凡痈疽初起之际。未出脓时名曰肿疡。当视其虚实。用药当不致其有误。如肿而 赤
痛。其脉洪大实数。是邪之在表。宜托宜补。肿硬深痛。脉沉实大紧者。是邪之在里。宜
下之。此言表里之虚实也。外无大 肿赤痛。内则便利调匀。知邪之在经络。亦视其在何
经络。宜托里荣卫汤治之。再加何经引经药。调其荣卫。使气血行而无滞。邪气去而无痛
苦。此经络之虚实也。如精神爽朗。语声柔弱。或声嘶色暗。小便难而大便滑。脉微涩细。
面目四肢浮肿。此元气之虚弱也。饮食如故。腹满。口苦。作渴。烦躁。身热。脉大而实。
精神 愦。肿大痛。手不可近。此元气之实也。经云。诸痛为实。诸痒为虚。如脉大实洪
数紧者为实。如微细软弱涩者为虚。此脉之虚实也。经曰。虚则补之。实则泄之。即托里
宣通调荣卫之法矣。
夫溃疡者。乃痈疽已出脓后之称也。当视其虚实而治之。如脓大出。而反痛。疮口久
而不敛。发热口干。
脓水清稀。肿下软慢。脉大虚微。此疮之虚也。宜补之八珍汤。如脓稀肿硬色泽。脉沉实
大。 痛。发热烦躁。大便秘结。疮口壅实。此疮之实也。宜解毒清凉饮治之则愈。
奇经八脉者。是十二经十五络。共二十七气。相随上下。如环无端。奇经八脉。取奇
偶之意也。故圣人图设沟渠以通江海。无令水之滥溢之意也。凡人之疮疡。因气血壅塞而
生者何也。人之经络二十七气。如天地江河湖海乃周流通辄之意。一日夜行。一万三千五
百息。脉行八百一十丈。焉得有壅滞耶。凡有壅滞。是奇经八脉之所为病也。如天降滂沱
大雨。沟渠满溢。水势泛滥。不能通于湖海之理也。经云。阳维起于诸阳之会。阴维起于
诸阴之交是也。阴阳不能自相维是也。故有疮疡。如生于头面背脊者。是阳维症也。如疮
生于颐项胸腹肢股内 者。是阴维症也。凡治疮疡。必察此意。而审载于何经部位。此上
工之医也。
凡痈疽初起之时，尚未化脓的阶段称为“肿疡”。此时应当辨别其虚实证候，用药时才不会出错。如果局部红肿、灼热疼痛，脉象洪大、实而数，这是邪气在体表，适宜采用托法或补法。如果局部肿胀坚硬、疼痛深重，脉象沉取有力、大而紧，这是邪气在体内，适宜采用下法。这是在说明表里层面的虚实辨证。
如果外部没有明显的红肿热痛，内部二便通畅调和，可知邪气在经络之中，也需观察具体在哪条经络，宜用托里荣卫汤治疗，并根据所属经络加入相应的引经药，以调和营卫，使气血运行畅通无阻，邪气去除且无痛苦。这是在说明经络层面的虚实辨证。
如果患者精神清爽，但说话声音微弱，或者声音嘶哑、面色晦暗，小便困难而大便滑泄，脉象微细涩弱，面目及四肢浮肿，这是元气虚弱的表现。如果饮食正常，腹部胀满，口苦，口渴，烦躁，身体发热，脉象大而实，精神昏乱，患处肿大疼痛，手不可触碰，这是元气实证的表现。医经说：“各种疼痛多属实证，各种瘙痒多属虚证。”如果脉象大、实、洪、数、紧，属于实证；如果脉象微、细、软、弱、涩，属于虚证。这是在说明脉象的虚实辨证。医经说：“虚证则用补法，实证则用泻法”，这就是托里、宣通、调和营卫的治疗方法了。
所谓“溃疡”，是指痈疽已经破溃排脓后的阶段。此时也应当辨别虚实进行治疗。如果脓液大量排出，反而感到疼痛，疮口长久不愈合，伴有发热、口干，脓水清稀，疮周皮肤松软塌陷，脉象大、虚、微，这是疮疡的虚证，适宜用八珍汤补益。如果脓液稀少、疮周坚硬、色泽异常，脉象沉取有力、大而实，伴有疼痛、发热、烦躁，大便秘结，疮口高突壅盛，这是疮疡的实证，适宜用解毒清凉饮治疗即可痊愈。
奇经八脉，与十二正经和十五络脉共二十七气相随上下循环，如环无端。奇经八脉的名称取自“奇”（特殊）和“偶”（配对）之意。所以圣人挖掘沟渠以疏通江海，不让水流泛滥溢出。人的疮疡，是因为气血壅滞堵塞而产生的吗？人的经络中流动的二十七气，就像天地间的江河湖海一样周流不息。一昼夜呼吸一万三千五百次，脉气运行八百一十丈，怎么会有壅滞呢？凡是出现壅滞，就是奇经八脉发生病变所致。这就像天降暴雨，沟渠满溢，水流泛滥，不能通达湖海的道理一样。医经说：“阳维脉起于诸阳经交会之处，阴维脉起于诸阴经交会之处”，这就是阴阳之气不能相互维系的表现。因此产生疮疡：如果生于头面、背部脊柱者，是阳维脉的病证；如果生于颐部、颈部、胸部、腹部、大腿内侧者，是阴维脉的病证。凡是治疗疮疡，必须洞察此意，并仔细审察记载于何经部位，这才是高明的医生。
At the initial stage of any carbuncle or ulcer, before suppuration occurs, it is termed "swollen ulcer" (Zhongyang). At this time, one must distinguish between deficiency and excess syndromes to ensure correct medication. If there is swelling, redness, and burning pain, accompanied by a surging, full, and rapid pulse, this indicates pathogenic factors in the exterior; appropriate treatment involves supporting methods (Tuo) or tonification. If there is hard swelling with deep-seated pain, and a deep, full, large, and tight pulse, this indicates pathogenic factors in the interior; purgative methods are indicated. This describes the differentiation of deficiency and excess at the level of the interior and exterior.
If there is no significant external swelling, redness, or pain, and internal bowel movements and urination are regular, the pathogen is known to be in the meridians. One must determine which specific meridian is involved and treat with Toli Rongwei Decoction (Supporting Interior Nourishing Defense Decoction), adding guiding herbs for the affected meridian to harmonize Ying and Wei (Nutritive and Defensive Qi), ensuring smooth blood and Qi circulation without stagnation, thereby eliminating pathogens and relieving pain. This describes the differentiation of deficiency and excess at the level of the meridians.
If the patient appears mentally clear but speaks with a weak voice, or has hoarseness and a dull complexion, experiences difficult urination and loose stools, and presents with a faint, choppy, fine, and weak pulse, along with edema of the face, eyes, and limbs, this indicates a deficiency of Yuan Qi (Original Qi). Conversely, if appetite remains normal, yet there is abdominal distension, bitter taste in the mouth, thirst, irritability, fever, a large and full pulse, mental confusion, severe swelling and pain where the area is intolerable to touch, this indicates an excess of Yuan Qi. The Classics state: "All pain belongs to excess, all itching belongs to deficiency." A pulse that is large, full, surging, rapid, or tight indicates excess; a pulse that is faint, fine, soft, weak, or choppy indicates deficiency. This describes the differentiation of deficiency and excess based on the pulse. The Classics state: "Tonify deficiency, drain excess." This constitutes the therapeutic principles of supporting the interior, promoting unblocking, and harmonizing Ying and Wei.
The term "ulcer" refers to the stage after a carbuncle or ulcer has ruptured and discharged pus. Treatment must also be guided by the differentiation of deficiency and excess. If a large amount of pus is discharged but pain persists, the wound fails to heal for a long time, accompanied by fever, dry mouth, thin and watery pus, and soft, collapsing tissue around the swelling, with a large, deficient, and faint pulse, this is a deficiency syndrome of the ulcer; it should be treated with Buzhen Tang (Eight Treasures Decoction) for tonification. If the pus is scanty, the surrounding tissue is hard, the color is abnormal, the pulse is deep, full, large, and strong, accompanied by pain, fever, irritability, constipation, and a protruding, congested wound margin, this is an excess syndrome of the ulcer; it can be cured with Jiedu Qingliang Yin (Detoxifying Cooling Drink).
The Eight Extraordinary Vessels, together with the Twelve Regular Meridians and Fifteen Collaterals, form twenty-seven Qi pathways that circulate continuously like a ring without beginning or end. The name "Extraordinary" implies uniqueness and pairing. Thus, sages dug channels to connect rivers and seas, preventing water from overflowing. Why do sores and ulcers arise due to the congestion and blockage of Qi and Blood? The twenty-seven Qi flowing through the meridians circulate endlessly like rivers, lakes, and seas in heaven and earth. In one day and night, there are 13,500 breaths, and the pulse travels 810 zhang. How could there be stagnation? Any stagnation arises from disorders of the Eight Extraordinary Vessels. This is analogous to heavy rain filling channels until they overflow, unable to drain into lakes and seas. The Classics state: "Yang Wei Mai originates from the convergence of all Yang meridians; Yin Wei Mai originates from the intersection of all Yin meridians." This signifies the failure of Yin and Yang to mutually support each other. Therefore, sores arising on the head, face, back, and spine are symptoms of Yang Wei Mai disorder. Sores arising on the chin, neck, chest, abdomen, and inner thighs are symptoms of Yin Wei Mai disorder. In treating all sores and ulcers, one must understand this principle and carefully identify the meridian and location involved; this is the practice of a skilled physician.