人之脾主四肢。肝主筋。肾主骨。下部发地。三阴主之。则腰足是也。苟或劳
乏罢极。伤筋骨皮肉而风寒湿乘间入之。则腿中作疼。发于肌肉者浅。入
于筋骨者深。使复加以风药。则愈耗其阴。进以寒凉。则愈伤其气。将至于
穿溃而不可支矣。故治此患者。仍补勿泻。仍温勿寒。仍托勿敛。非比上三
痈之喜攻喜泻喜消也。如补中益气汤八珍汤八味丸。或入木瓜肉桂杜
仲牛膝等引经药。气血充裕。筋骨坚强。则易溃易敛也。若沾沾于解毒。则败矣。
治验
一男子素勤苦。犯寒湿。腿中疼痛。半月余。除湿解散药太过。腿肿成痈。叫
号不绝。余因谓曰。陈氏云此症从肾经受寒非桂附不能通关节。非羌
活防风牛膝。不能行闭滞。非参术甘草。不能使脾气达四肢。非四物红
花。不能养血活血。令恪守其法而行之。果脓溃而痊。
大防风伤
人参（二钱） 防风 白术（土炒） 附子 当归 白芍（酒炒） 川芎 杜仲（盐水炒） 黄 羌活 牛膝 熟
地（各一钱） 甘草（五分）
姜一片。水煎。
按痈属阳而外发。疽属阴而内陷。阳缓而阴危。夫人而知之矣。然阳症
过寒凉。则毒不外发而反危。阴症能温托。则毒反克化而得缓。又夫人
而知之矣。殊不知治阳症者。疏散为上。解毒继之。调补继之。勿犯苦寒。
致令倒戈。治阴症者。升托为主。温补继之。调养继之。勿过辛热。致令液
竭。余虽不与是科。间尝参观其际。见有大温大补。乃得脓成易敛。若血
脉空虚。疼痛之久者。须气血兼补。佐以养育心神。盖心主血脉。脾主肌
肉。脓血去多。必藉资养。不可一味热药以复耗之。是或一道也。
凡疮疡一科。竞执解毒之名。不论其发于何部。属于何经。或阴或阳。或
外感六淫。或内伤七情。概以解毒为辞。即用芩连花粉苦寒药。致令毒
不化而邪内伏。变异顷刻者有之。终不起发者有之。故败毒散中。惟人
参败毒散为良。不知火郁发之开之。蕴毒托之化之。血热凉之。气虚补
之。水衰益之。火衰温之。种种不同。奈何甘蹈苦寒而不悔也。
人参败毒散
人参 茯苓 羌活 独活 前胡 柴胡 桔梗 枳壳（各一钱） 川芎（八分） 甘草（五分）
水煎。挟劳役者。倍用人参。加当归芍药。
化毒饮子 治七情怫郁而发。
远志肉（甘草制） 当归 甘草节（五分） 连翘 川贝母（去心研） 金银花（二钱） 白茯神 钩藤（二钱） 牡
丹皮（各一钱）
姜一片。水煎。或加柴胡木香香附。
仙方活命饮
穿山甲（蛤粉炒黄） 白芷 防风 赤芍药 没药 甘草 当归尾 乳香 贝母 天花粉 角针 陈皮（各一钱） 金
银花（三钱）
酒煎服。
人参内托散
人参（钱半） 黄 （三钱） 当归 川芎 穿山甲 白芷 广皮（各一钱） 甘草（五分）
姜一片水煎。血虚。加熟地白芍药。脾弱。加白术茯苓。虚寒。加炮姜附子。化毒。加金银花。
加减八味丸 治疮疽发渴神效
怀熟地（八两） 山药 山茱萸（各四两） 牡丹皮 茯苓 泽泻（各三两） 五味子 肉桂（各一两）
为末。地黄和丸。薛氏书。五味用四两。恐酸收太过也。
人的脾脏主管四肢。肝脏主管筋脉。肾脏主管骨骼。身体下部接触地面，由三阴经（太阴、少阴、厥阴）所主，指的就是腰部和足部。如果因为劳累过度导致极度疲乏，损伤了筋骨皮肉，风寒湿邪就会趁机侵入，从而引起腿部疼痛。病发在肌肉层面的较浅，深入筋骨层面的则较深。此时如果再使用风药（祛风药），会更加耗伤阴液；如果进用寒凉药物，则会进一步损伤正气。最终可能导致患处穿破溃烂而难以支撑。因此治疗这类患者，应当以补益为主而非泻实，以温通为主而非寒凉，以托毒外出为主而非收敛。这与上部三种痈证喜欢攻伐、泻下、消散不同。可以使用补中益气汤、八珍汤、八味丸等方剂，或者加入木瓜、肉桂、杜仲、牛膝等引经药。待气血充盛，筋骨坚固，疮疡就容易溃破也容易愈合。如果执着于使用解毒药，就会导致病情败坏。
医案记录：
有一个男子平时勤劳刻苦，遭受寒湿侵袭，腿部疼痛，持续半个多月。之前使用的除湿解散类药物太过猛烈，导致腿部肿胀形成痈疽，患者痛苦呼叫不止。我于是对他说：“陈氏说此症是从肾经受寒所致，非桂枝、附子不能通达关节；非羌活、防风、牛膝不能通行闭滞之气；非人参、白术、甘草不能使脾气达于四肢；非四物汤加红花不能养血活血。”让他严格遵守这些法则去执行，果然脓液溃排后痊愈。
大防风汤方：
人参（二钱）、防风、白术（土炒）、附子、当归、白芍（酒炒）、川芎、杜仲（盐水炒）、黄芪、羌活、牛膝、熟地黄（各一钱）、甘草（五分）。
生姜一片，水煎服。
按语：痈属于阳证，向外发散；疽属于阴证，向内陷没。阳证相对缓和而阴证危险，这是人人都知道的道理。然而，阳证如果过用寒凉药物，则毒邪不能向外发散反而更加危险；阴证如果能用温补托毒的方法，则毒邪反而能被化解而得到缓解，这也是人人都知道的道理。殊不知治疗阳证，疏散为上策，解毒次之，调补再次之，切勿犯苦寒之戒，以免导致正气倒戈（内陷）。治疗阴证，升提托毒为主，温补次之，调养再次之，切勿过用辛热，以免导致津液枯竭。我虽然不专门从事外科，但偶尔观察其情况，发现采用大温大补的方法，才能使脓成易敛。如果血脉空虚，疼痛时间较长者，必须气血兼补，佐以养育心神。因为心主血脉，脾主肌肉，脓血流失过多，必然依赖滋养，不可一味使用热药来重新耗伤它。这或许也是一种途径。
凡是疮疡这一科，竞相执着于“解毒”的名目，不论疮发于何部位，属于何经络，是阴是阳，或是外感六淫，或是内伤七情，一概以解毒为借口。即使使用黄芩、黄连、天花粉等苦寒药物，导致毒邪不化而邪气内伏，顷刻间发生变异的有之，最终无法起发（溃破）的有之。所以败毒散中，只有人参败毒散算是良方。不知道火郁应当发散开泄，蕴毒应当托毒化解，血热应当凉血，气虚应当补气，水衰应当滋阴，火衰应当温阳，种种情况各不相同，为何要甘愿陷入苦寒而不悔改呢？
人参败毒散方：
人参、茯苓、羌活、独活、前胡、柴胡、桔梗、枳壳（各一钱）、川芎（八分）、甘草（五分）。
水煎服。伴有劳役伤者，加倍用人参，加入当归、芍药。
化毒饮子：治疗因七情怫郁而引发的疮疡。
远志肉（甘草制）、当归、甘草节（五分）、连翘、川贝母（去心研碎）、金银花（二钱）、白茯神、钩藤（二钱）、牡丹皮（各一钱）。
生姜一片，水煎服。或者加入柴胡、木香、香附。
仙方活命饮方：
穿山甲（蛤粉炒至黄色）、白芷、防风、赤芍药、没药、甘草、当归尾、乳香、贝母、天花粉、皂角刺、陈皮（各一钱）、金银花（三钱）。
酒煎服。
人参内托散方：
人参（一钱半）、黄芪（三钱）、当归、川芎、穿山甲、白芷、广陈皮（各一钱）、甘草（五分）。
生姜一片，水煎服。血虚者，加熟地黄、白芍药；脾弱者，加白术、茯苓；虚寒者，加炮姜、附子；化毒者，加金银花。
加减八味丸：治疗疮疽发作时口渴，效果显著。
怀庆熟地黄（八两）、山药、山茱萸（各四两）、牡丹皮、茯苓、泽泻（各三两）、五味子、肉桂（各一两）。
研为细末，用生地黄汁和丸。出自薛氏医书。其中五味子用量为四两，恐怕酸收太过。
The Spleen governs the four limbs. The Liver governs the sinews (tendons). The Kidney governs the bones. The lower part of the body, which contacts the ground, is governed by the Three Yin meridians (Taiyin, Shaoyin, Jueyin), referring specifically to the waist and feet. If excessive labor leads to extreme fatigue, damaging the sinews, bones, skin, and flesh, Wind-Cold-Dampness pathogens will take advantage of this vulnerability to invade, causing pain in the legs. Manifestations in the muscle layer are superficial, while those penetrating into the sinews and bones are deep. If Wind-dispelling herbs are subsequently used, Yin fluids will be further depleted; if Cold-cooling herbs are administered, Qi will be further damaged. This may eventually lead to perforation and ulceration that becomes unmanageable. Therefore, treating such patients requires tonification rather than purging, warming rather than cooling, and expelling pus/toxins outward rather than astringing. This differs from the three types of carbuncles above, which favor attacking, purging, and dissipating. Formulas such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Bazhen Tang (Eight Treasure Decoction), or Bawei Wan (Eight-Ingredient Pill) may be used, possibly with meridian-guiding herbs like Papaya (Mugua), Cinnamon Twig (Rougui), Eucommia Bark (Duzhong), and Achyranthes Root (Niuxi). When Qi and Blood are abundant and sinews and bones are strong, the lesion will easily suppurate and heal. Clinging solely to detoxification will lead to failure.
Clinical Case:
A man, accustomed to hard work, contracted Cold-Dampness, resulting in leg pain lasting over half a month. Excessive use of damp-draining and exterior-resolving medications caused his leg to swell into a carbuncle, with the patient crying out in continuous pain. I told him, "Chen states that this condition arises from Cold invading the Kidney meridian; only Cinnamon Twig (Guizhi) and Aconite (Fuzi) can unblock the joints; only Notopterygium Rhizome (Qianghuo), Saposhnikovia Root (Fangfeng), and Achyranthes Root (Niuxi) can move stagnation; only Ginseng (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), and Licorice Root (Gancao) can transmit Spleen Qi to the four limbs; only Siwu Tang (Four Substance Decoction) combined with Carthamus Flower (Honghua) can nourish and invigorate Blood." He strictly followed this method and indeed recovered after suppuration occurred.
Da Fangfeng Tang (Great Saposhnikovia Decoction):
Ginseng (2 qian), Saposhnikovia Root (Fangfeng), Atractylodes Macrocephala Rhizome (Baizhu, stir-fried with earth), Prepared Aconite Root (Fuzi), Angelica Sinensis Radix (Danggui), White Peony Root (Baishao, fried with wine), Ligusticum Chuanxiong Rhizome (Chuanxiong), Eucommia Bark (Duzhong, stir-fried with salt water), Astragalus Membranaceus Root (Huangqi), Notopterygium Rhizome (Qianghuo), Achyranthes Bidentata Root (Niuxi), Prepared Rehmannia Root (Shudihuang) (each 1 qian), Licorice Root (Gancao, 0.5 qian).
One slice of Ginger, decocted in water.
Note: Carbuncles (Yong) belong to Yang and manifest externally; sores (Ju) belong to Yin and sink internally. Yang conditions are relatively mild while Yin conditions are critical—a fact known to all. However, it is also known that if Yang conditions are treated with excessive Cold-cooling herbs, toxins cannot disperse externally and the condition worsens; conversely, if Yin conditions are treated with Warming-Tonifying methods, toxins are transformed and the condition alleviates. Yet, few realize that for Yang conditions, dispersing is primary, detoxifying is secondary, and tonifying is tertiary; one must avoid Bitter-Cold herbs to prevent internal collapse. For Yin conditions, lifting and supporting is primary, warming-tonifying is secondary, and regulating is tertiary; one must avoid excessive Pungent-Hot herbs to prevent fluid exhaustion. Although I do not specialize in surgery, observing cases reveals that major Warming and Tonifying methods facilitate easy suppuration and healing. In cases of empty blood vessels and prolonged pain, both Qi and Blood must be supplemented, assisted by nurturing the Heart-Mind. Since the Heart governs blood vessels and the Spleen governs muscles, significant loss of pus and blood necessitates nourishment; one should not use purely Hot herbs to deplete again. This may be one approach.
In the field of sores and ulcers, practitioners often rigidly adhere to "detoxification," regardless of location, meridian affiliation, Yin/Yang nature, or etiology (external Six Evils or internal Seven Emotions). They indiscriminately use Bitter-Cold herbs like Scutellaria Root (Huangqin), Phellodendron Bark (Huanglian), and Trichosanthes Root (Huafen), causing toxins to fail to transform and pathogens to hide internally. This can lead to sudden variations or failure to suppurate. Among Baidu San (Eliminate Toxin Powder) formulas, only Renshen Baidu San (Ginseng Eliminate Toxin Powder) is considered effective. One must understand that Fire-Stagnation requires dispersal; accumulated toxins require support and transformation; Blood-Heat requires cooling; Qi-Deficiency requires tonification; Water-Deficiency requires enrichment; Fire-Deficiency requires warming. These approaches vary greatly; why persist in using Bitter-Cold herbs without remorse?
Renshen Baidu San (Ginseng Eliminate Toxin Powder):
Ginseng, Poria (Fuling), Notopterygium Rhizome (Qianghuo), Angelica Dahurica Root (Duhuo), Peucedanum Root (Qianhu), Bupleurum Root (Chaihu), Platycodon Root (Jiegeng), Aurantium Fruit (Zhike) (each 1 qian), Ligusticum Chuanxiong Rhizome (Chuanxiong, 0.8 fen), Licorice Root (Gancao, 0.5 fen).
Decoct in water. For cases involving fatigue/labor, double the Ginseng and add Angelica Sinensis Radix (Danggui) and White Peony Root (Shaoyao).
Huadu Yinzi (Toxin-Transforming Drink): Treats eruptions caused by emotional depression/stagnation.
Polygala Root (Yuanzhi, processed with Licorice), Angelica Sinensis Radix (Danggui), Licorice Node (Gancao Jie, 0.5 fen), Forsythia Fruit (Lianqiao), Fritillaria Bulb (Chuanbeimu, heart removed and crushed), Honeysuckle Flower (Jinyinhua, 2 qian), Poria with Hostwood (Baifushen), Uncaria Ramulus (Gouteng, 2 qian), Moutan Cortex (Mudanpi) (each 1 qian).
One slice of Ginger, decoct in water. Optionally add Bupleurum Root (Chaihu), Aucklandia Root (Muxiang), and Cyperus Rhizome (Xiangfu).
Xianfang Huoming Yin (Immortal Formula for Preserving Life):
Pangolin Scales (Chuanshanjia, stir-fried with clam powder until yellow), Angelica Dahurica Root (Baizhi), Saposhnikovia Root (Fangfeng), Red Peony Root (Chishaoyao), Myrrh (Moyao), Licorice Root (Gancao), Angelica Sinensis Radix Tail (Dangguiwei), Frankincense (Ruxiang), Trichosanthes Root (Huafen), Soapberry Thorn (Jiaozhen), Citrus Peel (Chenpi) (each 1 qian), Honeysuckle Flower (Jinyinhua, 3 qian).
Decoct with wine.
Renshen Neituo San (Ginseng Internal Support Powder):
Ginseng (1.5 qian), Astragalus Membranaceus Root (Huangqi, 3 qian), Angelica Sinensis Radix (Danggui), Ligusticum Chuanxiong Rhizome (Chuanxiong), Pangolin Scales (Chuanshanjia), Angelica Dahurica Root (Baizhi), Tangerine Peel (Guangpi) (each 1 qian), Licorice Root (Gancao, 0.5 fen).
Decoct with one slice of Ginger. For Blood Deficiency, add Prepared Rehmannia Root (Shudihuang) and White Peony Root (Baishaoyao); for Weak Spleen, add Atractylodes Macrocephala Rhizome (Baizhu) and Poria (Fuling); for Deficient-Cold, add Roasted Ginger (Paojiang) and Aconite (Fuzi); for Detoxification, add Honeysuckle Flower (Jinyinhua).
Jiajian Bawei Wan (Modified Eight-Ingredient Pill): Highly effective for thirst during eruption of sores/carbuncles.
Huai Rehmannia Root (Huaishudihuang, 8 liang), Chinese Yam (Shanyao), Cornus Officinalis Fruit (Shanzhuyu) (each 4 liang), Moutan Cortex (Mudanpi), Poria (Fuling), Alisma Rhizome (Zexie) (each 3 liang), Schisandra Berry (Wuweizi), Cinnamon Twig (Rougui) (each 1 liang).
Grind into powder, form pills with juice of fresh Rehmannia Root. From Dr. Xue's medical texts. Note: Dr. Xue used 4 liang of Schisandra Berry, fearing excessive astringency.