疮疡之症，脓成者，当辨其生熟浅深。肉死者，当验其腐溃连脱。丹溪先生云∶痈疽因
积毒在脏腑，当先助胃壮气为主，使根本坚固，而行经活血佐之，令其内消。余尝治脉症虚
弱者，用托里之药，则气血壮而肉不死。脉证实热者，用清热之剂，则毒瓦斯退而肉自生。凡
疮聚于筋
何死肉之有。若不大痛，或不痛，或不赤，或内脓不溃，或外肉不腐，乃气血虚弱，宜用桑
枝灸及十全大补加姜、桂，壮其阳气，则四畔即消，疮头即腐，其毒自解，又何待于针割
！若脾胃虚弱，饮食少思，用六君倍加白术，壮其荣气，则肌肉受毒者自活，已死者自溃，
已溃者自敛。若初起，或因克伐，或犯房事，以致色黯而不痛者，乃阳气脱陷，变为阴症，
急用参附汤，温补回阳，亦有可生。
治验
吴庠史邦直之内，仲夏患背疽，死肉不溃，发热痛甚，作呕少食，口干饮汤，脉洪大，
按之如无，此内真寒而外假热，当舍时从症，先用六君加炮姜、肉桂，四剂饮食顿进，诸症顿退
；复用十全大补汤仍加姜，桂之类，五十余剂而死肉溃；又五十余剂而新肉生。斯人气血充
盛，而疮易起易敛，使医者逆知，预为托里，必无此患。
疮疡之症，当察经之传受，病之表里，人之虚实，而攻补之。假如肿痛热渴，大便秘结
者，邪在内也，疏通之。肿 作痛，寒热头疼者，邪在表也，发散之。 肿痛甚者，邪在经络也
，和解之。微肿微痛而不作脓者，气血虚也，补托之。漫肿不痛，或不作脓，或脓成而不溃
者，气血虚甚也，峻补之。色黯而微肿痛，或脓成不出，或腐肉不溃者，阳气虚寒也，温补
之。若泥其未溃，而概用败毒，复损脾胃，不惟肿者不能成脓，而溃者亦难收敛。七恶之症
蜂起，多致不救。丹溪先生云∶肿疡内外皆壅，宜以托里表散为主，如欲用大黄，宁无孟浪
之非。溃疡内外皆虚，宜以托里补接为主，如欲用香散，未免虚虚之失，治者审之。
治验
一男子不慎房劳，背胛肿高三寸许，阔径尺余，自汗盗汗，内热发热，口干饮汤，脉浮
大，按之弱涩，此精虚气节为患，用十全大补加麦门、五味、山茱、山药，四剂诸症悉退。因余
他往，别用流气饮一剂，虚症悉具，肿硬如石，余仍以前药，六剂而愈。
一儒者背肿一块，按之则软，肉色如故，饮食如常，劳则吐痰体倦，此脾气虚而痰滞，
用补中益气加茯苓、半夏，少加羌活，外用阴阳散，以姜汁调搽而消。后因劳，头晕作呕，仍以
前药去羌活加生姜、蔓荆子而愈。
昆庠马进伯母，左胛连胁作痛，遣人索治。余意此郁怒伤肝脾，用六君加桔梗、枳壳、
柴胡、升麻。彼别用疮药益甚，始请治。其脉右关弦长，按之软弱，左关弦洪，按之涩滞，乃脾
土不及，肝木太过。因饮食之毒，七情之火也，遂用前药四剂，脉症悉退；再加芎、归全愈
。此等症，误用行气败毒，破血导痰，以致不起者多矣。
疮疡这类病症，脓液已经形成的，应当辨别其成熟程度以及病变部位的深浅。肌肉坏死的，应当检验其腐烂脱落的情况。丹溪先生曾说：痈疽是由于毒素积聚在脏腑所致，治疗时应当以扶助胃气、强壮正气为主要原则，使人体根本坚固，再辅以行经活血的药物，促使毒邪从内部消散。我曾经治疗脉象和症状表现为虚弱的患者，使用托里透脓的药物，则气血壮盛而肌肉不会坏死。脉象和症状表现为实热的患者，使用清热的方剂，则毒邪退去而肌肉自然生长。凡是疮疡聚集在筋骨之间，哪里会有死肉呢？如果疼痛不明显，或者不痛，或者局部不发红，或者内部脓液不溃破，或者外部肌肉不腐烂，这是气血虚弱所致，适宜采用桑枝灸法，并服用十全大补汤加入生姜、肉桂，以壮旺阳气，那么疮疡四周的肿胀就会消退，疮头就会腐烂，毒邪自然解除，又何必等待针割手术呢！如果脾胃虚弱，饮食减少且没有食欲，使用六君子汤加倍白术，以壮旺营气，那么受毒侵袭的肌肉自然会存活，已经坏死的肌肉自然会溃破，已经溃破的疮口自然会愈合。如果是疾病初起，或者因为误用攻伐药物，或者因房事不慎，导致患处颜色暗黑且不疼痛，这是阳气脱陷，转变为阴证，急需使用参附汤，温补回阳，也有痊愈的可能。
治验案例：
吴庠史邦直的夫人，在仲夏时节患背疽，死肉不溃烂，发热且疼痛剧烈，伴有呕吐、食欲不振，口干想喝热汤，脉象洪大，但重按却感觉空虚无力，这是内里真寒而外表假热，应当舍弃季节因素而从症状论治，先使用六君子汤加入炮姜、肉桂，服用四剂后饮食突然增进，各种症状迅速消退；接着再次使用十全大补汤，仍然加入姜、桂等药，服用五十多剂后死肉溃破；又服用五十多剂后新肉生长。这位患者气血充盛，所以疮疡容易起发也容易收敛，如果医生能预先知晓病情，提前进行托里治疗，必然不会有这种祸患。
疮疡这类病症，应当观察经络的传变情况、病位的表里属性、人体的虚实状态，从而决定攻邪或补益。假如出现肿痛、发热、口渴、大便秘结等症状，说明邪气在体内，应当疏通排泄。假如肿胀发作疼痛，伴有恶寒、发热、头痛等症状，说明邪气在体表，应当发散解表。假如肿痛严重，说明邪气在经络，应当和解调理。假如轻微肿胀疼痛且不化脓，说明气血虚弱，应当补益托毒。假如漫肿无定形且不痛，或者不化脓，或者脓成但不溃破，说明气血极度虚弱，应当峻猛补益。假如患处颜色暗黑且轻微肿痛，或者脓成但不排出，或者腐肉不溃破，说明阳气虚寒，应当温补。如果拘泥于疮疡未溃这一阶段，一概使用败毒药物，反而会损伤脾胃，不仅肿胀处不能化脓，而且已经溃破的疮口也难以收敛。七恶证候蜂拥而起，大多导致无法救治。丹溪先生说：肿疡（未溃之疮）内外皆壅滞，应当以托里透脓、发表散邪为主，如果想要使用大黄，恐怕会有鲁莽之嫌。溃疡（已溃之疮）内外皆虚损，应当以托里补接为主，如果想要使用香燥发散之品，未免有虚其虚的错误，治疗者务必审慎。
治验案例：
一名男子不慎房劳过度，背部肩胛处肿胀高三寸左右，宽度有一尺多，自汗盗汗，内热发热，口干想喝热汤，脉象浮大，重按弱涩，这是精气亏虚、气机阻滞导致的病患，使用十全大补汤加入麦门冬、五味子、山茱萸、山药，服用四剂后各种症状全部消退。因为我其他事务外出，他人改用流气饮一剂，导致虚症全部显现，肿块坚硬如石，我仍用之前的药物，服用六剂后痊愈。
一位儒生背部肿胀一块，按压时柔软，皮肤颜色如常，饮食正常，劳累后则吐痰、身体疲倦，这是脾气虚弱而痰湿停滞，使用补中益气汤加入茯苓、半夏，少量加入羌活，外用阴阳散，用姜汁调匀涂抹而消散。后来因劳累，出现头晕呕吐，仍用之前的药物去掉羌活，加入生姜、蔓荆子而痊愈。
昆庠马进伯的母亲，左侧肩胛连及胁部疼痛，派人来求治。我推测这是郁怒伤及肝脾，使用六君子汤加入桔梗、枳壳、柴胡、升麻。她之前使用了其他疮科药物导致病情加重，这才请我诊治。她的脉象右关部弦长，重按软弱，左关部弦洪，重按涩滞，这是脾土不足，肝木太过。这是由于饮食之毒和七情之火所致，于是使用前面的药物四剂，脉象和症状全部消退；再加入川芎、当归，完全痊愈。这类病症，误用行气败毒、破血导痰的方法，导致死亡的情况很多。
The condition of sores and ulcers (Chuang Yang), when pus has formed, requires differentiation based on the maturity of the pus and the depth of the lesion. For necrotic flesh (Si Rou), one must examine whether it is rotting and detaching. Mr. Danxi stated: Carbuncles and furuncles (Yong Ju) are caused by accumulated toxins in the Zang-Fu organs. Treatment should primarily focus on supporting the Stomach Qi and strengthening vital energy (Zheng Qi), thereby solidifying the root, assisted by herbs that promote circulation in the meridians and invigorate blood, allowing the toxin to dissipate internally. I have treated patients with weak pulse and symptoms using formulas for supporting the interior (Tuo Li), resulting in strengthened Qi and Blood, preventing flesh necrosis. For those with excess-heat patterns indicated by pulse and symptoms, I used heat-clearing formulas, which caused the toxic factors to retreat and allowed flesh to regenerate naturally. Wherever sores gather around tendons and bones, how could there be dead flesh? If there is little pain, no pain, or lack of redness, or if internal pus does not ulcerate, or external flesh does not rot, this indicates deficiency of Qi and Blood. It is appropriate to use moxibustion with mulberry branches and administer Shiquan Dabu Tang (Complete and Sufficient Great Tonifying Decoction) added with Ginger and Cinnamon Twig to strengthen Yang Qi. Consequently, swelling at the periphery will subside, the sore head will slough off, and the toxin will resolve spontaneously, without awaiting needle incision! If the Spleen and Stomach are weak, with reduced appetite and desire for food, use Liujunzi Tang (Six Gentlemen Decoction) with doubled Atractylodis Macrocephalae Rhizoma (Baizhu) to strengthen Ying Qi. Then, flesh affected by toxins will survive, necrotic flesh will ulcerate, and open sores will heal. If at the onset, due to improper use of purgatives or sexual indiscretion, the area becomes dark and painless, this indicates collapse and sinking of Yang Qi, transforming into a Yin syndrome. Urgently use Shenfu Tang (Ginseng and Aconite Decoction) to warm, tonify, and restore Yang; recovery is possible.
Clinical Case 1:
The wife of Shi Bangzhi from Wu Xiang suffered from a back carbuncle in midsummer. The necrotic flesh did not ulcerate, accompanied by fever and severe pain, vomiting, poor appetite, dry mouth desiring hot drinks, and a surging pulse that felt empty upon deep pressure. This presented as true cold internally with false heat externally. One should disregard the season and treat according to symptoms. Initially, Liujunzi Tang was administered with roasted Ginger and Cinnamon Twig. After four doses, appetite suddenly improved, and all symptoms receded rapidly. Subsequently, Shiquan Dabu Tang (Complete and Sufficient Great Tonifying Decoction) was continued with Ginger and Cinnamon Twig. After more than fifty doses, the necrotic flesh ulcerated; after another fifty doses, new flesh grew. This patient had abundant Qi and Blood, so the sore easily raised and healed. Had the physician anticipated this and pre-emptively supported the interior, such complications would have been avoided.
In treating sores and ulcers, one must observe the transmission through meridians, the location of the disease (exterior or interior), and the constitution of the person (deficiency or excess) to decide between attacking pathogens or tonifying deficiencies. For example, if there is swelling, pain, heat, thirst, and constipation, the pathogen is inside; it should be unblocked and drained. If swelling arises with pain, aversion to cold, fever, and headache, the pathogen is on the exterior; it should be dispersed and released. If swelling and pain are severe, the pathogen is in the meridians; it should be harmonized. If there is slight swelling and pain without suppuration, it indicates Qi and Blood deficiency; it should be tonified and supported to expel toxins. If there is diffuse swelling without pain, or failure to suppurate, or pus formation without ulceration, it indicates severe Qi and Blood deficiency; it requires vigorous tonification. If the color is dark with slight swelling and pain, or pus forms but does not discharge, or necrotic flesh does not slough, it indicates Yang deficiency and cold; it should be warmed and tonified. If one rigidly adheres to the stage before ulceration and indiscriminately uses detoxifying drugs, it further damages the Spleen and Stomach. Not only will swelling fail to suppurate, but already ulcerated sores will also struggle to heal. The "Seven Evils" syndromes may arise simultaneously, often leading to untreatable conditions. Mr. Danxi stated: For sores and ulcers before ulceration (Zhongyang), where both interior and exterior are obstructed, treatment should primarily focus on supporting the interior and dispersing the exterior. If one wishes to use Rheum Radix et Rhizoma (Dahuang), it risks being rash. For ulcers after rupture (Kuangyang), where both interior and exterior are deficient, treatment should primarily focus on supporting the interior and reconnecting tissues. If one wishes to use aromatic dispersants, it inevitably leads to the error of further depleting the deficient. Physicians must exercise caution.
Clinical Case 2:
A man suffered from excessive sexual activity, resulting in swelling on his back shoulder blade about three cun high and over one chi wide. He experienced spontaneous sweating and night sweats, internal heat and fever, dry mouth desiring hot drinks, and a floating-superficial pulse that was weak and choppy upon deep pressure. This was caused by essence deficiency and Qi stagnation. I prescribed Shiquan Dabu Tang (Complete and Sufficient Great Tonifying Decoction) added with Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), Corni Fructus (Shanzhuyu), and Dioscoreae Rhizoma (Shanyao). After four doses, all symptoms subsided. Due to my absence, another practitioner administered Liuqi Yin (Flowing Qi Drink) for one dose, causing all deficiency symptoms to manifest, with the swelling becoming hard as stone. I resumed the previous prescription, and he recovered after six doses.
Clinical Case 3:
A scholar had a single swelling on his back. It was soft upon pressure, with normal skin color and diet. However, fatigue induced phlegm expectoration and body weakness. This indicated Spleen Qi deficiency with phlegm stagnation. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Poria Sclerotium (Fuling) and Pinelliae Tuber (Banxia), with a small amount of Notopterygii Rhizoma et Radix (Qianghuo). Externally, Yinyang San was applied mixed with ginger juice, leading to resolution. Later, due to fatigue, he developed dizziness and vomiting. I used the same formula, removing Qianghuo and adding Zingiberis Rhizoma Recens (Shengjiang) and Viticis Trifoliate Fructus (Manjingzi), resulting in recovery.
Clinical Case 4:
The mother of Ma Jinbo from Kun Xiang complained of pain extending from the left shoulder blade to the hypochondrium. She sent someone to request treatment. I suspected this was Liver and Spleen injury due to suppressed anger, and prescribed Liujunzi Tang (Six Gentlemen Decoction) added with Platycodonis Radix (Jiegeng), Aurantii Fructus (Zhiqiao), Bupleuri Radix (Chaihu), and Cimicifugae Rhizoma (Shengma). She had previously used other topical sore remedies, worsening her condition, before seeking my care. Her pulse was wiry and long at the right Guan position, feeling weak upon pressure, and wiry and surging at the left Guan position, feeling choppy upon pressure. This indicated insufficient Spleen Earth and excessive Liver Wood. The cause was toxicity from diet and fire from emotional disturbances. I used the aforementioned prescription for four doses, after which the pulse and symptoms completely receded. Then, Chuanxiong Rhizoma (Chuanxiong) and Angelicae Sinensis Radix (Danggui) were added, leading to full recovery. Many such cases have proven fatal due to the mistaken use of Qi-moving, detoxifying, blood-breaking, and phlegm-draining methods.