内经曰∶“诸痛痒疮，皆属于心”。又曰∶“营气不从，逆于肉理，乃生痈肿”。又曰∶“高粱之变，足生
大疔”。又曰∶“汗出偏沮，使人偏枯，汗出见湿，乃生痤 ”。又曰∶“开阖不得，寒气从之，乃生大偻”。
地之湿气盛则寒，皮肉筋脉，即此数者而穷之，则知脏腑结病之枝叶。内无郁热蕴蓄于中，外无湿热侵害于内，
则气血和平，肌肉轻快，痈从何来，疽从何生！凡治痈疽，先辨虚实阴阳。经云∶“诸痛为实，诸痒为虚，诸痈
为阳，诸疽为阴”。又当辨是痈是疽，是疔是发背，然后用药施治，庶不差谬。热发于肌肉之上，微肿根小，不
过一二寸者为疖；热发于脏腑之间，肿高根阔，大四五寸余者为痈；五脏热毒流于骨髓，附骨而生者为疽；酒食
过度，浓味适口，心志不遂，郁热不伸，专生膊内处，小孔如蜂窠，皆是发也。若疔毒，乃五脏积热，六腑受伤，
或冲冒禽兽之毒，剥受牛羊之秽，始生黍米大，不知谨护而触犯之，轻者必重，重者必死。用香油调雄黄末服之，
以攻其毒，不然立见其败矣。夫痈毒发背之生，有五善七恶，不可不辨。动静自宁，饮食知味一善也；大小便均
调，二善也；神气清，语声明，三善也；脓溃肿散，色鲜不臭，四善也；身体最和平，起居如一，五善也。五善
俱见则善，无以加矣。若眼白睛黑，两目紧小，唇青疮黑，一恶也；胫膊难转，四肢沉重，眼闭、口张、耳聋，
二恶也；不饮食，不纳药，或不知味，痛极渴甚，三恶也；痰喘气急，面色青黑，目闭口开，四恶也；时出冷汗，
恍惚嗜卧，语言颠倒，五恶也；烦躁咳嗽，腹中利泻，小便混浊，六恶也；肿高痛甚，脓水腥臭，七恶也。七恶
俱全，则不可治。五善见三则吉，七恶见四则危。凡治痈毒，初宜解毒拔毒，既溃，宜排脓定痛，如未溃时，不
可服热药，既溃时，不可服凉药。如初作者，先须托里，既溃者，必要排脓，此治痈疽等疮之大法也。又须看其
时令，诊其脉理，辨其虚实，决其轻重，量其病势，斟酌用之，庶不夭折。如毒始作，无论痈疽发背等症，先须
以千金托里散，服三四剂，固定脏腑，千金内托散亦可。然后除热以凉膈散，托里以败毒散，定痛以乳香汤，憎
寒壮热以小柴胡汤，呕吐不纳以人参养胃汤，饮食不克以参朱养胃汤，声嘶以麦冬清音汤，大便秘以大柴胡汤，
发渴饮水以黄 汤，秽浊触犯以连翘三香汤，腹痛以甘草芍药汤，烦躁以黄连清热汤，好眠以益气清身汤，虚弱
以人参黄 汤，气喘而咳以木香顺气汤，痛甚以清肌快肤汤，恍惚恐惧以镇惊散，日久不作脓者以妙济散，脓溃
而肿不消者以真人活命饮，清泻不止者以真人养脏汤，出虚汗不止者以黄 固真汤，彻脓以万灵膏，收口以生肌
散。以上病症，无过于此。如遇危恶之症，即当灸竹马穴数十壮，实有起死回生之功。又有生于内者为痈，曰脑
痈，曰肠痈，曰肺痈，曰胞痈。此症与前症不同，医者认验真实，然后下手，不可妄用汤散，以惹毒祸，为害不
小，慎之慎之。
方诀俱载图形卷中，甚勿轻视。凡毒于未溃之先，而有前数项之症，即从各症汤内，加连翘、栀子、牛子、
二花、皂角刺之类。既溃之后，而有前数项之症，于各症汤内，加人参、黄 、二花、连翘、栀子，春多用防风、
白芷、柴胡、川芎；夏多用黄连、栀子、连翘、麦冬；秋多用黄芩、苍术、连翘、栀子；冬多用人参、白术、连
翘、甘草。痈疽发背之治，大概如此。
又伤寒之症，有汗而未汗者，和而未和者，汗滞皮肤，毒阻骨髓，以致发为痈症，因气血逆而不和，当解毒
清热，以千金消毒饮，不可用膏药贴，开其毒，若见危殆，危如前症相同，即以前法治之。又有疔毒种类不同，其害则
一，惟满三十六种疔毒耳，先当以拔毒散用之，或以铁箍散围之，内服败毒散、雄黄散之类，若有变症，亦同前治。
又有痰核、瘿瘤并马刀疮之类，皆是湿热生痰，痰甚生火，火甚生风，风甚生热，热甚极而病作矣。宜清痰
降火之剂，宣热拔毒之方，初觉以艾灸之，切勿妄行烂割。甚矣，医之难言也。若非穷通性理，识别阴阳，博览
诗书，曷能底造真方。见今传外科者，多是乡巷之徒，不通文理之人，疡科未曾目见，疮脉未曾耳闻，药品不知
性味，汤散未辨君臣，略知数件草之药，对人称言通晓，以夸其效，希图苟利，病家吝财，诚信此等，付性命于
庸人之手，良可叹哉！谚云∶“穷无达士，将金赠病”。有庸人说药方，此所宜深戒也。
先贤曰∶“诸经惟有少阴、厥阴二经生痈疽，少阳、阳明生瘰疠”。庸人岂达二经之窍，盖由此经多气少血
故也。
凡诊外科脉，如未溃之先，宜洪大拍指，按之有力，举之健浮。既溃之后，按之宜沉健，举之宜轻浮，此易
收功之脉也。若未溃之先，脉来沉缓，不疾不数；既溃之后，脉来健实，或大或洪，此难收功之脉也。若前后俱
得微弱之脉，此危症也，经年月日，难获全功。须当养气血，健脾胃，如参、 、归、术之类。若迟延不治，疮
毒变而入腹，既发饱满、喘气、肿胀、呻吟，疮形平没，此危症也。当速以千金托里散，表而出之，或立马回生
散，迎而夺之，间或可治。不然，立见其祸也。
凡治痈肿，须看有脓无脓，当看正处偏处，以手按之，热则有脓，不热无脓，以纸浸湿贴之，干处是正脓点，
然后持针开之，勿嫌口烂，以针口大而脓易尽也。
凡治痈疖，深处深针，浅处浅针，何谓浅？盖症生于脐腹处，若深针，恐伤内膜，慎之。症生于浓肉之处，
宜深针之，以泻
其毒，不可不知。吾见今之针发背者，专行勾割，去其筋膜败肉，更加痛苦，此岂仁人之术哉！只宜用药调治，
自有愈时。切勿听此毒手，自取危笃。见如此者，误人甚多，恐后治人有失，故纂成疡科方脉，以补目之未见，
耳之未闻，况痈疽之生，皆由内蕴郁热，外感风湿，肿高硕者为痈，隐伏于骨者为疽，三背而作者为发，始生如
黍米大，憎寒壮热，由渐而起，勿勾洗，宜用艾灸，多效。不然，先须内攻，攻里之后，宣热解毒，定痛排脓，
生肌敛口，此正道也。绝房事，一切牛马秽气不可触，触之非轻。常常闻香，痛是可分，如若不然，痛楚难禁。
昧人不知，付之神鬼，求神礼佛，有何福生。智者察之不合，惟修合诸药，穷究医书，药乃百草根苗，医为九流
魁首。重医者，视疡科为圣训，悭财者，视此道为儿戏。凡我子孙，及家后医，细心诊察，寒热虚实，修合药品，
辨别君臣，庶不差谬，学人须当自操。
《黄帝内经》说：“各种疼痛、瘙痒和疮疡，都归属于心。”又说：“营气运行不畅，逆乱于肌肉纹理之间，就会发生痈肿。”又说：“长期食用肥甘厚味，会导致身体生出大疔疮。”又说：“半身出汗而半身无汗（偏沮），会导致半身不遂；出汗时受湿气侵袭，就会生痤疮。”又说：“腠理开阖失常，寒气乘虚而入，就会形成严重的脊柱弯曲（大偻）。”
地面上的湿气旺盛则导致寒冷，通过皮、肉、筋、脉这几种组织来推究，就能了解脏腑结聚病变的枝叶表现。如果体内没有郁积的热邪蕴蓄在中间，体外没有湿热侵害在内，那么气血就会平和，肌肉感到轻快，痈从何而来？疽从何而生！凡是治疗痈疽，首先要辨别虚实和阴阳。经书说：“所有的痛证属于实证，所有的痒证属于虚证，所有的痈属于阳证，所有的疽属于阴证。”还应当辨别是痈还是疽，是疔疮还是发背，然后用药施治，这样才不会出错。热毒发于肌肉之上，轻微肿胀且根基小，直径不超过一两寸的称为疖；热毒发于脏腑之间，肿胀高耸且根基宽阔，直径四五寸以上的称为痈；五脏的热毒流注到骨髓，附着在骨骼上生长的称为疽；饮酒饮食过度，浓烈滋味适口，心意不顺，郁热无法伸展，专门生在胳膊内侧，小孔像蜂巢一样的，都是发背之症。如果是疔毒，那是五脏积热，六腑受伤，或者是冲撞冒犯了禽兽的毒气，或者接触了牛羊的秽气，起初像黍米大小，如果不谨慎保护而触犯它，轻的会变重，重的必死无疑。用香油调匀雄黄粉内服，以攻解毒毒，否则立刻就会败坏死亡。至于痈毒发背的产生，有五善七恶的症状，不可不辨别。行动安静自然，饮食知味，这是一善；大小便调和均匀，这是二善；神志清醒，说话声音洪亮，这是三善；脓液溃破后肿胀消散，颜色鲜红且不臭，这是四善；身体最平和，起居如常，这是五善。五善全部出现就是吉兆，没有比这更好的了。如果出现眼白黑睛缩小，两眼紧闭变小，嘴唇发青，疮色发黑，这是一恶；小腿和胳膊难以转动，四肢沉重，眼睛闭合、嘴巴张开、耳聋，这是二恶；不能进食，不能服药，或者不知味道，疼痛极度剧烈且口渴严重，这是三恶；痰多气喘，呼吸急促，面色青黑，眼睛闭合嘴巴张开，这是四恶；时常出冷汗，神情恍惚嗜睡，言语颠倒错乱，这是五恶；烦躁咳嗽，腹部腹泻，小便浑浊，这是六恶；肿胀高耸疼痛剧烈，脓水腥臭，这是七恶。七恶症状全部具备，就无法治疗了。五善见到三条就吉利，七恶见到四条就危险了。凡是治疗痈毒，初期应当解毒拔毒，已经溃破后，应当排脓定痛。如果在未溃破时，不可以服用热性药物；已经溃破后，不可以服用凉性药物。如果初起发作，必须先托里扶正；已经溃破的，必须排脓，这是治疗痈疽等疮疡的大法。还必须观察时令气候，诊察脉理，辨别虚实，决断轻重，衡量病势，斟酌用药，这样才不会导致夭折。比如毒气刚开始发作，无论是痈疽发背等症状，都必须先用千金托里散，服用三四剂，以固定脏腑功能，千金内托散也可以。然后清除热毒用凉膈散，托里扶正用败毒散，定痛用乳香汤，怕冷高热用小柴胡汤，呕吐不能纳服用人参养胃汤，饮食难消化用参朱养胃汤，声音嘶哑用麦冬清音汤，大便秘结用大柴胡汤，发热口渴饮水用黄芩汤（注：原文缺字，据语境推测为清热类方或药），秽浊触犯用连翘三香汤，腹痛用甘草芍药汤，烦躁用黄连清热汤，好眠嗜睡用益气清身汤，虚弱用人参黄芪汤，气喘咳嗽用木香顺气汤，疼痛剧烈用清肌快肤汤，神情恍惚恐惧用镇惊散，日久不化脓的用妙济散，脓已溃破但肿胀不消的用真人活命饮，清泻不止的用真人养脏汤，出虚汗不止的用黄芪固真汤，彻除脓液用万灵膏，收敛伤口用生肌散。以上病症，没有超出这些方法的。如果遇到危重恶性的病症，就应当灸竹马穴几十壮，确实有起死回生的功效。又有生于体内的痈，叫做脑痈、肠痈、肺痈、胞痈。这些病症与前文所述不同，医生必须认真识别验证，然后下手治疗，不可妄用汤药散剂，以免招惹毒祸，危害不小，务必谨慎。
方剂歌诀都记载在图形卷中，千万不要轻视。凡是毒疮在未溃破之前，出现前面提到的那些症状，就在各症对应的汤剂中加入连翘、栀子、牛蒡子、金银花、皂角刺之类。溃破之后，出现前面提到的那些症状，在各症汤剂中加入人参、黄芪、金银花、连翘、栀子，春季多用防风、白芷、柴胡、川芎；夏季多用黄连、栀子、连翘、麦冬；秋季多用黄芩、苍术、连翘、栀子；冬季多用人参、白术、连翘、甘草。治疗痈疽发背，大概就是这样。
另外，伤寒病症中，有该出汗而未出汗的，该和解而未和解的，汗液停滞在皮肤，毒气阻塞骨髓，以致发展为痈症，因为气血逆乱而不和谐，应当解毒清热，使用千金消毒饮，不可用膏药贴敷，以免开启毒气外泄的路径，如果见到危急情况，危险程度与前文所述相同，就用前面的方法治疗。又有疔毒种类不同，但其危害是一样的，共有三十六种疔毒罢了，应当先用拔毒散，或者用铁箍散围敷，内服败毒散、雄黄散之类，如果有变症，也同前法治疗。又有痰核、瘿瘤和马刀疮之类的，都是湿热生痰，痰盛生火，火盛生风，风盛生热，热盛至极而发病。应当使用清痰降火的药剂，宣热拔毒的方子，刚觉得不适时用艾灸治疗，切勿妄行腐烂切割。啊，医学真是难以言说啊！如果不是穷通性命哲理，识别阴阳，博览诗书，怎么能达到真正良方的境界。现在流传外科医术的人，大多是乡野市井之徒，不通文理之人，从未亲眼见过疡科病例，从未耳闻疮脉知识，不知道药品的性味，分辨不清汤散中的君臣佐使，仅仅知道几味草药，就对人称自己通晓，以此夸耀疗效，贪图苟且利益，病人吝啬钱财，轻信这种人，把性命交给庸医之手，实在令人叹息！谚语说：“贫穷时找不到通达的士人，只能将金子赠予病人（意指庸医误人）。”有庸人说药方，这是应该深深警惕的。
先贤说：“各条经脉中只有少阴、厥阴两条经容易生痈疽，少阳、阳明两条经容易生瘰疠。”庸人哪里懂得这两条经的窍奥，大概是因为这两条经多气少血的原因吧。
凡是诊断外科脉象，在未溃破之前，脉象宜洪大拍指，按之有力，举之健浮。溃破之后，按之宜沉健，举之宜轻浮，这是容易收功的脉象。如果未溃破之前，脉象来势沉缓，不急不数；溃破之后，脉象来势健实，或者大或者洪，这是难以收功的脉象。如果前后都得到微弱的脉象，这是危重症，经过年月日，很难获得痊愈。应当滋养气血，健运脾胃，如人参、黄芪、当归、白术之类。如果拖延不治，疮毒变化侵入腹部，进而出现腹部饱满、喘气、肿胀、呻吟，疮形平陷没入皮下，这是危重症。应当迅速使用千金托里散，从表透发出来，或者立马回生散，迎头痛击，间或可以治愈。不然，立刻就会招致灾祸。
凡是治疗痈肿，必须查看有脓无脓，应当看是正中还是偏侧，用手按压，感觉热的就有脓，不热的就没有脓，用湿纸贴在患处，干燥的地方就是真正的脓点，然后用持针切开，不要嫌弃伤口烂，因为针口大脓液容易排尽。
凡是治疗痈疖，深处深针，浅处浅针。什么叫浅？因为病症生于脐腹部位，如果深针，恐怕伤及内膜，务必谨慎。病症生于厚肉之处，适宜深针，以泻出毒气，不可不知道。我看现在治疗发背的人，专门进行勾割手术，去除筋膜败肉，更加增加痛苦，这难道是仁人的医术吗！只适宜用药调理治疗，自然会有痊愈的时候。切勿听信这种毒手，自取危重。见到这样的情况，误人很多，恐怕后人治疗有所失误，所以编纂成疡科方脉，以补充未曾目睹、未曾耳闻的不足。况且痈疽的产生，都是由内蕴郁热，外感风湿引起，肿胀高耸硕大的称为痈，隐伏在骨骼深处的称为疽，生于背部三处的称为发，起初像黍米大小，怕冷高热，逐渐发展起来，不要勾洗，适宜用艾灸，效果很好。不然，必须先内攻，攻里之后，宣热解毒，定痛排脓，生肌敛口，这才是正道。禁止房事，一切牛马秽气不可触碰，触碰了后果不轻。常常闻香气，疼痛是可以缓解的，如果不这样，疼痛难以忍受。愚昧的人不知道，把它付之于神鬼，求神礼佛，有什么福报可言。明智的人察觉到此不合常理，只修合各种药物，穷究医书，药物是百草根苗，医生是九流魁首。重视医学的人，视疡科为圣训；吝啬钱财的人，视此道为儿戏。凡是我的子孙，以及后来的医生，细心诊察，辨别寒热虚实，修合药品，辨别君臣佐使，这样才不会出错，学医之人应当亲自操练。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All pain, itching, and sores belong to the Heart." It further states: "When Ying Qi (Nutritive Energy) does not flow smoothly and reverses into the muscle tissue, carbuncles and swellings arise." It also states: "Changes resulting from excessive consumption of rich and sweet foods can lead to the growth of large Ding sores (hard, deep-seated infections)." It says: "Sweating on only one half of the body (Pian Ju) leads to hemiplegia; sweating while exposed to dampness generates acne." It also states: "If the opening and closing of the pores are dysfunctional, cold Qi enters, leading to severe spinal curvature (Da Lou)."
When earthly dampness is abundant, it causes cold. By examining the skin, flesh, sinews, and vessels, one can understand the branch manifestations of internal organ blockages. If there is no stagnant heat accumulating internally, and no damp-heat invading externally, then Qi and Blood remain harmonious, and the muscles feel light and agile. From where would a Yang abscess (Yong) come? From where would a Yin ulcer (Ju) arise! In treating Yong and Ju, one must first differentiate between Deficiency and Excess, and Yin and Yang. The classics state: "All pain indicates Excess; all itching indicates Deficiency; all Yong are Yang syndromes; all Ju are Yin syndromes." One must also distinguish whether it is Yong or Ju, Ding sore or Back-Fa (Back Carbuncle), before administering medication, thus avoiding errors. Heat manifesting on the surface of the muscles, with slight swelling and a small base, not exceeding one or two cun in diameter, is called a Jie (small boil); heat originating between the internal organs, with high swelling and a broad base, exceeding four or five cun in diameter, is called Yong; heat-toxin from the Five Zang organs flowing into the bone marrow and attaching to the bones is called Ju; excessive drinking and eating, consuming strong flavors, thwarted will, and unexpressed stagnant heat, specifically appearing on the inner arms with small holes like a honeycomb, are all cases of Fa (Back Carbuncle). If it is a Ding toxin, it arises from accumulated heat in the Five Zang and injury to the Six Fu organs, or from exposure to animal toxins, or contact with cattle/sheep filth. Initially the size of a millet grain, if not carefully protected and touched, mild cases become severe, and severe cases result in death. Administer realgar powder mixed with sesame oil orally to attack the toxin; otherwise, rapid deterioration will occur. Regarding the generation of Yong toxins and Back-Fa, there are Five Good Signs and Seven Bad Signs that must be distinguished. Calm movement and appetite indicate the First Good Sign; regular bowel and bladder functions indicate the Second Good Sign; clear spirit and loud voice indicate the Third Good Sign; pus discharge with reduced swelling, fresh color, and no odor indicate the Fourth Good Sign; physical peace and normal daily routine indicate the Fifth Good Sign. If all Five Good Signs appear, it is auspicious. If the whites of the eyes turn black, eyes shrink tightly, lips turn blue, and the sore turns black, this is the First Bad Sign; difficulty turning legs/arms, heavy limbs, closed eyes, open mouth, and deafness constitute the Second Bad Sign; inability to eat or take medicine, loss of taste, extreme pain, and severe thirst constitute the Third Bad Sign; phlegm, wheezing, rapid breathing, blue-black complexion, closed eyes, and open mouth constitute the Fourth Bad Sign; spontaneous cold sweat, mental confusion, drowsiness, and incoherent speech constitute the Fifth Bad Sign; irritability, coughing, diarrhea, and turbid urine constitute the Sixth Bad Sign; high swelling, severe pain, and foul-smelling pus constitute the Seventh Bad Sign. If all Seven Bad Signs are present, the condition is incurable. Seeing three of the Five Good Signs is auspicious; seeing four of the Seven Bad Signs is critical. In treating Yong toxins, initially resolve toxicity and extract poison; after ulceration, drain pus and relieve pain. Before ulceration, do not administer hot-natured medicines; after ulceration, do not administer cold-natured medicines. For initial onset, first support the interior (Tuo Li); for ulcerated cases, drain pus. This is the general principle for treating Yong, Ju, and other sores. One must also consider seasonal timing, diagnose pulse patterns, differentiate deficiency/excess, determine severity, assess disease progression, and adjust treatment accordingly to avoid premature death. For example, when toxins first appear, regardless of Yong, Ju, or Back-Fa, first administer Qianjin Tuo Li San (Thousand-Gold Interior-Supporting Powder) for three to four doses to stabilize the internal organs; Qianjin Nei Tuo San is also acceptable. Then, use Liang Ge San (Cool the Diaphragm Powder) to clear heat, Bai Du San (Detoxifying Powder) to support the interior, Ru Xiang Tang (Frankincense Decoction) to relieve pain, Xiao Chai Hu Tang (Minor Bupleurum Decoction) for chills and high fever, Ren Shen Yang Wei Tang (Ginseng Stomach-Nourishing Decoction) for vomiting and inability to retain intake, Shen Zhu Yang Wei Tang for indigestion, Mai Dong Qing Yin Tang for hoarseness, Da Chai Hu Tang for constipation, Huang Qin Tang (Scutellaria Decoction) for fever and thirst, Lian Qiao San Xiang Tang for filth exposure, Gan Cao Shao Yao Tang for abdominal pain, Huang Lian Qing Re Tang for irritability, Yi Qi Qing Shen Tang for excessive sleep, Ren Shen Huang Qi Tang for weakness, Mu Xiang Shun Qi Tang for asthma and cough, Qing Ji Kuai Fu Tang for severe pain, Zhen Jing San for fright and confusion, Miao Ji San for delayed suppuration, Zhen Ren Huo Ming Yin (True Man’s Life-Preserving Decoction) for persistent swelling after ulceration, Zhen Ren Yang Zang Tang for uncontrollable diarrhea, Huang Qi Gu Zhen Tang for persistent spontaneous sweating, Wan Ling Gao (Ten-Thousand Spirits Ointment) for draining pus, and Sheng Ji San (Flesh-Generating Powder) for wound closure. These methods cover all aforementioned conditions. For critical malignant cases, moxa dozens of times at Zhuma Acupoint, which has the power to revive the dying. Internal Yong include Brain Yong, Intestine Yong, Lung Yong, and Bladder Yong. These differ from external sores; physicians must accurately identify them before treating. Do not recklessly use decoctions or powders to avoid triggering toxic disasters. Exercise extreme caution.
Formulas and rhymes are recorded in the Graphic Volume; do not underestimate them. For sores before ulceration presenting with the aforementioned symptoms, add Lian Qiao (Forsythiae Fructus), Zhi Zi (Gardeniae Fructus), Niu Bang Zi (Arctii Fructus), Er Hua (Lonicerae Japonicae Flos & Forsythiae Fructus), and Zao Jiao Ci (Gleditsiae Spina) to the respective decoctions. After ulceration, add Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Er Hua, Lian Qiao, and Zhi Zi. In spring, add more Fang Feng (Saposhnikoviae Radix), Bai Zhi (Angelicae Dahuricae Radix), Chai Hu (Bupleuri Radix), and Chuan Xiong (Chuanxiong Rhizoma); in summer, add Huang Lian (Coptidis Rhizoma), Zhi Zi, Lian Qiao, and Mai Dong (Ophiopogonis Radix); in autumn, add Huang Qin (Scutellariae Radix), Cang Zhu (Atractylodis Rhizoma), Lian Qiao, and Zhi Zi; in winter, add Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Lian Qiao, and Gan Cao (Glycyrrhizae Radix et Rhizoma). Treatment of Yong, Ju, and Back-Fa generally follows this pattern.
Regarding Cold Damage (Shang Han) syndromes, there are cases where sweating should have occurred but did not, or harmonization was needed but failed. Sweat stagnates in the skin, and toxins block the bone marrow, leading to Yong syndromes due to rebellious and disharmonious Qi and Blood. Resolve toxicity and clear heat using Qianjin Xiao Du Yin (Thousand-Gold Detoxifying Drink). Do not apply plasters, as this may open pathways for toxin release. If critical, treat as described previously. There are various types of Ding sores, thirty-six in total, all equally harmful. Use Ba Du San (Toxin-Extracting Powder) or apply Tie Gu San (Iron-Hoop Powder) circumferentially, and internally administer Bai Du San and Xiong Huang San. If complications arise, treat according to previous methods. Phlegm nodules, goiters, and Scrofula (Ma Dao Chuang) are caused by damp-heat generating phlegm, phlegm generating fire, fire generating wind, wind generating heat, and extreme heat causing illness. Use phlegm-resolving and fire-descending agents, and heat-releasing and toxin-extracting formulas. Apply moxibustion at the first sign; never perform reckless incisions. Medicine is indeed difficult to master. Without profound understanding of nature and principles, Yin-Yang differentiation, and extensive reading, how can one achieve true efficacy? Modern practitioners of surgery are often uneducated villagers who have never seen surgical cases or heard of wound pulses, do not know herb properties, cannot distinguish sovereign-minister herbs in formulas, yet claim expertise based on a few herbs to boast and profit. Patients, stingy with money, trust these quacks, handing their lives to incompetent hands—a lamentable situation. As the proverb says: "When poor, no wise doctor is found; give gold to the sick [to buy bad advice]." One must deeply beware of quack prescriptions.
Ancients stated: "Among the meridians, only Shaoyin and Jueyin generate Yong and Ju; Shaoyang and Yangming generate Scrofula." Quacks do not understand the essence of these meridians, likely because these meridians have abundant Qi but scarce Blood.
In diagnosing surgical pulses: Before ulceration, the pulse should be洪大 (Hong Da - Surging and Large), forceful upon pressure, and floating upon lifting. After ulceration, it should be沉健 (Chen Jian - Deep and Strong) upon pressure, and lightly floating upon lifting; this indicates easy recovery. If before ulceration the pulse is 沉缓 (Chen Huan - Deep and Slow), neither rapid nor frequent, and after ulceration it becomes 健实 (Jian Shi - Strong and Solid) or large/surging, recovery will be difficult. If the pulse is weak throughout, it is a critical condition; full recovery over time is unlikely. Nourish Qi and Blood, strengthen Spleen and Stomach using Ren Shen, Huang Qi, Dang Gui (Angelicae Sinensis Radix), and Bai Zhu. If neglected, toxin enters the abdomen, causing abdominal distension, asthma, swelling, groaning, and flat sores; this is critical. Immediately use Qianjin Tuo Li San to vent from the exterior, or Ma Li Hui Sheng San to intercept the pathogen; there is a chance of cure. Otherwise, disaster is imminent.
When treating swellings, check for pus presence by palpation: warmth indicates pus; coolness indicates none. Place wet paper on the area; the dry spot marks the center of the pus. Then puncture with a needle. Do not fear a large wound, as a larger opening facilitates complete drainage. For deep sores, use deep needling; for superficial ones, shallow needling. Superficial needling applies to umbilical/abdominal areas to avoid injuring internal membranes. Deep needling applies to thick-fleshed areas to drain toxin. Current surgeons who perform hook-cutting on Back-Fa to remove necrotic fascia cause unnecessary pain; this is not the way of benevolence. Medication alone suffices for healing. Avoid such violent methods. I compile this Surgical Pulse and Formula text to remedy lack of observation and hearing. Yong and Ju arise from internal stagnant heat and external Wind-Damp. High, large swellings are Yong; deep, bony ones are Ju; those on the back are Fa. Starting as millet-sized grains with chills and fever, they develop gradually. Do not cut/wash; use moxibustion for good effect. Alternatively, use internal attack, followed by heat-clearing, detoxification, pain relief, pus drainage, flesh-generation, and wound closure. This is the correct path. Abstain from sexual activity and avoid animal filth odors. Inhose fragrances to alleviate pain; otherwise, pain is unbearable. Ignorant people attribute this to spirits and pray, gaining no benefit. Wise people recognize this, compound medicines, and study medical texts. Herbs are plant roots; doctors are leaders of the nine schools. Those valuing medicine treat surgery as sacred; those stingy with money treat it as a game. My descendants and future physicians must carefully diagnose cold/heat, deficiency/excess, compound medicines correctly, and distinguish sovereign-minister roles to avoid error. Students must practice diligently.