立斋曰∶针灸之法，有太乙人神，周身血忌，逐年FS 神，逐日人神。而其穴有禁针禁灸
之论。犯者，其病难瘳，理固然也。但疮疡气血已伤，肌肉已坏，急宜迎而夺之，顺而取之
，非平人针灸之比，何忌之有。《外科精义》云∶疮疡之证，毒瓦斯无从而解，脓瘀无从而泄
，反攻于内，内既消败，欲望其生，岂可得乎。危恶之证，发于致命之所，祸在反掌。腹痈
囊痈，二便不通，胸腹胀闷，唇疔喉痹，咽喉肿塞，其祸尤速，患者审之。
邻人苏子遇之内，左手指患疔，麻痒寒热恶心，左半体皆麻，脉数不时见。余曰，凡疮
不宜不痛，不宜大痛，烦闷者不治，今作麻痒尤其恶也。用夺命丹二服不应，又用解毒之剂
，麻痒始去，乃作肿痛。余曰，势虽危，所喜作痛，但毒瓦斯无从而泄，欲针之。适值望日，
其家俱言FS 神不从，势愈肿甚。余强针之，诸证顿退，又用解毒之剂，其疮乃愈。（薛按）
《内经》云∶五脏不和，九窍不通，六腑不和，则留结为痈。又云∶形伤痛，气伤肿。此
则脏腑不和，而疮发于外也，明矣。若涂贴寒凉，岂能调合脏腑，宣通气血耶。若其肿痛热渴
，脉滑数而有力，证属纯阳者，宜内用济阴汤，外用抑阳散，则热毒自解，瘀滞自散。若似
肿非肿，似痛非痛，似溃不溃，似赤不赤，脉洪数而无力，属半阴半阳者，宜内用冲和汤，
外用阴阳散，则气血自和，瘀滞自消。若微肿微痛，或色黯不痛，或坚硬不溃，脉虽洪大，
按之微细软弱，属纯阴者，宜内服回阳汤，外敷抑阴散，则脾胃自健，阳气自回也。丹溪曰
∶敷贴之剂，应酬轻小热证耳。若不辨其阴证阳证之所由分，而妄敷寒凉之剂，则迷塞腠理
，凝滞气血，毒反内攻，而肉反死矣。况运气得寒而不健，瘀血得寒而不散，败肉得寒则不
溃，新肉得寒则不生，治者审焉。（见《外科枢要》）
立斋曰∶大抵疮之起发溃敛，皆血气使然，各人元气虚实不同，有不能发出而死者，有
发出不能成脓而死者，有成脓不能腐溃而死者，有腐溃不能收敛而死者。敷贴之法，但可应
酬轻小之证耳。若血气已竭，其患必死，不但敷贴不效，且气血喜温而恶寒，腠理喜通而恶
塞，气血因而愈滞，肿患因而愈盛，邪气因而愈深，腐溃因而愈大，怯弱之人取败多矣。况
疮疡乃七情相火，或食膏梁，或饵金石，以伤阴血，阳盛阴虚，受病于内而发于外。若不别
气分血分，阴阳虚实，腐溃浅深，即服药，尚有不能保生者，可敷贴而已乎。
施二守，项右患一核，用凉药敷贴，颈皆肿。又敷之，肿胤胸腋，冷应腹内，不悟凉药
所致，尚以为毒盛。形体困惫，自分不起，延余治之。见其敷药处热气如雾，急令去药，良
久疮色变赤，刺出脓血，用托里药而愈。
张侍御，发背，专用敷药，疮黯不起，胸膈闷气，不能呼吸，自分不治，余用辛温托里
药而愈。
一男子，臀痈腐溃，肌肉不生，用药敷之，肌肉四沿反硬。予诊之，脉涩而弱，此气血
俱虚，不能营于患处，故敷凉药反硬，乃血气受寒凝结而非毒也。用大补药而愈。
一男子，患胸疽，肿高作痛，肿处敷药，痛虽止，而色变黯，肿外作痛。仍敷之，肉色
亦黯，喉内作痛。不悟此为凉药所误，反尽颈敷之，其颈皆溃而死。
一男子，因怒左胁肿一块，不作痛，脉涩而浮。余曰，此肝经邪火炽盛，而真气不足为
患，宜培养血气为主。彼以草药敷贴，遂致不救。
王安人，发背正溃时，欲速效，敷以草药，即日而死。
张宜人，年逾六十，患发背三日，肉色不变，头如粟许，肩背肿，脉洪数，寒热饮冷。
予以人参败毒散二剂，及隔蒜灸五十余壮，毒大发，背始轻。再用托里药渐溃，因血气虚甚
而作渴，用参 归熟等药，而渴亦止。彼欲速效，乃自用草药罨患处，毒瓦斯复入，遂不救。
（薛按）
凡痈疡肿痛，宜用围药敷治者，惟降痈散为第一，无论阴毒阳毒，皆所宜也。
薛己说：针灸疗法中，有太乙人神、周身血忌、逐年飞尸神、逐日人神的禁忌，以及穴位禁针禁灸的说法。触犯这些禁忌，病情难以痊愈，道理确实如此。但是疮疡患者气血已经受损，肌肉已经坏死，应当紧急采用迎而夺之、顺而取之的治法，这与健康人的针灸治疗不同，有什么忌讳呢？《外科精义》说：疮疡病症，毒气没有途径消散，脓血瘀滞没有途径排出，反而攻冲于体内，内脏既然已经衰败，想要指望生存，怎么可能呢？危重恶性的病症，发生在致命部位，祸患就在转瞬之间。腹痈、囊痈导致大小便不通，胸腹胀闷；唇疔、喉痹导致咽喉肿胀堵塞，其祸害尤其迅速，患者务必审慎对待。
邻居苏子遇在家，左手手指患上疔疮，出现麻木、瘙痒、寒热、恶心症状，左半身都麻木，脉搏快且不时显现。我说：凡是疮疡，不宜完全不痛，也不宜剧烈疼痛，若伴有烦闷者属不治之症。现在出现麻木瘙痒更是凶险之兆。服用两剂夺命丹无效，又使用解毒药剂，麻木瘙痒才去除，转为肿痛。我说：病势虽然危险，但可喜的是开始作痛，只是毒气没有途径排出，我想用针刺排脓。恰逢农历十五（望日），他的家人都说飞尸神方位不利，不能针刺，结果肿胀更加严重。我强行为他针刺，各种症状顿时消退，再用解毒药剂，疮疡才得以痊愈。（薛己按语）
《黄帝内经》说：五脏功能不和，九窍就不通利；六腑功能不和，就会留结形成痈肿。又说：形体受伤则疼痛，气机受伤则肿胀。这显然是脏腑不和，导致疮疡发于体表，这是很明白的道理。如果涂抹寒凉药物，怎么能调和脏腑、宣通气血呢？如果红肿热渴，脉象滑数而有力，证候属于纯阳的，适宜内服济阴汤，外敷抑阳散，那么热毒自然解除，瘀滞自然消散。如果似肿非肿，似痛非痛，似溃不溃，似红不红，脉象洪数但无力，属于半阴半阳的，适宜内服冲和汤，外敷阴阳散，那么气血自然调和，瘀滞自然消除。如果微肿微痛，或者颜色暗紫且不痛，或者坚硬不溃破，脉象虽然洪大，但按压时微细软弱，属于纯阴的，适宜内服回阳汤，外敷抑阴散，那么脾胃自然强健，阳气自然恢复。朱丹溪说：敷贴的药物，只是用来应付轻微的小热证罢了。如果不辨别阴证阳证的区分依据，而胡乱敷用寒凉药物，就会闭塞腠理，凝滞气血，毒气反而内攻，肌肉反而死亡。况且运气得寒则不健运，瘀血得寒则不散去，败肉得寒则不溃破，新肉得寒则不生发，治疗者务必审慎。（见《外科枢要》）
薛己说：大抵疮疡的起发、溃破、收敛，都是气血作用的结果。每个人的元气虚实不同，有的因不能起发而死亡，有的因起发但不能成脓而死亡，有的因成脓但不能腐溃而死亡，有的因腐溃但不能收敛而死亡。敷贴的方法，只能用来应付轻微的病症。如果气血已经枯竭，患病必然死亡，不仅仅是敷贴无效，而且气血喜欢温暖而厌恶寒冷，腠理喜欢通畅而厌恶闭塞，气血因此更加停滞，肿胀患处因此更加严重，邪气因此更加深入，腐溃因此更加扩大，体弱之人往往因此败亡。况且疮疡多由七情相火，或食用膏粱厚味，或服用金石丹药，损伤阴血，导致阳盛阴虚，病源在内而表现于外。如果不分辨气分血分、阴阳虚实、腐溃深浅，即使服药，还有不能保全性命的，何况仅仅依靠敷贴呢？
施二守，颈部右侧长了一个肿块，使用凉药敷贴，导致整个颈部肿胀。再次敷贴，肿胀蔓延至胸部和腋下，冷感应及腹部，他不明白是凉药所致，还认为是毒气旺盛。身体困倦疲惫，自认无法存活，请我治疗。我看到他敷药的地方热气像雾一样蒸腾，急忙让他去掉药物，过了很久疮色变红，刺出脓血，使用托里药而痊愈。
张侍御，背部生疽，专门使用敷药，疮色暗紫不起发，胸膈闷气，不能呼吸，自认为无法治愈，我用辛温托里药而使其痊愈。
一个男子，臀部生痈已腐溃，但肌肉不生，用药敷贴后，四周肌肉反而变硬。我诊察他的脉象涩而弱，这是气血俱虚，不能滋养患处，所以敷用凉药反而变硬，这是气血受寒凝结而非毒气所致。使用大补药而痊愈。
一个男子，患胸疽，肿高作痛，在肿处敷药，疼痛虽止，但颜色变暗，肿处外围作痛。继续敷药，肌肉颜色也变暗，喉咙内部作痛。不明白这是被凉药所误，反而将药敷满颈部，结果颈部全部溃烂而死。
一个男子，因愤怒导致左侧胁部肿起一块，不疼痛，脉象涩而浮。我说：这是肝经邪火炽盛，而真气不足导致的病患，应当以培养血气为主。他却用草药敷贴，最终导致不治身亡。
王安人，背部生疽正在溃破时，想要快速见效，敷用草药，当天就死亡。
张宜人，年过六十，患背部生疽三天，肉色不变，疮头如粟米大小，肩背肿胀，脉象洪数，寒热交替，想喝冷饮。我给她服用两剂人参败毒散，并隔蒜灸五十多壮，毒气大发，背部才开始减轻。再用托里药逐渐溃破，因为气血非常虚弱而口渴，用人参、当归、熟地黄等药，口渴也就停止了。她想要快速见效，自己用草药罨敷患处，毒气复入体内，最终不治身亡。（薛己按语）
Xue Ji stated: In the practice of acupuncture and moxibustion, there are taboos regarding Taiyi Ren Shen (Taiyi Human Spirit), Zhou Shen Xue Ji (Whole Body Blood Taboo), Nian Fei Shi Shen (Yearly Flying Corpse Spirit), and Ri Ren Shen (Daily Human Spirit). There are also discussions on acupoints that are forbidden for needling or moxibustion. Violating these leads to difficult recovery, which is logically sound. However, in cases of sores and ulcers where Qi and Blood are already damaged and muscles are necrotic, it is urgent to employ the methods of "meeting and seizing" (Ying Er Duo Zhi) and "following and taking" (Shun Er Qu Zhi). This differs from acupuncture in healthy individuals; what is there to fear? *Waike Jingyi* (Essentials of Surgery) states: In sore and ulcer conditions, if toxic factors have no way to dissipate and pus/blood stasis has no way to drain, they will attack inward. Once the internal organs are depleted, how can survival be expected? Critical and malignant conditions occurring at vital sites bring disaster in an instant. Abdominal carbuncles and scrotal carbuncles causing obstruction of urination and defecation, chest and abdominal distension; lip carbuncles and throat bi (obstruction) causing swelling and blockage of the throat—these dangers are particularly rapid. Patients must exercise caution.
My neighbor, Su Ziyu, suffered from a ding (carbuncle/furuncle) on his left finger, presenting with numbness, itching, aversion to cold with fever, nausea, and numbness throughout the left half of his body. His pulse was rapid and intermittent. I said: Generally, sores should not be completely painless, nor should they cause severe pain. Cases accompanied by irritability and oppression are untreatable. The current presentation of numbness and itching is even more ominous. Two doses of Duoming Dan (Life-Rescuing Pill) were ineffective. After using detoxifying agents, the numbness and itching subsided, turning into swelling and pain. I said: Although the condition is critical, it is fortunate that pain has developed, indicating the toxic factor has a pathway to express itself. However, since the toxin lacks an outlet, I wish to use needling to drain it. Coinciding with the full moon (Wang day), his family insisted that the Fei Shi Shen taboo prohibited treatment. Consequently, the swelling worsened. I forcefully performed needling, after which all symptoms instantly receded. Subsequent use of detoxifying agents led to the healing of the sore. (Commentary by Xue Ji)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the five zang organs are disharmonious, the nine orifices become obstructed; when the six fu organs are disharmonious, stagnation forms abscesses. It further states: Injury to form causes pain; injury to Qi causes swelling. This clearly indicates that disharmony of the zang-fu organs leads to sores manifesting externally. If one applies cooling herbs, how can one harmonize the zang-fu and promote the circulation of Qi and Blood? If the presentation involves redness, swelling, heat, and thirst, with a slippery and rapid yet forceful pulse, the syndrome belongs to Pure Yang. One should internally administer Jiyin Tang (Nourish Yin Decoction) and externally apply Yiyang San (Suppress Yang Powder), so that heat-toxin resolves and blood stasis disperses spontaneously. If the presentation is swollen but not fully swollen, painful but not severely painful, appearing to ulcerate but not actually ulcerating, reddish but not truly red, with a surging and rapid but weak pulse, the syndrome belongs to Half-Yin Half-Yang. One should internally administer Chonghe Tang (Harmonizing Decoction) and externally apply Yinyang San (Yin-Yang Powder), so that Qi and Blood harmonize and stasis消 (disappears) spontaneously. If there is slight swelling and pain, or dark discoloration without pain, or hardness without ulceration, and although the pulse appears surging and large, it is fine and weak upon pressure, the syndrome belongs to Pure Yin. One should internally take Huiyang Tang (Restore Yang Decoction) and externally apply Yiying San (Suppress Yin Powder), so that the Spleen and Stomach strengthen and Yang Qi returns spontaneously. Zhu Danxi stated: Topical applications are only suitable for mild, minor heat syndromes. If one fails to distinguish between Yin and Yang syndromes and recklessly applies cooling agents, one will block the couli (pores/skin texture), stagnate Qi and Blood, cause toxins to attack inward, and result in tissue death. Moreover, if the physiological climate encounters cold, vitality is impaired; if blood stasis encounters cold, it does not disperse; if necrotic tissue encounters cold, it does not ulcerate; if new flesh encounters cold, it does not grow. Practitioners must be cautious. (From *Waike Shuyao*)
Xue Ji stated: Generally, the initiation, suppuration, and healing of sores depend on Qi and Blood. Since each person's Yuan Qi (Original Qi) varies in deficiency or excess, some die because the sore cannot initiate; some die because it initiates but fails to suppurate; some die because it suppurates but fails to putrefy and drain; some die because it drains but fails to heal. Topical applications are only suitable for mild conditions. If Qi and Blood are exhausted, the patient will inevitably die. Not only will topical treatments fail, but since Qi and Blood prefer warmth and dislike cold, and the couli prefer openness and dislike blockage, the use of cold/cooling agents will further stagnate Qi and Blood, intensify swelling, deepen the pathogenic factor, enlarge the area of putrefaction, and lead to defeat in frail patients. Furthermore, sores often arise from the fire of the seven emotions, consumption of rich/greasy foods, or ingestion of mineral drugs, which damage Yin Blood, leading to Excess Yang and Deficiency Yin. The disease originates internally and manifests externally. If one does not differentiate between Qi and Blood aspects, Yin and Yang, deficiency and excess, and the depth of putrefaction, even oral medication may fail to save life, let alone topical applications.
Shi Erzhou developed a nodule on the right side of his neck. After applying cooling herbs topically, the entire neck swelled. Upon re-application, the swelling extended to the chest and axillae, with a sensation of cold extending to the abdomen. Unaware that this was caused by the cooling herbs, he believed it indicated intense toxicity. He became physically exhausted and despaired of recovery. I treated him and observed heat vapor rising like fog from the application site. I urgently ordered the removal of the herbs. After a long time, the lesion turned red, and pus and blood were expressed via puncture. Treatment with Tuoli medicines (Supporting Interior Agents) led to recovery.
Zhang Siyu developed a back carbuncle and relied solely on topical applications. The lesion remained dark and did not rise; he experienced chest and diaphragm oppression and dyspnea, believing himself incurable. I treated him with Xinwen Tuoli medicines (Acrid-Warm Supporting Interior Agents) and he recovered.
A male patient had a gluteal carbuncle that had ulcerated but failed to regenerate muscle. After topical application, the surrounding muscle became hard. My diagnosis revealed a choppy and weak pulse, indicating dual deficiency of Qi and Blood, unable to nourish the affected area. Thus, the cooling herbs caused cold coagulation rather than toxicity. Treatment with major tonifying agents resulted in recovery.
A male patient suffered from a chest carbuncle, characterized by high swelling and pain. Topical application stopped the pain but caused the color to darken and pain to spread to the periphery. Continued application darkened the skin and caused throat pain. Unaware of the error caused by cooling herbs, he applied them extensively over the neck, resulting in total neck ulceration and death.
A male patient developed a non-painful lump on the left hypochondrium due to anger. The pulse was choppy and floating. I diagnosed this as blazing evil fire in the Liver channel combined with insufficiency of True Qi, requiring cultivation of Qi and Blood as the primary strategy. He used herbal poultices instead, leading to an untreatable outcome.
Wang Anren developed a back carbuncle. During the active ulceration phase, seeking rapid results, she applied herbal poultices and died on the same day.
Zhang Yiren, over sixty years old, developed a back carbuncle three days prior. The skin color was unchanged, the head was millet-sized, with shoulder and back swelling, surging and rapid pulse, alternating chills and fever, and a desire for cold drinks. I administered two doses of Renshen Baidu San (Ginseng Detoxification Powder) and performed fifty-plus moxa cones using garlic partitioning. The toxin erupted vigorously, and the back swelling subsided. Subsequent use of Tuoli medicines led to gradual ulceration. Due to severe Qi and Blood deficiency, she developed thirst, which ceased after administration of Renshen (Ginseng), Danggui (Angelica Sinensis), and Shudi (Prepared Rehmannia Root). Seeking rapid results, she self-applied herbal poultices to the lesion, causing the toxin to re-enter the interior, leading to her death. (Commentary by Xue Ji)
For all swellings and pains associated with sores and ulcers, if topical encircling medications (Weiyao) are indicated, Jiangyong San (Descending Carbuncle Powder) is the premier choice, suitable for both Yin and Yang toxic conditions.