先生问师曰∶痈疽之异，何重何轻。视外得内，据形知死生，以何别之。师曰∶皮肤之
深，肌肉之浅，浮虚以广，或蔓延三四，游走旁注，此则痈也。曰∶治之何先。曰∶成者
之，盛者疾之，攻内后外，三日成功。（此言痈成而有脓者，当针以泄之。热毒盛者，针以
出之。）曰∶痈之治即闻矣，疽可得闻乎。师曰∶甚哉。五脏锐毒而为疽，热蕴乎五脏而聚
，逆乎诸阳而欲越，会丹府燥，荣卫大盛而作结乎。此根于里，十之已七，毒诸外，三见其
一。小形坚本，锐若纤足，欲触摇，畏痛心脑骨。寒热以乘阳之证悉具，来者速泄阳会，败
者急救其里（泄会言灸，救里言药。）巧工如经，先时具全，未越未透，妙在揭指。（针也，
出皮肤曰越。）
问曰∶病有至甚而生，至微而死，病证唯辨，死生何从决乎。
答曰∶发背透膜者死不治（此言肝 以上。）未溃内陷，面青唇黑，便污者死。（此言脏
见瘀血。）溃喉者不治。阴入腹者不治。入囊者死。鬓深及寸者不治（谓如及寸针者。）左颐
后一寸三分毒锐者不治，无此者生，流注虽多，疗之必愈。
问曰∶针灸之法不一，何者为工。
答曰∶针固妙法，不得其旨，祸若反掌。灸亦要道，热病必亡（谓如九毒心火俱盛，而
劫之以火，于疮上而灸之则立死）。
问曰∶痈疽之病，有取乎脉否。
答曰∶圣人周知治病若合符节，非脉而何。脉之，周身安则至常衰盛迟数于此，以决生
死。病甚反迟，逆也。病痿犹数，未瘥也。迟冷数热，了然不匿。洪数紧盛，乃病之脉。病
今隆结，虽盛不畏；及濡而沉，死在七月；绵微不治。病在上焦，寸不能应，浮于皮肤者，
为痈为顺；入于肌肉者，为疽为逆。病在下焦，寸反攻盛，尺不能应，迟数顺逆尤存乎消息
。浮滑而透寸，沉实而滑坚，此金石脉也。厥阴阳明数而实，食毒也。坚牢，痈结太阴，遇
厥阴弦荣，少专经所主，以九部称之。
问曰∶五善七恶可得闻乎。
答曰∶饮食如常，一善也；实热而大小便涩，二善也；内外病相应，三善也；肌肉好恶
分明，四善也；用药如所料，五善也。发渴而喘，精明眼角向鼻，大小便反滑，一恶也；气
绵绵而脉濡，与病相反，二恶也；目中不了了，精明内陷，三恶也；未溃肉黑以陷，四恶也
；已溃青黑，腐筋骨黑，五恶也；发痰，六恶也；呕吐，七恶也。
夫人禀五行之气而生者，金木水火土是也。故分发四季有阴阳寒暑之位，顺之则风调而
气和，逆之则风乱而气悖，百病所以生也。虽人能知其理，奈缘四时之气或有乘失，故表窍
不匀，三焦壅塞，血涩肌表，致有五发痈疽之患也。发者，五脏六腑不和之所生。盖五脏主
里气，生经络而沉；六腑主表气，生经络而浮。若喜怒不常，饮食不节，阴阳不调，冷热相
干，于是脏气虚，则腠理开疏。腠理开疏，则寒邪客热于经络之间。寒气既折，则荣卫稽留
于脉。且荣者血也，卫者气也，血荣得寒则涩不行，卫气从之，与寒邪相搏，故壅遏不通；
气者阳也，阳气蕴积则生热，热则血涩，寒热不散，故积聚为痈疽。疽之状，气内攻，皮浓
强实，痹而生寒，寒久发热，寒热蓄积，故伤肉而不坏肌，肌坏则化为脓血。夫痈患属表，
骨髓不枯，易为医治。疽患属里，伤骨坏筋，则难调理。
经曰∶一寸二寸为痈，以上至一尺来许者为疽。其五发各有五色，起因瘭癌疽痼之四发
，各有颜色，惟小者为痈，所治颇为易耳。凡人才觉发作结聚，发作寒热或不寒只热之状，
疼痛肿赤，瘢痕阔硬；若过五寸以来者，或在头背，或在肢节，或不见形状者，便宜下大车
螯散；如只三寸二寸瘢痕者，只下小车螯散。如痈已破既不可用大小车螯散。今画出五发形
象颜色，图之于后。
正发论。正发者，脉洪盛，头痛发寒热，大便结，小便赤，痛彻骨筋，眼睛疼痛，如阳
证伤寒。但苦痛有形，肿赤不可近手，肿赤 长，上有如烟浆沸泼者，如粟米之白者，皆
毒心火三者所并而然也。当下大黄、犀角、生地黄汁、丝瓜汁之药与正药并行之，仍相度用
针灸，乘其未脓而攻之，得宣以不溃而愈，此上工也。渴者，无畏；大小便结赤，渴而喘，
无畏；大小便滑者，逆。善恶前论。
先生问老师道：“痈和疽的区别，哪个重、哪个轻？通过观察外部表现来推断内部情况，根据形态判断生死，该如何区分它们呢？”
老师说：“皮肤深层受病，肌肉浅层受邪，肿胀浮虚且范围广泛，或者蔓延三四寸，游走不定并旁注扩散，这就是痈。”
先生问：“治疗它应该先做什么？”
老师说：“已经成脓的要切开排脓，热毒炽盛的要用针法泄热，先攻内后治外，三天即可见效。（这里说的是痈已成且有脓的情况，应当用针刺以排出脓液。如果热毒炽盛，用针刺以引出毒邪。）”
先生问：“关于痈的治疗我已经听明白了，那么疽可以讲一讲吗？”
老师说：“太严重了。五脏的锐利毒气形成疽，热毒蕴结在五脏之中而聚集，逆乱于诸阳经而想要外越，导致丹田府库干燥，营气和卫气大盛而形成结聚。这种病根在于体内，十分之七源于内，十分之三表现为外。形体虽小但根基坚硬，尖锐如同细足，想要触碰摇动时，患者会感到心痛、脑痛、骨痛。寒热交替等阳气受损的症状全部具备，发病迅速要泄阳经之会穴，病情败坏时要紧急救治内脏（‘泄会’指艾灸穴位，‘救里’指服用药物）。高明的医生遵循经典，在疾病未完全爆发、未穿透之前进行干预，妙在手指精准操作（‘针’即针刺，‘出皮肤’称为‘越’）。”
先生问道：“有的病极其轻微却致死，有的病极其严重却能存活，病症既然已经辨别清楚，生死又该如何决断呢？”
回答说：“发背疮透穿膜膜的属于死证，无法治愈（这指的是肝脏病变波及膈膜以上）。尚未溃破而毒气内陷，面色青紫、嘴唇发黑、大便污秽的属于死证（这指的是脏腑出现瘀血）。咽喉溃烂的无法治愈。毒气侵入腹部的无法治愈。侵入阴囊的属于死证。鬓角处深达一寸的无法治愈（意思是如果像针刺入一寸深那样严重）。左侧面颊后方一寸三分处毒气尖锐严重的无法治愈，如果没有这种情况则能生存，即使流注疮很多，治疗也必定痊愈。”
先生问道：“针灸的方法不止一种，哪种算是高明的手法？”
回答说：“针刺固然是一种精妙的疗法，但如果不得其要领，灾祸就会反掌之间发生。艾灸也是重要的途径，但对于热性病必须禁止使用（例如九种毒邪、心火都旺盛的情况下，如果用火法强行劫夺，在疮上施灸则会立即死亡）。”
回答说：“圣人全面知晓治病之道，就像符节相合一样准确，不靠脉象还能靠什么呢？诊察脉象，全身安宁则脉象趋于常态，通过衰盛、迟数来判断生死。病情严重而脉象反而迟缓，这是逆证。病情虚弱而脉象仍然急促，说明病未愈。脉迟主冷，脉数主热，清晰明了不隐藏。脉象洪大、数急、紧盛，是疾病的脉象。如果病势隆起结聚，虽然脉象盛大也不可怕；如果脉象濡软而沉，预示七月后可能死亡；脉象绵软微弱则难以治愈。病在上焦，寸口脉不应，浮于皮肤表面的，为痈，属顺证；深入肌肉的，为疽，属逆证。病在下焦，寸口脉反而盛大，尺部脉不应，迟数和顺逆的变化更在于细微的观察。脉象浮滑而透达寸口，沉实而滑坚，这是金石脉（坚硬如石）。厥阴、阳明脉数而实，是食毒所致。脉象坚牢，是痈结于太阴经；遇到厥阴经弦脉反映营气状况，少阳专主经脉所主，以此九部脉象来称述。”
先生问道：“五善七恶可以讲一讲吗？”
回答说：“饮食正常，是一善；实热而大小便涩滞，是二善；内外病症相应，是三善；肌肉好坏分明，是四善；用药效果如预料之中，是五善。发热口渴而气喘，眼神精明但眼角向鼻侧塌陷，大小便反而滑泄，是一恶；气息微弱而脉象濡软，与病症相反，是二恶；眼中视物不清，眼神精明内陷，是三恶；未溃破时肉色黑且凹陷，是四恶；已溃破时颜色青黑，腐筋坏骨呈黑色，是五恶；生痰，是六恶；呕吐，是七恶。”
人禀受五行之气而生，金、木、水、火、土即是。所以分布四季有阴阳寒暑的位置，顺应它则风调气和，违背它则风乱气悖，百病因此产生。虽然人能知道这个道理，奈何四时之气有时会有乘袭或失误，导致体表窍穴不均匀，三焦壅塞，血液涩滞于肌表，从而导致五种痈疽的患害。所谓“五发”，是五脏六腑不和所产生的。大概五脏主管里气，生成经络而深沉；六腑主管表气，生成经络而浮浅。如果喜怒无常，饮食不节制，阴阳不调和，冷热相互干扰，于是脏气虚弱，腠理开疏。腠理开疏，则寒邪客居于经络之间。寒气既已折损正气，则营卫之气稽留在脉中。而且营就是血，卫就是气，血得到寒邪则涩滞不行，卫气随之，与寒邪相搏，所以壅遏不通；气属阳，阳气蕴积则生热，热则血涩，寒热不散，所以积聚形成痈疽。疽的形状，气向内攻，皮肤浓密强实，麻木而感觉寒冷，寒冷久了发热，寒热蓄积，所以损伤肌肉而不使肌肤腐烂，肌肤腐烂则化为脓血。痈患属于表证，骨髓不枯，容易医治。疽患属于里证，伤骨坏筋，则难调理。
经文说：“一寸二寸大小的为痈，以上至一尺左右的为疽。这五种发作各有五色，起因于瘭、癌、疽、痼四种发作，各有颜色，只有小的为痈，治疗颇为容易罢了。凡是人才觉得发作结聚，出现寒热或不寒只热的症状，疼痛肿赤，瘢痕宽阔坚硬；如果超过五寸以上的，或在头背，或在肢节，或不见形状的，应当立刻服用大车螯散；如果只是三寸二寸的瘢痕，只需服用小车螯散。如果痈已经破溃，就不可再用大小车螯散。现在画出五发的形象颜色，图绘在后面。”
正发论。正发者，脉象洪盛，头痛伴有寒热，大便干结，小便赤红，疼痛彻骨及筋，眼睛疼痛，如同阳证伤寒。只是苦于疼痛有形，肿赤不可触碰，肿赤生长，上面有如烟浆沸腾泼洒的样子，如有粟米般的白色脓点，这都是毒心火三者合并所致。当下大黄、犀角、生地黄汁、丝瓜汁等药物与正药并行使用，同时斟酌使用针灸，趁其未成脓时攻伐，得以宣通而不溃破即愈，这是上工（高明的医生）。口渴的，无危险；大小便结赤，口渴而气喘，无危险；大小便滑泄的，为逆证。善恶的前面已经论述过。
The master asked the teacher, "What is the difference between carbuncle (Yong) and gangrene (Ju), which is heavier and which is lighter? By observing the exterior to understand the interior, and judging life and death based on morphology, how can they be distinguished?"
The teacher said, "When the disease is deep in the skin and superficial in the muscles, swelling is floating, empty, and extensive, or it spreads three or four cun, wanders around and injects laterally, this is Carbuncle (Yong)."
The master asked, "What should be done first in treating it?"
The teacher said, "For those that have formed pus, puncture them; for those with excessive heat and toxicity, hasten their treatment with needles. Attack the interior first, then the exterior, and success will be achieved in three days. (This refers to cases where the carbuncle has formed and contains pus; one should use acupuncture to drain it. If the heat and toxicity are severe, use needles to expel the pathogenic factors.)"
The master said, "I have heard of the treatment for carbuncles; may I ask about gangrene?"
The teacher said, "It is very serious. The sharp toxicity of the five Zang organs forms gangrene; heat accumulates within the five Zang organs and gathers, reversing through the Yang meridians and attempting to emerge, causing the Danfu (Elixir Field/Dantian) to become dry, while Ying (Nutritive Qi) and Wei (Defensive Qi) become excessively abundant and form knots. This root lies in the interior, seven-tenths originating from within, and three-tenths manifesting externally. The lesion appears small but the base is firm, sharp like a fine foot; touching or shaking it causes pain in the heart, brain, and bones. Symptoms of cold and heat attacking the Yang are all present. For rapid onset, drain the Hui-meeting points of the Yang meridians; for deteriorating conditions, urgently rescue the interior ('draining Hui' refers to moxibustion, 'rescuing the interior' refers to herbal medicine). Skilled practitioners follow the classics, intervening before the disease fully erupts or penetrates; the subtlety lies in the precision of the fingers. (Acupuncture is meant here; 'exiting the skin' is called 'Yue'.)"
The master asked, "Some diseases arise from extreme severity yet lead to survival, while others arise from slight symptoms yet lead to death. Since the pathological signs are clearly identified, how is life and death determined?"
The answer was, "Back carbuncles that penetrate the membrane are fatal and incurable (this refers to Liver pathology affecting above the diaphragm). Internal collapse without ulceration, with a cyan face and black lips, and foul stool, indicates death (this refers to organ involvement with blood stasis). Ulceration of the throat is incurable. Invasion into the abdomen is incurable. Invasion into the scrotum is fatal. Toxicity at the temples penetrating an inch deep is incurable (meaning depth equivalent to an inch needle insertion). Toxicity at the sharp point one inch and three fen behind the left cheek is incurable; if absent, survival is possible. Even with numerous flowing injections, treatment will surely lead to recovery."
The master asked, "There are various methods of acupuncture and moxibustion; which one is considered skilled?"
The answer was, "Acupuncture is indeed a wonderful method, but if its essence is not grasped, disaster can occur in the flip of a hand. Moxibustion is also a crucial path, but it must be avoided in heat diseases (for example, when the nine toxins and Heart Fire are both excessive, using fire to forcibly deplete them by applying moxa directly on the sore will cause immediate death)."
The master asked, "In treating diseases like carbuncles and gangrene, is there any reliance on pulse diagnosis?"
The answer was, "The Sages knew all about treating diseases as perfectly as matching tally marks; what else but the pulse could achieve this? By palpating the pulse, if the whole body is peaceful, the pulse returns to normal; changes in fullness/emptiness, slow/fast rates determine life and death. A severe illness presenting with a slow pulse is a counter-indication (Ni). A wasting disease presenting with a rapid pulse indicates the illness is not yet resolved. Slow indicates cold, rapid indicates heat, clear and unhidden. Full, rapid, tight, and vigorous pulses are disease pulses. If the disease presents with隆起 (protrusion/knotting), even if the pulse is vigorous, there is no fear; if the pulse is soggy and deep, death may occur in seven months; a thread-like and faint pulse is untreatable. For diseases in the Upper Jiao, if the Cun position does not respond and the pulse floats on the skin, it is a Carbuncle (Shun/Favorable); if it enters the muscles, it is Gangrene (Ni/Unfavorable). For diseases in the Lower Jiao, if the Cun position reverses to be vigorous and the Chi position does not respond, the determination of slow/fast and favorable/unfavorable depends on subtle observation. Floating, slippery, and penetrating the Cun; deep, solid, slippery, and firm—these are Metal-Stone pulses. Rapid and solid Ju-Yin and Yang-Ming pulses indicate food toxicity. Firm and secure pulses indicate Carbuncle knotting in Taiyin; encountering Ju-Yin string-like Ying pulses reflects the dominance of specific meridians, described by the Nine Sections."
The master asked, "May I hear about the Five Good Signs and Seven Bad Signs?"
The answer was, "Normal diet and appetite is the First Good Sign; excess heat with difficult urination and defecation is the Second Good Sign; correspondence between internal and external symptoms is the Third Good Sign; clear distinction between healthy and unhealthy muscle tissue is the Fourth Good Sign; medication effects match expectations is the Fifth Good Sign. Fever, thirst, panting, bright eyes but sunken inner canthi, and paradoxical loose stools and urine constitute the First Bad Sign; weak breath and soggy pulse contrary to the disease state constitute the Second Bad Sign; inability to see clearly and sinking of the spirit's brightness constitutes the Third Bad Sign; pre-ulceration with black, sunken flesh constitutes the Fourth Bad Sign; post-ulceration with cyan-black color, rotting tendons, and black bones constitutes the Fifth Bad Sign; generation of phlegm is the Sixth Bad Sign; vomiting is the Seventh Bad Sign."
Humans are born endowing the Qi of the Five Elements: Metal, Wood, Water, Fire, Earth. Thus, they distribute across the four seasons with positions of Yin/Yang and Cold/Heat. Following them leads to harmonious wind and Qi; opposing them leads to chaotic wind and rebellious Qi, which is why hundred diseases arise. Although humans can understand this principle, due to occasional mishaps or overacting of the Four Seasons' Qi, the surface apertures become uneven, the Sanjiao becomes obstructed, blood becomes stagnant in the muscle surface, leading to the affliction of the Five Types of Carbuncles and Gangrenes. 'Fa' (Eruptions) are generated by disharmony among the Five Zang and Six Fu organs. Generally, the Five Zang govern interior Qi, generating meridians that sink; the Six Fu govern exterior Qi, generating meridians that float. If emotions are irregular, diet is immoderate, Yin and Yang are unbalanced, and cold and heat interfere with each other, then Zang Qi becomes deficient, and Couli (pores/skin texture) become open and sparse. When Couli are open, Cold Pathogens lodge between the meridians. Once the Cold Qi damages the Zheng Qi, Ying and Wei stagnate in the vessels. Ying is Blood, Wei is Qi; when Blood receives Cold, it becomes stagnant and fails to flow; Wei Qi follows, battling with the Cold Pathogen, thus becoming blocked and obstructed. Qi belongs to Yang; accumulated Yang Qi generates Heat; Heat causes Blood stagnation. With Cold and Heat unresolved, accumulation occurs forming Carbuncles and Gangrenes. The appearance of Gangrene involves Qi attacking internally, skin thick and strong, numbness and cold sensation; long-standing cold generates fever; accumulation of cold and heat damages flesh but does not immediately destroy muscle; once muscle is destroyed, it transforms into pus and blood. Carbuncle affections belong to the Exterior, bone marrow remains intact, making them easy to treat. Gangrene affections belong to the Interior, damaging bones and destroying tendons, making them difficult to regulate.
The Classic states: "One or two cun in size is Carbuncle; extending up to about one chi is Gangrene. Each of the Five Eruptions has its own color. Originating from the four eruptions of Biao, Ai, Ju, and Gu, each has distinct colors. Only the small ones are Carbuncles, which are relatively easy to treat. As soon as people feel the onset of nodulation, accompanied by chills and fever or just heat, pain, swelling, redness, and broad, hard scars; if exceeding five cun, whether on the head/back or limbs, or shapeless, one should immediately administer Da Che Ao San (Large Scorpion Powder); if only three or two cun of scar, administer Xiao Che Ao San (Small Scorpion Powder). If the Carbuncle has already ruptured, neither Da nor Xiao Che Ao San should be used. Now drawing the images and colors of the Five Eruptions, depicted below."
Discussion on Zheng Fa (Regular Eruption). Zheng Fa presents with a full and vigorous pulse, headache with chills and fever, constipation, dark urine, pain penetrating bones and tendons, eye pain, resembling Yang-pattern Shanghan (Cold Damage). However, the pain is tangible, swelling and redness make it intolerable to touch, swelling grows, with surfaces resembling boiling smoke-paste or white millet grains; these are caused by the combined action of Toxic Heart Fire. One should administer Rhubarb, Rhinoceros Horn, Juice of Raw Rehmannia Root, and Juice of Luffa Fruit alongside standard medications, while simultaneously assessing the use of acupuncture and moxibustion. Attacking while pus has not yet formed allows for resolution without ulceration; this is the work of a Superior Physician. Thirst alone carries no danger; constipation and dark urine with thirst and panting carry no danger; loose stools and urine indicate a counter-indication (Ni). The discussion on Good and Bad signs precedes this.