李东垣治通父家翟 ，于尻臀上足太阳经生痈，坚硬肿痛大作，左右尺脉俱紧，按之无力。羌活、黄柏各
二钱，防风， 本、连翘各一钱，肉桂七分，甘草、苍术、陈皮各五分，当归一钱，黄 一钱五分，酒二大盏，
水一大盏，煎至一盏，去渣空心热服。以夹被盖覆其痈，使药行罢去之，一服愈。
予族叔父平生多虑，质弱神劳，年近五十，忽右膊外侧廉上生结核，身微寒热而易怒，食味颇浓。脉之，
俱弦大浮数，而重按似涩。曰∶此多虑而忧伤血，时在初秋，勿轻视之，宜急补以防变症。以人参一斤作膏，
下以竹沥。病者吝费，招一外科，以十宣、五香散间与服。旬日后，一日大风拔木，病者发热，神思不佳。急
召视之，核稍高硕，似有脓于中，起一红线，延过肩后，斜走绕背脊过，入右胁下，不痛，觉肩背重而急迫，
食有呕意，脉同前，但弦多耳。作人参膏合芎、术、生姜汁饮之。用人参三斤，疮溃脓干。又与四物汤加参、
术、陈皮、甘草、半夏、生姜，百余帖而安。此等若在春令，虽神仙不治也。幸而在秋金之令，不幸因时下暴
风，激起木中相火而致此，自非参膏骤补，何由得免。
朱朗年四十余，恶寒发热，右腿内廉厥阴分生一肿毒，此是冷折热在肝经血分。与此方∶蒌仁、黄药子、
赤芍、归头、条芩各三钱，青皮、角刺、桂枝各二钱，甘草节一钱，分四帖，煎服一盏，入忍冬藤汁二蛤壳，
食前饮，以忍冬藤渣敷肿上。
吕孺人恶寒发热，腹上有小疽，此血少有热。与此方∶白术、川芎各三钱，赤芍、连翘各二钱半，
防风、陈皮、黄芩各二钱，木通钱半，甘草五分，分五帖煎服。
郑经历性嗜酒与煎爆，年五十余，忽春末夏初，患额丝竹空涌出一角，长短大小如鸡距，稍坚，
求治。曰∶此非膏粱所致而何？宜断浓味，先解食毒，针灸以开泄壅滞，未易治也。此少阳经所过，
气多血少者。郑以惮烦召他医，以大黄、朴硝、脑子等凉药罨之，一夕豁开如酱蚶，径三寸。一二日
后，血自蚶中溅出，高数尺而死。此凉药外逼，热郁不得发，宜其发之，暴如此也。
陈自明《外科精要》云∶神仙截法，治痈疽发背，一切恶症，预服则毒瓦斯不入内。真麻油一斤，
银石器内熬十数沸，候冷，用酒两碗，入油五盏，通口热服，一日用尽，缓则数日服之。吴安世云∶
吾家三世用之，无有不验。又云∶猎者云，丸中药箭，急饮麻油，药毒即消。郑学谕德甫屡用之，甚
验。
薛立斋治一男子，患痈肿硬疼痛，发热烦躁，饮冷，脉沉实，大便秘，乃邪在脏也。用内疏黄连
汤疏通之，以绝其源。先投一剂，候行一次，势退一二，再进一剂，诸症悉退，乃用黄连消毒散四剂
而消。
一男子患痈，脓熟不溃，欲针之，补以托里。不信，乃服攻毒药，及致恶心少食，始悟而用针。
更以六君子汤加藿香、当归，四剂少可。再以加味十全大补汤，数剂而敛。凡疮脓熟，不行针刺，脓
毒侵蚀，轻者难疗，重者不治。老弱之人，或偏僻之处，及紧要之所，若一有脓，宜急针之，更以托
里，庶几无变。
一男子患痈作痛，服寒凉药，痛虽止，而食愈少，疮亦不溃。以六君子汤而食进，再以托里药溃
之而愈。大抵疮疽之症，寒热虚实，皆能作痛。热毒之痛者，以寒凉之剂折之；寒邪之痛者，以温热
之剂散之；因风而痛者，除其风；因湿而痛者，导其湿；燥而痛者，润之；塞而痛者，通之；虚而痛
者，补之；实而痛者，泻之；脓郁而闭者，开之；恶肉侵蚀者，去之；阴阳不和者，调之；经络闭涩
者，利之。慎勿概用寒凉之药，况血脉喜温而恶寒，若冷气入里，血即凝滞，反为难瘥矣。
冯楚瞻治赵翁，年七十二，右颊肿硬，连及颐项，耳后一片坚实，不热不痛，已两月余，诸治不
效，渐至
口内出脓，牙噤不开，饮食少进，精神日衰。脉则洪大而空，知为元气大亏，阴寒所聚，所谓石疽是
也。不得阳和，何以外解？若内溃日久，穿喉破颊，不可疗矣。乃用猪脂捣烂，入肉桂细末、葱头、
食盐杵匀，浓敷患处。（敷药。）以脂膏治血肉，同气相应也。葱能透窍，盐能软坚，桂能行血，油能浸
润皮肤。内则空心生脉饮送八味丸，食远志、参、 、归、芍、苓、术、薄、桂、银花、角刺之类，
使阳回则阴寒自解，血气冲和，自能逐毒。三五日后，冰硬者热软，漫肿者高耸，木者疼痛，紫者红
活，饮食日进，血气渐长。毒既外出，久凝久瘀之血肉，消者消，脓者脓，不再旬而愈。
张景岳治一儒者，年近三旬，素病KT 耳，发必溃脓，至是益甚，自耳根下连颈项，上连头角，耳
前后莫不肿痛。或与散风降火，一月后稠脓鲜血，自耳迭出。每二三日必出钟许，而肿痛全不消，枕
不可近。察其形色，已大不足，而肿痛则若有余。脉之，或急或缓弱，此非实热可知。遂先与六味汤
二三剂，元气稍振。继与一阴煎加牛蒡、茯苓、泽泻，倍加白蒺藜为君，服五十余剂。外用降痈散，
昼夜敷治，两月而后愈。盖此症虽似溃疡有余，而实以肝肾不足，上实下虚，一奇症也。（何奇之有？）
张通府耳后发际患肿一块，无头，肉色不变，按之微痛，彼以为痰结核，其脉软而时见数。经云∶
脉数不时见，则生疮也，非痰结。仲景云∶微弱之脉，主血气俱虚，形精不足。又云∶沉迟软弱，皆
宜托里。遂以人参、白术、黄 、当归、川芎、炙草以托里，少加金银花、白芷、桔梗以消毒。彼谓
不然，内饮降火化痰，外帖凉药，觉寒彻脑，患处大热，头愈重，饮食愈少。复请治，以四君子汤加
藿香、炮干姜，数剂饮食渐进，脓成刺之。更以十全大补汤去桂及炙草，贴以豆豉饼，又月余而愈。
胡生耳后寸余发一毒，名曰锐疽， 痛发热，烦躁喜冷，此胆经蕴热而发。先用神仙活命饮，一
剂势减二三。时值仲冬，彼惑于药有用寒远寒之禁，故不再服，自用十宣散、托里之药，势渐炽，耳
内脓溃。复请治，视其喉肿闭，药不能下而殁。
一妇人年逾四十，近环跳穴生一毒，尺脉沉紧，腿不能伸。经曰∶脾寒移于肝，痈肿筋挛。夫脾
主肉，肝
主筋，肉温则筋舒，肉冷则筋急，遂与乳香定痛丸治之，少愈。更以助胃壮气血药，二十余剂而消。
一妇人倏伤次指，成脓不溃， 痛至手，误敷凉药，以致通 ，微呕少食，彼以为毒瓦斯内攻。诊
其脉沉细，此痛伤胃气而然也。遂刺之，服六君子汤加藿香、当归，食进。更服八珍汤加黄 、白芷、
桔梗，月余而愈。又一后生亦患此，色黑不痛，其指已死。欲令斩去，速服补剂，恐黑上臂不治。彼
不信，另服败毒药，手竟黑，遂不可救。又一男子亦伤拇指，色紫不痛，服托里药，及灸五十余壮，
作痛溃脓而愈。又吴举人幼女因冻伤两足，至春发溃，指俱坏，遂去之，服以大补药而愈。又蓝上舍
女患嵌甲伤指，年余不愈，日出脓数滴。谓足大趾乃肝脾二经发源之所，宜灸患处，使瘀血去，阳气
至，疮口自合，否则不治。彼忽之，不早治，后变劳症而殁。盖至阴之下，血气难到。若女人患此，
又多因扎缚，致血脉不通。或被风邪所袭，则无气血荣养，遂成死肉。惟当壮其脾胃，行其经络，生
其血气则愈。其有成破伤风，以致牙关紧急，口眼 斜者，先以玉真散一二服，然后投以通经生血之
剂。
于御郎骸胛患毒痛甚，服消毒药，其势未减，即以槐花酒一服，势随大退，再以托里消毒之药而
愈。
立斋曰∶予丙子年，忽恶心，大椎骨甚痒，须臾臂不能举，神思甚倦，此天疽危病也。急隔蒜灸
之，痒甚愈。又明灸五十余壮，痒遂止，旬日而愈。《精要》云∶灸法有回生之功，信矣。大凡蒸灸，
若未溃，则拔引郁毒，已溃则接补阳气，祛散寒邪，疮口自合，其功甚大。其法用大独蒜，切片如三
钱浓，贴疽顶上，以艾炷安蒜片上灸之，每三壮一易蒜。若灸时作痛，要灸至不痛，不痛要灸至痛方
止，大概以百壮为度。脓溃则以神异膏贴之，不日而安。一能使疮不开大，二内肉不坏，三疮口易合，
见效甚神。丹溪云∶惟头为诸阳所聚，艾壮宜小而宜少。
王大广年逾六十，素浓味，颊腮患毒，未溃而肉先死，脉数无力，胃经积毒所致。腮颊正属胃经，
未溃肉死，则胃气虚极，老人岂宜患此？辞不治，果殁。《内经》云∶膏粱之变，足生大疔，受如持
虚。
黄履素曰∶予座师茅五芝先生长公子子京，偶于肾间患一毒，地非要害，直易视之。子京素知医，
恐痛伤元气，辄服人参，其毒愈甚，发寒热，乃始延医。又遇粗工，溃后胸满，应服参、 ，又不能
多服，竟致不能收口而殁。盖痈疽初起，先宜泻毒，而后议补。若补之太早，遂有此祸可鉴也。
邱汝诚面生疽，即买药铺四所合神芎散丸予之，曰∶以此疗之。其人怒，不肯服，归而告人。人
曰∶未必非良法也，服之即瘥。盖其人嗜酒，此丸实去酒病云。（《挥尘新谈》）
彭羡门少宰，传治肿毒初起方，用∶鸡子用银簪插一孔，用明透雄黄三钱，研极细末入之，仍以
簪搅极匀，封孔入饭内，蒸熟食之，日三枚，神效。（《居易录》）
前宁都令李聘说∶麦粉不拘多少，用陈醋熬膏，贴无名肿毒，神效。（雄按∶此名乌龙膏，麦粉
乃洗麸造面筋澄下之粉也。）
徐灵胎曰∶疡科之法，全在外治，其手法必有传授。凡辨形察色，以知吉凶，及先后施治，皆有
成法。必读书临症，二者皆到，然后无误。其升降围点，去腐生肌，呼脓止血，膏涂洗熨等方，皆必
纯正和平。屡试屡验者，乃能应手而愈。至于内服之方，护心托毒，化脓长肉，亦有真传，非寻常经
方所能奏效也。惟煎方则必视其人之强弱阴阳，而为加减，此则必通于内科之理，全在学问根柢。然
又与内科不同，盖煎方之道相同，而其药则有某毒主某药，某症主某方，非此不效，亦另有传授焉。
故外科总以传授为主，徒恃学问之宏博无益也。有传授则较之内科为尤易，惟外科而兼内科之症，或
其人本有宿疾，或患外证之时，复感他气。或因外症重极，内伤脏腑，则不得不兼内科之法治之。此
必平日讲于内科之道，而通其理，然后能两全而无失。若不能治其内症，则并外症亦不可救，此则全
在学问深博矣。若为外科者，不能兼，则另请明理内科，为之定方。而为外科者，参议于其间，使其
药与外证无害，而后斟酌施治，则庶几两有所益。若其所现内症，本因外证而生，如痛极而昏晕，脓
欲成而生寒热，毒内陷而胀满，此则内症皆由外症而生，只治其外症。而内症已愈，此又不必商之内
科也。但其道甚微，其方甚众，亦非浅学人所能知也。故外科之道，浅言之，则惟记煎方数首，合膏
围药
几料，已可以自名一家。若深言之，则经络脏腑，气血骨脉之理，乃奇病怪疾，千态万状，无不尽识，
其方亦无病不全，其珍奇贵重难得之药，亦无所不备，虽遇极奇极险之症，亦了然无疑。此则较之内
科为更难，故外科之等级高下悬殊，而人之能识其高下者，亦不易也。
日外科之法，最重外治，而外治之中，尤重围药。凡毒之所最忌者，散大而顶不高。盖人之一身，
岂能无七情六欲之伏火，风寒暑湿之留邪，饮食痰涎之积毒？身无所病，皆散处退藏。气血一聚而成
痈肿，则诸邪四面皆会，惟围药能截之，使之并合，则周身之火毒不至矣。其已聚之毒，不能透出皮
肤，势必四布为害，惟围药能束之，使不散漫，则气聚而外泄矣。如此则形小顶高，易脓易溃矣。故
外治中之围药，较之他药为特重，不但初起为然，即成脓收口，始终赖之，一日不可缺。若世医之围
药，不过三黄散之类，每试不效，所以皆云围药无用。如有既破之后，而仍用围药者，则群然笑之。
故极轻之毒，往往至于散越而不可收拾者，皆不用围药之故。至于围药之方，亦甚广博，大假以消痰
拔毒束肌收火为主，而寒热攻提和平猛属，则当随症去取。世人不深求至理，而反轻议围药之非，安
望其术之能工也。
神授卫生汤，治一切疮症，能宣热散风，行瘀活血，解毒消肿，疏通脏腑，（徐灵胎曰∶其法不
外此四句。）药性和平，功效甚速，诚外科首用方也。羌活八分，搜风发表胜湿；防风胜湿，解表去
风；白芷发表散风热，活血排脓；穿山甲土炒研，沉香、红花散结消肿排脓，疮家圣药；连翘、石决
明各六分，金银花、皂鱼刺、归尾、甘草节，生肌止痛。花粉太寒，不可用，破后口渴者可用。以
上各一钱，乳香五分，大黄酒浸炒一钱，脉虚便利者勿用。水二碗，煎八分。病在上部，先服药，随
饮酒一杯。病在下部，先饮酒一杯，随后服药，以行药势。徐灵胎曰∶其方之分量，亦最宜斟酌得中，
除大黄共一两零五分，此外科之主方，加减不外乎此。又曰∶外科与内科大不相同，内科之病，千头
Li Dongyuan treated Zhai, a member of the Tongfu household, who developed an carbuncle (a deep-seated skin infection) on the sacro-gluteal region along the Foot-Taiyang Meridian. The swelling was hard, red, swollen, and severely painful. Both left and right Chi pulses were tight but felt weak upon heavy pressure. The prescription consisted of Qianghuo (Notopterygii Rhizoma et Radix) and Huangbai (Phellodendri Cortex), each 2 qian; Fangfeng (Saposhnikoviae Radix), Gaoben (Ligustici Rhizoma et Radix), and Lianqiao (Forsythiae Fructus), each 1 qian; Rougui (Cinnamomi Cortex) 7 fen; Gancao (Glycyrrhizae Radix et Rhizoma), Cangzhu (Atractylodis Rhizoma), and Chenpi (Citri Reticulatae Pericarpium), each 5 fen; Danggui (Angelicae Sinensis Radix) 1 qian; Huangqi (Astragali Radix) 1.5 qian. These were decocted with two large bowls of wine and one bowl of water until reduced to one bowl. The dregs were removed, and the decoction was taken hot on an empty stomach. After taking the medicine, the patient was covered with a quilt over the affected area to promote the action of the medicine, which was then removed after the medicinal effect had taken place. One dose resulted in a cure.
My clan's uncle had been prone to excessive worry throughout his life, possessed a weak constitution, and suffered from mental fatigue. At nearly fifty years old, he suddenly developed a nodule (hard lump) on the lateral edge of his right upper arm. He experienced slight chills and fever, irritability, and preferred rich flavors in his diet. His pulse was wiry, large, floating, and rapid, yet seemed choppy upon heavy pressure. I said, "This is caused by excessive worry and sorrow damaging the blood. It is early autumn; do not underestimate it. Urgent tonification is needed to prevent complications." Therefore, one jin of Ren Shen (Ginseng Radix et Rhizoma) was made into a paste and administered with Zhuli (Bambusa Textilis Caulis Juice). The patient, being stingy with expenses, consulted a surgeon who intermittently prescribed Shixuan San (Ten-Acupoint Powder) and Wuxiang San (Five-Fragrance Powder). Ten days later, during a day with fierce winds, the patient developed fever and poor mental state. Upon urgent examination, the nodule was slightly elevated, suggesting pus formation inside, with a red line extending from behind the shoulder, diagonally across the back spine, and entering the right hypochondrium. There was no pain, but a sensation of heaviness and urgency in the shoulder and back, and nausea when eating. The pulse remained similar to before, but with a more prominent wiry quality. The patient was given Ren Shen paste mixed with Xiong (Chuanxiong Rhizoma), Zhu (Atractylodis Macrocephalae Rhizoma), and Shengjiang (Zingiberis Recens Rhizoma et Rhizoma juice). Three jin of Ren Shen was used; the sore ulcerated and dried up. Subsequently, Siwu Tang (Four-Substance Decoction) was modified with Ren Shen, Zhu, Chenpi, Gancao, Banxia (Pinelliae Rhizoma), and Shengjiang, administered for over a hundred doses until stability was achieved. If this had occurred in spring, even immortals could not have cured it. Fortunately, it occurred in autumn when Metal energy dominates. Unfortunately, the sudden storm stirred up the Ministerial Fire within Wood, causing this condition. Without the rapid tonification of Ren Shen paste, how could he have avoided death?
Zhu Lang, in his forties, suffered from chills and fever. A toxic swelling appeared on the medial aspect of his right thigh, in the Jueyin distribution. This was cold obstructing heat in the Liver meridian blood level. The following formula was prescribed: Gualouren (Trichosanthis Semen), Huangyaozi (Dioscoreae Hypoglaucae Rhizoma), Chishao (Paeoniae Radix Rubra), Guaitou (Angelicae Sinensis Radix head), and Huangqin (Scutellariae Radix), each 3 qian; Qingpi (Citri Reticulatae Pericarpium Viride), Jiaoci (Gleditsiae Sinensis Spina), and Guizhi (Cinnamomi Ramulus), each 2 qian; Gancaojie (Glycyrrhizae Radix et Rhizoma with nodes) 1 qian. Divided into four doses, decocted with one bowl of water, adding Rendongteng (Lonicerae Japonicae Caulis) juice and Geke (Corbi Concha) before meals. The dregs of Rendongteng were applied topically to the swelling.
Lady Lv suffered from chills and fever with a small carbuncle on her abdomen. This indicated slight heat in the blood. The following formula was prescribed: Baizhu (Atractylodis Macrocephalae Rhizoma) and Chuanxiong (Chuanxiong Rhizoma), each 3 qian; Chishao (Paeoniae Radix Rubra) and Lianqiao (Forsythiae Fructus), each 2.5 qian; Fangfeng (Saposhnikoviae Radix), Chenpi (Citri Reticulatae Pericarpium), and Huangqin (Scutellariae Radix), each 2 qian; Mutong (Akebiae Caulis) 1.5 qian; Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen. Divided into five doses for decoction.
Zheng Jingli had a habit of drinking alcohol and eating fried foods. In his fifties, at the end of spring and beginning of summer, a horn-shaped swelling emerged from the Sizhukong point on his forehead, resembling a chicken spur in size and shape, slightly hard. Seeking treatment, I said, "Is this not caused by rich food and drink? You must stop consuming rich flavors, resolve the food toxicity first, and use acupuncture and moxibustion to open and drain the stagnation. This will be difficult to treat. This area is traversed by the Shaoyang Meridian, which has abundant Qi but scarce Blood." Zheng, fearing trouble, consulted another physician who applied cooling medicines such as Dahuang (Rhei Radix et Rhizoma), Puxiao (Natrii Sulfas), and Naozi (Borneolum Syntheticum) externally. Overnight, the swelling burst like a sauce clam, three cun in diameter. One or two days later, blood spurted from the wound several feet high, leading to his death. This was due to external cooling medicines forcing the heat inward, causing heat depression without release. It should have been dispersed, but instead was constrained violently.
Chen Ziming stated in *Waike Jingyao* (Essentials of Surgery): The Immortal Intercepting Method treats carbuncles, back infections, and all malignant conditions. Taking it beforehand prevents toxins from entering the interior. Take one jin of pure sesame oil, boil it ten times in a silver or earthenware vessel, cool it, then mix with two bowls of wine and five cups of oil. Drink hot through the mouth in one day. If slow, take over several days. Wu Anshi said: My family has used it for three generations without failure. He also said: Hunters say that if struck by a poisoned arrow, drinking sesame oil quickly eliminates the poison. Zheng Xueyu Defu used it frequently with great efficacy.
Xue Lizhai treated a man suffering from a hard, painful carbuncle with fever, restlessness, desire for cold drinks, deep and solid pulse, and constipation. This indicated pathogenic factors in the Zang organs. Neishu Huanglian Tang (Internal Draining Coptis Decoction) was used to unblock and clear the source. After one dose, once bowel movement occurred, symptoms decreased slightly. A second dose resolved all symptoms. Then, Huanglian Xiaodu San (Coptis Detoxifying Powder) was given for four doses until resolution.
Another man had a carbuncle where pus had matured but did not rupture. Needling was proposed along with Tonifying Interior methods. The patient refused, taking attacking/purgative drugs instead, resulting in nausea and loss of appetite. Only then did he agree to needling. Liujunzi Tang (Six-Gentlemen Decoction) was modified with Huoxiang (Pogostemonis Herba) and Danggui (Angelicae Sinensis Radix); after four doses, he improved slightly. Jiawei Shiquan Dabu Tang (Modified Complete Great Tonifying Decoction) was then used for several doses until healing. Generally, when pus is mature, failure to needle leads to erosion by pus toxin; mild cases are hard to treat, severe cases incurable. For the elderly, weak, those in remote areas, or critical locations, once pus forms, immediate needling followed by Tonifying Interior methods is essential to avoid complications.
Another man suffered from carbuncle pain. After taking cooling medicines, pain stopped but appetite decreased further, and the sore did not rupture. Liujunzi Tang (Six-Gentlemen Decoction) restored appetite, followed by Tonifying Interior medicines to induce rupture and cure. Broadly speaking, carbuncle pain can arise from Heat, Cold, Deficiency, or Excess. Heat-toxin pain is treated with cooling agents; Cold-pathogen pain with warming agents; Wind-induced pain by dispelling wind; Dampness-induced pain by draining dampness; Dryness-induced pain by moistening; Obstruction-induced pain by unblocking; Deficiency-induced pain by tonifying; Excess-induced pain by purging; Pus retention by opening; Necrotic tissue by removal; Yin-Yang disharmony by harmonizing; Meridian blockage by promoting flow. Never indiscriminately use cooling medicines. Blood vessels prefer warmth and dislike cold; if cold enters, blood stagnates, making recovery difficult.
Feng Chuzhan treated Old Man Zhao, aged 72, with hard swelling on the right cheek extending to the jaw and neck, and a firm patch behind the ear, non-hot and non-painful for over two months. Various treatments failed. Pus began oozing from the mouth, teeth locked, food intake reduced, spirit declining. Pulse was large, hollow, and forceless, indicating severe Yuan Qi deficiency and Yin-Cold accumulation, known as Stone Carbuncle (Shiju). Without Yang warmth, how can it resolve externally? If internal ulceration persists, penetrating throat and cheek, it becomes untreatable. Pig fat was mashed, mixed with fine Rougui (Cinnamomi Cortex) powder, scallion heads, and salt, and applied thickly to the site. Fat treats flesh/blood via resonance; scallions penetrate apertures; salt softens hardness; cinnamon moves blood; oil moisturizes skin. Internally, Shengmai Yin (Generate Pulse Drink) and Bawei Wan (Eight-Ingredient Pill) were taken on an empty stomach. After meals, Yuanzhi (Polygalae Radix), Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Bohe (Menthae Haplocalycis Herba), Rougui (Cinnamomi Cortex), Jinyinhua (Lonicerae Japonicae Flos), and Jiaoci (Gleditsiae Sinensis Spina) were added to restore Yang, resolve Yin-Cold, harmonize Qi and Blood, and expel toxins. Within three to five days, ice-hard areas softened, diffuse swelling rose, numbness turned painful, purple color became vibrant, appetite increased, Qi and Blood grew. Toxins expelled, old stagnant flesh dissolved or suppurated, curing within ten days.
Zhang Jingyue treated a scholar, nearly thirty, who suffered from Scrofula (Luoli), always ulcerating and discharging pus. Now worse, swelling extended from ear root down neck, up to head corner, painful and swollen around ears. Given wind-dispelling and fire-reducing herbs, after a month, thick pus and fresh blood flowed from ears every few days, swelling unchanged, pillow unbearable. Appearance showed severe deficiency despite apparent excess swelling. Pulse was variable, sometimes rapid, sometimes weak. Clearly not Excess-Heat. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was given for two to three doses to slightly boost Yuan Qi. Then Yiyin Jian (One-Yin Decoction) modified with Niubangzi (Arctii Fructus), Fuling (Poria), Zexie (Alismatis Rhizoma), and doubled Baijili (Tribuli Fructus) as the chief herb, taken for over fifty doses. Topically, Jiangyong San (Reduce Carbuncle Powder) was applied day and night. Cured in two months. Though appearing as excess ulceration, it was actually Liver-Kidney deficiency with Upper Excess and Lower Deficiency, a rare case.
Zhang Tongfu had a swelling at the hairline behind the ear, headless, normal color, slightly tender on pressure. He thought it was Phlegm-Nodule. Pulse was soft with occasional rapidity. Classics state: Irregular rapid pulse indicates sores, not phlegm. Zhang Zhongjing states: Weak pulse indicates Qi and Blood deficiency. Deep-slow-weak pulse requires Tonifying Interior. Ren Shen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma), and Zhi Cao (Prepared Licorice) were used to Tonify Interior, with minor amounts of Jinyinhua (Lonicerae Japonicae Flos), Baizhi (Angelicae Dahuricae Radix), and Jiegeng (Platycodonis Radix) to detoxify. Patient disagreed, taking fire-reducing and phlegm-resolving herbs internally, and cooling patches externally. Felt cold penetrating brain, local heat intensified, head heavier, appetite lower. Reconsulted. Sijunzi Tang (Four-Gentlemen Decoction) with Huoxiang (Pogostemonis Herba) and Paoganjiang (Prepared Ginger Rhizome) improved appetite. Once pus formed, it was needled. Shiquan Dabu Tang (Complete Great Tonifying Decoction) minus Rougui (Cinnamomi Ramulus) and Zhi Cao (Prepared Licorice), plus Fermented Soybean Cake poultice, cured after another month.
Hu Sheng developed a toxic swelling inch behind the ear, named Rui Ju (Sharp Carbuncle). Painful, feverish, restless, preferring cold. This was Gallbladder Meridian heat accumulation. Shenxian Huoming Yin (Immortal Life-Saving Decoction) reduced severity by half in one dose. In mid-winter, influenced by the taboo "avoid cold in cold season," he stopped taking it, using Shixuan San (Ten-Acupoint Powder) and Tonifying Interior herbs instead. Condition worsened, ear pus ruptured. Reconsulted, throat swollen shut, unable to swallow medicine, died.
A woman over forty developed a toxic swelling near the Huantiao point. Chi pulse was deep and tight, leg unable to extend. Classics say: Spleen Cold transferring to Liver causes carbuncles and tendon spasms. Spleen governs flesh, Liver governs tendons. Warm flesh relaxes tendons; cold flesh contracts. Rushing Dingtong Wan (Frankincense Pain-Stopping Pill) provided slight relief. Then Stomach-Assisting and Qi-Blood-Strengthening herbs cured it in twenty doses.
A woman injured her second finger, forming pus but not rupturing. Pain radiated to hand. Cooling herbs were mistakenly applied, causing systemic discomfort, slight vomiting, and poor appetite. She thought it was internal toxin attack. Pulse was deep and fine, indicating pain damaged Stomach Qi. Needling was performed, followed by Liujunzi Tang (Six-Gentlemen Decoction) with Huoxiang (Pogostemonis Herba) and Danggui (Angelicae Sinensis Radix), restoring appetite. Bazhen Tang (Eight-Treasure Decoction) modified with Huangqi (Astragali Radix), Baizhi (Angelicae Dahuricae Radix), and Jiegeng (Platycodonis Radix) cured it in a month. Another young man had similar injury, black and painless, finger dead. Amputation suggested, but urgent tonification advised to prevent spread to arm. He refused, took defeating/toxic herbs, hand turned black, fatal. Another man injured thumb, purple and painless. Took Tonifying Interior herbs and received over fifty moxa cones. Became painful, ruptured, and healed. Wu Juror's young daughter froze feet, ulcerated in spring, fingers destroyed, amputated, cured with Great Tonifying herbs. Lan Shangshe's daughter had ingrown nail injury, suppurating daily for over a year. Big toe is origin of Liver and Spleen meridians. Moxibustion recommended to remove stasis and restore Yang. Ignored, she died of Consumption. Lower extremities are Yin extremes, hard for Qi/Blood to reach. Women often suffer binding restrictions causing blockage, or Wind invasion leading to necrosis. Strengthening Spleen/Stomach, moving meridians, generating Qi/Blood is key. For Tetanus with lockjaw and facial deviation, Yuzhen San (Jade True Powder) first, then Meridian-unblocking and Blood-generating herbs.
Yu Yulang had severe pain from a toxic swelling on the shoulder blade. Disinfecting herbs failed. Huaihua Jiu (Sophora Flower Wine) rapidly reduced severity, followed by Tonifying Interior and Disinfecting herbs for cure.
Xue Lizhai said: In Bingzi year, I suddenly felt nausea, intense itching at Dazhui, inability to raise arm, extreme fatigue. This was Tian Ju (Heaven Carbuncle), a critical condition. Garlic-moxibustion stopped itching. Direct moxibustion for fifty cones stopped itching completely, cured in ten days. *Jingyao* says moxibustion has life-saving power. Unruptured sores: moxibustion draws out depressed toxins. Ruptured sores: moxibustion supplements Yang, dispels Cold, closes wounds. Method: Thick slice of single garlic placed on sore, moxa cone on garlic. Change garlic every three cones. If painful, continue until pain stops; if painless, continue until pain starts. Total about one hundred cones. After rupture, Shenyi Gao (Divine Miracle Ointment) applied. Prevents spreading, protects inner flesh, promotes closure. Danxi said: Head gathers all Yang, so moxa cones should be small and few.
Wang Daguang, over sixty, accustomed to rich food, developed toxic swelling on cheek/jaw. Flesh died before rupture. Pulse rapid and weak, indicating Stomach Meridian accumulated toxin. Cheek/jaw belongs to Stomach Meridian. Flesh death before rupture means extreme Stomach Qi deficiency. Elderly suffering this is dire. Refused treatment, died. *Neijing* says: Rich food changes produce large boils, entering easily like holding emptiness.
Huang Lvsu said: My mentor Mao Wuzhi's eldest son, Zijing, developed a toxic swelling between kidneys. Location non-critical, dismissed. Zijing knew medicine, feared pain damaged Yuan Qi, took Ren Shen (Ginseng Radix et Rhizoma), worsening toxicity, causing fever/chills, only then seeking doctor. Met incompetent practitioner. After rupture, chest fullness required Ren Shen/Huangqi, but dosage insufficient. Failed to close wound, died. Carbuncles initially require toxin drainage before tonification. Early tonification causes disaster.
Qiu Rucheng developed facial carbuncle, bought Shexiong San (Godsend Xiong Powder) pills from pharmacy, instructed to take. Patient angry, refused, complained. Others said it might be good method, would cure. Patient drank alcohol; pill removes alcohol toxicity (*Huichen Xintan*).
Peng Xianmen Vice Minister transmitted formula for initial toxic swelling: Egg pierced with silver needle, filled with 3 qian finely ground Xionghuang (Realgar), stirred, sealed, steamed in rice, eaten raw/cooked. Three per day, miraculous (*Ju Yi Lu*).
Former Ningdu Magistrate Li Pin said: Wheat flour boiled with aged vinegar into paste, applied to nameless swelling, miraculous. (Xiong notes: Named Wulong Gao, wheat flour is residue from washing gluten.)
Xu Lingtai said: Surgery relies entirely on external treatment, requiring transmission of techniques. Form/color diagnosis determines prognosis. Treatment sequence follows established laws. Must combine book learning with clinical practice. Methods for raising/lowering, surrounding, pointing, removing rot, generating flesh, calling pus, stopping bleeding, ointments/washes must be pure and balanced. Only proven formulas work. Internal formulas for protecting heart, pushing out toxins, resolving pus, growing flesh also require true transmission, not standard classics. Decoctions must adjust for individual strength/Yin-Yang, requiring Internal Medicine knowledge. However, surgery differs: while principles are same, specific poisons/herbs/symptoms/formulas have unique transmissions. Thus, surgery relies on transmission; broad learning alone is useless. Transmission makes surgery easier than Internal Medicine. But if surgery involves Internal symptoms, pre-existing diseases, or secondary pathogens, or severe external damage affecting Zang organs, Internal Medicine methods are necessary. One must understand Internal Medicine theory to balance both. If Internal symptoms cannot be treated, External cannot be saved either. If surgeon cannot handle Internal aspects, consult knowledgeable Internal Physician for prescriptions, while surgeon ensures compatibility with External condition. If Internal symptoms arise directly from External (e.g., fainting from extreme pain, fever/chills from pus formation, bloating from toxin sinking), treating External resolves Internal,无需 consulting Internal Medicine. But the Dao is subtle, formulas numerous, beyond shallow learning. Superficially, memorizing a few decoctions and preparing ointments/surrounding powders suffices to claim expertise. Profoundly, one must know meridians, Zang organs, Qi/Blood, bones, veins, recognize bizarre diseases, master all formulas, possess rare/expensive herbs, and confidently treat extreme dangers. This is harder than Internal Medicine, explaining the wide gap in surgical skill levels and difficulty in recognizing true experts.
Current surgical methods prioritize External Treatment, especially Surrounding Powders (Wei Yao). Most feared outcome is spreading wide with low peak. Human body harbors latent fires from emotions/desires, lingering pathogens from Wind/Cold/Summerheat/Dampness, accumulated toxins from food/phlegm. When healthy, these remain scattered. When Qi/Blood gather forming carbuncle, all pathogens converge. Only Surrounding Powder can intercept and concentrate them, preventing systemic fire-toxin. Concentrated toxins unable to exit skin spread harmfully. Surrounding Powder binds them, preventing dispersion, allowing Qi to gather and exit externally. Result: small shape, high peak, easy pus formation and rupture. Surrounding Powder is crucial in External Treatment, not just initially but throughout pus formation and healing. Daily use essential. Physicians using only Sanhuang San (Three-Yellow Powder) find it ineffective, claiming Surrounding Powder useless. Laughed at if used after rupture. Mild toxins often become uncontrollable due to lack of Surrounding Powder. Formulas vary widely, focusing on resolving phlegm, extracting toxins, binding muscle, containing fire. Cold/Hot/Attacking/Lifting/Gentle/Fierce choices depend on symptoms. People failing to seek truth criticize Surrounding Powder, hoping for skilled technique is futile.
Shenshou Weisheng Tang (Divine Grant Health-Preserving Decoction) treats all sores, disperses heat/wind, moves stasis/blood, detoxifies, reduces swelling, unblocks Zang organs. (Xu Lingtai: Method fits these four phrases.) Gentle nature, fast effect, premier Surgical formula. Qianghuo (Notopterygii Rhizoma et Radix) 8 fen searches wind/releases exterior/overcomes damp; Fangfeng (Saposhnikoviae Radix) overcomes damp/releases exterior/removes wind; Baizhi (Angelicae Dahuricae Radix) releases exterior/disperses wind-heat/moves blood/drains pus; Chanshanjia (Manis Squama) earth-fried/powdered, Chenxiang (Aquilariae Lignum Resinatum), Honghua (Carthami Flos) dissipate nodules/reduce swelling/drains pus, holy medicine for sores; Lianqiao (Forsythiae Fructus), Shijueming (Concha Arcae) 6 fen each, Jinyinhua (Lonicerae Japonicae Flos), Zaocys (Squama Manis - note: text says 'Zao Yu Ci' likely referring to Gleditsiae Spina or similar, context implies detox/pus), Dangwei (Angelicae Sinensis Radix tail), Gancaojie (Glycyrrhizae Radix et Rhizoma with nodes) generate flesh/stop pain. Huafen (Trichosanthis Radix) too cold, avoid unless thirsty post-rupture. Above each 1 qian, Rushan (Boswelliae Resina) 5 fen, Dahuang (Rhei Radix et Rhizoma) wine-fried 1 qian (avoid if pulse deficient/frequent stool). Two bowls water, decoct to 0.8 bowl. Upper body disease: take medicine then wine. Lower body: wine then medicine to drive action. Xu Lingtai: Dosages well-balanced. Excluding Dahuang, total 1 liang 0.5 qian. Main Surgical formula, modifications stay within this range. Also says: Surgery greatly differs from Internal Medicine. Internal diseases, thousand...