伍氏曰∶疮肿赤色，按之色不变者，此脓已成矣。按之随手赤色者，其亦有脓也。按之
白者，良久方赤，此游毒已息，可就赤白尽处灸断，赤肿自消。凡痈疽，以手按之，若牢
，未有脓也。若半软半 ，已有脓也。又按肿上，不热者为无脓。热甚者为有脓，宜急破之。
愚按∶疮疡毒瓦斯已结而不发者，法当补其血气，使脓速成而针之。其脓既溃，宜培养脾
胃以生肌敛口。大凡疮疡脓血既溃，当大补血气为先，虽有他症，当以末治。
附治验
二守施希禄，项患毒，脓已成，因畏针， 延至胸，色赤如霞，其脉滑数，饮食不进，
月余不寐，肢体甚倦。此气血虚，而不能溃也。余针之，肿出即睡，觉而思食，用托里药，
两月而愈。
州守胡延器，脓熟不溃，倦怠发热。余为针之，脓遂涌出，已而发热恶寒，大渴不止，
此虚之极也。服人参黄 汤二剂，热愈甚，又二剂始应。再以当归补血汤数剂渐痊。
一老人，腿患痈，脓自溃，忽发昏瞀，脉细微，此血虚极也。以大补之剂而苏。
一弱人，流注内溃，出败脓五六碗，是时口眼歪斜。以独参汤加附子二钱，二剂少愈，
更以十全大补之剂，月余而痊。大抵疮疡脓血既泄，当大补气血为先，虽有他症，当以末
治之。
治痈久不合，其肉白而脓少者，此气血俱虚，不能潮运，而疮口冷涩也。每日用艾叶一
把煎汤，避风热洗，及烧松香烟熏之，更以神异膏贴之，必须守禁调理，否则不效。
愚按∶前症，果因寒邪凝滞气血，不能荣卫，宜用斯法祛散寒邪，补接阳气，其功甚大。
若因血气虚弱，不能潮会疮口，必用补脾胃生气血为善。丹溪先生云∶诸经惟少阳、厥阴之
生痈疽，宜预防之，以其多气少血也。血少而肌肉难长，疮久未合，必成败症。苟反用驱利
毒药，以伐其阴分之血，祸不旋踵矣。
附治验
地官李孟卿，环跳穴患疽，内服外敷，皆败毒寒剂，因痛极刺之，脓瘀大泄，疮口开
张，其色紫黯，右关脉浮大。此胃气复伤，不能荣于患处也。余以豆豉饼、六君子加藿香、
砂仁、炮姜数剂，由是胃气醒而饮食渐进，患处暖而肌肉渐生，再以十全大补汤而愈。
大尹都承庆，患附骨疽，内痛如锥，外色不变，势不可消。喜其未用寒剂，只因痛伤胃
气，而不思饮食，用六君子汤治之，饮食少进。更以十全大补，二十余剂而脓成，针去。仍
以大补汤倍用参、 、归、术，加麦门、五味、远志、贝母，数服，脓渐止，而疮亦愈。按
二症，盖因湿热滞于肉理，真气不能运化。其始治宜实脾土，和气血，隔蒜灸，而疽自消矣。
治背疽糁药方
李氏云∶龙游有患背疽者，大溃，五脏仅隔膜耳，自谓必死，用鲫鱼去肠，实以羯羊粪，烘
焦为末，干糁之，疮口自收。此出洪氏方，屡用有效，故附于此，须候脓少欲生肌肉时用之。
附治验
黄汝耘，患发背，用生肌药益溃，大便泄泻，其脉微缓。余谓脾胃虚，先用二神丸以止
其泻，次用大补药以固其本，更用猪蹄汤洗患处，用黄 末以涂其外。喜其初起曾用艾灸，
毒不内攻，两月而愈。
许鸿胪，发背十余日，肿硬木闷，肉色不变，脉沉而实，此毒在内。先以黄连内 汤，
更以消毒托里药，其毒始发。奈欲速愈，急用生肌药，患处如负石，身如火 ，遂致不起。
伍氏说：疮肿呈现赤色，用手按压后颜色不改变的，这是脓已经形成了。按压后立刻变红的，也已经有脓了。按压后发白的，很久之后才变红，这说明游走的毒气已经平息，可以在红肿消退、白赤交界的地方施灸以截断病势，红肿自然会消散。凡是痈疽，用手按压，如果质地坚硬，说明还没有脓。如果半软半硬，说明已经有脓了。另外按压肿胀处，不发热的说明没有脓。发热明显的说明有脓，应当紧急破溃排脓。
我按语：疮疡的毒邪已经结聚但不能发散出来的，治法应当补益气血，使脓液迅速形成然后针刺排脓。脓液既已溃破，应当培养脾胃之气以生肌敛口。大凡疮疡脓血已经溃破之后，应当以大补气血为优先，即使有其他症状，也应当作为次要处理。
附治疗验案
二守施希禄，颈部患毒疮，脓已形成，因为害怕针刺，拖延导致毒气蔓延至胸部，颜色红如晚霞，脉象滑数，饮食不进，一个多月不能入睡，肢体非常疲倦。这是气血虚弱，不能托毒外出的缘故。我为他针刺，肿势消退后即能入睡，醒来便想吃东西，使用托里药，两个月后痊愈。
州守胡延器，脓熟但不溃破，倦怠发热。我为他针刺，脓液随即涌出，随后出现发热恶寒，极度口渴不止，这是虚损到了极点。服用人参黄芪汤两剂，热势反而更重，又服两剂才开始见效。再服用当归补血汤几剂，逐渐康复。
一位老人，腿部患痈，脓自行溃破，忽然发生昏厥神志不清，脉象细微，这是血虚到了极点的表现。用大补药剂后苏醒。
一位体弱的人，流注内溃，排出败脓五六碗，当时口眼歪斜。用独参汤加附子二钱，两剂后稍见好转，再用十全大补药剂，一个多月后痊愈。大抵疮疡脓血既已泄出，应当以大补气血为先，即使有其他病症，也应当作为次要处理。
治疗痈疽久不愈合，肌肉苍白而脓液稀少的，这是气血俱虚，不能运行滋养，导致疮口寒冷涩滞。每天用艾叶一把煎汤，避开风热清洗，并烧松香烟熏患处，再用神异膏贴敷，必须严格遵守禁忌进行调理，否则无效。
我按语：上述病症，果真是因寒邪凝滞气血，不能荣养卫气，适宜用这种方法祛除寒邪，补接阳气，功效很大。如果是因气血虚弱，不能汇聚于疮口，必须补益脾胃以生气血才是好的。丹溪先生说：各经中只有少阳、厥阴容易发生痈疽，应当预防，因为它们多气少血。血少则肌肉难以生长，疮口久久不合，必然变成坏症。如果反而使用攻逐利下的毒药，来损伤阴分之血，灾祸很快就会降临。
附治疗验案
地官李孟卿，环跳穴患疽，内服外敷都是败毒寒凉药物，因为疼痛剧烈而刺破，脓瘀大量流出，疮口开张，颜色紫暗，右关脉浮大。这是胃气再次受伤，不能荣养患处的缘故。我用豆豉饼、六君子汤加藿香、砂仁、炮姜等药数剂，从此胃气苏醒而饮食逐渐增加，患处温暖而肌肉逐渐生长，再用十全大补汤而痊愈。
大尹都承庆，患附骨疽，内部疼痛如锥刺，外部颜色不变，病势不可消除。庆幸他没有使用寒凉药物，只是因为疼痛损伤了胃气，不思饮食，用六君子汤治疗，饮食稍进。再用十全大补汤，二十多剂后脓成，针刺排脓。仍然用大补汤倍用人参、黄芪、当归、白术，加麦门冬、五味子、远志、贝母，服用几剂，脓渐止，疮口也愈合了。分析这两个病例，大概是因为湿热滞留于肌肉纹理之间，真气不能运化。其初始治疗宜实脾土，调和气血，隔蒜灸，疽毒自然消除。
治疗背疽撒药方
李氏说：龙游有一人患背疽，大面积溃烂，五脏仅隔着一层隔膜而已，自认为必死无疑，用鲫鱼去肠，填入羯羊粪，烘焦研为末，干撒在疮口上，疮口自然收敛。此方出自洪氏，屡用有效，所以附记于此，须等到脓少欲生肌肉时使用。
附治疗验案
黄汝耘，患发背，使用生肌药反而更加溃烂，大便泄泻，脉象微缓。我认为这是脾胃虚弱，先用二神丸以止住腹泻，再用大补药以固本，更用猪蹄汤清洗患处，用黄芪末涂在外表。庆幸其初起时曾用艾灸，毒邪未内攻，两个月后痊愈。
许鸿胪，发背十余日，肿硬木闷，肉色不变，脉沉而实，这是毒邪在体内。先用黄连内疏汤，再用消毒托里药，毒邪才发出。奈何想要快速痊愈，急用生肌药，患处感觉像背着石头，身体如火烧，最终导致死亡。
Wu stated: When a carbuncle or swelling is red, and the color does not change upon pressure, this indicates that pus has already formed. If it turns red immediately upon pressure, pus is also present. If it turns white upon pressure and only becomes red after a long time, this signifies that the wandering toxin has subsided; moxibustion can be applied at the boundary where redness and pallor meet to cut off the disease progression, and the redness and swelling will naturally dissipate. For all carbuncles and sores, if palpation reveals hardness, no pus is present. If it is half soft and half hard, pus is present. Furthermore, if the swollen area is not hot to the touch, there is no pus; if it is very hot, pus is present, and urgent incision and drainage are indicated.
My commentary: When the toxic qi of a sore or ulcer has condensed but cannot erupt, the treatment method should involve tonifying blood and qi to hasten pus formation, followed by needle drainage. Once the pus has erupted, one should nurture the spleen and stomach to generate flesh and close the wound. Generally, after a sore or ulcer has erupted with pus and blood, the priority must be massive tonification of blood and qi; even if other symptoms exist, they should be treated as secondary.
Attached Treatment Cases
Shi Xilu, an official of the Second Rank, suffered from a toxic sore on the neck. Pus had already formed, but due to fear of needles, he delayed treatment until the toxicity spread to the chest. The area was red like rosy clouds, the pulse was slippery and rapid, he could not eat, had not slept for over a month, and his limbs were extremely fatigued. This was due to deficiency of blood and qi, preventing eruption. I needled him; the swelling subsided, and he fell asleep immediately. Upon waking, he desired food. He used interior-supporting medicines and recovered in two months.
Hu Yanqi, a prefectural governor, had ripe pus that did not erupt, accompanied by fatigue and fever. I needled him, and pus gushed out. Subsequently, he experienced fever and aversion to cold, with extreme unquenchable thirst. This indicated extreme deficiency. After taking two doses of Ginseng and Astragalus Decoction (Renshen Huangqi Tang), the heat intensified. After two more doses, it began to respond. He then took several doses of Danggui Buxue Tang (Angelica Sinensis Blood-Nourishing Decoction) and gradually recovered.
An elderly man suffered from a carbuncle on his leg. The pus ruptured spontaneously, but he suddenly became comatose and confused, with a fine and minute pulse. This indicated extreme blood deficiency. He revived after receiving massive tonifying agents.
A frail person suffered from internal rupture of migrating abscesses (Liuzhu), expelling five or six bowls of foul pus. At that time, his mouth and eyes deviated. He took Dushen Tang (Single Ginseng Decoction) with two qian of Aconite Root (Fuzi). After two doses, he improved slightly. He then took Shiquan Dabu Tang (Complete Great Tonifying Decoction) and recovered in over a month. Generally, once pus and blood have drained from a sore or ulcer, massive tonification of blood and qi must be prioritized. Even if other symptoms exist, they should be treated secondarily.
Treatment for chronic non-healing sores with pale flesh and scanty pus: This indicates deficiency of both blood and qi, failing to circulate and nourish, resulting in a cold and stagnant sore opening. Daily, decoct a handful of Artemisia argyi Leaves (Aiye) in water, wash the area avoiding wind and heat, fumigate with burning pine smoke, and apply Shenyi Gao (Divine Miracle Plaster). Strict dietary and lifestyle prohibitions must be observed during recovery, otherwise efficacy will be lacking.
My commentary: In the aforementioned condition, if it is indeed caused by cold pathogen stagnating blood and qi, preventing proper nourishment and defense, this method effectively dispels cold and restores yang qi, yielding great results. However, if it is due to weak blood and qi failing to converge at the sore opening, tonifying the spleen and stomach to generate blood and qi is superior. Master Danxi stated: Among the meridians, only Shaoyang and Jueyin are prone to carbuncles and sores and require prevention, because they possess abundant qi and scarce blood. Scarce blood makes muscle growth difficult; if a sore remains open for a long time, it inevitably becomes a critical condition. If one instead uses purgative or toxic drugs to attack the blood of the yin aspect, disaster will follow swiftly.
Attached Treatment Cases
Li Mengqing, an official of the Earth Ministry, suffered from a gangrenous sore at the Huantiao Acupoint (GB30). Internal and external treatments consisted of detoxifying and cold-natured agents. Due to extreme pain, he lanced it, causing large amounts of pus and stasis to drain. The sore opened wide with a purple-dark color, and the right Guan pulse was floating and large. This indicated further injury to stomach qi, failing to nourish the affected area. I used Fermented Soybean Cake (Douchi Bing) and Liujunzi Tang (Six Gentlemen Decoction) added with Agastache Rhizome (Huoxiang), Amomum Fruit (Sharen), and Processed Ginger (Paojiang) for several doses. Consequently, stomach qi awakened, diet gradually increased, the affected area warmed, and flesh regenerated. He recovered after taking Shiquan Dabu Tang.
Du Chengqing, a district magistrate, suffered from deep bone gangrene (Fugu Ju). Internal pain felt like awl piercing, external color remained unchanged, and the condition could not resolve. Fortunately, he had not used cold-natured agents. The pain had injured stomach qi, leading to loss of appetite. I treated him with Liujunzi Tang, and his diet slightly improved. He then took Shiquan Dabu Tang for over twenty doses until pus formed, which was then drained. He continued with a modified Da Bu Tang (Great Tonifying Decoction) with doubled doses of Ginseng Root (Renshen), Astragalus Root (Huangqi), Angelica Sinensis Root (Danggui), and Atractylodes Macrocephala Rhizome (Baizhu), added with Ophiopogon Tuber (Maimendong), Schisandra Berry (Wuweizi), Polygala Root (Yuanzhi), and Fritillaria Bulb (Beimu). After several doses, pus secretion ceased, and the sore healed. Analyzing these two cases, the cause was likely damp-heat stagnating in the muscle tissue, preventing true qi transformation. Initial treatment should focus on strengthening spleen earth, harmonizing blood and qi, and using Garlic-Separated Moxibustion (Gesan Jiu), allowing the gangrene to dissipate naturally.
Formula for Sprinkling Powder on Back Carbuncles
The Li family stated: In Longyou, a patient with a back carbuncle had extensive ulceration, leaving only the diaphragm separating the viscera. Believing death was certain, he used a carp cleaned of entrails, stuffed with sheep dung, roasted until charred, ground into powder, and sprinkled dry onto the wound. The sore closed naturally. This formula comes from Hong Shi’s records and has been effective repeatedly, so it is attached here. It should only be used when pus is scant and flesh regeneration is desired.
Attached Treatment Cases
Huang Yuyun suffered from a back carbuncle. Use of flesh-generating medicines worsened the ulceration, accompanied by diarrhea and a faint, slow pulse. I diagnosed spleen and stomach deficiency. First, I used Ershen Wan (Two Spirits Pill) to stop diarrhea, then used massive tonifying agents to secure the root. Additionally, I washed the affected area with Pig Trotter Soup and applied Astragalus Root powder externally. Fortunately, moxibustion had been used initially, preventing internal invasion of toxicity. He recovered in two months.
Xu Honglu suffered from a back carbuncle for over ten days. The swelling was hard and numb, skin color unchanged, and the pulse was deep and excess. This indicated internal toxicity. Initially, I used Huanglian Neishu Tang (Coptis Internal-Draining Decoction), followed by detoxifying and interior-supporting medicines, which allowed the toxicity to surface. However, desiring a quick cure, he urgently used flesh-generating medicines. The affected area felt heavy as if bearing a stone, and his body felt like burning fire, ultimately leading to his death.