《灵枢经》云∶荣卫稽留于经脉之中，则血泣而不行，不行则卫气从之而不通，壅遏
而不得行故热。大热不止，热胜则肉腐，肉腐则为脓。然不能陷肌肤，骨髓不为焦枯，五
脏不为伤，故命曰痈。热气淳盛，下陷肌肤，筋髓枯，内连五脏，血气竭，当其痈下，筋
骨良肉皆无余，故命曰疽。疽者，上之皮夭以坚，状如牛领之皮。痈者，其皮上薄以
泽，此其候也。 《鬼遗方》云∶痈之痛只在皮肤之上，其发如火焚茅，初如黍米大，三
两日如掌面大，五七日如碗面大即易治。如肿冷，发渴，发逆，治之难愈。疽发或如小
疖，触则彻心痛，四边微起如橘皮孔，色红赤不全变，脓水不甚出，至七八日疼闷喘急
不止。若始发肿高，五七日忽平陷者，此内攻之候也。又云∶痈疽有三等，毒瓦斯浮浅属
腑，毒瓦斯沉深属脏，毒瓦斯猛烈而行经络，或浅或深无定。五脏六腑皆受五毒，难为调理。
唯宜急切于痈发诸处，不问虚实，高肿起盛，光泽疼痛，只在皮肤之上，热急胀满，或有
痒疼，别无恶候。初用温药平气，次用排脓发穴。（治痈所谓平气者，乃犀角饮之类。其方用犀
角、连翘、漏芦、甘草、当归、肉桂皆发表之药也。所谓发穴者，乃棘针之类。用皂角刺为君，甘草、川
芎、乳香为佐使，亦托里之药也。然不若洁古、东垣
诸方，发表、托里为稳当。）疽发诸处不拘大小，惟起在背，广一尺、二尺、三尺，皮浓而紫黑，
高肿不常，内疼如锥刺，攻击满闷，应四肢重疼，前心亦痛。余处发犹可，唯虚处及近
筋骨处，若脓毒未溃，即伤烂筋骨肉损。为疽者属五脏，毒瓦斯深沉，多气伏硬坚实而不
宜缓慢。治之须内实五脏外透皮肤，令软匀和即脓透，宜用内托实脏气之药，排脓匀气
乃可，不比痈之毒瓦斯浮浅也，毋作一类治之。凡一切疮肿，始觉患起高肿，五七日忽平陷
者，此是内攻之候也，急以内托散及内补汤药，补填脏腑令实，最怕透膜，膜穿十无一
生矣。 娄全善云∶痈之邪浅，其稽留壅遏，独在经脉之中而专攻于外，故初发时自表便
发热，患处便如碗如盆，高肿而痛，甚者纵欲下陷，缘正气内固不肯受，故或便秘，或
发渴，发逆以拒之，是以骨髓终不焦枯，五脏终不伤也。疽之邪深，其稽留壅遏，内连
五脏而不专攻于外，故身体或无热，患处或不肿痛，甚者声嘶气脱，眼黑眼小，十指肿
黑如墨多死也。治之之法，痈之初发，当以洁古法为主，表者散之，里者下之，火以灸
之，药以敷之，脓未成者必消，脓已成者速溃也。疽之初发，当以《鬼遗方》为主，补
填脏腑令实，勿令下陷之邪蔓延，外以火灸引邪透出，使有穴归着而不乱，则可转死回
生，变凶为吉。今世外科，不分痈疽，一例宣热拔毒，外以五香耗其气，内以大黄竭其
血，终不能自悟其药之非，惜哉《集验》云∶痈疽之名虽有二十余证，而其要有二，阴阳
而已。发于阳者，为痈为热为实。发于阴者，为疽为冷为虚。故阳发则皮薄、色赤、肿高，
多有椒眼数十而痛。阴发则皮浓、色淡、肿硬，状如牛颈之皮而不痛。又有阳中之阴，似
热而非热，虽肿而实虚，若赤而不燥，欲痛而无脓，既浮而复消，外盛而肉腐。阴中之
阳，似冷而非冷，不肿而实，赤微而燥，有脓而痛，外虽不盛，而内实烦闷。阳中之阴，
其人多肥，肉紧而内虚，阴中之阳，其人多瘦，肉缓而内实。而又有阳变而为阴者，草
医凉剂之过也。阴变而为阳者，大方热药之骤也。然阳变阴者其证多，犹可返于阳，故
多生。阴变为阳者其证少，不能复为阴矣，故多死。然间有生者，此医偶合于法，百中得
一耳。观此，则痈与疽，但有阴阳、深浅、内外、虚实之分，而无大小之别。《精要》乃谓
二寸至五寸为痈，五寸至一尺为疽者，谬也。
《灵枢经》说：营气与卫气在经脉中滞留，血液运行涩滞而不流通，血液不流通则卫气随之而受阻不通，壅塞遏制而不能通行，因此产生热邪。如果大热持续不退，热盛则肌肉腐败，肌肉腐败就形成脓液。然而，这种病邪不能深入肌肤、骨髓，骨髓不会焦枯，五脏也不会受到损伤，所以称为“痈”。如果热气淳厚盛大，向下陷入肌肤，导致筋髓干枯，内连五脏，血气耗尽，当痈疽发生部位，筋骨和正常肌肉都被破坏无余，所以称为“疽”。所谓疽，其表面皮肤颜色枯槁且坚硬，形状像牛颈部的皮一样厚实坚韧。所谓痈，其皮肤表面薄而有光泽，这是它们的征候特征。
《鬼遗方》说：痈的疼痛仅在皮肤表层，发作时像火烧茅草一样猛烈，初起如黍米大小，两三天后如手掌面大小，五到七天后如碗口大小，此时容易治疗。如果出现肿而发冷、口渴、气逆等症状，治疗就难以痊愈。疽的发作有时像小疖子，触碰时心痛彻骨，四周微微隆起像橘皮孔，颜色红赤但不均匀，脓水流出不多，到了七八天疼痛闷乱、喘息急促不止。如果起初肿胀高起，五到七天后突然平陷下去，这是毒邪内攻的征候。又说：痈疽分为三等，毒邪浮浅的属于腑，毒邪深沉的属于脏，毒邪猛烈并沿经络行走，深浅不定。五脏六腑都会受到各种毒邪侵袭，难以调理。只应当急切地在痈发作的各个部位处理，不论虚实，只要高肿隆起、光泽疼痛，仅在皮肤之上，感觉热急胀满，或者有痒痛，没有其他恶候。初期使用温药以平调气机，随后使用排脓透穴的药物。（治疗痈所说的“平气”，指的是犀角饮之类的方剂。该方由犀角、连翘、漏芦、甘草、当归、肉桂组成，都是发表的药物。所说的“发穴”，指的是棘针之类的疗法。以皂角刺为主药，甘草、川芎、乳香为佐使药，也是托里透脓的药物。然而，不如洁古老人、李东垣等人的方剂，在发表和托里方面更为稳妥。）疽发生在各个部位，不拘大小，唯独发生在背部，范围有一尺、二尺、三尺宽，皮肤浓厚且呈紫黑色，高肿不定，内部疼痛如锥刺，攻击感导致满闷，四肢沉重疼痛，前心也痛。其他部位发作尚可，唯独在虚损处及靠近筋骨的地方，如果脓毒未溃破，就会损伤腐烂筋骨肌肉。属于疽的病证关联五脏，毒邪深沉，多表现为气伏硬坚实，不宜缓慢治疗。治疗必须内实五脏，外透皮肤，使患处变软匀和从而脓液透出，适宜使用内托实脏气的药物，排脓匀气才可以，不像痈的毒邪那样浮浅，不要当作一类疾病来治疗。凡是所有疮肿，开始觉得患处高肿，五到七天后突然平陷下去的，这是毒邪内攻的征候，急需使用内托散及内补汤药，补填脏腑使其充实，最怕穿透膜络，膜穿破的话十有八九无法生还。
娄全善说：痈的邪气浅表，其稽留壅遏，独自在经脉之中而专门攻于外部，所以初发时体表就发热，患处就像碗或盆一样，高肿而疼痛，严重时即使想要下陷，因为正气内部坚固不肯受邪，所以出现便秘、口渴、气逆等反应来抵御它，因此骨髓最终不会焦枯，五脏最终不会受伤。疽的邪气深沉，其稽留壅遏，内连五脏而不专门攻于外部，所以身体可能没有热象，患处可能不肿痛，严重时声音嘶哑、气息脱失，眼睛发黑变小，十个手指肿黑如墨，大多死亡。治疗的方法，痈在初发时，应当以洁古老人的方法为主，在表的用发散法，在里的用泻下法，用火灸治疗，用药敷贴，脓未形成的必然消散，脓已形成的迅速溃破。疽在初发时，应当以《鬼遗方》为主，补填脏腑使其充实，不让下陷的邪气蔓延，外部用火灸引导邪气透出，使邪气有穴位归着而不紊乱，这样就可以转死回生，变凶为吉。当今世上的外科医生，不分痈疽，一律宣热拔毒，外用五香类药物耗散患者正气，内服大黄竭尽患者阴血，始终不能自己醒悟用药的错误，可惜啊！
《集验》说：痈疽的名称虽然有二十多种证候，但其要点有两个，就是阴阳而已。发于阳性的，是痈、是热、是实证。发于阴性的，是疽、是寒、是虚证。所以阳证发作则皮肤薄、色红、肿高，多有几十个椒眼样的小孔且疼痛。阴证发作则皮肤厚、色淡、肿硬，形状像牛颈部的皮且不疼痛。又有阳中之阴，看似热而非真热，虽然肿胀但其实是虚证，如果颜色红但不干燥，想痛但没有脓，既浮起又消退，外表盛壮但肌肉腐败。阴中之阳，看似冷而非真冷，不肿胀但其实是实证，颜色微红而干燥，有脓且疼痛，外表虽不盛壮，但内部实在烦闷。阳中之阴的患者，人多体肥，肌肉紧实但内部虚弱；阴中之阳的患者，人多体瘦，肌肉松弛但内部实热。还有阳证转变为阴证的，是草医滥用凉剂的过错。阴证转变为阳证的，是大剂量热药骤用的结果。然而，阳变阴的证候较多，还可以返回到阳证，所以大多能生还。阴变阳的证候较少，不能再恢复为阴证了，所以大多死亡。然而间或有生还的，这是医生偶然合乎法度，百中得其一罢了。看这些内容，那么痈与疽，只有阴阳、深浅、内外、虚实的区别，而没有大小的分别。《精要》却说两寸至五寸为痈，五寸至一尺为疽，这是错误的。
The *Ling Shu Jing* (Spiritual Pivot) states: When Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi) stagnate within the meridians, blood flow becomes sluggish and ceases to circulate. When blood circulation stops, Wei Qi follows but becomes obstructed, leading to congestion and blockage that prevents movement, thereby generating heat. If intense heat persists, excessive heat causes flesh to rot, and rotted flesh turns into pus. However, if the pathogen cannot penetrate deep into the skin and muscle, nor scorch the bone marrow, and does not injure the Zang organs, it is termed "Yong" (Carbuncle/Abscess). If the pathogenic heat is thick and abundant, sinking deep into the skin and muscle, causing withering of sinews and bone marrow, connecting internally to the Zang organs, exhausting blood and Qi, and destroying bones, sinews, and healthy flesh at the site of the lesion, it is termed "Ju" (Deep-seated Abscess/Gangrene). Ju is characterized by skin that is pale and hard, resembling the thick skin on a cow's neck. Yong is characterized by thin, shiny skin; these are their respective signs.
The *Gui Yi Fang* (Prescriptions from the Ghost's Legacy) states: The pain of Yong is confined to the superficial skin. Its onset is fierce like burning thatch; initially the size of a millet grain, it expands to the size of a palm within two or three days, and to the size of a bowl within five to seven days, making it easy to treat. However, if accompanied by cold swelling, thirst, and rebellious Qi, it is difficult to cure. Ju may initially appear like a small boil; touching it causes heartache penetrating to the back. The surrounding area rises slightly like orange peel pores, with uneven redness, and little pus discharges. By the seventh or eighth day, severe pain, stifling sensation, and rapid breathing persist. If the swelling is high initially but suddenly sinks flat after five to seven days, this indicates internal attack by the pathogen. Furthermore, Yong and Ju are categorized into three levels based on pathogen depth: shallow pathogens belong to the Fu organs, deep pathogens belong to the Zang organs, and fierce pathogens travel along the meridians with unpredictable depth. All Zang and Fu organs can be affected by various toxins, making regulation difficult. Urgent treatment should focus on the sites of Yong, regardless of deficiency or excess, provided there is high swelling, luster, pain, superficial location, feeling of heat and distension, or itching/pain, without other malignant signs. Initially, warm herbs should be used to calm the Qi, followed by herbs that drain pus and open acupoints. ("Calming Qi" in treating Yong refers to formulas like Xijiao Yin (Rhinoceros Horn Decoction), containing Rhinoceri Cornu (Xijiao), Forsythiae Fructum (Lianqiao), Euphorbiae Humifusae Herba (Loulu), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Danggui), and Cinnamomi Ramulus (Guizhi), all releasing exterior pathogens. "Opening Acupoints" refers to techniques like Ji Zhen (Thorn Needles), using Gleditsiae Sinensis Spina (Zaocys/Saponaria Thorn) as the sovereign herb, supported by Glycyrrhizae Radix et Rhizoma (Gancao), Ligusticum Chuanxiong Rhizoma (Chuanxiong), and Boswellia Carterii Resin (Ruxiang), which also tonify the interior. However, methods from Zhang Congzheng (Jiegu) and Li Dongyuan are more reliable for releasing the exterior and supporting the interior.) For Ju occurring anywhere, regardless of size, especially on the back spanning one to three chi, the skin is thick, purple-black, and variably swollen. Internal pain feels like needle pricking, causing fullness and oppression, heavy painful limbs, and anterior chest pain. Occurrences elsewhere are manageable, but those in deficient areas or near sinews and bones, if pus and toxin do not ulcerate, will damage sinews, bones, and muscles. Ju relates to the Zang organs, with deep-seated toxins manifesting as stagnant, hard, and firm conditions, requiring prompt treatment rather than delay. Treatment must solidify the Zang organs internally and promote external penetration through the skin, softening the area to allow pus discharge. Herbs that support the interior and strengthen Zang Qi, draining pus and harmonizing Qi, are suitable. This differs from the superficial nature of Yong toxins; they should not be treated identically. For any swelling that initially rises high but suddenly sinks flat after five to seven days, indicating internal attack, urgently use Neituo San (Internal Support Powder) and internal tonic decoctions to fill and solidify the Zang organs. The greatest fear is perforation of membranes; once perforated, survival is rare.
Lou Quanshan stated: The pathogen of Yong is superficial, stagnating only within the meridians and attacking externally. Thus, upon onset, the body surface heats up, and the lesion swells high like a bowl or basin, painful. Even if it tends to sink, the righteous Qi remains internally solid and rejects the pathogen, manifesting as constipation, thirst, or rebellious Qi to resist it. Therefore, bone marrow remains unscorched, and Zang organs remain uninjured. The pathogen of Ju is deep, stagnating and connecting internally to the Zang organs without focusing externally. Thus, the body may lack fever, and the lesion may not swell or hurt. In severe cases, hoarseness, Qi collapse, blackened eyes, and blackened fingers occur, often leading to death. Treatment for early-stage Yong should follow Jiegu’s methods: release the exterior with dispersants, purge the interior with purgatives, apply moxibustion, and use topical applications. Unformed pus will resolve; formed pus will quickly ulcerate. Early-stage Ju should follow the *Gui Yi Fang*: tonify and solidify the Zang organs to prevent sinking pathogens from spreading. Use external moxibustion to guide pathogens outward, ensuring they exit through specific points without chaos, turning fatal cases into recoveries and misfortune into auspiciousness. Modern surgeons fail to distinguish between Yong and Ju, uniformly clearing heat and extracting toxins. They use aromatic herbs externally to deplete Qi and Da Huang (Rhei Radix et Rhizoma) internally to exhaust Blood, never realizing their error. Regrettably!
The *Ji Yan* states: Although there are over twenty names for Yong and Ju, the essence lies in Yin and Yang. Manifestations of Yang are Yong, Heat, and Excess. Manifestations of Yin are Ju, Cold, and Deficiency. Yang lesions have thin skin, red color, high swelling, numerous pepper-like pores, and pain. Yin lesions have thick skin, pale color, hard swelling, resembling cow neck skin, and no pain. There is also "Yin within Yang," appearing hot but not truly so, swollen yet deficient, red but not dry, wanting pain but lacking pus, rising then subsiding, appearing vigorous but with rotting flesh. There is "Yang within Yin," appearing cold but not truly so, non-swollen yet substantial, slightly red and dry, with pus and pain, appearing mild externally but internally stifling. Patients with Yin within Yang are often obese with tight flesh but internal deficiency. Patients with Yang within Yin are often emaciated with loose flesh but internal excess. Yang transforming into Yin results from herbalists' misuse of cooling agents. Yin transforming into Yang results from physicians' abrupt use of strong heating drugs. Yang-to-Yin transformations are common and reversible, leading to survival. Yin-to-Yang transformations are rare and irreversible, leading to death. Rare survivals occur only when doctors accidentally adhere to correct principles. Thus, Yong and Ju differ only in Yin/Yang, depth, location, and excess/deficiency, not size. The claim in *Jing Yao* that lesions 2-5 cun are Yong and 5 cun-1 chi are Ju is erroneous.