内消，当审浅深大小，经络处所，形脉虚实。如脑、背、腰、项、臀、 皆太阳
经，宜黄连、羌活；脊背连胁处，为近少阳，宜败毒散；形实脉实者，宜漏芦汤、五利
大黄汤等疏利之；气虚参 为主，血虚当归、人参为主，佐以消毒，加以引经。六经分
野，各随本经标本寒温、气血多少，以行补泻，惟少阳一经，治与气血虚同法。（凡栝
蒌、射干、穿山甲、蟾酥、连翘、地丁、大力子、金银花、木鳖子之类，皆内消之药。）
外施贴药，正是发表之意。经曰∶发表不远热。大凡热得气则散，得冷则凝痛，医敷
贴冷药，岂理也哉？
疮疡作渴，不问肿溃，但脉数发热而渴，用竹叶黄 汤。不发热不渴，或脉数无力而
渴，或口干，用补中益气汤。若脉数便秘，用清凉饮。尺脉洪大，按之无力而渴，用加减
八味丸，若治口燥舌黄，饮水不渴，此丸尤妙。
《精要》曰∶渴与口干不同，不宜用丹药，镇坠，祸如反掌，惟桑枝煎、五味汤以救阳
水，甚妙。
丹溪曰∶不言食味起火，怒气生火，房劳激火，吾恐渴亦未易止也。
《精要》曰∶疮作渴甚急，与神仙追毒丸取下恶毒，清胆汤、千金漏芦汤、五香连翘
汤、六味车鳌散、万金散皆可选用。利后仍渴，却用生津补气药，津液生，气血充，渴自止。
丹溪曰∶大渴而与利药，非明示脉证，何以知其当下？后言利后仍渴，却用补药，又不
明言脉证，恐是但
有大渴必下，下后尚渴，方与补药。古人治未病，如此用药可乎？况渴属上焦，当肿疡时
犹或可用。或溃疡后渴，多因气血之虚，何待利后方议其虚也？
痈疽初发，乃气血虚，用参 以补气，归地以养血，或忍冬丸、黄 六一汤。
一人疡后发背未溃，脉数无力，此阴虚火动，用加减八味丸 咀，二剂稍缓，次用丸
剂而愈。
一人脑疽作渴，脉虽洪，按之无力，治以此药。不信，自用滋阴等药，愈盛，七恶并
至而死。
东垣云∶人病疽愈后发渴，多致不救，惟加减八味丸绝妙。盖痈疽多因虚而得，疽安
而渴者，服此丸则渴止而安，未渴者，服此丸永不渴，或未疽而先渴者，服此丸不惟渴止，
而疽亦不作。
一贵人疽未安而渴作，一日饮水数升。予用加减八味丸，诸医大笑，皆用木瓜、乌
梅、紫苏、参苓、百药煎等剂，而渴愈甚，不得已用此，三日渴止。其疾本以肾水枯竭，
心火上炎，是以生渴，此药生水降火为最，医者鉴之。
《精要》曰∶疽向安后发渴，与加减八味丸。
丹溪曰∶疽后发渴，此时气血两虚，当用参 补气，归地补血，渴者当止，何必泽
泻、茯苓，佐以肉桂，以导水耶？若忍冬丸、黄 六一汤亦为切当，忍冬养血，黄 补
气，渴何由作？（甫按∶丹溪此论，疽后发渴，气血两虚，治以参 补气，归 养血，则渴
自止，何必以桂导水，此诚确论。东垣谓疽后作渴，非八味丸莫能止。盖肾水虚而然，
非八味丸诚不能止，故其理也。至于概用八味九，不论疽后之虚，而云未疽作渴，悉能
服之，疽亦不作，恐非通论。夫何？痈疽多因积热而成。经云∶脉数不退，必作疮疡。可
见火积之久而后疽作也。予意未疽先渴，此火之象，当以解热败毒、凉血生津，则渴自止，
而疽或不作。若遽用八味丸，似非切当。且附子性悍，惟用于疽后虚热，以其从治之法为
宜。世人不知其虚，而惟以清热解渴之剂，所以东垣特激而进之之意云耳。甫恐后之医者，
执辞害意，虽于未疽之先作渴，概用附子，岂不误耶？大抵疽后作渴，远用丹溪，补养
气血甚稳当，而用之或不能效，再用八味丸以后治之，庶无剽悍之误也。）
内消法，应当审察病位的浅深、大小以及经络所在部位，辨别形证与脉象的虚实。例如脑、背、腰、项、臀部等部位，都属于太阳经（足太阳膀胱经循行区域），适宜使用黄连、羌活；脊背连接胁肋的部位，接近少阳经（足少阳胆经循行区域），适宜使用败毒散；形体壮实且脉象有力的患者，适宜使用漏芦汤、五利大黄汤等药物进行疏泄通利；气虚者以人参为主药，血虚者以当归、人参为主药，辅以消毒之品，并加入引经药。六经（太阳、阳明、少阳、太阴、少阴、厥阴）分野，各自根据本经标本的寒热属性及气血多少，施行补泻之法，唯独少阳一经的治疗原则，与气血虚损的治疗方法相同。（凡是栝蒌、射干、穿山甲、蟾酥、连翘、地丁、大力子、金银花、木鳖子这类药物，都是用于内消的药物。）
外用贴敷药物，正是为了发散表邪的意思。医经说：发散表邪不宜远离温热之性。大凡热邪遇到阳气则消散，遇到寒冷则凝结疼痛，医生如果敷贴寒凉药物，这符合医理吗？
疮疡导致口渴，不论是否肿胀或溃破，只要脉数、发热且口渴，使用竹叶石膏汤（原文“黄”后缺字，据方义补为石膏）。如果不发热不渴，或者脉数但无力且口渴，或者口干，使用补中益气汤。如果脉数且便秘，使用清凉饮。尺脉洪大，重按无力且口渴，使用加减八味丸。如果是治疗口燥舌苔黄、想喝水但不觉得渴的情况，这个丸剂尤为巧妙。
《精要》说：口渴与口干不同，不适宜使用丹药镇坠，祸患如反掌之间发生，只有用桑枝煎、五味汤来救助阳气之水，非常奇妙。
丹溪说：如果不考虑饮食口味引起的火、怒气引发的火、房劳激发的火，我恐怕口渴也不容易止住。
《精要》说：疮疡发作时口渴非常急迫，给予神仙追毒丸攻下恶毒之物，清胆汤、千金漏芦汤、五香连翘汤、六味车螯散、万金散都可以选用。通便之后仍然口渴，却改用生津补气药，津液生成，气血充盈，口渴自然停止。
丹溪说：大渴却给予泻下药，如果不是明确指示脉证，怎么知道应该攻下？后面说通便后仍然口渴，才改用补药，又不明确说明脉证，恐怕只是认为有大渴就必须攻下，攻下后仍然口渴，才给予补药。古人治未病，这样用药可以吗？况且口渴属于上焦，在肿疡阶段或许还可以使用。或者是溃疡后口渴，多是因为气血虚弱，何必等到通便后才议论其虚损呢？
痈疽初发，乃是气血虚弱，用人参来补气，当归、地黄来养血，或者使用忍冬丸、黄芪六一汤。
有一人疮疡后发背痈尚未溃破，脉数而无力，这是阴虚火动，使用加减八味丸研碎，服用两剂后稍见缓解，接着使用丸剂而痊愈。
有一人头部脑疽发作并口渴，脉象虽然洪大，但重按无力，用此药治疗。患者不信，自行服用滋阴等药物，病情加重，七恶证（中医外科危重证候）全部出现而死。
东垣说：人患疽病痊愈后发生口渴，大多导致无法救治，只有加减八味丸绝妙。大概痈疽多因虚损而得病，疽病安定后出现口渴的人，服用这个丸剂则口渴停止且身体安宁，没有口渴的人，服用这个丸剂永不口渴，或者还没有生疽却先出现口渴的人，服用这个丸剂不仅口渴停止，而且疽也不会发生。
一位权贵疽病尚未安定而口渴发作，一天饮水几升。我使用加减八味丸，其他医生大笑，都使用木瓜、乌梅、紫苏、人参茯苓、百药煎等药剂，结果口渴更加严重，不得已使用了我的药，三天后口渴停止。这个疾病本来是由于肾水枯竭，心火上炎，所以产生口渴，这个药生水降火最为有效，医者以此为鉴。
丹溪说：疽病后发生口渴，此时气血两虚，应当用人参补气，当归、地黄补血，口渴应当停止，何必用泽泻、茯苓，佐以肉桂，来引导水液呢？如果忍冬丸、黄芪六一汤也颇为恰当，忍冬养血，黄芪补气，口渴怎么会发生呢？（徐春甫按语：丹溪的这个论点，对于疽后发生口渴，认为是气血两虚，治疗用人参补气，当归养血，则口渴自然停止，何必用肉桂引导水液，这确实是确切的论述。东垣认为疽后发生口渴，非加减八味丸不能止住。大概是肾水虚损所致，非加减八味丸确实不能止住，所以他的道理是对的。至于一概使用八味丸，不论疽后是否虚损，就说未生疽时出现口渴，都能服用，疽也不会发生，恐怕不是通行的理论。为什么呢？痈疽多因积热而成。医经说：脉数不退，必定发生疮疡。可见火热积聚久了之后才会发生疽病。我认为未生疽之前先出现口渴，这是火的征象，应当使用解热败毒、凉血生津的方法，则口渴自然停止，而且疽或许不会发生。如果仓促使用八味丸，似乎不够恰当。况且附子药性猛烈，只适用于疽后虚热的情况，因为采用从治之法是适宜的。世人不知道这是虚证，而只用清热解渴的药剂，所以东垣特意激发并推荐它的意思罢了。我担心后来的医者，拘泥于言辞而损害原意，即使在未生疽之前出现口渴，一概使用附子，难道不是错误吗？大致来说，疽后发生口渴，远取丹溪的观点，补养气血非常稳妥得当，如果使用后不能见效，再用加减八味丸后续治疗，才不会有药性剽悍的错误。）
Internal resolution (Neixiao) should assess the depth and size of the lesion, its location along the meridians, and the deficiency or excess patterns manifested in the physical condition and pulse. For instance, the brain, back, waist, neck, and buttocks belong to the Taiyang Meridian (Foot-Taiyang Bladder Channel), where Huanglian (Coptidis Rhizoma) and Qianghuo (Notopterygii Rhizoma et Radix) are suitable. The area connecting the spine and back to the hypochondrium is close to the Shaoyang Meridian (Foot-Shaoyang Gallbladder Channel), making Baidu San (Detoxification Powder) appropriate. For patients with robust physique and a forceful pulse, Lulu Tang (Rhinanthi Decoction) or Wuli Dahuang Tang (Five-Advantage Rhubarb Decoction) can be used to promote drainage and purgation. In cases of Qi deficiency, Renshen (Ginseng Radix et Rhizoma) serves as the principal herb; for Blood deficiency, Danggui (Angelicae Sinensis Radix) and Renshen are primary, supplemented by detoxifying agents and guiding herbs. The six meridians (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin) each follow their respective root-and-branch cold-warm properties and the relative abundance of Qi and Blood to apply tonification or sedation methods. Only the Shaoyang meridian follows treatment principles similar to those for Qi and Blood deficiency. (Herbs such as Gualou (Trichosanthis Fructus), Shegan (Belamcandae Rhizoma), Chuanshanjia (Pangolin Scales), Chansu (Toad Venom), Lianqiao (Forsythiae Fructus), Dideng (Violaris Herba), Dalizi (Arctii Fructus), Jinyinhua (Lonicerae Japonicae Flos), and Mubiezi (Strychni Semen) are all drugs used for internal resolution.)
The external application of plasters aims to release the exterior pathogen. The Classics state: "Releasing the exterior does not distance itself from heat." Generally, heat dissipates when encountering Yang Qi but coagulates and causes pain when encountering cold. Would it be rational for physicians to apply cold medicines externally?
When sores and ulcers cause thirst, regardless of whether there is swelling or suppuration, if the pulse is rapid, accompanied by fever and thirst, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) should be used. If there is no fever or thirst, or if the pulse is rapid but weak with thirst, or only dry mouth, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is indicated. If the pulse is rapid with constipation, Qingliang Yin (Cooling Drink) is used. If the Chi pulse (Kidney position) is flooding but weak upon deep pressure, accompanied by thirst, Jiaban Bawei Wan (Modified Eight-Ingredient Pill) is prescribed. This pill is particularly effective for treating dry mouth, yellow tongue coating, and a desire to drink without actual thirst.
The *Jingyao* states: Thirst differs from dry mouth; one should not use mineral pills that suppress and sink, as disaster can strike instantly. Instead, Sangzhi Jian (Mulberry Twig Decoction) and Wuwei Tang (Five-Flavor Decoction) to nourish Kidney Water and rescue Yang are excellent.
Danxi stated: Without considering fire arising from dietary tastes, anger, or sexual exhaustion, I fear thirst will be difficult to stop.
The *Jingyao* states: When sores cause urgent thirst, Shenxian Zhuidu Wan (Immortal's Poison-Chasing Pill) can be used to purge toxic substances. Qingdan Tang (Clear Gallbladder Decoction), Qianjin Lulu Tang (Thousand-Gold Rhinanthi Decoction), Wuxiang Lianqiao Tang (Five-Aroma Forsythia Decoction), Liuwei Che'ao San (Six-Ingredient Sea-Cow Shell Powder), and Wanjin San (Ten-Thousand-Gold Powder) are also selectable options. If thirst persists after purgation, switch to herbs that generate fluids and tonify Qi. Once fluids are generated and Qi and Blood are replenished, thirst will cease naturally.
Danxi asked: If massive thirst is treated with purgatives, how can one know it is indicated without clearly stating the pulse and symptoms? Later, it says to use tonics if thirst persists after purgation, yet again without specifying pulse and symptoms. It seems the logic is simply that massive thirst requires purgation, and only if thirst remains afterward are tonics given. Is this how ancients practiced preventive treatment? Moreover, thirst belongs to the Upper Jiao (Upper Burner). Perhaps it could be used during the stage of indurated sores. However, thirst after ulceration is mostly due to Qi and Blood deficiency; why wait until after purgation to discuss deficiency?
At the initial onset of carbuncles and malignant sores, Qi and Blood are deficient. Use Renshen to tonify Qi, and Danggui and Dihuang to nourish Blood, or use Rendong Wan (Honeysuckle Pill) or Huangqi Liuyi Tang (Astragalus Six-to-One Decoction).
One patient developed a back carbuncle after a sore had healed, which had not yet suppurated. The pulse was rapid and weak, indicating Yin deficiency with floating Fire. Jiaban Bawei Wan was administered in coarse powder form. After two doses, symptoms slightly eased, followed by continued use of the pill for recovery.
Another patient with a nuchal carbuncle experienced thirst. Although the pulse was flooding, it was weak upon deep pressure, and this medication was used. The patient did not believe in it and self-medicated with Yin-nourishing herbs, causing the condition to worsen until the Seven Evil signs appeared, leading to death.
Dongyuan said: Patients who develop thirst after recovering from a carbuncle often prove incurable. Only Jiaban Bawei Wan is superb. Carbuncles and sores often arise from deficiency. For those whose carbuncles have settled but who develop thirst, taking this pill stops the thirst and brings peace. For those without thirst, taking it prevents future thirst. Even for those who experience thirst before developing a carbuncle, taking this pill not only stops thirst but may prevent the carbuncle from forming.
A nobleman developed thirst while his carbuncle was still unsettled, drinking several liters of water daily. I prescribed Jiaban Bawei Wan. Other physicians laughed, prescribing Queme (Papaveris Pericarpium), Wumei (Mume Fructus), Zisu (Perilla Folium), Renshen and Poria formulas, and Baiyaojian (Betel Nut Preparation), which exacerbated the thirst. Reluctantly, they used my prescription, and thirst ceased within three days. The disease originated from Kidney Water depletion and Heart Fire flaming upward, causing thirst. This drug generates Water and descends Fire most effectively; let physicians take note.
The *Jingyao* states: If thirst arises after a carbuncle tends toward healing, administer Jiaban Bawei Wan.
Danxi said: Thirst after a carbuncle indicates simultaneous deficiency of Qi and Blood. One should use Renshen to tonify Qi and Danggui/Dihuang to nourish Blood; thirst should then stop. Why use Ze Xie (Alismatis Rhizoma) and Fuling (Poria) assisted by Rougui (Cinnamon Bark) to guide water? Rendong Wan and Huangqi Liuyi Tang are also appropriate; Rendong nourishes Blood, and Huangqi tonifies Qi. How would thirst arise? (Xu Chunfu's commentary: Danxi’s argument that post-carbuncle thirst stems from Qi and Blood deficiency, treatable by Renshen for Qi and Danggui for Blood, thereby stopping thirst without needing Rougui to guide water, is indeed accurate. Dongyuan claimed that post-carbuncle thirst cannot be stopped except by Jiaban Bawei Wan, attributing it to Kidney Water deficiency. This reasoning holds true. However, universally applying Bawei Wan to all cases of pre-carbuncle thirst, claiming it prevents carbuncles, is not a general rule. Why? Carbuncles often result from accumulated heat. The Classics state: "If the pulse remains rapid, sores and ulcers will surely develop." Thus, prolonged accumulation of fire leads to carbuncles. I believe pre-carbuncle thirst is a sign of fire; one should use heat-clearing, toxin-resolving, blood-cooling, and fluid-generating methods to stop thirst and potentially prevent the carbuncle. Hasty use of Bawei Wan seems inappropriate. Furthermore, Fuzi (Aconiti Lateralis Radix Praeparata) is potent and suitable only for deficiency-cold after carbuncles via the method of following the false symptom. Laypeople mistake deficiency for heat, using only heat-clearing and thirst-quenching agents. Dongyuan likely emphasized Bawei Wan to counteract this error. I fear future physicians might misinterpret this and indiscriminately use Fuzi for pre-carbuncle thirst, which would be erroneous. Generally, for post-carbuncle thirst, adopting Danxi’s approach of tonifying Qi and Blood is very stable. If ineffective, one may then resort to Jiaban Bawei Wan, avoiding the risks of overly potent drugs.)