外科冠痈疽于杂病之先者，变故生于顷刻，性命悬于毫芒故也。夫痈疽之名，虽有
二十余证，而其要有二，何则？阴阳二证而已。发于阳者，为痈、为火、为实；发于阴者，
为疽、为郁、为虚。故阳发则皮薄、色赤、肿高，多有椒眼数十而痛浅；阴发则皮浓、色
淡、肿硬，状如顽肤，隐木而痛深。又有阳中之阴，似热而非热，虽肿而实虚，若亦而不
燥，欲痛而无脓，既浮而复消，外盛而内腐；阴中之阳，似冷而非冷，不肿而实，赤微
而燥，有脓而痛，外虽不盛，而内实烦闷。阳中之阴，其人多肥，肉紧而内虚；阴中之阳，
其人多瘦，肉缓而内实。而又有阳变而为阴者，草医凉剂之过也，阴变而为阳者，大方热
药之骤也。然阳变阴者，其证多，犹可返
于阳，故多生；阴变而阳者，其证少，不能复为阳矣，故多死。然间有生者，此医偶
合于法，百中得一耳。所谓发者，积于中而发于外也。大抵人之一身皆本于五脏，五
脏之气皆本于胃气，胃气为五脏之根本。故胃受谷，脾化之以生气，脾主肌肉，胃气传五脏，
而行血脉，以经络一身而昼夜一周。虽痈疽有虚实寒热，皆由气郁而成。其因有三∶内
因，外因，不内外因。内因候于人迎，人迎者，左关是也。（人迎指左关，误也。内因
当候于胃脉之人迎。胃为五脏六腑之源，故主内因也。）外因候于气口，气口者，右关
是也。（以气口专指右关，误也。两手皆为气口，经曰∶气口者，太阴也。太阴肺司
皮毛腠理，故以外因候气口明矣。）人迎、气口脉和平，则为不内不外因也。其源
有五∶一、天行时气，二、七情内郁，三、体虚外感，四、身热搏于风冷，五、食炙爆、
饮酒、服丹石等热毒。以此五者为邪气，郁于胃中，胃气盛而体实，则邪气相搏而流注
于经络，涩于所滞血脉，会聚壅结而成痈。胃气弱而体虚，则邪气盛而宿于经络，凝
滞留积，血脉不朝，内腐而成疽。故曰∶外形如粟，中可容谷；外貌如钱，里可养拳。
恶毒脓管，寸长深满；脓血胶粘，用药可痊。臭秽无丝，血败气衰；阳绝阴盛，神仙难
医。医之用，当酌其宜，量人虚实，察病冷热，推其所因，究其所原，而后治之。治内外
相应，不可一概而施治矣。如病发于阳而极热，则当有顺其气，匀其血，气顺则邪毒宣通
而不滞，血匀则血脉流动而自散。盖气为阳，血为阴，阴阳调和，病者自安。外则用凉药
而触之，热盛则气得凉而易散，不散则热已痿而血凝于凉，此阳变而阴之渐，乃坏烂
之根也。急以温凉以治，解其外，攻四围之血路，出其中间已成之脓毒，然后根据法以收
其功也。如病发于阴而极冷，则内用平补之药，以宣其气，滋其血，助其元阳，健其脾
胃，待其饮食进，精神回，然后顺气匀血如常法；外用热药以朝会一身之气血，回死
肌，拔毒瓦斯，然后用温药以散之。其极冷者，或又为凉药所误，不得已用三建而回阳，则
病必旁出再作，方为佳，此阴变为阳之候，更生之兆也。若内阳不回，外证不见，是为独阳
绝阴，不可为矣。盖阳者气也，阴者血也。阳动则阴随，气运则血行；气不运则血死，血
死则肌死，肌死则病死矣。冷证则用热药者，不过行气血也，气血遇热则行，凉则止也。虽
然，冷热之药用之固妙，尤当先乳香、豆粉救其心，护其膜。盖
心为一身之膜；为五脏之囊 ，病之初发，毒必上攻心胞络，故先呕逆而后痈疽，或
先痈疽而后呕者。胞络根于心者，苟治之不早，则心主受毒，神无守舍，元气昏瞑矣。
病之初发，毒沁膀胱、肌肉，苟治之不早，则毒瓦斯透膜，膜透则元气泄，脏腑失养，精神
枯槁，脉坏绝矣。故病至盛而生者，内见五脏而膜完全者也，亦有至微而死者，肌肉未溃
而膜先透者也。此救心护膜所以为第一义欤！是方乃遇神仙秘授，神圣工巧，不可具述，
宝之，宝之！（《青囊书》）
外科疾病之所以排在杂病之前，是因为病情变化发生在顷刻之间，性命安危系于毫发之微。痈疽的名称，虽然有二十多种证候，但其要点归结为两类，为什么呢？不过是阴证和阳证罢了。发于阳经的，称为痈、火、实；发于阴经的，称为疽、郁、虚。所以阳证发作时，皮肤薄、颜色红、肿胀高起，多有几十个像花椒眼一样的脓头，疼痛较浅；阴证发作时，皮肤厚、颜色淡、肿胀坚硬，形状像老皮一样，麻木隐痛且疼痛较深。又有阳证中夹杂阴证的，看似热象却并非真热，虽然肿胀但本质是虚，疮口湿润而不干燥，想要化脓却无脓，脉象浮取有力而重按即消，外表看似盛实则内部腐败；阴证中夹杂阳证的，看似寒象却并非真寒，不肿但实质充实，颜色微红而干燥，有脓且疼痛，外表虽不盛大，但内部实在烦闷。阳中之阴的人，大多身体肥胖，肌肉紧绷但内脏虚弱；阴中之阳的人，大多身体消瘦，肌肉松弛但内脏充实。还有阳证转变为阴证的，这是草医滥用凉药造成的过错；阴证转变为阳证的，这是医生使用大方热药过于急促造成的后果。然而阳证转阴证的情况较多，还可以逆转回阳证，所以多能存活；阴证转阳证的情况较少，不能恢复为阳证了，所以多死亡。然而间或有存活的，这是医生偶然合乎法度，百中得一罢了。所谓“发”，是指邪气积聚在体内而表现在体表。大抵人的全身都本源于五脏，五脏之气都本源于胃气，胃气是五脏的根本。所以胃受纳谷物，脾运化它来产生气，脾主肌肉，胃气传布给五脏，并运行血脉，在经络中周身循环，昼夜一周。虽然痈疽有虚实寒热之分，但都是由气机郁滞而成。其病因有三：内因、外因、不内外因。内因应在人迎脉诊察，人迎脉指的是左关脉。（注：说人迎指左关是错误的。内因应当诊察胃脉的人迎部位。胃是五脏六腑的源头，所以主管内因。）外因应在气口脉诊察，气口脉指的是右关脉。（注：以气口专指右关是错误的。两手寸口皆可称气口，经书说：气口者，太阴也。太阴肺主管皮毛腠理，所以以外因候气口是很明显的。）人迎、气口脉象平和，就是既非内因也非外因的不内外因。其病源有五种：一、天行时气（流行性传染病），二、七情内郁（情绪抑郁），三、体虚外感（体质虚弱感受外邪），四、身热搏于风冷（发热与风寒相搏），五、食用烤爆食物、饮酒、服用丹石等热毒之物。将这五种作为邪气，郁结在胃中，如果胃气旺盛且体质结实，则邪气相互搏击并流注于经络，阻滞在停滞的血脉中，汇聚壅塞结聚而成痈。如果胃气虚弱且体质亏虚，则邪气盛而留宿于经络，凝滞留积，血脉不能朝会充盈，内部腐败而成疽。所以说：外形如粟米大小，中间可容纳谷粒；外貌如铜钱大小，里面可容纳拳头。恶毒脓管，一寸长深满；脓血胶粘，用药可以痊愈。脓液臭秽无丝，血液败坏气息衰微；阳气绝灭阴气盛极，神仙也难医治。医生的治疗，应当斟酌适宜，衡量病人的虚实，察辨疾病的冷热，推究其原因，探究其本源，然后进行治疗。治疗要内外相应，不可一概而论施治。比如病发于阳而且极热，就应当顺其气机，调和其血液，气顺则邪毒宣通而不滞留，血匀则血脉流动而自然消散。盖气属阳，血属阴，阴阳调和，病人自然安康。外部则用凉药敷触，热盛则气得凉而易散，如果不散，则热已萎靡而血液凝滞在凉药中，这是阳证转为阴证的开始，乃溃烂坏死的根源。急需用温凉药配合治疗，解除外部症状，攻破四周的血路，排出中间已成形的脓毒，然后根据法则来收功。比如病发于阴而且极冷，则内部用平补的药物，以宣通气机，滋养血液，助益元阳，健旺脾胃，等到饮食进增，精神恢复，然后像常规方法那样顺气匀血；外部用热药来汇聚一身的气血，唤醒死肌，拔除毒瓦斯，然后用温药来消散它。对于极冷的情况，或者又被凉药所误，不得已使用三建汤来回阳，那么病势必然旁出再作，这才是佳兆，这是阴证转为阳证的征候，是再生的预兆。如果内部阳气不回，外部证候不见，这是独阳绝阴，就无法救治了。盖阳就是气，阴就是血。阳动则阴随，气运则血行；气不运行则血死，血死则肌肉死，肌肉死则人死亡。冷证用热药，不过是为了行气血罢了，气血遇热则行，遇凉则止。虽然如此，冷热药物的使用固然精妙，尤其应当先用乳香、豆粉来救心、护膜。盖心是一身的膜之主；也是五脏的囊袋。病之初发，毒邪必定上攻心包络，所以先呕吐逆乱而后发痈疽，或者先发痈疽而后呕吐的。心包络根于心，如果治疗不早，则心主受毒，神志无所守舍，元气昏昧了。病之初发，毒邪沁入膀胱、肌肉，如果治疗不早，则毒瓦斯透膜，膜透则元气泄漏，脏腑失去滋养，精神枯槁，脉象败坏断绝了。所以病势盛大而生存下来的，是内部五脏完好且膜完整的；也有病势微小而死亡的，是肌肉未溃破但膜先透破的。这就是救心护膜被视为第一要义的原因啊！这个方子是遇到神仙秘密传授的，神圣工巧，无法详尽叙述，珍重它，珍重它！（出自《青囊书》）
The reason why surgical diseases (Waike) are listed before miscellaneous diseases (Zabing) is that changes occur in an instant, and life hangs by a hair's breadth. Although there are more than twenty types of names for carbuncles and sores (Yongju), their essence can be summarized into two categories: Yin syndrome (Yin Zheng) and Yang syndrome (Yang Zheng). Those arising from Yang meridians are called Yong (Carbuncle), Fire, or Excess; those arising from Yin meridians are called Ju (Deep Abscess), Stagnation, or Deficiency. Thus, when a Yang lesion erupts, the skin is thin, red, and swollen high, often with dozens of pustules resembling pepper eyes, and the pain is shallow. When a Yin lesion erupts, the skin is thick, pale, and hard-swollen, resembling calloused skin, with numbness and deep, hidden pain. There is also "Yin within Yang," which appears hot but is not truly hot; although swollen, it is essentially deficient, moist rather than dry, desiring to suppurate but lacking pus, floating on superficial palpation but vanishing on deep pressure, appearing externally vigorous but internally corrupt. There is also "Yang within Yin," which appears cold but is not truly cold; not swollen but essentially solid, slightly red and dry, with pus and pain, appearing externally mild but internally vexatious and full. Patients with "Yin within Yang" are usually obese with tight flesh but internal deficiency; patients with "Yang within Yin" are usually emaciated with loose flesh but internal excess. Furthermore, Yang transforming into Yin is due to the overuse of cooling prescriptions by unskilled practitioners; Yin transforming into Yang is due to the abrupt use of large doses of heating medicines by physicians. However, cases of Yang transforming into Yin are numerous and can still revert to Yang, thus resulting in more survivals; cases of Yin transforming into Yang are rare and cannot revert to Yang, thus resulting in more deaths. Occasionally, survival occurs when a practitioner accidentally follows the correct method, one in a hundred. The term "Fa" (eruption) refers to pathogens accumulating internally and manifesting externally. Generally, the whole body originates from the Five Zang Organs (Wu Zang), whose Qi originates from Stomach Qi (Wei Qi), which is the root of the Five Zang Organs. The Stomach receives grain, the Spleen transforms it to generate Qi, the Spleen governs muscles, and Stomach Qi transmits to the Five Zang Organs, circulating blood vessels through the meridians around the body once day and night. Although carbuncles and sores have deficiencies, excesses, colds, and heats, they all result from Qi stagnation. The causes are three: Internal Causes (Nei Yin), External Causes (Wai Yin), and Non-Internal/External Causes (Bu Nei Wai Yin). Internal causes are diagnosed at the Renying pulse (Renying Mai), located at the left Guan position. (Note: Identifying Renying solely as the left Guan is incorrect. Internal causes should be diagnosed at the Renying position of the Stomach pulse, as the Stomach is the source of the Zang-Fu organs and governs internal causes.) External causes are diagnosed at the Qikou pulse (Qikou Mai), located at the right Guan position. (Note: Identifying Qikou solely as the right Guan is incorrect. Both wrists' Cun Kou positions are referred to as Qikou. The Classics state: "Qikou is Taiyin." Taiyin Lung governs skin and pores, so diagnosing external causes via Qikou is clear.) If Renying and Qikou pulses are harmonious, it indicates a Non-Internal/External Cause. The sources of pathology are five: 1. Seasonal epidemics (Tianxing Shiqi); 2. Emotional depression (Seven Emotions internal stagnation); 3. External contraction due to physical weakness; 4. Body heat clashing with wind-cold; 5. Heat toxins from roasted/fried foods, alcohol, or cinnabar/mineral pills. These five act as pathogenic factors stagnating in the Stomach. If Stomach Qi is strong and the constitution solid, pathogens clash and flow into the meridians, obstructing stagnant blood vessels, gathering and knotting to form a Yong (Carbuncle). If Stomach Qi is weak and the constitution deficient, pathogens flourish and lodge in the meridians, condensing and accumulating, causing blood vessels to fail to fill, leading to internal corruption and forming a Ju (Abscess). Therefore, it is said: externally like millet seeds, internally enough to hold grain; externally like coins, internally enough to hold a fist. Malignant pus tubes, one inch long and deep; sticky pus and blood, curable with medicine. Foul-smelling pus without threads, blood ruined and Qi exhausted; Yang exhausted and Yin excessive, even immortals cannot cure. Physicians must judge appropriateness, assess patient deficiency/excess, observe disease cold/heat, deduce causes, and investigate origins before treating. Treatment must correspond internally and externally, not applied uniformly. If a disease arises from Yang and is extremely hot, one should smooth Qi and harmonize Blood. Smoothed Qi allows pathogenic toxins to circulate freely without stagnation; harmonized Blood allows vessels to flow and disperse naturally. Qi is Yang, Blood is Yin; when Yin and Yang are harmonious, the patient recovers. Externally, apply cooling medicines. If heat is excessive, Qi disperses easily with cooling; if not dispersed, heat wanes while Blood coagulates due to cooling, marking the gradual transformation of Yang into Yin, the root of necrosis. Urgently treat with warm-cooling combinations, resolve exterior symptoms, attack blood pathways around the periphery, drain formed pus/toxins from the center, then follow protocols to complete healing. If a disease arises from Yin and is extremely cold, internally use balanced tonifying medicines to diffuse Qi, nourish Blood, assist Yuan Yang, and strengthen Spleen and Stomach. Wait for diet intake and spirit recovery, then smooth Qi and harmonize Blood as usual. Externally apply heating medicines to gather Qi and Blood throughout the body, revive dead tissue, and extract toxic vapors, then use warm medicines to dissipate them. For extreme cold, if mistakenly treated with cooling medicines, resort to Sanjian Tang (Three Jian Decoction) to restore Yang. If the condition flares up again, this is a good sign, indicating Yin transforming into Yang, a兆 of regeneration. If internal Yang does not return and external signs do not appear, it is "Solitary Yang Exhaustion, Yin Severance," which is incurable. Yang is Qi, Yin is Blood. Yang moves, Yin follows; Qi circulates, Blood flows. If Qi does not circulate, Blood dies; if Blood dies, Muscle dies; if Muscle dies, the patient dies. Cold syndromes use heating medicines merely to move Qi and Blood; Qi and Blood move with heat and stop with cold. Although the use of cold/hot medicines is subtle, one must first use Ru Xiang (Frankincense) and Dou Fen (Bean Powder) to protect the Heart and membranes. The Heart is the master of the body's membranes and the sac of the Five Zang Organs. At the onset of disease, toxins attack the Pericardium Collateral (Xin Bao Luo), causing vomiting/regurgitation before or after the carbuncle. The Pericardium Collateral roots in the Heart; if treatment is delayed, the Heart Master absorbs toxins, Spirit loses its residence, and Yuan Qi becomes confused. At onset, toxins seep into Bladder and muscles; if treatment is delayed, toxic vapors penetrate the membranes. Once penetrated, Yuan Qi leaks, Zang-Fu lose nourishment, spirit withers, and pulses fail. Thus, those who survive severe disease have intact internal Zang organs and membranes; those who die from minor disease have ruptured membranes before muscle ulceration. This is why protecting the Heart and membranes is the primary principle! This prescription was secretly transmitted by immortals, possessing divine efficacy and skill, too profound to fully describe. Treasure it, treasure it! (From *Qing Nang Shu*)