余素不知医，每于乡僻处，敬遵《御纂医宗金鉴》施治，其《外科心法》，更为附应，已
录要付梓。第恐初学未易入门，故于乾隆丙申秋，复将陈毓仁《外科正宗》，祁广生《外科大
成》，王宇泰《疡医准绳》，辑其简要易明者，汇为成帙。计二卷，名曰《外科选要》。庶初学
得近阶梯，更研究《金鉴》心法，可以升堂入室。不但具活人之心，而亦得养生之半矣，因
并付梓，附于《外科心法》之后。
昆山芹洲氏唐黉谨识
痈疽发背为何生，好好身躯出此形。
凡人处世而无疾病者，水升火降，精秘血盈也。养生篇曰∶毋摇尔精，毋劳尔形，
皈心静默，可以长生。此皆远世俗，忘名利，无贪嗔，却疾病，惟修身保命之志士所能。今
人岂能及哉？盖谓静则生水，动则生火，水能生万物，火能克万物，故百病由火而生；火
既生，七情六欲，皆随应而入之；既入之后，百病发焉。发于内者，为风劳蛊膈，痰喘内
伤；发于外者，成痈疽发背，对口疔疮。此皆言其大略也。故成痈者壅也，为阳属六腑，
毒腾于外，其发暴而所患浮浅。故易肿易脓，易腐易敛，诚为不伤筋骨，易治之症也。疽
者沮也。为阴属五脏，毒攻于内，其发缓而所患深沉，故为伤筋蚀骨，难治之症也。凡
年壮气血胜毒则顺，年老毒胜气血则险。
内被七情干脏腑，忧愁思虑总关心。
七情者，喜伤心，怒伤肝，忧伤肺，思伤脾，悲伤于魂魄，恐伤肾，惊伤胆。六欲
者，耳听声音，眼观物色，鼻闻香气，舌贪滋味，心帷大地，意幄万方。
外有六淫伤气血，风寒暑湿火相临。
六淫者，风、寒、暑、湿、燥、火、是也，皆从外而入之。体实之人，遇而不中者
有；体弱之人，感而随发者多；又有感之不发，邪气客于脏腑经络关节之内，积袭日久，
或待内伤，或因外感，邪气触而发之。既发之后，当参寒热温凉，邪正胜负而治之。
膏粱浓味多无忌，劳伤房欲致亏阴。
膏粱者，醇酒肥鲜，炙 之物也。惟取快意于一时，不觉阴消于平日。况生是疾者，
不起于藜藿，尽属于膏粱。谁识膏粱味短，不及藜藿味长。
故将五脏多乖变，自然六腑不调匀。
五脏属五行，金木水火土是也。相顺相生，相反相克，所谓相生者昌，相克者亡。五
脏不和，则六腑不通，九窍疲癃，留结为痈，盖痈疽必出于脏腑乖变，关窍不得宣通而发
也。治当寒邪而痛者，以温热散之；湿肿强痛者，渗而导之；燥搐挛痛者，滋而润之。泄
而痛者温之，塞而痛者通之，虚而痛者补之，实而痛者泻之，阴阳不和者调变之，经络秘
涩者冲和之，脓胀而痛者开之，恶肉侵蚀者去之，劳而痛者逸之，损而痛者续之，此等
皆为活法，惟在用者详之。
发于心上多危险，五脏相干事可明。
五脏者，心肝脾肺，四脏皆系于背。惟肾经一脏，独居于下，其精华津液，元气元
神，尽行灌溉，荣注于上。故四脏之火，皆赖一脏之水以济之，所谓五脏根本，皆系于
肾，即此意也。凡发痈疽者，未有不先伤五脏而后发之，且背乃太阳膀胱督脉所主，太
阳者，六经之首领也；督脉者，十二经络之统脉也。况心乃君主之位，岂容毒相犯之。凡
发于此者，危险难治之症。
心之以下多成顺，六腑之因亦许评。
凡疮生于心之以下者，除肾俞一穴外，皆为缓。六腑者，足阳明胃经，手太阳小肠经，足太阳膀胱经，手厥阴心包
络经，手少阳三焦经，足少阳胆经，此六经属腑，其形在下，其气主表，其病为痈，故发于六经者为轻。
脾家积毒生肩脊。
饮食膏粱积毒所致，高肿鲜明，根脚不过两肩者为顺。先宜解毒护心为主，次宜内
托清心为要，间用蜡矾丸、护心散，防毒攻心。如肿平坚硬，渐大渐开，攻注两肩胸项，
肿而不痛者危。
心经火毒对心临。
对心发者，乃心火妄动，热极而发之也。况心为主宰，周身蕴热，流会于此，其结为
患，最易伤人，刑截督经，害非轻浅，况背脊多坑，固难起发，疮形落陷，肿不高尖，治
当大降心火，急疏蕴热，顶用针通，随行拔法，使毒瓦斯内外疏通，庶不内攻，方为成守。
保至十五日后，内无变症，得脓为解。如变症渐生，坚硬渐大，不作脓者，死在二十二
朝先后。但此症贵在早治，十中可保其三四也。
两肩左右双生发，肺肝积受不虚名。
左搭属肝，右搭属肺，俱生于左右肩骨移动之处，为可治。有此症者，先用万灵丹
发汗，疏通内外，次以清肝解郁汤，柴胡清肝汤，气用四君子汤，血用四物汤，溃后八
珍汤，参而调治，诚为妥当。但此症原起于痰凝气滞火郁，气血不调而生，正谓郁者开
之，滞者行之，如误用疮科解毒泄气，误补误攻之药，必致多危。
莲子蜂窠防毒陷。
蜂窠莲子二发，多生于背，与心相近，与脊中平。轻者形长高肿，或偏半背；重者形
斜平塌。两胁俱伤，孔似蜂窠，突如莲子，疮形虽畏，常能多险多生。老弱不堪，反取常
安常稳。大规只怕不纯阳，治法何妨疮势恶。护心护膜丸丹，须要调停，执药执方，活法
在乎医意。机参总论，法决存亡。
腰间肾俞发难生。
肾俞发者，生于两腰陷肉之间，或正中亦发。凡生于此者，最为险候，盖内肾为性
命之本，藏精藏气藏神，又谓受命先天，育女育男育寿，此等皆出于肾脏也。是疾房劳
过度，气竭精伤，其脏必虚，诸火诸邪，乘虚而入，既入之后，浑结为疮，如本脏稍有
真阴制火，疮形自可红活高肿为脓。治以人参养荣汤，加山萸、五味子、黄柏、知母、及
加减八味丸，以救其源也。若疮形紫黑干枯坚硬，不作脓者，为真阴内败，再无可生之理。
督脉经虚从项发，俗名对口故相称。
对口有偏正之不同∶发于正者，属督脉所主；发于偏者，乃太阳膀胱所司。二者皆
起于湿热上攻，凝结而成也。督脉发疮易治，因督脉起于下，而贯脊行于上，故毒瓦斯得之，
反能冲突高肿。膀胱者发疮虽偏，而每为难治，盖膀胱之脉，起于巅顶，贯项两傍，顺
下而行，乃与疮毒交会下流，故疮多平塌。又太阳膀胱主司寒水，其质多冷多沉，故疮于
此多难起发，形色多难红活，坚硬难溃，又易流注两肩胸项作肿。十五日外无脓者，必
然变黑归阴，故多不治。治以黄连消毒饮主之，余皆降火化痰，解毒清心，托里为要也。
何期耳后多生发，夭疽锐毒本非轻。
发生于耳后一寸三分，致命之处，诚为险恶之候。左为夭疽属肝木，右为锐毒属肺
金。二者皆起于积想在心，谋虑不决，致火旺而又郁，郁而又旺，以成此疾也。故形多
坚硬，头多隐伏，未溃先黑，未脓先腐，臭秽易生，元气易败。凡生此疮，毒瓦斯多致不
得外发，发后必内攻而死。但此症初生，起于隐微，令人多不知觉，及其知觉，毒已入
内矣。如红活高肿，易脓易腐者，俱无妨。
又有脱疽生手足，丹房补术孽根因。
脱疽初生如粟，色似枣形，渐开渐大。筋骨伶仃，乌乌黑黑，痛割伤心，残残败败，污
气吞人，延至踝骨，性命将倾。此非天命，自丧其身。古人有法，截割可生。今人谁肯割
截为名？治法虽有，详在后文。
漫肿难治 肿易，总论中间法可凭。
漫肿者，肉肿疮不肿是也。 肿者，疮肿肉不肿是也。疮之初起，理当升发。溃脓
之后，不可内消，宜用托药。如不应者，乃毒胜气血，死在旬日。或已发出而不腐溃，根
脚坚硬，或软而散大者，急投托药，大补脾胃，不应，死在二旬。若已溃而色不变红活，
亦不生肌收敛，疮口晕大，肿痛不减，胃气不回，急须峻补。不应者，乃脾崩，死在月余。
诸疮另自分门说，岂许轻于紊此呈。
我向来不懂医术，每当在偏僻的乡间居住时，都恭敬地遵循《御纂医宗金鉴》进行治疗，其中《外科心法》更是作为辅助依据，我已经摘录其要点刻印出版。只是担心初学者难以入门，所以在乾隆丙申年（1776年）秋天，我又将陈毓仁的《外科正宗》、祁广生的《外科大成》、王宇泰的《疡医准绳》中简要易懂的内容，汇编成册。共计两卷，命名为《外科选要》。希望初学者能借此获得入门的阶梯，进而深入研究《金鉴》的心法，从而登堂入室。这不仅具备救人的心意，也得到养生的一半道理了，因此一并付梓，附在《外科心法》之后。
昆山芹洲氏唐黉谨识
痈疽发背为何产生，好好的身躯为何出现这种病症？
凡人在世间生活而没有疾病的人，是因为肾水上升、心火下降，精气固秘、血液充盈的缘故。养生篇说：不要动摇你的精气，不要劳累你的形体，使心神回归宁静沉默，就可以长生。这些都是远离世俗、忘记名利、没有贪婪和嗔怒、驱除疾病，只有修身保命的志士才能做到的。现在的人哪里能达到呢？大概因为静则生水，动则生火，水能生养万物，火能克制万物，所以百病由火而生；火既已产生，七情六欲便随之侵入体内；侵入之后，百病就发作了。发于体内的，表现为风劳蛊膈、痰喘内伤；发于体外的，形成痈疽发背、对口疔疮。这说的是大略情况。所以“痈”的意思是壅塞，属于阳证，关联六腑，毒气腾越于外，发病急骤且患处浮浅。所以容易肿胀、容易化脓、容易腐烂、容易愈合，确实是不损伤筋骨、容易治疗的病症。“疽”的意思是阻滞，属于阴证，关联五脏，毒气攻陷于内，发病缓慢且患处深沉，所以会损伤筋脉腐蚀骨骼，是难治的病症。凡是年轻力壮、气血旺盛胜过毒邪的就顺遂，年老体弱、毒邪胜过气血的就危险。
内部被七情干扰脏腑，忧愁思虑总是关乎内心。
七情是指：喜伤心，怒伤肝，忧伤肺，思伤脾，悲伤魂魄，恐伤肾，惊伤胆。六欲是指：耳听声音，眼观物色，鼻闻香气，舌贪滋味，心帷大地，意幄万方。
外部有六淫伤害气血，风寒暑湿火相继来临。
六淫是指：风、寒、暑、湿、燥、火，都是从外部侵入人体的。体质强壮的人，遇到邪气而不被侵害的情况有；体质虚弱的人，感受邪气而随即发病的情况多；又有感受邪气后不立即发病，邪气潜伏在脏腑经络关节之内，积累侵袭日久，或者等待内伤，或者因为外感，邪气触动而发作。发作之后，应当参考寒热温凉，邪正胜负来治疗。
膏粱厚味大多无忌惮，劳损房事欲望导致亏虚阴精。
膏粱指的是醇酒肥鲜、炙烤的食物。只图一时的快感，不知不觉在日常中消耗阴精。况且生出这些疾病的人，不是起于粗茶淡饭，全都属于膏粱厚味。谁认识膏粱味道短促，不如粗茶淡饭味道长久。
所以五脏多有乖违变异，自然六腑不调和均匀。
五脏对应五行，即金、木、水、火、土。相顺相生，相反相克，所谓相生者昌盛，相克者灭亡。五脏不和，则六腑不通，九窍疲弱癃闭，停留结聚成为痈，大概痈疽必然出于脏腑乖违变异，关窍不得宣通而发作。治疗应当：对于寒邪所致疼痛的，用温热药发散它；对于湿肿强痛的，用渗利导下的方法治疗；对于燥搐挛痛的，用滋润的方法治疗。泄泻而痛的温补它，闭塞而痛的通利它，虚弱而痛的补益它，实盛而痛的泻下它，阴阳不和的调和变化它，经络秘涩的冲和它，脓胀而痛的切开它，恶肉侵蚀的去除恶肉，劳损而痛的使其休息，损伤而痛的接续它，这些都属于灵活的治疗方法，只在于使用者仔细斟酌。
发于心脏部位的多危险，五脏相互干事可以明白。
五脏是心、肝、脾、肺，四脏都系联于背部。只有肾经这一脏，独自居于下方，它的精华津液、元气元神，全部灌溉、荣注于上部。所以四脏的火，都依赖这一脏的水来济助，这就是所谓的五脏根本，都系于肾的意思。凡是发生痈疽的人，没有不先损伤五脏而后发作的，而且背部是太阳膀胱经和督脉所主司的部位，太阳经是六经的首领；督脉是十二经络的统脉。何况心是君主之位，岂容毒邪侵犯。凡是发生在这部位的，都是危险难治的病症。
心之下发的多成顺症，六腑的原因也可以评价。
凡是疮生于心脏以下的，除了肾俞穴以外，都属于缓症。六腑包括：足阳明胃经、手太阳小肠经、足太阳膀胱经、手厥阴心包络经、手少阳三焦经、足少阳胆经，这六经属于腑，其形态在下，其气主表，其病为痈，所以发于六经的为轻症。
脾家积毒生在肩脊。
饮食膏粱积毒所致，高肿鲜明，根脚不超过两肩的属于顺症。先宜以解毒护心为主，其次以内托清心为关键，间或用蜡矾丸、护心散，防止毒邪攻心。如果肿平坚硬，逐渐变大张开，攻注到两肩胸项，肿而不痛的属危症。
心经火毒对着心脏来临。
对心发者，是心火妄动，热极而发作的。何况心为主宰，周身蕴热，流汇于此，结聚成为病患，最容易伤人，刑截督经，害处非轻浅，何况背脊多有坑洼，本来难起发，疮形落陷，肿不高尖，治疗应当大降心火，急疏蕴热，顶部用针疏通，随行拔毒之法，使毒瓦斯内外疏通，这样才不会内攻，才算成功防守。保守到十五日后，内部没有变症，得脓才算解脱。如果变症渐生，坚硬渐大，不作脓的，死在二十二天前后。但这种病症贵在早治，十人中可保全三四。
两肩左右双生发，肺肝积受不虚名。
左搭属肝，右搭属肺，都生于左右肩骨移动之处，为可治。有此症者，先用万灵丹发汗，疏通内外，其次用清肝解郁汤、柴胡清肝汤，气虚用四君子汤，血虚用四物汤，溃后用八珍汤，参合调治，诚为妥当。但这种病症原本起于痰凝气滞火郁，气血不调而生，正所谓郁者开之，滞者行之，如果误用疮科解毒泄气的药物，误补误攻的药物，必定导致多重危险。
莲子蜂窠防毒陷。
蜂窠、莲子两种发背，多生于背部，与心脏相近，与脊中平齐。轻者形长高肿，或偏半背；重者形斜平塌。两胁俱伤，孔似蜂窠，突如莲子，疮形虽可怕，常能多险多生。老弱之人不堪忍受，反而取常安常稳。大规只怕不纯阳，治法何妨疮势恶。护心护膜丸丹，须要调停，执药执方，活法在乎医意。机参总论，法决存亡。
腰间肾俞发难生。
肾俞发者，生于两腰陷肉之间，或正中亦发。凡是生在这部位的，最为险候，盖内肾为性命之本，藏精藏气藏神，又谓受命先天，育女育男育寿，这些都出于肾脏。此疾因房劳过度，气竭精伤，其脏必虚，诸火诸邪，乘虚而入，既入之后，浑结为疮，如果本脏稍有真阴制火，疮形自可红活高肿为脓。治疗用人参养荣汤，加山萸、五味子、黄柏、知母、及加减八味丸，以救其源。如果疮形紫黑干枯坚硬，不作脓的，为真阴内败，再无可生之理。
督脉经虚从项发，俗名对口故相称。
对口有偏正的不同：发于正中的，属督脉所主；发于偏侧的，乃太阳膀胱所司。二者都起于湿热上攻，凝结而成。督脉发疮易治，因督脉起于下，而贯脊行于上，所以毒瓦斯得到它，反能冲突高肿。膀胱者发疮虽偏，而每为难治，盖膀胱之脉，起于巅顶，贯项两傍，顺下而行，乃与疮毒交会下流，所以疮多平塌。又太阳膀胱主司寒水，其质多冷多沉，所以疮于此多难起发，形色多难红活，坚硬难溃，又易流注两肩胸项作肿。十五日外无脓的，必然变黑归阴，所以多不治。治疗以黄连消毒饮为主，其余皆降火化痰，解毒清心，托里为关键。
何期耳后多生发，夭疽锐毒本非轻。
发生于耳后一寸三分，致命之处，诚为险恶之候。左为夭疽属肝木，右为锐毒属肺金。二者都起于积想在心，谋虑不决，致火旺而又郁，郁而又旺，以成此疾。所以形多坚硬，头多隐伏，未溃先黑，未脓先腐，臭秽易生，元气易败。凡是生此疮，毒瓦斯多致不得外发，发后必内攻而死。但这种病症初生，起于隐微，令人多不知觉，及其知觉，毒已入内了。如果红活高肿，易脓易腐的，都无妨。
又有脱疽生手足，丹房补术孽根因。
脱疽初生如粟米，色似枣形，渐开渐大。筋骨伶仃，乌乌黑黑，痛割伤心，残残败败，污气吞人，延至踝骨，性命将倾。这不是天命，是自丧其身。古人有法，截割可生。今人谁肯割截为名？治法虽有，详在后文。
漫肿难治 肿易，总论中间法可凭。
漫肿者，肉肿疮不肿是也。肿者，疮肿肉不肿是也。疮之初起，理当升发。溃脓之后，不可内消，宜用托药。如果不应的，是毒胜气血，死在旬日。或已发出而不腐溃，根脚坚硬，或软而散大的，急投托药，大补脾胃，不应的，死在二旬。若已溃而色不变红活，也不生肌收敛，疮口晕大，肿痛不减，胃气不回，急须峻补。不应的，是脾崩，死在月余。
诸疮另自分门说，岂许轻于紊此呈。
I have never been versed in medicine. Whenever residing in remote rural areas, I respectfully followed the *Imperial Compilation of Medical Classic of Gold Mirror* (Yuzuan Yizong Jinjian) for treatment, with its *External Medicine Mind Method* (Waikexinfa) serving as a supplementary guide; I had already extracted the essentials and had them printed. However, fearing that beginners might find it difficult to enter the field, in the autumn of the Bing Shen year of the Qianlong reign (1776), I compiled the concise and easy-to-understand contents from Chen Yuren's *Orthodox Manual of External Medicine* (Waike Zhengzong), Qi Guangsheng's *Great Completion of External Medicine* (Waike Dacheng), and Wang Yutai's *Standard Rules for Surgeon* (Yangyi Zhunsheng) into a single volume. It consists of two volumes and is titled *Selected Essentials of External Medicine* (Waike Xuanya). This way, beginners can obtain a ladder to approach the path, and further study the mind methods of the *Gold Mirror*, thereby ascending the hall and entering the inner chamber. Not only does this embody the heart of saving lives, but it also attains half of the principles of health preservation. Therefore, I have it printed together, appended after the *External Medicine Mind Method*.
Respectfully recorded by Tang Hong of Qin Zhou, Kunshan.
Why do carbuncles, ulcers, and back eruptions arise? Why does such a condition appear on a healthy body?
Those who live in the world without disease are those whose Kidney Water ascends and Heart Fire descends, whose Essence is securely retained and Blood is abundant. The Health Preservation Chapter states: Do not agitate your Essence, do not overwork your Form, return your mind to quiet silence, and you can attain longevity. These are achievable only by those determined to cultivate their character and preserve life, who stay away from secular affairs, forget fame and profit, and eliminate greed and anger. How can modern people reach such a state? Generally speaking, stillness generates Water, while movement generates Fire. Water can generate all things, while Fire can overcome all things; thus, hundred diseases arise from Fire. Once Fire arises, the Seven Emotions and Six Desires follow suit and enter the body. After entering, the hundred diseases manifest. Those manifesting internally present as Wind, Consumption, Gu Poison, Diaphragm obstruction, Phlegm-wheezing, and Internal Injury; those manifesting externally form Carbuncles, Ulcers, Back Eruptions, Opposite-Heart Ding Sores. This describes the general overview. Thus, "Carbuncle" (Yong) means congestion; it belongs to Yang and the Six Fu Organs, with toxic heat surging outward. Its onset is sudden and the lesion is superficial. Therefore, it easily swells, suppurates, sloughs, and heals. Indeed, it does not damage sinews or bones and is an easy-to-treat condition. "Ulcer" (Ju) means obstruction; it belongs to Yin and the Five Zang Organs, with toxic heat attacking inward. Its onset is slow and the lesion is deep. Therefore, it damages sinews and erodes bones, making it a difficult-to-treat condition. Generally, if one is young and vigorous with strong Qi and Blood overcoming the toxin, the course is favorable; if one is old and weak with the toxin overpowering Qi and Blood, the course is dangerous.
Internally disturbed by the Seven Emotions affecting the Zang Organs, worry, sorrow, and anxiety always concern the heart.
The Seven Emotions are: Joy injures the Heart, Anger injures the Liver, Sorrow injures the Lungs, Pensive thought injures the Spleen, Grief harms the Hun and Po, Fear injures the Kidneys, and Shock injures the Gallbladder. The Six Desires are: ears listening to sounds, eyes observing colors, nose smelling fragrances, tongue craving flavors, the heart encompassing the earth, and the mind covering all directions.
Externally injured by the Six Excesses damaging Qi and Blood, Wind, Cold, Summerheat, Dampness, and Fire succeed each other.
The Six Excesses are: Wind, Cold, Summerheat, Dampness, Dryness, and Fire, all entering from the exterior. In robust individuals, encountering these pathogens without being affected occurs; in frail individuals, contracting them and developing symptoms immediately is common. There are also cases where infection does not immediately manifest, but the pathogen lodges within the Zang-Fu organs, meridians, collaterals, and joints, accumulating over time. Later, triggered by internal injury or external contraction, the pathogen activates. After manifestation, treatment should be based on evaluating Cold, Heat, Warmth, Coolness, and the struggle between Pathogenic factors and Righteous Qi.
Rich and greasy foods taken without restraint, labor and sexual indulgence leading to Yin deficiency.
"Gao Liang" refers to fine wine, rich meats, and roasted foods. People seek momentary pleasure, unaware of the daily consumption of Yin. Moreover, those suffering from these diseases rarely originate from coarse vegetables but mostly from rich diets. Who realizes that the flavor of rich food is short-lived, unlike the lasting benefit of coarse vegetables?
Thus, the Five Zang Organs often undergo abnormal changes, and naturally, the Six Fu Organs become unharmonious.
The Five Zang Organs correspond to the Five Elements: Metal, Wood, Water, Fire, and Earth. They mutually generate and mutually overcome. As stated, mutual generation leads to prosperity, while mutual overcoming leads to decline. If the Five Zang Organs are disharmonious, the Six Fu Organs will not circulate freely. The nine orifices become fatigued and obstructed, stagnation forms carbuncles. Generally, carbuncles and ulcers arise from Zang-Fu disharmony and the failure of orifices to ventilate and circulate. Treatment should be adapted: For pain caused by Cold pathogens, disperse with warm/hot herbs; for swelling and stiffness caused by Dampness, drain and guide downward; for spasms and cramps caused by Dryness, moisten and lubricate. For pain due to diarrhea, warm it; for pain due to constipation, unblock it; for pain due to deficiency, tonify it; for pain due to excess, purge it; for Yin-Yang disharmony, harmonize and adjust it; for blocked meridians, promote harmony; for pain due to pus distension, incise it; for necrotic flesh erosion, remove the dead tissue; for pain due to fatigue, allow rest; for pain due to injury, reconnect tissues. These are flexible methods, depending on the practitioner's discretion.
Eruptions on the heart area are often dangerous; the interaction of the Five Zang Organs can be understood.
The Five Zang Organs are Heart, Liver, Spleen, and Lung; four of them are connected to the back. Only the Kidney Meridian resides alone at the lower part. Its essence, fluids, Yuan Qi, and Yuan Shen irrigate and nourish the upper body. Thus, the fire of the four upper organs relies on the water of the Kidney to balance it. This is why the root of the Five Zang Organs is tied to the Kidney. Anyone developing carbuncles or ulcers first injures the Five Zang Organs before eruption. Furthermore, the back is governed by the Taiyang Bladder Meridian and the Du Mai (Governing Vessel). The Taiyang is the leader of the Six Meridians; the Du Mai is the commander of the Twelve Meridians. Since the Heart is the seat of the Sovereign, how can it tolerate toxic invasion? Eruptions here are dangerous and difficult to treat.
Eruptions below the heart tend to be favorable; the causes related to the Six Fu Organs can be evaluated.
Any sore arising below the Heart, except at the Shenshu acupoint, is considered mild. The Six Fu Organs include: Foot-Yangming Stomach Meridian, Hand-Taiyang Small Intestine Meridian, Foot-Taiyang Bladder Meridian, Hand-Jueyin Pericardium Meridian, Hand-Shaoyang Sanjiao Meridian, and Foot-Shaoyang Gallbladder Meridian. These six meridians belong to the Fu organs. Their form is lower, their Qi governs the exterior, and their pathology involves carbuncles. Thus, eruptions on these meridians are mild.
Toxin accumulation in the Spleen manifests on the shoulders and spine.
Caused by toxin accumulation from rich diet, presenting with high, bright swelling, with a base not exceeding the shoulders, this is a favorable sign. Initially, prioritize detoxification and protecting the Heart; subsequently, use internal support and clearing Heart heat. Occasionally use Larva and Alum Pill (Lafan Wan) or Heart Protection Powder (Huxin San) to prevent toxin attacking the Heart. If the swelling is flat and hard, gradually expanding to the shoulders, chest, and neck, with swelling but no pain, it is critical.
Heart Meridian Fire-Toxin attacks opposite the Heart.
Opposite-Heart eruption results from reckless Heart Fire moving upward due to extreme heat. Since the Heart is the sovereign, systemic heat gathers here, forming lesions. It easily harms the body and obstructs the Du Mai, causing severe damage. Additionally, the spine has many depressions, making eruption difficult. The sore shape sinks, swelling is not sharp. Treatment requires strongly descending Heart Fire and urgently dispersing accumulated heat. Use needle therapy on the apex to open pathways, followed by drawing-out methods to ensure internal and external ventilation of toxins, preventing internal attack. Maintain defense for fifteen days; if no internal changes occur and pus forms, it resolves. If changes develop, hardness increases, and no pus forms, death occurs around twenty-two days. Early treatment is crucial; three or four out of ten may survive.
Double eruptions on both left and right shoulders; Lung and Liver toxin accumulation is well-deserved.
Left shoulder involvement relates to the Liver; right shoulder involvement relates to the Lungs. Both occur at mobile points of the shoulder bones and are treatable. Initial treatment uses Ten Thousand Spirit Pill (Wanling Dan) to induce sweating and unblock interior/exterior. Follow with Liver-Clearing and Depression-Relieving Decoction (Qinggan Jieyu Tang) or Bupleurum Liver-Clearing Decoction (Chaihu Qinggan Tang). For Qi deficiency, use Four Gentlemen Decoction (Sijunzi Tang); for Blood deficiency, use Four Substance Decoction (Siwu Tang); after ulceration, use Eight Treasures Decoction (Bazhen Tang). Adjust accordingly. This condition originates from Phlegm stagnation, Qi stasis, and Fire depression, with disharmonious Qi and Blood. As stated, open stagnation, move stasis. Misusing external medicine detoxifying and draining Qi, or inappropriate tonifying/purging drugs, will lead to danger.
Lotus Seed and Beehive types fear toxin sinking.
Beehive and Lotus Seed eruptions often occur on the back, near the Heart and level with the spine. Mild cases show long, high swelling or half-back involvement; severe cases show slanting, flat collapse. Both hypochondriac regions are injured, holes resembling beehives, protrusions like lotus seeds. Though feared, they often present multiple risks yet allow survival. Frail elderly patients suffer more; standard care ensures stability. The main rule fears lack of Pure Yang; treatment method need not fear severe sore condition. Heart-Protection and Membrane-Protection Pills/Elixirs require careful adjustment. Adherence to formulas must be guided by medical wisdom. Refer to General Discussion for mechanisms; laws determine life and death.
Kidney Shu eruption on the waist is difficult to cure.
Kidney Shu eruptions occur between the muscles of both waists or in the center. Eruptions here are most critical because the internal Kidney is the root of life, storing Essence, Qi, and Spirit, governing congenital endowment, reproduction, and longevity. This disease results from excessive sexual activity, exhausting Qi and injuring Essence, leading to organ deficiency. Various Fires and Pathogens enter via deficiency, aggregating into sores. If the organ retains some True Yin to control Fire, the sore will be red, vibrant, swollen, and suppurative. Treat with Ginseng Nourishing Harmony Decoction (Renshen Yangrong Tang), adding Cornus Fruit (Shanzhuyu), Schisandra Berry (Wuweizi), Phellodendron Bark (Huangbai), Anemarrhena Rhizome (Zhimu), and Modified Eight Flavor Pill (Jiajian Bawei Wan) to restore the source. If the sore is purple-black, dry, hard, and non-suppurative, it indicates internal failure of True Yin, with no hope of survival.
Du Mai deficiency erupts from the neck, commonly called Opposite-Neck.
Opposite-Neck varies in position: central eruptions are governed by the Du Mai; lateral ones by the Taiyang Bladder. Both arise from Damp-Heat attacking upward and condensing. Du Mai eruptions are easier to treat because the Du Mai rises from below, pierces the spine, and travels upward; thus, toxins surge and swell high. Bladder eruptions, though lateral, are often difficult to treat because the Bladder meridian starts at the vertex, passes through the neck sides, and flows downward, intersecting with toxin flow downwards, resulting in flat sores. Also, Taiyang Bladder governs Cold Water, having cold and heavy qualities, making eruptions here hard to rise, lacking redness/vitality, hard to suppurate, and prone to flowing to shoulders/chest/neck. No pus after fifteen days indicates turning black and returning to Yin, usually untreatable. Treat primarily with Coptis Detoxification Drink (Huanglian Xiaodu Yin); others focus on descending Fire, resolving Phlegm, detoxifying, clearing Heart, and supporting the interior.
Unexpectedly, eruptions behind the ears are frequent; Tian Ju and Rui Du are not minor conditions.
Eruptions occurring 1.3 cun behind the ear are fatal and highly dangerous. Left side is Tian Ju (belonging to Liver Wood); right side is Rui Du (belonging to Lung Metal). Both arise from persistent thoughts and indecision, causing Fire to flare and stagnate repeatedly. Forms are often hard, heads hidden, turning black before ulceration, rotting before suppuration, foul-smelling, with rapid Qi depletion. Toxins often fail to express externally and attack inward after eruption, causing death. However, early stages are subtle and unnoticed; by the time noticed, toxins have entered. If red, vibrant, swollen, easy to suppurate and slough, there is no harm.
Another type, Gangrene of Extremities, arises on hands and feet, rooted in improper tonic practices.
Gangrene begins like millet grains, colored like dates, gradually enlarging. Sinews and bones stand out, turning pitch black, causing cutting pain, decay, and foul odor spreading to ankles, threatening life. This is self-inflicted, not fate. Ancients had methods where amputation could save life. Modern people refuse amputation for fame. Treatment details follow later.
Diffuse swelling is hard to treat; localized swelling is easier; methods in the General Discussion are reliable.
Diffuse swelling means flesh swells but the sore does not; localized swelling means the sore swells but the flesh does not. At initial stage, promotion and eruption are appropriate. After suppuration, internal resolution is contraindicated; use supporting drugs. If ineffective, toxin overpowers Qi and Blood, death in ten days. If erupted but not sloughing, with hard base or soft/diffuse base, urgently administer supporting drugs and strongly tonify Spleen/Stomach. If ineffective, death in twenty days. If ulcerated but color remains dull, failing to regenerate flesh and close, with large halo and unrelenting pain/swelling, indicating failed Stomach Qi, urgently apply strong tonification. If ineffective, it indicates Spleen collapse, death in over a month.
Different sores should be classified separately; do not lightly confuse this presentation.