诸痛痒疮疡。皆属心火。则疮疡之疾。非外得也。而昔人列之为外科者。以形症在外。
非若
之乎。疮疡之中。痈疽为甚。而大疔之毒。尤甚于痈疽。故治大疔者。十活其一二。治疽者
。十活其五六。治痈者。十活其八九。惟毒有浅深。故治有难易耳。然何以辨其痈疽大疔哉
。亦视其肿之高下。地之广狭。脉之浮沉而已。盖痈者。壅之义也。气血为毒所壅瘀而不行
。故发而为痈。其初发之时。必洒淅恶寒。而身微热。多生于背与顶。在背之上部。或左或
右。为上搭手。在背之下部。或为正发。生于脑后者。为对口。比之上下搭手。尤为毒也。
凡痈皆掀然热而肿高。其势易大。其根不甚深。从乎阳也。疽者沮之义也。气血为毒所阻滞
而不行。故发而为疽。其初发之时。亦洒淅恶寒。先觉麻痒如 之状。按之内实。手推不
能动。多发于背腰肩隅之间。及小腹胸傍。其发股足之间者。名附骨疽。凡疽皆肿不甚高。
势不易大。而其根反深。惟发于背心及股者。为至重。乃五脏所发。从乎阴也。疔者。丁之
似也犹钉之在木。拔之不能出。摇之不能动。其根至深。其毒至甚。其头至硬。其初发之时
。反不知痛痒。但不觉麻木。外虽如麻。里则如瓜。及其势甚。则痛苦异常。应心入胆。而
不可忍乃五脏六腑所发之火。 炼已久。并合于一处。而生疔者。多见于面部骨节之间。而
究其毒之所从来。多由于饮食服饵之中。经曰。膏粱之变。足生大疔。凡肥甘浓味。炙爆煎
熬之物。最能助火。嗜味之人。恣供口腹。醉之以酒。劳之以色。脾土于是乎燥烈。肾水于
是乎枯竭。积之既久。留于五脏。布于六腑。火郁而不散。乘其气血所虚之处。而发之根
抵于内。而烦炽于外。其毒甚于鸠鸟。试割其肉。以饲鸡犬。立见其毙。此大疔之所以多死
也。若夫似疔而非疔者。则俱以肿毒治之。而无大害。然三者之脉。何以辨之。盖浮而数者
毒瓦斯在表。故知其为痈。沉而数者。毒瓦斯在里。故知其为疽。若沉而又滑。数而弦急者。必
疔也。此皆有形之可见者。虽其治有难易。犹可因其症而施之。至于肠痈。腹痈。肺痈之类
。皆为内痈。其状与 瘕痞癖无异。苟或以为内科之症。而进以削坚破结之剂。所治非其所
忍。几何而不殒人之命也。大法疮疡之在外者。初发无如一灸。艾烟一透。其毒立效。若延
至六七日。则不可灸矣。毒之浅者点之。毒之深者决之。毒之尤深而针
刀所不及者。则烙之。未成毒脓。则用化毒。既成脓。则用托里。此外在人之临症机变矣。
各种疼痛、瘙痒及疮疡，都归属于心火。因此，疮疡这类疾病并非由外感邪气直接引起。过去的人将其列为外科病症，是因为其形态和症状表现在体表，不像内科病证那样深藏于内。在疮疡之中，痈和疽最为严重，而大疔的毒性尤其比痈疽更甚。所以，治疗大疔的患者，十人中能救活一两个；治疗疽的患者，十人能救活五六个；治疗痈的患者，十人能救活八九个。这仅仅是因为毒邪有浅深之分，所以治疗难度有难易之别。然而，如何辨别痈、疽和大疔呢？只需观察肿势的高低、病变范围的大小以及脉象的浮沉即可。
所谓“痈”，是壅塞的意思。气血被毒邪壅滞瘀阻而不能运行，从而发为痈。在初发时，必然会有怕冷（洒淅恶寒）且身体微热的症状。痈多生于背部和头顶。生在背上部，或在左或在右的，称为“上搭手”；生在背下部的，有的称为“正发”；生在脑后的，称为“对口”。这些相比上下搭手，毒性更为严重。凡是痈，都会红肿发热且肿势高突，病情容易扩散变大，但根基不深，属于阳证。
所谓“疽”，是阻滞的意思。气血被毒邪阻滞而不能运行，从而发为疽。在初发时，也会有怕冷的感觉，先感到麻木瘙痒，像蚂蚁爬行的样子。按压时感觉内部坚实，用手推不动。疽多发于背腰肩臀之间，以及小腹和胸侧。发于大腿和脚之间的，名叫“附骨疽”。凡是疽，肿势不高，病情不易迅速扩大，但根基反而很深。只有发于背心和大腿部位的，最为严重，这是五脏发出的毒，属于阴证。
所谓“疔”，形状像“丁”字，犹如钉子钉在木头里，拔不出来，摇动不了。它的根基极深，毒性极烈，顶部极硬。初发时，反而不知道痛痒，只觉得麻木。外表虽然看起来像普通的麻子，内部却像瓜一样空虚或坚硬（注：此处原文意象较晦涩，通常指根深蒂固或内里变化）。等到病情严重时，痛苦异常，令人心惊胆战，难以忍受。这是五脏六腑所生的火毒，经过长时间的煎熬，汇聚在一处而生成的疔。疔多见于面部和骨节之间。追究其毒邪的来源，多由于饮食和服药不当。《内经》说：“膏粱之变，足生大疔。”凡是肥甘厚味、烧烤煎炸的食物，最能助长火邪。喜好美味的人，放纵口腹之欲，饮酒无度，房劳过度，导致脾土燥热，肾水枯竭。积久之后，毒邪留于五脏，布散于六腑，火郁结而不散，趁着气血虚弱的地方发作。根源在内，烦躁炽盛于外。其毒性比鸠鸟之毒还厉害，如果割下它的肉来喂鸡狗，鸡狗会立即死亡。这就是大疔致死率高的原因。至于那些像疔但不是疔的，都可以按照一般的肿毒来治疗，不会有太大危害。
那么，这三者的脉象如何辨别呢？脉象浮而数的，说明毒邪在表，所以知道是痈；脉象沉而数的，说明毒邪在里，所以知道是疽；如果脉象沉而又滑，数而且弦急的，一定是疔。这些都是有形可见的症状，虽然治疗有难易之分，还可以根据症状施治。至于肠痈、腹痈、肺痈等，都属于内痈。它们的症状与癥瘕痞癖没有区别。如果误认为是内科病症，而使用削坚破结的药物，所治非其所宜，不久就会危及生命。
治疗外部疮疡的大法，初发时不如用艾灸。艾烟透入，毒邪立刻见效。如果拖延到六七天，就不可以灸了。毒邪浅的用点法（如药物点涂），毒邪深的用刀针决破排脓，毒邪特别深且针刀无法达到的，就用烙法。毒脓未形成时，用化毒的方法；已经成脓时，用托里透脓的方法。这是医生临症时的随机应变之法。
Various pains, itching, and sores/ulcers (chuang yang) all belong to Heart Fire. Therefore, diseases of sores and ulcers are not caused by external pathogens directly. In the past, people classified them as surgical conditions because their morphology and symptoms manifest on the exterior, unlike internal medicine conditions which are hidden within. Among sores and ulcers, carbuncles (yong) and gangrenous sores (ju) are the most severe, while the toxicity of large ding-sores (ding) is even more severe than that of carbuncles and gangrenous sores. Thus, when treating large ding-sores, only one or two out of ten survive; when treating gangrenous sores, five or six out of ten survive; and when treating carbuncles, eight or nine out of ten survive. This is merely due to the depth of toxicity, which determines the difficulty of treatment. However, how can one distinguish between carbuncles, gangrenous sores, and large ding-sores? One should only observe the height of swelling, the extent of the lesion, and the floating or sunken nature of the pulse.
The term "carbuncle" (yong) implies obstruction. Qi and Blood are obstructed and stasis-forming due to toxicity, failing to circulate, thus manifesting as a carbuncle. At the initial stage, there must be aversion to cold (saxi ehan) and slight fever. Carbuncles often occur on the back and crown. Those occurring on the upper back, either on the left or right, are called "Upper Hand-Clasping" (Shang Dashou); those on the lower back are sometimes called "Central Eruption" (Zheng Fa); those occurring at the back of the head are called "Opposite Mouth" (Dui Kou). Compared to the Upper Hand-Clasping, these have greater toxicity. Generally, carbuncles present with redness, heat, and high swelling, tend to expand rapidly, but have shallow roots, belonging to Yang syndromes.
The term "gangrenous sore" (ju) implies blockage. Qi and Blood are blocked by toxicity and fail to circulate, thus manifesting as a gangrenous sore. At the initial stage, there is also aversion to cold, preceded by numbness and itching, resembling the sensation of ants crawling. Palpation reveals hardness inside, and it cannot be moved by pushing. Gangrenous sores frequently occur between the back, waist, shoulders, and buttocks, as well as in the lower abdomen and sides of the chest. Those occurring between the thighs and feet are named "Bone-Attaching Gangrene" (Fugu Ju). Generally, gangrenous sores do not swell highly, do not expand easily, but have deep roots. Only those occurring on the center of the back and thighs are extremely severe, originating from the Five Zang Organs, belonging to Yin syndromes.
The term "ding-sore" (ding) resembles the character "Ding" (a nail-like shape), like a nail driven into wood, impossible to pull out or shake loose. Its root is extremely deep, its toxicity extreme, and its head very hard. At the initial stage, there is no pain or itching, only numbness. Externally it may look like common skin eruptions, but internally it is profound. When the condition becomes severe, the pain is excruciating, causing heart palpitations and胆 fear, unbearable. This is fire-toxicity generated from the Five Zang and Six Fu Organs, simmered for a long time and converging in one place to form a ding-sore. Ding-sores are mostly seen between the facial bones and joints. Investigating the source of this toxicity, it often arises from improper diet and medication. The Classic states: "Changes from rich and greasy foods can produce large ding-sores." Foods that are fatty, sweet, strong-flavored, roasted, fried, or boiled can best assist fire. People who indulge in flavors, overeat, drink excessively, and engage in sexual excess cause the Spleen Earth to become dry and hot, and Kidney Water to become depleted. After accumulation over time, the toxin remains in the Five Zang Organs and spreads through the Six Fu Organs. Fire stagnates and does not disperse, taking advantage of areas where Qi and Blood are deficient to erupt. The root is internal, while agitation and blazing occur externally. Its toxicity is worse than that of poisonous birds; if its flesh were cut and fed to chickens or dogs, they would die immediately. This is why large ding-sores often result in death. As for conditions that resemble ding-sores but are not, they can all be treated as general toxic swellings without major harm.
How then to distinguish the pulses of these three? A pulse that is floating and rapid indicates toxicity in the exterior, thus identifying it as a carbuncle. A pulse that is sunken and rapid indicates toxicity in the interior, thus identifying it as a gangrenous sore. If the pulse is sunken and slippery, rapid and wiry-tight, it must be a ding-sore. These are visible manifestations. Although treatment varies in difficulty, one can still apply therapy based on symptoms. However, conditions such as intestinal carbuncle, abdominal carbuncle, and pulmonary carbuncle belong to internal carbuncles. Their presentation is indistinguishable from masses and accumulations (zheng jia pi pi). If mistakenly treated as internal medicine conditions using herbs that break hardness and dissipate nodules, the treatment will be inappropriate, and life will soon be lost.
The general principle for treating external sores and ulcers is that at the initial stage, moxibustion is preferable. Once the smoke of moxa penetrates, the toxicity is immediately effective. If delayed until the sixth or seventh day, moxibustion should not be used. For superficial toxicity, use puncturing methods (e.g., topical application); for deep toxicity, use incision to drain; for toxicity particularly deep beyond the reach of needles and knives, use cauterization. Before pus forms, use detoxification methods; after pus forms, use methods to support the interior and promote drainage. This represents the clinical adaptability of the physician.