初虞世云∶凡痈疽始作，须以大黄等药亟转利之，勿以困苦为念。若与其溃烂而死，不
若利之而死，况有生道哉。古人立法，率用五香、连翘、漏芦等药，贫乏者单煎大黄汤以利
之。至于脓溃，乃服黄 等药以排脓，《千金》、《外台》备矣。世以疮发于外，不行转利而死
者多矣，悲夫！
愚按∶前症若肿高 痛，脏腑闭结，属内外俱实，当用前药泻之。若漫肿微痛，脏腑不
实，属内外俱虚，当用内托补之。若患肿无头，肉色不变，当助胃壮气，令其内消。若疼痛
不止， 肿不消，当用人参黄 散以托里排脓。若饮食少思，肌肉不生，当用参 托里散以
补养脾胃。丹溪云∶痈疽因积毒在脏腑，当先助胃壮气，使根本坚固，次以行经活血药佐
之，参以经络时令，使毒瓦斯外泄。治之早者，可以内消，此内托之旨也。又云；肿疡内外皆
壅，宜以托里表散为主，如用大黄，宁无孟浪之非；溃疡内外皆虚，宜以补接为主，如用香
散，未免虚虚之失。此盖古今气禀不同，治宜审之。
陈无择云∶痈则皮薄肿高，疽则皮浓肿坚，初发并宜灼艾。惟痈脓成则宜针，疽脓成则
宜烙，当审察其症， 利其毒，补托其里。然痈疽冠于杂病之首，治失次序，多致枉夭，故
集得效灸法，以贻学人，庶不致妄投也。
愚按∶前症若发热烦渴，大便秘结者，由邪蓄于内，宜黄连内 汤，以泄内毒。若头痛
拘急，发热恶寒者，由邪客于外，宜人参败毒散，以散表邪。若肿痛 赤，发热作渴，此毒
气凝于肉里，宜仙方活命饮，解散其毒。若食少体倦，发热恶寒，此中气虚弱，宜六君子汤，
以补脾胃。
初虞世说：凡是痈疽刚开始发作时，必须立即使用大黄等药物进行通腑泻下，不要顾虑患者身体虚弱而受不住攻伐。与其让疮疡溃烂导致死亡，不如通过泻下通便后死亡，况且还有生存的希望呢。古人制定治疗法则，通常使用五香、连翘、漏芦等药物，贫穷的人就单煎大黄汤来通利大便。等到脓液形成并溃破后，才服用黄芪等药物来排出脓液，《千金方》和《外台秘要》中对此记载得很详细。世人认为疮疡发于体表，不进行通腑泻下而导致死亡的很多啊，真是可悲！
我认为：上述病症如果肿胀高突且疼痛剧烈，伴有脏腑闭结不通，属于内外都实证，应当使用前文提到的药物进行泻下攻逐。如果肿胀平塌漫散且疼痛轻微，脏腑功能不充实，属于内外都虚证，应当使用内托法配合补益药物治疗。如果患处肿胀但没有脓头，皮肤颜色没有改变，应当扶助胃气、强壮元气，使毒邪在内部消散。如果疼痛不止，肿胀不消退，应当使用人参黄芪散来托毒排脓。如果饮食减少、食欲不振，肌肉不生肌长肉，应当使用参苓托里散来补养脾胃。丹溪说：痈疽是因为积毒存在于脏腑中，应当先扶助胃气、强壮元气，使根本坚固，其次配合使用疏通经络、活血的药物，参考经络与时令的关系，使毒邪从外部排泄。治疗得早的，可以使毒邪在体内消散，这就是内托法的宗旨。又说：肿疡（未溃破）阶段内外气血皆壅滞，应当以托里透表发散为主，如果使用大黄，难道不是过于鲁莽的错误吗？溃疡（已溃破）阶段内外皆虚，应当以补益接续为主，如果使用五香等辛散药物，未免会造成虚者更虚的过失。这大概是古今人的体质禀赋不同，治疗时应当仔细审察。
陈无择说：痈的特点是皮薄、肿胀高突；疽的特点是皮厚、肿胀坚硬。初发时都适宜用艾灸灼治。只有当痈成脓时才适宜针刺，疽成脓时才适宜火烙，应当仔细审察症状，引导毒邪外出，补益托毒于内。然而痈疽排在杂病的首位，如果治疗失去次序，往往导致枉然夭折，所以收集了有效的灸法，留给学习的人，希望不至于胡乱投药。
我认为：上述病症如果出现发热、烦躁口渴、大便秘结的情况，是由于邪气蓄积在体内，适宜使用黄连内托汤，以泄除体内的毒邪。如果出现头痛、肢体拘急、发热、恶寒的情况，是由于邪气客居在体表，适宜使用人参败毒散，以疏散体表的邪气。如果出现肿痛、局部发红、发热、口渴的情况，这是毒气凝结在肌肉腠理之间，适宜使用仙方活命饮，以解散其毒邪。如果饮食少、身体疲倦、发热、恶寒，这是中气虚弱，适宜使用六君子汤，以补益脾胃。
Chu Yushi stated: Whenever a carbuncle or ulcer (Yongju) first appears, one must urgently administer purgatives such as Rhizoma et Radix Rhei (Dahuang) to promote bowel movements, without worrying about the patient's debility. It is better to die after purgation than to die from the rotting and spreading of the sore; moreover, there remains a chance of survival. The ancients established treatment principles, generally using herbs such as Xiang Ru (Moslae Herba), Fructus Forsythiae (Lianqiao), and Radix Euphorbiae Humifusae (Loulu). For those in poverty, decocting Rhizoma et Radix Rhei (Dahuang) alone was used to promote defecation. Only after the pus has formed and ruptured should one take Astragali Radix (Huangqi) and other herbs to discharge pus, as detailed in *Qianjin Fang* and *Waitai Miyao*. In the world, many people die because they do not perform purgation for sores that appear on the exterior, which is truly tragic!
I observe: If the aforementioned symptoms present with high, protruding swelling and severe pain, accompanied by constipation and closure of the zang-fu organs, it belongs to excess syndrome both internally and externally, and one should use the aforementioned drugs to purge. If the swelling is flat and diffuse with slight pain, and the zang-fu organs are deficient, it belongs to deficiency syndrome both internally and externally, and one should use internal support methods combined with tonification. If the swollen area has no head and the skin color remains unchanged, one should assist the stomach qi and strengthen the vital energy to cause internal resolution. If pain persists and swelling does not subside, one should use Ren Shen Huang Qi San (Ginseng and Astragalus Powder) to support the interior and discharge pus. If dietary intake is poor and muscles fail to regenerate, one should use Shen Ling Tuo Li San (Ginseng and Atractylodes Powder to Support the Interior) to nourish the spleen and stomach. Danxi stated: Carbuncles and ulcers arise from accumulated toxins in the zang-fu organs. One should first assist the stomach qi and strengthen the vital energy to solidify the root, then supplement with herbs that unblock meridians and invigorate blood, referencing the meridians and seasonal timing to allow the toxic factors to be excreted externally. Early treatment can lead to internal resolution; this is the essence of the internal support method. He further stated: During the stage of a non-ulcerated sore (Zhongyang), where qi and blood are congested both internally and externally, the primary approach should be supporting the interior and dispersing via the exterior. Using Rhizoma et Radix Rhei (Dahuang) would surely be a rash error. During the stage of an ulcerated sore (Kuangyang), where both interior and exterior are deficient, the primary approach should be tonification and restoration. Using aromatic dispersants would inevitably cause the deficiency to worsen. This is likely due to differences in constitutional endowment between ancient and modern times; treatment requires careful examination.
Chen Wuyue stated: A carbuncle (Yong) is characterized by thin skin and high swelling; a chancre/ulcer (Ju) is characterized by thick skin and hard swelling. At the initial stage, moxibustion burning is suitable for both. Only when pus forms in a carbuncle should it be punctured with a needle; when pus forms in a chancre, cauterization should be used. One must carefully examine the symptoms, guide the toxin outwards, and tonify/support the interior. However, carbuncles and ulcers are listed at the beginning of miscellaneous diseases. If treatment order is lost, it often leads to premature death. Therefore, I have collected effective moxibustion methods to leave for students, hoping to prevent reckless medication.
I observe: If the aforementioned symptoms include fever, irritability, thirst, and dry stool, it is due to pathogenic factors accumulating internally. One should use Huang Lian Nei Tuo Tang (Coptis Internal Support Decoction) to drain internal toxins. If headache, stiffness, fever, and aversion to cold occur, it is due to pathogenic factors lodging in the exterior. One should use Ren Shen Bai Du San (Ginseng Detoxifying Powder) to disperse exterior pathogens. If swelling, pain, redness, fever, and thirst occur, it indicates toxic qi condensing within the flesh and interstices. One should use Xian Fang Huo Ming Yin (Immortal Formula for Preserving Life Infusion) to dissipate the toxicity. If poor appetite, physical fatigue, fever, and aversion to cold occur, it indicates weakness of middle qi. One should use Liu Jun Zi Tang (Six Gentlemen Decoction) to tonify the spleen and stomach.