痈疽毒要气血胜，内外因皆湿热凝。
痈者，壅也，为阳，属六腑。毒腾于外，其发暴而所患浮浅，不伤筋骨。疽，沮也，为阴，属五脏。毒攻于
内，其发缓而所患沉深，伤筋蚀骨。凡年壮，气血胜毒则顺；年老，毒胜气血则险。有内因饮食积毒者，经曰∶
膏粱之变，足生大疔。荣气不从，逆于肉理。荣气即胃气，胃和则荣卫顺，而滋养皮肤。膏粱金石，浓衣
烘被，以致蕴热脏腑，湿热聚下，烧烁肾水，阴火炽盛，八脉沸腾，经隧凝滞，故水谷精微，不能上行阳道，
反逆聚肉之腠理而成痈。有外感风寒湿蕴毒者，经曰∶地之湿气，感则害人皮肉。又曰∶诸痈肿筋挛骨痛者，
此寒气之肿，八风之变也。盖风湿外侵，郁久为热，自膀胱左迁，移热小肠，小肠移热于胆。风性上冲，疮形
高，色赤作痛，小则为疖，大则为痈而已，非若疽之自里也。有因心气郁结，饥饱劳役，房
室过度，水竭火炎，痰凝气滞而成。所谓相火能为疮疡，诸痛痒疮疡，皆属心火是也。因火有君相，疮分微甚，
或郁痛而不甚肿，或虚肿而不甚痛，虽然病该三因，总皆湿热。丹溪云∶人身血行脉中，气行脉外，气血周
流不息。惟寒湿搏之，则凝滞而行迟；火热搏之，则沸腾而行速。气为邪郁，津液为痰为饮，积久渗入脉中，
血为之浊，此阴滞于阳而为痈；血为邪郁，隧道或溢或结，积久溢出脉外，气为之乱，此阳滞于阴而为疽。盖
阳气无形，阴血有质，必湿热泣血，而后发为痈疽。故《局方》曰∶痈疽皆热胜血也。又曰∶二热相搏，热化
为脓。盖热非湿，则不能腐坏肌肉为脓，譬如夏热诸物皆不坏烂，坏烂者，交秋湿热大行之际，此理甚明。
纯阳 赤溃敛易，纯阴色黯全不疼。半阴半阳肿痛慢，用药回阳乃可生。
痈疽有大而愈者，有微如豆而死者。阳发，初起皮薄作热，色赤 肿疼痛，溃后肉色红活，此为外发。更
加身健能食，发热便秘，脉数有力，为纯阳，易治。阴发，初起皮浓不热。色黯微肿，硬如牛皮，不痛陷软，不
作脓不溃，微开阔，破后肉色紫黑，此为内发。未溃脏腑已前坏烂，更加身倦少食，不热便利，脉软无力，为纯
阴，不治。又有半阴半阳，似肿非肿，似痛非痛，似赤非赤，似溃非溃，脉数无力。如阳多阴少，用药托里变
阳者生；阴多阳少，用药托亦不起，投阴必死。就中尤以有热无热，为死生妙诀。盖阳证有热，则气血行而生
肌；阴证无热，则气血滞而不敛。遇有热者，切不可退热，但宜温药清渗。些小疖毒，无热亦不妨。
风则多痒气则痛，湿肿食则热寒增∶
痈疽虽止发于一经，或兼二经，多有挟风、挟湿、挟痰、挟气、挟血、挟阴虚等证。大较风、气、食三种，
俱以不换金正气散加川芎、木香为主。兼风多痒，加祛风药；兼气多痛，加调气药；兼食多发寒热，加消积药；
兼湿多肿，加渗湿药。又云，热疮 痛，虚疮淡白，风寒疮口带白。古方，外因四气，单用大黄（半生半熟）、
甘草节等分为末，每空心，酒下一匙，以利为度。内因七情，单用远志为末，酒调二钱，澄清服，以渣敷患处。
不内外因，金石、炙爆、房劳，国老膏。一切热毒，槐花酒。
药毒坚硬有如石，
金石药毒，则坚硬如石不痛，宜甘草、黑豆煎汤解之。
虚瘦重着怕潮蒸∶
虚劳瘦弱，荣卫痞涩，患处重着，如负石然，因其有骨蒸潮也，治宜滋补。故不可用赛命丹等香燥疏
泄之药，亦不可过用降火滞脾之药，惟肾气丸、托里散甚得其宜。且古方谓，药毒劳蒸，痈疽极重。
近骨生虫近虚漏，
近骨者多冷，久则化血为虫，多痒少痛；近虚者多热，久则传气成漏，多痛少痒。
细认穴道属何经。
脑发，属督脉、足太阳经；鬓发，手足少阳经；眉发，手足太阳、少阳经；颐发、髭发，足阳明经；腮发，
手阳明经，背发，中属督脉，余皆足太阳经；腋发，手太阳经；乳痈，内阳明，外少阳经，乳头足厥阴经。肾
痈，足太阳经；外肾痈；足厥阴经；腿发，外足三阳，内足三阴经；喉痈、脐痈，任脉、足阳明经；穿裆发，
督、冲、任三脉；跨马痈、囊痈，足厥阴经。内疽∶肺痈，手太阴经；肠痈，手太阳、阳明经；胃脘痈，足阳
明经。惟少阳、少阴、太阴多气少血；厥阴、太阳多血少气，肉皆难平。惟手足阳明，气血俱多。分经用药，
则不犯经禁，病禁，以致妄下、妄汗。且疮属肾经者最重，脾肺二经者次之，他经者又次之。脑乃诸阳所在，
咽喉饮食所通，肾俞命根所系，皆至险之地，又不可多着艾灸。俗方专图人形疮样，而忽经络，谬哉！
外因寒热宜表散，
毒因外感发者，内无便溺阻隔，外有六经形证，肿痛虽甚，饮食如常，脉浮数，邪在表
也，宜托里微汗以表散之。如发脑项背分，黄连消毒散；尻臀分，内托羌活汤；臂上，白芷升麻汤；乳胸，
内托升麻汤；两胁，十味中和汤；腿外侧，内托酒煎汤；腿内近膝股，内托 柴汤。通用∶败毒散、九味羌活
汤。辛热手足太阴经分，自汗浮肿，流注四肢，附子六物汤。辛温发热，十六味流气饮、赛命丹。暑月，内
托复煎散；寒月，内托十宣散，或不换金正气散。丹溪治形实脉浮数，冬月背生红肿，及胛骨下痛者，用桂麻各
半汤加生附、酒柏、栝蒌仁、甘草节、羌活、青皮、人参、黄芩、半夏，姜煎服，六帖而愈。此正内托法也。
有谓疮家身痛不可汗，汗之则发 者，邪不在表而误汗也。
内热痛秘急疏行；
内伤饮食积毒者，肿痛异常，外无六经形证，内有便溺阻隔，口渴烦躁，脉沉实，为邪在里，急与寒凉
攻里，内疏黄连汤、泻心汤、活命饮、四顺清凉饮。轻者，清热消毒饮加紫草，或清心散渗之。内积热毒，外
又感邪者，宜发表攻里，五香连翘汤、防风通圣散。毒盛者，解毒汤下神芎丸；湿盛者，除湿丹。
劳伤气郁无表里，邪在经中和卫荣∶
毒因内伤虚损，房劳郁怒而发者，形虽肿痛，外无六经之形证，内无便溺之阻隔，知邪在经也，不可妄
施汗下，只宜补形气，调经脉，和荣卫，或专补脾胃可也。郁怒者，十六味流气饮；虚劳者，托里消毒散、
内托复煎散、补中益气汤。古人治痈以寒药者正治法也；治疽以热药者，从治法也。盖药性热则开行，寒则疏
泄，疽乃有形之物，非热药从治，岂能行之乎？此内托、内疏、正治、从治之义也。
溃后托里排脓毒，脓尽肌肉自然平。
溃后气血大虚，惟恐毒陷，托里之法，一日不可缺也。古方托里散、托里清中汤、托里温中汤、托里和
中汤、托里建中汤、托里抑青汤、托里益黄汤、托里益气汤，选用。盖托里则气血壮而脾胃盛，脓秽自排，毒
气自解，死肉自溃，新肉自生，疮口自敛。若不务补托，而误用寒凉，反助邪火，脓多臭秽，甚则脉洪、大
渴，真气虚而死矣。丹溪云∶但见肿痛，参之脉证虚弱，更与滋补，乃可万全。又不必泥气质素实，及参、
满中滞痰也。但初溃时，间有热毒盛者，量加消毒清剂。如发背、搭肩，膜破穿心必死，尤宜托里，免致毒陷，
托里即护心也。若毒瓦斯上攻，心神昏闷欲呕者，间服护心散以救之。如带表邪面赤等证，势未甚起者，内托复
煎散，或内托十宣散，暂服。若无热毒表邪，但见秽气触犯，虚热少食不睡者，便进人参黄 汤；但见脓多心
烦少睡者，便进圣愈汤；但见脾亏气弱，不能生肌收敛者，便进补中益气汤；但见肾虚不能消溃收敛，或晡热
作渴者，便进八味丸，或肾气丸。紧急不及作丸，大料煎服，预防救危，始终妙剂。若不务本根，而专用敷围
生肌之药，则敛口太速，毒反内攻，或傍边再发一痈者有之，或愈后而恶证顿起，大命随去者有之。惟务内治，
而不贵外治者为高。
外治初起灸最妙，
形伤则痛，气伤则肿。或先痛后肿伤乎血；先肿后痛伤乎气；肿痛并攻，气血俱伤，皆因脏腑不和，
而非外治能调。古法，隔蒜灸法、豆豉饼，惟外伤成疮者不宜。自内发者，痛则灸至不痛，不痛则灸至痛时方
住，早觉早灸为佳。一日二日，十灸十活；三日四日，十灸七活；五日六日，十灸四活；过七日，则不可灸
矣。其余点割敷透，间有毒盛者，量用之则可。
热痛半软针相当；
痈疽毒瓦斯已成，宜托里以速其脓。脓成者，当验其生熟浅深而针之。若肿高而软者，发于血脉；肿下而
坚者，发于筋脉；肉色不变者，附于骨也。按之热者有脓，不热者无脓；按之便痛者脓浅，大按方痛者脓深；
按之陷而不起者脓未成，按之而复起者脓已成；按之都软者无脓，不痛者血瘤，痛者气瘤；按之一边软者有脓。
若脓生而用针，气血既泄，脓反难成；若脓熟而不针，腐溃益深，疮口难敛。若疮深
而针浅，内脓不出，外血反泄；疮浅而针深，内脓虽出，良肉受伤。元气虚者，必先补而后针其脓，诸证自退。
若疮毒炽盛，中有肉黯者；宜内壮脾胃，外涂单巴豆膏。令其黯处渐低，赤处渐高，六七日间，赤黯之处，
自有裂纹如刀划状，黯肉渐溃，当用披针利剪，徐徐引去。若脓出肉腐，肿痛仍作，必内有筋间隔，宜再引之，
急补脾胃，不痛者纯用补药，庶可收敛。若妄施针刀，伤肉出血，断之不止者立危。其披针用马衔铁为之。
敷围点瘀非得已，
人身气血遇温则散，遇寒则凝。概敷寒凉，闭塞腠理，气凝血瘀，旧肉不溃，新肉不生，则毒反内攻，难
以溃敛，甚则不起。必内分阴阳用药，外分阴阳敷围，内外夹攻，药气相通为妙。纯阳证，内服内疏黄连汤、
清热消毒饮之类，外敷柳阳散；半阴半阳证，内服托里消毒散，外敷阴阳散；纯阴证，内服补中益气汤加姜、
附，入酒煎，外敷抑阴散。点瘀炉灰膏，以去恶肉，药线三品锭子，以透脓管，皆欲败腐尽除，不至侵蚀筋骨，
非得已而用也。
止痛敛口免开张。
痈疽不可不痛，不可大痛。未溃前痛者为热毒，便秘，宜内疏黄连汤、解毒汤。作脓痛者，排之；脓胀痛
者，针之。已溃脓出反痛者，虚也。气虚，四君子汤加归、 ；血虚，四物汤加参、 ；气血俱虚，托里益气
汤；脾虚者，托里和中汤；肾虚者，肾气丸。因登厕犯秽气触者，药中加乳香、芷、芍之类和之；风寒逼者，
加防风、桂枝之类温散之。燥者，润之；湿者，导之。果系瘀血恶肉凝滞者，方可乳香止痛散和之。疮口不敛，由
于肌肉不生；肌肉不生由于腐肉不去；腐肉不去，由于脾胃不壮、气血不旺。必以补托为主，而佐以行经活血
之药，则肌肉受毒者自生；死者自溃，又何待于点割耶！大要∶气虚体倦食少者，补中益气汤；血虚晡热内热
者，四君子加归、地、牡丹皮；脓水清稀者，气血俱虚，十全大补汤。或不痛，或赤痛。或不赤，或内脓不溃，
或外肉不腐者，气血虚败，桑枝灸法，十全大补汤加姜、桂，壮其阳气，则四畔即消，疮头即腐。若脾胃虚弱，
漫肿不赤者，六君子汤倍白术。若初起肿痛，或因克伐及入房，以致色黯而不痛者，乃阳脱变阴，急用古参附
汤以救之。间有血分虚热者，疮口肉色必赤，四物汤加山栀、连翘；气分虚热烦渴者，竹叶黄 汤。要知疮口
难敛，或渐大渐开出血者危。俗皆以肿痕所至为晕，非真晕也。晕生于疮口之畔，状如红筋三晕，三晕尚可，
四晕、五晕者死。
洗能疏毒活血气，
洗药疏通气血，脓血 聚之时，所赖朝夕暖醋蘸洗败肉，或洗毒散，肉汁汤。风冷疮口白者，干艾煎汤亦
好。
贴膏不被风寒伤。
膏药多热，轻小疮疖贴之即消，发表不远热之意也。若大毒初起用之，迷塞凝滞，为祸不小。惟溃后只用白
蜡膏、太乙膏，或水粉膏外护，不致破伤风寒。
妇幼患此无他异，妇宜调血幼宜清。
妇人调血开郁为主。值经闭及溃后月水又发，所患坚硬，不破不肿不疼者凶。小儿主去胎毒。或有饮食
积热者，药稍宜清凉。如素禀受体薄，及稍长而久病者，仍以补托气血脾胃为主治之。
杂证仍以疮为主，溃未清心要酌量。
脉证俱热者，未溃前内消解毒，已溃后托里消毒；脉证俱虚者，未溃前托里消毒，已溃后托里补中。治其
疮而诸证自退。疮为本，病为标，若病急而元气实，暂治其标；病缓而元气虚，只治其本。心通诸窍，脏腑所
包者一膜耳。若忧惊入心，膜破必死，药中常加茯神、远志为妙。
五善能食便调顺，脓鲜不臭声音长；
五善∶动息自宁，饮食知味，一也；便利调匀，二也；脓溃肿消，水鲜不臭，三也；神彩精明，语音清朗，
四也；体气和平，五也。此属腑
证，病微邪浅，若能慎节，勿药自愈。
七恶皆因真气损，
七恶，乃五脏亏损之证，外似有余，而内实不足。法当纯补胃气，多有可生。不可因其恶而遂弃不治。大
抵元气虚弱，或脓水出多，气血亏损；或汗下失宜，荣卫消烁；或寒凉克伐，气血不足；或峻厉猛剂，胃气受
伤，以致真气虚而邪气实矣。
烦躁口干渴非常。或泄或闭或淋沥，
痈疽的发生，关键在于气血能否战胜毒邪，其内外病因都归结于湿热的凝结。
痈，意为壅塞，属于阳证，关联六腑。毒邪向外发散，发病急骤且病变部位浮浅，不损伤筋骨。疽，意为阻滞，属于阴证，关联五脏。毒邪向内攻伐，发病缓慢且病变部位沉深，会损伤筋脉和骨骼。凡是年壮之人，气血旺盛能胜毒邪则为顺证；年老之人，毒邪旺盛而气血虚弱则为险证。
有因内伤饮食积滞成毒的，《内经》说：“食用膏粱厚味引发的病变，足以生出大疔疮。”这是因为营气运行不畅，逆乱于肌肉纹理之间。营气即胃气，胃气和调则营卫顺畅，从而滋养皮肤。若过食膏粱金石之品，穿着浓衣、烘烤被褥，导致脏腑蕴热，湿热聚积于下焦，烧灼肾水，致使阴火炽盛，八脉沸腾，经络隧道凝滞，因此水谷精微不能上行至阳道，反而逆乱积聚在肌肉腠理之间形成痈。
有因外感风寒湿邪蕴结成毒的，《内经》说：“地之湿气，侵袭则伤害皮肉。”又说：“各种痈肿、筋挛、骨痛，这是寒气引起的肿胀，是八风变化所致。”大概是因为风湿外侵，郁久化热，自膀胱左移，热传小肠，小肠热再传于胆。风性上冲，所以疮形高起，色红疼痛，小则为疖，大则为痈，这与疽从体内发出不同。
还有因心气郁结、饥饱失常、劳役过度、房事不节，导致肾水枯竭、心火炎上，痰凝气滞而形成的。这就是所谓“相火能为疮疡”，“各种痛痒疮疡，都属于心火”。因为火有君火与相火之分，疮疡也有轻重之别，有的郁结疼痛但不怎么肿，有的虚肿但不怎么痛。虽然病因涵盖三因，但总归都是湿热。朱丹溪说：“人身血液行于脉中，气行于脉外，气血周流不息。只有寒湿搏结，才会凝滞而行迟；火热搏结，才会沸腾而行速。气被邪气郁遏，津液变成痰饮，积久渗入脉中，血变得浑浊，这是阴滞于阳而发为痈；血被邪气郁遏，经络或溢出或结聚，积久溢出脉外，气变得紊乱，这是阳滞于阴而发为疽。”大概阳气无形，阴血有形，必须湿热煎熬血液，而后才发为痈疽。所以《太平惠民和剂局方》说：“痈疽都是热胜血造成的。”又说：“两种热邪相搏，热化为脓。”大概热没有湿，就不能腐坏肌肉成为脓，就像夏天炎热时万物都不腐烂，腐烂的是在入秋后湿热盛行之际，这个道理很清楚。
纯阳证表现为红肿溃烂容易收敛，纯阴证表现为颜色暗黑完全不痛。半阴半阳证肿痛缓慢，用药回阳才能生肌。
痈疽有大而痊愈的，也有微小如豆却死亡的。阳证初起皮薄发热，色红肿痛，溃后肉色红活，这叫外发。如果加上身体健壮能食，发热便秘，脉数有力，就是纯阳证，容易治疗。阴证初起皮厚不热，色黯微肿，硬如牛皮，不痛陷软，不化脓不溃破，微微开阔，破后肉色紫黑，这叫内发。未溃前脏腑已先坏烂，加上身体疲倦少食，不发热大便通利，脉软无力，就是纯阴证，难以治愈。又有半阴半阳证，似肿非肿，似痛非痛，似赤非赤，似溃非溃，脉数无力。如果阳多阴少，用药托里转为阳证者可生；如果阴多阳少，用药托里也起不了作用，投用阴药必死。其中尤其以有无发热，作为判断生死的关键秘诀。大概阳证有热，则气血运行而生肌；阴证无热，则气血停滞而不收敛。遇到有热的情况，切不可退热，只宜用温药清渗。些小的疖毒，没有发热也无妨。
痈疽虽然只发于一经，或兼二经，大多夹杂风、湿、痰、气、血、阴虚等证候。大致来说，风、气、食三种，都以不换金正气散加川芎、木香为主方。兼风多痒，加祛风药；兼气多痛，加调气药；兼食积多发寒热，加消积药；兼湿多肿，加渗湿药。又说，热疮疼痛，虚疮淡白，风寒疮口带白。古方中，对于外因四气，单用大黄（半生半熟）、甘草节等分为末，每空腹时，酒送服一匙，以利为度。对于内因七情，单用远志为末，酒调服二钱，澄清后服用，药渣敷患处。对于不内外因，如金石药毒、炙爆烫伤、房劳过度，用国老膏。一切热毒，用槐花酒。
药毒坚硬有如石头，
虚瘦重着怕潮蒸：
虚劳瘦弱，营卫痞涩，患处沉重，如同背负石头一样，因为伴有骨蒸潮热，治疗宜滋补。所以不可用赛命丹等香燥疏泄的药物，也不可过用降火滞脾的药物，只有肾气丸、托里散非常适宜。而且古方说，药毒劳蒸，痈疽极重。
近骨生虫近虚漏，
靠近骨头的多冷，久了则化血为虫，多痒少痛；靠近虚损部位的多热，久了则传气成漏，多痛少痒。
仔细辨认穴位所属何经。
脑发，属督脉、足太阳经；鬓发，手足少阳经；眉发，手足太阳、少阳经；颐发、髭发，足阳明经；腮发，手阳明经；背发，中间属督脉，其余皆属足太阳经；腋发，手太阳经；乳痈，内部属阳明，外部属少阳经，乳头属足厥阴经。肾痈，足太阳经；外肾痈，足厥阴经；腿发，外侧属足三阳，内侧属足三阴经；喉痈、脐痈，任脉、足阳明经；穿裆发，督、冲、任三脉；跨马痈、囊痈，足厥阴经。内疽：肺痈，手太阴经；肠痈，手太阳、阳明经；胃脘痈，足阳明经。只有少阳、少阴、太阴多气少血；厥阴、太阳多血少气，肌肉都难平复。只有手足阳明经，气血俱多。分经用药，就不犯经禁、病禁，以致妄用汗法、下法。而且疮属肾经者最重，脾肺二经者次之，其他经者又次之。头部乃诸阳汇聚之处，咽喉是饮食通道，肾俞和命门根所系，都是极其危险的地方，又不可多用艾灸。俗方专门追求人形疮样，而忽视经络，真是谬误！
毒因外感引发者，内部没有大小便阻隔，外部有六经形证，肿痛虽甚，饮食如常，脉浮数，说明邪在表，宜用托里微汗的方法表散。如发于脑项背部，用黄连消毒散；发于尻臀部，用内托羌活汤；发于手臂上，用白芷升麻汤；发于乳胸部，用内托升麻汤；发于两胁，用十味中和汤；发于腿外侧，用内托酒煎汤；发于腿内侧近膝股处，用内托柴胡汤。通用方：败毒散、九味羌活汤。辛热证见手足太阴经分，自汗浮肿，流注四肢，用附子六物汤。辛温发热，用十六味流气饮、赛命丹。暑月，用内托复煎散；寒月，用内托十宣散，或不换金正气散。朱丹溪治疗形体实、脉浮数，冬天背部生红肿，及肩胛骨下痛者，用桂枝麻黄各半汤加生附子、酒黄柏、瓜蒌仁、甘草节、羌活、青皮、人参、黄芩、半夏，姜煎服，六帖而愈。这正是内托法。有人说疮家身痛不可发汗，发汗则变证，那是邪不在表而误汗的结果。
内热痛秘急疏行；
内伤饮食积毒者，肿痛异常，外部无六经形证，内部有大小便阻隔，口渴烦躁，脉沉实，说明邪在里，急用寒凉攻里，用内疏黄连汤、泻心汤、活命饮、四顺清凉饮。轻者，用清热消毒饮加紫草，或清心散渗之。内积热毒，外又感邪者，宜发表攻里，用五香连翘汤、防风通圣散。毒盛者，用解毒汤送服神芎丸；湿盛者，用除湿丹。
劳伤气郁无表里，邪在经中和卫荣：
毒因内伤虚损、房劳郁怒而发者，形体虽肿痛，外部无六经形证，内部无大小便阻隔，知道邪在经脉，不可妄施汗下，只宜补形气，调经脉，和营卫，或者专补脾胃即可。郁怒者，用十六味流气饮；虚劳者，用托里消毒散、内托复煎散、补中益气汤。古人治痈用寒药是正治法；治疽用热药是从治法。大概药性热则通行，寒则疏泄，疽是有形的东西，不用热药从治，怎么能行得通呢？这就是内托、内疏、正治、从治的意义。
溃后托里排脓毒，脓尽肌肉自然平。
溃后气血大虚，唯恐毒邪内陷，托里的方法，一日不可缺。古方托里散、托里清中汤、托里温中汤、托里和中汤、托里建中汤、托里抑青汤、托里益黄汤、托里益气汤，选用。大概托里则气血壮而脾胃盛，脓秽自排，毒气自解，死肉自溃，新肉自生，疮口自敛。如果不务补托，而误用寒凉，反助邪火，脓多臭秽，甚至脉洪、大渴，真气虚而死。朱丹溪说：“只要见到肿痛，参合脉证虚弱，更给予滋补，才可万全。”也不必拘泥于体质素实，以及人参、麦冬中滞痰的问题。只是初溃时，间或有热毒盛者，酌情加消毒清剂。如发背、搭肩，膜破穿心必死，尤宜托里，免致毒陷，托里即护心。如果毒瓦斯上攻，心神昏闷欲呕者，间服护心散以救之。如果带表邪面赤等证，势未甚起者，内托复煎散，或内托十宣散，暂服。若无热毒表邪，但见秽气触犯，虚热少食不睡者，便进人参黄芪汤；但见脓多心烦少睡者，便进圣愈汤；但见脾亏气弱，不能生肌收敛者，便进补中益气汤；但见肾虚不能消溃收敛，或午后发热作渴者，便进八味丸，或肾气丸。紧急不及作丸，大料煎服，预防救危，始终妙剂。如果不务本根，而专用敷围生肌之药，则敛口太速，毒反内攻，或旁边再发一痈者有之，或愈后而恶证顿起，大命随去者有之。惟务内治，而不贵外治者为高。
外治初起灸最妙，
形伤则痛，气伤则肿。或先痛后肿伤乎血；先肿后痛伤乎气；肿痛并攻，气血俱伤，皆因脏腑不和，而非外治能调。古法，隔蒜灸法、豆豉饼，惟外伤成疮者不宜。自内发者，痛则灸至不痛，不痛则灸至痛时方住，早觉早灸为佳。一日二日，十灸十活；三日四日，十灸七活；五日六日，十灸四活；过七日，则不可灸矣。其余点割敷透，间有毒盛者，量用之则可。
痈疽毒瓦斯已成，宜托里以速其脓。脓成者，当验其生熟浅深而针之。若肿高而软者，发于血脉；肿下而坚者，发于筋脉；肉色不变者，附于骨也。按之热者有脓，不热者无脓；按之便痛者脓浅，大按方痛者脓深；按之陷而不起者脓未成，按之而复起者脓已成；按之都软者无脓，不痛者血瘤，痛者气瘤；按之一边软者有脓。若脓生而用针，气血既泄，脓反难成；若脓熟而不针，腐溃益深，疮口难敛。若疮深而针浅，内脓不出，外血反泄；疮浅而针深，内脓虽出，良肉受伤。元气虚者，必先补而后针其脓，诸证自退。若疮毒炽盛，中有肉黯者；宜内壮脾胃，外涂单巴豆膏。令其黯处渐低，赤处渐高，六七日间，赤黯之处，自有裂纹如刀划状，黯肉渐溃，当用披针利剪，徐徐引去。若脓出肉腐，肿痛仍作，必内有筋间隔，宜再引之，急补脾胃，不痛者纯用补药，庶可收敛。若妄施针刀，伤肉出血，断之不止者立危。其披针用马衔铁为之。
人身气血遇温则散，遇寒则凝。概敷寒凉，闭塞腠理，气凝血瘀，旧肉不溃，新肉不生，则毒反内攻，难以溃敛，甚则不起。必内分阴阳用药，外分阴阳敷围，内外夹攻，药气相通为妙。纯阳证，内服内疏黄连汤、清热消毒饮之类，外敷柳阳散；半阴半阳证，内服托里消毒散，外敷阴阳散；纯阴证，内服补中益气汤加姜、附，入酒煎，外敷抑阴散。点瘀炉灰膏，以去恶肉，药线三品锭子，以透脓管，皆欲败腐尽除，不至侵蚀筋骨，非得已而用也。
止痛敛口免开张。
痈疽不可不痛，不可大痛。未溃前痛者为热毒，便秘，宜内疏黄连汤、解毒汤。作脓痛者，排之；脓胀痛者，针之。已溃脓出反痛者，虚也。气虚，四君子汤加当归、地黄；血虚，四物汤加人参、黄芪；气血俱虚，托里益气汤；脾虚者，托里和中汤；肾虚者，肾气丸。因登厕犯秽气触者，药中加乳香、白芷、芍药之类和之；风寒逼者，加防风、桂枝之类温散之。燥者，润之；湿者，导之。果系瘀血恶肉凝滞者，方可乳香止痛散和之。疮口不敛，由于肌肉不生；肌肉不生由于腐肉不去；腐肉不去，由于脾胃不壮、气血不旺。必以补托为主，而佐以行经活血之药，则肌肉受毒者自生；死者自溃，又何待于点割耶！大要：气虚体倦食少者，补中益气汤；血虚晡热内热者，四君子加当归、地黄、牡丹皮；脓水清稀者，气血俱虚，十全大补汤。或不痛，或赤痛。或不赤，或内脓不溃，或外肉不腐者，气血虚败，桑枝灸法，十全大补汤加姜、桂，壮其阳气，则四畔即消，疮头即腐。若脾胃虚弱，漫肿不赤者，六君子汤倍白术。若初起肿痛，或因克伐及入房，以致色黯而不痛者，乃阳脱变阴，急用古参附汤以救之。间有血分虚热者，疮口肉色必赤，四物汤加山栀、连翘；气分虚热烦渴者，竹叶黄芪汤。要知疮口难敛，或渐大渐开出血者危。俗皆以肿痕所至为晕，非真晕也。晕生于疮口之畔，状如红筋三晕，三晕尚可，四晕、五晕者死。
洗药疏通气血，脓血聚集之时，所赖朝夕暖醋蘸洗败肉，或洗毒散，肉汁汤。风冷疮口白者，干艾煎汤亦好。
膏药多热，轻小疮疖贴之即消，发表不远热之意也。若大毒初起用之，迷塞凝滞，为祸不小。惟溃后只用白蜡膏、太乙膏，或水粉膏外护，不致破伤风寒。
妇幼患此无他异，妇宜调血幼宜清。
妇人调血开郁为主。值经闭及溃后月水又发，所患坚硬，不破不肿不疼者凶。小儿主去胎毒。或有饮食积热者，药稍宜清凉。如素禀受体薄，及稍长而久病者，仍以补托气血脾胃为主治之。
杂证仍以疮为主，溃未清心要酌量。
脉证俱热者，未溃前内消解毒，已溃后托里消毒；脉证俱虚者，未溃前托里消毒，已溃后托里补中。治其疮而诸证自退。疮为本，病为标，若病急而元气实，暂治其标；病缓而元气虚，只治其本。心通诸窍，脏腑所包者一膜耳。若忧惊入心，膜破必死，药中常加茯神、远志为妙。
五善：动息自宁，饮食知味，一也；便利调匀，二也；脓溃肿消，水鲜不臭，三也；神彩精明，语音清朗，四也；体气和平，五也。此属腑证，病微邪浅，若能慎节，勿药自愈。
七恶，乃五脏亏损之证，外似有余，而内实不足。法当纯补胃气，多有可生。不可因其恶而遂弃不治。大抵元气虚弱，或脓水出多，气血亏损；或汗下失宜，荣卫消烁；或寒凉克伐，气血不足；或峻厉猛剂，胃气受伤，以致真气虚而邪气实矣。
The occurrence of carbuncle and deep-rooted sore depends on whether Qi and Blood can overcome the toxin; both internal and external causes are attributed to the coagulation of damp-heat.
Carbuncle (Yong) means obstruction, belongs to the Yang aspect, and is associated with the Six Fu Organs. The toxin moves outward, the onset is sudden and violent, the lesion is superficial, and it does not damage tendons and bones. Deep-rooted sore (Ju) means blockage, belongs to the Yin aspect, and is associated with the Five Zang Organs. The toxin attacks inward, the onset is slow, the lesion is deep-seated, and it damages tendons and erodes bones. Generally, in young and strong individuals, if Qi and Blood are strong enough to overcome the toxin, the prognosis is favorable; in elderly individuals, if the toxin overcomes the weak Qi and Blood, the condition is dangerous.
There are cases caused by internal injury from dietary accumulation of toxins. The Classic states: "Changes resulting from rich and greasy foods can give rise to large carbuncles." This is because Ying Qi (Nutritive Qi) fails to flow smoothly and rebels within the muscle tissue. Ying Qi is essentially Stomach Qi; when the Stomach is harmonious, Ying and Wei (Defensive) Qi flow smoothly, thereby nourishing the skin. Consumption of rich foods, minerals, and metals, along with wearing thick clothes and heating blankets, leads to heat accumulation in the Zang-Fu organs. Damp-heat gathers in the lower Jiao, scorching Kidney Water, causing Yin Fire to blaze, boiling the Eight Extraordinary Vessels, and stagnating the meridians. Consequently, the essence and turbidity of food and drink cannot ascend via the Yang pathways but instead rebel and gather in the interstices of muscles, forming a carbuncle.
There are cases caused by external contraction of wind-cold-dampness accumulating into toxins. The Classic states: "Dampness of the earth, when contracted, harms the skin and flesh." It also states: "Various swellings, tendon spasms, and bone pains are swellings caused by cold qi and changes due to the eight winds." Generally, wind and dampness invade externally, stagnate for a long time, transform into heat, move from the Bladder to the left, transfer heat to the Small Intestine, and then from the Small Intestine to the Gallbladder. Wind nature tends to rush upward, so the sore shape is high, red, and painful; small ones are boils (Jie), large ones are carbuncles (Yong), which differs from deep-rooted sores originating internally.
There are also cases caused by emotional depression of Heart Qi, irregular eating and drinking, overwork, excessive sexual activity, leading to exhaustion of Kidney Water and blazing Heart Fire, phlegm condensation, and Qi stagnation. This is what is meant by "Ministerial Fire can cause sores" and "All pain, itching, and sores belong to Heart Fire." Since Fire has Sovereign Fire and Ministerial Fire, sores vary in severity; some are郁 painful but not very swollen, some are vacuously swollen but not very painful. Although the etiology covers the Three Causes, they all ultimately involve damp-heat. Zhu Danxi said: "In the human body, blood flows within the vessels, and Qi flows outside the vessels, circulating endlessly. Only when cold and dampness contend will there be stagnation and slow movement; only when fire and heat contend will there be boiling and rapid movement. When Qi is constrained by pathogens, body fluids transform into phlegm and fluid retention; accumulated over time, they seep into the vessels, making the blood turbid. This is Yin stagnating in Yang, leading to carbuncle. When Blood is constrained by pathogens, the meridians may overflow or clot; accumulated over time, it overflows outside the vessels, causing Qi chaos. This is Yang stagnating in Yin, leading to deep-rooted sore." Generally, Yang Qi is formless, while Yin Blood has form; only when damp-heat boils the blood can carbuncle and deep-rooted sore manifest. Thus, the *Formulary of the Bureau of Taiping Renli Hospital* states: "Carbuncles and deep-rooted sores are all caused by heat overcoming blood." It also states: "When two types of heat contend, heat transforms into pus." Heat alone, without dampness, cannot rot the muscles into pus; for example, in summer heat, things do not rot; rotting occurs when damp-heat prevails in autumn, which is clear logic.
Pure Yang presents as red, ulcerated, and easy to heal; Pure Yin presents as dark-colored and completely painless. Half-Yin Half-Yang presents with slow swelling and pain; medication to restore Yang is necessary for survival.
Some carbuncles and deep-rooted sores heal despite being large, while others die despite being small like a bean. Yang-type onset: initially thin skin, hot, red, swollen, and painful; after ulceration, the flesh is red and lively; this is external manifestation. If accompanied by robust health, good appetite, fever, constipation, and a rapid, forceful pulse, it is Pure Yang, which is easy to treat. Yin-type onset: initially thick skin, not hot, dark-colored, slightly swollen, hard like cowhide, painless, sunken and soft, no pus formation or ulceration, slightly open; after breaking, the flesh is purple-black; this is internal manifestation. Before ulceration, the internal organs have already necrosed; accompanied by fatigue, poor appetite, no fever, normal bowel movements, and a soft, forceless pulse, it is Pure Yin, which is untreatable. There is also Half-Yin Half-Yang type: seemingly swollen but not really, seemingly painful but not really, seemingly red but not really, seemingly ulcerated but not really, with a rapid but forceless pulse. If Yang exceeds Yin, using medication to support the interior and transform into Yang leads to survival; if Yin exceeds Yang, even supporting the interior fails, and administering Yin medication leads to death. Among these, the presence or absence of fever is the crucial key to life and death. Generally, Yang syndromes with fever allow Qi and Blood to circulate and generate flesh; Yin syndromes without fever lead to Qi and Blood stagnation and failure to heal. When fever is present, one must not use cooling methods but should use warm medications to clear and drain. Minor boils without fever are not concerning.
Wind causes itching, Qi stagnation causes pain, Dampness causes swelling, Food accumulation causes heat, Cold exacerbates symptoms:
Although carbuncles and deep-rooted sores originate in one meridian or two, they often accompany Wind, Dampness, Phlegm, Qi, Blood, or Yin Deficiency patterns. Generally, for Wind, Qi, and Food patterns, the main formula is *Buhuanjin Zhengqi San* (Non-Changing Golden Spleen-Strengthening Powder) added with Chuanxiong (Rhizoma Chuanxiong) and Muxiang (Radix Aucklandiae). For accompanying Wind causing itching, add wind-dispelling herbs; for accompanying Qi causing pain, add Qi-regulating herbs; for accompanying Food accumulation causing chills and fever, add food-resolving herbs; for accompanying Dampness causing swelling, add damp-draining herbs. It is also said that heat sores are painful, deficiency sores are pale white, and wind-cold sores have white edges. Ancient formulas for external causes involving the Four Qi use equal parts of Dahuang (Rhei Radix et Rhizoma - half raw, half cooked) and Gancao Jie (Gancao joint) ground into powder; taken empty stomach with wine, one spoonful, until purgation occurs. For internal causes involving the Seven Emotions, use Yuanzhi (Radix Polygalae) ground into powder, mixed with wine, two qian taken after clarification, with dregs applied externally. For non-internal/non-external causes such as mineral drug toxicity, burns, or sexual exhaustion, use Guolao Gao. For all heat toxins, use Huaihua Jiu (Sophora Flower Wine).
Drug toxicity is hard as stone,
Mineral drug toxicity becomes hard as stone and painless; it should be resolved with decoction of Gancao (Radix Glycyrrhizae) and Heidou (Semen Sojae Nigrum Preparatum).
Deficiency, emaciation, heaviness, fear of tidal fever:
In consumptive emaciation, with obstructed Ying and Wei Qi, the affected area feels heavy as if carrying a stone, due to bone-steaming tidal fever; treatment should focus on tonification. Therefore, aromatic-drying and draining drugs like Sai Ming Dan should not be used, nor should excessive cooling drugs that stagnate the Spleen be used; Shengqi Wan (Kidney Qi Pill) and Tuoli San (Support Interior Powder) are most appropriate. Ancient texts state that drug toxicity and consumptive steaming make carbuncles extremely severe.
Near bone generates worms, near deficiency forms fistulas:
Lesions near bones are mostly cold; over time, blood transforms into worms, causing more itching than pain. Lesions near deficiency areas are mostly hot; over time, Qi transmits forming fistulas, causing more pain than itching.
Carefully identify which meridian the acupoint belongs to.
Nape carbuncle belongs to the Du Meridian and Foot-Taiyang Meridian; temple hair carbuncle belongs to Hand and Foot-Shaoyang Meridians; eyebrow carbuncle belongs to Hand and Foot-Taiyang and Shaoyang Meridians; jaw and beard carbuncle belongs to Foot-Yangming Meridian; cheek carbuncle belongs to Hand-Yangming Meridian; back carbuncle middle belongs to Du Meridian, rest to Foot-Taiyang Meridian; axillary carbuncle belongs to Hand-Taiyang Meridian; breast carbuncle internal belongs to Yangming, external to Shaoyang Meridian, nipple to Foot-Jueyin Meridian. Kidney carbuncle belongs to Foot-Taiyang Meridian; external genital carbuncle belongs to Foot-Jueyin Meridian; leg carbuncle lateral belongs to Foot-Sanyang, medial to Foot-Sanyin Meridians; throat and umbilical carbuncles belong to Ren Meridian and Foot-Yangming Meridian; perineal carbuncle involves Du, Chong, and Ren Meridians; straddle and scrotal carbuncles belong to Foot-Jueyin Meridian. Internal sores: Lung abscess belongs to Hand-Taiyin Meridian; intestinal abscess belongs to Hand-Taiyang and Yangming Meridians; gastric carbuncle belongs to Foot-Yangming Meridian. Only Shaoyang, Shaoyin, and Taiyin have abundant Qi and scarce Blood; Jueyin and Taiyang have abundant Blood and scarce Qi, making healing difficult. Only Hand and Foot-Yangming Meridians have abundant Qi and Blood. Prescribing according to meridians avoids violating meridian and disease contraindications, preventing reckless sweating or purging. Sores involving the Kidney Meridian are most severe, followed by Spleen and Lung, then others. The head is where all Yang converges, the throat is the passage for food and drink, and Shenshu and Mingmen are root connections; these are extremely dangerous areas, and moxibustion should not be used excessively. Folk prescriptions focusing on human-shaped sore patterns ignore meridians, which is erroneous!
External cold and heat should be dispersed via the exterior:
Toxins caused by external contraction, without internal stool/urine obstruction, presenting with Six Meridian symptoms, severe swelling/pain but normal diet, floating-rapid pulse, indicate pathogen in the exterior; use interior-supporting mild sweating to disperse. For nape/back lesions, use Huanglian Xiaodu San; for buttock lesions, use Neituo Qianghuo Tang; for arm lesions, use Baizhi Shengma Tang; for chest/breast lesions, use Neituo Shengma Tang; for flank lesions, use Shiwei Zhonghe Tang; for lateral leg lesions, use Neituo Jiu Jian Tang; for medial leg/knee/thigh lesions, use Neituo Chai Hu Tang. General formulas: Baidu San, Jiwei Qianghuo Tang. For cold-heat in Hand/Foot-Taiyin with spontaneous sweating, edema, flowing to limbs, use Fuzi Liuwu Tang. For warm-fever, use Shiliuwei Liuqi Yin, Sai Ming Dan. In summer, use Neituo Fujian San; in winter, use Neituo Shixuan San or Buhuanjin Zhengqi San. Zhu Danxi treated a solid constitution with floating-rapid pulse, winter dorsal red-swelling, and scapular pain using Guizhi Mahuang Gehan Tang (Cinnamon Twig and Ephedra Half-Half Decoction) added with Sheng Fuzi (Prepared Aconite Root), Jiubai (Wine-processed Phellodendron Bark), Gualou Ren (Trichosanthes Seed), Gancao Jie (Licorice Joint), Qianghuo (Notopterygium Rhizome), Qingpi (Aurantii Fructus Perforatus), Renshen (Ginseng Root), Huangqin (Scutellaria Root), Banxia (Pinellia Tuber), decocted with ginger; cured in six doses. This is the interior-supporting method. Some say carbuncle patients with body pain should not sweat; sweating causes complications only if the pathogen is not in the exterior and sweating is mistaken.
Internal heat, pain, constipation require urgent purgation:
Internal injury from dietary toxin accumulation causes abnormal swelling/pain, no external Six Meridian symptoms, internal stool/urine obstruction, thirst, irritability, deep-solid pulse, indicating pathogen in the interior; urgently use cold-cooling interior-purgatives like Neishu Huanglian Tang, Xiexin Tang, Miding Yin, Sishun Qingliang Yin. Mild cases: Qingre Xiaodu Yin added with Zicao (Arnebiae Radix), or Qingxin San. Internal heat-toxin with external contraction: use exterior-dispersing and interior-purgative methods like Wuxiang Liaoqiao Tang, Fangfeng Tongsheng San. Severe toxin: Jiedu Tang with Shenxiong Wan; severe dampness: Chushi Dan.
Labor injury and Qi stagnation have no exterior-interior distinction, pathogen is in meridians harmonizing Ying and Wei:
Toxins caused by internal injury, deficiency, sexual exhaustion, or anger/stress: although swollen/painful, no external Six Meridian symptoms, no internal stool/urine obstruction, indicating pathogen in meridians; do not recklessly sweat or purge. Tonify Qi/Blood, regulate meridians, harmonize Ying/Wei, or specifically tonify Spleen/Stomach. Anger/stress: Shiliuwei Liuqi Yin; consumption: Tuoli Xiaodu San, Neituo Fujian San, Buzhong Yiqi Tang. Ancients treating carbuncles with cold herbs is correct treatment; treating deep-rooted sores with hot herbs is contrary treatment. Hot herbs promote movement, cold herbs drain; deep-rooted sores are tangible masses, requiring hot herbs for contrary treatment to move them. This explains interior-supporting, interior-purgative, correct, and contrary treatments.
After ulceration, support interior to expel pus and toxin; once pus is gone, flesh naturally levels.
After ulceration, Qi and Blood are severely deficient, fearing toxin sinking; interior-supporting methods are essential daily. Select from ancient formulas: Tuoli San, Tuoli Qingzhong Tang, Tuoli Wenzhong Tang, Tuoli Hezhong Tang, Tuoli Jianzhong Tang, Tuoli Yiqing Tang, Tuoli Yi Huang Tang, Tuoli Yiqi Tang. Supporting interior strengthens Qi/Blood and Spleen/Stomach, allowing pus/dirt to expel, toxin to resolve, dead flesh to slough, new flesh to grow, and wound to close. Neglecting tonification/support and mistakenly using cold herbs aids evil fire, causing foul pus, potentially leading to flooding pulse, extreme thirst, Qi deficiency death. Zhu Danxi said: "If swelling/pain is seen with weak pulse/symptoms, provide tonification for safety." Do not rigidly adhere to constitutions or fear clogging from Renshen/Maidong. Only if initial ulceration has severe heat-toxin, add cooling detoxifiers moderately. For back/carbuncle crossing shoulder, if membrane breaks through heart, death is certain; strongly support interior to prevent toxin sinking (supporting interior protects Heart). If toxin attacks upward causing mental confusion/nausea, occasionally take Huxin San. If exterior pathogen with red face exists but not severe, temporarily take Neituo Fujian San or Neituo Shixuan San. If no heat-toxin/exterior pathogen, but秽气 (filth) triggers虛热 (deficiency heat), poor appetite/insomnia, immediately administer Renshen Huangqi Tang. If excessive pus, irritability, insomnia, administer Shengyu Tang. If Spleen deficiency/Qi weakness failing to generate flesh/close wound, administer Buzhong Yiqi Tang. If Kidney deficiency failing to resolve ulcer/close wound, or afternoon fever/thirst, administer Bawei Wan or Shengqi Wan. In emergencies, decoct large doses instead of pills for prevention/rescue; this is the ultimate妙剂 (miracle agent). Neglecting root treatment and relying solely on external dressings for flesh generation causes premature closure, toxin rebound, secondary carbuncles, or post-healing malignant symptoms leading to death. Prioritizing internal treatment over external is superior.
External treatment: moxibustion at onset is best:
Shape injury causes pain, Qi injury causes swelling. Pain then swelling indicates Blood injury; swelling then pain indicates Qi injury; simultaneous pain/swelling indicates both injured, all due to Zang-Fu disharmony, unadjustable by external treatment alone. Ancient methods: Garlic-separated moxibustion, Fermented Soybean cake; unsuitable for external trauma wounds. For internal onset: moxa until pain stops, or stop when pain starts; early detection and application is best. Day 1-2: 10 moxa, 10 live; Day 3-4: 10 moxa, 7 live; Day 5-6: 10 moxa, 4 live; After Day 7: moxibustion is ineffective. Other puncture/cutting/applications used sparingly for severe toxin.
Heat and pain, semi-soft: needle appropriately:
When carbuncle/toxin pus is formed, support interior to hasten pus. Once formed, assess ripeness/shallow-deep before needling. High/swollen/soft indicates Blood vessel origin; low/swollen/hard indicates tendon vessel origin; unchanged skin color indicates bone attachment. Hot to touch = pus; cold = no pus; tender to light touch = shallow pus; tender to deep pressure = deep pus; indentation remains = unformed pus; indentation rebounds = formed pus; uniformly soft = no pus; painless lump = blood tumor; painful lump = Qi tumor; soft on one side = pus. Needling before pus forms depletes Qi/Blood, hindering pus formation; not needling ripe pus deepens necrosis, hindering closure. Deep wound/shallow needle = internal pus retained, external blood lost; shallow wound/deep needle = internal pus released, healthy flesh damaged. Deficient Yuan Qi: tonify first, then needle, symptoms recede. Severe toxin with dark flesh: tonify Spleen/Stomach internally, apply single Baydou Gao externally. Let dark area lower, red area rise; in 6-7 days, cracks appear like knife cuts, dark flesh sloughs; use lance/scissors to gently remove. If pus/flesh out but pain/swelling persists, internal tendon separation likely; re-drain, urgently tonify Spleen/Stomach; if painless, pure tonification aids closure. Reckless cutting causing uncontrolled bleeding is critical danger. Lance made of horse-bit iron.
Dressing and cauterization are last resorts:
Qi/Blood disperses with warmth, coagulates with cold. Applying cold herbs generally closes pores, coagulates Qi/Blood, prevents old flesh sloughing/new flesh growth, causing toxin rebound, difficult healing, possibly death. Must differentiate Yin/Yang internally for medication, externally for dressing; internal-external attack with communicating medicinal energy is ideal. Pure Yang: internal Neishu Huanglian Tang/Qingre Xiaodu Yin; external Liuyang San. Half-Yin Half-Yang: internal Tuoli Xiaodu San; external Yinyang San. Pure Yin: internal Buzhong Yiqi Tang added with Ginger/Aconite, wine-decocted; external Yiyin San. Cauterization with Lu Hui Gao removes bad flesh; medicinal threads/Sanpin Dingzi penetrate pus tubes; all aim to remove decay without damaging bone/tendon, used only when necessary.
Pain relief and wound closure prevent gaping:
Carbuncles must hurt, but not severely. Pre-ulcer pain indicates heat-toxin; if constipated, use Neishu Huanglian Tang/Jiedu Tang. Pus-forming pain: drain; distending pus pain: needle. Post-ulcer pain upon pus discharge indicates deficiency. Qi deficiency: Sijunzi Tang added with Danggui/Dihuang; Blood deficiency: Siwu Tang added with Renshen/Huangqi; Both Qi/Blood deficiency: Tuoli Yiqi Tang; Spleen deficiency: Tuoli Hezhong Tang; Kidney deficiency: Shengqi Wan. Filth contact: add Rush Xiang/Bai Zhi/Shao Yao; Wind-Cold: add Fang Feng/Gui Zhi. Dry: moisten; Damp: guide. If stasis/bad flesh stagnation, use Rush Xiang Zhitong San. Non-healing wounds due to lack of flesh generation; lack of flesh due to retained necrotic flesh; retained necrotic flesh due to weak Spleen/Stomach/Qi/Blood. Primarily tonify/support, assist with meridian-regulating/blood-invigorating herbs; toxic flesh regenerates, dead flesh sloughs, no need for cautery/cutting. Summary: Qi deficiency/fatigue/poor appetite: Buzhong Yiqi Tang; Blood deficiency/afternoon fever/internal heat: Sijunzi added with Danggui/Dihuang/Mudan Pi; Thin pus/water: Qi/Blood deficiency, Shiquan Dabu Tang. Painless/red pain/no redness/internal pus not sloughing/external flesh not rotting: Qi/Blood exhaustion, Sang Zhi Moxibustion, Shiquan Dabu Tang added with Ginger/Cinnamon to strengthen Yang, reducing margins and rotting head. Spleen/Stomach weakness/generalized swelling/no redness: Liujunzi Tang doubled Baizhu. Initial swelling/pain due to over-treatment or sex leading to dark/painless: Yang collapse transforming to Yin, urgently use ancient Shenfu Tang. Blood deficiency heat: red wound flesh, Siwu Tang added with Zhizi/Lianqiao. Qi deficiency heat/thirst: Zhuye Huangqi Tang. Know that difficult healing or enlarging/bleeding wounds are critical. Folk mistake swelling marks for halo; true halos arise from wound edge, three red rings acceptable, four/five rings fatal.
Washing dispels toxin and invigorates Qi/Blood:
Washing herbs circulate Qi/Blood; during pus/blood accumulation, rely on morning/evening warm vinegar washing of necrotic flesh, or Xidu San, Rouzhi Tang. Wind-cold white wounds: dried Ai Ye decoction is good.
Plasters protect against wind-cold:
Plasters are mostly hot; applied to minor boils, they dissipate, following the principle "dispersing exterior is not far from heat." Applied to major toxins at onset, they cause blockage/stagnation, bringing disaster. Only after ulceration use Bai La Gao, Taiyi Gao, or Shufen Gao for protection against wind-cold injury.
Women and children have no difference, women regulate blood, children clear:
Women focus on regulating blood and resolving depression. During amenorrhea or post-ulcer menstruation recurrence, if lesion is hard, non-breaking, non-swelling, non-painful, it is ominous. Children focus on eliminating fetal toxin. Dietary heat accumulation: slightly cooling meds. Weak constitution or chronic illness: primarily tonify Qi/Blood/Spleen/Stomach.
Complications still prioritize the sore; assess mind before ulceration clears:
Hot pulse/symptoms: pre-ulcer internal detoxification, post-ulcer interior-supporting detoxification. Weak pulse/symptoms: pre-ulcer interior-supporting detoxification, post-ulcer interior-supporting tonification. Treating the sore resolves other symptoms. Sore is root, disease is branch; acute disease/strong Yuan Qi: temporarily treat branch; slow disease/weak Yuan Qi: treat root only. Heart connects orifices, enclosing organs in one membrane. If worry/fright enters Heart, membrane rupture means death; add Fushen/Yuanzhi to medication.
Five Good signs: eating well, regular bowels, fresh non-foul pus, clear voice:
Five Goods: calm movement/rest, good appetite, one; regular bowel/urine, two; pus drainage/swelling reduction, fresh non-foul water, three; bright spirit, clear voice, four; balanced body Qi, five. These are Fu organ syndromes, mild pathogen/shallow disease; if careful, self-healing without medicine.
Seven Evils all due to loss of True Qi:
Seven Evils are Five Zang deficiency syndromes, appearing excess externally but deficient internally. Method: purely tonify Stomach Qi, many can survive. Do not abandon due to evil appearance. Generally, weak Yuan Qi, excessive pus/Blood deficiency; improper sweating/purging consuming Ying/Wei; cold-draining herbs insufficient Qi/Blood; harsh agents injuring Stomach Qi, leading to True Qi deficiency and Evil Qi excess.
Restlessness, dry mouth, extreme thirst. Or diarrhea, or constipation, or dribbling,