《周礼·天官·冢宰》之属，有疾医、疡医、内外科之分久矣。疾医中士八人，疡医下士
八人，重内轻外，自古已然，然未有不精乎内，而能治外者也。疾医之所不能生者，于父母
遗体，犹得全而归之，而疡医不然，至于烂筋骨、溃肌肉、见脏腑而后终焉。故疾病于人，唯
疡最惨，而世顾轻之，何哉？乃世之疡医明经络，谙方药而不嗜利，唯以活人为心者，千
百无一也，其见轻固宜，然不曰并自轻其命耶！余童而习岐黄之术，弱冠而治女弟之乳疡，虞
翁之附骨疡，皆起白骨而肉之，未尝有所师受，以为外科易易耳。欲得聪明有志者指授之，使
为疡医而竟无有，故集先代名医方论，融以独得而成是编，与世专科书，图人形，刊方药，诧
为秘传者，万万不侔。能熟而玩，神而明之，可以名世矣。余既以便差还故山，例得支俸，受
之则不安，辞之则立异，乃以付梓人，逾期而后竣事，于是诸科分证用药之书略备。夫孰使
余窃禄于朝，而又得优游编葺以行于世，岂非圣主之赐也欤。
万历三十六年岁在戊申七夕微雨作凉金坛王肯堂奢懒轩下书
方书叙痈疽之源有五。一，天行时气。二，七情内郁。三，体虚外感。四，身热搏于风
冷，五，食炙爆、饮法酒、服丹石等热毒。总之不出于三因也。
外因者，运气痈疽有四∶一曰火热助心为疮。经云∶少阴所至为疮疹。又云∶
少阴司天，热气下临，肺气上从，甚则疮疡。又云∶少阴司天之政，初之气，寒乃始，阳气
郁，炎暑将起，中外疮疡。又云∶少阳所至为疮疡。又云∶少阳司天之政，风热参布，太
阴横流，寒乃时至，民病寒中，外发疮疡。初之气候乃太温，其病肤腠中疮。二之气火反
郁，其病热郁于上，疮发于中。三之气，炎暑至，民病脓疮。又云∶太阳司天之政，初
之气，气乃大温，肌腠疮疡，此皆常化，病之浅也。又云∶少阴司天，热淫所胜，甚则
疮疡。又云∶少阴司天。客胜，甚则疮疡。又云∶少阴之复，病痱疹、疮疽痈疽、痤痔。又
云∶火太过曰赫羲，其病疮疽血流。又云∶火郁之发，民病疮疡痈肿，此是邪变病之甚也。
二曰，寒邪伤心为疮疡。经云∶太阳司天之政，三之气，寒气行，民病寒，反热中，痈
疽注下。又云∶太阳司天，寒淫所胜，血变于中，发为痈疡，病本于心。又云∶阳明司
天之政，四之气，寒雨降，民病痈肿疮疡是也。三曰，燥邪伤肝为疮疡。经云∶木不及
曰委和，上商与正商同。其病支发，痈肿疮疡，邪伤肝也。又云∶阳明司天，燥淫所胜，
民病疡疮痤痈，病本于肝是也。四曰，湿邪疮疡。经云∶太阴司天，湿气变物，甚则身
后痈。又云∶太阴之胜，火气内郁，疮疡于中，流散于外是也。此四条，所谓天行时气
者也。《素问·脉要精微论》帝曰∶诸痈肿、筋挛、骨痛，此皆安生？岐伯曰∶此寒气之
肿，八风之变也。帝曰∶治之奈何？歧伯曰∶此四时之病，以其胜治之愈也。《灵枢经·痈
疽篇》云∶血脉荣卫，周流不休，上应星宿，下应经数。寒邪客于经络之中则血泣，血泣
则不通，不通则卫气归之，不得复反，故痈肿。寒气化为热，热胜则腐肉，腐肉则为脓，
脓不泻则烂筋，筋烂则伤骨，骨伤则髓消，不当骨空，不得泄泻，血枯空虚，则筋骨肌肉
不相荣，经脉败漏，熏于五脏，脏伤故死矣。又《生气通天论》云∶劳汗当风，寒薄为 ，
郁乃痤。又云∶阳气者，开阖不得，寒气从之，乃生大偻；荣气不从，逆于肉理，乃生
痈肿。是亦寒邪从劳汗之隙，及阳气开阖不得其理之隙，久客之为痈肿也。所谓体虚外
感，及身热搏于风冷者也。治法则《精要》十宣散、五香汤，洁古苍术复煎散等，发表之
剂是也。
内因者，陈无择云∶痈疽、瘰 ，不问虚实寒热，皆由气郁而成。经云∶气宿于经
络，与血俱涩而不行，壅结为痈疽。不言热之所作而后成痈者，此乃因喜怒忧思有所郁
而成也。治之以远志酒、独胜散，兼以五志相胜之理，如怒胜思之类是也。
不内外因者，经所谓膏粱之变，足生大疔，更如持虚。又东方之域，鱼盐之地，其
民食鱼嗜咸，安其处，美其食，鱼热中，咸胜血，故其民黑色疏理，其病为痈疽。又有
服丹石、法酒而致者，亦膏粱之类也。李东
垣曰∶膏粱之变，亦是滋味过度，荣气不从，逆于肉理，荣气者，胃气也。饮食入胃，先
输于脾而朝于肺，肺朝百脉，次及皮毛，先行肠道，下归五脏六腑而气口成寸矣。今富
贵之人，不知其节，法酒、肥羊，杂以浓味，积久大过。其气味俱浓之物，乃阳中之阳，不
能走空窍而先行阳道，乃反行阴道则湿气大胜，子令母实，火乃大旺。热湿既盛，必来
克肾，若不慎房事，损其真水，水乏则从湿气之化而上行，其疮多出背上及脑，此为大
疔之最重者。若毒瓦斯出肺或脾胃之部分，毒之次也，若出于他经，又其次也。湿热之毒
所止处，无不溃烂，故经言膏粱之变，足生大疔。更加持虚者，如持虚器以更物，则无
不更矣。治大疔之法，必当泻其荣气。以标本言之先受病为本，非苦寒之剂为主为君，不
能除其苦楚疼痛也，如东垣治元好问，丹溪治老妇脑疽，皆因好酒，故以三黄、大黄，酒
制治之，又如排脓散、当归散之类是也。又有尽力房室，精虚气节之所致者，亦属不内
外因，当以补虚内托为主，亦忌用五香之药，耗真阴而助邪热。治之之药，如内固黄 汤、
神效托里散之类也。经云∶五脏菀热，痈发六腑。又云∶六腑不和，留结为痈。又云∶诸
痛痒疮，皆属于心，肺乘肝则为痈，肾移寒于肝，痈肿少气，脾移寒于肝，痈肿筋挛，此
皆脏腑之变，亦属内因者也。
东垣曰∶生气通天论云∶荣气不从，逆于肉理，乃生痈肿。又云∶膏粱之变，足生
大疔，受如持虚。阴阳应象论云∶地之湿气，感则害人皮肉筋脉。是言湿气外伤则荣气不
行，营卫者，皆营气之所经营也，营气者胃气也，运气也。荣气为本，本逆不行，为湿
气所坏而为疮疡也。膏粱之变亦是，言浓滋味过度，而使荣气逆行，凝于经络为疮疡也。
此邪不在表亦不在里，唯在其经中道病也。以上《内经》所说，俱言因营气逆而作也。遍
看诸疮疡论中，多言二热相搏，热化为脓者。有只言热化为脓者，有言湿气生疮，寒化为
热而为脓者，此皆疮疽之源也。宜于所见部分，用引经药；并兼见证中，分阴证阳证，先
泻营气是其本，本逆助火，湿热相合，败坏肌肉而为脓血者比治次也。宜远取诸物以比
之，一岁之中，大热无过夏，当是时诸物皆不坏烂，坏烂者，交秋湿令大行之际也。近
取诸身，热病在身，止显热而不败坏肌肉，此理明矣，标本不得，邪气不服，言一而知百
者，可以为上工矣。
《周礼·天官·冢宰》这一职官体系中，早已将医生分为疾医（内科医生）和疡医（外科医生）。疾医配备中士八人，疡医配备下士八人，这种重内轻外的现象自古如此。然而，没有精通内科医术的人，却能够治好外科疾病的。如果疾医无法救活的患者，对于父母的遗体，尚且能保全并安葬；但疡医处理的情况则不然，往往导致筋骨腐烂、肌肉溃烂，甚至暴露脏腑后才死亡。因此，在各类疾病中，外科疮疡最为惨烈，但世人反而轻视它，这是为什么呢？这是因为世间的疡医中，那些通晓经络、熟悉方药且不贪图利益、一心以救人为宗旨的，千百人中难找到一个。他们被轻视是理所当然的，但这难道不是他们也轻视自己的生命吗！
我童年时便学习岐黄之术（中医），二十岁左右时为妹妹治疗乳痈（乳房急性化脓性疾病），为虞翁治疗附骨疽（深部脓肿），都能使白骨生肉，起死回生。这些经验并非师承传授，而是我认为外科相对容易。我曾想寻找聪明有志向的人来指点教导，希望能培养出真正的疡医，但却找不到这样的人。因此，我收集前代名医的方论，融入自己的独到见解，编成此书。这与世间那些专门著书、绘制人体图形、刊印方药并夸耀为秘传的书相比，相差万万倍。如果能熟读并深入领会，神而明之，就可以名扬于世了。
我因为公务便利回到故乡，按规定可以领取俸禄。接受它心里不安，推辞它又显得标新立异，于是便将书稿交付刻印。过了期限才完成工作，至此各科分证用药的书籍大致齐备。是谁让我在朝廷窃取俸禄，又能悠闲地编辑整理并在世上流传？这难道不是圣明的君主赐予的吗？
万历三十六年岁次戊申七夕微雨作凉，金坛王肯堂于奢懒轩写下。
论述痈疽（泛指体表化脓性感染）的起源有五种：一、天时气候异常（天行时气）；二、七情（喜、怒、忧、思、悲、恐、惊）内郁；三、体质虚弱感受外邪；四、身体发热与风冷搏结；五、食用烧烤油炸食物、饮用烈酒、服用丹石类药物等引起的热毒。总之，不出于“三因”（内因、外因、不内外因）的范围。
外因方面，关于运气（五运六气）导致的痈疽有四种情况：
第一，火热助心形成疮疡。经书说：“少阴所至表现为疮疹。”又说：“少阴司天（主管上半年气候），热气下行，肺气上从，严重时发生疮疡。”又说：“少阴司天之政，初之气（大寒至春分），寒气开始，阳气郁结，炎暑即将兴起，内外发生疮疡。”又说：“少阳所至表现为疮疡。”又说：“少阳司天之政，风热散布，太阴湿气横流，寒气时至，民众患寒中病，外部发为疮疡。初之气气候偏温，病在皮肤腠理间出现疮。二之气火气反被郁结，病热郁于上部，疮发于中部。三之气炎暑到来，民众患脓疮。”又说：“太阳司天之政，初之气，气候大温，肌肤腠理发生疮疡。这些都是正常的变化，属于病情较浅的。”又说：“少阴司天，热气过盛，严重时发生疮疡。”又说：“少阴司天，客气胜主气，严重时发生疮疡。”又说：“少阴复气，病见瘖痱、疹、疮疽痈疽、痤疮痔疮。”又说：“火气太过称为赫羲，其病为疮疽血流。”又说：“火气郁结发作，民众患疮疡痈肿。这是邪气变化导致的严重疾病。”
第二，寒邪伤心形成疮疡。经书说：“太阳司天之政，三之气（小满至大暑），寒气流行，民众患寒病，反而出现热中症，发生痈疽泄泻。”又说：“太阳司天，寒气过盛，血液在体内发生变化，发为痈疡，病本在于心。”又说：“阳明司天之政，四之气（秋分至小雪），寒雨下降，民众患痈肿疮疡。”
第三，燥邪伤肝形成疮疡。经书说：“木气不及称为委和，其表现与商金之气相同。其病表现为四肢发病，痈肿疮疡，这是邪气伤了肝脏。”又说：“阳明司天，燥气过盛，民众患疡疮痤疮痈，病本在于肝。”
第四，湿邪导致疮疡。经书说：“太阴司天，湿气改变万物，严重时身后发生痈。”又说：“太阴胜气，火气内郁，疮疡发于内部，流散于外部。”以上四条，就是所谓的“天行时气”。
《素问·脉要精微论》中，黄帝问：“各种痈肿、筋挛、骨痛，这是怎么产生的？”岐伯回答：“这是寒气引起的肿胀，以及八风（八方之风）变化所致。”黄帝问：“怎么治疗？”岐伯回答：“这是四时的疾病，用相克的方法治疗就能痊愈。”
《灵枢经·痈疽篇》说：“血脉营卫，周流不息，上应星宿，下应经脉度数。寒邪客居在经络之中，则血液凝涩，血液凝涩则不通畅，不通畅则卫气归聚于此，不能再返回，所以形成痈肿。寒气化为热，热盛则腐肉，腐肉则化为脓，脓液不排出则烂筋，筋烂则伤骨，骨伤则髓消，如果不从骨空处排泄，不得泄泻，血枯空虚，则筋骨肌肉不相滋养，经脉败漏，熏灼五脏，脏气受损就会死亡。”
又《生气通天论》说：“劳作出汗当风，寒气迫近成为皶（酒渣鼻类皮肤病），郁结则成痤（粉刺）。”又说：“阳气者，开阖功能失常，寒气随之侵入，就产生大偻（脊背弯曲）；营气不顺，逆乱于肌肉纹理，就产生痈肿。”这也是寒邪从劳作汗出的间隙，以及阳气开阖失理的间隙，长久停留成为痈肿的原因。这就是所谓的“体虚外感”及“身热搏于风冷”。治疗方法如《精要》中的十宣散、五香汤，洁古（张元素）的苍术复煎散等，属于发表（发散表邪）的药剂。
内因方面，陈无择说：“痈疽、瘰疬（颈部淋巴结结核），不问虚实寒热，都是由气郁而成。”经书说：“气滞留于经络，与血一起涩滞不行，壅结形成痈疽。”这里没有说由热引起而后成痈，这是因为因喜怒忧思等情绪郁结而成的。治疗用远志酒、独胜散，兼用五志相胜的原理，如怒胜思之类。
不内外因方面，经书所谓“膏粱之变，足生大疔”，又如持虚器更物。另外东方地域，是鱼盐之地，那里的百姓吃鱼嗜咸，安于居所，喜爱美食。鱼性热中，咸味胜血，所以那里的百姓肤色黑、毛孔疏理，他们的病多为痈疽。又有服用丹石、饮用法酒导致的，也属于膏粱之类。李东垣说：“膏粱之变，也是滋味过度，营气不顺，逆乱于肌肉纹理。营气，就是胃气。饮食入胃，先输送到脾而上朝于肺，肺朝百脉，其次及于皮毛，先行肠道，下归五脏六腑，而在气口形成寸脉。如今富贵之人，不知节制，饮用法酒、食用肥羊，混杂浓味，积久过量。气味浓厚的物品，属于阳中之阳，不能走空窍而先行阳道，反而行阴道则湿气大胜，子令母实，火气大旺。湿热既盛，必然来克肾，若不谨慎房事，损伤真水，水乏则随湿气化而上行，其疮多出在背上及脑部，这是大疔中最重的。如果毒瓦斯出于肺或脾胃的部分，毒性较轻；如果出于其他经络，就更轻了。湿热毒气停止之处，无不溃烂，所以经书说膏粱之变，足生大疔。再加上‘持虚’的情况，如同拿着空器皿更换东西，则无不更换。治疗大疔的方法，必须泻其营气。从标本来说，先受病为本，不用苦寒的药物为主药，不能消除其痛苦疼痛。如东垣治疗元好问，丹溪治疗老妇脑疽，都因为好酒，所以用三黄、大黄，酒制治疗，又如排脓散、当归散之类。又有尽力房事，精虚气竭导致的，也属于不内外因，应当以补虚内托为主，也忌用五香药物，以免耗损真阴而助长邪热。治疗的药物，如内固黄柏汤、神效托里散之类。经书说：‘五脏菀热，痈发六腑。’又说：‘六腑不和，留结为痈。’又说：‘诸痛痒疮，皆属于心。’肺乘肝则为痈，肾移寒于肝，痈肿少气，脾移寒于肝，痈肿筋挛。这些都是脏腑的变化，也属于内因。”
东垣说：“《生气通天论》说：‘营气不从，逆于肉理，乃生痈肿。’又说：‘膏粱之变，足生大疔，受如持虚。’《阴阳应象论》说：‘地之湿气，感则害人皮肉筋脉。’这是说湿气外伤则营气不行。营卫，都是营气所经营的，营气就是胃气，也就是运气。营气为本，本逆不行，被湿气破坏而形成疮疡。膏粱之变也是如此，是说浓滋味过度，而使营气逆行，凝于经络形成疮疡。这种邪气不在表也不在里，只在经络的中道发病。以上《内经》所说，都说是因营气逆乱而作的。遍看诸疮疡论中，多言二热相搏，热化为脓的。有的只言热化为脓，有的言湿气生疮，寒化为热而为脓，这都是疮疽的源头。应当在所见部位，使用引经药；并兼见证候中，分辨阴证阳证，先泻营气是其根本，本逆助火，湿热相合，败坏肌肉而为脓血，这比治疗次要。宜远取诸物来比喻，一年之中，大热没有超过夏天的，当时各种事物都不坏烂，坏烂的是交秋湿气大行之时。近取诸身，热病在身，只显热而不败坏肌肉，此理明显。标本不得，邪气不服，言一而知百者，可以称为上工（高明的医生）矣。”
According to the "Rites of Zhou" (Zhou Li), under the Minister of State (Tian Guan Zai Zai), physicians have long been divided into Ji Yi (Internal Medicine Physicians) and Yang Yi (Surgical Physicians). There were eight Zhong Shi (Middle-grade Scholars) for Internal Medicine and eight Xia Shi (Lower-grade Scholars) for Surgery. The emphasis on internal medicine over surgery has existed since ancient times; however, one cannot effectively treat external diseases without mastering internal medicine. If a patient cannot be saved by an Internal Medicine Physician, their parents' remains can still be preserved and buried intact. In contrast, Surgical Physicians often fail in this regard, leading to rotting bones and muscles, exposing viscera before death. Therefore, among all diseases, surgical sores are the most tragic, yet they are disregarded by the world. Why is this? Among contemporary Surgical Physicians, those who understand meridians, are proficient in prescriptions, do not crave profit, and solely focus on saving lives are fewer than one in a thousand or ten thousand. Their disregard is justified, but does this not also reflect their own disregard for life?
Since childhood, I studied Qi Huang's arts (Traditional Chinese Medicine). In my early twenties, I treated my sister's Ru Yong (Acute Mastitis) and Yu Weng's Fu Gu Ju (Deep Abscess), restoring flesh to bone and achieving remarkable recoveries. These experiences were not inherited from a master; I believed surgery was relatively straightforward. I sought intelligent and ambitious individuals to guide me in becoming a true Surgical Physician, but found none. Thus, I collected the formulas and theories of famous physicians from previous generations, integrated them with my unique insights, and compiled this book. Compared to specialized books circulating in the world that depict human figures, print prescriptions, and boast of secret transmissions, this work differs by tens of thousands of times. By studying it thoroughly and understanding it profoundly, one could achieve fame in the world.
After returning to my hometown due to convenient official duties, I was entitled to receive my salary according to regulations. Accepting it made me uneasy, while refusing it seemed eccentric. Therefore, I entrusted the manuscript to printers. After the deadline passed, the work was completed, and books covering various specialties and symptom-based treatments were roughly prepared. Who allowed me to draw a salary in court while leisurely editing and publishing this work? Is this not a gift from the Sage Emperor?
Written at She Lan Xuan in Jintan during the Qixi Festival of the year Wushen (1608), amidst light rain and cool weather, by Wang Kentang.
The origins of Yong Ju (general term for superficial suppurative infections) are fivefold: 1. Abnormal seasonal climates (Tian Xing Shi Qi); 2. Internal stagnation of the Seven Emotions (Qi Qing); 3. External pathogenic invasion due to physical weakness; 4. Conflict between body heat and wind-cold; 5. Heat toxins from consuming roasted/fried foods, strong alcohol, or cinnabar/stone elixirs. In summary, these fall within the scope of the Three Causes (Nei Yin, Wai Yin, Bu Nei Wai Yin).
Regarding external causes, there are four types of Yong Ju related to Yun Qi (Five Movements and Six Qi):
First, Fire-Heat assisting the Heart leads to sores. Classics state: "When Shao Yin prevails, ulcers and rashes appear." Also: "When Shao Yin governs the year, heat descends, Lung Qi rises, and severe cases result in sores." Also: "During Shao Yin's governance, in the first Qi period, cold begins, Yang Qi is stagnant, summer heat approaches, causing internal and external sores." Also: "When Shao Yang prevails, sores appear." Also: "During Shao Yang's governance, wind-heat spreads, Tai Yin dampness flows horizontally, cold arrives, people suffer from cold in the middle, manifesting externally as sores. In the first Qi period, the climate is warm, causing sores in the skin and interstices. In the second Qi period, fire is suppressed, causing heat stagnation above and sores in the middle. In the third Qi period, summer heat arrives, causing pustules." Also: "During Tai Yang's governance, in the first Qi period, the climate is very warm, causing sores in the skin and interstices. These are normal transformations, representing mild disease." Also: "When Shao Yin governs, excessive heat causes severe sores." Also: "When Shao Yin governs, if guest Qi wins, severe sores occur." Also: "In Shao Yin's return disease, symptoms include aphasia, paralysis, rashes, carbuncles, furuncles, acne, and hemorrhoids." Also: "Excessive fire is called He Xi, causing bleeding from sores." Also: "When fire is stagnant and erupts, people suffer from sores and swelling. This represents severe pathological changes."
Second, Cold Evil injuring the Heart causes sores. Classics state: "During Tai Yang's governance, in the third Qi period, cold qi moves, people suffer from cold, developing internal heat, carbuncles, and diarrhea." Also: "When Tai Yang governs, excessive cold alters blood internally, causing sores, rooted in the Heart." Also: "During Tai Yang's governance, in the fourth Qi period, cold rain falls, causing sores and swelling."
Third, Dryness Evil injuring the Liver causes sores. Classics state: "When Wood is deficient, it is called Wei He, resembling Metal Qi. Symptoms include limb lesions, carbuncles, and sores, caused by evil injuring the Liver." Also: "When Tai Yang governs, excessive dryness causes sores, acne, and carbuncles, rooted in the Liver."
Fourth, Dampness Evil causes sores. Classics state: "When Tai Yin governs, dampness affects objects, severely causing back sores." Also: "When Tai Yin wins, fire stagnates internally, causing internal sores that spread externally. These four points constitute 'Tian Xing Shi Qi'."
In *Su Wen: Mai Yao Jing Wei Lun*, the Yellow Emperor asked: "How do various swellings, tendon spasms, and bone pain arise?" Qi Bo replied: "These are swellings caused by cold and variations of the Eight Winds." The Emperor asked: "How to treat?" Qi Bo replied: "These are seasonal diseases; treating them with opposing elements brings recovery."
*Ling Shu: Yong Ju Pian* states: "Blood vessels, Ying, and Wei circulate continuously, corresponding to stars above and meridians below. When cold evil lodges in meridians, blood becomes sluggish and obstructed. Wei Qi gathers there and cannot return, causing swelling. Cold transforms into heat; excessive heat rots flesh, turning it into pus. If pus is not drained, tendons rot, damaging bones. Bone damage depletes marrow. If not excreted through bone openings, blood becomes empty, failing to nourish tendons, bones, and muscles. Meridians leak, fuming into the Five Viscera, leading to death."
*Sheng Qi Tong Tian Lun* states: "Sweating from labor exposed to wind causes cold to press in, forming acne-like lesions when stagnant. If Yang Qi's opening and closing functions fail, cold enters, causing severe curvature. If Ying Qi does not flow smoothly and reverses in muscle tissue, swelling occurs." This explains how cold evil enters through sweat pores or faulty Yang Qi regulation, lingering to cause swelling. This corresponds to "external invasion due to weakness" and "heat conflicting with wind-cold." Treatments include Shi Xuan San, Wu Xiang Tang from *Jing Yao*, and Cang Zhu Fu Jian San by Jie Gu (Zhang Yuansu), which are exterior-releasing agents.
Regarding internal causes, Chen Wuyue stated: "Yong Ju and Luo Li (scrofula), regardless of deficiency/excess or cold/heat, are formed by Qi stagnation." Classics say: "Qi stagnates in meridians, moving sluggishly with blood, obstructing and forming Yong Ju." This implies formation due to emotional stagnation (joy, anger, worry, thought) rather than just heat. Treatments use Yuan Zhi Jiu and Du Sheng San, applying the theory of the Five Emotions overcoming each other (e.g., anger overcoming thought).
Regarding non-internal/non-external causes, classics mention "changes from rich food causing large Ding," akin to replacing contents in an empty vessel. Eastern regions, rich in fish and salt, have people who eat fish and salty foods. Fish generates internal heat; salt damages blood. Thus, people have dark skin and loose pores, prone to Yong Ju. Consumption of elixirs and strong alcohol also falls into this category. Li Dongyuan stated: "Rich food changes involve excessive flavors, causing Ying Qi to reverse in muscle tissue. Ying Qi is Stomach Qi. Food enters the stomach, goes to the Spleen, then to the Lungs, which govern all vessels, extending to skin/hair, intestines, and finally the Viscera, forming the pulse at the Qi Kou. Wealthy people lack moderation, consuming strong alcohol, fatty mutton, and heavy flavors. These dense, yang substances should enter orifices and follow Yang pathways but instead enter Yin pathways, causing excessive dampness. The child enriches the mother, making fire vigorous. Excessive heat-dampness attacks the Kidney. If sexual activity is not regulated, True Water is damaged. Lack of water allows dampness to rise, causing sores on the back and head, known as severe Da Ding. Sores appearing in Lung/Stomach areas are less toxic; others are even less so. Wherever heat-damp toxin stops, ulceration occurs. Hence, 'rich food changes cause large Ding.' Combined with 'holding emptiness' (weakness), treatment must drain Ying Qi. From a root-branch perspective, the initial pathology is the root. Bitter-cold herbs must be primary to relieve pain. Examples include Dongyuan treating Yuan Haowen and Danxi treating an old woman's brain carbuncle, both using San Huang and Da Huang processed with wine, or Pai Nong San and Dang Gui San. Exhaustion from sexual activity causing essence/Qi deficiency also belongs here; treatment should tonify deficiency and support interior expulsion, avoiding Wu Xiang herbs that consume True Yin and aid evil heat. Medications include Nei Gu Huang Bai Tang and Shen Xiao Tuo Li San. Classics state: 'Stagnant heat in Five Viscera causes sores in Six Bowels.' 'Six Bowels disharmony leads to accumulation and sores.' 'All pain, itching, and sores belong to the Heart.' Lung overcoming Liver causes sores; Kidney transferring cold to Liver causes swelling and shortness of breath; Spleen transferring cold to Liver causes swelling and tendon spasms. These are visceral changes, belonging to internal causes."
Dongyuan cited *Sheng Qi Tong Tian Lun*: "Ying Qi reversal in muscle tissue causes swelling." And *Gao Liang Zhi Bian*: "Rich food causes large Ding, entering easily like an empty vessel." And *Yin Yang Ying Xiang Lun*: "Earth's dampness harms skin, flesh, tendons, and vessels." This indicates external dampness obstructs Ying Qi. Ying and Wei are managed by Ying Qi, which is Stomach Qi and Luck Qi. Ying Qi is the root; if the root reverses and is damaged by dampness, sores form. Rich food similarly causes Ying Qi reversal and stagnation in meridians. This pathogen is neither in the exterior nor interior, but in the mid-way of meridians. All *Nei Jing* passages attribute this to Ying Qi reversal. Most discussions on sores mention two heats clashing, turning into pus. Some mention only heat turning to pus; others mention dampness generating sores, cold transforming to heat to form pus. These are sources of sores. One should use channel-guiding herbs for affected areas, differentiate Yin/Yang syndromes, and prioritize draining Ying Qi as the root. Root reversal aids fire; heat-dampness combines to rot flesh into pus-blood, which is secondary. Analogy: Summer is hottest, yet things do not rot; rotting occurs in autumn when dampness dominates. On the body, fever shows heat but does not rot flesh. Clear understanding of root and branch subdues evil. Knowing one thing to understand a hundred qualifies one as a Superior Physician (Shang Gong).