（附论）
夫五发者。谓痈疽生于脑、背、肩、鬓、髯是也。大概论之分为三等。一者疽也。二者
痈也。三者疖也。夫疽初生如黍米大。痒痛有异。误触破之。即 展四畔。赤肿沉闷。牵引
胁肋。疼痛数日之后。渐觉肌肤壮热。恶寒、烦渴、眩晕。侵展 浆汁出。积日不溃。抑之
则流血者。谓之发背疽也。其发于脑者。为脑疽也。其发于鬓眉髯者。以类呼也。又有初生
。其状无头。肿阔三四寸。始觉注闷疼痛。因循数日。皮光微软者。甚则令人发热恶寒。头
痛烦渴者。谓之发背痈也。又有初生一头。色浮赤而无根。肿见于皮肤之间。大小一二寸者
、疖也。三者之候。惟疽最重。此疾初生。皆由滋味与浓衣。衣服浓暖。则表易招寒。滋味
过多。则五脏生热。脏腑积热。则血脉不流。而毒瓦斯凝滞。邪气伏留。热搏于血。血聚则肉
溃成疮。浅则为疖。实则为痈。深则为疽矣。亦有因服金石发动。而患此疾者。亦有平生不
服金石药。而亦患此疾者。盖由上祖曾服饵。其毒瓦斯流传子孙。此病初生。认是疽则宜速治
之。若气实之人。急服五香连翘汤、漏芦汤。若年未五十少壮实者。可服五利大黄汤、化毒
丸。取通利脏腑一二行。疮头上用追毒散之类。贴温热膏剂。更 肿汤、溃毒汤。淋 之。
如此调治。以待脓成。以前不可以诸药救疗。以安患人之心。慎懊恼触着。至脓成败溃。宜
服五香汤。及内托里散、茯苓汤、当归托里散之类。渴不止者。服竹叶黄 汤、乳香散。勿
为大热服大黄、朴硝苦寒之药。若因服利药。而利不止者死矣。若疮中恶肉未退。脓水不快
者。即用追蚀之药。或铤子 之。上用鹿角散。以醋熬为糊贴之。恶肉退去。好肉渐生。即
用搜脓散、翠霞散之类 之。若疮中毒瓦斯未尽。慎勿早敛。忌早上生肌之药。纵得平复必再
发。其间调理次第。临时致宜。将护忌慎之法耳。
痈疽者。乳石之疾。多发于阳部。故在背则发府俞之间。在头则发脑。以头者诸阳所会
。而足太阳之经。络脑故也。然脑为髓海。精血之所凑。而脑户、风府、哑门三穴。不可妄
行灸刺。令人有喑哑之病。灸刺犹不可。况痈疽之所发乎。古人谓五发之病。背脑为重。始
发皮肤若黍米。然赤肿旁 。耳项痛楚寒热。当急治之。稍纵不治。则毒瓦斯深入。销铄脑髓。
化为脓血。不可及矣。故经曰。痈疽不得顷时回。初发疽时。一粒如麻豆大。身体便发热热
。生疽处肉赤热肿大而高。多生疼痛。破后肉色红紫。此为外发。虽大若盆碗。如用药有理
。则全活必矣。初发疽时。不拘大小。身体无热。自觉倦怠。生疽处亦不热。数日之间。渐
渐开大。不肿不高。不疼不痛。低陷而坏烂。破后肉紫黑色。此为内发。未作之先。脏腑已
溃烂。则不治矣。复有心肾肺痈、肠痈、附骨疽证。心痈者、乃心经有热。或好饮酒。或嗜
热物。积聚成热。久而不散。熏发于皮肤之外。气血不流。凝滞而生。虽曰原道颇险。而实
可治。宜用托里活血之剂。攻出外来。肿高不陷。可保无虞。若陷入里。亦不可恃。如不饮
食。急须扶脾。能食疮已破穿见肉膜。亦未为害。但要洗涤净洁。以生肉药掺四畔。自然而
愈。
【附论】
所谓“五发”，是指痈疽生长在脑、背、肩、鬓角、胡须部位的情况。大致论述起来，分为三个等级。第一种是疽（一种深在性化脓性疾病），第二种是痈（一种浅表性化脓性疾病），第三种是疖（一种小型的急性化脓性疾病）。
疽初起时像黍米大小，瘙痒和疼痛的感觉各不相同。如果误触破溃，疮口就会向四周扩散，出现红肿胀痛、沉重闷塞感，并牵引胁肋部疼痛。几天之后，逐渐感觉肌肤壮热，伴有恶寒、心烦口渴、眩晕等症状。随后浸淫蔓延，流出浆液，多日不溃破，按压则出血的，称为发背疽。生在脑部的，称为脑疽。生在鬓角、眉毛、胡须部位的，依此类推称呼。
又有初起时，形状没有头绪，肿胀宽阔三四寸，开始觉得注闷疼痛，拖延数日后，皮肤光亮微软的，严重时令人发热恶寒、头痛心烦口渴的，称为发背痈。
又有初起时只有一个头，颜色浮赤且无根基，肿胀见于皮肤之间，大小一二寸的，称为疖。这三种病症中，只有疽最为严重。这种病初起，都是由饮食肥甘厚味与穿着过暖的衣服引起的。衣服穿得浓密温暖，体表就容易招致寒邪；饮食滋味过多，五脏就会产生内热。脏腑积热，导致血脉运行不畅，毒气凝滞，邪气潜伏停留。热邪搏结于血分，血液聚集则肌肉溃烂形成疮疡。位置浅表的为疖，实证的为痈，深在的为疽。
也有因为服用金石类药物引发而患此病的，也有平生不服用金石药却同样患此病的。这大概是由于祖先曾服用过这类药物，其毒气流传给子孙所致。此病初起，若认定为疽，应当迅速治疗。如果是体质壮实的人，急服五香连翘汤、漏芦汤。如果年龄未满五十岁且身体强壮结实者，可服用五利大黄汤、化毒丸，使脏腑通利一两次。疮头上使用追毒散之类，贴敷温热膏剂，再用更肿汤、溃毒汤淋洗。如此调治，等待脓液成熟。在此之前不可用各种药物强行救疗，以免让患者内心不安。谨慎避免懊恼情绪及触碰患处。等到脓液成熟败坏溃破后，宜服用五香汤，以及内托里散、茯苓汤、当归托里散之类。如果口渴不止，服用竹叶石膏汤、乳香散。不要因大热就服用大黄、朴硝等苦寒泻下的药物。如果因为服用泻下药而导致腹泻不止，就会死亡。如果疮中的腐肉未退，脓水排出不畅，就立即使用追蚀的药物，或用铤子腐蚀它。上部使用鹿角散，用醋熬成糊状贴敷。腐肉退去，好肉渐生，就使用搜脓散、翠霞散之类处理。如果疮中毒气未尽，千万不要过早收敛伤口。忌早上生肌的药，即使暂时平复也必定复发。其中的调理次序，需根据当时情况适宜处理，主要是护理和禁忌的方法罢了。
痈疽，是服用石药引发的疾病，多发于阳经部位。所以在背部则发生在腑俞穴之间，在头部则发生在脑部，因为头是诸阳经汇聚之处，而足太阳膀胱经络属脑部。然而脑为髓海，是精血汇聚的地方，脑户、风府、哑门这三个穴位，不可随意进行灸刺，否则会使人患上失音症。既然灸刺尚且不可，何况是痈疽发作的部位呢？古人说五发的病证，背部和脑部的病情较重。刚开始发病时皮肤如黍米大小，然而红肿旁侧，耳项疼痛，伴有寒热症状，应当紧急治疗。稍微拖延不治疗，毒气就会深入，销铄脑髓，化为脓血，就无法救治了。所以医经说：痈疽不得片刻延误。初发疽时，一粒如麻豆大小，身体便发热。生疽处肌肉赤热肿大而高突，多产生疼痛。破溃后肉色红紫，这是外发。虽然疮面大如盆碗，如果用药合理，则一定能保全生命。
初发疽时，无论大小，身体无热，自觉倦怠，生疽处也不热，几天之间，渐渐扩大，不肿不高，不疼不痛，低陷而坏烂。破溃后肉呈紫黑色，这是内发。在未发作之前，脏腑已经溃烂，那就无法治疗了。另外还有心痈、肾痈、肺痈、肠痈、附骨疽等证候。心痈，乃是心经有热，或者喜好饮酒，或者嗜食热物，积聚成热，久而不散，熏蒸发于皮肤之外，气血不流，凝滞而生。虽然说原道颇为危险，但实际上是可以治疗的。宜用托里活血的药剂，攻出外来邪毒。如果肿势高突不凹陷，可以保无虞。如果陷入内部，也不可依赖。如果不进食，急需扶持脾胃。如果能进食，疮已破穿见肉膜，也未为害处。只要洗涤干净，以生肌药掺撒在四周，自然痊愈。
[Supplementary Discussion]
The term "Five Fa" (Five types of eruptive sores) refers to carbuncles and ulcers occurring on the brain, back, shoulders, temples, and beard areas. Generally speaking, they are divided into three grades. The first is Ju (a deep-seated suppurative disease), the second is Yong (a superficial suppurative disease), and the third is Jie (a small acute suppurative lesion).
Ju initially appears as small as a millet seed, with varying sensations of itching and pain. If mistakenly touched and broken, the sore will spread to the surrounding sides, presenting with redness, swelling, heaviness, and stifling sensation, radiating pain to the hypochondrium. After several days, one gradually feels intense heat in the skin and muscles, accompanied by aversion to cold, vexation, thirst, and dizziness. Subsequently, it spreads, exuding serous fluid, failing to ulcerate for many days, and bleeding upon pressure; this is called Back-erupting Ju. Those occurring on the brain are called Brain Ju. Those occurring on the temples, eyebrows, and beard are named accordingly by analogy.
There is another type that initially has no distinct head, with swelling broad and spanning three or four cun. Initially, there is a feeling of stifling pain. After lingering for several days, the skin becomes smooth and soft. In severe cases, it causes fever, aversion to cold, headache, vexation, and thirst; this is called Back-erupting Yong.
There is yet another type that initially presents with a single head, floating red color without a root, swelling visible between the skin layers, measuring one or two cun in size; this is called Jie. Among these three conditions, only Ju is the most severe. The onset of this disease is generally caused by rich dietary flavors and wearing thick, warm clothing. Thick and warm clothing makes the exterior easily susceptible to cold pathogens; excessive consumption of rich foods generates internal heat in the five Zang organs. Accumulated heat in the Zang and Fu organs impedes blood vessel circulation, causing toxic qi to stagnate and evil qi to lurk. Heat combats with blood, leading to blood accumulation, muscle ulceration, and sore formation. Superficial lesions become Jie, substantial manifestations become Yong, and deep-seated ones become Ju.
Some suffer from this disease due to the activation of mineral drugs (Jinshi), while others who never take mineral drugs also suffer from it. This is likely because ancestors once ingested such substances, and their toxicity has been transmitted to descendants. When this disease first appears, if identified as Ju, it should be treated promptly. For individuals with robust Qi, Wuxiang Liaoqiao Tang (Five-Spice Forsythia Decoction) and Loulu Tang (Rhaponticum Decoction) should be taken urgently. For those under fifty years old and physically strong, Wuli Dahuang Tang (Five-Benefits Rhubarb Decoction) and Huadu Wan (Toxin-Dissolving Pill) can be administered to promote bowel movement and organ purification one or two times. Apply Zhuidu San (Toxin-Chasing Powder) to the sore head, followed by warm plaster application. Wash with Gengzhong Tang (More-Swelling Decoction) and Kuaidu Tang (Ulceration-Promoting Decoction). Through such regulation, wait for pus to mature. Prior to this stage, do not use various medicines for forced treatment to avoid unsettling the patient. Be cautious against emotional distress and touching the affected area. Once the pus matures and ulcerates, take Wuxiang Tang (Five-Spice Decoction), along with Neituoli San (Interior-Supporting Powder), Fuling Tang (Poria Decoction), and Danggui Tuoli San (Angelica Interior-Supporting Powder). If thirst persists, take Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) and Ruxiang San (Frankincense Powder). Do not administer bitter-cold purgatives like Dahuang (Rhubarb) and Puxiao (Mirabilite) merely due to high heat. If diarrhea continues uncontrollably after taking purgatives, death may ensue. If foul flesh remains in the sore and pus drainage is poor, immediately apply cauterizing agents or use cautery rods. Apply Luguan San (Deer Horn Powder) mixed with vinegar paste to the upper part. As foul flesh recedes and healthy flesh grows, apply Sonong San (Pus-Searching Powder) and Cuixia San (Emerald Cloud Powder). If toxic qi within the sore is not fully exhausted, do not close the wound prematurely. Avoid applying flesh-generating medicines early; even if temporary recovery occurs, recurrence is inevitable. The sequence of regulation depends on timely appropriateness, focusing mainly on nursing care and contraindications.
Yong and Ju are diseases induced by mineral drugs, frequently occurring in Yang meridians. Thus, on the back, they occur between the Shu points of the Fu organs; on the head, they occur in the brain, because the head is the convergence point of all Yang meridians, and the Foot-Taiyang Bladder Meridian connects to the brain. However, the brain is the Sea of Marrow, where essence and blood gather. The acupoints Naohu (GV17), Fengfu (GV16), and Yamen (GV15) must not be needled or moxed arbitrarily, as this may cause aphonia. Since needling and moxibustion are contraindicated, how much more so for the sites of Yong and Ju? Ancients stated that among the Five Fa diseases, those on the back and brain are critical. Initially appearing as small as a millet seed on the skin, with redness, swelling, side pain in the ears and neck, and alternating chills and fever, urgent treatment is required. Slight delay allows toxic qi to penetrate deeply, melting brain marrow into pus and blood, making it incurable. Hence, the classics state: "One cannot afford to delay the treatment of Yong and Ju." When Ju first appears, a grain-sized lesion like hemp or bean, the body fevers. The flesh at the site becomes red, hot, swollen, elevated, and painful. After rupture, the flesh turns red-purple, indicating external eruption. Even if large as a basin or bowl, rational medication ensures survival.
When Ju first appears, regardless of size, if the body has no fever but feels fatigued, and the site is not hot, expanding over days without swelling, elevation, or pain, becoming depressed and necrotic, turning purple-black upon rupture, this indicates internal eruption. Before manifestation, if the Zang and Fu organs are already necrotic, it is incurable. Additionally, there are Heart Yong, Kidney Yong, Lung Yong, Intestine Yong, and Gujia Ju (Bone-attached Ju) syndromes. Heart Yong arises from heat in the Heart Meridian, often due to alcohol consumption or preference for hot foods, accumulating heat that lingers and steams outward to the skin, impeding Qi and Blood flow. Although dangerous, it is treatable. Use formulas that support the interior and invigorate blood to expel external pathogens. If swelling is elevated and not depressed, safety can be assured. If it sinks inward, reliance is precarious. If appetite is lost, strengthen the Spleen urgently. If appetite returns and the sore ruptures exposing fascia, it is not harmful. Keep it clean, sprinkle flesh-generating powder around the edges, and it will heal naturally.