李氏云∶余之所着方论，靡不周备，但欲使治者一一玩味，次第用之，无有不效。今略
书用药要领节次于后∶
一、初患痈疽，便服内托散，以免后来口舌生疮，仍用骑竹马或隔蒜灸。
一、服五香连翘汤，如大便疏快即止，仍量人虚实。
一、痈疽溃后，宜服排脓内补散，若呕逆，用木香汤下。
一、痈疽初作，便宜灼艾，及麦饭石膏涂四围，中留口出毒。如疮小，通敷之，既溃，
用神异膏贴之。
一、痈疽已溃，日用猪蹄汤淋洗，将愈之际，三日一次。
一、痈疽将敛，宜用神异膏，如毒未尽，不可遽用生肌之剂。
一、痈疽将安，宜用加味十全汤补其气血，庶肌肉易生。
一、背疽多先渴而后发，或先疽而后渴，不救多矣。若服加减八味丸，非特杜绝渴疾，
抑且大滋气血，生长肌肉。
愚按∶前症及诸治法，各附四十七等论，当审用之。
一、痈疽呕逆有二∶一因初发不服内托散，伏热在心；一因脾气不正。若因伏热在心
者，心烦身热， 肿作痛，宜用内托散三两服。若因脾气不正者，则不烦热，或闻秽气作
呕，宜用嘉禾散。如有寒热，用不换金正气散，五更初兼服山药丸以补肾。
愚按∶前症治法，当与第十一论参看。
李氏云∶痈疽呕逆，是毒瓦斯冲心，非脾胃之冷，当服内托散。杨氏云∶鼻衄初愈，不曾
表汗，毒在经络，则背发大疽，自肩下连腰胁肿硬如石，其色紫黑，以凉药投之，终夜大
呕，连进托里散，呕止疮溃，赤水淋漓，四十日而愈。又有患 者，痛过彻呕，服此即止。
今有病疽不服此药者，故引杨氏之言，以解世人之惑。
愚按∶用药之法，有是病必用是药。但今之脾胃虚寒，气逆痰滞而呕吐者，十居八九；
热毒内攻而呕吐者，十才一二。当参首论及第十一论主之。
李氏说：我所撰写的方剂和论述，无不周全完备，只是希望治疗者逐一仔细研读，按顺序使用，没有不有效的。现在简要书写用药的要领和次序如下：
一、初次患痈疽时，立即服用内托散，以避免后来出现口舌生疮的情况，同时使用骑竹马灸法或隔蒜灸法。
一、服用五香连翘汤，如果大便通畅顺畅就停止服用，同时根据患者的虚实情况酌情调整。
一、痈疽溃破后，适宜服用排脓内补散，如果出现呕吐逆气症状，用木香汤送服。
一、痈疽初起时，应当及时施灸，并在疮疡四周涂抹麦饭石膏，中间留出孔洞以排出毒邪。如果疮疡较小，则全面涂抹；已经溃破后，使用神异膏贴敷。
一、痈疽已经溃破，每天用猪蹄汤淋洗患处，接近痊愈时，改为每三天一次。
一、痈疽即将收敛愈合时，适宜使用神异膏，如果毒邪未尽，不可急于使用生肌的药物。
一、痈疽病情趋于稳定时，适宜服用加味十全汤来补益气血，这样肌肉容易生长。
一、背疽患者大多先感到口渴而后发病，或者先发背疽而后感到口渴，这种情况大多难以救治。如果服用加减八味丸，不仅能杜绝口渴的病症，而且能大补气血，促进肌肉生长。
我按语：上述病症及各种治疗方法，分别附在第四十七等篇论中，应当审慎选用。
一、痈疽引起的呕吐逆气有两种原因：一种是因为初发时不服用内托散，导致伏热蕴结在心；另一种是因为脾气不正。如果是因伏热在心引起的，会出现心烦身热、肿胀疼痛的症状，适宜服用三两内托散。如果是因脾气不正引起的，则没有烦热感，或者闻到秽浊气味就会作呕，适宜服用嘉禾散。如果有寒热往来症状，使用不换金正气散，在五更初兼服山药丸以补肾。
我按语：上述病症的治疗方法，应当与第十一篇论参看。
李氏说：痈疽引起的呕吐逆气，是毒瓦斯冲犯心脏所致，并非脾胃虚冷，应当服用内托散。杨氏说：鼻衄（鼻出血）刚刚痊愈，未曾通过发汗解表，毒邪留在经络，于是背部发生大疽，从肩部向下连接腰胁，肿胀坚硬如石头，颜色紫黑，如果用凉药投治，整夜剧烈呕吐，连续进服托里散后，呕吐停止且疮疡溃破，流出赤色脓水淋漓，四十天后痊愈。又有患有此病的人，疼痛剧烈彻骨并引发呕吐，服用此药后呕吐即止。现在有患疽病不服用此药的人，所以引用杨氏的话，来解除世人的疑惑。
我按语：用药的原则，是有这种病就必须用这种药。但是现在脾胃虚寒、气逆痰滞而呕吐的患者，占十分之八九；因热毒内攻而呕吐的患者，仅占十分之一二。应当参考第一篇论及第十一篇论的主旨来主治。
Li stated: The prescriptions and discussions I have authored are comprehensive and complete. My intention is for practitioners to study them carefully one by one and apply them in sequence, ensuring efficacy without exception. Herein, I briefly outline the essential principles and sequence of medication usage:
1. Upon the initial onset of carbuncle and ulcer (Yong Ju), immediately administer Neituo San (Internal Support Powder) to prevent subsequent mouth and tongue ulcers. Simultaneously, employ Qizhuma moxibustion (Bamboo Horse Moxibustion) or garlic-separated moxibustion.
2. Administer Wuxiang Liaoqiao Tang (Five Fragrant Forsythia Decoction). Discontinue use once bowel movements become loose and smooth, adjusting dosage according to the patient’s deficiency or excess condition.
3. After the carbuncle and ulcer have suppurated and ruptured, it is appropriate to take Painong Neibu San (Pus-Draining Internal-Nourishing Powder). If vomiting and regurgitation occur, administer this powder using Muxiang Tang (Aucklandia Decoction) as a vehicle.
4. When carbuncle and ulcer first arise, moxibustion should be applied promptly. Apply Maifan Shi Gao (Wheat Meal Stone Gypsum) around the periphery of the lesion, leaving the center open to allow the discharge of toxins. If the lesion is small, apply it comprehensively; after rupture, apply Shenyi Gao (Divine Efficacy Ointment).
5. For already ruptured carbuncles and ulcers, wash the area daily with Zhuti Tang (Pig Trotter Decoction). As healing approaches, reduce frequency to once every three days.
6. When the carbuncle and ulcer are nearing closure, Shenyi Gao (Divine Efficacy Ointment) is suitable. If toxins remain, do not hastily use agents that promote tissue regeneration.
7. When the condition stabilizes, Jiawei Shiquan Tang (Modified Complete Ten Ingredients Decoction) should be used to tonify Qi and Blood, facilitating easier muscle growth.
8. Back carbuncles often present with thirst preceding the eruption, or eruption preceding thirst; such cases are frequently incurable. If Jiawei Bawei Wan (Modified Eight-Ingredient Pill) is administered, it not only prevents thirst but also greatly nourishes Qi and Blood, promoting muscle growth.
My commentary: The aforementioned symptoms and various treatment methods are detailed in Treatise 47 et al.; they should be selected with prudence.
1. Vomiting and regurgitation caused by carbuncle and ulcer have two etiologies: one is due to failing to take Neituo San at the onset, leading to latent heat accumulating in the Heart; the other is due to dysfunction of the Spleen Qi. If caused by latent heat in the Heart, symptoms include mental restlessness, fever, swelling, and pain; administer 3 liang of Neituo San. If caused by Spleen Qi dysfunction, there is no restlessness or fever, but nausea may be triggered by foul odors; administer Jiahe San (Harvesting Grain Powder). If chills and fever are present, use Buhuanjin Zhengqi San (Golden Exchange Rectifying Qi Powder); at dawn (wugeng), additionally administer Shanyao Wan (Dioscorea Pill) to tonify the Kidney.
My commentary: The treatment methods for these conditions should be cross-referenced with Treatise 11.
Li stated: Vomiting and regurgitation in carbuncle and ulcer result from toxic vapors rushing to the Heart, not from cold in the Spleen and Stomach; therefore, Neituo San should be taken. Yang stated: After epistaxis has just healed, if sweating was not induced to release the exterior, toxins remain in the meridians, leading to a large back carbuncle. This extends from the shoulder down to the waist and hypochondrium, becoming swollen, hard as stone, and purple-black. If treated with cooling herbs, severe vomiting occurs throughout the night. Continuous administration of Tuoli San (Support Interior Powder) stopped the vomiting and allowed the ulcer to rupture, discharging red pus profusely; recovery occurred in forty days. Another patient suffered from excruciating pain penetrating to the bones accompanied by vomiting, which ceased upon taking this medicine. Since some patients with carbuncles refuse to take this medicine, I cite Yang’s words to resolve worldly doubts.
My commentary: The principle of medication application is that specific diseases require specific medicines. However, currently, eight or nine out of ten cases of vomiting are due to Spleen-Stomach deficiency-cold, rebellious Qi, and phlegm stagnation; only one or two out of ten are due to internal attack by heat-toxin. Treatment should be guided by the principles outlined in Treatise 1 and Treatise 11.