痈疽，初发壅肿而未见脓者也。《集验》论疮疡之法，其名有三∶曰疖，曰痈，曰疽。
疖者，初生突起，浮赤而无根脚，肿见于皮肤间，止阔一二寸，有少疼痛，数日后则微
软，薄皮剥起，始出清水，后自破脓出，如不破，用替针丸、拔毒膏贴之，脓出即愈。痈
者，初生红肿，突起无头，便用火针针之即散，不散针侵根脚，阔三四寸，发热恶寒，烦
渴，或不发热，抽掣疼痛，四五日后，按之微软，此证毒瓦斯浮浅，春夏宜用防风败毒散，
加葱头、姜枣煎服，秋冬去姜枣、葱头，加木香。身半以上加栝蒌，身半以下宜加射干，
治早者即散。或用追毒丸、返魂丹、复元通气散微利之。脓成用铍针破开，或用替针丸
咬开。又一等皮色不变，但略微肿，肌肉内痛，夜间痛甚，发热恶寒，烦渴，此热毒深，
亦名为疽，谓其能伤筋脉骨髓也，日久按之，心中微软，脓成后用火烙烙开，以决大脓，外
用拔毒乳香膏贴之，宜服内托之药。初发，急用大针于肿硬处针之则散。疽者，初生白粒
如粟米大，便觉痒痛，触着其痛应心，此疽始发之兆也。急用火针于白粒上针开，或误
触破，或入汤，便觉微赤肿痛，三四日后不散，根脚赤晕展开，须详看之，方见其晕阔
狭，如阔四五寸左右，浑身发壮热，微渴，疮上亦热，此疽也。用火针于初起白粒上，刺
入一寸余，径寸之间，四边刺四处，便用四味紫葛汤淋洗，一日夜共五六次洗之，洗了
以软帛拭干，看疽上或有渐生白粒，如黍米或多或少，可用银篦儿挑去，勿令见血，或
有少血亦不妨，不见血尤妙。却用老皮散敷之，用凉水调大铁箍散围贴，却留疮口，疮
口处，用水调正铁箍散贴之，未可用膏药。如再要洗，须先去围药令净，然后洗之，一次
洗，一次点检，疽上渐生白粒，有则如前挑之，六七日疮头无数如蜂房，脓不肯出，仍
淋洗、围贴，冬月用五香连翘汤，大黄一味随虚实加减；夏秋用黄连羌活散，春末夏初
用防风败毒散，加葱白、枣煎服，秋去之加木香。若形气实，脉洪滑有力，痛肿 开，壮
热便闭，于五利大黄汤、漏芦汤、返魂丹、追毒丸、复元通气散，选一药以通利之。若大
便润，便止药，四十岁以前可用之，虚弱年老之人，虽有便闭之证，须慎之勿令过也。疮
热晕赤 开围贴，如赤晕收敛，却再换铁箍散，不及用火针，证七八日后，中间初起白
粒处，此窍已溃通内大脓，可用皮纸捻小纸 ，捻入窍中令透，渐渐流出，可不用针砭。
如要脓透，必以大针刺开，或周遭四五处，其窍四边如蜂房处，脓不肯出，用正铁箍散香
油调贴。一证初生白粒，误触后，便觉情怀不舒畅，背上沉重，如负五七斤米样，身体
烦疼，胸膈痞闷而躁，饮食无味，怕闻食气，所谓外如麻，里如瓜者，疽毒深恶，内连腑
脏也。三五日内，皆可用烙，于中间左右上
下，令毒瓦斯通畅后，脓从诸窍而出。五六日不散，疽顶生白粒如椒者，数日后渐生多，间
有大如蜂房、莲子者，指捺有脓血而不流，时有清水流出，微肿不突，根脚红晕，渐渐展
开，或痒痛，或不痛，或根脚晕紫赤， 开至七八寸，疽不甚热，此证甚重，用紫葛汤
加米醋一盏淋洗，可使红活，如法去白粒，敷老皮散，围大铁箍散，疮口涂正铁箍散，每
用前法，如得根脚红晕，收疽突，此药力到，变重为轻。如起第一颗顶上白粒，虽有脓而
引不透，按之犹硬，或渐不疼，便宜用火烙开透。若根脚仍旧紫黑，疮反陷下如牛项
之皮，渐变黑色，肌骨腐溃，恍惚沉重，用拔毒乳香膏，贴四边，仍用大铁箍散围，却
用猪蹄汤洗，此数项变证必多，又宜随证调理，脉若虚弱，便用大料人参、当归，浓汤
调解毒行经之药。凡痈疽必服万全散，夏月用桃红散，服以护心。若见脓之后，当以溃
疡法调理。（按《集验》治法，未可尽据为准绳，更当以后论为主，参酌诸方用之。）
大法肿高 痛，脉浮者邪在表也，宜托之，如内托复煎散。肿硬痛深，脉沉者邪在
内也，宜下之，如黄连内疏汤、仙方活命饮、苦参丸。外无 肿，内则便利调和者，邪在
经络也，宜调和荣卫，如托里荣卫汤，白芷、升麻辈。 痛躁烦，或咽干作渴者，宜降火，
如黄连解毒汤。 痛发热，或拘急，或头痛者，邪在表也，宜散之，如荆防败毒散、人
参败毒散辈，大痛或不痛者，邪气实也，隔蒜灸之，更用解毒如仙方活命饮。烦躁饮冷，
痛，脉数者，邪在上也，宜清之，如清凉饮，或金银花散。恶寒而不溃者，气实兼寒
邪也，宜宣而补之，如十宣散。 痛发热汗多，大渴便秘，谵语者，结阳证也，宜下之，
如黄连内疏汤、破棺丹辈。不作脓或熟而不溃者，虚也，宜补之，如补中益气汤、八物
汤、十全大补汤辈。 痛或不痛，及麻木者，邪气盛也，隔蒜灸之。肿痛或不作脓者，邪
气凝结也，宜解之，如仙方活命饮。肿痛饮冷，发热睡语者，火也，宜清之，如清心汤，
或防风通圣散加黄连。不作脓，或不溃及不敛者，阳气虚也，宜补之，如托里消毒散。
洁古云∶疮疡者，火之属，须分内外。若其脉沉实当先疏其内，以绝其原也。其脉浮
大，当先托里，恐邪气入内也。有内外之中者，邪气至甚，遏绝经络，故发痈肿。经曰∶
荣气不从，逆于肉理，乃生痈肿。此因失托里，及失疏通，又失和荣卫也。治疮之大要，
须明托里、疏通、行荣卫三法。托里者，治其外之内；流通者，治其内之外；行荣卫者，
治其中也。内之外者，其脉沉实，发热烦躁，外无 赤痛甚，邪气深于内也，故先疏通脏
腑，以绝其原，（内疏黄连汤。）外之内者，其脉浮数， 肿在外，形证外显，恐邪气极而内
行，故先托里以防其干也，（内托复煎散。）内外之中者，外无 恶之气，内亦脏腑宣通，知
其在经，当和荣卫也，（当归黄 汤。）用此三法之后，虽未瘥必无变证，亦可使邪气峻减，而
易痊也。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，则是皮毛始受之邪，引入骨髓；受之内者，法当疏利以寒剂，反用
温剂托裹，则是骨髓之病，上彻皮毛，表里通溃，共为一疮，助邪为毒，苦楚百倍，轻
则危殆，重则死矣。予闻洁古云，疮疡之生也，表里不同，或攻或发，少有差舛、变证，
随能杀人，甚于伤寒也。针灸施治，各随其宜。所用之药，又当明人五脏君臣，是其法
也。
内疏黄连汤 治呕哕心逆，发热而烦，脉沉而实，肿硬木闷，而皮色不变色，根系深
大，病远在内，脏腑秘涩，当急疏利之。
黄连 芍药 当归 槟榔 木香 黄芩 栀子 薄荷 桔梗 甘草（各一两） 连翘（二
两）
上除槟榔、木香为末外，并锉。每服一两，水一盏半，煎一盏。先吃一二服，次每
服加大黄一钱，再加二钱，以利为度。如有
热证，止服黄连汤，大便秘涩加大黄。如无热证，止用复煎散，时时呷之，如此内外皆
通，荣卫和调，则经络自不遏绝矣。
内托复煎散 治肿 于外，根盘不深，形证在表，其脉浮，痛在皮内，恐邪气盛则必
侵于内，急须内托以救其里。
地骨皮 黄 防风（各二两） 芍药 黄芩 白术 茯苓 人参 甘草 当归 防己
（各一两） 桂（五钱）
上 咀。先将苍术一斤，用水五升，煎至三升，去苍术滓。入前药十二味，再煎至
三四盏，绞取清汁，作三四服，终日服之。又煎苍术滓为汤，去滓，再根据前煎十二味药滓，
服之。此除湿散郁热，使胃气和平，如或未已，再作半料服之。若大便秘及烦热，少服
黄连汤。如微利，烦热已退，却服复煎散半料，如此使荣卫俱行，邪气不能内侵也。
当归黄 汤 治疮疡脏腑已行，而痛不可忍者。
当归 黄 地黄 川芎 地骨皮 芍药（各半钱）
上 咀，水煎服。如发热，加黄芩。如烦躁不能睡卧者，加栀子。如呕，则是湿气
侵胃，倍加白术。上三方，乃易水师弟治疮之三法，今特列于篇首，而以古今诸方胪列
于后，临病之工详审脉证而施用之，庶乎可以无失矣。
痈疽，是指初起时局部壅滞肿胀但尚未化脓的病症。《集验》中论述疮疡的方法，将其名称分为三类：疖、痈、疽。
疖，初起时突起，颜色浮红且没有根基（根脚），肿胀局限于皮肤之间，直径仅一二寸，伴有轻微疼痛，几天后变得微软，表皮剥起，先流出清水，随后自行破溃出脓；如果不自愈，可用替针丸、拔毒膏贴敷，脓液排出后即可痊愈。
痈，初起时红肿，突起但没有脓头，立即用火针穿刺即可消散；如果不消散，则针刺其根部，直径三四寸，伴有发热恶寒、心烦口渴，或者不发热但有抽掣样疼痛，四五日后按压感觉微软。此证毒邪浅表，春夏季节宜用防风败毒散，加葱白、生姜、大枣煎服；秋冬季节去掉生姜、大枣、葱白，加木香。身体上半部发病加栝蒌，下半部发病加射干，治疗及时即可消散。也可用追毒丸、返魂丹、复元通气散轻微通下。脓成后用铍针切开，或用替针丸腐蚀咬开。另一种情况皮色不变，只是略微肿胀，肌肉内部疼痛，夜间加重，伴有发热恶寒、心烦口渴，这是热毒深重，也名为疽，因为它能损伤筋脉骨髓。日久按压，中间微软，脓成后用火烙法烫开，以排出大量脓液，外用拔毒乳香膏贴敷，宜服用内托类药物。初发时，急用大针在肿硬处针刺则消散。
疽，初起时出现白色粟米大小的颗粒，立刻感到痒痛，触碰时疼痛应心，这是疽初发的征兆。急用火针在白粒上刺开，或误触破溃，或浸入汤水，便觉得微赤肿痛，三四日后不散，根部红色晕圈展开，须仔细观察才能看出晕圈的宽窄，如宽四五寸左右，全身壮热，微渴，疮面亦热，这是疽。用火针在初起的白粒上刺入一寸多，在一寸见方的范围内，四边各刺四处，随即用四味紫葛汤淋洗，一天一夜共洗五六次，洗后用软布擦干，观察疽上是否有逐渐增生的白粒，如黍米大小或多或少，可用银篦挑去，不要弄出血，即使有少量血也无妨，不出血更好。然后用老皮散敷贴，用凉水调和大铁箍散围贴，留出疮口，疮口处用水调正铁箍散贴敷，暂不可用膏药。如果要再洗，须先去除围药洗净，然后清洗，每次清洗都要检查，疽上渐生白粒，有的就按前述方法挑去。六七日疮头无数如蜂房状，脓液不肯流出，仍继续淋洗、围贴。冬季用五香连翘汤，大黄一味根据虚实加减；夏秋用黄连羌活散，春末夏初用防风败毒散，加葱白、大枣煎服，秋季去掉葱枣加木香。若形体气实，脉象洪滑有力，痛肿开阔，壮热便秘，在五利大黄汤、漏芦汤、返魂丹、追毒丸、复元通气散中选一药以通利之。若大便润，即停药。四十岁以下可用，虚弱年老之人，虽有便秘证，须谨慎勿令过剂。疮热晕赤开阔围贴，如赤晕收敛，再换铁箍散，来不及用火针，证七八日后，中间初起白粒处，此窍已溃通内有大脓，可用皮纸捻成小纸捻，捻入窍中令其通透，脓液渐渐流出，可不用针砭。若要脓透，必以大针刺开，或周遭四五处，其窍四边如蜂房处，脓液不肯出，用正铁箍散香油调贴。一证初生白粒，误触后，便觉得心情不舒畅，背上沉重，如背负五七斤米样，身体烦疼，胸膈痞闷而躁，饮食无味，怕闻食气，所谓外如麻，里如瓜者，是疽毒深恶，内连脏腑。三五日内，皆可用烙法，于中间左右上下，令毒邪通畅后，脓从诸窍而出。五六日不散，疽顶生白粒如椒者，数日后渐增多，间有大如蜂房、莲子者，指捺有脓血而不流，时有清水流出，微肿不突，根脚红晕，渐渐展开，或痒痛，或不痛，或根脚晕紫赤，开阔至七八寸，疽不甚热，此证甚重，用紫葛汤加米醋一盏淋洗，可使红活，如法去白粒，敷老皮散，围大铁箍散，疮口涂正铁箍散，每用前法，如得根脚红晕收束，疽体突起，此为药力到，变重为轻。如起第一颗顶上白粒，虽有脓而引不透，按之犹硬，或渐不疼，便宜用火烙开透。若根脚仍旧紫黑，疮反陷下如牛项之皮，渐变黑色，肌骨腐溃，恍惚沉重，用拔毒乳香膏，贴四边，仍用大铁箍散围，却用猪蹄汤洗，此数项变证必多，又宜随证调理，脉若虚弱，便用大料人参、当归，浓汤调解毒行经之药。凡痈疽必服万全散，夏月用桃红散，服以护心。若见脓之后，当以溃疡法调理。（按《集验》治法，未可尽据为准绳，更当以后论为主，参酌诸方用之。）
大法：肿高痛，脉浮者，邪在表也，宜托之，如内托复煎散。肿硬痛深，脉沉者，邪在内也，宜下之，如黄连内疏汤、仙方活命饮、苦参丸。外无肿，内则便利调和者，邪在经络也，宜调和营卫，如托里荣卫汤，白芷、升麻辈。痛躁烦，或咽干作渴者，宜降火，如黄连解毒汤。痛发热，或拘急，或头痛者，邪在表也，宜散之，如荆防败毒散、人参败毒散辈，大痛或不痛者，邪气实也，隔蒜灸之，更用解毒如仙方活命饮。烦躁饮冷，痛，脉数者，邪在上也，宜清之，如清凉饮，或金银花散。恶寒而不溃者，气实兼寒邪也，宜宣而补之，如十宣散。痛发热汗多，大渴便秘，谵语者，结阳证也，宜下之，如黄连内疏汤、破棺丹辈。不作脓或熟而不溃者，虚也，宜补之，如补中益气汤、八物汤、十全大补汤辈。痛或不痛，及麻木者，邪气盛也，隔蒜灸之。肿痛或不作脓者，邪气凝结也，宜解之，如仙方活命饮。肿痛饮冷，发热睡语者，火也，宜清之，如清心汤，或防风通圣散加黄连。不作脓，或不溃及不敛者，阳气虚也，宜补之，如托里消毒散。
洁古云：疮疡者，火之属，须分内外。若其脉沉实当先疏其内，以绝其原也。其脉浮大，当先托里，恐邪气入内也。有内外之中者，邪气至甚，遏绝经络，故发痈肿。经曰：营气不从，逆于肉理，乃生痈肿。此因失托里，及失疏通，又失和营卫也。治疮之大要，须明托里、疏通、行营卫三法。托里者，治其外之内；流通者，治其内之外；行营卫者，治其中也。内之外者，其脉沉实，发热烦躁，外无赤痛甚，邪气深于内也，故先疏通脏腑，以绝其原，（内疏黄连汤。）外之内者，其脉浮数，肿在外，形证外显，恐邪气极而内行，故先托里以防其干也，（内托复煎散。）内外之中者，外无恶之气，内亦脏腑宣通，知其在经，当和营卫也，（当归黄芪汤。）用此三法之后，虽未瘥必无变证，亦可使邪气峻减，而易痊也。
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，则是皮毛始受之邪，引入骨髓；受之内者，法当疏利以寒剂，反用温剂托裹，则是骨髓之病，上彻皮毛，表里通溃，共为一疮，助邪为毒，苦楚百倍，轻则危殆，重则死矣。予闻洁古云，疮疡之生也，表里不同，或攻或发，少有差舛、变证，随能杀人，甚于伤寒也。针灸施治，各随其宜。所用之药，又当明人五脏君臣，是其法也。
内疏黄连汤，治呕哕心逆，发热而烦，脉沉而实，肿硬木闷，而皮色不变色，根系深大，病远在内，脏腑秘涩，当急疏利之。
黄连、芍药、当归、槟榔、木香、黄芩、栀子、薄荷、桔梗、甘草（各一两），连翘（二两）。
上除槟榔、木香为末外，并锉。每服一两，水一盏半，煎一盏。先吃一二服，次每服加大黄一钱，再加二钱，以利为度。如有热证，止服黄连汤，大便秘涩加大黄。如无热证，止用复煎散，时时呷之，如此内外皆通，营卫和调，则经络自不遏绝矣。
内托复煎散，治肿于外，根盘不深，形证在表，其脉浮，痛在皮内，恐邪气盛则必侵于内，急须内托以救其里。
地骨皮、黄芪、防风（各二两），芍药、黄芩、白术、茯苓、人参、甘草、当归、防己（各一两），桂（五钱）。
上咀。先将苍术一斤，用水五升，煎至三升，去苍术滓。入前药十二味，再煎至三四盏，绞取清汁，作三四服，终日服之。又煎苍术滓为汤，去滓，再根据前煎十二味药滓，服之。此除湿散郁热，使胃气和平，如或未已，再作半料服之。若大便秘及烦热，少服黄连汤。如微利，烦热已退，却服复煎散半料，如此使营卫俱行，邪气不能内侵也。
当归黄芪汤，治疮疡脏腑已行，而痛不可忍者。
当归、黄芪、地黄、川芎、地骨皮、芍药（各半钱）。
上咀，水煎服。如发热，加黄芩。如烦躁不能睡卧者，加栀子。如呕，则是湿气侵胃，倍加白术。上三方，乃易水师弟治疮之三法，今特列于篇首，而以古今诸方胪列于后，临病之工详审脉证而施用之，庶乎可以无失矣。
Yongju (Carbuncle and Ulcer) refers to the condition where local congestion and swelling occur initially, but pus has not yet formed. The *Jiyan* discusses methods for treating sores and ulcers, classifying them into three names: Jie (Furuncle), Yong (Carbuncle), and Ju (Deep Abscess).
Jie (Furuncle): Initially appears as a protrusion, floating red in color with no distinct root (base). The swelling is confined to the skin, spanning only one or two cun, accompanied by slight pain. After several days, it becomes slightly soft, the thin skin peels off, first exuding clear fluid, then spontaneously rupturing to discharge pus. If it does not rupture spontaneously, apply Tipin Wan (Needle-Replacement Pill) and Badu Gao (Poison-Expelling Plaster). Once pus is discharged, it heals.
Yong (Carbuncle): Initially presents with redness and swelling, protruding without a head. Immediately puncture with a fire needle to disperse it. If it does not disperse, puncture the root. It spans three or four cun, accompanied by fever, aversion to cold, irritability, and thirst, or sometimes no fever but pulling pain. After four or five days, pressing reveals slight softness. This condition involves superficial toxin. In spring and summer, use Fangfeng Baidu San (Saposhnikovia Decoction to Overcome Toxins), adding scallion heads, ginger, jujube, and dates decocted together. In autumn and winter, remove ginger, jujube, and scallion heads, add Muxiang (Aucklandiae Radix). For lesions on the upper half of the body, add Gualou (Trichosanthis Fructus); for the lower half, add Shegan (Belamcandae Rhizoma). Timely treatment leads to dispersion. Alternatively, use Zhidu Wan (Toxin-Chasing Pill), Fanhun Dan (Soul-Returning Elixir), or Fuyuan Tongqi San (Restore-Origin Qi-Circulating Powder) for mild purgation. When pus forms, incise with a Pi Zhen (Pi Needle) or use Tipin Wan to erode/open it. Another type presents with unchanged skin color, slight swelling, deep muscle pain worsening at night, fever, aversion to cold, irritability, and thirst. This indicates deep heat-toxin, also named Ju (Deep Abscess), because it can damage sinews, vessels, and bone marrow. After prolonged duration, pressing reveals slight softness in the center. When pus forms, use fire cauterization to open it and drain large amounts of pus. Apply Badu Ruxiang Gao (Poison-Expelling Frankincense Plaster) externally, and internally administer Tuoli (Interior-Supporting) medicines. At onset, urgently puncture the swollen and hard area with a large needle to disperse it.
Ju (Deep Abscess): Initially presents as white granules the size of millet seeds, accompanied immediately by itching and pain. Touching causes pain to resonate in the heart; this is the sign of initial Ju development. Urgently puncture the white granule with a fire needle. If accidentally broken or immersed in water, it becomes slightly red, swollen, and painful. After three or four days, if it does not disperse, the red halo around the root expands. Observe carefully to determine the width of the halo, e.g., about four or five cun. The whole body experiences high fever, slight thirst, and the sore itself feels hot. This is Ju. Puncture the initial white granule with a fire needle to a depth of over one cun. Within an area of one cun square, puncture four points on each side. Immediately wash with Siwei Zigeg Tang (Four-Ingredient Purple Kudzu Decoction), washing five or six times over a day and night. Dry with a soft cloth after washing. Check if new white granules like millet seeds are forming on the Ju. If present, pick them off with a silver comb. Avoid bleeding; slight bleeding is acceptable, but no bleeding is better. Then apply Laopi San (Old Skin Powder). Surround the lesion with Datiegu San (Great Iron-Hoop Powder) mixed with cool water, leaving the sore opening uncovered. Do not use plasters yet. If washing again, first completely remove the surrounding powder, then wash. Each wash must be followed by inspection. As white granules gradually appear, pick them off as before. By the sixth or seventh day, numerous sore heads may resemble a honeycomb, refusing to discharge pus. Continue washing and surrounding. In winter, use Wuxiang Lianqiao Tang (Five-Aromatic Forsythia Decoction), adjusting Dahuang (Rhei Radix et Rhizoma) dosage according to deficiency or excess. In summer and autumn, use Huanglian Qianghuo San (Coptis and Notopterygium Powder). In late spring and early summer, use Fangfeng Baidu San, adding scallion whites and jujubes decocted; in autumn, remove these and add Muxiang. If the constitution is robust and the pulse is surging, slippery, and forceful, with wide-open painful swelling, high fever, and constipation, select one of Wuli Dahuang Tang (Five-Purgative Rhubarb Decoction), Loulu Tang (Euphorbiae Humifusae Herba Decoction), Fanhun Dan, Zhidu Wan, or Fuyuan Tongqi San to promote purgation. If stools are moist, stop the medicine. This applies to those under forty. For weak or elderly persons, even with constipation, exercise caution to avoid overdose. If the red halo opens wide for surrounding, and the redness recedes, change to Tiegu San (Iron-Hoop Powder). If too late for fire needles, after seven or eight days, when the central initial white granule has ulcerated internally with large pus, roll a small paper wick from bark paper, insert it into the orifice to ensure patency, allowing pus to flow out gradually, avoiding needle scarification. To ensure pus penetration, puncture with a large needle or around four or five points. If pus refuses to exit from honeycomb-like areas around the orifice, apply Zhengtiegu San (Correct Iron-Hoop Powder) mixed with sesame oil. After initial white granules are touched, if mood becomes depressed, back feels heavy as if carrying five to seven jin of rice, body aches irritably, chest and diaphragm feel stifled and restless, appetite is lost, and smell of food is repulsive—described as "externally like hemp, internally like melon"—the Ju toxin is deep and malignant, connecting internally to the zang-fu organs. Within three to five days, cauterization can be used on the center, left, right, top, and bottom to unblock toxins, allowing pus to exit through various orifices. If unresolved after five to six days, white granules like peppercorns appear on the Ju apex, increasing later, some as large as honeycombs or lotus seeds. Pressing yields pus and blood that do not flow, with occasional clear fluid leakage. Slight swelling without protrusion, red halo at the root expanding gradually, possibly itchy or painless, or purple-red halo widening to seven or eight cun, with low heat—this is a severe condition. Wash with Zigeg Tang (Purple Kudzu Decoction) plus one cup of rice vinegar to restore vitality. Remove white granules as directed, apply Laopi San, surround with Datiegu San, and apply Zhengtiegu San to the sore opening. Using these methods, if the root redness recedes and the Ju protrudes, the medicine is effective, turning severity into mildness. If the first white granule on top contains pus but drainage is blocked, remains hard upon pressing, or pain diminishes, promptly use fire cauterization to penetrate. If the root remains purple-black, the sore sinks like ox neck skin, turns black, muscles and bones rot, and the patient feels confused and heavy, apply Badu Ruxiang Gao to the periphery, surround with Datiegu San, and wash with Zhu Ti Tang (Pig Trotter Decoction). These changes often involve multiple complications; adjust treatment accordingly. If the pulse is weak, use large doses of Renshen (Ginseng Radix) and Danggui (Angelicae Sinensis Radix) in strong decoction to support detoxification and channel circulation. All Yongs and Jus require Wanquan San (Perfect Safety Powder); in summer, use Taohong San (Peach Kernel and Safflower Powder) to protect the Heart. After pus appears, manage according to ulceration methods. (Note: The treatments in *Jiyan* should not be taken as absolute standards; prioritize the following discussions and consult various formulas.)
General Principles: High swelling with pain and floating pulse indicate pathogen in the exterior; use Tuoli (Interior Support), e.g., Neituo Fujian San. Hard swelling with deep pain and sinking pulse indicate pathogen in the interior; use Xia (Purge), e.g., Huanglian Neishu Tang, Xianfang Huoming Yin, Kushen Wan. No external swelling but internal comfort indicates pathogen in channels and collaterals; harmonize Ying and Wei (Nutritive and Defensive Qi), e.g., Tuoli Yingwei Tang, Baizhi (Angelicae Dahuricae Radix), Shengma (Cimicifugae Rhizoma). Pain with restlessness and thirst indicates Fire; descend Fire, e.g., Huanglian Jiedu Tang. Pain with fever, stiffness, or headache indicates pathogen in the exterior; disperse, e.g., Jingfang Baidu San, Renshen Baidu San. Severe pain or absence of pain indicates Excess Pathogen; moxa with garlic partition, plus detoxification like Xianfang Huoming Yin. Restlessness, desire for cold drinks, pain, and rapid pulse indicate pathogen in the Upper Jiao; clear Heat, e.g., Qingliang Yin, Jinyinhua San. Aversion to cold without ulceration indicates Qi Excess combined with Cold Pathogen; diffuse and tonify, e.g., Shixuan San. Pain with fever, profuse sweating, extreme thirst, constipation, and delirium indicates Jieyang Syndrome (Yang Knotting); purge, e.g., Huanglian Neishu Tang, Po Guan Dan. Failure to form pus or ripening without ulceration indicates Deficiency; tonify, e.g., Buzhong Yiqi Tang, Bawu Tang, Shiquan Dabu Tang. Pain or numbness indicates Excess Pathogen; moxa with garlic partition. Swelling and pain or failure to form pus indicates Pathogen Congestion; resolve, e.g., Xianfang Huoming Yin. Swelling, pain, desire for cold drinks, fever, and sleep-talking indicate Fire; clear, e.g., Qingxin Tang, or Fangfeng Tongsheng San plus Huanglian. Failure to form pus, ulcerate, or heal indicates Yang Qi Deficiency; tonify, e.g., Tuoli Xiaodu San.
Jiegu said: Sores and ulcers belong to Fire; distinguish interior and exterior. If the pulse is deep and solid, first purge the interior to cut off the source. If the pulse is floating and large, first support the interior to prevent pathogen entry. In cases between interior and exterior, pathogen is extreme, blocking channels, causing carbuncles and swellings. The Classics state: "When Ying Qi does not follow its course and reverses in the flesh, carbuncles and swellings arise." This results from failure to support the interior, failure to purge/unblock, and failure to harmonize Ying and Wei. The key to treating sores requires understanding three methods: Tuoli (Interior Support), Shutong (Unblocking/Purging), and Xing Yingwei (Promoting Ying and Wei Circulation). Tuoli treats the exterior affecting the interior; Shutong treats the interior affecting the exterior; Xing Yingwei treats the middle. Interior affecting exterior: Pulse deep/solid, fever/irritability, no severe external redness/pain, pathogen deep inside; first unblock zang-fu to cut the source (Huanglian Neishu Tang). Exterior affecting interior: Pulse floating/rapid, swelling outside, symptoms manifest externally, fear pathogen reaching extreme and moving inward; first support interior to prevent invasion (Neituo Fujian San). Middle of interior/exterior: No external evil qi, internal zang-fu unblocked, knowing it is in the channels; harmonize Ying and Wei (Danggui Huangqi Tang). After using these three methods, even if not cured, complications will be avoided, pathogen reduced severely, and recovery facilitated.
Dongyuan said: The onset of sores and ulcers differs by interior/exterior origin, and treatment differs by cold/warm nature. Originating from exterior: method is to support interior with warm agents; using cold herbs instead draws pathogen from skin/hair into bone marrow. Originating from interior: method is to purge/drain with cold agents; using warm agents to wrap/support instead drives bone marrow disease up to skin, causing total perforation of interior/exterior, merging into one sore, aiding pathogen toxicity, causing hundredfold suffering, leading to danger or death. I heard Jiegu say: The birth of sores and ulcers differs in interior/exterior; whether attacking or releasing, slight errors lead to complications that can kill, worse than Shanghan (Cold Damage). Acupuncture and moxibustion should be applied appropriately. Medicines must clarify the Sovereign-Minister relationship of the Five Zang Organs; this is the method.
Huanglian Neishu Tang (Coptis Internal-Purging Decoction): Treats vomiting, hiccups, heart rebellion, fever with irritability, deep/solid pulse, hard/swollen woody sensation, unchanged skin color, deep/large root, distant interior disease, zang-fu constipation. Urgently purge/drain.
Ingredients: Huanglian (Coptidis Rhizoma), Shaoyao (Paeoniae Radix), Danggui (Angelicae Sinensis Radix), Binglang (Arecae Semen), Muxiang (Aucklandiae Radix), Huangqin (Scutellariae Radix), Zhizi (Gardeniae Fructus), Bohe (Menthae Haplocalycis Herba), Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix) — 1 liang each; Lianqiao (Forsythiae Fructus) — 2 liang.
Preparation: Except Binglang and Muxiang which are powdered, all are chopped. Take 1 liang, decoct in 1.5 cups of water to 1 cup. Take 1-2 doses first, then increase Dahuang (Rhei Radix et Rhizoma) by 1 qian per dose, up to 2 qian, stopping when purged. If heat signs exist, take only Huanglian Tang; if constipated, add Dahuang. If no heat signs, take Fujian San frequently. Thus interior and exterior are unblocked, Ying and Wei harmonized, channels unblocked.
Neituo Fujian San (Interior-Supporting Double-Decoction Powder): Treats external swelling, shallow root, exterior symptoms, floating pulse, pain in skin, fear of pathogen invading interior due to excess. Urgently support interior.
Ingredients: Digupi (Lycii Cortex), Huangqi (Astragali Radix), Fangfeng (Saposhnikoviae Radix) — 2 liang each; Shaoyao, Huangqin, Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Renshen (Ginseng Radix), Gancao, Danggui, Fangji (Stephaniae Tetrandrae Radix) — 1 liang each; Gui (Cinnamomi Ramulus) — 5 qian.
Preparation: Coarsely crush. First decoct 1 jin of Cangzhu (Atractylodis Rhizoma) in 5 sheng of water to 3 sheng, discard residue. Add the twelve prior herbs, decoct to 3-4 cups, strain clear liquid. Divide into 3-4 doses, take throughout the day. Also decoct Cangzhu residue in water, strain, and decoct the twelve herb residues again. This removes dampness and disperses stagnant heat, harmonizing Stomach Qi. If unresolved, take half dose. If constipated and febrile, take less Huanglian Tang. If mild diarrhea and heat subsided, take half dose of Fujian San. Thus Ying and Wei circulate, preventing interior invasion.
Danggui Huangqi Tang (Angelica and Astragalus Decoction): Treats sores/ulcers where zang-fu function is active but pain is unbearable.
Ingredients: Danggui, Huangqi, Dihuang (Rehmanniae Radix), Chuanxiong (Chuanxiong Rhizoma), Digupi, Shaoyao — 0.5 qian each.
Preparation: Coarsely crush, decoct in water. If feverish, add Huangqin. If irritable and unable to sleep, add Zhizi. If vomiting, dampness invades Stomach; double Baizhu. These three formulas represent the three methods of Yi Shui (Li Dongyuan's teacher Zhang Congzheng and Li himself) for treating sores. Listed here first, followed by ancient and modern formulas. Practitioners should examine pulse and symptoms carefully to apply them correctly.