凡治痈疽后。补血气。进饮食。实为切要。盖脓血出多。阴阳两虚。此药可以回生起死
其不分经络时令。须在识者触而长之。今医以肿平痛宽。遂以为安。漫不加省。往往于结痂
后两三月或半年。虚证乃见。医者不察。而加补养之功。因而转成他病者多矣。一人因脚弱
。详见后条。
精要云。大凡痈疽不可舍五香汤。
丹溪曰。吾不知良甫之时。有许多大府秘坚。病气郁塞。若是之顽浓。可以骤散而大下
。亦当开陈时之先后。症之可否。庶乎后人不敢孟浪杀人。殊不知此小寒热。或者由其气血
不和而然。便以为外感而行表散。害人最速。
此表里气血药也。治一切风毒。积热疮肿。脉候弦、洪、实、数、浮、紧。气血盛实者
丹溪曰。秘传以是方加人参、黄 、苍术、赤茯苓、金银花。名消肿托里散。虽以参、
主。复云人参无亦可。则又不能无疑而难用也。且临症加减。须较表里。如表症多者。当从
此方以辛甘为主散之也。里症多者。须当从变。
精要云。大黄宣热散毒。治痈疽要药。痈疽始作。皆须大黄等汤极转利之。排日不废。
又曰。疮疽泄利。皆是恶候。
丹溪曰。此皆不能使人无疑。借曰用大黄。恐因大府秘而病体实。有积热沉痼者发也。
破结导滞。推令转动而已。岂可谓极转利之。而且排日不废耶若下利之后。又与利药。恐非
防微杜渐之意。疮之始作。肿在肌肉。若非大满大坚实之症。自当行仲景发表之法。借五香
汤为例。散之于外可也。何必遽用峻下之药。夺其里哉。或曰。痈疽用大黄走泄以去毒。孙
真人尝言之。良甫祖述其说耳。曰。孙以盛名行奇术于公卿间者。良甫宋人。若其交游亦皆
公卿之家。肉食之辈。固皆捷效。今不分贫富苦乐。一概用之宁免孟浪之过乎。况有心劳而
虚者。忧怒而虚者。强力劳动而虚者。大醉饱而虚者。皆气少而涩。血少而浊。生疽固是难
治。若大府秘而稍安谷。甘淡薄而守戒律。犹为可治。不免尚费调补。苟因旬日半月。大府
秘实。不知亦有其气不降而然者。便以为实而行大黄。岂不杀人。
凡是治疗痈疽之后，补充气血、增进饮食，确实是非常关键紧要的。因为脓血排出过多，导致阴阳两虚，这个方药可以挽回生命、起死回生。但是不分经络和时令情况，必须在有识之士的指导下使用以扶助正气。现在的医生看到肿块平复、疼痛减轻，就认为已经痊愈，漫不经心不加省察，往往在结痂后两三个月或半年，虚证才显现出来。医生没有察觉，反而加上补养的措施，因而转变成其他疾病的很多。一个人因为脚弱（详见后文）。
丹溪说：我不知道良甫那个时代，有多少人大便秘结坚硬，病气郁塞，病情如此顽固浓重，可以骤然消散并大力攻下吗？也应当陈述时机的先后、病症是否适宜，这样后人就不敢鲁莽杀人了。殊不知这种轻微寒热，或许是因为气血不和所致，却误认为是外感而进行解表发散，害人性命最快。
这是调和表里气血的药物。治疗一切风毒、积热疮肿。脉象表现为弦、洪、实、数、浮、紧。气血盛实的人……
丹溪说：秘传的这个方子加入人参、黄芪、苍术、赤茯苓、金银花，名叫消肿托里散。虽然以参、芪为主药，却又说人参不用也可以，这就让人不能不怀疑而难以使用了。况且临症加减，必须比较表里情况。如表症多的，应当从此方以辛甘为主来发散它；里症多的，必须当从变通。
《精要》说：大黄宣散热毒，是治疗痈疽的要药。痈疽刚开始发作，都必须用大黄等汤剂极力通便泻下。每天不停止。又说：疮疽出现泄利，都是恶候。
丹溪说：这都不能不让人产生疑问。假如使用大黄，恐怕是因为大便秘结且病人体质壮实，有积热沉疴发作。只是破除结滞、导引积滞，推动其转动而已。怎么能说是极力通便泻下，而且每天不停止呢？如果在下利之后，又给予泻利的药物，恐怕不符合防微杜渐的本意。疮疡刚开始发作，肿胀在肌肉层面，如果不是大满大坚实的症状，自然应当采用张仲景发表的方法。借五香汤为例，从外部发散就可以了。何必急于使用峻猛的泻下药，损伤其里气呢？有人说：痈疽使用大黄走泄以去除毒素，孙真人曾经说过。良甫只是遵循他的学说罢了。我说：孙真人是以盛名在公卿之间施行奇特医术的人，良甫是宋人，如果他的交游也都是公卿之家，吃肉食的人，固然都见效快。现在不分贫富苦乐，一概使用，难道能避免鲁莽的错误吗？何况有心劳致虚的，忧怒致虚的，强力劳动致虚的，大醉饱食致虚的，都是气少而涩，血少而浊。生疽固然是难治，如果大便秘结但稍微能吃下食物，饮食甘淡薄味并遵守戒律，还是可治的，不免还需要费些调补功夫。如果因为十天半月大便秘结坚实，不知道也有因为气不下降导致的，就以为是实证而行用大黄，岂不是杀人？
In the treatment of carbuncles and sores after their onset, replenishing Qi and Blood and promoting dietary intake are indeed crucial. This is because excessive discharge of pus and blood leads to deficiency in both Yin and Yang; this prescription can restore life and revive the dying. However, regardless of the meridians involved or the season, it must be used under the guidance of knowledgeable practitioners to support healthy Qi. Modern physicians, seeing the swelling subside and pain alleviate, consider the condition cured and neglect further observation. Often, two to three months or even half a year after scabbing forms, deficiency syndromes manifest. Physicians fail to recognize this and instead apply tonifying treatments, frequently resulting in other diseases. One case involves weakness in the legs (see subsequent section).
The *Jingyao* states: In general, for carbuncles and sores, one should not discard Wuxiang Tang (Five Fragrances Decoction).
Danxi said: I do not know if, in Liangfu's time, there were many cases of severe constipation with stagnant pathogenic Qi and stubborn, thickened conditions that could be suddenly resolved and aggressively purged. One should explain the timing and suitability of symptoms, so that later generations dare not recklessly cause death. Little do they realize that slight chills and fever may result from disharmony of Qi and Blood; mistaking this for an external contraction and applying diaphoresis harms patients most rapidly.
This is a formula regulating the exterior and interior, Qi and Blood. It treats all wind-toxins and accumulated heat causing sores and swellings. The pulse may appear wiry, surging, excess, rapid, floating, or tight. For those with abundant and excess Qi and Blood...
Danxi said: A secret transmission adds Ginseng Radix (Renshen), Astragali Radix (Huangqi), Atractylodis Rhizoma (Cangzhu), Poria (Fuling), and Lonicerae Japonicae Flos (Jinyinhua) to this formula, naming it Xiao Zhong Tuo Li San (Reduce Swelling and Support Interior Powder). Although it lists Ginseng and Astragalus as main ingredients, it also states that Ginseng is optional, which raises doubts and makes its use difficult. Furthermore, modifications during clinical practice must compare exterior and interior conditions. If exterior symptoms predominate, one should follow this formula using pungent and sweet herbs to disperse them; if interior symptoms predominate, variations must be applied.
The *Jingyao* states: Dahuang (Rhei Radix et Rhizoma) disseminates heat and disperses toxins; it is a key herb for treating carbuncles and sores. When carbuncles and sores first arise, one must use decoctions containing Dahuang to vigorously promote bowel movements. This should be done daily without cessation. It also states: Diarrhea in sores and carbuncles is always a ominous sign.
Danxi said: These statements raise doubts. Even if Dahuang is used, it might be because of constipation combined with a robust constitution and entrenched accumulated heat. Its function is merely to break stagnation and guide blockage, promoting movement. How can it be described as vigorously purging daily? If laxatives are given after diarrhea has already occurred, it contradicts the principle of preventing disease progression. When a sore first appears, swelling is in the muscle layer. Unless there is severe fullness and hardness, one should naturally adopt Zhang Zhongjing’s method of releasing the exterior. Taking Wuxiang Tang as an example, dispersing from the outside is sufficient. Why rush to use harsh purgatives that damage the interior? Some say: Using Dahuang to drain and remove toxins in carbuncles was mentioned by Sun Simiao. Liangfu simply followed his theory. I reply: Sun Simiao practiced unique arts among nobles with great fame. Liangfu was a Song dynasty figure; if his associates were also nobles consuming rich diets, quick effects were natural. Today, applying this indiscriminately regardless of poverty or wealth invites reckless error. Moreover, those deficient due to mental exertion, anger/worry, strenuous labor, or overindulgence in alcohol and food suffer from scant Qi (stagnant) and scant Blood (turbid). Carbuncles in such cases are hard to treat. If constipation exists but appetite remains slightly intact, and diet is bland with disciplined habits, it is still treatable, though requiring adjustment and tonification. If one assumes constipation lasting ten days or half a month indicates excess syndrome and uses Dahuang, ignoring that it may stem from failing descent of Qi, is this not killing people?