脉浮数者。散之。
脉沉实者。下之。
表里俱实者。解表攻里。
麻木大痛或不痛者并灸之。更兼攻毒。
疔疮。以其疮形如丁盖之状也。多因肥甘过度。不慎房酒。以致邪毒蓄结。遂生疔疮。经
膏粱之变。足生大丁是也。亦有人汗滴入食肉而生。亦有误食死牛马而生。不可不慎。初生
头凹肿痛。青黄赤黑。无复定色。便令烦躁闷乱。或增寒头痛。或呕吐心逆者是也。急于艾
炷灸之。若不觉痛。针疮四边。皆令血出。以回疮锭子从疮孔 之。贴以膏药。仍服五香连
翘汤、漏芦汤等疏下之为效。若针之不痛无血者。以猛火烧铁针通赤。于疮上烙之。令如
炭。取痛为效。亦 前锭子贴以膏药。经一二日脓溃根出。服托里汤散。根据常疗之。如针不
痛。其人眼黑。或见火光者。不可治。此毒已入脏腑也。
一人足患作痒。恶寒呕吐。时发昏乱。脉浮数。明灸二十余壮始痛。以夺命丹一服。肿
起。更以荆防败毒散而愈。
一人左手臂患之。是日一臂麻木。次日半体皆然。神思昏溃。遂明灸二十余壮。始不痛
。至百壮始痛。以夺命丹一服始肿起。更用神异膏及荆防败毒散而愈。（此凭症也。）
一妇忽恶寒作呕。肩臂麻木。手心瘙痒。遂瞀闷不自知其故。但手有一泡。此疔毒也。
急灸患处五十余壮而苏。又五十余壮知痛。投荆防败毒散而愈。（此因恶寒。故用发表。）
一人脚面生疔。形虽如粟。其毒甚大。宜峻利之药攻之。因其怯弱。以隔蒜灸五十余
止再灸。片时知痛。更贴膏药。再以人参败毒散一服渐愈。至阴之下。道远位僻。药力难达
。若用峻剂。则药力未到。胃气先伤。不如灸之为宜。（此据形症而治。）
一人感痘毒。面生疔十余枚。肿痛脉数。服荆防败毒散稍愈。尚可畏。更用夺命丹（百
二四）一服而愈。（此凭脉症而治。）
一妇六十。右耳下天容穴间一疔。其头黑靥。四边泡起。黄水时流。浑身麻木。发热谵
时时昏沉。六脉浮洪。用乌金散汗之。就用铍针刺。疮心不痛。周遭再刺十余下。紫黑血出
。方知疼痛。即将寸金锭子 入疮内。外用提疔锭子放疮上。膏日贴护。次日汗后。精神微
爽。却用破棺丹下之。病即定。其疔溃动后。用守效散贴涂。红玉锭子 之。八日疔出。兹
所谓审脉症汗下之间。外治次第如此殊胜。不察脉症。但见发热谵语。便投下药。或兼香窜
之药。遂致误人远矣。
世人多云。是疮不是疮。且服五香、连翘汤。然或中或否。致误者多。盖不审形气虚实
毒浅深。发表攻里。所因不同故也。此既善于驱逐。又以五般香窜佐之。与漏芦汤相间。大
黄为佐。大黄入阳明、太阳。性走不守。泄诸实热。以其峻捷。故号将军。虽各有参、 、
漏芦、甘草之补药。宁免驱逐之祸乎。
一人胸患遍身麻木。脉数而实。急针出恶血。更明灸数壮始痛。服防风通圣散得利而愈
。（此凭脉症而治。）
一夫人面生疔。肿 痛甚。数日不溃。脉症俱实。治以荆防败毒散加芩连稍愈。彼以为
乃服托里散一剂。势盛痛极。始悟。再用凉膈散（二六）二剂。痛减肿溃。又与连翘消毒散（
二六）十余剂而愈。（此凭脉症也。）
一人唇生疔疮已五日。肿硬脉数。烦躁喜冷。此胃经积热所致。先以凉膈散（二六）一服
。热去五六。更与夺命丹（百二四）二粒。肿退二三。再以荆防败毒散四剂而愈。
（按此先攻里。因其脉症而施。后发表。不言脉症。当时必有所见。）
一人患之。发热烦躁。脉实。以清凉饮下之而愈。（此凭脉症而治。）
一郑氏举家生疔。多在四肢。皆食死牛肉所致。刺去恶血。更服紫金锭（百二十二）悉愈。
一人唇下生疔。脉症俱实。法宜下之。反用托里。故口鼻流脓而死。是谓实实之祸也。
一老妇足大指患疔甚痛。令灸之。彼不从。专服败毒药。致真气虚而邪气愈实。竟不救
盖败。毒药须能表散疮毒。然而感有表里。所发有轻重。体段有上下。所禀有虚实。岂
可一概而用之耶。
且至阴之下。药力难到。专假药力则缓不及事。不若灸之为速。故下部患疮。皆宜隔蒜
。不痛者宜明灸之。及针疔四畔去恶血。以夺命丹一粒入疮头孔内。仍以膏药贴之。若患在
手足。红系攻心腹者。就于系尽处刺去恶血。宜服荆防败毒散。若系近心腹者。宜挑破疮头
去恶水。亦以膏药贴之。如麻木者服夺命丹。如牙关紧急。或喉内患者。并宜噙一二丸。
疔疮丹溪用磁石为末。苦酒和封之。根即出。
又方 巴豆十粒。半夏一大颗。附子半个。蜣螂一枚。各为末。用麝香和。看疮大。小
以纸绳子围疮口。以药泥上。用帛贴敷。时换新药。以瘥为度。活人甚多。
脉象浮而数的，用发散法治疗。
脉象沉而实的，用泻下法治疗。
表证和里证都表现为实证的，用解表兼攻里的方法治疗。
患处麻木、剧烈疼痛或不痛的，都用艾灸治疗，同时配合攻毒药物。
疔疮，是因为疮形像钉子盖住的样子而得名。多因过食肥甘厚味，不慎节制房事和饮酒，导致邪毒蓄积结聚，从而生出疔疮。这就是《内经》所说的“膏粱之变，足生大丁”。也有的人汗水滴入肉食中而生，也有的人误食死牛马的肉而生，不可不谨慎。初起时疮头凹陷、肿痛，颜色青黄赤黑不定，随即出现烦躁闷乱，或伴有恶寒头痛，或呕吐恶心等症。应立即用艾炷灸治。如果感觉不到疼痛，就针刺疮的四周，使血液流出，将回疮锭子从疮孔插入，贴上膏药，同时服用五香连翘汤、漏芦汤等疏泄通下的药物以取效。如果针刺后既不痛也没有血流出，就用猛火烧红铁针，在疮上烙烫，使其像炭一样，以产生痛感为有效。也使用前文提到的锭子贴在疮上，盖上膏药。经过一两天脓液溃破、病根排出后，服用托里汤散，按照常规疗法处理。如果针刺仍不痛，且患者眼睛发黑，或看见火光，则无法治愈，这是因为毒气已经深入脏腑了。
有一人足部患此病，感到瘙痒，恶寒呕吐，时常昏乱，脉象浮数。经过明灸二十多壮后才感到疼痛，服用一服夺命丹，肿胀起来，再用荆防败毒散而痊愈。
有一人左手臂患病，当天整条手臂麻木，第二天半身都如此，神志昏沉溃乱。于是明灸二十多壮，起初不痛，直到一百壮才感到疼痛，服用一服夺命丹后肿胀起来，再用神异膏及荆防败毒散而痊愈。（这是根据症状治疗的。）
一位妇人突然恶寒作呕，肩臂麻木，手心瘙痒，于是神志昏闷不知原因，只是手上有一个水泡，这是疔毒。急忙在患处灸五十多壮后苏醒，又灸五十多壮后感到疼痛，投予荆防败毒散而痊愈。（这是因为有恶寒症状，所以用发表的方法。）
一人脚面生疔，形状虽然像粟米，但毒性很大，应该用峻猛的利药来攻伐。但因为患者体质怯弱，采用隔蒜灸五十多壮，再灸几次，片刻后感到疼痛，再贴上膏药，又服用一服人参败毒散逐渐痊愈。因为病灶位于人体下部（至阴之下），路途遥远位置偏僻，药力难以到达。如果使用峻猛药剂，药力未到，胃气先伤，不如艾灸适宜。（这是根据形态和症状进行治疗的。）
一人感染痘毒，面部生出十余枚疔疮，肿痛脉数，服用荆防败毒散稍有好转，但仍令人担忧，再服用一服夺命丹而痊愈。（这是根据脉象和症状进行治疗的。）
一位六十岁的妇人，右耳下天容穴之间生了一个疔疮，疮头黑色结痂，四周起泡，黄水时常流出，全身麻木，发热说胡话，时时昏沉，六脉浮洪。使用乌金散使其发汗，并用铍针刺破，疮心不痛，周围再刺十余下，流出紫黑色的血，这才感到疼痛。随即把寸金锭子放入疮内，外用提疔锭子放在疮上，每天贴膏药保护。次日发汗后，精神稍微清爽，却用破棺丹泻下它，病情就稳定了。疔疮溃动之后，用守效散贴涂，用红玉锭子擦拭。八天后疔疮排出。这就是所谓的审察脉象症状，在汗法和下法之间选择，外治的步骤如此殊胜。如果不审察脉象症状，只见到发热说胡话，就投用下药，或者兼用香窜的药物，就会严重误人。
世人大多说，这不是疮，暂且服用五香连翘汤。然而有时有效有时无效，导致误治的人很多。大概是因为没有审察形体体质的虚实和毒气的浅深，发表攻里，所依据的原因不同。这种药善于驱逐邪气，又用五种香窜药辅助，与漏芦汤交替使用，大黄作为佐药。大黄进入阳明经、太阳经，性质走而不守，泄除各种实热，因为它峻猛快捷，所以号称将军。虽然方中有参、[此处原文缺字，推测为黄芪或类似补药]、漏芦、甘草等补益药物，难道能避免驱逐带来的祸害吗？
有一人胸部患病，全身麻木，脉象数而实，急忙针刺放出恶血，再明灸几壮后才感到疼痛，服用防风通圣散通便后痊愈。（这是根据脉象和症状进行治疗的。）
一位夫人面部生疔，肿胀疼痛严重，几天不溃破，脉象症状都属实证，用荆防败毒散加黄芩、黄连治疗稍有好转。她以为没事就自行服用托里散一剂，结果势头更盛疼痛加剧，这才醒悟，再用凉膈散两剂，疼痛减轻肿胀溃破，又给予连翘消毒散十多个疗程而痊愈。（这是根据脉象和症状治疗的。）
一人嘴唇生疔疮已五天，肿胀坚硬脉数，烦躁喜冷，这是胃经积热所致。先用凉膈散一服，热势去除了五六成，再给夺命丹两粒，肿胀消退二三成，再用荆防败毒散四剂而痊愈。
（按：这里先攻里，是根据脉象症状施治；后发表，虽然没有提及脉症，当时必定有所观察。）
一人患病，发热烦躁，脉实，用清凉饮泻下而痊愈。（这是根据脉象和症状进行治疗的。）
郑氏全家生疔疮，多在四肢，都是吃死牛肉导致的。刺去恶血，再服用紫金锭全部痊愈。
一人唇下生疔，脉象症状都属实证，法度上应该用泻下法，反而用托里法，导致口鼻流脓而死，这叫作“实实”的祸害（实证用补法，使实证更实）。
一位老妇人大脚趾患疔非常疼痛，让人艾灸，她不听从，专门服用败毒药，导致真气虚弱而邪气更加实盛，最终没能救活。败毒药必须能表散疮毒，然而感受有表里之分，发作有轻重之别，部位有上下之异，禀赋有虚实之不同，怎么可以一概而论地使用呢？
况且病灶位于人体下部，药力难到，专门依靠药力则缓慢来不及救治，不如艾灸迅速。所以下部患疮，都适宜隔蒜灸。不痛的宜明灸，以及针刺疔疮四周去除恶血，将一粒夺命丹放入疮头孔内，仍然用膏药贴敷。如果患处在手足，红线攻向心腹的，就在红线尽头刺去恶血，宜服用荆防败毒散。如果红线靠近心腹的，宜挑破疮头去除恶水，也用膏药贴敷。如果麻木的服用夺命丹。如果牙关紧急，或者喉内有患处的，都宜含服一二丸疔疮丹。
又一方：巴豆十粒，半夏一大颗，附子半个，蜣螂一枚，各研为末，用麝香调和，看疮的大小，用纸绳围绕疮口，用药泥敷在上面，用布贴敷，时常更换新药，以痊愈为度，救活很多人。
If the pulse is floating and rapid, treat by dispersing.
If the pulse is deep and excess, treat by purging.
If both exterior and interior are excess, treat by releasing the exterior and attacking the interior.
For numbness, severe pain, or absence of pain, apply moxibustion, combined with anti-toxin measures.
Ding Chuang (carbuncle/furuncle resembling a nail head) gets its name because the lesion resembles a nail covering it. It is mostly caused by excessive consumption of rich and sweet foods, lack of restraint in sexual activity and alcohol intake, leading to the accumulation and knotting of pathogenic toxins, thus generating Ding Chuang. This corresponds to the saying in the Classic: "Changes from rich food can cause large ding on the feet." Some cases arise from sweat dripping into meat, or from accidentally eating dead cattle or horses; caution is necessary. Initially, the lesion has a depressed head with swelling and pain, with colors varying among green, yellow, red, and black without fixed hue. It quickly leads to restlessness and confusion, or may be accompanied by aversion to cold, headache, vomiting, and nausea. Immediately apply moxa cones. If there is no sensation of pain, prick the four sides of the lesion to allow blood to flow out, insert the Hui Chuang Ding Zi (Return Carbuncle Pill) into the pore, and apply a plaster. Simultaneously, administer Wu Xiang Lian Qiao Tang (Five-Spice Forsythia Decoction) or Lou Lu Tang (Rhaponticum Decoction) to promote drainage for efficacy. If pricking yields neither pain nor blood, heat an iron needle red-hot with strong fire and cauterize the lesion until it resembles charcoal, aiming for pain sensation as the effect. Also apply the aforementioned Ding Zi covered with a plaster. After one or two days, when pus discharges and the root emerges, administer Tuo Li Tang San (Support Interior Powder) and treat according to standard protocols. If pricking still causes no pain, and the patient experiences blackening of vision or sees flashes of light, the condition is incurable, indicating that the toxin has entered the zang-fu organs.
A case: A patient suffered from itching on the foot, aversion to cold, vomiting, and periodic confusion. The pulse was floating and rapid. After applying bright moxibustion for over twenty cone-burns, pain was finally felt. One dose of Duo Ming Dan (Life-Extending Pill) was administered, causing swelling to rise. The patient recovered after taking Jing Fang Bai Du San (Schizonepeta and Saposhnikaria Decoction to Overcome Toxicity).
A case: A patient’s left arm was affected. On that day, the entire arm was numb; the next day, half the body became numb. Mental clarity was lost. Bright moxibustion was applied for over twenty cone-burns, initially without pain, until one hundred cone-burns were reached before pain was felt. One dose of Duo Ming Dan caused swelling to rise. The patient recovered using Shen Yi Gao (Miraculous Plaster) and Jing Fang Bai Du San. (This treatment relied on symptoms.)
A case: A woman suddenly experienced aversion to cold, vomiting, numbness in shoulders and arms, and itching in palms. She became confused and unaware of the cause, except for a blister on her hand, which indicated Ding Du (Carbuncle Toxin). Urgent moxibustion of over fifty cone-burns on the affected area revived her consciousness. Another fifty cone-burns induced pain. She recovered after receiving Jing Fang Bai Du San. (Because of aversion to cold, a method to release the exterior was used.)
A case: A carbuncle appeared on the dorsum of a foot. Although small like millet, the toxicity was severe, warranting harsh purgatives. However, due to the patient's frailty, garlic-separated moxibustion was applied for over fifty cone-burns, repeated several times. Pain was felt shortly after. A plaster was applied, followed by one dose of Ren Shen Bai Du San (Ginseng Decoction to Overcome Toxicity), leading to gradual recovery. Lesions in the lower extremities ("extreme yin" areas) are distant and peripheral, making drug delivery difficult. Harsh drugs might damage stomach qi before reaching the site; thus, moxibustion is preferable. (Treatment based on morphology and symptoms.)
A case: A patient infected with smallpox toxin developed over ten carbuncles on the face, presenting with swelling, pain, and a rapid pulse. Jing Fang Bai Du San provided slight relief, but concern remained. One dose of Duo Ming Dan led to full recovery. (Treatment based on pulse and symptoms.)
A case: A sixty-year-old woman had a carbuncle below the right ear at Tian Rong (SI 17). The head was black and crusted, surrounded by blisters oozing yellow fluid. She suffered from whole-body numbness, fever, delirium, and periodic coma. All six pulses were floating and surging. Wu Jin San (Gold Metal Powder) was used to induce sweating. A Pi Zhen (Plana Needle) was used to puncture the lesion. No pain was felt at the center; after puncturing the surrounding area more than ten times, dark purple-black blood flowed, and pain was finally felt. Cun Jin Ding Zi (Inch Gold Pill) was inserted into the wound, and Ti Ding Ding Zi (Lifting Carbuncle Pill) placed on top externally, protected by daily plaster application. After sweating the next day, mental state slightly improved. Po Guan Dan (Coffin-Breaking Pill) was then used to purge. The condition stabilized. After the carbuncle ulcerated and moved, Shou Xiao San (Maintaining Efficacy Powder) was applied topically, and Hong Yu Ding Zi (Red Jade Pill) used for wiping. Eight days later, the carbuncle root discharged. This illustrates the superiority of examining pulse and symptoms to choose between sweating and purging methods, and the sequence of external treatments. Failure to examine pulse and symptoms, and merely seeing fever and delirium to prescribe purgatives or aromatic penetrating drugs, leads to significant error.
People often claim this is not a true carbuncle and suggest taking Wu Xiang and Lian Qiao Tang. However, results vary, causing many errors. This is likely due to failing to assess the deficiency or excess of constitution and the depth of toxin, where the reasons for releasing the exterior or attacking the interior differ. These formulas excel at expelling pathogens and use five types of aromatic penetrating herbs as assistants, alternating with Lou Lu Tang, with Da Huang (Rhubarb Root) as an assistant herb. Da Huang enters the Yangming and Taiyang channels, moves freely without staying, and drains various excess heats. Due to its harsh and swift action, it is called the "General." Although containing tonifying herbs like Ginseng, [missing character, likely Astragalus], Lou Lu, and Licorice, can one avoid the harm caused by such aggressive expulsion?
A case: A patient suffered from chest lesions and whole-body numbness. The pulse was rapid and excess. Urgent pricking released bad blood. Bright moxibustion for several cone-burns induced pain. Feng Fang Tong Sheng San (Saposhnikaria and Angelica Decoction to Unblock and Generate) was taken, resulting in bowel movement and recovery. (Treatment based on pulse and symptoms.)
A case: A lady developed facial carbuncles with severe swelling and pain, un-ulcerated for several days. Pulse and symptoms indicated excess. Jing Fang Bai Du San added with Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) provided slight relief. Believing herself cured, she took Tuo Li San (Support Interior Powder) alone. The condition worsened with intense pain. Realizing her mistake, she took Liang Ge San (Cooling Chest Powder) for two doses. Pain decreased, and swelling ulcerated. She then took Lian Qiao Xiao Du San (Forsythia Detoxification Powder) for over ten doses and recovered. (Treatment based on pulse and symptoms.)
A case: A carbuncle on the lip had persisted for five days. Swelling was hard, pulse rapid, with restlessness and preference for cold. This was caused by accumulated heat in the Stomach channel. First, one dose of Liang Ge San reduced heat by 50-60%. Then, two pills of Duo Ming Dan reduced swelling by 20-30%. Finally, four doses of Jing Fang Bai Du San led to recovery.
(Note: Here, interior attack was performed first based on pulse/symptoms, followed by exterior release. Though pulse/symptoms weren't explicitly stated for the second step, they must have been observed at the time.)
A case: A patient had fever, restlessness, and an excess pulse. Qing Liang Yin (Clearing and Cooling Drink) was used to purge, leading to recovery. (Treatment based on pulse and symptoms.)
The Zheng family all developed carbuncles, mostly on limbs, caused by eating dead beef. Pricking released bad blood, and Zijin Ding (Purple Gold Pill) was taken for complete recovery.
A case: Carbuncle under the lip, with excess pulse and symptoms. According to protocol, purging was indicated. Instead, Tuo Li (Support Interior) was used, resulting in pus flowing from mouth and nose and death. This is called the disaster of "excess reinforcing excess."
An elderly woman had a very painful carbuncle on the big toe. She refused moxibustion and exclusively took poison-dispelling drugs. This depleted genuine qi and strengthened pathogenic qi, leading to untreatability. Poison-dispelling drugs must be able to disperse surface toxins. However, pathogenesis differs in exterior/interior, severity varies, locations differ (upper/lower), and constitutions vary (deficiency/excess). How can they be treated uniformly?
Moreover, for lesions in the lower body, drug power is hard to reach. Relying solely on drugs is too slow. Moxibustion is faster. Therefore, lower body lesions should generally use garlic-separated moxibustion. For non-painful ones, apply bright moxibustion and prick the four sides of the carbuncle to remove bad blood. Insert one pill of Duo Ming Dan into the pore and cover with a plaster. If the lesion is on hands or feet and red lines attack towards the heart/abdomen, prick the end of the line to release bad blood and take Jing Fang Bai Du San. If the line is close to the heart/abdomen, puncture the head to drain bad water and apply a plaster. For numbness, take Duo Ming Dan. For trismus or throat involvement, hold one or two pills of Ding Chuang Dan in the mouth.
Dan Xi used Magnetite powder mixed with vinegar to seal the lesion, causing the root to discharge.
Another prescription: Ten seeds of Ba Dou (Croton Seed), one large Ban Xia (Pinellia Tuber), half a Fu Zi (Aconite Lateral Root), one dung beetle. Grind each into powder, mix with Musk. Measure the lesion size with a paper string around the mouth. Apply medicinal paste, cover with cloth, and change medicine frequently until healed. Many lives have been saved.