经云∶诸痛痒疮疡，皆属心火。若肿赤烦躁，发热引冷，便秘作渴，脉洪数实，是其常
也；虽在严寒之时，必用大苦寒之剂，以泻热毒。若脉细皮寒，泻利肠鸣，饮食不入，呕吐无时
，手足逆冷，是变常也；虽在盛暑之时，必用大辛温之剂，以助阳气。《内经》曰∶用寒远
寒，用热远热。有假者反之，虽违其时，必从其症。
东垣先生云∶疮疡热毒深固，呕 心逆，发热而烦，脉沉而实，肿硬木闷，大便秘结，
此毒在脏，宜疏通之。故曰∶疏通其内，以绝其源。又曰∶疮疡及诸病面赤，虽伏火热，不得妄
攻其里，而阳气拂郁，邪气在经，宜发表以去之。故曰∶火郁则发之。凡大便不通，饮食虽
多，肚腹不胀，切不可通。若腹痞胀而不通者，乃直肠干涸也，宜用猪胆汁导之。若肠胃气
虚，血涸而不通者，宜用十全大补汤培补之。若疮症属阳，或因入房伤肾而不通者，宜用前
汤加姜、附回阳，多有得生者。经云∶肾开窍于二阴。藏精于肾，津液润则大便如常。若溃
疡有此，因气血亏损，肠胃干涸，当大补为善。设若不审虚实，而一于疏利者，鲜有不误。
治验
舍亲居宾鸥，仲夏患发背，黯肿尺余，皆有小头，如铺黍状四日矣，此真气虚而邪气实
，遂隔蒜灸，服活命饮二剂，其邪顿退；乃纯补其真，又将生脉散以代茶饮，疮邪大退。余因他
往三日，复视之，饮食不入，中央肉死，大便秘结，小便赤浊，余曰∶中央肉死，毒瓦斯盛而
脾气虚也；大便不通，肠虚而不能传送；小便赤浊，脾虚而火下陷；治亦难矣。彼始云∶莫
非间断补药之过。余曰∶然。乃急用六君子加当归、柴胡、升麻，饮食渐进，大便自通；外
用乌金膏，涂中央三寸许，四围红肿渐消，中央黑腐渐去，乃敷当归膏，及地黄丸，与前
药间服，将百剂而愈。
一男子腿患痈，因服克伐，亏损元气，不能成脓，余为托里而溃，大补而敛，但大便结
燥，用十全大补汤加麦门、五味而润，月余仍结。惑于人言，乃服润肠丸，而泻不止。余用补中
益气，送四神丸，数服而止。
《内经》说：各种疼痛、瘙痒、疮疡，都归属于心火。如果患处红肿发热、烦躁不安、口渴喜冷饮、大便秘结、脉象洪大而数且有力，这是符合常理的情况；即使是在严寒的冬季，也必须使用大苦寒的药物，以泻除热毒。如果脉象细弱、皮肤寒冷、腹泻肠鸣、饮食难进、呕吐频繁、手足逆冷，这是违背常理的变证；即使是在盛夏酷暑之时，也必须使用大辛温的药物，以扶助阳气。《内经》说：使用寒凉药要避开寒气盛的季节，使用温热药要避开热气盛的季节。如果有假象出现，则相反处理，即使违背了季节时令，也必定顺从病症的实际表现。
李东垣先生说：疮疡热毒深重固结，伴有恶心呕吐、发热烦躁、脉象沉而有力、患处肿胀坚硬且麻木闷痛、大便秘结，这是毒邪在脏腑，应当疏通治疗。所以说：疏通内部，以断绝病源。又说：疮疡及其他疾病若见面部发红，虽然体内潜伏火热，但不能妄自攻下里实，因为这是阳气被郁遏，邪气在经络，应当通过发汗解表来祛除它。所以说：火邪郁结则用发散的方法。凡是导致大便不通，虽然进食很多但腹部不胀满的，切不可使用通下法。如果是腹部痞塞胀满而大便不通的，这是直肠干涸所致，适宜用猪胆汁灌肠导便。如果是肠胃气虚、血液枯竭导致的大便不通，适宜使用十全大补汤进行培补。如果疮疡症状属阳证，或者因房事损伤肾气导致的不通，适宜在前述方剂中加入生姜、附子来回阳救逆，往往能获救。《内经》说：肾开窍于前后二阴。肾藏精，津液滋润则大便正常。如果溃疡患者出现这种情况，是因为气血亏损，肠胃干涸，应当以大补为善。如果不审察虚实，一味地使用疏利通便的药物，很少有不误事的。
治验案例
我的亲戚居住在宾鸥，仲夏时节患发背疽，肿块暗红肿胀有一尺多宽，上面都有小脓头，像铺开的黍米状，已经四天了，这是真气虚弱而邪气实盛，于是采用隔蒜灸法，服用活命饮两剂，邪气顿时消退；接着纯用药物补益真气，又用生脉散代替茶饮，疮疡邪气大大减退。我因其他事情外出三天，回来复诊时，发现患者饮食不进，中央肌肉坏死，大便秘结，小便赤浊，我说：中央肌肉坏死，是毒瓦斯旺盛而脾气虚弱；大便不通，是肠道空虚而不能传导；小便赤浊，是脾虚而火邪下陷；治疗很难了。他这才说：莫非是间断服用补药的过错。我说：是的。于是急忙使用六君子汤加入当归、柴胡、升麻，饮食逐渐进服，大便自然通畅；外用乌金膏，涂抹在中央约三寸处，四周红肿逐渐消退，中央黑腐部分逐渐去除，然后敷上当归膏，以及地黄丸，与前药交替服用，大约一百剂后痊愈。
另一个男子腿部患痈疽，因为服用克伐（攻伐）药物，亏损元气，不能化脓，我为他托里透脓使其溃破，再用大补药物收敛伤口，只是大便干燥结硬，使用十全大补汤加入麦门冬、五味子以润燥，一个月后仍然结硬。被人言语迷惑，于是服用润肠丸，导致腹泻不止。我使用补中益气汤，送服四神丸，服用几剂后停止。
The *Classic of Internal Medicine* states: All pain, itching, and sores/ulcers belong to Heart Fire. If there is swelling, redness, irritability, fever with a desire for cold drinks, constipation, thirst, and a surging, rapid, and full pulse, this is the normal presentation; even in severe winter, bitter-cold agents must be used to drain heat and toxicity. If the pulse is fine, skin is cold, there is diarrhea with borborygmus, inability to eat, frequent vomiting, and cold extremities, this is an atypical variation; even in peak summer, acrid-warm agents must be used to assist Yang Qi. The *Inner Canon* says: When using cold remedies, avoid cold seasons; when using hot remedies, avoid hot seasons. However, if there are false signs, reverse this rule; although it may violate seasonal timing, one must follow the symptoms.
Mr. Li Dongyuan stated: In sores and ulcers where heat-toxicity is deep-seated and fixed, accompanied by nausea and vomiting, fever and irritability, a deep and full pulse, swollen and hard numbness, and constipation, the toxicity resides in the Zang organs, and dredging and unblocking are indicated. Thus it is said: Dredge the interior to cut off the source. It is also said: In sores, ulcers, and other diseases presenting with facial redness, although latent fire-heat exists, do not recklessly purge the interior, as this indicates Yang Qi being stifled and pathogenic factors in the meridians; release the exterior to dispel them. Thus it is said: For stifled fire, use dispersing methods. Whenever there is bowel obstruction but no abdominal distension despite heavy eating, purgatives must absolutely not be used. If there is abdominal stuffiness and distension with bowel obstruction, this is due to dryness of the large intestine; pig bile enema is appropriate. If bowel obstruction is due to deficiency of Qi in the stomach and intestines and depletion of blood, Shiquan Dabu Tang (Complete Great Tonifying Decoction) should be used to tonify. If the sore condition belongs to Yang syndromes, or if obstruction results from sexual excess damaging Kidney Qi, adding Ginger and Aconite to the aforementioned decoction to restore Yang can often save lives. The *Classic* states: The Kidney opens into the two yin orifices. The Kidneys store Essence; when fluids are moistening, bowel movements are normal. If ulcer patients present with this due to Qi and Blood depletion and intestinal dryness, major tonification is best. Failing to examine deficiency and excess, and solely using draining and lubricating methods, rarely avoids error.
Case Record
A relative of mine residing in Bin'ou suffered from a carbuncle on the back during mid-summer. The swelling was dark and measured over one chi in diameter, with multiple small heads resembling scattered millet grains, persisting for four days. This indicated deficiency of True Qi and excess of pathogenic factors. I applied garlic-partitioned moxibustion and administered Huoming Yin (Life-Saving Decoction) for two doses, after which the pathogen receded abruptly. Then, I purely tonified the True Qi, using Shengmai San (Generate the Pulse Powder) as a tea substitute, causing the sore pathogens to greatly diminish. Due to other matters, I was away for three days. Upon returning to examine him, he could not eat, the central tissue had died, he was constipated, and his urine was red and turbid. I said: Central tissue death indicates abundant toxin and Spleen Qi deficiency; constipation indicates empty intestines unable to transport; red and turbid urine indicates Spleen deficiency with sinking fire. Treatment will be difficult. He then remarked: Could this be the fault of interrupting the tonic herbs? I said: Indeed. I urgently prescribed Liujunzi Tang (Six Gentlemen Decoction) added with Angelicae Sinensis Radix (Danggui), Bupleuri Radix (Chaihu), and Cimicifugae Rhizoma (Shengma). Food intake gradually improved, and bowel movements naturally cleared. Externally, Wujin Gao (Black Gold Ointment) was applied to the central three cun area; surrounding redness and swelling gradually subsided, and central black necrosis gradually disappeared. Then, Danggui Gao (Angelica Ointment) and Dihuang Wan (Rehmannia Pill) were applied and taken alternately with the internal medicine. After approximately one hundred doses, he recovered.
Another man suffered from a boil on his leg. Because he had consumed attacking/draining medicines, his Yuan Qi was depleted, and pus failed to form. I treated him with methods to support the interior and promote suppuration until it ruptured, followed by major tonification to promote healing. However, his stool remained dry and hard. I used Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Ophiopogonis Radix (Maimendong) and Schisandrae Fructus (Wuweizi) to moisten, but after a month, it remained hard. Confused by others' advice, he took Runchang Wan (Moisten Intestine Pill), resulting in incessant diarrhea. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to deliver Sishen Wan (Four Spirit Pill); after several doses, the diarrhea stopped.