It is said: High, hard, painful, red-dark swelling indicates pathogens in blood vessels/skin; urgent sweating disperses toxins. Main formula: Jingfang Baidu San; Winter: Wanling Dan; Deficient pulse: Simiao Tang or Neituo Fujian Tang.
Zhang Zhongjing said: Sores patients with body pain should not sweat; sweating causes spasms. (Note: Sweating here means profuse sweating, not gentle dispersion via interior-supporting herbs.)
Xue Lizhai said: Sores arise from rich food, alcohol, sexual excess, emotional stagnation, yin deficiency with yang aggregation, essence/qi depletion, Mingmen fire failure failing to generate Earth, weak Ying/Wei, and external pathogens injuring qi-blood. Treat based on meridian involvement and root/branch urgency. Acute/excess: treat branch first; Chronic/deficient: treat root first; Acute/deficient: treat root primarily, branch secondarily. High/swollen/painful/thick pus: qi-blood intact, easy to treat. Flat/mild pain/thin pus: qi-blood weak, difficult. Non-swollen/non-painful/black/non-ulcerated: severe deficiency, very difficult. Treatment: High/swollen/painful: Xianfang Huoming Yin then Tuoli Xiaodu San; Flat/mild pain: Tuoli San, add Ginger/Cinnamon if ineffective; Pain after rupture: Ba Zhen Tang (qi-blood deficiency); No pus/ulceration: Si Jun Zi Tang + Rou Gui (yang deficiency); No granulation/convergence: Si Jun Zi Tang + Shaoyao/Muxiang (spleen deficiency); Chills/fever: Shiquan Dabu Tang + Ginger/Cinnamon (yang deficiency); Afternoon fever: Si Wu Tang + Renshen/Atractylodes (yin-blood deficiency); Vomiting: Liu Jun Zi Tang + Pao Jiang (stomach qi deficiency); Sweating: Liu Wei Di Huang Wan + Wuweizi (five zang deficiency); Fatigue/anorexia: Buzhong Yiqi Tang + Fuling/Banxia (spleen qi deficiency); Cough/wheezing: Previous decoction + Maidong/Wuweizi (spleen/lung deficiency); Vomiting/anorexia: Renshen Lizhong Tang (spleen/stomach deficiency); Abdominal pain/diarrhea: Fuzi Lizhong Tang (spleen/stomach cold); Lower abdominal fullness/leg edema: Shiquan Dabu Tang + Shanyao/Shanzhuyu/Rou Gui (spleen/kidney deficiency); Diarrhea/cold feet: Previous decoction + Guizhi/Fuzi (spleen/kidney cold); Thirst/dysuria: Jiaban Bawei Wan (kidney deficiency with false fire); Cough/dysuria: Buzhong Yiqi Tang / Jiaban Bawei Wan (lung/kidney false fire). For weak patients, prioritize stomach qi tonification before distinguishing sores. Avoid excessive Ginseng if it causes stagnation; add dispersing/detoxifying herbs cautiously. Do not assume robust constitutions tolerate no tonification; sores stem from yin-yang depletion. Post-drainage, qi-blood is further depleted; tonification is essential. Danxi said: If swelling/pain accompanies weak pulse/symptoms, tonify immediately to preserve qi-blood.
It is said: After massive pus/blood loss, prioritize qi-blood tonification; other symptoms are secondary. Even after healing, continue tonification.
It is said: Zhang Zhongjing used sweating, vomiting, purgation for Shanghan; Li Dongyuan used unblocking, interior support, harmonizing Ying/Wei for sores. Correct application cures disease. For hard/swollen/stagnant sores with fever/constipation/deep-excess pulse (internal pathogens), unblock internally with purgation. For flat/swollen/painful sores with normal bowels/surging-floating pulse (external pathogens), support interior with sweating. Yuanrong said: Excess Ying/Wei causing abscesses requires purgation to drain heat; deficient Ying/Wei causing abscesses requires tonification to restore qi. Li Dongyuan said: Facial redness/latent heat in sores contraindicates internal purgation (causes diarrhea). Zhongjing said: Sores patients with body pain contraindicate sweating (causes spasms). Negligent sweating/purgation damages qi-blood, hindering healing in youth and causing death in elders.
Zhu Danxi said: Sores result from accumulated toxins in zang-fu over time, now manifesting externally. Treat root and branch: first strengthen qi/stomach to secure the foundation, assist with blood-invigorating/meridian-circulating herbs, consider meridians/seasons to expel toxins externally. This aligns with Zhongjing’s use of Ephedra/Cinnamon for exterior release. Early treatment allows internal resolution, the essence of interior support.
It is said: Gardenia, Scutellaria, Sophora, Rhinoceros Horn (substitute) with Ginseng clear food-toxin heat. In winter or for deficient patients, adjustments are needed. *Neijing* states: Rich diet causes large ding (sores). Avoid rich foods to prevent reigniting latent heat. This applies to the wealthy; the poor are different. I treated a poor man with a foot-wide back carbuncle, deep and black. I prepared a Ginseng-Atractylodes-Danggui-Decoction paste and fed him meat-filled wontons, which cured him. Meat wontons benefit qi tonification.
Danxi said: Pain-Draining Interior-Supporting Shixuan San aids interior support for minor sores in winter. For winter abscesses, it shifts severity to mildness and depth to superficiality. For ulcers in summer, the warming properties of Cinnamon/Cassia bark combined with Saposhnikovia/Saposhnikovia may overwhelm even Ginseng/Atractylodes. Using this formula indiscriminately across seasons/meridians is like a blind man riding a blind horse near a deep pool—dangerous!
It is said: Shixuan San contains too many drying/blood-purging herbs; suitable only for mild cases. Not reliable for severe deficiency.
It is said: *Jingyao* states: Rhubarb is key for sores due to heat-clearing/toxin-extracting properties. It claims early sores require heavy Rhubarb purgation daily. Yet it notes diarrhea in sores is a bad sign. This is contradictory. If Rhubarb was used for excess constipation/heat, it should only break stagnation, not cause severe daily purgation. Purging again after diarrhea contradicts preventive principles. At the onset of sores (*Zhouli* stage), if not full/excess/hard, follow Zhongjing’s exterior-releasing method (e.g., Wuxiang Tang) to disperse externally. Why use harsh purgatives to damage interior qi?
It is said: Neituo San (Hu Xin Dan): Mung bean clears mineral poison (monarch); Frankincense removes swelling (minister); Licorice relieves toxicity (envoy). Designed for sores from mineral pill ingestion. Not essential for other sores.
It is said: Dusheng San (Aucklandia processed with ginger juice) treats qi stagnation/blood stasis. Taking it for six months post-recovery is beneficial for robust, stagnant constitutions. Aucklandia isn't explicitly tonifying, but the "Bu Lao Tang" (Anti-Aging Decoction) uses it with Turmeric and Licorice for the elderly, implying tonification within movement. Heaven’s strength lies in constant motion, generating life. Like Leonurus (Yimu Cao) invigorates blood/qi with yin-tonifying effects. Pregnancy/postpartum rely on qi-blood; pregnancy avoids stasis, postpartum avoids deficiency, because movement contains tonification. Prunella (Xiaku Cao) works similarly for scrofula.
*Jingyao* states: Never abandon Wuxiang Tang for sores. I question Liangfu’s era having so many cases of severe constipation/stagnation requiring sudden dispersal/heavy purgation. If such cases existed, timing and suitability must be clarified to avoid reckless harm. Some argue Sun Simiao’s *Qianjin Fang* advocated Rhubarb for sores, so why criticize Liangfu? Answer: Rhubarb is harsh. Sun practiced among nobles/meat-eaters in late Song, achieving quick results. Liangfu applied it universally regardless of constitution, risking recklessness. Deficient constitutions (sexual excess, anger, greed, overwork, drunkenness) have weak qi/turbid blood. Sores are hard to treat; if constipation exists but diet is controlled, tonification suffices. If constipation persists for weeks without addressing qi descent...