如抓破见风，毒即内攻不救。脚心发毒，浅者可治，深者不治。天蛇头者，手指毒疮，
各随经络而生，其痛殊甚，宜审其经，投以解毒和血，加以引经之剂。血丝疔者，发于
两手指而作，红丝渐渐行至关节，势必杀人，可先以线扎住红纹之处，次将银针砭去
血，上者血红，次者血紫，下者血黑。若一失治，则稽留不散者，患烂伤堕指，重则入
腹而死。手指忽肿痛者，名为代指以乌梅入醋浸研，涂患处立瘥。瘭疮者，因风热毒瓦斯
所乘，搏于皮肤，生瘭浆而溃成疮，故名瘭疮也。瘭疽者，其发有数种，小者如粟如
豆，大者如梅如李，青黑赤白，变易不常，或臂或肾，或口齿，或肚脐，发无定处，然
大概多见于手指之间，根深入肌，走辟游肿，毒血流注，贯筋串脉，烂肉见骨，出血
极多。若至狂言烦躁闷乱者，皆毒瓦斯攻心之候也，不治。杨梅疮者，因形相似而名之
也。凡气受之而得者坚实凸起，又名绵花疮。若血受之而得者，其形扁塌而溃，又名
果子疮，皆类其像而俗呼之，北方名曰天 疮，虽名异实同，然治疗须别。凡自致者
重，传染者轻。自致者淫欲太妄，以致阴处先见，乃纵口恣味，三焦皆热，精竭血结，
遗滞诸经而成也。传染者，中气不足，外染稍轻。然患此者，切不可用毒物发之，亦不
可用凉药遏之，并求速效，须用煎药解毒补益托散，外用煎药洗浴，乃以膏药搽贴，拔
毒出外，方无后患。
（张）按∶一切痈疽初起，则邪毒未曾达表，脏腑壅热，一毫热药不可用。若既出
脓后，则毒瓦斯外泄，气血皆虚，胃气亦弱，一毫凉药不可用，此古人之常法也。然亦有
气血虚寒，初起毒陷阴分者，非阳和托里，何能升达？在表既溃，而阴血干枯，若非滋
阴充畅，何能接续脓浆？外则疮毒焦枯，内则口干烦燥。故全在以脉消息。盖气主嘘
之，血主濡之，气以成形，血以华色，故诸痈疽平塌不易高耸者，乃阳气虚弱，不能逐
毒以出阴分，即为阴毒也。根红散漫者，亦气虚不能拘血紧附也。红活光润者，气血拘
毒出外也。外红里黑者，毒滞于内也。紫暗不明者，气血不充，不能化毒成脓也，脓色
浓浓者，气血旺也。脓色清淡者，气血衰也。未出脓前，或有有余之热，既出脓后，
尽从不足之治，但毒瓦斯一分未尽，不能姑纵容留，以致蔓延，便成大患，犹之养虎，久
必伤人。气虚不能遂毒者，温补兼托阳和一转，阴分凝泣之滞，自能冰解。血虚不能化
毒者，尤宜滋补排脓，故当溃脓，毒瓦斯未尽之时，其托里之功，刻不可缓，一容一纵，
毒即逗留，一解一清，毒即冰伏，托里不兼滋补气血，虚者何以成日？犹无米而使之炊
饭也。滋补不兼托里，仅可调和气血，何能直达溃所成功！且毒瓦斯盛者，则反受其助，
犹裹粟以资盗粮矣。滋补不兼温暖，则血凝气滞，孰作酿脓之具？犹之造酒不暖，何以
成浆？造饭无火，何以得熟！世人但知以毒为火，清火以解毒，殊不知毒即是火，毒化
而火亦清，毒凝而火愈郁。然毒之化火由脓，脓之来必由气血，气血之化必由火也。
火可清乎？况清凉之法仅可施于疮疥小疖耳，若遇通经达络之疽，攻托尚虞不暇，岂
可复行清解。反伤胃气以致阳气不振，难溃难长，甚则内攻脏腑，可不畏欤！迨至毒既
去尽，红润肌生，则和平补养气血之中，仍可佐以银花、国老，以解有余不尽之毒。至
如连翘、花粉，亦能解毒，但伤胃气，盒饭禁用，此（张）之管见也。
如果抓破后见风，毒气就会内攻，导致无法救治。脚心发毒，浅表的可以治疗，深部的则难以治愈。天蛇头（手指毒疮），生于手指各经络部位，疼痛非常剧烈，应当审查所属经络，投用解毒和血的方剂，并加入引经药。血丝疔（一种急性感染性疾病），发作于两手指，红色丝线逐渐延伸至关节，势必致死，可以先用线扎住红纹处，然后用银针刺破放血，血色鲜红的为轻症，紫暗的为中症，黑色的为重症。如果一旦失治，毒气稽留不散，会导致患处腐烂、手指脱落，严重时会入腹而死。手指突然肿痛，名为代指（指甲周围炎），用乌梅浸入醋中研磨，涂抹患处即可立即痊愈。瘭疮（一种皮肤疱疹性疾病），因风热毒邪侵袭，搏结于皮肤，生成瘭浆而后溃烂成疮，所以称为瘭疮。瘭疽（一种严重的化脓性感染），发病有几种类型，小的像粟米或豆子，大的像梅子或李子，颜色青黑赤白，变化无常，可发于手臂、肾脏区域、口齿、肚脐等部位，没有固定位置，但大概多见于手指之间，病根深陷入肌肉，游走肿胀，毒血流注，贯穿筋脉，腐蚀肌肉露出骨头，出血极多。如果出现胡言乱语、烦躁闷乱的症状，都是毒邪攻心的征象，属于不治之症。杨梅疮（梅毒的一种表现），因其形状相似而得名。凡是气分受邪而得的，疮形坚实凸起，又名棉花疮。凡是血分受邪而得的，疮形扁塌且溃烂，又名果子疮，都是根据其形象俗称的，北方称为天 疮，虽然名称不同实质相同，但治疗方法必须区别对待。凡自身致病者病情重，传染致病者病情轻。自身致病是因为淫欲过度，导致阴部先出现症状，加上放纵口腹之欲，三焦皆热，精竭血结，遗滞于各条经络而成。传染致病是因为中气不足，外感毒邪较轻。然而患此病的人，切不可用有毒药物发散，也不可用寒凉药物遏制，并追求速效，必须使用煎药解毒补益托毒外出，外用煎药洗浴，再以膏药搽贴，拔毒出体外，才无后患。
张氏按语：一切痈疽初起时，邪毒尚未达表，脏腑壅塞蕴热，丝毫不可使用热药。如果已经出脓后，毒邪外泄，气血皆虚，胃气也弱，丝毫不可使用凉药，这是古人的常规法则。然而也有气血虚寒，初起毒陷阴分的情况，如果不是用阳和汤类方剂托里透毒，怎么能升达？在体表既已溃破，而阴血干枯，如果不是滋阴充畅，怎么能接续脓浆？外则疮毒焦枯，内则口干烦躁。所以全在于通过脉象来斟酌判断。盖气主嘘（推动）之，血主濡（滋润）之，气形成形体，血荣华色泽，所以各种痈疽平塌不易高耸的，是阳气虚弱，不能逐毒出于阴分，即为阴毒。根盘红散漫的，也是气虚不能约束血液紧附所致。红活光润的，是气血拘束毒邪向外排出。外红里黑的，是毒邪滞留于内。紫暗不明的，是气血不充，不能化毒成脓。脓色浓稠的，是气血旺盛。脓色清淡的，是气血衰弱。未出脓前，或有有余之热，既出脓后，尽从不足之治，但只要毒邪一分未尽，就不能姑息纵容留滞，以致蔓延，便成大患，就像养虎，久了必伤人。气虚不能遂毒的，温补兼托阳和一转，阴分凝涩之滞，自然能冰解。血虚不能化毒的，尤其宜滋补排脓，所以在溃脓、毒邪未尽之时，其托里之功，片刻不可迟缓，一容一纵，毒即逗留；一解一清，毒即冰伏。托里不兼滋补气血，虚者凭什么成脓？就像无米而使之炊饭。滋补不兼托里，仅可调和气血，怎么能直达溃所成功！而且毒邪盛者，反受其助，就像裹着粮食资助盗粮。滋补不兼温暖，则血凝气滞，谁来做酿脓的工具？就像造酒不暖，怎么能成浆？造饭无火，怎么能得熟！世人只知道以毒为火，清火以解毒，殊不知毒即是火，毒化而火亦清，毒凝而火愈郁。然而毒之化火由脓，脓之来必由气血，气血之化必由火也。火可清乎？况且清凉之法仅可施于疮疥小疖耳，若遇通经达络之疽，攻托尚虞不暇，岂可复行清解。反而伤胃气以致阳气不振，难溃难长，甚至内攻脏腑，可不畏惧吗！等到毒既去尽，红润肌生，则在和平补养气血之中，仍可佐以金银花、国老（甘草），以解有余不尽之毒。至于连翘、花粉，也能解毒，但伤胃气，盒饭禁用，这是张氏的管见。
If the lesion is scratched open and exposed to wind, the pathogenic toxin will invade internally, leading to an incurable condition. Carbuncles or sores on the sole of the foot: superficial ones are treatable, while deep ones are not. "Tianshe Tou" (Snake-head on Heaven) refers to toxic sores on the fingers; they arise along various meridians, causing severe pain. One should examine the affected meridian and administer formulas that resolve toxicity and harmonize blood, supplemented by herbs that guide the action to the specific meridian. "Xuesi Ding" (Blood-thread Thorn) originates in the fingers, with red threads gradually extending to the joints, inevitably leading to death. Initially, one can tie a thread around the area where the red thread appears, then pierce it with a silver needle to release blood. Bright red blood indicates a mild case, purple indicates moderate, and black indicates severe. If treatment is delayed, the toxin lingers and does not dissipate, causing rotting and loss of fingers; in severe cases, it invades the abdomen and causes death. Sudden swelling and pain in the fingers is called "Daizhi" (Substitute Finger). Soak smoked plums (Wumei) in vinegar, grind them, and apply to the affected area for immediate recovery. "Bao Chuang" (Blistering Sore) occurs when wind-heat toxins invade and bind to the skin, forming blisters that ulcerate into sores, hence the name. "Bao Ju" (Blistering Carbuncle) presents in several types: small ones resemble millet seeds or beans, large ones resemble plums or peaches. Colors vary among green, black, red, and white, changing unpredictably. They may appear on arms, kidney regions, mouth/teeth, or umbilicus, without fixed locations, but are most commonly found between fingers. The root penetrates deeply into muscles, spreading with wandering swelling. Toxic blood flows and injects, penetrating sinews and collaterals, rotting flesh to expose bone, with massive bleeding. Symptoms such as delirium, restlessness, and confusion indicate the toxin attacking the heart, which is untreatable. "Yangmei Chuang" (Myrtle Ulcer) is named for its resemblance to myrtle fruits. When Qi is affected, lesions are firm and raised, also known as "Mianhua Chuang" (Cotton Ulcer). When Blood is affected, lesions are flat and ulcerated, also known as "Guozi Chuang" (Fruit Ulcer). These names are colloquial based on appearance. In the north, it is called "Tian Chuang". Although names differ, the essence is the same, but treatments must be distinguished. Self-inflicted cases are severe; contagious cases are mild. Self-inflicted cases result from excessive sexual desire, causing initial symptoms in the genital region, combined with indulgence in food and drink, leading to heat in the Triple Burner, exhaustion of essence, stagnation of blood, and accumulation in various meridions. Contagious cases result from deficiency of Middle Qi and lighter external infection. Patients must absolutely avoid using toxic drugs to induce sweating, nor use cold medicines to suppress the disease, nor seek quick results. One must use decoctions to resolve toxicity, tonify, and expel toxins outward. External treatment involves washing with decoctions and applying ointments to draw toxins out, ensuring no aftereffects.
Commentary by Zhang: At the initial stage of any carbuncle or sore, the pathogenic toxin has not yet reached the exterior, and the Zang-Fu organs are congested with heat. Not even a trace of hot medicine should be used. After pus has been discharged, the toxin escapes outward, Qi and Blood are both deficient, and Stomach Qi is weak. Not even a trace of cold medicine should be used. This is the conventional method of the ancients. However, there are cases of Qi and Blood deficiency with cold, where the toxin sinks into the Yin aspect at the onset. Without Yang-heating methods to support the interior and expel the toxin, how can it rise and emerge? Once the exterior lesion has ulcerated, if Yin Blood is dry, without nourishing and moistening Yin, how can pus formation continue? Externally, the sore becomes scorched and dry; internally, there is dry mouth and irritability. Therefore, diagnosis relies entirely on pulse examination. Qi primarily pushes and moves, while Blood primarily moistens. Qi forms the structure, and Blood provides luster. Thus, carbuncles and sores that are flat and fail to rise are due to weak Yang Qi, unable to drive the toxin out of the Yin aspect, constituting "Yin Toxin." Roots that are red and diffuse indicate Qi deficiency failing to constrain Blood tightly. Red, vibrant, and glossy lesions indicate Qi and Blood constraining the toxin and pushing it outward. Red externally but black internally indicates toxin stagnating inside. Purple and dark, unclear lesions indicate insufficient Qi and Blood, unable to transform toxin into pus. Thick, rich pus indicates robust Qi and Blood. Thin, clear pus indicates declining Qi and Blood. Before pus discharge, there may be excess heat; after discharge, treatment focuses on deficiency. As long as any portion of the toxin remains, one cannot tolerate its retention, lest it spread and become a major disaster, like raising a tiger which will eventually harm people. For Qi deficiency failing to expel toxin, warming and tonifying combined with Yang-heating transformation can melt the stagnation frozen in the Yin aspect. For Blood deficiency failing to transform toxin, nourishing and promoting pus discharge are especially appropriate. During ulceration, when toxin is not fully cleared, the function of supporting the interior cannot be delayed for a moment. Tolerance leads to toxin retention; clearing leads to toxin freezing. Supporting the interior without nourishing Qi and Blood leaves the deficient body unable to produce pus, like trying to cook rice without grain. Nourishing without supporting the interior only harmonizes Qi and Blood but cannot reach the ulcer site to achieve success. Moreover, if toxin is abundant, nourishment may aid it, like wrapping grain to supply bandits. Nourishment without warmth leads to blood coagulation and Qi stagnation, lacking the means to generate pus, like brewing wine without heat or cooking rice without fire. People generally know to treat toxin as fire and clear fire to resolve toxin, not realizing that toxin is fire itself. When toxin transforms, fire clears; when toxin stagnates, fire becomes more depressed. Toxin transforming into fire comes from pus; pus arises from Qi and Blood; Qi and Blood transformation requires fire. Can fire simply be cleared? Cold-clearing methods are only applicable to minor skin sores. For deep-seated carbuncles penetrating meridians, one is already busy with attacking and supporting; how can one additionally use clearing and resolving? Doing so damages Stomach Qi, causing Yang Qi to weaken, making ulceration and healing difficult, and potentially leading to internal invasion of Zang-Fu organs. Is this not something to fear! Once the toxin is completely gone and healthy pink tissue grows, within the gentle tonification of Qi and Blood, one can still add Honeysuckle Flower (Jinyinhua) and Licorice Root (Guolao/Gancao) to resolve residual toxin. Although Forsythia (Lianqiao) and Trichosanthes Root (Huafen) can also resolve toxicity, they damage Stomach Qi and should be strictly avoided. This is Zhang's humble opinion.