医家内外科实相表里，惟小儿为难治，故谓之“哑科”。虽疮疡为有形之症，然亦必先
审乎
赋，移于所感，是故人有老少强弱之等，而脉亦有盛衰虚实之异。故疗病治疮疡者，皆当先
辨其有余、不足，而为主客、缓急之施则善矣。其见于东垣、丹溪、河间、仲景之论，可考
而知也。吾切叹夫世之庸医，未尝读书明理，以疮疡试方药，而遂误人者，不少也。尝见南
京判院薛君《外科心法》，精当切要，可传，而许其有扶困起废之仁。一日，持是编以告余
先君，子欲以随治验方萃以成编，庶克济人，且以自验其力。余承先意，乃今分症异，欲而
录其既验者，尤致详于有余不足之辨，而为虚实主客之宜。欲锓诸梓以传，庶有便于穷乡下
邑之无名医者，不独自验而已也。少宰蒲汀李公尝见之，标曰∶《立斋外科发挥》，子盍叙
之。余惟君子不忘乎亲，不私其有。夫不忘其亲之谓孝，不私其有之谓仁，孝则仁，仁则公
，公则溥。君之是编，其真君子之用心哉！吾儒以推己及物求仁，而欲措天下于仁寿之域。
是编之行，于人必大有济，故为之叙，以推展而传之。
嘉靖戊子秋孟月朔，南京刑部员外郎前进士郡人张淮叙。
肿高 痛脉浮者，邪在表也，宜托之；肿硬痛深脉沉者，邪在内也，宜下之；外无 肿
，内
拘急，或头痛者，邪在表也，宜散之；大痛，或不痛者，邪气实也，隔蒜灸之，更用解毒；
烦躁饮冷， 痛脉数者，邪在上也，宜清之；恶寒而不溃者，气实兼寒邪也；宜宣而补之；
痛发热，汗多大渴，便秘谵语者，结阳证也，宜下之；不作脓，或熟而不溃者，虚也，宜
补之。
一男子胸患痈，肿高 痛，脉浮而紧，以内托复煎散二剂，表证悉减；以托里消毒散，
四剂而消。
一男子腹患痈，肿硬愈闷，烦热便秘，脉数而实。以黄连内疏汤，一剂少愈；以黄连解
毒汤，二剂顿退；更以金银花散四剂，出水而消。
一男子患腿痛而不 肿，内亦便利调和，用托里荣卫汤数剂而消。
一妇人项患毒， 痛发寒热。以荆防败毒散，二剂少愈；以小柴胡汤，加连翘、牛蒡子
、桔梗，四剂而消。
一男子肩患毒， 痛饮冷，烦躁便秘，脉数而实。以清凉饮二剂少愈；以金银花散四剂
悉退；又以十宣散，去桂加天花粉、金银花，数剂，疮头溃而痊。
一妇人臂患肿，恶寒不作脓。以十宣散六剂而溃；以托里散数剂而瘳。
一男子患痈，肿硬疼痛，发热烦躁，饮冷，脉沉实，大便秘，乃邪在脏也。用内疏黄连
汤疏
，四剂而消。
一男子内股患毒，肿硬痛甚，不作脓。隔蒜灸五十余壮，势退七八；以仙方活命饮，四
剂而脓成；用十宣散，六剂脓溃而愈。凡疮大痛，或不痛麻木，灸最良。
一妇人臂肿，未成脓，饮食少思，遇劳作痛发热。以补中益气汤二剂，痛少止；以补
气血健脾胃药而消。
一男子素弱，胸患痈，饮食少而倦。以六君子汤加芎、归、黄 ，脓成，针之；更以托
里药而愈。
一妇人胁患痈，未成脓，恶寒脉紧。以十宣散加柴胡二剂，表证悉退；更以托里散数剂
，脓溃而愈。
一妇人臂患毒肿硬，咽喉壅塞，四肢逆冷，发寒热。以五香连翘汤二剂，顿愈；以疮科
流气饮四剂而消。
一男子臂患痈，脉弦紧有力。以白芷升麻汤二剂顿退；又二剂而消。
一妇人肩下患毒，脉弦紧。以白芷升麻汤二剂，表证已退；更以托里药溃之而愈。
一男子臂患痈，不作脓。灸以豆豉饼，及饮托里药三十余剂而溃，又月余而瘳。
一男子脓熟不溃，予欲针之，补以托里。彼不信，乃服攻毒药，及致恶心少食，始悟而
用针
。更以六君子汤，加藿香、当归四剂，稍可；再以加味十全大补汤，数剂而敛。凡疮脓熟，
不行针刺，脓毒侵蚀，轻者难疗，重者不治。老弱之人，或偏僻之处，及紧要之所，若一有
脓，宜急针之，更以托里，庶无变证。
一男子患毒作痛。服寒凉药，痛虽止而食愈少，疮亦不溃。以六君子汤而食进，再以托
里药
者，以温热之剂散之。因风而痛者，除其风。因湿而痛者，导其湿。燥而痛者润之。塞而痛
者通之。虚而痛者补之。实而痛者泻之。脓郁而闭者开之。恶肉侵蚀者去之。阴阳不和者调
之。经络秘涩者利之。慎勿概用寒凉之药。况血脉喜温而恶寒，若冷气入里，血即凝滞，反
为难瘥之证矣。
一男子素弱，肘患肿。欲内消，服凉药，反致作泻少食。以二神丸及香砂六君子汤加肉
豆蔻
木坚固。次以行经活血药佐之，参以经络时令，使毒瓦斯外发，施治之早，可以内消。此内托
之意也。又云∶肿疡内外皆壅，宜以托里表散为主。如欲用大黄，宁无孟浪之非？溃疡内外
皆虚，宜以补接为主。如欲用香散，未免虚虚之失。大抵痈肿之证，不可专泥于火为患。经
云∶营气不从，逆于肉理，乃生痈肿。又云∶形伤痛，气伤肿，六淫七情，皆能致之。况禀
有虚实，及老弱不同，岂可概用寒凉之药？设若毒始聚，脓未作，势不盛，庶可消。尤当推
其病因，别其虚实，若概用寒凉药，必致误事。如脓将成，邪盛气实，用消毒之剂，先杀其
毒，虽作脓不为大苦，溃亦不甚。若就用托里，必益其势。如脓将成不成及不溃，方用托里
。脓成势盛者针之，脓一出，诸证悉退矣。
附方
内托复煎散 治疮疡肿 在外，其脉多浮。邪气胜，必侵内，宜用此药托之。
地骨皮 黄芩（炒） 茯苓 白芍药（炒） 人参 黄 （盐水拌炒） 白术（炒） 桂皮 甘
草（炙） 防己（酒拌） 当归（酒拌，各一钱） 防风（二钱）
咀，先以苍术一升，水五升，煎。去术，入药，再煎至二升，终日饮之。苍术渣外，再煎
服。
托里消毒散 治疮疽已攻发不消者，宜服此药，未成即消，已成即溃，腐肉易去
，新肉易生。如有疮口，宜贴膏药。敛即不用，切不可用生肌之药。
人参 黄 （盐水拌炒） 当归（酒拌） 川芎 芍药（炒） 白术（炒） 茯苓（各一钱） 白
芷
内疏黄连汤（一名黄连内疏汤） 治疮疡肿硬，发热作呕，大便秘涩，烦躁饮冷，
呕心烦，脉沉实。此邪在脏也。急服以内除之，使邪不得犯经络。
黄连 山栀 当归（酒拌） 芍药 木香 槟榔 黄芩 薄荷 桔梗 甘草（各一钱） 连
翘大黄（炒，各二钱） 作一剂，水二钟，煎八分，食前服。
黄连解毒汤（方见疮疡作呕门）
荆防败毒散（方见疔疮门）
隔蒜灸法
仙方活命饮
清凉饮
十宣散（四方见发背门）
香砂六君子汤（方见作呕门）
破棺丹（方见发背门）
托里散 治疮疡饮食少思，或不腐，不收敛。
人参 黄 （盐水拌炒） 当归（酒拌） 川芎 白术（炒） 茯苓 芍药（各一钱） 浓朴（
姜制） 白芷 甘草（各五分） 作一剂，水二钟，煎八分服。
代针膏 治疮疡脓熟不溃。
乳香（二分） 白丁香（细直者是） 巴豆（去壳炒焦） 碱（各五分） 为末，热水调，点疮
头上，常以碱水润之，勿令干也。
托里荣卫汤 治疮疡外无 肿，内亦便利调和，乃邪在经络，宜用此药调理。
黄 （炒） 红花（各一钱） 桂枝（七分） 苍术（米泔浸炒） 柴胡 连翘 羌活 防风
当
金银花散（方见作呕门）
小柴胡汤（方见瘰 门）
黄连消毒散（方见脑疽门）
补中益气汤（方见溃疡发热门）
六君子汤（方见作呕门）
十全大补汤（方见溃疡发热门）
五香连翘汤 治诸疮初觉，一二日便厥逆，咽喉塞，寒热。
沉香 木香 麝香 连翘 射干 升麻 丁香 独活 桑寄生 甘草（炙，各一钱） 大
黄木通 乳香（各一钱五分） 每服五钱，水一钟，煎八分，温服，取利。
疮科流气饮（方见流注门）
白芷升麻汤 治手臂患痈，左右手脉皆短，中按之俱弦，按下洪缓有力，此得之
八风之变也。
白芷（一钱五分） 升麻 桔梗（各一钱） 生黄芩（二钱） 红花 甘草（炙，各五分） 酒
黄芩 黄 （各一钱） 作一剂，水一钟半，煎八分，食远服。
豆豉饼（方见臀痈门）
二神丸（方见作呕门）
【背景信息】
书名：立斋外科发挥 作者：薛己 朝代：明 章节：叙 / 肿疡（谓疮疡未出脓者） 类别：外科
【待处理原文翻译】
医家内、外两科实际上互为表里，只有儿科因为患儿无法准确表述病情，难以诊治，所以被称为“哑科”。虽然疮疡是看得见的有形病症，但也必须先审察患者的先天禀赋，以及后天感受的外邪。因此，人有老少、强弱之分，脉象也有盛衰、虚实之别。所以治疗疾病和疮疡的人，都应当先辨别病证的有余（实证）或不足（虚证），根据主客、缓急的情况灵活施治，这样就好了。这些道理在东垣、丹溪、河间、仲景等医家的论述中，都可以考证得知。我深切感叹世上那些平庸的医生，不曾读书明理，拿疮疡来试验方药，从而误人的情况，并不少见。曾经看到南京判院薛君所著的《外科心法》，精当切要，可以流传，认为他具有扶助困苦、起死回生的仁德之心。有一天，他拿着这本书告诉我的父亲，说：“我想把随治随验的方剂收集起来编成书，希望能救济世人，并且以此验证自己的医术。”我秉承父亲的意愿，于是将症状分类，想要记录那些已经验证有效的方子，尤其详细地辨析有余与不足的区别，以及虚实主客的适宜治法。打算刻印出版以流传于世，希望方便穷乡僻壤中无名无姓的医生使用，不仅仅是为了自我验证罢了。少宰蒲汀李公曾经看过这本书，题名为《立斋外科发挥》，你为什么不写一篇序言呢？我认为君子不忘父母之恩，不独占私利。不忘父母之恩叫做孝，不独占私利叫做仁，有孝则生仁，有仁则公正，公正则广博。薛君的这本书，真是君子的用心啊！我们儒家学者推己及物以求仁道，希望将天下人安置在仁爱长寿的境界中。这本书的刊行，对世人一定大有裨益，所以我写了这篇序言，以推广并传播它。
嘉靖戊子年秋初一月朔日，南京刑部员外郎、前进士、同郡人张淮作序。
肿胀高突、疼痛、脉浮的，是邪气在体表，宜用托法；肿胀坚硬、疼痛深在、脉沉的，是邪气在体内，宜用下法；外表没有肿胀，内部拘急疼痛，或者头痛的，是邪气在体表，宜用散法；剧烈疼痛，或者不痛的，是邪气实盛，可用隔蒜灸法，再配合解毒药；烦躁、想喝冷水、局部灼痛、脉数的，是邪气在上焦，宜用清法；怕冷且疮口不溃破的，是气实兼感寒邪，宜宣通并补益；疼痛、发热、汗多、大渴、便秘、胡言乱语的，是结阳证，宜用下法；不能化脓，或者熟透却不溃破的，是虚证，宜用补法。
一个男子胸部患痈，肿胀高突、疼痛，脉浮而紧，服用内托复煎散两剂后，表证全部减轻；再用托里消毒散四剂，肿块消散。
一个男子腹部患痈，肿胀坚硬且更加闷痛，烦热、便秘，脉数而实。服用黄连内疏汤一剂后稍有好转；再用黄连解毒汤两剂，症状顿退；又用金银花散四剂，出水后消散。
一个男子患腿痛但不肿胀，内部二便调和，用托里荣卫汤数剂后消散。
一个妇人颈部患毒，局部疼痛并发寒热。用荆防败毒散两剂后稍有好转；用小柴胡汤，加连翘、牛蒡子、桔梗，四剂后消散。
一个男子肩部患毒，局部疼痛、想喝冷水，烦躁、便秘，脉数而实。用清凉饮两剂后稍有好转；用金银花散四剂后全部消退；又用十宣散，去掉桂枝加入天花粉、金银花，数剂后疮头溃破而痊愈。
一个妇人手臂患肿，怕冷且不化脓。用十宣散六剂后溃破；用托里散数剂后痊愈。
一个男子患痈，肿胀坚硬疼痛，发热烦躁，想喝冷水，脉沉实，大便秘结，这是邪气在脏腑。用内疏黄连汤疏泄，四剂后消散。
一个男子大腿内侧患毒，肿胀坚硬疼痛严重，不化脓。隔蒜灸五十多壮，势头退了七八成；用仙方活命饮四剂后化脓；用十宣散六剂后脓溃而愈。凡是疮疡剧痛或不痛麻木的，艾灸效果最好。
一个妇人手臂肿胀，未成脓，饮食减少思食，劳累时疼痛发热。用补中益气汤两剂，疼痛稍止；再用补气血健脾胃的药物后消散。
一个男子素体虚弱，胸部患痈，饮食少且疲倦。用六君子汤加川芎、当归、黄芪，脓成后针刺；再用托里药后痊愈。
一个妇人胁部患痈，未成脓，怕冷脉紧。用十宣散加柴胡两剂，表证全部消退；再用托里散数剂，脓溃而愈。
一个妇人手臂患毒，肿胀坚硬，咽喉壅塞，四肢逆冷，发寒热。用五香连翘汤两剂，顿然痊愈；用疮科流气饮四剂后消散。
一个男子手臂患痈，脉弦紧有力。用白芷升麻汤两剂后顿退；又两剂后消散。
一个妇人肩下患毒，脉弦紧。用白芷升麻汤两剂，表证已退；再用托里药使其溃破而愈。
一个男子手臂患痈，不化脓。用豆豉饼灸，并饮用托里药三十多剂后溃破，又过一个多月才痊愈。
一个男子脓熟但不溃破，我想给他针刺，并用托里药补益。他不相信，反而服用攻毒药，导致恶心、食欲减少，这才醒悟过来接受针刺。再用六君子汤，加藿香、当归四剂，稍有好转；再用加味十全大补汤，数剂后疮口收敛。凡是疮疡脓熟，不进行针刺，脓毒侵蚀，轻者难治，重者不治。年老体弱之人，或在偏僻之处，以及在重要部位，一旦有脓，应该紧急针刺，再用托里药，这样才能避免变证。
一个男子患毒作痛。服用寒凉药，痛虽止但食欲更少，疮也不溃破。用六君子汤后食欲增进，再用托里药……（此处原文似有脱漏，依上下文意译为：）对于因风寒湿邪致痛的，用温热药剂发散；因风致痛的，祛风；因湿致痛的，利湿；燥致痛的，润之；塞致痛的，通之；虚致痛的，补之；实致痛的，泻之；脓郁闭阻的，开之；恶肉侵蚀的，去除之；阴阳不和的，调和之；经络闭塞涩滞的，疏通之。千万不要一概使用寒凉药物。况且血脉喜温恶寒，如果冷气入里，血液就会凝滞，反而变成难治之证。
一个男子素体虚弱，肘部患肿。想要内消，服用凉药，反而导致腹泻、食欲减少。用二神丸及香砂六君子汤加肉豆蔻，使脾胃坚固。次用行经活血药辅助，参酌经络时令，使毒瓦斯向外发散，治疗及时，可以内消。这就是内托的意思。又说：肿疡内外皆壅滞，宜以托里表散为主。如果想用大黄，恐怕难免鲁莽之失；溃疡内外皆虚，宜以补接为主。如果想用香散类药物，未免有虚其虚的过失。大抵痈肿之证，不可专门拘泥于火为患。经文说：营气不从，逆于肉理，乃生痈肿。又说：形伤痛，气伤肿，六淫七情，都能导致。何况禀赋有虚实，以及老少不同，怎么能一概使用寒凉药物？假设毒邪刚聚集，脓未形成，势头不盛，或许可以消除。尤其应当推究病因，辨别虚实，如果一概用寒凉药，必定导致误事。如果脓即将形成，邪盛气实，用消毒之剂，先杀灭毒邪，即使化脓也不会太痛苦，溃破也不严重。如果此时就用托里药，必定助长邪势。只有当脓将成不成及不溃破时，才用托里。脓成势头盛的，针刺排脓，脓一出，各种症状都退去了。
附方
内托复煎散 治疗疮疡肿胀在外，脉象多浮。邪气胜，必侵内，宜用此药托之。
地骨皮、黄芩（炒）、茯苓、白芍药（炒）、人参、黄芪（盐水拌炒）、白术（炒）、桂皮、甘草（炙）、防己（酒拌）、当归（酒拌，各一钱）、防风（二钱）。
切碎，先用苍术一升，水五升，煎煮。去掉苍术，加入药料，再煎至二升，整天饮用。苍术渣另外煎服。
托里消毒散 治疗疮疽已经攻发但未消散的，宜服此药，未成即消，已成即溃，腐肉易去，新肉易生。如有疮口，宜贴膏药。敛口后即不用，切不可用生肌之药。
人参、黄芪（盐水拌炒）、当归（酒拌）、川芎、芍药（炒）、白术（炒）、茯苓（各一钱）、白芷……
内疏黄连汤（一名黄连内疏汤） 治疗疮疡肿硬，发热作呕，大便秘涩，烦躁饮冷，呕吐心烦，脉沉实。这是邪气在脏。急服以内除之，使邪不得犯经络。
黄连、山栀、当归（酒拌）、芍药、木香、槟榔、黄芩、薄荷、桔梗、甘草（各一钱）、连翘、大黄（炒，各二钱）。作一剂，水二钟，煎至八分，食前服。
黄连解毒汤（方见疮疡作呕门）
荆防败毒散（方见疔疮门）
隔蒜灸法
仙方活命饮
清凉饮
十宣散（四方见发背门）
香砂六君子汤（方见作呕门）
破棺丹（方见发背门）
托里散 治疗疮疡饮食少思，或不腐，不收敛。
人参、黄芪（盐水拌炒）、当归（酒拌）、川芎、白术（炒）、茯苓、芍药（各一钱）、浓朴（姜制）、白芷、甘草（各五分）。作一剂，水二钟，煎八分服。
代针膏 治疗疮疡脓熟不溃。
乳香（二分）、白丁香（细直者是）、巴豆（去壳炒焦）、碱（各五分）。研为末，热水调，点疮头上，常以碱水润之，勿令干也。
托里荣卫汤 治疗疮疡外无肿胀，内亦便利调和，乃邪在经络，宜用此药调理。
黄芪（炒）、红花（各一钱）、桂枝（七分）、苍术（米泔浸炒）、柴胡、连翘、羌活、防风、当归……
金银花散（方见作呕门）
小柴胡汤（方见瘰疬门）
黄连消毒散（方见脑疽门）
补中益气汤（方见溃疡发热门）
六君子汤（方见作呕门）
十全大补汤（方见溃疡发热门）
五香连翘汤 治疗诸疮初觉，一二日便厥逆，咽喉塞，寒热。
沉香、木香、麝香、连翘、射干、升麻、丁香、独活、桑寄生、甘草（炙，各一钱）、大黄、木通、乳香（各一钱五分）。每服五钱，水一钟，煎八分，温服，取利。
白芷升麻汤 治疗手臂患痈，左右手脉皆短，中按之俱弦，按下洪缓有力，此得之八风之变也。
白芷（一钱五分）、升麻、桔梗（各一钱）、生黄芩（二钱）、红花、甘草（炙，各五分）、酒黄芩、黄芪（各一钱）。作一剂，水一钟半，煎八分，食远服。
[Background Information]
Book: *Lizhai Waikke Fahui* (Elaboration on Surgery by Lizhai)
Author: Xue Ji (Ming Dynasty)
Chapter: Preface / Swollen Ulcer (referring to sores/ulcers before suppuration)
Category: Surgery
[English Translation]
Internal and external medicine practiced by physicians are actually interconnected as interior and exterior. Pediatrics is particularly difficult to treat because infants cannot articulate their symptoms, hence it is called the "Mute Department." Although sores and ulcers are visible, tangible conditions, one must first examine the patient's innate constitution and subsequent exposure to pathogenic factors. Therefore, people vary in age and strength, and pulse presentations differ in excess or deficiency, fullness or emptiness. Thus, when treating diseases and sores/ulcers, one must first distinguish between excess (Shi) and deficiency (Xu), and apply treatment principles according to the primary-secondary relationship and urgency. These principles can be verified in the discussions of Dong Yuan, Dan Xi, He Jian, and Zhong Jing. I deeply lament that many mediocre physicians today have not studied books to understand principles, experimenting with prescriptions for sores/ulcers and thereby harming patients, a situation that is not uncommon. I once saw Mr. Xue, Judge of Nanjing, authored *Waike Xinfa* (Essentials of External Medicine), which is precise and essential, worthy of transmission, demonstrating his benevolence in aiding the distressed and reviving the critical. One day, he presented this manuscript to my father, saying, "I wish to compile verified prescriptions from my clinical cases into a book, hoping to benefit others and verify my own skills." Following my father's intent, I categorized the symptoms, intending to record those proven effective, paying special attention to distinguishing excess from deficiency and determining appropriate treatments for primary-secondary and excess-deficiency patterns. I plan to have it printed for dissemination, hoping to assist unnamed physicians in remote villages, not merely for self-verification. Mr. Li Puting, Vice Minister, had seen this work and titled it *Lizhai Waikke Fahui*. Why do you not write a preface? I believe a gentleman does not forget his parents nor hoard benefits privately. Not forgetting parents is filial piety; not hoarding privately is benevolence. Filial piety leads to benevolence, benevolence leads to impartiality, and impartiality leads to universality. Mr. Xue's compilation truly reflects the heart of a gentleman! We Confucian scholars extend ourselves to all things to seek benevolence, aiming to place the world in a realm of benevolence and longevity. The publication of this book will surely greatly benefit humanity; therefore, I wrote this preface to promote and spread it.
On the first day of the first month of autumn in the Wuzi year of the Jiajing era, Zhang Huai, Former Jinshi, Member of the Court of Judicature and Revision in Nanjing, and fellow townsman, wrote the preface.
If swelling is high, painful, and the pulse is floating, the pathogen is at the exterior; use the supporting method (Tuo). If swelling is hard, pain is deep, and the pulse is sinking, the pathogen is internal; use the purgative method (Xia). If there is no external swelling but internal tension/pain or headache, the pathogen is at the exterior; use the dispersing method (San). If pain is severe or absent, the pathogen is excessive; use garlic-separated moxibustion and further employ detoxifying agents. If there is irritability, desire for cold drinks, burning pain, and a rapid pulse, the pathogen is in the upper jiao; use the clearing method (Qing). If there is aversion to cold and the sore does not ulcerate, it is excess qi combined with cold pathogen; use venting and tonifying methods. If there is pain, fever, profuse sweating, extreme thirst, constipation, and delirium, it is a Yang-binding syndrome; use the purgative method. If pus does not form, or if it is ripe but does not ulcerate, it is deficiency; use tonification.
A man suffered from a carbuncle on the chest, with high swelling, pain, and a floating-tight pulse. After two doses of Neituo Fujian San (Internal Supporting Double-Decoction Powder), the exterior symptoms subsided completely. Four doses of Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) caused the swelling to dissipate.
A man suffered from an abscess on the abdomen, with hard swelling, increasing oppression, irritability, fever, constipation, and a rapid-excess pulse. After one dose of Huanglian Neishu Tang (Coptis Internal-Draining Decoction), he improved slightly; two doses of Huanglian Jiedu Tang (Coptis Detoxifying Decoction) caused immediate relief. Four doses of Jinyinhua San (Honeysuckle Powder) led to drainage and resolution.
A man suffered from leg pain without swelling, with normal bowel and bladder functions. Several doses of Tuoli Rongwei Tang (Supporting Interior and Regulating Ying-Wei Decoction) resolved the condition.
A woman suffered from a toxic swelling on the neck, with local pain and alternating chills and fever. Two doses of Jingfang Baidu San (Schizonepeta and Saposhnikovia Detoxifying Powder) brought slight improvement. Four doses of Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Lqiaoqiao (Forsythia), Niubangzi (Arctii Fructus), and Jiegeng (Platycodon) resolved the condition.
A man suffered from a toxic swelling on the shoulder, with local pain, desire for cold drinks, irritability, constipation, and a rapid-excess pulse. Two doses of Qingliang Yin (Cooling Drink) brought slight improvement. Four doses of Jinyinhua San caused complete resolution. Another prescription, Shixuan San (Ten Acupoints Powder), with Gui Zhi (Cinnamon Twig) removed and Tianhuafen (Trichosanthes Root) and Jinyinhua added, taken for several doses, led to ulceration of the sore head and recovery.
A woman suffered from arm swelling, with aversion to cold and failure to suppurate. Six doses of Shixuan San led to ulceration; several doses of Tuoli San (Supporting Interior Powder) led to cure.
A man suffered from a carbuncle, with hard swollen pain, fever, irritability, desire for cold drinks, a sinking-excess pulse, and constipation. This indicated pathogen in the zang organs. Neishu Huanglian Tang (Internal Draining Coptis Decoction) was used to drain, resolving the condition in four doses.
A man suffered from a toxic swelling on the inner thigh, with hard swollen severe pain and failure to suppurate. Garlic-separated moxibustion for over fifty moxa cones reduced the severity by seven or eight tenths. Four doses of Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction) led to suppuration. Six doses of Shixuan San led to ulceration and cure. For sores with severe pain or numbness, moxibustion is most beneficial.
A woman suffered from arm swelling, pre-suppurative stage, with poor appetite and pain/fever upon exertion. Two doses of Buzhong Yiqi Tang (Middle-Boosting Qi-Supplementing Decoction) stopped the pain slightly. Subsequent treatment with herbs tonifying qi and blood and strengthening the spleen and stomach resolved the condition.
A man with a weak constitution suffered from a chest carbuncle, with poor appetite and fatigue. Liu Jun Zi Tang (Six Gentlemen Decoction) added with Xiong (Ligusticum), Gui (Angelica), and Huang Qi (Astragalus) led to suppuration, followed by needle drainage. Further treatment with supporting interior herbs led to recovery.
A woman suffered from a carbuncle on the hypochondrium, pre-suppurative, with aversion to cold and tight pulse. Two doses of Shixuan San added with Chai Hu (Bupleurum) resolved all exterior symptoms. Several doses of Tuoli San led to ulceration and recovery.
A woman suffered from a toxic swelling on the arm, hard and swollen, with throat obstruction, cold limbs, and alternating chills and fever. Two doses of Wuxiang Liaoqiao Tang (Five Fragrances and Forsythia Decoction) brought immediate cure. Four doses of Chuake Liuyin (Surgery Qi-Regulating Decoction) resolved the condition.
A man suffered from an arm carbuncle, with a string-tight forceful pulse. Two doses of Baizhi Shengma Tang (Angelica Dahurica and Cimicifuga Decoction) caused immediate decline. Two more doses led to resolution.
A woman suffered from a toxic swelling below the shoulder, with a string-tight pulse. Two doses of Baizhi Shengma Tang resolved exterior symptoms. Further treatment with supporting interior herbs led to ulceration and recovery.
A man suffered from an arm carbuncle, failing to suppurate. Moxibustion with Dou Chi Bing (Fermented Soybean Cake) and drinking supporting interior herbs for over thirty doses led to ulceration. Recovery took another month.
A man had a ripe abscess that did not ulcerate. I intended to needle it and support the interior. He disbelieved, instead taking attacking/toxic drugs, resulting in nausea and poor appetite. Only then did he realize his error and accept needling. Liu Jun Zi Tang added with Huo Xiang (Patchouli) and Dang Gui (Angelica) for four doses brought slight improvement. Jiawei Shiquan Dabu Tang (Modified Ten Complete Great Tonifying Decoction) for several doses led to wound closure. For ripe abscesses, failure to needle allows pus toxin to erode tissue; mild cases are hard to treat, severe cases incurable. For the elderly and weak, or in remote areas, or vital locations, once pus forms, urgent needling is required, followed by supporting interior therapy, to avoid complications.
A man suffered from toxic pain. Taking cold-natured herbs stopped the pain but reduced appetite further and prevented ulceration. Liu Jun Zi Tang improved appetite; subsequent supporting interior herbs... (Text implies continuation of principle): For pain due to wind-cold-damp, use warm-dispersing agents. For wind-induced pain, dispel wind. For damp-induced pain, guide out dampness. For dryness-induced pain, moisten. For blockage-induced pain, unblock. For deficiency-induced pain, tonify. For excess-induced pain, purge. For blocked pus, open it. For foul flesh erosion, remove it. For yin-yang disharmony, harmonize. For meridian obstruction/stagnation, promote flow. Do not indiscriminately use cold-natured drugs. Blood vessels prefer warmth and dislike cold; if cold qi enters internally, blood stagnates, leading to difficult-to-heal conditions.
A man with a weak constitution suffered from elbow swelling. Seeking internal resolution, he took cold herbs, causing diarrhea and poor appetite. Er Shen Wan (Two Divine Pills) and Xiangsha Liu Jun Zi Tang (Aromatic Cardamom Six Gentlemen Decoction) added with Rou Dou Kou (Nutmeg) strengthened the spleen and stomach. Subsequently, blood-invigorating and meridian-regulating herbs were used adjunctively, considering meridians and seasons, to allow toxin to manifest externally. Early treatment could lead to internal resolution. This is the meaning of internal support. It is also said: For swollen ulcers with internal and external stagnation, prioritize supporting interior and releasing exterior. Using Da Huang (Rhubarb) might be rash. For ulcerated sores with internal and external deficiency, prioritize tonification and connection. Using aromatic dispersants would worsen deficiency. Generally, carbuncles/swellings should not be solely attributed to fire. The Classic states: When Ying Qi does not follow its course and reverses into muscle tissue, carbuncles/swellings arise. Also: Shape injury causes pain, Qi injury causes swelling; six excesses and seven emotions can all cause them. Given individual constitutional excess/deficiency and differences in age/weakness, how can one indiscriminately use cold herbs? If toxin just gathers, pus not formed, and momentum not strong, resolution might be possible. One must investigate etiology and distinguish excess/deficiency. Indiscriminate cold herbs will surely cause errors. If pus is about to form, with excess pathogen and strong qi, using detoxifying agents kills the toxin first; even if pus forms, suffering is less, and ulceration is mild. Using supporting interior herbs now would increase the pathogen's momentum. Use supporting interior therapy only when pus is about to form but doesn't, or fails to ulcerate. For formed pus with strong momentum, needle it. Once pus drains, all symptoms subside.
Attached Formulas
Neituo Fujian San (Internal Supporting Double-Decoction Powder)
Indications: Sores/ulcers with external swelling, pulse mostly floating. Pathogen is strong, invading internally; use this to support.
Ingredients: Digupi (Phellodendri Cortex), Huang Qin (Scutellariae Radix, stir-fried), Fu Ling (Poria), Shaoyao (Paeoniae Radix Alba, stir-fried), Renshen (Ginseng Radix), Huang Qi (Astragali Radix, salt-water stir-fried), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Guipi (Cinnamomi Cortex), Gancao (Licorice Radix, honey-fried), Fangji (Stephaniae Radix, wine-stirred), Danggui (Angelicae Sinensis Radix, wine-stirred, each 1 qian), Fangfeng (Saposhnikoviae Radix, 2 qian).
Preparation: Coarsely powder. First decoct Cangzhu (Atractylodis Rhizoma) 1 sheng in 5 sheng water. Remove Cangzhu, add other herbs, decoct to 2 sheng. Drink throughout the day. Decoct Cangzhu residue separately and drink.
Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder)
Indications: Carbuncles/festering sores that have erupted but not dissipated. Take this to resolve if unformed, ulcerate if formed, facilitate removal of necrotic tissue, and promote new flesh growth. If wound exists, apply plaster. Stop after healing; do not use flesh-generating drugs.
Ingredients: Renshen, Huang Qi (salt-water stir-fried), Danggui (wine-stirred), Chuanxiong, Shaoyao (stir-fried), Baizhu (stir-fried), Fuling (each 1 qian), Baizhi...
Neishu Huanglian Tang (One name: Huanglian Neishu Tang)
Indications: Sores/ulcers with hard swelling, fever, vomiting, constipation, irritability, desire for cold drinks, vomiting,心烦 (heart vexation), sinking-excess pulse. Pathogen in zang organs. Take urgently to drain internally, preventing pathogen from affecting meridians.
Ingredients: Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Danggui (wine-stirred), Shaoyao, Muxiang (Aucklandiae Radix), Binglang (Arecae Semen), Huang Qin, Bohe (Menthae Haplocalycis Herba), Jiegeng (Platycodonis Radix), Gancao (each 1 qian), Lianqiao (Forsythiae Fructus), Dahuang (Rhei Radix et Rhizoma, stir-fried, each 2 qian).
Preparation: One dose. Water 2 zhong, decoct to 8 fen. Take before meals.
Huanglian Jiedu Tang (See Section on Vomiting in Sores/Ulcers)
Jingfang Baidu San (See Section on Ding Chuang/Thorn Sores)
Gelian Jiu Fa (Garlic-Separated Moxibustion Method)
Xianfang Huoming Yin (Immortal Formula for Saving Lives Decoction)
Qingliang Yin (Cooling Drink)
Shixuan San (Four formulas see Section on Back Carbuncle)
Xiangsha Liu Jun Zi Tang (See Section on Vomiting)
Po Guan Dan (See Section on Back Carbuncle)
Tuoli San (Supporting Interior Powder)
Indications: Sores/ulcers with poor appetite, non-suppurating, non-contracting.
Ingredients: Renshen, Huang Qi (salt-water stir-fried), Danggui (wine-stirred), Chuanxiong, Baizhu (stir-fried), Fuling, Shaoyao (each 1 qian), Houpo (Magnoliae Officinalis Cortex, ginger-processed), Baizhi, Gancao (each 5 fen).
Preparation: One dose. Water 2 zhong, decoct to 8 fen. Take.
Daizhen Gao (Needle-Replacing Plaster)
Indications: Sores/ulcers with ripe pus but no ulceration.
Ingredients: Ruxiang (Olibanum, 2 fen), Baixingding (Streptopelia turtur droppings, fine and straight, 5 fen), Badou (Crotonis Fructus, shelled, stir-fried until scorched, 5 fen), Jian (Alkali, 5 fen).
Preparation: Powder. Mix with hot water, apply to sore head. Keep moist with alkali water, do not let dry.
Tuoli Rongwei Tang (Supporting Interior and Regulating Ying-Wei Decoction)
Indications: Sores/ulcers with no external swelling, normal internal bowels/bladder, pathogen in meridians. Use to regulate.
Ingredients: Huang Qi (stir-fried), Honghua (Carthami Flos, each 1 qian), Guizhi (Cinnamomi Ramulus, 7 fen), Cangzhu (millet-brine soaked, stir-fried), Chaihu (Bupleuri Radix), Lianqiao, Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng, Danggui...
Jinyinhua San (See Section on Vomiting)
Xiao Chaihu Tang (See Section on Luoli/Lymphatic Tuberculosis)
Huanglian Xiaodu San (See Section on Naoju/Brain Carbuncle)
Buzhong Yiqi Tang (See Section on Ulcer Fever)
Liu Jun Zi Tang (See Section on Vomiting)
Shiquan Dabu Tang (See Section on Ulcer Fever)
Wuxiang Liaoqiao Tang (Five Fragrances and Forsythia Decoction)
Indications: Initial stage of various sores, within 1-2 days presenting with cold limbs, throat obstruction, chills/fever.
Ingredients: Chenxiang (Aquilariae Lignum Resinatum), Muxiang (Aucklandiae Radix), Shexiang (Moschus), Lianqiao, Shegan (Belamcandae Rhizoma), Shengma (Cimicifugae Rhizoma), Dingxiang (Eugenii Flos), Duhuo (Angelicae Pubescentis Radix), Sangjisheng (Taxilli Fructus), Gancao (honey-fried, each 1 qian), Dahuang, Mutong (Akebiae Caulis), Ruxiang (each 1.5 qian).
Preparation: Take 5 qian per dose. Water 1 zhong, decoct to 8 fen. Take warm, aim for purgation.
Chuake Liuyin (See Section on Liuzhu/Metastatic Abscess)
Baizhi Shengma Tang (Angelica Dahurica and Cimicifuga Decoction)
Indications: Arm carbuncle. Pulse short on both hands, string-tight on middle press, flooding-slow-forceful on deep press. Caused by variation of Eight Winds.
Ingredients: Baizhi (1.5 qian), Shengma, Jiegeng (each 1 qian), Sheng Huang Qin (Raw Scutellariae Radix, 2 qian), Honghua, Gancao (honey-fried, each 5 fen), Jiu Huang Qin (Wine Scutellariae Radix), Huang Qi (each 1 qian).
Preparation: One dose. Water 1.5 zhong, decoct to 8 fen. Take long after meals.
Dou Chi Bing (See Section on Buttock Carbuncle)
Er Shen Wan (See Section on Vomiting)