外科冠痈疽于杂病之先者，变故生于顷刻，性命悬于毫发故也。夫痈疽之名，虽有二十
余证
，而其要有二。何则？阴阳二证而已。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，外盛而内腐。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。阴变而阳者，其证少，不复能为阳矣，故多死。然间有
生者，此医偶合于法，百中得一耳。所谓发者，积于中而发于外也。大抵人之一身，皆本于
五脏；五脏之气，皆禀于胃气。胃为五脏之根本，故胃受谷，脾化之以生气。脾生肌肉，胃
气传五脏而行血脉，以经络一身，而昼夜一周。虽痈疽有虚实寒热，皆由气郁而成。其因有
三∶内因，外因，不内外因。内因候于人迎。人迎者，左手关前一分也。外因候于气口，气
口者，右手关前一分也。人迎气口之脉和平，则为不内外因也。其原有五∶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。以此五者为
邪气郁于胃中，胃气盛而体实，则邪气相搏而流注于经络，涩于所滞，血脉会聚，壅结而成
痈。胃气弱而体虚，则邪气盛而宿于经络，凝涩流积，血脉不潮，内腐而成疽。故曰∶外形
如粟，中可容谷；外貌如钱，里可着拳；恶毒脓管，寸长深满；脓血交粘，用药可痊；臭秽
无丝，血败气衰；阳绝阴盛，神仙难医。医之用药，当量人虚实，察病冷热，推其所因，究
其所原，而后治之，使内外相应，不可一概而论。如病发于阳而极热，则当有顺其气，匀其
血。气顺则阳气宣通而不滞，血匀则血脉流动而自散。盖气为阳，血为阴，阴阳调和，病者
自安。外则用凉药而蠲之，热盛则血得凉而易散，不散，则热已痿而血凝于凉。此阳变为阴
之
渐，乃坏烂之根也。急归温凉以治之，解其外攻四围之血路，出其中间已成之脓毒，然后根据
法以收其功也。如病发于阴而极冷，则内用平补之药，以宣其气，滋其血，助其元阳，从其
脾胃，待其饮食进，精神回，然后顺气匀血如常法。外因热药，以潮会一身之气血，回死肌
，拔毒瓦斯，然后用温药以散之。其极冷者，而又为凉药所误者，不得已于三建而回阳，则病
必不出，再作，方为佳。此阴变为阳之候，更生之兆也。若内阳不回，外证不见，是为独阳
绝阴，不可为矣。盖阳者气也，阴者血也；阳动则阴随，气运则血行；气不运而血死，血死
则肌死，肌死则病死矣。冷证则用热药者，不过行其气血也。盖血气遇热则行，遇凉则止也
。虽然，冷热之药用之固妙，尤当先乳香、豆粉救其心，护其膜。盖心为一身之主宰，膜为
五脏之囊橐。病之初发，毒必上攻心胞络，故先呕逆而后痈疽，或先痈疽而后呕逆者，胞络
根于心也。苟治之不早，则心主受毒。神无所舍，元气昏瞑矣。病之初发，毒必旁腑肌肉，
苟治之不早，则毒瓦斯透膜。膜透则元气泄，脏腑失养，精神枯槁，脉坏绝矣。故病至盛而生者
，内见五脏而膜完全者也。亦有至微而死者，肌肉未溃，而膜先透者也，此救心护膜所以为
第一义欤。是方乃遇神仙秘授神圣工巧，不可具述，非寻常草医，一草一木、一针一刀之比
，得其要者，宝之宝之。
外科疾病将痈疽列于杂病之首，是因为病情变化发生在顷刻之间，性命悬于毫发之末。痈疽的名称，虽然有一二十种证候，但其要点主要有两个。为什么呢？不过是阴证和阳证罢了。发于阳分的，称为痈、属于热证、属于实证；发于阴分的，称为疽、属于冷证、属于虚证。所以阳证发作时，皮肤薄、颜色红、肿胀高起，多有几十个像花椒眼一样的小孔且疼痛。阴证发作时，皮肤厚、颜色淡、肿胀坚硬，形状像牛的颈部皮肤且不痛。又有“阳中之阴”，看似热却不是热，虽然肿胀但实际上是虚证，颜色红但不燥烈，想要化脓却无脓，既浮起又消退，外表盛实而内部腐败。“阴中之阳”，看似冷却不是冷，不肿胀但实质充实，颜色微红且干燥，有脓且疼痛，外表虽不盛实，但内部烦闷。阳中之阴的人，身体多肥胖，肌肉紧绷但内部虚弱。阴中之阳的人，身体多消瘦，肌肉松弛但内部充实。还有阳证转变为阴证的，这是草医使用凉药过度的过错。阴证转变为阳证的，是大方使用热药过于急骤的结果。然而阳转阴的，证候较多，还可以回复到阳证，所以大多能生还。阴转阳的，证候较少，不能再转为阳证了，所以大多死亡。然而间或有存活的，这是医生偶然合乎法度，百中得一罢了。所谓“发”，就是邪气积聚在体内而表现在外部。大抵人的全身，都本源于五脏；五脏的气，都禀受于胃气。胃是五脏的根本，所以胃受纳谷物，脾将其运化以产生气。脾生成肌肉，胃气传送给五脏并运行血脉，贯通经络遍布全身，昼夜循环一周。虽然痈疽有虚实寒热之分，都是由气机郁滞而成。其病因有三：内因、外因、不内外因。内因通过人迎脉来诊察。人迎脉，位于左手关前一分处。外因通过气口脉来诊察。气口脉，位于右手关前一分处。人迎和气口的脉搏平和，则属于不内外因。其根源有五种：一是天行时气（流行性疫病）；二是七情内郁（情绪抑郁）；三是体虚外感；四是身热与风冷相搏；五是食用烤爆食物、饮用烈酒、服用丹石等热毒之物。因为这五种原因导致邪气郁结在胃中，如果胃气旺盛且体质强壮，则邪气相互搏结并流注于经络，涩滞在停滞之处，血脉汇聚，壅塞结聚而成痈。如果胃气虚弱且体质亏虚，则邪气强盛而留宿于经络，凝涩积聚，血脉不通畅，内部腐败而成疽。所以说：外形如粟米大小，中间可容纳谷粒；外貌如铜钱大小，里面可容纳拳头；恶毒脓管，一寸长深满；脓血交粘，用药可以痊愈；臭秽无丝，血败气衰；阳绝阴盛，神仙也难医治。医生用药，应当衡量病人的虚实，观察疾病的冷热，推究其成因，探究其根源，然后进行治疗，使内外相应，不可一概而论。如果病发于阳分且极热，则应当顺其气机，调和其血液。气顺则阳气宣通而不滞涩，血匀则血脉流动而自然消散。因为气属阳，血属阴，阴阳调和，病人自然安康。外部则用凉药来清除它，热盛则血液遇凉容易消散，如果不消散，则热已衰退而血液凝结在凉药之中。这是阳证转变为阴证的开始，乃溃烂坏死的根源。急忙回归温凉之法来治疗，解除外部攻向四周的血路，排出中间已成形的脓毒，然后根据法度来收功。如果病发于阴分且极冷，则内部使用平补的药物，以宣通气机，滋养血液，助益元阳，顺应脾胃，等待饮食进益，精神恢复，然后像常规方法一样顺气匀血。外部因势利导使用热药，以潮润会聚一身的气血，唤醒死肌，拔除毒瓦斯，然后用温药来消散它。对于极冷且又被凉药误治的情况，不得已使用三建汤来回阳，则病必不能外出，再次发作，这才是佳境。这是阴证转变为阳证的征候，是再生的兆头。如果内部阳气不回，外部证候不见，这是独阳绝阴，就无法救治了。因为阳就是气，阴就是血；阳动则阴随之而动，气运行则血随之而行；气不运行则血死，血死则肌肉死，肌肉死则病人死亡。冷证使用热药，不过是为了运行气血。因为血气遇热则运行，遇凉则停止。虽然冷热药物的使用固然精妙，尤其应当先用乳香、豆粉来救心、护膜。因为心是一身的君主，膜是五脏的外囊。疾病初发时，毒气必定上攻心包络，所以先呕吐逆乱而后出现痈疽，或者先出现痈疽而后呕吐逆乱的，因为心包络根源于心。如果治疗不早，则心主受毒。神无所依附，元气昏昧了。疾病初发时，毒气必定旁及脏腑肌肉，如果治疗不早，则毒瓦斯透入膜中。膜透则元气泄散，脏腑失去滋养，精神枯槁，脉象败绝。所以病势盛大而存活者，是内部五脏完好且膜未破损的病人。也有病势微小而死亡者，是肌肉尚未溃破，而膜先透破的病人，这就是救心护膜被视为第一要义的原因吧。这个方子是遇到神仙秘密传授的神圣工巧之法，无法详尽叙述，不是寻常草医，一草一木、一针一刀所能比拟的，得到其中要领的人，务必珍重珍重。
The reason why external medicine places carbuncles and sores (Yongju, 痈疽) before miscellaneous diseases is that changes occur in an instant, and life hangs by a hair. Although there are more than twenty types of carbuncle and sore syndromes, their key points are mainly two. Why? They are merely the Yin syndrome (Yin Zheng, 阴证) and Yang syndrome (Yang Zheng, 阳证). Those arising from Yang are called carbuncles (Yong, 痈), belong to heat syndromes (Re Zheng, 热证), and are excess syndromes (Shi Zheng, 实证); those arising from Yin are called sores (Ju, 疽), belong to cold syndromes (Leng Zheng, 冷证), and are deficiency syndromes (Xu Zheng, 虚证). Therefore, when a Yang lesion erupts, the skin is thin, red, and swollen high, often with dozens of pores like pepper eyes, accompanied by pain. When a Yin lesion erupts, the skin is thick, pale, and swollen hard, resembling the skin of an ox's neck, without pain. There is also "Yin within Yang," which appears hot but is not truly hot; although swollen, it is essentially deficient; though red, it is not dry; wanting to suppurate but lacking pus; rising then subsiding; appearing exteriorly full but interiorly rotting. There is "Yang within Yin," which appears cold but is not truly cold; not swollen but essentially solid; slightly red and dry; having pus and pain; appearing exteriorly not full but interiorly vexed and stifled. Patients with Yin within Yang tend to be obese, with tight flesh but internal deficiency. Patients with Yang within Yin tend to be emaciated, with loose flesh but internal solidity. Furthermore, Yang transforming into Yin is due to the overuse of cooling remedies by unskilled practitioners. Yin transforming into Yang is due to the sudden and excessive use of heating prescriptions by physicians. However, when Yang transforms into Yin, the symptoms are numerous, yet it can still revert to Yang, so survival is common. When Yin transforms into Yang, the symptoms are few, and it cannot revert to Yang, so death is common. Occasionally, survival occurs only when the physician accidentally adheres to proper methods, one in a hundred. The term "eruption" (Fa, 发) refers to pathogens accumulating internally and manifesting externally. Generally, the whole body originates from the Five Viscera (Wuzang, 五脏); the Qi of the Five Viscera is derived from Stomach Qi (Weiqi, 胃气). The Stomach is the root of the Five Viscera; thus, the Stomach receives grain, and the Spleen transforms it to generate Qi. The Spleen generates muscle tissue, while Stomach Qi transmits to the Five Viscera to circulate Blood (Xue, 血) through the meridians (Jingluo, 经络) throughout the body, completing a cycle day and night. Although carbuncles and sores vary in deficiency/excess and cold/heat, they all result from Qi stagnation (Qi Yu, 气郁). The causes are three: Internal causes (Nei Yin, 内因), External causes (Wai Yin, 外因), and Non-internal/External causes (Bu Nei Wai Yin, 不内外因). Internal causes are diagnosed via the Renying pulse (Renying Mai, 人迎脉). Renying is located one fen anterior to the Guan position on the left hand. External causes are diagnosed via the Qikou pulse (Qikou Mai, 气口脉). Qikou is located one fen anterior to the Guan position on the right hand. If both Renying and Qikou pulses are harmonious, it belongs to non-internal/external causes. The origins are five: First, epidemic pathogenic factors (Tianxing Shiqi, 天行时气); Second, emotional depression (Qingzhi Neiyu, 七情内郁); Third, constitutional weakness with external contraction; Fourth, body heat clashing with wind-cold; Fifth, consuming roasted/fried foods, drinking strong alcohol, or taking cinnabar/stone elixirs containing heat toxins. These five factors cause pathogens to stagnate in the Stomach. If Stomach Qi is strong and the constitution robust, pathogens clash and flow into the meridians, stagnating where blocked, causing blood vessels to converge, obstruct, and knot into carbuncles. If Stomach Qi is weak and the constitution deficient, pathogens prevail and lodge in the meridians, condensing and stagnating, preventing blood flow, leading to internal rotting and forming sores. Thus it is said: Exteriorly small as millet seeds, interiorly capable of holding grain; exteriorly small as coins, interiorly capable of holding fists; malignant pus tubes, an inch long and deep; pus and blood sticky, curable with medication; foul-smelling without silk threads, blood ruined and Qi exhausted; Yang exhausted, Yin prevailing, even immortals find it hard to treat. Physicians must assess patient deficiency/excess, observe disease cold/heat, deduce causes, investigate origins, and then treat, ensuring internal and external correspondence, avoiding generalizations. If a disease arises from Yang and is extremely hot, one should regulate Qi and harmonize Blood. Regulated Qi allows Yang Qi to circulate freely without stagnation; harmonized Blood ensures smooth vessel flow and natural dispersion. Since Qi is Yang and Blood is Yin, harmony between Yin and Yang brings peace to the patient. Externally, cooling medicines should be used to clear it. If heat is severe, blood disperses easily upon cooling; if it does not disperse, heat has waned while blood coagulates in the cold. This is the gradual transformation of Yang into Yin, the root of necrosis. Urgently return to warm-cool methods to treat it, resolve the blood pathways attacking the periphery, expel the formed pus and toxins from the center, and then follow protocol to achieve results. If a disease arises from Yin and is extremely cold, internally use balanced tonifying medicines to promote Qi circulation, nourish Blood, assist Yuan Yang (Yuan Yang, 元阳), support the Spleen and Stomach, wait for appetite to improve and spirit to recover, then regulate Qi and harmonize Blood as usual. Externally, utilize heating medicines to gather and circulate Qi and Blood throughout the body, revive dead muscle, extract toxic vapors, and then use warm medicines to dissipate it. For extreme cold cases mistakenly treated with cooling medicines, resorting to Sanjian Tang (Sanjian Wan, 三建丸) to restore Yang is necessary; if the disease does not exit, relapse may occur, which is considered favorable. This is the sign of Yin transforming into Yang, a兆 of regeneration. If internal Yang does not return and external signs do not appear, this is isolated Yang exhaustion and Yin severance, untreatable. Yang is Qi, Yin is Blood; Yang movement follows Yin, Qi transport drives Blood flow; if Qi fails to move, Blood dies; if Blood dies, Muscle dies; if Muscle dies, the Patient dies. Cold syndromes use heating medicines merely to move Qi and Blood. Qi and Blood move with heat and stop with cold. Although the use of cold/hot medicines is subtle, one must first use Ru Xiang (Frankincense, *Boswelliae Resina*) and Dou Fen (Bean Powder, *Fabae Semen Pulvis*) to save the Heart (Xin, 心) and protect the Membranes (Mo, 膜). The Heart is the sovereign of the body; membranes are the sacs of the Five Viscera. At onset, toxins attack the Pericardium Collateral (Baoluo, 包络); thus, vomiting precedes carbuncles, or carbuncles precede vomiting, because the Pericardium roots in the Heart. If treatment is delayed, the Heart Sovereign absorbs toxins, Spirit has no abode, and Yuan Qi becomes dim. At onset, toxins affect adjacent viscera and muscles; if treatment is delayed, toxic vapors penetrate the membranes. Penetrated membranes leak Yuan Qi, viscera lose nourishment, spirit withers, and pulses fail. Therefore, patients surviving severe illness have intact Five Viscera and membranes. Those dying from minor illnesses have penetrated membranes before muscle ulceration. This is why saving the Heart and protecting membranes is the primary principle. This prescription was secretly transmitted by immortals, embodying divine skill, incomparable to ordinary herbalists using single herbs or needles/knives. Those who grasp its essence, treasure it greatly.