齐氏曰∶若发肿都软而不痛者，血瘤也。发肿日渐增长而不大热，时时牵痛者，气瘤也
。气结微肿，久而不消，后亦成脓，此是寒热所为也。留积经久，极阴生阳，寒化为热，以
此溃者，必多成 ，宜早服内塞散以排之。又凡察痈疽，以手掩其上，大热者，脓成自软也
。若其上薄皮剥起者，脓浅也。其肿不甚热者，脓未成也。若患瘰 结核，寒热发渴，经久
不消，其人面色痿黄者，被热上蒸，已成脓也。至于脏腑肠胃内疮内疽，其疾隐而深藏，目
既不见，手不能近，所为至难，但以诊脉而辨之，亦可知也。有患胃脘痈者，当候胃脉。胃脉
者，人迎也。其脉沉数，气逆则甚，甚则热聚胃口，而胃脘为痈也。若其脉洪数者，脓已成
也。设脉迟紧，虽脓未就，已有瘀血也。宜急治之。不尔，则邪气内攻，腐烂肠胃，不可救
也。又《肺痈论》曰∶始萌则可救，脓成即死，不可不慎也。久之，咳脓如粳米粥者，不治
。呕脓而止者，自愈也。又《肠痈论》曰∶或绕脐生疮，脓从疮出者，有出脐中者，惟大便
下脓血者，自愈也。
伍氏曰∶疮肿赤色，按之色不变者，此脓已成也。按之随手赤色者，其亦有脓也。按之
白色良久方赤者，此游毒已息，可就赤白尽处灸断，赤肿自消。凡痈疽以手按之，若牢硬未
有脓也，若半软半硬已有脓也。又按肿上不热者，为无脓。热甚者，为有脓，宜急破之。
立斋曰∶疮疡之证，毒瓦斯已结者，但可补其气血使脓速成。脓成者，当验其生熟浅深，
视其可否，针而去之。不可论内消之法。小按便痛者，脓浅也。大按方痛者，脓深也。按之
不复起者，脓未成也。按之即复起者，脓已成也。脓生而用针，气血既泄，脓反难成。脓熟
而不针，则腐溃益深，疮口难敛。若疮深而针浅，内脓不出，外血反泄。若疮浅而针深，内
脓虽出，良肉受伤。若元气虚弱，必先补而后针，勿论尻神，其脓一出，诸证自退，若脓出
而反痛，或烦躁呕逆，皆由胃气亏损也。宜急补之。若背疮热毒炽盛，中央肉黯，内用托里
，壮其脾胃，外用乌金膏涂于黯处。其赤处渐高，黯处渐低，至六七日间赤黯分界，自有裂
纹，如刀划然，黯肉必渐溃矣。当用 针利剪徐徐去之，须使不知疼痛，不见鲜血为妙。
若
虽有裂纹，脓未流利，及脓水虽出而仍痛者，皆未通于内，并用针于纹中引之。若患于背胛
之间，凡人背近脊处并胛，皮里有筋一层。患此处者，外皮虽破，其筋难溃，以致内脓不出
，令人胀痛苦楚，气血转虚，变证百出。若待自溃，多致不救，必须开之引之，兼以托里。
常治此证，以利刀剪之，尚不能去，似此坚物，待其自溃，不反甚乎。此非气血壮实者，未
见其能自溃也。若元气虚弱而误服克伐，患处不痛，或肉将死，急须温补脾胃，亦有生者。
后须纯补之药，庶可收敛。若妄用刀针，去肉出血，则气血愈虚愈伤矣，何以生肌收敛乎。
大凡疮疡脓即溃，当大补血气为先，须有他证，当以未治。
又曰∶凡疮不起者，托而起之；不成脓者，补而成之，使不内攻。脓成则及时针之，不
数日即愈矣。常见患者皆畏针痛而不肯用，又有恐伤肉而不肯用，殊不知疮虽发于肉薄之所
，若其脓成必肿高寸余，疮皮又浓分许，用针深不过二分。若发于背，必肿高二三寸，入
针只于寸许。况患者肉既已坏，何痛之有。何伤之虑。凡怯弱之人，或患附骨等疽，待脓自
通，以致大溃不能收敛，气血沥尽而已者为多矣。
又曰∶凡疮既成脓，皮肤不得疏泄，昧者待其自穿，殊不知少壮而充实者，或能自解，
若老弱之人，气血枯槁，或兼攻发太过，不行针刺，脓毒乘虚内攻，穿肠腐膜，鲜不误事。
若毒结四肢，砭刺少缓，则腐溃深大，亦难收敛。毒结于颊项胸腹紧要之地，不问壮弱，急
宜针刺，否则难治。如沈氏室、黄上舍等，皆以此而殁者多矣。大抵疮疡之证，感有轻重，
发有深浅，浅者肿高而软，发于血脉，深者肿下而坚，发于筋骨，然又有发于骨髓者，则皮
肉不变。故古人制法，浅宜砭而深宜刺，使瘀血去于毒聚之始，则易消。若脓成之时，气血
壮实者，或自出，怯弱者，不行针刺，鲜有不误。凡疮疡透膜，十无一生，虽以大补药治之
，亦不能救，此可为待脓自出之戒也。故东垣云∶毒瓦斯无从而解，脓瘀无从而泄，过时不烙
，反功于内，内既消败，欲望其生，岂可得乎。兹举一二以告同道，并使患者知所慎云。
又曰∶凡患疮疽，虽因积热所成，若初起未成脓，脉洪数，乃阴虚阳亢之证。若脓溃于
内，不得发泄于外，身必发热，故脉见洪数，乃痈疽之病进也。脓既去则当脉静身凉，肿消
痛息，如伤寒表证之得汗也。若反发热作渴，脉洪数者，此真气虚而邪气实，死无疑矣。
又曰∶若治元气不足之证，即其初患，盒饭用参 归术，温补脾胃，外用桑枝葱熨，接
补阳气，使自消散。若久而不能成脓者，亦用前二法，补助以速之。若脓既成而不溃，用艾
于当头灸数炷以出之，却服十全大补汤。
齐氏说：如果肿胀部位柔软且不疼痛的，是血瘤。肿胀逐渐增大但热度不高，时常有牵拉性疼痛的，是气瘤。气机郁结导致轻微肿胀，日久不消退，后来也会化脓，这是寒热邪气作用的结果。邪气留滞积聚时间久了，极阴之中生出阳气，寒气转化为热气，因此溃破后，往往容易形成瘘管（漏），应当尽早服用内塞散来排出脓毒。另外，凡是观察痈疽，用手按压其上方，感觉大热的，说明脓已成熟且局部变软。如果表面薄皮剥起，说明脓液位置较浅。如果肿胀处热度不明显，说明脓尚未形成。如果患有瘰疬结核，伴有寒热、口渴，经久不消，且患者面色萎黄，这是被热邪上蒸，已经成脓了。至于脏腑肠胃内部的疮疡，病情隐蔽且深藏，眼睛看不见，手也摸不到，诊断非常困难，只能通过诊察脉象来辨别，也可以知晓。如果有患胃脘痈的，应当候察胃脉。胃脉指的是人迎脉。如果脉象沉而数，气逆症状严重，严重时热气聚集在胃口，就会形成胃脘痈。如果脉象洪大且数，说明脓已经形成。假如脉象迟而紧，虽然脓未形成，但已有瘀血存在。应当紧急治疗。如果不这样，邪气就会向内攻伐，腐蚀肠胃，就无法挽救了。另外，《肺痈论》说：病初起时还可以救治，脓成之后就会死亡，不可不谨慎。如果久病后，咳出的脓像粳米粥一样，属于不治之症。如果呕出脓液后症状停止，会自愈。另外，《肠痈论》说：有的绕脐生疮，脓从疮口流出，有的从脐中流出，只有大便下脓血的，会自愈。
伍氏说：疮肿颜色赤红，按压后颜色不变的，说明脓已成。按压后随即出现赤色的，也有脓。按压后呈白色，很久才变红的，说明游走的毒气已经平息，可以在赤白交界处施灸以截断毒势，赤色肿胀自然会消退。凡是痈疽，用手按压，如果坚硬没有脓，如果半软半硬说明已有脓。另外按压肿胀处如果不热，说明无脓。热势严重的，说明有脓，应当紧急刺破。
立斋说：疮疡的证候，毒气已经结聚的，只可补益气血使脓迅速生成。脓形成的时候，应当检验其生熟、深浅，视情况是否可行，用针排去脓液。不可以讨论内消的方法。轻轻按压就痛的，说明脓浅。用力按压才痛的，说明脓深。按压后凹陷不复起的，说明脓未形成。按压后立即复起的，说明脓已成。脓刚生成就用针刺，气血既已泄出，脓反而难以形成。脓成熟了而不针刺，则腐烂溃破更深，疮口难愈合。如果疮深而针刺浅，内部脓液出不来，外部血液反而流失。如果疮浅而针刺深，内部脓液虽出，但好肉受伤。如果元气虚弱，必须先补益而后针刺，不要顾虑其他，只要脓一排出，各种症状自然消退。如果脓排出后反而疼痛，或者烦躁呕吐逆气，这都是因为胃气亏损。应当紧急补益。如果是背部的疮疡，热毒炽盛，中央肌肉颜色暗黑，内服托里药，强壮脾胃，外用乌金膏涂抹在暗黑处。赤色部分逐渐高起，暗黑部分逐渐低陷，到六七日间赤暗分界处，自然出现裂纹，像刀划的一样，暗黑肌肉必然逐渐溃烂。应当用铍针利剪慢慢去除，必须做到不知疼痛、不见鲜血为妙。如果虽然有裂纹，但脓液不流畅，以及脓水虽出但仍然疼痛的，都是内部不通畅，都用针在裂纹中引导。如果患病在背胛之间，一般人背部靠近脊柱处和肩胛骨，皮里有筋一层。患此处的，外皮虽然破了，但筋难以溃烂，导致内部脓液出不来，使人胀痛苦楚，气血更加虚弱，变证百出。如果等待自行溃烂，多导致无法挽救，必须切开引流，兼用托里法。经常治疗这种证候，用利刀剪除，尚且不能去除，像这样的坚物，等待它自行溃烂，不是更严重吗？这不是气血壮实的人，没见它能自行溃烂的。如果元气虚弱而误服克伐药物，患处不痛，或者肌肉将死，急需温补脾胃，也有存活的。后来须用纯补的药，才可以收敛。如果妄用刀针，去肉出血，则气血越虚越伤，怎么能够生肌收敛呢？大凡疮疡脓即溃破，应当以大补气血为先，如果有其他症状，应当另行治疗。
又说：凡是疮不起发的，用托法使其起发；不成脓的，补益使其成脓，使毒气不向内攻伐。脓成则及时针刺，不几天就好了。常见患者都畏惧针刺疼痛而不肯使用，又有担心损伤肌肉而不肯使用的，殊不知疮虽然发于肌肉较薄的地方，但如果脓成必然肿胀高出寸余，疮皮又厚分许，用针刺深度不超过二分。如果发于背部，必然肿胀高二三寸，入针只在寸许。况且患者的肉已经坏死，有什么疼痛？有什么损伤的顾虑？凡是怯弱的人，或者患附骨疽等，等待脓自行通畅，以致大溃而不能收敛，气血沥尽而死的很多。
又说：凡是疮既然成脓，皮肤不得疏泄，无知者等待它自行穿破，殊不知身体强壮充实的人，或许能自行解开，如果是老弱之人，气血枯槁，或者兼攻发太过，不行针刺，脓毒乘虚向内攻伐，穿透肠胃腐坏膜原，很少有不误事的。如果毒结在四肢，砭刺稍微迟缓，则腐溃深大，也难收敛。毒结在颊项胸腹紧要之地，不论强壮虚弱，急宜针刺，否则难治。如沈氏家室、黄上舍等人，都因此死亡的很多。大抵疮疡的证候，感受毒气有轻重，发作有深浅，浅的肿胀高而软，发于血脉，深的肿胀下而坚硬，发于筋骨，然而又有发于骨髓的，则皮肉不变。所以古人制定方法，浅的适宜砭刺而深的适宜针刺，使瘀血在毒气聚集之初就去掉，就容易消散。如果脓成的时候，气血壮实的人，或许自行流出，怯弱的人，不行针刺，很少有不误事的。凡是疮疡穿透膜原，十无一活，即使以大补药治疗，也不能挽救，这可以作为等待脓自行流出的警戒。所以东垣说：毒气无处化解，脓瘀无处排泄，过时不烙治，反作用于内部，内部既已消败，希望它生存，怎么可能呢？这里举一二例告诉同道，并使患者知道谨慎。
又说：凡是患疮疽，虽然因积热所成，如果初起未成脓，脉象洪数，这是阴虚阳亢的证候。如果脓在内溃破，不能在外部发泄，身体必然发热，所以脉象见洪数，这是痈疽病情进展。脓既排出则应当脉静身凉，肿胀消退疼痛停止，就像伤寒表证得汗一样。如果反而发热口渴，脉象洪数的，这是真气虚而邪气实，必死无疑。
又说：如果治疗元气不足的证候，就在初患时，应当用参、芪、归、术，温补脾胃，外用桑枝葱熨，接补阳气，使其自然消散。如果久了不能成脓的，也用前两种方法，补助以加速成脓。如果脓既成而不溃破，用艾在顶部灸几壮以引出脓液，然后服用十全大补汤。
Qi stated: If the swelling is soft and painless, it is a blood tumor (Xueliu). If the swelling gradually increases but is not very hot, with occasional pulling pain, it is an air tumor (Qiliu). Qi stagnation causes slight swelling that does not resolve for a long time; later, pus may form. This is caused by cold and heat pathogens. After prolonged accumulation, extreme Yin generates Yang, and cold transforms into heat. When such lesions ulcerate, they often become fistulas (Lou); therefore, one should take Neisai San early to drain them. Furthermore, when examining carbuncles and sores, if pressing the area reveals intense heat, the pus has matured and the area becomes soft. If the superficial skin peels up, the pus is shallow. If the swelling is not very hot, the pus has not yet formed. If one suffers from scrofula (Luoli) with alternating chills and fever, thirst, and persistent non-resolution, accompanied with sallow complexion, this indicates steaming by heat pathogens, and pus has already formed. As for internal ulcers of the viscera and intestines, the disease is concealed and deep, invisible to the eye and inaccessible to touch, making diagnosis extremely difficult. It can be distinguished only by pulse diagnosis. For gastric epigastric abscess (Weiwanyong), one should inspect the Stomach pulse, which refers to the Renying (ST9) point. If the pulse is deep and rapid, with severe Qi rebellion, heat accumulates at the stomach opening, leading to gastric epigastric abscess. If the pulse is surging and rapid, pus has formed. If the pulse is slow and tight, although pus has not formed, blood stasis exists. Urgent treatment is required; otherwise, pathogenic factors will attack inward, rotting the intestines and stomach, rendering the condition incurable. Additionally, "Lung Abscess Treatise" states: It is curable in the initial stage, but fatal once pus forms; caution is essential. If after a long duration, coughing up pus resembling rice porridge occurs, it is untreatable. If vomiting pus stops the symptoms, spontaneous recovery will occur. "Intestinal Abscess Treatise" states: Sores may appear around the umbilicus with pus draining from the sore or from the umbilicus itself; only cases with pus and blood in the stool will heal spontaneously.
Wu stated: If the sore is red, and pressing it does not change color, pus has formed. If pressing it immediately turns red, pus is also present. If pressing turns it white, which slowly turns red after a long time, the wandering toxin has subsided; moxibustion can be applied at the boundary between red and pale areas to block the toxin, and the red swelling will subside. Generally, for carbuncles and sores, if pressing feels hard without fluctuation, there is no pus; if half-soft and half-hard, pus is present. If the swollen area is not hot upon pressing, there is no pus. Intense heat indicates pus presence, requiring urgent incision.
Lizhai stated: In ulcerative conditions where toxins have aggregated, one should tonify Qi and Blood to hasten pus formation. Once pus forms, assess its maturity, depth, and suitability for drainage, then use a needle to evacuate it. Do not rely on internal resolution methods. Slight tenderness upon pressing indicates shallow pus; deep tenderness upon heavy pressing indicates deep pus. Indentation that does not rebound indicates unformed pus; immediate rebound indicates formed pus. Needling too early depletes Qi and Blood, hindering pus formation. Delaying needling until pus matures leads to deeper necrosis and delayed healing. If the lesion is deep but needled shallowly, internal pus remains while external blood is lost. If the lesion is shallow but needled deeply, internal pus drains but healthy tissue is damaged. In cases of weak Yuan Qi, tonification must precede needling. Once pus drains, symptoms naturally recede. If pain persists or irritability/vomiting occurs after drainage, it indicates Stomach Qi deficiency; urgent tonification is needed. For back sores with intense heat toxicity and dark central flesh, use internal Tuoli (supporting interior) formulas to strengthen the Spleen and Stomach, and apply Wujin Ointment externally to the dark area. As the red area rises and the dark area sinks, a clear boundary appears after six to seven days with crack-like lines resembling knife cuts; the dark flesh will gradually slough off. Use a bi needle and sharp scissors to remove it slowly, aiming for painlessness and absence of fresh bleeding. If cracks exist but pus flow is poor, or pain persists despite drainage, internal blockage remains; use needles to guide drainage through the cracks. For lesions on the back/scapula region, where fascia lies beneath the skin, even if the skin breaks, the fascia resists rupture, trapping internal pus, causing distension, pain, Qi/Blood deficiency, and various complications. Waiting for spontaneous rupture often proves fatal; surgical opening and drainage combined with Tuoli therapy are necessary. Even with sharp instruments, removing hardened tissue is difficult; waiting for spontaneous rupture is worse. Only individuals with robust Qi and Blood can expect spontaneous rupture. If Yuan Qi is weak and astringent/cold-draining herbs are mistakenly used, causing lack of pain or impending necrosis, warm tonification of the Spleen and Stomach is urgent, and survival is possible. Subsequent pure tonification aids convergence. Reckless use of knives/needles causing bleeding further depletes Qi and Blood, hindering tissue regeneration. Upon ulceration, prioritizing massive tonification of Qi and Blood is essential; other symptoms should be addressed subsequently.
He further stated: For sores that do not protrude, use supporting methods to raise them; for those lacking pus, tonify to generate it, preventing internal invasion. Once pus forms, timely needling leads to quick recovery. Patients often fear pain or tissue damage from needling. However, even for superficial sores with inch-high swelling, needle depth should not exceed two fen. For back sores with three-inch swelling, needle depth is about one cun. Since the tissue is already necrotic, pain and damage concerns are unfounded. Weak patients suffering from bone-abscesses (Fugu Ju) who wait for spontaneous rupture often suffer extensive ulceration, exhaustion of Qi and Blood, and death.
He also stated: Once pus forms, if the skin does not vent, laypersons waiting for spontaneous rupture risk disaster. While robust individuals might self-resolve, frail persons with depleted Qi/Blood, especially after excessive purgation, face internal invasion of toxic pus, perforating intestines and membranes if not needled. Delayed needling for limb toxins causes deep necrosis. For critical areas like cheeks, neck, chest, or abdomen, urgent needling is required regardless of constitution; failure to do so is difficult to treat. Many, such as Lady Shen and Scholar Huang, died due to this negligence. Generally, superficial sores are high and soft, affecting blood vessels; deep sores are low and hard, affecting sinews and bones; bone marrow involvement shows no skin changes. Ancient methods prescribe bian (pricking) for superficial and ci (needle) for deep lesions to remove blood stasis early, facilitating resolution. At the pus stage, robust individuals may self-drain, but frail ones require needling; failure to do so is rarely successful. Penetration of membranes in ulcers is almost invariably fatal, even with strong tonics, serving as a warning against waiting for spontaneous drainage. Dongyuan noted: Without drainage, toxins cannot resolve, and pus/stasis cannot exit. Delaying cauterization/needling allows internal damage, leading to collapse and death. These examples are shared with colleagues and patients to encourage caution.
He further stated: Although sores/carbuncles arise from accumulated heat, early stages without pus showing surging/rapid pulses indicate Yin deficiency with Yang hyperactivity. Internal rupture without external venting causes fever and surging/rapid pulses, indicating disease progression. After pus drainage, the pulse should calm, body temperature normalize, and swelling/pain cease, similar to sweating resolving exterior Cold Damage syndromes. Persistent fever/thirst with surging/rapid pulses indicates true Qi deficiency and pathogen excess, signaling certain death.
Finally, he stated: For conditions of insufficient Yuan Qi, early treatment should use Ginseng (Renshen), Astragalus (Huangqi), Angelica (Danggui), and Atractylodes (Baizhu) to warm/tonify the Spleen/Stomach, combined with external mugwort-onion warming (Sangzhi Congyi) to support Yang Qi for spontaneous resolution. If pus fails to form over time, these methods accelerate maturation. If pus forms but does not rupture, moxa should be applied to the apex to induce drainage, followed by Shiquan Dabu Decoction.