外疡为病，外因有四时六淫之感触，内因有七情六郁之损伤，种种原由无不备具。而以
最普通者言之，则热病其多数也。盖外感六淫，蕴积无不化热；内因五志，变动皆有火生。
此则内科百病属热者亦必居其大半；况在外疡，肌肤灼痛，肉腐成脓，谓非热郁于中，有以
消烁之而何。此世俗治疡所以无不注重于清润寒凉一途，诚不能不谓其大有适用处也。虽然
疮疡之属于热者固是最多，颐必不敢偏信林屋山人阳和一汤，谓为泛应曲当，而妄加无辜者
以炮烙之刑，听其惨暴哀号，焦肌铄骨。究之热病情况，万有不齐。欲求其分量咸宜，铢两
悉称，似亦不易。固非如街头卖药，市上摇铃者，记得芩、连、膏、黄、银花、地丁数味，
而可以尽疡医之能事者也。
试以疡病之属于热，分别言之。有风热之证，因风而生热者，如头面诸疡及游风之类是
也。虽宜清热，而必先辛凉疏风，不得早用寒凉之药。否则热已退而坚块犹存，久留不消终
为顽证；甚者寒凉直折，反致血滞气凝，适以助虐。有湿热之病，因湿而生热者，如湿痒诸
疮及 疮流火是也。虽亦必清热，而尤须淡渗导湿，不得恃芩连等味。否则热势渐解，而湿
积不化，肿腐难瘳。惟有毒火之证，发为疔疮，来势迅疾，易散难聚，热毒不仅直入血分，
且必与心肝二脏有直接关系。所以毒散走黄（毒散而内陷，俗谓之“走黄”。字义极不可解
而妇孺皆知有“走黄”二字。以患疔毒死者，或有全体发黄如金色者，实即毒入经络，不能
自化，郁蒸以成此变，“走黄”之名，盖由于此）必有神志昏迷，肝火横逆见证。则治法虽
在
芍均是必需之要。否则变幻异常，捷于奔马，一击不中，补救綦难。此疡科中最为激烈暴
戾之证，所当救焚沃焦，重剂急进，不可轻描淡写，杯水车薪，反致顷刻燎原，不可向迩者
也。
疗毒之易于走黄者，头面诸疔为甚。肿势漫溢，坚硬异常，针之无血无水无脓，一至神
思恍惚，言语模糊，宜其难疗。早用犀、羚可治十九，亦是凉降以平气火，使之不复上攻耳
。所以头面之疔，易成危候也。又手指亦多疔疮，用药亦同此理，但其势较缓，可治者多。
惟红丝疔一种，自发肿之处生出红晕一条，现于肌肉之表，从臂上行，渐以及腋，相传谓此
红晕过腋入胸即为不治。而颐治疡三十年，尚未见此坏证，或亦古人理想之辞。阆师谓此是
心家之热，药以泻心为主，重用芩、连、栀、翘，投之辄效。总之皆清心肝二脏之热。盖心
肝是君相二火之源，证虽在表，而源本于里，所谓病之轻者，皆在经络，惟重病则涉及腑脏
者也。外疡之宜于大剂寒凉，而不虞其太过者，惟此一证。足部亦有所谓水疔者，初则红肿
蔓延，大热大痛，不一二日而腐化甚巨。此其湿火毒邪，亦必犀、羚、芩、连大剂急投，可
救危难，而又以淡渗导湿辅之。此是湿火与毒火相合之病，与专治毒火者，尚宜微分门径。
若夫外疡溃后，有火宜清，则视其证之险夷，而辨铢两。苟非阳发水疔（水疔亦称阳发毒），
绝
量，而惟以清凉解毒四字，作为枕中鸿宝，则疡患之不死于病而死于药者多矣。
外疡（体表疮疡）致病，外因有感受四时六淫邪气，内因有情志失调及气机郁结的损伤，各种病因无不具备。而以最普遍的情况来说，热证占大多数。因为外感六淫邪气，蕴积之后无不化热；内因五志变动，变化之中皆有火生。这也就是内科百病中属热的也必然占去大半；何况在外疡方面，肌肤灼热疼痛，肌肉腐烂化成脓液，如果说不是热邪郁结在体内，从而消烁肌肉，那又是什么呢？这就是世俗治疗外疡所以无不注重于清润寒凉这一途径的原因，确实不能不说其有很大的适用之处。虽然如此，疮疡属于热证的固然最多，但我绝不敢偏信林屋山人所说的“阳和一汤”，认为它泛应曲当（泛指广泛适用且恰当），从而妄加无辜患者以炮烙般的酷刑，听任他们悲惨暴烈地哀号，导致焦肌铄骨。究其实质，热病的病情情况，万有不齐（各不相同）。想要做到分量完全适宜，轻重恰到好处，似乎也不容易。这绝不是像街头卖药、市上摇铃的人那样，只记得黄芩、黄连、石膏、大黄、金银花、紫花地丁这几味药，就可以尽到疡医的职责了。
试着将属于热证的外疡分别论述。有风热之证，因风邪而生热者，如头面部的各种疮疡及游风（一种皮肤红肿瘙痒、游走不定的病症）之类是也。虽然应当清热，但必须先使用辛凉药物疏风，不得过早使用寒凉药物。否则热邪虽退但坚硬肿块依然存在，长久停留不消散，最终成为顽固难治之证；更严重的是，若用寒凉药物直折火势，反而导致血滞气凝，恰好助长邪气肆虐。有湿热之病，因湿邪而生热者，如湿痒诸疮及流火（丹毒的一种，表现为局部红肿热痛）是也。虽然也必须清热，但尤其需要淡渗利湿以导引湿邪外出，不得依赖黄芩、黄连等苦寒燥湿之品。否则热势逐渐缓解，但湿邪积聚不化，肿胀腐败难以痊愈。惟有毒火之证，发为疔疮，发病迅速，易散难聚，热毒不仅直接深入血分，而且必定与心、肝二脏有直接关系。所以毒邪扩散出现“走黄”（毒散而内陷，俗谓之“走黄”。字义极不可解而妇孺皆知有“走黄”二字。以患疔毒死者，或有全体发黄如金色者，实即毒入经络，不能自化，郁蒸以成此变，“走黄”之名，盖由于此）的症状，必有神志昏迷、肝火横逆的表现。那么治疗方法中，犀角、羚羊角都是必需的要药。否则病情变幻异常，快如奔马，一击不中，补救非常困难。这是疡科中最为激烈暴戾的证候，应当救焚沃焦（比喻抢救危急情况），重用急进，不可轻描淡写，杯水车薪，反而导致顷刻间燎原，不可收拾。
疗毒（疔疮）易于发生走黄的，以头面部的疔疮最为严重。肿势漫溢，坚硬异常，针刺无血无水无脓，一旦发展到神思恍惚、言语模糊，确实难以治疗。早期使用犀角、羚羊角可以治愈十分之九，这也是通过凉降来平抑气火，使其不再向上攻冲的缘故。所以头面部的疔疮，容易形成危重证候。另外手指上也多生疔疮，用药道理与此相同，但其势头较缓，可治愈的多。惟有一种红丝疔，自发肿之处生出一条红晕，显现于肌肉表面，从手臂上行，渐渐波及腋下，相传谓这条红晕越过腋窝进入胸部即为不治之症。而我治疗外疡三十年，尚未见到这种坏证，或许也是古人的理想之辞。阆师说这是心家之热，用药以泻心为主，重用黄芩、黄连、栀子、连翘，投药往往见效。总之都是清泻心、肝二脏的热邪。因为心、肝是君火和相火的源头，证候虽然在体表，但根源在于内脏，所谓病轻者，都在经络，只有重病才涉及腑脏。外疡适宜用大剂寒凉药物，而不必担心太过分的，只有这一种证候。足部也有所谓的“水疔”，初起则红肿蔓延，大热大痛，不一两天就腐化很严重。这是湿火毒邪，也必须大剂量急投犀角、羚羊角、黄芩、黄连，可以挽救危难，同时辅以淡渗利湿的药物。这是湿火与毒火相结合的病，与专门治疗毒火的，尚宜稍微区分门径。至于外疡溃破之后，有火应当清泻，则要视其证候的危险或平安，来辨别药量的轻重。如果不是阳发水疔（水疔亦称阳发毒），绝不可盲目追求清凉解毒四字，将其作为枕中鸿宝（指珍贵的秘籍或方法），那么疡病患者死于疾病的不多，死于药物的却很多了。
External sores (external ulcers) arise from external causes, such as the influence of the six climatic pathogens (Six Excesses) of the four seasons, and internal causes, such as damage from the seven emotions and six types of qi stagnation; all kinds of etiological factors are fully present. Speaking of the most common situations, heat syndromes account for the majority. This is because external contraction of the six climatic pathogens, when accumulated, invariably transforms into heat; and changes in the five zang organ emotions invariably generate fire. Thus, among the hundred diseases of internal medicine, those belonging to heat must also constitute more than half; moreover, in the case of external sores, where the skin and muscles are burning and painful, and flesh rots to form pus, if it is not due to heat郁结 (stagnation) within that consumes and melts the tissue, what else could it be? This is why secular treatments for external sores invariably focus on the path of clearing heat with moistening and cold-cooling agents; indeed, one cannot deny that this approach has significant applicability. Nevertheless, although heat-type sores are indeed the most numerous, I dare not blindly believe in Linwushanren's assertion that Yanghe Decoction (Warming and Unblocking Decoction) is universally appropriate, thereby inflicting upon innocent patients a punishment akin to branding or scorching, allowing them to wail miserably and violently until their flesh is scorched and bones melted. In reality, the manifestations of heat diseases vary infinitely. To achieve precise dosage balance, where every grain is weighed correctly, seems not easy at all. It is certainly not like street peddlers or market bell-ringers who merely memorize a few herbs such as Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Shigao (Gypsum Fibrosum), Dahuang (Rhei Radix et Rhizoma), Jinyinhua (Lonicerae Japonicae Flos), and Diding (Violae Herba), and thus claim to have fulfilled the duties of a surgeon.
Let us discuss heat-type external sores separately. There are Wind-Heat syndromes, where heat arises from wind, such as various sores on the head and face and Youfeng (Roaming Wind, a condition characterized by wandering redness and itching). Although clearing heat is indicated, one must first use pungent-cool herbs to disperse wind; cold-cooling drugs should not be used prematurely. Otherwise, even if the heat subsides, hard lumps may remain; lingering for a long time without dissolving, they eventually become stubborn and difficult-to-treat conditions. Worse still, if cold-cooling herbs are used to directly suppress the fire, it may instead cause blood stasis and qi condensation, inadvertently assisting the pathogen. There are Damp-Heat diseases, where heat arises from dampness, such as various itchy sores caused by dampness and Liuhuo (Flowing Fire, a type of erysipelas presenting with local redness, swelling, heat, and pain). Although clearing heat is necessary, especially light-draining and diuretic methods to guide dampness out are required; one must not rely solely on bitter-cold herbs like Huangqin and Lianzi. Otherwise, while the heat intensity gradually resolves, damp accumulation remains undissipated, making swelling and putrefaction difficult to heal. Only in Toxic-Fire syndromes, manifesting as Dingchuang (Ding sores/carbuncles), does the onset proceed rapidly, being easy to scatter but hard to gather. The toxic heat not only penetrates directly into the Blood level but also has a direct relationship with the Heart and Liver organs. Therefore, when the toxin spreads causing Zouhuang (Toxin spreading inward, colloquially known as "Zouhuang". The literal meaning is extremely obscure, yet everyone knows the term. Those who die from Ding toxicity may have their whole body turn yellow like gold; this is actually the toxin entering the meridians, unable to transform itself, accumulating and steaming to create this change, hence the name "Zouhuang"), there will inevitably be signs of coma and rebellious Liver Fire. Thus, Xijiao (Rhinocerotis Cornu) and Lingyangjiao (Capricornis Cornu) are essential in treatment. Otherwise, the condition changes abnormally, fast as a galloping horse; if the initial strike fails, remediation is extremely difficult. This is the most violent and aggressive syndrome in surgery, requiring urgent administration of heavy doses to extinguish a raging fire; one must not treat it lightly or with insufficient measures (like a cup of water trying to save a burning cartload of firewood), which would instead lead to an uncontrollable inferno in an instant.
Among Ding toxins prone to Zouhuang, those on the head and face are the most severe. The swelling spreads diffusely and is exceptionally hard; puncturing yields no blood, water, or pus. Once the patient reaches a state of mental confusion and slurred speech, it is indeed difficult to treat. Early use of Xijiao and Lingyangjiao can cure nine out of ten cases; this works by cooling and descending to calm Qi and Fire, preventing them from attacking upward. Hence, Ding sores on the head and face easily become critical. Additionally, fingers often develop Ding sores, and the therapeutic principle is the same, though the progression is slower and curable cases are more common. However, there is a specific type called Hongsi Ding (Red Thread Ding), where a red halo emerges from the site of initial swelling, visible on the surface of the muscle, traveling up the arm and gradually reaching the axilla. Tradition holds that if this red line crosses the armpit and enters the chest, it is incurable. Yet, having treated external sores for thirty years, I have never seen such a deteriorated condition; perhaps this is merely an idealized statement by ancients. Master Lang stated that this is Heat in the Heart, and treatment should focus on draining the Heart, heavily using Huangqin, Lianzi, Zhizi (Gardeniae Fructus), and Liaoqiao (Forsythiae Fructus), yielding immediate results. In summary, these all clear Heat from the Heart and Liver. Since the Heart and Liver are the sources of Ministerial and Sovereign Fires, although the manifestation is on the exterior, the root lies in the interior. As the saying goes, mild diseases reside in the meridians, while severe diseases involve the fu-zang organs. Among external sores, the only ones suitable for large doses of cold-cooling herbs without fear of excess are this specific type. On the feet, there is also what is called Shuiding (Water Ding). Initially, there is spreading redness and swelling, intense heat and pain, leading to massive putrefaction within one or two days. This involves Damp-Fire and Toxic-Dampness; it requires urgent, heavy doses of Xijiao, Lingyangjiao, Huangqin, and Lianzi to save the crisis, assisted by light-draining dampness-promoting herbs. This is a disease combining Damp-Fire and Toxic-Fire, which should be slightly distinguished from those treating Toxic-Fire alone. As for external sores after ulceration, if there is fire, it should be cleared, but the dosage must be judged according to the severity or mildness of the syndrome. Unless it is Yangfa Shuiding (Shuiding is also called Yangfa Du), one must not blindly pursue the four characters "Cooling and Detoxifying," treating them as a precious secret recipe; otherwise, many patients will die from the medication rather than the disease.