痛，或发热者，祛风清热； 痛，发寒热，或拘急者，发散表邪；作脓 痛者，托里
消
一男子患此， 肿作痛发热。以小柴胡汤加连翘、金银花、桔梗，四剂而消。
一男子因怒后，发际肿痛，发热。以小柴胡汤加连翘、金银花、天花粉、桔梗，四剂根
畔俱消。惟疮头作痛，以仙方活命饮，二剂痛止。脓成，针之，更以托里消毒药而愈。
一男子头面 肿作痛，时仲冬，脉弦紧。以托里温经汤，汗之而消。
一男子肿痛，寒热拘急，脉浮数。以荆防败毒散，二剂表证悉退，更以托里消毒散，溃
之而安。
一男子脓熟不溃，胀痛，针之而止，更以托里消毒散而愈。凡疮脓熟不溃，属气血虚也
，若不托里，必致难瘥。
一男子作脓 痛，发呕少食。以仙方活命饮，一剂而止。以六君子汤加当归、桔梗、皂
角刺，溃而愈。
一男子脓清不敛，以托里散加五味子、麦门冬而敛。
一老人肿痛发热，脓清作渴，脉软而涩，此血气俱虚也。欲补之，彼见作渴发热，乃服
降火
腑气血上下，各有虚实。（详见溃疡作痛第十三条。）况阴证似阳，阳证似阴（治验见《外科
心法》，）岂可以发热作渴，而概用寒凉之剂常治患者。正气虚，邪气实，以托里为主，消
毒佐之；正气实，邪气虚，以攻毒为主，托里佐之；正气虚，邪气实，而专用攻毒，则
先损胃气，宜先用仙方活命饮、托里消毒散，或用灸法，俟邪气退，正气复，更酌量治之。
大抵正气夺，则虚，邪气胜则实。盖邪正不并立，一胜则一负，其虚不待损而自虚矣。若发
背脑疽疔毒，及患在四肢，必用灸法，拔引郁毒，以行瘀滞，尤不可专于攻毒。诊其脉而辨
之，庶不有误。 如福泉黄吏部，肩患毒，发热恶寒，大渴烦躁，似有余之证，其脉虽大而
无力，却属不足，用当归补血治之。吾乡周都宪，两腿作痛，形体清 ，肝脉弦数，却属有
余之证。用龙胆泻肝汤治之并愈。齐氏云∶疮肿之证，若不诊候何以知阴阳勇怯，血气聚散
邪！又云∶脉洪大而数者，实也。细微而数者，虚也。河间云∶脉沉实者，其邪在脏。浮大
者，其邪在表。观此诚发前人之未发。诊候之道，其可缺邪！
一男子肿 痛甚，发寒热，服十宣散愈炽。诊之脉数而实，此表里俱有邪也。以荆防败
毒散加
来，或大便秘结，小便淋，心神愦闷，恍惚不宁，皆邪热之实也，岂可补哉。东垣云∶疮疽
之发，其受之有内外之别。治之有寒温之异。受之外者，法当托里以温剂，反用寒药，则是
皮
皮毛，表里通溃，共为一疮。助邪为毒，苦楚百倍，轻则危殆，重则死矣。
附方
小柴胡汤（方见溃疡门）
荆防败毒散（方见溃疡发热门）
托里消毒散（方见肿疡门）
仙方活命饮（方见发背门）
托里散（方见肿疡门）
六君子汤（方见作呕门）
托里温经汤 治寒覆皮毛，郁遏经络，不得伸越，热伏荣中聚结，赤肿作痛，恶
寒发热，或痛引肢体。若头面肿痛 甚，更宜砭之。
麻黄 升麻 防风 干葛 白芷 当归 苍术 人参 芍药 甘草（各一钱） 作一剂，
水二钟，煎一钟服，卧于暖处，得汗乃散。
八珍汤（方见溃疡发热门）
龙胆泻肝汤（方见下疳门）
十宣散（方见肿疡门）
当归补血汤（方见溃疡门）
疼痛，或伴有发热者，采用祛风清热法；疼痛，伴有恶寒发热，或肢体拘急者，采用发散表邪法；脓成疼痛者，采用托里法。
一男子患此病，局部肿胀疼痛并伴有发热。使用小柴胡汤加连翘、金银花、桔梗，服用四剂后消散。
一男子因发怒后，发际处肿痛，伴有发热。使用小柴胡汤加连翘、金银花、天花粉、桔梗，服用四剂后周围全部消散。仅疮头疼痛，使用仙方活命饮，服用两剂后疼痛停止。脓液形成后，用针穿刺排脓，随后改用托里消毒药而痊愈。
一男子头面部肿胀疼痛，正值仲冬时节，脉象弦紧。使用托里温经汤，通过发汗使病情消散。
一男子出现肿痛，伴有寒热往来及肢体拘急，脉象浮数。使用荆防败毒散，服用两剂后表证完全消退，随后改用托里消毒散，促使溃破后安定。
一男子脓液成熟但未溃破，感到胀痛，用针穿刺后疼痛停止，随后改用托里消毒散而痊愈。凡疮疡脓熟而不溃破，属于气血虚弱所致，如果不采用托里法，必然导致难以痊愈。
一男子脓成疼痛，伴有呕吐、食欲减退。使用仙方活命饮，服用一剂后症状停止。随后使用六君子汤加当归、桔梗、皂角刺，促使溃破后痊愈。
一老人肿痛发热，脓液清稀且口渴，脉象软弱而涩，这是气血俱虚的表现。想要补益他，但他见自己口渴发热，便自行服用降火药物。（脏腑气血上下各有虚实，详见溃疡作痛第十三条。）况且阴证似阳，阳证似阴（治验见《外科心法》），怎么能因为发热口渴，就一概使用寒凉药物治疗患者呢？正气虚，邪气实，以托里为主，解毒为辅；正气实，邪气虚，以攻毒为主，托里为辅；正气虚，邪气实，如果专用攻毒药，则会先损伤胃气，宜先用仙方活命饮、托里消毒散，或者使用灸法，等到邪气退去，正气恢复，再斟酌治疗。
大抵正气亏损则为虚，邪气亢盛则为实。邪正不能并存，一胜则一负，其虚损不需刻意损伤而自然显现。若发背、脑疽、疔毒，以及患病在四肢，必须使用灸法，拔引郁积之毒，以行瘀滞，尤其不可专门使用攻毒药。诊察其脉象来辨别，才不至于有误。如福泉黄吏部，肩部患毒，发热恶寒，大渴烦躁，看似有余的实证，但其脉虽大而无力，却属于不足，使用当归补血汤治疗。我同乡周都宪，双腿疼痛，形体消瘦，肝脉弦数，却属于有余的实证，使用龙胆泻肝汤治疗并痊愈。齐氏说：疮肿之证，若不诊察脉候，怎么知道阴阳的勇怯、血气的聚散和邪气的性质呢！又说：脉洪大而数的，是实证。细微而数的，是虚证。河间说：脉沉实的，邪气在脏。浮大的，邪气在表。看这些论述，确实阐发了前人未曾发表的观点。诊察脉候的道理，怎么可以缺失呢！
一男子肿胀疼痛严重，伴有恶寒发热，服用十宣散后病情更加炽盛。诊察其脉象数而实，这是表里都有邪气。如果出现大便干结，小便淋沥，心神烦闷，恍惚不宁，都是邪热实证的表现，怎么可以补益呢。东垣说：疮疽的发生，受邪有内外之别。治疗有寒温的差异。感受外邪者，法当用温剂托里，反而使用寒药，则是闭塞皮毛，表里贯通溃烂，共成一疮。助长邪气成为毒害，痛苦百倍，轻则危险，重则死亡。
附方
小柴胡汤（方剂见溃疡门）
荆防败毒散（方剂见溃疡发热门）
托里消毒散（方剂见肿疡门）
仙方活命饮（方剂见发背门）
托里散（方剂见肿疡门）
六君子汤（方剂见作呕门）
托里温经汤 治疗寒邪覆盖皮毛，郁遏经络，不得伸展越出，热伏于营分中聚结，赤肿疼痛，恶寒发热，或疼痛牵引肢体。若头面部肿胀疼痛严重，更适宜用砭石疗法。
麻黄、升麻、防风、干葛、白芷、当归、苍术、人参、芍药、甘草（各一钱），作一剂，水二钟，煎至一钟服用，卧于温暖之处，得汗后病邪乃散。
八珍汤（方剂见溃疡发热门）
龙胆泻肝汤（方剂见下疳门）
十宣散（方剂见肿疡门）
当归补血汤（方剂见溃疡门）
Pain, or accompanied by fever, is treated with dispelling wind and clearing heat; pain accompanied by aversion to cold and fever, or limb stiffness, is treated with dispersing exterior pathogenic factors; pain due to pus formation is treated with supporting the interior.
A man suffered from this condition, presenting with local swelling, pain, and fever. He was administered Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Lian Qiao (Forsythiae Fructus), Yin Yang Hua (Honeysuckle Flower), and Jie Geng (Platycodonis Radix). After four doses, the swelling subsided.
Another man developed swelling and pain at the hairline, accompanied by fever, following an episode of anger. He was given Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Lian Qiao (Forsythiae Fructus), Yin Yang Hua (Honeysuckle Flower), Tian Hua Fen (Trichosanthis Radix), and Jie Geng (Platycodonis Radix). After four doses, the surrounding area cleared completely. Only the head of the sore remained painful, which was treated with Xian Fang Huo Ming Yin (Immortal Life-Rescuing Powder). After two doses, the pain ceased. Once pus formed, it was lanced with a needle, and he subsequently recovered using Tuo Li Xiao Du Yao (Interior-Supporting and Toxin-Expelling Medicine).
A man presented with swelling and pain on the head and face during mid-winter, with a wiry and tight pulse. He was treated with Tuo Li Wen Jing Tang (Interior-Supporting and Meridian-Warming Decoction). Sweating induced the resolution of the condition.
A man exhibited swelling, pain, alternating chills and fever, and limb stiffness, with a floating and rapid pulse. He was prescribed Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Powder to Overcome Toxicity). After two doses, all exterior symptoms receded. He then took Tuo Li Xiao Du San (Interior-Supporting and Toxin-Expelling Powder), which promoted ulceration and stabilized the condition.
A man had mature pus that did not rupture, causing distending pain. It was lanced, stopping the pain, and he subsequently recovered after taking Tuo Li Xiao Du San (Interior-Supporting and Toxin-Expelling Powder). When sores have mature pus but fail to rupture, it belongs to deficiency of Qi and Blood. If the interior is not supported, healing will inevitably be difficult.
A man experienced pain upon pus formation, accompanied by vomiting and poor appetite. He was given Xian Fang Huo Ming Yin (Immortal Life-Rescuing Powder), which stopped the symptoms after one dose. He then took Liu Jun Zi Tang (Six Gentlemen Decoction) plus Dang Gui (Angelicae Sinensis Radix), Jie Geng (Platycodonis Radix), and Zao Jiao Ci (Gleditsiae Spina), leading to ulceration and recovery.
A man had clear, thin pus that failed to heal. He was treated with Tuo Li San (Interior-Supporting Powder) plus Wu Wei Zi (Schisandrae Fructus) and Mai Men Dong (Ophiopogonis Radix), which resulted in healing.
An elderly man presented with swelling, pain, and fever, with clear thin pus and thirst, and a soft and choppy pulse. This indicates deficiency of both Qi and Blood. Although he desired tonification, seeing his thirst and fever, he self-administered cooling herbs to reduce fire. (The Qi and Blood of the zang-fu organs have excess and deficiency above and below; see Article 13 for Pain in Ulcers.) Moreover, Yin syndromes may resemble Yang, and Yang syndromes may resemble Yin (see treatment records in *Wai Ke Xin Fa* [New Methods in Surgery]). How can one generally use cold-natured medicines for patients simply because they present with fever and thirst? When Zheng Qi (Upright Qi) is deficient and Xie Qi (Pathogenic Qi) is excessive, the primary treatment is supporting the interior, assisted by toxin expulsion. When Zheng Qi (Upright Qi) is sufficient and Xie Qi (Pathogenic Qi) is weak, the primary treatment is attacking toxicity, assisted by supporting the interior. If Zheng Qi (Upright Qi) is deficient and Xie Qi (Pathogenic Qi) is excessive, using only toxic-expelling drugs will first damage Stomach Qi. One should initially use Xian Fang Huo Ming Yin (Immortal Life-Rescuing Powder) or Tuo Li Xiao Du San (Interior-Supporting and Toxin-Expelling Powder), or apply moxibustion. Wait until the pathogenic factor recedes and upright Qi recovers, then adjust the treatment accordingly.
Generally, loss of Zheng Qi (Upright Qi) leads to deficiency, while dominance of Xie Qi (Pathogenic Qi) leads to excess. Pathogenic and upright factors cannot coexist; when one wins, the other loses, and the deficiency manifests naturally without needing further damage. For conditions such as Back Carbuncle, Brain Furuncle, Ding Du (Malignant Nodule), or lesions on the limbs, moxibustion must be used to draw out stagnant toxins and promote blood circulation. One must not specialize solely in attacking toxicity. By diagnosing the pulse and differentiating the syndrome, errors can be avoided. For example, Huang Libu from Fuquan suffered from a toxic lesion on his shoulder, with fever, aversion to cold, extreme thirst, and irritability, resembling an excess syndrome. However, his pulse was large but forceless, indicating insufficiency. He was treated with Dang Gui Bu Xue Tang (Dong Qu and Astragalus Decoction). My fellow townsman, Zhou Duxian, suffered from leg pain and emaciation, with a wiry and rapid Liver pulse, yet this indicated an excess syndrome. He was treated with Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver) and recovered. Qi Shi said: "In cases of swelling and sores, if one does not diagnose the pulse, how can one know the courage or timidity of Yin and Yang, the gathering or scattering of Blood and Qi, and the nature of the pathogen?" He also stated: "A pulse that is surging and rapid indicates excess. A pulse that is fine and rapid indicates deficiency." He Jian said: "A deep and solid pulse indicates the pathogen is in the Zang organs. A floating and large pulse indicates the pathogen is in the Exterior." These observations truly elucidate points previously unmentioned by predecessors. The principle of pulse diagnosis cannot be neglected!
A man suffered severe swelling and pain, accompanied by chills and fever. After taking Shi Xuan San (Ten Immortals Powder), the condition intensified. His pulse was rapid and solid, indicating pathogens in both the exterior and interior. If constipation occurs, dysuria, mental restlessness, confusion, and agitation arise, these are all manifestations of excess Heat pathogen. How can tonification be applied? Dong Yuan said: "The onset of carbuncles and ulcers has internal and external origins. Treatment varies between cold and warm methods. For externally acquired pathogens, the method dictates supporting the interior with warm agents. Conversely, using cold medicines closes the skin and hair pores, causing the interior and exterior to ulcerate together as one sore. This aids the pathogen to become toxic, causing hundreds of times more suffering. Mild cases become critical, severe cases lead to death."
Attached Formulas
Xiao Chai Hu Tang (Minor Bupleurum Decoction) (See Formula in Ulcer Section)
Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Powder to Overcome Toxicity) (See Formula in Ulcer Fever Section)
Tuo Li Xiao Du San (Interior-Supporting and Toxin-Expelling Powder) (See Formula in Swollen Sore Section)
Xian Fang Huo Ming Yin (Immortal Life-Rescuing Powder) (See Formula in Back Carbuncle Section)
Tuo Li San (Interior-Supporting Powder) (See Formula in Swollen Sore Section)
Liu Jun Zi Tang (Six Gentlemen Decoction) (See Formula in Vomiting Section)
Tuo Li Wen Jing Tang (Interior-Supporting and Meridian-Warming Decoction) Treats Cold covering the skin and hair, obstructing meridians, preventing extension and emergence. Heat stagnates in the Ying (Nutritive) level, forming knots, causing redness, swelling, and pain, aversion to cold, and fever, or pain radiating to the limbs. If head and face swelling and pain are severe, Bian (stone therapy/lancing) is additionally appropriate.
Ma Huang (Ephedrae Herba), Sheng Ma (Cimicifugae Rhizoma), Fang Feng (Saposhnikoviae Radix), Gan Ge (Puerariae Lobatae Radix), Bai Zhi (Angelicae Dahuricae Radix), Dang Gui (Angelicae Sinensis Radix), Cang Zhu (Atractylodis Rhizoma), Ren Shen (Ginseng Radix), Shao Yao (Paeoniae Radix), Gan Cao (Glycyrrhizae Radix) (each 1 qian). Prepare as one dose, add two zhong of water, decoct to one zhong, and drink. Lie in a warm place until sweating occurs, then the pathogen dissipates.
Ba Zhen Tang (Eight Treasures Decoction) (See Formula in Ulcer Fever Section)
Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver) (See Formula in Chancre Section)
Shi Xuan San (Ten Immortals Powder) (See Formula in Swollen Sore Section)
Dang Gui Bu Xue Tang (Dong Qu and Astragalus Decoction) (See Formula in Ulcer Section)