一凡痈疽已成。血气虚者。邪气深者。邪气散慢不能突起。亦难溃脓。或破后脓少。
清稀。或坚硬不软。或虽得脓而根脚红肿开大。皆气血虚。邪气盛。兼以六淫之邪变生。诸
症必用内托。令其毒热出于肌表。则易愈也。内托以补药为主。活血驱邪之药为臣。或以芳
香之药行其郁滞。或加温热之药御其风寒。亦有疮疽肿痛。初生一二日。便觉脉沉细而烦闷
。脏腑弱而皮寒。邪毒猛烈。恍惚不宁。外证沉深者。即当用托里散或增损茯苓汤。及温热
之剂以从治之。
或问内托。河间治肿 于外。根盘不深。形证在表。其脉多浮。病在皮肉。非气盛则必侵
急须内托。宜复煎散除湿散郁。使胃气和平。如或未已。再煎半料饮之。如大便秘及烦热。
少服黄连汤。如微利及烦热已退。却与复煎散。如此使荣卫俱行。邪气不能内伤。
溃疡内外皆虚。宜以补接为主。欲用香燥。宜戒虚虚之失。
外施贴药。正是发表之意。经曰发表不远热。大凡气得热则散。得冷则凝。庸医敷贴冷
药。岂理也哉。
一人年五十。嗜酒与煎爆。后左丝竹空忽努出一角。以硝黄脑子庵之。致毙。
疮疡作渴。不问肿溃。但脉数发热而渴。用竹叶黄 汤。脉不数。不发热。或脉数无力
而渴。或口干。用补中益气汤。若脉数便秘。用清凉饮。尺脉洪大。按之无力而渴。用加减
八味丸。若治口燥舌黄。饮水不歇。此丸尤妙。
精要曰。口渴与口干不同。不宜用丹药镇坠。祸如反掌。惟桑枝煎五味汤以救阴水。
丹溪曰。不言食味起火。怒气生火。房劳激火。吾恐渴亦未易止也。
精要曰。疮作渴甚。急与神仙追毒丸。取下恶毒。清膻汤。千金漏芦汤。五香连翘汤。
六味车螯散。万金散。皆可选用。利后仍渴。却用生津补气药。津液生。气血完。渴自止。
丹溪曰。大渴而与利药。非明示脉证。何以知其当下。后言利后仍渴。却用补药。又不
明言脉证。恐是但有大渴必下。下后尚渴。方与补药。古人治未病。如此用药可乎。况渴。
属上焦。当肿疡时。犹或可用。若溃疡后渴。多因血气之虚。何待利后方议甚虚也。
痈疽发渴。乃气血两虚。用参、 以补气。归、苓以养血。或忍冬丸。黄 六一汤。
一人渴后发背未溃。脉数无力。此阴虚火动。用加减八味丸。 咀二剂。稍缓次用丸剂
一人脑疽作渴。脉虽洪。按之无力。治以此药不信。自用滋阴等药愈盛。七恶并致而没
东坦云。论人病疽愈后发渴。多致不救。惟加减八味丸最妙。盖痈疽多因虚而得。疽安
而渴者。服此丸则渴止。安。而未渴者服此丸。永不发渴。或未疽而先渴者。服此不惟渴
止。而疽亦不作。
一贵人疽未安而渴作。一日饮水数升。予用加减八味丸。诸医大笑。云此能止渴。我辈
不复业医矣。皆用木瓜、乌梅、紫苏、参、苓、百药煎等剂而渴愈甚。不得已用此药。三日
渴止。其疾本以肾水枯竭。心火上炎。是以生渴。此药生水降火为最。患者鉴之。
附子气味劲悍。有回阳之功。命门火衰。非此不补。性虽有毒。但炮制有法。或用甘草
、防风同炒。或童便久浸以去其毒。复与地黄等味同用。以制其热。润其燥。缓其急。假其
克捷之功。而驾驭其剽悍之势。则虽久服亦无害也。观东垣八味丸论。则较然矣。
精要曰。疽向安后发渴。与加减八味丸。
丹溪曰。夫当此时气血两虚。当用参 补气。归、 补血。渴当自止。何必泽泻、茯苓
佐以肉桂以导水耶。若忍冬丸。黄 六一汤。亦为切当。忍冬养血。黄 补气。渴何由作。
（机）按丹溪所言
一、凡是痈疽已经形成，若患者血气虚弱，或邪气深重，导致邪气散漫不能突起，也难以化脓。或者破溃后脓液稀少、清稀，或者患处坚硬不软，或者虽然出了脓但根部红肿范围扩大，这些都是气血虚弱、邪气盛实，兼受六淫之邪影响而变生出的症状。这些情况都必须使用内托法，使毒热从肌表排出，这样才容易痊愈。内托法以补益药为主药，活血驱邪的药为辅助药。或者用芳香的药物来疏通郁滞，或者加入温热的药物来抵御风寒。也有疮疽肿痛，在初生的一两天内，就感觉脉象沉细且心中烦闷，脏腑虚弱且皮肤发冷，邪毒猛烈，神志恍惚不安，外部证候深沉严重的，应当立即使用托里散或增损茯苓汤，以及温热的药剂来顺从其病势进行治疗。
有人问：刘河间治疗肿疡在外，根盘不深，形证在表，其脉多浮，病位在皮肉之间，如果不是气盛则必定病情紧急，需要内托。适宜用复煎散来除湿散郁，使胃气平和。如果病势未止，再服用半剂。如果大便秘结及烦热，少量服用黄连汤。如果轻微腹泻及烦热已退，再给予复煎散。如此使营卫之气共同运行，邪气就不能内伤脏腑。
肿疡阶段内外皆壅塞，宜以内托和发散为主。如使用大黄，应当戒除鲁莽的错误。
溃疡阶段内外皆虚，宜以补益接续为主。想要使用香燥药物，应当戒除使虚者更虚的过失。
外用贴敷药物，正是发表的意思。经书说发表不远热。大凡气得到热则消散，得到冷则凝滞。庸医敷贴冷药，这符合道理吗？
有一人五十岁，嗜好饮酒和油炸爆炒食物，后来左眼外侧丝竹空穴突然突出一个角状物，用硝石、大黄、冰片捣烂外敷，导致死亡。
疮疡引起口渴，不问是肿疡还是溃疡，只要脉数、发热且口渴，用竹叶石膏汤。脉不数，不发热，或者脉数无力而口渴，或者口干，用补中益气汤。如果脉数且便秘，用清凉饮。尺脉洪大，按之无力而口渴，用加减八味丸。如果治疗口燥舌黄，饮水不停，这个方子尤其妙。
《精要》说：口渴与口干不同，不宜用丹药镇坠，祸患如在反掌之间。只有桑枝煎五味汤来救阴水。
朱丹溪说：如果不谈饮食口味引起的火，怒气引起的火，房劳激发的火，我恐怕口渴也不容易止住。
《精要》说：疮疡作渴严重，急用神仙追毒丸，取下恶毒。清膻汤、千金漏芦汤、五香连翘汤、六味车螯散、万金散，都可以选用。利下之后仍然口渴，再用生津补气药。津液生成，气血完备，口渴自然停止。
朱丹溪说：大渴却给予泻利药物，不是明确指示脉证，怎么知道应当攻下？后文说利下之后仍然口渴，再用补药，又不明确说明脉证，恐怕是因为只要有大的口渴就必须攻下，攻下后还渴，才给予补药。古人治未病，这样用药可以吗？况且口渴属于上焦，在肿疡时期，或许还可以用。如果在溃疡后口渴，多因气血虚弱，何必等到利下后才议论甚虚呢？
痈疽引发口渴，乃是气血两虚，用人参、黄芪以补气，当归、茯苓以养血。或者用忍冬丸，黄芪六一汤。
有一人渴后发背未溃，脉数无力，这是阴虚火动，用加减八味丸。切碎两剂，稍缓解后次用丸剂。
一人脑疽作渴，脉虽洪大，按之无力，治疗用此药他不相信，自己用滋阴等药使病情加重，七恶并至而死。
汪东坦说：论述人患疽病愈后发渴，多导致无法救治，只有加减八味丸最妙。大概痈疽多因虚而得，疽病安定而发渴的，服此丸则渴止。安定而未发渴的，服此丸，永不发渴。或者未患疽而先发渴的，服此药不仅渴止，而且疽也不会发作。
一位贵人疽病未安而口渴发作，一天饮水数升，我用加减八味丸。众医生大笑，说此药能止渴，我们不再行医了。都用木瓜、乌梅、紫苏、人参、茯苓、百药煎等药剂，结果口渴更严重。不得已用了此药，三天后口渴停止。他的病本因肾水枯竭，心火上炎，所以产生口渴。此药生水降火最为合适。患者以此为鉴。
附子气味刚劲猛烈，有回阳之功。命门火衰，非此药不能补。性虽有毒，但只要炮制有法，或者用甘草、防风同炒，或者用童便久浸以去除其毒性，再与地黄等味同用，以制约其热性，滋润其燥性，缓和其急迫，借用其快速奏效之功，而驾驭其剽悍之势，那么即使久服也无害。看李东垣关于八味丸的论述，就很清楚了。
《精要》说：疽病趋向安定后发渴，给予加减八味丸。
朱丹溪说：正当此时气血两虚，应当用人参、黄芪补气，当归、熟地补血，口渴应当自然停止，何必用泽泻、茯苓佐以肉桂来导水呢？如果忍冬丸，黄芪六一汤，也颇为恰当。忍冬养血，黄芪补气，口渴从何而来？
（汪机）按语：丹溪所说的……
1. Generally, when carbuncles and sores have formed, if the patient's blood and qi are deficient, or the pathogenic factor is deep-seated, causing the pathogen to scatter and fail to protrude, it will also be difficult to suppurate. Or after rupture, there is little pus, which is clear and thin; or the area remains hard and not soft; or although pus has been produced, the base of the swelling is red, swollen, and expanded. These are all signs of deficiency in blood and qi, excess of pathogenic factors, combined with changes induced by the six exogenous pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire). In such cases, internal support methods must be used to allow the toxic heat to exit from the muscle surface, making recovery easier. Internal support primarily uses tonifying herbs, with herbs that invigorate blood and expel pathogens as secondary agents. Alternatively, aromatic herbs may be used to move stagnation, or warming herbs added to resist wind-cold. There are also cases of painful and swollen sores where, within one or two days of onset, the pulse is deep and fine accompanied by restlessness, the zang-fu organs are weak, the skin is cold, the pathogenic toxin is fierce, mental state is unsettled, and external manifestations are deep and severe. In these instances, Tuoli San (Support-the-Interior Powder) or Zengsun Fuling Tang (Modified Poria Decoction), along with warming formulas, should be employed immediately to treat according to the disease's nature.
Someone asked: Liu Hejian treated external swellings where the root was not deep, the presentation was superficial, and the pulse was mostly floating, indicating the disease was in the skin and flesh. If qi is not excessive, the condition must be urgent, requiring internal support. It is suitable to use Fujian San (Double-Decoction Powder) to remove dampness and disperse stagnation, harmonizing stomach qi. If the condition persists, administer half a dose again. If there is constipation and irritability, take a small amount of Huanglian Tang (Coptis Decoction). If there is mild diarrhea and irritability has subsided, then give Fujian San. This allows both Ying (Nutritive) and Wei (Defensive) qi to circulate together, preventing pathogens from damaging the interior.
During the abscess stage, both interior and exterior are congested; treatment should focus on internal support and dispersing the exterior. If using Rhubarb (Dahuang), one must avoid rash errors.
During the ulcer stage, both interior and exterior are deficient; treatment should focus on tonification and repair. When using acrid-dry herbs, one must avoid the error of further depleting the deficient.
External application of plasters is essentially an expression method. The Classics state that expressing the exterior does not distance itself from heat. Generally, qi scatters when warmed and coagulates when cooled. Is it reasonable for mediocre physicians to apply cold medicines externally?
A fifty-year-old man who indulged in alcohol and fried foods suddenly developed a horn-like protrusion at Sizhukong (EX-HN4). He applied a paste of Nitre (Xiaosha), Rhubarb (Dahuang), and Borneol (Bingpian), which resulted in his death.
Regarding thirst caused by sores, regardless of whether it is an abscess or an ulcer, if the pulse is rapid, there is fever, and thirst, use Zhuye Shigao Tang (Leaf and Gypsum Decoction). If the pulse is not rapid, there is no fever, or the pulse is rapid but forceless with thirst, or dry mouth, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If the pulse is rapid with constipation, use Qingliang Yin (Cooling Drink). If the Chi position pulse is surging and large but forceless upon pressure with thirst, use Jiaban Bawei Wan (Modified Eight-Ingredient Pill). For treating dry mouth, yellow tongue, and incessant drinking, this pill is particularly excellent.
The Jingyao states: Thirst differs from dry mouth. One should not use mineral pills to suppress it, as disaster can occur instantly. Only Sangzhi Jian Wuwei Tang (Mulberry Twig Decoction with Five Flavors) should be used to nourish yin fluids.
Zhu Danxi said: If we do not discuss fire arising from diet, anger, or sexual exhaustion, I fear thirst will not be easily stopped.
The Jingyao states: For severe thirst due to sores, urgently use Shenxian Zhuodu Wan (Divine Immortal Pursuing-Toxin Pill) to purge evil toxins. Qingtan Tang, Qianjin Lulu Tang, Wuxiang Lianqiao Tang, Liuweiche'ao San, and Wanjinsan are all selectable options. After purgation, if thirst persists, use herbs that generate fluids and tonify qi. Once fluids are generated and blood and qi are complete, thirst will cease naturally.
Zhu Danxi said: Giving purgatives for severe thirst, without clearly indicating the pulse and symptoms, how can one know when to purge? The later text says if thirst persists after purgation, then use tonics, without specifying pulse and symptoms. It seems to imply that any severe thirst requires purging, and only if thirst persists after purging are tonics given. Is this consistent with the ancients' principle of treating disease before it arises? Moreover, thirst belongs to the Upper Jiao. During the abscess stage, it might be applicable. But for thirst after ulceration, it is mostly due to deficiency of blood and qi. Why wait until after purgation to discuss severe deficiency?
Thirst caused by carbuncles and sores is due to dual deficiency of blood and qi. Use Ginseng (Renshen) and Astragalus (Huangqi) to tonify qi, and Angelica (Danggui) and Poria (Fuling) to nourish blood. Or use Rendong Wan (Honeysuckle Pill) or Huangqi Liuyi Tang (Astragalus Six-to-One Decoction).
One patient developed a back abscess after thirst, which had not yet suppurated. The pulse was rapid and forceless, indicating yin deficiency with hyperactive fire. Use Jiaban Bawei Wan. Grind two doses, and once slightly relieved, switch to pill form.
Another patient with a brain carbuncle experienced thirst. Although the pulse was surging, it was forceless upon pressure. He did not trust the prescribed medicine, used yin-nourishing herbs himself, which aggravated the condition, leading to the manifestation of the Seven Adversities and death.
Wang Dongtan stated: Discussing patients who develop thirst after a carbuncle/abscess heals, most result in non-survival. Only Jiaban Bawei Wan is most effective. Generally, carbuncles and sores arise from deficiency. If a carbuncle is stable but thirst occurs, taking this pill stops the thirst. If stable and no thirst, taking this pill prevents future thirst. If thirst occurs before the carbuncle develops, taking this not only stops thirst but also prevents the carbuncle from forming.
A nobleman developed thirst while his carbuncle was not yet stabilized, drinking several liters of water a day. I used Jiaban Bawei Wan. Other doctors laughed, saying, "If this pill stops thirst, we might as well quit medicine." They all used Quince (Mugua), Mume (Wumei), Perilla (Zisu), Ginseng, Poria, and Metaplexis seed (Baiyaojian), resulting in worsened thirst. Reluctantly, they used my prescription. After three days, the thirst stopped. His illness was originally due to depletion of kidney water and flaming up of heart fire, causing thirst. This pill generates water and descends fire most effectively. Patients should take note.
Fuzi (Prepared Aconite Root) has a potent and fierce flavor and effect, possessing the power to restore yang. If Mingmen (Gate of Life) fire is declining, nothing else can tonify it. Although it is toxic, if processed correctly—such as stir-frying with Licorice (Gancao) and Saposhnikovia (Fangfeng), or soaking long-term in children's urine to remove toxicity—and then used with Rehmannia (Dihuang) etc., to restrain its heat, moisten dryness, and缓 its urgency, borrowing its swift efficacy while controlling its fierce nature, even long-term use causes no harm. Observing Li Dongyuan's discussion on the Eight-Ingredient Pill makes this clear.
The Jingyao states: For thirst occurring after a carbuncle/abscess tends toward stabilization, administer Jiaban Bawei Wan.
Zhu Danxi said: At this time, both blood and qi are deficient. One should use Ginseng and Astragalus to tonify qi, and Angelica and Rehmannia to tonify blood. Thirst should stop naturally. Why use Alisma (Zexie) and Poria with Cinnamon (Rougui) to guide water? Rendong Wan and Huangqi Liuyi Tang are also appropriate. Honeysuckle nourishes blood, Astragalus tonifies qi. How would thirst arise?
(Wang Ji) Commentary: What Danxi said...