治丹毒、疔疮，红丝走散，或时毒，瘀血壅盛，用细瓷器击碎，取有锋芒者一块，以
箸一根，劈开头尖夹之，用线缚定，两手指轻撮箸梢，令瓷芒正对患处，悬寸许，再用
箸一根，频击箸头，令毒血遇刺皆出，毒入腹膨胀者难治。
豆豉饼（法见兼证痛条。）
痈疽已破，脓出者是也。《集验》云∶痈疽既破，脓出肉腐，当用拔毒膏贴之，邪气
渐退，气血亦虚，脉之洪数，渐宜减退，当内补托里，必使气血滋荣，正气强盛，脓色
鲜浓，赤肿渐收，药宜补气生血，秋冬微加御风寒之药，十宣散、十全大补汤中用桂是
也，气滞加香附。如毒势大退，气血未复，多宜用人参、当归、黄 四物汤之类。痈疽虽
已见脓，根脚赤晕，反展开阔，或不痛，或大痛，此毒瓦斯不退，金银白芷散、十宣散，去
浓朴、桂，倍人参、川归、黄 ，加忍冬藤、连翘、犀角、栝蒌根，消毒之药。春末夏间
及秋初，宜加酒芩、黄连、黄柏、羌活，腰以下可去桔粳。见脓后须以补气血药为主，解
毒药助之，或不宜于补药者，宜忍冬丸，四围肿 处，用毫针烧赤刺之约一米深，红肿
则缩，服药脉得和缓为佳。或破后不溃，疮口坚硬者风也，用蜈蝎散敷之，或蠹肉不腐，
用雄黄、轻粉敷之，大忌红肿不退，或饮食进少，从权且调理脾胃，或兼他证，又另议
药。治腐肉不知痛痒，正黑者可去之，但不伤四畔好肉及里面良肉，当去外之黑腐者下
皆去，黄白如絮之状，脓内有红血丝路，又不可动。此项大脓次日必自脱落，庶免伤其
良肉。若怕刀砭，三四日必自脱落，但用刀去者，新肉易长，毒瓦斯渐消。凡腐肉亦有少
臭气，腐败去后则无变，四围腐者渐渐去令净，用长肉膏贴，间日用猪蹄汤洗，新肉长
如梅李，如石榴子红活可爱，日见堆阜，或上有白膜，皆是吉兆，若腐败去后，下面良
肉色白而平，略无纹理，亦不能如米如粟，不见渐生之意，或脓水清淡或臭，此积毒内连
五脏，血气枯竭，乃是危证。肉不能长，气血不荣，卫气不护疮，则风寒着之，用北艾
黄汤熏洗，生肌长肉药敷之，用乳香膏、长肉等膏贴之，或肉虽长起，色紫者，遗毒也，
用地榆汤、活血散敷，追毒膏贴之，即自红活，疮口渐收，仍用长肉膏贴，或疮口痒，用
细茶、葱盐煎汤热洗。或疮口易收，乃气血中热毒，故不分消，即使长肉，必防流注之
患，或更迷违，疮口如钱大时，恐转他证危殆。凡痈疽疮口已收，但皮嫩未可便去膏药。
《鬼遗方》云∶凡发背及痈疽，皆在背上，不问大小，有疼无疼，或热或不热，或冷或不
冷，但从小至大，肿起至一尺以上者，其赤肿 热者，即用紧急收赤肿药围定，不令引
开中心，即用抽脓聚毒散贴之，急令散毒外透，内服排脓缩毒、内托汤药，候脓成，相
次破穴，看疮大小深浅，内发其脓汁，脓水大泄，急须托里内补，虽破穴脓汁不多，再
须排脓拔毒，透后慎不令再肿，须疼止肿消，患人自觉轻便，即是顺疾也，最宜节慎饮食。
其热毒方盛，或发大渴，多饮冷水及冷浆之类，此是毒瓦斯攻心，令口干烦渴，但以心气
药，内补脏腑即止矣。（内补谓参 之属，排脓谓皂角刺之属。）
〔薛〕 脓熟而不溃者，阳气虚也，宜补之如圣愈汤之类。瘀肉不腐者，宜大补阳气，
更以桑柴火灸之。不作脓，脓不溃，气虚也，托里消毒散去金银花、白芷、连翘三味，加
参术、肉桂，如不应，暂用十全大补汤。肿赤作痛，血凝滞也，本方加乳香、没药；如
不应，暂用仙方活命饮。脓出反痛，气血虚
也，去三味，加参 归地。溃后食少无睡，或发热者，虚也，宜补之，内补黄 汤之类。倦
怠懒言，食少不睡者，虚也，宜补之黄 人参汤之类。寒气袭于疮口，不敛或陷下不敛
者，温补之，十全大补汤。脉大无力或涩而微，肌肉迟生者，气血俱虚也，峻补之，十
全大补汤倍用参 。肉赤而不敛，血虚有热也，托里消毒散去三味，加熟地、丹皮。肉
黯而不敛，阳气虚寒也，前散去三味，加参 、白蔹、官桂。漫肿不痛，或肉死不溃，脾
气虚也，前散去三味，加人参、白术；如不应，加姜桂；更不应，急加附子。肉白而不
敛，阳气虚也，前散去三味，加参 、归术。脓多而不敛，气血虚也，前散去三味，加参
、归术、熟地黄；如不应，暂用十全大补汤。饮食少思而不敛，胃气虚也，前散去三
味，加参 ；如不应，暂用补中益气汤。饮食难化而不敛，脾气虚也，前散去三味，加
参术；如不应，暂用六君子汤；又不应，佐以八味丸。脓多而带赤，血虚也，前散去三
味，加归地、参术；如不应，暂用八珍汤加牡丹皮。（出血、作痛、发热等，另分条在后。）
治疗丹毒、疔疮，出现红丝走散，或者时行毒气，瘀血壅盛的情况，使用细瓷器击碎，选取带有锋利边缘的一块，用一根筷子，劈开尖端夹住瓷片，用线绑紧固定。用两手指轻轻捏住筷梢，使瓷芒正对患处，悬空约一寸许，再用另一根筷子，频繁敲击筷头，使毒血遇到刺孔都排出来。如果毒气进入腹部导致腹胀膨胀的，难以治疗。豆豉饼（制法见兼证痛条）。
痈疽已经破溃，脓液流出，就是这种情况。《集验方》说：痈疽既然破溃，脓出肉腐，应当用拔毒膏贴敷，邪气逐渐消退，气血也虚弱，脉象洪数，逐渐适宜减退，应当内服补益托里药物，必须使气血滋长荣润，正气强盛，脓色鲜浓，赤肿逐渐收敛，药物宜补气生血，秋冬季节微加御风寒的药物，十宣散、十全大补汤中使用桂枝就是这样，气滞加香附。如果毒势大退，气血未恢复，多适宜用人参、当归、黄芪、四物汤之类的方剂。痈疽虽然已经见脓，根脚赤晕，反而展开宽阔，或者不痛，或者大痛，这是毒瓦斯不退，用金银白芷散、十宣散，去掉厚朴、桂枝，倍用人参、川当归、黄芪，加忍冬藤、连翘、犀角、栝蒌根，作为消毒的药物。春末夏间及秋初，适宜加酒炒黄芩、黄连、黄柏、羌活，腰部以下可去掉桔梗。见脓后必须以补气血药为主，解毒药辅助，或者不宜于补药的情况，适宜用忍冬丸，四周肿胀处，用毫针烧红刺入约一分深，红肿则收缩，服药后脉象和缓为最佳。或者破溃后不溃烂，疮口坚硬的，是风邪所致，用蜈蝎散敷之，或者腐肉不腐烂，用雄黄、轻粉敷之，大忌红肿不退，或者饮食进少，从权且调理脾胃，或者兼有其他证候，又另外议药。治疗腐肉不知痛痒，颜色正黑的可以去除，但不要伤及四周好肉及里面良肉，应当去除外面的黑腐者，下面全部去除，黄白如絮状，脓内有红血丝样，又不可动。此项大脓次日必自脱落，以免伤其良肉。如果怕刀砭，三四日必自脱落，但用刀去除的，新肉容易生长，毒瓦斯逐渐消除。凡腐肉也有少许臭气，腐败去后则无变化，四周腐者渐渐去除令净，用长肉膏贴敷，间日用猪蹄汤清洗，新肉生长如梅李，如石榴子红活可爱，日渐堆起，或者上面有白膜，都是吉兆，如果腐败去后，下面良肉色白而平，略无纹理，也不能如米如粟，不见渐生之意，或者脓水清淡或臭，这是积毒内连五脏，血气枯竭，乃是危重证候。肉不能长，气血不荣，卫气不护疮，则风寒着之，用北艾黄汤熏洗，生肌长肉药敷之，用乳香膏、长肉等膏贴敷，或者肉虽长起，颜色紫的，是遗毒，用地榆汤、活血散敷，追毒膏贴敷，即自红活，疮口逐渐收敛，仍用长肉膏贴敷，或者疮口痒，用细茶、葱盐煎汤热洗。或者疮口易收，乃气血中热毒，故不分消，即使长肉，必防流注之患，或者更迷违，疮口如钱大时，恐转他证危殆。凡痈疽疮口已收，但皮嫩未可便去膏药。《鬼遗方》说：凡发背及痈疽，都在背上，不问大小，有疼无疼，或者热或不热，或者冷或不冷，但从小至大，肿起至一尺以上者，其赤肿热者，即用紧急收赤肿药围定，不令引开中心，即用抽脓聚毒散贴敷，急令散毒外透，内服排脓缩毒、内托汤药，候脓成，相继破穴，看疮大小深浅，内发其脓汁，脓水大泄，急须托里内补，虽然破穴脓汁不多，再须排脓拔毒，透后慎不令再肿，须疼止肿消，患人自觉轻便，即是顺疾也，最宜节慎饮食。其热毒方盛，或者发大渴，多饮冷水及冷浆之类，这是毒瓦斯攻心，令口干烦渴，但以心气药，内补脏腑即止矣。（内补谓人参之属，排脓谓皂角刺之属。）
〔薛己〕脓熟而不溃者，阳气虚也，宜补之如圣愈汤之类。瘀肉不腐者，宜大补阳气，更以桑柴火灸之。不作脓，脓不溃，气虚也，托里消毒散去金银花、白芷、连翘三味，加参术、肉桂，如不应，暂用十全大补汤。肿赤作痛，血凝滞也，本方加乳香、没药；如不应，暂用仙方活命饮。脓出反痛，气血虚也，去三味，加参归地。溃后食少无睡，或者发热者，虚也，宜补之，内补黄芪汤之类。倦怠懒言，食少不睡者，虚也，宜补之黄芪人参汤之类。寒气袭于疮口，不敛或者陷下不敛者，温补之，十全大补汤。脉大无力或者涩而微，肌肉迟生者，气血俱虚也，峻补之，十全大补汤倍用人参。肉赤而不敛，血虚有热也，托里消毒散去三味，加熟地、丹皮。肉黯而不敛，阳气虚寒也，前散去三味，加人参、白蔹、官桂。漫肿不痛，或者肉死不溃，脾气虚也，前散去三味，加人参、白术；如不应，加姜桂；更不应，急加附子。肉白而不敛，阳气虚也，前散去三味，加人参、归术。脓多而不敛，气血虚也，前散去三味，加人参、归术、熟地黄；如不应，暂用十全大补汤。饮食少思而不敛，胃气虚也，前散去三味，加人参；如不应，暂用补中益气汤。饮食难化而不敛，脾气虚也，前散去三味，加参术；如不应，暂用六君子汤；又不应，佐以八味丸。脓多而带赤，血虚也，前散去三味，加归地、参术；如不应，暂用八珍汤加牡丹皮。（出血、作痛、发热等，另分条在后。）
To treat erysipelas (Dan Du), carbuncle (Ding Chuang), with spreading red threads, or epidemic toxins, and excessive blood stasis, crush fine porcelain ware, select a piece with sharp edges. Hold it between the split tip of a chopstick, secure it tightly with thread. Pinch the end of the chopstick lightly with two fingers, aligning the porcelain shard precisely against the affected area, suspending it about one cun away. Then, use another chopstick to frequently tap the head of the first chopstick, causing toxic blood to drain out upon being pierced. If the toxin enters the abdomen causing distension and swelling, it is difficult to treat. Fermented Soybean Cake (method seen in the section on complicated symptoms and pain).
This refers to when a carbuncle or ulcer has already ruptured and pus is discharging. The *Ji Yan Fang* states: Once a carbuncle or ulcer has ruptured, with pus discharge and flesh decay, one should apply Antidote-Extracting Ointment. As the pathogenic factors gradually recede and Qi and Blood become deficient, the pulse, previously flooding and rapid, should gradually subside. One should internally administer tonifying and supporting therapies, ensuring that Qi and Blood are nourished and prospered, and righteous Qi becomes strong. The pus should be fresh and thick, and redness and swelling should gradually resolve. Medications should benefit Qi and generate Blood. In autumn and winter, slightly add herbs that ward off wind and cold; for example, using Cinnamon Twig (Guizhi) in Ten-Auspicious Powder (Shixuan San) or Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). For Qi stagnation, add Cyperi Rhizoma (Xiangfu). If the toxic force has largely subsided but Qi and Blood have not yet recovered, it is advisable to use formulas such as Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi), and Four Substance Decoction (Sìwù Tāng). Although pus is visible in the carbuncle or ulcer, if the base shows expanding redness and halo, or if there is no pain or severe pain, this indicates that the toxic qi has not retreated. Use Silver-Gold and Angelica Dahurica Powder (Jinyin Baizhi San) or Ten-Auspicious Powder (Shixuan San), removing Magnolia Bark (Houpo) and Cinnamon Twig (Guizhi), doubling the dosage of Ginseng Radix (Renshen), Sichuan Angelica Root (Chuan Gui), and Astragali Radix (Huangqi), and adding Honeysuckle Stem (Ren Dong Teng), Forsythia Fruit (Lian Qiao), Rhinoceros Horn (Xi Jiao - note: substitute with Buffalo Horn in modern practice), and Trichosanthes Root (Gua Lou Gen) as detoxifying agents. In late spring, early summer, and early autumn, add Wine-fried Scutellaria Root (Jiu Huangqin), Coptis Rhizome (Huanglian), Phellodendron Bark (Huangbai), and Notopterygium Rhizome (Qianghuo); for conditions below the waist, remove Platycodon Root (Jiegeng). After pus appears, the primary treatment should focus on tonifying Qi and Blood, assisted by detoxifying herbs. If tonics are unsuitable, Honeysound Pill (Rendong Wan) is appropriate. On the swollen areas surrounding the wound, prick with a filiform needle heated until red to a depth of approximately one fen. If redness and swelling subside, and the pulse becomes harmonious and slow after medication, it is auspicious. If the wound fails to ulcerate after rupture and the opening is hard, it is due to Wind. Apply Centipede and Scorpion Powder (Wushe San). If necrotic tissue does not rot, apply Realgar (Xionghuang) and Calomel (Qingfen). It is strictly contraindicated if redness and swelling do not recede, or if food intake is low; in such cases, temporarily regulate the Spleen and Stomach. If other syndromes coexist, discuss medications separately. For necrotic tissue that is insensitive to pain and itch, appearing jet black, it can be removed, provided care is taken not to injure the healthy flesh at the periphery or the viable tissue inside. Only the external black necrotic tissue should be removed. Yellowish-white, cotton-like material within the pus should not be disturbed. Large amounts of pus will naturally detach the next day, sparing healthy tissue. If afraid of knife or lancet, detachment occurs naturally in three to four days. However, if removed by knife, new flesh grows easily, and toxic qi gradually dissipates. Necrotic tissue may have a slight foul odor, which disappears after removal. Gradually clean all surrounding necrotic tissue, then apply Flesh-Lengthening Ointment. Wash every other day with Pig Trotter Decoction. When new flesh grows like plums or pomegranate seeds—red, vibrant, and lovely—and rises in mound-like formations, or if a white membrane forms on top, these are auspicious signs. If, after necrotic tissue is removed, the underlying healthy flesh is white and flat, lacking texture, unable to resemble rice grains or millet, showing no sign of gradual regeneration, or if the pus is thin/clear or foul-smelling, this indicates accumulated toxins connecting internally to the Five Zang Organs, with exhaustion of Blood and Qi—a critical condition. If flesh cannot grow, Qi and Blood are not nourished, and Defensive Qi fails to protect the wound, Wind-Cold may invade. Use Northern Mugwort and Astragalus Decoction (Bei Ai Huang Tang) for fumigation and washing, apply Flesh-Generating and Lengthening Medicines, and paste with Frankincense Ointment (Ruxiang Gao) or Flesh-Lengthening Ointments. If flesh grows but appears purple, it indicates residual toxicity. Apply Sanguisorba Decoction (Diyu Tang) and Blood-Invigorating Powder (Huoxue San), and paste with Toxic-Chasing Ointment (Zuidu Gao). The wound will become red and vibrant, and the opening will gradually close; continue applying Flesh-Lengthening Ointment. If the wound itches, wash hotly with a decoction of fine tea, scallions, and salt. If the wound closes too easily, it may be due to heat-toxin in Qi and Blood; without dispersing it, even if flesh grows, there is a risk of metastatic abscesses (Liuzhu). If confusion occurs, and the wound shrinks to the size of a coin, fear transformation into other critical syndromes. Once the carbuncle or ulcer wound has closed, if the skin is tender, do not immediately remove ointments. The *Gui Yi Fang* states: Regarding Back Carbuncles (Fabei) and ulcers, all located on the back, regardless of size, painful or painless, hot or cold, if they grow from small to large, swelling up to over one chi, and are red, swollen, and hot, immediately encircle them with urgent Redness-Resolving and Swelling-Reducing Medicines to prevent spread toward the center. Apply Pus-Extracting and Toxin-Gathering Powder (Chounong Judu San) to urgently promote external dispersion of toxins. Internally administer Pus-Discharging and Toxin-Contracting, Internal-Supporting Decoctions. Wait for pus to mature, then sequentially incise. Assess the size and depth of the wound to express pus internally. With massive discharge of pus, urgently support the interior and tonify. Even if pus discharge is not abundant after incision, further pus-discharging and toxin-extracting measures are needed. After penetration, carefully prevent re-swelling. Pain must cease, swelling must subside, and the patient should feel light and comfortable; this is a favorable course. Dietary restraint is most essential. If heat-toxin is flourishing, causing extreme thirst, and the patient drinks much cold water or cold beverages, this indicates toxic qi attacking the Heart, causing dry mouth and vexatious thirst. Resolve this only with Heart-Qi tonifying herbs to internally nourish the Zang-Fu organs. (Internal tonification refers to herbs like Ginseng; pus-discharging refers to herbs like Gleditsia Spine.)
[Xue Ji] When pus is ripe but does not ulcerate, it is due to Yang Qi deficiency; tonify it, such as with Holy to Restore Life Decoction (Shengyu Tang). When necrotic tissue does not rot, greatly tonify Yang Qi, and additionally moxa with mulberry wood fire. When pus does not form, or does not ulcerate, it is Qi deficiency. Use Interior-Supporting and Detoxifying Powder (Tuoli Xiaodu San), removing Honeysuckle Flower (Jinyinhua), Angelica Dahurica Root (Baizhi), and Forsythia Fruit (Lian Qiao), adding Ginseng Radix (Renshen), Atractylodes Rhizome (Baizhu), and Cinnamon Bark (Rougui). If ineffective, temporarily use Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). Swelling, redness, and pain indicate Blood stagnation; add Frankincense Resin (Ruxiang) and Myrrh (Moyao) to the original formula. If ineffective, temporarily use Immortal Formula to Activate Life Decoction (Xianfang Huoming Yin). Pain returning after pus discharge indicates Qi and Blood deficiency; remove the three aforementioned herbs, add Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Shudi), and Paeoniae Radix Alba (Baishao). After ulceration, poor appetite, insomnia, or fever indicate deficiency; tonify it, such as with Internal-Tonifying Astragalus Decoction (Neibu Huangqi Tang). Fatigue, reluctance to speak, poor appetite, and insomnia indicate deficiency; tonify it, such as with Astragalus and Ginseng Decoction (Huangqi Renshen Tang). Cold Qi invading the wound, preventing closure or causing sinking without closure, requires warming and tonifying; use Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). A large, powerless, or choppy and faint pulse, with delayed muscle growth, indicates dual deficiency of Qi and Blood; strongly tonify with Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang), doubling the dosage of Ginseng Radix (Renshen). Red flesh that does not close indicates Blood deficiency with Heat; use Interior-Supporting and Detoxifying Powder (Tuoli Xiaodu San), removing the three herbs, adding Prepared Rehmannia Root (Shudihuang) and Moutan Cortex (Danpi). Dark flesh that does not close indicates Yang Qi deficiency and Cold; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen), Ampelopsis Radix (Bailian), and Official Cinnamon Bark (Guangui). Diffuse swelling without pain, or dead flesh failing to ulcerate, indicates Spleen Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen) and Atractylodes Rhizome (Baizhu). If ineffective, add Ginger (Shengjiang) and Cinnamon (Rougui). If still ineffective, urgently add Aconite Root (Fuzi). White flesh that does not close indicates Yang Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodes Rhizome (Baizhu). Excessive pus and failure to close indicate Qi and Blood deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Atractylodes Rhizome (Baizhu), and Prepared Rehmannia Root (Shudihuang). If ineffective, temporarily use Great Tonification Decoction for Ten Deficiencies (Shiquan Dabu Tang). Lack of desire to eat and failure to close indicates Stomach Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen). If ineffective, temporarily use Tonify the Middle and Augment the Qi Decoction (Buzhong Yiqi Tang). Difficulty digesting food and failure to close indicates Spleen Qi deficiency; use the previous formula, removing the three herbs, adding Ginseng Radix (Renshen) and Atractylodes Rhizome (Baizhu). If ineffective, temporarily use Six Gentlemen Decoction (Liu Junzi Tang). If still ineffective, assist with Eight-Ingredient Pill (Bawei Wan). Excessive pus with blood streaks indicates Blood deficiency; use the previous formula, removing the three herbs, adding Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Shudi), Ginseng Radix (Renshen), and Atractylodes Rhizome (Baizhu). If ineffective, temporarily use Eight Treasures Decoction (Bazhen Tang) plus Moutan Cortex (Danpi). (Bleeding, pain, fever, etc., are discussed in separate sections below.)