初起无口干，无寒热，饮食有味，举止寻常、发疮者顺。已成疮头肿起，根脚不散，形色红活， 痛溃脓
者顺。已溃脓稠，
色鲜红活，肿消痛止，项便、头轻、口和者顺。溃后瘀肉易腐，新肉易生，疮口易平，饮食有味者顺。
初起疮头如粟，顶软不高，色紫根散，木痛食少者逆。已成疮形紫黑，软陷无脓，足冷身凉，便利脉虚者
逆。已溃脓水清稀，多生臭秽，坏肉不腐，新肉不生者逆，溃后饮食餍餐，身体发热，口干不眠，肉削皮粗者逆。
初起 肿坚硬，内热口干，脉数有力，邪实也，当利之。已成憎寒壮热，四肢拘急，脉浮者，邪在表也，
宜散之。赤肿作痛，血凝滞也，散血清肝；色黯漫肿，升阳助胃。已溃坚肿不退，脉细而数，日晡发热者，宜
滋阴健脾。肝胆怒火上攻，心烦作躁，腮颧红热者，宜抑阴降火。已溃脓清，肿痛尤甚，虚烦食少者，宜养气
血、健脾胃。溃后气血俱虚，身凉脉细，大便多溏者，宜峻补温中。溃后不敛，新肉生迟，疮口淡白，脓水不
止，健中补脾。
一男子患此三日， 肿寒热，脉浮数。以荆防败毒散一剂，表症悉退，肿痛仍作，已欲作脓，以托里消毒
散，脓溃又以益气养荣汤加麦冬、五味渐敛而愈。
一男子患此五日，顶高根若钱大，形色红活，此肝经湿热为患。用麻子大艾灸七壮，以栀子清肝汤二服，肿
势稍止；以蟾酥饼膏贴灸上，更以柴胡清肝汤加白芷、黄 、天花粉数服，脓溃肿消，半月收敛。
一男子渴疾三年，寒热半月，自以为疟，鬓间忽生一小疮，三、四日，外形如粟，疮平坚硬，色暗不泽，
又兼脉洪数而无力，
此水竭火旺之症也。终难溃敛，辞不敢治。复请医，视为易治，用针刺肿上，去紫血钟许，内服解毒药，次日
边傍愈肿。医者谓肿高属阳易治，彼家欢悦。又三日，腮项俱肿，口噤不食，用针又刺肿上，日加昏愦。又复
请视，予曰∶死将及矣。但此症未病先作渴，肾水已竭；外形如粟，里可容谷，形色紫黑，气败血衰；脉洪无
力，元气内败，如此干涉，岂有不死者。彼家方信晚矣。共二十一日而殁。
一男子肿 五、六日，彼欲内消，外敷凉药，内服大黄泄气等剂，随后 肿虽退，乃生寒热，恶心干呕，
肩膊牵强，诊之脉数无力，此内虚毒瓦斯入里，凉药之过也。东垣云∶疮疽之发，受之有内外之别，治之有寒温
之异。受之外者，法当托里以温剂，反用寒药攻利，损伤脾胃，多致内虚，故外毒乘虚入里；受之内者，法当
疏利以寒剂，反用温剂托里。初病则是骨髓之毒，误用温剂使毒上彻皮毛，表里通溃，共为一疮，助邪为毒，
苦楚百倍，轻则变重，重则死矣。前症既出寒药之过，以托里健中汤，二服呕吐全止；又以十全大补汤加白芷，
数服而原疮渐起；又以人参养荣汤间服，腐溃脓稠；两月余，疮口收敛。
一妇人患此，肿硬寒热，口干 痛，脉洪大有力，此表里俱实也。以防风通圣散一剂，行二次，前症稍退；
又一剂，大行数次，热退渴止。惟原疮肿硬，用银针点破，插入蟾酥条，内服托里消毒散，渐溃脓而安。
一男子患此，三、四日顶高根活，且无表里之症，此肝经湿热为患。用针挑破疮顶，以蟾酥饼盖贴，内服
加味逍遥散加皂角针数服，头出微脓，根肿亦消。
鬓疽初起时，若无口干、无寒热症状，饮食正常，举止如常，发生疮疡的属于顺证。疮疡已成，疮头肿胀突起，根部不散，颜色红活，疼痛溃破后流出脓液的属于顺证。已经溃破，脓液稠厚，颜色鲜红活润，肿胀消退，疼痛停止，颈部舒适、头部轻爽、口中和缓的属于顺证。溃烂后，瘀腐之肉容易脱落，新肉容易生长，疮口容易平复，饮食有味道的属于顺证。
初起时疮头像粟米一样小，顶部柔软不高耸，颜色紫暗，根部散漫，麻木疼痛且食欲减少的属于逆证。疮疡已成，形状紫黑，软陷无脓，足部发冷身体凉，二便通利但脉象虚弱的属于逆证。已经溃破，脓水清稀，多产生臭秽之物，坏肉不腐烂，新肉不生长的属于逆证；溃后饮食过量（或指勉强进食），身体发热，口干失眠，肌肉消瘦皮肤粗糙的属于逆证。
初起时肿块坚硬，内部发热口干，脉搏数而有力，这是邪气实盛的表现，应当采用通利的方法治疗。疮疡已成，出现憎恶寒冷高热，四肢拘挛紧急，脉搏浮起的，这是邪气在表，适宜采用发散的方法治疗。红肿作痛，是血行凝滞所致，应使用散血和清肝的药物；颜色暗淡漫肿，应使用升阳助胃的药物。已经溃破，坚肿不退，脉象细而数，傍晚时分发热，适宜滋阴健脾。肝胆怒火上攻，心烦躁动，腮部和颧骨部位红热的，适宜抑制阴火、降泄火热。已经溃破，脓液清稀，肿痛依然严重，虚烦食欲减少的，适宜补养气血、健运脾胃。溃后气血都虚弱，身体凉爽脉象细弱，大便多稀溏的，适宜峻猛温补中焦。溃后疮口不愈合，新肉生长迟缓，疮口颜色淡白，脓水不止，宜健运中焦、补益脾胃。
有一个男子患此病三天，出现肿胀、寒热，脉搏浮数。服用荆防败毒散一剂，表证全部消退，但肿痛仍然发作，此时脓液即将形成，改用托里消毒散，脓液溃破后，又用益气养荣汤加麦冬、五味子，逐渐收敛而痊愈。
有一个男子患此病五天，疮顶高突，根部像铜钱大小，颜色形态红活，这是肝经湿热为患。用麻子大小的艾炷灸七壮，服用栀子清肝汤两服，肿胀势头稍止；再用蟾酥饼膏贴在灸处，又服用柴胡清肝汤加白芷、黄芩、天花粉几服，脓液溃破肿胀消退，半个月后收敛。
有一个男子患有消渴病三年，寒热交替半月，自认为是疟疾，鬓角间忽然生一个小疮，三、四天，外形像粟米，疮面平坦坚硬，颜色暗晦无光泽，又兼脉搏洪大数急但无力，这是肾水枯竭、心火旺盛的症状。最终难以溃破收敛，推辞不敢治疗。后来再次请医生诊治，视为容易治疗，用针刺破肿胀处，放出约一杯紫黑色血液，内服解毒药，第二天旁边更加肿胀。医生认为肿势高突属于阳证容易治疗，家属很高兴。又过了三天，腮部和颈部都肿胀，牙关紧闭不能进食，用针又刺破肿胀处，每天加重神志昏沉。再次请人诊治，我说：死期将至了。但这种病症在未发病前先出现口渴，说明肾水已竭；外形像粟米，内部空虚可容谷，颜色紫黑，气败血衰；脉搏洪大但无力，元气内部败坏，如此种种征象，岂有不死的道理。家属这才相信，但为时已晚。共二十一天而死。
有一个男子肿胀五、六天，患者想要内消，外敷凉药，内服大黄等泄气药物，随后肿胀虽然消退，却产生寒热，恶心干呕，肩膊牵强僵硬，诊察脉搏数而无力，这是内部虚弱，毒瓦斯入里，是凉药造成的过错。李东垣说：疮疽的发生，病因有内外之别，治疗有寒温之异。感受外部邪气的，法度应当用温剂托里，反而用寒药攻利，损伤脾胃，多导致内部虚弱，所以外部毒邪乘虚入里；感受内部邪气的，法度应当用寒剂疏利，反而用温剂托里。初病则是骨髓之毒，误用温剂使毒邪上透皮毛，表里贯通溃烂，合为一疮，助长邪气成为毒害，痛苦百倍，轻则病情加重，重则死亡。前面的病症既然出自寒药的过错，用托里健中汤，两服后呕吐完全停止；又用十全大补汤加白芷，几服后原疮逐渐隆起；又用人参养荣汤间隔服用，腐肉溃烂脓液变稠；两个多月后，疮口收敛。
有一个妇人患此病，肿胀坚硬寒热，口干疼痛，脉搏洪大有力，这是表里都实盛。服用防风通圣散一剂，排便两次，前症稍退；再服一剂，多次大便通畅，热退渴止。只有原疮肿胀坚硬，用银针点破，插入蟾酥条，内服托里消毒散，逐渐溃破流脓而安宁。
有一个男子患此病，三、四天疮顶高突，根部活润，且没有表里症状，这是肝经湿热为患。用针挑破疮顶，用蟾酥饼盖贴，内服加味逍遥散加皂角刺几服，头部出少量脓液，根部肿胀也消退。
At the initial stage, if there is no dryness of the mouth, no aversion to cold or fever, normal appetite, and ordinary behavior when sores appear, it is a favorable condition (Shun). When the sore has formed, if the head swells up, the base does not spread, the color is red and vibrant, and pain occurs with pus discharge, it is a favorable condition. After ulceration, if the pus is thick, the color is fresh and red/vibrant, swelling subsides, pain stops, the neck feels comfortable, the head feels light, and the mouth feels harmonious, it is a favorable condition. After ulceration, if necrotic flesh easily sloughs off, new flesh easily grows, the wound easily flattens, and appetite remains, it is a favorable condition.
At the initial stage, if the sore head is like millet grains, soft and not high at the apex, purple in color with a spreading base, accompanied by numbness/pain and poor appetite, it is an unfavorable condition (Ni). When the sore has formed, if the shape is purple-black, soft and depressed without pus, feet are cold, body is cool, bowels/bladder are open but pulse is deficient, it is an unfavorable condition. After ulceration, if the pus/water is clear and thin, foul odor is produced, necrotic flesh does not rot, and new flesh does not grow, it is an unfavorable condition; if after ulceration there is excessive eating, body fever, dry mouth, insomnia, muscle wasting, and rough skin, it is an unfavorable condition.
At the initial stage, if the swelling is hard, internal heat and dry mouth occur, and the pulse is rapid and forceful, this indicates excess pathogenic factors; one should use purgative methods. When the sore has formed, if aversion to cold with high fever, limb stiffness/spasms, and floating pulse occur, this indicates pathogens in the exterior; one should use dispersing methods. Red swelling with pain indicates blood stasis; use herbs to disperse blood and clear Liver heat. Dark color with diffuse swelling indicates failure to raise Yang and assist Stomach; use methods to raise Yang and support Stomach function. After ulceration, if hardness/swelling persists, pulse is fine and rapid, and afternoon fever occurs, nourish Yin and strengthen Spleen. If Liver/Gallbladder fire attacks upward causing mental restlessness/agitation, and redness/heat in cheeks/zygomatic area, suppress Yin fire and descend fire. After ulceration, if pus is clear, swelling/pain remain severe, with vexation and poor appetite, nourish Qi and Blood, strengthen Spleen/Stomach. After ulceration, if both Qi and Blood are deficient, body is cool, pulse is fine, and stools are often loose, use strong warming tonification of the Middle Jiao. If the ulcer fails to close, new flesh grows slowly, the wound is pale white, and pus flows endlessly, strengthen the Middle and tonify Spleen.
A man suffered from this for three days, presenting with swelling, aversion to cold/fever, and a floating-rapid pulse. One dose of Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction) resolved all exterior symptoms, but swelling and pain persisted as pus was about to form. Tuoli Xiaodu San (Support Interior and Eliminate Toxin Decoction) was administered. After pus discharged, Yiqi Yangrong Tang (Qi-Supporting and Nourishing Nutrient Decoction) with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) was used to gradually close the wound, leading to recovery.
A man suffered from this for five days, with a high apex and a base the size of a coin, red and vibrant in color. This was caused by Damp-Heat in the Liver Meridian. Seven moxa cones the size of hemp seeds were applied. Two doses of Zhizi Qinggan Tang (Gardenia Clearing Liver Decoction) slightly halted the swelling. A Chansu Bing Gao (Toad Venom Cake Paste) was applied over the moxa site. Several doses of Chaihu Qinggan Tang (Bupleurum Clearing Liver Decoction) with Baizhi (Angelica Dahurica), Huangqin (Scutellaria Root), and Tianguafen (Trichosanthes Root) were given. Pus discharged, swelling subsided, and healing occurred within half a month.
A man had suffered from Xiao Ke (Wasting-Thirst) for three years and alternating chills/fever for half a month, mistaking it for Malaria. A small sore suddenly appeared on his temple. After three to four days, it resembled a millet grain externally, was flat and hard, dark in color and dull. The pulse was surging, rapid, yet powerless. This indicated exhaustion of Kidney Water and flourishing Fire. It ultimately failed to ulcerate or heal, so he declined treatment. Another physician deemed it easy to treat, punctured the swelling with a needle, drained about a cup of purple blood, and prescribed detoxifying herbs internally. The next day, the surrounding area became more swollen. The physician stated that high swelling belongs to Yang and is easy to treat, pleasing the family. Three days later, the cheek and neck were swollen, jaw locked preventing eating. Needling was repeated, and daily confusion increased. Upon re-evaluation, I said: Death is imminent. This patient had thirst before the disease onset, indicating exhausted Kidney Water; the external appearance like a millet grain suggests internal emptiness; the purple-black color indicates Qi failure and Blood decline; the surging but powerless pulse indicates internal collapse of Yuan Qi. With such signs, how could he survive? The family finally believed, but it was too late. He died after twenty-one days.
A man had swelling for five to six days. He sought internal resolution, applying cooling herbs externally and taking Dahuang (Rhubarb Root) and other Qi-draining formulas internally. Although the swelling receded, he developed chills/fever, nausea/dry retching, and shoulder/arm stiffness. The pulse was rapid and powerless. This indicated internal deficiency allowing Toxic Heat to enter the interior, caused by the cooling herbs. Dongyuan (Li Dongyuan) stated: Sores and carbuncles arise from internal or external causes, requiring warm or cold treatments accordingly. For external pathogens, the method is to support the interior with warm agents; using cold drugs instead damages the Spleen/Stomach, causing internal deficiency, allowing external toxins to enter the interior. For internal pathogens, the method is to drain with cold agents; using warm tonics instead... [Note: Text implies error in treating internal origin with warm tonics]. Initially, the toxin is in the marrow; misusing warm agents forces the toxin to the skin surface, causing simultaneous exterior-interior ulceration, creating one large sore, aiding the pathogen into toxicity, causing hundredfold suffering. Mild cases worsen, severe cases lead to death. Since the previous case resulted from cold drugs, Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction) stopped vomiting after two doses. Shiquan Dabu Tang (Perfect Ten Tonifying Decoction) with Baizhi made the original sore rise after several doses. Ren Shen Yang Rong Tang (Ginseng Nourishing Nutrient Decoction) taken intermittently led to thick pus formation. Over two months, the wound closed.
A woman suffered from this, with hard swelling, chills/fever, dry mouth, pain, and a surging-forceful pulse. This indicated excess in both exterior and interior. One dose of Fangfeng Tongsheng San (Saposhnikovia Unblocking and Generating Defense Decoction) resulted in two bowel movements, slightly relieving symptoms. Another dose caused multiple bowel movements, stopping fever and thirst. Only the original sore remained hard/swollen. It was punctured with a silver needle, a Chansu strip inserted, and Tuoli Xiaodu San administered internally. Gradual ulceration and pus discharge led to stability.
A man suffered from this for three to four days, with a high apex and viable base, and no exterior-interior symptoms. This was caused by Damp-Heat in the Liver Meridian. The apex was pricked with a needle, covered with a Chansu Bing paste. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) with Zaojiaoci (Gleditsia Sinensis Thorn) was taken internally. A small amount of pus emerged from the head, and root swelling subsided.