疮疡之症，毒瓦斯已成者，宜用托里以速其脓。脓成者，当验其生熟深浅而针之。若肿高
而软
按方痛者，脓深也。按之而不复起者，脓未成也。按之而复起者，脓已成也。脓生而用针，
气血既泄，脓又难成。若脓熟而不针，腐溃益深，疮口难敛。若疮深而针浅，内脓不出，外
血反泄。若疮浅而针深，内脓虽出，良肉受伤。若元气虚弱，必先补而后针，其脓一出，诸
症自退。若脓出而反痛，或烦躁呕逆，皆由胃气亏损，宜急补之。若背疮热毒炽盛，中央肉
黯，内用托里，壮其脾胃；外用乌金膏，涂于黯处，其赤处渐高，黯处渐低，至六七日间，
赤黯分界，自有裂纹，如刀划然，黯肉渐溃矣，当用 针利剪，徐徐去之，须使不知疼痛，
不见鲜血为妙。虽有裂纹，脓未流利，及脓水虽出而仍痛者，皆未通于内，并用针于纹中引之。
患于背胛之间，肉腐脓出，肿痛仍作，此内有毒筋间隔脓未通耳，尤宜引之。若元气虚弱，
误服克伐，患处不痛，或肉将死，急温补脾胃，亦有生者。后须纯补之药，庶可收敛。若妄
用刀针，去肉出血，则气无所根据附，气血愈虚，元气愈伤矣，何以生肌收敛乎？
疮疡作呕，不可泥于毒瓦斯内攻，而概用败毒等药。如热甚 痛，邪气实也，仙方活命饮
解之。作脓 痛，胃气虚也，托里消毒散补之。脓熟胀痛，气血虚也，先用托里散，后用针
以泄
食而呕者，托里益中汤。中虚寒淫而呕者，托里温中汤。肝木乘脾土而呕者，托里抑青汤。
胃脘停痰而呕者，托里清中汤。脾虚自病而呕者，托里益黄汤。郁结伤脾而呕者，托里越鞠
汤。若不详究其源，而妄用攻毒之药，则肿者不能溃，溃者不能敛矣。丹溪虽曰∶肿疡时呕
，当作毒瓦斯攻心治之。溃疡时呕，当作阴虚补之。殊不知此大概言之耳，即《内经》诸痛痒疮
，皆属心火之意。况今之热毒内攻而呕者寡，脾胃虚寒而呕者多，岂可执前圣之言，而药今
治验
进士张德泓背疽，微肿微赤，饮食少思，余用六君等药，脓成而溃；再用大补阳气之类
，肉
胃气虚惫，非疮毒也。彼云∶果因侵晨登厕，闻秽气始作，信夫，先生胃虚之说也。用托补
一男子腹患痈，肿硬不溃，乃阳气虚弱；呕吐少食，乃胃气虚寒；法当温补脾胃。假如
肿赤
胃气，或感寒邪秽气而呕者，虽肿疡，犹当助胃壮气。彼不信，仍服攻伐药，而果殁。
疮疡这类病症，如果毒邪已经形成脓液，应当使用托里法来加速脓液的成熟。脓液已经形成的，应当根据脓液的深浅和成熟程度进行针刺引流。如果患处肿胀高起且质地柔软，按压时疼痛范围局限在指下，说明脓液位置较深。如果按压后凹陷不复起，说明脓液尚未形成。如果按压后迅速回弹，说明脓液已经形成。如果在脓液未生时使用针具，会导致气血泄泻，反而使脓液难以生成。如果脓液已熟却不进行针刺，腐溃会加深，疮口难以愈合。如果疮口深而针刺浅，内部的脓液排不出，外部的血液反而流出。如果疮口浅而针刺深，虽然内部脓液能排出，但会损伤健康的肌肉组织。如果患者元气虚弱，必须先进行补益治疗后再行针刺，这样脓液一旦排出，各种症状自然消退。如果脓液排出后反而疼痛，或者出现烦躁、恶心呕吐，这都是因为胃气亏损，应当紧急进行补益。如果是背部疮疡热毒炽盛，中央部位肌肉颜色暗黑，内服托里药以强壮脾胃；外用乌金膏涂抹在暗黑处，红色部位逐渐高起，暗黑部位逐渐降低，到六七天左右，红黑分界处自然出现裂纹，像刀划一样，暗黑肌肉逐渐溃烂，此时应当用锋利的剪刀慢慢去除，最好做到患者不知疼痛、不见鲜血为妙。即使有裂纹，如果脓液流出不畅，以及脓水虽出但仍疼痛的，都是内部脓液未通，应当用针在裂纹中引导引流。患处在背胛之间，肌肉腐烂脓液流出，肿痛仍然发作，这是内部有毒筋阻隔，脓液未通，尤其需要引导引流。如果元气虚弱，误服了克伐（攻伐）药物，患处不痛，或者肌肉即将坏死，应当紧急温补脾胃，也有治愈的可能。之后必须使用纯补的药物，才可以收敛愈合。如果妄用刀针，切除肌肉导致出血，那么气就无所依附，气血更加虚弱，元气更加受损，怎么能促进生肌收敛呢？
疮疡出现呕吐症状，不能拘泥于毒邪内攻的说法，而一概使用败毒等药物。如热毒严重且疼痛剧烈，属于邪气实证，用仙方活命饮来解毒。正在化脓且疼痛，属于胃气虚，用托里消毒散来补益。脓液成熟且胀痛，属于气血虚，先用托里散，后用针具泄脓。因饮食停滞而呕吐的，用托里益中汤。中焦虚寒湿盛而呕吐的，用托里温中汤。肝木乘脾土而呕吐的，用托里抑青汤。胃脘停痰而呕吐的，用托里清中汤。脾虚自病而呕吐的，用托里益黄汤。郁结伤脾而呕吐的，用托里越鞠汤。如果不详细探究病因源头，而妄用攻毒药物，那么肿疡不能溃破，溃疡不能收敛。丹溪曾说：肿疡时期呕吐，当作毒邪攻心治疗；溃疡时期呕吐，当作阴虚补益。却不知道这只是大概而言，即《内经》所说诸痛痒疮，皆属心火的意思。况且现在热毒内攻而呕吐的很少，脾胃虚寒而呕吐的多，怎么能固执前圣的话，用来治疗现在的病例呢？进士张德泓患背疽，轻微肿胀微红，饮食减少思虑，我用六君子汤等药物，脓成后溃破；再用大补阳气的药物，肌肉生长。这是因为胃气极度虚弱，并非疮毒所致。他说：果然因为清晨登厕，闻到秽气才开始发作，确实如此，印证了先生关于胃虚的说法。用托补法治疗。一男子腹部患痈，肿胀坚硬不溃破，是阳气虚弱；呕吐少食，是胃气虚寒；治法应当温补脾胃。假如……（原文此处有缺漏或语意中断，结合上下文推测意为：若因感受寒邪秽气而呕吐，即使是肿疡，也应当助胃壮气）。那人不信，仍服用攻伐药物，结果果然死亡。
For sores and ulcers (sores and ulcers), if the pathogenic toxins have formed pus, it is appropriate to use the method of supporting the interior (supporting the interior) to hasten the maturation of pus. When the pus has formed, one should examine its ripeness, depth, and shallowness before puncturing with a needle. If the swelling is high and soft, and pressing it causes pain localized under the finger, the pus is deep. If pressing leaves an indentation that does not rebound, the pus has not yet formed. If pressing causes immediate rebound, the pus has formed. Using a needle when pus has not yet generated will cause the leakage of Qi and blood, making it difficult for pus to form. If ripe pus is not drained by puncturing, the ulceration will deepen, and the wound will be difficult to heal. If the sore is deep but the puncture is shallow, internal pus will not drain, while external blood may leak out. If the sore is shallow but the puncture is deep, although internal pus may drain, healthy flesh will be injured. If the patient's Yuan Qi (vital energy) is weak, tonification must be performed first before puncturing; once the pus drains, various symptoms will naturally recede. If pain persists or there is irritability and vomiting after pus drainage, this is due to damage to Stomach Qi, requiring urgent tonification. For back sores with intense heat toxins and dark central flesh, internally use methods to support the interior and strengthen the Spleen and Stomach; externally apply Wujin Gao (Gold Ointment) to the dark areas. The red areas will gradually rise, and the dark areas will gradually lower. By the sixth or seventh day, a boundary between red and dark will appear with natural cracks, resembling knife marks, and the dark flesh will gradually slough off. At this point, sharp scissors should be used to slowly remove the necrotic tissue, ideally ensuring the patient feels no pain and sees no fresh blood. Even if cracks appear, if pus flow is not smooth, or if pain persists despite pus drainage, it indicates internal blockage; needles should be used within the cracks to guide drainage. For lesions between the shoulder blades where flesh rots and pus drains but swelling and pain persist, this is due to toxic sinews blocking the pus channel internally, requiring especially careful guidance of drainage. If Yuan Qi is weak and astringent/draining drugs are mistakenly taken, causing lack of pain at the site or impending death of flesh, urgent warming and tonification of the Spleen and Stomach are needed, and recovery is possible. Subsequently, purely tonifying medicines are necessary for healing. If knives and needles are used recklessly to cut flesh and cause bleeding, Qi will lose its anchor, Qi and blood will become more deficient, and Yuan Qi will be further damaged, making it impossible to promote flesh regeneration and wound closure.
Vomiting in sores and ulcers should not be treated solely based on the assumption of internal toxin attack, nor should detoxifying drugs be used indiscriminately. If heat is severe and pain is intense, indicating excess pathogenic factors, Xianfang Huoming Yin (Immortal Life Elixir Decoction) should be used to resolve the toxicity. If pain occurs during pus formation, indicating deficiency of Stomach Qi, Tuoli Xiaodu San (Support Interior and Detoxify Powder) should be used to tonify. If there is distending pain when pus is ripe, indicating Qi and blood deficiency, Tuoli San (Support Interior Powder) should be used first, followed by needle drainage. For vomiting caused by food stagnation, Tuoli Yizhong Tang (Support Interior and Benefit Middle Decoction) is indicated. For vomiting due to middle jiao deficiency and cold-dampness, Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) is indicated. For vomiting due to Liver Wood overacting on Spleen Earth, Tuoli Yiqing Tang (Support Interior and Suppress Green Decoction) is indicated. For vomiting due to phlegm retention in the stomach region, Tuoli Qingzhong Tang (Support Interior and Clear Middle Decoction) is indicated. For vomiting due to Spleen deficiency itself, Tuoli Yihuang Tang (Support Interior and Enrich Yellow Decoction) is indicated. For vomiting due to constraint injuring the Spleen, Tuoli Yueju Tang (Support Interior and Resolve Depression Decoction) is indicated. If the root cause is not investigated in detail and toxic-draining drugs are used recklessly, swellings will not suppurate, and ulcers will not heal. Danxi stated: Vomiting during the swelling stage should be treated as toxin attacking the Heart; vomiting during the ulcer stage should be treated as Yin deficiency requiring tonification. However, he did not realize this was a general statement, referring to the meaning in *Neijing* that all painful, itching sores belong to Heart Fire. Moreover, nowadays, vomiting due to internal heat toxin attack is rare, while vomiting due to Spleen-Stomach deficiency-cold is common. How can one rigidly adhere to the words of past sages to treat current cases? Scholar Zhang Dehong suffered from a carbuncle on the back, with slight swelling and redness, and poor appetite. I used Liujunzi Tang (Six Gentlemen Decoction) and similar formulas; after pus formed and ruptured, I used formulas to greatly tonify Yang Qi, leading to flesh regeneration. This was because his Stomach Qi was exhausted, not due to the sore toxin. He said: "Indeed, it started after smelling foul odors while using the toilet early in the morning." This confirms the theory of Stomach deficiency. Use supportive tonification. A man had an abscess on his abdomen, which was swollen, hard, and unruptured, indicating weak Yang Qi; vomiting and poor appetite indicated deficient-cold of Stomach Qi; the treatment method should be to warm and tonify the Spleen and Stomach. [Text gap/fragment] ...if vomiting is caused by contracting cold pathogens or foul odors, even in the swelling stage, one should still assist the Stomach and strengthen Qi. That person did not believe this, continued taking draining/astringent drugs, and indeed died.