痈疽已成，血气虚者，邪气深者，邪气散漫者，不能突起，亦难溃脓。或破后脓少，
或脓清稀，或坚硬不软；或虽得脓，而根脚红肿开大；或毒瓦斯不出，疮口不合，聚肿不
赤，结核无脓者，皆气血虚。气血既虚，兼以六淫之邪而变生诸证，必用内托，令其毒
热出于肌表，则可愈也。凡内托之药，以补药为主，活血祛邪之药佐之。或以芳香之药
行其郁滞，或加温热之药御其风寒。大抵托里消毒散、托里散、小托里散、十宣散皆为
要药，但用随时加减耳。如冬月并气滞之人，五香连翘汤，虚弱人去大黄。素不宜寒药者，
小五香汤。形脉实，脓色稠，不可用补药者，忍冬丸之类。大脓出，败肉去，红肿消，当
用黄 、人参、当归、白术大剂补之，令气血滋茂，新肉易长也。薛新甫，有随证加减
用药例，以托里消毒为主，诚内托之良法。今采入各证中，不复赘叙于此。
《元戎》云∶疮疡自外而入者不宜灸，自内而出者宜灸。外入者，托之而不内；内出
者，接之而令外。故经云∶陷者灸之。灸而不痛，痛而后止其灸。灸而不痛者，先及其
溃，所以不痛，而后及良肉，所以痛也。灸而痛，不痛而后止其灸，灸而痛者，先及其
未溃，所以痛，而次及将溃，所以不痛也。凡人初觉发背，欲结未结，赤热肿痛，先以湿
纸覆其上，立视候之，其纸先干处，即是结痈头也。取大蒜切成片，如当三钱浓薄，安
于头上，用大艾炷灸之三壮，即换一蒜片，痛者灸至不痛；不痛灸至痛时方住。最要早觉
早灸为上，一日二日，十灸十活，三日四日六七活，五六日三四活，过七日则不可救矣。
若有十数头，作一处生者，即用大蒜研成膏，作薄饼铺头上，聚艾于蒜饼上烧之，亦能活
也。若背上初发，赤肿一片，中间有一片黄粟米头子，便用独蒜，切去两头，取中间半
寸浓薄，正安于疮上，着艾灸十四壮，多至四十九壮。一法云∶灸乃开结破硬之法，倘
有一点白粒，如粟米起，四围微肿如钱，盒饭于米粒上，着艾火十四五壮。三日内灸者，
只成灸疮而散。三日外者，其肿渐少，宜多灸之，或灸火着处，则结热可伸，灸处先溃，
则毒势分减，庶免展开，不致下陷及坏筋骨，伤气血也。所谓灸至不痛者，谓着皮肉未坏
处则痛，火至着毒处，则不痛，必令火气至着毒处方止。所谓灸至痛者，谓初着毒处不
痛，至好肉则痛，必令火气至好肉方止。畏灸者，或用独蒜瓣，或用豆豉饼，或用椒姜
盐，烂捣捏作饼子，如当三钱浓，铺艾灸之，热则易新饼，亦可散也。灸乃从治之意，惟
头为诸阳所聚，艾炷宜小而少，若少阳分野，尤不可灸，灸之多至不救，亦有因灸而死者。
盖虚甚孤阳将绝，其脉必浮数而大，且鼓精神，必短而昏，无以抵挡火气，宜其危也。又
《精要》云∶脑为诸阳所会，颈项近咽喉，肾俞，皆致命之所，俱不可灼艾。
河间灸刺法谓∶凡疮疡，须分经络部分，血气多少， 穴远近。从背出者，当从太阳
五穴选用。至阴（在足小指外侧，去爪甲角如韭叶大。）通谷（在足小指外侧，本节前陷者中。）束骨（在足
小指外侧，本节后陷中。）昆仑（在足外踝，后跟骨上陷中。）委中（在 中央，约纹中动脉。）
从鬓出者，当从少阳五穴选用。窍阴（足小指、次指端，去爪甲如韭叶。）侠溪（在足小指、次指歧骨间，本
节前陷中。）临泣（在足小指、次指本节后间陷中。）阳辅（在外踝上四寸，辅骨前绝骨端，如前三分。）
阳陵泉（在膝下一寸，外廉陷中。）后髭出者，当从阳明五穴选用。厉兑（在足大指、次指，去爪甲如韭叶。）
内庭（在足大指、次指外间陷中。）陷谷（在足大指、次指间，本节后陷中。）冲阳（在足跗上五寸，骨间动
脉，去陷骨三寸。）解谷（在冲阳后一寸五分，腕上陷中。）从脑出者，
则唯绝骨一穴，（在外踝上三寸，动脉中。）详见痈疽灸经。
骑竹马灸法∶治一切疮疡，无有不愈。令病患以肘凭几，竖臂腕要直，用篾一条，自
臂腕中曲处横纹，男左女右，贴肉量起，直至中指尖尽处，截断为则，不量指甲。却用
竹杠一条，令病患脱衣，正身骑定，前后用两人扛起，令病者脚不着地，又令二人扶之
勿令伛偻，却将前所量臂篾，从竹杠坐处，尾 骨尽处，直贴脊背，量至篾尽处为则，用
墨笔点定，此只是取中，非灸穴也。却用薄篾作则子，量病患中指节，相去两横纹为则，
男左女右，截为一则，就前所点记处，两边各量一则尽处，即是灸穴。两穴各灸五七壮，
疽发于左，则灸右，疽发于右，则灸左，甚则左右皆灸。盖此二穴，心脉所过之处，凡
痈疽皆心火留滞之毒，灸此，则心火流通而毒散矣，起死回生之功，屡试屡验。
刘宗浓曰∶此谓痈疽初发，宜灸之也。然诸疮患久成痛者，常有脓水不绝，其脓不臭，
内无歹肉，尤宜用附子，浸透、切作大片，浓三二分，于疮上着艾灸之，仍服内托之药，隔
三二日再灸之，不五七次，自然肌肉长满矣。至有脓水恶物，渐渍根深者，郭氏治用白面、
硫黄、大蒜三物，一处捣烂，看疮大小，捻作饼子，浓约三分于疮上，用艾炷灸二十一
粒，一灸一易，后隔四五日，方用翠霞锭子，并信效锭子，互换用之， 入疮内，歹肉尽
去，好肉长平，然后贴收敛之药，内服应病之剂，调理即瘥矣。盖不止宜灸于疮之始发
也，大抵始发宜灸，要汗下补养之药对证，至灸冷疮，亦须内托之药切当，设反逆，不唯
不愈，恐致转生他病之患也。
痈疽已经形成，若患者血气虚弱、邪气深重或邪气散漫，导致疮疡不能突起，也难以化脓。或者破溃后脓液稀少，或脓液清稀，或疮体坚硬不软；或者虽然已有脓液，但疮根红肿范围扩大；或者毒热之气无法排出，疮口无法愈合，肿胀聚集但不发红，结核无脓者，这些都是气血虚弱的表现。既然气血已经虚弱，又兼受风、寒、暑、湿、燥、火六淫之邪侵袭而变生各种证候，必须使用内托法，使毒热之气从肌表透出，这样才可以痊愈。凡是内托的药物，以补益药为主，辅以活血祛邪的药物。或者用芳香的药物来疏通郁滞，或者加入温热的药物来抵御风寒。大抵托里消毒散、托里散、小托里散、十宣散都是重要的药物，只是使用时需根据情况随时加减。如果是冬季且伴有气滞的人，可用五香连翘汤，体虚之人去掉大黄。平时不宜服用寒凉药物的人，用小五香汤。形体壮实、脉象有力、脓色稠厚，不可使用补药的人，可用忍冬丸之类。当大量脓液排出，坏死组织去除，红肿消退时，应当重用黄芪、人参、当归、白术等大剂量补益药物，使气血滋长茂盛，新肉容易生长。薛己（字新甫）有随证加减用药的范例，以托里消毒散为主，这确实是内托法的良方。现将其采录在各证候中，此处不再赘述。
《元戎》说：疮疡由外侵入的不宜灸，由内生发的宜灸。外入的，用托法使其不向内陷；内出的，用接引法使其向外透发。所以医经说：下陷的疮疡用灸法。灸后如果不痛，等到疼痛时才停止灸疗。灸后不痛的，是因为先灸到了已溃烂处，所以不痛，而后才灸到健康肌肉，所以会痛。灸后如果痛，等到不痛时才停止灸疗。灸后痛的，是因为先灸到了未溃烂处，所以痛，而后才灸到将要溃烂处，所以不痛。凡是人刚开始感觉背部发背（痈疽），欲结而未结，局部红热肿痛，先用湿纸覆盖在患处，立即观察等待，纸上最先干燥的地方，就是痈头所在。取大蒜切成片，厚度约如三钱铜钱大小，放在痈头上，用大艾炷灸三壮，然后换一片蒜片，感到疼痛的就灸到不痛为止；不感到疼痛的就灸到感到疼痛时为止。最重要的是早发现早治疗，越早施灸越好。发病一两天，灸十个能活十个；三到四天，灸十个能活六七个；五到六天，灸十个能活三四个；过了七天就不能救治了。如果有十几个痈头，聚在一起生长的，就用大蒜研成膏，做成薄饼铺在痈头上，将艾炷聚在蒜饼上烧灼，也能救活。如果背上初发，红肿一片，中间有一片像黄粟米大小的头子，便用独头蒜，切去两头，取中间半寸厚的部分，正放在疮上，用艾灸十四壮，多至四十九壮。另一种方法说：灸是开结破硬的方法，倘若有一点白色颗粒，像粟米一样突起，四周微肿如铜钱大小，就放在米粒上，用艾火烧十四五壮。三天内施灸的，只形成灸疮而消散。三天外的，肿胀逐渐减少，宜多施灸，或者在灸火着处，则结热可以发散，灸处先溃烂，则毒势分减，从而避免扩散，不至于下陷及破坏筋骨，损伤气血。所谓“灸至不痛”，是指灸在未坏死的皮肉处则痛，火气到达有毒处，则不痛，必须让火气到达有毒处才停止。所谓“灸至痛”，是指初灸有毒处不痛，灸到好肉则痛，必须让火气到达好肉才停止。害怕灸疗的人，可以用独蒜瓣，或者豆豉饼，或者花椒、生姜、盐，捣烂捏成饼子，厚度约如三钱铜钱，铺在患处施灸，热了就换新的饼子，也可以消散。灸法属于从治的意思，只有头部是诸阳经汇聚之处，艾炷宜小而少，如果是少阳经分野的部位，尤其不可灸，灸多了甚至无法救治，也有因灸而死亡的。这是因为极度虚弱，孤阳即将绝灭，其脉象必然浮数而大，且鼓动精神，必定短促而昏沉，无法抵挡火气，所以危险。又《精要》说：脑部是诸阳经交会之处，颈部靠近咽喉，肾俞穴，都是致命的关键部位，都不可以灼艾。
河间的灸刺法认为：凡是疮疡，必须区分经络部位，血气的多少，穴位远近。从背部发出的，应当从足太阳膀胱经的五穴选用。至阴穴（在足小指外侧，距离爪甲角如韭菜叶宽。）通谷穴（在足小指外侧，本节前的凹陷中。）束骨穴（在足小指外侧，本节后的凹陷中。）昆仑穴（在足外踝后方，跟骨上的凹陷中。）委中穴（在腘窝中央，横纹中的动脉处。）从鬓角发出的，应当从足少阳胆经的五穴选用。窍阴穴（在小趾、次趾端，距离爪甲如韭菜叶宽。）侠溪穴（在足小趾、次趾歧骨间，本节前的凹陷中。）临泣穴（在足小趾、次趾本节后的凹陷中。）阳辅穴（在外踝上四寸，辅骨前绝骨端，向前三分。）阳陵泉穴（在膝下一寸，外侧凹陷中。）从胡须部位发出的，应当从足阳明胃经的五穴选用。厉兑穴（在足大趾、次趾，距离爪甲如韭菜叶宽。）内庭穴（在足大趾、次趾外间凹陷中。）陷谷穴（在足大趾、次趾间，本节后的凹陷中。）冲阳穴（在足背上五寸，骨间动脉，距离陷谷穴三寸。）解溪穴（在冲阳后一寸五分，腕上凹陷中。）从脑部发出的，则只有绝骨一穴（在外踝上三寸，动脉中。）详见《痈疽灸经》。
骑竹马灸法：治疗一切疮疡，没有不愈的。让病人手肘依靠在几案上，竖臂手腕要直，用一条篾条，从手臂腕部弯曲处的横纹开始，男左女右，贴着皮肤量起，直到中指指尖尽头，截断作为标准，不量指甲。然后用一根竹杠，让病人脱衣，端正身体骑在上面，前后用两人扛起，让病人的脚不着地，又让二人扶持不要弯腰驼背，然后将之前量的臂篾，从竹杠坐处尾骶骨尽头处，直贴脊背，量到篾条尽头为标准，用墨笔点定，这只是取中点，并非灸穴。再用薄篾做刻度尺，量病人的中指节，相距两个横纹为标准，男左女右，截为一则，就在前面所点的记号处，两边各量一则的尽头，就是灸穴。两穴各灸五七壮，疽发于左边，则灸右边，疽发于右边，则灸左边，严重时左右都灸。因为这两个穴位是心脉经过的地方，凡痈疽都是心火留滞的毒邪，灸这里，则心火流通而毒邪消散，有起死回生的功效，屡试屡验。
刘宗浓说：这是说痈疽初发时，宜施灸。然而各种疮患久了变成漏疮的，常有脓水不绝，其脓不臭，内部没有腐肉，尤其适宜用附子，浸透后切成大片，厚约二三分，放在疮上施灸，同时服用内托的药物，隔三两天再灸，不超过五七次，自然肌肉就会长满。至于有脓水恶物，逐渐侵蚀根深蒂固的，郭氏治疗用白面、硫黄、大蒜三物，一起捣烂，看疮的大小，捻成饼子，厚约三分放在疮上，用艾炷灸二十一个，一灸一换，之后隔四五日，再用翠霞锭子和信效锭子，互换使用，插入疮内，腐肉尽去，好肉长平，然后贴收敛的药，内服对症的药物，调理即可痊愈。不仅疮之初发宜灸，大抵初发宜灸，但要汗、下、补、养的药物对证，至于灸冷疮，也必须内托的药物恰当，如果相反逆乱，不仅不能痊愈，恐怕会导致转生其他疾病的祸患。
When a carbuncle or ulcer has formed, if the patient's blood and qi are deficient, the pathogenic factor is deep, or the pathogenic factor is scattered, the lesion will not protrude and it will be difficult for pus to form. Or after rupture, there is little pus, or the pus is clear and thin, or the swelling is hard and does not soften; or although pus has formed, the base of the swelling is red and swollen and expanded; or the toxic heat cannot be discharged, the wound does not heal, the swelling gathers but is not red, and there is a nodule without pus; these are all signs of deficiency of blood and qi. Since blood and qi are already deficient, and complicated by the invasion of the six exogenous pathogens (wind, cold, summerheat, dampness, dryness, fire) leading to various syndromes, internal support therapy must be used to allow the toxic heat to emerge from the muscle surface, then recovery can occur. All medicines for internal support are primarily tonifying herbs, assisted by herbs that invigorate blood and dispel pathogens. Aromatic herbs may be used to move stagnation, or warming and hot herbs may be added to resist wind and cold. Generally speaking, Tuoli Xiaodu San (Support Interior and Disperse Toxin Powder), Tuoli San (Support Interior Powder), Xiao Tuoli San (Minor Support Interior Powder), and Shixuan San (Ten Acupoints Powder) are all important formulas, but they should be modified according to circumstances. For those in winter with qi stagnation, Wuxiang Lianqiao Tang (Five-Aroma Forsythia Decoction) is used, removing Dahuang (Rhubarb Root and Rhizome) for weak individuals. For those who generally do not tolerate cold-natured medicines, Xiaowuxiang Tang (Minor Five-Aroma Decoction) is used. For those with robust physique, solid pulse, thick pus color, and who cannot take tonics, Ren Dong Wan (Lonicera Pill) and similar preparations are used. When large amounts of pus have been discharged, necrotic tissue removed, and redness and swelling subsided, large doses of Huangqi (Astragalus Root), Renshen (Ginseng Root), Danggui (Angelica Sinensis Root), and Baizhu (Atractylodes Macrocephala Rhizome) should be used to nourish and abundantize blood and qi, facilitating the growth of new flesh. Xue Xinpu (Xue Ji) provided examples of modifying prescriptions according to syndromes, primarily using Tuoli Xiaodu San, which is indeed an excellent method for internal support. This is now incorporated into the respective syndromes, and further discussion here is omitted.
*Yuanrong* states: Carbuncles and ulcers entering from the exterior are not suitable for moxibustion, while those emerging from the interior are suitable for moxibustion. Those entering from the exterior are treated with supporting methods to prevent inward sinking; those emerging from the interior are treated with connecting methods to guide them outward. Thus, the classics state: Depressed lesions are treated with moxibustion. If there is no pain after moxibustion, stop when pain occurs. If there is no pain after moxibustion, it is because the moxa first reached the ulcerated area, hence no pain, and later reached healthy flesh, hence pain. If there is pain after moxibustion, stop when pain ceases. If there is pain after moxibustion, it is because the moxa first reached the un-ulcerated area, hence pain, and later reached the area about to ulcerate, hence no pain. Whenever a person initially feels a back carbuncle forming, with redness, heat, swelling, and pain before it fully consolidates, cover the area with wet paper and observe immediately. The place where the paper dries first is the head of the carbuncle. Take garlic, slice it to a thickness equivalent to a three-qian coin, place it on the head, and apply large moxa cones for three moxibustions (zhuang), then replace with a fresh garlic slice. If painful, moxa until painless; if painless, moxa until painful. Early detection and early moxibustion are most crucial. Within one or two days, ten moxibustions yield ten recoveries; within three to four days, six or seven out of ten recover; within five to six days, three or four out of ten recover; after seven days, it is incurable. If there are ten or more heads growing together, grind garlic into a paste, make a thin cake, place it on the heads, and burn moxa on the garlic cake; this can also save the patient. If the back initially presents with a patch of red swelling, with a yellow millet-grain-sized head in the center, use a single garlic clove, cut off both ends, take the middle half-inch thick part, place it directly on the sore, and apply moxibustion for fourteen zhuang, up to forty-nine zhuang. Another method states: Moxibustion is a method to open knots and break hardness. If there is a small white grain like a millet seed rising, with slight swelling around it like a coin, place moxa on the grain for fifteen to seventeen zhuang. Moxibustion within three days results only in a moxa scar that dissipates. After three days, the swelling gradually decreases; more moxibustion is appropriate. Where the moxa fire touches, the accumulated heat can be dispersed; where the moxa site ulcerates first, the toxic force is divided and reduced, thereby preventing spread, avoiding sinking into deeper tissues, damaging bones and tendons, and injuring blood and qi. "Moxa until painless" means applying to undamaged skin and flesh causes pain, but when the fire reaches the toxic area, there is no pain; one must ensure the fire energy reaches the toxic area before stopping. "Moxa until pain" means applying to the toxic area initially causes no pain, but reaching healthy flesh causes pain; one must ensure the fire energy reaches the healthy flesh before stopping. Those afraid of moxibustion may use a single garlic clove, or a fermented soybean cake, or a mixture of pepper, ginger, and salt, mashed into a cake of three-qian thickness, placed on the site for moxibustion; replace with a new cake when hot, which can also disperse the swelling. Moxibustion follows the principle of treating contrary to symptoms. Only the head is the gathering point of all yang meridians; moxa cones should be small and few. In the areas of the Shaoyang meridian, moxibustion is particularly contraindicated; excessive moxibustion may lead to untreatable conditions or even death. This is due to extreme deficiency where isolated yang is about to perish; the pulse will be floating, rapid, and large, and spirit will be agitated yet short and confused, unable to withstand the fire energy, hence the danger. Furthermore, *Jingyao* states: The brain is the meeting point of all yang meridians; the neck near the throat, and the Shenshu acupoint are vital locations; moxibustion should not be applied to any of these.
He Jian's moxibustion and acupuncture method states: For all carbuncles and ulcers, one must distinguish the meridian parts, the abundance or scarcity of blood and qi, and the distance of acupoints. Those emerging from the back should select from the five acupoints of the Taiyang meridian. Zhiyin (on the lateral side of the fifth toe, at the corner of the nail, width of a leek leaf.) Tonggu (on the lateral side of the fifth toe, in the depression anterior to the proximal interphalangeal joint.) Shugu (on the lateral side of the fifth toe, in the depression posterior to the proximal interphalangeal joint.) Kunlun (posterior to the lateral malleolus, in the depression above the calcaneus.) Weizhong (in the center of the popliteal crease, over the pulsating artery.) Those emerging from the temples should select from the five acupoints of the Shaoyang meridian. Qiaoyin (at the tip of the fifth and fourth toes, at the corner of the nail, width of a leek leaf.) Xiaxi (between the fifth and fourth toes, in the depression anterior to the proximal interphalangeal joint.) Linqi (between the fifth and fourth toes, in the depression posterior to the proximal interphalangeal joint.) Yangfu (four cun above the lateral malleolus, anterior to the end of the fibula, three fen forward.) Yanglingquan (one cun below the knee, in the depression on the lateral margin.) Those emerging from the beard area should select from the five acupoints of the Yangming meridian. Lidui (on the big toe and second toe, at the corner of the nail, width of a leek leaf.) Neiting (in the depression between the big toe and second toe.) Xangu (between the big toe and second toe, in the depression posterior to the proximal interphalangeal joint.) Chongyang (five cun on the dorsum of the foot, in the bone gap artery, three cun from Xangu.) Xiangu (one inch and five fen posterior to Chongyang, in the depression above the ankle joint.) Those emerging from the brain area involve only the Jiegu acupoint (three cun above the lateral malleolus, in the arterial pulse.) See *Yongju Jiu Jing* for details.
Riding Bamboo Horse Moxibustion: Treats all carbuncles and ulcers, ensuring recovery. Have the patient rest their elbow on a table, keeping the arm vertical and wrist straight. Use a bamboo strip, starting from the transverse crease of the wrist, on the left for men and right for women, measuring along the skin to the tip of the middle finger. Cut this length as the standard, excluding the nail. Then use a bamboo pole. Have the patient remove clothing, sit upright on the pole, supported by two people lifting it so the feet do not touch the ground, and two others holding them to prevent stooping. Place the previously measured bamboo strip from the sitting point at the coccyx, straight along the spine, to the end of the strip. Mark this point with ink. This merely finds the midpoint, not an acupoint. Make a scale from a thin bamboo strip. Measure the middle finger joint, taking the distance of two transverse creases as one unit. On the left for men and right for women, cut one unit. From the marked point, measure one unit to each side; these endpoints are the moxibustion points. Apply five to seven moxibustions to each point. If the carbuncle is on the left, moxa the right; if on the right, moxa the left; if severe, moxa both sides. These two points are where the Heart meridian passes. All carbuncles and ulcers are toxins滞留 by Heart Fire. Moxibustion here circulates Heart Fire and disperses toxins, having miraculous effects of restoring life from death, tested repeatedly.
Liu Zongnong said: This refers to moxibustion for initial carbuncles and ulcers. However, for chronic sores that have become fistulas, with continuous non-odorous pus and no necrotic tissue inside, Fuzi (Aconite Lateralis Radix Praeparata) soaked, sliced thickly (two to three fen), placed on the sore for moxibustion, combined with internal support medicine, repeated every two to three days, will naturally result in full muscle regeneration within five to seven sessions. For sores with foul pus and deep-rooted infection, Guo's treatment uses flour, sulfur, and garlic, mashed together into a cake of about three fen thickness, placed on the sore, and moxa for twenty-one cones, replacing each time. After four to five days, use Cuixia Dingzi (Emerald Cloud Plug) and Xinxiao Dingzi (Trustworthy Effect Plug) alternately, inserted into the sore, to remove necrotic tissue and level healthy flesh. Then apply astringent medicines and take internal remedies corresponding to the disease; regulation leads to recovery. Not only is moxibustion indicated at the onset of sores; generally, early moxibustion requires matching sweating, purgative, tonifying, and nourishing medicines. For cold sores, internal support medicines must also be appropriate. If contrary measures are taken, not only will healing fail, but other diseases may arise.