一味峻补，与外症不相照顾，则余毒未清，反能增病。必须审度其虚实，或全属虚寒，然后择取对症之
药几味成方。如不问外症之有无，而一概以内科温补之全方治之，则其中必有不对症之药，反能有害。
不但不知内科，并外科之理亦不知也。薛立斋之用内科方尽如此，不值一笑也。）
张侍御背患疮三枚，皆如粟。彼以为小毒，服清热化痰之药，外用凉药敷贴，数日尚不起，色黯
不，腹中气不得出入，其势甚可畏。连用活命饮二剂，气虽利，脓清稀，疮不起。欲用补剂，彼泥
于素有痰火，不受参、术之补。因其固执，阳以败毒之剂与视之，而阴以参、 、归、术各五钱，姜、
桂各二钱，服二剂，背觉热，肿起，腐肉得溃，方信余言，始明用大补药乃愈。
南都聘士叶公玉表兄聂姓者，患发背，时六月，腐肉已去，疮口尺余，色赤而 ，发热不食，欲
呕不呕，
服十宣散等药，自谓不起，请决之。其脉轻诊则浮而数，重诊则弱而涩，此溃后之正脉。然疮口开张，
血气虚也；欲呕而不呕，脾胃虚也；色赤 肿，虚火之象也。尚可治，遂与十全大补汤加酒炒知、柏、
五味、麦冬，及饮童便，饮食顿进，肌肉顿生。服至八剂，疮口收如粟许。又惑于人言，又服消毒药
二剂，以为消余毒，反发热昏愦，急进前药，又二十余剂乃愈。后两月，因作善事，一昼夜不睡，至
劳发热，似睡不睡。与前药二剂，愈加发热，饮食不进，惟饮热汤。后以前药加附子一钱，二剂愈。
（五味能收敛毒瓦斯，不可轻用。）
石武选廉伯患发背，内服防风通圣散，外敷凉药，汗出不止，饮食不进，且不寐，疮盈尺，色黯
而坚硬，按之不痛，气息奄奄，此阳气已脱，脉息如无。急隔蒜灸时许，背顿轻，四围高，不知痛，
中央肉六寸许一块已死。服香砂六君子汤一剂，翌日复灸一次，痛处死肉得解，令砭去。薛归后，又
为他医所惑，未砭其血，复凝。又敷辛温活血药，翌日依言砭之，出黑血二盏许，背强顿去。以前药
加姜、桂，服一钟即鼾睡，觉来肢体少健，但饮食仍不思，吞酸，仍有疮，仍不痛。彼以为阴毒，乃
如此赤。曰∶此血气虚极，寒邪淫于内，无阳营于患处，故肌肉死也，非阴毒。若阳气一回，胃气即
省，死肉即溃，可保无虞矣。以前药二剂，各加姜、桂、附子二钱服之，略进米饮，精神复旧，患处
觉热，脉略有力，此阳气略回矣。是日他医谓疮疡属火症，况今暑令，乃敷芙蓉根等凉药，即进粥二
碗，服消毒药，死肉即溃。意芙蓉乃寒凉之药，与脾胃何益？饮食实时而进，消毒乃卒散之剂，与阳
气何补？死肉实时而溃，此盖前桂、附之功至，而脾胃之气省，故饮食阳气旺，死肉腐也。苟虚寒之
人，若内无辛热回阳之药，辄用寒凉攻毒之剂，岂可得而生耶。若以为火令属阳之症，内有热而用辛
温大补之剂，岂不致死，而反生耶。殊不知此乃舍时从症之治法也。（吞酸，乃伏邪未出之故。）
一男子患发背，脓始溃，肿未消，已十七日，脉微而静。曰∶脓毒未尽脉先弱，此元气虚，宜补
之，否则后必生变。彼惑于人言，乃服败毒药，腐肉虽溃，疮口不完，忽腹中似痛，后去白垢，肛门
里急，复求治。曰∶此里虚，然非痢非毒，当温补脾胃为善。因诸疡医皆以为毒未尽，仍服败毒药而
死。
贺少参朝仪背胛患疽，大如豆粒，根畔木闷不肿，肉色如常。曰∶气虚毒甚之症，虽用大补剂，
亦不能收敛。先用活命饮二剂，背强少和。又二剂，疽少赤。用大补剂，疮出黑血杯许，继有鲜血，
微有清脓。曰∶可见气血虚极矣。他医以为属气血有余之症，密用攻毒一钟即呕逆，腹内阴冷而死。
少司寇周玉岩背患疽在胛，已四日，疮头如粟，重如负石，坚硬不起。自以为小恙，外敷凉药，
内服连翘消毒散，去后四次，形体倦怠，自汗盗汗，口干无寐。曰∶疮不宜硬，色不宜黯。周曰∶初
起时赤而软，自煎二药，以致如此。曰∶凡疮外如麻，内如瓜，毒结于内，非小患也。脉轻诊如数，
按之则微，未溃脉先弱，主后难敛。因与卿雅，不能辞，遂隔蒜灸，二十余壮乃知痛，又十余壮背觉
少和，服六君子汤加黄 、藿香、当归、麻黄根、浮麦，二剂渴止，汗少敛。疮色仍黯坚硬，又服辛
温活血之药，疮起至渴止汗敛，所结死血得散。良久汗复出，口复干，又复数剂，外皮虽溃，清脓尚
未溃通于内，脓欲走别处，彼用药围之。曰∶里虚而脓不能溃于外，围药逼毒入内。至十二日，脉浮，
按之如无，再用前药一剂，加姜、桂服之即安寐。又二日，脉忽脱，再于前药加附子七分，服二剂乃
曰∶背今日始属吾也。形体亦健，颇有生意。因先日有言，难以收敛，屡更医，杂用清热解毒及敷凉
药，遂至里虚元气下陷，去后如痢，用治痢消毒药而死。（初起不宜用凉药以遏抑邪气，令不得出，
今犯此禁，故其病益加。明是阴血大亏，津液耗竭，乃不救其阴，专补其阳，以致生变尚不悟，而巧
为卸过，如此为医，安有长进之日？雄按∶凡遇重证，医者不知竭力图维，辄出危言，以致病家张皇，
屡屡更医，而竟无成功者多矣。此症隔蒜艾灸，用六君子汤以救外敷内服苦寒之失，至过热之品，围
药之法，均宜详参。）
姜举人患发背十日，正腐溃作渴，喜热汤饮，此中气虚，不能充津液而口干，宜预补之，否则不
能收敛。后疮口故不收，犹以毒为末尽，用败毒药，两月疮口不完，清利腹痛，又服清凉之药而死。
王序班患发背，元气虚弱，用托里药而始起，用大补药而始溃。彼惑他议，敷凉药，致腹内不和，
里急后重，去后如痢，大孔作痛。曰∶此里虚非痢，仍用败毒治痢药而死。
一男子四十余岁患发背，未溃即作渴，脉数肿高，色紫面赤，小便如膏。以加减八味丸料，加酒
炒知、柏
为丸，每日空心并食前，以童便送下百丸。用八珍汤加五味、麦冬、黄 、酒炒知母、赤小豆，食远
煎服。逐日又以童便代茶饮之，渴止疮溃而愈。吾治得生者，此人耳。（五味不可妄用。）
汪夫人患发背，用敷药冷眉，胸内欲呕，急令洗去，用托里药寻愈。又刘太宰紫岩太夫人，患发
背，元气不足，用托里药而起。王安人发背，正溃时欲速效，俱敷草药，即日而死。
刘大尹年将五十，陆路赴京，兼丧其妻，发背盈尺，中六寸许，不痛，发热口干，恶寒自汗，少
食，大便不禁且气促，脉浮大，按之空虚。用补中益气汤加半夏、茯苓四剂，又隔蒜灸之，彼云背重
已去，形气少健，但吞酸，前日所进饮食，觉仍在腹。又以前药加姜、桂服二帖，饮食少进，吞酸已
止，始得睡。疮且不痛不溃，疑为阴症。曰∶此阳气虚不能荣于患处，故所患肉死而不痛不溃也。若
胃气回，饮食进，死肉即溃矣。仍服前药六剂，饮食渐进，患处渐溃，脉有力。曰∶此阳气回矣。后
惑于他医云，必服飞龙夺命丹，出汗为善。遂进一服，汗大出，三日不止，复请治。曰∶汗多亡阳，
无能为也。强曰∶诸书云，汗之则疮已，岂遂为患？后果死。东垣曰∶疮疡因风热郁于下，其人多怒，
其疮色赤，肿高结硬而痛，左关脉洪缓而强，是邪客于血脉之上，皮肤之间。故发其汗，而通其荣卫，
则邪气去矣。谦甫治疮疡，冬月脉浮紧，按之洪缓，乃寒覆皮毛，郁遏经络，热不得升，聚而赤肿。
盖冬月乃因寒气收敛，皮肤致密，腠理汗不得出而设也。况发汗乃阴盛阳虚，邪不能自出，必得阳气
泄，汗乃出，是助阳退阴之意也。且前症未溃，其气血既虚，溃后气血愈虚。凡疮虽宜汗，然元气虚
者不宜。况所见之症，俱属不足，岂可汗耶？（口干者，渴之渐也，何以用半夏、茯苓？）
晋都机房纪姓者，背疮，胃气虚，用温补药而饮食进，大补药而疮腐愈。后患腿痛，用养血化痰
之剂少止。彼嫌功缓，他医以为湿热，服麻黄左经汤一剂，汗出不止。曰∶必发痉而死。已而果然。
王德之患发背，脉浮数，按之则涩，大便五六日不行，腹不加胀。曰∶邪在表不在里，但因气血
虚，饮食少，故大便不行，非热结也，宜生气血为主。彼泥积毒在内，用大黄之药下之，遂连泻三四
次，更加发热，来日又服一剂，泻遂不止，饮食不化，呃逆不绝，手足皆冷。诊之，脉已脱，辞不治。
其子曰∶泻之能为害乎？
曰∶服利药而利不止者死；不当泻而泻，令人开肠，洞泄不禁者死；下多亡阴者死。曰∶疮疡乃积毒
在脏，若不驱逐其毒，何以得解？曰∶疮疡虽积毒在脏腑，治法当先助胃气，使根本坚固，参以行经
活血时宜之药，非专用大黄也。今病在表，而反以峻利之剂重夺其阴可乎哉？故曰表病里和而反下之，
则中气虚，表邪乘虚而入，由是变症百出。虽云脉浮数，邪在表，属外因，当用内托复煎散，其中黄
芩、苍术亦不敢用。脉沉实，邪在内，属内因，当用内疏黄连汤，其中大黄、槟榔亦不敢用。况浮数
涩三脉，皆主气血俱虚。邪既在表，而反用峻利之剂，重泻其里，诛伐无故，不死何俟？
一县尹背疮，竟背腐溃，色黯，重若负石，危甚，饮食颇进，用红桃散，色渐赤，负渐轻，再用
而肌生，更用托里药而愈。盖此大毒症，非峻药莫能治。内用砒，故用攻毒有效。
平氏室患发背，以托里消毒药二十余剂而溃。因怒顿吐血五六碗许，气弱脉细，此气血虚极也。
遂令服独参膏斤许稍缓。更以参、 、归、术、陈皮、炙草三十余剂，疮口渐合。设投以犀角地黄汤
沉寒之药，鲜有不误。
徐符卿年逾四十，患发背，五日不起，肉色不变，脉弱少食，大便不实。但以疽未溃，脉先弱，
难于收敛，用托里消毒二剂，方起发。彼惑一妪言贴膏药，服攻毒剂，反甚，背如负石。复请治，遂
以隔蒜灸三十余壮，云背不觉重，但痒痛未知。更以托里药，知痒痛，脓清。仍以前药倍加参、 ，
佐以姜、桂，脓稍稠。又为人惑，外用猪腰子贴抽脓血，内服硝黄剂，遂流血五六碗许，连泻十行，
腹内如冰，饮食不进。不得已连诊之，脉遽脱，已不可为矣。盖其症属大虚不足之甚，虽一于温补，
犹恐不救，况用攻伐之剂，不死何俟？
顾浩室年逾四十，患发背，治以托里药而溃。忽呕而疮痛，胃脉弦紧，彼以为余毒内攻。东垣
云∶呕吐无时，手足厥冷，脏腑之虚也。丹溪云∶溃后发呕不食者，湿气侵于内也。又云∶脓出而反
痛者，虚也。今胃脉弦紧，木乘土位，是虚明矣。欲以六君子汤加酒芍、砂仁、藿香治之。彼自服护
心散，呕愈甚。仍用前药，更以补气血药，两月而愈。大抵湿气内侵，或感秽气而作呕，必喜温而脉
弱，热毒内攻而作呕者，必喜凉而脉数，必须辨认明白。
郑挥使年逾五十，患发背，形症俱虚，用托里药而溃。但有腐肉当去，彼惧不肯。延至旬日，则
好肉皆败矣。虽投大剂，毒甚竟不救。古人谓坏肉恶于野狼虎，毒于蜂螫，缓去之则戕贼性命。信哉。
张宜人年逾六十，患发背，三日肉色不变，头如粟许，肩背加重，寒热饮冷，脉洪数。陈良甫云∶
外如麻，里如瓜。齐氏云∶憎寒壮热，所患必深。又曰∶肉色不变，发于内也。以人参败毒散二剂，
乃隔蒜灸五十余壮，毒始发，背始轻，再用托里药渐溃。气血虚甚而作渴，参、 、归、地等药，渴亦
止。彼欲速，自用草药罨患处，毒瓦斯复入，遂不救。尝见老弱者患此，疮头不起，或坚如牛领之皮，
多不待溃而死。有溃后气血不能培养者亦死。凡疮初溃，毒正发越，宜用膏药吸之，参、 等药托之。
若反以药遏之，使毒瓦斯内攻者，必不救。
王太守宜人患发背，脓熟不开，昏闷不食。此毒入内也，断不治。强之针脓碗许稍苏，须臾竟亡。
大抵血气壮实，脓自涌出。老弱之人，血气枯槁，必须迎而夺之，顺而取之。若毒结四肢，砭刺少缓。
腐溃深大，亦难收敛。痛结于颊项胸腹紧要之地，不问壮弱，急宜针刺，否则难治。
郭职方名琏，患背疮，溃陷色紫，舌卷。谓下陷色紫，主阳气脱，舌卷囊缩，肝气绝，遂辞之。
经曰∶舌卷囊缩，此筋先死，庚日笃，辛日死。果至立秋日而殁。
姚应凤治抚军喻思恂，驻师温州，拒海贼刘香，受降有日，毒发背间剧甚。应凤至， 腐肉二大
器，洞见五脏，随敷以丹药，越二日痈平，开辕门坐受降抚。喻喜深德之。（《仁和县志》）
王洪绪治木渎谭姓妇，患背疮如碗，初起色白，近已转红，痛甚，时值三伏，与阳和汤。或曰∶
暑天何用麻、桂热剂？曰∶此阴症也。又云∶患色转红，阴已回阳。乃立令煎服，不一时痛止。连进
四服，症减其七，余三分有脓不痛而溃，五日收功。
钱国宾治湖州三官庙僧大乘，发背，长二尺，阔八寸，深寸许，中间如蜂窝，二百余头，流脓，
痛极欲死，乃半身发也。此僧素喜爆炙，多动肝气，其脉浮洪，可救。以新槐子一合，生白矾一钱，
A single approach of vigorous tonification, without attending to external symptoms, means residual toxins remain unclarified and may instead exacerbate the disease. One must carefully assess deficiency and excess; only if it is entirely deficient-cold should one select a few symptomatic herbs to form a prescription. If one ignores the presence or absence of external symptoms and uniformly treats with complete internal medicine warming-tonic formulas, there will inevitably be herbs that do not match the syndrome, causing harm. This demonstrates not only ignorance of internal medicine but also of surgical principles. (Xue Lizhai's use of internal medicine formulas was all like this, unworthy of a smile.)
Imperial Gentleman Zhang suffered from three sores on his back, each the size of millet grains. He considered them minor toxins, took heat-clearing and phlegm-resolving medicines, and applied cold external compresses. After several days, they did not resolve; the color was dark, abdominal qi was obstructed and could not move in or out, a situation very fearsome. He continuously took Huoming Yin (Life-Saving Decoction) for two doses. Although qi became smooth, the pus was clear and thin, and the sore did not elevate. He wished to use tonic agents, but he was stuck on his chronic phlegm-fire and refused the tonification of Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). Due to his obstinacy, [the physician] superficially gave him detoxifying agents for appearance, while secretly administering Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) each at 5 qian, along with Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex) each at 2 qian. After two doses, his back felt hot, swelling elevated, and necrotic tissue ulcerated. Only then did he believe my words, realizing that using major tonics was necessary for recovery.
The scholar Ye Gongyu's cousin surnamed Nie in Nanjing suffered from a carbuncle on the back. It was the sixth month; necrotic tissue had been removed, the sore opening was over one chi long, red and swollen, with fever, anorexia, nausea without vomiting. He took Shixuan San (Ten-Auspicious Powder) and believed he would not survive, asking for a prognosis. His pulse was floating and rapid when lightly palpated, weak and choppy when heavily palpated; this is the normal pulse after ulceration. However, the open sore indicates blood and qi deficiency; nausea without vomiting indicates spleen-stomach deficiency; redness and swelling indicate deficient fire. Treatment was still possible. I prescribed Shiquan Dabu Tang (Complete Great Tonifying Decoction) plus Jiuzhi Zhimu (Alcohol-fried Anemarrhenae Rhizoma), Jiuzhi Huangbai (Alcohol-fried Phellodendri Cortex), Wuweizi (Schisandrae Fructus), Maidong (Ophiopogonis Radix), and drinking Tongbian (Child's Urine). Diet immediately improved, and flesh regenerated rapidly. After eight doses, the sore contracted to the size of a millet grain. Confused by others' words, he took two doses of detoxifying medicine to eliminate residual toxins, resulting in fever and confusion. Urgently taking the previous medicine again, he recovered after more than twenty doses. Two months later, due to doing good deeds, he stayed awake for a day and night, leading to fatigue-induced fever and drowsiness. Two doses of the previous medicine worsened the fever and anorexia; he only drank hot water. Later, adding Fuzi (Aconiti Lateralis Radix Praeparata) 1 qian to the previous medicine cured him in two doses. (Wuweizi can astringe toxic vapors; it should not be used lightly.)
Shi Wuxuan Lianbo suffered from a carbuncle on the back. Internally taking Fangfeng Tongsheng San (Saposhnikovia-Regulating-the-Middle Powder), externally applying cold medicines, he had incessant sweating, anorexia, insomnia, a sore filling one chi, dark and hard, non-tender upon pressure, with faint breathing. This indicated Yang qi depletion, with pulse as if absent. Urgently, garlic-separated moxibustion was performed for about an hour. The back immediately felt lighter, surrounding areas elevated, pain ceased, but a six-cun piece of central flesh was dead. One dose of Xiangsha Liujunzi Tang (Amomum-Amomum Six-Gentlemen Decoction) was taken. The next day, moxibustion was repeated once. The painful dead flesh detached and was removed with a Bian stone. After Xue Ji returned, he was confused by other physicians; bloodletting was not performed, and blood coagulated again. Applying acrid-warm blood-invigorating medicines, the next day, following advice, bloodletting was done, yielding about two cups of black blood, removing back stiffness. Adding Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex) to the previous medicine, one cup caused snoring sleep. Upon waking, limbs were slightly stronger, but anorexia, acid regurgitation, and painless sores persisted. He thought it was Yin toxin, yet it was so red. I said: This is extreme blood and qi deficiency, with cold pathogens flooding internally, lacking Yang qi to nourish the affected area, hence muscle death, not Yin toxin. Once Yang qi returns and stomach qi improves, dead flesh will ulcerate, ensuring safety. Taking two doses of the previous medicine with added Shengjiang, Rougui, and Fuzi (Aconiti Lateralis Radix Praeparata) 2 qian each, he slightly consumed rice drink, spirit recovered, affected area felt hot, pulse slightly strong—Yang qi was returning. That day, another doctor claimed sores are Fire syndromes, especially in summer, and applied cool medicines like Furonggen (Hibisci Mutabilis Radix) and ate two bowls of porridge, taking detoxifying medicine. Dead flesh ulcerated. I reasoned: Furong is cold/cool; what benefit to spleen-stomach? Detoxifying medicines scatter abruptly; what benefit to Yang qi? Dead flesh ulcerated because the effect of Gui (Cinnamon Twig) and Fu (Prepared Aconite) arrived, spleen-stomach qi improved, diet/Yang qi flourished, rotting dead flesh. If deficient-cold persons use cold-cool detoxifying agents without acrid-hot Yang-returning medicines internally, how can they live? If one thinks summer/Fire syndromes involve internal heat and uses acrid-warm major tonics, wouldn't that cause death but instead produce life? This is actually "abandoning the season to follow the syndrome" treatment. (Acid regurgitation is due to latent pathogens not emerging.)
A man suffered from a carbuncle on the back. Pus had just ulcerated, swelling not reduced, seventeen days passed, pulse faint and quiet. I said: Pus toxin not exhausted, pulse weak first; this is Yuan Qi (Primal Qi) deficiency, suitable for tonification, otherwise changes will occur later. Confused by others, he took defeat-toxin medicines. Though necrotic tissue ulcerated, the sore opening was incomplete. Suddenly, abdominal pain, passing white residue, tenesmus. Seeking treatment again, I said: This is interior deficiency, not dysentery or toxin, should warm-tonify spleen-stomach. Because all surgeons thought toxin not exhausted, he continued taking defeat-toxin medicines and died.
He Shaocan Chaoyi suffered from a carbuncle on the shoulder blade, bean-sized, root numb/swollen, flesh color normal. I said: Qi deficiency with severe toxin; even with major tonics, cannot consolidate. First, Huoming Yin (Life-Saving Decoction) two doses, back stiffness eased. Another two doses, carbuncle slightly red. Using major tonics, black blood cup-sized flowed, followed by fresh blood, slight clear pus. I said: Shows extreme blood and qi deficiency. Other doctors thought it blood/qi excess; secretly using attacking/toxin-draining medicine caused one cup of vomiting, abdominal coldness, and death.
Shaosi Kou Zhou Yuyan suffered from a carbuncle on the shoulder blade for four days, sore head like millet, heavy as carrying a stone, hard and non-elevating. Thought it minor, applied cold external medicines, took Liaoqiao Xiaodu San (Forsythia Detoxifying Powder) internally. After four bowel movements, body fatigued, spontaneous/diaphoresis, dry mouth, insomnia. I said: Sores should not be hard, color should not be dark. Zhou said: Initially red and soft, self-decocted these two medicines, leading to this. I said: Generally, sores "external like hemp seeds, internal like melons," toxin knotted inside is not minor. Pulse light palpation like rapid, pressing then faint; pre-ulceration weak pulse indicates difficult consolidation later. Due to elegant friendship, could not refuse, performed garlic-separated moxibustion, over twenty moxa cones until pain was felt, another ten cones back felt easier. Took Liujunzi Tang (Six-Gentlemen Decoction) plus Huangqi (Astragali Radix), Huoxiang (Pogostemonis Herba), Danggui (Angelicae Sinensis Radix), Mahuanggen (Ephedrae Radix et Rhizoma), Fumai (Triticum Levis Fructus). Two doses thirst stopped, sweat reduced. Sore color still dark/hard, took acrid-warm blood-invigorating medicine. From sore elevation to thirst stopping/sweat reducing, congealed dead blood dispersed. Long after, sweat reappeared, mouth dry, more doses. External skin ulcerated, clear pus not yet connected internally, pus wanted to go elsewhere; he used encircling medicine. I said: Interior deficiency, pus cannot ulcerate externally; encircling medicine forces toxin inward. By twelfth day, pulse floating, pressing as if absent, took previous medicine one dose, added Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex), slept peacefully. Two days later, pulse suddenly vanished, added Fuzi (Aconiti Lateralis Radix Praeparata) 0.7 qian to previous medicine, two doses cured. Said: Back belongs to me today. Body healthy, signs of life. Because previously said difficult to consolidate, changed doctors many times, mixed heat-clearing/toxin-draining and cold compresses, leading to interior deficiency, Yuan Qi sinking, bowel movements like dysentery, died using dysentery-detoxifying medicine. (Initially, cold medicines should not be used to suppress pathogens, preventing exit; violating this prohibition worsened disease. Clearly Yin blood severely deficient, fluids exhausted, yet not saving Yin, only tonifying Yang, causing changes without realization, cleverly shifting blame. How can such a physician improve? Xiong notes: For severe cases, if physicians do not strive fully, uttering alarming words causes patient panic, frequent doctor changes, often failing. This case used garlic moxibustion and Liujunzi Tang to correct errors of external cold/internal bitter-cold, avoiding overheating and encircling methods.)
Jiang Juren suffered from a carbuncle on the back for ten days, ulcerating with thirst, preferring hot drinks. This is Middle Qi deficiency, unable to fill fluids causing dry mouth; should preemptively tonify, otherwise cannot consolidate. Later, sore did not close, still thinking toxin not exhausted, used defeat-toxin medicines. Two months, sore incomplete, clear discharge, abdominal pain, died taking cooling medicines.
Wang Xuban suffered from a carbuncle on the back, Yuan Qi weak. Started rising with Tuoli medicines, ulcerated with major tonics. Confused by other opinions, applied cold medicines, causing interior disharmony, tenesmus, dysentery-like stools, anal pain. I said: Interior deficiency, not dysentery; died taking defeat-toxin/dysentery medicines.
A man over forty suffered from a carbuncle on the back. Thirst before ulceration, rapid pulse, high swelling, purple color, red face, urine like paste. Prepared Jiajian Bawei Wan (Modified Eight-Immortal Pills) with Jiuzhi Zhimu (Alcohol-fried Anemarrhenae Rhizoma) and Jiuzhi Huangbai (Alcohol-fried Phellodendri Cortex), taken daily fasting and before meals with Tongbian (Child's Urine), 100 pills. Used Bazhen Tang (Eight-Treasure Decoction) plus Wuweizi (Schisandrae Fructus), Maidong (Ophiopogonis Radix), Huangqi (Astragali Radix), Jiuzhi Zhimu (Alcohol-fried Anemarrhenae Rhizoma), Chixiaodou (Vigna Semen Rubrum), decocted after meals. Daily drank Tongbian (Child's Urine) as tea. Thirst stopped, sore ulcerated, recovered. Among those I saved, this person was one. (Wuweizi should not be used recklessly.)
Madam Wang suffered from a carbuncle on the back. Applied cold compress medicine, chest nausea, urgently washed off, recovered quickly with Tuoli medicines. Madam Liu Tai Zai Ziyan's mother suffered from a carbuncle on the back, insufficient Yuan Qi, recovered with Tuoli medicines. Lady Wang An suffered from a carbuncle on the back, wanting quick results during ulceration, applied herbal medicines, died that day.
Magistrate Liu nearly fifty, traveled to Beijing by land, lost wife, carbuncle on back filling one chi, center six cun, painless, fever, dry mouth, aversion to cold, spontaneous sweat, little food, incontinence, shortness of breath, pulse floating-large, empty upon pressure. Took Buzhong Yiqi Tang (Center-Boosting Qi-Invigorating Decoction) plus Banxia (Pinelliae Rhizoma), Fuling (Poria) four doses, plus garlic-separated moxibustion. Said back heaviness gone, shape/qi slightly healthy, but acid regurgitation, previous food felt stuck in abdomen. Took previous medicine plus Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex) two doses, diet slightly increased, acid regurgitation stopped, slept. Sore painless/non-ulcerating, suspected Yin syndrome. I said: Yang qi deficiency cannot nourish affected area, hence dead flesh painless/non-ulcerating. If stomach qi returns, diet increases, dead flesh will ulcerate. Continued previous medicine six doses, diet gradually increased, affected area gradually ulcerated, pulse strong. I said: Yang qi returned. Later confused by other doctors saying Feilong Duoming Dan (Flying Dragon Life-Seizing Pill) must be taken to sweat beneficially. Took one dose, profuse sweating, three days uninterrupted, sought treatment again. I said: Sweating too much loses Yang, powerless. Strongly argued: Books say sweating cures sores, how can it be harmful? Eventually died. Dongyuan said: Sores due to wind-heat stagnating below, person angry, sore red, swollen/high/hard/painful, left Guan pulse洪缓strong, pathogen in upper blood vessels/skin. Thus sweating opens Ying-Wei, pathogen leaves. Qianfu treated sores, winter pulse floating-tight, pressing洪缓, cold covering hair/skin, blocking meridians, heat cannot rise, gathers red/swollen. Winter cold contracts, skin dense, pores sweat cannot exit, thus set. Moreover, sweating is Yin excess/Yang deficiency, pathogen cannot exit alone, must have Yang qi release, sweat exits, assisting Yang retreating Yin. Previous symptom pre-ulceration, blood/qi already deficient, post-ulceration blood/qi more deficient. Generally sores suitable for sweating, but Yuan Qi deficient unsuitable. Symptoms seen all deficiency, how can sweating? (Dry mouth is gradual thirst, why Banxia/Fuling?)
Jidu Workshop Ji surname, back sore, stomach qi deficient, warm-tonic medicines improved diet, major tonics healed necrotic tissue. Later leg pain, blood-nourishing/phlegm-resolving agents slightly stopped. Disliked slow progress, other doctors thought damp-heat, took Mahuang Zuojing Tang (Ephedra Left-Meridian Decoction) one dose, sweating incessant. I said: Will develop spasms and die. Indeed happened.
Wang Dezhi suffered from a carbuncle on the back, pulse floating-rapid, pressing choppy, stool not for 5-6 days, abdomen not distended. I said: Pathogen in exterior not interior, but due to blood/qi deficiency, little diet, hence stool not passing, not heat knot; should generate blood/qi primarily. Stuck on accumulated toxin inside, used Dahuang (Rhei Radix et Rhizoma) to purge, purged 3-4 times consecutively, fever increased, next day took another dose, purging incessant, food undigested, hiccups endless, hands/feet cold. Pulse depleted, declined treatment. Son asked: Can purging cause harm? I said: Taking laxatives and purging not stopping dies; purging when inappropriate, causing open intestines/uncontrollable diarrhea dies; excessive purging loses Yin dies. Asked: Sores are accumulated toxin in organs, if not driven out, how resolved? I said: Sores though toxin in viscera, treatment should first assist stomach qi, solidify root, combine with meridian-running/blood-invigorating timely herbs, not solely Dahuang. Now pathogen in exterior, using harsh purgative to severely rob Yin, is this acceptable? Thus, exterior illness interior harmony but purged, middle qi deficient, exterior pathogen enters via deficiency, hundred changes arise. Though pulse floating-rapid, pathogen in exterior, external cause, should use Neituo Fujian San (Internal Support Reviving Decoction), within which Huangqin (Scutellariae Radix) and Cangzhu (Atractylodis Rhizoma) dare not use. Pulse deep-solid, pathogen inside, internal cause, should use Neishu Huanglian Tang (Internal Drain Coptis Decoction), within which Dahuang (Rhei Radix et Rhizoma) and Binglang (Arecae Semen) dare not use. Floating-rapid-choppy pulses all indicate blood/qi dual deficiency. Pathogen in exterior, using harsh purgative, severely purging interior, punishing innocent, why not die?
County Magistrate back sore, back completely necrotic/ulcerated, dark color, heavy as carrying stone, critical, diet somewhat advanced. Used Hongtao San (Red Peach Powder), color gradually red, heaviness lightened, used again flesh generated, further used Tuoli medicines, recovered. This major toxin disease, non-harsh medicine cannot treat. Internally uses Pi (Arsenic), thus attacking toxin effective.
Ping family wife suffered from carbuncle on back, Tuoli Xiaodu medicines (Support Interior Detoxify Toxin) over twenty doses ulcerated. Due to anger, suddenly vomited blood 5-6 bowls, weak qi, fine pulse, extreme blood/qi deficiency. Ordered Du Shen Gao (Single Ginseng Paste) about one jin to slightly stabilize. Further used Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) over thirty doses, sore opening gradually closed. If given Xijiao Dihuang Tang (Rhinoceros Horn-Rehmannia Decoction) heavy-cold medicine, rarely without error.
Xu Fuqing over forty, suffered from carbuncle on back, five days not rising, flesh color unchanged, weak pulse, little food, loose stool. But carbuncle not ulcerated, pulse weak first, difficult to consolidate, used Tuoli Xiaodu (Support Interior Detoxify Toxin) two doses, finally rose. Confused by old woman's words, applied plaster, took attacking toxin agent, worsened, back like carrying stone. Sought treatment again, performed garlic-separated moxibustion over thirty cones, said back no longer heavy, but itch/pain unknown. Further Tuoli medicine, knew itch/pain, pus clear. Still previous medicine doubled Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), assisted by Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex), pus slightly thick. Again confused by others, externally pig kidney paste drew pus/blood, internally Xiao-Huang (Mirabilite-Rhubarb) agent, bled 5-6 bowls, purged ten times, abdomen like ice, anorexia. Forced continuous diagnosis, pulse suddenly depleted, beyond remedy. Case extreme deficiency, even solely warm-tonic feared not saving, let alone attacking agents, why not die?
Gu Hao's wife over forty, suffered from carbuncle on back, treated with Tuoli medicines ulcerated. Suddenly vomited, sore painful, stomach pulse string-tight, thought residual toxin attacking internally. Dongyuan said: Vomiting anytime, cold extremities, visceral deficiency. Danxi said: Post-ulceration vomiting anorexia, dampness invading internally. Also said: Pus out but pain returns, deficiency. Now stomach pulse string-tight, Wood overcoming Earth, deficiency clear. Wanted to treat with Liujunzi Tang (Six-Gentlemen Decoction) plus Jiushaoyao (Alcohol-fried Paeoniae Radix Alba), Sharen (Amomi Fructus), Huoxiang (Pogostemonis Herba). Self-took Huxin San (Heart-Protecting Powder), vomiting worse. Still used previous medicine, further blood/qi tonics, two months recovered. Generally dampness invading internally or foul qi causing vomiting, likes warmth, weak pulse; heat-toxin attacking internally causing vomiting, likes cool, rapid pulse, must distinguish clearly.
Zheng Huishi over fifty, suffered from carbuncle on back, form/symptoms both deficient, Tuoli medicines ulcerated. But necrotic tissue should be removed, he feared refusing. Delayed ten days, good flesh all ruined. Even large doses given, toxin severe, ultimately not saved. Ancients said bad flesh worse than wild wolves/tigers, toxic to bee stings, delaying removal kills life. True indeed.
Zhang Yiren over sixty, suffered from carbuncle on back, three days flesh color unchanged, head like millet, shoulder/back heavy, chills/fever drinking cold, pulse洪数large-rapid. Chen Liangfu said: External like hemp, internal like melon. Qi Shi said: Aversion to cold high fever, lesion must be deep. Also said: Flesh color unchanged, originates internally. Ren Shen Bai Du San (Ginseng-Dispersing-Toxin Powder) two doses, then garlic-separated moxibustion over fifty cones, toxin started emitting, back lightened, further Tuoli medicines gradually ulcerated. Blood/qi extremely deficient causing thirst, Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Shudi (Rehmanniae Radix Preparata) etc., thirst stopped. Wanted speed, self-applied herbal medicine to lesion, toxic vapors re-entered, not saved. Seen old/weak suffering this, sore head not rising, or hard like ox neck skin, mostly die before ulceration. Those post-ulceration blood/qi cannot cultivate also die. Generally sore initial ulceration, toxin just emitting, should use plaster to absorb, Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix) etc. to support. If contrary use medicine to suppress, making toxic vapors attack internally, surely not saved.
Governor Wang Yiren suffered from carbuncle on back, pus ripe not opened, confused/anorexic. Toxin entered internally, definitely untreatable. Forced needle pus bowl-slightly revived, shortly died. Generally blood/qi robust, pus spontaneously surges. Old/weak, blood/qi withered, must meet and seize, follow and take. If toxin knots limbs, Bian puncture slightly delayed. Necrotic/ulcerated deep/large, also difficult to consolidate. Pain knots in cheek/neck/chest/abdomen vital places, regardless robust/weak, urgent needle puncture, otherwise difficult to treat.
Guo Zhifang name Lian, suffered from back sore, ulcerated depressed purple, tongue curled. Depressed purple indicates Yang qi depletion, tongue curling scrotum contraction, Liver qi exhaustion, declined treatment. Classic says: Tongue curling scrotum contraction, sinews die first, Geng day severe, Xin day dies. Indeed died on Start of Autumn day.
Yao Yingfeng treated Governor Yu Sixun, stationed army Wenzhou, resisting pirate Liu Xiang, surrender imminent, toxin erupted back severe. Yingfeng arrived, two large vessels of necrotic tissue, visible five viscera, applied丹药 (Elixir/Pill) subsequently, two days later abscess flat, opened camp gate sat receiving surrender pacification. Yu pleased deeply grateful. (Renhe County Gazetteer)
Wang Hongxu treated Mudu Tan surname woman, back sore like bowl, initially white color, recently turned red, severe pain, time Sanfu (Dog Days), gave Yanghe Tang (Yang-Harmonizing Decoction). Someone said: Summer days why use Mahuang (Ephedrae Herba), Rougui (Cinnamomi Cortex) hot agents? Said: This Yin syndrome. Also said: Lesion color turned red, Yin returned to Yang. Immediately ordered decocted taken, not long pain stopped. Continuously four doses, symptoms reduced seven parts, remaining three parts pus painless ulcerated, five days concluded success.
Qian Guobin treated Huzhou Sangguan Temple monk Dacheng, carbuncle on back, length two chi, width eight cun, depth one cun approx, center like honeycomb, over two hundred heads, flowing pus, extreme pain wanting death, half-body eruption. This monk usually liked roasted foods, moved Liver qi easily, pulse floating洪large, savable. With Xin Huaizi (Sophorae Flavescentis Fructus) one he, Sheng Baifan (Alumen) one qian,