夫疮疽脓溃肿毒浸淫证候危恶者，须辨虚实，况夫虚者难补，实者易泻，补泻
之法，不可轻用，若或少差，利害甚大。然而虚实多端，有疮之虚实，有脏腑虚实，有
血气虚实，又有上实下虚，真虚邪实者，不可不辨也。夫肿起坚硬脓稠者，疮疽之实
也；肿下软漫脓稀者，疮疽之虚也。泻利肠鸣，饮食不入，呕吐无时，手足并冷，脉
弱皮寒，小便自利，或小便时难，大便滑利，声音不出，精神不爽者，悉脏腑之虚
也；大便硬，小便涩，饮食如故，肠满膨胀，胸膈痞闷，肢节疼痛，口苦嗌干，烦
躁多渴，身热脉大，精神昏塞者，悉脏腑之实也。如脓水清稀，疮口不合，聚肿不
赤，肌寒肉冷，自汗色脱者，气血之虚也；肿起色赤，寒热疼痛，皮肤壮热，脓水稠
粘，头目昏重者，气血之实也。头痛鼻塞，目赤心惊，咽喉不利，口舌生疮，烦渴饮
冷，睡语切牙者，上实也；精滑不敛，大便自利，腰脚沉重，睡卧不宁者，下虚也。
肩项不便，四肢沉重，目视不正，睛不了了，食不知味，音嘶声败，四肢浮肿者，真
气之虚也； 肿尤甚，痛不可近，积日不溃，寒热往来，大便秘涩，小便如淋，心
神烦闷，恍惚不宁者，邪气之实也。又曰∶真气夺则虚，邪气盛则实。又曰∶诸痛为
实，痒为虚也。又曰∶诊其脉洪大而数者，实也，微细而软者，虚也。虚则补之，和
其气，托里也。实则泻之，疏利而自导其气也。《内经》谓∶血实则决之，气虚则掣
引之。元戎云∶若人气血壅盛，营卫充满，抑遏不行，腐化而为痈者当泄之，以夺盛
热之气。若人饮食少思，精神衰弱，营卫短涩，寒搏而为痈者，当补之，以接虚怯
之气，此治虚实之大法也。疮疽，动息自宁，饮食知味，脉证俱缓，缓则治本，故
可以王道和平之药，徐而治之，亦无不愈。若脉实 肿，烦躁寒热，脉证俱实，非硝
黄猛烈之剂不能除，投以王道之剂，则非也。若疮疡聚肿不溃，溃而脓水清稀，或
泄利肠鸣，饮食不入，呕吐无时，或手足并冷，此脉证俱虚，非大补之药，不能平
投，以硝黄攻伐之剂，亦非也。故治其证者，当辨表里虚实，随宜治之，庶得万全。
（《准绳》）
凡是疮疽脓液溃破、肿毒蔓延浸淫，证候危急险恶的，必须辨别虚实。况且虚证难以补益，实证容易泻除，补法和泻法不可轻易使用，如果稍有差错，利害非常大。然而虚实的情况多种多样，有疮疡本身的虚实，有脏腑的虚实，有血气的虚实，又有上实下虚、真虚假实的，这些都不能不加以辨别。
凡是肿胀隆起、坚硬、脓液稠厚的，是疮疡的实证；肿胀平坦、漫散、脓液稀薄的，是疮疡的虚证。
凡是腹泻肠鸣、饮食无法进入、呕吐无常、手足冰冷、脉象微弱、皮肤寒冷、小便自利（通畅），或者小便排尿困难、大便滑泄不禁、声音嘶哑不出、精神昏沉不爽的，都是脏腑的虚证；大便秘结坚硬、小便涩滞不畅、饮食正常、腹部胀满膨胀、胸膈痞闷堵塞、肢体关节疼痛、口苦咽干、烦躁多渴、身体发热、脉象洪大、精神昏沉窒塞的，都是脏腑的实证。
如果脓水清稀、疮口不能愈合、聚集肿胀但不发红、肌肉寒冷、自汗出、面色苍白无华，这是气血的虚证；肿胀隆起、颜色红赤、伴有寒热疼痛、皮肤灼热、脓水稠粘、头目昏重，这是气血的实证。
头痛鼻塞、眼睛红赤、心惊不安、咽喉不利、口舌生疮、烦躁口渴想喝冷饮、睡梦中说胡话并咬紧牙齿的，是上实；精气滑脱不收敛、大便自利、腰脚沉重、睡眠卧不安宁的，是下虚。
肩颈项部活动不便、四肢沉重、视物不正、眼神不清、吃东西不知道味道、声音嘶哑败坏、四肢浮肿的，是真气（正气）的虚证；肿胀特别严重、疼痛剧烈不可触碰、经过多日不溃破、寒热往来、大便秘结涩滞、小便像淋证一样频急涩痛、心神烦闷、恍惚不安的，是邪气的实证。
又说：真气耗夺就是虚，邪气亢盛就是实。又说：各种疼痛属于实证，瘙痒属于虚证。又说：诊察脉象洪大而数的，是实证；脉象微细而软的，是虚证。
虚证就用补法，调和其气，托里扶正。实证就用泻法，疏通利导，自行引导其气机。《内经》说：血实则决之（刺破排脓或活血），气虚则掣引之（牵引升提）。元戎（张元素）说：如果人气血壅盛，营卫充满，郁遏不行，腐化而成痈疽的，应当用泻法，以消除亢盛的火热之气。如果人饮食减少思虑，精神衰弱，营卫短少涩滞，寒邪搏结而成痈疽的，应当用补法，以接续虚怯的气机，这是治疗虚实的大法。
疮疽病，如果动静休息自然安宁，饮食知道滋味，脉象和证候都缓和，缓和则治本，所以可以用王道（平和）的药物，缓慢地治疗，没有不痊愈的。如果脉象实、肿胀明显，烦躁寒热，脉象和证候都属实，不用硝石、大黄这样猛烈的药剂不能去除病邪，投用王道的药剂，就不对了。如果疮疡聚集肿胀不溃破，溃破后脓水清稀，或者腹泻肠鸣、饮食无法进入、呕吐无常，或者手足冰冷，这些脉证都属于虚，不用大补的药不能平复病情，投用硝石、大黄攻伐的药剂，也是不对的。所以治疗这些证候，应当辨别表里虚实，根据适宜的方法治疗，才能万无一失。
For conditions where sores and carbuncles have ruptured with pus, and toxic swelling is spreading and infiltrating, presenting with critical and dangerous symptoms, it is essential to differentiate between deficiency (Xu) and excess (Shi). Moreover, deficiency syndromes are difficult to tonify, while excess syndromes are easier to purge. The methods of tonification and purging must not be used lightly; even a slight error can lead to significant harm. However, the manifestations of deficiency and excess are manifold: there are deficiencies and excesses specific to the sores themselves, those of the Zang-Fu organs, those of Qi and Blood, as well as upper excess with lower deficiency, and true deficiency with false excess. These must not fail to be distinguished.
When swelling is raised, hard, and the pus is thick, it indicates an excess syndrome of the sore or carbuncle; when swelling is flat, diffuse, and the pus is thin, it indicates a deficiency syndrome of the sore or carbuncle.
Symptoms such as diarrhea with borborygmus, inability to take in food, frequent vomiting, coldness of hands and feet, weak pulse, cold skin, free urination, or difficulty in urination accompanied by loose stools, loss of voice, and mental dullness or discomfort, all indicate deficiency of the Zang-Fu organs. Conversely, hard constipation, astringent and difficult urination, normal appetite, abdominal fullness and distension, chest and diaphragm stuffiness, pain in limbs and joints, bitter taste in the mouth and dry throat, irritability, excessive thirst, fever, large pulse, and mental confusion or obstruction, all indicate excess of the Zang-Fu organs.
If the pus and water are clear and thin, the sore opening fails to heal, swelling gathers but is not red, muscles are cold, flesh is cold, spontaneous sweating occurs, and the complexion is pale and depleted, this is deficiency of Qi and Blood. If swelling is raised and red, accompanied by aversion to cold and fever, pain, hot skin, thick and sticky pus, and heaviness and dizziness of the head and eyes, this is excess of Qi and Blood.
Headache, nasal congestion, red eyes, palpitations, pharyngeal dysfunction, sores in the mouth and tongue, irritability and thirst for cold drinks, somnolence with muttering and teeth grinding, constitute upper excess. Essence slipping and failing to consolidate, spontaneous loose stools, heaviness in the waist and legs, and restless sleep constitute lower deficiency.
Inconvenience in the shoulders, neck, and nape, heaviness in the four limbs, abnormal vision, unclear gaze, loss of taste, hoarse and deteriorated voice, and edema of the four limbs indicate deficiency of True Qi (Zheng Qi). Swelling that is particularly severe, pain so intense it cannot be touched, failure to suppurate after many days, alternating chills and fever, constipation and astringency, urine resembling strangury, mental restlessness and oppression, and恍惚 (fluctuating) uneasiness indicate excess of Pathogenic Qi (Xie Qi).
It is said: Depletion of True Qi results in deficiency; flourishing of Pathogenic Qi results in excess. It is also said: All pain belongs to excess; itching belongs to deficiency. Furthermore: A pulse that is surging, large, and rapid indicates excess; a pulse that is minute, fine, and soft indicates deficiency. For deficiency, apply tonification to harmonize Qi and support the interior (Tuo Li). For excess, apply purging to unblock and guide Qi freely. The *Neijing* states: "If Blood is in excess, pierce/draining; if Qi is deficient, pull and lift." Yuan Rong (Zhang Yuansu) stated: If a person has congested Qi and Blood, full Ying and Wei, obstructed flow, leading to putrefaction and formation of abscesses, one should purge to drain the excessive heat. If a person has reduced appetite, weakened spirit, short and astringent Ying and Wei, with cold binding leading to abscesses, one should tonify to connect with the deficient and timid Qi. This is the general principle for treating deficiency and excess.
For sores and carbuncles, if movement and rest are naturally peaceful, appetite returns, and both pulse and symptoms are moderate/slow, treatment should address the root. Thus, one may use gentle, kingly-method (Wang Dao) medicines to treat slowly, and recovery will invariably follow. If the pulse is excess, swelling is prominent, accompanied by irritability, chills, and fever, and both pulse and symptoms indicate excess, only fierce agents like Mirabilite (Xiaoshi) and Rhubarb (Dahuang) can eliminate the pathogen; using gentle medicines would be incorrect. If sores gather and swell without suppurating, or upon suppuration the pus is clear and thin, or if there is diarrhea with borborygmus, inability to eat, frequent vomiting, or cold hands and feet, these pulse and symptom patterns indicate deficiency. Only major tonifying medicines can calm the condition; using purging agents like Mirabilite and Rhubarb would be incorrect. Therefore, in treating these conditions, one must distinguish exterior/interior and deficiency/excess, and treat according to appropriateness, thereby ensuring complete safety.