溃疡者，以疮疡脓溃而言也。脓溃而肿消痛止者，为顺。若脓溃肿痛，或发寒热者，气血虚
也，用十全大补汤。脓溃欲呕少食，脾胃虚弱也，用六君、炮姜；手足并冷者，脾气虚寒也
，用六君、姜、桂，如不应，急加附子。脓溃而仍痛，或二便秘涩者，热毒未解也，用清热
消毒散。热退而渴不退，津液不足也，用八珍加黄 、麦门、山茱萸。热止而小便频数，肾
虚也，用加减八味丸料。若热不止，或肿痛反甚，虚热内作也，用人参黄 汤。或热退而肌
肉不生者，气血俱虚也，用十全大补汤。疮色夭白，或陷下不敛，寒气所袭也，用五味异功
散，佐以豆豉饼。脓血过多，烦躁不安，乃亡阳也，急用独参汤。尤当审其肿之软硬，饮食
冷热与脓之稀稠多少，肉之赤色微甚青黯，及疮口之收敛迟速，而投以托里消毒调补之剂，
庶无变症。《痈疽论》云∶溃疡内外皆虚，宜以托里补接为主。盖溃疡之变症，因由于肿疡
之际，治失其宜，亏损元气之所致。治者诚能谨之于始，则无后变之患矣。
胎毒发丹者，因胎毒内伏，或频浴热汤，或着烘衣，或乳母饮食七情，内热助邪为患，发于
头面四肢，延及胸腹，色赤游走不定。古人云∶从四肢起入腹囊者，皆不治。当急令人随患
处，遍吮毒血，各聚一处，砭出之，急服活命饮。惟百日内忌砭，以其肌肉难任也。若发散
过剂，表虚热而赤不退者，用补中益气汤加防风、白芷。寒凉过剂，胃气受伤，而热赤不退
者，用异功散加柴胡、升麻；或兼发搐等症，用四君、升麻、当归、钩藤钩，若复行攻毒，必致不起
。头额间患者，当卧镰砭之。
史少参孙二岁，丙申正月，阴囊赤肿，余作胎毒治瘥，后患发热痰盛等症，诊其母有郁火血
热，用解郁凉血之药，子母俱服而愈。至六月初患吐泻，两眼 动，或投参、术之类，不应
，以为慢惊，欲用附子药，请余议，视其寅卯关脉赤，此属风热伤脾，用柴胡清肝散加钩藤
钩、木贼草一剂即愈。丁酉正月初旬，颈患热毒，脓出贴药，忽暴风启户，实时发热，翌日
，头面黯肿如斗，两耳浓寸许，此风邪上攻，血得热而沸腾也，急砭两额，出黑血三盏许，
随用清热化毒汤，黯肿十退七八，翌日复砭，则血不甚黑矣，仍以前药去牛蒡子加熟地黄而
愈。此症若不行砭法，或作破伤风治，必死。
一小儿四肢患之，外势虽轻，内则大便秘结，此患在脏也。服大连翘饮，敷神效散而瘥。
一小儿患之赤晕走彻遍身，难以悉砭，令人吮四肢胸背数处，使毒血各凝聚而砭之，先用活
命饮，米酒调二服，又以金银花、甘草节为末，用人乳汁调服渐愈。月余后，两足皆肿，仍
砭之，服前药而痊。数日后，两足复赤，或用犀角解毒丸之类，致乳食不进，肚腹膨胀，此
复伤脾胃而然也，敷神功散，服补中益气汤加茯苓而痊。
一小儿腿如霞片，游走不定，先以麻油涂患处，砭出恶血，其毒即散，用九味解毒散而安。
一小儿臂患之，砭出毒血而愈。惑于人言，服护心散，以杜后患，服之吐泻腹胀，患处复赤
，手足并冷，余谓此脾胃虚弱，前药复伤，用六君子汤一剂顿愈，又以异功散加升麻、柴胡
而痊。
一小儿患此，砭之而愈，但作呕不食，流涎面黄，余谓此脾气虚弱，用异功散加升麻治之，
吐止食进；又用补中益气汤，涎收而安。
一小儿患此，砭之而愈，翌日发搐作呕，手足并冷，此胃气虚而肝木侮之，用异功散加藿香
、木香，诸症顿止，又用异功散加升麻、柴胡而痊。
一小儿患此，砭之而愈，但面赤作呕饮冷，余谓胃经热毒未解，先用仙方活命饮，又用清热
消毒散，各一剂而愈。
一小儿腿上患之，神思如故，乳食如常，余谓毒发于肌表，令急砭出毒血自愈。不信，外敷
寒凉，内服峻剂，腹胀不乳而死。
一小儿遍身皆赤，砭之，投以解毒药而愈。
一小儿患此，二便不利，阴囊肚腹俱胀，急用砭法，随以活命饮加漏芦、木通、大黄为末，
时用热酒调服至两许，二便俱通，诸症顿退，却去三味，仍前时服而愈。
一小儿患此，二便不利，腹胀咳嗽，用活命饮加漏芦、木通、麻黄为末，时时热酒调服，二
便随通，遍身出汗，诸症顿退，鼻息似绝，气无以动，时或似躁，此邪气去而元气虚也，急
用当归补血汤而愈。
砭法 治丹毒赤色，游走不定，令口吮毒血，各聚一处，用细瓷器击碎，取有锋芒者，以箸
头劈开夹之，用线缚定。两指轻撮箸头，稍令磁芒对聚血处，再用箸一根，频击刺出毒血，
轻者止用口吮出毒，用药敷之。如患在头者，不用砭法，止宜用针，卧倒挑患处，以出毒血
，迟则毒血入腹，而难起矣。
神功散 治丹毒最效。若砭后毒甚者宜用。如毒轻者，砭后不可用，恐砭后皮肤既破，草乌
能作痛也。
仙方活命饮（方见热毒疮疡）
清热化毒汤
清热消毒散（方见热毒口疮）
柴胡清肝散（方见胁痈）
补中益气汤（方见内钓）
小柴胡汤（方见痉症）
大连翘饮（方见臂痈）
柴芍参苓饮（方见天蛇毒）
九味解毒散（方见黄水粘疮）
溃疡，是指疮疡化脓破溃而言。脓液排出后肿胀消退、疼痛停止的，属于顺证。如果脓液排出后仍然肿痛，或者出现寒热症状的，是气血虚弱的表现，使用十全大补汤。脓溃后想要呕吐、食欲减少的，是脾胃虚弱，使用六君子汤加炮姜；如果手脚都发冷的，是脾气虚寒，使用六君子汤加干姜、肉桂，如果不见效，紧急加上附子。脓溃后仍然疼痛，或者大小便不通畅的，是热毒没有解除，使用清热消毒散。热退但口渴不退的，是津液不足，使用八珍汤加黄芪、麦门冬、山茱萸。热止但小便频数的，是肾虚，使用加减八味丸料。如果热势不止，或者肿痛反而加重，是虚热内生，使用人参黄芪汤。或者热退但肌肉不生长的，是气血俱虚，使用十全大补汤。疮色枯白无华，或者凹陷不能收敛的，是寒气侵袭，使用五味异功散，配合豆豉饼外敷。脓血过多，烦躁不安的，是亡阳，紧急使用独参汤。尤其应当审察肿块的软硬程度，饮食冷热情况以及脓液的稀稠多少，肌肉颜色的红赤或青黯程度，以及疮口收敛的快慢，从而投用托里消毒或调补的药物，这样才不会有变症。《痈疽论》说：溃疡内外皆虚，宜以托里补接为主。大概溃疡的变症，是由于在肿疡阶段治疗不当，亏损元气所导致的。医者如果在开始时能谨慎对待，就不会有后来的变故之患。
胎毒发丹，是因为胎毒内伏，或者频繁洗热水澡，或者穿着烘烤过的衣服，或者乳母饮食和情绪波动，导致内热助长邪气为患，发作于头面四肢，蔓延至胸腹，颜色红赤且游走不定。古人说：从四肢起病传入腹部阴囊的，都是不治之症。应当紧急让人随着患处，遍吸毒血，聚集在一处，用砭石刺破放出，紧急服用活命饮。只有百天内的婴儿忌用砭法，因为他们的肌肉难以承受。如果发散药物过量，表虚发热而红赤不退的，使用补中益气汤加防风、白芷。寒凉药物过量，损伤胃气，而热赤不退的，使用异功散加柴胡、升麻；或者兼有抽搐等症状，使用四君子汤、升麻、当归、钩藤，如果再行攻毒治疗，必定导致死亡。发生在头额间的，应当让患者仰卧，用镰刀砭刺。
史少参的儿子两岁时，丙申年正月，阴囊红肿胀痛，我按胎毒治疗痊愈，后来出现发热痰多等症状，诊察其母亲有郁火血热，使用解郁凉血的药物，母子同服而愈。到了六月初患吐泻，两眼抽动，有人投用参、术之类的药，不见效，认为是慢惊风，想用附子类药物，请我商议，我看他寅卯关脉赤，这属于风热伤脾，使用柴胡清肝散加钩藤、木贼草，一剂即愈。丁酉年正月初旬，颈部患热毒，脓出贴药后，忽然暴风开门，当时立即发热，第二天，头面暗肿如斗，两耳流浓约一寸，这是风邪上攻，血受热而沸腾，紧急砭刺两额，流出黑血约三盏，随即使用清热化毒汤，暗肿消退十之七八，第二天再次砭刺，则血不那么黑了，仍用前药去掉牛蒡子加熟地黄而愈。此症如果不进行砭法，或者按破伤风治疗，必死无疑。
一个小孩四肢患病，外部形势虽轻，内部则大便秘结，这是病在脏腑。服用大连翘饮，敷神效散而痊愈。
一个小孩患病，红晕走窜遍及全身，难以全部砭刺，让人吮吸四肢胸背数处，使毒血各自凝聚后再砭刺，先用活命饮，米酒调服两次，又以金银花、甘草节研末，用人乳汁调服逐渐痊愈。月余后，两脚都肿，仍然砭刺，服用前药而痊愈。数日后，两脚又红，有人用犀角解毒丸之类，导致乳食不进，肚腹膨胀，这是再次损伤脾胃所致，敷神功散，服用补中益气汤加茯苓而痊愈。
一个小孩腿部像霞片一样，游走不定，先用麻油涂患处，砭出恶血，其毒即散，用九味解毒散而安。
一个小孩手臂患病，砭出毒血而愈。听信人言，服用护心散，以防后患，服用后吐泻腹胀，患处复红，手脚都冷，我说这是脾胃虚弱，前药再次受伤，用六君子汤一剂顿愈，又以异功散加升麻、柴胡而痊愈。
一个小孩患此病，砭刺后痊愈，但作呕不食，流涎面黄，我说这是脾气虚弱，用异功散加升麻治疗，呕吐停止进食增加；又用补中益气汤，涎收而安。
一个小孩患此病，砭刺后痊愈，第二天发搐作呕，手脚都冷，这是胃气虚而肝木侮之，用异功散加藿香、木香，诸症顿止，又用异功散加升麻、柴胡而痊愈。
一个小孩患此病，砭刺后痊愈，但面赤作呕饮冷，我说胃经热毒未解，先用仙方活命饮，又用清热消毒散，各一剂而愈。
一个小孩腿上患病，神思如故，乳食如常，我说毒发于肌表，令紧急砭出毒血自愈。不信，外敷寒凉，内服峻剂，腹胀不乳而死。
一个小孩遍身皆红，砭刺，投以解毒药而愈。
一个小孩患此病，二便不利，阴囊肚腹俱胀，急用砭法，随即以活命饮加漏芦、木通、大黄研末，时时用热酒调服至一两许，二便俱通，诸症顿退，却去三味，仍以前时服药而愈。
一个小孩患此病，二便不利，腹胀咳嗽，用活命饮加漏芦、木通、麻黄研末，时时用热酒调服，二便随通，遍身出汗，诸症顿退，鼻息似绝，气无以动，时或似躁，这是邪气去而元气虚也，紧急用当归补血汤而愈。
砭法：治疗丹毒赤色，游走不定，令口吸毒血，各聚一处，用细瓷器击碎，取有锋芒者，以筷子头劈开夹之，用线缚定。两指轻撮筷子头，稍令磁芒对聚血处，再用一根筷子，频频击刺出毒血，轻者只用口吸出毒，用药敷之。如患在头部的，不用砭法，只宜用针，卧倒挑患处，以出毒血，迟则毒血入腹，而难起了。
神功散：治疗丹毒最效。如果砭后毒甚重的宜用。如果毒轻者，砭后不可用，恐砭后皮肤既破，草乌能作痛也。
仙方活命饮（方见热毒疮疡）
清热化毒汤
清热消毒散（方见热毒口疮）
柴胡清肝散（方见胁痈）
补中益气汤（方见内钓）
小柴胡汤（方见痉症）
大连翘饮（方见臂痈）
柴芍参苓饮（方见天蛇毒）
九味解毒散（方见黄水粘疮）
Ulcer refers to the state where a sore or carbuncle has suppurated and ruptured. If, after the pus drains, the swelling subsides and pain stops, it is considered a favorable progression (Shun). However, if there is still swelling and pain after pus drainage, or if chills and fever occur, this indicates deficiency of Qi and Blood; treat with Shiquan Dabu Decoction (Ten Agents Great Supplement Decoction). If there is nausea and reduced appetite after pus drainage, it indicates Spleen-Stomach weakness; treat with Liujunzi Tang (Six Gentlemen Decoction) combined with Paojiang (Roasted Ginger). If both hands and feet are cold, it indicates Spleen-Qi deficiency and cold; treat with Liujunzi Tang combined with Jiang (Ginger) and Gui (Cinnamon Twig); if ineffective, urgently add Fuzi (Aconite Lateral Root). If pain persists after pus drainage, or if both stool and urine are difficult, it indicates unresolved Heat-Toxin; treat with Qingre Xiaodu San (Clear Heat and Detoxify Powder). If fever subsides but thirst remains, it indicates insufficiency of Body Fluids; treat with Bazhen Tang (Eight Treasures Decoction) added with Huangqi (Astragalus Root), Maimendong (Ophiopogon Tuber), and Shanzhuyu (Cornus Fruit). If fever stops but urination becomes frequent, it indicates Kidney deficiency; treat with Jiaban Bawei Wan (Modified Eight-Ingredient Pill) ingredients. If fever persists, or if swelling and pain worsen, it indicates internal deficient heat; treat with Renshen Huangqi Tang (Ginseng and Astragalus Decoction). If fever subsides but flesh does not regenerate, it indicates dual deficiency of Qi and Blood; treat with Shiquan Dabu Decoction. If the sore color is pale and lifeless, or sunken and unhealed, it indicates invasion by Cold pathogen; treat with Wuwei Yigong San (Five-Ingredient Extraordinary Efficacy Powder), assisted by Douchi Bing (Fermented Soybean Cake) externally. If there is excessive loss of pus and blood, accompanied by restlessness, it indicates collapse of Yang; urgently use Dushen Tang (Single Ginseng Decoction). One must carefully examine the hardness or softness of the swelling, the temperature of diet, the thickness and quantity of pus, the redness or cyanosis of the flesh, and the speed of wound contraction, then administer formulas for supporting interior and detoxifying or tonifying, so that adverse changes can be avoided. The *Yongju Lun* states: "Both interior and exterior are deficient in ulceration; one should primarily focus on supporting the interior and replenishing." Generally, adverse changes in ulcers arise from improper treatment during the initial swelling stage, leading to depletion of Yuan Qi (Original Qi). If practitioners are cautious from the beginning, they will avoid later complications.
Fetal Toxin Carbuncle (Tai Du Fa Dan) occurs due to latent fetal toxin, frequent bathing in hot water, wearing clothes heated by drying, or maternal dietary and emotional disturbances generating internal heat that aids the pathogen. It manifests on the head, face, and limbs, spreading to the chest and abdomen, appearing as red, wandering patches. Ancients stated: cases starting from the limbs and entering the abdomen or scrotum are incurable. Urgently have someone suck the toxic blood from the affected areas, gathering it in one spot, then pierce with Bian stones (stone needles) to release it, and immediately administer Huoming Yin (Life-Saving Decoction). Bian therapy is contraindicated for infants under 100 days old because their muscles cannot withstand it. If dispersing agents are overdosed, causing superficial deficiency with persistent redness and heat, use Buzhong Yiqi Tang (Center-Supplementing Qi-Augmenting Decoction) added with Fangfeng (Saposhnikovia Root) and Baizhi (Angelica Dahurica Root). If cooling agents are overdosed, damaging Stomach Qi while redness and heat persist, use Yigong San (Extraordinary Efficacy Powder) added with Chaihu (Bupleurum Root) and Shengma (Cimicifuga Rhizome); if accompanied by convulsions, use Sijunzi Tang (Four Gentlemen Decoction), Shengma, Danggui (Angelica Sinensis Root), and Goutenggou (Uncaria Ramulus cum Uncis). Further aggressive detoxification will certainly lead to death. For lesions on the forehead, the patient should lie down, and the area should be scarified with a sickle-like tool.
The son of Censor Shi, aged two, presented with red, swollen scrotum in the first month of Bing Shen year. I treated it as fetal toxin, and he recovered. Later, he developed fever and profuse phlegm. Diagnosing his mother with constrained fire and blood heat, I prescribed herbs to resolve constraint and cool blood; both mother and son took them and recovered. In early June, he suffered vomiting and diarrhea with eye twitching. Someone administered Ginseng and Atractylodes without effect, diagnosing slow convulsion and wishing to use Aconite. Upon consultation, I observed red pulses at the Yin-Mao positions, indicating Wind-Heat injuring the Spleen. I prescribed Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) added with Goutenggou and Muzeicao (Equisetum Hiemale), which cured him in one dose. In early January of Ding You year, he developed heat toxin on the neck. After pus drained and medication was applied, a sudden wind opened the door, causing immediate fever. The next day, his head and face were dark and swollen like a bowl, with ears oozing thick pus about one inch long. This was Wind pathogen attacking upward, causing blood to boil with heat. I urgently scarified both foreheads, releasing about three cups of black blood. I then used Qingre Huadu Tang (Clear Heat and Transform Toxin Decoction); the dark swelling reduced by seven or eight tenths. Scarification was repeated the next day, and the blood was less black. I continued with the previous formula, removing Niubangzi (Arctium Fruit) and adding Shudihuang (Prepared Rehmannia Root), leading to recovery. Without scarification, or if treated as broken-wind tetanus, death would have been inevitable.
A child had lesions on all four limbs. Although external signs were mild, internal constipation indicated disease in the Zang organs. He recovered after taking Dalianqiao Yin (Great Lonicera Decoction) and applying Shenxiao San (Divine Efficacy Powder).
Another child had red halos spreading over the entire body, making complete scarification impossible. Someone sucked toxic blood from several points on the limbs, chest, and back to gather it before scarification. Huoming Yin was administered first, mixed with rice wine for two doses. Then, Jinyinhua (Lonicera Flower) and Gancaojie (Licorice Joint) were powdered and taken with human breast milk, leading to gradual recovery. Over a month later, both feet swelled; scarification was performed again, and the previous medicine cured him. Several days later, both feet turned red again. Someone used Xijiao Jiedu Wan (Rhinoceros Horn Detoxifying Pills), causing refusal of milk/food and abdominal distension, re-injuring the Spleen and Stomach. Applying Shengong San (Divine Merit Powder) and taking Buzhong Yiqi Tang added with Fuling (Poria) led to recovery.
A child had leg lesions resembling cloud patterns, wandering and fixed. Sesame oil was applied first, followed by scarification to release foul blood, dispersing the toxin. Jiwei Jiedu San (Nine-Ingredient Detoxifying Powder) brought peace.
A child had arm lesions; scarification released toxic blood, curing him. Trusting hearsay, he took Huxin San (Heart-Protecting Powder) to prevent future issues, resulting in vomiting, diarrhea, abdominal distension, recurrence of redness at the lesion, and cold hands and feet. I diagnosed Spleen-Stomach weakness exacerbated by previous medicines. One dose of Liujunzi Tang (Six Gentlemen Decoction) cured him instantly, followed by Yigong San added with Shengma and Chaihu for full recovery.
A child healed via scarification but vomited, refused food, drooled, and had a yellow face. I diagnosed Spleen-Qi weakness, treating with Yigong San added with Shengma; vomiting stopped, appetite returned. Subsequently, Buzhong Yiqi Tang stopped drooling and stabilized him.
A child healed via scarification but developed convulsions, vomiting, and cold extremities the next day. This was Stomach-Qi weakness with Liver Wood insulting. Yigong San added with Huoxiang (Patchouli) and Muxiang (Aucklandia Root) stopped symptoms; subsequent treatment with Yigong San added with Shengma and Chaihu cured him.
A child healed via scarification but had a red face, vomiting, and desire for cold drinks. I diagnosed unresolved Heat-Toxin in the Stomach meridian. First, Xianfang Huoming Yin (Immortal Formula Life-Saving Decoction) was used, followed by Qingre Xiaodu San, each for one dose, leading to recovery.
A child had leg lesions but maintained normal spirit and feeding. I diagnosed toxin manifesting on the muscle surface and urged urgent scarification. Disbelieving, the parents applied cold compresses and strong internal purgatives; the child died from abdominal distension and inability to nurse.
A child had redness all over the body; scarification and detoxifying herbs cured him.
A child had difficulty with urination and defecation, with swollen scrotum and abdomen. Urgent scarification was used, followed by Huoming Yin added with Loulu (Leuzea Rhizome), Mutong (Akebia Stem), and Dahuang (Rhubarb Root) powdered and taken frequently with warm wine until reaching approximately one tael. Urination and defecation cleared, symptoms receded. The three herbs were removed, and the base formula continued until recovery.
Another child had difficulty with urination and defecation, abdominal distension, and cough. Huoming Yin added with Loulu, Mutong, and Mahuang (Ephedra Stem) was powdered and taken frequently with warm wine. Urination and defecation cleared, sweating occurred all over, symptoms receded. Breathing seemed absent, movement ceased, occasional restlessness appeared. This indicated pathogen departure and Yuan Qi deficiency. Urgent administration of Danggui Buxue Tang (Angelica Tonifying Blood Decoction) cured him.
Bian Therapy: Treats carbuncles with red, wandering colors. Have someone suck the toxic blood, gathering it in one place. Crush fine porcelain, select sharp fragments, split them with chopsticks, bind them with thread. Hold the chopstick ends lightly with two fingers, align the porcelain shard with the gathered blood, and use another stick to repeatedly strike, forcing out toxic blood. For mild cases, only sucking is needed, followed by topical application. For head lesions, do not use Bian; use needles instead. Have the patient lie down, puncture the lesion to release toxic blood. Delay allows toxin to enter the abdomen, becoming hard to cure.
Shengong San: Most effective for carbuncles. Use if toxin is severe after scarification. Do not use if toxin is mild post-scarification, as Caowu (Aconitum Carmichaelii Lateral Root) may cause pain on broken skin.
Xianfang Huoming Yin (See Heat-Toxin Sores and Ulcers)
Qingre Huadu Tang
Qingre Xiaodu San (See Heat-Toxin Mouth Ulcers)
Chaihu Qinggan San (See Hypochondriac Abscess)
Buzhong Yiqi Tang (See Internal Hook)
Xiao Chaihu Tang (See Spasm)
Dalianqiao Yin (See Arm Abscess)
Chaishao Shenling Yin (See Snake Poison)
Jiwei Jiedu San (See Yellow Water Blister)